MS 2: Hematology
Which statements by the mother of a toddler would lead the nurse to suspect that the child has iron-deficiency anemia? Select all that apply. "He drinks over 3 cups of milk per day." "I can't keep enough apple juice in the house; he must drink over 10 ounces per day." "He refuses to eat more than 2 different kinds of vegetables." "He doesn't like meat, but he will eat small amounts of it." "He sleeps 12 hours every night and take a 2-hour nap."
"I can't keep enough apple juice in the house; he must drink over 10 ounces per day."
As home health nurse, you are taking an admission history for a client who has a deep vein thrombosis and is taking warfarin (Coumadin) 2 mg daily. Which statement by the client is the best indicator that additional teaching about warfarin may be needed? "I have started to eat more healthy foods like green salads and fruit." "The doctor said that it is important to avoid becoming constipated." "Coumadin makes me feel a little nauseated unless I take it with food." "I will need to have some blood testing done once or twice a week."
"I have started to eat more healthy foods like green salads and fruit." R:Clients taking warfarin are advised to avoid making sudden diet changes, because changing the oral intake of foods high in vitamin K (such as green leafy vegetables and some fruits) will have an impact on the effectiveness of the medication. The other statements suggest that further teaching may be indicated, but more assessment for teaching needs is indicated first.
A client comes into the health clinic 3 years after undergoing a resection of the terminal ileum complaining of weakness, shortness of breath, and a sore tongue. Which client statement indicates a need for intervention and client teaching? "I have been drinking plenty of fluids." "I have been gargling with warm salt water for my sore tongue." "I have 3 to 4 loose stools per day." "I take a vitamin B12 tablet every day"
"I take a vitamin B12 tablet every day" R: Vitamin B12 combines with intrinsic factor in the stomach and is then carried to the ileum, where it is absorbed in the bloodstream. In this situation, vitamin B12 cannot be absorbed regardless of the amount of oral intake of sources of vitamin B12 such as animal protein or vitamin B12 tablets. Vitamin B12 needw to be injected every month, because the ileum has been surgically removed.
A 67-year-old client who is receiving chemotherapy for lung cancer is admitted to the hospital with thrombocytopenia. While you are taking the admission history, the client makes these statements. Which statement is of most concern? "I've noticed that I bruise more easily since the chemotherapy started." "My bowel movements are soft and dark brown in color." "I take one aspirin every morning because of my history of angina." "My appetite has decreased since the chemotherapy strated."
"I take one aspirin every morning because of my history of angina." R: Because aspiring will decrease platelet aggregation, clients with thrombocytopenia should not use aspirin routinely. Client teaching about his should be included in the care plan. Bruising is consistent with the client's admission problem of thrombocytopenia. Soft, dark brown stools indicate that there is no frank blood in the bowel movements. A decrease in appetite is common with chemotherapy, and more assessment is indicated.
A client with iron deficiency anemia is scheduled for discharge. Which instruction about prescribed ferrous gluconate therapy should the nurse include in the teaching plan? "Take the medication with an antacid." "Take the medication with a glass of milk." "Take the medication with cereal." "Take the medication on an empty stomach."
"Take the medication on an empty stomach."
A 22-year-old with stage I Hodgkin's disease is admitted to the oncology unit for radiation therapy. During the initial assessment, the client tells you, "Sometimes I am afraid of dying." Which response is most appropriate at this time? "Many individuals with this diagnosis have some fears." "Perhaps you should ask the doctor about medication." "Tell me a little bit more about your fear of dying." "Most people with stage I Hodgkin's disease survive."
"Tell me a little bit more about your fear of dying." R: Most assessment about what the client means is needed before any interventions can be planned or implemented. All of the other statements indicate a conclusion that the client is afraid of dying of Hodgkin's disease.
The mothers asks the nurse why her child's hemoglobin was normal at birth but now the child has S hemoglobin. Which of the following responses by the nurse is most appropriate? "The placenta bars passage of the hemoglobin S from the mother to the fetus." "The red bone marrow does not begin to produce hemoglobin S until several months after birth." "Antibodies transmitted from you to the fetus provide the newborn with temporary immunity." "The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth."
"The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth." R:Sickle cell disease is an inherited disease that is present at birth. However, 60% to 80% of a newborns hemoglobin is fetal hemoglobin, which has a structure different from that of hemoglobin S or hemoglobin A. Sickle cell symptoms usually occur about 4 months after birth, when hemoglobin S begins to replace the fetal hemoglobin. The gene for sickle cell disease is transmitted at the time of conception, not passed through the placenta. Some hemoglobin S is produced by the fetus near term. The fetus produces all its own hemoglobin from the earliest production in the first trimester.
A client with pernicious anemia asks why she must take vitamin B12 injections for the rest of her life. What is the nurse's best response? "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient acid." "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor." "The reason for your vitamin deficiency is an excessive excretion of the vitamin because of kidney dysfunction." "The reason for your vitamin deficiency is an increased requirement for the vitamin because of rapid red blood cell production."
"The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor."
A client states that she is afraid of receiving vitamin B12 injections because of the potential toxic reactions. What is the nurse's best response to relieve these fears? "Vitamin B12 will cause ringing in the eats before a toxic level is reached." "Vitamin B12 may cause a very mild skin rash initially." "Vitamin B12 may cause mild nausea but nothing toxic." "Vitamin B12 is generally free of toxicity because it is water soluble."
"Vitamin B12 is generally free of toxicity because it is water soluble."
A client was admitted with iron deficiency anemia and blood-streaked emesis. Which question is most appropriate for the nurse to ask in determining the extent of the client's activity intolerance? "What activities were you able to do 6 months ago compared with the present?" "How long have you had this problem?" "Have you been able to keep up with all your usual activities?" "Are you more tired now than you used to be?"
"What activities were you able to do 6 months ago compared with the present?" R: It is difficult to determine activity intolerance without objectively comparing activities from one time frame to another. Because iron deficiency anemia can occur gradually and individual endurance varies, the nurse can best assess the client's activity tolerance by asking the client to compare activities 6 months ago and at the present.
Nursing care for pt's with problems on platelets
1. Assess vital signs - ↓BP ↑PR ↑RR 2. Assess for signs of bleeding 3. Check for LOC - decreased sensorium (restlessness, agitation) → earliest sign of hypovolemia 4. Assess skin turgor a. ecchymosis - blackish or bluish discoloration b. purpura - purple-colored spot (bruising) c. hematoma TNTC - too numerous to count (lab results) - for urine, if TNTC, sign of hematuria - blood in stool test a. FOBT (Fecal Occult Blood Test) b. GUAIAC (check for microscopic blood in stool)
After receiving the change-of-shift report, which client will you assess first? A 20-year-old with possible acute myelogenous leukemia who has just arrived on the medical unit A 38-year-old with aplastic anemia who needs teaching about decreasing infection risk prior to discharge A 40-year-old with lymphedema who requests help to put on compression stockings before getting out of bed A 60-year-old with non-Hodgkin's lymphoma who is refusing the ordered chemotherapy regimen
A 20-year-old with possible acute myelogenous leukemia who has just arrived on the medical unit R: The newly admitted client should be assessed first, because the baseline assessment and plan of care need to be completed.
A group of clients is assigned to an RN-LPN/LVN team. The LPN/LVN is most likely to be assigned to provide client care and administer medications to which of these clients? 55-year-old client with a history of stem cell transplantation who will have a bone marrow aspiration A 36-year-old client with chronic renal failure who will need a subcutaneous injection of epoetin (Procrit) A 50-year-old client with newly diagnosed polycythemia vera who is scheduled for phlebotomy A 39-year-old client with hemophilia B who has been admitted for a blood transfusion
A 36-year-old client with chronic renal failure who will need a subcutaneous injection of epoetin (Procrit) R: Subcutaneous administration of epoetin is within the LPN/LVN scope of practice.
As charge nurse, you are making the daily assignments on the medical-surgical unit. Which client is best assigned to a nurse who has floated from the post-anesthesia care unit (PACU)? A 30-year-old client with thalassemia major who has an order for subcutaneous infusion of deferoxamine (Desferal) A 43-year-old client with multiple myeloma who needs discharge teaching A 52-year-old client with chronic gastrointestinal bleeding who has returned to the unit after a colonoscopy A 65-year-old client with pernicious anemia who has just been admitted to the unit
A 52-year-old client with chronic gastrointestinal bleeding who has returned to the unit after a colonoscopy R:A nurse who works in the PACU will be familiar with the monitoring needed for a client who has just returned from a procedure like a colonoscopy, which requires conscious sedation.
After receiving change-of-shift report about all of these clients, which one will you assess first? A 26-year-old with thalassemia major who has a short-stay admission for a blood transfusion A 44-year-old who was admitted 3 days previously with a sickle cell crisis and has orders for a CT scan A 50-year-old with newly diagnosed stage IV non-Hodgskin's lymphoma who is crying and stating "I'm not ready to die." A 69-year-old with chemotherapy-induced neutropenia who has an elevated oral temperature
A 69-year-old with chemotherapy-induced neutropenia who has an elevated oral temperature R: Any temperature elevation in a neutropenic client may indicate the presence of a life-threatening infection, so actions such as blood cultures and antibiotic administration should be initiated quickly. The other clients need to e assessed as soon as possible, but are not critically ill.
The primary purpose of the Schilling test is to measure the client's ability to: Store vitamin B12 Digest vitamin B12 Absorb vitamin B12 Produce vitamin B12
Absorb vitamin B12 R: Pernicious anemia is caused by the body's inability to absorb vitamin B12. This results in a lack of intrinsic factor in the gastric juices. Schilling's test helps diagnose pernicious anemia by determining the client's ability to absorb vitamin B12.
A 32-year-old client with a history of sickle cell anemia is admitted to the hospital during a sickle cell crisis. The physician orders all of these interventions. Which order will you implement first? Immunize with Pneumovax and Haemophilus influenzae vaccines. Start a large-gauge IV line and infuse normal saline at 200 mL/hour. Administer oxygen at an F102 of 100% per non-rebreather mask. Give morphine sulfate 4-8 mg IV every hour as needed.
Administer oxygen at an F102 of 100% per non-rebreather mask. R: Hypoxia and deoxygenation of the red blood cells are the most common cause of sickling, so administration of oxygen is the priority intervention here.
Prothrombin is a ____ globulin and is produced by the _____. Alpha, Kidney Alpha, Liver Beta, Kidney Beta, Liver
Alpha, Liver
You are the charge nurse in an oncology unit. A client with an absolute neutrophil count (ANC) of 300/mm3 is placed in protective isolation. Which staff member should you assign to provide care for this client, under the supervision of an experienced oncology RN? An LPN who has floated from the same-day-surgery unit An RN from the float pool who usually works on the surgical unit An LPN with 2 years of experience on the oncology unit An RN who transferred recently from the ED
An LPN with 2 years of experience on the oncology unit R: Because many aspects of nursing care need to be modified to prevent infection when a client has a low ANC, care should be provided by the staff member with the most experience with neutropenic clients.
↓RBC ↓platelet ↓WBC
Aplastic anemia
The nurse devises a teaching plan for the patient with aplastic anemia. Which of the following is the most important concept to teach for health maintenance? Eat animal protein and dark leafy vegetables each day Avoid exposure to others with acute infection Practice yoga and meditation to decrease stress and anxiety Get 8 hours of sleep at night and take naps during the day
Avoid exposure to others with acute infection R: Clients with aplastic anemia are severely immunocompromised and at risk for infection and possible death related to bone marrow suppression and pancytopenia. Strict aseptic technique and reverse isolation are important measures to prevent infection.
When a client is diagnosed with aplastic anemia, the nurse monitors for changes in which of the following physiological functions? Bleeding tendencies Intake and output Peripheral sensation Bowel function
Bleeding tendencies R:Aplastic anemia decreases the bone marrow production of RBCs, WBCs, and platelets. The client is at risk for bruising and bleeding tendencies. A change in the intake and output is important, but assessment for the potential for bleeding takes priority.
Which of the following arteries creates the left spenic, hepatic and gastric arteries? Left sacral artery Celiac artery Suprarenal artery Phrenic artery
Celiac artery
A client with macrocytic anemia has a burn on her foot and states that she had been watching television while lying on a heating pad. What is the nurse's first response? Assess for potential abuse Check for diminished sensations Document the findings Clean and dress the area
Check for diminished sensations R: Macrocytic anemias can result from deficiencies in vitamin B12 or ascorbic acid. Only vitamin B12 deficiency causes diminished sensations of peripheral nerve endings. The nurse should assess for peripheral neuropathy and instruct the client in self-care activities for her diminished sensation to heat and pain.
A long-term-care client with chronic lymphocytic leukemia has a nursing diagnosis of Activity Intolerance related to weakness and anemia. Which of these nursing activities is most appropriate for you, as the charge nurse, to delegate to a nursing assistant? Assist the client in choosing a diet that will improve strength. Check the client's blood pressure and pulse rate after ambulation. Determine which self-care activities the client can do independently. Evaluate the client's response to normal activities of daily living.
Check the client's blood pressure and pulse rate after ambulation. R: Nursing assistant education include routine nursing skills such as assessment of vital signs.
Which of the following assessments in a child with hemophilia would lead the nurse to suspect early hemarthrosis? Child's reluctance to move a body part Cool, pale, clammy extremity Eccymosis formation around a joint Instability of a long bone in passive movement
Child's reluctance to move a body part
A mother asks the nurse if her child's iron deficiency anemia is related to the child's frequent infections. The nurse responds based on the understanding of which of the following? Children with iron-deficiency anemia are less susceptible to infection than are other children. Little is known about iron-deficiency anemia and its relationship to infection in children. Children with iron-deficient anemia are equally as susceptible to infection as are other children. Children with iron deficiency anemia are more susceptible to infection than are other children.
Children with iron deficiency anemia are more susceptible to infection than are other children.
You have developed the nursing diagnosis Risk for Impaired Tissue Integrity related to effects of radiation for a client with Hodgkin's lymphoma who is receiving radiation to the groin area. Which nursing activity is best delegated to a nursing assistant caring for the client? Check the skin for signs of redness or peeling. Apply alcohol-free lotion to the area after cleaning. Explain good skin care to the client and family. Clean the skin over daily with a mild soap.
Clean the skin over daily with a mild soap. R: Skin care is included in nursing assistant education and job description. Assessment and client teaching are more complex tasks that should be delegated to registered nurses.
When comparing the hematocrit levels of a post-op client, the nurse notes that the hematocrit decreased from 36% to 34% on the third day even though the RBC and hemoglobin values remained stable at 4.5 million and 11.9 g/dL, respectively. Which nursing intervention is most appropriate? Check the dressing and drains for frank bleeding Call the physician Continue to monitor vital signs Start oxygen at 2L/min per NC
Continue to monitor vital signs
↓WBC → afebrile → ↓platelet
DENGUE
Which of the following diagnostic findings are most likely for a client with aplastic anemia? Decreased production of T-helper cells Decreased levels of white blood cells, red blood cells, and platelets Increased levels of WBCs, RBCs, and platelets Reed-Sternberg cells and lymph node enlargement
Decreased levels of white blood cells, red blood cells, and platelets
A vegetarian client was referred to a dietician for nutritional counseling for anemia. Which client outcome indicates that the client does not understand nutritional counseling? The client: Adds dried fruit to cereal and baked goods Cooks tomato-based foods in iron pots Drinks coffee or tea with meals Adds vitamin C to all meals
Drinks coffee or tea with meals R: Coffee and tea increase gastrointestinal mobility and inhibit the absorption of nonheme iron.
The nurse is preparing to teach a client with microcytic hypochromic anemia about the diet to follow after discharge. Which of the following foods should be included in the diet? Eggs Lettuce Citrus fruits Cheese
Eggs R: One of the microcytic, hypochromic anemias is iron-deficiency amenia. A rich source of iron is needed in the diet, and eggs are high in iron. Other foods high in iron include organ and muscle (dark) meats; shellfish, shrimp, and tuna; enriched, whole-grain, and fortified cereals and breads; legumes, nuts, dried fruits, and beans; oatmeal; and sweet potatoes. Dark green leafy vegetables and citrus fruits are good sources of vitamin C. Cheese is a good source of calcium.
Which of the following blood components is decreased in anemia? Erythrocytes Granulocytes Leukocytes Platelets
Erythrocytes R: Anemia is defined as a decreased number of erythrocytes (red blood cells). Leukopenia is a decreased number of leukocytes (white blood cells). Thrombocytopenia is a decreased number of platelets. Lastly, granulocytopenia is a decreased number of granulocytes (a type of white blood cells).
What hormone produced by kidneys that stimulate bone marrow for production of RBCs
Erythropoietin
A clinic nurse instructs the mother of a child with sickle cell disease about the precipitating factors related to pain crisis. Which of the following, if identified by the mother as a precipitating factor, indicates the need for further instructions? Infection Trauma Fluid overload Stress
Fluid overload
The nurse has just admitted a 35-year-old female client who has a serum B12 concentration of 800 pg/ml. Which of the following laboratory findings would cue the nurse to focus the client history on specific drug or alcohol abuse? Serum creatinine, 0.5 mg/dL Total bilirubin, 0.3 mg/dL Folate, 1.5 ng/mL Hemoglobin, 16 g/dL
Folate, 1.5 ng/mL R: The normal range of folic acid is 1.8 to 9 ng/mL, and the normal range of vitamin B12 is 200 to 900 pg/mL. A low folic acid level in the presence of a normal vitamin B12 level is indicative of a primary folic acid-deficiency anemia. Factors that affect the absorption of folic acid are drugs such as methotrexate, oral contraceptives, antiseizure drugs, and alcohol.
A client is to receive epoetin (Epogen) injections. What laboratory value should the nurse assess before giving the injection? Hematocrit Partial thromboplastin time Hemoglobin concentration Prothrombin time
Hematocrit R: Epogen is a recombinant DNA form of erythropoietin, which stimulates the production of RBCs and therefore causes the hematocrit to rise. The elevation in hematocrit causes an elevation in blood pressure; therefore, the blood pressure is a vital sign that should be checked.
Which of the following disorders results from a deficiency of factor VIII? Hemophilia A Hemophilia B Sickle cell disease Christmas disease
Hemophilia A R: Hemophilia A results from a deficiency of factor VIII. Sickle cell disease is caused by a defective hemoglobin molecule. Christmas disease, also called hemophilia B, results in a factor IX deficiency.
A pediatric nurse health educator provides a teaching session to the nursing staff regarding hemophilia. Which of the following information regarding this disorder would the nurse plan to include in the discussion? Hemophilia is a Y linked hereditary disorder Males inherit hemophilia from their fathers Females inherit hemophilia from their mothers Hemophilia A results from a deficiency of factor VIII
Hemophilia A results from a deficiency of factor VIII R: Males inherit hemophilia from their mothers, and females inherit the carrier status from their fathers. Hemophilia is inherited in a recessive manner via a genetic defect on the X-chromosome. Hemophilia A results from a deficiency of factor VIII. Hemophilia B (Christmas disease) is a deficiency of factor IX.
What is the most common site for bone marrow aspiration?
Iliac Crest
A client with graft-versus-host disease (GVHD) after a bone marrow transplant is being cared for on the medical unit. Which of these nursing activities is best delegated to a newly graduated RN who has had a 6-week orientation to the unit? Education of the client about ways to prevent infection Infusion of D5.45% normal saline at 125 mL/hour to the client Administration of methotrexate and cyclosporine to the client Assessment of the client for signs of infection caused by GVHD
Infusion of D5.45% normal saline at 125 mL/hour to the client R: Infusion of IV fluids is indicated in RN education, and the new RN would also have had experience with this as part of an orientation to the medical unit. Administration of potent immunosuppressive medications, assessment for subtle indications of infection, and client teaching are more complex tasks that should be delegated to more experienced RN staff members.
The nurse understands that the client with pernicious anemia will have which distinguishing laboratory findings? RBCs 5.0 million Sedimentation rate, 16 mm/hour Intrinsic factor, absent. Schilling's test, elevated
Intrinsic factor, absent. R: The defining characteristic of pernicious anemia, a megaloblastic anemia, is lack of the intrinsic factor, which results from atrophy of the stomach wall. Without the intrinsic factor, vitamin B12 cannot be absorbed in the small intestines, and folic acid needs vitamin B12 for DNA synthesis of RBCs.
↑WBC
Leukemia
The right coronary artery divides to form the posterior interventricular artery and the ___ artery. Marginal LVC RVC LAD
Marginal
The nurse would instruct the client to eat which of the following foods to obtain the best supply of vitamin B12? Whole grains Green leafy vegetables Meats and dairy products Broccoli and Brussels sprouts
Meats and dairy products R: Good sources of vitamin B12 include meats and dairy products. Whole grains are a good source of thiamine. Green leafy vegetables are good sources of niacin, folate, and carotenoids (precursors of vitamin A). Broccoli and Brussels sprouts are good sources of ascorbic acid (vitamin C).
A client who has been receiving cyclosporine following an organ transplant is experiencing these symptoms. Which one is of most concern? Occasional nausea after taking the medication Numbness and tingling of the feet Bleeding of the gums while brushing the teeth Non-tender swelling in the right groin
Non-tender swelling in the right groin R: A non-tender swelling in this area (or near any lymph node) may indicate that he client has developed lymphoma, a possible adverse effect of immunosuppressive therapy. The client should receive further evaluation immediately.
Which of the following symptoms is expected with hemoglobin of 10 g/dl? Shortness of breath None Palpitations Pallor
None R: Mild anemia usually has no clinical signs. Palpitations, SOB, and pallor are all associated with severe anemia.
Normal value and lifespan of Platelets
Normal value: 150 000-350 000 Life span: 7-10 days
The nurse explains to the parents of a 1-year-old child admitted to the hospital in a sickle cell crisis that the local tissue damage the child has on admission is caused by which of the following? Autoimmune reaction complicated by hypoxia Lack of oxygen in the red blood cells Obstruction to circulation Elevated serum bilirubin concentration.
Obstruction to circulation
A client with anemia may be tired due to a tissue deficiency of which of the following substances? Carbon dioxide Factor VIII Oxygen T-cell antibodies
Oxygen
Which of the following would the nurse identify as the priority nursing diagnosis during a toddler's vasoocclusive sickle cell crisis? Ineffective coping related to the presence of a life-threatening disease Decreased cardiac output related to abnormal hemoglobin formation Pain related to tissue anoxia Excess fluid volume related to infection
Pain related to tissue anoxia
The physician has ordered several laboratory tests to help diagnose an infant's bleeding disorder. Which of the following tests, if abnormal, would the nurse interpret as most likely to indicate hemophilia? Bleeding time Tourniquet test Clot retraction test Partial thromboplastin time (PTT)
Partial thromboplastin time (PTT)
Considerations in giving platelets
Patient taking antiplatelet drugs such as Aspirin and Clopidogrel (for MI, stroke, or cerebral infarction) malabnaw the blood = at risk for bleeding Nursing action: ask for patient's medications stop these medications 7 days prior the procedure
The liquid portion of the blood
Plasma
Which of the following foods would the nurse encourage the mother to offer to her child with iron deficiency anemia? Rice cereal, whole milk, and yellow vegetables Potato, peas, and chicken Macaroni, cheese, and ham Pudding, green vegetables, and rice
Potato, peas, and chicken
Which of the following nursing assessments is a late symptom of polycythemia vera? Headache Dizziness Pruritus Shortness of breath
Pruritus
Laboratory studies are performed for a child suspected of having iron deficiency anemia. The nurse reviews the laboratory results, knowing that which of the following results would indicate this type of anemia? An elevated hemoglobin level A decreased reticulocyte count An elevated RBC count Red blood cells that are microcytic and hypochromic
Red blood cells that are microcytic and hypochromic
Which of the following is not considered a major branch off of the descending thoracic aorta? Mediastinal artery Renal artery Bronchial artery Posterior intercostals artery
Renal artery
The nurse is assessing a client's activity intolerance by having the client walk on a treadmill for 5 minutes. Which of the following indicates an abnormal response? Pulse rate increased by 20 bpm immediately after the activity Respiratory rate decreased by 5 breaths/minute Diastolic blood pressure increased by 7 mm Hg Pulse rate within 6 bpm of resting phase after 3 minutes of rest.
Respiratory rate decreased by 5 breaths/minute
A child suspected of having sickle cell disease is seen in a clinic, and laboratory studies are performed. A nurse checks the lab results, knowing that which of the following would be increased in this disease? Platelet count Hematocrit level Reticulocyte count Hemoglobin level
Reticulocyte count
A client with acute myelogenous leukemia is receiving induction phase chemotherapy. Which assessment information is of most concern? Serum potassium level of 7.8 mEq/L Urine output less than intake by 400 mL Inflammation and redness of oral mucosa Ecchymoses present on anterior trunk
Serum potassium level of 7.8 mEq/L R: Fatal hyperkalemia may be caused by tumor lysis syndrome, a potentially serious consequence of chemotherapy in acute leukemia.
The nurse implements which of the following for the client who is starting a Schilling test? Administering methylcellulose (Citrucel) Starting a 24- to 48 hour urine specimen collection Maintaining NPO status Starting a 72 hour stool specimen collection
Starting a 24- to 48 hour urine specimen collection Maintaining NPO status R: Urinary vitamin B12 levels are measured after the ingestion of radioactive vitamin B12. A 24-to 48- hour urine specimen is collected after administration of an oral dose of radioactively tagged vitamin B12 and an injection of nonradioactive vitamin B12.
Which of the following cells is the precursor to the red blood cell (RBC)? B cell Macrophage Stem cell T cell
Stem cell
A transfusion of PRBCs has been infusing for 5 minutes when the client becomes flushed and tachypneic and says, "I am having chills. Please get me a blanket." Which action should you take first? Obtain a warm blanket for the client. Check the client's oral temperature. Stop the medication. Administer oxygen.
Stop the medication. R: The client's symptoms indicate that a transfusion reaction may be occurring so the first action should be to stop the transfusion. Chills are an indication of a febrile reaction, so warming the client is not appropriate.
A client admitted to the hospital with a sickle cell crisis complains of severe abdominal, hip, and knee pain. You observe an LPN accomplishing these client care tasks. Which one requires that you, as charge nurse, intervene immediately? The LPN encourages the client to use the ordered PCA. The LPN positions cold packs on the client's knees. The LPN places a "No Visitors" sign on the client's door. The LPN checks the client's temperature every 2 hours.
The LPN positions cold packs on the client's knees. R:The joint pain that occurs in sickle cell crisis is caused by obstruction to blood flow by the sickled red blood cells. The appropriate therapy for this client would be application of moist heat to the joints to cause vasodilation and improve circulation. Because control of pain is a priority during sickle cell crisis, there is no need to restrict all visitors or to check the temperature every 2 hours.
The nurse in the outpatient clinic is assessing a 22-year-old with a history of a recent splenectomy after a motor vehicle accident. Which information obtained during the assessment will be of most immediate concern to the nurse? The client engages in unprotected sex. The client has an oral temperature of 99.7o F The client has abdominal pain with light palpation. The client admits to occasional marijuana use.
The client has an oral temperature of 99.7o F R: Because the spleen has an important role in the phagocytosis of microorganisms, the client is at higher risk for severe infection after a splenectomy. Medical therapy, such as antibiotic administration, is usually indicated for any symptoms of infection.
You are making a room assignment for a newly arrived client whose laboratory testing indicates pancytopenia. All of these clients are already on the nursing unit. Which one will be the best roommate for the new client? The client with digoxin toxicity The client with viral pneumonia The client with shingles The client with cellulitis
The client with digoxin toxicity R: Clients with pancytopenia are at higher risk for infection. The client with digoxin toxicity presents the least risk of infecting the new client.
You are transferring a client with newly diagnosed chronic myeloid leukemia to a long-term-care (LTC) facility. Which information is most important to the LTC charge nurse prior to transferring the client? The Philadelphia chromosome is present in the blood smear Glucose is elevated as a result of prednisone therapy There has been a 20-pound weight loss over the past year The client's chemotherapy has resulted in neutropenia
The client's chemotherapy has resulted in neutropenia R: The neutropenic client is at increased risk for infection, so the LTC charge nurse needs to know this in order to make decisions about the client room assignment and to plan care.
A client is admitted to the intensive car unit (ICU) with disseminated intravascular coagulation (DIC) associated with a gram-negative infection. Which assessment information has the most immediate implications for the client's care? There is no palpable radial or pedal pulse. The client complains of chest pain. The client's oxygen saturation is 87% There is mottling of the hands and feet.
The client's oxygen saturation is 87% R: Because the decrease in oxygen saturation will have the greatest immediate effect on all body systems, improvement in oxygenation should be the priority goal of care.
A new RN is preparing to administer packed red blood cells (PRBCs) to a client whose anemia was caused by blood loss after surgery. Which action by the new RN requires that you, as charge nurse, intervene immediately? The new RN waits 20 minutes after obtaining the PRBCs before starting the infusion. The new RN starts an intravenous line for the transfusion using a 22-gauge catheter. The new RN primes the transfusion set using 5% dextrose in lactated Ringer's solution. The new RN tells the client that the PRBCs may cause a serious transfusion reaction.
The new RN primes the transfusion set using 5% dextrose in lactated Ringer's solution. R: Normal saline, an isotonic solution, should be used when priming the IV line to avoid causing hemolysis of RBCs. Ideally, blood products should be infused as soon as possible after they are obtained; however, a 20-minute delay would not be unsafe. Large-gauge IV catheters are preferable for blood administration; if a smaller catheter must be used, normal saline may be used to dilute the RBCs.
Platelet lower than 150 000
Thrombocytopenia
Following a car accident, a client with a Medic-Alert bracelet indicating hemophilia A is admitted to the emergency department (ED). Which physician order should you implement first? Transport to radiology for C-spine x-rays. Transfuse Factor VII concentrate. Type and cross-match for 4 units RBCs. Infuse normal saline at 250 mL/hour.
Transfuse Factor VII concentrate. R: When a hemophiliac client is at high risk for bleeding, for example, after a motor vehicle accident, the priority intervention is to maximize the availability of clotting factors. The other orders also should be implemented rapidly, but do not have as high a priority.
True or False. Platelets considered as not true cells
True
A 78-year-old client admitted to the hospital with chronic anemia caused by possible gastrointestinal bleeding has all of these activities included in the care plan. Which activity is best delegated to an experienced nursing assistant (NA)? Have the client sign a colonoscopy consent form. Check for allergies to contrast dye or shellfish. Use Hemoccult slides to obtain stool specimens. Administer PEG-ES (GoLYTELY) bowel preparation.
Use Hemoccult slides to obtain stool specimens. An experienced nursing assistant would have been taught how to obtain a stool specimen for the Hematoccult slide test, because this is a common screening test for hospitalized clients.
The nurse is teaching a client with polycythemia vera about potential complications from this disease. Which manifestations would the nurse include in the client's teaching plan? Select all that apply. Hearing loss Visual disturbance Headache Orthopnea Gout Weight loss
Visual disturbance Headache Orthopnea Gout
You are reviewing the complete blood count (CBC) for a client who has been admitted for knee arthroscopy. Which value is most important to report to the physician prior to surgery? Hemoglobin 10.9 g/dL White blood cell count 16,000/mm3 Platelet count 426,000/ mm3 Hematocrit 33%
White blood cell count 16,000/mm3 R: An elevation in white blood cells may indicate that the client has an infection, which would likely require rescheduling of the surgical procedure.
Because of the risks associated with administration of factor VIII concentrate, the nurse would teach the client's family to recognize and report which of the following? Constipation Yellowing of the skin Puffiness around the eyes Abdominal distention
Yellowing of the skin R: Because factor VIII concentrate is derived from large pools of human plasma, the risk of hepatitis is always present. Clinical manifestations of hepatitis include yellowing of the skin, mucous membranes, and sclera. Use of factor VIII concentrate is not associated with constipation, abdominal distention, or puffiness around the eyes.
Complications of Erythrocytes
erythrocytosis (↑) polycythemia (↑) anemia (↓)
You obtain the following data about a client admitted with multiple myeloma. Which information has the most immediate implications for the client's care? The client complains of chronic bone pain. The blood uric acid level is very elevated. The 24 hour urine shows Bence-Jones protein. The client is unable to plantarflex the feet.
he client is unable to plantarflex the feet. R: The lack of plantar flexion may indicate spinal cord compression, which should be evaluated and treated immediately by the physician to prevent further loss of function.
Complications of leukocytes or WBC
leukocytosis (↑) leukopenia (↓)
Platelets or thrombocytes are derived from big cells called?
megakaryocytes
Complications of Platelets
thrombocytosis (↑) thrombocytopenia (↓)
