EAQ: hematology, anemia, neutropenia
the nurse provides education to a patient with hemophilia about safety measures. which statements made by the patient indicate an understanding of the teaching?
-"i should wear a medic alert tag wherever i go" -"i should wear gloves while doing household chores" -"i should immediately consult my HCP after severe injury"
the nurse presents information about hemophilia to a group of nursing students. which information would the nurse include?
-hemophilia B is transmitted by female carriers -von willebrand disease is seen in both genders -hemophilia A is displayed almost exclusively in mn
the nurse concludes that a patient with von willebrand disease based on a decreased von willebrand coagulation factor and which other laboratory parameters?
-increased bleeding time -increased partial thromboplastin time
the nurse is caring for a patient with severe anemia. the nurse expects which compensatory respiratory changes?
-orthopnea -tachypnea -dyspnea at rest
a patient with factor VII deficiency experiences joint bleeding. which interventions would be included in the patient's plan of care?
-pack the joint in ice -provides analgesics such as acetaminophen -encourage the patient to perform ROM exercises when bleeding is stopped
which self-care strategies would the nurse include when preparing to discharge a patient with hemophilia who developed bleeding in a knee joint?
-packing the joint with ice -resting during an acute episode -avoiding weight bearing until swelling subsides
a patient with peptic ulcer disease has a history of bloody stools, a hemoglobin level of 10 g/dL, and a total iron level of 40 mcg/dL. the nurse would assess for which clinical manifestations?
-pallor -cheilitis -paresthesias
which findings would the nurse expect to see in a patient with a hemoglobin level of 8g/dL?
-palpitations -conjunctival pallor -heart rate of 104 beats/min
which laboratory values would the nurse monitor for signs of drug-related myelosuppression?
-platelets -neutrophils -red blood cells
the nurse provides information to a nursing student about the administration of EPO therapy to a patient with chronic kidney disease. which statement made by the student indicates effective learning?
"EPO is given IV or subcutaneously, usually 2 or 3 times per week"
the nurse is caring for a patient with hemolytic anemia. which question asked by the nurse when obtaining a history is most significant to this disease process?
"have you been taking methyldopa?"
which question would the nurse ask a patient after viewing the following administration assessment data?
"have you ever experienced dark, tarry bowel movements?"
a patient with neutropenia asks how the prescribed protective (reverse) isolation helps prevent the spread of organisms. which response by the nurse is appropriate?
"it is designed to minimize the spread of germs to you from sources outside your environment"
the nurse is providing discharge instructions to a patient who has anemia secondary to acute blood loss. which instruction would the nurse include in the discharge teaching?
"now that the blood loss is controlled and as your blood volume is replaced, the anemia generally corrects itself, so no long-term treatment is needed"
the nurse and a student nurse are discussing a patient's complete blood count, which shows RBCs 1.8X10^6/uL, WBCs 2X10^9/L, and platelets 90x10^9/L. which response by the student indicates an understanding of the results?
"the laboratory results indicate panyctopenia"
which instruction would be beneficial for the nurse to provide a patient diagnosed with pernicious anemia?
"undergo frequent gastrointestinal cancer screenings"
a male patient with hemophilia informs the nurse about plans to start a family. the patient asks, "do i need to take any precautions to prevent my child from acquiring this disease?" which response would the nurse provide?
"your female partner could have testing to see if she is a carrier of the same disorder"
to determine potential exposure to chemicals, which questions would the nurse include when taking the history of a patient with anemia?
-"have you worked in the military?" -"does your occupation expose you to hazardous substances?"
the nurse provides discharge teaching to a patient with sickle cell disease. which statements made by the patient indicate understanding of the teaching?
-"i should avoid high altitudes" -"i should start screening for retinopathy at age 10"
the nurse is meeting with several individuals for genetic testing education. for which item in a patient history will the nurse encourage that patient to have genetic carrier screening?
family history of sickle cell disease
which condition would the nurse assess for in a 70 year old patient who has anemia and poor intestinal iron absorption?
gastrointestinal bleeding
which statement is true regarding hemophilia?
hemophilia can be treated by replacement therapy
the nurse reviews documentation of assessment findings of a patient with severe anemia. which assessment finding would the nurse question?
hyperpigmentation
the nurse is caring for a patient with a viral infection and recognizes that the patient is at risk for which type of thrombocytopenia?
immune thrombocytopenia purpura (ITP)
which therapeutic outcome would the nurse expect for a patient with hemophilia A prescribed desmopressin acetate?
increase in factor VIII
the nurse recalls that hemolytic anemia can be caused by which extrinsic factors?
infectious agent
which condition may cause a patient to develop anemia due to decreased hemoglobin synthesis?
iron deficiency
the nurse provides education about thrombotic thrombocytopenic purpura to a group of nursing students and would indicate which information?
it is associated with hemolytic-uremic syndrome
the nurse understands that with repeated episodes of sickling, which organ is most affected?
lungs
a patient that has sickle cell disease has developed cellulitis above the left ankle. which action is the nurse's priority for this patient?
maintain oxygenation
a patient who is a strict vegan avoids taking any vitamin and mineral supplements. the nurse recognizes that the patient is predisposed to which condition?
megaloblastic anemia
a patient has a hemoglobin level of 11 g/dL. the nurse determines that the patient has which level of severity of anemia?
mild anemia
a patient has neutropenia and a body temperature of 100.4 F. which action would the nurse take?
notify the health care provider
which symptom would the nurse expect to find in a patient with vitamin b12 deficiency?
numbness sensation, impaired muscle movement, and extreme sensitivity in nerves
which assessment finding in a patient with severe neutropenia requires immediate action by the nurse?
oral temperature is 100.5 F
which assessment finding would the nurse associate with sever anemia?
pallor
a patient's laboratory report reveals a hemoglobin level of 11 g/dL. the nurse expects to observe which clinical manifestation?
palpitations
which patient is most likely to experience hemophilia?
patient D: partial thromboplastin time is 50 seconds
which patient would the nurse identify as the highest risk for sickle cell anemia?
patient a: african american
which complication would the nurse suspect due to a patient's loss of intrinsic factor after gastrectomy?
pernicious anemia
which strategy is most important for a nurse to include when planning care for a patient who has neutropenia?
placing the patient in a private room
which abnormal finding would the nurse relate to hemostasis abnormalities?
purpura
the nurse assesses a patient with pernicious anemia and expects to find which classic sign of this condition?
red, beefy tongue
which intervention would the nurse anticipate incorporating into the plan of care for a patient with hemophilia that experiences bleeding in a knee joint?
resting the patient's knee to prevent hemathrosis
which condition is characterized by the presence of a high percentage of hemoglobin S in the erythrocytes?
sickle cell disease
which finding supports the nurse's conclusion that a patient has pernicious anemia?
smooth, beefy-red tongue
the nurse reviews the medical record of an older patient and notes food intolerance and signs of anemia. the nurse identifies that the age-related changes are associated with which part of the gastrointestinal system?
stomach
which instruction would the nurse include in the teaching plan for a patient newly diagnosed with microcytic hypochromic anemia?
take the iron with orange juice one hour before meals
a patient with anemia experiences fatigue when performing activities of daily living. which nursing intervention is appropriate to include in the patient's plan of care?
assist the patient in prioritizing activities
the nurse finds that an older adult patient is showing signs of anemia. which age-related change is the reason for this condition?
atrophy of gastric mucosa
which finding supports heparin-induced thrombocytopenia (HIT)?
a patient has a platelet count of 100,000/uL
which patient would the nurse prepare to implement neutropenic precautions?
a patient with WBC count of 9000/uL and 10% neutrophils
which questions would the nurse ask a patient who has hematologic problems?
-"are you taking any herbal products?" -"have you ever received a blood transfusion?" -"is there any family history of anemia, cancer, bleeding, or clotting problems?" -"do you have any difficulty in performing daily activities because of lack of energy?"
the nurse would inquire about which conditions when obtaining information about existing hematologic conditions?
-anemia -hemophilia -clotting disorders
a palliative care patient, on bed rest for the past six months, begins corticosteroids for an acute asthma attack. pain control includes morphine intravenously, and a recent laboratory report indicates anemia and eosinophilia. which clinical manifestations place this patient at risk for skin breakdown?
-anemia -immobility
the nurse provides dietary teaching to a patient with anemia and would include which food sources to promote red blood cell maturation?
-avocados -red meat
which instructions would the nurse include when teaching home care measures to a patient diagnosed with hemophilia?
-avoid contact sports -perform oral hygiene -wear gloves while doing household chores
a patient's laboratory reports reveal a platelet level of 18,000/uL. which nursing actions will help prevent bleeding complications associated with this lab finding?
-avoid invasive procedures -obtain a prescription for a platelet transfusion -instruct the patient to avoid activities that increase the risk of injury
a female patient has been diagnosed with hemophilia. which family background information is possible?
-both the mother and father have hemophilia -the father has hemophilia and the mother is a carrier of the mutated gene for hemophilia
which interventions would the nurse include in the discharge teaching for a patient with neutropenia?
-encourage the patient to wash hands frequently -advise the patient to notify the health care provider if a fever develops -advise the patient to brush the teeth four times a day with a soft toothbrush
which interventions would the nurse provide a patient who has polycythemia?
-evaluating fluid intake and output -assessing the patient's nutritional status -initiating active and passive leg exercises
which replacement blood products may be administered to a patient with hemophilia who is scheduled for an invasive dental procedure?
-factor VIII -factor IX -DDAVP
which interventions are appropriate to include in the plan of care of a patient who has developed neutropenia?
-strict hand washing -daily skin care and oral hygiene -private room with a high-efficiency particulate air filter
a nurse mentor provides teaching to a group of nursing students about the cardiac manifestations of severe anemia. which compensatory cardiac changes would the nurse include?
-tachycardia -heart failure -intermittent claudication
which patient is most likely to experience anemia related to an increased destruction of red blood cells?
a 23-year-old african american man who has a diagnosis of sickle cell disease
which test result places a patient with leukemia at high risk for developing infection?
absolute neutrophil count 500 cells/uL
which condition is depicted in the figure?
acute hemathrosis
a patient undergoing chemotherapy has a low white blood cell count. which intervention would the nurse anticipate?
administer WBC growth factors
which measures to decrease the incidence of sickle cell disease would the nurse include in developing a community program?
carrier screening
which type of deficiency causes hemophilia B in a patient?
christmas factor deficiency
which laboratory finding would the nurse attribute to a patient's complaints of numbness in the hands and feet, and reporting poor coordination and balance?
cobalamin 150 pg/mL
which treatment is likely to be planned for a patient who develops pernicious anemia after a gastrectomy?
cobalamin replacement therapy
malaise and weakness in a patient after receiving multidrug chemotherapy 10 days ago can be assessed with which laboratory test?
complete blood count
a nurse recalls which test as helpful for the indication of types of hemolytic anemia?
coombs test
which occurrence would the nurse identify as being the most likely cause of anemia in a patient with chronic kidney disease?
decreased erythropoietin production
which condition would the nurse monitor for in a patient who has a hemoglobin level of 20 g/dL?
dehydration
which treatment would the nurse anticipate incorporating into the plan of care for a patient with mild hemophilia A?
desmopressin acetate (DDAVP)
which symptoms would the nurse expect to find in a patient who has a white blood cell count of 5000/uL, a platelet count of 90,000/uL, and an absolute neutrophil count OF 1200 cells/uL?
ecchymosis
the nurse is assessing a female patient with hemophilia. which inference is correct about the patient's family?
the father has hemophilia, and the mother is a carrier of hemophilia
the nurse notes that a patient has a smooth and shiny tongue surface. the nurse would attribute these findings to which condition?
the patient has pernicious anemia
which complications would the nurse monitor for in a patient who has a platelet count below 100,000/uL?
thrombocytopenia
the nurse recognizes that a primary deficiency for a patient who is a strict vegan is a lack of which vitamin?
vitamin b12
