The nurse is assessing an older client for any potential hematologic health problem. Which assessment finding is the most significant and would be reported to the primary health care provider?
Multiple petechiae and large bruises
A nurse is assessing a dark-skinned client for pallor. What nursing assessment is best to assess for pallor in this client?
Assess the conjunctiva of the eye
A hospitalized client has a platelet count of 58,000/mm3 (58,000/mm (58x 10/L). What action by the nurse is most appropriate?
Place the client on safety precautions.
A client is having a bone marrow aspiration and biopsy. What action by the nurse takes priority?
Ensure that valid consent is in the medical record.
What is the nurse’s priority when caring for a client who just completed a bone marrow aspiration and biopsy?
Check the pressure dressing frequently for signs of excessive or active bleeding.
A nurse is caring for four clients. After reviewing today’s laboratory results, which client would the nurse assess first?
Client with a prothrombin time (PT) of 28 seconds
A client is having a bone marrow aspiration and biopsy and is extremely anxious. What action by the nurse is the most appropriate
Assess the client’s fears and coping mechanisms.
A client is having a radioisotopic imaging scan. What action by the nurse is most important?
Teach the client about the procedure.
While taking a client history, which factor(s) that place the client at risk for a hematologic health problem will the nurse document? (Select all that apply.)
Family history of bleeding problems
Excessive alcohol consumption
Diet high in Vitamin K
An older client asks the nurse why “people my age” have weaker immune systems than younger people. What responses by the nurse are best? (Select all that apply.)
“Bone marrow produces fewer blood cells as you age.”
You have lower levels of plasma proteins in the blood.”
The nurse is assessing a client experiencing anemia. Which laboratory findings will the nurse expect for this client? (Select all that apply.)
Decreased red blood cell count
Decreased serum iron
Decreased hemoglobin
A nurse works in a gerontology clinic. What age-related change(s) related to the hematologic system will the nurse expect during health assessment? (Select all that apply.)
Nail beds may be thickened or discolored.
Progressive loss or thinning of hair occurs.
A nurse caring for a client with sickle cell disease (SCD) reviews the client’s laboratory test results. Which finding would the nurse report to the primary health care provider?
Creatinine: 2.9 mg/dL (256 mcmol/L)
The nurse is assessing a client in sickle cell disease (SCD) crisis. What priority client problem will the nurse expect?
Pain
A client in sickle cell crisis is dehydrated and in the emergency department. The nurse plans to start an IV. Which fluid choice is best?
0.45% normal saline
A client presents to the emergency department in sickle cell disease crisis. What intervention by the nurse takes priority?
Administer oxygen.
A client hospitalized with sickle cell disease crisis frequently asks for opioid pain medications, often shortly after receiving a dose. The nurses on the unit believe that the client is drug seeking. When the client requests pain medication, what action by the nurse is best?
Give the client pain medication if it is time for another dose.
The nurse is caring for a client experiencing sickle cell disease crisis. Which priority action would help prevent infection?
Performing frequent handwashing
A nurse in a hematology clinic is working with four clients who have polycythemia vera. Which client would the nurse assess first?
Client who reports shortness of breath
The nurse is teaching a client who has pernicious anemia about necessary dietary changes. Which statement by the client indicates understanding about those changes?
“I’ll increase animal proteins like fish and meat.”
An assistive personnel is caring for a client with leukemia and asks why the client is still at risk for infection when the white blood cell count (WBC) is high. What response by the nurse is correct?
“Those WBCs are abnormal and don’t provide protection.”
The family of a neutropenic client reports that the client “is not acting right.” What action by the nurse is the priority?
Assess the client for infection.
A nurse is caring for a client who is about to receive a bone marrow transplant. To best help the client cope with the long recovery period, what action by the nurse is best?
Help the client find things to hope for each day of recovery.
A client asks about the process of graft-versus-host disease. What explanation by the nurse is correct?
“The donor’s cells are actually attacking the patient’s cells.”
The nurse is caring for a patient with leukemia who has severe fatigue. What action by the client best indicates that an important outcome to manage this problem has been met?
Doing activities of daily living (ADLs) using rest periods
A nurse is caring for a young male client with lymphoma who is to begin treatment. What teaching topic is a priority?
Sperm banking
A client has been admitted after sustaining a humerus fracture that occurred when picking up the family cat. What test result would the nurse correlate to this condition?
Bence-Jones protein in urine
A client with multiple myeloma demonstrates worsening bone density on diagnostic scans. About what drug does the nurse plan to teach this client?
Zoledronic acid
A client has a platelet count of 9000/mm3 (9 x 10/L). The nurse finds the client confused and mumbling. What nursing action takes priority at this time?
Call the Rapid Response Team.
A nurse is preparing to administer a blood transfusion. What action is most important?
Ensure that informed consent is obtained.
A nurse is preparing to administer a blood transfusion. Which action is most important?
Put on a pair of gloves.
A client receiving a blood transfusion develops anxiety and low back pain. After stopping the transfusion, what action by the nurse is most important?
Double-check the client and blood product identification.
A client has thrombocytopenia. What statement indicates that the client understands self-management of this condition?
“I usually put ice on bumps or bruises.”
A nurse is caring for four clients with leukemia. After hand-off report, which client would the nurse assess first?
Client who had two bloody diarrhea stools this morning.
Which statement by a client with leukemia indicates a need for further teaching by the nurse?
“I will take a daily laxative to prevent constipation.”
The nurse is assessing a client who has probable lymphoma. What is the most common early assessment finding for clients with this disorder?
Enlarged painless lymph node(s)
The nurse assesses a client’s oral cavity as seen in the photo below:
What action by the nurse is most appropriate?
Teach the client about cobalamin therapy.
A nurse working with clients diagnosed with sickle cell disease (SCD) teaches about self-management to prevent exacerbations and sickle cell crises. What factor(s) should clients be taught to avoid? (Select all that apply.)
Dehydration
Extreme stress
High altitudes
Pregnancy
Which risk factor(s) places a client at risk for leukemia? (Select all that apply.)
Chemical exposure
Ionizing radiation exposure
Viral infections
The nurse is assessing a client with chronic leukemia. Which laboratory test result(s) is (are) expected for this client? (Select all that apply.)
Decreased hematocrit
Abnormal white blood cell count
Low platelet count
Decreased hemoglobin
The nurse is caring for a client being treated for Hodgkin lymphoma. For which side effect(s) of treatment will the nurse assess? (Select all that apply.)
Severe nausea and vomiting
Low platelet count
Skin irritation at radiation site
Low red blood cell count
The nurse is preparing to administer a blood transfusion. Which action(s) by the nurse is (are) most appropriate? (Select all that apply.)
Hang the blood product using normal saline and a filtered tubing set.
Take a full set of vital signs prior to starting the blood transfusion.
Use gloves to start the client’s IV if needed and to handle the blood product.
Which statement(s) about blood transfusion compatibilities is (are) correct? (Select all that apply.)
Donor blood type A can donate to recipient blood type AB.
Donor blood type O can donate to anyone.
The nurse is caring for a client receiving a unit of whole blood. Which nursing action(s) is (are) appropriate regarding infusion administration. (Select all that apply.)
Use a dedicated filtered blood administration set.
Stay with the client for the first 15 to 20 minutes of the infusion.
Monitor and document vital signs per agency policy.
Infuse the transfusion with intravenous normal saline.
A nurse is preparing to administer a packed red blood cell transfusion to an older adult. Understanding age-related changes, what alteration(s) in the usual protocol is (are) necessary for the nurse to implement? (Select all that apply.)
Assess vital signs at least every 15 minutes.
Avoid giving other IV fluids.
Assess the client for fluid overload.
Which assessment finding(s) may indicate that a client may be experiencing a blood transfusion reaction? (Select all that apply.)
Tachycardia
Fever
Bronchospasm
Tachypnea
Urticaria
Hypotension
A client has received a bone marrow transplant and is waiting for engraftment. What action(s) by the nurse are most appropriate? (Select all that apply.)
Placing the client in protective precautions
Teaching visitors appropriate hand hygiene
Telling visitors not to bring live flowers or plants
A nurse is caring for an older adult receiving multiple packed red blood cell transfusions. Which assessment finding(s) indicate(s) possible transfusion circulatory overload? (Select all that apply.)
Acute confusion
Dyspnea
Hypertension
Bounding pulse