Ch. 21-Learning: Disorders of Oxygen Transport

A patient receives immunosuppression and radiation as treatment for cancer. Which type of anemia should the nurse understand that this patient is at risk for developing? A. Anemia of chronic disease B. Sickle cell anemia C. Thalassemia D. Iron deficiency anemia

A. Anemia of chronic disease - Anemia of chronic disease is associated with infectious or inflammatory processes in individuals with chronic diseases. Patients with cancer receiving immunosuppression and radiation treatments are at increased risk for developing anemia related to their disease and the treatment side effects. - Sickle cell anemia is a genetic disorder in which red blood cells form a "sickle" shape and become less effective at transporting oxygen. - Iron deficiency anemia occurs as a result of an insufficient supply of iron. - Thalassemia is a recessive gene that results in insufficient production of hemoglobin.

The nurse learns that a patient has a history of polycythemia. For which effect on the patient's circulation should the nurse plan interventions? A. Blood clots due to increased blood viscosity B. Ineffective oxygen-carrying capacity due to decreased red blood cells C. Alteration in the shape of the red blood cells causing the cells to cluster in joints and veins D. Insufficient iron reducing the production of red blood cells

A. Blood clots due to increased blood viscosity - Polycythemia occurs as the result of overproduction of red blood cells, which results in increased blood volume and viscosity, placing the patient at an increased risk of developing blood clots, which can lead to pulmonary embolism and stroke. - Polycythemia is not a decrease in red blood cells but an increase to dangerous levels. - Sickle cell anemia is the type that results in a change in the shape of red blood cells. - Iron deficiency anemia is related to insufficient iron resulting in decreased production or maturation of red blood cells.

The nurse is performing an assessment on a 4-year-old child with a known history of thalassemia. Which clinical manifestations should the nurse expect to find upon assessment? A. Pain in joints and back B. Growth retardation and cognitive deficits C. Flushed skin and increased blood pressure D. Swelling in extremities

B. Growth retardation and cognitive deficits - Thalassemia is most frequently diagnosed in infancy, and is associated with other birth defects, along with growth retardation and cognitive deficits. - Swelling in extremities is not likely seen in thalassemia, nor is pain in joints and back. These findings are associated with sickle cell anemia. - Flushed skin and increased blood pressure is not associated with anemia.

A pregnant patient asks why the physician prescribed a folic acid supplement. Which statement should the nurse use to explain the reason for the supplement? A. "Insufficient folic acid can contribute to the development of anemia of chronic disease." B. "Folic acid stimulates the production of erythrocytes in the bone marrow." C. "Folic acid requirements increase during pregnancy, putting pregnant women at risk for folic acid deficiency." D. "Folic acid is needed to prevent the early hemolysis of red blood cells."

C. "Folic acid requirements increase during pregnancy, putting pregnant women at risk for folic acid deficiency." Pregnancy and breastfeeding increase the folic acid requirements. Pregnant women who follow their usual pre-pregnancy diet may be at increased risk for developing folic acid anemia. Folic acid is needed for healthy erythrocytes, but the effect of folic acid is not to stimulate the production of red blood cells or to prevent early hemolysis. Folic acid is not a contributing factor to the development of anemia of chronic disease.

Which type of anemia is an infant whose Rh factor is incompatible with the mother at risk for developing? A. Polycythemia B. Thalassemia C. Hemolytic D. Aplastic

C. Hemolytic - Hemolytic anemia occurs when the immune system responds to an antigen and launches an attack. In the case of Rh incompatibility, the mother's immune system will attack red blood cells that cross through the umbilical cord or placenta, and release antibodies that attack the fetus. - Thalassemia is a type of hemolytic anemia that is inherited, and predominantly found in those of Asian or Mediterranean ancestry. - Aplastic anemia is a condition in which red blood cells fail to form in the bone marrow. - Polycythemia is an overproduction of red blood cells.

Which type of anemia is characterized by a reduced survival time of red blood cells? A. Aplastic anemia B. Iron deficiency anemia C. Hemolytic anemia D. Cobalamine deficiency

C. Hemolytic anemia - Hemolytic anemia is characterized by the early destruction of red blood cells due to various causes. - Iron deficiency anemia is related to an insufficient supply of iron to allow red blood cells to develop. - Cobalamine deficiency is a type of anemia caused by a lack of Vitamin B12. - Aplastic anemia is the result of the body not producing enough erythrocytes.

A patient is diagnosed with sickle cell anemia. Which is the greatest risk factor for the development of this type of anemia? A. An inherited trait that suppresses the production of hemoglobin B. Insufficient cell production in the bone marrow C. Lack of Vitamin B in the diet D. Inheriting a mutated form of hemoglobin from each parent

D. Inheriting a mutated form of hemoglobin from each parent - Sickle cell anemia is a condition in which hemoglobin is mutated into hemoglobin S, which has a characteristic sickle shape and is not effective in transporting oxygen. The trait is inherited, and a person who inherits the trait from both parents will have sickle cell disease. It is possible to carry the trait and not have the disease. - Nutritional intake does not have an effect on sickle cell anemia, because it is an inherited condition. - Sickle cell anemia does not involve insufficient production of hemoglobin or of erythrocytes, but the form of hemoglobin is not effective at providing adequate oxygenation.

The nurse is preparing a vitamin B12 injection for a patient with anemia. Which type of anemia should the nurse suspect in the patient? A. Folic acid deficiency B. Sickle cell C. Hemolytic D. Pernicious

D. Pernicious Pernicious anemia refers to anemia associated with vitamin B12 deficiency. Treatment includes vitamin B12 injections, often over a long term. Vitamin B12 is not used in the treatment of sickle cell anemia, folic acid deficit, or hemolytic anemia.

A patient is diagnosed with aplastic anemia. The patient asks the nurse how this was acquired. Which is most appropriate response? A. "It may be genetic, or as a result of exposure to a virus or toxin." B. "This is due to a lack of iron in your diet." C. "Nobody knows how aplastic anemia is acquired." D. "You may have a slow, continuous bleed in your GI tract, resulting in anemia."

A. "It may be genetic, or as a result of exposure to a virus or toxin." - Aplastic anemia is most commonly genetically acquired, but may occur as a result of exposure to a virus or environmental toxin. - Aplastic anemia occurs as a result of a failure of the body to produce enough red blood cells, not a lack of iron intake. - Aplastic anemia has known causes, although it may be unclear how a particular individual acquired it. - A slow bleed in the gastrointestinal (GI) tract will not result in aplastic anemia, because this is a lack of formation of red blood cells, not a loss of cells.

The nurse notes that a patient with anemia has pale skin, increased heart rate, and tachypnea. Which reason should the nurse consider as causing these assessment findings? A. Compensatory mechanisms B. Tissue ischemia C. Deterioration in condition D. Resolution of anemia

A. Compensatory mechanisms The pale skin is due to blood being shunted away from peripheral circulation, increased heart rate is to maintain adequate cardiac output, and tachypnea is a compensation to increase circulating oxygen. These findings do not necessarily indicate a deterioration in condition or a resolution of anemia. Tissue ischemia is manifested by decreased circulation and cool, pale extremities.

The nurse is planning care for a patient with sickle cell disease. Which intervention(s) should the nurse include as part of supportive care for this patient? A. Increasing folic acid intake B. Avoiding risk factors, and maintaining adequate hydration and oxygenation C. Increasing iron intake D. Restricting fluids

B. Avoiding risk factors, and maintaining adequate hydration and oxygenation Supportive care for individuals with sickle cell disease (SCD) includes avoidance of risk factors and maintenance of adequate hydration and oxygen to decrease the risk of hemoglobin polymerization. Blood transfusion may be needed in some situations. Transfusion is not only beneficial in the raising of hemoglobin levels, it also provides a significant increase in the relative percentage of normal hemoglobin. Increasing dietary intake of iron or folic acid will have no effect on sickle cell disease, because this is not related to a nutrition deficiency. Fluid restriction would make the patient's symptoms worse.

A patient with a history of sickle cell anemia is having an exacerbation of symptoms. Which findings should the nurse expect when assessing this patient? A. Nausea and vomiting B. Chest pain, back pain, extremity pain C. Edema in lower extremities D. Diarrhea and dizziness

B. Chest pain, back pain, extremity pain - Sickle cell crisis occurs when hemoglobin forms abnormally, resulting in "sickle" shaped cells. These cells cluster in the peripheral circulatory system, occluding blood flow and resulting in ischemia. Manifestations of sickle cell crisis include chest pain, back pain, and pain in extremities, but other symptoms may occur as a result of ischemia of distal tissues. - Diarrhea, dizziness, nausea, and vomiting are not associated with sickle cell crisis. - Edema in lower extremities is more frequently seen in ineffective perfusion, such as heart failure.

A patient has a long-term ulcer that has caused significant blood loss over a prolonged period of time. For which type of anemia should the nurse plan care for this patient? A. Anemia of chronic disease B. Chronic C. Folic acid deficiency D. Acute

B. Chronic - A condition such as long-term ulcers, in which there is a sustained blood loss, can result in chronic anemia. There is a loss of both iron necessary for generation of red blood cells and red blood cells themselves. - Acute anemia is a rapid loss of blood, usually from trauma or surgical procedures. This is sudden in onset and can be corrected with blood product administration. - Folic acid deficiency anemia is the result of a nutritional insufficiency of folic acid. - Anemia of chronic disease is the destruction of or incomplete formation of red blood cells as a result of infection or inflammation.

A patient receiving cancer treatment with radiation and immunosuppressant therapy reports fatigue and shortness of breath. Which type of anemia should the nurse suspect in this patient? A. Iron deficiency B. Chronic disease C. Folic acid deficiency D. Hemolytic

B. Chronic disease - Anemia of chronic disease has mild symptoms that usually present as increased fatigue and shortness of breath. Patients who are being treated for cancer with immunosuppression and radiation are at increased risk of developing this type of anemia. - Iron deficiency anemia and folic acid deficiency are types of nutritional anemia and are usually associated with manifestations such as pallor, increased pulse, headache, and dizziness. - Hemolytic anemia is caused by the destruction of red blood cells and manifestations are dependent on the cause of the hemolysis.

A patient with renal failure has a low hemoglobin level. Which should the nurse consider as a reason for this patient to have anemia? A. Increased pH B. Decreased erythropoietin production C. Increased bloodstream toxicity D. Decreased iron absorption

B. Decreased erythropoietin production - Erythropoietin is a hormone that stimulates the production of red blood cells in the bone marrow. Erythropoietin is secreted by the kidneys, and red blood cells are produced in bone marrow. - Buildup of toxins in the bloodstream does not affect production of red blood cells, although it may contribute to other disease processes. - Blood pH level is not a factor in the production of red blood cells. - Decreased iron absorption is not related to renal function and red blood cell production.

A woman is diagnosed with aplastic anemia. A complete blood count (CBC) is ordered. Which would be the most likely CBC results the nurse would expect? A. Decreased red blood cells, increased white blood cells, increased platelets B. Decreased red blood cells, decreased white blood cells, decreased platelets C. Microcytic red blood cells, decreased platelets D. Decreased red blood cells, macrocytic and elevated counts of white blood cells

B. Decreased red blood cells, decreased white blood cells, decreased platelets Aplastic anemia occurs when the body stops producing enough new blood cells and results in a decrease in red blood cells, white blood cells, and platelets. The size and coloring of cells are normal, just a decrease in the number of cells circulating.

The nurse instructs a patient with iron deficiency anemia on dietary choices. Which menu choices should indicate to the nurse that the patient understands good nutritional sources of iron? A. Pasta with olive oil and garlic B. Green, leafy vegetables, lean beef, lentils C. Chicken breast, potatoes, rice D. Fruit salad, cheese and crackers

B. Green, leafy vegetables, lean beef, lentils - Red meat, legumes, and green leafy vegetables are good sources of iron. - Chicken and starches such as potatoes or rice do not contain large amounts of iron. - Citrus and dairy have many health benefits, but are not good sources of iron. - Pasta is similar in iron content to rice and other starches.

The nurse provides care for four patients, each of whom is prescribed a hemoglobin and hematocrit level. Which laboratory result should the nurse identify as being within normal limits? A. Hemoglobin 11 gm/dL, hematocrit 58% B. Hemoglobin 14 gm/dL , hematocrit 44% C. Hemoglobin 21 gm/dL, hematocrit 64% D. Hemoglobin 8 gm/dL, hematocrit 22%

B. Hemoglobin 14 gm/dL , hematocrit 44% - Normal values for hemoglobin are between 12 and 17.4 g/dL. - Normal values for hematocrit are between 36 and 62%. - A hemoglobin below 12 g/dL indicates possible anemia, and a decreased hematocrit shows a reduction in concentration of red blood cells. - An increase in both hemoglobin and hematocrit can indicate dehydration or other pathological condition. A low hemoglobin with an elevated hematocrit can indicate polycythemia.

A patient is diagnosed with a nutritional anemia related to malabsorption. For which type of anemia should the nurse plan care for this patient? A. Iron deficiency B. Vitamin B12 deficiency C. Thalassemia D. Folic acid deficiency

B. Vitamin B12 deficiency Vitamin B12 deficiency anemia is the type of nutritional anemia that may result from malabsorption conditions. Iron deficiency anemia, folic acid deficiency anemia, and thalassemia are not related to malabsorption.

A patient with newly diagnosed bacterial pneumonia has a hemoglobin of 7.5 g/dL and hematocrit of 22%. Which type of anemia should the nurse anticipate that this patient is at risk for developing? A. Thalassemia B. Sickle cell anemia C. Anemia of chronic disease D. Polycythemia

C. Anemia of chronic disease - Bacterial infections trigger the inflammatory process to reduce the amount of iron available to pathogens. This reduction also has an effect on the production of erythrocytes. Those with bacterial infections are at increased risk of anemia of chronic disease due to insufficient iron supply to produce red blood cells. - Sickle cell anemia is a genetic anomaly of the shape of red blood cells that causes the cells to change shape and cluster in venous spaces. - Thalassemia is a genetic condition that causes disruption in the production of red blood cells. - Polycythemia is an overproduction of red blood cells.

A patient is diagnosed with microcytic anemia. Which characteristic of the erythrocytes should the nurse recognize with this health problem? A. Cell color is pale and washed out. B. Erythrocytes are larger than normal. C. Erythrocytes are smaller than normal. D. Erythrocytes have decreased in number and density.

C. Erythrocytes are smaller than normal. - In microcytic anemia, the red blood cells are smaller than normal, usually due to lack of maturation time or decreased iron. - Macrocytic anemia results in cells being larger than normal due to lack of certain nutrients necessary for replication of deoxyribonucleic acid (DNA). - Hypochromic anemia is the condition in which red blood cells are pale in color due to low hemoglobin. - A decrease in volume and density results in an overall lowering of hemoglobin and hematocrit.

The nurse notes that a patient experiencing dizziness and headaches ingests a diet that lacks iron and folic acid. Which type of anemia should the nurse suspect this patient is experiencing? A. Hemolytic B. Blood loss C. Nutritional D. Chronic disease

C. Nutritional - Nutritional anemia develops when the supply of iron or folic acid is insufficient for optimal red blood cell formation. This results in nutritional anemia. - Anemia of chronic disease and hemolytic anemia include lysis of red blood cells, which leads to anemia. - Blood loss causes a direct loss of red blood cells and does not lead to nutritional anemia.

An Asian American patient is being tested for anemia. For which type of anemia should the nurse prepare teaching materials? A. Anemia of chronic disease B. Sickle cell C. Thalassemia D. Iron deficiency

C. Thalassemia - Being of Asian descent is a risk factor for thalassemia, but not for the other types of anemia. - Sickle cell anemia most frequently occurs in African Americans. - Iron deficiency anemia can occur in any population, regardless of demographics, due to inadequate nutritional intake of iron. - Anemia of chronic disease occurs secondary to bacterial or inflammatory condition, or certain cancers.

A patient is newly diagnosed with polycythemia vera. Which clinical manifestation(s) should the nurse expect when assessing this patient? A. Difficulty maintaining balance B. Shortness of breath C. Vision disturbance and high blood pressure D. Pale complexion and clammy skin

C. Vision disturbance and high blood pressure - The clinical manifestations of polycythemia vera reflect the increased blood viscosity and blood volume that result from the increased number of red blood cells. The patient will often complain of a headache, dizziness, and blurred vision associated with the increased blood volume. The increased preload can also manifest in hypertension. The increased thickness of the blood places the patient at an increased risk for the development of thrombi, or blood clots. - The patient will not be pale because of an increase in blood volume. - Shortness of breath is a clinical manifestation of aplastic anemia. - Difficulty maintaining balance is a clinical manifestation of vitamin B12 deficiency.

A couple expecting their first child each have first-degree relatives with sickle cell anemia and are concerned about the baby inheriting the health problem. How should the nurse respond to this couple? A. "It is impossible to predict whether or not you have the trait." B. "If neither of you have sickle cell anemia, then your child will not have it." C. "The trait can be inherited by one parent." D. "The trait must be inherited from both parents."

D. "The trait must be inherited from both parents." Sickle cell anemia is inherited from the passing on of the trait by both parents to the child. A couple who has a family history of sickle cell anemia may want to consider genetic testing if they are seeking to understand the likelihood of passing along the chromosome. The trait can be inherited from only one parent, but in order for the disease to develop, it must be inherited from both parents. It is possible to be a carrier for the trait, without having the disease. It is possible to predict the likelihood of having the trait, based on family history.

A patient's laboratory test result shows a decrease in mean corpuscular hemoglobin (MCH). For which type of anemia should the nurse plan care for this patient? A. Hyperchromic B. Microcytic C. Hemolytic D. Hypochromic

D. Hypochromic - A decreased mean corpuscular hemoglobin (MCH) indicates hypochromic red blood cells. The red blood cells are deficient in hemoglobin and may be macrocytic (enlarged). - Hemolytic anemia will show as an increased hematocrit. - Microcytic anemia will be associated with a decreased iron level. - Hyperchromic red blood cells are indicated by an increase in mean corpuscular hemoglobin.

A patient with sickle cell anemia is prescribed oxygen therapy. For which benefit of oxygen therapy should the nurse assess this patient? A. Absence of the shortness of breath that accompanies sickle cell disease B. Increased activity tolerance and cardiac output C. Increased respiratory rate due to sickle cell disease D. Increased circulating oxygen to minimize tissue hypoxia and ischemia

D. Increased circulating oxygen to minimize tissue hypoxia and ischemia The nature of sickle cell disease is that the misshapen cells occlude blood flow, resulting in hypoxia of tissues and ischemia. Administration of oxygen increases circulating oxygen in the bloodstream and minimizes accompanying hypoxia. Shortness of breath may accompany sickle cell disease, but the goal of oxygen treatment is to increase circulating oxygen. Activity tolerance may be increased with the administration of oxygen, but the primary goal is to prevent tissue ischemia. Increased respiratory rate may occur as a result of increased demand for oxygen by tissues. Oxygen administration is provided to decrease hypoxia in the bloodstream.

A nurse is assessing a patient with anemia. Which clinical manifestations should the nurse expect to find? A. Decreased heart rate, irritability, dry skin B. Tachypnea, tremors, nausea C. Increased blood pressure, decreased respiratory rate, flushed skin D. Increased heart rate, increased respiratory rate, pale skin

D. Increased heart rate, increased respiratory rate, pale skin A patient with anemia will frequently experience increased heart rate and increased respiratory rate. These are compensatory mechanisms to maintain adequate oxygenation by increasing cardiac output. Skin will appear pale as blood is shunted away from surface capillaries in order to optimize cardiac output. Additional findings include headache, dizziness, weakness, fatigue, and decreased blood pressure.

An older adult woman has a hemoglobin of 8.8 g/dL and hematocrit of 25%. Which screening should the nurse anticipate to be prescribed? A. Cancer B. Family history C. Bone density testing D. Nutritional

D. Nutritional - Postmenopausal women are more likely to develop nutritional-deficit-related anemia if their intake of glucose, protein, vitamin B12, vitamin C, and other essential nutrients is decreased. - Family history is not contributory when assessing for causes of anemia that have developed at age 60. - A bone density test may be appropriate but is not diagnostic for causes of anemia. - Cancer screening may be done, but not to determine contributing factors for anemia.

A patient is being treated for sickle cell crisis. Which symptoms should the nurse expect to assess? A. Diarrhea and dizziness B. Bradycardia and hypotension C. Nausea and vomiting D. Pain in the back, chest, and extremities

D. Pain in the back, chest, and extremities - The shape of blood cells in sickle cell anemia results in vascular obstruction. This obstruction can lead to ischemia of tissues, which can result in significant pain and can occur anywhere, but is most likely to occur in the chest, back, and extremities. The pain is accompanied by other signs of ischemic damage, such as swelling, tenderness, a rapid respiratory rate and hypertension. - Diarrhea and dizziness are not likely to occur with sickle cell anemia. - Nausea and vomiting are not associated with sickle cell anemia. - Bradycardia and hypotension are most often seen with hypovolemia and impending shock, not sickle cell anemia.