Hematologic

The spleen has 4 major functions

(1)Hematopoietic: spleen's ability to produce RBCs during fetal development (2)Filtration: the spleen can remove old and defective RBCs from the circulation by phagocytosis (3)Immunologic: has a rich supply of lymphocytes, monocytes, and stored immunoglobulins (4)Storage: storage site for RBCs and platelets. More then 300mL of blood can be stored.

Chvostek's sign refers to carpel spasms induced by inflating a Blood Pressure cuff on the arm. Question options:True/False

False

What is the preferred site for aspiration and biopsy of bone marrow?

The posterior iliac crest

A nursing action that is indicated for the collaborative problem of potential complication: cardiac dysrhythmia in a patient who has had a repair of a descending thoracic aortic aneurysm is to______________

titrate oxygen to keep O2 saturation greater than 90%.

A patient is recovering from a thyroidectomy. The patient starts to complain of tingling and numbness in the face, toes, and fingers. Which of the following findings below warrants attention?. a) Phosphate level: 4.3 mg/dL b) Ca+ level: 6 mg/dL c) K+ level: 3.5 mg/dL d) Na+ level: 145 mg/dL

b) Ca+ level: 6 mg/dL

A patient hospitalized with hypoparathyroidism is about to order lunch. Which food selection is best for this patient based on their dietary needs at this time a) Roast beef, carrots, and pinto beans b) Spinach salad, cottage cheese, and peaches c) Hamburger, fries, and sorbet d) Baked chicken, green beans, and boiled potatoes

b) Spinach salad, cottage cheese, and peaches

A physician orders Calcium Gluconate IV as treatment for a patient with hypoparathyroidism. The patient's calcium level is 5 mg/dL. Which of the following finding causes you to question this order? a) The patient complains of muscle cramping and numbness in the face. b) The patient is taking Aluminum carbonate. c) The patient's phosphate level is 7 mg/dL. d) The patient is taking Digoxin.

d) The patient is taking Digoxin.

Which of the following cells is the precursor to the red blood cell (RBC)? A B cell B Macrophage C Stem cell D T cell

C The precursor to the RBC is the stem cell. B cells, macrophages, and T cells and lymphocytes, not RBC precursors

Which statements by the mother of a toddler would lead the nurse to suspect that the child has iron-deficiency anemia? Select all that apply. A "He drinks over 3 cups of milk per day." B "I can't keep enough apple juice in the house; he must drink over 10 ounces per day." C "He refuses to eat more than 2 different kinds of vegetables." D "He doesn't like meat, but he will eat small amounts of it." E "He sleeps 12 hours every night and take a 2-hour nap."

A, B Toddlers should have between 2 and 3 cups of milk per day and 8 ounces of juice per day. If they have more than that, then they are probably not eating enough other foods, including iron-rich foods that have the needed nutrients.

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

A Anemia is defined as a decreased number of erythrocytes (red blood cells). Leukopenia is a decreased number of leukocytes (white blood cells). Thrombocytopenia is a decreased number of platelets. Lastly, granulocytopenia is a decreased number of granulocytes (a type of white blood cells)

When a client is diagnosed with aplastic anemia, the nurse monitors for changes in which of the following physiological functions? A Bleeding tendencies B Intake and output C Peripheral sensation D Bowel function

A Aplastic anemia decreases the bone marrow production of RBCs, WBCs, and platelets. The client is at risk for bruising and bleeding tendencies. A change in the intake and output is important, but assessment for the potential for bleeding takes priority. Change in the peripheral nervous system is a priority problem specific to clients with vitamin B12 deficiency. Change in bowel function is not associated with aplastic anemia.

Because of the risks associated with administration of factor VIII concentrate, the nurse would teach the client's family to recognize and report which of the following? A Yellowing of the skin B Constipation C Abdominal distention D Puffiness around the eyes

A Because factor VIII concentrate is derived from large pools of human plasma, the risk of hepatitis is always present. Clinical manifestations of hepatitis include yellowing of the skin, mucous membranes, and sclera. Use of factor VIII concentrate is not associated with constipation, abdominal distention, or puffiness around the eyes.

Which of the following assessments in a child with hemophilia would lead the nurse to suspect early hemarthrosis? A Child's reluctance to move a body part B Cool, pale, clammy extremity C Eccymosis formation around a joint D Instability of a long bone in passive movement

A Bleeding into the joints in the child with hemophilia leads to pain and tenderness, resulting in restricted movement. Therefore, an early sign of hemarthrosis would be the child's reluctance to move a body part. If the bleeding into the joint continues, the area becomes hot, swollen, and immobile—not cool, pale, and clammy. Ecchymosis formation around a joint would be difficult to assess. Instability of a long bone on passive movement is not associated with joint hemarthrosis.

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

A Epogen is a recombinant DNA form of erythropoietin, which stimulates the production of RBCs and therefore causes the hematocrit to rise. The elevation in hematocrit causes an elevation in blood pressure; therefore, the blood pressure is a vital sign that should be checked. The PTT, hemoglobin level, and PT are not monitored for this drug.

A client was admitted with iron deficiency anemia and blood-streaked emesis. Which question is most appropriate for the nurse to ask in determining the extent of the client's activity intolerance? A "What activities were you able to do 6 months ago compared with the present?" B "How long have you had this problem?" C "Have you been able to keep up with all your usual activities?" D "Are you more tired now than you used to be?"

A It is difficult to determine activity intolerance without objectively comparing activities from one time frame to another. Because iron deficiency anemia can occur gradually and individual endurance varies, the nurse can best assess the client's activity tolerance by asking the client to compare activities 6 months ago and at the present. Asking a client how long a problem has existed is a very open-ended question that allows for too much subjectivity for any definition of the client's activity tolerance. Also, the client may not even identify that a "problem" exists. Asking the client whether he is staying abreast of usual activities addresses whether the tasks were completed, not the tolerance of the client while the tasks were being completed or the resulting condition of the client after the tasks were completed. Asking the client if he is more tired now than usual does not address his activity tolerance. Tiredness is a subjective evaluation and again can be distorted by factors such as the gradual onset of the anemia or the endurance of the individual.

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

A Mild anemia usually has no clinical signs. Palpitations, SOB, and pallor are all associated with severe anemia.

Which of the following patients are most likely to experience secondary hyperparathyroidism? a) A 58 year-old male with chronic renal failure. b) A 69 year-old female with an adenoma on the parathyroid gland. c) A 56 year-old male with a magnesium level of 0.5 mg/dL. d) A 7 year-old with diabetes type 1.

A) A 58 year-old male with chronic renal failure

What does the liver do?

Acts as a filter, produces all the procoagulants that are essential to hemostasis and blood coagulation (aka clotting factors are produced), stores iron

Following an aortic aneurysm repair, the patient suddenly develops severe pain in the right lower extremity. The right pedal pulse is decreased, and the right foot is cool and pale. Which complication should the nurse suspect?

An embolization or graft occlusion

A client with microcytic anemia is having trouble selecting food items from the hospital menu. Which food is best for the nurse to suggest for satisfying the client's nutritional needs and personal preferences? A Egg yolks B Brown rice C Vegetables D

B Brown rice is a source of iron from plant sources (nonheme iron). Other sources of non heme iron are whole-grain cereals and breads, dark green vegetables, legumes, nuts, dried fruits (apricots, raisins, dates), oatmeal, and sweet potatoes. Egg yolks have iron but it is not as well absorbed as iron from other sources. Vegetables are a good source of vitamins that may facilitate iron absorption. Tea contains tannin, which combines with nonheme iron, preventing its absorption.

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 because of marked decreases in bone marrow functioning with microcytosis.

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 Clients with aplastic anemia are severely immunocompromised and at risk for infection and possible death related to bone marrow suppression and pancytopenia. Strict aseptic technique and reverse isolation are important measures to prevent infection. Although diet, reduced stress, and rest are valued in supporting health, the potentially fatal consequence of an acute infection places it as a priority for teaching the client about health maintenance. Animal meat and dark green leafy vegetables, good sources of vitamin B12 and folic acid, should be included in the daily diet. Yoga and meditation are good complimentary therapies to reduce stress. Eight hours of rest and naps are good for spacing and pacing activity and rest.

Which of the following diagnostic findings are most likely for a client with aplastic anemia? A Decreased production of T-helper cells B Decreased levels of white blood cells, red blood cells, and platelets C Increased levels of WBCs, RBCs, and platelets D Reed-Sternberg cells and lymph node enlargement

B In aplastic anemia, the most likely diagnostic findings are decreased levels of all the cellular elements of the blood (pancytopenia). T-helper cell production doesn't decrease in aplastic anemia. Reed-Sternberg cells and lymph node enlargement occur with Hodgkin's disease.

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 Macrocytic anemias can result from deficiencies in vitamin B12 or ascorbic acid. Only vitamin B12 deficiency causes diminished sensations of peripheral nerve endings. The nurse should assess for peripheral neuropathy and instruct the client in self-care activities for her diminished sensation to heat and pain. The burn could be related to abuse, but this conclusion would require more supporting data. The findings should be documented, but the nurse would want to address the client's sensations first. The decision of how to treat the burn should be determined by the physician.

A client with pernicious anemia asks why she must take vitamin B12 injections for the rest of her life. What is the nurse's best response? A "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient acid." B "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor." C "The reason for your vitamin deficiency is an excessive excretion of the vitamin because of kidney dysfunction." D "The reason for your vitamin deficiency is an increased requirement for the vitamin because of rapid red blood cell production."

B Most clients with pernicious anemia have deficient production of intrinsic factor in the stomach. Intrinsic factor attaches to the vitamin in the stomach and forms a complex that allows the vitamin to be absorbed in the small intestine. The stomach is producing enough acid, there is not an excessive excretion of the vitamin, and there is not a rapid production of RBCs in this condition.

Which of the following foods would the nurse encourage the mother to offer to her child with iron deficiency anemia? A Rice cereal, whole milk, and yellow vegetables B Potato, peas, and chicken C Macaroni, cheese, and ham D Pudding, green vegetables, and rice

B Potato, peas, chicken, green vegetables, and rice cereal contain significant amounts of iron and therefore would be recommended. Milk and yellow vegetables are not good iron sources. Rice by itself also is not a good source of iron.

The nurse understands that the client with pernicious anemia will have which distinguishing laboratory findings? A Schilling's test, elevated B Intrinsic factor, absent C Sedimentation rate, 16 mm/hour D RBCs 5.0 million

B The defining characteristic of pernicious anemia, a megaloblastic anemia, is lack of the intrinsic factor, which results from atrophy of the stomach wall. Without the intrinsic factor, vitamin B12 cannot be absorbed in the small intestines, and folic acid needs vitamin B12 for DNA synthesis of RBCs. The gastric analysis was done to determine the primary cause of the anemia. An elevated excretion of the injected radioactive vitamin B12, which is protocol for the first and second stage of the Schilling test, indicates that the client has the intrinsic factor and can absorb vitamin B12 into the intestinal tract. A sedimentation rate of 16 mm/hour is normal for both men and women and is a nonspecific test to detect the presence of inflammation. It is not specific to anemias. An RBC value of 5.0 million is a normal value for both men and women and does not indicate anemia.

The nurse is assessing a client's activity intolerance by having the client walk on a treadmill for 5 minutes. Which of the following indicates an abnormal response? A Pulse rate increased by 20 bpm immediately after the activity B Respiratory rate decreased by 5 breaths/minute C Diastolic blood pressure increased by 7 mm Hg D Pulse rate within 6 bpm of resting phase after 3 minutes of rest.

B The normal physiologic response to activity is an increased metabolic rate over the resting basal rate. The decrease in respiratory rate indicates that the client is not strong enough to complete the mechanical cycle of respiration needed for gas exchange. The post activity pulse is expected to increase immediately after activity but by no more than 50 bpm if it is strenuous activity. The diastolic blood pressure is expected to rise but by no more than 15 mm Hg. The pulse returns to within 6 bpm of the resting pulse after 3 minutes of rest.

The nurse implements which of the following for the client who is starting a Schilling test? A Administering methylcellulose (Citrucel) B Starting a 24- to 48 hour urine specimen collection C Maintaining NPO status D Starting a 72 hour stool specimen collection

B Urinary vitamin B12 levels are measured after the ingestion of radioactive vitamin B12. A 24-to 48- hour urine specimen is collected after administration of an oral dose of radioactively tagged vitamin B12 and an injection of non-radioactive vitamin B12. In a healthy state of absorption, excess vitamin B12 is excreted in the urine; in a malabsorption state or when the intrinsic factor is missing, vitamin B12 is excreted in the feces. Citrucel is a bulk-forming agent. Laxatives interfere with the absorption of vitamin B12. The client is NPO 8 to 12 hours before the test but is not NPO during the test. A stool collection is not part of the Schilling test. If stool contaminates the urine collection, the results will be altered.

The nurse is teaching a client with polycythemia vera about potential complications from this disease. Which manifestations would the nurse include in the client's teaching plan? Select all that apply. A Hearing loss B Visual disturbance C Headache D Orthopnea E Gout F Weight loss

B,C,D,E Polycythemia vera, a condition in which too many RBCs are produced in the blood serum, can lead to an increase in the hematocrit and hypervolemia, hyperviscosity, and hypertension. Subsequently, the client can experience dizziness, tinnitus, visual disturbances, headaches, or a feeling of fullness in the head. The client may also experience cardiovascular symptoms such as heart failure (shortness of breath and orthopnea) and increased clotting time or symptoms of an increased uric acid level such as painful swollen joints (usually the big toe). Hearing loss and weight loss are not manifestations associated with polycythemia vera.

A nurse is caring for a client who had a percutaneous insertion of an inferior vena cava filter and was on heparin therapy before surgery. The nurse would inspect the surgical site most closely for signs of: a. Thrombosis and infection b. Bleeding and infection c. Bleeding and wound dehiscence. d. Wound dehiscence and evisceration.

B. Bleeding and infection After inferior vena cava insertion, the nurse inspects the surgical site for bleeding and signs and symptoms of infection. Otherwise, care is the same as for any post-op client.

A nurse is assessing a client with an abdominal aortic aneurysm. Which of the following assessment findings by the nurse is probably unrelated to the aneurysm? a. Pulsatile abdominal mass b. Hyperactive bowel sounds in that area c. Systolic bruit over the area of the mass d. Subjective sensation of "heart beating" in the abdomen.

B. Hyperactive bowel sounds in that area Not all clients with abdominal aortic aneurysms exhibit symptoms. Those who do describe a feeling of the "heart beating" in the abdomen when supine or be able to feel the mass throbbing. A pulsatile mass may be palpated in the middle and upper abdomen. A systolic bruit may be auscultated over the mass. Hyperactive bowel sounds are not related specifically to an abdominal aortic aneurysm.

A client who has been receiving heparin therapy also is started on warfarin sodium (coumadin). The client asks the nurse why both medications are being administered. In formulating a response, the nurse incorporates the understanding that warfarin sodium: a. Stimulates the breakdown of specific clotting factors by the liver, and it takes 2-3 days for this is exhibit an anticoagulant effect. b. Inhibits synthesis of specific clotting factors in the liver, and it takes 3 to 4 days for this medication to exert an anticoagulation effect. c. Stimulates production of the body's own thrombolytic substances, but it takes 2-4 days for it to begin. d. Has the same mechanism action of heparin, and the crossover time is needed for the serum level of warfarin sodium to be therapeutic.

B. Inhibits synthesis of specific clotting factors in the liver, and it takes 3 to 4 days for this medication to exert an anticoagulation effect Warfarin sodium works in the liver and inhibits synthesis of four vitamin K-dependent clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic effect of warfarin is exhibited.

In preparation for discharge of a client with arterial insufficiency and Raynaud's disease, client teaching instructions should include: a. Walking several times each day as an exercise program. b. Keeping the heat up so that the environment is warm c. Wearing TED hose during the day d. Using hydrotherapy for increasing oxygenation

B. Keeping up the he The client's instructions should include keeping the environment warm to prevent vasoconstriction. Wearing gloves, warm clothes, and socks will also be useful when preventing vasoconstriction, but TED hose would not be therapeutic. Walking would most likely increase pain.

A client comes to the outpatient clinic and tells the nurse that he has had legs pains that begin when he walks but cease when he stops walking. Which of the following conditions would the nurse assess for? a. An acute obstruction in the vessels of the legs b. Peripheral vascular problems in both legs c. Diabetes d. Calcium deficiency

B. PVD in both legs Intermittent claudication is a condition that indicates vascular deficiencies in the peripheral vascular system. If an obstruction were present, the leg pain would persist when the client stops walking. Low calcium levels may cause leg cramps but would not necessarily be related to walking.

A 24-year old man seeks medical attention for complaints of claudication in the arch of the foot. A nurse also notes superficial thrombophlebitis of the lower leg. The nurse would next assess the client for: a. Familial tendency toward peripheral vascular disease b. Smoking history c. Recent exposures to allergens d. History of insect bites

B. Smoking History The mixture of arterial and venous manifestations (claudication and phlebitis, respectively) in the young male client suggests Buerger's disease. This is an uncommon disorder characterized by inflammation and thrombosis of smaller arteries and veins. This disorder typically is found in young adult males who smoke. The cause is not known precisely but is suspected to have an autoimmune component.

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 A diagnosis is established based on a complete blood count, examination for sickled red blood cells in the peripheral smear, and hemoglobin electrophoresis. Laboratory studies will show decreased hemoglobin and hematocrit levels and a decreased platelet count, and increased reticulocyte count, and the presence of nucleated red blood cells. Increased reticulocyte counts occur in children with sickle cell disease because the life span of their sickled red blood cells is shortened.

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 Anemia stems from a decreased number of red blood cells and the resulting deficiency in oxygen and body tissues. Clotting factors, such as factor VIII, relate to the body's ability to form blood clots and aren't related to anemia, not is carbon dioxide of T antibodies.

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 red blood cells C Obstruction to circulation D Elevated serum bilirubin concentration.

C Characteristic sickle cells tend to cause "log jams" in capillaries. This results in poor circulation to local tissues, leading to ischemia and necrosis. The basic defect in sickle cell disease is an abnormality in the structure of RBCs. The erythrocytes are sickle-shaped, rough in texture, and rigid. Sickle cell disease is an inherited disease, not an autoimmune reaction. Elevated serum bilirubin concentrations are associated with jaundice, not sickle cell disease.

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 Coffee and tea increase gastrointestinal motility and inhibit the absorption of nonheme iron. Clients are instructed to add dried fruits to dishes at every meal because dried fruits are a nonheme or nonanimal iron source. Cooking in iron cookware, especially acid-based foods such as tomatoes, adds iron to the diet. Clients are instructed to add a rich supply of vitamin C to every meal because the absorption of iron is increased when food with vitamin C or ascorbic acid is consumed.

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 For the child in a sickle cell crisis, pain is the priority nursing diagnosis because the sickled cells clump and obstruct the blood vessels, leading to occlusion and subsequent tissue ischemia. Although ineffective coping may be important, it is not the priority. Decreased cardiac output is not a problem with this type of vaso occlusive crisis. Typically, a sickle cell crisis can be precipitated by a fluid volume deficit or dehydration.

The nurse would instruct the client to eat which of the following foods to obtain the best supply of vitamin B12? A Whole grains B Green leafy vegetables C Meats and dairy products D Broccoli and Brussels sprouts

C Good sources of vitamin B12 include meats and dairy products. Whole grains are a good source of thiamine. Green leafy vegetables are good sources of niacin, folate, and carotenoids (precursors of vitamin A). Broccoli and Brussels sprouts are good sources of ascorbic acid (vitamin C).

Which of the following disorders results from a deficiency of factor VIII? A Sickle cell disease B Christmas disease C Hemophilia A D Hemophilia B

C Hemophilia A results from a deficiency of factor VIII. Sickle cell disease is caused by a defective hemoglobin molecule. Christmas disease, also called hemophilia B, results in a factor IX deficiency.

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 Pain crisis may be precipitated by infection, dehydration, hypoxia, trauma, or physical or emotional stress. The mother of a child with sickle cell disease should encourage fluid intake of 1 ½ to 2 times the daily requirement to prevent dehydration.

The primary purpose of the Schilling test is to measure the client's ability to: A Store vitamin B12 B Digest vitamin B12 C Absorb vitamin B12 D Produce vitamin B12

C Pernicious anemia is caused by the body's inability to absorb vitamin B12. This results in a lack of intrinsic factor in the gastric juices. Schilling's test helps diagnose pernicious anemia by determining the client's ability to absorb vitamin B12.

Which of the following nursing assessments is a late symptom of polycythemia vera? A Headache B Dizziness C Pruritus D Shortness of breath

C Pruritus is a late symptom that results from abnormal histamine metabolism. Headache and dizziness are early symptoms from engorged veins. Shortness of breath is an early symptom from congested mucous membrane and ineffective gas exchange.

When comparing the hematocrit levels of a post-op client, the nurse notes that the hematocrit decreased from 36% to 34% on the third day even though the RBC and hemoglobin values remained stable at 4.5 million and 11.9 g/dL, respectively. Which nursing intervention is most appropriate? A Check the dressing and drains for frank bleeding B Call the physician C Continue to monitor vital signs D Start oxygen at 2L/min per NC

C The nurse should continue to monitor the client, because this value reflects a normal physiologic response. The physician does not need to be called, and oxygen does not need to be started based on these laboratory findings. Immediately after surgery, the client's hematocrit reflects a falsely high value related to the body's compensatory response to the stress of sudden loss of fluids and blood. Activation of the intrinsic pathway and the renin-angiotensin cycle via antidiuretic hormone produces vasoconstriction and retention of fluid for the first 1 to 2 day post-op. By the second to third day, this response decreases and the client's hematocrit level is more reflective of the amount of RBCs in the plasma. Fresh bleeding is a less likely occurrence on the third post-op day but is not impossible; however, the nurse would have expected to see a decrease in the RBC and hemoglobin values accompanying the hematocrit.

When caring for a patient who has started anticoagulant therapy with warfarin (Coumadin), the nurse knows not to expect therapeutic benefits for: a. At least 12 hours b. The first 24 hours c. 2-3 days d. 1 week

C. 2-3 weeks

Which of the following patients are MOST at risk for hypoparathyroidism? a) A 85 year-old female complaining of flank pain and constipation. b) A 19 year-old male with a Ca+ level of 8.9 mg/dL. c) A 59 year-old male with a Mg+ level of 0.9 mg/dL. d) . A 75 year-old female who is diabetic and takes Os-Cal daily.

C. A 59 year-old male with a Mg+ level of 0.9 mg/dL

Varicose veins can cause changes in what component of Virchow's triad? a. Blood coagulability b. Vessel walls c. Blood flow d. Blood viscosity

C. Blood Flow

A patient is diagnosed with hyperparathyroidism. Which of the following signs and symptoms would you NOT find in this patient? Select all that apply: Calcium level 6 mg/dL Positive Trousseau's Sign Bone fracture Renal calculi Calcium level of 15 mg/dL Tingling and numbness of lips and fingers Phosphate level 1.2

Calcium level 6 mg/dL Positive Trousseau's Sign Tingling and numbness of lips and fingers

A pediatric nurse health educator provides a teaching session to the nursing staff regarding hemophilia. Which of the following information regarding this disorder would the nurse plan to include in the discussion? A Hemophilia is a Y linked hereditary disorder B Males inherit hemophilia from their fathers C Females inherit hemophilia from their mothers D Hemophilia A results from a deficiency of factor VIII

D Males inherit hemophilia from their mothers, and females inherit the carrier status from their fathers. Hemophilia is inherited in a recessive manner via a genetic defect on the X-chromosome. Hemophilia A results from a deficiency of factor VIII. Hemophilia B (Christmas disease) is a deficiency of factor IX.

The physician has ordered several laboratory tests to help diagnose an infant's bleeding disorder. Which of the following tests, if abnormal, would the nurse interpret as most likely to indicate hemophilia? A Bleeding time B Tourniquet test C Clot retraction test D Partial thromboplastin time (PTT)

D PTT measures the activity of thromboplastin, which is dependent on intrinsic clotting factors. In hemophilia, the intrinsic clotting factor VIII (antihemophilic factor) is deficient, resulting in a prolonged PTT. Bleeding time reflects platelet function; the tourniquet test measures vasoconstriction and platelet function; and the clot retraction test measures capillary fragility. All of these are unaffected in people with hemophilia.

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 Preferably, ferrous gluconate should be taken on an empty stomach. Ferrous gluconate should not be taken with antacids, milk, or whole-grain cereals because these foods reduce iron absorption.

The mothers 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 Sickle cell disease is an inherited disease that is present at birth. However, 60% to 80% of a newborns hemoglobin is fetal hemoglobin, which has a structure different from that of hemoglobin S or hemoglobin A. Sickle cell symptoms usually occur about 4 months after birth, when hemoglobin S begins to replace the fetal hemoglobin. The gene for sickle cell disease is transmitted at the time of conception, not passed through the placenta. Some hemoglobin S is produced by the fetus near term. The fetus produces all its own hemoglobin from the earliest production in the first trimester. Passive immunity conferred by maternal antibodies is not related to sickle cell disease, but this transmission of antibodies is important to protect the infant from various infections during early infancy.

The nurse has just admitted a 35-year-old female client who has a serum B12 concentration of 800 pg/ml. Which of the following laboratory findings would cue the nurse to focus the client history on specific drug or alcohol abuse? Total bilirubin, 0.3 mg/dL B Serum creatinine, 0.5 mg/dL C Hemoglobin, 16 g/dL D Folate, 1.5 ng/mL

D The normal range of folic acid is 1.8 to 9 ng/mL, and the normal range of vitamin B12 is 200 to 900 pg/mL. A low folic acid level in the presence of a normal vitamin B12 level is indicative of a primary folic acid-deficiency anemia. Factors that affect the absorption of folic acid are drugs such as methotrexate, oral contraceptives, antiseizure drugs, and alcohol. The total bilirubin, serum creatinine, and hemoglobin values are within normal limits.

Laboratory studies are performed for a child suspected of having iron deficiency anemia. The nurse reviews the laboratory results, knowing that which of the following results would indicate this type of anemia? A An elevated hemoglobin level B A decreased reticulocyte count C An elevated RBC count D Red blood cells that are microcytic and hypochromic

D The results of a CBC in children with iron deficiency anemia will show decreased hemoglobin levels and microcytic and hypochromic red blood cells. The red blood cell count is decreased. The reticulocyte count is usually normal or slightly elevated.

A client comes into the health clinic 3 years after undergoing a resection of the terminal ileum complaining of weakness, shortness of breath, and a sore tongue. Which client statement indicates a need for intervention and client teaching? A "I have been drinking plenty of fluids." B "I have been gargling with warm salt water for my sore tongue." C "I have 3 to 4 loose stools per day." D "I take a vitamin B12 tablet every day."

D Vitamin B12 combines with intrinsic factor in the stomach and is then carried to the ileum, where it is absorbed in the bloodstream. In this situation, vitamin B12 cannot be absorbed regardless of the amount of oral intake of sources of vitamin B12 such as animal protein or vitamin B12 tablets. Vitamin B12 needs to be injected every month, because the ileum has been surgically removed. Replacement of fluids and electrolytes is important when the client has continuous multiple loose stools on a daily basis. Warm salt water is used to soothe sore mucous membranes. Crohn's disease and small bowel resection may cause several loose stools a day.

A client states that she is afraid of receiving vitamin B12 injections because of the potential toxic reactions. What is the nurse's best response to relieve these fears? A "Vitamin B12 will cause ringing in the eats before a toxic level is reached." B "Vitamin B12 may cause a very mild skin rash initially." C "Vitamin B12 may cause mild nausea but nothing toxic." D "Vitamin B12 is generally free of toxicity because it is water soluble."

D Vitamin B12 is a water-soluble vitamin. When water-soluble vitamins are taken in excess of the body's needs, they are filtered through the kidneys and excreted. Vitamin B12 is considered to be nontoxic. Adverse reactions that have occurred are believed to be related to impurities or to the preservative in B12 preparations. Ringing in the ears, skin rash, and nausea are not considered to be related to vitamin B12 administration.

A client is admitted with a venous stasis leg ulcer. A nurse assesses the ulcer, expecting to note that the ulcer: a. Has a pale colored base b. Is deep, with even edges c. Has little granulation tissue d. Has brown pigmentation around it.

D. Has brown pigmentation around it. Venous leg ulcers, also called stasis ulcers, tend to be more superficial than arterial ulcers, and the ulcer bed is pink. The edges of the ulcer are uneven, and granulation tissue is evident. The skin has a brown pigmentation from accumulation of metabolic waste products resulting from venous stasis. The client also exhibits peripheral edema. (options 1, 2, and 3 is due to tissue malnutrition; and thus us an arterial problem)

The nurse is preparing to teach a client with microcytic hypochromic anemia about the diet to follow after discharge. Which of the following foods should be included in the diet? Eggs Lettuce Citrus fruits Cheese

Eggs One of the microcytic, hypochromic anemias is iron-deficiency anemia. A rich source of iron is needed in the diet, and eggs are high in iron. Other foods high in iron include organ and muscle (dark) meats; shellfish, shrimp, and tuna; enriched, whole-grain, and fortified cereals and breads; legumes, nuts, dried fruits, and beans; oatmeal; and sweet potatoes. Dark green leafy vegetables and citrus fruits are good sources of vitamin C. Cheese is a good source of calcium.

The nurse teaches a patient with peripheral arterial disease. The nurse determines that further teaching is needed if the patient makes which statement?

I should cut back on my walks if it causes pain in my leg

How does cigarette smoking affect the blood?

Increases LDL cholesterol and levels of CO2, leading to hypoxia and altering the anticoagulant properties of the endothelium. Smoking increases platelet reactivity, plasma fibrinogen, hematocrit, and blood viscosity

The cardiac effects of hypocalcemia include prolong ____________ and develop into ____________

QT Interval; Complete heart block

A patient with peripheral artery disease has marked peripheral neuropathy. An appropriate nursing diagnosis for the patient is:

Risk for injury related to decreased sensation.

A patient is being tested for sickle cell disease. As the nurse, you know the ________ will assess for abnormal hemoglobin on the red blood cell, but will not differentiate between sickle cell disease and sickle cell trait. Therefore, the patient will need to have what other test to determine this? A. dithionite test; hemoglobin electrophoresis B. hemoglobin electrophoresis; sickledex C. edrophonium test, dithionite test D. sickledex; edrophonium test

The answer is A.

A mother brings in her 8 month-old child to the ER. The mother reports the baby has recently started being extremely fussy, has a fever, and swelling in the hands and feet. The child is diagnosed with sickle cell disease. As the nurse you know that the swelling in the hands and feet in the infant is termed? A. Dactylitis B. Erythromelaglia C. Dyshidrotia D. Phalitis

The answer is A. Dactylitis (also called hand-foot syndrome) occurs mainly in infants who are newly diagnosed with sickle cell anemia.

Select the patient below who is at MOST risk for pernicious anemia: A. A 75 year old male who recently had surgery on the ileum. B. A 25 year old female who reports craving ice and clay. C. A 66 year old male whose peripheral blood smear showed hypochromic red blood cells. D. All the patients above are at risk for pernicious anemia.

The answer is A. Remember from the lecture that the elderly, patients who've had GI surgery (the ileum is part of the GI system), have endocrine disorders (like Addison's Disease, Diabetes Type 1 etc.), or GI disease are at risk for pernicious anemia. This reason is because as the person ages GI secretions decrease along with intrinsic factor and with GI surgery the parietal cells can be damaged (which are responsible for secreting intrinsic factor). So, the patient in option A is at most risk. Options B and C are risk factors for IRON-DEFICIENCY anemia (not pernicious anemia).

You're providing discharge teaching to a patient about pernicious anemia. Which statement by the patient indicates they did NOT understand the discharge teaching? A. "Pernicious anemia is caused by not consuming enough Vitamin B12." B. "Pernicious anemia causes the red blood cells to appear very large and oval." C. "Treatment for pernicious anemia includes a series of intramuscular injections of Vitamin B12." D. "A red, smooth tongue can be a sign of pernicious anemia."

The answer is A. This statement is wrong because pernicious anemia is caused by the patient lacking intrinsic factor which helps with the absorption of vitamin B12. The patient can consume supplements or foods with vitamin B12, but they will not absorb B12 because they lack intrinsic factor. All the other statements are correct about pernicious anemia.

A patient with severe pernicious anemia is being discharged home and requires routine injections of Vitamin B12. Which statement by the patient demonstrates they understood your instructions about their treatment regime? A. "I will require one injection every 6 months until my Vitamin B12 levels are therapeutic and then I'm done." B. "Initially, I will need weekly injections of Vitamin B12 and then monthly injections for maintenance, which will be a lifelong regime." C. "I will only need vitamin B12 injections for a month and then I can take a low dose of oral vitamin B12." D. "When I start to feel weak and short of breath I need to call the doctor so I can schedule an appointment for a Vitamin B12 injection."

The answer is B. A patient with pernicious anemia cannot absorb vitamin B12 through the GI system. So, eating foods or taking supplements of vitamin B12 are pointless because the patient lacks intrinsic factor to absorb vitamin B12. Therefore, the typical regime for a patient with pernicious anemia is to receive vitamin B12 through intramuscular injections. Normally, the physician will order weekly injections and then monthly as maintenance, which is usually a lifelong treatment.

A 25 year-old pregnant female and her partner both have sickle cell trait. What is the percentage that their offspring will develop sickle cell anemia? A. 50% B. 25% C. 75% D. 100%

The answer is B. If both parents have the sickle cell trait it means they each have normal hemoglobin A and abnormal hemoglobin S on their RBCs....so both present with hbg AS. Remember they don't have sickle cell disease just the abnormal gene that can be passed to their child. Sickle cell anemia is autosomal recessive, therefore there is a 25% chance their child will obtain both abnormal genes (the Hbg S) from EACH parent and develop sickle cell anemia.

Which type of hemoglobin is present in a patient who has sickle cell TRAIT? A. Hemoglobin AA B. Hemoglobin AS C. Hemoglobin SS D. Hemoglobin AC

The answer is B. Sickle cell TRAIT is heterozygous, which means the patient has one NORMAL allele (which is Hemoglobin A...this is NORMAL hemoglobin) and one ABNORMAL allele (which is Hemoglobin S).....this is the abnormal hemoglobin that leads to the abnormal construction of the RBC). However, most patients with sickle cell trait don't show signs and symptoms related to sickle cell anemia because they have just enough of the normal hemoglobin A to prevent sickling of the RBC.

You're assisting a physician with sickle cell anemia screening. As the nurse you know that which patient population listed below is at risk for sickle cell disease? A. Native Americans B. African-Americans C. Pacific Islanders D. Latino

The answer is B. Sickle cell anemia is most common in African-Americans along with Middle Eastern, Asian, Caribbean, and Eastern Mediterranean. WHY? According to the CDC, 1 in 12 African-Americans have the sickle cell trait, so it can easily be passed to their offspring. Remember if both parents have sickle cell trait there is a 25% chance they will pass it to their child.

You're providing education to a patient with sickle cell anemia who is taking Hydroxyurea. You will make it priority to tell the patient to? A. Consume foods high in calcium and potassium B. Avoid sick people and maintain strict hand hygiene C. Take this medication with at least 8 oz of water D. Monitor your blood glucose level daily

The answer is B. This medication can lower the white blood cell count. Therefore, the nurse should make it priority to tell the patient to avoid infection by avoiding sick people and performing hand hygiene regularly.

A doctor suspects pernicious anemia in a patient presenting with a beefy red tongue. The patient reports feeling extremely fatigued and numbness and tingling in the hands. The doctor orders a peripheral blood smear. From your nursing knowledge, how will the red blood cells appear in the peripheral blood smear if pernicious anemia is present? A. Round-shaped and hypochromic B. Oval-shaped and hyperchromic C. Large and oval-shaped D. Small and hyperchromic

The answer is C. In pernicious anemia, the RBCs will appear very large (rather than normal size) and oval-shaped (rather than round).

In pernicious anemia, intrinsic factor is not being secreted by the _______ cells which are found in the gastric mucosa. A. Visceral B. Langerhan C. Parietal D. Chief

The answer is C. Parietal cells in the GI system secrete intrinsic factor.

You're educating the parents of a 12 year-old, who was recently treated for sickle cell crisis, on ways to prevent further sickle cell crises in the further. Which statement by the parents demonstrates they understood your instructions? A. "We will limit fluid intake during the day to 1-2 L a day." B. "Cold showers are best to help with pain associated with sickling." C. "We will avoid traveling to high altitude locations." D. "It is important we refuse all future vaccinations unless absolutely necessary."

The answer is C. Remember sickle cell crisis can be caused by blood loss, illness (it's important the patient is up-to-date with all vaccinations), high altitudes, stress, dehydration, elevated temperature, or extreme cold temperatures. All options are wrong except C.

Which statement about how sickle cell anemia is passed to offspring is CORRECT? A. This disease is an x-linked recessive disease. B. Sickle cell anemia is an autosomal dominant disease. C. This condition is an autosomal recessive disease. D. Sickle cell anemia is rarely passed to offspring and is an autosomal x-linked dominant disease.

The answer is C. SCA is an autosomal recessive disease in that the offspring must receive TWO hemoglobin S genes (one for each parent). The parents usually don't have the disease but are carriers. For the disease to occur in the offspring they must receive both of those genes (Hbg SS). On the contrary, with autosomal dominant the offspring has to only receive an abnormal gene from one parent, who probably has signs and symptoms of the disease too.

Which type of hemoglobin is present in a patient who has sickle cell anemia? A. Hemoglobin AA B. Hemoglobin AS C. Hemoglobin SS C. Hemoglobin AC

The answer is C. SCA is homozygous and the patient must have two abnormal alleles present to have sickle cell anemia. The patient receives each abnormal allele for each parent (hence one from each parent which is Hemoglobin SS). If a patient has Hemoglobin AS (normal allele (A) and abnormal allele (S)) this is known as sickle cell trait, which most patients with this don't present with signs and symptoms of the disease...it's rare because they usually have just enough hemoglobin A to prevent the RBCs from sickling.

You're providing seminar teaching to a group of nurses about sickle cell anemia. Which of the following is NOT a treatment for this condition? A. Blood transfusion B. Stem cell transplant C. Intravenous fluids D. Iron supplements E. Antibiotics F. Morphine

The answer is D. Iron supplements are not prescribed (rather Folic Acid) because this type of anemia is not caused by low iron levels, and patients who take iron supplements with sickle cell disease are at risk for building up too much iron in the body, which will damage the organs.

During an outpatient well visit with a patient who has sickle cell anemia, you make it PRIORITY to assess the patient's? A. hemoglobin A1C level B. heart rate C. reflexes D. vaccination history

The answer is D. Patients will sickle cell anemia are at risk for infection because of spleen compromise. Many patients with SCA experience splenomegaly because blood flow is compromised to the spleen due to sickling of RBCs and the spleen is overworked from recycling the old RBCs (remember a patient with sickle cell anemia does NOT have long-living RBCs...the RBCs tend to die in 20 days rather than 120 days). Therefore, vaccination history is very important. The patient should be up-to-date with the flu, pneumococcal, and meningococcal vaccines.

A patient with pernicious anemia is ordered to receive supplementary Vitamin B12. What is the best route to administer this medication for patients with this disorder? A. Intravenous B. Orally C. Through a central line D. Intramuscular

The answer is D. Remember patients with Vitamin B12 do NOT absorb vitamin B12 through the GI system due to lacking intrinsic factor (which helps with the absorption of vitamin B12)....therefore, you would not give it orally. The best route for administering vitamin B12 is via the muscle (intramuscular).

True or False: Intrinsic factor is a protein that plays a role in how the body absorbs Vitamin B12. True False

The answer is TRUE.

An 18 year-old male is taking Hydroxyurea for treatment of sickle cell anemia. Which options below indicate this medication is working successfully? Select all that apply: A. The patient needs fewer blood transfusions. B. The patient experiences diuresis. C. The patient experiences an increase in fetal hemoglobin (Hbg F). D. The patient experiences a decrease in hemoglobin S.

The answers are A and C. This medications actually treats cancer, but it will help with SCA in that it will help create fetal hemoglobin hgb F (this helps decrease sickling episodes) and helps with anemia (decreasing the need for so many blood transfusions).

A 6 year-old is admitted with sickle cell crisis. The patient has a FACE scale rating of 10 and the following vital signs: HR 115, BP 120/82, RR 18, oxygen saturation 91%, temperature 101.4'F. Select all the appropriate nursing interventions for this patient at this time? A. Administer IV Morphine per MD order B. Administer oxygen per MD order C. Keep NPO D. Apply cold compresses E. Start intravenous fluids per MD order F. Administer iron supplement per MD order G. Keep patient on bed rest H. Remove restrictive clothing or objects from the patient

The answers are A, B, E, G, and H. When a patient is in sickle cell crisis, the abnormal RBCs are sickling and sticking together, which blocks blood flow. To help alleviate the RBCs from clumping together and sickling, oxygen and hydration are priority. This will help dilute the blood (hence decrease the sticking of RBCs) and help supply oxygen to the RBCs (remember abnormal RBCs with hemoglobin S are very sensitive to low oxygen levels and will sickle when there is low oxygen). In addition, pain needs to be addressed. Opioid medication is the best on a scheduled basis rather than PRN (as needed). Avoid keeping patient NPO unless needed (remember patient needs hydration). Avoid cold compresses (can lead to more sickling) but instead use warm compresses. The patient will need FOLIC ACID supplements to help with RBC creation rather than iron (iron can actually build up in the body and collect in the organs in patients with sickle cell disease). Patients definitely need to be on bedrest, and restrictive clothing or objects (blood pressure cuff etc.) should be removed to help blood flow.

A 14 year-old female has sickle cell anemia. Which factors below can increase the patient's risk for developing sickle cell crisis? Select all that apply: A. Shellfish B. Infection C. Dehydration D. Hypoxia E. Low altitudes F. Hemorrhage G. Strenuous exercise

The answers are B, C, D, F and G. Sickle cell crisis can occur when the body experiences low amounts of oxygen in the body (so think about something that increases the body's need for oxygen or affects how oxygen is being transported). Therefore, infection (especially respiratory infections), dehydration, hypoxia, HIGH (not low) altitudes, hemorrhage (blood loss), or strenuous exercise can lead to a sickle cell crisis.

Select ALL the signs and symptoms that can present in pernicious anemia: A. Erythema B. Paresthesia of hands and feet C. Racing thoughts D. Extreme hunger E. Depression F. Unsteady gait G. Shortness of breath with activity

The answers are B, E, F, and G. These are the signs and symptoms that present in pernicious anemia...the other options are incorrect.

Hematocrit

The percent of the volume of whole blood that is composed of red blood cells as determined by separation of red blood cells from the plasma usually by centrifugation. RBCs are the heavier component so they settle to the bottom

You are providing discharge teaching to a patient who is prescribed calcium supplements with vitamin D for treatment of hypoparathyroidism. Which of the following statements by the patient warrants you to re-educate the patient on how they should take this medication? a) "I will take my calcium supplements in the morning when I take my Synthroid." b) All the statements above are correctly stated by the patient. c) "I will also make sure I eat foods rich in calcium, such as dairy and green leafy vegetables while I'm taking this medication." d) "A side effect of this medication is constipation. Therefore, I should drink plenty of fluids."

a) "I will take my calcium supplements in the morning when I take my Synthroid."

A patient is recovery from a parathyroidectomy. Which of the following findings causes concern and requires nursing intervention? a) The patient's voice is hoarse. b) The patient is drowsy but arouses to name. c) The patient is in Semi-Fowler's position. d) The patient's calcium level is 8.9 mg/dL.

a) The patient's voice is hoarse

A 42-year-old service-counter worker undergoes sclerotherapy for treatment of superficial varicose veins at an outpatient center. Before discharging the patient, the nurse teaches the patient that a. sitting at the work counter, rather than standing, is recommended. b. compression stockings should be applied before getting out of bed. c. exercises such as walking or jogging cause recurrence of varicosities. d. taking one aspirin daily will help prevent clotting around venous valves.

b. compression stockings should be applied before getting out of bed in the morning

Which clinical manifestations are seen in patients with either Buerger's disease or Raynaud's phenomenon (select all that apply)?a.Intermittent fevers b.Sensitivity to cold temperatures c.Gangrenous ulcers on fingertips d.Color changes of fingers and toes e.Episodes of superficial vein thrombosis

b.Sensitivity to cold temperatures c.Gangrenous ulcers on fingertips d.Color changes of fingers and toes Both Buerger's disease and Raynaud's phenomenon have the following clinical manifestations in common: cold sensitivity, ischemic and gangrenous ulcers on fingertips, and color changes of the distal extremity (fingers or toes).

What is Pancytopenia?

deficiency of all three cellular components of the blood (red cells, white cells, and platelets).