Honan nursing management patients with hematologic disorders ch 19

The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? "Acute leukemia develops slowly." "Chronic leukemia develops slowly." "In chronic leukemia, the minority of leukocytes are mature." "In acute leukemia there are not many undifferentiated cells."

"Chronic leukemia develops slowly."

A client with anemia is prescribed an oral iron supplement. Which statement indicates that teaching about this supplement has been effective? "I will stop taking it if my stool turns black." "I will take it in the morning with orange juice." "I will be sure to take this medication with food." "I will limit my intake of raw fruit and vegetables."

"I will take it in the morning with orange juice."

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? "Most likely, the father is the carrier of the gene." "The trait is passed down through the mother." "The child must inherit two defective genes, one from each parent." "It is an acquired, not a hereditary disorder."

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

Which of the following is accurate regarding the use of corticosteroids for immune hemolytic anemia? Select all that apply. -They decrease the macrophages ability to clear the antibody-coated RBCs. -If the hemoglobin returns to normal, the corticosteroid dose can be lowered. -Corticosteroids are not effective in the treatment of immune hemolytic anemia. -The treatment consists of low doses of corticosteroids. -They produce lasting effects.

-They decrease the macrophages ability to clear the antibody-coated RBCs. -If the hemoglobin returns to normal, the corticosteroid dose can be lowered.

A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving: A-positive blood to an A-negative client. O-negative blood to an O-positive client. O-positive blood to an A-positive client. B-positive blood to an AB-positive client.

A-positive blood to an A-negative client.

The nurse is caring for a client with acute myeloid leukemia (AML) with high uric acid levels. What medication does the nurse anticipate administering that will prevent crystallization of uric acid and stone formation? Allopurinol Filgrastim Hydroxyurea Asparaginase

Allopurinol

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? Amoxicillin Aluminum hydroxide Prednisone Tegretol

Aluminum hydroxide

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process due to thrombocytopenia in a client with leukemia? Implementing neutropenic precautions Eliminating direct contact with others who are infectious Applying prolonged pressure to needle sites or other sources of external bleeding Monitoring temperature at least once per shift

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

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 Questions the administration of both medications Ensures the client has completed dialysis treatment Holds the epoetin alfa if the BUN is elevated

Assesses the hemoglobin level

A client who is undergoing consolidation therapy for the treatment of leukemia has been experiencing debilitating fatigue. How can the nurse best meet this client's needs for physical activity? Teach the client about the risks of immobility and the benefits of exercise. Assist the client to a chair during awake times, as tolerated. Collaborate with the physical therapist to arrange for stair exercises. Teach the client to perform deep breathing and coughing exercises.

Assist the client to a chair during awake times, as tolerated.

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? Thiamine Folate B12 Iron

B12

An interdisciplinary team has been commissioned to create policies and procedures aimed at preventing acute hemolytic transfusion reactions. What action has the greatest potential to reduce the risk of this transfusion reaction? Ensure that blood components are never infused at a rate greater than 125 mL/h. Administer prophylactic antihistamines prior to all blood transfusions. Establish baseline vital signs for all clients receiving transfusions. Be vigilant in identifying the client and the blood component.

Be vigilant in identifying the client and the blood component.

The nurse suspects that a client has multiple myeloma based on the client's major presenting symptom and the analysis of laboratory results. What classic symptom for multiple myeloma does the nurse assess for? Debilitating fatigue Bone pain in the back of the ribs Gradual muscle paralysis Severe thrombocytopenia

Bone pain in the back of the ribs

A night nurse is reviewing the next day's medication administration record (MAR) of a hospital client who has hemophilia. The nurse notes that the MAR specifies both oral and subcutaneous options for the administration of a PRN antiemetic. What is the nurse's best action? Ensure that the day nurse knows not to give the antiemetic. Contact the prescriber to have the subcutaneous option discontinued. Reassess the client's need for antiemetics. Remove the subcutaneous route from the client's MAR.

Contact the prescriber to have the subcutaneous option discontinued. Injections must be avoided in clients with hemophilia

The nurse is instructing the client with polycythemia vera how to perform isometric exercises such as contracting and relaxing the quadriceps and gluteal muscle during periods of inactivity. What does the nurse understand is the rationale for this type of exercise? -Isometric exercise programs are inclusive of all muscle groups and have an aerobic effect to increase the heart rate. -Isometric exercise decreases the workload of the heart and restores oxygenated blood flow. -This type of exercise increases arterial circulation as it returns to the heart. -Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.

Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.

A patient with end-stage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia? Potassium level of 5.2 mEq/L Magnesium level of 2.5 mg/dL Calcium level of 9.4 mg/dL Creatinine level of 6 mg/100 mL

Creatinine level of 6 mg/100 mL The degree of anemia in patients with end-stage renal disease varies greatly; however, in general, patients do not become significantly anemic until the serum creatinine level exceeds 3 mg/100 mL.

A nurse is caring for a client with Hodgkin lymphoma at the oncology clinic. The nurse should identify what main goal of care? Cure of the disease Enhancing quality of life Controlling symptoms Palliation

Cure of the disease

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? Do not take medication with orange juice because it will delay absorption of the iron. Iron may cause indigestion and should be taken with an antacid such as Mylanta. Dilute the liquid preparation with another liquid such as juice and drink with a straw. Discontinue the use of iron if your stool turns black.

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

The nurse is caring for a client with external bleeding. What is the nurse's priority intervention? Elevation of the extremity Pressure point control Direct pressure Application of a tourniquet

Direct pressure

The 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 Eating leafy green vegetables with a glass of water Eating apple slices with carrots Eating a steak with mushrooms

Eating calf's liver with a glass of orange juice

The nurse is interacting with a family that has been caring for a client with cancer for several months. What are the best interventions to assist in relieving caregiver stress in this family? Select all that apply. Educate the family about medications and side effects. Allow family members to express feelings. Suggest support for household maintenance. Suggest the prescription of antianxiety medications. Suggest the family go to church more often.

Educate the family about medications and side effects. Allow family members to express feelings. Suggest support for household maintenance.

A client receiving a blood transfusion reports shortness of breath, appears anxious, and has a pulse of 125 beats/minute. What is the best action for the nurse to take after stopping the transfusion and awaiting further instruction from the health care provider? Place the client in a recumbent position with legs elevated. Remove the intravenous line. Ensure there is an oxygen delivery device at the bedside. Administer prescribed PRN anti-anxiety agent.

Ensure there is an oxygen delivery device at the bedside.

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 Erythrocytes that are macrocytic and hyperchromic Clustering of platelets with sickled red blood cells An increased number of erythrocytes

Erythrocytes that are microcytic and hypochromic

A client who is diagnosed multiple myeloma experiences decreased production of red blood cells (RBCs). Which prescribed medication should the nurse prepare to administer to increase the production of erythrocytes? Filgrastim Pegfilgrastim Erythropoietin Dexamethasone

Erythropoietin

A client is scheduled for surgery to remove an abdominal mass. The nurse knows that which reason hemodilution would be contraindicated as a method to provide blood to the client during the surgery? History of renal disease Previous thyroidectomy Treatment for osteoarthritis Takes medications for seasonal allergies

History of renal disease

A nurse provides nutritional information for a patient diagnosed with an iron-deficiency anemia. What education should the nurse provide? -Decrease the intake of citrus fruits because they interfere with iron absorption. -Take an iron supplement with meals to reduce gastric irritation. -Increase the intake of green, leafy vegetables. -Decrease the intake of high-fat red meats, especially organ meats.

Increase the intake of green, leafy vegetables.

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 Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients Risk for falls related to complaints of dizziness Fatigue related to decreased hemoglobin and hematocrit

Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit

A 63-year-old woman has been diagnosed with polycythemia vera (PV) after undergoing a series of diagnostic tests. When the woman's nurse is providing health education, what subject should the nurse prioritize? Maintenance of long-term vascular access device Nutritional modifications necessary for maintaining a low-iron diet Strategies for managing activity Lifestyle modifications and techniques for preventing thromboembolism

Lifestyle modifications and techniques for preventing thromboembolism

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? Elevated hematocrit concentration Enlarged mean corpuscular volume (MCV) Low ferritin level concentration Elevated red blood cell (RBC) count

Low ferritin level concentration

A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal? Address issues of negative body image. Place the client in reverse isolation. Administer pain medication. Maintain nutrition.

Maintain nutrition.

A nurse is planning the care of a client who has a diagnosis of hemophilia A. When addressing the nursing diagnosis of Acute Pain Related to Joint Hemorrhage, what principle should guide the nurse's choice of interventions? Gabapentin (Neurontin) is effective because of the neuropathic nature of the client's pain. Opioids partially inhibit the client's synthesis of clotting factors. Opioids may cause vasodilation and exacerbate bleeding. NSAIDs are contraindicated due to the risk for bleeding.

NSAIDs are contraindicated due to the risk for bleeding.

A client with a diagnosis of pernicious anemia comes to the clinic reporting of numbness and tingling in his arms and legs. What do these symptoms indicate? Loss of vibratory and position senses Neurologic involvement Severity of the disease Insufficient intake of dietary nutrients

Neurologic involvement

A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever? Pancytopenia Thrombocytopenia Anemia Neutropenia

Neutropenia

The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? Osteopathic tumors destroy bone causing fractures. Osteoclasts break down bone cells so pathologic fractures occur. Osteolytic activating factor weakens bones producing fractures. Osteosarcomas form producing pathologic fractures.

Osteoclasts break down bone cells so pathologic fractures occur.

A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client? Pallor, bradycardia, and reduced pulse pressure Pallor, tachycardia, and a sore tongue Sore tongue, dyspnea, and weight gain Angina pectoris, double vision, and anorexia

Pallor, tachycardia, and a sore tongue

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

Pancytopenia

Clients with multiple myeloma have abnormal plasma cells that proliferate in the bone marrow where they release osteoclast-activating factor, resulting in the formation of osteoclasts. What is the most common complication of the pathology resulting from this process? Pathologic fractures Osteoporosis Calcified bones Increased mobility

Pathologic fractures

The nurse is performing an assessment on a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae. What laboratory study should the nurse be concerned about? WBC count of 4,200 cells/uL Hematocrit of 38% Platelet count of 9,000/mm3 Creatinine level of 1.0 mg/dL

Platelet count of 9,000/mm3

The nurse recognizes the clinical assessment of a patient with acute myeloid leukemia (AML) includes observing for signs of infection early. What nursing action will most likely help prevent infection? Monitor the client's temperature every shift. Maintain contact precautions. Encourage increased fluid consumption. Practice vigilant handwashing.

Practice vigilant handwashing.

A nurse is caring for a client with multiple myeloma. Which nursing intervention is most appropriate for this client? Monitoring respiratory status Balancing rest and activity Restricting fluid intake Preventing bone injury

Preventing bone injury

Place the pathophysiology of multiple myeloma in the correct order.

Proliferation of abnormal plasma cells Release of osteoclast-activating factor Break down and removal of bone cells Increased blood calcium levels

Which of the following is considered an antidote to heparin? Protamine sulfate Vitamin K Narcan Ipecac

Protamine sulfate

The nurse is caring for a patient with Hodgkin lymphoma in the hospital and preparing discharge planning education. Knowing that this patient is at risk for the development of a second malignancy, what education would be beneficial to reduce the risk factors? (Select all that apply.) Reduce exposure to excessive sunlight Smoking cessation Decrease alcohol intake Decrease intake of antipyretic medications such as acetaminophen Decrease fat intake

Reduce exposure to excessive sunlight Smoking cessation Decrease alcohol intake

A client with multiple myeloma reports severe paresthesia in the feet. When planning care for the client, which priority nursing diagnosis will the nurse choose? Acute pain Risk for falls Impaired tissue integrity Sensory-perception disturbance

Risk for falls

A 50-year-old woman recently sought care from her primary care provider and was diagnosed with hypoproliferative anemia following a diagnostic workup. The nurse at the clinic has been charged with the responsibility for organizing the woman's care and is consequently creating a nursing care plan. When planning this woman's care, what nursing diagnosis should the nurse prioritize? Decreased cardiac output Risk for fatigue Acute pain Risk for hypothermia

Risk for fatigue

The nurse is assessing a patent with polycythemia vera. What skin assessment data would the nurse determine is a normal finding for this patient? Pale skin and mucous membranes Bronze skin tone Ruddy complexion Jaundice skin and sclera

Ruddy complexion

Fresh-frozen plasma (FFP) has been prescribed for a hospital client. Prior to administration of this blood product, the nurse should prioritize which client education? Infection risks associated with FFP administration Physiologic functions of plasma Signs and symptoms of a transfusion reaction Strategies for managing transfusion-associated anxiety

Signs and symptoms of a transfusion reaction

transfusion reaction so

Stop the transfusion. Assess the client. Notify the health care provider. Notify the blood bank. Send the tubing and container to the blood bank.

A client is prescribed 325 mg/day of oral ferrous sulfate. What does the nurse include in client teaching? Take 1 hour before breakfast Take with dairy products Decrease intake of fruits and juices Decrease intake of dietary fiber

Take 1 hour before breakfast

The nurse is administering a blood transfusion to a client over 4 hours. After 2 hours, the client reports chills and has a fever of 101°F, an increase from a previous temperature of 99.2°F. What does the nurse recognize is occurring with this client? The client is having an allergic reaction to the blood. The client is experiencing vascular collapse. The client is having decrease in tissue perfusion from a shock state. The client is having a febrile nonhemolytic reaction.

The client is having a febrile nonhemolytic reaction. The signs and symptoms of a febrile nonhemolytic transfusion reaction are chills (minimal to severe) followed by fever (more than 1°C elevation). The fever typically begins within 2 hours after the transfusion is begun. Although the reaction is not life threatening, the fever, and particularly the chills and muscle stiffness, can be frightening to the client.

A client is being treated in the ICU after a medical error resulted in an acute hemolytic transfusion reaction. What was the etiology of this client's adverse reaction? Antibodies to donor leukocytes remained in the blood. The donor blood was incompatible with that of the client. The client had a sensitivity reaction to a plasma protein in the blood. The blood was infused too quickly and overwhelmed the client's circulatory system.

The donor blood was incompatible with that of the client.

A client is treated for anemia. What is the nurse's best understanding about the correlation between anemia and the client's iron stores? There is a strong correlation between iron stores and hemoglobin levels. There is a strong correlation between iron stores and hemoglobin characteristics. There is an inverse relationship between iron stores and hemoglobin levels. There is a weak correlation between iron stores and hemoglobin levels.

There is a strong correlation between iron stores and hemoglobin levels.

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. Avoid contact with family/friends who are sick. Encourage frequent handwashing. Plan for frequent periods of rest.

Use a disposable razor when shaving.

A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client? Limit visits by family members. Encourage the client to use a wheelchair. Use the smallest needle possible for injections. Maintain accurate fluid intake and output records.

Use the smallest needle possible for injections.

decreased iron absorption cause

calcium: milk and antacid

thrombocytopenia

deceased platelet normal: 150,000-400,000

iron rich foods

egg yolk apricot tofu legumes oyster tuna seeds potatoes fish fortified cereal red meat poultry nuts

Hemoglobin

found in RBC protein that contains iron

H+H range

hemat: F-> 36-38% M -> 39-54% hemo: F-> 12-16 M-> 13-18

thrombocytopenia precaution

no aspirin no straight razor/blades small gauge needles preferred decrease needle stick project from injury

iron deficiency anemia s/s

pallor weak fatigue microcytic (small) RBC dec. H+H

thrombocytopenia treatment

platelets bone barrow splenectomy

RBC role

transports 02 and removes CO2 from body with the help of hemoglobin

thrombocytopenia symptoms

weak dizzy prolonged bleeding time purpura (bruises) heavy period blood in stool/urine Inc. INR and PT/PTT

increase iron absorption

with vitamin C or multi vitamin drink through a straw (stain teeth)

A client with a pulmonary embolism is being treated with a heparin infusion. What diagnostic finding suggests to the nurse that treatment is effective? The client's PT is within reference ranges. Arterial blood sampling tests positive for the presence of factor XIII. The client's platelet level is below 100,000/mm3. The client's activated partial thromboplastin time (aPTT) is 1.5 to 2.5 times the control value.

The client's activated partial thromboplastin time (aPTT) is 1.5 to 2.5 times the control value.

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? Take ibuprofen for joint pain. Take warm baths to lessen pain. Wear a medical identification bracelet. Undergo genetic testing and counseling if the client is male.

Wear a medical identification bracelet.

Two units of packed red blood cells have been prescribed for a client who has experienced a gastrointestinal bleed. The client is highly reluctant to receive a transfusion, stating, "I'm terrified of getting acquired immunodeficiency syndrome (AIDS) from a blood transfusion." How can the nurse best address the client's concerns? -"All donated blood is treated with antiretroviral medications before it is used." -"That did happen in some high-profile cases in the20th century, but it is no longer a possibility." -"HIV was eradicated from the blood supply in the early 2000s." -"Donated blood is screened for human immunodeficiency virus (HIV), and the risk of contraction is very low."

-"Donated blood is screened for human immunodeficiency virus (HIV), and the risk of contraction is very low."

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 reaction to mismatched blood A hemolytic reaction to Rh-incompatible blood A hemolytic allergic reaction caused by an antigen reaction A hemolytic reaction caused by bacterial contamination of donor blood

A hemolytic allergic reaction caused by an antigen reaction

A 35-year-old client is admitted to the hospital reporting severe headaches, vomiting, and testicular pain. The client's blood work shows reduced numbers of platelets, leukocytes, and erythrocytes, with a high proportion of immature cells. The nurse caring for this client suspects which diagnosis? Acute myeloid leukemia (AML) Chronic myeloid leukemia (CML) Myelodysplastic syndromes (MDS) Acute lymphocytic leukemia (ALL)

Acute lymphocytic leukemia (ALL)

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? Select all that apply. Infection Blood loss Abnormal erythrocyte production Destruction of normally formed red blood cells Inadequate formed white blood cells

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

A client donated two units of blood to be used for transfusion during spinal fusion surgery. The client received one unit of autologous blood during the procedure but the second unit is not needed during the procedure. The nurse knows which action will come after the procedure is completed? Discard the additional unit. Use the unit for platelets and albumin. Provide it to the client before discharge. Release the additional unit for use to the general population.

Discard the additional unit.

A client is prescribed an intravenous dose of iron dextran. What is the nurse's best action? Ensures that epinephrine is available Realizes that use of this medication will produce a false-positive when checking stool for blood Informs the client that one dose will reverse iron-deficiency anemia Checks the client's hemoglobin level the following day

Ensures that epinephrine is available

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 Women rarely manifest the gene expression Women have lower hemoglobin levels Women require grater folic acid supplementation

Women lose iron through menstrual cycles

A client admitted to the 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: to the bathroom. to the bedside commode. onto the bedpan. to a standing position so he can urinate.

bedpan

thrombocytopenia diagnosis

bleeding time aPTT: partial PT: prothrombin time INR low Hgb and Hct

iron deficiency anemia cause

blood loss hemorrhage malabsorption inadequate intake of dietary iron

Immune Thrombocytopenic Purpura (ITP)

body produces antibodies against its own platelets <20,000 -easy bruising -petechiae on trunk and limbs

thrombocytopenia causes

platelet disorder leukemia anemia trauma enlarged spleen liver diease EHOL toxins sepsis

The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care? "Treatment is simple and consists of single-drug therapy." "Intrathecal chemotherapy is used primarily as preventive therapy." "The goal of therapy is palliation." "Side effects are rare with therapy."

"Intrathecal chemotherapy is used primarily as preventive therapy."

Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)? A 24-year-old female taking oral contraceptives A 40-year-old patient with a history of hypertension A 52-year-old patient with acute kidney injury A 72-year-old patient with a history of cancer

A 72-year-old patient with a history of cancer

A nurse provides nutritional information for a patient diagnosed with an iron-deficiency anemia. What education should the nurse provide? Decrease the intake of citrus fruits because they interfere with iron absorption. Take an iron supplement with meals to reduce gastric irritation. Increase the intake of green, leafy vegetables. Decrease the intake of high-fat red meats, especially organ meats.

Increase the intake of green, leafy vegetables.

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? -Compensatory polycythemia stimulated by thrombocytopenia -Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements -Increased blood viscosity, resulting from an overproduction of white cells -Reduced plasma volume in response to a reduced production of cellular elements

-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? The client has a decreased tolerance of pain related to the chronic nature of the illness. Bone marrow decreases the erythrocyte production causing decrease in hypoxia. Overhydration enlarges the red blood cells. Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.

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

A home care nurse visits a client diagnosed with atrial fibrillation who is ordered warfarin. The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching? "I'll watch my gums for bleeding when I brush my teeth." "I'll use an electric razor to shave." "I'll eat four servings of fresh, dark green vegetables every day." "I'll report unexplained or severe bruising to my doctor right away."

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

After chemotherapy for AML, what interventions will best help to prevent renal complications? Select all that apply. Increase hydration. Administer allopurinol. Administer rasburicase. Administer potassium therapy. Encourage exercise.

Increase hydration. Administer allopurinol. Administer rasburicase.

A patient with AML is having aggressive chemotherapy to attempt to achieve remission. The patient is aware that hospitalization will be necessary for several weeks. What type of therapy will the nurse explain that the patient will receive? Induction therapy Supportive therapy Antimicrobial therapy Standard therapy

Induction therapy Despite advances in understanding of the biology of AML, substantive advances in treatment response rates and survival rates have not occurred for decades, with the exception of advances made in treating APL (see later discussion). Even for patients with subtypes that have not benefited from advances in treatment, cure is still possible. The overall objective of treatment is to achieve complete remission, in which there is no evidence of residual leukemia in the bone marrow. Attempts are made to achieve remission by the aggressive administration of chemotherapy, called induction therapy, which usually requires hospitalization for several weeks.