HEMATOLOGICAL

The nurse is teaching a client with vitamin B12 deficiency anemia about dietary intake. Which type of food does the nurse encourage the client to eat? 1- Dairy products 2- Grains 3- Leafy vegetables 4- Starchy vegetables

1- Dairy products Dairy products such as milk, cheese, and eggs will provide the vitamin B12 that the client needs. Grains, leafy vegetables, and starchy vegetables are not a source of vitamin B12.

A 36-year-old mail carrier with a history of anemia tells the nurse she made an appointment with her physician because she has "been having trouble getting through the day lately." What symptom would you expect the patient to report? 1. Shortness of breath 2. Lymphadenopathy 3. Nausea and vomiting 4. Fatigue upon awakening

1. Shortness of breath

The client with O+ blood is in need of an emergency transfusion but the laboratory does not have any O+ blood available. Which potential unit of blood could be given to the client? 1. The O- unit. 2. The A+ unit. 3. The B+ unit. 4. Any Rh+ unit.

1. The O- unit.

After reviewing the laboratory test results, the nurse calls the health care provider about which client? 1- A 44-year-old receiving warfarin (Coumadin) with an international normalized ratio (INR) of 3.0 2- A 46-year-old with a fever and a white blood cell (WBC) count of 1500/mm3 3- A 49-year-old with hemophilia and a platelet count of 150,000/mm3 4- A 52-year-old who has had a hemorrhage with a reticulocyte count of 0.8%

2- A 46-year-old with a fever and a white blood cell (WBC) count of 1500/mm3 The client with a fever is neutropenic and is at risk for sepsis unless interventions such as medications to improve the WBC level and antibiotics are prescribed. The INR of 3.0 in the 44-year-old indicates a therapeutic warfarin level. A platelet count of 150,000/mm3 in the 49-year-old is normal. An elevated reticulocyte count in the 52-year-old is expected after hemorrhage.

he client is admitted to the emergency department after a motor-vehicle accident. The nurse notes profuse bleeding from a right-sided abdominal injury. Which intervention should the nurse implement first? 1. Type and crossmatch for red blood cells immediately (STAT). 2. Initiate an IV with an 18-gauge needle and hang normal saline. 3. Have the client sign a consent for an exploratory laparotomy. 4. Notify the significant other of the client's admission.

2. Initiate an IV with an 18-gauge needle and hang normal saline.

During the nursing assessment of a patient with anemia, the nurse notes ad significant the patients history of... a. reurring infections b. partial gastrectomy c. corticosteroid therapy d. oral contraceptive use

answer b the parietal ells of the stomach secrete intrinsic factor, a substance necessary for absorption of viam b 12 and if all or part of stomach is removed the lack of intrinsic factor can lead to impaired rbc production and perniscuous anemia

A patient is receiving cyanocobalamin for the treatment of pernicious anemia. Which electrolyte should the nurse monitor as a result of this treatment? 1- Sodium 2- Calcium 3- Chloride 4- Potassium

4- Potassium Potassium depletion (hypokalemia) may occur as a natural consequence of erythrocyte production. Because erythrocytes incorporate significant amounts of potassium and a large number of erythrocytes are being produced, potassium levels may fall. The other electrolytes are not affected

The nurse is preparing to care for a client with chronic kidney disease and anemia. Which describes the relationship between chronic kidney disease and anemia? 1. Lack of angiotensin I may cause anemia. 2. Increased production of aldosterone leads to anemia. 3. Anemia is caused by insufficient production of renin. 4. Decreased production of erythropoietin is causing anemia.

4. Decreased production of erythropoietin is causing anemia. Clients with chronic kidney disease do not manufacture adequate amounts of erythropoietin, which is a glycoprotein needed to synthesize red blood cells. Renin, aldosterone, and angiotensin are substances that assist in maintaining blood pressure

The client receiving a unit of PRBCs begins to chill and develops hives. Which action should be the nurse's first response? 1. Notify the laboratory and health-care provider. 2. Administer the histamine-1 blocker, Benadryl, IV. 3. Assess the client for further complications. 4. Stop the transfusion and change the tubing at the hub.

4. Stop the transfusion and change the tubing at the hub.

The nurse making a care plan for a client with severe thrombocytopenia should include which of the following? 1. C areful examination of spinal fluid obtained by lumbar puncture 2. A private room with reverse isolation precautions 3. A void intramuscular administration of medications 4. C areful monitoring of urinary output while titrating the dosage of furosemide (Lasix)

answer3. Severe thrombocytopenia is a platelet count of , 10,000 to 20,000/mm3. The client with this low number of platelets is at great risk of bleeding from any invasive procedure. Intramuscular injections can cause a hematoma in the muscle and should be avoided if possible. A lumbar puncture would put the client at an unnecessary risk of bleeding. A private room is not indicated unless there are other reasons for isolation (infection, neutropenia). Furosemide is a diuretic and not used as therapy for thrombocytopenia.

Which of the following statements accurately describes normocytic anemia? Normocytic anemia usually is caused by: 1.Iron deficiency and inadequate globin synthesis. 2.Acute or chronic blood loss or inadequate dietary intake of iron. 3.Concurrent chronic illness, such as chronic heart disease. 4.A deficiency in vitamin B12 or gastric surgery.

answer: 3 Rationale: Normocytic anemia usually is caused by concurrent chronic illness such as chronic heart, respiratory, or renal disease or malignancy. Hemolytic anemia also is a normocytic anemia.

A nurse is completing an integumentary assessment of a client who has anemia. which of the following is an expected finding a. absent turgor b. sppon shaped nails c. shiny, hairless legs, d. yellow mucous membranes

answer: b spoon shaped nails, pail nail beds and mucous membranes are all present iwithin these patients

The client is being admitted with Folic acid deficiency anemia. Which would be the most appropriate referral? A.Alcoholics anonymous B.Leukemia society of America C.A hematologist D.A social worker

A

The nurse is admitting a 24 year old American American female client with a dx of rule-out anemia. The client has a hx of gastric bypass surgery for obesity 4 years ago. Current assessment findings include height 5'5, wt. 75 kg, P 110, R 27, and BP 104/66; pale mucous membranes and dyspnea on exertion. Which type of anemia would the nurse suspect the client has developed? A.Vitamin B12 deficiency B.Folic acid deficiency C.Iron deficiency D.Sickle cell anemia

A

The nurse writes a client problem of "activity intolerance" for a client dx with anemia. Which intervention should the nurse implement? A.Pace activities according to tolerance B.Provide supplements high in iron and vitamins C.Administer packed red blood cells D.Monitor vital signs q4h

A

During care for patient with thrombocytopenia, the nurse a. takes frequent temperatures to assess for fever b. maintains the patient on strict bed rest to prevent injury c. monitors patient for headaches, vertigo, or confusion d. removes oral crusting and scabs with firm friction every two hours

answer: c Rationale: the major complication of thrombocytopenia is hemorrhage, and it may occur in any area of the body. cerebral hemorrhage may be fatal and evaluation of mental status for cns alteration to id cns bleeding is very important. fever is not a common finding in thrombocytopenia. protection from injury to prevent bleeding is an important nursing intervention, but strict bed rest is not indicated. oral care is performed very gently with minimum friction and soft swabs

On physical assessment of the patient with severe anemia the nurse would expect to fin? a. nervousness and agitiation b. fever and tenting of the skin c. systolic murmur and tachycardia d. bluish mucous membranes and reddened

answer: c. systolic murmors and tachycardia tachycardia occurs in severe anemia as the body compensates for hypoxemia and the low viscosity of the blood contributes to the development of systolic murmurs and bruits. depression of the cns is common with fatigue, lethargy, and malaise, poor skin turgor may be present, but fever is not associated with anemia. skin and membranes ar pale with blue tinged to sclera

A nurse in a clinic receives a phone call form a client seeking info about his new prescription for erythropoietin (epogen) which of the following inf o should be reviewed with the client. a. the client needs an erythrocyte sedimentation rate test weekly (esr) b. the client should have his hemoglobin checked twice a week c. o2 saturation levels should be monitored d. folic acid production will increase.

answer: hemoglobin/ hematocrit will be measured twice a week bp is monitored for an increase, erythropoietin promotes increased production of rbc, it is evaluated by changes in hematocrit

A client with anemia may be tired due to a tissue deficiency of which of the following substances a. carbon dioxide. b factor viiii c. oxygen d. t cell antibodies

Answer c: anemia stems from a decreased numbe rof rbc and the resulting deficiency in oxygen and body tissues. Clotting factors such as factor VIII relate to the bodys ability to form blood clots and aren't related to anemia, not is carbon dioxide of t antibodies.

The nurse is reviewing laboratory findings for a 2-year-old being treated for anemia. Which of the findings is the best indication that goals for this client have been met? 1.The child is no longer cyanotic. 2.The reticulocyte count is rising. 3.The child is more active. 4.Stools are black, indicating iron intake.

Answer: The reticulocyte count is rising. Rationale: An increase in the reticulocyte number means that the body is producing new RBC's. While improved oxygenation, increased activity, and indications of iron intake are desirable outcomes for the child with anemia, they are not laboratory data.

A client experiences postoperative blood loss. Which does the nurse assess to determine that the client is anemic? 1 Fatigue 2 Dyspnea 3 Bradycardia 4 Muscle cramps

Answer: 1 Rationale: The client with anemia is likely to complain of fatigue caused by deficient hemoglobin leading to a decreased oxygen-carrying capacity of the blood and ability to meet tissue oxygen demands. The respiratory rate can increase to improve oxygenation, but dyspnea (option 2) related to anemia is uncommon. The client is more likely to have tachycardia than bradycardia (option 3), because the heart beats faster to deliver the same amount of oxygen to tissues in compensation for less oxygen in the blood. Muscle cramps (option 4) are an unrelated finding

Age-related changes that affect the hematologic system include: (Select all that apply.) 1.Bone marrow in the long bones decline. 2.The number of stem cells in the marrow increases. 3.Lymphocyte function, especially cellular immunity, decreases. 4.Platelet adhesiveness decreases.

Answer: 1. 3. At about age 70, the amount of bone marrow in the long bones declines steadily; the number of stem cells in the marrow decreases; and lymphocyte function, especially cellular immunity, declines.

The nurse notes that the client has a low red blood cell count and anticipates which of the following subjective manifestations on assessment? 1.Chest pain 2.Nausea 3.Sore throat 4. Fatigue

Answer:Fatigue Rationale: Fatigue would signify that the body's tissues are not receiving enough oxygenation. Sore throat is a sign of infection. Chest pain may indicate an impending myocardial infarction. Nausea is a symptom for many disease processes, but is not typical for anemia.

The nurse has admitted a child newly diagnosed with anemia of unknown origin. Which of the following is a priority intervention for the nurse to initiate? 1. Administer fluids to increase cardiac output. 2. Plan for safe care due to weakness. 3.Teach the client about foods with iron. 4. Assess pain level.

Answer:Plan for safe care due to weakness. Rationale: The client with anemia is weak and the nurse would address safe care due to weakness. Since the cause of the anemia is undetermined, the nurse would not administer fluids or complete nutritional teaching without additional information. Clients with anemia do not normally have pain; pain is assessed in every client, but is not the priority of care in this client.

The nurse is working with a woman who is pregnant and her husband. The husband asks the nurse why his wife has a folic acid deficiency when she eats healthy meals. The nurse best responds with which of the following? 1.Pregnancy increases metabolic requirements for folic acid. 2.There is inadequate dietary intake of folic acid. 3.Pregnancy causes malabsorption of folic acid. 4.The client has some form of impaired metabolism

Answer:Pregnancy increases metabolic requirements for folic acid. Rationale: Pregnancy increases the metabolic requirements for folic acid. Since the husband states that they eat healthy meals, inadequate intake of folic acid is a less likely cause of the deficiency. Malabsorption and impaired metabolism are causes of folic acid deficiency that are not associated with pregnancy.

The client dx with anemia begins to complain of dyspnea when ambulating in the hall. Which intervention should the nurse implement first? A.Apply oxygen via nasal cannula B.Get a wheelchair for the client C.Assess the clients lung fields D.Assist the client when ambulating in the hall

B

The nurse is conducting a physical assessment on a client with anemia. Which of the following clinical manifestations would be most indicative of the anemia? A. BP 146/88 B. Respirations 28 shallow C. Weight gain of 10 pounds in 6 months D. Pink complexion

B

The nurse who just came on duty observes that the client, whose blood type is AB negative, is receiving a transfusion with type O negative packed red blood cells. What is the nurse's best first action? A. Call the blood bank. B. Take and record the client's vital signs. C. Stop the transfusion and keep the IV open. D. Document the observation as the only action.

B. Take and record the client's vital signs. Rationale: Clients with AB negative blood types can receive O negative blood because they do not have antibodies against this type of blood. Therefore, the transfusion does not need to be stopped nor does the blood bank need to be notified. The transfusion can proceed. Because the nurse is seeing the client for the first time since the transfusion was initiated, the client's vital signs need to be assessed rather than just documenting the observation.

An elderly client is admitted to the hospital Emergency Department (ED) with complaints of headache, visual disturbances, and burning pain, and erythema of the hands and feet. To accurately diagnose thrombocytopenia, the physician most likely will order: a.Peripheral blood smear. b.Allogenic bone marrow transplant. c.Bone marrow aspiration. d. Splenectomy.

C Thrombocytopenia is characterized by an increased number of circulating platelets in the blood. Accurate diagnosis requires bone marrow aspiration. Allogenic bone marrow transplantation is prescribed for younger persons with myelofibrosis. A splenectomy may be prescribed for persons with myelofibrosis

Which blood test result for a client being assessed for a hematologic problem indicates to the nurse that chronic anemia is likely? A. International normalized ratio (INR) is 0.9 B. Platelet count of 180,000/mm3 C. Reticulocyte value of 14% D. Hematocrit of 27%

C. Reticulocyte value of 14% Rationale: The normal reticulocyte value is 2% or less of the total red blood cell (RBC) count. A reticulocyte is an immature RBC that still has its nucleus. An elevated reticulocyte count indicates that RBCs are being produced and released by the bone marrow before they mature. This often happens when a person has a condition that causes continual but very slow bleeding and anemia. This client has a low hematocrit and is anemic. The INR and platelet values are norma

The nurse would instruct the client to eat which of the following foods to obtain the best supply of vitamin B12? a. Whole grains b. Green leafy vegetables c. Meats and dairy products d. Broccoli and Brussel sprouts

c. Meats and dairy products Good sources of vitamin B12 include meats and dairy products. Whole grains are a good source of thiamine. Green leafy vegetables are good sources of niacin, folate, and carotenoids (precursors of vitamin A). Broccoli and Brussels sprouts are good sources of ascorbic acid (vitamin C).

When caring for a client with a coagulation disorder, your primary focus should be on: a. Prevention of infection b. Pain management c. Reducing edema d. Prevention of injury and hemorrhage

d. Prevention of injury and hemorrhage

A client with anemia asks, "Why am I feeling tired all the time?" How does the nurse respond? 1- "How many hours are you sleeping at night?" 2- "You are not getting enough iron." 3- "You need to rest more when you are sick." 4- "Your cells are delivering less oxygen than you need."

"Your cells are delivering less oxygen than you need." The single most common symptom of anemia is fatigue, which occurs because oxygen delivery to cells is less than is required to meet normal oxygen needs. Although assessment of sleep and rest is good, it does not address the cause related to the diagnosis. While it may be true that the client isn't getting enough iron, it does not relate to the client's fatigue. The statement about the client needing rest because of being sick is simply not true.

The client has a hematocrit of 22.3% and a hemoglobin of 7.7 g/dL. The HCP has ordered two (2) units of packed red blood cells to be transfused. Which interventions should the nurse implement? Select all that apply. 1. Obtain a signed consent. 2. Initiate a 22-gauge IV. 3. Assess the client's lungs. 4. Check for allergies. 5. Hang a keep-open IV of D5W

1,3,4

The nurse is teaching a client about induction therapy for acute leukemia. Which client statement indicates a need for additional education? 1- "After this therapy, I will not need to have any more." 2- "I will need to avoid people with a cold or flu." 3- "I will probably lose my hair during this therapy." 4- "The goal of this therapy is to put me in remission."

1- "After this therapy, I will not need to have any more." Induction therapy is not a cure for leukemia, it is a treatment; therefore, the client needs more education to understand this. Because of infection risk, clients with leukemia should avoid people with a cold or flu. Induction therapy will most likely cause the client with leukemia to lose his or her hair. The goal of induction therapy is to force leukemia into remission.

Which client is at greatest risk for having a hemolytic transfusion reaction? 1- A 34-year-old client with type O blood 2- A 42-year-old client with allergies 3- A 58-year-old immune-suppressed client 4- A 78-year-old client

1- A 34-year-old client with type O blood Hemolytic transfusion reactions are caused by blood type or Rh incompatibility. When blood that contains antigens different from the client's own antigens is infused, antigen-antibody complexes are formed in the client's blood. Type O is considered the universal donor, but not the universal recipient. The client with allergies would be most susceptible to an allergic transfusion reaction. The immune-suppressed client would be most susceptible to a transfusion-associated graft-versus-host disease. The older adult client would be most susceptible to circulatory overload.

The healthcare provider is planning care for four patients. Which patient is most in need of interventions aimed at preventing anemia? The patient: Choose 1 answer: 1- with renal failure on hemodialysis. 2- who is a vegetarian. 3- who has been NPO for 3 days. 4- with a Jackson-Pratt drain.

1- with renal failure on hemodialysis. ♦ A true vegan may be at risk for certain types of anemia, but a vegetarian diet can include the appropriate nutrients to prevent anemia. ♦ If assessment of the Jackson-Pratt drain shows hemorrhage, anemia can occur; however this patient is not most at risk for anemia. ♦ Because of decreased erythropoietin, renal failure causes fewer red blood cells produced. Hemodialysis can cause hemolysis, so this patient is at highest risk for anemia.

A client has a bone marrow biopsy done. Which nursing intervention is the priority postprocedure? 1- Applying pressure to the biopsy site 2- Inspecting the site for ecchymoses 3- Sending the biopsy specimens to the laboratory 4- Teaching the client about avoiding vigorous activity

1-Applying pressure to the biopsy site The initial action should be to stop bleeding by applying pressure to the site. Inspecting for ecchymoses, sending specimens to the laboratory, and teaching the client about activity levels will be done after hemostasis has been achieved.

The nurse is reviewing complete blood count (CBC) data for a 76-year-old client. Which decreased value causes concern because it is not age-related? 1- Hemoglobin level 2- Platelet (thrombocyte) count 3- Red blood cell (RBC) count 4- White blood cell (WBC) response

2-Platelet (thrombocyte) count Platelet counts do not generally change with age. Hemoglobin levels in men and women fall after middle age; iron-deficient diets may play a role in this reduction. Total RBC and WBC counts (especially lymphocyte counts) are lower in older adults. The WBC count does not rise as high in response to infection in older adults as it does in younger people.

Which statement is the scientific rationale for infusing a unit of blood in less than four (4) hours? 1. The blood will coagulate if left out of the refrigerator for >four (4) hours. 2. The blood has the potential for bacterial growth if allowed to infuse longer. 3. The blood components begin to break down after four (4) hours. 4. The blood will not be affected; this is a laboratory procedure.

2. The blood has the potential for bacterial growth if allowed to infuse longer.

A client on anticoagulant therapy is being discharged. Which statement indicates that the client has a correct understanding of this therapy's purpose or action? 1- "It is to dissolve blood clots." 2- "It might cause me to get injured more often." 3- "It should prevent my blood from clotting." 4- "It will thin my blood."

3- "It should prevent my blood from clotting." Anticoagulants work by interfering with one or more steps involved in the blood clotting cascade. Thus, these agents prevent new clots from forming and limit or prevent extension of formed clots. Anticoagulants do not dissolve clots, fibrinolytics do. Anticoagulants do not cause more injuries, but may cause more bleeding and bruising when the client is injured. Anticoagulants do not cause any change in the thickness or viscosity of the blood.

The nurse is infusing platelets to a client who is scheduled for a hematopoietic stem cell transplant. What procedure does the nurse follow? 1- Administer intravenous corticosteroids before starting the transfusion. 2- Allow the platelets to stabilize at the client's bedside for 30 minutes. 3- Infuse the transfusion over a 15- to 30-minute period. 4- Set up the infusion with the standard transfusion Y tubing.

3- Infuse the transfusion over a 15- to 30-minute period. The volume of platelets—200 or 300 mL (standard amount)—needs to be infused rapidly over a 15- to 30-minute period. Administering steroids is not standard practice in administering platelets. Platelets must be administered immediately after they are received; they are considered to be quite fragile. A special transfusion set with a smaller filter and shorter tubing is used to get the platelets into the client quickly and efficiently.

Which collaborative treatment would the nurse anticipate for the client diagnosed with DIC? 1. Administer oral anticoagulants. 2. Prepare for plasmapheresis. 3. Administer frozen plasma. 4. Calculate the intake and output.

3. Administer frozen plasma.

The HCP orders two (2) units of blood to be administered over eight (8) hours each for a client diagnosed with heart failure. Which intervention(s) should the nurse take? 1. Call the HCP to question the order because blood must infuse within four (4) hours. 2. Retrieve the blood from the laboratory and run each unit at an eight (8)-hour rate. 3. Notify the lab to split each unit into half-units and infuse each half for four (4) hours. 4. Infuse each unit for four (4) hours, the maximum rate for a unit of blood

3. Notify the lab to split each unit into half-units and infuse each half for four (4) hours.

The nurse is caring for the following clients. Which client should the nurse assess first? 1. The client whose partial thromboplastin time (PTT) is 38 seconds. 2. The client whose hemoglobin is 14 g/dL and hematocrit is 45%. 3. The client whose platelet count is 75,000 per cubic millimeter of blood. 4. The client whose red blood cell count is 4.8 × 106/mm3.

3. The client whose platelet count is 75,000 per cubic millimeter of blood. A platelet count of less than 100,000 per cubic millimeter of blood indicates thrombocytopenia

The nurse is caring for a client with neutropenia. Which clinical manifestation indicates that an infection is present or should be ruled out? 1- Coughing and deep breathing 2- Evidence of pus 3- Fever of 102° F or higher 4- Wheezes or crackles

4- Wheezes or crackles Wheezes or crackles in the neutropenic client may be the first symptom of infection in the lungs. Coughing and deep breathing are not indications of infection, but can help prevent it. The client with leukopenia, not neutropenia, may have a severe infection without pus or with only a low-grade fever.

A patient is admitted to the intensive care unit with disseminated intravascular coagulation (DIC) associated with a gram-negative infection. Which assessment information has the most immediate implications for the patient's care? 1. There is no palpable radial or pedal pulse. 2. The patient reports chest pain. 3. The patient's oxygen saturation is 87%. 4. There is mottling of the hands and feet

3. The patient's oxygen saturation is 87%. Because the decrease in oxygen saturation will have the greatest immediate effect on all body systems, improvement in oxygenation should be the priority goal of care. The other data also indicate the need for rapid intervention, but improvement of oxygenation is the most urgent need.

A patient with chemotherapy-related neutropenia is receiving filgrastim injections. Which finding by the nurse is most important to report to the health care provider? 1. The patient says, "My bones are aching." 2. The patient's platelet count is 110,000 mm3 (110 × 109/L). 3. The patient's white blood cell count is 39,000 mm3 (39.0 × 109/L). 4. The patient reports that the medication stings when it is injected.

3. The patient's white blood cell count is 39,000 mm3 (39.0 × 109/L). Leukocytosis is an adverse effect of filgrastim and indicates a need to stop the medication or decrease dosage. Bone pain is a common adverse effect as the bone marrow starts to produce more neutrophils; the patient should receive analgesics, but the medication will be continued. Stinging with injection may occur; the nurse should administer the medication more slowly. The patient's platelet count is low and should be reported, but the level of 110,000 mm3 (110 × 109/L) does not increase risk for spontaneous bleeding.

A patient who is anemic has a hemoglobin is 9, and a hematocrit is 30\%. Which of these interventions should be a priority in the patient's plan of care? Choose 1 answer: 1- Administer epoetin alfa (Procrit) subcutaneously. 2- Transfuse 1 unit packed red blood cells. 3- Administer iron dextran IM. 4- Determine the cause of the anemia

4- Determine the cause of the anemia ♦ The healthcare provider will plan interventions which will be most effective in meeting the needs for this patient. ♦ The low hemoglobin and hematocrit can be caused by a variety of factors. ♦ Before implementing specific interventions, the cause of the anemia should be addressed.

The nurse is assessing the nutritional status of a client with anemia. How does the nurse obtain information about the client's diet? 1- Asks the client to rate his or her diet on a scale of 1 (poor) to 10 (excellent) 2- Determines who prepares the client's meals and plans an interview with him or her 3- From a prepared list, finds out the client's food preferences 4- Has the client write down everything he or she has eaten for the past week

4- Has the client write down everything he or she has eaten for the past week Having the client provide a list of items eaten in the past week is the most accurate way to find out what the client likes and dislikes, as well as what the client has been eating. It will provide information about "junk" food intake, as well as protein, vitamin, and mineral intake. Rating scales are good for subjective data collection about some conditions such as pain, but the subjectivity of a response such as this does not provide the nurse with specific data needed to assess a diet. Interviewing the food preparer is time-consuming and poses several problems, such as whether a number of people are preparing meals, or if the client goes "out" for meals. Determining food preferences from a prepared list provides information about what the client enjoys eating, not necessarily what the client has been eating; for instance, the client may like steak but may be unable to afford it.

Which client would be most at risk for developing disseminated intravascular coagulation (DIC)? 1. A 35-year-old pregnant client with placenta previa. 2. A 42-year-old client with a pulmonary embolus. 3. A 60-year-old client receiving hemodialysis 3 days a week. 4. A 78-year-old client diagnosed with septicemia

4. A 78-year-old client diagnosed with septicemia.

The nurse is performing an assessment on a client with a diagnosis of pernicious anemia. Which finding would the nurse expect to note in this client? 1. Dyspnea 2. Dusky mucous membranes 3. Shortness of breath on exertion 4. Red tongue that is smooth and sore

4. Red tongue that is smooth and sore Classic signs of pernicious anemia include weakness, mild diarrhea, and a smooth red tongue that is sore. The client also may have nervous system signs and symptoms such as paresthesias, difficulty with balance, and occasional confusion. The client does not exhibit dyspnea, the mucous membranes do not become dusky, and the client does not exhibit shortness of breath.

A patient has been diagnosed with thrombocytopenia. What teaching point should the nurse include in the patient's plan of care? 1.The patient should be instructed to avoid crowds. 2.The patient should be instructed to alternate periods of activity with periods of rest. 3.The patient should be instructed to increase fluid intake. 4.The patient should be instructed to use a soft toothbrush

4.The patient should be instructed to use a soft toothbrush

The nurse writes a dx of altered tissue perfusion for a client diagnosed with anemia. Which interventions should be included in the plan of care? Select all that apply. A.Monitor the clients hemoglobin and hematocrit B.Move the client to a room near the nurses desk C.Limit the clients dietary intake of green vegetables D.Assess the client for numbness and tingling E.Allow for rest periods during the day for the client

A,B,D,E

What are the risk factors for the development of leukemia? Select all that apply. 1- Bone marrow hypoplasia 2- Chemical exposure 3- Down syndrome 4- Ionizing radiation 5- Multiple blood transfusions 6- Prematurity at birth

ANS 1, 2, 3, 4 Reduced production of blood cells in the bone marrow is one of the risk factors for developing leukemia. Exposure to chemicals through medical need or by environmental events can also contribute. Certain genetic factors contribute to the development of leukemia; Down syndrome is one such condition. Radiation therapy for cancer or other exposure to radiation, perhaps through the environment, also contributes. There is no indication that multiple blood transfusions are connected to clients who have leukemia. Although some genetic factors may influence the incidence of leukemia, prematurity at birth is not one of them.

A patient with alcoholic liver disease has severe anemia. Which of the following explains the development of anemia in this particular patient? Choose all answers that apply: 1- Alcoholics are often deficient in folate. 2- Gastric ulcers may lead to chronic blood loss. 3- Alcohol suppresses erythropoiesis. 4- Alcohol causes inflammation, which leads to anemia. 5- Liver dysfunction leads to decreased clotting factors.

ANS 1, 2, 3, 5 ♦ Alcoholics are prone to gastric ulcers which can bleed, increasing risk for anemia. ♦ A decrease in clotting factors increases the patient's risk for bleeding, which may lead to anemia. ♦ Deficient folate impairs the production of functional red blood cells. Alcohol also directly suppresses hematopoiesis, leading to decreased erythrocytes. Both of these increase the risk of anemia.

The nurse is caring for a patient receiving vitamin B12 because of a deficiency. What are common causes of this deficiency? (Select all that apply.) 1- Regional enteritis and malabsorption 2- Celiac disease 3- Decreased intake of foods with vitamin B12 4- Advancing age 5- Use of drugs that lower stomach acid

ANS 1, 2, 4, 5 Vitamin B12 is needed in very small amounts in the diet. Dietary insufficiency is rarely the cause of a deficiency. The other options are common potential causes of this problem.

The nurse is teaching a client with newly diagnosed anemia about conserving energy. What does the nurse tell the client? Select all that apply. 1- "Allow others to perform your care during periods of extreme fatigue." 2- "Drink small quantities of protein shakes and nutritional supplements daily." 3- "Perform a complete bath daily to reduce your chance of getting an infection." 4- "Provide yourself with four to six small, easy-to-eat meals daily." 5- "Perform your care activities in groups to conserve your energy." 6- "Stop activity when shortness of breath or palpitations are present."

ANS 1, 2, 4, 6 It is critical to have others help the anemic client who is extremely tired. Although it may be difficult for him or her to ask for help, this practice should be stressed to the client. Drinking small protein or nutritional supplements will help rebuild the client's nutritional status. Having four to six small meals daily is preferred over three large meals; this practice conserves the body's expenditure of energy used in digestion and assimilation of nutrients. Stopping activities when strain on the cardiac or respiratory system is noted is critical. A complete bath should be performed only every other day; on days in between, the client can be taught to take a "mini" sponge bath, which will conserve energy and still be safe in preventing the risks for infection. Care activities should be spaced every hour or so rather than in groups to conserve energy; the time just before and after meals should be avoided.

Which of the following blood components is decreased in anemia a. erythrocytes b. granulocytes c. leukocytes d. platelets

ANswer a: anemia is defined as a decreased number of erythrocytes rbc, leukopenia ia decreased wbc, thrombocytopenia is decreased number of platelets

Before performing a venipuncture to initiate continuous intravenous (IV) therapy, a nurse should: 1 Inspect the IV solution and expiration date. 2 Apply a cool compress to the affected area. 3 Secure a padded armboard above the IV site. 4 Apply a tourniquet below the venipuncture site.

Answer: 1 Rationale: IV solutions should be free of particles or precipitates to prevent trauma to veins or a thromboembolic event; in addition, the nurse avoids administering IV solutions whose expiration date has passed to prevent infection. Cool compresses cause vasoconstriction, making the vein less visible, smaller, and more difficult to puncture. Arm boards are applied after the IV is started and are used only if necessary. A tourniquet is applied above the chosen vein site to halt venous return and engorge the vein; this makes the vein easier to puncture

The nurse cares for a client who is pale and complains of fatigue, weakness, and dizziness. Which serum laboratory test result is the nurse's priority for planning care? 1 Hematocrit 43% 2 Sodium 130 mEq/L 3 Potassium 4.8 mEq/L 4 Hemoglobin of 7 g/dL

Answer: 4 Rationale: The client's hemoglobin level and sodium level are low; however, the nurse uses the hemoglobin results to plan care because the client's clinical indicators are consistent with anemia. The client is pale because the serum hemoglobin is low; thus the client's tissues are perfused with blood that has a low oxygen-carrying capacity. The client is weak and dizzy because the blood does not carry enough oxygen to meet tissue oxygen demands. While a client who is hyponatremic can also feel weak and dizzy, a hyponatremic client is unlikely to be pale. The hematocrit and the potassium levels are within normal limits.

The charge nurse is making assignments on a medical floor. Which client should be assigned to the most experienced nurse? A.The client dx with iron-deficiency anemia who is prescribed iron supplements B.The client dx with pernicious anemia who is receiving vitamin B12 IM C.The client dx with aplastic anemia who has developed pancytopenia D.The client dx with renal disease who has deficiency of erythropoietin

C

The nurse is discharging a client dx with anemia. Which discharge instruction should the nurse teach? A.Take prescribed iron until it is completely gone B.Monitor P and BP at local pharmacy weekly C.Have complete blood count checked at the HCP's office D.Perform isometric exercise three times a week

C

The nurse following a client after a gastric resection observes carefully for evidence of nutritional deficiency anemia related to malabsorption including which of the following? 1.Bone pain 2.Dark yellow or bronze skin 3.Numbness and tingling of extremities 4. Steatorrhea

Correct Answer: Numbness and tingling of extremities Rationale: The client who has had a gastric resection is at risk for anemia because intrinsic factor may decrease, leading to vitamin B12 deficiency anemia with associated neurologic deficits such as numbness and tingling of extremities. The other symptoms are not related to nutritional deficiency anemia.

A patient has a folic acid deficiency related to chronic alcohol abuse. The nurse would expect a complete blood cell count (CBC) to reveal a. macrocytic, normochromic red cells. b. normocytic, normochromic red cells. c. microcytic, hypochromic red cells. d. microcytic, normochromic red cells.

a macrocytic, normochromic red cells With folic acid deficiency, the cells are larger than normal, but the iron levels are normal or elevated, leading to findings of a macrocytic, normochromic anemia. Microcytic anemia, hypochromic anemia is more typical of iron deficiency. Normocytic, normochromic RBC indicate that the patient does not have anemia or may occur in patients with anemia-related chronic disease.

A nurse is planning care for a client who has a Hgb of 7.5 and a Hct of 21.5. Which of the following should the nurse include in the plan of care? select all that apply a. provide assistance with ambulation b. monitor oxygen saturation c. weigh client weekly d. obtain stool specimen for occult blood e. schedule daily rest periods

a,b,d,e rationale: a client with anemia may be dizzy and should be assisted to prevent falls, o2 should be monitored due to decreased o2 carrying capacity in the blood, they should be weight dialy, stool testing is performed to id cause of anemia due to gi bleeding, a client may experience fatigue so rest period should be planned to conserve energy

When a client is diagnosed with aplastic anemia, the nurse monitors for changes in which of the following physiological functions? a.Bleeding tendencies b.Intake and output c.Peripheral sensation d.Bowel function

a. Bleeding tendencies Aplastic anemia decreases the bone marrow production of RBCs, WBCs, and Platelets. The client is at risk for bruising and bleeding tendencies

A client is to receive epoetin (Epogen) injections. What laboratory value should the nurse assess before giving the injection? a. Hematocrit b. Partial thromboplastin time c. Hemoglobin concentration d. Prothrombin time

a. Hematocrit Epogen is a recombinant DNA form of erythropoietin, which stimulates the production of RBCs and therefore causes the hematocrit to rise. The elevation in hematocrit causes an elevation in blood pressure; therefore, the blood pressure is a vital sign that should be checked. The PTT, hemoglobin level, and PT are not monitored for this drug.

A 52-year-old patient has a new diagnosis of pernicious anemia. After teaching the patient about pernicious anemia, the nurse determines that the patient understands the disorder when the patient states, a. "I will need to have cobalamin (B12) injections regularly for the rest of my life." b. "I will stop having a glass of wine with dinner." c. "The numbness in my feet will go away once my hemoglobin level returns to normal." d. "My diet should include more red meat or liver."

a. I will need to have cobalamin -B12 injections regularly for the rest of my life

The nurse has provided nutritional teaching on foods high in folate to a client with folate deficiency related to malabsorption syndromes and poor nutrition. Which of the following foods, if chosen by the client, indicates that the client understands the teaching? a. Liver, dark green leafy vegetables b. Whole milk and eggs c. Potatoes and carrots d. Bread and fish

a. Liver, dark green leafy vegetables Foods high in folate are liver, orange juice, cereals, whole grains, beans, nuts, and dark leafy vegetables like spinach

From the following teaching tips, choose all that are appropriate for a client with thrombocytopenia. a. Use an electric razor for shaving b. Avoid becoming chilled c. Avoid all skin or body punctures d. Do not scrub skin during bathing e. Eat low-roughage foods f. Avoid use of all aspirin products g. Avoid vigorous blowing of nose h. Use only a soft toothbrush

a. Use an electric razor for shaving c. Avoid all skin or bod punctures e. Eat low-roughage foods f. Avoid use of all aspirin products g. Avoid vigorous blowing of nose h. use only a soft toothbrush

The nurse has provided nutritional teaching on foods high in folate to a client with folate deficiency related to malabsorption syndromes and poor nutrition. Which of the following foods, if chosen by the client, indicates that the client understands the teaching? a.Liver and dark green leafy vegetables b.Whole milk and eggs c.Potatoes and carrots d.Bread and fish

answer a Foods high in folate are liver, orange juice, cereals, whole grains, beans, nuts, and dark leafy vegetables like spinach.

A nurse is providing discharge teaching to a chilent who has a gastrectomy for stomach cancer. Which of the following information should be included in the teaching? select all that apply a. you will need a monthly injection of vitamin b12 for the rest of your life b. using nasal spray of vitamin b12 may be an option daily c. an oral supplement of vitamin b12 may be taken as an option daily d. u should increase animal proteins, legumes, dairy to increase vitamin b12 e. add soy milk with vitamin b12 to your diet to decrase risk of pernisious anemia

answer a and b a client with gastrectomy will require monthly injections of vitamin b12 for the rest of his life, cyanocoblamin nasal spray is an option for a client with gastrectomy. the rest will not be absorbed due to lack of intrinisctfactor produced by stomach

While receiving a unit of packed rbc, the pt develops chills and a temp of 102.2. The nurse a. notifies physician and blood bank b. stops transfusion and removes iv catheter c. adds a leukocyte reduction filter to the blood administration set d. recognizes this as a mild allergic transfusion reaction and slows the transfusion

answer a: chills and fever are symptoms of an acute hemolytic or transfusion reaction if these develop the transfusion should be stopped, saline infused through the iv line, the physician and blood bank notified immediately, the id tags rechecked and vital signs and urine output monitored. addition of a leukocyte reduction filter may prevent a febrile reaction but is not helpful once the reaction has occurred. mild and transient allergic reactions indicated by itching and hives might permit restarting of transfusion after treatment with antihistamines.

Anemia or insufficient hemoglobin content is common in older persons. The client's body compensates for the deficiency by: 1.Decreasing the respiratory and heart rates. 2.Increasing the heart and respiratory rates. 3.Shunting blood away from vital organs and skin. 4.Decreasing blood viscosity in order to supply oxygen to hypoxic tissues.

answer b All anemias result in a loss of oxygen-carrying capacity of the blood, and produce generalized hypoxia. The body tries to compensate by raising the heart and respiratory rates, shunting blood to vital organs away from the skin, and increasing blood viscosity in order to supply oxygen to hypoxic tissues.

Because older persons can have severe anemia for a long period of time without detection, when diagnosed, quick reversal is warranted. Which of the following orders most likely would be prescribed at this time a.Platelet transfusion and osmotic diuretic b.Ferrous sulfate 325 mg orally three times a day c. Packed red blood cells followed by oral furosemide (Lasix) d. Erythropoietin (Procrit) injection twice per week

answer c Older persons might have heart problem that are compounded by severe anemia. The physician can prescribe blood transfusions to reverse the severity of the anemia, and a diuretic such as furosemide (Lasix) orally between units to prevent fluid overload and the development of congestive heart failure (CHF).

When caring for a client with a diagnosis of thrombocytopenia, the nurse should plan to: a.Discourage the use of stool softeners. b.Assess temperature readings every six hours. c.Avoid invasive procedures. d. Encourage the use of a hard, brittle toothbrush.

answer c Thrombocytopenia is characterized by an increased number of circulating platelets in the blood. Older persons with thrombocytopenia are at significantly increased risk of thrombosis, and careful monitoring of platelet levels and symptoms is indicated.

T he nurse has started a transfusion of packed red blood cells. The nurse should immediately stop the transfusion when which of the following occurs? 1. Fever and back pain 2. D ry mouth 3. H ypothermia and pallor 4. H eart rate of 74 beats per minute

answer. 1. Fever and back pain can occur in hemolytic blood transfusion reaction caused by the mismatch of blood types. If the transfusion is not stopped immediately, the client could go into shock and die. Dry mouth could be caused by an antihistamine given as a premedication or from dehydration, but it is not a reason to stop the transfusion. Blood products expire in a few hours and interruptions should be minimized. A heart beat of 74 beats per minute is not too high or too low. The client may also spike a temperature and have flushed skin.

A client with anemia has a nursing diagnosis of activity intolerance. Which of the following interventions will the nurse plan for this client? 1.Promote active and passive range-of-motion activities. 2.Space activities and plan rest periods. 3.Teach the client to change position slowly to prevent dizziness. 4. Teach the client the basics of good nutrition

answer: Space activities and plan rest periods. Rationale: The client with activity intolerance tires easily, so it is best for the nurse to plan care and activities around periods of rest. Teaching good nutrition will not help the client to be less tired. Promoting range of motion does not address the issue of fatigue, nor does teaching the client to change position slowly.

A patient with thrombocytopenia with active bleeding has 2 units of platelets prescribed. To administer the platelets the nurse a. checks for abo compatibility b. agitates the bag periodically during the transfusion c. takes vital signs every 15 minutes during the procedure d. refrigerates the second unit until the first unit has transfused

answer: b agitates the bag periodically during the transfusion platelets adhere to plastic bags and should be gently agitated throughout the transfusion. platelets do not have a b or rh antibodies and abo compatibility is not a consideration. baseline vital signs should be taken before the transfusion is started and the nurse should stay with patient during first 15 minutes platelets are stored at room temp and should not be refrigerated

During assessment of a patient with thrombocytopenia, the nurse would expet to find? a. sternal tenderness b. petechial and purpura c. jaundiced sclera and skin d. tender enlarged lymph nodes

answer: b. petachiae and purpura rationale: petechiae are small, flat, red, or red brown pinpoint microhemorrhages that occur ont eh skin when platelet levels are low and when they are numerous, they group causing reddish bruises known as purpura. jaundice occurs when anemias are of a hemolytic origin, resulting in accumulation of bile pigments from rbc, enlarged lymph nodes are associated with infection, sternal tendernesss w leukemias

A client with pernicious anemia asks why she must take vitamin B12 injections for the rest of her life. What is the nurse's best response? a. "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient acid." b. "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor." c. "The reason for your vitamin deficiency is an excessive excretion of the vitamin because of kidney dysfunction." d. "The reason for your vitamin deficiency is an increased requirement for the vitamin because of rapid red blood cell production."

b. "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor." Most clients with pernicious anemia have deficient production of intrinsic factor in the stomach. Intrinsic factor attaches to the vitamin in the stomach and forms a complex that allows the vitamin to be absorbed in the small intestine. The stomach is producing enough acid, there is not an excessive excretion of the vitamin, and there is not a rapid production of RBCs in this condition.

The nurse understands that the client with pernicious anemia will have which distinguishing laboratory findings? a. Schilling's test, elevated b. Intrinsic factor, absent. c. Sedimentation rate, 16 mm/hour d. RBCs 5.0 million

b. intrinsic factor, absent The defining characteristic of pernicious anemia, a megaloblastic anemia, is lack of the intrinsic factor, which results from atrophy of the stomach wall. Without the intrinsic factor, vitamin B12 cannot be absorbed in the small intestines, and folic acid needs vitamin B12 for DNA synthesis of RBCs. The gastric analysis was done to determine the primary cause of the anemia. An elevated excretion of the injected radioactive vitamin B12, which is protocol for the first and second stage of the Schilling test, indicates that the client has the intrinsic factor and can absorb vitamin B12 into the intestinal tract. A sedimentation rate of 16 mm/hour is normal for both men and women and is a nonspecific test to detect the presence of inflammation. It is not specific to anemias. An RBC value of 5.0 million is a normal value for both men and women and does not indicate anemia.

When comparing the hematocrit levels of a post-op client, the nurse notes that the hematocrit decreased from 36% to 34% on the third day even though the RBC and hemoglobin values remained stable at 4.5 million and 11.9 g/dL, respectively. Which nursing intervention is most appropriate? a. Check the dressing and drains for frank bleeding b. Call the physician c. Continue to monitor vital signs d. Start oxygen at 2L/min per NC

c. Continue to monitor vital signs The nurse should continue to monitor the client, because this value reflects a normal physiologic response. The physician does not need to be called, and oxygen does not need to be started based on these laboratory findings. Immediately after surgery, the client's hematocrit reflects a falsely high value related to the body's compensatory response to the stress of sudden loss of fluids and blood. Activation of the intrinsic pathway and the renin-angiotensin cycle via antidiuretic hormone produces vasoconstriction and retention of fluid for the first 1 to 2 day post-op. By the second to third day, this response decreases and the client's hematocrit level is more reflective of the amount of RBCs in the plasma. Fresh bleeding is a less likely occurrence on the third post-op day but is not impossible; however, the nurse would have expected to see a decrease in the RBC and hemoglobin values accompanying the hematocrit.

A client with anemia may be tired due to a tissue deficiency of which of the following substances? a. Carbon dioxide b. Factor VIII c. Oxygen d. T-cell antibodies

c. Oxygen Anemia stems from a decreased number of RBCs and the resulting def in O2 and body tiss. Clotting factors, such as 8 relate to the bodies ability to form blood clots and arnt related to anemia, not is carbon dioxide of T antibodies

A client comes into the health clinic 3 years after undergoing a resection of the terminal ileum complaining of weakness, shortness of breath, and a sore tongue. Which client statement indicates a need for intervention and client teaching? a. "I have been drinking plenty of fluids." b. "I have been gargling with warm salt water for my sore tongue." c. "I have 3 to 4 loose stools per day." d. "I take a vitamin B12 tablet every day."

d. I take a vitamin B12 tablet every day Vitamin B12 combines with intrinsic factor in the stomach and is then carried to the ileum, where it is absorbed in the bloodstream. In this situation, vitamin B12 cannot be absorbed regardless of the amount of oral intake of sources of vitamin B12 such as animal protein or vitamin B12 tablets. Vitamin B12 needs to be injected every month, because the ileum has been surgically removed. Replacement of fluids and electrolytes is important when the client has continuous multiple loose stools on a daily basis. Warm salt water is used to soothe sore mucous membranes. Crohn's disease and small bowel resection may cause several loose stools a day.

A client states that she is afraid of receiving vitamin B12 injections because of the potential toxic reactions. What is the nurse's best response to relieve these fears? a. "Vitamin B12 will cause ringing in the eats before a toxic level is reached." b. "Vitamin B12 may cause a very mild skin rash initially." c. "Vitamin B12 may cause mild nausea but nothing toxic." d. "Vitamin B12 is generally free of toxicity because it is water soluble.

d. Vitamin B12 is generally free of toxicity because it is water soluble Vitamin B12 is a water-soluble vitamin. When water-soluble vitamins are taken in excess of the body's needs, they are filtered through the kidneys and excreted. Vitamin B12 is considered to be nontoxic. Adverse reactions that have occurred are believed to be related to impurities or to the preservative in B12 preparations. Ringing in the ears, skin rash, and nausea are not considered to be related to vitamin B12 administration.