Chapter 37: Concepts of Care for Patients
with Hematologic Problems
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A client has been admitted after sustaining a humerus fracture that occurred when
picking up the family cat. What test result would the nurse correlate to this condition?
a. Bence-Jones protein in urine
b. Epstein-Barr virus: positive
c. Hemoglobin: 18 mg/dL (180 mmol/L)
d. Red blood cell count: 8.2 million/mcL (8.2 1012/L)
ANS: A
This client has possible multiple myeloma. A positive Bence-Jones protein finding
would correlate with this condition. The Epstein-Barr virus is a herpesvirus that
causes infectious mononucleosis and some cancers. A hemoglobin of 18 mg/dL (180
mmol/L) is slightly high for a male and somewhat high for a female; this can be
caused by several conditions, and further information would be needed to correlate
this value with a specific medical condition. A red blood cell count of 8.2
million/mcL (8.2 1012/L) is also high, but again, more information would be
needed to correlate this finding with a specific medical condition.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: Hematologic system, Laboratory values MSC: Client
Needs Category: Physiological Integrity: Reduction of Risk Potential
,2. A client with multiple myeloma demonstrates worsening bone density on diagnostic
scans. About what drug does the nurse plan to teach this client?
a. Bortezomib
b. Dexamethasone
c. Thalidomide
d. Zoledronic acid
ANS: D
All the options are drugs used to treat multiple myeloma, but the drug used
specifically for bone manifestations is zoledronic acid, which is a bisphosphonate.
This drug class inhibits bone resorption and is used to treat osteoporosis as well.
DIF: Applying TOP: Integrated Process: Teaching/Learning
KEY: Hematologic system, Bisphosphonates, Patient education
MSC: Client Needs Category: Physiological Integrity:
Pharmacological and Parenteral Therapies
3. A client has a platelet count of 9000/mm3 (9 109/L). The nurse finds the client
confused and mumbling. What nursing action takes priority at this time?
a. Call the Rapid Response Team.
b. Take a set of vital signs.
c. Institute bleeding precautions.
d. Place the client on bedrest.
ANS: A
With a platelet count this low, the client is at high risk of spontaneous bleeding. The
most disastrous complication would be intracranial bleeding. The nurse needs to call
the Rapid Response Team as this client has manifestations of a sudden neurologic
change. Bleeding precautions will not address the immediate situation. Placing the
client on bedrest is important, but the critical action is to call for immediate medical
attention.
, DIF: Applying TOP: Integrated Process: Communication and
Documentation KEY: Hematologic system, Laboratory values, Critical
rescue, Neurologic system MSC: Client Needs Category: Safe and
Effective Care Environment: Management of Care
4. A nurse is preparing to administer a blood transfusion. What action is most
important?
a. Correctly identify client using two identifiers.
b. Ensure that informed consent is obtained.
c. Hang the blood product with Ringer’s lactate.
d. Stay with the client for the entire transfusion.
ANS: B
If the facility requires informed consent for transfusions, this action is most important
because it precedes the other actions taken during the transfusion. Correctly
identifying the client and blood product is a National Patient Safety Goal, and is the
most important action after obtaining informed consent. Ringer’s lactate is not used to
transfuse blood. The nurse does not need to stay with the client for the duration of the
transfusion.
DIF: Applying TOP: Integrated Process: Nursing Process:
Implementation KEY: Informed consent, Blood transfusions,
Hematologic system MSC: Client Needs Category: Safe and Effective Care
Environment: Management of Care
5. A nurse is preparing to administer a blood transfusion. Which action is most
important?
a. Document the transfusion.
b. Place the client on NPO status.
c. Place the client in isolation.
d. Put on a pair of gloves.
with Hematologic Problems
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A client has been admitted after sustaining a humerus fracture that occurred when
picking up the family cat. What test result would the nurse correlate to this condition?
a. Bence-Jones protein in urine
b. Epstein-Barr virus: positive
c. Hemoglobin: 18 mg/dL (180 mmol/L)
d. Red blood cell count: 8.2 million/mcL (8.2 1012/L)
ANS: A
This client has possible multiple myeloma. A positive Bence-Jones protein finding
would correlate with this condition. The Epstein-Barr virus is a herpesvirus that
causes infectious mononucleosis and some cancers. A hemoglobin of 18 mg/dL (180
mmol/L) is slightly high for a male and somewhat high for a female; this can be
caused by several conditions, and further information would be needed to correlate
this value with a specific medical condition. A red blood cell count of 8.2
million/mcL (8.2 1012/L) is also high, but again, more information would be
needed to correlate this finding with a specific medical condition.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: Hematologic system, Laboratory values MSC: Client
Needs Category: Physiological Integrity: Reduction of Risk Potential
,2. A client with multiple myeloma demonstrates worsening bone density on diagnostic
scans. About what drug does the nurse plan to teach this client?
a. Bortezomib
b. Dexamethasone
c. Thalidomide
d. Zoledronic acid
ANS: D
All the options are drugs used to treat multiple myeloma, but the drug used
specifically for bone manifestations is zoledronic acid, which is a bisphosphonate.
This drug class inhibits bone resorption and is used to treat osteoporosis as well.
DIF: Applying TOP: Integrated Process: Teaching/Learning
KEY: Hematologic system, Bisphosphonates, Patient education
MSC: Client Needs Category: Physiological Integrity:
Pharmacological and Parenteral Therapies
3. A client has a platelet count of 9000/mm3 (9 109/L). The nurse finds the client
confused and mumbling. What nursing action takes priority at this time?
a. Call the Rapid Response Team.
b. Take a set of vital signs.
c. Institute bleeding precautions.
d. Place the client on bedrest.
ANS: A
With a platelet count this low, the client is at high risk of spontaneous bleeding. The
most disastrous complication would be intracranial bleeding. The nurse needs to call
the Rapid Response Team as this client has manifestations of a sudden neurologic
change. Bleeding precautions will not address the immediate situation. Placing the
client on bedrest is important, but the critical action is to call for immediate medical
attention.
, DIF: Applying TOP: Integrated Process: Communication and
Documentation KEY: Hematologic system, Laboratory values, Critical
rescue, Neurologic system MSC: Client Needs Category: Safe and
Effective Care Environment: Management of Care
4. A nurse is preparing to administer a blood transfusion. What action is most
important?
a. Correctly identify client using two identifiers.
b. Ensure that informed consent is obtained.
c. Hang the blood product with Ringer’s lactate.
d. Stay with the client for the entire transfusion.
ANS: B
If the facility requires informed consent for transfusions, this action is most important
because it precedes the other actions taken during the transfusion. Correctly
identifying the client and blood product is a National Patient Safety Goal, and is the
most important action after obtaining informed consent. Ringer’s lactate is not used to
transfuse blood. The nurse does not need to stay with the client for the duration of the
transfusion.
DIF: Applying TOP: Integrated Process: Nursing Process:
Implementation KEY: Informed consent, Blood transfusions,
Hematologic system MSC: Client Needs Category: Safe and Effective Care
Environment: Management of Care
5. A nurse is preparing to administer a blood transfusion. Which action is most
important?
a. Document the transfusion.
b. Place the client on NPO status.
c. Place the client in isolation.
d. Put on a pair of gloves.
