Hematologic Disorders

The patient receiving a blood transfusion is at risk for which type of anemia? A. Hemolytic B. Sickle cell C. Aplastic D. Iron deficiency

A. Hemolytic Blood transfusions can cause hemolytic anemia if lymphocytes in the transfused blood make antibodies against the person receiving the blood. Iron deficiency anemia results from a diet too low in iron or from the body not absorbing enough iron from the GI tract. Sickle cell anemia is a genetic disease that occurs almost exclusively in African Americans. Aplastic anemia results from the complete failure of the bone marrow.

The nurse is providing preoperative teaching to a patient scheduled to undergo a gastrectomy. The nurse prepares the patient about what expected consequence of the procedure? A. Monthly B12 injections for life B. Monthly phlebotomy appointments C. Positive Coombs test result D. Increased risk for aplastic anemia

A. Monthly B12 injections for life Patients who have a gastrectomy will need B12 injections for life because they cannot make intrinsic factor and therefore cannot absorb vitamin B12. Patients are prescribed a monthly intramuscular injection of vitamin B12 for life. A positive Coombs test result is associated with autoimmune hemolytic anemia, not gastrectomy. Patients who have gastrectomy are no more likely to have bone marrow failure (aplastic anemia). Patients who have polycythemia vera are instructed to regularly have their blood phlebotomized.

How does the body compensate for blood loss? (Select all that apply.) A. Dilating blood vessels B. Redistributing blood away from the skin, GI tract, and kidneys to the brain and heart C. Increasing the production of erythropoietin D. Increasing heart and respiratory rate E. Increasing circulation of intrinsic factor

B. Redistributing blood away from the skin, GI tract, and kidneys to the brain and heart C. Increasing the production of erythropoietin D. Increasing heart and respiratory rate Depending on whether the anemia is acute or chronic, the body compensates in three ways: (1) by increasing heart rate and respiratory rate to circulate the existing RBCs as quickly as possible with as much O2 as possible; (2) by redistributing the blood away from the skin, GI tract, and kidneys to the brain and heart; and (3) by increasing the production of erythropoietin, the hormone that stimulates the bone marrow to produce more RBCs. Dilating blood vessels and increasing circulation of intrinsic factor would not help the body compensate for blood loss.

The nurse is teaching the patient with sickle cell anemia about the disease. What stressors does she warn the patient about? (Select all that apply.) A. Hot, humid weather B. Smoking C. Infection D. Dehydration E. Exercise

B. Smoking C. Infection D. Dehydration Various stressors can trigger a sickle cell crisis. They include dehydration, infection, overexertion, cold weather changes, excessive alcohol consumption, and smoking.

The patient is admitted with polycythemia vera. What procedure does the nurse prepare the patient for? A. Vitamin B12 injection B. Therapeutic phlebotomy C. Bone marrow transplant D. Blood transfusion

B. Therapeutic phlebotomy Treatment for polycythemia vera is to have 1 U of blood (250 to 500 mL) phlebotomized, or taken off, to keep the patient's Hct normal. Vitamin B12 injection is the treatment for pernicious anemia. Blood transfusion may be needed for hemolytic anemia. Bone marrow transplant may be considered for patients with aplastic anemia.

A patient has received instructions on foods high in iron to help with iron deficiency anemia. Which food item, if selected by the patient for a meal, indicates that the patient understands the instructions? A. Peanut butter B. Oranges C. Spinach D. Milk

C. Spinach Foods highest in iron include red meats and dark green vegetables such as spinach. Many dairy products block the absorption of iron. Oranges are not high in iron but are high in vitamin C, which enhances the absorption of iron. Peanut butter is a good source of fats but not iron.

Which statement made by the patient indicates a priority for a patient with sickle cell disease? A. "I wish I knew how to prevent this from happening over and over again." B. "My family expects me to take care of everything, even when I'm sick." C. "I'm anxious about being in the hospital. I don't know anyone here." D. "My pain started all of a sudden, and it's 9 on a 0 to 10 scale."

D. "My pain started all of a sudden, and it's 9 on a 0 to 10 scale." The patient has acute pain because sickle cell disease causes severe pain during a crisis. During the acute stage, patients are administered intravenous narcotics. Although it is important to reduce anxiety, it is not the first priority. Also, anxiety tends to decrease when the patient has adequate pain medication. Lack of knowledge about preventive measures could have led to this event, but patient education can be done throughout the patient's stay, but pain needs to be treated immediately. Before discharge, patients with sickle cell disease need to be educated to prevent crises. Compromised family coping is not a priority because patient and family education can be completed at a later time before discharge.

A 6-year-old patient was recently diagnosed with hemophilia. Which responses by the parents indicate appropriate knowledge of the disease? A. "We keep our CPR up to date." B. "We carry an Epi-Pen at all times." C. "We get his monthly vitamin B12 shot." D. "We know how to administer replacement factor."

D. "We know how to administer replacement factor." Parents of children with hemophilia need to understand the importance of administering replacement factor. If an injury occurs at home, treatment can begin promptly to minimize blood loss. Epi-Pens are used for anaphylaxis, not hemophilia. Although CPR is important, it does not help the child with hemophilia. Getting a monthly vitamin B12 shot is for patients with pernicious anemia, not hemophilia.

During shift change, the night shift nurse reports that a patient has orthostatic hypotension. Which information is most important to include in patient education? A. How to prevent deep vein thrombosis B. When the patient can receive pain medication again C. The importance of smoking cessation D. How to press the call light when need to use the restroom

D. How to press the call light when need to use the restroom Patients who have orthostatic hypotension are at risk for falls. The nurse should educate the patient to press the call light when he or she needs to use the restroom. The nurse or aide should assist the patient to the restroom to decrease the risk for falls. Although smoking cessation, how to prevent deep vein thrombosis, and when the patient can receive pain medication again are important topics to teach patients, they are not specific to patients who have orthostatic hypotension.

Along with fatigue and pallor, which finding noted during data collection may indicate pernicious anemia? A. Ruddy complexion B. Blurred vision C. Ringing in the ears D. Sore tongue

D. Sore tongue In addition to the fatigue and pallor commonly seen with all anemias, symptoms of pernicious anemia characteristically include weakness, a sore tongue, and numbness of the hands or feet. A ruddy complexion is common with patients who have polycythemia vera. Other symptoms of polycythemia vera include headache, dizziness, ringing in the ears, and blurred vision.