Hematology Questions and Answers
(NLE 1-5)

Hematology Questions and Answers

1. The nurse is teaching a client with pernicious anemia who requires vitamin B12 replacement therapy. Which statement indicates that the client understands the treatment program

a. "I'll swallow one vitamin B12 pill every morning for 2 weeks."
b. "I'll take a vitamin B12 pill once each month for life."
c. "I'll need an injection of vitamin B12 every month for life."
d. "I'll only need daily injections of vitamin B12 until my blood count improves."

2. A client who is receiving cyclosporine (Sandimmune) must practice good oral hygiene, including regular brushing and flossing of the teeth, to minimize gingival hyperplasia. Good oral hygiene also is essential to minimize gingival hyperplasia during long-term therapy with certain drugs. Which of the following drugs falls into this category?

a. procainamide (Pronestyl)
b. azathioprine (Imuran)
c. phenytoin (Dilantin)
d. allopurinol (Zyloprim)

3. Hematology questions and answers about the nurse who is caring for a 32-year-old client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client?

a. Pallor, bradycardia, and reduced pulse pressure
b. Pallor, tachycardia, and a sore tongue
c. Sore tongue, dyspnea, and weight gain
d. Angina, double vision, and anorexia

4. Which nursing diagnosis should the nurse expect to see in a plan of care for a client in sickle cell crisis?

a. Imbalanced nutrition: Less than body requirements related to poor intake
b. Disturbed sleep pattern related to external stimuli
c. Impaired skin integrity related to pruritus
d. Pain related to sickle cell crisis

5. A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The physician begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption?

a. Intrinsic factor
b. Hydrochloric acid
c. Histamine
d. Liver enzyme

Hematology Questions and Answers with Rationale

1) C
- In pernicious anemia, the gastric mucosa doesn't secrete intrinsic factor, a protein necessary for vitamin B12 absorption. Without intrinsic factor, vitamin B12 replacements taken orally won't be absorbed; therefore, vitamin B12 must be administered through the I.M. or deep subcutaneous routes. Clients must take vitamin B12 each day for 2 weeks initially, then weekly for several months, then once each month for life.

2) C
- Gingival hyperplasia may occur with long-term administration of phenytoin, an anticonvulsant. This adverse effect presumably is dose related. Frequent toothbrushing removes food particles and helps prevent infection; regular dental care and frequent gum massage also are recommended. Gingival hyperplasia isn't a reported adverse effect of procainamide, azathioprine, or allopurinol.

3) B
- Hematology Questions and Answers for number 3 is B - Pallor, tachycardia, and a sore tongue are all characteristic findings in pernicious anemia. Other clinical manifestations include anorexia; weight loss; a smooth, beefy red tongue; a wide pulse pressure; palpitations; angina; weakness; fatigue; and paresthesia of the hands and feet. Bradycardia, reduced pulse pressure, weight gain, and double vision aren't characteristic findings in pernicious anemia.

4) D
- In sickle cell crisis, sickle-shaped red blood cells clump together in a blood vessel, which causes occlusion, ischemia, and extreme pain. Therefore, option D is the appropriate choice. Although nutrition is important, poor nutritional intake isn't necessarily related to sickle cell crisis. During sickle cell crisis, pain or another internal stimulus is more likely to disturb the client's sleep than external stimuli. Although clients with sickle cell anemia can develop chronic leg ulcers caused by small vessel blockage, they don't typically experience pruritus.

5) A
- Vitamin B12 absorption depends on intrinsic factor, which is secreted by parietal cells in the stomach. The vitamin binds with intrinsic factor and is absorbed in the ileum. Hydrochloric acid, histamine, and liver enzymes don't influence vitamin B12 absorption.

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