Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders

Which is a symptom of hemochromatosis? -Bronzing of the skin -Inflammation of the mouth -Inflammation of the tongue -Weight gain

-Bronzing of the skin Explanation: Clients with hemochromatosis exhibit symptoms of weakness, lethargy, arthralgia, weight loss, and loss of libido early in the illness trajectory. The skin may appear hyperpigmented from melanin deposits or appear bronze in color. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Hereditary Hemochromatosis, pp. 927-928. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 927-928

Which of the following is the most common hematologic condition affecting elderly patients -Anemia -Thrombocytopenia -Leukopenia -Bandemia

Anemia Explanation: Anemia is the most common hematologic condition affecting elderly patients: with each successive decade of life, the incidence of anemia increases. Thrombocytopenia is a low platelet count. Leukopenia is a low leukocyte count. Bandemia is an increased number of band cells. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, ANEMIA, p. 910. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 910

While assessing a client, the nurse will recognize what as the most obvious sign of anemia? -Pallor -Tachycardia -Flow murmurs -Jaundice

Pallor Explanation: On physical examination, pallor is the most common and obvious sign of anemia. Other findings may include tachycardia and flow murmurs. Patients with hemolytic anemia may exhibit jaundice and splenomegaly. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, ANEMIA, p. 912. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 912

A client is prescribed 325 mg/day of oral ferrous sulfate. What does the nurse include in client teaching? -Take 1 hour before breakfast -Take with dairy products -Decrease intake of fruits and juices -Decrease intake of dietary fiber

Take 1 hour before breakfast Explanation: Instructions the nurse will provide for the client taking oral ferrous sulfate is to administer the medication on an empty stomach. Instructions also include that there is decreased absorption of iron with food, particularly dairy products. The client is to increase vitamin C intake (fruits, juices, tomatoes, broccoli), which will enhance iron absorption. The client is to also increase foods high in fiber to decrease risk of constipation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Hypoproliferative Anemias, p. 915. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 915

The nurse is educating a client about iron supplements. The nurse teaches that what vitamin enhances the absorption of iron? -C -A -D -E

C Explanation: Vitamin C facilitates the absorption of iron. Therefore, iron supplements should be taken with a glass of orange juice or a vitamin C tablet to maximize absorption. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Hypoproliferative Anemias, p. 915. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 915

A client reports feeling tired, cold, and short of breath at times. Assessment reveals tachycardia and reduced energy. What would the nurse expect the physician to order? -CBC -antibiotic -chest radiograph -ECG

CBC Explanation: Most clients with iron-deficiency anemia have reduced energy, feel cold all the time, and experience fatigue and dyspnea with minor physical exertion. The heart rate usually is rapid even at rest. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased. A CBC would be ordered. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Hypoproliferative Anemias, p. 914. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 914

A thin client is prescribed iron dextran intramuscularly. What is most important action taken by the nurse when administering this medication? -Employs the Z-track technique -Uses a 23-gauge needle -Injects into the deltoid muscle -Rubs the site vigorously

Employs the Z-track technique Explanation: When iron medications are given intramuscularly, the nurse uses the Z-track technique to avoid local pain and staining of the skin. The gluteus maximus muscle is used. The nurse avoids rubbing the site vigorously and uses a 18- or 20-gauge needle. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Hypoproliferative Anemias, p. 915. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 915

A nurse is caring for a client with thalassemia who is being transfused. What is the nurse's role during a transfusion? -To closely monitor the rate of administration -To administer vitamin B12 injections -To instruct the client to rest immediately if chest pain develops -To assess for enlargement and tenderness over the liver and spleen

To closely monitor the rate of administration Explanation: In a client with thalassemia, when transfusions are necessary, the nurse closely monitors the rate of administration. Assessing for enlargement and tenderness over the liver and spleen, advising rest, or administering vitamin B12 injections are not indicated for thalassemia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Thalassemias, p. 926. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 926

Which medication is the antidote to warfarin? -Vitamin K -Protamine sulfate -Aspirin -Clopidogrel

Vitamin K Explanation: The antidote for warfarin is vitamin K. Protamine sulfate is the antidote for heparin. Aspirin and clopidogrel are both antiplatelet medications. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Protein C Deficiency, p. 945. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 945

A client has a history of sickle cell anemia with several sickle cell crises over the past 10 years. What blood component results in sickle cell anemia? -hemoglobin S -hemoglobin F -hemoglobin A -hemoglobin M

hemoglobin S Explanation: Hemoglobin A (HbA) normally replaces fetal hemoglobin (HbF) about 6 months after birth. In people with sickle cell anemia, however, an abnormal form of hemoglobin, hemoglobin S (HbS), replaces HbF. HbS causes RBCs to assume a sickled shape under hypoxic conditions. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Sickle Cell Disease, p. 921. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 921

A client with a diagnosis of pernicious anemia comes to the clinic and reports numbness and tingling in the arms and legs. What do these symptoms indicate? -Loss of vibratory and position senses -Neurologic involvement -Severity of the disease -Insufficient intake of dietary nutrients

Neurologic involvement Explanation: In clients with pernicious anemia, numbness and tingling in the arms and legs, and ataxia are the most common signs of neurologic involvement. Some affected clients lose vibratory and position senses. Jaundice, irritability, confusion, and depression are present when the disease is severe. Insufficient intake of dietary nutrients is not indicated by these symptoms. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Megaloblastic Anemias, p. 918. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 918

A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn's disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for? -The onset of a bacterial infection -Bleeding -Abdominal pain -Diarrhea

The onset of a bacterial infection Explanation: Lymphopenia (a lymphocyte count less than 1,500/mm3) can result from ionizing radiation, long-term use of corticosteroids, uremia, infections (particularly viral infections), some neoplasms (e.g., breast and lung cancers, advanced Hodgkin disease), and some protein-losing enteropathies (in which the lymphocytes within the intestines are lost) (Kipps, 2010). When lymphopenia is mild, it is often without sequelae; when severe, it can result in bacterial infections (due to low B lymphocytes) or in opportunistic infections (due to low T lymphocytes). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, NEUTROPENIA, p. 929. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 929

The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include a nutritional assessment for this patient? -It is part of the required assessment information. -It is important for the nurse to determine what type of foods the patient will eat. -It may indicate deficiencies in essential nutrients. -It will determine what type of anemia the patient has.

It may indicate deficiencies in essential nutrients. Explanation: A nutritional assessment is important, because it may indicate deficiencies in essential nutrients such as iron, vitamin B12, and folate. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, ANEMIA, p. 912. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 912

A client with megaloblastic anemia reports mouth and tongue soreness. What instruction will the nurse give the client regarding eating while managing the client's symptoms? -"Eat small amounts of bland, soft foods frequently." -"Eat larger amounts of bland, soft foods less frequently." -"Eat cold, bland foods with a large amount of water." -"Eat low-fiber blended foods only."

"Eat small amounts of bland, soft foods frequently." Explanation: Because the client with megaloblastic anemia often reports mouth and tongue soreness, the nurse should instruct the client to eat small amounts of bland, soft foods frequently. The other answer choices do not factor in the client's mouth soreness or need for nutrition. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Megaloblastic Anemias, p. 918. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 918

You are caring for a 13-year-old diagnosed with sickle cell anemia. The client asks you what they can do to help prevent sickle cell crisis. What would be an appropriate answer to this client? -Avoid any sports that tire you out. -Drink at least 8 glasses of water every day. -Avoid any activity that makes you short of breath. -Stay on oxygen therapy 24/7.

Drink at least 8 glasses of water every day. Explanation: During the physical examination, observe the client's appearance, looking for evidence of dehydration, which may have triggered a sickle cell crisis. Clients are taught moderation, not avoidance of activities. Most clients with sickle cell disease are not on oxygen therapy 24/7. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Sickle Cell Disease, p. 920. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 920

A nurse is caring for a client with iron deficiency anemia. Which food or beverage will the nurse suggest to the client to eat or drink when taking supplemental iron? -Milk -Orange juice -Leafy green vegetables -Kidney beans

Orange juice Explanation: Vitamin C found in orange juice improves the absorption of iron. The other answer choices are not the best for improving absorption of iron. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Hypoproliferative Anemias, p. 915. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 915

A client with sickle cell anemia has a -low hematocrit. -high hematocrit. -normal hematocrit. -normal blood smear.

low hematocrit. Explanation: A client with sickle cell anemia has a low hematocrit and sickled cells on the smear. A client with sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Sickle Cell Disease, pp. 919-921. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 919-921

The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency? -B12 -C -A -Folate

B12 Explanation: The medication metformin (Glucophage) increases the client's risk for developing B12 deficiency because the medication inhibits the absorption of B12. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Megaloblastic Anemias, p. 917. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 917

A client with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse? -Inform the client that the position must be changed, and then you will give her pain medication and omit the bath. -Inform the client that she will feel better after receiving a bath and clean sheets. -Obtain the pain medication and delay the bath and position change until the medication reaches its peak. -Inform the client that the bath and positioning is an important part of client care and will be done right after pain medication administration.

Obtain the pain medication and delay the bath and position change until the medication reaches its peak. Explanation: When pain is severe, the nurse delays position changes and bathing until an administered analgesic has reached its peak concentration level and the client is experiencing maximum pain relief. Pain medication should never be delayed to assist in the control of the level of pain. Pain will not be relieved by a bath and clean sheets, only analgesics at this point in the client's illness. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Platelet Defects, p. 935. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 935

The most common cause of iron deficiency anemia in men and postmenopausal women is -menorrhagia. -iron malabsorption. -bleeding. -chronic alcoholism.

bleeding. Explanation: The most common cause of iron deficiency anemia in men and postmenopausal women is bleeding from ulcers, gastritis, inflammatory bowel disease, or gastrointestinal (GI) tumors. Menorrhagia is the most common cause in premenopausal women. Iron malabsorption is another cause, which is seen in clients with celiac disease. Clients with chronic alcoholism often have chronic blood loss from the GI tract. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Iron Deficiency Anemia, p. 914. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 914

A patient with end-stage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia? -Potassium level of 5.2 mEq/L -Magnesium level of 2.5 mg/dL -Calcium level of 9.4 mg/dL -Creatinine level of 6 mg/100 mL

Creatinine level of 6 mg/100 mL Explanation: The degree of anemia in patients with end-stage renal disease varies greatly; however, in general, patients do not become significantly anemic until the serum creatinine level exceeds 3 mg/100 mL. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders.

A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify? -Potential hepatic dysfunction indicated by decreased blood urea nitrogen (BUN) and creatinine levels -Low levels of urine constituents normally excreted in the urine -Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels -Electrolyte imbalance that could affect the blood's ability to coagulate properly

-Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels Explanation: Low preoperative HCT and Hb levels indicate the client may require a blood transfusion before surgery. If the HCT and Hb levels decrease during surgery because of blood loss, the potential need for a transfusion increases. Possible renal failure is indicated by elevated BUN or creatinine levels. Urine constituents aren't found in the blood. Coagulation is determined by the presence of appropriate clotting factors, not electrolytes. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, ANEMIA, p. 910. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 910

A young client is diagnosed with a mild form of hemophilia and is experiencing bleeding in the joints with pain. In preparing the client for discharge, what instructions should the nurse provide? -Take ibuprofen for joint pain. -Take warm baths to lessen pain. -Wear a medical identification bracelet. -Undergo genetic testing and counseling if the client is male.

-Wear a medical identification bracelet. Explanation: Clients with hemophilia should wear a medical identification bracelet about having this disease. Ibuprofen interferes with platelet aggregation and may increase the client's bleeding. A warm bath may lessen pain but increase bleeding. Genetic testing and counseling are not necessary for male clients, because females are the carriers of the genetic material for hemophilia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Inherited Bleeding Disorders, p. 937. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 937

For a client diagnosed with pernicious anemia, the nurse emphasizes the importance of lifelong administration of -Vitamin A -Vitamin C -Folic acid -Vitamin B12

Vitamin B12 Explanation: For a client with pernicious anemia, the nurse emphasizes the importance of lifelong administration of vitamin B12. The nurse teaches the client or a family member the proper method to administer vitamin B12 injections. Administration of vitamin A, folic acid, or vitamin C is not recommended for this condition. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Megaloblastic Anemias, p. 917. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 917

Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents? -Hypochromic -Normocytic -Microcytic -Hyperchromic

-Hypochromic Explanation: An RBC that has pale or lighter cellular contents is hypochromic. A normocytic RBC is normal or average in size. A microcytic RBC is smaller than normal. Hyperchromic is used to describe an RBC that has darker cellular contents. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Anemia of Inflammation, p. 916. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 916

A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor? -Decreased level of erythropoietin -Decreased total iron-binding capacity -Increased mean corpuscular volume -Increased reticulocyte count

Decreased level of erythropoietin Explanation: As renal function decreases, erythropoietin, which is produced by the kidney, also decreases. Because erythropoietin is produced outside the kidney, some erythropoiesis continues, even in patients whose kidneys have been removed. However, the number of red blood cells produced is small and the degree of erythropoiesis is inadequate. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, ANEMIA, p. 910. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 910

The nurse is caring for a client with external bleeding. What is the nurse's priority intervention? -Elevation of the extremity -Pressure point control -Direct pressure -Application of a tourniquet

Direct pressure Explanation: Applying direct pressure to an injury is the initial step in controlling bleeding. Elevation reduces the force of flow, but direct pressure is the first step. The nurse may use pressure point control for severe or arterial bleeding. Pressure points (those areas where large blood vessels can be compressed against bone) include femoral, brachial, facial, carotid, and temporal artery sites. The nurse should avoid applying a tourniquet unless all other measures have failed, because it may further damage the injured extremity. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, ANEMIA, p. 910. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 910

A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the health care provider immediately because the client probably is experiencing which problem? -A hemolytic reaction to mismatched blood -A hemolytic reaction to Rh-incompatible blood -A hemolytic allergic reaction caused by an antigen reaction -A hemolytic reaction caused by bacterial contamination of donor blood

A hemolytic allergic reaction caused by an antigen reaction Explanation: Hemolytic allergic reactions are fairly common and may cause chills, fever, urticaria, tachycardia, dyspnea, chest pain, hypotension, and other signs of anaphylaxis a few minutes after blood transfusion begins. Although rare, a hemolytic reaction to mismatched blood can occur, triggering a more severe reaction and, possibly, leading to disseminated intravascular coagulation. A hemolytic reaction to Rh-incompatible blood is less severe and occurs several days to 2 weeks after the transfusion. Bacterial contamination of donor blood causes a high fever, nausea, vomiting, diarrhea, abdominal cramps and, possibly, shock. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders.

A client's low prothrombin time (PT) was attributed to low vitamin K levels and the client's PT normalized after administration of vitamin K. When performing discharge education in an effort to prevent recurrence, what should the nurse emphasize? -Adequate nutrition -Avoidance of NSAIDs -Constant access to clotting factor concentrates -Meticulous hygiene

Adequate nutrition Explanation: Vitamin K deficiency is often the result of a nutritional deficit. NSAIDs do not influence vitamin K synthesis and clotting factors are not necessary to treat or prevent a vitamin K deficiency. Hygiene is not related to the onset or prevention of vitamin K deficiency. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Vitamin K Deficiency, p. 939. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 939

When teaching a client with iron deficiency anemia about appropriate food choices, the nurse encourages the client to increase the dietary intake of which foods? -Beans, dried fruits, and leafy, green vegetables -Fruits high in vitamin C, such as oranges and grapefruits -Berries and orange vegetables -Dairy products

Beans, dried fruits, and leafy, green vegetables Explanation: Food sources high in iron include organ meats (e.g., beef or calf liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy and green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Iron Deficiency Anemia, pp. 914-915. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 914-915

The nurse is educating a patient with iron deficiency anemia about food sources high in iron and how to enhance the absorption of iron when eating these foods. What can the nurse inform the client would enhance the absorption? -Eating calf's liver with a glass of orange juice -Eating leafy green vegetables with a glass of water -Eating apple slices with carrots -Eating a steak with mushrooms

Eating calf's liver with a glass of orange juice Explanation: Food sources high in iron include organ meats (e.g., beef or calf's liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Hypoproliferative Anemias, p. 915. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 915

A client admitted to the hospital in preparation for a splenectomy to treat autoimmune hemolytic anemia asks the nurse about the benefits of splenectomy. Which statement best explains the expected effect of splenectomy? -It will remove the major site of red blood cell (RBC) destruction. -It will reduce the destruction of platelets by macrophages. -It will increase production of platelets by the bone marrow. -It will increase red blood cell (RBC) production to compensate for blood loss.

It will remove the major site of red blood cell (RBC) destruction. Explanation: For clients with autoimmune hemolytic anemia, if corticosteroids do not produce remission, a splenectomy (i.e., removal of the spleen) may be performed because it removes the major site of RBC destruction. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Immune Hemolytic Anemias, pp. 926-927. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 926-927

A client's family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC? -"DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs." -"DIC occurs when the immune system attacks platelets and causes massive bleeding." -"DIC is a complication of an autoimmune disease that attacks the body's own cells." -"DIC is caused when hemolytic processes destroy erythrocytes."

"DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs." Explanation: The inflammatory response initiates the process of inflammation and coagulation. The natural anticoagulant pathways within the body are simultaneously impaired, and the fibrinolytic system is suppressed, allowing a massive amount of tiny clots forms in the microcirculation. As the platelets and clotting factors form microthrombi, coagulation fails. Thus, the paradoxical result of excessive clotting is bleeding. Decline in organ function is usually a result of excessive clot formation (with resultant ischemia to all or part of the organ). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Liver Disease, pp. 939-941. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 939-941

A client awaiting a bone marrow aspiration asks the nurse to explain where on the body the procedure will take place. What body part does the nurse identify for the client? -Posterior iliac crest -Sternum -Femur -Ankle

-Posterior iliac crest Explanation: In adults, bone marrow is usually aspirated from the posterior iliac crest and rarely from the sternum. Bone marrow is not aspirated from the femur or ankle. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders.

Which nursing diagnosis should a nurse expect to see in a care plan for a client in sickle cell crisis? -Imbalanced nutrition: Less than body requirements related to poor intake -Disturbed sleep pattern related to external stimuli -Impaired skin integrity related to pruritus -Acute pain related to sickle cell crisis

Acute pain related to sickle cell crisis Explanation: In sickle cell crisis, sickle-shaped red blood cells clump together in a blood vessel, which causes occlusion, ischemia, and extreme pain. Therefore, Acute pain related to sickle cell crisis 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Sickle Cell Disease, p. 920. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 920

A nurse is caring for a client with severe anemia. The client is tachycardic and reports dizziness and exertional dyspnea. What signs and symptoms might develop if this client goes into heart failure? -Peripheral edema -Nausea and vomiting -Migraine -Fever

Peripheral edema Explanation: Cardiac status should be carefully assessed in clients with anemia. When the hemoglobin level is low, the heart attempts to compensate by pumping faster and harder in an effort to deliver more blood to hypoxic tissue. This increased cardiac workload can result in such symptoms such as tachycardia, palpitations, dyspnea, dizziness, orthopnea, and exertional dyspnea. Heart failure may eventually develop, as evidenced by an enlarged heart (cardiomegaly) and liver (hepatomegaly), and by peripheral edema. Nausea, migraine, and fever are not associated with heart failure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, ANEMIA, p. 912. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 912

While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters? -Platelet count, prothrombin time, and partial thromboplastin time -Platelet count, blood glucose levels, and white blood cell (WBC) count -Thrombin time, calcium levels, and potassium levels -Fibrinogen level, WBC, and platelet count

-Platelet count, prothrombin time, and partial thromboplastin time Explanation: The diagnosis of DIC is based on the results of laboratory studies of prothrombin time, platelet count, thrombin time, partial thromboplastin time, and fibrinogen level as well as client history and other assessment factors. Blood glucose levels, WBC count, calcium levels, and potassium levels aren't used to confirm a diagnosis of DIC. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, DISSEMINATED INTRAVASCULAR COAGULATION, p. 940. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 940

Which type of sickle crisis occurs as a result of infection with the human parvovirus? -Sequestration crisis -Aplastic crisis -Sickle cell crisis -Acute chest syndrome

Aplastic crisis Explanation: Aplastic crisis results from infection with the human parvovirus. Sequestration crisis results when other organs pool the sickled cells. Sickle cell crisis results from tissue hypoxia and necrosis due to inadequate blood flow to a specific region of tissue or organ. Acute chest syndrome is manifested by a rapidly decreasing hemoglobin concentration, tachycardia, fever, and bilateral infiltrates seen on chest x-ray. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Sickle Cell Disease, pp. 919-920. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 919-920

The nurse provides care for an older adult client, diagnosed with anemia, who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine the cause of the client's blood loss, which is the priority nursing action? -Observe the client's stools for blood. -Evaluate the client's dietary intake. -Monitor the client's body temperature. -Monitor the client's blood pressure.

Observe the client's stools for blood. Explanation: If an older adult is anemic, blood loss from the gastrointestinal (GI) or genitourinary (GU) tracts is suspected. Observing the stool for blood will determine if the source of the client's bleeding is in the GI tract. Iron-deficiency anemia is unusual in older adults because the body does not eliminate excessive iron, thus increasing total body iron stores and necessitating maintenance of hydration. If evaluation of the GI and GU tracts does not reveal a source of bleeding, evaluating the client's diet may be appropriate; however, this is not the priority nursing action. Monitoring the client's body temperature and BP will assist the nurse in determining the source of the client's blood loss, but these are not priority nursing actions. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, ANEMIA, p. 912. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 912

The nurse should advise a client with iron deficiency anemia to take which action in order to prevent staining of the teeth? -Take iron with or immediately after meals. -Use a straw or place a spoon at the back of the mouth to take the liquid supplement. -Avoid taking iron simultaneously with an antacid. -Do not combine iron with other prescribed or over-the-counter medications.

Use a straw or place a spoon at the back of the mouth to take the liquid supplement. Explanation: For a client with iron deficiency anemia who is taking an oral iron supplement, the nurse instructs the client to use a straw or place a spoon at the back of the mouth to take the liquid supplement to avoid staining the teeth. The nurse advises the client to take iron with or immediately after meals to avoid gastric distress. The client is advised to avoid having iron simultaneously with an antacid, as the antacid will interfere with iron absorption. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Iron Deficiency Anemia, p. 914, 915. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 914, 915

A nurse caring for a client who has hemophilia is getting ready to take the client's vital signs. What should the nurse do before taking a blood pressure? -Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints. -Ask if taking a blood pressure has ever produced pain in the upper arm. -Ask if taking a blood pressure has ever caused bruising in the hand and wrist. -Ask if taking a blood pressure has ever produced the need for medication.

Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints. Explanation: Due to the client's enhanced risk for bleeding, before taking a blood pressure, the nurse asks the client if the use of a blood-pressure cuff has ever produced bleeding under the skin or in the arm joints. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Inherited Bleeding Disorders, p. 936. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 936

A client in end-stage renal disease is prescribed epoetin alfa and oral iron supplements. Before administering the next dose of epoetin alfa and oral iron supplement, what is the priority action taken by the nurse? -Assesses the hemoglobin level -Questions the administration of both medications -Ensures the client has completed dialysis treatment -Holds the epoetin alfa if the BUN is elevated

Assesses the hemoglobin level Explanation: Erythropoietin (epoetin alfa [Epogen]) with oral iron supplements can raise hematocrit levels in the client with end-stage renal disease. The nurse should check the hemoglobin prior to administration of erythropoietin, because too high a hemoglobin level can put the client at risk for heart failure, myocardial infarction, and cerebrovascular accident. Erythropoietin may be administered during dialysis treatments. The BUN will be elevated in the client with end-stage renal disease. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Hemolytic Anemias, p. 922. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 922

The nurse is planning care for a client with severe fatigue secondary to anemia. What concept will the nurse use as the basis for planning interventions? -Assisting in prioritizing activities. -Determining what days to be active. -Keeping long activity periods to build client stamina. -Encouraging early and frequent activities.

Assisting in prioritizing activities. Explanation: When planning care for a client with severe fatigue secondary to anemia, the nurse should act collaboratively with the client and assist in prioritizing activities. The client ultimately determines the balance between rest and activity, not the nurse. The nurse will balance activities and group nursing interventions in order to prevent client fatigue. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, ANEMIA, p. 913. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 913

A patient has a probable diagnosis of polycythemia vera. The nurse reviews the patient's lab work for which diagnostic indicator? -Hematocrit of 60% -Erythrocyte count of 6.5 m/?L -Leukocyte count of 11,500/mm3 -Platelet value of 350,000/mm3

Hematocrit of 60% Explanation: Although all results are elevated, the diagnostic indicator is the elevated hematocrit (normal = 42% to 52% for a male). These results are used in combination with other indicators (e.g., splenomegaly) for a definitive diagnosis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, POLYCYTHEMIA, p. 928. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 928

A nurse provides nutritional information for a patient diagnosed with an iron-deficiency anemia. What education should the nurse provide? -Decrease the intake of citrus fruits because they interfere with iron absorption. -Take an iron supplement with meals to reduce gastric irritation. -Increase the intake of green, leafy vegetables. -Decrease the intake of high-fat red meats, especially organ meats.

Increase the intake of green, leafy vegetables. Explanation: Leafy greens, such as spinach, kale, swiss chard, collard and beet greens contain between 2.5-6.4 mg of iron per cooked cup. Clients should be encouraged to consume more green, leafy vegetables. Red meats, especially organ meats, are iron-rich foods and the client should not be discouraged from eating them. Vitamin C sources (citrus fruit and juices) enhance the absorption of iron, which should be taken 1 hour before or 2 hours after a meal. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Hypoproliferative Anemias, p. 915. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 915

A client with a diagnosis of pernicious anemia comes to the clinic reporting of numbness and tingling in his arms and legs. What do these symptoms indicate? -Loss of vibratory and position senses -Neurologic involvement -Severity of the disease -Insufficient intake of dietary nutrients

Neurologic involvement Explanation: In clients with pernicious anemia, numbness and tingling in the arms and legs and ataxia are the most common signs of neurologic involvement. Some affected clients lose vibratory and position senses. Jaundice, irritability, confusion, and depression are present when the disease is severe. Insufficient intake of dietary nutrients is not indicated by these symptoms Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Megaloblastic Anemias, p. 918. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 918

The nurse obtains a unit of blood for the client, Donald D. Smith. The name on the label on the unit of blood reads Donald A. Smith. All the other identifiers are correct. What action should the nurse take? -Administer the unit of blood -Check with the blood bank first and then administer the blood with their permission -Refuse to administer the blood -Ask the client if he was ever known as Donald A. Smith

Refuse to administer the blood Explanation: To ensure a safe transfusion, all components of the identification must be correct. The nurse should refuse to administer the blood and notify the blood bank about the discrepancy. The blood bank should then take the necessary steps to correct the name on the label on the unit of blood. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders. Add a Note

The nurse is preparing the patient for a test to determine the cause of vitamin B12 deficiency. The patient will receive a small oral dose of radioactive vitamin B12 followed by a large parenteral dose of nonradioactive vitamin B12. What test is the patient being prepared for? -Bone marrow aspiration -Schilling test -Bone marrow biopsy -Magnetic resonance imaging (MRI) study

Schilling test Explanation: The classic method of determining the cause of vitamin B12 deficiency is the Schilling test, in which the patient receives a small oral dose of radioactive vitamin B12, followed in a few hours by a large, nonradioactive parenteral dose of vitamin B12 (this aids in renal excretion of the radioactive dose). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Megaloblastic Anemias, p. 918. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 918

A client with a pulmonary embolism is being treated with a heparin infusion. What diagnostic finding suggests to the nurse that treatment is effective? -The client's PT is within reference ranges. -Arterial blood sampling tests positive for the presence of factor XIII. -The client's platelet level is below 100,000/mm3. -The client's activated partial thromboplastin time (aPTT) is 1.5 to 2.5 times the control value.

The client's activated partial thromboplastin time (aPTT) is 1.5 to 2.5 times the control value. Explanation: The therapeutic effect of heparin is monitored by serial measurements of the aPTT; the dose is adjusted to maintain the range at 1.5 to 2.5 times the laboratory control. Heparin dosing is not determined on the basis of platelet levels, the presence or absence of clotting factors, or PT levels. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Platelet Defects, p. 935. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 935

After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/mm3. What term should the nurse use to describe this low platelet count? -Anemia -Leukopenia -Thrombocytopenia -Neutropenia

Thrombocytopenia Explanation: A normal platelet count is 140,000 to 400,000/mm3 in adults. Chemotherapeutic agents produce bone marrow depression, resulting in reduced red blood cell counts (anemia), reduced white blood cell counts (leukopenia), and reduced platelet counts (thrombocytopenia). Neutropenia is the presence of an abnormally reduced number of neutrophils in the blood and is caused by bone marrow depression induced by chemotherapeutic agents. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Thrombocytopenia, p. 932. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 932

A nurse is doing a physical examination of a child with sickle cell anemia. When the child asks why the nurse auscultates the lungs and heart, what would be best the response by the nurse? -To detect the abnormal sounds suggestive of acute chest syndrome and heart failure -To detect the evidence of infection such as fever and tachycardia -To detect the evidence of dehydration that might have triggered a sickle cell crisis -To detect the motor strength and stroke-related signs and symptoms

To detect the abnormal sounds suggestive of acute chest syndrome and heart failure Explanation: The nurse auscultates the lungs and heart to detect abnormal sounds that indicate pneumonia, acute chest syndrome, and heart failure. The nurse assesses vital signs to detect evidence of infection, such as fever and tachycardia. During the physical examination, the nurse observes the client's appearance, looking for evidence of dehydration, which may have triggered a sickle cell crisis. The nurse assesses mental status, verbal ability, and motor strength to detect stroke-related signs and symptoms. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Sickle Cell Disease, p. 920. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 920

A nurse on a hematology/oncology floor is caring for a client with aplastic anemia. Which would not be included in the client's discharge instructions? -Use a disposable razor when shaving. -Avoid contact with family/friends who are sick. -Encourage frequent handwashing. -Plan for frequent periods of rest.

Use a disposable razor when shaving. Explanation: People with aplastic anemia usually have insufficient erythrocytes, leukocytes, and platelets. Encourage behaviors that will lower the risk for bleeding. Avoiding contact with people who are sick reduces the risk of acquiring an infection. Handwashing reduces the risk of acquiring an infection. Anemia can cause fatigue and shortness of breath with even mild exertion. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Aplastic Anemia, p. 916. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 916

A client with sickle cell crisis is admitted to the hospital in severe pain. While caring for the client during the crisis, which is the priority nursing intervention? -Limiting the client's intake of oral and IV fluids -Administering and evaluating the effectiveness of opioid analgesics -Encouraging the client to ambulate immediately -Limit foods that contain folic acid

Administering and evaluating the effectiveness of opioid analgesics Explanation: The priority nursing intervention is to manage the acute pain. Client-controlled analgesia is frequently used in the acute care setting. A patient with sickle cell crisis experiences severe extreme pain, the use of IV fluids and oral intake is need to hydrate the patient, the patient is initially placed on bed rest during the crisis due to extreme fatigue. The patient must continue to ingest folic acid and are placed on a daily folic acid supplement . Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Sickle Cell Disease, pp. 919-922. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 919-922

A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from? Select all that apply. -Infection -Blood loss -Abnormal erythrocyte production -Destruction of normally formed red blood cells -Inadequate formed white blood cells

-Blood loss -Abnormal erythrocyte production -Destruction of normally formed red blood cells Explanation: Most anemias result from (1) blood loss, (2) inadequate or abnormal erythrocyte production, or (3) destruction of normally formed red blood cells. The most common types include hypovolemic anemia, iron-deficiency anemia, pernicious anemia, folic acid deficiency anemia, sickle cell anemia, and hemolytic anemias. Although each form of anemia has unique manifestations, all share a common core of symptoms. Anemia does not result from infection or inadequate formed white blood cells. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, ANEMIA, p. 913. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 913

A nurse is caring for a client with a history of GI bleeding, sickle cell anemia, and a platelet count of 22,000/μl. The client, who is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hour, complains of severe bone pain and is scheduled to receive a dose of morphine sulfate. For which administration route should the nurse question an order? -Oral -I.V. -I.M. -Subcutaneous (subQ)

-I.M. Explanation: A client with a platelet count salineof 22,000/μl bleeds easily. The nurse should avoid using the I.M. route because the area is highly vascular. The client may bleed readily when penetrated by a needle, and it may be difficult for the nurse to stop the bleeding. The client's existing I.V. access would be the best route, especially because I.V. morphine is effective almost immediately. Oral and subQ routes are preferred over I.M., but they're less effective for acute pain management than I.V. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Hypoproliferative Anemias, p. 918. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 918

A client with sickle cell disease is treated for a thrombotic event. Which organs or body systems does the nurse recognize as being at greatest risk for thrombosis in a client with sickle cell disease? Select all that apply. -Spleen -Lungs -Central nervous system -Cardiac system -Liver

-Spleen -Lungs -Central nervous system Explanation: Any organ can be the site of a thrombotic event in sickle cell disease; however, the lungs, central nervous system, and the spleen are at greatest risk due to these areas having slower circulation. The liver is often involved in sequestration in adults, and hemolysis may occur. Anemia affects the heart. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Sickle Cell Disease, p. 920. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 920

A client comes to the walk-in clinic complaining of weakness and fatigue. While assessing this client, the nurse finds evidence of petechiae and ecchymoses. The nurse notes that the spleen appears enlarged. What would the nurse suspect is wrong with this client? -Aplastic anemia -Pernicious anemia -Iron-deficiency anemia -Agranulocytosis

Aplastic anemia Explanation: Clients with a plastic anemia experience all the typical characteristics of anemia (weakness and fatigue). In addition, they have frequent opportunistic infections plus coagulation abnormalities that are manifested by unusual bleeding, small skin hemorrhages called petechiae, and ecchymoses (bruises). The spleen becomes enlarged with an accumulation of the client's blood cells destroyed by lymphocytes that failed to recognize them as normal cells, or with an accumulation of dead transfused blood cells. The blood cell count shows insufficient numbers of blood cells. A bone marrow aspiration confirms that the production of stem cells is suppressed. This scenario does not describe a client with pernicious anemia, iron-deficiency anemia, or agranulocytosis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Aplastic Anemia, p. 916. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 916

When assessing a client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential? -Health history, such as bleeding, fatigue, or fainting -Menstrual history -Age and gender -Lifestyle assessments, such as exercise routines

-Health history, such as bleeding, fatigue, or fainting Explanation: When assessing a client with a disorder of the hematopoietic or the lymphatic system, it is essential to assess the client's health history. An assessment of drug history is essential because some antibiotics and cancer drugs contribute to hematopoietic dysfunction. Aspirin and anticoagulants may contribute to bleeding and interfere with clot formation. Because industrial materials, environmental toxins, and household products may affect blood-forming organs, the nurse needs to explore exposure to these agents. Menstrual history, age, gender, and lifestyle assessments, such as exercise routines and habits, do not directly affect the hematopoietic or lymphatic system. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Aplastic Anemia, p. 916. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 916

A client being treated for iron deficiency anemia with ferrous sulfate continues to be anemic despite treatment. The nurse should assess the client for use of which medication? -Amoxicillin -Aluminum hydroxide -Prednisone -Tegretol

Aluminum hydroxide Explanation: The nurse should assess the client for possible use of antacids such as aluminum hydroxide. Clients should take ferrous sulfate and an antacid at least 2 hours apart because antacids bind with iron in the GI tract, decreasing the rate or extent of iron absorption. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Hypoproliferative Anemias, p. 915. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 915

The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions? -Do not take medication with orange juice because it will delay absorption of the iron. -Iron may cause indigestion and should be taken with an antacid such as Mylanta. -Dilute the liquid preparation with another liquid such as juice and drink with a straw. -Discontinue the use of iron if your stool turns black.

Dilute the liquid preparation with another liquid such as juice and drink with a straw. Explanation: Dilute liquid preparations of iron with another liquid such as juice and drink with a straw to avoid staining the teeth. Avoid taking iron simultaneously with an antacid, which interferes with iron absorption. Drink orange juice or take other forms of vitamin C with iron to promote its absorption. Expect iron to color stool dark green or black. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Hypoproliferative Anemias, p. 915. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 915 Add a Note

A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia? -Nights sweats, weight loss, and diarrhea -Dyspnea, tachycardia, and pallor -Nausea, vomiting, and anorexia -Itching, rash, and jaundice

Dyspnea, tachycardia, and pallor Explanation: Signs of iron deficiency anemia include dyspnea, tachycardia, and pallor, as well as fatigue, listlessness, irritability, and headache. Night sweats, weight loss, and diarrhea may signal acquired immunodeficiency syndrome. Nausea, vomiting, and anorexia may be signs of hepatitis B. Itching, rash, and jaundice may result from an allergic or hemolytic reaction. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Hypoproliferative Anemias, p. 914. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 914

The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia? -Erythrocytes that are microcytic and hypochromic -Erythrocytes that are macrocytic and hyperchromic -Clustering of platelets with sickled red blood cells -An increased number of erythrocytes

Erythrocytes that are microcytic and hypochromic Explanation: A blood smear reveals erythrocytes that are microcytic (smaller than normal) and hypochromic (lighter in color than normal). It does not reveal macrocytic (larger than normal) or hyperchromic erythrocytes. Clustering of platelets with sickled red blood cells would indicate sickle cell anemia. An increase in the number of erythrocytes would indicate polycythemia vera. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, ANEMIA, p. 910. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 910

The nurse observes a co-worker who always seems to be eating a cup of ice. The nurse encourages the co-worker to have an examination and diagnostic workup with the health care provider. What type of anemia is the nurse concerned the co-worker may have? -Iron deficiency anemia -Megaloblastic anemia -Sickle cell anemia -Aplastic anemia

Iron deficiency anemia Explanation: People with iron deficiency anemia may crave ice, starch, or dirt; this craving is known as pica. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, ANEMIA, p. 912. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 912

During preparation for bowel surgery, a client receives an antibiotic to reduce intestinal bacteria. The nurse knows that hypoprothrombinemia may occur as a result of antibiotic therapy interfering with synthesis of which vitamin? -Vitamin A -Vitamin D -Vitamin E -Vitamin K

Vitamin K Explanation: Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Antibiotic therapy may interfere with synthesis of these substances, including vitamin K. Intestinal bacteria don't synthesize vitamins A, D, or E. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Vitamin K Deficiency, p. 939. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 939

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia? -Implement neutropenic precautions -Eliminate direct contact with others who are infectious -Apply prolonged pressure to needle sites or other sources of external bleeding -Monitor temperature at least once per shift

Apply prolonged pressure to needle sites or other sources of external bleeding Explanation: For a client with leukemia, the nurse should apply prolonged pressure to needle sites or other sources of external bleeding. Reduced platelet production results in a delayed clotting process and increases the potential for hemorrhage. Implementing neutropenic precautions and eliminating direct contact with others are interventions to address the risk for infection. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, THROMBOTIC DISORDERS, p. 943. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 943

A nurse cares for clients with hematological disorders and notes that women are diagnosed with hemochromatosis at a much lower rate than men. What is the primary reason for this? -Women lose iron through menstrual cycles -Women rarely manifest the gene expression -Women have lower hemoglobin levels -Women require grater folic acid supplementation

Women lose iron through menstrual cycles Explanation: Hemochromatosis is a genetic condition where excess iron is absorbed in the GI tract and deposited in various organs, making them dysfunctional. Women are often less affected than men because women lose excess iron through their menstrual cycles. The other answer choices are not correct reasons why women are impacted less than men with hemochromatosis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Hypoproliferative Anemias, p. 914. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 914

A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. The client is taking prednisone daily and reported feeling pain after manually opening the garage door. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain? -Hypertension -Osteoporosis -Muscle wasting -Truncal obesity

Osteoporosis Explanation: Hypertension, osteoporosis, muscle wasting, and truncal obesity are all adverse effects of long-term corticosteroid therapy; however, osteoporosis commonly causes compression fractures of the spine. Hypertension, muscle wasting, and truncal obesity aren't likely to cause severe back pain. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Immune Thrombocytopenic Purpura, p. 934. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 934

The nurse is collecting data for a client who has been diagnosed with iron-deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia? -"I feel hot all of the time." -"I have a difficult time falling asleep at night." -"I have an increase in my appetite." -"I have difficulty breathing when walking 30 feet."

"I have difficulty breathing when walking 30 feet." Explanation: Most clients with iron-deficiency anemia have reduced energy, feel cold all the time, and experience fatigue and dyspnea with minor physical exertion. The heart rate usually is rapid even at rest. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased. The client would feel cold and not hot. The client is fatigued and able to sleep often with a decrease in appetite, not an increase. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, ANEMIA, p. 913. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 913

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy? -"I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear." -"I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal." -"I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." -"I will receive parenteral vitamin B12 therapy for the rest of my life."

"I will receive parenteral vitamin B12 therapy for the rest of my life." Explanation: Because a client with pernicious anemia lacks intrinsic factor, oral vitamin B12 can't be absorbed. Therefore, parenteral vitamin B12 therapy is recommended and required for life. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Megaloblastic Anemias, p. 917. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 917

A patient had gastric bypass surgery 3 years ago and now, experiencing fatigue, visits the clinic to determine the cause. The patient takes pantoprazole for the treatment of frequent heartburn. What type of anemia is this patient at risk for? -Aplastic anemia -Iron deficiency anemia -Sickle cell anemia -Pernicious anemia

Pernicious anemia Explanation: A deficiency of vitamin B 12 can occur in several ways. Inadequate dietary intake is rare but can develop in strict vegans (who consume no meat or dairy products). Faulty absorption from the GI tract is a more common cause. This occurs in conditions such as Crohn's disease, or after ileal resection or gastrectomy. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Megaloblastic Anemias, p. 917. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 917

A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving: -A-positive blood to an A-negative client. -O-negative blood to an O-positive client. -O-positive blood to an A-positive client. -B-positive blood to an AB-positive client.

-A-positive blood to an A-negative client. Explanation: An acute hemolytic reaction occurs when there is an ABO or Rh incompatibility. For example, giving A blood to a B client would cause a hemolytic reaction. Likewise, giving Rh-positive blood to an Rh-negative client would cause a hemolytic reaction. It's safe to give Rh-negative blood to an Rh-positive client if there is a blood type compatibility. O-negative blood is the universal donor and can be given to all other blood types. AB clients can receive either A or B blood as long as there isn't an Rh incompatibility. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders.

A pregnant woman is hospitalized as the result of sickle-cell crisis. Which finding indicates the outcome has been achieved for this client? -Reports joint pain less than 3 on a scale of 0 to 10 -Takes hydroxyurea during her pregnancy -Exhibits a temperature more than 100.3°F -Describes the importance of staying cool

Reports joint pain less than 3 on a scale of 0 to 10 Explanation: An expected outcome for a client experiencing a sickle-cell crisis is control and reduction of pain. Hydroxyurea is contraindicated in pregnancy because of the risk it poses for congenital abnormalities. An indication that the client is free from infection is exhibiting a normal temperature; 100.3°F is an elevated temperature. To minimize crises, the client needs to stay warm not cool. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Sickle Cell Disease, p. 920. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 920

A home care nurse visits a client diagnosed with atrial fibrillation who is ordered warfarin. The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching? -"I'll watch my gums for bleeding when I brush my teeth." -"I'll use an electric razor to shave." -"I'll eat four servings of fresh, dark green vegetables every day." -"I'll report unexplained or severe bruising to my doctor right away."

"I'll eat four servings of fresh, dark green vegetables every day." Explanation: The client requires additional teaching if he states that he'll eat four servings of dark green vegetables every day. Dark, green vegetables contain vitamin K, which reverses the effects of warfarin. The client should limit his intake to one to two servings per day. The client should report bleeding gums and severe or unexplained bruising, which may indicate an excessive dose of warfarin. The client should use an electric razor to prevent cutting himself while shaving. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, THROMBOTIC DISORDERS, p. 945. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 945

A patient with sickle cell disease is brought to the emergency department by a parent. The patient has a fever of 101.6°F, heart rate of 116, and a respiratory rate of 32. The nurse auscultates bilateral wheezes in both lung fields. What does the nurse suspect this patient is experiencing? -Pneumocystis pneumonia -Acute chest syndrome -An exacerbation of asthma -Pulmonary edema

Acute chest syndrome Explanation: Acute chest syndrome is manifested by fever, respiratory distress (tachypnea, cough, wheezing), and new infiltrates seen on the chest x-ray. These signs often mimic infection, which is often the cause. However, the infectious etiology appears to be atypical bacteria such as Chlamydia pneumoniae and Mycoplasma pneumoniae as well as viruses such as respiratory syncytial virus and parvovirus. Other causes include pulmonary fat embolism, pulmonary infarction, and pulmonary thromboembolism. Seventy-five percent of patients who develop acute chest syndrome had a painful vaso-occlusive crisis, usually lasting an average of 2.5 days prior to developing symptoms of acute chest syndrome (Laurie, 2010). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Sickle Cell Disease, p. 920. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 920

The registered nurse (RN) and licensed practical nurse (LPN) are preparing an educational program for clients who may be at risk for the development of iron-deficiency anemia. Which client(s) would receive the greatest benefit from this program? Select all that apply. -An adolescent with bulimia nervosa -An older adult client on a fixed income -A client with Crohn's disease -A client who lives in a nursing home -A client who is a vegetarian

An adolescent with bulimia nervosa An older adult client on a fixed income A client with Crohn's disease Explanation: Those who consume a healthy diet absorb less than 10% of the iron in food. Clients whose nutrition is compromised by unhealthy dieting or who cannot afford to eat a healthy diet, lack knowledge about nutrition, or have malabsorption disorders are at great risk for iron-deficiency anemia. An adolescent client with bulimia nervosa has an unhealthy diet. An older adult client on a fixed income may not have the funds to eat a healthy diet. A client with Crohn's disease has a malabsorption syndrome. A client who resides in a nursing home has prepared meals as well as available supplements if required. A client who is a vegetarian is still able to receive ample iron supplementation in the vegetables being eaten. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Hypoproliferative Anemias, p. 914. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 914

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process due to thrombocytopenia in a client with leukemia? -Implementing neutropenic precautions -Eliminating direct contact with others who are infectious -Applying prolonged pressure to needle sites or other sources of external bleeding -Monitoring temperature at least once per shift

Applying prolonged pressure to needle sites or other sources of external bleeding Explanation: The interventions for a client with thrombocytopenia are the same as those for a client with cancer who is at risk for bleeding. For a client with leukemia, the nurse should apply prolonged pressure to needle sites or other sources of external bleeding. Reduced platelet production results in a delayed clotting process and increases the potential for hemorrhage. Implementing neutropenic precautions and eliminating direct contact with others are interventions to address the risk for infection. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Thrombocytopenia, p. 932. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 932

A client is being treated for DIC and the nurse has prioritized the nursing diagnosis of Risk for Deficient Fluid Volume Related to Bleeding. How can the nurse best determine if goals of care relating to this diagnosis are being met? -Assess for edema. -Assess skin integrity frequently. -Assess the client's level of consciousness frequently. -Closely monitor intake and output.

Closely monitor intake and output. Explanation: The client with DIC is at a high risk of deficient fluid volume. The nurse can best gauge the effectiveness of care by closely monitoring the client's intake and output. Each of the other assessments is a necessary element of care, but none addresses fluid balance as directly as close monitoring of intake and output. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, DISSEMINATED INTRAVASCULAR COAGULATION, p. 940. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 940

The nurse should advise a client with iron deficiency anemia to take which action in order to prevent staining of the teeth? -Take iron with or immediately after meals -Dilute liquid preparations of iron with juice and drink with a straw -Avoid taking iron simultaneously with an antacid -Do not combine iron with other prescribed or over-the-counter medications

Dilute liquid preparations of iron with juice and drink with a straw Explanation: For a client with iron deficiency anemia who is taking an oral iron supplement, the nurse instructs the client to dilute liquid preparations of iron with another liquid, such as juice, and drink with a straw to avoid staining the teeth. The nurse advises the client to take iron with or immediately after meals to avoid gastric distress. The client is advised to avoid taking iron simultaneously with an antacid, as the antacid will interfere with iron absorption. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Iron Deficiency Anemia, pp. 914-915. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 914-915

A client with severe anemia reports symptoms of tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Laboratory test results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which nursing diagnoses is most appropriate for this client? -Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit -Imbalanced nutrition, less than body requirements, related to inadequate -intake of essential nutrients -Risk for falls related to complaints of dizziness -Fatigue related to decreased hemoglobin and hematocrit

Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit Explanation: The symptoms indicate impaired tissue perfusion due to a decrease in the oxygen-carrying capacity of the blood. Cardiac status should be carefully assessed. When the hemoglobin level is low, the heart attempts to compensate by pumping faster and harder in an effort to deliver more blood to hypoxic tissue. This increased cardiac workload can result in such symptoms as tachycardia, palpitations, dyspnea, dizziness, orthopnea, and exertional dyspnea. Heart failure may eventually develop, as evidenced by an enlarged heart (cardiomegaly) and liver (hepatomegaly) and by peripheral edema. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Sickle Cell Disease, pp. 919-923. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 919-923

During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding? -Elevated hematocrit concentration -Enlarged mean corpuscular volume (MCV) -Low ferritin level concentration -Elevated red blood cell (RBC) count

Low ferritin level concentration Explanation: The most consistent indicator of iron deficiency anemia is a low ferritin level, which reflects low iron stores. As the anemia progresses, the MCV, which measures the size of the erythrocytes, also decreases. Hematocrit and RBC levels are also low in relation to the hemoglobin concentration. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Hereditary Hemochromatosis, pp. 927-928. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 927-928

A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client? -Pallor, bradycardia, and reduced pulse pressure -Pallor, tachycardia, and a sore tongue -Sore tongue, dyspnea, and weight gain -Angina pectoris, double vision, and anorexia

Pallor, tachycardia, and a sore tongue Explanation: 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 pectoris; 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Megaloblastic Anemias, p. 917. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 917

An older adult client who is a vegetarian has a hemoglobin of 10.2 gm/dL, vitamin B12 of 68 pg/mL (normal: 200-900 pg/mL), and MCV of 110 cubic micrometers. After interpreting the data, what instruction should the nurse give to the client? -Ingest a diet higher in vitamin B12 sources. -Supplement the diet with vitamin B12. -Continue with the diet but include more sources of iron. -Change the vegetarian diet and begin to eat red meat.

Supplement the diet with vitamin B12. Explanation: Data support that the client is experiencing megaloblastic anemia. Findings include the laboratory test results, the client's older age, and the client's status as a vegetarian. Many vegetarians need to supplement their diet with vitamin B12. Eating more foods with vitamin B12 will not provide enough of this vitamin for the client's body. Increasing iron sources will not resolve the client's anemia. Telling the client to discontinue the vegetarian practice and eat red meat is nontherapeutic. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Megaloblastic Anemias, p. 917. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 917

A client is seen in the emergency department with severe pain related to a sickle cell crisis. What does the nurse understand is occurring with this client? -The client has a decreased tolerance of pain related to the chronic nature of the illness. -Bone marrow decreases the erythrocyte production causing decrease in hypoxia. -Overhydration enlarges the red blood cells. -Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.

Vascular occlusion in small vessels decreasing blood and oxygen to the tissues. Explanation: The person with sickle cell disease repeatedly suffers from two major problems: (1) episodes of sickle cell crisis from vascular occlusion, which develops rapidly under hypoxic conditions, and (2) chronic hemolytic anemia. During a sickle cell crisis, the sickle-shaped cells lodge in small blood vessels, where they block the flow of blood and oxygen to the affected tissue. The vascular occlusion induces severe pain in the ischemic tissue. The client may have increased tolerance for pain due to the chronic nature of the illness. Bone marrow increases the erythrocyte production. Underhydration increases the client's risk of developing a vaso-occlusive crisis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, Sickle Cell Disease, p. 920. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 920

A client admitted to the hospital with abdominal pain, anemia, and bloody stools reports feeling weak and dizzy. The client has rectal pressure and needs to urinate and move their bowels. The nurse should help them: -to the bathroom. -to the bedside commode. -onto the bedpan. -to a standing position so he can urinate.

onto the bedpan. Explanation: A client who's dizzy and anemic is at risk for injury because of his weakened state. Assisting him with the bedpan would best meet his needs at this time without risking his safety. The client may fall if walking to the bathroom, left alone to urinate, or trying to stand up. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders, ANEMIA, p. 913. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 913