Samuel Merritt University N136 Managing Care of Adults 2
Lewis - Chapter 31: Hematologic Problems Questions With
Complete Solutions
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 findings to include
a. a hematocrit (Hct) of 38%.
b. an RBC count of 4,500,000/L.
c. normal red blood cell (RBC) indices.
d. a hemoglobin (Hgb) of 8.6 g/dL (86 g/L). Correct Answers
......
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.
2. Which menu choice indicates that the patient understands the
nurse's teaching about best 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 Correct Answers 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.
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.
b. folic acid.
c. cobalamin (vitamin B12).
d. ascorbic acid (vitamin C). Correct Answers 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.
4. A 52-year-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, "I
a. need to start eating more red meat and liver."
b. will stop having a glass of wine with dinner."
c. could choose nasal spray rather than injections of vitamin
B12."
d. will need to take a proton pump inhibitor like omeprazole
(Prilosec)." Correct Answers 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.
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. Correct Answers
......
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.
6. Which patient statement to the nurse indicates a need for
additional instruction about taking oral ferrous sulfate?
a. "I will call my health care provider if my stools turn black."
b. "I will take a stool softener if I feel constipated occasionally."
c. "I should take the iron with orange juice about an hour before
eating."
d. "I should increase my fluid and fiber intake while I am taking
iron tablets." Correct Answers ANS: A
...... ......
It is normal for the stools to appear black when a patient is
taking iron, and the patient should not call the doctor about this.
The other patient statements are correct.
7. Which collaborative problem will the nurse include in a care
plan for a patient admitted to the hospital with idiopathic
aplastic anemia?
a. Potential complication: seizures
b. Potential complication: infection
c. Potential complication: neurogenic shock
d. Potential complication: pulmonary edema Correct Answers
......
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.
8. It is important for the nurse providing care for a patient with
sickle cell crisis to
a. limit the patient's intake of oral and IV fluids.
b. evaluate the effectiveness of opioid analgesics.
c. encourage the patient to ambulate as much as tolerated.
d. teach the patient about high-protein, high-calorie foods.
Correct Answers 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.
9. Which statement by a patient indicates good understanding of
the nurse's teaching about prevention of sickle cell crisis?
a. "Home oxygen therapy is frequently used to decrease
sickling."
b. "There are no effective medications that can help prevent
sickling."
c. "Routine continuous dosage narcotics are prescribed to
prevent a crisis."
d. "Risk for a crisis is decreased by having an annual influenza
vaccination." Correct Answers ANS: D
...... ......
Because infection is the most common cause of a sickle cell
crisis, influenza, Haemophilus influenzae, pneumococcal
Lewis - Chapter 31: Hematologic Problems Questions With
Complete Solutions
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 findings to include
a. a hematocrit (Hct) of 38%.
b. an RBC count of 4,500,000/L.
c. normal red blood cell (RBC) indices.
d. a hemoglobin (Hgb) of 8.6 g/dL (86 g/L). Correct Answers
......
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.
2. Which menu choice indicates that the patient understands the
nurse's teaching about best 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 Correct Answers 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.
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.
b. folic acid.
c. cobalamin (vitamin B12).
d. ascorbic acid (vitamin C). Correct Answers 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.
4. A 52-year-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, "I
a. need to start eating more red meat and liver."
b. will stop having a glass of wine with dinner."
c. could choose nasal spray rather than injections of vitamin
B12."
d. will need to take a proton pump inhibitor like omeprazole
(Prilosec)." Correct Answers 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.
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. Correct Answers
......
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.
6. Which patient statement to the nurse indicates a need for
additional instruction about taking oral ferrous sulfate?
a. "I will call my health care provider if my stools turn black."
b. "I will take a stool softener if I feel constipated occasionally."
c. "I should take the iron with orange juice about an hour before
eating."
d. "I should increase my fluid and fiber intake while I am taking
iron tablets." Correct Answers ANS: A
...... ......
It is normal for the stools to appear black when a patient is
taking iron, and the patient should not call the doctor about this.
The other patient statements are correct.
7. Which collaborative problem will the nurse include in a care
plan for a patient admitted to the hospital with idiopathic
aplastic anemia?
a. Potential complication: seizures
b. Potential complication: infection
c. Potential complication: neurogenic shock
d. Potential complication: pulmonary edema Correct Answers
......
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.
8. It is important for the nurse providing care for a patient with
sickle cell crisis to
a. limit the patient's intake of oral and IV fluids.
b. evaluate the effectiveness of opioid analgesics.
c. encourage the patient to ambulate as much as tolerated.
d. teach the patient about high-protein, high-calorie foods.
Correct Answers 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.
9. Which statement by a patient indicates good understanding of
the nurse's teaching about prevention of sickle cell crisis?
a. "Home oxygen therapy is frequently used to decrease
sickling."
b. "There are no effective medications that can help prevent
sickling."
c. "Routine continuous dosage narcotics are prescribed to
prevent a crisis."
d. "Risk for a crisis is decreased by having an annual influenza
vaccination." Correct Answers ANS: D
...... ......
Because infection is the most common cause of a sickle cell
crisis, influenza, Haemophilus influenzae, pneumococcal
