Chapter 31: Caring for Clients with Disorders of the Hematopoietic System
After teaching a client about taking daily oral iron preparations for a moderate iron deficiency anemia, which statement by the client indicates to the nurse that additional instruction is needed? "I will occasionally take a stool softener if I feel constipated." "I will increase my fluid and fiber intake while I am taking the iron tablets." "I will call the doctor if my stools turn black." "I will take the iron with orange juice about an hour before eating."
"I will call the doctor if my stools turn black." Explanation: Iron replacement therapy may change the color of stool, usually to dark green or black. Iron is best absorbed on an empty stomach, so the client is instructed to take the supplement an hour before meals. Many clients have difficulty tolerating iron supplements because of gastrointestinal (GI) side effects (primarily constipation). Limit GI side effects by adding a stool softener or increasing dietary fiber and fluids. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.
A client with anemia is prescribed an oral iron supplement. Which statement indicates that teaching about this supplement has been effective? "I will be sure to take this medication with food." "I will limit my intake of raw fruit and vegetables." "I will take it in the morning with orange juice." "I will stop taking it if my stool turns black."
"I will take it in the morning with orange juice." Explanation: The client should be instructed to take the iron supplements on an empty stomach with a source of vitamin C such as orange juice. Iron supplements will turn the stool dark or black; this does not indicate that the supplement should be stopped. The supplement should be taken 1 hour before meals or 2 hours after a meal and not with a meal. The client should be instructed to increase the intake of high-fiber foods to reduce the risk of constipation.
A client with anemia is prescribed an oral iron supplement. Which statement indicates that teaching about this supplement has been effective? "I will take it in the morning with orange juice." "I will stop taking it if my stool turns black." "I will limit my intake of raw fruit and vegetables." "I will be sure to take this medication with food."
"I will take it in the morning with orange juice." Explanation: The client should be instructed to take the iron supplements on an empty stomach with a source of vitamin C such as orange juice. Iron supplements will turn the stool dark or black; this does not indicate that the supplement should be stopped. The supplement should be taken 1 hour before meals or 2 hours after a meal and not with a meal. The client should be instructed to increase the intake of high-fiber foods to reduce the risk of constipation.
The nurse is providing education to a patient with iron deficiency anemia who has been prescribed iron supplements. What statement should the nurse include in patient education? -"Take the iron with dairy products to enhance your body's absorption of it." -"Iron will likely cause your stools to darken in color." -"You should increase your intake of vitamin E while you're taking iron." -"Limit foods high in fiber due to the risk for diarrhea."
"Iron will likely cause your stools to darken in color." Explanation: The nurse will inform the patient that iron will cause the stools to become dark in color. Iron should be taken on an empty stomach, as its absorption is affected by food, especially dairy products. Patients should be instructed to increase their intake of vitamin C to enhance iron absorption. Foods high in fiber should be consumed to minimize problems with constipation, a common side effect associated with iron therapy.
A client with a recent diagnosis of ITP has asked the nurse why the care team has not chosen to administer platelets, stating, "I have low platelets, so why not give me a transfusion of exactly what I'm missing?" How should the nurse best respond? "Transfused platelets usually aren't beneficial because they're rapidly destroyed in the body." "A platelet transfusion often further blunts your body's own production of platelets." "Finding a matching donor for a platelet transfusion is exceedingly difficult." "A very small percentage of the platelets in a transfusion are actually functional."
"Transfused platelets usually aren't beneficial because they're rapidly destroyed in the body." Explanation: Despite extremely low platelet counts, platelet transfusions are usually avoided. Transfusions tend to be ineffective not because the platelets are nonfunctional but because the client's antiplatelet antibodies bind with the transfused platelets, causing them to be destroyed. Matching the client's blood type is not usually necessary for a platelet transfusion. Platelet transfusions do not exacerbate low platelet production.
A nurse is reviewing the various manifestations of anemia across the lifespan and notes a significant difference in how the older adult client responds to anemia versus a younger individual. Which concepts related to aging and the response to anemia does the nurse recognize? Select all that apply. Confusion is often greater than in younger clients. Fatigue is often greater than in younger clients. Dyspnea is not reported as often as in younger clients. Cardiac output increases more than in younger clients. Heart rate does not increase as much as in younger clients.
-Fatigue is often greater than in younger clients. -Heart rate does not increase as much as in younger clients. -Confusion is often greater than in younger clients. Correct response: Explanation: In the older adult client, fatigue, dyspnea, and confusion associated with anemia may be seen more readily versus a younger client. Cardiac output and heart rate compensatory mechanisms do not increase as much with older adult clients versus younger clients with anemia. Fatigue, dyspnea, and confusion related to anemia is often greater in the older adult client versus the younger client.
The nurse is caring for a client with an exacerbation of sickle cell disease (SCD). Which finding indicates to the nurse that the client is experiencing a liver complication from this condition? Glucose intolerance Abdominal pain Fatigue Weakness
Abdominal pain Explanation: Sickle cell disease (SCD) is an autosomal recessive disorder caused by inheritance of the sickle hemoglobin (HbS) gene. It is associated with severe hemolytic anemia. The HbS gene results in production of a defective hemoglobin molecule that causes the erythrocyte to change shape when exposed to low oxygen tension. The erythrocyte usually has a round, biconcave, pliable shape which in SCD becomes rigid and sickle shaped. Complications of SCD can affect all body systems. Evidence that the client is experiencing a complication in the liver would be the development of abdominal pain. Fatigue and weakness indicate complications involving the central nervous system and heart. Glucose intolerance is not identified as a complication of SCD.
The nurse is planning the care of a client with a nutritional deficit and a diagnosis of megaloblastic anemia. The nurse should recognize that this client's health problem is due to which issue with the red blood cells (RBCs)? -Abnormalities in the structure and function of RBCs -Injury to the RBCs in circulation -Production of inadequate quantities of RBCs -Premature release of immature RBCs
Abnormalities in the structure and function of RBCs Explanation: Vitamin B12 and folate deficiencies are characterized by the production of abnormally large erythrocytes called megaloblasts. Because these cells are abnormal, many are sequestered (trapped) while still in the bone marrow, and their rate of release is decreased. Some of these cells actually die in the marrow before they can be released into the circulation. This results in megaloblastic anemia. This pathologic process does not involve inadequate production, premature release, or injury to existing RBCs.
A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify? -Electrolyte imbalance that could affect the blood's ability to coagulate properly -Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels -Low levels of urine constituents normally excreted in the urine -Potential hepatic dysfunction indicated by decreased blood urea nitrogen (BUN) and creatinine levels
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.
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? -Constant access to clotting factor concentrates -Meticulous hygiene -Adequate nutrition -Avoidance of NSAIDs
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.
The nurse is caring for a client with acute myeloid leukemia (AML) with high uric acid levels. What medication does the nurse anticipate administering that will prevent crystallization of uric acid and stone formation? -Hydroxyurea -Asparaginase -Allopurinol -Filgrastim
Allopurinol Explanation: Massive leukemic cell destruction from chemotherapy results in the release of intracellular electrolytes and fluids into the systemic circulation. Increases in uric acid levels, potassium, and phosphate are seen; this process is referred to as tumor lysis (cell destruction) syndrome. The increased uric acid and phosphorus levels make the client vulnerable to renal stone formation and renal colic, which can progress to acute renal failure. Patients require a high fluid intake, and prophylaxis with allopurinol or rasburicase to prevent crystallization of uric acid and subsequent stone formation
A client with several chronic health problems has been newly diagnosed with a qualitative platelet defect. What component of the client's previous medication regimen may have contributed to the development of this disorder? -Calcium carbonate -Aspirin -Vitamin D -Vitamin B12
Aspirin Explanation: Aspirin may induce a platelet disorder. Even small amounts of aspirin reduce normal platelet aggregation, and the prolonged bleeding time lasts for several days after aspirin ingestion. Calcium, vitamin D, and vitamin B12 do not have the potential to induce a platelet defect.
A client with a new diagnosis of leukemia is about to start treatment and expresses fear and anxiety with the prognosis. Which action is the nurse's most appropriate? Encourage the client to call their family and discuss immediate role restructuring in both their family and professional life. Offer to call pastoral services and review hospice and/or palliative care so the client can have a quiet, dignified death. Communicate to the health care provider the need to provide more information to the client and family. Assess how much information is desired from the client in terms of illness, treatment, and complications.
Assess how much information is desired from the client in terms of illness, treatment, and complications. Explanation: As with any client exhibiting anxiety and fear about a prognosis, listening should come first in order to assess how much information the client wants to have regarding the illness, treatment and potential complications. This is an ongoing assessment, since needs and interest in information changes throughout the course of treatment. Managing a client's care is a team effort, so involving the primary care provider and family is important, but not the nurse's priority action. Offering pastoral services and role restructuring has its place in treatment but should be discussed after an assessment of the client's needs. A discussion about palliative care and hospice is not appropriate at this time. Offering realistic hope is important and only after all treatment options are exhausted, or the client is diagnosed as terminal, should palliative and/or hospice care be considered.
A client who is undergoing consolidation therapy for the treatment of leukemia has been experiencing debilitating fatigue. How can the nurse best meet this client's needs for physical activity? -Collaborate with the physical therapist to arrange for stair exercises. -Teach the client about the risks of immobility and the benefits of exercise. -Teach the client to perform deep breathing and coughing exercises. -Assist the client to a chair during awake times, as tolerated.
Assist the client to a chair during awake times, as tolerated. Explanation: Sitting up in a chair is preferable to bed rest, even if a client is experiencing severe fatigue. A client who has debilitating fatigue would not likely be able to perform stair exercises. Teaching about mobility may be necessary, but education must be followed by interventions that actually involve mobility. Deep breathing and coughing reduce the risk of respiratory complications but are not substitutes for physical mobility in preventing deconditioning.
A nurse cares for a client with anemia requiring nutritional supplementation. Which nursing intervention best promotes client adherence with the prescribed therapy? -Develop a therapeutic regimen based on the client's understanding of the medication. -Assist the client to use a medication reminder system for the therapeutic regimen. -Assist the client to incorporate the therapeutic regimen into daily activities. -Develop a therapeutic regimen recommendation for the client.
Assist the client to incorporate the therapeutic regimen into daily activities. Explanation: The best way for the nurse to promote adherence to the therapeutic regimen is to assist the client to incorporate the therapeutic regimen into daily activities. This action is the only answer choice that is a collaborative effort with the client and is the reason it is correct.
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? -Determining what days to be active. -Encouraging early and frequent activities. -Keeping long activity periods to build client stamina. -Assisting in prioritizing 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.
When teaching a client with sickle cell disease about strategies to prevent crises, what measures should the nurse recommend? -Avoiding cold temperatures and ensuring sufficient hydration -Maximizing physical activity and taking OTC iron supplements -Using prophylactic antibiotics and performing meticulous hygiene -Limiting psychosocial stress and eating a high-protein diet
Avoiding cold temperatures and ensuring sufficient hydration Explanation: Keeping warm and providing adequate hydration can be effective in diminishing the occurrence and severity of attacks. Hygiene, antibiotics, and high protein intake do not prevent crises. Maximizing activity may exacerbate pain and be unrealistic.
When teaching a client with sickle cell disease about strategies to prevent crises, what measures should the nurse recommend? -Maximizing physical activity and taking OTC iron supplements -Limiting psychosocial stress and eating a high-protein diet -Using prophylactic antibiotics and performing meticulous hygiene -Avoiding cold temperatures and ensuring sufficient hydration
Avoiding cold temperatures and ensuring sufficient hydration Explanation: Keeping warm and providing adequate hydration can be effective in diminishing the occurrence and severity of attacks. Hygiene, antibiotics, and high protein intake do not prevent crises. Maximizing activity may exacerbate pain and be unrealistic.
A patient describes numbness in the arms and hands with a tingling sensation. The patient also frequently stumbles when walking. What vitamin deficiency does the nurse determine may cause some of these symptoms? -Iron -Folate -B12 -Thiamine
B12 Explanation: The hematologic effects of vitamin B12 deficiency are accompanied by effects on other organ systems, particularly the gastrointestinal tract and nervous system. Patients with pernicious anemia may become confused; more often, they have paresthesias in the extremities (particularly numbness and tingling in the feet and lower legs). They may have difficulty maintaining their balance because of damage to the spinal cord, and they also lose position sense (proprioception).
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? -Fruits high in vitamin C, such as oranges and grapefruits -Beans, dried fruits, and leafy, green vegetables -Dairy products -Berries and orange vegetables
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.
A nurse cares for a client suspected of having iron deficient anemia. Which diagnostic test will the nurse expect the health care provider to order in order to definitively diagnose the condition? -Bone marrow aspiration -Complete blood count -Blood smear -Serum ferritin
Bone marrow aspiration Explanation: The definitive method of diagnosis for iron deficiency anemia is bone marrow aspiration. The other answer choices may also be used to help with the diagnosis of the condition; however, these are not definitive diagnostic tests.
The nurse cares for a client with acute myeloid leukemia with severe bone pain. What pathophysiological concept does the nurse understand is the reason for the client's pain? -Abnormal blood cells crystalize. -Abnormal blood cells deposit in small vessels. -Bone marrow expands. -Lymph nodes expand.
Bone marrow expands. Explanation: In acute myeloid leukemia, bone pain is caused when the bone marrow expands.
Which is a symptom of hemochromatosis? -Inflammation of the tongue -Weight gain -Bronzing of the skin -Inflammation of the mouth
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.
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? -antibiotic -CBC -ECG -chest radiograph
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.
A nurse is caring for a client who has been diagnosed with leukemia. The nurse's most recent assessment reveals the presence of ecchymoses on the client's sacral area and petechiae on the forearms. In addition to informing the client's primary care provider, the nurse should perform what action? Place the client on protective isolation. Initiate measures to prevent venous thromboembolism (VTE). Ambulate the client to promote circulatory function. Check the client's most recent platelet level.
Check the client's most recent platelet level. Explanation: The client's signs are suggestive of thrombocytopenia, thus the nurse should check the client's most recent platelet level. VTE is not a risk and this does not constitute a need for isolation. Ambulation and activity may be contraindicated due to the risk of bleeding.
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 the client's level of consciousness frequently. -Assess for edema. -Assess skin integrity 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.
A nurse is planning the care of a client who has been admitted with a diagnosis of multiple myeloma. What pathophysiologic effect of multiple myeloma most contributes to this client's risk for injury? -Labyrinthitis -Left ventricular hypertrophy -Hypercoagulation -Decreased bone density
Decreased bone density Explanation: Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis and osteolytic lesions. Labyrinthitis is uncharacteristic, and clients do not normally experience hypercoagulation or cardiac hypertrophy.
A nurse cares for a client with a hematological disorder and malnutrition. What is the nurse's best understanding of how the client's nutritional status may worsen the client's hematological condition? -Decreased calories lead to decreased immune response -Decreased carbohydrates lead to decreased oxygen affinity of the hemoglobin -Decreased fat stores lead to decreased ability for red blood cells -Decreased protein stores lead to decreased immune response
Decreased protein stores lead to decreased immune response Explanation: Decreased protein stores lead to a decreased immune response and worsening of the client's hematological condition. Decreased intake of carbohydrates, calories, or fat stores are not the primary sources for worsening of the client's condition.
A nurse cares for a client with a hematological disorder and malnutrition. What is the nurse's best understanding of how the client's nutritional status may worsen the client's hematological condition? -Decreased protein stores lead to decreased immune response -Decreased calories lead to decreased immune response -Decreased carbohydrates lead to decreased oxygen affinity of the hemoglobin -Decreased fat stores lead to decreased ability for red blood cells
Decreased protein stores lead to decreased immune response Explanation: Decreased protein stores lead to a decreased immune response and worsening of the client's hematological condition. Decreased intake of carbohydrates, calories, or fat stores are not the primary sources for worsening of the client's condition.
The nurse is caring for a client with external bleeding. What is the nurse's priority intervention? -Pressure point control -Elevation of the extremity -Application of a tourniquet -Direct pressure
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.
A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia? -Nausea, vomiting, and anorexia -Nights sweats, weight loss, and diarrhea -Itching, rash, and jaundice -Dyspnea, tachycardia, and pallor
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.
Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia? -Have the client use a soft toothbrush and electric razor, avoid using enemas, and watch for signs of bleeding. -Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing. -Put on a mask, gown, and gloves when entering the client's room. -Provide a clear liquid, low-sodium diet.
Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing. Explanation: Neutropenia occurs when the absolute neutrophil count falls below 1,000/mm3, reflecting a severe risk of infection. The nurse should provide a low-bacterial diet, which means eliminating fresh fruits and vegetables, avoiding invasive procedures such as enemas, and practicing frequent hand washing. Using a soft toothbrush, avoiding straight-edged razors and enemas, and monitoring for bleeding are precautions for clients with thrombocytopenia. Putting on a mask, gown, and gloves when entering the client's room are reverse isolation measures. A neutropenic client doesn't need a clear liquid diet or sodium restrictions.
Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia? -Put on a mask, gown, and gloves when entering the client's room. -Have the client use a soft toothbrush and electric razor, avoid using enemas, and watch for signs of bleeding. -Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing. -Provide a clear liquid, low-sodium diet.
Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing. Explanation: Neutropenia occurs when the absolute neutrophil count falls below 1,000/mm3, reflecting a severe risk of infection. The nurse should provide a low-bacterial diet, which means eliminating fresh fruits and vegetables, avoiding invasive procedures such as enemas, and practicing frequent hand washing. Using a soft toothbrush, avoiding straight-edged razors and enemas, and monitoring for bleeding are precautions for clients with thrombocytopenia. Putting on a mask, gown, and gloves when entering the client's room are reverse isolation measures. A neutropenic client doesn't need a clear liquid diet or sodium restrictions.
A client who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action? -Keep the client on bed rest. -Evaluate the client's INR. -Evaluate the client's platelet count. -Ask the client whether they have recently fallen.
Evaluate the client's platelet count. Explanation: Complications of AML include bleeding. The risk of bleeding correlates with the level and duration of platelet deficiency. Major hemorrhages may develop when the platelet count drops to less than 10,000/mm3. The bleeding is usually unrelated to falling. Keeping the client on bed rest will not prevent bleeding when the client has a low platelet count. Assessment for other areas of bleeding is also a priority intervention.
A nurse prepares a client for a bone marrow biopsy who is suspected of having acute myeloid leukemia. What results from the bone marrow biopsy does the nurse expect? Excess of immature erythrocytes Excess of immature leukocytes Deficiency of neutrophils Deficiency of erythrocytes
Excess of immature leukocytes Explanation: The bone marrow biopsy of a client with acute myeloid leukemia will reveal an excess of immature leukocytes.
A client was admitted to the hospital with the following laboratory values: hemoglobin 5 g/dL, leukocyte count 2000/mm3, and a platelet count of 48,000/mm3; abnormally shaped erythrocytes and hypersegmented neutrophils were seen. The platelets appear abnormally large. A bone marrow biopsy was competed and revealed hyperplasia. Based on this information, the nurse determines that client most likely has which diagnosis? -Folic acid deficiency -Hemolytic anemia Sickle cell anemia Thalassemia
Folic acid deficiency Explanation: Anemia caused by a deficiency of folic acid cause bone marrow and peripheral blood changes. The erythrocytes that are produced are abnormally large and are called megaloblastic red cells. Other cells derived from the myeloid stem cell are also abnormal. A bone marrow analysis reveals hyperplasia (abnormal increase in the number of cells). Pancytopenia (a decrease in all myeloid stem cell-derived cells) can develop. In advanced stages of disease, the hemoglobin value may be as low as 4-5 g/dL, the leukocyte count 2,000-3,000/mm3, and the platelet count less than 50,000/mm3. Cells that are released into the circulation are often abnormally shaped. The neutrophils are hypersegmented. The platelets may be abnormally large. The erythrocytes are abnormally shaped.
When assessing a female client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential? -Menstrual history -Health history, such as bleeding, fatigue, or fainting -Lifestyle assessments, such as exercise routines -Age and gender
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. Age, gender, menstrual history, or lifestyle assessments, such as exercise routines and habits, do not directly affect the hematopoietic or lymphatic system.
The nurse is currently planning the care of a patient with multiple myeloma who is experiencing bone destruction. When reviewing the patient's most recent blood work, what value would the nurse pay particular attention to? -Hyperproteinemia -Hypercalcemia -Elevated serum viscosity -Elevated red blood cell (RBC) count
Hypercalcemia Explanation: Hypercalcemia may occur when bone destruction occurs due to the disease process. Elevated serum viscosity occurs because plasma cells excrete excess immunoglobulin. RBC count will be decreased. Hyperproteinemia would not be present.
A nurse plans care for a client with multiple myeloma. Using the CRAB acronym for symptoms associated with this disease, which clinical features does the nurse expect to find upon assessment of the client? Select all that apply. -Hypercalcemia -Renal insufficiency -Anemia -Bone lesions -Acidosis
Hypercalcemia Renal insufficiency Anemia Bone lesions Explanation: The acronym CRAB is used to describe the combined pathologic effects of multiple myeloma and include: calcium levels elevated (hypercalcemia), renal insufficiency, anemia, bone lesions. Acidosis is not part of the acronym used to describe the pathologic effects of the disease.
A nurse plans care for a client with multiple myeloma. Using the CRAB acronym for symptoms associated with this disease, which clinical features does the nurse expect to find upon assessment of the client? Select all that apply. -Hypercalcemia -Bone lesions -Anemia -Renal insufficiency -Acidosis
Hypercalcemia Renal insufficiency Anemia Bone lesions Explanation: The acronym CRAB is used to describe the combined pathologic effects of multiple myeloma and include: calcium levels elevated (hypercalcemia), renal insufficiency, anemia, bone lesions. Acidosis is not part of the acronym used to describe the pathologic effects of the disease.
A nurse is planning the care of a client with a diagnosis of sickle cell disease who has been admitted for the treatment of an acute vaso-occlusive crisis. Which nursing diagnosis should the nurse prioritize in the client's plan of care? -Functional urinary incontinence related to urethral occlusion -Ineffective tissue perfusion related to thrombosis -Risk for disuse syndrome related to ineffective peripheral circulation -Ineffective thermoregulation related to hypothalamic dysfunction
Ineffective tissue perfusion related to thrombosis Explanation: There are multiple potential complications of sickle cell disease and sickle cell crises. Central among these, however, is the risk of thrombosis and consequent lack of tissue perfusion. Sickle cell crises are not normally accompanied by impaired thermoregulation or genitourinary complications. Risk for disuse syndrome is not associated with the effects of acute vaso-occlusive crisis.
A nurse practitioner is assessing a client who has a fever, malaise, and a white blood cell count that is elevated. What principle should guide the nurse's management of the client's care? -Infection is the most likely cause of the client's change in health status. -The client is exhibiting signs and symptoms of leukemia. -There is a need for the client to be assessed for lymphoma. -The client should undergo diagnostic testing for multiple myeloma.
Infection is the most likely cause of the client's change in health status. Explanation: Leukocytosis is most often the result of infection. It is only considered pathologic (and suggestive of leukemia) if it is persistent and extreme. Multiple myeloma and lymphoma are not likely causes of this constellation of symptoms.
A client is being treated on the medical unit for a sickle cell crisis. The nurse's most recent assessment reveals a fever and a new onset of fine crackles on lung auscultation. Which action by the nurse would be the most appropriate? -Liaise with the respiratory therapist and consider high-flow oxygen. -Administer bronchodilators by nebulizer. -Inform the health care provider that the client may have an infection. -Apply supplementary oxygen by nasal cannula.
Inform the health care provider that the client may have an infection. Explanation: Clients with sickle cell disease are highly susceptible to infection, thus any early signs of infection should be reported promptly. There is no evidence of respiratory distress, so oxygen therapy and bronchodilators are not indicated.
The nurse is administering packed red blood cell (RBC) transfusions for a patient with myelodysplastic syndrome (MDS). The patient has had several transfusions and is likely to receive several more. What is a priority for the nurse to monitor related to the transfusions? -Iron levels -Creatinine and blood urea nitrogen (BUN) levels -Magnesium levels -Potassium levels
Iron levels Explanation: For most patients with MDS, transfusions of RBCs may be required to control the anemia and its symptoms. These patients can develop iron overload from the repeated transfusions; this risk can be diminished with prompt initiation of chelation therapy (see following Nursing Management section).
The nurse is administering packed red blood cell (RBC) transfusions for a patient with myelodysplastic syndrome (MDS). The patient has had several transfusions and is likely to receive several more. What is a priority for the nurse to monitor related to the transfusions? -Iron levels -Creatinine and blood urea nitrogen (BUN) levels -Magnesium levels -Potassium levels
Iron levels Explanation: For most patients with MDS, transfusions of RBCs may be required to control the anemia and its symptoms. These patients can develop iron overload from the repeated transfusions; this risk can be diminished with prompt initiation of chelation therapy (see following Nursing Management section).
The nurse is administering packed red blood cell (RBC) transfusions for a patient with myelodysplastic syndrome (MDS). The patient has had several transfusions and is likely to receive several more. What is a priority for the nurse to monitor related to the transfusions? -Potassium levels -Creatinine and blood urea nitrogen (BUN) levels -Iron levels -Magnesium levels
Iron levels Explanation: For most patients with MDS, transfusions of RBCs may be required to control the anemia and its symptoms. These patients can develop iron overload from the repeated transfusions; this risk can be diminished with prompt initiation of chelation therapy (see following Nursing Management section).
The nurse is administering packed red blood cell (RBC) transfusions for a patient with myelodysplastic syndrome (MDS). The patient has had several transfusions and is likely to receive several more. What is a priority for the nurse to monitor related to the transfusions? -Potassium levels -Creatinine and blood urea nitrogen (BUN) levels -Magnesium levels -Iron levels
Iron levels Explanation: For most patients with MDS, transfusions of RBCs may be required to control the anemia and its symptoms. These patients can develop iron overload from the repeated transfusions; this risk can be diminished with prompt initiation of chelation therapy (see following Nursing Management section).
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 increase red blood cell (RBC) production to compensate for blood loss. -It will reduce the destruction of platelets by macrophages. -It will increase production of platelets by the bone marrow.
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.
The nurse is assessing a new client with reports of acute fatigue and a sore tongue that is visibly smooth and beefy red. This client is demonstrating signs and symptoms associated with what form of hematologic disorder? -Megaloblastic anemia -Thrombocytopenia -Hemophilia -Sickle cell disease
Megaloblastic anemia Explanation: A red, smooth, sore tongue is a symptom associated with megaloblastic anemia. Sickle cell disease, hemophilia, and thrombocytopenia do not have symptoms involving the tongue.
The nurse is assessing a new client with reports of acute fatigue and a sore tongue that is visibly smooth and beefy red. This client is demonstrating signs and symptoms associated with what form of hematologic disorder? -Thrombocytopenia -Sickle cell disease -Megaloblastic anemia -Hemophilia
Megaloblastic anemia Explanation: A red, smooth, sore tongue is a symptom associated with megaloblastic anemia. Sickle cell disease, hemophilia, and thrombocytopenia do not have symptoms involving the tongue.
An emergency department nurse is triaging a 77-year-old client who presents with uncharacteristic fatigue as well as back and rib pain. The client denies any recent injuries. The nurse should recognize the need for this client to be assessed for which health problem? -Hodgkin disease -Acute thrombocythemia -Multiple myeloma -Non-Hodgkin lymphoma
Multiple myeloma Explanation: Back pain, which is often a presenting symptom in multiple myeloma, should be closely investigated in older clients. The lymphomas and bleeding disorders do not typically present with the primary symptom of back pain or rib pain.
A nurse is planning the care of a client who has a diagnosis of hemophilia A. When addressing the nursing diagnosis of Acute Pain Related to Joint Hemorrhage, what principle should guide the nurse's choice of interventions? NSAIDs are contraindicated due to the risk for bleeding. Gabapentin (Neurontin) is effective because of the neuropathic nature of the client's pain. Opioids may cause vasodilation and exacerbate bleeding. Opioids partially inhibit the client's synthesis of clotting factors.
NSAIDs are contraindicated due to the risk for bleeding. Explanation: NSAIDs may be contraindicated in clients with hemophilia due to the associated risk of bleeding. Opioids do not have a similar effect and they do not inhibit platelet synthesis. The pain associated with hemophilia is not neuropathic.
A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever? -Neutropenia -Anemia -Pancytopenia -Thrombocytopenia
Neutropenia Explanation: Fever and infection result from a decrease in neutrophils (neutropenia). Decreased red blood cells (anemia) cause weakness, fatigue, dyspnea on exertion, and pallor in AML. Pancytopenia, an overall decrease in all blood components, is not cause of fever in clients with AML. Decreased platelet count (thrombocytopenia) causes petechiae and bruising in AML.
A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever? -Neutropenia -Thrombocytopenia -Anemia -Pancytopenia
Neutropenia Explanation: Fever and infection result from a decrease in neutrophils (neutropenia). Decreased red blood cells (anemia) cause weakness, fatigue, dyspnea on exertion, and pallor in AML. Pancytopenia, an overall decrease in all blood components, is not cause of fever in clients with AML. Decreased platelet count (thrombocytopenia) causes petechiae and bruising in AML.
The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? -Osteoclasts break down bone cells so pathologic fractures occur. -Osteopathic tumors destroy bone causing fractures. -Osteosarcomas form producing pathologic fractures. -Osteolytic activating factor weakens bones producing fractures.
Osteoclasts break down bone cells so pathologic fractures occur. Explanation: The abnormal plasma cells proliferate in the bone marrow, where they release osteoclast-activating factor. This, in turn, causes osteoclasts to break down bone cells, resulting in increased blood calcium and pathologic fractures. The plasma cells also form single or multiple osteolytic (bone-destroying) tumors that produce a "punched-out" or "honeycombed" appearance in bones such as the spine, ribs, skull, pelvis, femurs, clavicles, and scapulae. Weakened vertebrae lead to compression of the spine accompanied by significant pain. The other options are distractors for this question.
The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? -Osteosarcomas form producing pathologic fractures. -Osteopathic tumors destroy bone causing fractures. -Osteolytic activating factor weakens bones producing fractures. -Osteoclasts break down bone cells so pathologic fractures occur.
Osteoclasts break down bone cells so pathologic fractures occur. Explanation: The abnormal plasma cells proliferate in the bone marrow, where they release osteoclast-activating factor. This, in turn, causes osteoclasts to break down bone cells, resulting in increased blood calcium and pathologic fractures. The plasma cells also form single or multiple osteolytic (bone-destroying) tumors that produce a "punched-out" or "honeycombed" appearance in bones such as the spine, ribs, skull, pelvis, femurs, clavicles, and scapulae. Weakened vertebrae lead to compression of the spine accompanied by significant pain. The other options are distractors for this question.
A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client? -Angina pectoris, double vision, and anorexia -Pallor, tachycardia, and a sore tongue -Sore tongue, dyspnea, and weight gain -Pallor, bradycardia, and reduced pulse pressure
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.
The nurse's role in the management of polycythemia vera is primarily that of an educator. Choose the best health promotion advice that a nurse could give. -Participate in regular phlebotomy procedures to decrease blood viscosity. -Use compression stockings when walking to prevent deep vein thrombosis (DVT). -Take antiplatelets on a regular basis. -Take aspirin daily to prevent clot formation.
Participate in regular phlebotomy procedures to decrease blood viscosity. Explanation: Phlebotomy is a critical part of therapy and the only treatment that has demonstrated improved survival. Aspirin should be avoided, and antiplatelet therapy should be used with caution due to the risk of bleeding. Compression stockings are not necessary for walking but should be used for airplane travel.
The nurse's role in the management of polycythemia vera is primarily that of an educator. Choose the best health promotion advice that a nurse could give. -Use compression stockings when walking to prevent deep vein thrombosis (DVT). -Take aspirin daily to prevent clot formation. -Participate in regular phlebotomy procedures to decrease blood viscosity. -Take antiplatelets on a regular basis.
Participate in regular phlebotomy procedures to decrease blood viscosity. Explanation: Phlebotomy is a critical part of therapy and the only treatment that has demonstrated improved survival. Aspirin should be avoided, and antiplatelet therapy should be used with caution due to the risk of bleeding. Compression stockings are not necessary for walking but should be used for airplane travel.
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? -Nausea and vomiting -Migraine -Peripheral edema -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.
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 -Pernicious anemia -Sickle cell 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.
A client is diagnosed with low risk asymptomatic polycythemia vera. For which treatment will the nurse prepare teaching for this client? Phlebotomy Ruxolitinib Hydroxyurea Interferon-alfa
Phlebotomy Explanation: The objectives of management in polycythemia vera are to reduce the risk of thrombosis without increasing the risk of bleeding, reduce the risk of evolution to myelofibrosis or AML, and ameliorate symptoms associated with the disease. Phlebotomy is considered the mainstay of therapy and is used to maintain the hematocrit level at less than 45%. It involves removing enough blood (initially 500 mL once or twice weekly) to reduce blood viscosity and to deplete iron stores, thereby rendering the patient iron deficient and consequently unable to continue to manufacture excessive RBCs. Ruxolitinib is a JAK2 inhibitor and is used in clients who are unable to tolerate other treatment approaches. Cytoreductive therapy should be considered in clients at low-risk who are symptomatic due to progressive splenomegaly, leukocytosis, thrombocytosis, or have poor tolerance to phlebotomy. This type of therapy is accomplished through the use of hydroxyurea or interferon-alpha.
A patient with polycythemia vera has a high red blood cell (RBC) count and is at risk for the development of thrombosis. What treatment is important to reduce blood viscosity and to deplete the patient's iron stores? -Chelation therapy -Phlebotomy -Blood transfusions -Radiation
Phlebotomy Explanation: The objective of management is to reduce the high RBC count and reduce the risk of thrombosis. Phlebotomy is an important part of therapy (Fig. 34-5). It involves removing enough blood (initially 500 mL once or twice weekly) to reduce blood viscosity and to deplete the patient's iron stores, thereby rendering the patient iron deficient and consequently unable to continue to manufacture hemoglobin excessively.
A patient with a diagnosis of immune thrombocytopenic purpura (ITP) is currently receiving IVIG for the treatment of her health condition. The nurse who is providing this patient's care is aware that ITP is a consequence of: Impaired liver function and the sequestering of platelets by hepatocytes Inappropriate platelet aggregation on the walls of the great vessels Hemolysis of platelets in individuals who lack immunity to the Epstein-Barr virus Platelet destruction and impaired platelet production resulting from an autoimmune process
Platelet destruction and impaired platelet production resulting from an autoimmune process Explanation: Although the precise cause of ITP remains unknown, the platelet count is decreased by a combination of autoantibody-mediated platelet destruction and impaired platelet production secondary to autoantibody effects on the megakaryocyte. Viruses, impaired liver function, and inappropriate platelet aggregation are not dimensions of the etiology of ITP.
The nurse is assessing a patent with polycythemia vera. What skin assessment data would the nurse determine is a normal finding for this patient? -Jaundice skin and sclera -Ruddy complexion -Bronze skin tone -Pale skin and mucous membranes
Ruddy complexion Explanation: Polycythemia vera (sometimes called P vera), or primary polycythemia, is a proliferative disorder of the myeloid stem cells. Patients typically have a ruddy complexion and splenomegaly.
The nurse is assessing a patent with polycythemia vera. What skin assessment data would the nurse determine is a normal finding for this patient? -Pale skin and mucous membranes -Bronze skin tone -Jaundice skin and sclera -Ruddy complexion
Ruddy complexion Explanation: Polycythemia vera (sometimes called P vera), or primary polycythemia, is a proliferative disorder of the myeloid stem cells. Patients typically have a ruddy complexion and splenomegaly.
The nurse is assessing a patent with polycythemia vera. What skin assessment data would the nurse determine is a normal finding for this patient? -Pale skin and mucous membranes -Jaundice skin and sclera -Ruddy complexion -Bronze skin tone
Ruddy complexion Explanation: Polycythemia vera (sometimes called P vera), or primary polycythemia, is a proliferative disorder of the myeloid stem cells. Patients typically have a ruddy complexion and splenomegaly.
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? -Schilling test -Bone marrow aspiration -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).
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. -Cardiac system -Spleen -Central nervous system -Liver -Lungs
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.
The nurse's brief review of a client's electronic health record indicates that the client regularly undergoes therapeutic phlebotomy. Which of the following rationales for this procedure is most plausible? -The client may previously have undergone bone marrow biopsy. -The client may chronically produce excess red blood cells. -The client may frequently experience a low relative plasma volume. -The client may have impaired stem cell function.
The client may chronically produce excess red blood cells. Explanation: Persistently elevated hematocrit is an indication for therapeutic phlebotomy. It is not used to address excess or deficient plasma volume and is not related to stem cell function. Bone marrow biopsy is not an indication for therapeutic phlebotomy.
A client diagnosed with Von Willebrand disease (vWD) has experienced recent changes in bowel function that suggest the need for a screening colonoscopy. What intervention should be performed in anticipation of this procedure? The client should receive a unit of fresh-frozen plasma (FFP ) 48 hours before the procedure. The client should be given necessary clotting factors before the procedure. The client should not undergo the normal bowel cleansing protocol prior to the procedure. The client should be admitted to the surgical unit on the day before the procedure.
The client should be given necessary clotting factors before the procedure. Explanation: A goal of treating vWD is to replace the deficient protein (e.g., vWF or factor VIII) prior to an invasive procedure to prevent subsequent bleeding. Bowel cleansing is not contraindicated and FFP does not reduce the client's risk of bleeding. There may or may not be a need for preprocedure hospital admission.
A 12-year-old girl on the oncology unit at children's hospital tells the nurse that she has discovered that there are several different kinds of leukemia. The child asks the nurse to explain what makes them all "leukemia." What should the nurse reply? The different leukemias all have unregulated proliferation of red blood cells. The different leukemias all have decrease in production of white blood cells. The different leukemias all have decrease in production of red blood cells. The different leukemias all have unregulated proliferation of white blood cells.
The different leukemias all have unregulated proliferation of white blood cells. Explanation: Leukemia commonly involves unregulated proliferation of white blood cells. Decreased production of red blood cells is associated with anemias. Decreased production of white blood cells is associated with leukopenia.
The nurse is caring for a patient who will begin taking long-term biphosphate therapy. Why is it important for the nurse to encourage the patient to receive a thorough evaluation of dentition, including panoramic dental x-rays? -The patient will develop gingival hyperplasia. -The patient can develop osteonecrosis of the jaw. -The patient is at risk for tooth decay. -The patient can develop loosening of the teeth.
The patient can develop osteonecrosis of the jaw. Explanation: Osteonecrosis of the jaw is an infrequent but serious complication that can arise in patients treated long-term with bisphosphonates; the mandible or maxilla are affected. Careful assessment for this complication should be conducted and a thorough evaluation of the patient's dentition should be performed prior to initiating bisphosphonate therapy, including panoramic dental x-rays.
A client newly diagnosed with thrombocytopenia is admitted to the medical unit. After the admission assessment, the client asks the nurse to explain the condition. What should the nurse explain to this client? -There could be decreased production of platelets. -There could be impaired communication between platelets. -There could be an attack on the platelets by antibodies. -There could be an autoimmune process causing platelet malfunction.
There could be decreased production of platelets. Explanation: Thrombocytopenia can result from a decreased platelet production, increased platelet destruction, or increased consumption of platelets. Impaired platelet communication, antibodies, and autoimmune processes are not typical pathologies.
A client newly diagnosed with thrombocytopenia is admitted to the medical unit. After the admission assessment, the client asks the nurse to explain the condition. What should the nurse explain to this client? -There could be impaired communication between platelets. -There could be an attack on the platelets by antibodies. -There could be an autoimmune process causing platelet malfunction. -There could be decreased production of platelets.
There could be decreased production of platelets. Explanation: Thrombocytopenia can result from a decreased platelet production, increased platelet destruction, or increased consumption of platelets. Impaired platelet communication, antibodies, and autoimmune processes are not typical pathologies.
When evaluating a patient's symptoms that are consistent with a diagnosis of leukemia, the nurse is aware that all leukemias have which common feature? Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements Increased blood viscosity, resulting from an overproduction of white cells Compensatory polycythemia stimulated by thrombocytopenia Reduced plasma volume in response to a reduced production of cellular elements
Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements Explanation: The term leukemia means "white blood," which is used to describe the neoplastic proliferation of one hematopoietic cell type (granulocytes, monocytes, lymphocytes, and sometimes, erythrocytes and megakaryocytes).
When evaluating a patient's symptoms that are consistent with a diagnosis of leukemia, the nurse is aware that all leukemias have which common feature? -Increased blood viscosity, resulting from an overproduction of white cells -Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements -Reduced plasma volume in response to a reduced production of cellular elements -Compensatory polycythemia stimulated by thrombocytopenia
Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements Explanation: The term leukemia means "white blood," which is used to describe the neoplastic proliferation of one hematopoietic cell type (granulocytes, monocytes, lymphocytes, and sometimes, erythrocytes and megakaryocytes).
When evaluating a patient's symptoms that are consistent with a diagnosis of leukemia, the nurse is aware that all leukemias have which common feature? -Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements -Reduced plasma volume in response to a reduced production of cellular elements -Increased blood viscosity, resulting from an overproduction of white cells -Compensatory polycythemia stimulated by thrombocytopenia
Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements Explanation: The term leukemia means "white blood," which is used to describe the neoplastic proliferation of one hematopoietic cell type (granulocytes, monocytes, lymphocytes, and sometimes, erythrocytes and megakaryocytes).
A client with a history of atrial fibrillation has contacted the clinic reporting an accidental overdose on prescribed warfarin. The nurse should recognize the possible need for which antidote? -Factor VIII -Factor X -Vitamin K -Intravenous immunoglobulins (IVIG)
Vitamin K Explanation: Of the given options, only Vitamin K is administered as an antidote for warfarin toxicity.
A client with a history of atrial fibrillation has contacted the clinic reporting an accidental overdose on prescribed warfarin. The nurse should recognize the possible need for which antidote? -Vitamin K -Intravenous immunoglobulins (IVIG) -Factor VIII -Factor X
Vitamin K Explanation: Of the given options, only Vitamin K is administered as an antidote for warfarin toxicity.
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? -Undergo genetic testing and counseling if the client is male. -Take ibuprofen for joint pain. -Take warm baths to lessen pain. -Wear a medical identification bracelet.
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.
A nurse is caring for a client who developed toxicity after long-term treatment with sulfasalazine for Crohn's disease. The client is experiencing fatigue, fever, chills, and headache and is at risk to develop opportunistic infections. Which condition has the client most likely developed? -pernicious anemia -hemolytic anemia -agranulocytosis -leukopenia
agranulocytosis Explanation: Agranulocytosis refers specifically to a decreased production of granulocytes, neutrophils, basophils, and eosinophils. The most common cause of agranulocytosis is toxicity from drugs such as sulfonamides, chloramphenicol (Chloromycetin), antineoplastic, and some psychotropic medications. Clients with leukopenia have a general reduction in all WBCs. Clients with hemolytic anemia have a chronic premature destruction of erythrocytes. Pernicious anemia develops when a client lacks intrinsic factor, which normally is present in stomach secretions.
Hemophilia A is the most common of the three types of hemophilia. What is diminished in the less serious form of hemophilia A, known as von Willebrand's disease? -amount and quality of factor IX -quality of factor VIII -quality of factor XI -amount and quality of factor VIII
amount and quality of factor VIII Explanation: In a less serious form of hemophilia A, von Willebrand's disease, the amount and quality of factor VIII is diminished.
A client has been diagnosed with Cooley's anemia, a severe form of beta-thalassemia. Which is a symptom of Cooley's anemia? -bronzing of the skin -inflammation of the tongue -dyspnea -inflammation of the mouth
bronzing of the skin Explanation: Clients with Cooley's anemia exhibit symptoms of severe anemia and a bronzing of the skin, which is caused by hemolysis of erythrocytes.
An client has pernicious anemia and has been receiving treatment for several years. What is the client lacking that results in pernicious anemia? -hemoglobin -vitamin B -intrinsic factor -extrinsic factor
intrinsic factor Explanation: Pernicious anemia develops when a client lacks intrinsic factor, which normally is present in stomach secretions. Intrinsic factor is necessary for absorption of vitamin B12. Vitamin B12, the extrinsic factor in blood, is required for the maturation of erythrocytes.
