EAQ- hemo

The nurse provides discharge teaching to a patient with sickle cell disease (SCD). Which statements made by the patient indicate understanding of the teaching? Select all that apply. Select all that apply "I should avoid high altitudes." "I should drink orange juice quite often." "I can safely consume uncooked seafood." "I shouldn't receive the pneumococcal injection." "I should start screening for retinopathy at age 10."

"I should avoid high altitudes." "I should start screening for retinopathy at age 10." Patients with SCD should avoid crises by avoiding activities that cause hypoxia. High altitudes can increase the risk for the development of hypoxia. Regular screenings for retinopathy are recommended. The patient should not drink orange juice too often because orange juice is rich in vitamin C. Eating uncooked seafood increases the risk of infection; this type of product is rich in iron and should be avoided. The pneumococcal injection is recommended to prevent infection.

The nurse provides education to a patient with hemophilia about safety measures. Which statements made by the patient indicate an understanding of the teaching? Select all that apply. Select all that apply "I should participate in contact sports." "I should wear a Medic Alert tag wherever I go." "I should wear gloves while doing household chores." "I should carry an epinephrine injection wherever I go." "I should immediately consult my health care provider after severe injury."

"I should wear a Medic Alert tag wherever I go." "I should wear gloves while doing household chores." "I should immediately consult my health care provider after severe injury."

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? Encourage frequent visitors. Assist the patient in prioritizing activities. Assist the patient in walking immediately after meals. Ensure that all physical activities are completed in the morning.

Assist the patient in prioritizing activities.

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. Administer antibiotics. Assess pain every 4 hours. Start IV fluids.

Maintaining oxygenation is a priority because sickling episodes frequently are triggered by low oxygen tension in the blood, which commonly is caused by an infection. Antibiotics to treat cellulitis, pain control, and fluids to reduce blood viscosity also will be used, but oxygenation is the priority.

A patient has neutropenia and a body temperature of 100.4° F (38° C). Which action would the nurse take? Initiate parenteral fluids. Give aspirin to the patient. Administer pamidronate to the patient. Notify the health care provider.

Notify the health care provider.

The nurse recognizes that a primary deficiency for a patient who is a strict vegan is a lack of which vitamin? Vitamin E Vitamin A Vitamin K Vitamin B 12

Vitamin B 12 A primary deficiency for a strict vegan is a lack of cobalamin (vitamin B 12). Cobalamin is only obtained from animal protein, special supplements, or foods fortified with the vitamin. Vegans not using cobalamin supplements are susceptible to the development of megaloblastic anemia and the neurologic signs of cobalamin deficiency.

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? "Are you pregnant?" "Have you ever had a heart attack?" "Have you been taking methyldopa?" "Are you taking any iron supplements?"

"Have you been taking methyldopa?" Hemolytic anemia can occur from the administration of methyldopa. It is not caused by pregnancy, iron supplements, or a history of myocardial infarction.

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? Type 1 diabetes Iron-deficiency anemia Family history of sickle cell disease Mother and sister died of breast cancer

Family history of sickle cell disease

Which intervention would the nurse anticipate incorporating into the plan of care for a patient with hemophilia that experiences bleeding in a knee joint? Immediate transfusion of platelets Resting the patient's knee to prevent hemarthrosis Assistance with intracapsular injection of corticosteroids Range-of-motion exercises to prevent thrombus formation

Resting the patient's knee to prevent hemarthrosis In patients with hemophilia, joint bleeding requires resting of the joint to prevent deformities from hemarthrosis. Clotting factors, not platelets or corticosteroids, are administered. Thrombus formation is not a central concern in a patient with hemophilia.

Which test result places a patient with leukemia at high risk for developing infection? Platelet count 150,000/µL Absolute neutrophil count (ANC) 500 cells/µL Total red blood cell (RBC) count 4.3 × 10 6/µL Mean corpuscular hemoglobin concentration (MCHC) 35%

Absolute neutrophil count (ANC) 500 cells/µL Neutropenia indicates an increased risk of developing infection. Platelet count, total RBC count, and MCHC are in the normal range.

Which type of deficiency causes hemophilia B in a patient? Iron deficiency Christmas factor deficiency Anti-hemophilic factor deficiency Von Willebrand coagulation protein deficiency

Christmas factordeficiency , or factor IX, is a clotting protein, and its deficiency causes hemophilia B; this leads to prolonged or spontaneous bleeding. Iron deficiency causes anemia. Anti-hemophilic factor, or factor VIII deficiency, causes hemophilia A. Von Willebrand coagulation protein deficiency causes von Willebrand disease.

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? Bilirubin 2 mg/dL Folic acid 10 ng/dL Hemoglobin 10 g/dL Cobalamin 150 pg/mL

Cobalamin 150 pg/mL Paresthesia of the feet and hands and poor coordination and balance due to ataxia are the clinical manifestations of vitamin B 12 (Cobalamin), or folic acid, deficiency. The normal value of cobalamin is 200 to 835 pg/mL. Cobalamin (vitamin B 12) of 150 pg/mL is less than the normal value, which indicates vitamin B 12 deficiency. The normal range of total bilirubin is 0.2 to 1.2 mg/dL. A bilirubin level of 2 mg/dL indicates jaundice or liver dysfunction. The normal range of folic acid is 3 to 16 ng/mL. The patient's folic acid is within the normal range and does not indicate folic acid deficiency. A normal range for hemoglobin is 11 to 16 g/dL in females and 13.2 to 17.3 mg/dL in males. Hemoglobin of 10 g/dL indicates anemia in the patient. The patient with anemia may experience tachycardia, palpitations, pallor, and cyanosis.

Which treatment is likely to be planned for a patient who develops pernicious anemia after a gastrectomy? Triple-drug therapy IV therapy Quadruple-drug therapy Cobalamin replacement therapy

Cobalamin replacement therapy \ A patient who has undergone a gastrectomy may have a long-term complication of pernicious anemia due to the loss of intrinsic factor, which is produced by parietal cells. Cobalamin replacement therapy restores the intrinsic factor and halts vitamin B 12 deficiency that occurs due to pernicious anemia. Triple-drug and quadruple-drug therapy are administered for patients with long-term Helicobacter pylori ( H. pylori) infection. IV therapy is used when a nasogastric tube is connected to the suction.

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 use special techniques to decrease discharge from your body." "It is designed to use special techniques to handle your linens and personal items." "It is designed to minimize the spread of germs to you from sources outside your environment." "It is designed to minimize the spread of germs from you to health care personnel, visitors, and other patients."

"It is designed to minimize the spread of germs to you from sources outside your environment."

A patient undergoing chemotherapy has a low white blood cell (WBC) count. Which intervention would the nurse anticipate? Monitor the respiratory rate of the patient. Administer WBC growth factors. Request that the chemotherapy dose be reduced. Allow the patient to visit with family and friends.

Administer WBC growth factors. Chemotherapy may suppress the proliferation of bone marrow, resulting in neutropenia, or low WBC counts. Low WBC count makes the patient prone to developing infections; therefore the nurse should consult the health care provider and get WBC growth factors administered. In addition, the nurse should monitor the temperature of the patient because it can indicate fever. The number of visitors should be limited to prevent risk of infection. The chemotherapy dose need not be reduced, because neutropenia is a common side effect. Respiratory rate is routinely monitored, but in this case it is not directly related to the patient's WBC.

Malaise and weakness in a patient after receiving multidrug chemotherapy 10 days ago can be assessed with which laboratory test? Urinalysis (UA) Liver function tests (LFTs) Basic metabolic panel (BMP) Complete blood count (CBC)

Complete blood count (CBC) Malaise and weakness at 10 days following multidrug chemotherapy can be an indication of anemia (decreased red blood cell level) and/or immunosuppression (decreased white blood cell level). This is best assessed with a CBC. A UA assesses for urinary tract infection, which presents with symptoms of urinary urgency, frequency, and dysuria. LFTs assess for decreased hepatic function due to potential toxic effects of the chemotherapy. Hepatic dysfunction would present as right upper quadrant pain, liver enlargement on abdominal palpation, and jaundice. A BMP assesses for electrolyte imbalance, which is most often the result of vomiting following chemotherapy.

Which occurrence would the nurse identify as being the most likely cause of anemia in a patient with chronic kidney disease? Excess blood loss Decreased intake of iron Decreased thyroid gland activity Decreased erythropoietin production

Decreased erythropoietin production Erythropoietin is a hormone secreted by the kidneys that stimulates the bone marrow cells to produce red blood cells (RBCs). Chronic kidney disease causes a reduction in erythropoietin production, which ultimately leads to a decreased production of RBCs. This results in anemia. Excessive blood loss results in anemia but is not a likely cause in this patient. A decreased iron intake causes anemia but is less likely in this patient. Hypothyroidism can indirectly lead to anemia, but it is not a cause in this patient because the patient does not suffer from thyroid abnormality. The cause of anemia in this patient is related to kidney disease.

Which treatment would the nurse anticipate incorporating into the plan of care for a patient with mild hemophilia A? Splenectomy IV immunoglobulin Romiplostim therapy Desmopressin acetate (DDAVP)

Desmopressin acetate (DDAVP) DDAVP is beneficial for a patient with mild hemophilia A and certain subtypes of von Willebrand disease. It is a synthetic analog of vasopressin and may be used to stimulate an increase in factor VIII and von Willebrand factor (vWF). Splenectomy is indicated only if the patient does not respond to drug therapy. IV immunoglobulin is used in a patient who is unresponsive to corticosteroids or splenectomy. Romiplostim therapy is used in a patient with chronic immune thrombocytopenic purpura (ITP) who had an insufficient response to the other treatments or who has a contraindication to splenectomy.

Which interventions would the nurse include in the discharge teaching for a patient with neutropenia? Select all that apply. Select all that apply Encourage the patient to eat raw eggs. Encourage the patient to wash hands frequently. Encourage the patient to frequent crowded areas. 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.

Encourage the patient to eat raw eggs. 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. Neutropenia, or decreased neutrophil count, increases the risk of developing infection. Therefore measures should be taken to prevent infections. The self-care instructions provided by the nurse should include frequent hand washing to prevent transmission of germs. Brushing the teeth four times a day with a soft toothbrush prevents the risk of oral infections. Fever is an emergency situation in cases of neutropenia and should be immediately reported to the health care provider. Eating raw eggs and staying in crowded areas increase the risk of acquiring infections and should be avoided.

Which interventions would the nurse provide a patient who has polycythemia? Select all that apply. Select all that apply Monitoring liver function tests Evaluating fluid intake and output Assessing the patient's nutritional status Initiating active and passive leg exercises Instructing the patient to avoid high altitudes

Evaluating fluid intake and output Assessing the patient's nutritional status Initiating active and passive leg exercises In polycythemia vera, laboratory findings show an elevated hemoglobin and red blood cell (RBC) count with microcytosis, as well as an elevated white blood cell (WBC) count with basophilia. Fluid intake and output should be evaluated to avoid fluid overload because this may further complicate circulatory congestion. Nutritional status should be assessed regularly because inadequate food intake may result in gastrointestinal symptoms, such as fullness, pain, and dyspepsia. Active and passive leg exercises should be initiated to prevent thrombus formation. Liver function tests should be monitored regularly in patients who require lifelong supplementation of iron. Patients with sickle cell disease should be advised to avoid high altitudes because this may lead to hypoxia.

The nurse presents information about hemophilia to a group of nursing students. Which information would the nurse include? Select all that apply. Select all that apply Hemophilia A is transmitted by male carriers. Hemophilia B is transmitted by female carriers. Von Willebrand disease is seen in both genders. Hemophilia A is displayed almost exclusively in men. Hemophilia B is displayed almost exclusively in women.

Hemophilia B is transmitted by female carriers. Von Willebrand disease is seen in both genders. Hemophilia A is displayed almost exclusively in men. The nurse should include that hemophilia A is displayed almost exclusively in men, von Willebrand disease is seen in both genders, and hemophilia B is transmitted via female carriers. Hemophilia A is transmitted by female carriers, not male carriers. Hemophilia B is displayed almost exclusively in men, not women.

Which statement is true regarding hemophilia? Hemophilia is not hereditary in nature. Hemophilia can be treated by replacement therapy. Hemophilia is an X-linked dominant genetic disorder. Hemophilia B is the most common form of hemophilia.

Hemophilia can be treated by replacement therapy.

The nurse is caring for a patient with a viral infection and recognizes that the patient is at risk for which type of thrombocytopenia? Hereditary thrombocytopenia Immune thrombocytopenic purpura (ITP) Heparin-induced thrombocytopenia (HIT) Thrombotic thrombocytopenic purpura (TTP)

ITP Viral infections compromise the immune system and contribute to the development of ITP. Hereditary thrombocytopenia is observed in the patient with inherited thrombocytopenia. HIT is observed in the patient who is on long-term heparin therapy. TTP is observed in a patient with hemolytic anemia.

The nurse concludes that a patient has von Willebrand disease based on a decreased von Willebrand coagulation factor (vWF) and which other laboratory parameters? Select all that apply. Select all that apply Decreased factor IX Increased bleeding time Increased thrombin time Decreased platelet count Increased partial thromboplastin time

Increased bleeding time Increased partial thromboplastin time Increased bleeding time is observed in patients with von Willebrand disease because of structurally defective platelets. The patient with von Willebrand disease will have a deficiency in the intrinsic clotting system factor; therefore the partial thromboplastin time may be prolonged. Decreased factor IX is associated with hemophilia B. The thrombin time remains normal in patients with von Willebrand disease because it does not impair thrombin-fibrinogen reaction. A decreased platelet count is seen in patients with thrombocytopenia. However, platelet counts remain normal in von Willebrand disease because there will be adequate platelet production.

The nurse would inquire about which conditions when obtaining information about existing hematologic conditions? Select all that apply. Select all that apply Anemia Influenza Hemophilia Conjunctivitis Clotting disorders

anemia hemophilia clotting disorder When taking a family history, it is important to explore hematologic conditions such as anemia, hemophilia (a bleeding disorder), and other clotting disorders. Information about influenza and conjunctivitis is not relevant to hematologic conditions.

The nurse provides education about thrombotic thrombocytopenic purpura (TTP) to a group of nursing students and would include which information? It is caused by Helicobacter pylori infection. It is not considered as a medical emergency. It is associated with hemolytic-uremic syndrome. It is associated with decreased platelet aggregation.

It is associated with hemolytic-uremic syndrome. TTP is an uncommon syndrome associated with hemolytic-uremic syndrome because both disorders are acute and characterized by thrombocytopenia and microangiopathic hemolytic anemia. TTP is caused by the deficiency of a plasma enzyme (ADAMTS13), not by a Helicobacter pylori infection. TTP is considered a medical emergency because bleeding and clotting occur simultaneously. TTP is associated with increased platelet aggregation; this causes the formation of microthrombi, which can get deposited in arterioles and capillaries.

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? Sepsis Dementia Depression Megaloblastic anemia

Megaloblastic anemia The primary deficiency of a strict vegan is lack of cobalamin. This vitamin is obtained from animal protein, special supplements, or foods that have been fortified with the vitamin. The patient who avoids eating any vitamin and mineral supplements is susceptible to the development of megaloblastic anemia, which is due to deficiency of cobalamin. Sepsis, dementia, and depression are not associated with cobalamin deficiency. These are conditions that increase the risk for malnutrition.

Which findings would the nurse expect to see in a patient with a hemoglobin level of 8 g/dL? Select all that apply. Select all that apply Palpitations Conjunctival pallor Sternal tenderness High oxygen saturation Heart rate of 104 beats/min

Palpitations Conjunctival pallor Heart rate of 104 beats/min A hemoglobin level of 8 g/dL indicates anemia. Palpitations—a fluttering or pounding in the chest—may occur in the patient. Conjunctival pallor is paleness, with decreased or absent coloration in the conjunctiva. It can occur due to decreased hemoglobin content. A heart rate of 104 beats/min indicates tachycardia, one of the manifestations of anemia. Sternal tenderness is observed in patients with leukemia and results from increased bone marrow cellularity. Low, rather than high, oxygen saturation is seen in patients with anemia due to the decreased oxygen carrying capacity of the blood.

Which complication would the nurse suspect due to a patient's loss of intrinsic factor after gastrectomy? Bile reflux gastritis Pernicious anemia Dumping syndrome Postprandial hypoglycemia

Pernicious anemia is a complication that occurs in a patient after undergoing a partial gastrectomy. It occurs due to loss of intrinsic factor, which is required to produce vitamin B 12. Bile reflux gastritis occurs as a complication of gastric surgery of the pylorus. Dumping syndrome occurs as a complication after surgical removal of the stomach and pylorus. Postprandial hypoglycemia is a variant of dumping syndrome that occurs due to uncontrolled gastric emptying of a bolus of fluid high in carbohydrate into the small intestine.

Which interventions are appropriate to include in the plan of care of a patient who has developed neutropenia? Select all that apply. Select all that apply Strict hand washing Daily nasal swabs for culture Monitoring temperature every hour Daily skin care and oral hygiene Encouraging eating all foods to increase nutrients Private room with a high-efficiency particulate air (HEPA) filter

Strict hand washing Daily skin care and oral hygiene Private room with a high-efficiency particulate air (HEPA) 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? Select all that apply. Select all that apply Tachycardia Heart failure Diastolic murmurs Intermittent claudication Decreased pulse pressure

Tachycardia Heart failure intermittent claudification The compensatory cardiac symptoms of severe anemia are tachycardia, heart failure, and intermittent claudication. The cardiac murmurs that occur in severe anemia are systolic, not diastolic, in nature. In severe anemia, there is an increase in pulse pressure.

Which instruction would the nurse include in the teaching plan for a patient newly diagnosed with microcytic hypochromic anemia? Take enteric-coated iron with each meal. Take cobalamin with green, leafy vegetables. Take the iron with orange juice one hour before meals. Decrease the intake of the antiseizure medications to improve.

Take the iron with orange juice one hour before meals. With microcytic, hypochromic anemia, there may be an iron, B 6, or copper deficiency; thalassemia; or lead poisoning. The iron prescribed should be taken with orange juice one hour before meals, as it is absorbed best in an acid environment. Enteric-coated capsules would not be used because iron is best absorbed in an acidic environment. Megaloblastic anemias occur with cobalamin (vitamin B 12) and folic acid deficiencies. Vitamin B 12 may help red blood cell (RBC) maturation if the patient has the intrinsic factor in the stomach. Green, leafy vegetables provide folic acid for RBC maturation. Antiseizure drugs may contribute to aplastic anemia or folic acid deficiency, but the patient should not stop taking the medications. Changes in medications will be prescribed by the health care provider.

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 father has hemophilia, and the mother is unaffected by hemophilia. The father is unaffected by hemophilia, and the mother has hemophilia. The father is unaffected by hemophilia, and the mother is a carrier of hemophilia.

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 neutropenia. The patient has polycythemia. The patient has pernicious anemia. The patient has elevated estrogen levels.

The patient has pernicious anemia. A smooth, shiny tongue surface can be observed in patients with pernicious anemia. A pallor of the gingival and mucosal membrane is observed due to low hemoglobin level. Patients with neutropenia may have gingival and mucosal ulceration, swelling, or bleeding. Patients with polycythemia may have decreased visual acuity and transient episodic redness of the skin. A patient with elevated estrogen levels may have spider nevus, a form of telangiectasia.

Which complications would the nurse monitor for in a patient who has a platelet count below 100,000/µL? Leukemia Leukopenia Neutropenia Thrombocytopenia

Thrombocytopenia Thrombocytopenia is a condition in which the platelet counts falls below 100,000/µL. Normal platelet counts are between 150,000 and 400,000/µL. Leukemia is a type of cancer of the blood or bone marrow characterized by an abnormal increase of immature white blood cells. Leukopenia is a condition in which the white blood cell count is less than 4000/µL. Neutropenia is a condition in which the absolute neutrophil count (ANC) is less than 1000 cells/µL.

Which instruction would be beneficial for the nurse to provide a patient diagnosed with pernicious anemia? "Avoid consuming red meat and fish." "Limit consuming milk and dairy products." "Undergo frequent hepatitis A screenings." "Undergo frequent gastrointestinal cancer screenings."

Undergo frequent gastrointestinal cancer screenings." Pernicious anemia is characterized by decreased secretion of hydrochloric acid in the stomach due to autoimmune-mediated destruction of parietal cells and thereby causes an increased risk for gastric cancer. The patient with cobalamin deficiency can develop pernicious anemia, so the patient should consume foods such as red meat, fish, milk, and dairy products. Patients with thalassemia may contract hepatitis C from blood transfusions.

The nurse recalls that hemolytic anemia can be caused by which extrinsic factors? Infectious agent Enzyme deficiency Sickle cell disease Membrane abnormalities

infectious agent Infectious agents, such as malaria, are extrinsic factors that can lead to acquired hemolytic anemias. Abnormal hemoglobin, such as sickle cell disease, and enzyme deficiencies are intrinsic factors that lead to hereditary (intrinsic) hemolytic anemias. Membrane abnormalities, such as paroxysmal nocturnal hemoglobinuria, cause increased red blood cell (RBC) destruction and are hereditary (intrinsic) factors.

Which laboratory values would the nurse monitor for signs of drug-related myelosuppression? Select all that apply. Select all that apply Platelets Basophils Neutrophils Eosinophils Red blood cells (RBCs)

platelts nwutrophils RBCs Monitoring the platelet count helps to detect the risk of bleeding in the patient and the need for using platelet growth factors or a platelet transfusion. Monitoring the RBC count helps the nurse to detect the severity of anemia and assess the need for administering RBC growth factors or an RBC transfusion. Monitoring the neutrophil count helps to detect the risk of infection and the need for using white blood cell (WBC) growth factors and measures to prevent infection. Basophil and eosinophil counts should be assessed only in patients who have an allergic predisposition or if the drug is known to produce allergic reactions.

The nurse assesses a patient with pernicious anemia and expects to find which classic sign of this condition? Diarrhea Indigestion Flushed skin Red, beefy tongue

red, beefy tongue The decreased absorption of vitamin B 12 resulting from a lack of intrinsic factor causes a decrease in hemoglobin, hematocrit, and red blood cells. A smooth, red, enlarged or "beefy" appearance of the tongue may also be seen. Intrinsic factor is produced by the parietal cells of the stomach lining and is required to absorb vitamin B 12 from the intestines. Causes of decreased intrinsic factor production include surgical alterations such as gastrectomy and autoimmune disease. Diarrhea, indigestion, and flushed skin appearance are not signs specifically associated with pernicious anemia.

Which condition is characterized by the presence of a high percentage of hemoglobin S (Hgb S) in the erythrocytes? Thalassemia Aplastic anemia Sickle cell disease Acquired hemolytic anemia

sickle cell Sickle cell disease is characterized by the presence of a high percentage of Hgb S in the erythrocytes. Thalassemia occurs due to the absence of reduced globulin protein. Aplastic anemia is a disease characterized by pancytopenia in which all the blood cell types decrease. Acquired hemolytic anemia results from hemolysis of red blood cells (RBCs) from extrinsic factors. It is characterized by increased mean corpuscular volume (MCV), reticulocytes, and bilirubin.

Which questions would the nurse ask a patient who has hematologic problems? Select all that apply. Select all that apply "Have you ever had a fracture?" "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 a lack of energy?"

"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 a lack of energy?"

The nurse provides information to a nursing student about the administration of erythropoietin (EPO) therapy to a patient with chronic kidney disease (CKD). Which statement made by the student indicates effective learning? "EPO benefits a patient with plasma ferritin concentrations less than 100 mg/mL." "EPO should be administered in higher doses to a patient with hemoglobin levels of more than 12 g/dL." "EPO is given IV or subcutaneously, usually 2 or 3 times per week." "EPO can be safely given to a patient whose BP is 150/90 mm Hg."

"EPO is given IV or subcutaneously, usually 2 or 3 times per week." Anemia in CKD is caused by a decreased production of erythropoietin by the kidneys. Exogenous EPO is used to treat anemia. It is available as epoetin alfa (Epogen, Procrit), which can be given IV or subcutaneously, usually two or three times per week. Higher hemoglobin levels (more than 12 g/dL) and higher doses of EPO are associated with a higher rate of thromboembolic events and increased risk for death from serious cardiovascular (CV) events (myocardial infarction [MI], heart failure [HF], stroke). The recommendation is to use the lowest possible dose of EPO to treat anemia. EPO can increase BP and is contraindicated in uncontrolled hypertension. The underlying mechanism is related to the hemodynamic changes (e.g., increased whole blood viscosity) that occurs as the anemia is corrected. EPO therapy may lead to iron deficiency from the increased demand for iron to support erythropoiesis. Iron supplementation is recommended if the plasma ferritin concentrations fall below 100 ng/mL

To determine potential exposure to chemicals, which questions would the nurse include when taking the history of a patient with anemia? Select all that apply. Select all that apply "Is your appetite affected?" "Have you worked in the military?" "What kind of diet do you follow?" "Does your occupation expose you to hazardous substances?" "Has your present illness caused a change in your eating habits?"

"Have you worked in the military?" "Does your occupation expose you to hazardous substances?"

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? "You will need to take an iron supplement for the rest of your life to make sure the anemia does not return." "You will need to make dietary changes to help support the production of red blood cells for the next one to two years." "It would be best to take several supplements to prevent the anemia from recurring, including folic acid, niacin, and riboflavin." "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."

"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." Anemia caused by acute blood loss generally resolves itself once the source of the bleeding is identified and controlled and blood/fluid volume is replaced. It is incorrect to tell the patient he or she will need supplements for the rest of his or her life, that dietary changes will be necessary for the next year or two, or that several supplements are necessary to prevent recurrence.

The nurse and a student nurse are discussing a patient's complete blood count (CBC), which shows red blood cells (RBCs) 1.8 × 10 6/µL, white blood cells (WBCs) 2 × 10 9/L, and platelets 90 × 10 9/L. Which response by the student indicates an understanding of the results? "The laboratory results indicate leukopenia." "The laboratory results indicate neutropenia." "The laboratory results indicate pancytopenia." "The laboratory results indicate thrombocytopenia."

"The laboratory results indicate pancytopenia." The patient's complete blood count is suppressed. There is a marked decrease in the number of RBCs, WBCs, and platelets. This condition is called pancytopenia. Leukopenia is a condition in which WBCs count less than 4000/µL. Neutropenia is a condition in which the absolute neutrophil count (ANC) is less than 1000 cells/µL. Thrombocytopenia is a condition in which platelet counts falls below 100,000/µL.

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? "No specific precautions are needed; your child will not get this disease from you." "Your female partner could have testing to see if she is a carrier of the same disorder." "You can take medications to prevent your child from being affected by this disorder." "Hemophilia is not a genetic disorder; it cannot be passed on from one generation to another."

"Your female partner could have testing to see if she is a carrier of the same disorder."

Which patient is most likely to experience anemia related to an increased destruction of red blood cells? A 59-year-old man whose alcoholism has precipitated folic acid deficiency A 23-year-old African American man who has a diagnosis of sickle cell disease A 30-year-old woman with a history of "heavy periods" accompanied by anemia A 3-year-old child whose impaired growth and development is attributable to thalassemia

A 23-year-old African American man who has a diagnosis of sickle cell disease A result of a sickling episode in sickle cell anemia involves increased hemolysis of the sickled cells. Anemia due to alcoholism can be due to impaired liver function or an enlarged spleen. Alcoholics often suffer from B 1, B 3, and B 6, or thiamin, niacin and pyridoxine deficiencies. Anemia related to menstruation is a direct result of blood loss. Thalassemias and folic acid deficiencies cause a decrease in erythropoiesis.

Which finding supports heparin-induced thrombocytopenia (HIT)? A patient has a viral infection. A patient has hemolytic anemia. A patient has a platelet count of 100,000/µL. A patient has systemic lupus erythematosus.

A patient has a platelet count of 100,000/µL. Long-term heparin therapy can cause HIT that results in a decrease in the platelet count. A platelet count of 100,000/µL indicates HIT. Immune thrombocytopenic purpura (ITP) will be suspected if the patient has a viral infection. Thrombotic thrombocytopenic purpura (TTP) will be suspected if the patient has hemolytic anemia and an autoimmune disorder like systemic lupus erythematosus.

Which patient would the nurse prepare to implement neutropenic precautions? A patient with a white blood cell (WBC) count of 5000/µL and 30% neutrophils A patient with a WBC count of 7000/µL and 30% neutrophils A patient with a WBC count of 9000/µL and 10% neutrophils A patient with a WBC count of 10,000/µL and 10% neutrophils

A patient with a WBC count of 9000/µL and 10% neutrophils Neutropenia is a condition in which the absolute neutrophil count (ANC) is less than 1000 cells/µL. The ANC is determined by multiplying the total WBC count by the percentage of neutrophils. The ANC of a patient with a WBC count of 9000/µL and 10% neutrophils is 900 cells/µL. Therefore the nurse suspects neutropenia in this patient. The ANC of a patient who has a WBC count of 5000/µL and 30% neutrophils is 1500 cells/µL, which does not indicate neutropenia. The ANC of a patient with a WBC count of 7000/µL and 30% neutrophils is 2100 cells/µL, which is normal. Therefore the nurse does not suspect neutropenia in this patient. The ANC of patient who has a WBC count of 10,000/µL and 10% neutrophils is 1000 cells/µL, which is normal and does not indicate neutropenia.

Which instructions would the nurse include when teaching home care measures to a patient diagnosed with hemophilia? Select all that apply. Select all that apply Avoid contact sports. Perform oral hygiene daily. Use alcohol-based mouthwashes. Wear gloves while doing household chores. Blow your nose with force if there is a nosebleed.

Avoid contact sports. Perform oral hygiene daily. Wear gloves while doing household chores.

A female patient has been diagnosed with hemophilia. Which family background information is possible? Select all that apply. Select all that apply Both the mother and father have hemophilia. The father has hemophilia and the mother is a carrier of the mutated gene for hemophilia. The mother has hemophilia and the father is a carrier of the mutated gene for hemophilia. The father has hemophilia and the mother is neither hemophilic nor a carrier of the mutated gene for hemophilia. The mother has hemophilia and the father is neither hemophilic nor a carrier of the mutated gene for hemophilia.

Both the mother and father have hemophilia. The father has hemophilia and the mother is a carrier of the mutated gene for hemophilia. Hemophilia is an X-linked recessive disorder. If a female (X'X') has hemophilia, it indicates that the sex chromosomes derived from each parent (XX and XY) contain the mutation causing hemophilia. Therefore, either both the parents are hemophilic (X'X' and X'Y), or the father (X'Y) is hemophilic and the mother is a carrier (X'X). The father has only one X chromosome. Therefore, if he has the mutated gene for hemophilia, he has hemophilia; the father cannot be the carrier of this disease. If the father has hemophilia (X'Y) and the mother is neither hemophilic nor a carrier of the mutated gene for hemophilia (XX), the daughter becomes the carrier of the mutation (X'X). If the mother has hemophilia (X'X') and the father is neither hemophilic nor a carrier of the mutated gene for hemophilia (XY), the daughter becomes a carrier of the mutated gene (X'X).

Which measures to decrease the incidence of sickle cell disease would the nurse include in developing a community program? Proper nutrition Carrier screening Passive immunization Bone marrow transplantation

Carrier screening

Which symptom would the nurse expect to find in a patient with vitamin B 12 deficiency? Lack of physical strength or energy Pain in the pelvis, ribs, spine, and sternum Abnormal sensitivity to touch or pressure on the sternum Numbness sensation, impaired muscle movement, and extreme sensitivity in nerves

Numbness sensation, impaired muscle movement, and extreme sensitivity in nerves Cobalamin deficiency can affect the production of red blood cells (RBCs). A deficiency of RBCs in the blood circulation can manifest as a numbness sensation, impaired muscle movement, and extreme sensitivity in nerves. Lacking physical strength or energy is the sign of low hemoglobin level (anemia). Pain in the pelvis, ribs, spine, and sternum is the symptom of multiple myeloma. Abnormal sensitivity to touch or pressure on the sternum is a sign of leukemia.

Which assessment finding in a patient with severe neutropenia requires immediate action by the nurse? Patient reports fatigue. BP is 106/72 mm Hg. Patient reports nausea and anorexia. Oral temperature is 100.5° F (36.7° C).

Oral temperature is 100.5° F (36.7° C). A low-grade fever in neutropenic patients is of great significance because it may indicate infection and lead to septic shock and death unless treated promptly. Neutropenic fever (greater than 100.4° F [38.1° C]) in a severely neutropenic patient is a medical emergency. Patients who have had chemotherapy induced neutropenia may experience nausea, anorexia, and fatigue. These symptoms may be treated; however, they are not the priority. The BP is normal.

The nurse is caring for a patient with severe anemia. The nurse expects which compensatory respiratory changes? Select all that apply. Select all that apply Orthopnea Tachypnea Dyspnea at rest Dyspnea on exertion Impaired thought process

Orthopnea Tachypnea Dyspnea at rest The compensatory respiratory changes that occur in severe anemia are orthopnea, tachypnea, and dyspnea at rest. Impaired thought process is a neurologic symptom associated with severe anemia. Dyspnea on exertion is seen in mild anemia.

A patient with factor VIII deficiency experiences joint bleeding. Which interventions would be included in the patient's plan of care? Select all that apply. Select all that apply Administer aspirin. Pack the joint in ice. Provide analgesics such as acetaminophen. Encourage the patient to perform weight-bearing activity to increase muscle strength. Encourage the patient to perform range-of-motion exercises when bleeding is stopped.

Pack the joint in ice. Provide analgesics such as acetaminophen. Encourage the patient to perform range-of-motion exercises when bleeding is stopped. Factor VIII deficiency leads to hemophilia, which is a severe bleeding disorder. When joint bleeding occurs, the joint should be packed in ice to reduce bleeding. Analgesics such as acetaminophen should be provided to reduce pain. When bleeding is stopped, the patient should be encouraged to perform range-of-motion exercises to increase mobilization. Aspirin should be avoided because it may increase bleeding. Weight-bearing activity should be performed when the swelling has decreased and muscle strength has returned.

Which self-care strategies would the nurse include when preparing to discharge a patient with hemophilia who developed bleeding in a knee joint? Select all that apply. Select all that apply Packing the joint with ice Resting during an acute episode Taking high-dose aspirin to reduce pain Avoiding weight bearing until swelling subsides Avoiding mobilization until the muscle regains strength

Packing the joint with ice Resting during an acute episode Avoiding weight bearing until swelling subsides Hemophilia increases the risk of bleeding in joints. Packing the joint with ice provides comfort and reduces inflammation. Providing rest to the affected joint is important to promote healing and prevent further bleeding. Weight bearing should be avoided until the swelling subsides and muscle strength improves. Aspirin-based medications should be avoided because they increase the risk for bleeding. Mobilization of the joint should be started as soon as the bleeding stops in order to facilitate healing; immobilization may cause stiffness of the joint.

Which strategy is most important for a nurse to include when planning care for a patient who has neutropenia? Restricting all visitors Placing the patient in a private room Advising the patient to use only an electric shaver Wearing a gown and gloves when in direct contact with the patient

Placing the patient in a private room Neutropenia is the reduction in the number of neutrophils in the blood. This leaves a patient prone to infection. The risk of infection can be reduced by placing a patient in a private room. Restriction of all visitors is not necessary; however, visitors with signs and symptoms of infections, such as a cough or fever, should be restricted. Use of an electric shaver would be recommended for a patient taking anticoagulants but is not required for this condition. Wearing a gown and gloves when in direct contact with the patient is not necessary; however, meticulous hand hygiene is a must. If the patient is in protective isolation, a mask will need to be worn.

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? Select all that apply. Select all that apply Anemia Asthma Immobility Use of morphine Use of corticosteroids

anemia immboility A nurse must be aware of the reasons for skin breakdown. Anemia results in poor circulation and predisposes a patient to skin breakdown. Immobility puts undue pressure on the bony prominences and increases the risk of skin breakdown. Morphine and corticosteroids can result in delirium but do not increase the risk of skin breakdown. Asthma is a respiratory disorder and is not related to skin breakdown.

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 Reduced protein synthesis Decreased HCl acid secretion Destruction of α-cells of islets of Langerhans

atrophy of gastric mucosa The aging process causes atrophy of the gastric mucosa and decreases blood flow to the stomach. It also causes cobalamin malabsorption, which results in anemia. Reduced protein synthesis decreases hormone metabolism. Decreased HCl acid secretion causes hypochlorhydria. Destruction of α-cells of the islets of Langerhans causes diabetes mellitus.

The nurse provides dietary teaching to a patient with anemia and would include which food sources to promote red blood cell (RBC) maturation? Select all that apply. Select all that apply Shellfish Bananas Avocados Red meat Cornmeal

avocados red meat Avocado contains niacin, which is required for the maturation of RBC. Red meat is rich in cobalamin (vitamin B 12). Cobalamin is an essential nutrient that plays an important role in erythropoiesis by enhancing the RBC maturation. Therefore the nurse would expect these two food sources to promote red blood cell (RBC) maturation. Shellfish contains copper, which is an essential nutrient useful for mobilization of iron from tissues to plasma. Bananas and cornmeal are rich in pyridoxine (vitamin B 6), which is essential for hemoglobin synthesis.

A patient's laboratory reports reveal a platelet level of 18,000/μL. Which nursing actions will help prevent bleeding complications associated with this lab finding? Select all that apply. Select all that apply Avoid invasive procedures. Ensure proper hand washing. Include iron-rich food in the diet. Obtain a prescription for a platelet transfusion. Instruct the patient to avoid activities that increase the risk of injury.

avoid invasive procedures Obtain a prescription for a platelet transfusion. Instruct the patient to avoid activities that increase the risk of injury. The patient is at increased risk of bleeding because the platelet levels are below 20,000/μL. The nurse should avoid any invasive procedures because these can cause bleeding. Platelet transfusion should be performed to increase the platelet levels. The patient should avoid all activities that increase the risk of injury and bleeding, because even a minor injury can result in huge blood loss. Proper hand washing should be performed before and after handling any patient; however, it does not help to decrease the bleeding risk. Including iron-rich food in the diet helps to manage anemia but may not be helpful in decreasing the risk of bleeding.

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 Severe anemia Aplastic anemia Moderate anemia

mild In mild anemia, hemoglobin is in the range of 10-12 g/dL. In severe anemia, it is less than 6 g/dL. Aplastic anemia refers to a type of anemia caused by a decrease in red blood cell precursors. It does not refer to the severity of anemia. In moderate anemia, the hemoglobin it is in the range of 6-10 g/dL. Hemoglobin above 12 g/dL is considered normal (no anemia).

A nurse recalls which test as helpful for the identification of types of hemolytic anemia? Ferritin Coombs test Reticulocyte count Erythrocyte sedimentation rate

coombs test A Coombs test is used to determine the Rh status of a person. Identification of the types of hemolytic anemia can be done by the Coombs test. Ferritin is used to determine major iron storage protein. It is normally present in blood in concentrations directly related to iron storage. A reticulocyte count helps to measure immature red blood cells, a reflection of bone-marrow activity in producing red blood cells. The erythrocyte sedimentation rate is used to measure sedimentation or settling of red blood cells in one hour. Inflammatory processes cause an alteration in plasma proteins, resulting in aggregation of red blood cells and making them heavier, thus changing the sedimentation rate.

Which condition would the nurse monitor for in a patient who has a hemoglobin level of 20 g/dL? Anemia Dehydration Fluid volume excess internal hemmorhage

dehydration The hemoglobin level in a normal healthy adult is 11 to 17 g/dL. The hemoglobin level may increase as a result of hemoconcentration as found in dehydration. A patient with anemia would have a low hemoglobin level due to decreased production of red blood cells (RBCs). A patient with fluid volume excess would have a low hemoglobin level due to hemodilution. A patient with internal hemorrhage would not have a high hemoglobin level of 20 g/dL; the patient would have a low hemoglobin level due to loss of intravascular volume.

Which symptoms would the nurse expect to find in a patient who has a white blood cell (WBC) count of 5000/µL, a platelet count of 90,000/µL, and an absolute neutrophil count (ANC) of 1200 cells/µL.? Pruritus Ecchymosis Spider nevus The mucosa of the tongue is thin and red.

ecchymosis The patient's laboratory report values reveal a platelet count of 90,000/µL, which is very low compared to the normal value. The normal range of a platelet count is 150,000 to 4,000,000/µL. The other laboratory values such as WBC and ANC are within the normal range. Therefore the patient has thrombocytopenia and may have ecchymosis, the result of hemorrhage into the skin. Pruritus can be observed in patients with increased bilirubin levels. Spider nevus may occur in the patients with increased estrogen levels due to pregnancy or liver disease. Thin and red mucosa of the tongue may occur due to pernicious anemia or iron-deficiency anemia.

Which replacement blood products may be administered to a patient with hemophilia who is scheduled for an invasive dental procedure? Select all that apply. Select all that apply Thrombin Factor VI Factor VIII Factor IX Desmopressin acetate (DDAVP)

factor VIII Factor IX Desmopressin acetate (DDAVP) Replacement of deficient clotting factors is the primary means of supporting a patient with hemophilia. In addition to treating acute crises, replacement therapy may be given before surgery and dental care as a prophylactic measure. For hemophilia, the clotting factors include Factor VIII and Factor IX, as well as the administration of DDAVP, a synthetic analog of vasopressin, which may be used to stimulate an increase in factor VIII. Thrombin and Factor VI are not used to replace clotting factors in hemophiliacs.

Which condition would the nurse assess for in a 70-year-old patient who has anemia and poor intestinal iron absorption? Stomatitis Gastrointestinal bleeding Decreased total serum iron Decreased total iron-binding capacity

gastrointestinal bleeding x Hemoglobin levels commonly decrease in both men and women after middle age. However, the nurse should also check for signs of gastrointestinal bleeding. Stomatitis is an inflammation of the mucous lining of any of the structures in the mouth, which may involve the cheeks, gums, tongue, lips, throat, and roof or floor of the mouth. Severe iron-deficiency anemia can lead to stomatitis, but stomatitis does not cause anemia. Total serum iron and total iron-binding capacity are decreased in older adults but do not account for potential alterations due to disease process and do not result in anemia.

The nurse reviews documentation of assessment findings of a patient with severe anemia. Which assessment finding would the nurse question? Pallor Pruritus Jaundice Hyperpigmentation

hyperpigmentation Common integumentary changes observed in anemia include pallor, pruritus, and jaundice. Pallor results from reduced amounts of hemoglobin and reduced blood flow to the skin. Pruritus occurs because of increased serum and skin bile salt concentration. Jaundice occurs when hemolysis of red blood cells (RBCs) results in an increased concentration of serum bilirubin. Hyperpigmentation is usually not associated with anemia.

Which therapeutic outcome would the nurse expect for a patient with hemophilia A prescribed desmopressin acetate? Increase in factor VIII Increase platelet count Increase in hemoglobin Increase in neutrophil count

increase in factor VIII Ecchymosis and subcutaneous hematomas are the clinical manifestations of bleeding in a patient with hemophilia A. Desmopressin acetate is used to stimulate an increase in factor VIII in patients with hemophilia. An increase in platelet count is a therapeutic outcome related to corticosteroids and immunosuppressants, which are used in the treatment of thrombocytopenia. An increase in hemoglobin is seen in the patients who are receiving erythropoietin therapy for anemia. Granulocyte colony-stimulating factors such as filgrastim and pegfilgrastim are used in the treatment of neutropenia. These drugs stimulate the production of neutrophils, thereby increasing the neutrophil count.

Which condition may cause a patient to develop anemia due to decreased hemoglobin synthesis? Leukemia Iron deficiency Cobalamin deficiency G6PD enzyme deficiency

iron deficiency Iron deficiency may cause anemia due to decreased hemoglobin synthesis. Leukemia may cause anemia due to a decreased number of red blood cell (RBC) precursors. Cobalamin deficiency may result in anemia due to defective deoxyribonucleic acid (DNA) synthesis. G6PD enzyme deficiency is hereditary and causes increased RBC destruction (hemolytic anemias).

The nurse understands that with repeated episodes of sickling, which organ is mostaffected? Liver Heart Lungs Stomach

lungs With repeated episodes of sickling, there is gradual involvement of all body systems and organs, especially the spleen, lungs, kidneys, and brain. Organs that have a need for large amounts of O 2, like the lungs, are most often affected and form the basis for many of the complications of sickle cell disease (SCD). Although the liver, heart, and stomach may be affected, they are less so when compared to the lungs.

Which assessment finding would the nurse associate with severe anemia? Pallor Diarrhea Palpitations Exertional dyspnea

pallor The integumentary finding of pallor is associated with severe anemia. Gastrointestinal diarrhea is not associated with anemia. Cardiovascular palpitations are associated with mild anemia. Pulmonary exertional dyspnea is associated with mild anemia.

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? Select all that apply. Select all that apply Pallor Cheilitis Jaundice Paresthesias Hepatomegaly

pallor cheilitis paresthesia The normal range of total serum iron level is 50 to 175 mcg/dL. The normal range of hemoglobin is 13.2 to 17.3 g/dL in males and 11.7 to 15.5 g/dL in females. Therefore a hemoglobin value of 10 g/dL and total iron of 40 mcg/dL are indicative of iron-deficiency anemia, which may be due to blood loss from peptic ulcer disease. The clinical manifestations of iron-deficiency anemia are pallor, cheilitis (inflammation of the lips), and paresthesias. Hepatomegaly may occur in patients with thalassemia due to iron deposition. Jaundice occurs due to prominent hemolysis of red blood cells in patients with thalassemia.

A patient's laboratory report reveals a hemoglobin (Hgb) level of 11 g/dL. The nurse expects to observe which clinical manifestation? Glossitis Palpitations Dyspnea at rest Roaring in the ears

palpations An Hgb range of 10 to 12 g/dL indicates mild anemia. Therefore the patient with an Hgb of 11 g/dL may experience palpitations. Glossitis is one of the manifestations of severe anemia in which the patient would have an Hgb level below 6 g/dL. Exertional dyspnea is seen in patients with mild anemia. However, dyspnea at rest is a manifestation of severe anemia. Roaring in the ears is seen in patients with moderate anemia whose Hgb values range between 6 and 10 g/dL.

Which abnormal finding would the nurse relate to hemostasis abnormalities? Pruritus Purpura Weakness Pale conjunctiva

purpura Purpura may occur when platelets or clotting factors are decreased and bleeding into the skin occurs. Pruritus is not related to hemostasis but to hematologic cancers (e.g., lymphomas, leukemias) or increased bilirubin. Weakness and pale conjunctiva are not related to hemostasis unless a lot of bleeding leads to anemia with a low hemoglobin level.

Which finding supports the nurse's conclusion that a patient has pernicious anemia? Bleeding of the gums Smooth, beefy-red tongue Spoon-shaped concave nails Fissures in corners of the mouth

smooth, beefy red tongue Pernicious anemia is characterized by the presence of abdominal pain and a smooth, beefy-red tongue. Platelet function is reduced in the patient with leukemia; therefore bleeding from the gums is associated with leukemia. The presence of spoon-shaped, concave nails and fissures in the corners of the mouth is associated with iron-deficiency anemia.

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 (GI) system? Liver Stomach Esophagus Small intestine

stomach Age-related changes in the stomach include atrophy of the gastric mucosa and decreased blood flow. The results are food intolerance, signs of anemia (as a result of cobalamin malabsorption), and slower gastric emptying. Impaired liver function can result in decreased drug and hormone metabolism. Improper functioning of the esophagus can cause epigastric distress. Impaired functional activity of the small intestine can slow the intestinal tract and cause delayed absorption of fat-soluble vitamins.