HEMATOLOGIC DISORDER NCLEX
ACTUAL EXAM QUESTIONS WITH
ALL CORRECT ANSWERS A
GRADED
A patient arrived to the clinic complaining of generalized pruritus and pain in the
extremities. He has a history of diabetes, HTN, dyslipidemia, COPD, and A-fib. His
blood pressure is 155/90. His face is a ruddy color. On palpation of his abdomen, his
spleen is palpable. His blood values indicate a Hgb of 18.5 and Hct of 60%. The nurse
suspects which diagnosis?
A) Polycythemia Vera
B) Multiple Myeloma
C) Thrombocytopenia
D) Secondary Polycythemia - Answer-Answer: D. based on a history of COPD, the
nurse suspects that the polycythemia is based on the secondary cause of chronic
reduced oxygen intake. Other possible causes of secondary polycythemia would include
smoking history, cyanotic heart disease, or even living in a high altitude. There are also
several other causes. If a cause is noted, polycythemia Vera (primary polycythemia) is
ruled out
The patient with polycythemia Vera asks you "Why the **** am I taking aspirin!? I never
needed any medications before!" What is the best response by the nurse?
A) The aspirin is prescribed in order to treat HA, a common symptom of this disease
B) Aspirin has been proven to be effective in preventing all complications of this
disorder
C) This medication will help reduce the burning pain you have in your extremities
D) If I wanted you to ask a question, I would have let you know. Now shut up and take
your pill. - Answer-Answer: C. Aspirin is prescribed to help with erythromelalgia which is
a problem caused by PV which causes warmth, redness, and burning pain in the
extremities. Cool compresses may also help with this problem. It is important to monitor
patients taking aspirin for bleeding because patients with PV are already at an
increased risk for bleeding which could be exacerbated by aspirin use.
You are providing discharge teaching to the patient with polycythemia Vera about
treating pruritus. Which of the following statements indicates the need for further
teaching?
A) A cold ice pack can help relieve some of my itching
B) I will take some Benadryl to help relieve the itching
C) Water will probably make my itching worse rather than help it
, D) My doctor may discuss the use of Interferon with me which could help relieve my
itching - Answer-Answer: B. Use of antihistamines are not effective in relieving pruritus
caused by polycythemia. Cold compresses may help relieve itching (avoid warm or hot).
Water often aggravates pruritus with polycythemia Vera (aquagenic pruritus). Interferon,
a myelosuppressive agent given to high risk patients could help relieve itching.
The nurse is providing teaching to the patient diagnosed with Polycythemia Vera. Which
statement, if made by the patient, indicates the need for further teaching?
A) I need to make sure I stay active to prevent clot formation
B) I guess I will have to stop drinking all my alcohol now. Poop.
C) I should limit my bath time to less than thirty minutes
D) I will need to take an iron supplement to help replace what is taken away by
therapeutic blood draws - Answer-Answer: D. The patient with polycythemia vera should
NEVER take an iron supplement. It will stimulate further RBC production which would
be a negative effect. Staying active to avoid clot formation is important as this is a major
complication of this disorder. Limiting or avoiding alcohol will help minimize risk for
bleeding. Limiting baths will help keep pruritus from being aggravated.
The nurse is taking care of the 73 year old patient with polycythemia vera. The nurse is
most concerned when the patient mentions which of the following?
A) I've had a UTI in the past so I've been drinking cranberry juice to prevent this from
happening again
B) I want to be healthy so I started taking a daily multivitamin
C) I had my last blood draw about a week ago now
D) My doctor started me on a blood pressure medication called Metroprolol - Answer-
Answer: B. Multivitamins often contain iron which would further stimulate blood
production. It would be important to make sure the vitamin did not contain that
ingredient before the client continued with its use. All other statements are not
concerning
Which of the following symptoms is expected with hemoglobin of 10 g/dl?
a. None
b. Pallor
c. Palpitations
d. Shortness of breath - Answer-Answer: None. Symptoms are not expected with mild
anemia
A 72 year old male walks into the clinic complaining of lower back pain. He says he
feels fine in the morning but that his Alieve doesn't work well enough at night time. His
serum protein levels are elevated. Which of the following assessment findings is most
concerning to the nurse?
A) The patient tells you "I have felt more weak and tired lately too"
B) My mother had a history of osteoporosis
C) The patient says he has been constipated
D) The patient says "I haven't peed as much in the past week as I used to" - Answer-
Answer: D. This is a sign of decreasing renal function and possible renal failure, a
ACTUAL EXAM QUESTIONS WITH
ALL CORRECT ANSWERS A
GRADED
A patient arrived to the clinic complaining of generalized pruritus and pain in the
extremities. He has a history of diabetes, HTN, dyslipidemia, COPD, and A-fib. His
blood pressure is 155/90. His face is a ruddy color. On palpation of his abdomen, his
spleen is palpable. His blood values indicate a Hgb of 18.5 and Hct of 60%. The nurse
suspects which diagnosis?
A) Polycythemia Vera
B) Multiple Myeloma
C) Thrombocytopenia
D) Secondary Polycythemia - Answer-Answer: D. based on a history of COPD, the
nurse suspects that the polycythemia is based on the secondary cause of chronic
reduced oxygen intake. Other possible causes of secondary polycythemia would include
smoking history, cyanotic heart disease, or even living in a high altitude. There are also
several other causes. If a cause is noted, polycythemia Vera (primary polycythemia) is
ruled out
The patient with polycythemia Vera asks you "Why the **** am I taking aspirin!? I never
needed any medications before!" What is the best response by the nurse?
A) The aspirin is prescribed in order to treat HA, a common symptom of this disease
B) Aspirin has been proven to be effective in preventing all complications of this
disorder
C) This medication will help reduce the burning pain you have in your extremities
D) If I wanted you to ask a question, I would have let you know. Now shut up and take
your pill. - Answer-Answer: C. Aspirin is prescribed to help with erythromelalgia which is
a problem caused by PV which causes warmth, redness, and burning pain in the
extremities. Cool compresses may also help with this problem. It is important to monitor
patients taking aspirin for bleeding because patients with PV are already at an
increased risk for bleeding which could be exacerbated by aspirin use.
You are providing discharge teaching to the patient with polycythemia Vera about
treating pruritus. Which of the following statements indicates the need for further
teaching?
A) A cold ice pack can help relieve some of my itching
B) I will take some Benadryl to help relieve the itching
C) Water will probably make my itching worse rather than help it
, D) My doctor may discuss the use of Interferon with me which could help relieve my
itching - Answer-Answer: B. Use of antihistamines are not effective in relieving pruritus
caused by polycythemia. Cold compresses may help relieve itching (avoid warm or hot).
Water often aggravates pruritus with polycythemia Vera (aquagenic pruritus). Interferon,
a myelosuppressive agent given to high risk patients could help relieve itching.
The nurse is providing teaching to the patient diagnosed with Polycythemia Vera. Which
statement, if made by the patient, indicates the need for further teaching?
A) I need to make sure I stay active to prevent clot formation
B) I guess I will have to stop drinking all my alcohol now. Poop.
C) I should limit my bath time to less than thirty minutes
D) I will need to take an iron supplement to help replace what is taken away by
therapeutic blood draws - Answer-Answer: D. The patient with polycythemia vera should
NEVER take an iron supplement. It will stimulate further RBC production which would
be a negative effect. Staying active to avoid clot formation is important as this is a major
complication of this disorder. Limiting or avoiding alcohol will help minimize risk for
bleeding. Limiting baths will help keep pruritus from being aggravated.
The nurse is taking care of the 73 year old patient with polycythemia vera. The nurse is
most concerned when the patient mentions which of the following?
A) I've had a UTI in the past so I've been drinking cranberry juice to prevent this from
happening again
B) I want to be healthy so I started taking a daily multivitamin
C) I had my last blood draw about a week ago now
D) My doctor started me on a blood pressure medication called Metroprolol - Answer-
Answer: B. Multivitamins often contain iron which would further stimulate blood
production. It would be important to make sure the vitamin did not contain that
ingredient before the client continued with its use. All other statements are not
concerning
Which of the following symptoms is expected with hemoglobin of 10 g/dl?
a. None
b. Pallor
c. Palpitations
d. Shortness of breath - Answer-Answer: None. Symptoms are not expected with mild
anemia
A 72 year old male walks into the clinic complaining of lower back pain. He says he
feels fine in the morning but that his Alieve doesn't work well enough at night time. His
serum protein levels are elevated. Which of the following assessment findings is most
concerning to the nurse?
A) The patient tells you "I have felt more weak and tired lately too"
B) My mother had a history of osteoporosis
C) The patient says he has been constipated
D) The patient says "I haven't peed as much in the past week as I used to" - Answer-
Answer: D. This is a sign of decreasing renal function and possible renal failure, a
