Chapter 33 PrepU (Hematologic Disorders)

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

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

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? A. "DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs." B. "DIC is a complication of an autoimmune disease that attacks the body's own cells." C. "DIC is caused when hemolytic processes destroy erythrocytes." D. "DIC occurs when the immune system attacks platelets and causes massive bleeding."

A. "DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs." Rationale: The inflammatory response initiates the process of inflammation and coagulation. The natural anticoagulant pathways within the body are simultaneously impaired, and the fibrinolytic system is suppressed, allowing a massive amount of tiny clots forms in the microcirculation. As the platelets and clotting factors form microthrombi, coagulation fails. Thus, the paradoxical result of excessive clotting is bleeding. Decline in organ function is usually a result of excessive clot formation (with resultant ischemia to all or part of the organ).

An older adult client at the free clinic has a history of seizures and presents with severe fatigue, frequent headaches, and a sore and beefy red tongue. Which of the following does the nurse suspect as causes of the client's current condition? Select all that apply. A. Alcoholism B. Not eating vegetables C. Intestinal disorders D. Poor nutrition

A. Alcoholism B. Not eating vegetables C. Intestinal disorders D. Poor nutrition Rationale: The client is showing signs of folic acid deficiency anemia caused by a deficiency of folate or folic acid in the client. Alcoholism, Intestinal disorders that affect absorption, lack of vegetables or other folate-containing foods in the diet where folic acid is not being supplemented or consumed by other sources, and poor nutrition are all causes of folic acid deficiencies.

A client with chronic anemia has received multiple transfusions. Which client action would the nurse be concerned about relative to the client's condition? A. Takes over-the-counter iron supplements B. Takes 60 grams of protein each day C. Takes a daily multiple vitamin pill D. Eliminates use of alcohol

A. Takes over-the-counter iron supplements Rationale: When a client receives multiple transfusions and takes iron supplements, there may be a problem with iron overload. It is recommended that clients who are experiencing anemia either avoid or limit alcohol due to interference of alcohol with utilization of essential nutrients. The typical U.S. diet includes 60 grams of protein daily. Clients may be prescribed multivitamins.

A client with megaloblastic anemia reports mouth and tongue soreness. What instruction will the nurse give the client regarding eating while managing the client's symptoms? A. "Eat cold, bland foods with a large amount of water." B. "Eat larger amounts of bland, soft foods less frequently." C. "Eat small amounts of bland, soft foods frequently." D. "Eat low-fiber blended foods only."

C. "Eat small amounts of bland, soft foods frequently." Rationale: Because the client with megaloblastic anemia often reports mouth and tongue soreness, the nurse should instruct the client to eat small amounts of bland, soft foods frequently. The other answer choices do not factor in the client's mouth soreness or need for nutrition.

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? A. Pernicious anemia B. Agranulocytosis C. Aplastic anemia D. Iron-deficiency anemia

C. Aplastic anemia Rationale: Clients with aplastic anemia experience all the typical characteristics of anemia (weakness and fatigue). In addition, they have frequent opportunistic infections plus coagulation abnormalities that are manifested by unusual bleeding, small skin hemorrhages called petechiae, and ecchymoses (bruises). The spleen becomes enlarged with an accumulation of the client's blood cells destroyed by lymphocytes that failed to recognize them as normal cells, or with an accumulation of dead transfused blood cells. The blood cell count shows insufficient numbers of blood cells. A bone marrow aspiration confirms that the production of stem cells is suppressed. This scenario does not describe a client with pernicious anemia, iron-deficiency anemia, or agranulocytosis.

Which is a symptom of hemochromatosis? A. Weight gain B. Inflammation of the mouth C. Bronzing of the skin D. Inflammation of the tongue

C. Bronzing of the skin Rationale: Clients with hemochromatosis exhibit symptoms of weakness, lethargy, arthralgia, weight loss, and loss of libido early in the illness trajectory. The skin may appear hyperpigmented from melanin deposits or appear bronze in color.

During a routine assessment of a patient diagnosed with anemia, the nurse observes the patient's beefy red tongue. The nurse is aware that this is a sign of what kind of anemia? A. Folate deficiency B. Autoimmune C. Megaloblastic D. Iron deficiency

C. Megaloblastic Rationale: A beefy, red, sore tongue is a characteristic indicator of megaloblastic anemia. The nurse should assess for other signs such as fatigue, hypotension, and tachycardia. Safety issues should also be assessed because balance, coordination, and gait are affected.

A health care provider prescribes one tablet of ferrous sulfate daily for a 15-year-old girl who experiences heavy blood flow during her menstrual cycle. The nurse advises the patient and her parent that this over-the-counter preparation must be taken for how many months before stored iron replenishment can occur? A. 1 to 2 months B. Longer than 12 months C. 3 to 5 months D. 6 to 12 months

D. 6 to 12 months Rationale: Ferrous sulfate can increase hemoglobin levels in a few weeks, and anemia may be corrected in a few months. However, it takes 6 to 12 months for stored iron replenishment to occur.

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? A. hemoglobin A B. hemoglobin M C. hemoglobin F D. hemoglobin S

D. hemoglobin S Rationale: Hemoglobin A (HbA) normally replaces fetal hemoglobin (HbF) about 6 months after birth. In people with sickle cell anemia, however, an abnormal form of hemoglobin, hemoglobin S (HbS), replaces HbF. HbS causes RBCs to assume a sickled shape under hypoxic conditions.

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

B. "I will receive parenteral vitamin B12 therapy for the rest of my life." Rationale: Because a client with pernicious anemia lacks intrinsic factor, oral vitamin B12 can't be absorbed. Therefore, parenteral vitamin B12 therapy is recommended and required for life.

The nurse obtains a unit of blood for the client, Donald D. Smith. The name on the label on the unit of blood reads Donald A. Smith. All the other identifiers are correct. What action should the nurse take? A. Ask the client if he was ever known as Donald A. Smith B. Refuse to administer the blood C. Check with the blood bank first and then administer the blood with their permission D. Administer the unit of blood

B. Refuse to administer the blood. Rationale: To ensure a safe transfusion, all components of the identification must be correct. The nurse should refuse to administer the blood and notify the blood bank about the discrepancy. The blood bank should then take the necessary steps to correct the name on the label on the unit of blood.

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? A. Bleeding B. The onset of a bacterial infection C. Diarrhea D. Abdominal pain

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

A client is 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, which action should the nurse take? A. Monitor partial thromboplastin (PTT) time. B. Have the client limit physical activity. C. Administer the prescribed enoxaparin (Lovenox). D. Encourage a diet high in vitamin K.

C. Administer the prescribed enoxaparin (Lovenox). Rationale: Clients who are prescribed warfarin at home and need to have a major invasive procedure stop taking warfarin prior to the procedure. Low molecular weight heparin, such as enoxaparin, may be used until the procedure is performed. The client will continue with a diet that has a daily consistent amount of vitamin K. The client needs to ambulate frequently throughout the day. Prothrombin (PT) time is monitored, not PTT, when warfarin had been administered.

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

C. To closely monitor the rate of administration Rationale: In a client with thalassemia, when transfusions are necessary, the nurse closely monitors the rate of administration. Assessing for enlargement and tenderness over the liver and spleen, advising rest, or administering vitamin B12 injections are not indicated for thalassemia.

A client with sickle cell anemia has a: A. high hematocrit. B. normal hematocrit. C. low hematocrit. D. normal blood smear.

C. low hematocrit. Rationale: A client with sickle cell anemia has a low hematocrit and sickled cells on the smear. A client with sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear.

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

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

You are caring for a 13-year-old diagnosed with sickle cell anemia. The client asks you what they can do to help prevent sickle cell crisis. What would be an appropriate answer to this client? A. Stay on oxygen therapy 24/7. B. Avoid any activity that makes you short of breath. C. Avoid any sports that tire you out. D. Drink at least 8 glasses of water every day.

D. Drink at least 8 glasses of water every day. Rationale: During the physical examination, observe the client's appearance, looking for evidence of dehydration, which may have triggered a sickle cell crisis. Clients are taught moderation, not avoidance of activities. Most clients with sickle cell disease are not on oxygen therapy 24/7.

A client at the clinic has just been diagnosed with iron deficiency anemia. What would you recommend the client consume to promote the absorption of iron? A. Vitamin E B. Sources of vitamin B12 C. Meat, egg yolks, oysters, and shellfish D. Rich sources of vitamin C

D. Rich sources of vitamin C Rationale: Sources of vitamin C such as citrus fruits and juices, strawberries, green peppers, and tomatoes enhance the absorption of nonheme iron. To maximize nonheme iron absorption, the client should consume a rich source of vitamin C at every meal. Meat, egg yolks, oysters, and shellfish are the sources of heme iron whose absorption is influenced by body need. Vitamin E and sources of vitamin B12 do not promote the absorption of iron.

A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor? A. Decreased level of erythropoietin B. Decreased total iron-binding capacity C. Increased reticulocyte count D. Increased mean corpuscular volume

A. Decreased level of erythropoietin Rationale: As renal function decreases, erythropoietin, which is produced by the kidney, also decreases. Because erythropoietin is produced outside the kidney, some erythropoiesis continues, even in patients whose kidneys have been removed. However, the number of red blood cells produced is small and the degree of erythropoiesis is inadequate.

A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor? A. Decreased level of erythropoietin B. Increased reticulocyte count C. Decreased total iron-binding capacity D. Increased mean corpuscular volume

A. Decreased level of erythropoietin Rationale: As renal function decreases, erythropoietin, which is produced by the kidney, also decreases. Because erythropoietin is produced outside the kidney, some erythropoiesis continues, even in patients whose kidneys have been removed. However, the number of red blood cells produced is small and the degree of erythropoiesis is inadequate.

A patient with End Stage Kidney Disease is taking recombinant erythropoietin for the treatment of anemia. What laboratory study does the nurse understand will have to be assessed at least monthly related to this medication? A. Hemoglobin level B. Folate levels C. Potassium level D. Creatinine level

A. Hemoglobin level Rationale: When using recombinant erythropoietin, the hemoglobin must be checked at least monthly (more frequently until a maintenance dose is established) and the dose titrated to ensure the hemoglobin level does not exceed 12 g/dL.

An older adult client who is a vegetarian has a hemoglobin of 10.2 gm/dL, vitamin B12 of 68 pg/mL (normal: 200-900 pg/mL), and MCV of 110 cubic micrometers. After interpreting the data, what instruction should the nurse give to the client? A. Supplement the diet with vitamin B12. B. Change the vegetarian diet and begin to eat red meat. C. Ingest a diet higher in vitamin B12 sources. D. Continue with the diet but include more sources of iron.

A. Supplement the diet with vitamin B12. Rationale: Data support that the client is experiencing megaloblastic anemia. Findings include the laboratory test results, the client's older age, and the client's status as a vegetarian. Many vegetarians need to supplement their diet with vitamin B12. Eating more foods with vitamin B12 will not provide enough of this vitamin for the client's body. Increasing iron sources will not resolve the client's anemia. Telling the client to discontinue the vegetarian practice and eat red meat is nontherapeutic.

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? A. Prednisone B. Aluminum hydroxide C. Tegretol D. Amoxicillin

B. Aluminum hydroxide Rationale: The nurse should assess the client for possible use of antacids such as aluminum hydroxide. Clients should take ferrous sulfate and an antacid at least 2 hours apart because antacids bind with iron in the GI tract, decreasing the rate or extent of iron absorption.

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process due to thrombocytopenia in a client with leukemia? A. Monitoring temperature at least once per shift B. Applying prolonged pressure to needle sites or other sources of external bleeding C. Eliminating direct contact with others who are infectious D. Implementing neutropenic precautions

B. Applying prolonged pressure to needle sites or other sources of external bleeding Rationale: The interventions for a client with thrombocytopenia are the same as those for a client with cancer who is at risk for bleeding. For a client with leukemia, the nurse should apply prolonged pressure to needle sites or other sources of external bleeding. Reduced platelet production results in a delayed clotting process and increases the potential for hemorrhage. Implementing neutropenic precautions and eliminating direct contact with others are interventions to address the risk for infection.

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? A. Thiamine B. B12 C. Iron D. Folate

B. B12 Rationale: The hematologic effects of vitamin B12 deficiency are accompanied by effects on other organ systems, particularly the gastrointestinal tract and nervous system. Patients with pernicious anemia may become confused; more often, they have paresthesias in the extremities (particularly numbness and tingling in the feet and lower legs). They may have difficulty maintaining their balance because of damage to the spinal cord, and they also lose position sense (proprioception).

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. A. Infection B. Blood loss C. Inadequate formed white blood cells D. Abnormal erythrocyte production E. Destruction of normally formed red blood cells

B. Blood loss D. Abnormal erythrocyte production E. Destruction of normally formed red blood cells Rationale: Most anemias result from (1) blood loss, (2) inadequate or abnormal erythrocyte production, or (3) destruction of normally formed red blood cells. The most common types include hypovolemic anemia, iron-deficiency anemia, pernicious anemia, folic acid deficiency anemia, sickle cell anemia, and hemolytic anemias. Although each form of anemia has unique manifestations, all share a common core of symptoms. Anemia does not result from infection or inadequate formed white blood cells.

A young female client has pale nailbeds. Her hemoglobin count is 10.2 gm/dL and her hematocrit count is 30%. She reports fatigue and states, "I'm tired all the time." The client also reports excessive menstrual flow. The nurse assesses further and determines the client's diet is balanced and provides adequate calories. The client is prescribed supplemental iron therapy. The highest nursing diagnosis is: A. Fatigue related to diminished oxygen-carrying capacity of the blood B. Deficient knowledge related to new information with no previous experience C. Altered tissue perfusion related to diminished oxygen-carrying capacity of the blood D. Altered nutrition: less than body requirements, related to inadequate intake of nutrients

C. Altered tissue perfusion related to diminished oxygen-carrying capacity of the blood Rationale: All the nursing diagnoses are appropriate for this client who is experiencing anemia. Physiological needs take priority per Maslow's hierarchy of needs. Under physiological needs, airway, breathing, and then circulation take priority. Altered tissue perfusion would be classified under circulation, thus making it the priority over the other diagnoses listed.

Which type of sickle crisis occurs as a result of infection with the human parvovirus? A. Sequestration crisis B. Acute chest syndrome C. Aplastic crisis D. Sickle cell crisis

C. Aplastic crisis Rationale: Aplastic crisis results from infection with the human parvovirus. Sequestration crisis results when other organs pool the sickled cells. Sickle cell crisis results from tissue hypoxia and necrosis due to inadequate blood flow to a specific region of tissue or organ. Acute chest syndrome is manifested by a rapidly decreasing hemoglobin concentration, tachycardia, fever, and bilateral infiltrates seen on chest x-ray.

The nurse is educating a client about iron supplements. The nurse teaches that what vitamin enhances the absorption of iron? A. D B. A C. C D. E

C. C Rationale: Vitamin C facilitates the absorption of iron. Therefore, iron supplements should be taken with a glass of orange juice or a vitamin C tablet to maximize absorption.

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

C. Pallor, tachycardia, and a sore tongue Rationale: Pallor, tachycardia, and a sore tongue are all characteristic findings in pernicious anemia. Other clinical manifestations include anorexia; weight loss; a smooth, beefy red tongue; a wide pulse pressure; palpitations; angina pectoris; weakness; fatigue; and paresthesia of the hands and feet. Bradycardia, reduced pulse pressure, weight gain, and double vision aren't characteristic findings in pernicious anemia.

A client awaiting a bone marrow aspiration asks the nurse to explain where on the body the procedure will take place. What body part does the nurse identify for the client? A. Ankle B. Femur C. Posterior iliac crest D. Sternum

C. Posterior iliac crest Rationale: In adults, bone marrow is usually aspirated from the posterior iliac crest and rarely from the sternum. Bone marrow is not aspirated from the femur or ankle.

A client is brought to the ED reporting fatigue, large amounts of bruising on the extremities, and abdominal pain localized in the left upper quadrant. A health history reveals the client has been treated for a sore throat three times in the past 2 months. Laboratory tests indicate severe anemia, significant neutropenia, and thrombocytopenia. Based on the symptoms, what could be the client's diagnosis? A. Sickle cell anemia B. Hemolytic anemia C. Iron deficiency anemia D. Aplastic anemia

D. Aplastic anemia Rationale: Aplastic anemia can be congenital or acquired, but most cases are idiopathic. It can be triggered by infection. The manifestations of aplastic anemia are symptoms of anemia, purpura (bruising), retinal hemorrhages, significant neutropenia, and thrombocytopenia. Other lymphadenopathies and splenomegaly sometimes occur.

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 A. Teaches the client to bend at the back when lifting objects B. Checks the client's BUN and creatinine C. Questions the physician about the use of both medications D. Instructs the client not to lift more than 20 pounds

B. Checks the client's BUN and creatinine Rationale: Naproxen may cause renal dysfunction. It will be important to check and monitor the BUN and creatinine levels, which are indicators of renal function. Because of the disease, the client is not to lift more than 10 pounds and is to use correct body mechanics, by bending with the knees and not bending with the back. Both naproxen and oxycodone may be prescribed for bone pain for a client who has multiple myeloma.

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? A. Eating a steak with mushrooms B. Eating calf's liver with a glass of orange juice D. Eating apple slices with carrots C. Eating leafy green vegetables with a glass of water

B. Eating calf's liver with a glass of orange juice Rationale: Food sources high in iron include organ meats (e.g., beef or calf's liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.

A patient has a probable diagnosis of polycythemia vera. The nurse reviews the patient's lab work for which diagnostic indicator? A. Leukocyte count of 11,500/mm3 B. Platelet value of 350,000/mm3 C. Hematocrit of 60% D. Erythrocyte count of 6.5 m/?L

C. Hematocrit of 60% Rationale: Although all results are elevated, the diagnostic indicator is the elevated hematocrit (normal = 42% to 52% for a male). These results are used in combination with other indicators (e.g., splenomegaly) for a definitive diagnosis.

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? A. Severity of the disease B. Insufficient intake of dietary nutrients C. Neurologic involvement D. Loss of vibratory and position senses

C. Neurologic involvement Rationale: In clients with pernicious anemia, numbness and tingling in the arms and legs and ataxia are the most common signs of neurologic involvement. Some affected clients lose vibratory and position senses. Jaundice, irritability, confusion, and depression are present when the disease is severe. Insufficient intake of dietary nutrients is not indicated by these symptoms

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? A. Inform the client that the position must be changed, and then you will give her pain medication and omit the bath. B. Inform the client that the bath and positioning is an important part of client care and will be done right after pain medication administration. C. Obtain the pain medication and delay the bath and position change until the medication reaches its peak. D. Inform the client that she will feel better after receiving a bath and clean sheets.

C. Obtain the pain medication and delay the bath and position change until the medication reaches its peak. Rationale: When pain is severe, the nurse delays position changes and bathing until an administered analgesic has reached its peak concentration level and the client is experiencing maximum pain relief. Pain medication should never be delayed to assist in the control of the level of pain. Pain will not be relieved by a bath and clean sheets, only analgesics at this point in the client's illness.

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 health care provider immediately because the client probably is experiencing which problem? A. A hemolytic reaction to Rh-incompatible blood B. A hemolytic reaction caused by bacterial contamination of donor blood C. A hemolytic reaction to mismatched blood D. A hemolytic allergic reaction caused by an antigen reaction

D. A hemolytic allergic reaction caused by an antigen reaction Rationale: Hemolytic allergic reactions are fairly common and may cause chills, fever, urticaria, tachycardia, dyspnea, chest pain, hypotension, and other signs of anaphylaxis a few minutes after blood transfusion begins. Although rare, a hemolytic reaction to mismatched blood can occur, triggering a more severe reaction and, possibly, leading to disseminated intravascular coagulation. A hemolytic reaction to Rh-incompatible blood is less severe and occurs several days to 2 weeks after the transfusion. Bacterial contamination of donor blood causes a high fever, nausea, vomiting, diarrhea, abdominal cramps and, possibly, shock.

A nurse is caring for a client with iron deficiency anemia. Which food or beverage will the nurse suggest to the client to eat or drink when taking supplemental iron? A. Kidney beans B. Milk C. Leafy green vegetables D. Orange juice

D. Orange juice Rationale: Vitamin C found in orange juice improves the absorption of iron. The other answer choices are not the best for improving absorption of iron.

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? A. Acute chest syndrome B. Vaso-occlusive crisis C. Acute muscular strain D. Pneumocystis pneumonia

A. Acute chest syndrome Rationale: One of the unique manifestations of sickle cell disease is "acute chest syndrome," a type of pneumonia triggered by decreased hemoglobin and infiltrates in the lungs. Acute chest syndrome is characterized by respiratory symptoms, such as coughing, wheezing, tachypnea, and chest pain. Vaso-occlusive crisis causes decrease in tissue perfusion and predisposes the client to pneumonia but is not the present problem with this client. Pneumocystis pneumonia is present in the client with HIV/AIDS or other immunocompromised clients. The client's symptoms do not correlate with a diagnosis of acute muscular strain.

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

A. Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints. Rationale: Due to the client's enhanced risk for bleeding, before taking a blood pressure, the nurse asks the client if the use of a blood-pressure cuff has ever produced bleeding under the skin or in the arm joints.

After teaching a client about taking daily oral iron preparations for a moderate iron deficiency anemia, which statement by the client indicates to the nurse that additional instruction is needed? A. "I will take the iron with orange juice about an hour before eating." B. "I will increase my fluid and fiber intake while I am taking the iron tablets." C. "I will call the doctor if my stools turn black." D. "I will occasionally take a stool softener if I feel constipated."

C. "I will call the doctor if my stools turn black." Rationale: Iron replacement therapy may change the color of stool, usually to dark green or black. Iron is best absorbed on an empty stomach, so the client is instructed to take the supplement an hour before meals. Many clients have difficulty tolerating iron supplements because of gastrointestinal (GI) side effects (primarily constipation). Limit GI side effects by adding a stool softener or increasing dietary fiber and fluids. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.

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

C. Pallor Rationale: On physical examination, pallor is the most common and obvious sign of anemia. Other findings may include tachycardia and flow murmurs. Patients with hemolytic anemia may exhibit jaundice and splenomegaly.

A patient had gastric bypass surgery 3 years ago and now, experiencing fatigue, visits the clinic to determine the cause. The patient takes pantoprazole for the treatment of frequent heartburn. What type of anemia is this patient at risk for? A. Aplastic anemia B. Sickle cell anemia C. Pernicious anemia D. Iron deficiency anemia

C. Pernicious anemia Rationale: A deficiency of vitamin B 12 can occur in several ways. Inadequate dietary intake is rare but can develop in strict vegans (who consume no meat or dairy products). Faulty absorption from the GI tract is a more common cause. This occurs in conditions such as Crohn's disease, or after ileal resection or gastrectomy.

A female patient has a hemoglobin of 6.4 g/dL and is preparing to have a blood transfusion. Why would it be important for the nurse to obtain information about the patient's history of pregnancy prior to the transfusion? A. If the patient has never been pregnant, it increases the risk of reaction. B. If the patient has been pregnant, she may have developed allergies. C. Obtaining information about gravidity and parity is routine information for all female patients. D. A high number of pregnancies can increase the risk of reaction.

D. A high number of pregnancies can increase the risk of reaction. Rationale: The patient history is an important component of the pretransfusion assessment to determine the history of previous transfusions as well as previous reactions to transfusion. The history should include the type of reaction, its manifestations, the interventions required, and whether any preventive interventions were used in subsequent transfusions. The nurse assesses the number of pregnancies a woman has had, because a high number can increase her risk of reaction due to antibodies developed from exposure to fetal circulation.

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? A. Holds the epoetin alfa if the BUN is elevated B. Questions the administration of both medications C. Ensures the client has completed dialysis treatment D. Assesses the hemoglobin level

D. Assesses the hemoglobin level Rationale: Erythropoietin (epoetin alfa [Epogen]) with oral iron supplements can raise hematocrit levels in the client with end-stage renal disease. The nurse should check the hemoglobin prior to administration of erythropoietin, because too high a hemoglobin level can put the client at risk for heart failure, myocardial infarction, and cerebrovascular accident. Erythropoietin may be administered during dialysis treatments. The BUN will be elevated in the client with end-stage renal disease.

A nurse provides nutritional information for a patient diagnosed with an iron-deficiency anemia. What education should the nurse provide? A. Take an iron supplement with meals to reduce gastric irritation. B. Decrease the intake of citrus fruits because they interfere with iron absorption. C. Decrease the intake of high-fat red meats, especially organ meats. D. Increase the intake of green, leafy vegetables.

D. Increase the intake of green, leafy vegetables. Rationale: Leafy greens, such as spinach, kale, swiss chard, collard and beet greens contain between 2.5-6.4 mg of iron per cooked cup. Clients should be encouraged to consume more green, leafy vegetables. Red meats, especially organ meats, are iron-rich foods and the client should not be discouraged from eating them. Vitamin C sources (citrus fruit and juices) enhance the absorption of iron, which should be taken 1 hour before or 2 hours after a meal.

During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding? A. Elevated hematocrit concentration B. Elevated red blood cell (RBC) count C. Enlarged mean corpuscular volume (MCV) D. Low ferritin level concentration

D. Low ferritin level concentration Rationale: The most consistent indicator of iron deficiency anemia is a low ferritin level, which reflects low iron stores. As the anemia progresses, the MCV, which measures the size of the erythrocytes, also decreases. Hematocrit and RBC levels are also low in relation to the hemoglobin concentration.

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? A. Magnetic resonance imaging (MRI) study B. Bone marrow aspiration C. Bone marrow biopsy D. Schilling test

D. Schilling test Rationale: The classic method of determining the cause of vitamin B12 deficiency is the Schilling test, in which the patient receives a small oral dose of radioactive vitamin B12, followed in a few hours by a large, nonradioactive parenteral dose of vitamin B12 (this aids in renal excretion of the radioactive dose).

A client is treated for anemia. What is the nurse's best understanding about the correlation between anemia and the client's iron stores? A. There is a strong correlation between iron stores and hemoglobin characteristics. B. There is an inverse relationship between iron stores and hemoglobin levels. C. There is a weak correlation between iron stores and hemoglobin levels. D. There is a strong correlation between iron stores and hemoglobin levels.

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