**MSN Ch17 Random Questions Nursing 3
Is a state in which there are insufficient numbers of functioning RBCs, or a lack of hemoglobin, to meet the demands of the tissues for oxygen.
Anemia
Nursing interventions for the pt with aplastic anemia are directed toward the prevention of the complications of:
a. fatigue and dyspnea b. hemorrhage and infection c. thromboemboli and gangrene d. cardiac arrhythmias and heart failure Answer B. Hemorrhage from thrombocytopenia and infection from neutropenia are the greatest risks for the pt with aplastic anemia. The pt will experience fatigue from anemia, but bleeding and infection are the major causes of death in aplastic anemia.
The nurse evaluates that teaching for the pt with iron deficiency anemia has been effective when the pt states:
a. "I will need to take the iron supplements the rest of my life" b. "I will increase my dietary intake of milk and milk products" c. "I should increase my activity to increase my aerobic capacity" d. "I should take the iron for several months after my blood is normal" Answer D. To replace the body's iron stores, iron supplements should be continued for 2 to 3 months after the hemoglobin (Hb) level returns to normal, but if the cause of the iron deficiency is corrected, the supplements do not need to be taken for a lifetime. Milk and milk products are poor sources of dietary iron. Activity should be gradually increased as Hb levels return to normal since aerobic capacity can only be increased when adequate Hb is available.
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." ANSWER B. 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.
A client was admitted with iron deficiency anemia and blood-streaked emesis. Which question is most appropriate for the nurse to ask in determining the extent of the client's activity intolerance?
a. "What activities were you able to do 6 months ago compared with the present?" b. "How long have you had this problem?" c. "Have you been able to keep up with all your usual activities?" d. "Are you more tired now than you used to be?" ANSWER A. It is difficult to determine activity intolerance without objectively comparing activities from one time frame to another. Because iron deficiency anemia can occur gradually and individual endurance varies, the nurse can best assess the client's activity tolerance by asking the client to compare activities 6 months ago and at the present. Asking a client how long a problem has existed is a very open-ended question that allows for too much subjectivity for any definition of the client's activity tolerance. Also, the client may not even identify that a "problem" exists. Asking the client whether he is staying abreast of usual activities addresses whether the tasks were completed, not the tolerance of the client while the tasks were being completed or the resulting condition of the client after the tasks were completed. Asking the client if he is more tired now than usual does not address his activity tolerance. Tiredness is a subjective evaluation and again can be distorted by factors such as the gradual onset of the anemia or the endurance of the individual.
The age group most at risk for developing anemia is:
a. 20-25 years old b. 26-32 years old c. 40-50 years old d. >65 years old Answer D. Keyword: MOST AT RISK. Rationale: The elderly are most at risk for anemia often due to financial concerns affecting protein intake or poor dentition that interferes with chewing meat.
What is the life span of normal platelets?
a. 3-4 months b. 1-2 months c. 1-3 days d. 7-10 days Answer D. Rationale: The life span of a normal platelet is 7-10 days. However, in idiopathic thrombocytopenia the life span is reduced to 1-3 days.
A vegetarian client was referred to a dietician for nutritional counseling for anemia. Which client outcome indicates that the client does not understand nutritional counseling? The client:
a. Adds dried fruit to cereal and baked goods b. Cooks tomato-based foods in iron pots c. Drinks coffee or tea with meals d. Adds vitamin C to all meals ANSWER C. Coffee and tea increase gastrointestinal mobility and inhibit the absorption of nonheme iron. Clients are instructed to add dried fruits to dishes at every meal because dried fruits are a nonheme or nonanimal iron source. Cooking in iron cookware, especially acid-based foods such as tomatoes, adds iron to the diet. Clients are instructed to add a rich supply of vitamin C to every meal because the absorption of iron is increased when food with vitamin C or ascorbic acid is consumed.
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 ANSWER A. Aplastic anemia decreases the bone marrow production of RBCs, WBCs, and platelets. The client is at risk for bruising and bleeding tendencies. A change in the intake and output is important, but assessment for the potential for bleeding takes priority. Change in the peripheral nervous system is a priority problem specific to clients with vitamin B12 deficiency. Change in bowel function is not associated with aplastic anemia.
The nurse devises a teaching plan for the patient with aplastic anemia. Which of the following is the most important concept to teach for health maintenance?
a. Eat animal protein and dark leafy vegetables each day b. Avoid exposure to others with acute infection c. Practice yoga and meditation to decrease stress and anxiety d. Get 8 hours of sleep at night and take naps during the day ANSWER B. Clients with aplastic anemia are severely immunocompromised and at risk for infection and possible death related to bone marrow suppression and pancytopenia. Strict aseptic technique and reverse isolation are important measures to prevent infection. Although diet, reduced stress, and rest are valued in supporting health, the potentially fatal consequence of an acute infection places it as a priority for teaching the client about health maintenance. Animal meat and dark green leafy vegetables, good sources of vitamin B12 and folic acid, should be included in the daily diet. Yoga and meditation are good complimentary therapies to reduce stress. Eight hours of rest and naps are good for spacing and pacing activity and rest.
A client with microcytic anemia is having trouble selecting food items from the hospital menu. Which food is best for the nurse to suggest for satisfying the client's nutritional needs and personal preferences?
a. Egg yolks b. Brown rice c. Vegetables d. Tea ANSWER B. Brown rice is a source of iron from plant sources (nonheme iron). Other sources of nonheme iron are whole-grain cereals and breads, dark green vegetables, legumes, nuts, dried fruits (apricots, raisins, dates), oatmeal, and sweet potatoes. Egg yolks have iron but it is not as well absorbed as iron from other sources. Vegetables are a good source of vitamins that may facilitate iron absorption. Tea contains tannin, which combines with nonheme iron, preventing its absorption.
The nurse is preparing to teach a client with microcytic hypochromic anemia about the diet to follow after discharge. Which of the following foods should be included in the diet?
a. Eggs b. Lettuce c. Citrus fruits d. Cheese ANSWER A. One of the microcytic, hypochromic anemias is iron-deficiency amenia. A rich source of iron is needed in the diet, and eggs are high in iron. Other foods high in iron include organ and muscle (dark) meats; shellfish, shrimp, and tuna; enriched, whole-grain, and fortified cereals and breads; legumes, nuts, dried fruits, and beans; oatmeal; and sweet potatoes. Dark green leafy vegetables and citrus fruits are good sources of vitamin C. Cheese is a good source of calcium
In anemia, which of the following blood components is decreased?
a. Erythrocytes b. Granulocytes c. Leukocytes d. Platelets Answer A. erythrocytes (RBC)
Which of the following is essential for the hemoglobin synthesis during RBC production?
a. Folic Acid b. Iron c. Vitamin B12 d. All of these Answer B. Keyword: HEMOGLOBIN SYNTHESIS. Rationale: Dietary elements are essential for RBC production. The following are needed by the red marrow to produce erythrocytes: • Iron - for hemoglobin synthesis • Folic Acid - for DNA synthesis • Vitamin B12 - for DNA synthesis
Which of the following nursing assessments is a late symptom of polycythemia vera?
a. Headache b. Dizziness c. Pruritus d. Shortness of breath ANSWER C. Pruritus is a late symptom that results from abnormal histamine metabolism. Headache and dizziness are early symptoms from engorged veins. Shortness of breath is an early symptom from congested mucous membrane and ineffective gas exchange.
In teaching the pt with pernicious anemia about the disease, the nurse explains that it results from a lack of:
a. folic acid b. intrinsic factor c. extrinsic factor d. cobalamine (vit B-12) intake Answer B. Pernicious anemia is a type of cobalamin (vit B12) deficiency that results when parietal cells in the stomach fail to secrete enough intrinsic factor to absorb ingested cobalamin. Extrinsic factor IS cobalamin and may be a factor in some cobalamin deficiencies but not in pernicious anemia.
The nurse is teaching a client with polycythemia vera about potential complications from this disease. Which manifestations would the nurse include in the client's teaching plan? Select all that apply.
a. Hearing loss b. Visual disturbance c. Headache d. Orthopnea e. Gout f. Weight loss ANSWERS B, C, D and E. Polycythemia vera, a condition in which too many RBCs are produced in the blood serum, can lead to an increase in the hematocrit and hypervolemia, hyperviscosity, and hypertension. Subsequently, the client can experience dizziness, tinnitus, visual disturbances, headaches, or a feeling of fullness in the head. The client may also experience cardiovascular symptoms such as heart failure (shortness of breath and orthopnea) and increased clotting time or symptoms of an increased uric acid level such as painful swollen joints (usually the big toe). Hearing loss and weight loss are not manifestations associated with polycythemia vera.
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 ANSWER B. 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
Decreased number of platelets is called:
a. Thrombectomy b. Thrombocytopenia c. Thrombocytopathy d. Thrombocytosis Answer B. Keyword: DECREASED NUMBER OF PLATELETS. Rationale: thrombocytopenia is a decreased number of platelets. Thrombocytosis is an excess in the number of platelets. Thrombocytopathy is a platelet dysfunction. Thrombectomy is the surgical removal of a thrombus.
Which food should a client with leukemia avoid?
a. Wheat bread b. Steak c. Orange d. All of these Answer C. Keyword: AVOID. Rationale: a low-bacteria diet would be indicated. Raw fruits and vegetables are excluded in the client's diet.
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 Brussels sprouts ANSWER C. 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).
Which organ is responsible for stimulating the production of red blood cells?
a. Yellow marrow b. Red marrow c. Spleen d. Kidney Answer D Kidneys produce and release the hormone erythropoietin that is responsible for initiating the production of RBCs in the red marrow The Red Marrow is the site of RBC production. The spleen is responsible for removing the damage RBC.
The nurse explains to the pt with pernicious anemia that:
a. death can be prevented by cobalamin supplementation for the rest of the pt's life b. the syptoms of the disease can be completely reversed with cobalamin (vit B12) therapy c. bone marrow transplantation to change the defective marrow cells is an alternative therapy for pernicious anemia d. dietary intake of foods high in cobalamin is the most inexpensive and convenient treatment of pernicious anemia Answer A. Without cobalamin (vit. B-12) replacement, individuals with pernicious anemia will die in 1 to 3 years, but the disease can be controlled with cobalamin (B-12) supplements for life. Hematologic manifestations can be completely reveresed with therapy, but long-standing neuromuscular complications may not be reversed. Since pernicious anemia results from an inability to absorb cobalamin, dietary intake of the vitamin is not a treatment option, nor is a bone marrow transplant.
A nursing diagnosis that is appropriate for pts with moderate to severe anemia of any etiology is:
a. impaired skin integrity r/t edema and pruritis b. disturbed body image r/t changes in appearance and body function c. imbalanced nutrition: less than body requirements r/t lack of knowledge of adequate nutrition d. activity intolerance r/t decreased Hgb and imbalance between oxygen supply and demand Answer D. Pts with any type of anemia have decreased hemoglobin and symptoms of hypoxemia, leading to activity intolerance. Impaired skin integrity and body image disturbance may be appropriate for pts with jaundice from hemolytic anemias, and altered nutrition is indicated when iron, folic acid, or vitamin B intake is deficient.
On physical assessment of the pt with severe anemia, the nurse would expect to find:
a. nervousness and agitation b. fever and tenting of the skin c. systolic murmurs and tachycardia d. bluish mucous membranes and reddened skin Answer C. 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. The skin and mucous membranes are pale, with a bluish tinge to the sclera.
In addition to the general symptoms of anemia, the pt with pernicious anemia also manifests:
a. neurologic symptoms b. coagulation deficiencies c. cardiovascular disturbances d. a decreased immunologic response Answer A. Neurologic manifestations of weakness, paresthesias of the feet and hands, and impaired thought processes are characteristic of pernicious anemia. Cardiovascular effects are most common with acute blood loss, and aplastic anemias include a leukopenia that leads to decreased immunologic response.
A nursing diagnosis that is appropriate for the effects of the deficiency of all of the cells associated with aplastic anemia is:
a. risk for injury: falls b. impaired physical mobility c. risk for impaired skin integrity d. risk for impaired oral mucous membrane Answer D. The anemia of aplastic anemia may cause an inflamed, painful tongue; the thrombocytopenia may contribute to blood-filled bullae in the mouth and gingival bleeding; and the leukopenia may lead to stomatitis and oral ulcers and infections.
To prevent a common side effect of oral iron supplements, the nurse teaches the pt to:
a. take the iron preparations with meals b. increase fluid and dietary fiber intake c. report the presence of black stools to the physician d. use enteric-coated preparations taken with orange juice Answer B. Constipation is a common side effect of oral iron supplementation, and increased fluids and fiber should be consumed to prevent this effect. Because iron can be bound in the GI tract by food, it should be taken before meals unless gastric side effects of the supplements necessitate its ingestion with food. Black stools are an expected result of oral iron preparations. Taking iron with ascorbic acid or orange juice enhances absorption of the iron, but enteric-coated iron often is ineffective because of unpredictable release of the iron in areas of the GI tract where it can be absorbed.
The strict vegetarian is at highest risk for the development of:
a. thalassemias b. iron deficiency anemia c. folic acid deficiency anemia d. cobalamin deficiency anemia Answer D. Because red meats are the primary dietary source of cobalamin (vit. B-12), a strict vegetarian is most at risk for cobalamin-deficiency anemia. Meats are also an important source of iron and folic acid, but whole grains, legumes, and green leafy vegetables also supply these nutrients. Thalassemia is not related to dietary deficiencies.
To administer iron IM, the nurse should:
a. use a short, fine needle to avoid pain b. massage the site after the injection to promote absorption c. include 0.5 ml of air in the syringe to clear the iron from the needle d. administer the injection in the vastus lateralis to prevent nerve damage Answer C Parenteral iron is very irritating and can stain the skin, so needles are changed between withdrawing and administering the medication; 0.5 ml of air is left in the syringe to completely clear the solution from the syringe during administration; it is administered Z-track in the large upper outer quad of the buttocks; and the site is not massaged after administration.
Three major classifications of anemia
• Anemia resulting from blood loss • Anemia resulting from a failure in blood cell production • Anemia associated with an excessive destruction of red cells
