Hematologic Disorders

A student nurse is caring for a patient who is receiving chemotherapy for cancer. The student nurse reviews the laboratory data with his preceptor and notes that the patient has thrombocytopenia. Which nursing diagnosis should the nurse give the highest priority?

Ineffective tissue perfusion (cerebral, cardiopulmonary, GI)

A patient has come to the OB/GYN clinic with complaints of a heavy menstrual flow. The nurse knows that red blood cell production will be increased in the patient's body. Because of this, the nurse is aware that the patient may need to increase her daily intake of what?

Iron

A patient comes to the clinic complaining of fatigue and pica. Laboratory findings reveal a low serum iron level and a low ferritin level. What would the nurse suspect that the patient will be diagnosed with?

Iron deficiency anemia

The nurse is providing education to a patient with iron deficiency anemia who has been prescribed iron supplements. What will the nurse include in her teaching?

Iron will cause the stools to darken in color.

You are caring for a patient with a diagnosis of hypoproliferative anemia. You are aware that this type of anemia is due to what?

Lack of production of RBCs

In the process of hematopoiesis stem cells differentiate into either myeloid or lymphoid stem cells. What do myeloid stem cells further differentiate into

Leukocytes, platelets, and erythrocytes

You are caring for a patient whose bone marrow has been replaced by scar tissue in many of the areas that produce blood cells for the body. What organs can become active in blood cell production by the process of extramedullary hematopoiesis?

Liver and spleen

You are assessing a new patient with complaints of a sore, red, and smooth tongue. Based upon your assessment findings, you know that the patient is demonstrating symptoms associated with what?

Megaloblastic anemia

You are the nurse caring for a patient with acute leukemia. What would you do to assess the risk for infection?

Monitor WBC count

You are triaging patients in the walk-in clinic. A 77-year-old man comes in complaining of fatigue and back pain. What should be closely evaluated in this patient?

Multiple myeloma

The home health nurse is caring for a patient with multiple myeloma. What does the nurse know is a priority issue to be managed in a patient with multiple myeloma?

Pain

You are the nurse assessing a patient with multiple myeloma. What should you keep in mind that patients with multiple myeloma are at risk for?

Pathologic bone fractures.

When a human body receives an injury that causes blood loss, there are several processes involved in maintaining hemostasis. When a blood clot is no longer needed, what digests the fibrinogen and fibrin?

Plasmin

A patient undergoing a hip replacement has autologous blood on standby if a transfusion is needed. What is the primary advantage of autologous transfusions?

Prevention of viral infections from another person's blood

A nursing student is caring for a patient with acute myeloid leukemia who is preparing to undergo induction therapy. In preparing a plan of care for this patient, the student should assign the highest priority to which nursing diagnoses?

Risk for infection

You are caring for a patient with Hodgkin's lymphoma at the oncology clinic. While doing patient teaching you know you need to stress what?

Risk of infection

A nurse is caring for a 16-year-old who has sickle cell anemia. The nurse is concerned about substance abuse in this patient. What would the nurse encourage the patient to do to prevent substance abuse of analgesics in this patient?

Seek care from a single provider for pain relief.

An elderly man trips over his dog and receives an injury to the skin, which causes minor blood loss. Primary hemostasis is activated in this patient. What occurs in primary hemostasis?

Severed blood vessels constrict

A critical care nurse is caring for a patient with autoimmune hemolytic anemia. The patient is not responding to conservative treatments, and his condition is now becoming life threatening. The nurse is aware that a treatment option in this case may include what?

Splenectomy

The nurse caring for a patient receiving a transfusion notes that 15 minutes after the infusion of packed red blood cells (RBCs) has begun, the patient is having difficulty breathing and chest tightness. What is the most appropriate initial action for the nurse to take?

Stop the transfusion immediately.

A nurse is admitting a patient with idiopathic thrombocytopenic purpura to the unit. In completing the admission assessment, the nurse must be alert for what medications that alter platelet function?

Sulfa-containing medications, aspirin-based drugs, and NSAIDs

A 12-year-old on the oncology unit at children's hospital tells the nurse that they have discovered there are different kinds of leukemia. The child asks the nurse to explain what makes them all "leukemia." What would the nurse reply

The different leukemias all have unregulated proliferation of white blood cells.

A patient newly diagnosed with thrombocytopenia is admitted to your unit. After the admission assessment, the patient asks you to explain the disease to her. What would you explain to the patient about this condition?

There could be decreased production of platelets.

You are doing patient teaching with a patient newly diagnosed with primary thrombocythemia. While teaching the patient about the signs and symptoms of thrombosis, what neurologic manifestations would you include?

Visual changes

A patient is admitted to the ICU with a diagnosis of bleeding esophageal varices. The patient has a comorbidity of cirrhosis. An attempt to stop the bleeding has been only partially successful. What would the critical care nurse expect to have ordered for this patient?

Fresh frozen plasma

A patient, 25 years of age, comes to the emergency department complaining of excessive bleeding from a cut sustained when cleaning a knife. Blood work shows a prolonged PT but a vitamin K deficiency is ruled out. When assessing the patient, areas of ecchymosis are noted on other areas of the body. The nurse caring for this patient suspects what?

Hepatic dysfunction

A 67-year-old male is admitted to your unit with a suspected diagnosis of acute myeloid leukemia (AML). The patient asks you how much time he has left. What would you tell this patient?

"The 5-year survival rate for those older than 65 years of age is 4%."

A patient with non-Hodgkin's lymphoma is receiving information from the oncology nurse. The patient asks the nurse why she should stop drinking and smoking and stay out of the sun. What would be the nurse's best response?

"You need to reduce other factors that increase the risk of developing second cancers."

The nurse is caring for a patient with severe anemia. The patient is tachycardic and complains of dizziness and exertional dyspnea. The nurse knows that in an effort to deliver more blood to hypoxic tissue the workload on the heart is increased. What signs and symptoms might develop if this patient goes into heart failure?

Hepatomegaly

A patient with renal failure has decreased erythropoietin production. Upon analysis of the patient's complete blood count, the nurse will expect which of the following complete blood count results?

A decreased hemoglobin and hematocrit

A 16-year-old female comes into the clinic complaining of fatigue. Blood work shows an increased bilirubin concentration and an increased reticulocyte count. What would the nurse suspect the patient has?

A hemolytic anemia

The nursing instructor is talking with the students about the care of a patient with multiple myeloma who is experiencing bone destruction. What would the instructor tell the students the patient should be assessed for signs of?

Hypercalcemia

A 35-year-old male is admitted to the hospital complaining of severe headaches, vomiting, and testicular pain. His blood work shows reduced numbers of platelets, leukocytes, and erythrocytes with a high proportion of immature cells. The nurse caring for this patient suspects a diagnosis of what?

ALL- Acute Lymphotic Leukemia

You are caring for a patient with a hematologic disorder. The patient asks you where the body forms blood cells. Where would you tell the patient that blood cells are formed?

In the bone marrow

A student asks the physiology instructor about the clotting cascade. The instructor explains that plasminogen is a component necessary in the clotting cascade. Where in the body is plasminogen present?

All body fluids

A patient with advanced leukemia is responding poorly to treatment. You find the patient tearful and trying to express his feelings, but he is having difficulty. What would be your first nursing action?

Ask if he would like you to sit with him while he collects his thoughts.

A patient with leukemia has developed stomatitis and is not eating. An oral anesthetic has been prescribed. What would you warn the patient about?

Chew with extreme care to avoid inadvertently biting the tongue.

A patient is admitted to the hospital with pernicious anemia. What possible complications would the nurse caring for this patient know to monitor for?

Confusion

The nurse on the pediatric unit is caring for a 10-year-old boy with a diagnosis of hemophilia. The nurse knows that a priority nursing diagnosis for a patient with hemophilia is what?

Coping

A patient diagnosed with leukemia has just been admitted to the oncology unit. You are helping to write this patient's care plan. You know that potential complications for patients with leukemia include what?

DIC