Pathophysiology Chapter 10: Blood and Lymphatic Disorders
A client has been diagnosed with anemia. Which decreased hormone level may be the cause?
Bradykinin Prostaglandin # Erythropoietin Activated vitamin D ----------------------------------------------------------------- Erythropoietin stimulates the production of red blood cells (RBCs) in the bone marrow. Deficiency of erythropoietin causes a decrease in RBCs, thereby resulting in anemia. Bradykinin increases blood flow and vascular permeability. Prostaglandins regulate kidney perfusion. Activated vitamin D promotes the absorption of calcium in the gastrointestinal (GI) tract.
The nurse is caring for some clients with chronic anemia who are on blood transfusion therapy. The nurse notices that one of the clients requires immediate treatment. Which client is the nurse addressing in this situation?
Client with itching Client with flushing Client with pruritus # Client with wheezing ----------------------------------------------------------------- Wheezing indicates anaphylactic and allergic reactions in the client who is on blood transfusion therapy. Therefore the client with wheezing should be treated first. Itching, flushing, and pruritus indicate a mild allergic reaction. Clients with itching, flushing, and pruritus can be treated after treating the client with wheezing symptoms.
A client had part of the ileum surgically removed. The nurse monitors the client closely for anemia. What is the rationale for the nurse's action?
Folic acid is absorbed in the ileum. # Cobalamin is absorbed in the ileum. Iron absorption is dependent on simultaneous bile salt absorption in the ileum. Copper, cobalt, and nickel are dependent on simultaneous bile salt absorption in the ileum. ----------------------------------------------------------------- Vitamin B12 (cobalamin) combines with intrinsic factor, a substance secreted by the parietal cells of the gastric mucosa, and is absorbed in the ileum. Cobalamin is needed to make red blood cells. Folic acid and iron are not absorbed. Copper, cobalt, and nickel are not absorbed in the ileum.
A nurse is caring for a client with a diagnosis of polycythemia vera. The client asks, "Why do I have an increased tendency to develop blood clots?" Which effect of the polycythemia vera should the nurse include in the teaching session?
Elevated blood pressure # Increased blood viscosity Fragility of the blood cells Immaturity of red blood cells ----------------------------------------------------------------- Polycythemia vera results in pathologically high concentrations of erythrocytes in the blood; increased viscosity promotes thrombus formation. Hypertension usually is related to narrowing or sclerosing of arteries, not to an increased number of blood cells. The fragility of blood cells does not affect the viscosity of the blood. Erythrocyte immaturity is not related to increased viscosity.
A nurse is reviewing the health history and laboratory results of a school-aged child admitted to the pediatric unit with acute nonlymphoid leukemia (acute myeloid leukemia). What clinical findings does the nurse expect? Select all that apply.
Oliguria # Listlessness Few stem cells Difficulty swallowing # Bone marrow depression ----------------------------------------------------------------- Listlessness in a child with leukemia is caused by anemia; anemia is expected in children with leukemia because of generalized bone marrow depression. Depressed bone marrow production of formed elements of blood is characteristic of nonlymphoid leukemia; it leads to neutropenia and increases susceptibility to infection. Urine output will be within expected limits; there is no kidney involvement at this stage of the disease. There are more, not fewer, stem cells in the peripheral blood and bone marrow; the production of mature blood cells is depressed. The swallowing reflex is not
Polycythemia is frequently associated with chronic obstructive pulmonary disease (COPD). Which should the nurse monitor for when assessing for this complication?
Pallor and cyanosis Dyspnea on exertion # Elevated hemoglobin Decreased hematocrit ----------------------------------------------------------------- The body attempts to compensate for decreased oxygen to tissues by increasing the number of blood cells, the oxygen-carrying component of the blood. With polycythemia, the skin, especially the face, appears flushed, not pale. Dyspnea on exertion is not specific to polycythemia; there is more than one cause of dyspnea on exertion. The hematocrit is increased with polycythemia.
When discussing the therapeutic regimen of vitamin B12 for pernicious anemia with a client, what teaching does the nurse provide?
Weekly Z-track injections provide needed control. Daily intramuscular injections are required for control. # Intramuscular injections once a month will maintain control. Oral vitamin B12 tablets taken daily will provide symptom control. ----------------------------------------------------------------- Intramuscular injections bypass the vitamin B12 absorption defect (lack of intrinsic factor, the transport carrier component of gastric juices). A monthly dose usually is sufficient because it is stored in active body tissues, such as the liver, kidney, heart, muscles, blood, and bone marrow. The Z-track method need not be used as it is for iron dextran injections. Because it is stored and only slowly depleted, injections once a month usually are sufficient. Vitamin B12 cannot be taken by mouth because of the lack of intrinsic factor
A 2-year-old child is admitted to the pediatric unit with a diagnosis of thalassemia major (Cooley anemia). The parents are told that there is no cure, but the anemia can be treated with frequent blood transfusions. The father tells the nurse he is glad that there is a treatment that "fixes" his child's problem. Before responding, the nurse should recall that blood transfusions do what?
# The anemia, but may cause other problems Reverse the anemia, but also present a risk of hepatitis Are a supportive treatment; fewer will be needed as the child grows older Are a replacement for defective red blood cells; they are like giving insulin to a person with diabetes ----------------------------------------------------------------- Excess iron from hemolysis of the replaced red blood cells is deposited in the organs and body tissue, causing hemosiderosis. Chelation therapy is then required. With the practice of aseptic technique and screening of donated blood, hepatitis should not occur. Red blood cell replacement depends on the child's hematologic picture; the number of transfusions is not related to age. Although red blood cells are replaced, it is erroneous to compare this treatment with insulin therapy.
What medication does a nurse expect to administer to control bleeding in a child with hemophilia A?
Albumin Fresh frozen plasma # Factor VIII concentrate Factors II, VII, IX, X complex ----------------------------------------------------------------- Factor VIII is the missing plasma component necessary to control bleeding in a child with hemophilia A. Factor VIII is not provided by albumin. Although fresh frozen plasma does contain factor VIII, there is an insufficient amount in a plasma transfusion; a higher volume is required. A complex of factors II, VII, IX, and X is not useful in this situation. STUDY TIP: A helpful method for decreasing test stress is to practice self-affirmation. After you have adequately studied and really know the material, start looking in the mirror each time you pass one and say to yourself—preferably out loud—"I know this material, and I will do well on the test." After several times of watching and hearing yourself reaffirm your knowledge, you will gain inner confidence and be able to perform much better during the test period. This technique really works for students who are adventurous enough to use it. It may feel silly at first, but if it works, who cares? It will work for performing skills in clinical as well, as long as you have practiced the skill sufficiently.
A 10-year-old child is found to have hemophilia. The nurse is explaining how hemophilia is inherited. What is the best explanation of the genetic factor that is involved?
It follows the Mendelian law of inherited disorders. # The mother is a carrier of the disorder but is not affected by it. It is an autosomal dominant disorder in which the woman carries the trait. A carrier may be male or female, but the disease occurs in the sex opposite that of the carrier. ----------------------------------------------------------------- The hemophilia gene is carried on the X chromosome but is recessive. Therefore the female is the carrier (an unaffected XO and an affected XH). If the male receives the affected XH (XHYO), he will have the disorder. Hemophilia is carried by the female; the Mendelian laws of inheritance are not sex specific. Hemophilia is a sex-linked recessive disorder. Females only carry the trait; usually males are affected.
A nurse is teaching a pregnant client with sickle cell anemia about the importance of taking supplemental folic acid. How does folic acid help this client?
Lessens sickling of red blood cells Prevents vaso-occlusive crises Decreases cellular oxygen need # Promotes production of hemoglobin ----------------------------------------------------------------- Folic acid is needed to produce heme for hemoglobin. Supplementation with folic acid does not reduce sickling, and it will not prevent vaso-occlusive crisis. Adequate oxygenation and hydration help prevent vaso-occlusive crisis. It does not decrease cellular oxygenation need, although, through production of hemoglobin, it can improve oxygen supply.
A 28-year-old male client is undergoing tests to confirm the diagnosis of Hodgkin lymphoma. The client and his wife are worried that he may have cancer. The wife states, "Don't you think it is unlikely for someone like my husband to have cancer?" The nurse's response is based on what information about Hodgkin lymphoma?
More likely to affect women than men # Diagnosed during adolescence and young adulthood Typically a disease of older rather than younger adults Common among populations of Asian heritage ----------------------------------------------------------------- Hodgkin lymphoma occurs most often between the ages of 15 and 35 years and 50 and 60 years. Hodgkin lymphoma affects younger men and women equally and affects more men than women between the ages of 50 and 60 years. The incidence of Hodgkin lymphoma is not limited to people in older age groups. The prevalence of Hodgkin lymphoma is increased in teenagers and young adults (15 to 35 years of age). Asian populations are less likely to develop Hodgkin lymphoma than other populations.
What should the plan of care include to minimize the potential for a sickling episode in a child with sickle cell anemia?
Providing an iron-rich diet Ensuring hemoconcentration Enforcing periods of quiet play # Promoting adequate oxygenation ----------------------------------------------------------------- Low oxygen tension may precipitate sickling; therefore adequate oxygenation is desirable. Oral intake of iron may contribute to iron overload. Some children with sickle cell anemia receive frequent transfusions to suppress the production of red blood cells containing the sickle hemoglobin. Hemoconcentration results in increased viscosity, which promotes thrombus formation and sickling. Quiet play is desirable during a painful episode, but it is not used routinely to prevent a crisis.
An 11-month-old infant with iron-deficiency anemia is started on an oral iron supplement. What information should the nurse include when teaching the parents about the side effects of iron supplements?
The urine may turn red. The skin will turn yellow. # The teeth may become stained. The stools will take on a clay color. ----------------------------------------------------------------- Liquid oral iron supplements may stain the teeth; brushing the teeth after administration may limit the discoloration. There should be no change in the color of the urine. Yellowing of the skin is a sign of jaundice; it is not a side effect of an iron supplement. The stools will become black-green; clay-colored stools are a sign of biliary obstruction. Test-Taking Tip: On a test day, eat a normal meal before going to school. If the test is late in the morning, take a high-powered snack with you to eat 20 minutes before the examination. The brain works best when it has the glucose necessary for cellular function.
When receiving chemotherapy for non-Hodgkin lymphoma, a client states, "I get so sick to my stomach. The medication is useless." What is the best response by the nurse that uses the technique of paraphrasing?
You get sick to your stomach." "Tell me more about how you feel." "I'll get a prescription for an antiemetic." # "You don't think the medication is helping you." ----------------------------------------------------------------- Rewording of the client's statement is paraphrasing that promotes further verbalization. The response "You get sick to your stomach" is not paraphrasing; this repeats the client's exact words. The response "Tell me more about how you feel" is clarifying, a therapeutic technique; it is not paraphrasing. The response "I'll get a prescription for an antiemetic" is not an interviewing technique; it does not address the theme in the client's statement, and it cuts off communication.
