Unit 5 questions
Ethnic neutropenia
African american naturally have low wbc count
_______ is when blood is taken away from the patient and passed thru a centrifuge where a specific component is separated from the blood and removed.
Apheresis/Plasmapheresis
Neutropenia
Decreased production or increased destruction of neutrophils (<2,000/mm3)
A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia? a) Dyspnea, tachycardia, and pallor b) Nights sweats, weight loss, and diarrhea c) Itching, rash, and jaundice d) Nausea, vomiting, and anorexia
Dyspnea, tachycardia, and pallor Explanation: 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. (less)
A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia?
Dyspnea, tachycardia, and pallor,fatigue,listlessness, headache
A 15-year-old client with hemophilia sustains a leg laceration after falling off of his skateboard and is brought to the emergency department. The laceration is bleeding profusely even with direct pressure to the site. What does the nurse anticipate will be ordered for administration to control bleeding? a) A crystalloid solution such as lactated Ringer's b) Albumin c) Fresh frozen plasma d) A colloid solution such as hetastarch (Hespan)
Fresh frozen plasma Correct Explanation: Treatment includes transfusion of fresh blood, frozen plasma, factor VIII concentrate, and anti-inhibitor coagulant complex for hemophilia A, factor IX concentrate for hemophilia B, factor XI for hemophilia C, and the application of thrombin or fibrin to the bleeding area. Other measures used to help control bleeding are the administration of fresh frozen plasma, aminocaproic acid (Amicar) that helps to hold a clot in place once it has formed, direct pressure over the bleeding site, and cold compresses or ice packs. Hespan, lactated Ringer's, or albumin will not control the bleeding related to hemophilia
Test to measure amount of Hgb S in the blood SCD - 80% or > blood with Hgb S SC Trait - < 40% blood Hgb S
Hgb electrophoresis
Ms. Wilson is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). You are teaching her and her family information about managing her disease. All of the following would be included, except? a) If you have problems with a medication, you may stop it until your next physician visit. b) Pace activities. c) Avoid sunlight and ultraviolet radiation. d) Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing.
If you have problems with a medication, you may stop it until your next physician visit. Correct Explanation: Take medications exactly as directed and do not stop the medication if symptoms are relieved unless advised to do so by the physician. Sunlight tends to exacerbate the disease. Because fatigue is a major issue, allow for adequate rest, along with regular activity to promote mobility and prevent joint stiffness. Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing
When developing a care plan for a client newly diagnosed with scleroderma, which nursing diagnosis has the highest priority? a) Imbalanced nutrition: More than body requirements b) Risk for constipation c) Impaired skin integrity d) Impaired gas exchange
Impaired skin integrity Correct Explanation: Impaired skin integrity is a concern for the client with scleroderma in its earlier stages. Meticulous skin care is required to prevent complications. Although Risk for constipation may also be appropriate, this nursing diagnosis isn't the priority. Clients with scleroderma are at risk for Imbalanced nutrition: Less than body requirements. The client with advanced scleroderma, not newly diagnosed scleroderma, is at increased risk for developing respiratory complications
_______ - produce the hormone erythropoietin (Epogen, Procrit, Aranesp)
Kidneys
Causative agents for G6PD?
Macrodantin, Pyridium, Bactrim
A client with a diagnosis of pernicious anemia comes to the clinic complaining of numbness and tingling in their arms and legs. What do these symptoms indicate? a) Severity of the disease b) Neurologic involvement c) Loss of vibratory and position senses d) Insufficient intake of dietary nutrients
Neurologic involvement Explanation: 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
A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? a) "OA is more common in women. RA is more common in men." b) "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints." c) "OA affects joints on both sides of the body. RA is usually unilateral." d) "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints.
OA is a degenerative arthritis, characterized by the loss of cartilage on the articular surfaces of weight-bearing joints with spur development. RA is characterized by inflammation of synovial membranes and surrounding structures. OA may occur in one hip or knee and not the other, whereas RA commonly affects the same joints bilaterally. RA is more common in women; OA affects both sexes equally
What lab values will you see for a pt with hemophillia
PTT = abnormal; measures the intrinsic arm of the coagulation cascade (the part of the cascade involving Factor VIII & IX). The PTT is abnormal due to lacking factors on this side of the cascade.(25-35)
A client with suspected exposure to HIV has been tested with the enzyme-linked immunosorbent assay with positive results twice. What is the next step for the nurse to explain to the patient for confirmation of the diagnosis? a) Perform a T4-cell count for confirmation of diagnosis. b) Perform a Western blot test for confirmation of diagnosis. c) Perform a polymerase chain reaction test for confirmation of diagnosis. d) Perform the p24 antigen test for confirmation of diagnosis.
Perform a Western blot test for confirmation of diagnosis. Correct Explanation: The enzyme-linked immunosorbent assay (ELISA) test, an initial HIV screening test, is positive when there are sufficient HIV antibodies; it also is positive when there are antibodies from other infectious diseases. The test is repeated if results are positive. If results of a second ELISA test are positive, the Western blot is performed. The p24 antigen test and the polymerase chain reaction test determine the viral load, and the T4-cell count is not used for diagnostic confirmation of the presence of HIV in the blood
Medical management for hemophilia?
Recombinant forms of VIII and X concentrate and sometimes FFP.Analgesics help to alleviate the pain and warm baths aide in relaxation
Foods high in B12 are mostly _______?
animal products
When patient albumin ______, you will see the fluid shift.
decreases
Tx of neutropenia
depends on the cause
What is a splenectomy performed?
done when there is spleenomegaly or destruction of rbcs.
In Megablastic anemia (vit b12 def(pernicious, folic def) you will assess _______?
for jaundice, premature graying of hair in pts with pernicious anemia, tongue soreness
iron, B12, and folic acid deficiencies result in
hypoproliferative anemia
polycythemia
increase hgb and hct. Risk for MI and stoke
Pernicious anemia
is one way a deficiency in vitamin B12 can occur. It is caused by an absence intrinsic factors that help absorb vitamin b12.
A nurse is assessing a client with multiple myeloma. The nurse should keep in mind that clients with multiple myeloma are at risk for
pathologic bone fractures secondary to diffuse osteoporosis and osteolytic lesions. Also, clients are at risk for renal failure secondary to myeloma proteins by causing renal tubular obstruction
Which of the following is considered an antidote to heparin? a) Ipecac b) Narcan c) Vitamin K d) Protamine sulphate
protamine sulphate
When albumin levels are low what is at risk?
risk for imbalanced fluid volume
What is consolidation?
therapy that is administered to eliminate residual leukaemia cells that are not clinically detectable and reduce the chance for recurrence. It is also termed post-remission therapy. It is not a side effect of chemotherapy, but the administration of chemotherapy
Hydoxyurea (Hydrea)
tx for SCD
Schillings test
used to diagnose Pernicious Anemia to assess for the lack of the intrinsic factor 24 hour urine is done after the patient has had a radioactive capsule of vitamin B12 and an IM injection of B12 by a nurse; This procedure is done in nuclear medicine
What is the antidote for warfarin?
vitamin K
A patient with severe anemia is complaining of the following symptoms: tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Lab results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which of the following nursing diagnoses is most appropriate for this patient? a) Fatigue related to decreased hemoglobin and hematocrit b) Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit c) Risk for falls related to complaints of dizziness d) Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients
Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit Explanation: 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 edem
A patient with HIV develops a nonproductive cough, shortness of breath, a fever of 101°F and an O2 saturation of 92%. What infection caused by Pneumocystis jiroveci does the nurse know could occur with this patient? a) Tuberculosis b) Community-acquired pneumonia c) Mycobacterium avium complex (MAC) d) Pneumocystis pneumonia
Pneumocystis pneumonia
What is the antedote for heparin?
Protamine sulfate
A client with HIV will be started on a medication regimen of three medications. Which medication will be given that will interfere with the virus's ability to make a genetic blueprint. What drug will the nurse instruct the client about? a) Integrase inhibitors b) Reverse transcriptase inhibitors c) Protease inhibitor d) Hydroxyurea (Hydrea)
Reverse transcriptase inhibitors Explanation: Reverse transcriptase inhibitors are drugs that interfere with the virus' ability to make a genetic blueprint. A protease inhibitor is a drug that inhibits the ability of virus particles to leave the host cell. The integrase inhibitors are a class of drug that prevents the incorporation of viral DNA into the host cell's DNA. Hydrea is a drug that is used as an adjunct therapy that tries to halt the progression of AIDS.
The client comes to the clinic to obtain the results from the test to determine if he is infected with HIV. The physician informs the client that he has a CD4 cell count of 300 cells/mm3 and a high viral load. What does the nurse anticipate the physician will discuss with the client? a) The initiation of antibiotic therapy to prevent the development of an opportunistic infection b) The administration of an antifungal medication to prevent the development of an opportunistic fungal infection c) Retroviral therapy is not warranted at this time. d) The initiation of antiretroviral therapy
he initiation of antiretroviral therapy Explanation: Based on randomized trials, nonrandomized trials, and observational studies, the current guideline is to initiate treatment if the client has a CD4 T-cell count less than 350 to 500 cells/mm3,whereas others will begin treatment with a CD4 cell count over 500 cells/mm3 based on expert opinions. Prophylactic antibiotic and antifungal drug therapy is not warranted at this time and can cause drug resistance strains to emerge. (