Exam 1 - Chapter 20
The nurse cares for an older adult client with unprovoked back pain and increased serum protein. Which hematologic neoplasm does the nurse suspect the client has? Chronic myeloid leukemia Multiple myeloma Hodgkin lymphoma Non-Hodgkin lymphoma
Multiple myeloma
The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? "Acute leukemia develops slowly." "Chronic leukemia develops slowly." "In chronic leukemia, the minority of leukocytes are mature." "In acute leukemia there are not many undifferentiated cells."
"Chronic leukemia develops slowly."
The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care? "Treatment is simple and consists of single-drug therapy." "Intrathecal chemotherapy is used primarily as preventive therapy." "The goal of therapy is palliation." "Side effects are rare with therapy."
"Intrathecal chemotherapy is used primarily as preventive therapy."
A patient describes numbness in the arms and hands with a tingling sensation. The patient also frequently stumbles when walking. What vitamin deficiency does the nurse determine may cause some of these symptoms? Thiamine Folate B12 Iron
B12 The hematologic effects of vitamin B12 deficiency are accompanied by effects on other organ systems, particularly the gastrointestinal tract and nervous system. Patients with pernicious anemia may become confused; more often, they have paresthesias in the extremities (particularly numbness and tingling in the feet and lower legs). They may have difficulty maintaining their balance because of damage to the spinal cord, and they also lose position sense (proprioception).
The nurse is educating a client about iron supplements. The nurse teaches that what vitamin enhances the absorption of iron? C A D E
C
A client with multiple myeloma reports pain along the spinal column. The client is prescribed naproxen (Aleve) and oxycodone. Prior to administering these medications, the nurse Checks the client's BUN and creatinine Instructs the client not to lift more than 20 pounds Teaches the client to bend at the back when lifting objects Questions the physician about the use of both medications
Checks the client's BUN and creatinine
A client who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action? Ask the client whether they have recently fallen. Evaluate the client's INR. Keep the client on bed rest. Evaluate the client's platelet count.
Evaluate the client's platelet count. Complications of AML include bleeding. The risk of bleeding correlates with the level and duration of platelet deficiency. Major hemorrhages may develop when the platelet count drops to less than 10,000/mm3. The bleeding is usually unrelated to falling. Keeping the client on bed rest will not prevent bleeding when the client has a low platelet count. Assessment for other areas of bleeding is also a priority intervention.
The nurse is caring for a client with chronic myeloid leukemia (CML). The nurse knows that which symptoms indicate the client is in the accelerated phase of the condition? Select all that apply. Fatigue Dyspnea Bone pain Confusion Splenomegaly
Fatigue Dyspnea Bone pain Confusion Splenomegaly
The nurse is currently planning the care of a patient with multiple myeloma who is experiencing bone destruction. When reviewing the patient's most recent blood work, what value would the nurse pay particular attention to? Hypercalcemia Hyperproteinemia Elevated serum viscosity Elevated red blood cell (RBC) count
Hypercalcemia
A patient with AML is having aggressive chemotherapy to attempt to achieve remission. The patient is aware that hospitalization will be necessary for several weeks. What type of therapy will the nurse explain that the patient will receive? Induction therapy Supportive therapy Antimicrobial therapy Standard therapy
Induction therapy
The nurse should notify the healthcare provider before administering fresh frozen plasma (FFP) based on which assessment finding? White sclera Jugular venous distention Strong pedal pulses Absence of tenting skin turgor
Jugular venous distention
A nurse cares for a client with myelodysplastic syndrome (MDS). Which assessment finding does the nurse recognize is the most common finding with this condition? Macrocytic anemia Microcytic anemia Proliferative anemia Hemolytic anemia
Macrocytic anemia Macrocytic anemia is the most common symptom of MDS.
A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client? Pallor, bradycardia, and reduced pulse pressure Pallor, tachycardia, and a sore tongue Sore tongue, dyspnea, and weight gain Angina pectoris, double vision, and anorexia
Pallor, tachycardia, and a sore tongue
The nurse obtains a unit of blood for the client, Donald D. Smith. The name on the label on the unit of blood reads Donald A. Smith. All the other identifiers are correct. What action should the nurse take? Administer the unit of blood Check with the blood bank first and then administer the blood with their permission Refuse to administer the blood Ask the client if he was ever known as Donald A. Smith
Refuse to administer the blood
A client is prescribed 325 mg/day of oral ferrous sulfate. What does the nurse include in client teaching? Take 1 hour before breakfast Take with dairy products Decrease intake of fruits and juices Decrease intake of dietary fiber
Take 1 hour before breakfast
A client with polycythemia vera reports gouty arthritis symptoms in the toes and fingers. What is the nurse's best understanding of the pathophysiological reason for this symptom? The dead red blood cells release excess uric acid. The dead red blood cells occlude the small vessels in the joints. Excess red blood cells produce extracellular toxins that build up. Excess red blood cells cause vascular injury in the joints.
The dead red blood cells release excess uric acid.
Folate deficiency occurs in people who rarely eat which of the following? Uncooked vegetables Meat Fruit Bread
Uncooked vegetables
Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called blast cells. megaloblasts. mast cells. monocytes.
megaloblasts.
The nurse is discussing disorders of the hematopoietic system when a client asked about erythrocytosis. What disease will the nurse mention with a primary characteristic of erythrocytosis? polycythemia vera sickle cell disease aplastic anemia pernicious anemia
polycythemia vera
A client with megaloblastic anemia reports mouth and tongue soreness. What instruction will the nurse give the client regarding eating while managing the client's symptoms?. "Eat small amounts of bland, soft foods frequently." "Eat larger amounts of bland, soft foods less frequently." "Eat cold, bland foods with a large amount of water." "Eat low-fiber blended foods only."
"Eat small amounts of bland, soft foods frequently."
Which statement indicates the client understands teaching about induction therapy for leukemia? "I will start slowly with medication treatment." "I will need to come every week for treatment." "I will be in the hospital for several weeks." "I know I can never be cured."
"I will be in the hospital for several weeks."
Which client is most at risk for developing disseminated intravascular coagulation (DIC)? A client admitted with suspected cocaine overdose A client with an amniotic fluid embolism A client with a stage IV pressure ulcer A client with heart failure and renal failure
A client with an amniotic fluid embolism
A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving: A-positive blood to an A-negative client. O-negative blood to an O-positive client. O-positive blood to an A-positive client. B-positive blood to an AB-positive client.
A-positive blood to an A-negative client.
A 20-year-old man has been admitted to the emergency department with a femoral fracture as a result of a motorcycle accident. When the nurse is taking the patient's history, he states, "I had leukemia when I was little kid but they managed to cure it." The nurse should suspect that this patient likely had what type of leukemia? Acute lymphoid leukemia (ALL) Chronic lymphoid leukemia (CLL) Acute myeloid leukemia (AML) Chronic myeloid leukemia (CML)
Acute lymphoid leukemia (ALL)
A 50-year-old woman was recently diagnosed with non-Hodgkin's lymphoma (NHL) and has begun a treatment regimen that includes simultaneous radiation therapy and chemotherapy. The combination of severe symptoms and aggressive therapy has necessitated admission to the hospital. When providing care for this patient, which of the following actions should the nurse implement? Encouraging frequent mobilization and independence in activities of daily living Applying standard precautions conscientiously to reduce the patient's risk of infection Providing meticulous skin care and turning the patient at least once every 2 hours Monitoring the patient's bowel pattern and facilitating a high-fiber diet
Applying standard precautions conscientiously to reduce the patient's risk of infection
The client has been diagnosed with myelodysplastic syndrome with an absolute neutrophil count less than 1000/mm³ and is being admitted to the hospital. The nurse Assigns the client to a private room Allows unlicensed assistive personnel who reports having a sore throat to provide care Places the client in isolation and allows no visitors Changes the water in the humidifier for oxygen therapy every 48 hours
Assigns the client to a private room
A client reports feeling tired, cold, and short of breath at times. Assessment reveals tachycardia and reduced energy. What would the nurse expect the physician to order? CBC antibiotic chest radiograph ECG
CBC
A male client has been receiving a continuous infusion of weight-based heparin for more than 4 days. The client's PTT is at a level that requires an increase of heparin by 100 units per hour. The client has the laboratory findings shown above. What is the most important action for the nurse to take? Continue with the present infusion rate of heparin. Consult with the physician about discontinuing heparin. Begin treatment with the prescribed warfarin (Coumadin). Increase the heparin infusion by 100 units per hour.
Consult with the physician about discontinuing heparin.
A client receiving a unit of packed red blood cells (PRBCs) has been prescribed morphine 1 mg intravenously now for pain. What is the best method for the nurse to administer the morphine? Add the morphine to the blood to be slowly administered. Inject the morphine into a distal port on the blood tubing. Administer the morphine into the closest tubing port to the client for fast delivery. Disconnect the blood tubing, flush with normal saline, and administer morphine.
Disconnect the blood tubing, flush with normal saline, and administer morphine.
A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse know is the most likely clinical disorder the patient is being treated for? Essential thrombocythemia Extreme leukocytosis Sickle cell anemia Renal transplantation
Essential thrombocythemia
A nurse assisting at a blood donation drive is screening individuals for eligibility. An individual would be rejected if he or she had: A hemoglobin level of 14.5 g/dL. Oral surgery within 72 hours. A body weight of 60 kg. Received a blood transfusion 15 months prior to the current date for donating.
Oral surgery within 72 hours.
The client is diagnosed with polycythemia vera. The nurse prepares the client for which procedure? Apheresis Phlebotomy Blood transfusion Platelet infusion
Phlebotomy
The nursing instructor is discussing disorders of the hematopoietic system with the pre-nursing pathophysiology class. What disease would the instructor list with a primary characteristic of erythrocytosis? Polycythemia vera Sickle cell disease Aplastic anemia Pernicious anemia
Polycythemia vera
A nurse is caring for a client with multiple myeloma. Which nursing intervention is most appropriate for this client? Monitoring respiratory status Balancing rest and activity Restricting fluid intake Preventing bone injury
Preventing bone injury
A client has pernicious anemia and has been receiving treatment for several years. Which symptom may be confused with another condition in older adults? dementia stomatitis glossitis ataxia
dementia
A preoperative client is discussing blood donation with the nurse. Which statement by the client indicates to the nurse the need for further teaching? "My family will donate blood, because it's safer." "I should expect blood withdrawal to take about 15 minutes." "Donated blood is tested for blood type and infections." "I could donate my own blood in case I need a transfusion."
"My family will donate blood, because it's safer." Directed donations from friends and family members are not any safer than those provided by random donors. Withdrawal of 450 mL of blood usually takes about 15 minutes. Specimens from donated blood are tested to detect infections and to identify the specific blood type. Autologous blood donation is useful for many elective surgeries where the potential need for transfusion is high.
The nurse is interacting with a family that has been caring for a client with cancer for several months. What are the best interventions to assist in relieving caregiver stress in this family? Select all that apply. Educate the family about medications and side effects. Allow family members to express feelings. Suggest support for household maintenance. Suggest the prescription of antianxiety medications. Suggest the family go to church more often.
Educate the family about medications and side effects. Allow family members to express feelings. Suggest support for household maintenance.
Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents? Hypochromic Normocytic Microcytic Hyperchromic
Hypochromic
A nursing instructor is evaluating a student caring for a neutropenic client. The instructor concludes that the nursing student demonstrates accurate knowledge of neutropenia based on which intervention? Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential Monitoring the client's breathing and reviewing the client's arterial blood gases Monitoring the client's heart rate and reviewing the client's hemoglobin Monitoring the client's blood pressure and reviewing the client's hematocrit
Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential
A nurse is caring for a client with iron deficiency anemia. Which food or beverage will the nurse suggest to the client to eat or drink when taking supplemental iron? Milk Orange juice Leafy green vegetables Kidney beans
Orange juice
The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? Osteopathic tumors destroy bone causing fractures. Osteoclasts break down bone cells so pathologic fractures occur. Osteolytic activating factor weakens bones producing fractures. Osteosarcomas form producing pathologic fractures.
Osteoclasts break down bone cells so pathologic fractures occur.
Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? Pancytopenia Anemia Leukopenia Thrombocytopenia
Pancytopenia Pancytopenia 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.
The nurse has completed a plan of care for a patient who has been hospitalized for the treatment of acute leukemia. When planning this patient's care, the nurse has specified that assessments be performed more often than is the unit norm. Frequent, thorough assessments are indicated in the treatment of patients with acute leukemia because: Changes in condition must be identified early because treatment options do not normally exist. Patients with leukemia are often unable to accurately describe their symptoms. Leukemia has characteristics of chronic diseases as well as acute illnesses. Patients with leukemia often experience clinical changes that may be subtle and nonspecific.
Patients with leukemia often experience clinical changes that may be subtle and nonspecific.
After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/mm3. What term should the nurse use to describe this low platelet count? Anemia Leukopenia Thrombocytopenia Neutropenia
Thrombocytopenia
A nurse cares for clients with hematological disorders and notes that women are diagnosed with hemochromatosis at a much lower rate than men. What is the primary reason for this? Women lose iron through menstrual cycles Women rarely manifest the gene expression Women have lower hemoglobin levels Women require grater folic acid supplementation
Women lose iron through menstrual cycles Hemochromatosis is a genetic condition where excess iron is absorbed in the GI tract and deposited in various organs, making them dysfunctional. Women are often less affected than men because women lose excess iron through their menstrual cycles. The other answer choices are not correct reasons why women are impacted less than men with hemochromatosis.
The nurse and the client are discussing some strategies for ingesting iron to combat the client's iron-deficiency anemia. Which is among the nurse's strategies? Drink liquid iron preparations with a straw. Take iron with an antacid to avoid stomach upset. Avoid vitamin C as it prevents absorption. Taking iron pills with milk aids in absorption.
Drink liquid iron preparations with a straw.
A client with anemia is prescribed an oral iron supplement. Which statement indicates that teaching about this supplement has been effective? "I will stop taking it if my stool turns black." "I will take it in the morning with orange juice." "I will be sure to take this medication with food." "I will limit my intake of raw fruit and vegetables."
I will take it in the morning with orange juice. The client should be instructed to take the iron supplements on an empty stomach with a source of vitamin C such as orange juice. Iron supplements will turn the stool dark or black; this does not indicate that the supplement should be stopped. The supplement should be taken 1 hour before meals or 2 hours after a meal and not with a meal. The client should be instructed to increase the intake of high-fiber foods to reduce the risk of constipation.
The nurse suspects a client's diagnosis of acute myeloid leukemia (AML) will be confirmed. What laboratory result is consistent with the medical diagnosis? Erythrocyte count of 5.8 million per µL Platelet count of 300,000/mm3 Neutrophil reading of 60% Immature blast cells greater than 20%
Immature blast cells greater than 20%
A nurse provides nutritional information for a patient diagnosed with an iron-deficiency anemia. What education should the nurse provide? Decrease the intake of citrus fruits because they interfere with iron absorption. Take an iron supplement with meals to reduce gastric irritation. Increase the intake of green, leafy vegetables. Decrease the intake of high-fat red meats, especially organ meats.
Increase the intake of green, leafy vegetables.
A patient who has long-term packed RBC (PRBC) transfusions has developed symptoms of iron toxicity that affect liver function. What immediate treatment should the nurse anticipate preparing the patient for that can help prevent organ damage? Iron chelation therapy Oxygen therapy Therapeutic phlebotomy Anticoagulation therapy
Iron chelation therapy
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
A client with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse? Inform the client that the position must be changed, and then you will give her pain medication and omit the bath. Inform the client that she will feel better after receiving a bath and clean sheets. Obtain the pain medication and delay the bath and position change until the medication reaches its peak. Inform the client that the bath and positioning is an important part of client care and will be done right after pain medication administration.
Obtain the pain medication and delay the bath and position change until the medication reaches its peak.
A critical care nurse is caring for a patient with autoimmune hemolytic anemia. The patient is not responding to conservative treatments, and her condition is now becoming life-threatening. The nurse is aware that a treatment option in this case may include what? Hepatectomy Vitamin K administration Platelet transfusion Splenectomy
Splenectomy
A client is treated for anemia. What is the nurse's best understanding about the correlation between anemia and the client's iron stores? There is a strong correlation between iron stores and hemoglobin levels. There is a strong correlation between iron stores and hemoglobin characteristics. There is an inverse relationship between iron stores and hemoglobin levels. There is a weak correlation between iron stores and hemoglobin levels.
There is a strong correlation between iron stores and hemoglobin levels. A strong correlation exists between laboratory values that measure iron stores and hemoglobin levels. After iron stores are depleted (as reflected by low serum ferritin levels), the hemoglobin level falls.
A young client is diagnosed with a mild form of hemophilia and is experiencing bleeding in the joints with pain. In preparing the client for discharge, what instructions should the nurse provide? Take ibuprofen for joint pain. Take warm baths to lessen pain. Wear a medical identification bracelet. Undergo genetic testing and counseling if the client is male.
Wear a medical identification bracelet.
The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care? "Treatment is simple and consists of single-drug therapy." "Intrathecal chemotherapy is used primarily as preventive therapy." "The goal of therapy is palliation." "Side effects are rare with therapy."
"Intrathecal chemotherapy is used primarily as preventive therapy." Intrathecal chemotherapy is a key part of the treatment plan to prevent invasion of the central nervous system. The therapy uses multiple drugs, with many side effects. The goal of therapy is remission.
A client diagnosed with polycythemia vera has come into the clinic because he has developed a nighttime cough, fatigue, and shortness of breath. What complication would you suspect in this client? Stroke Tissue infarction Congestive heart failure Pulmonary embolus
Congestive heart failure The symptoms exhibited by this client are indicative of congestive heart failure. Complications include hypertension, congestive heart failure, stroke, tissue and organ infarction, and hemorrhage. Stroke would present with headache, aphasia, and/or numbness in extremities. Tissue infarction would involve extremity discoloration or an organ failure. Pulmonary embolism would be associated with chest pain.
You are caring for a 13-year-old diagnosed with sickle cell anemia. The client asks you what they can do to help prevent sickle cell crisis. What would be an appropriate answer to this client? Avoid any sports that tire you out. Drink at least 8 glasses of water every day. Avoid any activity that makes you short of breath. Stay on oxygen therapy 24/7.
Drink at least 8 glasses of water every day. During the physical examination, observe the client's appearance, looking for evidence of dehydration, which may have triggered a sickle cell crisis. Clients are taught moderation, not avoidance of activities. Most clients with sickle cell disease are not on oxygen therapy 24/7.
The nurse and the client are discussing some strategies for ingesting iron to combat the client's iron-deficiency anemia. Which is among the nurse's strategies? Drink liquid iron preparations with a straw. Take iron with an antacid to avoid stomach upset. Avoid vitamin C as it prevents absorption. Taking iron pills with milk aids in absorption.
Drink liquid iron preparations with a straw. Dilute liquid preparations of iron with another liquid such as juice and drink with a straw to avoid staining the teeth. Avoid taking iron simultaneously with an antacid, which interferes with iron absorption. Drink orange juice or take other forms of vitamin C with iron to promote its absorption.
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
The nurse is educating a patient with iron deficiency anemia about food sources high in iron and how to enhance the absorption of iron when eating these foods. What can the nurse inform the client would enhance the absorption? Eating calf's liver with a glass of orange juice Eating leafy green vegetables with a glass of water Eating apple slices with carrots Eating a steak with mushrooms
Eating calf's liver with a glass of orange juice
A nurse prepares a client for a bone marrow biopsy who is suspected of having acute myeloid leukemia. What results from the bone marrow biopsy does the nurse expect? Excess of immature leukocytes Excess of immature erythrocytes Deficiency of neutrophils Deficiency of erythrocytes
Excess of immature leukocytes The bone marrow biopsy of a client with acute myeloid leukemia will reveal an excess of immature leukocytes.
A client is receiving chemotherapy for cancer. The nurse reviews the client's laboratory report and notes that he has thrombocytopenia. To which nursing diagnosis should the nurse give the highest priority? Activity intolerance Impaired tissue integrity Impaired oral mucous membranes Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI
Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI These are all appropriate nursing diagnoses for the client with thrombocytopenia. However, the risk of cerebral and GI hemorrhage and hypotension pose the greatest risk to the physiological integrity of the client.
A nurse is developing a care plan for a client with disseminated intravascular coagulation (DIC). Which nursing intervention should the nurse include? Administer aspirin daily as ordered. Provide mouth care every 4 hours with lemon-glycerin swabs. Administer meperidine (Demerol) I.M. as needed for pain. Place a pressure-reducing mattress on the client's bed.
Place a pressure-reducing mattress on the client's bed.
A client at the clinic has just been diagnosed with iron deficiency anemia. What would you recommend the client consume to promote the absorption of iron? Vitamin E Meat, egg yolks, oysters, and shellfish Rich sources of vitamin C Sources of vitamin B12
Rich sources of vitamin C
A client with multiple myeloma reports severe paresthesia in the feet. When planning care for the client, which priority nursing diagnosis will the nurse choose? Acute pain Risk for falls Impaired tissue integrity Sensory-perception disturbance
Risk for falls
The nurse is preparing the patient for a test to determine the cause of vitamin B12 deficiency. The patient will receive a small oral dose of radioactive vitamin B12 followed by a large parenteral dose of nonradioactive vitamin B12. What test is the patient being prepared for? Bone marrow aspiration Schilling test Bone marrow biopsy Magnetic resonance imaging (MRI) study
Schilling test The classic method of determining the cause of vitamin B12 deficiency is the Schilling test, in which the patient receives a small oral dose of radioactive vitamin B12, followed in a few hours by a large, nonradioactive parenteral dose of vitamin B12 (this aids in renal excretion of the radioactive dose).
A client with suspected multiple myeloma is reporting back pain. What is the priority nursing action? Have the client lie on a hard surface. Have the client rest. Encourage ambulation. Send the client for a spinal x-ray study.
Send the client for a spinal x-ray study. The client with myeloma can have bone pain, especially in the back and ribs. The pain will decrease with rest and increase with activity. Lying on a hard surface will not relieve the pain. The priority action is to make certain the client does not have a fractured spine, as the bone destruction in this disease is sufficiently severe to cause vertebral collapse.
A client with multiple myeloma presents to the emergency department and reports excessive thirst and constipation. Family members report that the client has been confused for the last day. Which laboratory value is most likely responsible for this client's symptoms? Platelet count 300,000/mm3 Serum calcium level 13.8 mg/dl Serum sodium level of 133 mEq/L Hemoglobin of 9.8 g/dl
Serum calcium level 13.8 mg/dl
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.
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
During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding? Elevated hematocrit concentration Enlarged mean corpuscular volume (MCV) Low ferritin level concentration Elevated red blood cell (RBC) count
Low ferritin level concentration
A client with a diagnosis of pernicious anemia comes to the clinic complaining of numbness and tingling in his arms and legs. What do these symptoms indicate? Loss of vibratory and position senses Neurologic involvement Severity of the disease Insufficient intake of dietary nutrients
Neurologic involvement
A nurse suspects that a patient may have aplastic anemia based on clinical manifestations and assessment. Which one of the following lab results would be consistent with this diagnosis? Hemoglobin level of 15 g/dL Erythrocyte count of 5.3 m/?L Neutrophil count of 50% Platelet level of 275,000/mm3
Neutrophil count of 50%
The nurse provides care for an older adult client, diagnosed with anemia, who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine the cause of the client's blood loss, which is the priority nursing action? Observe the client's stools for blood. Evaluate the client's dietary intake. Monitor the client's body temperature. Monitor the client's blood pressure.
Observe the client's stools for blood. If an older adult is anemic, blood loss from the gastrointestinal (GI) or genitourinary (GU) tracts is suspected. Observing the stool for blood will determine if the source of the client's bleeding is in the GI tract. Iron-deficiency anemia is unusual in older adults because the body does not eliminate excessive iron, thus increasing total body iron stores and necessitating maintenance of hydration. If evaluation of the GI and GU tracts does not reveal a source of bleeding, evaluating the client's diet may be appropriate; however, this is not the priority nursing action. Monitoring the client's body temperature and BP will assist the nurse in determining the source of the client's blood loss, but these are not priority nursing actions.
A 48-year-old female recently diagnosed with leukemia presents with increased immature lymphocytes, decreased granulocytes, and normal erythrocytes. The client most likely has which type of leukemia? Chronic lymphocytic leukemia Acute lymphocytic leukemia Acute myelogenous leukemia Chronic myelogenous leukemia
Chronic lymphocytic leukemia Clients with CLL are typically older than 40 years of age, have increased immature lymphocytes, normal or decreased granulocytes, but erythrocyte and platelet counts may be normal or low. Clients with ALL are younger than 5 years of age; uncommon after 15 years of age. Clients with AML have a decrease in all myeloid formed cells: monocytes, granulocytes, erythrocytes, and platelets. Clients with CML are similar to those with AML but greater number of normal cells than in acute form.
A nurse is caring for a client with a history of GI bleeding, sickle cell anemia, and a platelet count of 22,000/μl. The client, who is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hour, complains of severe bone pain and is scheduled to receive a dose of morphine sulfate. For which administration route should the nurse question an order? Oral I.V. I.M. Subcutaneous (subQ)
I.M. A client with a platelet count of 22,000/μl bleeds easily. The nurse should avoid using the I.M. route because the area is highly vascular. The client may bleed readily when penetrated by a needle, and it may be difficult for the nurse to stop the bleeding. The client's existing I.V. access would be the best route, especially because I.V. morphine is effective almost immediately. Oral and subQ routes are preferred over I.M., but they're less effective for acute pain management than I.V.
A teenaged client with hemophilia sustains a leg laceration after falling off a skateboard and is brought to the emergency department. The laceration is bleeding profusely even with direct pressure to the site. What does the nurse anticipate will be prescribed for administration to control bleeding? Fresh frozen plasma A colloid solution such as hetastarch (Hespan) A crystalloid solution such as lactated Ringer's Albumin
Fresh frozen plasma Treatment includes transfusion of fresh blood, frozen plasma, factor VIII concentrate, and anti-inhibitor coagulant complex for hemophilia A, factor IX concentrate for hemophilia B, factor XI for hemophilia C, and the application of thrombin or fibrin to the bleeding area. Other measures used to help control bleeding are the administration of fresh frozen plasma, aminocaproic acid that helps to hold a clot in place once it has formed, direct pressure over the bleeding site, and cold compresses or ice packs. Hetastarch, lactated Ringer's, or albumin will not control the bleeding related to hemophilia.
A client has been diagnosed with polycythemia vera. What is the best instruction for the nurse to give to this client? Take a daily multivitamin with iron supplement Maintain adequate blood pressure control Drink alcohol to decrease blood viscosity Bath in tepid or cool water to control itching
Maintain adequate blood pressure control The client with polycythemia vera needs to control blood pressure, because of the increased risk for thrombosis or hemorrhage. Iron supplements can stimulate red blood cell production. Ingestion of alcohol may cause bleeding. Bathing in cool or tepid water may control itching, but this is not as high a priority as preventing thrombosis or hemorrhage.
Place the following steps in order when determining the type and severity of a transfusion reaction. Use all options. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1Stop the transfusion. 2Assess the client. 3Notify the health care provider. 4Notify the blood bank. 5Send the tubing and container to the blood bank.
1Stop the transfusion. 2Assess the client. 3Notify the health care provider. 4Notify the blood bank. 5Send the tubing and container to the blood bank.
A client with a history of congestive heart failure has an order to receive 1 unit of packed red blood cells (RBCs). If the nurse hangs the blood at 12:00 pm, by what time must the infusion be completed? 2:00 pm 3:00 pm 4:00 pm 6:00 pm
4:00 pm
A client in end-stage renal disease is prescribed epoetin alfa and oral iron supplements. Before administering the next dose of epoetin alfa and oral iron supplement, what is the priority action taken by the nurse? Assesses the hemoglobin level Questions the administration of both medications Ensures the client has completed dialysis treatment Holds the epoetin alfa if the BUN is elevated
Assesses the hemoglobin level
A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from? Select all that apply. Infection Blood loss Abnormal erythrocyte production Destruction of normally formed red blood cells Inadequate formed white blood cells
Blood loss Abnormal erythrocyte production Destruction of normally formed red blood cells
A nurse cares for a client with early Hodgkin lymphoma. While assessing the client, the nurse will most likely find painless enlargement of which lymph node? Axillary Cervical Inguinal Popliteal
Cervical
A client with a history of sickle cell anemia has developed iron overload from repeated blood transfusions. What treatment does the nurse anticipate will be prescribed? White blood cell filter Hepatitis B immunization Red blood cell phenotyping Chelation therapy
Chelation therapy
The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly? Crackles auscultated bilaterally Respiratory rate of 10 breaths/minute Oral temperature of 97°F Pain and tenderness in calf area
Crackles auscultated bilaterally Increasing the flow rate of a blood transfusion too rapidly can result in circulatory overload. Fluid overload can be manifested by crackles in the lungs. A decreased respiratory rate and decreased temperature are not manifestations of fluid overload. Pain and tenderness in the calf area may indicate a thrombosis which is not as common a manifestation as fluid overload.
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
A home care nurse is caring for a client with multiple myeloma. Which nursing interventions are appropriate for this client? Select all that apply. Delay position changes and bathing if the client is experiencing pain. Instruct the client to avoid activities that may cause injury. Assist with ambulation because exercise can worsen loss of calcium from the bone. Limit fluid intake. Monitor renal function
Delay position changes and bathing if the client is experiencing pain Instruct the client to avoid activities that may cause injury. Monitor renal function
A client with severe anemia reports symptoms of tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Laboratory test results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which nursing diagnoses is most appropriate for this client? Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients Risk for falls related to complaints of dizziness Fatigue related to decreased hemoglobin and hematocrit
Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit
A health care provider orders a unit of packed red blood cells (PRBC) for a postoperative patient. The nurse is responsible for patient assessment and health care information pre- and post-transfusion. Which of the following are the guidelines that the nurse should follow? Select all that apply. a. Determine the history of any previous transfusions and possible reactions. b. Review the signs and symptoms of a transfusion reaction. c. Explain that since 1985 the supply of blood available for transfusions is risk-free. d. Report any increase of 1 degree in temperature, during or after transfusion, which falls into a febrile range. e. Explain that urticaria is a harmless, common reaction to a transfusion occurring at least 50% of the time.
a. Determine the history of any previous transfusions and possible reactions. d. Report any increase of 1 degree in temperature, during or after transfusion, which falls into a febrile range. b. Review the signs and symptoms of a transfusion reaction.
