NURS 301 Hematology
A client who is in hypovolemic shock has a hematocrit value of 25%. What does the nurse anticipate that the primary healthcare provider will prescribe? Lactated Ringer solution Serum albumin Blood replacement High molecular dextran
Blood replacement Blood replacement is needed to increase the oxygen-carrying capacity of the blood; the expected hematocrit for women is 37% to 47% and for men is 42% to 52%. Lactated Ringer solution does not increase the oxygen-carrying capacity of the blood. Serum albumin helps maintain volume but does not affect the hematocrit level. Although dextran does expand blood volume, it decreases the hematocrit because it does not replace red blood cells.
An adolescent is admitted with an acute hemophilia episode. For what are rest, ice, compression, and elevation most helpful? Encouraging immobilization Decreasing swelling and inflammation Providing pain relief and reducing anxiety Controlling bleeding and retaining joint function
Decreasing swelling and inflammation Rest, ice, compression, and elevation (RICE) therapy is implemented to support joints and prevent bleeding into joints. Reducing inflammation is not the goal of treatment for the hemophiliac process. Total immobilization is not required. Pain may be relieved to some degree but is not assured.
What functions of leukocytes are involved in inflammation? Select all that apply. Destruction of bacteria and cellular debris Selective attack and destruction of non-self cells Release of vasoactive amines during allergic reactions Secretion of immunoglobulins in response to a specific antigen Enhancement of immune activity through secretion of various factors, cytokines, and lymphokines
Destruction of bacteria and cellular debris Release of vasoactive amines during allergic reactions Rationale Leukocytes such as monocytes and eosinophils are involved in inflammation. Their functions include the destruction of bacteria and cellular debris and the release of vasoactive amines during allergic reactions to limit these reactions. Helper/inducer T-cells and cytotoxic cells selectively attack and destroy non-self cells and secrete immunoglobulins in response to the presence of a specific antigen. B-lymphocytes, or plasma cells, secrete immunoglobulins in response to the presence of a specific antigen. Helper/inducer T-cells are involved in cell-mediated immunity, enhancing immune activity through the secretion of various factors, cytokines, and lymphokines.
A client develops iron-deficiency anemia. Which of the client's laboratory test results should the nurse expect to be decreased? Ferritin level Platelet count White blood cell count Total iron-binding capacity
Ferritin level Ferritin, a form of stored iron, is reduced with iron-deficiency anemia. Platelets will be within the expected range or increased with iron-deficiency anemia. Red, not white, blood cells are decreased with iron-deficiency anemia. Total iron-binding capacity will be increased with iron-deficiency anemia.
During a yearly physical examination a complete blood count (CBC) is performed to determine a client's hematologic status. Which laboratory result will the nurse check? Blood glucose Hemoglobin (Hb) C-reactive protein Blood urea nitrogen (BUN)
Hemoglobin (Hb) A CBC includes red blood cell (RBC) count and RBC indices, white blood cell (WBC) count and WBC differential count, Hb, hematocrit (Hct), and platelet count. A blood glucose level is not part of a CBC. The C-reactive protein level is not part of a CBC. BUN is not part of a CBC.
A client is admitted with a higher than expected red blood cell (RBC) count. What physiologic alteration does the nurse expect will result from this clinical finding? Increased serum pH Decreased hematocrit Increased blood viscosity Decreased immune response
Increased blood viscosity Viscosity, a measure of a fluid's internal resistance to flow, is increased as the number of red blood cells suspended in plasma increases. The number of cells does not affect the blood pH. The hematocrit will be higher. RBCs do not affect immunity.
The nurse is caring for a client with iron deficiency anemia that has decreased hemoglobin and hematocrit levels. The nurse expects to identify what other abnormal laboratory level? Macrocytic red blood cells (RBCs) Thrombocytopenia Decreased folate levels Increased total iron-binding capacity (TIBC)
Increased total iron-binding capacity (TIBC) TIBC may be elevated from 350 to 500 mcg/dL (82 µmol/L) (expected range is 250 to 460 mcg/dL [45-82 mcmol/L]) because the RBCs are compensating for the iron deficiency. The RBCs are microcytic, not macrocytic, because of their low iron content. A low platelet count is not associated with iron deficiency anemia. Decreased folate levels often are noted in vitamin B 12 anemias, such as occur with sprue and celiac diseases, as well as in folate deficiency anemia, but not in iron deficiency anemia.
A client's laboratory report shows severe neutropenia and thrombocytopenia. Which medication may have caused this condition? Daclizumab Cyclosporine Methylprednisolone Mycophenolate mofetil
Mycophenolate mofetil Mycophenolate mofetil is a cytotoxic drug that may cause neutropenia and thrombocytopenia. Daclizumab may cause hypersensitivity reaction and anaphylaxis. Cyclosporine may cause neurotoxicity, nephrotoxicity, and hypertension. Methylprednisolone may cause peptic ulcers, osteoporosis, and hyperglycemia.
While reviewing a client's laboratory reports, the nurse finds a neutrophil count of 12,000/mm 3. Which condition may be present in this client? Influenza Pneumonia Immunosuppression Autoimmune disorder
Pneumonia The normal adult leukocyte count is 5,000 to 10,000/mm 3. A count of 12,000/mm 3 indicates an increased neutrophil level, which indicates the presence of an acute bacterial infection that could result in pneumonia or inflammation. Viral influenza may occur when the neutrophil count is low. Immunosuppression and autoimmune disorders may result from a decreased leukocyte count.
A client develops thrombophlebitis in the right calf. Bed rest is prescribed, and an IV of heparin is initiated. What drug action will the nurse include when describing the purpose of this drug to the client? Prevents extension of the clot Reduces the size of the thrombus Dissolves the blood clot in the vein Facilitates absorption of red blood cells
Prevents extension of the clot Heparin interferes with activation of prothrombin to thrombin and inhibits aggregation of platelets. Heparin does not reduce the size of a thrombus. Heparin does not dissolve blood clots in the veins. Heparin does not facilitate the absorption of red blood cells.
A client with small-cell lung cancer is receiving chemotherapy. A complete blood count is prescribed before each round of chemotherapy. Which component of the complete blood count is of greatest concern to the nurse? Platelets Hematocrit Red blood cells (RBCs) White blood cells (WBCs)
White blood cells (WBCs) Antineoplastic drugs depress bone marrow, which causes leukopenia; the client must be protected from infection, which can be life threatening. RBCs diminish slowly and can be replaced with a transfusion of packed red blood cells. Platelets decrease as rapidly as WBCs, but complications can be limited with infusions of platelets.
Which leukocyte values should be assessed to determine the adequacy of a client's response to inflammation? Select all that apply. Monocytes Neutrophils Plasma cells T-helper cells Macrophages
Monocytes Neutrophils Macrophages In response to inflammation, monocytes destroy bacteria and cellular debris; neutrophils ingest and phagocytize microorganisms and foreign protein; and macrophages destroy bacteria and cellular debris. Plasma cells are a part of antibody-mediated immunity and secrete immunoglobulins in response to the presence of a specific antigen. T-helper cells are a part of cell-mediated immunity and enhance immune activity through the secretion of various factors, cytokines, and lymphokines.
Which of the following signs are indications of hydration status during a sickle cell crisis? Select all that apply. Turgor of tissue Edema of the ankles Specific gravity of urine Amount of urinary output Texture of mucous membranes
Turgor of tissue Texture of mucous membrane Loss of tissue elasticity (decreased tissue turgor) indicates dehydration. Skin that takes 30 or more seconds to return to its original position after being pinched (tenting) is a sign of dehydration. Dry mucous membranes indicate inadequate hydration; moist mucous membranes indicate adequate hydration. The problem is dehydration, not retention of fluid; ankle edema is associated with interstitial fluid accumulation around the ankles. The amount and specific gravity of urine are not reliable indicators of hydration because the kidneys' ability to concentrate urine is impaired in sickle cell anemia.
An adolescent who has sickle cell anemia is recovering from a painful episode. What does the nurse see as the priority issue for this adolescent? Restriction of movement during periods of arthralgia Separation from family during periods of hospitalization Alteration in body image resulting from skeletal deformities Interruption of education as a result of multiple hospitalizations
Alteration in body image resulting from skeletal deformities The adolescent is concerned with body image and fears change or mutilation of body parts. The occlusions in the microvasculature associated with sickle cell anemia can cause bone deformities. Restriction of movement is not a major problem because when the pain is relieved and the crisis is over, activity is resumed. Teenagers can tolerate extended periods of separation from the family. Although learning interruptions may be a concern for a teenager, altered body image is a more feared threat.
The hemoglobin levels of a 30-year-old female client are measured at 8 mg/dL (80 g/L). Which integumentary findings can be noticed in this client? Select all that apply. Pallor Clubbing Café au lait spots Brittle nails Koilonychia
Pallor Brittle nails Koilonychia Hemoglobin levels less than 12 mg/dL (120 g/L) in a female result in anemia. Integumentary manifestations of anemia include pallor, brittle nails, concave nails (koilonychias), and intolerance to cold temperatures. Clubbing is an integumentary manifestation of heart and lung diseases from chronic hypoxia. Café au lait spots are tan-brown patches that are usually nonpathogenic.
The laboratory report of a client reveals that the platelet count is 60,000/µL (60 x 10 9/L). Which integumentary changes can be anticipated in this client? Select all that apply. Cyanosis Petechiae Varicosity Ecchymosis Hematoma
Petechiae Ecchymosis Hematoma Normal blood platelet counts range between 150,000 and 400,000/µL (150-400 x 10 9/L). A count of less than 100,000/µL (100 x 10 9/L) is referred to as thrombocytopenia, which results in prolonged bleeding time. Petechiae, ecchymosis, and the formation of hematoma are the results of bleeding disorders. Cyanosis is caused by cardiorespiratory problems, vasoconstriction, asphyxiation, and deoxygenated blood. Varicosity is caused by interruption of venous return commonly found on lower legs with aging
A client with cirrhosis of the liver has a prolonged prothrombin time and a low platelet count. A regular diet is prescribed. What should the nurse instruct the client to do considering the client's condition? Avoid foods high in phytonadione. Check the pulse several times a day. Drink a glass of milk when taking aspirin. Report signs of bleeding no matter how slight.
Report signs of bleeding no matter how slight One of the many functions of the liver is the manufacture of clotting factors; there is interference in this process with cirrhosis of the liver, resulting in bleeding tendencies. The storage of fat-soluble vitamins (A, D, E, and K), water-soluble vitamins (B 1, B 2, folic acid, and cobalamin), and minerals (including iron) is compromised in cirrhosis; therefore, these nutrients, including phytonadione, should not be limited. Should the client bleed, the pulse rate may be increased, but it is not necessary for the client to check the pulse rate several times daily. A client whose prothrombin time is prolonged and platelet count is low should not be taking aspirin, even with milk.
A 60-year-old client with gastric cancer has a shiny tongue, paresthesias of the limbs, and ataxia. The laboratory results show cobalamin levels of 125 pg/mL. Which medication would the nurse consider to be a high priority for the client? Oral hydroxyurea Vitamin B 12 injections Oral iron supplements Erythropoietin injections
Vitamin B 12 injections A shiny tongue, paresthesias of the limbs, ataxia, and cobalamin of 125 pg/mL (normal: 200- 835 pg/mL) are the manifestations of pernicious anemia. The client has pernicious anemia due to a vitamin B 12 deficiency and should be given vitamin B 12 injections. Vitamin B 12 cannot be given orally to a client with pernicious anemia because the client does not produce the intrinsic factors needed to absorb Vitamin B 12. Hydroxyurea is administered orally to clients with hemochromatosis. Oral iron supplements are given to clients with iron deficiency anemia. Erythropoietin injections are given to clients who have low red blood cells, hemoglobin, and hematocrit.
A nurse concludes that the teaching about sickle cell anemia has been understood when an adolescent with the disorder makes which statement? "I'll start to have symptoms when I drink less fluid." "I'll start to have symptoms when I have fewer platelets." "I'll start to have symptoms when I decrease the iron in my diet." "I'll start to have symptoms when I have fewer white blood cells."
"I'll start to have symptoms when I drink less fluid." Dehydration precipitates sickling of red blood cells and therefore is a major causative factor for painful episodes associated with sickle cell anemia. An inadequate number of platelets (thrombocytes) is unrelated to painful episodes associated with sickle cell anemia. Iron intake is unrelated to the sickling phenomenon. An inadequate number of white blood cells is unrelated to painful episodes associated with sickle cell anemia.
The student nurse demonstrates correct understanding of anemia related to chronic disease with which statement? "Red blood cells appear normal in size and color; however, there is a decreased amount produced." "The red blood cells have an increased life span with a decrease in normal functioning." "Administration of vitamins B 12 and folate will help to treat this type of long-term anemia." "This is the mildest form of anemia and is easily corrected through administration of blood products."
"Red blood cells appear normal in size and color; however, there is a decreased amount produced." Anemia of chronic disease results in a decrease in the production of red blood cells (RBCs) in response to chronic inflammation; the red blood cells are normal size, shape, and color. There is a decrease in the life span of the RBC, and the administration of folate or B 12 will not correct the anemia, as these levels are generally within normal limits. This form of anemia can be very severe, and treatment is directed at identification and management of the underlying cause.
A client is started on a continuous infusion of heparin. Which finding does the nurse use to conclude that the intervention is therapeutic? International normalized ratio (INR) is between 2 and 3 Prothrombin time (PT) is 2.5 times the control value Activated partial thromboplastin time (APTT) is double the control value Activated clotting time (ACT) is in the range of 70 to 120
Activated partial thromboplastin time (APTT) is double the control value Activated partial thromboplastin time should be 1.5 to 2.5 for the control of heparin therapy. INR and PT are used to evaluate therapeutic levels of warfarin. The ACT increases to a range of 150 to 200 when heparin reaches therapeutic levels.
A client is admitted with thrombocytopenia. Which specific nursing actions are appropriate to include in the plan of care for this client? Select all that apply. Avoid intramuscular injections Institute neutropenic precautions Monitor the white blood cell count Administer prescribed anticoagulants Examine the skin for ecchymotic area
Avoid intramuscular injections Examine the skin for ecchymotic area Intramuscular injections should be avoided because of the increased risk of bleeding and possible hematoma formation. Decreased platelets increase the risk of bleeding, which leads to ecchymoses. Neutropenic precautions are for clients with decreased white blood cells (WBCs), not platelets. Thrombocytopenia refers to decreased platelets, not WBCs. Anticoagulants are contraindicated because of the increased bleeding risk.
A client is diagnosed with pancytopenia caused by chemotherapy. What should a nurse teach the client about this complication? Begin a program of meticulous mouth care. Avoid traumatic injury and exposure to infection. Increase oral fluid intake to at least 3 L/day. Report unusual muscle cramps or tingling sensations in the extremities.
Avoid traumatic injury and exposure to infection. Reduced platelets increase the likelihood of uncontrolled bleeding; reduced lymphocytes increase the susceptibility to infection. Beginning a program of meticulous mouth care is helpful for stomatitis, not pancytopenia; aggressive oral hygiene may precipitate bleeding from the gums. Although fluids may be increased to flush out the toxic byproducts of chemotherapy, this will have no effect on pancytopenia. Unusual muscle cramps or tingling sensations in the extremities are signs of hypocalcemia and do not apply to pancytopenia.
A client had part of the ileum surgically removed. The nurse monitors the client closely for anemia. What is the rationale for the nurse's action? Folic acid is absorbed in the ileum. Cobalamin is absorbed in the ileum. Iron absorption is dependent on simultaneous bile salt absorption in the ileum. Copper, cobalt, and nickel are dependent on simultaneous bile salt absorption in the ileum.
Cobalamin is absorbed in the ileum. Vitamin B12(cobalamin) combines with intrinsic factor, a substance secreted by the parietal cells of the gastric mucosa, and is absorbed in the ileum. Cobalamin is needed to make red blood cells. Folic acid and iron are not absorbed. Copper, cobalt, and nickel are not absorbed in the ileum.
A 78-year-old client comes to the health clinic presenting with fatigue. The client's laboratory results indicate a hematocrit of 32.1% and a hemoglobin of 10.5 g/dL (105 mmol/L). Which is the most appropriate nursing intervention in response to these laboratory results? Conduct a complete nutritional assessment of the client Nothing, because these are expected values for this client's age Advise the client to come back to the clinic to have the test repeated in three months Investigate the cause of the anemia while understanding that mild anemia is an expected response to the aging process
Conduct a complete nutritional assessment of the client A nutritional assessment starts the investigation for a cause of the client's anemia and is an independent function of the nurse. These are not expected values; an intervention is indicated. Medical treatment should be initiated first, and then the test should be repeated to determine the client's response to therapy; it is not within the legal function of the nurse to give medical advice. Anemia is not an expected response to the aging process.
A child has been diagnosed with hemophilia type A after experiencing excessive bleeding from a minor trauma. The parents ask what symptoms of bleeding they should be looking for in the future. What symptoms should the nurse list? Select all that apply. <p>A child has been diagnosed with hemophilia type A after experiencing excessive bleeding from a minor trauma. The parents ask what symptoms of bleeding they should be looking for in the future. What symptoms should the nurse list? <b>Select all that apply.</b> </p> Epistaxis Hematuria Hemarthrosis Easy bruising Frequent fevers Fast clotting of injuries Dark-colored tarry stools
Epistaxis Hematuria Hemarthrosis Easy bruising Dark-colored tarry stools Epistaxis, also known as nosebleeds, is a common symptom of a lack of clotting factor. Hematuria (blood in the urine) may be grossly apparent. The child may experience joint pain and deformities from bleeding into joints. Excessive bruising will occur from bleeding into tissue with seemingly minor injuries. Dark-colored tarry consistency stools are indicative of gastrointestinal bleeding. Frequent fevers are not associated with hemophilia. Prolonged clotting times occur with this condition.
Which laboratory test will be elevated in a client with inflammatory arthritis? Leukocyte count Hemoglobin and hematocrit Blood urea nitrogen and creatinine Erythrocyte sedimentation rate (ESR)
Erythrocyte sedimentation rate (ESR) The erythrocyte sedimentation rate (ESR) measures the rate at which red blood cells fall through plasma. This rate is most significantly affected by an increased number of acute-phase reactants, which occur with inflammation. An elevated ESR (>20 mm/hr) indicates inflammation or infection somewhere in the body. The ESR is chronically elevated with inflammatory arthritis. Leukocytes will be elevated when a bacterial infection is present. Hemoglobin and hematocrit are not used to determine the presence of inflammation. Blood urea nitrogen and creatinine levels are used to determine renal function.
A child has been diagnosed with hemophilia type A after experiencing excessive bleeding from a minor trauma. The parents ask how this could happen in addition to many other questions. Hemophilia A is linked to a deficiency in what? Factor II Factor III Factor IX Factor VIII
Factor VIII Hemophilia type A, which is the most common type of hemophilia, is from a deficiency of Factor VIII. Factors II and III are distractors. Factor IX is associated with hemophilia type B.
What does a shift to the left indicate in the white blood cell count differential? Heightened phagocytosis Functioning bone marrow Infection is being contained Immature neutrophils in the blood
Immature neutrophils in the blood A shift to the left in the white blood cell count differential indicates that immature neutrophils are being released into the blood. The immature neutrophils are not capable of phagocytizing. The bone marrow is unable to produce mature neutrophils, and the infection is continuing, not being contained.
The nurse is caring for a client who is receiving therapy for vitamin B 12 deficiency. Which finding indicates that the therapy is having the desired effect? Normal serum electrolyte levels Healthy skin integrity Resolution of peripheral edema Improved hemoglobin and hematocrit levels
Improved hemoglobin and hematocrit levels Vitamin B12is essential for appropriate maturation of red blood cells; therefore relieving the deficiency is expected to improve hemoglobin and hematocrit (H & H) levels and decrease hypoxia-related problems. This disorder is known as pernicious anemia. Normal serum electrolytes, healthy skin integrity, and resolution of peripheral edema, if present, would be secondary to improved hemoglobin and hematocrit levels.
Two days after delivery a client has a temperature of 101° F (38.3° C), general malaise, anorexia, and chills. Which clinical finding does the nurse expect to identify on the client's laboratory report? <p>Two days after delivery a client has a temperature of 101° F (38.3° C), general malaise, anorexia, and chills. Which clinical finding does the nurse expect to identify on the client’s laboratory report?</p> Increased hemoglobin level Decreased C-reactive protein Increased white blood cell (WBC) count Right-shift differential WBC count
Increased white blood cell (WBC) count An increased WBC count is indicative of an infectious process. In postpartum clients hemoglobin values usually decrease because of the typical blood loss during the birth process. C-reactive protein is increased during an infectious process. A right-shift differential WBC count occurs in clients with liver disease and pernicious anemia; a shift to the left occurs in an infectious process and is related to an increase in immature neutrophils.
A client with a diagnosis of anemia is receiving packed red blood cells. What is the most important action by the nurse when administering the transfusion? Warning the client about the possibility of fluid overload Monitoring the client's response, particularly within the first 10 minutes Adjusting the client's transfusion flow rate so that it infuses at a consistent rate during the procedure Having the client tested for human immunodeficiency virus (HIV) before administering the blood transfusion
Monitoring the client's response, particularly within the first 10 minutes Transfusion reactions usually occur early during the administration of a blood transfusion (first 30 mL of blood); early detection of a transfusion reaction will permit a quick termination of the infusion. The risk of fluid overload is unlikely, and this information can be frightening. The donor's, not the recipient's, blood is tested for HIV. The flow rate should be slower during the first 10 to 15 minutes of the infusion to limit the amount of blood infused; this allows time to assess the client's response for signs and symptoms of a transfusion reaction before too much of the blood is infused.
A client has been experiencing extreme fatigue lately. The nurse suspects anemia and examines the client to identify additional clinical manifestations to support this inference. Which locations on the client's body should the nurse assess? Select all that apply. Sclera Nail beds Conjunctivae Palms of hands Bony prominences
Nail beds Conjunctivae Palms of hands Nail beds lose their pink coloration because of reduced hemoglobin. A reduced amount of hemoglobin decreases pink color of the lining of the eyelids (conjunctiva). Palms of the hands will become pale because of the decreased hemoglobin. Sclera is observed for signs of jaundice, not anemia, when they become pale yellow to orange. Bony prominences are not assessed when a client has anemia. Bony prominences are examined for redness caused by pressure that, if prolonged, can lead to a break in the skin and development of pressure ulcers.
A client with cancer develops pancytopenia during the course of chemotherapy. The client asks the nurse why this has occurred. What explanation will the nurse provide? Steroid hormones have a depressant effect on the spleen and bone marrow. Lymph node activity is depressed by radiation therapy used before chemotherapy. Noncancerous cells also are susceptible to the effects of chemotherapeutic drugs. Dehydration caused by nausea, vomiting, and diarrhea results in hemoconcentration.
Noncancerous cells also are susceptible to the effects of chemotherapeutic drugs. Chemotherapy destroys erythrocytes, white blood cells, and platelets indiscriminately along with the neoplastic cells because these are all rapidly dividing cells that are vulnerable to the effects of chemotherapy. Stating that steroid hormones have a depressant effect on the spleen and bone marrow is not a true description of the side effects of steroids. Depressed lymph node activity as a result of radiation therapy used before chemotherapy is not the cause for fewer erythrocytes, white blood cells, and platelets. Although it is true that dehydration caused by nausea, vomiting, and diarrhea results in hemoconcentration, this does not explain pancytopenia.
What are the priority nursing interventions for a client with neutropenia in an emergency department? Select all that apply. Monitor for rashes and pruritus. Prepare an appropriate diet plan. Obtain blood cultures immediately. Teach hygiene measures to be followed. Administer antibiotic STAT as prescribed.
Obtain blood cultures immediatel Administer antibiotic STAT as prescribed. Identifying the causative agent for neutropenia is important for starting treatment. Therefore the priority nursing intervention is to obtain blood cultures immediately and administer antibiotic STAT as prescribed to the client. The nurse can monitor for rashes and pruritus after administering the medication. The nurse can prepare a diet plan and teach hygiene measures after stabilizing the client.
The nurse caring for a client with a systemic infection is aware that the assessment finding that is most indicative of a systemic infection is what? White blood cell (WBC) count of 8200/mm 3 (8.2 X 10 9/L) Bilateral 3+ pitting pedal edema Oral temperature of 101.3° F (38.5° C) Pale skin and nail beds
Oral temperature of 101.3° F (38.5° C) An elevated temperature of 101.3° F (38.5° C) is most indicative of a systemic infection. A WBC count of 8200/mm 3 (8.2 X 10 9/L) is within the normal range of 5000 to 10,000/mm 3 (5 to 10 X 10 9/L). Pedal edema is generally not related to an infectious process. Pale skin and nail beds may be related to an infectious process, but not necessarily
The nurse assesses a client for the development of pernicious anemia after reviewing the client's history. Which condition did the nurse most likely find in the history? Acute gastritis Diabetes mellitus Partial gastrectomy Unhealthy dietary habits
Partial gastrectomy Removal of the fundus of the stomach (gastrectomy) destroys the parietal cells that secrete intrinsic factor (needed to combine with vitamin B 12 preliminary to its absorption in the ileum). Hemorrhaging may cause anemia; however, pernicious anemia occurs when the intrinsic factor is not produced. The beta cells of the pancreas are not involved in secretion of intrinsic factor. Dietary intake does not affect the production of intrinsic factor.
The laboratory values of a client with a new diagnosis of cancer of the esophagus include a hemoglobin of 7 g/dL (70 mmol/L), hematocrit of 25%, and red blood cell (RBC) count of 2.5 million/mm 3 (2.5 X 10 12/L). Which priority goal should the nurse add to the plan of care? The client will be free of injury. The client will remain pain free. The client will demonstrate improved nutrition. The client will maintain effective airway clearance.
The client will demonstrate improved nutrition. Based on the presented data, improving nutritional status is the priority at this time. The decreased hemoglobin and hematocrit levels and RBC count may be a result of malnutrition; also, cancer of the esophagus can cause dysphagia and anorexia. Although maintaining the client's safety is a goal, it is not as high a priority as another concern based on the data provided in the question. The data given do not relate to the presence of pain. The data given do not relate to airway obstruction.
A client is receiving warfarin. The nurse explains the need for careful regulation of dietary intake of vitamin K. What is the rationale for the nurse's teaching? Vitamin K promotes platelet aggregation. Vitamin K promotes ionization of blood calcium. Vitamin K promotes fibrinogen formation by the liver. Vitamin K promotes prothrombin formation by the liver.
Vitamin K promotes prothrombin formation by the liver Vitamin K promotes the liver's synthesis of prothrombin, an important blood clotting factor, and will reverse the effects of warfarin. Platelet aggregation and fibrinogen formation by the liver are not promoted by vitamin K. Vitamin K does not affect calcium ionization.
The nurse is making rounds on a client who has developed severe bone marrow depression after receiving chemotherapy for cancer. Which of these actions by the nurse is appropriate? Select all that apply. Monitor for signs of alopecia. Encourage an increase in fluids. Wash hands before entering the client's room. Advise use of a soft toothbrush for oral hygiene. Report an elevation in temperature immediately. Encourage the client to eat raw, fresh fruits and vegetables.
Wash hands before entering the client's room. Advise use of a soft toothbrush for oral hygiene. Report an elevation in temperature immediately. It is essential to prevent infection in a client with severe bone marrow depression; thorough handwashing before touching the client or client's belongings is important. Thrombocytopenia occurs with most chemotherapy treatment programs; using a soft toothbrush helps prevent bleeding gums. Any temperature elevation in a client with neutropenia must be reported to the primary healthcare provider immediately because it may be a sign of infection. Although alopecia does occur with chemotherapy, it is not related to bone marrow suppression. Increasing fluids will neither reverse bone marrow suppression nor stimulate hematopoiesis. This is not related to bone marrow suppression. Clients who have severe bone marrow depression must avoid eating raw fruits and vegetables and undercooked meat, eggs, and fish to prevent possible exposure to microbes.
A 13-year-old child with sickle cell anemia is experiencing a painful episode (vaso-occlusive crisis). The nurse assesses the child, obtains the child's vital signs, and reviews the child's laboratory test results. What is the priority nursing intervention? Providing oxygen therapy Administering an analgesic Initiating a blood transfusion Monitoring intravenous fluids
administering an analgesic The pain experienced by the vaso-occlusive crisis is caused by sickle-shaped red blood cells that block blood flow through tiny blood vessels to the chest, abdomen, joints, and bones. Pain management is priority. If the client has evidence of hypoxia, then oxygen should be administered. Although a blood transfusion may be needed to treat the anemia and intravenous fluid reduce the viscosity of the sickled blood, it will not immediately relieve the pain.
The mother of a 13-year-old child with sickle cell anemia tells the nurse that the family is going camping by a lake this summer. She asks what activities are appropriate for her child. Which activity should the nurse suggest? Swimming in the lake Soccer with the family Climbing the mountain trails Motorboat rides around the lake
motor boat rides around the lake Motorboating is a relatively passive activity that will not increase the child's oxygen demands, which can precipitate sickling and therefore a painful episode. Mountain lakes are usually cold; temperature extremes can contribute to sickling that may precipitate a painful episode. Playing soccer may lead to increased cellular metabolism and increased tissue hypoxia, which can precipitate sickling that could progress to a painful episode. High altitudes should be avoided because the lower oxygen concentration of the air might trigger a painful episode.
