cell regulation *prepU
The nurse is teaching a community class about early screening for malignant melanoma. The nurse should be concerned with which questions/concerns raised by audience members?
"I have noticed that the mole on my back is changing shape and has developed an irregular border."
A nurse is teaching a client with a vitamin B12 deficiency about appropriate food choices to increase the amount of B12 ingested with each meal. The nurse knows the teaching is effective based on which statement by the client?
"I will eat a meat source such as chicken or pork with each meal."
A patient is scheduled to receive radiation therapy for 6 weeks after her lumpectomy. The patient states she is worried about the side effects of the radiation. What can the nurse inform her about the side effects of the radiation?
"The radiation can cause some skin breakdown in the axillary folds toward the end of treatment."
Which patient will be at the greatest risk for anemia and be the most likely candidate for epoetin alfa therapy?
A 62-year-old male with cancer
An intensive care 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 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
The nurse is obtaining the health history of a client suspected of having a hematological condition. The nurse notes the client has a history of alcohol abuse. Which clinical presentation is related to alcohol consumption?
Anemia
A client is brought to the ED reporting fatigue, large amounts of bruising on the extremities, and abdominal pain localized in the left upper quadrant. A health history reveals the client has been treated for a sore throat three times in the past 2 months. Laboratory tests indicate severe anemia, significant neutropenia, and thrombocytopenia. Based on the symptoms, what could be the client's diagnosis?
Aplastic anemia
Diagnosis of skin cancer is confirmed by which of the following diagnostic tests?
Biopsy
A nurse is caring for four clients. Which client is most likely to be affected by sickle-cell anemia?
Black American
The sister of a 25-year-old female client has breast cancer, and genetic testing showed her to have the BRCA1 gene. The client asks the nurse how she can prevent developing breast cancer herself. Which prophylactic interventions might be considered in this situation? Select all that apply.
Breast magnetic resonance imaging (MRI) Bilateral mastectomy Bilateral oophorectomy
Two years after chemotherapy and radiation therapy for lung cancer, a 72-year-old client reports being extremely tired all the time. The physician suspects the client may have developed aplastic anemia. The nurse assessing the client will likely find which clinical manifestation of aplastic anemia? Select all that apply.
Complaints of weakness and fatigue Small spots of skin hemorrhages over entire body Excess bleeding from gums and nose
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.
Decreased MCV Decreased reticulocytes
A client is receiving radiation to the abdominal area as part of cancer treatment. Which assessments findings would the nurse expect to find? Select all that apply.
Dermatitis (abdomen) Diarrhea
The nurse is assessing a patient diagnosed with anemia. What symptoms does the nurse expect to assess in the patient? (Select all that apply.)
Elevated heart rate Fatigue
A client receiving a blood transfusion reports shortness of breath, appears anxious, and has a pulse of 125 beats/minute. What is the best action for the nurse to take after stopping the transfusion and awaiting further instruction from the health care provider?
Ensure there is an oxygen delivery device at the bedside.
Therapeutic radiation can be delivered by which methods? Select all that apply.
External beam Systemic therapy Brachytherapy
Which factor places a client at greatest risk for skin cancer?
Fair skin and history of chronic sun exposure
A nurse is reviewing the chart of a patient with megaloblastic anemia. What might be used in the treatment of this patient? (Select all that apply.)
Folic acid Vitamin B12
A client was admitted to the hospital with the following laboratory values: hemoglobin 5 g/dL, leukocyte count 2000/mm3, and a platelet count of 48,000/mm3; abnormally shaped erythrocytes and hypersegmented neutrophils were seen. The platelets appear abnormally large. A bone marrow biopsy was competed and revealed hyperplasia. Based on this information, the nurse determines that client most likely has which diagnosis?
Folic acid deficiency
A nurse cares for a client with aplastic anemia. Which laboratory results will the nurse expect to find with this client? Select all that apply.
Hemoglobin 7 g/dL Neutrophil count 12,000/microliter Platelets 35,000 microliters
A 25-year-old client comes to the emergency department with 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 client, areas of ecchymosis are noted on other areas of the body. Which of the following is the most plausible cause of the client's signs and symptoms?
Hepatic dysfunction
Splenic sequestration is diagnosed in a client admitted with splenomegaly. What is the priority of care for this client?
Hypovolemia
The client's CBC with differential reveals small-shaped hemoglobin molecules. The nurse expects to administer which medication to this client?
Iron
A client is receiving epoetin alfa for anemia. Which adjunctive therapy is imperative with epoetin alfa?
Iron supplementation
For a client with Hodgkin disease who has developed neutropenia, what is an appropriate nursing intervention to include in the care plan?
Monitoring temperature every 4 hours
The nurse is caring for a client who has terminal lung cancer and is unconscious. What assessment would indicate to the nurse that the client's death is imminent?
Mottling of the lower limbs
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.
The nurse is providing care for an older adult who has a hematologic disorder. What age-related change in hematologic function should the nurse integrate into care planning?
Older adults are less able to increase blood cell production when demand suddenly increases.
When assessing a patient with anemia, the nurse notes that the patient has developed peripheral numbness and poor coordination. The patient's family states that the patient appears to be confused at times at home. Neurologic symptoms most often accompany which type of anemia?
Pernicious anemia
A patient's blood work reveals a platelet level of 17,000/mm3. When inspecting the patient's integumentary system, what finding would be most consistent with this platelet level?
Petechiae
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:
Platelet destruction and impaired platelet production resulting from an autoimmune process
A client undergoing a hip replacement has autologous blood on standby if a transfusion is needed. What is the primary advantage of autologous transfusions?
Prevention of viral infections from another person's blood
A client with a diagnosis of acute myeloid leukemia (AML) is being treated with induction therapy on the oncology unit. What nursing action should be prioritized in the client's care plan?
Protective isolation and vigilant use of standard precautions
Place the clotting cascade in the correct order.
Prothrombin activator Prothrombin Thrombin Fibrinogen Fibrin
A patient's chart indicates a diagnosis of hemolytic anemia. The nurse understands that the patient has:
Sickle-cell anemia
Place the following steps in order when determining the type and severity of a transfusion reaction. Use all options.
Stop the transfusion. Assess the client. Notify the health care provider. Notify the blood bank. Send the tubing and container to the blood bank.
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
While caring for a client, the nurse notes petechiae on the client's trunk and lower extremities. What precaution will the nurse take when caring for this client?
Use an electric razor when assisting client with shaving.
A client who is receiving external beam radiation therapy as part of her treatment for breast cancer comes to the clinic for a follow-up visit. The nurse determines that the client is experiencing side effects of the treatment based on which findings? Select all that apply.
anorexia breast swelling
The couple with the lowest risk of having a child with sickle cell anemia disease is the one in which the:
father is HbA and the mother is HbS.
An older adult client is to receive 2 units of packed red blood cells. During the transfusion of the first unit at 125 mL/hour, the client reports shortness of breath 30 minutes into the process. The client exhibits the vital signs shown in the accompanying table. What is the nurse's best intervention?
slow the rate of the transfusion and obtain an order for furosemide
A patient with sickle cell anemia is to begin treatment for the disease with hydroxyurea. What does the nurse inform the patient will be the benefits of treatment with this medication? Select all that apply.
Fewer painful episodes of sickle cell crisis Lower incidence of acute chest syndrome Decreased need for blood transfusions
A child with acute lymphoblastic leukemia (ALL) is receiving methotrexate for therapy. Which nursing diagnosis would best apply during therapy?
Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy
A male client, age 68 years, presents to the primary care office for follow-up for pernicious anemia. The nurse takes a history and finds that the client had the anemia for six months before starting treatment. Based on the history, which body system would the nurse include in the assessment?
The neurological system with a focus on the spinal cord
A client with breast cancer will have radiation therapy and then begin chemotherapy. Drug therapy will consist of a combination of doxorubicin, cyclophosphamide, and paclitaxel. What should the nurse include in the client's teaching plan concerning the drug therapy? Select all that apply.
Take special care when shaving or when brushing the teeth. Avoid large crowds and public places whenever possible.
A client is being treated in the ICU after a medical error resulted in an acute hemolytic transfusion reaction. What was the etiology of this client's adverse reaction?
The donor blood was incompatible with that of the client.
After teaching a client about taking daily oral iron preparations for a moderate iron deficiency anemia, which statement by the client indicates to the nurse that additional instruction is needed?
"I will call the doctor if my stools turn black."
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 client is diagnosed with pernicious anemia. The nurse completes an assessment and finds severe pain on palpation at T12. The nurse would inform the health care provider because the nurse knows that which complication of pernicious anemia may be present?
Vitamin B12 deficiency causing pernicious anemia, progressing for more than three months, can cause degenerative lesions of the spinal cord.
