Anemia

h factor suggests to the nurse that a farmer is at higher risk for aplastic anemia? Regular exposure to pesticides Nutritional deficiencies Environmental depletion of intrinsic factor Poor folic acid intake

Regular exposure to pesticides In aplastic anemia, the bone marrow is unable to produce the blood cells. Stem cell damage, such as from exposure to benzene, arsenic, pesticides, antibiotics, and chemotherapeutic drugs, can cause aplastic anemia. Infections such as mono, hepatitis C, and HIV are also potential causes of aplastic anemia.

The nurse is working with a pregnant patient who asks why she needs to take an iron supplement. Which response by the nurse is appropriate? "During pregnancy, your blood volume expands, which can dilute the number of red blood cells you have and make you anemic." "You do not need to take an iron supplement; it is included in your prenatal vitamin." "The baby uses all of your iron stores for its growth and development, so you can become anemic." "It is more difficult for women to adapt to changing nutritional needs during pregnancy."

"During pregnancy, your blood volume expands, which can dilute the number of red blood cells you have and make you anemic." During pregnancy, a woman's blood volume expands to accommodate the growing fetus. This blood volume increase can cause iron levels to become diluted and the woman anemic. It is important for a pregnant woman to eat a well-balanced diet and take her prenatal vitamins, which should contain iron.

The nurse is counseling a patient about iron deficiency. The patient asks why iron deficiency is so common. How should the nurse reply? "Iron deficiency anemia is so common because many people eat a diet that is high in processed foods." "Iron deficiency anemia is so common because of the prevalence of the genetic changes that cause it." "Iron deficiency anemia is common due to the poor quality of meat products available today." "Iron deficiency anemia is common because of the lack of vitamin B12 in the diet."

"Iron deficiency anemia is so common because many people eat a diet that is high in processed foods." Iron deficiency anemia is the most common type of anemia due to the consumption of diets high in processed foods or strict vegetarian diets. It is also common in women of childbearing age due to the loss of blood during menstruation.

The nurse is discussing with a colleague how nutritional anemias affect the appearance of red blood cells. Which statement by the colleague reflects correct understanding? "Iron deficiency anemia will cause red blood cells to be misshapen and pale." "A folic acid deficiency will cause the red blood cells to form a sickle shape." "Nutritional anemias affect the number of red blood cells but not the size or shape of them." "A dietary iron deficiency will result in red blood cells that are fragile and oversized."

"Iron deficiency anemia will cause red blood cells to be misshapen and pale." A lack of dietary iron intake results in red blood cells that are hypochromic (pale) and misshapen because iron is necessary for hemoglobin and red blood cell synthesis. Folic acid deficiency creates red blood cells that are megaloblastic but does not create sickle-shaped red blood cells. Nutritional deficiencies will affect the size and shape of the red blood cells. Iron deficiency does not result in fragile, oversized red blood cells.

The nurse teaches a patient with iron deficiency anemia to ingest foods high in vitamin C. The patient states, "I thought that vitamin C was used to prevent you from getting a cold. What does it have to do with anemia?" Which response by the nurse is accurate? "Vitamin C will help your body to absorb iron." "Vitamin C will stimulate your body to produce more red blood cells." "Vitamin C will change the acid-base balance in your stomach and will allow you to absorb B vitamins." "Vitamin C helps your immune system so that your red blood cells will last longer."

"Vitamin C will help your body to absorb iron." Vitamin C enhances the absorption of iron from nonheme sources. The role of vitamin C in the treatment of a patient with anemia is not related to stimulation of bone marrow. It is incorrect that vitamin C will extend the life of existing red blood cells. Vitamin C will not change the acid-base balance of the stomach.

The nurse should anticipate an order for erythropoietin administration for which patient? A patient with chronic renal failure and severe anemia A pregnant woman with iron deficiency anemia A strict vegetarian who is new to this type of diet An older infant who is exclusively breastfed and has not started solid food yet

A patient with chronic renal failure and severe anemia Erythropoietin helps to stimulate the production of red blood cells (RBCs) in patients with low levels. It is most commonly used for patients with chronic renal failure or other chronic health conditions. It is given subcutaneously up to three times per week.

The nurse is caring for a patient who is about to receive a blood transfusion. The nurse knows that a transfusion reaction can put the patient at risk for which type of anemia? Acquired hemolytic anemia Blood loss anemia Iron deficiency anemia Vitamin B12 anemia

Acquired hemolytic anemia Transfusion reactions can destroy red blood cells and hemolytic anemia. Other causes of acquired hemolytic anemia include mechanical trauma to the RBCs, bacterial or protozoal infection, autoimmune disorders, drugs, or toxins.

Which patient should the nurse identify as the best candidate for parenteral iron administration? An older man with chronic renal failure A young woman with iron deficiency secondary to heavy menstruation A pregnant woman A toddler with iron deficiency anemia

An older man with chronic renal failure Parenteral administration of iron is indicated in an iron deficiency that does not respond to dietary modifications or oral supplements. It can also be helpful in patients with an acute deficiency or anemia associated with chronic gastrointestinal blood loss, chronic renal failure, or other chronic condition.

The nurse is caring for a patient with a vitamin B12 deficiency. The patient is complaining of cracks in the corners of the mouth. What intervention should the nurse suggest? Apply a petroleum-based lubricating jelly to the lips after oral care. Rinse the mouth with a commercially available mouthwash. Limit teeth brushing to twice a day to prevent further irritation. Maintain the regular diet to which the patient is accustomed.

Apply a petroleum-based lubricating jelly to the lips after oral care. The patient should be advised to apply a petroleum-based lubricating jelly or ointment to the lips after performing oral care, or periodically throughout the day, to protect the mouth and oral cavity.

The nurse is caring for a 14-year-old female patient with iron deficiency anemia. Which intervention should the nurse implement to assist the patient in obtaining normal iron levels? Assessing patient compliance with iron supplements Considering starting the patient on birth control Monitoring blood transfusions for signs of reactions Administering weekly vitamin B12 injections

Assessing patient compliance with iron supplements Iron deficiency anemia is common in adolescents. Interventions focus on increasing iron in the body and treating the anemia. Assisting the patient to identify food choices that are iron-rich and evaluating compliance with iron supplements assists the patient in increasing iron stores in the body. The nurse cannot start a patient on birth control; this is an action made by the healthcare provider. Monitoring for blood transfusion reaction is appropriate for a patient receiving a transfusion; however, this scenario does not indicate this.

A patient is diagnosed with acquired hemolytic anemia. The nurse should understand that which condition can cause this type of anemia? Blood transfusion Nutritional deficiency Iron deficiency Blood loss

Blood transfusion Acquired hemolytic anemia is caused by hemolysis resulting from factors outside of the RBCs. One common cause is an immune system-mediated response, such as blood transfusion reactions. Other causes include mechanical trauma to RBC produced by prosthetic heart valves, severe burns, hemodialysis, or radiation; bacterial or protozoal infection; autoimmune disorders; and drugs, toxins, chemical agents, or venoms. Acquired hemolytic anemia is not caused by nutritional deficiencies or blood loss.

The nurse is caring for a patient with cheilosis. Which action by the patient requires intervention by the nurse? Brushing the teeth twice a day Frequent rinsing with a saline mouthwash Using a soft-bristle toothbrush Encouraging the patient to eat a high-protein diet

Brushing the teeth twice a day A patient with cheilosis or glossitis should be advised to perform frequent oral hygiene—at least after each meal and at night before bedtime. The patient should use a soft-bristle toothbrush and a saline mouthwash. These interventions promote comfort and reduce the risk of an infection.

Which lab test should the nurse examine when evaluating a patient for anemia? Complete blood count Urinalysis Blood glucose Arterial blood gas

Complete blood count Tests that may be performed include, but are not limited to, a complete blood count, iron level, serum ferritin, and hemoglobin electrophoresis. Urinalysis, blood glucose, and arterial blood gas examination are not typically used when evaluating a patient for anemia.

the nurse is initiating intravenous iron supplementation for a patient. The patient begins to report itching, nausea, and shortness of breath. Which should be the nurse's first action? Discontinuing the iron infusion Notifying the healthcare provider Documenting the reaction Reassuring the patient

Discontinuing the iron infusion Signs of an anaphylactic reaction include itching, redness or flushing, swelling, wheezing, dyspnea, nausea and vomiting, and anxiety. If the nurse suspects a reaction, the priority intervention is to discontinue the infusion, stay with the patient, and then notify the healthcare provider. The nurse should monitor the patient's airway and prepare to administer emergency medications.

The nurse is helping a patient plan diet changes to accommodate their iron deficiency anemia. Which meal contains both heme and nonheme iron? Egg yolk omelet with whole-grain toast Green leafy salad with cheese Milkshake made from milk and frozen fruit Pasta with shrimp

Egg yolk omelet with whole-grain toast Egg yolks are rich in heme iron, while the whole-grain toast is a good source of nonheme iron. This is the meal that best combines both sources of iron. A green leafy salad is a good source of nonheme iron, but the cheese is a source of vitamin B12. Milk is a good source of both folic acid and vitamin B12. Shrimp is a source of vitamin B12.

The nurse is caring for a child who does not like to eat meat. Which foods should the nurse advise the parents to include in the child's diet to prevent anemia? Eggs Cereal Oranges Red peppers

Eggs Vegetarians and people who do not eat meat are at a higher risk for developing iron deficiency anemia. Foods such as whole grains, low-fat milk and dairy products, and eggs are good sources of iron. Some vegetables, such as leafy greens, are also high in iron.

The nurse is caring for a patient who is receiving an iron infusion. Which intervention should the nurse provide to help the patient maintain energy levels? Helping the patient to identify priorities for tasks and delegate whenever possible Encouraging the patient to sleep at night and avoid napping during the day Encouraging 6 to 7 hours of sleep at night Helping the patient make a plan to quit smoking after the anemia has been resolved

Helping the patient to identify priorities for tasks and delegate whenever possible It is important for the nurse to help the patient set priorities, delegate responsibilities whenever possible, and find times to rest. The patient should be advised to get between 8 and 10 hours of sleep at night and plan periods of rest during the day.

The nurse is caring for a child with a new diagnosis of thalassemia and is counseling the parents about treatment options. Which instruction should the nurse include? Need for regular blood transfusions Strict avoidance of exercise Regular iron supplementation Periodic administration of chemotherapeutic medications

Need for regular blood transfusions Thalassemia is an inherited condition where portions of hemoglobin molecules are missing or defective. Patients with thalassemia may need a periodic blood transfusion but will also need iron chelation therapy to prevent iron-related damage. Iron supplementation and chemotherapeutic medications are not appropriate for a patient with thalassemia.

The nurse is caring for a patient with iron deficiency. In addition to iron-rich foods, which food should the nurse advise the patient to include in the diet? Oranges Cheese Fortified cereals Healthy oils

Oranges Vitamin C enhances the absorption of iron from nonheme sources. The role of vitamin C in treatment of a patient with anemia is not related to stimulation of bone marrow. It is incorrect that vitamin C will extend the life of existing red blood cells. Vitamin C will not change the acid-base balance of the stomach. Oranges and other citrus fruits are rich in vitamin C.

Which food is best for the nurse to suggest for a patient with an iron deficiency? Oysters Crispy baked asparagus Brown rice with sautéed vegetables Green salad with a slice of whole-grain bread

Oysters Oysters are the best meal for a patient with iron deficiency. Sources of heme iron include beef, chicken, egg yolk, clams, oysters, pork loin, turkey, and veal. Brown rice is a good source of nonheme iron. Asparagus and green leafy vegetables are excellent sources of folic acid.

The nurse is caring for a patient with aplastic anemia that has so far been unresponsive to medical treatment. The nurse should expect that which surgical intervention will be considered? Stem cell transplant Explorative laparotomy Splenectomy Surgical repair of damaged tissue

Stem cell transplant Patients with aplastic anemia that results from damaged bone marrow may require a bone marrow transplant or stem cell transplant. Explorative laparotomy or laparoscopy may be needed for a patient with pernicious anemia to assess for other medical disorders. Splenectomy is sometimes indicated in patients with thalassemia major. Patients with blood loss anemia may require a surgical repair of damaged tissue.

Which patient is at high risk for developing a true vitamin B12 deficiency? Strict vegan Chronically undernourished older adult Woman of childbearing age Young child with an inherited enzyme deficiency

Strict vegan Vitamin B12 is almost exclusively found in animal products, such as meat, dairy, and eggs. Strict vegetarians and vegans are at higher risk for developing this type of anemia and should take a supplement to prevent it.

A patient with a stab wound has been brought to the emergency department. Which symptom of acute blood loss anemia should the nurse expect upon assessing this patient? Tachycardia Hypertension Bradypnea Dysuria

Tachycardia Initial manifestations of hypovolemic shock include tachycardia, tachypnea, and pale, cool, and clammy skin. As blood loss progresses, hypotension, decreased level of consciousness, and oliguria will develop. Dysuria is not a clinical manifestation of blood loss anemia.

The nurse is caring for an 8-year-old child who is diagnosed with a type of anemia that requires blood transfusions for life. Which type of anemia does this child have? Thalassemia Iron deficiency anemia Glucose-6-phosphate dehydrogenase (G6PD) anemia Folic acid deficiency anemia

Thalassemia A child with thalassemia will require blood transfusions for life. The other types of anemia do not require this intervention.

A patient is admitted with a pathologic fracture of the ulna, abdominal pain, and shortness of breath. The nurse notes that the patient's skin is a bronze color. The nurse should recognize these findings as manifestations of which type of anemia? Thalassemia Sickle cell anemia Aplastic anemia Pernicious anemia

Thalassemia Patients with the major form of thalassemia can develop fractures of the long bones secondary to bone marrow expansion and thinning of bones caused by increased hematopoiesis. Jaundice occurs secondary to hemolysis, and the accumulation of iron in the liver can lead to hepatic failure. The patient's presenting symptoms are not consistent with sickle cell anemia. Patients in sickle cell crisis present with fever and severe pain. Patients with pernicious anemia present with pallor; a sore, beefy red tongue; and paresthesias, which are not consistent with the patient's presenting symptoms. Aplastic anemia results in signs and symptoms resulting from pancytopenia, not the symptoms that the patient is exhibiting.

Which example of a nursing observation during the evaluative phase best reflects the patient's achievement of an identified outcome for sickle cell disease (SCD)? The patient maintained an oxygen saturation of >90%. The patient experienced improved breathing. The patient produced urine output of >0.2 ml/kg/h. The patient's pain was tolerable.

The patient maintained an oxygen saturation of >90%. Evaluative statements should reflect achievement of patient goals and outcomes that are both desirable and measurable. Maintenance of an oxygen saturation level of > 90% is reflective of an evaluative statement that is both desirable and measurable. Production of urine output of >0.2 ml/kg/kg/h is measurable; however, the desired rate of urine output is >0.5 ml/kg/h. Improvement of breathing status and decreased pain are desirable outcomes; however, as stated, these evaluative statements do not represent outcomes that are directly measurable.

A patient diagnosed with blood loss anemia had a blood transfusion yesterday. Which condition should indicate to the nurse that the patient is ready for discharge? The patient verbalizes an increase in activity tolerance. The patient's red blood cell (RBC) count indicates moderate anemia instead of severe anemia. The patient verbalizes that shortness of breath is present only with minimal activity. The patient verbalizes the importance of decreasing the amount of red meat in their diet.

The patient verbalizes an increase in activity tolerance. Outcomes for a patient with anemia should include absence of shortness of breath, increased activity tolerance, acceptable red blood cell (RBC) count, and correct patient verbalization of dietary choices to increase iron. The only outcome that supports patient discharge is the patient's verbalization of increased activity tolerance. Moderate anemia is not an acceptable RBC count, shortness of breath that is present with minimal activity is not an absence of anemia, and the patient verbalizing the importance of decreasing red meat is not a correct dietary choice.

Which anemia is associated with macrocytic and misshapen red blood cells (RBCs) with thin membranes? Vitamin B12 deficiency anemia Iron deficiency anemia Blood loss anemia Thalassemia

Vitamin B12 deficiency anemia Vitamin B12 deficiency anemia results in macrocytic and misshapen RBCs. Iron deficiency anemia results in fewer numbers of RBCs that are misshapen and pale in color; blood loss anemia results in RBCs that are small (microcytic) and pale; thalassemia produces fragile, pale, small (microcytic) RBCs.

The nurse is collecting a health history of a 22-year-old female. She shares that she has recently experienced pallor, weakness, and difficulty maintaining her balance. Which type of anemia does the nurse suspect that the patient is experiencing? Vitamin B12 deficiency anemia Iron deficiency anemia Acquired hemolytic anemia Blood loss anemia

Vitamin B12 deficiency anemia Clinical manifestations of vitamin B12 anemia include pallor; weakness; sore, beefy red tongue; paresthesias; and difficulty maintaining balance. Paresthesias are not associated with the other types of anemia listed.

Which condition increases an older adult patient's risk for anemia? Kidney disease Pneumonia Decreased motility Cellulitis

kidney Older adult patients are more likely to have chronic medical conditions such as chronic kidney disease, iron deficiency, and inflammation. These conditions predispose them to anemia. The bodies of older adults cannot adapt as readily to symptoms of anemia as younger people. Older adults with anemia have higher mortality and are more likely to be hospitalized, which reduces their ability to perform routine activities of daily living (ADLs).