Hematological

A client with sickle cell disease has been admitted to the hospital complaining of a sudden onset of severe pain in the extremities, abdomen, back, and chest. Which interventions would the nurse expect to be included in the care of the client? Select all that apply. 1. Administer oxygen per nasal cannula. 2Apply ice bags to joints of extremities. 3Administer the prescribed opioid analgesic. 4Keep room temperature at or below 65°F. 5Encourage the client to keep extremities extended. 6Hydrate the client with 0.9% normal saline 125 mL/hr intravenously.

Correct Answer 1. Administer oxygen per nasal cannula. 3Administer the prescribed opioid analgesic. 5Encourage the client to keep extremities extended. 6Hydrate the client with 0.9% normal saline 125 mL/hr intravenously. Rationale: A client in a sickle cell crisis will have pain as the body's tissues become hypoxic. A state of adequate hydration is important. The nurse administers oxygen, an opioid analgesic to control the pain, and isotonic intravenous fluids to achieve and maintain hydration. Keeping the extremities extended and not bent decreases sickling risk. The client should be kept warm to counteract the sickling. The room should be 72 degrees or higher, and ice bags should not be applied to joints.

A client has been diagnosed with disseminated intravascular coagulation (DIC). Which laboratory tests would the nurse anticipate being prescribed? Select all that apply. 1. D-dimer 2. Amylase 3. Albumin 4. Potassium 5. Hemoglobin 6. Prothrombin time

Correct Answer 1. D-dimer 5. Hemoglobin 6. Prothrombin time Rationale: The D-dimer is elevated with DIC. There is decreased hemoglobin due to bleeding. The prothrombin time is increased because clotting factors are being used up. Albumin is checked for disorders of the liver and/or edema, and amylase is checked for disorders of the liver or pancreas, not for DIC. The potassium level should not be greatly affected by DIC, either.

Which food sources would the nurse include in the discharge teaching plan of a client with vitamin B12 deficiency anemia? Select all that apply. 1. Eggs 2. Liver 3. Ice cream 4. Red meats 5. Citrus fruits

Correct Answer 1. Eggs 2. Liver 4. Red meats Rationale: Eggs, enriched grain products, and red meats, especially liver, are food sources high in vitamin B12. Ice cream (high in calcium and fat) and citrus fruits (high in vitamin C) are not food sources high in vitamin B12.

The nurse has conducted dietary teaching with the client diagnosed with iron deficiency anemia. The nurse determines that the client understands the information if the client states the intention to increase intake of which foods? Select all that apply. 1. Oysters 2. Spinach 3. Pineapple 4. Egg whites 5. Kidney beans 6. Refined white bread

Correct Answer 1. Oysters 2. Spinach 5. Kidney beans Rationale: The client with iron deficiency anemia should increase intake of foods that are naturally high in iron. The best sources of dietary iron are red meat, liver, other organ meats, blackstrap molasses, and oysters. Other good sources of iron are kidney beans, whole wheat bread, egg yolk, spinach, kale, turnip tops, beet greens, carrots, raisins, and apricots. Pineapple, egg whites, and refined white bread are not rich sources of iron.

The nurse is caring for a client with thrombocytopenia. Which data would the nurse monitor for related to this condition? Select all that apply. 1. Purpura 2. Ecchymoses 3. Hemoglobin at 14.0 g/dL 4. Thrombocytes at 300,000 mm3 5. Prothrombin time (PT) 14 seconds 6. Platelet count less than 150,000 mm3

Correct Answer 1. Purpura 2. Ecchymoses 6. Platelet count less than 150,000 mm3 Rationale: Purpura, which is small areas of petechiae, is a sign of thrombocytopenia. Ecchymoses, areas of hemorrhage under the skin, are seen with thrombocytopenia. A platelet count under 150,000 mm3 is indicative of thrombocytopenia. A hemoglobin of 14.0 is within normal range for a male or female. Thrombocytes are platelets, and 300,000 mm3 is within normal range. A prothrombin time of 14 seconds is within the normal coagulation time of 12 to 14 seconds.

The nurse is doing discharge teaching with a client who has sickle cell disease. The nurse reinforces instructions to the client to avoid which factors that could precipitate a sickle cell crisis? Select all that apply. 1. infection 2. Mild exercise 3. Fluid overload 4. Warm weather 5. Emotional stress

Correct Answer 1. infection 5. Emotional stress Rationale: The client should avoid infections and emotional stress, which can increase metabolic demand and cause dehydration, precipitating a sickle cell crisis. The client should also avoid dehydration from other causes. Warm weather and mild exercise do not need to be avoided, but the client should take measures to avoid dehydration during these conditions. Fluids are important to prevent dehydration. Finally, the client should avoid being in areas of high altitude, or flying in a nonpressurized aircraft because of lesser oxygen tension in these areas.

The nurse is caring for a client following a total hip replacement. The client has been diagnosed with iron deficiency anemia. The nurse instructs the client to increase intake of which foods? Select all that apply. 1. Milk and yogurt 2. Clams and mussels 3. Apples and mangos 4. Potatoes and carrots 5. Lean beef and chicken liver

Correct Answer 2. Clams and mussels 5. Lean beef and chicken liver Rationale: The client with iron deficiency anemia should increase intake of foods that are naturally high in iron. The best sources of dietary iron are red meat, liver and other organ meats, blackstrap molasses, clams, mussels, and oysters. Milk products are lowest in iron of all of the food sources listed. Potatoes, carrots, apples, and mangos are not rich sources of iron.

A client is admitted to the hospital with vitamin B12 deficiency. When taking the client's history, which symptoms would the nurse expect the client to report? Select all that apply. 1. Craving to eat ice 2. Muscle weakness 3. Dry and brittle hair 4. Difficulty in walking 5. Numbness in hands

Correct Answer 2. Muscle weakness 4. Difficulty in walking 5. Numbness in hands Rationale: Vitamin B12 is necessary for red blood cell production, myelin maintenance, and nerve function. Lack of vitamin B12 can lead to anemia, as well as damage to the spinal cord, peripheral nerves, and brain. Neurological symptoms include muscle weakness, difficulty in walking, and numbness in hands. Dry and brittle hair and a craving to eat ice are symptoms of iron deficiency anemia.

The nurse is caring for a client with a suspected diagnosis of aplastic anemia. Which test would the nurse anticipate to be performed to confirm the diagnosis? 1. Schilling test 2. Sickle cell screen 3. Bone marrow aspiration 4. Complete blood cell count

Correct Answer 3. Bone marrow aspiration Rationale: A bone marrow aspiration will identify aplastic anemia and will identify pancytopenia, a deficiency in erythrocytes, leukocytes, and thrombocytes, and confirm that the source of the problem is bone marrow dysfunction. A Schilling test is diagnostic for pernicious anemia. A sickle cell screen is diagnostic for sickle cell anemia. A complete blood cell count will identify anemia but may not identify the specific type and also the leukopenia and thrombocytopenia.

The nurse is reinforcing instructions to a client with iron deficiency anemia about eating a diet with iron-rich foods. Which food sources would the nurse include in the discharge teaching plan of a client with iron deficiency anemia? Select all that apply. 1. Milk 2. Fish 3. Eggs 4. Liver5Cheese

Correct Answer 3. Eggs 4. Liver5Cheese Rationale: Liver and muscle meats; eggs; dried fruits; and dark green, leafy vegetables are iron-rich foods. Milk, fish, and cheese are not significant sources of iron.

The nurse is caring for a client with a diagnosis of aplastic anemia. Which are the most likely signs/symptoms associated with aplastic anemia? Select all that apply. 1. Pain 2. Nausea 3. Fatigue 4. Infection 5. Petechiae 6. Shortness of breath

Correct Answer 3. Fatigue 4. Infection 5. Petechiae 6. Shortness of breath Rationale: Aplastic anemia is a decrease in red blood cells, white blood cells, and platelets. A reduced number of red blood cells will cause the hemoglobin to drop, and clients commonly report fatigue and shortness of breath. A reduced number of white blood cells will make the client susceptible to infection. A reduced number of platelets will cause the blood to not clot properly and can result in bleeding manifested as petechiae. Pain is a symptom of sickle cell disease, chronic myelogenous leukemia, and multiple myeloma. Nausea is not a symptom of aplastic anemia.

Which test would the nurse expect to have done for a client suspected of having pernicious anemia? 1. D-dimer 2. Myoglobin 3. Schilling test 4. Hemoglobin A1c

Correct Answer 3. Schilling test Rationale: The Schillling test determines the ability to absorb vitamin B12 and is used to diagnose pernicious anemia. D-dimer is used for diagnosis of pulmonary embolism and disseminated intravascular coagulation. Myoglobin is used to detect damage to the myocardium. Hemoglobin A1c is a test to tell average glucose control over a 3-month period.

A client has experienced several episodes of sickle cell crisis. Which reinforced instructions would be included in the client's teaching plan to prevent recurrence? Select all that apply. 1. Vigorous exercise is encouraged to maintain cardiovascular function. 2. Iced liquids will combat dehydration and should be consumed regularly. 3. Wear shoes and socks when walking outside to prevent damage to the feet. 4. To prevent opioid tolerance, avoid taking pain medication at the beginning of the crisis 5. Recognize early symptoms of infection and contact the primary health care provider (PHCP).

Correct Answer 3. Wear shoes and socks when walking outside to prevent damage to the feet. 5. Recognize early symptoms of infection and contact the primary health care provider (PHCP). Rationale: Wearing socks and shoes will prevent wounds to the legs and feet, which heal slowly and frequently become infected in clients with sickle cell disease. Recognizing the early symptoms of an infection and seeking medical assistance may lessen the severity and avoid a crisis. Vigorous exercise and iced liquids can precipitate a crisis and should be avoided. Opioid tolerance is not a priority or immediate concern for clients experiencing a sickle cell crisis. These clients experience a great deal of pain and require opioids for pain relief. Pain medication should be taken when the client recognizes a crisis.

The nurse is caring for a client receiving chemotherapy and determines that the client has developed myelosuppression. Which laboratory value would support the client's diagnosis of myelosuppression? 1. Protein 7 g/dL 2Magnesium 1.8 mg/dL 3Hemoglobin 9.4 g/dL, hematocrit 26% 4Blood urea nitrogen (BUN) 15 mg/dL, creatinine 0.9 mg/dL

Correct Answer 3Hemoglobin 9.4 g/dL, hematocrit 26% Rationale: The client has been diagnosed with myelosuppression, which is bone marrow depression. The correct option is the hemoglobin and hematocrit, which is decreased. Hemoglobin is the main component of erythrocytes. Hematocrit represents red blood cell mass and is an important measurement in the identification of blood abnormalities. Red blood cells are produced in the bone marrow. BUN and creatinine address renal function. Protein levels address the amount of albumin in serum and low levels reflect decreased functioning by the liver and/or poor protein intake. These other laboratory values are within normal range.

The nurse is reviewing the laboratory results of a client receiving chemotherapy. The nurse prepares to initiate neutropenic precautions when the nurse notes which laboratory result? 1. A bleeding time of 3 minutes 2. An ammonia level of 20 mcg/dL 3. A platelet count of 200,000 mm3 4. A white blood cell (WBC) count of 2000 mm3

Correct Answer 4. A white blood cell (WBC) count of 2000 mm3 Rationale: When the WBC count drops, neutropenic precautions need to be implemented. The normal WBC count is 5000 to 10,000 mm3. This includes protective isolation measures to protect the client from infection. Bleeding precautions need to be initiated when the platelet count drops. Bleeding precautions include avoiding all trauma such as rectal temperatures or injections. The normal platelet count is 150,000 to 450,000 mm3. The normal bleeding time is 1 to 6 minutes, depending on laboratory method used. The normal ammonia value is 10 to 80 mcg/dL.

A client has been diagnosed with pernicious anemia. In planning care for the client, the nurse anticipates that the client will be treated with which vitamin or mineral? 1. Iron 2. Folic acid 3. Thiamine 4. Vitamin B12

Correct Answer 4. Vitamin B12 Rationale: Pernicious anemia is caused by a deficiency of the intrinsic factor, which results in the inability to absorb vitamin B12 in the intestine. Treatment consists of weekly at first and then monthly injections of vitamin B12. Thiamine is most often prescribed for the client with alcoholism. Iron is administered for iron deficiency anemia, and folic acid is prescribed for folic acid deficiency.