Med Surge Anemia Quiz

Which patient is at greatest risk for infection and sepsis? a. 18-year-old who had an emergency splenectomy b. 22-year-old with recently diagnosed sickle cell anemia c. 38-year-old with hemolytic anemia d. 40-year-old alcoholic with liver disease

Correct Answer: a. 18-year-old who had an emergency splenectomy Rationale: Removal of the spleen causes reduced immune function. Without a spleen, the patient is less able to remove disease-causing organisms and is at increased risk for infection. Sickle cell anemia causes pain and discomfort because of the changed cell morphology, so acute pain, especially at joints, is the greatest threat to this patient. A low red blood cell (RBC) count can contribute to a patient's risk for infection, but this patient is more at risk for low oxygen levels and ensuing fatigue. The liver plays a role in blood coagulation, so this patient is more at risk for coagulation problems than for infection. Reference: p. 780

A registered nurse (RN) from pediatrics has 'floated" to the medical-surgical unit. Which patient should be assigned to the float nurse? a. 42-year-old with sickle cell disease receiving a transfusion of packed red blood cells b. 50-year-old with pancytopenia needing assessment of risk factors for aplastic anemia c. 55-year-old with folic acid deficiency anemia caused by alcohol abuse who needs counseling d. 60-year-old with newly diagnosed polycythemia vera who needs teaching about the disease

Correct Answer: a. 42-year-old with sickle cell disease receiving a transfusion of packed red blood cells Rationale for the answer: Because sickle cell disease is commonly diagnosed during childhood, the pediatric nurse will be familiar with the disease and with red blood cell transfusion; therefore he or she should be assigned to the patient with sickle cell disease. Aplastic anemia, folic acid deficiency, and polycythemia vera are problems more commonly seen in adult patients who should be cared for by nurses who are more experienced in caring for adults.

Which complication would the nurse associate with continued bleeding in a patient with diminished clotting ability? a. Anemia b. Embolus c. Polycythemia d. Thrombocytopenia

Correct Answer: a. Anemia Rationale: Continued bleeding may lead to anemia. An embolus is a dislodged thrombus resulting from excessive clotting. Polycythemia may lead to excessive clotting. Thrombocytopenia may lead to decreased clotting and put the patient at risk for continued bleeding. Reference: p. 34

Which condition is contraindicated for acute normovolemic hemodilution autologous blood transfusion therapy? a. Anemia b. Obesity c. Liver failure d. Cardiac failure

Correct Answer: a. Anemia Rationale for the answer: Acute normovolemic hemodilution is a type of autologous blood transfusion therapy. This therapy involves the withdrawal of a patient's red blood cells and volume replacement just before a surgical procedure. This type of autologous transfusion is not used with anemia. Obese and cardiac failure patients can receive this therapy to avoid the risk for transfusion reactions. This therapy is not contraindicated for patients with liver failure.

Which symptom of anemia occurs most commonly? a. Fatigue b. Headache c. Palpitations d. Sore tongue

Correct Answer: a. Fatigue Rationale for the answer: Fatigue is the most common symptom of anemia. Oxygen-carrying capacity is reduced in anemic patients because of either a decrease in the number of red blood cells (RBCs) or a dysfunction in RBCs. The tissues are therefore not supplied with adequate oxygen, and less energy is produced. Headaches, palpitations, and a sore tongue are less common symptoms associated with anemia.

Which symptom is a typical clinical manifestation of anemia? Select all that apply. One, some, or all responses may be correct. a. Pallor b. Fatigue c. Tachycardia d. Dyspnea (shortness of breath) on exertion e. Elevated temperature f. Decreased breath sounds

Correct Answer: a. Pallor, b. Fatigue, c. Tachycardia, d. Dyspnea on exertion Rationale: Difficulty breathing, especially with activity, is common with anemia. Lower levels of hemoglobin carry less O2 to the cells of the body. Fatigue is a classic symptom of anemia; lowered O2 levels contribute to a faster pulse (i.e., cardiac rate) and tend to "wear out" a patient's energy. Lowered O2 levels deliver less oxygen to all cells, making patients with anemia pale, especially their ears, nail beds, palms, conjunctiva, and around the mouth. Respiratory problems with anemia do not include changes in breath sounds; dyspnea and decreased oxygen saturation levels are present. Skin is cool to the touch, and an intolerance to cold is noted; an elevated temperature would signify something additional, such as infection. Reference: p. 799

The nurse is teaching a patient with iron deficiency anemia about increasing the intake of dietary iron. The nurse considers the teaching successful when the patient makes which food selection? a. Roast beef b. Baked potato c. Low-fat turkey d. Citrus products

Correct Answer: a. Roast beef Rationale: Management of iron deficiency anemia involves increasing the oral intake of iron from food sources (e.g., red meat, organ meat, egg yolks, kidney beans, leafy green vegetables, and raisins). Baked potatoes are high in potassium, and citrus products will help with iron absorption, but they will not replace iron. Turkey is a white, not red, meat. Reference: p. 800

Which rationale would the nurse provide to an older patient with anemia regarding the importance of seeking follow-up care from a health care provider? a. "You may get dizzy and fall because of your anemia." b. "GI bleeding is the most frequent cause of anemia, so you should be monitored closely." c. "To help with your blood levels, you need to increase your fluid intake, and we need to monitor your intake." d. "There is a link between anemia and many skin disorders, so you need to be further assessed for these conditions."

Correct Answer: b. "GI bleeding is the most frequent cause of anemia, so you should be monitored closely." Rationale: In adults, anemia is most frequently caused by GI bleeding. It is associated with GI cancer, peptic ulcers, and inflammatory bowel diseases. Although low hemoglobin and hematocrit may lead to syncope, they are not the most important reasons to seek follow-up. Increased fluids will not cure anemia, and there is no relationship between anemia and skin disorders. Reference: p. 1065

Which complication would the nurse monitor for in a patient prescribed a multivitamin and an iron preparation to treat anemia? a. Bone pain b. Constipation c. Nasolabial seborrhea d. Nausea and vomiting

Correct Answer: b. Constipation Rationale: Iron preparations and multivitamins are generally prescribed to treat anemia; however, the prolonged use of iron preparations can lead to constipation. Vitamin D is needed for the absorption of calcium from food, and calcium helps maintain bone health; therefore vitamin D deficiency can result in bone pain, osteomalacia, and rickets. A deficiency in niacin causes nasolabial seborrhea. The chronic use of zinc supplements can cause nausea and vomiting. Reference: p. 1204

A patient with a history of chronic alcohol abuse is pale and jaundiced. A review of the medical record reveals a low hemoglobin level with macrocytic red blood cells. This information may point to which nutrient deficiency? a. Iron b. Folic acid c. Vitamin A d. Vitamin B12

Correct Answer: b. Folic acid Rationale for the answer: Patients who have alcoholism often have folic acid deficiency anemia secondary to malnutrition. Patients deficient in iron in the diet have iron deficiency anemia. Patients who have undergone a partial gastrectomy or have malabsorption syndrome are likely to have vitamin B 12 deficiency anemia. A diet deficient in vitamin A is common among people in developing countries and is linked to multiple eye disorders.

An African-American patient taking a thiazide diuretic develops hemolytic anemia. The nurse notifies the health care provider and anticipates a prescription to test this patient for which type of anemia? a. Iron deficiency b. Glucose-6-phosphate dehydrogenase (G6PD) deficiency c. Immunohemolytic d. Sickle cell disease

Correct Answer: b. Glucose-6-phosphate dehydrogenase (G6PD) deficiency Rationale: Patients with G6PD deficiency do not have symptoms until they develop a severe infection or are exposed to certain drugs, such as a thiazide, a diuretic that causes red blood cells (RBCs) with reduced G6PD to break more easily. Immunohemolytic anemia results from increased RBC destruction after viral illness, trauma, and exposure to some drugs. Iron deficiency anemia and sickle cell disease are not characterized by hemolysis of RBCs. Reference: pp. 799-800

Which condition is detected by using the Coombs test? a. Hemophilia b. Hemolytic anemia c. Polycythemia vera d. Megaloblastic anemia

Correct Answer: b. Hemolytic anemia Rationale for the answer: The Coombs test is used to detect antibodies against red blood cells (RBCs) that may be attached to a person's RBCs. The presence of these antibodies can cause hemolytic anemia. Anti-RBC antibodies are not found in conditions like hemophilia, polycythemia vera, or megaloblastic anemia; using the Coombs test would not detect these conditions.

A patient with iron deficiency anemia has a prescription for ferrous sulfate. Which finding by the nurse indicates a positive outcome from the medication? a. Pale skin b. Increased energy c. Hematocrit of 27% d. Macrocytic red blood cells reported on the complete blood count

Correct Answer: b. Increased energy normal hematocrit is about 35%-55%. Rationale: Signs that iron deficiency has resolved include less fatigue, less dyspnea, and an increase in exercise tolerance. Pallor and low hematocrit are symptomatic of anemia; therefore, they are not considered positive responses. Iron deficiency produces a small, pale, microcytic cell; macrocytic cells are symptomatic of B12 or folic acid deficiency. Reference: p. 800

Which patient does the nurse consider at risk for folic acid deficiency anemia? a. Patient with heart failure b. Patient with Crohn disease c. Patient recovering from fracture of the tibia d. Patient with a basal skin cancer of the nose

Correct Answer: b. Patient with Crohn disease Rationale: Malabsorption syndromes, such as Crohn disease, are the second most common cause of folic acid deficiency anemia. Other risk factors include poor nutrition and the use of anticonvulsants or oral contraceptives. Those with an increased need for folic acid are at a higher risk. Heart failure and basal cell skin cancer are not included in these risks. Patients with fractures may require additional calcium, not folic acid. Reference: p. 799

Which condition causes an increase in systolic blood pressure? a. Iron deficiency anemia b. Polycythemia vera c. Sickle cell disease d. Von Willebrand disease

Correct Answer: b. Polycythemia vera Rationale for the answer: Systolic blood pressure is increased in conditions such as polycythemia vera. In this condition, the red blood cell levels in the blood are increased. This increases the viscosity of the blood, which ultimately causes an increase in blood pressure. In iron deficiency anemia, there is a drop in systolic blood pressure. In sickle cell disease and Von Willebrand disease, the systolic blood pressure is not affected.

Which nursing intervention is the priority when caring for a patient with sickle cell anemia who is in crisis? a. Improving nutrition b. Restoring tissue perfusion c. Correcting decreased cardiac output d. Restoring normal hemoglobin and hematocrit

Correct Answer: b. Restoring tissue perfusion Rationale: Patients with sickle cell anemia who have decreased oxygen conditions develop crisis, causing reduction in oxygen supply and furthering development of sickled cells and organ damage. The nurse must encourage oral fluids and administer parenteral fluids to restore tissue perfusion. During a sickle cell crisis, restoring tissue perfusion is most important. Usually sickled cells go back to normal shape when the precipitating condition is removed, and the blood oxygen level is normalized, which allows tissue perfusion to resume. Improving nutrition, correcting decreased cardiac output, and restoring normal hemoglobin and hematocrit are not priorities during a sickle cell crisis. Reference: p. 793

The nurse is caring for a patient who has weakness, pallor, fatigue, reduced exercise tolerance, and fissures at the corners of the mouth. The nurse recognizes these symptoms are associated with which condition? a. Aplastic anemia b. Folic acid deficiency c. Iron deficiency anemia d. Vitamin B12 deficiency (pernicious) anemia

Correct Answer: c. Iron deficiency anemia Rationale: Weakness, pallor, fatigue, reduced exercise tolerance, and fissures at the corners of the mouth are symptoms of iron deficiency anemia. In patients with aplastic anemia, a complete blood count shows severe macrocytic anemia, leukopenia, and thrombocytopenia. Patients with folic acid deficiency and vitamin B12 deficiency anemia may exhibit pallor and jaundice, glossitis, fatigue, and weight loss. Reference: p. 799

Which patient does the nurse identify as at risk for iron deficiency anemia? a. Patient with systemic lupus erythematosus b. Patient with a seizure disorder, who takes valproate c. Patient who has undergone gastric bypass procedure for obesity d. Patient who has received radiation therapy to the pelvis for ovarian cancer

Correct Answer: c. Patient who has undergone gastric bypass procedure for obesity Rationale: The gastric bypass procedure can cause anemia by reducing the available surface for absorption of iron. Additionally, hydrochloric acid is reduced; therefore iron absorption is reduced. The patient with systemic lupus erythematosus develops anemia because of the autoimmune process whereby the body recognizes the patient's RBCs as foreign tissue and attacks them. Anticonvulsant medications produce a folic acid deficiency anemia. The patient who has received radiation is at risk for anemia caused by destruction of the bone marrow. Reference: p. 798

How does a nurse respond when a patient with anemia asks, 'Why am I feeling tired all the time?' a. "How many hours are you sleeping at night?" b. "You are not getting enough iron." c. "You need to rest more when you are sick." d. "Your cells are delivering less oxygen than you need."

Correct Answer: d. "Your cells are delivering less oxygen than you need." Rationale: The single most common symptom of anemia is fatigue, which occurs because oxygen delivery to the cells is less than the amount required to meet normal oxygen needs. Although assessment of sleep is good, it does not address the cause related to the diagnosis. The statement about the patient needing rest because of being sick is simply not true. Although it may be true that the patient is not getting enough iron, it does not relate to the patient's fatigue. Reference: p. 784

Which patient does the nurse assign as a roommate to the patient with aplastic anemia? a. 23-year-old with sickle cell disease who has two draining leg ulcers b. 30-year-old with leukemia who is receiving induction chemotherapy c. 34-year-old with idiopathic thrombocytopenia who is taking steroids d. 28-year-old with glucose-6-phosphate deficiency (G6PD) anemia who is receiving mannitol

Correct Answer: d. 28-year-old with glucose-6-phosphate deficiency (G6PD) anemia who is receiving mannitol Rationale for the answer: Because patients with aplastic anemia usually have low white blood cell counts that place them at high risk for infection, roommates should be free from infection or infection risk, such as the patient with G6PD anemia. The patient with sickle cell disease has two draining leg ulcer infections that would threaten the diminished immune system of the patient with aplastic anemia. The patient with leukemia who is receiving induction chemotherapy and the patient with idiopathic thrombocytopenia who is taking steroids are at risk for development of infection, which places the patient with aplastic anemia at risk, too.

Which vitamin absorption is affected by a lack of intrinsic factor, as occurs with pernicious anemia? a. Iron b. Folic acid c. Pyridoxine d. Cyanocobalamin

Correct Answer: d. Cyanocobalamin (B12) Rationale: The parietal cells of the stomach produce intrinsic factor, which aids in the absorption of cyanocobalamin, or vitamin B12. An absence of intrinsic factor leads to pernicious anemia. Depletion of iron leads to iron deficiency anemia. Depletion of folic acid leads to megaloblastic anemia. Depletion of pyridoxine, or vitamin B6, leads to a collection of symptoms including peripheral neuropathy, seborrheic dermatitis, glossitis, and cheilosis and, in adults, depression, confusion, and seizures. Reference: p. 1058

Which sources of B12 would the nurse include in the teaching plan for a patient who follows a vegan diet and has been diagnosed with pernicious anemia? a. Fruit b. Fiber c. Vegetables d. Fortified soy beverage

Correct Answer: d. Fortified soy beverage Rationale: The most common cause of pernicious anemia is deficiency of vitamin B12, which is found in high amounts in animal products and meat. Vegans eat only plant-based foods, so it is suggested that the patient include fortified soy beverages in the diet to compensate for the vitamin B12 deficiency. Dietary guidelines for Americans recommend increased consumption of fruits and vegetables to maintain balanced nutrition, but this is not a recommendation for pernicious anemia. Older-adult patients are advised to consume fiber-rich foods to manage constipation. Reference: p. 1197

While performing an admission assessment on a 55-year-old woman, the nurse notes a serum hemoglobin level that indicates anemia. Which question does the nurse ask the patient first? a. Does she consume red meat regularly? b. Does she still have menstrual periods? c. Does she take a vitamin supplement? d. Has she noticed blood in her stools?

Correct Answer: d. Has she noticed blood in her stools? Rationale: Any adult with iron deficiency should be evaluated for abnormal bleeding, especially from the GI tract; therefore the nurse should ask about blood in her stools. Dietary intake of iron should be assessed, but this is a less common cause of iron deficiency anemia. Blood loss from periods is not as likely in an older woman. A vitamin B12 deficiency results in pernicious anemia; therefore asking whether she takes a vitamin supplement is important, but still does not address how she got anemia. Reference: p. 798

A patient who underwent partial gastrectomy for gastric cancer has a shiny, smooth tongue with characteristic "beefy appearance." The patient states, "I feel like my tongue is on fire." Which nutrient deficiency would the nurse suspect? a. Iron b. Calcium c. Folic acid d. Vitamin B12

Correct Answer: d. Vitamin B12 Rationale: Gastrectomy results in inadequate production of intrinsic factors leading to deficiency in the absorption of vitamin B12, iron, calcium, and folic acid. Deficiency of B12 results in atrophic glossitis, a condition in which the papillae of the tongue are lost, resulting in a burning sensation. Deficiency of iron results in iron deficiency anemia. Deficiency of calcium results in decreased bone density. Deficiency of folic acid may result in megaloblastic anemia. Reference: p. 1106

A patient has pallor; jaundice; a smooth, beefy-red tongue; has been experiencing difficulty with balance; and reports tingling of the hands and feet. The patient's laboratory workup indicates macrocytic anemia. The nurse notifies the health care provider of these findings and anticipates a prescription for which medication? a. Steroids b. Folic acid c. Iron dextran d. Vitamin B12

Correct Answer: d. Vitamin B12 Rationale: This patient exhibits symptoms of vitamin B12 deficiency anemia, characterized by the symptoms described, and should receive vitamin B12. Symptoms of folic acid deficiency anemia are similar, but folic acid deficiency anemia does not cause neurologic symptoms. Unless the underlying deficiency of B12 is addressed, giving iron will not be effective, because B12 is necessary for synthesizing red blood cells. Steroids are typically given for immune deficiency anemia. Reference: p. 800