Perfusion

A nurse is contributing to the plan of care for a client who has a Hgb of 7.5 g/dL and a Hct or 21.5%. Which of the following interventions should the nurse include? Select all that apply. A. Provide assistance with ambulation B. Monitor oxygen saturation C. Weigh the client weekly D. Obtain stool specimen for occult blood E. Schedule daily rest periods

A, B, D, E

Anemia

An abnormally low amount of circulating RBCs, Hgb concentration, or both. Results in diminished oxygen-carrying capacity and delivery to tissues and organs.

A nurse is collecting data from a client who has anemia. Which of the following integumentary findings should the nurse expect? A. Absent turgor B. Spoon-shaped nails C. Shiny, hairless legs D. Yellow mucous membranes

B

A nurse is reinforcing teaching with a client who has heart failure about the need to limit sodium in the diet to 2,000 mg daily. Which of the following foods should the nurse recommend for the client? Select all that apply. A. 1 slice cheddar cheese B. 1 medium beef hot dog C. 3 oz Atlantic salmon D. 3 oz roasted chicken breast E. 2 oz lean baked ham

A, C, D One slice cheddar cheese contains 180 mg sodium. A medium beef hot dog contains 557 mg sodium. 3 oz Atlantic salmon contains 37 mg sodium. 3 oz roasted chicken breast contains 62 mg sodium. 2 oz lean baked ham contains 782 mg sodium. (Foods should be less than 300 mg per serving for a 2,000 mg sodium-restricted diet).

The nurse is caring for a client who is receiving epoetin alfa. What adjunct treatment will the nurse expect the health care provider to order for this client? A. Iron supplement B. Potassium supplement C. Renal dialysis D. Sodium restriction

A Iron supplementation is used adjunctively with epoetin to increase RBCs. The nurse would not expect a potassium supplement, sodium restriction or renal dialysis to be ordered.

Which patient will be at the greatest risk for anemia and be the most likely candidate for epoetin alfa therapy? A. A 62-year-old male with cancer B. A 40-year-old male with a high white blood cell count C. A 30-year-old pregnant woman D. A 20-year-old female

A Older adults who have cancer and are receiving chemotherapy are especially vulnerable to the adverse effects of anemia as a result of chemotherapy and would therefore be the most likely candidates for epoetin alfa therapy. Young adults over age 18, pregnant women, and patients with a high white blood cell count are not as vulnerable to anemia and would not require epoetin alfa therapy.

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

A 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.

A 26-year-old white male client has been prescribed captopril for hypertension. A nurse has been assigned to the client to provide education regarding the use of this drug. The nurse will advise the client that: A. a persistent, dry cough may occur; however, it is not serious. B. if sore throat, fever, and swollen hands or feet occur, do not be alarmed. These manifestations will subside. C. the first dose of the medication should be taken at breakfast. D. he should use a salt substitute containing potassium to avoid hypokalemia.

A The nurse will advise the client that the captopril may produce a persistent, dry cough that is not serious. Clients may want to discontinue therapy because of the cough, but the nurse should encourage the client to continue therapy and help the client minimize the cough. However, if the cough becomes intolerable, the client should contact the prescriber. The client should be instructed to take the first dose at bedtime to minimize the possibilities of injury from first-dose hypotension. The client should be advised to notify the prescriber promptly if sore throat; fever; swollen hands or feet; irregular heartbeat; chest pain; swollen face, eyes, lips and tongue; difficulty breathing; or hoarseness occur. These effects could indicate angioedema, which can be life threatening. If the client normally uses a salt substitute containing potassium or a potassium supplement, these substances may need to be discontinued to avoid possible hyperkalemia. Hypokalemia is not a concern.

Which blood cell type is matched correctly with its function? A. Plasma cell: Cell-mediated immunity B. Leukocyte: Fights infection C. T lymphocyte: Humoral immunity D. B lymphocyte: Secretes immunoglobulin

B Various blood cell types have unique, major functions. Leukocytes fight infection, T lymphocytes are integral in cell-mediated immunity, plasma cells secrete immunoglobulin, and B lymphocytes are integral in humoral immunity.

The nurse is providing discharge teaching to a patient diagnosed with heart failure. What should the nurse teach this patient to do to monitor fluid balance? A. Monitor bowel movements B. Assess radial pulses. C. Monitor blood pressure. D. Monitor weight daily.

D Daily weights at the same time every day can be a good indicator of fluid balance. Assessing radial pulses and monitoring the blood pressure may be done, but they do not provide information about fluid balance.

What are the types of cardiomyopathy?

Dilated (most common) Hypertrophic Restrictive

Heart failure generally results in...

Increased central venous pressure Increased pulmonary wedge pressure Increased pulmonary artery pressure Decreased cardiac output

A patient with sickle cell anemia is to begin treatment for the disease with hydroxyurea. What does the nurse inform the patient will be the benefits of treatment with this medication? Select all that apply. A. Ability to reverse the damage done from sickling of cells B. Decreased need for other analgesic medications C. Lower incidence of acute chest syndrome D. Decreased need for blood transfusions E. Fewer painful episodes of sickle cell crisis

C, D, E Hydroxyurea is a chemotherapy agent that is effective in increasing fetal hemoglobin (i.e., hemoglobin F) levels in patients with sickle cell anemia, thereby decreasing the formation of sickled cells. Patients who receive hydroxyurea appear to have fewer painful episodes of sickle cell crisis, a lower incidence of acute chest syndrome, and less need for transfusions. However, whether hydroxyurea can prevent or reverse actual organ damage remains unknown.

A nurse obtains the serum digoxin level and immediately reports a level greater than which value? A. 2.0 ng/mL. B. 0.1 ng/mL. C. 1.0 ng/mL. D. 0.5 ng/mL.

A A nurse must immediately report serum digoxin levels greater than 2.0 ng/mL. Therapeutic drug levels are between 0.8 and 2 ng/mL.

A nurse plans to have an education session with a client with cardiomyopathy and the client's spouse about ways to increase activity tolerance. What instructions would the nurse provide? A. Alternate active periods with rest periods. B. Include isometric exercises in the daily routine. C. Gradually work up to strenuous activity. D. Avoid all physical and emotional stress.

A The client should plan activities to occur in cycles, alternating rest with active periods. The client with cardiomyopathy must avoid strenuous activity and isometric exercises. It is impossible to avoid all physical and emotional stress.

Approximately what percentage of the body's red blood cells (RBCs) is destroyed and replaced each day? A. 2% B. 1% C. 4% D. 3%

B Erythropoiesis is a constant process by which approximately 1% of the body's RBCs are destroyed and replaced each day.

The nurse administers epoetin alfa (Epogen). What is the therapeutic response the nurse expects to assess? A. Increased resistance to infection B. Elevated heart rate C. Increased red blood cell count D. Elevated white blood cell count

C Epoetin alfa is the recombinant form of human erythropoietin, which increases the body's ability to produce red blood cells (RBCs). The patient's RBCs should increase in response. This medication will not increase white blood cells or the patient's resistance to infection. The patient's heart rate would not increase in response to this medication.

A client 19 years of age who is a drug addict comes to the emergency department reporting extreme fatigue and shortness of breath. The nurse assesses the client and, after taking a complete history, determines that the client has malnutrition. The nurse knows that malnutrition can cause which type of anemia? A. Anemia in chronic kidney disease occurs because of a dietary lack of folic acid, a component necessary in the formation of red blood cells. B. Pernicious anemia occurs because of a dietary lack of folic acid, a component necessary in the formation of red blood cells. C. Folic acid deficiency anemia occurs because of a dietary lack of folic acid, a component necessary in the formation of red blood cells. D. Iron deficiency anemia occurs because of a dietary lack of folic acid, a component necessary in the formation of red blood cells.

C Folic acid deficiency anemia occurs because of a dietary lack of folic acid, a component necessary in the formation of red blood cells. Iron deficiency anemia is due to a lack of iron. Pernicious anemia is due to a lack of intrinsic factor needed to form red blood cells and absorb vitamin B12.

Which would a nurse expect to assess if a client is experiencing right-sided heart failure? A. Dyspnea B. Hemoptysis C. Peripheral edema D. Wheezing

C Peripheral edema would be noted in clients with right-sided heart failure. Wheezing, hemoptysis, and dyspnea would suggest left-sided heart failure.

When administering iron injections, which method would the nurse use? A. This medication is not to be given as an injection. B. Subcutaneous C. Intradermal D. Z-track intramuscular

D The Z-track method is used when injecting iron to reduce the risks of subcutaneous staining and irritation.

B-type natriuretic peptide (BNP) for heart failure

In clients who have dyspnea, elevated BNP confirms a diagnosis of HF rather than a problem originating in the respiratory system. Less than 100 pg/mL = no heart failure Greater than 100 pg/mL = heart failure

Vasodilators used to treat heart failure include nitrates and ACE inhibitors. True False

True Drug therapies used to treat heart failure include vasodilators, such as angiotensin-converting enzyme (ACE) inhibitors and nitrates, which decrease cardiac workload, relax vascular smooth muscle to decrease afterload, and allow pooling in the veins, thereby decreasing preload of the heart and helping to improve function.

There is a risk of antibody production with the use of epoetin. True False

True Use of any therapeutic protein brings with it the risk of antibody production. All of the erythropoietic proteins now carry a warning about the potential for this problem.

Which nursing intervention would reduce cardiac workload in a client with myocarditis? A. Maintain the client on bed rest. B. Lower the client's head. C. Administer a prescribed antipyretic. D. Eliminate all phone calls and visitors.

A The nurse should maintain the client on bed rest to reduce cardiac workload and promote healing. The nurse would administer a prescribed antipyretic only if the client has a fever. The nurse elevates the client's head to promote maximal breathing potential. Treatment for myocarditis does not preclude allowing the client to have visitors or use the telephone.

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? A. Administering and evaluating the effectiveness of opioid analgesics B. Limiting the client's intake of oral and IV fluids C. Encouraging the client to ambulate immediately D. Limit foods that contain folic acid

A 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 male client states that he is seeing halos around lights. The client takes digoxin (Lanoxin) by mouth every day. The health care provider orders the client to have serum digoxin level drawn. Which of the digoxin levels indicate the client is experiencing toxicity? A. 4.0 nanograms per milliliter B. 2.0 nanograms per milliliter C. 0.5 nanograms per milliliter D. 1.0 nanograms per milliliter

A Therapeutic serum levels of digoxin are 0.5 to 2 nanograms per milliliter; toxic serum levels are above 2.0.

A client with heart failure reports a sudden change in the ability to perceive colors. The client reports nausea, and assessment reveals an irregular pulse of 39 beats per minute. What is the nurse's best action? A. Report the possibility of digitalis toxicity to the care provider promptly B. Facilitate an ophthalmology referral promptly C. Monitor the client's vital signs every 30 minutes D. Withhold the client's next scheduled dose of furosemide and report to the care provider

A This client's presentation is characteristic of digitalis toxicity, which must be promptly reported. This constellation of symptoms is less likely to result from furosemide. Close monitoring is necessary; vital signs every 30 minutes is insufficient. Referrals are not the most time-dependent priority

A nurse is caring for a client who has heart failure and reports increased shortness of breath. The nurse increases the client's oxygen per protocol. Which of the following of the actions should the nurse take first? A. weigh the client B. assist the client into high-Fowler's C. auscultate the lungs D. check oxygen saturation

B

A client who was diagnosed with iron deficiency anemia is worried because she does not know why she was prescribed iron supplements. The nurse teaches the client about which action of oral iron administration? A. Iron supplements prevent bleeding to replenish hemoglobin cells faster to treat anemia. B. Iron acts by elevating the serum iron concentration to replenish hemoglobin to treat anemia. C. Iron supplements prevent infection so hemoglobin cells grow back faster to treat anemia. D. Iron supplements prevent depletion of hemoglobin cells from anxiety to treat anemia.

B Iron acts by elevating the serum iron concentration to replenish hemoglobin to treat anemia. Iron supplements do not treat anxiety, infection, or bleeding.

A nurse caring for a client recently admitted to the ICU observes the client coughing up large amounts of pink, frothy sputum. Lung auscultation reveals course crackles to lower lobes bilaterally. Based on this assessment, the nurse recognizes this client is developing A. bilateral pneumonia. B. decompensated heart failure with pulmonary edema. C. acute exacerbation of chronic obstructive pulmonary disease. D. tuberculosis.

B Large quantities of frothy sputum, which is sometimes pink or tan (blood tinged), may be produced, indicating acute decompensated heart failure with pulmonary edema. These signs can be confused with pneumonia and tuberculosis, however the patient reveals course crackles upon auscultation which is indicitive of pulmonary edema. A patient with acute COPD would have diminished lung sounds bilaterally.

A 54-year-old client with CHF is admitted to the unit. The nurse knows that what physiologic changes will affect a client's stroke volume? A. Changes in respiratory rate B. Changes in heart contraction C. Changes in heparin dose D. Changes in walking pattern

B Stroke volume is the volume of blood ejected from the heart at each beat. If a heart contracts harder, more blood is ejected. If a heart cannot contract very well, then less blood is ejected and stroke volume falls. Heparin dose, walking patterns, and respiratory rate do not directly affect stroke volume.

Cardiomyopathy

Blood circulation to the lungs is impaired when the cardiac pump is compromised

What are the causes of anemia?

Blood loss Inadequate RBC production (hypoproliferative) Increased RBC destruction (hemolytic) Deficiency of necessary components (folic acid, iron, erythropoietin, Vitamin B12)

A client diagnosed with heart failure presents with a temperature of 99.1° F, pulse 100 beats/minute, respirations 42 breaths/minute, BP 110/50 mm Hg; crackles in both lung bases; nausea; and pulse oximeter reading of 89%. Which finding indicates a need for immediate attention? A. nausea B. blood pressure C. lung congestion D. temperature

C Because pulmonary edema can be fatal, lung congestion needs to be relieved as quickly as possible. Supplemental oxygen or mechanical ventilation is used to support breathing. Inotropic medications, which improve myocardial contractility, are administered to relieve symptoms.

A malnourished and hypertensive client is being treated with losartan. Considering the client's nutritional status, how should the dose of the medication be adjusted in this client? A. increased B. discontinued C. lowered D. prescribed according to normal dosages

C Both losartan and the metabolite are highly bound to plasma albumin, and losartan has a shorter duration of action. Due to malnutrition, a low-dose of losartan should be prescribed. The dose should not be higher than normal due to possible toxicity. The dose should not be the same as normal due to possible toxicity. The medication will not be combined with a diuretic unless the blood pressure is not controlled.

A patient is to be administered an erythropoiesis-stimulating agent. Which of the following drugs would the nurse administer? A. Hydroxyurea B. Ferrous sulfate C. Epoetin alfa D. Folic acid

C Epoetin alfa is an erythropoesis-stimulating agent. Ferrous sulfate is used in the treatment of iron-deficiency anemia. Megaloblastic anemia is treated with folic acid. Hydroxyurea is used in the treatment of sickle-cell anemia.

The nurse is preparing to administer furosemide to a client with severe heart failure. What lab study should be of most concern for this client while taking furosemide? A. BNP of 100 B. Sodium level of 135 C. Hemoglobin of 12 D. Potassium level of 3.1

D Severe heart failure usually requires a loop diuretic such as furosemide (Lasix). These drugs increase sodium and therefore water excretion, but they also increase potassium excretion. If a client becomes hypokalemic, digitalis toxicity is more likely. The BNP does not demonstrate a severe heart failure. Sodium level of 135 is within normal range, as is the hemoglobin level.

A patient is prescribed digitalis preparations. Which of the following conditions should the nurse closely monitor when caring for the patient? A. Enlargement of joints B. Flexion contractures C. Vasculitis D. Potassium levels

D A key concern associated with digoxin therapy is digitalis toxicity. Clinical manifestations of toxicity include anorexia, nausea, visual disturbances, confusion, and bradycardia. The serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity may occur.

What are the signs & symptoms of left-sided heart failure?

Dyspnea Orthopnea (shortness of breath while lying down) Nocturnal dyspnea Fatigue Displaced apical pulse (hypertrophy) S3 heart sound (gallop) Pulmonary congestion (dyspnea, cough, bibasilar crackles) Frothy sputum (can be blood-tinged) Altered mental status Manifestations of organ failure, such as oliguria (decrease in urine output)

What are the manifestations of cardiomyopathy?

Fatigue, weakness Heart failure (left with dilated type, right with restrictive type) Dysrhythmias (heart block) S3 gallop Cardiomegaly (enlarged heart), more severe with dilated type Angina (hypertrophic type)

What are the signs & symptoms of right-sided heart failure?

Jugular vein distention Ascending dependent edema (legs, ankles, sacrum) Abdominal distention, ascites Fatigue, weakness Nausea & anorexia Polyuria at rest (nocturnal) Liver enlargement (hepatomegaly) and tenderness Weight gain

What are the signs & symptoms of anemia?

Pallor Fatigue Irritability Numbness & tingling of extremities Dyspnea on exertion Sensitivity to cold Pain and hypoxia with sickle cell crisis SOB Tachycardia & palpitations Dizziness or syncope upon standing or with exertion Pallor with pale nail beds and mucous membranes Nail bed deformities (spoon-shaped nails) Smooth, sore, bright-red tongue (vitamin B12 deficiency)

A client, newly diagnosed with hypertension is started on captopril, an ACE inhibitor. The client should be informed of the possibility of what adverse effect? A. Persistent cough B. Hypokalemia C. Sweating D. Sedation

A A persistent, nonproductive cough develops in approximately 10% to 20% of clients using ACE inhibitors and may lead to stopping the drug. Hyperkalemia can occur in some clients, such as those who have diabetes mellitus or renal impairment or who are taking nonsteroidal anti-inflammatory drugs, potassium supplements, or potassium-sparing diuretics.

A nurse is transfusing whole blood to a client with impaired renal function. During the transfusion, the client tells the nurse, "I feel very short of breath all of a sudden." What is the nurse's primary action? A. Stop the infusion. B. Slow the infusion. C. Call the health care provider. D. Assess the client's vital signs.

A A client with impaired renal function is at increased risk for transfusion-associated circulatory overload (TACO). Signs of circulatory overload include dyspnea, orthopnea, tachycardia, an increase in blood pressure, and sudden anxiety. If the symptoms are mild, the nurse may be able to slow the infusion and administer diuretics; however, sudden shortness of breath should clue the nurse to immediately stop the infusion and sit the client upright with feet dangling. Next, the nurse will notify the health care provider after normal saline is infused into the site. Only after stopping the infusion will the nurse obtain the client's vital signs.

A nurse is obtaining a history from a new client in the cardiovascular clinic. When investigating for childhood diseases and disorders associated with structural heart disease, which finding should the nurse consider significant? A. Rheumatic fever B. Medullary sponge kidney C. Severe staphylococcal infection D. Croup

A Childhood diseases and disorders associated with structural heart disease include rheumatic fever and severe streptococcal (not staphylococcal) infections. Croup — a severe upper airway inflammation and obstruction that typically strikes children ages 3 months to 3 years — may cause latent complications, such as ear infection and pneumonia. However, it doesn't affect heart structures. Likewise, medullary sponge kidney, characterized by dilation of the renal pyramids and formation of cavities, clefts, and cysts in the renal medulla, may eventually lead to hypertension but doesn't damage heart structures.

A male client is diagnosed with heart failure. The health care provider orders a loading dose of digoxin. Loading doses are necessary for what reason? A. Digoxin's long half-life makes therapeutic serum levels difficult to obtain without loading. B. Oral digoxin is ineffective for the treatment of heart failure. C. The client is at risk for dysthymia with titrated doses. D. Digoxin's short half-life increases the risk for toxicity.

A Digoxin dosages must be interpreted with consideration of specific client characteristics, including age, weight, gender, renal function, general health state, and concurrent drug therapy. Loading or digitalizing doses are necessary for initiating therapy, because digoxin's long half-life makes therapeutic serum levels difficult to obtain without loading. Loading doses should be used cautiously in clients who have taken digoxin within the previous 2 or 3 weeks.

A client takes digoxin and furosemide (Lasix) for peripheral edema resulting from heart failure. Hypokalemia, caused by furosemide, has what effect on digoxin? A. Increased action of digoxin B. Decreased sodium retention C. Decreased action of digoxin D. Increased sodium retention

A Hypokalemia makes the heart muscle more sensitive to digitalis, thereby increasing the possibility of developing digitalis toxicity. There is no effect on sodium levels.

The nurse is caring for an older adult client who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine where the blood loss is coming from, what intervention can the nurse provide? A. Observe stools for blood. B. Observe the sputum for signs of blood. C. Observe client for facial droop. D. Observe the gums for bleeding after the client brushes teeth.

A Iron-deficiency anemia is unusual in older adults. Normally, the body does not eliminate excessive iron, causing total body iron stores to increase with age and necessitating maintenance of hydration. If an older adult is anemic, blood loss from the gastrointestinal or genitourinary tracts is suspected. Observing the stool for blood will help detect blood from GI loss. Bleeding gums may indicate periodontal disease, or anticoagulation from medication is not related to age. Blood in sputum can be an indicator of various lung disorders that may affect all age groups. Facial droop may indicate an impending stroke or Bell's palsy and would not be a reason for blood loss.

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? A. "I have difficulty breathing when walking 30 feet." B. "I feel hot all of the time." C. "I have an increase in my appetite." D. "I have a difficult time falling asleep at night."

A 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 fatigue and able to sleep often with a decrease in appetite, not an increase.

Which would be appropriate for a client who is receiving iron therapy? A. Cautioning the client that stool may be dark or green B. Encouraging the client to take the drug on an empty stomach C. Advising the client to limit the amount of fiber in his diet D. Ensuring that the client consumes three large meals per day

A The client needs to be informed that his stools may become dark or green. Small frequent meals with snacks can help minimize nausea. The client may take the drug with meals as long as those meals do not include eggs, milk, coffee, or tea. Constipation is possible, so the client needs to increase the fiber in his diet.

A nurse is caring for a patient admitted to the intensive care unit because of heart failure. The patient is prescribed digoxin. Which nursing diagnosis would be appropriate for this patient? A. Decreased Cardiac Output related to altered cardiac function B. Acute Pain and Headache related to adverse effects of the drug therapy C. Risk for Hyperthyroidism related to adverse effects of drug therapy D. Risk of Constipation related to adverse effects of the drug therapy

A Use of digoxin increases the risk for Decreased Cardiac Output related to altered cardiac function from the drug therapy. The use of digoxin does not pose a risk for acute pain, headache, hyperthyroidism, or constipation.

When teaching about the advantages of autologous blood transfusion to a client, the nurse should include which information? Select all that apply. A. If not needed immediately, the blood can be frozen for future use. B. It resolves anemia for clients with a hemoglobin less than 11g/dL. C. Blood can be transfused to family members and close relatives. D. It is safer for clients with a history of transfusion reactions. E. The primary advantage is prevention of viral infections.

A, D, E The primary advantage of autologous transfusions is the prevention of viral infections from another person's blood. Other advantages include safe transfusion for client with a history of transfusion reactions; and if the blood is not required immediately, it can be frozen until the donor needs it. It is the policy of the American Red Cross that autologous blood is transfused only to the donor. Hemoglobin level less than 11g/dL is a contraindication to autologous blood donation.

Risk factors for anemia

Acute or chronic blood loss: -Trauma -Menorrhagia -GI bleed (ulcers, tumor) -Intra- or postsurgical blood loss or henorrhage Chemical or radiation exposure Increased hemolysis: -Defective Hgb (sickle cell disease): RBCs become malformed during periods of hypoxia and obstruct capillaries in joints and organs -Impaired glycolysis -Immune disorder or destruction (transfusion reactions, autoimmune disorders) -Mechanical trauma to RBCs (mechanical heart valve, cardiopulmonary bypass) Inadequate dietary intake or malabsorption: -Iron deficiency -Vitamin B12 deficiency: pernicious anemia due to deficiency of intrinsic factor produced by gastric mucosa -Folic acid deficiency -Pica (persistent eating of substances not normally considered food, such as soil or chalk, for at least 1 month Bone marrow suppression: -Exposure to radiation or chemicals (insecticides, solvents) -Aplastic anemia results in decreased number of RBCs as well as decreased platelets and WBCs Age: -Older adult clients are at risk for nutrition-deficient anemias (iron, vitamin B12, folate) -Anemia can be misdiagnosed as depression or debilitation in older adult clients -GI bleeding is a common cause of anemia in older adult clients. Check stools for occult blood

The nursing instructor is teaching their clinical group how to assess a client for congestive heart failure. How would the instructor teach the students to assess a client with congestive heart failure for nocturnal dyspnea? A. By collecting the client's urine output B. By questioning how many pillows the client normally uses for sleep C. By observing the client's diet during the day D. By measuring the client's abdominal girth

B The nurse should ask the client about nocturnal dyspnea by questioning how many pillows the client normally uses for sleep. This is because being awakened by breathlessness may prompt the client to use several pillows in bed. Collecting the client's urine output, observing the client's diet, or measuring the client's abdominal girth does not help assess for nocturnal dyspnea.

A client is prescribed captopril. What adverse effect should the client be instructed on that can occur with angiotensin-converting enzyme (ACE) inhibitors? A. sedation B. persistent cough C. rash D. tachycardia

B A persistent cough can develop with the use of ACE inhibitors like captopril. Sedation, tachycardia, and rash are not generally associated as adverse effects of ACE inhibitors.

A nurse caring for a client with cardiomyopathy determines a diagnosis of anxiety related to a fear of death. Which behavior would indicate to the nurse recognizes that the client's level of anxiety has decreased when the client A. is resting in bed watching TV. B. is able to discuss the prognosis freely. C. eagerly awaits visits from family. D. answers questions about physical status with no problem.

B As anxiety decreases, clients will be able to discuss prognosis freely, verbalize fears and concerns, participate in support groups, and demonstrate appropriate coping mechanisms.

A client being treated for hypokalemia has a medication history that includes propranolol, digoxin, and warfarin. When the client reports nausea, abdominal discomfort, and visual changes, the nurse suspects what as the causative factor? A. heart failure B. digitalis toxicity C. myocardial infarction D. acute renal failure

B People diagnosed with hypokalemia can develop digitalis toxicity even when digoxin levels are not considered elevated. Signs of toxicity include potentially life-threatening heart rhythm disturbances, ranging from very slow to rapid ventricular rhythms. Other side effects include nausea, vomiting, loss of appetite, abdominal discomfort, blurred vision, and mental changes. The situation described does not support the conclusion that any of the other options are responsible for the client's described symptomology.

Which type of lymphocyte is responsible for cellular immunity? A. Basophil B. T lymphocyte C. Plasma cell D. B lymphocyte

B T lymphocytes are responsible for delayed allergic reactions, rejection of foreign tissue (e.g., transplanted organs), and destruction of tumor cells. This process is known as cellular immunity. B lymphocytes are responsible for humoral immunity. A plasma cell secretes immunoglobulin. A basophil contains histamine and is an integral part of hypersensivity reactions.

A client in acute renal failure has been prescribed 2 units of packed red blood cells (PRBCs). The nurse explains to the client that the blood transfusion is most likely needed for which reason? A. Hypervolemia B. Lack of erythropoietin C. Increases the effectiveness of dialysis D. Preparation for likely nephrectomy

B The kidneys produce erythropoietin, a hormone that stimulates red blood cell production. A lack of this hormone is the most likely reason for blood transfusion due to the acute kidney failure. There is no indication for a nephrectomy in this question. A blood transfusion will not necessarily increase the effectiveness of dialysis. Transfusing a client with hypervolemia could lead to circulatory overload.

A nurse is caring for a 66-year-old female client who is receiving digoxin. When preparing to administer a dose, the nurse observes that the client's apical pulse rate is 55 bpm. What is the appropriate action to take? A. Give the dose and contact the health care provider. B. Reduce the dose and contact the health care provider. C. Omit the dose and contact the health care provider. D. Omit the dose and inform the oncoming nurse at the next shift change.

C Bradycardia is a potential adverse effect of digoxin. Nurses should assess the client's apical pulse before each dose. If the rate is lower than 60 bpm in an adult client, the nurse should omit the dose and notify the provider.

A client with right-sided heart failure is admitted to the medical-surgical unit. What information obtained from the client may indicate the presence of edema? A. The client says he is short of breath when ambulating. B. The client says he has been hungry in the evening. C. The client says his rings have become tight and are difficult to remove. D. The client says that he has been urinating less frequently at night.

C Clients may observe that rings, shoes, or clothing have become tight. The client would most likely be urinating more frequently in the evening. Accumulation of blood in abdominal organs may cause anorexia, nausea, flatulence, and a decrease in hunger. Shortness of breath with ambulation would occur most often in left-sided heart failure.

A patient has been prescribed epoetin alfa. The nurse recognizes that this medication is indicated for treatment of anemia associated with which disease process? A. Liver failure B. Lung failure C. Renal failure D. Heart failure

C Epoetin alfa acts like the natural glycoprotein erythropoietin to stimulate the production of red blood cells (RBCs) in the bone marrow. It is often used in the treatment of anemia related to renal failure.

A client has been experiencing increasing shortness of breath and fatigue. The health care provider has ordered a diagnostic test in order to determine what type of heart failure the client is having. What diagnostic test does the nurse anticipate being ordered? A. An electrocardiogram B. A ventriculogram C. An echocardiogram D. A chest x-ray

C Increasing shortness of breath (dyspnea) and fatigue are common signs of left-sided heart failure (HF). However, some of the physical signs that suggest HF may also occur with other diseases, such as renal failure and chronic obstructive pulmonary disease; therefore, diagnostic testing is essential to confirm a diagnosis of HF. Assessment of ventricular function is an essential part of the initial diagnostic workup. An echocardiogram is usually performed to determine the ejection fraction, identify anatomic features such as structural abnormalities and valve malfunction, and confirm the diagnosis of HF.

The nurse is obtaining data on an older adult client. What finding may indicate to the nurse the early symptom of heart failure? A. Decreased urinary output B. Tachycardia C. Dyspnea on exertion D. Hypotension

C Left-sided heart failure produces hypoxemia as a result of reduced cardiac output of arterial blood and respiratory symptoms. Many clients notice unusual fatigue with activity. Some find exertional dyspnea to be the first symptom. An increase in urinary output may be seen later as fluid accumulates. Hypotension would be a later sign of decompensating heart failure as well as tachycardia.

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? A. Neutrophil B. Monocyte C. Myeloid stem cell D. Lymphoid stem cell

C Myeloid stem cells are responsible not only for all nonlymphoid white blood cells (WBC) but also for the production of red blood cells and platelets. Lymphoid cells produce either T or B lymphocytes. A monocyte is large WBC that becomes a macrophage when is leaves the circulation and moves into body tissues, and not responsible for RBC production.. A neutrophil is a fully mature WBC capable of phagocytosis and not responsible for RBC production.

After teaching a group of students about the types of anemia, the instructor determines that the teaching was successful when the students identify which anemia results from an inability to produce the intrinsic factor? A. Iron deficiency anemia B. Sickle cell anemia C. Pernicious anemia D. Folic acid deficiency anemia

C Pernicious anemia occurs when the gastric mucosa cannot produce the intrinsic factor and vitamin B12 cannot be absorbed. Iron deficiency anemia occurs when blood is lost or the diet is insufficient in supplying adequate iron. Sickle cell anemia results from a genetically inherited hemoglobin S. Folic acid deficiency anemia results from inadequate folic acid intake or malabsorption.

A nurse is reinforcing teaching with a client who has a new prescription for ferrous sulfate. Which of the following information should the nurse include? A. Stools will be dark red B. Take with a glass of milk if gastrointestinal distress occurs C. Foods high in Vitamin C will promote absorption D. Take for 14 days

C Stools will be dark green to black when taking iron. Milk binds with iron and decreases its absorption. Iron therapy usually takes 4-6 weeks for Hgb and Hct to return to the expected reference range.

What conclusion should the nurse draw when a client's digoxin level is reported to be 2.2 ng/mL? A. The medication is at a subtherapeutic drug level. B. A therapeutic drug level has been achieved. C. Digitalis toxicity is a possibility. D. A loading dose of digoxin has been given.

C The normal digoxin level is 0.5 to 2.0 ng/mL. Toxic serum levels are greater than 2 ng/mL; however, toxicity may occur at any serum level. None of the other options would result in a digoxin level above normal serum levels.

One hour after the completion of a fresh frozen plasma transfusion, a client reports shortness of breath and is very anxious. The client's vital signs are BP 98/60, HR 110, temperature 99.4°F, and SaO2 88%. Auscultation of the lungs reveals posterior coarse crackles to the mid and lower lobes bilaterally. Based on the symptoms, the nurse suspects the client is experiencing which problem? A. Exacerbation of congestive heart failure B. Delayed hemolytic reaction C. Transfusion-related acute lung injury D. Bacterial contamination of blood

C Transfusion-related acute lung injury (TRALI) is a potentially fatal, idiosyncratic reaction that is defined as the development of acute lung injury within 6 hours after a blood transfusion. It is more likely to occur when plasma and platelets are transfused. Onset is abrupt (usually within 6 hours of transfusion, often within 2 hours). Signs and symptoms include acute shortness of breath, hypoxia (arterial oxygen saturation [SaO2] less than 90%; pressure of arterial oxygen [PaO2] to fraction of inspired oxygen [FIO2] ratio less than 300), hypotension, fever, and eventual pulmonary edema.

The nurse is assuming care for a client who is receiving an infusion of packed red blood cells (PRBCs). The PRBCs were hung 4 hours ago, and 100 mL is left to infuse. Which action is most appropriate? Continue to infuse the PRBCs until they are completely infused. A. Fully open the roller clamp on the infusion set and infuse the remaining PRBCs as rapidly as possible. B. Insert a larger gauge IV catheter and transfer the infusion to the new insertion site. C. Discontinue the infusion and record the volume left in the blood bag.

C Transfusions must be completed within 4 hours due to the potential for bacterial growth in a blood product at room temperature.

A patient is experiencing nausea and visual disturbances when taking digoxin (Lanoxin). Which medication will be administered? A. Felbamate (Felbatol) B. Nesiritide (Natrecor) C. Acetylsalicylic acid (aspirin) D. Digoxin immune fab (Digibind)

D A patient who has nausea and visual changes while taking digoxin will most likely be administered digoxin immune fab (Digibind). Acetylsalicylic acid is not administered for digoxin toxicity. Nesiritide is not administered when the patient is experiencing digoxin toxicity. Felbamate is administered for the treatment of seizures.

A nurse is caring for a client who is taking digoxin and a loop diuretic. Which would be mostimportant for the nurse to monitor? A. Liver enzymes B. Sodium levels C. Electrocardiogram results D. Potassium levels

D Although it is important to monitor the client's ECG, it is more important to closely monitor potassium levels when the client is taking a drug that promotes the loss of potassium, such as thiazide or loop diuretics. Hypokalemia increases the effect of digoxin and increases the risk for digoxin toxicity. The client's sodium levels and liver enzyme levels may need to be monitored periodically, but not as closely as potassium levels.

Which of the following is the most common hematologic condition affecting elderly patients A. Thrombocytopenia B. Leukopenia C. Bandemia D. Anemia

D Anemia is the most common hematologic condition affecting elderly patients: with each successive decade of life, the incidence of anemia increases. Thrombocytopenia is a low platelet count. Leukopenia is a low leukocyte count. Bandemia is an increased number of band cells.

A 46-year-old client with a high body-mass index and a sedentary lifestyle has been diagnosed with hypertension after serial blood pressure readings. The clinician has opted to begin the client on captopril (Capoten). The nurse should recognize that the therapeutic effect of this drug is achieved in what way? A. By blocking aldosterone from binding to mineralocorticoid receptors B. By blocking the movement of calcium ions into arterial smooth muscles C. By directly relaxing vascular smooth muscle D. By inhibiting the transformation of angiotensin I to angiotensin II

D Captopril inhibits the ACE needed to change the inactive angiotensin I to the active form, angiotensin II. This reduction of angiotensin II decreases the secretion of aldosterone, thus preventing sodium and water retention. Captopril therefore decreases peripheral vascular resistance and lowers blood pressure. Calcium channel blockers such as verapamil block the movement of calcium ions into arterial smooth muscles and aldosterone blockers such as Eplerenone (Inspra) inhibit aldosterone from binding to mineralocorticoid receptors. ACE inhibitors do not have a direct effect on vascular smooth muscle.

Which is a symptom of severe thrombocytopenia? A. Inflammation of the mouth B. Inflammation of the tongue C. Dyspnea D. Petechiae

D Clients with severe thrombocytopenia have petechiae, which are pinpoint hemorrhagic lesions, usually more prominent on the trunk or anterior aspects of the lower extremities.

A client with chronic heart failure is receiving digoxin 0.25 mg by mouth daily and furosemide 20 mg by mouth twice daily. The nurse should assess the client for what sign of digoxin toxicity? A. dry mouth and urine retention. B. taste and smell alterations. C. nocturia and sleep disturbances. D. visual disturbances.

D Digoxin toxicity may cause visual disturbances (e.g., flickering flashes of light, colored or halo vision, photophobia, blurring, diplopia, and scotomata), central nervous system abnormalities (e.g., headache, fatigue, lethargy, depression, irritability and, if profound, seizures, delusions, hallucinations, and memory loss), and cardiovascular abnormalities (e.g., abnormal heart rate, arrhythmias). Digoxin toxicity doesn't cause taste and smell alterations. Dry mouth and urine retention typically occur with anticholinergic agents, not inotropic agents such as digoxin. Nocturia and sleep disturbances are adverse effects of furosemide — especially if the client takes the second daily dose in the evening, which may cause diuresis at night.

When an older adult client receiving a blood transfusion presents with an elevated blood pressure, distended neck veins, and shortness of breath, the client is most likely experiencing: A. pulmonary embolism. B. anaphylaxis. C. allergic reaction. D. fluid overload.

D Fluid overload can occur when blood components are infused too quickly or too voluminously. Symptoms include increased venous pressure, distended neck veins, dyspnea, coughing, and abnormal breath sounds.

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? A. Eating a steak with mushrooms B. Eating apple slices with carrots C. Eating leafy green vegetables with a glass of water D. Eating calf's liver with a glass of orange juice

D 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.

The nurse is working in a long-term care facility with a group of older adults with cardiac disorders. Why would it be important for the nurse to closely monitor an older adult receiving digitalis preparations for cardiac disorders? A. Older adults are at increased risk for hyperthyroidism. B. Older adults are at increased risk for cardiac arrests. C. Older adults are at increased risk for asthma. D. Older adults are at increased risk for toxicity.

D Older adults receiving digitalis preparations are at increased risk for toxicity because of the decreased ability of the kidneys to excrete the drug due to age-related changes. The margin between a therapeutic and toxic effect of digitalis preparations is narrow. Using digitalis preparations does not increase the risk of cardiac arrests, hyperthyroidism, or asthma.

A client is admitted to the ICU with a diagnosis of heart failure. The client is exhibiting symptoms of weakness, ascites, weight gain, and jugular vein distention. The nurse would know that the client is exhibiting signs of what kind of heart failure? A. Left-sided heart failure B. Chronic heart failure C. Acute heart failure D. Right-sided heart failure

D Signs and symptoms of Right Ventricular Failure include: Weakness; Ascites; Weight gain; Nausea, vomiting; Dysrhythmias; Elevated central venous pressure; Jugular vein distention. The scenario does not indicate whether the heart failure is chronic or acute. Therefore, options A, B, and C are incorrect.

A client is being treated for heart failure. Which is most indicative of improved health status? A. increased skin turgor B. heart rate of 52 C. improved sensorium D. decreased pitting edema

D The absence of pitting edema, decreased size of ankles and abdominal girth, and decreased weight improves circulation and increases renal blood flow. The diminished fluid volume is indicative of an improved blood supply to the body tissues. Increased skin turgor indicates that the client is well hydrated and does not have fluid volume excess. A heart rate of 52 is too slow to provide good contractility. Improved sensorium indicates adequate perfusion but is not the most indicative of improved heart failure status.

A patient with congestive heart failure has been digitalized. The patient requires long-term digoxin therapy. Which instructions should the nurse provide the patient on discharge? A. Report to the center if the pulse is less than 70 bpm. B. Take the drug with high fiber meals. C. Take antacids promptly to avoid gastric problems. D. Take the drug regularly without skipping a dose.

D The nurse should instruct the patient to take the drug regularly without skipping a dose. The patient should consult the provider before discontinuing the drug. Taking the drug with high-fiber meals will decrease the absorption of the drug. The patient should be advised to report to the center if the pulse is less than 60 bpm. Antacids should not be taken as it alters the plasma digoxin levels.

Which nursing intervention should a nurse perform when a client with cardiomyopathy receives a diuretic? A. Administer oxygen B. Allow unrestricted physical activity C. Maintain bed rest D. Check regularly for dependent edema

D The nurse should regularly monitor for dependent edema if the client with cardiomyopathy receives a diuretic. Oxygen is administered either continuously or when dyspnea or dysrhythmias develop. Bed rest is not necessary. The nurse should ensure that the client's activity level is reduced and should sequence any activity that is slightly exertional between periods of rest.

A nurse is caring for a client who will undergo total knee replacement and will have an autologous transfusion. Which statement will the nurse include when teaching the client about the transfusion? A. "You will likely not need the blood that is donated." B. "You will be prescribed calcium to replace what is lost during donation." C. "You typically donate blood the day of the surgery." D. "You typically donate blood 4 to 6 weeks before the surgery."

D With autologous donation, a client's own blood may be collected for future transfusion; this is an effective method for orthopedic surgery, where the likelihood of transfusion is high. Preoperative donation is ideally collected 4-6 weeks before surgery. The nurse will not tell the client that the blood will not be needed; orthopedic surgeries often require transfusion of blood. The client will be prescribed iron supplements during the donation time, not calcium.

Medications for anemia

Iron supplements: Ferrous sulfate, ferrous fumarate, ferrous gluconate -Oral iron supplements are used to replenish serum iron and iron stores. Iron is an essential component of Hgb, and subsequently, oxygen transport. -Parenteral iron supplements (iron dextran) are only given for severe anemia or when oral iron supplements are ineffective or poorly tolerated by the client -Administer parenteral iron using z-track method -Have hgb checked in 4-6 weeks to determine efficacy -Vitamin C can increase oral iron absorption -Take iron supplements between meals to increase absorption, if tolerated -Stools can appear green to back while taking iron Erythropoietin (epoetin alfa): Hematopoietic growth factor used to increase production of RBCs -Monitor for an increase in BP -Monitor Hgb and Hct twice per week -Monitor for cardiovascular event if Hgb increases too rapidly (greater than 1 g/dL in 2 weeks) Vitamin B12 supplementation (cyancobalamin): -Vitamin B12 is necessary to convert folic acid from its inactive form to its active form. All cells rely on folic acid for DNA production. -Vitamin B12 supplementation can be given orally if the deficit is due to inadequate dietary intake. -If deficiency is due to lack of intrinsic factor being produced by the parietal cells of the stomach or malabsorption syndrome, it must be administered parenterally or intranasally to be absorbed. -Administer parental forms IM or deep subcutaneous to decrease irritation. Dont mix other medications in the syringe. -For clients who lack intrinsic factor or have an irreversible malabsorption syndrome, this therapy must be continued for the rest of their life. -Clients should receive Vitamin B12 injections on a monthly basis. Folic acid supplements: -Folic acid is a water soluble B-complex vitamin. It's necessary for the production of new RBCs. -Administer orally or parenterally. -Large doses of folic acid can mask vitamin B12 deficiency. -Large doses of folic acid will turn urine dark yellow.

What are common medications for heart failure?

Loop diuretics: furosemide Thiazide diuretics: Hydrochlorothiazide Potassium-sparing diuretics: Spironolactone - Loop & thiazide diuretics can cause hypokalemia, and potassium supplementation can be required. - When taking loop or thiazide diuretics, ingest foods and drinks that are high in potassium to counter the effects of hypokalemia. ACE Inhibitors: Enalapril, Captopril - Monitor for hypotension for 2 hr following the initial dose - ACE inhibitors can cause angioedema (swelling of the tongue & throat), decreased sense of taste, or skin rash. - Monitor for increased levels of potassium - Can cause a dry cough Angiotensin receptor II blockers: Losartan Inotropic agents: Digoxin - Take apical HR for 1 min. Hold med if HR is less than 60/min, and notify the provider - Observe for nausea & vomiting - Take digoxin dose at the same time each day - Don't take digoxin at the same time as antacids. Separate the two meds by at least 2 hr. - Report indications of toxicity, including fatigue, muscle weakness, confusion, and loss of appetite - Regularly have digoxin & potassium levels checked Beta blockers: Metoprolol - Monitor BP, HR, activity tolerance, and orthopnea - Check orthostatic BP readings - Weigh daily