Chapter 29 PrepU: Management of Patients with Nonmalignant Hematologic Disorders
A client's family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC?
"DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs."
A client with megaloblastic anemia reports mouth and tongue soreness. What instruction will the nurse give the client regarding eating while managing the client's symptoms?
"Eat small amounts of bland, soft foods frequently."
After teaching a client about taking daily oral iron preparations for a moderate iron deficiency anemia, which statement by the client indicates to the nurse that additional instruction is needed?
"I will call the doctor if my stools turn black."
A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from? Select all that apply.
-Blood loss -Abnormal erythrocyte production -Destruction of normally formed red blood cells
Place the pathophysiological processes in order for how sickle cell disease leads to fatigue.
-Decreased hemoglobin in RBC -Inflamed vascular endothelium -Increased inflammatory cytokines -Decreased muscle strength
A nurse is reviewing the various manifestations of anemia across the lifespan and notes a significant difference in how the older adult client responds to anemia versus a younger individual. Which concepts related to aging and the response to anemia does the nurse recognize? Select all that apply.
-Fatigue is often greater than in younger clients. -Heart rate does not increase as much as in younger clients. -Confusion is often greater than in younger clients.
A health care provider prescribes one tablet of ferrous sulfate daily for a 15-year-old girl who experiences heavy blood flow during her menstrual cycle. The nurse advises the patient and her parent that this over-the-counter preparation must be taken for how many months before stored iron replenishment can occur?
6 to 12 months
A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the health care provider immediately because the client probably is experiencing which problem?
A hemolytic allergic reaction caused by an antigen reaction
A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving:
A-positive blood to an A-negative client.
A client is hospitalized 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin at home, which is now discontinued. To prevent the formation of blood clots, which action should the nurse take?
Administer the prescribed enoxaparin (Lovenox).
A young female client has pale nailbeds. Her hemoglobin count is 10.2 gm/dL and her hematocrit count is 30%. She reports fatigue and states, "I'm tired all the time." The client also reports excessive menstrual flow. The nurse assesses further and determines the client's diet is balanced and provides adequate calories. The client is prescribed supplemental iron therapy. The highest nursing diagnosis is -Altered tissue perfusion related to diminished oxygen-carrying capacity of the blood -Altered nutrition: less than body requirements, related to inadequate intake of nutrients -Fatigue related to diminished oxygen-carrying capacity of the blood -Deficient knowledge related to new information with no previous experience
Altered tissue perfusion related to diminished oxygen-carrying capacity of the blood
A nurse cares for a client with anemia requiring nutritional supplementation. Which nursing intervention best promotes client adherence with the prescribed therapy?
Assist the client to incorporate the therapeutic regimen into daily activities.
The nurse is planning care for a client with severe fatigue secondary to anemia. What concept will the nurse use as the basis for planning interventions?
Assisting in prioritizing activities.
The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency?
B12
A nurse is caring for an older client who has been admitted to the unit with iron-deficiency anemia. What would the nurse suspect?
Blood loss from the gastrointestinal or genitourinary tract
Which is a symptom of hemochromatosis?
Bronzing of the skin
A client with multiple myeloma reports pain along the spinal column. The client is prescribed naproxen (Aleve) and oxycodone. Prior to administering these medications, the nurse
Checks the client's BUN and creatinine
A client is being treated for DIC and the nurse has prioritized the nursing diagnosis of Risk for Deficient Fluid Volume Related to Bleeding. How can the nurse best determine if goals of care relating to this diagnosis are being met?
Closely monitor intake and output.
A male client has been receiving a continuous infusion of weight-based heparin for more than 4 days. The client's PTT is at a level that requires an increase of heparin by 100 units per hour. The client has the laboratory findings shown above. What is the most important action for the nurse to take?
Consult with the physician about discontinuing heparin.
A patient with end-stage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia?
Creatinine level of 6 mg/100 mL
A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor?
Decreased level of erythropoietin
The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions?
Dilute the liquid preparation with another liquid such as juice and drink with a straw.
The nurse and the client are discussing some strategies for ingesting iron to combat the client's iron-deficiency anemia. Which is among the nurse's strategies?
Drink liquid iron preparations with a straw.
A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia?
Dyspnea, tachycardia, and pallor
The nurse is educating a patient with iron deficiency anemia about food sources high in iron and how to enhance the absorption of iron when eating these foods. What can the nurse inform the client would enhance the absorption?
Eating calf's liver with a glass of orange juice
A patient with chronic anemia has had many blood transfusions over the last 3 years. What type of transfusion reaction should the nurse monitor for that is commonly found in patients who frequently receive blood transfusions?
Febrile nonhemolytic reactions
When assessing a client with anemia, which assessment is essential?
Health history, including menstrual history in women
When assessing a client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential?
Health history, such as bleeding, fatigue, or fainting
A patient with End Stage Kidney Disease is taking recombinant erythropoietin for the treatment of anemia. What laboratory study does the nurse understand will have to be assessed at least monthly related to this medication?
Hemoglobin level
A nurse provides nutritional information for a patient diagnosed with an iron-deficiency anemia. What education should the nurse provide?
Increase the intake of green, leafy vegetables.
A client with severe anemia reports symptoms of tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Laboratory test results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which nursing diagnoses is most appropriate for this client?
Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit
A client is receiving chemotherapy for cancer. The nurse reviews the client's laboratory report and notes that he has thrombocytopenia. To which nursing diagnosis should the nurse give the highest priority?
Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI
The nurse observes a co-worker who always seems to be eating a cup of ice. The nurse encourages the co-worker to have an examination and diagnostic workup with the health care provider. What type of anemia is the nurse concerned the co-worker may have?
Iron deficiency anemia
The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include a nutritional assessment for this patient?
It may indicate deficiencies in essential nutrients.
During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding?
Low ferritin level concentration
During a routine assessment of a patient diagnosed with anemia, the nurse observes the patient's beefy red tongue. The nurse is aware that this is a sign of what kind of anemia?
Megaloblastic
A client with a diagnosis of pernicious anemia comes to the clinic reporting of numbness and tingling in his arms and legs. What do these symptoms indicate?
Neurologic involvement
The nurse provides care for an older adult client, diagnosed with anemia, who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine the cause of the client's blood loss, which is the priority nursing action?
Observe the client's stools for blood.
A client with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse?
Obtain the pain medication and delay the bath and position change until the medication reaches its peak.
A nurse is caring for a client with iron deficiency anemia. Which food or beverage will the nurse suggest to the client to eat or drink when taking supplemental iron?
Orange juice
A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. The client is taking prednisone daily and reported feeling pain after manually opening the garage door. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain?
Osteoporosis
While assessing a client, the nurse will recognize what as the most obvious sign of anemia?
Pallor
A nurse is caring for a client with severe anemia. The client is tachycardic and reports dizziness and exertional dyspnea. What signs and symptoms might develop if this client goes into heart failure?
Peripheral edema
A pregnant woman is hospitalized as the result of sickle-cell crisis. Which finding indicates the outcome has been achieved for this client?
Reports joint pain less than 3 on a scale of 0 to 10
The nurse is preparing the patient for a test to determine the cause of vitamin B12 deficiency. The patient will receive a small oral dose of radioactive vitamin B12 followed by a large parenteral dose of nonradioactive vitamin B12. What test is the patient being prepared for?
Schilling test
An older adult client who is a vegetarian has a hemoglobin of 10.2 gm/dL, vitamin B12 of 68 pg/mL (normal: 200-900 pg/mL), and MCV of 110 cubic micrometers. After interpreting the data, what instruction should the nurse give to the client?
Supplement the diet with vitamin B12.
A client with chronic anemia has received multiple transfusions. Which client action would the nurse be concerned about relative to the client's condition?
Takes over-the-counter iron supplements
A client with a pulmonary embolism is being treated with a heparin infusion. What diagnostic finding suggests to the nurse that treatment is effective?
The client's activated partial thromboplastin time (aPTT) is 1.5 to 2.5 times the control value.
A client's low prothrombin time (PT) was attributed to low vitamin K levels and the client's PT normalized after administration of vitamin K. When performing discharge education in an effort to prevent recurrence, what should the nurse emphasize?
The need for adequate nutrition
A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn's disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for?
The onset of a bacterial infection
A client is treated for anemia. What is the nurse's best understanding about the correlation between anemia and the client's iron stores?
There is a strong correlation between iron stores and hemoglobin levels.
A nurse is caring for a client with thalassemia who is being transfused. What is the nurse's role during a transfusion?
To closely monitor the rate of administration
When evaluating a patient's symptoms that are consistent with a diagnosis of leukemia, the nurse is aware that all leukemias have which common feature?
Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements
A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client?
Use the smallest needle possible for injections.
For a client diagnosed with pernicious anemia, the nurse emphasizes the importance of lifelong administration of
Vitamin B12
A young client is diagnosed with a mild form of hemophilia and is experiencing bleeding in the joints with pain. In preparing the client for discharge, what instructions should the nurse provide?
Wear a medical identification bracelet.
A nurse cares for clients with hematological disorders and notes that women are diagnosed with hemochromatosis at a much lower rate than men. What is the primary reason for this?
Women lose iron through menstrual cycles
The nurse is educating a client about iron supplements. The nurse teaches that what vitamin enhances the absorption of iron?
c
A client has a history of sickle cell anemia with several sickle cell crises over the past 10 years. What blood component results in sickle cell anemia?
hemoglobin S
A client with sickle cell anemia has a
low hematocrit.
