exam four, n245

A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct?

"OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."

What is an important pre-step in providing thalidomide (thalomid)? What is one of it's major risk factors?

(think isotretinoin) - birth defects. Patients should be under contract of birth control usage.

Supporting signs of acute myeloid leukemia?

-fatigue/weakness -bone pain -petechiae -enlarged lymph nodes

AML results from a defect in the hematopoietic stem cells that differentiates into which of the following myeloid cells?

-granulocytes -erythrocytes -monocytes

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.)

-intubation and mechanical ventilation -oxygen -fluid support

The nurse is caring for a client who has been diagnosed with a "rheumatic disease." What nursing diagnoses will most likely apply to this client's care? Select all that apply

1. altered self-concept 2. fluid and electrolyte imbalance 3. pain 4. fatigue

A nurse has established for a client the nursing diagnosis of risk for infection. Which of the following interventions would the nurse include in the plan of care for this client? Select all answers that apply.

1. auscultate lung sounds every shift and pen 2. assess skin and mucus membranes every shift 3. encourage the client to take deep breaths every 4 hours

The nurse is caring for a patient with Hodgkin lymphoma in the hospital and preparing discharge planning education. Knowing that this patient is at risk for the development of a second malignancy, what education would be beneficial to reduce the risk factors? (Select all that apply.)

1. decrease alcohol 2. smoking cessation 3. reduce exposure to excessive light

Which of the following classifications are considered antiarthritic drugs? Select all that apply.

1. glucocorticoids 2. disease-modifying anirhematics (DMARDs) 3. anti-inflammatory

sickle cell anemia and the nurse is preparing a teaching plan to review with the client and the client's family. Which interventions should be included? Select all that apply.

1. never exceed the recommended analgesic dosage 2. wear tight clothes for better circulation during exercise 3. dress warmly in cold temperatures

Which intervention should the nurse implement to manage pain for the client with rheumatoid arthritis? Select all that apply.

1. support joints with splints/pillows 2. provide diversional activities 3. provide opportunities for client to verbalize feelings

normal platelet count?

150,000-450,000 count/mm3

What is splenomegaly?

Abnormally enlarged spleen

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

What does albumin do?

Albumin is important for the maintenance of fluid balance within the vascular system.

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

Patient with acute myeloid leukemia (AML) reports low back pain during chemotherapy. What is the nurse's first action?

Assess renal function.

Which of the following cells are capable of differentiating into plasma cells?

B lymphocytes

cells that are capable of differentiating into plasma cells?

B lymphocytes

Multiple Myeloma along spinal cord, is prescribed naproxen (aleve) and oxycodone. What labs should be checked before giving these pain medications?

BUN and creatinine

What is the genetic pattern of sickle cell disease?

Both parents have to have the gene, and it's manifest when a child inherits one defective gene from each parent.

CREST signs of scleroderma

C...Calcinosis refers to the formation of tiny deposits of calcium in the skin R...Reynauds E...Esophagus disease in scleroderma is characterized by poorly functioning muscle of the lower two-thirds of the esophagus S...Sclerodactyly is the localized thickening and tightness of the skin of the fingers or toes T...Telangiectasias are tiny red areas, frequently on the face, hands, and in the mouth behind the lips.

Define coagulopathies?

Coagulopathies are bleeding disorders that involve low platelet count and clotting factors.

A client who has been diagnosed with osteoarthritis asks if he'll eventually begin to notice deformities in his hands and fingers as the condition progresses. Which concept should the nurse include in her response?

Hand and finger deformities are associated with the development of rheumatoid arthritis.

what does celecoxib do?

NSAID for pain and inflammation but can cause stroke

A nurse should expect to administer which vaccine to a client after a splenectomy?

Pneumovax 23

patient presents to the physician's office with a complaint of exhaustion. The nurse, aware of the most common hematologic condition affecting the elderly, knows that which laboratory values should be assessed?

RBC count

Multiple myeloma suspected patient reports back pain. What test should be run?

Send client for spinal x-ray study

patient has a deficiency in the leukocyte responsible for cell-mediated immunity. What should the nurse check the WBC count for?

T lymphocytes

what is hematopoiesis?

The production of all types of blood cells including formation, development, and differentiation of blood cells. Prenatally, hematopoiesis occurs in the yolk sack, then in the liver, and lastly in the bone marrow.

Patients with leukemia should use electrical razors. Why?

Trauma and microabrasians may contribute to anemia.

The client is to receive a unit of packed red blood cells. The first intervention of the nurse is to

Verify that the client has signed a written consent form.

Neurological damage - what vitamin deficiency may be a part of the problem

Vitamin B12

iron dextran intramuscularly. The nurse, when administering the medication...

Z-track technique

what is chelation therapy?

a therapy for mercury or lead poisoning that binds the toxins in the bloodstream by circulating a chelating solution (a chelating solution is a molecule capable of multiple bonds to metals)

A client with Hodgkin disease had a bone marrow biopsy yesterday and reports aching at the biopsy site, rated a 5 (on a 1-10 scale). After assessing the biopsy site, which nursing intervention is most appropriate?

administer acetaminophen 500 mg PO, as ordered

The nurse is caring for a client with rheumatoid arthritis who suffers with chronic pain in the hands. When would be the best time for the nurse to perform range-of-motion exercises?

after the client has had a warm paraffin hand bath

The most significant risk factor for primary osteoarthritis is:

age.

the nurse monitors the serum level of the plasma protein responsible for maintaining oncotic pressure, which is:

albumin

Which of the following is the only curative treatment for chronic myeloid leukemia (CML)?

allogenic stem cell transplant

AML) with high uric acid levels. What medication does the nurse anticipate administering that will prevent crystallization of uric acid and stone formation?

allopurinol (zyloprim)

Which term refers to fixation or immobility of a joint?

ankylosis

The physician has diagnosed fibromyalgia. What would not be a part of teaching plan for this condition?

application of ice

Pale mucous membranes and bruises on legs of AML patient, leads the nurse to:

assess the client's hemoglobin and platelets.

what is scleroderma?

autoimmune disease that affects connective tissue.

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?

blood loss from the gastrointestinal and genitourinary tract

NP suspects multiple myeloma, what is the classic symptom for the disease?

bone pain in the back of the ribs

Which is a symptom of hemochromatosis?

bronzing of the skin

What can the nurse inform the client would enhance the absorption or iron for a patient with anemia?

calf's liver and orange juice

The nurse is educating a patient about the risks of stroke related to the new prescription for a COX-2 inhibitor and what symptoms they should report. Which COX-2 inhibitor is the nurse educating the patient about?

celecoxib (celebrex)

What treatment does the nurse anticipate will be prescribed for a client with a history of sickle-cell but current iron overload from blood transfusions?

chelation therapy

Which finding is consistent with the diagnosis of rheumatoid arthritis?

cloudy synovial fluid

A nurse should expect to administer which medication to a client with gout?

colchicine

Select the agent of first choice when an acute inflammatory attack begins.

colchicine

The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is suffering from an acute attack of gout?

colchicine

what is solumedrol?

corticosteroid hormone for anti-inflammatory

A patient is being placed on a purine-restricted diet. What food should be suggested by the nurse?

dairy products

a client who had undergone hemodilution during surgery, what lab result is expected immediately?

decreased hematocrit.

A patient with chronic renal failure is examined by the nurse practitioner for anemia. The nurse knows to review the laboratory data for a decreased hemoglobin level, red blood cell count, and which of the following?

decreased level of erythropoietin

A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included?

delaying exercise for at least 1 hour after waking up

A client is receiving radiation therapy for lesions in the abdomen from non-Hodgkin's lymphoma. Because of the effects of the radiation treatments, the nurse now assesses for

diarrheal stools

What is thalassemia?

disorder where RBCs are destroyed as a result of abnormal hemoglobin molecules, and pt often acquires anemia.

Which of the following clinical manifestations would the nurse expect to find in a client with osteoarthritis?

early morning stiffness

The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. Which of the following would the nurse expect to find?

elevated erythrocyte sedimentation rate

Which precautions should a nose include in the care plan for a client with leukemia and neutropenia?

eliminate fresh fruits/vegetables, avoid using enemas, and practice frequent hand washing

What test result is consistent for patients with AML?

excess immature blast cells

Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)?

facial erythema, pericarditis, pleuritis, fever, and weight loss

A client was admitted to the hospital with the following laboratory values: hemoglobin 5 g/dL, leukocyte count 2000/mm3, and a platelet count of 48,000/mm3; abnormally shaped erythrocytes and hypersegmented neutrophils were seen. The platelets appear abnormally large. A bone marrow biopsy was competed and revealed hyperplasia. Based on this information, the nurse determines that client most likely has which diagnosis?

folic acid deficiency

Why would the physician prescribe antineoplastic drugs for an autoimmune disorder?

for their immunosuppressant effects.

presence of crystals in the synovial fluid obtained from arthrocentesis confirms which disease process?

gout

the donor's lymphocytes recognize the patient's body as foreign and set up reactions to attack the foreign host?

graft v host

A patient with ESRD 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?

hemoglobin level

A nurse is caring for a patient who has had a bone marrow aspiration with biopsy. What complication should the nurse be aware of and monitor the patient for?

hemorrhage

hemophilia A patients need to know:

how to administer factor VIII intravenously at first sign of bleeding

What is most common lab finding for multiple myeloma

hypercalcemia

When developing a care plan for a client newly diagnosed with scleroderma, which nursing diagnosis has the highest priority?

impaired skin integrity

AML treatment of aggressive chemotherapy with hospitalization for several weeks, what treatment is this?

induction therapy

Low neutrophil count: what should the nurse monitor for?

infection.

The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care?

intrathecal chemotherapy is primary a preventative therapy.

A patient who has long-term packed RBC (PRBC) transfusions has developed symptoms of iron toxicity that affect liver function. What immediate treatment should the nurse anticipate preparing the patient for that can help prevent organ damage?

iron chelation therapy

The nurse observes a co-worker who always seems to be eating a cup of ice. The nurse encourages the co-worker to have an examination and diagnostic workup with the physician. What type of anemia is the nurse concerned the co-worker may have?

iron deficiency anemia

The nurse is administering packed red blood cell (RBC) transfusions for a patient with myelodysplastic syndrome (MDS). The patient has had several transfusions and is likely to receive several more. What is a priority for the nurse to monitor related to the transfusions?

iron levels

Which points should be included in the medication teaching plan for a client taking adalimumab?

it is important to monitor for injection site reactions

Which findings best correlate with a diagnosis of osteoarthritis?

joint stiffness that decreases with activity

A client complains of feeling faint after donating blood. What is the nurse's best action?

keep client in recumbent position to rest

nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. What position will the nurse place the patient in?

lateral position with one leg flexed

iron deficiency anemia - what foods should be increased?

leafy green vegetables, dried fruits, beans

Albumin is produced by which of the following?

liver

A nursing student asks the instructor how to identify rheumatoid nodules in a client with rheumatoid arthritis. Which of the following characteristics would the instructor include?

located over bony prominences

What is lovenox? why would it be prescribed for someone who was but no longer is on warfarin?

lovenox is SQ, warfarin is PO. lovenox is safe during pregnancy and is more expensive. Both are anticoagulants or "blood thinners"

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 client with sickle cell anemia has a

low hematocrit

white blood cell involved in immune response?

lymphocyte

A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal?

maintain nutrition

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?

may indicate essential nutrient deficiencies

most commonly affected joint of gout?

metatarsophalangeal

The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about?

methotrexate (rheumatrex)

An arthrocentesis is done to remove synovial fluid from a joint. Synovial fluid from an inflamed joint is characteristically:

milky, cloudy, and dark yellow

A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan?

monitor your body temperature

A client with rheumatoid arthritis arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of rheumatoid arthritis?

my finger joints are oddly shaped

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets?

myeloid stem cells

numbness and tingling symptom in arms are legs - what system is involved?

neurologic

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be?

ordering analgesic and monitoring effect

A nurse should advise a patient with gout to avoid which of the following foods?

organ meats, scallops, sardines

Which condition is the leading cause of disability and pain in the elderly?

osteoarthritis

why would it be important to assess a client w multiple myeloma for fractures?

osteoclasts break down bone cells so pathologic fractures occur

What is an adverse effect of long-term corticosteroid use, that also causes pain?

osteoporosis

common signs/symptoms of patients with pernicious anemia?

pallor, tachicardia, sore throat

Multiple myeloma risks, intervention

pathologic bone fracture, prevent bone injury

gastrointestinal bleeding. Laboratory test results show that the client's platelets are 9000/mm³. The client is receiving prednisone and azathioprine (Imuran). The nurse

performs a neurologic assessment with vital signs

symptom of severe thrombocytopenia?

petechiae

Which is the major function of neutrophils?

phagocytosis

polycythemia vera has a high red blood cell (RBC) count and is at risk for the development of thrombosis. What treatment is important to reduce blood viscosity and to deplete the patient's iron stores?

phlebotomy

ITP (immune thrombocytopenia purpura is a consequence of

platelet destruction and impaired platelet production resulting from an autoimmune process.

What disease would an instructor list with a primary characteristic of erythrocytosis?

polycythemia vera

In adults, bone marrow is usually aspirated from which area?

posterior iliac crest

Which of the following would a nurse encourage a client with gout to limit?

purine-rich foods

What is the course of treatment for stage I hodgkin's lymphoma?

radiotherapy to the specific node over 2-4 months.

Client with systemic lupus erythematous is suffering from hypertension? what organ system may be involved?

renal (kidney related)

progressive systemic sclerosis. For a client with this disease, the nurse is most likely to formulate which nursing diagnosis?

risk for impaired skin integrity

What skin assessment data would the nurse determine normal for pt with polycythemia vera?

ruddy complexion

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?

self-care, lifestyle modifications and techniques for preventing thromboembolism

Does chronic leukemia develop quickly or slow?

slowly.

Which of the following is the hallmark of polycythemia vera (PV)?

splenomegaly

A patient has a serum study that is positive for the rheumatoid factor. What does the nurse understand is the significance of this test result?

suggestive of RA

A 74-year-old 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. The nurse interprets these data and instructs the client to

supplement with vitamin B12 in diet

A client with a diagnosis of thrombocytopenia has been admitted to your unit for IV corticosteroid treatment. As the nurse caring for this client, you would expect the physician's orders to include which of the following?

tapering dose of solumedrol at discharge

a client's platelet count falls to 98,000/mm3. What term should the nurse use to describe this low platelet count?

thrombocytopenia

chronic lymphocytic leukemia (CLL) is being assess in a patient in the late stage, what is the telling sign?

thrombocytopenia (low platelet)

True/False: fibromyalgia is an autoimmune disorder

true

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?

use a disposable razor when shaving

client with thrombocytopenia. What is the best way to protect this client?

use the smallest needle possible for injections

What vitamin is required for life-long injections for patients with pernicious anemia?

vitamin B12

Which assessment finding indicates the client with osteoarthritis is having difficulty implementing self-care?

weight gain of 5 lbs

what is pancytopenia?

an abnormal decrease in white blood cells, red blood cells and platelets.

What does the nurse understand is the rationale for isometric exercises (contracting/relaxing quad and gluteal muscles)?

contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.

(DIC) has a critically low fibrinogen level and is beginning to hemorrhage. To increase the amount of fibrinogen in the body, the nurse anticipates administering which blood product?

cryoprecipitate

The nurse and the client are discussing some strategies for ingesting iron to combat the client's iron-deficiency anemia. Which is among the nurse's strategies?

drinking liquid iron preparations with a straw

pharmacologic therapy using which drug stimulates the production of red blood cells?

epoetin alfa

A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse know is the most likely clinical disorder the patient is being treated for?

essential thrombocythemia

Excessive thirst, constipation and confusion can be signs of what lab abnormality?

excess calcium - 13.8 mg/dL (normal: 8.5-10.2 mg/dL)

abdominal pain, anemia, and bloody stools. He complains of feeling weak and dizzy. He has rectal pressure and needs to urinate and move his bowels. The nurse should help him:

onto a bedpan

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. The most important action of the nurse is to

consult with physician about discontinuing the heparin.

Which of the following is the most common hematologic condition affecting elderly patients

anemia

What is the cause of (DIC) disseminated intravascular coagulation?

"DIC is caused by abnormal activation of clotting pathways, causing excessive amounts of tiny clots to form inside organs.

A client verbalizes fear of infection from a blood transfusion. What is the nurse's best response?

"Every unit of donated blood is typed and tested for antibodies to infections."

What subjective findings does the nurse recognize as symptoms related to iron-deficiency anemia?

"I have difficulty breathing when walking 30 feet."

A patient will need a blood transfusion but states, "That stuff isn't safe!" What is the best response from the nurse?

"I understand your concern. The blood is carefully screened but is not completely risk free."

A client with a history of congestive heart failure has an order to receive 1 unit of packed red blood cells (RBCs). If the nurse hangs the blood at 12:00 pm, by what time must the infusion be completed?

4pm

What is a normal creatinine level?

60-120 mg/mL

What intervention should the nurse perform after bone marrow biopsy from the posterior iliac crest on a client with a pancytopenia?

Apply pressure over the site for 5-7 minutes

Nursing intervention incorporated into the plan of care to manage the delayed clotting process in a client with leukemia?

Apply prolonged pressure to needle sites or other sources of external bleeding.

A patient with chronic kidney disease is being examined by the nurse practitioner for anemia. The nurse has reviewed the laboratory data for hemoglobin and RBC count. What other test results would the nurse anticipate observing?

Decreased level of erythropoietin

A client receiving a unit of packed red blood cells (PRBCs) has been prescribed morphine 1 mg intravenously now for pain. What is the best method for the nurse to administer the morphine?

Disconnect the blood tubing, flush with normal saline, and administer morphine.

What can a pt do to help avoid sickle cell crisis?

Drink at least 8 glasses of water a day

Which assessment findings are characteristic of iron deficiency anemia?

Dyspnea, tachycardia, and pallor

blood transfusion complains of shortness of breath, appears anxious, and has a pulse of 125 beats/minute. What is the best action for the nurse?

Ensure there is an oxygen delivery device at the bedside.

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?

Erythrocytes that are microcytic and hypochromic

When assessing a client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential?

Health history, such as bleeding, fatigue, or fainting

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?

I'll receive this therapy of vitB12 for the rest of my life

A client receiving a blood transfusion experiences an acute hemolytic reaction. Which nursing intervention is the most important?

Immediately stop the transfusion, infuse normal saline solution, call the physician, and notify the blood bank.

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. which nursing diagnoses is most appropriate for this client?

Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit

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?

Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI

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?

Obtain the pain medication and delay the bath and position change until the medication reaches its peak.

severely hypotensive. The nurse suspects he has several fractures in the pelvis and legs. Which parenteral fluid is the best choice for the client's current condition?

Packed red blood cells (RBCs)

The tongue appears smooth and beefy red in color. The nurse also observes a 5-cm incision on the upper left quadrant of the abdomen. When questioned, the client states, "I had a partial gastrostomy 2 years ago." Based on this information, the nurse attributes these symptoms to which problem?

Vitamin B12 deficiency

A client in end-stage renal disease is prescribed epoetin alfa (Epogen) and oral iron supplements. Before administering the next dose of epoetin alfa and oral iron supplement, the nurse

assess the hemoglobin level.

The body responds to infection by increasing the production of white blood cells (WBCs). The nurse knows to evaluate the differential count for the level of __________, the first WBCs to respond to an inflammatory event.

neutrophils

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?

onset of bacterial infection

Function of stem cells in the bone marrow?

production of all blood cells.

antidote to heparin?

protamine sulfate

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. The nurse

refuses to administer the blood

What vitamin should be consumed along with iron for better absorption?

vitamin C

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

remove the prescribed unit of blood

The nurse is preparing the patient for a test to determine the cause of vitamin B12 deficiency. The patient will receive a small oral dose of radioactive vitamin B12 followed by a large parenteral dose of nonradioactive vitamin B12. What test is the patient being prepared for?

schillings test