Hematologic Disorders

A nurse is developing a care plan for a client with disseminated intravascular coagulation (DIC). Which nursing intervention should the nurse include? Administer aspirin daily as ordered. Provide mouth care every 4 hours with lemon-glycerin swabs. Administer meperidine (Demerol) I.M. as needed for pain. Place a pressure-reducing mattress on the client's bed.

Place a pressure-reducing mattress on the client's bed. A client with DIC is at risk for Impaired skin integrity secondary to bleeding or ischemia. The nurse should place the client on a pressure-reducing mattress and perform skin care every 2 hours. The nurse should avoid administering any medication that decreases platelet function, such as aspirin. The nurse should perform mouth care using sponge swabs and baking soda solution, not lemon-glycerin swabs, because lemon-glycerin swabs can dry the oral mucosa, which may lead to bleeding. I.M. injections should be avoided in clients with DIC because of the potential for bleeding.

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? a. Adequate nutrition b. Avoidance of NSAIDs c. Constant access to clotting factor concentrates d. Meticulous hygiene

a. Adequate nutrition 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.

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

The nurse provides care for an older adult client, diagnosed with anemia, who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine the cause of the client's blood loss, which is the priority nursing action? a. Observe the client's stools for blood. b. Evaluate the client's dietary intake. c. Monitor the client's body temperature. d. Monitor the client's blood pressure.

a. Observe the client's stools for blood.

A pregnant woman is hospitalized as the result of sickle-cell crisis. Which finding indicates the outcome has been achieved for this client? a. Reports joint pain less than 3 on a scale of 0 to 10 b. Takes hydroxyurea during her pregnancy c. Exhibits a temperature more than 100.3°F d. Describes the importance of staying cool

a. Reports joint pain less than 3 on a scale of 0 to 10

A nurse is transfusing whole blood to a client with impaired renal function. During the transfusion, the client tells the nurse, "I feel very short of breath all of a sudden." What is the nurse's primary action? a. Stop the infusion. b. Slow the infusion. c. Call the health care provider. d. Assess the client's vital signs.

a. Stop the infusion.

A home care nurse visits a client diagnosed with atrial fibrillation who is ordered warfarin. The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching? a. "I'll watch my gums for bleeding when I brush my teeth." b. "I'll use an electric razor to shave." c. "I'll eat four servings of fresh, dark green vegetables every day." d. "I'll report unexplained or severe bruising to my doctor right away."

c. "I'll eat four servings of fresh, dark green vegetables every day." The client requires additional teaching if he states that he'll eat four servings of dark green vegetables every day. Dark, green vegetables contain vitamin K, which reverses the effects of warfarin. The client should limit his intake to one to two servings per day. The client should report bleeding gums and severe or unexplained bruising, which may indicate an excessive dose of warfarin. The client should use an electric razor to prevent cutting himself while shaving.

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? a. "The condition is likely caused by a folate deficiency." b. "The condition causes abnormally small red blood cells." c. "The condition is likely caused by a vitamin B12 deficiency." d. "The condition causes abnormally rigid red blood cells."

c. "The condition is likely caused by a vitamin B12 deficiency." Vitamin B12 combines with intrinsic factor produced in the stomach. The vitamin B12 -intrinsic factor complex is absorbed in the distal ileum. Clients who have had a partial or total gastrectomy may have limited amounts of intrinsic factor, and the absorption of vitamin B12 may be diminished. Megaloblastic anemia may be caused by a folate deficiency; however, the client's history of gastrectomy indicates the likely cause is a vitamin B12 deficiency. Megaloblastic anemia causes large erythrocytes (RBCs), not small or rigid.

Which client is not a candidate to be a blood donor according to the American Red Cross? a. 86-year-old male with blood pressure 110/70 mm Hg b. 50-year-old female with pulse 95 beats/minute c. 26-year-old female with hemoglobin 11.0 g/dL d. 18-year-old male weighing 52 kg

c. 26-year-old female with hemoglobin 11.0 g/dL Clients must meet a number of criteria to be eligible as blood donors, including the following: body weight at least 50 kg; pulse rate regular between 50 and 100 bpm; systolic BP 90-100 to 180 mm Hg and diastolic 50 to 100 mm Hg; hemoglobin level at least 12.5 g/dL. There is no upper age limit to donation.

The nurse is caring for a client with external bleeding. What is the nurse's priority intervention? a. Elevation of the extremity b. Pressure point control c. Direct pressure d. Application of a tourniquet

c. Direct pressure

The nurse obtains a unit of blood for the client, Donald D. Smith. The name on the label on the unit of blood reads Donald A. Smith. All the other identifiers are correct. What action should the nurse take? a. Administer the unit of blood b. Check with the blood bank first and then administer the blood with their permission c. Refuse to administer the blood d. Ask the client if he was ever known as Donald A. Smith

c. Refuse to administer the blood