Chapter 39: Assessment of the Hematologic System

Chapter 39: Assessment of the Hematologic System

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A nursing student wants to know why clients with chronic obstructive pulmonary disease tend to be polycythemic. What response by the nurse instructor is best?
   1. It is due to side effects of medications for bronchodilation.
   2. It is from overactive bone marrow in response to chronic disease.
   3. It combats the anemia caused by an increased metabolic rate.
   4. It compensates for tissue hypoxia caused by lung disease.

ANS:   D

In response to hypoxia, more red blood cells are made so more oxygen can be carried and delivered to tissues. This is a physiologic process in response to the disease; it is not a medication side effect, the result of overactive bone marrow, or a response to anemia.

DIF:     Remembering/Knowledge                 REF: 787                     KEY: Hematologic system| pathophysiology                                                          MSC:             Integrated Process: Teaching/Learning                                                      NOT:              Client Needs Category: Physiological Integrity: Physiological Adaptation

2. A client is receiving rivaroxaban (Xarelto) and asks the nurse to explain how it works. What response by the nurse is best?
   1. “It inhibits thrombin.”
   2. “It inhibits fibrinogen.”
   3. “It thins your blood.”
   4. “It works against vitamin K.”

ANS:   A

Rivaroxaban is a direct thrombin inhibitor. It does not work on fibrinogen or vitamin K. It is not a “blood thinner,” although many clients call anticoagulants by this name.

DIF:     Understanding/Comprehension         REF: 791                     KEY: Hematologic system| anticoagulants                                                             MSC:             Integrated Process: Teaching/Learning                                                      NOT:              Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

3. The health care provider tells the nurse that a client is to be started on a platelet inhibitor. About what drug does the nurse plan to teach the client?
   1. Clopidogrel (Plavix)
   2. Enoxaparin (Lovenox)
   3. Reteplase (Retavase)
   4. Warfarin (Coumadin)

ANS:   A

Clopidogrel is a platelet inhibitor. Enoxaparin is an indirect thrombin inhibitor. Reteplase is a fibrinolytic agent. Warfarin is a vitamin K antagonist.

DIF:            Remembering/Knowledge                 REF:    791                   KEY: Hematologic system| anticoagulants                                                                     MSC:             Integrated Process: Teaching/Learning                                                             NOT:              Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A nurse is assessing a dark-skinned client for pallor. What action is best?
   1. Assess the conjunctiva of the eye.
   2. Have the client open the hand widely.
   3. Look at the roof of the client’s mouth.
   4. Palpate for areas of mild swelling.

ANS:           A

To assess pallor in dark-skinned people, assess the conjunctiva of the eye or the mucous membranes. Looking at the roof of the mouth can reveal jaundice. Opening the hand widely is not related to pallor, nor is palpating for mild swelling.

DIF:            Applying/Application                         REF:    791                   KEY: Hematologic system| nursing assessment| anemia                                    MSC: Integrated Process: Nursing Process: Assessment                      NOT:                                                 Client Needs Category: Physiological Integrity: Reduction of Risk Potential