Chapter 33 - Nonmalignant Hematologic Disorders - Exam 1

A client with idiopathic thrombocytopenic purpura (ITP), an autoimmune disorder, is admitted to an acute care facility. Concerned about hemorrhage, 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: 1. 135,000/μl. 2. 75,000/μl. 3. 20,000/μl. 4. 500/μl.

10,000/?I.

Ferrous sulfate is prescribed daily for client with heavy menstrual cycle. How many months before stored iron replenishment can occur?

6 to 12 months

Client weak and fatigued. nurse finds evidence of petechiae and ecchymoses. Nurse notes that the spleen appears enlarged. What would the nurse suspect is wrong with this client?

Aplastic anemia

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

Apply prolonged pressure to needle sites or other sources of external bleeding

A nurse cares for a client with anemia requiring nutritional supplementation. Which nursing intervention best promotes client adherence with the prescribed therapy?

Assist the client to incorporate the therapeutic regimen into daily activities

Client with 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

A patient with end stage kidney disease is taking recombinant erythropoietin for the treatment of anemia. What lab study does the nurse understand will have to be assessed at least monthly related to this medication?

Hemoglobin level

The nurse is collecting data for a client who has been diagnosed with iron deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia?

I have difficulty breathing when walking 30 feet

After teaching a client about taking daily oral 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

Review of morning labs for a client reporting severe fatigue and a red, swollen tongue, nurse suspects chronic, severe iron deficiency anemia based on which finding?

Low ferritin level concentration

A pregnant women 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

What would you recommend the client to consume to promote the absorption of iron?

Rich sources of vitamin C

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

Take 1 hour before breakfast

Young 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

A client is treated for anemia. What is the nurse's best understanding about the correlation between anemia and client's iron stores?

There is a strong correlation between iron stores and hemoglobin levels

Which medication is the antidote to warfarin?

Vitamin K

"A few minutes after beginning a blood transfusion, the nurse notes that the client has chills, dyspnea, and urticaria. The nurse reports this to the physician immediately because the client probably is experiencing:

a hemolytic allergic reaction caused by an antigen reaction

Client has pale nailbeds, hemoglobin is 10.2 gm/dL and hematocrit count is 30%. reports fatigue and tired all the time. Excessive menstrual flow. client is prescribed supplemental iron therapy. The HIGHEST nursing diagnosis is

altered tissue perfusion related to diminished oxygen - carrying capacity of the blood

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

amount and quality of factor VIII

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

assesses the hemoglobin level

The client has been diagnosed with myelodysplastic syndrome with an absolute neutrophil count less than 1000/mm3 and is being admitted to the hospital. The nurse

assigns the client to a private room

The most common cause of iron deficiency anemia in men and postmenopausal women is

bleeding

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

hematologic disorder and malnutrition. What is the nurses BEST understanding of how the client's nutritional status may worsen the clients condition

decreased protein stores lead to decreased immune response

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

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

a nurse should expect to administer which vaccine to the client after a splenectomy?

Pneumovax 23

Which of the following is considered an antidote to heparin?

Protamine sulfate

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

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

A client with sepsis is experiencing disseminated intravascular coagulation (DIC). The client is bleeding from mucous membranes, venipuncture sites and rectum. Blood is present in the urine. The nurse establishes nursing diagnosis of risk for deficient fluid volume related to bleeding. The most appropriate and measurable outcome for this client is that the client exhibits

Urine output greater than or equal to 30 mL/hour

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 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

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?

dilute the liquid preparation with another liquid such as juice and drink with a straw

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

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

lamb and peaches

client with hodgkin disease who has developed neutropenia, what is an appropriate nursing intervention to include in the care plan?

monitoring temperature every 4 hours

Client in ED has severe nosebleed and asks for a bedpan. The nurse documents the stool as loose, tarry and black. The nurse suspects the client may have thrombocytopenia. What should the nurse's priority action?

notify the physician

Nurse is caring for 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

Which is a symptom of hemochromatosis?

Bronzing of the skin

The nurse is educating a client about iron supplements. The nurse teaches that what vitamin enhances the absorption of iron?

C

Client reports feeling tired, cold and SOB at times. Assessment reveals tachycardia and reduced energy. What would the nurse expect the physician to order?

CBC

A client's family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC?

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

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

Nurse observes labs for client with fatigue, feeling cold all the time and hemoglobin of 8.6 g/dL and hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia?

Erythrocytes that are microcytic and hypochromic

Patient has probable diagnosis of polycythemia vera. nurse reviews lab work for which diagnostic indicator?

Hematocrit of 60%

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?

I will receive parental vitamin B12 therapy for the rest of my life

Client diagnosed with atrial fibrillation who is ordered warfarin. Nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching?

I'll eat four servings of fresh, dark green vegetables every day

A female client with beta-thalassemia trait plans to marry a man of italian ancestry who also has the trait. Which client statement indicates that she understands the teaching provided by the nurse?

I'll see a genetic counselor before starting a family

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

Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit

The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nruse need to include a nutritional assessment for this patient?

It may indicate deficiencies in essential nutrients

A client 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

A client with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse?

Obtain the pain medication and delay the bath and position change until the medication reaches its peak

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

Pallor, tachycardia, sore tongue

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

Pancytopenia

A client is seen in the emergency department with severe pain related to 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

Client admitted to 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

onto the bedpan

While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters?

platelet count, prothrombin time, partial thromboplastin time

A client awaiting 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

Older client is to receive 2 units of PRBCs. During the transfusion of the first unit at 125mL/hour, the client reports shortness of breath 30 minutes into the process. The client exhibits the vital signs shown in the accompanying table. What is the nurse's best intervention?

slow the rate of the transfusion and obtain an order for furosemide

A client with hemophilia was admitted after sustaining an injury while playing outdoors. Initially client presented with severe bleeding but has stabilized. Which interventions will the nurse include in the care plan for this client?

support painful joints on pillows encourage the client to use soft toothbrush and rinse mouth with warm water between meals eliminate aspirin and NSAIDs

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