Chapter 34: Assessment and Management of Patients With Hematologic Disorders NCLEX

C (A client who's dizzy and anemic is at risk for injury because of his weakened state. Assisting him with the bedpan would best meet his needs at this time without risking his safety. The client may fall if walking to the bathroom, left alone to urinate, or trying to stand up.)

A client is being admitted to the hospital with abdominal pain, anemia, and bloody stools. He complains of feeling weak and dizzy. He has rectal pressure and needs to urinate and move his bowels. The nurse should help him: A. to the bathroom. B. to the bedside commode. C. onto the bedpan. D. to a standing position so he can urinate.

B, C, D (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, sicklecell 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 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. Abnormal erythrocyte production D. Destruction of normally formed red blood cells E. Inadequate formed white blood cells

A (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 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 A. Administer the prescribed enoxaparin (Lovenox). B. Encourage a diet high in vitamin K. C. Have the client limit physical activity. D. Monitor partial thromboplastin (PTT) time.

A (Instructions the nurse will provide for the client taking oral ferrous sulfate is to administer the medication on an empty stomach. Instructions also include that there is decreased absorption of iron with food, particularly dairy products. The client is to increase vitamin C intake (fruits, juices, tomatoes, broccoli), which will enhance iron absorption. The client is to also increase foods high in fiber to decrease risk of constipation.)

A client is prescribed 325 mg/day of oral ferrous sulfate. The nurse includes in client teaching, "Take your iron pill: A. 1 hour before breakfast. B. With dairy products. C. And decrease fruits and juices in your diet. D. Along with a decreased amount of dietary fiber.

D (When a transfusion reaction occurs, the transfusion should be immediately stopped, normal saline solution should be infused to maintain venous access, and the physician and blood bank should be notified immediately. Other nursing actions include saving the blood bag and tubing, rechecking the blood type and identification numbers on the blood tags, monitoring vital signs, obtaining necessary laboratory blood and urine samples, providing proper documentation, and monitoring and treating for shock. Because they can cause red blood cell hemolysis, dextrose solutions shouldn't be infused with blood products. Antihistamines are administered for a mild allergic reaction, not a hemolytic reaction.)

A client receiving a blood transfusion experiences an acute hemolytic reaction. Which nursing intervention is the most important? A. Immediately stop the transfusion, infuse dextrose 5% in water (D5W), and call the physician. B. Slow the transfusion and monitor the client closely. C. Stop the transfusion, notify the blood bank, and administer antihistamines. D. Immediately stop the transfusion, infuse normal saline solution, call the physician, and notify the blood bank.

A (Most clients with iron-deficiency anemia have reduced energy, feel cold all the time, and experience fatigue and dyspnea with minor physical exertion. The heart rate usually is rapid even at rest. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased. A CBC would be ordered.)

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

B (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 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

A (The client with ITP is at greatest risk for cerebral hemorrhage when the platelet count falls below 10,000/?l. Although platelet counts of 20,000/?l and 75,000/?l are below normal and increase the client's risk for bleeding, they don't increase the risk as much as a platelet count below 10,000/?l. A platelet count of 135,000/?l is normal and wouldn't occur in a client with ITP.)

A client with idiopathic thrombocytopenic purpura (ITP), an autoimmune disorder, is admitted to an acute care facility. Concerned about hemorrhage, the nurse monitors the client's platelet count and observes closely for signs and symptoms of bleeding. The client is at greatest risk for cerebral hemorrhage when the platelet count falls below: A. 10,000/?l. B. 20,000/?l. C. 75,000/?l. D. 135,000/?l.

A (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.)

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

D (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.)

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."

A (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 client with sickle cell anemia has a A. Low hematocrit. B. High hematocrit. C. Normal hematocrit. D. Normal blood smear.

C (Low preoperative HCT and Hb levels indicate the client may require a blood transfusion before surgery. If the HCT and Hb levels decrease during surgery because of blood loss, the potential need for a transfusion increases. Possible renal failure is indicated by elevated BUN or creatinine levels. Urine constituents aren't found in the blood. Coagulation is determined by the presence of appropriate clotting factors, not electrolytes.)

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

D (Two people with the beta-thalassemia trait have a 25% chance of having a child with thalassemia major, a potentially life-threatening disease. Iron supplements aren't used to treat thalassemia; in fact, they could contribute to iron overload. Vitamin B12 injections are used to treat pernicious anemia, not thalassemia. Thalassemia occurs primarily in people of Italian, Greek, African, Asian, Middle Eastern, East Indian, and Caribbean descent.)

A female client with the beta-thalassemia trait plans to marry a man of Italian ancestry who also has the trait. Which client statement indicates that she understands the teaching provided by the nurse? a) "If my fiancé was of Middle Eastern descent, I wouldn't be worried about having children." b) "I need to learn how to give myself vitamin B12 injections." c) "Thalassemia is treated with iron supplements." d) "I'll see a genetic counselor before starting a family."

C (Hemolytic allergic reactions are fairly common and may cause chills, fever, urticaria, tachycardia, dyspnoea, 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, diarrhoea, abdominal cramps and, possibly, shock.)

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. A hemolytic reaction to mismatched blood B. A hemolytic reaction to Rh-incompatible blood C. A hemolytic allergic reaction caused by an antigen reaction D. A hemolytic reaction caused by bacterial contamination of donor blood

B (Platelet counts may decrease with heparin therapy, and this client's platelet count has decreased. The client may have heparin-induced thrombocytopenia (HIT). Treatment of HIT includes discontinuing the heparin. The question asks about the most important action of the nurse and that is to consult with the physician about discontinuing heparin therapy. The nurse may continue with the current rate and should not increase the heparin dose until consulting with the physician. Warfarin is not administered until the platelet count has returned to normal levels.)

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: 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.

B (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 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

C (Because thrombocytopenia alters coagulation, it poses a high risk of bleeding. To help prevent capillary bleeding, the nurse should use the smallest needle possible when administering injections. The nurse doesn't need to limit visits by family members because they don't pose any danger to the client. The nurse should provide comfort measures and maintain the client on bed rest; activities such as using a wheelchair can cause bleeding. The nurse records fluid intake and output to monitor hydration; however, this action doesn't protect the client from a complication of thrombocytopenia.)

A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client? A. Limit visits by family members. B. Encourage the client to use a wheelchair. C. Use the smallest needle possible for injections. D. Maintain accurate fluid intake and output records.

B (Because many psychosocial and physiological issues affect the life of an adolescent with a chronic illness, assuring the existence of a good support structure is the most essential element of care. Availability of pain medication and adequate support are both important considerations, but it's more important to emphasize the need for an adequate support structure. The need for good hydration and follow-up visits are important, but a good support structure will help the adolescent with this treatment.)

A nurse is preparing to discharge an adolescent with sickle cell anemia. What client need should the nurse emphasize in her discharge assessment? a) The need to have pain medication available b) The need for an adequate support structure c) The need to maintain good hydration d) The need to follow up with physician visits

A (People with aplastic anemia usually have insufficient erythrocytes, leukocytes, and platelets. Encourage behaviors that will lower the risk for bleeding. Avoiding contact with people who are sick reduces the risk of acquiring an infection. Handwashing reduces the risk of acquiring an infection. Anemia can cause fatigue and shortness of breath with even mild exertion.)

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.

A (Clients with neutropenia often do not exhibit classic signs of infection. Fever is the most common indicator of infection, yet it is not always present. No definite symptoms of neutropenia appear until the client develops an infection. A routine CBC with differential can reveal neutropenia before the onset of infection.)

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

A (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 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

C (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.)

A patient with ESRD 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. Potassium level B. Creatinine level C. Hemoglobin level D. Folate levels

A (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 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? a) Decreased level of erythropoietin b) Increased reticulocyte count c) Increased mean corpuscular volume d) Decreased total iron-binding capacity

A (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 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? A. Decreased level of erythropoietin B. Decreased total iron-binding capacity C. Increased mean corpuscular volume D. Increased reticulocyte count

B (The degree of anemia in patients with end-stage renal disease varies greatly; however, in general, patients do not become significantly anemic until the serum creatinine level exceeds 3 mg/100 mL)

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) Calcium level of 9.4 mg/dL b) Creatinine level of 6 mg/100 mL c) Magnesium level of 2.5 mg/dL d) Potassium level of 5.2 mEq/L

D (The degree of anemia in patients with end-stage renal disease varies greatly; however, in general, patients do not become significantly anemic until the serum creatinine level exceeds 3 mg/100 mL.)

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

A (An expected outcome for a client experiencing a sickle-cell crisis is control of pain. Hydroxyurea is contraindicated in pregnancy because of the risk it poses for congenital abnormalities. An indication that the client is free from infection is exhibiting a normal temperature; 100.3°F is an elevated temperature. To minimize crises, the client needs to stay warm.)

A pregnant woman is hospitalized as the result of sickle-cell crisis. A finding that indicates the outcome has been achieved for this client is that the client a) Reports joint pain less than 3 on a scale of 0 to 10 b) Takes hydroxyurea (Hydrea) during her pregnancy c) Exhibits a temperature less than 100.3°F d) Describes the importance of staying cool

A (Clients with hemophilia should wear a medical identification bracelet about having this disease. Ibuprofen interferes with platelet aggregation and may increase the client's bleeding. A warm bath may lessen pain but increase bleeding. Genetic testing and counseling are not necessary for male clients, because females are the carriers of the genetic material for hemophilia.)

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 a) Wear a medical identification bracelet. b) Take ibuprofen (Motrin) for joint pain. c) Undergo genetic testing and counseling. d) Take warm baths to lessen pain.

C (Clients with hemophilia should wear a medical identification bracelet about having this disease. Ibuprofen interferes with platelet aggregation and may increase the client's bleeding. A warm bath may lessen pain but increase bleeding. Genetic testing and counseling are not necessary for male clients, because females are the carriers of the genetic material for hemophilia.)

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 A. Take ibuprofen (Motrin) for joint pain. B. Take warm baths to lessen pain. C. Wear a medical identification bracelet. D. Undergo genetic testing and counseling.

A (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.)

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

C (A nutritional assessment is important, because it may indicate deficiencies in essential nutrients such as iron, vitamin B12, and folate.)

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.

D (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).)

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) Bone marrow biopsy b) Magnetic resonance imaging (MRI) study c) Bone marrow aspiration d) Schilling test

B (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).)

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

C (Clients and families are taught to administer factor VIII intravenously. This helps to prevent bleeding episodes. Activities that minimize trauma are allowed for the toddler, and playground activities may place the toddler at risk for increased bleeding. Over-the-counter cold preparations are to be avoided, because they will interfere with platelet aggregation. Nasal packing is avoided, because when the nasal packing is removed, bleeding may occur.)

The nurse is talking with the parents of a toddler who was diagnosed with hemophilia A. The nurse teaches the parents a) To allow the toddler to participate in playground activities with other toddlers b) The importance of administering over-the-counter preparations for a cold c) How to administer factor VIII intravenously at the first sign of bleeding d) That nasal packing will be necessary for any nose bleeds

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

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

A (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.)

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) Drink at least 8 glasses of water every day. b) Avoid any sports that tire you out. c) Stay on oxygen therapy 24/7. d) Avoid any activity that makes you short of breath

A (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.)

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

A (Treatment for hemochromatosis is phlebotomy or removal of whole blood from a vein to reduce iron. Limiting dietary intake of iron is not an effective treatment. The client needs to perform activities to protect the liver, such as limiting alcohol ingestion. The definitive test for hemochromatosis had been a liver biopsy, but now genetic testing is performed. A liver biopsy could be performed to determine liver damage. However, this does not address the most immediate problem of too high iron.)

A client has hereditary hemochromatosis. Laboratory test results indicate an elevated serum iron level, high transferrin saturation, and normal complete blood count (CBC). It is most important for the nurse to A. Remove the prescribed one unit of blood. B. Instruct the client to limit iron intake in the diet. C. Inform the client to limit ingestion of alcohol. D. Educate about precautions to follow after a liver biopsy.

C (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 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.

B (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 (eg, splenomegaly) for a definitive diagnosis.)

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

A (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. Options B, C, and D are incorrect.)

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.

C (A normal platelet count is 140,000 to 400,000/mm3 in adults. Chemotherapeutic agents produce bone marrow depression, resulting in reduced red blood cell counts (anemia), reduced white blood cell counts (leukopenia), and reduced platelet counts (thrombocytopenia). Neutropenia is the presence of an abnormally reduced number of neutrophils in the blood and is caused by bone marrow depression induced by chemotherapeutic agents.)

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? A. Anemia B. Leukopenia C. Thrombocytopenia D. Neutropenia

D (Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Antibiotic therapy may interfere with synthesis of these substances, including vitamin K. Intestinal bacteria don't synthesize vitamins A, D, or E.)

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? A. Vitamin A B. Vitamin D C. Vitamin E D. Vitamin K

C (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.)

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

D (Sickle cell disease is a hereditary disorder. To manifest this disorder, a person must inherit two defective genes, one from each parent, in which case all the hemoglobin is inherently abnormal. If the person inherits only one gene, he or she carries sickle cell trait. The hemoglobin of those who have sickle cell trait is about 40% affected. The other distractors are incorrect due to these factors.)

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? A. "Most likely, the father is the carrier of the gene." B. "The trait is passed down through the mother." C. "The child must inherit two defective genes, one from each parent." D. "It is an acquired, not a hereditary disorder."

D (The client with an absolute neutrophil count less than 1000/mm³ is to be placed in a private room. Staff with a sore throat or cold should not be assigned to provide care for this client. The client does not need to be placed in isolation, but other neutropenic precautions needs to be followed, such as allowing no visitors with infection. Water in oxygen humdifiers should be changed every 24 hours.)

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 a) Changes the water in the humidifier for oxygen therapy every 48 hours b) Places the client in isolation and allows no visitors c) Allows unlicensed assistive personnel who reports having a sore throat to provide care d) Assigns the client to a private room

A (The most common cause of iron deficiency anemia in premenopausal women is menorrhagia. In pregnancy, it may be caused by inadequate intake of iron. Iron malabsorption may occur following a gastrectomy or with celiac disease. Lack of vitamin B12 is also a potential cause of anemia.)

The most common cause of iron-deficiency anemia in premenopausal women includes which of the following? A. Menorrhagia B. Inadequate iron supplementation C. Iron malabsorption D. Lack of vitamin B12

A (Iron-deficiency anemia is unusual in older adults. Normally, the body does not eliminate excessive iron, causing total body iron stores to increase with age and necessitating maintenance of hydration. If an older adult is anemic, blood loss from the gastrointestinal or genitourinary tracts is suspected. Observing the stool for blood will help detect blood from GI loss. Bleeding gums may indicate periodontal disease, or anticoagulation from medication is not related to age. Blood in sputum can be an indicator of various lung disorders that may affect all age groups. Facial droop may indicate an impending stroke or Bell's palsy and would not be a reason for blood loss.)

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? A. Observe stools for blood. B. Observe the gums for bleeding after the client brushes teeth. C. Observe the sputum for signs of blood. D. Observe client for facial droop.

A (People with iron deficiency anemia may crave ice, starch, or dirt; this craving is known as pica.)

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 physician. 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

D (Phlebotomy is a critical part of therapy and the only treatment that has demonstrated improved survival. Aspirin should be avoided, and antiplatelet therapy should be used with caution due to the risk of bleeding. Compression stockings are not necessary for walking but should be used for airplane travel.)

The nurse's role in the management of polycythemia vera is primarily that of an educator. Choose the best health promotion advice that a nurse could give. a) Take aspirin daily to prevent clot formation. b) Use compression stockings when walking to prevent deep vein thrombosis (DVT). c) Take antiplatelets on a regular basis. d) Participate in regular phlebotomy procedures to decrease blood viscosity.

B (Megaloblasts are abnormally large erythrocytes. Blast cells are primitive white blood cells (WBCs). Mast cells are cells found in connective tissue involved in defense of the body and coagulation. Monocytes are large WBCs that become macrophages when they leave the circulation and move into body tissues.)

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called A. Blast cells. B. Megaloblasts. C. Mast cells. D. Monocytes.

B (The client with the amniotic fluid embolism is at greatest risk for developing DIC. Other risk factors for developing DIC include trauma, cancer, shock, and sepsis. Possible cocaine overdose, a stage IV pressure ulcer, and heart failure and renal failure aren't risk factors for DIC.)

Which client is most at risk for developing disseminated intravascular coagulation (DIC)? A. A client admitted with suspected cocaine overdose B. A client with an amniotic fluid embolism C. A client with a stage IV pressure ulcer D. A client with heart failure and renal failure

A (The antidote for warfarin is vitamin K. Protamine sulfate is the antidote for heparin. Aspirin and clopidogrel are both antiplatelet medications.)

Which medication is the antidote to warfarin? A. Vitamin K B. Protamine sulfate C. Aspirin D. Clopidogrel

C (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.)

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

A (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.)

Which of the following vitamins enhance the absorption of iron? A. Vitamin C B. Vitamin A C. Vitamin D D. Vitamin E

B (Both B and T lymphocytes respond to exposure to antigens. Granulocytes include basophils, neutrophils, and eosinophils. A spherocyte is a red blood cell without central pallor, seen with hemolysis. A thrombocyte is a platelet.)

Which term refers to a form of white blood cell involved in immune response? A. Granulocyte B. Lymphocyte C. Spherocyte D. Thrombocyte

B (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.)

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

A (An RBC that has pale or lighter cellular contents is hypochromic. A normocytic RBC is normal or average in size. A microcytic RBC is smaller than normal. Hyperchromic is used to describe an RBC that has darker cellular contents.)

Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents? a) Hypochromic b) Microcytic c) Normocytic d) Hyperchromic

A (Protamine sulphate, in the appropriate dosage, acts quickly to reverse the effects of heparin. Vitamin K is the antidote to warfarin (Coumadin). Narcan is the drug used to reverse signs and symptoms of medication-induced narcosis. Ipecac is an emetic used to treat some poisonings.)

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

A (The myeloid stem cell is responsible not only for all non lymphoid white blood cells, but also for the production of red blood cells and platelets. Lymphoid cells produce either T or B lymphocytes. A monocyte is large WBC that becomes a macrophage when is leaves the circulation and moves into body tissues. A neutrophil is a fully mature WBC capable of phagocytosis.)

Which cell of haematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? a) Myeloid stem cell b) Neutrophil c) Monocyte d) Lymphoid stem cell

A (Myeloid stem cells are responsible not only for all nonlymphoid white blood cells (WBC) but also for the production of red blood cells and platelets. Lymphoid cells produce either T or B lymphocytes. A monocyte is large WBC that becomes a macrophage when is leaves the circulation and moves into body tissues. A neutrophil is a fully mature WBC capable of phagocytosis.)

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? A. Myeloid stem cell B. Lymphoid stem cell C. Monocyte D. Neutrophil

A (Establishing a written emergency plan that includes what to do in specific situations helps the family provide safety measures for their child with hemophilia. Padding corners of furniture and using kneepads don't help provide a safe home environment for children of all ages. Telling the parents to be a role model by wearing a bike helmet is only applicable to children who are old enough to emulate their parent's behaviors. Having the child problem-solve hypothetical health situations doesn't help provide a safe environment; it addresses problem solving.)

Which nursing instructions help parents of a child with hemophilia provide a safe home environment for their child? a) "Establish a written emergency plan including what to do in specific situations and the names and phone numbers of emergency contacts." b) "Talk with your child about home safety and have him problem-solve hypothetical situations about his health." c) "Pad the corners of coffee tables when your child is a toddler and provide kneepads for sports when the child is older." d) "Be a role model to your child by wearing a helmet when riding a bike so your child will, too."

A (Anemia is the most common hematologic condition affecting elderly patients: with each successive decade of life, the incidence of anemia increases. Thrombocytopenia is a low platelet count. Leukopenia is a low leukocyte count. Bandemia is an increased number of band cells.)

Which of the following is the most common hematologic condition affecting elderly patients A. Anemia B. Thrombocytopenia C. Leukopenia D. Bandemia