Hematologic Disorders

1. The following are appropriate nursing interventions for a client with polycythemia vera except:
A. Increase fluid intake
B. Monitor for signs and symptoms of thromboembolism
C. Advice to avoid high altitude
D. Place in isolation

2. The client has been diagnosed to have iron deficiency anemia. The following are appropriate nursing
interventions when administering iron therapy:
A. Administer oral iron after meals
B. Administer oral iron with antacid
C. Inform the client that his stools will be dark green or black
D. Advise the client to increase his fluid intake

3. The client is suspected to have pernicious anemia. He will undergo Schilling’s test. The specimen to be
collected is:
A. blood by venipuncture
B. stool specimen
C. 24-hour urine specimen
D. arterial blood

4. Which of the following statements made by the client with pernicious anemia indicates the need for
further teaching?
A. “I will have to take vitamin B12 tablets for lifetime”
B. “I will have to take vitamin B12 injections for lifetime”
C. “I will have a physical examination every six months”
D. “I will have blood transfusions as necessary”

5. The client had been diagnosed to have aplastic anemia. Which of the following statements of the
client needs further teaching?
A. “I will brush my teeth with a soft-bristled toothbrush”
B. “I will avoid eating raw fruits and vegetables”
C. “I am allowed to go and watch a basketball game”
D. “I have to avoid people with cough and colds”

6. Iron dextran (Imferon) IM has been ordered to the patient with iron- deficiency anemia. This
medication should be administered:
A. Intradermally
B. Subcutaneously
C. Z-track
D. Intravenously

7. A priority nursing diagnosis for a client with iron deficiency anemia would be:
A. Fluid volume Excess related to anemia
B. Self-care deficit related to fatigue
C. Alteration in Nutrition related to anemia
D. Inadequate Home Maintenance related to immobility

8. The nurse should instruct the client to eat which of the following foods to obtain the best supply of
vitamin B12?
A. Fresh fruits
B. Meat and dairy products
C. Green leafy vegetable
D. Whole-wheat bread and cereals

9. Mrs. Jane Sy, 60 years old, is seen in the physician’s office because of symptoms suggestive of
pernicious anemia. Which of these symptoms is associated with pernicious anemia?
A. Bleeding tendency
B. Painful joints
C. Peripheral neuropathy
D. Digestive complaints

10. Mrs. Sy asks the nurse, “What is a Schillings test?” which of these responses by the nurse is correct?
A. “It will demonstrate if ingested vitamin B12 is being absorbed”
B. “It will evaluate if foods you have eaten have vitamin B12 content”
C. “It will determine if Vitamin B12 is circulating through the capillaries”
D. “It will reveal the availability of vitamin B12 in muscle tissue”

11. Following the bone marrow aspiration procedure to a client suspected of having aplastic anemia, the
nurse applies a pressure dressing and asked the patient to:
A. Assume a sitting position
B. Lie in a prone position
C. Lie a recumbent position
D. Turn and cough periodically

12. The clinical symptoms of polycythemia vera are pruritus, ruddy complexion, dizziness, headache, and
angina. These symptoms are due to:
A. Increased blood viscosity and volume
B. Iron deficiency anemia
 C. Insidious blood test
D. Hemoglobin concentration

13. Which assessment finding is not a characteristic clinical manifestation of polycythemia vera?
A. Splenomegaly
B. Plethora
C. Elevated temperature (over 37.8)
D. Pruritus

14. Which of the following symptoms are classic for thrombocytopenia?

A. Weakness and fatigue
B. Dizziness and vomiting
C. Bruising and petechiae
D. Light- headedness and nausea

15. The nurse is preparing to administer a unit of blood to a client who's anemic. After its removal from
the refrigerator, the blood should be administered within:
A. 1 hour
B. 2 hours
C. 4 hours
D. 6 hours

16. The client with chronic myelocytic leukemia will receive a blood transfusion. Which of the following is
inappropriate nursing action?
A. Check cross matching and blood typing before administration of blood transfusion
B. Administer lactated ringers in dextrose 5% as “piggyback”
C. Use blood transfusion set with filter
D. Obtain initial vital signs

17. For which of the following conditions is a client who has just an appendectomy most at risk?
A. Anemia
B. Polycythemia
C. Purpura
D. Thrombocytopenia

18. A client with blood disorders has neutropenia. Which of the following functions must be frequently
assessed?
A. Blood pressure
B. Bowel sounds
C. Heart sounds
D. Breath sounds

19. Which of the following symptoms is the primary clinical manifestation of hemophilia?
A. Petechiae
B. Prolonged bleeding
C. Decrease clotting time
D. Decrease white blood cell count

20. Which of the following areas is the most frequent site of internal bleeding associated with hemophilia?
A. Brain tissue
B. GI tract
C. Joint cavities
D. Spinal cord

21. Which of the following measures should parents of a hemophilic child be taught to prepare them to
initiate immediate treatment before blood loss is excessive?
A. Apply heat to the area.
B. Don’t give factor replacement
C. Apply pressure for at least 5 minutes
D. Immobilize and elevate the affected area

22. Which of the following nursing measures should be implemented for a client with von Willebrand’s
disease who is having epistaxis?
A. Lying the child supine
B. Avoid packing the nostrils
C. c. Avoid pressure to the nose
D. Applying ice to the brides of the nose

23. Which of the following complications are the three main consequences of leukemia?
A. Bone deformities, anemia, and infection
B. Anemia, infection, and bleeding tendencies
C. Pneumonia, thrombocytopenia, and alopecia
D. Polycythemia, decrease clotting time, and infection

24. Which of the following assessment findings in a client with leukemia would indicate that cancer has
invaded the brain?
A. Headache and vomiting
B. Restlessness and tachycardia
C. Normal level of consciousness
D. Increased heart rate and decreased blood pressure
25. Which of the following intervention is a priority for a hemophiliac child who has fallen and badly
bruised his leg?
A. Appropriate dose of aspirin ad rest
B. Immobilization of the leg and a dose of ibuprofen
C. Heating pad and administration of factor VIII concentrate
D. Pressure on the site and administration of factor VIII concentrate

26. A four-year-old child is admitted to the pediatric unit with a diagnosis of a sickle-cell crisis. Which of
the following actions should receive the highest priority while caring for the child?
A. Hydration
B. Elimination
C. Mobility
D. Oxygenation

27. After 30 minutes of blood transfusion to a child, the child’s cheeks are flushed and he has hives on his
abdomen and lower extremities. Which should the nurse do first?
A. Continue to monitor for any increase in the symptoms.
B. Stop the transfusion and begin an IV infusion of normal saline.
C. Check the child’s vital signs and notify the physician immediately
D. Contact the blood bank to double-check the blood type

28. A ten-year-old child with hemophilia cuts his hands while working on a craft project in the hospital
playroom. The initial nursing action to take is.
A. Apply pressure to the bleeding area for at least 10-15 minutes
B. Apply an ice pack
C. Cover the wound with a sterile dressing
D. Notify the physician immediately

29. The nurse is caring for a client with thrombocytopenia. What is the best way to protect this client?
A. Limit visits by family members.
B. Encourage the client to use a wheelchair.
C. Use the smallest needle possible for injections.
D. Maintain accurate fluid intake and output records.

30. The nurse is caring for a 32-year-old client admitted with pernicious anemia. Which set of findings
should the nurse expect when assessing the client?
A. Pallor, bradycardia, and reduced pulse pressure
B. Pallor, tachycardia, and a sore tongue
C. Sore tongue, dyspnea, and weight gain
D. Angina, double vision, and anorexia

31. A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are
characteristic of iron deficiency anemia?
A. Nights sweats, weight loss, and diarrhea
B. Dyspnea, tachycardia, and pallor
C. Nausea, vomiting, and anorexia
D. Itching, rash, and jaundice

32. A client has had heavy menstrual bleeding for 6 months. Her gynecologist diagnoses microcytic
hypochromic anemia and prescribes ferrous sulfate (Feosol), 300 mg P.O. daily. Before initiating iron
therapy, the nurse reviews the client's medical history. Which condition would contraindicate the use
of ferrous sulfate?
A. Pregnancy
B. Asthma
C. Ulcerative colitis
D. Severely impaired liver function

33. A complete blood count is commonly performed before a client goes into surgery. What does this test
seek to identify?
A. Potential hepatic dysfunction indicated by decreased blood urea nitrogen (BUN) and
creatinine levels
B. Low levels of urine constituents normally excreted in the urine
C. Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels
D. Electrolyte imbalance that could affect the blood's ability to coagulate properly

34. Which of the following would the nurse identify as an abnormal finding?
A. Red blood cells (RBCs): 4 million/mm3
B. Platelets: 200,000/mm3
C. White blood cells (WBCs): 7,000/mm3
D. Hematocrit: 45%

35. A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct
the client to:
A. lie supine with his neck extended.
B. sit upright, leaning slightly forward.
C. blow his nose and then put lateral pressure on his nose.
D. hold his nose while bending forward at the waist.

36. While monitoring a client for the development of disseminated intravascular coagulation (DIC), the
nurse should take note of what assessment parameters?
A. Platelet count, prothrombin time, and partial thromboplastin time
B. Platelet count, blood glucose levels, and white blood cell (WBC) count
C. Thrombin time, calcium levels, and potassium levels
D. Fibrinogen level, WBC, and platelet count