Chapter 29

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? A. Meticulous hand hygiene B. Timely administration of antibiotics C. Provision of a nutrient-dense diet D. Maintaining a sterile care environment

A. Meticulous hand hygiene

A client with acute kidney injury has decreased erythropoietin production. Upon analysis of the client's complete blood count, the nurse will expect which of the following results? A. An increased hemoglobin and decreased hematocrit B. A decreased hemoglobin and hematocrit C. A decreased mean corpuscular volume (MCV) and red cell distribution width (RDW) D. An increased mean corpuscular volume (MCV) and red cell distribution width (RDW)

B. A decreased hemoglobin and hematocrit

A client is admitted to the hospital with pernicious anemia. The nurse should prepare to administer which of the following medications? A. Folic acid B. Vitamin B12 C. Lactulose D. Magnesium sulfate

B. Vitamin B12

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? A. Calcium carbonate B. Vitamin B12 C. Aspirin D. Vitamin D

C. Aspirin

A client comes into the clinic reporting fatigue. Blood work shows an increased bilirubin concentration and an increased reticulocyte count. Which condition should the nurse most suspect the client has? A. A hypoproliferative anemia B. A leukemia C. Thrombocytopenia D. A hemolytic anemia

D. A hemolytic anemia

A patient with neutropenia is at an increased risk for __________, which increases proportionately with the decrease in the neutrophil count.

Infection

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

A. "Transfused platelets usually aren't beneficial because they're rapidly destroyed in the body."

The results of a client's most recent blood work and physical assessment are suggestive of immune thrombocytopenic purpura (ITP). This client should undergo testing for which of the following potential causes? Select all that apply. A. Hepatitis B. Acute kidney injury C. HIV D. Malignant melanoma E. Cholecystitis

A. Hepatitis C. HIV

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? A. Iron deficiency anemia B. Pernicious anemia C. Sickle cell disease D. Hemolytic anemia

A. Iron deficiency anemia

A client with a history of cirrhosis is admitted to the ICU with a diagnosis of bleeding esophageal varices; an attempt to stop the bleeding has been only partially successful. What would the critical care nurse expect the care team to prescribe for this client? A. Packed red blood cells (PRBCs) B. Vitamin K C. Oral anticoagulants D. Heparin infusion

A. Packed red blood cells (PRBCs)

A client with a documented history of glucose-6-phosphate dehydrogenase deficiency has presented to the emergency department with signs and symptoms including pallor, jaundice, and malaise. Which of the nurse's assessment questions relates most directly to this client's hematologic disorder? A. "When did you last have a blood transfusion?" B. "What medications have you taken recently?" C. "Have you been under significant stress lately?" D. "Have you suffered any recent injuries?"

B. "What medications have you taken recently?"

A group of nurses are learning about the high incidence and prevalence of anemia among different populations. Which individual is most likely to have anemia? A. A 50-year-old black woman who is going through menopause B. An 81-year-old woman who has chronic heart failure C. A 48-year-old man who travels extensively and has a high-stress job D. A 13-year-old girl who has just experienced menarche

B. An 81-year-old woman who has chronic heart failure

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? A. Avoiding buses, subways, and other crowded, public sites B. Avoiding activities that carry a risk for injury C. Keeping immunizations current D. Avoiding foods high in vitamin K

B. Avoiding activities that carry a risk for injury

A night nurse is reviewing the next day's medication administration record (MAR) of a hospital client who has hemophilia. The nurse notes that the MAR specifies both oral and subcutaneous options for the administration of a PRN antiemetic. What is the nurse's best action? A. Ensure that the day nurse knows not to give the antiemetic. B. Contact the prescriber to have the subcutaneous option discontinued. C. Reassess the client's need for antiemetics. D. Remove the subcutaneous route from the client's MAR.

B. Contact the prescriber to have the subcutaneous option discontinued.

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? A. An attack on the platelets by antibodies B. Decreased production of platelets C. Impaired communication between platelets D. An autoimmune process causing platelet malfunction

B. Decreased production of platelets

A client with sickle cell disease is taking narcotic analgesics for pain control. Which intervention by the nurse would decrease the risk for narcotic substance abuse? A. Encourage the client to rely on complementary and alternative therapies. B. Encourage the client to seek care from a single provider for pain relief. C. Teach the client to accept chronic pain as an inevitable aspect of the disease. D. Limit the reporting of emergency department visits to the primary health care provider.

B. Encourage the client to seek care from a single provider for pain relief.

A client's electronic health record notes that the client has previously undergone treatment for secondary polycythemia. The nurse should assess for which factor? A. Recent blood donation B. Evidence of lung disease C. A history of venous thromboembolism D. Impaired renal function

B. Evidence of lung disease

A client's blood work reveals a platelet level of 17,000/mm3. When inspecting the client's integumentary system, what finding would be most consistent with this platelet level? A. Dermatitis B. Petechiae C. Urticaria D. Alopecia

B. Petechiae

A woman who is in her third trimester of pregnancy has been experiencing an exacerbation of iron-deficiency anemia in recent weeks. When providing the client with nutritional guidelines and meal suggestions, what foods would be most likely to increase the woman's iron stores? A. Salmon accompanied by whole milk B. Mixed vegetables and brown rice C. Beef liver accompanied by orange juice D. Yogurt, almonds, and whole grain oats

C. Beef liver accompanied by orange juice

A nurse in a long-term care facility is admitting a new resident who has a bleeding disorder. When planning this resident's care, the nurse should include which action? A. Housing the resident in a private room B. Implementing a passive ROM program C. Implementing of a plan for fall prevention D. Providing the client with a high-fiber diet

C. Implementing of a plan for fall prevention

The nurse on the pediatric unit is caring for a 10-year-old child with a diagnosis of hemophilia. The nurse should assess carefully for indication of what nursing diagnosis? A. Hypothermia B. Diarrhea C. Ineffective coping D. Imbalanced nutrition: Less than body requirements

C. Ineffective coping

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? A. Risk for disuse syndrome related to ineffective peripheral circulation B. Functional urinary incontinence related to urethral occlusion C. Ineffective tissue perfusion related to thrombosis D. Ineffective thermoregulation related to hypothalamic dysfunction

C. Ineffective tissue perfusion related to thrombosis

A nurse is providing education to a client with iron deficiency anemia who has been prescribed iron supplements. What should the nurse include in health education? A. Take the iron with dairy products to enhance absorption. B. Increase the intake of vitamin E to enhance absorption. C. Iron will cause the stools to darken in color. D. Limit foods high in fiber due to the risk for diarrhea.

C. Iron will cause the stools to darken in color.

The nurse is assessing a new client with reports of acute fatigue and a sore tongue that is visibly smooth and beefy red. This client is demonstrating signs and symptoms associated with what form of hematologic disorder? A. Sickle cell disease B. Hemophilia C. Megaloblastic anemia D. Thrombocytopenia

C. Megaloblastic anemia

A young man with a diagnosis of hemophilia A has been brought to emergency department after suffering a workplace accident resulting in bleeding. Rapid assessment has revealed the source of the client's bleeding and established that his vital signs are stable. What should be the nurse's next action? A. Position the client in a prone position to minimize bleeding. B. Establish IV access for the administration of vitamin K. C. Prepare for the administration of factor VIII. D. Administer a normal saline bolus to increase circulatory volume.

C. Prepare for the administration of factor VIII.

A nurse is admitting a client with immune thrombocytopenic purpura to the unit. In completing the admission assessment, the nurse must be alert for what medications that potentially alter platelet function? Select all that apply. A. Antihypertensives B. Penicillins C. Sulfa-containing medications D. Aspirin-based drugs E. NSAIDs

C. Sulfa-containing medications D. Aspirin-based drugs E. NSAIDs

A client with a history of atrial fibrillation has contacted the clinic reporting an accidental overdose on prescribed warfarin. The nurse should recognize the possible need for which antidote? A. Intravenous immunoglobulins (IVIG) B. Factor IX C. Vitamin K D. Factor VIII

C. Vitamin K

Disseminated intravascular coagulation (DIC) is characterized by a process of inflammation and _______________ within the vasculature.

Coagulation

An intensive care nurse is aware of the need to identify clients who may be at risk of developing disseminated intravascular coagulation (DIC). Which ICU client most likely faces the highest risk of DIC? A. A client with extensive burns B. A client who has a diagnosis of acute respiratory distress syndrome C. A client who suffered multiple trauma in a workplace accident D. A client who is being treated for septic shock

D. A client who is being treated for septic shock

When teaching a client with sickle cell disease about strategies to prevent crises, what measures should the nurse recommend? A. Using prophylactic antibiotics and performing meticulous hygiene B. Maximizing physical activity and taking OTC iron supplements C. Limiting psychosocial stress and eating a high-protein diet D. Avoiding cold temperatures and ensuring sufficient hydration

D. Avoiding cold temperatures and ensuring sufficient hydration

An adult client has been diagnosed with iron-deficiency anemia. What nursing diagnosis is most likely to apply to this client's health status? A. Risk for deficient fluid volume related to impaired erythropoiesis B. Risk for infection related to tissue hypoxia C. Acute pain related to uncontrolled hemolysis D. Fatigue related to decreased oxygen-carrying capacity

D. Fatigue related to decreased oxygen-carrying capacity

A 25-year-old client comes to the emergency department with excessive bleeding from a cut sustained when cleaning a knife. Blood work shows a prolonged prothrombin time (PT), but a vitamin K deficiency is ruled out. When assessing the client, areas of ecchymosis are noted on other areas of the body. Which of the following is the most plausible cause of the client's signs and symptoms? A. Lymphoma B. Leukemia C. Hemophilia D. Hepatic dysfunction

D. Hepatic dysfunction

A client is being treated on the medical unit for a sickle cell crisis. The nurse's most recent assessment reveals a fever and a new onset of fine crackles on lung auscultation. Which action by the nurse would be the most appropriate? A. Apply supplementary oxygen by nasal cannula. B. Administer bronchodilators by nebulizer. C. Liaise with the respiratory therapist and consider high-flow oxygen. D. Inform the health care provider that the client may have an infection.

D. Inform the health care provider that the client may have an infection.

A nurse is planning the care of a client who has a diagnosis of hemophilia A. When addressing the nursing diagnosis of Acute Pain Related to Joint Hemorrhage, what principle should guide the nurse's choice of interventions? A. Gabapentin (Neurontin) is effective because of the neuropathic nature of the client's pain. B. Opioids partially inhibit the client's synthesis of clotting factors. C. Opioids may cause vasodilation and exacerbate bleeding. D. NSAIDs are contraindicated due to the risk for bleeding.

D. NSAIDs are contraindicated due to the risk for bleeding.

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? A. Venous ulcers and visual disturbances B. Fever and signs of hyperkalemia C. Epistaxis and gastroesophageal reflux D. Shortness of breath and peripheral edema

D. Shortness of breath and peripheral edema

A critical care nurse is caring for a client with immune hemolytic anemia. The client is not responding to conservative treatments, and the client's condition is now becoming life-threatening. The nurse is aware that a treatment option in this case may include which intervention? A. Hepatectomy B. Vitamin K administration C. Platelet transfusion D. Splenectomy

D. Splenectomy

A client with von Willebrand disease (vWD) has experienced recent changes in bowel function that suggest the need for a screening colonoscopy. What intervention should be performed in anticipation of this procedure? A. The client should not undergo the normal bowel cleansing protocol prior to the procedure. B. The client should receive a unit of fresh-frozen plasma 48 hours before the procedure. C. The client should be admitted to the surgical unit on the day before the procedure. D. The client should be given necessary clotting factors before the procedure.

D. The client should be given necessary clotting factors before the procedure.

In hypoproliferative anemias, premature destruction of erythrocytes results in the liberation of hemoglobin from the erythrocytes into the plasma.

FALSE

The most common symptom and complication of anemia is _________, which has the greatest negative impact on a patient's level of functioning.

Fatigue

____________________ is a genetic condition in which excess iron, absorbed from the GI tract, is deposited in various body organs.

Hemochromatosis

Patients with __________ anemia develop a smooth sore red tongue.

Pernicious

Anemia is the most common hematologic condition affecting older adults, particularly those admitted to hospitals or those in long-term care facilities.

TRUE

Iron deficiency anemia, the most common type of anemia in all age groups, also is the most common anemia in the world.

TRUE

Secondary polycythemia is caused by excessive production of erythropoietin.

TRUE

The patient with sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear.

TRUE