Chapter 30: Hematologic Problems

Chapter 30: Hematologic Problems

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. A 62-year old man with chronic anemia is experiencing increased fatigue and occasional palpitations at rest. The nurse would expect the patient’s laboratory test findings to include

a.	an RBC count of 4,500,000/mL.
b.	a hematocrit (Hct) value of 38%.
c.	normal red blood cell (RBC) indices.
d.	a hemoglobin (Hgb) of 8.6 g/dL (86 g/L).

 

 

ANS:  D

The patient’s clinical manifestations indicate moderate anemia, which is consistent with a Hgb of 6 to 10 g/dL. The other values are all within the range of normal.

 

DIF:    Cognitive Level: Understand (comprehension)                   REF:   607

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Physiological Integrity

 

2. Which menu choice indicates that the patient understands the nurse’s teaching about recommended dietary choices for iron-deficiency anemia?

a.	Omelet and whole wheat toast	c.	Strawberry and banana fruit plate
b.	Cantaloupe and cottage cheese	d.	Cornmeal muffin and orange juice

 

 

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)           REF:               610

TOP:   Nursing Process: Evaluation            MSC:  NCLEX: Physiological Integrity

 

3. A patient who is receiving methotrexate for severe rheumatoid arthritis develops a megaloblastic anemia. The nurse will anticipate teaching the patient about increasing oral intake of

a.	iron.	c.	cobalamin (vitamin B12).
b.	folic acid.	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)           REF:               612

TOP:   Nursing Process: Planning               MSC:  NCLEX: Physiological Integrity

 

4. A 52-yr-old patient has a new diagnosis of pernicious anemia. The nurse determines that the patient understands the teaching about the disorder when the patient states,

a.	“I need to start eating more red meat and liver.”
b.	“I will stop having a glass of wine with dinner.”
c.	“I could choose nasal spray rather than injections of vitamin B12.”
d.	“I will need to take a proton pump inhibitor such as omeprazole (Prilosec).”

 

 

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)           REF:               612

TOP:   Nursing Process: Evaluation            MSC:  NCLEX: Physiological Integrity

 

5. An appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia is to

a.	provide a diet high in vitamin K.
b.	alternate periods of rest and activity.
c.	teach the patient how to avoid injury.
d.	place the patient on protective isolation.

 

 

ANS:  B

Nursing care for patients with anemia should alternate periods of rest and activity to encourage activity without causing undue fatigue. There is no indication that the patient has a bleeding disorder, so a diet high in vitamin K or teaching about 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)           REF:               608

TOP:   Nursing Process: Implementation     MSC:  NCLEX: Physiological Integrity