Ch31: Caring for Clinets with Disorders

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy? 1) "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." 2) "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal." 3) "I will receive parenteral vitamin B12 therapy for the rest of my life." 4) "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear."

"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 client with anemia is prescribed an oral iron supplement. Which statement indicates that teaching about this supplement has been effective? 1) "I will limit my intake of raw fruit and vegetables." 2) "I will take it in the morning with orange juice." 3) "I will stop taking it if my stool turns black." 4) "I will be sure to take this medication with food."

"I will take it in the morning with orange juice." The client should be instructed to take the iron supplements on an empty stomach with a source of vitamin C such as orange juice. Iron supplements will turn the stool dark or black; this does not indicate that the supplement should be stopped. The supplement should be taken 1 hour before meals or 2 hours after a meal and not with a meal. The client should be instructed to increase the intake of high-fiber foods to reduce the risk of constipation.

A client 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? 1) "A very small percentage of the platelets in a transfusion are actually functional." 2) "A platelet transfusion often further blunts your body's own production of platelets." 3) "Transfused platelets usually aren't beneficial because they're rapidly destroyed in the body." 4) "Finding a matching donor for a platelet transfusion is exceedingly difficult."

"Transfused platelets usually aren't beneficial because they're rapidly destroyed in the body." Despite extremely low platelet counts, platelet transfusions are usually avoided. Transfusions tend to be ineffective not because the platelets are nonfunctional but because the client's antiplatelet antibodies bind with the transfused platelets, causing them to be destroyed. Matching the client's blood type is not usually necessary for a platelet transfusion. Platelet transfusions do not exacerbate low platelet production.

Which patient does the nurse recognize as being most likely to be affected by sickle cell disease? 1) A 28-year-old Israeli man 2) A 14-year-old African American boy 3) A 26-year-old Eastern European Jewish woman 4) An 18-year-old Chinese woman

A 14-year-old African American boy The HbS gene is inherited in people of African descent and to a lesser extent in people from the Middle East, the Mediterranean area, and aboriginal tribes in India. Sickle cell anemia is the most severe form of sickle cell disease.

The nurse is caring for a client with an exacerbation of sickle cell disease (SCD). Which finding indicates to the nurse that the client is experiencing a liver complication from this condition? 1) Fatigue 2) Glucose intolerance 3) Weakness 4) Abdominal pain

Abdominal Pain Sickle cell disease (SCD) is an autosomal recessive disorder caused by inheritance of the sickle hemoglobin (HbS) gene. It is associated with severe hemolytic anemia. The HbS gene results in production of a defective hemoglobin molecule that causes the erythrocyte to change shape when exposed to low oxygen tension. The erythrocyte usually has a round, biconcave, pliable shape which in SCD becomes rigid and sickle shaped. Complications of SCD can affect all body systems. Evidence that the client is experiencing a complication in the liver would be the development of abdominal pain. Fatigue and weakness indicate complications involving the central nervous system and heart. Glucose intolerance is not identified as a complication of SCD.

The nurse is planning the care of a client with a nutritional deficit and a diagnosis of megaloblastic anemia. The nurse should recognize that this client's health problem is due to which issue with the red blood cells (RBCs)? 1) Production of inadequate quantities of RBCs 2) Injury to the RBCs in circulation 3) Abnormalities in the structure and function of RBCs 4) Premature release of immature RBCs

Abnormalities in the structure and function of RBCs Vitamin B12 and folate deficiencies are characterized by the production of abnormally large erythrocytes called megaloblasts. Because these cells are abnormal, many are sequestered (trapped) while still in the bone marrow, and their rate of release is decreased. Some of these cells actually die in the marrow before they can be released into the circulation. This results in megaloblastic anemia. This pathologic process does not involve inadequate production, premature release, or injury to existing RBCs.

A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify? 1) Electrolyte imbalance that could affect the blood's ability to coagulate properly 2) Potential hepatic dysfunction indicated by decreased blood urea nitrogen (BUN) and creatinine levels 3) Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels 4) Low levels of urine constituents normally excreted in the urine

Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels Low preoperative HCT and Hb levels indicate the client may require a blood transfusion before surgery. If the HCT and Hb levels decrease during surgery because of blood loss, the potential need for a transfusion increases. Possible renal failure is indicated by elevated BUN or creatinine levels. Urine constituents aren't found in the blood. Coagulation is determined by the presence of appropriate clotting factors, not electrolytes.

A client with a new onset of rib and spine pain is being evaluated for multiple myeloma. For which manifestations will the nurse assess this client? Select all that apply. 1) Hypercalcemia 2) Bone destructions 3) Renal dysfunction 4) Anemia 5) Lymph enlargement

Anemia Hypercalcemia Renal dysfunction Bone destructions Clinical manifestations of multiple myeloma result not only from the malignant cells themselves, but also from the abnormal protein they produce. The classic clinical manifestations of multiple myeloma are referred to as the CRAB features and include anemia, hypercalcemia, renal dysfunction, and bone destruction. Lymph enlargement is associated with lymphomas, but not with multiple myeloma.

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a patient with leukemia? 1) Apply prolonged pressure to needle sites or other sources of external bleeding. 2) Monitor temperature at least once per shift. 3) Eliminate direct contact with others who are infectious. 4) Implement neutropenic precautions.

Apply prolonged pressure to needle sites or other sources of external bleeding. For a patient 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. Changes in temperature can indicate infections but do not play a role in the prevention of bleeding.

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? 1) Aspirin 2) Vitamin D 3) Vitamin B12 4) Calcium carbonate

Aspirin 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 with a new diagnosis of leukemia is about to start treatment and expresses fear and anxiety with the prognosis. Which action is the nurse's most appropriate? 1) Communicate to the health care provider the need to provide more information to the client and family. 2) Encourage the client to call their family and discuss immediate role restructuring in both their family and professional life. 3) Assess how much information is desired from the client in terms of illness, treatment, and complications. 4) Offer to call pastoral services and review hospice and/or palliative care so the client can have a quiet, dignified death.

Assess how much information is desired from the client in terms of illness, treatment, and complications. As with any client exhibiting anxiety and fear about a prognosis, listening should come first in order to assess how much information the client wants to have regarding the illness, treatment and potential complications. This is an ongoing assessment, since needs and interest in information changes throughout the course of treatment. Managing a client's care is a team effort, so involving the primary care provider and family is important, but not the nurse's priority action. Offering pastoral services and role restructuring has its place in treatment but should be discussed after an assessment of the client's needs. A discussion about palliative care and hospice is not appropriate at this time. Offering realistic hope is important and only after all treatment options are exhausted, or the client is diagnosed as terminal, should palliative and/or hospice care be considered.

A nurse cares for a client with anemia requiring nutritional supplementation. Which nursing intervention best promotes client adherence with the prescribed therapy? 1) Assist the client to incorporate the therapeutic regimen into daily activities. 2) Develop a therapeutic regimen based on the client's understanding of the medication. 3) Assist the client to use a medication reminder system for the therapeutic regimen. 4) Develop a therapeutic regimen recommendation for the client.

Assist the client to incorporate the therapeutic regimen into daily activities. The best way for the nurse to promote adherence to the therapeutic regimen is to assist the client to incorporate the therapeutic regimen into daily activities. This action is the only answer choice that is a collaborative effort with the client and is the reason it is correct.

A nurse is providing discharge education to a client who has recently been diagnosed with a bleeding disorder. Which topic should the nurse prioritize when teaching this client? 1) Avoiding foods high in vitamin K 2) Avoiding activities that carry a risk for injury 3) Avoiding buses, subways, and other crowded, public sites 4) Keeping immunizations current

Avoiding activities that carry a risk for injury 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 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? 1) Folate 2) B12 3) Iron 4) Thiamine

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).

The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency? 1) Folate 2) A 3) C 4) B12

B12 The medication metformin (Glucophage) increases the client's risk for developing B12 deficiency because the medication inhibits the absorption of B12.

When teaching a client with iron deficiency anemia about appropriate food choices, the nurse encourages the client to increase the dietary intake of which foods? 1) Beans, dried fruits, and leafy, green vegetables 2) Berries and orange vegetables 3) Fruits high in vitamin C, such as oranges and grapefruits 4) Dairy products

Beans, dried fruits, and leafy, green vegetables Food sources high in iron include organ meats (e.g., beef or calf liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy and 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 are assessment findings associated with thrombocytopenia? Select all that apply. 1) Epistaxis 2) Hematemesis 3) Bleeding gums 4) Bradypnea 5) Hypertension

Bleeding gums Epistaxis Hematemesis Pertinent findings of thrombocytopenia include: bleeding gums, epistaxis, hematemesis, hypotension, and tachypnea.

The nurse suspects that a client has multiple myeloma based on the client's major presenting symptom and the analysis of laboratory results. What classic symptom for multiple myeloma does the nurse assess for? 1) Bone pain in the back of the ribs 2) Debilitating fatigue 3) Severe thrombocytopenia 4) Gradual muscle paralysis

Bone pain in the back of the ribs Although patients can have asymptomatic bone involvement, the most common presenting symptom of multiple myeloma is bone pain, usually in the back or ribs. Unlike arthritic pain, the bone pain associated with myeloma increases with movement and decreases with rest; clients may report that they have less pain on awakening but the pain intensity increases during the day.

A nurse is caring for a client who has been diagnosed with leukemia. The nurse's most recent assessment reveals the presence of ecchymoses on the client's sacral area and petechiae on the forearms. In addition to informing the client's primary care provider, the nurse should perform what action? 1) Ambulate the client to promote circulatory function. 2) Initiate measures to prevent venous thromboembolism (VTE). 3) Place the client on protective isolation. 4) Check the client's most recent platelet level.

Check the client's most recent platelet level. The client's signs are suggestive of thrombocytopenia, thus the nurse should check the client's most recent platelet level. VTE is not a risk and this does not constitute a need for isolation. Ambulation and activity may be contraindicated due to the risk of bleeding.

The nurse is caring for a client with chronic myeloid leukemia (CML) who is taking imatinib mesylate. In what phase of the leukemia does the nurse understand that this medication is most useful to induce remission? 1) Chronic 2) Accelerated 3) Transformation 4) Blast crisis

Chronic Advances in understanding the pathology of CML at a molecular level have led to dramatic changes in treatment. An oral formulation of a tyrosine kinase inhibitor, imatinib mesylate (Gleevec), works by blocking signals within the leukemia cells that express the BCR-ABL protein, thus preventing a series of chemical reactions that cause the cell to grow and divide. Imatinib therapy appears to be most useful in the chronic phase of the illness. It can induce complete remission at the cellular and even molecular level.

A client is being treated for DIC and the nurse has prioritized the nursing diagnosis of Risk for Deficient Fluid Volume Related to Bleeding. How can the nurse best determine if goals of care relating to this diagnosis are being met? 1) Assess the client's level of consciousness frequently. 2) Assess for edema. 3) Assess skin integrity frequently. 4) Closely monitor intake and output.

Closely monitor intake and output. The client with DIC is at a high risk of deficient fluid volume. The nurse can best gauge the effectiveness of care by closely monitoring the client's intake and output. Each of the other assessments is a necessary element of care, but none addresses fluid balance as directly as close monitoring of intake and output.

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? 1) Potassium level of 5.2 mEq/L 2) Calcium level of 9.4 mg/dL 3) Magnesium level of 2.5 mg/dL 4) Creatinine level of 6 mg/100 mL

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 nurse is planning the care of a client who has been admitted to the medical unit with a diagnosis of multiple myeloma. In the client's care plan, the nurse has identified a diagnosis of Risk for Injury, which should be attributed to which factor? 1) Hypercoagulation 2) Left ventricular hypertrophy 3) Decreased bone density 4) Labyrinthitis

Decreased bone density Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis (decreased bone density) and osteolytic lesions. Labyrinthitis is uncharacteristic, and clients do not normally experience hypercoagulation or cardiac hypertrophy as a result of multiple myeloma.

A client newly diagnosed with thrombocytopenia is admitted to the medical unit. After the admission assessment, the client asks the nurse to explain the condition. The nurse explains to this client that this condition occurs due to which factor? 1) Impaired communication between platelets 2) Decreased production of platelets 3) An attack on the platelets by antibodies 4) An autoimmune process causing platelet malfunction

Decreased production of platelets Thrombocytopenia can result from a decreased platelet production, increased platelet destruction, or increased consumption of platelets. Impaired platelet communication, antibodies, and autoimmune processes are not typical pathologies.

A nurse cares for a client with a hematological disorder and malnutrition. What is the nurse's best understanding of how the client's nutritional status may worsen the client's hematological condition? 1) Decreased carbohydrates lead to decreased oxygen affinity of the hemoglobin 2) Decreased fat stores lead to decreased ability for red blood cells 3) Decreased protein stores lead to decreased immune response 4) Decreased calories lead to decreased immune response

Decreased protein stores lead to decreased immune response Decreased protein stores lead to a decreased immune response and worsening of the client's hematological condition. Decreased intake of carbohydrates, calories, or fat stores are not the primary sources for worsening of the client's condition.

The nurse is caring for a client with external bleeding. What is the nurse's priority intervention? 1) Direct pressure 2) Pressure point control 3) Application of a tourniquet 4) Elevation of the extremity

Direct pressure 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 anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia? 1) Dyspnea, tachycardia, and pallor 2) Itching, rash, and jaundice 3) Nausea, vomiting, and anorexia 4) Nights sweats, weight loss, and diarrhea

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 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? 1) Eating leafy green vegetables with a glass of water 2) Eating a steak with mushrooms 3) Eating apple slices with carrots 4) Eating calf's liver with a glass of orange juice

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.

A thin client is prescribed iron dextran intramuscularly. What is most important action taken by the nurse when administering this medication? 1) Uses a 23-gauge needle 2) Rubs the site vigorously 3) Injects into the deltoid muscle 4) Employs the Z-track technique

Employs the Z-track technique When iron medications are given intramuscularly, the nurse uses the Z-track technique to avoid local pain and staining of the skin. The gluteus maximus muscle is used. The nurse avoids rubbing the site vigorously and uses a 18- or 20-gauge needle.

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? 1) Magnesium sulfate 2) Epoetin alfa 3) Vitamin K 4) Low-molecular-weight heparin

Epoetin Alfa The anemia that accompanies end-stage 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.

A client who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action? 1) Keep the client on bed rest. 2) Evaluate the client's INR. 3) Ask the client whether they have recently fallen. 4) Evaluate the client's platelet count.

Evaluate the client's platelet count. Complications of AML include bleeding. The risk of bleeding correlates with the level and duration of platelet deficiency. Major hemorrhages may develop when the platelet count drops to less than 10,000/mm3. The bleeding is usually unrelated to falling. Keeping the client on bed rest will not prevent bleeding when the client has a low platelet count. Assessment for other areas of bleeding is also a priority intervention.

A patient has been diagnosed with thrombocytopenia. What are the primary nursing interventions while instituting corticosteroid therapy in this patient? 1) Examine the extremities for redness. 2) Eliminate aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). 3) Palpate the lymph nodes and tonsils every shift. 4) Gradually taper the dose and frequency of medication.

Gradually taper the dose and frequency of medication. For a patient with thrombocytopenia, he or she gradually tapers the dose and frequency of steroid medication before discontinuing it to avoid adrenal insufficiency or crisis. Eliminating aspirin and NSAIDS will help manage bleeding tendencies. Assessment of the extremities, tonsils, or the lymph nodes is part of a physical examination of a patient and not applicable to corticosteroid therapy.

A 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? 1) hemoglobin M 2) hemoglobin S 3) hemoglobin A 4) hemoglobin F

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.

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? 1) Hyperproteinemia 2) Elevated serum viscosity 3) Elevated red blood cell (RBC) count 4) Hypercalcemia

Hypercalcemia Hypercalcemia may occur when bone destruction occurs due to the disease process. Elevated serum viscosity occurs because plasma cells excrete excess immunoglobulin. RBC count will be decreased. Hyperproteinemia would not be present.

Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents? 1) Hyperchromic 2) Microcytic 3) Hypochromic 4) Normocytic

Hypochromic An RBC that has pale or lighter cellular contents is hypochromic. A normocytic RBC is normal or average in size. A microcytic RBC is smaller than normal. Hyperchromic is used to describe an RBC that has darker cellular contents

A client is undergoing diagnostic testing for chronic lymphocytic leukemia (CLL). Which assessment finding is certain to be present if the client has CLL? 1) Thrombocytopenia with no evidence of bleeding 2) Increased lymphocyte levels 3) Intractable bone pain 4) Increased numbers of blast cells

Increased lymphocyte levels An increased lymphocyte count (lymphocytosis) is always present in clients with CLL. Each of the other listed symptoms may or may not be present, and none is definitive for CLL.

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. Which nursing diagnosis should the nurse prioritize in the client's plan of care? 1) Risk for disuse syndrome related to ineffective peripheral circulation 2) Ineffective tissue perfusion related to thrombosis 3) Ineffective thermoregulation related to hypothalamic dysfunction 4) Functional urinary incontinence related to urethral occlusion

Ineffective tissue perfusion related to thrombosis 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.

A nurse practitioner is assessing a client who has a fever, malaise, and a white blood cell count that is elevated. What principle should guide the nurse's management of the client's care? 1) The client is exhibiting signs and symptoms of leukemia. 2) The client should undergo diagnostic testing for multiple myeloma. 3) Infection is the most likely cause of the client's change in health status. 4) There is a need for the client to be assessed for lymphoma.

Infection is the most likely cause of the client's change in health status. Leukocytosis is most often the result of infection. It is only considered pathologic (and suggestive of leukemia) if it is persistent and extreme. Multiple myeloma and lymphoma are not likely causes of this constellation of symptoms.

A nurse caring for a client with myeloma prepares to administer dexamethasone to the client. What is the nurse's best understanding of how this medication is an effective treatment option for this client? 1) It decreases immune response. 2) It kills affected cells. 3) It kills affected bone marrow. 4) It decreases tumor necrosis factor.

It kills affected cells. Dexamethasone is used to induce myeloma apoptosis and cell death and to reduce bone pain.

A client's absolute neutrophil count (ANC) is 440/mm3 but the nurse's assessment reveals no apparent signs or symptoms of infection. What action should the nurse prioritize when providing care for this client? 1) Timely administration of antibiotics 2) Meticulous hand hygiene 3) Maintaining a sterile care environment 4) Provision of a nutrient-dense diet

Meticulous hand hygiene Providing care for a client with neutropenia requires that the nurse adhere closely to standard precautions and infection control procedures. Hand hygiene is central to such efforts. Prophylactic antibiotics are rarely used and it is not possible to provide a sterile environment for care. Nutrition is highly beneficial, but hand hygiene is the central aspect of care.

An emergency department nurse is triaging a 77-year-old client who presents with uncharacteristic fatigue as well as back and rib pain. The client denies any recent injuries. The nurse should recognize the need for this client to be assessed for which health problem? 1) Multiple myeloma 2) Non-Hodgkin lymphoma 3) Acute thrombocythemia 4) Hodgkin disease

Multiple myeloma Explanation: Back pain, which is often a presenting symptom in multiple myeloma, should be closely investigated in older clients. The lymphomas and bleeding disorders do not typically present with the primary symptom of back pain or rib pain.

The nurse cares for an older adult client with unprovoked back pain and increased serum protein. Which hematologic neoplasm does the nurse suspect the client has? 1) Non-Hodgkin lymphoma 2) Chronic myeloid leukemia 3) Multiple myeloma 4) Hodgkin lymphoma

Multiple myeloma Any older adult with unprovoked or unexplained back pain and increased protein in the serum should be assessed for multiple myeloma. Bone pain occurs because of bone breakdown and the malignant cells of multiple myeloma increase the serum protein levels.

A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever? 1) Anemia 2) Neutropenia 3) Thrombocytopenia 4) Pancytopenia

Neutropenia Fever and infection result from a decrease in neutrophils (neutropenia). Decreased red blood cells (anemia) cause weakness, fatigue, dyspnea on exertion, and pallor in AML. Pancytopenia, an overall decrease in all blood components, is not cause of fever in clients with AML. Decreased platelet count (thrombocytopenia) causes petechiae and bruising in AML.

The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? 1) Osteolytic activating factor weakens bones producing fractures. 2) Osteoclasts break down bone cells so pathologic fractures occur. 3) Osteosarcomas form producing pathologic fractures. 4) Osteopathic tumors destroy bone causing fractures.

Osteoclasts break down bone cells so pathologic fractures occur The abnormal plasma cells proliferate in the bone marrow, where they release osteoclast-activating factor. This, in turn, causes osteoclasts to break down bone cells, resulting in increased blood calcium and pathologic fractures. The plasma cells also form single or multiple osteolytic (bone-destroying) tumors that produce a "punched-out" or "honeycombed" appearance in bones such as the spine, ribs, skull, pelvis, femurs, clavicles, and scapulae. Weakened vertebrae lead to compression of the spine accompanied by significant pain. The other options are distractors for this question.

A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client? 1) Sore tongue, dyspnea, and weight gain 2) Pallor, bradycardia, and reduced pulse pressure 3) Pallor, tachycardia, and a sore tongue 4) Angina pectoris, double vision, and anorexia

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.

Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? 1) Leukopenia 2) Thrombocytopenia 3) Anemia 4) Pancytopenia

Pancytopenia Pancytopenia may be congenital or acquired. Anemia refers to decreased red cell mass. Leukopenia refers to a less-than-normal amount of WBCs in circulation. Thrombocytopenia refers to a lower-than-normal platelet count.

The nurse is performing an assessment on a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae. What laboratory study should the nurse be concerned about? 1) Platelet count of 9,000/mm3 2) Hematocrit of 38% 3) WBC count of 4,200 cells/uL 4) Creatinine level of 1.0 mg/dL

Platelet count of 9,000/mm3 Complications of AML include bleeding and infection, which are the major causes of death. The risk of bleeding correlates with the level and duration of platelet deficiency (thrombocytopenia). The low platelet count can cause ecchymoses (bruises) and petechiae. Major hemorrhages also may develop when the platelet count drops to less than 10,000/mm3.

A pregnant woman is hospitalized as the result of sickle-cell crisis. Which finding indicates the outcome has been achieved for this client? 1) Exhibits a temperature more than 100.3°F 2) Describes the importance of staying cool 3) Reports joint pain less than 3 on a scale of 0 to 10 4) Takes hydroxyurea during her pregnancy

Reports joint pain less than 3 on a scale of 0 to 10 Explanation: An expected outcome for a client experiencing a sickle-cell crisis is control and reduction of pain. Hydroxyurea is contraindicated in pregnancy because of the risk it poses for congenital abnormalities. An indication that the client is free from infection is exhibiting a normal temperature; 100.3°F is an elevated temperature. To minimize crises, the client needs to stay warm not cool.

The nurse is assessing a patent with polycythemia vera. What skin assessment data would the nurse determine is a normal finding for this patient? 1) Pale skin and mucous membranes 2) Jaundice skin and sclera 3) Ruddy complexion 4) Bronze skin tone

Ruddy complexion Polycythemia vera (sometimes called P vera), or primary polycythemia, is a proliferative disorder of the myeloid stem cells. Patients typically have a ruddy complexion and splenomegaly.

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? 1) Schilling test 2) Bone marrow aspiration 3) Bone marrow biopsy 4) Magnetic resonance imaging (MRI) study

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).

A client has been living with a diagnosis of anemia for several years and has experienced recent declines in hemoglobin levels despite active treatment. Which assessment finding would signal complications of anemia? 1) Epistaxis and gastroesophageal reflux 2) Shortness of breath and peripheral edema 3) Fever and signs of hyperkalemia 4) Venous ulcers and visual disturbances

Shortness of breath and peripheral edema A significant complication of anemia is heart failure from chronic diminished blood volume and the heart's compensatory effort to increase cardiac output. Clients with anemia should be assessed for signs and symptoms of heart failure, including dyspnea and peripheral edema. None of the other listed signs and symptoms is characteristic of heart failure.

A client is prescribed 325 mg/day of oral ferrous sulfate. What does the nurse include in client teaching? 1) Decrease intake of dietary fiber 2) Take with dairy products 3) Decrease intake of fruits and juices 4) Take 1 hour before breakfast

Take 1 hour before breakfast Instructions the nurse will provide for the client taking oral ferrous sulfate is to administer the medication on an empty stomach. Instructions also include that there is decreased absorption of iron with food, particularly dairy products. The client is to increase vitamin C intake (fruits, juices, tomatoes, broccoli), which will enhance iron absorption. The client is to also increase foods high in fiber to decrease risk of constipation

The nurse's brief review of a client's electronic health record indicates that the client regularly undergoes therapeutic phlebotomy. Which of the following rationales for this procedure is most plausible? 1) The client may chronically produce excess red blood cells. 2) The client may previously have undergone bone marrow biopsy. 3) The client may have impaired stem cell function. 4) The client may frequently experience a low relative plasma volume.

The client may chronically produce excess red blood cells Persistently elevated hematocrit is an indication for therapeutic phlebotomy. It is not used to address excess or deficient plasma volume and is not related to stem cell function. Bone marrow biopsy is not an indication for therapeutic phlebotomy.

A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn's disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for? 1) The onset of a bacterial infection 2) Diarrhea 3) Bleeding 4) Abdominal pain

The onset of a bacterial infection Lymphopenia (a lymphocyte count less than 1,500/mm3) can result from ionizing radiation, long-term use of corticosteroids, uremia, infections (particularly viral infections), some neoplasms (e.g., breast and lung cancers, advanced Hodgkin disease), and some protein-losing enteropathies (in which the lymphocytes within the intestines are lost) (Kipps, 2010). When lymphopenia is mild, it is often without sequelae; when severe, it can result in bacterial infections (due to low B lymphocytes) or in opportunistic infections (due to low T lymphocytes).

A client is treated for anemia. What is the nurse's best understanding about the correlation between anemia and the client's iron stores? 1) There is a strong correlation between iron stores and hemoglobin characteristics. 2) There is a strong correlation between iron stores and hemoglobin levels. 3) There is a weak correlation between iron stores and hemoglobin levels. 4) There is an inverse relationship between iron stores and hemoglobin levels.

There is a strong correlation between iron stores and hemoglobin levels. A strong correlation exists between laboratory values that measure iron stores and hemoglobin levels. After iron stores are depleted (as reflected by low serum ferritin levels), the hemoglobin level falls.

A nurse on a hematology/oncology floor is caring for a client with aplastic anemia. Which would not be included in the client's discharge instructions? 1) Avoid contact with family/friends who are sick. 2) Plan for frequent periods of rest. 3) Use a disposable razor when shaving. 4) Encourage frequent handwashing.

Use a disposable razor when shaving. People with aplastic anemia usually have insufficient erythrocytes, leukocytes, and platelets. Encourage behaviors that will lower the risk for bleeding. Avoiding contact with people who are sick reduces the risk of acquiring an infection. Handwashing reduces the risk of acquiring an infection. Anemia can cause fatigue and shortness of breath with even mild exertion.

A nurse cares for clients with hematological disorders and notes that women are diagnosed with hemochromatosis at a much lower rate than men. What is the primary reason for this? 1) Women require grater folic acid supplementation 2) Women rarely manifest the gene expression 3) Women lose iron through menstrual cycles 4) Women have lower hemoglobin levels

Women lose iron through menstrual cycles Hemochromatosis is a genetic condition where excess iron is absorbed in the GI tract and deposited in various organs, making them dysfunctional. Women are often less affected than men because women lose excess iron through their menstrual cycles. The other answer choices are not correct reasons why women are impacted less than men with hemochromatosis.

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. 1) intestinal disorders 2) alcoholism 3) lack of meat consumption 4) lack of vitamin B

alcoholism intestinal disorders Older adults and clients with alcoholism, intestinal disorders that affect food absorption, malignant disorders, and chronic illnesses often have a folic acid deficiency because of poor nutrition.

An client has pernicious anemia and has been receiving treatment for several years. What is the client lacking that results in pernicious anemia? 1) hemoglobin 2) extrinsic factor 3) intrinsic factor 4) vitamin B

intrinsic factor Explanation: 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.

A client comes to the clinic reporting 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 client will be diagnosed? 1) Sickle cell disease 2) Hemolytic anemia 3) Pernicious anemia 4) Iron deficiency anemia

iron Deficiency Anemia A low serum iron level, a low ferritin level, and symptoms of pica are associated with iron deficiency anemia. TIBC may also be elevated. None of the other anemias are associated with pica.