AMSN Hematological and Oncological Nursing 2 — Questions and Answers
Question 1: A patient with iron-deficiency anemia is prescribed ferrous sulfate. Which instruction should the nurse include?
- Take the medication with milk to reduce GI upset
- Take the medication with orange juice on an empty stomach (Correct answer)
- Take the medication with antacids to improve absorption
- Take the medication at bedtime to avoid daytime nausea
Correct answer: Take the medication with orange juice on an empty stomach
Vitamin C (ascorbic acid) in orange juice enhances iron absorption, and taking ferrous sulfate on an empty stomach maximizes uptake despite potential GI discomfort.
Question 2: Which assessment finding is an EARLY sign of tumor lysis syndrome (TLS)?
- Hypercalcemia and hypokalemia
- Hyperkalemia, hyperphosphatemia, and hyperuricemia (Correct answer)
- Hypoglycemia and metabolic alkalosis
- Hyponatremia and hypochloremia
Correct answer: Hyperkalemia, hyperphosphatemia, and hyperuricemia
TLS occurs when tumor cells rapidly lyse and release intracellular contents, causing hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia.
Question 3: A patient receiving heparin therapy has a platelet count that dropped from 240,000 to 62,000/mm³ over 5 days. What condition does the nurse suspect?
- Idiopathic thrombocytopenic purpura (ITP)
- Heparin-induced thrombocytopenia (HIT) (Correct answer)
- Disseminated intravascular coagulation (DIC)
- Aplastic anemia
Correct answer: Heparin-induced thrombocytopenia (HIT)
A significant platelet drop (>50%) occurring 5–10 days after heparin initiation is the hallmark of HIT, an immune-mediated complication requiring immediate cessation of all heparin products.
Question 4: The nurse is educating a patient newly diagnosed with polycythemia vera. Which statement reflects accurate understanding of the condition?
- 'My bone marrow is producing too few red blood cells.'
- 'I need to drink more fluids and may need phlebotomy to reduce my blood thickness.' (Correct answer)
- 'I should avoid all physical activity to prevent bleeding.'
- 'This condition means I am at lower risk for blood clots.'
Correct answer: 'I need to drink more fluids and may need phlebotomy to reduce my blood thickness.'
Polycythemia vera involves overproduction of RBCs, increasing blood viscosity and clot risk; phlebotomy and hydration are key management strategies.
Question 5: A patient with non-Hodgkin's lymphoma is starting rituximab infusion. Which adverse effect should the nurse monitor for MOST closely during the infusion?
- Hypoglycemia and diaphoresis
- Infusion-related reaction including fever, chills, and hypotension (Correct answer)
- Severe constipation and ileus
- Pulmonary edema and decreased urine output
Correct answer: Infusion-related reaction including fever, chills, and hypotension
Rituximab commonly causes infusion-related reactions (fever, chills, rigors, hypotension) especially during the first infusion, requiring close monitoring and slowing or stopping the infusion if reactions occur.
Question 6: When caring for a patient with pernicious anemia, which finding confirms this diagnosis over other types of anemia?
- Low serum iron and elevated TIBC
- Decreased intrinsic factor and low serum vitamin B12 (Correct answer)
- Elevated reticulocyte count and jaundice
- Microcytic hypochromic red blood cells on smear
Correct answer: Decreased intrinsic factor and low serum vitamin B12
Pernicious anemia is caused by the absence of intrinsic factor, which is required for vitamin B12 absorption, resulting in megaloblastic anemia and neurological deficits.
Question 7: A patient with acute myeloid leukemia (AML) asks why they need a bone marrow biopsy. What is the BEST nursing response?
- 'It is a routine screening test used in all cancer patients.'
- 'It helps confirm the diagnosis and identify the specific leukemia cell type to guide treatment.' (Correct answer)
- 'It will determine how well your kidneys are functioning.'
- 'It replaces the need for a CT scan in your case.'
Correct answer: 'It helps confirm the diagnosis and identify the specific leukemia cell type to guide treatment.'
Bone marrow biopsy is essential to confirm AML, classify the disease subtype, and guide treatment planning with chemotherapy regimens.
AMSN Hematological and Oncological Nursing 2
A patient with iron-deficiency anemia is prescribed ferrous sulfate.
Which instruction should the nurse include?