Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders questions

Parents arrive to the clinic with their young child and inform the nurse the child has just been diagnosed with sickle cell disease. The parents ask the nurse how this could have happened and which one of them is the carrier. What is the best response by the nurse?

"The child must inherit two defective genes, one from each parent."

Which of the following are assessment findings associated with thrombocytopenia? Select all that apply.

- Bleeding gums - Epistaxis - Hematemesis

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.

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

A client with a diagnosis of pernicious anemia comes to the clinic complaining of numbness and tingling in his arms and legs. What do these symptoms indicate?

Neurologic involvement

The nurse is caring for an older adult client who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine where the blood loss is coming from, what intervention can the nurse provide?

Observe stools for blood.

After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/mm3. What term should the nurse use to describe this low platelet count?

Thrombocytopenia

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?

Use a disposable razor when shaving.

A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify?

Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels

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?

B12

When teaching a client with iron deficiency anemia about appropriate food choices, the nurse encourages the client to increase the dietary intake of which foods?

Beans, dried fruits, and leafy, green vegetables

Which of the following vitamins enhance the absorption of iron?

C

A patient with end-stage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia?

Creatinine level of 6 mg/100 mL

A patient with chronic renal failure is examined by the nurse practitioner for anemia. The nurse knows to review the laboratory data for a decreased hemoglobin level, red blood cell count, and which of the following?

Decreased level of erythropoietin

The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia?

Erythrocytes that are microcytic and hypochromic

When assessing a client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential?

Health history, such as bleeding, fatigue, or fainting

A client with severe anemia reports symptoms of tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Laboratory test results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which nursing diagnoses is most appropriate for this client?

Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit

In adults, bone marrow is usually aspirated from which area?

Posterior iliac crest

You are caring for a client with thalassemia who is being transfused. What is your role during a transfusion?

To closely monitor the rate of administration

A client with sickle cell anemia has a ...

low hematocrit.

A client's family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC?

"DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs."

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?

"I will receive parenteral vitamin B12 therapy for the rest of my life."

A home care nurse visits a client diagnosed with atrial fibrillation who is ordered warfarin (Coumadin). The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching?

"I'll eat four servings of fresh, dark green vegetables every day."

A patient with sickle cell anemia is to begin treatment for the disease with hydroxyurea (Hydrea). What does the nurse inform the patient will be the benefits of treatment with this medication? (Select all that apply.)

- Fewer painful episodes of sickle cell crisis - Lower incidence of acute chest syndrome - Decreased need for blood transfusions

A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the physician immediately because the client probably is experiencing which problem?

A hemolytic allergic reaction caused by an antigen reaction

A client with sickle cell disease informs the nurse that he is having chest pain. The nurse hears the client coughing, wheezing, and breathing rapidly. What does the nurse suspect is occurring with this client?

Acute chest syndrome

Which is a symptom of hemochromatosis?

Bronzing of the skin

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 ...

Checks the clients's BUN and creatinine

The nurse is educating a patient with iron deficiency anemia about food sources high in iron and how to enhance the absorption of iron when eating these foods. What can the nurse inform the client would enhance the absorption?

Eating calf's liver with a glass of orange juice

A client receiving a blood transfusion experiences an acute hemolytic reaction. Which nursing intervention is the most important?

Immediately stop the transfusion, infuse normal saline solution, call the physician, and notify the blood bank.

A nurse practitioner provides nutritional information for a patient diagnosed with an iron-deficiency anemia. Select the best advice the nurse would give.

Increase the intake of green, leafy vegetables.

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?

Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI

The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include a nutritional assessment for this patient?

It may indicate deficiencies in essential nutrients.

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.

Which iron-rich foods should a nurse encourage an anemic client requiring iron therapy to eat?

Lamb and peaches

A nursing instructor is evaluating a student caring for a neutropenic client. The instructor concludes that the nursing student demonstrates accurate knowledge of neutropenia based on which intervention?

Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential

The nurse, caring for a client in the emergency room with a severe nosebleed, becomes concerned when the client asks for a bedpan. The nurse documents the stool as loose, tarry, and black looking. The nurse suspects the client may have thrombocytopenia. What should be the nurse's priority action?

Notify the physician

A client with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse?

Obtain the pain medication and delay the bath and position change until the medication reaches its peak.

A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. She reports that she first felt pain after manually opening her garage door and that she is taking prednisone daily. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain?

Osteoporosis

Which is the following is the most obvious sign of anemia?

Pallor

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

Pancytopenia

Which of the following is considered an antidote to heparin?

Protamine sulphate

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

A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn's disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for?

The onset of a bacterial infection

When evaluating a patient's symptoms that are consistent with a diagnosis of leukemia, the nurse is aware that a common feature of all leukemias is which of the following?

Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements

A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client?

Use the smallest needle possible for injections.

For a client diagnosed with pernicious anemia, the nurse emphasizes the importance of lifelong administration of ...

Vitamin B12

During preparation for bowel surgery, a client receives an antibiotic to reduce intestinal bacteria. The nurse knows that hypoprothrombinemia may occur as a result of antibiotic therapy interfering with synthesis of which vitamin?

Vitamin K

Which medication is the antidote to warfarin?

Vitamin K

An client has pernicious anemia and has been receiving treatment for several years. What is the client lacking that results in pernicious anemia?

intrinsic factor

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called ...

megaloblasts.

A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving:

A-positive blood to an A-negative client.

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?

Aplastic anemia

A client being treated for iron deficiency anemia with ferrous sulfate (Ferasol) continues to be anemic despite treatment. The nurse should assess the client for use of which medication?

Aluminum hydroxide (Maalox)

The nurse and the client are discussing some strategies for ingesting iron to combat the client's iron-deficiency anemia. Which is among the nurse's strategies?

Drink liquid iron preparations with a straw.

A client is hospitalized 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin at home, which is now discontinued. To prevent the formation of blood clots, it is important for the nurse to ...

Administer the prescribed enoxaparin (Lovenox).

The client has been diagnosed with myelodysplastic syndrome with an absolute neutrophil count less than 1000/mm³ and is being admitted to the hospital. The nurse ...

Assigns the client to a private room

A male client has been receiving a continuous infusion of weight-based heparin for more than 4 days. The client's PTT is at a level that requires an increase of heparin by 100 units per hour. The client has the laboratory findings shown above. The most important action of the nurse is to ...

Consult with the physician about discontinuing heparin.

A young male client is diagnosed with a mild form of hemophilia. He is experiencing bleeding in the joints with pain. In preparing the client for discharge, the nurse educates the client to ...

Wear a medical identification bracelet.