Anemia
Ans: 2 Hypoxia and deoxygenation of the RBCs are the most common cause of sickling, so administration of oxygen is the priority intervention here. Pain control and hydration are also important interventions for this patient and should be accomplished rapidly. Vaccination may help prevent future sickling episodes by decreasing the risk of infection, but it will not help with the current sickling crisis. Focus: Prioritization
3. A 32-year-old patient with sickle cell anemia is admitted to the hospital during a sickle cell crisis. Which action prescribed by the health care provider will you implement first? 1. Give morphine sulfate 4 to 8 mg IV every hour as needed. 2. Administer 100% oxygen using a nonrebreather mask. 3. Start a 14-gauge IV line and infuse normal saline at 200 mL/hr. 4. Give pneumococcal (Pneumovax) and Haemophilus influenzae (ActHIB) vaccines.
Ans: 1 An experienced UAP will have been taught how to obtain a stool specimen for the Hemoccult slide test, because this is a common screening test for hospitalized patients. Having the patient sign an informed consent form should be done by the physician who will be performing the colonoscopy. Administering medications and checking for allergies are within the scope of practice of licensed nursing staff. Focus: Delegation
4. These activities are included in the care plan for a 78-year-old patient admitted to the hospital with anemia caused by possible gastrointestinal bleeding. Which activity can you delegate to an experienced UAP? 1. Obtaining stool specimens for fecal blood test (Hemoccult) slides 2. Having the patient sign a colonoscopy consent form 3. Giving the prescribed polyethylene glycol electrolyte solution (GoLYTELY) 4. Checking for allergies to contrast dye or shellfish
a
A client is admitted to the hospital for vomiting large amounts of blood. Which assessment finding does the nurse associate with blood loss anemia? a Tachycardia b Jaundice c Bradycardia d Sore, red tongue
b
A client is admitted to the medical-surgical unit with a pathologic fracture of the ulna, abdominal pain, and shortness of breath. The nurse notes that the client's skin is a bronze color. The nurse recognizes these findings as manifestations of which type of anemia? a Pernicious anemia b Thalassemia c Aplastic anemia d Sickle cell anemia
d
A client is admitted to the surgical floor with a diagnosis of blood loss anemia after having outpatient surgery earlier in the day. The nurse reviews the healthcare provider's orders and places which order at highest priority? a Intravenous normal saline at 250 mL/hr b Regular diet c Bed rest with bathroom privileges d Oxygen at 2 L via nasal cannula
a due to hypovolemia from dehydration
A client is admitted with sickle cell crisis and sequestration. Upon assessing the client the nurse would expect to find: a. Decreased blood pressure b. moist mucus membranes c. decreased respirations d increased blood pressure
c
A client with anemia has a nursing diagnosis of activity intolerance. Which intervention will the nurse plan for this client? a Promote active and passive range-of-motion activities. b Teach the client the basics of good nutrition. c Space activities and plan rest periods. d Teach the client to change position slowly to prevent dizziness.
a
A client with iron deficiency anemia has been placed on an iron supplement. Which would the nurse include in the teaching plan about this form of therapy? a Iron may cause the stools to be tarry. b Iron can cause severe headaches. c Iron can cause the urine to be orange. d Iron should be taken in the afternoon.
d
A nurse is caring for a client with suspected anemia. Which of the following laboratory test results should the nurse expect? a. Iron 90 mcg/dL b. RBC 6.5 million/uL c. WBC 4800 mm d. Hgb 10 g/dL
b
A nurse is conducting a physical assessment on a client with mild anemia. Which of the following would the nurse expect to observe? a. heart murmur b. increased RR c. activity intolerance d. frequent respiratory infections
b
Abigail Derry is a 20-year-old woman who is diagnosed with iron deficiency anemia. Abigail states that she is vegan and wants to stay that way. She started this new diet about 6 months ago because it is "healthy." Abigail reveals that she has not really explored being vegan except that she eats only vegetables. Which suggestion might the nurse offer to Abigail? a "Increase your consumption of iron from heme iron sources only." b "Try to eat more dried beans and dried fruits." c "Eat more eggs and cheese." d "You should give up being vegan."
RBC
An increase in the reticulocyte number means that the body is producing new _____'s
folic acid
B12 activates enzymes that move ________ _________ into the cell for DNA synthesis
beefy
In Pernicious anemai: (b12 deficient): Signs and symptoms include a smooth, sore,_______ tongue.
hemoglobin
In iron deficiency anemia, iron stores are depleted first followed by __________ stores
increases
In response to hemolytic anemia, bone marrow hematopoietic activity ___________, leading to an increase in reticulocytes. (immature RBCS circulating in blood)
IM,z track
In severe cases of anemia Iron solutions are given ____ using the ___ ____ method
intrinsic factor,pernicious,b12
Lack of _________ __________ can result in ___________ anemia, from a failure to absorb ___________. This anemia develops slowly and usually produces few symptoms.
c
Maria Garcia is a 50-year-old woman diagnosed with blood loss anemia secondary to injuries which occurred after a motor vehicle crash. She had a blood transfusion yesterday. At that time, her breathing was shallow at 28 breaths/min. Her pulse was 98 beats/min and thready. Her blood pressure was 90/60 mmHg. She had 2+ pitting edema to both legs and was pale. Ms. Garcia's nurse is anticipating discharge care for the client. Which condition would indicate to the nurse that Ms. Garcia is ready for discharge? a The client verbalizes shortness of breath is present only with minimal activity. b The client verbalizes importance of decreasing the amount of red meat in her diet. c The client verbalizes increase in activity tolerance. d The client's RBC count indicates moderate anemia instead of severe anemia.
13.5-18
Norm Hgb________-_______
40-54
Norm hct_____-_______%
b12,pernicious
Paresthesia may occur with _______ deficiency or _________ anemia ( not with folic acid deficiency!!)
thalassemia
Signs of _____________ anemia are often asymptomatic. May bronze skin coloring, enlarge spleen. jaundice. accumulation of iron in heart, liver and pancreas. Life long transfusions are needed and may cause failure of these organs.
iron deficiency
Small Rbcs, mild symptoms of anemia-weakness and pallor. Type of anemia ___________ ____________
b
The CBC of a client admitted with anemia reveals that the RBC's are hypochromic and microcytic. The nurse recognizes the client has: a. aplastic anemia b. iron-deficiency anemia c. pernicious anemia d. hemolytic anemia
a
The Dr. has prescribed a diet high in B12 for a client with pernicious anemia. Which foods are the best sources of b12? a. meat eggs dairy products b. peanut butter, raisens, molasses c. broccoli, cauliflower, cabbage d. shrimp, legumes, bran cereals
decrease
The client who has had a gastric resection is at risk for anemia because intrinsic factor may _________, leading to vitamin B12 deficiency anemia with associated neurologic deficits such as numbness and tingling of extremities.
c
The nurse is teaching a client about choosing dietary sources of iron. Which statement by the client indicates the need for further education? a "I will eat a lot more spinach than I used to eat." b "Oatmeal or whole-wheat toast would be a good choice for breakfast." c "I will be sure to increase the amount of cow's milk that I drink." d "I can get iron from most of the meats that I eat."
a,b,f
The home care nurse is preparing a teaching plan for a client with deficiencies in folic acid. Which foods will increase the clients folic acid level? select all that apply a broccoli b cabbage c chicken d dried fruit e white bread f milk
a
The nurse caring for the client with anemia recognizes which clinical manifestation as the one that is specific for a hemolytic type of anemia? a. jaundice b. anorexia c. tachycardia d. fatigue
c
The nurse educator is discussing with a student how nutritional anemias affect the appearance of red blood cells. Which statement by the student reflects correct understanding of the teaching session? a "A folic acid deficiency will cause the red blood cells to form a sickle shape." b A dietary iron deficiency will result in red blood cells that are fragile and oversized." c "Iron deficiency anemia will cause red blood cells to be misshapen and pale." d "Nutritional anemias affect the number of red blood cells but not the size or shape of them."
b
The nurse has admitted a child newly diagnosed with anemia of unknown origin. Which intervention is priority for the nurse to initiate? a Administer fluids to increase cardiac output. b Plan for safe care due to weakness. c Assess pain level. d Teach the client about foods with iron.
b,c,e
The nurse is caring for a 78-year-old client with active alcoholism who has a vitamin B12 deficiency. The nurse plans to teach the client to select which of the following food choices? (Select all that apply.) a Carrots b Oranges c Spinach d Apples e Liver
b
The nurse is caring for a client complaining of diarrhea and a sore, beefy red tongue. Which condition does the nurse suspect? a Aplastic anemia b Vitamin B12 deficiency anemia c Thalassemia d Iron deficiency anemia
d
The nurse is caring for an 8-year-old child who is diagnosed with a type of anemia that requires blood transfusions for life. Which type of anemia does this child have? a Folic acid deficiency anemia b Iron deficiency anemia c G6PD anemia d Thalassemia
d
The nurse is caring for a 10-year-old client with thalassemia who had a splenectomy. Which nursing diagnosis is a priority for this client? a Inadequate oxygenation b Activity intolerance c Risk for cellular hypoxia d Risk for sepsis
a,b,d
The nurse is caring for a 14-year-old female client with iron deficiency anemia. Which interventions can assist the client in obtaining normal iron levels? (Select all that apply.) a Apply supplemental oxygen as ordered b Help the client pick iron-rich food choices c Consider starting the client on birth control d Assess client compliance with iron supplements e Monitor blood transfusion for signs of reactions
b,c,d,e
The nurse is caring for a 17-year-old client with blood loss anemia. Which independent nursing interventions would be appropriate for this client? (Select all that apply.) a Transfuse blood as soon as hemoglobin level falls below normal b Assess vital signs c Supplement iron as ordered d Administer supplemental oxygen as ordered e Encourage periods of rest
a,d,e
The nurse is caring for a 9-year-old client with iron deficiency anemia. When providing teaching about iron supplements, what information should the nurse provide to the caregivers? (Select all that apply.) a Iron supplements can cause dark stools. b Give with dairy products to increase absorption. c Iron supplements require a doctor's prescription. d Iron supplements can cause constipation. e Give with orange juice to increase absorption.
c
The nurse is collecting a health history of Mary Williams, a 22-year-old female. Mary shares that she has recently experienced pallor, weakness, and difficulty maintaining her balance. She also reports some numbness and tingling in her hands. Which type of anemia does the nurse suspect that Mary is experiencing? a Iron deficiency b Acquired hemolytic c Vitamin B12 deficiency d Blood loss anemia
c
The nurse is following a client after a gastric resection. Which shows evidence of nutritional deficiency anemia related to malabsorption? a Steatorrhea b Bone pain c Numbness and tingling of extremities d Dark yellow or bronze skin
b
The nurse is reviewing laboratory findings for a 2-year-old being treated for anemia. Which findings is the best indication that goals for this client have been met? a The child is no longer cyanotic. b The reticulocyte count is rising. c Stools are black, indicating iron intake. d The child is more active.
c
The nurse is working with a woman who is pregnant and her husband. The husband asks the nurse why his wife has a folic acid deficiency when she eats healthy meals. How should the nurse respond to the client's family? a "Pregnancy causes malabsorption of folic acid." b "There is inadequate dietary intake of folic acid." c "Pregnancy increases metabolic requirements for folic acid." d "The client has some form of impaired metabolism."
a
The nurse notes that the client has a low red blood cell count and anticipates which manifestation on assessment? a Fatigue b Nausea c Sore throat d Chest pain
c
The nurse teaches a client with iron deficiency anemia to ingest foods high in vitamin C. The client states, "I thought that vitamin C was used to prevent you from getting a cold. What does it have to do with anemia?" Which response by the nurse is most appropriate? a "Vitamin C will stimulate your body to produce more red blood cells." b "Vitamin C will change the aciddash-base balance in your stomach, and will allow you to absorb B vitamins." c "Vitamin C will help your body to absorb iron." d "Vitamin C helps your immune system so that your red blood cells will last longer.
a,c,f petechiae occurs with aplastic anemia cheilosis with iron deficiency anemia splenomegaly with hemolytic anemia
The nurse working in a clinic is reviewing the chart of a client with probable anemia. Which would most likely indicate a deficiency in vitamin b12? select all that apply: a night cramps b splenomegaly c nausea d cheilosis e petechiae f anorexia
d
The primary cause of anemia in a client with chronic renal failure is: a. poor iron absorption b. destruction of RBC's c. Lack of intrinisic factor d. insufficient erythropoietin
d
What nursing intervention is most appropriate for the client with anemia who is experiencing activity intolerance? a Administer medications to client as ordered. b Assess client vital signs and apical pulse. c Ensure client walks the halls twice daily to prevent lung infection. d Provide client adequate rest periods.
b,c,d,e
What nursing interventions are appropriate to include in the plan of care for a client with anemia? (Select all that apply.) a Place the client in supine position. b Assess for signs of hypoxia. c Administer supplemental oxygen as ordered. d Administer medications as ordered. e Provide rest periods as needed.
pancytopenia
When bone marrow fails to produce all three types of blood cells:_____________________
c
Which anemia is associated with macrocytic and misshapen red blood cells (RBCs) with thin membranes? a Blood loss anemia b Thalassemia c Vitamin B12 deficiency anemia d Iron deficiency anemia
d
Which diagnostic test is used to diagnose aplastic anemia? a Iron levels b Schilling test c Complete blood count d Bone marrow examination
a
Which lab test is used when evaluating a client for anemia? a Complete blood count b Blood glucose c Urinalysis d Arterial blood gas
c
Which meal selection is most appropriate for a client with iron deficiency anemia? a. roast turkey, gelatin, green beans b. chicken salad sandwich, coleslaw, FF c. egg salad on WW bread, carrot sticks, spinach and kale salad d. pork chop, mashed potatoes, green peas
b
Which nursing intervention would be of highest priority when caring for a pt admitted with sickle cell vaso-occlusive crisis? a. starting IV NS b. applying oxygen c. applying heat to the affected joints d. administering pain medication
a
Which type of anemia produces brittle, spoon-shaped nails? a Iron deficiency anemia b Blood loss anemia c Aplastic anemia d Folic acid deficiency anemia
folic acid
________ _________ deficiency anemia: comes from inadequate intake. Common in undernourished,older adults,alcoholics,drug addicts. Pregnant women at greatest risk.
thalassemia
________ is an inherited anemia. alpha or beta chains of hemoglobin are missing or defective. Leads to deficient hemoglobin, and fragile hypochromic (pale), microcytic RBC's.
hemolytic anemia
__________ __________ characterized by premature destruction of RBC's
a,b,c
a adult client is admitted to the orthopedic unit with a history of thassalemia. What clinical manifestations does the nurse expect the client to exhibit? a splenomegaly b mild anemia c jaundice d headache complaints e epistaxis
c
a client is admitted with pernicious anemia. Which findings support this diagnosis? a. the client complains of feeling tired and listless b. the client has waxy pale skin c. the client exhibits loss of coordination and position sense d the client has a rapid pulse rate and detectable heart murmur
hypoxia
cerebral ______can lead to headache,dizziness and dim vision
o2
every anemia, regardless of cause reduces ____ carrying capacity of the blood
hypoxia
tissue ________ may cause angina, fatigue,dyspnea on exertion and night cramps
