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Hematologic System Questions and Answers for NCLEX-PN and NCLEX-RN
Question 1: The nurse is discussing dietary sources of iron with a client who has iron deficiency anemia. Which menu, if selected by the client, indicates the best understanding of the diet?
Foods that are high in iron include:
- Red meat, poultry, and fish
- Beans, lentils, and peas
- Tofu and tempeh
- Fortified cereals and bread
- Spinach and other dark leafy greens
- Nuts and seeds
- Dried fruits, such as raisins and apricots
A balanced diet that includes a variety of these foods can help the client meet their iron needs. Additionally, consuming foods that are high in vitamin C (such as citrus fruits, tomatoes, and peppers) can increase the absorption of iron from plant-based sources.
It’s also important to note that certain foods and beverages can interfere with iron absorption, such as coffee, tea, and dairy products. The client should be advised to avoid consuming these at the same time as iron-rich foods.
Therefore, if the client selects a menu that includes a variety of the above-mentioned foods, with a special emphasis on iron-rich sources and vitamin C-containing foods, it would indicate a good understanding of the recommended diet for treating iron deficiency anemia.
Question 2: Ferrous sulfate is prescribed for a client. She returns to the clinic in two weeks. Which assessment by the nurse indicates that she has NOT been taking iron as ordered?
If the client has not been taking the prescribed ferrous sulfate as directed, there may be a few potential indications during the assessment, such as:
- No improvement in symptoms: One of the primary reasons for prescribing ferrous sulfate is to treat iron deficiency anemia, which can cause fatigue, weakness, and shortness of breath. If the client has not been taking the medication as directed, these symptoms may persist or even worsen over time.
- No increase in hemoglobin levels: Iron is necessary for the body to produce hemoglobin, the protein in red blood cells that carries oxygen. A lack of iron can lead to a decrease in hemoglobin levels. Therefore, if the client’s hemoglobin levels have not increased since the last visit, it may indicate that the iron supplement is not being taken as prescribed.
- No change in iron stores: Iron deficiency anemia can also cause a decrease in the body’s iron stores. This can be assessed through blood tests such as serum ferritin or transferrin saturation. If there has been no improvement in these levels, it may indicate that the iron supplement is not being taken as directed.
- Adverse effects related to the medication: Ferrous sulfate can cause side effects such as nausea, constipation, and abdominal pain. If the client has been experiencing these symptoms since starting the medication, it may indicate that they have been taking the iron supplement as directed, but are experiencing adverse effects that are impacting their compliance.
- It’s important for the nurse to ask the client directly if they have been taking the medication as directed and explore any barriers to compliance or concerns about side effects. The nurse should also educate the client on the importance of taking the medication as directed to effectively treat iron deficiency anemia.
Question 3: A Schilling test has been ordered for a client suspected of having pernicious anemia. What is the nurse’s primary responsibility in relation to this test?
The Schilling test is a medical test that is used to diagnose pernicious anemia, a type of anemia that occurs due to a deficiency in vitamin B12. The nurse’s primary responsibility in relation to this test would be to prepare the client and provide education about the test.
The following are the nurse’s primary responsibilities related to the Schilling test:
- Explain the purpose of the test: The nurse should explain to the client why the test has been ordered, how it works, and what it will involve. This can help alleviate any fears or concerns that the client may have and help them understand the importance of the test.
- Provide instructions for preparation: The nurse should provide instructions to the client regarding any preparation that may be required for the test, such as fasting or avoiding certain medications. The client may also need to drink a special liquid or receive an injection of radioactive vitamin B12 for the test, and the nurse should explain what to expect during the procedure.
- Ensure informed consent: The nurse should ensure that the client understands the risks and benefits of the test and has given informed consent before proceeding with the procedure.
- Monitor the client during the test: The nurse should remain with the client during the test and monitor them for any adverse reactions or discomfort. They should also ensure that the client is following instructions and completing the test as required.
- Provide follow-up care: After the test, the nurse should provide instructions for any necessary follow-up care and ensure that the client understands any medications or treatments that may be prescribed based on the test results.
- By preparing the client and providing education about the Schilling test, the nurse can help ensure that the test is performed safely and accurately, and that the client receives appropriate care and follow-up based on the test results.
Question 4: A client who receives a diagnosis of pernicious anemia asks why she must receive vitamin shots. What is the best answer for the nurse to give?
The best answer for the nurse to give to a client with pernicious anemia who asks why they must receive vitamin B12 shots is:
“Pernicious anemia is a type of anemia that occurs due to a deficiency of vitamin B12, which is essential for the production of healthy red blood cells. Unfortunately, some people with pernicious anemia are unable to absorb enough vitamin B12 from food sources. This is because their body does not produce enough of a substance called intrinsic factor, which is needed for the absorption of vitamin B12 in the small intestine.
Therefore, to treat pernicious anemia, it is necessary to replace the missing vitamin B12 by receiving injections of the vitamin. These injections are given directly into the muscle, bypassing the need for absorption in the small intestine. The injections will help to restore the body’s vitamin B12 levels and enable the production of healthy red blood cells, which will reduce symptoms and complications of pernicious anemia.”
The nurse should also emphasize the importance of receiving regular injections as prescribed, as failure to do so can result in worsening symptoms and complications of pernicious anemia. The nurse should encourage the client to ask any questions they have and address any concerns they may have about receiving vitamin B12 injections.
Question 5: A client who has been diagnosed as having pernicious anemia asks how long she will have to take shots. What is the best answer for the nurse to give?
When a client with pernicious anemia asks how long they will have to take vitamin B12 shots, the nurse’s best answer would be:
“Pernicious anemia is a chronic condition that requires ongoing treatment to maintain normal vitamin B12 levels and prevent symptoms from returning. The length of time that you will need to receive vitamin B12 injections will depend on your individual needs and the severity of your condition. Some people may need to receive injections for the rest of their lives, while others may be able to stop after a period of time.
Your healthcare provider will monitor your vitamin B12 levels and symptoms over time to determine the best course of treatment for you. It is important to follow your healthcare provider’s instructions regarding the timing and frequency of your injections to ensure that you are receiving the appropriate dose and that your condition is being properly managed.”
The nurse should also reassure the client that vitamin B12 injections are generally safe and well-tolerated, with few side effects. However, they should also inform the client of any potential risks or complications associated with long-term use of vitamin B12 injections, such as hypokalemia or blood clots, and encourage them to report any unusual symptoms or side effects.
Question 6: A toddler has been treated for sickle cell crisis. The crisis subsides, and the child improves. Which statement is essential for the nurse to include in the discharge teaching?
When discharging a toddler who has been treated for sickle cell crisis, an essential statement for the nurse to include in the discharge teaching would be:
“It is important to continue taking medications as prescribed and follow-up with regular appointments with the healthcare provider to manage sickle cell disease and prevent future complications.”
Other important statements to include in the discharge teaching for a toddler with sickle cell disease may include:
Encouraging the parents to learn the signs and symptoms of sickle cell crisis, such as pain, fever, or swelling, and to seek prompt medical attention if these occur.
Providing instructions for pain management, such as using heat or cold therapy, taking prescribed medications, and engaging in relaxation techniques.
Advising the parents to maintain a healthy lifestyle for their child, including a balanced diet, regular exercise, and getting enough rest and sleep.
Educating the parents about the importance of preventing infections, such as through hand washing, avoiding sick contacts, and getting recommended vaccinations.
Discussing the potential complications of sickle cell disease, such as stroke, organ damage, and infections, and advising the parents to report any new or unusual symptoms to their healthcare provider.
Overall, the nurse should provide clear and thorough discharge instructions to the parents of a toddler with sickle cell disease, emphasizing the importance of ongoing management and follow-up care to prevent complications and ensure the child’s health and wellbeing.
Question 7: Which statement made by the parent of a child newly diagnosed with sickle cell anemia indicates a need for more teaching?
If a parent of a child newly diagnosed with sickle cell anemia makes the following statement, it indicates a need for more teaching:
“I don’t need to take my child to the doctor unless he is having a sickle cell crisis.”
This statement indicates a lack of understanding of the importance of ongoing monitoring and management of sickle cell disease. While it is true that sickle cell crises are a common and potentially serious complication of sickle cell disease, ongoing care is also necessary to prevent complications, such as infections, organ damage, and stroke. Regular appointments with the healthcare provider are necessary to monitor the child’s health and manage the disease, even when the child is not experiencing a crisis.
Other important aspects of sickle cell disease management that the nurse should emphasize during teaching include:
- The importance of maintaining a healthy lifestyle, including a balanced diet, regular exercise, and getting enough rest and sleep.
- The need to avoid triggers that can cause sickle cell crisis, such as extreme temperatures, dehydration, and stress.
- The importance of staying up-to-date with vaccinations to prevent infections.
- The need for close monitoring of the child’s growth and development, as sickle cell disease can affect these processes.
- The importance of seeking prompt medical attention if the child experiences any signs or symptoms of a sickle cell crisis, such as pain, fever, or swelling.
By providing clear and thorough teaching on sickle cell disease management, the nurse can help ensure that parents have the knowledge and skills they need to effectively manage their child’s condition and prevent complications.
Question 8: A 5-year-old boy is admitted because he bled profusely when he lost his first baby tooth. After a workup, he is diagnosed as having classic hemophilia. His mother asks the nurse if his two younger sisters will also develop hemophilia. What is the best answer for the nurse to give?
When a mother asks if her 5-year-old son’s two younger sisters will also develop hemophilia, the best answer for the nurse to give would be:
“Hemophilia is an inherited disorder that is caused by a mutation in the gene that produces clotting factors. The specific type of hemophilia that your son has, called classic hemophilia, is inherited through the X chromosome. This means that the gene for hemophilia is located on the X chromosome, which is one of the two sex chromosomes.
Since females have two X chromosomes, they have a higher chance of being carriers of the hemophilia gene. If a female carries the hemophilia gene on one of her X chromosomes, she may pass it on to her children. However, the severity of hemophilia and the likelihood of passing it on can vary depending on the carrier status of the mother and the father.
In general, if the mother is a carrier of the hemophilia gene, there is a 50% chance that her daughters will be carriers and a 50% chance that her sons will have hemophilia. If the father has hemophilia, all of his daughters will be carriers, but none of his sons will have hemophilia.
It is important to discuss your family history with a genetic counselor or healthcare provider, who can provide more specific information about the likelihood of your daughters developing hemophilia or being carriers.”
By providing clear and accurate information about the inheritance pattern of hemophilia, the nurse can help the mother better understand the risk of hemophilia in her daughters and the importance of seeking genetic counseling or medical advice.
Question 9: The nurse has been teaching the parents of a child with hemophilia about the care he will need. Which statement by the parents indicates a need for more instruction?
If the parents of a child with hemophilia make the following statement, it indicates a need for more instruction:
“We don’t need to worry about our child getting injured as long as we keep him indoors and avoid any activities that could cause bleeding.”
This statement suggests a misconception that the child with hemophilia should be restricted from physical activities or that he is completely safe from bleeding while staying indoors. In fact, regular physical activity is important for the child’s overall health, and the risk of bleeding cannot be completely eliminated even with precautions.
The nurse should provide additional teaching to address this misconception and emphasize the importance of balancing physical activity with appropriate precautions to minimize the risk of bleeding. Some important points to emphasize in hemophilia education include:
Regular physical activity is important for overall health, but the child should avoid contact sports and activities with a high risk of injury.
Protective equipment, such as helmets and padding, should be used during physical activities to reduce the risk of injury.
If the child does experience a bleeding episode, prompt treatment is essential to prevent complications. The family should have a plan in place for managing bleeding episodes, including having a supply of clotting factor replacement medication and knowing how to administer it.
The child should receive regular medical care from a healthcare provider with experience in treating hemophilia.
The family should be educated on signs and symptoms of bleeding, such as pain, swelling, and bruising, and should seek medical attention promptly if these occur.
By providing clear and accurate teaching on the care and management of hemophilia, the nurse can help ensure that the child and family have the knowledge and skills they need to effectively manage the condition and prevent complications.
Question 10: A college student who is diagnosed as having infectious mononucleosis asks how the disease is spread. The nurse’s response is based on the knowledge that the usual mode of transmission is through:
The usual mode of transmission of infectious mononucleosis is through close contact with saliva from an infected person. This can occur through activities such as kissing, sharing drinks or utensils, or engaging in contact sports where there is close contact with other people’s saliva.
Therefore, the nurse’s response to the college student’s question would be:
“Infectious mononucleosis is usually spread through close contact with the saliva of an infected person. This can happen through activities like kissing or sharing drinks or utensils. The virus can also be spread through contact with mucus from the nose or throat of an infected person. It’s important to avoid close contact with others while you’re infectious and to practice good hygiene, such as washing your hands frequently, to prevent the spread of the virus.”
Question 11: A young man who has infectious mononucleosis asks what the treatment is for his condition. What is the best response for the nurse to make?
Infectious mononucleosis is caused by a virus, and there is no specific treatment for the condition. Therefore, the nurse’s response to the young man’s question would be:
“Infectious mononucleosis is caused by a virus, and there is no specific treatment for the condition. Antibiotics are not effective against viruses, and most people with infectious mononucleosis recover on their own with rest and self-care measures. You can take over-the-counter pain relievers like acetaminophen or ibuprofen to help with any discomfort or fever. It’s also important to get plenty of rest, stay hydrated, and avoid alcohol and contact sports while you’re recovering. In rare cases, complications such as an enlarged spleen or liver can occur, so it’s important to follow up with your healthcare provider if you have any concerns or if your symptoms worsen.”
Question 12: An 8-year-old boy is admitted to the unit with a diagnosis of acute lymphocytic leukemia. During a routine physical exam, numerous ecchymotic areas were noted on his body. The parent reported that the child has been more tired than usual lately. The parent says that the child has had a cold for the last several weeks and asks if this is related to the leukemia. The nurse’s response is based on the knowledge that:
The nurse’s response should be based on the knowledge that acute lymphocytic leukemia can cause a number of symptoms, including easy bruising and bleeding, fatigue, and increased susceptibility to infections.
The ecchymotic areas noted on the child’s body may be a result of the leukemia causing a decrease in the number of platelets, which are responsible for blood clotting. The child’s increased tiredness may be due to anemia, which can occur when the leukemia affects the production of red blood cells. The fact that the child has had a cold for several weeks may also be related to the leukemia, as the disease can weaken the immune system and make it more difficult for the body to fight off infections.
Therefore, the nurse’s response to the parent’s question would be:
“Acute lymphocytic leukemia can cause a number of symptoms, including easy bruising and bleeding, fatigue, and increased susceptibility to infections. The ecchymotic areas on your child’s body may be due to a decrease in the number of platelets caused by the leukemia. Your child’s increased tiredness may be due to anemia, which can also be caused by the leukemia. The fact that your child has had a cold for several weeks may also be related to the leukemia, as the disease can weaken the immune system and make it more difficult for the body to fight off infections. It’s important that we continue to monitor your child’s symptoms and provide appropriate care to manage them.”
Question 13: A child with leukemia bruises easily. This is most likely due to the following:
A child with leukemia may bruise easily due to a decrease in the number of platelets in the blood. Platelets are responsible for blood clotting, and when the platelet count is low, the blood does not clot properly, leading to easy bruising and bleeding.
Leukemia is a type of cancer that affects the blood and bone marrow, and it can interfere with the normal production of blood cells, including platelets. Therefore, a child with leukemia may be at risk for decreased platelet counts and subsequent easy bruising.
Other factors that can contribute to easy bruising in children with leukemia include anemia, which can make the blood vessels more fragile, and chemotherapy, which can also affect the blood’s ability to clot.
Question 14: A child who is being treated for leukemia develops stomatitis. Which of the following nursing care measures is essential?
Stomatitis, which is inflammation of the mouth and lips, is a common side effect of chemotherapy treatment for leukemia. The following nursing care measures are essential in managing stomatitis in a child being treated for leukemia:
- Encourage good oral hygiene: Encourage the child to brush their teeth and rinse their mouth regularly to help prevent infection and reduce inflammation.
- Provide pain relief: Administer appropriate pain relief medication as ordered to manage discomfort and help the child eat and drink.
- Promote nutrition: Offer soft, bland foods and liquids that are easy to swallow, and encourage the child to eat small, frequent meals to maintain adequate nutrition.
- Provide mouth care: Gently swab the inside of the child’s mouth with a soft, moistened cloth or gauze to remove debris and promote healing.
- Monitor for signs of infection: Watch for signs of infection, such as fever or increased redness and swelling of the gums and mouth, and report them to the healthcare provider.
- Educate the child and family: Teach the child and family about the importance of good oral hygiene, the need for regular follow-up with the healthcare provider, and signs and symptoms to watch for that may indicate the need for further medical attention.
In summary, all of the above nursing care measures are important in managing stomatitis in a child being treated for leukemia. However, pain relief and good oral hygiene are particularly essential to prevent infection, reduce inflammation, and promote healing.
Question 15: When planning care for a client who is HIV positive, the nurse should do what?
When planning care for a client who is HIV positive, the nurse should:
- Assess the client’s physical and emotional status: Assess the client’s current physical and emotional status, including their immune function, nutritional status, and mental health.
- Educate the client: Provide education about the importance of adherence to antiretroviral therapy (ART), safe sex practices, and infection control measures.
- Provide emotional support: Offer emotional support and counseling to help the client cope with the emotional and psychological aspects of living with HIV.
- Encourage a healthy lifestyle: Encourage the client to adopt a healthy lifestyle, including regular exercise, a balanced diet, and stress management techniques.
- Monitor for complications: Monitor the client for signs and symptoms of opportunistic infections and other complications associated with HIV, and promptly report any concerns to the healthcare provider.
- Collaborate with the healthcare team: Collaborate with the healthcare team, including the healthcare provider, social worker, and case manager, to ensure that the client receives comprehensive care and support.
In summary, when planning care for a client who is HIV positive, the nurse should focus on assessing the client’s physical and emotional status, providing education and emotional support, encouraging a healthy lifestyle, monitoring for complications, and collaborating with the healthcare team. The goal of nursing care for clients with HIV is to promote optimal health, prevent disease progression, and enhance quality of life.
Question 16: Which action should the nurse expect to perform after a client has a bone marrow biopsy taken from the iliac crest?
After a client has a bone marrow biopsy taken from the iliac crest, the nurse should expect to:
- Apply pressure: Apply pressure to the biopsy site to help control bleeding and promote clotting.
- Monitor vital signs: Monitor the client’s vital signs, particularly blood pressure and pulse, to detect any signs of bleeding or shock.
- Assess the biopsy site: Assess the biopsy site for signs of bleeding, such as hematoma or ecchymosis, and monitor for signs of infection, such as redness, swelling, or drainage.
- Administer pain medication: Administer pain medication as ordered to help relieve discomfort at the biopsy site.
- Educate the client: Educate the client about the importance of rest and activity restrictions following the biopsy, as well as signs and symptoms to report to the healthcare provider, such as fever, bleeding, or signs of infection.
In summary, after a client has a bone marrow biopsy taken from the iliac crest, the nurse should apply pressure to the biopsy site, monitor vital signs, assess the biopsy site, administer pain medication, and educate the client. The goal of nursing care after a bone marrow biopsy is to prevent complications and promote healing at the biopsy site.
Question 17: Which would be the most appropriate snack for a client who has iron deficiency anemia?
The most appropriate snack for a client who has iron deficiency anemia would be one that is rich in iron. Some examples of iron-rich snacks include:
Dried fruits: such as apricots, raisins, and prunes, which are a good source of iron.
Nuts and seeds: such as pumpkin seeds, cashews, almonds, and peanuts, which are rich in iron.
Dark chocolate: which contains iron and can be a satisfying snack.
Whole-grain bread: which is a good source of iron and can be paired with iron-rich toppings such as hummus or almond butter.
Green leafy vegetables: such as spinach or kale, which are high in iron and can be added to a salad or smoothie.
In summary, snacks that are rich in iron, such as dried fruits, nuts and seeds, dark chocolate, whole-grain bread, and green leafy vegetables, can be appropriate for a client with iron deficiency anemia. It is important to note that dietary sources of iron are often better absorbed when consumed with a source of vitamin C, such as citrus fruits or bell peppers.
Question 18: Which assessment findings should alert the nurse that the elderly client should be evaluated for pernicious anemia?
Pernicious anemia is a type of anemia that occurs when the body is unable to absorb vitamin B12, which is necessary for the production of red blood cells. The elderly are at an increased risk for developing pernicious anemia due to a decrease in stomach acid production, which can interfere with the absorption of vitamin B12. Some assessment findings that may suggest pernicious anemia in an elderly client include:
- Pale skin or mucous membranes
- Fatigue, weakness, or lightheadedness
- Shortness of breath or rapid heartbeat
- Confusion or memory loss
- Numbness or tingling in the hands and feet
- Glossitis (inflamed tongue) or mouth sores
- Loss of appetite or weight loss
- Diarrhea or constipation
It is important to note that these symptoms are not specific to pernicious anemia and can be present in a variety of other health conditions. Therefore, a thorough evaluation by a healthcare provider, including laboratory testing, is necessary to diagnose pernicious anemia.
Question 19: An elderly client who is being treated for pernicious anemia needs to be monitored periodically for which conditions?
An elderly client with pernicious anemia is at risk for developing several conditions due to the deficiency of vitamin B12, which can affect various organs and systems in the body. Therefore, it is important to monitor the client periodically for the following conditions:
- Neurological symptoms: Vitamin B12 deficiency can cause damage to the nervous system, leading to symptoms such as numbness or tingling in the hands and feet, difficulty walking, memory loss, and confusion.
- Cardiovascular disease: Vitamin B12 deficiency can lead to an increase in homocysteine levels, which is a risk factor for cardiovascular disease. Therefore, the client may need to be monitored for high blood pressure, coronary artery disease, and stroke.
- Osteoporosis: Vitamin B12 plays a role in bone metabolism and a deficiency can lead to decreased bone density, increasing the risk of fractures. The client may need to be monitored for signs of osteoporosis, such as bone pain and loss of height.
- Gastrointestinal complications: Clients with pernicious anemia may also be at risk for gastrointestinal complications, such as atrophic gastritis, peptic ulcers, and gastrointestinal cancers. Therefore, the client may need to be monitored for symptoms such as abdominal pain, bloating, and changes in bowel habits.
- Depression: Vitamin B12 deficiency has been associated with depression, and the client may need to be monitored for symptoms of depression, such as sadness, hopelessness, and loss of interest in activities.
It is important to note that the client may need additional monitoring depending on their individual health status and comorbidities.
Question 20: Which would be the best lunch for a client with folic acid deficiency anemia?
A lunch for a client with folic acid deficiency anemia should include foods that are high in folate. Good food choices include:
- Spinach salad with grilled chicken and sliced strawberries
- Lentil soup with a side of steamed broccoli
- Turkey and avocado wrap with a side of baby carrots
- Baked sweet potato topped with black beans, salsa, and Greek yogurt
- Grilled salmon with quinoa and roasted asparagus
It is important for the client to consume a balanced diet that includes a variety of fruits, vegetables, whole grains, and lean protein sources.