Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders

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 small amounts of bland, soft foods frequently."

The nurse is collecting data for a client who has been diagnosed with iron-deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia?

"I have difficulty breathing when walking 30 feet."

A client with anemia is prescribed an oral iron supplement. Which statement indicates that teaching about this supplement has been effective?

"I will take it in the morning with orange juice."

A client who is diagnosed with hemophilia is admitted after sustaining an injury while playing outdoors with friends. Initially, the client presented with severe bleeding but has since stabilized. Which intervention(s) should the nurse include in the client's updated plan of care? Select all that apply.

A. eliminate aspirin and NSAIDs C. support painful joints on pillows D. encourage the client to use a soft toothbrush and rinse the mouth with warm water between and after meals

A nurse caring for a client who has hemophilia is getting ready to take the client's vital signs. What should the nurse do before taking a blood pressure?

Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints.

A client in end-stage renal disease is prescribed epoetin alfa and oral iron supplements. Before administering the next dose of epoetin alfa and oral iron supplement, what is the priority action taken by the nurse?

Assesses the hemoglobin level

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

A client is being treated for DIC and the nurse has prioritized the nursing diagnosis of Risk for Deficient Fluid Volume Related to Bleeding. How can the nurse best determine if goals of care relating to this diagnosis are being met?

Closely monitor intake and output.

A nurse working with clients diagnosed with sickle cell disease notices that sickle cell crisis cases increase in the winter months. What is the primary pathophysiological reason for this?

Colder temperatures slows the blood flow.

A male client has been receiving a continuous infusion of weight-based heparin for more than 4 days. The client's PTT is at a level that requires an increase of heparin by 100 units per hour. The client has the laboratory findings shown above. What is the most important action for the nurse to take?

Consult with the physician about discontinuing heparin.

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?

Creatinine level of 6 mg/100 mL

A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia?

Dyspnea, tachycardia, and pallor

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 calf's liver with a glass of orange juice

A thin client is prescribed iron dextran intramuscularly. What is most important action taken by the nurse when administering this medication?

Employs the Z-track technique

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 mostappropriate for this client?

Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit

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?

Low ferritin level concentration

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?

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?

Osteoporosis

While assessing a client, the nurse will recognize what as the most obvious sign of anemia?

Pallor

A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client?

Pallor, tachycardia, and a sore tongue

A nurse is caring for a client with severe anemia. The client is tachycardic and reports dizziness and exertional dyspnea. What signs and symptoms might develop if this client goes into heart failure?

Peripheral edema

Which of the following is considered an antidote to heparin?

Protamine sulfate

A client has hereditary hemochromatosis. Laboratory test results indicate an elevated serum iron level, high transferrin saturation, and normal complete blood count (CBC). What is most important action for the nurse to take?

Remove the prescribed one unit of blood.

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?

The onset of a bacterial infection

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 abnormal sounds suggestive of acute chest syndrome and heart failure

A client is seen in the emergency department with severe pain related to a sickle cell crisis. What does the nurse understand is occurring with this client?

Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.

Which medication is the antidote to warfarin?

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 HbS and the mother is HbS.

A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify?

Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels

A client with weakness, fatigue, and general malaise is being tested for iron deficiency anemia. Which laboratory values will the nurse expect to confirm this diagnosis? Select all that apply.

Mean corpuscle volume of 70 Hemoglobin of 11.0 Ferritin level of 20 Total iron-binding capacity of 450 mcg/dL

A client with sickle cell anemia has a

low hematocrit