Nonhematologic Disorders

The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency? C Folate B12 A

B12 The medication metformin (Glucophage) increases the client's risk for developing B12 deficiency because the medication inhibits the absorption of B12.

Which is a symptom of hemochromatosis? Weight gain Inflammation of the mouth Bronzing of the skin Inflammation of the tongue

Bronzing of the skin Clients with hemochromatosis exhibit symptoms of weakness, lethargy, arthralgia, weight loss, and loss of libido early in the illness trajectory. The skin may appear hyperpigmented from melanin deposits or appear bronze in color.

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 Calcium level of 9.4 mg/dL Magnesium level of 2.5 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.

(REVIEW) A patient with chronic renal failure is examined by the healthcare provider for anemia. Which laboratory results will the nurse monitor? Decreased total iron-binding capacity Decreased level of erythropoietin Increased reticulocyte count Increased mean corpuscular volume

Decreased level of erythropoietin As renal function decreases, erythropoietin, which is produced by the kidney, also decreases. Because erythropoietin is produced outside the kidney, some erythropoiesis continues, even in patients whose kidneys have been removed. However, the number of red blood cells produced is small and the degree of erythropoiesis is inadequate.

The nurse and the client are discussing some strategies for ingesting iron to combat the client's iron-deficiency anemia. Which is among the nurse's strategies? Drink liquid iron preparations with a straw. Avoid vitamin C as it prevents absorption. Taking iron pills with milk aids in absorption. Take iron with an antacid to avoid stomach upset.

Drink liquid iron preparations with a straw. Dilute liquid preparations of iron with another liquid such as juice and drink with a straw to avoid staining the teeth. Avoid taking iron simultaneously with an antacid, which interferes with iron absorption. Drink orange juice or take other forms of vitamin C with iron to promote its absorption.

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 a steak with mushrooms 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 calf's liver with a glass of orange juice Food sources high in iron include organ meats (e.g., beef or calf's liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron

Which of the following are assessment findings associated with thrombocytopenia? Select all that apply. Epistaxis Bleeding gums Hypertension Hematemesis Bradypnea

Epistaxis Bleeding gums Hematemesis

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

Erythrocytes that are microcytic and hypochromic A blood smear reveals erythrocytes that are microcytic (smaller than normal) and hypochromic (lighter in color than normal). It does not reveal macrocytic (larger than normal) or hyperchromic erythrocytes. Clustering of platelets with sickled red blood cells would indicate sickle cell anemia. An increase in the number of erythrocytes would indicate polycythemia vera.

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

Low ferritin level concentration The most consistent indicator of iron deficiency anemia is a low ferritin level, which reflects low iron stores. As the anemia progresses, the MCV, which measures the size of the erythrocytes, also decreases. Hematocrit and RBC levels are also low in relation to hemoglobin concentration.

(REVIEW) The nurse is instructing the client with sickle cell disease about the use of an inhaled vasodilator that may reduce sickling. What medication is the nurse instructing the client about? Terbutaline Betamethasone Nitric oxide Nitrous oxide

Nitric oxide Inhaled nitric oxide—not nitrous oxide (laughing gas), a vasodilating agent—is believed to reduce sickling by promoting the binding of oxygen to hemoglobin. It is being used in the form of handheld inhalers to abort or relieve pain experienced during sickle cell crises. Betamethasone is a corticosteroid, and terbutaline is not used as an inhaler.

A nurse is caring for a client with iron deficiency anemia. Which food or beverage will the nurse suggest to the client to eat or drink when taking supplemental iron? Milk Orange juice Leafy green vegetables Kidney beans

Orange juice Vitamin C found in orange juice improves the absorption of iron. The other answer choices are not the best for improving absorption of iron.

A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. The client is taking prednisone daily and reported feeling pain after manually opening the garage door. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain? Truncal obesity Osteoporosis Hypertension Muscle wasting

Osteoporosis Hypertension, osteoporosis, muscle wasting, and truncal obesity are all adverse effects of long-term corticosteroid therapy; however, osteoporosis commonly causes compression fractures of the spine. Hypertension, muscle wasting, and truncal obesity aren't likely to cause severe back pain.

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

Pancytopenia Pancytopenia is defined as an abnormal decrease in WBCs, RBCs, and platelets. The condition may be congenital or acquired. Anemia refers to decreased red cell mass. Leukopenia refers to a less-than-normal amount of WBCs in circulation. Thrombocytopenia refers to a lower-than-normal platelet count.

A client awaiting a bone marrow aspiration asks the nurse to explain where on the body the procedure will take place. What body part does the nurse identify for the client? Femur Posterior iliac crest Sternum Ankle

Posterior iliac crest In adults, bone marrow is usually aspirated from the posterior iliac crest and rarely from the sternum. Bone marrow is not aspirated from the femur or ankle.

A client at the clinic has just been diagnosed with iron deficiency anemia. What would you recommend the client consume to promote the absorption of iron? Sources of vitamin B12 Vitamin E Meat, egg yolks, oysters, and shellfish Rich sources of vitamin C

Rich sources of vitamin C Sources of vitamin C such as citrus fruits and juices, strawberries, green peppers, and tomatoes enhance the absorption of nonheme iron. To maximize nonheme iron absorption, the client should consume a rich source of vitamin C at every meal. Meat, egg yolks, oysters, and shellfish are the sources of heme iron whose absorption is influenced by body need. Vitamin E and sources of vitamin B12 do not promote the absorption of iron.

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 an inverse relationship between iron stores and hemoglobin levels. There is a strong correlation between iron stores and hemoglobin characteristics. There is a strong correlation 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 strong correlation exists between laboratory values that measure iron stores and hemoglobin levels. After iron stores are depleted (as reflected by low serum ferritin levels), the hemoglobin level falls.

(SKIP) A nurse is caring for a client with thalassemia who is being transfused. What is the nurse's role during a transfusion? To closely monitor the rate of administration To assess for enlargement and tenderness over the liver and spleen To instruct the client to rest immediately if chest pain develops To administer vitamin B12 injections

To closely monitor the rate of administration In a client with thalassemia, when transfusions are necessary, the nurse closely monitors the rate of administration. Assessing for enlargement and tenderness over the liver and spleen, advising rest, or administering vitamin B12 injections are not indicated for thalassemia.

Which medication is the antidote to warfarin? Aspirin Protamine sulfate Vitamin K Clopidogrel

Vitamin K The antidote for warfarin is vitamin K. Protamine sulfate is the antidote for heparin. Aspirin and clopidogrel are both antiplatelet medications.

A client has pernicious anemia and has been receiving treatment for several years. Which symptom may be confused with another condition in older adults? ataxia glossitis dementia stomatitis

dementia Pernicious anemia may be accompanied by a dementia with symptoms similar to Alzheimer's disease. Therefore, clients experiencing cognitive changes should be screened because early detection of pernicious anemia is critical to prevent neurologic damage.

The nurse is collecting data for a client who has been diagnosed with iron-deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia? "I have a difficult time falling asleep at night." "I have difficulty breathing when walking 30 feet." "I feel hot all of the time." "I have an increase in my appetite."

"I have difficulty breathing when walking 30 feet." Most clients with iron-deficiency anemia have reduced energy, feel cold all the time, and experience fatigue and dyspnea with minor physical exertion. The heart rate usually is rapid even at rest. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased. The client would feel cold and not hot. The client is fatigued and able to sleep often with a decrease in appetite, not an increase.

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy? "I will receive parenteral vitamin B12 therapy for the rest of my life." "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear." "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal."

"I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal."

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

6 to 12 months Ferrous sulfate can increase hemoglobin levels in a few weeks, and anemia may be corrected in a few months. However, it takes 6 to 12 months for stored iron replenishment to occur.

(REVIEW) For a client diagnosed with idiopathic thrombocytopenia purpura (ITP), which nursing intervention is appropriate? Administering stool softeners, as ordered, to prevent straining during defecation Giving aspirin, as ordered, to control body temperature Teaching coughing and deep-breathing techniques to help prevent infection Administering platelets, as ordered, to maintain an adequate platelet count

Administering stool softeners, as ordered, to prevent straining during defecation The nurse should take measures to prevent bleeding because the client with ITP is at increased risk for bleeding. Straining at stool causes the Valsalva maneuver, which may raise intracranial pressure (ICP), thus increasing the risk for intracerebral bleeding. Therefore, the nurse should give stool softeners to prevent straining, which may result from constipation. Teaching coughing techniques would be inappropriate because coughing raises ICP. Platelets rarely are transfused prophylactically in clients with ITP because the cells are destroyed, providing little therapeutic benefit. Aspirin interferes with platelet function and is contraindicated in clients with ITP.

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? Iron B12 . .

B12 The hematologic effects of vitamin B12 deficiency are accompanied by effects on other organ systems, particularly the gastrointestinal tract and nervous system. Patients with pernicious anemia may become confused; more often, they have paresthesias in the extremities (particularly numbness and tingling in the feet and lower legs). They may have difficulty maintaining their balance because of damage to the spinal cord, and they also lose position sense (proprioception).

A client reports feeling tired, cold, and short of breath at times. Assessment reveals tachycardia and reduced energy. What would the nurse expect the physician to order? chest radiograph ECG antibiotic CBC

CBC Most clients with iron-deficiency anemia have reduced energy, feel cold all the time, and experience fatigue and dyspnea with minor physical exertion. The heart rate usually is rapid even at rest. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased. A CBC would be ordered.

(IMPORTANT) A nurse cares for older adult clients in a long-term care facility. The nurse notices that many of the clients have chronic anemia. What long-term impact does the nurse associate with this population and the presence of anemia? Decreased immune function. Increased risk of gastrointestinal disease. Decreased cognitive function. Increased risk of infection.

Decreased cognitive function. Chronic anemia in the older adult is associated with declining cognitive function . Older adult clients do have decreased immunity; however, this is not directly related to chronic anemia. Gastrointestinal disease and anemia are not associated with one another in the older adult client.

A thin client is prescribed iron dextran intramuscularly. What is most important action taken by the nurse when administering this medication? Rubs the site vigorously Employs the Z-track technique Uses a 23-gauge needle Injects into the deltoid muscle

Employs the Z-track technique When iron medications are given intramuscularly, the nurse uses the Z-track technique to avoid local pain and staining of the skin. The gluteus maximus muscle is used. The nurse avoids rubbing the site vigorously and uses a 18- or 20-gauge needle.

The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include a nutritional assessment for this patient? It is important for the nurse to determine what type of foods the patient will eat. It is part of the required assessment information. It will determine what type of anemia the patient has. It may indicate deficiencies in essential nutrients.

It may indicate deficiencies in essential nutrients. A nutritional assessment is important, because it may indicate deficiencies in essential nutrients such as iron, vitamin B12, and folate.

(SKIP) A client with a diagnosis of pernicious anemia comes to the clinic and reports numbness and tingling in the 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 In clients with pernicious anemia, numbness and tingling in the arms and legs, and ataxia are the most common signs of neurologic involvement. Some affected clients lose vibratory and position senses. Jaundice, irritability, confusion, and depression are present when the disease is severe. Insufficient intake of dietary nutrients is not indicated by these symptoms.

The nurse, caring for a client in the emergency room with a severe nosebleed, becomes concerned when the client asks for a bedpan. The nurse documents the stool as loose, tarry, and black looking. The nurse suspects the client may have thrombocytopenia. What should be the nurse's priority action? Ask someone to clean the bedpan Notify the physician Put in an IV line Stop the nosebleed

Notify the physician Thrombocytopenia is evidenced by purpura, small hemorrhages in the skin, mucous membranes, or subcutaneous tissues. Bleeding from other parts of the body, such as the nose, oral mucous membrane, and the gastrointestinal tract, also occurs. Internal hemorrhage, which can be severe and even fatal, is possible. This nurse should notify the physician of the suspected disorder.

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 activated partial thromboplastin time (aPTT) is 1.5 to 2.5 times the control value. The client's platelet level is below 100,000/mm3. The client's PT is within reference ranges. Arterial blood sampling tests positive for the presence of factor XIII.

The client's PT is within reference ranges.

After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/mm3. What term should the nurse use to describe this low platelet count? Leukopenia Neutropenia Thrombocytopenia Anemia

Thrombocytopenia A normal platelet count is 140,000 to 400,000/mm3 in adults. Chemotherapeutic agents produce bone marrow depression, resulting in reduced red blood cell counts (anemia), reduced white blood cell counts (leukopenia), and reduced platelet counts (thrombocytopenia). Neutropenia is the presence of an abnormally reduced number of neutrophils in the blood and is caused by bone marrow depression induced by chemotherapeutic agents.

A nurse assesses a client diagnosed with megaloblastic anemia. Which clinical findings will the nurse most likely find? Select all that apply. Restless leg syndrome Ulcerated corners of the mouth Smooth, red tongue Concave nails Jaundice

Ulcerated corners of the mouth Concave nails Jaundice Megaloblastic anemia may cause angular cheilosis (ulcerated corners of the mouth), jaundice (a yellowing of the skin and sclera), and concave nails. A smooth, red tongue and restless leg syndrome are associated with iron deficiency anemia.

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 lose iron through menstrual cycles Hemochromatosis is a genetic condition where excess iron is absorbed in the GI tract and deposited in various organs, making them dysfunctional. Women are often less affected than men because women lose excess iron through their menstrual cycles. The other answer choices are not correct reasons why women are impacted less than men with hemochromatosis.

A client with sickle cell anemia has a high hematocrit. normal blood smear. normal hematocrit. low hematocrit.

low hematocrit A client with sickle cell anemia has a low hematocrit and sickled cells on the smear. A client with sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear.

A client is hospitalized 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin (Coumadin; blood thinner) at home, which is now discontinued. To prevent the formation of blood clots, which action should the nurse take? Monitor partial thromboplastin (PTT) time. Encourage a diet high in vitamin K. Have the client limit physical activity. Administer the prescribed enoxaparin (Lovenox; anticoagulant).

Administer the prescribed enoxaparin (Lovenox; anticoagulant). Clients who are prescribed warfarin at home and need to have a major invasive procedure stop taking warfarin prior to the procedure. Low molecular weight heparin, such as enoxaparin, may be used until the procedure is performed. The client will continue with a diet that has a daily consistent amount of vitamin K. The client needs to ambulate frequently throughout the day. Prothrombin (PT) time is monitored, not PTT, when warfarin had been administered.

When teaching a client with iron deficiency anemia about appropriate food choices, the nurse encourages the client to increase the dietary intake of which foods? Beans, dried fruits, and leafy, green vegetables Fruits high in vitamin C, such as oranges and grapefruits Dairy products Berries and orange vegetables

Beans, dried fruits, and leafy, green vegetables Food sources high in iron include organ meats (e.g., beef or calf liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy and green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.

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

Take 1 hour before breakfast Instructions the nurse will provide for the client taking oral ferrous sulfate is to administer the medication on an empty stomach. Instructions also include that there is decreased absorption of iron with food, particularly dairy products. The client is to increase vitamin C intake (fruits, juices, tomatoes, broccoli), which will enhance iron absorption. The client is to also increase foods high in fiber to decrease risk of constipation.

(REVIEW) A client's low prothrombin time (PT) was attributed to low vitamin K levels and the client's PT normalized after administration of vitamin K. When performing discharge education in an effort to prevent recurrence, what should the nurse emphasize? The need for adequate nutrition The need for constant access to factor VIII concentrate The need to avoid NSAIDs The need for meticulous hygiene

The need for adequate nutrition Vitamin K deficiency is often the result of a nutritional deficit. NSAIDs do not influence vitamin K synthesis and clotting factors are not necessary to treat or prevent a vitamin K deficiency. Hygiene is not related to the onset or prevention of vitamin K deficiency.

A client has a history of sickle cell anemia with several sickle cell crises over the past 10 years. What blood component results in sickle cell anemia? hemoglobin A hemoglobin M hemoglobin F hemoglobin S

hemoglobin S Hemoglobin A (HbA) normally replaces fetal hemoglobin (HbF) about 6 months after birth. In people with sickle cell anemia, however, an abnormal form of hemoglobin, hemoglobin S (HbS), replaces HbF. HbS causes RBCs to assume a sickled shape under hypoxic conditions.

A patient with sickle cell disease is brought to the emergency department by a parent. The patient has a fever of 101.6°F, a heart rate of 116, and a respiratory rate of 32. The nurse auscultates bilateral wheezes in both lung fields. What does the nurse suspect this patient is experiencing? Pulmonary edema Acute chest syndrome Pneumocystis pneumonia An exacerbation of asthma

Acute chest syndrome Acute chest syndrome is manifested by fever, respiratory distress (tachypnea, cough, wheezing), and new infiltrates seen on the chest x-ray. These signs often mimic infection, which is often the cause. However, the infectious etiology appears to be atypical bacteria such as Chlamydia pneumoniae and Mycoplasma pneumoniae as well as viruses such as respiratory syncytial virus and parvovirus. Other causes include pulmonary fat embolism, pulmonary infarction, and pulmonary thromboembolism. Seventy-five percent of patients who develop acute chest syndrome had a painful vaso-occlusive crisis, usually lasting an average of 2.5 days prior to developing symptoms of acute chest syndrome (Laurie, 2010).

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? Monitoring temperature at least once per shift Eliminating direct contact with others who are infectious Applying prolonged pressure to needle sites or other sources of external bleeding Implementing neutropenic precautions

Applying prolonged pressure to needle sites or other sources of external bleeding The interventions for a client with thrombocytopenia are the same as those for a client with cancer who is at risk for bleeding. For a client with leukemia, the nurse should apply prolonged pressure to needle sites or other sources of external bleeding. Reduced platelet production results in a delayed clotting process and increases the potential for hemorrhage. Implementing neutropenic precautions and eliminating direct contact with others are interventions to address the risk for infection.

The nurse is planning care for a client with severe fatigue secondary to anemia. What concept will the nurse use as the basis for planning interventions? Encouraging early and frequent activities. Assisting in prioritizing activities. Keeping long activity periods to build client stamina. Determining what days to be active.

Assisting in prioritizing activities. When planning care for a client with severe fatigue secondary to anemia, the nurse should act collaboratively with the client and assist in prioritizing activities. The client ultimately determines the balance between rest and activity, not the nurse. The nurse will balance activities and group nursing interventions in order to prevent client fatigue.

A client is being treated for DIC and the nurse has prioritized the nursing diagnosis of Risk for Deficient Fluid Volume Related to Bleeding. How can the nurse best determine if goals of care relating to this diagnosis are being met? Assess for edema. Assess skin integrity frequently. Assess the client's level of consciousness frequently. Closely monitor intake and output.

Closely monitor intake and output. The client with DIC is at a high risk of deficient fluid volume. The nurse can best gauge the effectiveness of care by closely monitoring the client's intake and output. Each of the other assessments is a necessary element of care, but none addresses fluid balance as directly as close monitoring of intake and output.

(REVIEW) A client has hereditary hemochromatosis. Laboratory test results indicate an elevated serum iron level, high transferrin saturation, and normal complete blood count (CBC). What is most important action for the nurse to take? Instruct the client to limit iron intake in the diet. Inform the client to limit ingestion of alcohol. Educate about precautions to follow after a liver biopsy. Remove the prescribed one unit of blood.

Remove the prescribed one unit of blood. Treatment for hemochromatosis is phlebotomy or removal of whole blood from a vein to reduce iron. Limiting dietary intake of iron is not an effective treatment. The client needs to perform activities to protect the liver, such as limiting alcohol ingestion. The definitive test for hemochromatosis had been a liver biopsy, but now genetic testing is performed. A liver biopsy could be performed to determine liver damage. However, this does not address the most immediate problem of too high iron.

A pregnant woman is hospitalized as the result of sickle-cell crisis. Which finding indicates the outcome has been achieved for this client? Describes the importance of staying cool Reports joint pain less than 3 on a scale of 0 to 10 Exhibits a temperature more than 100.3°F Takes hydroxyurea during her pregnancy

Reports joint pain less than 3 on a scale of 0 to 10 An expected outcome for a client experiencing a sickle-cell crisis is control and reduction of pain. Hydroxyurea is contraindicated in pregnancy because of the risk it poses for congenital abnormalities. An indication that the client is free from infection is exhibiting a normal temperature; 100.3°F is an elevated temperature. To minimize crises, the client needs to stay warm not cool.

You are caring for a 13-year-old diagnosed with sickle cell anemia. The client asks you what they can do to help prevent sickle cell crisis. What would be an appropriate answer to this client? Stay on oxygen therapy 24/7. Avoid any sports that tire you out. Avoid any activity that makes you short of breath. Drink at least 8 glasses of water every day.

Drink at least 8 glasses of water every day. During the physical examination, observe the client's appearance, looking for evidence of dehydration, which may have triggered a sickle cell crisis. Clients are taught moderation, not avoidance of activities. Most clients with sickle cell disease are not on oxygen therapy 24/7.

A client's family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC? "DIC is caused when hemolytic processes destroy erythrocytes." "DIC occurs when the immune system attacks platelets and causes massive bleeding." "DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs." "DIC is a complication of an autoimmune disease that attacks the body's own cells."

"DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs." The inflammatory response initiates the process of inflammation and coagulation. The natural anticoagulant pathways within the body are simultaneously impaired, and the fibrinolytic system is suppressed, allowing a massive amount of tiny clots forms in the microcirculation. As the platelets and clotting factors form microthrombi, coagulation fails. Thus, the paradoxical result of excessive clotting is bleeding. Decline in organ function is usually a result of excessive clot formation (with resultant ischemia to all or part of the organ).

A client with megaloblastic anemia reports mouth and tongue soreness. What instruction will the nurse give the client regarding eating while managing the client's symptoms? "Eat small amounts of bland, soft foods frequently." "Eat larger amounts of bland, soft foods less frequently." "Eat low-fiber blended foods only." "Eat cold, bland foods with a large amount of water."

"Eat small amounts of bland, soft foods frequently." Because the client with megaloblastic anemia often reports mouth and tongue soreness, the nurse should instruct the client to eat small amounts of bland, soft foods frequently. The other answer choices do not factor in the client's mouth soreness or need for nutrition.

A client with sickle cell crisis is admitted to the hospital in severe pain. While caring for the client during the crisis, which is the priority nursing intervention? Limiting the client's intake of oral and IV fluids Encouraging the client to ambulate immediately Limit foods that contain folic acid Administering and evaluating the effectiveness of opioid analgesics

Administering and evaluating the effectiveness of opioid analgesics The priority nursing intervention is to manage the acute pain. Client-controlled analgesia is frequently used in the acute care setting. A patient with sickle cell crisis experiences severe extreme pain, the use of IV fluids and oral intake is need to hydrate the patient, the patient is initially placed on bed rest during the crisis due to extreme fatigue. The patient must continue to ingest folic acid and are placed on a daily folic acid supplement .

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

Assesses the hemoglobin level Erythropoietin (epoetin alfa [Epogen]) with oral iron supplements can raise hematocrit levels in the client with end-stage renal disease. The nurse should check the hemoglobin prior to administration of erythropoietin, because too high a hemoglobin level can put the client at risk for heart failure, myocardial infarction, and cerebrovascular accident. Erythropoietin may be administered during dialysis treatments. The BUN will be elevated in the client with end-stage renal disease.

A client is found to have low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from? Select all that apply. Blood loss Abnormal erythrocyte production Infection Inadequate formed white blood cells Destruction of normally formed red blood cells

Blood loss Abnormal erythrocyte production Destruction of normally formed red blood cells Most anemias result from (1) blood loss, (2) inadequate or abnormal erythrocyte production, or (3) destruction of normally formed red blood cells. The most common types include hypovolemic anemia, iron-deficiency anemia, pernicious anemia, folic acid deficiency anemia, sickle cell anemia, and hemolytic anemia. Although each form of anemia has unique manifestations, all share a common core of symptoms. Anemia does not result from infection or inadequate formed white blood cells.

The nurse observes a co-worker who always seems to be eating a cup of ice. The nurse encourages the co-worker to have an examination and diagnostic workup with the health care provider. What type of anemia is the nurse concerned the co-worker may have? Sickle cell anemia Megaloblastic anemia Iron deficiency anemia Aplastic anemia

Iron deficiency anemia People with iron deficiency anemia may crave ice, starch, or dirt; this craving is known as pica.

(REVIEW) Which iron-rich foods should a nurse encourage an anemic client requiring iron therapy to eat? Lobster and Squash Cheese and Bananas Lamb and peaches Shrimp and tomatoes

Lamb and peaches Iron-rich foods include lamb and peaches. Shrimp, tomatoes, lobster, squash, cheese, and bananas are NOT high in iron content.

A male client has been receiving a continuous infusion of weight-based heparin for more than 4 days. The client's PTT is at a level that requires an increase of heparin by 100 units per hour. The client has the laboratory findings shown above. What is the most important action for the nurse to take? (chart shows significant decrease in platelets) Consult with the physician about discontinuing heparin. Continue with the present infusion rate of heparin. Increase the heparin infusion by 100 units per hour. Begin treatment with the prescribed warfarin (Coumadin).

Consult with the physician about discontinuing heparin. Platelet counts may decrease with heparin therapy, and this client's platelet count has decreased. The client may have heparin-induced thrombocytopenia (HIT). Treatment of HIT includes discontinuing the heparin. The question asks about the most important action of the nurse and that is to consult with the physician about discontinuing heparin therapy. The nurse may continue with the current rate and should not increase the heparin dose until consulting with the physician. Warfarin is not administered until the platelet count has returned to normal levels.

A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia? Dyspnea, tachycardia, and pallor Itching, rash, and jaundice Nights sweats, weight loss, and diarrhea Nausea, vomiting, and anorexia

Dyspnea, tachycardia, and pallor Signs of iron deficiency anemia include dyspnea, tachycardia, and pallor, as well as fatigue, listlessness, irritability, and headache. Night sweats, weight loss, and diarrhea may signal acquired immunodeficiency syndrome. Nausea, vomiting, and anorexia may be signs of hepatitis B. Itching, rash, and jaundice may result from an allergic or hemolytic reaction.

When assessing a client with anemia, which assessment is essential? Health history, including menstrual history in women Lifestyle assessments, such as exercise routines Age and gender Family history

Health history, including menstrual history in women When assessing a client with anemia, it is essential to assess the client's health history. Women should be questioned about their menstrual periods (e.g., excessive menstrual flow, other vaginal bleeding) and the use of iron supplements during pregnancy.

A patient has a probable diagnosis of polycythemia vera. The nurse reviews the patient's lab work for which diagnostic indicator? Leukocyte count of 11,500/mm3 Erythrocyte count of 6.5 m/?L Hematocrit of 60% Platelet value of 350,000/mm3

Hematocrit of 60% Although all results are elevated, the diagnostic indicator is the elevated hematocrit (normal = 42% to 52% for a male). These results are used in combination with other indicators (e.g., splenomegaly) for a definitive diagnosis.

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

Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit The symptoms indicate impaired tissue perfusion due to a decrease in the oxygen-carrying capacity of the blood. Cardiac status should be carefully assessed. When the hemoglobin level is low, the heart attempts to compensate by pumping faster and harder in an effort to deliver more blood to hypoxic tissue. This increased cardiac workload can result in such symptoms as tachycardia, palpitations, dyspnea, dizziness, orthopnea, and exertional dyspnea. Heart failure may eventually develop, as evidenced by an enlarged heart (cardiomegaly) and liver (hepatomegaly) and by peripheral edema.

(IMPORTANT) A client is receiving chemotherapy for cancer. The nurse reviews the client's laboratory report and notes that he has thrombocytopenia. To which nursing diagnosis should the nurse give the highest priority? Impaired oral mucous membranes Impaired tissue integrity Activity intolerance Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI

Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI These are all appropriate nursing diagnoses for the client with thrombocytopenia. However, the risk of cerebral and GI hemorrhage and hypotension pose the greatest risk to the physiological integrity of the client.

A nurse cares for a client with aplastic anemia. Which laboratory results will the nurse expect to find with this client? Select all that apply. Neutrophil count 1200/microliter White blood cell count 10,000/microliter Neutrophil count 17,000/microliter Platelets 35,000 microliters Hemoglobin 7 g/dL

Neutrophil count 1200/microliter Platelets 35,000 microliters Hemoglobin 7 g/dL Aplastic anemia causes pancytopenia, or overall decrease to all myeloid stem cell-derived cells. Pancytopenia manifests as neutrophil count less than 1500/microliter, hemoglobin less than 10 g/dL, and platelets less than 50,000/microliter.

An older adult client who is a vegetarian has a hemoglobin of 10.2 gm/dL, vitamin B12 of 68 pg/mL (normal: 200-900 pg/mL), and MCV of 110 cubic micrometers. After interpreting the data, what instruction should the nurse give to the client? Change the vegetarian diet and begin to eat red meat. Ingest a diet higher in vitamin B12 sources. Supplement the diet with vitamin B12. Continue with the diet but include more sources of iron.

Supplement the diet with vitamin B12. Data support that the client is experiencing megaloblastic anemia. Findings include the laboratory test results, the client's older age, and the client's status as a vegetarian. Many vegetarians need to supplement their diet with vitamin B12. Eating more foods with vitamin B12 will not provide enough of this vitamin for the client's body. Increasing iron sources will not resolve the client's anemia. Telling the client to discontinue the vegetarian practice and eat red meat is nontherapeutic.

The nurse monitors the laboratory data for several clients who are diagnosed with hypoproliferative anemias. For each laboratory data, click to specify if the finding indicates microcytic anemia or megaloblastic anemia. Laboratory Data: decreased folate decreased vitamin B12 decreased mean corpuscular volume (MCV) decreased reticulocytes increased mean corpuscular volume (MCV) increased total iron-binding capacity (TIBC)

decreased folate -- megaloblastic decreased vitamin B12 -- megaloblastic decreased mean corpuscular volume (MCV) -- microcytic decreased reticulocytes -- microcytic increased mean corpuscular volume (MCV) -- megaloblastic increased total iron-binding capacity (TIBC) -- microcytic There are three basic types of anemia: hypoproliferative, bleeding, and hemolytic. Each type of anemia presents differently in regard to laboratory data that is expected. The client who is diagnosed with microcytic anemia will have the following laboratory data: decreased mean corpuscular volume (MCV), decreased reticulocytes, and decreased total iron-binding capacity (TIBC). The client who is diagnosed with a megaloblastic anemia (e.g., vitamin B12 and folate deficiencies) will have the following laboratory data: increased MCV and decreases in either serum vitamin B12 or folate levels. Microcytic anemias do not present with the following laboratory data: increased MCV and deficiencies in both vitamin B12 and folate levels. Megaloblastic anemias do not present with the following laboratory data: decreased MCV, decreased reticulocytes, and increased TBIC.