Ch. 20 PrepU: Patients With Hematologic Disorders (Pellico, 1st Ed)

The nurse should provide further teaching when a preoperative client considering blood donation makes which of the following statements? -"My family will donate blood, because it's safer." -"I should expect blood withdrawal to take about 15 minutes." -"Donated blood is tested for blood type and infections." -"I could donate my own blood in case I need a transfusion."

"My family will donate blood, because it's safer."

Parents arrive to the clinic with their young child and inform the nurse the child has just been diagnosed with sickle cell disease. The parents ask the nurse how this could have happened and which one of them is the carrier. What is the best response by the nurse? -"Most likely, the father is the carrier of the gene." -"The trait is passed down through the mother." -"The child must inherit two defective genes, one from each parent." -"It is an acquired, not a hereditary disorder."

"The child must inherit two defective genes, one from each parent."

Which of the following is the most common hematologic condition affecting elderly patients -Anemia -Thrombocytopenia -Leukopenia -Bandemia

Anemia. (p. 528)

A client comes to the walk-in clinic complaining of weakness and fatigue. While assessing this client, the nurse finds evidence of petechiae and ecchymoses. The nurse notes that the spleen appears enlarged. What would the nurse suspect is wrong with this client? -Aplastic anemia -Pernicious anemia -Iron-deficiency anemia -Agranulocytosis

Aplastic anemia

A nurse caring for a client who has hemophilia is getting ready to take the client's vital signs. What should the nurse do before taking a blood pressure? -Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints. -Ask if taking a blood pressure has ever produced pain in the upper arm. -Ask if taking a blood pressure has ever caused bruising in the hand and wrist. -Ask if taking a blood pressure has ever produced the need for medication.

Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints.

The nurse practitioner suspects that a patient has multiple myeloma based on his major presenting symptom and the analysis of his laboratory results. Select the classic symptom for this disease. -Debilitating fatigue -Bone pain in the back of the ribs -Gradual muscle paralysis -Severe thrombocytopenia

Bone pain in the back of the ribs (p. 549)

A client reports feeling tired, cold, and short of breath at times. Your assessment reveals tachycardia and reduced energy. What would you expect the physician to order? -CBC -Antibiotic -Chest radiograph -ECG

CBC (p. 531)

The nursing instructor is talking with their clinical group about coagulopathies. How should the instructor define coagulopathies? -Coagulopathies are bleeding disorders that are characterized by abnormalities in the numbers and types of red blood cells in the body. -Coagulopathies are bleeding disorders that involve platelets or clotting factors. -Coagulopathies are bleeding disorders that are characterized by a deficiency of globulins in the plasma. -Coagulopathies are bleeding disorders that involve the destruction of stem cells in the bone marrow.

Coagulopathies are bleeding disorders that involve platelets or clotting factors.

The nurse is instructing the client with polycythemia vera how to perform isometric exercises such as contracting and relaxing the quadriceps and gluteal muscle during periods of inactivity. What does the nurse understand is the rationale for this type of exercise? -Isometric exercise programs are inclusive of all muscle groups and have an aerobic effect to increase the heart rate. -Isometric exercise decreases the workload of the heart and restores oxygenated blood flow. -This type of exercise increases arterial circulation as it returns to the heart. -Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.

Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.

An 89-year-old client is preparing to leave the physician's office. The nurse is discussing with the client some strategies for ingesting iron to combat her iron-deficient anemia. Which of the following are among the nurse's strategies? -Drink liquid iron preparations with a straw. -Take iron with an antacid to avoid stomach upset. -Avoid vitamin C - it prevents absorption. -Taking iron pills with milk aids in absorption.

Drink liquid iron preparations with a straw. (p. 534)

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

Dyspnea, tachycardia, and pallor. (p. 532)

The client is a young, thin woman who is prescribed iron dextran intramuscularly. The nurse, when administering the medication, -Employs the Z-track technique -Uses a 23-gauge needle -Injects into the deltoid muscle -Rubs the site vigorously

Employs the Z-track technique (p. 533)

A patient with acute myeloid leukemia (AML) is having hematopoietic stem cell transplantation (HSCT) with radiation therapy. In which complication do the donor's lymphocytes recognize the patient's body as foreign and set up reactions to attack the foreign host? -Acute respiratory distress syndrome -Graft-versus-host disease -Remission -Bone marrow depression

Graft-versus-host disease

A patient with End Stage Kidney Disease is taking recombinant erythropoietin for the treatment of anemia. What laboratory study does the nurse understand will have to be assessed at least monthly related to this medication? -Potassium level -Creatinine level -Hemoglobin level -Folate levels

Hemoglobin level. (p. 563)

A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? -Hypercalcemia -Hyperkalemia -Hypernatremia -Hypermagnesemia

Hypercalcemia

A nurse provides nutritional information for a patient diagnosed with an iron-deficiency anemia. What education should the nurse provide? -Decrease the intake of citrus fruits because they interfere with iron absorption. -Take an iron supplement with meals to reduce gastric irritation. -Increase the intake of green, leafy vegetables. -Decrease the intake of high-fat red meats, especially organ meats.

Increase the intake of green, leafy vegetables. (p. 533)

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 health care provider. What type of anemia is the nurse concerned the co-worker may have? -Iron deficiency anemia -Megaloblastic anemia -Sickle cell anemia -Aplastic anemia

Iron deficiency anemia. (p. 532)

The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include a nutritional assessment for this patient? -It is part of the required assessment information. -It is important for the nurse to determine what type of foods the patient will eat. -It may indicate deficiencies in essential nutrients. -It will determine what type of anemia the patient has.

It may indicate deficiencies in essential nutrients. (p. 532)

The most common cause of iron-deficiency anemia in premenopausal women includes which of the following? -Menorrhagia -Inadequate iron supplementation -Iron malabsorption -Lack of vitamin B12

Menorrhagia. (p. 557)

A client was admitted to the hospital with a pathologic pelvic fracture. The client informs the nurse that he has been having a strange pain in the pelvic area for a couple of weeks that was getting worse with activity prior to the fracture. What does the nurse suspect may be occurring based on these symptoms? -Hemolytic anemia -Polycythemia vera -Leukemia -Multiple myeloma

Multiple myeloma

A client with a diagnosis of pernicious anemia comes to the clinic complaining of numbness and tingling in his arms and legs. What do these symptoms indicate? -Loss of vibratory and position senses -Neurologic involvement -Severity of the disease -Insufficient intake of dietary nutrients

Neurologic involvement

A client with a diagnosis of pernicious anemia comes to the clinic and reports numbness and tingling in the arms and legs. What do these symptoms indicate? -Loss of vibratory and position senses -Neurologic involvement -Severity of the disease -Insufficient intake of dietary nutrients

Neurologic involvement. (p. 532)

The nurse is performing an assessment on a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae. What laboratory study should the nurse be concerned about? -WBC count of 4,200 cells/mcL -Hematocrit of 38% -Platelet count of 9,000/mm3 -Creatinine level of 1.0 mg/dL

Platelet count of 9,000/mm3 (p. 553)

Which nursing intervention is most appropriate for a client with multiple myeloma? -Monitoring respiratory status -Balancing rest and activity -Restricting fluid intake -Preventing bone injury

Preventing bone injury (p. 549)

A client with multiple myeloma presents to the emergency department complaining of excessive thirst and constipation. His family members report that he has been confused for the last day. Which laboratory value is most likely responsible for this client's symptoms? -Platelet count 300,000/mm3 -Serum calcium level 13.8 mg/dl -Serum sodium level of 133 mEq/L -Hemoglobin of 9.8 g/dl

Serum calcium level 13.8 mg/dl (p. 549)

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? -Anemia -Leukopenia -Thrombocytopenia -Neutropenia

Thrombocytopenia (p. 534)

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 -To detect the evidence of infection such as fever and tachycardia -To detect the evidence of dehydration that might have triggered a sickle cell crisis -To detect the motor strength and stroke-related signs and symptoms

To detect the abnormal sounds suggestive of acute chest syndrome and heart failure.

A 79-year-old client has been diagnosed with pernicious anemia. In your client education, as his nurse, you emphasize the importance of lifelong intramuscular administration of which of the following? -Vitamin B -Vitamin A -Vitamin C -Folic acid

Vitamin B (p. 536)

During preparation for bowel surgery, a client receives an antibiotic to reduce intestinal bacteria. The nurse knows that hypoprothrombinemia may occur as a result of antibiotic therapy interfering with synthesis of which vitamin? -Vitamin A -Vitamin D -Vitamin E -Vitamin K

Vitamin K (p. 558)

A home care nurse visits a client diagnosed with atrial fibrillation who is ordered warfarin. The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching? -"I'll watch my gums for bleeding when I brush my teeth." -"I'll use an electric razor to shave." -"I'll eat four servings of fresh, dark green vegetables every day." -"I'll report unexplained or severe bruising to my doctor right away."

"I'll eat four servings of fresh, dark green vegetables every day." (p. 558)

A health care provider orders a unit of packed red blood cells (PRBC) for a postoperative patient. The nurse is responsible for patient assessment and health care information pre- and post-transfusion. Which of the following are the guidelines that the nurse should follow? Select all that apply. -Determine the history of any previous transfusions and possible reactions. -Review the signs and symptoms of a transfusion reaction. -Explain that since 1985 the supply of blood available for transfusions is risk-free. -Report any increase of 1 degree in temperature, during or after transfusion, which falls into a febrile range. -Explain that urticaria is a harmless, common reaction to a transfusion occurring at least 50% of the time.

-Determine the history of any previous transfusions and possible reactions. -Review the signs and symptoms of a transfusion reaction. -Report any increase of 1 degree in temperature, during or after transfusion, which falls into a febrile range.

The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia? -Erythrocytes that are microcytic and hypochromic -Erythrocytes that are macrocytic and hyperchromic -Clustering of platelets with sickled red blood cells -An increased number of erythrocytes

Erythrocytes that are microcytic and hypochromic

A patient with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this patient? -GM-CSF (Leukine) -Erythropoietin (Epogen) -Eltrombopag (Promacta) -Thrombopoietin (TPO)

Erythropoietin (Epogen)

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? -Observe stools for blood. -Observe the gums for bleeding after the client brushes teeth. -Observe the sputum for signs of blood. -Observe client for facial droop.

Observe stools for blood.

The nurse obtains a unit of blood for the client, Donald D. Smith. The name on the label on the unit of blood reads Donald A. Smith. All the other identifiers are correct. The nurse -Administers the unit of blood -Checks with Blood Bank first and then administers the blood with their permission -Refuses to administer the blood -Asks the client if he was ever known as Donald A. Smith

Refuses to administer the blood. (p. 567)

The nurse is assisting the client with multiple myeloma to ambulate. What is the most important nursing diagnosis to help prevent fractures in this client? -Increased mobility -Adequate hydration -Safety -Adequate nutrition

Safety (p. 549-550)

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. -Fewer painful episodes of sickle cell crisis -Lower incidence of acute chest syndrome -Decreased need for blood transfusions -Decreased need for other analgesic medications

-Fewer painful episodes of sickle cell crisis -Lower incidence of acute chest syndrome -Decreased need for blood transfusions

A female client with the beta-thalassemia trait plans to marry a man of Italian ancestry who also has the trait. Which client statement indicates that she understands the teaching provided by the nurse? -"Thalassemia is treated with iron supplements." -"I need to learn how to give myself vitamin B12 injections." -"I'll see a genetic counselor before starting a family." -"If my fiancé was of Middle Eastern descent, I wouldn't be worried about having children."

"I'll see a genetic counselor before starting a family." (p. 537)

While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters? -Platelet count, prothrombin time, and partial thromboplastin time -Platelet count, blood glucose levels, and white blood cell (WBC) count -Thrombin time, calcium levels, and potassium levels -Fibrinogen level, WBC, and platelet count

Platelet count, prothrombin time, and partial thromboplastin time. (p. 558)