Chapter 33 Quiz

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Question #1

When evaluating a patient’s symptoms that are consistent with a diagnosis of leukemia, the nurse is aware that all leukemias have which common feature?

A Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements

B Increased blood viscosity, resulting from an overproduction of white cells

C Compensatory polycythemia stimulated by thrombocytopenia

D Reduced plasma volume in response to a reduced production of cellular elements

Question #2

A patient describes numbness in the arms and hands with a tingling sensation. The patient also frequently stumbles when walking. What vitamin deficiency does the nurse determine may cause some of these symptoms?

A B12

B Folate

C Thiamine

D Iron

Question #3

An client has pernicious anemia and has been receiving treatment for several years. Which symptom may be confused with another condition in older adults?

A dementia

B stomatitis

C glossitis

D ataxia

Question #4

A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client?

A Sore tongue, dyspnea, and weight gain

B Pallor, tachycardia, and a sore tongue

C Angina pectoris, double vision, and anorexia

D Pallor, bradycardia, and reduced pulse pressure

Question #5

A client with sickle cell disease informs the nurse that he is having chest pain. The nurse hears the client coughing, wheezing, and breathing rapidly. What does the nurse suspect is occurring with this client?

A Pneumocystis pneumonia

B Acute muscular strain

C Vaso-occlusive crisis

D Acute chest syndrome

Question #6

A client at the clinic has just been diagnosed with iron deficiency anemia. What would you recommend the client consume to promote the absorption of iron?

A Rich sources of vitamin C

B Meat, egg yolks, oysters, and shellfish

C Sources of vitamin B12

D Vitamin E

Question #7

Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets?

A Anemia

B Thrombocytopenia

C Leukopenia

D Pancytopenia

Question #8

A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor?

A Increased mean corpuscular volume

B Decreased level of erythropoietin

C Increased reticulocyte count

D Decreased total iron-binding capacity

Question #9

A nurse is caring for a client with iron deficiency anemia. Which food or beverage will the nurse suggest to the client to eat or drink when taking supplemental iron?

A Orange juice

B Milk

C Leafy green vegetables

D Kidney beans

Question #10

The nurse is assessing a patient who is a strict vegetarian. What type of anemia is the nurse aware that this patient is at risk for?

A Iron deficiency anemia

B Megaloblastic anemia

C Sickle cell anemia

D Aplastic anemia

Question #11

A nurse on a hematology/oncology floor is caring for a client with aplastic anemia. Which would not be included in the client’s discharge instructions?

A Plan for frequent periods of rest.

B Use a disposable razor when shaving.

C Avoid contact with family/friends who are sick.

D Encourage frequent handwashing.

Question #12

A nurse is caring for a client with thalassemia who is being transfused. What is the nurse’s role during a transfusion?

A To assess for enlargement and tenderness over the liver and spleen

B To closely monitor the rate of administration

C To instruct the client to rest immediately if chest pain develops

D To administer vitamin B12 injections

Question #13

A client with multiple myeloma reports pain along the spinal column. The client is prescribed naproxen (Aleve) and oxycodone. Prior to administering these medications, the nurse

A Checks the clients’s BUN and creatinine

B Questions the physician about the use of both medications

C Teaches the client to bend at the back when lifting objects

D Instructs the client not to lift more than 20 pounds

Question #14

A pregnant woman is hospitalized as the result of sickle-cell crisis. Which finding indicates the outcome has been achieved for this client?

A Takes hydroxyurea during her pregnancy

B Describes the importance of staying cool

C Reports joint pain less than 3 on a scale of 0 to 10

D Exhibits a temperature more than 100.3°F

Question #15

A client in end–stage renal disease is prescribed epoetin alfa and oral iron supplements. Before administering the next dose of epoetin alfa and oral iron supplement, what is the priority action taken by the nurse?

A Ensures the client has completed dialysis treatment

B Assesses the hemoglobin level

C Questions the administration of both medications

D Holds the epoetin alfa if the BUN is elevated

Question #16

A client with chronic anemia has received multiple transfusions. Which client action would the nurse be concerned about relative to the client’s condition?

A Takes 60 grams of protein each day

B Takes over–the–counter iron supplements

C Eliminates use of alcohol

D Takes a daily multiple vitamin pill

Question #17

A client is receiving chemotherapy for cancer. The nurse reviews the client’s laboratory report and notes that he has thrombocytopenia. To which nursing diagnosis should the nurse give the highest priority?

A Activity intolerance

B Impaired oral mucous membranes

C Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI

D Impaired tissue integrity

Question #18

The nurse is preparing the patient for a test to determine the cause of vitamin B12 deficiency. The patient will receive a small oral dose of radioactive vitamin B12 followed by a large parenteral dose of nonradioactive vitamin B12. What test is the patient being prepared for?

A Bone marrow aspiration

B Bone marrow biopsy

C Magnetic resonance imaging (MRI) study

D Schilling test

Question #19

The nurse is educating a patient with iron deficiency anemia about food sources high in iron and how to enhance the absorption of iron when eating these foods. What can the nurse inform the client would enhance the absorption?

A Eating apple slices with carrots

B Eating calf’s liver with a glass of orange juice

C Eating leafy green vegetables with a glass of water

D Eating a steak with mushrooms

Question #20

Which of the following is considered an antidote to heparin?

A Vitamin K

B Ipecac

C Narcan

D Protamine sulphate

Question #21

The nurse, caring for a client in the emergency room with a severe nosebleed, becomes concerned when the client asks for a bedpan. The nurse documents the stool as loose, tarry, and black looking. The nurse suspects the client may have thrombocytopenia. What should be the nurse’s priority action?

A Stop the nosebleed

B Ask someone to clean the bedpan

C Put in an IV line

D Notify the physician

Question #22

A client with a diagnosis of pernicious anemia comes to the clinic and reports numbness and tingling in the arms and legs. What do these symptoms indicate?

A Severity of the disease

B Insufficient intake of dietary nutrients

C Loss of vibratory and position senses

D Neurologic involvement

Question #23

A client is hospitalized 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin at home, which is now discontinued. To prevent the formation of blood clots, which action should the nurse take?

A Encourage a diet high in vitamin K.

B Have the client limit physical activity.

C Monitor partial thromboplastin (PTT) time.

D Administer the prescribed enoxaparin (Lovenox).

Question #24

A client with sickle cell anemia has a

A low hematocrit.

B normal blood smear.

C normal hematocrit.

D high hematocrit.

Question #25

A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. The client is taking prednisone daily and reported feeling pain after manually opening the garage door. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain?

A Muscle wasting

B Hypertension

C Osteoporosis

D Truncal obesity

Question #26

The nurse is caring for a client with external bleeding. What is the nurse’s priority intervention?

A Elevation of the extremity

B Pressure point control

C Direct pressure

D Application of a tourniquet

Question #27

The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency?

A B12

B C

C Folate

D A

Question #28

A nurse provides nutritional information for a patient diagnosed with an iron-deficiency anemia. What education should the nurse provide?

A Decrease the intake of citrus fruits because they interfere with iron absorption.

B Increase the intake of green, leafy vegetables.

C Take an iron supplement with meals to reduce gastric irritation.

D Decrease the intake of high-fat red meats, especially organ meats.

Question #29

A patient with End Stage Kidney Disease is taking recombinant erythropoietin for the treatment of anemia. What laboratory study does the nurse understand will have to be assessed at least monthly related to this medication?

A Potassium level

B Hemoglobin level

C Folate levels

D Creatinine level

Question #30

During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding?

A Enlarged mean corpuscular volume (MCV)

B Low ferritin level concentration

C Elevated hematocrit concentration

D Elevated red blood cell (RBC) count

Question #31

A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from? Select all that apply.,,

A Inadequate formed white blood cells

B Infection

C Abnormal erythrocyte production

D Destruction of normally formed red blood cells

E Blood loss

Question #32

An client has pernicious anemia and has been receiving treatment for several years. Which symptom may be confused with another condition in older adults?

A stomatitis

B dementia

C ataxia

D glossitis

Question #33

The nurse and the client are discussing some strategies for ingesting iron to combat the client’s iron-deficiency anemia. Which is among the nurse’s strategies?

A Take iron with an antacid to avoid stomach upset.

B Avoid vitamin C as it prevents absorption.

C Drink liquid iron preparations with a straw.

D Taking iron pills with milk aids in absorption.

Question #34

The most common cause of iron deficiency anemia in men and postmenopausal women is

A chronic alcoholism.

B menorrhagia.

C iron malabsorption.

D bleeding.

Question #35

A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client?

A Pallor, tachycardia, and a sore tongue

B Pallor, bradycardia, and reduced pulse pressure

C Sore tongue, dyspnea, and weight gain

D Angina pectoris, double vision, and anorexia

Question #36

A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the health care provider immediately because the client probably is experiencing which problem?

A A hemolytic allergic reaction caused by an antigen reaction

B A hemolytic reaction to Rh-incompatible blood

C A hemolytic reaction caused by bacterial contamination of donor blood

D A hemolytic reaction to mismatched blood

Question #37

When evaluating a patient’s symptoms that are consistent with a diagnosis of leukemia, the nurse is aware that all leukemias have which common feature?

A Compensatory polycythemia stimulated by thrombocytopenia

B Reduced plasma volume in response to a reduced production of cellular elements

C Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements

D Increased blood viscosity, resulting from an overproduction of white cells

Question #38

A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn’s disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for?

A Bleeding

B Abdominal pain

C Diarrhea

D The onset of a bacterial infection

Question #39

A patient with end-stage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia?

A Creatinine level of 6 mg/100 mL

B Magnesium level of 2.5 mg/dL

C Calcium level of 9.4 mg/dL

D Potassium level of 5.2 mEq/L

Question #40

The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include a nutritional assessment for this patient?

A It is important for the nurse to determine what type of foods the patient will eat.

B It will determine what type of anemia the patient has.

C It is part of the required assessment information.

D It may indicate deficiencies in essential nutrients.

Question #41

The nurse observes a co-worker who always seems to be eating a cup of ice. The nurse encourages the co-worker to have an examination and diagnostic workup with the health care provider. What type of anemia is the nurse concerned the co-worker may have?

A Aplastic anemia

B Megaloblastic anemia

C Sickle cell anemia

D Iron deficiency anemia

Question #42

A client with sickle cell crisis is admitted to the hospital in severe pain. While caring for the client during the crisis, which is the priority nursing intervention?

A Encouraging the client to ambulate immediately

B Limiting the client’s intake of oral and IV fluids

C Limit foods that contain folic acid

D Administering and evaluating the effectiveness of opioid analgesics

Question #43

A nursing instructor is evaluating a student caring for a neutropenic client. The instructor concludes that the nursing student demonstrates accurate knowledge of neutropenia based on which intervention?

A Monitoring the client’s temperature and reviewing the client’s complete blood count (CBC) with differential

B Monitoring the client’s heart rate and reviewing the client’s hemoglobin

C Monitoring the client’s blood pressure and reviewing the client’s hematocrit

D Monitoring the client’s breathing and reviewing the client’s arterial blood gases

Question #44

Which medication is the antidote to warfarin?

A Protamine sulfate

B Aspirin

C Clopidogrel

D Vitamin K

Question #45

A nurse caring for a client who has hemophilia is getting ready to take the client’s vital signs. What should the nurse do before taking a blood pressure?

A Ask if taking a blood pressure has ever produced pain in the upper arm.

B Ask if taking a blood pressure has ever caused bruising in the hand and wrist.

C Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints.

D Ask if taking a blood pressure has ever produced the need for medication.

Question #46

A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client?

A Limit visits by family members

B Use the smallest needle possible for injections.

C Encourage the client to use a wheelchair.

D Maintain accurate fluid intake and output records.

Question #47

A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor?

A Increased reticulocyte count

B Increased mean corpuscular volume

C Decreased total iron-binding capacity

D Decreased level of erythropoietin

Question #48

The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia?

A An increased number of erythrocytes

B Erythrocytes that are macrocytic and hyperchromic

C Clustering of platelets with sickled red blood cells

D Erythrocytes that are microcytic and hypochromic

Question #49

The nurse is caring for an older adult client who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine where the blood loss is coming from, what intervention can the nurse provide?

A Observe the sputum for signs of blood.

B Observe stools for blood.

C Observe the gums for bleeding after the client brushes teeth.

D Observe client for facial droop.

Question #50

The nurse is educating a client about iron supplements. The nurse teaches that what vitamin enhances the absorption of iron?

A E

B D

C A

D C

Question #51

While asessing a client, the nurse will recognize what as the most obvious sign of anemia?

A Pallor

B Tachycardia

C Jaundice

D Flow murmurs

Question #52

Which type of hemolytic anemia is categorized as inherited disorder?

A Hypersplenism

B Cold agglutinin disease

C Sickle cell anemia

D Autoimmune hemolytic anemia

Question #53

A client receiving a blood transfusion experiences an acute hemolytic reaction. What is the nurse’s priority intervention?

A Slow the transfusion and monitor the client closely.

B Stop the transfusion, notify the blood bank, and administer antihistamines.

C Immediately stop the transfusion, infuse dextrose 5% in water (D5W), and call the health care provider.

D Immediately stop the transfusion, infuse normal saline solution, call the health care provider, and notify the blood bank.

Question #54

A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia?

A Nausea, vomiting, and anorexia

B Nights sweats, weight loss, and diarrhea

C Itching, rash, and jaundice

D Dyspnea, tachycardia, and pallor

Question #55

A home care nurse visits a client diagnosed with atrial fibrillation who is ordered warfarin. The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching?

A “I’ll use an electric razor to shave.”

B “I’ll eat four servings of fresh, dark green vegetables every day.”

C “I’ll report unexplained or severe bruising to my doctor right away.”

D “I’ll watch my gums for bleeding when I brush my teeth.”

Question #56

The nurse is collecting data for a client who has been diagnosed with iron-deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia?

A “I feel hot all of the time.”

B “I have a difficult time falling asleep at night.”

C “I have difficulty breathing when walking 30 feet.”

D “I have an increase in my appetite.”

Question #57

Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents?

A Hyperchromic

B Microcytic

C Normocytic

D Hypochromic

Question #58

The nurse is screening donors for blood donation. Which client is an acceptable donor for blood?

A Received a blood transfusion within 1 year

B Has a history of viral hepatitis as a teenager 10 years ago

C Reports having a cold 1 month ago that resolved quickly

D Had a dental extraction 2 days ago for caries in a tooth

Question #59

When assessing a client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential?

A Menstrual history

B Age and gender

C Lifestyle assessments, such as exercise routines

D Health history, such as bleeding, fatigue, or fainting

Question #60

A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify?

A Low levels of urine constituents normally excreted in the urine

B Potential hepatic dysfunction indicated by decreased blood urea nitrogen (BUN) and creatinine levels

C Electrolyte imbalance that could affect the blood’s ability to coagulate properly

D Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels

Question #61

While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters?

A Thrombin time, calcium levels, and potassium levels

B Platelet count, prothrombin time, and partial thromboplastin time

C Fibrinogen level, WBC, and platelet count

D Platelet count, blood glucose levels, and white blood cell (WBC) count

Question #62

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?

A “I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear.”

B “I will receive parenteral vitamin B12 therapy monthly for 6 months to a year.”

C “I will receive parenteral vitamin B12 therapy for the rest of my life.”

D “I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal.”

Question #63

A client admitted to the hospital with abdominal pain, anemia, and bloody stools reports feeling weak and dizzy. The client has rectal pressure and needs to urinate and move their bowels. The nurse should help them:

A to the bedside commode.

B to a standing position so he can urinate.

C to the bathroom.

D onto the bedpan.

Question #64

During preparation for bowel surgery, a client receives an antibiotic to reduce intestinal bacteria. The nurse knows that hypoprothrombinemia may occur as a result of antibiotic therapy interfering with synthesis of which vitamin?

A Vitamin D

B Vitamin A

C Vitamin E

D Vitamin K

Question #65

A A hemolytic reaction to Rh-incompatible blood

B A hemolytic allergic reaction caused by an antigen reaction

C A hemolytic reaction caused by bacterial contamination of donor blood

D A hemolytic reaction to mismatched blood

Question #66

A client is treated for anemia. What is the nurse’s best understanding about the correlation between anemia and the client’s iron stores?

A There is a strong correlation between iron stores and hemoglobin levels.

B There is a strong correlation between iron stores and hemoglobin characteristics.

C There is an inverse relationship between iron stores and hemoglobin levels.

D There is a weak correlation between iron stores and hemoglobin levels.

Question #67

A client with severe anemia reports symptoms of tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Laboratory test results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which nursing diagnoses is mostappropriate for this client?

A Fatigue related to decreased hemoglobin and hematocrit

B Risk for falls related to complaints of dizziness

C Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients

D Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit

Question #68

Which is a symptom of hemochromatosis?

A Weight gain

B Inflammation of the tongue

C Bronzing of the skin

D Inflammation of the mouth

Question #69

A client reports feeling tired, cold, and short of breath at times. Assessment reveals tachycardia and reduced energy. What would the nurse expect the physician to order?

A ECG

B antibiotic

C chest radiograph

D CBC

Question #70

Which of the following is the most common hematologic condition affecting elderly patients

A Anemia

B Bandemia

C Thrombocytopenia

D Leukopenia

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