The nurse assesses a patient with pernicious anemia. Which finding would the nurse expect?

Tender, bleeding gums

A patient’s complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding?

Do you have any history of lung disease?”

The nurse is reviewing laboratory results and notes a patient’s activated partial thromboplastin time (aPTT) level is 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication?

Heparin

The nurse notes pallor of the skin and nail beds in a newly admitted patient. The nurse should ensure that which laboratory test has been ordered?

Hemoglobin level

The nurse examines the lymph nodes of a patient during a physical assessment. Which finding would be of most concern to the nurse?

A 2-cm nontender supraclavicular node

A patient who had a total hip replacement had an intraoperative hemorrhage 14 hours ago. Which laboratory test result would the nurse expect?

Elevated reticulocyte count

The complete blood count (CBC) indicates that a patient is thrombocytopenic. Which action should the nurse include in the plan of care?

Avoid intramuscular injections.

The health care provider’s progress note for a patient states that the complete blood count (CBC) shows a “shift to the left.” Which assessment finding should the nurse expect?

Elevated temperature

The health care provider orders a liver and spleen scan for a patient who has been in a motor vehicle crash. Which action should the nurse take to prepare the patient for this procedure?

Assist the patient to a flat position.

A patient with pancytopenia of unknown origin is scheduled for diagnostic tests. The nurse will ensure a consent form was signed before which test?

Bone marrow biopsy

The nurse reviews the laboratory test results of a patient admitted with abdominal pain. Which information will be most important for the nurse to communicate to the health care provider?

White blood cell count 15,500/μL

Which information shown in the table below about a patient who has just arrived in the emergency department is most urgent for the nurse to communicate to the health care provider?

Platelet count

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?

Hemoglobin (Hgb) of 8.6 g/dL (86 g/L)

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

Omelet and whole wheat toast

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?

Folic acid

Which patient statement to the nurse indicates that the patient understands self-care for pernicious anemia?

“I could choose nasal spray rather than injections of vitamin B12.”

Which is an appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia?

Encourage alternating rest and activity.

Which patient statement to the nurse indicates a need for additional instruction about taking oral ferrous sulfate?

“I should notify my health care provider if my stools turn black.”

Which potential complication should the nurse identify as a high risk for a patient admitted to the hospital with idiopathic aplastic anemia?

Infection

Which nursing intervention is important when providing care for a patient with sickle cell crisis?

Evaluating the effectiveness of opioid analgesics

Which statement by a patient indicates good understanding of the nurse’s teaching about preventing sickle cell crisis

Risk for a crisis is decreased by having an annual influenza vaccination.

Which instruction will the nurse plan to include in discharge teaching for a patient admitted with a sickle cell crisis?

Avoid exposure to crowds when possible.

The nurse observes scleral jaundice in a patient being admitted with hemolytic anemia. Which laboratory result the nurse should check?

Bilirubin level

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?

Discontinue the heparin infusion.

What action is expected by the nurse caring for a patient who has an acute exacerbation of polycythemia vera?

Monitor fluid intake and output.

Which intervention will be included in the nursing care plan for a patient with immune thrombocytopenic purpura?

Avoid intramuscular (IM) injections.

Which laboratory result will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)?

Activated partial thromboplastin time

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?

Immobilize the knee joint.

A young adult who has von Willebrand disease is admitted to the hospital for minor knee surgery. Which laboratory value should the nurse monitor?

Bleeding time

A routine complete blood count for an active older man indicates possible myelodysplastic syndrome. What should the nurse plan to explain to the patient?

Bone marrow biopsy

Which action will the admitting nurse include in the care plan for a patient who has neutropenia?

Check temperature every 4 hours.

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?

Absolute neutrophil count

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?

“The side effects of chemotherapy are difficult, but AML often goes into remission with chemotherapy.

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?

Transfuse leukocyte-reduced PRBCs.

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?

Inquire whether there are questions or concerns about HSCT.

Which action will the nurse include in the plan of care for a patient admitted with multiple myeloma?

Monitor fluid intake and output.

Which nursing intervention is appropriate for a patient with non-Hodgkin’s lymphoma whose platelet count drops to 18,000/μL during chemotherapy?

Test all stools for occult blood.

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??

Teach the patient to administer filgrastim (Neupogen) injections.

Which assessment finding should the nurse caring for a patient with thrombocytopenia communicate immediately to the health care provider?

The patient is difficult to arouse.

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)?

Obtain the patient’s temperature and blood pressure before the transfusion.

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?

Administer PRN acetaminophen (Tylenol).

A patient in the emergency department reports back pain and difficulty breathing 15 minutes after a transfusion of packed red blood cells is started. What should the nurse’s first action be?

Disconnect the transfusion and infuse normal saline.

Which patient should the nurse assign as the roommate for a patient who has aplastic anemia?

A patient with chronic heart failure

Which patient requires the most rapid assessment and care by the emergency department nurse?

The patient with neutropenia who has a temperature of 101.8° F.

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?

Platelet count is 42,000/UL

Which problem reported by a patient with hemophilia is most important for the nurse to communicate to the health care provider

Tarry stools

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?

Notify the health care provider.

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?

Infuse normal saline 500 mL over 30 minutes.

Which action for a patient with neutropenia is appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/VN)?

Administering subcutaneous filgrastim (Neupogen) injection

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 23-yr-old with no previous health problems who has a nontender axillary lump

After receiving change-of-shift report for several patients with neutropenia, which patient should the nurse assess first?

A 33-yr-old with a fever of 100.8° F (38.2° C)

Which action will the nurse include in the plan of care for a patient who has thalassemia major?

Administer chelation therapy as needed.

Which information is most important for the nurse to monitor when evaluating the effectiveness of deferoxamine (Desferal) for a patient with hemochromatosis?

Serum iron level

Which finding about a patient with polycythemia vera is most important for the nurse to report to the health care provider?

Calf swelling and pain

Following successful treatment of Hodgkin’s lymphoma for a 55-yr-old woman, which topic will the nurse include in patient teaching?

Need for follow-up appointments to screen for malignancy

A patient who has non-Hodgkin’s lymphoma is receiving combination treatment with rituximab (Rituxan) and chemotherapy. Which patient assessment finding requires the most rapid action by the nurse?

Lip swelling

Which information obtained by the nurse assessing a patient admitted with multiple myeloma is most important to report to the health care provider?

Serum calcium level is 15 mg/dL.

When a patient with splenomegaly is scheduled for splenectomy, which action will the nurse include in the preoperative plan of care?

1. Schedule immunization with pneumocommal vaccine

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?

Neutropenia