M/S Exam 4: Heme

For a client with Hodgkin disease who has developed neutropenia, what is an appropriate nursing intervention to include in the care plan? A. Monitoring temperature every 4 hours B. Omitting fresh fruits and vegetables from the diet C. Positioning the client to increase lung expansion D. Avoiding intramuscular (IM) injections

A (If the client develops a fever, the client is considered to have an infection and is usually admitted to the hospital)

Which conditions put patients at risk for vitamin B12 deficiency, and thus megaloblastic anemia? Select all that apply: A. Crohn's disease B. Frequent antacid use C. Frequent PPI use D. Pregnancy E. Heavy menorrhea

ABC (pregnancy is linked to folate)

Which of the following are short-term complications from chemotherapy? Select all that apply: A. Infection B. Insomnia C. Osteoporosis D. Hypovolemia E. Hematuria

ABD

Which of the following are manifestations of TTP? Select all that apply: A. Jaundice B. Bradycardia C. N/V D. SOB E. Fever

ADE

Which of the following side effects is most likely associated with Cobalamin (Vitamin B12)? A. Amenorrhea B. Hypokalemia C. Hepatotoxicity D. Hypernatremia E. Hyperkalemia

B

Which of the following medications are known to alter platelets? Select all that apply: A. Antacids B. NSAIDs C. Sulfa drugs D. Metformin

BC (A&D alter vit B12 absorption)

Which of the following are common complications resulting from long-term PRBC transfusion? Select all that apply: A. Anemia B. Iron overload C. Infection D. Sensitization E. Neutropenia

BCD

What might cause thrombocytopenia? Select all that apply: A. Metformin B. ETOH C. Sepsis D. HF E. Trauma

BCE

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

C

A transfusion of PRBCs should not exceed ____ A. 60 min B. 2 hr C. 4 hr D. 6 hr

C

What should be recommended to a patient with sickle cell anemia? A. Avoid all exercise B. Avoid NSAIDs C. Avoid High Altitudes D. Avoid Antibiotics

C

When starting an IV for FFP or platelets the needle should be ___ g or larger. A. 18 B. 20 C. 22 D. 32

C

The HCP prescribes one tab ferrous sulfate QD for a 15 yo F who experiences heavy blood flow during her menstrual cycle. The nurse advises the patient and her parent that this OTC preparation must be taken for how many months before stored iron replenishment can occur? A. 1-2 months B. 3-5 months C. 6-12 months D. 12+ months

C (Ferrous sulfate can increase Hgb levels in a few weeks and anemia may be corrected in a few months, but it takes longer for stored iron replenishment to occur)

Which of the following instructions or patient education points is best associated with iron (ferrous sulfate)? A. Increased Risk of Thrombosis B. Avoid Potassium Supplements C. Caution with GI Disorders D. Monitor Liver Enzymes E. Caution with Cardiovascular Disorders

C (can exacerbate symptoms)

Which of the following are expected lab findings for a patient with thrombocytopenia? A. Decreased MCV B. Increased RBCs C. Decreased platelets D. Increased PTT E. Decreased PTT

CD

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

D

While assessing a client, the nurse discovers the client has a history of restless leg syndrome. Which hematological condition does the nurse associate with this condition? A. Thalassemia B. Folate deficiency anemia C. Sickle cell disease D. Iron deficiency anemia

D

A patient with chronic anemia has had many blood transfusions over the last 3 years. What type of transfusion reaction should the nurse monitor for that is commonly found in patients who frequently receive blood transfusions? A. Allergic reactions B. Acute hemolytic reaction C. Circulatory overload D. Febrile nonhemolytic reactions

D (the most common type of transfusion reaction, which is caused by antibodies to donor leukocytes that remain in the blood)

The transfusion of PRBCs must be given within ___ minutes of removal from blood bank refrigerator?

30

Hemoglobin contains ___ iron hemes: 1 2 3 4 5

4 (Globe has "4 corners")

A patient has been diagnosed with thrombocytopenia. What are the primary nursing interventions while instituting corticosteroid therapy in this patient? A. Gradually taper the dose and frequency of medication. B. Eliminate aspirin and NSAIDs. C. Palpate the lymph nodes and tonsils every shift. D. Examine the extremities for redness.

A

FFP and platelets must be given _____ after they are obtained. A. immediately B. within 5 minutes C. not greater than 10 minutes D. within 30 minutes

A

A condition that occurs when anti-platelet antibodies develop and destroy platelets in the blood A. Polycythemia vera B. Immune thrombocytopenia purpura C. Hemochromatosis D. Megablastic anemia

B

True or false: Hematocrit is the protein in the RBCs that carries O2 to the body's organs and tissues and transports CO2 from the organs and tissues back to the lungs.

False (answer is hemoglobin, hematocrit measures the proportion of RBCs in total blood)

A patient who has long-term packed RBC (PRBC) transfusions has developed symptoms of iron toxicity that affect liver function. What immediate treatment should the nurse anticipate preparing the patient for that can help prevent organ damage? A. Iron chelation therapy B. Oxygen therapy C. Therapeutic phlebotomy D. Anticoagulation therapy

A

A pt comes to the clinic c/o weakness & fatigue. While assessing this pt, the nurse finds evidence of petechiae and ecchymoses and notes that the spleen appears enlarged. What would the nurse suspect is wrong with this pt? A. aplastic anemia B. pernicious anemia C. iron deficiency anemia D. agranulocytosis

A

Iron deficiency anemia falls into this category A. Hypoproliferative anemia B. Hemolytic anemia C. Aplastic anemia D. Megaloblastic anemia

A

Which of the following instructions or patient education points is best associated with iron (ferrous sulfate)? A. Avoid Antacids B. Take with Milk C. No Switching Brands D. Take Around the Clock E. Beta-blockers Reduce Effects

A

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

A

Which of the following is not potentially transmitted by blood transfusion? A. Hepatits A B. Creutzfeldt-Jakob Disease C. Graft-versus-host disease D. Cytomegalovirus E. HIV

A (HVA is transmitted the fecal-oral route)

A client has pernicious anemia and has been receiving treatment for several years. Which symptom may be confused with another condition in older adults? A. dementia B. stomatitis C. glossitis D. ataxia

A (Pernicious anemia may be accompanied by a dementia with symptoms similar to Alzheimer's disease)

A teenaged client with hemophilia sustains a leg laceration after falling off of his skateboard and is brought to the emergency department. The laceration is bleeding profusely. What does the nurse anticipate will be ordered for administration to control bleeding? A. Fresh frozen plasma B. A colloid solution such as hetastarch (Hespan) C. A crystalloid solution such as lactated Ringer's D. Albumin

A (tx for hemophilia includes transfusion of fresh blood, frozen plasma, factor VIII concentrate, and anti-inhibitor coagulant complex)

For which conditions would you consider administering cryoprecipitate? Select all that apply: A. Von Willebrand's B. TTP C. HIT D. Hemophilia E. Sickle cell disease

AD (note, cryoprecipitate contains plasma rich fibrinogen and clotting factors)

Which of the following medication administration or route details are best associated with Cobalamin (Vitamin B12)? Select all that apply: A. IM Injection for pernicious anemia B. Avoid with asthma or bradycardia C. Prophylaxis D. Give SQ for pernicious anemia E. Never give IV

AE

A patient with chronic kidney disease is being examined by the nurse practitioner for anemia. The nurse has reviewed the laboratory data for hemoglobin and RBC count. What other test results would the nurse anticipate observing? A. Increased mean corpuscular volume B. Decreased level of erythropoietin C. Decreased total iron-binding capacity D. Increased reticulocyte count

B

A sickle cell anemia patient presenting in a vaso-occlusive crisis would most likely have what finding? A. Purpura B. Fever C. Ptosis D. Diarrhea

B

Sickle cell disease falls into this category A. Hypoproliferative anemia B. Hemolytic anemia C. Aplastic anemia D. Megaloblastic anemia

B

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. A B. B12 C. C D. Folate

B

This is the most dangerous type of transfusion reaction. S/S include flank pain, fever/chills, chest tightness, hemoglobinuria, tachycardia and hypotension. A. Febrile nonhemolytic reaction B. Hemolytic reaction C. Allergic reaction D. Transfusion-associated circulatory overload

B

What is most likely a potential long-term intervention for sickle cell anemia? A. Immunosuppressants B. Hydroxyurea C.Bisphosphonates D. Anticholinergics E. Corticosteroids

B

Which are the first WBCs to respond to an inflammatory event? A. Eosinophils B. Neutrophils C. Monocytes D. Basophils

B

What are S/S of transfusion-associated circulatory overload? Select all that apply: A. Bradycardia B. Tachycardia C. Anxiety D. Hypotension E. Orthopnea

BCE (S/S are similar to fluid overload: dyspnea, increased BP, JVD, crackles at the base of the lungs)

A nurse cares for a client with megaloblastic anemia who had a total gastrectomy three years ago. What statement will the nurse include in the client's teaching regarding the condition? A. "The condition is likely caused by a folate deficiency." B. "The condition causes abnormally small red blood cells." C. "The condition is likely caused by a vitamin B12 deficiency." D. "The condition causes abnormally rigid red blood cells."

C

What is most likely a potential intervention for a sickle cell vaso-occlusive crisis? A. Colchicine B. Retinoids C. Oxygen D. Immunosuppressants E. Corticosteroids

C

Which of the following is the most likely cause of iron deficiency anemia? A. Vit B12 deficiency B. Folate deficiency C. Hemorrhage D. Hemochromatosis

C

Which of the following side effects is most likely associated with iron (ferrous sulfate) administration AND diminishes with continued use? A. Hearing Loss B. Blurring of Vision C. Nausea and Vomiting D. Swollen Gums E. Niacin Deficiency

C

A patient with sickle cell disease comes to the emergency department and reports severe pain in the back, right hip, and right arm. What intervention is important for the nurse to provide? A. Administer aspirin B. Administer ibuprofen C. Start an intravenous line with dextrose 5% in 0.25 normal saline D. Begin oxygen at 2 L/M

C (hydration is important during a painful sickling episode)

This is required for maturation of RBCs in the bone marrow A. Iron B. Folic acid C. Vitamin B12 D. Erythropoietin

C (note, Erythropoietin stimulates RBC production in the bone marrow)

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

C (reflects low iron stores)

For which conditions would you consider administering albumin? Select all that apply: A. AKI B. Fluid overload C. Liver disease D. Burn patient E. Post-op

CD

A nurse is caring for a patient who has had a bone marrow aspiration with biopsy. What complication should the nurse be aware of and monitor the patient for? A. Blood transfusion reaction B. Shock C. Splintering of bone fragments D. Hemorrhage

D (Hazards of either bone marrow aspiration or biopsy include bleeding and infection)

Which lab value is most likely associated w/ iron def anemia? A. Increased HbA2 B. Neutropenia C. Increased hemoglobin D. Poikilocytosis

D (blood smear showing variation in RBC shape)

This is a proliferative disorder of the myeloid stem cells that leads to increased RBCs, leukocytes, and platelets A. Polycythemia vera B. Immune thrombocytopenia purpura C. Hemochromatosis D. Von Willebrand disease

A

Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils? A. Phagocytosis B. Rejection of foreign tissue C. Destruction of tumor cells D. Production of antibodies called immunoglobulin (Ig)

A

The client's CBC with differential reveals small-shaped hemoglobin molecules. The nurse expects to administer which medication to this client? A. Iron B. Vitamin B12 C. Folate D. Fresh frozen plasma

A (With iron deficiency, the RBCs produced by the marrow are small and low in hemoglobin. Vitamin B12 and folate deficiencies are characterized by the production of abnormally large RBCs)

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 (people with aplastic anemia usually have insufficient erythrocytes, leukocytes, and platelets. Thus, encourage behaviors that will lower the risk for bleeding)

A client develops a hemolytic reaction to a blood transfusion. What actions should the nurse take after this occurs? Select all that apply. A. Collect a urine sample to detect hemoglobin B. Administer dexamethasone C. Obtain appropriate blood specimens D. Begin chelation therapy E. Document the reaction according to policy

ACE

Which of the following statements by the patient with polycythemia vera indicate that teaching was sufficient? Select all that apply: A. "I will take my antihypertensives as prescribed" B. "I will take a daily OTC iron supplement" C. "I will switch from smoking cigarettes to vaping" D. "I will minimize alcohol consumption"

AD

What is true of sickle cell anemia? A. It's X-linked recessive B. Patients have increased risk of DM C. May be asymptomatic D. It's X-linked dominant E. Most prominent in Asians

C

The nurse is obtaining the health history of a client suspected of having a hematological condition. The nurse notes the client has a history of alcohol abuse. Which clinical presentation is related to alcohol consumption? A. Neutropenia B. Myelodysplastic syndrome C. Anemia D. Thrombocytopenia

C ( Individuals with a history of alcohol consumption may have anemia due to nutritional deficiencies)