Decreased Circulating Oxygen/ Anemia
A nurse is preparing a dose of furosemide for an older adult with heart failure. The health care provider orders furosemide 1 mg/kg to be given intravenously. The client weighs 50 kg. The concentration of the drug is 40 mg/4mL (10 mg/mL). How many milliliters would the nurse administer? Record your answer using a whole number.
5 1 mg/kg X 50 kg = 50 mg then divide by 10 mg/mL = 5 mL
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. "Eat small amounts of bland, soft foods frequently." Because the client with megaloblastic anemia often reports mouth and tongue soreness, the nurse should instruct the client to eat small amounts of bland, soft foods frequently. The other answer choices do not factor in the client's mouth soreness or need for nutrition.
A woman's routine complete blood count (CBC) revealed a highly elevated platelet level, and subsequent diagnostic testing has resulted in a diagnosis of primary thrombocythemia. The nurse has begun the relevant health education with the patient. What should the nurse teach this woman about her health problem? a. "Primary thrombocythemia creates potential problems at both ends of the clotting spectrum: inappropriate clotting or inappropriate bleeding." b. "Your doctor will likely order a series of blood transfusions for you over the next several months." c. "It's very important that you try to adopt a diet that's high in organ meats and leafy green vegetables." d. "Primary thrombocythemia makes you quite vulnerable to hemorrhage, so you'll need regular injections of some important clotting factors."
a. "Primary thrombocythemia creates potential problems at both ends of the clotting spectrum: inappropriate clotting or inappropriate bleeding." Primary thrombocythemia creates risks for significant thrombotic or hemorrhagic complications. Clotting factors and transfusions are not relevant treatments, and a high-iron diet is not necessary.
Which of the following is the most common hematologic condition affecting elderly patients a. Anemia b. Thrombocytopenia c. Leukopenia d. Bandemia
a. Anemia Anemia is the most common hematologic condition affecting elderly patients: with each successive decade of life, the incidence of anemia increases. Thrombocytopenia is a low platelet count. Leukopenia is a low leukocyte count. Bandemia is an increased number of band cells.
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? a. Beans, dried fruits, and leafy, green vegetables b. Fruits high in vitamin C, such as oranges and grapefruits c. Berries and orange vegetables d. Dairy products
a. Beans, dried fruits, and leafy, green vegetables Food sources high in iron include organ meats (e.g., beef or calf liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy and green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.
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. Bleeding gums b. Epistaxis c. Hematemesis Pertinent findings of thrombocytopenia include: bleeding gums, epistaxis, hematemesis, hypotension, and tachypnea.
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. Bronzing of the skin Clients with hemochromatosis exhibit symptoms of weakness, lethargy, arthralgia, weight loss, and loss of libido early in the illness trajectory. The skin may appear hyperpigmented from melanin deposits or appear bronze in color.
A client reports feeling tired, cold, and short of breath at times. Assessment reveals tachycardia and reduced energy. What would the nurse expect the physician to order? a. CBC b. antibiotic c. chest radiograph d. ECG
a. CBC Most clients with iron-deficiency anemia have reduced energy, feel cold all the time, and experience fatigue and dyspnea with minor physical exertion. The heart rate usually is rapid even at rest. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased. A CBC would be ordered.
A nurse assesses a client who has been diagnosed with DIC. Which indicators are consistent with this diagnosis? Select all that apply. a. Cyanosis in the extremities b. Capillary fill time <3 seconds c. Dyspnea and hypoxia d. Increased breath sounds e. Increased blood urea nitrogen (BUN) and creatinine f. Polyuria
a. Cyanosis in the extremities c. Dyspnea and hypoxia e. Increased blood urea nitrogen (BUN) and creatinine Urine output would be decreased in DIC, and capillary fill time would be more than 3 seconds; breath sounds would be decreased.
A health care provider orders a unit of packed red blood cells (PRBC) for a postoperative patient. The nurse is responsible for patient assessment and health care information pre- and post-transfusion. Which of the following are the guidelines that the nurse should follow? Select all that apply. a. Determine the history of any previous transfusions and possible reactions. b. Review the signs and symptoms of a transfusion reaction. c. Explain that since 1985 the supply of blood available for transfusions is risk-free. d. Report any increase of 1 degree in temperature, during or after transfusion, which falls into a febrile range. e. Explain that urticaria is a harmless, common reaction to a transfusion occurring at least 50% of the time.
a. Determine the history of any previous transfusions and possible reactions. b. Review the signs and symptoms of a transfusion reaction. d. Report any increase of 1 degree in temperature, during or after transfusion, which falls into a febrile range. Although every unit of blood is carefully tested, it is not completely risk-free. The patient needs to be aware of the risk and sign a consent form. Urticaria only occurs in 1% to 3% of transfusions. Reactions are usually mild and respond to antihistamines.
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. Eating calf's liver with a glass of orange juice Food sources high in iron include organ meats (e.g., beef or calf's liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.
When assessing a female client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential? a. Health history, such as bleeding, fatigue, or fainting b. Menstrual history c. Age and gender d. Lifestyle assessments, such as exercise routines
a. Health history, such as bleeding, fatigue, or fainting When assessing a client with a disorder of the hematopoietic or the lymphatic system, it is essential to assess the client's health history. An assessment of drug history is essential because some antibiotics and cancer drugs contribute to hematopoietic dysfunction. Aspirin and anticoagulants may contribute to bleeding and interfere with clot formation. Because industrial materials, environmental toxins, and household products may affect blood-forming organs, the nurse needs to explore exposure to these agents. Age, gender, menstrual history, or lifestyle assessments, such as exercise routines and habits, do not directly affect the hematopoietic or lymphatic system.
Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents? a. Hypochromic b. Normocytic c. Microcytic d. Hyperchromic
a. Hypochromic An RBC that has pale or lighter cellular contents is hypochromic. A normocytic RBC is normal or average in size. A microcytic RBC is smaller than normal. Hyperchromic is used to describe an RBC that has darker cellular contents.
A patient has been diagnosed with a vitamin B12 deficiency. The nurse is aware that this is a macrocytic-type anemia characterized by which of the following? a. Increased mean corpuscular volume (MCV) b. Increased hematocrit c. Abnormal mean corpuscular hemoglobin (MCH) d. Elevated hemoglobin
a. Increased mean corpuscular volume (MCV) Macrocytic anemia is associated with the following lab values: increased MCV, a normal MCH, and decreased levels of hemoglobin and hematocrit. Refer to Table 20-1 in the text.
The nurse is caring for a patient with a diagnosis of hypoproliferative anemia. When planning this patient's care, the nurse should be aware that this type of anemia is due to what? a. Lack of production of red blood cells (RBCs) b. Loss of RBCs c. Injury to the RBCs in circulation d. Abnormality of RBCs
a. Lack of production of red blood cells (RBCs) Hypoproliferative anemia is usually a result of inadequate numbers of RBCs being produced by the bone marrow. Loss of RBCs is usually a result of blood loss. Hemolytic anemia can be a result of injury to the RBCs in circulation, possibly due to heart valve hemolysis. Abnormality of RBCs can occur in sickle cell anemia.
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. Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential Clients with neutropenia often do not exhibit classic signs of infection. Fever is the most common indicator of infection, yet it is not always present. No definite symptoms of neutropenia appear until the client develops an infection. A routine CBC with differential can reveal neutropenia before the onset of infection.
While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters? a. Platelet count, prothrombin time, and partial thromboplastin time b. Platelet count, blood glucose levels, and white blood cell (WBC) count c. Thrombin time, calcium levels, and potassium levels d. Fibrinogen level, WBC, and platelet count
a. Platelet count, prothrombin time, and partial thromboplastin time The diagnosis of DIC is based on the results of laboratory studies of prothrombin time, platelet count, thrombin time, partial thromboplastin time, and fibrinogen level as well as client history and other assessment factors. Blood glucose levels, WBC count, calcium levels, and potassium levels aren't used to confirm a diagnosis of DIC.
Which of the following is considered an antidote to heparin? a. Protamine sulfate b. Vitamin K c. Narcan d. Ipecac
a. Protamine sulfate Protamine sulfate, in the appropriate dosage, acts quickly to reverse the effects of heparin. Vitamin K is the antidote to warfarin (Coumadin). Narcan is the drug used to reverse signs and symptoms of medication-induced narcosis. Ipecac is an emetic used to treat some poisonings.
A client with sickle cell disease is treated for a thrombotic event. Which organs or body systems does the nurse recognize as being at greatest risk for thrombosis in a client with sickle cell disease? Select all that apply. a. Spleen b. Lungs c. Central nervous system d. Cardiac system e. Liver
a. Spleen b. Lungs c. Central nervous system Any organ can be the site of a thrombotic event in sickle cell disease; however, the lungs, central nervous system, and the spleen are at greatest risk due to these areas having slower circulation. The liver is often involved in sequestration in adults, and hemolysis may occur. Anemia affects the heart.
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? a. The onset of a bacterial infection b. Bleeding c. Abdominal pain d. Diarrhea
a. The onset of a bacterial infection Lymphopenia (a lymphocyte count less than 1,500/mm3) can result from ionizing radiation, long-term use of corticosteroids, uremia, infections (particularly viral infections), some neoplasms (e.g., breast and lung cancers, advanced Hodgkin disease), and some protein-losing enteropathies (in which the lymphocytes within the intestines are lost) (Kipps, 2010). When lymphopenia is mild, it is often without sequelae; when severe, it can result in bacterial infections (due to low B lymphocytes) or in opportunistic infections (due to low T lymphocytes).
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. To detect the abnormal sounds suggestive of acute chest syndrome and heart failure The nurse auscultates the lungs and heart to detect abnormal sounds that indicate pneumonia, acute chest syndrome, and heart failure. The nurse assesses vital signs to detect evidence of infection, such as fever and tachycardia. During the physical examination, the nurse observes the client's appearance, looking for evidence of dehydration, which may have triggered a sickle cell crisis. The nurse assesses mental status, verbal ability, and motor strength to detect stroke-related signs and symptoms.
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. Use a disposable razor when shaving. People with aplastic anemia usually have insufficient erythrocytes, leukocytes, and platelets. Encourage behaviors that will lower the risk for bleeding. Avoiding contact with people who are sick reduces the risk of acquiring an infection. Handwashing reduces the risk of acquiring an infection. Anemia can cause fatigue and shortness of breath with even mild exertion.
The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? a. "Acute leukemia develops slowly." b. "Chronic leukemia develops slowly." c. "In chronic leukemia, the minority of leukocytes are mature." d. "In acute leukemia there are not many undifferentiated cells."
b. "Chronic leukemia develops slowly." Chronic leukemia develops slowly, and the majority of leukocytes produced are mature. Acute leukemia develops quickly and the majority of leukocytes are undifferentiated cells.
A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia? a. Nights sweats, weight loss, and diarrhea b. Dyspnea, tachycardia, and pallor c. Nausea, vomiting, and anorexia d. Itching, rash, and jaundice
b. Dyspnea, tachycardia, and pallor Signs of iron deficiency anemia include dyspnea, tachycardia, and pallor, as well as fatigue, listlessness, irritability, and headache. Night sweats, weight loss, and diarrhea may signal acquired immunodeficiency syndrome. Nausea, vomiting, and anorexia may be signs of hepatitis B. Itching, rash, and jaundice may result from an allergic or hemolytic reaction.
A patient with acute myeloid leukemia (AML) is having hematopoietic stem cell transplantation (HSCT) with radiation therapy. In which complication do the donor's lymphocytes recognize the patient's body as foreign and set up reactions to attack the foreign host? a. Acute respiratory distress syndrome b. Graft-versus-host disease c. Remission d. Bone marrow depression
b. Graft-versus-host disease Patients who undergo HSCT have a significant risk of infection, graft-versus host disease (in which the donor's lymphocytes [graft] recognize the patient's body as "foreign" and set up reactions to attack the foreign host), and other complications.
The nurse cares for an older adult client with unprovoked back pain and increased serum protein. Which hematologic neoplasm does the nurse suspect the client has? a. Chronic myeloid leukemia b. Multiple myeloma c. Hodgkin lymphoma d. Non-Hodgkin lymphoma
b. Multiple myeloma Any older adult with unprovoked or unexplained back pain and increased protein in the serum should be assessed for multiple myeloma. Bone pain occurs because of bone breakdown and the malignant cells of multiple myeloma increase the serum protein levels.
A client with a diagnosis of pernicious anemia comes to the clinic complaining of numbness and tingling in his 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. Neurologic involvement In clients with pernicious anemia, numbness and tingling in the arms and legs and ataxia are the most common signs of neurologic involvement. Some affected clients lose vibratory and position senses. Jaundice, irritability, confusion, and depression are present when the disease is severe. Insufficient intake of dietary nutrients is not indicated by these symptoms
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. Neurologic involvement In clients with pernicious anemia, numbness and tingling in the arms and legs, and ataxia are the most common signs of neurologic involvement. Some affected clients lose vibratory and position senses. Jaundice, irritability, confusion, and depression are present when the disease is severe. Insufficient intake of dietary nutrients is not indicated by these symptoms.
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. Osteoporosis Hypertension, osteoporosis, muscle wasting, and truncal obesity are all adverse effects of long-term corticosteroid therapy; however, osteoporosis commonly causes compression fractures of the spine. Hypertension, muscle wasting, and truncal obesity aren't likely to cause severe back pain.
A patient receiving plasma develops transfusion-related acute lung injury (TRALI) 4 hours after the transfusion. What type of aggressive therapy does the nurse anticipate the patient will receive to prevent death from the injury? (Select all that apply.) a. Serial chest x-rays b. Oxygen c. Fluid support d. Intubation and mechanical ventilation e. Intra-aortic balloon pump
b. Oxygen c. Fluid support d. Intubation and mechanical ventilation Transfusion-related acute lung injury (TRALI) is a potentially fatal, idiosyncratic reaction that is defined as the development of acute lung injury occurring within 6 hours after a blood transfusion. Aggressive supportive therapy (e.g., oxygen, intubation, fluid support) may prevent death.
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. Pallor, tachycardia, and a sore tongue Pallor, tachycardia, and a sore tongue are all characteristic findings in pernicious anemia. Other clinical manifestations include anorexia; weight loss; a smooth, beefy red tongue; a wide pulse pressure; palpitations; angina pectoris; weakness; fatigue; and paresthesia of the hands and feet. Bradycardia, reduced pulse pressure, weight gain, and double vision aren't characteristic findings in pernicious anemia.
A patient, newly diagnosed with thrombocytopenia, is admitted to the medical unit. After the admission assessment the patient asks the nurse to explain the disease. What should the nurse explain to the patient about this condition? a. There could be an attack on the platelets by the antibodies b. There could be decreased production of platelets c. There could be elevated platelet production. d. There could be decreased white blood cell production.
b. There could be decreased production of platelets Thrombocytopenia can result from a decreased platelet production, increased platelet destruction, or increased consumption of platelets. Increased production of platelets is associated with thrombocythemia. Decreased white blood cell production is associated with leukopenia.
One hour after the completion of a fresh frozen plasma transfusion, a client reports shortness of breath and is very anxious. The client's vital signs are BP 98/60, HR 110, temperature 99.4°F, and SaO2 88%. Auscultation of the lungs reveals posterior coarse crackles to the mid and lower lobes bilaterally. Based on the symptoms, the nurse suspects the client is experiencing which problem? a. Delayed hemolytic reaction b. Transfusion-related acute lung injury c. Exacerbation of congestive heart failure d. Bacterial contamination of blood
b. Transfusion-related acute lung injury Transfusion-related acute lung injury (TRALI) is a potentially fatal, idiosyncratic reaction that is defined as the development of acute lung injury within 6 hours after a blood transfusion. It is more likely to occur when plasma and platelets are transfused. Onset is abrupt (usually within 6 hours of transfusion, often within 2 hours). Signs and symptoms include acute shortness of breath, hypoxia (arterial oxygen saturation [SaO2] less than 90%; pressure of arterial oxygen [PaO2] to fraction of inspired oxygen [FIO2] ratio less than 300), hypotension, fever, and eventual pulmonary edema.
Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called a. blast cells. b. megaloblasts. c. mast cells. d. monocytes.
b. megaloblasts. Megaloblasts are abnormally large erythrocytes. Blast cells are primitive WBCs. Mast cells are cells found in connective tissue involved in defense of the body and coagulation. Monocytes are large WBCs that become macrophages when they leave the circulation and move into body tissues.
A 71-year-old woman with a history of rheumatoid arthritis and chronic heart failure has been admitted to the hospital for the treatment of a suspected upper gastrointestinal bleed. When performing an assessment of this patient, which of the following questions most directly addresses a likely cause of the woman's bleeding disorder? a. "How closely do you tend to monitor your blood pressure when you're at home?" b. "Has your doctor prescribed a water pill for your heart failure?" c. "Do you ever take aspirin to treat the pain of your arthritis?" d. "Did either of your parents or siblings have problems with bleeding?"
c. "Do you ever take aspirin to treat the pain of your arthritis?" An important functional platelet disorder is that induced by aspirin. Even small amounts of aspirin reduce normal platelet aggregation, and the prolonged bleeding time lasts for several days after aspirin ingestion. Diuretics, hypertension, and family history are not central parameters in the assessment of a bleeding disorder.
A home care nurse visits a client diagnosed with atrial fibrillation who is ordered warfarin. The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching? a. "I'll watch my gums for bleeding when I brush my teeth." b. "I'll use an electric razor to shave." c. "I'll eat four servings of fresh, dark green vegetables every day." d. "I'll report unexplained or severe bruising to my doctor right away."
c. "I'll eat four servings of fresh, dark green vegetables every day." The client requires additional teaching if he states that he'll eat four servings of dark green vegetables every day. Dark, green vegetables contain vitamin K, which reverses the effects of warfarin. The client should limit his intake to one to two servings per day. The client should report bleeding gums and severe or unexplained bruising, which may indicate an excessive dose of warfarin. The client should use an electric razor to prevent cutting himself while shaving.
A female client with the beta-thalassemia trait plans to marry a man of Italian ancestry who also has the trait. Which client statement indicates that she understands the teaching provided by the nurse? a. "Thalassemia is treated with iron supplements." b. "I need to learn how to give myself vitamin B12 injections." c. "I'll see a genetic counselor before starting a family." d. "If my fiancé was of Middle Eastern descent, I wouldn't be worried about having children."
c. "I'll see a genetic counselor before starting a family." Two people with the beta-thalassemia trait have a 25% chance of having a child with thalassemia major, a potentially life-threatening disease. Iron supplements aren't used to treat thalassemia; in fact, they could contribute to iron overload. 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.
Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia? a. Implement neutropenic precautions b. Eliminate direct contact with others who are infectious c. Apply prolonged pressure to needle sites or other sources of external bleeding d. Monitor temperature at least once per shift
c. Apply prolonged pressure to needle sites or other sources of external bleeding For a client with leukemia, the nurse should apply prolonged pressure to needle sites or other sources of external bleeding. Reduced platelet production results in a delayed clotting process and increases the potential for hemorrhage. Implementing neutropenic precautions and eliminating direct contact with others are interventions to address the risk for infection.
A client receiving a blood transfusion reports shortness of breath, appears anxious, and has a pulse of 125 beats/minute. What is the best action for the nurse to take after stopping the transfusion and awaiting further instruction from the health care provider? a. Place the client in a recumbent position with legs elevated. b. Remove the intravenous line. c. Ensure there is an oxygen delivery device at the bedside. d. Administer prescribed PRN anti-anxiety agent.
c. Ensure there is an oxygen delivery device at the bedside. The client is exhibiting signs of circulatory overload. After stopping the transfusion and notifying the healthcare provider, the nurse should place the client in a more upright position with the legs dependent to decrease workload on the heart. The IV line is kept patent in case emergency medications are needed. Oxygen and morphine may be needed to treat severe dyspnea. Administering an anti-anxiety agent is not a priority action over ensuring oxygen is available.
A client with severe anemia is admitted to the hospital. Because of religious beliefs, the client is refusing blood transfusions. The nurse anticipates pharmacologic therapy with which drug to stimulate the production of red blood cells? a. Filgrastim b. Sargramostim c. Epoetin alfa d. Eltrombopag
c. Epoetin alfa Erythropoietin (epoetin alfa) is an effective alternative treatment for clients with chronic anemia secondary to diminished levels of erythropoietin. This medication stimulates erythropoiesis. Filgratism (Neupogen) and Sargramostim stimulate granulocytosis (increasing WBC count) , Eltrombopag (Promacta) is used to treat aplastic anemia and thrombocytopenia.
A client with end-stage renal disease has a decreased red blood cell production. What medication can the nurse administer with physician's order that will increase the production of erythrocytes? a. Filgrastim b. Pegfilgrastim c. Epoetin alfa d. Interleukin 2
c. Epoetin alfa The drug epoetin alfa can be used to stimulate the production of RBCs. Filgrastim and pegfilgrastim promote proliferation of neutrophils. Interleukin 2 stimulates cytokine production by lymphocytes.
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. Hemoglobin level When using recombinant erythropoietin, the hemoglobin must be checked at least monthly (more frequently until a maintenance dose is established) and the dose titrated to ensure the hemoglobin level does not exceed 12 g/dL.
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. It may indicate deficiencies in essential nutrients. A nutritional assessment is important, because it may indicate deficiencies in essential nutrients such as iron, vitamin B12, and folate.
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. Low ferritin level concentration The most consistent indicator of iron deficiency anemia is a low ferritin level, which reflects low iron stores. As the anemia progresses, the MCV, which measures the size of the erythrocytes, also decreases. Hematocrit and RBC levels are also low in relation to the hemoglobin concentration.
The nurse is performing an assessment on a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae. What laboratory study should the nurse be concerned about? a. WBC count of 4,200 cells/uL b. Hematocrit of 38% c. Platelet count of 9,000/mm3 d. Creatinine level of 1.0 mg/dL
c. Platelet count of 9,000/mm3 Complications of AML include bleeding and infection, which are the major causes of death. The risk of bleeding correlates with the level and duration of platelet deficiency (thrombocytopenia). The low platelet count can cause ecchymoses (bruises) and petechiae. Major hemorrhages also may develop when the platelet count drops to less than 10,000/mm3.
A nurse cares for several mothers and babies in the postpartum unit. Which mother does the nurse recognize as being most at risk for a febrile nonhemolytic reaction? a. Rh-negative mother; Rh-negative child b. Rh-positive mother; Rh-negative child c. Rh-negative mother; Rh-positive child d. Rh-positive mother; Rh-positive child
c. Rh-negative mother; Rh-positive child A mother who is Rh negative and gives birth to an Rh positive child is at greatest risk for a febrile nonhemolytic reaction because exposure to an Rh-positive fetus raises antibody levels in the Rh negative mother. An Rh-negative mother can carry an Rh-negative child without being at greatest risk for a febrile nonhemolytic reaction; however, these mothers are often treated prophylactically. An Rh-positive mother may carry either an Rh-positive or Rh-negative child without increased risk.
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. onto the bedpan. A client who's dizzy and anemic is at risk for injury because of his weakened state. Assisting him with the bedpan would best meet his needs at this time without risking his safety. The client may fall if walking to the bathroom, left alone to urinate, or trying to stand up.
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. "I have difficulty breathing when walking 30 feet." Most clients with iron-deficiency anemia have reduced energy, feel cold all the time, and experience fatigue and dyspnea with minor physical exertion. The heart rate usually is rapid even at rest. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased. The client would feel cold and not hot. The client is fatigue and able to sleep often with a decrease in appetite, not an increase.
Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)? a. A 24-year-old female taking oral contraceptives b. A 40-year-old patient with a history of hypertension c. A 52-year-old patient with acute kidney injury d. A 72-year-old patient with a history of cancer
d. A 72-year-old patient with a history of cancer Primary MDS tends to be a disease of people older than 70 years. Because the initial findings are so subtle, the disease may not be diagnosed until later in the illness trajectory, if at all. Thus, the actual incidence of MDS is not known.
The nurse is instructing the client with polycythemia vera how to perform isometric exercises such as contracting and relaxing the quadriceps and gluteal muscle during periods of inactivity. What does the nurse understand is the rationale for this type of exercise? a. Isometric exercise programs are inclusive of all muscle groups and have an aerobic effect to increase the heart rate. b. Isometric exercise decreases the workload of the heart and restores oxygenated blood flow. c. This type of exercise increases arterial circulation as it returns to the heart. d. Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.
d. Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart. Isometric exercise induce contraction of skeletal muscle so that it compresses the walls of veins and increases the circulation of venous blood as it returns to the heart. Isometric exercises do not have an aerobic effect and should not increase the heart rate; although, it may increase blood pressure. Isometric exercise does not decrease the workload of the heart. Arterial flow moves blood flow away from the heart after being oxygenated.
A client who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action? a. Ask the client whether they have recently fallen. b. Evaluate the client's INR. c. Keep the client on bed rest. d. Evaluate the client's platelet count.
d. Evaluate the client's platelet count. Complications of AML include bleeding. The risk of bleeding correlates with the level and duration of platelet deficiency. Major hemorrhages may develop when the platelet count drops to less than 10,000/mm3. The bleeding is usually unrelated to falling. Keeping the client on bed rest will not prevent bleeding when the client has a low platelet count. Assessment for other areas of bleeding is also a priority intervention.
A 63-year-old woman has been diagnosed with polycythemia vera (PV) after undergoing a series of diagnostic tests. When the woman's nurse is providing health education, what subject should the nurse prioritize? a. Maintenance of long-term vascular access device b. Nutritional modifications necessary for maintaining a low-iron diet c. Strategies for managing activity d. Lifestyle modifications and techniques for preventing thromboembolism
d. Lifestyle modifications and techniques for preventing thromboembolism The increased blood volume and viscosity that are the hallmarks of PV create a significant risk of thromboembolism. A vascular access device is not necessary for the treatment of PV, and a low-iron diet does not resolve the disease. Patients may experience fatigue, but this risk is superseded by that of thromboembolism.
A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal? a. Address issues of negative body image. b. Place the client in reverse isolation. c. Administer pain medication. d. Maintain nutrition.
d. Maintain nutrition. Maintaining nutrition is the most important goal after induction therapy because the client experiences severe diarrhea and can easily become nutritionally deficient and develop fluid and electrolyte imbalance. The client is most likely not in pain at this point, and this is an intervention, not a goal.
The nurse recognizes the clinical assessment of a patient with acute myeloid leukemia (AML) includes observing for signs of infection early. What nursing action will most likely help prevent infection? a. Monitor the client's temperature every shift. b. Maintain contact precautions. c. Encourage increased fluid consumption. d. Practice vigilant handwashing.
d. Practice vigilant handwashing. Infection prevention is best handled by vigilant handwashing. Monitoring the client's temperature once a shift is not often enough. The client will take precautions, but precautions are enough to prevent infections. Encouraging increased fluid consumption will not prevent infection.
The nurse is working at a blood donation clinic. What teaching should the nurse provide to the donor immediately after blood donation? a. Hold the involved arm below the heart. b. Remove the band-aid after 5 minutes. c. Sit up promptly after the needle is removed. d. Remain for observation after eating and drinking.
d. Remain for observation after eating and drinking. After blood donation, the donor receives food and fluids and is asked to remain for observation. After the needle is removed, donors are asked to hold the involved arm straight up, and firm pressure is applied with sterile gauze for 2 to 3 minutes. A firm bandage is then applied. The donor remains recumbent until he or she feels able to sit up, usually within a few minutes.
