PrepU ch 29

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, which action should the nurse take? Have the client limit physical activity. Monitor partial thromboplastin (PTT) time. Administer the prescribed enoxaparin (Lovenox). Encourage a diet high in vitamin K.

Administer the prescribed enoxaparin (Lovenox).

A client being treated for iron deficiency anemia with ferrous sulfate continues to be anemic despite treatment. The nurse should assess the client for use of which medication? Tegretol Aluminum hydroxide Amoxicillin Prednisone

Aluminum hydroxide

Which of the following is the most common hematologic condition affecting elderly patients Anemia Thrombocytopenia Bandemia Leukopenia

Anemia

A client comes to the walk-in clinic complaining of weakness and fatigue. While assessing this client, the nurse finds evidence of petechiae and ecchymoses. The nurse notes that the spleen appears enlarged. What would the nurse suspect is wrong with this client? Aplastic anemia Iron-deficiency anemia Agranulocytosis Pernicious anemia

Aplastic anemia

A client at the clinic has just been diagnosed with iron deficiency anemia. What would you recommend the client consume to promote the absorption of iron? Meat, egg yolks, oysters, and shellfish Vitamin E Rich sources of vitamin C Sources of vitamin B12

Rich sources of vitamin C

After receiving chemotherapy for lung cancer, a client's platelet count falls to 20 x109L. What term should the nurse use to describe this low platelet count? Leukopenia Neutropenia Thrombocytopenia Anemia

Thrombocytopenia

A young client is diagnosed with a mild form of hemophilia and is experiencing bleeding in the joints with pain. In preparing the client for discharge, what instructions should the nurse provide? Take ibuprofen for joint pain. Take warm baths to lessen pain. Wear a medical identification bracelet. Undergo genetic testing and counseling if the client is male.

Wear a medical identification bracelet.

A client with sickle cell anemia has a high hematocrit. normal blood smear. normal hematocrit. low hematocrit.

low hematocrit.

A patient describes numbness in the arms and hands with a tingling sensation. The patient also frequently stumbles when walking. What vitamin deficiency does the nurse determine may cause some of these symptoms? Iron Thiamine B12 Folate

B12

When teaching a client with iron deficiency anemia about appropriate food choices, the nurse encourages the client to increase the dietary intake of which foods? Beans, dried fruits, and leafy, green vegetables Berries and orange vegetables Fruits high in vitamin C, such as oranges and grapefruits Dairy products

Beans, dried fruits, and leafy, green vegetables

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? Magnesium level of 2.5 mg/dL Calcium level of 9.4 mg/dL Potassium level of 5.2 mEq/L Creatinine level of 6 mg/100 mL

Creatinine level of 6 mg/100 mL

The nurse and the client are discussing some strategies for ingesting iron to combat the client's iron-deficiency anemia. Which is among the nurse's strategies? Avoid vitamin C as it prevents absorption. Taking iron pills with milk aids in absorption. Drink liquid iron preparations with a straw. Take iron with an antacid to avoid stomach upset.

Drink liquid iron preparations with a straw.

The nurse is educating a patient with iron deficiency anemia about food sources high in iron and how to enhance the absorption of iron when eating these foods. What can the nurse inform the client would enhance the absorption? Eating leafy green vegetables with a glass of water Eating apple slices with carrots Eating a steak with mushrooms Eating calf's liver with a glass of orange juice

Eating calf's liver with a glass of orange juice

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

Hypochromic

An older adult client who is a vegetarian has a hemoglobin of 10.2 gm/dL, vitamin B12 of 68 pg/mL (normal: 200-900 pg/mL), and MCV of 110 cubic micrometers. After interpreting the data, what instruction should the nurse give to the client? Supplement the diet with vitamin B12. Change the vegetarian diet and begin to eat red meat. Ingest a diet higher in vitamin B12 sources. Continue with the diet but include more sources of iron.

Supplement the diet with vitamin B12.

A client with megaloblastic anemia reports mouth and tongue soreness. What instruction will the nurse give the client regarding eating while managing the client's symptoms? "Eat cold, bland foods with a large amount of water." "Eat small amounts of bland, soft foods frequently." "Eat larger amounts of bland, soft foods less frequently." "Eat low-fiber blended foods only."

"Eat small amounts of bland, soft foods frequently."

After teaching a client about taking daily oral iron preparations for a moderate iron deficiency anemia, which statement by the client indicates to the nurse that additional instruction is needed? "I will take the iron with orange juice about an hour before eating." "I will call the doctor if my stools turn black." "I will occasionally take a stool softener if I feel constipated." "I will increase my fluid and fiber intake while I am taking the iron tablets."

"I will call the doctor if my stools turn black."

A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving: B-positive blood to an AB-positive client. O-positive blood to an A-positive client. O-negative blood to an O-positive client. A-positive blood to an

A-positive blood to an A-negative client.

A patient with sickle cell disease is brought to the emergency department by a parent. The patient has a fever of 101.6°F, heart rate of 116, and a respiratory rate of 32. The nurse auscultates bilateral wheezes in both lung fields. What does the nurse suspect this patient is experiencing? Acute chest syndrome Pneumocystis pneumonia Pulmonary edema An exacerbation of asthma

Acute chest syndrome

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? chest radiograph antibiotic ECG CBC

CBC

Which of the following are immunosuppressants that prevent the patient's lymphocytes from destroying the stem cells in a patient diagnosed with aplastic anemia? Select all that apply. Cyclophosphamide ATG Filgrastim Cyclosporine Corticosteroids

Cyclophosphamide ATG Cyclosporine Corticosteroids

The nurse is caring for a client with external bleeding. What is the nurse's priority intervention? Application of a tourniquet Pressure point control Direct pressure Elevation of the extremity

Direct pressure

The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia? Clustering of platelets with sickled red blood cells Erythrocytes that are macrocytic and hyperchromic An increased number of erythrocytes Erythrocytes that are microcytic and hypochromic

Erythrocytes that are microcytic and hypochromic

A client was admitted to the hospital with the following laboratory values: hemoglobin 5 g/dL, leukocyte count 2000/mm3, and a platelet count of 48,000/mm3; abnormally shaped erythrocytes and hypersegmented neutrophils were seen. The platelets appear abnormally large. A bone marrow biopsy was competed and revealed hyperplasia. Based on this information, the nurse determines that client most likely has which diagnosis? Folic acid deficiency Hemolytic anemia Thalassemia Sickle cell anemia

Folic acid deficiency

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

Hematocrit of 60%

A client with severe anemia reports symptoms of tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Laboratory test results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which nursing diagnoses is most appropriate for this client? Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients Risk for falls related to complaints of dizziness Fatigue related to decreased hemoglobin and

Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit

A client is receiving chemotherapy for cancer. The nurse reviews the client's laboratory report and notes that he has thrombocytopenia. To which nursing diagnosis should the nurse give the highest priority? Impaired oral mucous membranes Impaired tissue integrity Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI Activity intolerance

Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI

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

Iron deficiency anemia

A client admitted to the hospital in preparation for a splenectomy to treat autoimmune hemolytic anemia asks the nurse about the benefits of splenectomy. Which statement best explains the expected effect of splenectomy? It will increase red blood cell (RBC) production to compensate for blood loss. It will reduce the destruction of platelets by macrophages. It will increase production of platelets by the bone marrow. It will remove the major site of red blood cell (RBC) destruction.

It will remove the major site of red blood cell (RBC) destruction.

Which iron-rich foods should a nurse encourage an anemic client requiring iron therapy to eat? Lamb and peaches Cheese and bananas Lobster and squash Shrimp and tomatoes

Lamb and peaches

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

Low ferritin level concentration

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

Neurologic involvement

A client with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse? Inform the client that the bath and positioning is an important part of client care and will be done right after pain medication administration. Inform the client that the position must be changed, and then you will give her pain medication and omit the bath. Obtain the pain medication and delay the bath and position change until

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

A nurse is caring for a client with iron deficiency anemia. Which food or beverage will the nurse suggest to the client to eat or drink when taking supplemental iron? Leafy green vegetables Kidney beans Milk Orange juice

Orange juice

A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. The client is taking prednisone daily and reported feeling pain after manually opening the garage door. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain? Hypertension Truncal obesity Muscle wasting Osteoporosis

Osteoporosis

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

Pallor, tachycardia, and a sore tongue

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

Pancytopenia

A client awaiting a bone marrow aspiration asks the nurse to explain where on the body the procedure will take place. What body part does the nurse identify for the client? Ankle Sternum Posterior iliac crest Femur

Posterior iliac crest

Which of the following is considered an antidote to heparin? Ipecac Protamine sulfate Vitamin K Narcan

Protamine sulfate

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

Reports joint pain less than 3 on a scale of 0 to 10

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? Bone marrow biopsy Schilling test Bone marrow aspiration Magnetic resonance imaging (MRI) study

Schilling test

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

Take 1 hour before breakfast

A client with chronic anemia has received multiple transfusions. Which client action would the nurse be concerned about relative to the client's condition? Takes a daily multiple vitamin pill Eliminates use of alcohol Takes over-the-counter iron supplements Takes 60 grams of protein each day

Takes over-the-counter iron supplements

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? Bleeding The onset of a bacterial infection Diarrhea Abdominal pain

The onset of a bacterial infection

A client is treated for anemia. What is the nurse's best understanding about the correlation between anemia and the client's iron stores? There is a weak correlation between iron stores and hemoglobin levels. There is a strong correlation between iron stores and hemoglobin characteristics. There is a strong correlation between iron stores and hemoglobin levels. There is an inverse relationship between iron stores and hemoglobin levels.

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

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

Use the smallest needle possible for injections.

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? Vitamin E Vitamin K Vitamin D Vitamin A

Vitamin K

Which medication is the antidote to warfarin? Protamine sulfate Aspirin Vitamin K Clopidogrel

Vitamin K

The couple with the lowest risk of having a child with sickle cell anemia disease is the one in which the: father is HbA and the mother is HbS. father is HbS and the mother is HbS. father is HbAS and the mother is HbAS. father is HbS and the mother is HbAS.

father is HbA and the mother is HbS.

An client has pernicious anemia and has been receiving treatment for several years. What is the client lacking that results in pernicious anemia? extrinsic factor vitamin B hemoglobin intrinsic factor

intrinsic factor

A client admitted to the hospital with abdominal pain, anemia, and bloody stools reports feeling weak and dizzy. The client has rectal pressure and needs to urinate and move their bowels. The nurse should help them: to the bathroom. onto the bedpan. to the bedside commode. to a standing position so he can urinate.

onto the bedpan.

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy? "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." "I will receive parenteral vitamin B12 therapy for the rest of my life." "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear." "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal."

"I will receive parenteral vitamin B12 therapy for the rest of my life."

Which of the following are assessment findings associated with thrombocytopenia? Select all that apply. Bradypnea Hematemesis Hypertension Bleeding gums Epistaxis

Bleeding gums Epistaxis Hematemesis

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

Use a disposable razor when shaving.

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

"The child must inherit two defective genes, one from each parent."

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

Women lose iron through menstrual cycles

A nurse is doing a physical examination of a child with sickle cell anemia. When the child asks why the nurse auscultates the lungs and heart, what would be best the response by the nurse? To detect the evidence of dehydration that might have triggered a sickle cell crisis To detect the abnormal sounds suggestive of acute chest syndrome and heart failure To detect the motor strength and stroke-related signs and symptoms To detect the evidence of infection such as fever and tachycardia

To detect the abnormal sounds suggestive of acute chest syndrome and heart failure

A nurse cares for a client with a hematological disorder and malnutrition. What is the nurse's best understanding of how the client's nutritional status may worsen the client's hematological condition? Decreased calories lead to decreased immune response Decreased fat stores lead to decreased ability for red blood cells Decreased carbohydrates lead to decreased oxygen affinity of the hemoglobin Decreased protein stores lead to decreased immune response

Decreased protein stores lead to decreased immune response

The nurse, caring for a client in the emergency room with a severe nosebleed, becomes concerned when the client asks for a bedpan. The nurse documents the stool as loose, tarry, and black looking. The nurse suspects the client may have thrombocytopenia. What should be the nurse's priority action? Put in an IV line Notify the physician Stop the nosebleed Ask someone to clean the bedpan

Notify the physician