Hematologic Management
The client with digoxin toxicity
Hematologic Problems
1. You are reviewing the complete blood count (CBC) for a
client who has been admitted for knee arthroscopy. Which
value is most important to report to the physician prior to
surgery?
White blood cell count 16,000/mm3
Hematocrit 33%
Platelet count 426,000/ mm3
Hemoglobin 10.9 g/dL
2. A new RN is preparing to administer packed red blood cells
(PRBCs) to a client whose anemia was caused by blood loss
after surgery. Which action by the new RN requires that you,
as charge nurse, intervene immediately?
The new RN waits 20 minutes after obtaining the PRBCs
before starting the infusion.
The new RN starts an intravenous line for the transfusion
using a 22-gauge catheter.
The new RN primes the transfusion set using 5% dextrose in
lactated Ringer’s solution.
The new RN tells the client that the PRBCs may cause a
serious transfusion reaction.
3. A 32-year-old client with a history of sickle cell anemia is
admitted to the hospital during a sickle cell crisis. The
physician orders all of these interventions. Which order will
you implement first?
Give morphine sulfate 4-8 mg IV every hour as needed.
Start a large-gauge IV line and infuse normal saline at 200
mL/hour.
Immunize with Pneumovax and Haemophilus influenzae
vaccines.
Administer oxygen at an F102 of 100% per non-rebreather
mask.
4. A 78-year-old client admitted to the hospital with chronic
anemia caused by possible gastrointestinal bleeding has all of
these activities included in the care plan. Which activity is
best delegated to an experienced nursing assistant (NA)?
Use Hemoccult slides to obtain stool specimens.
Have the client sign a colonoscopy consent form.
Administer PEG-ES (GoLYTELY) bowel preparation.
Check for allergies to contrast dye or shellfish.
5. As charge nurse, you are making the daily assignments on
the medical-surgical unit. Which client is best assigned to a
nurse who has floated from the post-anesthesia care unit
(PACU)?
A 30-year-old client with thalassemia major who has an order
for subcutaneous infusion of deferoxamine (Desferal)
A 43-year-old client with multiple myeloma who needs
discharge teaching
A 52-year-old client with chronic gastrointestinal bleeding
who has returned to the unit after a colonoscopy
A 65-year-old client with pernicious anemia who has just
been admitted to the unit
6. You are making a room assignment for a newly arrived
client whose laboratory testing indicates pancytopenia. All of
these clients are already on the nursing unit. Which one will
be the best roommate for the new client?
The client with viral pneumonia
The client with shingles
The client with cellulitis
7. A client admitted to the hospital with a sickle cell crisis
complains of severe abdominal, hip, and knee pain. You
observe an LPN accomplishing these client care tasks. Which
one requires that you, as charge nurse, intervene
immediately?
The LPN encourages the client to use the ordered PCA.
The LPN positions cold packs on the client’s knees.
The LPN places a “No Visitors” sign on the client’s door.
The LPN checks the client’s temperature every 2 hours.
8. A 67-year-old client who is receiving chemotherapy for
lung cancer is admitted to the hospital with
thrombocytopenia. While you are taking the admission
history, the client makes these statements. Which statement
is of most concern?
“I’ve noticed that I bruise more easily since the
chemotherapy started.”
“My bowel movements are soft and dark brown in color.”
“I take one aspirin every morning because of my history of
angina.”
“My appetite has decreased since the chemotherapy
strated.”
9. Following a car accident, a client with a Medic-Alert
bracelet indicating hemophilia A is admitted to the
emergency department (ED). Which physician order should
you implement first?
Transport to radiology for C-spine x-rays.
Transfuse Factor VII concentrate.
Type and cross-match for 4 units RBCs.
Infuse normal saline at 250 mL/hour.
10.As home health nurse, you are taking an admission history
for a client who has a deep vein thrombosis and is taking
warfarin (Coumadin) 2 mg daily. Which statement by the
client is the best indicator that additional teaching about
warfarin may be needed?
“I have started to eat more healthy foods like green salads
and fruit.”
“The doctor said that it is important to avoid becoming
constipated.”
“Coumadin makes me feel a little nauseated unless I take it
with food.”
“I will need to have some blood testing done once or twice a
week.”
11.A client is admitted to the intensive car unit (ICU) with
disseminated intravascular coagulation (DIC) associated with
a gram-negative infection. Which assessment information has
the most immediate implications for the client’s care?
There is no palpable radial or pedal pulse.
The client complains of chest pain.
The client’s oxygen saturation is 87%
There is mottling of the hands and feet.
12.A 22-year-old with stage I Hodgkin’s disease is admitted to
the oncology unit for radiation therapy. During the initial
assessment, the client tells you, “Sometimes I am afraid of
dying.” Which response is most appropriate at this time?
“Many individuals with this diagnosis have some fears.”
“Perhaps you should ask the doctor about medication.”
“Tell me a little bit more about your fear of dying.”
“Most people with stage I Hodgkin’s disease survive.”
13.After receiving change-of-shift report about all of these
clients, which one will you assess first?
A 26-year-old with thalassemia major who has a short-stay
admission for a blood transfusion
A 44-year-old who was admitted 3 days previously with a
sickle cell crisis and has orders for a CT scan
A 50-year-old with newly diagnosed stage IV non-Hodgskin’s
lymphoma who is crying and stating “I’m not ready to die.”
A 69-year-old with chemotherapy-induced neutropenia who
has an elevated oral temperature
14.A long-term-care client with chronic lymphocytic leukemia
has a nursing diagnosis of Activity Intolerance related to
weakness and anemia. Which of these nursing activities is
most appropriate for you, as the charge nurse, to delegate to
a nursing assistant?
Evaluate the client’s response to normal activities of daily
living.
Check the client’s blood pressure and pulse rate after
ambulation.
Determine which self-care activities the client can do
independently.
Assist the client in choosing a diet that will improve strength.
15.A transfusion of PRBCs has been infusing for 5 minutes
when the client becomes flushed and tachypneic and says, “I
am having chills. Please get me a blanket.” Which action
should you take first?
Obtain a warm blanket for the client.
Check the client’s oral temperature.
Stop the medication.
Administer oxygen.
16.A group of clients is assigned to an RN-LPN/LVN team. The
LPN/LVN is most likely to be assigned to provide client care
and administer medications to which of these clients?
A 36-year-old client with chronic renal failure who will need a
subcutaneous injection of epoetin (Procrit)
A 39-year-old client with hemophilia B who has been
admitted for a blood transfusion
A 50-year-old client with newly diagnosed polycythemia vera
who is scheduled for phlebotomy
A 55-year-old client with a history of stem cell
transplantation who will have a bone marrow aspiration
17.You obtain the following data about a client admitted with
multiple myeloma. Which information has the most
immediate implications for the client’s care?
The client complains of chronic bone pain.
The blood uric acid level is very elevated.
The 24 hour urine shows Bence-Jones protein.
The client is unable to plantarflex the feet.
18.The nurse in the outpatient clinic is assessing a 22-year-
old with a history of a recent splenectomy after a motor
vehicle accident. Which information obtained during the
assessment will be of most immediate concern to the nurse?
The client engages in unprotected sex.
The client has an oral temperature of 99.7o F
The client has abdominal pain with light palpation.
The client admits to occasional marijuana use.
19.A client with graft-versus-host disease (GVHD) after a
bone marrow transplant is being cared for on the medical
unit. Which of these nursing activities is best delegated to a
newly graduated RN who has had a 6-week orientation to the
unit?
Administration of methotrexate and cyclosporine to the
client
Assessment of the client for signs of infection caused by
GVHD
Infusion of D5.45% normal saline at 125 mL/hour to the client
Education of the client about ways to prevent infection
20.You are the charge nurse in an oncology unit. A client with
an absolute neutrophil count (ANC) of 300/mm3 is placed in
protective isolation. Which staff member should you assign
to provide care for this client, under the supervision of an
experienced oncology RN?
An LPN who has floated from the same-day-surgery unit
An RN from the float pool who usually works on the surgical
unit
An LPN with 2 years of experience on the oncology unit
An RN who transferred recently from the ED
21.You are transferring a client with newly diagnosed chronic
myeloid leukemia to a long-term-care (LTC) facility. Which
information is most important to the LTC charge nurse prior
to transferring the client?
The Philadelphia chromosome is present in the blood smear
Glucose is elevated as a result of prednisone therapy
There has been a 20-pound weight loss over the past year
The client’s chemotherapy has resulted in neutropenia
22.A client with acute myelogenous leukemia is receiving
induction phase chemotherapy. Which assessment
information is of most concern?
Serum potassium level of 7.8 mEq/L
Urine output less than intake by 400 mL
Inflammation and redness of oral mucosa
Ecchymoses present on anterior trunk
23.A client who has been receiving cyclosporine following an
organ transplant is experiencing these symptoms. Which one
is of most concern?
Bleeding of the gums while brushing the teeth
Non-tender swelling in the right groin
Occasional nausea after taking the medication
Numbness and tingling of the feet
24.You have developed the nursing diagnosis Risk for
Impaired Tissue Integrity related to effects of radiation for a
client with Hodgkin’s lymphoma who is receiving radiation to
the groin area. Which nursing activity is best delegated to a
nursing assistant caring for the client?
Check the skin for signs of redness or peeling.
Apply alcohol-free lotion to the area after cleaning.
Explain good skin care to the client and family.
Clean the skin over daily with a mild soap.
25.After receiving the change-of-shift report, which client will
you assess first?
A 20-year-old with possible acute myelogenous leukemia
who has just arrived on the medical unit
A 38-year-old with aplastic anemia who needs teaching about
decreasing infection risk prior to discharge
A 40-year-old with lymphedema who requests help to put on
compression stockings before getting out of bed
A 60-year-old with non-Hodgkin’s lymphoma who is refusing
the ordered chemotherapy regimen
26. The nurse is preparing to teach a client with microcytic
hypochromic anemia about the diet to follow after discharge.
Which of the following foods should be included in the diet?
Eggs
Lettuce
Citrus fruits
Cheese
27. The nurse would instruct the client to eat which of the
following foods to obtain the best supply of vitamin B12?
Whole grains
Green leafy vegetables
Meats and dairy products
Broccoli and Brussels sprouts
28. The nurse has just admitted a 35-year-old female client
who has a serum B12 concentration of 800 pg/ml. Which of
the following laboratory findings would cue the nurse to
focus the client history on specific drug or alcohol abuse?
Total bilirubin, 0.3 mg/dL
Serum creatinine, 0.5 mg/dL
Hemoglobin, 16 g/dL
Folate, 1.5 ng/mL
29. The nurse understands that the client with pernicious
anemia will have which distinguishing laboratory findings?
Schilling’s test, elevated
Intrinsic factor, absent.
Sedimentation rate, 16 mm/hour
RBCs 5.0 million
30. The nurse devises a teaching plan for the patient with
aplastic anemia. Which of the following is the most important
concept to teach for health maintenance?
Eat animal protein and dark leafy vegetables each day
Avoid exposure to others with acute infection
Practice yoga and meditation to decrease stress and anxiety
Get 8 hours of sleep at night and take naps during the day
31. A client comes into the health clinic 3 years after
undergoing a resection of the terminal ileum complaining of
weakness, shortness of breath, and a sore tongue. Which
client statement indicates a need for intervention and client
teaching?
“I have been drinking plenty of fluids.”
“I have been gargling with warm salt water for my sore
tongue.”
“I have 3 to 4 loose stools per day.”
“I take a vitamin B12 tablet every day.”
32. A vegetarian client was referred to a dietician for
nutritional counseling for anemia. Which client outcome
indicates that the client does not understand nutritional
counseling? The client:
Adds dried fruit to cereal and baked goods
Cooks tomato-based foods in iron pots
Drinks coffee or tea with meals
Adds vitamin C to all meals
33. A client was admitted with iron deficiency anemia and
blood-streaked emesis. Which question is most appropriate
for the nurse to ask in determining the extent of the client’s
activity intolerance?
“What activities were you able to do 6 months ago compared
with the present?”
“How long have you had this problem?”
“Have you been able to keep up with all your usual
activities?”
“Are you more tired now than you used to be?”
34.The primary purpose of the Schilling test is to measure the
client’s ability to:
Store vitamin B12
Digest vitamin B12
Absorb vitamin B12
Produce vitamin B12
35. The nurse implements which of the following for the
client who is starting a Schilling test?
Administering methylcellulose (Citrucel)
Starting a 24- to 48 hour urine specimen collection
Maintaining NPO status
Starting a 72 hour stool specimen collection
36. A client with pernicious anemia asks why she must take
vitamin B12 injections for the rest of her life. What is the
nurse’s best response?
“The reason for your vitamin deficiency is an inability to
absorb the vitamin because the stomach is not producing
sufficient acid.”
“The reason for your vitamin deficiency is an inability to
absorb the vitamin because the stomach is not producing
sufficient intrinsic factor.”
“The reason for your vitamin deficiency is an excessive
excretion of the vitamin because of kidney dysfunction.”
“The reason for your vitamin deficiency is an increased
requirement for the vitamin because of rapid red blood cell
production.”
37. The nurse is assessing a client’s activity intolerance by
having the client walk on a treadmill for 5 minutes. Which of
the following indicates an abnormal response?
Pulse rate increased by 20 bpm immediately after the activity
Respiratory rate decreased by 5 breaths/minute
Diastolic blood pressure increased by 7 mm Hg
Pulse rate within 6 bpm of resting phase after 3 minutes of
rest.
38. When comparing the hematocrit levels of a post-op
client, the nurse notes that the hematocrit decreased from
36% to 34% on the third day even though the RBC and
hemoglobin values remained stable at 4.5 million and 11.9
g/dL, respectively. Which nursing intervention is most
appropriate? Bleeding tendencies
Intake and output
Check the dressing and drains for frank bleeding Peripheral sensation
Call the physician Bowel function
Continue to monitor vital signs 46. Which of the following blood components is decreased in
Start oxygen at 2L/min per NC anemia?
39. A client is to receive epoetin (Epogen) injections. What
laboratory value should the nurse assess before giving the Erythrocytes
injection? Granulocytes
Leukocytes
Hematocrit Platelets
Partial thromboplastin time 47. A client with anemia may be tired due to a tissue
Hemoglobin concentration deficiency of which of the following substances?
Prothrombin time
40. A client states that she is afraid of receiving vitamin B12 Carbon dioxide
injections because of the potential toxic reactions. What is Factor VIII
the nurse’s best response to relieve these fears? Oxygen
T-cell antibodies
“Vitamin B12 will cause ringing in the eats before a toxic level 48. Which of the following cells is the precursor to the red
is reached.” blood cell (RBC)?
“Vitamin B12 may cause a very mild skin rash initially.”
“Vitamin B12 may cause mild nausea but nothing toxic.” B cell
“Vitamin B12 is generally free of toxicity because it is water Macrophage
soluble.” Stem cell
41. A client with microcytic anemia is having trouble T cell
selecting food items from the hospital menu. Which food is 49. Which of the following symptoms is expected with
best for the nurse to suggest for satisfying the client’s hemoglobin of 10 g/dl?
nutritional needs and personal preferences?
None
Egg yolks Pallor
Brown rice Palpitations
Vegetables Shortness of breath
Tea 50. Which of the following diagnostic findings are most likely
42. A client with macrocytic anemia has a burn on her foot for a client with aplastic anemia?
and states that she had been watching television while lying
on a heating pad. What is the nurse’s first response? Decreased production of T-helper cells
Decreased levels of white blood cells, red blood cells, and
Assess for potential abuse platelets
Check for diminished sensations Increased levels of WBCs, RBCs, and platelets
Document the findings Reed-Sternberg cells and lymph node enlargement
Clean and dress the area 51. A client with iron deficiency anemia is scheduled for
43. Which of the following nursing assessments is a late discharge. Which instruction about prescribed ferrous
symptom of polycythemia vera? gluconate therapy should the nurse include in the teaching
plan?
Headache
Dizziness “Take the medication with an antacid.”
Pruritus “Take the medication with a glass of milk.”
Shortness of breath “Take the medication with cereal.”
44. The nurse is teaching a client with polycythemia vera “Take the medication on an empty stomach.”
about potential complications from this disease. Which 52. Which of the following disorders results from a
manifestations would the nurse include in the client’s deficiency of factor VIII?
teaching plan? Select all that apply.
Sickle cell disease
Hearing loss Christmas disease
Visual disturbance Hemophilia A
Headache Hemophilia B
Orthopnea 53. The nurse explains to the parents of a 1-year-old child
Gout admitted to the hospital in a sickle cell crisis that the local
Weight loss tissue damage the child has on admission is caused by which
45. When a client is diagnosed with aplastic anemia, the of the following?
nurse monitors for changes in which of the following
physiological functions? Autoimmune reaction complicated by hypoxia
Lack of oxygen in the red blood cells
Obstruction to circulation
Elevated serum bilirubin concentration.
54. The mothers asks the nurse why her child’s hemoglobin
was normal at birth but now the child has S hemoglobin.
Which of the following responses by the nurse is most
appropriate?
“The placenta bars passage of the hemoglobin S from the
mother to the fetus.”
“The red bone marrow does not begin to produce
hemoglobin S until several months after birth.”
“Antibodies transmitted from you to the fetus provide the
newborn with temporary immunity.”
“The newborn has a high concentration of fetal hemoglobin
in the blood for some time after birth.”
55. Which of the following would the nurse identify as the
priority nursing diagnosis during a toddler’s vasoocclusive
sickle cell crisis?
Ineffective coping related to the presence of a life-
threatening disease
Decreased cardiac output related to abnormal hemoglobin
formation
Pain related to tissue anoxia
Excess fluid volume related to infection
56. A mother asks the nurse if her child’s iron deficiency
anemia is related to the child’s frequent infections. The nurse
responds based on the understanding of which of the
following?
Little is known about iron-deficiency anemia and its
relationship to infection in children.
Children with iron deficiency anemia are more susceptible to
infection than are other children.
Children with iron-deficiency anemia are less susceptible to
infection than are other children.
Children with iron-deficient anemia are equally as susceptible
to infection as are other children.
57. Which statements by the mother of a toddler would lead
the nurse to suspect that the child has iron-deficiency
anemia? Select all that apply.
“He drinks over 3 cups of milk per day.”
“I can’t keep enough apple juice in the house; he must drink
over 10 ounces per day.”
“He refuses to eat more than 2 different kinds of vegetables.”
“He doesn’t like meat, but he will eat small amounts of it.”
“He sleeps 12 hours every night and take a 2-hour nap.”
58. Which of the following foods would the nurse encourage
the mother to offer to her child with iron deficiency anemia?
Rice cereal, whole milk, and yellow vegetables
Potato, peas, and chicken
Macaroni, cheese, and ham
Pudding, green vegetables, and rice
59. The physician has ordered several laboratory tests to
help diagnose an infant’s bleeding disorder. Which of the
following tests, if abnormal, would the nurse interpret as
most likely to indicate hemophilia?
Bleeding time
Tourniquet test
Clot retraction test
Partial thromboplastin time (PTT)
60. Which of the following assessments in a child with
hemophilia would lead the nurse to suspect early
hemarthrosis?
Child’s reluctance to move a body part
Cool, pale, clammy extremity
Eccymosis formation around a joint
Instability of a long bone in passive movement
61. Because of the risks associated with administration of
factor VIII concentrate, the nurse would teach the client’s
family to recognize and report which of the following?
Yellowing of the skin
Constipation
Abdominal distention
Puffiness around the eyes
62. A child suspected of having sickle cell disease is seen in a
clinic, and laboratory studies are performed. A nurse checks
the lab results, knowing that which of the following would be
increased in this disease?
Platelet count
Hematocrit level
Reticulocyte count
Hemoglobin level
63. A clinic nurse instructs the mother of a child with sickle
cell disease about the precipitating factors related to pain
crisis. Which of the following, if identified by the mother as a
precipitating factor, indicates the need for further
instructions?
Infection
Trauma
Fluid overload
Stress
64. Laboratory studies are performed for a child suspected of
having iron deficiency anemia. The nurse reviews the
laboratory results, knowing that which of the following
results would indicate this type of anemia?
An elevated hemoglobin level
A decreased reticulocyte count
An elevated RBC count
Red blood cells that are microcytic and hypochromic
65. A pediatric nurse health educator provides a teaching
session to the nursing staff regarding hemophilia. Which of
the following information regarding this disorder would the
nurse plan to include in the discussion?
Hemophilia is a Y linked hereditary disorder
Males inherit hemophilia from their fathers
Females inherit hemophilia from their mothers
Hemophilia A results from a deficiency of factor VIII
Answers and Rationales
1. ANSWER A – An elevation in white blood cells may
indicate that the client has an infection, which would
likely require rescheduling of the surgical procedure.
The other values are slightly abnormal, but would not
be likely to cause post-operative problems for a knee
arthroscopy. Focus: Prioritization
2. ANSWER C – Normal saline, an isotonic solution,
should be used when priming the IV line to avoid
causing hemolysis of RBCs. Ideally, blood products
should be infused as soon as possible after they are
obtained; however, a 20-minute delay would not be
unsafe. Large-gauge IV catheters are preferable for
blood administration; if a smaller catheter must be
used, normal saline may be used to dilute the RBCs.
Although it is appropriate to instruct clients to notify
the nurse if symptoms of a transfusion reaction such as
shortness of breath or chest pain occur, it will cause
unnecessary anxiety to indicate that a serious reaction
is likely to occur. Focus: Prioritization
3. ANSWER D – Hypoxia and deoxygenation of the red
blood cells are the most common cause of sickling, so
administration of oxygen is the priority intervention
here. Pain control and hydration are also important
interventions for this client and should be
accomplished rapidly. Vaccination may help prevent
future sickling episodes by decreasing the risk of
infection, but it will not help with the current sickling
crisis. Focus: Prioritization
4. ANSWER A – An experienced nursing assistant would
have been taught how to obtain a stool specimen for
the Hematoccult slide test, because this is a common
screening test for hospitalized clients. Having the client
sign an informed consent should be done by the
physician who will be doing the colonoscopy.
Administration of medications and checking for
allergies are within the scope of practice for licensed
nursing staff. Focus: Delegation
5. ANSWER C – A nurse who works in the PACU will be
familiar with the monitoring needed for a client who
has just returned from a procedure like a colonoscopy,
which requires conscious sedation. The other clients
require more experience with various types of
hematologic disorders and would be better to assign to
nursing staff who regularly work on the medical –
surgical unit. Focus: Prioritization
6. ANSWER A – Clients with pancytopenia are at higher
risk for infection. The client with digoxin toxicity
presents the least risk of infecting the new client. Viral
pneumonia, shingles, and cellulites are infectious
processes. Focus: Prioritization
7. ANSWER B – The joint pain that occurs in sickle cell
crisis is caused by obstruction to blood flow by the
sickled red blood cells. The appropriate therapy for this
client would be application of moist heat to the joints
to cause vasodilation and improve circulation. Because
control of pain is a priority during sickle cell crisis,
there is no need to restrict all visitors or to check the
temperature every 2 hours. Focus: Prioritization
8. ANSWER C – Because aspiring will decrease platelet
aggregation, clients with thrombocytopenia should not
use aspirin routinely. Client teaching about his should
be included in the care plan. Bruising is consistent with
the client’s admission problem of thrombocytopenia.
Soft, dark brown stools indicate that there is no frank
blood in the bowel movements. A decrease in appetite
is common with chemotherapy, and more assessment
is indicated. Focus: Prioritization
9. ANSWER B – When a hemophiliac client is at high risk
for bleeding, for example, after a motor vehicle
accident, the priority intervention is to maximize the
availability of clotting factors. The other orders also
should be implemented rapidly, but do not have as
high a priority. Focus: Prioritization
10. ANSWER A – Clients taking warfarin are advised to
avoid making sudden diet changes, because changing
the oral intake of foods high in vitamin K (such as
green leafy vegetables and some fruits) will have an
impact on the effectiveness of the medication. The
other statements suggest that further teaching may be
indicated, but more assessment for teaching needs is
indicated first. Focus: Prioritization
11. ANSWER C – Because the decrease in oxygen
saturation will have the greatest immediate effect on
all body systems, improvement in oxygenation should
be the priority goal of care. The other data also
indicate the need for rapid intervention, but
improvement of oxygenation is the most urgent need.
Focus: Prioritization
12. ANSWER C – Most assessment about what the client
means is needed before any interventions can be
planned or implemented. All of the other statements
indicate a conclusion that the client is afraid of dying of
Hodgkin’s disease. Focus: Prioritization
13. ANSWER D – Any temperature elevation in a
neutropenic client may indicate the presence of a life-
threatening infection, so actions such as blood cultures
and antibiotic administration should be initiated
quickly. The other clients need to e assessed as soon as
possible, but are not critically ill. Focus: Prioritization
14. ANSWER B – Nursing assistant education include
routine nursing skills such as assessment of vital signs.
Evaluation, baseline assessment of client abilities, and
nutrition planning are roles appropriate to RN practice.
15. ANSWER C – The client’s symptoms indicate that a
transfusion reaction may be occurring so the first
action should be to stop the transfusion. Chills are an
indication of a febrile reaction, so warming the client is
not appropriate. Checking the client’s temperature and
administration of oxygen are also appropriate actions
if a transfusion reaction is suspected; however,
stopping the transfusion is the priority. Focus:
Prioritization
16. ANSWER A – Subcutaneous administration of epoetin
is within the LPN/LVN scope of practice. The other
clients require skills (blood transfusion and client
teaching about phlebotomy and bone marrow
aspiration) that are more appropriate to RN-level
practice. Focus: Assignment
17. ANSWER D – The lack of plantar flexion may indicate
spinal cord compression, which should be evaluated
and treated immediately by the physician to prevent
further loss of function. While chronic bone pain,
hyperuricemia, and the presence of Bence-Jones
protein in the urine all are typical Focus: Prioritization
18. ANSWER B – Because the spleen has an important role
in the phagocytosis of microorganisms, the client is at
higher risk for severe infection after a splenectomy.
Medical therapy, such as antibiotic administration, is
usually indicated for any symptoms of infection. The
other information also indicates the need for more
assessment and intervention, but prevention and
 treatment of infection are the highest priorities for this
client. Focus: Prioritization
19. ANSWER C – Infusion of IV fluids is indicated in RN
education, and the new RN would also have had
experience with this as part of an orientation to the
medical unit. Administration of potent
immunosuppressive medications, assessment for
subtle indications of infection, and client teaching are
more complex tasks that should be delegated to more
experienced RN staff members. Focus:Delegation
20. ANSWER C – Because many aspects of nursing care
need to be modified to prevent infection when a client
has a low ANC, care should be provided by the staff
member with the most experience with neutropenic
clients. The other staff members have the education
required to care for this client, but are not as clinically
experienced. When making acute care client
assignments for LPN staff members, they must work
under the supervision of an RN. The LPN in this case
would report to the RN assigned to the client. Focus:
Assignment
21. ANSWER D – The neutropenic client is at increased risk
for infection, so the LTC charge nurse needs to know
this in order to make decisions about the client room
assignment and to plan care. The other information
also will impact on planning for client care, but the
charge nurse needs the information about neutropenia
before the client is transferred. Focus: Prioritization
22. ANSWER A – Fatal hyperkalemia may be caused by
tumor lysis syndrome, a potentially serious
consequence of chemotherapy in acute leukemia. The
other symptoms also indicate a need for further
assessment or intervention, but are not as critical as
the elevated potassium level. Focus: Prioritization
23. ANSWER B – A non-tender swelling in this area (or near
any lymph node) may indicate that he client has
developed lymphoma, a possible adverse effect of
immunosuppressive therapy. The client should receive
further evaluation immediately. The other symptoms
may also indicate side effects of cyclosporine (gingival
hyperplasia, nausea, paresthesia) but do not indicate
the need for immediate action. Focus: Prioritization
24. ANSWER D – Skin care is included in nursing assistant
education and job description. Assessment and client
teaching are more complex tasks that should be
delegated to registered nurses. Use of lotions to the
irradiated area is usually avoided during radiation
therapy. Focus: Delegation
25. ANSWER A – The newly admitted client should be
assessed first, because the baseline assessment and
plan of care need to be completed. The other clients
also need assessments or interventions, but do not
need immediate nursing care. Focus: Prioritization
26. ANSWER A. One of the microcytic, hypochromic
anemias is iron-deficiency amenia. A rich source of iron
is needed in the diet, and eggs are high in iron. Other
foods high in iron include organ and muscle (dark)
meats; shellfish, shrimp, and tuna; enriched, whole-
grain, and fortified cereals and breads; legumes, nuts,
dried fruits, and beans; oatmeal; and sweet potatoes.
Dark green leafy vegetables and citrus fruits are good
sources of vitamin C. Cheese is a good source of
calcium.
27. ANSWER C. Good sources of vitamin B12 include meats
and dairy products. Whole grains are a good source of
thiamine. Green leafy vegetables are good sources of
niacin, folate, and carotenoids (precursors of vitamin
A). Broccoli and Brussels sprouts are good sources of
ascorbic acid (vitamin C).
28. ANSWER D. The normal range of folic acid is 1.8 to 9
ng/mL, and the normal range of vitamin B12 is 200 to
900 pg/mL. A low folic acid level in the presence of a
normal vitamin B12 level is indicative of a primary folic
acid-deficiency anemia. Factors that affect the
absorption of folic acid are drugs such as
methotrexate, oral contraceptives, antiseizure drugs,
and alcohol. The total bilirubin, serum creatinine, and
hemoglobin values are within normal limits.
29. ANSWER B. The defining characteristic of pernicious
anemia, a megaloblastic anemia, is lack of the intrinsic
factor, which results from atrophy of the stomach wall.
Without the intrinsic factor, vitamin B12 cannot be
absorbed in the small intestines, and folic acid needs
vitamin B12 for DNA synthesis of RBCs. The gastric
analysis was done to determine the primary cause of
the anemia. An elevated excretion of the injected
radioactive vitamin B12, which is protocol for the first
and second stage of the Schilling test, indicates that
the client has the intrinsic factor and can absorb
vitamin B12 into the intestinal tract. A sedimentation
rate of 16 mm/hour is normal for both men and
women and is a nonspecific test to detect the presence
of inflammation. It is not specific to anemias. An RBC
value of 5.0 million is a normal value for both men and
women and does not indicate anemia.
30. ANSWER B. Clients with aplastic anemia are severely
immunocompromised and at risk for infection and
possible death related to bone marrow suppression
and pancytopenia. Strict aseptic technique and reverse
isolation are important measures to prevent infection.
Although diet, reduced stress, and rest are valued in
supporting health, the potentially fatal consequence of
an acute infection places it as a priority for teaching
the client about health maintenance. Animal meat and
dark green leafy vegetables, good sources of vitamin
B12 and folic acid, should be included in the daily diet.
Yoga and meditation are good complimentary
therapies to reduce stress. Eight hours of rest and naps
are good for spacing and pacing activity and rest.
31. ANSWER D. Vitamin B12 combines with intrinsic factor
in the stomach and is then carried to the ileum, where
it is absorbed in the bloodstream. In this situation,
vitamin B12 cannot be absorbed regardless of the
amount of oral intake of sources of vitamin B12 such
as animal protein or vitamin B12 tablets. Vitamin B12
needw to be injected every month, because the ileum
has been surgically removed. Replacement of fluids
and electrolytes is important when the client has
continuous multiple loose stools on a daily basis.
Warm salt water is used to soothe sore mucous
membranes. Crohn’s disease and small bowel
resection may cause several loose stools a day.
32. ANSWER C. Coffee and tea increase gastrointestinal
mobility and inhibit the absorption of nonheme iron.
Clients are instructed to add dried fruits to dishes at
every meal because dried fruits are a nonheme or
 nonanimal iron source. Cooking in iron cookware,
especially acid-based foods such as tomatoes, adds
iron to the diet. Clients are instructed to add a rich
supply of vitamin C to every meal because the
absorption of iron is increased when food with vitamin
C or ascorbic acid is consumed.
33. ANSWER A. It is difficult to determine activity
intolerance without objectively comparing activities
from one time frame to another. Because iron
deficiency anemia can occur gradually and individual
endurance varies, the nurse can best assess the client’s
activity tolerance by asking the client to compare
activities 6 months ago and at the present. Asking a
client how long a problem has existed is a very open-
ended question that allows for too much subjectivity
for any definition of the client’s activity tolerance.
Also, the client may not even identify that a “problem”
exists. Asking the client whether he is staying abreast
of usual activities addresses whether the tasks were
completed, not the tolerance of the client while the
tasks were being completed or the resulting condition
of the client after the tasks were completed. Asking
the client if he is more tired now than usual does not
address his activity tolerance. Tiredness is a subjective
evaluation and again can be distorted by factors such
as the gradual onset of the anemia or the endurance of
the individual.
34. ANSWER C. Pernicious anemia is caused by the body’s
inability to absorb vitamin B12. This results in a lack of
intrinsic factor in the gastric juices. Schilling’s test
helps diagnose pernicious anemia by determining the
client’s ability to absorb vitamin B12.
35. ANSWER B. Urinary vitamin B12 levels are measured
after the ingestion of radioactive vitamin B12. A 24-to
48- hour urine specimen is collected after
administration of an oral dose of radioactively tagged
vitamin B12 and an injection of nonradioactive vitamin
B12. In a healthy state of absorption, excess vitamin
B12 is excreted in the urine; in a malabsorption state
or when the intrinsic factor is missing, vitamin B12 is
excreted in the feces. Citrucel is a bulk-forming agent.
Laxatives interfere with the absorption of vitamin B12.
The client is NPO 8 to 12 hours before the test but is
not NPO during the test. A stool collection is not part
of the Schilling test. If stool contaminates the urine
collection, the results will be altered.
36. ANSWER B. Most clients with pernicious anemia have
deficient production of intrinsic factor in the stomach.
Intrinsic factor attaches to the vitamin in the stomach
and forms a complex that allows the vitamin to be
absorbed in the small intestine. The stomach is
producing enough acid, there is not an excessive
excretion of the vitamin, and there is not a rapid
production of RBCs in this condition.
37. ANSWER B. The normal physiologic response to activity
is an increased metabolic rate over the resting basal
rate. The decrease in respiratory rate indicates that the
client is not strong enough to complete the mechanical
cycle of respiration needed for gas exchange. The
postactivity pulse is expected to increase immediately
after activity but by no more than 50 bpm if it is
strenuous activity. The diastolic blood pressure is
expected to rise but by no more than 15 mm Hg. The
pulse returns to within 6 bpm of the resting pulse after
3 minutes of rest.
38. ANSWER C. The nurse should continue to monitor the
client, because this value reflects a normal physiologic
response. The physician does not need to be called,
and oxygen does not need to be started based on
these laboratory findings. Immediately after surgery,
the client’s hematocrit reflects a falsely high value
related to the body’s compensatory response to the
stress of sudden loss of fluids and blood. Activation of
the intrinsic pathway and the renin-angiotensin cycle
via antidiuretic hormone produces vasoconstriction
and retention of fluid for the first 1 to 2 day post-op.
By the second to third day, this response decreases
and the client’s hematocrit level is more reflective of
the amount of RBCs in the plasma. Fresh bleeding is a
less likely occurrence on the third post-op day but is
not impossible; however, the nurse would have
expected to see a decrease in the RBC and hemoglobin
values accompanying the hematocrit.
39. ANSWER A. Epogen is a recombinant DNA form of
erythropoietin, which stimulates the production of
RBCs and therefore causes the hematocrit to rise. The
elevation in hematocrit causes an elevation in blood
pressure; therefore, the blood pressure is a vital sign
that should be checked. The PTT, hemoglobin level,
and PT are not monitored for this drug.
40. ANSWER D. Vitamin B12 is a water-soluble vitamin.
When water-soluble vitamins are taken in excess of
the body’s needs, they are filtered through the kidneys
and excreted. Vitamin B12 is considered to be
nontoxic. Adverse reactions that have occurred are
believed to be related to impurities or to the
preservative in B12 preparations. Ringing in the ears,
skin rash, and nausea are not considered to be related
to vitamin B12 administration.
41. ANSWER B. Brown rice is a source of iron from plant
sources (nonheme iron). Other sources of nonheme
iron are whole-grain cereals and breads, dark green
vegetables, legumes, nuts, dried fruits (apricots,
raisins, dates), oatmeal, and sweet potatoes. Egg yolks
have iron but it is not as well absorbed as iron from
other sources. Vegetables are a good source of
vitamins that may facilitate iron absorption. Tea
contains tannin, which combines with nonheme iron,
preventing its absorption.
42. ANSWER B. Macrocytic anemias can result from
deficiencies in vitamin B12 or ascorbic acid. Only
vitamin B12 deficiency causes diminished sensations of
peripheral nerve endings. The nurse should assess for
peripheral neuropathy and instruct the client in self-
care activities for her diminished sensation to heat and
pain. The burn could be related to abuse, but this
conclusion would require more supporting data. The
findings should be documented, but the nurse would
want to address the client’s sensations first. The
decision of how to treat the burn should be
determined by the physician.
43. ANSWER C. Pruritus is a late symptom that results
from abnormal histamine metabolism. Headache and
dizziness are early symptoms from engorged veins.
Shortness of breath is an early symptom from
 congested mucous membrane and ineffective gas
exchange.
44. ANSWER B, C, D, E. Polycythemia vera, a condition in
which too many RBCs are produced in the blood
serum, can lead to an increase in the hematocrit and
hypervolemia, hyperviscosity, and hypertension.
Subsequently, the client can experience dizziness,
tinnitus, visual disturbances, headaches, or a feeling of
fullness in the head. The client may also experience
cardiovascular symptoms such as heart failure
(shortness of breath and orthopnea) and increased
clotting time or symptoms of an increased uric acid
level such as painful swollen joints (usually the big
toe). Hearing loss and weight loss are not
manifestations associated with polycythemia vera.
45. ANSWER A. Aplastic anemia decreases the bone
marrow production of RBCs, WBCs, and platelets. The
client is at risk for bruising and bleeding tendencies. A
change in the intake and output is important, but
assessment for the potential for bleeding takes
priority. Change in the peripheral nervous system is a
priority problem specific to clients with vitamin B12
deficiency. Change in bowel function is not associated
with aplastic anemia.
46. ANSWER A. Anemia is defined as a decreased number
of erythrocytes (red blood cells). Leukopenia is a
decreased number of leukocytes (white blood cells).
Thrombocytopenia is a decreased number of platelets.
Lastly, granulocytopenia is a decreased number of
granulocytes (a type of white blood cells).
47. ANSWER C. Anemia stems from a decreased number of
red blood cells and the resulting deficiency in oxygen
and body tissues. Clotting factors, such as factor VIII,
relate to the body’s ability to form blood clots and
aren’t related to anemia, not is carbon dioxide of T
antibodies.
48. ANSWER C. The precursor to the RBC is the stem cell. B
cells, macrophages, and T cells and lymphocytes, not
RBC precursors.
49. ANSWER A. Mild anemia usually has no clinical signs.
Palpitations, SOB, and pallor are all associated with
severe anemia.
50. ANSWER B. In aplastic anemia, the most likely
diagnostic findings are decreased levels of all the
cellular elements of the blood (pancytopenia). T-helper
cell production doesn’t decrease in aplastic anemia.
Reed-Sternberg cells and lymph node enlargement
occur with Hodgkin’s disease.
51. ANSWER D. Preferably, ferrous gluconate should be
taken on an empty stomach. Ferrous gluconae should
not be taken with antacids, milk, or whole-grain
cereals because these foods reduce iron absorption.
52. ANSWER C. Hemophilia A results from a deficiency of
factor VIII. Sickle cell disease is caused by a defective
hemoglobin molecule. Christmas disease, also called
hemophilia B, results in a factor IX deficiency.
53. ANSWER C. Characteristic sickle cells tend to cause “log
jams” in capillaries. This results in poor circulation to
local tissues, leading to ischemia and necrosis. The
basic defect in sickle cell disease is an abnormality in
the structure of RBCs. The erythrocytes are sickle-
shaped, rough in texture, and rigid. Sickle cell disease
is an inherited disease, not an autoimmune reaction.
Elevated serum bilirubin concentrations are associated
with jaundice, not sickle cell disease.
54. ANSWER D. Sickle cell disease is an inherited disease
that is present at birth. However, 60% to 80% of a
newborns hemoglobin is fetal hemoglobin, which has a
structure different from that of hemoglobin S or
hemoglobin A. Sickle cell symptoms usually occur
about 4 months after birth, when hemoglobin S begins
to replace the fetal hemoglobin. The gene for sickle cell
disease is transmitted at the time of conception, not
passed through the placenta. Some hemoglobin S is
produced by the fetus near term. The fetus produces
all its own hemoglobin from the earliest production in
the first trimester. Passive immunity conferred by
maternal antibodies is not related to sickle cell disease,
but this transmission of antibodies is important to
protect the infant from various infections during early
infancy.
55. ANSWER C. For the child in a sickle cell crisis, pain is
the priority nursing diagnosis because the sickled cells
clump and obstruct the blood vessels, leading to
occlusive and subsequent tissue ischemia. Although
ineffective coping may be important, it is not the
priority. Decreased cardiac output is not a problem
with this type of vasoocclusive crisis. Typically, a sickle
cell crisis can be precipitated by a fluid volume deficit
or dehydration.
56. ANSWER B. Children with iron-deficiency anemia are
more susceptible to infection because of marked
decreases in bone marrow functioning with
microcytosis.
57. ANSWER A, B. Toddlers should have between 2 and 3
cups of milk per day and 8 ounces of juice per day. If
they have more than that, then they are probably not
eating enough other foods, including iron-rich foods
that have the needed nutrients.
58. ANSWER B. Potato, peas, chicken, green vegetables,
and rice cereal contain significant amounts of iron and
therefore would be recommended. Milk and yellow
vegetables are not good iron sources. Rice by itself also
is not a good source of iron.
59. ANSWER D. PTT measures the activity of
thromboplastin, which is dependent on intrinsic
clotting factors. In hemophilia, the intrinsic clotting
factor VIII (antihemiphilic factor) is deficient, resulting
in a prolonged PTT. Bleeding time reflects platelet
function; the tourniquet test measures
vasoconstriction and platelet function; and the clot
retraction test measures capillary fragility. All of these
are unaffected in people with hemophilia.
60. ANSWER A. Bleeding into the joints in the child with
hemophilia leads to pain and tenderness, resulting in
restricted movement. Therefore, an early sign of
hemarthrosis would be the child’s reluctance to move
a body part. If the bleeding into the joint continues,
the area becomes hot, swollen, and immobile—not
cool, pale, and clammy. Ecchymosis formation around
a joint would be difficult to assess. Instability of a long
bone on passive movement is not associated with joint
hemarthrosis.
61. ANSWER A. Because factor VIII concentrate is derived
from large pools of human plasma, the risk of hepatitis
is always present. Clinical manifestations of hepatitis
 include yellowing of the skin, mucous membranes, and 5. Which of the following occurs during ventricular systole?
sclera. Use of factor VIII concentrate is not associated
with constipation, abdominal distention, or puffiness Increased aortic pressure
around the eyes. Increased ventricular volume
62. ANSWER C. A diagnosis is established based on a Dup heart sound
complete blood count, examination for sickled red P wave
blood cells in the peripheral smear, and hemoglobin 6. Which of the following occurs during ventricular diastole?
electrophoresis. Laboratory studies will show
decreased hemoglobin and hematocrit levels and a Increased aortic pressure
decreased platelet count, and increased reticulocyte Increased ventricular volume
count, and the presence of nucleated red blood cells. Lub heart sound
Increased reticulocyte counts occur in children with T wave
sickle cell disease because the life span of their sickled 7. The innermost layer of a blood vessel is lined with _______
red blood cells is shortened. ______ cells
63. ANSWER C. Pain crisis may be precipitated by
infection, dehydration, hypoxia, trauma, or physical or Simple squamous
emotional stress. The mother of a child with sickle cell Stratified squamous
disease should encourage fluid intake of 1 ½ to 2 times Simple cuboidal epithelium
the daily requirement to prevent dehydration. Stratified cuboidal epithelium
64. ANSWER D. The results of a CBC in children with iron 8. Angiotension can directly cause the release of ____ from
deficiency anemia will show decreased hemoglobin the adrenal cortex.
levels and microcytic and hypochromic red blood cells.
The red blood cell count is decreased. The reticulocyte Renin
count is usually normal or slightly elevated. Aldosterone
65. ANSWER D. Males inherit hemophilia from their Calcitonin
mothers, and females inherit the carrier status from Thyroxine
their fathers. Hemophilia is inherited in a recessive 9. Cardiac output is the product of ____ and ____.
manner via a genetic defect on the X-chromosome.
Hemophilia A results from a deficiency of factor VIII. HR and Disastolic pressure
Hemophilia B (Christmas disease) is a deficiency of HR and Stroke Volume
factor IX. HR and EF
Diastolic and Systolic pressure
Hematologic System 10. Pulmonary edema is most like associated with a failing
1. Prothrombin is a ____ globulin and is produced by the _____ _____.
_____.
Right atrium
Alpha, Kidney Left atrium
Alpha, Liver Right ventricle
Beta, Kidney Left ventricle
Beta, Liver 11. Which of the following is the first branch off the aortic
2. The right coronary artery divides to form the posterior arch?
interventricular artery and the ___ artery.
Common carotid
Marginal Brachiocephalic
LVC Right Subclavian
RVC Thoracic
LAD 12. The brachiocephalic artery divides to form the right
3. Blood flowing into the cardiac veins enters the _______ common carotid and the ____ ____ artery.
next.
Left subclavian
Coronary Sinus Right subclavian
Left Ventricle Left common carotid
Right Ventricle Right thoracic artery
Left Atrium 13. Which of the following arteries creates the left spenic,
4. If you are using a stethoscope and trying to detect the hepatic and gastric arteries?
tricuspid valve which of the following would be the best
location? Left sacral artery
Celiac artery
Within 2 inches of the xyphoid process Suprarenal artery
On the right side of the sternum Phrenic artery
On the left side of the sternum near the midpoint 14. Which of the following is not considered a major branch
On the left side of the sternum near the midpoint of the sixth off of the descending thoracic aorta?
rib
Mediastinal artery 17. D. Subclavian vein
Renal artery 18. A. Basilar
Bronchial artery 19. A. Difference between the systolic and diastolic
Posterior intercostals artery pressure
15. Which of the following is not considered a major branch 20. A. Accelerator
off of the abdominal aorta?
Anticoagulants
Phrenic artery 1. Anticoagulants are indicated for an indefinite period in
Common iliac artery patients with:
Gonadal artery
Mediastinal artery Atrial fibrillation
16. Which of the following is not considered a major branch Venous thromboembolism
off of the femoral artery? High risk of myocardial infarction
All of the above
Superficial pudendal arteries 2. Which of the following sentence is true with regard to
Deep external pudendal arteries warfarin?
Superficial circumflex iliac artery
Deep circumflex iliac artery Is a vitamin K antagonist
17. Which of the following is not considered a tributary of the Is a thrombin inhibitor
portal vein? Activates fibrinolysis
Binds to antithrombin III
Inferior mesenteric vein 3. Which of the following is not an approved indication for
Splenic vein warfarin therapy?
Left gastric vein
Subclavian vein Atrial fibrillation
18. Inside the cranial cavity the vertebral arteries form the Heart valve replacement
____ artery. Deep vein thrombosis
Peripheral artery disease
Basilar 4. Time taken for observable anticoagulant effect of warfarin
Common Carotid is:
MCA
PCA 6-12 hours
19. Pulse pressure (pp) is considered the _____. 24-36 hours
2-7 days
Difference between the systolic and diastolic pressure 8-10days
The sum of the systolic and diastolic pressure 5. Which of the following is the recommended test to
The inverse of the blood pressure monitor the effect of oral anticoagulant therapy?
Half of the systolic pressure
20. _____ nerves can be found joining the SA and AV nodes in Thrombin time
the heart. International normalized ratio (INR)
Bleeding time
Accelerator Partial thromboplastin time (PTT)
Phrenic 6. What is the most acceptable frequency of INR monitoring
Thoracic in a patient taking warfarin?
Gastric
Initially thrice daily, then twice daily, then daily, then weekly,
Answers and then monthly
1. B. Alpha, Liver Initially twice daily, then daily, then weekly, and then
2. A. Marginal monthly
3. A. Coronary Sinus Initially daily, then weekly, and then monthly
4. A. Within 2 inches of the xyphoid process Initially twice per week, then weekly, then every two or three
5. A. Increased aortic pressure weeks, and then monthly
6. B. Increased ventricular volume 7. What is the value of International normalized ratio (INR)
7. A. Simple squamous above which warfarin does not provide any additional
8. B. Aldosterone therapeutic benefit in most patients, but is associated with a
9. B. HR and Stroke Volume higher risk of bleeding?
10. D. Left ventricle
11. B. Brachiocephalic 4.0
12. B. Right subclavian 3.5
13. B. Celiac artery 3.0
14. B. Renal artery 2.5
15. D. Mediastinal artery 8. Which of the following is used for reversal of anticoagulant
16. D. Deep circumflex iliac artery effect of warfarin in case of life-threatening bleeding?
 Restart regular warfarin therapy after surgery once adequate
Platelets haemostasis is achieved
Protamine All of the above
Vitamin K or Vitamin K dependant coagulation factors Answers
Any of the above 1. A. Atrial fibrillation
9. Which of the following statement(s) concerning heparin 2. A. Is a vitamin K antagonist
is/are true? 3. D. Peripheral artery disease
4. C. 2-7 days
It binds to antithrombin III leading to anticoagulant effect 5. B. International normalized ratio (INR)
It exhibits varying anticoagulant response 6. D. Initially twice per week, then weekly, then every
Heparin therapy is monitored with activated partial two or three weeks, and then monthly
thromboplastin time (APTT) 7. A. 4.0
All of the above 8. C. Vitamin K or Vitamin K dependant coagulation
10. Which of the following is an advantage of low molecular factors
weight heparin (LMWH) over unfractionated heparin? 9. D. All of the above
10. D. All of the above
Does not require monitoring of activated partial 11. A. Anti-factor Xa level
thromboplastin time 12. A. Protamine
Has a greater bioavailibility 13. A. Warfarin
Given subcutaneously therefore can be administered in “out 14. A. Do not stop warfarin but check INR prior to surgery
of hospital setting” 15. D. All of the above
All of the above
11. Low molecular weight heparins (LMWHs) do not require Hodgkin’s Disease
monitoring, but when necessary, which of the following is 1) A 22-year-old with stage I Hodgkin’s disease is admitted to
measured? the oncology unit for radiation therapy. During the initial
assessment, the client tells you, “Sometimes I am afraid of
Anti-factor Xa level dying.” Which response is most appropriate at this time?
Thrombin time
Prothrombin time “Many individuals with this diagnosis have some fears.”
Activated partial thromboplastin time (APTT) “Perhaps you should ask the doctor about medication.”
12. The anticoagulant effect of heparin is rapidly reversed “Tell me a little bit more about your fear of dying.”
with: “Most people with stage I Hodgkin’s disease survive.”
2) After receiving the change-of-shift report, which client will
Protamine you assess first?
Infusion of vitamin K dependant coagulation factors
Packed red blood cells A 20-year-old with possible acute myelogenous leukemia
Platelets who has just arrived on the medical unit
13. Which of the following anticoagulant should not be given A 38-year-old with aplastic anemia who needs teaching about
during pregnancy? decreasing infection risk prior to discharge
A 40-year-old with lymphedema who requests help to put on
Warfarin compression stockings before getting out of bed
Low molecular weight heparins (LMWHs) A 60-year-old with non-Hodgkin’s lymphoma who is refusing
Unfractionated heparin the ordered chemotherapy regimen
All of the above 3) The Hodgkin’s disease patient described in the question
14. Which of the following is correct with regard to patients above undergoes a lymph node biopsy for definitive
taking warfarin undergoing surgery with minimal risk of diagnosis. If the diagnosis of Hodgkin’s disease were correct,
bleeding? which of the following cells would the pathologist expect to
find?
Do not stop warfarin but check INR prior to surgery
Switch over to heparin two days prior to surgery and restart Reed-Sternberg cells.
warfarin after surgery Lymphoblastic cells.
Switch over to heparin five days prior to surgery and restart Gaucher’s cells.
warfarin after surgery Rieder’s cells
Switch over to heparin seven days prior to surgery and 4) A male client is admitted to the hospital with a suspected
restart warfarin after surgery diagnosis of Hodgkin’s disease. Which assessment findings
15. Anticoagulation in warfarin users at high risk of would the nurse expect to note specifically in the client?
thromboembolism, undergoing surgery associated with high
risk of bleeding involves: Fatigue
Weakness
Stop warfarin 4-5 days prior to surgery Weight gain
Start with full dose unfractionated heparin or LMWH 2-3 days Enlarged lymph nodes
preoperatively 5) A newly admitted client is diagnosed with Hodgkin’s
disease undergoes an excisional cervical lymph node biopsy
under local anesthesia. What does the nurse assess first after Headache
the procedure? 14) Non-Hodgkin lymphoma can spread to almost any part of
the body, including the liver, bone marrow, and spleen.
Vital signs
Incision site True
Airway False
Level of consciousness 15) Hodgkin lymphoma only occurs in a group of lymph
6) Hodgkin lymphoma, named for Thomas Hodgkin, is an nodes, not in a single lymph node or in other parts of the
American physician who identified it in 1832. lymphatic system, such as the bone marrow and spleen.

True True
False False
7) Hodgkin lymphoma may be cured with chemotherapy with 16) A patient is admitted to the oncology unit for diagnosis of
almost no incidence of secondary acute nonlymphocytic suspected Hodgkin’s disease. Which of the following
leukemia within 10 years. symptoms is typical of Hodgkin’s disease?

True Painful cervical lymph nodes.

False Night sweats and fatigue.
Q.8) The nurse is aware that the following symptoms is most Nausea and vomiting.
commonly an early indication of stage 1 Hodgkin’s disease? Weight gain.
17) Sex is one of the risk factors for developing NHL, but race
Pericarditis is not.
Night sweat
Splenomegaly True
Persistent hypothermia False
9) You have developed the nursing diagnosis Risk for 18) A 21-year-old male with Hodgkin’s lymphoma is a senior
Impaired Tissue Integrity related to effects of radiation for a at the local university. He is engaged to be married and is to
client with Hodgkin’s lymphoma who is receiving radiation to begin a new job upon graduation. Which of the following
the groin area. Which nursing activity is best delegated to a diagnoses would be a priority for this client?
nursing assistant caring for the client?
Sexual dysfunction related to radiation therapy
Check the skin for signs of redness or peeling. Anticipatory grieving related to terminal illness
Apply alcohol-free lotion to the area after cleaning. Tissue integrity related to prolonged bed rest
Explain good skin care to the client and family. Fatigue related to chemotherapy
Clean the skin over daily with a mild soap. 19) People infected with HIV are more likely to develop
10) The nurse understands that Hodgkin’s disease is lymphatic disease.
suspected when a client presents with a painless, swollen
lymph node. Hodgkin’s disease typically affects people in True
which age group? False

Children (ages 6-12 years) Answers and Rationales

Teenagers (ages 13-20 years) 1. C. “Tell me a little bit more about your fear of
Young adults (ages 21-40 years) dying.”Most assessment about what the client means
Older adults (ages 41-50 years) is needed before any interventions can be planned or
11) The two main groups of lymphoma in humans are implemented. All of the other statements indicate a
Hodgkin lymphoma and the non-Hodgkin Lymphomas (NHL). conclusion that the client is afraid of dying of
Hodgkin’s disease. Focus: Prioritization
True 2. A. A 20-year-old with possible acute myelogenous
False leukemia who has just arrived on the medical unit .
12) One of the symptoms for lymphatic disease is swelling of The newly admitted client should be assessed first,
the lymph nodes; however, this symptom may be easily because the baseline assessment and plan of care need
overlooked because the enlargement does not cause any to be completed. The other clients also need
pain. assessments or interventions, but do not need
immediate nursing care. Focus: Prioritization
True 3. A. Reed-Sternberg cells. A definitive diagnosis of
False Hodgkin’s disease is made if Reed-Sternberg cells are
13) A client admitted with newly diagnosed with Hodgkin’s found on pathologic examination of the excised lymph
disease. Which of the following would the nurse expect the node. Lymphoblasts are immature cells found in the
client to report? bone marrow of patients with acute lymphoblastic
leukemia. Gaucher’s cells are large storage cells found
Lymph node pain in patients with Gaucher’s disease. Rieder’s cells are
Weight gain myeloblasts found in patients with acute myelogenous
Night sweats leukemia.
4. D. Enlarged lymph nodes. Hodgkin’s disease is a
chronic progressive neoplastic disorder of lymphoid
tissue characterized by the painless enlargement of
lymph nodes with progression to extralymphatic sites,
such as the spleen and liver. Weight loss is most likely
to be noted. Fatigue and weakness may occur but are
not related significantly to the disease.
5. C. Airway . Assessing for an open airway is the priority.
The procedure involves the neck, the anesthesia may
have affected the swallowing reflex or the
inflammation may have closed in on the airway leading
to ineffective air exchange.
6. B. False
7. B. False
8. B. Night sweat . In stage 1, symptoms include a single
enlarged lymph node (usually), unexplained fever,
night sweats, malaise, and generalized pruritis.
Although splenomegaly may be present in some
clients, night sweats are generally more prevalent.
Pericarditis isn’t associated with Hodgkin’s disease, nor
is hypothermia. Moreover, splenomegaly and
pericarditis aren’t symptoms. Persistent hypothermia
is associated with Hodgkin’s but isn’t an early sign of
the disease.
9. D. Clean the skin over daily with a mild soap. Skin care
is included in nursing assistant education and job
description. Assessment and client teaching are more
complex tasks that should be delegated to registered
nurses. Use of lotions to the irradiated area is usually
avoided during radiation therapy. Focus: Delegation
10. C. Young adults (ages 21-40 years)
11. A. True
12. A. True
13. C. Night sweats. Assessment of a client with Hodgkin’s
disease most often reveals enlarged, painless lymph
node, fever, malaise and night sweats.
14. A. True
15. B. False
16. B. Night sweats and fatigue. Symptoms of Hodgkin’s
disease include night sweats, fatigue, weakness, and
tachycardia. The disease is characterized by painless,
enlarged cervical lymph nodes. Weight loss occurs
early in the disease. Nausea and vomiting are not
typically symptoms of Hodgkin’s disease.
17. B. False
18. A. Sexual dysfunction related to radiation therapy.
Radiation therapy often causes sterility in male clients
and would be of primary importance to this client. The
psychosocial needs of the client are important to
address in light of the age and life choices. Hodgkin’s
disease, however, has a good prognosis when
diagnosed early.
19. A. True
Acute Leukemia
1) A child is undergoing remission induction therapy to treat
leukemia. Allopurinol is included in the regimen. The main
reason for administering allopurinol as part of the client’s
chemotherapy regimen is to:
Prevent metabolic breakdown of xanthine to uric acid
Prevent uric acid from precipitating in the ureters
Enhance the production of uric acid to ensure adequate
excretion of urine
Ensure that the chemotherapy doesn’t adversely affect the
bone marrow
2) A nurse is caring for a patient with acute lymphoblastic
leukemia (ALL). Which of the following is the most likely age
range of the patient?
3-10 years.
25-35 years.
45-55 years.
over 60 years.
3) The client with leukemia is receiving busulfan (Myleran)
and allopurinol (Zyloprim). The nurse tells the client that the
purpose if the allopurinol is to prevent:
Nausea
Alopecia
Vomiting
Hyperuricemia
4) An African American client is admitted with acute
leukemia. The nurse is assessing for signs and symptoms of
bleeding. Where is the best site for examining for the
presence of petechiae?
The abdomen
The thorax
The earlobes
The soles of the feet
5) A 33-year-old male is being evaluated for possible acute
leukemia. Which of the following would the nurse inquire
about as a part of the assessment?
The client collects stamps as a hobby.
The client recently lost his job as a postal worker.
The client had radiation for treatment of Hodgkin’s disease as
a teenager.
The client’s brother had leukemia as a child.
6) A client with acute leukemia is admitted to the oncology
unit. Which of the following would be most important for the
nurse to inquire?
“Have you noticed a change in sleeping habits recently?”
“Have you had a respiratory infection in the last 6 months?”
“Have you lost weight recently?”
“Have you noticed changes in your alertness?”
7) Francis with leukemia has neutropenia. Which of the
following functions must frequently assessed?
Blood pressure
Bowel sounds
Heart sounds
Breath sounds
8) The treatment protocol for a client with acute lymphatic
leukemia includes prednisone, methotrexate, and
cimetadine. The purpose of the cimetadine is to:
Decrease the secretion of pancreatic enzymes
Enhance the effectiveness of methotrexate
Promote peristalsis
Prevent a common side effect of prednisone
9) A 4-year-old is admitted with acute leukemia. It will be
most important to monitor the child for:
Abdominal pain and anorexia
Fatigue and bruising
Bleeding and pallor
Petechiae and mucosal ulcers
10) The nurse is reviewing the laboratory report of a client
who underwent a bone marrow biopsy. The finding that
would most strongly support a diagnosis of acute leukemia is
the existence of a large number of immature:
lymphocytes
thrombocytes
reticulocytes
leukocytes
11) A leukemia patient has a relative who wants to donate
blood for transfusion. Which of the following donor medical
conditions would prevent this?
A history of hepatitis C five years previously.
Cholecystitis requiring cholecystectomy one year previously.
Asymptomatic diverticulosis.
Crohn’s disease in remission.
12) A patient with leukemia is receiving chemotherapy that is
known to depress bone marrow. A CBC (complete blood
count) reveals a platelet count of 25,000/microliter. Which of
the following actions related specifically to the platelet count
should be included on the nursing care plan?
Monitor for fever every 4 hours.
Require visitors to wear respiratory masks and protective
clothing.
Consider transfusion of packed red blood cells.
Check for signs of bleeding, including examination of urine
and stool for blood.
13) Which of the following would the nurse identify as the
initial priority for a child with acute lymphocytic leukemia?
Instituting infection control precautions
Encouraging adequate intake of iron-rich foods
Assisting with coping with chronic illness
Administering medications via IM injections
14) A 22-year-old man is admitted to the hospital with
complaints of fatigue and weight loss. Physical examination
reveals pallor and multiple bruises on his arms and legs. The
results of the patients tests reveal acute lymphocytic
leukemia and thrombocytopenia. Which of the following
nursing diagnoses MOST accurately reflects his condition?
Potential for injury.
Self-care deficit
Potential for self-harm.
Alteration in comfort.
15) Which of the following would be the priority nursing
diagnosis for the adult client with acute leukemia?
Oral mucous membrane, altered related to chemotherapy
Risk for injury related to thrombocytopenia
Fatigue related to the disease process
Interrupted family processes related to life-threatening
illness of a family member
16) The patient receiving mitoxantrone (Novantrone) for
treatment of secondary progressive multiple sclerosis (MS) is
closely monitored for
leukopenia and cardiac toxicity.
mood changes and fluid and electrolyte alterations.
renal insufficiency.
hypoxia.
17) Marie with acute lymphocytic leukemia suffers from
nausea and headache. These clinical manifestations may
indicate all of the following except
effects of radiation
chemotherapy side effects
meningeal irritation
gastric distension
18) Situation: Stacy is diagnosed with acute lymphoid
leukemia (ALL) and beginning chemotherapy. Stacy is
discharged from the hospital following her chemotherapy
treatments. Which statement of Stacy’s mother indicated
that she understands when she will contact the physician?
“I should contact the physician if Stacy has difficulty in
sleeping”.
“I will call my doctor if Stacy has persistent vomiting and
diarrhea”.
“My physician should be called if Stacy is irritable and
unhappy”.
“Should Stacy have continued hair loss, I need to call the
doctor”.
19) A patient is undergoing the induction stage of treatment
for leukemia. The nurse teaches family members about
infectious precautions. Which of the following statements by
family members indicates that the family needs more
education?
We will bring in books and magazines for entertainment.
We will bring in personal care items for comfort.
We will bring in fresh flowers to brighten the room.
We will bring in family pictures and get well cards.
20) A child with leukemia is being discharged after beginning
chemotherapy. What instructions will the nurse include in
the teaching plan for the parents of this child?
Provide a diet low in protein and high in carbohydrates
Avoid fresh vegetables that are not cooked or peeled
Notify the M.D. if the child’s temperature exceeds 101F (39C)
Increase the use of humidifiers throughout the house
21) The treatment for patients with leukemia is bone marrow
transplantation. Which statement about bone marrow
transplantation is not correct?
The patient is under local anesthesia during the procedure
The aspirated bone marrow is mixed with heparin.
The aspiration site is the posterior or anterior iliac crest.
The recipient receives cyclophosphamide (Cytoxan) for 4
consecutive days before the procedure.
22) What is the peak age range in acquiring acute
lymphocytic leukemia (ALL)?
4 to 12 years.
20 to 30 years
40 to 50 years
60 to 70 years
23) A client jokes about his leukemia even though he is
becoming sicker and weaker. The nurse’s most therapeutic
response would be:
“Your laugher is a cover for your fear.”
“He who laughs on the outside, cries on the inside.”
“Why are you always laughing?”
“Does it help you to joke about your illness?”
24) The laboratory results of the client with leukemia indicate
bone marrow depression. The nurse should encourage the
client to:
Increase his activity level and ambulate frequently
Sleep with the head of his bed slightly elevated
Drink citrus juices frequently for nourishment
Use a soft toothbrush and electric razor
25) During chemotherapy for lymphocytic leukemia, Mathew
develops abdominal pain, fever, and “horse barn” smelling
diarrhea. It would be most important for the nurse to advise
the physician to order:
enzyme-linked immunosuppressant assay (ELISA) test.
electrolyte panel and hemogram.
stool for Clostridium difficile test.
flat plate X-ray of the abdomen.
26) A 68-year-old woman is diagnosed with
thrombocytopenia due to acute lymphocytic leukemia. She is
admitted to the hospital for treatment. The nurse should
assign the patient
to a private room so she will not infect other patients and
health care workers.
to a private room so she will not be infected by other
patients and health care workers.
to a semiprivate room so she will have stimulation during her
hospitalization.
to a semiprivate room so she will have the opportunity to
express her feelings about her illness.
Answers and Rationales
1. A. Prevent metabolic breakdown of xanthine to uric
acid . The massive cell destruction resulting from
chemotherapy may place the client at risk for
developing renal calculi; adding allopurinol decreases
this risk by preventing the breakdown of xanthine to
uric acid. Allopurinol doesn’t act in the manner
described in the other options.
2. A. 3-10 years. The peak incidence of ALL is at 4 years
(range 3-10). It is uncommon after the mid-teen years.
The peak incidence of chronic myelogenous leukemia
(CML) is 45-55 years. The peak incidence of acute
myelogenous leukemia (AML) occurs at 60 years. Two-
thirds of cases of chronic lymphocytic leukemia (CLL)
occur after 60 years.
3. D. Hyperuricemia . Allopurinol decreases uric acid
production and reduces uric acid concentrations in
serum and urine. In the client receiving chemotherapy,
uric acid levels increase as a result of the massive cell
destruction that occurs from the chemotherapy. This
medication prevents or treats hyperuricemia caused by
chemotherapy. Allopurinol is not used to prevent
alopecia, nausea, or vomiting.
4. D. The soles of the feet . Petechiae are not usually
visualized on dark skin. The soles of the feet and palms
of the hand provide a lighter surface for assessing the
client for petichiae.
5. C. The client had radiation for treatment of Hodgkin’s
disease as a teenager. Radiation treatment for other
types of cancer can result in leukemia. Some hobbies
and occupations involving chemicals are linked to
leukemia, but not the ones in these answers;
therefore, answers A and B are incorrect. Answer D is
incorrect because the incidence of leukemia is higher
in twins than in siblings.
6. B. “Have you had a respiratory infection in the last 6
months?” The client with leukemia is at risk for
infection and has often had recurrent respiratory
infections during the previous 6 months.
Insomnolence, weight loss, and a decrease in alertness
also occur in leukemia, but bleeding tendencies and
infections are the primary clinical manifestations
7. D. Breath sounds . Pneumonia, both viral and fungal, is
a common cause of death in clients with neutropenia,
so frequent assessment of respiratory rate and breath
sounds is required. Although assessing blood pressure,
bowel sounds, and heart sounds is important, it won’t
help detect pneumonia.
8. D. Prevent a common side effect of prednisone . A
common side effect of prednisone is gastric ulcers.
Cimetadine is given to help prevent the development
of ulcers.
9. C. Bleeding and pallor . The child with leukemia has
low platelet counts, which contribute to spontaneous
bleeding.
10. D. leukocytes . Leukemia is manifested by an abnormal
overpopulation of immature leukocytes in the bone
marrow.
11. A. A history of hepatitis C five years previously.
Hepatitis C is a viral infection transmitted through
bodily fluids, such as blood, causing inflammation of
the liver. Patients with hepatitis C may not donate
blood for transfusion due to the high risk of infection
in the recipient. Cholecystitis (gall bladder disease),
diverticulosis, and history of Crohn’s disease do not
preclude blood donation.
12. D. Check for signs of bleeding, including examination of
urine and stool for blood. A platelet count of
25,000/microliter is severely thrombocytopenic and
should prompt the initiation of bleeding precautions,
including monitoring urine and stool for evidence of
bleeding. Monitoring for fever and requiring protective
clothing are indicated to prevent infection if white
blood cells are decreased. Transfusion of red cells is
indicated for severe anemia.
13. A. Instituting infection control precautions . Acute
lymphocytic leukemia (ALL) causes leukopenia,
resulting in immunosuppression and increasing the risk
of infection, a leading cause of death in children with
ALL. Therefore, the initial priority nursing intervention
would be to institute infection control precautions to
decrease the risk of infection. Iron-rich foods help with
anemia, but dietary iron is not an initial intervention.
The prognosis of ALL usually is good. However, later
on, the nurse may need to assist the child and family
with coping since death and dying may still be an issue
 in need of discussion. Injections should be
discouraged, owing to increased risk from bleeding due
to thrombocytopenia.
14. A. Potential for injury. Question: What nursing
diagnosis is seen with acute lymphocytic leukemia and
thromocytopenia? Needed Info: Thromocytopenia:
decreased platelet count increases the patient’s risk
for injury, normal count: 200,000-400,000 per mm3.
Leukemia: group of malignant disorders involving
overproduction of immature leukocytes in bone
marrow. This shuts down normal bone marrow
production of erythrocytes, platelets, normal
leukocytes. Causes anemia, leukopenia, and
thrombocytopenia leading to infection and
hemorrhage. Symptoms: pallor of nail beds and
conjunctiva, petechiae (small hemorrhagic spot on
skin), tachycardia, dyspnea, weight loss, fatigue.
Treatment: chemotherapy, antibiotics, blood
transfusions, bone marrow transplantation. Nursing
responsibilities: private room, no raw fruits or vegs,
small frequent meals, O2, good skin care.
Potential for injury — CORRECT: low platelet increases risk
of bleeding from even minor injuries. Safety measures:
shave with an electric razor, use soft tooth brush, avoid SQ
or IM meds and invasive procedures (urinary drainage
catheter or a nasogastric tube), side-rails up, remove sharp
objects, frequently assess for signs of bleeding, bruising,
hemorrhage.
Self-care deficit — may feel weak, doesn’t address condition
Potential for self-harm — implies risk for purposeful self-
injury, not given any info, assumption
Alteration in comfort — patient is not comfortable, and
comfort measures would address problem
15. B. Risk for injury related to thrombocytopenia . The
client with acute leukemia has bleeding tendencies
due to decreased platelet counts, and any injury would
exacerbate the problem.
16. A. leukopenia and cardiac toxicity. Mitoxantrone is an
antineoplastic agent used primarily to treat leukemia
and lyphoma but is also used to treat secondary
progressive MS. Patients need to have laboratory tests
ordered and the results closely monitored due to the
potential for leukopenia and cardiac toxicity.
17. D. gastric distension . Acute Lymphocytic Leukemia
(ALL) does not cause gastric distention. It does invade
the central nervous system, and clients experience
headaches and vomiting from meningeal irritation.
18. B. “I will call my doctor if Stacy has persistent vomiting
and diarrhea”. Persistent (more than 24 hours)
vomiting, anorexia, and diarrhea are signs of toxicity
and the patient should stop the medication and notify
the health care provider. The other manifestations are
expected side effects of chemotherapy.
19. C. We will bring in fresh flowers to brighten the room.
During induction chemotherapy, the leukemia patient
is severely immunocompromised and at risk of serious
infection. Fresh flowers, fruit, and plants can carry
microbes and should be avoided. Books, pictures, and
other personal items can be cleaned with
antimicrobials before being brought into the room to
minimize the risk of contamination.
20. B. Avoid fresh vegetables that are not cooked or
peeled
21. A. The patient is under local anesthesia during the
procedure . Before the procedure, the patient is
administered with drugs that would help to prevent
infection and rejection of the transplanted cells such as
antibiotics, cytotoxic, and corticosteroids. During the
transplant, the patient is placed under general
anesthesia.
22. A. 4 to 12 years. The peak incidence of Acute
Lymphocytic Leukemia (ALL) is 4 years of age. It is
uncommon after 15 years of age.
23. D. “Does it help you to joke about your illness?” This
non-judgmentally on the part of the nurse points out
the client’s behavior.
24. D. Use a soft toothbrush and electric razor .
Suppression of red bone marrow increases bleeding
susceptibility associated with thrombocytopenia,
decreased platelets. Anemia and leucopenia are the
two other problems noted with bone marrow
depression.
25. C. stool for Clostridium difficile test.
Immunosuppressed clients — for example, clients
receiving chemotherapy, — are at risk for infection
with C. difficile, which causes “horse barn” smelling
diarrhea. Successful treatment begins with an accurate
diagnosis, which includes a stool test. The ELISA test is
diagnostic for human immunodeficiency virus (HIV)
and isn’t indicated in this case. An electrolyte panel
and hemogram may be useful in the overall evaluation
of a client but aren’t diagnostic for specific causes of
diarrhea. A flat plate of the abdomen may provide
useful information about bowel function but isn’t
indicated in the case of “horse barn” smelling diarrhea.
26. B. to a private room so she will not be infected by
other patients and health care workers.
Question: What are the needs of the patient with acute
lymphocytic leukemia and thrombocytopenia?
Needed Info: Lymphocytic leukemia, disease characterized
by proliferation of immature WBCs. Immature cells unable
to fight infection as competently as mature white cells.
Treatment: chemotherapy, antibiotics, blood transfusions,
bone marrow transplantation.
Nursing responsibilities: private room, no raw fruits or vegs,
small frequent meals, O2, good skin care.
to a private room so she will not infect other patients and
health care workers — poses little or no threat
to a private room so she will not be infected by other
patients and health care workers — CORRECT: protects
patient from exogenous bacteria, risk for developing
infection from others due to depressed WBC count, alters
ability to fight infection
to a semiprivate room so she will have stimulation during
her hospitalization — should be placed in a room alone
to a semiprivate room so she will have the opportunity to
express her feelings about her illness — ensure that patient
is provided with opportunities to express feelings about
illness