Management of Patients With Nonmalignant Hematologic Disorders

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? A) Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential B) Monitoring the client's breathing and reviewing the client's arterial blood gases C) Monitoring the client's heart rate and reviewing the client's hemoglobin D) Monitoring the client's blood pressure and reviewing the client's hematocrit

A (Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential Explanation: Clients with neutropenia often do not exhibit classic signs of infection. Fever is the most common indicator of infection, yet it is not always present. No definite symptoms of neutropenia appear until the client develops an infection. A routine CBC with differential can reveal neutropenia before the onset of infection.)

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? A) Myeloid stem cell B) Lymphoid stem cell C) Monocyte D) Neutrophil

A (Myeloid stem cell Explanation: Myeloid stem cells are responsible not only for all nonlymphoid white blood cells (WBC) but also for the production of red blood cells and platelets. Lymphoid cells produce either T or B lymphocytes. A monocyte is large WBC that becomes a macrophage when is leaves the circulation and moves into body tissues. A neutrophil is a fully mature WBC capable of phagocytosis.)

The nurse is caring for an older adult client who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine where the blood loss is coming from, what intervention can the nurse provide? A) Observe stools for blood. B) Observe the gums for bleeding after the client brushes teeth. C) Observe the sputum for signs of blood. D) Observe client for facial droop.

A (Observe stools for blood. Explanation: Iron-deficiency anemia is unusual in older adults. Normally, the body does not eliminate excessive iron, causing total body iron stores to increase with age and necessitating maintenance of hydration. If an older adult is anemic, blood loss from the gastrointestinal or genitourinary tracts is suspected. Observing the stool for blood will help detect blood from GI loss. Bleeding gums may indicate periodontal disease, or anticoagulation from medication is not related to age. Blood in sputum can be an indicator of various lung disorders that may affect all age groups. Facial droop may indicate an impending stroke or Bell's palsy and would not be a reason for blood loss.)

You are caring for a client with thalassemia who is being transfused. What your role during a transfusion? A) To closely monitor the rate of administration B) To administer vitamin B12 injections C) To instruct the client to rest immediately if chest pain develops D) To assess for enlargement and tenderness over the liver and spleen

A (To closely monitor the rate of administration Explanation: In a client with thalassemia, when transfusions are necessary, the nurse closely monitors the rate of administration. Assessing for enlargement and tenderness over the liver and spleen, advising rest, or administering vitamin B12 injections are not indicated for thalassemia.)

A nurse on a hematology/oncology floor is caring for a client with aplastic anemia. Which would not be included in the client's discharge instructions? A) Use a disposable razor when shaving. B) Avoid contact with family/friends who are sick. C) Encourage frequent handwashing. D) Plan for frequent periods of rest.

A (Use a disposable razor when shaving. Explanation: People with aplastic anemia usually have insufficient erythrocytes, leukocytes, and platelets. Encourage behaviors that will lower the risk for bleeding. Avoiding contact with people who are sick reduces the risk of acquiring an infection. Handwashing reduces the risk of acquiring an infection. Anemia can cause fatigue and shortness of breath with even mild exertion.)

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? A) Beans, dried fruits, and leafy, green vegetables B) Fruits high in vitamin C, such as oranges and grapefruits C) Berries and orange vegetables D) Dairy products

A (Beans, dried fruits, and leafy, green vegetables Explanation: Food sources high in iron include organ meats (e.g., beef or calf liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy and green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.)

A woman who is in her third trimester of pregnancy has been experiencing an exacerbation of iron- deficiency anemia in recent weeks. When providing the patient with nutritional guidelines and meal suggestions, what foods would be most likely to increase the womans iron stores? A) Salmon accompanied by whole milk B) Mixed vegetables and brown rice C) Beef liver accompanied by orange juice D) Yogurt, almonds, and whole grain oats

Ans: C Feedback: Food sources high in iron include organ meats, other meats, beans (e.g., black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron. All of the listed foods are nutritious, but liver and orange juice are most likely to be of benefit.

The nurse on the pediatric unit is caring for a 10-year-old boy with a diagnosis of hemophilia. The nurse knows that a priority nursing diagnosis for a patient with hemophilia is what? A) Hypothermia B) Diarrhea C) Ineffective coping D) Imbalanced nutrition: Less than body requirements

Ans: C Feedback: Most patients with hemophilia are diagnosed as children. They often require assistance in coping with the condition because it is chronic, places restrictions on their lives, and is an inherited disorder that can be passed to future generations. Children with hemophilia are not at risk of hypothermia, diarrhea, or imbalanced nutrition.

A patient has been living with a diagnosis of anemia for several years and has experienced recent declines in her hemoglobin levels despite active treatment. What assessment finding would signal complications of anemia? A) Venous ulcers and visual disturbances B) Fever and signs of hyperkalemia C) Epistaxis and gastroesophageal reflux D) Ascites and peripheral edema

Ans: D Feedback: A significant complication of anemia is heart failure from chronic diminished blood volume and the hearts compensatory effort to increase cardiac output. Patients with anemia should be assessed for signs and symptoms of heart failure, including ascites and peripheral edema. None of the other listed signs and symptoms is characteristic of heart failure.

A patient comes into the clinic complaining of fatigue. Blood work shows an increased bilirubin concentration and an increased reticulocyte count. What would the nurse suspect the patient has? A) A hypoproliferative anemia B) A leukemia C) Thrombocytopenia D) A hemolytic anemia

Ans: D Feedback: In hemolytic anemias, premature destruction of erythrocytes results in the liberation of hemoglobin from the erythrocytes into the plasma; the released hemoglobin is converted in large part to bilirubin, and therefore the bilirubin concentration rises. The increased erythrocyte destruction leads to tissue hypoxia, which in turn stimulates erythropoietin production. This increased production is reflected in an increased reticulocyte count as the bone marrow responds to the loss of erythrocytes. Hypoproliferative anemias, leukemia, and thrombocytopenia lack this pathology and presentation.

Which nursing instructions help parents of a child with hemophilia provide a safe home environment for their child? a) "Establish a written emergency plan including what to do in specific situations and the names and phone numbers of emergency contacts." b) "Talk with your child about home safety and have him problem-solve hypothetical situations about his health." c) "Pad the corners of coffee tables when your child is a toddler and provide kneepads for sports when the child is older." d) "Be a role model to your child by wearing a helmet when riding a bike so your child will, too."

Correct response: "Establish a written emergency plan including what to do in specific situations and the names and phone numbers of emergency contacts." Explanation: Establishing a written emergency plan that includes what to do in specific situations helps the family provide safety measures for their child with hemophilia. Padding corners of furniture and using kneepads don't help provide a safe home environment for children of all ages. Telling the parents to be a role model by wearing a bike helmet is only applicable to children who are old enough to emulate their parent's behaviors. Having the child problem-solve hypothetical health situations doesn't help provide a safe environment; it addresses problem solving

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy? A) "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear." B) "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal." C) "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." D) "I will receive parenteral vitamin B12 therapy for the rest of my life."

D ("I will receive parenteral vitamin B12 therapy for the rest of my life." Explanation: Because a client with pernicious anemia lacks intrinsic factor, oral vitamin B12 can't be absorbed. Therefore, parenteral vitamin B12 therapy is recommended and required for life.)

A client receiving a blood transfusion experiences an acute hemolytic reaction. Which nursing intervention is the most important? A) Immediately stop the transfusion, infuse dextrose 5% in water (D5W), and call the physician. B) Slow the transfusion and monitor the client closely. C) Stop the transfusion, notify the blood bank, and administer antihistamines. D) Immediately stop the transfusion, infuse normal saline solution, call the physician, and notify the blood bank.

D (Immediately stop the transfusion, infuse normal saline solution, call the physician, and notify the blood bank. Explanation: When a transfusion reaction occurs, the transfusion should be immediately stopped, normal saline solution should be infused to maintain venous access, and the physician and blood bank should be notified immediately. Other nursing actions include saving the blood bag and tubing, rechecking the blood type and identification numbers on the blood tags, monitoring vital signs, obtaining necessary laboratory blood and urine samples, providing proper documentation, and monitoring and treating for shock. Because they can cause red blood cell hemolysis, dextrose solutions shouldn't be infused with blood products. Antihistamines are administered for a mild allergic reaction, not a hemolytic reaction.)

A patient with chronic renal failure is examined by the nurse practitioner for anemia. The nurse knows to review the laboratory data for a decreased hemoglobin level, red blood cell count, and which of the following? a) Decreased level of erythropoietin b) Increased reticulocyte count c) Increased mean corpuscular volume d) Decreased total iron-binding capacity

Decreased level of erythropoietin Explanation: As renal function decreases, erythropoietin, which is produced by the kidney, also decreases. Because erythropoietin is produced outside the kidney, some erythropoiesis continues, even in patients whose kidneys have been removed. However, the number of red blood cells produced is small and the degree of erythropoiesis is inadequate.

A female client with the beta-thalassemia trait plans to marry a man of Italian ancestry who also has the trait. Which client statement indicates that she understands the teaching provided by the nurse? a) "If my fiancé was of Middle Eastern descent, I wouldn't be worried about having children." b) "I need to learn how to give myself vitamin B12 injections." c) "Thalassemia is treated with iron supplements." d) "I'll see a genetic counselor before starting a family."

"I'll see a genetic counselor before starting a family." Explanation: Two people with the beta-thalassemia trait have a 25% chance of having a child with thalassemia major, a potentially life-threatening disease. Iron supplements aren't used to treat thalassemia; in fact, they could contribute to iron overload. Vitamin B12 injections are used to treat pernicious anemia, not thalassemia. Thalassemia occurs primarily in people of Italian, Greek, African, Asian, Middle Eastern, East Indian, and Caribbean descent.

The most common cause of iron-deficiency anemia in premenopausal women includes which of the following? A) Menorrhagia B) Inadequate iron supplementation C) Iron malabsorption D) Lack of vitamin B12

A (Menorrhagia Explanation: The most common cause of iron deficiency anemia in premenopausal women is menorrhagia. In pregnancy, it may be caused by inadequate intake of iron. Iron malabsorption may occur following a gastrectomy or with celiac disease. Lack of vitamin B12 is also a potential cause of anemia.)

Which of the following is considered an antidote to heparin? A) Protamine sulphate B) Vitamin K C) Narcan D) Ipecac

A (Protamine sulphate Explanation: Protamine sulphate, in the appropriate dosage, acts quickly to reverse the effects of heparin. Vitamin K is the antidote to warfarin (Coumadin). Narcan is the drug used to reverse signs and symptoms of medication-induced narcosis. Ipecac is an emetic used to treat some poisonings.)

Which medication is the antidote to warfarin? A) Vitamin K B) Protamine sulfate C) Aspirin D) Clopidogrel

A (Vitamin K Explanation: The antidote for warfarin is vitamin K. Protamine sulfate is the antidote for heparin. Aspirin and clopidogrel are both antiplatelet medications.)

You are caring for a 13-year-old diagnosed with sickle cell anemia. The client asks you what they can do to help prevent sickle cell crisis. What would be an appropriate answer to this client? a) Drink at least 8 glasses of water every day. b) Avoid any sports that tire you out. c) Stay on oxygen therapy 24/7. d) Avoid any activity that makes you short of breath

Drink at least 8 glasses of water every day. Correct Explanation: During the physical examination, observe the client's appearance, looking for evidence of dehydration, which may have triggered a sickle cell crisis. Clients are taught moderation, not avoidance of activities. Most clients with sickle cell disease are not on oxygen therapy 24/7.

A patient with renal failure has decreased erythropoietin production. Upon analysis of the patients complete blood count, the nurse will expect which of the following results? A) An increased hemoglobin and decreased hematocrit B) A decreased hemoglobin and hematocrit C) A decreased mean corpuscular volume (MCV) and red cell distribution width (RDW) D) An increased MCV and RDW

Ans: B Feedback: The decreased production of erythropoietin will result in a decreased hemoglobin and hematocrit. The patient will have normal MCV and RDW because the erythrocytes are normal in appearance.

A nurse is admitting a patient with immune thrombocytopenic purpura to the unit. In completing the admission assessment, the nurse must be alert for what medications that potentially alter platelet function? Select all that apply. A) Antihypertensives B) Penicillins C) Sulfa-containing medications D) Aspirin-based drugs E) NSAIDs

Ans: C, D, E Feedback: The nurse must be alert for sulfa-containing medications and others that alter platelet function (e.g., aspirin-based or other NSAIDs). Antihypertensive drugs and the penicillins do not alter platelet function.

An intensive care nurse is aware of the need to identify patients who may be at risk of developing disseminated intravascular coagulation (DIC). Which of the following ICU patients most likely faces the highest risk of DIC? A) A patient with extensive burns B) A patient who has a diagnosis of acute respiratory distress syndrome C) A patient who suffered multiple trauma in a workplace accident D) A patient who is being treated for septic shock

Ans: D Feedback: Sepsis is a common cause of DIC. A wide variety of acute illnesses can precipitate DIC, but sepsis is specifically identified as a cause.

When teaching a patient with iron deficiency anemia about appropriate food choices, the nurse will encourage the patient to increase the dietary intake of which of the following foods? a) Beans, dried fruits, and leafy green vegetables b) Berries and orange vegetables c) Dairy products d) Fruits high in vitamin C, such as oranges and grapefruits

Beans, dried fruits, and leafy green vegetables Explanation: Food sources high in iron include organ meats (e.g., beef or calf's liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.

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? A) Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints. B) Ask if taking a blood pressure has ever produced pain in the upper arm. C) Ask if taking a blood pressure has ever caused bruising in the hand and wrist. D) Ask if taking a blood pressure has ever produced the need for medication.

C (Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints. Explanation: Before taking a blood pressure, the nurse asks the client if the use of a blood-pressure cuff has ever produced bleeding under the skin or in the arm joints. Options B, C, and D are incorrect.)

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? A) It is part of the required assessment information. B) It is important for the nurse to determine what type of foods the patient will eat. C) It may indicate deficiencies in essential nutrients. D) It will determine what type of anemia the patient has.

C (It may indicate deficiencies in essential nutrients. Explanation: A nutritional assessment is important, because it may indicate deficiencies in essential nutrients such as iron, vitamin B12, and folate.)

A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client? A) Limit visits by family members. B) Encourage the client to use a wheelchair. C) Use the smallest needle possible for injections. D) Maintain accurate fluid intake and output records.

C (Use the smallest needle possible for injections. Explanation: Because thrombocytopenia alters coagulation, it poses a high risk of bleeding. To help prevent capillary bleeding, the nurse should use the smallest needle possible when administering injections. The nurse doesn't need to limit visits by family members because they don't pose any danger to the client. The nurse should provide comfort measures and maintain the client on bed rest; activities such as using a wheelchair can cause bleeding. The nurse records fluid intake and output to monitor hydration; however, this action doesn't protect the client from a complication of thrombocytopenia.)

A male patient has a probable diagnosis of polycythemia vera. The nurse reviews the patient's lab work for which of the following diagnostic indicator? a) Platelet value of 350,000/mm3 b) Hematocrit of 60% c) Leukocyte count of 11,500/mm3 d) Erythrocyte count of 6.5 m/?L

Hematocrit of 60% Explanation: Although all results are elevated, the diagnostic indicator is the elevated hematocrit (normal = 42% to 52% for a male). These results are used in combination with other indicators (eg, splenomegaly) for a definitive diagnosis.

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? a) Calcium level of 9.4 mg/dL b) Creatinine level of 6 mg/100 mL c) Magnesium level of 2.5 mg/dL d) Potassium level of 5.2 mEq/L

Creatinine level of 6 mg/100 mL Explanation: The degree of anemia in patients with end-stage renal disease varies greatly; however, in general, patients do not become significantly anemic until the serum creatinine level exceeds 3 mg/100 mL

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? A) Potassium level of 5.2 mEq/L B) Magnesium level of 2.5 mg/dL C) Calcium level of 9.4 mg/dL D) Creatinine level of 6 mg/100 mL

D (Creatinine level of 6 mg/100 mL Explanation: The degree of anemia in patients with end-stage renal disease varies greatly; however, in general, patients do not become significantly anemic until the serum creatinine level exceeds 3 mg/100 mL.)

A patient comes to the clinic complaining of fatigue and the health interview is suggestive of pica. Laboratory findings reveal a low serum iron level and a low ferritin level. With what would the nurse suspect that the patient will be diagnosed? A) Iron deficiency anemia B) Pernicious anemia C) Sickle cell anemia D) Hemolytic anemia

Ans: A Feedback: A low serum iron level, a low ferritin level, and symptoms of pica are associated with iron deficiency anemia. TIBC may also be elevated. None of the other anemias are associated with pica.

A patient is admitted to the hospital with pernicious anemia. The nurse should prepare to administer which of the following medications? A) Folic acid B) Vitamin B12 C) Lactulose D) Magnesium sulfate

Ans: B Feedback: Pernicious anemia is characterized by vitamin B12 deficiency. Magnesium sulfate, lactulose, and folic acid do not address the pathology of this type of anemia.

A patient, 25 years of age, comes to the emergency department complaining of excessive bleeding from a cut sustained when cleaning a knife. Blood work shows a prolonged PT but a vitamin K deficiency is ruled out. When assessing the patient, areas of ecchymosis are noted on other areas of the body. Which of the following is the most plausible cause of the patients signs and symptoms? A) Lymphoma B) Leukemia C) Hemophilia D) Hepatic dysfunction

Ans: D Feedback: Prolongation of the PT, unless it is caused by vitamin K deficiency, may indicate severe hepatic dysfunction. The majority of hemophiliacs are diagnosed as children. The scenario does not describe signs or symptoms of lymphoma or leukemia.

Which of the following vitamins enhance the absorption of iron? C A D E

C (Explanation: Vitamin C facilitates the absorption of iron. Therefore, iron supplements should be taken with a glass of orange juice or a vitamin C tablet to maximize absorption.)

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? A) Elevated hematocrit concentration B) Enlarged mean corpuscular volume (MCV) C) Low ferritin level concentration D) Elevated red blood cell (RBC) count

C (Low ferritin level concentration Explanation: The most consistent indicator of iron deficiency anemia is a low ferritin level, which reflects low iron stores. As the anemia progresses, the MCV, which measures the size of the erythrocytes, also decreases. Hematocrit and RBC levels are also low in relation to the hemoglobin concentration.)

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

Reports joint pain less than 3 on a scale of 0 to 10 Explanation: An expected outcome for a client experiencing a sickle-cell crisis is control of pain. Hydroxyurea is contraindicated in pregnancy because of the risk it poses for congenital abnormalities. An indication that the client is free from infection is exhibiting a normal temperature; 100.3°F is an elevated temperature. To minimize crises, the client needs to stay warm

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? a) Bone marrow biopsy b) Magnetic resonance imaging (MRI) study c) Bone marrow aspiration d) Schilling test

Schilling test Correct Explanation: The classic method of determining the cause of vitamin B12 deficiency is the Schilling test, in which the patient receives a small oral dose of radioactive vitamin B12, followed in a few hours by a large, nonradioactive parenteral dose of vitamin B12 (this aids in renal excretion of the radioactive dose).

A young male client is diagnosed with a mild form of hemophilia. He is experiencing bleeding in the joints with pain. In preparing the client for discharge, the nurse educates the client to a) Wear a medical identification bracelet. b) Take ibuprofen (Motrin) for joint pain. c) Undergo genetic testing and counseling. d) Take warm baths to lessen pain.

Wear a medical identification bracelet. Explanation: Clients with hemophilia should wear a medical identification bracelet about having this disease. Ibuprofen interferes with platelet aggregation and may increase the client's bleeding. A warm bath may lessen pain but increase bleeding. Genetic testing and counseling are not necessary for male clients, because females are the carriers of the genetic material for hemophilia.

The client has been diagnosed with myelodysplastic syndrome with an absolute neutrophil count less than 1000/mm³ and is being admitted to the hospital. The nurse a) Changes the water in the humidifier for oxygen therapy every 48 hours b) Places the client in isolation and allows no visitors c) Allows unlicensed assistive personnel who reports having a sore throat to provide care d) Assigns the client to a private room

igns the client to a private room Explanation: The client with an absolute neutrophil count less than 1000/mm³ is to be placed in a private room. Staff with a sore throat or cold should not be assigned to provide care for this client. The client does not need to be placed in isolation, but other neutropenic precautions needs to be followed, such as allowing no visitors with infection. Water in oxygen humdifiers should be changed every 24 hours.

The nurse is assessing a new patient with complaints of overwhelming fatigue and a sore tongue that is visibly smooth and beefy red. This patient is demonstrating signs and symptoms associated with what form of what hematologic disorder? A) Sickle cell anemia B) Hemophilia C) Megaloblastic anemia D) Thrombocytopenia

Ans: C Feedback: A red, smooth, sore tongue is a symptom associated with megaloblastic anemia. Sickle cell disease, hemophilia, and thrombocytopenia do not have symptoms involving the tongue.

An adult patient has been diagnosed with iron-deficiency anemia. What nursing diagnosis is most likely to apply to this patients health status? A) Risk for deficient fluid volume related to impaired erythropoiesis B) Risk for infection related to tissue hypoxia C) Acute pain related to uncontrolled hemolysis D) Fatigue related to decreased oxygen-carrying capacity

Ans: D Feedback: Fatigue is the major assessment finding common to all forms of anemia. Anemia does not normally result in acute pain or fluid deficit. The patient may have an increased risk of infection due to impaired immune function, but fatigue is more likely.

A patient with ESRD 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? A) Potassium level B) Creatinine level C) Hemoglobin level D) Folate levels

C (Hemoglobin level Explanation: When using recombinant erythropoietin, the hemoglobin must be checked at least monthly (more frequently until a maintenance dose is established) and the dose titrated to ensure the hemoglobin level does not exceed 12 g/dL.)

The nurse is talking with the parents of a toddler who was diagnosed with hemophilia A. The nurse teaches the parents a) To allow the toddler to participate in playground activities with other toddlers b) The importance of administering over-the-counter preparations for a cold c) How to administer factor VIII intravenously at the first sign of bleeding d) That nasal packing will be necessary for any nose bleeds

How to administer factor VIII intravenously at the first sign of bleeding Explanation: Clients and families are taught to administer factor VIII intravenously. This helps to prevent bleeding episodes. Activities that minimize trauma are allowed for the toddler, and playground activities may place the toddler at risk for increased bleeding. Over-the-counter cold preparations are to be avoided, because they will interfere with platelet aggregation. Nasal packing is avoided, because when the nasal packing is removed, bleeding may occur.

A client with sickle cell anemia has a A) Low hematocrit. B) High hematocrit. C) Normal hematocrit. D) Normal blood smear.

A (Low hematocrit. Explanation: A client with sickle cell anemia has a low hematocrit and sickled cells on the smear. A client with sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear.)

A patient with a history of atrial fibrillation has contacted the clinic saying that she has accidentally overdosed on her prescribed warfarin (Coumadin). The nurse should recognize the possible need for what antidote? A) IVIG B) Factor X C) Vitamin K D) Factor VIII

Ans: C Feedback: Vitamin K is administered as an antidote for warfarin toxicity.

During preparation for bowel surgery, a client receives an antibiotic to reduce intestinal bacteria. The nurse knows that hypoprothrombinemia may occur as a result of antibiotic therapy interfering with synthesis of which vitamin? A) Vitamin A B) Vitamin D C) Vitamin E D) Vitamin K

D (Vitamin K Explanation. Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Antibiotic therapy may interfere with synthesis of these substances, including vitamin K. Intestinal bacteria don't synthesize vitamins A, D, or E.)

Which cell of haematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? a) Myeloid stem cell b) Neutrophil c) Monocyte d) Lymphoid stem cell

Myeloid stem cell Explanation: The myeloid stem cell is responsible not only for all non lymphoid white blood cells, but also for the production of red blood cells and platelets. Lymphoid cells produce either T or B lymphocytes. A monocyte is large WBC that becomes a macrophage when is leaves the circulation and moves into body tissues. A neutrophil is a fully mature WBC capable of phagocytosis.

A client with idiopathic thrombocytopenic purpura (ITP), an autoimmune disorder, is admitted to an acute care facility. Concerned about hemorrhage, the nurse monitors the client's platelet count and observes closely for signs and symptoms of bleeding. The client is at greatest risk for cerebral hemorrhage when the platelet count falls below: A) 10,000/?l. B) 20,000/?l. C) 75,000/?l. D) 135,000/?l.

A (10,000/?l. Explanation: The client with ITP is at greatest risk for cerebral hemorrhage when the platelet count falls below 10,000/?l. Although platelet counts of 20,000/?l and 75,000/?l are below normal and increase the client's risk for bleeding, they don't increase the risk as much as a platelet count below 10,000/?l. A platelet count of 135,000/?l is normal and wouldn't occur in a client with ITP.)

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 physician. What type of anemia is the nurse concerned the co-worker may have? A) Iron deficiency anemia B) Megaloblastic anemia C) Sickle cell anemia D) Aplastic anemia

A (Iron deficiency anemia Explanation: People with iron deficiency anemia may crave ice, starch, or dirt; this craving is known as pica.)

A client has hereditary hemochromatosis. Laboratory test results indicate an elevated serum iron level, high transferrin saturation, and normal complete blood count (CBC). It is most important for the nurse to A) Remove the prescribed one unit of blood. B) Instruct the client to limit iron intake in the diet. C) Inform the client to limit ingestion of alcohol. D) Educate about precautions to follow after a liver biopsy.

A (Remove the prescribed one unit of blood. Explanation: Treatment for hemochromatosis is phlebotomy or removal of whole blood from a vein to reduce iron. Limiting dietary intake of iron is not an effective treatment. The client needs to perform activities to protect the liver, such as limiting alcohol ingestion. The definitive test for hemochromatosis had been a liver biopsy, but now genetic testing is performed. A liver biopsy could be performed to determine liver damage. However, this does not address the most immediate problem of too high iron.)

A patient with a history of cirrhosis is admitted to the ICU with a diagnosis of bleeding esophageal varices; an attempt to stop the bleeding has been only partially successful. What would the critical care nurse expect the care team to order for this patient? A) Packed red blood cells (PRBCs) B) Vitamin K C) Oral anticoagulants D) Heparin infusion

Ans: A Feedback: Patients with liver dysfunction may have life-threatening hemorrhage from peptic ulcers or esophageal varices. In these cases, replacement with fresh frozen plasma, PRBCs, and platelets is usually required. Vitamin K may be ordered once the bleeding is stopped, but that is not what is needed to stop the bleeding of the varices. Anticoagulants would exacerbate the patients bleeding.

A patients absolute neutrophil count (ANC) is 440/mm3 . But the nurses assessment reveals no apparent signs or symptoms of infection. What action should the nurse prioritize when providing care for this patient? A) Meticulous hand hygiene B) Timely administration of antibiotics C) Provision of a nutrient-dense diet D) Maintaining a sterile care environment

Ans: A Feedback: Providing care for a patient with neutropenia requires that the nurse adhere closely to standard precautions and infection control procedures. Hand hygiene is central to such efforts. Prophylactic antibiotics are rarely used and it is not possible to provide a sterile environment for care. Nutrition is highly beneficial, but hand hygiene is the central aspect of care.

A nurse is caring for a patient who has sickle cell anemia and the nurses assessment reveals the possibility of substance abuse. What is the nurses most appropriate action? A) Encourage the patient to rely on complementary and alternative therapies. B) Encourage the patient to seek care from a single provider for pain relief. C) Teach the patient to accept chronic pain as an inevitable aspect of the disease. D) Limit the reporting of emergency department visits to the primary health care provider.

Ans: B Feedback: The patient should be encouraged to use a single primary health care provider to address health care concerns. Emergency department visits should be reported to the primary health care provider to achieve optimal management of the disease. It would inappropriate to teach the patient to simply accept his or her pain. Complementary therapies are usually insufficient to fully address pain in sickle cell disease.

A patient newly diagnosed with thrombocytopenia is admitted to the medical unit. After the admission assessment, the patient asks the nurse to explain the disease. What should the nurse explain to this patient? A) There could be an attack on the platelets by antibodies. B) There could be decreased production of platelets. C) There could be impaired communication between platelets. D) There could be an autoimmune process causing platelet malfunction.

Ans: B Feedback: Thrombocytopenia can result from a decreased platelet production, increased platelet destruction, or increased consumption of platelets. Impaired platelet communication, antibodies, and autoimmune processes are not typical pathologies.

A young man with a diagnosis of hemophilia A has been brought to emergency department after suffering a workplace accident resulting in bleeding. Rapid assessment has revealed the source of the patients bleeding and established that his vital signs are stable. What should be the nurses next action? A) Position the patient in a prone position to minimize bleeding. B) Establish IV access for the administration of vitamin K. C) Prepare for the administration of factor VIII. D) Administer a normal saline bolus to increase circulatory volume.

Ans: C Feedback: Injuries in patients with hemophilia necessitate prompt administration of clotting factors. Vitamin K is not a treatment modality and a prone position will not be appropriate for all types and locations of wounds. A normal saline bolus is not indicated.

A critical care nurse is caring for a patient with autoimmune hemolytic anemia. The patient is not responding to conservative treatments, and his condition is now becoming life threatening. The nurse is aware that a treatment option in this case may include what? A) Hepatectomy B) Vitamin K administration C) Platelet transfusion D) Splenectomy

Ans: D Feedback: A splenectomy may be the course of treatment if autoimmune hemolytic anemia does not respond to conservative treatment. Vitamin K administration is treatment for vitamin K deficiency and does not resolve anemia. Platelet transfusion may be the course of treatment for some bleeding disorders. Hepatectomy would not help the patient.

A nurse is planning the care of a patient who has a diagnosis of hemophilia A. When addressing the nursing diagnosis of Acute Pain Related to Joint Hemorrhage, what principle should guide the nurses choice of interventions? A) Gabapentin (Neurontin) is effective because of the neuropathic nature of the patients pain. B) Opioids partially inhibit the patients synthesis of clotting factors. C) Opioids may cause vasodilation and exacerbate bleeding. D) NSAIDs are contraindicated due to the risk for bleeding.

Ans: D Feedback: NSAIDs may be contraindicated in patients with hemophilia due to the associated risk of bleeding. Opioids do not have a similar effect and they do not inhibit platelet synthesis. The pain associated with hemophilia is not neuropathic.

A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client? A) Pallor, bradycardia, and reduced pulse pressure B) Pallor, tachycardia, and a sore tongue C) Sore tongue, dyspnea, and weight gain D) Angina pectoris, double vision, and anorexia

B (Pallor, tachycardia, and a sore tongue Explanation: Pallor, tachycardia, and a sore tongue are all characteristic findings in pernicious anemia. Other clinical manifestations include anorexia; weight loss; a smooth, beefy red tongue; a wide pulse pressure; palpitations; angina pectoris; weakness; fatigue; and paresthesia of the hands and feet. Bradycardia, reduced pulse pressure, weight gain, and double vision aren't characteristic findings in pernicious anemia.)

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? A) Anemia B) Leukopenia C) Thrombocytopenia D) Neutropenia

C (Thrombocytopenia Explanation: A normal platelet count is 140,000 to 400,000/mm3 in adults. Chemotherapeutic agents produce bone marrow depression, resulting in reduced red blood cell counts (anemia), reduced white blood cell counts (leukopenia), and reduced platelet counts (thrombocytopenia). Neutropenia is the presence of an abnormally reduced number of neutrophils in the blood and is caused by bone marrow depression induced by chemotherapeutic agents.)

A client with a diagnosis of pernicious anemia comes to the clinic complaining of numbness and tingling in his arms and legs. What do these symptoms indicate? a) Severity of the disease b) Neurologic involvement c) Loss of vibratory and position senses d) Insufficient intake of dietary nutrients

Neurologic involvement Explanation: In clients with pernicious anemia, numbness and tingling in the arms and legs and ataxia are the most common signs of neurologic involvement. Some affected clients lose vibratory and position senses. Jaundice, irritability, confusion, and depression are present when the disease is severe. Insufficient intake of dietary nutrients is not indicated by these symptoms

The nurse's role in the management of polycythemia vera is primarily that of an educator. Choose the best health promotion advice that a nurse could give. a) Take aspirin daily to prevent clot formation. b) Use compression stockings when walking to prevent deep vein thrombosis (DVT). c) Take antiplatelets on a regular basis. d) Participate in regular phlebotomy procedures to decrease blood viscosity.

Participate in regular phlebotomy procedures to decrease blood viscosity. Explanation: Phlebotomy is a critical part of therapy and the only treatment that has demonstrated improved survival. Aspirin should be avoided, and antiplatelet therapy should be used with caution due to the risk of bleeding. Compression stockings are not necessary for walking but should be used for airplane travel.

Which of the following is the most common hematologic condition affecting elderly patients A) Anemia B) Thrombocytopenia C) Leukopenia D) Bandemia

A (Anemia Explanation: Anemia is the most common hematologic condition affecting elderly patients: with each successive decade of life, the incidence of anemia increases. Thrombocytopenia is a low platelet count. Leukopenia is a low leukocyte count. Bandemia is an increased number of band cells.)

A patients low prothrombin time (PT) was attributed to a vitamin K deficiency and the patients PT normalized after administration of vitamin K. When performing discharge education in an effort to prevent recurrence, what should the nurse emphasize? A) The need for adequate nutrition B) The need to avoid NSAIDs C) The need for constant access to factor concentrate D) The need for meticulous hygiene

Ans: A Feedback: 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.

The results of a patients most recent blood work and physical assessment are suggestive of immune thrombocytopenic purpura (ITP). This patient should undergo testing for which of the following potential causes? Select all that apply. A) Hepatitis B) Acute renal failure C) HIV D) Malignant melanoma E) Cholecystitis

Ans: A, C Feedback: Viral illnesses have the potential to cause ITP. Renal failure, malignancies, and gall bladder inflammation are not typical causes of ITP.

A patient with poorly controlled diabetes has developed end-stage renal failure and consequent anemia. When reviewing this patients treatment plan, the nurse should anticipate the use of what drug? A) Magnesium sulfate B) Epoetin alfa C) Low-molecular weight heparin D) Vitamin K

Ans: B Feedback: The availability of recombinant erythropoietin (epoetin alfa [Epogen, Procrit], darbepoetin alfa [Aranesp]) has dramatically altered the management of anemia in end-stage renal disease. Heparin, vitamin K, and magnesium are not indicated in the treatment of renal failure or the consequent anemia.

A nurse is a long-term care facility is admitting a new resident who has a bleeding disorder. When planning this residents care, the nurse should include which of the following? A) Housing the resident in a private room B) Implementing a passive ROM program to compensate for activity limitation C) Implementing of a plan for fall prevention D) Providing the patient with a high-fiber diet

Ans: C Feedback: To prevent bleeding episodes, the nurse should ensure that an older adult with a bleeding disorder does not suffer a fall. Activity limitation is not necessarily required, however. A private room is not necessary and there is no reason to increase fiber intake.

Which term refers to a form of white blood cell involved in immune response? A) Granulocyte B) Lymphocyte C) Spherocyte D) Thrombocyte

B (Lymphocyte Explanation: Both B and T lymphocytes respond to exposure to antigens. Granulocytes include basophils, neutrophils, and eosinophils. A spherocyte is a red blood cell without central pallor, seen with hemolysis. A thrombocyte is a platelet.)

A client is prescribed 325 mg/day of oral ferrous sulfate. The nurse includes in client teaching, "Take your iron pill A) 1 hour before breakfast" B) With dairy products" C) And decrease fruits and juices in your diet" D) Along with a decreased amount of dietary fiber"

A (1 hour before breakfast" Explanation: Instructions the nurse will provide for the client taking oral ferrous sulfate is to administer the medication on an empty stomach. Instructions also include that there is decreased absorption of iron with food, particularly dairy products. The client is to increase vitamin C intake (fruits, juices, tomatoes, broccoli), which will enhance iron absorption. The client is to also increase foods high in fiber to decrease risk of constipation.)

A client reports feeling tired, cold, and short of breath at times. Assessment reveals tachycardia and reduced energy. What would the nurse expect the physician to order? A) CBC B) Antibiotic C) Chest radiograph D) ECG

A (CBC Explanation: Most clients with iron-deficiency anemia have reduced energy, feel cold all the time, and experience fatigue and dyspnea with minor physical exertion. The heart rate usually is rapid even at rest. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased. A CBC would be ordered.)

A patients electronic health record notes that he has previously undergone treatment for secondary polycythemia. How should this aspect of the patients history guide the nurses subsequent assessment? A) The nurse should assess for recent blood donation. B) The nurse should assess for evidence of lung disease. C) The nurse should assess for a history of venous thromboembolism. D) The nurse should assess the patient for impaired renal function.

Ans: B Feedback: Any reduction in oxygenation, such as lung disease, can cause secondary polycythemia. Blood donation does not precipitate this problem and impaired renal function typically causes anemia, not polycythemia. A history of VTE is not a likely contributor.

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, it is important for the nurse to A) Administer the prescribed enoxaparin (Lovenox). B) Encourage a diet high in vitamin K. C) Have the client limit physical activity. D) Monitor partial thromboplastin (PTT) time.

A (Administer the prescribed enoxaparin (Lovenox). Explanation: Clients who are prescribed warfarin at home and need to have a major invasive procedure stop taking warfarin prior to the procedure. Low molecular weight heparin, such as enoxaparin, may be used until the procedure is performed. The client will continue with a diet that has a daily consistent amount of vitamin K. The client needs to ambulate frequently throughout the day. Prothrombin (PT) time is monitored, not PTT, when warfarin had been administered.)

A patient with a documented history of glucose-6-phosphate dehydrogenase deficiency has presented to the emergency department with signs and symptoms including pallor, jaundice, and malaise. Which of the nurses assessment questions relates most directly to this patients hematologic disorder? A) When did you last have a blood transfusion? B) What medications have taken recently? C) Have you been under significant stress lately? D) Have you suffered any recent injuries?

Ans: B Feedback: Exacerbations of glucose-6-phosphate dehydrogenase deficiency are nearly always precipitated by medications. Blood transfusions, stress, and injury are less common triggers.

A patient with Von Willebrand disease (vWD) has experienced recent changes in bowel function that suggest the need for a screening colonoscopy. What intervention should be performed in anticipation of this procedure? A) The patient should not undergo the normal bowel cleansing protocol prior to the procedure. B) The patient should receive a unit of fresh-frozen plasma 48 hours before the procedure. C) The patient should be admitted to the surgical unit on the day before the procedure. D) The patient should be given necessary clotting factors before the procedure.

Ans: D Feedback: A goal of treating vWD is to replace the deficient protein (e.g., vWF or factor VIII) prior to an invasive procedure to prevent subsequent bleeding. Bowel cleansing is not contraindicated and FFP does not reduce the patients risk of bleeding. There may or may not be a need for preprocedure hospital admission.

Parents arrive to the clinic with their young child and inform the nurse the child has just been diagnosed with sickle cell disease. The parents ask the nurse how this could have happened and which one of them is the carrier. What is the best response by the nurse? A) "Most likely, the father is the carrier of the gene." B) "The trait is passed down through the mother." C) "The child must inherit two defective genes, one from each parent." D) "It is an acquired, not a hereditary disorder."

C ("The child must inherit two defective genes, one from each parent." Explanation: Sickle cell disease is a hereditary disorder. To manifest this disorder, a person must inherit two defective genes, one from each parent, in which case all the hemoglobin is inherently abnormal. If the person inherits only one gene, he or she carries sickle cell trait. The hemoglobin of those who have sickle cell trait is about 40% affected. The other distractors are incorrect due to these factors.)

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia? A) Implement neutropenic precautions B) Eliminate direct contact with others who are infectious C) Apply prolonged pressure to needle sites or other sources of external bleeding D) Monitor temperature at least once per shift

C (Apply prolonged pressure to needle sites or other sources of external bleeding Explanation: For a client with leukemia, the nurse should apply prolonged pressure to needle sites or other sources of external bleeding. Reduced platelet production results in a delayed clotting process and increases the potential for hemorrhage. Implementing neutropenic precautions and eliminating direct contact with others are interventions to address the risk for infection.)

A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn's disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for? A) The onset of a bacterial infection B) Bleeding C) Abdominal pain D) Diarrhea

A (The onset of a bacterial infection Explanation: Lymphopenia (a lymphocyte count less than 1,500/mm3) can result from ionizing radiation, long-term use of corticosteroids, uremia, infections (particularly viral infections), some neoplasms (e.g., breast and lung cancers, advanced Hodgkin disease), and some protein-losing enteropathies (in which the lymphocytes within the intestines are lost) (Kipps, 2010). When lymphopenia is mild, it is often without sequelae; when severe, it can result in bacterial infections (due to low B lymphocytes) or in opportunistic infections (due to low T lymphocytes).)

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called A) Blast cells. B) Megaloblasts. C) Mast cells. D) Monocytes.

B (Megaloblasts. Explanation: Megaloblasts are abnormally large erythrocytes. Blast cells are primitive white blood cells (WBCs). Mast cells are cells found in connective tissue involved in defense of the body and coagulation. Monocytes are large WBCs that become macrophages when they leave the circulation and move into body tissues.)

A patients blood work reveals a platelet level of 17,000/mm3 . When inspecting the patients integumentary system, what finding would be most consistent with this platelet level? A) Dermatitis B) Petechiae C) Urticaria D) Alopecia

Ans: B Feedback: When the platelet count drops to less than 20,000/mm3 , petechiae can appear. Low platelet levels do not normally result in dermatitis, urticaria (hives), or alopecia (hair loss).

Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents? a) Hypochromic b) Microcytic c) Normocytic d) Hyperchromic

Hypochromic Explanation: An RBC that has pale or lighter cellular contents is hypochromic. A normocytic RBC is normal or average in size. A microcytic RBC is smaller than normal. Hyperchromic is used to describe an RBC that has darker cellular contents.

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 physician immediately because the client probably is experiencing which problem? A) A hemolytic reaction to mismatched blood B) A hemolytic reaction to Rh-incompatible blood C) A hemolytic allergic reaction caused by an antigen reaction D) A hemolytic reaction caused by bacterial contamination of donor blood

C (A hemolytic allergic reaction caused by an antigen reaction Explanation: Hemolytic allergic reactions are fairly common and may cause chills, fever, urticaria, tachycardia, dyspnoea, chest pain, hypotension, and other signs of anaphylaxis a few minutes after blood transfusion begins. Although rare, a hemolytic reaction to mismatched blood can occur, triggering a more severe reaction and, possibly, leading to disseminated intravascular coagulation. A hemolytic reaction to Rh-incompatible blood is less severe and occurs several days to 2 weeks after the transfusion. Bacterial contamination of donor blood causes a high fever, nausea, vomiting, diarrhoea, abdominal cramps and, possibly, shock.)

A night nurse is reviewing the next days medication administration record (MAR) of a patient who has hemophilia. The nurse notes that the MAR specifies both oral and subcutaneous options for the administration of a PRN antiemetic. What is the nurses best action? A) Ensure that the day nurse knows not to give the antiemetic. B) Contact the prescriber to have the subcutaneous option discontinued. C) Reassess the patients need for antiemetics. D) Remove the subcutaneous route from the patients MAR.

Ans: B Feedback: Injections must be avoided in patients with hemophilia. Consequently, the nurse should ensure that the prescriber makes the necessary change. The nurse cannot independently make a change to a patients MAR in most cases. Facilitating the necessary change is preferable to deferring to the day nurse.

A nurse is providing discharge education to a patient who has recently been diagnosed with a bleeding disorder. What topic should the nurse prioritize when teaching this patient? A) Avoiding buses, subways, and other crowded, public sites B) Avoiding activities that carry a risk for injury C) Keeping immunizations current D) Avoiding foods high in vitamin K

Ans: B Feedback: Patients with bleeding disorders need to understand the importance of avoiding activities that increase the risk of bleeding, such as contact sports. Immunizations involve injections and may be contraindicated for some patients. Patients with bleeding disorders do not need to normally avoid crowds. Foods high in vitamin K may beneficial, not detrimental.

A nurse is planning the care of a patient with a diagnosis of sickle cell disease who has been admitted for the treatment of an acute vaso-occlusive crisis. What nursing diagnosis should the nurse prioritize in the patients plan of care? A) Risk for disuse syndrome related to ineffective peripheral circulation B) Functional urinary incontinence related to urethral occlusion C) Ineffective tissue perfusion related to thrombosis D) Ineffective thermoregulation related to hypothalamic dysfunction

Ans: C Feedback: There are multiple potential complications of sickle cell disease and sickle cell crises. Central among these, however, is the risk of thrombosis and consequent lack of tissue perfusion. Sickle cell crises are not normally accompanied by impaired thermoregulation or genitourinary complications. Risk for disuse syndrome is not associated with the effects of acute vaso-occlusive crisis.

A client with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse? A) Inform the client that the position must be changed, and then you will give her pain medication and omit the bath. B) Inform the client that she will feel better after receiving a bath and clean sheets. C) Obtain the pain medication and delay the bath and position change until the medication reaches its peak. D) Inform the client that the bath and positioning is an important part of client care and will be done right after pain medication administration.

C (Obtain the pain medication and delay the bath and position change until the medication reaches its peak. Explanation: When pain is severe, the nurse delays position changes and bathing until an administered analgesic has reached its peak concentration level and the client is experiencing maximum pain relief. Pain medication should never be delayed to assist in the control of the level of pain. Pain will not be relieved by a bath and clean sheets, only analgesics at this point in the client's illness.)

A young male client is diagnosed with a mild form of hemophilia. He is experiencing bleeding in the joints with pain. In preparing the client for discharge, the nurse educates the client to A) Take ibuprofen (Motrin) for joint pain. B) Take warm baths to lessen pain. C) Wear a medical identification bracelet. D) Undergo genetic testing and counseling.

C (Wear a medical identification bracelet. Explanation: Clients with hemophilia should wear a medical identification bracelet about having this disease. Ibuprofen interferes with platelet aggregation and may increase the client's bleeding. A warm bath may lessen pain but increase bleeding. Genetic testing and counseling are not necessary for male clients, because females are the carriers of the genetic material for hemophilia.)

A group of nurses are learning about the high incidence and prevalence of anemia among different populations. Which of the following individuals is most likely to have anemia? A) A 50-year-old African-American woman who is going through menopause B) An 81-year-old woman who has chronic heart failure C) A 48-year-old man who travels extensively and has a high-stress job D) A 13-year-old girl who has just experienced menarche

Ans: B Feedback: The incidence and prevalence of anemia are exceptionally high among older adults, and the risk of anemia is compounded by the presence of heart disease. None of the other listed individuals exhibits high-risk factors for anemia, though exceptionally heavy menstrual flow can result in anemia.

A client with several chronic health problems has been newly diagnosed with a qualitative platelet defect. What component of the patients previous medication regimen may have contributed to the development of this disorder? A) Calcium carbonate B) Vitamin B12 C) Aspirin D) Vitamin D

Ans: C Feedback: Aspirin may induce a platelet disorder. Even small amounts of aspirin reduce normal platelet aggregation, and the prolonged bleeding time lasts for several days after aspirin ingestion. Calcium, vitamin D, and vitamin B12 do not have the potential to induce a platelet defect.

A nurse is providing education to a patient with iron deficiency anemia who has been prescribed iron supplements. What should the nurse include in health education? A) Take the iron with dairy products to enhance absorption. B) Increase the intake of vitamin E to enhance absorption. C) Iron will cause the stools to darken in color. D) Limit foods high in fiber due to the risk for diarrhea.

Ans: C Feedback: The nurse will inform the patient that iron will cause the stools to become dark in color. Iron should be taken on an empty stomach, as its absorption is affected by food, especially dairy products. Patients should be instructed to increase their intake of vitamin C to enhance iron absorption. Foods high in fiber should be consumed to minimize problems with constipation, a common side effect associated with iron therapy.

A male client has been receiving a continuous infusion of weight-based heparin for more than 4 days. The client's PTT is at a level that requires an increase of heparin by 100 units per hour. The client has the laboratory findings shown above. The most important action of the nurse is to A) Continue with the present infusion rate of heparin. B) Consult with the physician about discontinuing heparin. C) Begin treatment with the prescribed warfarin (Coumadin). D) Increase the heparin infusion by 100 units per hour.

B (Consult with the physician about discontinuing heparin. Explanation: Platelet counts may decrease with heparin therapy, and this client's platelet count has decreased. The client may have heparin-induced thrombocytopenia (HIT). Treatment of HIT includes discontinuing the heparin. The question asks about the most important action of the nurse and that is to consult with the physician about discontinuing heparin therapy. The nurse may continue with the current rate and should not increase the heparin dose until consulting with the physician. Warfarin is not administered until the platelet count has returned to normal levels.)

The medical nurse is aware that patients with sickle cell anemia benefit from understanding what situations can precipitate a sickle cell crisis. When teaching a patient with sickle cell anemia about strategies to prevent crises, what measures should the nurse recommend? A) Using prophylactic antibiotics and performing meticulous hygiene B) Maximizing physical activity and taking OTC iron supplements C) Limiting psychosocial stress and eating a high-protein diet D) Avoiding cold temperatures and ensuring sufficient hydration

Ans: D Feedback: Keeping warm and providing adequate hydration can be effective in diminishing the occurrence and severity of attacks. Hygiene, antibiotics, and high protein intake do not prevent crises. Maximizing activity may exacerbate pain and be unrealistic.

A patient is being treated on the medical unit for a sickle cell crisis. The nurses most recent assessment reveals an oral temperature of 100.5F and a new onset of fine crackles on lung auscultation. What is the nurses most appropriate action? A) Apply supplementary oxygen by nasal cannula. B) Administer bronchodilators by nebulizer. C) Liaise with the respiratory therapist and consider high-flow oxygen. D) Inform the primary care provider that the patient may have an infection.

Ans: D Feedback: Patients with sickle cell disease are highly susceptible to infection,thus any early signs of infection should be reported promptly. There is no evidence of respiratory distress, so oxygen therapy and bronchodilators are not indicated.

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. A) Infection B) Blood loss C) Abnormal erythrocyte production D) Destruction of normally formed red blood cells E) Inadequate formed white blood cells

B, C, D (Blood loss Abnormal erythrocyte production Destruction of normally formed red blood cells Explanation: Most anemias result from (1) blood loss, (2) inadequate or abnormal erythrocyte production, or (3) destruction of normally formed red blood cells. The most common types include hypovolemic anemia, iron-deficiency anemia, pernicious anemia, folic acid deficiency anemia, sicklecell anemia, and hemolytic anemias. Although each form of anemia has unique manifestations, all share a common core of symptoms. Anemia does not result from infection or inadequate formed white blood cells.

A client with a diagnosis of pernicious anemia comes to the clinic complaining of numbness and tingling in his arms and legs. What do these symptoms indicate? A) Loss of vibratory and position senses B) Neurologic involvement C) Severity of the disease D) Insufficient intake of dietary nutrients

B (Neurologic involvement Explanation: In clients with pernicious anemia, numbness and tingling in the arms and legs and ataxia are the most common signs of neurologic involvement. Some affected clients lose vibratory and position senses. Jaundice, irritability, confusion, and depression are present when the disease is severe. Insufficient intake of dietary nutrients is not indicated by these symptoms)

A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify? A) Potential hepatic dysfunction indicated by decreased blood urea nitrogen (BUN) and creatinine levels B) Low levels of urine constituents normally excreted in the urine C) Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels D) Electrolyte imbalance that could affect the blood's ability to coagulate properly

C (Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels Explanation: Low preoperative HCT and Hb levels indicate the client may require a blood transfusion before surgery. If the HCT and Hb levels decrease during surgery because of blood loss, the potential need for a transfusion increases. Possible renal failure is indicated by elevated BUN or creatinine levels. Urine constituents aren't found in the blood. Coagulation is determined by the presence of appropriate clotting factors, not electrolytes.)

A patient with chronic renal failure is examined by the nurse practitioner for anemia. The nurse knows to review the laboratory data for a decreased hemoglobin level, red blood cell count, and which of the following? A) Decreased level of erythropoietin B) Decreased total iron-binding capacity C) Increased mean corpuscular volume D) Increased reticulocyte count

A (Decreased level of erythropoietin Explanation: As renal function decreases, erythropoietin, which is produced by the kidney, also decreases. Because erythropoietin is produced outside the kidney, some erythropoiesis continues, even in patients whose kidneys have been removed. However, the number of red blood cells produced is small and the degree of erythropoiesis is inadequate.)

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? A) Eating calf's liver with a glass of orange juice B) Eating leafy green vegetables with a glass of water C) Eating apple slices with carrots D) Eating a steak with mushrooms

A (Eating calf's liver with a glass of orange juice Explanation: Food sources high in iron include organ meats (e.g., beef or calf's liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.)

A nurse is caring for a patient with severe anemia. The patient is tachycardic and complains of dizziness and exertional dyspnea. The nurse knows that in an effort to deliver more blood to hypoxic tissue, the workload on the heart is increased. What signs and symptoms might develop if this patient goes into heart failure? A) Peripheral edema B) Nausea and vomiting C) Migraine D) Fever

Ans: A Feedback: Cardiac status should be carefully assessed in patients with anemia. When the hemoglobin level is low, the heart attempts to compensate by pumping faster and harder in an effort to deliver more blood to hypoxic tissue. This increased cardiac workload can result in such symptoms as tachycardia, palpitations, dyspnea, dizziness, orthopnea, and exertional dyspnea. Heart failure may eventually develop, as evidenced by an enlarged heart (cardiomegaly) and liver (hepatomegaly), and by peripheral edema. Nausea, migraine, and fever are not associated with heart failure.

A patient is being treated for DIC and the nurse has prioritized the nursing diagnosis of Risk for Deficient Fluid Volume Related to Bleeding. How can the nurse best determine if goals of care relating to this diagnosis are being met? A) Assess for edema. B) Assess skin integrity frequently. C) Assess the patients level of consciousness frequently. D) Closely monitor intake and output.

Ans: D Feedback: The patient with DIC is at a high risk of deficient fluid volume. The nurse can best gauge the effectiveness of care by closely monitoring the patients intake and output. Each of the other assessments is a necessary element of care, but none addresses fluid balance as directly as close monitoring of intake and output.

A patient with a pulmonary embolism is being treated with a heparin infusion. What diagnostic finding suggests to the nurse that treatment is effective? A) The patients PT is within reference ranges. B) Arterial blood sampling tests positive for the presence of factor XIII. C) The patients platelet level is below 100,000/mm3 . D) The patients activated partial thromboplastin time (aPTT) is 1.5 to 2.5 times the control value.

Ans: D Feedback: The therapeutic effect of heparin is monitored by serial measurements of the aPTT; the dose is adjusted to maintain the range at 1.5 to 2.5 times the laboratory control. Heparin dosing is not determined on the basis of platelet levels, the presence or absence of clotting factors, or PT levels.

A nurse is preparing to discharge an adolescent with sickle cell anemia. What client need should the nurse emphasize in her discharge assessment? a) The need to have pain medication available b) The need for an adequate support structure c) The need to maintain good hydration d) The need to follow up with physician visits

The need for an adequate support structure Explanation: Because many psychosocial and physiological issues affect the life of an adolescent with a chronic illness, assuring the existence of a good support structure is the most essential element of care. Availability of pain medication and adequate support are both important considerations, but it's more important to emphasize the need for an adequate support structure. The need for good hydration and follow-up visits are important, but a good support structure will help the adolescent with this treatment.

A patient with a recent diagnosis of ITP has asked the nurse why the care team has not chosen to administer platelets, stating, I have low platelets, so why not give me a transfusion of exactly what Im missing? How should the nurse best respond? A) Transfused platelets usually arent beneficial because theyre rapidly destroyed in the body. B) A platelet transfusion often blunts your bodys own production of platelets even further. C) Finding a matching donor for a platelet transfusion is exceedingly difficult. D) A very small percentage of the platelets in a transfusion are actually functional.

Ans: A Feedback: Despite extremely low platelet counts, platelet transfusions are usually avoided. Transfusions tend to be ineffective not because the platelets are nonfunctional but because the patients antiplatelet antibodies bind with the transfused platelets, causing them to be destroyed. Matching the patients blood type is not usually necessary for a platelet transfusion. Platelet transfusions do not exacerbate low platelet production.

Which client is most at risk for developing disseminated intravascular coagulation (DIC)? A) A client admitted with suspected cocaine overdose B) A client with an amniotic fluid embolism C) A client with a stage IV pressure ulcer D) A client with heart failure and renal failure

B (A client with an amniotic fluid embolism Explanation: The client with the amniotic fluid embolism is at greatest risk for developing DIC. Other risk factors for developing DIC include trauma, cancer, shock, and sepsis. Possible cocaine overdose, a stage IV pressure ulcer, and heart failure and renal failure aren't risk factors for DIC.)

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? A) Bone marrow aspiration B) Schilling test C) Bone marrow biopsy D) Magnetic resonance imaging (MRI) study

B (Schilling test Explanation: The classic method of determining the cause of vitamin B12 deficiency is the Schilling test, in which the patient receives a small oral dose of radioactive vitamin B12, followed in a few hours by a large, nonradioactive parenteral dose of vitamin B12 (this aids in renal excretion of the radioactive dose).)

A client is being admitted to the hospital with abdominal pain, anemia, and bloody stools. He complains of feeling weak and dizzy. He has rectal pressure and needs to urinate and move his bowels. The nurse should help him: A) To the bathroom. B) To the bedside commode. C) Onto the bedpan. D) A standing position so he can urinate.

C (Onto the bedpan. Explanation: A client who's dizzy and anemic is at risk for injury because of his weakened state. Assisting him with the bedpan would best meet his needs at this time without risking his safety. The client may fall if walking to the bathroom, left alone to urinate, or trying to stand up.)