PrepU (Hematology)

(Select All that Apply): A nurse is caring for a client hospitalized with idiopathic thrombocytopenic purpura (ITP). Which self- care measures should the nurse plan to include when teaching the client? A. "Use dental floss after brushing your teeth to prevent gum hyperplasia." B. "Use only an electric razor when shaving." C. "Remove throw rugs in your home, and avoidclutter." D. "Increase fiber in your diet, and drink plenty of liquids to avoid constipation." E. "Keep appointments for monthly platelet transfusions."

B, C, D

(Select All that Apply): The results of a client's most recent blood work and physical assessment are suggestive of immune thrombocytopenic purpura (ITP). This client should undergo testing for which of the following potential causes? A. Acute kidney injury B. Cholecystitis C. Hepatitis D. HIV E. Malignant melanoma

C, D (Viral illnesses have the potential to cause ITP. Kidney injury, malignancies, and gall bladder inflammation are not typical causes of ITP.)

A patient has been living with a diagnosis of anemia for several years and has experienced recent declines in her hemoglobin levels despite active treatment. What assessment finding would signal complications of anemia? A) Venous ulcers and visual disturbances B) Fever and signs of hyperkalemia C) Epistaxis and gastroesophageal reflux D) shortness of breath and peripheral edema

D (A significant complication of anemia is heart failure from chronic diminished blood volume and the hearts compensatory effort to increase cardiac output. Patients with anemia should be assessed for signs and symptoms of heart failure, including ascites and peripheral edema. None of the other listed signs and symptoms is characteristic of heart failure.)

Erythropoietin growth factor increases production of which of the following? A. Plasma B. Red blood cells C. Platelets D. White blood cells

B

Which laboratory test will the nurse use to determine whether Romiplastim is effective for a patient with Immune Thrombocytopenic Purpura? A. Total lymphocte count B. Platelet count C. Absolute neutrophil count D. Reticulocyte count

B

A nurse is providing discharge education to a client who has recently been diagnosed with a bleeding disorder. What topic should the nurse prioritize when teaching this client? A. Avoiding buses, subways, and other crowded, public sites B. Avoiding activities that carry a risk for injury C. Avoiding foods high in vitamin K D. Keeping immunizations current

B (Clients with bleeding disorders need to understand the importance of avoiding activities that increase the risk of bleeding, such as contact sports. Immunizations involve injections and may be contraindicated for some clients. Clients with bleeding disorders do not need to normally avoid crowds. Foods high in vitamin K may be beneficial, not detrimental.)

A client was diagnosed with pernicious anemia. Which vitamin cannot be absorbed without an intrinsic factor? A. Vitamin C B. Vitamin D C. Vitamin B12 D. Vitamin A

C

A client with a history of atrial fibrillation has contacted the clinic saying that she has accidentally overdosed on her prescribed warfarin. The nurse should recognize the possible need for what antidote? A. IVIG B. Factor X C. Vitamin K D. Factor VIII

C

The nurse is assessing a new patient with complaints of overwhelming fatigue and a sore tongue that is visibly smooth and beefy red. This patient is demonstrating signs and symptoms associated with what form of what hematologic disorder? A) Sickle cell anemia B) Hemophilia C) Megaloblastic anemia D) Thrombocytopenia

C

A patient who has been receiving a heparin infusion and warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when her platelet level drops to 110,000/µL. Which action will the nurse include in the plan of care? A. Administer the warfarin (Coumadin) at the scheduled time. B. Use low-molecular-weight heparin (LMWH) only. C. Discontinue heparin and flush intermittent IV lines using normal saline. D. Teach the patient about the purpose of platelet transfusions.

C (All heparin is discontinued when the HIT is diagnosed. The patient should be instructed to never receive heparin or LMWH. Warfarin is usually not given until the platelet count has returned to 150,000/µL. The platelet count does not drop low enough in HIT for a platelet transfusion, and platelet transfusions increase the risk for thrombosis.)

The patient diagnosed with thrombocytopenia is at risk for which of the following adverse effects: A. Stomatitis B. Diminished reflexes C. Bleeding D. Headache

C (The patient diagnosed with thrombocytopenia is at risk for bleeding and infection until blood cell counts return to normal. Headache, diminished reflexes, and stomatitis are not adverse effects related to the diagnosis.)

A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The health care provider begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption? A. Hydrochloric acid B. Liver enzyme C. Histamine D. Intrinsic factor

D

A young mother with a 2 year old and a 6 month old is experiencing fatigue related to anemia. The client states that she is having difficulty performing the activities needed for her job, family, and home. With what task is it most appropriate for the nurse to assist the client? A. Finding a babysitter to take care of her children. B. Requesting a leave of absence from her job. C. Obtaining assistance from someone to help with cleaning in the home. D. Prioritizing and balancing activities and rest.

D ( Fatigue is the most common symptom and complication of anemia. The nurse should assist the client to prioritize activities and to establish a balance between activity and rest that the client finds acceptable. With the other options, the nurse is jumping to conclusions that these things will help the client.)

A 19-year-old woman with immune thrombocytopenic purpura (ITP) has an order for a platelet transfusion. Which information indicates that the nurse should consult with the health care provider before obtaining and administering platelets? a. The platelet count is 42,000/µL. b. Petechiae are present on the chest c. Blood pressure (BP) is 94/56 mm Hg. d. Blood is oozing from the venipuncture site.

A

A client is admitted to the hospital with pernicious anemia. The nurse should prepare to administer which of the following medications? A. Vitamin B12 B. Magnesium sulfate C. Lactulose D. Folic acid

A

A patient comes to the clinic complaining of fatigue and the health interview is suggestive of pica. Laboratory findings reveal a low serum iron level and a low ferritin level. With what would the nurse suspect that the patient will be diagnosed? A) Iron deficiency anemia B) Pernicious anemia C) Sickle cell anemia D) Hemolytic anemia

A

Which menu choice indicates that the patient understands the nurse's teaching about best dietary choices for iron-deficiency anemia? a. Omelet and whole wheat toast b. Cantaloupe and cottage cheese c. Strawberry and banana fruit plate d. Cornmeal muffin and orange juice

A

A nurse is planning the care of a client with a diagnosis of sickle cell disease who has been admitted for the treatment of an acute vaso-occlusive crisis. What nursing diagnosis should the nurse prioritize in the client's plan of care? A. Ineffective tissue perfusion related to thrombosis B. Functional urinary incontinence related to urethral occlusion C. Ineffective thermoregulation related to hypothalamic dysfunction D. Risk for disuse syndrome related to ineffective peripheral circulation

A (There are multiple potential complications of sickle cell disease and sickle cell crises. Central among these, however, is the risk of thrombosis and consequent lack of tissue perfusion. Sickle cell crises are not normally accompanied by impaired thermoregulation or genitourinary complications. Risk for disuse syndrome is not associated with the effects of acute vaso-occlusive crisis.)

"Packed red blood cells have been prescribed for a client with a low hemoglobin and hematocrit levels. The nurse takes the client's temperature before hanging the blood transfusion and records 100.6 degrees orally. Which of the following is the appropriate nursing action? A) Begin the transfusion as prescribed B) Delay hanging blood and notify the physician C) Administer an antihistamine and begin the transfusion D) Administer two tablets of Tylenol and begin the transfusion"

B

Which information obtained by the nurse caring for a patient with thrombocytopenia should be immediately communicated to the health care provider? a. The platelet count is 52,000/µL. b. The patient is difficult to arouse. c. There are purpura on the oral mucosa. d. There are large bruises on the patient's back.

B

· A patient newly diagnosed with thrombocytopenia is admitted to the medical unit. After the admission assessment, the patient asks the nurse to explain the disease. What should the nurse explain to this patient? A) There could be an attack on the platelets by antibodies. B) There could be decreased production of platelets. C) There could be impaired communication between platelets. D) There could be an autoimmune process causing platelet malfunction.

B

A patient is to receive iron dextran injections. Which technique is appropriate when the nurse is administering this medication? A. Intramuscular injection in the upper arm B. Intramuscular injection using the Z-track method C. Subcutaneous injection into the abdomen D. Intravenous administration mixed with 5% dextrose

B (Intramuscular iron is given using the Z-track method deep into a large muscle mass. If given intravenously, it is given with normal saline, not 5% dextrose.)

The nurse is collecting data for a client who has been diagnosed with iron-deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia? A. "I have a difficult time falling asleep at night." B. "I have difficulty breathing when walking 30 feet." C. "I feel hot all of the time." D. "I have an increase in my appetite."

B (Most clients with iron-deficiency anemia have reduced energy, feel cold all the time, and experience fatigue and dyspnea with minor physical exertion. The heart rate usually is rapid even at rest. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased. The client would feel cold and not hot. The client is fatigue and able to sleep often with a decrease in appetite, not an increase.)

A client's diagnosis of atrial fibrillation has prompted the primary provider to prescribe warfarin. When assessing the therapeutic response to this medication, what is the nurse's most appropriate action? A. Assess for signs of myelosuppression B. Assess the client's capillary refill time C. Review the client's international normalized ratio (INR) D. Review the client's platelet level

C (The INR and aPTT serve as useful screening tools for evaluating a client's clotting ability and to monitor the therapeutic effectiveness of anticoagulant medications. The client's platelet level is not normally used as a short-term indicator of anticoagulation effectiveness. Assessing the client for signs of myelosuppression and capillary refill time does not address the effectiveness of anticoagulants.)

When assessing a client with anemia, which assessment is essential? A. Lifestyle assessments, such as exercise routines B. Family history C. Health history, including menstrual history in women D. Age and gender

C (When assessing a client with anemia, it is essential to assess the client's health history. Women should be questioned about their menstrual periods (e.g., excessive menstrual flow, other vaginal bleeding) and the use of iron supplements during pregnancy.)

The nurse determines that teaching regarding cobalamin injections has been effective when the patient with chronic atrophic gastritis states which of the following? A. "These injections will increase the hydrochloric acid in my stomach." B. "These injections will decrease my risk for developing stomach cancer." C. "The cobalamin injections will prevent gastric inflammation." D. "The cobalamin injections will prevent me from becoming anemic."

D (Cobalamin supplementation prevents the development of pernicious anemia. Chronic gastritis may cause achlorhydria, but cobalamin does not correct this. The loss of intrinsic factor secretion with chronic gastritis is permanent, and the patient will need lifelong supplementation with cobalamin. The incidence of stomach cancer is higher in patients with chronic gastritis, but cobalamin does not reduce the risk for stomach cancer.)

When teaching a client with sickle cell disease about strategies to prevent crises, what measures should the nurse recommend? A. Avoiding cold temperatures and ensuring sufficient hydration B. Limiting psychosocial stress and eating a high-protein diet C. Using prophylactic antibiotics and performing meticulous hygiene D. Maximizing physical activity and taking OTC iron supplements

A (Keeping warm and providing adequate hydration can be effective in diminishing the occurrence and severity of attacks. Hygiene, antibiotics, and high protein intake do not prevent crises. Maximizing activity may exacerbate pain and be unrealistic.)

The nurse is administering liquid oral iron supplements. Which intervention is appropriate when administering this medication? A. Instruct the patient to take the medication through a plastic straw. B. Have the patient drink the medication, undiluted, from the unit-dose cup. C. Have the patient sip the medication slowly. D. Have the patient take the liquid iron with milk.

A (Liquid oral forms of iron need to be taken through a plastic straw to avoid discoloration of tooth enamel. Milk may decrease absorption.)

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process due to thrombocytopenia in a client with leukemia? A. Applying prolonged pressure to needle sites or other sources of external bleeding B. Implementing neutropenic precautions C. Monitoring temperature at least once per shift D. Eliminating direct contact with others who are infectious

A (The interventions for a client with thrombocytopenia are the same as those for a client with cancer who is at risk for bleeding. For a client with leukemia, the nurse should apply prolonged pressure to needle sites or other sources of external bleeding. Reduced platelet production results in a delayed clotting process and increases the potential for hemorrhage. Implementing neutropenic precautions and eliminating direct contact with others are interventions to address the risk for infection.)

A client is admitted to the hospital with an exacerbation of chronic gastritis. When assessing the client's nutritional status, the nurse should expect to find what type of deficiency? A. vitamin B12 B. vitamin C C. vitamin B6 D. vitamin A

A (The nurse should expect vitamin B12 deficiency. Injury to the gastric mucosa causes gastric atrophy and impaired function of the parietal cells. These changes result in reduced production of intrinsic factor, which is necessary for the absorption of vitamin B12. Eventually, pernicious anemia will occur. Deficiencies in vitamins A, B6, and C aren't expected in a client with chronic gastritis.)

A nurse is providing education to a client with iron deficiency anemia who has been prescribed iron supplements. What should the nurse include in health education? A. Iron will cause the stools to darken in color. B. Limit foods high in fiber due to the risk for diarrhea. C. Increase the intake of vitamin E to enhance absorption. D. Take the iron with dairy products to enhance absorption.

A (The nurse will inform the client that iron will cause the stools to become dark in color. Iron should be taken on an empty stomach, as its absorption is affected by food, especially dairy products. Clients should be instructed to increase their intake of vitamin C to enhance iron absorption. Foods high in fiber should be consumed to minimize problems with constipation, a common side effect associated with iron therapy.)

A young female client has pale nailbeds. Her hemoglobin count is 10.2 gm/dL and her hematocrit count is 30%. She reports fatigue and states, "I'm tired all the time." The client also reports excessive menstrual flow. The nurse assesses further and determines the client's diet is balanced and provides adequate calories. The client is prescribed supplemental iron therapy. The highest nursing diagnosis is A. Altered nutrition: less than body requirements, related to inadequate intake of nutrients B. Fatigue related to diminished oxygen-carrying capacity of the blood C. Altered tissue perfusion related to diminished oxygen-carrying capacity of the blood D. Deficient knowledge related to new information with no previous experience

C (All the nursing diagnoses are appropriate for this client who is experiencing anemia. Physiological needs take priority per Maslow's hierarchy of needs. Under physiological needs, airway, breathing, and then circulation take priority. Altered tissue perfusion would be classified under circulation, thus making it the priority over the other diagnoses listed.)

A client's blood work reveals a platelet level of 17,000/mm3. When inspecting the client's integumentary system, what finding would be most consistent with this platelet level? A. Dermatitis B. Urticaria C. Alopecia D. Petechiae

D (When the platelet count drops to less than 20,000/mm3, petechiae can appear. Low platelet levels do not normally result in dermatitis, urticaria (hives), or alopecia (hair loss).)

A patient has been taking iron supplements for anemia for 2 months. During a follow-up assessment, the nurse will observe for which therapeutic response? A. Decreased palpitations B. Increased appetite C. Decreased weight D. Increased activity tolerance

D (Absence of fatigue, increased activity tolerance and well-being, and improved nutrition status are therapeutic responses to iron supplementation. The other options are incorrect.)

A nurse is providing education to a client with iron deficiency anemia who has been prescribed iron supplements. What should the nurse include in health education? A. Take the iron with dairy products to enhance absorption B. Limit foods high in fiber due to the risk for diarrhea C. Increase the intake of vitamin E to enhance absorption D. Iron will cause the stools to darken in color

D (The nurse will inform the client that iron will cause the stools to become dark in color. Iron should be taken on an empty stomach, as its absorption is affected by food, especially dairy products. Clients should be instructed to increase their intake of vitamin C to enhance iron absorption. Foods high in fiber should be consumed to minimize problems with constipation, a common side effect associated with iron therapy.)

A client has been diagnosed with pernicious anemia. During client education, the nurse emphasizes the importance of lifelong intramuscular administration of: A. vitamin B12. B. vitamin C. C. vitamin A. D. folic acid.

A (For a client with pernicious anemia, the nurse emphasizes the importance of lifelong administration of vitamin B12. He or she teaches the client or a family member of the proper method to administer vitamin B12 injections.)

A patient with a recent diagnosis of ITP has asked the nurse why the care team has not chosen to administer platelets, stating, I have low platelets, so why not give me a transfusion of exactly what I'm missing? How should the nurse best respond? A) Transfused platelets usually aren't beneficial because they're rapidly destroyed in the body. B) A platelet transfusion often blunts your body's own production of platelets even further. C) Finding a matching donor for a platelet transfusion is exceedingly difficult. D) A very small percentage of the platelets in a transfusion are actually functional.

A

The nurse is caring for a client with external bleeding. What is the nurse's priority intervention? A. Direct pressure B. Pressure point control C. Elevation of the extremity D. Application of a tourniquet

A (Applying direct pressure to an injury is the initial step in controlling bleeding. Elevation reduces the force of flow, but direct pressure is the first step. The nurse may use pressure point control for severe or arterial bleeding. Pressure points (those areas where large blood vessels can be compressed against bone) include femoral, brachial, facial, carotid, and temporal artery sites. The nurse should avoid applying a tourniquet unless all other measures have failed, because it may further damage the injured extremity.)

A client with several chronic health problems has been newly diagnosed with a qualitative platelet defect. What component of the client's previous medication regimen may have contributed to the development of this disorder? A. Aspirin B. Vitamin D C. Calcium carbonate D. Vitamin B12

A (Aspirin may induce a platelet disorder. Even small amounts of aspirin reduce normal platelet aggregation, and the prolonged bleeding time lasts for several days after aspirin ingestion. Calcium, vitamin D, and vitamin B12 do not have the potential to induce a platelet defect.)

A client comes into the emergency department reporting an enlarged tongue. The tongue appears smooth and beefy red in color. The nurse also observes a 5-cm incision on the upper left quadrant of the abdomen. When questioned, the client states, "I had a partial gastrostomy 2 years ago." Based on this information, the nurse attributes these symptoms to which problem? A. Vitamin B12 deficiency B. Folic acid deficiency C. Vitamin A deficiency D. Vitamin C deficiency

A (Because vitamin B12 is found only in foods of animal origin, strict vegetarians may ingest little vitamin B12. Vitamin B12 combines with intrinsic factor produced in the stomach. The vitamin B12-intrinsic factor complex is absorbed in the distal ileum. Clients who have had a partial or total gastrectomy may have limited amounts of intrinsic factor, and therefore the absorption of vitamin B12 may be diminished. The effects of either decreased absorption or decreased intake of vitamin B12 are not apparent for 2-4 years. This results in megaloblastic anemia. Some symptoms are a smooth, beefy red, enlarged tongue and cranial nerve deficiencies.)

A client with a history of cirrhosis is admitted to the ICU with a diagnosis of bleeding esophageal varices; an attempt to stop the bleeding has been only partially successful. What would the critical care nurse expect the care team to prescribe for this client? A. Packed red blood cells (PRBCs) B. Vitamin K C. Oral anticoagulants D. Heparin infusion

A (Clients with liver dysfunction may have life-threatening hemorrhage from peptic ulcers or esophageal varices. In these cases, replacement with fresh-frozen plasma, PRBCs, and platelets is usually required. Vitamin K may be prescribed once the bleeding is stopped, but that is not what is needed to stop the bleeding of the varices. Anticoagulants would exacerbate the client's bleeding.)

Which patient statement to the nurse indicates a need for additional instruction about taking oral ferrous sulfate? A. "I will call my health care provider if my stools turn black." B. "I will take a stool softener if I feel constipated occasionally." C. "I should increase my fluid and fiber intake while I am taking iron tablets." D. "I should take the iron with orange juice about an hour before eating."

A (It is normal for the stools to appear black when a patient is taking iron, and the patient should not call the doctor about this. The other patient statements are correct.)

The nurse should advise a client with iron deficiency anemia to take which action in order to prevent staining of the teeth? A. Do not combine iron with other prescribed or over-the-counter medications. B. Take iron with or immediately after meals. C. Use a straw or place a spoon at the back of the mouth to take the liquid supplement. D. Avoid taking iron simultaneously with an antacid.

C (For a client with iron deficiency anemia who is taking an oral iron supplement, the nurse instructs the client to use a straw or place a spoon at the back of the mouth to take the liquid supplement to avoid staining the teeth. The nurse advises the client to take iron with or immediately after meals to avoid gastric distress. The client is advised to avoid having iron simultaneously with an antacid, as the antacid will interfere with iron absorption.)

A client with poorly controlled diabetes has developed end-stage kidney injury and consequent anemia. When reviewing this client's treatment plan, the nurse should anticipate the use of what drug? A. Magnesium sulfate B. Low--molecular-weight heparin C. Epoetin alfa D. Vitamin K

C (The anemia that accompanies kidney injury is caused by decreased synthesis of erythropoietin. Exogenous forms are necessary to stimulate erythropoiesis. Heparin, vitamin K, and magnesium are not indicated in the treatment of kidney injury or the consequent anemia.)

When assessing a client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential? A. Menstrual history B. Lifestyle assessments, such as exercise routines C. Health history, such as bleeding, fatigue, or fainting D. Age and gender

C (When assessing a client with a disorder of the hematopoietic or the lymphatic system, it is essential to assess the client's health history. An assessment of drug history is essential because some antibiotics and cancer drugs contribute to hematopoietic dysfunction. Aspirin and anticoagulants may contribute to bleeding and interfere with clot formation. Because industrial materials, environmental toxins, and household products may affect blood-forming organs, the nurse needs to explore exposure to these agents. Menstrual history, age, gender, and lifestyle assessments, such as exercise routines and habits, do not directly affect the hematopoietic or lymphatic system.)

The nurse is administering folic acid to a patient with a new diagnosis of anemia. Which statement about treatment with folic acid is true? A. Folic acid is used to treat iron-deficiency anemia. B. Folic acid is used to treat pernicious anemia. C. Folic acid is used to treat any type of anemia. D. The specific cause of the anemia needs to be determined before treatment.

D (Folic acid should not be used to treat anemias until the underlying cause and type of anemia have been identified. Administering folic acid to a patient with pernicious anemia may correct the hematologic changes of anemia, but the symptoms of pernicious anemia (which is due to a vitamin B12 deficiency, not a folic acid deficiency) may be deceptively masked. The other options are incorrect.)

The nurse should advise a client with iron deficiency anemia to take which action in order to prevent staining of the teeth? A. Avoid taking iron simultaneously with an antacid B. Do not combine iron with other prescribed or over-the-counter medications C. Take iron with or immediately after meals D. Dilute liquid preparations of iron with juice and drink with a straw

D (For a client with iron deficiency anemia who is taking an oral iron supplement, the nurse instructs the client to dilute liquid preparations of iron with another liquid, such as juice, and drink with a straw to avoid staining the teeth. The nurse advises the client to take iron with or immediately after meals to avoid gastric distress. The client is advised to avoid taking iron simultaneously with an antacid, as the antacid will interfere with iron absorption.)

The nurse is caring for an older adult client who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine where the blood loss is coming from, what intervention can the nurse provide? A. Observe the sputum for signs of blood. B. Observe the gums for bleeding after the client brushes teeth. C. Observe client for facial droop. D. Observe stools for blood.

D (Iron-deficiency anemia is unusual in older adults. Normally, the body does not eliminate excessive iron, causing total body iron stores to increase with age and necessitating maintenance of hydration. If an older adult is anemic, blood loss from the gastrointestinal or genitourinary tracts is suspected. Observing the stool for blood will help detect blood from GI loss. Bleeding gums may indicate periodontal disease, or anticoagulation from medication is not related to age. Blood in sputum can be an indicator of various lung disorders that may affect all age groups. Facial droop may indicate an impending stroke or Bell's palsy and would not be a reason for blood loss.)

While assessing a client, the nurse will recognize what as the most obvious sign of anemia? A. Jaundice B. Flow murmurs C. Tachycardia D. Pallor

D (On physical examination, pallor is the most common and obvious sign of anemia. Other findings may include tachycardia and flow murmurs. Patients with hemolytic anemia may exhibit jaundice and splenomegaly.)

Which laboratory result will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)? A. Erythrocyte count B. Fibrinogen degradation products C. Prothrombin time D. Activated partial thromboplastin time

D (Platelet aggregation in HIT causes neutralization of heparin, so that the activated partial thromboplastin time will be shorter and more heparin will be needed to maintain therapeutic levels. The other data will not be affected by HIT.)