Hema Q&a

NCLEX - Pediatrics - Hematology
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Correct Answer: 4
Rationale: Hemophilia refers to a group

The nurse analyzes the laboratory re-
of bleeding disorders resulting from a de-
sults of a child with hemophilia. The
ficiency of specific coagulation proteins.
nurse understands that which result will
Results of tests that measure platelet
most likely be abnormal in this child?
function are normal; results of tests that
1.Platelet count
measure clotting factor function may be
2.Hematocrit level
abnormal. Abnormal laboratory results in
3.Hemoglobin level
hemophilia indicate a prolonged partial
4.Partial thromboplastin time
thromboplastin time. The platelet count,
hemoglobin level, and hematocrit level
are normal in hemophilia.
Correct Answer: 3
The nurse is providing home care in-
structions to the parents of a 10-year-old
Rationale: Hemophilia refers to a group
child with hemophilia. Which sport ac-
of bleeding disorders resulting from a de-
tivity should the nurse suggest for this
child?
Children with hemophilia need to avoid
1.Soccer
contact sports and to take precautions
2.Basketball
such as wearing elbow and knee pads
3.Swimming
and helmets with other sports. The safe
4.Field hockey
activity for them is swimming.
The nursing student is presenting a clini-
Correct Answer: 2
cal conference and discusses the cause
of ²-thalassemia. The nursing student in-
Rationale: ²-Thalassemia is an autosomal
forms the group that a child at greatest
recessive disorder characterized by the
risk of developing this disorder is which
reduced production of 1 of the globin
of these?
chains in the synthesis of hemoglobin
1.A child of Mexican descent
(both parents must be carriers to pro-
2.A child of Mediterranean descent
duce a child with ²-thalassemia major).
3.A child whose intake of iron is extreme-
This disorder is found primarily in individ-
ly poor
uals of Mediterranean descent. Options
4.A breast-fed child of a mother with
1, 3, and 4 are incorrect.
chronic anemia
Correct Answer: 4
Rationale: ²-Thalassemia is an autoso-

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mal recessive disorder characterized by
the reduced production of 1 of the glo-
bin chains in the synthesis of hemoglo-
A child with ²-thalassemia is receiving bin (both parents must be carriers to
long-term blood transfusion therapy for produce a child with ²-thalassemia ma-
the treatment of the disorder. Chelation jor). The major complication of long-term
therapy is prescribed as a result of too transfusion therapy is hemosiderosis. To
much iron from the transfusions. Which prevent organ damage from too much
medication should the nurse anticipate iron, chelation therapy with either Ex-
to be prescribed? jade or deferoxamine may be prescribed.
1.Fragmin Deferoxamine is classified as an anti-
2.Meropenem dote for acute iron toxicity. Fragmin is
3.Metoprolol an anticoagulant used as prophylaxis
4.Deferoxamine for postoperative deep vein thrombosis.
Meropenem is an antibiotic. Metoprolol
is a beta blocker used to treat hyperten-
sion.
Correct Answer: 4
Rationale: Sickle cell crises are acute

The clinic nurse instructs parents of a
exacerbations of the disease, which
child with sickle cell anemia about the
vary considerably in severity and fre-
precipitating factors related to sickle cell
quency; these include vaso-occlusive
crisis. Which, if identified by the parents
crisis, splenic sequestration, hyperhe-
as a precipitating factor, indicates the
molytic crisis, and aplastic crisis. Sick-
need for further instruction?
le cell crisis may be precipitated by in-
1.Stress
fection, dehydration, hypoxia, trauma, or
2.Trauma
physical or emotional stress. The mother
3.Infection
of a child with sickle cell disease should
4.Fluid overload
encourage fluid intake of 1½ to 2 times
the daily requirement to prevent dehy-
dration.
Correct Answer: 3
A 10-year-old child with hemophilia A Rationale: Hemophilia refers to a group

has slipped on the ice and bumped his of bleeding disorders resulting from a de-
The primary treatment is replacement
2 / 16
of the missing clotting factor; additional
medications, such as agents to relieve
knee. The nurse should prepare to ad- pain, may be prescribed depending on
minister which prescription? the source of bleeding from the disor-
1.Injection of factor X der. A child with hemophilia A is at risk
2.Intravenous infusion of iron for joint bleeding after a fall. Factor VIII
3.Intravenous infusion of factor VIII would be prescribed intravenously to re-
4.Intramuscular injection of iron using place the missing clotting factor and min-
the Z-track method imize the bleeding. Factor X and iron are
not used to treat children with hemophilia
A.
Correct Answer: 2
Rationale: In iron deficiency anemia, iron

stores are depleted, resulting in a de-
creased supply of iron for the manufac-
The nurse is instructing the parents of
ture of hemoglobin in red blood cells.
a child with iron deficiency anemia re-
An oral iron supplement should be ad-
garding the administration of a liquid
ministered through a straw or medicine
oral iron supplement. Which instruction
dropper placed at the back of the mouth
should the nurse tell the parents?
because the iron stains the teeth. The
1.Administer the iron at mealtimes.
parents should be instructed to brush or
2.Administer the iron through a straw.
wipe the child's teeth or have the child
3.Mix the iron with cereal to administer.
brush the teeth after administration. Iron
4.Add the iron to formula for easy admin-
is administered between meals because
istration.
absorption is decreased if there is food in
the stomach. Iron requires an acid envi-
ronment to facilitate its absorption in the
duodenum. Iron is not added to formula
or mixed with cereal or other food items.
Correct Answer: 4
Laboratory studies are performed for a
child suspected to have iron deficiency
Rationale: In iron deficiency anemia, iron
anemia. The nurse reviews the labora-
stores are depleted, resulting in a de-
tory results, knowing that which result
creased supply of iron for the manufac-
indicates this type of anemia?
ture of hemoglobin in red blood cells. The
1.Elevated hemoglobin level
results of a complete blood cell count
2.Decreased reticulocyte count
in children with iron deficiency anemia
3 / 16
show decreased hemoglobin levels and
3.Elevated red blood cell count microcytic and hypochromic red blood
4.Red blood cells that are microcytic and cells. The red blood cell count is de-
hypochromic creased. The reticulocyte count is usual-
ly normal or slightly elevated.
Correct Answer: 1,6
Rationale:Sickle cell anemia is one of

a group of diseases termed hemoglo-
binopathies, in which hemoglobin A is
partly or completely replaced by abnor-
mal sickle hemoglobin S. It is caused
by the inheritance of a gene for a struc-
The nurse is reviewing a health care turally abnormal portion of the hemoglo-
provider's prescriptions for a child with bin chain. Hemoglobin S is sensitive to
sickle cell anemia who was admitted to changes in the oxygen content of the red
the hospital for the treatment of vaso-oc- blood cell; insufficient oxygen causes the
clusive crisis. Which prescriptions docu- cells to assume a sickle shape, and the
mented in the child's record should the cells become rigid and clumped togeth-
nurse question? Select all that apply. er, obstructing capillary blood flow. Oral
1.Restrict fluid intake. and intravenous fluids are an important
2.Position for comfort. part of treatment. Meperidine is not rec-
3.Avoid strain on painful joints. ommended for a child with sickle cell dis-
4.Apply nasal oxygen at 2 L/minute. ease because of the risk for normeperi-
5.Provide a high-calorie, high-protein dine-induced seizures. Normeperidine, a
diet. metabolite of meperidine, is a central
6.Give meperidine, 25 mg intravenously, nervous system stimulant that produces
every 4 hours for pain. anxiety, tremors, myoclonus, and gener-
alized seizures when it accumulates with
repetitive dosing. The nurse would ques-
tion the prescription for restricted fluids
and meperidine for pain control. Position-
ing for comfort, avoiding strain on painful
joints, oxygen, and a high-calorie and
high-protein diet are also important parts
of the treatment plan.
The nurse is conducting staff in-ser- Correct Answer: 1,2,3,4,6
vice training on von Willebrand's dis-
4 / 16
ease. Which should the nurse include as Rationale: von Willebrand's disease is a
characteristics of von Willebrand's dis- hereditary bleeding disorder character-
ease? Select all that apply. ized by a deficiency of or a defect in
1.Easy bruising occurs. a protein termed von Willebrand factor.
2.Gum bleeding occurs. The disorder causes platelets to adhere
3.It is a hereditary bleeding disorder. to damaged endothelium. It is character-
4.Treatment and care are similar to that ized by an increased tendency to bleed
for hemophilia. from mucous membranes. Assessment
5.It is characterized by extremely high findings include epistaxis, gum bleeding,
creatinine levels. easy bruising, and excessive menstrual
6.The disorder causes platelets to ad- bleeding. An elevated creatinine level is
here to damaged not associated with this disorder.
Correct Answer: 4
Oral iron supplements are prescribed for
a 6-year-old child with iron deficiency
Rationale: Vitamin C (ascorbic acid) in-
anemia. Which beverage is the best op-
creases the absorption of iron by the
tion to recommend with iron administra-
body. The mother should be instructed to
tion?
administer the medication with a citrus
1.Milk
fruit or juice high in vitamin C. From the
2.Water
options presented, the correct option is
3.Apple juice
the only one that identifies the food high-
4.Orange juice
est in vitamin C.
Correct Answer: 2
Rationale: Sickle cell disease is a

group of diseases termed hemoglo-
The pediatric nursing instructor asks a
nursing student to prioritize care for a
child diagnosed with sickle cell disease.
Which student response correctly identi-
turally abnormal portion of the hemoglo-
fies the priority of care?
bin chain. Hemoglobin S is sensitive to
1.Fatigue
changes in the oxygen content of the
2.Hypoxia
red blood cell. Hypoxia causes the cells
to assume a sickle shape, and the cells
become rigid and clumped together, ob-
structing capillary blood flow and leading
to a vaso-occlusive crisis. All the clini-
5 / 16
cal manifestations of sickle cell anemia
result from the sickled cells being un-
able to flow easily through the microvas-
culature, and their clumping obstructs
blood flow. With reoxygenation most of
3.Delayed growth
the sickled red blood cells resume their
4.Avascular necrosis
normal shape. Fatigue is a result of hy-
poxia; hypoxia should be addressed first.
Avascular necrosis of the hips and shoul-
ders and delayed growth are general
manifestations of sickle cell disease.
The nurse is caring for a child with a Correct Answer: 3
diagnosis of hemophilia, and hemarthro-
sis is suspected because the child is Rationale: In an acute period, immo-
complaining of pain in the joints. Which bilization of the joint would be pre-
measure should the nurse expect to be scribed. Range-of-motion exercise dur-
prescribed for the child? ing the acute period can increase the
1.Range-of-motion exercises to the af- bleeding and would be avoided at this
fected joint time. Heat will increase blood flow to
2.Application of a heating pad to the af- the area, so it would promote increased
fected joint bleeding to the area. Nonsteroidal anti-
3.Application of a bivalved cast for inflammatory drugs (NSAIDs) can pro-
joint immobilization 4.Nonsteroidal anti- long bleeding time and would not be pre-
inflammatory drugs for the pain scribed for the child.
Correct Answer: 1
The home care nurse is providing safety
instructions to the mother of a child with Rationale: The nurse should instruct the
hemophilia. Which instruction should the mother to remove toys with sharp edges
nurse include to promote a safe environ- that may cause injury from the child's
ment for the child? play area. It is not necessary to restrict
1.Eliminate any toys with sharp edges play if safety measures have been imple-
from the child's play area. 2.Allow the mented. It is not necessary that the child
child to use play equipment only when a be restricted from outdoor play activity,
parent is present. but the activities that the child partici-
3.Allow the child to play indoors only, and pates in should be monitored. Requir-
avoid any outdoor play or playgrounds. ing that the child wear a helmet and
4.Place a helmet and elbow pads on elbow pads immediately on awakening
and throughout the day is not necessary;
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the child every day as soon as the child however, these items should be worn
awakens. during activities that could cause injury.
The nurse on the pediatric unit is car-
Correct Answer: 4
ing for a child with hemophilia who has
been in a motor vehicle crash. Which
Rationale: When caring for a child with
assessment finding, if noted in the child,
hemophilia who has sustained injuries,
indicates the need for follow-up?
the nurse should monitor for signs of
1.The child maintains affected joints in
internal bleeding. One sign of internal
an immobilized position and denies pain
bleeding is change in level of conscious-
at this time.
ness, which could indicate intracranial
2.The child's urine is noted to be clear
hemorrhage. Additional signs of bleeding
and light yellow and is negative for red
include pain, tenderness, and bruising of
blood cells.
the affected area and hematuria. Denial
3.The child maintains bruised joints in an
of pain of affected joints, clear and light
elevated position; the bruises noted are
yellow urine that is negative for red blood
beginning to turn yellow.
cells, and bruises that are beginning to
4.The child is drowsy and difficult to
turn yellow are not signs of internal or
arouse; previously the child was able to
external bleeding.
respond to questions effectively.
The nurse provides instructions regard- Correct Answer: 3
ing home care to the parents of a
3-year-old child hospitalized with hemo- Rationale: The nurse needs to stress
philia. Which statement, if made by the the importance of immunizations, den-
parent, indicates a need for further in- tal hygiene, and routine well-child care.
structions? The remaining options are appropriate.
1."We will supervise our child closely." The parents also are instructed in the
2."We will pad corners of the furniture." measures to implement in the event of
3."We will avoid having our child receive blunt trauma, especially trauma involving
immunizations." the joints, and taught to apply prolonged
4."We will remove household items that pressure to superficial wounds until the
can easily fall over." bleeding has stopped.
A child is brought to the emergency de-
Correct Answer: 2
partment after being accidentally struck
in the lower back region with a baseball
Rationale: Because the kidneys are lo-
bat. When gathering assessment data,
cated in the flank region of the body, trau-
the nurse discovers that the child has he-
ma to the back area can cause hema-
mophilia. The nurse should immediately
turia, particularly in a child with hemo-
assess for which data?
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1.
Slurred speech philia. The nurse would be most con-
2. cerned about the child's airway and res-
Presence of hematuria piratory rate if the child had sustained an
3. injury to the neck region. Slurred speech
Complaints of headache and headache are associated with head
4. trauma.
Change in respiratory rate
Correct Answer: 4
Rationale: Sickle cell anemia is a

group of diseases termed hemoglo-
turally abnormal portion of the hemoglo-
A child in whom sickle cell anemia is bin chain. Hemoglobin S is sensitive to
suspected is seen in a clinic, and labo- changes in the oxygen content of the
ratory studies are performed. The nurse red blood cell. Insufficient oxygen caus-
checks the laboratory results, knowing es the cells to assume a sickle shape,
that which value would be increased in and the cells become rigid and clumped
this disease? together, obstructing capillary blood flow.
1.Platelet count A diagnosis is established on the ba-
2.Hematocrit level sis of a complete blood count, exami-
3.Hemoglobin level nation for sickled red blood cells in the
4.Reticulocyte count peripheral smear, and hemoglobin elec-
trophoresis. Laboratory studies will show
decreased hemoglobin level and hema-
tocrit, a decreased platelet count, an in-
creased reticulocyte count, and the pres-
ence of nucleated red blood cells. Retic-
ulocyte counts are increased in children
with sickle cell disease because the life
span of their sickled red blood cells is
shortened.
The pediatric nurse educator provides Correct Answer: 4
a teaching session to the nursing staff
8 / 16
regarding hemophilia. Which statement Rationale: Hemophilia refers to a group
regarding this disorder should the nurse of bleeding disorders resulting from a de-
plan to include in the discussion? ficiency of specific coagulation proteins.
1.Males inherit hemophilia from their fa- Hemophilia A results from a deficiency
thers. of factor VIII. Males inherit hemophilia
2.Hemophilia is a Y-linked hereditary dis- from their mothers, and females inher-
order. it the carrier status from their fathers.
3.Females inherit hemophilia from their Hemophilia is inherited in a recessive
mothers. manner via a genetic defect on the X
4.Hemophilia A results from deficiency chromosome. Hemophilia B (Christmas
of factor VIII. disease) is a deficiency of factor IX.
Correct Answer: 3
A child arrives at the emergency depart-
Rationale: The initial nursing action for a
ment with a nosebleed. On assessment,
child with a nosebleed is to have him or
the nurse is told by the mother that the
her sit down, ask the child to lean for-
nosebleed began suddenly and for no
ward, and apply pressure to the nose for
apparent reason. What is the initial nurs-
5 to 10 minutes. Ice or cool compresses
ing action?
may also be applied to the nose and face.
1.Insert nasal packing.
Placing the child in semi Fowler's po-
2.Prepare a nasal balloon for insertion.
sition would cause swallowing of blood.
3.Ask the child to sit down and lean for-
Inserting nasal packing and preparing a
ward, and apply pressure to the nose.
nasal balloon are not appropriate initial
4.Place the child in a semi Fowler's po-
interventions. A nasal packing or nasal
sition, and apply ice packs to the nose.
balloon may be used if conservative
measures fail.
Correct Answer: 4
A 12-year-old child with newly diag-
nosed thalassemia is brought to the clin-
Rationale: Defective hemoglobin is pro-
ic exhibiting delayed sexual maturation,
duced as a result of genetically deficient
fatigue, anorexia, pallor, and complaints
beta-polypeptide. This hemoglobin is un-
of headache. The child seems listless
stable, disintegrates, and damages the
and small for age and has frontal boss-
erythrocytes. Rapid destruction of the
ing. What should the nurse expect to
red cells stimulates rapid production of
note on review of the results of the labo-
immature red cells, and the net gain is
ratory tests?
less than optimally functioning red cells.
1.Macrocytosis and hyperchromia
Iron from the red blood cell destruction
2.Excessive red blood cell production
is stored in the tissues, causing mul-
9 / 16
tiple problems. In thalassemia, imma-
3.Excessive mature erythrocyte prolifer-
ture erythrocytes proliferate, not mature
ation
ones. This is a progressive anemia. The
4.Deficient production of functional he-
nurse also would note microcytosis and
moglobin
hypochromia.
Correct Answer: 4
Rationale: The female offspring of an af-

The pediatric nurse educator is providing fected male and a carrier female is at
a teaching session to nursing staff about risk for hemorrhage once puberty is at-
hemophilia. Which statement should the tained and menstrual cycles begin, and
nurse educator include? depending on the severity of the hemo-
1."Acetylsalicylic acid is given for pain philia, a hysterectomy or ablation may
control." be performed. The remaining options are
2."Hemarthrosis is the result of synovial incorrect statements. Aspirin is not rou-
cavity aspiration." tinely given to young children and would
3."Total joint rest along with ice pack not be given to a child with a bleeding
application continues for 72 hours after disorder because of its effects on platelet
factor VIII is administered." aggregation. Hemarthrosis is the result
4."Affected prepubescent girls should of bleeding into the joint cavity, not of
be counseled concerning menorrhagia, aspiration. Seventy-two hours is too long
which may be life-threatening." for the joint to be rested because main-
tenance of mobility is a primary concern
once the bleeding episode has been ar-
rested.
Correct Answer: 2
An 11-year-old child is admitted to the Rationale: During vaso-occlusive sickle

hospital in vaso-occlusive sickle cell cri- cell crisis, the care focuses on adequate
sis. The nurse plans for which priority hydration and pain management. Ade-
treatments in the care of the child? quate hydration with intravenous nor-
1.Splenectomy, correction of acidosis mal saline and oral fluids maintains
2.Adequate hydration, pain manage- blood flow and decreases the severity
ment of the vaso-occlusive crisis. Analgesics
3.Frequent ambulation, oxygen adminis- for pain management are necessary dur-
tration ing a vaso-occlusive crisis. Splenectomy
would not be done with a vaso-occlusive
crisis. Acidosis is not present. Oxygen
10 / 16
can be administered to increase tissue
perfusion but is not the priority treatment
4.Passive range-of-motion exercises,
for a vaso-occlusive crisis. Passive range
adequate hydration
of motion is not recommended; bed rest
is prescribed initially.
A 2-year-old boy with a diagnosis of Correct Answer: 1
hemophilia is admitted to the hospi-
tal with bleeding into the joint of the Rationale: Interventions for bleeding into
right knee. Which intervention should the the joint include measuring the injured
nurse plan to implement with this child? joint to assess for progression of the
1.Measure the injured knee joint every bleeding. This provides objective rather
shift. than subjective data, which are needed
2.Take the temperature by rectal method to determine if the bleeding is increasing.
only. Rectal temperatures can cause tissue
3.Administer acetylsalicylic acid for pain trauma, causing further bleeding. The
control. application of heat and the administra-
4.Immobilize the joint and apply moist tion of acetylsalicylic acid will increase
heat to the joint. bleeding.
Correct Answer: 2
Rationale: Increased fluid volume re-

A child with sickle cell anemia who is duces the viscosity of the blood, pre-
in vaso-occlusive crisis is admitted to venting further vascular occlusion and
the hospital. Which health care provider further sickling caused by dehydration.
prescription would assist in reversing the Pulse oximetry and vital sign monitoring
vaso-occlusive crisis? may be components of care, but they
1.Monitor pulse oximetry. are actions that relate to monitoring the
2.Begin intravenous fluids. client versus treating. The intravenous
3.Administer oxygen by face mask. fluids, however, will treat the condition.
4.Monitor vital signs and respiratory sta- Vaso-occlusive crisis treatment includes
tus. analgesic and fluid administration. Oxy-
gen may help relieve symptoms of respi-
ratory distress, but analgesics and fluids
treat the condition.
Correct Answer: 4
A child with a diagnosis of sickle cell ane-
mia and vaso-occlusive crisis is com-
Rationale: Morphine sulfate is the med-
plaining of severe pain, selecting num-
ication of choice for severe pain for the
11 / 16
child with sickle cell anemia. Opioids
ber 8 on the 1 to 10 pain scale. Which
such as morphine sulfate provide sys-
medication would the nurse expect to be
temic relief. Ibuprofen decreases inflam-
prescribed for pain control?
mation locally. Meperidine has neuro-
1.Ibuprofen
logical adverse effects and can cause
2.Meperidine
seizures and should be avoided. Aceta-
3.Acetaminophen
minophen would not provide adequate
4.Morphine sulfate
pain relief.
Correct Answer: 2
Rationale: Establishment of an age-ap-

The nurse is providing home care in- propriate, safe environment is of para-
structions to the mother of an infant who mount importance for hemophiliacs. Pro-
has just been found to have hemophilia. viding a safe environment for an infant
The nurse should tell the mother that includes padding table corners and crib
care of the infant should include which rails, providing extra padding on clothes
appropriate measure? to protect the joints, observing a mobile
1.Use aspirin for pain relief. infant at all times, and keeping items that
2.Pad crib rails and table corners. can be pulled down onto the infant out
3.Use a soft toothbrush for dental hy- of reach. Use of a soft toothbrush is an
giene. appropriate measure for a child with he-
4.Use a generous amount of lubricant mophilia but is not typically necessary for
when taking a temperature rectally. an infant. Rectal temperature measure-
ments and the use of aspirin are con-
traindicated in hemophiliacs because of
the risk of bleeding.
The nurse is collecting data on a
Correct Answer: 3
12-month-old child with iron deficiency
anemia. Which finding should the nurse
Rationale: Clinical manifestations of iron
expect to note in this child?
deficiency anemia will vary with the de-
1.Cyanosis
gree of anemia but usually include ex-
2.Bronze skin
treme pallor with a porcelain-like skin,
3.Tachycardia
tachycardia, lethargy, and irritability.
4.Hyperactivity
Oral iron is prescribed for a child with
Correct Answer: 1
iron deficiency anemia. The nurse pro-
vides instructions to the mother regard-
Rationale: The mother should be in-
ing the administration of the iron. The
12 / 16
nurse should instruct the mother to ad-
structed to administer oral iron supple-
minister the medication in which way?
ments between meals. The iron should
1.Between meals
be given with a citrus fruit or juice high in
2.Just before a meal
vitamin C because vitamin C increases
3.Just after the meal
the absorption of iron by the body.
4.With a fruit low in vitamin C
Correct Answer: 4
The nurse provides instructions to the
mother of a child with sickle cell disease.
Rationale: The nurse should instruct the
Which statement by the mother indicates
mother to encourage fluid intake 1.5 to 2
a need for further teaching?
times the daily requirements. Adequate
1."I need to be sure that my child has
rest periods should be provided, and the
adequate rest periods."
child should not be exposed to cold or
2."I will take my child's temperature and
heat stress. The mother should be taught
watch for a fever."
how to take the child's body temperature
3."I need to encourage my child to drink
and how to use a thermometer proper-
large amounts of fluids."
ly. Sources of infection should be avoid-
4."I know my child must spend as much
ed, as should prolonged exposure to the
time as possible in the sun."
sun.
Correct Answer: 3
The nurse is reviewing the laboratory Rationale: The normal white blood cell
results of a child with aplastic anemia (WBC) count ranges from 5000 to
and notes that the white blood cell count 10,000 mm3 (5 to 10 × 109/L)and
is 2000 mm3 (2 × 109/L) and that the the normal platelet count ranges from
platelet count is 150,000 mm3 (150 × 150,000 to 400,000 mm3 (150 to 400
109/L). Which intervention should the × 109/L). Strict neutropenic procedures
nurse incorporate into the plan of care? would be required if the WBC count
1.Avoid unnecessary injections. were low to protect the child from in-
2.Encourage quiet play activities. fection. Precautionary measures to pre-
3.Maintain strict neutropenic precau- vent bleeding should be taken when a
tions. child has a low platelet count. These in-
4.Encourage the child to use a soft tooth- clude no injections, no rectal tempera-
brush. tures, use of a soft toothbrush, and ab-
stinence from contact sports or activities
that could cause an injury.
Correct Answer: 2
13 / 16
Rationale: Hemophilia is a lifelong
hereditary blood disorder associated
The nursing student is assigned to care
with deficiency of clotting factors. It is
for a child with hemophilia. The nursing
inherited in a recessive manner via a
instructor reviews the plan of care with
genetic defect on the X chromosome.
the student. Which intervention on the
Hemophilia A results from a deficien-
student written plan of care requires cor-
cy of factor VIII. Hemophilia B (Christ-
rection?
mas disease) is a deficiency of fac-
1.Measure circumference of injured
tor IX. Blood product transfusion is not
joints.
the treatment of choice over adminis-
2.Blood transfusion of packed red blood
tering recombinant factors intravenous-
cells.
ly. Measuring circumference of injured
3.Monitor temperature with oral ther-
joints is appropriate to assess for enlarg-
mometers.
ing hematomas or bleeding under the
4.Intravenous administration of recombi-
skin. The nurse should avoid taking rec-
nant factor.
tal temperatures to decrease the risk for
injury.
The nurse is providing instructions to
the mother of a 3-year-old child with
Correct Answer: 1
hemophilia regarding care of the child.
Which statement by the mother indicates
Rationale: The nurse needs to stress
a need for further teaching?
the importance of immunizations, den-
1."I need to cancel the upcoming dental
tal hygiene, and routine well-child care.
appointment that I made for my child."
The remaining options are appropriate
2."If my child gets a cut, I should hold
care measures. The mother is instructed
pressure on it until the bleeding stops."
regarding actions in the event of blunt
3."I should check the house and remove
trauma, especially trauma involving the
any household items that can easily fall
joints, and is told to apply prolonged
over."
pressure to superficial wounds until the
4."I should move furniture with sharp
bleeding has stopped.
corners out of the way and pad the cor-
ners of the furniture."
A child is brought to the emergency de- Correct Answer: 1
partment after falling from a high swing
and landing on the back. The nurse Rationale: Because the kidneys are lo-
notes that the client also has hemophilia. cated in the flank region of the body, trau-
Based on the client's history and the na- ma to the back area can cause hema-
ture of the injury, which should the nurse turia, particularly in the child with he-
14 / 16
mophilia. The nurse would be most con-
assess for first?
cerned about the child's airway and res-
1.Blood in the urine
piratory rate if the child sustained an in-
2.Oxygen saturation
jury to the neck region. Headache and
3.Presence of headache
slurred speech are associated with head
4.Presence of slurred speech
trauma.
Correct Answer: 3
Rationale: Intravenous fluid and in-

creased oral fluids are a component of
A child with a diagnosis of sickle cell the treatment plan for the child with
disease is being admitted for the treat- vaso-occlusive crisis. Management of
ment of vaso-occlusive crisis. The nurse the severe pain that occurs with vaso-oc-
prepares for the admission anticipating clusive crisis includes the use of opi-
which prescription for the child? oid analgesics, such as morphine sulfate
1.NPO status and hydromorphone. Meperidine is con-
2.Meperidine for pain traindicated because of its side effects
3.Intravenous fluids and the increased risk of seizures with
4.Intubation to administer oxygen its use. Oxygen is administered when
hypoxia is present and the oxygen sat-
uration level is less than 95%. Intubation
is not necessary to treat vaso-occlusive
crisis.
A nursing student is assigned to care for
a child with sickle cell disease (SCD). Correct Answer: 3
The nursing instructor asks the student
to describe the causative factors related Rationale: SCD is an autosomal reces-
to this disease. Which statement by the sive disease. Children with the HbS trait
student indicates a need for further re- are not symptomatic. If one parent has
search? the HbS trait and the other parent is nor-
1.SCD is an autosomal recessive dis- mal, there is a 50% chance that each off-
ease. spring will inherit the trait. If each parent
2.Children with the HbS (sickle cell he- carries the trait, there is a 25% chance
moglobin) trait are not symptomatic. that their child will be normal, a 50%
3.If each parent carries the trait, the child chance that the child will carry the trait,
will carry the trait, and the probability of and a 25% chance that each child will
the child having the disease is 75%. have the disease.
4.If one parent has the HbS trait and the
15 / 16
other parent is normal, there is a 50%
chance that each offspring will inherit the
trait.
Correct Answer: 4
The nurse is caring for a child with he-
mophilia and is reviewing the results that
Rationale: PTT measures the activity of
were sent from the laboratory. Which re-
thromboplastin, which is dependent on
sult should the nurse expect in this child?
intrinsic factors. In hemophilia, the intrin-
1.Shortened prothrombin time (PT)
sic clotting factor VIII (antihemophilic fac-
2.Prolonged PT
tor) is deficient, resulting in a prolonged
3.Shortened partial thromboplastin time
PTT. The results in the remaining options
(PTT)
are incorrect. The PT may not necessar-
4.Prolonged PTT
ily be affected in this disorder.
A child is seen in the health care clinic for
complaints of fever. On data collection,
Correct Answer: 4
the nurse notes that the child is pale,
tachycardic, and has petechiae. Aplastic
Rationale: Although the diagnosis of
anemia is suspected. The nurse should
aplastic anemia may be suspected from
prepare the child to obtain which speci-
the child's history and from the results of
men that will confirm the diagnosis?
a complete blood count, a bone marrow
1.Platelet count
biopsy must be performed to confirm the
2.Granulocyte count
diagnosis.
3.Red blood cell count
4.Bone marrow biopsy
Correct Answer: 4
The nurse is monitoring the laborato-
ry values of a child with leukemia who Rationale: If a child is thrombocytopenic,
is receiving chemotherapy. The nurse precautions need to be taken because
prepares to implement bleeding precau- of the increased risk of bleeding. The
tions if the child becomes thrombocy- precautions include limiting activity that
topenic and the platelet count is less could result in head injury, using soft
than how many cells/mm3? toothbrushes, checking urine and stools
1.200,000 mm3 (200 × 109/L) for blood, and administering stool soft-
2.180,000 mm3 (180 × 109/L) eners to prevent straining with constipa-
3.160,000 mm3 (160× 109/L) tion. Additionally, suppositories and rec-
4.150,000 mm3 (150 × 109/L) tal temperatures are avoided. The nor-
mal platelet count ranges from 150,000
to 400,000 mm3 (150 to 400 × 109/L).
16 / 16
Hematology NCLEX
Study online at https://quizlet.com/_9jd6jf
The patient is diagnosed with chronic

lymphocytic leukemia (CLL) after routine
laboratory tests during a yearly physical.
The patient tells the nurse, "I don't be-
lieve I have leukemia, I don't have any
symptoms. The doctor must have made
a mistake." The nurse is aware which of
the following should be discussed with
the patient regarding the random nature
D. Symptoms with this form of leukemia
of discovering the illness?
are not recognized because they are
A. This is a childhood illness and is
viewed as normal signs of aging.
self-limiting.
B. In early stages of CLL there may be
no symptoms and require no treatment.
C. CLL is not serious enough to have to
treat, and patients die from other causes
first.
D. Symptoms with this form of leukemia
are not recognized because they are
viewed as normal signs of aging.
A patient who is suspected of having
leukemia has a bone marrow aspiration
and biopsy. Immediately following the
procedure, the nurse should take which
most appropriate action? A. Swab the
site with an antiseptic solution. C. Apply a pressure dressing to the biop-
B. Ask the patient to lie on the unaffected sy site.
side.
C. Apply a pressure dressing to the biop-
sy site.
D. Take the patient's temperature every
one hour for four hours.
The nurse is assessing a patient
diagnosed with acute myelogenous
leukemia. Which assessment data sup-
B. Infection and abnormal bleeding.
port this diagnosis?
A. Nausea and vomiting.
B. Infection and abnormal bleeding.
1/8
Hematology NCLEX
C. Excessive energy and high platelet
counts.
D. Cervical lymph node enlargement and
positive acid-fast bacillus.
The nurse is assessing a patient follow-
ing a bone marrow transplant for graft
versus host disease. Which manifesta-
tions indicate the patient may be devel-
oping graft versus host disease? SE- A. Skin rash.
LECT ALL THAT APPLY. C. Mild jaundice.
A. Skin rash. E. Abdominal discomfort.
B. Chest pain.
C. Mild jaundice.
D. Blurred vision.
E. Abdominal discomfort.
The nurse is preparing a patient with
acute leukemia for the induction phase
of chemotherapy. The nurse should ex-
plain the patient will receive which of the
following?
A. An intense course of chemotherapy.
B. Alternating chemotherapeutic regi- A. An intense course of chemotherapy.
mens.
C. A series of preliminary
non-chemotherapeutic drugs.
D. Pharmacologic agents introduced
gradually to allow for adjustment to ther-
apy.
The oncology nurse specialist pro-
vides an educational session to nurs-
ing staff regarding the characteristics
of Hodgkin's lymphoma. The oncology
nurse specialist determines further edu-
B. Occurs most often in young children.
cation is needed if a nursing staff mem-
ber states which of the following is a
characteristic of the disease?
A. Presence of Reed Sternberg cells.
B. Occurs most often in young children.
2/8
Hematology NCLEX
C. Involvement of cervical, axillary, or
inguinal lymph nodes.
D. Prognosis is better than that of many
other forms of cancer.
Which of the following factors is known
to increase the risk of developing
non-Hodgkin's lymphoma?
A. Obesity. D. Immunosuppressive medications.
B. Female sex.
C. Cigarette smoking.
D. Immunosuppressive medications.
The nurse is providing instructions fol-
lowing successful treatment of and re-
mission for Hodgkin's lymphoma for a
55-year-old female. Which topic will the
nurse include in patient teaching?
A. Potential impact of chemotherapy
C. Use of maintenance chemotherapy to
treatment on fertility.
maintain remission.
B. Application of soothing lotions to treat
residual pruritus.
C. Use of maintenance chemotherapy to
maintain remission.
D. Need for follow-up appointments to
screen for other malignancies.
The nurse is admitting a patient with a
diagnosis of Hodgkin's lymphoma who
has B symptoms. Which manifestations
would the nurse expect to note during
the initial assessment?
A. Fever, night sweats, and weight loss.
A. Fever, night sweats, and weight loss.
B. Tachycardia, petechiae, and chest
pain.
C. Rectal bleeding, dysphagia, and
tachypnea.
D. Painful mediastinal lymph nodes, hal-
itosis, and paresthesia.
A patient who has had bone pain of insid-
ious onset for 4 months is suspected of
3/8
Hematology NCLEX
having multiple myeloma. The nurse un-
derstands which of the following would
be a diagnostic finding specific for multi-
ple myeloma?
C. Bence Jones protein in the urine.
A. Occult blood in the stool.
B. Low serum calcium levels.
C. Bence Jones protein in the urine.
D. Positive bacterial culture of sputum.
The nurse hears a patient recently di-
agnosed with multiple myeloma talking
about the disease with a family member.
Which patient statement requires further
instruction regarding the treatment of the
disease?
A. "I will have my calcium levels moni- D. "I will be cured of the disease if the
tored." chemotherapy and radiation are effec-
B. "I will have radiation to help reduce the tive."
pain in my bones."
C. "I will take chemotherapy for 4 to 7
days every 4 to 6 weeks."
D. "I will be cured of the disease if the
chemotherapy and radiation are effec-
tive."
The nurse is preparing to administer
zoledronic acid (Zometa), a bisphos-
phonate, to a patient diagnosed with
multiple myeloma. The nurse plans to do
which of the following?
A. Administer as a bolus over 2 minutes.
C. Instruct the patient to return in one
B. Make sure the patient has been NPO
month for additional Zometa administra-
for at least 12 hours.
tion.
C. Instruct the patient to return in one
month for additional Zometa administra-
tion.
D. Administer metoclopramide hy-
drochloride (Reglan) 30 minutes prior to
Zometa administration.
4/8
Hematology NCLEX
While performing an admission assess-
ment on a severely anemic patient, the
nurse would expect to find a history of
which of the following? SELECT ALL
THAT APPLY. A. Bone pain.
A. Bone pain. B. Tachycardia.
B. Tachycardia.
C. Blurred vision.
D. Increased appetite.
E. Warm, flushing sensations.
14. In addition to the general symptoms
of anemia, the nurse is aware the patient
with pernicious anemia may also mani-
fest which of the following?
A. Paresthesias.
A. Paresthesias.
B. Coagulation deficiencies.
C. Cardiovascular disturbances.
D. A decreased immune response.
A patient with a diagnosis of pernicious
anemia is experiencing weakness and
paresthesia of the feet and hands. Af-
ter teaching the patient about pernicious
anemia, the nurse determines the pa-
tient understands the disorder when the
patient makes which statement?
A. "I will need to have vitamin B12 injec-
C. "I will increase sources of vitamin B12
tions regularly for the rest of my life."
in my diet, such as muscle meats and
B. "The feeling in my hands and feet will
liver, in my diet."
return when my hemoglobin level returns
to normal."
C. "I will increase sources of vitamin B12
in my diet, such as muscle meats and
liver, in my diet."
D. "I should plan for only part-time em-
ployment because of the chronic fatigue
that pernicious anemia causes."
A patient with iron-deficiency anemia
has inflammation of the lips of the mouth.
5/8
Hematology NCLEX
How would the nurse document this find-
ing?
A. Pica.
B. Cheilitis.
B. Cheilitis.
C. Glossitis.
D. Cheilosis.
The nurse is implementing dietary in-
structions with a patient who is vegetari-
an and has dietary related iron deficien-
cy anemia. Which food choices would
the nurse include in the teaching plan? D. Dark, green leafy vegetables and
A. Milk and cheese. whole grain breads.
B. Apples and pears.
C. Fresh squash and cabbage.
D. Dark, green leafy vegetables and
whole grain breads.
The nurse is teaching a patient about
measures to increase the absorption
of the prescribed oral iron preparation.
Which instruction would the nurse give
to the patient?
A. Take the iron pill with milk. B. Take the iron pill with a drink that con-
B. Take the iron pill with a drink that contains vitamin C.
tains vitamin C.
C. Take the iron pill immediately before
the evening meal.
D. Take the iron pill in the morning with
breakfast or shortly after breakfast.
The nurse is assessing a group of pa-
tients and identifies which of the follow-
ing populations as being at high risk for
the development of folic acid deficiency
anemia? B. Alcoholics.
A. Athletes.
B. Alcoholics.
C. Young adults.
D. Obese individuals.
6/8
Hematology NCLEX
The nurse is aware which diagnostic
finding is most likely seen for a patient
with aplastic anemia?
A. Decreased production of T-helper
cells.
B. Decreased levels of all bone marrow
B. Decreased levels of all bone marrow
elements.
elements.
C. Increased levels of WBCs, RBCs, and
platelets.
D. Reed-Sternberg cells and lymph node
enlargement.
A patient has an order to receive a unit of
packed red blood cells. The nurse would
obtain which of the following intravenous
solutions to hang with the blood prod-
uct?
B. 0.9% sodium chloride.
A. Lactated ringers.
B. 0.9% sodium chloride.
C. 5% dextrose in 0.9% sodium chloride.
D. 5% dextrose in 0.45% sodium chlo-
ride.
The nurse is teaching a patient with
polycythemia vera about manifestations
of this disease. Which manifestations
would the nurse include in the patient's
A. Headache.
teaching plan? SELECT ALL THAT AP-
B. Ecchymosis.
PLY.
C. Weight loss.
A. Headache.
E. General pruritis.
B. Ecchymosis.
C. Weight loss.
D. Hearing loss.
E. General pruritis.
Collaborative care for a patient experi-
encing heparin-induced thrombocytope-
nia and thrombosis syndrome (HITTS)
whose platelet count is 100,000/mL in-
cludes administration of which of the fol-
lowing?
7/8
Hematology NCLEX
A. A transfusion of platelets.
B. A Vitamin K antagonist such as war-
farin (Coumadin).
C. A direct thrombin inhibitor such as
C. A direct thrombin inhibitor such as
lepirudin (Refludan).
lepirudin (Refludan).
D. A low molecular weight heparin such
as enoxaparin (Lovenox).
A patient with asymptomatic immune
thrombocytopenic purpura (ITP) has
an order for a platelet transfusion.
Which information indicates the nurse
should consult with the health care
provider before obtaining and adminis-
A. The platelet count is 42,000/mL.
tering platelets?
A. The platelet count is 42,000/mL.
B. Blood pressure is 94/56 mm Hg.
C. Petechiae are present on the chest.
D. Blood is oozing from the venipuncture
site.
8/8
Hematology NCLEX style questions
Study online at https://quizlet.com/_82071b
The nurse is reviewing the laboratory re-

sults of a client diagnosed with multiple
myeloma. Which would the nurse expect
to not specifically in this disorder?
increased calcium level
-increased calcium level
-increased white blood cells
-decreased blood urea nitrogen level
-decreased number of plasma cells in
the bone marrow
The nurse is creating a plan of care for
the client with multiple myeloma and in-
cludes which priority intervention in the
plan?
encouraging fluids
-encouraging fluids
-providing frequent oral care
-coughing and deep breathing
-monitoring the red blood cell count
When caring for a client with an internal
radiation implant, the nurse should ob-
serve which principles? SATA
-limiting the time with the client to 1 hour

per shift
-keeping pregnant women out of the
-keeping pregnant women out of the
client's room
client's room
-placing the client in a private room with
-placing the client in a private room with
a private bath
a private bath
-wearing a lead shield when providing
-wearing a lead shield when providing
direct client care
direct client care
-removing the dosimeter film badge
when entering the client's room
-allowing individuals younger than 16
years old in the room as long as they are
6 feet away from the client
While giving care to a client with an inter-
nal cervical radiation implant, the nurse
1/9
finds the implant in the bed. The nurse
should take which initial action?
-call the health care provider (HCP)

pick up the implant with long-handled
-reinsert the implant into the vagina
forceps and place it in a lead container
-pick up the implant with gloved hands
and flush it down the toilet
-pick up the implant with long-handled
forceps and place it in a lead container
The nurse should plan to implement
which intervention in the care of a client
experiencing neutropenia as a result of
chemotherapy?
teach the client and family about the
-restrict all visitors
need for hand hygeine
-restrict fluid intake
-teach the client and family about the
need for hand hygiene
-insert an indwelling urinary catheter to
prevent skin breakdown
The home health care nurse is caring
for a client with cancer who is complain-
ing of acute pain. The most appropriate
determination of the client's pain should
include which assessment?
the client's pain rating
-the client's pain rating
-nonverbal cues from the client
-the nurse's impression of the client's
pain
-pain relief after appropriate nursing in-
terventions
The nurse is caring for a client who
is postoperative following a pelvic ex-
enteration and the health care provider
Bowel sounds
changes the client's diet from NPO
(nothing by mouth) status to clear liquids.
The nurse should check which priority
2/9
item before adminstering the diet?
-bowel sounds
-ability to ambulate
-incision appearance
-urine specific gravity
A client is admitted to the hospital with
a suspected diagnosis of Hodgkin's dis-
ease. Which assessment finding would
the nurse expect to note specifically in
the client?
-enlarged lymph nodes
-fatigue
-weakness
-weight gain
-enlarged lymph nodes
During the admission assessment of a
client with advanced ovarian cancer, the
nurse recognizes which manifestation as
typical of the disease?
abdominal distention
-diarrhea
-hypermenorrhea
-abnormal bleeding
-abdominal distention
The nurse is caring for a client with lung
cancer and bone metastasis. What signs
and symptoms would the nurse recog-
nize as indications of a possible onco-
logical emergency? SATA
-facial edema in the morning
-serum calcium level of 12 mg/dL
-facial edema in the morning
-numbness and tingling of the lower ex-
-weight loss of 20 lb in 1 month
tremities
-serum calcium level of 12 mg/dL
-serum sodium level of 136 mg/dL
-serum potassium level of 3.4 mg/dL
-numbness and tingling of the lower ex-
tremities
3/9
A client who has been receiving radi-
ation therapy for bladder cancer tells
the nurse that it feels as if she is void-
ing through the vagina. The nurse inter-
prets that the client may be experiencing
which condition?
The development of a vesicovaginal fis-
-rupture of the bladder tula
-the development of a vesicovaginal fis-
tula
-extreme stress caused by the diagnosis
of cancer
-altered perineal sensation as a side ef-
fect of radiation therapy
The nurse is instructing a client to per-
form a testicular self-examination (TSE).
The nurse should provide the client with
which information about the procedure?
-to examine the testicles while lying

that the best time for the examination is
down
after a shower
-that the best time for the examination is
after a shower
-to gently feel the testicle with 1 finger to
feel for a growth
-that TSEs should be done at least every
6 months
The nurse is conducting a history and
monitoring laboratory values on a client
with multiple myeloma. What assess-
ment findings should the nurse expect to
note? SATA -pathological fracture
-urinalysis positive for nitrites
-pathological fracture -serum creatinine level of 2.0 mg/dL
-urinalysis positive for nitrites
-hemoglobin level of 15.5 g/dL
-calcium level of 8.6 mg/dL
-serum creatnine level of 2.0 mg/dL
4/9
A gastrectomy is performed on a client
with gastric cancer. In the immediate
postoperative period, the nurse notes
bloody drainage from the nasogastric
tube. The nurse should take which most
appropriate action? Continue to monitor the drainage
-measure abdominal girth

-irrigate the nasogastric tube
-continue to monitor the drainage
-notify the health care provider (HCP)
The nurse is teaching a client about
the risk factors associated with colorec-
tal cancer. The nurse determines that
further teaching is necessary related to
colorectal cancer if the client identifies
which item as an associated risk factor? age younger than 50 years
-age younger than 50 years

-history of colorectal polyps
-family history of colorectal polyps
-chronic inflammatory bowel disease
The nurse is assessing the perineal
wound in a client who has returned
from the operating room following an
abdominal perineal resection and notes
serosanguineous drainage from the
wound. Which nursing intervention is
most appropriate? change the dressing as prescribed
-clamp the surgical drain

-change the dressing as prescribed
-notify the health care provider (HCP)
-remove and replace the perineal pack-
ing
The nurse is assessing the colostomy of
a client who has had an abdominal per-
ineal resection for a bowel tumor. Which
5/9
assessment finding indicates that the
colostomy is beginning to function?
-the passage of flatus the passage of flatus

-absent bowel sounds
-the client's ability to tolerate food
-bloody drainage from the colostomy
The nurse is reviewing the history of a
client with bladder cancer. The nurse ex-
pects to note documentation of which
most common sign of symptom of this
type of cancer?
hematuria
-dysuria
-hematuria
-urgency on urination
-frequency of urination
The nurse is assessing a client who has
a new ureterostomy. Which statement by
the client indicates the need for more
education about urinary stoma care?
"I empty the urinary collection bag when
-"I change my pouch every week."
it is two-thirds full."
-"I change the appliance in the morning."
-"I empty the urinary collection bag when
it is two-thirds full."
-"When I'm in the shower I direct the flow
of water away from my stoma."
A client with carcinoma of the lung de-
velops syndrome of inappropriate antid-
iuretic hormone (SIADH) as a compli-
-radiation
cation of cancer. The nurse anticipates
-chemotherapy
that the health care provider will request
-serum sodium level determination
which prescriptions? SATA
-medication that is antagonistic to antid-
iuretic hormone
-radiation
-chemotherapy
-increased fluid intake
6/9
-decreased oral sodium intake
-serum sodium level determination
-medication that is antagonistic to antid-
iuretic hormone
The nurse is monitoring a client for signs
and symptoms related to superior vena
cava syndrome. Which is an early sign of
this oncological emergency?
periorbital edema
-cyanosis
-arm edema
-periorbital edema
-mental status changes
The nurse manager is teaching the nurs-
ing staff about signs and symptoms re-
lated to hypercalcemia in a client with
metastatic prostate cancer, and tells the
staff that which is a late sign or symptom
of this oncological emergency? -Electrocardiographic changes
-headache
-dysphagia
-constipation
-electrocardiographic changes
As part of chemotherapy education, the
nurse teaches a female client about the
risk for bleeding and self-care during the
period of greatest bone marrow suppres-
sion (the nadir). The nurse understands
that further teaching is needed if the
"I'm going to take aspirin for my
client makes which statement?
headache as soon as I get home."
-"I should avoid blowing my nose."
-"I may need a platelet transfusion if my
platelet count is too low."
-"I'm going to take aspirin for my
headache as soon as I get home."
7/9
-"I will count the number of pads and
tampons I use when menstruating."
The community health nurse is in-
structing a group of young female
clients about breast self-examination.
The nurse should instruct the clients to
perform the examination at which time?
-1 week after menstruation begins
-at the onset of menstruation
-every month during ovulation
-weekly at the same time of day
A client is diagnosed as having a bow-
el tumor. The nurse should monitor the
client for which complications of this type
of tumor? SATA
-peritonitis
-hemorrhage
-flatulence
-fistula formation
-peritonitis
-bowel perforation
-hemorrhage
-fistula formation
-bowel perforation
-lactose intolerance
The nurse is caring for a client following a
mastectomy. Which nursing intervention
would assist in preventing lymphedema
of the affected arm?
-placing cool compresses on the affect-

elevating the affected arm on a pillow
ed arm
above heart level
-elevating the affected arm on a pillow
above heart level
-avoiding arm exercises in the immedi-
ate postoperative period
-maintaining an intravenous site below
the antecubital area on the affected side
The community health nurse is in-
structing a group of young female
8/9
clients about breast self-examination.
The nurse should instruct the clients to
perform the examination at which time?
-at the onset of menstruation

-every month during ovulation
-weekly at the same time of day
9/9
Hematologic Disorders NCLEX
Study online at https://quizlet.com/_1pl1xf
You are preparing the client for a bone

marrow aspiration and biopsy. Which of
Answer: A. There is no need to avoid
the following statements, if made by the
ambulation after the biopsy. Some dis-
patient, indicates the need for further
comfort at the site can occur for about
teaching?
a day or two. Tylenol can be given in
A) After the procedure I should avoid
this case but aspirin based medications
ambulating for 24-48 hours
should be avoid d/t risk for bleeding. The
B) Pain and discomfort is expected after
patient should be advised to avoid tak-
the surgery. I can take some Tylenol for
ing a bath or submerging the site in any
the discomfort.
other way with water. The specimen is
C) I should not take a bath for about 24
typically taken from the iliac crest, part
hours
of the hip bone.
D) The surgeon will collect the samples
from my hip bone
The patient who underwent a bone biop-
sy yesterday calls the office thinking Answer: A and B. These are signs of
something is wrong. Which of the follow- possible bleeding or infection at the site.
ing would be cause for concern by the A temperature of 99.5 is still considered
nurse? SATA: WNL. Pain in the area would be expect-
A) Swelling and redness at the site ed (unusual or increased pain should be
B) Red streaks spreading away from the reported). A small amount of blood on
area dressing would be expected. Any pus
C) T of 99.5 found in the drainage should be report-
D) Pain in the area ed.
E) Small amount of blood on dressing
Nurse Kelly is caring for a patient who
is 65 years old with a platelet count
Answer: C. A platelet count less than
of 7,000 resulting from myelodysplastic
10,000 puts the client a severe risk for
syndrome. At 10 p.m. the patient com-
spontaneous bleed. The nurse should be
plains of a headache. What should be
aware of any signs such as HA, chang-
the nurse's immediate action?
ing mentation, irritability, restlessness,
A) Administer aspirin per prn orders
changes in vision, abdominal distention,
B) Administer acetaminophen per orders
or any other signs of bleeding anywhere
C) Notify the health care provider
in the body.
D) Administer a nonpharmacological in-
tervention like a cool compress
A young mother of three with history of
Type 1 diabetes comes into the clinic c/o
1 / 13
of fatigue and says "my Fitbit has been Answer: B. People with stressful and ac-
rating my heart rate higher than it used to tive lifestyles are much more likely to feel
be" Her Hgb is taken and found to be 11 symptoms of anemia such as fatigue.
g/dL. Which of the following factors most Any increased demand for oxygen is go-
likely influenced this patient's ability to ing to increase symptoms in a patient. A
feel anemia symptoms (fatigue)? patient with a heart defect or pulmonary
A) Hx of diabetes disease would be more likely to experi-
B) Stressful lifestyle ence symptoms of anemia rather than a
C) Lack of exercise patient with hypothyroidism who has a
D) Multipara status decreased demand for O2
The patient diagnosed with iron deficien-
cy anemia tells you that she constantly
Answer: B. Asking this client explain how
feels tired and exhausted. She tells you
the fatigue is affecting her life will help
that she is concerned about this prob-
open up the conversation and build rap-
lem. What is the nurse's best initial re-
port. Fatigue is a real life-changing issue
sponse?
for patients with anemia and should not
A) Keep taking your supplements and
be dismissed. Telling her that she must
report back to me in a couple to days
take a break from "things" is not an un-
B) How has this affected your life?
derstanding response and may not solve
C) You are going to need to take a break
the underlying problem. Clients should
from those things for a period of time to
not be instructed to get rid of all the
rest
stress in life.
D) Try to help get rid of the stress in your
life. This will help with the tired feeling
Answer: B. An antihypertensive medica-
Which medication might the nurse ques-
tion such as an ACE inhibitor could de-
tion if administered to the client with ane-
crease the preload even further which
mia?
could be detrimental for a patient with
A) Cipro
anemia. An antibiotic or Tylenol should
B) Lisinopril
not affect the anemia problem directly.
C) Acetaminophen
Ferrous sulfate is often prescribed to pa-
D) Ferrous sulfate
tients with anemia to help bring up RBC.
The patient with anemia has been pre-
scribed an iron supplement. With which Answer: C. Vitamin C helps aid in the
beverage should the nurse encourage absorption of iron. Therefore iron supple-
the patient to take the supplement? ments should be taken with a glass or
A) Milk orange juice or a vitamin C tablet.
B) Water only
2 / 13
C) Orange Juice
D) Tea
The nurse is teaching the client pre-
scribed with an iron supplement. Which
statement, if made by the patient, indi- Answer: D. Constipation is expected with
cates the need for further teaching? this supplement, not diarrhea. Increasing
A) I should take this medication on an fiber in the diet can prevent this problem.
empty stomach Food in the stomach impairs iron ab-
B) When I start taking this pill, I will start sorption so the patient should take it on
with only one tablet a day and then in- an empty stomach. Slowly increasing the
crease to two amount of pills can help prevent any GI
C) My stools can become really dark in discomfort. Stool is expected to become
color when I take this supplement dark (almost black).
D) I need to watch out for diarrhea that
can occur with this supplement
You, the super amazing nurse, is taking
care of a 65 year old woman with ESRD.
The doctor has informed her that she
has anemia. She asks you "My friend
has some anemia and she takes an iron
pill every day. Why don't you just give me
Answer: C. An iron supplement may be
that?" What is the best response by the
given to a patient with ESRD related ane-
nurse?
mia. However, an iron supplement would
A) I'm sorry ma'am, but if you needed
be given in conjunction with erythropoi-
iron supplements the doctor would have
etin. They would help in this case, but not
prescribed them
given alone. Hemodialysis does not fully
B) Those supplements are for anemia
fix anemia, in fact, it can further lower
caused by blood loss or iron deficiency.
iron and folic acid levels and worsen the
They wouldn't work for you
anemic fatigue.
C) An iron supplement alone would not
be enough to fix your specific type of
anemia
D) You are going to be put on hemodial-
ysis to treat your renal disease which
should alleviate the anemia
Imagine this. You enter the unit as an RN
Answer: A. Mr. Smith is at risk for bleed-
on your first day on the job. You breathe
ing because of overgrown, dysfunctional
in the smell of awesomeness and drink
3 / 13
your Starbucks coffee. You see that you
are taking care of a Mr. Smith who has platelets r/t his disease process. He is
been diagnosed Polycythemia Vera. Be- also at risk for clot formation and there-
cause you are so freakin' awesome, you fore at risk for a CVA or MI. Pruritis would
know that Mr. Smith is at risk for which of be an expected symptom of his disease,
the following complications? not a complication. Splenomegaly, not
A) Excessive Bleeding hepatomegaly, is associated with this
B) Pruritus disorder. Pancreatitis was a red herring,
C) Hepatomegaly sorry.
D) Pancreatitis
Answer: A,B,C, and E. The patient with
PV would have symptoms based on in-
creased blood volume and increased
Which of the following symptoms would
blood viscosity. HA, dizziness, tinnitus,
be expected in the patient diagnosed
fatigue, paresthesia, and blurred vision
with Polycythemia Vera (PV)?
are possible symptoms of increased
A) HA
blood volume. Angina, claudication, dys-
B) Palpatable spleen
pnea, and thrombophlebitis are possible
C) Angina
symptoms of increased blood viscosity.
D) Polyuria
Splenomegaly (enlarged spleen) occurs
E) Dyspnea
as it takes on blood producing responsi-
bility. Polyuria is not associated with this
disorder
A patient arrived to the clinic complain-
ing of generalized pruritus and pain in
Answer: D. based on a history of COPD,
the extremities. He has a history of di-
the nurse suspects that the polycythemia
abetes, HTN, dyslipidemia, COPD, and
is based on the secondary cause of
A-fib. His blood pressure is 155/90. His
chronic reduced oxygen intake. Oth-
face is a ruddy color. On palpation of
er possible causes of secondary poly-
his abdomen, his spleen is palpable. His
cythemia would include smoking history,
blood values indicate a Hgb of 18.5 and
cyanotic heart disease, or even living in
Hct of 60%. The nurse suspects which
a high altitude. There are also several
diagnosis?
other causes. If a cause is noted, poly-
A) Polycythemia Vera
cythemia Vera (primary polycythemia) is
B) Multiple Myeloma
ruled out
C) Thrombocytopenia
D) Secondary Polycythemia
4 / 13
The patient with polycythemia Vera asks
you "Why the **** am I taking aspirin!? I
never needed any medications before!"
Answer: C. Aspirin is prescribed to help
What is the best response by the nurse?
with erythromelalgia which is a problem
A) The aspirin is prescribed in order to
caused by PV which causes warmth,
treat HA, a common symptom of this
redness, and burning pain in the extrem-
disease
ities. Cool compresses may also help
B) Aspirin has been proven to be effec-
with this problem. It is important to mon-
tive in preventing all complications of this
itor patients taking aspirin for bleeding
disorder
because patients with PV are already
C) This medication will help reduce the
at an increased risk for bleeding which
burning pain you have in your extremities
could be exacerbated by aspirin use.
D) If I wanted you to ask a question, I
would have let you know. Now shut up
and take your pill.
You are providing discharge teaching to
the patient with polycythemia Vera about
treating pruritus. Which of the following
Answer: B. Use of antihistamines are
statements indicates the need for further
not effective in relieving pruritus caused
teaching?
by polycythemia. Cold compresses may
A) A cold ice pack can help relieve some
help relieve itching (avoid warm or hot).
of my itching
Water often aggravates pruritus with
B) I will take some Benadryl to help re-
polycythemia Vera (aquagenic pruritus).
lieve the itching
Interferon, a myelosuppressive agent
C) Water will probably make my itching
given to high risk patients could help re-
worse rather than help it
lieve itching.
D) My doctor may discuss the use of In-
terferon with me which could help relieve
my itching
The nurse is providing teaching to the
patient diagnosed with Polycythemia Answer: D. The patient with polycythemia
Vera. Which statement, if made by the vera should NEVER take an iron supple-
patient, indicates the need for further ment. It will stimulate further RBC pro-
teaching? duction which would be a negative effect.
A) I need to make sure I stay active to Staying active to avoid clot formation is
prevent clot formation important as this is a major complication
B) I guess I will have to stop drinking all of this disorder. Limiting or avoiding al-
my alcohol now. Poop.
5 / 13
C) I should limit my bath time to less than
thirty minutes cohol will help minimize risk for bleed-
D) I will need to take an iron supplement ing. Limiting baths will help keep pruritus
to help replace what is taken away by from being aggravated.
therapeutic blood draws
The nurse is taking care of the 73 year
old patient with polycythemia vera. The
nurse is most concerned when the pa-
tient mentions which of the following? Answer: B. Multivitamins often contain
A) I've had a UTI in the past so I've been iron which would further stimulate blood
drinking cranberry juice to prevent this production. It would be important to
from happening again make sure the vitamin did not contain
B) I want to be healthy so I started taking that ingredient before the client contin-
a daily multivitamin ued with its use. All other statements are
C) I had my last blood draw about a week not concerning
ago now
D) My doctor started me on a blood pres-
sure medication called Metroprolol
Which of the following symptoms is ex-
pected with hemoglobin of 10 g/dl?
a. None Answer: None. Symptoms are not ex-
b. Pallor pected with mild anemia
c. Palpitations
d. Shortness of breath
A 72 year old male walks into the clin-
ic complaining of lower back pain. He
says he feels fine in the morning but that Answer: D. This is a sign of decreasing
his Alieve doesn't work well enough at renal function and possible renal failure,
night time. His serum protein levels are a complication of multiple myeloma. Mul-
elevated. Which of the following assess- tiple Myeloma is suspected in patients
ment findings is most concerning to the with back pain and protein elevations.
nurse? Weakness and tired feeling may be d/t
A) The patient tells you "I have felt more associated anemia. Constipation can be
weak and tired lately too" caused by hypercalcemia and should be
B) My mother had a history of osteoporo- investigated. Renal function is the priori-
sis ty as failure can occur
C) The patient says he has been consti-
pated
6 / 13
D) The patient says "I haven't peed as
much in the past week as I used to"
Answer: C. Patients with multiple myelo-
The nurse is discharging the patient with
ma are at an increased risk for in-
multiple myeloma. Which of the following
fection r/t impaired antibody produc-
teaching should be included during the
tion. Teaching would include avoiding
discharge?
sick indviduals, hand hygiene, calling for
A) You will need to avoid the use of
fever/signs of infection, getting vaccines
NSAID's
such as pneumonia and flu. Increasing
B) It may be necessary to limit fluid in-
fluid intake will help prevent complica-
take
tions such as hypercalcemia and renal
C) You will need to get your Pneumonia
failure. NSAID's may be used to help re-
vaccine
lieve pain. Hypercalcemia, not hypocal-
D) Here are the signs of hypocalcemia
cemia, is a common complication of mul-
you will need to know
tiple myeloma
Answer: B, C, and D. Protein levels in
Which of the following abnormal lab re-
urine are an expected result of the dis-
sults would the nurse expect to see in the
ease process. Because bones are being
patient with multiple myeloma?
destroyed, an excess calcium level may
A) K 5.4
also be expected. Serum M (Monocolon-
B) Ca 11.5
al protein) in the blood is the main pro-
C) Positive proteinuria
tein created d/t multiple myeloma. There
D) Serum M protein
would be no expected changes in potas-
E) Platelets 80,000
sium or platelet counts
The patient with multiple myeloma is tak-
ing dexamethasone. Which of the follow- Answer: C. Osteoporosis can be caused
ing would be a complication of the ther- by corticosteroids and would be even
apy? more so likely to happen because of the
A) Dehydration multiple myeloma. This would be an im-
B) Hypoglycemia portant assessment for the nurse taking
C) Osteoporosis care of the patient
D) Leukopenia
The patient with multiple myeloma and
lytic lesions has been prescribed a bis-
phosphonate called pmidronate (Aren- Answer: C. Bisphosphonates are often
dia). He says, "Why am I taking this prescribed the patients with multiple
medication?" What is the nurse's best
response?
7 / 13
A) This medication is to help lower your
overactive immune system
myeloma in order to maintain the bone
B) Hopefully this medication will help kill
and prevent breakdown and fracture. It
the malignant cells in your body
can caused locked jaw in patients with
C) This medication should help protect
multiple myeloma so the nurse should be
renal function from damage
wary to assess for that complication
D) This medication will help prevent
bone fracture and lower calcium levels
Answer: A. Bleeding and clot formation
are two common complications of pri-
Which of the following complications
mary thrombocytopenia. In this disor-
would the nurse know to monitor for
der, platelet levels are high (600,000+)
in the patient with primary thrombo-
and platelets are often dysfunctional. Be-
cythemia?
cause of this clots leading to possible
A) bleeding and clot formation
DVT, MI, or CVA may occur as well as
B) HA and dizziness
possible hemorrhage. HA and dizziness
C) Stroke and syncope
are two common symptoms of the dis-
D) Infection and DVT
ease. Syncope and infection would not
be associated complications.
You are a proud nursing teacher of 20
years. You are really pushing hard for
your students to be as awesome as you
are. Ok, let's not push it here. You real-
ly just need them to pass the NCLEX.
You are teaching about the difference
between primary thrombocythemia and
secondary thrombocytosis. Which nurs-
ing student is the smartest?
A) Thrombocytosis is much more severe Answer: B. Page 553
than thromboycthemia and is caused by
smoking
B) Thrombocythemia can lead to com-
plications such as bleeding and clotting
while platelet levels in thrombocytosis
rarely get high enough to cause such
problems
C) Thrombocytosis is a drop in platelet
counts with thrombocythemia is a rise
8 / 13
D) Thrombocythemia is caused by can-
cer while thrombocytosis does not have
a cause
Which of the following statements, if
Answer: C. Herbal supplements can in-
made by the patient diagnosed with im-
crease bleeding time (garlic, ginseng,
mune thrombocytopenic purpura (ITP)
kava kava, etc.) and should not be tak-
would be most concerning to the nurse?
en if platelet levels are already low (as
A) My menstrual periods are really
in ITP) Menstrual periods would be ex-
heavy
pected to be heavy. Prednisone is of-
B) I've been taking prednisone every day
ten prescribed for ITP to reduce immune
C) I started taking some vitamins and
destruction of platelets. Metamucil may
herbs to be healthy
be prescribed to prevent constipation
D) I've been taking Metamucil every
(which could lead to GI bleeding)
morning
A nurse has just begun an 8 hour shift
and is presented with the following pa-
tients. Which patient is the nurse's prior-
ity at this time?
a) A 43 year-old female just transferred
to the floor who is complaining of gen-
eralized weakness for the past 3 weeks
and appears pale and thin. No labs
have been drawn. Vital signs are 109/65,
T98.8, P72, R19, O2 94%, pain 0/10.
b) A 66 year-old male with a history Answer: B. Patients with polycythemia
of polycythemia vera who has a ruddy vera are at an increased risk for clot for-
complexion, whose wife pressed the call mation. This patient appears to be hav-
bell because her husband has devel- ing symptoms of a stroke.
oped weakness on the L side of his body
with accompanying slurred speech.
c) A 19 year-old female who has had
bloody stools and unexplained bruising
for the past 2 days. Hgb is 9, Hct is 27,
RBC count is 3.9, WBC count is 7,000,
Platelets are 145,000.
d) A 75 year-old male who has a history
of mutiple myeloma who has a Ca+ level
of 12.3
9 / 13
A patient with ITP is scheduled for a
splenectomy. He asks you "Why would I
want to have my spleen removed? How
will this help me?" What is the nurse's
best response?
a) "Tell me more about what is causing
your anxiety"
Answer: C. Splenectomy is removal the
b) "The splenectomy is going to cure
spleen which is a platelet "trap". When
your disorder by increasing platelet pro-
removed it allows the platelets to go back
duction"
into the bloodstream and hopefully nor-
c) "Many times platelet cells get trapped
malize overtime.
inside the spleen. When we remove the
spleen they suddenly become free again
to help prevent bleeding"
d) "Your spleen is a recycling plant for
platelet cells, when remove it, we won't
have so many platelets circulating in the
blood"
Answer: A. Infection is a serious com-
plication of a splenectomy because the
spleen plays an important role for the
The nurse is taking care of a patient after
patients immune system. Any sign of in-
a splenectomy. Which of the following
fection should be reported immediate-
would the nurse report immediately to
ly. Platelet count would be expected to
the physician?
be high directly following a splenecto-
A) T 100.1
my, as the spleen is a storage cen-
B) Platelets 600,000
ter for platelets and when removed, the
C) BP 155/78
platelets are freed into the bloodstream.
D) RR 22
A low blood pressure would be a cause
for concern, as this would be an indica-
tion of hemorrhage. RR 22 is normal.
Which of the following would be allowed
Answer: D. Pregnant patient should
to give blood?
not give blood d/t increased nutrition-
A) The pregnant 23 year old mother of 2
al needs during pregnancy. The tattoo
who got a tattoo 14 months ago
is 14 months old and would not affect
B) The patient who says "I don't have
blood donation. HIV or syphilis infection
HIV or syphilis. Heck the only thing
would be a contraindication to blood do-
wrong with me was that tooth I got re-
10 / 13
moved 2 days ago!"
nation, and having a tooth extraction up
C) The eager beaver who says he gave
to 72 hours ago is also a contraindica-
six months ago who says "I got my flu
tion. Having a recent vaccine would be a
shot yesterday too!"
contraindication to blood donation. There
D) The patient who says "I used to be an
is no reason stated why patient D cannot
alcoholic, but thanks to AA, I'm clean and
give blood
ready to help someone else!"
The nurse is preparing the client for
Answer: A, B. During the pre-transfu-
a blood transfusion. While performing
sion assessment, the nurse needs to
the pre-transfusion assessment, which
be assessing any possibility of reaction
of the following questions are the most
that could occur. Patients who have had
important for the nurse to ask?
blood transfusions in the past are at a
A) Have you had any previous blood
higher risk for blood transfusion reaction.
transfusions?
Patients with a high number of pregnan-
B) Have you had children or ever been
cies are at a higher risk for blood transfu-
pregnant?
sion reactions d/t antibody development
C) Do you have a history of diabetes?
from exposure to fetal circulation. All oth-
D) Have you had any recent head trau-
er questions are good to ask, but are not
ma?
the most critical to ask at this time.
E) What is your pain level?
You are transfusing a unit of blood into
this awesome patient you have. It's pret-
ty cool cuz they are almost as awe-
some as you are! It's not every day that
happens. Anyway, suddenly your patient
complains of low back pain and feels a
little short of breath. You look at the vi-
Answer: B. Acute hemolytic reaction of-
tals and see that the blood pressure has
ten manifests with dyspnea, fever, anxi-
dropped and the patient is running a mild
ety, hypotension, back pain, nausea and
fever. The patient tells you they feel really
vomiting, chest tightness, and bleeding.
anxious. You stop the transfusion (cuz
you so smart!). What type of transfusion
reaction do you suspect?
A) Febrile, nonhemolytic reaction
B) Acute Hemolytic Reaction
C) Circulatory Overload
D) Allergic Reaction
11 / 13
Well, you are transfusing blood to a pa-
tient today named Mr. Guinea. He's been
losing blood through a GI bleed and he's
Answer: A. Febrile nonhemolytic reac-
kind of grumpy. You finish the transfusion
tion is the most common type of blood
and everything seems fine. Suddenly,
transfusion reaction ocuring d/t donor
the patient says "I feel cold" and begins
antibodies remaining in the blood react-
to experience chills. His temperature is
ing in the patient's blood. Symptoms in-
100.4. What transfusion reaction does
clude fever and chills (minimal to se-
the nurse suspect?
vere). Antipyretics can be given before
A) Febrile, nonhemolytic reaction
the transfusion to prevent this reaction
B) Hemolytic Reaction
C) Circulatory Overload
D) Allergic Reaction
You are working yet another awesome
amazing day in the ED when in comes a
trauma patient. You find yourself admin-
istering blood to this patient. You careful-
ly run the fluid really slowly at 5ml/min for
Answer: D. Circulatory overload mani-
the first fifteen minutes before you raise
fests as tachycardia, feelings of fullness
the rate some. Suddenly your patient's
in chest, crackles, JVD, dyspnea, orthop-
heart rate jumps up to 135. The patient
nea, and sudden anxiety. Diuretics may
sits up a little bit and says I feel like there
be administered prophylactically to pre-
is something heavy in my chest. He's
vent circulatory overload in patients at
having labored breathing. You stop the
risk. HINT: priority action = stop transfu-
transfusion and hear crackles in the lung
sion + apply O2
bases. What reaction do you suspect?
A) Allergic Reaction
B) Delayed Hemolytic Reaction
C) Hemolytic Reaction
D) Circulatory Overload
Answer: B, D. Foley catheters should
The patient's platelet count is at 45,000. and IM injections should be avoided d/t
Which of the the following orders would increased risk for trauma and excess
the nurse question? bleeding. Tylenol is not contraindicated
A) Tylenol prn pain in this condition. Colace will soften the
B) Indwelling Foley Catheter stool and prevent damage in the rectum
C) Colace from straining which could cause bleed-
ing. IV's may still be inserted in order
12 / 13
to have emergency access to the blood-
D) Flu shot stream. Pressure should be held for 5-10
E) IV insertion minutes after insertion or until bleeding
stops.
13 / 13
NCLEX Qs 280 Exam 3: Anemia and Hematology
Study online at https://quizlet.com/_58kr4g
Neutropenia, a condition involving the ANS 1, 2, 3, 5

blood's neutrophil count, is believed to
be caused by its: (select all that apply) The causes of neutropenia, in addition
to an overwhelming infection, include de-
1- decreased production. creased production, increased turnover,
2- increased turnover. and abnormal distribution. Decreased vi-
3- abnormal distribution. tamin intake can cause decreased pro-
4- increased tendency to store vitamins. duction due to the lack of appropriate
5- reaction to an overwhelming infection. building blocks.
Which condition is a known cause of ANS 1, 3, 4
eosinophilia? (select all that apply)
Asthma, eczema, and atopic dermatitis
1- Asthma may all increase eosinophil production
2- Prolonged infection resulting in eosinophilia. Prolonged in-
3- Atopic dermatitis fection may actually cause leukopenia,
4- Eczema while poor protein intake has no known
5- Poor protein intake relationship to eosinophilia.
C. Reticulocyte value of 14%
Rationale: The normal reticulocyte value

Which blood test result for a client being is 2% or less of the total red blood cell
assessed for a hematologic problem in- (RBC) count. A reticulocyte is an imma-
dicates to the nurse that chronic anemia ture RBC that still has its nucleus. An
is likely? elevated reticulocyte count indicates that
RBCs are being produced and released
A. International normalized ratio (INR) is by the bone marrow before they mature.
0.9 This often happens when a person has a
B. Platelet count of 180,000/mm3 condition that causes continual but very
C. Reticulocyte value of 14% slow bleeding and anemia. This client
D. Hematocrit of 27% has a low hematocrit and is anemic. The
INR and platelet values are norma
Iggy ch 39 8th edition

D. Facial drooping on the right side
Which new assessment finding in a
client with sickle cell disease who cur-
Rationale: All current assessment find-
rently is in crises does the nurse report
ings are important. However, the pain
immediately to the health care provider?
in the hip, the slow capillary refill, and
1 / 26
the yellow appearance of the roof of
the mouth are related to the crises and
A. Pain in the right hip with limited range
are expected. The facial drooping as a
of motion
new finding indicates the possibility of
B. Slow capillary refill in the toes of the
reduced brain perfusion and stroke. This
right foot
dew development requires immediate at-
C. Yellow appearance of the roof of the
tention and intervention.
mouth
D. Facial drooping on the right side
Iggy
B. The disease has become more ag-
gressive.
Rationale: The leukemia is progressing

and the drug therapy is no longer effec-
tive. CML has three phases: The chronic
phase is often a slowly progressing (in-
dolent) course during which the patient
The blood of a client who has chron- may have mild symptoms and respond to
ic myelogenous leukemia shows a high standard treatments. The bone marrow
percentage of blast cells and promyelo- usually shows less than 10% blast cells
cytes. What is the nurse's correct inter- at this time. The accelerated phase fea-
pretation of this test result? tures spleen enlargement and progres-
sive manifestation, such as intermittent
A. The client's risk for infection is de- fevers, night sweats, and unexplained
creasing. weight loss. The patient usually does not
B. The disease has become more ag- respond to standard treatment, and the
gressive. bone marrow may contain 10% to 30%
C. The drug therapy for the disease is blast cells and promyelocytes. The blast
effective. phase indicates transformation to a very
D. The type of leukemia is now lympho- aggressive acute leukemia. The bone
cytic rather than myelogenous. marrow contains more than 30% blast
cells. The promyelocytes and blast cells
commonly spread to other tissues and
organs. The leukemia becomes more
similar to acute leukemia than chron-
ic leukemia but does not change from
myelogenous to lymphocytic. With so
many blast cells that are immature and
do not function properly, the client is now
2 / 26
at greatly increased risk for infection.
Iggy
B. Take and record the client's vital signs.
The nurse who just came on duty ob-
Rationale: Clients with AB negative
serves that the client, whose blood type
blood types can receive O negative
is AB negative, is receiving a transfusion
blood because they do not have anti-
with type O negative packed red blood
bodies against this type of blood. There-
cells. What is the nurse's best first ac-
fore, the transfusion does not need to be
tion?
stopped nor does the blood bank need to
be notified. The transfusion can proceed.
A. Call the blood bank.
Because the nurse is seeing the client for
B. Take and record the client's vital signs.
the first time since the transfusion was
C. Stop the transfusion and keep the IV
initiated, the client's vital signs need to
open.
be assessed rather than just document-
D. Document the observation as the only
ing the observation.
action.
Iggy
#1 A client has a bone marrow biopsy 1- Applying pressure to the biopsy site
done. Which nursing intervention is the
priority postprocedure? The initial action should be to stop bleed-
ing by applying pressure to the site. In-
1- Applying pressure to the biopsy site specting for ecchymoses, sending spec-
2- Inspecting the site for ecchymoses imens to the laboratory, and teaching the
3- Sending the biopsy specimens to the client about activity levels will be done
laboratory after hemostasis has been achieved.
4- Teaching the client about avoiding vig-
orous activity Iggy ch 39 8th edition
2- Platelet (thrombocyte) count
#2 The nurse is reviewing complete
blood count (CBC) data for a 76-year-old Platelet counts do not generally change
client. Which decreased value causes with age. Hemoglobin levels in men and
concern because it is not age-related? women fall after middle age; iron-defi-
cient diets may play a role in this re-
1- Hemoglobin level duction. Total RBC and WBC counts (es-
2- Platelet (thrombocyte) count pecially lymphocyte counts) are lower in
older adults. The WBC count does not
3 / 26
rise as high in response to infection in
3- Red blood cell (RBC) count older adults as it does in younger people.
4- White blood cell (WBC) response
1- An 18-year-old who had an emer-
gency splenectomy
Removal of the spleen causes reduced

immune function. Without a spleen,
#3 The nurse is caring for a group of the client is less able to remove dis-
hospitalized clients. Which client is at ease-causing organisms, and is at in-
greatest risk for infection and sepsis? creased risk for infection. Sickle cell ane-
mia causes pain and discomfort be-
1- An 18-year-old who had an emer- cause of the changed cell morphology,
gency splenectomy so acute pain, especially at joints, is the
2- A 22-year-old with recently diagnosed greatest threat to this client. A low red
sickle cell anemia blood cell count with hemolytic anemia
3- A 38-year-old with hemolytic anemia can contribute to a client's risk for infec-
4- A 40-year-old alcoholic with liver dis- tion, but this client is more at risk for low
ease oxygen levels and ensuing fatigue. The
liver plays a role in blood coagulation, so
this client is more at risk for coagulation
problems than for infection.

3- "It should prevent my blood from clot-
ting."
#7 A client on anticoagulant therapy is
being discharged. Which statement indi-
Anticoagulants work by interfering with
cates that the client has a correct un-
one or more steps involved in the blood
derstanding of this therapy's purpose or
clotting cascade. Thus, these agents pre-
action?
vent new clots from forming and lim-
it or prevent extension of formed clots.
1- "It is to dissolve blood clots."
Anticoagulants do not dissolve clots,
2- "It might cause me to get injured more
fibrinolytics do. Anticoagulants do not
often."
cause more injuries, but may cause
3- "It should prevent my blood from clot-
more bleeding and bruising when the
client is injured. Anticoagulants do not
4 / 26
cause any change in the thickness or
ting." viscosity of the blood.
4- "It will thin my blood."
4- Has the client write down everything
he or she has eaten for the past week
Having the client provide a list of items

eaten in the past week is the most ac-
curate way to find out what the client
likes and dislikes, as well as what the
#8 The nurse is assessing the nutritional client has been eating. It will provide in-
status of a client with anemia. How does formation about "junk" food intake, as
the nurse obtain information about the well as protein, vitamin, and mineral in-
client's diet? take. Rating scales are good for subjec-
tive data collection about some condi-
1- Asks the client to rate his or her diet tions such as pain, but the subjectivity of
on a scale of 1 (poor) to 10 (excellent) a response such as this does not provide
2- Determines who prepares the client's the nurse with specific data needed to
meals and plans an interview with him or assess a diet. Interviewing the food pre-
her parer is time-consuming and poses sev-
3- From a prepared list, finds out the eral problems, such as whether a num-
client's food preferences ber of people are preparing meals, or
4- Has the client write down everything if the client goes "out" for meals. Deter-
he or she has eaten for the past week mining food preferences from a prepared
list provides information about what the
client enjoys eating, not necessarily what
the client has been eating; for instance,
the client may like steak but may be un-
able to afford it.

2- Hemolytic anemia
#10 A newly admitted client has an ele- An elevated reticulocyte count in an

vated reticulocyte count. Which disorder anemic client indicates that the bone
marrow is responding appropriately to
a decrease in the total red blood cell
5 / 26
(RBC) mass and is prematurely destroy-
ing RBCs. Therefore, more immature
does the nurse suspect in this client? RBCs are in circulation. Aplastic ane-
mia is associated with a low reticulo-
1- Aplastic anemia cyte count. A high white blood cell count
2- Hemolytic anemia is expected in clients with infection. A
3- Infectious process low white blood cell count is expected in
4- Leukemia clients with leukemia.

2- "You may experience a crunching
sound or a scraping sensation as the
needle punctures your bone."
#12 The nurse is teaching a client about It is accurate to describe a crunching

what to expect during a bone marrow sound or scraping sensation. Proper ex-
biopsy. Which statement by the nurse pectations minimize the client's fear dur-
accurately describes the procedure? ing the procedure. A very large-bore nee-
dle is used for a bone marrow biopsy, not
1- "The doctor will place a small needle a small needle; the puncture is made in
in your back and will withdraw some flu- the hip or in the sternum, not the back.
id." The nurse, or sometimes a family mem-
2- "You may experience a crunching ber, is available to the client for support
sound or a scraping sensation as the during a bone marrow biopsy. The pro-
needle punctures your bone." cedure is sterile at the site of the biopsy,
3- "You will be alone because the proce- but others can be present without cont-
dure is sterile; we cannot allow additional amination at the site. A local anesthetic
people to contaminate the area." agent is injected into the skin around
4- "You will be sedated, so you will not be the site. The client may also receive a
aware of anything." mild tranquilizer or a rapid-acting seda-
tive (such as lorazepam [Ativan]) but will
not be completely sedated.

2- A 46-year-old with a fever and a white
#17 After reviewing the laboratory test
blood cell (WBC) count of 1500/mm3
results, the nurse calls the health care
provider about which client?
The client with a fever is neutropenic
6 / 26
and is at risk for sepsis unless inter-
ventions such as medications to improve
1- A 44-year-old receiving warfarin
the WBC level and antibiotics are pre-
(Coumadin) with an international nor-
scribed. The INR of 3.0 in the 44-year-old
malized ratio (INR) of 3.0
indicates a therapeutic warfarin level. A
2- A 46-year-old with a fever and a white
platelet count of 150,000/mm3 in the
blood cell (WBC) count of 1500/mm3
49-year-old is normal. An elevated retic-
3- A 49-year-old with hemophilia and a
ulocyte count in the 52-year-old is ex-
platelet count of 150,000/mm3
pected after hemorrhage.
4- A 52-year-old who has had a hemor-
rhage with a reticulocyte count of 0.8%
4- "Your cells are delivering less oxygen
than you need."
#18 A client with anemia asks, "Why am The single most common symptom of
I feeling tired all the time?" How does the anemia is fatigue, which occurs because
nurse respond? oxygen delivery to cells is less than is
required to meet normal oxygen needs.
1- "How many hours are you sleeping at Although assessment of sleep and rest
night?" is good, it does not address the cause
2- "You are not getting enough iron." related to the diagnosis. While it may be
3- "You need to rest more when you are true that the client isn't getting enough
sick." iron, it does not relate to the client's
4- "Your cells are delivering less oxygen fatigue. The statement about the client
than you need." needing rest because of being sick is
simply not true.

3- Infuse the transfusion over a 15- to
#3 The nurse is infusing platelets to a
30-minute period.
client who is scheduled for a hematopoi-
etic stem cell transplant. What procedure
The volume of platelets—200 or 300 mL
does the nurse follow?
(standard amount)—needs to be infused
rapidly over a 15- to 30-minute peri-
1- Administer intravenous corticos-
od. Administering steroids is not stan-
teroids before starting the transfusion.
dard practice in administering platelets.
2- Allow the platelets to stabilize at the
Platelets must be administered immedi-
client's bedside for 30 minutes.
ately after they are received; they are
7 / 26
considered to be quite fragile. A special
3- Infuse the transfusion over a 15- to transfusion set with a smaller filter and
30-minute period. shorter tubing is used to get the platelets
4- Set up the infusion with the standard into the client quickly and efficiently.
transfusion Y tubing.
2- Hydroxyurea (Droxia)
#4 A 32-year-old client is recovering
from a sickle cell crisis. His discomfort
Hydroxyurea (Droxia) has been used
is controlled with pain medications and
successfully to reduce sickling of cells
he is to be discharged. What medication
and pain episodes associated with sickle
does the nurse expect to be prescribed
cell disease (SCD). Clients with SCD are
for him before his discharge?
not prescribed anticoagulants such as
heparin or warfarin (Coumadin). t-PA is
1- Heparin (Heparin)
used as a "clot buster" in clients who
2- Hydroxyurea (Droxia)
have had ischemic strokes.
3- Tissue plasminogen activator (t-PA)
4- Warfarin (Coumadin)
2- Frequent and thorough handwashing
Prevention and early detection strate-

gies are used to protect the client in sick-
#7 The nurse is caring for a client with le cell crisis from infection. Frequent and
sickle cell disease. Which action is most thorough handwashing is of the utmost
effective in reducing the potential for importance. Drug therapy is a major de-
sepsis in this client? fense against infections that develop in
the client with sickle cell disease, but is
1- Administering prophylactic drug ther- not the most effective way that the nurse
apy can reduce the potential for sepsis. Con-
2- Frequent and thorough handwashing tinually assessing the client for infection
3- Monitoring laboratory values to look and monitoring the daily complete blood
for abnormalities count with differential white blood cell
4- Taking vital signs every 4 hours, day count is early detection, not prevention.
and night Taking vital signs every 4 hours will help
with early detection of infection, but is not
prevention.
8 / 26
ANS 1, 2, 4, 6
It is critical to have others help the ane-

mic client who is extremely tired. Al-
#13 The nurse is teaching a client with
though it may be difficult for him or her
newly diagnosed anemia about conserv-
to ask for help, this practice should be
ing energy. What does the nurse tell the
stressed to the client. Drinking small pro-
client?
tein or nutritional supplements will help
Select all that apply.
rebuild the client's nutritional status. Hav-
ing four to six small meals daily is pre-
1- "Allow others to perform your care
ferred over three large meals; this prac-
during periods of extreme fatigue."
tice conserves the body's expenditure of
2- "Drink small quantities of protein
energy used in digestion and assimila-
shakes and nutritional supplements dai-
tion of nutrients. Stopping activities when
ly."
strain on the cardiac or respiratory sys-
3- "Perform a complete bath daily to re-
tem is noted is critical. A complete bath
duce your chance of getting an infec-
should be performed only every other
tion."
day; on days in between, the client can
4- "Provide yourself with four to six small,
be taught to take a "mini" sponge bath,
easy-to-eat meals daily."
which will conserve energy and still be
5- "Perform your care activities in groups
safe in preventing the risks for infection.
to conserve your energy."
Care activities should be spaced every
6- "Stop activity when shortness of
hour or so rather than in groups to con-
breath or palpitations are present."
serve energy; the time just before and
after meals should be avoided.

ANS 2, 3
What are serious side effects of antiviral
agents prescribed for a client with acute
Antiviral agents, although helpful in
myelogenous leukemia?
combating severe infection, have seri-
ous side effects, especially nephrotoxic-
ity and ototoxicity. Cardiomyopathy and
1- Cardiomyopathy
stroke are not serious side effects of
2- Nephrotoxicity
antiviral agents. Diarrhea is a mild side
3- Ototoxicity
effect associated with antibiotic therapy.
4- Stroke
5- Diarrhea
9 / 26
4- Wheezes or crackles
#23 The nurse is caring for a client with
Wheezes or crackles in the neutropenic
neutropenia. Which clinical manifesta-
client may be the first symptom of in-
tion indicates that an infection is present
fection in the lungs. Coughing and deep
or should be ruled out?
breathing are not indications of infection,
but can help prevent it. The client with
1- Coughing and deep breathing
leukopenia, not neutropenia, may have a
2- Evidence of pus
severe infection without pus or with only
3- Fever of 102° F or higher
a low-grade fever.
4- Wheezes or crackles
#22 The nurse is teaching a client with 1- Dairy products
vitamin B12 deficiency anemia about di-
etary intake. Which type of food does the Dairy products such as milk, cheese,
nurse encourage the client to eat? and eggs will provide the vitamin B12
that the client needs. Grains, leafy veg-
1- Dairy products etables, and starchy vegetables are not
2- Grains a source of vitamin B12.
3- Leafy vegetables
4- Starchy vegetables Iggy ch 40 8th edition
1- A 34-year-old client with type O blood
Hemolytic transfusion reactions are

caused by blood type or Rh incompati-
bility. When blood that contains antigens
#25 Which client is at greatest risk for
different from the client's own antigens
having a hemolytic transfusion reaction?
is infused, antigen-antibody complexes
are formed in the client's blood. Type O
1- A 34-year-old client with type O blood
is considered the universal donor, but
2- A 42-year-old client with allergies
not the universal recipient. The client
3- A 58-year-old immune-suppressed
with allergies would be most suscepti-
client
ble to an allergic transfusion reaction.
4- A 78-year-old client
The immune-suppressed client would be
most susceptible to a transfusion-associ-
ated graft-versus-host disease. The old-
er adult client would be most susceptible
to circulatory overload.
10 / 26

ANS 1, 2, 3, 4
Reduced production of blood cells in

the bone marrow is one of the risk fac-
tors for developing leukemia. Exposure
#35 What are the risk factors for the to chemicals through medical need or
development of leukemia? by environmental events can also con-
Select all that apply. tribute. Certain genetic factors contribute
to the development of leukemia; Down
1- Bone marrow hypoplasia syndrome is one such condition. Radi-
2- Chemical exposure ation therapy for cancer or other expo-
3- Down syndrome sure to radiation, perhaps through the
4- Ionizing radiation environment, also contributes. There is
5- Multiple blood transfusions no indication that multiple blood transfu-
6- Prematurity at birth sions are connected to clients who have
leukemia. Although some genetic factors
may influence the incidence of leukemia,
prematurity at birth is not one of them.

1- "After this therapy, I will not need to
#37 The nurse is teaching a client about have any more."
induction therapy for acute leukemia.
Which client statement indicates a need Induction therapy is not a cure for
for additional education? leukemia, it is a treatment; therefore,
the client needs more education to un-
1- "After this therapy, I will not need to derstand this. Because of infection risk,
have any more." clients with leukemia should avoid peo-
2- "I will need to avoid people with a cold ple with a cold or flu. Induction thera-
or flu." py will most likely cause the client with
3- "I will probably lose my hair during this leukemia to lose his or her hair. The goal
therapy." of induction therapy is to force leukemia
4- "The goal of this therapy is to put me into remission.
in remission."
11 / 26
3. The patient's white blood cell count is
39,000 mm3 (39.0 × 109/L).
A patient with chemotherapy-related Leukocytosis is an adverse effect of fil-

neutropenia is receiving filgrastim injec- grastim and indicates a need to stop the
tions. Which finding by the nurse is most medication or decrease dosage. Bone
important to report to the health care pain is a common adverse effect as the
provider? bone marrow starts to produce more
neutrophils; the patient should receive
1. The patient says, "My bones are analgesics, but the medication will be
aching." continued. Stinging with injection may
2. The patient's platelet count is 110,000 occur; the nurse should administer the
mm3 (110 × 109/L). medication more slowly. The patient's
3. The patient's white blood cell count is platelet count is low and should be re-
39,000 mm3 (39.0 × 109/L). ported, but the level of 110,000 mm3
4. The patient reports that the medica- (110 × 109/L) does not increase risk for
tion stings when it is injected. spontaneous bleeding.
La Charity Prioritization, Delegation, and

Assignment, 4th Edition
2. Give oxygen at 4 L/min per nasal can-
A 32-year-old patient with sickle cell nula.
anemia is admitted to the hospital dur-
ing a sickle cell crisis. Blood pressure National guidelines for sickle cell crisis
is 104/62 mm Hg, oxygen saturation is indicate that oxygen should be adminis-
92%, and the patient reports pain at a tered if the oxygen saturation is less than
level 8 (on a scale of 0 to 10). Which 95%. Hypoxia and deoxygenation of the
action prescribed by the health care blood cells are the most common cause
provider will the nurse implement first? of sickling, so administration of oxygen
is the priority intervention here. Pain con-
1. Administer morphine sulfate 4 to 8 mg trol (including administration of morphine
IV. and application of warm packs to joints)
2. Give oxygen at 4 L/min per nasal can- and hydration are also important inter-
nula. ventions for this patient and should be
3. Start an infusion of normal saline at accomplished rapidly.
200 mL/hr.
4. Apply warm packs to painful joints. La Charity Prioritization, Delegation, and
12 / 26
3. The patient's oxygen saturation is
A patient is admitted to the intensive
87%.
care unit with disseminated intravascu-
lar coagulation (DIC) associated with a
Because the decrease in oxygen satu-
gram-negative infection. Which assess-
ration will have the greatest immediate
ment information has the most immedi-
effect on all body systems, improvement
ate implications for the patient's care?
in oxygenation should be the priority goal
of care. The other data also indicate the
1. There is no palpable radial or pedal
need for rapid intervention, but improve-
pulse.
ment of oxygenation is the most urgent
2. The patient reports chest pain.
need.
3. The patient's oxygen saturation is
87%.
4. There is mottling of the hands and feet
4. The patient takes an antacid with the
iron to avoid nausea.
A patient with iron deficiency anemia
who is taking oral iron supplements is Concurrent use of antacids with iron sup-
evaluated by the nurse in the outpatient plements will decrease absorption of the
clinic. Which finding by the nurse is of iron and decrease the efficacy in resolv-
most concern? ing the patient's anemia. Black stools are
expected when taking oral iron. The pa-
1. The patient reports that stools are tient's occasional constipation may indi-
black. cate a need for information about pre-
2. The patient complains of occasional vention of constipation while taking iron.
constipation. Use of a multivitamin tablet is safe when
3. The patient takes a multivitamin tablet taking iron supplements (although the
every day. patient may need to avoid taking com-
4. The patient takes an antacid with the bined vitamin and mineral supplements).
iron to avoid nausea.
The nurse in the outpatient clinic is as- 2. The oral temperature is 100°F
sessing a 22-year-old patient who needs (37.8°C).
a physical exam before starting a new
job. The patient reports a history of a Because the spleen has an important
splenectomy several years previously af- role in the phagocytosis of microorgan-
ter an accident but has otherwise been isms, the patient is at higher risk for se-
13 / 26
healthy. Which information obtained dur-
vere infection after a splenectomy. An-
ing the assessment will be of most im-
tibiotic administration is usually indicated
mediate concern to the nurse?
for any symptoms of infection. The other
information also indicates the need for
1. The patient engages in unprotected
more assessment and intervention, but
sex.
prevention and treatment of infection are
2. The oral temperature is 100°F
the highest priorities for this patient.
(37.8°C).
3. The blood pressure is 148/76 mm Hg.
4. The patient admits to daily marijuana
use.
1. The international normalized ratio
(INR) is 5.2.
An INR of 2 to 3 is the goal for patients

The nurse is caring for a patient who who are taking warfarin for atrial fibrilla-
takes warfarin daily for a diagnosis of tion; the INR of 5.2 will require that the
atrial fibrillation. Which information about medication dose be adjusted. Because
the patient is most important to report to bleeding times are prolonged when pa-
the health care provider (HCP)? tients receive anticoagulants, bruising is
a common adverse effect. Green leafy
1. The international normalized ratio vegetables contain vitamin K and have
(INR) is 5.2. an impact on the effectiveness of war-
2. Bruising is noted at sites where blood farin, but if patients eat these vegeta-
has been drawn. bles consistently, then warfarin dosing
3. The patient reports eating a green sal- will also be consistent. The HCP may
ad for lunch every day. need to discuss use of the newer oral an-
4. The patient has questions about ticoagulants (which do not require blood
whether a different testing) with the patient, but the highest
concern is the very prolonged INR.

2. Nontender lump in the right groin
A patient who has been receiving cy-
closporine following an organ transplan- A nontender lump in this area (or near
tation is experiencing these symptoms. any lymph node) may indicate that the
patient has developed lymphoma, a pos-
14 / 26
sible adverse effect of immunosuppres-
Which one is of most concern? sive therapy. The patient should receive
further evaluation immediately. The oth-
1. Bleeding of the gums while brushing er symptoms may also indicate side ef-
the teeth fects of cyclosporine (gingival hyperpla-
2. Nontender lump in the right groin sia, nausea, paresthesia) but do not in-
3. Occasional nausea after taking the dicate the need for immediate action.
medication
4. Numbness and tingling of the feet La Charity Prioritization, Delegation, and
4. Sit the client down, ask the client to
lean forward slightly, and apply pressure
to the nose for 5 to 10 minutes.
A client enters the hospital emergency
department with a nosebleed. On as- The initial nursing action for a client with
sessment the client tells the nurse that a nosebleed is to sit the client down,
the nosebleed just suddenly began. The ask the client to lean forward slightly,
nurse notes no obvious facial injury. and apply pressure to the nose for 5
Which is the initial nursing action? to 10 minutes. Inserting nasal packing
or preparing a nasal balloon is not an
1. Insert nasal packing. appropriate initial intervention. These in-
2. Prepare a nasal balloon for insertion. terventions are used when conservative
3. Place the client in a semi Fowler's po- measures fail. Placing the client in a semi
sition, and apply ice packs to the nose. Fowler's position would promote swal-
4. Sit the client down, ask the client to lowing blood, which is not helpful be-
lean forward slightly, and apply pressure cause of the risk of vomiting and resul-
to the nose for 5 to 10 minutes. tant aspiration.
Saunders Comprehensive Review for

the NCLEX-RN Examination, 7th Edition
4. Red tongue that is smooth and sore
The nurse is performing an assessment
Classic signs of pernicious anemia in-
on a client with a diagnosis of pernicious
clude weakness, mild diarrhea, and a
anemia. Which finding would the nurse
smooth red tongue that is sore. The client
expect to note in this client?
also may have nervous system signs
and symptoms such as paresthesias, dif-
ficulty with balance, and occasional con-
15 / 26
fusion. The client does not exhibit dys-
pnea, the mucous membranes do not
1. Dyspnea
become dusky, and the client does not
2. Dusky mucous membranes
exhibit shortness of breath.
3. Shortness of breath on exertion
4. Red tongue that is smooth and sore
ANS 1, 2, 3, 5
The nurse is preparing to perform an
assessment on a client being admitted
Sickle cell crises are acute exacerba-
to the hospital with a diagnosis of sickle
tions of the disease. Vaso-occlusive cri-
cell crisis, vaso-occlusive crisis. Which
sis is caused by stasis of blood with
findings should the nurse expect to note
clumping of cells in the microcirculation,
on assessment of the client? Select all
ischemia, and infarction. Manifestations
that apply.
include pallor; fever; painful swelling of
hands, feet, and joints; and abdominal
1. Pallor
pain. Blurred vision is not a manifestation
2. Fever
of vaso-occlusive crisis.
3. Joint swelling
4. Blurred vision
5. Abdominal pain
1. Initiate an intravenous (IV) line for the
administration of fluids.
The nurse is preparing a plan of care for
a client with sickle cell crisis who will be
The priorities in management of sickle
admitted to the nursing unit. The nurse
cell crisis are hydration therapy and pain
should include which intervention as a
relief. To achieve this, the client is given
priority in the plan of care for the client?
IV fluids to promote hydration and re-
verse the agglutination of sickled cells in
1. Initiate an intravenous (IV) line for the
small blood vessels. Opioid analgesics
administration of fluids.
may be given to relieve the pain that
2. Consult with the psychiatric depart-
accompanies the crisis. Genetic coun-
ment regarding genetic counseling.
seling is recommended but not during
3. Call the blood bank and request
the acute phase of illness. Red blood
preparation of a unit of packed red blood
cell transfusion may be done in selected
cells.
circumstances such as aplastic crisis or
4. Call the respiratory department to pre-
when the episode is refractive to oth-
er therapy. Oxygen would be adminis-
16 / 26
tered according to individual need, but
the client would not require intubation
pare for intubation and mechanical ven- and mechanical ventilation
tilation.
The nurse is preparing to care for a
4. Decreased production of erythropoi-
client with chronic kidney disease and
etin is causing anemia.
anemia. Which describes the relation-
ship between chronic kidney disease
Clients with chronic kidney disease do
and anemia?
not manufacture adequate amounts of
erythropoietin, which is a glycoprotein
1. Lack of angiotensin I may cause ane-
needed to synthesize red blood cells.
mia.
Renin, aldosterone, and angiotensin are
2. Increased production of aldosterone
substances that assist in maintaining
leads to anemia.
blood pressure
3. Anemia is caused by insufficient pro-
duction of renin.
4. Decreased production of erythropoi-
etin is causing anemia.
2. Dietary intake of iron
Microcytic normochromic anemias in-

volve the presence of small, pale-col-
When obtaining assessment data from ored red blood cells. Causes are iron de-
a client with a microcytic normochromic ficiency anemia, thalassemia, and lead
anemia, which should the nurse ques- poisoning. The only choice that fits this
tion the client about? description is option 2. Folic acid de-
ficiency is caused by macrocytic nor-
1. Folic acid intake mochromic cells; these are large red
2. Dietary intake of iron blood cells. Gastric surgery can result in
3. A history of gastric surgery vitamin B12 deficiency. Sickle cell ane-
4. A history of sickle cell anemia mia results in sickled cells and erythro-
cyte destruction.

17 / 26
A patient who is anemic has a hemo- 4- Determine the cause of the anemia
globin is 9, and a hematocrit is 30\%.
Which of these interventions should be f The healthcare provider will plan inter-
a priority in the patient's plan of care? ventions which will be most effective in
Choose 1 answer: meeting the needs for this patient.
f The low hemoglobin and hematocrit can
1- Administer epoetin alfa (Procrit) sub- be caused by a variety of factors.
cutaneously. f Before implementing specific interven-
2- Transfuse 1 unit packed red blood tions, the cause of the anemia should be
cells. addressed.
3- Administer iron dextran IM.
4- Determine the cause of the anemia Khan Academy NCLEX-RN questions
A patient who is anemic has a HGB of 4- Determine the cause of the anemia
9 and HCT of 30% Which of these in-
terventions should be a priority in the f The healthcare provider will plan inter-
patient's plan of care? ventions which will be most effective in
Choose 1 answer: meeting the needs for this patient.
f The low hemoglobin and hematocrit can
1- Administer epoetin alfa (Procrit) sub- be caused by a variety of factors.
cutaneously. f Before implementing specific interven-
2- Transfuse 1 unit packed red blood tions, the cause of the anemia should be
cells. addressed.
3- Administer iron dextran IM.
4- Determine the cause of the anemia Khan Academy NCLEX-RN questions
The healthcare provider is seeing four 2- The woman of childbearing age re-
patients at the neighborhood clinic. porting a craving for ice.
Which of these patients should the
healthcare provider identify to be most at f Gastric bypass surgery may result in
risk for iron-deficiency anemia? decreased intrinsic factor and absorption
Choose 1 answer: of vitamin
f Iron-deficiency anemia will not develop
1- The patient who has a diagnosis of as long as the vegan diet is well-planned.
chronic renal failure. f Menses may increase the risk of iron-de-
2- The woman of childbearing age re- ficiency anemia in some women. Pica,
porting a craving for ice. the craving to eat unusual substances
3- The obese patient with a history of like ice or dirt is a classic manifestation
gastric bypass surgery. of iron-deficiency anemia.
18 / 26
4- The patient who follows a strict vegan
diet. Khan Academy NCLEX-RN questions
3- Give a small test dose and observe
A patient who has severe iron-deficiency the patient for several minutes.
anemia will receive iron dextran IV. When
administering this medication to the pa- f Iron dextran should never be added to a
tient, which of these actions should the patient's parenteral nutrition solution.
healthcare provider implement? f Caution should be used when adminis-
Choose 1 answer: tering iron dextran because there is high
potential for adverse reactions.
1- Dilute the medication in 50mLL nor- f Anaphylactic reactions are possible
mal saline and infuse over 30 minutes. when giving iron dextran so the health-
2- Add the iron dextran to the patient's care provider will give a small test dose
parenteral nutrition solution. and observe the patient for several min-
3- Give a small test dose and observe utes. The medication will be infused
the patient for several minutes. slowly, in accordance with the dose, dilu-
4- Administer the medication IV push ent, and patient response.
over 1 minute into a large vein.
Khan Academy NCLEX-RN questions
A patient is receiving ferrous sulfate to
treat iron-deficiency anemia. When re- 2- The patient is beginning to recover
viewing the laboratory report, the health- from the anemia.
care provider notes the patient's reticu-
locyte count has increased. How should f Reticulocytes are immature red blood
the healthcare provider interpret these cells.
findings? f As the bone marrow makes new red
Choose 1 answer: blood cells, reticulocytes are released
into circulation.
1- The ferrous sulfate dosage should be f After replacement therapy begins, the
discontinued. bone marrow responds by increasing
2- The patient is beginning to recover production of red blood cells. An in-
from the anemia. creased reticulocyte count is an indica-
3- The patient is not responding to treat- tion the anemia is beginning to resolve.
ment.
4- The ferrous sulfate dosage should be Khan Academy NCLEX-RN questions
increased.
The healthcare provider is admitting a 3- Spoon-shaped nails
patient with a diagnosis of iron-deficien-
19 / 26
cy anemia. The patient's skin and con- f When anemia is present, the body will
junctiva are pale, the tongue is smooth compensate for decreased tissue oxy-
and red, and there are sores on the genation by increasing the heart rate and
corners of the mouth. Which addition- respiratory rate.
al assessment finding will the health- f Lack of vitamin B 12 causes defective
care provider identify as related to the nerve myelination and paresthesias.
iron-deficiency anemia? f Hemolytic anemia can cause a build-up
Choose 1 answer: of bilirubin, resulting in jaundice.
f Brittle, spoon shaped nails (koilonychia)
1- Bradycardia are associated with iron-deficiency ane-
2- Jaundice mia.
3- Spoon-shaped nails
4- Paresthesias Khan Academy NCLEX-RN questions
The healthcare provider is teaching par-
1- Vitamin C
ents of a child who has a diagnosis of
iron-deficiency anemia how to increase
f Vitamin B 12 and folic acid are neces-
their child's absorption of dietary iron.
sary for the prevention of megaloblastic
Which of these supplements should the
anemias.
healthcare provider recommend?
f Vitamin D promotes the absorption of
Choose 1 answer:
dietary calcium.
f Vitamin C promotes the absorption of
1- Vitamin C
dietary iron.
2- Folic acid
3- Vitamin D
4- Vitamin B 12
The healthcare provider is counseling a
ANS 1, 3, 5
pregnant woman who is a lacto-ovo veg-
etarian about foods to include in her diet
f Cheese is a good source of protein and
to avoid iron-deficiency anemia. Which
calcium, but it is low in iron
of these foods should be included? Se-
f Oranges are not a good source of iron,
lect all that apply.
but the vitamin C in them will enhance
Choose all answers that apply:
absorption of iron.
f Good sources of iron for the lacto-ovo
1- Raisins
vegetarian include egg yolk, legumes,
2- Oranges
and raisins.
3- Eggs
4- Cheese
5- Legumes
20 / 26
The healthcare provider is caring for a
patient who reports increasing fatigue
over the past 4 months. The patient has
no significant past medical history and
takes no daily medications. A complete
blood count was ordered. What do these
results tell the healthcare provider about
the patient?
ANS 2, 3, 4
f Hemoglobin 10
f All of these results are abnormal.
f Hematocrit 29
f A deficiency in folic acid or vitamin B 12
f Decreased mean corpuscular volume
will result in megaloblastic anemia.
(MCV)
f This patient's labs are typical of iron-de-
f Decreased mean corpuscular hemoglo-
ficiency anemia, which will result in im-
bin concentration (MCHC)
paired tissue oxygenation.
1- The patient is deficient in B vitamins.
2- Tissue oxygenation is impaired.
3- Red blood cells are small and pale.
4- The patient is deficient in iron.
5- Red blood cell function is normal.
6- Red blood cells are large and of vari-
ous shapes
ANS 1, 2, 4, 5
A patient who is being treated for
iron-deficiency anemia is prescribed fer-
f Vitamin C promotes absorption of iron,
rous sulfate tablets. The teaching plan
so the iron may be taken with orange
for this patient should include which of
juice if desired. Coffee and tea interfere
these instructions? Select all that apply.
with absorption.
f The patient should be advised their
stools may turn dark green or black.
1- "Your stools may turn dark green or
f Oral ferrous sulfate often causes consti-
black, but this is harmless."
pation, so the diet should include fiber.
2- "Be sure to keep your iron pills out of
f Stomach upset often occurs when tak-
the reach of young children."
ing iron, but iron should not be taken with
3- "You should eat a low fiber diet when
antacids because this will reduce iron
you are taking this medication."
absorption. Ideally iron should be taken
21 / 26
on an empty stomach, but if gastric upset
4- "Avoid taking this medication with cof-
occurs the iron may be taken with food.
fee."
f Accidental overdose of iron-containing
5- "You should take this medication be-
products is a leading cause of fatal poi-
tween meals on an empty stomach."
soning in young children.
6- "Taking the medication with an antacid
will decrease stomach irritation."
ANS 1, 2, 4
A patient is being evaluated for iron-defi-
ciency anemia. Which of these laborato-
f The red blood cells of a patient with
ry results would the healthcare provider
iron-deficiency anemia tend to be small
expect? Select all that apply.
and pale.
f Ferritin is an iron-storage protein that
will be decreased in iron-deficiency ane-
1- Decreased serum ferritin
mia.
2- Decreased hematocrit
f An increase in the TIBC is an indication
3- Increased mean corpuscular volume
that transferrin (an iron transport protein)
(MCV)
is carrying less iron because less iron is
4- Increased total iron binding capacity
available
(TIBC)
5- Increased hemoglobin
1- with renal failure on hemodialysis.
f A true vegan may be at risk for certain

types of anemia, but a vegetarian diet
The healthcare provider is planning care
can include the appropriate nutrients to
for four patients. Which patient is most in
prevent anemia.
need of interventions aimed at prevent-
f If assessment of the Jackson-Pratt drain
ing anemia? The patient:
shows hemorrhage, anemia can occur;
Choose 1 answer:
however this patient is not most at risk
for anemia.
1- with renal failure on hemodialysis.
f Because of decreased erythropoietin,
2- who is a vegetarian.
renal failure causes fewer red blood cells
3- who has been NPO for 3 days.
produced. Hemodialysis can cause he-
4- with a Jackson-Pratt drain.
molysis, so this patient is at highest risk
for anemia.
22 / 26
ANS 3, 5
f In aplastic anemia, the bone marrow

A child is admitted to the hospital with does not produce sufficient numbers of
a diagnosis of aplastic anemia. When circulating hematopoietic cells.
planning care for this patient, which of f The healthcare provider will want to im-
the following interventions is appropri- plement care aimed at decreasing com-
ate? plications related to bone marrow failure.
Choose all answers that apply: f Poor tissue oxygenation may cause the
child to be easily fatigued, so balancing
1- Administering chelating agents, as or- rest and activity is helpful. Because of
dered. immunodeficiency, pet therapy for this
2- Coordinating pet therapy for the child. patient is not indicated.
3- Promoting a balance of rest and activ- f In the early stages of the disease,
ity. administration of hematopoietic growth
4- Encouraging intake of foods high in factors may be beneficial. Iron overload
iron. may develop from multiple blood trans-
5- Administering hematopoietic growth fusions, so chelating agents (drugs that
factors, as ordered. bind with iron so it can be excreted) can
reduce iron overload.

ANS 1, 2, 3, 5
A patient with alcoholic liver disease has
severe anemia. Which of the following
f Alcoholics are prone to gastric ulcers
explains the development of anemia in
which can bleed, increasing risk for ane-
this particular patient?
mia.
f A decrease in clotting factors increases
the patient's risk for bleeding, which may
1- Alcoholics are often deficient in folate.
lead to anemia.
2- Gastric ulcers may lead to chronic
f Deficient folate impairs the production
blood loss.
of functional red blood cells. Alcohol
3- Alcohol suppresses erythropoiesis.
also directly suppresses hematopoiesis,
4- Alcohol causes inflammation, which
leading to decreased erythrocytes. Both
leads to anemia.
of these increase the risk of anemia.
5- Liver dysfunction leads to decreased
clotting factors.
23 / 26
4- Continue to monitor the patient.
On the second postoperative day, the
f If the patient is experiencing increased
healthcare provider notes the patient's
bleeding, the hemoglobin and hemat-
hemoglobin has remained steady but the
ocrit would decrease together.
hematocrit has decreased from 48%to
f One of the ways the body reacts to
46%. Which intervention is most appro-
the stress of surgery is by activating
priate for the healthcare provider to im-
the renal-angiotensin-aldosterone sys-
plement?
tem (RAAS).
Choose 1 answer:
f The healthcare provider should con-
tinue to monitor the patient, as this is
1- Increase the IV flow rate.
an expected response. Aldosterone and
2- Check the surgical site for increased
vasopressin will cause fluid retention
bleeding.
and hemodilution, thereby decreasing
3- Administer oxygen at 2 L/minute.
the hematocrit.
4- Continue to monitor the patient.
1- Intestines
Most of the iron absorbed in the body

stays in place and there is not a great
deal of iron turnover. Some is lost
Which organ regulates the body's iron through the gastrointestinal (GI) tract,
stores? and much more can be lost through he-
morrhage. The body prevents excessive
1- Intestines buildup of iron by controlling the amount
2- Kidneys of uptake in the intestines. When stores
3- Liver are high, only about 2% to 3% of dietary
4- Bloodstream iron is absorbed. Conversely, when iron
levels are low, as much as 20% is ab-
sorbed.
Lehne's Pharmacology for Nursing Care,

10th Edition
The nurse is administering iron dextran
1- Ensure that epinephrine is available
(INFeD) by intravenous (IV) infusion to a
as needed.
patient with iron deficiency. Which is the
priority nursing action during the admin-
24 / 26
istration of this drug?
An anaphylactic reaction is the most se-
1- Ensure that epinephrine is available rious potential adverse reaction to iron
as needed. dextran administration. Epinephrine and
2- Assess the lung sounds and respira- resuscitation equipment should be read-
tory rate. ily available
3- Monitor the blood urea nitrogen and
creatinine levels. Lehne's Pharmacology for Nursing Care,
4- Use Y-connector tubing to connect to 10th Edition
the primary line.
2- An intravenous test dose of 25 mg
over 5 minutes must be administered.
To reduce the risk of a fatal anaphylac-

Which is the priority nursing intervention
tic reaction to parenteral iron dextran,
for a patient receiving parenteral iron
each full dose should be preceded by
dextran (INFeD) infusion?
a small test dose of 25 mg given in-
travenously over 5 minutes. Iron dex-
1- The medication must be administered
tran should not be administered sub-
by deep subcutaneous injection.
cutaneously. It can be administered by
2- An intravenous test dose of 25 mg
deep intramuscular injection using the
over 5 minutes must be administered.
Z-track technique to prevent leakage and
3- Erythropoietin must also be given
surface discoloration. Sodium-ferric glu-
when a patient is receiving parenteral
conate complex [Ferrlecit], not iron dex-
iron dextran.
tran, is always used in conjunction with
4- After administration of a test dose of
erythropoietin. If the test dose of iron
intramuscular (IM) iron dextran, the pa-
dextran is administered IM, the patient
tient must be observed for 15 minutes
must be observed for 1 hour before the
before the full therapeutic dose is given.
full dose is administered.

10th Edition
4- Potassium
A patient is receiving cyanocobalamin
for the treatment of pernicious anemia. Potassium depletion (hypokalemia) may
Which electrolyte should the nurse mon- occur as a natural consequence of ery-
itor as a result of this treatment? throcyte production. Because erythro-
cytes incorporate significant amounts of
25 / 26
potassium and a large number of ery-
throcytes are being produced, potassi-
1- Sodium um levels may fall. The other electrolytes
2- Calcium are not affected.
3- Chloride
4- Potassium Lehne's Pharmacology for Nursing Care,
10th Edition
The nurse is caring for a patient receiv-
ANS 1, 2, 4, 5
ing vitamin B12 because of a deficiency.
What are common causes of this defi-
Vitamin B12 is needed in very small
ciency? (Select all that apply.)
amounts in the diet. Dietary insufficien-
cy is rarely the cause of a deficiency.
1- Regional enteritis and malabsorption
The other options are common potential
2- Celiac disease
causes of this problem.
3- Decreased intake of foods with vita-
min B12
4- Advancing age
10th Edition
5- Use of drugs that lower stomach acid
26 / 26
Hematologic System nclex questions
Study online at https://quizlet.com/_15rjpv
A client is scheduled for a bone marrow

aspiration. What does the client's nurse
4. Verifying informed consent must be
do before taking the client to the treat-
done before the procedure can be per-
ment room for the biopsy?
formed. A signed permit must be on the
1. Cleans the biopsy site with an antisep-
client's chart. Cleaning the biopsy site is
tic or povidone-iodine (Betadine)
done before the procedure but is not the
2. Holds the client's hand and asks about
first thing that should be done. It is not
concerns
done until consent is verified. It will be
3. Reviews the client's platelet (thrombo-
done just before the procedure is per-
cyte) count
formed.
4. Verifies that the client has given in-
formed consent
A nurse is assessing an adult client's en- 3. This question from Gordon's Func-
durance in performing ADLs. What ques- tional Health Pattern Assessment is an
tion does the nurse ask the client? activity exercise question that correct-
1."Can you prepare your own meals?" ly assesses endurance compared with
2."Has your weight changed by 5 pounds self-assessment in the past. It is most
or more this year?" likely to provide data about the client's
3."How is your energy level-compared ability and endurance with ADLs. The
with last year?" client may never have been able to pre-
4."What medications do you take daily, pare his or her own meals. This question
weekly, monthly?" does not really address endurance.
A nurse is assessing a client for hema-
tologic function risks. The nurse seeks
to determine whether there is a risk that
cannot be reduced or eliminated. Which 2. An accurate family history is impor-
clinical health history question does the tant because many disorders that affect
nurse ask to obtain this information? blood and blood clotting are inherited.
1."Do you seem to have excessive Genetics cannot be changed. Excessive
bleeding or bruising?" bleeding or bruising is a symptom, not a
2. "Does anyone in your family bleed a risk.
lot?"
3. "Tell me what you eat in a day."
4. "Where do you work?"
2. This description is accurate. Proper
expectations minimize the client's fear
during the procedure. A very large-bore
needle is used for a bone marrow biopsy,
1 / 12
not a small needle. The puncture is made
A nurse is teaching a client about what
in the hip or in the sternum, not the back.
to expect during a bone marrow biopsy.
The nurse, or sometimes a family mem-
Which statement by the nurse accurately
ber, is available to the client for support
describes the procedure?
during a bone marrow biopsy. The pro-
1. "The doctor will place a small needle in
cedure is sterile at the site of the biopsy,
your back and will withdraw some fluid."
but others can be present without cont-
2. "You may experience a crunching
amination at the site. A local anesthetic
sound or a scraping sensation as the
agent is injected into the skin around
needle punctures your bone."
the site. The client may also receive a
3. "You will be alone because the proce-
mild tranquilizer or a rapid-acting seda-
dure is a sterile one; we cannot allow ad-
tive (such as lorazepam [Ativan]) but will
ditional people to contaminate the area."
not be completely sedated. Clients are
4. "You will be sedated, so you will not be
aware of what is happening during the
aware of anything."
procedure.
A client with anemia asks, "Why am I
feeling tired all the time?" How does the
nurse respond?
4. The single most common symptom of
1. "How many hours are you sleeping at
anemia is fatigue. This problem occurs
night?"
because oxygen delivery to cells is less
2. "You are not getting enough iron."
than is required to meet normal oxygen
3. "You need to rest more when you are
needs.
sick."
4. "Your cells are delivering less oxygen
than you need."
A client with anemia asks the nurse, "Do
most people have the same number of
red blood cells?" How does the nurse
respond? 2. This is the most educational and rea-
1."No, they don't." sonable response to the client's ques-
2. "The number varies with gender, age, tion. the first option is true, but not infor-
and general health." mative.
3. "Yes, they do."
4. "You have fewer red blood cells be-
cause you have anemia."'
2. Platelet counts do not generally
A nurse is reviewing complete blood
change with age. Hemoglobin levels in
count (CBC) data for a 76-year-old client.
men and women fall after middle age.
2 / 12
Iron-deficient diets may play a role in
Which decreased value causes concern
this reduction. Total red blood cell (RBC)
because it is not age related?
and white blood cell (WBC) counts (es-
1.Hemoglobin (Hgb) level
pecially lymphocyte counts) are lower in
2. Platelet (thrombocyte) count
older adults. The WBC count does not
3. Red blood cell (RBC) count
rise as high in response to infection in
4. White blood cell (WBC) response
older adults as it does in younger people.
A client with a low platelet count asks
why platelets are important. How does
3. Platelets begin the blood clotting
the nurse answer?
process by forming platelet plugs, but
1."Platelets make blood clots for you."
these platelet plugs are not clots and
2. "Blood clotting is prevented by your
cannot provide complete hemostasis.
platelets."
Platelets do not clot blood. They are a
3. "The clotting process begins with your
part of the clotting process or cascade of
platelets."
coagulation.
4. "Your platelets finish the clotting
process."
2. An elevated reticulocyte count in the
anemic client indicates that the bone
marrow is responding appropriately to
A newly admitted client has an elevated
a decrease in the total red blood cell
reticulocyte count. Which disorder does
(RBC) mass and is prematurely destroy-
the nurse suspect in this client?
ing red blood cells. Therefore more im-
1. Aplastic anemia
mature RBCs are in circulation. Aplastic
2. Hemolytic anemia
anemia is associated with a low reticulo-
3. Infectious process
cyte count. A high white blood cell count
4. Leukemia
is expected in clients with infection, while
a low WBC is expected in clients with
leukemia
A client on anticoagulant therapy is be- 3. Anticoagulants work by interfering with
ing discharged. Which statement indi- one or more steps involved in the blood
cates that the client has a correct un- clotting cascade. Thus, these agents pre-
derstanding of this therapy's purpose or vent new clots from forming and limit or
action? prevent extension of formed clots. Anti-
1. "It is to dissolve blood clots." coagulants do not cause any change in
2. "It might cause me to get injured more the thickness or viscosity of the blood.
often." Anticoagulants do not cause more in-
3. "It should prevent my blood from clot- juries but may cause more bleeding and
3 / 12
bruising when someone is injured. Anti-
ting."
coagulants do not dissolve clots, rather
4. "It will thin my blood."
fibrinolytics do.
1. Removal of the spleen causes the
client to have reduced immune function.
Without a spleen, people are less able
A nurse is caring for a group of hospi-
to remove disease-causing organisms.
talized clients. Which client is at greatest
Sickle cell anemia causes pain and dis-
risk for infection and sepsis?
comfort owing to the changed cell mor-
1. 18-year-old who had an emergency
phology. Acute pain, especially at joints,
splenectomy
is the greatest threat to this client. A
2. 22-year-old with recently diagnosed
low red blood cell (RBC) count can con-
sickle cell anemia
tribute to a client's risk for infection, but
3. 38-year-old with hemolytic anemia
this client is more at risk for low oxy-
4. 40-year-old alcoholic with liver dis-
gen levels and ensuing fatigue.The liver
ease
plays a role in blood coagulation. This
client is more at risk for coagulation prob-
lems than for infection.
A nurse is assessing the nutritional sta-
tus of a client with anemia. How does 4. This method is the most accurate way
the nurse obtain information about the to find out what the client likes and dis-
client's diet? likes, as well as what the client has been
1.Asks the client to rate his or her diet on eating. It will provide information about
a scale of 1 (poor) to 10 (excellent) "junk" food intake, as well as about the
2. Determines who prepares the client's client's protein, vitamin, and mineral in-
meals and plans an interview with him or take. the third option method of dietary
her analysis provides a list of what the client
3. From a prepared list, finds out the enjoys eating, not necessarily what the
client's food preferences client has been eating. The client may
4. Has the client write down everything like steak but may be unable to afford it.
he or she has eaten for the past week
A clinic nurse is discharging a 3. Ice to the site will help limit bruis-
20-year-old client who had a bone mar- ing and tissue damage during the first
row aspiration performed. What does the 24 hours postprocedure. Contact sports
nurse advise the client to do? and traumatic activity needs to be ex-
1. "Avoid contact sports or activity that cluded for 48 hours, or 2 days.The site
may traumatize the site for 24 hours." should be carefully monitored by the
2. "Inspect the site for bleeding every 4 client every 2 hours for the first 24 hours
4 / 12
to 6 hours."
following the procedure.A mild analgesic
3. "Place an ice pack over the site to
is appropriate, but it should be aspirin
reduce the bruising."
free. Acetaminophen (Tylenol) would be
4. "Take a mild analgesic, such as 2 as-
a good choice.
pirin, for pain or discomfort at the site."
3. This client has a chronic condition
Which client does the medical unit that is not considered life threatening.
charge nurse assign to an LPN/LVN? A bone marrow biopsy with conscious
1.23-year-old scheduled for a bone mar- sedation requires more complex assess-
row biopsy with conscious sedation ment or nursing care and should be as-
2. 35-year-old with a history of a splenec- signed to RN staff members. A history
tomy and a temperature of 100.9° F of a splenectomy and a temperature re-
(38.3° C) quire more complex assessment or nurs-
3. 48-year-old with chronic microcytic ing care and should be assigned to RN
anemia associated with alcohol use staff members. Atrial fibrillation and an
4. 62-year-old man with atrial fibrilla- international normalized ratio (INR) of
tion and an international normalized ra- 6.6 require more complex assessment or
tio (INR) of 6.6 nursing care and should be assigned to
RN staff members.
Which action does the RN delegate to
unlicensed assistive personnel (UAP)?
4. Reporting findings during routine care
1. Drawing a partial thromboplastin time
is expected and required of unlicensed
(PTT) from a saline lock on a client with
staff members. Drawing a partial throm-
a pulmonary embolism
boplastin time is more complex and
2. Performing a capillary fragility test to
should be done by licensed nursing staff.
check vascular hemostatic function on a
Performing a capillary fragility test is
client with liver failure
more complex and should be done by
3. Referring for counseling a client with a
licensed nursing staff. Referring a client
daily alcohol consumption of 12 beers a
for alcohol counseling is more complex
day
and should be done by licensed nursing
4. Reporting any bleeding noted when
staff.
catheter care is given to a client with a
history of hemophilia
A nurse is starting the shift by making
rounds. Which client does the nurse de- 4. This client may be experiencing the
cide to assess first? bleeding as a result of excessive antico-
1.42-year-old with anemia who is report- agulation and should be assessed for the
ing shortness of breath when ambulating
5 / 12
down the hallway
2. 47-year-old who recently had a severity of the situation before the other
Rumpel-Leede test and is requesting a clients, whose conditions are stable, are
nurse to "look at the bruises on my arm" assessed. regarding option number 3,
3. 52-year-old who has just had a bone Making clients wait for pain medication
marrow aspiration and is requesting pain is not desirable, but in this scenario, the
medication client who is bleeding is the higher pri-
4. 59-year old who has a nosebleed and ority. This client should be next on the
is receiving heparin to treat a pulmonary nurse's "to do" list.
embolism
After reviewing the laboratory test re-
sults, the nurse calls the health care
provider about which client? 2. This client is neutropenic and is at risk
1.44-year-old receiving warfarin for sepsis unless interventions such as
(Coumadin) with an international nor- medications to improve WBC level and
malized ratio (INR) of 3.0 antibiotics are prescribed. The INR of 3.0
2. 46-year-old with a fever and a white indicates a therapeutic Coumadin level.
blood cell (WBC) count of 500/µl This platelet count is normal. An elevated
3. 49-year-old with hemophilia and a reticulocyte count is expected after hem-
platelet count of 150,000/mm3 orrhage.
4. 52-year-old who has had a hemor-
rhage with a reticulocyte count of 0.8%
3. Assessment of respiratory rate before
and after ambulation is within the scope
Which nursing action does the RN del- of practice for UAP. UAP will report this
egate to unlicensed assistive personnel information to the RN.
(UAP) who are assisting with the care of Asking the client about the amount of
a female client with anemia? blood loss with each menstrual period
1. Asking the client about the amount of requires skilled assessment techniques
blood loss with each menstrual period and knowledge of normal parameters
2. Checking for sternal tenderness while and should be done by the RN. Checking
applying fingertip pressure for sternal tenderness requires skilled
3. Determining the respiratory rate be- assessment techniques and knowledge
fore and after the client walks 20 feet of normal parameters and should be
4. Monitoring her oral mucosa for pallor, done by the RN. Monitoring of oral mu-
bleeding, or ulceration cosa requires skilled assessment tech-
niques and knowledge of normal para-
meters and should be done by the RN.
6 / 12
A client has a bone marrow biopsy done. 1. The initial action should be to stop
Which nursing intervention is the priority bleeding by applying pressure to the site.
postprocedure? Inspecting for ecchymoses will be done
1.Applying pressure to the biopsy site after hemostasis has been achieved.
2. Inspecting the site for ecchymoses Sending specimens to the laboratory
3. Sending the biopsy specimens to the will be done after hemostasis has been
laboratory achieved. Teaching the client about ac-
4. Teaching the client about avoiding vig- tivity levels will be done after hemostasis
orous activity has been achieved.
A. Any changes in the skin's texture
When assessing a patient's nutrition-
or color should be explored when as-
al-metabolic pattern related to hemato-
sessing the patient's nutritional-metabol-
logic health, the nurse would:
ic pattern related to hematologic health.
A. Insepct the skin for petechiae
The presence of petechiae or ecchymot-
B. ask about joint pain
ic areas could be indicative of hemato-
C. assess for Vit C deficiency
logic deficiencies related to poor nutri-
D. Determine if the pt can perform ADLs
tional intake or related causes.
D. When infections are severe, such as
in septicemia, more granulocytes are
When assessing lab values on a pa-
released from the bone marrow as a
tient admitted with septicemia, the nurse
compensatory mechanism. To meet the
would expect to find
increased demand, many young, im-
A. Increased platelets.
mature polymorphonuclear neutrophils
B. Decreased red blood cells.
(bands) are released into circulation.
C. Decreased erythrocyte sedimentation
WBCs are usually reported in order of
rate (ESR).
maturity, with the less mature forms on
D. Increased bands in the white blood
the left side of a written report. Hence,
cell (WBC) differential (shift to the left).
the term "shift to the left" is used to de-
note an increase in the number of bands.
Results of a patient's most recent blood
work indicate an elevated neutrophil lev-
B. An increase in neutrophil count most
el. You recognize that this diagnostic
commonly occurs in response to infec-
finding most likely suggests:
tion or inflammation. Hypoxemia and co-
A. Hypoxemia
agulation do not directly affect neutrophil
B. an infection
production.
C. risk of hypocoagulation
D. an acute thrombotic event
7 / 12
A 30-year-old patient has undergone a
splenectomy as a result of injuries suf- B., E.: Splenectomy can result in in-
fered in a motor vehicle accident. Which creased platelet levels and impaired im-
of the following phenomena is likely to munologic function as a consequence
result from the absence of the patient's of the loss of storage and immunologic
spleen (select all that apply)? functions of the spleen. Fibrinolysis, fa-
Impaired fibrinolysis tigue, and cold intolerance are less likely
Increased platelet levels to result from the loss of the spleen since
Increased eosinophil levels coagulation and oxygenation are not pri-
Fatigue and cold intolerance mary responsibilities of the spleen
Impaired immunologic function
You are providing care for older adults
on a subacute, geriatric medicine unit.
Which of the following effects is aging B. An individual with type A blood has A
likely to have on hematologic function of antigens, not A antibodies, on his RBCs.
older adults? An AB transfusion would result in agglu-
A. Hypercoagulability tination, but he may be transfused with
B. decreased hemoglobin either type A or type O.
C. decreased blood volume
D. decreased WBC count
When caring for a patient with
metastatic cancer, the nurse notes a he-
B. The patient with a low hemoglobin
moglobin level of 8.7 g/dl and hematocrit
and hematocrit is anemic and would be
of 26%. The nurse would place highest
most likely to experience fatigue. Fatigue
priority on initiating interventions that will
develops because of the lowered oxy-
reduce which of the following?
gen-carrying capacity that leads to re-
A. thirst
duced tissue oxygenation to carry out
B. fatigue
cellular functions.
C. headache
D. abdominal pain
The nurse is caring for a patient who is
to receive a transfusion of two units of
D. Before hanging a transfusion, the reg-
packed red blood cells. After obtaining
istered nurse must check the unit with
the first unit from the blood bank, the
another RN or with a licensed practical
nurse would ask which of the following
(vocational) nurse, depending on agency
health team members in the nurses' sta-
policy.
tion to assist in checking the unit before
administration?
8 / 12
A. unit secretary
B. a phlebotomist
C. a physician's assistant
D. another RN
Before starting a transfusion of packed
red blood cells for an anemic patient, the
B. As part of standard procedure, the
nurse would arrange for a peer to mon-
nurse remains with the patient for the first
itor his or her other assigned patients
15 minutes after starting a blood trans-
for how many minutes when the nurse
fusion. Patients who are likely to have a
begins the transfusion?
transfusion reaction will more often ex-
A. 5
hibit signs within the first 15 minutes that
B. 15
the blood is infusing.
C. 30
D. 60
When preparing to administer an or-
dered blood transfusion, the nurse se- C. The blood set should be primed before
lects which of the following intravenous the transfusion with 0.9% sodium chlo-
solutions to use when priming the blood ride, also known as normal saline. It is
tubing? also used to flush the blood tubing after
A. Lactated Ringer's the infusion is complete to ensure the
B. 5% Dextrose in water patient receives blood that is left in the
C. 0.9% NaCl tubing when the bag is empty.
D. 0.45% NaCl
The nurse notes a physician's order writ-
ten at 10:00 am for two units of packed
red blood cells to be administered to
a patient who is anemic as a result of
chronic blood loss. If the transfusion is
B. noon. The nurse must hang the unit of
picked up at 11:30 am, the nurse should
packed red blood cells within 30 minutes
plan to hang the unit no later than which
of signing them out from the blood bank.
of the following times?
A. 11:45 am
B. 12:00 noon
C. 12:30 pm
D. 15:30 pm
The nurse receives a physician's order
to transfuse fresh frozen plasma to a pa-
tient suffering from an acute blood loss.
9 / 12
Which of the following procedures is
most appropriate for infusing this blood
product? A. The fresh frozen plasma should be
A. Infuse the fresh frozen plasma as administered as rapidly as possible and
rapidly as the patient will tolerate. should be used within 2 hours of thaw-
B. Hang the fresh frozen plasma as a ing. Fresh frozen plasma is infused using
piggyback to the primary IV solution. any straight-line infusion set. Any exist-
C. Infuse the fresh frozen plasma as a ing IV should be interrupted while the
piggyback to a primary solution of nor- fresh frozen plasma is infused, unless a
mal saline. second IV line has been started for the
D. Hang the fresh frozen plasma as a transfusion.
piggyback to a new bag of primary IV
solution without KCl.
Before beginning a transfusion of RBCs,
which of the following actions by the
nurse would be of highest priority to
avoid an error during this procedure?
A. The patient's identifying information
A. Check the identifying information on
(name, date of birth, medical record
the unit of blood against the patient's ID
number) on the ID bracelet should ex-
bracelet.
actly match the information on the blood
B. Select new primary IV tubing primed
bank tag that has been placed on the
with lactated Ringer's solution to use for
unit of blood. If any information does not
the transfusion.
match, the transfusions should not be
C. Remain with the patient for 60 minutes
hung because of possible error and risk
after beginning the transfusion to watch
to the patient.
for signs of a transfusion reaction.
D. Add the blood transfusion as a sec-
ondary line to the existing IV and use the
IV controller to maintain correct flow.
The blood bank notifies the nurse that
the two units of blood ordered for an
anemic patient are ready for pick up. The B. Because a transfusion reaction is
nurse should take which of the following more likely to occur at the beginning of
actions to prevent an adverse effect dur- a transfusion, the nurse should initially
ing this procedure? infuse the blood at a rate no faster than
A. Immediately pick up both units of 2 ml/min and remain with the patient for
blood from the blood bank.
B. Correct Infuse the blood slowly for the
10 / 12
first 15 minutes of the transfusion.
C. Regulate the flow rate so that each
unit takes at least 4 hours to transfuse. the first 15 minutes after hanging a unit
D. Set up the Y-tubing of the blood set of blood.
with dextrose in water as the flush solu-
tion.
Which of the following patients is most
likely to experience anemia with an etiol-
ogy of increased destruction of red blood
cells?
A. An African American man who has a A. The etiology of sickle cell ane-
diagnosis of sickle cell disease mia involves increased hemolysis. Tha-
B. A 59-year-old man whose alcoholism lassemias and folic acid deficiencies
has precipitated folic acid deficiency cause a decrease in erythropoiesis
C. A 30-year-old woman with a history whereas the anemia surrounding men-
of "heavy periods" accompanied by ane- struation is a direct result of blood loss.
mia
D. A 3-year-old child whose impaired
growth and development is attributable
to thalassemia
Caring for a patient with a diagnosis of
B. Primary polycythemia may often re-
polycythemia vera will likely require the
quire phlebotomy in order to reduce
nurse to
blood volume. The increased risk of
A. Encourage deep-breathing and
thrombus formation that accompanies
coughing.
the disease requires regular exercis-
B. Assist with or perform phlebotomy at
es and ambulation. Deep-breathing and
the bedside.
coughing exercises do not directly ad-
C. Teach the patient how to maintain a
dress the etiology or common sequelae
low-activity lifestyle.
of polycythemia, and neurologic mani-
D. Perform thorough and regularly
festations are not typical.
scheduled neurologic assessments.
Which of the following nursing interven-
tions should the nurse prioritize in the C. Common treatment modalities for ITP
care of a 30-year-old woman who has a include corticosteroid therapy to sup-
diagnosis of immune thrombocytopenic press the phagocytic response of splenic
purpura (ITP)? macrophages. Blood transfusions, ad-
A. Administration of packed red blood ministration of clotting factors, and re-
cells
11 / 12
B. Administration of clotting factors VIII
and IX
verse isolation are not interventions that
C. Administration of oral or intravenous
are indicated in the care of patients with
corticosteroids
ITP.
D. Maintenance of reverse isolation and
application of standard precautions
A patient with a diagnosis of hemophil-
ia had a fall down an escalator earli-
er in the day and is now experiencing
bleeding in her left knee joint. The emer-
B. In patients with hemophilia, joint
gency nurse's immediate response to
bleeding requires resting of the joint
this should include
in order to prevent deformities from
hemarthrosis. Clotting factors, not
A. Immediate transfusion of platelets.
platelets or steroids, are administered.
B. Resting the patient's knee to prevent
Thrombus formation is not a central con-
hemarthroses.
cern in a patient with hemophilia.
C. Assistance with intracapsular injec-
tion of corticosteroids.
D. Range-of-motion exercises to prevent
thrombus formation.
12 / 12
Hematology NCLEX questions
Study online at https://quizlet.com/_1r6w6z
What intervention most effectively pro-

tects a client with thrombocytopenia?
Correct answer B
A. Avoiding the use of dentures The client should be advised to use an
B. Encouraging the use of an electric electric shaver instead of a razor. Any
shaver small cuts or nicks can cause problems
C. Taking rectal temperatures because of the prolonged clotting time.
D. Using warm compresses on trauma
sites
A client with leukemia is being dis-
charged from the hospital. After hear-
ing a nurse's instructions to keep reg-
ularly scheduled follow-up provider ap-
pointments, the client says, "I don't have
Correct answer C
transportation." How does the nurse re-
Many local units of the American Can-
spond?
cer Society offer free transportation to
clients with cancer, including those with
A. "A pharmaceutical company might be
leukemia.
able to help."
B. "I might be able to take you."
C. "The local American Cancer Society
may be able to help."
D. "You can take the bus."
Which client statement indicates that
stem cell transplantation that is sched-
uled to take place in his home is not a Correct answer B
viable option? Stem cell transplantation in the home
setting requires support, assistance, and
A. "I don't feel strong enough, but my wife coordination from others. The client can-
said she would help." not manage this type of care on his own.
B. "I was a nurse, so I can take care of The client must be emotionally stable to
myself." be a candidate for this type of care.
C. "I will have lots of medicine to take."
D. "We live 5 miles from the hospital."
A client who has been newly diagnosed
with leukemia is admitted to the hospital.
Avoiding which potential problem takes
priority in the client's nursing care plan?
1/6
Correct answer D
A. Fluid overload (overhydration)
The main objective in caring for a newly
B. Hemorrhage
diagnosed client with leukemia is protec-
C. Hypoxia
tion from infection.
D. Infection
A client with thrombocytopenia is being
discharged. What information does the
nurse incorporate into the teaching plan
for this client? Correct answer D
Using a soft-bristled toothbrush reduces
A. "Avoid large crowds." the risk for bleeding in the client with
B. "Drink at least 2 liters of fluid per day." thrombocytopenia.
C. "Elevate your lower extremities when
sitting."
D. "Use a soft-bristled toothbrush."
A distant family member arrives to vis-
it a female client recently diagnosed Correct answers A,B,D
with leukemia. The family member asks, A. This is a broad general opening and
"What should I say to her?" Which re- would be nonthreatening to the client.
sponses does the nurse suggest? Select B. This is a therapeutic communication of
all that apply. offering self and would be considered to
be therapeutic and helpful to the client.
A. "Ask her how she is feeling." D. There is no need to act differently
B. "Ask her if she needs anything." with the client. If she wants to offer her
C. "Tell her to be brave and to not cry." feelings, keeping a normal atmosphere
D. "Talk to her as you normally would facilitates that option. Acting as if things
when you haven't seen her for a long are "different" because she has cancer
time." takes the control of the situation from the
E. "Tell her what you know about client.
leukemia."
A nurse is teaching a client about induc-
tion therapy for acute leukemia. Which
client statement indicates a need for ad-
Correct answer A
ditional education?
Induction therapy is not a cure for
leukemia, it is a treatment.
A. "After this therapy, I will not need to
have any more."
B. "I will need to avoid people with a cold
2/6
or flu."
C. "I will probably lose my hair during this
therapy."
D. "The goal of this therapy is to put me
in remission."
A client with multiple myeloma reports
bone pain that is unrelieved by anal-
gesics. How does the nurse respond to
this client's problem? Correct answer D
Because most clients with multiple
A. "Ask your doctor to prescribe more myeloma have local or generalized bone
medication." pain, analgesics and alternative ap-
B. "It is too soon for additional medica- proaches for pain management, such as
tion to be given." relaxation techniques, are used for pain
C. "I'll turn on some soothing classical relief. This also offers the client a choice.
music for you."
D. "Would you like to try some relaxation
techniques?"
Correct answers A,B,C,D
A. Reduced production of blood cells in
the bone marrow is one of the risk factors
What are the risk factors for the develop- for developing leukemia.
ment of leukemia? Select all that apply. B. Exposure to chemicals through med-
ical need or by environmental events
A. Bone marrow hypoplasia contributes to the development of
B. Chemical exposure leukemia.
C. Down syndrome C. Certain genetic factors contribute to
D. Ionizing radiation the development of leukemia. Down syn-
E. Multiple blood transfusions drome is one such condition.
F. Prematurity at birth D. Radiation therapy for cancer or other
exposure to radiation, perhaps through
the environment, contributes to the de-
velopment of leukemia.
A nurse is caring for a client with neu-
tropenia. Which clinical manifestation in-
Correct answer D
dicates that an infection is present or
Wheezes or crackles in the neutropenic
should be ruled out?
3/6
A. Coughing and deep breathing
B. Evidence of pus client may be the first symptom of infec-
C. Fever of 102 F or higher tion in the lungs.
D. Wheezes or crackles
A nurse is caring for a client with neu-
tropenia who has a suspected infection.
Which intervention does the nurse im-
plement first?
Correct answer C
A. Hydrates the client with 1000 mL of IV Obtaining cultures to identify the infec-
normal saline tious agent correctly is the priority for this
B. Initiates the administration of pre- client.
scribed antibiotics
C. Obtains requested cultures
D. Places the client on Bleeding Precau-
tions
A nurse is assessing a newly admitted
client with thrombocytopenia. Which fac-
tor needs immediate intervention? Correct answer A
The client with thrombocytopenia has
A. A nosebleed a high risk for bleeding. The nosebleed
B. Reports of pain should be attended to immediately.
C. Decreased urine output
D. Increased temperature
A nurse is infusing platelets to a client
who is scheduled for a hematopoietic
stem cell transplant (HSCT). What pro-
cedure does the nurse follow?
Correct answer C
A. Administers intravenous (IV) corticos-
The volume of platelets-200 or 300 mL
teroids before starting the transfusion
(standard amount)-needs to be infused
B. Allows the platelets to stabilize at the
rapidly-over a 15- to 30-minute period.
client's bedside for 30 minutes
C. Infuses the transfusion over a 15- to
30-minute period
D. Sets up the infusion with the standard
transfusion "Y" tubing.
4/6
The client is a 56-year-old man admit-
ted with a diagnosis of acute myeloge-
nous leukemia (AML). He is prescribed
Correct answer A
IV cytosine arabinoside for 7 days and
This is a commonly prescribed course
an infusion of daunorubicin for the first 3
of aggressive chemotherapy, and bone
days. What is the major side effect of this
marrow suppression is a major side ef-
therapy?
fect. The client is even more at risk for
infection than before treatment was be-
A. Bone marrow suppression
gun.
B. Liver toxicity
C. Nausea
D. Stomatitis
The client is a 56-year-old man admit-
ted with a diagnosis of acute myeloge-
nous leukemia (AML). He is prescribed
IV cytosine arabinoside for 7 days and
an infusion of daunorubicin for the first
3 days. He develops an infection. What
knowledge does the nurse use to deter-
mine that the appropriate antibiotic has Correct answer C
been prescribed for this client? Drug therapy is the main defense against
infections that develop in clients under-
A. Evaluating the client's liver function going therapy for AML. Agents used de-
tests (LFTs) and serum creatinine levels pend on the client's sensitivity to various
B. Evaluating the client's white blood cell antibiotics for the organism causing the
(WBC) count level infection.
C. Checking the culture and sensitivity
test results to be certain that the request-
ed antibiotic is effective against the or-
ganism causing the infection
D. Recognizing that vancomycin (Van-
cocin) is the drug of choice used to treat
all infections in clients with AML
A 56-year-old man is admitted with a di-
agnosis of acute myelogenous leukemia
(AML). He is prescribed IV cytosine ara-
binoside for 7 days and an infusion of
daunorubicin for the first 3 days. He is
5/6
started on an antiviral agent. What are
serious side effects of antiviral agents?
Correct answers B,C
Antiviral agents, although helpful in com-
bating severe infection, have serious
A. Cardiomyopathy
side effects, especially nephrotoxicity
B. Nephrotoxicity
and ototoxicity.
C. Ototoxicity
D. Stroke
6/6
Study online at https://quizlet.com/_6wbxy9
1. A nurse in a clinic is caring for a A. An iron level of 90 mcg/dL is within the

client who has suspected ane- expected reference
mia. Which of the following lab- range and is not an expected finding of
oratory test results should the anemia.
nurse expect? B. RBC count of 6.5 million/uL is above the
A. Iron 90 mcg/dL expected reference
B. RBC 6.5 million/uL range. A decreased RBC count is an ex-
C. WBC 4,800 mm3 pected finding of anemia.
D. Hgb 10 g/dL C. WBC count of 4800 mm3
is below the expected reference
range and is not an expected finding of
anemia.
D. CORRECT: Hgb of 10 g/dL is below the
expected
reference range and is an expected finding
of anemia.
2. A nurse is caring for a client A. aPTT is monitored for clients receiving

who is receiving warfarin for heparin therapy. An aPTT of 38 seconds
anticoagulation therapy. Which is within the expected reference range for
of the following laboratory test clients not receiving heparin therapy.
results indicates to the nurse B. CORRECT: INR of 1.1 is within the ex-
that the client needs an in- pected reference range for a client who is
crease in the dosage? not receiving warfarin. However, this value
A. aPTT 38 seconds is subtherapeutic for anticoagulation ther-
B. INR 1.1 apy. The nurse should expect the client to
C. PT 22 seconds receive an increased dosage of warfarin
D. Ddimer negative until the INR is 2 to 3.
C. PT of 22 seconds is above the expected
reference range for a client receiving war-
farin therapy. This result indicates the client
is at an increased risk for bleeding.
D. A negative Ddimer test indicates the
absence of a pulmonary embolus or deep
vein thrombosis and is not used to deter-
mine the dosage needs for warfarin thera-
py.
3.
1 / 23
A nurse is providing teaching A. The nurse should inform the client that
for a client who is scheduled for he will be placed in a prone or sidelying
a bone marrow biopsy of the ili- position during the test in order to expose
ac crest. Which of the following the iliac crest.
statements made by the client B. CORRECT: The nurse should inform the
indicates an understanding of client of the need to stay on bed rest for 30
the teaching? to 60 min following the test to reduce the
A. "This test will be performed risk for bleeding.
while I am lying flat on my C. The nurse should inform the client that
back." a culture and sensitivity test determines
B. "I will need to stay in bed for the type of antibiotics needed to treat an
about an hour after the test." infection.
C."This test will determine D. The nurse should inform the client that
which antibiotic I should take he will receive a sedative prior to the test
for treatment." and that a local anesthetic will be used at
D."I will receive general anes- the site.
thesia for the test."
4. 1. A nurse is preparing to ad- A. The nurse should obtain consent from

minister the client for
packed RBCs to a client who the transfusion prior to initiating the trans-
has a Hgb of 8 g/dL. Which of fusion.
the following actions should B. CORRECT: The nurse should assess for
the an acute hemolytic reaction
nurse plan to take during the during the first 15 min of the transfusion.
first 15 min of the transfusion? This form of a reaction can
A. Obtain consent from the occur following the transfusion of as little as
client for the transfusion. 10 mL of blood product.
B. Assess for an acute C. The nurse should explain the transfusion
hemolytic reaction. procedure
C. Explain the transfusion to the client prior to initiating the transfu-
procedure to the client. sion.
D. Obtain blood culture D. The nurse should obtain blood culture
specimens to send to the lab specimens
5. 2. A nurse is caring for a client A. CORRECT: The nurse should immedi-

who ately stop the infusion if an allergic transfu-
is receiving a blood transfusion reaction is suspected.
sion. B. The nurse should monitor for hypoten-
2 / 23
Which of the following actions sion if an allergic transfusion reaction is
should the nurse expect if an suspected due to the risk for shock.
allergic transfusion reaction is C. CORRECT: The nurse should administer
suspected? (Select all that ap- 0.9% sodium chloride solution through new
ply.) IV tubing if an allergic transfusion reaction
A. Stop the transfusion. is suspected.
B. Monitor for hypertension. D. The nurse should position the client in an
C. Maintain an IV infusion with upright position with the feet lower than the
0.9% sodium chloride. level of the heart if a circulatory overload is
D. Position the client in an suspected.
upright position with the E. CORRECT: The nurse should admin-
feet lower than the heart. ister an antihistamine, such as diphenhy-
E. Administer diphenhy- dramine, if an allergic transfusion reaction
dramine. is suspected.
6. 3. A nurse is monitoring a client A. A temperature increase of 1° F (0.5°

who began receiving a unit C) is an indication of a febrile transfusion
of packed RBCs 10 min ago. reaction.
Which of the following findings B. Hypotension is an indication of a febrile
should the nurse identify as an transfusion reaction.
indication of a febrile transfu- C. CORRECT: Tachycardia is an indication
sion of a febrile transfusion reaction.
reaction? (Select all that apply.) D. The client's report of itching is an indica-
A. Temperature change from tion of an allergic transfusion reaction.
37° C (98.6° F) pretransfusion E. CORRECT: A flushed appearance of the
to 37.2° C (99.0° F) client can indicate a febrile transfusion re-
B. Current blood pressure action
178/90 mm Hg
C. Heart rate change from
88/min
pretransfusion to 120/min
D. Client report of itching
E. Client appears flushed
7. 4. A nurse is providing preoper- A. The client should donate blood for an

ative autologous
teaching for a client who re- transfusion no sooner than 6 weeks prior to
quests surgery.
autologous donation in prepa- B. An autologous donation refers to the
3 / 23
ration client's
for a scheduled orthopedic donation of blood for his own personal use.
surgical procedure. Which of C. CORRECT: Beginning 6 weeks prior to
the surgery, the
following statements should client can donate blood each week for au-
the tologous
nurse include in the teaching? transfusion if his Hgb and Hct remain sta-
A. "You should make an ble.
appointment to donate blood D. An autologous donation is for use only
8 weeks prior to the surgery." by the client.
B. "If you need an autologous
transfusion, the blood your
brother donates can be used."
C."You can donate blood
each week if your
hemoglobin is stable."
D."Any unused blood that
is donated can be us
8. 5. A nurse preceptor is observ- A. The nurse should use no larger than a

ing a 19gauge
newly licensed nurse on the needle in the older adult client.
unit who B. The nurse should verify the client's iden-
is preparing to administer a tity and blood compatibility,
blood and expiration date of the blood with anoth-
transfusion to an older adult er nurse. This task
client. is beyond the scope of practice for an as-
Which of the following actions sistive personnel.
by C. The nurse should administer blood prod-
the newly licensed nurse indi- ucts with 0.9% sodium
cates chloride. IV solutions containing dextrose
an understanding of the proce- cannot be used.
dure? D. CORRECT: The nurse should check the
A. Inserts an 18gauge IV older adult client's
catheter in the client vital signs every 15 min throughout the
B. Verifies blood compatibility transfusion to allow for
and expiration date of the early detection of fluid overload or other
blood with an assistive transfusion reaction.
personnel (AP)
4 / 23
C. Administers dextrose 5%
in 0.9% sodium chloride
IV with the transfusion
D. Obtains vital signs
every 15 min throughout
the procedure.
9. 1. An individual who lives at b. hypoxia caused by decreased atmos-

a high altitude may normally pheric oxygen stimulates erythropoiesis.
have an increased RBC count
because
a. high altitudes cause vascular
fluid loss, leading to hemocon-
centration.
b. hypoxia caused by de-
creased atmospheric oxygen
stimulates erythropoiesis.
c. the function of the spleen in
removing old RBCs is impaired
at high altitudes.
d. impaired production of
leukocytes and platelets leads
to proportionally higher red
cell counts.
10. 2. Malignant disorders that d. decreased phagocytosis of bacteria.

arise from granulocytic cells in
the bone marrow will have the
primary effect of causing
a. risk for hemorrhage.
b. altered oxygenation.
c. decreased production of an-
tibodies.
d. decreased phagocytosis of
bacteria.
11. 3. An anticoagulant such as b. activation of thrombin.

warfarin (Coumadin) that inter-
feres with prothrombin produc-
5 / 23
tion will alter the clotting mech-
anism during
a. platelet aggregation.
b. activation of thrombin.
c. the release of tissue throm-
boplastin.
d. stimulation of factor activa-
tion comple
12. 4. When reviewing laborato- a. minimal leukocytosis.

ry results of an 83-year-old
patient with an infection, the
nurse would expect to find
a. minimal leukocytosis.
b. decreased platelet count.
c. increased hemoglobin and
hematocrit levels.
d. decreased erythrocyte sedi-
mentation rate (ESR).
13. 5. Significant information ob- a. jaundice.

tained from the patient's health
history that relates to the
hematologic system includes
a. jaundice.
b. bladder surgery.
c. early menopause.
d. multiple pregnancies.
14. 6. While assessing the lymph c. lightly palpate superficial lymph nodes
nodes, the nurse should with the pads of the fingers.
a. apply gentle, firm pressure to
deep lymph nodes.
b. palpate the deep cervical and
supraclavicular nodes last.
c. lightly palpate superficial
lymph nodes with the pads of
the fingers.
d. use the tips of the second,
6 / 23
third, and fourth fingers to ap-
ply deep palpation.
15. 7. If a lymph node is palpated, b. Firm, mobile nodes

what is a normal finding?
a. Hard, fixed nodes
b. Firm, mobile nodes
c. Enlarged, tender nodes
d. Hard, nontender node
16. Hematologic System a, c, d

8. Nursing care for a patient im- a. administering analgesics as necessary.
mediately after a bone marrow c. instructing on need to lie still with a sterile
biopsy and aspiration includes pressure dressing intact.
(select all that apply) d. monitoring vital signs and assessing the
a. administering analgesics as site for excess drainage or bleeding.
necessary.
b. preparing to administer a
blood transfusion.
c. instructing on need to lie still
with a sterile pressure dressing
intact.
d. monitoring vital signs and
assessing the site for excess
drainage or bleeding.
e. instructing on the need for
preprocedure and postproce-
dure antibiotic medications.
17. 9. You are taking care of a male c. Your patient is at risk for bleeding.
patient who has the follow-
ing laboratory values from his
CBC: WBC 6.5 × 103/µL, Hgb
13.4 g/dL, Hct 40%, platelets 50
× 103/µL. What are you most
concerned about?
a. Your patient is neutropenic.
b. Your patient has an infection.
c. Your patient is at risk for
7 / 23
bleeding.
d. Your patient is at fall risk due
to his anemia
18. A nurse is caring for a A. CORRECT: In DIC, platelet levels are de-
client who has disseminated increased, causing clotting factors to become
travascular coagulation (DIC). depleted. Clotting times are increased,
Which of the following lab- which raises the risk for fatal hemorrhage.
oratory values indicates the B. CORRECT: In DIC, fibrinogen levels
client's clotting factors are de- are decreased, causing clotting factors to
pleted? (Select all that apply.) become depleted. Clotting times are in-
A. Platelets 100,000/mm3 creased, which raises the risk for fatal he-
B. Fibrinogen levels 57 mg/dL morrhage.
C. Fibrin degradation products C. Fibrin degradation products are in-
4.3 mcg/mL creased when DIC occurs.
D. Ddimer 0.03 mcg/mL E. Sed- D. A Ddimer level is increased when DIC
imentation rate 38 mm/hr occurs. E. The sedimentation rate is in-
creased, but it is not an indicator of DIC
19. A nurse is assessing a client A. Tachycardia is a finding that is indicative

and suspects the client is of DIC.
experiencing DIC. Which of B. Hypotension is a finding that is indicative
the following physical findings of DIC.
should the nurse anticipate? C. CORRECT: Epistaxis is unexpected
A. Bradycardia bleeding of the gums and nose and is a
B. Hypertension finding indicative of DIC.
C. Epistaxis D. Xerostomia is dryness of the mouth and
D. Xerostomia is not indicative of DIC.
20. A nurse is caring for a client A. Petechiae on the upper chest can indi-
who has idiopathic throm- cate impaired clotting.
bocytopenic purpura (ITP). B. Hypotension can indicate impaired clot-
The nurse should notify the ting.
provider and report possi- C. CORRECT: Cyanotic nail beds indi-
ble smallvessel clotting when cate microvascular clotting is occurring and
which of the following is as- should be immediately reported to avoid
sessed? ischemic loss of the fingers or toes.
A. Petechiae on the upper D. Severe headache can indicate cerebral
chest bleeding.
8 / 23
B. Hypotension
C. Cyanotic nail beds
D. Severe headache
21. A nurse is caring for a client A. CORRECT: Heparin can be adminis-

who has DIC. Which of the tered to decrease the formation of micro-
following medications should clots, which deplete clotting factors.
the nurse anticipate adminis- B. Vitamin K promotes blood coagulation
tering? and is not prescribed for a client who has
A. Heparin DIC.
B. Vitamin K C. Mefoxin is an antibiotic given to treat
C. Mefoxin bacterial infection and is not a medication
D. Simvastatin that the nurse should anticipate being ad-
ministered to a client who has DIC.
D. Simvastatin is an antilipemic given to
treat hyperlipidemia and is not a medica-
tion that the nurse should anticipate being
administered to a client who has DIC.
22. A nurse is teaching a new- A. Warfarin therapy and atrial fibrillation are
ly licensed nurse about he- not related to development of HIT.
parininduced thrombocytope- B. Placental abruption is a risk factor for
nia. Which of the following risk development of DIC.
factors for this disorder should C. Systemic lupus erythematosus is an au-
the nurse include in the teach- toimmune disorder that places the client at
ing? risk for development of ITP.
A. Warfarin therapy for atrial D. CORRECT: The client who is receiving
fibrillation heparin therapy for longer than 1 week is at
B. Placental abruption increased risk for the development of HIT.
C. Systemic lupus erythemato-
sus
D. Heparin therapy for deepvein
thrombosis
23. A nurse is caring for a client A. The nurse should offer the client rest pe-
who has leukemia and has riods throughout the day. However, another
developed thrombocytopenia. action is the priority.
Which of the following actions B. The nurse should encourage the client to
should the nurse take first? cough, turn and deep breathe every 2 hr.
9 / 23
A. Plan for the client to take rest However, another action is the priority.
periods throughout the day. C. The nurse should assess the client's
B. Encourage the client to temperature every 4 hr. However, another
cough, turn, and deep breath action is the priority
every 2 hr. D. CORRECT: The greatest risk to the
C. Assess temperature every 4 client who has thrombocytopenia is injury
hr. due to bleeding. The priority action for the
D. Monitor platelet counts nurse to take is to initiate bleeding precau-
tions, such monitoring platelet count.
24. 1. In a severely anemic patient, a. dyspnea and tachycardia.

the nurse would expect to find
a. dyspnea and tachycardia.
b. cyanosis and pulmonary
edema.
c. cardiomegaly and pul-
monary fibrosis.
d. ventricular dysrhythmias
and wheezing.
25. 2. When obtaining assessment b. dietary intake of iron.

data from a patient with a mi-
crocytic, hypochromic anemia,
the nurse would question the
patient about
a. folic acid intake.
b. dietary intake of iron.
c. a history of gastric surgery.
d. a history of sickle cell ane-
mia
26. 3. Nursing interventions for a a. monitoring stools for guaiac.

patient with severe anemia re- b. instructions for high-iron diet.
lated to peptic ulcer disease in-
clude (select all that apply)
a. monitoring stools for guaiac.
b. instructions for high-iron
diet.
c. taking vital signs every 8
10 / 23
hours.
d. teaching self-injection of ery-
thropoietin.
e. administration of cobalamin
(vitamin B12) injections.
27. 4. The nursing management of a. monitoring CBC.

a patient in sickle cell crisis in- b. optimal pain management and O2 thera-
cludes (select all that apply) py.
a. monitoring CBC. c. blood transfusions if required and iron
b. optimal pain management chelation.
and O2 therapy. d. rest as needed and deep vein thrombosis
c. blood transfusions if re- prophylaxis.
quired and iron chelation.
d. rest as needed and deep vein
thrombosis prophylaxis.
e. administration of IV iron and
diet high in iron content.
28. 5. A complication of the hyper- a. thrombosis.

viscosity of polycythemia is
a. thrombosis.
b. cardiomyopathy.
c. pulmonary edema.
d. disseminated intravascular
coagulation (DIC).
29. 6. When caring for a pa- a. dab his or her nose instead of blowing.
tient with thrombocytopenia,
the nurse instructs the patient
to
a. dab his or her nose instead
of blowing.
b. be careful when shaving with
a safety razor.
c. continue with physical ac-
tivities to stimulate throm-
bopoiesis.
d. avoid aspirin because it may
11 / 23
mask the fever that occurs with
thrombocytopenia.
30. 7. The nurse would antici- d. factor VIII.

pate that a patient with von
Willebrand disease undergoing
surgery would be treated with
administration of vWF and
a. thrombin.
b. factor VI.
c. factor VII.
d. factor VIII.
31. 8. DIC is a disorder in which c. a disease process stimulates coagula-

a. the coagulation pathway is tion processes with resultant thrombosis,
genetically altered, leading to as well as depletion of clotting factors, lead-
thrombus formation in all major ing to diffuse clotting and hemorrhage.
blood vessels.
b. an underlying disease de-
pletes hemolytic factors in the
blood, leading to diffuse throm-
botic episodes and infarcts.
c. a disease process stimulates
coagulation processes with re-
sultant thrombosis, as well as
depletion of clotting factors,
leading to diffuse clotting and
hemorrhage.
d. an inherited predisposition
causes a deficiency of clotting
factors that leads to overstim-
ulation of coagulation process-
es in the vasculature.
32. 11. The most common type of d. chronic lymphocytic leukemia.

leukemia in older adults is
a. acute myelocytic leukemia.
b. acute lymphocytic leukemia.
c. chronic myelocytic
12 / 23
leukemia.
d. chronic lymphocytic
leukemia.
33. 12. Multiple drugs are often d. the drugs work by different mechanisms
used in combinations to treat to maximize killing of malignant cells.
leukemia and lymphoma be-
cause
a. there are fewer toxic and side
effects.
b. the chance that one drug will
be effective is increased.
c. the drugs are more effective
without causing side effects.
d. the drugs work by differ-
ent mechanisms to maximize
killing of malignant cells.
34. 13. The nurse is aware c. non-Hodgkin's lymphoma can manifest

that a major difference be- in multiple organs.
tween Hodgkin's lymphoma
and non-Hodgkin's lymphoma
is that
a. Hodgkin's lymphoma occurs
only in young adults.
b. Hodgkin's lymphoma is con-
sidered potentially curable.
c. non-Hodgkin's lymphoma
can manifest in multiple or-
gans.
d. non-Hodgkin's lymphoma is
treated only with radiation ther-
apy.
35. 16. Complications of transfu- d. transmission of cytomegalovirus and

sions that can be decreased by fever
the use of leukocyte depletion
or reduction of RBC transfu-
sion are
13 / 23
a. chills and hemolysis.
b. leukostasis and neutrophil-
ia.
c. fluid overload and pul-
monary edema.
d. transmission of cy-
tomegalovirus and fever
36. The patient has been diag- d. Reed-Sternberg (R-S) cells

nosed with Hodgkins lym-
phoma. The nurse is aware that If Reed-Sternberg (R-S) cells are present,
this patient has which type of the patient has Hodgkins lymphoma. If the
cells present in the blood? R-S cells are not present, the patient is
a. Abnormal B cells diagnosed as having non-Hodgkins lym-
b. Abnormal T cells phoma. Non-Hodgkins lymphoma is then
c. Cytotoxic T cells identified as either B-cell or T-cell lym-
d. Reed-Sternberg (R-S) cells phoma.
37. The nurse is assessing a pa- c. Noncontiguous enlarged lymph nodes

tients lymph nodes. Which find-
ing would alert the nurse to the NHL typically manifests as enlargement in
possibility of the patient hav- one node, then one or more nodes are
ing non-Hodgkins lymphoma skipped, and then another node is affect-
(NHL)? ed (noncontiguous). These enlarged nodes
a. Enlarged lymph nodes that are usually painless with NHL.
form an adjacent line of en-
largement
b. Painful widespread enlarged
lymph nodes
c. Noncontiguous enlarged
lymph nodes
d. Enlarged lymph nodes pri-
marily in the neck and axillary
region
38. The patient diagnosed a. bone marrow transplantation.

with non-Hodgkins lymphoma b. peripheral stem cell transplantation.
(NHL) asks the nurse about c. injection of monoclonal antibodies.
treatment options. The nurse is d. radiation therapy.
14 / 23
aware that various treatment
options exist, including: (Se- High-dose continuous antibiotic therapy is
lect all that apply.) not currently a treatment option for NHL.
a. bone marrow transplanta- All other options listed are possible treat-
tion. ment options, as well as chemotherapy and
b. peripheral stem cell trans- surgery.
plantation.
c. injection of monoclonal anti-
bodies.
d. radiation therapy.
e. high-dose continuous antibi-
otic therapy.
39. The nurse cautions the b. pernicious

79-year-old male who had a
gastrectomy a month ago that Pernicious anemia will result from the lack
he is at risk for _____ anemia. of the intrinsic factor found in the stomach
a. aplastic lining. Without the intrinsic factor, the body
b. pernicious is unable to absorb vitamin B12. Aplastic
c. iron deficiency anemia is related to bone marrow suppres-
d. nutritional sion. Iron deficiency anemia is often related
to a deficiency of iron in the diet.
40. Because of a deficiency of iron, c. hemoglobin.

the person with iron deficiency
anemia is unable to make suffi- Deficiency of iron causes reduced produc-
cient: tion of hemoglobin.
a. plasma.
b. WBCs.
c. hemoglobin.
d. antibodies.
41. The nurse anticipates that the b. hypochromic and microcytic.

patient with iron deficiency
anemia will have red cells that Iron deficiency anemia causes the RBCs to
are: be small and have less color.
a. normochromic and normo-
cytic.
b. hypochromic and microcyt-
15 / 23
ic.
c. hyperchromic and macrocyt-
ic.
d. normochromic and microcyt-
ic.
42. The home health nurse as- a. It tastes better when I take my medicine
sesses the patient taking fer- with milk.
rous sulfate (Feosol). Which pa-
tient statement alerts the nurse Milk products inhibit the absorption of iron.
that teaching is necessary re- Iron is better absorbed if vitamin C is in
garding this medication? the GI tract at the same time, so drink-
a. It tastes better when I take my ing orange juice with the ferrous sulfate
medicine with milk. is beneficial. Capsules and enteric-coated
b. My wife says I should take my iron preparations should not be opened or
medicine with orange juice. crushed. Whole grains are not known as
c. I am always careful not to inhibitors of iron absorption.
break open the capsule.
d. I usually take my iron with my
whole-grain toast during break-
fast.
43. The nurse instructs the d. the trait can be passed on to all children.
20-year-old female patient with
sickle cell trait that: A person who has the trait can pass it on to
a. the condition will evolve into male or female children, even if there are no
sickle cell anemia as she ages. symptoms. Fifty percent of the patients total
b. all of her children will have hemoglobin may be affected. Age does not
sickle cell anemia. increase the chance of the trait evolving
c. the trait will be transmitted to into the disease.
male children only.
d. the trait can be passed on to
all children.
44. The nurse stresses to the pa- b. maintain adequate fluid intake.
tient with sickle cell anemia
that one of the most elemen- The maintenance of an adequate fluid in-
tary home interventions to help take keeps the circulating blood volume hy-
prevent sickle cell crisis is to:
16 / 23
a. take iron supplements daily. drated, which discourages clumping of the
b. maintain adequate fluid in- sickle cells
take.
c. engage in daily exercise.
d. eat leafy green vegetables.
45. The nurse is conscientious in a. stasis ulcers are a constant threat.

the care of the feet and legs of
a patient with sickle cell anemia Because of the sluggish flow of blood, sta-
because: sis ulcers are a constant threat and are very
a. stasis ulcers are a constant difficult to heal.
threat.
b. bleeding may occur on the
soles of the feet.
c. edema of the feet increases
activity intolerance.
d. toenails must be kept short
to avoid ingrown nails
46. The nurse evaluates a need for d. I am looking forward to my annual ski trip
further instruction to the pa- to Colorado
tient with sickle cell anemia
when he says: People with sickle cell anemia should
a. I know Im not supposed to avoid cold temperatures and high altitudes,
drink iced drinks. which can bring on a crisis due to thicken-
b. I surely do miss my three ing of the blood. Avoidance of iced drinks,
beers in the afternoon. alcohol, and strenuous exercise is benefi-
c. I walk every day rather than cial
doing other strenuous exer-
cise.
d. I am looking forward to my
annual ski trip to Colorado
47. The nurse assessing a patient c. high hemoglobin.

with polycythemia vera would
anticipate: The person with polycythemia vera will
a. pale complexion. have high hemoglobin and hematocrit re-
b. low blood pressure. lated to the large number of red cells. The
complexion is ruddy with blue lips; there
17 / 23
c. high hemoglobin. is fatigue and weakness and high blood
d. normal energy level. pressure.
48. The home health nurse car- a. maintenance of high fluid intake.
ing for the patient with poly-
cythemia vera will focus care The major focus is maintaining a high fluid
on: intake to keep the circulating fluid well hy-
a. maintenance of high fluid in- drated.
take.
b. daily exercise to reduce
weight.
c. daily dose of anticoagulants.
d. adequate intake of vitamin C.
49. The patient with acute myel- a. are not as effective as normal white cells
ogenous leukemia (AML) asks would be.
why he is making more WBCs
when he already has so many. The many leukemic white cells cannot func-
The nurse clarifies that the tion as normal WBCs do. The bone marrow
large number of leukemic white rushes production of immature white cells
cells he already has: (blasts) to try to create adequate protection.
a. are not as effective as normal These cells do not protect against infection,
white cells would be. nor do they take over the functions of the
b. protect against infection. RBCs. AML originates in the bone marrow.
c. attempt to take over the func-
tions of RBCs.
d. are produced by the lymphat-
ic system.
50. The nurse explains that induc- a. intensive protocol of chemotherapy in

tion therapy for acute lympho- high doses to achieve remission.
cytic leukemia (ALL) is a(n):
a. intensive protocol of A combination of several antileukemic
chemotherapy in high doses to drugs in high doses has been found to in-
achieve remission. duce a remission.
b. long-term protocol with
smaller doses of chemothera-
py to achieve a cure.
c. 2- to 5-year low-dose
18 / 23
chemotherapy regimen to re-
duce painful symptoms.
d. combination of chemothera-
py and radiation to achieve re-
mission.
51. The nurse recommends to a pa- a. liver.

tient with iron deficiency ane- b. lima beans.
mia to include foods high in c. prune juice.
iron, such as: (Select all that e. dried apricots.
apply.)
a. liver.
b. lima beans.
c. prune juice.
d. cabbage.
e. dried apricots.
52. Aplastic anemia has its etiolo- a. antimetabolite cancer drugs.

gy in a variety of drugs, such b. phenylbutazone (Butazolidin).
as: (Select all that apply.) d. chloramphenicol (Chloromycetin).
a. antimetabolite cancer drugs. e. sulfonamides.
b. phenylbutazone (Butazo-
lidin).
c. oral contraception drugs.
d. chloramphenicol
(Chloromycetin).
e. sulfonamides.
53. The patient with AML has a a. Observe for melena and hematuria.
platelet count of 95,000. What c. Measure abdominal girth daily.
interventions should be includ- d. Apply ice and pressure to puncture sites.
ed in the plan of care for this e. Use electric razor.
patient? (Select all that apply.)
a. Observe for melena and A low platelet makes the patient prone to
hematuria. excessive bleeding. The nurse should mon-
b. Brush and floss at least twice itor for bleeding into the stool and urine.
daily. Soft toothbrushes will decrease the likeli-
c. Measure abdominal girth dai- hood of the gums bleeding. An increase
ly. in the abdominal girth will alert the nurse
19 / 23
d. Apply ice and pressure to to the possibility of internal bleeding. Ice
puncture sites. and pressure on puncture sites aid in stop-
e. Use electric razor. ping bleeding. An electric razor reduces the
chance of the patient being cut during shav-
ing.
54. The nurse monitoring a patient b. a headache.

who is receiving a transfusion c. back pain.
will stop the transfusion in the d. a rash.
event of the patient complain- e. urticaria.
ing of: (Select all that apply.)
a. feeling cold. The complaint of feeling chilled is caused
b. a headache. by the infusion of the chilled blood. The
c. back pain. transfusion is not stopped; the patient is
d. a rash. given a blanket. All other options are events
e. urticaria. that indicate a reaction to the transfu-
sion and should cause the infusion to
be stopped and the saline infusion to be
opened into the line to keep the IV line
open.
55. 14. A patient who developed b. An antigenantibody reaction is causing

hemolytic anemia related to destruction of red blood cells.
the administration of penicillin
asks for an explanation of this For no known reason, autoantibodies are
condition. What is the most produced that attach to RBCs and cause
appropriate response by the them to either lyse or agglutinate (clump).
nurse? A. C. D. These choices do not correctly ex-
a. The red blood cells are being plain the development of hemolytic anemia
produced inappropriately. in this patient.
b. An antigenantibody reaction
is causing destruction of red
blood cells.
c. An allergy to penicillin is de-
stroying your platelets for un-
known reasons.
d. Allergens are invading the
bone marrow and interfering
with red blood cell production.
20 / 23
56. 15. A patient is receiving a a. Stop the blood infusion.
transfusion of packed RBCs.
Ten minutes after the infusion Low back pain and headache can be symp-
begins the patient reports low toms of a transfusion reaction. If symptoms
back pain and a headache. of a reaction are noted, the blood is imme-
Which action should the nurse diately stopped so that no more blood is
take first? infused into the patient. B. The physician
a. Stop the blood infusion. should be notified after the transfusion is
b. Notify the physician STAT. stopped. C. D. A new normal saline infusion
c. Start the new 0.9% normal with new tubing is prepared and started to
saline infusion. keep the vein patent should medications
d. Prepare a new 0.9% normal need to be administered as ordered. New
saline infusion. tubing must be used so that not one more
drop of blood enters the patient.
57. 16. A patient is to receive a c. Verify blood type of the patient and donor.
transfusion of packed RBCs.
Before administering the trans- Prevention of hemolytic reactions is cru-
fusion, which action should the cial. At the bedside, double-check the pa-
nurse take? tients name and identification number on
a. Verify the patients kidney the chart, unit of blood, and patients iden-
function. tification bracelet, as well as check the pa-
b. Verify the patients hemat- tients blood type in the chart, on the unit of
ocrit level. blood, and paperwork with the unit of blood.
c. Verify blood type of the pa- A. B. D. These actions will not help prevent
tient and donor. the development of a transfusion reaction.
d. Verify the patients admitting
medical diagnosis.
58. 25. The nurse has been car- c. An increase in vitamin B12 levels and
ing for a patient with pernicious decrease in number of enlarged RBCs
anemia. Which finding should
indicate to the nurse that treat- Macrocytic (enlarged RBCs) anemia, and
ment has been successful? low vitamin B12 levels are indicators of
a. Decreased folic acid level pernicious anemia, so increased vitamin
and an increase in enlarged B12 levels and decreased enlarged RBCs
RBCs would indicate successful treatment. A. B.
b. A decrease in intrinsic factor D. These findings would not support treat-
and increased vitamin B12 ex-
21 / 23
creted in the urine ment for pernicious anemia as being suc-
c. An increase in vitamin B12 cessful.
levels and decrease in number
of enlarged RBCs
d. A decrease in hydrochloric
acid levels in gastric secretion
and decrease in production of
RBCs
59. 29. A patient is suspected as b. Direct Coombs test

having a blood transfusion re-
action. Which laboratory test The direct Coombs test confirms the diag-
should the nurse expect to be nosis of transfusion reaction. In the labora-
done to confirm this diagno- tory, a small amount of the patients RBCs
sis? is washed to remove any unattached an-
a. Skin testing tibodies. Antihuman globulin is added to
b. Direct Coombs test see if agglutination (clumping) of the RBCs
c. White blood cell count results. If agglutination occurs, an immune
d. C-reactive protein level reaction such as a hemolytic transfusion
reaction is taking place. A. Skin testing is
used to determine the presence of a type I
hypersensitivity reaction. C. D. These tests
might be done to determine the presence
of serum sickness.
60. 31. The nurse is reinforcing b. I will need to take vitamin B12 injections
teaching provided to a pa- for the rest of my life.
tient with pernicious anemia.
Which patient statement indi- If vitamin B12 injections are prescribed, the
cates that teaching has been patient must understand that this is a life-
effective? long need to prevent the return of symp-
a. I can miss a month or two of toms. A. C. Patients should not miss injec-
injections if I am feeling better. tions. D. Injections are not taken as needed
b. I will need to take vitamin B12 for fatigue.
injections for the rest of my life.
c. I will take the vitamin B12
injections until my strength re-
turns.
d. I can take a vitamin B12 in-
22 / 23
jection when I feel tired or fa-
tigued.
61. 32. A patient is being started on c. 15

a blood transfusion. For how
many minutes should the nurse The nurse should stay at the bedside with a
stay with the patient during this patient for the first 15 minutes of any blood
transfusion? transfusion to detect signs of a reaction. A.
a. 5 B. The nurse needs to stay longer than 5 or
b. 10 10 minutes. D. The nurse does not need to
c. 15 stay beyond 15 minutes.
d. 20
62. 45. A patient is receiving a A. Stop the blood infusion.

transfusion of packed RBCs. C. Obtain vital signs and assess patient.
Ten minutes after the infusion B. Notify the physician stat.
begins, the patient reports low E. Prepare a new 0.9% normal saline infu-
back pain and a headache. sion.
Place the actions in order (15) D. Start the new 0.9% normal saline infu-
of importance of performance. sion.
A. ___ Stop the blood infusion.
B. ___ Notify the physician stat. Low back pain and headache can be symp-
C. ___ Obtain vital signs and toms of a transfusion reaction. If symptoms
assess patient. of a reaction are noted, the blood trans-
D. ___ Start the new 0.9% nor- fusion is immediately stopped and agency
mal saline infusion. policy for a suspected transfusion reac-
E. ___ Prepare a new 0.9% nor- tion is followed. A normal saline infusion
mal saline infusion. with new tubing is started to keep the vein
patent. The physician and blood bank are
immediately notified. A nurse remains with
the patient for reassurance and monitor-
ing of symptoms and vital signs. If a blood
incompatibility is suspected, the unused
blood and blood tubing are returned to the
blood bank for testing. A series of blood and
urine specimens are collected and sent to
the laboratory for analysis. The physicians
orders are followed to treat the patients
symptoms.
23 / 23
Hematology NCLEX
Study online at https://quizlet.com/_185ghw
A. Inspect the skin for petechiae.
When assessing a patient's nutrition- Any changes in the skin's texture or color
al-metabolic pattern related to hemato- should be explored when assessing the
logic health, what should the nurse do? patient's nutritional-metabolic pattern re-
A. Inspect the skin for petechiae. lated to hematologic health. The pres-
B. Ask the patient about joint pain. ence of petechiae or ecchymotic areas
C. Assess for vitamin C deficiency. could be indicative of hematologic defi-
D. Determine if the patient can perform ciencies related to poor nutritional intake
ADLs. or related causes. The other options are
not specific to the nutritional-metabolic
pattern related to hematologic health.
cell (WBC) differential (shift to the left)
When infections are severe, such as

in septicemia, more granulocytes are
released from the bone marrow as a
When assessing laboratory values on a
compensatory mechanism. To meet the
patient admitted with septicemia, what
increased demand, many young, im-
should the nurse expect to find?
mature polymorphonuclear neutrophils
A. Increased platelets
(bands) are released into circulation.
B. Decreased red blood cells
WBCs are usually reported in order of
C. Decreased erythrocyte sedimentation
maturity (initially with the less mature
rate (ESR)
forms on the left side of a written report).
Hence, the term "shift to the left" is used
cell (WBC) differential (shift to the left)
to denote an increase in the number of
bands. Thrombocytosis occurs with in-
flammation and some malignant disor-
ders. Decreased red blood cells indicate
anemia. Decreased ESR is not indicative
of septicemia.
Results of a patient's most recent blood
B. An infection
work indicate an elevated neutrophil lev-
el. The nurse should recognize that this
An increase in the neutrophil count most
diagnostic finding most likely suggests
commonly occurs in response to infec-
which problem?
tion or inflammation. Hypoxemia and co-
A. Hypoxemia
1 / 13
Hematology NCLEX
B. An infection
agulation do not directly affect neutrophil
C. A risk of hypocoagulation
production.
D. An acute thrombotic event
B. Increased platelet levels
A 30-year-old patient has undergone a
E. Impaired immunologic function
splenectomy as a result of injuries suf-
fered in a motor vehicle accident. Which
Splenectomy can result in increased
phenomena are likely to result from the
platelet levels and impaired immunologic
absence of the patient's spleen (select
function as a consequence of the loss
all that apply)?
of storage and immunologic functions of
A. Impaired fibrinolysis
the spleen. Fibrinolysis, fatigue, and cold
B. Increased platelet levels
intolerance are less likely to result from
C. Increased eosinophil levels
the loss of the spleen since coagulation
D. Fatigue and cold intolerance
and oxygenation are not primary respon-
E. Impaired immunologic function
sibilities of the spleen.
B. Decreased hemoglobin
The nurse is providing care for older
adults on a subacute, geriatric medicine
Older adults frequently experience de-
unit. What effect is aging likely to have
creased hemoglobin levels as a result
on hematologic function of older adults?
of changes in erythropoiesis. Decreased
A. Thrombocytosis
blood volume, decreased WBCs, and al-
B. Decreased hemoglobin
terations in platelet number are not con-
C. Decreased WBC count
sidered to be normal, age-related hema-
D. Decreased blood volume
tologic changes.
A blood type and cross-match has been
ordered for a male patient who is expe-
riencing an upper gastrointestinal bleed.
The results of the blood work indicate C. The patient has A antigens on his red
that the patient has type A blood. Which blood cells (RBCs).
description explains what this means?
A. The patient can be transfused with An individual with type A blood has A
type AB blood. antigens, not A antibodies, on his RBCs.
B. The patient may only receive a type A An AB transfusion would result in agglu-
transfusion. tination, but he may be transfused with
C. The patient has A antigens on his red either type A or type O blood.
blood cells (RBCs).
D. Antibodies are present on the surface
of the patient's RBCs.
2 / 13
Hematology NCLEX
A. Increased homocysteine
The patient has anemia and has had
C. Decreased cobalamin (vitamin B12)
laboratory tests done to diagnose the
D. Increased methylmalonic acid (MMA)
cause. Which results should the nurse
know indicates a lack of nutrients need-
Increased homocysteine and MMA
ed to produce new red blood cells (select
along with decreased cobalamin (vita-
all that apply)?
min B12) indicate cobalamin deficien-
A. Increased homocysteine
cy, which is a nutrient needed for RBC
B. Decreased reticulocyte count
production. Decreased reticulocytes in-
C. Decreased cobalamin (vitamin B12)
dicate low bone marrow activity in pro-
D. Increased methylmalonic acid (MMA)
ducing RBCs, not available nutrients. El-
E. Elevated erythrocyte sedimentation
evated ESR is related to an increased
rate (ESR)
inflammatory process, not anemia.
A. Purpura
In assessing the patient, which abnor- Purpura may occur when platelets or
mal finding should the nurse relate to clotting factors are decreased and bleed-
hemostasis abnormalities? ing into the skin occurs. Pruritus is not re-
A. Purpura lated to hemostasis, but to hematologic
B. Pruritus cancers (e.g., lymphomas, leukemias) or
C. Weakness increased bilirubin. Weakness and pale
D. Pale conjunctiva conjunctiva are not related to hemosta-
sis unless a lot of bleeding leads to ane-
mia with low Hgb level.
During the admission assessment, the
nurse discovers that the patient has
used illicit drugs. Related to the hemato- B. "What agent and when did you last
logic system, what question should the use it?"
nurse next ask the patient?
A. "Do you have any blood in your Although all these questions are appro-
stools?" priate related to the hematologic system,
B. "What agent and when did you last the only one related specifically to illicit
use it?" drug use is asking about what agent and
C. "Have you had any surgeries causing when it was last used. The route and
pain?" frequency should also be assessed
D. "Do you have shortness of breath with
activity?"
3 / 13
Hematology NCLEX
B. Apply a pressure dressing.
the thrombocytopenic patient has had
The sterile pressure dressing is applied
a bone marrow biopsy taken from the
after a bone marrow biopsy to ensure
posterior iliac crest. What nursing care
hemostasis. If bleeding is present, the
is the priority for this patient after this
patient will lie on the site and may need a
procedure?
rolled towel for additional pressure, thus
A. Position the patient prone.
this patient will not be in the prone posi-
B. Apply a pressure dressing.
tion. The analgesic should have been ad-
C. Administer analgesic for pain.
ministered preprocedure. Metal objects
D. Return metal objects to the patient.
would be removed for an MRI, not a bone
marrow biopsy.
C. "Older adults with infections may have
only a mild white blood cell count eleva-
The nurse is planning health promotion
tion."
teaching for a group of healthy older
adults in a residential community. Which
During an infection, the older adult may
statement accurately describes expect-
have only a minimal elevation in the total
ed hematologic effects of aging?
white blood cell count and may not have
A. "Platelet production increases with
a fever. Presentation of infection can ini-
age and leads to easy bruising."
tially be nonspecific with disorientation,
B. "Anemia is very common with aging
anorexia, and weakness. Platelets are
because iron absorption is impaired ."
unaffected by the aging process. Howev-
C. "Older adults with infections may have
er, changes in vascular integrity from ag-
only a mild white blood cell count eleva-
ing can manifest as easy bruising. Ane-
tion."
mia is not common in older adults. The
D. "Older adults often have an en-
total WBC count and differential are gen-
hanced immune response to new anti-
erally not affected by aging. However, a
gens, which causes autoimmune dis-
decrease in humoral antibody response
ease."
and decrease in T-cell function may oc-
cur.
The nurse is caring for a 36-year-old
male patient receiving phenytoin (Dilan-
A. Anemia
tin) to treat seizures resulting from his
traumatic brain injury while a teenager.
Hematologic adverse effects of pheny-
It is most important for the nurse to ob-
toin include anemia, thrombocytopenia,
serve for which hematologic adverse ef-
fect of this medication?
4 / 13
Hematology NCLEX
A. Anemia
B. Leukemia leukopenia, granulocytopenia, agranulo-
C. Polycythemia cytosis, and pancytopenia
D. Thrombocytosis
C. Spinach, beans, and liver
Normal intake of iron and folic acid is

The nurse collects a nutritional history
necessary for the development of red
from a 22-year-old woman who is plan-
blood cells, and normal levels before
ning to conceive a child in the next year.
conception and in early pregnancy are
Which foods reported by the woman
particularly important for normal fetal de-
would indicate that her diet is high in
velopment. Foods high in both folic acid
folate and iron?
and iron include liver, red meat, egg
A. Crab, fish, and tuna
yolks, turkey or chicken giblets, beans,
B. Milk, cheese, and yogurt
lentils, chick peas, soybeans, spinach,
C. Spinach, beans, and liver
and collard greens. In addition, enriched
D. White rice, potatoes, and pasta
cereals, pasta, and breads are also high
in both folic acid and iron (check the la-
bels).
B. Purpura
A 62-year-old male patient with dissem-
The normal range for a platelet count is
inated intravascular coagulation (DIC)
150,000 to 400,000/¼ L. Purpura is caused
after urosepsis has a platelet count of
by decreased platelets or clotting factors,
48,000/¼L. The nurse should assess the
resulting in small hemorrhages into the
patient for which abnormality?
skin and/or mucous membranes. Pain
A. Pain
is not a manifestation of low platelet
B. Purpura
counts. Pruritus is an intense itching sen-
C. Pruritus
sation. Palpitation is a sensation of feel-
D. Palpitation
ing the heart beat, flutter, or pound in the
chest.
C. "I have rheumatoid arthritis and take
aspirin for joint pain."
A 36-year-old female patient suspect-
ed to have leukemia is scheduled for a
Complications of bone marrow aspira-
bone marrow aspiration. What statement
tion are minimal, but there is a pos-
in the patient's health history requires
sibility of damaging underlying struc-
tures (especially if the sternum site is
5 / 13
Hematology NCLEX
used). Other complications include he-
morrhage (particularly if the patient is
immediate follow up by the nurse? thrombocytopenic) and infection (partic-
A. "I had a bad reaction to iodine before ularly if the patient is leukopenic). The
and almost died." risk of hemorrhage is increased if the pa-
B. "I am taking an antibiotic to treat a tient takes aspirin because it promotes
urinary tract infection." bleeding by inhibiting platelet aggrega-
C. "I have rheumatoid arthritis and take tion. Contrast dye is not used during a
aspirin for joint pain." bone marrow aspiration. A bone marrow
D. "I have dialysis for chronic renal failure aspiration is not contraindicated in pa-
three times a week." tients who have chronic renal failure (on
dialysis) or a urinary tract infection (on
an antibiotic)
B. Encourage foods high in protein, iron,
vitamin C, and folate.
Increased intake of protein, iron, folate,

and vitamin C provides nutrients need-
A 36-year-old mother of two children has
ed for maximum iron absorption and he-
anemia related to inadequate intake of
moglobin production. The other interven-
essential nutrients. Which intervention
tions do not address the patient's identi-
would be appropriate for the nurse to in-
fied problem of inadequate intake of es-
clude in the plan of care for this woman?
sential nutrients. Selection of foods that
A. Plan for 30 minutes of rest before and
are soft, bland, and nonacidic is appro-
after every meal.
priate if the patient has oral mucosal ir-
B. Encourage foods high in protein, iron,
ritation. Scheduled rest is an appropri-
vitamin C, and folate.
ate intervention if the patient has fatigue
C. Instruct the patient to select soft,
related to anemia. Providing information
bland, and nonacidic foods.
about medications that may inhibit iron
D. Give the patient a list of medications
absorption (e.g., antacids, tetracycline,
that inhibit iron absorption.
soft drinks, tea, coffee, calcium, phos-
phorus, and magnesium salts) is impor-
tant but does not address the patient's
problem of inadequate intake of essen-
tial nutrients.
The nurse instructs an African American
C. "When my vision is blurred, I will close
man who has sickle cell disease about
my eyes and rest for an hour."
symptom management and prevention
6 / 13
Hematology NCLEX
of sickle cell crisis. The nurse determines
further teaching is necessary if the pa-
tient makes which statement? Blurred vision should be reported imme-
A. "When I take a vacation, I should not diately and may indicate a detached reti-
go to the mountains." na or retinopathy. Hypoxia (at high alti-
B. "I should avoid contact with anyone tudes) and infection are common causes
who has a respiratory infection." of a sickle cell crisis. Severe pain may
C. "When my vision is blurred, I will close occur during a sickle cell crisis, and nar-
my eyes and rest for an hour." cotic analgesics are indicated for pain
D. "I may experience severe pain during management.
a crisis and need narcotic analgesics."
A 64-year-old man with leukemia ad-
mitted for severe hypovolemia after pro-
longed diarrhea has a platelet count of
43,000/µL. It is most important for the
nurse to take which action? D. Check stools for presence of frank or
A. Administer prescribed enoxaparin occult blood.
(Lovenox).
B. Insert two 18-gauge IV catheters. A platelet count
C. Monitor the patient?s temperature
every 2 hours.
D. Check stools for presence of frank or
occult blood.
The nurse is assigned to care for several
patients on a medical unit. Which patient
should the nurse check on first? D.5 A 30-year-old patient with a pulse of
A. A 60-year-old patient with a blood 112 beats/minute and a white blood cell
pressure of 92/64 mm Hg and hemoglo- count of 14,000/µL
bin of 9.8 g/dL
B. A 50-year-old patient with a respira- a low-grade fever greater than 100.4°
tory rate of 26 breaths/minute and an F (38° C) in a patient with a neutrophil
elevated D-dimer count below 500/µL is a medical emer-
C. A 40-year-old patient with a temper- gency and may indicate an infection. An
ature of 100.8o F (38.2o C) and a neu- infection in a neutropenic patient could
trophil count of 256/µL lead to septic shock and possible death
D.5 A 30-year-old patient with a pulse of if not treated immediately.
112 beats/minute and a white blood cell
count of 14,000/µL
7 / 13
Hematology NCLEX
B. Obtain the vital signs before the trans-
fusion is initiated
A 50-year-old man with an acute peptic
ulcer and major blood loss requires an
The registered nurse (RN) may delegate
immediate transfusion with packed red
tasks such as taking vital signs to un-
blood cells. Which task is appropriate
licensed assistive personnel (UAP). As-
for the nurse to delegate to unlicensed
sessments (e.g., monitoring for signs of
assistive personnel (UAP)?
a blood transfusion reaction [shortness
A. Confirm the IV solution is 0.9% saline.
of breath and back pain]) are within the
B. Obtain the vital signs before the trans-
scope of practice of the RN and may not
fusion is initiated.
be delegated to UAP. The RN must also
C. Monitor the patient for shortness of
assume responsibility for ensuring the
breath and back pain.
correct IV fluid is used with blood prod-
D. Double check the patient identity and
ucts. Verification of the patient's identity
verify the blood product.
and the blood product data must be com-
pleted by a licensed nurse.
When caring for a patient with metasta- B. Fatigue
tic cancer, the nurse notes a hemoglo-
bin level of 8.7 g/dL and hematocrit of The patient with a low hemoglobin and
26%. What should the nurse place high- hematocrit is anemic and would be most
est priority on initiating interventions to likely to experience fatigue. Fatigue de-
reduce? velops because of the lowered oxy-
A. Thirst gen-carrying capacity that leads to re-
B. Fatigue duced tissue oxygenation to carry out
C. Headache cellular functions. Thirst, headache, and
D. Abdominal pain abdominal pain are not related to anemia
Which patient is most likely to experi-
B. A 23-year-old African American man
ence anemia related to an increased de-
who has a diagnosis of sickle cell dis-
struction of red blood cells?
ease
A. A 59-year-old man whose alcoholism
has precipitated folic acid deficiency
A result of a sickling episode in sickle
B. A 23-year-old African American man
cell anemia involves increased hemoly-
who has a diagnosis of sickle cell dis-
sis of the sickled cells. Thalassemias and
ease
folic acid deficiencies cause a decrease
C. A 30-year-old woman with a history
in erythropoiesis, whereas the anemia
of "heavy periods" accompanied by ane-
related to menstruation is a direct result
mia
of blood loss.
D. A 3-year-old child whose impaired
8 / 13
Hematology NCLEX
growth and development is attributable
to thalassemi
B. Assist with or perform phlebotomy at
What will caring for a patient with a diag- the bedside.
nosis of polycythemia vera likely require
the nurse to do? Primary polycythemia vera often re-
A. Encourage deep breathing and quires phlebotomy in order to reduce
coughing. blood volume. The increased risk of
B. Assist with or perform phlebotomy at thrombus formation that accompanies
the bedside. the disease requires regular exercises
C. Teach the patient how to maintain a and ambulation. Deep breathing and
low-activity lifestyle. coughing exercises do not directly ad-
D. Perform thorough and regularly dress the etiology or common sequelae
scheduled neurologic assessments. of polycythemia, and neurologic mani-
festations are not typical.
What nursing intervention should be the B. Administration of oral or IV corticos-
priority in the care of a 30-year-old teroids
woman who has a diagnosis of immune
thrombocytopenic purpura (ITP)? Common treatment modalities for ITP
A. Administration of packed red blood include corticosteroid therapy to sup-
cells press the phagocytic response of splenic
B. Administration of oral or IV corticos- macrophages. Blood transfusions, ad-
teroids ministration of clotting factors, and re-
C. Administration of clotting factors VIII verse isolation are not interventions that
and IX are indicated in the care of patients with
D. Maintenance of reverse isolation and ITP. Standard precautions are used with
application of standard precautions all patients.
C. Take the iron with orange juice one
hour before meals.
An older patient relates that she has
increased fatigue and a headache. The
With microcytic, hypochromic anemia,
nurse identifies pale skin and glossitis
there may be an iron, B6, or copper de-
on assessment. In response to these
ficiency, thalassemia, or lead poisoning.
findings, which teaching will be help-
The iron prescribed should be taken with
ful to the patient if she has microcytic,
orange juice one hour before meals as
hypochromic anemia?
it is best absorbed in an acid environ-
A. Take enteric-coated iron with each
ment. Megaloblastic anemias occur with
cobalamin (vitamin B12) and folic acid
9 / 13
Hematology NCLEX
deficiencies. Vitamin B12 may help RBC
maturation if the patient has the intrinsic
meal.
factor in the stomach. Green leafy veg-
B. Take cobalamin with green leafy veg-
etables provide folic acid for RBC matu-
etables.
ration. Antiseizure drugs may contribute
C. Take the iron with orange juice one
to aplastic anemia or folic acid deficien-
hour before meals.
cy, but the patient should not stop tak-
D. Decrease the intake of the antiseizure
ing the medications. Changes in med-
medications to improve.
ications will be prescribed by the health
care provider.
The patient with leukemia has acute A. Elevated D-dimers
disseminated intravascular coagulation
(DIC) and is bleeding. What diagnostic The D-dimer is a specific marker for the
findings should the nurse expect to find? degree of fibrinolysis and is elevated with
A. Elevated D-dimers DIC. FDP is elevated as the breakdown
B. Elevated fibrinogen products from fibrinogen and fibrin are
C. Reduced prothrombin time (PT) formed. Fibrinogen and platelets are re-
D. Reduced fibrin degradation products duced. PT, PTT, aPTT, and thrombin time
(FDPs) are all prolonged.
C. Treat the causative problem.
Treating the underlying cause of DIC

After the diagnosis of disseminated in- will interrupt the abnormal response of
travascular coagulation (DIC), what is the clotting cascade and reverse the
the first priority of collaborative care? DIC. Blood product administration oc-
A. Administer heparin. curs based on the specific component
B. Administer whole blood. deficiencies and is reserved for patients
C. Treat the causative problem. with life-threatening hemorrhage. He-
D. Administer fresh frozen plasma. parin will be administered if the manifes-
tations of thrombosis are present and the
benefit of reducing clotting outweighs the
risk of further bleeding.
A. Strict hand washing
The patient with cancer is hav- D. Daily skin care and oral hygiene
ing chemotherapy treatments and has F. Private room with a high-efficiency
now developed neutropenia. What care particulate air (HEPA) filter
should the nurse expect to provide and
Strict hand washing and daily skin and
10 / 13
Hematology NCLEX
oral hygiene must be done with neu-
tropenia, because the patient is predis-
teach the patient about (select all that
posed to infection from the normal body
apply)?
flora, other people, and uncooked meats,
A. Strict hand washing
seafood, eggs, unwashed fruits and veg-
B. Daily nasal swabs for culture
etables, and fresh flowers or plants. The
C. Monitor temperature every hour.
private room with HEPA filtration reduces
D. Daily skin care and oral hygiene
the aerosolized pathogens in the pa-
E. Encourage eating all foods to increase
tient's room. Blood cultures and antibiot-
nutrients.
ic treatment are used when the patient
F. Private room with a high-efficiency
has a temperature of 100.4° F or more,
particulate air (HEPA) filter
but temperature is not monitored every
hour.
B. Attaining remission
Attaining remission is the initial goal

of collaborative care for leukemia. The
methods to do this are decided based
A 57-year-old patient has been diag-
on age and cytogenetic analysis. The
nosed with acute myelogenous leukemia
treatments include leukapheresis or hy-
(AML). The nurse explains to the pa-
droxyurea to reduce the WBC count
tient that collaborative care will focus on
and risk of leukemia-cell-induced throm-
what?
bosis. A combination of chemotherapy
A. Leukapheresis
agents will be used for aggressive treat-
B. Attaining remission
ment to destroy leukemic cells in tis-
C. One chemotherapy agent
sues, peripheral blood, and bone mar-
D. Waiting with active supportive care
row and minimize drug toxicity. In non-
symptomatic patients with chronic lym-
phocytic leukemia (CLL), waiting may be
done to attain remission, but not with
AML.
D. Treatment type and expected side ef-
The patient is being treated for
fects
non-Hodgkin's lymphoma (NHL). What
should the nurse first teach the patient
The patient should first be taught about
about the treatment?
the type of treatment and the expected
A. Skin care that will be needed
and potential side effects. Nursing care
B. Method of obtaining the treatment
is related to the area affected by the
11 / 13
Hematology NCLEX
disease and treatment. Skin care will be
C. Gastrointestinal tract effects of treat- affected if radiation is used. Not all pa-
ment tients will have gastrointestinal tract ef-
D. Treatment type and expected side effects of NHL or treatment. The method
fects of obtaining treatment will be included in
the teaching about the type of treatment.
A. Multiple myeloma
The patient is admitted with hypercal-
Multiple myeloma typically manifests
cemia, polyuria, and pain in the pelvis,
with skeletal pain and osteoporosis that
spine, and ribs with movement. Which
may cause hypercalcemia, which can
hematologic problem is likely to display
result in polyuria, confusion, or cardiac
these manifestations in the patient?
problems. Serum hyperviscosity syn-
A. Multiple myeloma
drome can cause renal, cerebral, or
B. Thrombocytopenia
pulmonary damage. Thrombocytopenia,
C. Megaloblastic anemia
megaloblastic anemia, and myelodys-
D. Myelodysplastic syndrome
plastic syndrome are not characterized
by these manifestations.
B. Maintain oxygenation.
A patient who has sickle cell disease has
developed cellulitis above the left ankle. Maintaining oxygenation is a priority as
What is the nurse's priority for this pa- sickling episodes are frequently trig-
tient? gered by low oxygen tension in the blood
A. Start IV fluids. which is commonly caused by an infec-
B. Maintain oxygenation. tion. Antibiotics to treat cellulitis, pain
C. Maintain distal warmth. control, and fluids to reduce blood vis-
D. Check peripheral pulses. cosity will also be used, but oxygenation
is the priority.
C. Macroangiopathic or microangiopath-
The nurse knows that hemolytic anemia ic factors
can be caused by which extrinsic fac-
tors? Macroangiopathic or microangiopathic
A. Trauma or splenic sequestration crisis extrinsic factors lead to acquired he-
B. Abnormal hemoglobin or enzyme de- molytic anemias. Trauma or splenic se-
ficiency questration crisis can lead to anemia
C. Macroangiopathic or microangiopath- from acute blood loss. Abnormal hemo-
ic factors globin or enzyme deficiency are intrinsic
factors that lead to hereditary hemolytic
12 / 13
Hematology NCLEX
anemias. Chronic diseases or medica-
D. Chronic diseases or medications and tions and chemicals can decrease the
chemicals number of RBC precursors which reduce
RBC production.
13 / 13

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NCLEX - Pediatrics - Hematology

Study online at https://quizlet.com/_931e9g

Rationale: Hemophilia refers to a group

Rationale: ²-Thalassemia is an autoso-

Rationale: Sickle cell crises are acute

A 10-year-old child with hemophilia A Rationale: Hemophilia refers to a group

Rationale: In iron deficiency anemia, iron

Rationale:Sickle cell anemia is one of

Rationale: Sickle cell disease is a

Rationale: Sickle cell anemia is a

Rationale: The female offspring of an af-

An 11-year-old child is admitted to the Rationale: During vaso-occlusive sickle

Rationale: Increased fluid volume re-

Rationale: Establishment of an age-ap-

Rationale: Intravenous fluid and in-

The patient is diagnosed with chronic

The nurse is reviewing the laboratory re-

-limiting the time with the client to 1 hour

-call the health care provider (HCP)

-to examine the testicles while lying

-measure abdominal girth

-age younger than 50 years

-clamp the surgical drain

-the passage of flatus the passage of flatus

-placing cool compresses on the affect-

-at the onset of menstruation

You are preparing the client for a bone

Neutropenia, a condition involving the ANS 1, 2, 3, 5

Rationale: The normal reticulocyte value

Iggy ch 39 8th edition

Rationale: The leukemia is progressing

Removal of the spleen causes reduced

Iggy ch 39 8th edition

Having the client provide a list of items

Iggy ch 39 8th edition

#10 A newly admitted client has an ele- An elevated reticulocyte count in an

Iggy ch 39 8th edition

#12 The nurse is teaching a client about It is accurate to describe a crunching

Iggy ch 39 8th edition

Iggy ch 39 8th edition

Prevention and early detection strate-

Iggy ch 40 8th edition

It is critical to have others help the ane-

Iggy ch 40 8th edition

Hemolytic transfusion reactions are

Iggy ch 40 8th edition

Reduced production of blood cells in

Iggy ch 40 8th edition

A patient with chemotherapy-related Leukocytosis is an adverse effect of fil-

La Charity Prioritization, Delegation, and

An INR of 2 to 3 is the goal for patients

La Charity Prioritization, Delegation, and

Saunders Comprehensive Review for

Microcytic normochromic anemias in-

Saunders Comprehensive Review for

f A true vegan may be at risk for certain

Khan Academy NCLEX-RN questions

f In aplastic anemia, the bone marrow

Khan Academy NCLEX-RN questions

Most of the iron absorbed in the body

Lehne's Pharmacology for Nursing Care,

To reduce the risk of a fatal anaphylac-

Lehne's Pharmacology for Nursing Care,