Chapter 23: Disorders of Red Blood Cells

The dietary student is studying folic acid deficiency. The faculty member knows the student is ready to teach clients about this topic when the student makes which statement?

"The 30-year-old client who is trying to become pregnant should evaluate her folic acid intake."

The staff educator is teaching the nurse orientee about red cell changes in the neonate. The educator knows that the orientee understands the neonatal changes and care when she states:

"The hemoglobin concentration falls after birth due to reduced red cell production and plasma dilution."

The neonate displays a yellow discoloration of her skin on the third day of life. The neonatologist explains this condition to the parents. Which statement is most accurate?

"The increase in bilirubin, which causes the jaundice, is related to the increased red blood cell breakdown."

The pathophysiology student is studying erythropoiesis. Which statement demonstrates understanding of this process?

"The reticulocyte count serves as an index of erythropoietic activity of the bone marrow."

A nurse is teaching parents expecting their first child about the benefits of umbilical cord blood donation. The nurse determines teaching was effective based on which statement?

"Umbilical cord blood can provide stem cells for transplantation."

Which individuals likely are at the highest risk of megaloblastic anemia?

A 21-year-old college student who has a poor diet that does not include meat sources

The nursing is reviewing assessment data of four clients. Which client is at greatest risk for developing pernicious anemia?

A client who has undergone partial gastrectomy

A person with type A blood who exhibits the D antigen would be considered to have which blood type?

A+

A client with a gastrointestinal bleed has been prescribed a transfusion of packed red blood cells. The client possesses type B antibodies but lacks type B antigens on the red cells. Transfusion of which blood type would best prevent a transfusion reaction?

A-

The burn client is hypotensive and has hypoproteinemia. Which blood component will be utilized in this client's treatment?

Albumin

For which health problem is stem cell transplantation likely to be of therapeutic benefit?

Aplastic anemia

A nurse is preparing her client for a blood transfusion. She knows that a client with type A blood is said to have which type of antibodies?

B

Pernicious anemia is thought to be an autoimmune disease that destroys the gastric mucosa. This results in chronic atrophic gastritis and the production of antibodies that interfere with which vitamin's ability to bind to intrinsic factor?

B12

The provider is treating her client with regular blood transfusions and iron chelation therapy. The nurse knows the client has which type of anemia?

Beta-thalassemia

The nurse is assessing an 83-year-old adult client for signs and symptoms of anemia. What normal, age-related change increases this client's risk for anemia?

Blood cells are not replaced as quickly as they are in younger clients.

After birth, red blood cells are normally made in which location?

Bone marrow

A client with iron-deficiency anemia reports feeling "tired all of the time." What does the nurse understand may be the cause of the fatigue that the client is experiencing?

Chronic blood loss with inadequate iron available for recycling

An older adult client asks the nurse why so many older people develop anemia. Which response by the nurse is most accurate?

Chronic disease

Clients with lung disease can develop polycythemia as a result of which condition?

Chronic hypoxia

An older adult with an 80 pack/year history of smoking is diagnosed with emphysema. Recent blood work shows excessive production of red blood cells (erythrocytes), a problem that suggests the need for which intervention?

Continuous supplementary oxygen therapy

A nurse is evaluating the laboratory values of a client who developed a hemorrhage during surgery. Which hematology laboratory results would the nurse expect to find?

Elevated reticulocyte count

The practitioner notes the client has a yellowish discoloration of the skin. Which lab result would the practitioner expect to see?

Elevated unconjugated bilirubin

The microbiology technician explains to the student that which blood cell is the most common?

Erythrocyte

The nurse is teaching a client about the signs and symptoms of anemia. If the client has a diminished oxygen-carrying capacity of hemoglobin (Hgb), then which manifestation should be assessed?

Fatigue

The surgical nurse is administering a unit of packed red blood cells to the postoperative client. Which of the following is the most common transfusion reaction?

Febrile reaction

The practitioner is examining a client who is fatigued and has a hemoglobin of 8.7 g/dL (87 g/L). Before ordering treatment, which lab will the practitioner order?

Ferritin

The provider notes that the client's hemaglobin is 8.2 g/dL (82 g/L). Which supplement will the provider recommend to the client?

Ferrous sulfate

Which nursing interventions would be a priority when caring for a newborn who is receiving phototherapy for high bilirubin levels? Select all that apply.

Frequent monitoring of temperature Maintaining oral intake to prevent dehydration

A client is being treated for newly diagnosed inherited enzyme defect resulting in hemolytic anemia. The nurse should anticipate which diagnostic test deficiency will confirm this diagnosis?

Glucose-6-phosphate dehydrogenase.

Which substance, when deficient, results in a diagnosis of anemia?

Hemoglobin

The client is an average-sized adult and has abnormal microcytic hypochromic red blood cells due to a long-term, chronic disease. Which complete blood count (CBC) result is characteristic of this type of anemia?

Hemoglobin 7.8 g/dL (78 g/L)

A nurse is assessing a client who displays pale skin and nail beds. Which laboratory data should the nurse evaluate?

Hemoglobin level

When an Rh-negative mother gives birth to an Rh-positive infant, the mother usually produces antibodies that will attack any subsequent pregnancies in which the fetus is Rh positive. When subsequent babies are Rh positive, erythroblastosis fetalis occurs. What is another name for erythroblastosis fetalis?

Hemolytic disease of the newborn

Polycythemia vera is characterized by which clinical manifestations? Select all that apply.

Hypertension Chest pain Risk for blood clots Dusky red appearance

A nurse is monitoring a client with anemia and low oxygen levels. The nurse knows that which condition stimulates the secretion of erythropoietin?

Hypoxia

The client presents with a reduction in red blood cells, white blood cells, and platelets. The practitioner is unable to determine the cause of the client's condition. Which type of anemia does the client have?

Idiopathic aplastic

The pathologic effects of the thalassemias are primarily due to which pathophysiologic process?

Impaired hemoglobin synthesis

Hemolytic anemia is characterized by excessive red blood cell destruction and compensatory increase in which physiologic process?

Increased erythropoiesis

The client is exhibiting signs of premature destruction of red blood cells and an increase in erythropoiesis after having a transfusion. This is an example of:

Intravascular hemolysis

The rate at which hemoglobin is synthesized depends on availability of which substance?

Iron

A female client comes to the clinic with symptoms of fatigue and heavy menses over the last 6 months. Laboratory tests reveal a microcytic hemochromic anemia. Based on these results, the nurse anticipates teaching the client about which type of anemia?

Iron deficiency anemia

A 13-year-old boy comes to the ER reporting fatigue and a rapid heartbeat. In conversation with the parent, it becomes apparent that the boy has grown 2 in (5 cm) in the previous 5 months. What is the first condition the health care team would attempt to rule out?

Iron-deficiency anemia

The nurse is educating a pregnant client about the importance of dietary folic acid to prevent anemia. Which food source will the nurse encourage because it is high in folic acid?

Kale

A client is experiencing fatigue and laboratory results reveal: Hct 40% (0.40); Hgb 8 g/dL (80 g/L); WBC 8000 (8 x 109/L); and platelets 175,000/ µL (175 ×109/L). The nurse would interpret these results as indicative of which diagnosis?

Low hemoglobin/anemia

The practitioner is examining a client and notes that he has small, punctate skin hemorrhages on his abdomen and chest. This finding is suggestive of which lab result?

Low platelets

A 40-year-old client is admitted to the hospital after experiencing 3 days of extreme vomiting. The doctor reviews the lab results and notes that the hemoglobin and hematocrit are elevated. What is the likely cause of these abnormal lab findings?

Manifestation of dehydration

Megaloblastic anemias caused by folic acid or vitamin B12 deficiencies can seriously affect RBC production. Which lab result would correlate with this diagnosis?

Mean corpuscular hemoglobin (MCV) 120 fL (high)

The nurse is reviewing the client's laboratory data showing an increased mean corpuscular volume (MCV) and a normal mean corpuscular hemoglobin concentration (MCHC). The client most likely has which type of anemia?

Megaloblastic anemia

During chronic blood loss, iron deficiency anemia occurs. Most clients are asymptomatic until their hemoglobin falls below 8 g/dL (80 g/L). The red blood cells that the body does produce have too little hemoglobin. What is the term for the resulting anemia?

Microcytic hypochromic

The client with chronic kidney disease and congestive heart failure is weak and dyspneic. Lab work reveals a hemaglobin of 6.5 g/dL (65 g/L). Which type of blood product will the provider order?

Packed red blood cells (RBCs)

The client with a history of gastrectomy presents with severe anemia, mild jaundice, and spastic ataxia. The lab work demonstrates an elevated mean corpuscular volume (MCV). The practitioner suspects the client has which type of anemia?

Pernicious

A parent has brought her 2-week-old infant to the emergency department due to the infant's persistent and increasing jaundice. Laboratory testing reveals indirect bilirubin level is 28 mg/dL (479 µmol/L), but otherwise a normal physical assessment. Which intervention will most likely be prescribed for this infant?

Phototherapy

When a 3-day-old full-term infant has an elevated bilirubin level of 18 mg/dL (307.87 μmol/L), the nurse will expect to support which intervention?

Phototherapy

A client presents to his physician with a red face, hands, feet, and ears; a headache; and drowsiness. A blood smear reveals an increased number of erythrocytes. Based on the laboratory results, the nurse prepares teaching material for which disease process?

Polycythemia

A client presents to the clinic with symptoms of elevated blood pressure, dizziness, red face, pain in fingers and toes, headache, and difficulty concentrating. A blood smear reveals an increased number of erythrocytes. Based on these findings, the nurse anticipates which diagnosis?

Polycythemia vera

A client tells the nurse that the doctor told her she has too many red blood cells accompanied by elevated white cells and platelet counts. The nurse recognizes this as:

Polycythemia vera

The client explains to her new provider that she receives periodic phlebotomies to decrease her red blood cell mass. The provider believes the client may have:

Polycythemia vera

The nurse is preparing a client with suspected leukemia for a bone marrow and biopsy. What preferred site will the nurse be sure is accessible for the physician?

Posterior iliac crest

Which anatomical site would the nurse expect to monitor when caring for an adult client who has just had a bone marrow aspiration performed?

Posterior iliac crest

When an Rh-negative mother has been sensitized and is pregnant with an Rh-positive fetus, what happens to the fetus?

Profound red cell hemolysis

What of these would be tested by a complete blood count (CBC)?

Red blood cells and platelets

The nurse is caring for a client diagnosed with sickle cell disease. For which factor should the nurse assess to prevent the cells from sickling?

Reduced oxygen tension while the client sleeps

A male client with chronic obstructive pulmonary disease has a hematocrit of 55%. The practitioner tells the client that he has:

Secondary polycythemia

The practitioner carefully monitors his client who exhibits hemoglobin S (HbS) genes. The practitioner know that the client is predisposed to life-threatening infection due to damage by HbS to which organ?

Spleen

When red blood cells age, which organ is responsible for their destruction?

Spleen

A client with iron-deficiency anemia asks, "What does this low mean corpuscular volume (MCV) level mean?" Which response by the nurse is most accurate?

The MCV is one red blood cell (RBC) index that indicates your RBCs are small cells

The nurse is caring for a 2-day-old newborn infant who appears lethargic and has a yellowish tint to the skin. Select the most likely cause of this newborn's signs and symptoms.

The inability of the immature liver to conjugate bilirubin

When it is determined that a client's red blood cells (RBCs) have a biconcave shape, what will be the nurse's reaction?

The nurse will be pleased, as that shape allows for increased oxygen diffusion

Administration of Rh immune globulin has been ordered for a pregnant client who is at 28 weeks' gestation. The nurse should draw what conclusion from these data?

The risk of hemolytic disease of the newborn will be reduced.

A normally healthy client is diagnosed with polycythemia vera. The nurse should prioritize assessments aimed at the early identification of which complication associated with this diagnosis?

Thromboembolism

A nurse assessing a client with an acute exacerbation of polycythemia vera notes coolness to the right leg and foot, pale color, and an absent right pedal pulse. Based on these findings the nurse suspects that the client has developed which complication?

Thrombosis in the right leg

Thalassemia can be classed as major or minor. If therapy for thalassemia major is not started in infants who present with this disease, severe growth retardation will occur. At 6 months of age, which therapy must be started?

Transfusion

An infant from parents of Mediterranean decent has been diagnosed with a severe form of β-thalassemia anemia. The nurse caring for this infant knows that the infant will most likely receive which medical treatment?

Transfusion therapy

The nurse is caring for a client who is a strict vegetarian; the client is at greatest risk for the development of:

Vitamin B12 deficiency anemia

A 53-year-old man presents with inability to concentrate, itching in his fingers and toes, elevated blood pressure, and unexplained weight loss. He is diagnosed with primary polycythemia. The primary goal of his treatment will be to:

reduce the viscosity of his blood.

All cells of the body age and are replaced in a natural order. When RBCs age, they are destroyed in the spleen. During this process, the iron from their hemoglobin is released into the circulation and returned:

to the bone marrow for incorporation into new RBCs.

A neonate has been diagnosed with hyperbilirubinemia and has begun phototherapy. The infant's risk of encephalopathy will increase if:

unconjugated bilirubin levels are not successfully reduced.