Nurs. 107 Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders Prep-U & Nclex questions
what are the interventions for the patient with DIC
Assessment and interventions should target potential sites of organ damage Monitor and assess carefully Avoid trauma and procedures that increase the risk of bleeding, including activities that would increase intracranial pressure
What type of anemia results from red blood cell destruction? A. Iron deficiency B. Hemolytic C. Hypoproliferative D. None of the above
B. Hemolytic Rationale: Hemolytic anemia results from red blood cell destruction. In hemolytic anemias, premature destruction of erythrocytes results in the liberation of hemoglobin from the erythrocytes into the plasma. The bilirubin concentration rises, and increased erythrocyte destruction leads to tissue hypoxia, which in turn stimulates erythropoietin production, reflected in an increased reticulocyte count.
what are the interventions for a patient with anemia
Balance physical activity, exercise, and rest Maintain adequate nutrition and perfusion Patient education to promote compliance with medications and nutrition Monitor VS and pulse oximetry; provide supplemental oxygen as needed Monitor for potential complications
Hemophilia A is the most common of the three types of hemophilia. What is diminished in the less serious form of hemophilia A, known as von Willebrand's disease? A) amount and quality of factor IX B) quality of factor VIII C) amount and quality of factor VIII D) quality of factor XI
C) amount and quality of factor VIII Explanation: In a less serious form of hemophilia A, von Willebrand's disease, the amount and quality of factor VIII is diminished.
what is neutropenia
Decreased production or increased destruction of neutrophils (<2000/mm3)
**what is secondary polycythemia
Excessive production of erythropoietin from reduced amounts of oxygen, cyanotic heart disease, nonpathologic conditions or neoplasms
What are the causes of lymphopenia
Exposure to radiation Long-term use of corticosteroids Infections Neoplasms (cancers) Alcohol abuse
what should be part of your assessment of a patient with anemia
Health history and physical exam Laboratory data Presence of symptoms and impact of those symptoms on patient's life; fatigue, weakness, malaise, pain Nutritional, Cardiac, GI, Neuro assessment Medications Blood loss: menses, potential GI loss
what are the diagnostic testing for anemia
Hemoglobin and hematocrit Reticulocyte count RBC indices Iron studies Vitamin B12 Folate Haptoglobin and erythropoietin levels Bone marrow aspiration
Describe how blood cells are formed?
Hemopoiesis is the process of blood cell formation. The site where blood cells are formed is referred to as hemopoietic tissues or organs. The principal hemopoietic organs are the: 1. Bone marrow 2. Spleen 3. Lymph nodes 4. Thymus 5. liver
what are potential complications and problems with sickle cell disease
Hypoxia, ischemia, infection Dehydration CVA Anemia Acute and chronic kidney disease Heart failure Impotence Poor compliance Substance abuse
what are the different Hypoproliferative Anemias
Iron deficiency anemia Anemia in renal disease Anemia of inflammation Aplastic anemia: immune compromised Megaloblastic anemia
what are potential problems and complications of DIC
Kidney injury gangrene pulmonary embolism or hemorrhage acute respiratory distress syndrome stroke
Which of the following food choices made by a client with anemia best indicates that the nurse's instruction about foods high in iron has been successful? A) Oranges and grapefruits B) Spinach and broccoli C) Eggs, milk, and milk products D) Liver and muscle meats
Liver and muscle meats Explanation: Liver and muscle meat are excellent sources of iron.
what is anemia
Lower than normal hemoglobin and fewer than normal circulating erythrocytes; a sign of an underlying disorder
what is Lymphopenia
Lymphocyte count less than 1500/mm3
What are the planning and goals for a patient with anemia
Major goals include decreased fatigue, attainment or maintenance of adequate nutrition, maintenance of adequate tissue perfusion, compliance with prescribed therapy, and absence of complications
What are the interventions for sickle cell disease
Pain management Manage fatigue Infection prevention Promote coping Education of disease process Monitor for complications
What should you assess for in patients with DIC
S/S and progression of thrombi and bleeding swelling in calf heat redness SOB Stroke PE DVT
name 6 types of bleeding disorders
Secondary thrombocytosis Thrombocytopenia Immune thrombocytopenic purpura (ITP) Platelet defects—Refer to Chart 29-9 Hemophilia von Willebrand disease
what are the different types of hemolytic anemias
Sickle cell disease Thalassemia Glucose-6-phosphate dehydrogenase deficiency Immune hemolytic anemia Hereditary hemochromatosis
What are the causes of bleeding disorders
Trauma Platelet abnormality Coagulation factor abnormality
what is the medical management for polycythemia
Treatment not needed if condition is mild Treat underlying cause Therapeutic phlebotomy
what the treatments for anemia
Treatment specific to the type of anemia Dietary therapy Iron or vitamin supplementation: iron, folate, B12 Transfusions Immunosuppressive therapy
True or false disseminated intravascular coagulation is caused by alteration of normal hemostatic mechanisms
True Rationale: Normal hemostatic mechanisms are altered in DIC. The inflammatory response generated by the underlying disease initiates the process of inflammation and coagulation within the vasculature. Normal anticoagulation pathways are impaired and fibrinolysis is suppressed allowing small clots to form. As platelets and clotting factors are consumed by the microthrombi, coagulation fails, leading to excessive clotting and bleeding
what are the managements for anemias
correct or control the cause transfusion of packed RBCs
what is hypoproliferative
defect in production of erythrocytes RBCs
what does DIC stand for and what is it
disseminated intravascular coagulation altered hemostasis mechanism causes massive clotting in microcirculation. As clotting factors are consumed, bleeding occurs. Symptoms are related to tissue ischemia and bleeding
what is hemolytic
excess destruction of erythrocytes (RBCs)
what are bleeding disorders
failure of hemostatic mechanisms
what are the two deficiencies involved with megaloblastic anemia
folic acid vitamin b12
what is polycythemia
increased volume of RBCs
what are patients with neutropenia at risk for
infection
what is hypoproliferative caused by
iron vitamin b12 or folate deficiency decreased erythropoietin production cancer bone marrow damage
what is ischemia
lack of blood flow
what is the nursing management for bleeding disorders
limint injury assess for bleeding bleedin precautions
what are the planning and goals for DIC
maintenance of hemodynamic status, maintenance of intact skin and oral mucosa, maintenance of fluid balance, maintenance of tissue perfusion, enhanced coping, and absence of complications
what is the treatment for DIC
treat underlying cause, correct tissue ischemia, replace fluids and electrolytes, maintain blood pressure, replace coagulation factors, use heparin or LMWH
The nurse is caring for a client with leukemia who requires a bone marrow transplant. The nurse teaches the client and family that the following activities take place in what order? Place the options in the correct sequence
1. Find a donor with closely matched tissue antigens 2. Administer high doses of chemotherapy to destroy leukemic cells 3. Administer the donor's bone marrow through a central venous line into the recipient 4. Monitor for graft-versus-host disease
Which of the following statements made by a client with sickle cell trait indicates the need for further teaching? A) "I don't have to worry about developing sickle cell crisis since I only have the trait" B) "I will need to seek genetic counseling before I get married and plan to have children" C) "I will need to plan my activities, avoiding those that decrease my oxygen levels" D) "I need to avoid the use of recreational drugs and alcohol"
A) " I don't have to worry about developing sickle cell crisis since I only have the trait".
A nurse cares for a client with anemia requiring nutritional supplementation. Which nursing intervention best promotes client adherence with the prescribed therapy? A) Assist the client to incorporate the therapeutic regimen into daily activities. B) Develop a therapeutic regimen based on the client's understanding of the medication. C) Develop a therapeutic regimen recommendation for the client. D) Assist the client to use a medication reminder system for the therapeutic regimen.
A) Assist the client to incorporate the therapeutic regimen into daily activities. Explanation: The best way for the nurse to promote adherence to the therapeutic regimen is to assist the client to incorporate the therapeutic regimen into daily activities. This action is the only answer choice that is a collaborative effort with the client and is the reason it is correct.
Which of the following nursing observations indicate that a positive outcome for a client with sickle cell crisis has been met. A) Client has an intake of 3,000 ml per day B) Urinary output is 20ml per hour C) Client reports persistent joint pain D) Client has a temp of 100.0 F
A) Client has an intake of 3,000 ml per day
Which of the following nursing diagnoses should receive the highest priority in a client with sickle cell crisis? A) Pain B) Self-care deficit C) Activity intolerance D) Ineffective health maintenance
A) Pain Explanation: Pain; related to ischemic crisis of tissue.
A client has pernicious anemia and has been receiving treatment for several years. Which symptom may be confused with another condition in older adults? A) dementia B) ataxia C) stomatitis D) glossitis
A) dementia Explanation: 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.
A couple seeks genetic counseling for sickle cell anemia. Both individuals have sickle cell traits. The nurse concludes that the couple has what chance with each pregnancy of having a child who develops sickle cell disease? A) 0% B) 25% C) 50 % D) 100 %
B) 25% Explanation: 25% chance that each pregnancy will produce a child with the disease.
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? A) 3 to 5 months B) 6 to 12 months C) Longer than 12 months D 1 to 2 months
B) 6 to 12 months Explanation: 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.
The nurse is assessing a group of clients and identifies which client as being at high risk for developing folic acid deficiency anemia? A) Obese individual B) An client with alcoholism C) An adolescent D) An athlete
B) A client with alcoholism Explanation: Individuals who are chronically undernourished including the elderly. alcoholism, substance abuse are at risk for folic acid deficiency.
The nurse would asses a client who has undergone a small bowel resection of the ileum for development of which type of anemia? A) Sickle cell amenia B) Vitamin B 12 deficiency anemia C) Anemia of chronic disease D) Aplastic anemia
B) Vitamin B12 deficiency anemia Explanation: Resection of the distal ileum results in the impaired absorption of vitamin B 12.
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. A) Infection B) Inadequate formed white blood cells C) Destruction of normally formed red blood cells D) Abnormal erythrocyte production E) Blood loss
C) Destruction of normally formed red blood cells D) Abnormal erythrocyte production E) Blood loss Explanation: 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 anemias. 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 who is assessing a client with vitamin B12 deficiency anemia notes that the tongue is inflamed. The documents this observation as: A) Cheilitis B) Achlorhydria C) Glossitis D) Cheilosis
C) Glossitis Explanation: Vitamin B12 deficiency anemia is manifested clinically by glossitis of inflammation of the tongue.
Which iron-rich foods should a nurse encourage an anemic client requiring iron therapy to eat? A) Lobster and squash B) Shrimp and tomatoes C) Lamb and peaches D) Cheese and bananas
C) Lamb and peaches Explanation: Iron-rich foods include lamb and peaches. Shrimp, tomatoes, lobster, squash, cheese, and bananas aren't high in iron content.
A client with a pulmonary embolism is being treated with a heparin infusion. What diagnostic finding suggests to the nurse that treatment is effective? A) The client's platelet level is below 100,000/mm3. B) The client's PT is within reference ranges. C) The client's activated partial thromboplastin time (aPTT) is 1.5 to 2.5 times the control value. D) Arterial blood sampling tests positive for the presence of factor XIII.
C) The client's activated partial thromboplastin time (aPTT) is 1.5 to 2.5 times the control value. Explanation: The therapeutic effect of heparin is monitored by serial measurements of the aPTT; the dose is adjusted to maintain the range at 1.5 to 2.5 times the laboratory control. Heparin dosing is not determined on the basis of platelet levels, the presence or absence of clotting factors, or PT levels.
A client with chronic anemia has received multiple transfusions. Which client action would the nurse be concerned about relative to the client's condition? A) Takes 60 grams of protein each day B) Eliminates use of alcohol C) Takes a daily multiple vitamin pill D) Takes over-the-counter iron supplements
D) Takes over-the-counter iron supplements Explanation: When a client receives multiple transfusions and takes iron supplements, there may be a problem with iron overload. It is recommended that clients who are experiencing anemia either avoid or limit alcohol due to interference of alcohol with utilization of essential nutrients. The typical U.S. diet includes 60 grams of protein daily. Clients may be prescribed multivitamins.
A nurse is caring for a client with thalassemia who is being transfused. What is the nurse's role during a transfusion? A) To instruct the client to rest immediately if chest pain develops B) To administer vitamin B12 injections C) To assess for enlargement and tenderness over the liver and spleen D) To closely monitor the rate of administration
D) To closely monitor the rate of administration Explanation: 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.
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? A) hemoglobin A B) hemoglobin M C) hemoglobin F D) hemoglobin S
D) hemoglobin S Explanation: 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.
what are the manifestations of anemias
Depends on the rapidity of the development of the anemia, duration of the anemia, metabolic requirements of the patient, concurrent problems, and concomitant features Fatigue, weakness, malaise Pallor or jaundice Cardiac, GI, neurologic and respiratory symptoms Tongue changes Nail changes Angular cheilitis Pica
what are 12 acquired coagulation disorders
Liver disease Vitamin K deficiency Complications of anticoagulant therapy Disseminated intravascular coagulation (DIC) Thrombotic disorders Hyperhomocysteinemia Antithrombin deficiency Protein C & S deficiency Activated protein C resistance and factor V Leiden mutation Acquired thrombophilia Malignancy
The nurse is preparing a teaching plan for a client with sickle cell disease about ways to prevent crisis episodes. Which of the following should be emphasized to prevent sickle cell crisis? A) Eat nutritious foods that high in iron. B) Seek treatment for infections as soon as possible. C) Take adequate amounts of supplement vitamins and minerals. D) Avoid any type of physical activity.
Seek treatment for infections as soon as possible. Explanation: Clients with sickle cell disease have an impaired spleen resulting in decreased ability to fight infection, must seek treatment early for illness/infectious processes.
true or false polycythemia is a form of anemia
false Rationale: Polycythemia is caused by excessive production of erythropoietin. Examples of conditions causing polycythemia include smoking, obstructive sleep apnea, chronic obstructive pulmonary disease, severe heart disease, living at high altitudes or exposure to low levels of carbon monoxide. Secondary polycythemia can result from neoplasms that stimulate erythropoietic production.
true or false is DIC a disease
no it's a sign of an underlying disorder
what are the nursing management for neutropenia
patient education: can't go out in large crowds wash your hands know the s/s of early infection prevention and managing complication
what may the triggers include for DIC
sepsis, trauma, shock, cancer, abruptio placentae, toxins, and allergic reactions
What is the medical management of bleeding disorders
specific blood products
What clinical manifestations of iron deficiency anemia would the nurse observe in a client whose hemoglobin is 7.5 grams/dL? Select all that apply. A) Fatigue B) SOB with activity C) Pallor D) Cheilosis E) Smooth, red tongue F) Pica G) Restless leg syndrome
A) Fatigue B) SOB with activity C) Pallor D) Cheilosis E) Smooth, red tongue F) Pica G) Restless leg syndrome Explanation: All of the above are manifestations when a client's hemoglobin drops below 7-8 grams/dL.
The nurse is conducting a health screening at a local health fair. which of the following factors should the nurse recognize as possibly increasing the risk for developing non-Hodgkin's lymphoma? SELECT ALL THAT APPLY A) Genetics B) Epstein-Barr virus C) High fat diet D) Female gender E) Age between 15-35 yrs old
A) Genetics B) Epstein-Barr virus
The results of a client's most recent bloodwork and physical assessment are suggestive of immune thrombocytopenic purpura (ITP). This client should undergo testing for which of the following potential causes? Select all that apply. A) Hepatitis B) Acute renal failure C) HIV D) Malignant melanoma E) Cholecystitis
A) Hepatitis C) HIV Explanation: Viral illness have the potential to cause ITP.
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? A) Impaired oral mucous membranes B) Activity intolerance C) Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI D) Impaired tissue integrity
C) Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI Explanation: 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 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? A) "Eat cold, bland foods with a large amount of water." B) "Eat low-fiber blended foods only." C) "Eat larger amounts of bland, soft foods less frequently." D) "Eat small amounts of bland, soft foods frequently."
D) "Eat small amounts of bland, soft foods frequently." Explanation: 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 a hemolytic blood disorder presents to the primary care center with jaundice. The nurse explains to the client that the jaundice is most likely caused by which of the following? A) Increased bilirubin in plasma. B) Increased haptoglobin in plasma. C) Hepatitis infection. D) Loss of plasma proteins.
A) Increased bilirubin in plasma Explanation: Lysis of RBC's causes retention of iron and other substances including bilirubin to accumulate in plasma.
A nurse is preparing to administer an intramuscular IM dose of iron to a client with anemia. Which of the following precautions should the nurse take? A) Administer drug utilizing a Z track method. B) Use a 10inch 19-guage needle C) Administer drug deep in the deltoid muscle D) Massage area vigorously after administering the iron
A) Administer drug utilizing a z-track technique Explanation: When administering iron preparation via IM it should be given in a deep muscle the site should be upper outer quad of the buttocks utilizing the Z-track method.
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? A) Low ferritin level concentration B) Elevated red blood cell (RBC) count C) Elevated hematocrit concentration D) Enlarged mean corpuscular volume (MCV)
A) Low ferritin level concentration Explanation: 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 the hemoglobin concentration.
The nurse cares for a client with iron deficiency anemia. What findings will the nurse expect to find when reviewing the client's CBC results? A) Increased reticulocytes B) Decreased MCV C) Decreased reticulocytes D) Increased MCV E) Fragmented RBCs
B) Decreased MCV C) Decreased reticulocytes Explanation: In iron deficiency anemia (hypoproliferative anemia), the nurse can expect to find decreased MCV (mean corpuscular volume), and decreased reticulocytes. Fragmented RBCs are found in hemolytic anemias.
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? A) Leafy green vegetables B) Orange juice C) Kidney beans D) Milk
B) Orange juice Explanation: 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 with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse? A) Obtain the pain medication and delay the bath and position change until the medication reaches its peak. B) Inform the client that she will feel better after receiving a bath and clean sheets. C) Inform the client that the bath and positioning is an important part of client care and will be done right after pain medication administration. D) Inform the client that the position must be changed, and then you will give her pain medication and omit the bath.
A) Obtain the pain medication and delay the bath and position change until the medication reaches its peak. Explanation: When pain is severe, the nurse delays position changes and bathing until an administered analgesic has reached its peak concentration level and the client is experiencing maximum pain relief. Pain medication should never be delayed to assist in the control of the level of pain. Pain will not be relieved by a bath and clean sheets, only analgesics at this point in the client's illness.
A patient had gastric bypass surgery 3 years ago and now, experiencing fatigue, visits the clinic to determine the cause. The patient takes pantoprazole for the treatment of frequent heartburn. What type of anemia is this patient at risk for? A) Pernicious anemia B) Iron deficiency anemia C) Sickle cell anemia D) Aplastic anemia
A) Pernicious anemia Explanation: A deficiency of vitamin B 12 can occur in several ways. Inadequate dietary intake is rare but can develop in strict vegans (who consume no meat or dairy products). Faulty absorption from the GI tract is a more common cause. This occurs in conditions such as Crohn's disease, or after ileal resection or gastrectomy.
A client with sepsis is experiencing disseminated intravascular coagulation (DIC). The client is bleeding from mucous membranes, venipuncture sites, and the rectum. Blood is present in the urine. The nurse establishes the nursing diagnosis of Risk for deficient fluid volume related to bleeding. The most appropriate and measurable outcome for this client is that the client exhibits: A) Urine output greater than or equal to 30 mL/hour B) Stable level of consciousness C) Systolic blood pressure greater than 70 mm Hg D) Decreased bleeding
A) Urine output greater than or equal to 30 mL/hour Explanation: All options could be expected outcomes for a nursing diagnosis of risk for deficient fluid volume. However, the key words are most appropriate and measurable. That would be the option relating to urine output, which is the most direct measurement listed of fluid volume.
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? A) Truncal obesity B) Muscle wasting C) Hypertension D) Osteoporosis
D) Osteoporosis Explanation: 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.
A pregnant woman is hospitalized as the result of sickle-cell crisis. Which finding indicates the outcome has been achieved for this client? A) Describes the importance of staying cool B) Takes hydroxyurea during her pregnancy C) Reports joint pain less than 3 on a scale of 0 to 10 D) Exhibits a temperature more than 100.3°F
C) Reports joint pain less than 3 on a scale of 0 to 10 Explanation: 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.
Which of the following is considered an antidote to heparin? A) Narcan B) Ipecac C) Vitamin K D) Protamine sulfate
D) Protamine sulfate Explanation: Protamine sulfate, in the appropriate dosage, acts quickly to reverse the effects of heparin. Vitamin K is the antidote to warfarin (Coumadin). Narcan is the drug used to reverse signs and symptoms of medication-induced narcosis. Ipecac is an emetic used to treat some poisonings.
For a client diagnosed with pernicious anemia, the nurse emphasizes the importance of lifelong administration of: A) Vitamin C B) Vitamin B12 C) Folic acid D) Vitamin A
B) Vitamin B12 Explanation: For a client with pernicious anemia, the nurse emphasizes the importance of lifelong administration of vitamin B12. The nurse teaches the client or a family member the proper method to administer vitamin B12 injections. Administration of vitamin A, folic acid, or vitamin C is not recommended for this condition.
A nurse should expect to administer which vaccine to the client after a splenectomy? A) Attenuvax B) Tetanus toxoid C) Pneumovax 23 D) Recombivax HB
C) Pneumovax 23 Explanation: Pneumovax 23, a polyvalent pneumococcal vaccine, is administered prophylactically to prevent the pneumococcal sepsis that sometimes occurs after splenectomy. Recombivax HB is a vaccine for hepatitis B. Attenuvax is a live, attenuated virus vaccine for immunization against measles (rubeola). Tetanus toxoid is administered to prevent tetanus resulting from impaired skin integrity caused by traumatic injury.
A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor? A) Decreased total iron-binding capacity B) Decreased level of erythropoietin C) Increased mean corpuscular volume D) Increased reticulocyte count
B) Decreased level of erythropoietin Explanation: 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.
A patient has a probable diagnosis of polycythemia vera. The nurse reviews the patient's lab work for which diagnostic indicator? A) Leukocyte count of 11,500/mm3 B) Hematocrit of 60% C) Erythrocyte count of 6.5 m/?L D) Platelet value of 350,000/mm3
B) Hematocrit of 60% Explanation: 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 nurse is evaluating the response of a client with anemia to therapy. Which laboratory test result would the nurse review that best reflects bone marrow production of red blood cells (RBC's)? A) Hematocrit B) Hemoglobin C) Serum ferritin D) Reticulocyte count
D) Reticulocyte count Explanation: Reticulocyte (immature RBC) count is an indicator that new RBC's are being produced by the bone marrow.
Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? A) Thrombocytopenia B) Leukopenia C) Anemia D) Pancytopenia
D) Pancytopenia Explanation: 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 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) B-positive blood to an AB-positive client. B) A-positive blood to an A-negative client. C) O-positive blood to an A-positive client. D) O-negative blood to an O-positive client.
B) A-positive blood to an A-negative client. Explanation: An acute hemolytic reaction occurs when there is an ABO or Rh incompatibility. For example, giving A blood to a B client would cause a hemolytic reaction. Likewise, giving Rh-positive blood to an Rh-negative client would cause a hemolytic reaction. It's safe to give Rh-negative blood to an Rh-positive client if there is a blood type compatibility. O-negative blood is the universal donor and can be given to all other blood types. AB clients can receive either A or B blood as long as there isn't an Rh incompatibility.
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? A) Thiamine B) Folate C) Iron D) B12
D) B12 Explanation: 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 paresthesia 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 comes to the walk-in clinic complaining of weakness and fatigue. While assessing this client, the nurse finds evidence of petechiae and ecchymoses. The nurse notes that the spleen appears enlarged. What would the nurse suspect is wrong with this client? A) Aplastic anemia B) Pernicious anemia C) Iron-deficiency anemia D) Agranulocytosis
A) Aplastic anemia Explanation: Clients with a plastic anemia experience all the typical characteristics of anemia (weakness and fatigue). In addition, they have frequent opportunistic infections plus coagulation abnormalities that are manifested by unusual bleeding, small skin hemorrhages called petechiae, and ecchymoses (bruises). The spleen becomes enlarged with an accumulation of the client's blood cells destroyed by lymphocytes that failed to recognize them as normal cells, or with an accumulation of dead transfused blood cells. The blood cell count shows insufficient numbers of blood cells. A bone marrow aspiration confirms that the production of stem cells is suppressed. This scenario does not describe a client with pernicious anemia, iron-deficiency anemia, or agranulocytosis.
The nurse is talking with the parents of a toddler who was diagnosed with hemophilia A. What instruction should the nurse give to the parents? A) Encourage the toddler to participate in playground activities with other toddlers B) Administer factor VIII intravenously at the first sign of bleeding C) Administer over-the-counter preparations for a cold D) Use nasal packing for any nose bleeds
B) Administer factor VIII intravenously at the first sign of bleeding Explanation: Clients and families are taught to administer factor VIII intravenously. This helps to prevent bleeding episodes. Activities that minimize trauma are allowed for the toddler, however, playground activities may place the toddler at risk for increased bleeding. Over-the-counter cold preparations are to be avoided because they will interfere with platelet aggregation. Nasal packing is avoided because when the nasal packing is removed, bleeding may occur.
A nurse is caring for a client with a history of GI bleeding, sickle cell anemia, and a platelet count of 22,000/μl. The client, who is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hour, complains of severe bone pain and is scheduled to receive a dose of morphine sulfate. For which administration route should the nurse question an order? A) Oral B) I.M. C) I.V. D) Subcutaneous (subQ)
B) I.M. Explanation: A client with a platelet count of 22,000/μl bleeds easily. The nurse should avoid using the I.M. route because the area is highly vascular. The client may bleed readily when penetrated by a needle, and it may be difficult for the nurse to stop the bleeding. The client's existing I.V. access would be the best route, especially because I.V. morphine is effective almost immediately. Oral and subQ routes are preferred over I.M., but they're less effective for acute pain management than I.V.
A client admitted to the hospital in preparation for a splenectomy to treat autoimmune hemolytic anemia asks the nurse about the benefits of splenectomy. Which statement best explains the expected effect of splenectomy? A) It will increase red blood cell (RBC) production to compensate for blood loss. B) It will increase production of platelets by the bone marrow. C) It will remove the major site of red blood cell (RBC) destruction. D) It will reduce the destruction of platelets by macrophages.
C) It will remove the major site of red blood cell (RBC) destruction. Explanation: For clients with autoimmune hemolytic anemia, if corticosteroids do not produce remission, a splenectomy (i.e., removal of the spleen) may be performed because it removes the major site of RBC destruction.
what is hemolytic caused by
altered erythropoiesis or direct injury to the erythrocyte
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? A) Assess the client's level of consciousness frequently. B) Closely monitor intake and output. C) Assess for edema. D) Assess skin integrity frequently.
B) Closely monitor intake and output. Explanation: 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.
What are some potential complications patients with anemia may have HACID
Heart failure Angina Paresthesias Confusion Injury related to falls Depressed mood
After teaching a client about taking daily oral iron preparations for a moderate iron deficiency anemia, which statement by the client indicates to the nurse that additional instruction is needed? A) "I will call the doctor if my stools turn black." B) "I will take the iron with orange juice about an hour before eating." C) "I will increase my fluid and fiber intake while I am taking the iron tablets." D) "I will occasionally take a stool softener if I feel constipated."
"I will call the doctor if my stools turn black." Explanation: Iron replacement therapy may change the color of stool, usually to dark green or black. Iron is best absorbed on an empty stomach, so the client is instructed to take the supplement an hour before meals. Many clients have difficulty tolerating iron supplements because of gastrointestinal (GI) side effects (primarily constipation). Limit GI side effects by adding a stool softener or increasing dietary fiber and fluids. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.
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? A) Drink at least 8 glasses of water every day. B) Avoid any activity that makes you short of breath. C) Avoid any sports that tire you out. D) Stay on oxygen therapy 24/7.
A) Drink at least 8 glasses of water every day. Explanation: 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.
The nurse is caring for a client with a diagnosis of disseminated intravascular coagulopathy (DIC). The client's spouse asks why heparin has been ordered. The nurse's response would incorporate which of the following points? Select all that apply. A) Maintaining tissue perfusion B) Preventing occlusion of the microcirculation C) Preserving the myocardium D) Dissolving clots that have formed in the large vessels E) Preventing deep vein thrombosis (DVT)
A) Maintaining tissue perfusion B) Preventing occlusion in the microcirculation Explanation: In DIC the clotting factors cause to form in the microcirculation. Heparin is an anticoagulant that prevents further propagation of these clots. This maintains tissue perfusion.
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 at home, which is now discontinued. To prevent the formation of blood clots, which action should the nurse take? A) Encourage a diet high in vitamin K. B) Administer the prescribed enoxaparin (Lovenox). C) Have the client limit physical activity. D) Monitor partial thromboplastin (PTT) time.
B) Administer the prescribed enoxaparin (Lovenox). Explanation: 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.
A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client? A) Angina pectoris, double vision, and anorexia B) Pallor, tachycardia, and a sore tongue C) Sore tongue, dyspnea, and weight gain D) Pallor, bradycardia, and reduced pulse pressure
B) Pallor, tachycardia, and a sore tongue Explanation: Pallor, tachycardia, and a sore tongue are all characteristic findings in pernicious anemia. Other clinical manifestations include anorexia; weight loss; a smooth, beefy red tongue; a wide pulse pressure; palpitations; angina pectoris; weakness; fatigue; and paresthesia of the hands and feet. Bradycardia, reduced pulse pressure, weight gain, and double vision aren't characteristic findings in pernicious anemia.
The nurse is preparing the patient for a test to determine the cause of vitamin B12 deficiency. The patient will receive a small oral dose of radioactive vitamin B12 followed by a large parenteral dose of nonradioactive vitamin B12. What test is the patient being prepared for? A) Magnetic resonance imaging (MRI) study B) Schilling test C) Bone marrow biopsy D) Bone marrow aspiration
B) Schilling test Explanation: The classic method of determining the cause of vitamin B12 deficiency is the Schilling test, in which the patient receives a small oral dose of radioactive vitamin B12, followed in a few hours by a large, nonradioactive parenteral dose of vitamin B12 (this aids in renal excretion of the radioactive dose).
During nursing assessment, which question is important for the nurse to ask a client suspected of having nutritional anemia? A) "Do you have any pain?" B) "What color are your stools?" C) "Do you experience any tingling or numbness?" D) "Have you noticed an increase in bruising?"
C) " Do you experience any tingling or numbness"
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? A) The need for constant access to factor VIII concentrate B) The need to avoid NSAIDs C) The need for adequate nutrition D) The need for meticulous hygiene
C) The need for adequate nutrition Explanation: 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.
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? A) Increased blood viscosity, resulting from an overproduction of white cells B) Compensatory polycythemia stimulated by thrombocytopenia C) Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements D) Reduced plasma volume in response to a reduced production of cellular elements
C) Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements Explanation: The term leukemia means "white blood," which is used to describe the neoplastic proliferation of one hematopoietic cell type (granulocytes, monocytes, lymphocytes, and sometimes, erythrocytes and megakaryocytes).
what should be part of your assessment on a patient with sickle cell disease
Health history and physical exam Pain assessment Laboratory data: S-shaped hemoglobin Presence of symptoms and impact of those symptoms on patient's life; swelling, fever, pain Sickle cell crisis assessment: pain and dehydration Blood loss: menses, potential GI loss Cardiovascular and neurologic assessment
The client has been diagnosed with myelodysplastic syndrome with an absolute neutrophil count less than 1000/mm³ and is being admitted to the hospital. The nurse: A) Places the client in isolation and allows no visitors B) Assigns the client to a private room C) Allows unlicensed assistive personnel who reports having a sore throat to provide care D) Changes the water in the humidifier for oxygen therapy every 48 hours
B) Assigns the client to a private room Explanation: The client with an absolute neutrophil count less than 1000/mm³ is to be placed in a private room. Staff with a sore throat or cold should not be assigned to provide care for this client. The client does not need to be placed in isolation, but other neutropenic precautions need to be followed, such as allowing no visitors with infection. Water in oxygen humidifiers should be changed every 24 hours.
A client with multiple myeloma reports pain along the spinal column. The client is prescribed naproxen (Aleve) and oxycodone. Prior to administering these medications, the nurse: A) Questions the physician about the use of both medications B) Checks the client's BUN and creatinine C) Teaches the client to bend at the back when lifting objects D) Instructs the client not to lift more than 20 pounds
B) Checks the client's BUN and creatinine Explanation: Naproxen may cause renal dysfunction. It will be important to check and monitor the BUN and creatinine levels, which are indicators of renal function. Because of the disease, the client is not to lift more than 10 pounds and is to use correct body mechanics, by bending with the knees and not bending with the back. Both naproxen and oxycodone may be prescribed for bone pain for a client who has multiple myeloma.
