Chapter 33

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 signs and symptoms disappear." B) "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal." C) "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." D) "I will receive parenteral vitamin B12 therapy for the rest of my life."

"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. The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching? A) "I'll watch my gums for bleeding when I brush my teeth." B) "I'll use an electric razor to shave." C) "I'll eat four servings of fresh, dark green vegetables every day." D) "I'll report unexplained or severe bruising to my doctor right away."

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

A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify? A) Potential hepatic dysfunction indicated by decreased blood urea nitrogen (BUN) and creatinine levels B) Low levels of urine constituents normally excreted in the urine C) Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels D) Electrolyte imbalance that could affect the blood's ability to coagulate properly

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

Which nursing diagnosis should a nurse expect to see in a care plan for a client in sickle cell crisis? A) Imbalanced nutrition: Less than body requirements related to poor intake B) Disturbed sleep pattern related to external stimuli C) Impaired skin integrity related to pruritus D) Acute pain related to sickle cell crisis

Acute pain related to sickle cell crisis

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.

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

The nurse is planning care for a client with severe fatigue secondary to anemia. What concept will the nurse use as the basis for planning interventions? A) Assisting in prioritizing activities. B) Determining what days to be active. C) Keeping long activity periods to build client stamina. D) Encouraging early and frequent activities.

Assisting in prioritizing activities.

The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency? A) B12 B) C C) A D) Folate

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? A) Beans, dried fruits, and leafy, green vegetables B) Fruits high in vitamin C, such as oranges and grapefruits C) Berries and orange vegetables D) Dairy products

Beans, dried fruits, and leafy, green vegetables

A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from? Select all that apply. Infection Blood loss Abnormal erythrocyte production Destruction of normally formed red blood cells Inadequate formed white blood cells

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

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

C

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. What is the most important action for the nurse to take? A) Continue with the present infusion rate of heparin. B) Consult with the physician about discontinuing heparin. C) Begin treatment with the prescribed warfarin (Coumadin). D) Increase the heparin infusion by 100 units per hour.

Consult with the physician about discontinuing heparin.

The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions? A) Do not take medication with orange juice because it will delay absorption of the iron. B) Iron may cause indigestion and should be taken with an antacid such as Mylanta. C) Dilute the liquid preparation with another liquid such as juice and drink with a straw. D) Discontinue the use of iron if your stool turns black.

Dilute the liquid preparation with another liquid such as juice and drink with a straw.

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? A) Drink liquid iron preparations with a straw. B) Take iron with an antacid to avoid stomach upset. C) Avoid vitamin C as it prevents absorption. D) Taking iron pills with milk aids in absorption.

Drink liquid iron preparations with a straw.

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

Eating calf's liver with a glass of orange juice

When assessing a client with anemia, which assessment is essential? A) Health history, including menstrual history in women B) Family history C) Age and gender D) Lifestyle assessments, such as exercise routines

Health history, including menstrual history in women

When assessing a client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential? A) Health history, such as bleeding, fatigue, or fainting B) Menstrual history C) Age and gender D) Lifestyle assessments, such as exercise routines

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? A) Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit B) Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients C) Risk for falls related to complaints of dizziness D) Fatigue related to decreased hemoglobin and hematocrit

Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit

The nurse observes a co-worker who always seems to be eating a cup of ice. The nurse encourages the co-worker to have an examination and diagnostic workup with the health care provider. What type of anemia is the nurse concerned the co-worker may have? A) Iron deficiency anemia B) Megaloblastic anemia C) Sickle cell anemia D) Aplastic anemia

Iron deficiency anemia

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) Enlarged mean corpuscular volume (MCV) C) Low ferritin level concentration D) Elevated red blood cell (RBC) count

Low ferritin level concentration

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? A) Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential B) Monitoring the client's breathing and reviewing the client's arterial blood gases C) Monitoring the client's heart rate and reviewing the client's hemoglobin D) Monitoring the client's blood pressure and reviewing the client's hematocrit

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? A) Stop the nosebleed B) Put in an IV line C) Ask someone to clean the bedpan D) Notify the physician

Notify the physician

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

Pallor

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

Pallor, tachycardia, and a sore tongue

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

Pancytopenia

While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters? A) Platelet count, prothrombin time, and partial thromboplastin time B) Platelet count, blood glucose levels, and white blood cell (WBC) count C) Thrombin time, calcium levels, and potassium levels D) Fibrinogen level, WBC, and platelet count

Platelet count, prothrombin time, and partial thromboplastin time

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) Posterior iliac crest B) Sternum C) Femur D) Ankle

Posterior iliac crest

Which of the following is considered an antidote to heparin? A) Protamine sulfate B) Vitamin K C) Narcan D) Ipecac

Protamine sulfate

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) The onset of a bacterial infection B) Bleeding C) Abdominal pain D) Diarrhea

The onset of a bacterial infection

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

Use a disposable razor when shaving.

A client is seen in the emergency department with severe pain related to a sickle cell crisis. What does the nurse understand is occurring with this client? A) The client has a decreased tolerance of pain related to the chronic nature of the illness. B) Bone marrow decreases the erythrocyte production causing decrease in hypoxia. C) Overhydration enlarges the red blood cells. D) Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.

Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.

A nurse cares for clients with hematological disorders and notes that women are diagnosed with hemochromatosis at a much lower rate than men. What is the primary reason for this? A) Women lose iron through menstrual cycles B) Women rarely manifest the gene expression C) Women have lower hemoglobin levels D) Women require grater folic acid supplementation

Women lose iron through menstrual cycles

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

low hematocrit.

A client reports feeling tired, cold, and short of breath at times. Assessment reveals tachycardia and reduced energy. What would the nurse expect the physician to order? A) CBC B) antibiotic C) chest radiograph D) ECG

CBC

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? A) Potassium level of 5.2 mEq/L B) Magnesium level of 2.5 mg/dL C) Calcium level of 9.4 mg/dL D) Creatinine level of 6 mg/100 mL

Creatinine level of 6 mg/100 mL

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 mean corpuscular volume D) Increased reticulocyte count

Decreased level of erythropoietin

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? A) It is part of the required assessment information. B) It is important for the nurse to determine what type of foods the patient will eat. C) It may indicate deficiencies in essential nutrients. D) It will determine what type of anemia the patient has.

It may indicate deficiencies in essential nutrients.

A client with a diagnosis of pernicious anemia comes to the clinic and reports numbness and tingling in the arms and legs. What do these symptoms indicate? A) Loss of vibratory and position senses B) Neurologic involvement C) Severity of the disease D) Insufficient intake of dietary nutrients

Neurologic involvement

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

Neurologic involvement

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 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. D) Inform the client that the bath and positioning is an important part of client care and will be done right after pain medication administration.

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

When a nurse is planning discharge teaching for a client admitted with sickle cell crisis, which information should the nurse include in the teaching? A) Drink only one caffeinated beverage daily B) Take a daily multivitamin with iron C) Limit fluids to 2 quarts a day D) Receive pneumococcal and annual influenza vaccinations

Receive pneumococcal and annual influenza vaccinations

The nurse is screening donors for blood donation. Which client is an acceptable donor for blood? A) Has a history of viral hepatitis as a teenager 10 years ago B) Received a blood transfusion within 1 year C) Reports having a cold 1 month ago that resolved quickly D) Had a dental extraction 2 days ago for caries in a tooth

Reports having a cold 1 month ago that resolved quickly

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) Meat, egg yolks, oysters, and shellfish C) Rich sources of vitamin C D) Sources of vitamin B12

Rich sources of vitamin C

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

Take 1 hour before breakfast

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 levels. B) There is a strong correlation between iron stores and hemoglobin characteristics. C) There is an inverse relationship between iron stores and hemoglobin levels. D) There is a weak correlation between iron stores and hemoglobin levels.

There is a strong correlation between iron stores and hemoglobin levels.

The nurse caring for an older adult with a diagnosis of leukemia would encourage the client to use an electric razor. What is the rationale for this statement by the nurse? A) Trauma and microabrasions from a non-electric razor may contribute to anemia. B) Strong tissues and intact clotting mechanisms may prevent hemorrhage. C) The client is at risk for spontaneous and uncontrolled bleeding. D) The client is not at risk for infection from microorganisms.

Trauma and microabrasions from a non-electric razor may contribute to anemia.