NRSG 3420 - Module 1

The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? "Acute leukemia develops slowly." "In chronic leukemia, the minority of leukocytes are mature." "Chronic leukemia develops slowly." "In acute leukemia there are not many undifferentiated cells."

"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 nurse is caring for a client who will undergo total knee replacement and will have an autologous transfusion. Which statement will the nurse include when teaching the client about the transfusion? "You will be prescribed calcium to replace what is lost during donation." "You typically donate blood 4 to 6 weeks before the surgery." "You will likely not need the blood that is donated." "You typically donate blood the day of the surgery."

"You typically donate blood 4 to 6 weeks before the surgery." With autologous donation, a client's own blood may be collected for future transfusion; this is an effective method for orthopedic surgery, where the likelihood of transfusion is high. Preoperative donation is ideally collected 4-6 weeks before surgery. The nurse will not tell the client that the blood will not be needed; orthopedic surgeries often require transfusion of blood. The client will be prescribed iron supplements during the donation time, not calcium.

Which client is not a candidate to be a blood donor according to the American Red Cross? 18-year-old male weighing 52 kg 86-year-old male with blood pressure 110/70 mm Hg 26-year-old female with hemoglobin 11.0 g/dL 50-year-old female with pulse 95 beats/minute

26-year-old female with hemoglobin 11.0 g/dL Clients must meet a number of criteria to be eligible as blood donors, including the following: body weight at least 50 kg; pulse rate regular between 50 and 100 bpm; systolic BP 90-100 to 180 mm Hg and diastolic 50 to 100 mm Hg; hemoglobin level at least 12.5 g/dL. There is no upper age limit to donation.

A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify? Low levels of urine constituents normally excreted in the urine Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels Electrolyte imbalance that could affect the blood's ability to coagulate properly Potential hepatic dysfunction indicated by decreased blood urea nitrogen (BUN) and creatinine levels

Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels Low preoperative HCT and Hb levels indicate the client may require a blood transfusion before surgery. If the HCT and Hb levels decrease during surgery because of blood loss, the potential need for a transfusion increases. Possible renal failure is indicated by elevated BUN or creatinine levels. Urine constituents aren't found in the blood. Coagulation is determined by the presence of appropriate clotting factors, not electrolytes.

A client's low prothrombin time (PT) was attributed to low vitamin K levels and the client's PT normalized after administration of vitamin K. When performing discharge education in an effort to prevent recurrence, what should the nurse emphasize? Constant access to clotting factor concentrates Meticulous hygiene Adequate nutrition Avoidance of NSAIDs

Adequate nutrition Vitamin K deficiency is often the result of a nutritional deficit. NSAIDs do not influence vitamin K synthesis and clotting factors are not necessary to treat or prevent a vitamin K deficiency. Hygiene is not related to the onset or prevention of vitamin K deficiency.

A nurse is assigned to care for a patient with ascites, secondary to cirrhosis. The nurse understands that the fluid accumulation in the peritoneal cavity results from a combination of factors including an alteration in oncotic pressure gradients and increased capillary permeability. Therefore, the nurse monitors the serum level of the plasma protein responsible for maintaining oncotic pressure, which is: Fibrinogen. Prothrombin. Globulin. Albumin.

Albumin Albumin, only produced in the liver, is essential for maintaining oncotic pressure in the vascular system. A decrease in oncotic pressure due to low albumin causes fluid to leak into the peritoneal cavity.

A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention? Assess the client's hemoglobin and platelets. Assess the client's skin. Check the client's history. Assess the client's pulse and blood pressure.

Assess the client's hemoglobin and platelets. Clients with AML may develop pallor from anemia and a tendency to bleed because of a low platelet count. Assessing the client's hemoglobin and platelets will help to determine whether this is the cause of the symptoms. This would be the priority above assessing pulses, blood pressure, history, or skin.

Which of the following are assessment findings associated with thrombocytopenia? Select all that apply. Hypertension Bleeding gums Bradypnea Epistaxis Hematemesis

Bleeding gums Epistaxis Hematemesis Pertinent findings of thrombocytopenia include: bleeding gums, epistaxis, hematemesis, hypotension, and tachypnea.

The nurse is educating a client about iron supplements. The nurse teaches that what vitamin enhances the absorption of iron? A D E C

C Vitamin C facilitates the absorption of iron. Therefore, iron supplements should be taken with a glass of orange juice or a vitamin C tablet to maximize absorption.

The nurse is assessing a client experiencing symptoms of non-Hodgkin lymphoma with a suspected mediastinal mass. The nurse knows that which assessment findings would indicate this complication? Select all that apply. Shortness of breath Nausea Chest pain Abdominal pain Cough

Cough Chest Pain Shortness of Breath Symptoms of NHL are variable and may start as a painless swelling in one or more lymph nodes. The degree of symptoms depends upon the site and size of the enlarged node. A mass in the mediastinum can cause a cough, chest pain, and shortness of breath. A mass in the spleen can cause nausea and abdominal pain.

A patient with end-stage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia? Calcium level of 9.4 mg/dL Creatinine level of 6 mg/100 mL Magnesium level of 2.5 mg/dL Potassium level of 5.2 mEq/L

Creatinine level of 6 mg/100 mL The degree of anemia in patients with end-stage renal disease varies greatly; however, in general, patients do not become significantly anemic until the serum creatinine level exceeds 3 mg/100 mL.

A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor? Decreased total iron-binding capacity Increased reticulocyte count Increased mean corpuscular volume Decreased level of erythropoietin

Decreased level of erythropoietin As renal function decreases, erythropoietin, which is produced by the kidney, also decreases. Because erythropoietin is produced outside the kidney, some erythropoiesis continues, even in patients whose kidneys have been removed. However, the number of red blood cells produced is small and the degree of erythropoiesis is inadequate.

The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions? Do not take medication with orange juice because it will delay absorption of the iron. Dilute the liquid preparation with another liquid such as juice and drink with a straw. Iron may cause indigestion and should be taken with an antacid such as Mylanta. Discontinue the use of iron if your stool turns black.

Dilute the liquid preparation with another liquid such as juice and drink with a straw. Dilute liquid preparations of iron with another liquid such as juice and drink with a straw to avoid staining the teeth. Avoid taking iron simultaneously with an antacid, which interferes with iron absorption. Drink orange juice or take other forms of vitamin C with iron to promote its absorption. Expect iron to color stool dark green or black.

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? Eating leafy green vegetables with a glass of water Eating a steak with mushrooms Eating apple slices with carrots Eating calf's liver with a glass of orange juice

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.

A thin client is prescribed iron dextran intramuscularly. What is most important action taken by the nurse when administering this medication? Injects into the deltoid muscle Uses a 23-gauge needle Rubs the site vigorously Employs the Z-track technique

Employs the Z-track technique When iron medications are given intramuscularly, the nurse uses the Z-track technique to avoid local pain and staining of the skin. The gluteus maximus muscle is used. The nurse avoids rubbing the site vigorously and uses a 18- or 20-gauge needle

The nurse is preparing to educate a group of students on the signs and symptoms of disseminated intravascular coagulation (DIC). The nurse knows that teaching was effective when the students are able to recognize which symptom as being associated with DIC? Select all that apply. Cyanotic extremities Tachypnea Headache Capillary refill 6 seconds Abdominal distention

Headache, tachypnea, distended abdomen Disseminated intravascular coagulation (DIC) is a systemic syndrome that is characterized by microthromboses and bleeding. Symptoms can be linked to either microvascular thrombosis or microvascular bleeding. Findings associated with microvascular bleeding include a headache, tachypnea, and abdominal distention. Symptoms of microvascular thrombosis include cyanotic extremities, and a capillary refill greater than 3 seconds.

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? Potassium level Hemoglobin level Creatinine level Folate levels

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.

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. Based on the assessment data, which nursing diagnoses is most appropriate for this client? Risk for falls related to complaints of dizziness Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit Fatigue related to decreased hemoglobin and hematocrit

Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit The symptoms indicate impaired tissue perfusion due to a decrease in the oxygen-carrying capacity of the blood. Cardiac status should be carefully assessed. When the hemoglobin level is low, the heart attempts to compensate by pumping faster and harder in an effort to deliver more blood to hypoxic tissue. This increased cardiac workload can result in such symptoms as tachycardia, palpitations, dyspnea, dizziness, orthopnea, and exertional dyspnea. Heart failure may eventually develop, as evidenced by an enlarged heart (cardiomegaly) and liver (hepatomegaly) and by peripheral edema.

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? It is part of the required assessment information. It may indicate deficiencies in essential nutrients. It will determine what type of anemia the patient has. It is important for the nurse to determine what type of foods the patient will eat.

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.

Which iron-rich foods should a nurse encourage an anemic client requiring iron therapy to eat? Shrimp and tomatoes Cheese and bananas Lobster and squash Lamb and peaches

Lamb and peaches Iron-rich foods include lamb and peaches. Shrimp, tomatoes, lobster, squash, cheese, and bananas aren't high in iron content.

The nurse is providing health education to an older adult client who has low red blood cell levels. To promote red blood cell production, the nurse should encourage intake of what foods? Select all that apply. Animal fats Organic foods Leafy green vegetables Lean meats Nuts and seeds

Leafy green vegetables, lean meats, nuts and seeds A healthy diet that includes lean meats, nuts, seeds and green vegetables can promote red cell production. Animal fats are not known to promote red cell production. Organic foods are not necessarily more likely to promote red cell synthesis.

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following? Kidney Large intestine Pancreas Liver

Liver

Which term refers to a form of white blood cell involved in immune response? Granulocyte Lymphocyte Spherocyte Thrombocyte

Lymphocyte Both B and T lymphocytes respond to exposure to antigens. Granulocytes include basophils, neutrophils, and eosinophils. A spherocyte is a red blood cell without central pallor, seen with hemolysis. A thrombocyte is a platelet.

Which term refers to a form of white blood cell involved in immune response? Lymphocyte Spherocyte Granulocyte Thrombocyte

Lymphocyte Both B and T lymphocytes respond to exposure to antigens. Granulocytes include basophils, neutrophils, and eosinophils. A spherocyte is a red blood cell without central pallor, seen with hemolysis. A thrombocyte is a platelet.

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

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.

A client was admitted to the hospital with a pathologic pelvic fracture. The client informs the nurse that he has been having a strange pain in the pelvic area for a couple of weeks that was getting worse with activity prior to the fracture. What does the nurse suspect may be occurring based on these symptoms? Polycythemia vera Leukemia Hemolytic anemia Multiple myeloma

Multiple myeloma The first symptom usually is vague pain in the pelvis, spine, or ribs. As the disease progresses, the pain becomes more severe and localized. The pain intensifies with activity and is relieved by rest. When tumors replace bone marrow, pathologic fractures develop. Hemolytic anemia does not result in pathologic fractures nor does polycythemia vera or leukemia.

Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? Pancytopenia Thrombocytopenia Leukopenia Anemia

Pancytopenia Pancytopenia is defined as an abnormal decrease in WBCs, RBCs, and platelets. The condition may be congenital or acquired. Anemia refers to decreased red cell mass. Leukopenia refers to a less-than-normal amount of WBCs in circulation. Thrombocytopenia refers to a lower-than-normal platelet count.

Clients with multiple myeloma have abnormal plasma cells that proliferate in the bone marrow where they release osteoclast-activating factor, resulting in the formation of osteoclasts. What is the most common complication of the pathology resulting from this process? Increased mobility Calcified bones Osteoporosis Pathologic fractures

Pathologic fractures Osteoclasts are cells that break down and remove bone cells, which results in increased blood calcium and pathologic fractures.

A nurse cares for a client who has had a bone marrow aspiration. In addition to the client's aspiration site, what locations on the body does the nurse recognize as having bone marrow? Select all that apply. Vertebrae Tibia Pelvis Sternum Ribs

Pelvis, Ribs, Vertebrae, Sternum Bone marrow can be found in the pelvis, ribs, vertebrae, and sternum. Additionally, bone marrow is found on the spongy end of the femur and humerus long bones. The tibia does not have bone marrow.

The nurse is assisting the client with multiple myeloma to ambulate. What is the most important nursing intervention to help prevent fractures in the client? Promote safety. Encourage adequate nutrition. Increase mobility. Provide adequate hydration.

Promote safety. Safety is paramount because any injury, no matter how slight, can result in a fracture. Mobility, hydration, and nutrition are important, but will not prevent fractures.

Which of the following is considered an antidote to heparin? Ipecac Vitamin K Narcan Protamine sulfate

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.

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? Bone marrow biopsy Magnetic resonance imaging (MRI) study Bone marrow aspiration Schilling test

Schilling test The classic method of determining the cause of vitamin B12 deficiency is the Schilling test, in which the patient receives a small oral dose of radioactive vitamin B12, followed in a few hours by a large, nonradioactive parenteral dose of vitamin B12 (this aids in renal excretion of the radioactive dose).

An older adult 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. After interpreting the data, what instruction should the nurse give to the client? Ingest a diet higher in vitamin B12 sources. Change the vegetarian diet and begin to eat red meat. Continue with the diet but include more sources of iron. Supplement the diet with vitamin B12.

Supplement the diet with vitamin B12. Data support that the client is experiencing megaloblastic anemia. Findings include the laboratory test results, the client's older age, and the client's status as a vegetarian. Many vegetarians need to supplement their diet with vitamin B12. Eating more foods with vitamin B12 will not provide enough of this vitamin for the client's body. Increasing iron sources will not resolve the client's anemia. Telling the client to discontinue the vegetarian practice and eat red meat is nontherapeutic.

The health care provider believes that the client has a deficiency in the leukocyte responsible for cell-mediated immunity. What should the nurse check the WBC count for? Monocytes Basophils Plasma cells T lymphocytes

T lymphocytes T lymphocytes are responsible for cell-mediated immunity, in which they recognize material as "foreign," acting as a surveillance system.

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? Bleeding The onset of a bacterial infection Abdominal pain Diarrhea

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).

Which medication is the antidote to warfarin? Aspirin Clopidogrel Vitamin K Protamine sulfate

Vitamin K The antidote for warfarin is vitamin K. Protamine sulfate is the antidote for heparin. Aspirin and clopidogrel are both antiplatelet medications.

A young client is diagnosed with a mild form of hemophilia and is experiencing bleeding in the joints with pain. In preparing the client for discharge, what instructions should the nurse provide? Take ibuprofen for joint pain. Take warm baths to lessen pain. Undergo genetic testing and counseling if the client is male. Wear a medical identification bracelet.

Wear a medical identification bracelet. Clients with hemophilia should wear a medical identification bracelet about having this disease. Ibuprofen interferes with platelet aggregation and may increase the client's bleeding. A warm bath may lessen pain but increase bleeding. Genetic testing and counseling are not necessary for male clients, because females are the carriers of the genetic material for hemophilia.

A nurse cares for clients with hematological disorders and notes that women are diagnosed with hemochromatosis at a much lower rate than men. What is the primary reason for this? Women require grater folic acid supplementation Women lose iron through menstrual cycles Women rarely manifest the gene expression Women have lower hemoglobin levels

Women lose iron through menstrual cycles Hemochromatosis is a genetic condition where excess iron is absorbed in the GI tract and deposited in various organs, making them dysfunctional. Women are often less affected than men because women lose excess iron through their menstrual cycles. The other answer choices are not correct reasons why women are impacted less than men with hemochromatosis.

A client with sickle cell anemia has a high hematocrit. low hematocrit. normal blood smear. normal hematocrit.

low hematocrit. A client with sickle cell anemia has a low hematocrit and sickled cells on the smear. A client with sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear.

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: to the bathroom. to a standing position so he can urinate. onto the bedpan. to the bedside commode.

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.

When evaluating a patient's symptoms that are consistent with a diagnosis of leukemia, the nurse is aware that all leukemias have which common feature? Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements Compensatory polycythemia stimulated by thrombocytopenia Increased blood viscosity, resulting from an overproduction of white cells Reduced plasma volume in response to a reduced production of cellular elements

Unregulated accumulation of white cells in the bone marrow, which replace normal marrow The term leukemia means "white blood," which is used to describe the neoplastic proliferation of one hematopoietic cell type (granulocytes, monocytes, lymphocytes, and sometimes, erythrocytes and megakaryocytes).

A client with sepsis is experiencing disseminated intravascular coagulation (DIC). The client is bleeding from mucous membranes, venipuncture sites, and the rectum. Blood is present in the urine. The nurse establishes the nursing diagnosis of Risk for deficient fluid volume related to bleeding. The most appropriate and measurable outcome for this client is that the client exhibits Stable level of consciousness Systolic blood pressure greater than 70 mm Hg Decreased bleeding Urine output greater than or equal to 30 mL/hour

Urine output greater than or equal to 30 mL/hour All options could be expected outcomes for a nursing diagnosis of risk for deficient fluid volume. However, the key words are most appropriate and measurable. That would be the option relating to urine output, which is the most direct measurement listed of fluid volume.

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. Plan for frequent periods of rest. Avoid contact with family/friends who are sick. Encourage frequent handwashing.

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.

A client is seen in the emergency department with severe pain related to a sickle cell crisis. What does the nurse understand is occurring with this client? Overhydration enlarges the red blood cells. The client has a decreased tolerance of pain related to the chronic nature of the illness. Bone marrow decreases the erythrocyte production causing decrease in hypoxia. Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.

Vascular occlusion in small vessels decreasing blood and oxygen to the tissues. The person with sickle cell disease repeatedly suffers from two major problems: (1) episodes of sickle cell crisis from vascular occlusion, which develops rapidly under hypoxic conditions, and (2) chronic hemolytic anemia. During a sickle cell crisis, the sickle-shaped cells lodge in small blood vessels, where they block the flow of blood and oxygen to the affected tissue. The vascular occlusion induces severe pain in the ischemic tissue. The client may have increased tolerance for pain due to the chronic nature of the illness. Bone marrow increases the erythrocyte production. Underhydration increases the client's risk of developing a vaso-occlusive crisis.

An older adult client is to receive 2 units of packed red blood cells. During the transfusion of the first unit at 125 mL/hour, the client reports shortness of breath 30 minutes into the process. The client exhibits the vital signs shown in the accompanying table. What is the nurse's best intervention? administer oxygen through nasal cannula at 2 L/minute slow the rate of the transfusion and obtain an order for furosemide obtain blood and urine specimens for a transfusion reaction contact the health care provider and obtain an order for diphenhydramine (Benadryl)

slow the rate of the transfusion and obtain an order for furosemide The description is consistent with a client who is experiencing circulatory overload. The nurse is to slow the rate of the transfusion and administer a diuretic. Oxygen is administered with a prescription and for severe dyspnea. This option does not allow for the nurse to slow the transfusion. The nurse would still be administering the blood at the current rate of 125 mL/hour. Diphenhydramine (Benadryl) would be prescribed for an allergic reaction. Blood and urine specimens are obtained for acute hemolytic reactions.

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? ECG chest radiograph antibiotic CBC

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.

Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents? Hyperchromic Hypochromic Microcytic Normocytic

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 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? "Eat larger amounts of bland, soft foods less frequently." "Eat low-fiber blended foods only." "Eat cold, bland foods with a large amount of water." "Eat small amounts of bland, soft foods frequently."

"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.

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? "I have difficulty breathing when walking 30 feet." "I have an increase in my appetite." "I feel hot all of the time." "I have a difficult time falling asleep at night."

"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 fatigued and able to sleep often with a decrease in appetite, not an increase.

A patient will need a blood transfusion for the replacement of blood loss from the gastrointestinal tract. The patient states, "That stuff isn't safe!" What is the best response from the nurse? "The blood is carefully screened, so there is no possibility of you contracting any illness or disease from the blood." "You will have to decide if refusing the blood transfusion is worth the risk to your health." "I understand your concern. The blood is carefully screened but is not completely risk free." "I agree that you should be concerned with the safety of the blood, but it is important that you have this transfusion."

"I understand your concern. The blood is carefully screened but is not completely risk free." Despite advances in donor screening and blood testing, certain diseases can still be transmitted by transfusion of blood components (Chart 32-4).

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy? "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear." "I will receive parenteral vitamin B12 therapy for the rest of my life." "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal."

"I will receive parenteral vitamin B12 therapy for the rest of my life." Because a client with pernicious anemia lacks intrinsic factor, oral vitamin B12 can't be absorbed. Therefore, parenteral vitamin B12 therapy is recommended and required for life.

A client with anemia is prescribed an oral iron supplement. Which statement indicates that teaching about this supplement has been effective? "I will limit my intake of raw fruit and vegetables." "I will stop taking it if my stool turns black." "I will take it in the morning with orange juice." "I will be sure to take this medication with food."

"I will take it in the morning with orange juice." The client should be instructed to take the iron supplements on an empty stomach with a source of vitamin C such as orange juice. Iron supplements will turn the stool dark or black; this does not indicate that the supplement should be stopped. The supplement should be taken 1 hour before meals or 2 hours after a meal and not with a meal. The client should be instructed to increase the intake of high-fiber foods to reduce the risk of constipation.

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? "I'll eat four servings of fresh, dark green vegetables every day." "I'll watch my gums for bleeding when I brush my teeth." "I'll report unexplained or severe bruising to my doctor right away." "I'll use an electric razor to shave."

"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 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.

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A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the health care provider immediately because the client probably is experiencing which problem? A hemolytic reaction to mismatched blood A hemolytic reaction to Rh-incompatible blood A hemolytic allergic reaction caused by an antigen reaction A hemolytic reaction caused by bacterial contamination of donor blood

A hemolytic allergic reaction caused by an antigen reaction Hemolytic allergic reactions are fairly common and may cause chills, fever, urticaria, tachycardia, dyspnea, chest pain, hypotension, and other signs of anaphylaxis a few minutes after blood transfusion begins. Although rare, a hemolytic reaction to mismatched blood can occur, triggering a more severe reaction and, possibly, leading to disseminated intravascular coagulation. A hemolytic reaction to Rh-incompatible blood is less severe and occurs several days to 2 weeks after the transfusion. Bacterial contamination of donor blood causes a high fever, nausea, vomiting, diarrhea, abdominal cramps and, possibly, shock.

A client is hospitalized 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin at home, which is now discontinued. To prevent the formation of blood clots, which action should the nurse take? Monitor partial thromboplastin (PTT) time. Encourage a diet high in vitamin K. Administer the prescribed enoxaparin (Lovenox). Have the client limit physical activity.

Administer the prescribed enoxaparin (Lovenox). Clients who are prescribed warfarin at home and need to have a major invasive procedure stop taking warfarin prior to the procedure. Low molecular weight heparin, such as enoxaparin, may be used until the procedure is performed. The client will continue with a diet that has a daily consistent amount of vitamin K. The client needs to ambulate frequently throughout the day. Prothrombin (PT) time is monitored, not PTT, when warfarin had been administered.

A client being treated for iron deficiency anemia with ferrous sulfate continues to be anemic despite treatment. The nurse should assess the client for use of which medication? Tegretol Aluminum hydroxide Amoxicillin Prednisone

Aluminum hydroxide The nurse should assess the client for possible use of antacids such as aluminum hydroxide. Clients should take ferrous sulfate and an antacid at least 2 hours apart because antacids bind with iron in the GI tract, decreasing the rate or extent of iron absorption.

The registered nurse (RN) and licensed practical nurse (LPN) are preparing an educational program for clients who may be at risk for the development of iron-deficiency anemia. Which client(s) would receive the greatest benefit from this program? Select all that apply. An adolescent with bulimia nervosa An older adult client on a fixed income A client who is a vegetarian A client with Crohn's disease A client who lives in a nursing home

An adolescent with bulimia nervosa An older adult client on a fixed income A client with Crohn's disease Those who consume a healthy diet absorb less than 10% of the iron in food. Clients whose nutrition is compromised by unhealthy dieting or who cannot afford to eat a healthy diet, lack knowledge about nutrition, or have malabsorption disorders are at great risk for iron-deficiency anemia. An adolescent client with bulimia nervosa has an unhealthy diet. An older adult client on a fixed income may not have the funds to eat a healthy diet. A client with Crohn's disease has a malabsorption syndrome. A client who resides in a nursing home has prepared meals as well as available supplements if required. A client who is a vegetarian is still able to receive ample iron supplementation in the vegetables being eaten.

The physician performs a bone marrow biopsy from the posterior iliac crest on a client with pancytopenia. What intervention should the nurse perform after the procedure? Pack the wound with half-inch sterile gauze Apply pressure over the site for 5-7 minutes Elevate the head of the bed to 45 degrees Administer a topical analgesic to control pain at the site

Apply pressure over the site for 5-7 minutes Hazards of either bone marrow aspiration or biopsy include bleeding and infection. The risk of bleeding is somewhat increased if the client's platelet count is low or if the client has been taking a medication (e.g., aspirin) that alters platelet function. After the marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing.

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process due to thrombocytopenia in a client with leukemia? Eliminating direct contact with others who are infectious Applying prolonged pressure to needle sites or other sources of external bleeding Implementing neutropenic precautions Monitoring temperature at least once per shift

Applying prolonged pressure to needle sites or other sources of external bleeding The interventions for a client with thrombocytopenia are the same as those for a client with cancer who is at risk for 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 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. Ask if taking a blood pressure has ever produced pain in the upper arm. Ask if taking a blood pressure has ever caused bruising in the hand and wrist. Ask if taking a blood pressure has ever produced the need for medication.

Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints. Due to the client's enhanced risk for bleeding, before taking a blood pressure, the nurse asks the client if the use of a blood-pressure cuff has ever produced bleeding under the skin or in the arm joints.

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? Berries and orange vegetables Fruits high in vitamin C, such as oranges and grapefruits Beans, dried fruits, and leafy, green vegetables Dairy products

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.

A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from? Select all that apply. Inadequate formed white blood cells Abnormal erythrocyte production Destruction of normally formed red blood cells Infection Blood loss

Blood loss, abnormal erythrocyte production, destruction of normally formed red blood cells Most anemias result from (1) blood loss, (2) inadequate or abnormal erythrocyte production, or (3) destruction of normally formed red blood cells. The most common types include hypovolemic anemia, iron-deficiency anemia, pernicious anemia, folic acid deficiency anemia, sickle cell anemia, and hemolytic anemias. Although each form of anemia has unique manifestations, all share a common core of symptoms. Anemia does not result from infection or inadequate formed white blood cells.

Which is a symptom of hemochromatosis? Weight gain Inflammation of the tongue Bronzing of the skin Inflammation of the mouth

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 with multiple myeloma reports pain along the spinal column. The client is prescribed naproxen (Aleve) and oxycodone. Prior to administering these medications, the nurse Teaches the client to bend at the back when lifting objects Checks the client's BUN and creatinine Instructs the client not to lift more than 20 pounds Questions the physician about the use of both medications

Checks the client's BUN and creatinine Naproxen may cause renal dysfunction. It will be important to check and monitor the BUN and creatinine levels, which are indicators of renal function. Because of the disease, the client is not to lift more than 10 pounds and is to use correct body mechanics, by bending with the knees and not bending with the back. Both naproxen and oxycodone may be prescribed for bone pain for a client who has multiple myeloma.

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. What is the most important action for the nurse to take? Increase the heparin infusion by 100 units per hour. Begin treatment with the prescribed warfarin (Coumadin). Consult with the physician about discontinuing heparin. Continue with the present infusion rate of heparin.

Consult with the physician about discontinuing heparin. Platelet counts may decrease with heparin therapy, and this client's platelet count has decreased. The client may have heparin-induced thrombocytopenia (HIT). Treatment of HIT includes discontinuing the heparin. The question asks about the most important action of the nurse and that is to consult with the physician about discontinuing heparin therapy. The nurse may continue with the current rate and should not increase the heparin dose until consulting with the physician. Warfarin is not administered until the platelet count has returned to normal levels.

The nurse is caring for a client with external bleeding. What is the nurse's priority intervention? Pressure point control Direct pressure Application of a tourniquet Elevation of the extremity

Direct pressure Applying direct pressure to an injury is the initial step in controlling bleeding. Elevation reduces the force of flow, but direct pressure is the first step. The nurse may use pressure point control for severe or arterial bleeding. Pressure points (those areas where large blood vessels can be compressed against bone) include femoral, brachial, facial, carotid, and temporal artery sites. The nurse should avoid applying a tourniquet unless all other measures have failed, because it may further damage the injured extremity.

A client with multiple myeloma is complaining about pain. What instructions will the nurse give the client to help to reduce pain during activity? Stay in bed as much as possible. Do not lift more than 10 pounds. Limit fluids to prevent going to the bathroom. Limit activity to once a day.

Do not lift more than 10 pounds. The client with multiple myeloma needs education about activity instructions, such as lifting no more than 10 pounds and using proper body mechanics. Braces may be needed. The client should be active and would not be instructed to stay in bed or limit activity, as he or she would become very stiff. Limiting fluids would be contraindicated; the client needs to remain well hydrated.

A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia? Nights sweats, weight loss, and diarrhea Itching, rash, and jaundice Nausea, vomiting, and anorexia Dyspnea, tachycardia, and pallor

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.

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? Clustering of platelets with sickled red blood cells An increased number of erythrocytes Erythrocytes that are microcytic and hypochromic Erythrocytes that are macrocytic and hyperchromic

Erythrocytes that are microcytic and hypochromic A blood smear reveals erythrocytes that are microcytic (smaller than normal) and hypochromic (lighter in color than normal). It does not reveal macrocytic (larger than normal) or hyperchromic erythrocytes. Clustering of platelets with sickled red blood cells would indicate sickle cell anemia. An increase in the number of erythrocytes would indicate polycythemia vera.

When assessing a female client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential? Lifestyle assessments, such as exercise routines Health history, such as bleeding, fatigue, or fainting Age and gender Menstrual history

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.

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? Blood transfusion reaction Shock Hemorrhage Splintering of bone fragments

Hemorrhage Hazards of either bone marrow aspiration or biopsy include bleeding and infection. The risk of bleeding is somewhat increased if the patient's platelet count is low or if the patient has been taking a medication (e.g., aspirin) that alters platelet function.

A client is scheduled for surgery to remove an abdominal mass. The nurse knows that which reason hemodilution would be contraindicated as a method to provide blood to the client during the surgery? Takes medications for seasonal allergies Treatment for osteoarthritis History of renal disease Previous thyroidectomy

History of renal disease Hemodilution is the removal of 1 to 2 units of blood after induction of anesthesia and replaced with a colloid or crystalloid solution. The blood is then reinfused after the surgery. The purpose of this approach is to reduce the amount of erythrocytes lost during the surgery because the intravenous fluids dilute the concentration of red blood cells and lowers the hematocrit. Hemodilution has been linked to tissue ischemia in the kidneys and would be contraindicated in the client with a history of renal disease. Hemodilution would not be contraindicated for a previous thyroidectomy, treatment for osteoarthritis, or medication used to treat seasonal allergies.

A nurse is caring for a client with a history of GI bleeding, sickle cell anemia, and a platelet count of 22,000/μl. The client, who is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hour, complains of severe bone pain and is scheduled to receive a dose of morphine sulfate. For which administration route should the nurse question an order? Subcutaneous (subQ) Oral I.M. I.V.

I.M. A client with a platelet count salineof 22,000/μl bleeds easily. The nurse should avoid using the I.M. route because the area is highly vascular. The client may bleed readily when penetrated by a needle, and it may be difficult for the nurse to stop the bleeding. The client's existing I.V. access would be the best route, especially because I.V. morphine is effective almost immediately. Oral and subQ routes are preferred over I.M., but they're less effective for acute pain management than I.V.

A nurse provides nutritional information for a patient diagnosed with an iron-deficiency anemia. What education should the nurse provide? Decrease the intake of citrus fruits because they interfere with iron absorption. Increase the intake of green, leafy vegetables. Take an iron supplement with meals to reduce gastric irritation. Decrease the intake of high-fat red meats, especially organ meats.

Increase the intake of green, leafy vegetables. Leafy greens, such as spinach, kale, swiss chard, collard and beet greens contain between 2.5-6.4 mg of iron per cooked cup. Clients should be encouraged to consume more green, leafy vegetables. Red meats, especially organ meats, are iron-rich foods and the client should not be discouraged from eating them. Vitamin C sources (citrus fruit and juices) enhance the absorption of iron, which should be taken 1 hour before or 2 hours after a meal.

A client is receiving chemotherapy for cancer. 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 Impaired oral mucous membranes Impaired tissue integrity Activity intolerance

Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI These are all appropriate nursing diagnoses for the client with thrombocytopenia. However, the risk of cerebral and GI hemorrhage and hypotension pose the greatest risk to the physiological integrity of the client.

The nurse should notify the healthcare provider before administering fresh frozen plasma (FFP) based on which assessment finding? Jugular venous distention Strong pedal pulses Absence of tenting skin turgor White sclera

Jugular venous distention During the pre-transfusion assessment, the nurse should carefully inspect for any signs of cardiac failure, such as jugular venous distention. The sclera should be examined for icterus; white is an expected finding. Weak pedal pulses would be a sign of cardiac failure. Tenting skin turgor is a sign of dehydration; low vascular volume would be a cause for transfusion, not a contraindication.

A client in acute renal failure has been prescribed 2 units of packed red blood cells (PRBCs). The nurse explains to the client that the blood transfusion is most likely needed for which reason? Preparation for likely nephrectomy Hypervolemia Lack of erythropoietin Increases the effectiveness of dialysis

Lack of erythropoietin The kidneys produce erythropoietin, a hormone that stimulates red blood cell production. A lack of this hormone is the most likely reason for blood transfusion due to the acute kidney failure. There is no indication for a nephrectomy in this question. A blood transfusion will not necessarily increase the effectiveness of dialysis. Transfusing a client with hypervolemia could lead to circulatory overload.

Which blood cell type is matched correctly with its function? T lymphocyte: Humoral immunity B lymphocyte: Secretes immunoglobulin Plasma cell: Cell-mediated immunity Leukocyte: Fights infection

Leukocyte: Fights infection Various blood cell types have unique, major functions. Leukocytes fight infection, T lymphocytes are integral in cell-mediated immunity, plasma cells secrete immunoglobulin, and B lymphocytes are integral in humoral immunity.

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? Monitoring the client's breathing and reviewing the client's arterial blood gases Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential Monitoring the client's blood pressure and reviewing the client's hematocrit Monitoring the client's heart rate and reviewing the client's hemoglobin

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.

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? Monocyte Neutrophil Lymphoid stem cell Myeloid stem cell

Myeloid stem cell Myeloid stem cells are responsible not only for all nonlymphoid white blood cells (WBC) but also for the production of red blood cells and platelets. Lymphoid cells produce either T or B lymphocytes. A monocyte is large WBC that becomes a macrophage when is leaves the circulation and moves into body tissues, and not responsible for RBC production. A neutrophil is a fully mature WBC capable of phagocytosis and not responsible for RBC production.

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? Loss of vibratory and position senses Severity of the disease Insufficient intake of dietary nutrients Neurologic involvement

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.

The nurse, caring for a client in the emergency room with a severe nosebleed, becomes concerned when the client asks for a bedpan. The nurse documents the stool as loose, tarry, and black looking. The nurse suspects the client may have thrombocytopenia. What should be the nurse's priority action? Ask someone to clean the bedpan Put in an IV line Stop the nosebleed Notify the physician

Notify the physician Thrombocytopenia is evidenced by purpura, small hemorrhages in the skin, mucous membranes, or subcutaneous tissues. Bleeding from other parts of the body, such as the nose, oral mucous membrane, and the gastrointestinal tract, also occurs. Internal hemorrhage, which can be severe and even fatal, is possible. This nurse should notify the physician of the suspected disorder.

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? Inform the client that the bath and positioning is an important part of client care and will be done right after pain medication administration. Inform the client that she will feel better after receiving a bath and clean sheets. Inform the client that the position must be changed, and then you will give her pain medication and omit the bath. Obtain the pain medication and delay the bath and position change until the medication reaches its peak.

Obtain the pain medication and delay the bath and position change until the medication reaches its peak. When pain is severe, the nurse delays position changes and bathing until an administered analgesic has reached its peak concentration level and the client is experiencing maximum pain relief. Pain medication should never be delayed to assist in the control of the level of pain. Pain will not be relieved by a bath and clean sheets, only analgesics at this point in the client's illness.

The nurse is working at a blood donation clinic. What teaching should the nurse provide to the donor immediately after blood donation? Sit up promptly after the needle is removed. Remove the band-aid after 5 minutes. Hold the involved arm below the heart. Remain for observation after eating and drinking.

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.

A client has hereditary hemochromatosis. Laboratory test results indicate an elevated serum iron level, high transferrin saturation, and normal complete blood count (CBC). What is most important action for the nurse to take? Remove the prescribed one unit of blood. Educate about precautions to follow after a liver biopsy. Inform the client to limit ingestion of alcohol. Instruct the client to limit iron intake in the diet.

Remove the prescribed one unit of blood. Treatment for hemochromatosis is phlebotomy or removal of whole blood from a vein to reduce iron. Limiting dietary intake of iron is not an effective treatment. The client needs to perform activities to protect the liver, such as limiting alcohol ingestion. The definitive test for hemochromatosis had been a liver biopsy, but now genetic testing is performed. A liver biopsy could be performed to determine liver damage. However, this does not address the most immediate problem of too high iron.

The nurse is screening donors for blood donation. Which client is an acceptable donor for blood? Received a blood transfusion within 1 year Had a dental extraction 2 days ago for caries in a tooth Has a history of viral hepatitis as a teenager 10 years ago Reports having a cold 1 month ago that resolved quickly

Reports having a cold 1 month ago that resolved quickly Donors must meet certain requirements to be able to donate blood. A client should be in good health, such as the client who had a cold more than 1 month ago that resolved quickly. Those excluded from donating blood have a history of viral hepatitis, report a blood transfusion within 12 months, and had a dental extraction within 72 hours. The reason for exclusion is that they are at increased risk of transmitting an infectious disease.

A nurse is caring for a client with thalassemia who is being transfused. What is the nurse's role during a transfusion? To administer vitamin B12 injections To assess for enlargement and tenderness over the liver and spleen To closely monitor the rate of administration To instruct the client to rest immediately if chest pain develops

To closely monitor the rate of administration In a client with thalassemia, when transfusions are necessary, the nurse closely monitors the rate of administration. Assessing for enlargement and tenderness over the liver and spleen, advising rest, or administering vitamin B12 injections are not indicated for thalassemia.

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? To detect the motor strength and stroke-related signs and symptoms To detect the evidence of dehydration that might have triggered a sickle cell crisis To detect the abnormal sounds suggestive of acute chest syndrome and heart failure To detect the evidence of infection such as fever and tachycardia

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.