Chapter 31: Caring for Clients with Disorders of the Hematopoietic System

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." "Eat larger amounts of bland, soft foods less frequently." "Eat cold, bland foods with a large amount of water." "Eat low-fiber blended foods only."

"Eat small amounts of bland, soft foods frequently."

A client with a recent diagnosis of ITP has asked the nurse why the care team has not chosen to administer platelets, stating, "I have low platelets, so why not give me a transfusion of exactly what I'm missing?" How should the nurse best respond? "Transfused platelets usually aren't beneficial because they're rapidly destroyed in the body." "A platelet transfusion often blunts your body's own production of platelets even further." "Finding a matching donor for a platelet transfusion is exceedingly difficult." "A very small percentage of the platelets in a transfusion are actually functional."

"Transfused platelets usually aren't beneficial because they're rapidly destroyed in the body."

A client with acute kidney injury has decreased erythropoietin production. Upon analysis of the client's complete blood count, the nurse will expect which of the following results? An increased hemoglobin and decreased hematocrit A decreased hemoglobin and hematocrit A decreased mean corpuscular volume (MCV) and red cell distribution width (RDW) An increased mean corpuscular volume (MCV) and red cell distribution width (RDW)

A decreased hemoglobin and hematocrit

A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify? Potential hepatic dysfunction indicated by decreased blood urea nitrogen (BUN) and creatinine levels Low levels of urine constituents normally excreted in the urine Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels Electrolyte imbalance that could affect the blood's ability to coagulate properly

Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels

A patient with sickle cell disease is brought to the emergency department by a parent. The patient has a fever of 101.6°F, heart rate of 116, and a respiratory rate of 32. The nurse auscultates bilateral wheezes in both lung fields. What does the nurse suspect this patient is experiencing? Pneumocystis pneumonia Acute chest syndrome An exacerbation of asthma Pulmonary edema

Acute chest syndrome

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia? Implement neutropenic precautions Eliminate direct contact with others who are infectious Apply prolonged pressure to needle sites or other sources of external bleeding Monitor temperature at least once per shift

Apply prolonged pressure to needle sites or other sources of external bleeding

A client with several chronic health problems has been newly diagnosed with a qualitative platelet defect. What component of the client's previous medication regimen may have contributed to the development of this disorder? Calcium carbonate Vitamin B12 Aspirin Vitamin D

Aspirin

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. Develop a therapeutic regimen recommendation for the client. Assist the client to use a medication reminder system for the therapeutic regimen. Develop a therapeutic regimen based on the client's understanding of the medication.

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. Determining what days to be active. Keeping long activity periods to build client stamina. Encouraging early and frequent activities.

Assisting in prioritizing activities.

A patient describes numbness in the arms and hands with a tingling sensation. The patient also frequently stumbles when walking. What vitamin deficiency does the nurse determine may cause some of these symptoms? Thiamine Folate B12 Iron

B12

Which is a symptom of hemochromatosis? Bronzing of the skin Inflammation of the mouth Inflammation of the tongue Weight gain

Bronzing of the skin

The nurse is educating a client about iron supplements. The nurse teaches that what vitamin enhances the absorption of iron? C A D E

C

A client reports feeling tired, cold, and short of breath at times. Assessment reveals tachycardia and reduced energy. What would the nurse expect the physician to order? CBC antibiotic chest radiograph ECG

CBC

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? Assess for edema. Assess skin integrity frequently. Assess the client's level of consciousness frequently. Closely monitor intake and output.

Closely monitor intake and output.

The nurse cares for a client with iron deficiency anemia. What findings will the nurse expect to find when reviewing the client's CBC results? Select all that apply. Decreased MCV Increased MCV Decreased reticulocytes Increased reticulocytes Fragmented RBCs

Decreased MCV Decreased reticulocytes

A client with poorly controlled diabetes has developed end-stage kidney injury and consequent anemia. When reviewing this client's treatment plan, the nurse should anticipate the use of what drug? Magnesium sulfate Epoetin alfa Low-molecular-weight heparin Vitamin K

Epoetin alfa

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 is part of the required assessment information. It is important for the nurse to determine what type of foods the patient will eat. It may indicate deficiencies in essential nutrients. It will determine what type of anemia the patient has.

It may indicate deficiencies in essential nutrients.

A 63-year-old woman has been diagnosed with polycythemia vera (PV) after undergoing a series of diagnostic tests. When the woman's nurse is providing health education, what subject should the nurse prioritize? Maintenance of long-term vascular access device Nutritional modifications necessary for maintaining a low-iron diet Strategies for managing activity Lifestyle modifications and techniques for preventing thromboembolism

Lifestyle modifications and techniques for preventing thromboembolism

A client's absolute neutrophil count (ANC) is 440/mm3 but the nurse's assessment reveals no apparent signs or symptoms of infection. What action should the nurse prioritize when providing care for this client? Meticulous hand hygiene Timely administration of antibiotics Provision of a nutrient-dense diet Maintaining a sterile care environment

Meticulous hand hygiene

A nurse is planning the care of a client who has a diagnosis of hemophilia A. When addressing the nursing diagnosis of Acute Pain Related to Joint Hemorrhage, what principle should guide the nurse's choice of interventions? Gabapentin (Neurontin) is effective because of the neuropathic nature of the client's pain. Opioids partially inhibit the client's synthesis of clotting factors. Opioids may cause vasodilation and exacerbate bleeding. NSAIDs are contraindicated due to the risk for bleeding.

NSAIDs are contraindicated due to the risk for bleeding.

While assessing a client, the nurse will recognize what as the most obvious sign of anemia? Pallor Tachycardia Flow murmurs Jaundice

Pallor

Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? Pancytopenia Anemia Leukopenia Thrombocytopenia

Pancytopenia

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 Nausea and vomiting Migraine Fever

Peripheral edema

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? Aplastic anemia Iron deficiency anemia Sickle cell anemia Pernicious anemia

Pernicious anemia

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 Takes hydroxyurea during her pregnancy Exhibits a temperature more than 100.3°F Describes the importance of staying cool

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? Bone marrow aspiration Schilling test Bone marrow biopsy Magnetic resonance imaging (MRI) study

Schilling test

Which type of hemolytic anemia is categorized as inherited disorder? Sickle cell anemia Autoimmune hemolytic anemia Cold agglutinin disease Hypersplenism

Sickle cell anemia

A client with sickle cell disease is treated for a thrombotic event. Which organs or body systems does the nurse recognize as being at greatest risk for thrombosis in a client with sickle cell disease? Select all that apply. Spleen Lungs Central nervous system Cardiac system Liver

Spleen Lungs Central nervous system

A client is prescribed 325 mg/day of oral ferrous sulfate. What does the nurse include in client teaching? Take 1 hour before breakfast Take with dairy products Decrease intake of fruits and juices Decrease intake of dietary fiber

Take 1 hour before breakfast

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 Bleeding Abdominal pain Diarrhea

The onset of a bacterial infection

A patient, newly diagnosed with thrombocytopenia, is admitted to the medical unit. After the admission assessment the patient asks the nurse to explain the disease. What should the nurse explain to the patient about this condition? There could be an attack on the platelets by the antibodies There could be decreased production of platelets There could be elevated platelet production. There could be decreased white blood cell production.

There could be decreased production of platelets

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. There is a strong correlation between iron stores and hemoglobin characteristics. There is an inverse relationship between iron stores and hemoglobin levels. There is a weak correlation between iron stores and hemoglobin levels.

There is a strong correlation between iron stores and hemoglobin levels.

After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/mm3. What term should the nurse use to describe this low platelet count? Anemia Leukopenia Thrombocytopenia Neutropenia

Thrombocytopenia

Which medication is the antidote to warfarin? Vitamin K Protamine sulfate Aspirin Clopidogrel

Vitamin K

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? Take ibuprofen for joint pain. Take warm baths to lessen pain. Wear a medical identification bracelet. Undergo genetic testing and counseling if the client is male.

Wear a medical identification bracelet.

A client with sickle cell anemia has a low hematocrit. high hematocrit. normal hematocrit. normal blood smear.

low hematocrit.

A nurse is planning the care of a client with a diagnosis of sickle cell disease who has been admitted for the treatment of an acute vaso-occlusive crisis. What nursing diagnosis should the nurse prioritize in the client's plan of care? Risk for disuse syndrome related to ineffective peripheral circulation Functional urinary incontinence related to urethral occlusion Ineffective tissue perfusion related to thrombosis Ineffective thermoregulation related to hypothalamic dysfunction

Ineffective tissue perfusion related to thrombosis

A night nurse is reviewing the next day's medication administration record (MAR) of a hospital client who has hemophilia. The nurse notes that the MAR specifies both oral and subcutaneous options for the administration of a PRN antiemetic. What is the nurse's best action? Ensure that the day nurse knows not to give the antiemetic. Contact the prescriber to have the subcutaneous option discontinued. Reassess the client's need for antiemetics. Remove the subcutaneous route from the client's MAR.

Contact the prescriber to have the subcutaneous option discontinued.

A patient with sickle cell anemia is to begin treatment for the disease with hydroxyurea. What does the nurse inform the patient will be the benefits of treatment with this medication? Select all that apply. Fewer painful episodes of sickle cell crisis Lower incidence of acute chest syndrome Decreased need for blood transfusions Decreased need for other analgesic medications Ability to reverse the damage done from sickling of cells

Fewer painful episodes of sickle cell crisis Lower incidence of acute chest syndrome Decreased need for blood transfusions

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 Megaloblastic anemia Sickle cell anemia Aplastic anemia

Iron deficiency anemia

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? Milk Orange juice Leafy green vegetables Kidney beans

Orange juice

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 Eating leafy green vegetables with a glass of water Eating apple slices with carrots Eating a steak with mushrooms

Eating calf's liver with a glass of orange juice

An adult client has been diagnosed with iron-deficiency anemia. What nursing diagnosis is most likely to apply to this client's health status? Risk for deficient fluid volume related to impaired erythropoiesis Risk for infection related to tissue hypoxia Acute pain related to uncontrolled hemolysis Fatigue related to decreased oxygen-carrying capacity

Fatigue related to decreased oxygen-carrying capacity

A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client? Pallor, bradycardia, and reduced pulse pressure Pallor, tachycardia, and a sore tongue Sore tongue, dyspnea, and weight gain Angina pectoris, double vision, and anorexia

Pallor, tachycardia, and a sore tongue

A client has been diagnosed with Cooley's anemia, a severe form of beta-thalassemia. Which is a symptom of Cooley's anemia? bronzing of the skin inflammation of the mouth inflammation of the tongue dyspnea

bronzing of the skin