Exam 2 Med Surg
Following an ophthalmologic exam, an anxious client asks the nurse, "How serious is a refraction error?" Which of the following is the best response from the nurse?
"It means corrective lenses are required."
A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?
"I will receive parenteral vitamin B12 therapy for the rest of my life." Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 929
A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify?
Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 927
On ocular examination, the health care provider notes severely elevated IOP, corneal edema, and a pupil that is fixed in a semi-dilated position. The nurse knows that these clinical signs are diagnostic of the type of glaucoma known as:
Acute angle-closure.
Patients who have had a partial or total gastrectomy may have limited amounts of intrinsic factor, therefore the absorption of vitamin _______ may be diminished.
B12
When teaching a client with iron deficiency anemia about appropriate food choices, the nurse encourages the client to increase the dietary intake of which foods?
Beans, dried fruits, and leafy, green vegetables Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 931
Which of the following are assessment findings associated with thrombocytopenia? Select all that apply.
Bleeding gums Hematemesis Epistaxis
A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from? Select all that apply.
Blood loss Destruction of normally formed red blood cells Abnormal erythrocyte production
Which is a symptom of hemochromatosis?
Bronzing of the skin Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 944
The nurse is caring for a client with chronic myeloid leukemia (CML) who is taking imatinib mesylate. In what phase of the leukemia does the nurse understand that this medication is most useful to induce remission?
Chronic
The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions?
Dilute the liquid preparation with another liquid such as juice and drink with a straw. Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 931
Which statement best describes the function of stem cells in the bone marrow?
They produce all blood cells. Chapter 34: Management of Patients With Hematologic Neoplasms - Page 970
A nurse is caring for a client with thalassemia who is being transfused. What is the nurse's role during a transfusion?
To closely monitor the rate of administration Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 942
A nurse cares for clients with hematological disorders and notes that women are diagnosed with hemochromatosis at a much lower rate than men. What is the primary reason for this?
Women lose iron through menstrual cycles Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 944
The nurse is caring for a client with external bleeding. What is the nurse's priority intervention?
Direct pressure
A client with severe anemia is admitted to the hospital. Because of religious beliefs, the client is refusing blood transfusions. The nurse anticipates pharmacologic therapy with which drug to stimulate the production of red blood cells?
Epoetin alfa Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 923
The nurse should monitor for which manifestation in a client who has had LASIK surgery?
Halos and glare
Which type of benign tumor of the eyelids is characterized by superficial, vascular capillary lesions that are strawberry-red in color?
Hemangioma
Which term describes the percentage of blood volume that consists of erythrocytes?
Hematocrit Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 909
A patient with End Stage Kidney Disease is taking recombinant erythropoietin for the treatment of anemia. What laboratory study does the nurse understand will have to be assessed at least monthly related to this medication?
Hemoglobin level Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 931
A client has undergone enucleation. What complication of enucleation should be addressed by the nurse?
Hemorrhage
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?
Hemorrhage Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 912
A client with severe anemia reports symptoms of tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Laboratory test results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which nursing diagnoses is most appropriate for this client?
Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 928
The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include a nutritional assessment for this patient?
It may indicate deficiencies in essential nutrients. Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 929
The nurse should notify the healthcare provider before administering fresh frozen plasma (FFP) based on which assessment finding?
Jugular venous distention Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 918
Which surgical procedure involves flattening the anterior curvature of the cornea by removing a stromal lamella?
Laser-assisted in situ keratomileusis (LASIK)
During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding?
Low ferritin level concentration Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 930
Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following?
Liver Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 908
A nurse conducted a history and physical for a newly admitted patient who states, "My arms are too short. I have to hold my book at a distance to read." The nurse knows that the patient is most likely experiencing:
Loss of accommodative power in the lens.
Which term refers to a form of white blood cell involved in immune response?
Lymphocyte Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 907
A client has been diagnosed with polycythemia vera. What is the best instruction for the nurse to give to this client?
Maintain adequate blood pressure control
A nursing instructor is evaluating a student caring for a neutropenic client. The instructor concludes that the nursing student demonstrates accurate knowledge of neutropenia based on which intervention?
Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 946
Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets?
Myeloid stem cell Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 903
To avoid the side effects of corticosteroids, which medication classification is used as an alternative to treat inflammatory conditions of the eyes?
NSAIDs
A client with a diagnosis of pernicious anemia comes to the clinic and reports numbness and tingling in the arms and legs. What do these symptoms indicate?
Neurologic involvement Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 934
A client suffered trauma to the sclera and is being treated for a subsequent infection. During client education, the nurse indicates where the sclera is attached. Which structure would not be included?
eyelids
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
A nurse is caring for a client with iron deficiency anemia. Which food or beverage will the nurse suggest to the client to eat or drink when taking supplemental iron?
Orange juice Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 931
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. Chapter 34: Management of Patients With Hematologic Neoplasms - Page 997
A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. The client is taking prednisone daily and reported feeling pain after manually opening the garage door. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain?
Osteoporosis Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 951
The hospitalized client is experiencing gastrointestinal bleeding with a platelets at 9,000/mm³. The client is receiving prednisone and azathioprine. What action will the nurse take?
Perform a neurologic assessment with vital signs.
Which is a symptom of severe thrombocytopenia?
Petechiae Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 9113
Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils?
Phagocytosis Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018.
The diagnosis of Hodgkin lymphoma is made by means of an excisional lymph node biopsy and the finding of the __________________ cell.
Reed--Sternberg
The nurse is caring for a client ordered for multiple eye screening. Following which procedure will the nurse instruct the client on a yellow coloring to the skin and urine as being normal?
Retinal Angiography
A nurse cares for several mothers and babies in the postpartum unit. Which mother does the nurse recognize as being most at risk for a febrile nonhemolytic reaction?
Rh-negative mother; Rh-positive child Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 919
A client at the clinic has just been diagnosed with iron deficiency anemia. What would you recommend the client consume to promote the absorption of iron?
Rich sources of vitamin C Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 931
A client with multiple myeloma reports severe paresthesia in the feet. When planning care for the client, which priority nursing diagnosis will the nurse choose?
Risk for falls
The nurse is assessing a patent with polycythemia vera. What skin assessment data would the nurse determine is a normal finding for this patient?
Ruddy complexion
A client with suspected multiple myeloma is reporting back pain. What is the priority nursing action?
Send the client for a spinal x-ray study.
A client is newly diagnosed with Hodgkin lymphoma. The nurse understands that the client's treatment will be based on what concept?
Staging of disease
The nurse began transfusing the first unit of packed red blood cells (PRBCs) fifteen minutes ago. The client reports shortness of breath, nausea, and is restless. What is the nurse's priority action?
Stop the infusion. Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 917
Place the following steps in order when determining the type and severity of a transfusion reaction. Use all options.
Stop the transfusion. Assess the client. Notify the health care provider. Notify the blood bank. Send the tubing and container to the blood bank. Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 922
An older adult client who is a vegetarian has a hemoglobin of 10.2 gm/dL, vitamin B12 of 68 pg/mL (normal: 200-900 pg/mL), and MCV of 110 cubic micrometers. After interpreting the data, what instruction should the nurse give to the client?
Supplement the diet with vitamin B12. Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 933
The nurse is administering a blood transfusion to a client over 4 hours. After 2 hours, the client reports chills and has a fever of 101°F, an increase from a previous temperature of 99.2°F. What does the nurse recognize is occurring with this client?
The client is having a febrile nonhemolytic reaction. Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 919
The nurse is assessing an older client's vision. The nurse integrates knowledge of which of the following during the assessment?
The power of the lens to accommodate will be decreased.
Iron deficiency anemia, the most common type of anemia in all age groups, also is the most common anemia in the world.
true
Multiple myeloma is a malignant disease of plasma cells in bone marrow.
true
Polycythemia vera is a rare form of anemia.
true
The patient with sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear.
true
A client with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this client?
Erythropoietin Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 923
The client with chronic open-angle glaucoma is receiving timolol (Timoptic) eye drops. Which evaluation finding would indicate to the nurse the treatment is working?
Intraocular pressure 15 mm Hg
The nurse is providing health education to an older adult client who has low red blood cell levels. To promote red blood cell production, the nurse should encourage intake of what foods? Select all that apply.
Nuts and seeds Lean meats Leafy green vegetables
A client admitted to the hospital with abdominal pain, anemia, and bloody stools reports feeling weak and dizzy. The client has rectal pressure and needs to urinate and move their bowels. The nurse should help them:
onto the bedpan. Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 928
Patients with __________ anemia develop a smooth sore red tongue.
pernicious
A nurse is performing an eye examination. Which question would not be included in the examination?
"Are you able to raise both eyebrows?"
The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan?
"Chronic leukemia develops slowly."
The nurse is teaching the client about consolidation. What statement should be included in the teaching plan?
"Consolidation therapy is administered to reduce the chance of leukemia recurrence."
A client's family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC?
"DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs." Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 956
The nurse is collecting data for a client who has been diagnosed with iron-deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia?
"I have difficulty breathing when walking 30 feet." Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 930
Which statement indicates the client understands teaching about induction therapy for leukemia?
"I will be in the hospital for several weeks."
Which client statement would lead the nurse to suspect that the client is experiencing bacterial conjunctivitis?
"My eyelids were stuck together this morning."
A nurse cares for a client with megaloblastic anemia who had a total gastrectomy three years ago. What statement will the nurse include in the client's teaching regarding the condition?
"The condition is likely caused by a vitamin B12 deficiency." Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 906
A client's vision is assessed at 20/200. The client asks what that means. Which is the most appropriate response by the nurse?
"You see an object from 20 feet away that a person with normal vision sees from 200 feet away."
A 52-year-old comes to the clinic for a follow-up examination after being diagnosed with glaucoma. The client states, "I'm hoping that I don't have to use these drops for very long." Which response by the nurse would be most appropriate?
"You'll need to use the drops for the rest of your life to control the glaucoma."
Delayed hemolytic reactions usually occur within _________ days after transfusion, when the level of antibody has been increased to the extent that a reaction can occur.
14
It is determined that a patient is legally blind and will be unable to drive any longer. Legal blindness refers to a best-corrected visual acuity (BCVA) that does not exceed what reading in the better eye?
20/200
Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)?
A 72-year-old patient with a history of cancer
A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the health care provider immediately because the client probably is experiencing which problem?
A hemolytic allergic reaction caused by an antigen reaction Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 938
A client is being evaluated for a diagnosis of chronic myeloid leukemia (CML). What diagnostic indicator will the nurse assess?
A leukocyte count >100,000/mm3
A patient comes to the clinic with a suspected eye infection. The nurse recognizes that the patient most likely has conjunctivitis, as evidenced by what symptom?
A mucopurulent ocular discharge
A client is hospitalized 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin at home, which is now discontinued. To prevent the formation of blood clots, which action should the nurse take?
Administer the prescribed enoxaparin (Lovenox). Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 963
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?
Allopurinol
A client has been referred to an ophthalmologist for suspected macular degeneration. The nurse knows to prepare what test for the physician to give the client?
Amsler grid
The nurse is obtaining the health history of a client suspected of having a hematological condition. The nurse notes the client has a history of alcohol abuse. Which clinical presentation is related to alcohol consumption?
Anemia Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 911
Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia?
Apply prolonged pressure to needle sites or other sources of external bleeding.
A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention?
Assess the client's hemoglobin and platelets.
A nurse cares for a client with anemia requiring nutritional supplementation. Which nursing intervention best promotes client adherence with the prescribed therapy?
Assist the client to incorporate the therapeutic regimen into daily activities.
An elderly client is hospitalized for induction of chemotherapy to treat leukemia. The client reports fatigue to the nurse. What nursing intervention would best address the client's fatigue?
Assist the client to sit in a chair for meals.
The nurse suspects that a client has multiple myeloma based on the client's major presenting symptom and the analysis of laboratory results. What classic symptom for multiple myeloma does the nurse assess for?
Bone pain in the back of the ribs
A client with multiple myeloma reports pain along the spinal column. The client is prescribed naproxen (Aleve) and oxycodone. Prior to administering these medications, the nurse
Checks the client's BUN and creatinine
A client diagnosed with polycythemia vera has come into the clinic because he has developed a nighttime cough, fatigue, and shortness of breath. What complication would you suspect in this client?
Congestive heart failure
Which of the following medications needs to be withheld for 5 to 7 days prior to cataract surgery?
Coumadin
The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly?
Crackles auscultated bilaterally Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 920
A patient with end-stage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia?
Creatinine level of 6 mg/100 mL Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 926
A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor?
Decreased level of erythropoietin
The nurse is educating a patient with iron deficiency anemia about food sources high in iron and how to enhance the absorption of iron when eating these foods. What can the nurse inform the client would enhance the absorption?
Eating calf's liver with a glass of orange juice Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 931
The nurse is interacting with a family that has been caring for a client with cancer for several months. What are the best interventions to assist in relieving caregiver stress in this family? Select all that apply.
Educate the family about medications and side effects. Suggest support for household maintenance. Allow family members to express feelings.
Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia?
Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing.
A client with multiple myeloma reports uncomfortable muscle cramping. Which nursing interventions will the nurse implement in response to the client's report of symptoms? Select all that apply.
Encourage hydration Encourage ambulation
A client with leukemia has developed a cough and increased fatigue. What is the primary nursing intervention?
Evaluate the client for potential infection.
A client who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action?
Evaluate the client's platelet count. Chapter 34: Management of Patients With Hematologic Neoplasms - Page 973
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 leukocytes
The nurse asks a client to follow the movement of a pencil up, down, right, left, and both ways diagonally. The nurse is assessing which of the following?
Extraocular muscle function
A patient has a probable diagnosis of polycythemia vera. The nurse reviews the patient's lab work for which diagnostic indicator?
Hematocrit of 60% Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 944
____________________ is a genetic condition in which excess iron, absorbed from the GI tract, is deposited in various body organs.
Hemochromatosis
A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see?
Hypercalcemia Chapter 34: Management of Patients With Hematologic Neoplasms - Page 994
Splenic sequestration is diagnosed in a client admitted with splenomegaly. What is the priority of care for this client?
Hypovolemia Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 921
A patient with AML is having aggressive chemotherapy to attempt to achieve remission. The patient is aware that hospitalization will be necessary for several weeks. What type of therapy will the nurse explain that the patient will receive?
Induction therapy
A patient who has long-term packed RBC (PRBC) transfusions has developed symptoms of iron toxicity that affect liver function. What immediate treatment should the nurse anticipate preparing the patient for that can help prevent organ damage?
Iron chelation therapy Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 921
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
A client reports feeling faint after donating blood. What is the nurse's best action?
Keep client in recumbent position to rest. Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 915
Which surgical procedure involves flattening the anterior curvature of the cornea by removing a stromal lamella layer?
Laser-assisted stromal in situ keratomileusis (LASIK)
The nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. What position will the nurse place the patient in?
Lateral position with one leg flexed Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 912
The nurse is assessing a patient who comes to the clinic and reports feeling constantly tired and very weak. The patient also has a very sore tongue, and upon observing the patient's oral cavity, the nurse notices the tongue is beefy red. What type of anemia does the nurse know these symptoms indicate?
Megaloblastic anemia Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 928
A client was admitted to the hospital with a pathologic pelvic fracture. The client informs the nurse that he has been having a strange pain in the pelvic area for a couple of weeks that was getting worse with activity prior to the fracture. What does the nurse suspect may be occurring based on these symptoms?
Multiple myeloma
Assessment of visual acuity reveals that the client has blurred vision when looking at distant objects but no difficulty seeing near objects. The nurse documents this as which of the following?
Myopia
The nurse is assisting the eye surgeon in completing an examination of the eye. Which piece of equipment would the nurse provide to the physician to examine the optic disc under magnification?
Ophthalmoscope
There are four major types of ophthalmic procedures to complete a glaucoma examination. If the health care provider wants to inspect the optic nerve, the nurse would prepare the patient for:
Ophthalmoscopy.
Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets?
Pancytopenia Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 932
Which term refers to swelling of the optic disc due to increased intracranial pressure?
Papilledema
Clients with multiple myeloma have abnormal plasma cells that proliferate in the bone marrow where they release osteoclast-activating factor, resulting in the formation of osteoclasts. What is the most common complication of the pathology resulting from this process?
Pathologic fractures
The nurse is performing an assessment on a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae. What laboratory study should the nurse be concerned about?
Platelet count of 9,000/mm3
Acute myeloid leukemia (AML) results from a defect in the hematopoietic stem cell that differentiates into which of the following myeloid cells? Select all that apply.
Platelets Granulocytes Monocytes Erythrocytes
The nursing instructor is discussing disorders of the hematopoietic system with the pre-nursing pathophysiology class. What disease would the instructor list with a primary characteristic of erythrocytosis?
Polycythemia vera
The nurse recognizes the clinical assessment of a patient with acute myeloid leukemia (AML) includes observing for signs of infection early. What nursing action will most likely help prevent infection?
Practice vigilant handwashing.
A nurse is caring for a client with multiple myeloma. Which nursing intervention is most appropriate for this client?
Preventing bone injury Chapter 34: Management of Patients With Hematologic Neoplasms - Page 997
The nurse is reviewing the medical record of a client with glaucoma. Which of the following would alert the nurse to suspect that the client was at increased risk for this disorder?
Prolonged use of corticosteroids
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
A patient has been brought to the emergency room after being hit in the head with a baseball. The nurse should be alert to which of the following clinical manifestations of a detached retina? Select all that apply.
Sensation of a curtain coming across vision of one eye Bright flashing lights Cobwebs Sudden onset of floaters
A client with multiple myeloma presents to the emergency department and reports excessive thirst and constipation. Family members report that the client has been confused for the last day. Which laboratory value is most likely responsible for this client's symptoms?
Serum calcium level 13.8 mg/dl
The primary function of lymphocytes is to attack foreign material.
TRUE
A client is prescribed 325 mg/day of oral ferrous sulfate. What does the nurse include in client teaching?
Take 1 hour before breakfast Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 931
The nurse is educating a client taking imatinib mesylate for treatment of leukemia. What should the nurse be sure to include when educating the client on the best way to take the medication to optimize absorption?
Take antacids if needed for gastrointestinal (GI) upset 2 hours after taking imatinib mesylate.
A client with polycythemia vera reports severe itching. What triggers does the nurse know can cause this distressing symptom? Select all that apply.
Temperature change Alcohol consumption Exposure to water of any temperature
A client with polycythemia vera reports gouty arthritis symptoms in the toes and fingers. What is the nurse's best understanding of the pathophysiological reason for this symptom?
The dead red blood cells release excess uric acid.
A nurse is preparing to discharge an adolescent with sickle cell anemia. What client need should the nurse emphasize in the discharge assessment?
The need for an adequate support structure Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 938
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 can develop osteonecrosis of the jaw.
A client is treated for anemia. What is the nurse's best understanding about the correlation between anemia and the client's iron stores?
There is a strong correlation between iron stores and hemoglobin levels. Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 930
A young client is being seen by a pediatric ophthalmologist due to a recent skateboarding accident that resulted in trauma to the right cornea, and is now at risk of developing an infection. Which nursing intervention would be contraindicated for a client at risk for infection?
To ensure correct application of antibiotic ointment, gently drag tip of tube along lower lid while squeezing ointment on to lid.
The patient, who is experiencing severe circulatory overload due to too much blood infusing too quickly, should be placed in an upright position with the feet in a dependent position.
True
A client is scheduled to have a cataract removed and an artificial lens implanted. What test would the nurse know would be useful in measuring for an intraocular lens implant in this client?
Ultrasonography
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
While caring for a client, the nurse notes petechiae on the client's trunk and lower extremities. What precaution will the nurse take when caring for this client?
Use an electric razor when assisting client with shaving. Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 911
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?
Wear a medical identification bracelet. Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 954
Plasma proteins consist primarily of __________ and globulins.
albumin
____________ is the primary site for hematopoiesis, a process of continuous blood cell formation.
bone marrow
Disseminated intravascular coagulation (DIC) is characterized by a process of inflammation and _______________ within the vasculature.
coagulation
A client has pernicious anemia and has been receiving treatment for several years. Which symptom may be confused with another condition in older adults?
dementia
A client has a history of sickle cell anemia with several sickle cell crises over the past 10 years. What blood component results in sickle cell anemia?
hemoglobin S Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 937
A patient with neutropenia is at an increased risk for __________, which increases proportionately with the decrease in the neutrophil count.
infection
Two primary complications seen in acute myeloid leukemia (AML), bleeding and __________, are the major causes of death for these patients.
infection
A nurse is reviewing a client's morning laboratory results and notes a left shift in the band cells. Based on this result, the nurse can interpret that the client
may be developing an infection. Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 906
An increase in _______________ may be seen in patients exposed to a bacterial infection.
neutrophils
A client has developed diabetic retinopathy and is seeing the physician regularly to prevent further loss of sight. From where do the nerve cells of the retina extend?
optic nerve
A nurse is assessing a client with multiple myeloma. Due to this condition, what will this client be at risk for?
pathologic bone fractures. Chapter 34: Management of Patients With Hematologic Neoplasms - Page 997
A client with multiple sclerosis is being seen by a neuro-ophthalmologist for a routine eye exam. The nurse explains to the client that during the examination, the client will be asked to maintain a fixed gaze on a stationary point while an object is moved from a point on the side, where it can't be seen, toward the center. The client will indicate when the object becomes visible The nurse further explains that the test being performed is called a:
perimetry test
The nurse is discussing disorders of the hematopoietic system when a client asked about erythrocytosis. What disease will the nurse mention with a primary characteristic of erythrocytosis?
polycythemia vera
Common symptoms seen in polycythemia vera include a ruddy complexion and ____________ from increased blood volume and viscosity.
splenomegaly
The nurse is assessing a client admitted with a deep vein thrombosis with an elevated red blood cell count. The admitting diagnosis is polycythemia vera. What is the hallmark clinical sign of PV?
splenomegaly
A primary nursing diagnosis for a patient with acute leukemia is impaired nutritional intake due to the pain and discomfort associated with mucositis and stomatitis.
true
Anemia is the most common hematologic condition affecting older adults, particularly those admitted to hospitals or those in long-term care facilities.
true
Chronic lymphocytic leukemia the most common form of leukemia and may require no treatment in the early stages.
true
Nursing interventions for the patient with acute leukemia should focus on assisting the patient to establish a balance between ___________ and _______ because fatigue and deconditioning are common symptoms of the disease.
activity, rest
An older adult with a chief complaint of ______________ and an elevated total protein level should be evaluated for multiple myeloma.
back pain
A preoperative client is discussing blood donation with the nurse. Which statement by the client indicates to the nurse the need for further teaching?
"My family will donate blood, because it's safer." Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 915
For a client diagnosed with idiopathic thrombocytopenia purpura (ITP), which nursing intervention is appropriate?
Administering stool softeners, as ordered, to prevent straining during defecation Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 951
Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents?
Hypochromic Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 941
The nurse is caring for a client with hypoxia. What does the nurse understand is true regarding the client's oxygen level and the production of red blood cells?
The kidneys sense low oxygen levels in the blood and produce erythropoietin, stimulating the bone marrow to produce more red blood cells. Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 906
A nurse caring for a client who has hemophilia is getting ready to take the client's vital signs. What should the nurse do before taking a blood pressure?
Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints. Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 951-953
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?
Ensure there is an oxygen delivery device at the bedside. Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 916
When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply.
Ethnicity Medication use Herbal supplements Dietary intake Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 909
The most common symptom and complication of anemia is _________, which has the greatest negative impact on a patient's level of functioning.
fatigue
A patient will need a blood transfusion for the replacement of blood loss from the gastrointestinal tract. The patient states, "That stuff isn't safe!" What is the best response from the nurse?"
"I understand your concern. The blood is carefully screened but is not completely risk free." Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 914
A patient with chronic kidney disease is being examined by the nurse practitioner for anemia. The nurse has reviewed the laboratory data for hemoglobin and RBC count. What other test results would the nurse anticipate observing?
Decreased level of erythropoietin Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 906
A patient will need a blood transfusion for the replacement of blood loss from the gastrointestinal tract. The patient states, "That stuff isn't safe!" What is the best response from the nurse?
"I understand your concern. The blood is carefully screened but is not completely risk free." Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 914
A nurse is teaching a client with a vitamin B12 deficiency about appropriate food choices to increase the amount of B12 ingested with each meal. The nurse knows the teaching is effective based on which statement by the client?
"I will eat a meat source such as chicken or pork with each meal." Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 906
A nurse is caring for a client who will undergo total knee replacement and will have an autologous transfusion. Which statement will the nurse include when teaching the client about the transfusion?
"You typically donate blood 4 to 6 weeks before the surgery." Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 915
Which nursing diagnosis should a nurse expect to see in a care plan for a client in sickle cell crisis?
Acute pain related to sickle cell crisis Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 936
A client with Hodgkin disease had a bone marrow biopsy yesterday and reports aching at the biopsy site, rated a 5 (on a 1-10 scale). After assessing the biopsy site, which nursing intervention is most appropriate?
Administer acetaminophen 500 mg po, as ordered Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 570
A client who has idiopathic thrombocytopenia purpura (ITP) has a critically low platelet count. Which nursing intervention will be included in the care plan for this client?
Administer eltrombopag Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 923
Which of the following is the most common hematologic condition affecting elderly patients
Anemia Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 927
The nurse expects which assessment finding when caring for a client with a decreased hemoglobin level?
Decreased oxygen level. Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 905
A client receiving a unit of packed red blood cells (PRBCs) has been prescribed morphine 1 mg intravenously now for pain. What is the best method for the nurse to administer the morphine?
Disconnect the blood tubing, flush with normal saline, and administer morphine. Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 917
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?
Drink liquid iron preparations with a straw. Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 929
A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse know is the most likely clinical disorder the patient is being treated for?
Essential thrombocythemia Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 913
The average lifespan of a normal circulating erythrocyte is 60 days or about 2 months.
FALSE
The most common type of blood transfusion reaction is an allergic reaction that causes urticaria.
FALSE
Hematopoiesis is characterized by a slow, continuous process of the formation and maturation of blood cells.
False
Polycythemia vera is a condition that places the patient at risk for increased infection.
False
To be considered a blood donor, a man must have a minimum hemoglobin level of 12 g/dL.
False
A nurse provides nutritional information for a patient diagnosed with an iron-deficiency anemia. What education should the nurse provide?
Increase the intake of green, leafy vegetables. Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 931
The nurse is completing a physical assessment on a client's lymphatic system. The nurse should palpate for enlarged nodes in which areas? Select all that apply.
Inguinal Neck Submental Popliteal Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 910
The client's CBC with differential reveals small-shaped hemoglobin molecules. The nurse expects to administer which medication to this client?
Iron Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 906
The nurse observes a co-worker who always seems to be eating a cup of ice. The nurse encourages the co-worker to have an examination and diagnostic workup with the health care provider. What type of anemia is the nurse concerned the co-worker may have?
Iron deficiency anemia Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 930
A client in acute renal failure has been prescribed 2 units of packed red blood cells (PRBCs). The nurse explains to the client that the blood transfusion is most likely needed for which reason?
Lack of erythropoietin Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 923
A nurse is developing a care plan for a client with disseminated intravascular coagulation (DIC). Which nursing intervention should the nurse include?
Place a pressure-reducing mattress on the client's bed. Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 959
The nurse is working at a blood donation clinic. What teaching should the nurse provide to the donor immediately after blood donation?
Remain for observation after eating and drinking. Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 916
The nurse is screening donors for blood donation. Which client is an acceptable donor for blood?
Reports having a cold 1 month ago that resolved quickly
Which type of lymphocyte is responsible for cellular immunity?
T lymphocyte Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 907
A nurse, caring for a client with human immunodeficiency virus (HIV), reviews the client's differential WBC count. What type of WBC will the nurse check the level of?
T lymphocytes Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 907
A nursing instructor is reviewing the role and function of stem cells in the bone marrow with a group of nursing students. After providing the explanation, the instructor asks the students to use their knowledge of anatomy and physiology to determine an alternate way in which adults with diseases that destroy marrow can resume production of blood cells. Which explanation by the students is correct?
The liver and spleen can resume production of blood cells through extramedullary hematopoiesis. Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 903
After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/mm3. What term should the nurse use to describe this low platelet count?
Thrombocytopenia Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 948
A nurse is doing a physical examination of a child with sickle cell anemia. When the child asks why the nurse auscultates the lungs and heart, what would be best the response by the nurse?
To detect the abnormal sounds suggestive of acute chest syndrome and heart failure Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 936
The physician orders a transfusion with packed red blood cells (RBCs) for a client hospitalized with severe iron deficiency anemia. When blood is administered, what is the most important action the nurse can take to prevent a transfusion reaction?
Verify the client's identity according to hospital policy Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 920
A client comes into the emergency department reporting an enlarged tongue. The tongue appears smooth and beefy red in color. The nurse also observes a 5-cm incision on the upper left quadrant of the abdomen. When questioned, the client states, "I had a partial gastrostomy 2 years ago." Based on this information, the nurse attributes these symptoms to which problem?
Vitamin B12 deficiency Chapter 32: Assessment of Hematologic Function and Treatment Modalities - Page 911
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? term-105
Erythrocytes that are microcytic and hypochromic Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - Page 930
