Chapter 20: Patients with Hematologic Disorders 5-8

Hemochromatosis

A nurse is performing an initial assessment and notes the client's skin is a gray-tan color, especially on the scars of the client's arms. Which hematological condition does the nurse suspect? Hemochromatosis Polycythemia Thrombocytopenia Vitamin B12 deficiency

Risk for fatigue

A 50-year-old woman recently sought care from her primary care provider and was diagnosed with hypoproliferative anemia following a diagnostic workup. The nurse at the clinic has been charged with the responsibility for organizing the woman's care and is consequently creating a nursing care plan. When planning this woman's care, what nursing diagnosis should the nurse prioritize? Decreased cardiac output Risk for fatigue Acute pain Risk for hypothermia

B12

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? Iron Thiamine B12 Folate

Increase hydration. Administer allopurinol. Administer rasburicase.

After chemotherapy for AML, what interventions will best help to prevent renal complications? Select all that apply. Increase hydration. Administer allopurinol. Administer rasburicase. Administer potassium therapy. Encourage exercise.

"Chronic leukemia develops slowly."

The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? "Acute leukemia develops slowly." "In acute leukemia there are not many undifferentiated cells." "Chronic leukemia develops slowly." "In chronic leukemia, the minority of leukocytes are mature."

Bronzing of the skin

Which is a symptom of Cooley anemia? Inflammation of the mouth Inflammation of the tongue Bronzing of the skin Dyspnea

Pancytopenia

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

Pallor

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

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? It will remove the major site of red blood cell (RBC) destruction. It will reduce the destruction of platelets by macrophages. It will increase production of platelets by the bone marrow. It will increase red blood cell (RBC) production to compensate for blood loss.

Bone marrow analysis

A client is being tested for acute myeloid leukemia (AML). The nurse knows that which diagnostic test will be used as the hallmark for the diagnosis? Clotting factors Bone marrow analysis Complete blood count Alkaline phosphatase level

To closely monitor the rate of administration

A nurse is caring for a client with thalassemia who is being transfused. What is the nurse's role during a transfusion? To administer vitamin B12 injections To instruct the client to rest immediately if chest pain develops To closely monitor the rate of administration To assess for enlargement and tenderness over the liver and spleen

Excess of immature leukocytes

A nurse prepares a client for a bone marrow biopsy who is suspected of having acute myeloid leukemia. What results from the bone marrow biopsy does the nurse expect? Excess of immature erythrocytes Deficiency of neutrophils Deficiency of erythrocytes Excess of immature leukocytes

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? amount and quality of factor IX amount and quality of factor VIII quality of factor XI quality of factor VIII

Disposing of the blood container and tubing in biohazard waste.

The charge nurse should intervene when observing a new nurse perform which action after a client has suffered a possible hemolytic blood transfusion reaction? Notifying the blood bank of the reaction. Disposing of the blood container and tubing in biohazard waste. Informing the client to leave a urine sample after the client's next void. Documenting the reaction in the client's medical record.

Decreased MCV Decreased reticulocytes

The nurse cares for a client with iron deficiency anemia. What findings will the nurse expect to find when reviewing the client's CBC results? Select all that apply. Increased reticulocytes Decreased MCV Decreased reticulocytes Fragmented RBCs Increased MCV

Iron levels

The nurse is administering packed red blood cell (RBC) transfusions for a patient with myelodysplastic syndrome (MDS). The patient has had several transfusions and is likely to receive several more. What is a priority for the nurse to monitor related to the transfusions? Creatinine and blood urea nitrogen (BUN) levels Iron levels Magnesium levels Potassium levels

Verify the client's identity according to hospital policy

The physician orders a transfusion with packed red blood cells (RBCs) for a client hospitalized with severe iron deficiency anemia. When blood is administered, what is the most important action the nurse can take to prevent a transfusion reaction? Verify the client's identity according to hospital policy Administer the blood as soon as it arrives Premedicate the client with acetaminophen Assess the client 30 minutes after the start of the initial transfusion

Bronzing of the skin

Which is a symptom of hemochromatosis? Bronzing of the skin Inflammation of the mouth Inflammation of the tongue Weight gain

Bleeding gums Hematemesis Epistaxis

Which of the following are assessment findings associated with thrombocytopenia? Select all that apply. Hypertension Bleeding gums Bradypnea Hematemesis Epistaxis

Anemia

Which of the following is the most common hematologic condition affecting elderly patients Leukopenia Bandemia Thrombocytopenia Anemia

Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing.

Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia? Provide a clear liquid, low-sodium diet. Put on a mask, gown, and gloves when entering the client's room. Have the client use a soft toothbrush and electric razor, avoid using enemas, and watch for signs of bleeding. Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing.

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? Pernicious anemia Aplastic anemia Iron-deficiency anemia Agranulocytosis

hemoglobin S

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? hemoglobin F hemoglobin M hemoglobin A hemoglobin S

Assesses the hemoglobin level

A client in end-stage renal disease is prescribed epoetin alfa and oral iron supplements. Before administering the next dose of epoetin alfa and oral iron supplement, what is the priority action taken by the nurse? Questions the administration of both medications Ensures the client has completed dialysis treatment Holds the epoetin alfa if the BUN is elevated Assesses the hemoglobin level

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

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. Infection Blood loss Abnormal erythrocyte production Destruction of normally formed red blood cells Inadequate formed white blood cells

Type O

A client is in the hospital with a bleeding gastric ulcer and requires a blood transfusion. He has been typed and crossmatched for 2 units of packed red blood cells and found to have type O blood. What type of blood will the nurse administer to this client? Type B Type O Type A Type AB

Take 1 hour before breakfast

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

10,000/?l.

A client with idiopathic thrombocytopenic purpura (ITP) is admitted to an acute care facility. The nurse monitors the client's platelet count and observes closely for signs and symptoms of bleeding. The client is at greatest risk for cerebral hemorrhage when the platelet count falls below what number? 20,000/?l. 75,000/?l. 135,000/?l. 10,000/?l.

Serum calcium level 13.8 mg/dl

A client with multiple myeloma presents to the emergency department and reports excessive thirst and constipation. Family members report that the client has been confused for the last day. Which laboratory value is most likely responsible for this client's symptoms? Platelet count 300,000/mm3 Serum calcium level 13.8 mg/dl Serum sodium level of 133 mEq/L Hemoglobin of 9.8 g/dl

Checks the client's BUN and creatinine

A client with multiple myeloma reports pain along the spinal column. The client is prescribed naproxen (Aleve) and oxycodone. Prior to administering these medications, the nurse Instructs the client not to lift more than 20 pounds Teaches the client to bend at the back when lifting objects Questions the physician about the use of both medications Checks the client's BUN and creatinine

Monitoring the patient closely and administering antipyretics

The nurse has been monitoring a patient's vital signs closely after initiating a transfusion of packed red blood cells (PRBCs). The nurse has observed that the patient's temperature is trending upward, and the patient is complaining of chills. The nurse has stopped the transfusion and informed the patient's health care provider, who believes that the patient is experiencing a febrile nonhemolytic transfusion reaction (FNHTR). What course of action should the nurse anticipate? Administering a bolus of normal saline Monitoring the patient closely and administering antipyretics Initiating apheresis and administering IV antihistamines Performing a stat cross-match and beginning a transfusion of the correct blood type

The client is having a febrile nonhemolytic reaction.

The nurse is administering a blood transfusion to a client over 4 hours. After 2 hours, the client reports chills and has a fever of 101°F, an increase from a previous temperature of 99.2°F. What does the nurse recognize is occurring with this client? The client is having an allergic reaction to the blood. The client is experiencing vascular collapse. The client is having decrease in tissue perfusion from a shock state. The client is having a febrile nonhemolytic reaction.

splenomegaly

The nurse is assessing a client admitted with a deep vein thrombosis with an elevated red blood cell count. The admitting diagnosis is polycythemia vera. What is the hallmark clinical sign of PV? splenomegaly weight gain peripheral edema pale body color

Megaloblastic anemia

The nurse is assessing a patient who is a strict vegetarian. What type of anemia is the nurse aware that this patient is at risk for? Iron deficiency anemia Aplastic anemia Megaloblastic anemia Sickle cell anemia

Allopurinol

The nurse is caring for a client with acute myeloid leukemia (AML) with high uric acid levels. What medication does the nurse anticipate administering that will prevent crystallization of uric acid and stone formation? Filgrastim Hydroxyurea Allopurinol Asparaginase

Abdominal pain

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? Fatigue Weakness Abdominal pain Glucose intolerance

Enlarged spleen Body mass index 33 Received erythropoietin injections History of receiving blood transfusions

The nurse is caring for a client with erythematous fingers and renal calculi. Which assessment findings help determine if the client is experiencing polycythemia vera? Select all that apply. Enlarged spleen Body mass index 33 Difficulty swallowing Received erythropoietin injections History of receiving blood transfusions

Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI

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? Impaired tissue integrity Activity intolerance Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI Impaired oral mucous membranes

Disconnect the blood tubing, flush with normal saline, and administer morphine.

A client receiving a unit of packed red blood cells (PRBCs) has been prescribed morphine 1 mg intravenously now for pain. What is the best method for the nurse to administer the morphine? Inject the morphine into a distal port on the blood tubing. Administer the morphine into the closest tubing port to the client for fast delivery. Disconnect the blood tubing, flush with normal saline, and administer morphine. Add the morphine to the blood to be slowly administered.

"Every unit of donated blood is typed and tested for antibodies to infections."

A client verbalizes fear of infection from a blood transfusion. What is the nurse's best response? "The risk of transmission of HIV is so low, there's no need to worry." "Blood typing is more important than testing for infection." "There is no need for testing unless you have a history of a transfusion reaction." "Every unit of donated blood is typed and tested for antibodies to infections."

Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints.

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? Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints. Ask if taking a blood pressure has ever produced pain in the upper arm. Ask if taking a blood pressure has ever caused bruising in the hand and wrist. Ask if taking a blood pressure has ever produced the need for medication.

"I will need to come every week for treatment."

Which statement indicates the client understands teaching about induction therapy for leukemia? "I will start slowly with medication treatment." "I will need to come every week for treatment." "I will be in the hospital for several weeks." "I know I can never be cured."

Start an intravenous line with dextrose 5% in 0.25 normal saline

A patient with sickle cell disease comes to the emergency department and reports severe pain in the back, right hip, and right arm. What intervention is important for the nurse to provide? Start an intravenous line with dextrose 5% in 0.25 normal saline Administer ibuprofen Administer aspirin Begin oxygen at 2 L/M

Patients with leukemia often experience clinical changes that may be subtle and nonspecific.

The nurse has completed a plan of care for a patient who has been hospitalized for the treatment of acute leukemia. When planning this patient's care, the nurse has specified that assessments be performed more often than is the unit norm. Frequent, thorough assessments are indicated in the treatment of patients with acute leukemia because: Leukemia has characteristics of chronic diseases as well as acute illnesses. Patients with leukemia are often unable to accurately describe their symptoms. Patients with leukemia often experience clinical changes that may be subtle and nonspecific. Changes in condition must be identified early because treatment options do not normally exist.

Blood loss from the gastrointestinal or genitourinary tract

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? Decrease in the total body iron stores with age Excessive consumption of coffee or tea Blood loss from the gastrointestinal or genitourinary tract Elimination of iron by the body

Educate the family about medications and side effects. Allow family members to express feelings. Suggest support for household maintenance.

The nurse is interacting with a family that has been caring for a client with cancer for several months. What are the best interventions to assist in relieving caregiver stress in this family? Select all that apply. Educate the family about medications and side effects. Allow family members to express feelings. Suggest support for household maintenance. Suggest the prescription of antianxiety medications. Suggest the family go to church more often.

Schilling test

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? Schilling test Bone marrow biopsy Magnetic resonance imaging (MRI) study Bone marrow aspiration

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? Lymphadenopathy Bone pain Fatigue and activity intolerance Recurrent infections

Administer factor VIII intravenously at the first sign of bleeding

The nurse is talking with the parents of a toddler who was diagnosed with hemophilia A. What instruction should the nurse give to the parents? Encourage the toddler to participate in playground activities with other toddlers Administer over-the-counter preparations for a cold Administer factor VIII intravenously at the first sign of bleeding Use nasal packing for any nose bleeds

Aluminum hydroxide

A client being treated for iron deficiency anemia with ferrous sulfate continues to be anemic despite treatment. The nurse should assess the client for use of which medication? Amoxicillin Aluminum hydroxide Prednisone Tegretol

Osteoporosis

A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. The client is taking prednisone daily and reported feeling pain after manually opening the garage door. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain? Muscle wasting Truncal obesity Hypertension Osteoporosis

5 mL

A nurse is preparing a dose of furosemide for an older adult with heart failure. The health care provider orders furosemide 1 mg/kg to be given intravenously. The client weighs 50 kg. The concentration of the drug is 40 mg/4mL (10 mg/mL). How many milliliters would the nurse administer? Record your answer using a whole number. 5 mL

Use a disposable razor when shaving.

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? Plan for frequent periods of rest. Avoid contact with family/friends who are sick. Encourage frequent handwashing. Use a disposable razor when shaving.

Pallor of the mucous membranes Palpitations Tachypnea Dizziness

A person who becomes gradually anemic can adjust to reduced levels of hemoglobin over time. However, as the hemoglobin count drops below 8 g/dL, the nurse needs to assess for the following indicators of serious complications. Select all that apply. Pallor of the mucous membranes Palpitations Hypertension Tachypnea Bradycardia Dizziness

Cervical

A nurse cares for a client with early Hodgkin lymphoma. While assessing the client, the nurse will most likely find painless enlargement of which lymph node? Axillary Cervical Inguinal Popliteal

Evaluate the client's platelet count.

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

Risk for falls

A client with multiple myeloma reports severe paresthesia in the feet. When planning care for the client, which priority nursing diagnosis will the nurse choose? Impaired tissue integrity Acute pain Risk for falls Sensory-perception disturbance

The dead red blood cells release excess uric acid.

A client with polycythemia vera reports gouty arthritis symptoms in the toes and fingers. What is the nurse's best understanding of the pathophysiological reason for this symptom? The dead red blood cells release excess uric acid. Excess red blood cells cause vascular injury in the joints. The dead red blood cells occlude the small vessels in the joints. Excess red blood cells produce extracellular toxins that build up.

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? There could be decreased production of platelets There could be an attack on the platelets by the antibodies There could be decreased white blood cell production. There could be elevated platelet production.