Chapter 33: Nursing Management: Hematological Conditions: Lewis’s
Medical-Surgical Nursing, 5th Edition
1. The nurse is caring for a patient with anemia who is experiencing increased fatigue
and occasional palpitations at rest. Which of the following laboratory findings should
the nurse expect?
A. Normal red blood cell (RBC) indices
B. Hematocrit (Hct) of 38%
C. Hemoglobin (Hb) of 86 g/L
D. RBC count of 4.5 x 10^12/L
Answer: C
Explanation: The patient's symptoms are consistent with moderate anemia, which is defined
by a hemoglobin level of 60–100 g/L. The other values listed are within normal ranges and
would not typically cause these symptoms.
2. The nurse is caring for a patient with a sickle cell crisis. While caring for the patient
during the crisis, which of the following actions is priority?
A. Limit the patient's intake of oral and IV fluids.
B. Evaluate the effectiveness of opioid analgesics.
C. Encourage the patient to ambulate as much as tolerated.
D. Teach the patient about high-protein, high-calorie foods.
Answer: B
Explanation: Pain is the most prominent and debilitating symptom of a sickle cell crisis, and
managing it with effective analgesia, often requiring large doses of opioids, is the priority.
Fluid intake should be increased, not limited, and rest is encouraged over ambulation during a
crisis.
3. The nurse is caring for a patient with idiopathic aplastic anemia. Which of the
following collaborative problems should the nurse include when developing the care
plan?
A. Potential complication: seizures
B. Potential complication: infection
C. Potential complication: neurogenic shock
D. Potential complication: pulmonary edema
Answer: B
Explanation: Aplastic anemia involves pancytopenia, which includes neutropenia. This
significantly increases the risk for infection. The other complications are not typically
associated with aplastic anemia.
4. The nurse is caring for a patient who is receiving methotrexate and develops a
megaloblastic anemia. Which of the following nutrients should the nurse include in the
teaching plan?
A. Iron
,B. Folic acid
C. Cobalamin (vitamin B12)
D. Ascorbic acid (vitamin C)
Answer: B
Explanation: Methotrexate is known to cause folic acid deficiency, which can lead to
megaloblastic anemia. Supplementation with folic acid is the standard treatment. The other
nutrients are used to treat other types of anemia but do not correct folic acid deficiency.
5. The nurse is teaching a patient with a new diagnosis of pernicious anemia about the
disorder. Which of the following patient statements indicates that the teaching has been
effective?
A. "I need to start eating more red meat or liver."
B. "I will stop having a glass of wine with dinner."
C. "I will need to take a proton pump inhibitor like omeprazole."
D. "I would rather use the nasal spray than have to get injections of vitamin B12."
Answer: D
Explanation: Pernicious anemia is characterized by a lack of intrinsic factor, which prevents
the absorption of vitamin B12 from the gastrointestinal tract. Therefore, treatment requires
parenteral or intranasal administration of cobalamin. Dietary increases or proton pump
inhibitors are not effective, and alcohol use is not a direct cause.
6. The nurse is caring for a patient who is hospitalized for treatment of severe hemolytic
anemia. Which of the following actions should the nurse implement?
A. Provide a diet high in vitamin K.
B. Place the patient on protective isolation.
C. Alternate periods of rest and activity.
D. Teach the patient how to avoid injury.
Answer: C
Explanation: A key nursing intervention for anemia is to balance rest and activity to manage
fatigue. There is no indication of a bleeding disorder requiring a high vitamin K diet or injury
prevention teaching. Protective isolation is typically reserved for conditions like aplastic
anemia, not hemolytic anemia.
7. Which of the following menu choices indicate that the patient understands the nurse's
teaching about best dietary choices for iron-deficiency anemia?
A. Omelet and whole wheat toast
B. Cantaloupe and cottage cheese
C. Strawberry and banana fruit plate
D. Cornmeal muffin and orange juice
Answer: A
Explanation: Eggs and whole grain breads are excellent dietary sources of iron. The other
options are not rich in iron and are more appropriate for addressing other nutritional
deficiencies.
,8. The nurse has finished teaching a patient about taking oral ferrous sulphate. Which
of the following patient statements indicates that additional instruction is needed?
A. "I will call the doctor if my stools start to turn black."
B. "I will take a stool softener if I feel constipated occasionally."
C. "I should take the iron with orange juice about an hour before eating."
D. "I should increase my fluid and fibre intake while I am taking the iron tablets."
Answer: A
Explanation: Black, tarry stools are a common, expected side effect of iron therapy and are
not a cause for alarm. The other statements demonstrate correct understanding of managing
constipation and enhancing iron absorption.
9. Which of the following statements by a patient with sickle cell anemia indicates good
understanding of the nurse's teaching about prevention of 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 narcotics are prescribed to prevent a crisis."
D. "Risk for a crisis can be lowered by having an annual influenza vaccination."
Answer: D
Explanation: Infection is a common precipitant of sickle cell crises. Therefore,
immunizations, including the annual flu shot, are a key preventive measure. Hydroxyurea is a
medication used to prevent crises, and oxygen/narcotics are typically used during a crisis, not
for prevention.
10. The nurse is planning discharge teaching for a patient who was admitted with
neutropenia. Which of the following instructions should the nurse include?
A. Limit fluids to 2–3 litres a day.
B. Include eggs and fish in the diet.
C. Avoid exposure to crowds as much as possible.
D. Drink only one or two caffeinated beverages daily.
Answer: C
Explanation: The primary risk for a neutropenic patient is infection. Avoiding crowds
reduces exposure to pathogens. There is no specific fluid restriction; in fact, hydration is
often encouraged. Eggs and fish are not restricted, and caffeine limitation is not a standard
recommendation.
11. The nurse is admitting a patient with hemolytic anemia and notes jaundice of the
sclerae. Which of the following laboratory results should the nurse assess?
A. Schilling test
B. Bilirubin level
C. Stool occult blood test
D. Gastric analysis testing
Answer: B
Explanation: Jaundice in hemolytic anemia is caused by the increased breakdown of red
blood cells, leading to elevated bilirubin levels. The other tests are not relevant to diagnosing
or monitoring hemolytic anemia.
, 12. The nurse is caring for a patient who has been receiving a heparin infusion and
warfarin for a deep vein thrombosis (DVT) with a diagnosis of heparin-induced
thrombocytopenia (HIT). Which of the following actions should the nurse include in the
plan of care?
A. Use low-molecular-weight heparin (LMWH) only.
B. Flush all intermittent IV lines using normal saline.
C. Administer the warfarin at the scheduled time.
D. Teach the patient about the purpose of platelet transfusions.
Answer: B
Explanation: In HIT, all heparin products must be discontinued, including in IV flushes.
LMWH is contraindicated. Warfarin is usually held until the platelet count recovers to avoid
catastrophic thrombosis. Platelet transfusions are generally avoided as they can exacerbate
thrombosis.
13. The nurse is caring for a patient with an acute exacerbation of polycythemia vera.
Which of the following actions should the nurse implement during treatment?
A. Place the patient on bed rest.
B. Administer iron supplements.
C. Avoid use of Aspirin products.
D. Monitor fluid intake and output.
Answer: D
Explanation: Careful hydration monitoring is crucial during an exacerbation to prevent
complications like thrombosis from hyperviscosity or fluid overload from therapy.
Ambulation is encouraged to prevent DVT. Aspirin is often used to reduce thrombosis risk,
and iron is contraindicated as it would stimulate red blood cell production.
14. Which of the following nursing interventions should be included in the care plan for
a patient with immune thrombocytopenic purpura (ITP)?
A. Assign the patient to a private room.
B. Avoid intramuscular (IM) injections.
C. Use rinses rather than a toothbrush for oral care.
D. Restrict activity to passive and active range of motion.
Answer: B
Explanation: The main risk in ITP is bleeding. IM injections can cause significant hematoma
formation and should be avoided. A soft-bristled toothbrush is acceptable. There is no need
for a private room or strict activity restriction unless the platelet count is extremely low.
15. Which of the following laboratory information should the nurse monitor to detect
heparin-induced thrombocytopenia (HIT) in a patient who is receiving a continuous
heparin infusion?
A. Prothrombin time
B. Erythrocyte count
C. Fibrinogen degradation products
D. Activated partial thromboplastin time
Answer: D
Medical-Surgical Nursing, 5th Edition
1. The nurse is caring for a patient with anemia who is experiencing increased fatigue
and occasional palpitations at rest. Which of the following laboratory findings should
the nurse expect?
A. Normal red blood cell (RBC) indices
B. Hematocrit (Hct) of 38%
C. Hemoglobin (Hb) of 86 g/L
D. RBC count of 4.5 x 10^12/L
Answer: C
Explanation: The patient's symptoms are consistent with moderate anemia, which is defined
by a hemoglobin level of 60–100 g/L. The other values listed are within normal ranges and
would not typically cause these symptoms.
2. The nurse is caring for a patient with a sickle cell crisis. While caring for the patient
during the crisis, which of the following actions is priority?
A. Limit the patient's intake of oral and IV fluids.
B. Evaluate the effectiveness of opioid analgesics.
C. Encourage the patient to ambulate as much as tolerated.
D. Teach the patient about high-protein, high-calorie foods.
Answer: B
Explanation: Pain is the most prominent and debilitating symptom of a sickle cell crisis, and
managing it with effective analgesia, often requiring large doses of opioids, is the priority.
Fluid intake should be increased, not limited, and rest is encouraged over ambulation during a
crisis.
3. The nurse is caring for a patient with idiopathic aplastic anemia. Which of the
following collaborative problems should the nurse include when developing the care
plan?
A. Potential complication: seizures
B. Potential complication: infection
C. Potential complication: neurogenic shock
D. Potential complication: pulmonary edema
Answer: B
Explanation: Aplastic anemia involves pancytopenia, which includes neutropenia. This
significantly increases the risk for infection. The other complications are not typically
associated with aplastic anemia.
4. The nurse is caring for a patient who is receiving methotrexate and develops a
megaloblastic anemia. Which of the following nutrients should the nurse include in the
teaching plan?
A. Iron
,B. Folic acid
C. Cobalamin (vitamin B12)
D. Ascorbic acid (vitamin C)
Answer: B
Explanation: Methotrexate is known to cause folic acid deficiency, which can lead to
megaloblastic anemia. Supplementation with folic acid is the standard treatment. The other
nutrients are used to treat other types of anemia but do not correct folic acid deficiency.
5. The nurse is teaching a patient with a new diagnosis of pernicious anemia about the
disorder. Which of the following patient statements indicates that the teaching has been
effective?
A. "I need to start eating more red meat or liver."
B. "I will stop having a glass of wine with dinner."
C. "I will need to take a proton pump inhibitor like omeprazole."
D. "I would rather use the nasal spray than have to get injections of vitamin B12."
Answer: D
Explanation: Pernicious anemia is characterized by a lack of intrinsic factor, which prevents
the absorption of vitamin B12 from the gastrointestinal tract. Therefore, treatment requires
parenteral or intranasal administration of cobalamin. Dietary increases or proton pump
inhibitors are not effective, and alcohol use is not a direct cause.
6. The nurse is caring for a patient who is hospitalized for treatment of severe hemolytic
anemia. Which of the following actions should the nurse implement?
A. Provide a diet high in vitamin K.
B. Place the patient on protective isolation.
C. Alternate periods of rest and activity.
D. Teach the patient how to avoid injury.
Answer: C
Explanation: A key nursing intervention for anemia is to balance rest and activity to manage
fatigue. There is no indication of a bleeding disorder requiring a high vitamin K diet or injury
prevention teaching. Protective isolation is typically reserved for conditions like aplastic
anemia, not hemolytic anemia.
7. Which of the following menu choices indicate that the patient understands the nurse's
teaching about best dietary choices for iron-deficiency anemia?
A. Omelet and whole wheat toast
B. Cantaloupe and cottage cheese
C. Strawberry and banana fruit plate
D. Cornmeal muffin and orange juice
Answer: A
Explanation: Eggs and whole grain breads are excellent dietary sources of iron. The other
options are not rich in iron and are more appropriate for addressing other nutritional
deficiencies.
,8. The nurse has finished teaching a patient about taking oral ferrous sulphate. Which
of the following patient statements indicates that additional instruction is needed?
A. "I will call the doctor if my stools start to turn black."
B. "I will take a stool softener if I feel constipated occasionally."
C. "I should take the iron with orange juice about an hour before eating."
D. "I should increase my fluid and fibre intake while I am taking the iron tablets."
Answer: A
Explanation: Black, tarry stools are a common, expected side effect of iron therapy and are
not a cause for alarm. The other statements demonstrate correct understanding of managing
constipation and enhancing iron absorption.
9. Which of the following statements by a patient with sickle cell anemia indicates good
understanding of the nurse's teaching about prevention of 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 narcotics are prescribed to prevent a crisis."
D. "Risk for a crisis can be lowered by having an annual influenza vaccination."
Answer: D
Explanation: Infection is a common precipitant of sickle cell crises. Therefore,
immunizations, including the annual flu shot, are a key preventive measure. Hydroxyurea is a
medication used to prevent crises, and oxygen/narcotics are typically used during a crisis, not
for prevention.
10. The nurse is planning discharge teaching for a patient who was admitted with
neutropenia. Which of the following instructions should the nurse include?
A. Limit fluids to 2–3 litres a day.
B. Include eggs and fish in the diet.
C. Avoid exposure to crowds as much as possible.
D. Drink only one or two caffeinated beverages daily.
Answer: C
Explanation: The primary risk for a neutropenic patient is infection. Avoiding crowds
reduces exposure to pathogens. There is no specific fluid restriction; in fact, hydration is
often encouraged. Eggs and fish are not restricted, and caffeine limitation is not a standard
recommendation.
11. The nurse is admitting a patient with hemolytic anemia and notes jaundice of the
sclerae. Which of the following laboratory results should the nurse assess?
A. Schilling test
B. Bilirubin level
C. Stool occult blood test
D. Gastric analysis testing
Answer: B
Explanation: Jaundice in hemolytic anemia is caused by the increased breakdown of red
blood cells, leading to elevated bilirubin levels. The other tests are not relevant to diagnosing
or monitoring hemolytic anemia.
, 12. The nurse is caring for a patient who has been receiving a heparin infusion and
warfarin for a deep vein thrombosis (DVT) with a diagnosis of heparin-induced
thrombocytopenia (HIT). Which of the following actions should the nurse include in the
plan of care?
A. Use low-molecular-weight heparin (LMWH) only.
B. Flush all intermittent IV lines using normal saline.
C. Administer the warfarin at the scheduled time.
D. Teach the patient about the purpose of platelet transfusions.
Answer: B
Explanation: In HIT, all heparin products must be discontinued, including in IV flushes.
LMWH is contraindicated. Warfarin is usually held until the platelet count recovers to avoid
catastrophic thrombosis. Platelet transfusions are generally avoided as they can exacerbate
thrombosis.
13. The nurse is caring for a patient with an acute exacerbation of polycythemia vera.
Which of the following actions should the nurse implement during treatment?
A. Place the patient on bed rest.
B. Administer iron supplements.
C. Avoid use of Aspirin products.
D. Monitor fluid intake and output.
Answer: D
Explanation: Careful hydration monitoring is crucial during an exacerbation to prevent
complications like thrombosis from hyperviscosity or fluid overload from therapy.
Ambulation is encouraged to prevent DVT. Aspirin is often used to reduce thrombosis risk,
and iron is contraindicated as it would stimulate red blood cell production.
14. Which of the following nursing interventions should be included in the care plan for
a patient with immune thrombocytopenic purpura (ITP)?
A. Assign the patient to a private room.
B. Avoid intramuscular (IM) injections.
C. Use rinses rather than a toothbrush for oral care.
D. Restrict activity to passive and active range of motion.
Answer: B
Explanation: The main risk in ITP is bleeding. IM injections can cause significant hematoma
formation and should be avoided. A soft-bristled toothbrush is acceptable. There is no need
for a private room or strict activity restriction unless the platelet count is extremely low.
15. Which of the following laboratory information should the nurse monitor to detect
heparin-induced thrombocytopenia (HIT) in a patient who is receiving a continuous
heparin infusion?
A. Prothrombin time
B. Erythrocyte count
C. Fibrinogen degradation products
D. Activated partial thromboplastin time
Answer: D
