Lewis's Medical Surgical Nursing Test Bank 11th Edition [Harding]
Chapter 29 - Assessment: Hematologic System
1. The nurse is caring for a patient who is being discharged after an emergency
splenectomy following an automobile accident. Which instructions should the
nurse include in the discharge teaching?
A. Watch for excess bruising.
B. Check for swollen lymph nodes.
C. Take iron supplements to prevent anemia.
D. Wash hands and avoid persons who are ill.
Answer: D
Explanation: The spleen plays a key role in immune function, particularly against
encapsulated bacteria. After splenectomy, patients are at increased risk for infection and
should be taught to practice good hand hygiene and avoid sick individuals.
2. The nurse assesses a patient who has numerous petechiae on both arms. Which
question should the nurse ask the patient?
A. Do you take salicylates?
B. Are you taking any oral contraceptives?
C. Have you been prescribed antiseizure drugs?
D. How long have you taken antihypertensive drugs?
Answer: A
Explanation: Salicylates (e.g., aspirin) can inhibit platelet function and lead to bleeding
manifestations like petechiae. Assessing medication use is critical to identify potential causes.
3. A nurse reviews the laboratory data for an older patient. The nurse would be
most concerned about which finding?
A. Hematocrit of 35%
B. Hemoglobin of 11.8 g/dL
C. Platelet count of 400,000/L
D. White blood cell (WBC) count of 2800/L
Answer: D
Explanation: A WBC count of 2800/L indicates leukopenia, which significantly increases the
risk for infection. This finding is abnormal and requires further investigation, unlike the other
values which may be near normal for an older adult.
, 4. A patient with pancytopenia has a bone marrow aspiration from the left
posterior iliac crest. Which action would be important for the nurse to take after
the procedure?
A. Elevate the head of the bed to 45 degrees.
B. Apply a sterile 2-inch gauze dressing to the site.
C. Use a half-inch sterile gauze to pack the wound.
D. Have the patient lie on the left side for 1 hour.
Answer: D
Explanation: Lying on the aspiration site applies direct pressure, which helps prevent
bleeding and hematoma formation—a key concern in a pancytopenic patient with reduced
platelets.
5. The nurse assesses a patient with pernicious anemia. Which assessment finding
would the nurse expect?
A. Yellow-tinged sclerae
B. Shiny, smooth tongue
C. Numbness of the extremities
D. Gum bleeding and tenderness
Answer: C
Explanation: Pernicious anemia (vitamin B12 deficiency) can cause neurological symptoms
like numbness and tingling due to impaired myelin synthesis. A smooth tongue may occur in
iron deficiency, not typically B12 deficiency.
6. A patients complete blood count (CBC) shows a hemoglobin of 19 g/dL and a
hematocrit of 54%. Which question should the nurse ask to determine possible
causes of this finding?
A. Have you had a recent weight loss?
B. Do you have any history of lung disease?
C. Have you noticed any dark or bloody stools?
D. What is your dietary intake of meats and protein?
Answer: B
Explanation: Elevated hemoglobin and hematocrit (polycythemia) can be secondary to
chronic hypoxemia from lung diseases like COPD, which stimulates increased red blood cell
production.
7. The nurse is reviewing laboratory results and notes an aPTT level of 28 seconds.
The nurse should notify the health care provider in anticipation of adjusting
, which medication?
A. Aspirin
B. Heparin
C. Warfarin
D. Erythropoietin
Answer: B
Explanation: aPTT is used to monitor heparin therapy. A value of 28 seconds is within the
normal range (typically 25–35 seconds), indicating the heparin dose may be subtherapeutic
and require adjustment.
8. When assessing a newly admitted patient, the nurse notes pallor of the skin and
nail beds. The nurse should ensure that which laboratory test has been ordered?
A. Platelet count
B. Neutrophil count
C. White blood cell count
D. Hemoglobin (Hgb) level
Answer: D
Explanation: Pallor is a classic sign of anemia, which is reflected by a low hemoglobin level.
This test is essential to confirm the suspected diagnosis.
9. The nurse examines the lymph nodes of a patient during a physical assessment.
Which assessment finding would be of most concern to the nurse?
A. A 2-cm nontender supraclavicular node
B. A 1-cm mobile and nontender axillary node
C. An inability to palpate any superficial lymph nodes
D. Firm inguinal nodes in a patient with an infected foot
Answer: A
Explanation: A large, nontender, fixed node (especially in the supraclavicular area) is
suspicious for malignancy, such as lymphoma or metastatic cancer, and requires further
evaluation.
10. A patient who had a total hip replacement had an intraoperative hemorrhage 14
hours ago. Which laboratory result would the nurse expect to find?
A. Hematocrit of 46%
B. Hemoglobin of 13.8 g/dL
C. Elevated reticulocyte count
D. Decreased white blood cell (WBC) count
, Answer: C
Explanation: After significant bleeding, the bone marrow increases production of red blood
cells, releasing immature reticulocytes into the bloodstream. An elevated reticulocyte count
reflects this compensatory response.
11. The complete blood count (CBC) indicates that a patient is thrombocytopenic.
Which action should the nurse include in the plan of care?
A. Avoid intramuscular injections.
B. Encourage increased oral fluids.
C. Check temperature every 4 hours.
D. Increase intake of iron-rich foods.
Answer: A
Explanation: Thrombocytopenia increases the risk of bleeding. Avoiding IM injections and
other traumatic procedures helps prevent hematoma formation and bleeding complications.
12. The health care providers progress note for a patient states that the complete
blood count (CBC) shows a shift to the left. Which assessment finding will the
nurse expect?
A. Cool extremities
B. Pallor and weakness
C. Elevated temperature
D. Low oxygen saturation
Answer: C
Explanation: A "shift to the left" indicates an increased number of immature neutrophils
(bands), which is commonly seen in bacterial infections and often accompanied by fever.
13. The health care provider orders a liver/spleen scan for a patient who has been in
a motor vehicle accident. Which action should the nurse take before this
procedure?
A. Check for any iodine allergy.
B. Insert a large-bore IV catheter.
C. Place the patient on NPO status.
D. Assist the patient to a flat position.
Answer: D
Explanation: For a liver/spleen scan, the patient is typically positioned flat to facilitate
accurate imaging after IV injection of a radioactive tracer. NPO status and iodine allergy are
not relevant for this scan.
Chapter 29 - Assessment: Hematologic System
1. The nurse is caring for a patient who is being discharged after an emergency
splenectomy following an automobile accident. Which instructions should the
nurse include in the discharge teaching?
A. Watch for excess bruising.
B. Check for swollen lymph nodes.
C. Take iron supplements to prevent anemia.
D. Wash hands and avoid persons who are ill.
Answer: D
Explanation: The spleen plays a key role in immune function, particularly against
encapsulated bacteria. After splenectomy, patients are at increased risk for infection and
should be taught to practice good hand hygiene and avoid sick individuals.
2. The nurse assesses a patient who has numerous petechiae on both arms. Which
question should the nurse ask the patient?
A. Do you take salicylates?
B. Are you taking any oral contraceptives?
C. Have you been prescribed antiseizure drugs?
D. How long have you taken antihypertensive drugs?
Answer: A
Explanation: Salicylates (e.g., aspirin) can inhibit platelet function and lead to bleeding
manifestations like petechiae. Assessing medication use is critical to identify potential causes.
3. A nurse reviews the laboratory data for an older patient. The nurse would be
most concerned about which finding?
A. Hematocrit of 35%
B. Hemoglobin of 11.8 g/dL
C. Platelet count of 400,000/L
D. White blood cell (WBC) count of 2800/L
Answer: D
Explanation: A WBC count of 2800/L indicates leukopenia, which significantly increases the
risk for infection. This finding is abnormal and requires further investigation, unlike the other
values which may be near normal for an older adult.
, 4. A patient with pancytopenia has a bone marrow aspiration from the left
posterior iliac crest. Which action would be important for the nurse to take after
the procedure?
A. Elevate the head of the bed to 45 degrees.
B. Apply a sterile 2-inch gauze dressing to the site.
C. Use a half-inch sterile gauze to pack the wound.
D. Have the patient lie on the left side for 1 hour.
Answer: D
Explanation: Lying on the aspiration site applies direct pressure, which helps prevent
bleeding and hematoma formation—a key concern in a pancytopenic patient with reduced
platelets.
5. The nurse assesses a patient with pernicious anemia. Which assessment finding
would the nurse expect?
A. Yellow-tinged sclerae
B. Shiny, smooth tongue
C. Numbness of the extremities
D. Gum bleeding and tenderness
Answer: C
Explanation: Pernicious anemia (vitamin B12 deficiency) can cause neurological symptoms
like numbness and tingling due to impaired myelin synthesis. A smooth tongue may occur in
iron deficiency, not typically B12 deficiency.
6. A patients complete blood count (CBC) shows a hemoglobin of 19 g/dL and a
hematocrit of 54%. Which question should the nurse ask to determine possible
causes of this finding?
A. Have you had a recent weight loss?
B. Do you have any history of lung disease?
C. Have you noticed any dark or bloody stools?
D. What is your dietary intake of meats and protein?
Answer: B
Explanation: Elevated hemoglobin and hematocrit (polycythemia) can be secondary to
chronic hypoxemia from lung diseases like COPD, which stimulates increased red blood cell
production.
7. The nurse is reviewing laboratory results and notes an aPTT level of 28 seconds.
The nurse should notify the health care provider in anticipation of adjusting
, which medication?
A. Aspirin
B. Heparin
C. Warfarin
D. Erythropoietin
Answer: B
Explanation: aPTT is used to monitor heparin therapy. A value of 28 seconds is within the
normal range (typically 25–35 seconds), indicating the heparin dose may be subtherapeutic
and require adjustment.
8. When assessing a newly admitted patient, the nurse notes pallor of the skin and
nail beds. The nurse should ensure that which laboratory test has been ordered?
A. Platelet count
B. Neutrophil count
C. White blood cell count
D. Hemoglobin (Hgb) level
Answer: D
Explanation: Pallor is a classic sign of anemia, which is reflected by a low hemoglobin level.
This test is essential to confirm the suspected diagnosis.
9. The nurse examines the lymph nodes of a patient during a physical assessment.
Which assessment finding would be of most concern to the nurse?
A. A 2-cm nontender supraclavicular node
B. A 1-cm mobile and nontender axillary node
C. An inability to palpate any superficial lymph nodes
D. Firm inguinal nodes in a patient with an infected foot
Answer: A
Explanation: A large, nontender, fixed node (especially in the supraclavicular area) is
suspicious for malignancy, such as lymphoma or metastatic cancer, and requires further
evaluation.
10. A patient who had a total hip replacement had an intraoperative hemorrhage 14
hours ago. Which laboratory result would the nurse expect to find?
A. Hematocrit of 46%
B. Hemoglobin of 13.8 g/dL
C. Elevated reticulocyte count
D. Decreased white blood cell (WBC) count
, Answer: C
Explanation: After significant bleeding, the bone marrow increases production of red blood
cells, releasing immature reticulocytes into the bloodstream. An elevated reticulocyte count
reflects this compensatory response.
11. The complete blood count (CBC) indicates that a patient is thrombocytopenic.
Which action should the nurse include in the plan of care?
A. Avoid intramuscular injections.
B. Encourage increased oral fluids.
C. Check temperature every 4 hours.
D. Increase intake of iron-rich foods.
Answer: A
Explanation: Thrombocytopenia increases the risk of bleeding. Avoiding IM injections and
other traumatic procedures helps prevent hematoma formation and bleeding complications.
12. The health care providers progress note for a patient states that the complete
blood count (CBC) shows a shift to the left. Which assessment finding will the
nurse expect?
A. Cool extremities
B. Pallor and weakness
C. Elevated temperature
D. Low oxygen saturation
Answer: C
Explanation: A "shift to the left" indicates an increased number of immature neutrophils
(bands), which is commonly seen in bacterial infections and often accompanied by fever.
13. The health care provider orders a liver/spleen scan for a patient who has been in
a motor vehicle accident. Which action should the nurse take before this
procedure?
A. Check for any iodine allergy.
B. Insert a large-bore IV catheter.
C. Place the patient on NPO status.
D. Assist the patient to a flat position.
Answer: D
Explanation: For a liver/spleen scan, the patient is typically positioned flat to facilitate
accurate imaging after IV injection of a radioactive tracer. NPO status and iodine allergy are
not relevant for this scan.
