Anemia

13) Which form of anemia can be prevented by a change in diet? A) Iron deficiency anemia B) Aplastic anemia C) Blood loss anemia D) Hemolytic anemia

Answer: A Explanation: A) Nutritional causes of anemia include iron deficiency, vitamin B12 deficiency, and folic acid deficiency. Blood loss anemia recurs as a result of hemorrhage or other forms of blood loss. Aplastic anemia occurs when the bone marrow fails to produce red and white blood cells. Hemolytic anemias occur when red blood cells are destroyed prematurely. Only nutritional anemias can be prevented by a change in diet.

8) The nurse suspects that a client with severe shortness of breath in the absence of cyanosis is experiencing anemia. Which laboratory tests should the nurse review to confirm anemia? Select all that apply. A) Serum electrolytes B) Cardiac enzymes C) Hemoglobin D) Blood sugar E) Hematocrit

Answer: C, E Explanation: Severe anemia will interfere with the development of cyanosis, so the nurse should review the hemoglobin and hematocrit. Blood sugar, cardiac enzymes, and serum electrolytes are not implicated in this phenomenon.

2) A client experiencing fatigue, pallor, and dyspnea on exertion has a complete blood count drawn. Which red blood cell disorder should the nurse anticipate the client is experiencing? A) Polycythemia B) Erythropoiesis C) Herpes simplex D) Anemia

Answer: D Explanation: Anemia is the most common red blood cell disorder, involving a low RBC count and decreased hemoglobin content. Signs and symptoms of anemia can include pallor of the skin and mucous membranes and dyspnea on exertion. Polycythemia is an abnormally high RBC count. Herpes simplex is not a red blood cell disorder; erythropoiesis is the term for RBC production.

14) A NICU nurse is caring for several newborns with anemia. Which infant with anemia would the nurse be least concerned about? A) A baby born at 32 weeks' gestation after the mother suffered from abruptio placentae B) A baby born at 38 weeks' gestation who has a blood group incompatibility with the mother C) A baby born at 35 weeks' gestation who suffered birth trauma to the head D) A baby born at 39 weeks' gestation via a scheduled cesarean section

Answer: D Explanation: For full-term infants with no birth complications, a normal, gradual drop in hemoglobin during the first 6 to 12 weeks of life is called physiologic anemia of the newborn. When the hemoglobin begins to drop, the bone marrow produces RBCs again, and the anemia disappears. The infants who suffered birth trauma, abruptio placentae, or blood group incompatibility may have anemia related to blood loss or hemolysis, which is much more serious than physiologic anemia of the newborn.

4) An older adult client with renal failure is diagnosed with anemia. Based on this data, which cause of anemia will the nurse plan for when providing care? A) Loss of the kidney hormone erythropoietin B) A loss of appetite related to elevated blood urea nitrogen (BUN) and creatinine levels C) The renal dialysis used to treat the chronic renal failure D) Loss of blood through the urine because the failing kidney does not function properly

Answer: A Explanation: A) The anemia associated with renal failure is related to the loss of erythropoietin, which is produced by the healthy kidney and stimulates bone marrow to produce red blood cells. The anemia is not directly related to anorexia or hemodialysis, although these factors may be somewhat associated with the anemia. Renal failure causes the loss of protein, not blood, through the urine.

3) A client with a history of anemia has started a vegan diet. Which addition to meals should the nurse recommend to help ensure that this client has adequate amounts of iron in the diet? Select all that apply. A) Legumes B) Orange juice C) Yeast D) Okra E) Peas

Answer: A, B, E Explanation: A) While all these options are good ones for someone on a vegan diet, the ones that would best prevent iron deficiency are legumes, peas, and orange juice. Legumes and peas are good sources of nonheme iron. Orange juice supports iron absorption from foods since it is high in vitamin C. Yeast is a good source of folic acid. Okra is not a good source of iron.

5) A nursing student is preparing an educational program on hemolytic anemia for the residents of an assisted living center. Which extrinsic causes of hemolytic anemia should the student include in the program? Select all that apply. A) Bacterial infection B) Thalassemia C) Blood transfusion reaction D) Prosthetic heart valves E) Acetaminophen use

Answer: A, C, D Explanation: A) Prosthetic heart valves, blood transfusion reactions, and bacterial infections are all extrinsic causes of hemolytic anemia. Acetaminophen use is not associated with hemolytic anemia. Thalassemia is considered an intrinsic cause of hemolytic anemia and would not be appropriate to include in this particular teaching.

12) A nurse is providing discharge instructions to a client with iron deficiency anemia who is experiencing glossitis. Which statements will the nurse include in the discharge teaching for this client? Select all that apply. A) Monitor the condition of the lips and tongue daily. B) Use an alcohol-based mouthwash every 2 to 4 hours. C) Provide frequent oral hygiene. D) Apply a non-petroleum-based lubricating jelly or ointment to the lips after oral care. E) Use a soft toothbrush or sponge to provide oral care.

Answer: A, C, E Explanation: A) Glossitis, inflammation of the tongue that may cause the tongue and lips to turn red, and cheilosis (fissures or cracks at the corners of the mouth) may occur with nutritional deficiencies of iron, folate, and vitamin B12. Client education should include monitoring the condition of lips and tongue daily and providing frequent oral hygiene with a soft-bristle toothbrush or sponge. The client should not use an alcohol-based mouthwash, as this would worsen the glossitis. The client should use a petroleum-based lubricating jelly or ointment to the lips after oral care.

1) A client complaining of mouth soreness had gastric bypass surgery 1 year ago. During the assessment, the nurse notes the client's tongue is beefy, red, and smooth and the client's skin appears yellowish. Which additional information is most likely needed before diagnosing this client? A) Vitamin B6 levels B) Vitamin B12 levels C) Potassium levels D) Iron levels

Answer: B Explanation: Vitamin B12 deficiency is associated with resection of the stomach or ileum. A deficiency of vitamin B12 will result in pernicious anemia. This deficiency will manifest as pallor, jaundice, weakness, and a beefy, smooth red tongue. Iron deficiency anemia will manifest with weakness and fatigue. Vitamin B6 deficiencies are not typically seen with gastric bypass surgeries and are not manifested with a beefy, red, smooth tongue. The client's reports are not consistent with a potassium deficiency.

6) The home healthcare nurse is preparing a care plan for a client with severe anemia. The client currently lives alone and states, "I can't even walk to the kitchen without getting winded." What would be the priority nursing diagnosis for this client? A) Hopelessness B) Activity Intolerance C) Imbalanced Nutrition, Less than Body Requirements D) Anxiety

Answer: B Explanation: Activity Intolerance would be a priority diagnosis for this client. While Anxiety, Hopelessness, and Imbalanced Nutrition may be appropriate nursing diagnoses for this client, they are not the priority.

A client with anemia is prescribed synthetic erythropoietin. When teaching the client about the therapeutic effect of this treatment, which is appropriate for the nurse to include? A) Increase in platelets B) Increase in red blood cells C) Decrease in white blood cells D) Decrease in lymph fluid

Answer: B Explanation: Erythropoietin is a hormone produced in the body to stimulate production of red blood cells; synthetic forms are available for administration to cancer clients or others with significantly low red blood cell counts. Erythropoietin will not stimulate or decrease the production of platelets, white blood cells, or lymph fluid.

7) The nurse is evaluating a client's understanding of dietary needs to treat dietary deficiency anemia. Which client statement indicates a need for additional teaching? A) "I will eat more fruits and vegetables, especially green leafy ones, to get more iron in my diet." B) "I will need to include more protein foods in my diet such as meats, dried beans, and whole-grain breads." C) "I will decrease foods high in vitamin C, as they decrease my absorption of iron." D) "I will take vitamins with extra iron in addition to eating a balanced diet with meat to correct my anemia."

Answer: C Explanation: Increasing foods high in vitamin C will increase absorption of iron. The lack of iron is the problem that needs to be addressed. Extra iron is needed to help replace RBCs and treat the dietary deficiency anemia. Green leafy vegetables will increase iron in the diet. Protein foods such as meats, dried beans, and whole-grain breads do contain iron that will help dietary deficiency anemia.

11) A nurse is educating a client with anemia about the pathophysiological mechanisms of anemia. Which should be excluded in the nurse's teaching plan for this client? A) Altered hemoglobin synthesis B) Altered DNA synthesis C) Decreased hemolysis D) Bone marrow failure

Answer: C Explanation: The pathophysiological mechanisms of anemia include altered hemoglobin synthesis, altered DNA synthesis, bone marrow failure, and increased hemolysis. Altered hemoglobin synthesis is the mechanism involved in iron deficiency anemia, Thalassemia, and chronic inflammation. Altered DNA synthesis is the mechanism involved in vitamin B12 malabsorption or deficiency, and folic acid malabsorption or deficiency. Bone marrow failure is the mechanism in aplastic anemia, red cell aplasia, myeloproliferative leukemias, and lymphomas.

10) The nurse is instructing a client with iron deficiency anemia about appropriate menu choices. Which diet choice indicates that teaching has been effective? A) Tofu with mixed vegetables in curry, milk, whole-wheat bun B) Broiled fish, lettuce salad, grapefruit half, carrot sticks C) Pork chop, mashed potatoes and gravy, cauliflower, tea D) Roast beef, steamed spinach, tomato soup, orange juice

Answer: D Explanation: This client is anemic and needs iron. This meal contains iron in the beef, folic acid and iron in the spinach, and vitamin C in the tomato soup and orange juice. Vitamin C helps absorption of the iron; folic acid is needed for production of red cells. The meal of tofu with mixed vegetables in curry, milk, and a whole-wheat bun is high in calcium, but the client has iron deficiency anemia and requires a high-iron diet. The meal with a pork chop, mashed potatoes and gravy, cauliflower, and tea has a moderate amount of protein, but no vitamin C. The meal of fish, lettuce, grapefruit, and carrot sticks is high in fiber, low in fat, and moderately high in protein, but low in iron.