Anemia

The nurse is caring for a young woman who does not have children and has a medical history of severe anemia. She is visiting the clinic today to discuss birth control options and asks about getting an intrauterine device (IUD). How should the nurse reply? A) "Getting an IUD is not a great option for you because of your history of anemia." B) "Sure, I'll get you an appointment with a doctor." C) "You may not be a candidate for an IUD since you don't have children." D) "Only post-menopausal women are eligible for an IUD"

A) "Getting an IUD is not a great option for you because of your history of anemia." Rationale: Women of reproductive age are at higher risk for iron deficiency anemia due to heavy​ menstruation, pregnancy, and use of an IUD. A client with a history of severe anemia may have her health and iron levels further compromised by using an IUD. Women who do not have children and premenopausal women are eligible to use an IUD.

Which form of anemia can be prevented by a change in diet? A) Iron deficiency anemia B) Aplastic anemia C) Blood loss anemia D) Hemolytic anemia

A) Iron deficiency anemia Rationale: Nutritional causes of anemia include iron deficiency, vitamin B12 deficiency, and folic acid deficiency. Blood loss anemia recurs as a result of hemorrhage or other forms of blood loss. Aplastic anemia occurs when the bone marrow fails to produce red and white blood cells. Hemolytic anemias occur when red blood cells are destroyed prematurely. Only nutritional anemias can be prevented by a change in diet.

And older adult with renal failure is diagnosed with anemia. Based on this data, which cause of anemia will the nurse plan for when providing care? A) Loss of the kidney hormone erythropoietin B) A loss of appetite related to elevated blood urea nitrogen (BUN) and creatinine levels C) The renal dialysis used to treat the chronic renal failure D) Loss of blood through the urine because the failing kidney does not function properly

A) Loss of the kidney hormone erythropoietin Rationale: The anemia associated with renal failure is related to the loss of erythropoietin, which is produced by the healthy kidney and stimulates bone marrow to produce red blood cells. The anemia is not directly related to anorexia or hemodialysis, although these factors may be somewhat associated with the anemia. Renal failure causes the loss of protein, not blood, through the urine.

The nurse is caring for a 10-year-old client with thalassemia who had a splenectomy. Which nursing diagnosis is a priority for this client? A) Sepsis: Risk for B) Self neglect C) Fatigue D) Activity intolerance

A) Sepsis: Risk for ​Rationale: After receiving a​ splenectomy, the client is at risk for sepsis. This would be an appropriate diagnosis. Activity Intolerance​, Fatigue​, and Self Neglect are nursing diagnoses associated with​ anemia; however, the priority nursing diagnosis for this client is a risk for sepsis.

A client is admitted to the hospital for vomiting large amounts of blood. The nurse understands which assessment finding is associated with anemia related to blood loss? A) Tachycardia B) Sore, beefy red tongue C) Jaundice D) Bradycardia

A) Tachycardia ​ Rationale: Acute blood loss results in hypoxia to tissue. Tachycardia is a compensatory effort by the body to restore oxygenation. Jaundice can occur as a result of the hemolysis of red blood cells. It is not a manifestation of acute blood loss anemia. A client with blood loss anemia would have tachycardia related to fluid volume deficit. A​ sore, beefy red tongue is a symptom of nutritional​ anemias, not acute blood loss anemia

The nurse is caring for a 9-year-old client with iron deficiency anemia. When providing teaching about iron supplements, what information should the nurse provide to the caregivers? SATA A) Iron supplements can cause dark stools. B) Iron supplements can cause constipation. C) Give iron supplements with orange juice to increase absorption D) Give iron supplements with dairy products to increase absorption. E) Iron supplements require a doctor's prescription.

A, B, C Rationale: If given on an empty​ stomach, iron supplements can cause nausea and hinder compliance. Iron supplements can be given with juice that has vitamin C to increase​ absorption, but dairy products need to be avoided because they decrease absorption. Iron supplements can cause​ constipation, and caregivers should provide adequate fluids and fiber to avoid constipation. Iron supplements are available​ over-the-counter (OTC) and do not require a​ doctor's prescription

The nurse is caring for an older adult who is at risk for anemia and is providing teaching about the importance of eating iron-rich foods. The nurse knows that anemia in older adults is associated with which condition? SATA A) Increased mortality B) Decreased mobility C) Increased hospitalizations D) Decreased ability to perform ADLs E) Increased risk of infection

A, B, C, D Rationale: Anemia in older adults is associated with increased​ mortality, increased difficulty with​ motility, increased​ hospitalizations, and decreased ability to perform routine ADLs. The bodies of older adults who develop anemia cannot adapt as well as those of younger​ individuals, and older adults can display symptoms of​ fatigue, dyspnea, and confusion more easily. In​ addition, the prevalence of anemia in older adults who have chronic disease is even​ greater, and those with existing renal or cardiac disease have an increased mortality risk if they are anemic. Anemia is not associated with an increased risk of infection.

The nurse is caring for a 17-year-old client with blood loss anemia. Which independent nursing intervention would be appropriate for this client? SATA A) Assess vital signs B) Encourage periods of rest C) Supplement iron as ordered D) Administer supplemental oxygen as ordered E) Transfuse blood as soon as hemoglobin level falls below normal

A, B, C, D Rationale: Vital signs must be monitored as blood loss anemia can cause an increase in cardiac workload which can affect blood​ pressure, heart​ rate, and respiratory rate. Due to impaired oxygenation and​ perfusion, supplemental oxygen is usually​ required, and the client will be fatigued and need periods of rest. An iron supplement will help replace some of the iron that is lost. The nurse cannot transfuse blood without an order from the healthcare provider.​ Further, because of the risks involved with​ transfusion, it is not generally ordered until the hemoglobin level approaches a critical low unless the​ client's condition warrants otherwise.

Which nursing intervention is appropriate to include in the plan of care for a client with anemia? SATA A) Assess for signs of hypoxia B) Provide rest periods as needed C) Place the client in the supine position D) Administer medications as ordered E) Administer supplemental oxygen as needed

A, B, D, E ​Rationale: Appropriate interventions for the client with anemia include administering supplemental oxygen as​ ordered, assessing for signs of​ hypoxia, providing rest periods as​ needed, and administering medications as ordered. The nurse should place the client in a position that facilitates adequate​ respiration, such as Fowler or​ high-Fowler position.

A client with a history of anemia has started a vegan diet. Which addition to meals should the nurse recommend to help ensure that this client has adequate amounts of iron in the diet? SATA A) Legumes B) Orange juice C) Yeast D) Okra E) Peas

A, B, E Legumes, Orange juice, Peas Rationale: While all these options are good ones for someone on a vegan diet, the ones that would best prevent iron deficiency are legumes, peas, and orange juice. Legumes and peas are good sources of nonheme iron. Orange juice supports iron absorption from foods since it is high in vitamin C. Yeast is a good source of folic acid. Okra is not a good source of iron.

A nursing student is preparing an education program on hemolytic anemia for the residents of an assisted living center. Which extrinsic causes of hemolytic anemia should the student include in the program? SATA A) Bacterial infection B) Thalassemia C) Blood transfusion reaction D) Prosthetic heart valves E) Acetaminophen use

A, C, D Prosthetic heart valves, blood transfusion reactions, and bacterial infections are all extrinsic causes of hemolytic anemia. Acetaminophen use is not associated with hemolytic anemia. Thalassemia is considered an intrinsic cause of hemolytic anemia and would not be appropriate to include in this particular teaching.

A nurse is providing discharge instructions to a client with iron deficiency anemia who is experiencing glossitis. Which statements will the nurse include in the discharge teaching for this client? SATA A) Monitor the condition of the lips and tongue daily B) Use an alcohol based mouthwash every 2 to 4 hours C) Provide frequent oral hygiene D) Apply a non-petroleum based lubricating jelly or ointment to the lips after oral care E) Use a soft toothbrush or sponge to provide oral care

A, C, E Rationale: Glossitis, inflammation of the tongue that may cause the tongue and lips to turn red, and cheilosis (fissures or cracks at the corners of the mouth) may occur with nutritional deficiencies of iron, folate, and vitamin B12. Client education should include monitoring the condition of lips and tongue daily and providing frequent oral hygiene with a soft-bristle toothbrush or sponge. The client should not use an alcohol-based mouthwash, as this would worsen the glossitis. The client should use a petroleum-based lubricating jelly or ointment to the lips after oral care.

The nurse is caring for a client with an acute sickle cell crisis. Which medical order does the nurse anticipate? SATA A) Narcotic analgesia B) Vitamin B12 supplementation C) Blood transfusion D) Iron supplements E) Oxygen via nasal cannula

A, C, E ​Rationale: Acute sickle cell crisis causes severe lethargy and pain and requires narcotic analgesia. Blood transfusions and oxygen therapy are also​ needed, as well as treatment of the underlying issue causing the crisis. Oral or parenteral vitamin B12 is indicated in clients with pernicious anemia. Iron supplements are used to treat iron deficient anemia.

A woman asks her nurse why she needs to take an iron supplement during pregnancy if she does not have a history of anemia. How should the nurse reply? A) "You may need extra iron in case you bleed a lot during childbirth." B) "When you're pregnant, you gain extra blood volume, which can make you anemic." C) "You do not need to take an iron supplement." D) "It's just a standard part of every prenatal vitamin."

B) "When you're pregnant you gain extra blood volume, which can make you anemic." ​Rationale: Iron deficiency anemia is quite common in pregnancy. Pregnant women gain quite a bit in blood​ volume, which dilutes the red blood cells​ (RBCs) and can be reflected as anemia. The amount of iron needed by the body is also increased due to the growing fetus and placenta. All women should take a prenatal vitamin that contains iron and other important nutrients.

The home healthcare nurse is preparing a care plan for a client with severe anemia. The client currently lives alone and states, "I can't even walk to the kitchen without getting winded." What would be the priority nursing diagnosis for this client? A) Hopelessness B) Activity intolerance C) Imbalanced Nutrition, Less than body requirements D) Anxiety

B) Activity intolerance Rationale: Activity Intolerance would be a priority diagnosis for this client. While Anxiety, Hopelessness, and Imbalanced Nutrition may be appropriate nursing diagnoses for this client, they are not the priority.

The nurse is caring for a client with anemia who is receiving IV iron supplementation. The nurse knows to monitor for which complication? A) Black, tarry stools B) Anaphylaxis C) Nausea D) Respiratory failure

B) Anaphylaxis ​Rationale: Though​ rare, anaphylaxis can occur with parenteral iron​ administration, and the nurse must monitor for the development of this type of reaction. Oral iron supplements can cause​ constipation, nausea,​ heartburn, and​ black, tarry stools. Respiratory failure is not associated with parenteral iron administration.

The nurse is informing a client that a test has been ordered to diagnose aplastic anemia. Which test will the client have? A) Iron levels B) Bone marrow examination C) Complete blood count D) Schilling test

B) Bone marrow examination Rationale: Aplastic anemia is diagnosed by bone marrow examination. Aplastic anemia is a condition in which the bone marrow fails to produce all three types of blood cells. The other diagnostic tests listed are used in clients with other types of anemia.

While performing a physical examination, the nurse notes that the client has brittle, spoon shaped nails. The nurse should perform further evaluation for which type of anemia? A) Aplastic anemia B) Iron deficiency anemia C) Blood loss anemia D) Folic acid deficiency anemia

B) Iron deficiency anemia Rationale: Chronic iron deficiency anemia produces​ brittle, spoon-shaped nails. The nurse should further assess for cheilosis​ (cracks at the corner of the​ mouth); a​ smooth, cracked​ tongue; and pica. The other types of anemia do not produce this alteration.

The nurse anticipates that vitamin B12 supplementation may be ordered for a client with which condition? A) Aplastic anemia B) Pernicious anemia C) Thalassemia D) Iron deficiency anemia

B) Pernicious anemia Rationale: Pernicious anemia is a vitamin B12 deficiency caused by malabsorption or lack of intrinsic factor. Vitamin B12 supplementation is used to treat it. Aplastic anemia is treated with blood transfusions and bone marrow transplantation as needed. Iron deficiency is treated with an increase in dietary intake of iron and iron supplementation. Thalassemia is also treated with regular blood transfusion and folic acid supplements.

A client complaining of mouth soreness had gastric bypass surgery 1 year ago. During the assessment, the nurse notes the client's tongue is beefy, red, and smooth and the client's skin appears yellowish. Which additional information is most likely needed before diagnosing this client? A) Vitamin B6 levels B) Vitamin B12 levels C) Potassium levels D) Iron levels

B) Vitamin B12 levels Rationale: Vitamin B12 deficiency is associated with resection of the stomach or ileum. A deficiency of vitamin B12 will result in pernicious anemia. This deficiency will manifest as pallor, jaundice, weakness, and a beefy, smooth red tongue. Iron deficiency anemia will manifest with weakness and fatigue. Vitamin B6 deficiencies are not typically seen with gastric bypass surgeries and are not manifested with a beefy, red, smooth tongue. The client's reports are not consistent with a potassium deficiency.

The nurse is teaching a client about choosing dietary sources of iron. Which statement by the client indicates the need for further education? A) "I can get iron form most of the meats that I eat." B) "I will eat a lot more spinach than I used to eat." C) "I will be sure to increase the amount of cow's milk that I drink." D) "Oatmeal or whole-wheat toast would be a good choice for breakfast."

C) "I will be sure to increase the amount of cow's milk that I drink." ​Rationale: Milk is not considered to be a high dietary source of iron. Oatmeal and​ whole-grain breads, as well as greens such as​ spinach, are sources of non-heme iron.​ Beef, chicken, pork​ loin, turkey, and veal are all considered sources of heme iron.

The nurse is evaluating a client's understanding of dietary needs to treat dietary deficiency anemia. Which client statement indicates a need for additional teaching? A) "I will eat more fruits and vegetables, especially green leafy ones, to get more iron in my diet." B) "I will need to include more protein foods in my diet such as meats, dried beans, and whole grain breads." C) "I will decrease foods high in Vitamin C, as they decrease my absorption of iron." D) "I will take vitamins with extra iron in addition to eating a balanced diet with meat to correct my anemia."

C) "I will decrease foods high in Vitamin C, as they decrease my absorption of iron." Rationale: Increasing foods high in vitamin C will increase absorption of iron. The lack of iron is the problem that needs to be addressed. Extra iron is needed to help replace RBCs and treat the dietary deficiency anemia. Green leafy vegetables will increase iron in the diet. Protein foods such as meats, dried beans, and whole-grain breads do contain iron that will help dietary deficiency anemia.

A nurse is educating a client with anemia about the pathophysiological mechanisms of anemia. Which should be excluded in the nurse's teaching plan for this client? A) Altered hemoglobin synthesis B) Altered DNA synthesis C) Decreased hemolysis D) Bone marrow failure

C) Decreased hemolysis Rationale: The pathophysiological mechanisms of anemia include altered hemoglobin synthesis, altered DNA synthesis, bone marrow failure, and increased hemolysis. Altered hemoglobin synthesis is the mechanism involved in iron deficiency anemia, Thalassemia, and chronic inflammation. Altered DNA synthesis is the mechanism involved in vitamin B12 malabsorption or deficiency, and folic acid malabsorption or deficiency. Bone marrow failure is the mechanism in aplastic anemia, red cell aplasia, myeloproliferative leukemias, and lymphomas.

A client is admitted with a diagnosis of blood loss anemia after having outpatient surgery earlier in the day. The nurse reviews the healthcare provider's orders and places which order at highest priority? A) Regular diet B) IV normal saline at 250 mL/hr C) Oxygen at 2 L via nasal cannula D) Bed rest with bathroom privileges

C) Oxygen at 2 L via nasal cannula Rationale: Anemia decreases the​ oxygen-carrying capacity of the hemoglobin. Providing supplemental oxygen will help to increase oxygen to the​ tissues, preventing hypoxia. Provision of intravenous fluids to a client with blood loss anemia will ensure maintenance of adequate fluid​ volume, but the highest priority will be directed toward correction or prevention of hypoxia. Bed rest is an appropriate order for a client with​ anemia, but it is not the highest priority. The​ client's diet is not a priority in treating the​ client's blood loss.

What nursing intervention is most appropriate for the client with anemia who is experiencing activity intolerance? A) Administer medications to the client as ordered B) Ensure that the client walks the halls twice daily to prevent lung infection C) Provide the client adequate rest periods D) Assess the client's vital signs and apical pulse

C) Provide the client adequate rest periods Rationale: The most appropriate nursing intervention for the client with anemia who is experiencing activity intolerance is to provide the client adequate rest periods. While it is important to prevent lung infection in the hospitalized​ client, a client who is experiencing activity intolerance should not be encouraged to walk the halls twice daily. The nurse will take the​ client's vital signs and administer ordered​ medications; however, these are not the most important interventions for the client with anemia who is experiencing activity intolerance.

The nurse is counseling a couple of Mediterranean descent. For which condition is this client at risk? A) Aplastic anemia B) Pernicious anemia C) Thalassemia D) Sickle cell disease

C) Thalassemia ​Rationale: Thalassemia is an inherited condition where either the alpha or beta chains of the hemoglobin molecule are defective. It is more common in people of​ Mediterranean, African, and South Asian descent. Sickle cell disease is more common in people of African American descent. Pernicious anemia and aplastic anemia are not inherited disorders.

The nurse suspects that a client with severe shortness of breath in the absence of cyanosis is experiencing anemia. Which laboratory tests should the nurse review to confirm anemia? SATA A) Serum electrolytes B) Cardiac enzymes C) Hemoglobin D) Blood sugar E) Hematocrit

C, E Hemoglobin, Hematocrit Rationale: Severe anemia will interfere with the development of cyanosis, so the nurse should review the hemoglobin and hematocrit. Blood sugar, cardiac enzymes, and serum electrolytes are not implicated in this phenomenon.

A client experiencing fatigue, pallor, and dyspnea on exertion has a CBC drawn. Which RBC disorder should the nurse anticipate the client is experiencing? A) Polycythemia B) Erythropoiesis C) Herpes simplex D) Anemia

D) Anemia Rationale: Anemia is the most common red blood cell disorder, involving a low RBC count and decreased hemoglobin content. Signs and symptoms of anemia can include pallor of the skin and mucous membranes and dyspnea on exertion. Polycythemia is an abnormally high RBC count. Herpes simplex is not a red blood cell disorder; erythropoiesis is the term for RBC production.

The nurse is caring for a client and notes that the client has a history of rib and vertebral fractures, splenic enlargement, and bronze skin discoloring. The nurse prepares a referral for the client to which specialist? A) Orthopedist B) Gastroenterologist C) Dermatologist D) Genetic counselor

D) Genetic counselor ​Rationale: The​ client's symptoms are suggestive of​ thalassemia, which is treated with regular blood transfusions and folic acid supplementation. Referral to a genetic counselor is suggested because it is a hereditary disorder. The client does not need to see a dermatologist or an orthopedist because there are no new fractures or skin conditions. This client does not need to see a gastroenterologist because there are no stomach or intestinal problems.

The nurse is caring for a client with a history of very heavy menstrual periods. For which type of anemia is this client at risk? A) Aplastic anemia B) Pernicious anemia C) Blood loss anemia D) Iron deficient anemia

D) Iron deficient anemia Rationale: Women with very heavy menstrual periods are at risk for developing iron deficiency anemia due to blood loss during their period. Blood loss anemia results from significantly more blood loss than a​ woman's period. Pernicious anemia occurs with a deficiency of vitamin B12​, while aplastic anemia occurs when the bone marrow fails to produce both white and red blood cells.

The nurse is caring for an older adult client with hemolytic anemia. When planning care for this client, which should the nurse take into consideration regarding this diagnosis? A) It causes the RBCs to be microcytic B) It is associated with a decrease in the reticulocyte count C) It is the result of blood loss D) It is a result of the premature destruction of RBCs

D) It is a result of the premature destruction of RBCs Rationale: Hemolytic anemia is more common with aging and is caused by the premature destruction of the red blood cells. It is not associated with blood loss. There is an increase, not a decrease, in the reticulocyte (immature red blood cell) count because they are released early from the bone marrow to compensate. Hemolytic anemias are normocytic (red blood cells are normal size), not microcytic.

The nurse is instructing a client with iron deficiency anemia about appropriate menu choices. Which diet choice indicates that the teaching has been effective? A) Tofu with mixed vegetables in curry, milk, whole wheat bun B) Broiled fish, lettuce salad, grapefruit half, carrot sticks C) Pork chop, mashed potatoes and gravy, cauliflower, tea D) Roast beef, steamed spinach, tomato soup, orange juice

D) Roast beef, steamed spinach, tomato soup, orange juice Rationale: This client is anemic and needs iron. This meal contains iron in the beef, folic acid and iron in the spinach, and vitamin C in the tomato soup and orange juice. Vitamin C helps absorption of the iron; folic acid is needed for production of red cells. The meal of tofu with mixed vegetables in curry, milk, and a whole-wheat bun is high in calcium, but the client has iron deficiency anemia and requires a high-iron diet. The meal with a pork chop, mashed potatoes and gravy, cauliflower, and tea has a moderate amount of protein, but no vitamin C. The meal of fish, lettuce, grapefruit, and carrot sticks is high in fiber, low in fat, and moderately high in protein, but low in iron.

The nurse is caring for a client complaining of diarrhea and a sore, beefy red tongue. Which condition does the nurse consider may be the cause? A) Iron deficiency anemia B) Thalassemia C) Aplastic anemia D) Vitamin B12 deficiency anemia

D) Vitamin B12 deficiency anemia Rationale: The nurse would suspect vitamin B12 deficiency anemia. With this​ condition, the client may present with diarrhea and a​ sore, beefy red tongue. Thalassemia manifestations include bronze skin coloring and bone fractures. Iron deficiency anemia manifestations include​ brittle, spoon-shaped nails and cheilosis​ (cracks in the corner of the​ mouth). Manifestations of aplastic anemia include bleeding gums and bruising.