Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders
A client admitted to the hospital in preparation for a splenectomy to treat autoimmune hemolytic anemia asks the nurse about the benefits of splenectomy. Which statement best explains the expected effect of splenectomy? a) It will remove the major site of red blood cell (RBC) destruction. b) It will reduce the destruction of platelets by macrophages. c) It will increase production of platelets by the bone marrow. d) It will increase red blood cell (RBC) production to compensate for blood loss.
a
A client awaiting a bone marrow aspiration asks the nurse to explain where on the body the procedure will take place. What body part does the nurse identify for the client? a) Posterior iliac crest b) Sternum c) Femur d) Ankle
a
A client comes to the walk-in clinic complaining of weakness and fatigue. While assessing this client, the nurse finds evidence of petechiae and ecchymoses. The nurse notes that the spleen appears enlarged. What would the nurse suspect is wrong with this client? a) Aplastic anemia b) Pernicious anemia c) Iron-deficiency anemia d) Agranulocytosis
a
A client has a history of sickle cell anemia with several sickle cell crises over the past 10 years. What blood component results in sickle cell anemia? a) hemoglobin S b) hemoglobin F c) hemoglobin A d) hemoglobin M
a
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? a) Assesses the hemoglobin level b) Questions the administration of both medications c) Ensures the client has completed dialysis treatment d) Holds the epoetin alfa if the BUN is elevated
a
A client is hospitalized 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin at home, which is now discontinued. To prevent the formation of blood clots, which action should the nurse take? a) Administer the prescribed enoxaparin (Lovenox). b) Encourage a diet high in vitamin K. c) Have the client limit physical activity. d) Monitor partial thromboplastin (PTT) time.
a
A client is treated for anemia. What is the nurse's best understanding about the correlation between anemia and the client's iron stores? a) There is a strong correlation between iron stores and hemoglobin levels. b) There is a strong correlation between iron stores and hemoglobin characteristics. c) There is an inverse relationship between iron stores and hemoglobin levels. d) There is a weak correlation between iron stores and hemoglobin levels.
a
A client with chronic anemia has received multiple transfusions. Which client action would the nurse be concerned about relative to the client's condition? a) Takes over-the-counter iron supplements b) Eliminates use of alcohol c) Takes 60 grams of protein each day d) Takes a daily multiple vitamin pill
a
A client with idiopathic thrombocytopenic purpura (ITP) is admitted to an acute care facility. The nurse monitors the client's platelet count and observes closely for signs and symptoms of bleeding. The client is at greatest risk for cerebral hemorrhage when the platelet count falls below what number? a) 10,000/?l. b) 20,000/?l. c) 75,000/?l. d) 135,000/?l.
a
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? a) "Eat small amounts of bland, soft foods frequently." b) "Eat larger amounts of bland, soft foods less frequently." c) "Eat cold, bland foods with a large amount of water." d) "Eat low-fiber blended foods only."
a
A client with multiple myeloma reports pain along the spinal column. The client is prescribed naproxen (Aleve) and oxycodone. Prior to administering these medications, the nurse a) Checks the client's BUN and creatinine b) Instructs the client not to lift more than 20 pounds c) Teaches the client to bend at the back when lifting objects d) Questions the physician about the use of both medications
a
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 most appropriate for this client? a) Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit b) Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients c) Risk for falls related to complaints of dizziness d) Fatigue related to decreased hemoglobin and hematocrit
a
A client with sickle cell anemia has a a) low hematocrit. b) high hematocrit. c) normal hematocrit. d) normal blood smear.
a
A client's low prothrombin time (PT) was attributed to low vitamin K levels and the client's PT normalized after administration of vitamin K. When performing discharge education in an effort to prevent recurrence, what should the nurse emphasize? a) Adequate nutrition b) Avoidance of NSAIDs c) Constant access to clotting factor concentrates d) Meticulous hygiene
a
A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving: a) A-positive blood to an A-negative client. b) O-negative blood to an O-positive client. c) O-positive blood to an A-positive client. d) B-positive blood to an AB-positive client.
a
A nurse cares for a client with a hematological disorder and malnutrition. What is the nurse's best understanding of how the client's nutritional status may worsen the client's hematological condition? a) Decreased protein stores lead to decreased immune response b) Decreased fat stores lead to decreased ability for red blood cells c) Decreased calories lead to decreased immune response d) Decreased carbohydrates lead to decreased oxygen affinity of the hemoglobin
a
A nurse cares for a client with anemia requiring nutritional supplementation. Which nursing intervention best promotes client adherence with the prescribed therapy? a) Assist the client to incorporate the therapeutic regimen into daily activities. b) Develop a therapeutic regimen recommendation for the client. c) Assist the client to use a medication reminder system for the therapeutic regimen. d) Develop a therapeutic regimen based on the client's understanding of the medication.
a
A nurse cares for clients with hematological disorders and notes that women are diagnosed with hemochromatosis at a much lower rate than men. What is the primary reason for this? a) Women lose iron through menstrual cycles b) Women rarely manifest the gene expression c) Women have lower hemoglobin levels d) Women require grater folic acid supplementation
a
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? a) Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints. b) Ask if taking a blood pressure has ever produced pain in the upper arm. c) Ask if taking a blood pressure has ever caused bruising in the hand and wrist. d) Ask if taking a blood pressure has ever produced the need for medication.
a
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? a) Peripheral edema b) Nausea and vomiting c) Migraine d) Fever
a
A nurse is caring for a client with thalassemia who is being transfused. What is the nurse's role during a transfusion? a) To closely monitor the rate of administration b) To administer vitamin B12 injections c) To instruct the client to rest immediately if chest pain develops d) To assess for enlargement and tenderness over the liver and spleen
a
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? a) To detect the abnormal sounds suggestive of acute chest syndrome and heart failure b) To detect the evidence of infection such as fever and tachycardia c) To detect the evidence of dehydration that might have triggered a sickle cell crisis d) To detect the motor strength and stroke-related signs and symptoms
a
A nurse on a hematology/oncology floor is caring for a client with aplastic anemia. Which would not be included in the client's discharge instructions? a) Use a disposable razor when shaving. b) Avoid contact with family/friends who are sick. c) Encourage frequent handwashing. d) Plan for frequent periods of rest.
a
A nursing instructor is evaluating a student caring for a neutropenic client. The instructor concludes that the nursing student demonstrates accurate knowledge of neutropenia based on which intervention? a) Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential b) Monitoring the client's breathing and reviewing the client's arterial blood gases c) Monitoring the client's heart rate and reviewing the client's hemoglobin d) Monitoring the client's blood pressure and reviewing the client's hematocrit
a
A patient has a probable diagnosis of polycythemia vera. The nurse reviews the patient's lab work for which diagnostic indicator? a) Hematocrit of 60% b) Erythrocyte count of 6.5 m/?L c) Leukocyte count of 11,500/mm3 d) Platelet value of 350,000/mm3
a
A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor? a) Decreased level of erythropoietin b) Decreased total iron-binding capacity c) Increased mean corpuscular volume d) Increased reticulocyte count
a
A pregnant woman is hospitalized as the result of sickle-cell crisis. Which finding indicates the outcome has been achieved for this client? a) Reports joint pain less than 3 on a scale of 0 to 10 b) Takes hydroxyurea during her pregnancy c) Exhibits a temperature more than 100.3°F d) Describes the importance of staying cool
a
A thin client is prescribed iron dextran intramuscularly. What is most important action taken by the nurse when administering this medication? a) Employs the Z-track technique b) Uses a 23-gauge needle c) Injects into the deltoid muscle d) Rubs the site vigorously
a
A young client is diagnosed with glucose-6-phosphate dehydrogenase deficiency (G-6-PD). After reviewing the client's recent activities, what instruction should the nurse recommend to the client? a) Consult a health care provider about ingesting trimethoprim/sulfamethoxazole for a urinary tract infection. b) Discontinue exposure on a sun tanning bed. c) Quit cigarette smoking. d) Stop drinking excessive caffeinated beverages in less than 24 hours.
a
An client has pernicious anemia and has been receiving treatment for several years. What is the client lacking that results in pernicious anemia? a) intrinsic factor b) vitamin B c) extrinsic factor d) hemoglobin
a
Folate deficiency occurs in people who rarely eat which of the following? a) Uncooked vegetables b) Meat c) Fruit d) Bread
a
For a client with Hodgkin disease who has developed neutropenia, what is an appropriate nursing intervention to include in the care plan? a) Monitoring temperature every 4 hours b) Omitting fresh fruits and vegetables from the diet c) Positioning the client to increase lung expansion d) Avoiding intramuscular (IM) injections
a
Hemophilia A is the most common of the three types of hemophilia. What is diminished in the less serious form of hemophilia A, known as von Willebrand's disease? a) amount and quality of factor VIII b) amount and quality of factor IX c) quality of factor XI d) quality of factor VIII
a
The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency? a) B12 b) C c) A d) Folate
a
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? a) Eating calf's liver with a glass of orange juice b) Eating leafy green vegetables with a glass of water c) Eating apple slices with carrots d) Eating a steak with mushrooms
a
The nurse is planning care for a client with severe fatigue secondary to anemia. What concept will the nurse use as the basis for planning interventions? a) Assisting in prioritizing activities. b) Determining what days to be active. c) Keeping long activity periods to build client stamina. d) Encouraging early and frequent activities.
a
The nurse is talking with the parents of a toddler who was diagnosed with hemophilia A. What instruction should the nurse give to the parents? a) Administer factor VIII intravenously at the first sign of bleeding b) Encourage the toddler to participate in playground activities with other toddlers c) Administer over-the-counter preparations for a cold d) Use nasal packing for any nose bleeds
a
The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia? a) Erythrocytes that are microcytic and hypochromic b) Erythrocytes that are macrocytic and hyperchromic c) Clustering of platelets with sickled red blood cells d) An increased number of erythrocytes
a
What pathophysiological concept related to sickle cell disease predisposes a client with sickle cell disease to pneumonia? a) Damage to the spleen increases the risk for infection. b) Damage to the lymphatic system increases the risk for infection. c) Sequestration of sickled cells lead to infection in the area of sequestration. d) Sequestration of sickled cells lead to infection in the area distal to the sequestration.
a
When assessing a client with anemia, which assessment is essential? a) Health history, including menstrual history in women b) Family history c) Age and gender d) Lifestyle assessments, such as exercise routines
a
Which is a symptom of Cooley anemia? a) Bronzing of the skin b) Inflammation of the mouth c) Inflammation of the tongue d) Dyspnea
a
Which of the following is the most common hematologic condition affecting elderly patients a) Anemia b) Thrombocytopenia c) Leukopenia d) Bandemia
a
Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? a) Pancytopenia b) Anemia c) Leukopenia d) Thrombocytopenia
a
A nurse assesses a client diagnosed with megaloblastic anemia. Which clinical findings will the nurse most likely find? Select all that apply. a) Jaundice b) Smooth, red tongue c) Ulcerated corners of the mouth d) Concave nails e) Restless leg syndrome
a, c, d
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? a) Hypertension b) Osteoporosis c) Muscle wasting d) Truncal obesity
b
A client with a diagnosis of pernicious anemia comes to the clinic and reports numbness and tingling in the arms and legs. What do these symptoms indicate? a) Loss of vibratory and position senses b) Neurologic involvement c) Severity of the disease d) Insufficient intake of dietary nutrients
b
A client with anemia is prescribed an oral iron supplement. Which statement indicates that teaching about this supplement has been effective? a) "I will stop taking it if my stool turns black." b) "I will take it in the morning with orange juice." c) "I will be sure to take this medication with food." d) "I will limit my intake of raw fruit and vegetables."
b
A client with sickle cell crisis is admitted to the hospital in severe pain. While caring for the client during the crisis, which is the priority nursing intervention? a) Limiting the client's intake of oral and IV fluids b) Administering and evaluating the effectiveness of opioid analgesics c) Encouraging the client to ambulate immediately d) Limit foods that contain folic acid
b
A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client? a) Pallor, bradycardia, and reduced pulse pressure b) Pallor, tachycardia, and a sore tongue c) Sore tongue, dyspnea, and weight gain d) Angina pectoris, double vision, and anorexia
b
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? a) Milk b) Orange juice c) Leafy green vegetables d) Kidney beans
b
A patient with sickle cell disease is brought to the emergency department by a parent. The patient has a fever of 101.6°F, heart rate of 116, and a respiratory rate of 32. The nurse auscultates bilateral wheezes in both lung fields. What does the nurse suspect this patient is experiencing? a) Pneumocystis pneumonia b) Acute chest syndrome c) An exacerbation of asthma d) Pulmonary edema
b
After teaching a client about taking daily oral iron preparations for a moderate iron deficiency anemia, which statement by the client indicates to the nurse that additional instruction is needed? a) "I will occasionally take a stool softener if I feel constipated." b) "I will call the doctor if my stools turn black." c) "I will increase my fluid and fiber intake while I am taking the iron tablets." d) "I will take the iron with orange juice about an hour before eating."
b
An older adult client who is a vegetarian has a hemoglobin of 10.2 gm/dL, vitamin B12 of 68 pg/mL (normal: 200-900 pg/mL), and MCV of 110 cubic micrometers. After interpreting the data, what instruction should the nurse give to the client? a) Ingest a diet higher in vitamin B12 sources. b) Supplement the diet with vitamin B12. c) Continue with the diet but include more sources of iron. d) Change the vegetarian diet and begin to eat red meat.
b
The nurse should advise a client with iron deficiency anemia to take which action in order to prevent staining of the teeth? a) Take iron with or immediately after meals. b) Use a straw or place a spoon at the back of the mouth to take the liquid supplement. c) Avoid taking iron simultaneously with an antacid. d) Do not combine iron with other prescribed or over-the-counter medications.
b
When evaluating a patient's symptoms that are consistent with a diagnosis of leukemia, the nurse is aware that all leukemias have which common feature? a) Compensatory polycythemia stimulated by thrombocytopenia b) Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements c) Increased blood viscosity, resulting from an overproduction of white cells d) Reduced plasma volume in response to a reduced production of cellular elements
b
Which type of sickle crisis occurs as a result of infection with the human parvovirus? a) Sequestration crisis b) Aplastic crisis c) Sickle cell crisis d) Acute chest syndrome
b
You are caring for a 13-year-old diagnosed with sickle cell anemia. The client asks you what they can do to help prevent sickle cell crisis. What would be an appropriate answer to this client? a) Avoid any sports that tire you out. b) Drink at least 8 glasses of water every day. c) Avoid any activity that makes you short of breath. d) Stay on oxygen therapy 24/7.
b
A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from? Select all that apply. a) Infection b) Blood loss c) Abnormal erythrocyte production d) Destruction of normally formed red blood cells e) Inadequate formed white blood cells
b, c, d
A client admitted to the hospital with abdominal pain, anemia, and bloody stools reports feeling weak and dizzy. The client has rectal pressure and needs to urinate and move their bowels. The nurse should help them: a) to the bathroom. b) to the bedside commode. c) onto the bedpan. d) to a standing position so he can urinate.
c
A client is brought to the ED reporting fatigue, large amounts of bruising on the extremities, and abdominal pain localized in the left upper quadrant. A health history reveals the client has been treated for a sore throat three times in the past 2 months. Laboratory tests indicate severe anemia, significant neutropenia, and thrombocytopenia. Based on the symptoms, what could be the client's diagnosis? a) Iron deficiency anemia b) Sickle cell anemia c) Aplastic anemia d) Hemolytic anemia
c
A client who is diagnosed multiple myeloma experiences decreasedproduction of red blood cells (RBCs). Which prescribed medicationshould the nurse prepare to administer to increase the production of erythrocytes? a) Filgrastim b) Pegfilgrastim c) Erythropoietin d) Dexamethasone
c
A client with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse? a) Inform the client that the position must be changed, and then you will give her pain medication and omit the bath. b) Inform the client that she will feel better after receiving a bath and clean sheets. c) Obtain the pain medication and delay the bath and position change until the medication reaches its peak. d) Inform the client that the bath and positioning is an important part of client care and will be done right after pain medication administration.
c
A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify? a) Potential hepatic dysfunction indicated by decreased blood urea nitrogen (BUN) and creatinine levels b) Low levels of urine constituents normally excreted in the urine c) Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels d) Electrolyte imbalance that could affect the blood's ability to coagulate properly
c
A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the health care provider immediately because the client probably is experiencing which problem? a) A hemolytic reaction to mismatched blood b) A hemolytic reaction to Rh-incompatible blood c) A hemolytic allergic reaction caused by an antigen reaction d) A hemolytic reaction caused by bacterial contamination of donor blood
c
A health care provider prescribes one tablet of ferrous sulfate daily for a 15-year-old girl who experiences heavy blood flow during her menstrual cycle. The nurse advises the patient and her parent that this over-the-counter preparation must be taken for how many months before stored iron replenishment can occur? a) 1 to 2 months b) 3 to 5 months c) 6 to 12 months d) Longer than 12 months
c
A nurse suspects that a patient may have aplastic anemia based on clinical manifestations and assessment. Which one of the following lab results would be consistent with this diagnosis? a) Hemoglobin level of 15 g/dL b) Erythrocyte count of 5.3 m/?L c) Neutrophil count of 50% d) Platelet level of 275,000/mm3
c
A patient describes numbness in the arms and hands with a tingling sensation. The patient also frequently stumbles when walking. What vitamin deficiency does the nurse determine may cause some of these symptoms? a) Thiamine b) Folate c) B12 d) Iron
c
A patient with End Stage Kidney Disease is taking recombinant erythropoietin for the treatment of anemia. What laboratory study does the nurse understand will have to be assessed at least monthly related to this medication? a) Potassium level b) Creatinine level c) Hemoglobin level d) Folate levels
c
A young client is diagnosed with a mild form of hemophilia and is experiencing bleeding in the joints with pain. In preparing the client for discharge, what instructions should the nurse provide? a) Take ibuprofen for joint pain. b) Take warm baths to lessen pain. c) Wear a medical identification bracelet. d) Undergo genetic testing and counseling if the client is male.
c
After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/mm3. What term should the nurse use to describe this low platelet count? a) Anemia b) Leukopenia c) Thrombocytopenia d) Neutropenia
c
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? a) Elevated hematocrit concentration b) Enlarged mean corpuscular volume (MCV) c) Low ferritin level concentration d) Elevated red blood cell (RBC) count
c
Parents arrive to the clinic with their young child and inform the nurse the child has just been diagnosed with sickle cell disease. The parents ask the nurse how this could have happened and which one of them is the carrier. What is the best response by the nurse? a) "Most likely, the father is the carrier of the gene." b) "The trait is passed down through the mother." c) "The child must inherit two defective genes, one from each parent." d) "It is an acquired, not a hereditary disorder."
c
The nurse is assessing a patient who is a strict vegetarian. What type of anemia is the nurse aware that this patient is at risk for? a) Iron deficiency anemia b) Aplastic anemia c) Megaloblastic anemia d) Sickle cell anemia
c
The nurse is caring for a client with an exacerbation of sickle cell disease (SCD). Which finding indicates to the nurse that the client is experiencing a liver complication from this condition? a) Fatigue b) Weakness c) Abdominal pain d) Glucose intolerance
c
The nurse is caring for a client with external bleeding. What is the nurse's priority intervention? a) Elevation of the extremity b) Pressure point control c) Direct pressure d) Application of a tourniquet
c
The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions? a) Do not take medication with orange juice because it will delay absorption of the iron. b) Iron may cause indigestion and should be taken with an antacid such as Mylanta. c) Dilute the liquid preparation with another liquid such as juice and drink with a straw. d) Discontinue the use of iron if your stool turns black.
c
The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include a nutritional assessment for this patient? a) It is part of the required assessment information. b) It is important for the nurse to determine what type of foods the patient will eat. c) It may indicate deficiencies in essential nutrients. d) It will determine what type of anemia the patient has.
c
The nurse obtains a unit of blood for the client, Donald D. Smith. The name on the label on the unit of blood reads Donald A. Smith. All the other identifiers are correct. What action should the nurse take? a) Administer the unit of blood b) Check with the blood bank first and then administer the blood with their permission c) Refuse to administer the blood d) Ask the client if he was ever known as Donald A. Smith
c
The nurse's role in the management of polycythemia vera is primarily that of an educator. Choose the best health promotion advice that a nurse could give. a) Use compression stockings when walking to prevent deep vein thrombosis (DVT). b) Take aspirin daily to prevent clot formation. c) Participate in regular phlebotomy procedures to decrease blood viscosity. d) Take antiplatelets on a regular basis.
c
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? a) Assess for edema. b) Assess skin integrity frequently. c) Assess the client's level of consciousness frequently. d) Closely monitor intake and output.
d
A client is receiving chemotherapy for cancer. The nurse reviews the client's laboratory report and notes that he has thrombocytopenia. To which nursing diagnosis should the nurse give the highest priority? a) Activity intolerance b) Impaired tissue integrity c) Impaired oral mucous membranes d) Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI
d
A client with a pulmonary embolism is being treated with a heparin infusion. What diagnostic finding suggests to the nurse that treatment is effective? a) The client's PT is within reference ranges. b) Arterial blood sampling tests positive for the presence of factor XIII. c) The client's platelet level is below 100,000/mm3. d) The client's activated partial thromboplastin time (aPTT) is 1.5 to 2.5 times the control value.
d
A client with pernicious anemia is receiving parenteral vitamin B12therapy. Which client statement indicates effective teaching about this therapy? a) "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear." b) "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal." c) "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." d) "I will receive parenteral vitamin B12 therapy for the rest of my life."
d
A patient had gastric bypass surgery 3 years ago and now, experiencing fatigue, visits the clinic to determine the cause. The patient takes pantoprazole for the treatment of frequent heartburn. What type of anemia is this patient at risk for? a) Aplastic anemia b) Iron deficiency anemia c) Sickle cell anemia d) Pernicious anemia
d
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? a) Potassium level of 5.2 mEq/L b) Magnesium level of 2.5 mg/dL c) Calcium level of 9.4 mg/dL d) Creatinine level of 6 mg/100 mL
d
During a routine assessment of a patient diagnosed with anemia, the nurse observes the patient's beefy red tongue. The nurse is aware that this is a sign of what kind of anemia? a) Autoimmune b) Folate deficiency c) Iron deficiency d) Megaloblastic
d
During preparation for bowel surgery, a client receives an antibiotic to reduce intestinal bacteria. The nurse knows that hypoprothrombinemia may occur as a result of antibiotic therapy interfering with synthesis of which vitamin? a) Vitamin A b) Vitamin D c) Vitamin E d) Vitamin K
d
The nurse is caring for an older adult client who has been admitted to the unit with anemia. What would the nurse expect the client to possibly exhibit? a) Excessive consumption of coffee or tea b) Elimination of iron by the body c) Decrease in the total body iron stores with age d) Blood loss from the gastrointestinal or genitourinary tract
d
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? a) "I feel hot all of the time." b) "I have a difficult time falling asleep at night." c) "I have an increase in my appetite." d) "I have difficulty breathing when walking 30 feet."
d
The nurse, caring for a client in the emergency room with a severe nosebleed, becomes concerned when the client asks for a bedpan. The nurse documents the stool as loose, tarry, and black looking. The nurse suspects the client may have thrombocytopenia. What should be the nurse's priority action? a) Stop the nosebleed b) Put in an IV line c) Ask someone to clean the bedpan d) Notify the physician
d
Which iron-rich foods should a nurse encourage an anemic client requiring iron therapy to eat? a) Shrimp and tomatoes b) Lobster and squash c) Cheese and bananas d) Lamb and peaches
d
While assessing a client, the nurse discovers the client has a history of restless leg syndrome. Which hematological condition does the nurse associate with this condition? a) Thalassemia b) Folate deficiency anemia c) Sickle cell disease d) Iron deficiency anemia
d
A client at the clinic has just been diagnosed with iron deficiency anemia. What would you recommend the client consume to promote the absorption of iron? a) Vitamin E b) Meat, egg yolks, oysters, and shellfish c) Rich sources of vitamin C d) Sources of vitamin B12
c
Which is a symptom of hemochromatosis? a) Bronzing of the skin b) Inflammation of the mouth c) Inflammation of the tongue d) Weight gain
a
Which medication is the antidote to warfarin? a) Vitamin K b) Protamine sulfate c) Aspirin d) Clopidogrel
a
Which of the following is considered an antidote to heparin? a) Protamine sulfate b) Vitamin K c) Narcan d) Ipecac
a
Which of the following are assessment findings associated with thrombocytopenia? Select all that apply. a) Bleeding gums b) Epistaxis c) Hematemesis d) Bradypnea e) Hypertension
a, b, c
A nurse should expect to administer which vaccine to the client after a splenectomy? a) Recombivax HB b) Attenuvax c) Pneumovax 23 d) Tetanus toxoid
c
