Anemic Disorders

A nurse is doing an assessment of a 50-year-old female. She complains of abdominal pain and the nurse suspects that the patient may be bleeding into her abdomen because of a complication with a coagulation disorder. The nurse notifies the physician. What is the nurse's greatest concern about this patient? A. Hypotension, hypovolemic shock B. Kidney disorder C. Ectopic pregnancy D. Infection

A) Hypotension, hypovolemic shock

A client must receive a blood transfusion of packed red blood cells (RBCs) for severe anemia. What I.V. fluid should the nurse use to prime the tubing before hanging this blood product? A. no priming needed since blood products must be infused alone per current guidelines B. dextrose 5% in water as this is considered an isotonic solution C. lactated Ringer's solution as this is considered an isotonic solution D. normal saline solution as this is considered an isotonic solution

D. Normal saline solution as this is considered an isotonic solution Exp. - Normal saline solution is used for administering blood transfusions. Lactated Ringer's solution or dextrose solutions may cause blood clotting or RBC hemolysis. Current guidelines do not indicate a "no priming" method without NSS.

A 22-year-old male is in the ICU with sepsis. The physicians are trying to rule out acute DIC. The nurse performs a primary assessment of the patient at the beginning of shift. Which of the following items would be part of the initial assessment of this patient? SATA A. Check for signs of bleeding in the gums/mouth B. Check pupils for reaction C. Check IV sites or any areas the patient may have had labs drawn for bleeding D. Check for altered level of consciousness

A) Check for signs of bleeding in the gums/mouth C) Check IV sites or any areas the patient may have had labs drawn for bleeding D) Check for altered level of consciousness

A nurse is caring for a patient with severe aplastic anemia. The patient was otherwise healthy up until about 2 weeks ago and just returned from a trip to Mexico where she received some medication for a dog bite. The patient asks when she will be able to go home and how serious this is. What is the nurse's best response? SATA A. You may have a serious adverse event from the medication you received in Mexico, which caused your bone marrow to alter or stop producing red blood cells. B. The physicians may be talking to you about a bone marrow transplant as that is the best treatment for your diagnosis C. This is something that is easily treated with a blood transfusion D. You will need a white cell transfusion

A) You may have a serious adverse event from the medication you received in Mexico, which caused your bone marrow to alter or stop producing red blood cells.

A client with the beta-thalassemia trait plans to marry a person of Italian ancestry who also has the trait. Which client statement indicates understanding of the teaching provided by the nurse? A. "We should never plan to have children." B. "I need to learn how to give myself vitamin B12 injections." C. "We'll need more genetic counseling in the future." D. "If my fiancé was of Middle Eastern descent, I wouldn't be worried about having children."

C. "We'll need more genetic counseling in the future." Exp. - Two people with the beta-thalassemia trait have a 25% chance of having a child with thalassemia major, a potentially life-threatening disease. Vitamin B<!sub>12!sub> injections are used to treat pernicious anemia, not thalassemia. Thalassemia occurs primarily in people of Italian, Greek, African, Asian, Middle Eastern, East Indian, and Caribbean descent. The client needs to know the risks before starting a family.

Secondary polycythemia is often the result of increased RBC production that can develop as a result of which of the following? A. Chronic chemotherapy B. Obesity hypoventilation system C. Myocardial infarction D. Sleep apnea

B) Obesity hypoventilation system

A diagnosis of hemophilia A is confirmed in an infant. Which of the instructions should the nurse provide the parents as the infant becomes more mobile and starts to crawl? A. Administer one-half of a children's aspirin for a temperature higher than 101° F (38.3° C). B. Sew thick padding into the elbows and knees of the child's clothing. C. Check the color of the child's urine every day. D. Expect the eruption of the primary teeth to produce moderate to severe bleeding.

B) Sew thick padding into the elbows and knees of the child's clothing Exp. - As the hemophilic infant begins to acquire motor skills, falls and bumps increase that risk of bleeding. Such injuries can be minimized by padding vulnerable joints. Aspirin is contraindicated because of its antiplatelet properties, which increase the infant's risk for bleeding.

The nurse completes a physical assessment of a 40-year-old female patient who presents with a history of anemia. What is the most important aspect of the assessment to determine if the patient has hemodilution? A. A stool guiac test B. BUN and creatinine C. Intake and output D. Bilirubin

C) Intake and output

A client with aplastic anemia is instructed to eat foods rich in iron. The nurse should instruct the client to include which food in the diet to increase iron intake? A. fresh fruits B. cheese C. dark green leafy vegetables D. chicken breasts

C. dark green leafy vegetables Exp. - Foods high in iron include dark green leafy vegetables, liver and red meat, eggs, dried fruit, legumes, and whole grain breads.Fruits, cheese, and chicken are not high in iron.

The nurse is administering packed red blood cells (PRBCs) to a client. What should the nurse do first? A. Discontinue the IV catheter if a blood transfusion reaction occurs. B. Administer the PRBCs through a percutaneously inserted central catheter line with a 20-gauge needle. C. Flush PRBCs with 5% dextrose and 0.45% normal saline solution. D. Stay with the client during the first 15 minutes of infusion.

D) Stay with the client during the first 15 minutes of infusion. Exp. - The most likely time for a blood transfusion reaction to occur is during the first 15 minutes or first 50 ml of the infusion. If a blood transfusion reaction does occur, it is imperative to keep an established I.V. line so that medication can be administered to prevent or treat cardiovascular collapse in case of anaphylaxis. PRBCs should be administered through a 19-gauge or larger needle; a peripherally inserted central catheter line is not recommended, in order to avoid a slow flow. RBCs will hemolyze in dextrose or lactated Ringer's solution and should be infused with only normal saline solution.