Chapter 30 - Hematologic System

The complete blood count (CBC) indicates that a patient is thrombocytopenic. Which action should the nurse include in the plan of care? a. Avoid intramuscular injections. b. Encourage increased oral fluids. c. Check temperature every 4 hours. d. Increase intake of iron-rich foods.

ANS: A Thrombocytopenia is a decreased number of platelets, which places the patient at high risk for bleeding. Neutropenic patients are at high risk for infection and sepsis and should be monitored frequently for signs of infection. Encouraging fluid intake and iron-rich food intake is not indicated in a patient with thrombocytopenia

A patient's complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding? a. "Have you had a recent weight loss?" b. "Do you have any history of lung disease?" c. "Have you noticed any dark or bloody stools?" d. "What is your dietary intake of meats and protein?"

ANS: B The hemoglobin and hematocrit results indicate polycythemia, which can be associated with chronic obstructive pulmonary disease (COPD). The other questions would be appropriate for patients who are anemic

The nurse assesses a patient with pernicious anemia. Which assessment finding would the nurse expect? a. Yellow-tinged sclerae b. Shiny, smooth tongue c. Numbness of the extremities d. Gum bleeding and tenderness

ANS: C Extremity numbness is associated with cobalamin (vitamin B12) deficiency or pernicious anemia. Loss of the papillae of the tongue occurs with chronic iron deficiency. Yellow-tinged sclera is associated with hemolytic anemia and the resulting jaundice. Gum bleeding and tenderness occur with thrombocytopenia or neutropenia

A patient who had a total hip replacement had an intraoperative hemorrhage 14 hours ago. Which laboratory result would the nurse expect to find? a. Hematocrit of 46% b. Hemoglobin of 13.8 g/dL c. Elevated reticulocyte count d. Decreased white blood cell (WBC) count

ANS: C Hemorrhage causes the release of reticulocytes (immature red blood cells) from the bone marrow into circulation. The hematocrit and hemoglobin levels are normal. The WBC count is not affected by bleeding

The health care provider's progress note for a patient states that the complete blood count (CBC) shows a "shift to the left." Which assessment finding will the nurse expect? a. Cool extremities b. Pallor and weakness c. Elevated temperature d. Low oxygen saturation

ANS: C The term shift to the left indicates that the number of immature polymorphonuclear neutrophils (bands) is elevated and that finding is a sign of infection. There is no indication that the patient is at risk for hypoxemia, pallor/weakness, or cool extremities

A nurse reviews the laboratory data for an older patient. The nurse would be most concerned about which finding? a. Hematocrit of 35% b. Hemoglobin of 11.8 g/dL c. Platelet count of 400,000/µL d. White blood cell (WBC) count of 2800/µL

ANS: D Because the total WBC count is not usually affected by aging, the low WBC count in this patient would indicate that the patient's immune function may be compromised and the underlying cause of the problem needs to be investigated. The platelet count is normal. The slight decrease in hemoglobin and hematocrit are not unusual for an older patient

When assessing a newly admitted patient, the nurse notes pallor of the skin and nail beds. The nurse should ensure that which laboratory test has been ordered? a. Platelet count b. Neutrophil count c. White blood cell count d. Hemoglobin (Hgb) level

ANS: D Pallor of the skin or nail beds is indicative of anemia, which would be indicated by a low Hgb level. Platelet counts indicate a person's clotting ability. A neutrophil is a type of white blood cell that helps to fight infection

The nurse is caring for a patient who is being discharged after an emergency splenectomy following an automobile accident. Which instructions should the nurse include in the discharge teaching? a. Watch for excess bruising. b. Check for swollen lymph nodes. c. Take iron supplements to prevent anemia. d. Wash hands and avoid persons who are ill.

ANS: D Splenectomy increases the risk for infection, especially with gram-positive bacteria. The risks for lymphedema, bleeding, and anemia are not increased after a person has a splenectomy

The nurse reviews the complete blood count (CBC) and white blood cell (WBC) differential of a patient admitted with abdominal pain. Which information will be most important for the nurse to communicate to the health care provider? a. Monocytes 4% b. Hemoglobin 13.6 g/dL c. Platelet count 168,000/µL d. White blood cells (WBCs) 15,500/µL

ANS: D The elevation in WBCs indicates that the patient has an inflammatory or infectious process ongoing, which may be the cause of the patient's pain, and that further diagnostic testing is needed. The monocytes are at a normal level. The hemoglobin and platelet counts are normal

The nurse recalls that the role of folic acid in erythropoiesis is what? A. Aids in absorption of iron B. Promotes RBC maturation C. Promotes hemoglobin synthesis D. Aids in mobilization of iron from tissue to plasma

B Folic acid promotes the maturation of red blood cells (RBC). Ascorbic acid aids in the absorption of iron. Iron and pyridoxine promote hemoglobin synthesis. Copper helps in the mobilization of iron from tissue to plasma.

Which finding supports the nurse's conclusion that a patient has pernicious anemia? Bleeding of the gums Smooth, beefy-red tongue Spoon-shaped concave nails Fissures in corners of the mouth

B Pernicious anemia is characterized by the presence of a smooth, beefy-red tongue, and abdominal pain. Platelet function is reduced in the patient with leukemia; therefore, bleeding from the gums is associated with leukemia. The presence of spoon-shaped, concave nails and fissures in the corners of the mouth is associated with iron deficiency anemia.

The nurse recalls that which condition is characterized by the presence of a high percentage of Hgb S in the erythrocytes? A. Thalassemia B. Aplastic anemia C. Sickle cell disease D. Acquired hemolytic anemia

C

The nurse prepares to administer a unit of fresh frozen plasma to a patient and notes that it contains what quantity? 1 60 mL 2 250 mL 3 350 mL 4 400 mL

Correct2 One unit contains approximately 250 mL of fresh frozen plasma.

A patient with non-Hodgkin's lymphoma asked the nurse why a lumbar puncture has been prescribed. What rationale should the nurse give? 1 It helps establish cell type. 2 It helps establish cell pattern. 3 It helps rule out bone marrow infiltration. 4 It helps rule out central nervous system involvement.

Correct4 A lumbar puncture is performed in a patient with lymphoma to rule out CNS involvement. A lymph node excisional biopsy is used to establish cell type and cell pattern. Magnetic resonance imaging is used to rule out bone marrow infiltration.

The nurse recognizes that which diagnostic study is helpful in determining the clinical stage of Hodgkin's lymphoma? 1 Barium enema 2 Upper endoscopy 3 Magnetic resonance imaging (MRI) 4 Positron emission tomography (PET) with CT scan

Correct4 Positron emission tomography (PET) with CT scan Positron emission tomography (PET) with CT is helpful to define all sites and determine the clinical stage of Hodgkin's lymphoma. Barium enemas and upper endoscopies are used to diagnose any suspected gastrointestinal involvement in non-Hodgkin's lymphoma. MRI scans are used to rule out central nervous system or bone marrow infiltration.

The nurse recalls that which condition may cause patient anemia due to decreased hemoglobin synthesis? Leukemia Iron deficiency Cobalamin deficiency G6PD enzyme deficiency

Iron

The nurse reviews the blood test reports of four patients and determines that which patient is most likely to have an increased heart rate? 1 Patient A 2 Patient B 3 Patient C 4 Patient D

Correct2 Hemoglobin content of less than 60 g/dL indicates severe anemia, which can result in tachycardia, or increased heart rate. Patient B is showing symptoms of tachycardia and increased pulse pressure. Patient A has a hemoglobin content between 60 and 100 g/dL, which indicates moderate anemia but is not associated with an increased heart rate. Patients C and D have a hemoglobin content between 100 and 120 g/dL, which indicates mild anemia.

A patient experiences thrombocytopenia. The nurse should monitor the patient for which major complication? 1 Fatigue 2 Weakness 3 Hemorrhage 4 Abdominal pain

Correct3 The major complication of thrombocytopenia is hemorrhage. This occurs due to a decreased number of platelets in blood, which results in excessive bleeding. Fatigue, weakness, and abdominal pain are minor complications of thrombocytopenia.

The nurse recognizes that the events associated with the development of disseminated intravascular coagulation (DIC) occur in what order? Correct 1. Thrombolytic occlusion of microcirculation of all organs Correct 2. Fibrinolysis in the microcirculation Correct 3. Circulation of fibrin degradation products Correct 4. Consumption of platelets and coagulation proteins

Circulating thrombi causes thrombolytic occlusion of microcirculation of all organs. This is followed by fibrinolysis in the microcirculation. The products of fibrinolysis, that is fibrin degradation products, enter the circulation. Finally, consumption of platelets and coagulation proteins results in bleeding.

The nurse recognizes that which medication may benefit a patient with immune thrombocytopenic purpura (ITP) by increasing the platelet production? 1 Danazol 2 Eltrombopag 3 Tranexamic acid 4 Desmopressin acetate

Correct2 Eltrombopag is a thrombopoietin receptor agonist that acts by increasing platelet production. Danazol is an androgen that acts by increasing CD4+T cells. Tranexamic acid is an antifibrinolytic drug that acts by inhibiting plasminogen activation in the fibrin clot. Desmopressin acetate is a synthetic analog of vasopressin that acts on platelets and endothelial cells to release von Willebrand factor (vWF). Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer.

The nurse recalls that the standard of care for pain includes what component? 1 That the pain assessment is based on nursing judgment 2 The minimal amount of intervention required to address pain 3 That competent and compassionate care is provided to all patients 4 Notifying the health care provider regarding the effects of the pain medication

Correct3 The standard of care for pain includes providing competent and compassionate care for all patients. The patient's pain assessment is not based on nursing judgment

The nurse is reviewing the lab reports of several patients. Which report is consistent with a diagnosis of thrombocytopenia? 1 Hemoglobin 13 2 Hemoglobin 16 3 Platelets 20,000/µL 4 Platelets 1,000,000/ µL

Correct3 Thrombocytopenia means there are low levels of circulating platelets. A platelet count below 150,000/ µL is considered low. As such, a platelet count of 20,000/µL is consistent with a diagnosis of thrombocytopenia. A normal hemoglobin level is 12-17 g/dL depending on the sex of the patient. Hemoglobin levels of 13 g/dL and 16 g/dL are normal.

The nurse reviews documentation of assessment findings of a patient with severe anemia. The nurse should question which assessment finding? 1 Pallor 2 Pruritus 3 Jaundice 4 Hyperpigmentation

Correct4 Common integumentary changes observed in anemia include pallor, jaundice, and pruritus. Pallor results from reduced amounts of hemoglobin and reduced blood flow to the skin. Jaundice occurs when hemolysis of RBCs results in an increased concentration of serum bilirubin. Pruritus occurs because of increased serum and skin bile salt concentration. Hyperpigmentation is usually not associated with anemia.

The nurse recognizes that patients with von Willebrand disease are at risk for prolonged bleeding times for what reason? 1 Adequate platelet production 2 Deficiency in intrinsic clotting system factor 3 Impairment of thrombin fibrinogen reaction 4 Variable factor VIII deficiencies and platelet dysfunction

Correct4 Von Willebrand disease is characterized by a deficiency of the von Willebrand coagulation protein and variable factor VIII deficiencies and platelet dysfunction. Therefore the bleeding time is prolonged in the patient with von Willebrand disease. Adequate platelet production does not alter the normal bleeding time in a patient. Deficiency in intrinsic clotting system factor will alter the PTT. Impairment of thrombin fibrinogen reaction alters the thrombin time.

A patient's laboratory reports show a low mean corpuscular volume (MCV) and a high reticulocyte count. The nurse suspects which condition? Thalassemia Hemolytic anemia Sickle cell anemia Folic acid deficiency

Thalassemia In thalassemia, a low mean corpuscular volume and a high reticulocyte count are observed. In sickle cell anemia, a normal MCV and low reticulocyte count are seen. In hemolytic anemia, a normal MCV and increased reticulocytes are found. An increased MCV and normal or low reticulocyte count occur due to a folic acid deficiency.

The nurse identifies that the stages of chemotherapy for the treatment of leukemia are administered in what order? Correct 1. Induction therapy Correct 2. Intensification therapy Correct 3. Consolidation therapy Correct 4. Maintenance therapy

The first stage of chemotherapy is induction therapy, which involves treatment with high doses of drugs to attain remission. The second stage of chemotherapy is intensification therapy. This involves an increase in the dose of drugs given during the induction phase. The next stage of chemotherapy is consolidation, aimed at removing the tumor cells, which are clinically and pathologically not evident. The final stage of chemotherapy is maintenance therapy, which involves treatment with low doses of drugs every three to four weeks for a prolonged period.

A patient is in the early stage of Hodgkin's lymphoma. What chemotherapeutic agent does the oncology nurse anticipate administering? 1 Rituximab 2 Bleomycin 3 Vincristine 4 Fludarabine

Correct2 Bleomycin is one of the medications included in a standard chemotherapy regimen to treat early stage Hodgkin's lymphoma. Rituximab, vincristine, and fludarabine are chemotherapy drugs used to treat non-Hodgkin's lymphoma.

The nurse reviews the laboratory test results for a patient with upper gastrointestinal bleeding and notes that the hemoglobin level is 8.7 g/dL and the hematocrit is 26%. The nurse should place highest priority on initiating interventions that will reduce which symptom? 1 Nausea 2 Dizziness 3 Headache 4 Constipation

Correct2 The patient with a low hemoglobin and hematocrit (normal values 13.5% to 17% and 40% to 54%, respectively, for males) is anemic and would be most likely to experience fatigue and dizziness. This symptom develops because of the lowered oxygen-carrying capacity that leads to reduced tissue oxygenation to carry out cellular functions. Constipation, nausea, and headache are not associated with decreased hemoglobin and hematocrit levels. Test-Taking Tip: Pace yourself while taking a quiz or exam. Read the entire question and all answer choices before answering the question. Do not assume that you know what the question is asking without reading it entirely.

To prepare for a patient's transfusion of packed red blood cells, the nurse should select which intravenous solution to use for the procedure? 1 3% normal saline 2 Lactated Ringer's 3 5% dextrose in water 4 0.9% normal saline

Correct4 The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It is also used to flush the blood tubing after the infusion is complete to ensure the patient receives blood that is left in the tubing when the bag is empty. Lactated Ringer's, 5% dextrose in water, and 3% normal saline are not compatible with blood products.

The nurse assesses a patient with pernicious anemia and expects to find what classic sign of this condition? 1 Diarrhea 2 Indigestion 3 Flushed skin 4 Red, beefy tongue

Correct4 The decreased absorption of vitamin B12 resulting from a lack of intrinsic factor causes a decrease in hemoglobin, hematocrit, and red blood cells. A smooth, red, enlarged or "beefy" appearance of the tongue may also be seen. Intrinsic factor is produced by the parietal cells of the stomach lining and is required to absorb vitamin B12 from the intestines. Causes of decreased intrinsic factor production include surgical alterations such as gastrectomy and autoimmune disease. Diarrhea, indigestion, and flushed skin appearance are not signs specifically associated with pernicious anemia.

A patient who is at risk for disseminated intravascular coagulation (DIC) experiences shortness of breath and increased heart rate. The nurse expects what other symptoms that indicate thrombotic manifestations? Select all that apply. 1 Cyanosis 2 Dizziness 3 Joint pains 4 Vision changes 5 Abdominal pain

Correct 1, 5 A patient with disseminated intravascular coagulation (DIC) disorder may show thrombotic manifestations due to fibrin or platelet deposition in the microvasculature. Thrombotic manifestations include shortness of breath and an increase in heart rate, which are called dyspnea and tachycardia, respectively. The other thrombotic manifestations include cyanosis and abdominal pain. Dizziness, joint pains, and vision changes are manifestations of bleeding that occur due to depletion of platelets and coagulation factors.

The nurse recognizes that which type of leukemia is characterized by the proliferation of immature small lymphocytes in the bone marrow? 1 Acute lymphocytic leukemia (ALL) 2 Acute myelogenous leukemia (AML) 3 Chronic lymphocytic leukemia (CLL) 4 Chronic myelogenous leukemia (CML)

A Acute lymphocytic leukemia is characterized by the presence of an excessive number of immature small lymphocytes in the bone marrow. Acute myelogenous leukemia is characterized by an increase in the number of myeloblasts. Chronic lymphocytic leukemia is characterized by the accumulation of small, mature-appearing lymphocytes. Chronic myelogenous leukemia occurs when there is an excessive development of mature neoplastic granulocytes in the bone marrow.

The nurse examines the lymph nodes of a patient during a physical assessment. Which assessment finding would be of most concern to the nurse? a. A 2-cm nontender supraclavicular node b. A 1-cm mobile and nontender axillary node c. An inability to palpate any superficial lymph nodes d. Firm inguinal nodes in a patient with an infected foot

ANS: A Enlarged and nontender nodes are suggestive of malignancies such as lymphoma. Firm nodes are an expected finding in an area of infection. The superficial lymph nodes are usually not palpable in adults, but if they are palpable, they are normally 0.5 to 1 cm and nontender

A patient with anemia experiences fatigue when performing activities of daily living. Which nursing intervention is appropriate to include in the patient's plan of care? A. Encourage frequent visitors. B. Assist the patient in prioritizing activities. C. Assist the patient in walking immediately after meals. D. Ensure that all physical activities are completed in the morning.

B The nurse should teach and assist the patient and caregiver to assign priority to activities to accommodate energy levels and promote tolerance for important activities. The patient should be asked to avoid activity immediately after meals to reduce competition for oxygen supply to vital functions. Activities should be alternated with rest periods throughout the day rather than completed in the morning. The caregiver should limit the number of visitors so that the patient receives adequate rest.

A patient has a hemoglobin level of 11 g/dL. The nurse determines that the patient has what level of severity of anemia? Mild anemia Severe anemia Aplastic anemia Moderate anemia

In mild anemia, hemoglobin is in the range of 10-12 g/dL. Aplastic anemia refers to a type of anemia caused by a decrease in red blood cell precursors. It does not refer to the severity of anemia. In severe anemia, it is less than 6 g/dL. In moderate anemia, the hemoglobin it is in the range of 6-10 g/dL. Hemoglobin above 12 g/dL is considered normal (no anemia).

The nurse is reviewing laboratory results and notes an aPTT level of 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication? a. Aspirin b. Heparin c. Warfarin d. Erythropoietin

ANS: B Activated partial thromboplastin time (aPTT) assesses intrinsic coagulation by measuring factors I, II, V, VIII, IX, X, XI, XII. aPTT is increased (prolonged) in heparin administration. aPTT is used to monitor whether heparin is at a therapeutic level (needs to be greater than the normal range of 25 to 35 sec). Prothrombin time (PT) and international normalized ratio (INR) are most commonly used to test for therapeutic levels of warfarin (Coumadin). Aspirin affects platelet function. Erythropoietin is used to stimulate red blood cell production

Which diagnostic test can detect destruction of circulating platelets as the cause of thrombocytopenia? A. Hemoglobin B. Bone marrow analysis C. Prothrombin time (PT) D. Peripheral blood smear

B When destruction of circulating platelets is the cause, bone marrow analysis shows megakaryocytes (precursors of platelets) to be normal or increased, even though circulating platelets are reduced. Prothrombin time (PT) is used to assess secondary hemostasis. Peripheral blood smear is used to distinguish acquired disorders from congenital disorders. Hemoglobin measures the amount of protein in the red blood cells that carries oxygen to the body's organs and tissues and transports carbon dioxide from the organs and tissues back to the lungs.

A patient is diagnosed with coagulopathy and receives a prescription for warfarin therapy. The nurse provides dietary education. Which statement made by the patient indicates that the teaching was effective? "Vitamin K is only in fruits and salad." "I can eat as many green, leafy vegetables as I want." "I need to have a consistent amount of vitamin K in my diet." "I should avoid green, leafy vegetables, and I cannot eat salad regularly."

C Patients on warfarin therapy must be taught to identify foods high in vitamin K and to consume consistent amounts daily. Patients should be advised not to eat large amounts of green, leafy vegetables sporadically as this decreases the effectiveness of warfarin. A balanced diet that includes a consistent amount of vitamin K is necessary to maintain good health. As such, patients should not avoid foods containing vitamin K. Vitamin K is found in many fruits, vegetables, and meats.

A patient with neutropenia asks how the prescribed protective (reverse) isolation helps prevent the spread of organisms. What primary explanation should the nurse give? A. "It is designed to use special techniques to decrease discharge from your body." B. "It is designed to use special techniques to handle your linens and personal items." C. "It is designed to minimize the spread of germs to you from sources outside your environment." D. "It is designed to minimize the spread of germs from you to health care personnel, visitors, and other patients."

C The primary purpose of protective, or reverse, isolation is to reduce transmission of organisms to the patient from sources outside the patient's environment. The use of special techniques to destroy discharge or handle the patient's linen and personal items and preventing the spread from the patient to others are not the purpose of protective isolation.

The nurse is caring for a patient admitted for treatment of sickle cell disease (SCD). The nurse recalls that with repeated episodes of sickling, there is gradual involvement of all body systems and organs, especially which one? Liver Heart Lungs Stomach

C With repeated episodes of sickling, there is gradual involvement of all body systems and organs, especially the spleen, lungs, kidneys, and brain. Organs that have a need for large amounts of O 2, like the lungs, are most often affected and form the basis for many of the complications of SCD. Although the liver, heart, and stomach may be affected, they are less so when compared to the lungs.

Which parameters should the nurse assess while monitoring a patient for the development of disseminated intravascular coagulation (DIC)? Select all that apply. 1 Fibrinogen levels 2 Hemoglobin levels 3 Red blood cell (RBC) count 4 White blood cell (WBC) count 5 Partial thromboplastin time (PTT)

Correct 1, 5 The nurse should assess the parameters such as fibrinogen levels and partial thromboplastin time (PTT) while monitoring a patient for the development of disseminated intravascular coagulation (DIC) disorder. Hemoglobin levels, red blood cell (RBC) count, and white blood cell (WBC) count are not altered in a patient with DIC. Therefore the nurse need not assess these parameters in a patient with DIC.

The nurse assesses a patient who has numerous petechiae on both arms. Which question should the nurse ask the patient? a. "Do you take salicylates?" b. "Are you taking any oral contraceptives?" c. "Have you been prescribed antiseizure drugs?" d. "How long have you taken antihypertensive drugs?"

ANS: A Salicylates interfere with platelet function and can lead to petechiae and ecchymoses. Antiseizure drugs may cause anemia, but not clotting disorders or bleeding. Oral contraceptives increase a person's clotting risk. Antihypertensives do not usually cause problems with decreased clotting

A patient with pancytopenia of unknown origin is scheduled for the following diagnostic tests. The nurse will provide a consent form to sign for which test? a. ABO blood typing b. Bone marrow biopsy c. Abdominal ultrasound d. Complete blood count (CBC)

ANS: B A bone marrow biopsy is a minor surgical procedure that requires the patient or guardian to sign a surgical consent form. The other procedures do not require a signed consent by the patient or guardian

The health care provider orders a liver/spleen scan for a patient who has been in a motor vehicle accident. Which action should the nurse take before this procedure? a. Check for any iodine allergy. b. Insert a large-bore IV catheter. c. Place the patient on NPO status. d. Assist the patient to a flat position.

ANS: D During a liver/spleen scan, a radioactive isotope is injected IV and images from the radioactive emission are used to evaluate the structure of the spleen and liver. An indwelling IV catheter is not needed. The patient is placed in a flat position before the scan

A patient with pancytopenia has a bone marrow aspiration from the left posterior iliac crest. Which action would be important for the nurse to take after the procedure? a. Elevate the head of the bed to 45 degrees. b. Apply a sterile 2-inch gauze dressing to the site. c. Use a half-inch sterile gauze to pack the wound. d. Have the patient lie on the left side for 1 hour.

ANS: D To decrease the risk for bleeding, the patient should lie on the left side for 30 to 60 minutes. After a bone marrow biopsy, the wound is small and will not be packed with gauze. A pressure dressing is used to cover the aspiration site. There is no indication to elevate the patient's head

The nurse should question which therapy that is listed on a treatment plan for a patient who has thrombotic thrombocytopenic purpura (TTP)? A. Plasmapheresis B. Rituximab therapy C. Platelet transfusion D. Corticosteroid therapy

C Administration of platelets or platelet transfusion is contraindicated in a patient who has thrombotic thrombocytopenic purpura (TTP) because it leads to new vWF-platelet complexes and increased clotting. Plasmapheresis supplies the appropriate vWF and enzyme (ADAMTS13) and removes large vWF molecules that bind with platelets

A patient with anemia receives a new prescription for oral iron supplements. What should the nurse include in the medication education related to improving the absorption of the supplement? A. "Take it with meals." B. "Take it one hour after eating." C. "Take it one hour before breakfast, with orange juice." D. "Take it on an empty stomach with a full glass of water."

C Iron is absorbed best as ferrous sulfate in an acidic environment. For this reason and to avoid binding the iron with food, iron should be taken about an hour before meals, when the duodenal mucosa is most acidic. Taking iron with vitamin C (ascorbic acid) or orange juice, which contains ascorbic acid, enhances iron absorption. Gastric side effects, however, may necessitate ingesting iron with meals.

A patient is prescribed oral iron for the treatment of anemia. The nurse should instruct the patient about what side effects? Anorexia Red stools Heartburn Black stools Constipation

C, D, E Because the GI tract excretes excess iron, the primary side effects of oral iron preparations are heartburn, black stools, and constipation. Red stool is not a side effect of iron preparation, but can be caused by the presence of fresh blood in the stools due to bleeding from hemorrhoids or irritable bowel syndrome. Anorexia is not an expected side effect.

The nurse provides education regarding daily activities to a patient with thrombocytopenia. Which patient activity indicates understanding of the teaching? 1 Flossing using thick tape floss 2 Shaving using an electric razor 3 Wearing flip flops to go walking 4 Brushing using a stiff-bristle toothbrush

Correct 2 A patient with thrombocytopenia has a decreased number of platelets, and therefore prolonged bleeding will be observed even for minor injuries. Shaving using an electric razor blade decreases the risk of cuts and wounds resulting in decreased bleeding. Therefore this activity of the patient indicates understanding of the nurse's teaching. Walking with flip flops can cause the patient to trip, causing the risk for cuts or wounds and increased bleeding. Flossing using a thick tape floss is not safe and can cause an increased risk for bleeding. Brushing using a stiff-bristle toothbrush causes injury to the gums and is not safe

A patient with cancer who is receiving methotrexate therapy has developed anemia. The nurse recognizes that which therapies may benefit this patient? Select all that apply. 1 Oral iron 2 Epoetin alfa 3 Oral folic acid 4 Blood transfusion 5 Parenteral vitamin B12

Correct 2, 3 Epoetin alfa is used to treat anemia related to cancer and its therapies. Methotrexate leads to folic acid deficiency resulting in megaloblastic anemia. Therefore folic acid therapy is given to treat the patient. Oral iron is administered to patients with iron deficiency anemia, which is seen mostly in premenopausal and pregnant women. Blood transfusions are required to keep the approximate hemoglobin level to at least 10 g/dL in the case of thalassemia and severe anemia. Parenteral vitamin B12 is administered to treat cobalamin deficiency caused by pernicious anemia. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options.

A patient experiences a decreased neutrophil count (neutropenia). To prevent complications, which interventions should the nurse include in the patient's discharge teaching? Select all that apply. 1 Encourage the patient to eat raw eggs. 2 Encourage the patient to wash hands frequently. 3 Encourage the patient to frequent crowded areas. 4 Advise the patient to notify the health care provider if a fever develops. 5 Advise the patient to brush the teeth four times a day with a soft toothbrush.

Correct 2, 4, 5 Neutropenia, or decreased neutrophil count, increases the risk of developing infection. Therefore measures should be taken to prevent infections. The self-care instructions provided by the nurse should include frequent hand washing to prevent transmission of germs. Brushing the teeth four times a day with a soft toothbrush prevents the risk of oral infections. Fever is an emergency situation in cases of neutropenia and should be immediately reported to the healthcare provider. Eating raw eggs and staying in crowded areas increase the risk of acquiring infections, and should be avoided.

The nurse cares for a patient that is newly diagnosed with disseminated intravascular coagulation (DIC). What is the primary goal of the plan of care? 1 Administer heparin 2 Administer whole blood 3 Treat the causative problem 4 Administer fresh frozen plasma

Correct 3 Treating the underlying cause of DIC will interrupt the abnormal response of the clotting cascade and reverse the DIC. Blood product administration occurs based on the specific component deficiencies and is reserved for patients with life-threatening hemorrhage. Heparin will be administered if the manifestations of thrombosis are present and the benefit of reducing clotting outweighs the risk of further bleeding.

A patient with chronic disseminated intravascular coagulation (DIC) experiences episodes of bleeding. Which interventions are appropriate to be included in the patient's plan of care? Select all that apply. 1 Routine hematocrit tests 2 Routine white blood cell counts 3 Instructing the patient to report oozing of blood from the gums 4 Instructing the patient to use a soft toothbrush to clean the teeth 5 Instructing the patient to observe stools and urine for the presence of blood

Correct 3, 4, 5 The patient with chronic disseminated intravascular coagulation (DIC) disorder may experience episodes of bleeding due to microvascular thrombosis and hemorrhage. Gingival oozing is a sign of hemorrhage in DIC. Oozing of blood from the gums should be reported to determine the effectiveness of the therapy. Using a soft toothbrush to clean the teeth reduces damage to mucosal surfaces. Hematuria is also a sign of hemorrhage in a patient with DIC. Therefore instructing the patient to observe stools and urine for the presence of blood will help in the effective management of the patient's condition. Routine blood tests include CBC, blood smears, PT and PTT, D-dimer, and fibrinogen. Hematocrit levels and white blood cell counts should be monitored in a patient with neutropenia.

The nurse recognizes that which assessment finding in a patient with disseminated intravascular coagulation (DIC) is a thrombotic manifestation? 1 Decreased urinary output 2 Presence of blood in urine 3 Presence of blood in stools 4 Increased body temperature

Correct1 A patient with disseminated intravascular coagulation (DIC) disorder may have bleeding and thrombotic manifestations. Thrombotic manifestations occur due to fibrin or platelet deposition in the vasculature. Decreased urinary output or oliguria is a sign of thrombotic manifestation. Presence of blood in urine (hematuria) or presence of blood in stools indicates that the patient is exhibiting bleeding manifestations. Increased body temperature is a clinical manifestation seen in a patient with neutropenia caused by infections.

The nurse recognizes that desmopressin acetate needs to be given to a patient in repeated doses for what reason? 1 It is relatively short-lived. 2 It is effective within 30 minutes. 3 It stimulates an increase in factor VIII. 4 It acts on platelets and endothelial cells.

Correct1 Desmopressin acetate is relatively short-lived and therefore should be given in repeated doses to prolong its beneficial effects. Effectiveness of desmopressin acetate within 30 minutes does not indicate the need for repeated dosing. Increased stimulation of factor VIII and its action on platelets and endothelial cells do not indicate the need for repeated dosing.

A patient receives a prescription for rituximab. Prior to administering the medication, the nurse should check the patient's history for which condition? 1 Hepatitis 2 Migraine attack 3 Vitamin D deficiency 4 Vitamin A deficiency

Correct1 Rituximab is used to treat non-Hodgkin's lymphoma. The nurse should check for hepatitis before administering the medication because this drug may reactivate hepatitis.

Which patient is most likely to experience anemia related to an increased destruction of red blood cells? 1 A 59-year-old man whose alcoholism has precipitated folic acid deficiency 2 A 23-year-old African American man who has a diagnosis of sickle cell disease 3 A 30-year-old woman with a history of "heavy periods" accompanied by anemia 4 A 3-year-old child whose impaired growth and development is attributable to thalassemia

Correct2 A result of a sickling episode in sickle cell anemia involves increased hemolysis of the sickled cells. Thalassemias and folic acid deficiencies cause a decrease in erythropoiesis, whereas the anemia related to menstruation is a direct result of blood loss.

A patient's laboratory report reveals a hemoglobin (Hgb) level of 11 g/dL. The nurse expects to observe which clinical manifestation? 1 Glossitis 2 Palpitations 3 Dyspnea at rest 4 Roaring in the ears

Correct2 An Hgb range of 10 to 12 g/dL indicates mild anemia. Therefore the patient with an Hgb of 11 g/dL may experience palpitations. Glossitis is one of the manifestations of severe anemia in which the patient would have an Hgb level below 6 g/dL. Exertional dyspnea is seen in patients with mild anemia. However, dyspnea at rest is a manifestation of severe anemia. Roaring in the ears is seen in patients with moderate anemia whose Hgb values range between 6 and 10 g/dL.

A patient that is receiving treatment for thalassemia show evidence of hemolysis. The nurse anticipates a prescription for which supplementation? 1 Zinc 2 Folic acid 3 Vitamin B 12 4 Ascorbic acid

Correct2 Folic acid is given if there is any evidence of hemolysis in patients with thalassemia. Zinc supplementation is required in patients with thalassemia after chelation therapy, because zinc levels may decline. Vitamin B12 supplementation is required for patients with megaloblastic anemias. Ascorbic acid supplementation may be needed during chelation therapy in patients receiving treatment for thalassemia, because it increases urinary excretion of iron.

Which statement is true regarding hemophilia? 1 Hemophilia is not hereditary in nature. 2 Hemophilia can be treated by replacement therapy. 3 Hemophilia is an X-linked dominant genetic disorder. 4 Hemophilia B is the most common form of hemophilia.

Correct2 Hemophilia decreases the clotting ability of the blood in a patient and can be treated by replacement therapy during acute phases of bleeding. Hemophilia is hereditary in nature. Hemophilia is an X-linked recessive genetic disorder. The most common form of hemophilia is hemophilia A.

A patient receives a prescription for ferrous gluconate. The nurse should provide education related to what potential side effect? 1 Hypotension 2 Constipation 3 Clay-colored stool 4 Abdominal swelling

Correct2 Iron supplements such as ferrous gluconate reduce peristalsis and result in constipation. Ferrous gluconate does not reduce blood pressure and does not result in hypotension. Ferrous gluconate can cause gastrointestinal bleeding and black, tarry stools. Ferrous gluconate does not cause fluid accumulation in the peritoneal cavity or abdominal swelling.

The nurse reviews a patient's pre-op prescription which states: "Infuse one unit of fresh frozen plasma (FFP) before arrival to the operating room." To complete this prescription safely, the nurse should take which action? 1 Infuse the FFP over four hours and then take the patient to the operating room. 2 Infuse the FFP as rapidly as the patient will tolerate. 3 Administer the FFP as an IV piggyback to the primary IV solution. 4 Administer the FFP as an IV piggyback to lactated Ringer's solution.

Correct2 The fresh frozen plasma should be administered as rapidly as possible and should be used within six hours. Fresh frozen plasma is infused with the use of any straight-line infusion set. Any existing IV should be interrupted while the fresh frozen plasma is infusing, unless a second IV line has been started for the transfusion.

The nurse provides care for a patient with immune thrombocytopenic purpura (ITP) that has a platelet count of 90,000/mcL of blood. What could be the reason for this condition in the patient? 1 Destruction of platelets 2 Decreased production of platelets 3 Enhanced aggregation of platelets 4 Increased consumption of platelets

Correct2 The normal platelet count is in the range of 150,000 to 450,000 platelets/mcL of blood. A decreased blood platelet count indicates thrombocytopenia in the patient. A patient with ITP will have thrombocytopenia because of decreased platelet production. Ingestion of herbs results in thrombocytopenia by destroying the platelets. Enhanced aggregation of platelets is associated with thrombotic thrombocytopenic purpura (TTP). Increased consumption of platelets will cause heparin-induced thrombocytopenia (HIT).

The nurse reviews a patient's medical record and notes assessment findings which include fatigue, arthralgia, abdominal pain, weight loss, an enlarged liver, and a total body iron level of 70 g. The nurse suspects which condition? 1 Polycythemia 2 Hemochromatosis 3 Sickle cell disease 4 Iron deficiency anemia

Correct2 The normal range of total body iron is 2 to 6 g and its concentration exceeds 50 g in case of hemochromatosis. Fatigue, arthralgia, abdominal pain, weight loss, and enlarged liver and spleen are the clinical manifestations of hemochromatosis. Polycythemia is characterized by laboratory manifestations such as elevated hemoglobin and RBC count, low to normal erythropoietin, elevated WBC, platelet, uric acid, and cobalamin levels. The clinical manifestations include headaches, vertigo, dizziness, tinnitus, and visual disturbances. In patients with sickle cell disease, the peripheral blood smear will show sickled cells and abnormal reticulocytes. The patient may have elevated serum bilirubin levels, and bone and joint deformities. In patients with iron deficiency anemia, the laboratory findings indicate a low total body iron and hemoglobin levels along with clinical manifestations such as glossitis, cheilitis, and pallor. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking

The nurse is preparing to administer two units of blood to a patient. The nurse should take which action to prevent an adverse effect during this procedure? 1 Immediately obtain both units of blood from the blood bank. 2 Infuse the blood slowly for the first 15 minutes of the transfusion. 3 Regulate the flow rate so that each unit takes at least four hours to transfuse. 4 Prepare a solution of dextrose in water to be administered after the transfusion is complete.

Correct2 Because a transfusion reaction is more likely to occur at the beginning of a transfusion, the nurse initially should infuse the blood at a rate no faster than 2 mL/min and remain with the patient for the first 15 minutes after hanging a unit of blood. Only one unit of blood can be picked up at a time, must be infused within four hours, and cannot be hung with dextrose.

A patient is scheduled to receive two units of packed red blood cells. The prescription was written at 1000. The nurse picks the transfusion up from the laboratory at 1130 and recognizes that it must be initiated no later than what time? 1 1145 2 1200 3 1230 4 1530

Correct2 The nurse must hang the unit of packed red blood cells within 30 minutes of signing them out from the blood bank. Because the blood was picked up at 1130, 1200 is the latest it can be hung. It is okay to hang the blood at 1145. It is too late to hang the blood at 1230 or at 1530

A patient is diagnosed with acute lymphocytic leukemia (ALL). The nurse identifies that which assessment finding is associated with the diagnosis? Incorrect1 Lymphadenopathy 2 Gingival hyperplasia 3 Leukemic meningitis 4 Hepatosplenomegaly

Correct3 Central nervous system manifestations, such as leukemic meningitis, are most commonly observed in patients with acute lymphocytic leukemia (ALL). Gingival hyperplasia in patients is associated with acute myelogenous leukemia. Lymphadenopathy is also observed in patients with chronic lymphocytic leukemia. Hepatosplenomegaly is also common in patients with acute myelogenous leukemia and chronic lymphocytic leukemia.

A patient experiences a minor bleeding episode during a dental procedure. The nurse recognizes that which therapy will be beneficial? 1 Tranexamic acetate 2 Fresh frozen plasma 3 Desmopressin acetate 4 Epsilon-aminocaproic acid

Correct3 Desmopressin acetate is used to treat minor bleeding episodes and dental procedures. Tranexamic acetate is the antifibrinolytic used to stabilize the clot in patients with epistaxis and menorrhagia. Fresh frozen plasma is used as replacement therapy in treating hemophilia. Epsilon-aminocaproic acid is the antifibrinolytic used for clot stability in patients with difficult episodes of epistaxis and menorrhagia. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.

The nurse recognizes that which drug is directly myelosuppressive and may cause patient thrombocytopenia? 1 Abciximab 2 Cimetidine 3 Ganciclovir 4 Haloperidol

Correct3 Ganciclovir is an antiinfective drug that causes thrombocytopenia

An initial emergency plan of care for a patient with leukemia includes leukapheresis and hydroxyurea. The nurse concludes that the treatments were prescribed based on which laboratory parameter? 1 Hemoglobin of 9 g/dL 2 Platelet count of 90,000/µL 3 WBC count of 120,000 cells/µL 4 Lactate dehydrogenase 300 U/L

Correct3 The initial emergent treatment with leukapheresis and hydroxyurea is indicated if the patient has a high WBC count of 100,000 cells/μL or more. The normal range of hemoglobin is 13.2 to 17.3 g/dL in males and 11.7 to 15.5 g/dL in females. Therefore a hemoglobin value of 9 g/dL is indicative of severe anemia and a blood transfusion would be beneficial to this patient. The normal range of platelets is 150,000 to 400,000/μL. Therefore the platelet count of 90,000/μL is indicative of thrombocytopenia. Patients with leukemia may have thrombocytopenia due to bone marrow depression. Thrombocytopenia is treated using colony stimulating factors and platelet transfusions. The normal lactate dehydrogenase level is 140 to 280 mcg/dL. This will be elevated due to tissue damage that occurs from cancer cell destruction.

Which syndrome is caused by the deficiency of plasma enzyme ADAMTS13? 1 Immune thrombocytopenic purpura (ITP) 2 Heparin-induced thrombocytopenia (HIT) 3 Thrombotic thrombocytopenic purpura (TTP) 4 Disseminated intravascular coagulation (DIC)

Correct3 Thrombotic thrombocytopenic purpura (TTP) is caused due to the deficiency of plasma enzyme ADAMTS13. Without the enzyme, unusually large amounts of von Willebrand factor will attach to activated platelets and promote platelet aggregation. Increased use of heparin causes heparin-induced thrombocytopenia (HIT). Immune thrombocytopenic purpura (ITP) is caused by decreased platelet production. Overstimulation of proteins involved in clotting factors can result in disseminated intravascular coagulation (DIC).

The nurse reviews the history of an older patient and notes increased fatigue, headache, pale skin, and glossitis. The nurse suspects the patient has microcytic, hypochromic anemia and should provide what teaching? 1 Take enteric-coated iron with each meal. 2 Take cobalamin with green leafy vegetables. 3 Take the iron with orange juice one hour before meals. 4 Decrease the intake of the antiseizure medications to improve.

Correct3 With microcytic, hypochromic anemia, there may be an iron, B6, or copper deficiency, thalassemia, or lead poisoning. The iron prescribed should be taken with orange juice one hour before meals as it is absorbed best in an acid environment. Megaloblastic anemias occur with cobalamin (vitamin B12) and folic acid deficiencies. Vitamin B12 may help red blood cell (RBC) maturation if the patient has the intrinsic factor in the stomach. Green leafy vegetables provide folic acid for RBC maturation. Antiseizure drugs may contribute to aplastic anemia or folic acid deficiency, but the patient should not stop taking the medications. Changes in medications will be prescribed by the health care provider.

The treatment plan for a patient with chronic lymphocytic leukemia (CLL) includes a drug that acts by binding to CD52, a panlymphocyte antigen present on both T and B cells. The nurse anticipates that what drug will be prescribed? 1 Lomustine 2 Carboplatin 3 Alemtuzumab 4 Cyclophosphamide

Correct3 Alemtuzumab is used to treat chronic lymphocytic leukemia by binding to CD52, a panlymphocyte antigen present on both T and B cells. Lomustine acts by breaking DNA helix and interfering with DNA replication. Carboplatin acts by binding to DNA and RNA and inhibiting DNA replication. Cyclophosphamide damages DNA by causing breaks in the double-stranded helix.

A patient who is in acute sickle cell crisis cries and reports a pain level of "10" on a 1 to 10 scale. The nurse identifies that which type of medication is most appropriate for the patient? 1 Acetaminophen (Tylenol) oral tablets every six hours. 2 Oral morphine tablets, every four hours, as needed (PRN) 3 Intravenous meperidine (Demerol), every four hours, PRN 4 Hydromorphone (Dilaudid) via patient-controlled analgesia (PCA)

Correct4 During an acute sickle cell crisis, optimal pain control usually includes large doses of continuous (rather than PRN) opioid analgesics along with breakthrough analgesia, often in the form of PCA. Morphine and hydromorphone are the drugs of choice. Acetaminophen is appropriate for minor pain or fever, not for severe pain. Meperidine is contraindicated because high doses can lead to the accumulation of a toxic metabolite, normeperidine, which can cause seizures.

A patient with cancer experiences fever, drenching night sweats, and weight loss. The laboratory reports show intrathoracic involvement. The nurse should monitor the patient for which complication? 1 Bone pain 2 Paraplegia 3 Renal failure 4 Superior vena cava syndrome

Correct4 Fever, drenching night sweats, and weight loss are clinical manifestations of Hodgkin's lymphoma. Intrathoracic involvement results in superior vena cava syndrome due to intravascular thrombosis. Bone pain occurs as a result of bone involvement. Paraplegia may occur with extradural involvement due to spinal cord compression. Renal failure may occur due to enlarged peritoneal nodes.

A patient with immune thrombocytopenic purpura (ITP) is scheduled for a splenectomy. The goal of the surgery is complete remission. The nurse recognizes that the surgery is an appropriate treatment plan because of what splenic function? 1 The spleen sequesters total platelets. 2 The spleen does not contain macrophages. 3 The spleen does not synthesize any antibodies. 4 The spleen affects the platelet-macrophage interaction.

Correct4 Splenectomy causes complete remission in a patient with immune thrombocytopenic purpura (ITP) because the structural features of the spleen enhance the interaction between antibody-coated platelets and macrophages. The spleen sequesters approximately one third of the platelets, so removal of the spleen increases the number of platelets in circulation. The spleen contains abundant macrophages that sequester and destroy platelets. The spleen synthesizes some antibodies and thus antiplatelet antibodies decrease after splenectomy. Test-Taking Tip: Be alert for grammatical inconsistencies. If the response is intended to complete the stem (an incomplete sentence) but makes no grammatical sense to you, it might be a distractor rather than the correct response. Question writers typically try to eliminate these inconsistencies.

The student nurse creates a list of risk factors that predispose a patient to chronic disseminated intravascular coagulation (DIC). What is appropriate to be included on the list? Incorrect1 Heat stroke 2 Septic abortion 3 Glomerulonephritis 4 Systemic lupus erythematosus (SLE)

Correct4 Systemic lupus erythematosus is the risk factor that predisposes a patient to chronic disseminated intravascular coagulation (DIC) disorder. Heat stroke, septic abortion, and glomerulonephritis are the risk factors that predispose a patient to acute DIC disorder. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking

A patient receives a new prescription for a transfusion of two units of packed red blood cells (PRBCs). The nurse should take which action to ensure patient safety? 1 Add the blood transfusion as a secondary line to the existing IV and infuse over 60 minutes or less. 2 Remain with the patient for 60 minutes after beginning the transfusion to watch for signs of transfusion reaction. 3 Select a new primary intravenous (IV) tubing to use for the administration and piggyback with 500 mL of normal saline. 4 Have a second registered nurse check the identifying information on the unit of blood against the identification bracelet and blood-bank identification bracelet.

Correct4 The patient's identifying information (name, date of birth, medical record number) on the identification bracelet should match exactly the information on the blood-bank tag that has been placed on the unit of blood. If any information does not match, the transfusion should not be hung because of possible error and risk to the patient. Blood tubing, not primary tubing, is needed for blood transfusion and should not be administered as a secondary infusion. The nurse should remain with the patient for 15 minutes following initiation of transfusion.

A patient with thrombocytopenia experiences a nosebleed. What is the priority nursing intervention? 1 Notify the primary health care provider. 2 Tap the patient's nose gently with a tissue. 3 Place ice bags over the bridge of the patient's nose. 4 Position the patient's head upwards and apply pressure to nostrils.

Correct4 The primary nursing intervention for a patient with thrombocytopenia and nosebleed is to prevent excessive blood loss. Positioning the patient's head upwards and applying pressure on the nostrils will reduce the flow of blood and will decrease bleeding. The primary health care provider is called if the bleeding does not stop after 10 minutes. The patient's nose will be tapped gently if the patient has a feeling of discomfort in the nose after reducing the risk of excessive blood loss. If the bleeding continues after positioning the patient's head upward, then ice bags should be placed over the bridge of the patient's nose to decrease bleeding.

A patient experiences thrombocytopenia due to consumption of certain herbs. The nurse suspects that which mechanism of thrombocytopenia occurred? 1 Altered platelet aggregation 2 Adequate platelet production 3 Decreased platelet production 4 Accelerated platelet destruction

Correct4 Ingestion of herbs may cause accelerated platelet destruction due to drug-dependent antibodies. Altered platelet aggregation is the cause of thrombotic thrombocytopenic purpura (TTP). Adequate platelet production will not cause thrombocytopenia in the patient. Decreased platelet production contributes to idiopathic thrombocytopenic purpura.

A patient experiences anemia secondary to acute blood loss following trauma. The patient asks the nurse about treatment that will be needed following discharge. How should the nurse respond? "You will need to take an iron supplement for the rest of your life to make sure the anemia does not return." "You will need to make dietary changes to help support the production of red blood cells for the next one to two years." "It would be best to take several supplements to prevent the anemia from recurring, including folic acid, niacin, and riboflavin." "Once the blood loss is controlled and blood volume is replaced, the anemia generally corrects itself, so no long-term treatment is needed."

D Anemia caused by acute blood loss generally resolves itself once the source of the bleeding is identified and controlled and blood/fluid volume is replaced. It is incorrect to tell the patient he or she will need supplements for the rest of his or her life, that several supplements are necessary to prevent recurrence, or that dietary changes will be necessary for the next year or two.