Med Surge ch 33

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

Administer the prescribed enoxaparin (Lovenox).

After teaching the patient about taking daily oral iron preparations for a moderate iron deficiency anemia, which statement made by the patient indicates to the nurse that additional instruction is still needed?

"I will call the doctor if my stools turn black."

A client is prescribed 325 mg/day of oral ferrous sulfate. The nurse includes in client teaching, "Take your iron pill

1 hour before breakfast" **Empty stomach

An elderly client is hospitalized for induction of chemotherapy to treat leukemia. The client reports fatigue to the nurse. What nursing intervention would best address the client's fatigue?

Assist the client to sit in a chair for meals.

Discuss Hemophilia

A Factor VII, B factor IX. Childhood

A patient with sickle cell crisis is admitted to the hospital in severe pain. While caring for the patient during the crisis, which of the following is the priority nursing intervention?

Administering and evaluating the effectiveness of opioid analgesics

Which of the following is the most common hematologic condition affecting elderly patients

Anemia

A patient is brought to the ER complaining of fatigue, large amounts of bruising on the extremities, and abdominal pain localized in the left upper quadrant. A health history reveals the patient has been treated three times in the past 2 months for a sore throat. Lab tests indicate severe anemia, significant neutropenia, and thrombocytopenia. Based on the symptoms, with what could the patient be diagnosed?

Aplastic anemia

A patient presents with peripheral neuropathy and hypothesia of the feet. What is the best nursing intervention?

Assess for signs of injury.

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

Assigns the client to a private room - Page 918 (1500-8000 norm)

Discuss the management of pernicious anemia.

B-12 Deficiency Lack of intrinsic factor which binds B-12, carries to ileum for absorption

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?

Beans, dried fruits, and leafy green vegetable Page 905

A young male client is diagnosed with glucose 6 phosphate dehydrogenase deficiency (G 6 PD). The nurse reviews his recent activities and most emphatically recommends the following:

Consult a physician about ingesting trimethoprim/sulfamethoxazole (Bactrim) for a urinary tract infection.

A patient with leukemia has developed a cough and increased fatigue. What is the primary nursing intervention?

Evaluate the patient for potential infection.

When assessing a female patient with a disorder of the hematopoietic or the lymphatic system, which of the following assessments is most essential?

Health history, such as bleeding, fatigue, or fainting

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 vasoocclusive crisis. What nursing diagnosis should the nurse prioritize in the patient's plan of care?

Ineffective tissue perfusion related to thrombosis

A patient is being treated on the medical unit for a sickle cell crisis. The nurse's most recent assessment reveals an oral temperature of 100.5ºF and a new onset of fine crackles on lung auscultation. What is the nurse's most appropriate action?

Inform the primary care provider that the patient may have an infection (sickle cell highly susceptible to infection!)

An 82yo client has pernicious anemia and has been receiving treatment for several years. What is she lacking that results in pernicious anemia?

Intrinsic factor

During the review of morning lab values on a patient complaining of severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which of the following findings

Low ferritin level Page 901

Which is the following is the most obvious sign of anemia?

Pallor

Which of the following terms refers to an abnormal decrease in white blood cells, red blood cells, and platelets?

Pancytopenia

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

Remove the prescribed one unit of blood.

A client with sepsis is experiencing disseminated intravascular coagulation (DIC). The client is bleeding from mucous membranes, venipuncture sites, and the rectum. Blood is present in the urine. The nurse establishes the nursing diagnosis of Risk for deficient fluid volume related to bleeding. The most appropriate and measurable outcome for this client is that the client exhibits

Urine output greater than or equal to 30 mL/hour

Pica

desire to eat clay, dirt, dried paint, starch, ice

A patient with sickle cell anemia has a

low hematocrit in smear

A red, smooth, sore tongue is a symptom associated with

pernicious anemia (megaloblastic)

A patient with renal failure has decreased erythropoietin production. Upon analysis of the patient's complete blood count, the nurse will expect which of the following results?

A decreased hemoglobin and hematocrit

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 hemolytic anemia

Which of the following nursing interventions should be incorporated into the plan of care to manage the delayed clotting process in a patient with leukemia?

Apply prolonged pressure to needle sites or other sources of external bleeding

Which of the following nursing interventions should be incorporated into the plan of care to manage the delayed clotting process due to thrombocytopenia in a patient with leukemia?

Applying prolonged pressure to needle sites or other sources of external bleeding

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 woman's iron stores?

Beef liver accompanied by orange juice (organ meats!)

Which of the following is a symptom of Cooley's anemia?

Bronzing of the skin

The client is a young, thin woman who is prescribed iron dextran intramuscularly. The nurse, when administering the medication,

Employs the Z-track technique

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?

Ineffective coping Dx is common in children, requires life changes, come with anxiety)

A patient with severe anemia is complaining of the following symptoms: tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Lab results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which of the following nursing diagnoses is most appropriate for this patient?

Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit. *Hemoglobin carries O2!!

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?

Iron will cause the stools to darken in color.

Vitamin B12 and folic acid deficiencies are characterized by production of abnormally large erythrocytes called

Megaloblasts -abnormally large erythrocytes

A client with chronic anemia has received multiple transfusions. About which of the following would the nurse be concerned relative to effects on the client's condition?

Over-the-counter iron supplements Page 903

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?

Peripheral edema

In adults, bone marrow is usually aspirated from which area?

Posterior iliac crest -Page 887

Which of the following is considered an antidote to heparin?

Protamine sulfate (Ipecac=emetic, poisoning, Vitamin K =warfarin/Coumadin, Narcan =Opioid)

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.

Sulfa-containing medications, Aspirin-based drugs, NSAIDs

What patient education should be given to the patient taking oral iron supplements?

Take on empty stomach 1 hr before meal With Vit-C OJ, absorbs better Gradually increase amount, avoid GI distress Increase Vit-C intake (citrus, strawberries, tomatoes) Increase fiber intake, minimize constipation ***Stools will become dark use straw, spoon at back of throat, avoid teeth staining

A nurse on a hematology/oncology floor is caring for a client with aplastic anemia. Which of the following would not be included in the client's discharge instructions?

Use a disposable razor when shaving.

Thrombocytopenia can result from or consumption of platelets.

decreased platelet production Increased platelet destruction

A decrease production of erythropoietin will result in a decreased _________ _____________

erythropoietihormone produced by kidney for erythropoiesis (to make, red)

Increased bilirubin concentration and an increased reticulocyte count areindicative of _______________ ____________________.

hemolytic anemia

The major function of neutrophils is

phagocytosis.

Procrit is the trade name for ________________________ ___________________________ and can dramatically alter the management of anemia in end-stage ____________ ___________.

recombant erythropoietin, organ damage.

What are symptoms associated with iron deficiency anemia?

smooth, sore tongue ridged, brittle nails angular cheilosis

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?

splenectomy (where destruction mainly occurs)

A male client has a hemoglobin count of 10.2 gm/dl, a hematocrit value of 36%, and a low ferritin level. What question should the nurse ask first?

Have you experienced abdominal pain? (Men 38.8 - 50, women 39.9 - 49%)

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 patient's signs and symptoms?

Hepatic dysfunction

An adult patient has been diagnosed with iron deficiency anemia. What nursing diagnosis is most likely to apply to this patient's health status?

Fatigue related to decreased oxygen-carrying capacity

When a nurse is planning discharge teaching for a patient admitted with a sickle cell crisis, which of the following should the nurse include in the teaching?

Teach patients to receive pneumococcal and annual influenza vaccinations

Folate deficiency occurs in people who rarely eat which of the following?

Uncooked vegetables

A patient with a documented history of glucose 6 phosphate dehydrogenase deficiency has presented to the emergency department with sigs and symptoms including pallor, jaundice, and malaise. Which of the nurse's assessment questions relates most directly to this patient's hematologic disorder?

What medications have taken recently?

The nurse is collecting data for a patient who has been diagnosed with iron deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia?

"I have difficulty breathing when walking 30 feet."

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?

An 81-year-old woman who has chronic heart failure

A patient has been diagnosed with thrombocytopenia. What are the primary nursing interventions while instituting corticosteroid therapy in this patient?

Gradually taper the dose and frequency of medication.

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

Wear a medical identification bracelet. Page 927

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?

Iron deficiency anemia

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?

Observe stools for blood.

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?

Packed red blood cells (PRBCs)

Discuss the management of Sickle Cell Anemia.

Stem cell transplants Rx: Arginine and Hydroxurea (no Preggo) Chemo RBC transfusion Daily folic acid Opioid pain management Adequate hydration

A patient is admitted to the hospital with pernicious anemia. The nurse should prepare to administer which of the following medications?

Vitamin B12

For a patient diagnosed with pernicious anemia, the nurse emphasizes the importance of lifelong administration of which of the following?

Vitamin B12

Which of the following medications is the antidote to Coumadin?

Vitamin K

A client with several chronic health problems has been newly diagnosed with a qualitative platelet defect. What component of the patient's previous medication regimen may have contributed to the development of this disorder

asprin = anti-platelet aggregation

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?

Ascites and peripheral edema (due to heart failure from chronic low blood volume and heart compensating)

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

Avoiding activities that carry a risk for injury

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?

Avoiding cold temperatures and ensuring sufficient hydration

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 -

Consult with the physician about discontinuing heparin.

Which of the following are immunosuppressants that prevent the patient's lymphocytes from destroying the stem cells in a patient diagnosed with aplastic anemia? Select all that apply.

Cyclosporine, Corticosteroids, ATG, Cyclophosphamide

A patient was admitted to the hospital with the following lab values: hemoglobin 5 g/dL, abnormally shaped erythrocytes, leukocyte count 2000/mm3 with hypersegmented neutrophils and a platelet count of 48,000/mm3. The platelets appear abnormally large. A bone marrow biopsy was competed and revealed hyperplasia. Based on this information, the nurse determines that patient most likely has which of the following diagnoses?

Folic acid deficiency -low Hgb,

The thalassemias are a group of hereditary anemias characterized by which of the following? Select all that apply.

Hypochromia, Extreme microcytosis, Hemolysis, Anemia

A patient admitted to the hospital in preparation for a splenectomy for treatment of autoimmune hemolytic anemia asks the nurse about the benefits of the splenectomy. Which of the following statements best explains the expected effect of the splenectomy?

It will remove the major site of erythrocyte destruction.

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?

Megaloblastic anemia

A nursing instructor is evaluating a student caring for a neutropenic patient. The instructor concludes that the nursing student demonstrates accurate knowledge of neutropenia based on which of the following interventions?

Monitoring the patient's temperature and reviewing the patient's complete blood count (CBC) with differential

For a patient with Hodgkin's disease who has developed neutropenia, what is the most appropriate nursing intervention to include in the care plan?

Monitoring the temperature every 4 hours Page 919

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

Reports joint pain less than 3 on a scale of 0 to 10 Page 912

Petechiae

Thrombocytopenia, reduced platelet delays clotting = tiny hemorrhages

For a patient with iron deficiency anemia, the nurse should advise the patient to do which of the following to prevent staining the teeth?

Use a straw or place a spoon at the back of the mouth to take the liquid supplement

A patient with poorly controlled diabetes has developed endstage renal failure and consequent anemia. When reviewing this patient's treatment plan, the nurse should anticipate the use of what drug?

Epoetin alfa

hemolytic anemia.

Erythrocytes destroyed prematurely Fewer erythrocytes=less O2=hypoxia kidneys compensate w/ erythropoietin Stimulates bone marrow to make new/premature reticulocytes increased bilirubin (destruction) Ex: SC, Thalassemia, G6PD,

A nurse is a long term care facility is admitting a new resident who has a bleeding disorder. When planning this resident's care, the nurse should include which of the following?

Implementing of a plan for fall prevention (internal bleeds, hematomas common)