A patient with severe anemia reports feeling lightheaded when getting up to use the bathroom. Which intervention protects the patient from injury?
Institute fall precautions and assist with getting up
✓
Encourage the patient to walk alone to build strength
Keep the bed in its highest position
Limit fluids to reduce trips to the bathroom
Correct Answer
Institute fall precautions and assist with getting up
Anemia reduces oxygen delivery to the brain and can cause dizziness when the patient stands, so fall precautions and help with getting up protect the patient. Encourage the patient to walk alone to build strength raises the risk of a fall while symptoms persist. Keep the bed in its highest position makes any fall more dangerous; the bed belongs in its lowest position. Limit fluids to reduce trips to the bathroom can cause dehydration and worsen lightheadedness.
Category: Anemias
Question 2
Which instruction helps a patient with iron-deficiency anemia absorb more iron from an oral supplement?
Take it with a glass of milk
Take it with orange juice
✓
Take it with an antacid
Take it with a calcium tablet
Correct Answer
Take it with orange juice
Vitamin C in orange juice keeps iron in a form the intestine absorbs more easily. Take it with a glass of milk reduces absorption because calcium in dairy interferes with iron uptake. Take it with an antacid lowers stomach acid, which iron needs for absorption. Take it with a calcium tablet also blocks iron absorption, so the two are separated.
Category: Anemias
Question 3
A patient with severe anemia becomes short of breath and exhausted while bathing. Which intervention does the nurse include in the plan of care?
Encourage brisk walks in the hallway
Limit fluid intake to reduce effort
Plan rest periods between activities
✓
Keep the patient flat to save energy
Correct Answer
Plan rest periods between activities
Anemia lowers the oxygen delivered to tissues, so spacing activities with rest periods limits fatigue and dyspnea while the cause is treated. Encourage brisk walks in the hallway increases oxygen demand the patient cannot meet. Limit fluid intake to reduce effort has no benefit and can cause dehydration. Keep the patient flat to save energy does not improve oxygenation and makes breathing harder.
Category: Anemias
Question 4
Which statement by a patient with sickle cell disease shows understanding of how to prevent a crisis?
I will plan my next vacation at high altitude.
I can skip my vaccines while I feel well.
I will push through hard workouts when I am tired.
I will drink plenty of fluids every day.
✓
Correct Answer
I will drink plenty of fluids every day.
Staying well hydrated keeps the blood less viscous and helps prevent red cells from sickling and blocking small vessels. I will plan my next vacation at high altitude raises the risk because lower oxygen promotes sickling. I can skip my vaccines while I feel well is unsafe because infection is a common crisis trigger. I will push through hard workouts when I am tired increases oxygen demand, another known trigger.
Category: Sickle Cell and Thalassemia
Question 5
Why is the reticulocyte count elevated in a patient with sickle cell disease?
The marrow releases more young red cells to replace those destroyed
✓
The spleen stores extra mature red cells for later release
Excess dietary iron speeds up red cell maturation
Sickled cells survive longer than normal red cells
Correct Answer
The marrow releases more young red cells to replace those destroyed
Sickled cells are destroyed early, so the bone marrow compensates by releasing more immature red cells into the blood. The spleen stores extra mature red cells for later release does not describe a rising count of immature cells. Excess dietary iron speeds up red cell maturation is not the mechanism. Sickled cells survive longer than normal red cells is the opposite of what happens; their life span is shortened.
Category: Sickle Cell and Thalassemia
Question 6
A patient with beta-thalassemia receives regular transfusions. The nurse monitors iron studies to detect which complication?
Iron deficiency
Iron overload
✓
Vitamin K deficiency
Folate toxicity
Correct Answer
Iron overload
Each unit of red cells adds iron that the body cannot excrete, so frequent transfusions lead to iron overload that can damage the heart and liver; chelation therapy binds the excess iron. Iron deficiency is not the concern with repeated transfusions. Vitamin K deficiency affects clotting, not iron studies. Folate toxicity is not a recognized risk; folate supplements are often given to support red cell production.
Category: Sickle Cell and Thalassemia
Question 7
A patient with polycythemia vera reports intense itching. Which self-care measure does the nurse recommend?
Take long, hot baths to soothe the skin
Scrub the skin with a stiff brush
Take cool showers and apply moisturizer
✓
Apply an alcohol-based lotion
Correct Answer
Take cool showers and apply moisturizer
Itching in polycythemia vera is linked to histamine release, and cool showers with moisturizer are recommended nonpharmacologic measures. Take long, hot baths to soothe the skin tends to worsen the itching. Scrub the skin with a stiff brush damages the skin and invites infection. Apply an alcohol-based lotion dries the skin and increases irritation.
Category: Polycythemia
Question 8
Which patient is at greatest risk for secondary polycythemia?
A patient with heavy menstrual bleeding
A patient receiving chemotherapy for leukemia
A patient with an autoimmune platelet disorder
A patient with chronic lung disease and long-term hypoxemia
✓
Correct Answer
A patient with chronic lung disease and long-term hypoxemia
Chronic hypoxemia prompts the kidneys to release more erythropoietin, which drives the marrow to make extra red cells as an adaptive response. A patient with heavy menstrual bleeding is at risk for iron-deficiency anemia. A patient receiving chemotherapy for leukemia is at risk for marrow suppression and low counts. A patient with an autoimmune platelet disorder has low platelets, not excess red cells.
Category: Polycythemia
Question 9
A patient with long-term heavy alcohol use has easy bruising and frequent nosebleeds. Which explanation for the low platelet count is correct?
Alcohol suppresses the marrow, and liver damage lowers thrombopoietin
✓
Alcohol triggers antibodies against heparin and platelets
Alcohol makes the kidneys release too much erythropoietin
Alcohol converts platelets into extra red blood cells
Correct Answer
Alcohol suppresses the marrow, and liver damage lowers thrombopoietin
Chronic alcohol use impairs bone marrow production of platelets, and the damaged liver makes less thrombopoietin, the hormone that stimulates platelet production; nutritional deficiencies and an enlarged spleen that traps platelets can add to the problem. Alcohol triggers antibodies against heparin and platelets describes heparin-induced thrombocytopenia. Alcohol makes the kidneys release too much erythropoietin is not a recognized effect. Alcohol converts platelets into extra red blood cells is not possible because platelets and red cells develop from separate lines.
Category: Thrombocytopenia
Question 10
A patient with severe thrombocytopenia slips and strikes the head on the bathroom floor but says they feel fine. What does the nurse anticipate?
Observation only, since the patient feels fine
A head CT to rule out intracranial bleeding
✓
A skull x-ray to look for a fracture
A lumbar puncture to check the spinal fluid
Correct Answer
A head CT to rule out intracranial bleeding
With very few platelets, even a minor head injury can cause intracranial bleeding that is not apparent at first, so a head CT is warranted. Observation only, since the patient feels fine could miss a slowly developing bleed. A skull x-ray to look for a fracture cannot show bleeding in the brain. A lumbar puncture to check the spinal fluid is invasive, risks bleeding at the puncture site and is not the way to look for a brain bleed.
Category: Thrombocytopenia
Question 11
Which activity does the nurse teach a patient with chronic immune thrombocytopenic purpura to avoid?
Walking on a treadmill
Doing gentle yoga
Playing American football
✓
Riding a stationary bike
Correct Answer
Playing American football
Contact sports carry a high risk of trauma that can cause serious bleeding when platelets are low, so they are avoided. Walking on a treadmill is low-impact exercise that is generally safe. Doing gentle yoga carries little risk of injury. Riding a stationary bike is a low-impact activity without falls or collisions.
Category: Thrombocytopenia
Question 12
Why may a patient with severe neutropenia have an infection without the redness, swelling or pus that would usually appear?
Earlier antibiotics have hidden every sign of infection
Neutropenia raises the body's resistance to bacteria
A high platelet count prevents tissue swelling
Too few neutrophils are present to mount an inflammatory response
✓
Correct Answer
Too few neutrophils are present to mount an inflammatory response
Pus and much of local inflammation come from neutrophils, so when they are scarce an infection can progress with few visible signs, and fever may be the main clue. Earlier antibiotics have hidden every sign of infection is not the reason the classic signs are missing. Neutropenia raises the body's resistance to bacteria is the opposite of the truth. A high platelet count prevents tissue swelling is incorrect, and platelets do not control inflammation this way.
Category: Neutropenia
Question 13
A patient on bed rest after abdominal surgery has no signs of a clot. Which nursing action helps prevent deep vein thrombosis?
Encourage frequent active leg and ankle exercises
✓
Place a pillow under both knees
Limit oral fluids to reduce edema
Keep the legs as still as possible
Correct Answer
Encourage frequent active leg and ankle exercises
Active leg and ankle exercises make the calf muscles pump blood through the deep veins, countering the venous stasis of bed rest. Place a pillow under both knees compresses the veins behind the knee and slows flow. Limit oral fluids to reduce edema promotes dehydration, which thickens the blood; adequate hydration is encouraged instead. Keep the legs as still as possible worsens stasis, since immobility is a major risk factor for clots.
Category: Thrombotic Disorders
Question 14
A patient on prolonged bed rest suddenly develops sharp chest pain on inspiration, shortness of breath and anxiety. Which nursing action is a priority?
Place the patient flat with the legs elevated
Raise the head of the bed and apply oxygen
✓
Encourage the patient to cough forcefully
Massage both legs to improve circulation
Correct Answer
Raise the head of the bed and apply oxygen
These findings suggest a pulmonary embolism, so the nurse supports oxygenation by applying oxygen and positioning the patient in high Fowler's, then notifies the provider. Place the patient flat with the legs elevated makes breathing harder. Encourage the patient to cough forcefully does not treat a blocked pulmonary artery. Massage both legs to improve circulation could dislodge more clot.
Category: Thrombotic Disorders
Question 15
In disseminated intravascular coagulation, why does the patient bleed even though clots are forming throughout the body?
The liver suddenly stops making all plasma proteins
Antibodies destroy only the red blood cells
Clotting factors and platelets are used up faster than they are made
✓
Excess vitamin K blocks the clotting cascade
Correct Answer
Clotting factors and platelets are used up faster than they are made
In disseminated intravascular coagulation, triggers such as sepsis or trauma overactivate clotting, and widespread clot formation consumes platelets and clotting factors, leaving too few to stop bleeding. The liver suddenly stops making all plasma proteins does not describe this process. Antibodies destroy only the red blood cells describes autoimmune hemolysis. Excess vitamin K blocks the clotting cascade is incorrect because vitamin K supports clotting factor production.
Category: Thrombotic Disorders
Question 16
During bedside verification, the nurse finds that a patient with type A blood is about to receive a red cell unit labeled type B. What does the nurse do?
Start the unit slowly and watch for a reaction
Give a premedication and then start the unit
Start the unit because the vital signs are stable
Do not hang the unit and notify the blood bank
✓
Correct Answer
Do not hang the unit and notify the blood bank
A patient with type A blood has anti-B antibodies that would destroy type B red cells and cause an acute hemolytic reaction, so the unit is not started and the blood bank is contacted to resolve the discrepancy. Start the unit slowly and watch for a reaction still exposes the patient to incompatible cells, and even a small volume can cause harm. Give a premedication and then start the unit cannot stop antibodies from destroying incompatible cells. Start the unit because the vital signs are stable ignores the mismatch, since stable vital signs do not make incompatible blood safe.
Category: Blood Products and Transfusion
Question 17
Which patient receiving packed red blood cells is at greatest risk for transfusion-associated circulatory overload?
An older adult with heart failure
✓
A young adult with bleeding from trauma
A teenager recovering from a broken wrist
A young adult recovering from appendectomy
Correct Answer
An older adult with heart failure
Circulatory overload occurs when the volume infused exceeds what the heart can handle, so an older adult with heart failure is at greatest risk and may need a slower rate or a diuretic. A young adult with bleeding from trauma has lost volume and usually tolerates rapid replacement. A teenager recovering from a broken wrist has normal cardiac function. A young adult recovering from appendectomy also has no condition limiting fluid tolerance.
Category: Blood Products and Transfusion
Question 18
Which blood product carries the highest risk of bacterial contamination because it is stored at room temperature?
Packed red blood cells
Platelets
✓
Fresh frozen plasma
Cryoprecipitate
Correct Answer
Platelets
Platelets are kept at room temperature to preserve their function, which allows bacteria to grow, so they are the product most linked to septic transfusion reactions. Packed red blood cells are refrigerated. Fresh frozen plasma is stored frozen. Cryoprecipitate is also stored frozen.
Category: Blood Products and Transfusion
Question 19
A patient with severe neutropenia is being admitted. Which room assignment is appropriate?
A shared room with a patient who has influenza
A shared room with a patient who has a wound infection
A private room away from patients with infections
✓
A hallway bed near the nurses' station
Correct Answer
A private room away from patients with infections
A patient with severe neutropenia needs a private room away from patients with infections to limit exposure to pathogens. A shared room with a patient who has influenza exposes the patient to a contagious virus. A shared room with a patient who has a wound infection risks transfer of bacteria. A hallway bed near the nurses' station exposes the patient to heavy traffic and many sources of infection.
Category: Neutropenia
Question 20
Which blood product is given to replace clotting factors in a bleeding patient with liver disease?
Packed red blood cells
Albumin
Granulocytes
Fresh frozen plasma
✓
Correct Answer
Fresh frozen plasma
Fresh frozen plasma contains the clotting factors that a diseased liver fails to make, so it corrects the coagulation deficiency. Packed red blood cells restore oxygen-carrying capacity but contain few clotting factors. Albumin expands plasma volume but does not supply clotting factors. Granulocytes are white cells given for severe infection with neutropenia.
Category: Blood Products and Transfusion