Chapter 27
The nurse is caring for of a 6-month-old infant diagnosed with iron deficiency anemia. The nurse determines further teaching is necessary when the mother states: "I must stop breast-feeding my baby because of the anemia." "I need to decrease my baby's intake of whole milk to provide the best nutrition." "I need to feed my baby cereals with fortified iron." "I know this anemic condition can be resolved with good nutrition."
"I must stop breast-feeding my baby because of the anemia." Explanation: A mother does not have to stop breast-feeding an infant with iron deficiency anemia, but may need to provide iron supplementation. All the other options are true statements regarding treatments for iron deficiency anemia.
he dietary student is studying folic acid deficiency. The faculty member knows the student is ready to teach patients about this topic when the student makes which of the following statements? "The 30-year-old client who is trying to become pregnant should evaluate her folic acid intake." "The client should have at least 200 micrograms in her daily diet." "Folate deficiency is not common in clients with neoplastic disease." "The client should increase his intake of cooked green leafy vegatables."
"The 30-year-old client who is trying to become pregnant should evaluate her folic acid intake." Explanation: Because pregnancy increases the need for folic acid 5- to 10-fold, all childbearing women who are sexually active are advised to evaluate their folic acid intake. Folic acid is found in vegetables (particularly the green leafy types); however, much of the vitamin is lost in cooking. 50 micrograms is required in the daily diet. In neoplastic disease, tumor cells compete for folate, and deficiency is
Mature red blood cells have a life span of approximately: 90 days 30 days 120 days 10 days
120 days Explanation: Mature red blood cells have a life span of approximately 4 months, or 120 days.
The nurse is caring for a client with sickle cell disease. The most important treatment for the nurse to provide would be: Iron dextran and a high-carbohydrate diet Transfusion of white blood cells Ferrous sulfate and a high-iron diet Aggressive intravenous hydration and morphine
Aggressive intravenous hydration and morphine Explanation: The treatment goal of sickle cell anemia is to manage the symptoms through pain control, hydration, and prevention of complications. Intravenous fluids and pain medication would assist with this. Treatment with iron supplements would not assist in management of the symptoms, nor would a WBC transfusion.
Which of the following is the most abundant type of plasma proteins? Beta globulin Globulins Albumin Fibrinogens
Albumin Explanation: Albumin makes up approximately 54% of the plasma proteins. Although the others are made up plasma proteins, they are in the plasma in smaller numbers than is albumin.
Pernicious anemia is thought to be an autoimmune disease that destroys the gastric mucosa. This results in chronic atrophic gastritis and the production of antibodies that interfere with which vitamin's ability to bind to intrinsic factor? B6 Vitamin C B12 Folate
B12 Explanation: Pernicious anemia is believed to result from immunologically mediated, possibly autoimmune, destruction of the gastric mucosa. The resultant chronic atrophic gastritis is marked by loss of parietal cells and production of antibodies that interfere with binding of vitamin B12 to intrinsic factor. Folate, vitamin C, and B6 all have different methods of absorption.
After birth, red blood cells are normally made in which of the following locations? Kidneys Liver Bone marrow Spleen
Bone marrow Explanation: After birth, red cells are produced in the red bone marrow. Until a child is 5 years old, almost all bones produce red cells to meet the growth needs of a child, after which bone marrow activity gradually declines.
The practitioner knows the client has hemoglobin S (HbS). The practitioner explains to the client that which of the following are the major consequences of this disorder? Select all that apply. Polycythemia vera Blood vessel occlusion Acute blood loss anemia Chronic hemolytic anemia Aplastic anemia
Chronic hemolytic anemia Blood vessel occlusion Explanation: Sickle cell disease is an inherited disorder in which an abnormal hemoglobin (hemoglobin S) can lead to chronic hemolytic anemia and blood vessel occlusion. The other options are not consequences of sickle cell disease.
Polycythemia develops in clients with lung disease as a result of: Hyperventilation Chronic hypoxia Decreased blood viscosity Excessive respiratory fluid loss
Chronic hypoxia Explanation: Secondary polycythemia results from a physiologic increase in the level of erythropoietin, commonly as a compensatory response to hypoxia. Conditions causing hypoxia include living at high altitudes, chronic heart and lung disease, and smoking.
Megaloblastic anemias caused by folic acid or vitamin B12 deficiencies can seriously affect RBC production. This is because both are necessary for _______ synthesis and _______. Iron; hemoglobin adhesion DNA; red blood cell maturation Thrombin; platelet aggregation Protein; reticulocyte maturation
DNA; red blood cell maturation Explanation: Both folic acid and vitamin B12 are essential for DNA synthesis and maturation of red blood cells. Folic acid and/or vitamin B12 do not have a critical role in hemoglobin adhesion, reticulocyte maturation, or platelet aggregation.
An adult client with good overall health has reported headaches and dizziness in recent weeks. The nurse's assessment reveals blood pressure of 158/99 mm Hg, which is unprecedented for the client. On observation, the client's skin appears reddened, though he denies feeling warm. The nurse should anticipate what further diagnostic finding? Normal RBC, hemoglobin and hematocrit with alterations in morphology. Abnormal RBC indices coupled with low platelets. Elevated RBC, hemoglobin, and hematocrit. Further signs and symptoms of internal hemorrhage.
Elevated RBC, hemoglobin, and hematocrit. Explanation: The client's presentation is characteristic of polycythemia. RBC, hemoglobin and hematocrit are likely to be elevated. Platelets are not likely to be low. Polycythemia is not linked to hemorrhage and RBC morphology is not directly affected.
The microbiology technician explains to the student that which of the following blood cells is the most common? Erythrocyte Platelet Neutrophil Lymphocyte
Erythrocyte Explanation: The erythrocytes, 500 to 1000 times more numerous than other blood cells, are the most common type of blood cells.
The nurse is teaching her patient about the signs and symptoms of anemia. Symptoms that are directly due to the diminished oxygen-carrying capacity of hemoglobin (Hgb) include which of the following? Bone pain Pale skin Fatigue Bleeding
Fatigue Explanation: Anemia is frequently the result of tissue oxygen deficit, which is secondary to decreased circulating red blood cells or hemoglobin for oxygen delivery. The insufficient oxygen-carrying capacity to tissues causes fatigue. Pale skin is caused by the compensatory redistribution of blood from cutaneous tissues. Accelerated erythropoiesis can cause bone pain. Bleeding is associated with blood volume depletion, unrelated to the Hgb.
The surgical nurse is administering a unit of packed red blood cells to the post-operative client. Which of the following is the most common transfusion reaction? Febrile reaction Constricting pain in the chest Dyspnea Tachycardia
Febrile reaction Explanation: A febrile reaction is the most common transfusion reaction. The other options are signs and symptoms of a reaction, but are less frequent.
Anemia refers to a deficiency of: Platelets Hemoglobin Blood plasma Folic acid
Hemoglobin Explanation: Anemia is a condition of an abnormally low number of circulating red blood cells or hemoglobin level, or both. It is not a disease but a manifestation of a disease process or alteration in body function.
he client is an average-sized adult and has abnormal microcytic hypochromic red blood cells due to a long-term, chronic disease. Which of the following complete blood count (CBC) results is characteristic of her type of anemia? Hematocrit 44% Reticulocytes 1.5% Band cells 3000/mL Hemoglobin 8 g/dL
Hemoglobin 8 g/dL Explanation: Anemia of chronic disease is characterized by a low hemoglobin level, low hematocrit, and low reticulocyte count. The quantity of band cells, immature neutrophils released from the marrow, is unrelated to the anemia.
hen an Rh-negative mother gives birth to an Rh-positive infant, the mother usually produces antibodies that will attack any subsequent pregnancies in which the fetus is Rh positive. When subsequent babies are Rh positive, erythroblastosis fetalis occurs. What is another name for erythroblastosis fetalis? Hemolytic iron deficiency anemia Microcytic disease of the newborn Hemolytic disease of the newborn Macrocytic disease of the newborn
Hemolytic disease of the newborn Explanation: Erythroblastosis fetalis, or hemolytic disease of the newborn, occurs in Rh-positive infants of Rh-negative mothers who have been sensitized. The Rh-negative mother usually becomes sensitized during the first few days after delivery, when fetal Rh-positive red cells from the placental site are released into the maternal circulation. Because the antibodies take several weeks to develop, the first Rh-positive infant of an Rh-negative mother usually is not affected. There is no such thing as microcytic or macrocytic disease of the newborn, nor is there a hemolytic iron deficiency anemia.
A patient is diagnosed with pernicious anemia. The nurse determines the most likely cause of this condition is related to which of the following? Blocked protein synthesis History of a gastrectomy Inherited DNA abnormality Abnormal synthesis of hemoglobin
History of a gastrectomy Explanation: Pernicious anemia is a specific form of megaloblastic anemia caused by atrophic gastritis and failure to produce intrinsic factor that leads to failure to absorb vitamin B12. Pernicious anemia is believed to result from immunologically mediated, possibly autoimmune, destruction of the gastric mucosa. Other causes of vitamin B12-deficiency anemia include gastrectomy, ileal resection, inflammation or neoplasms in the terminal ileum, and malabsorption syndromes.
A nurse is monitoring a patient with anemia and low oxygen levels. The nurse knows that which of the following stimulates the secretion of erythropoietin? Low blood pressure Tachycardia Inflammation Hypoxia
Hypoxia Explanation: Erythropoiesis is governed for the most part by tissue oxygen needs. Any condition that causes a decrease in the amount of oxygen that is transported in the blood produces an increase in red cell production. The oxygen content of the blood does not act directly on the bone marrow to stimulate red blood cell production. Instead, the decreased oxygen content is sensed by the peritubular cells in the kidneys, which then produce a hormone called erythropoietin.
A patient with iron-deficiency anemia complains of feeling "tired all of the time." What does the nurse understand may be the cause of the fatigue that the patient is experiencing? A decrease in lactic acid Alteration in carbohydrate metabolism Impaired function of the electron transport chain Increased diffusion of electrolytes
Impaired function of the electron transport chain Explanation: Although iron-deficiency anemia is characterized by decreased levels of hemoglobin, the iron-containing cytochromes in the electron transport chain in tissues such as skeletal muscle are affected as well. Thus, the fatigue that develops in iron-deficiency anemia results, in part, from impaired function of the electron transport chain.
Sickle cell anemia is an inherited disorder seen in African American people. It is marked by the characteristic sickling of red blood cells. This causes both chronic hemolytic anemia and occlusion of blood vessels. Which are considered to be triggers of an episode of sickling? (Select all that apply.) Infection Stress Heat Dehydration Alkalosis
Infection Stress Dehydration Explanation: Factors associated with sickling and vessel occlusion include cold, stress, physical exertion, infection, and illnesses that cause hypoxia, dehydration, or acidosis.
The nurse is assessing a client diagnosed with anemia and notes that the client's skin and mucous membranes are pale. The nurse interprets this as: Changes in blood viscosity Presence of systolic murmur Insufficient hemoglobin Tissue hypoxia to the brain
Insufficient hemoglobin Explanation: The redistribution of the blood from cutaneous tissues or a lack of hemoglobin causes pallor of the skin, mucous membranes, conjunctiva, and nail beds. Tissue hypoxia to the brain causes headache, faintness, and dim vision but is not the direct cause of pallor. Changes in blood viscosity may lead to a systolic murmur.
The rate at which hemoglobin is synthesized depends on availability of which of the following? Glucose Iron Calcium Oxygen
Iron Explanation: The rate at which hemoglobin is synthesized depends on the availabilty of iron for heme sythesis.
A female patient comes to the clinic with symptoms of fatigue and heavy menses over the last 6 months. Laboratory tests reveal a microcytic hemochromic anemia. Based on these results, the nurse anticipates teaching the patient about which type of anemia? Iron deficiency anemia Aplastic anemia Sickle cell anemia Anemia related to kidney disease
Iron deficiency anemia Explanation: The red blood cell indices identified that it was a microcytic hemochromic anemia, specifically iron deficiency.
A patient has a hematocrit of 32% and is diagnosed with iron deficiency anemia. The nurse anticipates which of the following treatments to be prescribed? Splenectomy Continued monitoring with weekly laboratory tests Bone marrow transplant Iron replacement therapy
Iron replacement therapy Explanation: Treatment for microcytic hemochromic anemia (iron deficiency anemia), is iron (ferrous sulfate) three times daily and follow-up monitoring.
The nurse is educating a pregnant client about the importance of folic acid. Select the food that has the highest levels of folic acid. Eggs Kale Apples Carrots
Kale Explanation: Folic acid is readily absorbed from the intestine. It is found in vegetables (particularly the green leafy types), fruits, cereals, and meats. Much of the vitamin, however, is lost in cooking. The most common causes of folic acid deficiency are malnutrition or dietary lack, especially in the elderly or in association with alcoholism.
The practitioner is examining a client and notes that he has small, punctate skin hemorrhages on his abdomen and chest. This finding is suggestive of which of the following lab results? Low neutrophils Low platelets Low white blood cells Low red blood cells
Low platelets Explanation: Petechiae (small, punctate skin hemorrhages) and ecchymoses often occur on the skin, and bleeding from the nose, gums, vagina or gastrointestinal tract may be seen because of decreased platelet levels.
Megaloblastic anemias caused by folic acid or vitamin B12 deficiencies can seriously affect RBC production. Which of the following lab results would correlate with this diagnosis? Mean corpuscular hemoglobin (MCV) 120 fL (high) Reticulocyte count 3.6% (high) Iron level of 70 μg/dL (normal) Platelet count 200,000 (normal)
Mean corpuscular hemoglobin (MCV) 120 fL (high) Explanation: Megaloblastic anemias are caused by impaired DNA synthesis that results in enlarged red cells (MCV >100 fL) due to impaired maturation and division. Folic acid and/or vitamin B12 do not have a critical role in normal iron and platelet levels or a high reticulocyte count.
The client is being crossmatched for a blood transfusion. The lab technologist notes that the client has neither A nor B antigens. Which type of blood should the client receive? O B A AB
O Explanation: People who have neither A nor B antigens are classified as having type O blood and this is what this client should receive. Those with A antigens are classified as having type A blood; those with B antigens, as having type B blood; those with A and B antigens, as having type AB blood.
A mother has brought her 2-week-old infant to the emergency department due to the baby's persistent and increasing jaundice. Blood testing reveals that the infant's unconjugated bilirubin level is 28 mg/dL, and assessment does not reveal neurologic deficits. The infant's weight is normal, and the mother claims to have had no significant difficulty feeding the infant. The most likely treatment for this infant will be: Intravenous antibiotics Packed red blood cell transfusion Phlebotomy Phototherapy
Phototherapy Explanation: Phototherapy is the standard treatment for mild to moderate hyperbilirubinemia, with exchange transfusion an option for greater risks of kernicterus. Blood transfusions, phlebotomy, and antibiotics are not indicated in hyperbilirubinemia.
A patient 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 Anemia Leukemia Thrombocytopenia
Polycythemia Explanation: Unregulated overproduction of the red cell mass is termed polycythemia.
A patient 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 of the following diagnoses? Polycythemia vera Hemolytic anemia Hyperbilirubinemia Leukemia
Polycythemia vera Explanation: 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.
The client explains to her new provider that she receives periodic phlebotomies to decrease their red blood cell mass. The provider believes the client may have which of the following? Polycythemia vera Sickle cell disease Beta-thalassemia Megaloblastic anemia
Polycythemia vera Explanation: Primary polycythemia, or polycythemia vera, is characterized by an absolute increase in total red blood cell mass. The goal of treatment is to reduce blood viscosity. Withdrawing blood by periodic phlebotomy to reduce red blood cell volume can do this. Sickle cell and beta-thalassemias are treated with transfusions. Megaloblastic anemias, caused by vitamin B12 and folic acid deficiencies, are treated by replacement of these nutrients.
Which of the following would be tested by a complete blood count (CBC)? Lymphocytes and neutrophils Red blood cells and platelets Size and shape of blood cells Sodium and potassium
Red blood cells and platelets Explanation: A CBC is a commonly performed screening test that determines the number of red blood cells, white blood cells, and platelets per unit of blood. Lymphocytes and neutrophils may be included in the CBC if a differential of white blood cells was also ordered. Electrolytes and size/shape of blood cells are not part of a CBC.
The nurse is caring for a client diagnosed with sickle cell disease. Select the most important factor for the nurse to be aware of that may cause the cells to sickle. Acute chest syndrome Reduced oxygen tension while the client sleeps Rapid administration of intravenous fluids Presence of pain in the client's joints
Reduced oxygen tension while the client sleeps Explanation: Factors associated with sickling include cold, stress, physical exertion, infection, dehydration and illnesses that cause hypoxia, dehydration, or acidosis. Even such trivial incidents as reduced oxygen tension induced by sleep may contribute to the sickling process. Pain and acute chest syndrome are complications of sickle cell disease.
The practitioner carefully monitors his client who exhibits hemoglobin S (HbS) genes. The practitioner know that the client is predisposed to life-threatening infection due to damage by HbS to which of the following organs? Pancreas Lungs Heart Spleen
Spleen Explanation: Sickle cell disease is an inherited disorder in which the person has abnormal hemoglobin S (HbS). The spleen is especially susceptible to damage by HbS. The congestion of the spleen predisposes the person to life-threatening infections caused by encapsulated organisms.
When red blood cells age, which of the following organs are responsible for their destruction? Spleen Red bone marrow Kidneys Liver
Spleen Explanation: When red blood cells age, they are destroyed in the spleen.
The neonate displays a yellow discoloration of her skin on the third day of life. The neonatologist explains this condition to the parents. Which of the following statements is most accurate? "The increase in bilirubin, which causes the jaundice, is related to the increased red blood cell breakdown." "Breastfeeding will not affect the bilirubin levels." "Hyperbilirubinemia places the neonate at risk for a cardiac condition known as kernicterus." "Most neonatal jaundice resolves spontaneously within six weeks."
The increase in bilirubin, which causes the jaundice, is related to the increased red blood cell breakdown." Explanation: Physiologic jaundice appears in term infants on the second or third day of life. The increase in bilirubin is related to the increased red cell breakdown and the inability of the immature liver to conjugate bilirubin. Many factors cause elevated bilirubin levels in the neonate, including breastfeeding. Hyperbilirubinemia places the neonate at risk for development of a neurologic syndrome called kernicterus. Most neonatal jaundice resolves spontaneously within one week.
A 48-year-old male client, who normally enjoys good health, has been admitted to the hospital for the treatment of polycythemia vera. The nurse who is providing care for the client should prioritize assessments aimed at the early identification of which of the following health problems? Orthostatic hypotension Thromboembolism Hyperventilation Vasculitis
Thromboembolism Explanation: The increased blood viscosity that accompanies primary polycythemia creates a significant risk of thromboembolism. Hypertension, not hypotension, is also a common sign. Vasculitis and hyperventilation are unlikely to result directly from polycythemia vera.
A nurse assessing a client with an acute exacerbation of polycythemia vera notes coolness to the right leg and foot, pale color and an absent right pedal pulse. Based on these findings the nurse suspects that the client has developed which of the following complications? Thrombosis in the right leg Infection in the right leg Compartment syndrome in the right leg Edema in the right leg
Thrombosis in the right leg Explanation: Unregulated overproduction of the red cell mass is termed polycythemia. Thrombocytosis occurs when the bone marrow produces too many platelets.
When a client is in chronic renal failure, he or she almost always has anemia because of a deficiency of erythropoietin. What else contributes to the anemia experienced by clients in chronic renal failure? Uremic toxins and retained nitrogen Bleeding tendencies and lack of fibrinogen in blood Hemodialysis and decreased nitrogen Hemolysis of RBCs and lack of fibrinogen in blood
Uremic toxins and retained nitrogen Explanation: Chronic renal failure almost always results in anemia, primarily because of a deficiency of erythropoietin. Unidentified uremic toxins and retained nitrogen also interfere with the actions of erythropoietin, and red cell production and survival. Hemolysis and blood loss associated with hemodialysis and bleeding tendencies also contribute to the anemia of renal failure. Fibrinogen is essential for blood clotting, not oxygen transportation.
The nurse is caring for a client who is a strict vegetarian; the client is at greatest risk for the development of: Blood loss anemia Folic acid deficiency anemia Microcytic anemia Vitamin B12 deficiency anemia
Vitamin B12 deficiency anemia Explanation: Vitamin B12 is found in all foods of animal origin. Dietary deficiency is rare and usually found only in strict vegetarians who avoid all dairy products as well as meat and fish. The hallmark of vitamin B12 deficiency is megaloblastic anemia. The other options are not affected by the client being a vegetarian.
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: Aplastic anemia Polycythemia vera Hemolytic anemia Pernicious anemia
polycythemia vera Explanation: 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.
