Blood Diseases
A client with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse? A) Inform the client that the position must be changed, and then you will give her pain medication and omit the bath. B) Inform the client that she will feel better after receiving a bath and clean sheets. C) Obtain the pain medication and delay the bath and position change until the medication reaches its peak. D) Inform the client that the bath and positioning is an important part of client care and will be done right after pain medication administration.
C (Obtain the pain medication and delay the bath and position change until the medication reaches its peak. Explanation: When pain is severe, the nurse delays position changes and bathing until an administered analgesic has reached its peak concentration level and the client is experiencing maximum pain relief. Pain medication should never be delayed to assist in the control of the level of pain. Pain will not be relieved by a bath and clean sheets, only analgesics at this point in the client's illness.)
A patient describes numbness in the arms and hands with a tingling sensation. The patient also frequently stumbles when walking. What vitamin deficiency does the nurse determine may cause some of these symptoms?
B 12
A patient is taking hydroxyurea for the treatment of primary myelofibrosis. While the patient is taking this medication, what will the nurse monitor to determine effectiveness?
Leukocyte and platelet count. Explanation: Hydroxyurea is often used in patients with primary myelofibrosis to control high leukocyte and platelet counts and to reduce the size of the spleen
During a routine assessment of a patient diagnosed with anemia, the nurse observes the patient's beefy red tongue. The nurse is aware that this is a sign of what kind of anemia?
Megaloblastic
A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. The client is taking prednisone daily and reported feeling pain after manually opening the garage door. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain?
Osteoporosis
Which type of hemolytic anemia is categorized as inherited disorder?
Sickle cell anemia
A client with sickle cell anemia has a A) Low hematocrit. B) High hematocrit. C) Normal hematocrit. D) Normal blood smear.
A (Low hematocrit. Explanation: A client with sickle cell anemia has a low hematocrit and sickled cells on the smear. A client with sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear.)
A patient with renal failure has decreased erythropoietin production. Upon analysis of the patient's complete blood count, the nurse will expect which of the following results? A) An increased hemoglobin and decreased hematocrit B) A decreased hemoglobin and hematocrit C) A decreased mean corpuscular volume (MCV) and red cell distribution width (RDW) D) An increased MCV and RDW
B. A decreased hemoglobin & hematocrit
Which is a symptom of hemochromatosis?
Bronzing of the skin
A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy? A) "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear." B) "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal." C) "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." D) "I will receive parenteral vitamin B12 therapy for the rest of my life."
D ("I will receive parenteral vitamin B12 therapy for the rest of my life." Explanation: Because a client with pernicious anemia lacks intrinsic factor, oral vitamin B12 can't be absorbed. Therefore, parenteral vitamin B12 therapy is recommended and required for life.)
A patient has a probable diagnosis of polycythemia vera. The nurse reviews the patient's lab work for which diagnostic indicator?
Hematocrit of 60%
A nurse is performing an initial assessment and notes the client's skin is a gray-tan color, especially on the scars of the client's arms. Which hematological condition does the nurse suspect?
Hemochromatosis
The nurse is administering packed red blood cell (RBC) transfusions for a patient with myelodysplastic syndrome (MDS). The patient has had several transfusions and is likely to receive several more. What is a priority for the nurse to monitor related to the transfusions?
Iron levels
The nurse cares for an older adult client with unprovoked back pain and increased serum protein. Which hematologic neoplasm does the nurse suspect the client has?
Multiple Myeloma
A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever?
Neutropenia
The nursing instructor is discussing disorders of the hematopoietic system with the pre-nursing pathophysiology class. What disease would the instructor list with a primary characteristic of erythrocytosis?
Polycythemia Vera
A male client has been receiving a continuous infusion of weight-based heparin for more than 4 days. The client's PTT is at a level that requires an increase of heparin by 100 units per hour. The client has the laboratory findings shown above. The most important action of the nurse is to A) Continue with the present infusion rate of heparin. B) Consult with the physician about discontinuing heparin. C) Begin treatment with the prescribed warfarin (Coumadin). D) Increase the heparin infusion by 100 units per hour.
B (Consult with the physician about discontinuing heparin. Explanation: Platelet counts may decrease with heparin therapy, and this client's platelet count has decreased. The client may have heparin-induced thrombocytopenia (HIT). Treatment of HIT includes discontinuing the heparin. The question asks about the most important action of the nurse and that is to consult with the physician about discontinuing heparin therapy. The nurse may continue with the current rate and should not increase the heparin dose until consulting with the physician. Warfarin is not administered until the platelet count has returned to normal levels.)
An older adult client who is a vegetarian has a hemoglobin of 10.2 gm/dL, vitamin B12 of 68 pg/mL (normal: 200-900 pg/mL), and MCV of 110 cubic micrometers. After interpreting the data, what instruction should the nurse give to the client?
Supplement the diet with vitamin B12
A client with polycythemia vera reports gouty arthritis symptoms in the toes and fingers. What is the nurse's best understanding of the pathophysiological reason for this symptom?
The dead red blood cells release excess uric acid.
A nurse is doing a physical examination of a child with sickle cell anemia. When the child asks why the nurse auscultates the lungs and heart, what would be best the response by the nurse?
To detect the abnormal sounds suggestive of acute chest syndrome and heart failure
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 calf's liver with a glass of orange juice B) Eating leafy green vegetables with a glass of water C) Eating apple slices with carrots D) Eating a steak with mushrooms
A (Eating calf's liver with a glass of orange juice Explanation: 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 observes a co-worker who always seems to be eating a cup of ice. The nurse encourages the co-worker to have an examination and diagnostic workup with the physician. What type of anemia is the nurse concerned the co-worker may have? A) Iron deficiency anemia B) Megaloblastic anemia C) Sickle cell anemia D) Aplastic anemia
A (Iron deficiency anemia Explanation: People with iron deficiency anemia may crave ice, starch, or dirt; this craving is known as pica.)
Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia? A) Implement neutropenic precautions B) Eliminate direct contact with others who are infectious C) Apply prolonged pressure to needle sites or other sources of external bleeding D) Monitor temperature at least once per shift
C (Apply prolonged pressure to needle sites or other sources of external bleeding Explanation: For a client with leukemia, the nurse should apply prolonged pressure to needle sites or other sources of external bleeding. Reduced platelet production results in a delayed clotting process and increases the potential for hemorrhage. Implementing neutropenic precautions and eliminating direct contact with others are interventions to address the risk for infection.) Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia? A) Implement neutropenic precautions B) Eliminate direct contact with others who are infectious C) Apply prolonged pressure to needle sites or other sources of external bleeding D) Monitor temperature at least once per shift
The nurse suspects that a client has multiple myeloma based on the client's major presenting symptom and the analysis of laboratory results. What classic symptom for multiple myeloma does the nurse assess for?
Bone pain in the back of the ribs
The nurse is assessing a patent with polycythemia vera. What skin assessment data would the nurse determine is a normal finding for this patient?
Ruddy complexion
