NUR 350 Chap 30 Hematologic Problems

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

Palpitations An Hgb range of 10 to 12 g/dL indicates mild anemia. Therefore the patient with an Hgb of 11 g/dL may experience palpitations. Glossitis is one of the manifestations of severe anemia in which the patient would have an Hgb level below 6 g/dL. Exertional dyspnea is seen in patients with mild anemia. However, dyspnea at rest is a manifestation of severe anemia. Roaring in the ears is seen in patients with moderate anemia whose Hgb values range between 6 and 10 g/dL. p. 607

The nurse reviews the laboratory results of a patient with acute disseminated intravascular coagulation (DIC) and notes prolonged thrombin time, prothrombin time (PT), and partial thromboplastin time (PPT). Which other laboratory finding indicates partial occlusion of small vessels? Schistocytes Elevated D-dimers Soluble fibrin monomer Reduced fibrin split products (FSPs)

Schistocytes In a patient with disseminated intravascular coagulation (DIC) disorder, the values that measure clotting mechanism such as thrombin time, prothrombin time (PT), and partial thromboplastin time (PPT), are usually prolonged. Peripheral blood smear test detects the presence of schistocytes, or fragmented erythrocytes. These schistocytes are indicative of partial occlusion of small vessels by fibrin thrombi. Elevated D-dimers, soluble fibrin monomer, and fibrin split products (FSPs) are not indicative of partial occlusion of small vessels by fibrin thrombi. However, elevated D-dimers, positive soluble fibrin monomer, and elevated fibrin split products (FSPs) indicate the degree of fibrinolysis. p. 630

A patient is suspected of having disseminated intravenous coagulation (DIC). Which questions should the nurse ask to determine the presence of bleeding? "Do you get frequent headaches?" "Has your appetite or weight changed?" "Have you noticed changes in vision or dizziness?" "Have you noticed changes in your urine or stools?" "Are you experiencing breathing that is faster than normal?"

"Do you get frequent headaches?" "Have you noticed changes in vision or dizziness?" "Have you noticed changes in your urine or stools?" "Are you experiencing breathing that is faster than normal?" The patient with suspected disseminated intravascular coagulation (DIC) shows bleeding manifestations due to depletion of platelets and coagulation factors. Neurologic manifestations include headaches, changes in vision, and dizziness. Renal manifestations associated with this disorder include hematuria. Therefore the nurse should ask the patient questions regarding the occurrence of frequent headaches, changes in vision or dizziness, and changes in urine or stools. The patient with DIC does not necessarily have changes in weight. Tachypnea is a manifestation associated with DIC; the nurse should ask the patient about this symptom. p. 630

To prepare for a patient's transfusion of packed red blood cells, the nurse should select which intravenous solution to use for the procedure? 3% normal saline Lactated Ringer's 5% dextrose in water 0.9% normal saline

0.9% normal saline The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It is also used to flush the blood tubing after the infusion is complete to ensure the patient receives blood that is left in the tubing when the bag is empty. Lactated Ringer's, 5% dextrose in water, and 3% normal saline are not compatible with blood products. p. 648

The nurse reviews a patient's medical history and identifies that which finding increases the patient's risk of subacute disseminated intravascular coagulation (DIC)? Toxins from snakebite A retained dead fetus Transfusion of mismatched blood Malignancy due to tumor lysis syndrome

A retained dead fetus The types of disseminated intravascular coagulation (DIC) disorders include acute, chronic, and subacute types. The risk factors that predispose a patient to subacute DIC disorder include obstetric conditions such as a retained dead fetus. Toxins from snakebites, malignancy due to tumor lysis syndrome, and hemolytic processes such as transfusion of mismatched blood may predispose a patient to acute disseminated intravascular coagulation (DIC). p.629

A patient with a platelet count of 52,000/mm 3 is diagnosed with thrombocytopenia. The nurse expects what clinical manifestations? Weakness and fatigue Bruising and petechiae Dizziness and vomiting Lightheadedness and nausea

Bruising and petechiae A low platelet count, known as thrombocytopenia, may be accompanied by signs of hemorrhage, such as bruising and petechiae. A normal platelet count is 150,000 to 400,000/mm 3. The symptoms listed in the other answer options are not directly associated with thrombocytopenia. p. 623

The nurse cares for a patient with polycythemia vera and expects what assessment finding? Orthopnea Peripheral edema Increased hemoglobin Increased C-reactive protein

Increased hemoglobin In polycythemia vera, hemoglobin and hematocrit are increased because of a hyperproliferation of red blood cells. Orthopnea, peripheral edema, and increased C-reactive protein are not associated with polycythemia vera. p. 621

When preparing to administer a prescribed blood transfusion, the nurse should select which intravenous (IV) solution to prime the blood tubing? Lactated Ringer's 5% Dextrose in water 0.9% Sodium chloride 0.45% Sodium chloride

0.9% Sodium chloride The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It also is used to flush the blood tubing after the infusion is complete to ensure the patient receives blood that is left in the tubing when the bag is empty. Dextrose and lactated Ringer's solutions cannot be used with blood, because they will cause red blood cell (RBC) hemolysis. p. 649

A patient has a prescription written at 1000 for two units of packed red blood cells. If the transfusion is picked up from the laboratory at 1015, the nurse should plan to hang the unit no later than what time? 1030 1045 1100 1115

1045 The nurse must hang the unit of packed red blood cells within 30 minutes of signing them out from the blood bank, which would be at 1045. 1030, 1100, and 1115 are not consistent with this policy. p. 649

Recalling that myelodysplastic syndrome (MDS) arises from the pluripotent hematopoietic stem cell in the bone marrow, that nurse expects what laboratory results? An excess of platelets An excess of red blood cells A deficiency of granulocytes A deficiency of clotting factors Inefficiently functioning platelets

A deficiency of granulocytes Inefficiently functioning platelets MDS commonly manifests as infection and bleeding caused by inadequate numbers of ineffective functioning circulating granulocytes or platelets. Red blood cells and platelets are decreased. p. 635

What nursing intervention should be the priority in the care of a patient that is diagnosed with immune thrombocytopenic purpura (ITP)? Administration of packed red blood cells Administration of clotting factors VIII and IX Administration of oral or intravenous (IV) corticosteroids Maintenance of reverse isolation and application of standard precautions

Administration of oral or intravenous (IV) corticosteroids Common treatment modalities for ITP include corticosteroid therapy to suppress the phagocytic response of splenic macrophages. Blood transfusions, administration of clotting factors, and reverse isolation are not interventions that are indicated in the care of patients with ITP. Standard precautions are used with all patients. p. 624

The nurse creates a plan of care for a patient with disseminated intravascular coagulation (DIC) and should include what nursing diagnosis that is related to the disease process and therapy? Anxiety Peripheral edema Altered level of consciousness Decreased cardiac output related to fluid volume overload

Anxiety Anxiety related to fear of the unknown, the disease process, diagnostic procedures, and therapy may be observed in a patient with disseminated intravascular coagulation (DIC). Decreased cardiac output is related to fluid volume deficit. Peripheral edema does not occur with DIC. There is no change in level of consciousness with DIC. p. 631

An obstetric patient who had a placental abruption is experiencing acute hemorrhage due to disseminated intravascular coagulation (DIC). Which action is the highest priority for the nurse? Maintaining the patient's intake and output accurately. Instructing the patient regarding measures to prevent bleeding Assessing the patient for signs and symptoms of hypovolemic shock Assessing the patient's discharge needs in regards to caring for a newborn

Assessing the patient for signs and symptoms of hypovolemic shock Abruptio placentae can involve massive blood loss and consequent loss of clotting factors and components, resulting in disseminated intravascular coagulation. Without immediate intervention, the patient is at high risk for profound hypovolemic shock. Maintaining an accurate input and output log, instructing the patient in measures to prevent bleeding, and assessing the patient's discharge needs are all appropriate but are of lower priority in light of the patient's urgent care need. p. 630

The nurse reviews the laboratory test results for a patient with upper gastrointestinal bleeding and notes that the hemoglobin level is 8.7 g/dL and the hematocrit is 26%. The nurse should place highest priority on initiating interventions that will reduce which symptom? Nausea Dizziness Headache Constipation

Dizziness The patient with a low hemoglobin and hematocrit (normal values 13.5% to 17% and 40% to 54%, respectively, for males) is anemic and would be most likely to experience fatigue and dizziness. This symptom develops because of the lowered oxygen-carrying capacity that leads to reduced tissue oxygenation to carry out cellular functions. Constipation, nausea, and headache are not associated with decreased hemoglobin and hematocrit levels. p. 607

A patient is prescribed oral iron for the treatment of anemia. The nurse should instruct the patient about what side effects? Anorexia Red stools Heartburn Black stools Constipation

Heartburn Black stools Constipation Because the GI tract excretes excess iron, the primary side effects of oral iron preparations are heartburn, black stools, and constipation. Red stool is not a side effect of iron preparation, but can be caused by the presence of fresh blood in the stools due to bleeding from hemorrhoids or irritable bowel syndrome. Anorexia is not an expected side effect. p. 611

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

Hemophilia can be treated by replacement therapy. Hemophilia decreases the clotting ability of the blood in a patient and can be treated by replacement therapy during acute phases of bleeding. Hemophilia is hereditary in nature. Hemophilia is an X-linked recessive genetic disorder. The most common form of hemophilia is hemophilia A. pp. 626-627

The nurse cares for a patient with iron-deficiency anemia. Which nursing diagnostic statement associated with the condition is the highest priority? Deficient fluid volume Impaired gas exchange Impaired breathing pattern Decreased cardiac output

Impaired gas exchange Iron is necessary for hemoglobin synthesis. Hemoglobin is responsible for oxygen transport in the body. With iron-deficiency anemia a subnormal hemoglobin level cannot carry enough oxygen to the tissues. This results in impaired tissue oxygenation caused by impaired gas exchange. Deficient fluid volume and decreased cardiac output are not directly associated with iron-deficiency anemia. An impaired breathing pattern may develop as a result of impaired gas exchange. pp. 610-611

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

Infectious agent Infectious agents, such as malaria, are c extrinsic factors that can lead to acquired hemolytic anemias. Membrane abnormalities, such as paroxysmal nocturnal hemoglobinuria, cause increased RBC destruction and are hereditary (intrinsic) factors, Abnormal hemoglobin, such as sickle cell disease, and enzyme deficiencies are intrinsic factors that lead to hereditary (intrinsic) hemolytic anemias. p. 607

Which body system should the nurse assess to determine the signs of external bleeding in a patient with disseminated intravascular coagulation (DIC)? Neurologic Cardiovascular Integumentary Gastrointestinal

Integumentary To determine the signs of external bleeding in a patient with disseminated intravascular coagulation (DIC) disorder, the nurse assesses the integumentary system. The nurse assesses the neurologic, cardiovascular, and gastrointestinal systems for internal bleeding. p.630

The nurse assesses four patients and identifies that which patient is at the highest risk for sickle cell anemia? Patient A Patient B Patient C Patient D

Patient A Sickle cell anemia is most common in African Americans. African Americans and people of Mediterranean origin are at the highest risk for thalassemia. Tay-Sachs disease is a rare, autosomal-recessive genetic metabolic disorder found in Ashkenazi Jews. Deficiency in red blood cell production due to a lack of vitamin B 12 results in pernicious anemia and most commonly occurs in Scandinavians and African Americans. p. 607

A patient is suspected to have acute disseminated intravascular coagulation (DIC). The nurse expects that which laboratory test will be prescribed to confirm the presence of fragmented erythrocytes? Factor assays Peripheral blood smear Soluble fibrin monomer Fibrin split products (FSPs)

Peripheral blood smear Fragmented erythrocytes or schistocytes are indicative of partial occlusion of small vessels by fibrin thrombi. Peripheral blood smear test detects the presence of fragmented erythrocytes. Factor assays, soluble fibrin monomer, and fibrin split products (FSPs) tests do not detect the presence of fragmented erythrocytes; however, they are useful in determining the degree of fibrinolysis. p. 630

A patient is scheduled for a hematopoietic stem cell transplant (HSCT) and receives preoperative combination chemotherapy. What is the nursing priority? Prevent patient infection Avoid abnormal bleeding Give pneumococcal vaccine Provide companionship while isolated

Prevent patient infection After combination chemotherapy for HSCT, the patient's bone marrow is destroyed in preparation to receive the bone marrow graft. Thus the patient is immunosuppressed and is at risk for a life-threatening infection. The priority is preventing infection. Bleeding usually is not a problem. Giving the pneumococcal vaccine at this time should not be done, but should have been done previously. Providing companionship is not the primary role of the nurse, although the patient will need support during the time of isolation. p. 642

A patient is diagnosed with coagulopathy and receives a prescription for warfarin therapy. The nurse provides dietary education. Which statement made by the patient indicates that the teaching was effective? "Vitamin K is only in fruits and salad." "I can eat as many green, leafy vegetables as I want." "I need to have a consistent amount of vitamin K in my diet." "I should avoid green, leafy vegetables, and I cannot eat salad regularly."

"I need to have a consistent amount of vitamin K in my diet." Patients on warfarin therapy must be taught to identify foods high in vitamin K and to consume consistent amounts daily. Patients should be advised not to eat large amounts of green, leafy vegetables sporadically as this decreases the effectiveness of warfarin. A balanced diet that includes a consistent amount of vitamin K is necessary to maintain good health. As such, patients should not avoid foods containing vitamin K. Vitamin K is found in many fruits, vegetables, and meats. p. 625

The nurse teaches a group of student nurses about assessing for signs of fibrin or platelet deposition in the microvasculature in patients with disseminated intravascular coagulation (DIC). Which statement made by a student nurse indicates the need for further teaching? "I should check the integumentary system to assess for gangrene." "I should check the mucous membrane surfaces to assess for oozing." "I should check the gastrointestinal system to assess for abdominal pain." "I should check the pulmonary function to assess for acute respiratory distress syndrome."

"I should check the mucous membrane surfaces to assess for oozing." Damage to mucous membranes results in epistaxis or gingival oozing, indicating hemorrhage or bleeding in a patient with disseminated intravascular coagulation (DIC). The integumentary, gastrointestinal, and pulmonary manifestations associated with the signs of microvascular thrombosis in a patient with DIC include cyanosis, abdominal pain, and acute respiratory distress syndrome (ARDS), respectively. p. 630

A patient with anemia experiences fatigue when performing activities of daily living. Which nursing intervention is appropriate to include in the patient's plan of care? Encourage frequent visitors. Assist the patient in prioritizing activities. Assist the patient in walking immediately after meals. Ensure that all physical activities are completed in the morning.

Assist the patient in prioritizing activities. The nurse should teach and assist the patient and caregiver to assign priority to activities to accommodate energy levels and promote tolerance for important activities. The patient should be asked to avoid activity immediately after meals to reduce competition for oxygen supply to vital functions. Activities should be alternated with rest periods throughout the day rather than completed in the morning. The caregiver should limit the number of visitors so that the patient receives adequate rest. p. 608

The nurse assesses a patient and identifies signs of hemorrhage based on what changes in the mucous membranes? Pallor Purpura Epistaxis Hematoma

Epistaxis The signs of hemorrhage that are manifested by changes in mucous membranes include epistaxis and gingival oozing. The signs of hemorrhage such as pallor, purpura, and hematoma are associated with the integumentary system. p. 630

The nurse recognizes that which assessment finding in a patient with disseminated intravascular coagulation (DIC) is a thrombotic manifestation? Decreased urinary output Presence of blood in urine Presence of blood in stools Increased body temperature

Decreased urinary output A patient with disseminated intravascular coagulation (DIC) disorder may have bleeding and thrombotic manifestations. Thrombotic manifestations occur due to fibrin or platelet deposition in the microvasculature. Decreased urinary output or oliguria is a sign of thrombotic manifestation. Presence of blood in urine (hematuria) or presence of blood in stools indicates that the patient is exhibiting bleeding manifestations. Increased body temperature is a clinical manifestation seen in a patient with neutropenia caused by infections. p. 630

The nurse recognizes that a factor assays laboratory test may produce a false positive result when used to diagnose disseminated intravascular coagulation (DIC) disorder. This misleading lab finding is likely related to which factor that rises with inflammation? Factor V Factor VI Factor X Factor XII

Factor V The factor assays laboratory tests measure prothrombin (PT) levels and factors such as V, VIII, X, and XII. Misleading results may occur, because factors V and VIII level rises with inflammation. Factors VI, X, and XII are not affected by inflammation and are not associated with false positive results. p. 630

The nurse recognizes that cryoprecipitate therapy is helpful in the treatment of disseminated intravascular coagulation (DIC) because it replaces what factor? Factor V Factor VIII Factor X Factor XIII

Factor VIII Cryoprecipitates may be required in disseminated intravascular coagulation (DIC) disorder when the fibrinogen levels are less than 100 mg/dL. This therapy helps to replace factor VIII, which plays a major role in clotting. Cryoprecipitates do not replace factors V, X, and XIII. p. 630

A patient with hemophilia is scheduled for an invasive dental procedure. The nurse recognizes that is appropriate to prescribe what blood products to a patient with this disorder? Thrombin Factor VI Factor VIII Factor IX Desmopressin acetate (DDAVP)

Factor VIII Factor IX Desmopressin acetate (DDAVP) Replacement of deficient clotting factors is the primary means of supporting a patient with hemophilia. In addition to treating acute crises, replacement therapy may be given before surgery and dental care as a prophylactic measure. For hemophilia, the clotting factors include Factor VIII and Factor IX, as well as the administration of DDAVP, a synthetic analog of vasopressin, which may be used to stimulate an increase in factor VIII. Thrombin and Factor VI are not used to replace clotting factors in hemophiliacs. p. 628

A patient that is receiving treatment for thalassemia show evidence of hemolysis. The nurse anticipates a prescription for which supplementation? Zinc Folic acid Vitamin B 12 Ascorbic acid

Folic acid Folic acid is given if there is any evidence of hemolysis in patients with thalassemia. Zinc supplementation is required in patients with thalassemia after chelation therapy, because zinc levels may decline. Vitamin B 12 supplementation is required for patients with megaloblastic anemias. Ascorbic acid supplementation may be needed during chelation therapy in patients receiving treatment for thalassemia, because it increases urinary excretion of iron. p. 612

A patient receives a new prescription for a transfusion of two units of packed red blood cells (PRBCs). The nurse should take which action to ensure patient safety? Add the blood transfusion as a secondary line to the existing IV and infuse over 60 minutes or less. Remain with the patient for 60 minutes after beginning the transfusion to watch for signs of transfusion reaction. Select a new primary intravenous (IV) tubing to use for the administration and piggyback with 500 mL of normal saline. Have a second registered nurse check the identifying information on the unit of blood against the identification bracelet and blood-bank identification bracelet.

Have a second registered nurse check the identifying information on the unit of blood against the identification bracelet and blood-bank identification bracelet. The patient's identifying information (name, date of birth, medical record number) on the identification bracelet should match exactly the information on the blood-bank tag that has been placed on the unit of blood. If any information does not match, the transfusion should not be hung because of possible error and risk to the patient. Blood tubing, not primary tubing, is needed for blood transfusion and should not be administered as a secondary infusion. The nurse should remain with the patient for 15 minutes following initiation of transfusion. p. 649

The nurse assesses a patient with disseminated intravascular coagulation (DIC) and expects to find what signs of hemorrhage? Azotemia Hemoptysis Hypotension Focal ischemia Abdominal distention

Hemoptysis Hypotension Abdominal distention Pulmonary manifestations such as hemoptysis, is a sign of hemorrhage in disseminated intravascular coagulation (DIC) disorder. Hypotension and increased abdominal girth are also bleeding manifestations. Renal manifestations such as azotemia and integumentary manifestations such as focal ischemia are signs of microvascular thrombosis that are observed in a patient with DIC disorder. p. 630

A patient that reports recent weight loss, fever, and night sweats is diagnosed with chronic lymphocytic leukemia. The nurse expects what dianostic findings? Hepatomegaly Sternal tenderness Hemoglobin 19 g/dL Platelet count 50,000/mcL White blood cell count 110,000/mcL

Hepatomegaly Platelet count 50,000/mcL White blood cell count 110,000/mcL Clinical manifestations of CLL include splenomegaly, lymphadenopathy, and hepatomegaly. Diagnostic findings include mild anemia, thrombocytopenia, and total white blood cell (WBC) count greater than 100,000/mcL. Hemoglobin levels decrease. Sternal tenderness does not occur in CLL. p. 636

The nurse reviews the medical record of a patient with acute myelogenous leukemia (AML) and expects what finding? Hypercellular bone marrow with lymphoblasts Presence of lymphoblasts in cerebrospinal fluid Hypercellular bone marrow with myeloblasts Increased peripheral lymphocytes and lymphocytes in the bone marrow

Hypercellular bone marrow with myeloblasts Hypercellular bone marrow with myeloblasts indicates AML. Hypercellular bone marrow with lymphoblasts and presence of lymphoblasts in cerebrospinal fluid are observed in acute lymphocytic leukemia (ALL). An increase in peripheral lymphocytes and lymphocytes in the bone marrow are noted in chronic lymphocytic leukemia (CLL). p. 636

While caring for a patient with disseminated intravascular coagulation (DIC), which nursing diagnosis is the highest priority? Anxiety Acute pain Decreased cardiac output Ineffective peripheral tissue perfusion

Ineffective peripheral tissue perfusion Priority is given to the management of ABCs (airway, breathing, and circulation) and safety. Nursing diagnoses are chosen based on the clinical findings and problems identified. Ineffective peripheral tissue perfusion related to bleeding and sluggish or diminished blood flow secondary to thrombosis occurs in a patient with disseminated intravascular coagulation (DIC) disorder. The nurse should recognize signs of ineffective peripheral perfusion and take immediate actions to prevent further complications. Anxiety related to fear of the unknown, the disease process, diagnostic procedures, and/or therapy may be observed in a patient with DIC, but it is not a high priority for the nurse. The acute pain is related to bleeding into tissues and diagnostic procedures in a patient with DIC disorder. Although it is an appropriate nursing diagnosis, it is not a high priority. Decreased cardiac output related to fluid volume deficit is also one of the diagnoses in patients with DIC, but it is not a high priority. pp. 630-631

While taking undiluted liquid iron that was prescribed, a patient asks the nurse why it must be drunk through a straw. How should the nurse respond? It reduces iron absorption. It increases iron absorption. It reduces allergic reactions. It prevents staining of the teeth.

It prevents staining of the teeth. An undiluted iron preparation causes staining of the teeth if consumed without using a straw. Such preparations should therefore be taken using a straw. Compared to drinking undiluted liquid iron without a straw, consuming it with a straw does not boost iron absorption, reduce iron absorption, or reduce allergic reactions. p. 611

The nurse reviews the history of a patient with acute disseminated intravascular coagulation (DIC). The nurse identifies which factors that put the patient at risk for DIC? Septicemia An extensive burn Abruptio placentae Severe head trauma Acute respiratory distress syndrome (ARDS)

Septicemia An extensive burn Abruptio placentae Severe head trauma Risk factors associated with acute disseminated intravascular coagulation (DIC) include severe head injury, abruptio placentae, extensive burns, and septicemia. ARDS is not a risk factor for acute DIC. p. 629

The nurse recalls that the standard of care for pain includes what component? That the pain assessment is based on nursing judgment The minimal amount of intervention required to address pain That competent and compassionate care is provided to all patients Notifying the health care provider regarding the effects of the pain medication

That competent and compassionate care is provided to all patients The standard of care for pain includes providing competent and compassionate care for all patients. The patient's pain assessment is not based on nursing judgment; it is based on the patient's self report. The standard of care for pain includes providing the best possible relief under the circumstances. Notifying the health care provider regarding the effects of the pain medication should occur if the medication is not providing adequate pain relief for the patient. p. 619

A competent patient is hospitalized with suspected internal bleeding. The patient states, "I am a Jehovah's Witness and do not want to receive any blood products if they are needed." Shortly after admission, the patient becomes unconscious. It is determined that the patient needs packed red blood cells (pRBCs). What is the nurse's most appropriate action? Withhold the blood products. Contact the agency's ethics committee. Contact the family for permission to administer blood products to the patient. Administer blood products with the intent of informing the patient after the procedure.

Withhold the blood products. Competent adults have the right to make all health care decisions, including the right to refuse treatment based on their religious beliefs. The nurse should withhold the blood products in accordance with the patient's wishes. Contacting the ethics committee is not necessary since the patient's wishes are clear. Administering the blood products with intent of informing the patient later or after contacting the family is unethical, as either action is in violation of the patient's stated refusal. p. 649

A patient with thalassemia major is anemic and has a history of numerous blood transfusions. The nurse expects what to be included in the patient's treatment plan? Iron supplementation Zinc supplementation Oral deferasirox (Exjade) Continued blood transfusions Ascorbic acid supplementation

Zinc supplementation Oral deferasirox (Exjade) Continued blood transfusions Ascorbic acid supplementation The patient has thalessemia, is anemic, and has a history of blood transfusions. Oral deferasirox (Exjade) is a chelating agent that binds with iron to prevent iron overload. Such chelation therapy reduces zinc in the body, so zinc supplements should be administered. Blood transfusions are performed to keep the hemoglobin level at approximately 10 g/dL. Adequate hemoglobin promotes erythropoiesis and prevents spleen enlargement. Ascorbic acid supplements increase the excretion of iron, so they are administered during the chelation therapy. Blood transfusions and hemolysis lead to iron overload, so iron supplements should not be administered. p. 612