Hematologic Problems EAQs

The nurse is helping an adolescent with iron-deficiency anemia make breakfast meal choices. Which food would the nurse suggest? 1 Apple fruit cup 2 Bowl of raisin bran 3 Cup of blueberry yogurt 4 Slice of wheat bread toast with butter

A bowl of raisin bran

Which actions would the nurse take when admitting a client having a sickle cell crisis to the nursing unit? Select all that apply. One, some, or all responses may be correct. 1 Place on strict isolation. 2 Administer hydroxyurea. 3 Administer aspirin 325 mg daily. 4 Apply oxygen via nasal cannula. 5 Administer intravenous (IV) hydration. 6 Avoid opiate-type analgesics

Administer hydroxyurea Apply oxygen via nasal cannula Administer intravenous (IV) hydration

When a client is admitted to the emergency department with disseminated intravascular coagulation caused by sepsis, which prescribed action will the nurse take first? 1 Apply antiembolism stockings. 2 Draw blood for culture and sensitivity. 3 Administer vancomycin 1 gram intravenously. 4 Transfer the client to the intensive care unit.

Draw blood for culture and sensitivity.

Which instruction would the nurse give to the pregnant client with anemia? 1 Take an iron and calcium supplement together daily. 2 Drink orange juice with an iron supplement. 3 Include fresh fruit at every meal. 4 Include 4 servings of calcium-rich foods daily.

Drink orange juice with an iron supplement

A client with mild preeclampsia is admitted to the labor and birthing suite. Which signs or symptoms would the client be likely to display if she were developing hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome)? Select all that apply. One, some, or all responses may be correct. 1 Headache 2 Constipation 3 Right upper quadrant abdominal pain 4 Vaginal bleeding 5 Nausea and vomiting

Headache Right upper quadrant abdominal pain Nausea and vomiting

A client develops hemolytic anemia. Which client medication can cause this adverse effect? 1 Famotidine 2 Methyldopa 3 Levothyroxine 4 Ferrous sulfate

Methyldopa

For which medication would the nurse monitor a client closely for hemolytic anemia? 1 Tacrolimus 2 Methyldopa 3 Azathioprine 4 Procainamide

Methyldopa

A client with sickle cell anemia is experiencing a painful episode (vaso-occlusive crisis) and has a patient-controlled analgesia (PCA) pump. The current pain rating is 5 on a scale of 1 to 10 at the right elbow. The nurse observes that the pump is "locked out" for another 10 minutes. Which action would the nurse implement? 1 Turning on the television for diversion 2 Placing the prescribed as-needed warm, wet compress on the elbow 3 Calling the primary health care provider for another analgesic prescription 4 Informing the client gently that she must wait until the pump reactivates to get more medication

Placing the prescribed as-needed warm, wet compress on the elbow

A 2-year-old child with previously diagnosed hemophilia is admitted to the pediatric unit for observation after a motor vehicle collision. The toddler has several bruises but no other apparent injuries. Which is the nurse's specific concern regarding this child? 1 Possibility of falls 2 Undetected injury 3 Low fluid volume 4 Development of infection

Undetected injury

When a client develops iron-deficiency anemia, which of the client's laboratory test results would the nurse expect to be decreased? 1 Ferritin level 2 Platelet count 3 White blood cell count 4 Total iron-binding capacity

Ferritin level

Which assessment finding would the nurse expect when assessing an 11-month-old infant with iron-deficiency anemia whose hemoglobin is 8 g/dL (80 mmol/L)? 1 Pallor 2 Tremors 3 Cyanosis 4 Spasticity

Pallor

Which is the most appropriate nursing intervention for an adolescent child with sickle cell anemia? Correct1 Teaching the family how to limit sickling episodes 2 Preparing the child for occasional blood transfusions 3 Educating the family about prophylactic medications 4 Explaining to the child how excess oxygen causes sickling

Teaching the family how to limit sickling episodes

Which laboratory result in a client who has just been admitted with anemia of unknown etiology requires the most rapid action by the nurse? 1 Hematocrit 30% (0.30) 2 Hemoglobin 10 g/dL (100 g/L) 3 Platelet count 120,000 mm 3 (120 × 10 9/L) 4 White blood cell count 950 mm 3 (950 × 10 9/L)

White blood cell count 950 mm 3 (950 × 10 9/L)

An adolescent is admitted with an acute hemophilia episode. For which are rest, ice, compression, and elevation most helpful? 1 Encouraging immobilization 2 Decreasing swelling and inflammation 3 Providing pain relief and reducing anxiety 4 Controlling bleeding and retaining joint function

Controlling bleeding and retaining joint function

The nurse is teaching a pregnant client with sickle cell anemia about the importance of taking supplemental folic acid. Which response by the nurse explains how folic acid would help? 1 "It lessens sickling of red blood cells." 2 "It prevents vaso-occlusive crises." 3 "It helps decrease the cellular oxygen need." 4 "It will promote production of hemoglobin.

"It will promote production of hemoglobin."

A pregnant client and her husband tell the nurse they have a 1-year-old daughter with sickle cell anemia, but that they themselves do not have the disease. Which response would correctly answer the clients' question, "Will this baby also have sickle cell anemia?" 1 "The chance that another child will have sickle cell anemia is 25%." 2 "Only one child in a family is affected, so the others will probably be all right." 3 "The most likely conclusion is that your children will have sickle cell anemia." 4 "If your partner has the sickle cell gene, 50% of your children will have sickle cell anemia."

"The chance that another child will have sickle cell anemia is 25%."

A child has been diagnosed with hemophilia type A after experiencing excessive bleeding from a minor trauma. The mother states that the toddler is very active and is difficult, constantly saying "no". Which response would the nurse communicate that would be an appropriate response? 1 "Toddlers are curious, trying to make decisions and be independent." 2 "Saying 'no' at this stage is a signal that the child may need some therapy." 3 "You must show the child from a young age that you are the boss and in charge." 4 "Responsible parenting means you must protect the child from all future injuries."

"Toddlers are curious, trying to make decisions and be independent."

Which value for hemoglobin would the nurse expect in a client who is experiencing sickle cell crisis? 1 6 to 8 g/100 mL (60-80 mmol/L) 2 10 to 12 g/100 mL (100-120 mmol/L) 3 12 to 14 g/100 mL (120-140 mmol/L) 4 16 to 18 g/100 mL (160-180 mmol/L)

6 to 8 g/100 mL (60-80 mmol/L)

A client had part of the ileum surgically removed. The nurse monitors the client closely for anemia based on which rationale? 1 Folic acid is absorbed in the ileum. 2 Cobalamin is absorbed in the ileum. 3 Iron absorption is dependent on simultaneous bile salt absorption in the ileum. 4 Copper, cobalt, and nickel are dependent on simultaneous bile salt absorption in the ileum.

Cobalamin is absorbed in the ileum

Which is the nurse's priority when evaluating a child with sickle cell anemia whose spleen auto infarcted 2 years prior? 1 Monitoring for signs of jaundice 2 Assessing the abdomen frequently 3 Monitoring serial hematocrit readings 4 Determining parental knowledge about infection

Determining parental knowledge about infection

Which medication would the nurse expect to administer to control bleeding in a child with hemophilia A? 1 Albumin 2 Fresh frozen plasma 3 Factor VIII concentrate 4 Factors II, VII, IX, X complex

Factor VIII concentrate

Which postpartum client is at the highest risk for disseminated intravascular coagulation (DIC)? 1 Gravida III with twins 2 Gravida V with endometriosis 3 Gravida II who had a 9-lb baby 4 Gravida I who has had an intrauterine fetal death

Gravida I who has had an intrauterine fetal death

The parents of a child with sickle cell anemia (SSA) tell the nurse, "We have never had any symptoms of SSA and do not understand why our child has this problem." Which information will the nurse include when teaching the parents? 1 SSA is caused by a random genetic mutation with no known cause. 2 People who are carriers of SSA may not have symptoms, but all of their children will have SSA. 3 If both parents are carriers of SSA, there is a 25% chance that offspring will have SSA. 4 When a child is born with SSA, genetic testing of both parents is needed to determine if they have sickle cell trait.

If both parents are carriers of SSA, there is a 25% chance that offspring will have SSA.

The nurse assesses a client for the development of pernicious anemia after reviewing the client's history. Which condition did the nurse most likely find in the history? 1 Acute gastritis 2 Diabetes mellitus 3 Partial gastrectomy 4 Unhealthy dietary habits

Partial gastrectomy

Which education would the nurse provide to the family of a 10-year-old child diagnosed with hemophilia about the genetic inheritance of the condition? 1 It follows the Mendelian law of inherited disorders. 2 The mother is a carrier of the disorder but usually is not affected by it. 3 It is an autosomal dominant disorder in which the woman carries the trait. 4 A carrier may be male or female, but the disease occurs in the sex opposite that of the carrier.

The mother is a carrier of the disorder but usually is not affected by it.

A transfusion of packed red blood cells is prescribed for a client with anemia. List the actions in the order in which they will be performed by the nurse.

1. Ensure that the client signed a consent for the transfusion. 2. Determine the client's vital signs. 3. Verify that the number on the blood product, laboratory record, and client arm band match. 4. Don a pair of clean gloves. 5. Initiate the transfusion slowly.

In which order will the nurse take these actions when caring for a client who is having a hemolytic reaction to a transfusion of packed red blood cells?

1. Stop the transfusion. 2. Change the intravenous (IV) administration set. 3. Run 0.9% normal saline at a rapid rate. 4. Notify the primary health care provider and blood bank.

Which foods will the nurse recommend to a client with iron deficiency anemia? Select all that apply. One, some, or all responses may be correct. 1 Grapes 2 Spinach 3 Oranges 4 Beef liver 5 Cantaloupe

Spinach Beef liver

A 4-year-old child diagnosed with sickle cell anemia is at a high risk of acquiring pneumococcal diseases. The child has previously received two doses of the pneumococcal conjugate vaccine (PCV). Based on the immunization protocol, which dose of PCV should the nurse administer? 1 Administer four more doses of PCV. 2 Administer three more doses of PCV. 3 Administer two more doses of PCV. 4 Administer one more dose of PCV

Administer two more doses of PCV

The parents of a 3-month old infant who is breast-fed ask the nurse how to prevent nutritional anemia. Which is the best response by the nurse? 1 Supplemental iron will not be needed for the first year. 2 Solid foods need not be introduced until 7 or 8 months of age. 3 Anemia will not develop as long as the infant is gaining weight. 4 Baby cereal or an iron supplement should be given around 4 months of age.

Baby cereal or an iron supplement should be given around 4 months of age

Which assessment finding indicates that disseminated intravascular coagulation (DIC) is occurring in a postpartum client who has experienced an abruptio placentae? 1 Boggy uterus 2 Hypovolemic shock 3 Multiple vaginal clots 4 Bleeding at the venipuncture site

Bleeding at the venipuncture site

An adolescent child with sickle cell anemia is admitted to the pediatric unit during a vaso-occlusive crisis. Which pathophysiology is correct? 1 Severe depression of the circulating thrombocytes 2 Diminished red blood cell (RBC) production by the bone marrow 3 Pooling of blood in the spleen with splenomegaly as a consequence 4 Blockage of small blood vessels as a result of clumping of RBCs

Blockage of small blood vessels as a result of clumping of RBCs

Which finding would the nurse expect when assessing the nasal passages of a client with thrombocytopenia? 1 Blood clots 2 Nasal polyps 3 Purulent discharge 4 Pale, swollen turbinates

Blood clots

Which iron-rich foods would the nurse recommend for a toddler diagnosed with iron deficiency anemia? Select all that apply. One, some, or all responses may be correct. 1 Carrots 2 Chicken 3 Broccoli 4 Lean steak 5 Whole milk

Chicken Broccoli Lean steak

Which iron-rich foods would the nurse encourage the client with mild anemia in early pregnancy to eat? Select all that apply. One, some, or all responses may be correct. 1 Dark leafy green vegetables 2 Legumes 3 Dried fruits 4 Yogurt 5 Ground beef patty

Darky leafy green vegetables Legumes Dried fruit Ground beef patty

A client who has renal failure asks the nurse why anemia keeps recurring. Which reason would the nurse explain to the client? 1 Increase in blood pressure 2 Decrease in erythropoietin 3 Increase in serum phosphate levels 4 Decrease in sodium concentration

Decrease in erythropoietin

A client who is underweight has autoimmune hemolytic anemia that has been unresponsive to corticosteroids. A splenectomy is scheduled. For which complication would the nurse assess the client in the immediate postoperative period? 1 Dehiscence 2 Hemorrhage 3 Wound infection 4 Abscess formation

Hemorrhage

A 6-year-old child with sickle cell disease is admitted with a vaso-occlusive crisis (pain episode). Which are the priority nursing concerns? Select all that apply. One, some, or all responses may be correct. 1 Nutrition 2 Hydration 3 Pain management 4 Prevention of infection 5 Oxygen supplementation

Hydration Pain Management Oxygen Supplementation

The nurse is conducting discharge teaching with an adolescent with hemophilia. Which statement by the client indicates a need for further teaching? 1 "I'll use a straight razor when I start shaving." 2 "I plan on trying out for the swim team next year." 3 "If I injure a joint, I'll keep it still, elevate it, and apply ice." 4 "If I get a little scratch, I can apply gentle pressure for 10 to 15 minutes."

I'll use a straight razor when I start shaving

Which cause of anemia would the nurse recognize as the most common cause of anemia in 1-year-olds? 1 Thalassemia 2 Lead poisoning 3 Iron deficiency 4 Sickle shape of blood cells

Iron deficiency

The nurse is teaching the parents of a toddler with a recent diagnosis of hemophilia about the disease. Which area of the body would the nurse include as the most common site for bleeding? 1 Brain 2 Joints 3 Kidneys 4 Abdomen

Joints

When reviewing the results of a toddler's complete blood count, the nurse notes decreased hemoglobin and hematocrit levels. Which other laboratory findings would the nurse expect in iron-deficiency anemia? Select all that apply. One, some, or all responses may be correct. 1 Microcytic red blood cells 2 Hyperchromic red blood cells 3 Low total iron-binding capacity 4 Slightly reduced reticulocyte count 5 Increased erythrocyte sedimentation rate (ESR)

Microcytic red blood cells Slightly reduced reticulocyte count

The parent of a child with sickle cell anemia tells the nurse that the family is going camping by a lake in the mountains this summer. The parent inquires what activities are appropriate. Which activity would the nurse suggest? 1 Swimming in the lake 2 Soccer with the family 3 Climbing the mountain trails 4 Motorboat rides around the lake

Motorboat rides around the lake

When performing a focused assessment on a client with a possible diagnosis of iron deficiency anemia, which locations would the nurse examine? Select all that apply. One, some, or all responses may be correct. 1 Sclera 2 Nail beds 3 Conjunctivae 4 Palms of hands 5 Bony prominences

Nail beds Conjunctivae Palms of hands

The parents of a child who has just been diagnosed with hemophilia A ask the nurse what symptoms of bleeding they should look for in the future. Which symptoms would the nurse list? Select all that apply. One, some, or all responses may be correct. 1 Nosebleeds 2 Blood in the urine 3 Painful and swollen joints 4 Easy bruising 5 Frequent fevers 6 Fast clotting of injuries 7 Dark-colored tarry stools

Nosebleeds Blood in the urine Painful and swollen joints Easy bruising Dark-colored tarry stools

Which dietary choices by a client with iron deficiency anemia indicate that the nurse's dietary teaching has been effective? Select all that apply. One, some, or all responses may be correct. 1 Scrambled eggs 2 Baked potato 3 Steamed carrots 4 Spinach salad 5 Dried apricots 6 Sliced oranges

Scrambled eggs Baked Potato Spinach salad Dried apricots

Which drink would the nurse instruct a client with iron deficiency anemia to choose to drink with the supplement for efficient absorption? 1 Water 2 Skim milk 3 Orange juice 4 A strawberry milkshake

Orange juice

Which parent education would the nurse provide when teaching an infant's parents about the major cause of iron-deficiency anemia? 1 Blood disorders 2 Overfeeding of milk 3 Lack of adequate iron reserves from the mother 4 Introduction of solid foods too early for adequate absorption

Overfeeding of milk

How would the nurse explain physiological anemia to a pregnant client? 1 Erythropoiesis decreases. 2 Plasma volume increases. 3 Utilization of iron decreases. 4 Detoxification by the liver increases.

Plasma volume increases

Which nursing intervention is the priority when the nurse notices that the client receiving a blood transfusion is having an acute hemolytic reaction? 1 Stop the blood transfusion immediately. 2 Report to the primary health care provider. 3 Recheck identifying tags and numbers on the client. 4 Maintain a patent intravenous (IV) line with saline solution.

Stop the blood transfusion immediately

Which parent education would the nurse provide the pregnant mother whose son was recently diagnosed with hemophilia about the chances that her next child will also be affected? 1 There is a 5% chance that the baby will be affected. 2 There is a 25% chance that the baby will be affected. 3 There is a 50% chance that the baby will be affected. 4 There is a 75% chance that the baby will be affected.

There is a 25% chance that the baby will be affected.

The mother of a toddler with hemophilia A asks the nurse, "Can I give my child ibuprofen for fever or pain?" How will the nurse respond? 1 "Ibuprofen is a good choice for fever or pain." 2 "Give your child acetaminophen. Ibuprofen may cause bleeding." 3 "No. I'll explain why your child isn't allowed pain medications." 4 "You seem concerned about giving medications to your child."

"Give your child acetaminophen. Ibuprofen may cause bleeding."

After the nurse has finished teaching a client about sickle cell anemia, which statement indicates that the client has a correct understanding of the condition? 1 "I have abnormal platelets." 2 "I have abnormal hemoglobin." 3 "I have abnormal hematocrit." 4 "I have abnormal white blood cells."

"I have abnormal hemoglobin"

The nurse concludes that the teaching about sickle cell anemia has been understood when an adolescent with the disorder makes which statement? 1 "I'll start to have symptoms when I drink less fluid." 2 "I'll start to have symptoms when I have fewer platelets." 3 "I'll start to have symptoms when I decrease the iron in my diet." 4 "I'll start to have symptoms when I have fewer white blood cells."

"I'll start to have symptoms when I drink less fluid."