Medical Surgical
MEDICAL SURGICAL NURSING
CARE OF CLIENTS WITH HEMATOLOGICAL DISORDERS
SITUATION: Unlike many other body systems, the hematologic system encompasses the entire human body.
Patients with hematologic disorders often have significant abnormalities in blood tests but few or no symptoms.
1. A patient has had a splenectomy to control bleeding from a lacerated spleen following an automobile accident. The
nurse will teach the patient about the increased risk for
a. Lymphedema.
b. Infection.
c. Prolonged bleeding.
d. Chronic anemia.
ANSWER: B
Splenectomy increases the risk for infection, especially with gram-positive bacteria. The risks for lymphedema,
bleeding, and anemia are not increased after splenectomy.
Reference: Lewis. Medical Surgical Nursing 7th ed page 670
2. The nurse who is reviewing laboratory data for an 86-year-old patient will be most concerned about:
a. WBC 3500/ul.
b. hemoglobin 11.8 g/dl.
c. platelets 400,000/ul.
d. hematocrit 37%.
Answer: A
The total WBC count is not usually affected by aging, and the low WBC here would indicate that the patient’s immune
function may be compromised. The platelet count is normal for an older patient. The slight decrease in hemoglobin
and hematocrit are not unusual for an older patient.
Reference: Lewis. Medical Surgical Nursing 7th ed page 671
3. The health care provider performs a bone marrow aspiration from the posterior iliac crest on a patient with
pancytopenia. Following the procedure, the nurse should:
a. Use half-inch sterile gauze to pack the wound.
c. Apply pressure over the site for 5 to 10 minutes.
b. Administer an analgesic to control pain at the site.
d. Elevate the head of the bed to 30 degrees.
Answer: C
Because the patient has pancytopenia and is at increased risk for bleeding, pressure should be applied for at least 5 to
10 minutes at the site of the aspiration. A Band-Aid is used to cover the aspiration site. The patient will have pain
during the aspiration, but not after the procedure is completed. There is no indication that the head needs to be
elevated for this patient.
Reference: Lewis. Medical Surgical Nursing 7th ed page 681
4. A client is admitted with a disorder that is affecting his bone marrow. The nurse realizes that this disorder will
negatively impact which body system?
a. Nervous
b. Musculoskeletal
c. Gastrointestinal
d. Hematologic
Answer: D
All blood cells originate from cells in the bone marrow that are called stem cells or hemocytoblasts. The direct
negative effects of a bone marrow disorder would be on the hematological system of the body, not the
gastrointestinal, musculoskeletal or nervous systems.
Reference: Lewis. Medical Surgical Nursing 7th ed page
5. When discussing appropriate food choices with a patient who has iron-deficiency anemia and follows a lowcholesterol diet, the
nurse will encourage the patient to increase the dietary intake of
a. Eggs and muscle meats.
b. Nuts and cornmeal.
c. Milk and milk products.
d. Legumes and dried fruits.
Answer: D
Legumes and dried fruits are high in iron and low in fat and cholesterol. Eggs and muscle meats are high in iron but
also high in fat and cholesterol. Nuts and milk products will improve amino acid intake but are not high in iron.
Cornmeal would be an appropriate choice for a vitamin B6 deficiency.
Reference: Lewis. Medical Surgical Nursing 7th ed page 689
6. A patient has a folic acid deficiency related to chronic alcohol abuse. The nurse would expect a complete blood cell
count (CBC) to reveal:
a. Macrocytic, normochromic red cells.
c. Microcytic, hypochromic red cells.
b. Normocytic, normochromic red cells.
d. Microcytic, normochromic red cells.
Answer: A
With folic acid deficiency, the cells are larger than normal, but the iron levels are normal or elevated, leading to
findings of a macrocytic, normochromic anemia. Microcytic anemia, hypochromic anemia is more typical of iron
deficiency. Normocytic, normochromic RBC indicate that the patient does not have anemia or may occur in patients
with anemia-related chronic disease.
Reference: Lewis. Medical Surgical Nursing 7th ed page 686, 690
7. A 52-year-old patient has a new diagnosis of pernicious anemia. After teaching the patient about pernicious
anemia, the nurse determines that the patient understands the disorder when the patient states,
a. “I will need to have cobalamin (B12) injections regularly for the rest of my life.”
b. “I will stop having a glass of wine with dinner.”
c. “The numbness in my feet will go away once my hemoglobin level returns to normal.”
,d. “My diet should include more red meat or liver.”
Answer: A
Pernicious anemia prevents the absorption of vitamin B12, and the patient requires injections or intranasal
administration of cobalamin. Alcohol use does not cause cobalamin deficiency. Neurologic symptoms may not resolve
,with treatment. Eating more foods rich in B12 is not helpful because the lack of intrinsic factor prevents absorption of
the vitamin.
Reference: Lewis. Medical Surgical Nursing 7th ed page 692
8. A patient with chronic lymphocytic leukemia is hospitalized for treatment of severe hemolytic anemia. An
appropriate nursing intervention for the patient is to
a. provide a diet high in vitamin K.
c. plan care to alternate periods of rest and activity.
b. isolate the patient from visitors.
d. encourage increased intake of fluid and fiber in the diet.
Answer: C
Nursing care for patients with anemia should alternate periods of rest and activity to maintain patient mobility without
causing undue fatigue. High vitamin K diets might be used for a patient with a bleeding disorder. There is no
indication that the patient is neutropenic, so isolation is not needed. Increased intake of fluid and fiber will not
improve the anemia.
Reference: Lewis. Medical Surgical Nursing 7th ed page 688
9. Another client comes to the health clinic 3 years after undergoing a resection of the terminal ileum complaining of
weakness, shortness of breath, and a sore tongue. Which client statement indicates a need for intervention and client
teaching?
a. “I have been drinking plenty of fluids.”
c. “I have three to four loose stools per day”
b. “I have been gargling with warm salt water for my sore tongue.”
d. “I take a vitamin B12 tablet every day.”
ANSWER: D
Rationale: B12 combines with intrinsic factor in the stomach and is then carried to the ileum, where it is absorbed into
the blood stream. In this situation, B12 cannot be absorbed regardless of the amount of oral intake of sources of B12,
such as animal protein or B12 tablets. B12 injection is needed every month because of the removal of the ileum. Fluid
replacement is important when the client has continuous multiple loose stools on a daily basis. Warm salt water is
used to soothe sore mucus membranes. Crohn’s disease and a small-bowel resection may cause several loose stools a
day.
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p. 1053-1054
10. The primary purpose of the schilling test is to measure which of the following client’s ability?
a. Store vitamin B12.
b. Digest vitamin B12.
c. Absorb vitamin B12.
d. Produce vitamin B12.
ANSWER: C
Rationale: PA is caused by the inability to absorb B12 because of lack of If in the gastric juices. Schilling’s test helps
diagnose a PA by determining the ability to absorb B12.
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.1053
11. When planning discharge teaching for the patient who was admitted with a sickle cell crisis, which information will
the nurse include?
a. Drink only one or two caffeinated beverages daily.
c. Limit fluids to 2 to 3 quarts a day.
b. Take a daily multivitamin with iron.
d. Avoid exposure to crowds as much as possible.
Answer: D
Exposure to crowds increases the patient’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.
Reference: Lewis. Medical Surgical Nursing 7th ed page 697
12. Which of these assessment data obtained by the nurse when caring for a patient with thrombocytopenia should be
immediately communicated to the health care provider?
a. Platelet count is 52,000/ul.
c. The patient is difficult to arouse.
b. There are bullae on the oral mucosa.
d. There are large bruises on the back.
Answer: C
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 they are not urgent.
Reference: Lewis. Medical Surgical Nursing 7th ed page 703,705,707
13. During the admission assessment of a patient who has an Hb of 7.6 g/dl (76 g/L), the nurse notes jaundice of the
sclera. The nurse will plan to check the laboratory results for:
a. The stool occult blood test.
b. The bilirubin level.
c. The gastric analysis testing.
d. The Schilling test.
Answer: B
Jaundice is caused by the elevation of bilirubin level associated with RBC hemolysis. The presence of jaundice
suggests a hemolytic anemia, rather than gastrointestinal bleeding or cobalamin deficiency, as the cause of the
anemia.
Reference: Lewis. Medical Surgical Nursing 7th ed page 686
14. The nurse is planning to instruct a client with secondary polycythemia about ways to prevent blood stasis. Which
of the following should be included in these instructions?
a. Restrict fluids.
c. Elevate feet and legs when sitting.
b. Leg pain is normal.
, d. Black stools are to be expected.
Answer: C
Discuss measures to prevent blood stasis: elevate legs and feet when sitting, use support stockings, and continue
treatment measures. Teach the client and family the importance of maintaining adequate hydration, and increase fluid
intake during hot weather and when exercising. Instruct the client to report manifestations of thrombosis such as leg
or calf pain; chest pain; neurologic symptoms or bleeding manifested as black, tarry stools, and vomiting blood or
coffee-ground emesis.
Reference: Lewis. Medical Surgical Nursing 7th ed page
15. A young adult female has sickle cell anemia. The nurse becomes an effective health educator if she reminds the
client to do which of the following?
i. Drink plenty of fluids when outside in hot weather.
MEDICAL SURGICAL NURSING
CARE OF CLIENTS WITH HEMATOLOGICAL DISORDERS
SITUATION: Unlike many other body systems, the hematologic system encompasses the entire human body.
Patients with hematologic disorders often have significant abnormalities in blood tests but few or no symptoms.
1. A patient has had a splenectomy to control bleeding from a lacerated spleen following an automobile accident. The
nurse will teach the patient about the increased risk for
a. Lymphedema.
b. Infection.
c. Prolonged bleeding.
d. Chronic anemia.
ANSWER: B
Splenectomy increases the risk for infection, especially with gram-positive bacteria. The risks for lymphedema,
bleeding, and anemia are not increased after splenectomy.
Reference: Lewis. Medical Surgical Nursing 7th ed page 670
2. The nurse who is reviewing laboratory data for an 86-year-old patient will be most concerned about:
a. WBC 3500/ul.
b. hemoglobin 11.8 g/dl.
c. platelets 400,000/ul.
d. hematocrit 37%.
Answer: A
The total WBC count is not usually affected by aging, and the low WBC here would indicate that the patient’s immune
function may be compromised. The platelet count is normal for an older patient. The slight decrease in hemoglobin
and hematocrit are not unusual for an older patient.
Reference: Lewis. Medical Surgical Nursing 7th ed page 671
3. The health care provider performs a bone marrow aspiration from the posterior iliac crest on a patient with
pancytopenia. Following the procedure, the nurse should:
a. Use half-inch sterile gauze to pack the wound.
c. Apply pressure over the site for 5 to 10 minutes.
b. Administer an analgesic to control pain at the site.
d. Elevate the head of the bed to 30 degrees.
Answer: C
Because the patient has pancytopenia and is at increased risk for bleeding, pressure should be applied for at least 5 to
10 minutes at the site of the aspiration. A Band-Aid is used to cover the aspiration site. The patient will have pain
during the aspiration, but not after the procedure is completed. There is no indication that the head needs to be
elevated for this patient.
Reference: Lewis. Medical Surgical Nursing 7th ed page 681
4. A client is admitted with a disorder that is affecting his bone marrow. The nurse realizes that this disorder will
negatively impact which body system?
a. Nervous
b. Musculoskeletal
c. Gastrointestinal
d. Hematologic
Answer: D
All blood cells originate from cells in the bone marrow that are called stem cells or hemocytoblasts. The direct
negative effects of a bone marrow disorder would be on the hematological system of the body, not the
gastrointestinal, musculoskeletal or nervous systems.
Reference: Lewis. Medical Surgical Nursing 7th ed page
5. When discussing appropriate food choices with a patient who has iron-deficiency anemia and follows a lowcholesterol diet, the
nurse will encourage the patient to increase the dietary intake of
a. Eggs and muscle meats.
b. Nuts and cornmeal.
c. Milk and milk products.
d. Legumes and dried fruits.
Answer: D
Legumes and dried fruits are high in iron and low in fat and cholesterol. Eggs and muscle meats are high in iron but
also high in fat and cholesterol. Nuts and milk products will improve amino acid intake but are not high in iron.
Cornmeal would be an appropriate choice for a vitamin B6 deficiency.
Reference: Lewis. Medical Surgical Nursing 7th ed page 689
6. A patient has a folic acid deficiency related to chronic alcohol abuse. The nurse would expect a complete blood cell
count (CBC) to reveal:
a. Macrocytic, normochromic red cells.
c. Microcytic, hypochromic red cells.
b. Normocytic, normochromic red cells.
d. Microcytic, normochromic red cells.
Answer: A
With folic acid deficiency, the cells are larger than normal, but the iron levels are normal or elevated, leading to
findings of a macrocytic, normochromic anemia. Microcytic anemia, hypochromic anemia is more typical of iron
deficiency. Normocytic, normochromic RBC indicate that the patient does not have anemia or may occur in patients
with anemia-related chronic disease.
Reference: Lewis. Medical Surgical Nursing 7th ed page 686, 690
7. A 52-year-old patient has a new diagnosis of pernicious anemia. After teaching the patient about pernicious
anemia, the nurse determines that the patient understands the disorder when the patient states,
a. “I will need to have cobalamin (B12) injections regularly for the rest of my life.”
b. “I will stop having a glass of wine with dinner.”
c. “The numbness in my feet will go away once my hemoglobin level returns to normal.”
,d. “My diet should include more red meat or liver.”
Answer: A
Pernicious anemia prevents the absorption of vitamin B12, and the patient requires injections or intranasal
administration of cobalamin. Alcohol use does not cause cobalamin deficiency. Neurologic symptoms may not resolve
,with treatment. Eating more foods rich in B12 is not helpful because the lack of intrinsic factor prevents absorption of
the vitamin.
Reference: Lewis. Medical Surgical Nursing 7th ed page 692
8. A patient with chronic lymphocytic leukemia is hospitalized for treatment of severe hemolytic anemia. An
appropriate nursing intervention for the patient is to
a. provide a diet high in vitamin K.
c. plan care to alternate periods of rest and activity.
b. isolate the patient from visitors.
d. encourage increased intake of fluid and fiber in the diet.
Answer: C
Nursing care for patients with anemia should alternate periods of rest and activity to maintain patient mobility without
causing undue fatigue. High vitamin K diets might be used for a patient with a bleeding disorder. There is no
indication that the patient is neutropenic, so isolation is not needed. Increased intake of fluid and fiber will not
improve the anemia.
Reference: Lewis. Medical Surgical Nursing 7th ed page 688
9. Another client comes to the health clinic 3 years after undergoing a resection of the terminal ileum complaining of
weakness, shortness of breath, and a sore tongue. Which client statement indicates a need for intervention and client
teaching?
a. “I have been drinking plenty of fluids.”
c. “I have three to four loose stools per day”
b. “I have been gargling with warm salt water for my sore tongue.”
d. “I take a vitamin B12 tablet every day.”
ANSWER: D
Rationale: B12 combines with intrinsic factor in the stomach and is then carried to the ileum, where it is absorbed into
the blood stream. In this situation, B12 cannot be absorbed regardless of the amount of oral intake of sources of B12,
such as animal protein or B12 tablets. B12 injection is needed every month because of the removal of the ileum. Fluid
replacement is important when the client has continuous multiple loose stools on a daily basis. Warm salt water is
used to soothe sore mucus membranes. Crohn’s disease and a small-bowel resection may cause several loose stools a
day.
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p. 1053-1054
10. The primary purpose of the schilling test is to measure which of the following client’s ability?
a. Store vitamin B12.
b. Digest vitamin B12.
c. Absorb vitamin B12.
d. Produce vitamin B12.
ANSWER: C
Rationale: PA is caused by the inability to absorb B12 because of lack of If in the gastric juices. Schilling’s test helps
diagnose a PA by determining the ability to absorb B12.
Reference: Medical-Surgical by Brunner and Suddarth’s, 11th edition, p.1053
11. When planning discharge teaching for the patient who was admitted with a sickle cell crisis, which information will
the nurse include?
a. Drink only one or two caffeinated beverages daily.
c. Limit fluids to 2 to 3 quarts a day.
b. Take a daily multivitamin with iron.
d. Avoid exposure to crowds as much as possible.
Answer: D
Exposure to crowds increases the patient’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.
Reference: Lewis. Medical Surgical Nursing 7th ed page 697
12. Which of these assessment data obtained by the nurse when caring for a patient with thrombocytopenia should be
immediately communicated to the health care provider?
a. Platelet count is 52,000/ul.
c. The patient is difficult to arouse.
b. There are bullae on the oral mucosa.
d. There are large bruises on the back.
Answer: C
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 they are not urgent.
Reference: Lewis. Medical Surgical Nursing 7th ed page 703,705,707
13. During the admission assessment of a patient who has an Hb of 7.6 g/dl (76 g/L), the nurse notes jaundice of the
sclera. The nurse will plan to check the laboratory results for:
a. The stool occult blood test.
b. The bilirubin level.
c. The gastric analysis testing.
d. The Schilling test.
Answer: B
Jaundice is caused by the elevation of bilirubin level associated with RBC hemolysis. The presence of jaundice
suggests a hemolytic anemia, rather than gastrointestinal bleeding or cobalamin deficiency, as the cause of the
anemia.
Reference: Lewis. Medical Surgical Nursing 7th ed page 686
14. The nurse is planning to instruct a client with secondary polycythemia about ways to prevent blood stasis. Which
of the following should be included in these instructions?
a. Restrict fluids.
c. Elevate feet and legs when sitting.
b. Leg pain is normal.
, d. Black stools are to be expected.
Answer: C
Discuss measures to prevent blood stasis: elevate legs and feet when sitting, use support stockings, and continue
treatment measures. Teach the client and family the importance of maintaining adequate hydration, and increase fluid
intake during hot weather and when exercising. Instruct the client to report manifestations of thrombosis such as leg
or calf pain; chest pain; neurologic symptoms or bleeding manifested as black, tarry stools, and vomiting blood or
coffee-ground emesis.
Reference: Lewis. Medical Surgical Nursing 7th ed page
15. A young adult female has sickle cell anemia. The nurse becomes an effective health educator if she reminds the
client to do which of the following?
i. Drink plenty of fluids when outside in hot weather.
