Nursing Hematology
The nurse is teaching a client with pernicous anemia who requires vitamin B12 replacement therapy. Which statement indicates taht the client understands the treatment program? 1) "Ill swallow one vitamin B12 pill every morning for 2 weeks" 2) "Ill take vitamin B12 pill once each month for life 3) "Ill need an injection of vitamin B12 every month for life 4) "Ill only need daily injection of vitamin B12 until my blood count improves
In pernicous anemia, the gastric mucosa doesn't secrete intrinsic factyor, a protein necessary for vitamin B12 absorption. Without intrinsic factor, vitamin B12 replacements taken orally won't be absorbed; therefore, vitamin B12 must be administered through the I.M or deep subcutaneous routes. Clients must take vitamin B12 each day for 2 weeks initially, then weekly for several months, then once each month for life.
Which of the following nursing interventions and client instructions are appropriate in caring fora client who has pancytopenia? (select all that apply) 1) Restrict fresh friuts and vegetables in the diet 2) Restrict all visitors 3) Insert a foley catheter to monitor intake and output 4) restrict fluids 5) Report low grade temperature 6) Hold firm pressure for 5 mins following necessary venipunctures 7) Administer epoetin alfa (Procrit) as prescribed
Answer: 1, 5, 6, 7 Fresh fruits and vegetables pose a risk for introduction of bacteria into the gastrointestinal systems. A low-grade temperature may represent an immune response to an infection for clients who are immunosuppressed. Clients are at greater risk for bleeding due to low platelet counts. Firm pressure for longer periods of time is indicated following invasive procedures. Anemia is probably consequence of the disease and or treatment. Administration of a colony stimulating factor, such as epoetin alfa, can be vital in RBC production to counter disease/treatment-induced anemia.
The couple with the lowest risk of having a child with sickle cell disease is the one in which the: 1) father is HbS and the mother is HbS. 2) father is HbS and the mother is HbAS 3) father is HbA and the mother is HbS 4) father is HbAS and the mother is HbAS
If the father has normal hemoglobin (HbA) and the mother has sickle cell disease (HbS), the couple has a 0% chance of having a child with sickle cell disease. If both parents have sickle disease, the couple has a 100% chance of having a child with sickle cell disease. If the father has sickle cell disease and the mother has sickle cell train (HbAS), the couple has a 50% chance of having a child with sickle cell disease. If both parents have sickle cell train, the couple has a 25% chance of having a child with sickle cell disease
A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron-deficiency anemia? 1) Nights sweats, weight loss and diarrhea 2) Dyspnea, tachycardia and pallor 3) Nausea, vomiting and anorexia 4) Itching, rash and jaundice
Signs of iron deficiency anemia include dyspnea, tachycardia and pallor as well as fatigue, listlessness, irritability and headache.
While monitoring a client for the development of disseminated intravascular coagulation (DIC) the nurse should take note of which assessment parameters? 1) Platelet count, prothrombin time, and partial thromboplastin time 2) Platelet count, blood glucose levels, and white blood cell (WBC) count 3) Thrombin time, calcium levels, and potassium levels 4) Fibrinogen level, WBC and platelet count
The diagnosis of DIC is based on the resulys of laboratory studies of Prothrombin time, platelet count, thrombin time, partial tromboplastin time and fibrinogen level as well as client history and other assessment factors. Blood glucose levels, WBC count, calcium levels, and potassium levels aren't used to confirm a diagnosis of DIC
Which step must be done first when administering a blood transfusion? 1) Verify the blood product and client identity 2) Verify the physician's order 3) Verify client identity and blood product with another nurse 4) Assess the I.V. site
The nurse must verify the physician's order and then make sure the informed consent form is signed. Next, the nurse should make sure that an appropriate size IV is in place and she should assess the site for patency. After doing so, the nurse should verify the blood product and client identity with another nurse.
A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to: 1) lie supine with his neck extended 2) sit upright, leaning slightly forward 3) blow his nose and then put lateral pressure on his nose 4) hold his nose while bending foward at the waist
Sitting upright and leaning slightly forward avoids increasing vascular pressure in the nose and helps the client avoid aspirating blood. Lying supine won't prevent aspiration of the blood. Nose blowing can dislodge any clotting that has occurred. Bending at the waist increases vascular pressure in the nose and promotes bleeding rather than halting it.
A client receiving ferrous sulfate (Fer-Iron) therapy to treat an iron deficiency reports taking an antacid frequently to relieve heartburn. Which instruction should the nurse provide? 1) Take ferrous sulfate and the antacid together 2) Take ferrous sulfate and the antacid at least 2 hours apart 3) Avoid taking an antacid altogether 4) Take ferrous sulfate and the antacid at least 1 hr apart
THe nurse should instruct the client to take ferrous sulfate and an antacid at least 2 hours apart because antacids bind with iron in the GI tract, decreasing the rate or extent of iron absorption
Clients with cancer who receive multiple blood transfusions are at risk for forming antibodies against the blood. What precautions should the nurse take when administering blood to a client with a history of multiple transfusions? 1) Use a blood filter the leukocytes 2) Ask all clients about previous blood product administration 3) Administer allogeneic blood products 4) Make sure that leukocyte reduced blood products are prescribed
The nurse should make sure taht leukocyte reduced blood products are prescribed to reduce the risk of a blood transufion reaction caused by an antibody formation. Filter use doesn't guarantee leukocyte removal. The nurse can ask the client about previous blood transfusions, but that doesn't protect the client from a transfusion reaction. Allogeneic blood products aren't always possible in clients with a history of multiple blood transfusions.
A client is receiving a blood transfusion. If this client experiences an acute hemolytic reaction, which nursing intervention is the most important? 1) Immediately stop the transfusion, infuse dextrose 5% in water (D5W) and call the physician 2) Slow the transfusion and monitor the client closely 3) Stop the transfusion, notify the blood bank, and administer antihistamines. 4) Immediately stop the transfusion, infuse normal saline solution, notify the blood bank, and call the physician
When a transfusion reaction occurs, the transfusion should be immediately stopped, normal saline solution should be infused to maintain venous access, and the blood bank and physician should be notified immediately. Other nursing actions include saving the blood bag and tubing, rechecking the blood type and identification numbers on the blood tags, monitoring vital signs, obtaining necessary laboratory blood and urine samples, providing proper documentsation, and monitoring and treating for shock. Because they can cause red blood cell hemolysis, dextrose solutions shouldn't be infused with blood products. Antihistamines may be administered for a mild allergic reaction
For a client diagnosed with idopathic thrombocytopenia purpura (ITP), which nursing intervention is appropriate? 1) Teaching coughing and deep-breathing techniques to prevent infection 2) Administering platelets, as ordered, to maintain an adequate platelet count 3) Giving Aspirin, as prescribed, to control body temperature 4) Administering stool softeners, as ordered to prevent straining during infection
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.
The nurse is caring for a 32 year old client admitted with pernicious anemia. Which set of finding should the nurse expect when assessing the client? 1) Pallor, bradycardia, and reduced pulse pressure 2) Pallor, tachycardia, and a sore tongue 3) Sore tongue, dyspnea and weight gain 4) Angina, double vision and anorexia
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, weakness, fatigue and paresthesia of the hands and feet.
