Anemia PrepU
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 the bedside commode. onto the bedpan. to a standing position so he can urinate.
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.
A client with sickle cell anemia has a low hematocrit. high hematocrit. normal hematocrit. normal blood smear.
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. (hematocrit is the volume of blood to fluid or whatever)
After receiving chemotherapy for lung cancer, a client's platelet count falls to 20 x109L. What term should the nurse use to describe this low platelet count? Anemia Leukopenia Thrombocytopenia Neutropenia
A normal platelet count is 150-400 x 10/3 L in adults. Chemotherapeutic agents produce bone marrow depression, resulting in reduced red blood cell counts (anemia), reduced white blood cell counts (leukopenia), and reduced platelet counts (thrombocytopenia). Neutropenia is the presence of an abnormally reduced number of neutrophils in the blood and is caused by bone marrow depression induced by chemotherapeutic agents.
Adverse effects of epoetin and darbepoetin include increased risks of what condition? Hyperlipidemia Diabetes mellitus type 2 Myocardial infarction Cirrhosis of the liver
Adverse effects of epoetin and darbepoetin include increased risks of hypertension, myocardial infarction, and stroke, especially when used to increase hemoglobin above 12 g/dL.
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 until my vitamin B12 level returns to normal." "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." "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 5-year-old boy is diagnosed with congenital aplastic anemia. Which symptoms should be considered when developing the plan of care? Select all that apply. Pallor Fatigue Easy bruising Cyanosis Bradycardia Bradypnea
Correct response: Pallor Fatigue Easy bruising Cyanosis When symptoms begin, a child appears pale, fatigues easily, and has anorexia from the lowered RBC count and tissue hypoxia. Because of reduced platelet formation (thrombocytopenia), the child bruises easily or develops petechiae (pinpoint, macular, purplish-red spots caused by intradermal or submucous hemorrhage). A child may have excessive nosebleeds or gastrointestinal bleeding. As a result of a decrease in WBCs (neutropenia) a child may contract an increased number of infections and respond poorly to antibiotic therapy. Observe closely for signs of cardiac decompensation such as tachycardia (not bradycardia), tachypnea (not bradypnea), shortness of breath, or cyanosis from the long-term increased workload of all these effects on the heart.
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. Iron may cause indigestion and should be taken with an antacid such as Mylanta. Dilute the liquid preparation with another liquid such as juice and drink with a straw. Discontinue the use of iron if your stool turns black.
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.
A patient has been prescribed epoetin alfa. The nurse recognizes that this medication is indicated for treatment of anemia associated with which disease process? Lung failure Heart failure Renal failure Liver failure
Epoetin alfa acts like the natural glycoprotein erythropoietin to stimulate the production of red blood cells (RBCs) in the bone marrow. It is often used in the treatment of anemia related to renal failure.
A patient is to be administered an erythropoiesis-stimulating agent. Which of the following drugs would the nurse administer? Ferrous sulfate Epoetin alfa Folic acid Hydroxyurea
Epoetin alfa is an erythropoesis-stimulating agent. Ferrous sulfate is used in the treatment of iron-deficiency anemia. Megaloblastic anemia is treated with folic acid. Hydroxyurea is used in the treatment of sickle-cell anemia.
Folic acid is necessary for cell growth and maintenance of the myelin sheath. True False
Folic acid is necessary for cell growth and development; vitamin B12 is necessary for maintenance of the myelin sheath.
The provider notes that the client's hemaglobin is 8.2 g/dL (82 g/L). Which supplement will the provider recommend to the client? Ferrous sulfate Magnesium oxide Potassium chloride Calcium carbonate
Iron deficiency is a common, worldwide cause of anemia affecting people of all ages. The treatment of iron deficiency anemia in children and adults is directed toward controlling chronic blood loss, increasing dietary intake of iron, and administering supplemental iron. Ferrous sulfate is the usual oral replacement therapy.
A 9-month-old infant with iron-deficiency anemia is given ferrous sulfate therapy. Which assessment would best help the nurse determine that the infant is actually taking it daily? The reticulocyte count will have decreased. The infant will develop diarrhea. The stools will appear black. The infatn will be more irritable than at the last visit.
Oral iron supplements are dark in color because the iron is pigmented. As a result of digestion of this pigment, the stools of an infant taking iron will be dark to black. Taking iron supplemnts will cause constipation, not diarrhea. After treatment with iron, the reticulocyte count should increased, not decreased. Children with iron deficiency are tired and many times irritable. With correction of the deficiency, the infant should be less irritable and have more energy.
A client tells the nurse that the doctor told her she has too many red blood cells accompanied by elevated white cells and platelet counts. The nurse recognizes this as: Polycythemia vera Pernicious anemia Aplastic anemia Hemolytic anemia
Polycythemia vera is a neoplastic disease of the pluripotent cells of the bone marrow characterized by an absolute increase in total red blood cell (RBC) mass accompanied by elevated white cell and platelet counts. In pernicious anemia, the RBCs are not high in number but are larger in size. In aplastic and hemolytic anemia, there is a small number of RBCs.
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 Dyspnea, tachycardia, and pallor Nausea, vomiting, and anorexia Itching, rash, and jaundice
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.
A client with severe chronic anemia is receiving ongoing transfusion therapy. The nurse frequently assesses the client for what major complication of this therapy? Toxic iron overload Fibrin clots Chronic idiopathic thrombocytic purpura Vaso-occlusive crisis
The major complication of an ongoing transfusion therapy program is the development of toxic iron overload, which leads to pathologic changes in body systems, including the hepatic, endocrine, and cardiac systems. Fibrin clots, chronic idiopathic thrombocytic purpura or vaso-occlusive crisis are not complications of ongoing transfusion therapy.
The patient is being prescribed epoetin alfa for the treatment of anemia related to the renal failure. The patient also has a history of diabetes mellitus, uncontrolled hypertension, osteoarthritis, and hypothyroidism. Which of these conditions should the nurse bring to the physician's attention prior to administering the medication? Diabetes mellitus Hypothyroidism Osteoarthritis Uncontrolled hypertension
The nurse should determine whether the patient has pre-existing uncontrolled hypertension, which is a contraindication for the use of epoetin alfa.
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? 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. Overhydration enlarges the red blood cells. 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.
A client presents to his physician with a red face, hands, feet, and ears; a headache; and drowsiness. A blood smear reveals an increased number of erythrocytes. Based on the laboratory results, the nurse prepares teaching material for which disease process? Polycythemia Leukemia Anemia Thrombocytopenia
Unregulated overproduction of the red cell mass is termed polycythemia.
There is a risk of antibody production with the use of epoetin. True False
Use of any therapeutic protein brings with it the risk of antibody production. All of the erythropoietic proteins now carry a warning about the potential for this problem.
A nursing instructor is teaching students about the myelin sheath of the central nervous system (CNS). The nurse knows that teaching has been effective when a student identifies which vitamin as necessary for the formation of the myelin sheath in the CNS? Vitamin C Folic acid Vitamin B12 Vitamin D
Vitamin B12 is necessary for the formation and maintenance of the myelin sheath in the CNS and for the health of RBCs.
A nurse is reviewing laboratory test results of a child with iron-deficiency anemia. Which laboratory results would be communicated with the next shift during shift hand-off? Select all that apply. Hemoglobin 11.8 g/100 mL Serum iron 70 ug/100 mL Iron-binding capacity 390 ug/100 mL Serum ferritin 8 ug/100mL Hematocrit 30%
Correct response: Iron-binding capacity 390 ug/100 mL Serum ferritin 8 ug/100mL Hematocrit 30% Explanation: As iron-deficiency anemia develops, laboratory studies will reveal a decreased hemoglobin level (less than 11 g/100 mL of blood) and reduced hematocrit level (below 33%). The red blood cells are microcytic, hypochromic, and possibly poikilocytic (irregular in shape). The mean corpuscular volume is low. The mean corpuscular hemoglobin may be reduced. Serum iron levels are normally 70 g/100 mL; with iron-deficiency anemia the level is often as low as 30 g/100 mL, with an increased iron-binding capacity (more than 350 g/100 mL). The level of serum ferritin reflects the extent of iron stores so is less than 10 g/100 mL (normal is 35 g/mL).
A patient with chronic renal failure receiving epoetin alfa will be having a total left hip arthroplasty. What supplementation should the patient receive prior to surgery? A protein supplement An iron supplement A blood transfusion A folic acid supplement
Patients taking epoetin alfa who require surgery may require iron supplementation.
The home care nurse is caring for a client who is self-administering epoetin. What assessment is most important for the nurse to complete during the visit? Pulse Blood pressure Temperature Respirations
The most important assessment is the blood pressure because epoetin can cause hypertension.
A child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in two divided doses. What does this prescription indicate to the nurse? The child requires a prophylactic dose of iron. The child has mild to moderate iron deficiency. The child has severe iron deficiency. The child is being prepared for packed red blood cell administration.
The recommended dosage for iron supplementation for a child with mild to moderate iron deficiency is 3 mg/kg/day of ferrous fumarate. A prophylactic dose is 1 to 2 mg/kg/day of up to a maximum of 15 mg elemental iron per day. Severe iron deficiency requires 4 to 6 mg/kg/day of elemental iron in three divided doses. Transfusion of packed red blood cells is reserved for the most severe cases. Prior to the transfusion of packed red blood cells, the nurse would follow specific blood bank guidelines.
A patient with sickle cell anemia is to begin treatment for the disease with hydroxyurea. What does the nurse inform the patient will be the benefits of treatment with this medication? Select all that apply. Fewer painful episodes of sickle cell crisis Lower incidence of acute chest syndrome Decreased need for blood transfusions Decreased need for other analgesic medications Ability to reverse the damage done from sickling of cells
Fewer painful episodes of sickle cell crisis Lower incidence of acute chest syndrome Decreased need for blood transfusions Explanation: Hydroxyurea is a chemotherapy agent that is effective in increasing fetal hemoglobin (i.e., hemoglobin F) levels in patients with sickle cell anemia, thereby decreasing the formation of sickled cells. Patients who receive hydroxyurea appear to have fewer painful episodes of sickle cell crisis, a lower incidence of acute chest syndrome, and less need for transfusions. However, whether hydroxyurea can prevent or reverse actual organ damage remains unknown.
The nurse is caring for an older adult client who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine where the blood loss is coming from, what intervention can the nurse provide? Observe stools for blood. Observe the gums for bleeding after the client brushes teeth. Observe the sputum for signs of blood. Observe client for facial droop.
Iron-deficiency anemia is unusual in older adults. Normally, the body does not eliminate excessive iron, causing total body iron stores to increase with age and necessitating maintenance of hydration. If an older adult is anemic, blood loss from the gastrointestinal or genitourinary tracts is suspected. Observing the stool for blood will help detect blood from GI loss. Bleeding gums may indicate periodontal disease, or anticoagulation from medication is not related to age. Blood in sputum can be an indicator of various lung disorders that may affect all age groups. Facial droop may indicate an impending stroke or Bell's palsy and would not be a reason for blood loss.
A pediatric client is diagnosed with hemolytic anemia. As the nurse explains the disease process to the parents, which statement correctly identifies the body's physiologic compensations for the increase in demand for red blood cells (RBCs)? Resubstitution of red marrow for yellow marrow can occur. Increase in erythropoietin is produced. Body saves RBCs past their 120-day life span. Spleen assists with the production of RBCs.
When the demand for RBC replacement increases, as in hemolytic anemia, there can be resubstitution of red marrow for yellow marrow.
Your client with end-stage renal disease is receiving 2 units of packed red blood cells for anemia (Hgb of 8.2 g/dL [82 g/L]). Twenty minutes into the first transfusion, the nurse observes the client has a flushed face, hives over upper body trunk, and is reporting pain in lower back. His vital signs include pulse rate of 110 and BP drop to 95/56. What is the nurse's priority action? Slow the rate of the blood infusion to 50 mL/hour. Document the assessment as the only action. Discontinue the transfusion and begin an infusion of normal saline. Recheck the type of blood infusing with the chart documentation of client's blood type.
An immediate hemolytic reaction usually is caused by ABO incompatibility. The signs include flushing of the face, urticaria [hives], headache, pain in the lumbar area, chills, fever, chest pain, tachycardia, hypotension, and dyspnea. If any of these actions occur, the transfusion should be stopped immediately. Access to a vein should be maintained because it may be necessary to infuse IV solutions to ensure diuresis. Slowing the rate of the blood infusion will not correct this hemolytic reaction and will only worsen the client's condition. Of course, documentation after the above interventions are performed is vital. Rechecking the blood type infusing will not stop the hemolytic reaction. After corrective actions/interventions are taken, the blood bag is returned to the blood bank for further testing.
During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding? Elevated hematocrit concentration Enlarged mean corpuscular volume (MCV) Low ferritin level concentration Elevated red blood cell (RBC) count
The most consistent indicator of iron deficiency anemia is a low ferritin level, which reflects low iron stores. As the anemia progresses, the MCV, which measures the size of the erythrocytes, also decreases. Hematocrit and RBC levels are also low in relation to the hemoglobin concentration.
Mr. Lepp is a 63-year-old man who was diagnosed with colon cancer several weeks ago and who is scheduled to begin chemotherapy. He reports to the nurse that he read about the need for erythropoietin in an online forum for cancer patients and wants to explore the use of epoetin alfa with his oncologist. Which fact should underlie the nurse's response to Mr. Lepp? Epoetin alfa is normally contraindicated in patients who are receiving radiotherapy or chemotherapy. Treatment with epoetin alfa will likely begin 4 to 6 days before Mr. Lepp's first round of chemotherapy and continue indefinitely. The potential benefits of epoetin alfa must be weighed carefully against the potential adverse effects in cancer patients. Mr. Lepp's oncologist should have begun treatment with epoetin alfa immediately after he was diagnosed.
In patients with cancer, epoetin alfa should only be used when anemia is due to concomitant myelosuppressive chemotherapy and should be discontinued when the chemotherapy course is completed. The use of epoetin alfa during cancer may shorten survival and/or increase the risk of tumor progression or recurrence. Patients with cancer are also at risk for serious cardiovascular and thrombovascular events. Consequently, the benefits of treatment must be considered in light of these potentially adverse effects.
A client presents to the clinic with symptoms of elevated blood pressure, dizziness, red face, pain in fingers and toes, headache, and difficulty concentrating. A blood smear reveals an increased number of erythrocytes. Based on these findings, the nurse anticipates which diagnosis? Polycythemia vera Leukemia Hemolytic anemia Hyperbilirubinemia
Polycythemia vera is a neoplastic disease of the pluripotent cells of the bone marrow characterized by an absolute increase in total red blood cell mass accompanied by elevated white cell and platelet counts. In polycythemia vera, the clinical manifestations are hypertension, headache, dizziness, inability to concentrate, and some difficulty with hearing and vision because of decreased cerebral blood flow. Venous stasis gives rise to a plethoric appearance or dusky redness, even cyanosis, particularly of the lips, fingernails, and mucous membranes. Because of the increased concentration of blood cells, the person may experience itching and pain in the fingers or toes, and the hypermetabolism may induce night sweats and weight loss.
