Chapter 30: Hematologic Disorders
Linton: Medical-Surgical Nursing, 7th Edition
MULTIPLE CHOICE
1. What should be a major focus in a teaching plan for a teenager with sickle cell anemia?
a. Limit tobacco use to no more than two cigarettes a day.
b. Eat foods high in iron and vitamin B.
c. Maintain environmental temperature at 65 F to 68 F.
d. Maintain adequate hydration.
ANS: D
The maintenance of adequate fluid intake (4 to 6 L/day) prevents hemoconcentration. The use
of alcohol and tobacco is contraindicated for the patient with sickle cell anemia as the cause
vasoconstriction. Warm environments are more therapeutic as warm environments do not
cause vasoconstriction.
DIF: Cognitive Level: Application REF: p. 548 OBJ: 2
TOP: Sickle Cell Anemia KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
2. A nurse is caring for a patient who is having radiation treatment for cancer. How many days
after the start of radiation should the nurse know that the threat of thrombocytopenia exists?
a. 2
b. 5
c. 9
d. 12
ANS: D
Thrombocytopenia becomes a nursing concern 10 to 14 days after therapy has begun. This
concern is true for radiation and chemotherapy.
DIF: Cognitive Level: Knowledge REF: p. 549 OBJ: 1
TOP: Thrombocytopenia KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
3. What happens to the sickle-shaped red blood cells during a sickle cell crisis?
a. Rupture
b. Production of hemoglobin S
c. Interference with blood production
d. Obstruction of major arteries
ANS: D
Circulatory obstruction causes severe pain in patients with sickle cell anemia, which is the
major symptom in sickle cell crisis. The hemoglobin S does not, in itself, cause the crises until
the cells obstruct a vessel.
DIF: Cognitive Level: Comprehension REF: p. 546 OBJ: 1
TOP: Sickle Cell Anemia KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
4. What information should a nurse be sure to include when preparing discharge plans for a
patient recently diagnosed with pernicious anemia?
a. Adding daily high-fat, low-fiber supplements
b. Adding a rigorous daily workout
c. Avoiding prolonged exposure to direct sunlight
d. Providing sufficient rest periods throughout the day
ANS: D
Fatigue and weakness are seen in all anemias.
DIF: Cognitive Level: Application REF: p. 545 OBJ: 2
TOP: Pernicious Anemia KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
5. What is the rationale for administering injections of vitamin B12 to patients with pernicious
anemia?
a. The patient’s body does not normally manufacture enough vitamin B12.
b. The patient may lack the intrinsic factor necessary for vitamin B12 absorption.
c. Vitamin B12 is found in very small quantities in the patient’s body.
d. Vitamin B12 is a mineral necessary to aid in the formation of strong bones.
ANS: B
The patient with pernicious anemia lacks the intrinsic factor, found in the stomach, which is
essential for vitamin B12 absorption.
DIF: Cognitive Level: Comprehension REF: p. 545 OBJ: 1
TOP: Pernicious Anemia KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
6. Which foods should a nurse include in a nutrition teaching plan for a patient with iron
deficiency anemia?
a. Beans and dried fruit
b. Apples and white rice
c. Yogurt and cooked carrots
d. Yellow squash and tortillas
ANS: A
Iron-rich foods include beans, dried fruit, liver, red meat, fish, and whole-grain breads.
DIF: Cognitive Level: Comprehension REF: p. 545 OBJ: 2
TOP: Iron-Deficiency Anemia KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
7. A child with sickle cell anemia is prescribed the drug hydroxyurea. What effect from the drug
should the patient expect to have?
a. Increase energy
b. Decrease cardiomegaly
c. Clean out obstructed vessels
d. Produce a hemoglobin that resists sickling
ANS: D
Hydroxyurea produces a hemoglobin that resists sickling.
DIF: Cognitive Level: Comprehension REF: p. 546 OBJ: 1
TOP: Hydroxyurea KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
8. A newborn infant has developed significant jaundice and has a positive Coombs test result
resulting from high levels of bilirubin. What should a nurse be aware that these symptoms
may indicate?
a. Aplastic anemia
b. Hemophilia
c. Hemolytic anemia
d. Sickle cell anemia
ANS: C
Newborns can develop hemolytic anemias resulting from blood incompatibility to their
mother. These are typical signs of hemolytic anemia in the newborn.
DIF: Cognitive Level: Comprehension REF: p. 545 OBJ: 1
TOP: Hemolytic Anemia KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
9. A 3-year-old African-American child is diagnosed with sickle cell anemia. The parents know
that sickle cell anemia is hereditary but do not understand why their child has the disease
because neither of them has it. What is the most accurate information to provide?
a. At least one of the parents has to have the disease.
b. Only one parent has to have the disease or the trait.
c. Someone in previous generations had the disease.
d. Both parents were carriers of the sickle cell trait.
ANS: D
Sickle cell anemia is a genetic disease carried by the recessive genes of both parents, who will
not exhibit any symptoms of the disease.
DIF: Cognitive Level: Comprehension REF: pp. 545-546 OBJ: 1
TOP: Anemia KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
10. A 35-year-old man is examined in an urgent care clinic. His presenting symptoms suggest
polycythemia vera. Which extreme laboratory value would confirm this possible diagnosis?
a. High hemoglobin level
b. Low white cell count
c. Low platelet count
d. High iron level
ANS: A
The symptoms of polycythemia vera are extremely high hemoglobin and hematocrit values
because of the excessive production of red blood cells. Patients with polycythemia vera have 1
pint of blood taken from them until the blood values become more normal. The blood is
collected as it would be for a blood donation, but it cannot be used for transfusion purposes.
DIF: Cognitive Level: Comprehension REF: p. 544 OBJ: 1
TOP: Polycythemia Vera KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
11. A 52-year-old man has a diagnosis of aplastic anemia. What information in the patient history
is pertinent to this diagnosis?
a. Long family history of cancer
b. Regular blood donor
c. 25-year employee in a chemical plant
d. Gain of 5 lb in the last 2 years
ANS: C
Exposure to toxic chemicals can cause aplastic anemia.
DIF: Cognitive Level: Analysis REF: p. 544 OBJ: 1
TOP: Aplastic Anemia KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
12. At the end of a shift, a nurse documents the effectiveness of parent teaching concerning the
transmission of hemophilia. Which statement by the mother would best indicate an accurate
parental perception?
a. “Hemophilia is a genetic disorder, and I am a carrier, although I do not have the
disease.”
b. “My son developed hemophilia because I had measles while I was pregnant.”
c. “Because my husband isn’t affected by the disease, our daughter will not be a
carrier.”
d. “I know it is not necessary to have my two daughters tested for the disease.”
ANS: A
Women carry the trait and pass it on to their sons.
DIF: Cognitive Level: Comprehension REF: p. 549 OBJ: 1
TOP: Hemophilia KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
13. What should a nurse be careful to observe for when assessing a patient with
thrombocytopenia?
a. Distended neck veins and skin discoloration
b. Discoloration of the nails and sclera
c. Petechiae on the skin and bleeding gums
d. Enlarged thyroid gland and excitability
ANS: C
Symptoms of thrombocytopenia include petechiae, purpura, bleeding gums, and epistaxis.
DIF: Cognitive Level: Analysis REF: p. 549 OBJ: 1
TOP: Thrombocytopenia KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
14. A nurse caring for a patient with crushing injuries from an automobile accident notes that the
patient is bleeding profusely from the nose, mouth, and rectum, as well as from the injuries.
What should the nurse suspect as the cause of this patient’s bleeding?
a. Hemophilia
b. Disseminated intravascular coagulation (DIC)
c. Leukemia
d. Thrombocytopenia
ANS: B
DIC occurs in massive crushing injuries, burns, and allergic responses. The body’s clotting
ability is exhausted because of its attempt to repair so many areas with coagulation. When the
platelet supply is gone, the clotting ability is lost, and massive hemorrhaging occurs.
DIF: Cognitive Level: Analysis REF: p. 549 OBJ: 1 | 2
TOP: DIC KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
MULTIPLE RESPONSE
1. The nurse is caring for a patient with hemophilia who is experiencing a bleeding episode.
Which intervention(s) should the nurse anticipate implementing? (Select all that apply.)
a. Providing intravenous morphine for pain relief
b. Administering rectal suppositories
c. Activities ad lib
d. Administering aspirin
e. Prepare for transfusion
ANS: A, E
Medical treatment for patients experiencing a bleeding episode is symptomatic. The physician
usually prescribes transfusions of FFP or cryoprecipitate, or both. The pain can be very severe.
The patient needs adequate pain relief during these episodes, even if they last several days.
Intravenous morphine is commonly prescribed for pain relief. Rectal suppositories would be
avoided due to high risk for mucous membrane bleeding if inserted. Bed rest would be
anticipated during a bleeding episode. Aspirin would enhance bleeding due to anticoagulant
effects.
DIF: Cognitive Level: Application REF: p. 550 OBJ: 1 | 2
TOP: Hemophilia KEY: Nursing Process Step: Interventions
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
COMPLETION
1. ______ is a condition in which too many RBCs are produced.
ANS:
Polycythemia vera
Polycythemia vera is a condition in which too many red blood cells are produced.
DIF: Cognitive Level: Knowledge REF: p. 544 OBJ: 1
TOP: Red Blood Cell Disorders KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
