NCLEX 3500: Hematological and Immune
Disorders Exam Questions With 100% 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
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.
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
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
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.
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."
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 membranes, or nonintact skin is expected. Nurses have an increased, not
decreased, risk of occupational exposure to blood-borne pathogens. HIV isn't transmitted in sputum
unless blood is present.
The nurse encourages a client with an immunologic disorder to eat a nutritionally balanced diet to
promote optimal immunologic function. Autoimmunity has been linked to excessive ingestion of:
1. protein.
2. fat.
3. vitamin A.
4. zinc.
Answer 2:
, RATIONALES: A diet containing excessive fat seems to contribute to autoimmunity — overreaction of
the body against constituents of its own tissues. Immune dysfunction has been linked to deficient —
not excessive — intake of protein, vitamin A, and zinc.
Which white blood cells are involved in releasing histamine during an allergic reaction?
1. Basophils
2. Eosinophils
3. Monocytes
4. Neutrophils
Answer 1:
RATIONALES: Basophils are responsible for releasing histamine. Eosinophils' major function is
phagocytosis of antigen-antibody complexes that are formed in allergic reactions. Monocytes and
neutrophils are predominately phagocytic.
The nurse practitioner assesses a client in the physician's office. Which assessment findings support a
suspicion of systemic lupus erythematosus (SLE)?
1. Facial erythema, profuse proteinuria, pleuritis, fever, and weight loss
2. Pericarditis, photosensitivity, polyarthralgia, and painful mucous membrane ulcers
3. Weight gain, hypervigilance, hypothermia, and edema of the legs
4. Hypothermia, weight gain, lethargy, and edema of the arms
Answer 1:
RATIONALES: An autoimmune disorder characterized by chronic inflammation of the connective
tissues, SLE causes fever, weight loss, malaise, fatigue, skin rashes, and polyarthralgia. Nearly half of
clients with SLE have facial erythema, the classic butterfly rash. SLE also may cause profuse
proteinuria (excretion of more than 0.5 g/day of protein), pleuritis, pericarditis, photosensitivity, and
painless mucous membrane ulcers. Weight gain, hypervigilance, hypothermia, and edema of the legs
and arms don't suggest SLE.
A client with allergic rhinitis is prescribed loratadine (Claritin). On a follow-up visit, the client tells the
nurse, "I take one 10-mg tablet of Claritin with a glass of water two times daily." The nurse concludes
that the client requires additional teaching about this medication because:
1. loratadine isn't available in 10-mg tablets.
2. loratadine should be taken on an empty stomach.
3. loratadine should be taken once daily for allergic rhinitis.
4. Claritin isn't the trade name for loratadine.
Answer 3:
RATIONALES: When prescribed for allergic rhinitis, loratadine is usually taken once, not twice, daily.
Loratadine is available in 10-mg tablets, should be taken on an empty stomach, and is dispensed
under the trade name Claritin.
Which nursing instructions help parents of a child with hemophilia provide a safe home environment
for their child?
1. Pad the corners of coffee tables when your child is a toddler and provide kneepads for sports when
the child is older.
2. Establish a written emergency plan including what to do in specific situations and the names and
phone numbers of emergency contacts.
3. Be a role model to your child by wearing a helmet when riding a bike so your child will too.
4. Talk to your child about home safety and have him problem-solve hypothetical situations about his
health.
Answer 2:
RATIONALES: Establishing a written emergency plan that includes what to do in specific situations
helps the family provide safety measures for their child with hemophilia. Option 1 doesn't help
provide a safe home environment for children of all ages. Option 3 is only applicable to children who
Disorders Exam Questions With 100% 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
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.
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
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
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.
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."
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 membranes, or nonintact skin is expected. Nurses have an increased, not
decreased, risk of occupational exposure to blood-borne pathogens. HIV isn't transmitted in sputum
unless blood is present.
The nurse encourages a client with an immunologic disorder to eat a nutritionally balanced diet to
promote optimal immunologic function. Autoimmunity has been linked to excessive ingestion of:
1. protein.
2. fat.
3. vitamin A.
4. zinc.
Answer 2:
, RATIONALES: A diet containing excessive fat seems to contribute to autoimmunity — overreaction of
the body against constituents of its own tissues. Immune dysfunction has been linked to deficient —
not excessive — intake of protein, vitamin A, and zinc.
Which white blood cells are involved in releasing histamine during an allergic reaction?
1. Basophils
2. Eosinophils
3. Monocytes
4. Neutrophils
Answer 1:
RATIONALES: Basophils are responsible for releasing histamine. Eosinophils' major function is
phagocytosis of antigen-antibody complexes that are formed in allergic reactions. Monocytes and
neutrophils are predominately phagocytic.
The nurse practitioner assesses a client in the physician's office. Which assessment findings support a
suspicion of systemic lupus erythematosus (SLE)?
1. Facial erythema, profuse proteinuria, pleuritis, fever, and weight loss
2. Pericarditis, photosensitivity, polyarthralgia, and painful mucous membrane ulcers
3. Weight gain, hypervigilance, hypothermia, and edema of the legs
4. Hypothermia, weight gain, lethargy, and edema of the arms
Answer 1:
RATIONALES: An autoimmune disorder characterized by chronic inflammation of the connective
tissues, SLE causes fever, weight loss, malaise, fatigue, skin rashes, and polyarthralgia. Nearly half of
clients with SLE have facial erythema, the classic butterfly rash. SLE also may cause profuse
proteinuria (excretion of more than 0.5 g/day of protein), pleuritis, pericarditis, photosensitivity, and
painless mucous membrane ulcers. Weight gain, hypervigilance, hypothermia, and edema of the legs
and arms don't suggest SLE.
A client with allergic rhinitis is prescribed loratadine (Claritin). On a follow-up visit, the client tells the
nurse, "I take one 10-mg tablet of Claritin with a glass of water two times daily." The nurse concludes
that the client requires additional teaching about this medication because:
1. loratadine isn't available in 10-mg tablets.
2. loratadine should be taken on an empty stomach.
3. loratadine should be taken once daily for allergic rhinitis.
4. Claritin isn't the trade name for loratadine.
Answer 3:
RATIONALES: When prescribed for allergic rhinitis, loratadine is usually taken once, not twice, daily.
Loratadine is available in 10-mg tablets, should be taken on an empty stomach, and is dispensed
under the trade name Claritin.
Which nursing instructions help parents of a child with hemophilia provide a safe home environment
for their child?
1. Pad the corners of coffee tables when your child is a toddler and provide kneepads for sports when
the child is older.
2. Establish a written emergency plan including what to do in specific situations and the names and
phone numbers of emergency contacts.
3. Be a role model to your child by wearing a helmet when riding a bike so your child will too.
4. Talk to your child about home safety and have him problem-solve hypothetical situations about his
health.
Answer 2:
RATIONALES: Establishing a written emergency plan that includes what to do in specific situations
helps the family provide safety measures for their child with hemophilia. Option 1 doesn't help
provide a safe home environment for children of all ages. Option 3 is only applicable to children who
