Chapter 16, Care of Patients with Hematologic Disorders: Therapies Frequently Used in the Management of Hematologic Disorders

Question 1 of 9

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Which type of blood transfusion problem would the nurse associate with a patient experiencing jugular venous distention, cough, dyspnea, and tachycardia?

• • SepsisSepsis involves signs and symptoms such as the rapid onset of chills, high fever, vomiting, diarrhea, marked hypotension, or shock.
• Correct
  • Circulatory overloadJugular venous distention, cough, dyspnea, and tachycardia are associated with circulatory overload.
• • Anaphylactic reactionAnaphylactic reaction signs and symptoms include anxiety, urticaria, and wheezing with progression to cyanosis, shock, and possible cardiac arrest.
• • Allergic reactionA patient experiencing an allergic reaction would have itching, hives, and potentially, an anaphylactic reaction.

Question 2 of 9

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Which is an appropriate action for a licensed practical nurse (LPN) to take when asked by a registered nurse (RN) to verify a unit of packed red blood cells before administration?

• • Locate another RN for the verification process.This may not be necessary depending on facility’s policy and the training of the LPN.
• • Inform the RN that blood verification is outside the scope of practice for an LPN.LPNs may be able to verify blood depending on the facility’s policy and training.
• • Report to the patient’s bedside to assist the RN with the verification process.Assisting with verification may be against policy depending on state laws and facilities.
• Correct
  • Consult the organization’s policy regarding license requirements for blood verification.LPNs may be able to verify blood depending on policy and training.

Question 3 of 9

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The nurse suspects which complication when an 82-year-old patient who is receiving a blood transfusion develops hypertension, dyspnea, and distended jugular veins?

• • Allergic reactionSymptoms of an allergic reaction are itching and urticaria.
• Correct
  • Fluid overloadFluid overload is a potential complication from a blood transfusion in older adults. It presents with hypertension, dyspnea, and swollen veins.
• • Acute hemolytic reactionClinical manifestations of an acute hemolytic reaction include chills, fever, low back pain, flushing, tachycardia, tachypnea, hypotension, and dark urine.
• • Bacterial contaminationChills and fever, nausea, vomiting, tachycardia, dyspnea, hypotension, and shock are indications of bacterial contamination.

Question 4 of 9

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The nurse expects that which medication will be listed on the treatment plan of a patient who is scheduled to receive packed red blood cells (pRBCs) and has a history of fever and chills with previous transfusions?

• • Give furosemide if pulmonary congestion occurs.The goal is to prevent a reaction; a diuretic will not prevent a reaction. It may be used to treat circulatory overload.
• • Provide aspirin if temperature rises 2 degrees about the starting temperature during the transfusion.The goal is to prevent a reaction; aspirin will not prevent a reaction.
• • Administer Solu-Medrol between transfusions.Solu-Medrol is a steroid and will not prevent a reaction.
• Correct
  • Administer acetaminophen prior to transfusion.Premedication with acetaminophen and diphenhydramine is the most commonly used approach to reduce the incidence of a hemolytic reaction.

Question 5 of 9

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Which nursing response is appropriate when a sibling of a patient with cancer volunteers to donate bone marrow?

• • “I will begin the process for you to make your donation.”Testing is necessary before a potential bone marrow donation can be made.
• Correct
  • “You will need to be tested for potential matching. Even siblings do not always match.”Even siblings are only able to provide matching bone marrow approximately 25% of the time.
• • “I recommend that you give much thought into that decision. Your sibling may be hesitant to receive your donation.”It is evident that the family member has already given thought into the decision. It is not appropriate for the nurse to state that the patient may be hesitant for receive the donation; there are many factors that impact this type of donation. .
• • “You should discuss this with your health care provider to receive more information.”Deflecting all questions to the health care provider is not appropriate. There is information the nurse can provide to the family member.

Question 6 of 9

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Which nursing response is appropriate when a patient with gastrointestinal bleeding asks, “Why can’t I take my iron supplement by mouth?”

• • “The intravenous (IV) administration will build up your red blood cell counts much faster.”IV administration may work faster, but that is not the primary reason it would be given to this patient.
• • “You will not be able to absorb the oral administration because of your gastrointestinal (GI) bleeding.”GI bleeding would not prevent absorption of oral iron.
• Correct
  • “The oral administration may cause further gastric irritation.”Oral administration of iron could further exacerbate conditions such as gastrointestinal bleeding.
• • “IV administration of iron will prevent a reaction.”IV administration of iron can cause significant reactions.

Question 7 of 9

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Which intervention may be included on a list of treatments that a home care nurse could provide to a patient with leukemia? Select all that apply. One, some, or all responses may be correct.

• Correct
  • Provide education regarding infection prevention.Education regarding infection prevention is an important responsibility of the home care nurse.
• Correct
  • Administer some chemotherapy products.Chemotherapy is administered at home and monitored by home care nurses for patients with leukemia.
• Correct
  • Administer blood products.Blood products can sometimes be administered in the home setting.
• Correct
  • Draw pertinent labs.Home care nurses frequently obtain lab specimens.
• Correct
  • Provide education about nutrition choices.Teaching about nutrition choices is an intervention that could be performed by a home care nurse.
• • Prescribe new medications.Home care nurses are typically unable to prescribe medications. This would fall under the practice of advanced practice providers or physicians.

Question 8 of 9

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Which dietary recommendation would the nurse make when a patient with nutritional anemia asks, “How can I increase my protein intake?”

• • “Add water to hot or cold cereal.”Adding dry skim milk to hot or cold cereal may help increase protein.
• Correct
  • “Add dry skim milk to scrambled eggs.”Adding dry skim milk to scrambled eggs is a way to add protein to the diet.
• • “Eat apples or celery for snacks.”Adding peanut butter to apple or celery for snacks may help increase protein intake.
• • “Increase the intake of green leafy vegetables such as kale.”Kale is a good source of calcium. Vegetables with the most protein include broccoli, spinach, asparagus, artichokes, potatoes, sweet potatoes, and Brussels sprouts.

Question 9 of 9

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The nurse would recommend which nutrient to enhance the effect of iron therapy in a patient with anemia?

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  • Vitamin CVitamin C usually is given with iron because it enhances iron’s absorption.
• • Vitamin B₁₂Vitamin B₁₂ is administered to treat megaloblastic anemia, not to improve the efficacy of iron therapy.
• • Folic acidFolic acid is a B-group vitamin that is needed for red blood cell maturation, but it is not administered to increase efficacy of iron therapy.
• • ProteinPatients receiving Vitamin B₁₂ therapy should consume a high-protein diet.