Davis Ch. 34: Anemia

As Susan is preparing to leave, the nurse is reviewing a teaching handout about increasing dietary folic acid. What should be included in the teaching plan? Select all that apply. a. Red meat b. Green leafy vegetables c. Fortified grains d. Dairy products e. Nuts

b. Green leafy vegetables c. Fortified grains e. Nuts Rationale: Green leafy vegetables, fortified grains and cereals, and nuts are sources of folate, which the body converts to folic acid. Red meat and dairy products are not good sources of folate.

The client has been diagnosed with a vitamin B12 deficiency. What would the nurse ask more about in the client history related to this finding? a. Seasonal allergies b. Diet c. Medications d. Exercise

b. Diet

The nurse is explaining the diagnosis of aplastic anemia to the client. The nurse would include which of these statements in the explanation? a. The client has a decreased number of red blood cells in the bloodstream. b. The client has a decrease in red blood cell production. c. The client is deficient in red blood cells, white blood cells, and platelets. d. The client has a lack of vitamin B12, known as extrinsic factor.

c. The client is deficient in red blood cells, white blood cells, and platelets.

The nurse is aware that client education about oral iron supplements was effective when the client makes which of these statements? a. "There are no side effect symptoms that I need to worry about." b. "It would be good for me to take my iron supplement with a glass of orange juice." c. "It will be best for me to take my supplement immediately after breakfast." d. "If I eat a healthy diet today, I can skip my iron supplement."

b. "It would be good for me to take my iron supplement with a glass of orange juice." Rationale: Ingesting citrus fruits such as oranges or grapefruits increases the vitamin C intake and may improve iron absorption.

The nurse would explain to the client which of these foods are dietary sources of iron? Select all that apply. a. Dark green leafy vegetables b. Seafood c. Fortified cereals and breads d. Citrus fruits e. Red meat

a. Dark green leafy vegetables c. Fortified cereals and breads e. Red meat Rationale: Adjusting the diet to increase iron intake is the easiest and best way to prevent IDA, especially long term. Good dietary sources of iron include meat (especially red meat), dark green leafy vegetables (spinach, broccoli, peas), beets, dried beans, iron-fortified breakfast cereals and breads, and Cream of Wheat.

The nurse is caring for Susan, a young adult female client, in the healthcare provider's office. She has symptoms of "feeling tired" and "having no energy."The nurse questions if Susan may be experiencing anemia. Which symptoms should the nurse evaluate for? Select all that apply. a. Fatigue b. Hypokalemia c. Pallor d. Tachycardia e. Constipation f. Tachypnea g. Dehydration h. Shortness of breath

a. Fatigue c. Pallor d. Tachycardia f. Tachypnea h. Shortness of breath Rationale: Common general signs and symptoms of most types of anemia include fatigue, pallor, tachycardia, tachypnea, and shortness of breath. The oxygen-carrying capacity of the blood is impacted by the decreased hemoglobin and lack of red blood cells. It is uncommon for a client with anemia to have hypokalemia, constipation, or dehydration directly related to the anemia.

The nurse is aware that a patient who presents with anemia could exhibit which of these signs and symptoms of the disorder? Select all that apply. a. Fatigue b. Bradycardia c. Shortness of breath d. Bradypnea e. Pallor

a. Fatigue c. Shortness of breath e. Pallor Rationale: As the body's iron stores are depleted, the decreased hemoglobin levels lead to inadequate oxygenation of the body's tissues, or hypoxia. This oxygen deficiency manifests itself as fatigue and pallor, with the onset of tachycardia and tachypnea resulting from the heart and lungs attempting to compensate for the hypoxemia (oxygen deficiency of the blood). As hypoxia increases, the patient may become increasingly short of breath.

The nurse is instructing a client with vitamin B12 anemia about dietary changes. What foods should be increased in this client's diet? Select all that apply. a. Meat b. Seafood c. Eggs d. Avocados e. Green leafy vegetables

a. Meat b. Seafood c. Eggs Rationale: Prevention of vitamin B12 deficiency is important, and animal proteins provide the only source of vitamin B12 in the world. Vitamin B12 has not been discovered in any plants. Dietary sources of vitamin B12 include meat, seafood, eggs, and dairy products.

The nurse is aware that a client with anemia could exhibit which generalized symptoms? Select all that apply. a. Hypersensitivity to light b. Dizziness c. Shortness of breath d. Bleeding gums e. Fatigue

b. Dizziness c. Shortness of breath e. Fatigue

Johnston asks the nurse what he should expect as treatment for his aplastic anemia. What should the nurse say? a. Most symptoms will be resolved with dietary changes. b. Often blood transfusions are a part of the treatment for the anemia. c. Removal of your HIV medications will treat the aplastic anemia. d. There are medications that will cure your bone marrow disease.

b. Often blood transfusions are a part of the treatment for the anemia. Rationale: During the diagnostic evaluation phase of aplastic anemia, blood transfusions are a primary treatment. Other treatments focus on stimulating bone marrow with medications such as filgrastim (Neupogen) and epoetin-alfa (Epogen), as they stimulate bone marrow production of cells and relieve symptoms.

While completing a nursing history, the nurse learns that Susan is prescribed metformin and oral contraceptives. She is at risk for what type of anemia? a. Iron deficiency anemia b. Vitamin B12 anemia c. Folic acid deficiency d. Sickle cell anemia

c. Folic acid deficiency Rationale: The client who takes metformin, oral contraceptives, and certain chemotherapeutic agents may be at risk of folic acid deficiency. Other individuals at risk for this condition can include individuals with a history of gastrointestinal resections and individuals with a history of alcohol abuse.

The nurse is preparing client-teaching handouts about iron deficiency anemia. The nurse knows which of these would be a common cause of this condition? Select all that apply. a. Hemorrhage and chronic blood loss b. Peptic ulcer c. Chronic respiratory conditions d. Poor nutritional intake e. Sickle cell trait

a. Hemorrhage and chronic blood loss b. Peptic ulcer d. Poor nutritional intake Rationale: Iron-deficiency anemia often occurs as a result of hemorrhage and chronic blood loss, for example, heavy menstrual bleeding, certain types of cancer (esophageal, colon, stomach), and ulcerative gastrointestinal problems such as peptic ulcer disease. Poor absorption of iron may be due to celiac disease, Crohn's disease, and the chronic use of medications such as H2 inhibitors, proton-pump inhibitors, antacids, aspirin, and NSAIDs. Gastrointestinal surgeries such as gastric bypass surgery and partial and total gastrectomy can lead to poor absorption of iron and IDA. In older adults with multiple comorbidities, anemia is frequently a cause for hospitalization and exacerbates many chronic conditions, such as congestive heart failure (CHF) and chronic kidney disease.

The nurse is teaching a client diagnosed with iron deficiency anemia about the importance of increasing iron intake in the diet. The nurse would know the teaching was effective when the client states which of the following foods are rich in dietary iron? Select all that apply. a. Red meat b. Dark green leafy vegetables c. Fish and shellfish d. Dried beans e. Citrus fruits

a. Red meat b. Dark green leafy vegetables d. Dried beans

Which symptoms should the nurse assess Johnston for? a. Shortness of breath b. Constipation c. Bruising d. Infection e. Sleeplessness

a. Shortness of breath c. Bruising d. Infection Rationale: Aplastic anemia is typically associated with symptoms of low red blood cells, white blood cells, and platelets; therefore, symptoms include fatigue, shortness of breath, tachycardia, pallor, dizziness, headache, infections, bruising, nosebleeds, gum bleeding, and prolonged bleeding from cuts and other injuries.

Johnston is a 22-year-old male with human immunodeficiency virus. He was born with the virus and has been maintained with medications since birth. He presents to the clinic today with extreme fatigue.The practitioner draws serum blood work and the results include decreased red blood cells, white blood cells, and platelets. What type of anemia could cause these results? a. Folic acid anemia b. B12 anemia c. Iron deficiency anemia d. Aplastic anemia

d. Aplastic anemia Rationale: Aplastic anemia, also called hypoplastic anemia, is a rare disease process that develops due to bone marrow depression or damage, and is often acquired secondary to infections, including hepatitis and human immunodeficiency virus. Blood work typically shows pancytopenia because of poor bone marrow function.

Lab work is drawn, and folic acid deficiency anemia is diagnosed by the healthcare provider. Susan states, "If I have folic acid deficiency anemia, I will have to increase my iron intake." How should the nurse respond to this statement? a. "Yes, you will need to take an iron supplement first thing in the morning, with a glass of orange juice to help with the absorption of the iron." b. "Not only will you need to take an iron supplement, but you will also have to take a folic acid supplement." c. "An iron supplement will not be necessary with your type of anemia, but you will have to take a folic acid supplement." d. "Your medications are affected the absorption of folic acid by your body. You may have to take oral or parenteral folic acid supplements to meet your body's need of folic acid."

d. "Your medications are affected the absorption of folic acid by your body. You may have to take oral or parenteral folic acid supplements to meet your body's need of folic acid." Rationale: The client with folic acid deficiency anemia will not have to take an iron supplement. Many people with folic acid deficiency anemia can take oral supplements, but with the client taking both metformin and oral contraceptives, oral or parenteral folic acid supplements may be necessary.

Susan is exhibiting several of the general symptoms of anemia. The nurse asks if she has had any episodes of confusion and disorientation. Susan states, "Now that you mention it, I have had some afternoons where I have not felt like myself. I guess you could call it confused or disoriented. Why would I be feeling like that? Does anemia cause these symptoms?" What would be the nurse's best response? a. "Some types of anemia can cause these symptoms due to decreased oxygenation of the brain." b. "If you are having these symptoms it could mean that there is something going on more serious than anemia." c. "I doubt it is anything to worry about. You can mention it to the healthcare provider when they see you." d. "I will let the healthcare provider know right now of these symptoms."

a. "Some types of anemia can cause these symptoms due to decreased oxygenation of the brain." Rationale: Susan's symptoms of confusion and disorientation can be caused by decreased oxygenation of the brain. Fewer mature red blood cells and hemoglobin are available to oxygenate the brain and the rest of the body.

The nurse understands that anemia has many possible etiologies. Which can cause anemia? Select all that apply. a. Diet low in vitamin D b. Reduction in the number of red blood cells c. Inability of the body to absorb vitamin B12 d. Reduction in hemoglobin e. Excess amount of folic acid in the body

b. Reduction in the number of red blood cells c. Inability of the body to absorb vitamin B12 d. Reduction in hemoglobin

Johnston is placed on bleeding precautions for his low platelet count. What should the nurse include with this? Select all that apply. a. Bladed razors b. Soft toothbrushes c. Frequent rotation of IV sites d. Direct pressure to venipuncture and injection sites e. Flossing

b. Soft toothbrushes d. Direct pressure to venipuncture and injection sites Rationale: Decreased platelets increase the risk of bleeding, and bleeding precautions include use of soft toothbrushes and direct pressure to venipuncture and injection sites until bleeding stops. Exposure to anything sharp or rough should be prevented.