Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders course point questions

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.

A client with sickle cell disease informs the nurse that he is having chest pain. The nurse hears the client coughing, wheezing, and breathing rapidly. What does the nurse suspect is occurring with this client?

Acute chest syndrome

The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency?

B12

A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from?

Blood loss Abnormal erythrocyte production Destruction of normally formed red blood cells

A nurse cares for a client suspected of having iron deficient anemia. Which diagnostic test will the nurse expect the health care provider to order in order to definitively diagnose the condition?

Bone marrow aspiration

Which is a symptom of hemochromatosis?

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

A client with multiple myeloma reports pain along the spinal column. The client is prescribed naproxen (Aleve) and oxycodone. Prior to administering these medications, the nurse

Checks the client's BUN and creatinine

with what level of platelets do we see things like bleeding and petechia?

less than 20,000

if someone tells your something is right

listen to them "i dont know what but something is wrong"

A client with sickle cell anemia has a

low hematocrit.

Thrombocytopenia

low platelet count

When assessing a client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential?

Health history, such as bleeding, fatigue, or fainting

A nursing instructor is evaluating a student caring for a neutropenic client. The instructor concludes that the nursing student demonstrates accurate knowledge of neutropenia based on which intervention?

Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential

A client with a diagnosis of pernicious anemia comes to the clinic and reports numbness and tingling in the arms and legs. What do these symptoms indicate?

Neurologic involvement

DIC

disseminated intravascular coagulation -not a disease but a disorder

if you cant find a pts pulse what do you do?

first try the dopler

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

sickle cell has bleeding

in the joints, hemophilia does not

protein c&s

inactivate factors V and VIII; enhance fibrinolysis prone to blood clots

Major goals of DIC

include maintenance of hemodynamic status, maintenance of intact skin and oral mucosa, maintenance of fluid balance, maintenance of tissue perfusion, enhanced coping, and absence of complications

The nurse is preparing the patient for a test to determine the cause of vitamin B12 deficiency. The patient will receive a small oral dose of radioactive vitamin B12 followed by a large parenteral dose of nonradioactive vitamin B12. What test is the patient being prepared for?

Schilling test Explanation: The classic method of determining the cause of vitamin B12 deficiency is the Schilling test, in which the patient receives a small oral dose of radioactive vitamin B12, followed in a few hours by a large, nonradioactive parenteral dose of vitamin B12 (this aids in renal excretion of the radioactive dose).

A client with megaloblastic anemia reports mouth and tongue soreness. What instruction will the nurse give the client regarding eating while managing the client's symptoms?

"Eat small amounts of bland, soft foods frequently."

normal platelet count

150,000-300,000

normal INR

2-3 (if mechanical valves want thinner)

A health care provider prescribes one tablet of ferrous sulfate daily for a 15-year-old girl who experiences heavy blood flow during her menstrual cycle. The nurse advises the patient and her parent that this over-the-counter preparation must be taken for how many months before stored iron replenishment can occur?

6 to 12 months

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

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

dementia

Parents arrive to the clinic with their young child and inform the nurse the child has just been diagnosed with sickle cell disease. The parents ask the nurse how this could have happened and which one of them is the carrier. What is the best response by the nurse?

"The child must inherit two defective genes, one from each parent."

DIC 101

- increased HR, decreased bp - impaired gas exchange -decreased perfusion, shock -abd distention -occult blood in stool/emesis (gi bleeding) -watch gums for bleeding -monitor output (the nurse not the aide!) -blood clots kill kidneys -gangrene from bad circulation to feet/hands -pulmonary emboli

potential problems of DIC

-Kidney injury -Gangrene -Pulmonary embolism or hemorrhage -Acute respiratory distress syndrome -Stroke

treatment for neutropenia

-Neupogen -steroids -immunoglobulins

A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the health care provider immediately because the client probably is experiencing which problem?

A hemolytic allergic reaction caused by an antigen reaction

The nurse is talking with the parents of a toddler who was diagnosed with hemophilia A. What instruction should the nurse give to the parents?

Administer factor VIII intravenously at the first sign of bleeding

For a client diagnosed with idiopathic thrombocytopenia purpura (ITP), which nursing intervention is appropriate?

Administering stool softeners, as ordered, to prevent straining during defecation Explanation: The nurse should take measures to prevent bleeding because the client with ITP is at increased risk for bleeding. Straining at stool causes the Valsalva maneuver, which may raise intracranial pressure (ICP), thus increasing the risk for intracerebral bleeding.

A client being treated for iron deficiency anemia with ferrous sulfate continues to be anemic despite treatment. The nurse should assess the client for use of which medication?

Aluminum hydroxide

A client comes to the walk-in clinic complaining of weakness and fatigue. While assessing this client, the nurse finds evidence of petechiae and ecchymoses. The nurse notes that the spleen appears enlarged. What would the nurse suspect is wrong with this client?

Aplastic anemia

A client comes to the walk-in clinic reporting weakness and fatigue. While assessing this client, the nurse finds evidence of petechiae and ecchymoses and notes that the spleen appears enlarged. What would the nurse suspect is wrong with this client?

Aplastic anemia

The nurse cares for a client with iron deficiency anemia. What findings will the nurse expect to find when reviewing the client's CBC results? Select

Decreased MCV Decreased reticulocytes

A nurse cares for a client with a hematological disorder and malnutrition. What is the nurse's best understanding of how the client's nutritional status may worsen the client's hematological condition?

Decreased protein stores lead to decreased immune response

A nurse cares for several clients with anemia and notes that all the clients have different types of anemia. What is the nurse's best understanding of how anemias are classified, based on the deficiency of erythrocytes?

Defective production of erythrocytes Destruction of erythrocytes Loss of erythrocytes

A nurse is reviewing the various manifestations of anemia across the lifespan and notes a significant difference in how the older adult client responds to anemia versus a younger individual. Which concepts related to aging and the response to anemia does the nurse recognize?

Fatigue is often greater than in younger clients. Heart rate does not increase as much as in younger clients. Confusion is often greater than in younger clients.

A nurse provides nutritional information for a patient diagnosed with an iron-deficiency anemia. What education should the nurse provide?

Increase the intake of green, leafy vegetables.

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

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.

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

Pancytopenia

A client awaiting a bone marrow aspiration asks the nurse to explain where on the body the procedure will take place. What body part does the nurse identify for the client?

Posterior iliac crest

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

Take 1 hour before breakfast

A client with chronic anemia has received multiple transfusions. Which client action would the nurse be concerned about relative to the client's condition?

Takes over-the-counter iron supplements

Causes of bleeding disorders

Trauma Platelet abnormality Coagulation factor abnormality

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

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?

Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.

if you have liver disease then you have problems with

bleeding such as petechia, bruises and third spacing

secondary polycythemia

caused by other conditions going on: Sleep apnea Dehydration Smoking COPD/emphysema High altitude

aplastic anemia

characterized by an absence of all formed blood elements caused by the failure of blood cell production in the bone marrow

Neutropenia

deficiency of neutrophils (2000 or less) -normal is 5-10,000

platelets are removed by the

spleen

thrombotic prone

to getting clots

polycythemia vera

too many erythrocytes (RBCs); blood becomes too thick to flow easily through blood vessels

what nursing things do we want to avoid with DIC pts?

trauma procedures that increase risk of bleeding actives that would increase intracranial pressure

with polycythemia we have to

treat the cause -use a CPAP -can do phlebotomy to remove some of the RBCs

Antithrombin deficiency

-inherited deficiency of antithrombin -hypercoaguability, reduced increase in PTT after administration of heparin so cannot give heparin bc it works to activate antithrombin

what happens with DIC?

-leads to massive bleeding hemostasis is altered causing massive clotting and microcirculation. As clotting factors are consumed, bleeding occurs. Symptoms are related to tissue ischemia and bleeding

acquired thrombophilia

1. Antiphospholipid syndrome --> antibody to a protein (B2 glycoprotein) **In vitro --> prolongs aPTT time --> not corrected by mixing study** **In vivo --> predisposes to clots --> strong correlation b/w antiphospholipid syndrome and recurring pregnancy loss** 2. Cancer 3. Pregnancy 4. Smoking

what do we worry about with DIC

Assessing for pulses watch the skin b/c they can have breakdown, bruising and bleeding

A client admitted to the hospital in preparation for a splenectomy to treat autoimmune hemolytic anemia asks the nurse about the benefits of splenectomy. Which statement best explains the expected effect of splenectomy?

It will remove the major site of red blood cell (RBC) destruction.

Hemophilia

A hereditary disease where blood does not coagulate to stop bleeding

A client with severe anemia reports symptoms of tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Laboratory test results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which nursing diagnoses is most appropriate for this client?

Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit

The nurse's role in the management of polycythemia vera is primarily that of an educator. Choose the best health promotion advice that a nurse could give.

Participate in regular phlebotomy procedures to decrease blood viscosity.

After teaching a client about taking daily oral iron preparations for a moderate iron deficiency anemia, which statement by the client indicates to the nurse that additional instruction is needed?

"I will call the doctor if my stools turn black."

"DIC occurs when the immune system attacks platelets and causes massive bleeding."

DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs."

A male client has a hemoglobin count of 10.2 gm/dl, a hematocrit value of 36%, and a low ferritin level. What question should the nurse ask first?

Have you experienced abdominal pain? Explanation: The laboratory data support that the client has iron-deficiency anemia. The most common cause of iron-deficiency anemia in men is bleeding from ulcers, gastritis, inflammatory bowel disease, or gastrointestinal tumors

A client with idiopathic thrombocytopenic purpura (ITP) is admitted to an acute care facility. The nurse monitors the client's platelet count and observes closely for signs and symptoms of bleeding. The client is at greatest risk for cerebral hemorrhage when the platelet count falls below what number?

10,000/?l.

causes of neutropenia

1) Drug toxicity (chemotherapy/pt on radiation) 2) Severe infection (go into tissue to fight infection) 3) aplastic anemia

A client in end-stage renal disease is prescribed epoetin alfa and oral iron supplements. Before administering the next dose of epoetin alfa and oral iron supplement, what is the priority action taken by the nurse?

Assesses the hemoglobin level Explanation: Erythropoietin (epoetin alfa [Epogen]) with oral iron supplements can raise hematocrit levels in the client with end-stage renal disease.

Which of the following are assessment findings associated with thrombocytopenia?

Bleeding gums Epistaxis Hematemesis

A nurse working with clients diagnosed with sickle cell disease notices that sickle cell crisis cases increase in the winter months. What is the primary pathophysiological reason for this?

Colder temperatures slows the blood flow.

You are caring for a 13-year-old diagnosed with sickle cell anemia. The client asks you what they can do to help prevent sickle cell crisis. What would be an appropriate answer to this client?

Drink at least 8 glasses of water every day. Explanation: During the physical examination, observe the client's appearance, looking for evidence of dehydration, which may have triggered a sickle cell crisis. Clients are taught moderation, not avoidance of activities. Most clients with sickle cell disease are not on oxygen therapy 24/7.

The nurse and the client are discussing some strategies for ingesting iron to combat the client's iron-deficiency anemia. Which is among the nurse's strategies?

Drink liquid iron preparations with a straw.

Which iron-rich foods should a nurse encourage an anemic client requiring iron therapy to eat?

Lamb and peaches

The nurse obtains a unit of blood for the client, Donald D. Smith. The name on the label on the unit of blood reads Donald A. Smith. All the other identifiers are correct. What action should the nurse take?

Refuse to administer the blood

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.

Hemophilia A is the most common of the three types of hemophilia. What is diminished in the less serious form of hemophilia A, known as von Willebrand's disease?

amount and quality of factor VIII

A patient describes numbness in the arms and hands with a tingling sensation. The patient also frequently stumbles when walking. What vitamin deficiency does the nurse determine may cause some of these symptoms?

B12

A client is hospitalized 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin at home, which is now discontinued. To prevent the formation of blood clots, which action should the nurse take?

Administer the prescribed enoxaparin (Lovenox).

A client receiving a blood transfusion experiences an acute hemolytic reaction. What is the nurse's priority intervention?

Immediately stop the transfusion, infuse normal saline solution, call the health care provider, and notify the blood bank.

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. Explanation: 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

how do we treat DIC?

-heparin or LMWH -pt may need intubated, they cant get 02 -Eliminate the underlying condition -replace fluids and electrolytes -replace coagulation factors -bring up blood pressure

A female patient has a hemoglobin of 6.4 g/dL and is preparing to have a blood transfusion. Why would it be important for the nurse to obtain information about the patient's history of pregnancy prior to the transfusion?

A high number of pregnancies can increase the risk of reaction.

A nurse caring for a client who has hemophilia is getting ready to take the client's vital signs. What should the nurse do before taking a blood pressure?

Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints.

Which is a symptom of Cooley anemia?

Bronzing of the skin

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?

Low ferritin level concentration

A nurse is caring for a client with thalassemia who is being transfused. What is the nurse's role during a transfusion?

To closely monitor the rate of administration

A nurse is doing a physical examination of a child with sickle cell anemia. When the child asks why the nurse auscultates the lungs and heart, what would be best the response by the nurse?

To detect the abnormal sounds suggestive of acute chest syndrome and heart failure

causes of DIC

-Sepsis -Trauma -Shock -Cancer -Abruptio placentae -toxins -allergic reactions

how do we treat bleeding disorders and what do we teach the pt?

-treat with PRBCs, FFP, platelets, albumin (give them what they are lacking) -teach the pt to use an electric razor, a soft bristle tooth brush, not to leave the blood pressure cuff on for longer than necessary (should only go 20-30 higher than normal systolic pressure) -hold pressure longer with shots/ivs -pt needs to report things like gum bleeding

The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia?

Erythrocytes that are microcytic and hypochromic

A patient has been diagnosed with thrombocytopenia. What are the primary nursing interventions while instituting corticosteroid therapy in this patient?

Gradually taper the dose and frequency of medication. Explanation: For a patient with thrombocytopenia, he or she gradually tapers the dose and frequency of steroid medication before discontinuing it to avoid adrenal insufficiency or crisis.

A patient has a probable diagnosis of polycythemia vera. The nurse reviews the patient's lab work for which diagnostic indicator?

Hematocrit of 60%

thrombocytosis

an abnormal increase in the number of platelets in the circulating blood -bleeding, or infection can cause more platelets to be produced