Lewis Chapter 30: Hematologic Problems
Practice |Questions with 100% Correct Answers
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?
a. Platelet count c. Total lymphocyte count
b. Reticulocyte count d. Absolute neutrophil count - ✔️✔️ANS: D
Filgrastim increases the neutrophil count and function in neutropenic patients. Although total
lymphocyte, platelet, and reticulocyte counts are also important to monitor in this patient, the
absolute neutrophil count is used to evaluate the effects of filgrastim.
DIF: Cognitive Level: Apply (application) REF: 634
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
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?
a. "If you do not want to have chemotherapy, other treatment options include stem
cell transplantation."
b. "The side effects of chemotherapy are difficult, but AML frequently goes into
remission with chemotherapy."
c. "The decision about treatment is one that you and the doctor need to make rather
than asking what I would do."
d. "You don't need to make a decision about treatment right now because leukemias in adults
tend to progress slowly." - ✔️✔️ANS: B
This response uses therapeutic communication by addressing the patient's question and giving
accurate information. The other responses either give inaccurate information or fail to address
the patient's question, which will discourage the patient from asking the nurse for
information.
DIF: Cognitive Level: Apply (application) REF: 636
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
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?
a. Infuse the PRBCs slowly over 4 hours.
b. Transfuse only leukocyte-reduced PRBCs.
c. Administer the scheduled diuretic before the transfusion.
d. Give the PRN dose of antihistamine before the transfusion. - ✔️✔️ANS: B
TRALI is caused by a reaction between the donor and the patient leukocytes that causes
pulmonary inflammation and capillary leaking. The other actions may help prevent respiratory
problems caused by circulatory overload or by allergic reactions, but they will not prevent
TRALI.
DIF: Cognitive Level: Apply (application) REF: 651
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
, A patient who has acute myelogenous leukemia (AML) is considering treatment with a
hematopoietic stem cell transplant (HSCT). The best approach for the nurse to assist the
patient with a treatment decision is to
a. discuss the need for insurance to cover post-HSCT care.
b. ask whether there are questions or concerns about HSCT.
c. emphasize the positive outcomes of a bone marrow transplant.
d. explain that a cure is not possible with any treatment except HSCT. - ✔️✔️ANS: B
Offering the patient an opportunity to ask questions or discuss concerns about HSCT will
encourage the patient to voice concerns about this treatment and will allow the nurse to assess
whether the patient needs more information about the procedure. Treatment of AML using
chemotherapy is another option for the patient. It is not appropriate for the nurse to ask the
patient to consider insurance needs in making this decision.
DIF: Cognitive Level: Apply (application) REF: 635
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
Which action will the nurse include in the plan of care for a patient admitted with multiple
myeloma?
a. Monitor fluid intake and output.
b. Administer calcium supplements.
c. Assess lymph nodes for enlargement.
d. Limit weight bearing and ambulation. - ✔️✔️ANS: A
A high fluid intake and urine output helps prevent the complications of kidney stones caused
by hypercalcemia and renal failure caused by deposition of Bence-Jones protein in the renal
tubules. Weight bearing and ambulation are encouraged to help bone retain calcium. Lymph
nodes are not enlarged with multiple myeloma. Calcium supplements will further increase the
patient's calcium level and are not used.
DIF: Cognitive Level: Apply (application) REF: 646
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
An appropriate nursing intervention for a patient with non-Hodgkin's lymphoma whose
platelet count drops to 18,000/μL during chemotherapy is to
a. check all stools for occult blood.
b. encourage fluids to 3000 mL/day.
c. provide oral hygiene every 2 hours.
d. check the temperature every 4 hours. - ✔️✔️ANS: A
Because the patient is at risk for spontaneous bleeding, the nurse should check stools for
occult blood. A low platelet count does not require an increased fluid intake. Oral hygiene is
important, but it is not necessary to provide oral care every 2 hours. The low platelet count
does not increase risk for infection, so frequent temperature monitoring is not indicated.
DIF: Cognitive Level: Apply (application) REF: 644
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
A patient who has acute myelogenous leukemia develops an absolute neutrophil count of
850/μL while receiving outpatient chemotherapy. Which action by the outpatient clinic nurse
is most appropriate?
a. Discuss the need for hospital admission to treat the neutropenia.
Practice |Questions with 100% Correct Answers
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?
a. Platelet count c. Total lymphocyte count
b. Reticulocyte count d. Absolute neutrophil count - ✔️✔️ANS: D
Filgrastim increases the neutrophil count and function in neutropenic patients. Although total
lymphocyte, platelet, and reticulocyte counts are also important to monitor in this patient, the
absolute neutrophil count is used to evaluate the effects of filgrastim.
DIF: Cognitive Level: Apply (application) REF: 634
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
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?
a. "If you do not want to have chemotherapy, other treatment options include stem
cell transplantation."
b. "The side effects of chemotherapy are difficult, but AML frequently goes into
remission with chemotherapy."
c. "The decision about treatment is one that you and the doctor need to make rather
than asking what I would do."
d. "You don't need to make a decision about treatment right now because leukemias in adults
tend to progress slowly." - ✔️✔️ANS: B
This response uses therapeutic communication by addressing the patient's question and giving
accurate information. The other responses either give inaccurate information or fail to address
the patient's question, which will discourage the patient from asking the nurse for
information.
DIF: Cognitive Level: Apply (application) REF: 636
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
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?
a. Infuse the PRBCs slowly over 4 hours.
b. Transfuse only leukocyte-reduced PRBCs.
c. Administer the scheduled diuretic before the transfusion.
d. Give the PRN dose of antihistamine before the transfusion. - ✔️✔️ANS: B
TRALI is caused by a reaction between the donor and the patient leukocytes that causes
pulmonary inflammation and capillary leaking. The other actions may help prevent respiratory
problems caused by circulatory overload or by allergic reactions, but they will not prevent
TRALI.
DIF: Cognitive Level: Apply (application) REF: 651
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
, A patient who has acute myelogenous leukemia (AML) is considering treatment with a
hematopoietic stem cell transplant (HSCT). The best approach for the nurse to assist the
patient with a treatment decision is to
a. discuss the need for insurance to cover post-HSCT care.
b. ask whether there are questions or concerns about HSCT.
c. emphasize the positive outcomes of a bone marrow transplant.
d. explain that a cure is not possible with any treatment except HSCT. - ✔️✔️ANS: B
Offering the patient an opportunity to ask questions or discuss concerns about HSCT will
encourage the patient to voice concerns about this treatment and will allow the nurse to assess
whether the patient needs more information about the procedure. Treatment of AML using
chemotherapy is another option for the patient. It is not appropriate for the nurse to ask the
patient to consider insurance needs in making this decision.
DIF: Cognitive Level: Apply (application) REF: 635
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
Which action will the nurse include in the plan of care for a patient admitted with multiple
myeloma?
a. Monitor fluid intake and output.
b. Administer calcium supplements.
c. Assess lymph nodes for enlargement.
d. Limit weight bearing and ambulation. - ✔️✔️ANS: A
A high fluid intake and urine output helps prevent the complications of kidney stones caused
by hypercalcemia and renal failure caused by deposition of Bence-Jones protein in the renal
tubules. Weight bearing and ambulation are encouraged to help bone retain calcium. Lymph
nodes are not enlarged with multiple myeloma. Calcium supplements will further increase the
patient's calcium level and are not used.
DIF: Cognitive Level: Apply (application) REF: 646
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
An appropriate nursing intervention for a patient with non-Hodgkin's lymphoma whose
platelet count drops to 18,000/μL during chemotherapy is to
a. check all stools for occult blood.
b. encourage fluids to 3000 mL/day.
c. provide oral hygiene every 2 hours.
d. check the temperature every 4 hours. - ✔️✔️ANS: A
Because the patient is at risk for spontaneous bleeding, the nurse should check stools for
occult blood. A low platelet count does not require an increased fluid intake. Oral hygiene is
important, but it is not necessary to provide oral care every 2 hours. The low platelet count
does not increase risk for infection, so frequent temperature monitoring is not indicated.
DIF: Cognitive Level: Apply (application) REF: 644
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
A patient who has acute myelogenous leukemia develops an absolute neutrophil count of
850/μL while receiving outpatient chemotherapy. Which action by the outpatient clinic nurse
is most appropriate?
a. Discuss the need for hospital admission to treat the neutropenia.
