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 Increased blood viscosity, resulting from an overproduction of white cells

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

C Compensatory polycythemia stimulated by thrombocytopenia

D Unregulated accumulation of white cells in the bone marrow, which replace normal marrow 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 Thiamine

B Folate

C B12

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 glossitis

C stomatitis

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 Pallor, bradycardia, and reduced pulse pressure

B Pallor, tachycardia, and a sore tongue

C Angina pectoris, double vision, and anorexia

D Sore tongue, dyspnea, and weight gain

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 Acute muscular strain

B Acute chest syndrome

C Pneumocystis pneumonia

D Vaso-occlusive crisis

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 Thrombocytopenia

B Anemia

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 Decreased level of erythropoietin

B Decreased total iron-binding capacity

C Increased mean corpuscular volume

D Increased reticulocyte count

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 Kidney beans

B Orange juice

C Leafy green vegetables

D Milk

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 Aplastic anemia

B Sickle cell anemia

C Megaloblastic anemia

D Iron deficiency 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 Encourage frequent handwashing.

B Plan for frequent periods of rest.

C Use a disposable razor when shaving.

D Avoid contact with family/friends who are sick.

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 administer vitamin B12 injections

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

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

D To closely monitor the rate of administration

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 Teaches the client to bend at the back when lifting objects

B Questions the physician about the use of both medications

C Instructs the client not to lift more than 20 pounds

D Checks the clients’s BUN and creatinine

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 Describes the importance of staying cool

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

C Exhibits a temperature more than 100.3°F

D Takes hydroxyurea during her pregnancy

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 Holds the epoetin alfa if the BUN is elevated

D Questions the administration of both medications

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 over–the–counter iron supplements

B Takes a daily multiple vitamin pill

C Eliminates use of alcohol

D Takes 60 grams of protein each day

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 Impaired oral mucous membranes

B Impaired tissue integrity

C Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI

D Activity intolerance

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 Schilling test

B Bone marrow aspiration

C Bone marrow biopsy

D Magnetic resonance imaging (MRI) study

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 leafy green vegetables with a glass of water

B Eating apple slices with carrots

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

D Eating a steak with mushrooms

Question #20

Which of the following is considered an antidote to heparin?

A Vitamin K

B Protamine sulphate

C Ipecac

D Narcan

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 Put in an IV line

B Ask someone to clean the bedpan

C Notify the physician

D Stop the nosebleed

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 Neurologic involvement

B Loss of vibratory and position senses

C Insufficient intake of dietary nutrients

D Severity of the disease

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 Have the client limit physical activity.

B Monitor partial thromboplastin (PTT) time.

C Administer the prescribed enoxaparin (Lovenox).

D Encourage a diet high in vitamin K.

Question #24

A client with sickle cell anemia has a

A normal blood smear.

B low hematocrit.

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 Hypertension

B Osteoporosis

C Truncal obesity

D Muscle wasting

Question #26

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

A Application of a tourniquet

B Elevation of the extremity

C Direct pressure

D Pressure point control

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 C

B Folate

C B12

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 Take an iron supplement with meals to reduce gastric irritation.

B Increase the intake of green, leafy vegetables.

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

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 Folate levels

C Creatinine level

D Hemoglobin 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 red blood cell (RBC) count

D Elevated hematocrit concentration

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 Abnormal erythrocyte production

B Inadequate formed white blood cells

C Destruction of normally formed red blood cells

D Infection

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 ataxia

B stomatitis

C glossitis

D dementia

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 Avoid vitamin C as it prevents absorption.

B Take iron with an antacid to avoid stomach upset.

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 bleeding.

D iron malabsorption.

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 Angina pectoris, double vision, and anorexia

B Pallor, bradycardia, and reduced pulse pressure

C Pallor, tachycardia, and a sore tongue

D Sore tongue, dyspnea, and weight gain

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 caused by bacterial contamination of donor blood

C A hemolytic reaction to mismatched blood

D A hemolytic reaction to Rh-incompatible 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 Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements

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

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

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 Diarrhea

C Abdominal pain

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 Calcium level of 9.4 mg/dL

B Potassium level of 5.2 mEq/L

C Magnesium level of 2.5 mg/dL

D Creatinine level of 6 mg/100 mL

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 may indicate deficiencies in essential nutrients.

C It is part of the required assessment information.

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

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 Iron deficiency anemia

B Sickle cell anemia

C Megaloblastic anemia

D Aplastic 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 Administering and evaluating the effectiveness of opioid analgesics

B Encouraging the client to ambulate immediately

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

D Limit foods that contain folic acid

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 heart rate and reviewing the client’s hemoglobin

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

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

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

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 caused bruising in the hand and wrist.

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

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

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

Question #46

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

A Use the smallest needle possible for injections.

B Maintain accurate fluid intake and output records.

C Limit visits by family members

D Encourage the client to use a wheelchair.

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 mean corpuscular volume

B Decreased level of erythropoietin

C Decreased total iron-binding capacity

D Increased reticulocyte count

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 Clustering of platelets with sickled red blood cells

C Erythrocytes that are microcytic and hypochromic

D Erythrocytes that are macrocytic and hyperchromic

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 client for facial droop.

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

D Observe stools for blood.

Question #50

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

A C

B E

C D

D A

Question #51

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

A Jaundice

B Flow murmurs

C Pallor

D Tachycardia

Question #52

Which type of hemolytic anemia is categorized as inherited disorder?

A Autoimmune hemolytic anemia

B Hypersplenism

C Sickle cell anemia

D Cold agglutinin disease

Question #53

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

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

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

C Slow the transfusion and monitor the client closely.

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 Nights sweats, weight loss, and diarrhea

B Itching, rash, and jaundice

C Dyspnea, tachycardia, and pallor

D Nausea, vomiting, and anorexia

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 eat four servings of fresh, dark green vegetables every day.”

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

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

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

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 have difficulty breathing when walking 30 feet.”

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

C “I feel hot all of the time.”

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 Microcytic

B Normocytic

C Hypochromic

D Hyperchromic

Question #58

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

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

B Received a blood transfusion within 1 year

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

D Reports having a cold 1 month ago that resolved quickly

Question #59

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

A Age and gender

B Lifestyle assessments, such as exercise routines

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

D Menstrual history

Question #60

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

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

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

C Low levels of urine constituents normally excreted in the urine

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

Question #61

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

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

B Thrombin time, calcium levels, and potassium levels

C Fibrinogen level, WBC, and platelet count

D Platelet count, prothrombin time, and partial thromboplastin time

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 vitamin B12 level returns to normal.”

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

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

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

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 the bathroom.

C onto the bedpan.

D to a standing position so he can urinate.

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 E

B Vitamin K

C Vitamin D

D Vitamin A

Question #65

A A hemolytic reaction to Rh-incompatible blood

B A hemolytic reaction to mismatched blood

C A hemolytic allergic reaction caused by an antigen reaction

D A hemolytic reaction caused by bacterial contamination of donor 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 an inverse relationship between iron stores and hemoglobin levels.

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

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

D There is a strong 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 Bronzing of the skin

C Inflammation of the mouth

D Inflammation of the tongue

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 antibiotic

B ECG

C chest radiograph

D CBC

Question #70

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

A Thrombocytopenia

B Leukopenia

C Anemia

D Bandemia

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