Hema Case Study and Questions

20. A healthy person can often tolerate as much as ______% gradual reduction in hemoglobin without pronounced symptoms or significant incapacity.

50%

14. A patient who has a long term packed RBC transfusions has developed symptoms of iron-toxicity that affect liver function. What immediate treatment should the nurse anticipate preparing the patient for that may help prevent organ damage? A. Iron chelation therapy B. Oxygen therapy C. Therapeutic phlebotomy D. Anticoagulation therapy

A

8. A female patient has a hemoglobin of 6.4g/dL (Normal 12-16g/dL) and is preparing to have blood transfusion. Why would be important for the nurse to obtain information about the patient's history of pregnancy prior to the transfusion? A. A high number of pregnancies can increase the risk of infection B. If the patient has never ben pregnant, it increases the risk for infection C. Obtaining information about the gravidity and parity is routine information for all female patients D. If the patient has been pregnant, she may have developed allergies

A. A high number or pregnancies can increase the risk of infection

7. A patient with chronic kidney disease is being examined by the nurse practitioner for anemia. The nurse has reviewed the laboratory data for hemoglobin and RBC count. What other test results would the nurse anticipate? A. Decreased level of erythropoietin B. Decreased total iron-binding capacity C. Increased mean corpuscular volume D. Increased reticulocyte count

A. Decreased level of erythropoietin

6. A nurse is caring for a patient who has had bone marrow aspiration with biopsy. What complication should the nurse monitor the patient for? A. Hemorrhage B. Infection C. Shock D. Splintering of bone fragments

A. Hemorrhage

19. Is a condition in which the hemoglobin concentration is lower than normal, reflecting presence of fewer than the normal number of erythrocytes within the circulatory system?

Anemia

23. What should not be taken with the iron preparations, because they gently diminish the absorption of the iron.

Antacids and Dairy Products

13. A patient receiving plasma develops transfusion-related acute lung injury (TRALI) 4 hours after the transfusion. What type of aggressive therapy does the nurse anticipate the patient will receive to prevent death from the injury? SATA A. Performance of serial chest x-rays B. Supplemental oxygen C. Provision of intravenous fluid support D. Intubation and mechanical ventilation E. Intra-aortic balloon pump

B, C, D

27. When the patient has anemia, what medical management goal will the nurse assist the patient and health care team in nursing?

Correcting or controlling the cause of the anemia.

12. The nurse is administering two units of packed RBC's to an older adult patient with a bleeding duodenal ulcer. The patient begins experience difficulty breathing and the nurse assess crackles in the lung bases, jugular vein distention, and an increase in blood pressure. What action by the nurse is necessary if the reaction is severe? SATA A. Continue the infusion but slow the rate down B. Place the patient in an upright position with the feet dependent C. Administer diuretics as prescribed D. Administer oxygen E. Discontinue the distribution

D, C, D, E

10. A patient with chronic anemia has had many blood transfusion over the last 3 years. What type of transfusion reaction should the nurse monitor for that is commonly found in the patients who frequently receive blood transfusion? A. Allergic reaction B. Acute hemolytic reaction C. Circulatory overload D. Febrile non-hemolytic reactions

D. Febrile non-hemolytic reactions

4. The health care provider believes that a patient has a deficiency in the leukocytes responsible for cell-mediated immunity. What should the nurse assess the WBC count for? A. Basophils B. Monocytes C. Plasma cells D. T lymphocytes

D. Lymphocytes

28. Describe how anemia impacts the older adult patient?

Decreased mobility Increased depression Increased risk for falling Delirium. Fatigue, dyspnea, and confusion may be seen more readily in anemic older adult

2. The nurse is preparing to administer one unit pf packed RBC's to jerry. What assessment should the nurse make prior to initiating the transfusion?

Determine any history of previous transfusion as well as previous reactions to transfusion

34. Megaloblastic Anemias

Folic acid deficiency B12 deficiency

21. General complications in SEVERE anemia include:

Heart Failure Paresthesias delirium

26. Is a controversial treatment strategy that treats DIC by interrupting the thrombosis process

Heparin Infusion

39. What medication does the nurse anticipate infusing?

Heparon

31. What diagnostic finding are present in patient who have sickle cell trait versus those present in the patients who have sickle cell disease?

Low hematocrit and sickled cells on the smear Diagnosis confirmed by hemoglobin electrophoresis

22. What assessment should be performed for patients with known MEGALOBLASTIC ANEMIA?

Neurologic assessment

32. Which triggers may lead to the development of disseminated intravascular coagulation (DIC)?

Sepsis Trauma Cancer Shock Abruption placentae Toxins Allergic reactions

25. It is a SEVERE HEMOLYTIC ANEMIA that results from the inheritance of the sickle hemoglobin gene, which causes hemoglobin molecule to be defective

Sickle cell disease

36-39. SITUATION: George is a. 75 year old patient with urosepsis. Being treated in the intensive care unit ICU. The nurse assess George and finds that he has blood in his urine and stool, and is oozing blood from his central line site and his gums. What does the nurse suspect may be occurring with George?

The patient is having DIC.

24. It is a RARE disease caused by a DECREASE in or damage to marrow stem cells, damage to the microenvironment within the marrow, or replacement of the marrow with fat.

Aplastic anemia

33. Hemolytic Anemias

Aplastic anemia Iron deficiency

37. What medications should the nurse avoid administering to George?

Avoid medications that interfere with platelet function such as : Aspirin Non-steroidal anti-inflammatory drugs (NSAIDS) Beta-lactam antibiotics

17. A patient with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this patient? A. GM-CSF B. Erythropoietin C. Eltrombopag D. Thrombopooietin

B

40. The nurse is assessing a patient who comes to clinic reporting constantly tired and very weak. The patient also has a very sore tongue, and upon observing that patient's oral cavity, the nurse notices the tongue is beefy red. What time of anemia does the nurse know these symptoms indicate? A. Iron deficiency B. Megaloblastic anemia C. Sickle cell disease D. Aplastic anemia

B

47. A patient with ESRD is taking recombinant erythropoietin for the treatment of anemia. What laboratory study does he nurse determine will have to be assessed at least monthly related to this medication? A. Potassium level B. Creatinine level C. Hemoglobin level D. Folate level

C

15. A patient develops a hemolytic reaction to a blood transfusion. What actions should the nurse take after this occurs? SATA A. Administer diphenhydramine B. Begin iron chelation therapy C. Obtain appropriate blood specimens D. Collect a urine sample to detect hemoglobin E. Document the reaction according to policy

C, D, E

11. The nurse is administering a blood transfusion to a patient over 4 hours, after 2 hours the patient report chills and has a fever of 101F, an increase from the previous temperature of 99.2F. What does the nurse recognize is occurring with this patient? A. The patient is having an allergic reaction B. The patient is experiencing vascular collapse C. The patient. Is having decrease in tissue perfusion from a shock state D. The patient is having a febrile non-hemolytic reaction

D

46. A patient with end-sage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia? A. Potassium level of 5.2 mEq/l B. Magnesium level of 2.5 mEq/l C. Calcium level of 9.4 mEq/l D. Creatinine level of 6mg/100 ml

D

48. A patient had gastric bypass surgery 3 years ago and now, experiencing fatigue, visits the clinic to determine the cause. The patient takes pantoprazole for the treatment of frequent heartburn. What type of anemia is this patient at risk for? A. Aplastic anemia B. Iron deficiency anemia C. Sickle cell disease D. Pernicious anemia

D

38. The nurse is monitoring George's vital signs every 15 minutes. What other monitoring is essential to include along with the vital signs?

Neurological checks Hemodynamics Abdominal girth Urine output Amount of external bleeding

35. Hypo proliferative anemias

Sickle cell disease Thalassemia major

3. The nurse begins transfusion of packed cells after obtaining vital signs. Fifteen minutes after the infusion begins, jerry informs the nurse that he is itching all over. How does the nurse respond?

The nurse should know that reaction are usually mild and should respond to an ANTI-HISTAMINE such as DIPHENHYDRAMINE (benadryl)

50. Which patien does the nurse rcognize as being the most likely to be affected by sicle cell disease? A. A 14-year old African American boy B. A 26 year old eastern European jewish woman C. An 18 year old Chinese woman D. A 28 year old Israeli man

A

9. A patient will need a blood transfusion for the replacement of blood loss from the gastrointestinal tract. The patient states " That stuff isn't safe!" What is the best response from the nurse? A. "I agree that you should be concerned with the safety of the blood, but it is important that you have this transfusion" B. " The blood is carefully screened, so there is no possibility of you contracting any illness of disease from the blood" C. " I understand your concern. The blood is carefully screened but it not completely risk free" D. " You will have to decide if refusing the blood transfusion is worth the risk to yor health"

C. " I understand your concern. The blood is carefully screened but it not completely risk free"

1-3 SITUATION: Blood Transfusion Jerry has been admitted to the hospital diagnosis of gastrointestinal bleeding and has a hemoglobin of 8g/dL (Normal 13-18g/dL). He has been type and cross-matched for two units of packed RBCs and is to receive his first unit. The nurse is performing a pre transfusion history, What information should be obtained prior to the transfusion?

Check for the abnormmal presence of gas bubbles Cloudiness in the blood bag Check if the blood has been typed Check if the recipient's blood numbers match the donor's blood numbers.

16. The nurse is preparing a patient for bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. What position will the nurse place the patient in? A. Lateral position with one leg flexed B. Lithotomy position C. Supine with the head of the bed elevated 3o degrees D. Jackknife position

A

18. A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse recognize is the most likely clinical disorder the patient is being treated fro? A. Essential thrombocythemia B. Extreme leukocytosis C. Sickle cell disease D. Renal Transplantation

A

41. The nurse observe a co worker eating ice frequently. The nurse encourages the coworker to have an examination and diagnostic workup with the healthcare provider. What type of anemia is the nurse concerned the coworker may have? A. Iron deficiency B. Megaloblastic anemia C. Sickle cell disease D. Aplastic anemia

A

45. The nurse is educating a patient with iron deficiency anemia about the food sources high in iron and how to enhance the absorption of iron when eating these foods. What can the nurse inform the client would enhance the absorption? A. Eating calf's liver with glass of orange juice B. Eating leafy green vegetable with glass of water C. Eating apple slices with carrots D. Eating steak with mushrooms

A

49. The nurse preparing the patient for the 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 dose of b12. What test is the patient being prepared for? A. Bone marrow aspirations B. Schilling test C. Bone marrow biopsy D. Magnetic resonance imaging MRI study

B

5. An older adult patient presents to the healthcare provider reporting exhaustion. The nurse aware of the common hematologic condition affecting older adults, assess for which laboratory results? A. WBC count B. RBW count C. Thrombocyte counts D. Levels of plasma proteins

B. RBC count

30. What chemical agents may be responsible for producing bone marrow aplasia?

Benzene and benzene derivatives such as airplane glue, paint remover, and dry cleaning solution. Certain toxic materials; such as inorganic arsenic, glycol ethers plutonium, and radon

29. List four most common causes of iron-deficiency anemia in men and postmenopausal women.

Bleeding from ulcers Gastritis Inflammatory bowel disease (BID) Gastrointestinal (GI) tumors

42. The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include a nutritional assessment for this patient? A. It is part of the required assessment information B. It is important for the nurse to determine what type pf food the patient will eat C. It may indicate deficiencies in essential nutrients D. It will determine what type of anemia the patient has

C

43. The nurse is assessing a patient who is a strict vegetarian. What type of anemia is the nurse aware that this patient is at risk for? A. Iron deficiency B. Aplastic anemia C. Megaloblastic anemia D. Sickle cell disease

C

44. A patient describes numbness in the arms and hands with a tingling sensation and frequent stumbling when walking. What vitamin deficiency does the nurse determine ma y contribute to some of these symptoms? A. Thiamine B. Folate C. B12 D. Iron

C