ADN 420 Exam 1
What is secondary healthcare's goal?
Prevent
What are tissue layers affected by a tumor outside to inside?
Serosa -> Subserosa -> Muscle -> Submucosa -> Mucosa
What other fluids can infuse with blood?
0.9% normal saline
What is the normal range for HGB?
15,000 Men: 13-18 Women: 12-16
What is the normal range for ANC?
2,000 - 8,000
Diagnosis of skin cancer is confirmed by which diagnostic test?
Biopsy
What is FFP?
Fresh frozen plasma
Metastisis
M0) No mets M1) Mets
What does a high MCV count indicate?
Macrocytic anemia
What does a low MCV count indicate?
Microcytic anemia
For a client with Hodgkin disease who has developed neutropenia, what is an appropriate nursing intervention to include in the care plan?
Monitoring temp Q4 hours
The nurse is caring for a client who has terminal lung cancer + is unconscious. What assessment would indicate to the nurse that the clients death is imminent?
Mottling of the lower extremities
Risk factors for skin cancer?
Prolonged sun exposure, chronic arensic exposure
What is primary healthcare's goal?
Promotion
Place the clotting cascade in the correct order.
Prothrombin activator, prothrombin, thrombin, fibrinogen, fibrin
What is macrocytic anemia?
RBCs are bigger than normal (as if one less division occurred)
What is an autoglogous donor?
Self
What is ITP (immune/idiopathic thrombocytopenic purpura)?
platelets with antibodies go to liver and spleen, Fc receptor is activated, sky is activated and directs macrophage to eat platelet.
The nurse is teaching a community class about early screening for malignant melanoma. The nurse should be concerned with which statement?
"I have noticed that the mole on my back is changing color and size."
What is the normal range for MCV?
80-100
An ICU nurse is aware of the need to identify patients who may be at risk of developing disseminated intravascular coagulation (DIC). Which ICU client most likely faces the highest risk of DIC?
A client who is being treated for septic shock
A patient with renal failure has decreased erythopoietin production. Upon analysis of the patient's complete blood count, the nurse will expect which of the following results?
A decreased hemoglobin + hematocrit
Who is the universal recipient?
AB positive
What is mucositis?
Breakdown of epithelial tissue
What are the treatments for skin cancer?
Cryotherapy, radiation, chemo, imiquimod cream, excision
What is xerostomia?
Decreased or fast growing saliva
What does a high RBC count indicate?
Dehydration
What does a high HBG count indicate?
Dehydration, HF, smoker, and cancer of the blood
Splenic sequestration is diagnosed in a client admitted with splenomegaly. What is the priority of care for this client?
Hypovolemia
What do you do when you suspect a blood reaction?
Stop the transfusion + page the doctor
A patient is scheduled for radiation therapy for 6 weeks after her lumpectomy. The patient states she is worried about the side effects of the radiation. What is the best response by the nurse?
The radiation can cause some skin breakdown in the axillary folds toward the end of treatment.
What is tertiary healthcare's goal?
Treatment
Hypoproliferative anemia
Under production of RBCs
What does a high WBC count indicate?
infection
What is microcytic anemia?
iron deficiency, small red blood cells
What is the normal range for PLT?
150,000 - 450,000
What is the normal range for HCT?
45% Men: 42-52 Women: 36-48
What does a high PLT count indicate?
Cancer, most commonly lung cancer, gastrointestinal cancer, ovarian cancer, breast cancer, or lymphoma.
Which factor places a client at greatest risk for skin cancer?
Fair skin + history of chronic sun exposure
A patient with sickle cell anemia is to begin treatment of the disease with hydroxyurea. What does the nurse inform the patient will be the benefits of treatment with this medication? (SAP)
Fewer painful episodes of sickle cell crisis, lower incidence of acute chest syndrome, decreased need for blood transfusion.
What are 10 signs of a blood reaction?
Flank pain, fever, tachycardia, chills, SOB, headache, flushed, hypotension, tachypnea, + hives
A nurse is reviewing the chart of a patient with megaloblastic anemia. What might be used in the treatment of this picture? (SAP)
Folic acid, Vitamin B12
What is Primary Hemostasis?
Formation of a platelet plug when the endothelial cells vasoconstrict, platelets arrive, vonwilinbrand factor acts as glue (wet glue), collagen arrives, ADP + TXA2 and activate platelets.
Bleeding
Loss of blood
Would you page the doctor for a HCT of 20%?
Yes, it is low.
hemolytic anemia
anemia caused by the destruction of red blood cells
What does a low HBG count indicate?
Anemia
What does a low HCT count indicate?
Anemia
What does a low RBC count indicate?
Anemia
A client is brought to the ED reporting fatigue, large amounts of bruising on the extremities, + abdominal pain localized in the left upper quadrant. A health hx reveals the client has been treated for a sore throat 3 times in the past 2 months. Lab tests indicate severe anemia, significant neutropenia, + thrombocytopenia. Based on symptoms, what could be the client's diagnosis?
Aplastic Anemia
What does a low WBC count indicate?
Infection risk
What is stomatitis?
Inflammation of mouth and lips
What is an allogeneic donor?
Infusion from someone else.
The client's CBC with differential reveals small-shaped hemoglobin molecules. The nurse expects to administer which medication to this client?
Iron
What is treatment for prostate cancer?
Low fat diet, high intake of omega 3, hormone therapy, chemo, immunotherapy, prostatectomy, orchiectomy
What is the normal range for RBC?
5,000
What is the normal range for WBC?
5,000-10,000
What are risk factors for prostate cancer?
Age 50+, black ethnicity, infection, family hx, environmental agents, alcohol ingestion, diet high in fat and low in fiber
What are prevention and testings for prostate cancer?
Avoid alcohol, low fat diet, healthy lifestyle, hydration; PSA or alkaline phosphate
A client with breast cancer will have radiation therapy + then begin chemotherapy. Drug therapy will consist of a combination of doxorubicin, cyclophosphamide, + paclitaxel. What should the nurse include in the clients teaching plan concerning the drug therapy? (SAP)
Avoid large crowds + public places, take special care when shaving + oral care
What are prevention and testing for lung cancer?
Avoid smoking, avoid air pollutants; biopsy, chest xray, arterial blood gases, CBC, sputum
When assessing a patient with anemia, the nurse notes that the patient has developed peripheral numbness + poor coordination. The patients family states the patient appears to be confused at times at home. Neurologic symptoms mostly accompaterm-64ny which type of anemia?
Pernicious anemia
Would you page the doctor for a WBC count of 11,000?
No, but it is high.
Would you page the doctor for a RBC count of 4.1?
No, but it is low.
Would you page the doctor for a leukocytes count of 4,500?
No, but it is low.
Would you page the doctor for a plt count of 120,000?
No, but it is low.
Would you page the doctor for a HGB of 16?
No, it is within normal range.
Would you page the doctor for a WBC of 8,000?
No, it is within normal range.
What does a low ANC count indicate?
Cancer/bone marrow disorders, infections, chemotherapy, vitamin or mineral deficiency
Would you page the doctor for an ANC of 2,000?
No, it is within normal range.
Would you page the doctor for an erythrocyte count of 5?
No, it is within normal range.
Who is the universal donor?
O negative
The nurse is caring for an older adult client who has a hemoglobin of 9.6 g/dL + a hematocrit level of 34% to determine where the blood loss is coming from, what intervention can the nurse provide?
Observe stools for blood
What does a high HCT count indicate?
Dehydration, lung/heart disease
A client is receiving radiation to the abdominal area as part of cancer treatment. Which assessment findings would the nurse expect to find? (SAP)
Diarrhea, dermatitis (abdomen)
A patient's blood work reveals a platelet level of 17,000/mm. When inspecting the patient's integumentary system, what finding would be most consistent with this platelet level?
Petechiae
What is a syngeneic donor?
From twin (identical)
What does a low PLT count indicate?
HIV, aids, HepC, pregnancy
How fast should you hang blood after receiving it from the blood bank?
Hang it within 30 minutes
A patient comes into the clinic complaining of fatigue. Blood work shows an increased bilirubin concentration + an increased reticulocyte count. What would the nurse suspect the patient has?
Hemolytic anemia
A 25-year-old client comes to the ED with excessive bleeding from a cut sustaiend when cleaning a knife. Blood work shows a prolonged PT but a vitamin K deficiency is ruled out. When assessing the client, areas of ecchymosis are noted on other areas of the body. Which of the following is the most plausible cause of the clients signs/symptoms?
Hepatic dysfunction
While caring for a client, the nurse notes petechiae on the client's trunk + lower extremities. What precaution will the nurse take when caring for this client?
Use an electric razor when helping client shave
Would you page the doctor for a PLT count of 600,000?
Yes, it is high.
Would you page the doctor for a WBC count of 17,000 normal?
Yes, it is high.
Would you page the doctor for a leukocyte count of 25,000?
Yes, it is high.
Would you page the doctor for a Hgb of 6?
Yes, it is low.
Would you page the doctor for a WBC of 2,500?
Yes, it is low.
Would you page the doctor for a thrombocyte count of 30,000?
Yes, it is low.
Would you page the doctor for a thrombocyte count of 90,000?
Yes, it is low.
Would you page the doctor for an ANC of 1,000?
Yes, it is low.
Would you page the doctor for a HGB of 10.5?
You would not page the doctor, but it is low.
Would you page the doctor for a HCT of 35%?
You would not page the doctor, but its low.
Node
N1) No nodes N2) 1-3 local nodes N3) 4+
A patient with a diagnosis of immune thrombocytopenic purpura (ITP) is currently receiving IVIG for the treatment of her health condition. The nurse who is providing this patient's care is aware that ITP is a consequence of what?
Platelet destruction + impaired platelet production resulting from an autoimmune process
An older adult client is to recieve 2 units of packed red blood cells, During the transfusion of the first unit a 125 mL/hr, the client reports shortness of breath 30 minutes into the process. The clients vitals are (Pre: PR-72, R-18, BP-108/72; 15 min: PR-76, R-18, BP-110/72; 30 min: PR-88, R-28, BP-132/84) What is the nurse's best intervention?
Slow the rate of the transfusion + obtain an order for furosemide
What are risk factors for lung cancer?
Smoking, exposure to second hand smoke or radon gas, exposure to carcinogen + industrial air pollutant, genetics, pulmonary fibrosis, radiation therapy
How is cancer staged and what is the prognosis with each stage?
Stage 1) No mets + no nodes - Very good (T2N1M0) Stage 2) Some node involvement in primary origin - Good/fair (T2N2M0) Stage 3) Spreading to local tissues and lymph - Guarded (T4N2M0) Stage 4) Mets - Poor (T4N3M1)
Place the steps in order when determining the type/severity of a transfusion reaction.
Stop transfusion -> Assess client -> Notify care provider -> Notify blood bank -> Send tubing + container to blood bank
Prevention and testing for skin cancer?
Sunscreen, avoid tanning beds, avoid prolonged sun exposure, look over skin 1/month for abnormalities; biopsy
Tumor
T1) Mucosa + submucosa T2) Mucosa, submucosa, + muscle T3) Mucosa, submucosa, muscle, serosa, + subserosa T4) Mucosa, submucosa, muscle, serosa, subserosa, + extends out of primary origin
