Anemia NCLEX Questions-New

A client with pernicious anemia asks why she must take vitamin B12 injections for the rest of her life. What is the nurse's best response? a. "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient acid." b. "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor." c. "The reason for your vitamin deficiency is an excessive excretion of the vitamin because of kidney dysfunction." d. "The reason for your vitamin deficiency is an increased requirement for the vitamin because of rapid red blood cell production."

b. "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor." Most clients with pernicious anemia have deficient production of intrinsic factor in the stomach. Intrinsic factor attaches to the vitamin in the stomach and forms a complex that allows the vitamin to be absorbed in the small intestine. The stomach is producing enough acid, there is not an excessive excretion of the vitamin, and there is not a rapid production of RBCs in this condition.

The nurse writes a client problem of "activity intolerance" for a client dx with anemia. Which intervention should the nurse implement? A.Pace activities according to tolerance B.Provide supplements high in iron and vitamins C.Administer packed red blood cells D.Monitor vital signs q4h

A

The client is being admitted with Folic acid deficiency anemia. Which would be the most appropriate referral? A.Alcoholics anonymous B.Leukemia society of America C.A hematologist D.A social worker

A alcoholism is the most common cause for folic acid anemia as alcoholics are often malnourished due to substituting food for liquor

The nurse writes a dx of altered tissue perfusion for a client diagnosed with anemia. Which interventions should be included in the plan of care? Select all that apply. A.Monitor the clients hemoglobin and hematocrit B.Move the client to a room near the nurses desk C.Limit the clients dietary intake of green vegetables D.Assess the client for numbness and tingling E.Allow for rest periods during the day for the client

A,B,D,E b because of the patient being weak from low blood count and gives for faster response times?

The nurse and nursing assistant are caring for clients on a medical unit. Which task should the nurse delegate to the nursing assistant? A.Check on the bowel movements of a client dx with melena B.Take vital signs if a client who received blood the day before C.Evaluate the dietary intake of a client who has been noncompliant with eating D.Shave the client dx with severe hemolytic anemia

B

The client dx with anemia begins to complain of dyspnea when ambulating in the hall. Which intervention should the nurse implement first? A.Apply oxygen via nasal cannula B.Get a wheelchair for the client C.Assess the clients lung fields D.Assist the client when ambulating in the hall

B a is incorrect because the patient has anemia which is whats causing the anemia from lack of SpO2. It isn't the actual intake of O2 being the problem c the patient has anemia causing the dyspnea, it isn't the lungs causing dyspnea d should be done but that doesn't address the situation at hand, its not an intervention against dyspnea

What is the biggest difference in clinical manifestations between Vitamin B12 deficiency and Folic Acid deficiency (anemia)?

Both of the defiencies/anemia's presents very similarly except that B12 def. presents with NEURO changes and FA defiency DOES NOT FA def. presents with a red smooth beefy red tongue vs. a sore beefy red tongue FA deficiency can also present with cheilosis and B12 def. does not

The nurse is discharging a client dx with anemia. Which discharge instruction should the nurse teach? A.Take prescribed iron until it is completely gone B.Monitor P and BP at local pharmacy weekly C.Have complete blood count checked at the HCP's office D.Perform isometric exercise three times a week

C

mother asks the nurse if her child's iron deficiency anemia is related to the child's frequent infections. The nurse responds based on the understanding of which of the following? a. Little is known about iron-deficiency anemia and its relationship to infection in children. b. Children with iron deficiency anemia are more susceptible to infection than are other children. c. Children with iron-deficiency anemia are less susceptible to infection than are other children. d. Children with iron-deficient anemia are equally as susceptible to infection as are other children.

Children with iron deficiency anemia are more susceptible to infection than are other children. Rationale: If iron deficiency anaemia is left untreated, it can make you more susceptible to illness and infection, as a lack of iron affects the body's natural defence system (the immune system).

A client with anemia may be tired due to a tissue deficiency of which of the following substances? a. Carbon dioxide b. Factor VIII c. Oxygen d. T-cell antibodies

c. Oxygen Anemia stems from a decreased number of RBCs and the resulting def in O2 and body tiss. Clotting factors, such as 8 relate to the bodies ability to form blood clots and arnt related to anemia, not is carbon dioxide of T antibodies

During physical assessment of a patient, the nurse suspects a chronic, severe iron-deficiency anemia on finding a. Yellow-tinged sclerae b. Gum bleeding and tenderness c. Shiny, smooth tongue d. Numbness of extremities

c. Shiny, smooth tongue rationale: iron deficiency anemia presents with: • chronic bleeding • increased chance of infection • Brittle Nails • Cheilosis (cracking at the edges of the mouth) • Pica (craving for unusual substances) • Smooth red tongue Loss of the papillae of the tongue occurs with chronic iron deficiency. Scleral jaundice is associated with hemolysis, gum bleeding and tenderness occur with thrombocytopenia or neutropenia, and extremity numbness is associated with vitamin B12 deficiency or pernicious anemia.

The nurse is admitting a 24 year old American American female client with a dx of rule-out anemia. The client has a hx of gastric bypass surgery for obesity 4 years ago. Current assessment findings include height 5'5, wt. 75 kg, P 110, R 27, and BP 104/66; pale mucous membranes and dyspnea on exertion. Which type of anemia would the nurse suspect the client has developed? A.Vitamin B12 deficiency B.Folic acid deficiency C.Iron deficiency D.Sickle cell anemia

A rationale: Vitamin B12 deficiency C/M = - pallor, slight jaundice, SOB, fatigue - sore beefy red tongue - diarrhea - NEUROLOGIC S/S (paresthesia, proprioception, balance difficulties, cognitive dysfunction)

When a client is diagnosed with aplastic anemia, the nurse monitors for changes in which of the following physiological functions? a. Bleeding tendencies b. Intake and output c. Peripheral sensation d. Bowel function

a. Bleeding tendencies Aplastic anemia decreases the bone marrow production of RBCs, WBCs, and Platelets (aka pancytopenia, the decrease in overall CBC's). The client is at risk for bruising and bleeding tendencies. The patient is also at risk for infections

Which of the following assessments in a child with hemophilia would lead the nurse to suspect early hemarthrosis? a. Child's reluctance to move a body part b. Cool, pale, clammy extremity c. Ecchymosis formation around a joint d. Instability of a long bone in passive movement

a. Childs reluctance to move a body part Bleeding into the joints in the child with hemophilia leads to pain and tenderness, resulting in restricted movement. Therefore, an early sign of hemarthrosis would be the child's reluctance to move a body part. If the bleeding into the joint continues, the area becomes hot, swollen, and immobile—not cool, pale, and clammy. Ecchymosis formation around a joint would be difficult to assess. Instability of a long bone on passive movement is not associated with joint hemarthrosis.

From the following teaching tips, choose all that are appropriate for a client with thrombocytopenia. a. Use an electric razor for shaving b. Avoid becoming chilled c. Avoid all skin or body punctures d. Do not scrub skin during bathing e. Eat low-roughage foods f. Avoid use of all aspirin products g. Avoid vigorous blowing of nose h. Use only a soft toothbrush

a. Use an electric razor for shaving c. Avoid all skin or bod punctures e. Eat low-roughage foods f. Avoid use of all aspirin products g. Avoid vigorous blowing of nose h. use only a soft toothbrush

The usual treatment for iron-deficiency anemia includes: a. Vitamin B12 injection b. Non-enteric-coated ferrous sulfate c. Enteric-coated or sustained-release ferrous sulfate d. Whole blood transfusion

b. Non-enteric-coated ferrous sulfate The usual tx is 325 mg p.o. daily. enteric-coated and sustained rls formulas should be avoided, as they are poorly absorbed

The physician has ordered several laboratory tests to help diagnose an infant's bleeding disorder. Which of the following tests, if abnormal, would the nurse interpret as most likely to indicate hemophilia? a. Bleeding time b. Tourniquet test c. Clot retraction test d. Partial thromboplastin time (PTT)

d. PTT PTT measures the activity of thromboplastin, which is dependent on intrinsic clotting factors. In hemophilia, the intrinsic clotting factor VIII (antihemophilic factor) is deficient, resulting in a prolonged PTT. Bleeding time reflects platelet function; the tourniquet test measures vasoconstriction and platelet function; and the clot retraction test measures capillary fragility. All of these are unaffected in people with hemophilia.

When caring for a client with a coagulation disorder, your primary focus should be on: a. Prevention of infection b. Pain management c. Reducing edema d. Prevention of injury and hemorrhage

d. Prevention of injury and hemorrhage

While obtaining a health history from a patient with numerous petechiae on the skin, the nurse asks the patient specifically about the patient's use of a. anticonvulsants. b. oral contraceptives. c. aspirin medications. d. antihypertensives.

c. aspirin meds Salicylates interfere with platelet function and can lead to petechiae and ecchymosis. Anticonvulsants may cause anemia, but not bleeding. Oral contraceptives increase clotting risk. Antihypertensives do not commonly cause problems with decreased clotting.

A patient with a history of iron-deficiency anemia who has not taken iron supplements for several years is experiencing increased fatigue and occasional palpitations. The nurse would expect the patient's laboratory findings to include a. hematocrit (Hct) 38%. b. red blood cell count (RBC) 4,500,000/l. c. hemoglobin (Hgb) 8.6 g/dl (86 g/L). d. normal RBC indices.

c. hgb 8.6 g/dL The patient's clinical manifestations indicate moderate anemia, which is consistent with a Hgb of 6 to 10 g/dl. The other values are all within the range of low-normal to normal. remember: HCT measures how much of your blood is made up of red blood cells. These don't include WBC's, platelets, etc., only RBC's. HGB measures how many IRON CONTAINING RBC's there are in circulation that can carry O2. Thus, HCT is a good measure for blood loss anemia, whereas HGB is a good measure of iron deficiency anemia

A client states that she is afraid of receiving vitamin B12 injections because of the potential toxic reactions. What is the nurse's best response to relieve these fears? a. "Vitamin B12 will cause ringing in the eats before a toxic level is reached." b. "Vitamin B12 may cause a very mild skin rash initially." c. "Vitamin B12 may cause mild nausea but nothing toxic." d. "Vitamin B12 is generally free of toxicity because it is water soluble."

d. Vitamin B12 is generally free of toxicity because it is water soluble Vitamin B12 is a water-soluble vitamin. When water-soluble vitamins are taken in excess of the body's needs, they are filtered through the kidneys and excreted. Vitamin B12 is considered to be nontoxic. Adverse reactions that have occurred are believed to be related to impurities or to the preservative in B12 preparations. Ringing in the ears, skin rash, and nausea are not considered to be related to vitamin B12 administration.

When comparing the hematocrit levels of a post-op client, the nurse notes that the hematocrit decreased from 36% to 34% on the third day even though the RBC and hemoglobin values remained stable at 4.5 million and 11.9 g/dL, respectively. Which nursing intervention is most appropriate? a. Check the dressing and drains for frank bleeding b. Call the physician c. Continue to monitor vital signs d. Start oxygen at 2L/min per NC

c. Continue to monitor vital signs The nurse should continue to monitor the client, because this value reflects a normal physiologic response (considering the fact that she just went through surgery). The physician does not need to be called, and oxygen does not need to be started based on these laboratory findings. Immediately after surgery, the client's hematocrit reflects a falsely high value related to the body's compensatory response to the stress of sudden loss of fluids and blood. Activation of the intrinsic pathway and the renin-angiotensin cycle via antidiuretic hormone produces vasoconstriction and retention of fluid for the first 1 to 2 day post-op. By the second to third day, this response decreases and the client's hematocrit level is more reflective of the amount of RBCs in the plasma. Fresh bleeding is a less likely occurrence on the third post-op day but is not impossible; however, the nurse would have expected to see a decrease in the RBC and hemoglobin values accompanying the hematocrit.

The nurse would instruct the client to eat which of the following foods to obtain the best supply of vitamin B12? a. Whole grains b. Green leafy vegetables c. Meats and dairy products d. Broccoli and Brussel sprouts

c. Meats and dairy products Good sources of vitamin B12 include meats and dairy products. Whole grains are a good source of thiamine. Green leafy vegetables are good sources of niacin, folate, and carotenoids (precursors of vitamin A). Broccoli and Brussels sprouts are good sources of ascorbic acid (vitamin C).

The client was dx with iron-deficiency anemia is prescribed ferrous gluconate orally. Which should the nurse teach the client? A.Take Imodium, and anti diarrheal, OTC for diarrhea B.Limit exercise for several weeks until a tolerance is achieved C.The stools may be very dark, and this can mask blood D.Eat only red meats and organ meats for protein

C Ferrous gluconate s/e can include Constipation or stools that are black or green also occur. (The unusual coloring is because of absorbed iron, and is not harmful.) In rare cases, ferrous sulfate side effects include: Diarrhea.

A client is to receive epoetin (Epogen) injections. What laboratory value should the nurse assess before giving the injection? a. Hematocrit b. Partial thromboplastin time c. Hemoglobin concentration d. Prothrombin time

a. Hematocrit Epogen is a recombinant DNA form of erythropoietin, which stimulates the production of RBCs and therefore causes the hematocrit to rise. The elevation in hematocrit causes an elevation in blood pressure; therefore, the blood pressure is a vital sign that should be checked. The PTT, hemoglobin level, and PT are not monitored for this drug.

A 52-year-old patient has a new diagnosis of pernicious anemia. After teaching the patient about pernicious anemia, the nurse determines that the patient understands the disorder when the patient states, a. "I will need to have cobalamin (B12) injections regularly for the rest of my life." b. "I will stop having a glass of wine with dinner." c. "The numbness in my feet will go away once my hemoglobin level returns to normal." d. "My diet should include more red meat or liver."

a. I will need to have cobalamin -B12 injections regularly for the rest of my life rationale: pernicious anemia is the lack of intrinsic factor within the stomach to absorb vitamin B12. inherently, pernicious anemia is simply vitamin B12 deficiency. To correct pernicious anemia, you have to give B12 injections so that vitamin B12 goes directly into the bloodstream rather than it being absorbed via the stomach which'll then bring it into the bloodstream. So basically you're skipping the mediator

A client was admitted with iron deficiency anemia and blood-streaked emesis. Which question is most appropriate for the nurse to ask in determining the extent of the client's activity intolerance? a. "What activities were you able to do 6 months ago compared with present?" b. "How long have you had this problem?" c. "Have you been able to keep up with all your usual activities?" d. "Are you more tired now than you used to be?"

a. What activities were you able to do 6 months ago compared with present? Rationale: It is difficult to determine activity intolerance without objectively comparing activities from one time frame to another. Because iron deficiency anemia can occur gradually and individual endurance varies, the nurse can best assess the clients activity tolerance by asking the client to compare activities 6 months ago and at the present

A client is beginning a regimen of ferrous sulfate or iron. As you prepare to administer the medication, it is important for you to advise the client that select all that apply: a. Her urine will turn a dark orange b. Her bowel movements will be dark and tarry c. Her appetite will be diminished d. Her vision will become slightly blurred e. She may experience constipation

b. Her bowel movements will be dark and tarry r/t increased iron in their system e. She may experience constipation rationale: Constipation or stools that are black or green also occur. (The unusual coloring is because of absorbed iron, and is not harmful.) In rare cases, ferrous sulfate side effects include: Diarrhea.

The nurse understands that the client with pernicious anemia will have which distinguishing laboratory findings? a. Schilling's test, elevated b. Intrinsic factor, absent. c. Sedimentation rate, 16 mm/hour d. RBCs 5.0 million

b. intrinsic factor, absent The defining characteristic of pernicious anemia, a megaloblastic anemia, is lack of the intrinsic factor, which results from atrophy of the stomach wall. Without the intrinsic factor, vitamin B12 cannot be absorbed in the small intestines, and folic acid needs vitamin B12 for DNA synthesis of RBCs. The gastric analysis was done to determine the primary cause of the anemia. An elevated excretion of the injected radioactive vitamin B12, which is protocol for the first and second stage of the Schilling test, indicates that the client has the intrinsic factor and can absorb vitamin B12 into the intestinal tract. A sedimentation rate of 16 mm/hour is normal for both men and women and is a nonspecific test to detect the presence of inflammation. It is not specific to anemias. An RBC value of 5.0 million is a normal value for both men and women and does not indicate anemia.

A client with iron deficiency anemia is scheduled for discharge. Which instruction about prescribed ferrous gluconate therapy should the nurse include in the teaching plan? a. "Take the medication with an antacid." b. "Take the medication with a glass of milk." c. "Take the medication with cereal." d. "Take the medication on an empty stomach."

d. Take the meds on an empty stomach Preferably, ferrous gluconate should be taken on an empty stomach. Ferrous gluconate should not be taken with antacids, milk, or whole-grain cereals because these foods reduce iron absorption.