NCLEX 3500: Hematological and Immune Disorders
Questions with correct answers
A client with rheumatoid arthritis is being discharged with a prescription
for aspirin (Ecotrin), 600 mg P.O. every 6 hours. The nurse should
instruct the client to notify the physician if which adverse drug reaction
occurs?
1. Dysuria
2. Tinnitus
3. Leg cramps
4. Constipation Correct Answer.-Answer 2:
RATIONALES: The client with rheumatoid arthritis typically takes a
relatively high dosage of aspirin for its anti-inflammatory effect. The
nurse should instruct the client to report signs and symptoms of aspirin
toxicity, such as tinnitus (ringing in the ears). The other options aren't
associated with aspirin use or toxicity.
A client with acquired immunodeficiency syndrome (AIDS) is admitted
with Pneumocystis carinii pneumonia. During a bath, the client begins to
cry and says that most friends and relatives have stopped visiting and
calling. What should the nurse do?
1. Continue with the bath and tell the client not to worry.
2. Ask the physician to obtain a psychiatric consultation.
3. Listen and show interest as the client expresses feelings.
4. State that these friends' behavior shows that they aren't true friends.
Correct Answer.-Answer: 3
,RATIONALES: The nurse should listen actively and nonjudgmentally
as the client expresses feelings. Telling the client not to worry would
provide false reassurance. A psychiatric consultation would be
appropriate only after further assessment. Stating that the client's friends
aren't true friends would discount the client's feelings.
Which nonpharmacologic interventions should the nurse include in the
care plan for a client who has moderate rheumatoid arthritis (RA)?
1. Massaging inflamed joints
2. Avoiding range-of-motion (ROM) exercises
3. Applying splints to inflamed joints
4. Using assistive devices at all times
5. Selecting clothing that has Velcro fasteners
6. Applying moist heat to joints Correct Answer.-Answer 3,5,6
RATIONALES: Supportive, nonpharmacologic measures for the client
with RA include applying splints to rest inflamed joints, using Velcro
fasteners on clothes to aid in dressing, and applying moist heat to joints
to relax muscles and relieve pain. Inflamed joints should never be
massaged because doing so can aggravate inflammation. A physical
therapy program, including ROM exercises and carefully individualized
therapeutic exercises, prevents loss of joint function. Assistive devices
should be used only when marked loss of ROM occurs.
A 40-year-old client with mild dementia related to end-stage acquired
immunodeficiency syndrome (AIDS) is preparing for discharge. She has
decided against further curative treatment and wishes to return home.
Before discharge, she develops ocular cytomegalovirus (CMV). Her
physician recommends treatment with a Ganciclovir-impregnated
,implant (Vitrasert), which requires a surgical procedure. The client 's
husband feels the implant won't help the patient and asks the nurse if the
implant will cure CMV. Which answer from the nurse best answers the
husband's question reflecting client advocacy?
1. "The implant won't cure the virus. I'll tell the physician that you don't
want her to have the procedure."
2. "The implant won't cure the virus but it may protect her sight. Just
because your wife has dementia doesn't mean she shouldn't be given the
opportunity to see."
3. "The implant won't cure the virus in your wife's eye. T Correct
Answer.-Answer 4:
RATIONALES: In option 4, the nurse is advocating for the client's
wishes. She is explaining the client's wishes for no further curative
treatment, yet promoting an improved quality of life and safety while the
client is being cared for at home. Option 1 answers the husband's
question, but it doesn't advocate for the client's needs. Option 2 provides
factual information, but it's delivered in a confrontational manner.
Option 3 also provides factual information but doesn't show client
advocacy.
A client with idiopathic thrombocytopenic purpura (ITP), an
autoimmune disorder, is admitted to an acute care facility. Concerned
about hemorrhage, the nurse monitors the client's platelet count and
observes closely for signs and symptoms of bleeding. The client is at
greatest risk for cerebral hemorrhage when the platelet count falls
below:
1. 135,000/μl.
2. 75,000/μl.
3. 20,000/μl.
, 4. 500/μl. Correct Answer.-Answer 4:
RATIONALES: The client with ITP is at greatest risk for cerebral
hemorrhage when the platelet count falls below 500/μl. A platelet count
of 135,000/μl is normal and wouldn't occur in a client with ITP.
Although platelet counts of 75,000/μl and 20,000/μl are below normal
and increase the client's risk for bleeding, they don't increase the risk as
much as a platelet count below 500/μl.
The nurse is planning care for a client with human immunodeficiency
virus (HIV). She's being assisted by a licensed practical nurse (LPN).
Which statements by the LPN indicate her understanding of HIV
transmission?
1. "I'll wear a gown, mask, and gloves for all client contact."
2. "I don't need to wear any personal protective equipment because
nurses have a low risk of occupational exposure."
3. "I'll wear a mask if the client has a cough caused by an upper
respiratory infection."
4. "I'll wear a mask, gown, and gloves when splashing of body fluids is
likely."
5. "I'll wash my hands after client care." Correct Answer.-Answer 4,5:
RATIONALES: Standard precautions include wearing gloves for any
known or anticipated contact with blood or other body fluids, tissue,
mucous membranes, or nonintact skin. If the task may result in splashing
or splattering of blood or body fluids to the face, a mask and goggles or
face shield should be worn. If the task may result in splashing or
splattering of blood or body fluids to the body, a fluid-resistant gown or
apron should be worn. Hands should be washed before and after client
care and after removing gloves. A gown, mask, and gloves aren't
necessary for client care unless contact with body fluids, tissue, mucous
Questions with correct answers
A client with rheumatoid arthritis is being discharged with a prescription
for aspirin (Ecotrin), 600 mg P.O. every 6 hours. The nurse should
instruct the client to notify the physician if which adverse drug reaction
occurs?
1. Dysuria
2. Tinnitus
3. Leg cramps
4. Constipation Correct Answer.-Answer 2:
RATIONALES: The client with rheumatoid arthritis typically takes a
relatively high dosage of aspirin for its anti-inflammatory effect. The
nurse should instruct the client to report signs and symptoms of aspirin
toxicity, such as tinnitus (ringing in the ears). The other options aren't
associated with aspirin use or toxicity.
A client with acquired immunodeficiency syndrome (AIDS) is admitted
with Pneumocystis carinii pneumonia. During a bath, the client begins to
cry and says that most friends and relatives have stopped visiting and
calling. What should the nurse do?
1. Continue with the bath and tell the client not to worry.
2. Ask the physician to obtain a psychiatric consultation.
3. Listen and show interest as the client expresses feelings.
4. State that these friends' behavior shows that they aren't true friends.
Correct Answer.-Answer: 3
,RATIONALES: The nurse should listen actively and nonjudgmentally
as the client expresses feelings. Telling the client not to worry would
provide false reassurance. A psychiatric consultation would be
appropriate only after further assessment. Stating that the client's friends
aren't true friends would discount the client's feelings.
Which nonpharmacologic interventions should the nurse include in the
care plan for a client who has moderate rheumatoid arthritis (RA)?
1. Massaging inflamed joints
2. Avoiding range-of-motion (ROM) exercises
3. Applying splints to inflamed joints
4. Using assistive devices at all times
5. Selecting clothing that has Velcro fasteners
6. Applying moist heat to joints Correct Answer.-Answer 3,5,6
RATIONALES: Supportive, nonpharmacologic measures for the client
with RA include applying splints to rest inflamed joints, using Velcro
fasteners on clothes to aid in dressing, and applying moist heat to joints
to relax muscles and relieve pain. Inflamed joints should never be
massaged because doing so can aggravate inflammation. A physical
therapy program, including ROM exercises and carefully individualized
therapeutic exercises, prevents loss of joint function. Assistive devices
should be used only when marked loss of ROM occurs.
A 40-year-old client with mild dementia related to end-stage acquired
immunodeficiency syndrome (AIDS) is preparing for discharge. She has
decided against further curative treatment and wishes to return home.
Before discharge, she develops ocular cytomegalovirus (CMV). Her
physician recommends treatment with a Ganciclovir-impregnated
,implant (Vitrasert), which requires a surgical procedure. The client 's
husband feels the implant won't help the patient and asks the nurse if the
implant will cure CMV. Which answer from the nurse best answers the
husband's question reflecting client advocacy?
1. "The implant won't cure the virus. I'll tell the physician that you don't
want her to have the procedure."
2. "The implant won't cure the virus but it may protect her sight. Just
because your wife has dementia doesn't mean she shouldn't be given the
opportunity to see."
3. "The implant won't cure the virus in your wife's eye. T Correct
Answer.-Answer 4:
RATIONALES: In option 4, the nurse is advocating for the client's
wishes. She is explaining the client's wishes for no further curative
treatment, yet promoting an improved quality of life and safety while the
client is being cared for at home. Option 1 answers the husband's
question, but it doesn't advocate for the client's needs. Option 2 provides
factual information, but it's delivered in a confrontational manner.
Option 3 also provides factual information but doesn't show client
advocacy.
A client with idiopathic thrombocytopenic purpura (ITP), an
autoimmune disorder, is admitted to an acute care facility. Concerned
about hemorrhage, the nurse monitors the client's platelet count and
observes closely for signs and symptoms of bleeding. The client is at
greatest risk for cerebral hemorrhage when the platelet count falls
below:
1. 135,000/μl.
2. 75,000/μl.
3. 20,000/μl.
, 4. 500/μl. Correct Answer.-Answer 4:
RATIONALES: The client with ITP is at greatest risk for cerebral
hemorrhage when the platelet count falls below 500/μl. A platelet count
of 135,000/μl is normal and wouldn't occur in a client with ITP.
Although platelet counts of 75,000/μl and 20,000/μl are below normal
and increase the client's risk for bleeding, they don't increase the risk as
much as a platelet count below 500/μl.
The nurse is planning care for a client with human immunodeficiency
virus (HIV). She's being assisted by a licensed practical nurse (LPN).
Which statements by the LPN indicate her understanding of HIV
transmission?
1. "I'll wear a gown, mask, and gloves for all client contact."
2. "I don't need to wear any personal protective equipment because
nurses have a low risk of occupational exposure."
3. "I'll wear a mask if the client has a cough caused by an upper
respiratory infection."
4. "I'll wear a mask, gown, and gloves when splashing of body fluids is
likely."
5. "I'll wash my hands after client care." Correct Answer.-Answer 4,5:
RATIONALES: Standard precautions include wearing gloves for any
known or anticipated contact with blood or other body fluids, tissue,
mucous membranes, or nonintact skin. If the task may result in splashing
or splattering of blood or body fluids to the face, a mask and goggles or
face shield should be worn. If the task may result in splashing or
splattering of blood or body fluids to the body, a fluid-resistant gown or
apron should be worn. Hands should be washed before and after client
care and after removing gloves. A gown, mask, and gloves aren't
necessary for client care unless contact with body fluids, tissue, mucous
