Lewis ATI MED SURG; Hematologic Problems: Medical-
Surgical Nursing Chapter 34 Study guide Exam Questions
with Key Marking Scheme Updated 2025/2026
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.
b. Teach the patient to administer filgrastim (Neupogen) injections.
c. Plan to discontinue the chemotherapy until the neutropenia resolves.
d. Order a high-efficiency particulate air (HEPA) filter for the patient's home. - correct
answer ANS: B
The patient may be taught to self-administer filgrastim injections. Although
chemotherapy
may be stopped with severe neutropenia (neutrophil count <500/μL), administration of
filgrastim usually allows the chemotherapy to continue. Patients with neutropenia are at
higher risk for infection when exposed to other patients in the hospital. HEPA filters are
expensive and are used in the hospital, where the number of pathogens is much higher
than in
the patient's home environment.
DIF: Cognitive Level: Apply (application) REF: 633
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
Which assessment finding should the nurse caring for a patient with thrombocytopenia
communicate immediately to the health care provider?
a. The platelet count is 52,000/μL.
b. The patient is difficult to arouse.
c. There are purpura on the oral mucosa.
,d. There are large bruises on the patient's back. - correct answer ANS: B
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
would not be unusual in a patient with thrombocytopenia.
DIF: Cognitive Level: Analyze (analysis) REF: 623
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
The nurse is planning to administer a transfusion of packed red blood cells (PRBCs) to
a
patient with blood loss from gastrointestinal hemorrhage. Which action can the nurse
delegate
to unlicensed assistive personnel (UAP)?
a. Verify the patient identification (ID) according to hospital policy.
b. Obtain the temperature, blood pressure, and pulse before the transfusion.
c. Double-check the product numbers on the PRBCs with the patient ID band.
d. Monitor the patient for shortness of breath or chest pain during the transfusion. -
correct answer ANS: B
UAP education includes measurement of vital signs. UAP would report the vital signs to
the
registered nurse (RN). The other actions require more education and a larger scope of
practice
and should be done by licensed nursing staff members.
DIF: Cognitive Level: Apply (application) REF: 632
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
A postoperative patient receiving a transfusion of packed red blood cells develops chills,
, fever, headache, and anxiety 35 minutes after the transfusion is started. After stopping
the
transfusion, what action should the nurse take?
a. Give the PRN diphenhydramine .
b. Send a urine specimen to the laboratory.
c. Administer PRN acetaminophen (Tylenol).
d. Draw blood for a new type and crossmatch. - correct answer ANS: C
The patient's clinical manifestations are consistent with a febrile, nonhemolytic
transfusion
reaction. The transfusion should be stopped and antipyretics administered for the fever
as
ordered. A urine specimen is needed if an acute hemolytic reaction is suspected.
Diphenhydramine is used for allergic reactions. This type of reaction does not indicate
incorrect crossmatching.
DIF: Cognitive Level: Apply (application) REF: 650
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
A patient in the emergency department complains of back pain and difficulty breathing
15
minutes after a transfusion of packed red blood cells is started. The nurse's first action
should
be to
a. administer oxygen therapy at a high flow rate.
b. obtain a urine specimen to send to the laboratory.
c. notify the health care provider about the symptoms.
d. disconnect the transfusion and infuse normal saline. - correct answer ANS: D
The patient's symptoms indicate a possible acute hemolytic reaction caused by the
transfusion. The first action should be to disconnect the transfusion and infuse normal
saline.
The other actions also are needed but are not the highest priority.
Surgical Nursing Chapter 34 Study guide Exam Questions
with Key Marking Scheme Updated 2025/2026
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.
b. Teach the patient to administer filgrastim (Neupogen) injections.
c. Plan to discontinue the chemotherapy until the neutropenia resolves.
d. Order a high-efficiency particulate air (HEPA) filter for the patient's home. - correct
answer ANS: B
The patient may be taught to self-administer filgrastim injections. Although
chemotherapy
may be stopped with severe neutropenia (neutrophil count <500/μL), administration of
filgrastim usually allows the chemotherapy to continue. Patients with neutropenia are at
higher risk for infection when exposed to other patients in the hospital. HEPA filters are
expensive and are used in the hospital, where the number of pathogens is much higher
than in
the patient's home environment.
DIF: Cognitive Level: Apply (application) REF: 633
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
Which assessment finding should the nurse caring for a patient with thrombocytopenia
communicate immediately to the health care provider?
a. The platelet count is 52,000/μL.
b. The patient is difficult to arouse.
c. There are purpura on the oral mucosa.
,d. There are large bruises on the patient's back. - correct answer ANS: B
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
would not be unusual in a patient with thrombocytopenia.
DIF: Cognitive Level: Analyze (analysis) REF: 623
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
The nurse is planning to administer a transfusion of packed red blood cells (PRBCs) to
a
patient with blood loss from gastrointestinal hemorrhage. Which action can the nurse
delegate
to unlicensed assistive personnel (UAP)?
a. Verify the patient identification (ID) according to hospital policy.
b. Obtain the temperature, blood pressure, and pulse before the transfusion.
c. Double-check the product numbers on the PRBCs with the patient ID band.
d. Monitor the patient for shortness of breath or chest pain during the transfusion. -
correct answer ANS: B
UAP education includes measurement of vital signs. UAP would report the vital signs to
the
registered nurse (RN). The other actions require more education and a larger scope of
practice
and should be done by licensed nursing staff members.
DIF: Cognitive Level: Apply (application) REF: 632
OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
A postoperative patient receiving a transfusion of packed red blood cells develops chills,
, fever, headache, and anxiety 35 minutes after the transfusion is started. After stopping
the
transfusion, what action should the nurse take?
a. Give the PRN diphenhydramine .
b. Send a urine specimen to the laboratory.
c. Administer PRN acetaminophen (Tylenol).
d. Draw blood for a new type and crossmatch. - correct answer ANS: C
The patient's clinical manifestations are consistent with a febrile, nonhemolytic
transfusion
reaction. The transfusion should be stopped and antipyretics administered for the fever
as
ordered. A urine specimen is needed if an acute hemolytic reaction is suspected.
Diphenhydramine is used for allergic reactions. This type of reaction does not indicate
incorrect crossmatching.
DIF: Cognitive Level: Apply (application) REF: 650
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
A patient in the emergency department complains of back pain and difficulty breathing
15
minutes after a transfusion of packed red blood cells is started. The nurse's first action
should
be to
a. administer oxygen therapy at a high flow rate.
b. obtain a urine specimen to send to the laboratory.
c. notify the health care provider about the symptoms.
d. disconnect the transfusion and infuse normal saline. - correct answer ANS: D
The patient's symptoms indicate a possible acute hemolytic reaction caused by the
transfusion. The first action should be to disconnect the transfusion and infuse normal
saline.
The other actions also are needed but are not the highest priority.
