NCLEX 3500 Hematological And Immune
Disorders Exam And Answers
A client with rheumatoid arthritis is being discharged with a prescription for aspirin (Ecotrin), 600 mg P.O.
e e e e e e e e e e e e e e e e e
every 6 hours. The nurse should instruct the client to notify the physician if which adverse drug reaction
e e e e e e e e e e e e e e e e e e
occurs?
1. Dysuria
e
2. Tinnitus
e
3. Leg cramps
e e
4. Constipation - correct answersAnswer 2:
e e e e e
RATIONALES: The client with rheumatoid arthritis typically takes a relatively high dosage of aspirin for its anti-
e e e e e e e e e e e e e e e e
inflammatory effect. The nurse should instruct the client to report signs and symptoms of aspirin toxicity,
e e e e e e e e e e e e e e e e
such as tinnitus (ringing in the ears). The other options aren't associated with aspirin use or toxicity.
e e e e e e e e e e e e e e e e
A client with acquired immunodeficiency syndrome (AIDS) is admitted with Pneumocystis carinii pneumonia.
e e e e e e e e e e e e e
During a bath, the client begins to cry and says that most friends and relatives have stopped visiting and
e e e e e e e e e e e e e e e e e e e
calling. What should the nurse do?
e e e e e
1. Continue with the bath and tell the client not to worry.
e e e e e e e e e e e
,2. Ask the physician to obtain a psychiatric consultation.
e e e e e e e e
3. Listen and show interest as the client expresses feelings.
e e e e e e e e e
4. State that these friends' behavior shows that they aren't true friends. - correct answersAnswer: 3
e e e e e e e e e e e e e e e
RATIONALES: The nurse should listen actively and nonjudgmentally as the client expresses feelings. Telling
e e e e e e e e e e e e e e
the client not to worry would provide false reassurance. A psychiatric consultation would be appropriate only
e e e e e e e e e e e e e e e e
after further assessment. Stating that the client's friends aren't true friends would discount the client's
e e e e e e e e e e e e e e e
feelings.
Which nonpharmacologic interventions should the nurse include in the care plan for a client who has
e e e e e e e e e e e e e e e e
moderate rheumatoid arthritis (RA)? e e e
1. Massaging inflamed joints
e e e
2. Avoiding range-of-motion (ROM) exercises
e e e e
3. Applying splints to inflamed joints
e e e e e
4. Using assistive devices at all times
e e e e e e
5. Selecting clothing that has Velcro fasteners
e e e e e e
6. Applying moist heat to joints - correct answersAnswer 3,5,6
e e e e e e e e e
RATIONALES: Supportive, nonpharmacologic measures for the client with RA include applying splints to rest
e e e e e e e e e e e e e e
inflamed joints, using Velcro fasteners on clothes to aid in dressing, and applying moist heat to joints to relax
e e e e e e e e e e e e e e e e e e e
muscles and relieve pain. Inflamed joints should never be massaged because doing so can aggravate
e e e e e e e e e e e e e e e
inflammation. A physical therapy program, including ROM exercises and carefully individualized therapeutic
e e e e e e e e e e e e
exercises, prevents loss of joint function. Assistive devices should be used only when marked loss of ROM
e e e e e e e e e e e e e e e e e
occurs.
A 40-year-old client with mild dementia related to end-stage acquired immunodeficiency syndrome (AIDS) is
e e e e e e e e e e e e e e
preparing for discharge. She has decided against further curative treatment and wishes to return home.
e e e e e e e e e e e e e e e
Before discharge, she develops ocular cytomegalovirus (CMV). Her physician recommends treatment with a
e e e e e e e e e e e e e
Ganciclovir-impregnated implant (Vitrasert), which requires a surgical procedure. The client 's husband feels e e e e e e e e e e e e e
the implant won't help the patient and asks the nurse if the implant will cure CMV. Which answer from the
e e e e e e e e e e e e e e e e e e e e
nurse best answers the husband's question reflecting client advocacy?
e e e e e e e e
1. "The implant won't cure the virus. I'll tell the physician that you don't want her to have the procedure."
e e e e e e e e e e e e e e e e e e e
2. "The implant won't cure the virus but it may protect her sight. Just because your wife has dementia doesn't
e e e e e e e e e e e e e e e e e e e e
mean she shouldn't be given the opportunity to see."
e e e e e e e e
3. "The implant won't cure the virus in your wife's eye. T - correct answersAnswer 4:
e e e e e e e e e e e e e e e
,RATIONALES: In option 4, the nurse is advocating for the client's wishes. She is explaining the client's wishes e e e e e e e e e e e e e e e e e e
for no further curative treatment, yet promoting an improved quality of life and safety while the client is being
e e e e e e e e e e e e e e e e e e e
cared for at home. Option 1 answers the husband's question, but it doesn't advocate for the client's needs.
e e e e e e e e e e e e e e e e e e
Option 2 provides factual information, but it's delivered in a confrontational manner. Option 3 also provides
e e e e e e e e e e e e e e e e
factual information but doesn't show client advocacy.e e e e e e
A client with idiopathic thrombocytopenic purpura (ITP), an autoimmune disorder, is admitted to an acute
e e e e e e e e e e e e e e e
care facility. Concerned about hemorrhage, the nurse monitors the client's platelet count and observes
e e e e e e e e e e e e e e
closely for signs and symptoms of bleeding. The client is at greatest risk for cerebral hemorrhage when the
e e e e e e e e e e e e e e e e e e
platelet count falls below: e e e
1. 135,000/μl.
e
2. 75,000/μl.
e
3. 20,000/μl.
e
4. 500/μl. - correct answersAnswer 4:
e e e e e
RATIONALES: The client with ITP is at greatest risk for cerebral hemorrhage when the platelet count falls e e e e e e e e e e e e e e e e e
below 500/μl. A platelet count of 135,000/μl is normal and wouldn't occur in a client with ITP. Although
e e e e e e e e e e e e e e e e e e
platelet counts of 75,000/μl and 20,000/μl are below normal and increase the client's risk for bleeding, they
e e e e e e e e e e e e e e e e e
don't increase the risk as much as a platelet count below 500/μl.
e e e e e e e e e e e
The nurse is planning care for a client with human immunodeficiency virus (HIV). She's being assisted by a
e e e e e e e e e e e e e e e e e e
licensed practical nurse (LPN). Which statements by the LPN indicate her understanding of HIV transmission?
e e e e e e e e e e e e e e
1. "I'll wear a gown, mask, and gloves for all client contact."
e e e e e e e e e e e
2. "I don't need to wear any personal protective equipment because nurses have a low risk of occupational
e e e e e e e e e e e e e e e e e e
exposure."
3. "I'll wear a mask if the client has a cough caused by an upper respiratory infection."
e e e e e e e e e e e e e e e e
4. "I'll wear a mask, gown, and gloves when splashing of body fluids is likely."
e e e e e e e e e e e e e e
5. "I'll wash my hands after client care." - correct answersAnswer 4,5:
e e e e e e e e e e e
RATIONALES: Standard precautions include wearing gloves for any known or anticipated contact with blood e e e e e e e e e e e e e e
or other body fluids, tissue, mucous membranes, or nonintact skin. If the task may result in splashing or
e e e e e e e e e e e e e e e e e e
splattering of blood or body fluids to the face, a mask and goggles or face shield should be worn. If the task may
e e e e e e e e e e e e e e e e e e e e e e e
result in splashing or splattering of blood or body fluids to the body, a fluid-resistant gown or apron should be
e e e e e e e e e e e e e e e e e e e e
worn. Hands should be washed before and after client care and after removing gloves. A gown, mask, and
e e e e e e e e e e e e e e e e e e
gloves aren't necessary for client care unless contact with body fluids, tissue, mucous membranes, or
e e e e e e e e e e e e e e e
nonintact skin is expected. Nurses have an increased, not decreased, risk of occupational exposure to blood-
e e e e e e e e e e e e e e e
borne pathogens. HIV isn't transmitted in sputum unless blood is present.
e e e e e e e e e e
, The nurse encourages a client with an immunologic disorder to eat a nutritionally balanced diet to promote
e e e e e e e e e e e e e e e e e
optimal immunologic function. Autoimmunity has been linked to excessive ingestion of:
e e e e e e e e e e
1. protein.
e
2. fat.
e
3. vitamin A.
e e
4. zinc. - correct answersAnswer 2:
e e e e e
RATIONALES: A diet containing excessive fat seems to contribute to autoimmunity — overreaction of the
e e e e e e e e e e e e e e e
body against constituents of its own tissues. Immune dysfunction has been linked to deficient — not excessive
e e e e e e e e e e e e e e e e
— intake of protein, vitamin A, and zinc.
e e e e e e e e
Which white blood cells are involved in releasing histamine during an allergic reaction?
e e e e e e e e e e e e
1. Basophils
e
2. Eosinophils
e
3. Monocytes
e
4. Neutrophils - correct answersAnswer 1:
e e e e e
RATIONALES: Basophils are responsible for releasing histamine. Eosinophils' major function is phagocytosis
e e e e e e e e e e e e
of antigen-antibody complexes that are formed in allergic reactions. Monocytes and neutrophils are
e e e e e e e e e e e e e
predominately phagocytic. e
The nurse practitioner assesses a client in the physician's office. Which assessment findings support a
e e e e e e e e e e e e e e e
suspicion of systemic lupus erythematosus (SLE)? e e e e e
1. Facial erythema, profuse proteinuria, pleuritis, fever, and weight loss
e e e e e e e e e
2. Pericarditis, photosensitivity, polyarthralgia, and painful mucous membrane ulcers
e e e e e e e e
3. Weight gain, hypervigilance, hypothermia, and edema of the legs
e e e e e e e e e
4. Hypothermia, weight gain, lethargy, and edema of the arms - correct answersAnswer 1:
e e e e e e e e e e e e e
RATIONALES: An autoimmune disorder characterized by chronic inflammation of the connective tissues, SLE
e e e e e e e e e e e e e
causes fever, weight loss, malaise, fatigue, skin rashes, and polyarthralgia. Nearly half of clients with SLE have
e e e e e e e e e e e e e e e e e
facial erythema, the classic butterfly rash. SLE also may cause profuse proteinuria (excretion of more than 0.5
e e e e e e e e e e e e e e e e e
g/day of protein), pleuritis, pericarditis, photosensitivity, and painless mucous membrane ulcers. Weight
e e e e e e e e e e e e
gain, hypervigilance, hypothermia, and edema of the legs and arms don't suggest SLE.
e e e e e e e e e e e e
Disorders Exam And Answers
A client with rheumatoid arthritis is being discharged with a prescription for aspirin (Ecotrin), 600 mg P.O.
e e e e e e e e e e e e e e e e e
every 6 hours. The nurse should instruct the client to notify the physician if which adverse drug reaction
e e e e e e e e e e e e e e e e e e
occurs?
1. Dysuria
e
2. Tinnitus
e
3. Leg cramps
e e
4. Constipation - correct answersAnswer 2:
e e e e e
RATIONALES: The client with rheumatoid arthritis typically takes a relatively high dosage of aspirin for its anti-
e e e e e e e e e e e e e e e e
inflammatory effect. The nurse should instruct the client to report signs and symptoms of aspirin toxicity,
e e e e e e e e e e e e e e e e
such as tinnitus (ringing in the ears). The other options aren't associated with aspirin use or toxicity.
e e e e e e e e e e e e e e e e
A client with acquired immunodeficiency syndrome (AIDS) is admitted with Pneumocystis carinii pneumonia.
e e e e e e e e e e e e e
During a bath, the client begins to cry and says that most friends and relatives have stopped visiting and
e e e e e e e e e e e e e e e e e e e
calling. What should the nurse do?
e e e e e
1. Continue with the bath and tell the client not to worry.
e e e e e e e e e e e
,2. Ask the physician to obtain a psychiatric consultation.
e e e e e e e e
3. Listen and show interest as the client expresses feelings.
e e e e e e e e e
4. State that these friends' behavior shows that they aren't true friends. - correct answersAnswer: 3
e e e e e e e e e e e e e e e
RATIONALES: The nurse should listen actively and nonjudgmentally as the client expresses feelings. Telling
e e e e e e e e e e e e e e
the client not to worry would provide false reassurance. A psychiatric consultation would be appropriate only
e e e e e e e e e e e e e e e e
after further assessment. Stating that the client's friends aren't true friends would discount the client's
e e e e e e e e e e e e e e e
feelings.
Which nonpharmacologic interventions should the nurse include in the care plan for a client who has
e e e e e e e e e e e e e e e e
moderate rheumatoid arthritis (RA)? e e e
1. Massaging inflamed joints
e e e
2. Avoiding range-of-motion (ROM) exercises
e e e e
3. Applying splints to inflamed joints
e e e e e
4. Using assistive devices at all times
e e e e e e
5. Selecting clothing that has Velcro fasteners
e e e e e e
6. Applying moist heat to joints - correct answersAnswer 3,5,6
e e e e e e e e e
RATIONALES: Supportive, nonpharmacologic measures for the client with RA include applying splints to rest
e e e e e e e e e e e e e e
inflamed joints, using Velcro fasteners on clothes to aid in dressing, and applying moist heat to joints to relax
e e e e e e e e e e e e e e e e e e e
muscles and relieve pain. Inflamed joints should never be massaged because doing so can aggravate
e e e e e e e e e e e e e e e
inflammation. A physical therapy program, including ROM exercises and carefully individualized therapeutic
e e e e e e e e e e e e
exercises, prevents loss of joint function. Assistive devices should be used only when marked loss of ROM
e e e e e e e e e e e e e e e e e
occurs.
A 40-year-old client with mild dementia related to end-stage acquired immunodeficiency syndrome (AIDS) is
e e e e e e e e e e e e e e
preparing for discharge. She has decided against further curative treatment and wishes to return home.
e e e e e e e e e e e e e e e
Before discharge, she develops ocular cytomegalovirus (CMV). Her physician recommends treatment with a
e e e e e e e e e e e e e
Ganciclovir-impregnated implant (Vitrasert), which requires a surgical procedure. The client 's husband feels e e e e e e e e e e e e e
the implant won't help the patient and asks the nurse if the implant will cure CMV. Which answer from the
e e e e e e e e e e e e e e e e e e e e
nurse best answers the husband's question reflecting client advocacy?
e e e e e e e e
1. "The implant won't cure the virus. I'll tell the physician that you don't want her to have the procedure."
e e e e e e e e e e e e e e e e e e e
2. "The implant won't cure the virus but it may protect her sight. Just because your wife has dementia doesn't
e e e e e e e e e e e e e e e e e e e e
mean she shouldn't be given the opportunity to see."
e e e e e e e e
3. "The implant won't cure the virus in your wife's eye. T - correct answersAnswer 4:
e e e e e e e e e e e e e e e
,RATIONALES: In option 4, the nurse is advocating for the client's wishes. She is explaining the client's wishes e e e e e e e e e e e e e e e e e e
for no further curative treatment, yet promoting an improved quality of life and safety while the client is being
e e e e e e e e e e e e e e e e e e e
cared for at home. Option 1 answers the husband's question, but it doesn't advocate for the client's needs.
e e e e e e e e e e e e e e e e e e
Option 2 provides factual information, but it's delivered in a confrontational manner. Option 3 also provides
e e e e e e e e e e e e e e e e
factual information but doesn't show client advocacy.e e e e e e
A client with idiopathic thrombocytopenic purpura (ITP), an autoimmune disorder, is admitted to an acute
e e e e e e e e e e e e e e e
care facility. Concerned about hemorrhage, the nurse monitors the client's platelet count and observes
e e e e e e e e e e e e e e
closely for signs and symptoms of bleeding. The client is at greatest risk for cerebral hemorrhage when the
e e e e e e e e e e e e e e e e e e
platelet count falls below: e e e
1. 135,000/μl.
e
2. 75,000/μl.
e
3. 20,000/μl.
e
4. 500/μl. - correct answersAnswer 4:
e e e e e
RATIONALES: The client with ITP is at greatest risk for cerebral hemorrhage when the platelet count falls e e e e e e e e e e e e e e e e e
below 500/μl. A platelet count of 135,000/μl is normal and wouldn't occur in a client with ITP. Although
e e e e e e e e e e e e e e e e e e
platelet counts of 75,000/μl and 20,000/μl are below normal and increase the client's risk for bleeding, they
e e e e e e e e e e e e e e e e e
don't increase the risk as much as a platelet count below 500/μl.
e e e e e e e e e e e
The nurse is planning care for a client with human immunodeficiency virus (HIV). She's being assisted by a
e e e e e e e e e e e e e e e e e e
licensed practical nurse (LPN). Which statements by the LPN indicate her understanding of HIV transmission?
e e e e e e e e e e e e e e
1. "I'll wear a gown, mask, and gloves for all client contact."
e e e e e e e e e e e
2. "I don't need to wear any personal protective equipment because nurses have a low risk of occupational
e e e e e e e e e e e e e e e e e e
exposure."
3. "I'll wear a mask if the client has a cough caused by an upper respiratory infection."
e e e e e e e e e e e e e e e e
4. "I'll wear a mask, gown, and gloves when splashing of body fluids is likely."
e e e e e e e e e e e e e e
5. "I'll wash my hands after client care." - correct answersAnswer 4,5:
e e e e e e e e e e e
RATIONALES: Standard precautions include wearing gloves for any known or anticipated contact with blood e e e e e e e e e e e e e e
or other body fluids, tissue, mucous membranes, or nonintact skin. If the task may result in splashing or
e e e e e e e e e e e e e e e e e e
splattering of blood or body fluids to the face, a mask and goggles or face shield should be worn. If the task may
e e e e e e e e e e e e e e e e e e e e e e e
result in splashing or splattering of blood or body fluids to the body, a fluid-resistant gown or apron should be
e e e e e e e e e e e e e e e e e e e e
worn. Hands should be washed before and after client care and after removing gloves. A gown, mask, and
e e e e e e e e e e e e e e e e e e
gloves aren't necessary for client care unless contact with body fluids, tissue, mucous membranes, or
e e e e e e e e e e e e e e e
nonintact skin is expected. Nurses have an increased, not decreased, risk of occupational exposure to blood-
e e e e e e e e e e e e e e e
borne pathogens. HIV isn't transmitted in sputum unless blood is present.
e e e e e e e e e e
, The nurse encourages a client with an immunologic disorder to eat a nutritionally balanced diet to promote
e e e e e e e e e e e e e e e e e
optimal immunologic function. Autoimmunity has been linked to excessive ingestion of:
e e e e e e e e e e
1. protein.
e
2. fat.
e
3. vitamin A.
e e
4. zinc. - correct answersAnswer 2:
e e e e e
RATIONALES: A diet containing excessive fat seems to contribute to autoimmunity — overreaction of the
e e e e e e e e e e e e e e e
body against constituents of its own tissues. Immune dysfunction has been linked to deficient — not excessive
e e e e e e e e e e e e e e e e
— intake of protein, vitamin A, and zinc.
e e e e e e e e
Which white blood cells are involved in releasing histamine during an allergic reaction?
e e e e e e e e e e e e
1. Basophils
e
2. Eosinophils
e
3. Monocytes
e
4. Neutrophils - correct answersAnswer 1:
e e e e e
RATIONALES: Basophils are responsible for releasing histamine. Eosinophils' major function is phagocytosis
e e e e e e e e e e e e
of antigen-antibody complexes that are formed in allergic reactions. Monocytes and neutrophils are
e e e e e e e e e e e e e
predominately phagocytic. e
The nurse practitioner assesses a client in the physician's office. Which assessment findings support a
e e e e e e e e e e e e e e e
suspicion of systemic lupus erythematosus (SLE)? e e e e e
1. Facial erythema, profuse proteinuria, pleuritis, fever, and weight loss
e e e e e e e e e
2. Pericarditis, photosensitivity, polyarthralgia, and painful mucous membrane ulcers
e e e e e e e e
3. Weight gain, hypervigilance, hypothermia, and edema of the legs
e e e e e e e e e
4. Hypothermia, weight gain, lethargy, and edema of the arms - correct answersAnswer 1:
e e e e e e e e e e e e e
RATIONALES: An autoimmune disorder characterized by chronic inflammation of the connective tissues, SLE
e e e e e e e e e e e e e
causes fever, weight loss, malaise, fatigue, skin rashes, and polyarthralgia. Nearly half of clients with SLE have
e e e e e e e e e e e e e e e e e
facial erythema, the classic butterfly rash. SLE also may cause profuse proteinuria (excretion of more than 0.5
e e e e e e e e e e e e e e e e e
g/day of protein), pleuritis, pericarditis, photosensitivity, and painless mucous membrane ulcers. Weight
e e e e e e e e e e e e
gain, hypervigilance, hypothermia, and edema of the legs and arms don't suggest SLE.
e e e e e e e e e e e e
