Ch. 39 & 40 Assessment and Care of Patients with Hematologic Disorders

The nurse is teaching a client about induction therapy for acute leukemia. Which client statement indicates a need for additional education? "I will need to avoid people with a cold or flu." "I will probably lose my hair during this therapy." "The goal of this therapy is to put me in remission." "After this therapy, I will not need to have any more."

"After this therapy, I will not need to have any more." **The client statement that indicates a need for additional education about induction therapy is "after this therapy, I won't need to have any more". Induction therapy is not a cure for leukemia, it is a treatment. So, the leukemia client needs more education to understand this. Because of infection risk, clients with leukemia must avoid people with a cold or flu. Induction therapy will most likely cause the client with leukemia to lose his or her hair. The goal of induction therapy is to force leukemia into remission.Because of infection risk, clients with leukemia need to avoid people with a cold or flu. Induction therapy will most likely cause the client with leukemia to lose his or her hair. The goal of induction therapy is to force leukemia into remission.

A distant family member arrives to visit a female client recently diagnosed with leukemia. The family member asks the nurse, "What should I say to her?" Which responses does the nurse suggest? Select all that apply. "Ask her how she is feeling." "Ask her if she needs anything." "Tell her to be brave and to not cry." "Tell her what you know about leukemia." "Talk to her as you normally would when you haven't seen her for a long time."

"Ask her how she is feeling." "Ask her if she needs anything." "Talk to her as you normally would when you haven't seen her for a long time." **The nurse suggests some comments a family member of a recently diagnosed client with leukemia might say to the client. The first statement may be, "ask her how she is feeling." This is a broad general opening and would be nonthreatening to the client. Or "ask her if she needs anything" Asking if she needs anything is a therapeutic communication of offering self and would be considered to be therapeutic and helpful to the client. The family member would talk to her as she normally would when she hasn't seen her in a long time. There is no need to act differently with the client. If she wants to offer her feelings, keeping a normal atmosphere facilitates that option.Telling her to be brave and not to cry is callous and unfeeling. If the client is feeling vulnerable and depressed, telling her to "be brave" shuts off any opportunity for her to express her feelings. There is no need to inform the client about her disease, unless she asks about it. Opening the conversation with discussion about leukemia would be the client's prerogative.

A hematology unit is staffed by registered nurse's (RNs), licensed practical nurses (LPNs)/licensed vocational nurse (LVNs), and unlicensed assistive personnel (UAP). When the nurse manager is reviewing staff documentation, which entry indicates the need for staff education for his or her appropriate level of responsibility and client care? "Abdominal pain relieved by morphine 4 mg IV; client resting comfortably and denies problems. B.C., RN" "Ambulated in hallway for 40 feet (12 m) and denies shortness of breath at rest or with ambulation. T.Y., LPN" "Client reporting increased shortness of breath; oxygen increased to 4 L by nasal cannula. M.N., UAP" "Vital signs 98.6°F (37.0°C), heart rate 60, respiratory rate 20, blood pressure 110/68, and oximetry 98% on room air. L.D., UAP"

"Client reporting increased shortness of breath; oxygen increased to 4 L by nasal cannula. M.N., UAP" **The documentation entry that needs education is the one from the UAP that states that the "client reports increased shortness of breath and that oxygen was increased to 4 L by nasal cannula." Determination of the need for oxygen and administration of oxygen must be done by licensed nurses who have the education and scope of practice required to administer it.All other documentation entries reflect appropriate delegation and assignment of care.

The nurse is assessing the endurance level of a client in a long-term care facility. What question does the nurse ask to get this information? "How much exercise do you get?" "What is your endurance level?" "Are your feet or hands cold, even when you are in bed?" "Do you feel more tired after you get up and go to the bathroom?"

"Do you feel more tired after you get up and go to the bathroom?" **Asking about feeling tired after using the bathroom is the best question to ask to assess a client's endurance level. This question is pertinent to the client's activity and provides a comparison. The specific activity helps the client relate to the question and provides needed answers.The hospitalized client typically does not get much exercise. This would be a difficult assessment for a client in long-term care facility to make. Asking the client about his or her endurance level is too vague. The client may not know how to answer this question. Asking about cold feet or hands does not address the client's endurance.

The nurse is assessing a client for hematologic risks. Which health history question would the nurse ask to determine if the risk cannot be reduced or eliminated? "Where do you work?" "Tell me what you eat in a day." "Does anyone in your family bleed a lot?" "Do you seem to have excessive bleeding or bruising?"

"Does anyone in your family bleed a lot?" **To determine if hematologic risks exist while obtaining a health history from a client, the nurse asks if anyone in the client's family bleeds a lot. An accurate family history is important because many disorders that affect blood and blood clotting are inherited. Genetics cannot be changed.Work habits can be a risk, such as working near radiation, but these are behaviors that can be changed. Diet can affect risk, but it is a health behavior that can be changed.Excessive bleeding or bruising is a symptom, not a risk.

The nurse is educating a group of young women who have sickle cell disease (SCD). Which statement from a class member indicates further teaching is necessary? "The pneumonia vaccine is protection that I need." "Getting an annual 'flu shot' would be dangerous for me." "I must take my penicillin pills as prescribed, all the time." "Frequent handwashing is an important habit for me to develop."

"Getting an annual 'flu shot' would be dangerous for me." **Further teaching is needed when a young women with sickle cell disease says, "Getting an annual 'flu shot' would be dangerous for me." The client with SCD can receive annual influenza and pneumonia vaccinations. This helps prevent the development of these infections, which could cause a sickle cell crisis.The pneumonia vaccine is also appropriate for the client with sickle cell disease to receive. Prophylactic penicillin is given to clients with SCD orally twice a day to prevent the development of infection. Handwashing is a very important habit for the client with SCD to develop because it reduces the risk for infection.

The nurse is assessing an adult client's endurance in performing activities of daily living (ADLs). What question would the nurse ask the client? "Can you prepare your own meals every day?" "How is your energy level compared with last year?" "Has your weight changed by 5 pounds (2.3 kg) or more this year?" "What medications do you take daily, weekly, and monthly?"

"How is your energy level compared with last year?" **The question the nurse needs to ask the client about endurance in performing ADLs is "How is your energy level compared with last year"? Asking the client how his or her energy level compares with last year is an activity exercise question that correctly assesses endurance compared with self-assessment in the past. It is most likely to provide data about the client's ability and endurance for ADLs.The client may never have been able to prepare his or her own meals, and the ability to prepare meals does not really address endurance. The question about weight change addresses nutrition and metabolic needs, rather than ADL performance. The question about how often the client takes medication addresses nutrition and metabolic needs and focuses on health maintenance through the use of drugs, not on the client's ability to perform ADLs.

Which client statement indicates in-home stem cell transplantation is not a viable option? "We live 5 miles from the hospital." "I will have lots of medicine to take." "I was a nurse, so I can take care of myself." "I don't feel strong enough, but my wife said she would help."

"I was a nurse, so I can take care of myself." **The client statement that indicates that in-home stem cell transplantation is not a viable option is "I was a nurse, so I can take care of myself." Stem cell transplantation in the home setting requires support, assistance, and coordination from others. The client cannot manage this type of care on his own.It is acceptable for the client's spouse to support the client undergoing this procedure. It is not unexpected for the client to be taking several prescriptions. Five miles is an acceptable distance from the hospital, in case of emergency.

A client on anticoagulant therapy is being discharged. Which statement by the client indicates an understanding of the anticoagulants drug action? "It will thin my blood." "It is used to dissolve blood clots." "It should prevent my blood from clotting." "It might cause me to get injured more often."

"It should prevent my blood from clotting." **The statement that shows the client understands anticoagulant drug action is, "it will prevent my blood from clotting." Anticoagulants work by interfering with one or more steps involved in the blood clotting cascade. Thus, these agents prevent new clots from forming and limit or prevent extension of formed clots.Anticoagulants do not cause any change in the thickness or viscosity of the blood.Anticoagulants do not dissolve clots, fibrinolytics do. Anticoagulants do not cause more injuries but may cause more bleeding and bruising when the client is injured.

The nurse is teaching a client who is preparing for discharge after a bone marrow aspiration. The nurse provides which discharge instructions to the client? "Inspect the site for bleeding every 4 to 6 hours." "Place an ice pack over the site to reduce the bruising." "Avoid contact sports or activity that may traumatize the site for 24 hours." "Take a mild analgesic, such as two aspirin, for pain or discomfort at the site."

"Place an ice pack over the site to reduce the bruising." **Discharge instructions after a bone marrow include placing an ice pack over the site to reduce bruising. Ice to the site will help limit bruising and tissue damage during the first 24 hours after the procedure.The client must carefully monitor the site every 2 hours for the first 24 hours after the procedure. Contact sports and traumatic activity must be excluded for 48 hours, or 2 days. A mild analgesic is appropriate, but it needs to be aspirin-free. Acetaminophen (Tylenol) would be a good choice.

The nurse is teaching a client with newly diagnosed anemia about conserving energy. Which instructions would the nurse give to the client? Select all that apply. "Provide yourself with four to six small, easy-to-eat meals daily." "Perform your care activities in groups to conserve your energy." "Stop activity when shortness of breath or palpitations is present." "Allow others to perform your care during periods of extreme fatigue." "Drink small quantities of protein shakes and nutritional supplements daily." "Perform a complete bath daily to reduce your chance of getting an infection."

"Provide yourself with four to six small, easy-to-eat meals daily." "Stop activity when shortness of breath or palpitations is present." "Allow others to perform your care during periods of extreme fatigue." "Drink small quantities of protein shakes and nutritional supplements daily." **Having four to six small meals daily is preferred over three large meals. This practice conserves the body's expenditure of energy used in digestion and assimilation of nutrients. Stopping activities when strain on the cardiac or respiratory system is noted is critical. It is critical to have others help the anemic client who is extremely tired. Although it may be difficult for him or her to ask for help, this practice should be stressed to the client. Drinking small protein or nutritional supplements will help rebuild the client's nutritional status.A complete bath needs to be performed only every other day. On days in between, the client can be taught to take a "mini" sponge bath, which will conserve energy and still be safe in preventing the risks for infection. Care activities would be spaced every hour or so rather than in groups to conserve energy. Care activities need to be avoided just before and after meals.

A client with a low platelet count asks the nurse, "Why are platelets important?" Which statement is the nurse's best response? "Platelets will make your blood clot." "Your platelets finish the clotting process." "Blood clotting is prevented by your platelets." "The clotting process begins with your platelets."

"The clotting process begins with your platelets." **The nurse's best response to why platelets are important is that, "The clotting process begins with your platelets." Platelets begin the blood clotting process by forming platelet plugs, but these platelet plugs are not clots and cannot provide complete hemostasis.Platelets do not clot blood but are a part of the clotting process or cascade of coagulation. Platelets do not prevent the blood from clotting. Rather they function to help blood form clots. Platelets do not finish the clotting process, they begin it.

A client with leukemia is being discharged from the hospital. The nurse's discharge instructions say to keep regularly scheduled follow-up primary health care provider appointments. The client says, "I don't have transportation." Which is the most appropriate nursing response? "You can take the bus." "I might be able to take you." "A pharmaceutical company might be able to help." "The local American Cancer Society may be able to help."

"The local American Cancer Society may be able to help." **The most appropriate nursing response to the client who does not have transportation for follow-up appointments is that "the local American Cancer Society may be able to help." Many local units of the American Cancer Society offer free transportation to clients with cancer, including those with leukemia.Telling the client to take the bus is dismissive and does not take into consideration the client's situation (e.g., the client may live nowhere near a bus route). Although the nurse offering to take the client is compassionate, it is not appropriate for the nurse to offer the client transportation. Suggesting a pharmaceutical company is not the best answer. Drug companies typically do not provide this type of service.

A client with anemia asks the nurse, "Do most people have the same number of red blood cells?" Which is the nurse's best response to the client? "Yes, they do." "No, they don't." "The number varies with gender, age, and general health." "You have fewer red blood cells because you have anemia."

"The number varies with gender, age, and general health." **The nurse's best response to the client with anemia about most people having the same number of blood cells is, "The number varies with gender, age, and general health." This statement is the most educational and reasonable response to the client's question.Responding "yes, they do." and "no, they don't." are not educational statements. Although telling the client that people do not have the same number of RBCs is true, it is not informative, and there is a better answer. While it may be true that the client has fewer red blood cells because of anemia, it does not answer the client's general question.

The nurse is reinforcing information about genetic counseling to a client with sickle cell disease who has a healthy spouse. What information would the nurse explain to the parents about the risk of a child having sickle cell disease? "Sickle cell disease will be inherited by your children." "The sickle cell trait will be inherited by your children." "Your children will have the disease, but your grandchildren will not." "Your children will not have the disease, but your grandchildren could."

"The sickle cell trait will be inherited by your children." **The statement that explains to parents about the risk of a child having sickle cell disease is that the children of the client with sickle cell disease will inherit the sickle cell trait but may not inherit the disease. If both parents have the sickle cell trait, their children could get the disease.The children of the client with sickle cell disease will inherit the sickle cell trait but may not inherit the disease. If both parents have the sickle cell trait, their children could get the disease.

A client with thrombocytopenia is being discharged. Which instruction would the nurse include in a teaching plan for this client? "Avoid large crowds." "Use a soft-bristled toothbrush." "Drink at least 2 L of fluid per day." "Elevate your lower extremities when sitting."

"Use a soft-bristled toothbrush." **Using a soft-bristled toothbrush reduces the risk for bleeding in the client with thrombocytopenia.Avoiding large crowds reduces the risk for infection but is not specific to the client with thrombocytopenia. Increased fluid intake reduces the risk for dehydration but is not particularly relevant to the client with thrombocytopenia. Elevating extremities reduces the risk for dependent edema but is not specific to the client with thrombocytopenia.

A client with multiple myeloma reports bone pain that is unrelieved by analgesics. What is the most appropriate response by the nurse? "Ask your doctor to prescribe more medication." "Would you like to try some relaxation techniques?" "I'll turn on some soothing classical music for you." "It is too soon for additional medication to be given."

"Would you like to try some relaxation techniques?" **The most appropriate response by the nurse to the client with multiple myeloma is "would you like to try some relaxation techniques"? Because most clients with multiple myeloma have local or generalized bone pain, analgesics, and alternative approaches for pain management, such as relaxation techniques are used for pain relief. This also offers the client a choice.Before prescribing additional medication, other avenues would be explored to relieve this client's pain. Although music therapy can be helpful, this response does not give the client a choice. Even if it is too soon to give additional medication, telling that to the client is not helpful because it dismisses the client's pain concerns.

The nurse is teaching a client about what to expect during a bone marrow biopsy. Which statement by the nurse accurately describes the procedure? "The doctor will place a small needle in your back and will withdraw some fluid." "You will be sedated during the procedure, so you will not be aware of anything." "You may experience a crunching sound or a scraping sensation as the needle punctures your bone." "You will be alone because the procedure is sterile; we cannot allow additional people to contaminate the area."

"You may experience a crunching sound or a scraping sensation as the needle punctures your bone." **When describing a bone marrow biopsy procedure to a client, it is accurate to describe a crunching sound or scraping sensation when the needle punctures the bone. Proper expectations minimize the client's fear during the procedure.A very large-bore needle is used for a bone marrow biopsy, not a small needle, and the puncture is made in the hip or in the sternum, not the back. A local anesthetic agent is injected into the skin around the site. The client may also receive a mild tranquilizer or a rapid-acting sedative (such as lorazepam [Ativan]) but will not be completely sedated. The nurse, or sometimes a family member, is available to the client for support during a bone marrow biopsy. The procedure is sterile at the site of the biopsy, but others can be present without contamination at the site.

A client with anemia asks the nurse, "Why am I feeling tired all the time?" What is the nurse's best response? "You are not getting enough iron." "When you are sick you need to rest more." "How many hours are you sleeping at night?" "Your cells are delivering less oxygen than you need."

"Your cells are delivering less oxygen than you need." **The nurse's best response to the client complaining about feeling tired all the time is "Your cells are delivering less oxygen than you need." The single most common symptom of anemia is fatigue, which occurs because oxygen delivery to cells is less than is required to meet normal oxygen needs.While it may be true that the client isn't getting enough iron, it does not relate to the client's fatigue. The statement about the client needing rest because of being sick is simply not true. Although assessment of sleep and rest is good, it does not address the cause related to the diagnosis.

Health Promotion and Maintenance (Ch. 40)

* Make referrals to support groups *Teach people to avoid unnecessary contact with environmental chemicals or toxins. If contact cannot be avoided, teach people to use safety precautions *Identify pts at high risk for infection because of disease or therapy

Psychological Integrity (Ch. 40)

*Allow pt and family the opportunity to express their feelings regarding the diagnosis of leukemia or lymphoma or the treatment regimen *Explain all procedures, restrictions, drugs, and follow-up care to the pt and family *Reassure pts having pain using opioid analgesics for needed pain relief is not drug abuse

Physiological Integrity (Ch. 39)

*Interpret blood cell counts and clotting tests to assess hematologic status *Be aware that: >Tissue oxygenation and perfusion rely on normal hematologic function for oxygen delivery >Most common symptom of hematologic problem is fatigue >A platelet plug and a fibrin clot are not the same >Both clotting forces and anticlotting forced are needed to maintain adequate perfusion *Use the lip rather than the nailbeds to assess capillary refill on older adults *Rely on lab tests rather than skin color changes in older adults to assess anemia or jaundice *Assess the pt's endurance in performing ADLs *Teach pt and family about what to expect during procedures to assess hematologic function, including restrictions, drugs, and follow-up care *Ask pts about their activity level and whether they are satisfied with the energy they have for activities *Apply an ice pack to the needle site after a bone marrow aspiration or biopsy *Check the needle insertion site at least every 2 hrs after a bone marrow aspiration or biopsy. If the pt is going home, teach pt and family how to assess the site for bleeding and when to seek help *Instruct pts to avoid activities that may traumatize the site after a bone marrow aspiration or biopsy

Physiological Integrity (Ch. 40)

*Pace non-urgent health care activities to reduce the risk for fatigue among pts with anemia or pancytopenia *Assess pts in the induction phase of chemo, those after HSCT, and anyone with neutropenia every 8 hrs for indicators of infeciton *Assess the skin integrity of the perianal region of a pt with leukemia or profound neutropenia after every bowel movement *Administer analgesics on a schedule infusing with blood products *Transfuse blood products more slowly to older pts or those who have a cardiac problem *Remain with the pt during the first 15min of infusion of any blood product *Do not administer any drugs in the same line with infusing blood products

Health Promotion and Maintenence (Ch. 39)

*Teach adults to avoid unnecessary contact with environmental chemicals or toxins. If contact cannot be avoided, teach them to use safety precautions *Instruct pts about the importance of eating a diet with adequate amounts of foods that are good sources of iron, folic acid, and vitamin B12

Safe and Effective Care Environment (Ch. 40)

*Use aseptic technique during all central line dressing changes or any invasive procedure *Use good handwashing technique before providing any care to pt who is immunocompromised or has reduced immunity *Modify the environment to protect pts who have thrombocytopenia *Use bleeding precautions for any pt with thrombocyotpenia or pancytopenia *Ensure that informed consent is obtained before any invasive procedure or transfusion *Verify with other RN prescriptions for transfusion of blood products *Use at least 2 forms of identification for the pt who is to receive a blood product transfusion (name and DOB) *Teach pts with sickle cell disease to avoid conditions that are known to trigger crises *Teach pt and family about symptoms of infection and when to seek medical advice *Instruct pts who have anemia as a result of a dietary deficiency which foods are good sources of iron, folic acid, and vitamin B12 *Teach precautions to take to avoid injury to pts at risk for poor clotting and increased bleeding *Report any temperature over 100 degrees in a pt with neutropenia

Safe and Effective Care Environment (Ch. 39)

*Verify that a pt having a bone marrow aspiration or biopsy has signed an informed consent statement *Handle pts with suspected hematologic problems gently to avoid bleeding or bruising *Do not palpate the splenic area of any pt. suspected to have a hematologic problem *Maintain pressure over a venipuncture site for at least 5 minutes to prevent excessive bleeding

Which client does the nurse assign as a roommate for a client with aplastic anemia? A 34-year-old with idiopathic thrombocytopenia who is taking steroids A 23-year-old with sickle cell disease who has two draining leg ulcers A 30-year-old with leukemia who is receiving induction chemotherapy A 28-year-old with glucose-6-phosphate dehydrogenase (G6PD) deficiency anemia who is receiving mannitol (Osmitrol)

A 28-year-old with glucose-6-phosphate dehydrogenase (G6PD) deficiency anemia who is receiving mannitol (Osmitrol) **The nurse assigns as a roommate to the client with aplastic anemia a 28-year-old with glucose-6-pgisphate dehydrogenase (G6PD) deficiency anemia who is receiving mannitol. Because clients with aplastic anemia usually have low white blood cell counts that place them at high risk for infection, roommates such as the client with G6PD deficiency anemia would be free from infection or infection risk.The client with sickle cell disease has two draining leg ulcer infections that would threaten the diminished immune system of the client with aplastic anemia. The client with leukemia who is receiving induction chemotherapy and the client with idiopathic thrombocytopenia who is taking steroids are at risk for development of infection, which places the client with aplastic anemia at risk, too.

Which client is at greatest risk for experiencing a hemolytic transfusion reaction? A 42-year-old client with allergies A 78-year-old client with arthritis A 58-year-old immune-suppressed client A 34-year-old client with type O blood

A 34-year-old client with type O blood **The client at greatest risk for experiencing a hemolytic transfusion reaction is the 34-year-old client with type O blood. Hemolytic transfusion reactions are caused by blood type or Rh incompatibility. When blood that contains antigens different from the client's own antigens is infused, antigen-antibody complexes are formed in the client's blood. Type O is considered the universal donor, but not the universal recipient.The client with allergies would be most susceptible to an allergic transfusion reaction. The older adult client with arthritis would be most susceptible to circulatory overload. The immune-suppressed client would be most susceptible to a transfusion-associated graft-versus-host disease.

A pediatric nurse is floated to a medical-surgical unit. Which client is assigned to the float nurse? A 60-year-old with newly diagnosed polycythemia vera who needs teaching about the disease A 50-year-old with pancytopenia needing assessment of risk factors for aplastic anemia A 55-year-old with folic acid deficiency anemia caused by alcohol abuse who needs counseling A 42-year-old with sickle cell disease receiving a transfusion of packed red blood cells

A 42-year-old with sickle cell disease receiving a transfusion of packed red blood cells **The client who is assigned to the pediatric float nurse is the 42-year-old sickle cell disease client receiving a transfusion of packed blood cells. Because sickle cell disease is commonly diagnosed during childhood, the pediatric nurse will be familiar with the disease and with red blood cell transfusion. Therefore, he or she would be assigned to the client with sickle cell disease.Polycythemia vera, aplastic anemia, and folic acid deficiency are problems more commonly seen in adult clients who would be cared for by nurses who are more experienced in caring for adults.

After reviewing the laboratory test results, the nurse calls the primary care provider about which client? A 52-year-old who had a hemorrhage with a reticulocyte count of 0.8% A 49-year-old with hemophilia and a platelet count of 150,000/mm3 (150 × 109/L) A 46-year-old with a fever and a white blood cell (WBC) count of 1500/mm3 (1.5 × 109/L) A 44-year-old prescribed warfarin (Coumadin) with an international normalized ratio (INR) of 3.0

A 46-year-old with a fever and a white blood cell (WBC) count of 1500/mm3 (1.5 × 109/L) **The nurse calls the PCP about a 46-year-old client with a fever and a WBC of 1500/mm3 (1.5 × 109/L). This client is neutropenic and is at risk for sepsis unless interventions such as medications to improve the WBC level and antibiotics are prescribed.An elevated reticulocyte count in the 52-year-old is expected after hemorrhage. A platelet count of 150,000/mm3 (150 × 109/L) in the 49-year-old is normal. The INR of 3.0 in the 44-year-old indicates a therapeutic warfarin level.

The nurse is starting the shift by making rounds. Which client would the nurse assess first? A 52-year-old who just had a bone marrow aspiration and is requesting pain medication A 59-year-old who has a nosebleed and is receiving heparin to treat a pulmonary embolism A 47-year-old who had a Rumpel-Leede test and asks the nurse to "look at the bruises on my arm" A 42-year-old with a diagnosis of anemia who reports shortness of breath when ambulating down the hallway

A 59-year-old who has a nosebleed and is receiving heparin to treat a pulmonary embolism **After rounds, the nurse would first assess the 59-year-old client who has a nosebleed and is getting heparin to treat a pulmonary embolism. The client with the nosebleed may be experiencing the bleeding as a result of excessive anticoagulation and must be assessed first for the severity of the situation.The client waiting for pain medication would be next on the nurse's "to do" list. Making clients wait for pain medication is not desirable, but in this scenario, the client who is bleeding is the higher priority. The client who had a Rumpel-Leede test and the client with anemia are more stable and can be assessed later. The Rumpel-Leede test is a tourniquet test used to determine the presence of vitamin C deficiency or thrombocytopenia.

The nurse is caring for a group of hospitalized clients. Which client is at highest risk for infection and sepsis? A client with hemolytic anemia A client with cirrhosis of the liver A client who had an emergency splenectomy A client with recently diagnosed sickle cell anemia

A client who had an emergency splenectomy **The client who is at the highest risk for infection and sepsis is the client who had an emergency splenectomy. Removal of the spleen causes reduced immune function. Without a spleen, the client is less able to remove disease-causing organisms and is at increased risk for infection.A low red blood cell count with hemolytic anemia can contribute to a client's risk for infection, but this client is more at risk for low oxygen levels and ensuing fatigue. The liver plays a role in blood coagulation, so this client is more at risk for coagulation problems than for infection. Sickle cell anemia causes pain and discomfort because of the changed cell morphology, so acute pain, especially at joints, is the greatest threat to this client.

Which client does the medical unit charge nurse assign to a licensed practical nurse (LPN)/licensed vocational nurse (LVN)? A client with chronic microcytic anemia associated with alcohol use A client scheduled for a bone marrow biopsy with conscious sedation A client with a history of a splenectomy and a temperature of 100.9°F (38.3°C) A client with atrial fibrillation and an international normalized ratio of 6.6

A client with chronic microcytic anemia associated with alcohol use **The medical unit charge nurse assigns the LPN/LVN a client with chronic microcytic anemia related to alcohol use. Chronic microcytic anemia is not considered life-threatening and is within the skill level of an LPN/LVN.The client with a bone marrow biopsy with conscious sedation, a history of splenectomy and a temperature, and atrial fibrillation require more complex assessment or nursing care and would be assigned to RN staff members.

Leukemia Clasifications

AML: most common in adults ALL: most common in pediatrics CML and CLL: typically over age 50

The nurse is transfusing a unit of whole blood to a client when the primary health care provider prescribes "Furosemide (Lasix) 20 mg IV push." Which intervention would the nurse perform? Piggyback the furosemide into the infusing blood. Give furosemide to the client intramuscularly (IM). Administer the furosemide after completion of the transfusion. Add furosemide to the normal saline that is infusing with the blood.

Administer the furosemide after completion of the transfusion. **Completing the transfusion before administering furosemide is the best course of action in this scenario.Drugs are not to be administered with infusing blood products, because they can interact with the blood, causing risks for the client. Changing the admission route is not a nursing decision. Stopping the infusing blood to administer the drug and then restarting it is also not the best decision.

The nurse assess the client with which hematologic condition first? A 32-year-old with pernicious anemia who needs a vitamin B12 injection A 67-year-old with acute myelocytic leukemia with petechiae on both legs An 81-year-old with thrombocytopenia and an increase in abdominal girth A 40-year-old with iron deficiency anemia who needs a Z-track iron injection

An 81-year-old with thrombocytopenia and an increase in abdominal girth **The nurse needs to first assess the 81-year-old client with thrombocytopenia and an increase in abdominal girth. An increase in abdominal girth in a client with thrombocytopenia indicates possible hemorrhage, and warrants further assessment immediately.The 32-year-old with pernicious anemia, the 67-year-old with acute myelocytic leukemia, and the 40-year-old with iron deficiency anemia do not indicate any acute complications, so the nurse can assess them after assessing the client with thrombocytopenia.

A client has a bone marrow biopsy performed. What is the priority postprocedure nursing action? Inspect the site for ecchymosis Apply pressure to the biopsy site Send the biopsy specimens to the laboratory Teach the client to avoid vigorous activity

Apply pressure to the biopsy site **The priority postprocedure action after a bone marrow biopsy would be to stop bleeding by applying pressure to the site.Inspecting for ecchymosis, sending specimens to the laboratory and teaching the client about activity levels will be done after hemostasis has been achieved.

The nurse performs an assessment on a newly admitted client with thrombocytopenia. Which assessment finding requires immediate intervention by the nurse? Reports of pain Increased temperature Bleeding from the nose Decreased urine output

Bleeding from the nose **The assessment finding on a newly admitted client with thrombocytopenia that needs immediate intervention by the nurse is bleeding from the nose. The client with thrombocytopenia has a high risk for bleeding. The nosebleed would be attended to immediately.The client's report of pain, decreased urine output, and increased temperature are not the highest priority.

A client admitted with a diagnosis of acute myelogenous leukemia is prescribed intravenous (IV) cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. What is the major side effect of this drug therapy? Nausea Stomatitis Liver toxicity Bone marrow suppression

Bone marrow suppression **The major side effect of this drug therapy is bone marrow suppression. Intravenous cytosine arabinoside and daunorubicin are a commonly prescribed course of aggressive chemotherapy, and bone marrow suppression is a major side effect. The client is even more at risk for infection than before treatment began.Liver toxicity, nausea, and stomatitis are not the major problems with this therapy.

A 56-year-oldclient admitted with a diagnosis of acute myelogenous leukemia (AML) has been prescribed intravenous (IV) cytosine arabinoside and an IV infusion of daunorubicin. The client develops an infection. Which action would the nurse take to determine that the appropriate antibiotic has been prescribed to treat this condition? Monitor the client's white blood cell (WBC) count level Evaluate the client's liver function tests (LFTs) and serum creatinine levels Recognize that vancomycin (Vancocin) is the drug of choice used to treat all infections in clients with AML Check the culture and sensitivity test results to be certain that the requested antibiotic is effective against the organism causing the infection

Check the culture and sensitivity test results to be certain that the requested antibiotic is effective against the organism causing the infection **The best action the nurse takes to determine if the appropriate antibiotic has been prescribed is to check the culture and sensitivity test results to be sure that the prescribed antibiotic is effective against the organism causing the infection. Drug therapy is the main defense against infections that develop in clients undergoing therapy for AML. Agents used depend on the client's sensitivity to various antibiotics for the organism causing the infection.Although the WBC count is elevated in infection, this test does not influence which antibiotic will be effective in fighting the infection. Although LFTs and kidney function tests may be influenced by antibiotics, these tests do not determine the effectiveness of the antibiotic. Vancomycin may not be effective in all infections. Culturing of the infection site and determining the organism's sensitivity to a cohort of drugs are needed. This will provide data on drugs that are capable of eradicating the infection in this client.

Which task does the nurse delegate to unlicensed assistive personnel (UAP) who is assisting with the care of a female client with anemia? Monitor the oral mucosa for pallor, bleeding, or ulceration Ask about the amount of blood loss with each menstrual period Check for sternal tenderness while applying fingertip pressure Count the respiratory rate before and after ambulating 20 feet (6 m)

Count the respiratory rate before and after ambulating 20 feet (6 m) **Counting the respiratory rate before and after ambulation is within the scope of practice for a UAP. The UAP will report this information to the RN.Monitoring oral mucosa requires skilled assessment techniques and knowledge of normal parameters, asking the client about the amount of blood loss with each menstrual period, and checking for sternal tenderness would be done by the RN.

The nurse is teaching a client with vitamin B12 deficiency anemia about dietary intake. Which type of food does the nurse encourage the client to eat? Grains Dairy products Leafy vegetables Starchy vegetables

Dairy products **The nurse encourages the client to eat dairy products such as milk, cheese, and eggs. These foods will provide the vitamin B12 that the client needs.Grains, leafy vegetables, and starchy vegetables are not a source of vitamin B12.

aplastic anemia

Deficiency of circulating red blood cells from failure of bone marrow to produce Pancytopenia: deficiency of all blood cells (RBC's, WBC's, platelets) Management: blood transfusion, immunosuppressive therapy; splenectomy, stem cell transplant (most successful)

What are the risk factors for the development of leukemia? Select all that apply. Down syndrome Chemical exposure Ionizing radiation Prematurity at birth Bone marrow hypoplasia Multiple blood transfusions

Down Syndorme Chemical exposure Ionizing radiation Bone marrow hypoplasia **Risk factors related to the development of leukemia include: Down syndrome, chemical exposure, ionizing radiation, and bone marrow hypoplasia. Certain genetic factors contribute to the development of leukemia. Down syndrome is one such condition. Exposure to chemicals through medical need or by environmental events can also contribute. Radiation therapy for cancer or other exposure to radiation, perhaps through the environment, also contributes. Reduced production of blood cells in the bone marrow is one of the risk factors for developing leukemia.Although some genetic factors may influence the incidence of leukemia, prematurity at birth is not one of them. There is no indication that multiple blood transfusions are connected to clients who have leukemia.

Which nursing intervention most effectively protects a client with thrombocytopenia? Take rectal temperatures Avoid the use of dentures Apply warm compresses on trauma sites Encourage the use of an electric shaver

Encourage the use of an electric shaver **The most effective nursing intervention that protects a client with thrombocytopenia is encouraging the client to use an electric shaver. This client must be advised to use an electric shaver instead of a razor. Any small cuts or nicks can cause problems because of the prolonged clotting time.To prevent rectal trauma, rectal thermometers would not be used. Oral or tympanic temperatures would be taken. Dentures may be used by clients with thrombocytopenia as long as they fit properly and do not rub. Ice (not heat) would be applied to areas of trauma.

iron deficiency anemia

From poor GI absorption, blood loss, inadequate diet Eat greens leafy vegetables, red meat, egg yolks, kidney beans, organs/liver

The nurse is assessing the nutritional status of a client with anemia. How does the nurse obtain information about the client's diet? Uses a prepared list and finds out the client's food preferences Asks the client to rate his or her diet on a scale of 1 (poor) to 10 (excellent) Has the client write down everything he or she has eaten for the past week Determines who prepares the client's meals and plans an interview with him or her

Has the client write down everything he or she has eaten for the past week **The best way for the nurse to assess an anemic client's diet is to have the client write down everything he/she has eaten in the last week. Having the client provide a list of items eaten in the past week is the most accurate way to find out what the client likes and dislikes, as well as what the client has been eating. It will provide information about "junk" food intake, as well as protein, vitamin, and mineral intake.Determining food preferences from a prepared list provides information about what the client enjoys eating, not necessarily what the client has been eating. For instance, the client may like steak but may be unable to afford it. Rating scales are good for subjective data collection about some conditions such as pain, but the subjectivity of a response such as this does not provide the nurse with specific data needed to assess a diet. Interviewing the food preparer is time-consuming and poses several problems, such as whether a number of people are preparing meals, or if the client goes "out" for meals.

A newly admitted client has an elevated reticulocyte count. Which condition does the nurse suspect in this client? Leukemia Aplastic anemia Hemolytic anemia Infectious process

Hemolytic anemia **The nurse suspects that the client has hemolytic anemia. An elevated reticulocyte count in an anemic client indicates that the bone marrow is responding appropriately to a decrease in the total red blood cell (RBC) mass and is prematurely destroying RBCs. Therefore, more immature RBCs are in circulation.A low white blood cell count is expected in clients with leukemia. Aplastic anemia is associated with a low reticulocyte count. A high white blood cell count is expected in clients with infection.

Hemophilia

Heredity bleeding disorders from clotting deficiencies>>Abnormal bleeding from any trauma Assessment: excessive bleeding, joint and muscle hemorrhage, bruise easily, prolonged hemorrhage after surgery Antihemophilic drugs

A 32-year-oldclient is recovering from a sickle cell crisis. The client's discomfort is controlled with pain medications and discharge planning has been initiated. What medication will the nurse anticipate to be prescribed before discharge? Heparin (Heparin) Warfarin (Coumadin) Hydroxyurea (Droxia) Tissue plasminogen activator (t-PA)

Hydroxyurea (Droxia) **The nurse anticipates Hydroxyurea to be prescribed for pain for a sickle cell disease client who is being discharge. Hydroxyurea (Droxia) has been used successfully to reduce sickling of cells and pain episodes associated with sickle cell disease (SCD).Clients with SCD are not prescribed anticoagulants such as heparin or warfarin (Coumadin). t-PA is used as a "clot buster" in clients who have had ischemic strokes.

The nurse is transfusing 2 units of packed red blood cells to a postoperative client. What electrolyte imbalance would the nurse monitor for after the blood transfusion? Hyponatremia Hyperkalemia Hypercalcemia Hypomagnesemia

Hyperkalemia **The electrolyte imbalance the nurse needs to monitor after transfusing 2 units of blood to a postoperative client is hyperkalemia. During transfusion, some cells are damaged. These cells release potassium, thus raising the client's serum potassium level (hyperkalemia). This complication is especially common with packed cells and whole-blood products.High serum calcium levels, low magnesium levels, or low sodium levels are not expected with blood transfusions.

An 82-year-oldclient with anemia is prescribed 2 units of whole blood. Which assessment findings cause the nurse to discontinue the transfusion because it is unsafe for the client? Select all that apply. Hypotension Hypertension Decreased pallor Rapid, bounding pulse Flattened superficial veins Capillary refill less than 3 seconds

Hypotension Hypertension Rapid, bounding pulse **The assessment findings that are unsafe for the nurse to continue the blood transfusion for the client are: hypotension, hypertension, and rapid, bounding pulse. In an older adult receiving a transfusion, low blood pressure is a sign of a transfusion reaction, hypertension is a sign of overload, and a rapid and bounding pulse is a sign of fluid overload. In this scenario, 2 units, or about a liter of fluid, could be problematic.Increased (not decreased) pallor and cyanosis are signs of a transfusion reaction, while swollen (not flattened) superficial veins are present in fluid overload in older adult clients receiving transfusions. Capillary refill time that is less than 3 seconds is considered to be normal and would not pose a problem.

Acute Leukemia 3 phases

Induction: intense chemo know more out WBC's Consolidation: kill any floating leukemia cells Maintenance: months-years after/try to keep in remission

A client who has been newly diagnosed with leukemia is admitted to the hospital. Avoiding which potential problem takes priority in the client's nursing care plan? Hypoxia Infection Hemorrhage Fluid overload (overhydration)

Infection **Avoiding infection is the priority potential problem when caring for a newly diagnosed client with leukemia.Fluid overload, hemorrhage, and hypoxia are not priority problems for the client with leukemia.

The nurse is infusing platelets to a client who is scheduled for a hematopoietic stem cell transplant. What procedure does the nurse follow for administering this blood product? Infuse the transfusion over a 15- to 30-minute period. Set up the infusion with the standard transfusion Y tubing. Give intravenous corticosteroids before starting the transfusion. Allow the platelets to stabilize at the client's bedside for 30 minutes.

Infuse the transfusion over a 15- to 30-minute period. **The procedure the nurse follows to administer platelets to a hematopoietic stem cell transplant is to infuse the transfusion over a 15-to-30-minute period. The volume of platelets—200 or 300 mL (standard amount)—needs to be infused rapidly over a 15- to 30-minute period.A special transfusion set with a smaller filter and shorter tubing is used to get the platelets into the client quickly and efficiently. Administering steroids is not standard practice in administering platelets. Platelets must be administered immediately after they are received because they are considered to be quite fragile

A recently admitted client who is in sickle cell crisis requests "something for pain." What medication would the nurse be prepared to administer? Oral ibuprofen (Motrin) Oral morphine sulfate (MS-Contin) Intramuscular (IM) morphine sulfate Intravenous (IV) hydromorphone (Dilaudid)

Intravenous (IV) hydromorphone (Dilaudid) **The client with sickle cell disease needs IV pain relief, and it needs to be administered on a routine schedule (i.e., before the client has to request it).Nonsteroidal anti-inflammatory drugs may be used for clients with SCD for pain relief once their pain is under control. However, in a crisis, this choice of analgesic is not strong enough. Moderate pain may be treated with oral opioids, but this client is in a sickle cell crisis. IV analgesics would be used until his or her condition stabilizes. Morphine is not administered intramuscularly (IM) to clients with sickle cell disease (SCD). In fact, all IM injections are avoided because absorption is impaired by poor perfusion and sclerosed skin.

Blood products

Never add to or infuse other drugs with blood products bc they may clot the blood during transfusion The nurse who will actually infuse the blood products must be one of the two professionals comparing the pt's identification with the info on the blood component bag

The nurse is caring for a client with neutropenia who has a suspected infection. Which intervention would the nurse implement first? Obtain prescribed blood cultures. Place the client on Bleeding Precautions. Initiate the administration of prescribed antibiotics. Give 1000 mL of IV normal saline to hydrate the client.

Obtain prescribed blood cultures. **The intervention the nurse would first implement is to draw prescribed blood cultures. Obtaining blood cultures to identify the infectious agent correctly is the priority for this client.Placing the client on Bleeding Precautions is unnecessary. Administering antibiotics is important, but antibiotics must always be started after cultures are obtained. Hydrating the client is not the priority.

Which task is appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP) working on a medical-surgical unit? Obtain vital signs on a client receiving a blood transfusion Assist a client with folic acid deficiency in making diet choices Administer erythropoietin to a client with myelodysplastic syndrome Assess skin integrity on an anemic client who fell during ambulation

Obtain vital signs on a client receiving a blood transfusion **The appropriate task for the nurse to delegate to a UAP is obtaining vital signs on a client receiving a blood transfusion. This activity is within the scope of practice for UAPs.Assisting with prescribed diet choices, administering medication, and assessing clients are complex actions that must be done by licensed nurses.

What are serious side effects of antiviral agents prescribed for a client with acute myelogenous leukemia? Select all that apply. Stroke Diarrhea Ototoxicity Cardiomyopathy Nephrotoxicity

Ototoxicity Nephrotoxicity **Antiviral agents, although helpful in combating severe infection, have serious side effects, especially nephrotoxicity and ototoxicity.Cardiomyopathy and stroke are not serious side effects of antiviral agents. Diarrhea is a mild side effect associated with antibiotic therapy.

multiple myeloma

Overgrowth is B-lymphocytes in bone marrow Decrease RBC's, WBC's, and platelets Black American men most at risk

The nurse is performing an assessment on a client with anemia. What are the typical clinical manifestations of anemia? Select all that apply. Pallor Fatigue Tachycardia Dyspnea on exertion Elevated temperature Decreased breath sounds

Pallor Fatigue Tachycardia Dyspnea on exertion **The typical clinical manifestations of anemia are: pallor, fatigue, tachycardia, and dyspnea on exertion. Lowered O2 levels deliver less oxygen to all cells, making clients with anemia pale—especially their ears, nail beds, palms, and conjunctivae and around the mouth. Fatigue is a classic symptom of anemia because lowered O2 levels contribute to a faster pulse (i.e., cardiac rate) and tend to "wear out" a client's energy. Difficulty breathing—especially with activity—is common with anemia. Lower levels of hemoglobin carry less O2 to the cells of the body.Respiratory problems with anemia do not include changes in breath sounds. Skin is cool to the touch, and an intolerance to cold is noted. Elevated temperature would signify something additional, such as infection.

A client recovering from a sickle cell crisis is to be discharged. The nurse says to the client, "You and all clients with sickle cell disease are at risk for infection because of your decreased spleen function. For this reason, you will most likely be prescribed an antibiotic before discharge." Which drug does the nurse anticipate the primary health care provider (PHCP) will prescribe? Cefaclor (Ceclor) Vancomycin (Vancocin) Gentamicin (Garamycin) Penicillin V (Pen-V K)

Penicillin V (Pen-V K) **The nurse expects the PHCP to prescribe Penicillin V for a client recovering from sickle cell crisis who is at risk for infection. Prophylactic therapy with twice-daily oral penicillin reduces the incidence of pneumonia and other streptococcal infections and is the correct drug to use. It is a standard protocol for long-term prophylactic use in clients with sickle cell disease.Cefaclor (Ceclor) and vancomycin (Vancocin) are antibiotics more specific for short-term use and would be inappropriate for this client. Gentamicin (Garamycin) is a drug that can cause liver and kidney damage with long-term use.

The nurse is caring for a client with sickle cell disease. Which nursing action is most effective in reducing the potential for sepsis in this client? Check vital signs every 4 hours Administer prophylactic drug therapy Monitor for abnormal laboratory values Perform frequent and thorough handwashing

Perform frequent and thorough handwashing **The most effective nursing action to reduce the risk for sepsis in a client with sickle cell anemia is to perform frequent and thorough handwashing. Prevention and early detection strategies are used to protect the client in sickle cell crisis from infection. Frequent and thorough handwashing is of the utmost importance.Taking vital signs every 4 hours will help with early detection of infection but is not prevention. Drug therapy is a major defense against infections that develop in the client with sickle cell disease but is not the most effective way that the nurse can reduce the potential for sepsis. Continually assessing the client for infection and monitoring the daily complete blood count with differential white blood cell count is early detection, not prevention.

Vitamin B12 (cobalamin) deficiency anemia

Pernicious anemia: failure to absorb B12 (from intrinsic deficiency) Pallor, jaundice, glossitis/beefy red tongue, paresthesias (tingling/numbness) Management: vitamin B12 injections rest of life Eat: dairy, dark green leafy veggies, animal proteins, fish, eggs, citrus fruits

The nurse is reviewing complete blood count (CBC) data for a 76-year-old client. Which decreased laboratory value would be of greatest concern to the nurse because it is not age-related? Hemoglobin level Red blood cell (RBC) count Platelet (thrombocyte) count White blood cell (WBC) response

Platelet (thrombocyte) count **The decreased laboratory value of the greatest concern to the nurse is the 76-year-old client's platelet count. Platelet counts do not generally change with age.Hemoglobin levels in men and women fall after middle age. Iron-deficient diets may play a role in this reduction. Total RBC and WBC counts (especially lymphocyte counts) are lower in older adults. The WBC count does not rise as high in response to infection in older adults as it does in younger people.

Autoimmune Thrombocytopenic Purpura

Platelet destruction is greater than platelet production Symptoms: large ecchymoses (bruising) or petechial rash on arms, legs, upper chest, and back and mucosal bleeding Give steroids to suppress immune system (corticosteroids) Maintain safe environment: no sharp objects, remove clutter to decrease fall injury, electric razors, etc.

The nurse is caring for a client who is in sickle cell crisis. What action would the nurse perform first? Provide pain medications as needed. Apply cool compresses to the client's forehead. Increase food sources of iron in the client's diet. Encourage the client's use of two methods of birth control.

Provide pain medications as needed. **The action the nurse would perform first for a client in sickle cell crisis is to provide pain medications as needed. Analgesics are needed to treat sickle cell pain.Cool compresses do not help the client in sickle cell crisis. Birth control is not the priority for this client. Increasing iron in the diet is not pertinent for the client in sickle cell crisis.

Which task does the nurse delegate to unlicensed assistive personnel (UAP)? Refer a client with a daily alcohol consumption of 12 beers for counseling Obtain a partial thromboplastin time from a saline lock on a client with a pulmonary embolism Report any bleeding noted when catheter care is given to a client with a history of hemophilia Perform a capillary fragility test to check vascular hemostatic function on a client with liver failure

Report any bleeding noted when catheter care is given to a client with a history of hemophilia **The task the nurse delegates to the UAP is to report any bleeding when catheter care is given to a client with a history of hemophilia. Reporting findings during routine care is expected and required of unlicensed staff members.Referring a client for alcohol counseling, drawing a partial thromboplastin time, and performing a capillary fragility test are more complex and would be done by licensed nursing staff.

The nurse is assessing several clients who are receiving transfusions of blood components. Which assessment finding requires immediate action by the nurse? Respiratory rate of 36 breaths/min in a client receiving red blood cells Temperature of 99.1°F (37.3°C) for a client with a platelet transfusion Sleepiness in a client who received diphenhydramine (Benadryl) as a premedication A partial thromboplastin time (PTT) that is 1.2 times normal in a client who received a transfusion of fresh-frozen plasma (FFP)

Respiratory rate of 36 breaths/min in a client receiving red blood cells **The assessment finding that requires immediate action by the nurse is a respiratory rate of 36 breaths/min in a client receiving red blood cells. An increased respiratory rate indicates a possible hemolytic transfusion reaction. The nurse must quickly stop the transfusion and assess the client further.Temperature elevations are not an indication of an allergic reaction to a platelet transfusion, although the nurse may administer acetaminophen (Tylenol) to decrease the fever. Sleepiness is expected when Benadryl is administered. Because FFP is not usually given until the PTT is 1.5 times above normal, a PTT that is 1.2 times normal indicates that the FFP has had the desired response.

The nurse is to administer packed red blood cells to a client. How does the nurse ensure proper client identification? Ask the client's name Check the client's armband Verify the client's room number Review all information with another registered nurse (RN)

Review all information with another registered nurse (RN) **With another registered nurse, all information must be reviewed. This process includes verifying the client by name and number, checking blood compatibility, and noting the expiration time. Human error is the most common cause of ABO incompatibility reactions, even for experienced nurses.Asking the client's name and checking the client's armband are not adequate for identifying the client before transfusion therapy. Using the room number to verify client identification is never appropriate.

Folic acid deficiency

Similar to B12 deficiency, but nervous system function remains normal Causes: poor nutrition ( elderly and alcoholics), malabsorption (crohn's), anticonvulsants and oral contraceptives Eat: leafy greens, citrus fruits, beans, orange juice

What is the most important environmental risk for developing leukemia? Family history Smoking cigarettes Living near high-voltage power lines Direct contact with others with leukemia

Smoking cigarettes **The most important environmental risk for developing leukemia is smoking cigarettes. According to the American Cancer Society (ACS), the only proven lifestyle-related risk factor for leukemia is cigarette smoking.Genetics is a strong indicator, but it is not an environmental risk factor. According to the ACS, living near high-voltage power lines is not a proven risk factor for leukemia. Leukemia is not contagious.

A client who is receiving a blood transfusion suddenly tells the nurse, "I don't feel right!" What is the nurse's first action? Stop the transfusion. Call the Rapid Response Team. Slow the infusion rate of the transfusion. Obtain vital signs and continue to monitor.

Stop the transfusion. **The nurse's first action when a client receiving a blood transfusion says, "I don't feel right," is to stop the transfusion. The client may be experiencing a transfusion reaction, so the nurse must stop the transfusion immediately.Calling the Rapid Response Team or obtaining vital signs is not the first thing that must be done. The nurse would not slow the infusion rate but would stop it altogether.

Heparin induces Thrombocytopenia (HIT)

Unexplained drop in platelets after heparin treatment Hallmark signs: thrombocytopenia after heparin Anticoagulation therapy Risks: Heparin more than 1 week, female, post-surgery heparin

A client is scheduled for a bone marrow aspiration. What is the priority nursing action before this procedure is performed? Hold the client's hand and ask about concerns. Review the client's platelet (thrombocyte) count. Verify that the client has given informed consent. Clean the biopsy site with an antiseptic or povidone-iodine (Betadine).

Verify that the client has given informed consent. **The priority nursing action before a scheduled bone marrow aspiration is done is for the nurse to verify that the client has been given informed consent. A signed permit must be on the client's chart.Cleaning the biopsy site is done before the procedure, but this is not done until consent is verified. Cleaning the site will be done just before the procedure is performed. Holding the client's hand and offering verbal support may be done during the procedure, but the procedure cannot be completed until the consent is signed. Reviewing the client's platelet count is not imperative.

The nurse is mentoring a recent graduate registered nurse (RN) about administering blood and blood products. What action does the nurse perform before starting the transfusion? Verify with another RN all of the data on blood products. Use a 22-gauge needle to obtain venous access when starting the infusion. Remain with the client who is receiving the blood for the first 5 minutes of the infusion. Obtain the client's initial set of vital signs (VS) within the first 10 minutes of the infusion.

Verify with another RN all of the data on blood products. **Before administering blood and blood products, the nurse must verify with another RN all of the data on blood products. All data are checked by two RNs. Human error is the most common cause of ABO incompatibilities when administering blood and blood products.A 20-gauge needle (or a central line catheter) is used. The 22-gauge needle is too small. Initial VS must be recorded before the start of infusion of blood, not after it has begun. The nurse remains with the client for the first 15 to 30 minutes (not 5) of the infusion. This is the period when any transfusion reactions are likely to happen.

The nurse is caring for a client with neutropenia. Which clinical manifestation indicates that the client has an infection or an infection needs to be ruled out? Evidence of pus Wheezes or crackles Fever of 102°F (38.9°C) or higher Coughing and deep breathing

Wheezes or crackles **The clinical manifestation that indicates the client with neutropenia has an infection or an infection that needs to be ruled out is wheezes or crackles. Wheezes or crackles in the neutropenic client may be the first symptom of infection in the lungs.Coughing and deep breathing are not indications of infection but can help prevent it. The client with leukopenia, not neutropenia, may have a severe infection without pus or with only a low-grade fever.