Ch 33 - Nonmalignant hematologic disorders
A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the physician immediately because the client probably is experiencing which problem? a) A haemolytic reaction caused by bacterial contamination of donor blood b) A haemolytic reaction to mismatched blood c) A haemolytic allergic reaction caused by an antigen reaction d) A haemolytic reaction to Rh-incompatible blood
A haemolytic allergic reaction caused by an antigen reaction Haemolytic allergic reactions are fairly common and may cause chills, fever, urticaria, tachycardia, dyspnoea, chest pain, hypotension, and other signs of anaphylaxis a few minutes after blood transfusion begins. Although rare, a haemolytic reaction to mismatched blood can occur, triggering a more severe reaction and, possibly, leading to disseminated intravascular coagulation. A haemolytic reaction to Rh-incompatible blood is less severe and occurs several days to 2 weeks after the transfusion. Bacterial contamination of donor blood causes a high fever, nausea, vomiting, diarrhoea, abdominal cramps and, possibly, shock.
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. a) A client with Crohn's disease b) A client who lives in a nursing home c) A client who is a vegetarian d) An older adult client on a fixed income e) A young female client with bulimia nervosa
• A young female client with bulimia nervosa • An older adult client on a fixed income • A client with Crohn's disease Those who consume a healthy diet absorb less than 10% of the iron in food. Clients whose nutrition is compromised by unhealthy dieting or who cannot afford to eat a healthy diet, lack knowledge about nutrition, or have malabsorption disorders are at great risk for iron-deficiency anemia. A young female client with bulimia nervosa has an unhealthy diet. An older adult client on a fixed income may not have the funds to eat a healthy diet. A client with Crohn's disease has a malabsorption syndrome. A client who resides in a nursing home has prepared meals as well as available supplements if required. A client who is a vegetarian is still able to receive ample iron supplementation in the vegetables being eaten.
The client has been diagnosed with myelodysplastic syndrome with an absolute neutrophil count less than 1000/mm³ and is being admitted to the hospital. The nurse a) Assigns the client to a private room b) Allows unlicensed assistive personnel who reports having a sore throat to provide care c) Places the client in isolation and allows no visitors d) Changes the water in the humidifier for oxygen therapy every 48 hours
Assigns the client to a private room The client with an absolute neutrophil count less than 1000/mm³ is to be placed in a private room. Staff with a sore throat or cold should not be assigned to provide care for this client. The client does not need to be placed in isolation, but other neutropenic precautions needs to be followed, such as allowing no visitors with infection. Water in oxygen humdifiers should be changed every 24 hours.
A patient with sickle cell anemia has a a) high hematocrit. b) low hematocrit. c) normal hematocrit. d) normal blood smear.
low hematocrit. The patient with sickle cell anemia has a low hematocrit and sickled cells on the smear. The patient with sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear.
A 36-year-old African American client has a history of sickle cell anemia with several sickle cell crises over the past 10 years. What blood component results in sickle cell anemia? a) Hemoglobin S b) Hemoglobin M c) Hemoglobin F d) Hemoglobin A
Hemoglobin S Hemoglobin A (HbA) normally replaces fetal hemoglobin (HbF) about 6 months after birth. In people with sickle cell anemia, however, an abnormal form of hemoglobin, hemoglobin S (HbS), replaces HbF. HbS causes RBCs to assume a sickled shape under hypoxic conditions.
A patient with ESRD is taking recombinant erythropoietin for the treatment of anemia. What laboratory study does the nurse understand will have to be assessed at least monthly related to this medication? a) Potassium level b) Hemoglobin level c) Folate levels d) Creatinine level
Hemoglobin level When using recombinant erythropoietin, the hemoglobin must be checked at least monthly (more frequently until a maintenance dose is established) and the dose titrated to ensure the hemoglobin level does not exceed 12 g/dL.
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? a) Severity of the disease b) Insufficient intake of dietary nutrients c) Neurologic involvement d) Loss of vibratory and position senses
Neurologic involvement In clients with pernicious anemia, numbness and tingling in the arms and legs and ataxia are the most common signs of neurologic involvement. Some affected clients lose vibratory and position senses. Jaundice, irritability, confusion, and depression are present when the disease is severe. Insufficient intake of dietary nutrients is not indicated by these symptoms
A young male client is diagnosed with glucose-6-phosphate dehydrogenase deficiency (G-6-PD). The nurse reviews his recent activities and most emphatically recommends the following: a) Discontinue exposure on a sun tanning bed. b) Consult a physician about ingesting trimethoprim/sulfamethoxazole (Bactrim) for a urinary tract infection. c) Stop drinking excessive caffeinated beverages in less than 24 hours. d) Quit cigarette smoking.
Consult a physician about ingesting trimethoprim/sulfamethoxazole (Bactrim) for a urinary tract infection. Certain drugs can cause haemolysis associated with G-6-PD, such as trimethoprim/sulfamethoxazole. The other options do not cause the haemolysis.
A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia? a) Dyspnea, tachycardia, and pallor b) Nausea, vomiting, and anorexia c) Nights sweats, weight loss, and diarrhea d) Itching, rash, and jaundice
Dyspnea, tachycardia, and pallor Signs of iron deficiency anemia include dyspnea, tachycardia, and pallor, as well as fatigue, listlessness, irritability, and headache. Night sweats, weight loss, and diarrhea may signal acquired immunodeficiency syndrome. Nausea, vomiting, and anorexia may be signs of hepatitis B. Itching, rash, and jaundice may result from an allergic or hemolytic reaction.
The nurse, caring for a client in the emergency room with a severe nosebleed, becomes concerned when the client asks for a bedpan. The nurse documents the stool as loose, tarry, and black looking. The nurse suspects the client may have thrombocytopenia. What should be the nurse's priority action? a) Put in an IV line b) Stop the nosebleed c) Notify the physician d) Ask someone to clean the bedpan
Notify the physician Thrombocytopenia is evidenced by purpura, small hemorrhages in the skin, mucous membranes, or subcutaneous tissues. Bleeding from other parts of the body, such as the nose, oral mucous membrane, and the gastrointestinal tract, also occurs. Internal hemorrhage, which can be severe and even fatal, is possible. This nurse should notify the physician of the suspected disorder.
Which is the following is the most obvious sign of anaemia? a) Flow murmurs b) Tachycardia c) Pallor d) Jaundice
Pallor On physical examination, pallor is the most common and obvious sign of anaemia. Other findings may include tachycardia and flow murmurs. Patients with haemolytic anaemia may exhibit jaundice and spelnomegaly.
In adults, bone marrow is usually aspirated from which area? a) Femur b) Posterior iliac crest c) Ankle d) Sternum
Posterior iliac crest In adults, bone marrow is usually aspirated from the posterior iliac crest and rarely from the sternum. Bone marrow is not aspirated from the femur or ankle.
A client is being admitted to the hospital with abdominal pain, anemia, and bloody stools. He complains of feeling weak and dizzy. He has rectal pressure and needs to urinate and move his bowels. The nurse should help him: a) to the bathroom. b) to a standing position so he can urinate. c) onto the bedpan. d) to the bedside commode.
onto the bedpan. A client who's dizzy and anemic is at risk for injury because of his weakened state. Assisting him with the bedpan would best meet his needs at this time without risking his safety. The client may fall if walking to the bathroom, left alone to urinate, or trying to stand up.
A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy? a) "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." b) "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal." c) "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear." d) "I will receive parenteral vitamin B12 therapy for the rest of my life."
"I will receive parenteral vitamin B12 therapy for the rest of my life." Because a client with pernicious anemia lacks intrinsic factor, oral vitamin B12 can't be absorbed. Therefore, parenteral vitamin B12 therapy is recommended and required for life.
A female client with the beta-thalassaemia trait plans to marry a man of Italian ancestry who also has the trait. Which client statement indicates that she understands the teaching provided by the nurse? a) "If my fiancé was of Middle Eastern descent, I wouldn't be worried about having children." b) "I'll see a genetic counselor before starting a family." c) "I need to learn how to give myself vitamin B12 injections." d) "Thalassaemia is treated with iron supplements."
"I'll see a genetic counselor before starting a family." Two people with the beta-thalassaemia trait have a 25% chance of having a child with thalassaemia major, a potentially life-threatening disease. Iron supplements aren't used to treat thalassaemia; in fact, they could contribute to iron overload. Vitamin B12 injections are used to treat pernicious anaemia, not thalassaemia. Thalassaemia occurs primarily in people of Italian, Greek, African, Asian, Middle Eastern, East Indian, and Caribbean descent.
A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute haemolytic reaction would occur when giving: a) O-negative blood to an O-positive client. b) A-positive blood to an A-negative client. c) O-positive blood to an A-positive client. d) B-positive blood to an AB-positive client.
A-positive blood to an A-negative client. An acute haemolytic reaction occurs when there is an ABO or Rh incompatibility. For example, giving A blood to a B client would cause a haemolytic reaction. Likewise, giving Rh-positive blood to an Rh-negative client would cause a haemolytic reaction. It's safe to give Rh-negative blood to an Rh-positive client if there is a blood type compatibility. O-negative blood is the universal donor and can be given to all other blood types. AB clients can receive either A or B blood as long as there isn't an Rh incompatibility.
A patient is brought to the ER complaining of fatigue, large amounts of bruising on the extremities, and abdominal pain localised in the left upper quadrant. A health history reveals the patient has been treated three times in the past 2 months for a sore throat. Lab tests indicate severe anaemia, significant neutropenia, and thrombocytopenia. Based on the symptoms, with what could the patient be diagnosed? a) Aplastic anaemia b) Iron deficiency anaemia c) Haemolytic anaemia d) Sickle cell anaemia
Aplastic anaemia Aplastic anaemia can be congenital or acquired, but most cases are idiopathic. It can be triggered by infection. The manifestations of aplastic anaemia are symptoms of anaemia, purpura (bruising), retinal haemorrhages, significant neutropenia, and thrombocytopenia. Other lymphadenopathies and splenomegaly sometimes occur.
A patient describes numbness in the arms and hands with a tingling sensation. The patient also frequently stumbles when walking. What vitamin deficiency does the nurse determine may cause some of these symptoms? a) B12 b) Thiamine c) Folate d) Iron
B12 The hematologic effects of vitamin B12 deficiency are accompanied by effects on other organ systems, particularly the gastrointestinal tract and nervous system. Patients with pernicious anemia may become confused; more often, they have paresthesias in the extremities (particularly numbness and tingling in the feet and lower legs). They may have difficulty maintaining their balance because of damage to the spinal cord, and they also lose position sense (proprioception).
Which of the following is a symptom of Cooley's anemia? a) Inflammation of the tongue b) Dyspnea c) Inflammation of the mouth d) Bronzing of the skin
Bronzing of the skin Patients with Cooley's anemia exhibit symptoms of severe anemia and a bronzing of the skin, which is caused by hemolysis of erythrocytes. Dyspnea, stomatitis (inflammation of the mouth), and glossitis (inflammation of the tongue) are symptoms of pernicious anemia.
A patient with end-stage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia? a) Potassium level of 5.2 mEq/L b) Calcium level of 9.4 mg/dL c) Creatinine level of 6 mg/100 mL d) Magnesium level of 2.5 mg/dL
Creatinine level of 6 mg/100 mL The degree of anemia in patients with end-stage renal disease varies greatly; however, in general, patients do not become significantly anemic until the serum creatinine level exceeds 3 mg/100 mL.
A client is receiving chemotherapy for cancer. The nurse reviews the client's laboratory report and notes that he has thrombocytopenia. To which nursing diagnosis should the nurse give the highest priority? a) Impaired oral mucous membranes b) Impaired tissue integrity c) Activity intolerance d) Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI
Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI These are all appropriate nursing diagnoses for the client with thrombocytopenia. However, the risk of cerebral and GI hemorrhage and hypotension pose the greatest risk to the physiological integrity of the client.
During the review of morning lab values on a patient complaining of severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anaemia based on which of the following findings? a) Low ferritin level b) Elevated red blood cells (RBCs) c) Elevated haematocrit level d) Enlarged mean corpuscular volume (MCV)
Low ferritin level The most consistent indicator of iron deficiency anaemia is a low ferritin level, which reflects low iron stores. As the anaemia progresses, the MCV, which measures the size of the erythrocytes, also decreases. Haematocrit and RBC levels are also low in relation to the haemoglobin level.
A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client? a) Pallor, tachycardia, and a sore tongue b) Angina pectoris, double vision, and anorexia c) Sore tongue, dyspnea, and weight gain d) Pallor, bradycardia, and reduced pulse pressure
Pallor, tachycardia, and a sore tongue Pallor, tachycardia, and a sore tongue are all characteristic findings in pernicious anemia. Other clinical manifestations include anorexia; weight loss; a smooth, beefy red tongue; a wide pulse pressure; palpitations; angina pectoris; weakness; fatigue; and paresthesia of the hands and feet. Bradycardia, reduced pulse pressure, weight gain, and double vision aren't characteristic findings in pernicious anemia.
A nurse should expect to administer which vaccine to the client after a splenectomy? a) Tetanus toxoid b) Attenuvax c) Recombivax HB d) Pneumovax 23
Pneumovax 23 Pneumovax 23, a polyvalent pneumococcal vaccine, is administered prophylactically to prevent the pneumococcal sepsis that sometimes occurs after splenectomy. Recombivax HB is a vaccine for hepatitis B. Attenuvax is a live, attenuated virus vaccine for immunization against measles (rubeola). Tetanus toxoid is administered to prevent tetanus resulting from impaired skin integrity caused by traumatic injury.
When a nurse is planning discharge teaching for a patient admitted with a sickle cell crisis, which of the following should the nurse include in the teaching? a) Teach patients to drink only one caffeinated beverage daily b) Teach patients to take a daily multivitamin with iron c) Teach patients to receive pneumococcal and annual influenza vaccinations d) Teach patients to limit fluids to 2 quarts a day
Teach patients to receive pneumococcal and annual influenza vaccinations Patients with sickle cell anaemia must treat infections promptly with appropriate antibiotics; infections, particularly pneumococcal infections, can be serious. These patients should receive pneumococcal and annual influenza vaccinations.
During preparation for bowel surgery, a client receives an antibiotic to reduce intestinal bacteria. The nurse knows that hypoprothrombinemia may occur as a result of antibiotic therapy interfering with synthesis of which vitamin? a) Vitamin D b) Vitamin K c) Vitamin E d) Vitamin A
Vitamin K Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Antibiotic therapy may interfere with synthesis of these substances, including vitamin K. Intestinal bacteria don't synthesize vitamins A, D, or E.
A nurse caring for a client who has hemophilia is getting ready to take the client's vital signs. What should the nurse do before taking a blood pressure? a) Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints. b) Ask if taking a blood pressure has ever produced pain in the upper arm. c) Ask if taking a blood pressure has ever caused bruising in the hand and wrist. d) Ask if taking a blood pressure has ever produced the need for medication.
Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints. Before taking a blood pressure, the nurse asks the client if the use of a blood-pressure cuff has ever produced bleeding under the skin or in the arm joints. Options B, C, and D are incorrect.
When teaching a patient with iron deficiency anaemia about appropriate food choices, the nurse will encourage the patient to increase the dietary intake of which of the following foods? a) Dairy products b) Fruits high in vitamin C, such as organs and grapefruits c) Berries and orange vegetables d) Beans, dried fruits, and leafy green vegetables
Beans, dried fruits, and leafy green vegetables Food sources high in iron include organ meats (e.g., beef or calf's liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.
A patient with chronic renal failure is examined by the nurse practitioner for anemia. The nurse knows to review the laboratory data for a decreased hemoglobin level, red blood cell count, and which of the following? a) Decreased level of erythropoietin b) Increased mean corpuscular volume c) Decreased total iron-binding capacity d) Increased reticulocyte count
Decreased level of erythropoietin As renal function decreases, erythropoietin, which is produced by the kidney, also decreases. Because erythropoietin is produced outside the kidney, some erythropoiesis continues, even in patients whose kidneys have been removed. However, the number of red blood cells produced is small and the degree of erythropoiesis is inadequate.
The nurse is educating a patient with iron deficiency anemia about food sources high in iron and how to enhance the absorption of iron when eating these foods. What can the nurse inform the client would enhance the absorption? a) Eating a steak with mushrooms b) Eating apple slices with carrots c) Eating calf's liver with a glass of orange juice d) Eating leafy green vegetables with a glass of water
Eating calf's liver with a glass of orange juice Food sources high in iron include organ meats (e.g., beef or calf's liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.
Which of the following is accurate regarding the use of corticosteroids for immune haemolytic anaemia? Select all that apply. a) Corticosteroids are not effective in the treatment of immune haemolytic anaemia. b) If the haemoglobin returns to normal, the corticosteroid dose can be lowered. c) They decrease the macrophages ability to clear the antibody-coated RBCs. d) The treatment consists of low doses of corticosteroids. e) They produce lasting effects.
• They decrease the macrophages ability to clear the antibody-coated RBCs. • If the haemoglobin returns to normal, the corticosteroid dose can be lowered. The treatment consists of high doses of corticosteroids until haemolysis decreases. Corticosteroids decrease the macrophage's ability to clear the antibody-coated RBCs. If the haemoglobin level returns to normal, usually after several weeks, the corticosteroid dose can be lowered or, in some cases tapered and discontinued.
The nurse is preparing the patient for a test to determine the cause of vitamin B12 deficiency. The patient will receive a small oral dose of radioactive vitamin B12 followed by a large parenteral dose of nonradioactive vitamin B12. What test is the patient being prepared for? a) Magnetic resonance imaging (MRI) study b) Bone marrow aspiration c) Schilling test d) Bone marrow biopsy
Schilling test The classic method of determining the cause of vitamin B12 deficiency is the Schilling test, in which the patient receives a small oral dose of radioactive vitamin B12, followed in a few hours by a large, nonradioactive parenteral dose of vitamin B12 (this aids in renal excretion of the radioactive dose).
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 stools for blood. b) Observe the sputum for signs of blood. c) Observe the gums for bleeding after the client brushes teeth. d) Observe client for facial droop.
Observe stools for blood. 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.
A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client? a) Maintain accurate fluid intake and output records. b) Limit visits by family members. c) Use the smallest needle possible for injections. d) Encourage the client to use a wheelchair.
Use the smallest needle possible for injections. Because thrombocytopenia alters coagulation, it poses a high risk of bleeding. To help prevent capillary bleeding, the nurse should use the smallest needle possible when administering injections. The nurse doesn't need to limit visits by family members because they don't pose any danger to the client. The nurse should provide comfort measures and maintain the client on bed rest; activities such as using a wheelchair can cause bleeding. The nurse records fluid intake and output to monitor hydration; however, this action doesn't protect the client from a complication of thrombocytopenia.
While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters? a) Platelet count, blood glucose levels, and white blood cell (WBC) count b) Thrombin time, calcium levels, and potassium levels c) Fibrinogen level, WBC, and platelet count d) Platelet count, prothrombin time, and partial thromboplastin time
Platelet count, prothrombin time, and partial thromboplastin time The diagnosis of DIC is based on the results of laboratory studies of prothrombin time, platelet count, thrombin time, partial thromboplastin time, and fibrinogen level as well as client history and other assessment factors. Blood glucose levels, WBC count, calcium levels, and potassium levels aren't used to confirm a diagnosis of DIC.
Which nursing diagnosis should a nurse expect to see in a care plan for a client in sickle cell crisis? a) Imbalanced nutrition: Less than body requirements related to poor intake b) Acute pain related to sickle cell crisis c) Disturbed sleep pattern related to external stimuli d) Impaired skin integrity related to pruritus
Acute pain related to sickle cell crisis In sickle cell crisis, sickle-shaped red blood cells clump together in a blood vessel, which causes occlusion, ischemia, and extreme pain. Therefore, Acute pain related to sickle cell crisis is the appropriate choice. Although nutrition is important, poor nutritional intake isn't necessarily related to sickle cell crisis. During sickle cell crisis, pain or another internal stimulus is more likely to disturb the client's sleep than external stimuli. Although clients with sickle cell anemia can develop chronic leg ulcers caused by small vessel blockage, they don't typically experience pruritus.
A client is hospitalised 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin at home, which is now discontinued. To prevent the formation of blood clots, it is important for the nurse to a) Monitor partial thromboplastin (PTT) time. b) Encourage a diet high in vitamin K. c) Have the client limit physical activity. d) Administer the prescribed enoxaparin (Lovenox).
Administer the prescribed enoxaparin (Lovenox). Clients who are prescribed warfarin at home and need to have a major invasive procedure stop taking warfarin prior to the procedure. Low molecular weight heparin, such as enoxaparin, may be used until the procedure is performed. The client will continue with a diet that has a daily consistent amount of vitamin K. The client needs to ambulate frequently throughout the day. Prothrombin (PT) time is monitored, not PTT, when warfarin had been administered.
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) Altered tissue perfusion related to diminished oxygen-carrying capacity of the blood c) Fatigue related to diminished oxygen-carrying capacity of the blood d) Deficient knowledge related to new information with no previous experience
Altered tissue perfusion related to diminished oxygen-carrying capacity of the blood 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 patient with ESRD is taking recombinant erythropoietin for the treatment of anemia. What laboratory study does the nurse understand will have to be assessed at least monthly related to this medication? a) Creatinine level b) Folate levels c) Hemoglobin level d) Potassium level
Hemoglobin level When using recombinant erythropoietin, the hemoglobin must be checked at least monthly (more frequently until a maintenance dose is established) and the dose titrated to ensure the hemoglobin level does not exceed 12 g/dL.
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? a) Erythrocytes that are microcytic and hypochromic b) An increased number of erythrocytes c) Erythrocytes that are macrocytic and hyperchromic d) Clustering of platelets with sickled red blood cells
Erythrocytes that are microcytic and hypochromic A blood smear reveals erythrocytes that are microcytic (smaller than normal) and hypochromic (lighter in color than normal). It does not reveal macrocytic (larger than normal) or hyperchromic erythrocytes. Clustering of platelets with sickled red blood cells would indicate sickle cell anemia. An increase in the number of erythrocytes would indicate polycythemia vera.
The Pediatric Nurse Practitioner is doing a physical examination of a client with sickle cell anemia. Why would the nurse practitioner auscultate the lungs and heart? a) To detect the motor strength and stroke-related signs and symptoms b) To detect the evidence of infection such as fever and tachycardia c) To detect the abnormal sounds suggestive of acute chest syndrome and heart failure d) To detect the evidence of dehydration that might have triggered a sickle cell crisis
To detect the abnormal sounds suggestive of acute chest syndrome and heart failure The nurse auscultates the lungs and heart to detect abnormal sounds that indicate pneumonia, acute chest syndrome, and heart failure. The nurse assesses vital signs to detect evidence of infection, such as fever and tachycardia. During the physical examination, the nurse observes the client's appearance, looking for evidence of dehydration, which may have triggered a sickle cell crisis. The nurse assesses mental status, verbal ability, and motor strength to detect stroke-related signs and symptoms.
Which of the following is a symptom of Haemochromatosis? a) Bronzing of the skin b) Inflammation of the tongue c) Weight gain d) Inflammation of the mouth
Bronzing of the skin Patients with Haemochromatosis exhibit symptoms of weakness, lethargy, arthralgia, weight loss, and loss of libido early in the illness trajectory. The skin may appear hyperpigmented from melanin deposits or appear bronze in colour.
The nurse is talking with the parents of a toddler who was diagnosed with hemophilia A. The nurse teaches the parents a) The importance of administering over-the-counter preparations for a cold b) How to administer factor VIII intravenously at the first sign of bleeding c) To allow the toddler to participate in playground activities with other toddlers d) That nasal packing will be necessary for any nose bleeds
How to administer factor VIII intravenously at the first sign of bleeding Clients and families are taught to administer factor VIII intravenously. This helps to prevent bleeding episodes. Activities that minimize trauma are allowed for the toddler, and playground activities may place the toddler at risk for increased bleeding. Over-the-counter cold preparations are to be avoided, because they will interfere with platelet aggregation. Nasal packing is avoided, because when the nasal packing is removed, bleeding may occur.
A patient with severe anemia is complaining of the following symptoms: tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Lab results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which of the following nursing diagnoses is most appropriate for this patient? a) Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients b) Fatigue related to decreased hemoglobin and hematocrit c) Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit d) Risk for falls related to complaints of dizziness
Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit The symptoms indicate impaired tissue perfusion due to a decrease in the oxygen-carrying capacity of the blood. Cardiac status should be carefully assessed. When the hemoglobin level is low, the heart attempts to compensate by pumping faster and harder in an effort to deliver more blood to hypoxic tissue. This increased cardiac workload can result in such symptoms as tachycardia, palpitations, dyspnea, dizziness, orthopnea, and exertional dyspnea. Heart failure may eventually develop, as evidenced by an enlarged heart (cardiomegaly) and liver (hepatomegaly) and by peripheral edema.
A 74-year-old client who is a vegetarian has a hemoglobin of 10.2 gm/dL, vitamin B12 of 68 pg/mL (normal: 200-900 pg/mL), and MCV of 110 cubic micrometers. The nurse interprets these data and instructs the client to a) Ingest a diet higher in vitamin B12 sources. b) Continue with the diet but include more sources of iron. c) Change the vegetarian diet and begin to eat red meat. d) Supplement the diet with vitamin B12.
Supplement the diet with vitamin B12. Data support that the client is experiencing megaloblastic anemia. Findings include the laboratory test results, the client's age, and the client's status as a vegetarian. Many vegetarians need to supplement their diet with vitamin B12. Eating more foods with vitamin B12 will not provide enough of this vitamin for the client's body. Increasing iron sources will not resolve the client's anemia. Telling the client to discontinue the vegetarian practice and eat red meat is nontherapeutic. Other options are available.
A nurse is preparing to discharge an adolescent with sickle cell anaemia. What client need should the nurse emphasise in her discharge assessment? a) The need to have pain medication available b) The need for an adequate support structure c) The need to follow up with physician visits d) The need to maintain good hydration
The need for an adequate support structure Because many psychosocial and physiological issues affect the life of an adolescent with a chronic illness, assuring the existence of a good support structure is the most essential element of care. Availability of pain medication and adequate support are both important considerations, but it's more important to emphasise the need for an adequate support structure. The need for good hydration and follow-up visits are important, but a good support structure will help the adolescent with this treatment.
Which cell of haematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? a) Monocyte b) Lymphoid stem cell c) Neutrophil d) Myeloid stem cell
Myeloid stem cell The myeloid stem cell is responsible not only for all non lymphoid white blood cells, but also for the production of red blood cells and platelets. Lymphoid cells produce either T or B lymphocytes. A monocyte is large WBC that becomes a macrophage when is leaves the circulation and moves into body tissues. A neutrophil is a fully mature WBC capable of phagocytosis.
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? a) Acute muscular strain b) Vaso-occlusive crisis c) Pneumocystis pneumonia d) Acute chest syndrome
Acute chest syndrome One of the unique manifestations of sickle cell disease is "acute chest syndrome," a type of pneumonia triggered by decreased hemoglobin and infiltrates in the lungs. Acute chest syndrome is characterized by respiratory symptoms, such as coughing, wheezing, tachypnea, and chest pain. Vaso-occlusive crisis causes decrease in tissue perfusion and predisposes the client to pneumonia but is not the present problem with this client. Pneumocystis pneumonia is present in the client with HIV/AIDS or other immunocompromised clients. The client's symptoms do not correlate with a diagnosis of acute muscular strain.
You are caring for an 87-year-old female who has been admitted to your unit with iron-deficiency anemia. What would you suspect? a) Elimination of iron by the body b) Decrease in the total body iron stores with age c) Blood loss from the gastrointestinal or genitourinary tract d) Excessive consumption of coffee or tea
Blood loss from the gastrointestinal or genitourinary tract If an older adult is anemic, blood loss from the gastrointestinal or genitourinary tract is suspected. This is because iron deficiency anemia is unusual in older adults as the body does not eliminate excessive iron, causing total body iron stores to increase with age. Excessive consumption of coffee or tea is not a causative factor for anemia in older adults.
An 82-year-old client has pernicious anemia and has been receiving treatment for several years. Which symptom may be confused with another condition in older adults? a) Glossitis b) Dementia c) Stomatitis d) Ataxia
Dementia Pernicious anemia may be accompanied by a dementia with symptoms similar to Alzheimer's disease. Therefore, clients experiencing cognitive changes should be screened because early detection of pernicious anemia is critical to prevent neurologic damage.
A patient's family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which of the following statements made by the nurse correctly explains the cause of DIC? a) DIC is caused when haemolytic processes destroy erythrocytes. b) DIC is a complication of an autoimmune disease that attacks the body's own cells. c) DIC occurs when the immune system attacks platelets and causes massive bleeding. d) DIC is caused by an abnormal activation of clotting pathway causing excessive amounts of tiny clots to form inside organs.
DIC is caused by an abnormal activation of clotting pathway causing excessive amounts of tiny clots to form inside organs. The inflammatory response initiates the process of inflammation and coagulation. The natural anticoagulant pathways within the body are simultaneously impaired, and the fibrinolytic system is suppressed so that a massive amount of tiny clots forms in the microcirculation. As the platelets and clotting factors form microthrombi, coagulation fails. Thus, the paradoxical result of excessive clotting is bleeding. Decline in organ function is usually a result of excessive clot formation (with resultant ischemia to all or part of the organ).
A male patient has a probable diagnosis of polycythemia vera. The nurse reviews the patient's lab work for which of the following diagnostic indicator? a) Leukocyte count of 11,500/mm3 b) Erythrocyte count of 6.5 m/?L c) Platelet value of 350,000/mm3 d) Hematocrit of 60%
Hematocrit of 60% Although all results are elevated, the diagnostic indicator is the elevated hematocrit (normal = 42% to 52% for a male). These results are used in combination with other indicators (eg, splenomegaly) for a definitive diagnosis.
An 82-year-old client has pernicious anemia and has been receiving treatment for several years. What is she lacking that results in pernicious anemia? a) Intrinsic factor b) Hemoglobin c) Vitamin B d) Extrinsic factor
Intrinsic factor Pernicious anemia develops when a client lacks intrinsic factor, which normally is present in stomach secretions. Intrinsic factor is necessary for absorption of vitamin B12. Vitamin B12, the extrinsic factor in blood, is required for the maturation of erythrocytes.
