Chapter 33 continued
Parents arrive to the clinic with their young child and inform the nurse the child has just been diagnosed with sickle cell disease. The parents ask the nurse how this could have happened and which one of them is the carrier. What is the best response by the nurse?
"The child must inherit two defective genes, one from each parent." (Sickle cell disease is a hereditary disorder. To manifest this disorder, a person must inherit two defective genes, one from each parent, in which case all the hemoglobin is inherently abnormal. If the person inherits only one gene, he or she carries sickle cell trait. The hemoglobin of those who have sickle cell trait is about 40% affected.)
A client comes to the walk-in clinic complaining of weakness and fatigue. While assessing this client, the nurse finds evidence of petechiae and ecchymoses. The nurse notes that the spleen appears enlarged. What would the nurse suspect is wrong with this client?
Aplastic anemia
A nurse caring for a client who has hemophilia is getting ready to take the client's vital signs. What should the nurse do before taking a blood pressure?
Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints.
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. (Platelet counts may decrease with heparin therapy, and this client's platelet count has decreased. The client may have heparin-induced thrombocytopenia (HIT). Treatment of HIT includes discontinuing the heparin)
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 ( As renal function decreases, erythropoietin, which is produced by the kidney, also decreases. Because erythropoietin is produced outside the kidney, some erythropoiesis continues, even in patients whose kidneys have been removed. However, the number of red blood cells produced is small and the degree of erythropoiesis is inadequate. )
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.
A client with a diagnosis of pernicious anemia comes to the clinic complaining of numbness and tingling in his arms and legs. What do these symptoms indicate?
Neurologic involvement
A client is prescribed 325 mg/day of oral ferrous sulfate. What does the nurse include in client teaching?
Take 1 hour before breakfast
After receiving chemotherapy for lung cancer, a client's platelet count falls to 20 x109L. What term should the nurse use to describe this low platelet count?
Thrombocytopenia
A client being treated for iron deficiency anemia with ferrous sulfate continues to be anemic despite treatment. The nurse should assess the client for use of which medication? a.) Tegretol b.) Aluminum hydroxide c.) Prednisone d.) Amoxicillin
b.) Aluminum hydroxide
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. a.) Take aspirin daily to prevent clot formation. b.) Participate in regular phlebotomy procedures to decrease blood viscosity. c.) Take antiplatelets on a regular basis. d.) Use compression stockings when walking to prevent deep vein thrombosis (DVT).
b.) Participate in regular phlebotomy procedures to decrease blood viscosity. (Phlebotomy is a critical part of therapy and the only treatment that has demonstrated improved survival. Aspirin should be avoided, and antiplatelet therapy should be used with caution due to the risk of bleeding. Compression stockings are not necessary for walking but should be used for airplane travel.)
Which of the following is the most common hematologic condition affecting elderly patients a.) Leukopenia b.) Anemia c.) Thrombocytopenia d.) Bandemia
b.)Anemia
The nurse is collecting data for a client who has been diagnosed with iron-deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia? a.) "I feel hot all of the time." b.) "I have an increase in my appetite." c.) "I have difficulty breathing when walking 30 feet." d.) "I have a difficult time falling asleep at night."
c.) "I have difficulty breathing when walking 30 feet."
Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents? a.) Microcytic b.) Hyperchromic c.) Hypochromic d.) Normocytic
c.) Hypochromic
A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia? a.) Nausea, vomiting, and anorexia b.) Itching, rash, and jaundice c.) Nights sweats, weight loss, and diarrhea d.) Dyspnea, tachycardia, and pallor
d.) 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? a.) Eating calf's liver with a glass of orange juice b.) Eating a steak with mushrooms c.) Eating apple slices with carrots d.) Eating leafy green vegetables with a glass of water
a.) Eating calf's liver with a glass of orange juice
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? a.) Hemoglobin level b.) Folate levels c.) Potassium level d.) Creatinine level
a.) Hemoglobin level
A female client with the beta-thalassemia trait plans to marry a man of Italian ancestry who also has the trait. Which client statement indicates that she understands the teaching provided by the nurse? a.) "If my fiancé was of Middle Eastern descent, I wouldn't be worried about having children." b.) "Thalassemia is treated with iron supplements." c.) "I'll see a genetic counselor before starting a family." d.) "I need to learn how to give myself vitamin B12 injections."
c.) "I'll see a genetic counselor before starting a family."
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? a.) "DIC occurs when the immune system attacks platelets and causes massive bleeding." b.) "DIC is a complication of an autoimmune disease that attacks the body's own cells." c.) "DIC is caused when hemolytic processes destroy erythrocytes." d.) "DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs."
d.) "DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs."
The client has been diagnosed with myelodysplastic syndrome with an absolute neutrophil count less than 1000/mm³ and is being admitted to the hospital. The nurse a.) Allows unlicensed assistive personnel who reports having a sore throat to provide care b.) Changes the water in the humidifier for oxygen therapy every 48 hours c.) Places the client in isolation and allows no visitors d.) Assigns the client to a private room
d.) Assigns the client to a private room
Which is a symptom of hemochromatosis? a.) Weight gain b.) Inflammation of the mouth c.) Inflammation of the tongue d.) Bronzing of the skin
d.) Bronzing of the skin (Clients with hemochromatosis exhibit symptoms of weakness, lethargy, arthralgia, weight loss, and loss of libido early in the illness trajectory. The skin may appear hyperpigmented from melanin deposits or appear bronze in color.)
A nurse is doing a physical examination of a child with sickle cell anemia. When the child asks why the nurse auscultates the lungs and heart, what would be best the response by the nurse? a.) To detect the abnormal sounds suggestive of acute chest syndrome and heart failure b.) To detect the evidence of dehydration that might have triggered a sickle cell crisis c.) To detect the evidence of infection such as fever and tachycardia d.) To detect the motor strength and stroke-related signs and symptoms
a.) To detect the abnormal sounds suggestive of acute chest syndrome and heart failure
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? a.) Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients b.) Risk for falls related to complaints of dizziness c.) Fatigue related to decreased hemoglobin and hematocrit d.) Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit
d.) Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit
