CH. 31 HEMATOPOETIC DISORDERS CARE

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 for the rest of my life." Explanation: 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.

The nurse is caring for a client with an exacerbation of sickle cell disease (SCD). Which finding indicates to the nurse that the client is experiencing a liver complication from this condition?

- Abdominal pain Explanation: Sickle cell disease (SCD) is an autosomal recessive disorder caused by inheritance of the sickle hemoglobin (HbS) gene. It is associated with severe hemolytic anemia. The HbS gene results in production of a defective hemoglobin molecule that causes the erythrocyte to change shape when exposed to low oxygen tension. The erythrocyte usually has a round, biconcave, pliable shape which in SCD becomes rigid and sickle shaped. Complications of SCD can affect all body systems. Evidence that the client is experiencing a complication in the liver would be the development of abdominal pain. Fatigue and weakness indicate complications involving the central nervous system and heart. Glucose intolerance is not identified as a complication of SCD.

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?

- Adequate nutrition Explanation: 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.

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a patient with leukemia?

- Apply prolonged pressure to needle sites or other sources of external bleeding. Explanation: For a patient 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.

The nurse is planning care for a client with severe fatigue secondary to anemia. What concept will the nurse use as the basis for planning interventions?

- Assisting in prioritizing activities. Explanation: When planning care for a client with severe fatigue secondary to anemia, the nurse should act collaboratively with the client and assist in prioritizing activities. The client ultimately determines the balance between rest and activity, not the nurse. The nurse will balance activities and group nursing interventions in order to prevent client fatigue.

When teaching a client with sickle cell disease about strategies to prevent crises, what measures should the nurse recommend?

- Avoiding cold temperatures and ensuring sufficient hydration Explanation: Keeping warm and providing adequate hydration can be effective in diminishing the occurrence and severity of attacks. Maximizing activity may exacerbate pain and be unrealistic.

The nurse cares for a client with acute myeloid leukemia with severe bone pain. What pathophysiological concept does the nurse understand is the reason for the client's pain?

- Bone marrow expands. Explanation: In acute myeloid leukemia, bone pain is caused when the bone marrow expands.

Which is a symptom of hemochromatosis?

- Bronzing of the skin Explanation: Clients with hemochromatosis exhibit symptoms of: - weakness - lethargy - arthralgia - weight loss - loss of libido early in the illness trajectory - Skin may appear hyperpigmented from melanin deposits or appear bronze in color

A client is being treated for DIC and the nurse has prioritized the nursing diagnosis of Risk for Deficient Fluid Volume Related to Bleeding. How can the nurse best determine if goals of care relating to this diagnosis are being met?

- Closely monitor intake and output. Explanation: The client with DIC is at a high risk of deficient fluid volume. The nurse can best gauge the effectiveness of care by closely monitoring the client's intake and output.

A night nurse is reviewing the next day's medication administration record (MAR) of a hospital client who has hemophilia. The nurse notes that the MAR specifies both oral and subcutaneous options for the administration of a PRN antiemetic. What is the nurse's best action?

- Contact the prescriber to have the subcutaneous option discontinued. Explanation: Injections must be avoided in clients with hemophilia. Consequently, the nurse should ensure that the prescriber makes the necessary change. The nurse cannot independently make a change to a client's MAR in most cases.

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?

- Creatinine level of 6 mg/100 mL Explanation: 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 nurse is planning the care of a client who has been admitted with a diagnosis of multiple myeloma. What pathophysiologic effect of multiple myeloma most contributes to this client's risk for injury?

- Decreased bone density Explanation: Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis and osteolytic lesions.

Define Anemia

- Deficiency of either erythrocytes or hemoglobin

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 Explanation: Signs of iron deficiency anemia include: - dyspnea - tachycardia - pallor - fatigue - listlessness - irritability - 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 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 calf's liver with a glass of orange juice Explanation: Food sources high in iron include: - organ meats (beef or calf's liver, chicken liver) - beans (black, pinto, garbanzo) - leafy green vegetables - Raisins - molasses Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.

A client with poorly controlled diabetes has developed end-stage kidney injury and consequent anemia. When reviewing this client's treatment plan, the nurse should anticipate the use of what drug?

- Epoetin alfa Explanation: The availability of recombinant erythropoietin (epoetin alfa, darbepoetin alfa) has dramatically altered the management of anemia in end-stage renal disease. Heparin, vitamin K, and magnesium are not indicated in the treatment of renal failure or the consequent anemia.

A client who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action?

- Evaluate the client's platelet count. Explanation: Complications of AML include bleeding. The risk of bleeding correlates with the level and duration of platelet deficiency. Major hemorrhages may develop when the platelet count drops to less than 10,000/mm3.

A nurse prepares a client for a bone marrow biopsy who is suspected of having acute myeloid leukemia. What results from the bone marrow biopsy does the nurse expect?

- Excess of immature leukocytes Explanation: The bone marrow biopsy of a client with acute myeloid leukemia will reveal an excess of immature leukocytes.

An adult client has been diagnosed with iron deficiency anemia. Which is most likely based on this client's health status?

- Fatigue related to decreased oxygen-carrying capacity Explanation: Fatigue is the major assessment finding common to all forms of anemia.

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?

- Hemoglobin level Explanation: 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.

The results of a client's most recent blood work and physical assessment are suggestive of immune thrombocytopenic purpura (ITP). This client should undergo testing for which of the following potential causes?

- Hepatitis - HIV

The nurse is currently planning the care of a patient with multiple myeloma who is experiencing bone destruction. When reviewing the patient's most recent blood work, what value would the nurse pay particular attention to?

- Hypercalcemia Explanation: Hypercalcemia may occur when bone destruction occurs due to the disease process. Elevated serum viscosity occurs because plasma cells excrete excess immunoglobulin. RBC count will be decreased. Hyperproteinemia would not be present.

A nurse is planning the care of a client with a diagnosis of sickle cell disease who has been admitted for the treatment of an acute vaso-occlusive crisis. Which nursing diagnosis should the nurse prioritize in the client's plan of care?

- Ineffective tissue perfusion related to thrombosis Explanation: There are multiple potential complications of sickle cell disease and sickle cell crises. Central among these, however, is the risk of thrombosis and consequent lack of tissue perfusion.

A patient with acute myeloid leukemia (AML) has a neutrophil count that persists at less than 100/mm3. What should the nurse cautiously monitor this patient for?

- Infection Explanation: Because of the lack of mature and normal granulocytes that help fight infection, patients with leukemia are prone to infection. The likelihood of infection increases with the degree and duration of neutropenia; neutrophil counts that persist at less than 100/mm3 dramatically increase the risk of systemic infections.

A nurse practitioner is assessing a client who has a fever, malaise, and a white blood cell count that is elevated. What principle should guide the nurse's management of the client's care?

- Infection is the most likely cause of the client's change in health status. Explanation: Leukocytosis is most often the result of infection. It is only considered pathologic (and suggestive of leukemia) if it is persistent and extreme.

A client comes to the clinic reporting fatigue. Laboratory findings reveal a low serum iron level, a low transferrin saturation, and a low ferritin level. Which type of anemia does the nurse suspect that correlates with the laboratory findings?

- Iron deficiency anemia Explanation: Iron deficiency Anemia - low serum iron level - low transferrin saturation - low ferritin level Pernicious anemia is caused by: - low level of vitamin B12 Hemolytic anemia - Reticulocyte count is elevated - Indirect (unconjugated) bilirubin is increased - supply of haptoglobin (a binding protein for free hemoglobin) is depleted as more hemoglobin is released. As a result, the plasma haptoglobin level is low. Sickle cell anemia is identified by: - sickled shape red blood cells

The nurse observes a co-worker who always seems to be eating a cup of ice. The nurse encourages the co-worker to have an examination and diagnostic workup with the health care provider. What type of anemia is the nurse concerned the co-worker may have?

- Iron deficiency anemia Explanation: People with iron deficiency anemia may crave ice, starch, or dirt; this craving is known as pica.

The nurse is administering packed red blood cell (RBC) transfusions for a patient with myelodysplastic syndrome (MDS). The patient has had several transfusions and is likely to receive several more. What is a priority for the nurse to monitor related to the transfusions?

- Iron levels Explanation: For most patients with MDS, transfusions of RBCs may be required to control the anemia and its symptoms. These patients can develop iron overload from the repeated transfusions; this risk can be diminished with prompt initiation of chelation therapy

A client lives with a diagnosis of sickle cell disease and receives frequent blood transfusions. The nurse should recognize the client's consequent risk of what complication of treatment?

- Iron overload Explanation: Clients with chronic transfusion requirements can quickly acquire more iron than they can use, leading to iron overload. These individuals are not at risk for hypovolemia and there is no consequent risk for low platelet or vitamin B12 levels.

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 may indicate deficiencies in essential nutrients. Explanation: A nutritional assessment is important, because it may indicate deficiencies in essential nutrients such as: - iron - vitamin B12 - folate

A 63-year-old woman has been diagnosed with polycythemia vera (PV) after undergoing a series of diagnostic tests. When the woman's nurse is providing health education, what subject should the nurse prioritize?

- Lifestyle modifications and techniques for preventing thromboembolism Explanation: The increased blood volume and viscosity that are the hallmarks of PV create a significant risk of thromboembolism.

Define Erythrocytes

- Mature RBCs which hemoglobin is attached

The nurse cares for an older adult client with unprovoked back pain and increased serum protein. Which hematologic neoplasm does the nurse suspect the client has?

- Multiple myeloma Explanation: Any older adult with unprovoked or unexplained back pain and increased protein in the serum should be assessed for multiple myeloma. Bone pain occurs because of bone breakdown and the malignant cells of multiple myeloma increase the serum protein levels.

A nurse is planning the care of a client who has a diagnosis of hemophilia A. When addressing the nursing diagnosis of Acute Pain Related to Joint Hemorrhage, what principle should guide the nurse's choice of interventions?

- NSAIDs are contraindicated due to the risk for bleeding. Explanation: NSAIDs may be contraindicated in clients with hemophilia (blood does not clot) due to the associated risk of bleeding.

A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. The client is taking prednisone daily and reported feeling pain after manually opening the garage door. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain?

- Osteoporosis Explanation: Hypertension, osteoporosis, muscle wasting, and truncal obesity are all adverse effects of long-term corticosteroid therapy; however, osteoporosis commonly causes compression fractures of the spine. Hypertension, muscle wasting, and truncal obesity aren't likely to cause severe back pain.

A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client?

- Pallor, tachycardia, and a sore tongue Explanation: Pernicious Anemia: - Pallor - tachycardia - sore tongue - anorexia - weight loss - a smooth, beefy red tongue - a wide pulse pressure - palpitations - angina pectoris - weakness - fatigue - paresthesia of the hands and feet.

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

- Pancytopenia Explanation: Pancytopenia 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.

A patient had gastric bypass surgery 3 years ago and now, experiencing fatigue, visits the clinic to determine the cause. The patient takes pantoprazole for the treatment of frequent heartburn. What type of anemia is this patient at risk for?

- Pernicious anemia Explanation: A deficiency of vitamin B 12 can occur in several ways. Inadequate dietary intake is rare but can develop in strict vegans (who consume no meat or dairy products). Faulty absorption from the GI tract is a more common cause. This occurs in conditions such as Crohn's disease, or after ileal resection or gastrectomy.

The nurse is performing an assessment on a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae. What laboratory study should the nurse be concerned about?

- Platelet count of 9,000/mm3 Explanation: Complications of AML include bleeding and infection, which are the major causes of death. The risk of bleeding correlates with the level and duration of platelet deficiency (thrombocytopenia). The low platelet count can cause ecchymoses (bruises) and petechiae. Major hemorrhages also may develop when the platelet count drops to less than 10,000/mm3.

A patient with a diagnosis of immune thrombocytopenic purpura (ITP) is currently receiving IVIG for the treatment of her health condition. The nurse who is providing this patient's care is aware that ITP is a consequence of:

- Platelet destruction and impaired platelet production resulting from an autoimmune process Explanation: Although the precise cause of ITP remains unknown, the platelet count is decreased by a combination of autoantibody-mediated platelet destruction and impaired platelet production secondary to autoantibody effects on the megakaryocyte. Viruses, impaired liver function, and inappropriate platelet aggregation are not dimensions of the etiology of ITP.

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 Explanation: An expected outcome for a client experiencing a sickle-cell crisis is control and reduction of pain. Hydroxyurea is contraindicated in pregnancy because of the risk it poses for congenital abnormalities. An indication that the client is free from infection is exhibiting a normal temperature; 100.3°F is an elevated temperature. To minimize crises, the client needs to stay warm not cool.

A client has been living with a diagnosis of anemia for several years and has experienced recent declines in hemoglobin levels despite active treatment. Which assessment finding would signal complications of anemia?

- Shortness of breath and peripheral edema Explanation: A significant complication of anemia is heart failure from chronic diminished blood volume and the heart's compensatory effort to increase cardiac output. Clients with anemia should be assessed for signs and symptoms of: - heart failure - dyspnea - peripheral edema

A client is prescribed 325 mg/day of oral ferrous sulfate. What does the nurse include in client teaching?

- Take 1 hour before breakfast Explanation: Instructions the nurse will provide for the client taking oral ferrous sulfate is to administer the medication on an empty stomach. Instructions also include that there is decreased absorption of iron with food, particularly dairy products. The client is to increase vitamin C intake (fruits, juices, tomatoes, broccoli), which will enhance iron absorption. The client is to also increase foods high in fiber to decrease risk of constipation.

The nurse's brief review of a client's electronic health record indicates that the client regularly undergoes therapeutic phlebotomy. Which of the following rationales for this procedure is most plausible?

- The client may chronically produce excess red blood cells. Explanation: Persistently elevated hematocrit is an indication for therapeutic phlebotomy.

A client diagnosed with Von Willebrand disease (vWD) has experienced recent changes in bowel function that suggest the need for a screening colonoscopy. What intervention should be performed in anticipation of this procedure?

- The client should be given necessary clotting factors before the procedure. Explanation: A goal of treating vWD is to replace the deficient protein (e.g., vWF or factor VIII) prior to an invasive procedure to prevent subsequent bleeding.

A 12-year-old girl on the oncology unit at children's hospital tells the nurse that she has discovered that there are several different kinds of leukemia. The child asks the nurse to explain what makes them all "leukemia." What should the nurse reply?

- The different leukemias all have unregulated proliferation of white blood cells. Explanation: Leukemia commonly involves unregulated proliferation of white blood cells. Decreased production of red blood cells is associated with anemias. Decreased production of white blood cells is associated with leukopenia.

A client newly diagnosed with thrombocytopenia is admitted to the medical unit. After the admission assessment, the client asks the nurse to explain the condition. What should the nurse explain to this client?

- There could be decreased production of platelets. Explanation: Thrombocytopenia can result from: - a decreased platelet production - increased platelet destruction - increased consumption of platelets

After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/mm3. What term should the nurse use to describe this low platelet count?

- Thrombocytopenia Explanation: A normal platelet count is 140,000 to 400,000/mm3 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.

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 Explanation: 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 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. Explanation: People with aplastic anemia usually have insufficient: - erythrocytes - leukocytes - 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.

The nurse should advise a client with iron deficiency anemia to take which action in order to prevent staining of the teeth?

- Use a straw or place a spoon at the back of the mouth to take the liquid supplement. Explanation: For a client with iron deficiency anemia who is taking an oral iron supplement, the nurse instructs the client to use a straw or place a spoon at the back of the mouth to take the liquid supplement to avoid staining the teeth. The nurse advises the client to take iron with or immediately after meals to avoid gastric distress. The client is advised to avoid having iron simultaneously with an antacid, as the antacid will interfere with iron absorption.

A client is admitted to the hospital with a diagnosis of pernicious anemia. The nurse should prepare to administer which of the following medications?

- Vitamin B12 Explanation: Pernicious anemia is characterized by vitamin B12 deficiency

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 lose iron through menstrual cycles Explanation: 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.

A client has pernicious anemia and has been receiving treatment for several years. Which symptom may be confused with another condition in older adults?

- dementia Explanation: Pernicious anemia may be accompanied by a dementia with symptoms similar to Alzheimer's disease. Therefore, clients experiencing cognitive changes should be screened because early detection of pernicious anemia is critical to prevent neurologic damage.

A client has a history of sickle cell anemia with several sickle cell crises over the past 10 years. What blood component results in sickle cell anemia?

- hemoglobin S Explanation: Hemoglobin A (HbA) normally replaces fetal hemoglobin (HbF) about 6 months after birth. In people with sickle cell anemia, however, an abnormal form of hemoglobin, hemoglobin S (HbS), replaces HbF. HbS causes RBCs to assume a sickled shape under hypoxic conditions.

A client with sickle cell anemia has a

- low hematocrit. Explanation: 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.

List the 4 types of Leukemia, their cellular characteristics and age onset

1. Acute lymphocytic leukemia (ALL) - Increased immature lymphocytes - Normal or decreased granulocytes - Decreased platelets Younger than 5 year Uncommon > 15 years 2. Chronic lymphocytic leukemia (CLL) (Same as above) - Increased immature lymphocytes - Normal or decreased granulocytes - Erythrocytes & platelet counts may be normal or low 40 yrs old (Most common type in adults) 3. Acute Myelogenous leukemia (AML) - Decreased in all myeloid formed cells: monocytes, granulocytes, erythrocytes and platelets All ages 4. Chronic myelogenous leukemia (CML) (Same as above) but greater number of normal cells than in acute form 20 yrs old, increases with age Genetic link in 90%-95% of cases

List the 3 reasons Most anemias result from.

1. Blood loss 2. Inadequate or abnormal erythrocyte production 3. Destruction of normally formed RBCs

List the 7 Types of Anemia's

1. Hypovolemic- loss of blood volume 2. Iron-deficiency- Iron is insufficient to produce hemoglobin 3. Sickle cell- Erythrocytes become sickle (crescent-shaped) when oxygen supply in blood is inadequate 4. Hemolytic- Generic term for acquired, hereditary or idiopathic 5. Thalassemias- Hereditary hemolytic: 2 groups alpha & beta 6. Pernicious- Lack intrinsic factor, fail to consume sufficient dietary sources of the extrinsic factor 7. Folic acid-deficiency- Immature erythrocytes

List the 6 Leukocyte Cues

1. Infections 2. Fatigue from anemia 3. Easy bursing 4. Fever 5. Spleen and lymph nodes enlarged 6. Bleeding

List the 13 Compensatory Mechanisms for Lost RBC Function​

1. Tachycardia 2. Cool, clammy skin 3. Amenorrhea 4. low RBC function 5. Dyspnea 6. Chest discomfort 7. Acidosis 8. Headache 9. Vertigo 10. Pallor 11. Constipation 12. Difficulty concentrating 13. Decreased bowel sounds

The nurse is caring for a client with acute myeloid leukemia (AML) with high uric acid levels. What medication does the nurse anticipate administering that will prevent crystallization of uric acid and stone formation?

Allopurinol

Which of the following is a symptom of Cooley's anemia?

Bronzing of the skin Explanation: Patients with Cooley's anemia exhibit symptoms of: - severe anemia - bronzing of the skin (caused by hemolysis of erythrocytes) Pernicious anemia Symptom - Dyspnea - stomatitis (inflammation of the mouth) - glossitis (inflammation of the tongue)

Define and list 4 Symptoms of Anemia

Definition: - Inadequate RBC Volume Sx:1. Orthostatic HYPOtension 2. Tready Pulses 3. Oliguria 4. Heart Murmur

A thin client is prescribed iron dextran intramuscularly. What is most important action taken by the nurse when administering this medication?

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

Define Leukocytosis

Increased number of leukocytes above normal limits

Define Leukemia

Leukemia: Malignant blood disorder where proliferation of leukocytes, usually in an immature form are unregulated Leukocytes - Increased normally = protective mechanism in response to inflammation and healing - Decrease in production of erythrocytes and platelets - Classified according to bone marrow stem cell line dysfunction that affects the lymphoid stem cells

Which of the following are assessment findings associated with thrombocytopenia? Select all that apply.

Pertinent findings of thrombocytopenia include: - bleeding gums - epistaxis - hematemesis - hypotension - tachypnea

A nurse is teaching a client with multiple myeloma about the therapeutic benefits of radiation therapy. Which statements will the nurse include in the teaching? Select all that apply.

Radiation therapy is useful in strengthening the bone at a specific lesion, particularly a bone at risk for fracture or spinal cord compression. It is also extremely useful in relieving bone pain. Radiation therapy is not effective in decreasing bone malignancy, decreasing excess calcium, or activating an immune response.

A nurse is admitting a client with immune thrombocytopenic purpura to the unit. In completing the admission assessment, the nurse must be alert for what medications that potentially alter platelet function?

The nurse must be alert for sulfa-containing medications and others that alter platelet function (e.g., aspirin-based or other NSAIDs). Antihypertensive drugs and the penicillins do not alter platelet function.

The nurse monitors the laboratory data for several clients who are diagnosed with hypoproliferative anemias.

There are three basic types of anemia: hypoproliferative, bleeding, and hemolytic. Each type of anemia presents differently in regard to laboratory data that is expected. The client who is diagnosed with microcytic anemia will have the following laboratory data: decreased mean corpuscular volume (MCV), decreased reticulocytes, and decreased total iron-binding capacity (TIBC). The client who is diagnosed with a megaloblastic anemia (e.g., vitamin B12 and folate deficiencies) will have the following laboratory data: increased MCV and decreases in either serum vitamin B12 or folate levels. Microcytic anemias do not present with the following laboratory data: increased MCV and deficiencies in both vitamin B12 and folate levels. Megaloblastic anemias do not present with the following laboratory data: decreased MCV, decreased reticulocytes, and increased TBIC.

The nurse in the oncology clinic is caring for a 42-year-old female client receiving chemotherapy with fludarabine for acute myeloid leukemia who has developed petechiae, epistaxis, and ecchymosis.

This client has manifestations of hemorrhage, including: - petechiae (pinpoint bleeding in the skin) - epistaxis (nosebleeds) - ecchymosis (bruises) due to a low platelet count (thrombocytopenia) secondary to chemotherapy. Chemotherapy with fludarabine may cause bone marrow suppression with neutropenia (low neutrophil count) and thrombocytopenia (low platelet count). When the platelet count is low, the client is at risk for hemorrhage as evidenced by petechiae, epistaxis, and ecchymosis