Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
Chapter 30: Hematologic Problems
-Surgical Nursing, 11th Edition
MULTIPLE CHOICE
1. An adult male with chronic anemia is experiencing increased fatigue and occasional
palpitations at rest. Which laboratory data would the nurse identify as consistent with these
symptoms?
a. RBC count of 4,500,000/ L
b. Hematocrit (Hct) value of 38%
c. Normal red blood cell (RBC) indices
d. Hemoglobin (Hgb) of 8.6 g/dL (86 g/L)
ANS: D
g/dL. The other values are all within the range of normal.
DIF: Cognitive Level: Understand (comprehension)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
2.
dietary choices for iron-deficiency anemia?
a. Omelet and whole wheat toast
b. Cantaloupe and cottage cheese
c. Strawberry and banana fruit plate
d. Cornmeal muffin and orange juice
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ANS: A
Eggs and whole grain breads are high in iron. The other choices are appropriate for other
nutritional deficiencies but are not the best choice for a patient with iron-deficiency anemia.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Evaluation
3. A patient who is receiving methotrexate for severe rheumatoid arthritis develops a
megaloblastic anemia. Which nutrient supplement should the nurse plan to explain to the
patient?
a. Iron
b. Folic acid
c. Cobalamin (vitamin B12)
d. Ascorbic acid (vitamin C)
ANS: B
Methotrexate use can lead to folic acid deficiency. Supplementation with oral folic acid
supplements is the usual treatment. The other nutrients would not correct folic acid deficiency,
although they would be used to treat other types of anemia.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
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Nursing Process: Planning
Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
4. Which patient statement to the nurse indicates that the patient understands self-care for
pernicious anemia?
a.
b.
c.
d.
12
ANS: C
Because pernicious anemia prevents the absorption of vitamin B12, this patient requires
injections or intranasal administration of cobalamin. Alcohol use does not cause cobalamin
deficiency. Proton pump inhibitors decrease the absorption of vitamin B12. Eating more foods
rich in vitamin B12 is not helpful because the lack of intrinsic factor prevents absorption of the
vitamin.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Evaluation
5. Which is an appropriate nursing intervention for a hospitalized patient with severe hemolytic
anemia?
a. Provide a diet high in vitamin K.
b. Teach the patient how to avoid injury.
c. Encourage alternating rest and activity.
d. Place the patient on protective isolation.
ANS: C
Nursing care for patients with anemia should alternate periods of rest and activity to avoid
undue fatigue. There is no indication that the patient has a bleeding disorder, so a diet high in
vitamin K or teaching about TESTBANKWORLD.ORG
how to avoid injury is not needed. Protective isolation might be
used for a patient with aplastic anemia, but it is not indicated for hemolytic anemia.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
6. Which patient statement to the nurse indicates a need for additional instruction about taking
oral ferrous sulfate?
a.
b.
c.
d.
ANS: C
It is normal for the stools to appear black when a patient is taking iron, and the patient should
not call the health care provider about this. The other patient statements are correct.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Evaluation
7. Which potential complication should the nurse identify as a high risk for a patient admitted to
the hospital with idiopathic aplastic anemia?
a. Seizures
b. Infection
c. Neurogenic shock
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
d. Pulmonary edema
ANS: B
Because the patient with aplastic anemia has pancytopenia, the patient is at risk for infection
and bleeding. There is no increased risk for seizures, neurogenic shock, or pulmonary edema.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Planning
8. Which nursing intervention is important when providing care for a patient with sickle cell
crisis?
a.
b. Evaluating the effectiveness of opioid analgesics
c. Encouraging the patient to ambulate as much as tolerated
d. Teaching the patient about high-protein, high-calorie foods
ANS: B
Pain is the most common clinical manifestation of a crisis and usually requires large doses of
continuous opioids for control. Fluid intake should be increased to reduce blood viscosity and
improve perfusion. Rest is usually ordered to decrease metabolic requirements. Patients are
instructed about the need for dietary folic acid, but high-protein, high-calorie diets are not
emphasized.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
9.
preventing sickle cell crisis? TESTBANKWORLD.ORG
a.
b.
c.
d.
ANS: D
Because infection is the most common cause of a sickle cell crisis, influenza, Haemophilus
influenzae, pneumococcal pneumonia, and hepatitis immunizations should be administered.
Although continuous dose opioids and oxygen may be administered during a crisis, patients
do not receive these therapies to prevent crisis. Hydroxyurea (Hydrea) is a medication used to
decrease the number of sickle cell crises.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Evaluation
10. Which instruction will the nurse plan to include in discharge teaching for a patient admitted
with a sickle cell crisis?
a. Limit fluids to 2 to 3 quarts per day.
b. Avoid exposure to crowds when possible.
c. Take a daily multivitamin supplement with iron.
d. Drink no more than two caffeinated beverages daily.
ANS: B
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
s risk for infection, the most common cause of sickle
cell crisis. There is no restriction on caffeine use. Iron supplementation is generally not
recommended. A high-fluid intake is recommended.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Planning
11. The nurse observes scleral jaundice in a patient being admitted with hemolytic anemia. Which
laboratory result the nurse should check?
a. Schilling test
b. Bilirubin level
c. Stool occult blood
d. Gastric acid analysis
ANS: B
Jaundice is caused by the elevation of bilirubin level associated with red blood cell hemolysis.
Other tests would not be helpful in monitoring hemolytic anemia.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
12. A patient who has been receiving IV heparin infusion and oral warfarin (Coumadin) for a
deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT)
when the platelet level drops to 110,000/µL. Which action will the nurse include in the plan of
care?
a. Prepare for platelet transfusion.
b. Discontinue the heparin infusion.
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c. Administer prescribed warfarin
(Coumadin).
d. Give low-molecular-weight heparin (LMWH).
ANS: B
All heparin is discontinued when HIT is diagnosed. The patient should be instructed to never
receive heparin or LMWH. Warfarin is usually not given until the platelet count has returned
to 150,000/µL. The platelet count does not drop low enough in HIT for a platelet transfusion,
and platelet transfusions increase the risk for thrombosis.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Planning
13. What action is expected by the nurse caring for a patient who has an acute exacerbation of
polycythemia vera?
a. Place the patient on bed rest.
b. Administer iron supplements.
c. Avoid use of aspirin products.
d. Monitor fluid intake and output.
ANS: D
Monitoring hydration status is important during an acute exacerbation because the patient is at
risk for fluid overload or underhydration. Aspirin therapy is used to decrease risk for
thrombosis. The patient should be encouraged to ambulate to prevent deep vein thrombosis.
Iron is contraindicated in patients with polycythemia vera.
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DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
14. Which intervention will be included in the nursing care plan for a patient with immune
thrombocytopenic purpura?
a. Assign the patient to a private room.
b. Avoid intramuscular (IM) injections.
c. Use rinses rather than a soft toothbrush for oral care.
d. Restrict activity to passive and active range of motion.
ANS: B
IM or subcutaneous injections should be avoided because of the risk for bleeding. A soft
toothbrush can be used for oral care. There is no need to restrict activity or place the patient in
a private room.
DIF: Cognitive Level: Apply (application)
TOP:
MSC: NCLEX: Safe and Effective Care Environment
Nursing Process: Planning
15. Which laboratory result will the nurse expect to show a decreased value if a patient develops
heparin-induced thrombocytopenia (HIT)?
a. Prothrombin time
b. Erythrocyte count
c. Fibrinogen degradation products
d. Activated partial thromboplastin time
ANS: D
Platelet aggregation in HIT causes neutralization of heparin, so the activated partial
thromboplastin time will be shorter,
and more heparin will be needed to maintain therapeutic
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levels. The other data will not be affected by HIT.
DIF: Cognitive Level: Understand (comprehension)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
16. The nurse is caring for a patient with type A hemophilia being admitted to the hospital with
severe pain and swelling in the right knee. Which action should the nurse take?
a. Apply heat to the knee.
b. Immobilize the knee joint.
c. Assist the patient with light weight bearing.
d. Perform passive range of motion to the knee.
ANS: B
The initial action should be total rest of the knee to minimize bleeding. Ice packs are used to
decrease bleeding. Range of motion (ROM) and weight-bearing exercise are contraindicated
initially, but after the bleeding stops, ROM and physical therapy are started.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
17. A young adult who has von Willebrand disease is admitted to the hospital for minor knee
surgery. Which laboratory value should the nurse monitor?
a. Platelet count
b. Bleeding time
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
c. Thrombin time
d. Prothrombin time
ANS: B
The bleeding time is affected by von Willebrand disease. Platelet count, prothrombin time,
and thrombin time are normal in von Willebrand disease.
DIF: Cognitive Level: Understand (comprehension)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
18. A routine complete blood count for an active older man indicates possible myelodysplastic
syndrome. What should the nurse plan to explain to the patient?
a. Blood transfusion
b. Bone marrow biopsy
c. Filgrastim administration
d. Erythropoietin administration
ANS: B
Bone marrow biopsy is needed to make the diagnosis and determine the specific type of
myelodysplastic syndrome. The other treatments may be necessary later if there is progression
of the myelodysplastic syndrome, but the initial action for this asymptomatic patient will be a
bone marrow biopsy.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Planning
19. Which action will the admitting nurse include in the care plan for a patient who has
neutropenia?
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a. Avoid intramuscular injections.
b. Check temperature every 4 hours.
c.
d. Omit fruits and vegetables from the diet.
ANS: B
The earliest sign of infection in a neutropenic patient is an elevation in temperature. While
unpeeled fresh fruits and vegetables should be avoided, fruits and vegetables that are peeled or
cooked are acceptable. Injections may be required for administration of medications such as
filgrastim (Neupogen). The number of visitors may be limited and visitors with communicable
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Planning
20. Which laboratory test will the nurse use to determine whether filgrastim (Neupogen) is
effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy?
a. Platelet count
b. Reticulocyte count
c. Total lymphocyte count
d. Absolute neutrophil count
ANS: D
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
Filgrastim increases the neutrophil count and function in neutropenic patients. Although total
lymphocyte, platelet, and reticulocyte counts are also important to monitor in this patient, the
absolute neutrophil count is used to evaluate the effects of filgrastim.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Evaluation
21. A patient who has acute myelogenous leukemia (AML) asks the nurse whether the planned
chemotherapy will be worth undergoing. Which response by the nurse is appropriate?
a.
cell
b.
c.
t is one that you and the doctor need to make rather
d.
ANS: B
This response uses therapeutic communication
accurate information. The other responses either give inaccurate information or fail to address
information.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity
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22. A patient who has a history of
a transfusion-related acute lung injury (TRALI) is to receive a
transfusion of packed red blood cells (PRBCs). Which action by the nurse will decrease the
risk for TRALI for this patient?
a. Infuse PRBCs slowly over 4 hours.
b. Transfuse leukocyte-reduced PRBCs.
c. Administer the prescribed diuretic before the transfusion.
d. Give the PRN dose of antihistamine before the transfusion.
ANS: B
TRALI is caused by a reaction between the donor and the patient leukocytes that causes
pulmonary inflammation and capillary leaking. The other actions may help prevent respiratory
problems caused by circulatory overload or by allergic reactions, but they will not prevent
TRALI.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
23. A patient who has acute myelogenous leukemia (AML) is considering treatment with a
hematopoietic stem cell transplant (HSCT). What is the best approach for the nurse to assist
the patient with this treatment decision?
a. Discuss the need for insurance to cover post-HSCT care.
b. Inquire whether there are questions or concerns about HSCT.
c. Emphasize the positive outcomes of a bone marrow transplant.
d. Explain that a cure is not possible with any treatment except HSCT.
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
ANS: B
Offering the patient an opportunity to ask questions or discuss concerns about HSCT will
encourage the patient to voice concerns about this treatment and will allow the nurse to assess
whether the patient needs more information about the procedure. Treatment of AML using
chemotherapy is another option for the patient. It is not appropriate for the nurse to ask the
patient to consider insurance needs in making this decision.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity
24. Which action will the nurse include in the plan of care for a patient admitted with multiple
myeloma?
a. Monitor fluid intake and output.
b. Administer calcium supplements.
c. Assess lymph nodes for enlargement.
d. Limit weight bearing and ambulation.
ANS: A
A high fluid intake and urine output helps prevent the complications of kidney stones caused
by hypercalcemia and renal failure caused by deposition of Bence-Jones protein in the renal
tubules. Weight bearing and ambulation are encouraged to help bone retain calcium. Lymph
nodes are not enlarged with multiple myeloma. Calcium supplements will further increase the
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Planning
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25. Which nursing intervention is appropriate for a patient with non-
platelet count drops to 18,000/µL during chemotherapy?
a. Test all stools for occult blood.
b. Encourage fluids to 3000 mL/day.
c. Provide oral hygiene every 2 hours.
d. Check the temperature every 4 hours.
ANS: A
Because the patient is at risk for spontaneous bleeding, the nurse should check stools for
occult blood. A low platelet count does not require an increased fluid intake. Oral hygiene is
important, but it is not necessary to provide oral care every 2 hours. The low platelet count
does not increase risk for infection, so frequent temperature monitoring is not indicated.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
26. A patient receiving outpatient chemotherapy for myelogenous leukemia develops an absolute
neutrophil count of 850/µL. Which collaborative action should the outpatient clinic nurse
anticipate??
a. Discuss the need for hospital admission to treat the neutropenia.
b. Teach the patient to administer filgrastim (Neupogen) injections.
c. Plan to discontinue the chemotherapy until the neutropenia resolves.
d. Order a high-
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
ANS: B
The patient may be taught to self-administer filgrastim injections. Although chemotherapy
may be stopped with severe neutropenia (neutrophil count <500/µL), administration of
filgrastim usually allows the chemotherapy to continue. Patients with neutropenia are at
higher risk for infection when exposed to other patients in the hospital. HEPA filters are
expensive and are used in the hospital, where the number of pathogens is much higher than in
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Planning
27. Which assessment finding should the nurse caring for a patient with thrombocytopenia
communicate immediately to the health care provider?
a. Brui
b. The patient is difficult to arouse.
c.
d.
ANS: B
Difficulty in arousing the patient may indicate a cerebral hemorrhage, which is life threatening
and requires immediate action. The other information should be documented and reported but
would not be unusual in a patient with thrombocytopenia.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
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28. The nurse is planning to administer
a transfusion of packed red blood cells (PRBCs) to a
patient with blood loss from gastrointestinal hemorrhage. Which action can the nurse delegate
to unlicensed assistive personnel (UAP)?
a. Verify the patient identification (ID) according to hospital policy.
b.
c. Double-check the product numbers on the PRBCs with the patient ID band.
d. Monitor the patient for shortness of breath or chest pain during the transfusion.
ANS: B
UAP education includes measurement of vital signs. UAP would report the vital signs to the
registered nurse (RN). The other actions require more education and a larger scope of practice
and should be done by licensed nursing staff members.
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Delegation
TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
29. A postoperative patient receiving a transfusion of packed red blood cells develops chills,
fever, headache, and anxiety 35 minutes after the transfusion is started. After stopping the
transfusion, what action should the nurse take?
a. Send a urine specimen to the laboratory.
b. Administer PRN acetaminophen (Tylenol).
c. Draw blood for a new type and crossmatch.
d. Give the prescribed PRN diphenhydramine.
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ANS: B
c transfusion
reaction. The transfusion should be stopped, and antipyretics administered for the fever as
ordered. A urine specimen is needed if an acute hemolytic reaction is suspected.
Diphenhydramine is used for allergic reactions. This type of reaction does not indicate
incorrect crossmatching.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
30. A patient in the emergency department reports back pain and difficulty breathing 15 minutes
first action
be?
a.
b.
c.
d.
Administer oxygen therapy at a high flowrate.
Obtain a urine specimen to send to the laboratory.
Notify the health care provider about the symptoms.
Disconnect the transfusion and infuse normal saline.
ANS: D
transfusion. The first action should be to disconnect the transfusion and infuse normal saline.
The other actions also are needed but are not the highest priority.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
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31. Which patient should the nurse
assign as the roommate for a patient who has aplastic anemia?
a. A patient with chronic heart failure
b. A patient who has viral pneumonia
c. A patient who has right leg cellulitis
d. A patient with multiple abdominal drains
ANS: A
Patients with aplastic anemia are at risk for infection because of the low white blood cell
production associated with this type of anemia, so the nurse should avoid assigning a
roommate with any possible infectious process.
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Multiple Patients
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
32. Which patient requires the most rapid assessment and care by the emergency department
nurse?
a. The patient with hemochromatosis who reports abdominal pain.
b. The patient with neutropenia who has a temperature of 101.8° F.
c. The patient with thrombocytopenia who has oozing gums after a tooth extraction.
d. The patient with sickle cell anemia who has had nausea and diarrhea for 24 hours.
ANS: B
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A neutropenic patient with a fever is assumed to have an infection and is at risk for rapidly
developing sepsis. Rapid assessment, cultures, and initiation of antibiotic therapy are needed.
The other patients also require rapid assessment and care but not as urgently as the
neutropenic patient.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Multiple Patients | Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Safe and Effective Care Environment
33. A patient with immune thrombocytopenic purpura (ITP) has an order for a platelet
transfusion. Which information indicates that the nurse should consult with the health care
provider before obtaining and administering platelets?
a. Platelet count is 42,000/ L.
b. Blood pressure is 94/56 mm Hg.
c. Petechiae are present on the chest.
d. Blood is oozing from the venipuncture site.
ANS: A
Platelet transfusions are not usually indicated until the platelet count is below 10,000 to
20,000/ L unless the patient is actively bleeding. Therefore, the nurse should clarify the order
with the health care provider before giving the transfusion. The other data all indicate that
bleeding caused by ITP may be occurring and that the platelet transfusion is appropriate.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Planning
34. Which problem reported by a patient with hemophilia is most important for the nurse to
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communicate to the health care
provider?
a. Leg bruises
b. Tarry stools
c. Skin abrasions
d. Bleeding gums
ANS: B
Melena is a sign of gastrointestinal bleeding and requires collaborative actions such as
checking hemoglobin and hematocrit and administration of coagulation factors. The other
problems indicate a need for patient teaching about how to avoid injury but are not indicators
of possible serious blood loss.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
35. A patient with septicemia develops prolonged bleeding from venipuncture sites and blood in
the stools. Which action is most important for the nurse to take?
a. Avoid other venipunctures.
b. Apply dressings to the sites.
c. Notify the health care provider.
d. Give prescribed proton-pump inhibitors.
ANS: C
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nated
intravascular coagulation (DIC) may have developed, which will require collaborative actions
such as diagnostic testing, blood product administration, and heparin administration. The
other actions are also appropriate, but the most important action should be to notify the health
care provider so that DIC treatment can be initiated rapidly.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
36. A patient with possible disseminated intravascular coagulation arrives in the emergency
department with a blood pressure of 82/40, temperature of 102° F (38.9° C), and severe back
pain. Which prescribed action will the nurse implement first?
a. Administer morphine sulfate 4 mg IV.
b. Give acetaminophen (Tylenol) 650 mg.
c. Infuse normal saline 500 mL over 30 minutes.
d. Schedule complete blood count and coagulation studies.
ANS: C
s blood pressure indicates hypovolemia caused by blood loss and should be
addressed immediately to improve perfusion to vital organs. The other actions are also
appropriate and should be rapidly implemented, but improving perfusion is the priority for
this patient.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
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37. Which action for a patient with neutropenia is appropriate for the registered nurse (RN) to
delegate to a licensed practical/vocational nurse (LPN/VN)?
a. Assessing the patient for signs and symptoms of infection
b. Teaching the patient the purpose of neutropenic precautions
c. Administering subcutaneous filgrastim (Neupogen) injection
d. Developing a discharge teaching plan for the patient and family
ANS: C
Administration of subcutaneous medications is included in LPN/VN education and scope of
practice. Patient teaching, assessment, and developing the plan of care require RN level
education and scope of practice.
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Delegation
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
38. Several patients call the outpatient clinic and ask to make an appointment as soon as possible.
Which patient should the nurse schedule to be seen first?
a. A 44-yr-old with sickle cell anemia who says his eyes always look yellow
b. A 23-yr-old with no previous health problems who has a nontender axillary lump
c. A 50-yr-old with early-stage chronic lymphocytic leukemia who reports chronic
fatigue
d. A 19-yr-old with hemophilia who wants to learn to self-administer factor VII
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replacement
ANS: B
phoma,
which needs rapid diagnosis and treatment. The other patients have questions about treatment
or symptoms that are consistent with their diagnosis but do not need to be seen urgently.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Multiple Patients
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
39. After receiving change-of-shift report for several patients with neutropenia, which patient
should the nurse assess first?
a. A 23-yr-old who reports severe fatigue
b. A 56-yr-old with frequent explosive diarrhea
c. A 33-yr-old with a fever of 100.8° F (38.2° C)
d. A 66-yr-old who has white pharyngeal lesions
ANS: C
Any fever in a neutropenic patient indicates infection and can quickly lead to sepsis and septic
shock. Rapid assessment and (if prescribed) initiation of antibiotic therapy within 1 hour are
needed. The other patients also need to be assessed but do not have symptoms of potentially
life-threatening problems.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization | Special Questions: Multiple Patients
TOP: Nursing Process: Assessment
MSC: NCLEX: Safe and Effective Care Environment
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40. Which action will the nurse include in the plan of care for a patient who has thalassemia
major?
a. Administer chelation therapy as needed.
b. Teach the patient to use iron supplements.
c. Avoid the use of intramuscular injections.
d. Notify health care provider of hemoglobin 11 g/dL.
ANS: A
The frequent transfusions used to treat thalassemia major lead to iron toxicity in patients
unless iron chelation therapy is consistently used. Iron supplementation is avoided in patients
with thalassemia. There is no need to avoid intramuscular injections. The goal for patients
with thalassemia major is to maintain a hemoglobin of 10 g/dL or greater.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Planning
41. Which information is most important for the nurse to monitor when evaluating the
effectiveness of deferoxamine (Desferal) for a patient with hemochromatosis?
a. Skin color
b. Hematocrit
c. Liver function
d. Serum iron level
ANS: D
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Because iron chelating agents are used to lower serum iron levels, the most useful information
e monitored but are not the
most important to monitor when determining the effectiveness of deferoxamine.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
42. Which finding about a patient with polycythemia vera is most important for the nurse to
report to the health care provider?
a. Hematocrit 55%
b. Presence of plethora
c. Calf swelling and pain
d. Platelet count 450,000/ L
ANS: C
The calf swelling and pain suggest that the patient may have developed a deep vein
thrombosis, which will require diagnosis and treatment to avoid complications such as
pulmonary embolus. The other findings will also be reported to the health care provider but
are expected in a patient with this diagnosis.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
43.
ymphoma for a 55-yr-old woman, which topic
will the nurse include in patient teaching?
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a. Potential impact of chemotherapy
treatment on fertility
b. Application of soothing lotions to treat residual pruritus
c. Use of maintenance chemotherapy to maintain remission
d. Need for follow-up appointments to screen for malignancy
ANS: D
gh incidence of
secondary malignancies; follow-up screening is needed. Chemotherapy will not impact the
fertility of a 55-yrlymphoma. Pruritus is a clinical manifestation of lymphoma but should not be a concern after
treatment.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
44. A patient who has non-
Nursing Process: Planning
s lymphoma is receiving combination treatment with
rituximab (Rituxan) and chemotherapy. Which patient assessment finding requires the most
rapid action by the nurse?
a. Anorexia
b. Vomiting
c. Oral ulcers
d. Lip swelling
ANS: D
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
Lip swelling in angioedema may indicate a hypersensitivity reaction to the rituximab. The
nurse should stop the infusion and further assess for anaphylaxis. The other findings may
occur with chemotherapy but are not immediately life threatening.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
45. Which information obtained by the nurse assessing a patient admitted with multiple myeloma
is most important to report to the health care provider?
a. Patient reports severe back pain.
b. Serum calcium level is 15 mg/dL.
c. Patient reports no stool for 5 days.
d. Urine sample has Bence-Jones protein.
ANS: B
Hypercalcemia may lead to complications such as dysrhythmias or seizures and should be
addressed quickly. The other patient findings will also be discussed with the health care
provider but are not life threatening.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
46. When a patient with splenomegaly is scheduled for splenectomy, which action will the nurse
include in the preoperative plan of care?
a. Recommend ibuprofen for left upper quadrant pain.
b. Schedule immunization with
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the pneumococcal vaccine.
c. Avoid the use of acetaminophen (Tylenol) for 2 weeks prior to surgery.
d. Discourage deep breathing and coughing to reduce risk for splenic rupture.
ANS: B
Asplenic patients are at high risk for infection with pneumococcal infections and
immunization reduces this risk. There is no need to avoid acetaminophen use before surgery,
but nonsteroidal antiinflammatory drugs (NSAIDs) may increase bleeding risk and should be
avoided. The enlarged spleen may decrease respiratory depth, and the patient should be
encouraged to take deep breaths.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Planning
47. The nurse has obtained the health history, physical assessment data, and laboratory results
shown in the accompanying figure for a patient admitted with aplastic anemia. Which
information is most important to communicate to the health care provider?
History
Fatigue, which has
increased over last month
Frequent constipation
Physical Assessment
Conjunctiva pale pink,
moist
Multiple bruises
Clear lung sounds
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Laboratory Results
Hct 33%
WBC 1500/µL
Platelets 70,000/µL
Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
a.
b.
c.
d.
Bruising
Neutropenia
Increasing fatigue
Thrombocytopenia
ANS: B
The low white blood cell count indicates that the patient is at high risk for infection and needs
immediate actions to diagnose and treat the cause of the leukopenia. The other information
may require further assessment or treatment but does not place the patient at immediate risk
for complications.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
SHORT ANSWER
1. A patient is to receive an infusion of 250 mL of platelets over 2 hours through tubing that is
labeled: 1 mL equals 10 drops. How many drops per minute will the nurse infuse?
ANS:
21
To infuse 250 mL over 2 hours, the calculated drip rate is 20.8 drops/min or 21 drops/min.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
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