Chapter 30: Hematologic Problems
10. In teaching the patient with pernicious anemia about the disease, the nurse explains that it results from a lack of a. folic acid. b. intrinsic factor. c. extrinsic factor. d. cobalamin intake.
10. b. Pernicious anemia is a type of cobalamin (vitamin B12) deficiency that results when parietal cells in the stomach fail to secrete enough intrinsic factor to absorb ingested cobalamin. Folic acid deficiency may contribute to folic acid deficiency anemia, not pernicious anemia. Extrinsic factor may be a factor in some cobalamin deficiencies but not in pernicious anemia. Lack of cobalamin intake can cause cobalamin deficiency but not pernicious anemia. Increasing cobalamin intake cannot improve pernicious anemia without intrinsic factor to aid its absorption.
11. During the assessment of a patient with cobalamin deficiency, what manifestation would the nurse expect to find in the patient? a. Icteric sclera b. Hepatomegaly c. Paresthesia of the hands and feet d. Intermittent heartburn with acid reflux
11. c. Neurologic manifestations of weakness, paresthesia of the feet and hands, and impaired thought processes are characteristic of cobalamin deficiency and pernicious anemia. Hepatomegaly and jaundice often occur with hemolytic anemia. The patient with cobalamin deficiency often has achlorhydria or decreased stomach acidity and would not experience effects of gastric hyperacidity.
12. The nurse determines that teaching about pernicious anemia has been effective when the patient says, a. "This condition can kill me unless I take injections of the vitamin for the rest of my life." b. "My symptoms can be completely reversed after I take a cobalamin (vitamin B12) supplement." c. "If my anemia does not respond to cobalamin therapy, my only other alternative is a bone marrow transplant." d. "The least expensive and most convenient treatment of pernicious anemia is to use a diet with foods high in cobalamin."
12. a. Without cobalamin replacement, individuals with pernicious anemia will die in 1 to 3 years, but the disease can be controlled with cobalamin supplements for life. Hematologic manifestations can be completely reversed with therapy, but long-standing neuromuscular complications may not be reversed. Because pernicious anemia results from an inability to absorb cobalamin, dietary intake of the vitamin is not a treatment option, nor is a bone marrow transplant.
13. The strict vegetarian is at highest risk for the development of which anemia? a. Thalassemia b. Iron-deficiency anemia c. Folic acid deficiency anemia d. Cobalamin deficiency anemia
13. d. Because red meats are the primary dietary sources of cobalamin, a strict vegetarian is most at risk for cobalamin deficiency anemia. Meats are also an important source of iron and folic acid, but whole grains, legumes, and green leafy vegetables also supply these nutrients. Thalassemia is not related to dietary deficiencies.
14. A patient with aplastic anemia has a nursing diagnosis of impaired oral mucous membrane. The etiology of this diagnosis can be related to the effects of what deficiencies (select all that apply)? a. RBCs b. Ferritin c. Platelets d. Coagulation factor VIII e. White blood cells (WBCs)
14. a, c, e. Aplastic anemia may cause an inflamed, painful tongue. Oxygen is not delivered without red blood cells. The thrombocytopenia may contribute to blood-filled bullae in the mouth and gingival bleeding. The leukopenia may lead to stomatitis and oral ulcers and infections. MCV will be normal or slightly increased. Ferritin and coagulation factors are not affected in aplastic anemia.
15. Nursing interventions for the patient with aplastic anemia are directed toward the prevention of which complications? a. Fatigue and dyspnea b. Hemorrhage and infection c. Thromboemboli and gangrene d. Cardiac dysrhythmias and heart failure
15. b. Hemorrhage from thrombocytopenia and infection from neutropenia are the greatest risks for the patient with aplastic anemia. The patient will experience fatigue from anemia, but bleeding and infection are the major causes of death in aplastic anemia.
16. Which statements describe anemia related to blood loss (select all that apply)? a. A major concern is prevention of shock. b. This anemia is most frequently treated with increased dietary iron intake. c. In addition to the general symptoms of anemia, this patient also manifests jaundice. d. A patient who has acute blood loss may have postural hypotension and increased heart rate. e. Initial clinical symptoms are the most reliable way to evaluate the effect and degree of blood loss.
16. a, d, e. With rapid blood loss, hypovolemic shock may occur. Clinical manifestations, such as postural hypotension and increased heart rate, will be more reliable than laboratory values as they reflect the body's attempt to meet oxygen requirements. As the percentage of blood loss increases, clinical manifestations worsen.
17. What causes the anemia of sickle cell disease? a. Intracellular hemolysis of sickled RBCs b. Accelerated breakdown of abnormal RBCs c. Autoimmune antibody destruction of RBCs d. Isoimmune antibody-antigen reactions with RBCs
17. b. Because RBCs become abnormal related to hypoxia or infection in sickle cell anemia, the spleen accelerates RBC breakdown as the sickling increases. Antibody reactions with RBCs may be seen in other types of hemolytic anemias but are not present in sickle cell anemia.
18. A patient with sickle cell anemia asks the nurse why the sickling crisis does not stop when oxygen therapy is started. Which explanation should the nurse give to the patient? a. Sickling occurs in response to decreased blood viscosity, which is not affected by oxygen therapy. b. When RBCs sickle, they occlude small vessels, which causes more local hypoxia and more sickling. c. The primary problem during a sickle cell crisis is destruction of the abnormal cells, resulting in fewer RBCs to carry oxygen. d. Oxygen therapy does not alter the shape of the abnormal erythrocytes but only allows for increased oxygen concentration in hemoglobin.
18. b. During a sickle cell crisis, the sickling cells clog small capillaries, and the resulting hemostasis promotes a self-perpetuating cycle of local hypoxia, deoxygenation of more erythrocytes, and more sickling. Administration of oxygen may reverse sickling at first, but eventually the sickling becomes irreversible because of cell membrane damage from recurrent sickling.
19. What is a nursing intervention that is indicated for the patient during a sickle cell crisis? a. Frequent ambulation b. Application of antiembolism hose c. Restriction of sodium and oral fluids d. Administration of large doses of continuous opioid analgesics
19. d. Because pain is the most common symptom with a sickle cell crisis and may last for 4 to 6 days, pain control is an essential part of treatment. Rest is indicated to reduce metabolic needs. Although thrombosis does occur in capillaries, antiembolism stockings that primarily affect venous circulation are not indicated; anticoagulants are more effective. Fluids and electrolytes are administered to reduce blood viscosity and maintain renal function.
2. A patient with a hemoglobin (Hgb) level of 7.8 g/dL (78 g/L) has cardiac palpitations, a heart rate of 102 bpm, and an increased reticulocyte count. Considering the severity of anemia, what other manifestation would the nurse expect the patient to exhibit? a. Pallor b. Dyspnea c. A smooth tongue d. Sensitivity to cold
2. b. The patient's hemoglobin (Hgb) level indicates a moderate anemia, and at this severity additional findings usually include dyspnea and fatigue. Pallor, smooth tongue, and sensitivity to cold usually manifest in severe anemia when the Hgb level is below 6 g/dL (60 g/L).
20. During discharge teaching of a patient with newly diagnosed sickle cell disease, what should the nurse teach the patient to do? a. Limit fluid intake. b. Avoid humid weather. c. Eliminate exercise from the lifestyle. d. Seek early medical intervention for upper respiratory infections
20. d. The patient with sickle cell disease is particularly prone to upper respiratory infection, and infection can precipitate a sickle cell crisis. Patients should seek medical attention quickly to counteract upper respiratory infections because pneumonia is the most common infection in patients with sickle cell disease. Fluids should be increased to decrease blood viscosity, which may precipitate a crisis. Moderate activity is permitted. Dehydration in hot weather may precipitate a sickling episode, but humid weather alone will not do so.
21. Which statements accurately describe thrombocytopenia (select all that apply)? a. Patients with platelet deficiencies can have internal or external hemorrhage. b. The most common acquired thrombocytopenia is thrombotic thrombocytopenic purpura (TTP). c. Immune thrombocytopenic purpura (ITP) is characterized by increased platelet destruction by the spleen. d. TTP is characterized by decreased platelets, decreased RBCs, and enhanced aggregation of platelets. e. A classic clinical manifestation of thrombocytopenia that the nurse would expect to find on physical examination of the patient is ecchymosis.
21. a, c, d. Platelet deficiencies lead to internal and external hemorrhage. Immune thrombocytopenic purpura (ITP) is characterized by increased platelet destruction by the spleen. Thrombotic thrombocytopenic purpura (TTP) is characterized by decreased platelets and RBCs with enhanced agglutination of the platelets. ITP is the most common acquired thrombocytopenia. Petechiae, not ecchymosis, is a common manifestation of thrombocytopenia.
22. A 45-yr-old patient has symptoms including arthralgia, impotence, weight loss, and liver enlargement. His laboratory results include an elevated serum iron, total iron binding capacity (TIBC), and serum ferritin levels. Which disorder does this describe and which treatment will be used? a. Thalassemia; combination chemotherapy b. Hemochromatosis; deferoxamine (Desferal) c. Myelodysplastic syndrome; filgrastim (Neupogen) d. Delayed transfusion reaction; deferasirox (Exjade)
22. b. The symptoms describe hemochromatosis, which is treated with iron chelating agents to remove accumulated iron via the kidneys. Thalassemia involves inadequate production of normal hemoglobin, is asymptomatic or has growth and development deficits, and is treated with blood transfusion and chelating agents (e.g., deferasirox). Myelodysplastic syndrome has disordered and ineffective hematopoiesis and is treated supportively with hematologic monitoring, antibiotic therapy, transfusions, iron chelators, or intensive chemotherapy and/or HSCT. Delayed transfusion reactions exhibit delayed hemolytic reactions, infections, and i
23. In providing care for a patient hospitalized with an acute exacerbation of polycythemia vera, the nurse gives priority to which activity? a. Maintaining protective isolation b. Promoting leg exercises and ambulation c. Protecting the patient from injury or falls d. Promoting hydration with a large oral fluid intake
23. b. Active or passive leg exercises and ambulation should be implemented to prevent thrombus formation. Thrombus and embolization are the major complications of polycythemia vera because of hypervolemia and hyperviscosity. Isolation is not needed and falls are not expected. Hydration therapy is important to decrease blood viscosity. However, because the patient already has hypervolemia, a careful balance of intake and output must be maintained and fluids are not increased injudiciously.
24. A patient has a platelet count of 50,000/μL and is diagnosed with ITP. What does the nurse anticipate that initial treatment will include? a. Splenectomy b. Corticosteroids c. Administration of platelets d. Immunosuppressive therapy
24. b. Corticosteroids are used in initial treatment of ITP because they suppress the phagocytic response of splenic macrophages, decreasing platelet destruction. They also depress autoimmune antibody formation and reduce capillary leakage. All of the other therapies may be used but only in patients who are unresponsive to corticosteroid therapy and severely reduced platelet counts.
25. Priority Decision: A patient is admitted to the hospital for evaluation and treatment of thrombocytopenia. Which action is most important for the nurse to implement? a. Taking the temperature every 4 hours to assess for fever b. Maintaining the patient on strict bed rest to prevent injury c. Monitoring the patient for headaches, vertigo, or confusion d. Removing the oral crusting and scabs with a soft brush four times a day
25. c. The major complication of thrombocytopenia is hemorrhage, and it may occur in any area of the body. Cerebral hemorrhage may be fatal, and evaluation of mental status for central nervous system (CNS) alterations to identify CNS bleeding is very important. Fever is not a common finding in thrombocytopenia. Protection from injury to prevent bleeding is an important nursing intervention, but strict bed rest is not indicated. Oral care is performed very gently with minimum friction and soft swabs.
26. The nurse caring for a patient with heparin-induced thrombocytopenia (HIT) identifies risk for bleeding as the priority nursing diagnosis. Identify at least five nursing interventions that should be implemented.
26. Any five of these are appropriate: - Heparin administration must be discontinued and expect a direct or indirect thrombin inhibitor to be ordered. - Monitor for signs and symptoms of bleeding (check IV sites, wounds, any secretions). - Monitor ordered coagulation studies. Avoid injections. - Use an electric razor. - Protect the patient from trauma. - Administer ordered blood products. - Instruct the patient and caregiver to avoid aspirin and other anticoagulants. - Instruct the patient to avoid high-contact activities (many sports).
27. In reviewing the laboratory results of a patient with hemophilia A, what would the nurse expect to find? a. An absence of factor IX b. A decreased platelet count c. A prolonged bleeding time d. A prolonged partial thromboplastin time (PTT)
27. d. A prolonged partial thromboplastin time (PTT) occurs when there is a deficiency of clotting factors, such as factor VIII associated with hemophilia A. Factor IX is deficient in hemophilia B and prolonged bleeding time, and decreased platelet counts are associated with platelet deficiencies.
28. A patient with hemophilia comes to the clinic for treatment. What should the nurse anticipate that he or she will need to administer? a. Whole blood b. Thromboplastin c. Coagulation factor d. Fresh frozen plasma
28. c. Although whole blood and fresh frozen plasma contain the clotting factors that are deficient in hemophilia, specific coagulation factors have been developed that are purer and safer in preventing infection transmission. Thromboplastin is factor III and is not deficient in patients with hemophilia.
29. A patient with hemophilia is hospitalized with acute knee pain and swelling. What is an appropriate nursing intervention for the patient? a. Wrapping the knee with an elastic bandage b. Placing the patient on bed rest and applying ice to the joint c. Administering nonsteroidal antiinflammatory drugs (NSAIDs) as needed for pain d. Gently performing range-of-motion (ROM) exercises to the knee to prevent adhesions
29. b. During an acute bleeding episode in a joint, it is important to rest the involved joint totally and slow bleeding with application of ice. Drugs that decrease platelet aggregation, such as aspirin or nonsteroidal antiinflammatory drugs (NSAIDs), should not be used for pain. As soon as bleeding stops, mobilization of the affected area is encouraged with range-of-motion (ROM) exercises and physical therapy.
3. Priority Decision: A 76-yr-old woman has an Hgb of 7.3 g/dL (73 g/L) and is experiencing ataxia, confusion, weakness, and fatigue on admission to the hospital. What is the priority nursing intervention for this patient? a. Provide a darkened, quiet room. b. Have the family stay with the patient. c. Keep top bedside rails up and call bell in close reach. d. Question the patient about possible causes of anemia.
3. c. Keeping the top bedside rails up and the call bell within reach will facilitate safety and safe mobility for this patient. In the older adult, confusion, ataxia, fatigue, and weakness are common manifestations of anemia and place the patient at risk for injury. Nursing interventions should include safety precautions to prevent falls and injury when these symptoms are present. The nurse, not the patient's family, is responsible for the patient, and although a quiet room may promote rest, it is not as important as protection of the patient.
30. Which bleeding disorder affects both genders, is autosomal dominant, and will have laboratory results showing prolonged bleeding time? a. Hemophilia A b. Hemophilia B c. Thrombocytopenia d. von Willebrand disease
30. d. This description is characteristic of von Willebrand disease with prolonged bleeding time occurring because of defective platelets, which does not occur with either type of hemophilia. Although inherited thrombocytopenia is believed to be autosomal dominant, the number of platelets is decreased.
32. A patient has a WBC count of 2300/μL and a neutrophil percentage of 40%. Answer the following questions. a. Does the patient have leukopenia? b. What is the patient's absolute neutrophil count? c. Does the patient have neutropenia? d. Is the patient at risk for developing a bacterial infection? If so, why?
32. a. Yes, as the WBC count is below 4000/μL. b. The absolute neutrophil count (ANC) is 2300 × 40% = 920/μL. c. Yes, as the ANC is less than 1000/μL. d. Yes, the patient is at moderate risk of infection with opportunistic pathogens and nonpathogenic organisms from normal body flora because normal phagocytic mechanisms are impaired.
33. What is the most important method to identify the presence of infection in a neutropenic patient? a. Frequent temperature monitoring b. Routine blood and sputum cultures c. Assessing for redness and swelling d. Monitoring white blood cell (WBC) count
33. a. An elevated temperature is of most significance in recognizing the presence of an infection in the neutropenic patient because there is little leukocytic response to injury with low WBC count. Minor complaints of pain or other symptoms should also be reported. Monitoring WBC count will not identify infection. Cultures are indicated if the temperature is elevated but are not used to monitor for infection.
34. What is a major method of preventing infection in the patient with neutropenia? a. Prophylactic antibiotics b. A diet that eliminates fresh fruits and vegetables c. High-efficiency particulate air (HEPA) filtration d. Strict hand washing by all persons in contact with the patient
34. d. Despite its seeming simplicity, hand washing before, during, and after care of the patient with neutropenia is the major method to prevent transmission of harmful pathogens to the patient. IV antibiotics are administered when febrile episodes occur. Some oral antibiotics may be used prophylactically in some neutropenic patients. High-efficiency particulate air (HEPA) filtration will be used for the neutropenic patient at home to reduce the number of aerosolized pathogens.
35. How does myelodysplastic syndrome (MDS) differ from acute leukemias? a. MDS has a slower disease progression. b. MDS does not result in bone marrow failure. c. MDS is a clonal disorder of hematopoietic cells. d. MDS affects only the production and function of platelets and WBCs.
35. a. Myelodysplastic syndromes, like leukemias, are a group of disorders in which hematopoietic stem cells of the bone marrow undergo clonal change and may cause eventual bone marrow failure. However, the primary difference from leukemias is that myelodysplastic cells have some degree of maturation, and the disease progression is slower than in acute leukemias.
36. Which leukemia is seen in 80% of adults with acute leukemia and exhibits proliferation of precursors of granulocytes? a. Hairy cell leukemia b. Biphenotypic leukemia c. Acute lymphocytic leukemia (ALL) d. Acute myelogenous leukemia (AML)
36. d. Acute myelogenous leukemia (AML) is seen in 80% of adults with acute leukemia and is characterized by hyperplasia of the bone marrow with uncontrolled proliferation of myeloblasts, the precursors of granulocytes. Hairy cell leukemia is a rare cancer with hairy-looking abnormal lymphocytes. Biphenotypic leukemia is a rare form of both types of acute leukemia. Acute lymphocytic leukemia (ALL), the other acute leukemia, is most common in children and is characterized by small, immature lymphocytes, primarily of B-cell origin, proliferated in the bone marrow.
37. Which statements accurately describe chronic lymphocytic leukemia (CLL) (select all that apply)? a. Most common leukemia of adults b. Only cure is bone marrow transplant c. Neoplasm of activated B lymphocytes d. Increased incidence in survivors of atomic bombs e. Philadelphia chromosome is a diagnostic hallmark f. Mature-appearing but functionally inactive lymphocyte
37. a, c, f. Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults. It is a neoplasm of activated B lymphocytes that are mature appearing but functionally inactive. As it progresses, pressure on nerves from enlarged lymph nodes causes pain and paralysis. Mediastinal node enlargement leads to pulmonary symptoms. The other characteristics are related to chronic myelogenous leukemia (CML).
38. What is the underlying cause of lymphadenopathy, splenomegaly, and hepatomegaly in leukemia? a. The development of infection at these sites b. Increased compensatory production of blood cells by these organs c. Infiltration of the organs by increased numbers of WBCs in the blood d. Normal hypertrophy of the organs in an attempt to destroy abnormal cel
38. c. Almost all leukemias cause some degree of hepatosplenomegaly because of infiltration of these organs as well as the bone marrow, lymph nodes, bones, and central nervous system by excessive WBCs in the blood.
39. A patient with acute myelogenous leukemia is considering a hematopoietic stem cell transplant and asks the nurse what is involved. What is the best response the nurse can give the patient? a. "Your bone marrow is destroyed by radiation, and new bone marrow cells from a matched donor are injected into your bones." b. "A specimen of your bone marrow may be aspirated and treated to destroy any leukemic cells and then reinfused when your disease becomes worse." c. "Leukemic cells and bone marrow stem cells are eliminated with chemotherapy and/or totalbody radiation, and new bone marrow cells from a donor are infused." d. "During chemotherapy and/or total-body irradiation to destroy all of your blood cells, you may be given transfusions of red blood cells and platelets to prevent complications."
39. c. Whether the donor bone marrow is from a human leukocyte antigen (HLA)-matched donor or taken from the patient during a remission for later use, hematopoietic stem cell transplant always involves the use of chemotherapy and/or total-body radiation to eliminate leukemic cells and the patient's bone marrow stem cells totally before IV infusion of the donor cells. A severe pancytopenic period follows the transplant, during which the patient must be in protective isolation and during which RBC and platelet transfusions may be given.
4. During the physical assessment of the patient with severe anemia, which finding is of the most concern to the nurse? a. Anorexia b. Bone pain c. Hepatomegaly d. Dyspnea at rest
4. d. Dyspnea at rest indicates that the patient is making an effort to provide adequate amounts of oxygen to the tissues. If oxygen needs are not met, angina, myocardial infarction, heart failure, and pulmonary and systemic congestion can occur. The other manifestations are present in severe anemia, but they do not reflect hypoxemia, a priority problem.
41. What characteristics should the nurse be aware of in planning care for the patient with Hodgkin's lymphoma? a. Staging of Hodgkin's lymphoma is not important to predict prognosis. b. Management of the patient being treated for Hodgkin's lymphoma includes measures to prevent infection. c. Hodgkin's lymphoma is characterized by proliferation of malignant activated B cells that destroy the kidneys. d. An important nursing intervention in the care of patients with Hodgkin's lymphoma is increasing fluids to manage hypercalcemia.
41. b. The patient is monitored for infection because leukopenia and thrombocytopenia may develop from the disease or usually as a consequence of treatment. Staging of Hodgkin's disease is important to determine treatment. Multiple myeloma is characterized by proliferation of malignant activated B cells that destroy the bones. The intervention of increasing fluid to manage hypercalcemia is used with multiple myeloma.
42. Following a splenectomy for the treatment of ITP, what laboratory test result would the nurse expect to find? a. Decreased RBCs b. Decreased WBCs c. Increased platelets d. Increased immunoglobulin
42. c. Splenectomy may be indicated for treatment for ITP, and when the spleen is removed, platelet counts increase significantly in most patients. In any of the disorders in which the spleen removes excessive blood cells, splenectomy will most often increase peripheral RBC, WBC, and platelet counts.
43. Patient-Centered Care: A 60-yr-old male farmer is diagnosed with multiple myeloma. He has pain in his ribs with movement and his diagnostic studies show hypercalcemia. What nursing interventions should be implemented for this patient as the interprofessional care is being initiated (select all that apply)? a. Provide privacy b. Complete bed rest c. Adequate hydration d. Prepare for dialysis e. Assess for infection f. Encourage ambulation
43. c, e, f. Because he has hypercalcemia, adequate hydration and ambulation, not bed rest, are implemented to dilute calcium and prevent protein precipitates from causing renal tubular obstruction and help bones resorb some calcium with weight bearing. Assessing for infection must be done because the excess plasma cells are monoclonal and ineffective against infection. Privacy would be provided for all patients. Although this patient may need dialysis in the late states of multiple myeloma, it is not needed at this time. Analgesia for rib pain will be provided as prescribed by the HCP.
44. Priority Decision: While receiving a unit of packed RBCs, the patient develops chills and a temperature of 102.2° F (39° C). What is the priority action for the nurse to take? a. Stop the transfusion and instill normal saline. b. Notify the health care provider and the blood bank. c. Add a leukocyte reduction filter to the blood administration set. d. Recognize this as a mild allergic transfusion reaction and slow the transfusion.
44. a. Chills and fever are symptoms of an acute hemolytic or febrile transfusion reaction, and if these develop, the nurse should stop the transfusion, infuse saline through the IV line, notify the HCP and blood bank immediately, recheck the ID tags, and monitor vital signs and urine output. The addition of a leukocyte reduction filter may prevent a febrile reaction but is not helpful once the reaction has occurred. Mild and transient allergic reactions indicated by itching and hives may permit restarting the transfusion after treatment with antihistamines
45. A patient with thrombocytopenia with active bleeding is to receive two units of platelets. To administer the platelets, what should the nurse do? a. Check for ABO compatibility. b. Agitate the bag periodically during the transfusion. c. Take vital signs every 15 minutes during the procedure. d. Refrigerate the second unit until the first unit has transfused.
45. b. Because platelets adhere to the plastic bags, the bag should be gently agitated throughout the transfusion. Platelets do not have A, B, or Rh antibodies, and ABO compatibility is not a consideration. Baseline vital signs should be taken before the transfusion is started, and the nurse should stay with the patient during the first 15 minutes. Platelets are stored at room temperature for 1 to 5 days.
46. Which type of transfusion reaction occurs with leukocyte or plasma protein incompatibility and may be avoided with leukocyte reduction filters? a. Allergic reaction b. Acute hemolytic reaction c. Febrile, nonhemolytic reaction d. Massive blood transfusion reaction
46. c. Febrile nonhemolytic reaction is the most common transfusion reaction. Allergic reactions occur with sensitivity to foreign plasma proteins and can be treated prophylactically with antihistamines. Acute hemolytic reactions are related to the infusion of ABO-incompatible blood or components with 10 mL or more of RBCs. Massive blood transfusion reactions occur when patients receive more RBCs or blood than the total blood volume.
47. Which characteristics are related to an acute hemolytic transfusion reaction (select all that apply)? a. ABO incompatibility b. Hypothermia common c. Destruction of donor RBCs d. Acute kidney injury occurs e. Hypocalcemia and hyperkalemia f. Epinephrine used for severe reaction
47. a, c, d. ABO incompatibility, destruction of donor RBCs, and acute kidney injury may occur in an acute hemolytic transfusion reaction. Hypothermia, hypocalcemia, and hyperkalemia are most likely to occur in massive blood transfusion reactions. Epinephrine may be used for severe allergic transfusion reactions, and the infusion may be restarted after treatment with antihistamines in mild cases.
5. Which anemia is manifested with pancytopenia? a. Thalassemia b. Aplastic anemia c. Megaloblastic anemia d. Anemia of chronic disease
5. b. Aplastic anemia has a decrease of all blood cell types and hypocellular bone marrow. Thalassemia is characterized by inadequate production of normal hemoglobin and decreased erythrocyte production. Megaloblastic anemias (cobalamin deficiency and folic acid deficiency anemias) are caused by impaired DNA synthesis, which results in the presence of large red blood cells (RBCs). Anemia of chronic disease occurs with chronic inflammation, autoimmune and infectious disorders, heart failure, malignancies, or bleeding episodes. It manifests with underproduction of RBCs and shortened RBC survival.
6. Which descriptions are characteristic of iron-deficiency anemia (select all that apply)? a. Lack of intrinsic factor b. Autoimmune-related disease c. Most common type of anemia d. Associated with chronic blood loss e. May occur with removal of the stomach f. May occur with removal of the duodenum
6. c, d, f. Iron-deficiency anemia is the most common type of anemia and occurs with chronic blood loss or malabsorption in the duodenum so it may occur with duodenal removal. The other options are associated with cobalamin deficiency.
7. A 20-yr-old female patient is in the emergency department for anorexia and fatigue. She takes phenytoin (Dilantin) for a seizure disorder and oral contraceptives. For which type of anemia is this patient most at risk? a. Aplastic anemia b. Hemolytic anemia c. Iron-deficiency anemia d. Folic acid deficiency anemia
7. d. Folic acid deficiency megaloblastic anemia is related to dietary deficiency as seen in anorexia and with the use of oral contraceptives and antiseizure medications. The other anemias are unrelated to this patient's history.
9. When teaching the patient about a new prescription for oral iron supplements, what does the nurse instruct the patient to do? a. Increase fluid and dietary fiber intake. b. Take the iron preparations with meals. c. Use enteric-coated preparations taken with orange juice. d. Report the presence of black stools to the health care provider.
9. a. Constipation is a common side effect of oral iron supplementation, and increased fluids and fiber should be consumed to prevent this effect. Because iron is best absorbed in an acid environment and can be bound in the gastrointestinal (GI) tract by food, it should be taken before meals, unless gastric side effects of the supplements necessitate its ingestion with food. Taking iron with ascorbic acid or orange juice enhances absorption of the iron, but enteric-coated iron often is ineffective because of unpredictable release of the iron in areas of the GI tract where it can be absorbed. Black stools are an expected result of oral iron preparations.
