Ch. 28: Nursing Care of patients with Hematologic and Lymphatic Disorders

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

The nurse is teaching a patient who has iron deficiency anemia about nutrition. Which statement by the patient indicates an understanding of the teaching?

"For dinner, I am eating legumes and chicken."

A patient asks the nurse to explain sickle cell anemia. Which response by the nurse is accurate?

"It is an inherited anemia that causes blood cells to take on a crescent shape and clump."

The nurse is teaching the parent of a child with hemophilia. Which of the following statements by the parent demonstrates understanding about preventing bleeding episodes?

"My son will have to avoid contact sports."

A nurse is caring for a patient admitted with gastrointestinal tract bleeding and a hemoglobin level of 6. The patient asks the nurse why the low hemoglobin causes shortness of breath. Which response is best?

"You do not have enough hemoglobin to carry oxygen to your tissues."

The nurse is caring for a patient with anemia. Which interventions will the nurse implement? Select all that apply.

-monitor vital signs before and after activity. -allow periods of rest between activities -monitor hemoglobin and hematocrit levels -ensure a dietitician is consulted for planning meals.

The nurse is caring for a group of patients with sickle cell anemia. Which patient is at high risk for development of sickle cell crisis?

A patient with pneumonia

The nurse is caring for a patient in sickle cell crisis. Which intervention will the nurse implement?

Administer opioid analgesics as ordered

The nurse is caring for a group of patients. Which patient is at high risk for a diagnosis of sickle cell anemia?

An individual who is of African descent

A patient with multiple myeloma develops hypercalcemia. Which intervention can help minimize complications related to hypercalcemia?

Encourage 3 to 4 liters daily

The nurse is caring for a patient with severe anemia and a hemoglobin level of 4 g/dL. Which clinical manifestation will the nurse expect the patient to exhibit?

Glossitis

A client is recovering from infectious mononucleosis. For which of the following conditions is the nurse aware that the client may also be at increased future risk?

Hodgkin's lymphoma

Which circumstances places the patient at most risk for postoperative pneumonia following a splenectomy?

Nothing by mouth status

A patient with a history of hemophilia A arrives in the ED with a "funny feeling" in the elbow. The patient believes he is bleeding into the joint. Which response by the nurse is correct?

Notify the physician immediately and expect an order for factor VIII.

A client with a diagnosis of acute myeloid leukemia (AML) is being treated with induction therapy. What nursing action should be prioritized in the client's care plan?

Protective isolation and vigilant use of standard precautions

A pregnant woman is hospitalized as the result of sickle-cell crisis. Which finding indicates the outcome has been achieved for this client?

Reports joint pain less than 3 on a scale of 0 to 10

A client at the health care facility is diagnosed with Hodgkin's disease that has extended to the liver. What stage should the nurse use to describe the progress of the disease?

Stage IV

A client with a pulmonary embolism is being treated with a heparin infusion. What diagnostic finding suggests to the nurse that treatment is effective?

The client's activated partial thromboplastin time (aPTT) is 1.5 to 2.5 times the control value.

The nurse instructed a patient with thrombocytopenia on methods to prevent bleeding. Which is the best evidence that the teaching has been effective?

The patient uses an electric razor instead of a safety razor.

A 27 year old male patient is admitted in sickle cell crisis. Which of the following events most likely contributed to the onset of the crisis?

The patient walked home in a cold rain yesterday.

A patient has hand foot syndrome related to sickle cell anemia. Which finding does the nurse expect to see during physical examination?

Unequal growth of fingers and toes

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?

Wear a medical identification bracelet.

A 50 year old black patient is diagnosed with anemia. Where can the nurse best observe for pallor?

conjunctiva

Which of the following medications would be least likely to be used in an older adult with Hodgkin's disease?

doxorubicin

A client is in the early stages of Hodgkin's disease. When palpating the client's lymph nodes, the nurse is most likely to find that the lymph nodes are:

enlarged and painless

The nurse is reviewing lab values for a patient with anemia. Which lab value will concern the nurse the most?

hemoglobin 9.8

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

pancytopenia

What discharge teaching is most important to help the patient who has had a splenectomy prevent infection?

receive a yearly flu vaccine

The nurse is caring for a patient with pernicious anemia. Which classic clinical manifestation can the nurse expect to find?

sore, beefy red tongue

A patient is admitted to the hospital for a splenectomy. The nurse understands that the HCP prescribes an injection of vitamin K prior to surgery for which action?

to correct a clotting problem

The nurse is teaching a patient with multiple myeloma how to remain safe in the home. Which problem should be a priority for this patient?

unsteady gait