NURS MED SURGE CH 30 HEMATOLOGIC PROBLEMS
QUESTIONS WITH ANSWERS A+ 2023 ASSUARED
SUCCESS
MULTIPLE CHOICE
Which patient statement to the nurse indicates that the patient understands self-care for
pernicious anemia?
A. “I need to start eating more red meat and liver.”
B. “I will stop having a glass of wine with dinner.”
C. “I could choose nasal spray rather than injections of vitamin B12.”
D. “I will need to take a proton pump inhibitor such as omeprazole (Prilosec).”
ANS: C
Because pernicious anemia prevents the absorption of vitamin B 12, 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.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Evaluation MSC: NCLEX:
Physiological Integrity
Which is an appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia?
A. Provide a diet high in vitamin K.
B. Teach the patient how to avoid injury.
C. Encourage alternating rest and activity.
D. Place the patient on protective isolation.
ANS: C
Nursing care for patients with anemia should alternate periods of rest and activity to avoid 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.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
Which patient statement to the nurse indicates a need for additional instruction about taking
oral ferrous sulfate?
A. “I could take a stool softener if I feel constipated.”
B. “I can take the iron with orange juice before eating.”
C. “I should notify my health care provider if my stools turn black.”
D. “I will increase my fluid and fiber intake while I am taking iron.”
ANS: C
It is normal for the stools to appear black when a patient is taking iron, and the patient should not call the
health care provider about this. The other patient statements are correct.
,NURS MED SURGE CH 30 HEMATOLOGIC PROBLEMS
QUESTIONS WITH ANSWERS A+ 2023 ASSUARED
SUCCESS
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Evaluation MSC: NCLEX:
Physiological Integrity
Which potential complication should the nurse identify as a high risk for a patient admitted to
the hospital with idiopathic aplastic anemia?
A. Seizures
B. Infection
C. Neurogenic shock
D. Pulmonary edema
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.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological
Integrity
Which nursing intervention is important when providing care for a patient with sickle cell crisis?
A. Limiting the patient’s intake of oral and IV fluids
B. Evaluating the effectiveness of opioid analgesics
C. Encouraging the patient to ambulate as much as tolerated
D. Teaching the patient about high-protein, high-calorie foods
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.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Implementation MSC: NCLEX:
Physiological Integrity
Which statement by a patient indicates good understanding of the nurse’s teaching about
preventing 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 opioids are prescribed to prevent a crisis.”
D. “Risk for a crisis is decreased by having an annual influenza vaccination.”
ANS: D
Because infection is the most common cause of a sickle cell crisis, influenza, Haemophilus influenzae,
pneumococcal pneumonia, and hepatitis immunizations should be administered. Although continuous
dose opioids and oxygen may be administered during a crisis, patients do not receive these therapies to
prevent crisis. Hydroxyurea (Hydrea) is a medication used to decrease the number of sickle cell crises.
, NURS MED SURGE CH 30 HEMATOLOGIC PROBLEMS
QUESTIONS WITH ANSWERS A+ 2023 ASSUARED
SUCCESS
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Evaluation MSC: NCLEX:
Physiological Integrity
Which instruction will the nurse plan to include in discharge teaching for a patient admitted with
a sickle cell crisis?
A. Limit fluids to 2 to 3 quarts per day.
B. Avoid exposure to crowds when possible.
C. Take a daily multivitamin supplement with iron.
D. Drink no more than two caffeinated beverages daily.
ANS: B
Exposure to crowds increases the patient’s risk for infection, the most common cause of sickle cell
crisis. There is no restriction on caffeine use. Iron supplementation is generally not recommended. A
high-fluid intake is recommended.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological
Integrity
The nurse observes scleral jaundice in a patient being admitted with hemolytic anemia.
Which laboratory result the nurse should check?
A. Schilling test
B. Bilirubin level
C. Stool occult blood
D. Gastric acid analysis
ANS: B
Jaundice is caused by the elevation of bilirubin level associated with red blood cell hemolysis. Other
tests would not be helpful in monitoring hemolytic anemia.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
A patient who has been receiving IV heparin infusion and oral warfarin (Coumadin) for a deep
vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when the platelet
level drops to 110,000/μL. Which action will the nurse include in the plan of care?
A. Prepare for platelet transfusion.
B. Discontinue the heparin infusion.
C. Administer prescribed warfarin (Coumadin).
D. Give low-molecular-weight heparin (LMWH).
ANS: B
All heparin is discontinued when HIT is diagnosed. The patient should be instructed to never receive
heparin or LMWH. Warfarin is usually not given until the platelet count has returned to 150,000/μL. The
platelet count does not drop low enough in HIT for a platelet transfusion, and platelet transfusions
increase the risk for thrombosis.
QUESTIONS WITH ANSWERS A+ 2023 ASSUARED
SUCCESS
MULTIPLE CHOICE
Which patient statement to the nurse indicates that the patient understands self-care for
pernicious anemia?
A. “I need to start eating more red meat and liver.”
B. “I will stop having a glass of wine with dinner.”
C. “I could choose nasal spray rather than injections of vitamin B12.”
D. “I will need to take a proton pump inhibitor such as omeprazole (Prilosec).”
ANS: C
Because pernicious anemia prevents the absorption of vitamin B 12, 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.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Evaluation MSC: NCLEX:
Physiological Integrity
Which is an appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia?
A. Provide a diet high in vitamin K.
B. Teach the patient how to avoid injury.
C. Encourage alternating rest and activity.
D. Place the patient on protective isolation.
ANS: C
Nursing care for patients with anemia should alternate periods of rest and activity to avoid 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.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
Which patient statement to the nurse indicates a need for additional instruction about taking
oral ferrous sulfate?
A. “I could take a stool softener if I feel constipated.”
B. “I can take the iron with orange juice before eating.”
C. “I should notify my health care provider if my stools turn black.”
D. “I will increase my fluid and fiber intake while I am taking iron.”
ANS: C
It is normal for the stools to appear black when a patient is taking iron, and the patient should not call the
health care provider about this. The other patient statements are correct.
,NURS MED SURGE CH 30 HEMATOLOGIC PROBLEMS
QUESTIONS WITH ANSWERS A+ 2023 ASSUARED
SUCCESS
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Evaluation MSC: NCLEX:
Physiological Integrity
Which potential complication should the nurse identify as a high risk for a patient admitted to
the hospital with idiopathic aplastic anemia?
A. Seizures
B. Infection
C. Neurogenic shock
D. Pulmonary edema
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.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological
Integrity
Which nursing intervention is important when providing care for a patient with sickle cell crisis?
A. Limiting the patient’s intake of oral and IV fluids
B. Evaluating the effectiveness of opioid analgesics
C. Encouraging the patient to ambulate as much as tolerated
D. Teaching the patient about high-protein, high-calorie foods
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.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Implementation MSC: NCLEX:
Physiological Integrity
Which statement by a patient indicates good understanding of the nurse’s teaching about
preventing 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 opioids are prescribed to prevent a crisis.”
D. “Risk for a crisis is decreased by having an annual influenza vaccination.”
ANS: D
Because infection is the most common cause of a sickle cell crisis, influenza, Haemophilus influenzae,
pneumococcal pneumonia, and hepatitis immunizations should be administered. Although continuous
dose opioids and oxygen may be administered during a crisis, patients do not receive these therapies to
prevent crisis. Hydroxyurea (Hydrea) is a medication used to decrease the number of sickle cell crises.
, NURS MED SURGE CH 30 HEMATOLOGIC PROBLEMS
QUESTIONS WITH ANSWERS A+ 2023 ASSUARED
SUCCESS
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Evaluation MSC: NCLEX:
Physiological Integrity
Which instruction will the nurse plan to include in discharge teaching for a patient admitted with
a sickle cell crisis?
A. Limit fluids to 2 to 3 quarts per day.
B. Avoid exposure to crowds when possible.
C. Take a daily multivitamin supplement with iron.
D. Drink no more than two caffeinated beverages daily.
ANS: B
Exposure to crowds increases the patient’s risk for infection, the most common cause of sickle cell
crisis. There is no restriction on caffeine use. Iron supplementation is generally not recommended. A
high-fluid intake is recommended.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological
Integrity
The nurse observes scleral jaundice in a patient being admitted with hemolytic anemia.
Which laboratory result the nurse should check?
A. Schilling test
B. Bilirubin level
C. Stool occult blood
D. Gastric acid analysis
ANS: B
Jaundice is caused by the elevation of bilirubin level associated with red blood cell hemolysis. Other
tests would not be helpful in monitoring hemolytic anemia.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
A patient who has been receiving IV heparin infusion and oral warfarin (Coumadin) for a deep
vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when the platelet
level drops to 110,000/μL. Which action will the nurse include in the plan of care?
A. Prepare for platelet transfusion.
B. Discontinue the heparin infusion.
C. Administer prescribed warfarin (Coumadin).
D. Give low-molecular-weight heparin (LMWH).
ANS: B
All heparin is discontinued when HIT is diagnosed. The patient should be instructed to never receive
heparin or LMWH. Warfarin is usually not given until the platelet count has returned to 150,000/μL. The
platelet count does not drop low enough in HIT for a platelet transfusion, and platelet transfusions
increase the risk for thrombosis.
