Hematologic System Disorders and Drugs

The patient who underwent a bone biopsy yesterday calls the office thinking something is wrong. Which of the following would be cause for concern by the nurse? SATA: A) Swelling and redness at the site B) Red streaks spreading away from the area C) T of 99.5 D) Pain in the areaE) Small amount of blood on dressing

Answer: A and B. These are signs of possible bleeding or infection at the site. A temperature of 99.5 is still considered WNL. Pain in the area would be expected (unusual or increased pain should be reported). A small amount of blood on dressing would be expected. Any pus found in the drainage should be reported.

Which of the following symptoms would be expected in the patient diagnosed with Polycythemia Vera (PV)? A) HA B) Palpatable spleen C) Angina D) Polyuria E) Dyspnea

Answer: A,B,C, and E. The patient with PV would have symptoms based on increased blood volume and increased blood viscosity. HA, dizziness, tinnitus, fatigue, paresthesia, and blurred vision are possible symptoms of increased blood volume. Angina, claudication, dyspnea, and thrombophlebitis are possible symptoms of increased blood viscosity. Splenomegaly (enlarged spleen) occurs as it takes on blood producing responsibility. Polyuria is not associated with this disorder

Which of the following complications would the nurse know to monitor for in the patient with primary thrombocythemia? A) bleeding and clot formation B) HA and dizziness C) Stroke and syncope D) Infection and DVT

Answer: A. Bleeding and clot formation are two common complications of primary thrombocytopenia. In this disorder, platelet levels are high (600,000+) and platelets are often dysfunctional. Because of this clots leading to possible DVT, MI, or CVA may occur as well as possible hemorrhage. HA and dizziness are two common symptoms of the disease. Syncope and infection would not be associated complications.

You are preparing the client for a bone marrow aspiration and biopsy. Which of the following statements, if made by the patient, indicates the need for further teaching? A) After the procedure I should avoid ambulating for 24-48 hours B) Pain and discomfort is expected after the surgery. I can take some Tylenol for the discomfort. C) I should not take a bath for about 24 hours D) The surgeon will collect the samples from my hip bone

Answer: A. There is no need to avoid ambulation after the biopsy. Some discomfort at the site can occur for about a day or two. Tylenol can be given in this case but aspirin based medications should be avoid d/t risk for bleeding. The patient should be advised to avoid taking a bath or submerging the site in any other way with water. The specimen is typically taken from the iliac crest, part of the hip bone.

Which medication might the nurse question if administered to the client with anemia? A) Cipro B) Lisinopril C) Acetaminophen D) Ferrous sulfate

Answer: B An antihypertensive medication such as an ACE inhibitor could decrease the preload even further which could be detrimental for a patient with anemia. An antibiotic or Tylenol should not affect the anemia problem directly. Ferrous sulfate is often prescribed to patients with anemia to help bring up RBC.

Which of the following abnormal lab results would the nurse expect to see in the patient with multiple myeloma?Select all that applies A) K 5.4 B) Ca 11.5 C) Positive proteinuria D) Serum M protein E) Platelets 80,000

Answer: B, C, and D. Protein levels in urine are an expected result of the disease process. Because bones are being destroyed, an excess calcium level may also be expected. Serum M (Monocolonal protein) in the blood is the main protein created d/t multiple myeloma. There would be no expected changes in potassium or platelet counts

A young mother of three with history of Type 1 diabetes comes into the clinic c/o of fatigue and says "my Fitbit has been rating my heart rate higher than it used to be" Her Hgb is taken and found to be 11 g/dL. Which of the following factors most likely influenced this patient's ability to feel anemia symptoms (fatigue)? A) Hx of diabetes B) Stressful lifestyle C) Lack of exercise D) Multipara status

Answer: B. People with stressful and active lifestyles are much more likely to feel symptoms of anemia such as fatigue. Any increased demand for oxygen is going to increase symptoms in a patient. A patient with a heart defect or pulmonary disease would be more likely to experience symptoms of anemia rather than a patient with hypothyroidism who has a decreased demand for O2

The patient diagnosed with iron deficiency anemia tells you that she constantly feels tired and exhausted. She tells you that she is concerned about this problem. What is the nurse's best initial response? A) Keep taking your supplements and report back to me in a couple to days B) How has this affected your life? C) You are going to need to take a break from those things for a period of time to rest D) Try to help get rid of the stress in your life. This will help with the tired feeling

Answer: B. Asking this client explain how the fatigue is affecting her life will help open up the conversation and build rapport. Fatigue is a real life-changing issue for patients with anemia and should not be dismissed. Telling her that she must take a break from "things" is not an understanding response and may not solve the underlying problem. Clients should not be instructed to get rid of all the stress in life.

The nurse is taking care of the 73 year old patient with polycythemia vera. The nurse is most concerned when the patient mentions which of the following? A) I've had a UTI in the past so I've been drinking cranberry juice to prevent this from happening again B) I want to be healthy so I started taking a daily multivitamin C) I had my last blood draw about a week ago now D) My doctor started me on a blood pressure medication called Metroprolol

Answer: B. Multivitamins often contain iron which would further stimulate blood production. It would be important to make sure the vitamin did not contain that ingredient before the client continued with its use. All other statements are not concerning

You are providing discharge teaching to the patient with polycythemia Vera about treating pruritus. Which of the following statements indicates the need for further teaching? A) A cold ice pack can help relieve some of my itching B) I will take some Benadryl to help relieve the itching C) Water will probably make my itching worse rather than help it D) My doctor may discuss the use of Interferon with me which could help relieve my itching

Answer: B. Use of antihistamines are not effective in relieving pruritus caused by polycythemia. Cold compresses may help relieve itching (avoid warm or hot). Water often aggravates pruritus with polycythemia Vera (aquagenic pruritus). Interferon, a myelosuppressive agent given to high risk patients could help relieve itching.

The patient with polycythemia Vera asks you "Why the **** am I taking aspirin!? I never needed any medications before!" What is the best response by the nurse? A) The aspirin is prescribed in order to treat HA, a common symptom of this disease B) Aspirin has been proven to be effective in preventing all complications of this disorder C) This medication will help reduce the burning pain you have in your extremities D) If I wanted you to ask a question, I would have let you know. Now shut up and take your pill.

Answer: C. Aspirin is prescribed to help with erythromelalgia which is a problem caused by PV which causes warmth, redness, and burning pain in the extremities. Cool compresses may also help with this problem. It is important to monitor patients taking aspirin for bleeding because patients with PV are already at an increased risk for bleeding which could be exacerbated by aspirin use.

The nurse is discharging the patient with multiple myeloma. Which of the following teaching should be included during the discharge? A) You will need to avoid the use of NSAID's B) It may be necessary to limit fluid intake C) You will need to get your Pneumonia vaccine D) Here are the signs of hypocalcemia you will need to know

Answer: C. Patients with multiple myeloma are at an increased risk for infection r/t impaired antibody production. Teaching would include avoiding sick indviduals, hand hygiene, calling for fever/signs of infection, getting vaccines such as pneumonia and flu. Increasing fluid intake will help prevent complications such as hypercalcemia and renal failure. NSAID's may be used to help relieve pain. Hypercalcemia, not hypocalcemia, is a common complication of multiple myeloma

The patient with anemia has been prescribed an iron supplement. With which beverage should the nurse encourage the patient to take the supplement? A) Milk B) Water only C) Orange Juice D) Tea

Answer: C. Vitamin C helps aid in the absorption of iron. Therefore iron supplements should be taken with a glass or orange juice or a vitamin C tablet.

Nurse Kelly is caring for a patient who is 65 years old with a platelet count of 7,000 resulting from myelodysplastic syndrome. At 10 p.m. the patient complains of a headache. What should be the nurse's immediate action? A) Administer aspirin per prn orders B) Administer acetaminophen per orders C) Notify the health care provider D) Administer a nonpharmacological intervention like a cool compress

Answer: C. A platelet count less than 10,000 puts the client a severe risk for spontaneous bleed. The nurse should be aware of any signs such as HA, changing mentation, irritability, restlessness, changes in vision, abdominal distention, or any other signs of bleeding anywhere in the body.

You, the super amazing nurse, is taking care of a 65 year old woman with ESRD. The doctor has informed her that she has anemia. She asks you "My friend has some anemia and she takes an iron pill every day. Why don't you just give me that?" What is the best response by the nurse? A) I'm sorry ma'am, but if you needed iron supplements the doctor would have prescribed them B) Those supplements are for anemia caused by blood loss or iron deficiency. They wouldn't work for you C) An iron supplement alone would not be enough to fix your specific type of anemia D) You are going to be put on hemodialysis to treat your renal disease which should alleviate the anemia

Answer: C. An iron supplement may be given to a patient with ESRD related anemia. However, an iron supplement would be given in conjunction with erythropoietin. They would help in this case, but not given alone. Hemodialysis does not fully fix anemia, in fact, it can further lower iron and folic acid levels and worsen the anemic fatigue.

A patient arrived to the clinic complaining of generalized pruritus and pain in the extremities. He has a history of diabetes, HTN, dyslipidemia, COPD, and A-fib. His blood pressure is 155/90. His face is a ruddy color. On palpation of his abdomen, his spleen is palpable. His blood values indicate a Hgb of 18.5 and Hct of 60%. The nurse suspects which diagnosis? A) Polycythemia Vera B) Multiple Myeloma C) Thrombocytopenia D) Secondary Polycythemia

Answer: D. Based on a history of COPD, the nurse suspects that the polycythemia is based on the secondary cause of chronic reduced oxygen intake. Other possible causes of secondary polycythemia would include smoking history, cyanotic heart disease, or even living in a high altitude. There are also several other causes. If a cause is noted, polycythemia Vera (primary polycythemia) is ruled out

The nurse is teaching the client prescribed with an iron supplement. Which statement, if made by the patient, indicates the need for further teaching? A) I should take this medication on an empty stomach B) When I start taking this pill, I will start with only one tablet a day and then increase to two C) My stools can become really dark in color when I take this supplement D) I need to watch out for diarrhea that can occur with this supplement

Answer: D. Constipation is expected with this supplement, not diarrhea. Increasing fiber in the diet can prevent this problem. Food in the stomach impairs iron absorption so the patient should take it on an empty stomach. Slowly increasing the amount of pills can help prevent any GI discomfort. Stool is expected to become dark (almost black).

The nurse is providing teaching to the patient diagnosed with Polycythemia Vera. Which statement, if made by the patient, indicates the need for further teaching? A) I need to make sure I stay active to prevent clot formation B) I guess I will have to stop drinking all my alcohol now. Poop. C) I should limit my bath time to less than thirty minutes D) I will need to take an iron supplement to help replace what is taken away by therapeutic blood draws

Answer: D. The patient with polycythemia vera should NEVER take an iron supplement. It will stimulate further RBC production which would be a negative effect. Staying active to avoid clot formation is important as this is a major complication of this disorder. Limiting or avoiding alcohol will help minimize risk for bleeding. Limiting baths will help keep pruritus from being aggravated.

A 72 year old male walks into the clinic complaining of lower back pain. He says he feels fine in the morning but that his Alieve doesn't work well enough at night time. His serum protein levels are elevated. Which of the following assessment findings is most concerning to the nurse? A) The patient tells you "I have felt more weak and tired lately too" B) My mother had a history of osteoporosis C) The patient says he has been constipated D) The patient says "I haven't peed as much in the past week as I used to"

Answer: D. This is a sign of decreasing renal function and possible renal failure, a complication of multiple myeloma. Multiple Myeloma is suspected in patients with back pain and protein elevations. Weakness and tired feeling may be d/t associated anemia. Constipation can be caused by hypercalcemia and should be investigated. Renal function is the priority as failure can occur

Which of the following symptoms is expected with hemoglobin of 10 g/dl? a. None b. Pallor c. Palpitations d. Shortness of breath

Answer: None. Symptoms are not expected with mild anemia

You are caring for a client who is receiving alteplase to dissolve thrombus. Which of the following should you include in your care plan for this client? Select all that applies a. Monitor temperature b. Reposition frequently c.Limit venipunctures d. Assess neurologic status e. Applt pressure to oozing sites

a. Monitor temperature c.Limit venipunctures d. Assess neurologic status e. Applt pressure to oozing sites

The provider discharges the client to home with a prescription foe warfarin. You should advise the client to do which of the following? Select all that applies a. avoid taking NSAIDs b. use a disposable razor c. brush his teeth with a soft toothbrush d. increase intake of dark green leafy vegetables e. ask the provider before taking otc drugs

a. avoid taking NSAIDs c. brush his teeth with a soft toothbrush e. ask the provider before taking otc drugs

Drag the drug in the left column to match it with it's therapeutic use in the right column a. filgrastim chronic neutropenia b. folic hemophilia A c.factor viii megaloplastic anemia d. heparin DVT

a. filgrastim chronic neutropenia b. folic acid megaloblastic anemia c.factor viii hemophilia A d. heparin DVT

A client is about to start taking cyanocobalamin, a vitamin B12 preparation.You understand that this drug treats which of the following types of anemia? a. pernicious b. sickle c. aplastic d. iron deficiency

a. pernicious

A client is about to start taking clopidogrel to prevent transient ischemic attacks. You should instruct the client to watch for and report which of the following adverse effects of this drug? a. petechiae b. tinnitus c. diaphoresis d. weakness e. vision changes

a. petechiae d. weakness e. vision changes

You should monitor a client throughout a continuous heparin therapy for which of the following adverse reactions? Select all that applies a. thrombocytopenia b. hypotension c. hypokalemia d. DVT e. fever

a. thrombocytopenia b. hypotension d. DVT e. fever

While a client is stil receiving continuos IV heparin (enoxaparin), the provider prescribes oral warfarin. This is because a. warfarin takes 3 to 5 days to achieve therapeutic effects b. IV heparin alone becomes ineffective after the first 1 to 2 days c. abrupt cessation of heparin therapy increases the risk of developing thrombocytopenia d. warfarin incrreases the risk of hemorrhage

a. warfarin takes 3 to 5 days to achieve therapeutic effects

A provider prescribes heparin for a client. Which of the following parameters should you monitor for inn regard to determining if a therapeutic dose is being administered? a. INR, 2 to 3 times the clients baseline b. aPTT 1.5 to 2 times the clients baseline c. platelet count of 125,000 cubic millimeters d. PT 11 to 12.5 sec

b. aPTT 1.5 to 2 times the clients baseline check the client's activated partial thromboplastin time or aPTT, every 4 to 6 hours for initial continuous IV heparin therapy

A client is about to start taking liquid ferrous sulfate to treat iron deficiency anemia. Which of the following instructions you should include when talking to the client about this drug? a. swish it in your mouth before swallowing it b. drink it through a straw c. do not rinse your mouth after taking it d. dilute it first with water d. take it with food if needed

b. drink it with straw d. dilute it first with water e.take it with food if needed

A client is about to start warfarin to prevent venous thrombosis. You should explain to the client that taking this drug initially requires daily blood samples to monitor the results of which of the following laboratory test? a. Fibrinogen b. PT/INR c. Platelets d. aPTT

b. prothrombin time (PT) and international normalized ratio (INR)

A client is about to start taking oprelvekin for thrombocytopenia. To assess for adverse effects of this drug, you should monitor which of the following carefully during drug therapy? a. liver function b. hearing c.ecg d.level of consciousness

c.ecg oprelvekin, a thrombopoietic growth factor can cause cardiac dysrythmias.

Which of the following drugs stimulates RBC production? a. clopidogrel b. filgrastim c.epoitiin alfa d. alteplase

c.epoitiin alfa clopidogrel inhibits platelet aggregation; filgrastim stimulates leukocyte production; alteplase dissolves blood clots

You are reviewing the history of a client who is about to start a therapy with factor viii to treat hemophilia A. Which of the following drugs the client takes should alert you in taking further action? a. albuterol b. phenytoin c. phenezine d. aspirin

d. aspirin

Which of the following drugs you should ready in case of heparin overdose? a. aminocaproic acid b. deferoxamine c. vitamin K d. protamine

d. protamine

Before adminidtering IV folic acid, you should explain to the client that this drug can cause which adverse effect? a.headache b. nausea c.dizziness d. rash

d. rash