Hematology

An adolescent is admitted with an acute hemophilia episode. Rest, ice, compression, and elevation will be most helpful in: 1. Encouraging immobilization 2. Decreasing swelling and inflammation 3. Providing pain relief and reduce anxiety 4. Controlling bleeding and retaining joint function

Correct 4. Controlling bleeding and retaining joint function Rest, ice, compression, and elevation (RICE) therapy is implemented to support joints and prevent bleeding into joints. Total immobilization is not required. Pain may be relieved to some degree but is not assured. Reducing inflammation is not the goal of treatment for the hemophiliac process.

A nurse in the pediatric clinic is assessing an 11-month-old infant with iron-deficiency anemia. The infant's hemoglobin is 8 g/dL. What does the nurse expect to observe when assessing the infant? 1. Pallor 2. Tremors 3. Cyanosis 4. Spasticity

Correct 1. Pallor Paleness occurs because the hemoglobin within the erythrocytes gives them their red color; a low hemoglobin level in the blood results in pallor. Tremors are not a sign of anemia. The skin is usually pale; cyanosis is not typical. Spasticity is not a sign of anemia.

The mother of a 13-year-old child with sickle cell anemia tells the nurse that the family is going camping by a lake this summer. She asks what activities are appropriate for her child. Which activity should the nurse suggest? 1. Swimming in the lake 2. Soccer with the family 3. Climbing the mountain trails 4. Motorboat rides around the lake

Correct 4. Motorboat rides around the lake Motorboating is a relatively passive activity that will not increase the child's oxygen demands, which can precipitate sickling and therefore a painful episode. Mountain lakes are usually cold; temperature extremes can contribute to sickling that may precipitate a painful episode. Playing soccer may lead to increased cellular metabolism and increased tissue hypoxia, which can precipitate sickling that could progress to a painful episode. High altitudes should be avoided because the lower oxygen concentration of the air might trigger a painful episode.

A nurse is teaching the parents of a toddler with a recent diagnosis of hemophilia about the disease. What area of the body should the nurse include as the most common site for bleeding? 1. Brain 2. Joints 3. Kidneys 4. Abdomen

correct 2. Joints The joints are the most commonly involved areas because of weight-bearing and constant movement. Neither the brain, the kidneys, nor the abdomen is the most common site; however, bleeding may occur in any of these areas.

A nurse provides teaching regarding vitamin B12 injections to a client with pernicious anemia. The nurse concludes that the teaching was understood when the client states, "I must take the drug: 1. When feeling fatigued." 2. Until my symptoms subside." 3. Monthly, for the rest of my life." 4. During exacerbations of anemia."

Correct 3. Monthly, for the rest of my life." Because the intrinsic factor does not return to gastric secretions even with therapy, B12 injections will be required for the remainder of the client's life. The drug must be taken on a regular basis for the rest of the client's life.

A client develops iron deficiency anemia. Which of the client's laboratory test results should the nurse expect to be decreased? 1. Ferritin level 2. Platelet count 3. White blood cell count 4. Total iron-binding capacity

1. Ferritin level Ferritin, a form of stored iron, is reduced with iron deficiency anemia. Platelets will be within the expected range or increased with iron deficiency anemia. Red, not white, blood cells are decreased with iron deficiency anemia. Total iron-binding capacity will be increased with iron deficiency anemia.

A 4-year-old child is admitted to the pediatric unit with a tentative diagnosis of acute lymphocytic leukemia (ALL). The mother states that changes in her child's behavior and the "black and blue" marks were noticed several days ago. She blames herself for not bringing her child to the clinic sooner. On what information about the pathophysiology of leukemia should the nurse base a response? 1. The diagnosis can be certain only after a blood smear is analyzed. 2. If leukemia is diagnosed, the child's prognosis is probably guarded. 3. Early signs and symptoms of leukemia are similar to those of other mild illnesses of childhood. 4. The description of the clinical findings indicates that the child has been ill for longer than a single week.

Correct 3. Early signs and symptoms of leukemia are similar to those of other mild illnesses of childhood. To allay parental guilt and anxiety, it is important to acknowledge how difficult it is to recognize severe illness on the basis of changes in the child's behavior and ecchymoses that can result when a child bangs into an object, a common occurrence in young children. A bone marrow aspiration or biopsy is required for a definitive diagnosis. ALL in children has a favorable prognosis, depending on several factors, including the child's age at diagnosis, the white blood cell count, and the type of cell involved. Even if the mother missed the fact that her child was so ill, mentioning this may cause more anxiety and guilt and interfere with the development or a nurse-client rapport.

A toddler with hemophilia A is receiving factor VIII. The mother asks the nurse, "If my son hurts himself, I'll give him 2 children's Advil. Is that right?" How should the nurse respond? 1. "That's right. Advil will ease the pain." 2. "Give him Tylenol. Advil may cause bleeding." 3. "No. I'll explain why he isn't allowed pain medications." 4. "You seem concerned about giving medications to your child."

Correct 2. "Give him Tylenol. Advil may cause bleeding." The parent is asking a specific question that should be answered by the nurse. Ibuprofen (Advil) is contraindicated because it may cause more bleeding. Ibuprofen interferes with platelet function and may cause more bleeding; therefore an analgesic such as acetaminophen (Tylenol) should be administered, because it does not interfere with coagulation. Analgesics are permitted, provided they do not have anticoagulant effects.

A client is receiving epoetin (Epogen) for the treatment of anemia associated with chronic renal failure. Which client statement indicates to the nurse that further teaching about this medication is necessary? 1. "I realize it is important to take this medication because it will cure my anemia." 2. "I know many ways to protect myself from injury because I am at risk for seizures." 3. "I recognize that I may still need blood transfusions if my blood values are very low." 4. "I understand that I will still have to take supplemental iron therapy with this medication."

Correct 1. "I realize it is important to take this medication because it will cure my anemia." Epoetin will increase a sense of wellbeing but it will not cure the underlying medical problem; this misconception needs to be corrected. Seizures are a risk during the first 90 days of therapy, especially if the hematocrit increases more than four points in a two week period. A dose adjustment may be necessary. Blood transfusions may still be necessary when the client is severely anemic. Supplemental iron therapy is still necessary when receiving epoetin because the increased red blood cell production still requires iron.

The nurse expects that the most definitive test to confirm a diagnosis of multiple myeloma is: 1. Bone marrow biopsy 2. Serum test for hypercalcemia 3. Urine test for Bence Jones protein 4. X-ray films of the ribs, spine, and skull

Correct 1. Bone marrow biopsy A definite confirmation of multiple myeloma can be made only through a bone marrow biopsy; this is a plasma cell malignancy with widespread bone destruction. Although calcium is lost from bone tissue and hypercalcemia results, this is not a confirmation of the disease. Although Bence Jones protein is found in the urine, it does not confirm the disease. X-ray films will show the characteristic "punched-out" areas caused by the increased number of plasma cells, which contributes to the making of the diagnosis. The definitive diagnosis is made on biopsy.

A client is seen in the clinic with sickle cell anemia. The primary health care provider has prescribed an iron supplement to treat the client's anemia. The primary concern in regards to giving the supplement 1. Giving iron with this condition is contraindicated. 2. Give iron with orange juice to improve absorption. 3. Iron given in liquid form should be given using a straw to prevent staining teeth. 4. The client must be warned that iron usually changes the color of feces to black.

Correct 1. Giving iron with this condition is contraindicated. Giving iron is contraindicated as sickled cells do not incorporate the iron so it will build up in the body, causing pain, rather than being absorbed. Giving iron with orange juice is correct but not to a person with sickle cell anemia. Liquid iron should be administered with a straw to prevent staining teeth, but not with this condition. Feces will turn dark with iron supplements; however, this client should not be receiving iron.

A client is receiving warfarin (Coumadin). Which test result should the nurse use to determine if the daily dose of this anticoagulant is therapeutic? 1. International normalized ratio (INR) 2. Accelerated partial thromboplastin time (APTT) 3. Bleeding time 4. Sedimentation rate

Correct 1. International normalized ratio (INR) Warfarin initially is prescribed day by day, based on INR blood test results. This test provides a standard system to interpret prothrombin times. APTT is used to evaluate the effects of heparin, which acts on the intrinsic pathway. Bleeding time is the time required for blood to cease flowing from a small wound; it is not used for warfarin dosage calculation. Sedimentation rate is a test used to determine the presence of inflammation or infection; it does not indicate clotting ability.

A 12-year-old child with sickle cell anemia is admitted during a vaso-occlusive crisis. What is the priority of care for this child? 1. Relieving pain 2. Exercising joints 3. Increasing urine output 4. Improving respirations

Correct 1. Relieving pain A vaso-occlusive crisis is accompanied by severe pain because the clumped red blood cells block small vessels. Swollen limbs are painful and should not be exercised during a pain episode. Although increased output, associated with appropriate hydration, is an important objective, pain relief is the priority. Improved respiratory function occurs as pain is relieved.

A child has been diagnosed with hemophilia type A after experiencing excessive bleeding from a minor trauma. The mother shares that she is four weeks pregnant and questions as to whether this pregnancy will result in a child with hemophilia. The best response is: 1. Probably not, as there is a 50% risk of a mother who is a carrier transmitting the disease, and one child already has the condition. 2. With each pregnancy, there is a 50% chance of a carrier transmitting the condition or being a carrier, depending on the sex of the child. 3. Definitely, because the one child is hemophiliac, all future pregnancies will result in children with the condition. 4. If both parents have the condition, the child automatically will have hemophilia.

Correct 2, With each pregnancy, there is a 50% chance of a carrier transmitting the condition or being a carrier, depending on the sex of the child. With each pregnancy there is a 50% chance of a carrier transmitting the condition or being a carrier. The odds are the same with each pregnancy and do not change based upon a previous pregnancy. One child currently having the condition does not affect this pregnancy. A recessive trait will not automatically mean all future pregnancies will result in children with hemophilia. Both parents having the condition will not result necessarily in a child having hemophilia, as this is a recessive trait.

A client is seen in the clinic with sickle cell anemia. The hemoglobin range that is expected to be seen in this client in sickle cell crisis would be: 1. 3--4g/100 mL 2. 6--8g/100 mL 3. 12--14g/100 mL 4. 16--18g/100 mL

Correct 2. 6--8g/100 mL In sickle cell crisis, hemoglobin values are usually in the 6--8g/100 mL range showing many sickle shaped cells, and the client also will have a low oxygen level. A level of 3--4g/100 mL would not carry enough oxygen as hemoglobin carries oxygen. A range of 12--14g/100 mL is not indicative of anemia. 16--18g/100 mL may be indicative of dehydration rather than anemia.

A client is receiving warfarin (Coumadin) for a pulmonary embolism. Which drug is contraindicated when taking warfarin? 1. Ferrous sulfate 2. Acetylsalicylic acid (aspirin) 3. Atenolol (Tenormin) 4. Chlorpromazine (Thorazine)

Correct 2. Acetylsalicylic acid (aspirin) Acetylsalicylic acid can cause decreased platelet aggregation, increasing the risk for undesired bleeding that may occur with administration of anticoagulants. Ferrous sulfate does not affect warfarin; it is used for red blood cell synthesis. Atenolol is a beta blocker that reduces blood pressure; it does not affect bleeding. Chlorpromazine is a neuroleptic; it does not affect bleeding.

An older adult with cerebral arteriosclerosis is admitted with atrial fibrillation and is started on a continuous heparin infusion. What clinical finding enables the nurse to conclude that the anticoagulant therapy is effective? 1. A reduction of confusion 2. An activated partial thromboplastin (APTT) twice the usual value 3. An absence of ecchymotic areas 4. A decreased viscosity of the blood

Correct 2. An activated partial thromboplastin (APTT) twice the usual value Desired anticoagulant effect is achieved when the activated partial thromboplastin time is 1.5 to 2 times normal. While anticoagulants help prevent thrombi that could block cerebral circulation, they do not increase cerebral perfusion, and so will not affect existing confusion. Although absence of bleeding suggests that the drug has not reached toxic levels, it does not indicate its effectiveness. This medication does not affect the viscosity of blood.

A client is diagnosed with pancytopenia caused by chemotherapy. What should a nurse teach the client about this complication? 1. Begin a program of meticulous mouth care. 2. Avoid traumatic injury and exposure to infection. 3. Increase oral fluid intake to at least 3 L a day. 4. Report unusual muscle cramps or tingling sensations in the extremities.

Correct 2. Avoid traumatic injury and exposure to infection. Reduced platelets increase the likelihood of uncontrolled bleeding; reduced lymphocytes increase the susceptibility to infection. Beginning a program of meticulous mouth care is helpful for stomatitis, not pancytopenia; aggressive oral hygiene may precipitate bleeding from the gums. Although fluids may be increased to flush out the toxic byproducts of chemotherapy, this will have no effect on pancytopenia. Unusual muscle cramps or tingling sensations in the extremities are signs of hypocalcemia and do not apply to pancytopenia.

A 28-year-old male client is undergoing tests to confirm the diagnosis of Hodgkin lymphoma. The client and his wife are worried that he may have cancer. The wife states, "Don't you think it is unlikely for someone like my husband to have cancer?" The nurse's response is based on the information that Hodgkin lymphoma is: 1. More likely to affect women than men. 2. Diagnosed during adolescence and young adulthood. 3. Typically a disease of older rather than younger adults. 4. Usually occurs frequently among populations of Asian heritage.

Correct 2. Diagnosed during adolescence and young adulthood. Hodgkin lymphoma occurs most often during the ages of 15 to 35 years of age and between 50 to 60 years of age. Hodgkin lymphoma affects younger men and women equally and affects more men than women between the ages of 50 and 60 years. The incidence of Hodgkin lymphoma is not limited to people in older age groups. The prevalence of Hodgkin lymphoma is increased in teenagers and young adults (15 to 35 years of age). Asian populations are less likely to develop Hodgkin lymphoma than other populations.

A nurse is administering erythropoietin (Epogen) three times a week to a client receiving chemotherapy for cancer. Which client response is considered most significant? 1. Elevated liver enzymes 2. Elevated hematocrit level 3. Increase in the white blood cell (WBC) count 4. Increase in Kaposi's sarcoma lesions .

Correct 2. Elevated hematocrit level Erythropoietin stimulates red blood cell production, thereby increasing the hematocrit level. An elevated liver panel is not related to erythropoietin because erythropoietin is not hepatotoxic. Erythropoietin increases red blood cells (RBCs), not WBCs. Increased Kaposi's sarcoma lesions are a sign of acquired immunodeficiency syndrome (AIDS) progression and are not affected by erythropoietin

A client with multiple myeloma who is receiving the alkylating agent melphalan (Alkeran) returns to the oncology clinic for a follow-up visit. For which side effect should the nurse monitor the client? 1. Hirsutism 2. Leukopenia 3. Constipation 4. Photosensitivity

Correct 2. Leukopenia Melphalan depresses the bone marrow, causing a reduction in white blood cells (leukopenia), red blood cells (anemia), and thrombocytes (thrombocytopenia); leukopenia increases the risk of infection. Hirsutism occurs with the administration of androgens to women. Diarrhea, not constipation, occurs with melphalan. Photosensitivity occurs with 5-fluorouracil, floxuridine, and methotrexate, not with melphalan.

A client with follicular non-Hodgkin lymphoma is to be treated with rituximab (Rituxan), a targeted monoclonal antibody. The nurse should monitor the client for what common side effect of rituximab? 1. Polyphagia 2. Leukopenia 3. Constipation 4. Hypertension

Correct 2. Leukopenia Rituximab targets the CD 20 antigen, which regulates cell cycle differentiation and is found on malignant B lymphocytes; as a result, rituximab therapy can cause leukopenia and neutropenia. Anorexia, not polyphagia, may occur with rituximab therapy. Frequent stools and diarrhea, not constipation, may occur with rituximab therapy. Hypotension, not hypertension, may occur as a fatal infusion reaction to rituximab therapy.

What group of clients should the nurse anticipate to have the highest incidence of non-Hodgkin lymphomas? 1. Children 2. Older adults 3. Young adults 4. Middle-aged persons

Correct 2. Older adults The incidence increases with age; the median age when diagnosed is 67 years old. Younger individuals have a lower incidence of non-Hodgkin lymphomas.

A client who is receiving methotrexate for acute lymphocytic leukemia (ALL) develops a temperature of 101° F. The nurse notifies the health care provider. Aspirin 650 mg every four hours as needed for temperature equal to or greater than 101° F is prescribed. What should the nurse do regarding this prescription? 1. Express concern about the dosage prescribed. 2. Request a prescription for an antacid. 3. Express concern about the type of antipyretic prescribed. 4. Ask if the frequency should be every six hours instead.

Correct 3. Express concern about the type of antipyretic prescribed. Aspirin is contraindicated in the presence of bleeding tendencies, which often occur with acute lymphocytic leukemia because of its inhibitory effect on platelet aggregation. Although expressing a concern about the dosage is within acceptable limits, this analgesic is contraindicated. Although an antacid will reduce the gastric irritation common with aspirin, this analgesic is contraindicated. Although the frequency is within acceptable limits, this analgesic is contraindicated.

A client diagnosed with multiple myeloma has been given a poor prognosis. After discharge, the client plans to travel on an airplane and attend sporting events with friends and family. The nurse prepares a discharge teaching plan for this client and includes: 1. Eliminating travel plans to combat anemia-related fatigue 2. Reinforcing a positive mental attitude to improve prognosis 3. Preventing infection; the client is at risk for leukopenia 4. Restricting fluid intake; the client is at risk for congestive heart failure

Correct 3. Preventing infection; the client is at risk for leukopenia The bone marrow is impaired with multiple myeloma; the effectiveness of white blood cells and immunoglobulins is reduced, which increases susceptibility to bacterial infections. Travel can be accomplished with careful planning and adequate rest periods. Although a positive mental attitude can contribute to quality of life and may even extend life, generally it does not change the prognosis. The client is encouraged to drink plenty of fluids to help dilute the Bence Jones protein fragments in the urine, which may help prevent kidney damage.

An 11-month-old infant with iron-deficiency anemia is started on an oral iron supplement. What information should the nurse include when teaching the parents about the side effects of iron supplements? 1. The urine may turn red. 2. The skin will turn yellow. 3. The teeth may become stained. 4. The stools will take on a clay color. .

Correct 3. The teeth may become stained. Liquid oral iron supplements may stain the teeth; brushing the teeth after administration may limit the discoloration. There should be no change in the color of the urine. Yellowing of the skin is a sign of jaundice; it is not a side effect of an iron supplement. The stools will become black-green; clay-colored stools are a sign of biliary obstruction

A client who has been diagnosed with acute lymphocytic leukemia will be receiving doxorubicin (Adriamycin) infusions as part of a chemotherapy regimen. The nurse monitors the client for signs and symptoms of doxorubicin toxicity. What clinical finding indicates that toxicity has occurred? 1. Alopecia 2. Dyspnea 3. Metallic taste to food 4. Abnormalities in cardiac rhythm

Correct 4. Abnormalities in cardiac rhythm Doxorubicin is cardiotoxic, which is manifested by transient ECG abnormalities. Alopecia is an expected side effect of doxorubicin, not a toxic effect. Dyspnea and a metallic taste to food are not effects of doxorubicin.

A client with a tentative diagnosis of pernicious anemia is scheduled for a Schilling test. Which body process associated with vitamin B12 is assessed with the Shilling test? 1. Storage 2. Digestion 3. Production 4. Absorption

Correct 4. Absorption With the Schilling test, radioactive vitamin B12 is administered, and its absorption and excretion are ascertained. Storage is not measured by this test. Digestion is not measured by this test. Vitamin B12 is not produced in the body. Pernicious anemia is caused by an inability to absorb vitamin B12 as a result of a lack of intrinsic factor in gastric juices.

The nurse expects that the plan of care for a client diagnosed with multiple myeloma will include: 1. Radiotherapy on an outpatient basis 2. Human leukocyte interferon therapy 3. Surgery to remove the invasive lesions 4. Chemotherapy employing a combination of drugs

Correct 4. Chemotherapy employing a combination of drugs Chemotherapy employing a combination of drugs is the treatment of choice; a variety of chemotherapeutic drugs affect rapidly dividing cells at different stages of cell division. Although radiotherapy on an outpatient basis may be used to alleviate pain and treat acute vertebral lesions, it is not the primary approach. Although human leukocyte interferon therapy may be done, it is not the primary treatment. Multiple myeloma is a diffuse disorder of the bone, and no single lesion can be removed.

A nurse in the pediatric clinic is evaluating a 6-year-old child with sickle cell anemia whose spleen autoinfarcted by age 4. What is the priority nursing care at this time? 1. Monitoring for signs of jaundice 2. Assessing the abdomen frequently 3. Monitoring serial hematocrit readings 4. Determining parental knowledge about infection

Correct 4. Determining parental knowledge about infection The spleen plays a role in immunity. Initially the spleen enlarges and becomes congested with accumulated sickled red blood cells; in time, fibrous material replaces the tissue in the spleen, and by age 5 the spleen is obliterated. Without a spleen the child is prone to infection, which can precipitate a sickle cell crisis. Assessing the child for jaundice is not a priority, because jaundice is an expected adaptation that is not life threatening. Abdominal assessments are important but not required frequently in this situation. Serial hematocrit readings are necessary only if the child is in sickle cell crisis.

A client who was admitted with a diagnosis of acute lymphoblastic leukemia is receiving chemotherapy. Which assessment findings should alert the nurse to the possible development of the life threatening response of thrombocytopenia? Select all that apply. 1. Fever 2. Diarrhea 3. Headache 4. Hematuria 5. Ecchymosis

Correct 4. Hematuria 5. Ecchymosis Hematuria is blood in the urine. Thrombocytes are involved in the clotting mechanism; thrombocytopenia is a reduced number of thrombocytes in the blood. Ecchymosis is a superficial bruise caused by bleeding under the skin or mucous membrane. With thrombocytopenia, bleeding occurs because there are insufficient platelets. Fever is unrelated to thrombocytopenia. Fever is a sign of infection; infection results when the white blood cells are reduced (leukopenia). Diarrhea is unrelated to thrombocytopenia; diarrhea may result from the effects of chemotherapy on the rapidly dividing cells of the gastrointestinal system. Headache is unrelated to thrombocytopenia; headache may be caused by the effects of chemotherapy on central nervous system cells or indicate that the leukemia has invaded the central nervous system.

The nurse is caring for a client with iron deficiency anemia that has decreased hemoglobin and hematocrit levels. The nurse expects to identify what other abnormal laboratory level? 1. Macrocytic red blood cells (RBCs) 2. Thrombocytopenia 3. Decreased folate levels 4. Increased total iron-binding capacity (TIBC)

Correct 4. Increased total iron-binding capacity (TIBC) TIBC may be elevated from 350 to 500 mg/dL (expected range is 250 to 350 mg/dL) because the RBCs are compensating for the iron deficiency. The RBCs are microcytic, not macrocytic, because of their low iron content. A low platelet count is not associated with iron deficiency anemia. Decreased folate levels often are noted in vitamin B12 anemias, such as occur with sprue and celiac diseases as well as in folate deficiency anemia, but not in iron deficiency anemia.

A client had a total knee replacement several days ago and has been receiving warfarin sodium (Coumadin) therapy. An international normalized ratio (INR) is performed each afternoon, and the evening warfarin sodium dose is prescribed by the health care provider on a daily basis. The nurse identifies that the afternoon INR is 4.6. The next action the nurse should take is to: 1. Contact the health care provider to request the day's dosage of warfarin sodium. 2. Obtain a blood specimen to have a partial thromboplastin time performed. 3. Assist with meal planning to increase the intake of foods high in vitamin k. 4. Maintain the client on bed rest until the health care provider reviews the laboratory results.

Correct 4. Maintain the client on bed rest until the health care provider reviews the laboratory results. An INR of 4.6 is higher than the desired therapeutic level of 2 to 3.5. It is prudent to maintain bed rest to prevent injury until the health care provider evaluates the client's INR result. Another dose of warfarin sodium may be contraindicated in light of the client's increased INR result. A partial thromboplastin time is performed to evaluate a client's response to the administration of heparin. Increasing the intake of food high in vitamin K is contraindicated; vitamin K is the antidote for warfarin sodium. The client should have a consistent, limited intake of food high in vitamin K

An adolescent is undergoing radiation for Hodgkin's lymphoma. The nurse talks with the family about the importance of: 1. Keeping up with schoolwork 2. Accelerated sexual maturation 3. Consistent skin care with lotion 4. Overwhelming fatigue and the need for rest

Correct 4. Overwhelming fatigue and the need for rest The major side effect of radiation therapy is overwhelming fatigue. Lotions can cause irritation if the skin reacts to the radiation. Schoolwork is not a major concern at this time. Accelerated sexual maturation is not an effect of irradiation.

A nurse assesses for the development of pernicious anemia when a client has a history of: 1. Acute gastritis. 2. Diabetes mellitus. 3. Unhealthy dietary habits. 4. Partial gastrectomy.

Correct 4. Partial gastrectomy. Removal of the fundus of the stomach destroys the parietal cells that secrete intrinsic factor (needed to combine with vitamin B12 preliminary to its absorption in the ileum). Hemorrhaging may cause anemia; however, pernicious anemia occurs when the intrinsic factor is not produced. The beta cells of the pancreas are not involved in secretion of intrinsic factor. Dietary intake does not affect the production of intrinsic factor.

A client is receiving Coumadin (warfarin). The nurse explains the need for careful regulation of dietary intake of vitamin K. What physiologic process does vitamin K promote that makes this instruction essential? 1. Platelet aggregation 2. Ionization of blood calcium 3. Fibrinogen formation by the liver 4. Prothrombin formation by the liver

Correct 4. Prothrombin formation by the liver Vitamin K promotes the liver's synthesis of prothrombin, an important blood clotting factor, and will reverse the effects of warfarin. Platelet aggregation and fibrinogen formation by the liver are not promoted by vitamin K. Vitamin K does not affect calcium ionization.

To prevent excessive bruising when administering subcutaneous heparin, the nurse should: 1. Administer the injection via the Z-track technique. 2. Inject the drug into the vastus lateralus muscle in the thigh. 3. Avoid massaging the injection site after the injection. 4. Use 2 mL of sterile normal saline to dilute the heparin.

Correct 3 Avoid massaging the injection site after the injection. The site of the injection should not be massaged to avoid dispersion of the heparin around the site and subsequent bleeding into the area. The Z-track technique and the intramuscular route are not used with heparin; subcutaneous injection and intravenous administration are the routes appropriate for heparin administration. The drug should be injected into the subcutaneous tissue slowly, not quickly. Diluting heparin with normal saline is unnecessary. Generally heparin is provided by the pharmacy department in single dose syringes