PNC 2 PrepU - Anemias - ML5
The nurse is teaching a nursing student about anemia and knows that it is important to start by explaining the causes of anemia. Which statement is true about the cause of anemia? A. "Anemia is a condition caused by reduced amounts of protein, causing less oxygen to be delivered to the tissues." B. "Anemia is a condition caused by reduced amounts of hemoglobin, causing less oxygen to be delivered to the tissues." C. "Anemia is a condition caused by reduced amounts of platelets, causing less oxygen to be delivered to the tissues." D. "Anemia is a condition caused by reduced amounts of hematocrit, causing less oxygen to be delivered to the tissues."
"Anemia is a condition caused by reduced amounts of hemoglobin, causing less oxygen to be delivered to the tissues." Explanation: The nurse teaches the student that anemia is a condition caused by reduced amounts of hemoglobin, causing less oxygen to be delivered to the tissues; hemoglobin carries oxygen to the cells of the body. Protein, hematocrit, and platelets do not carry oxygen to the tissues.
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 larger amounts of bland, soft foods less frequently." B. "Eat cold, bland foods with a large amount of water." C. "Eat small amounts of bland, soft foods frequently." D. "Eat low-fiber blended foods only."
"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.
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 feel hot all of the time." B. "I have difficulty breathing when walking 30 feet." C. "I have a difficult time falling asleep at night." D. "I have an increase in my appetite."
"I have difficulty breathing when walking 30 feet." Explanation: Most clients with iron-deficiency anemia have reduced energy, feel cold all the time, and experience fatigue and dyspnea with minor physical exertion. The heart rate usually is rapid even at rest. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased. The client would feel cold and not hot. The client is fatigued and able to sleep often with a decrease in appetite, not an increase.
The parents of a 6-year-old child with idiopathic thrombocytopenic purpura (ITP) ask the nurse, "What causes this disease?" Which response by the nurse would be most appropriate? A. "ITP is characterized by the loss of surface area on the red blood cell membrane." B. "ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." C. "ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional coagulation." D. "ITP occurs when the body's iron stores are depleted due to rapid physical growth, inadequate iron intake, inadequate iron absorption, or loss of blood."
"ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." Explanation: Idiopathic thrombocytopenic purpura (ITP) is primarily an autoimmune disease, which is an acquired, self-limiting disorder of hemostasis characterized by destruction and decreased numbers of circulating platelets. Hemophilia A and hemophilia B are distinguished by the particular procoagulant factor that is decreased, absent, or dysfunctional. Iron deficiency anemia occurs when the body's iron stores are depleted. Hereditary spherocytosis (HS) is characterized by loss of surface area on the red blood cell membrane.
A community health nurse is conducting the nutritional component of a class for new mothers. Which teaching point would be most justified? A. "Iron supplementation is not necessary provided you are breast-feeding your infant." B. "Be aware that cow's milk depletes your baby's supply of iron." C. "Your infant needs the same amount of iron as you, but has far fewer sources for obtaining it." D. "If you choose to feed your baby with formula, ensure that it is iron-fortified."
"If you choose to feed your baby with formula, ensure that it is iron-fortified." Explanation: Formula and cereals for infants should be iron-fortified to preclude iron deficiency anemia. Breast-feeding does not necessarily mitigate the need for iron supplementation. Cow's milk does not deplete existing iron stores but fails to provide sufficient levels of absorbable iron. Infants and children have significantly higher iron needs than do adults.
After teaching a patient who is receiving ferrous sulfate about the drug therapy regimen, which patient statement indicates that the teaching was successful? A. "I need to watch the amount of fiber I eat." B. "I must take the drug on an empty stomach." C. "I need to eat three large meals every day." D. "My stools might turn dark or green."
"My stools might turn dark or green." Explanation: The patient needs to know that his stools may become dark or green. Small frequent meals with snacks can help minimize nausea and GI upset associated with this drug. The patient may take the drug with meals as long as those meals do not include eggs, milk, coffee, and tea. Constipation is possible, so the patient needs to increase the fiber in his diet.
The nurse is caring for a child with aplastic anemia. The nurse is reviewing the child's blood work and notes the granulocyte count is about 500, platelet count is over 20,000, and the reticulocyte count is over 1%. The parents ask if these values have any significance. Which response by the nurse is appropriate? A. "The doctor will discuss these findings with you when he comes to the hospital." B. "These labs are just common labs for children with this disease." C. "These values will help us monitor the disease." D. "I'm really not allowed to discuss these findings with you."
"These values will help us monitor the disease." Explanation: This response answers the parent's questions. In the nonsevere form, the granulocyte count remains about 500, the platelets are over 20,000, and the reticulocyte count is over 1%. The other responses do not address what the parents are asking and would block therapeutic communication.
A client has been diagnosed with anemia. The physician suspects an immune hemolytic anemia and orders a Coombs test. The client asks the nurse what this test will tell the doctor. The nurse replies: A. "They will wash your RBCs. Then mix the cells with a reagent to see if they clump together." B. "They will look at your RBCs under a microscope to see if they have an irregular shape (poikilocytosis)." C. "They will be looking to see if you have enough ferritin in your blood." D. "They are looking for the presence of antibody or complement on the surface to the RBC."
"They are looking for the presence of antibody or complement on the surface to the RBC." Explanation: The Coombs test is used to diagnose immune hemolytic anemias. It detects the presence of antibody or complement on the surface of the red blood cell. Washing the RBCs and mixing the cells with a reagent is a direct antiglobulin test (DAT). Poikilocytosis would occur with a blood smear. Enough ferritin in the blood relates to an iron stores test.
A female client diagnosed with vitamin B12 deficiency asks the nurse why she needs to take the vitamin. Which statement would the nurse use when teaching the client about vitamin B12? A. "Vitamin B12 is essential to growth, cell reproduction, and the manufacture of myelin." B. "Vitamin B12 is essential to growth, cell reproduction, the manufacture of myelin, vitreous humor, and blood cells." C. "Vitamin B12 is essential to growth, cell reproduction, the manufacture of myelin, the repair of broken bones, and blood cells." D. "Vitamin B12 is essential to growth, cell reproduction, and the manufacture of myelin, and blood cells."
"Vitamin B12 is essential to growth, cell reproduction, and the manufacture of myelin, and blood cells." Explanation: Vitamin B12 is essential to growth, cell reproduction, and the manufacture of myelin, and blood cells. Vitamin B12 does not repair broken bones or vitreous humor.
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. Blood loss B. Destruction of normally formed red blood cells C. Inadequate formed white blood cells D. Infection E. Abnormal erythrocyte production
-Blood loss -Abnormal erythrocyte production -Destruction of normally formed red blood cells 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 is assessing a patient diagnosed with anemia. What symptoms does the nurse expect to assess in the patient? (Select all that apply.) A. Fatigue B. Elevated white blood cell (WBC) count C. Elevated oxygen saturation D. Flushed skin E. Elevated heart rate
-Elevated heart rate -Fatigue Explanation: The patient with anemia has a decreased red blood cell count, and the heart rate increases to compensate. Oxygen-carrying capacity of the blood decreases and so does the patient's oxygen saturation. WBC count elevation would not be a symptom in anemia. Skin becomes pale in severe anemia.
The nurse is teaching a nursing student about anemia and knows that it is important to include why anemia occurs. Which statement is true about why anemia occurs? A. Anemia occurs due to chronic illnesses or specific deficiencies such as vitamin C. B. Anemia occurs due to acute illnesses or specific deficiencies such as vitamin D. C. Anemia occurs due to chronic illnesses or specific deficiencies such as iron. D. Anemia occurs due to chronic illnesses or specific deficiencies such as vitamin A.
Anemia occurs due to chronic illnesses or specific deficiencies such as iron. Explanation: Anemia occurs due to chronic illnesses or specific deficiencies such as iron. Deficiencies of vitamins C, A, and D do not cause anemia.
When teaching a client with iron deficiency anemia about appropriate food choices, the nurse encourages the client to increase the dietary intake of which foods? A. Dairy products B. Beans, dried fruits, and leafy, green vegetables C. Fruits high in vitamin C, such as oranges and grapefruits D. Berries and orange vegetables
Beans, dried fruits, and leafy, green vegetables Explanation: Food sources high in iron include organ meats (e.g., beef or calf liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy and green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.
The home care nurse is caring for a client who is self-administering epoetin. What assessment is most important for the nurse to complete during the visit? A. Temperature B. Blood pressure C. Respirations D. Pulse
Blood pressure Explanation: The most important assessment is the blood pressure because epoetin can cause hypertension.
A client with iron-deficiency anemia reports feeling "tired all of the time." What does the nurse understand may be the cause of the fatigue that the client is experiencing? A. A decrease in lactic acid B. Increased diffusion of electrolytes C. Chronic blood loss with inadequate iron available for recycling D. Alteration in carbohydrate metabolism
Chronic blood loss with inadequate iron available for recycling Explanation: Although iron-deficiency anemia is characterized by decreased levels of hemoglobin, the usual reason for iron deficiency in adults in the western world is chronic blood loss because of inadequate iron available for recycling. Thus, the fatigue that develops in iron-deficiency anemia results, in part, from impaired function of the electron transport chain.
The practitioner notes the client with hemolytic anemia has Raynaud phenomenon. What causes this type of anemia? A. Prosthetic heart valve B. Deficiency of glucose-6-phosphate dehydrogenase (G6PD) C. Cold-reacting antibodies D. Warm-reacting antibodies
Cold-reacting antibodies Explanation: The hemolytic process caused by cold-reacting antibodies occurs in distal body parts, where the temperature may fall below 30°C. Vascular obstruction of red cells results in pallor, cyanosis of the body parts exposed to cold temperatures, and Raynaud phenomenon. The other options cause hemolytic anemia, but not Raynaud phenomenon.
A patient with chronic kidney disease is being examined by the nurse practitioner for anemia. The nurse has reviewed the laboratory data for hemoglobin and RBC count. What other test results would the nurse anticipate observing? A. Increased reticulocyte count B. Decreased level of erythropoietin C. Decreased total iron-binding capacity D. Increased mean corpuscular volume
Decreased level of erythropoietin Explanation: Differentiation of the primitive myeloid stem cell into an erythroblast is stimulated by erythropoietin, a hormone produced primarily by the kidney. If the kidney detects low levels of oxygen, as occurs when fewer red cells are available to bind oxygen (i.e., anemia), or with people living at high altitudes with lower atmospheric oxygen concentrations, erythropoietin levels increase. The increased erythropoietin then stimulates the marrow to increase production of erythrocytes. The entire process of erythropoiesis typically takes 5 days (Cook, Ineck, & Lyons, 2011). For normal erythrocyte production, the bone marrow also requires iron, vitamin B12, folate, pyridoxine (vitamin B6), protein, and other factors. A deficiency of these factors during erythropoiesis can result in decreased red cell production and anemia.
Which conditions predispose a person with sickle cell anemia to develop sickling of hemoglobin? A. Decreased oxygen saturation B. Increased iron content of blood C. Impaired red blood cell maturation D. Increased intravascular volume
Decreased oxygen saturation Explanation: Low oxygen in the tissues will cause red blood cells to take on the sickle shape in persons with sickle cell anemia. Sickle cell disease is a disorder of hemoglobin S and does not affect red blood cell maturation. The iron content is not affected by the sickling, but the capacity to carry the iron can be an effect of the affected RBCs. Dehydration can cause sickling by increasing the concentration of hemoglobin.
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. Itching, rash, and jaundice C. Nausea, vomiting, and anorexia D. Nights sweats, weight loss, and diarrhea
Dyspnea, tachycardia, and pallor Explanation: 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 patient is to be administered an erythropoiesis-stimulating agent. Which of the following drugs would the nurse administer? A. Epoetin alfa B. Folic acid C. Ferrous sulfate D. Hydroxyurea
Epoetin alfa Explanation: Epoetin alfa is an erythropoiesis-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 teaching a client about the signs and symptoms of anemia. If the client has a diminished oxygen-carrying capacity of hemoglobin (Hgb), then which manifestation should be assessed? A. Bone pain B. Fatigue C. Bleeding D. Pale skin
Fatigue Explanation: Anemia is frequently the result of tissue oxygen deficit, which is secondary to decreased circulating red blood cells or hemoglobin for oxygen delivery. The insufficient oxygen-carrying capacity to tissues causes fatigue. Pale skin is caused by the compensatory redistribution of blood from cutaneous tissues. Accelerated erythropoiesis can cause bone pain. Bleeding is associated with blood volume depletion, unrelated to the Hgb.
The provider notes that the client's hemoglobin is 8.2 g/dL (82 g/L). Which supplement will the provider recommend to the client? A. Calcium carbonate B. Ferrous sulfate C. Potassium chloride D. Magnesium oxide
Ferrous sulfate Explanation: Iron deficiency is a common, worldwide cause of anemia affecting people of all ages. The treatment of iron deficiency anemia in children and adults is directed toward controlling chronic blood loss, increasing dietary intake of iron, and administering supplemental iron. Ferrous sulfate is the usual oral replacement therapy.
A nurse is assessing a client who displays pale skin and nail beds. Which laboratory data should the nurse evaluate? A. Neutrophil count B. Erythrocyte sedimentation rate C. White blood cell count D. Hemoglobin level
Hemoglobin level Explanation: RBCs contain the oxygen-carrying protein hemoglobin that functions in the transport of oxygen. Pallor of the skin or nail beds is a sign of anemia, which can be indicated by a low Hgb level.
A nurse is monitoring a client with anemia and low oxygen levels. The nurse knows that which condition stimulates the secretion of erythropoietin? A. Inflammation B. Hypoxia C. Low blood pressure D. Tachycardia
Hypoxia Explanation: Erythropoiesis is governed for the most part by tissue oxygen needs. Any condition that causes a decrease in the amount of oxygen that is transported in the blood produces an increase in red blood cell production. The oxygen content of the blood does not act directly on the bone marrow to stimulate red blood cell production. Instead, the decreased oxygen content is sensed by the peritubular cells in the kidneys, which then produce a hormone called erythropoietin.
The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with sickle cell disease. The nurses in the group make the following statements. Which statement is most accurate regarding this condition? A. "The trait or the disease is seen in one generation and skips the next generation." B. "Males are much more likely to have the disease than females." C. "The disease is most often seen in individuals of Asian decent." D. "If the trait is inherited from both parents the child will have the disease."
If the trait is inherited from both parents the child will have the disease." Explanation: When the trait is inherited from both parents (homozygous state), the child has sickle cell disease, and anemia develops. The trait does not skip generations. The trait occurs most commonly in black clients. Either sex can have the trait and disease.
The pharmacology class learns that epoetin alfa is an immunosuppressant drug that is designed to have what expected outcome? A. Decreased RBC count B. Decreased WBC count C. Increased WBC count D. Increased RBC count
Increased RBC count Explanation: Epoetin is a hormone that stimulates bone marrow production of red blood cells.
Which would a nurse identify as the primary issue associated with anemias? A. Lack of vitamin B12 B. Increased plasma proteins C. Ineffective red blood cells D. Defective white blood cells
Ineffective red blood cells Explanation: Anemias are disorders that involve too few or ineffective RBCs that alter the ability of the blood to carry oxygen. White blood cells are associated with the immune response. Plasma proteins are important in the immune response and blood clotting. Lack of vitamin B12 is associated with a specific type of anemia.
The client is exhibiting signs of premature destruction of red blood cells and an increase in erythropoiesis after having a transfusion. This is an example of: A. Intravascular hemolysis B. Extravascular hemolysis C. Acute blood loss D. Megaloblastic anemia
Intravascular hemolysis Explanation: Hemolytic anemia is characterized by premature destruction of red cells and an increase in erythropoiesis. In hemolytic anemia, red cell breakdown can occur within or outside the vascular compartment. Intravascular hemolysis is less common and occurs as a result of transfusion reaction. Extravascular hemolysis occurs when red cells become less deformable, making it difficult for them to traverse the splenic sinusoids. In acute blood loss, the red blood cells remain normal in size and color. Megaloblastic anemia results from impaired production of red blood cells.
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 acts by elevating the serum iron concentration to replenish hemoglobin to treat anemia. B. Iron supplements prevent infection so hemoglobin cells grow back faster to treat anemia. C. Iron supplements prevent bleeding to replenish hemoglobin cells faster to treat anemia. D. Iron supplements prevent depletion of hemoglobin cells from anxiety to treat anemia.
Iron acts by elevating the serum iron concentration to replenish hemoglobin to treat anemia. Explanation: 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 has been assigned to a 43-year-old man who is to receive epoetin alfa therapy. The patient is HIV-positive and has anemia related to zidovudine therapy. The nurse will monitor: A. Chemotherapy B. Iron levels C. Swelling of veins D. Renal failure
Iron levels Explanation: Monitoring iron and hematocrit levels may help the nurse track the progress and effectiveness of the epoetin alfa therapy. Chemotherapy is a cancer treatment, not an assessment that determines the success or effectiveness of the epoetin alfa therapy. Swelling of veins and renal failure are not normally monitored in an ongoing assessment of a patient who takes epoetin alfa.
When describing the function of vitamin B12, what would be appropriate to include? A. Oxygen transport to the tissues B. Important role in cell division C. Maintenance of myelin sheath D. Prevention of neural tube defects
Maintenance of myelin sheath Explanation: Vitamin B12 is important for maintaining the myelin sheath. Folic acid is important in preventing neural tube defects and is essential for cell division in all types of tissues. RBCs are important for transporting oxygen to the tissues.
Adverse effects of epoetin and darbepoetin include increased risks of what condition? A. Myocardial infarction B. Cirrhosis of the liver C. Hyperlipidemia D. Diabetes mellitus type 2
Myocardial infarction Explanation: Adverse effects of epoetin and darbepoetin include increased risks of hypertension, myocardial infarction, and stroke, especially when used to increase hemoglobin above 12 g/dL.
After teaching a group of students about therapy for iron toxicity, the instructor determines that the students need additional teaching when they identify that the antidote can be administered by which route? A. Oral B. Subcutaneous C. Intravenous D. Intramuscular
Oral Explanation: The antidote for iron toxicity, deferoxamine, can be administered IM, IV, or subcutaneously.
A client tells the nurse that the doctor told her she has too many red blood cells accompanied by elevated white cells and platelet counts. The nurse recognizes this as: A. Aplastic anemia B. Pernicious anemia C. Polycythemia vera D. Hemolytic anemia
Polycythemia vera Explanation: Polycythemia vera is a neoplastic disease of the pluripotent cells of the bone marrow characterized by an absolute increase in total red blood cell (RBC) mass accompanied by elevated white cell and platelet counts. In pernicious anemia, the RBCs are not high in number but are larger in size. In aplastic and hemolytic anemia, there is a small number of RBCs.
A client has been diagnosed with aplastic anemia. The nurse correlates this diagnosis with which laboratory value? A. Relative polycythemia B. Decreased inflammatory cytokines C. Increased hemoglobin counts D. Reduction of white blood cells
Reduction of white blood cells Explanation: Aplastic anemia is caused by bone marrow suppression and usually results in a reduction of white blood cells and platelets, as well as red blood cells. Chronic diseases such as inflammatory disorders (rheumatoid arthritis), cancers, and renal failure cause anemia through the production of inflammatory cytokines that interfere with erythropoietin production or response.
When it is determined that a client's red blood cells (RBCs) have a biconcave shape, what will be the nurse's reaction? A. The nurse will be pleased, as that shape allows for increased oxygen diffusion. B. The nurse will immediately notify the client's health care provider of this serious finding. C. The nurse will be concerned, as this is an indication of sickle cell anemia. D. The nurse will arrange for bedside oxygen for the client to use as needed.
The nurse will be pleased, as that shape allows for increased oxygen diffusion. Explanation: The RBC provides the means for transporting oxygen from the lungs to the tissues. The biconcave shape of the red cell increases the surface area for diffusion of oxygen across the thin cell membrane. There is only one appropriate reaction to the fact that the RBCs are biconcave in shape.
Which symptom, if assessed after the administration of epoetin alfa (Epogen), would be cause for alarm? A. The patient states the injection "hurts." B. The patient is tired. C. The patient reports "bone pain." D. The patient displays weakness on one side of the body.
The patient displays weakness on one side of the body. Explanation: Epoetin increases the risk of myocardial infarction and stroke. Any symptoms that could indicate these conditions would be cause for alarm. Weakness on one side of the body could indicate a stroke. The nurse should continue with a neurological assessment and alert the health care provider. Bone pain and pain at the injection site are expected side effects and not cause for alarm. Patients who have anemia, the condition which this medication treats, typically report feeling tired and fatigued, and this is not cause for alarm.
After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/mm3. What term should the nurse use to describe this low platelet count? A. Thrombocytopenia B. Neutropenia C. Leukopenia D. Anemia
Thrombocytopenia Explanation: A normal platelet count is 140,000 to 400,000/mm3 in adults. Chemotherapeutic agents produce bone marrow depression, resulting in reduced red blood cell counts (anemia), reduced white blood cell counts (leukopenia), and reduced platelet counts (thrombocytopenia). Neutropenia is the presence of an abnormally reduced number of neutrophils in the blood and is caused by bone marrow depression induced by chemotherapeutic agents.
An infant from parents of Mediterranean decent has been diagnosed with a severe form of β-thalassemia anemia. The nurse caring for this infant knows that the infant will most likely receive which medical treatment? A. Iron sulfate supplements B. Warfarin, a blood thinner to decrease clot formation C. Transfusion therapy D. Stem cell transplant
Transfusion therapy Explanation: Persons who are homozygous for the trait (thalassemia major) have severe, transfusion-dependent anemia that is evident at 6 to 9 months of age when the hemoglobin switches from HbF to HbA. If transfusion therapy is not started early in life, severe growth retardation occurs in children with the disorder. Iron and blood thinners will not be therapeutic for this client. Stem cell transplantation is a potential cure for low-risk clients, particularly in younger persons with no complications of the disease or its treatment, and has excellent results.
Cyanocobalamin is a vitamin B12 in a nasal formulation. True False
True Explanation: Vitamin B12 includes hydroxocobalamin (generic), an injectable drug, and cyanocobalamin (Nascobal), a nasal spray.
The patient is being prescribed epoetin alfa for the treatment of anemia related to the renal failure. The patient also has a history of diabetes mellitus, uncontrolled hypertension, osteoarthritis, and hypothyroidism. Which of these conditions should the nurse bring to the physician's attention prior to administering the medication? A. Uncontrolled hypertension B. Diabetes mellitus C. Hypothyroidism D. Osteoarthritis
Uncontrolled hypertension Explanation: The nurse should determine whether the patient has pre-existing uncontrolled hypertension, which is a contraindication for the use of epoetin alfa.
A nurse on a hematology/oncology floor is caring for a client with aplastic anemia. Which would not be included in the client's discharge instructions? A. Use a disposable razor when shaving. B. Avoid contact with family/friends who are sick. C. Plan for frequent periods of rest. D. Encourage frequent handwashing.
Use a disposable razor when shaving. Explanation: People with aplastic anemia usually have insufficient erythrocytes, leukocytes, and platelets. Encourage behaviors that will lower the risk for bleeding. Avoiding contact with people who are sick reduces the risk of acquiring an infection. Handwashing reduces the risk of acquiring an infection. Anemia can cause fatigue and shortness of breath with even mild exertion.
A client is seen in the emergency department with severe pain related to a sickle cell crisis. What does the nurse understand is occurring with this client? A. Vascular occlusion in small vessels decreasing blood and oxygen to the tissues. B. Bone marrow decreases the erythrocyte production causing decrease in hypoxia. C. The client has a decreased tolerance of pain related to the chronic nature of the illness. D. Overhydration enlarges the red blood cells.
Vascular occlusion in small vessels decreasing blood and oxygen to the tissues. Explanation: The person with sickle cell disease repeatedly suffers from two major problems: (1) episodes of sickle cell crisis from vascular occlusion, which develops rapidly under hypoxic conditions, and (2) chronic hemolytic anemia. During a sickle cell crisis, the sickle-shaped cells lodge in small blood vessels, where they block the flow of blood and oxygen to the affected tissue. The vascular occlusion induces severe pain in the ischemic tissue. The client may have increased tolerance for pain due to the chronic nature of the illness. Bone marrow increases the erythrocyte production. Underhydration increases the client's risk of developing a vaso-occlusive crisis.
A nursing instructor is teaching students about the myelin sheath of the central nervous system (CNS). The nurse knows that teaching has been effective when a student identifies which vitamin as necessary for the formation of the myelin sheath in the CNS? A. Folic acid B. Vitamin D C. Vitamin B12 D. Vitamin C
Vitamin B12 Explanation: Vitamin B12 is necessary for the formation and maintenance of the myelin sheath in the CNS and for the health of RBCs.
A client admitted to the hospital with abdominal pain, anemia, and bloody stools reports feeling weak and dizzy. The client has rectal pressure and needs to urinate and move their bowels. The nurse should help them: A. to the bedside commode. B. onto the bedpan. C. to the bathroom. D. to a standing position so he can urinate.
onto the bedpan. Explanation: A client who's dizzy and anemic is at risk for injury because of his weakened state. Assisting him with the bedpan would best meet his needs at this time without risking his safety. The client may fall if walking to the bathroom, left alone to urinate, or trying to stand up.
The client with chronic kidney disease and heart failure is weak and dyspneic. Laboratory work reveals a hemoglobin of 6.5 g/dl (65 g/l). Which type of blood product will nurse expect the health care provider to order? A. albumin B. plasma C. whole blood D. packed red blood cells
packed red blood cells Explanation: Transfusion is suggested for people with hemoglobin levels less than 7g/dl (70 g/l). Most anemias are treated with transfusions of red cell concentrates (packed red blood cells), which supply only the blood component that is deficient. Whole blood is utilized for acute, massive blood loss and would be avoided in this client due to the possibility of fluid volume overload. Albumin and plasma do not contain the needed red blood cells.
The nurse is administering meperidine as ordered for pain management for a 10-year-old boy in sickle cell crisis. The nurse would be alert for: A. seizures. B. priapism. C. behavioral addiction. D. leg ulcers.
seizures. Explanation: Repeated use of meperidine for pain management during sickle cell crisis increases the risk of seizures when used in children with sickle cell anemia. Behavioral addiction is rarely a concern in the child with sickle cell anemia if the opioid is used for the alleviation of severe pain. Priapism is a complication of sickle cell anemia unrelated to meperidine administration. Leg ulcers are a complication of sickle cell anemia unrelated to meperidine administration.
