AH2 Hematology (Ch. 32-34)

The nurse cares for a client with iron deficiency anemia. What findings will the nurse expect to find when reviewing the client's CBC results? Select all that apply.

the nurse can expect to find decreased MCV (mean corpuscular volume), and decreased reticulocytes

What is chelation therapy?

use of a chemical compound that combines with the metal poisoning for rapid and safe excretion

Plasma proteins consist primarily of

Albumin and globulins

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

Anemia

A patient with acute myeloid leukemia (AML) is having hematopoietic stem cell transplantation (HSCT) with radiation therapy. In which complication do the donor's lymphocytes recognize the patient's body as foreign and set up reactions to attack the foreign host?

Graft-versus-host disease

The nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. What position will the nurse place the patient in?

Lateral position with one leg flexed

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following?

Liver

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?

Low Ferritin level

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

Megaloblasts are abnormally large erythrocytes

Lymphoid cells produce

T cells (T lymphocytes), B cells (B Lymphocytes), NK cells

A client with polycythemia vera reports gouty arthritis symptoms in the toes and fingers. What is the nurse's best understanding of the pathophysiological reason for this symptom?

The dead red blood cells release excess uric acid.

Most clients with ______ have too many white blood cells, not enough red blood cells, and not enough platelets

AML (Acute Myeloid Leukemia)

_______ leukemia develops quickly and the majority of leukocytes are undifferentiated cells.

Acute

ferrous sulfate patient teaching:

-administer the medication on an empty stomach -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

Delayed hemolytic reactions usually occur within _________ days after transfusion, when the level of antibody has been increased to the extent that a reaction can occur

14

Fragmented RBCs are found in what kind of anemia?

Hemolytic Anemia

The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions?

Dilute the liquid preparation with another liquid such as juice and drink with a straw

The patient, who is experiencing severe circulatory overload due to too much blood infusing too quickly, should be placed in an upright position with the feet in a dependent position.

True

Which is a symptom of hemochromatosis?

bronzing of the skin

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?

"I will receive parenteral vitamin B12 therapy for the rest of my life."

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?

"The child must inherit two defective genes, one from each parent."

A nurse cares for a client with megaloblastic anemia who had a total gastrectomy three years ago. What statement will the nurse include in the client's teaching regarding the condition?

"The condition is likely caused by a vitamin B12 deficiency."

Normal Albumin levels

3.4 to 5.4

Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)?

A 72-year-old patient with a history of cancer (Rationale: Primary MDS tends to be a disease of people older than 70 years)

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 health care provider immediately because the client probably is experiencing which problem?

A hemolytic allergic reaction caused by an antigen reaction

A client is being evaluated for a diagnosis of chronic myeloid leukemia (CML). What diagnostic indicator will the nurse assess?

A leukocyte count >100,000/mm3 Raitonale: Although there is an increase in the production of blast cells and the client may have an enlarged liver and tender spleen, it is the high leukocyte count that is diagnostic.

multiple myeloma

A malignant cancer of bone marrow. (The plasma cells are a type of white blood cell in the bone marrow)

A nurse is assigned to care for a patient with ascites, secondary to cirrhosis. The nurse understands that the fluid accumulation in the peritoneal cavity results from a combination of factors including an alteration in oncotic pressure gradients and increased capillary permeability. Therefore, the nurse monitors the serum level of the plasma protein responsible for maintaining oncotic pressure, which is:

Albumin

The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency?

B12

Which of the following are assessment findings associated with thrombocytopenia? Select all that apply

Bleeding gums Epistaxis Hematemesis

______ ________ is the primary site for hematopoiesis, a process of continuous blood cell formation.

Bone Marrow

A client with a history of sickle cell anemia has developed iron overload from repeated blood transfusions. What treatment does the nurse anticipate will be prescribed?

Chelation Therapy

_________ leukemia develops slowly, and the majority of leukocytes produced are mature.

Chronic

The nurse is instructing the client with polycythemia vera how to perform isometric exercises such as contracting and relaxing the quadriceps and gluteal muscle during periods of inactivity. What does the nurse understand is the rationale for this type of exercise?

Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart

A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor?

Decreased level of erythropoietin Rationale: 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

The nurse and the client are discussing some strategies for ingesting iron to combat the client's iron-deficiency anemia. Which is among the nurse's strategies?

Drink liquid iron preparations with a straw.

A client with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this client?

Erythropoietin

A nurse is performing an initial assessment and notes the client's skin is a gray-tan color, especially on the scars of the client's arms. Which hematological condition does the nurse suspect?

Hemochromatosis

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets?

Myeloid stem cell

What assessment finding best indicates that the client has recovered from induction therapy?

Neutrophil and platelet count within normal limits

An increase in _______________ may be seen in patients exposed to a bacterial infection

Neutrophils

The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures?

Osteoclasts break down bone cells so pathologic fractures occur. Rationale: The abnormal plasma cells proliferate in the bone marrow, where they release osteoclast-activating factor. This, in turn, causes osteoclasts to break down bone cells, resulting in increased blood calcium and pathologic fractures.

The nursing instructor is discussing disorders of the hematopoietic system with the pre-nursing pathophysiology class. What disease would the instructor list with a primary characteristic of erythrocytosis?

Polycythemia Vera

A nurse cares for several mothers and babies in the postpartum unit. Which mother does the nurse recognize as being most at risk for a febrile nonhemolytic reaction?

Rh-negative mother; Rh-positive child

The nurse expects which assessment finding of the oral cavity when the client is diagnosed with pernicious anemia?

Smooth tongue

Which type of lymphocyte is responsible for cellular immunity?

T cell

The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma?

The client with enlarged lymph nodes in the neck. Rationale: Lymph node enlargement in Hodgkin lymphoma is not painful. The client with enlarged lymph nodes in the neck is most likely to have Hodgkin lymphoma if the enlarged nodes are painless.

he client is to receive a unit of packed red blood cells. What is the nurse's first action?

Verify that the client has signed a written consent form.

The nurse is educating a client about iron supplements. The nurse teaches that what vitamin enhances the absorption of iron?

Vitamin C

The nurse is caring for a client with acute myeloid leukemia (AML) with high uric acid levels. What medication does the nurse anticipate administering that will prevent crystallization of uric acid and stone formation?

allopurinol (Zyloprim)

Patients who have had a partial or total gastrectomy may have limited amounts of intrinsic factor, therefore the absorption of vitamin _______ may be diminished

b 12

Complications of AML include

bleeding and infection, which are the major causes of death

Monocytes are

large WBCs that become macrophages when they leave the circulation and move into body tissues.

Thrombocytopenia

low platelet count (Can cause bruising, petechiae and hemorrhages

Blast cells are

primitive white blood cells (WBCs)

When iron medications are given intramuscularly like iron Dextran, the nurse uses which technique and why?

the Z-track technique to avoid local pain and staining of the skin.

Mast cells are cells found in

connective tissue involved in defense of the body and coagulation

A nurse prepares a client for a bone marrow biopsy who is suspected of having acute myeloid leukemia. What results from the bone marrow biopsy does the nurse expect?

excess immature leukocytes

People with iron deficiency anemia may crave

ice, starch, or dirt; this craving is known as pica

A nurse cares for a client with multiple myeloma who reports severe back pain that worsens throughout the day. What additional clinical symptoms will the nurse associate with the pathophysiology of the client's disease?

Excessive thirst Rationale: Bone pain in multiple myeloma results from bone breakdown. As a result of the breakdown, ionized calcium is released into the blood causing hypercalcemia. Symptoms of hypercalcemia include excessive thirst, dehydration, and constipation.

A patient with AML is having aggressive chemotherapy to attempt to achieve remission. The patient is aware that hospitalization will be necessary for several weeks. What type of therapy will the nurse explain that the patient will receive?

Induction therapy

A client is treated for anemia. What is the nurse's best understanding about the correlation between anemia and the client's iron stores?

There is a strong correlation between iron stores and hemoglobin levels. Rationale:A strong correlation exists between laboratory values that measure iron stores and hemoglobin levels. After iron stores are depleted (as reflected by low serum ferritin levels), the hemoglobin level falls.