chapter 31
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 nurse cares for an adult client with chronic lymphocytic leukemia (CLL). Which statements regarding the disease will the nurse include in the teaching? Select all that apply.
"This type of leukemia primarily impacts older adults." "This type of leukemia is rarely seen in certain ethnicities."
Most anemias result from
(1) blood loss, (2) inadequate or abnormal erythrocyte production, or (3) destruction of normally formed RBCs.
Iron-Deficiency Anemia
(1) heme cannot be recycled because of blood loss, (2) dietary intake of iron is insufficient, (3) absorption of iron from food is inadequate, and (4) the need for iron exceeds the reserves.
hemoglobin S (HbS)
, replaces HbF.
Monocytes
100-500/mm3
Platelets
150,000-450,000/mm3
Lymphocytes
1500-4500/mm3
Basophils
25-100/mm3
Neutrophils
3000-7500/mm3
Eosinophils
50-400/mm3
ANC of 99 or less
= almost certain development of infection
ANC of 499 to 100
= high risk for infection
ANC of 999 to 500
= risk for infection
Hemophilia
A hereditary disease where blood does not coagulate to stop bleeding
A female patient has a hemoglobin of 6.4 g/dL and is preparing to have a blood transfusion. Why would it be important for the nurse to obtain information about the patient's history of pregnancy prior to the transfusion?
A high number of pregnancies can increase the risk of reaction.
acute chest syndrome
A symptom associated with sickle cell anemia where sickle cells get trapped in the lung and cause infection pneumonia triggered by decreased hemoglobin and infiltrates in the lungs
A client is brought to the ED reporting fatigue, large amounts of bruising on the extremities, and abdominal pain localized in the left upper quadrant. A health history reveals the client has been treated for a sore throat three times in the past 2 months. Laboratory tests indicate severe anemia, significant neutropenia, and thrombocytopenia. Based on the symptoms, what could be the client's diagnosis?
Aplastic anemia
Osteolytic Tumors
Bone destroying tumors (bone-destroying) that produce a "punched-out" or "honeycombed" appearance in bones such as the spine, ribs, skull, pelvis, femurs, clavicles, and scapulae
The nurse cares for a client with acute myeloid leukemia with severe bone pain. What pathophysiological concept does the nurse understand is the reason for the client's pain?
Bone marrow expands.
The nurse is providing palliative care for a 69-year-old patient who has a diagnosis of multiple myeloma. The patient states that she enjoyed good health for most of her life and rarely had to visit her family health care provider until she experienced the first signs and symptoms of her current illness. Which of the following complaints most likely prompted the patient to initially seek care?
Bone pain
A nurse is caring for a client who has been diagnosed with leukemia. The nurse's most recent assessment reveals the presence of ecchymoses on the client's sacral area and petechiae on the forearms. In addition to informing the client's primary care provider, the nurse should perform what action?
Check the client's most recent platelet level.
The nurse is caring for a client with chronic myeloid leukemia (CML) who is taking imatinib mesylate. In what phase of the leukemia does the nurse understand that this medication is most useful to induce remission?
Chronic
Aplastic
Decreased cell production
A nurse cares for a client with a hematological disorder and malnutrition. What is the nurse's best understanding of how the client's nutritional status may worsen the client's hematological condition?
Decreased protein stores lead to decreased immune response
A client with multiple myeloma reports uncomfortable muscle cramping. Which nursing interventions will the nurse implement in response to the client's report of symptoms? Select all that apply.
Encourage hydration Encourage ambulation
A nurse prepares a client for a bone marrow biopsy who is suspected of having acute myeloid leukemia. What results from the bone marrow biopsy does the nurse expect?
Excess of immature leukocytes
A clinic nurse is working with a client who has a long-standing diagnosis of polycythemia vera. How can the nurse best gauge the course of the client's disease?
Follow the trends of the client's hematocrit.
Leukemia
Leukemia refers to any malignant blood disorder in which proliferation of leukocytes, usually in an immature form, is unregulated.
hypochromic
Low hemoglobin concentration
Hemoglobin
M 13.5-18 g/dL FM 12-16 g/dL
Red Blood Cells (Erythrocytes)
M 4.6-6.2 million/mm3 FM 4.2-5.4 million/mm3
Hematocrit
M 40%-54% FM 38%-47%
White Blood Cells (Leukocytes)
M 5000-13,000/mm3 FM 5000-10,000/mm3
Mean cell volume (MCV)
M 80-94 mcg/m3 FM 81-99 mcg/m3
The nurse's role in the management of polycythemia vera is primarily that of an educator. Choose the best health promotion advice that a nurse could give.
Participate in regular phlebotomy procedures to decrease blood viscosity.
A patient had gastric bypass surgery 3 years ago and now, experiencing fatigue, visits the clinic to determine the cause. The patient takes pantoprazole for the treatment of frequent heartburn. What type of anemia is this patient at risk for?
Pernicious anemia
Pernicious
Potentially injurious
Hemolytic
Premature destruction
A client with polycythemia vera reports gouty arthritis symptoms in the toes and fingers. What is the nurse's best understanding of the pathophysiological reason for this symptom?
The dead red blood cells release excess uric acid.
hemoglobin polymerization
The formation of crystal like rods that change the biconcave RBC into an irregular, brittle, sticky, sickle- shaped cell.
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
Hemoglobin A (HbA),
a normal form of hemoglobin, eventually replaces HbF.
blood dyscrasias
abnormality of blood cell structure
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?
adiquate nurtion
Thalassemias anemia
are hereditary hemolytic anemias.Alpha-thalassemias are found in people from Southeast Asia and Africa; beta-thalassemias are found in people from the Mediterranean islands and the Po Valley in Italy.
osteoclasts
cells that break down and remove bone cells, which results in increased blood calcium and pathologic fractures
graft-versus-host disease (GVHD)
complication that occurs following a stem cell or bone marrow transplant in which the transplant produces antibodies against recipient's organs that can be severe enough to cause death
Pernicious anemia
develops when a client lacks the intrinsic factor, which normally is present in stomach secretions, or fails to consume sufficient dietary sources of the extrinsic factor.
A client's electronic health record notes that he has previously undergone treatment for secondary polycythemia. The nurse should assess for:
evidence of lung disease.
polycythemia vera
general increase in red blood cells
Hyperchromic
high hemoglobin concentration
erythrocytosis
increase in the number of red blood cells
An client has pernicious anemia and has been receiving treatment for several years. What is the client lacking that results in pernicious anemia?
intrinsic factor
hemolytic anemia
is a generic term that refers to the consequence of a widely diverse group of conditions, some acquired, for example, with malaria; some hereditary (see sickle cell disease); and some idiopathic, in which there is chronic premature destruction of erythrocytes.
Multiple myeloma
is a malignancy involving plasma cells, which are B-lymphocyte cells in bone marrow.
Anemia
is a term that refers to a deficiency of either erythrocytes or hemoglobin
Leukocytosis
is an increased number of leukocytes above normal limits.
Hypovolemic Anemia
is caused by a loss of blood volume, which results in fewer blood cells.
coagulopathy
refers to conditions in which a component that is necessary to control bleeding
Pancytopenia
refers to conditions in which numbers of all marrow-produced blood cells are reduced.
purpura
small hemorrhages in the skin, mucous membranes, or subcutaneous tissues.
Agranulocytosis refers
specifically to a decreased production of granulocytes, neutrophils, basophils, and eosinophils.
Absolute Neutrophil Count (ANC)
total number of WBC's x percentage of neutrophils
multiple myeloma
tumors of the bone marrow
sickle cell crisis
two interventions to prioritize: fluids and pain relief.
A client has a diagnosis of multiple myeloma and the nurse is preparing health education in preparation for discharge from the hospital. What action should the nurse promote?
Close monitoring of urine output and kidney function
A client is being treated on the medical unit for a sickle cell crisis. The nurse's most recent assessment reveals a fever and a new onset of fine crackles on lung auscultation. What is the nurse's most appropriate action?
Inform the health care provider that the client may have an infection.
A client is hospitalized with sickle cell anemia and the nurse is preparing a teaching plan to review with the client and the client's family. Which interventions should be included? Select all that apply.
Never exceed the recommended dosages of analgesics. Dress warmly in cold temperatures.
Normochromic
Normal hemoglobin concentration
Macrocytic
large cells
Megaloblastic
large immature cell
Thrombocytopenia
low platelet count
Normocytic
normal cell size
A nurse working with clients diagnosed with sickle cell disease notices that sickle cell crisis cases increase in the winter months. What is the primary pathophysiological reason for this?
Colder temperatures slows the blood flow.
Sickle Cell Disease
is a type of anemia in which erythrocytes become sickle- or crescent-shaped when oxygen supply in the blood is inadequate genetic disorder, found primarily in African Americans and also in people from the Mediterranean and Middle Eastern countries, currently affects 1 in 625 African Americans in the United States (Maakaron, 2015).
Folic acid-deficiency anemia
is characterized by immature erythrocytes
Aplastic anemia
is more than just a deficiency of erythrocytes, although rarely that is the case.
l hemoglobin (HbF)
is present during intrauterine development through 6 months of age
aplasia
lack of development