Hematology, Immunology & Oncology 1.

The blood cells that transport oxygen and carbon dioxide to and from body tissues are: A. RBCs. B. WBCs. C. platelets. D. granulocytes. Answer: A. RBCs transport oxygen and carbon dioxide. Because of their biconcave shape, they have the flexibility to travel through blood vessels of different sizes. 2. A patient with blood type B can receive a transfusion of: A. type A or type O blood. B. type B or type O blood. C. type AB or type O blood. D. type A or type B. Answer: B. Type B blood contains B antigens and anti-A antibodies, but no anti-B antibodies. Therefore, a patient with type B blood can receive type B or type O blood (which contains neither anti-A nor anti-B antibodies). 3. Which type of anemia results from deficiency of all the bloods formed elements, caused by failure of the bone marrow to generate enough new cells? A. Sickle cell anemia B. Folic acid deficiency anemia C. Aplastic anemia D. Iron deficiency anemia Answer: C. Aplastic anemia usually develops when damaged or destroyed stem cells inhibit RBC production. 4. Which disorder results from a deficiency of circulating platelets? A. Hemophilia B. Sickle cell anemia C. Von Willebrands disease D. Thrombocytopenia Answer: D. Thrombocytopenia, the most common hemorrhagic disorder, results from a deficiency of circulating platelets. 1. If a patient whos allergic to peanut butter eats peanut butter cookies, which antigen-specific immunoglobulin will his body produce? A. IgA B. IgD C. IgE D. IgG Answer: C. IgE is responsible for allergic reactions. 2. The most common anaphylaxis-causing agent is: A. shellfish. B. contrast dye. C. bee venom. D. penicillin. Answer: D. Penicillin is the most common anaphylaxis-causing antigen because of its systemic effects on the body.

3. Asthma is most strongly associated with: A. a family history of asthma. B. a history of anaphylactic reactions. C. high blood pressure. D. a history of frequent upper respiratory infections. Answer: A. About one-third of asthmatics share the condition with at least one member of their immediate family, and threefourths of children with two asthmatic parents also have asthma. 4. In most cases, the treatment of choice for SLE is: A. antibiotics. B. antifungals. C. corticosteroids. D. cyclosporine. Answer: C. Corticosteroids are the treatment of choice for systemic symptoms of SLE. 1. Reed-Sternberg cells are associated with: A. prostate cancer. B. malignant melanoma. C. Hodgkin disease. D. multiple myeloma. Answer: C. The diagnosis of Hodgkin disease hinges on the presence of Reed-Sternberg cells. 2. According to the ACS, how often should a woman have a mammogram? A. Once every 3 years starting at age 21 B. Once a year starting at age 35 C. Every 5 years starting at age 30 D. Once a year starting at age 40 Answer: D. The ACS recommends a yearly mammogram for all women age 40 and older. 3. One risk factor for prostate cancer is: A. a history of infertility. B. poverty. C. being between ages 15 and 34. D. being older than age 40. Answer: D. Prostate cancer seldom develops before age 40. Socioeconomic status and infertility dont appear to affect the risk of this cancer. 4. The leading cause of cancer death in women is: A. breast cancer. B. lung cancer. C. cervical cancer. D. ovarian cancer. Answer: B. Lung cancer is the second most common cancer among females in the United States (after breast cancer) and is the leading cause of cancer death in women. 5. Which medication is used to treat RA? A. Aspirin B. Acetominophen (Tylenol) C. Calcitonin D. Etidronate (Didronel)

Answer: A. Salicylates, particularly aspirin, provide the mainstay of RA therapy because they decrease inflammation and relieve joint pain.
1. A client with major abdominal trauma needs an emergency blood transfusion. The clients blood type is AB negative. Of the blood types available, the safest type for the nurse to administer is: 1. AB positive. 2. A positive. 3. B negative. 4. O positive. Answer: 3. Individuals with AB negative blood (AB type, Rh negative) can receive A negative, B negative, and AB negative blood. Its unsafe to give Rh-positive blood to an Rh-negative person. 2. A nurse is preparing a client with systemic lupus erythematosus for discharge. Which instructions should the nurse include in the teaching plan? 1. Exposure to sunlight will help control skin rashes. 2. There are no activity limitations between flare-ups. 3.Monitor body temperature. 4. Corticosteroids may be stopped when symptoms are relieved. Answer: 3. The client should monitor his temperature because fever can signal an exacerbation and should be reported to the physician. Sunlight and other sources of ultraviolet light may precipitate severe skin reactions and exacerbate the disease. Fatigue can cause a flare-up of systemic lupus erythematosus, and clients should be encouraged to pace activities and plan for rest periods. Corticosteroids must be gradually tapered because they can suppress the function of the adrenal gland. Abruptly stopping corticosteroids can cause adrenal insufficiency, a potentially life-threatening situation. 3. The nurse is administering didanosine (Videx) to a client with acquired immunodeficiency syndrome. Which intervention is most appropriate? 1. Crushing the tablets and mixing them with fruit juice 2. Instructing the client to swallow the tablets whole with water 3. Telling the client to chew the tablets thoroughly before swallowing 4. Dissolving the tablets in fruit juice Answer: 3. Didanosine is an antiretroviral

drug (reverse transcriptase inhibitor) thats given to treat human immunodeficiency virus infections. Didanosine tablets contain buffers that raise stomach pH to levels that prevent degradation of the active drug. Tablets must be chewed thoroughly before swallowing. They may also be crushed and mixed with water. They shouldnt be added to fruit juices or other acidic liquids. Tablets may be dispersed in a nonacidic liquid for administration. Didanosine tablets arent taken whole. 4. A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to: 1. lie supine with his neck extended. 2. sit upright, leaning slightly forward. 3. blow his nose and then put lateral pressure on his nose. 4. hold his nose while bending forward at the waist. Answer: 2. The upright position, leaning slightly forward, avoids increasing the vascular pressure in the nose and helps the client avoid aspirating blood. Lying supine wont prevent aspiration of the blood. Nose blowing can dislodge any clotting that has occurred. Bending at the waist increases vascular pressure in the nose and promotes bleeding rather than halting it. 5. The nurse is preparing to administer iron dextran (Imferon) to a client with iron deficiency anemia. Which action is appropriate? 1. Using a 25G needle 2. Administering a Z-track injection 3. Using the same needle to draw up the solution and to administer the injection 4. Preparing the deltoid site for injection Answer: 2. A Z-track or zig-zag technique should be used to administer an iron injection. This prevents iron from leaking into and irritating the subcutaneous tissue. A 25G needle is used for a subcutaneous injection, not for a deep I.M. injection (such as that needed to administer iron). The needle should be changed after drawing up the iron solution to avoid staining and irritating the tissues. A deep I.M. site such as the upper outer quadrant of the buttocks should be used to administer iron; the deltoid site doesnt provide enough muscle mass for an iron injection. 6. A nurse is reviewing the laboratory report of a client who underwent a bone marrow biopsy. The finding that would most strongly support a diagnosis of acute leukemia is the presence of a large number of immature: 1. monocytes.

2. thrombocytes. 3. basophils. 4. leukocytes. Answer: 4. Leukemia is manifested by an abnormal overproduction of immature leukocytes in the bone marrow. An increased number of monocytes may result from a viral infection. An increased number of basophils may result from an allergic reaction. A large number of thrombocytes indicates polycythemia vera. 7. Which nonpharmacologic interventions should a nurse include in the care plan for a client who has moderate rheumatoid arthritis? Select all that apply. 1. Massaging inflamed joints 2. Avoiding range-of-motion (ROM) exercises 3. Applying splints to inflamed joints 4. Using assistive devices at all times 5. Selecting clothing that has Velcro fasteners 6. Applying moist heat to joints Answer: 3, 5, 6. Supportive, nonpharmacologic measures for a client with rheumatoid arthritis include applying splints to rest inflamed joints, choosing clothes with Velcro fasteners to aid in dressing, and applying moist heat to joints to relax muscles and relieve pain. Inflamed joints should never be massaged because doing so can aggravate inflammation. A physical therapy program including ROM exercises and carefully individualized therapeutic exercises prevents loss of joint function. Assistive devices should be used only when marked loss of ROM occurs. 8. A nurse is providing care for a client with acquired immunodeficiency syndrome (AIDS) and Pneumocystis pneumonia (PCP). The client is receiving aerosolized pentamidine isethionate (NebuPent). What is the best evidence that the therapy is succeeding? 1. A sudden gain in lost body weight 2. Whitening of lung fields on the chest X-ray 3. Improving client vitality and activity tolerance 4. Afebrile body temperature and development of leukocytosis Answer: 3. Because a common manifestation of PCP is activity intolerance and loss of vitality, improvements in these areas would suggest success of pentamidine isethionate therapy. Sudden weight gain, whitening of the lung fields on chest X-ray, and leukocytosis arent evidence of therapeutic success. 9. A nurse is documenting her care for

a client with iron deficiency anemia. Which nursing diagnosis is most appropriate? 1. Impaired gas exchange 2. Deficient fluid volume 3. Ineffective airway clearance 4. Ineffective breathing pattern Answer: 1. Hemoglobin is responsible for oxygen transport in the body. Iron is necessary for hemoglobin synthesis. Iron deficiency anemia causes subnormal hemoglobin levels, which impair tissue oxygenation and impair gas exchange. Iron deficiency anemia doesnt cause deficient fluid volume and is less directly related to ineffective airway clearance and breathing pattern than it is to impaired gas exchange. 10. A nurse is administering cyanocobalamin (vitamin B12) to a client with pernicious anemia, secondary to gastrectomy. Which administration route should the nurse use? 1. Topical route 2. Transdermal route 3. Enteral route 4. Parenteral route Answer: 4. Following a gastrectomy, the client no longer has the intrinsic factor available to promote vitamin B12 absorption in his GI tract. Vitamin B12 is administered parenterally (I.M. or deep subcutaneous). Topical and transdermal administrations arent available, and the enteral route is inappropriate in a gastrectomy. 1. A nurse is taking a history from the mother of a child suspected of having Reye syndrome. The history reveals the use of several medications. Which medication might be implicated in the development of Reye syndrome? 1. Phenytoin (Dilantin) 2. Furosemide (Lasix) 3. Phytonadione 4. Aspirin Answer: 4. Aspirin use has been implicated in the development of Reye syndrome in children with a history of recent acute viral infection. Phenytoin, furosemide, and phytonadione arent associated with the development of Reye syndrome. 2. A 3-year-old child has been hospitalized in a vaso-occlusive crisis. To manage the pain associated with this crisis, the nurse should perform which intervention? 1. Apply moist heat and administer analgesics based on pain assessment. 2. Apply ice compresses to the affected areas and initiate range-of-motion exercises.

3. Elevate the affected areas and administer analgesics. 4. Provide a cooling blanket and administer acetaminophen (Tylenol). Answer: 1. The major clinical feature of sickle cell anemia is pain from a vaso-occlusive crisis. Moist heat is applied to promote tissue oxygenation. Cold should be avoided because it promotes vasoconstriction and sickling. Analgesics should be administered based on the childs pain level, and arent limited to acetaminophen. 3. A nurse is teaching the mother of a child with sickle cell anemia. Which statement by the mother indicates a need for further teaching? 1. My child cant possibly have sickle cell anemia. Hes 4 months old, and he has never been sick before. 2. I know my child should receive a pneumococcal vaccine when the doctor suggests. 3. I know I should call the pediatrician immediately if my child begins to vomit. 4. I know I should try to keep my childs body temperature normal by keeping him away from fluctuations in temperature. Answer: 1. Further teaching is indicated if the mother states that her child cant have sickle cell anemia because hes 4 months old and has never been sick before. Symptoms of sickle cell anemia rarely appear before age 4 months because the predominance of fetal hemoglobin prevents excessive sickling. The child should receive a pneumococcal vaccine when appropriate. The mother should notify the physician if the child vomits so that treatment can be initiated to prevent dehydration, which can precipitate crisis. Changes in body temperature may also trigger crisis and should be avoided. 4. A nurse is teaching a mother about the benefits of breast-feeding her infant. Which type of immunity is passed on to the infant during breast-feeding? 1. Natural immunity 2. Naturally acquired active immunity 3. Naturally acquired passive immunity 4. Artificially acquired active immunity Answer: 3. Naturally acquired passive immunity is received through placental transfer and breast-feeding. Natural immunity is present at birth. Naturally acquired active immunity occurs when the immune system makes antibodies after exposure to disease. Artificially acquired immunity

occurs when medically engineered substances are ingested or injected to stimulate the immune response against a specific disease (immunizations) 5. Which nursing interventions should a nurse anticipate when caring for a child in acute sickle cell crisis? Select all that apply. 1. Maintaining adequate hydration 2. Providing adequate pain control 3. Assessing family education needs 4. Encouraging healthy eating habits 5. Monitoring vital signs frequently 6. Attending to the childs play needs Answer: 1, 2, 5. Because the child is in acute crisis, maintaining adequate hydration, providing pain control, and monitoring vital signs frequently are priority points of care. After the childs condition is stabilized, the nurse can then evaluate family learning needs, encourage healthy eating habits, and attend to the childs play needs. 6. A nurse is providing dietary teaching for the mother of a child with iron deficiency anemia. Which iron-rich foods should the nurse instruct the mother to include in her childs diet? 1. Liver, dark leafy vegetables, and whole grains 2. Dark leafy vegetables, chicken, and whole grains 3. Whole grains, citrus fruit, and yogurt 4. Citrus fruit, liver, and whole grains Answer: 1. The mother should be instructed to give her child iron-rich foods, such as liver, dark leafy vegetables, and whole grains. Chicken is a good source of protein, but it isnt high in iron. Citrus fruits aid iron absorption but arent high in iron. Yogurt is a good source of calcium but isnt high in iron. 7. A nurse is teaching a child with sickle cell anemia and the childs mother about activities that may promote a vaso-occlusive crisis. Which activity is acceptable for this child? 1. Skiing 2. Mountain climbing 3. Deep sea diving 4. Bowling Answer: 4. A child with sickle cell anemia should be instructed to avoid activities that promote a crisis, such as excessive exercise, mountain climbing, or deep sea diving. Extremes in temperature can also promote a crisis, so skiing should be avoided. Mountain

climbing and deep sea diving may expose the child to altered atmospheric pressures and a deoxygenated state. These conditions can lead to a sickle cell crisis 8. A neonate experiences prolonged bleeding after his circumcision and has multiple bruises without petechiae. These assessment findings suggest which condition? 1. Iron deficiency anemia 2. Hemophilia 3. Sickle cell anemia 4. Leukemia Answer: 2. Signs of hemophilia include prolonged bleeding after circumcision, immunizations, or minor injuries; multiple bruises without petechiae; peripheral neuropathies from bleeding near peripheral nerves; bleeding into the throat, mouth, and thorax; and hemarthrosis. Some of the signs associated with iron deficiency anemia include dyspnea on exertion, fatigue, and listlessness. Signs and symptoms associated with sickle cell anemia include pain at the site of occlusion, poor healing of leg wounds, priapism, enuresis, and delayed growth and sexual maturity. Signs and symptoms associated with leuke mia include history of infections, lymph ade nopathy, hematuria, hematemesis, blood in stools, petechiae, and ecchymosis. 9. A child is admitted to the pediatric floor with hemophilia. The nurse encourages fantasy play and participation in his care. This developmental approach is most appropriate for which pediatric age-group? 1. The school-age child (ages 5 to 12) 2. The preschool child (ages 3 to 5) 3. The toddler (ages 1 to 3) 4. The adolescent (ages 12 to 18) Answer: 1. School-age children engage in fantasy play and daydreaming. Therefore, its appropriate for the nurse to encourage this type of play for the hospitalized child. The school-age child is also able to participate in his care. Doll play is helpful for the preschool hospitalized child. The toddler enjoys push-pull toys and games of peek-a-boo. The adolescent can engage in role playing in various situations. 10. A nurse is providing instructions to the parents of an infant recovering from a sickle cell crisis. Which instruction should the nurse include in her teaching? 1. Discontinue administration of all antibiotics. 2. Keep the child isolated from all family members. 3. Restrict the childs nighttime fluids.

4. Make sure you hold the thermometer tightly under the arm. Answer: 4. Infants with sickle cell anemia have altered immune function and are highly susceptible to bacterial sepsis. A fever in a child with sickle cell anemia is a medical emergency that requires prompt evaluation. The child should receive antibiotics until he is at least 5 years old. The infant should be isolated from persons with a known illness, but theres no reason to isolate him from all family members. Hydration is necessary for hemodilution and the prevention of sickling