N4 test Interventions 4 Blood Probs

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 4th Edition

Self-Assessment Questions

Chapter 40: Interventions for Clients with Hematologic Problems


1. Which client problem is common to all types of anemia, regardless of cause?

A. Increased risk for bleeding
B. Fatigue/activity intolerance
C. Impaired blood clotting
D. Weight loss

2. The client with anemia from sickle cell disease asks you what causes this disease. What is your best response?

A. “A pair of genes you inherited makes defective hemoglobin which causes your red blood cells to die off faster than normal.”
B. “Your body doesn’t recognize your red blood cells as belonging to you and makes antibodies that destroy them.”
C. “A gene you inherited doesn’t allow you to make an important enzyme that is responsible for keeping enough iron in your red blood cells.”
D. “The actual cause of sickle cell disease is unknown but it appears that exposure to some chemicals, like benzene or chemotherapy, poisons the bone marrow.”

3. What is the priority nursing diagnosis for the adult client with sickle cell disease admitted to the hospital in crisis?

A. Acute pain related to tissue hypoxia
B. Activity intolerance related to dyspnea
C. Risk for impaired skin integrity related to hypoxia
D. Knowledge deficiency related to risk factors for sickle cell crisis

4. The client who is a vegetarian is diagnosed with iron deficiency anemia. Selecting which menu items for breakfast indicates an adequate understanding of nonmeat food sources of iron?

A. Milk, orange juice, and oatmeal
B. Coffee, grapefruit, and yogurt
C. Tea, eggs, and whole-wheat raisin toast
D. Tomato juice and mushroom and cheese omelet made with egg substitute

5. The client is receiving injections of epoetin alfa to offset the anemia present after bone marrow transplantation. What assessment parameter should be monitored for possible side effects of this therapy?

A. Abdominal girth
B. Blood pressure
C. Urine amount and color
D. Occult blood in the stool

6. What is the pathologic mechanism involved in hemolytic anemia?

A. Decreased intake of iron
B. Decreased bone marrow production of red blood cells
C. Increased (excessive) metabolic demand for oxygen
D. Increased rate of red blood cell destruction

7. How are malignant lymphomas different from the leukemias?

A. Leukemias are more common among women and lymphomas are more common among men.
B. Lymphomas usually resolve spontaneously and leukemias are always fatal without treatment.
C. Lymphomas form solid tumors and leukemias are cellular suspensions within the blood.
D. Leukemias represent cancer of the white blood cells and lymphomas represent cancer of the red blood cells.

8. In exploring risk factors for the client newly diagnosed with acute leukemia, what question should you ask?

A. “When did you last receive a flu shot?”
B. “How often do you experience serious nosebleeds?”
C. “Have any other members of your family ever had leukemia?”
D. “Are you exposed to any chemicals with your job or hobbies?”

9. The client being treated for leukemia is neutropenic and has a temperature of 100° F. What is your best first action?

A. Obtain a specimen of urine and sputum for culture.
B. Administer the prescribed antipyretic agent.
C. Document the findings as the only action.
D. Notify the physician.

10. What is the purpose of maintenance chemotherapy for acute leukemia?

A. Reinducing a remission after the client has relapsed.
B. Maintaining the remission initiated by induction chemotherapy.
C. Curing the leukemia by achieving a rapid, complete remission.
D. Curing the leukemia by providing chemotherapy after radiation therapy has induced a remission.

11. Which intervention for the client with leukemia would be effective in preventing autocontamination-induced infection?

A. Washing hands thoroughly with an antimicrobial soap upon entering the client’s room.
B. Assisting the client to perform oral hygiene every four hours with antimicrobial rinses.
C. Keeping supplies for the client separate from supplies for other clients.
D. Limiting visitors to healthy adults.

12. Which nursing intervention prevents injury in the client with thrombocytopenia?

A. Avoid taking rectal temperatures.
B. Measuring abdominal girth every eight hours.
C. Encouraging fluid intake of at least 3000 mL/day.
D. Washing hands thoroughly upon entering the client’s room

13. Which precaution has the highest priority for instruction of the female client going home with thrombocytopenia?

A. Be sure to use a condom during intercourse.
B. Apply heat immediately to any injured area.
C. Avoid walking with bare feet even when you are indoors.
D. Weigh yourself daily at the same time, wearing the same clothing.

14. Which special precaution or technique should you use when administering a platelet transfusion?

A. Avoid using a standard blood transfusion tubing set.
B. Administer the product slowly, over at least two hours.
C. Stop the transfusion immediately if the client develops a fever.
D. Avoid administration of opioids for one hour before, during, and one hour after a platelet transfusion.

15. Which complication of transfusion therapy is more common among older adult clients?

A. Bleeding at the transfusion site
B. Allergic transfusion reactions
C. Pulmonary edema
D. Hives