Clinical Concepts 3 - Anemia/Sickle Cell Anemia

True or False The component of the red blood cell that is not recycled is bilirubin.

True

A client with sickle cell anemia has a A) low hematocrit. B) high hematocrit. C) normal hematocrit. D) normal blood smear.

A) low hematocrit.

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called A) blast cells. B) megaloblasts. C) mast cells. D) monocytes.

B) megaloblasts.

Which of the following symptoms is expected with hemoglobin of 10 g/dl? A) Shortness of Breath B) Pallor C) None D) Palpitations

C) None 6 - 7 Hgb = transfusion

A client with anemia may be tired due to a tissue deficiency of which of the following substances? A) Carbon dioxide B) Factor VIII C) Oxygen D) T-cell antibodies

C) Oxygen

A nurse is caring for a newborn whose screening test result indicates the possibility of sickle cell anemia (SCA) or sickle cell trait. The nurse would expect the test result to be confirmed by which lab tests? A) Reticulocyte count B) Peripheral blood smear C) Erythrocyte sedimentation rate D) Hemoglobin electrophoresis

D) Hemoglobin electrophoresis

The nurse devises a teaching plan for the patient with aplastic anemia. Which of the following is the most important concept to teach for health maintenance? A) Eat animal protein and dark leafy vegetables each day B) Avoid exposure to others with acute infection C) Practice yoga and meditation to decrease stress and anxiety D) Get 8 hours of sleep at night and take naps during the day

B) Avoid exposure to others with acute infection Aplastic Anemia - total lack of production of any blood cells - increased risk for infection

The nurse notes a decreased red blood cell (RBC) count, decreased hemoglobin and hematocrit, as well as a decreased mean corpuscular volume. This could be attributable to a decrease in secretion of what hormone? A) Interleukins B) Interferon C) Erythropoietin D) Colony-stimulating factor

C) Erythropoietin

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

D) "I will receive parenteral vitamin B12 therapy for the rest of my life."

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

A) "Eat small amounts of bland, soft foods frequently."

A patient has been receiving intramuscular injections of hydroxocobalamin as treatment for pernicious anemia. Which statement by the patient indicates that he understands the therapy? A) "I will need these injections monthly for the rest of my life." B) "Once my levels are up, I won't need the drug anymore." C) "I will get the injection for a week and then stop." D) "I need the injections now, but then I can switch to a pill."

A) "I will need these injections monthly for the rest of my life."

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

A) B12

A nurse is caring for a patient who has had a bone marrow aspiration with biopsy. What complication should the nurse be aware of and monitor the patient for? A) Hemorrhage B) Blood transfusion reaction C) Shock D) Splintering of bone fragments

A) Hemorrhage

The client with liver cancer is being treated with chemotherapy. The provider notes that the client is fatigued and has a hemoglobin of 9.5 g/dL (95 g/L) and a normal ferritin level. Which medication does the practitioner prescribe? A) Human erythropoietin B) Ferrous sulfate C) Albumin D) Gamma globulin

A) Human erythropoietin

A client presents to his physician with a red face, hands, feet, and ears; a headache; and drowsiness. A blood smear reveals an increased number of erythrocytes. Based on the laboratory results, the nurse prepares teaching material for which disease process? A) Polycythemia B) Leukemia C) Anemia D) Thrombocytopenia

A) Polycythemia

A client presents to the clinic with symptoms of elevated blood pressure, dizziness, red face, pain in fingers and toes, headache, and difficulty concentrating. A blood smear reveals an increased number of erythrocytes. Based on these findings, the nurse anticipates which diagnosis? A) Polycythemia vera B) Leukemia C) Hemolytic anemia D) Hyperbilirubinemia

A) Polycythemia vera

The nurse is caring for a client who is a strict vegetarian; the client is at greatest risk for the development of: A) Vitamin B12 deficiency anemia B) Blood loss anemia C) Folic acid deficiency anemia D) Microcytic anemia

A) Vitamin B12 deficiency anemia Vitamin B12 is found in all foods of animal origin.

A patient with chronic heart failure has begun treatment with epoetin alfa, which she will receive in her own home from a home health nurse. The nurse should teach the patient to supplement this treatment with a diet that is high in: A) iron-rich foods such as beans and leafy green vegetables. B) complex carbohydrates and vegetable-source proteins. C) calcium, such as dairy products, fish and vegetables. D) protein and low in carbohydrates.

A) iron-rich foods such as beans and leafy green vegetables.

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with sickle cell anemia. The nurses in the group make the following statements. Which statement is most accurate regarding sickle cell anemia? A) "The trait or the disease is seen in one generation and skips the next generation." B) "If the trait is inherited from both parents the child will have the disease." C) "The disease is most often seen in individuals of Asian decent." D) "Males are much more likely to have the disease than females."

B) "If the trait is inherited from both parents the child will have the disease."

A patient with chronic renal failure receiving epoetin alfa will be having a total left hip arthroplasty. What supplementation should the patient receive prior to surgery? A) A protein supplement B) An iron supplement C) A blood transfusion D) A folic acid supplement

B) An iron supplement

A client with macrocytic anemia has a burn on her foot and states that she had been watching television while lying on a heating pad. What is the nurse's first response? A) Assess for potential abuse B) Check for diminished sensations C) Document the findings D) Clean and dress the area

B) Check for diminished sensations

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

B) Dyspnea, tachycardia, and pallor

A clinic nurse instructs the mother of a child with sickle cell disease about the precipitating factors related to pain crisis. Which of the following, if identified by the mother as a precipitating factor, indicates the need for further instructions? A) Infection B) Trauma C) Fluid Overload D) Stress

C) Fluid Overload

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

D) "I have difficulty breathing when walking 30 feet."

A client with iron deficiency anemia is scheduled for discharge. Which instruction about prescribed ferrous gluconate therapy should the nurse include in the teaching plan? A) "Take the medication with an antacid" B) "Take the medication with a glass of milk" C) "Take the medication with cereal" D) "Take the medication on an empty stomach"

D) "Take the medication on an empty stomach"

After receiving chemotherapy for lung cancer, a client's platelet count falls to 20 x109L. What term should the nurse use to describe this low platelet count? A) Anemia B) Leukopenia C) Thrombocytopenia D) Neutropenia

C) Thrombocytopenia

A student nurse is caring for a client who is receiving a hematopoietic agent. To test the student's understanding, the nursing instructor states that the drug could be administered by what route? A) Oral B) Subcutaneous C) Intravenous D) B and C

D) B and C

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? A) Beans, dried fruits, and leafy, green vegetables B) Fruits high in vitamin C, such as oranges and grapefruits C) Berries and orange vegetables D) Dairy products

A) Beans, dried fruits, and leafy, green vegetables

Which of the following blood components is decreased in anemia? A) Erythrocytes B) Granulocytes C) Leukocytes D) Platelets

A) Erythrocytes

A mother asks the nurse if her child's iron deficiency anemia is related to the child's frequent infections. The nurse responds based on the understanding of which of the following? A) Little is known about iron-deficiency anemia and its relationship to infection in children B) Children with iron deficiency anemia are more susceptible to infection than are other children C) Children with iron deficiency anemia are less susceptible to infection than are other children D) Children with iron-deficient anemia are equally as susceptible to infection as are other children

B) Children with iron deficiency anemia are more susceptible to infection than are other children

Which term refers to a form of white blood cell involved in immune response? A) Granulocyte B) Lymphocyte C) Spherocyte D) Thrombocyte

B) Lymphocyte

The body responds to infection by increasing the production of white blood cells (WBCs). The nurse should evaluate the differential count for what type of WBCs, which are the first WBCs to respond to an inflammatory event? A) Basophils B) Neutrophils C) Eosinophils D) Monocytes

B) Neutrophils

A client receiving a blood transfusion reports shortness of breath, appears anxious, and has a pulse of 125 beats/minute. What is the best action for the nurse to take after stopping the transfusion and awaiting further instruction from the health care provider? A) Place the client in a recumbent position with legs elevated. B) Remove the intravenous line. C) Ensure there is an oxygen delivery device at the bedside. D) Administer prescribed PRN anti-anxiety agent.

C) Ensure there is an oxygen delivery device at the bedside.

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

C) It may indicate deficiencies in essential nutrients.

A child suspected of having sickle cell disease is seen in a clinic, and laboratory studies are performed. A nurse checks the lab results, knowing that which of the following would be increased in this disease? A) Platelet count B) Hematocrit level C) Reticulocyte count D) Hemoglobin level

C) Reticulocyte count

The most common cause of iron deficiency anemia in men and postmenopausal women is A) menorrhagia. B) iron malabsorption. C) bleeding. D) chronic alcoholism.

C) bleeding. The most common cause of iron deficiency anemia in men and postmenopausal women is bleeding from ulcers, gastritis, inflammatory bowel disease or gastrointestinal (GI) tumors.

The nurse is teaching a client about erythrocytes. Which information would the nurse include in the teaching plan? A) Erythrocytes are also called white blood cells. B) Erythrocytes are also called plasma. C) Erythrocytes are also called platelets. D) Erythrocytes are also called red blood cells.

D) Erythrocytes are also called red blood cells.

The nurse is preparing to teach a client with iron-deficiency anemia about the diet to follow after discharge. Which of the following foods should be included in the diet? A) Eggs B) Lettuce C) Citrus fruits D) Cheese

A) Eggs

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

A) Health history, such as bleeding, fatigue, or fainting

A client is to receive epoetin (Epogen) injections. What laboratory values should the nurse assess before giving the injection? (select all that apply) A) Hematocrit B) Partial thromboplastin time C) Hemoglobin concentration D) Prothrombin time

A) Hematocrit C) Hemoglobin concentration

The nurse explains to the parents of a 1-year-old child admitted to the hospital in a sickle cell crisis that the local tissue damage the child has on admission is caused by which of the following? A) Autoimmune reaction complicated by hypoxia B) Lack of oxygen in the RBCs C) Obstruction to circulation D) Elevated serum bilirubin concentration

C) Obstruction to circulation

Which of the following would the nurse identify as the priority nursing diagnosis during a toddler's vaso-occlusive sickle cell crisis? A) Ineffective coping related to the presence of a life-threatening disease B) Decreased cardiac output related to abnormal hemoglobin formation C) Pain related to tissue anoxia D) Excess fluid volume related to infection

C) Pain related to tissue anoxia

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

D) Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.

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? A) CBC B) antibiotic C) chest radiograph D) ECG

A) CBC CBC, H&H, and serum iron levels are decreased with iron deficiency anemia

A nurse working in hematology reviews the characteristics of stem cells and their role in disease. Which statements does the nurse understand is true regarding stem cells? Select all that apply. A) There is a continuous supply throughout the life cycle. B) Lymphoid stem cells produce lymphocytes. C) Myeloid stem cells produce erythrocytes. D) They have the ability to self-replicate. E) There is a limited supply throughout the life cycle.

A) There is a continuous supply throughout the life cycle. B) Lymphoid stem cells produce lymphocytes. C) Myeloid stem cells produce erythrocytes. D) They have the ability to self-replicate.

A client is treated for anemia. What is the nurse's best understanding about the correlation between anemia and the client's iron stores? A) There is a strong correlation between iron stores and hemoglobin levels. B) There is a strong correlation between iron stores and hemoglobin characteristics. C) There is an inverse relationship between iron stores and hemoglobin levels. D) There is a weak correlation between iron stores and hemoglobin levels.

A) There is a strong correlation between iron stores and hemoglobin levels. After iron stores are depleted (as reflected by low serum ferritin levels), the hemoglobin level falls.

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

A) To detect the abnormal sounds suggestive of acute chest syndrome and heart failure

Which patient will be at the greatest risk for anemia and be the most likely candidate for epoetin alfa therapy? A) A 20-year-old female B) A 30-year-old pregnant woman C) A 62-year-old male with cancer D) A 40-year-old male with a high white blood cell count

C) A 62-year-old male with cancer Older adults who have cancer and are receiving chemotherapy are especially vulnerable to the adverse effects of anemia as a result of chemotherapy

A vegetarian client was referred to a dietitian for nutritional counseling for anemia. Which client outcome indicates that the client does not understand nutritional counseling? The client: A) Adds dried fruit to cereal and baked goods B) Cooks tomato-based foods in iron pots C) Drinks coffee or tea with meals D) Adds vitamin C to all meals

C) Drinks coffee or tea with meals Caffeine impedes absorption of iron

A mother asks the nurse why her child's hemoglobin was normal at birth but now the child has S hemoglobin. Which of the following responses by the nurse is most appropriate? A) "The placenta bars passage of the hemoglobin S from the mother to the fetus." B) "The red bone marrow does not begin to produce hemoglobin S until several months after birth." C) "Antibodies transmitted from you to the fetus provide the newborn with temporary immunity." D) "The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth."

D) "The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth."

The patient with chronic renal failure requires an agent to increase red blood cell production. What drug does the nurse anticipate administering? A) Epoetin alfa B) Filgrastim C) Oprelvekin D) Thrombopoetin

A) Epoetin alfa

When assessing a client with anemia, which assessment is essential? A) Health history, including menstrual history in women B) Family history C) Age and gender D) Lifestyle assessments, such as exercise routines

A) Health history, including menstrual history in women

Which substance, when deficient, results in a diagnosis of anemia? A) Hemoglobin B) Blood plasma C) Platelets D) Folic acid

A) Hemoglobin

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following? A) Liver B) Pancreas C) Kidney D) Large intestine

A) Liver

A client with severe chronic anemia is receiving ongoing transfusion therapy. The nurse frequently assesses the client for what major complication of this therapy? A) Development of toxic iron overload B) Development of fibrin clots C) Chronic idiopathic thrombocytic purpura D) Vaso-occlusive crisis

A) Development of toxic iron overload

The nurse and the client are discussing some strategies for ingesting iron to combat the client's iron-deficiency anemia. Which is among the nurse's strategies? A) Drink liquid iron preparations with a straw. B) Take iron with an antacid to avoid stomach upset. C) Avoid vitamin C as it prevents absorption. D) Taking iron pills with milk aids in absorption.

A) Drink liquid iron preparations with a straw.

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

A) Erythrocytes that are microcytic and hypochromic

A nurse is monitoring a client with anemia and low oxygen levels. The nurse knows that which condition stimulates the secretion of erythropoietin? A) Low blood pressure B) Tachycardia C) Inflammation D) Hypoxia

D) Hypoxia Erythropoiesis is governed for the most part by tissue oxygen needs. Any condition that causes a decrease in the amount of oxygen that is transported in the blood produces an increase in red blood cell production.

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

A) Iron deficiency anemia

When describing the function of vitamin B12, what would be appropriate to include? A) Maintenance of myelin sheath B) Prevention of neural tube defects C) Important role in cell division D) Oxygen transport to the tissues

A) Maintenance of myelin sheath

The nurse is reviewing the client's laboratory data showing an increased mean corpuscular volume (MCV) and a normal mean corpuscular hemoglobin concentration (MCHC). The client most likely has which type of anemia? A) Megaloblastic anemia B) Hemolytic anemia D) Sickle cell anemia C) Iron deficiency anemia

A) Megaloblastic anemia

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? A) Myeloid stem cell B) Lymphoid stem cell C) Monocyte D) Neutrophil

A) Myeloid stem cell

The nurse is caring for an older adult client who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine where the blood loss is coming from, what intervention can the nurse provide? A) Observe stools for blood. B) Observe the gums for bleeding after the client brushes teeth. C) Observe the sputum for signs of blood. D) Observe client for facial droop.

A) Observe stools for blood.

Which type of hemolytic anemia is categorized as inherited disorder? A) Sickle cell anemia B) Autoimmune hemolytic anemia C) Cold agglutinin disease D) Hypersplenism

A) Sickle cell anemia

Which patient should not receive epoetin alfa (Epogen) as ordered at 9 am? A) The patient who has a blood pressure of 240/120 mm Hg B) The patient with a heart rate of 100 beats per minute C) The patient who is "too tired to get out of bed" D) The patient who has missed a round of chemotherapy

A) The patient who has a blood pressure of 240/120 mm Hg

The couple with the lowest risk of having a child with sickle cell anemia disease is the one in which the: A) father is HbS and the mother is HbS. B) father is HbS and the mother is HbAS. C) father is HbA and the mother is HbS. D) father is HbAS and the mother is HbAS.

C) father is HbA and the mother is HbS. If the father has normal hemoglobin (HbA) and the mother has sickle cell anemia (HbS), the couple has a 0% chance of having a child with sickle cell anemia. If both parents have sickle cell anemia, the couple has a 100% chance of having a child with sickle cell anemia. If the father has sickle cell anemia and the mother has sickle cell trait (HbAS), the couple has a 50% chance of having a child with sickle cell anemia. If both parents have sickle cell trait, the couple has a 25% chance of having a child with sickle cell anemia.