Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders

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 Decreased total iron-binding capacity Increased mean corpuscular volume Increased reticulocyte count

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.

During preparation for bowel surgery, a client receives an antibiotic to reduce intestinal bacteria. The nurse knows that hypoprothrombinemia may occur as a result of antibiotic therapy interfering with synthesis of which vitamin? Vitamin A Vitamin D Vitamin E Vitamin K

Vitamin K Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Antibiotic therapy may interfere with synthesis of these substances, including vitamin K. Intestinal bacteria don't synthesize vitamins A, D, or E.

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). Encourage a diet high in vitamin K. Have the client limit physical activity. Monitor partial thromboplastin (PTT) time.

Administer the prescribed enoxaparin (Lovenox). Clients who are prescribed warfarin at home and need to have a major invasive procedure stop taking warfarin prior to the procedure. Low molecular weight heparin, such as enoxaparin, may be used until the procedure is performed. The client will continue with a diet that has a daily consistent amount of vitamin K. The client needs to ambulate frequently throughout the day. Prothrombin (PT) time is monitored, not PTT, when warfarin had been administered.

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? Potassium level of 5.2 mEq/L Magnesium level of 2.5 mg/dL Calcium level of 9.4 mg/dL Creatinine level of 6 mg/100 mL

Creatinine level of 6 mg/100 mL The degree of anemia in patients with end-stage renal disease varies greatly; however, in general, patients do not become significantly anemic until the serum creatinine level exceeds 3 mg/100 mL.

What pathophysiological concept related to sickle cell disease predisposes a client with sickle cell disease to pneumonia? Damage to the spleen increases the risk for infection. Damage to the lymphatic system increases the risk for infection. Sequestration of sickled cells lead to infection in the area of sequestration. Sequestration of sickled cells lead to infection in the area distal to the sequestration.

Damage to the spleen increases the risk for infection. Sickle cell disease can damage the spleen by thrombosis and subsequent damage or necrosis of tissue. This damage to the spleen increases the risk for infection, predisposing the client to pneumonia and acute chest syndrome. Sequestration causes thrombosis, not infection.

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 Decreased fat stores lead to decreased ability for red blood cells Decreased calories lead to decreased immune response Decreased carbohydrates lead to decreased oxygen affinity of the hemoglobin

Decreased protein stores lead to decreased immune response Decreased protein stores lead to a decreased immune response and worsening of the client's hematological condition. Decreased intake of carbohydrates, calories, or fat stores are not the primary sources for worsening of the client's condition.

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 An expected outcome for a client experiencing a sickle-cell crisis is control and reduction of pain. Hydroxyurea is contraindicated in pregnancy because of the risk it poses for congenital abnormalities. An indication that the client is free from infection is exhibiting a normal temperature; 100.3°F is an elevated temperature. To minimize crises, the client needs to stay warm not cool.

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

low hematocrit. A client with sickle cell anemia has a low hematocrit and sickled cells on the smear. A client with sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear.

A patient has been diagnosed with thrombocytopenia. What are the primary nursing interventions while instituting corticosteroid therapy in this patient? Gradually taper the dose and frequency of medication. Eliminate aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). Palpate the lymph nodes and tonsils every shift. Examine the extremities for redness.

Gradually taper the dose and frequency of medication. For a patient with thrombocytopenia, he or she gradually tapers the dose and frequency of steroid medication before discontinuing it to avoid adrenal insufficiency or crisis. Eliminating aspirin and NSAIDS will help manage bleeding tendencies. Assessment of the extremities, tonsils, or the lymph nodes is part of a physical examination of a patient and not applicable to corticosteroid therapy.

A client with sickle cell crisis is admitted to the hospital in severe pain. While caring for the client during the crisis, which is the priority nursing intervention? Limiting the client's intake of oral and IV fluids Administering and evaluating the effectiveness of opioid analgesics Encouraging the client to ambulate immediately Limit foods that contain folic acid

Administering and evaluating the effectiveness of opioid analgesics The priority nursing intervention is to manage the acute pain. Client-controlled analgesia is frequently used in the acute care setting. A patient with sickle cell crisis experiences severe extreme pain, the use of IV fluids and oral intake is need to hydrate the patient, the patient is initially placed on bed rest during the crisis due to extreme fatigue. The patient must continue to ingest folic acid and are placed on a daily folic acid supplement .

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. Ask if taking a blood pressure has ever produced pain in the upper arm. Ask if taking a blood pressure has ever caused bruising in the hand and wrist. Ask if taking a blood pressure has ever produced the need for medication.

Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints. Due to the client's enhanced risk for bleeding, before taking a blood pressure, the nurse asks the client if the use of a blood-pressure cuff has ever produced bleeding under the skin or in the arm joints.

A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia? Nights sweats, weight loss, and diarrhea Dyspnea, tachycardia, and pallor Nausea, vomiting, and anorexia Itching, rash, and jaundice

Dyspnea, tachycardia, and pallor Signs of iron deficiency anemia include dyspnea, tachycardia, and pallor, as well as fatigue, listlessness, irritability, and headache. Night sweats, weight loss, and diarrhea may signal acquired immunodeficiency syndrome. Nausea, vomiting, and anorexia may be signs of hepatitis B. Itching, rash, and jaundice may result from an allergic or hemolytic reaction.

A thin client is prescribed iron dextran intramuscularly. What is most important action taken by the nurse when administering this medication? Employs the Z-track technique Uses a 23-gauge needle Injects into the deltoid muscle Rubs the site vigorously

Employs the Z-track technique When iron medications are given intramuscularly, the nurse uses the Z-track technique to avoid local pain and staining of the skin. The gluteus maximus muscle is used. The nurse avoids rubbing the site vigorously and uses a 18- or 20-gauge needle.

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 Vitamin C found in orange juice improves the absorption of iron. The other answer choices are not the best for improving absorption of iron.

A client awaiting a bone marrow aspiration asks the nurse to explain where on the body the procedure will take place. What body part does the nurse identify for the client? Posterior iliac crest Sternum Femur Ankle

Posterior iliac crest In adults, bone marrow is usually aspirated from the posterior iliac crest and rarely from the sternum. Bone marrow is not aspirated from the femur or ankle.

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

Sickle cell anemia Glucose 6-phosphate dehydrogenase deficiency is an inherited abnormality resulting in hemolytic anemia. Autoimmune hemolytic anemia is an acquired anemia. Cold agglutinin disease is an acquired anemia. Hypersplenism results in an acquired hemolytic anemia.

A nurse on a hematology/oncology floor is caring for a client with aplastic anemia. Which would not be included in the client's discharge instructions? Use a disposable razor when shaving. Avoid contact with family/friends who are sick. Encourage frequent handwashing. Plan for frequent periods of rest.

Use a disposable razor when shaving. Use a disposable razor when shaving.

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." "DIC occurs when the immune system attacks platelets and causes massive bleeding." "DIC is a complication of an autoimmune disease that attacks the body's own cells." "DIC is caused when hemolytic processes destroy erythrocytes."

"DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs." The inflammatory response initiates the process of inflammation and coagulation. The natural anticoagulant pathways within the body are simultaneously impaired, and the fibrinolytic system is suppressed, allowing a massive amount of tiny clots forms in the microcirculation. As the platelets and clotting factors form microthrombi, coagulation fails. Thus, the paradoxical result of excessive clotting is bleeding. Decline in organ function is usually a result of excessive clot formation (with resultant ischemia to all or part of the organ).

A nurse cares for a client with severe hemoglobinuria after an upper respiratory infection and fever. Diagnostic testing reveals degraded hemoglobin within the client's erythrocytes. Which hematological condition does the nurse suspect the client has? Glucose-6-phosphate dehydrogenase deficiency Sickle cell disease Aplastic anemia Polycythemia vera

Glucose-6-phosphate dehydrogenase deficiency Glucose-6-phosphate dehydrogenase deficiency (G-6-PD) is the deficiency of a gene that produces an enzyme within the erythrocyte essential for membrane stability. Clients are asymptomatic and have normal hemoglobin levels and reticulocyte counts most of the time. However, after a normally-harmless virus or ingestion of a particular medication, clients develop pallor, jaundice, and hemoglobinuria (hemoglobin in the urine). The other answer choices are hematological diseases or conditions; however, these do not present in the same manner.

A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client? Limit visits by family members. Encourage the client to use a wheelchair. Use the smallest needle possible for injections. Maintain accurate fluid intake and output records.

Use the smallest needle possible for injections. Because thrombocytopenia alters coagulation, it poses a high risk of bleeding. To help prevent capillary bleeding, the nurse should use the smallest needle possible when administering injections. The nurse doesn't need to limit visits by family members because they don't pose any danger to the client. The nurse should provide comfort measures and maintain the client on bed rest; activities such as using a wheelchair can cause bleeding. The nurse records fluid intake and output to monitor hydration; however, this action doesn't protect the client from a complication of thrombocytopenia.

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

Vitamin K The antidote for warfarin is vitamin K. Protamine sulfate is the antidote for heparin. Aspirin and clopidogrel are both antiplatelet medications.

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 hemoglobin F hemoglobin A hemoglobin M

hemoglobin S Hemoglobin A (HbA) normally replaces fetal hemoglobin (HbF) about 6 months after birth. In people with sickle cell anemia, however, an abnormal form of hemoglobin, hemoglobin S (HbS), replaces HbF. HbS causes RBCs to assume a sickled shape under hypoxic conditions.

A home care nurse visits a client diagnosed with atrial fibrillation who is ordered warfarin. The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching? "I'll watch my gums for bleeding when I brush my teeth." "I'll use an electric razor to shave." "I'll eat four servings of fresh, dark green vegetables every day." "I'll report unexplained or severe bruising to my doctor right away."

"I'll eat four servings of fresh, dark green vegetables every day." The client requires additional teaching if he states that he'll eat four servings of dark green vegetables every day. Dark, green vegetables contain vitamin K, which reverses the effects of warfarin. The client should limit his intake to one to two servings per day. The client should report bleeding gums and severe or unexplained bruising, which may indicate an excessive dose of warfarin. The client should use an electric razor to prevent cutting himself while shaving.

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? Autoimmune Folate deficiency Iron deficiency Megaloblastic

Megaloblastic A beefy, red, sore tongue is a characteristic indicator of megaloblastic anemia. The nurse should assess for other signs such as fatigue, hypotension, and tachycardia. Safety issues should also be assessed because balance, coordination, and gait are affected.

A client admitted to the hospital with abdominal pain, anemia, and bloody stools reports feeling weak and dizzy. The client has rectal pressure and needs to urinate and move their bowels. The nurse should help them: to the bathroom. to the bedside commode. onto the bedpan. to a standing position so he can urinate.

onto the bedpan. A client who's dizzy and anemic is at risk for injury because of his weakened state. Assisting him with the bedpan would best meet his needs at this time without risking his safety. The client may fall if walking to the bathroom, left alone to urinate, or trying to stand up.

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 People with iron deficiency anemia may crave ice, starch, or dirt; this craving is known as pica.

A client with a diagnosis of pernicious anemia comes to the clinic and reports numbness and tingling in the arms and legs. What do these symptoms indicate? Loss of vibratory and position senses Neurologic involvement Severity of the disease Insufficient intake of dietary nutrients

Neurologic involvement In clients with pernicious anemia, numbness and tingling in the arms and legs, and ataxia are the most common signs of neurologic involvement. Some affected clients lose vibratory and position senses. Jaundice, irritability, confusion, and depression are present when the disease is severe. Insufficient intake of dietary nutrients is not indicated by these symptoms.

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

Pallor On physical examination, pallor is the most common and obvious sign of anemia. Other findings may include tachycardia and flow murmurs. Patients with hemolytic anemia may exhibit jaundice and splenomegaly.

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

Pancytopenia Pancytopenia is defined as an abnormal decrease in WBCs, RBCs, and platelets. The condition may be congenital or acquired. Anemia refers to decreased red cell mass. Leukopenia refers to a less-than-normal amount of WBCs in circulation. Thrombocytopenia refers to a lower-than-normal platelet count.

While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters? Platelet count, prothrombin time, and partial thromboplastin time Platelet count, blood glucose levels, and white blood cell (WBC) count Thrombin time, calcium levels, and potassium levels Fibrinogen level, WBC, and platelet count

Platelet count, prothrombin time, and partial thromboplastin time The diagnosis of DIC is based on the results of laboratory studies of prothrombin time, platelet count, thrombin time, partial thromboplastin time, and fibrinogen level as well as client history and other assessment factors. Blood glucose levels, WBC count, calcium levels, and potassium levels aren't used to confirm a diagnosis of DIC.

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 Lymphopenia (a lymphocyte count less than 1,500/mm3) can result from ionizing radiation, long-term use of corticosteroids, uremia, infections (particularly viral infections), some neoplasms (e.g., breast and lung cancers, advanced Hodgkin disease), and some protein-losing enteropathies (in which the lymphocytes within the intestines are lost) (Kipps, 2010). When lymphopenia is mild, it is often without sequelae; when severe, it can result in bacterial infections (due to low B lymphocytes) or in opportunistic infections (due to low T lymphocytes).

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? To detect the abnormal sounds suggestive of acute chest syndrome and heart failure To detect the evidence of infection such as fever and tachycardia To detect the evidence of dehydration that might have triggered a sickle cell crisis

To detect the abnormal sounds suggestive of acute chest syndrome and heart failure The nurse auscultates the lungs and heart to detect abnormal sounds that indicate pneumonia, acute chest syndrome, and heart failure. The nurse assesses vital signs to detect evidence of infection, such as fever and tachycardia. During the physical examination, the nurse observes the client's appearance, looking for evidence of dehydration, which may have triggered a sickle cell crisis. The nurse assesses mental status, verbal ability, and motor strength to detect stroke-related signs and symptoms.