AMSN Hematological and Oncological Nursing 1 — Questions and Answers
Question 1: A patient receiving chemotherapy develops a neutrophil count of 400 cells/mm³. Which intervention is the HIGHEST priority?
- Administer prophylactic antiemetics
- Initiate neutropenic precautions and reverse isolation (Correct answer)
- Encourage oral fluid intake
- Obtain a routine CBC in 24 hours
Correct answer: Initiate neutropenic precautions and reverse isolation
A neutrophil count below 500 cells/mm³ indicates severe neutropenia, and reverse isolation (protective precautions) is the priority to prevent life-threatening infection.
Question 2: Which assessment finding is MOST consistent with a patient experiencing sickle cell crisis?
- Bradycardia and hypotension
- Severe localized bone pain and fever (Correct answer)
- Petechiae and prolonged bleeding
- Jaundice and elevated platelet count
Correct answer: Severe localized bone pain and fever
Vaso-occlusive (painful) sickle cell crisis causes severe bone and joint pain due to microvascular obstruction, often accompanied by fever.
Question 3: A nurse is caring for a patient with thrombocytopenia (platelet count 18,000/mm³). Which action should the nurse AVOID?
- Applying firm pressure after venipuncture
- Administering stool softeners
- Administering aspirin for headache (Correct answer)
- Using a soft-bristled toothbrush
Correct answer: Administering aspirin for headache
Aspirin inhibits platelet aggregation and is contraindicated in thrombocytopenia because it further increases the risk of serious bleeding.
Question 4: A patient is receiving a blood transfusion and develops chills, fever, and back pain 15 minutes after initiation. What is the FIRST nursing action?
- Slow the infusion rate and notify the provider
- Stop the transfusion and keep the IV line open with normal saline (Correct answer)
- Administer acetaminophen and continue the transfusion
- Draw blood cultures and continue monitoring
Correct answer: Stop the transfusion and keep the IV line open with normal saline
Stopping the transfusion immediately while maintaining IV access with normal saline is the priority to prevent further exposure to incompatible blood products.
Question 5: Which laboratory value requires IMMEDIATE intervention in a patient with multiple myeloma?
- Hemoglobin 10.2 g/dL
- Serum calcium 13.8 mg/dL (Correct answer)
- BUN 24 mg/dL
- Platelet count 150,000/mm³
Correct answer: Serum calcium 13.8 mg/dL
A serum calcium of 13.8 mg/dL indicates hypercalcemia, a serious complication of multiple myeloma that can cause cardiac dysrhythmias, altered mental status, and renal failure.
Question 6: A patient with leukemia is being discharged after chemotherapy. Which statement by the patient indicates a need for FURTHER teaching?
- 'I will wash my hands frequently throughout the day.'
- 'I will avoid fresh fruits and salads until my counts recover.'
- 'I can visit my grandchildren even if they have a cold; they need me.' (Correct answer)
- 'I will take my temperature daily and report a reading above 100.4°F.'
Correct answer: 'I can visit my grandchildren even if they have a cold; they need me.'
Immunocompromised patients must avoid contact with individuals who have infections, including minor colds, as these can be life-threatening when neutropenic.
Question 7: Which finding is characteristic of disseminated intravascular coagulation (DIC)?
- Elevated fibrinogen and decreased D-dimer
- Prolonged PT, prolonged aPTT, and elevated D-dimer (Correct answer)
- Thrombocytosis and shortened bleeding time
- Decreased PT with elevated fibrinogen levels
Correct answer: Prolonged PT, prolonged aPTT, and elevated D-dimer
DIC involves consumption of clotting factors and platelets, resulting in prolonged PT and aPTT, thrombocytopenia, low fibrinogen, and elevated D-dimer from fibrinolysis.
AMSN Hematological and Oncological Nursing 1
A patient receiving chemotherapy develops a neutrophil count of 400 cells/mm³.
Which intervention is the HIGHEST priority?