Our Lady of Fatima University CMPA412 Post-Test 4 Hematology PDF

# OUR LADY OF FATIMA UNIVERSITY ## COLLEGE OF NURSING (1ST SEMESTER 2024-2025) ## CMPA412 - POST-TEST 4 - PRELIMS - HEMA 1. A client is diagnosed with anemia. The nurse realizes that which of the following could be the treatment for this client's disorder? - A. Erythropoietin therapy - B....

# OUR LADY OF FATIMA UNIVERSITY ## COLLEGE OF NURSING (1ST SEMESTER 2024-2025) ## CMPA412 - POST-TEST 4 - PRELIMS - HEMA 1. A client is diagnosed with anemia. The nurse realizes that which of the following could be the treatment for this client's disorder? - A. Erythropoietin therapy - B. Leukemia - C. Poor nutrition - D. Trauma *erythropoietin produced by the kidneys when there is low O2 level 2. A client is diagnosed with alpha- and beta- defect thalassemia. The nurse realizes that this disease is common within which of the following cultural groups? - A. Persons from China - B. Mediterranean ancestry - C. People of Philippines - D. Persons from the African Americans Thalassemia – hereditary disease Hemoglobin = heme (pigment) + globin (protein) HEME = HfeO2 - HfeO2 – HfeO2 – HfeO2 GLOBIN = amino acids 2 alpha chains of amino acids 2 beta chains of acids Thalassemia – lack alpha (alpha thalassemia) or beta chains (beta thalassemia) Major thalassemia = beta thalassemia 3. The mother of a newborn is concerned since the baby is jaundiced. The nurse realizes that the infant should be assessed for which of the following anemias? - A. Glucose-6-phosphate dehydrogenase (G6PD) - Enzyme = needed for metabolism of certain foods & drugs - ⇨ RBC membrane = hemolysis = jaundice - B. Hereditary spherocytosis - normal rbc biconcave - C. Sickle-cell anemia - Hereditary = autosomal recessive - Hemoglobin problem Globin - amino acids - one amino acid called glutamate has been replaced by valine RBC = exposed to low O2 tension -> rbc form sickling shape = obstruction Sickle cell crisis – ischemia – pain - Dehydration -> painful sickle cell crisis Infection -> aplastic sickle cell crisis High altitude -> sequestration sickle cell crisis D. Thalassemia Jaundice Causes: Liver disease = hepatic jaundice CBD obstruction = post hepatic jaundice Rbc die => hemoglobin = heme + globin Heme -> biliverdin -> bilirubin -> liver -> bile -> GB cbd -> SI Rbc rupture = hemolysis = HEMOLYTIC ANEMIA Ex. ABO INCOMPATIBILITY 4. During the health history portion of the assessment, the client states, "I have sickle-cell trait." The nurse realizes that: - A. precautions should be taken to prevent the cell from sickling. - B. the client is a carrier. - C. the client will show signs of the disease as she grows older. - D. the client will transmit the disease to any offspring. 5. A client diagnosed with acute myeloid leukemia is recovering from a bone marrow transplant. Which of the following nursing interventions would not be appropriate for this client? - A. Assess for reactions to anesthesia. - B. Maintain isolation precautions. - C. Assess vital signs. - D. Obtain a low-pressure mattress to prevent skin breakdown. 6. A client diagnosed with chronic disseminated intravascular coagulation is prescribed heparin. The nurse realizes that this medication is used to: - A. Increase blood flow to the circulation. - B. Decrease blood flow in the circulation. - C. Increase blood clot formation. - D. Decrease blood clot formation. 7. The nurse should assess a client diagnosed with multiple myeloma for which of the following electrolyte imbalances? - A. Hypercalcemia - B. Hyperkalemia - C. Hypermagnesemia - D. Hypernatremia Multiple myeloma – cancer of the plasma cells – memory cells – stay in the bone marrow - Bone pain - Stones in the urinary tract 8. A client is receiving treatment for the diagnosis of hemophilia. Which of the following should the nurse assess in this client? - A. Appetite - B. Urine output - C. Muscle and joint pain - D. Respiratory rate Hemophilia – lack of clotting factors Classic hemophilia = hemophilia A – lack of CF viii - Bleeding - Hemarthrosis – bleeding in the joints 9. A client is diagnosed with emphysema. For which of the following hematologic disorders should the nurse include in the assessment of this client? - A. Hemolytic anemia - B. Disseminated intravascular coagulation - C. Polycythemia - D. Hemophilia Emphysema = severe hypoxemia -> stimulate kidneys to release erythropoietin -> inc RBC production (pink puffer) 10. A client, diagnosed with acute lymphoblastic leukemia, is receiving the first phase of chemotherapy. The nurse realizes this client is in which phase of treatment for the disorder? - A. Induction - B. Consolidation - C. Maintenance - D. Central nervous system prophylaxis 11. The nurse is encouraging a client diagnosed with chronic leukemia to join a support group. Which of the following would a support group address? - A. Fatigue - B. Infection - C. Anxiety - D. Social Isolation 12. When doing discharge teaching for a patient who has had an emergency splenectomy following an automobile accident, the nurse will teach the patient about the increased risk for - A. Infection. - B. Lymphedema. - C. Chronic anemia. - D. Prolonged bleeding. 13. While obtaining a health history from a patient with numerous petechiae on the skin, the nurse asks the patient specifically about the patients use of - A. Salicylates. - B. Contraceptives. - C. Antiseizure drugs. - D. Antihypertensives. Petechia - sign of bleeding, small rashes from ruptured small vessels Salicylates – acetyl salicylic acid – aspirin – antiplatelet effect 14. The nurse who is reviewing laboratory data for an 86-year-old patient will be most concerned about - A. A white blood cell (WBC) count of 3500/ml. - B. A hematocrit of 37%. - C. A platelet count of 400,000/ml. - D. A hemoglobin of 11.8 g/dL. 15. The health care provider performs a bone marrow aspiration from the left posterior iliac crest on a patient with pancytopenia. Following the procedure, the nurse should - A. Elevate the head of the bed to 45 degrees. - B. Apply a sterile band-aid at the aspiration site. - C. Use half-inch sterile gauze to pack the wound. - D. Have the patient lie on the left side for an hour. BMA – best position during = PRONE Doctor's choice side lying Most dangerous complications – bleeding 16. When caring for a patient with a chronic iron deficiency anemia, the nurse will assess for - A. Yellow-tinged sclerae.(jaundice) - B. Shiny, smooth tongue. – cheilosis, pica = IDA - C. Numbness of the extremities. - D. Gum bleeding and tenderness. 17. A patient's complete blood count shows a hemoglobin of 20 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding? - A. Has there been any recent weight loss? - B. Do you have any history of lung disease? - C. What is your intake of fruits and vegetables? - D. Have you noticed any dark or bloody stools? 18. A patient with anemia is experiencing increased fatigue and occasional palpitations at rest. The nurse would expect the patient's laboratory findings to include - A. normal red blood cell (RBC) indices. - B. a hematocrit (Hct) of 38%. - C. a hemoglobin (Hb) of 8.6 g/dL (86 g/L). - D. an RBC count of 4,500,000/mL. 19. Which menu choice indicates that the patient understands the nurses teaching about best dietary choices for iron-deficiency anemia? - A. Omelet and whole wheat toast - B. Strawberry and banana fruit plate and orange juice - C. Cantaloupe and cottage cheese - D. Cornmeal muffin 20. A patient who is receiving methotrexate develops a megaloblastic anemia. The nurse will anticipate teaching the patient about increasing oral intake of - A. iron. - B. folic acid. - C. cobalamin (vitamin B12). - D. ascorbic acid (vitamin C). Megaloblastic anemia Folic acid deficiency Vit B2 deficiency Methotrexate – ani cancer drug, immunosuppressant drug SE: dec folic acid level 21. A 52-year-old patient has a new diagnosis of pernicious anemia. After teaching the patient about pernicious anemia, the nurse determines that the patient understands the disorder when the patient states, - A. I need to start eating more red meat or liver. - B. I will stop having a glass of wine with dinner. - C. I will need to take a proton pump inhibitor like omeprazole (Prilosec). - D. I would rather use the nasal spray than have to get injections of vitamin B12. 22. A patient is hospitalized for treatment of severe hemolytic anemia. An appropriate nursing action for the patient is to - A. provide a diet high in vitamin K. - B. alternate periods of rest and activity. - C. place the patient on protective isolation. - D. teach the patient how to avoid injury. 23. After the nurse has finished teaching a patient about taking oral ferrous sulfate, which patient statement indicates that additional instruction is needed? - A. I will call the doctor if my stools start to turn black. - B. I will take a stool softener if I feel constipated occasionally. - C. I should take the iron with orange juice about an hour before eating. - D. I should increase my fluid and fiber intake while I am taking the iron tablets. 24. A patient is admitted to the hospital with idiopathic aplastic anemia (BM has been replaced by fats and fibrous tissues)Which of these collaborative problems will the nurse include when developing the care plan? - A. Potential complication: seizures - B. Potential complication: neurogenic shock (SCI) - C. Potential complication: infection - D. Potential complication: pulmonary edema (CHF) 25. A patient is admitted to the hospital with a sickle cell crisis. While caring for the patient during the crisis, it is important for the nurse to - A. Limit the patient's intake of oral and IV fluids. - B. Evaluate the effectiveness of opioid analgesics. - C. Encourage the patient to ambulate as much as tolerated. - D. Teach the patient about high-protein, high-calorie foods. 26. Which statement by a patient with sickle cell anemia indicates good understanding of the nurses teaching about prevention of sickle cell crisis? - A. Home oxygen therapy is frequently used to decrease sickling. - B. There are no effective medications that can help prevent sickling. - C. Routine continuous dosage narcotics are prescribed to prevent a crisis. - D. Risk for a crisis can be lowered by having an annual influenza vaccination. 27. When planning discharge teaching for the patient who was admitted with a sickle cell crisis, which instruction will the nurse include? - A. Limit fluids to 2 to 3 quarts a day. - B. Take a daily multivitamin with iron. - C. Avoid exposure to crowds as much as possible. - D. Drink only one or two caffeinated beverages daily. 28. During the admission assessment of a patient with hemolytic anemia, the nurse notes jaundice of the sclerae. The nurse will plan to check the laboratory results for - A. the Schilling test. - B. the stool occult blood test. - C. the bilirubin level. - D. the gastric analysis testing. 29. A patient who has been receiving a heparin infusion and warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT). Which action will the nurse include in the plan of care? - A. Use low-molecular-weight heparin (LMWH) only. - B. Flush all intermittent IV lines using normal saline. - C. Administer the warfarin (Coumadin) at the scheduled time. - D. Teach the patient about the purpose of platelet transfusions. 30. During treatment of the patient with an acute exacerbation of polycythemia vera, a critical action by the nurse is to - A. Place the patient on bed rest. - B. Avoid use of aspirin products. - C. Administer iron supplements. - D. Monitor fluid intake and output. Polycythemia vera – primary polycythemia Idiopathic 65 y/o Hereditary - jak2 gene INCreased RBC, WBC, platelets HCT > 65% Increased viscosity of the blood -> slow BF > hypercoagulable -> thrombus formation Most impt nursing intervention – increase oral fluid intake THE LEVEL OF ERYTHROPOEITIN IS LOW! Ruddy complexion Medical mgt = PHLEBOTOMY 31. Joseph was admitted with suspected pernicious anemia. Which of the following laboratory exams is the most definitive of this diagnosis? - A. Peripheral blood smear – to check the shape, size and characteristics of RBC - B. CBC - C. Schilling's test - D. Coomb's test (hemolytic anemia – ABO incompatibility 32. Carlo, 28 years old, has been diagnosed with aplastic anemia. Which of the following statements of Carlo requires further instruction from the nurse? - A. “I can watch basketball games live!” - B. "I should not eat raw foods." - C. “I should avoid invasive procedures.” - D. “I need to protect myself from respiratory tract infections.” 33. Which of the following is not true about the administration of iron supplements to a patient with iron-deficiency anemia (IDA)? - a. iron dextran should be given in Z-track method - b. oral iron supplements should be given with orange juice - C. ferrous sulfate and ferrous fumarate are given with meals - D. liquid iron should be given with straw 34. Aplastic anemia is a disorder characterized by bone marrow hypoplasia or aplasia. The nurse understands that this condition may result to: - A. leukocytosis - B. polycythemia - C. thrombocytosis - D. pancytopenia 35. What is the most characteristic manifestation of hemolytic anemia? - A. cheilosis - B. beefy-red tongue - C. koilonychia - D. jaundice 36. When caring for a client with iron-deficiency anemia, the following nursing interventions are needed and the highest priority should be on: - A. Promoting rest - B. Diet with iron-rich foods - C. Erythropoeitin injection - D. Preventing break in the skin integrity 37. The nursing diagnosis for asymptomatic patient with Iron deficiency anemia is - A. Fatigue - B. Risk for fall related to dizziness - C. Imbalanced nutrition less than body requirements - D. All of the above 38. A client with anemia revealed macrocytic cells in the peripheral smear, possible type of anemia is - A. Iron deficiency anemia - B. Folic Acid deficiency anemia - C. Hemolytic anemia - D. Aplastic anemia 39. Because of a deficiency of iron, the person with iron deficiency anemia is unable to make sufficient: - A. Plasma - B. Wbcs - C. Hemoglobin - D. Antibodies 40. The nurse is aware that a common cause of reduced amounts of erythropoietin is: - A. Renal failure - B. Liver cancer - C. Emphysema - D. Diabetes 41. The nurse anticipates that the patient with iron deficiency anemia will have red cells that are: - A. normochromic and normocytic - B. hyperchromic and macrocytic - C. hypochromic and microcytic - D. normochromic and microcyti 42. The home health nurse assesses the patient taking ferrous sulfate (Feosol). Which patient statement alerts the nurse that teaching is necessary regarding this medication? - A. It tastes better when I take my medicine with milk - B. My wife says I should take my medicine with orange juice - C. I am always careful not to break open the capsule - D. I usually take my iron with my whole-grain toast during breakfast. 43. The nurse frequently assesses for signs of infection on the patient with aplastic anemia because the patient will not be able to produce an inflammatory response related to the low level of: - A. Leukocytes - B. Erythrocytes - C. Histamine - D. Hemopoietin 44. The nurse instructs the 20-year-old female patient with sickle cell trait that: - A. The condition will evolve into sickle cell anemia as she ages - B. The trait will be transmitted to male children only - C. All of her children will have sickle cell anemia - D. The trait can be passed on to all children. 45. The nurse stresses to the patient with sickle cell anemia that one of the most elementary home interventions to help prevent sickle cell crisis is to: - A. Take iron supplements daily - B. Engage in daily exercise - C. Maintain adequate fluid intake - D. Eat leafy green vegetables 46. The nurse is conscientious in the care of the feet and legs of a patient with sickle cell anemia because: - A. Stasis ulcers are a constant threat may occur on the soles of the feet - B. Edema of the feet increases activity intolerance - C. Bleeding - D. Toenails must be kept short to avoid ingrown nails 47. The home health nurse caring for the patient with polycythemia vera will focus care on: - A. maintenance of high fluid intake - B. daily dose of anticoagulants - C. daily exercise to reduce weight - D. adequate intake of vitamin C 48. The patient with acute myelogenous leukemia (AML) asks why he is making more WBCs when he already has so many. The nurse clarifies that the large number of leukemic white cells he already has: - A. are not as effective as normal white cells would be - B. attempt to take over the functions of RBCs produced by the lymphatic system - C. protect against infection - D. are 49. Which of the following is not an example of Megaloblastic Anemia? - A. folate deficiency anemia - B. vitamin B12 deficiency anemia - C. iron-deficiency anemia - D. none of the above 50. The most definitive diagnostic procedure for anemia is the bone marrow aspiration. Which of the following is considered as the best site among adults for this invasive procedure? - A. sternum - B. skull - C. long bones - D. iliac crest most common symptom of anemia fatigue most common sign pallor dyspnea palpitation tachycardia dizziness weakness weigh loss specific symptoms jaundice – hemolytic PICA, smooth tongue, cheilosis – IDA Numbness / paresthesias – Pernicious anemia Microcytic hypochromic – IDA, thalassemia Megaloblastic – Pernicious, Folic acid def anemia Schilling's test – for absorption of vit B12 Coomb's test - hemolytic anemia (ABO, RH Incompatibility) BMA - most definitive diagnostic test for ALL blood disorders best position – prone most dangerous complication – lie on the affected side most common blood product in severe anemia = packed RBC blood products to hemophilia cryoprecipitate/ Fresh frozen plasma Polycythemia Primary – idiopathic Polycythemia vera Erythropoietin level - low Secondary known causes Erythropoietin level is high ==End of OCR for page 11==