Cardiology Chpt. 31

Applying prolonged pressure to needle sites or other sources of external bleeding

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?

Pancytopenia

Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets?

vitamin B12.

A client has been diagnosed with pernicious anemia. During client education, the nurse emphasizes the importance of lifelong intramuscular administration of:

Neutrophil count 1200/microliter Hemoglobin 7 g/dL Platelets 35,000 microliters

A nurse cares for a client with aplastic anemia. Which laboratory results will the nurse expect to find with this client? Select all that apply.

A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from? Select all that apply.

Blood loss Abnormal erythrocyte production Destruction of normally formed red blood cells

The nurse is admitting a client with Cooley's anemia to the hospital with a hemoglobin of 6.2 g/dL and hematocrit of 26%. What does the nurse document about the client's skin?

Bronzing of the skin

A client with end-stage renal disease has a decreased red blood cell production. What medication can the nurse administer with physician's order that will increase the production of erythrocytes?

Epoetin alfa

amount and quality of factor VIII

Hemophilia A is the most common of the three types of hemophilia. What is diminished in the less serious form of hemophilia A, known as von Willebrand's disease?

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?

Observe stools for blood.

Reduced urine output

The client was admitted to the Emergency Department after an accident with a chain saw. The client is exhibiting signs and symptoms of acute hypovolemic anemia from severe blood loss. What signs and symptoms would the nurse assess for?

Nitric oxide

The nurse is instructing the client with sickle cell disease about the use of an inhaled vasodilator that may reduce sickling. What medication is the nurse instructing the client about?

A young female client with bulimia nervosa An older adult client on a fixed income A client with Crohn's disease

The registered nurse (RN) and licensed practical nurse (LPN) are preparing an educational program for clients who may be at risk for the development of iron-deficiency anemia. Which clients would receive the greatest benefit from this program? Select all that apply.

Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.

A client is seen in the emergency department with severe pain related to a sickle cell crisis. What does the nurse understand is occurring with this client?

Splenectomy

A critical care nurse is caring for a client with immune hemolytic anemia. The client is not responding to conservative treatments, and his condition is now becoming life-threatening. The nurse is aware that a treatment option in this case may include what?

Fresh frozen plasma

A teenaged client with hemophilia sustains a leg laceration after falling off of his skateboard and is brought to the emergency department. The laceration is bleeding profusely even with direct pressure to the site. What does the nurse anticipate will be ordered for administration to control bleeding?

Wear a medical identification bracelet.

A young client is diagnosed with a mild form of hemophilia and is experiencing bleeding in the joints with pain. In preparing the client for discharge, what instructions should the nurse provide?

A client is being treated in the hospital for hypovolemia related to a bleeding peptic ulcer. The nurse obtains a blood pressure reading of 88/62 mm Hg, heart rate of 112 beats/minute, and a respiratory rate of 24 breaths/minute. What is the first action by the nurse?

Notify the physician.

Prepare for the administration of factor VIII.

A young man with a diagnosis of hemophilia A has been brought to emergency department after suffering a workplace accident resulting in bleeding. Rapid assessment has revealed the source of the client's bleeding and established that his vital signs are stable. What should be the nurse's next action?

The nurse is caring for an older adult client who has been admitted to the unit with anemia. What would the nurse expect the client to possibly exhibit?

Blood loss from the gastrointestinal or genitourinary tract

Infection Bleeding

The nurse cares for several clients with hematological conditions. Which assessment needs will the nurse prioritize for the client with aplastic anemia? Select all that apply.

Trauma and microabrasions from a non-electric razor may contribute to anemia.

The nurse caring for an older adult with a diagnosis of leukemia would encourage the client to use an electric razor. What is the rationale for this statement by the nurse?

"It helps adequately hydrate you and ensures a sufficient urine production."

The nurse is assigned to care for a client with polycythemia vera. When the nurse encourages the client to drink 3 L of fluid per day, the client states, "Why do I have to drink so much?" What is the best response by the nurse?

Bone pain

The nurse is providing palliative care for a 69-year-old patient who has a diagnosis of multiple myeloma. The patient states that she enjoyed good health for most of her life and rarely had to visit her family health care provider until she experienced the first signs and symptoms of her current illness. Which of the following complaints most likely prompted the patient to initially seek care?

Erythrocytes that are microcytic and hypochromic

The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia?

Ineffective coping

The nurse on the pediatric unit is caring for a 10-year-old boy with a diagnosis of hemophilia. The nurse should assess carefully for indication of what nursing diagnosis?

Coagulopathies are bleeding disorders that involve platelets or clotting factors.

The nursing instructor is talking with her clinical group about coagulopathies. How should the instructor define coagulopathies?

A 19-year-old African American male

The nurse is caring for four clients on the medical-surgical unit of the hospital. What client is mostly likely to be receiving treatment for sickle cell crisis?

"I have difficulty breathing when walking 30 feet."

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?

Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.

The nurse is instructing the client with polycythemia vera how to perform isometric exercises such as contracting and relaxing the quadriceps and gluteal muscle during periods of inactivity. What does the nurse understand is the rationale for this type of exercise?

alcoholism intestinal disorders

A client has a history of seizures and presents with severe fatigue, frequent headaches, and a sore, beefy-red tongue. What could be causing the client's current condition? Select all that apply.

Postural hypotension

A client is experiencing chronic hypovolemic anemia as evidenced by laboratory results. What symptoms does the nurse expect to find for this client when collecting objective data?

Parents arrive to the clinic with their young child and inform the nurse the child has just been diagnosed with sickle cell disease. The parents ask the nurse how this could have happened and which one of them is the carrier. What is the best response by the nurse?

"The child must inherit two defective genes, one from each parent."

Aplastic anemia

A client comes to the walk-in clinic complaining of weakness and fatigue. While assessing this client, the nurse finds evidence of petechiae and ecchymoses. The nurse notes that the spleen appears enlarged. What would the nurse suspect is wrong with this client?

Petechiae

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?

Implementing of a plan for fall prevention

A nurse in a long-term care facility is admitting a new resident who has a bleeding disorder. When planning this resident's care, the nurse should include what action??

There could be decreased production of platelets

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 the patient about this condition?

A client diagnosed with polycythemia vera has come into the clinic because they have developed a night-time cough, fatigue, and shortness of breath. From these clinical manifestations, what complication would the nurse suspect in this client?

Congestive heart failure

Urine output of 15 mL/hour

The nurse is caring for a client with hypovolemic anemia who is now in hypovolemic shock. What indication does the nurse have that the client is having inadequate renal perfusion?

The different leukemias all have unregulated proliferation of white blood cells.

A 12-year-old girl on the oncology unit at children's hospital tells the nurse that she has discovered that there are several different kinds of leukemia. The child asks the nurse to explain what makes them all "leukemia." What should the nurse reply?

Increased lymphocytes

A 70-year-old man attended a scheduled check-up with his primary care provider, during which he exhibited lymphadenopathy and splenomegaly. The man's primary care provider has ordered blood work to assess the man for chronic lymphocytic leukemia (CLL). The nurse at the clinic would recognize that a diagnosis of CLL would be most consistent with what laboratory finding?

"Do you ever take aspirin to treat the pain of your arthritis?"

A 71-year-old woman with a history of rheumatoid arthritis and chronic heart failure has been admitted to the hospital for the treatment of a suspected upper gastrointestinal bleed. When performing an assessment of this patient, which of the following questions most directly addresses a likely cause of the woman's bleeding disorder?

Gradually taper the dose and frequency of medication.

A patient has been diagnosed with thrombocytopenia. What are the primary nursing interventions while instituting corticosteroid therapy in this patient?

The LPN is following a plan of care for a client who is being treated for hypovolemic anemia and is at risk for hypovolemic shock. The nurse assesses vital signs and O2 saturation and observes the saturation at 89% for 3 minutes. What should the first action by the nurse be?

Give oxygen per nasal cannula

It will remove the major site of red blood cell (RBC) destruction.

A client admitted to the hospital in preparation for a splenectomy to treat autoimmune hemolytic anemia asks the nurse about the benefits of splenectomy. Which statement best explains the expected effect of splenectomy?

agranulocytosis

A nurse is caring for a client who developed toxicity after long-term treatment with sulfasalazine for Crohn's disease. The client is experiencing fatigue, fever, chills, and headache and is at risk to develop opportunistic infections. Which condition has the client most likely developed?

Avoiding activities that carry a risk for injury

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?

Neutrophil count of 50%

A nurse suspects that a patient may have aplastic anemia based on clinical manifestations and assessment. Which one of the following lab results would be consistent with this diagnosis?

Aplastic anemia

A client is brought to the ED reporting fatigue, large amounts of bruising on the extremities, and abdominal pain localized in the left upper quadrant. A health history reveals the client has been treated for a sore throat three times in the past 2 months. Laboratory tests indicate severe anemia, significant neutropenia, and thrombocytopenia. Based on the symptoms, what could be the client's diagnosis?

Support painful joints on pillows. Encourage the client to use a soft toothbrush and rinse the mouth with warm water between and after meals. Eliminate aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).

A client with hemophilia was admitted after sustaining an injury while playing outdoors with friends. Initially, the client presented with severe bleeding but has since stabilized. Which interventions will the nurse include in the care plan for this client? Select all that apply.

Obtain the pain medication and delay the bath and position change until the medication reaches its peak.

A client with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse?

Neurologic involvement

A client with a diagnosis of pernicious anemia comes to the clinic complaining of numbness and tingling in his arms and legs. What do these symptoms indicate?

Hypercalcemia

The nurse is currently planning the care of a patient with multiple myeloma who is experiencing bone destruction. When reviewing the patient's most recent blood work, what value would the nurse pay particular attention to?

The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions?

Dilute the liquid preparation with another liquid such as juice and drink with a straw.

A client with sickle cell disease informs the nurse that he is having chest pain. The nurse hears the client coughing, wheezing, and breathing rapidly. What does the nurse suspect is occurring with this client?

Acute chest syndrome