PrepU CH.13

A pediatric nurse is treating a 2-day-old infant for jaundice. The treatment involves exposing the infant's skin to fluorescent light at 420 nm to 470 nm wavelengths. What does the light do to the bilirubin?

It converts the bilirubin into a soluble form that is easily excreted in the stool and urine.

The nurse is educating a pregnant client about the importance of folic acid. Select the food that has the highest levels of folic acid.

Kale

The nurse is teaching the client with a deficiency of glucos-6-phosphate-dehydrogenase (G6PD). In order to prevent the triggering of premature destruction of red blood cells, the nurse teaches the client to avoid which of the following medications?

Primaquine

The practitioner is examining a client and notes that he has small, punctate skin hemorrhages on his abdomen and chest. This finding is suggestive of which of the following lab results?

Low platelets

A 40-year-old client is admitted to the hospital after experiencing 3 days of extreme vomiting .The doctor reviews the lab results and notes that the hemoglobin and hematocrit are elevated. This is interpreted as:

Manifestation of dehydration

The client with chronic kidney disease and congestive heart failure is weak and dyspneic. Lab work reveals a hemaglobin of 6.5g/dL. Which type of blood product will the provider order?

Packed red blood cells

The nurse is performing an admission assessment on a client with the diagnosis of primary polycythemia. The nurse anticipates that the assessment will include: Select all that apply.

Plethora • Hypertension • Itching • Pain

A patient presents to his physician with a red face, hands, feet, and ears; a headache; and drowsiness. A blood smear reveals an increased number of erythrocytes. Based on the laboratory results, the nurse prepares teaching material for which disease process?

Polycythemia

The nurse is caring for a client diagnosed with sickle cell disease. Select the most important factor for the nurse to be aware of that may cause the cells to sickle.

Reduced oxygen tension while the client sleeps

A pediatric patient is diagnosed with hemolytic anemia. The nurse explains the disease process to the parents. Which of the following statements correctly identifies the body's physiologic compensations for the increase in demand for red blood cells (RBCs)?

Resubstitution of red marrow for yellow marrow can occur.

The anemic client is receiving erythopoietin. If there is a marked increase in red blood cell production, which lab result would increase?

Reticulocytes

If an Rh-negative mother is giving birth to an Rh-positive infant, the nurse should be prepared to administer:

Rh immune globulin.

The nurse is caring for a client with chronic lung disease who has a history of smoking 2 packs of cigarettes per day for 25 years. The client is at high risk for the development of:

Secondary polycythemia

A 66-year-old female patient has presented to the emergency department because of several months of intermittently bloody stool which has recently become worse. The woman has since been diagnosed with a gastrointestinal bleed secondary to overuse of nonsteroidal anti-inflammatory drugs that she takes for her arthritis. The health care team would realize that which of the following situations is most likely?

She will have iron-deficiency anemia due to depletion of iron stores.

The practitioner carefully monitors his client who exhibits hemoglobin S (HbS) genes. The practitioner know that the client is predisposed to life-threatening infection due to damage by HbS to which of the following organs?

Spleen

When red blood cells age, which of the following organs are responsible for their destruction?

Spleen

A child has been diagnosed with thalassemia. Which of the following co-morbidities may occur as a result of having thalassemia?

Splenomegaly.

The nurse is caring for a 2-day-old newborn infant who appears lethargic and has a yellowish tint to the skin. Select the most likely cause of this newborn's signs and symptoms.

The inability of the immature liver to conjugate bilirubin

When it is determined that a patient's red blood cells (RBCs) have a biconcave shape, which of the following will be the nurse's reaction?

The nurse will be pleased, as that shape allows for increased oxygen diffusion.

Administration of Rh immune globulin has been ordered for a pregnant client who is at 28 weeks' gestation. The nurse should draw what conclusion from these data?

The risk of hemolytic disease of the newborn will be reduced.

Which of the following would be tested by a complete blood count (CBC)?

Red blood cells and platelets

A client has been diagnosed with aplastic anemia. The nurse is aware that the client's lab results will identify:

Reduction of white blood cells

Which of the following is the most abundant type of plasma proteins?

Albumin

The provider notes that the client's hemaglobin is 8.2g/dL. Which of the following supplements will the provider recommend to the client?

Ferrous sulfate

The family of an elderly patient are wondering why his 'blood counts' are not rising after his last GI bleed. They state, "He has always bounced back after one of these episodes, but this time it isn't happening. Do you know why?" The nurse will respond based on which of the following pathophysiological principles?

"Due stress, the red blood cells of older adults are not replaced as promptly as younger people."

A nurse is caring for a client admitted with a complete blood count (CBC) that shows a low red blood cell count, low hemoglobin, and low hematocrit levels. Which of the following questions should the nurse ask to help determine a possible cause for these findings?

"Have you noticed any dark or bloody stools recently?"

The nurse is caring for of a 6-month-old infant diagnosed with iron deficiency anemia. The nurse determines further teaching is necessary when the mother states:

"I must stop breast-feeding my baby because of the anemia."

A community health nurse is conducting the nutritional component of a class for new mothers. Which of the following teaching points would be most justified?

"If you choose to feed your baby with formula, ensure that it is iron-fortified."

The pediatrician is teaching the mother of a one-year-old child about iron deficiency anemia in children. Which statement is most accurate?

"In infancy, low levels of iron are due to a diet consisting mainly of cow's milk."

The staff development nurse is teaching a class of orientees about care of the geriatric patient. Which of the following statements is accurate about red cell changes with aging?

"The location of bone cells involved in red cell production shifts toward the axial skeleton."

The lab technician is evaluating the student's knowledge of laboratory values for red blood cells. The technician knows the student has been studying when she correctly states which of the following?

"The major components of blood are the red cell mass and plasma volume."

The pathophysiology student is studying erythropoiesis. Which statement demonstrates understanding of this process?

"The reticulocyte count serves as an index of erythropoietic activity of the bone marrow."

The pathophysiology student is learning about the shape of the erythrocyte and how it contributes to oxygen transport. Which statement by the student demonstrates understanding?

"The thinness of the cell membrane enables oxygen to diffuse rapidly between the exterior and innermost regions of the cell."

A patient has been diagnosed with anemia. The physician suspects an immune hemolytic anemia and orders a Coombs test. The patient asks the nurse what this test will tell the doctor. The nurse replies:

"They are looking for the presence of antibody or complement on the surface to the RBC."

How many days do erythrocytes live in circulation?

120 days

A previously healthy client was involved in a traumatic fall and lost a large amount of blood. The client is now stable and has a normal serum ferritin level. How long will it take for red cell concentration to return to normal?

3 to 4 weeks

Which assessment finding related to the red blood cells of infants would warrant referral for further testing and treatment?

A 6-week-old infant has a hemoglobin level of 59 g/L.

Which of the following patients would be most likely to be experiencing an increase in renal erythropoietin production?

A 71-year-old smoker admitted to hospital with exacerbation of his chronic obstructive pulmonary disease (COPD)

The nursing is reviewing assessment data of four clients. Select the client who is at greatest risk for developing pernicious anemia.

A client who has undergone partial gastrectomy

Two years after chemotherapy and radiation therapy for lung cancer, a 72 year old patient notices that they seem to be extremely tired all the time. The physician suspects the patient may have developed aplastic anemia. The nurse assessing the patient will likely find which of the following clinical manifestations of aplastic anemia? Select all that apply.

A)Complaints of weakness and fatigue B)Small spots of skin hemorrhages over the entire body C)Excess bleeding from gums and nose

The nurse is caring for a client with sickle cell disease. The most important treatment for the nurse to provide would be:

Aggressive intravenous hydration and morphine

A client was involved in an auto accident and suffered massive internal injuries that resulted in a large blood loss. Select the type of anemia the client is at greatest risk to develop.

Blood loss

Which of the following is a function of plasma?

Carrying nutrients

An elderly patient is brought to the emergency department with garbled speech, unilateral facial drooping, and weakness. One hour after admission, the patient dies. An autopsy reveals the presence of polycythemia. Which of the following was the most likely cause of the patient's death?

Cerebral thrombosis

A client who is being treated for colorectal cancer has developed anemia. The nurse should first suspect what potential causes of this client's anemia? Select all that apply.

Chemotherapy Iron deficiency

The physician is examining a postmenopausal female and explains that which of the following is the most usual reason for iron deficiency in adults?

Chronic blood loss

An elderly client asks the nurse why so many older people develop anemia. The best response would be:

Chronic disease

The practitioner knows the client has hemoglobin S (HbS). The practitioner explains to the client that which of the following are the major consequences of this disorder? Select all that apply.

Chronic hemolytic anemia Blood vessel occlusion

The practitioner notes the client with hemolytic anemia has Raynaud phenomenon. Which of the following causes this type of anemia?

Cold-reacting antibodies

The client, with a hemaglobin of 7.8g/dL, tells the nurse that "my bones ache and my sternum is tender." The nurse understands this discomfort may be caused by which of the following?

Erythropoiesis

A patient was recently diagnosed with iron deficiency anemia. The nurse anticipates which of the following treatments to be prescribed?

Iron supplementation and dietary teaching

A 62-year-old female with a diagnosis of acute and chronic renal failure secondary to diabetes mellitus is receiving her weekly injection of epoetin, a supplementary form of erythropoietin. Which of the following statements best captures the necessity of this medication?

Erythropoietin causes the erythrocyte colony forming units to proliferate and mature.

A 22-year-old female who adheres to a vegan diet has been diagnosed with iron deficiency anemia. Which of the following components of her diagnostic blood work would be most likely to necessitate further investigation?

Decreased erythropoietin levels

Your ESRD patient is receiving two units of packed red blood cells for anemia (Hgb of 8.2). Twenty minutes into the first transfusion, the nurse observes the patient has a flushed face, hives over upper body trunk, and is complaining of pain in lower back. His vital signs include pulse rate of 110 and BP drop to 95/56. What is the nurse's priority action?

Discontinue the transfusion and begin an infusion of normal saline.

Which of the following is the calculation for the mean cell volume (MCV) of a red cell?

Dividing hematocrit by red cell count

The nurse is assessing a female patient with a hemoglobin of 6.8g/dL. Which of the following symptoms would the nurse expect to find? Select all that apply.

Dyspnea • Headache • Faintness

The nurse is providing dietary instruction for a client diagnosed with folic acid deficiency. The nurse should provide the client with what information to help assure the client ingests sufficient amounts of folic acid? Select all that apply.

Eat green leafy vegetables daily. Include a variety of cereals in the daily diet. Alcohol consumption is a risk factor for folic acid deficiency.

An adult client with good overall health has reported headaches and dizziness in recent weeks. The nurse's assessment reveals blood pressure of 158/99 mm Hg, which is unprecedented for the client. On observation, the client's skin appears reddened, though he denies feeling warm. The nurse should anticipate what further diagnostic finding

Elevated RBC, hemoglobin, and hematocrit.

The practitioner notes the client has a yellowish discoloration of the skin. Which of the following lab results would the practitioner expect to see?

Elevated unconjugated bilirubin

The microbiology technician explains to the student that which of the following blood cells is the most common?

Erythrocyte

Select the option that best describes the pathogenesis of the anemia in a client with beta-thalassemia.

Heinz bodies impair DNA synthesis and damage the red blood cell (RBC) membrane.

A nurse is assessing a newly admitted client, noting pale skin and nail beds. Which of the following laboratory data should the nurse evaluate?

Hemoglobin (Hgb) level

A patient arrives in the emergency department with symptoms of extreme fatigue, shortness of breath, and a yellowish discoloration to the skin. The nurse interprets these finding as being which of the following types of anemia?

Hemolytic anemia

The client comes to the emergency department with sudden onset of dizziness. The staff note a sudden drop in hemoglobin and hematocrit due to an aplastic crisis. Which of the following hereditary anemias could the client have?

Hereditary spherocytosis

The male client with liver cancer is being treated with chemotherapy. The provider notes that the client is fatigued and has a hemoglobin of 9.5g/dL and a normal ferritin level. Which of the following medications does the practitioner prescribe?

Human erythropoietin

A nurse is monitoring a patient with anemia and low oxygen levels. The nurse knows that which of the following stimulates the secretion of erythropoietin?

Hypoxia

The client presents with a reduction in red blood cells, white blood cells and platelets. The practitioner is unable to determine the cause of the client's condition. Which type of anemia does the client have?

Idiopathic aplastic

A patient with iron-deficiency anemia complains of feeling "tired all of the time." What does the nurse understand may be the cause of the fatigue that the patient is experiencing?

Impaired function of the electron transport chain

The nurse is assessing a client diagnosed with anemia and notes that the client's skin and mucous membranes are pale. The nurse interprets this as:

Insufficient hemoglobin

The client is exhibiting signs of premature destruction of red cells and an increase in erythropoiesis after having a transfusion. This is an example of which of the following?

Intravascular hemolysis

The rate at which hemoglobin is synthesized depends on availability of which of the following?

Iron

The nurse is caring for a client who is a strict vegetarian; the client is at greatest risk for the development of:

Vitamin B12 deficiency anemia

A client is being treated for the effects of newly diagnosed hemolytic anemia. The nurse should anticipate that diagnostic testing will reveal alterations in:

glucose-6-phosphate dehydrogenase.

A 53-year-old man presents with inability to concentrate, itching in his fingers and toes, elevated blood pressure, and unexplained weight loss. He is diagnosed with primary polycythemia. The primary goal of his treatment will be to:

reduce the viscosity of his blood.

A nursing instructor questions students on the removal of erythrocytes from the body. The instructor knows that the students understand when which of the following locations are identified at the site of removal by macrophages? Select all that apply.

• Liver • Spleen • Bone marrow

A nurse is preparing a presentation for a community prenatal group about umbilical cord blood banking and donation. Which of the following statements should be included in the presentation? Select all that apply.

• Sources of the stem cells include bone marrow and umbilical cord blood. • People with immunodeficiencies and malignancies can receive donated stem cell transplants to replenish stem cells after chemotherapy. • Stem cells must be from a histocompatible matched donor to prevent graft-versus-host disease.

A nurse is completing an assessment on an infant with a low hemoglobin level. Which of the following symptoms will the nurse expect to observe? Select all that apply.

• Tachycardia • Lethargy • Pallor

A female patient comes to the clinic with symptoms of fatigue and heavy menses over the last 6 months. Laboratory tests reveal a microcytic hemochromic anemia. Based on these results, the nurse anticipates teaching the patient about which type of anemia?

Iron deficiency anemia

A patient has a hematocrit of 32% and is diagnosed with iron deficiency anemia. The nurse anticipates which of the following treatments to be prescribed?

Iron replacement therapy

A professor is teaching nursing students about erythropoietin production. The professor determines that the students understand when they correctly identify which of the following organs as being responsible for erythropoietin production?

Kidneys

The nurse knows that the hypoxic patient will produce erythropoietin to stimulate red blood cell production. The nurse knows this hormone is produced in which of the following?

Kidneys

The student correctly associates macrocytic and misshapen red blood cells with which type of anemia?

Megaloblastic

The nurse is reviewing the client's laboratory data showing an increased mean corpuscular volume (MCV) and a normal mean corpuscular hemoglobin concentration (MCHC). The client most likely has which of the following types of anemia?

Megaloblastic anemia

The client explains to her new provider that she receives periodic phlebotomies to decrease their red blood cell mass. The provider believes the client may have which of the following?

Polycythemia vera

The nurse is preparing a client with suspected leukemia for a bone marrow and biopsy. What preferred site will the nurse be sure is accessible for the physician?

Posterior iliac crest

Which of the following anatomical sites would the nurse expect to monitor when caring for an adult patient who has just had a bone marrow aspiration performed?

Posterior iliac crest

The neonate displays a yellow discoloration of her skin on the third day of life. The neonatologist explains this condition to the parents. Which of the following statements is most accurate?

"The increase in bilirubin, which causes the jaundice, is related to the increased red blood cell breakdown."

The dietary student is studying folic acid deficiency. The faculty member knows the student is ready to teach patients about this topic when the student makes which of the following statements?

"The 30-year-old client who is trying to become pregnant should evaluate her folic acid intake."

A client with a diagnosis of hemolytic anemia has gone to a community-based laboratory for follow-up blood work. The lab technician confirms with the client that hematocrit is one of the components of the blood work. The client replies, "I thought the point of the blood work was to see how many red blood cells I have today." How could the technician best respond to the client's statement?

"The hematocrit measures the mass that your red blood cells account for in a quantity of your blood."

The staff educator is teaching the nurse orientee about red cell changes in the neonate. The educator knows that the orientee understands the neonatal changes and care when she states which of the following?

"The hemoglobin concentration falls after birth due to reduced red cell production and plasma dilution."

A client tells the nurse that the doctor told her she has too many red blood cells accompanied by elevated white cells and platelet counts. The nurse recognizes this as:

Polycythemia vera

A patient presents to the clinic with symptoms of elevated blood pressure, dizziness, red face, pain in fingers and toes, headache, and difficulty concentrating. A blood smear reveals an increased number of erythrocytes. Based on these findings, the nurse anticipates which of the following diagnoses?

Polycythemia vera

A nurse assessing a client with an acute exacerbation of polycythemia vera notes coolness to the right leg and foot, pale color and an absent right pedal pulse. Based on these findings the nurse suspects that the client has developed which of the following complications?

Thrombosis in the right leg

A 53-year-old man presents with inability to concentrate, itching in his fingers and toes, elevated blood pressure, and unexplained weight loss. He is diagnosed with primary polycythemia. What will be the primary goal of his treatment?

To reduce the viscosity of his blood

A neonate has been diagnosed with hyperbilirubinemia and begun phototherapy. The infant's risk of encephalopathy will increase if:

unconjugated bilirubin levels are not successfully reduced.