Hematology

A client with anemia may be tired due to a tissue deficiency of which of the following substances? A Carbon dioxide B Factor VIII C Oxygen D T-cell antibodies

C Oxygen

Which of the following nursing assessments is a late symptom of polycythemia vera? A Headache B Dizziness C Pruritus D Shortness of breath

C Pruritus

Nursing assessment for a patient with leukemia should include observation for: a. fever and infection. c. petechiae and ecchymoses. b. dehydration. d. all of the above.

d. all of the above.

The nurse is told by a health care provider that a client in hypovolemic shock will require plasma expansion. The nurse should prepare which supplies for transfusion? 1.Bag of platelets with filtered tubing 2.Bottle of albumin with vented tubing 3.Cryoprecipitate bag with vented tubing 4.Infusion pump and bag of packed red blood cells

2.Bottle of albumin with vented tubing Albumin in a colloid used for volume expansion

You're providing discharge teaching to a patient about pernicious anemia. Which statement by the patient indicates they did NOT understand the discharge teaching? A. "Pernicious anemia is caused by not consuming enough Vitamin B12." B. "Pernicious anemia causes the red blood cells to appear very large and oval." C. "Treatment for pernicious anemia includes a series of intramuscular injections of Vitamin B12." D. "A red, smooth tongue can be a sign of pernicious anemia."

A. "Pernicious anemia is caused by not consuming enough Vitamin B12."

Which of the following foods would the nurse encourage the mother to offer to her child with iron deficiency anemia? A Rice cereal, whole milk, and yellow vegetables B Potato, peas, and chicken C Macaroni, cheese, and ham D Pudding, green vegetables, and rice

B Potato, peas, and chicken

A nurse who cares for a patient who has experienced bone marrow aspiration or biopsy should be aware of the most serious hazard of: a. hemorrhage. c. shock. b. infection. d. splintering of bone fragments.

a. hemorrhage.

Which menu choice indicates that the patient understands the nurse's teaching about recommended dietary choices for iron-deficiency anemia? a.Omelet and whole wheat toast c.Strawberry and banana fruit plate b.Cantaloupe and cottage cheese d.Cornmeal muffin and orange juice

a.Omelet and whole wheat toast

A nurse should know that a diagnosis of hemolytic anemia is associated with all of the following except: a. abnormality in the circulation of plasma. c. defect in the erythrocyte. b. decrease in the reticulocyte count. d. elevated indirect bilirubin.

b. decrease in the reticulocyte count.

The nurse notes that a patient, who is a vegetarian, has an abnormal number of megaloblasts. The nurse suspects a deficiency in: a. iron. c. vitamin C. b. zinc. d. vitamin B12.

d. vitamin B12.

The nurse is preparing to perform an assessment on a client being admitted to the hospital with a diagnosis of sickle cell crisis, vaso-occlusive crisis. Which findings should the nurse expect to note on assessment of the client? Select all that apply. 1.Pallor 2.Fever 3.Joint swelling 4.Blurred vision 5.Abdominal pain

1.Pallor 2.Fever 3.Joint swelling 5.Abdominal pain Sickle cell crises are acute exacerbations of the disease. Vaso-occlusive crisis is caused by stasis of blood with clumping of cells in the microcirculation, ischemia, and infarction. Manifestations include pallor; fever; painful swelling of hands, feet, and joints; and abdominal pain. Blurred vision is not a manifestation of vaso-occlusive crisis

Which of the following symptoms is expected with hemoglobin of 10 g/dl? A None B Pallor C Palpitations D Shortness of breath

A None Mild anemia is usually asymptomatic.

Select ALL the signs and symptoms that can present in pernicious anemia: A. Erythema B. Paresthesia of hands and feet C. Racing thoughts D. Extreme hunger E. Depression F. Unsteady gait G. Shortness of breath with activity

B. Paresthesia of hands and feet E. Depression F. Unsteady gait G. Shortness of breath with activity

Which of the following disorders results from a deficiency of factor VIII? A Sickle cell disease B Christmas disease C Hemophilia A D Hemophilia B

C Hemophilia A Hemophilia A results from a deficiency of factor VIII. Sickle cell disease is caused by a defective hemoglobin molecule. Christmas disease, also called hemophilia B, results in a factor IX deficiency.

The nurse has just admitted a 35-year-old female client who has a serum B12 concentration of 800 pg/ml. Which of the following laboratory findings would cue the nurse to focus the client history on specific drug or alcohol abuse? A Total bilirubin, 0.3 mg/dL B Serum creatinine, 0.5 mg/dL C Hemoglobin, 16 g/dL D Folate, 1.5 ng/mL

D Folate, 1.5 ng/mL The normal range of folic acid is 1.8 to 9 ng/mL, and the normal range of vitamin B12 is 200 to 900 pg/mL. A low folic acid level in the presence of a normal vitamin B12 level is indicative of a primary folic acid-deficiency anemia. Factors that affect the absorption of folic acid are drugs such as methotrexate, oral contraceptives, antiseizure drugs, and alcohol. The total bilirubin, serum creatinine, and hemoglobin values are within normal limits.

The physician has ordered several laboratory tests to help diagnose an infant's bleeding disorder. Which of the following tests, if abnormal, would the nurse interpret as most likely to indicate hemophilia? A Bleeding time B Tourniquet test C Clot retraction test D Partial thromboplastin time (PTT)

D Partial thromboplastin time (PTT) PTT measures the activity of thromboplastin, which is dependent on intrinsic clotting factors. In hemophilia, the intrinsic clotting factor VIII (antihemophilic factor) is deficient, resulting in a prolonged PTT. Bleeding time reflects platelet function; the tourniquet test measures vasoconstriction and platelet function; and the clot retraction test measures capillary fragility. All of these are unaffected in people with hemophilia.

You're providing seminar teaching to a group of nurses about sickle cell anemia. Which of the following is NOT a treatment for this condition? A. Blood transfusion B. Stem cell transplant C. Intravenous fluids D. Iron supplements E. Antibiotics F. Morphine

D. Iron supplements Iron supplements are not prescribed (rather Folic Acid) because this type of anemia is not caused by low iron levels, and patients who take iron supplements with sickle cell disease are at risk for building up too much iron in the body, which will damage the organs.

During an outpatient well visit with a patient who has sickle cell anemia, you make it PRIORITY to assess the patient's? A. hemoglobin A1C level B. heart rate C. reflexes D. vaccination history

D. vaccination history Patients will sickle cell anemia are at risk for infection because of spleen compromise. Many patients with SCA experience splenomegaly because blood flow is compromised to the spleen due to sickling of RBCs and the spleen is overworked from recycling the old RBCs (remember a patient with sickle cell anemia does NOT have long-living RBCs...the RBCs tend to die in 20 days rather than 120 days). Therefore, vaccination history is very important. The patient should be up-to-date with the flu, pneumococcal, and meningococcal vaccines.

Which action will the nurse include in the plan of care for a patient admitted with multiple myeloma? a.Monitor fluid intake and output. b.Administer calcium supplements. c.Assess lymph nodes for enlargement. d.Limit weight bearing and ambulation.

a.Monitor fluid intake and output. A high fluid intake and urine output helps prevent the complications of kidney stones caused by hypercalcemia and renal failure caused by deposition of Bence-Jones protein in the renal tubules. Weight bearing and ambulation are encouraged to help bone retain calcium. Lymph nodes are not enlarged with multiple myeloma. Calcium supplements will further increase the patient's calcium level and are not used.

An appropriate nursing intervention for a patient with non-Hodgkin's lymphoma whose platelet count drops to 18,000/µL during chemotherapy is to a.check all stools for occult blood. b.encourage fluids to 3000 mL/day. c.provide oral hygiene every 2 hours. d.check the temperature every 4 hours.

a.check all stools for occult blood. Because the patient is at risk for spontaneous bleeding, the nurse should check stools for occult blood.

The classic presenting symptom of multiple myeloma is: a. debilitating fatigue. b. bone pain in the back of the ribs. c. gradual muscle paralysis. d. severe thrombocytopenia.

b. bone pain in the back of the ribs.

An elderly patient presents to the physician's office with a complaint of exhaustion. The nurse, aware of the most common hematologic condition affecting the elderly, knows to check the patient's: a. white blood cell count. c. thrombocyte count. b. red blood cell count. d. levels of plasma proteins.

b. red blood cell count.

A patient who has been receiving IV heparin infusion and oral warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when the platelet level drops to 110,000/µL. Which action will the nurse include in the plan of care? a.Prepare for platelet transfusion. b.Discontinue the heparin infusion. c.Administer prescribed warfarin (Coumadin). d.Use low-molecular-weight heparin (LMWH).

b.Discontinue the heparin infusion.

A patient who is receiving methotrexate for severe rheumatoid arthritis develops a megaloblastic anemia. The nurse will anticipate teaching the patient about increasing oral intake of a.iron. c.cobalamin (vitamin B12). b.folic acid. d.ascorbic acid (vitamin C).

b.folic acid.

The nurse assesses a patient who has numerous petechiae on both arms. Which question should the nurse ask the patient? a."Are you taking any oral contraceptives?" b."Have you been prescribed antiseizure drugs?" c."Do you take medication containing salicylates?" d."How long have you taken antihypertensive drugs?"

c."Do you take medication containing salicylates?" Salicylates interfere with platelet function and can lead to petechiae and ecchymoses.

Which action will the nurse include in the plan of care for a patient who has thalassemia major? a.Teach the patient to use iron supplements. b.Avoid the use of intramuscular injections. c.Administer iron chelation therapy as needed. d.Notify health care provider of hemoglobin 11 g/dL.

c.Administer iron chelation therapy as needed.

The nurse notes pallor of the skin and nail beds in a newly admitted patient. The nurse should ensure that which laboratory test has been ordered? a.Platelet count c.Hemoglobin level b.Neutrophil count d.White blood cell count

c.Hemoglobin level

The complete blood count (CBC) indicates that a patient is thrombocytopenic. Which action should the nurse include in the plan of care? a.Avoid intramuscular injections. c.Check temperature every 4 hours. b.Encourage increased oral fluids. d.Increase intake of iron-rich foods.

a.Avoid intramuscular injections. Thrombocytopenia is a decreased number of platelets, which places the patient at high risk for bleeding. Neutropenic patients are at high risk for infection and sepsis and should be monitored frequently for signs of infection. Encouraging fluid intake and iron-rich food intake is not indicated in a patient with thrombocytopenia.

Which patient information is most important for the nurse to monitor when evaluating the effectiveness of deferoxamine (Desferal) for a patient with hemochromatosis? a.Skin color c.Liver function b.Hematocrit d.Serum iron level

d.Serum iron level

The nurse is picking up a unit of packed red blood cells at the hospital blood bank. After putting the pen down, the nurse glances at the clock, which reads 1300. The nurse calculates that the transfusion must be started by which time? 1.1330 2.1400 3.1430 4.1500

1.1330 Blood must be hung as soon as possible (within 30 minutes) after it is obtained from the blood bank. After that time, the blood temperature will be higher than 50°F (10°C), and the blood could be unsafe for use. For this reason, the remaining options are incorrect.

The nurse is assisting in monitoring a client who is receiving a transfusion of packed red blood cells (PRBCs). Before leaving the room, the nurse tells the client to immediately report which symptoms of a transfusion reaction? Select all that apply. 1.Chills 2.Fatigue 3.Sleepiness 4.Chest pain 5.Lower back pain 6.Difficulty breathing

1.Chills 4.Chest pain 5.Lower back pain 6.Difficulty breathing

The nurse is performing an assessment on a client with a diagnosis of pernicious anemia. Which finding would the nurse expect to note in this client? 1.Dyspnea 2.Dusky mucous membranes 3.Shortness of breath on exertion 4.Red tongue that is smooth and sore

4.Red tongue that is smooth and sore Classic signs of pernicious anemia include weakness, mild diarrhea, and a smooth red tongue that is sore. The client also may have nervous system signs and symptoms such as paresthesias, difficulty with balance, and occasional confusion. The client does not exhibit dyspnea, the mucous membranes do not become dusky, and the client does not exhibit shortness of breath.

A client with macrocytic anemia has a burn on her foot and states that she had been watching television while lying on a heating pad. What is the nurse's first response? A Assess for potential abuse B Check for diminished sensations C Document the findings D Clean and dress the area

B Check for diminished sensations Macrocytic anemias can result from deficiencies in vitamin B12 or ascorbic acid. Only vitamin B12 deficiency causes diminished sensations of peripheral nerve endings. The nurse should assess for peripheral neuropathy and instruct the client in self-care activities for her diminished sensation to heat and pain. The burn could be related to abuse, but this conclusion would require more supporting data. The findings should be documented, but the nurse would want to address the client's sensations first. The decision of how to treat the burn should be determined by the physician.

A mother asks the nurse if her child's iron deficiency anemia is related to the child's frequent infections. The nurse responds based on the understanding of which of the following? A Little is known about iron-deficiency anemia and its relationship to infection in children B Children with iron deficiency anemia are more susceptible to infection than are other children C Children with iron-deficiency anemia are less susceptible to infection than are other children D Children with iron-deficient anemia are equally as susceptible to infection as are other children.

B Children with iron deficiency anemia are more susceptible to infection than are other children

The nurse is caring for a patient with type A hemophilia being admitted to the hospital with severe pain and swelling in the right knee. The nurse should a.apply heat to the knee. b.immobilize the knee joint. c.assist the patient with light weight bearing. d.perform passive range of motion to the knee.

b.immobilize the knee joint. Initial action should be total rest of the knee to minimize bleeding.

A nurse reviews the laboratory data for an older patient. The nurse would be most concerned about which finding? a.Hematocrit of 35% b.Hemoglobin of 11.8 g/dL c.Platelet count of 400,000/µL d.White blood cell (WBC) count of 2800/µL

d.White blood cell (WBC) count of 2800/µL Because the total WBC count is not usually affected by aging, the low WBC count in this patient would indicate that the patient's immune function may be compromised and the underlying cause of the problem needs to be investigated. The platelet count is normal. The slight decrease in hemoglobin and hematocrit are not unusual for an older patient.

A child suspected of having sickle cell disease is seen in a clinic, and laboratory studies are performed. A nurse checks the lab results, knowing that which of the following would be increased in this disease? A Platelet count B Hematocrit level C Reticulocyte count D Hemoglobin level

C Reticulocyte count A diagnosis is established based on a complete blood count, examination for sickled red blood cells in the peripheral smear, and hemoglobin electrophoresis. Laboratory studies will show decreased hemoglobin and hematocrit levels and a decreased platelet count, and increased reticulocyte count, and the presence of nucleated red blood cells. Increased reticulocyte counts occur in children with sickle cell disease because the life span of their sickled red blood cells is shortened.

Which patient statement to the nurse indicates a need for additional instruction about taking oral ferrous sulfate? a."I will call my health care provider if my stools turn black." b."I will take a stool softener if I feel constipated occasionally." c."I should take the iron with orange juice about an hour before eating." d."I should increase my fluid and fiber intake while I am taking iron tablets."

a."I will call my health care provider if my stools turn black." It is normal for the stools to appear black when a patient is taking iron, and the patient should not call the health care provider about this. The other patient statements are correct.

A person with sickle cell trait would: a. be advised to avoid fluid loss and dehydration. b. be protected from crisis under ordinary circumstances. c. experience hemolytic jaundice. d. have chronic anemia.

d. have chronic anemia.

The nurse is performing an assessment on a client with a diagnosis of anemia that developed as a result of blood loss after a traumatic injury. The nurse should expect to find which sign or symptom in the client as a result of the anemia? 1.Bradycardia 2.Muscle cramps 3.Increased respiratory rate 4.Shortness of breath with activity

4.Shortness of breath with activity

The nurse is preparing to teach a client with microcytic hypochromic anemia about the diet to follow after discharge. Which of the following foods should be included in the diet? A Eggs B Lettuce C Citrus fruits D Cheese

A Eggs One of the microcytic, hypochromic anemias is iron-deficiency anemia. A rich source of iron is needed in the diet, and eggs are high in iron. Other foods high in iron include organ and muscle (dark) meats; shellfish, shrimp, and tuna; enriched, whole-grain, and fortified cereals and breads; legumes, nuts, dried fruits, and beans; oatmeal; and sweet potatoes. Dark green leafy vegetables and citrus fruits are good sources of vitamin C. Cheese is a good source of calcium.

A client is to receive epoetin (Epogen) injections. What laboratory value should the nurse assess before giving the injection? A Hematocrit B Partial thromboplastin time C Hemoglobin concentration D Prothrombin time

A Hematocrit Epogen is a recombinant DNA form of erythropoietin, which stimulates the production of RBCs and therefore causes the hematocrit to rise. The elevation in hematocrit causes an elevation in blood pressure; therefore, the blood pressure is a vital sign that should be checked. The PTT, hemoglobin level, and PT are not monitored for this drug.

Select the patient below who is at MOST risk for pernicious anemia: A. A 75 year old male who recently had surgery on the ileum. B. A 25 year old female who reports craving ice and clay. C. A 66 year old male whose peripheral blood smear showed hypochromic red blood cells. D. All the patients above are at risk for pernicious anemia.

A. A 75 year old male who recently had surgery on the ileum. elderly patients who've had GI surgery (the ileum is part of the GI system), have endocrine disorders (like Addison's Disease, Diabetes Type 1 etc.), or GI disease are at risk for pernicious anemia. This reason is because as the person ages GI secretions decrease along with intrinsic factor and with GI surgery the parietal cells can be damaged (which are responsible for secreting intrinsic factor). So, the patient in option A is at most risk. Options B and C are risk factors for IRON-DEFICIENCY anemia (not pernicious anemia).

The nurse is assessing a client's activity intolerance by having the client walk on a treadmill for 5 minutes. Which of the following indicates an abnormal response? A Pulse rate increased by 20 bpm immediately after the activity B Respiratory rate decreased by 5 breaths/minute C Diastolic blood pressure increased by 7 mm Hg D Pulse rate within 6 bpm of resting phase after 3 minutes of rest.

B Respiratory rate decreased by 5 breaths/minute The decrease in respiratory rate indicates that the client is not strong enough to complete the mechanical cycle of respiration needed for gas exchange.

The nurse implements which of the following for the client who is starting a Schilling test? A Administering methylcellulose (Citrucel) B Starting a 24- to 48 hour urine specimen collection C Maintaining NPO status D Starting a 72 hour stool specimen collection

B Starting a 24- to 48 hour urine specimen collection Urinary vitamin B12 levels are measured after the ingestion of radioactive vitamin B12. A 24-to 48- hour urine specimen is collected after administration of an oral dose of radioactively tagged vitamin B12 and an injection of non-radioactive vitamin B12. In a healthy state of absorption, excess vitamin B12 is excreted in the urine; in a malabsorption state or when the intrinsic factor is missing, vitamin B12 is excreted in the feces. Citrucel is a bulk-forming agent. Laxatives interfere with the absorption of vitamin B12. The client is NPO 8 to 12 hours before the test but is not NPO during the test. A stool collection is not part of the Schilling test. If stool contaminates the urine collection, the results will be altered.

The primary purpose of the Schilling test is to measure the client's ability to: A Store vitamin B12 B Digest vitamin B12 C Absorb vitamin B12 D Produce vitamin B12

C Absorb vitamin B12 Pernicious anemia is caused by the body's inability to absorb vitamin B12. This results in a lack of intrinsic factor in the gastric juices. Schilling's test helps diagnose pernicious anemia by determining the client's ability to absorb vitamin B12.

The nurse explains to the parents of a 1-year-old child admitted to the hospital in a sickle cell crisis that the local tissue damage the child has on admission is caused by which of the following? A Autoimmune reaction complicated by hypoxia B Lack of oxygen in the red blood cells C Obstruction to circulation D Elevated serum bilirubin concentration.

C Obstruction to circulation Characteristic sickle cells tend to cause "log jams" in capillaries. This results in poor circulation to local tissues, leading to ischemia and necrosis. The basic defect in sickle cell disease is an abnormality in the structure of RBCs. The erythrocytes are sickle-shaped, rough in texture, and rigid. Sickle cell disease is an inherited disease, not an autoimmune reaction. Elevated serum bilirubin concentrations are associated with jaundice, not sickle cell disease.

Which of the following would the nurse identify as the priority nursing diagnosis during a toddler's vaso-occlusive sickle cell crisis? A Ineffective coping related to the presence of a life-threatening disease B Decreased cardiac output related to abnormal hemoglobin formation C Pain related to tissue anoxia D Excess fluid volume related to infection

C Pain related to tissue anoxia For the child in a sickle cell crisis, pain is the priority nursing diagnosis because the sickled cells clump and obstruct the blood vessels, leading to occlusion and subsequent tissue ischemia. Although ineffective coping may be important, it is not the priority. Decreased cardiac output is not a problem with this type of vaso occlusive crisis. Typically, a sickle cell crisis can be precipitated by a fluid volume deficit or dehydration.

A client comes into the health clinic 3 years after undergoing a resection of the terminal ileum complaining of weakness, shortness of breath, and a sore tongue. Which client statement indicates a need for intervention and client teaching? A "I have been drinking plenty of fluids." B "I have been gargling with warm salt water for my sore tongue." C "I have 3 to 4 loose stools per day." D "I take a vitamin B12 tablet every day."

D "I take a vitamin B12 tablet every day." Vitamin B12 combines with intrinsic factor in the stomach and is then carried to the ileum, where it is absorbed in the bloodstream. In this situation, vitamin B12 cannot be absorbed regardless of the amount of oral intake of sources of vitamin B12 such as animal protein or vitamin B12 tablets. Vitamin B12 needs to be injected every month, because the ileum has been surgically removed. Replacement of fluids and electrolytes is important when the client has continuous multiple loose stools on a daily basis. Warm salt water is used to soothe sore mucous membranes. Crohn's disease and small bowel resection may cause several loose stools a day.

A client with iron deficiency anemia is scheduled for discharge. Which instruction about prescribed ferrous gluconate therapy should the nurse include in the teaching plan? A "Take the medication with an antacid." B "Take the medication with a glass of milk." C "Take the medication with cereal." D "Take the medication on an empty stomach."

D "Take the medication on an empty stomach." Preferably, ferrous gluconate should be taken on an empty stomach. Ferrous gluconate should not be taken with antacids, milk, or whole-grain cereals because these foods reduce iron absorption.

A pediatric nurse health educator provides a teaching session to the nursing staff regarding hemophilia. Which of the following information regarding this disorder would the nurse plan to include in the discussion? A Hemophilia is a Y linked hereditary disorder B Males inherit hemophilia from their fathers C Females inherit hemophilia from their mothers D Hemophilia A results from a deficiency of factor VIII

D Hemophilia A results from a deficiency of factor VIII Males inherit hemophilia from their mothers, and females inherit the carrier status from their fathers. Hemophilia is inherited in a recessive manner via a genetic defect on the X-chromosome. Hemophilia A results from a deficiency of factor VIII. Hemophilia B (Christmas disease) is a deficiency of factor IX.

A patient is admitted with essential thrombocytopenia due to decreased platelet production. The nurse knows that the diagnosis is most likely: a. disseminated intravascular coagulation (DIC). c. lupus erythematosus. b. aplastic anemia. d. malignant lymphoma.

a. disseminated intravascular coagulation (DIC).

The nurse examines the lymph nodes of a patient during a physical assessment. Which assessment finding would be of most concern to the nurse? a.A 2-cm nontender supraclavicular node b.A 1-cm mobile and nontender axillary node c.An inability to palpate any superficial lymph nodes d.Firm inguinal nodes in a patient with an infected foot

a.A 2-cm nontender supraclavicular node Enlarged and nontender nodes are suggestive of malignancies such as lymphoma.

A potential blood donor would be rejected if he or she: a. had a history of infectious disease exposure within the past 2 to 4 months. b. had close contact with a hemodialysis patient within the past 6 months. c. had donated blood within the past 3 to 6 months. d. had received a blood transfusion 9 to 12 months before the blood donation time.

b. had close contact with a hemodialysis patient within the past 6 months.

A patient's complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding? a."Have you had a recent weight loss?" b."Do you have any history of lung disease?" c."Have you noticed any dark or bloody stools?" d."What is your dietary intake of meats and protein?"

b."Do you have any history of lung disease?" The hemoglobin and hematocrit results indicate polycythemia, which can be associated with chronic obstructive pulmonary disease. The other questions would be appropriate for patients who are anemic.

A 52-yr-old patient has a new diagnosis of pernicious anemia. The nurse determines that the patient understands the teaching about the disorder when the patient states, a."I need to start eating more red meat and liver." b."I will stop having a glass of wine with dinner." c."I could choose nasal spray rather than injections of vitamin B12." d."I will need to take a proton pump inhibitor such as omeprazole (Prilosec)."

c."I could choose nasal spray rather than injections of vitamin B12." Because pernicious anemia prevents the absorption of vitamin B12, this patient requires injections or intranasal administration of cobalamin. Alcohol use does not cause cobalamin deficiency. Proton pump inhibitors decrease the absorption of vitamin B12. Eating more foods rich in vitamin B12 is not helpful because the lack of intrinsic factor prevents absorption of the vitamin.

Hypoprothrombinemia, in the absence of gastrointestinal or biliary dysfunction, may be caused by a deficiency in vitamin: a. A. b. B12. c. C. d. K.

d. K.

During a routine assessment of a patient diagnosed with anemia, the nurse notes the patient's beefy red tongue. The nurse knows that this is a sign of what kind of anemia? a. Autoimmune c. Iron deficiency b. Folate deficiency d. Megaloblastic

d. Megaloblastic

The physician expects that the patient has a deficiency in the leukocyte responsible for cell-mediated immunity. The nurse knows to check the white blood cell count for: a. basophils. c. plasma cells. b. monocytes. d. T lymphocytes.

d. T lymphocytes.

Sickle-shaped erythrocytes cause: a. cellular blockage in small vessels. b. decreased organ perfusion. c. tissue ischemia and infarction. d. all of the above.

d. all of the above.

The cause of aplastic anemia may: a. be related to drugs, chemicals, or radiation damage. b. result from the body's T cells attacking the bone marrow. c. result from certain infections. d. be related to all of the above.

d. be related to all of the above.

A nurse expects an adult patient with sickle cell anemia to have a hemoglobin value of: a. near 3 g/dL. c. between 5 and 7 g/dL. b. near 5 g/dL. d. between 7 and 10 g/dL.

d. between 7 and 10 g/dL.

Which statement by a patient indicates good understanding of the nurse's teaching about prevention of sickle cell crisis? a."Home oxygen therapy is frequently used to decrease sickling." b."There are no effective medications that can help prevent sickling." c."Routine continuous dosage narcotics are prescribed to prevent a crisis." d."Risk for a crisis is decreased by having an annual influenza vaccination."

d."Risk for a crisis is decreased by having an annual influenza vaccination."

When obtaining assessment data from a client with a microcytic normochromic anemia, which should the nurse question the client about? 1.Folic acid intake 2.Dietary intake of iron 3.A history of gastric surgery 4.A history of sickle cell anemia

2.Dietary intake of iron Microcytic normochromic anemias involve the presence of small, pale-colored red blood cells. Causes are iron deficiency anemia and thalassemia

The nurse has provided instructions to a client with sickle cell disease regarding measures that will prevent a sickle cell crisis. Which client statement indicates an understanding of these measures? 1."I need to avoid any exercise." 2."I need to avoid increasing my fluid intake." 3."I need to avoid going outdoors in warm weather." 4."I need to avoid situations that may lead to an infection."

4."I need to avoid situations that may lead to an infection." The client should avoid infections, which can increase metabolic demands and cause dehydration, precipitating a sickle cell crisis. Fluids are important to prevent dehydration, which could lead to sickle cell crisis. Warm weather and mild exercise do not need to be avoided, but the client should take measures to avoid dehydration during these conditions.

A 6 year-old is admitted with sickle cell crisis. The patient has a FACE scale rating of 10 and the following vital signs: HR 115, BP 120/82, RR 18, oxygen saturation 91%, temperature 101.4'F. Select all the appropriate nursing interventions for this patient at this time? A. Administer IV Morphine per MD order B. Administer oxygen per MD order C. Keep NPO D. Apply cold compresses E. Start intravenous fluids per MD order F. Administer iron supplement per MD order G. Keep patient on bed rest H. Remove restrictive clothing or objects from the patient

A. Administer IV Morphine per MD order B. Administer oxygen per MD order E. Start intravenous fluids per MD order G. Keep patient on bed rest H. Remove restrictive clothing or objects from the patient When a patient is in sickle cell crisis, the abnormal RBCs are sickling and sticking together, which blocks blood flow. To help alleviate the RBCs from clumping together and sickling, oxygen and hydration are priority. This will help dilute the blood (hence decrease the sticking of RBCs) and help supply oxygen to the RBCs (remember abnormal RBCs with hemoglobin S are very sensitive to low oxygen levels and will sickle when there is low oxygen). In addition, pain needs to be addressed. Opioid medication is the best on a scheduled basis rather than PRN (as needed). Avoid keeping patient NPO unless needed (remember patient needs hydration). Avoid cold compresses (can lead to more sickling) but instead use warm compresses. The patient will need FOLIC ACID supplements to help with RBC creation rather than iron (iron can actually build up in the body and collect in the organs in patients with sickle cell disease). Patients definitely need to be on bedrest, and restrictive clothing or objects (blood pressure cuff etc.) should be removed to help blood flow.

After receiving change-of-shift report for several patients with neutropenia, which patient should the nurse assess first? a.A 56-yr-old with frequent explosive diarrhea b.A 33-yr-old with a fever of 100.8° F (38.2° C) c.A 66-yr-old who has white pharyngeal lesions d.A 23-yr-old who is complaining of severe fatigue

b.A 33-yr-old with a fever of 100.8° F (38.2° C) Any fever in a neutropenic patient indicates infection and can quickly lead to sepsis and septic shock. Rapid assessment and (if prescribed) initiation of antibiotic therapy within 1 hour are needed. The other patients also need to be assessed but do not exhibit symptoms of potentially life-threatening problems.

A patient with pancytopenia has a bone marrow aspiration from the left posterior iliac crest. Which action would be important for the nurse to take after the procedure? a.Elevate the head of the bed to 45 degrees. b.Have the patient lie on the left side for 1 hour. c.Apply a sterile 2-inch gauze dressing to the site. d.Use a half-inch sterile gauze to pack the wound.

b.Have the patient lie on the left side for 1 hour. To decrease the risk for bleeding, the patient should lie on the left side for 30 to 60 minutes. After a bone marrow biopsy, the wound is small and will not be packed with gauze. A pressure dressing is used to cover the aspiration site. There is no indication to elevate the patient's head.

A patient with possible disseminated intravascular coagulation arrives in the emergency department with a blood pressure of 82/40, temperature of 102°F and severe back pain. Which prescribed action will the nurse implement first? a.Administer morphine sulfate 4 mg IV. b.Give acetaminophen (Tylenol) 650 mg. c.Infuse normal saline 500 mL over 30 minutes. d.Schedule complete blood count and coagulation studies.

c.Infuse normal saline 500 mL over 30 minutes. The patient's blood pressure indicates hypovolemia caused by blood loss and should be addressed immediately to improve perfusion to vital organs. The other actions are also appropriate and should be rapidly implemented, but improving perfusion is the priority for this patient.

Which collaborative problem will the nurse include in a care plan for a patient admitted to the hospital with idiopathic aplastic anemia? a.Potential complication: seizures b.Potential complication: infection c.Potential complication: neurogenic shock d.Potential complication: pulmonary edema

b.Potential complication: infection Because the patient with aplastic anemia has pancytopenia, the patient is at risk for infection and bleeding. There is no increased risk for seizures, neurogenic shock, or pulmonary edema.

An appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia is to a.provide a diet high in vitamin K. b.alternate periods of rest and activity. c.teach the patient how to avoid injury. d.place the patient on protective isolation.

b.alternate periods of rest and activity. Nursing care for patients with anemia should alternate periods of rest and activity to encourage activity without causing undue fatigue. There is no indication that the patient has a bleeding disorder, so a diet high in vitamin K or teaching about how to avoid injury is not needed. Protective isolation might be used for a patient with aplastic anemia, but it is not indicated for hemolytic anemia.

A client has experienced high blood pressure and crackles in the lungs during previous blood transfusions. The client asks the nurse whether it is safe to receive another transfusion. The nurse explains that which medication most likely will be prescribed before the transfusion is begun? 1.Furosemide 2.Acetaminophen 3.Diphenhydramine 4.Acetylsalicylic acid

1.Furosemide Fluid overload is one of the potential complications of a blood transfusion and is characterized by a variety of signs, including high blood pressure, fluid in the lungs manifesting as crackles, and distended jugular veins. This type of transfusion reaction is prevented by pretreating the client with a diuretic such as furosemide. Acetaminophen and aspirin are analgesics, which can also be used for analgesia. These medications may reduce fever as well but do not treat fluid overload.

The nurse understands that the client with pernicious anemia will have which distinguishing laboratory findings? A Schilling's test, elevated B Intrinsic factor, absent C Sedimentation rate, 16 mm/hour D RBCs 5.0 million

B Intrinsic factor, absent The defining characteristic of pernicious anemia, a megaloblastic anemia, is lack of the intrinsic factor, which results from atrophy of the stomach wall. Without the intrinsic factor, vitamin B12 cannot be absorbed in the small intestines, and folic acid needs vitamin B12 for DNA synthesis of RBCs. The gastric analysis was done to determine the primary cause of the anemia. An elevated excretion of the injected radioactive vitamin B12, which is protocol for the first and second stage of the Schilling test, indicates that the client has the intrinsic factor and can absorb vitamin B12 into the intestinal tract. A sedimentation rate of 16 mm/hour is normal for both men and women and is a nonspecific test to detect the presence of inflammation. It is not specific to anemias. An RBC value of 5.0 million is a normal value for both men and women and does not indicate anemia.

It is important for the nurse providing care for a patient with sickle cell crisis to a.limit the patient's intake of oral and IV fluids. b.evaluate the effectiveness of opioid analgesics. c.encourage the patient to ambulate as much as tolerated. d.teach the patient about high-protein, high-calorie foods.

b.evaluate the effectiveness of opioid analgesics. Pain is the most common clinical manifestation of a crisis and usually requires large doses of continuous opioids for control. Fluid intake should be increased to reduce blood viscosity and improve perfusion. Rest is usually ordered to decrease metabolic requirements. Patients are instructed about the need for dietary folic acid, but high-protein, high-calorie diets are not emphasized.

The nurse assesses a patient with pernicious anemia. Which assessment finding would the nurse expect? a.Yellow-tinged sclerae c.Numbness of the extremities b.Shiny, smooth tongue d.Gum bleeding and tenderness

c.Numbness of the extremities Extremity numbness is associated with cobalamin (vitamin B12) deficiency or pernicious anemia. Loss of the papillae of the tongue occurs with chronic iron deficiency. Yellow-tinged sclera is associated with hemolytic anemia and the resulting jaundice. Gum bleeding and tenderness occur with thrombocytopenia or neutropenia.

A diagnostic sign of pernicious anemia is: a. a smooth, sore, red tongue. b. exertional dyspnea. c. pale mucous membranes. d. weakness.

a. a smooth, sore, red tongue

A patient with chronic renal failure is being examined by the nurse practitioner for anemia. The nurse knows to review the laboratory data for a decreased hemoglobin level, red blood cell count, and: a. decreased level of erythropoietin. c. increased mean corpuscular volume. b. decreased total iron-binding capacity. d. increased reticulocyte count.

a. decreased level of erythropoietin.

The nurse is preparing a client with thrombocytopenia for discharge. Which statement by the client about measures minimizing injury indicates that discharge teaching was effective?Select all that apply. 1."I may continue to use an electric shaver." 2."I will not blow my nose if I get a cold." 3."I should use an enema instead of laxatives for constipation." 4."I definitely will play football with my friends this weekend." 5."I should use a soft-bristled toothbrush to avoid mouth trauma."

1."I may continue to use an electric shaver." 2."I will not blow my nose if I get a cold." 5."I should use a soft-bristled toothbrush to avoid mouth trauma." Bleeding precautions are used to protect the client with thrombocytopenia from bleeding. The client with thrombocytopenia may experience internal and external bleeding. Bleeding is frequently provoked by trauma, but it also may be spontaneous. The client with thrombocytopenia should be educated about activities that increase the risk for bleeding, such as contact sports and trauma to oral, nasal, and rectal mucosa. This will help to eliminate options 3 and 4.

The nurse has provided medication instructions to a client with an iron deficiency anemia who will be taking iron supplements. Which statement made by the client indicates an understanding of this medication? 1."I need to increase my fluid intake." 2."I should eliminate fiber foods from my diet." 3."I need to take the medication with water before a meal." 4."I should be sure to chew the tablet thoroughly before swallowing it."

1."I need to increase my fluid intake."

The nurse is monitoring a client who is receiving a blood transfusion. After 30 minutes of the infusion, the client begins to have chills and back pain. His temperature is 100.1°F (37.8°C). What action should the nurse take first? 1.Assess the client for other symptoms. 2.Slow the blood transfusion and monitor the client's vital signs. 3.Remind the client that these are expected reactions to a blood transfusion. 4.Discontinue the infusion and start an infusion of normal saline using new tubing.

4.Discontinue the infusion and start an infusion of normal saline using new tubing. Signs of a transfusion reaction include fever, chills, tachycardia, tachypnea, dyspnea, hives or skin rash, flushing, backache, and decreased blood pressure. If the client shows any symptoms of a blood transfusion reaction, the nurse needs to discontinue the infusion immediately and start an infusion of normal saline using new tubing connected to the hub of the intravenous insertion site. The nurse should stay with the client and monitor his or her condition while asking a colleague to notify the health care provider immediately.

A client who was diagnosed with toxic shock syndrome (TSS) now exhibits petechiae, oozing from puncture sites, and coolness of the digits of the hands and feet. Clotting times determined for this client are prolonged. The nurse interprets these clinical signs as being most compatible with which condition? 1.Heparin overdose 2.Vitamin K deficiency 3.Factor VIII deficiency 4.Disseminated intravascular coagulopathy (DIC)

4.Disseminated intravascular coagulopathy (DIC) TSS is caused by infection and often is associated with tampon use. The client's clinical signs in this question are compatible with DIC, which is a complication of TSS. The nurse assesses the client at risk and notifies the health care provider promptly when signs and symptoms of DIC are noted. Although signs of bleeding may be seen with each of the conditions listed in the incorrect options, the initial diagnosis of TSS makes DIC the logical correct option.

The nurse devises a teaching plan for the patient with aplastic anemia. Which of the following is the most important concept to teach for health maintenance? A Eat animal protein and dark leafy vegetables each day B Avoid exposure to others with acute infection C Practice yoga and meditation to decrease stress and anxiety D Get 8 hours of sleep at night and take naps during the day

B Avoid exposure to others with acute infection Clients with aplastic anemia are severely immunocompromised and at risk for infection and possible death related to bone marrow suppression and pancytopenia. Strict aseptic technique and reverse isolation are important measures to prevent infection. Although diet, reduced stress, and rest are valued in supporting health, the potentially fatal consequence of an acute infection places it as a priority for teaching the client about health maintenance. Animal meat and dark green leafy vegetables, good sources of vitamin B12 and folic acid, should be included in the daily diet. Yoga and meditation are good complimentary therapies to reduce stress. Eight hours of rest and naps are good for spacing and pacing activity and rest.

A patient with severe pernicious anemia is being discharged home and requires routine injections of Vitamin B12. Which statement by the patient demonstrates they understood your instructions about their treatment regime? A. "I will require one injection every 6 months until my Vitamin B12 levels are therapeutic and then I'm done." B. "Initially, I will need weekly injections of Vitamin B12 and then monthly injections for maintenance, which will be a lifelong regime." C. "I will only need vitamin B12 injections for a month and then I can take a low dose of oral vitamin B12." D. "When I start to feel weak and short of breath I need to call the doctor so I can schedule an appointment for a Vitamin B12 injection."

B. "Initially, I will need weekly injections of Vitamin B12 and then monthly injections for maintenance, which will be a lifelong regime."

A 14 year-old female has sickle cell anemia. Which factors below can increase the patient's risk for developing sickle cell crisis? Select all that apply: A. Shellfish B. Infection C. Dehydration D. Hypoxia E. Low altitudes F. Hemorrhage G. Strenuous exercise

B. Infection C. Dehydration D. Hypoxia F. Hemorrhage G. Strenuous exercise Sickle cell crisis can occur when the body experiences low amounts of oxygen in the body (so think about something that increases the body's need for oxygen or affects how oxygen is being transported). Therefore, infection (especially respiratory infections), dehydration, hypoxia, HIGH (not low) altitudes, hemorrhage (blood loss), or strenuous exercise can lead to a sickle cell crisis.

The mothers asks the nurse why her child's hemoglobin was normal at birth but now the child has S hemoglobin. Which of the following responses by the nurse is most appropriate? A "The placenta bars passage of the hemoglobin S from the mother to the fetus." B "The red bone marrow does not begin to produce hemoglobin S until several months after birth." C "Antibodies transmitted from you to the fetus provide the newborn with temporary immunity." D "The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth."

D "The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth." Sickle cell disease is an inherited disease that is present at birth. However, 60% to 80% of a newborns hemoglobin is fetal hemoglobin, which has a structure different from that of hemoglobin S or hemoglobin A. Sickle cell symptoms usually occur about 4 months after birth, when hemoglobin S begins to replace the fetal hemoglobin. The gene for sickle cell disease is transmitted at the time of conception, not passed through the placenta. Some hemoglobin S is produced by the fetus near term. The fetus produces all its own hemoglobin from the earliest production in the first trimester. Passive immunity conferred by maternal antibodies is not related to sickle cell disease, but this transmission of antibodies is important to protect the infant from various infections during early infancy.

A client with pernicious anemia asks why she must take vitamin B12 injections for the rest of her life. What is the nurse's best response? A "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient acid." B "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor." C "The reason for your vitamin deficiency is an excessive excretion of the vitamin because of kidney dysfunction." D "The reason for your vitamin deficiency is an increased requirement for the vitamin because of rapid red blood cell production."

B "The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor." Most clients with pernicious anemia have deficient production of intrinsic factor in the stomach. Intrinsic factor attaches to the vitamin in the stomach and forms a complex that allows the vitamin to be absorbed in the small intestine. The stomach is producing enough acid, there is not an excessive excretion of the vitamin, and there is not a rapid production of RBCs in this condition.

The most frequent symptom and complication of anemia is: a. bleeding gums b. ecchymosis c. fatigue d. jaundice

c. fatigue

You're educating the parents of a 12 year-old, who was recently treated for sickle cell crisis, on ways to prevent further sickle cell crises in the further. Which statement by the parents demonstrates they understood your instructions? A. "We will limit fluid intake during the day to 1-2 L a day." B. "Cold showers are best to help with pain associated with sickling." C. "We will avoid traveling to high altitude locations." D. "It is important we refuse all future vaccinations unless absolutely necessary."

C. "We will avoid traveling to high altitude locations." sickle cell crisis can be caused by blood loss, illness (it's important the patient is up-to-date with all vaccinations), high altitudes, stress, dehydration, elevated temperature, or extreme cold temperatures. All options are wrong except C.

Multiple myeloma: a. can be diagnosed by roentgenograms that show bone lesion destruction. b. is a malignant disease of plasma cells that affects bone and soft tissue. c. is suspected in any person who evidences albuminuria. d. is associated with all of the above.

b. is a malignant disease of plasma cells that affects bone and soft tissue.

The common feature of the leukemias is: a. a compensatory polycythemia stimulated by thrombocytopenia. b. an unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements. c. increased blood viscosity, resulting from an overproduction of white cells. d. reduced plasma volume in response to a reduced production of cellular elements.

b. an unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements.

The nurse is reviewing laboratory results and notes a patient's activated partial thromboplastin time (aPTT) level of 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication? a.Aspirin c.Warfarin b.Heparin d.Erythropoietin

b.Heparin aPTT assesses intrinsic coagulation by measuring factors I, II, V, VIII, IX, X, XI, XII. aPTT is increased (prolonged) in heparin administration. aPTT is used to monitor whether heparin is at a therapeutic level (needs to be greater than the normal range of 25 to 35 sec). Prothrombin time (PT) and international normalized ratio (INR) are most commonly used to test for therapeutic levels of warfarin (Coumadin). Aspirin affects platelet function. Erythropoietin is used to stimulate red blood cell production.

Which patient requires the most rapid assessment and care by the emergency department nurse? a.The patient with hemochromatosis who reports abdominal pain b.The patient with neutropenia who has a temperature of 101.8° F c.The patient with thrombocytopenia who has oozing gums after a tooth extraction d.The patient with sickle cell anemia who has had nausea and diarrhea for 24 hours

b.The patient with neutropenia who has a temperature of 101.8° F A neutropenic patient with a fever is assumed to have an infection and is at risk for rapidly developing sepsis. Rapid assessment, cultures, and initiation of antibiotic therapy are needed. The other patients also require rapid assessment and care but not as urgently as the neutropenic patient.

A physician prescribes one tablet of ferrous sulfate daily for a 15-year-old girl who experiences heavy flow during her menstrual cycle. The nurse advises the patient and her mother that this over-the-counter preparation must be taken for how many months for iron replenishment to occur? a. 1 to 2 months c. 6 to 12 months b. 3 to 5 months d. Longer than 12 months

c. 6 to 12 months

The nurse begins to design a nutritional packet of information for a patient diagnosed with iron deficiency anemia. The nurse would recommend an increased intake of: a. fresh citrus fruits. b. milk and cheese. c. organ meats. d. whole-grain breads.

c. organ meats.

Which laboratory result will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)? a.Prothrombin time b.Erythrocyte count c.Fibrinogen degradation products d.Activated partial thromboplastin time

d.Activated partial thromboplastin time Platelet aggregation in HIT causes neutralization of heparin, so the activated partial thromboplastin time will be shorter, and more heparin will be needed to maintain therapeutic levels. The other data will not be affected by HIT.