CHAPTER 40: CARE OF PATIENTS WITH HEMATOLOGIC PROBLEMS

19. The nurse is assessing a client with anemia. Which clinical manifestation does the nurse expect to see in this client? a. Dyspnea with activity b. Hypertension c. Bradycardia d. Warm, flushed skin

ANS: A Anemia is a reduction in the number of red blood cells (RBCs), the amount of hemoglobin, or the hematocrit level. Tissue oxygenation depends on RBCs. Typical symptoms of anemic clients include dyspnea, increased somnolence, tachycardia, and pallor. A client who is anemic tends to have lower blood pressure, increased heart rate, and skin that is pale and cool to touch.

13. Which risk factor does the nurse assess for to determine a client's cause of anemia? a. Antacid therapy b. Chronic alcoholism c. Congestive heart failure d. Type 2 diabetes

ANS: B Chronic alcohol abuse is strongly associated with malnutrition of many dietary essentials, including iron, folic acid, and vitamin B12. Antacids, heart failure, and diabetes affect nutrition at varying levels, but anemia is most closely related to the malnutrition seen with chronic alcohol abuse.

23. The nurse is teaching a client who was recently diagnosed with thrombocytopenia. Which instruction does the nurse include in this client's discharge teaching? a. "Drink at least 3 liters of fluid each day." b. "Use a soft-bristled toothbrush." c. "Avoid blowing your nose." d. "Use only aspirin when having pain."

ANS: B Decreased platelet counts increase the risk for prolonged bleeding, even with slight injury. Fluid intake will not affect the platelet count. The client can blow his or her nose if necessary but should be instructed to do so gently. Aspirin should be avoided because it can cause an even greater risk of bleeding.

12. The nurse assesses that a client has a smooth, beefy red tongue. Which intervention does the nurse implement for this client? a. Administer prescribed oral iron supplements. b. Monitor the daily white blood cell count. c. Provide a diet high in green leafy vegetables. d. Perform more frequent mouth care.

ANS: C A smooth, beefy red tongue could signify glossitis, which is seen with vitamin B12 deficiency. Green leafy vegetables are high in vitamin B12. Iron supplements would be used with iron deficiency anemia. The red blood cell count is what is affected by vitamin B12 deficiency—not the white blood cell count. The beefy red tongue is caused by the vitamin deficiency, not by poor mouth care.

22. A client who has sickle cell anemia is admitted to the hospital. The client reports severe pain. Which action does the nurse take first? a. Administer one unit of packed red blood cells. b. Administer prescribed hydroxyurea (Droxia). c. Begin intravenous fluids at 250 mL/hr. d. Prepare for bone marrow transplantation.

ANS: C All of these are treatments for sickle cell anemia. However, the client in severe pain is likely to be in sickle cell crisis. To prevent further sickling of the red blood cells, adequate hydration of at least 200 mL/hr is needed during a crisis. The other interventions should be implemented after the fluids are started.

21. A client is newly diagnosed with sickle cell anemia. Which information does the nurse include in the client's discharge instructions? a. "Eat a diet high in iron." b. "Take hydroxyurea (Droxia) every morning." c. "Be aware of the early symptoms of crisis." d. "Do not use any oral contraceptives."

ANS: C Clients need to know the early symptoms of crisis so that treatment can be started early to prevent pain, complications, and permanent tissue damage. The iron level is not low in sickle cell anemia. Hydroxyurea is used in the hospital during a sickle cell crisis. The use of oral contraceptives is controversial because they may enhance clot formation, predisposing the client to crisis.

20. The nurse is transfusing red blood cells to a client who has sickle cell disease. Which laboratory result indicates that the nurse should discontinue the transfusion? a. Hematocrit level (Hct), 32% b. Hemoglobin S, 88% c. Serum iron level, 300 mcg/dL d. Total white blood cell count, 12,000/mm3

ANS: C Clients with sickle cell disease are anemic but are not iron deficient. Transfusions are prescribed cautiously to prevent iron overload with repeated transfusions. Iron overload damages the heart, liver, and endocrine organs. Monitor the client's serum ferritin, serum iron (Fe), and total iron-binding capacity (TIBC) during transfusion therapy. The other laboratory values should not result in discontinuation of the transfusion by the nurse.

18. The nurse is caring for a client during a sickle cell crisis. Which intervention does the nurse implement for the client? a. Administer acetaminophen (Tylenol) as needed. b. Administer intravenous fluids to keep the vein open. c. Keep the room temperature at 80° F. d. Transfuse red blood cells (RBCs).

ANS: C Keeping the room warm can be used as a complementary therapy to relieve the pain of a sickle cell crisis. Cold can act as a factor in causing a crisis. Analgesia is an important part of relieving pain. The analgesia routine should be followed on an around-the-clock basis and should consist of IV opioids for severe pain, followed by treatment with oral doses of opioids or NSAIDs. High-volume intravenous fluids should be administered to minimize pain during a sickle cell crisis.

10. The nurse is teaching a client with vitamin B12 deficiency anemia to eat a diet high in this vitamin. Which meal selected by the client indicates that the client correctly understands the prescribed diet? a. Baked chicken breast, mashed potatoes, glass of milk b. Eggplant parmesan, cottage cheese, iced tea c. Fried liver and onions, orange juice, spinach salad d. Fettuccine alfredo, green salad, glass of red wine

ANS: C Organ meats and leafy green vegetables have the highest content of vitamin B12. The other selections do not indicate understanding of the teaching on diet.

11. The nurse is teaching a client who has iron deficiency anemia. Which food choice indicates that the client correctly understands the teaching? a. Chicken b. Oranges c. Steak d. Tomatoes

ANS: C Treatment for iron deficiency anemia involves increasing oral intake of iron from food sources. Foods high in iron include red meat, organ meat, kidney beans, leafy green vegetables, and raisins.

2. The nurse is teaching a client who has sickle cell disease and was admitted for splenomegaly and abdominal pain. Which instruction does the nurse include in the client's discharge teaching? a. "Avoid drinking large amounts of fluids." b. "Eat six small meals daily instead of large meals." c. "Engage in aerobic exercise 3 days a week." d. "Receive a yearly influenza vaccination."

ANS: D Abdominal pain and a palpable spleen could indicate blood trapping in the spleen. Over time, the spleen may become nonfunctional, which makes the client at risk for infection. An annual influenza vaccination helps prevent infection. A client with sickle cell disease should not become dehydrated or engage in strenuous physical activity because this could precipitate a crisis. Eating smaller meals has no impact on sickle cell disease or infection.