Ch. 30 Hematologic Problems

A patient has a WBC count of 2300/μL and a neutrophil percentage of 40%. Does the patient have leukopenia?

Yes, the WBC count is below 4000/μL.

A patient has a WBC count of 2300/μL and a neutrophil percentage of 40%. Does the patient have neutropenia?

Yes, the neutrophil count is less than 1000/μL.

A patient has a WBC count of 2300/μL and a neutrophil percentage of 40%. Is the patient at risk for developing a bacterial infection? If so, why?

Yes, the patient is at moderate risk of infection with opportunistic pathogens and nonpathogenic organisms from normal body flora.

The nurse caring for a patient with heparin-induced thrombocytopenia (HIT) identifies risk for bleeding as the priority nursing diagnosis. Identify at least five nursing interventions that should be implemented.

*Discontinue heparin administration and expect a direct or indirect thrombin inhibitor to be ordered. *Monitor for signs and symptoms of bleeding (check IV sites, wounds, any secretions). *Monitor ordered coagulation studies. *Avoid injections. *Use an electric razor. *Protect the patient from trauma. *Administer ordered blood products. *Instruct the patient and caregiver to avoid aspirin and other anticoagulants. *Instruct the patient to avoid high-contact activities (many sports).

Before beginning a transfusion of packed red blood cells (PRBCs), which action by the nurse would be of highest priority to avoid an error during this procedure? A. Check the identifying information on the unit of blood against the patient's ID bracelet. B. Select new primary IV tubing primed with lactated Ringer's solution to use for the transfusion. C. Remain with the patient for 60 minutes after beginning the transfusion to watch for signs of a transfusion reaction. D. Add the blood transfusion as a secondary line to the existing IV and use the IV controller to maintain correct flow.

A. Check the identifying information on the unit of blood against the patient's ID bracelet. (The patient's identifying information (name, date of birth, medical record number) on the ID bracelet should exactly match the information on the blood bank tag that has been placed on the unit of blood. If any information does not match, the transfusions should not be hung because of possible error and risk to the patient. The transfusion is hung on blood transfusion tubing, not a secondary line, and cannot be hung with lactated Ringer's solution because it will cause RBC hemolysis. Usually, the patient will need continuous monitoring for 15 minutes after the transfusion is started, as this is the time most transfusion reactions occur. Then the patient should be monitored every 30 to 60 minutes during the administration.)

The patient with leukemia has acute disseminated intravascular coagulation (DIC) and is bleeding. What diagnostic findings should the nurse expect to find? A. Elevated D-dimers B. Elevated fibrinogen C. Reduced prothrombin time (PT) D. Reduced fibrin degradation products (FDPs)

A. Elevated D-dimers (The D-dimer is a specific marker for the degree of fibrinolysis and is elevated with DIC. FDP is elevated as the breakdown products from fibrinogen and fibrin are formed. Fibrinogen and platelets are reduced. PT, PTT, aPTT, and thrombin time are all prolonged.)

The nurse receives a physician's order to transfuse fresh frozen plasma to a patient with acute blood loss. Which procedure is most appropriate for infusing this blood product? A. Infuse the fresh frozen plasma as rapidly as the patient will tolerate. B. Hang the fresh frozen plasma as a piggyback to the primary IV solution. C. Infuse the fresh frozen plasma as a piggyback to a primary solution of normal saline. D. Hang the fresh frozen plasma as a piggyback to a new bag of primary IV solution without KCl.

A. Infuse the fresh frozen plasma as rapidly as the patient will tolerate. (The fresh frozen plasma should be administered as rapidly as possible and should be used within 24 hours of thawing to avoid a decrease in factors V and VIII. Fresh frozen plasma is infused using any straight-line infusion set. Any existing IV should be interrupted while the fresh frozen plasma is infused, unless a second IV line has been started for the transfusion.)

A patient will receive a hematopoietic stem cell transplant (HSCT). What is the nurse's priority after the patient receives combination chemotherapy before the transplant? A. Prevent patient infection. B. Avoid abnormal bleeding. C. Give pneumococcal vaccine. D. Provide companionship while isolated.

A. Prevent patient infection. (After combination chemotherapy for HSCT, the patient's bone marrow is destroyed in preparation to receive the bone marrow graft. Thus the patient is immunosuppressed and is at risk for a life-threatening infection. The priority is preventing infection. Bleeding is not usually a problem. Giving the pneumococcal vaccine at this time should not be done; it should have been done previously. Providing companionship is not the primary role of the nurse, although the patient will need support during the time of isolation.)

A patient with cancer is having chemotherapy treatments and has now developed neutropenia. What care should the nurse expect to provide and teach the patient about (select all that apply.)? A. Strict hand washing B. Daily nasal swabs for culture C. Monitor temperature every hour. D. Daily skin care and oral hygiene E. Encourage eating all foods to increase nutrients. F. Private room with a high-efficiency particulate air (HEPA) filter

A. Strict hand washing D. Daily skin care and oral hygiene F. Private room with a HEPA filter

The patient is admitted with hypercalcemia; polyuria; and pain in the pelvis, spine, and ribs with movement. Which hematologic problem is likely to display these manifestations in the patient? A.Multiple myeloma B. Thrombocytopenia C. Megaloblastic anemia D. Myelodysplastic syndrome

A.Multiple myeloma (Multiple myeloma typically manifests with skeletal pain and osteoporosis that may cause hypercalcemia, which can result in polyuria, confusion, or cardiac problems. Serum hyperviscosity syndrome can cause renal, cerebral, or pulmonary damage. Thrombocytopenia, megaloblastic anemia, and myelodysplastic syndrome are not characterized by these manifestations.)

The nurse notes a physician's order written at 10:00 AM for two units of packed red blood cells to be administered to a patient who is anemic as a result of chronic blood loss. If the transfusion is picked up at 11:30 AM, the nurse should plan to hang the unit no later than what time? A. 11:45 AM B. 12:00 noon C. 12:30 PM D. 3:30 PM

B. 12:00 noon (The nurse must hang the unit of packed RBCs within 30 minutes of signing them out from the blood bank.)

Before starting a transfusion of packed red blood cells for an older anemic patient, the nurse would arrange for a peer to monitor his or her other assigned patients for how many minutes when the nurse begins the transfusion? A. 5 B. 15 C. 30 D. 60

B. 15 (As part of standard procedure, the nurse remains with the patient for the first 15 minutes after starting a blood transfusion. Patients who are likely to have a transfusion reaction will more often exhibit signs within the first 15 minutes that the blood is infusing. Monitoring during the transfusion will be every 30 to 60 minutes.)

Which patient is most likely to experience anemia related to an increased destruction of red blood cells? A. A 59-yr-old man whose alcoholism has precipitated folic acid deficiency B. A 23-yr-old African American man who has a diagnosis of sickle cell disease C. A 30-yr-old woman with a history of "heavy periods" accompanied by anemia D. A 3-yr-old child whose impaired growth and development is attributable to thalassemia

B. A 23-yr-old African American man who has a diagnosis of sickle cell disease (A result of a sickling episode in sickle cell anemia involves increased hemolysis of the sickled cells. Thalassemias and folic acid deficiencies cause a decrease in erythropoiesis, whereas the anemia related to menstruation is a direct result of blood loss.)

The nurse is caring for a patient with a diagnosis of immune thrombocytopenic purpura (ITP). What is a priority nursing action in the care of this patient? A. Administration of packed red blood cells B. Administration of oral or IV corticosteroids C. Administration of clotting factors VIII and IX D. Maintenance of reverse isolation and application of standard precautions

B. Administration of oral or IV corticosteroids (Common treatment modalities for ITP include corticosteroid therapy to suppress the phagocytic response of splenic macrophages. Blood transfusions, administration of clotting factors,& reverse isolation are not interventions that are indicated in the care of pts w/ ITP. Standard precautions are used with all patients.)

The nurse is caring for a patient with polycythemia vera. What is an important action for the nurse to initiate? A. Encourage deep breathing and coughing. B. Assist with or perform phlebotomy at the bedside. C. Teach the patient how to maintain a low-activity lifestyle. D. Perform thorough and regularly scheduled neurologic assessments.

B. Assist with or perform phlebotomy at the bedside. (Primary polycythemia vera often requires phlebotomy in order to reduce blood volume. The increased risk of thrombus formation that accompanies the disease requires regular exercises and ambulation. Deep breathing & coughing exercises do not directly address the etiology or common sequelae of polycythemia, and neurologic manifestations are not typical.)

A patient has been diagnosed with acute myelogenous leukemia (AML). What should the nurse educate the patient that care will focus on? A. Leukapheresis B. Attaining remission C. One chemotherapy agent D. Waiting with active supportive care

B. Attaining remission (Attaining remission is the initial goal of care for leukemia. The methods to do this are decided based on age and cytogenetic analysis. The treatments include leukapheresis or hydroxyurea to reduce the white blood cell count and risk of leukemia-cell-induced thrombosis. A combination of chemotherapy agents will be used for aggressive treatment to destroy leukemic cells in tissues, peripheral blood, and bone marrow and minimize drug toxicity. In nonsymptomatic patients with chronic lymphocytic leukemia, waiting may be done to attain remission, but not with AML.)

A patient has anemia related to inadequate intake of essential nutrients. Which intervention would be appropriate for the nurse to include in the plan of care for this patient? A. Plan for 30 minutes of rest before and after every meal. B. Encourage foods high in protein, iron, vitamin C, and folate. C. Instruct the patient to select soft, bland, and nonacidic foods. D. Give the patient a list of medications that inhibit iron absorption.

B. Encourage foods high in protein, iron, vitamin C, and folate. (Increased intake of protein, iron, folate, and vitamin C provides nutrients needed for maximum iron absorption and hemoglobin production. The other interventions do not address the patient's identified problem of inadequate intake of essential nutrients. Selection of foods that are soft, bland, and nonacidic is appropriate if the patient has oral mucosal irritation. Scheduled rest is an appropriate intervention if the patient has fatigue related to anemia. Providing information about medications that may inhibit iron absorption (e.g., antacids, tetracycline, soft drinks, tea, coffee, calcium, phosphorus, and magnesium salts) is important but does not address the patient's problem of inadequate intake of essential nutrients.)

When caring for a patient with metastatic cancer, the nurse notes a hemoglobin level of 8.7 g/dL and hematocrit of 26%. What associated clinical manifestations does the nurse anticipate observing? A. Thirst B. Fatigue C. Headache D. Abdominal pain

B. Fatigue (The patient with a low hemoglobin and hematocrit is anemic and would be most likely to experience fatigue. Fatigue develops because of the lowered oxygen-carrying capacity that leads to reduced tissue oxygenation to carry out cellular functions. Thirst, headache, & abdominal pain are not related to anemia.)

The blood bank notifies the nurse that the two units of blood ordered for a patient is ready for pick up. Which action should the nurse take to prevent an adverse effect during this procedure? A. Immediately pick up both units of blood from the blood bank. B. Infuse the blood slowly for the first 15 minutes of the transfusion. C. Regulate the flow rate so that each unit takes at least 4 hours to transfuse. D. Set up the Y-tubing of the blood set with dextrose in water as the flush solution.

B. Infuse the blood slowly for the first 15 minutes of the transfusion. (Because a transfusion reaction is more likely to occur at the beginning of a transfusion, the nurse should initially infuse the blood at a rate no faster than 2 mL/min and remain with the patient for the first 15 minutes after hanging 1 unit of blood. Only 1 unit of blood can be picked up at a time, it must be infused within 4 hours, and it cannot be hung with dextrose.)

A patient who has sickle cell disease has developed cellulitis above the left ankle. What is the nurse's priority for this patient? A. Start IV fluids. B. Maintain oxygenation. C. Maintain distal warmth. D. Check peripheral pulses.

B. Maintain oxygenation. (Maintaining oxygenation is a priority as sickling episodes are frequently triggered by low oxygen tension in the blood which is commonly caused by an infection. Antibiotics to treat cellulitis, pain control, and fluids to reduce blood viscosity will also be used, but oxygenation is the priority.)

A patient with an acute peptic ulcer and major blood loss requires an immediate transfusion with packed red blood cells. Which task is appropriate for the registered nurse (RN) to delegate to unlicensed assistive personnel (UAP)? A. Confirm the IV solution is 0.9% saline. B. Obtain the vital signs before the transfusion is initiated. C. Monitor the patient for shortness of breath and back pain. D. Double check the patient identity and verify the blood product.

B. Obtain the vital signs before the transfusion is initiated. (The RN may delegate tasks such as taking vital signs to UAP. Assessments (e.g., monitoring for signs of a blood transfusion reaction [shortness of breath and back pain]) are within the scope of practice of the RN and may not be delegated to UAP. The RN must also assume responsibility for ensuring the correct IV fluid is used with blood products. A licensed nurse must complete verification of the patient's identity and the blood product data.)

A patient with a diagnosis of hemophilia had a fall down an escalator earlier in the day and is now experiencing bleeding in the left knee joint. What should be the emergency nurse's immediate action? A. Immediate transfusion of platelets B. Resting the patient's knee to prevent hemarthroses C. Assistance with intracapsular injection of corticosteroids D. Range-of-motion exercises to prevent thrombus formation

B. Resting the patient's knee to prevent hemarthroses (In patients with hemophilia, joint bleeding requires resting of the joint to prevent deformities from hemarthrosis. Clotting factors, not platelets or corticosteroids, are administered. Thrombus formation is not a central concern in a patient with hemophilia.)

A patient has been diagnosed with stage 1A Hodgkin's lymphoma. The nurse knows that which chemotherapy regimen is most likely to be prescribed for this patient? A. Brentuximab vedotin (Adcetris) B. Two to four cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine C. Four to six cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine D. BEACOPP: bleomycin, etoposide, doxorubicin (Adriamycin), cyclophosphamide, vincristine (Oncovin), procarbazine, and prednisone

B. Two to four cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine (The patient with a favorable prognosis early-stage Hodgkin's lymphoma (stage 1A) will receive two to four cycles of ABVD. The unfavorable prognostic featured (stage 1B) Hodgkin's lymphoma would be treated with four to six cycles of chemotherapy. Advanced-stage Hodgkin's lymphoma is treated more aggressively with more cycles or with BEACOPP. Brentuximab vedotin (Adcetris) is a newer agent that will be used to treat patients who have relapsed or refractory disease.Note: Some of acronyms for drug protocols use the brand/trade name of drugs (Adriamycin, Oncovin). These brand/trade names have been discontinued but the drugs are still available as generic drugs.)

The nurse instructs an African American man who has sickle cell disease about symptom management and prevention of sickle cell crisis. The nurse determines further teaching is necessary if the patient makes which statement? A. "When I take a vacation, I should not go to the mountains." B. "I should avoid contact with anyone who has a respiratory infection." C. "When my vision is blurred, I will close my eyes and rest for an hour." D. "I may experience severe pain during a crisis and need narcotic analgesics."

C. "When my vision is blurred, I will close my eyes and rest for an hour." (Blurred vision should be reported immediately and may indicate a detached retina or retinopathy. Hypoxia (at high altitudes) and infection are common causes of a sickle cell crisis. Severe pain may occur during a sickle cell crisis, and narcotic analgesics are indicated for pain management.)

When preparing to administer an ordered blood transfusion, which IV solution does the nurse use when priming the blood tubing? A. Lactated Ringer's B. 5% dextrose in water C. 0.9% sodium chloride D. 0.45% sodium chloride

C. 0.9% sodium chloride (The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It is also used to flush the blood tubing after the infusion is complete to ensure the pt receives blood that is left in the tubing when the bag is empty. Dextrose & lactated Ringer's solutions cannot be used with blood because they will cause RBC hemolysis.)

The nurse is assigned to care for several patients on a medical unit. Which patient should the nurse check on first? A. A 60-yr-old patient with a blood pressure of 92/64 mm Hg and hemoglobin of 9.8 g/dL B. A 50-yr-old patient with a respiratory rate of 26 breaths/minute and an elevated D-dimer C. A 40-yr-old patient with a temperature of 100.8oF (38.2oC) and a neutrophil count of 256/μL D. A 30-yr-old patient with a pulse of 112 beats/min and a white blood cell count of 14,000/μL

C. A 40-yr-old patient with a temperature of 100.8oF (38.2oC) and a neutrophil count of 256/μL (A low-grade fever greater than 100.4°F (38°C) in a patient with a neutrophil count below 500/μL is a medical emergency and may indicate an infection. An infection in a neutropenic patient could lead to septic shock and possible death if not treated immediately.)

The nurse is caring for a patient who is to receive a transfusion of two units of packed red blood cells. After obtaining the first unit from the blood bank, the nurse would ask which health team member in the nurses' station to assist in checking the unit before administration? A. Unit secretary B. A physician's assistant C. Another registered nurse D. An unlicensed assistive personnel

C. Another registered nurse (Before hanging a transfusion, the registered nurse must check the unit with another RN or with a licensed practical (vocational) nurse, depending on agency policy. The unit secretary, physician's assistant, or unlicensed assistive personnel should not be asked.)

The nurse knows that hemolytic anemia can be caused by which extrinsic factors? A. Trauma or splenic sequestration crisis B. Abnormal hemoglobin or enzyme deficiency C. Macroangiopathic or microangiopathic factors D. Chronic diseases or medications and chemicals

C. Macroangiopathic or microangiopathic factors (Macroangiopathic or microangiopathic extrinsic factors lead to acquired hemolytic anemias. Trauma or splenic sequestration crisis can lead to anemia from acute blood loss. Abnormal hemoglobin or enzyme deficiency are intrinsic factors that lead to hereditary hemolytic anemias. Chronic diseases or medications and chemicals can decrease the number of red blood cell (RBC) precursors which reduce RBC production.)

The nurse is caring for a patient with microcytic, hypochromic anemia. What teaching should the nurse provide that would be beneficial to the patient? A. Take enteric-coated iron with each meal. B. Take cobalamin with green leafy vegetables. C. Take the iron with OJ one hour before meals. D. Decrease the intake of the antiseizure medications to improve.

C. Take the iron with OJ one hour before meals. (With microcytic, hypochromic anemia may be caused by iron, vitamin B6, or copper deficiency; thalassemia; or lead poisoning. The iron prescribed should be taken with OJ one hour before meals as it is best absorbed in an acid environment. Megaloblastic anemias occur with cobalamin (vitamin B12) and folic acid deficiencies. Vitamin B12 may help red blood cell (RBC) maturation if the patient has the intrinsic factor in the stomach. Green leafy vegetables provide folic acid for RBC maturation. Antiseizure drugs may contribute to aplastic anemia or folic acid deficiency, but the patient should not stop taking the medications. The health care provider will prescribe changes in medications.)

The nurse is caring for a patient with a diagnosis of disseminated intravascular coagulation (DIC). What is the first priority of care? A. Administer heparin. B. Administer whole blood. C. Treat the causative problem. D. Administer fresh frozen plasma.

C. Treat the causative problem. (Treating the underlying cause of DIC will interrupt the abnormal response of the clotting cascade and reverse the DIC. Blood product administration occurs based on the specific component deficiencies and is reserved for patients with life-threatening hemorrhage. Heparin will be administered if the manifestations of thrombosis are present and the benefit of reducing clotting outweighs the risk of further bleeding.)

A patient with leukemia is admitted for severe hypovolemia after prolonged diarrhea has a platelet count of 43,000/µL. It is most important for the nurse to take which action? A. Insert two 18-gauge IV catheters. B. Administer prescribed enoxaparin. C. Monitor the patient's temperature every 2 hours. D. Check stools for presence of frank or occult blood.

D. Check stools for presence of frank or occult blood. (A platelet count below 150,000/µL indicates thrombocytopenia. Prolonged bleeding from trauma or injury does not usually occur until the platelet counts are below 50,000/µL. Bleeding precautions (e.g., check all secretions for frank & occult blood) are indicated for patients with thrombocytopenia. Injections (including IVs) should be avoided; however, when needed for critical fluids & medications, IV access should be provided through the smallest bore devices that are feasible. Enoxaparin, an anticoagulant administered subcutaneously, is contraindicated in patients with thrombocytopenia. Monitoring temperature would be indicated in a pt with leukopenia.)

A patient is being treated for non-Hodgkin's lymphoma (NHL). What should the nurse first teach the patient about the treatment? A. Skin care that will be needed B. Method of obtaining the treatment C. Gastrointestinal tract effects of treatment D. Treatment type and expected side effects

D. Treatment type and expected side effects (The patient should first be taught about the type of treatment and the expected and potential side effects. Nursing care is related to the area affected by the disease and treatment. Skin care will be affected if radiation is used. Not all patients will have gastrointestinal tract effects of NHL or treatment. The method of obtaining treatment will be included in the teaching about the type of treatment.)

A patient has a WBC count of 2300/μL and a neutrophil percentage of 40%. What is the patient's neutrophil count?

The neutrophil count is 2300 × 40% = 920/μL.

The nurse determines that teaching about pernicious anemia has been effective when the patient says a. "This condition can kill me unless I take injections of the vitamin for the rest of my life." b. "My symptoms can be completely reversed if I take cobalamin (vitamin B12) supplements." c. "If my anemia does not respond to cobalamin therapy, my only other alternative is a bone marrow transplant." d. "The least expensive and most convenient treatment of pernicious anemia is to use a diet with foods high in cobalamin."

a. "This condition can kill me unless I take injections of the vitamin for the rest of my life." (W/O cobalamin replacement individuals w/ pernicious anemia will die in 1 to 3 years but the disease can be controlled with cobalamin supplements for life. Hematologic manifestations can be completely reversed w/ therapy but long-standing neuromuscular complications might not be reversed. Because pernicious anemia results from an inability to absorb cobalamin, dietary intake of the vitamin is not a treatment option, nor is a bone marrow transplant.)

Which statements describe anemia related to blood loss (select all that apply)? a. A major concern is prevention of shock. b. This anemia is most frequently treated with increased dietary iron intake. c. In addition to the general symptoms of anemia, this patient also manifests jaundice. d. Clinical symptoms are the most reliable way to evaluate the effect and degree of blood loss. e. A patient who has acute blood loss may have postural hypotension and increased heart rate.

a. A major concern is prevention of shock. d. Clinical symptoms are the most reliable way to evaluate the effect and degree of blood loss. e. A patient who has acute blood loss may have postural hypotension and increased heart rate. (With rapid blood loss, hypovolemic shock may occur. Clinical manifestations will be more reliable, as they reflect the body's attempt to meet oxygen requirements. As the percentage of blood loss increases, clinical manifestations worsen. Blood transfusions will first be used, then iron, vitamin B12, and folic acid supplements may be used.)

Which characteristics are related to an acute hemolytic transfusion reaction (select all that apply)? a. ABO incompatibility b. Hypothermia common c. Destruction of donor RBCs d. Acute kidney injury occurs e. Hypocalcemia and hyperkalemia f. Epinephrine used for severe reaction

a. ABO incompatibility c. Destruction of donor RBCs d. Acute kidney injury occurs (ABO incompatibility, destruction of donor RBCs, and AKI may occur in an acute hemolytic transfusion reaction. Hypothermia, hypocalcemia, & hyperkalemia are most likely to occur in massive blood transfusion reactions. Epinephrine may be used for severe allergic transfusion reactions &the infusion may be restarted after treatment with antihistamines in mild cases.)

In a severely anemic patient, the nurse would expect to find: a. Dyspnea and tachycardia b. Cyanosis and pulmonary edema c. Cardiomegaly and pulmonary fibrosis d. ventricular dysrhythmias and wheezing

a. Dyspnea and tachycardia (Patients with severe anemia (Hgb level less than 6 g/dL) exhibit the following cardiovascular & pulmonary manifestations: tachycardia, increased pulse pressure, systolic murmurs, intermittent claudication, angina, heart failure, myocardial infarction, tachypnea, orthopnea, & dyspnea at rest.)

What is the most important method for identifying the presence of infection in a neutropenic patient? a. Frequent temperature monitoring b. Routine blood and sputum cultures c. Assessing for redness and swelling d. Monitoring white blood cell (WBC) count

a. Frequent temperature monitoring (An elevated temperature is of most significance in recognizing the presence of an infection in the neutropenic patient because there is no leukocytic response to injury. When the WBC count is depressed, the normal phagocytic mechanisms of infection are impaired and the classic signs of inflammation may not occur. Cultures are indicated if the temperature is elevated but are not used to monitor for infection.)

When teaching the patient about a new prescription for oral iron supplements, what does the nurse instruct the patient to do? a. Increase fluid and dietary fiber intake b. Take the iron preparations with meals c. Use enteric-coated preparations taken with orange juice d. Report the presence of black stools to the health care provider

a. Increase fluid and dietary fiber intake (Constipation is a common side effect of oral iron supplementation and increased fluids and fiber should be consumed to prevent this effect. Because iron can be bound in the gastrointestinal (GI) tract by food, it should be taken before meals unless gastric side effects of the supplements necessitate its ingestion with food. Black stools are an expected result of oral iron preparations. Taking iron with ascorbic acid or orange juice enhances absorption of the iron but enteric-coated iron often is ineffective because of unpredictable release of the iron in areas of the GI tract where it can be absorbed.)

How does myelodysplastic syndrome (MDS) differ from acute leukemias? a. MDS has a slower disease progression. b. MDS does not result in bone marrow failure. c. MDS is a clonal disorder of hematopoietic ells. d. MDS affects only the production and function of platelets and WBCs.

a. MDS has a slower disease progression. (Although myelodysplastic syndromes, like leukemias, are a group of disorders in which hematopoietic stem cells of the bone marrow undergo clonal change and may cause eventual bone marrow failure, the primary difference from leukemias is that myelodysplastic cells have some degree of maturation and the disease progression is slower than in acute leukemias.)

Nursing interventions for a pt with severe anemia related to peptic ulcer disease include (sata) a. instruction for high iron diet b. taking vitals every 8 hours c. monitoring stools for occult blood d. teaching self injection of erythropoietin e. administration of cobalamin (vitamin b12) injections

a. instruction for high iron diet c. monitoring stools for occult blood (Stool occult blood test is performed to determine the cause of iron-deficiency anemia that is related to gastrointestinal bleeding. Iron is increased in the diet. Teach the patient which foods are good sources of iron. If nutrition is already adequate, increasing iron intake by dietary means may not be practical. The patient with iron deficiency related to acute blood loss may require a transfusion of packed RBCs.)

Which statements accurately describe chronic lymphocytic leukemia (select all that apply)? a. Most common leukemia of adults b. Only cure is bone marrow transplant c. Neoplasm of activated B lymphocytes d. Increased incidence in survivors of atomic bombs e. Philadelphia chromosome is a diagnostic hallmark f. Mature-appearing but functionally inactive lymphocytes

a. Most common leukemia of adults c. Neoplasm of activated B lymphocytes f. Mature-appearing but functionally inactive lymphocytes (Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults. It is a neoplasm of activated B lymphocytes that are mature appearing but functionally inactive. As it progresses, pressure on nerves from enlarged lymph nodes causes pain and paralysis. Mediastinal node enlargement leads to pulmonary symptoms. The other characteristics are related to chronic myelogenous leukemia (CML).)

Which statements accurately describe thrombocytopenia (select all that apply)? a. Patients with platelet deficiencies can have internal or external hemorrhage. b. The most common acquired thrombocytopenia is thrombotic thrombocytopenic purpura (TTP). c. Immune thrombocytopenic purpura (ITP) is characterized by increased platelet destruction by the spleen. d. TTP is characterized by decreased platelets, decreased RBCs, and enhanced aggregation of platelets. e. A classic clinical manifestation of thrombocytopenia that the nurse would expect to find on physical examination of the patient is ecchymosis.

a. Patients with platelet deficiencies can have internal or external hemorrhage. c. Immune thrombocytopenic purpura (ITP) is characterized by increased platelet destruction by the spleen. d. TTP is characterized by decreased platelets, decreased RBCs, and enhanced aggregation of platelets. (Immune thrombocytopenic purpura (ITP) is characterized by increased platelet destruction by the spleen. Thrombotic thrombocytopenic purpura (TTP) has decreased platelets & RBCs with enhanced agglutination of the platelets. Platelet deficiencies lead to superficial site bleeding. ITP is the most common acquired thrombocytopenia. Petechiae, not ecchymosis, is a common manifestation of thrombocytopenia.)

A patient with aplastic anemia has a nursing diagnosis of impaired oral mucous membrane. The etiology of this diagnosis can be related to the effects of what deficiencies (select all that apply)? a. RBCs b. Ferritin c. Platelets d. Coagulation factor VIII e. White blood cells (WBCs)

a. RBCs c. Platelets e. White blood cells (WBCs) (Aplastic anemia may cause an inflamed, painful tongue. The thrombocytopenia may contribute to blood filled bullae in the mouth & gingival bleeding. The leukopenia may lead to stomatitis and oral ulcers and infections. MCV will be normal or slightly increased. Ferritin and coagulation factors are not affected in aplastic anemia.)

While receiving a unit of packed RBCs, the patient develops chills &a temperature of 102.2°F (39°C). What is the priority action for the nurse to take? a. Stop the transfusion and instill normal saline. b. Notify the health care provider and the blood bank. c. Add a leukocyte reduction filter to the blood administration set. d. Recognize this as a mild allergic transfusion reaction and slow the transfusion.

a. Stop the transfusion and instill normal saline. (Chills & fever are symptoms of an acute hemolytic or febrile transfusion reaction. If these develop, the nurse should stop the transfusion, infuse saline through the IV line, notify the HCP & blood bank immediately, recheck the ID tags, & monitor vital signs & urine output. The addition of a leukocyte reduction filter may prevent a febrile reaction but is not helpful once the reaction has occurred. Mild and transient allergic reactions indicated by itching and hives might permit restarting the transfusion after treatment with antihistamines.)

Priority nursing actions when caring for a hospitalized patient with a new onset temperature of 102.2 and severe neutropenia include (sata): a. administering the prescribed antibiotic STAT b. drawing peripheral and central line blood cultures c. ongoing monitoring of the patient's vitals for septic shock d. taking a full set of vitals and notifying the physician immediately e. administering transfusions of WBCs treated to decrease immunogenicity

a. administering the prescribed antibiotic STAT b. drawing peripheral and central line blood cultures c. ongoing monitoring of the patient's vitals for septic shock d. taking a full set of vitals & notifying the physician immediately (Early identification of an infective organism is a priority, and cultures should be obtained from various sites. Serial blood cultures (at least two) or one from a peripheral site & one from a venous access device should be obtained promptly. In a febrile neutropenic patient, antibiotics should be started immediately (within 1 hour). Cultures of the nose, throat, sputum, urine, stool, obvious lesions, & blood may be indicated. Ongoing febrile episodes or a change in the patient's assessment findings (or vital signs) necessitates a call to HCP for additional cultures, diagnostic tests, addition of antimicrobial therapies, or a combination of these.)

When caring for a pt with thrombocytopenia, the nurse instructs the patient to: a. dab his or her nose instead of blowing b. be careful when shaving with a safety razor c. continue with physical activities to stimulate thrombopoiesis d. avoid aspirin because it may mask the fever that occurs with thrombocytopenia

a. dab his or her nose instead of blowing (Patients with thrombocytopenia should avoid aspirin because it reduces platelet adhesiveness, which contributes to bleeding. Patients should not perform vigorous exercise or lift weights. If a patient is weak and at risk for falling, supervise the patient when he or she is out of bed. Blowing the nose forcefully should be avoided. The patient should gently pat the nose with a tissue if needed. Instruct patients not to shave with a blade; an electric razor should be used.)

A patient with hemophilia comes to the clinic for treatment. What should the nurse anticipate that he or she will need to administer? a. Whole blood b. Thromboplastin c. Coagulation factor d. Fresh frozen plasma

c. Coagulation factor (Although whole blood and fresh frozen plasma contain the clotting factors that are deficient in hemophilia, specific factor concentrates have been developed that are more pure and safer in preventing infection transmission. Thromboplastin is factor III and is not deficient in patients with hemophilia.)

The nursing management of a patient in sickle cell crisis includes: SATA a. monitoring CBC b. optimal pain management and oxygen therapy c. blood transfusions if required and iron chelation d. rest as needed and dvt prophylaxis e. admin of IV iron and diet high in iron content

a. monitoring CBC b. optimal pain management and oxygen therapy c. blood transfusions if required and iron chelation d. rest as needed and dvt prophylaxis (Complete blood count (CBC) is monitored. Infections are common with elevated WBC counts, & anemia may occur with low hemoglobin levels & low RBC counts. O2 may be administered to treat hypoxia & control sickling. Rest may be instituted to reduce metabolic requirements, & prophylaxis for DVT (with anti-coagulants) is prescribed. Transfusion therapy is indicated when an aplastic crisis occurs. Patients may require iron chelation therapy to reduce transfusion-produced iron overload. Pain occurring during an acute crisis is usually undertreated; patients should have optimal pain control with opioid analgesics, nonsteroidal antiinflammatory agents, antineuropathic pain medications, local anesthetics, or nerve blocks.)

A complication of the hyperviscosity of polycythemia is: a. thrombosis b. cardiomyopathy c. pulmonary edema d. disseminated intravascular coagulation (DIC)

a. thrombosis (The patient with polycythemia may experience angina, heart failure, intermittent claudication, and thrombophlebitis, which may be complicated by embolization. These manifestations are caused by blood vessel distention, impaired blood flow, circulatory stasis, thrombosis, and tissue hypoxia, which is caused by the hypervolemia and hyperviscosity. The most common serious acute complication is stroke, caused by thrombosis.)

What causes the anemia of sickle cell disease? a. Intracellular hemolysis of sickled RBCs b. Accelerated breakdown of abnormal RBCs c. Autoimmune antibody destruction of RBCs d. Isoimmune antibody-antigen reactions with RBCs

b. Accelerated breakdown of abnormal RBCs (Because RBCs are abnormal in sickle cell anemia, the mean RBC survival time is 10 to 15 days (rather than the normal 120 days) because of accelerated RBC breakdown by the spleen, not in the blood vessels. Antibody reactions with RBCs may be seen in other types of hemolytic anemias but are not present in sickle cell anemia.)

A patient with thrombocytopenia with active bleeding is to receive two units of platelets. To administer the platelets, what should the nurse do? a. Check for ABO compatibility. b. Agitate the bag periodically during the transfusion. c. Take vital signs every 15 minutes during the procedure. d. Refrigerate the second unit until the first unit has transfused.

b. Agitate the bag periodically during the transfusion. (Because platelets adhere to the plastic bags, the bag should be gently agitated throughout the transfusion. Platelets do not have A, B, or Rh antibodies and ABO compatibility is not a consideration. Baseline vital signs should be taken before the transfusion is started and the nurse should stay with the patient during the first 15 minutes. Platelets are stored at room temperature and should not be refrigerated.)

Which anemia is manifested with pancytopenia? a. Thalassemia b. Aplastic anemia c. Megaloblastic anemia d. Anemia of chronic disease

b. Aplastic anemia (Aplastic anemia has a decrease of all blood cell types and hypocellular bone marrow. Thalassemia is characterized by inadequate production of normal hemoglobin and decreased erythrocyte production. Megaloblastic anemias (cobalamin deficiency and folic acid deficiency anemias) are caused by impaired DNA synthesis, which results in the presence of large red blood cells (RBCs). Anemia of chronic disease occurs with chronic inflammation, autoimmune and infectious disorders, heart failure, malignancies, or bleeding episodes. It manifests with underproduction of RBCs and shortened RBC survival.)

A patient has a platelet count of 50,000/μL and is diagnosed with ITP. What does the nurse anticipate that initial treatment will include? a. Splenectomy b. Corticosteroids c. Administration of platelets d. Immunosuppressive therapy

b. Corticosteroids (Corticosteroids are used in initial treatment of ITP because they suppress the phagocytic response of splenic macrophages, decreasing platelet destruction. They also depress autoimmune antibody formation and reduce capillary fragility and bleeding time. All of the other therapies may be used but only in patients who are unresponsive to corticosteroid therapy.)

A patient with a hemoglobin (Hgb) level of 7.8 g/dL (78 g/L) has cardiac palpitations, a heart rate of 102 bpm, and an increased reticulocyte count. At this severity of anemia, what other manifestation would the nurse expect the patient to exhibit? a. Pallor b. Dyspnea c. A smooth tongue d. Sensitivity to cold

b. Dyspnea (The patient's Hgb level indicates a moderate anemia & at this severity additional findings usually include dyspnea & fatigue. Pallor, smooth tongue, & sensitivity to cold usually manifest in severe anemia when the Hgb level is below 6 g/dL (60 g/L).)

A 45-year-old patient has symptoms including arthralgia, impotence, weight loss, and liver enlargement. His laboratory results include an elevated serum iron, total iron binding capacity (TIBC), and serum ferritin levels. Which disorder does this describe and which treatment will be used? a. Thalassemia; combination chemotherapy b. Hemochromatosis; deferoxamine (Desferal) c. Myelodysplastic syndrome; filgrastim (Neupogen) d. Delayed transfusion reaction; deferasirox (Exjade)

b. Hemochromatosis; deferoxamine (Desferal) (The symptoms describe hemochromatosis, which is treated with iron chelating agents to remove accumulated iron via the kidneys.)

Nursing interventions for the patient with aplastic anemia are directed toward the prevention of which complications? a. Fatigue and dyspnea b. Hemorrhage and infection c. Thromboemboli and gangrene d. Cardiac dysrhythmias and heart failure

b. Hemorrhage and infection (Hemorrhage from thrombocytopenia & infection from neutropenia are the greatest risks for the pt w/ aplastic anemia. The pt will experience fatigue from anemia but bleeding & infection are the major causes of death in aplastic anemia.)

What characteristics should the nurse be aware of in planning care for the patient with Hodgkin's lymphoma? a. Staging of Hodgkin's lymphoma is not important to predict prognosis. b. Nursing management of the patient undergoing treatment for Hodgkin's lymphoma includes measures to prevent infection. c. Hodgkin's lymphoma is characterized by proliferation of malignant activated B cells that destroy the kidneys. d. An important nursing intervention in the care of patients with Hodgkin's lymphoma is increasing fluids to manage hypercalcemia.

b. Nursing management of the patient undergoing treatment for Hodgkin's lymphoma includes measures to prevent infection. (The patient is monitored for infection as leukopenia and thrombocytopenia may develop from the disease or usually as a consequence of treatment. Staging of Hodgkin's disease is important to determine treatment. Multiple myeloma is characterized by proliferation of malignant activated B cells that destroy the bones. The intervention of increasing fluid to manage hypercalcemia is used with multiple myeloma.)

A patient with hemophilia is hospitalized with acute knee pain and swelling. What is an appropriate nursing intervention for the patient? a. Wrapping the knee with an elastic bandage b. Placing the patient on bed rest and applying ice to the joint c. Administering nonsteroidal antiinflammatory drugs (NSAIDs) as needed for pain d. Gently performing range-of-motion (ROM) exercises to the knee to prevent adhesions

b. Placing the patient on bed rest and applying ice to the joint (During an acute bleeding episode in a joint, it is important to rest the involved joint totally and slow bleeding with application of ice. Drugs that decrease platelet aggregation, such as aspirin or nonsteroidal antiinflammatory drugs (NSAIDs), should not be used for pain. As soon as bleeding stops, mobilization of the affected area is encouraged with range-of-motion (ROM) exercises and physical therapy.)

In providing care for a patient hospitalized with an acute exacerbation of polycythemia vera, the nurse gives priority to which activity? a. Maintaining protective isolation b. Promoting leg exercises and ambulation c. Protecting the patient from injury or falls d. Promoting hydration with a large oral fluid intake

b. Promoting leg exercises and ambulation (Thrombus and embolization are the major complications of polycythemia vera because of increased hypervolemia & hyperviscosity. Active or passive leg exercises & ambulation should be implemented to prevent thrombus formation. Hydration therapy is important to decrease blood viscosity. However, because the pt already has hypervolemia, a careful balance of intake & output must be maintained & fluids are not increased injudiciously.)

A patient with sickle cell anemia asks the nurse why the sickling crisis does not stop when oxygen therapy is started. Which explanation should the nurse give to the patient? a. Sickling occurs in response to decreased blood viscosity, which is not affected by oxygen therapy. b. When RBCs sickle, they occlude small vessels, which causes more local hypoxia and more sickling. c. The primary problem during a sickle cell crisis is destruction of the abnormal cells, resulting in fewer RBCs to carry oxygen. d. Oxygen therapy does not alter the shape of the abnormal erythrocytes but only allows for increased oxygen concentration in hemoglobin.

b. When RBCs sickle, they occlude small vessels, which causes more local hypoxia and more sickling. (During a sickle cell crisis, the sickling cells clog small capillaries and the resulting hemostasis promotes a self perpetuating cycle of local hypoxia, deoxygenation of more erythrocytes, and more sickling. Administration of oxygen may help to control further sickling but additional oxygen does not reach areas of local hypoxia caused by occluded vessels.)

When obtaining assessment data from a patient with a microcytic, hypochromic anemia, the nurse would question the patient about: a. folic acid intake b. dietary intake of iron c. a history of gastric surgery d. a history of sickle cell anemia

b. dietary intake of iron (Iron-deficiency anemia is a microcytic, hypochromic anemia.)

In teaching the patient with pernicious anemia about the disease, the nurse explains that it results from a lack of a. folic acid. b. intrinsic factor. c. extrinsic factor. d. cobalamin intake.

b. intrinsic factor. (Pernicious anemia is a type of cobalamin (vitamin B12) deficiency that results when parietal cells in the stomach fail to secrete enough intrinsic factor to absorb ingested cobalamin. Folic acid deficiency may contribute to folic acid deficiency anemia, not pernicious anemia. Extrinsic factor may be a factor in some cobalamin deficiencies but not in pernicious anemia. Lack of cobalamin intake can cause cobalamin deficiency but not pernicious anemia. Increasing cobalamin intake cannot improve pernicious anemia without intrinsic factor to aid its absorption.)

A patient with acute myelogenous leukemia is considering a hematopoietic stem cell transplant and asks the nurse what is involved. What is the best response the nurse can give the patient? a. "Your bone marrow is destroyed by radiation and new bone marrow cells from a matched donor are injected into your bones." b. "A specimen of your bone marrow may be aspirated and treated to destroy any leukemic cells and then reinfused when your disease becomes worse." c. "Leukemic cells and bone marrow stem cells are eliminated with chemotherapy and/or total-body radiation and new bone marrow cells from a donor are infused." d. "During chemotherapy and/or total-body irradiation to destroy all of your blood cells, you may be given transfusions of red blood cells and platelets to prevent complications."

c. "Leukemic cells and bone marrow stem cells are eliminated with chemotherapy and/or total-body radiation and new bone marrow cells from a donor are infused." (Whether the donor bone marrow is from a HLA-matched donor or taken from the patient during a remission for later use, hematopoietic stem cell transplant always involves the use of chemotherapy &/or total-body radiation to eliminate leukemic cells & the patient's bone marrow stem cells totally before IV infusion of the donor cells. A severe pancytopenic period follows the transplant, during which the pt must be in protective isolation & during which RBC & platelet transfusions may be given.)

Which leukemia is seen in 80% of adults with acute leukemia and exhibits proliferation of precursors of granulocytes? a. Acute lymphocytic leukemia (ALL) b. Chronic lymphocytic leukemia (CLL) c. Acute myelogenous leukemia (AML) d. Chronic myelogenous leukemia (CML)

c. Acute myelogenous leukemia (AML) (AML is seen in 80% of adults with acute leukemia & is characterized by hyperplasia of the bone marrow with uncontrolled proliferation of myeloblasts, the precursors of granulocytes. Acute lymphocytic leukemia (ALL), the other acute leukemia, is most common in children and is characterized by small, immature lymphocytes, primarily of B-cell origin, proliferated in the bone marrow. Fever, bleeding, and central nervous system manifestations are also common with ALL. The other two leukemias are chronic in onset and the maturity of WBCs.))

Which type of transfusion reaction occurs with leukocyte or plasma protein incompatibility and may be avoided with leukocyte reduction filters? a. Allergic reaction b. Acute hemolytic reaction c. Febrile , nonhemolytic reaction d. Massive blood transfusion reaction

c. Febrile , nonhemolytic reaction (Febrile nonhemolytic reaction is the most common transfusion reaction. Allergic reactions occur with sensitivity to foreign plasma proteins and can be treated prophylactically with antihistamines. Acute hemolytic reactions are related to the infusion of ABO-incompatible blood or components with 10 mL or more of RBCs. Massive blood transfusion reactions occur when patients receive more RBCs or blood than the total blood volume.)

Following a splenectomy for the treatment of ITP, the nurse would expect the patient's laboratory test results to reveal which of the following? a. Decreased RBCs b. Decreased WBCs c. Increased platelets d. Increased immunoglobulins

c. Increased platelets (Splenectomy may be indicated for treatment for ITP and when the spleen is removed, platelet counts increase significantly in most patients. In any of the disorders in which the spleen removes excessive blood cells, splenectomy will most often increase peripheral RBC, WBC, and platelet counts.)

What is the underlying cause of lymphadenopathy, splenomegaly, and hepatomegaly in leukemia? a. The development of infection at these sites b. Increased compensatory production of blood cells by these organs c. Infiltration of the organs by increased numbers of WBCs in the blood d. Normal hypertrophy of the organs in an attempt to destroy abnormal cells

c. Infiltration of the organs by increased numbers of WBCs in the blood (Almost all leukemias cause some degree of hepatosplenomegaly because of infiltration of these organs as well as the bone marrow, lymph nodes, bones, & central nervous system by excessive WBCs in the blood.)

Priority Decision: A 76-year-old woman has an Hgb of 7.3 g/dL (73 g/L) and is experiencing ataxia and confusion on admission to the hospital. What is a priority nursing intervention for this patient? a. Provide a darkened, quiet room. b. Have the family stay with the patient. c. Keep top bedside rails up and call bell in close reach d. Question the patient about possible causes of anemia

c. Keep top bedside rails up and call bell in close reach (In the older adult, confusion, ataxia, and fatigue are common manifestations of anemia and place the patient at risk for injury. Nursing interventions should include safety precautions to prevent falls and injury when these symptoms are present. The nurse, not the patient's family, is responsible for the patient and although a quiet room may promote rest, it is not as important as protection of the patient.)

Priority Decision: A patient is admitted to the hospital for evaluation and treatment of thrombocytopenia. Which action is most important for the nurse to implement? a. Taking the temperature every 4 hours to assess for fever b. Maintaining the patient on strict bed rest to prevent injury c. Monitoring the patient for headaches, vertigo, or confusion d. Removing the oral crusting and scabs with a soft brush four times a day

c. Monitoring the patient for headaches, vertigo, or confusion (The major complication of thrombocytopenia is hemorrhage and it may occur in any area of the body. Cerebral hemorrhage may be fatal and evaluation of mental status for central nervous system (CNS) alterations to identify CNS bleeding is very important. Fever is not a common finding in thrombocytopenia. Protection from injury to prevent bleeding is an important nursing intervention but strict bed rest is not indicated. Oral care is performed very gently with minimum friction and soft swabs.)

Which descriptions are characteristic of iron-deficiency anemia (select all that apply)? a. Lack of intrinsic factor b. Autoimmune-related disease c. Most common type of anemia d. Associated with chronic blood loss e. May occur with removal of the stomach f. May occur with removal of the duodenum

c. Most common type of anemia d. Associated with chronic blood loss f. May occur with removal of the duodenum (Iron-deficiency anemia is the most common type of anemia and occurs with chronic blood loss or malabsorption in the duodenum so it may occur with duodenal removal. The other options are associated with cobalamin deficiency.)

During the assessment of a patient with cobalamin deficiency, what manifestation would the nurse expect to find in the patient? a. Icteric sclera b. Hepatomegaly c. Paresthesia of the hands and feet d. Intermittent heartburn with acid reflux

c. Paresthesia of the hands and feet (Neurologic manifestations of weakness, paresthesias of the feet & hands, & impaired thought processes are characteristic of cobalamin deficiency & pernicious anemia. Hepatomegaly & jaundice often occur with hemolytic anemia & the pt with cobalamin deficiency often has achlorhydria or decreased stomach acidity & would not experience effects of gastric hyperacidity.)

DIC is a disorder in which a. the coagulation pathway is genetically altered, leading to thrombus formation in all major blood vessels b. an underlying disease depletes hemolytic factors in the blood, leading to diffuse thrombotic episodes and infarcts c. a disease process stimulates coagulation processes with resultant thrombosis, as well as depletion of clotting factors, leading to diffuse clotting and hemorrhage. d. an inherited prediposition causes a deficiency of clotting factors that leads to overstimulation of coagulation processes in the vasculature

c. a disease process stimulates coagulation processes with resultant thrombosis, as well as depletion of clotting factors, leading to diffuse clotting and hemorrhage. (In DIC, the coagulation process is stimulated, with resultant thrombosis and depletion of clotting factors, which leads to diffuse clotting and hemorrhage. The paradox of this condition is characterized by the profuse bleeding that results from the depletion of platelets and clotting factors.)

A pt with multiple myeloma becomes confused and lethargic. The nurse would expect that these clinical manifestations may be explained by diagnostic results that indicate: a. hyperkalemia b. hyperuricemia c. hypercalcemia d. CNS myeloma

c. hypercalcemia (Bone degeneration in multiple myeloma causes calcium to be lost from bones, which eventually results in hypercalcemia. Hypercalcemia may cause renal, gastrointestinal, or neurologic manifestations, such as polyuria, anorexia, or confusion, and may ultimately cause seizures, coma, and cardiac problems.)

The nurse is aware that a major difference between Hodgkin's lymphoma and non Hodgkin's lymphoma is that a. Hodgkin's lymphoma occurs only in young adults b. Hodgkin's lymphoma is considered potentially curable c. non Hodgkin's lymphoma can manifest in multiple organs d. non Hodgkin's lymphoma is treated only with radiation therapy

c. non Hodgkin's lymphoma can manifest in multiple organs (Non-Hodgkin's lymphoma can originate outside the lymph nodes, the method of spread can be unpredictable, and most affected patients have widely disseminated disease.)

In reviewing the laboratory results of a patient with hemophilia A, what would the nurse expect to find? a. An absence of factor IX b. A decreased platelet count c. A prolonged bleeding time d. A prolonged partial thromboplastin time (PTT)

d. A prolonged partial thromboplastin time (PTT) (A prolonged partial thromboplastin time (PTT) occurs when there is a deficiency of clotting factors, such as factor VIII associated with hemophilia A. Factor IX is deficient in hemophilia B and prolonged bleeding time and decreased platelet counts are associated with platelet deficiencies)

What is a nursing intervention that is indicated for the patient during a sickle cell crisis? a. Frequent ambulation b. Application of antiembolism hose c. Restriction of sodium and oral fluids d. Administration of large doses of continuous opioid analgesics

d. Administration of large doses of continuous opioid analgesics (Because pain usually accompanies a sickle cell crisis & may last for 4-6 days, pain control is an important part of treatment. Rest is indicated to reduce metabolic needs & fluids and electrolytes are administered to reduce blood viscosity & maintain renal function. Although thrombosis does occur in capillaries, elastic stockings that primarily affect venous circulation are not indicated; anticoagulants are used instead.)

The strict vegetarian is at highest risk for the development of which anemia? a. Thalassemia b. Iron-deficiency anemia c. Folic acid deficiency anemia d. Cobalamin deficiency anemia

d. Cobalamin deficiency anemia (Because red meats are the primary dietary sources of cobalamin, a strict vegetarian is most at risk for cobalamin deficiency anemia. Meats are also an important source of iron & folic acid but whole grains, legumes, & green leafy vegetables also supply these nutrients. Thalassemia isn't related to dietary deficiencies.)

During the physical assessment of the patient with severe anemia, which finding is of the most concern to the nurse? a. Anorexia b. Bone pain c. Hepatomegaly d. Dyspnea at rest

d. Dyspnea at rest (Dyspnea at rest indicates that the patient is making an effort to provide adequate amounts of oxygen to the tissues. If oxygen needs are not met, angina, myocardial infarction, heart failure, & pulmonary & systemic congestion can occur. The other manifestations are present in severe anemia but they do not reflect hypoxemia, a priority problem.)

A 20-year-old female patient is in the emergency department for anorexia and fatigue. She takes phenytoin (Dilantin) for a seizure disorder and oral contraceptives. Which type of anemia is this patient most at risk for? a. Aplastic anemia b. Hemolytic anemia c. Iron-deficiency anemia d. Folic acid deficiency anemia

d. Folic acid deficiency anemia (Folic acid deficiency megaloblastic anemia is related to dietary deficiency as seen in anorexia & with the use of oral contraceptives and antiseizure medications. The other anemias are unrelated to this patient's history.)

During discharge teaching of a patient with newly diagnosed sickle cell disease, what should the nurse teach the patient to do? a. Limit fluid intake b. Avoid humid weather c. Eliminate exercise from the lifestyle d. Seek early medical intervention for upper respiratory infections

d. Seek early medical intervention for upper respiratory infections (The patient with sickle cell disease is particularly prone to URI & infection can precipitate a sickle cell crisis. Patients should seek medical attention quickly to counteract upper respiratory infections because pneumonia is the most common infection of patients with sickle cell disease. Fluids should be increased to decrease blood viscosity, which may precipitate a crisis, and moderate activity is permitted. Dehydration in hot weather may precipitate a sickling episode but humid weather alone will not do so.)

What is a major method of preventing infection in the patient with neutropenia? a. Prophylactic antibiotics b. A diet that eliminates fresh fruits and vegetables c. High-efficiency particulate air (HEPA) filtration rooms d. Strict hand washing by all persons in contact with the patient

d. Strict hand washing by all persons in contact with the patient (Despite its seeming simplicity, hand washing before, during, & after care of the patient with neutropenia is the major method to prevent transmission of harmful pathogens to the pt. IV antibiotics are administered when febrile episodes occur. Some oral antibiotics may be used prophylactically in some neutropenic patients. HEPA filtration and laminar airflow (LAF) rooms may reduce the number of aerosolized pathogens but they are expensive and LAF use is controversial.)

The most common type of leukemia in older adults is; a. acute myelocytic leukemia b. acute lymphocytic leukemia c. chronic myelocytic leukemia d. chronic lymphocytic leukemia

d. chronic lymphocytic leukemia (Chronic lymphocytic leukemia is a disease primarily of older adults.)

Because myelodysplastic syndrome arises from the pluripotent hematopoietic stem cell in the bone marrow, lab results the nurse would expect to find include a. excess of T cells b. excess of platelets c. deficiency of granulocytes d. deficiency of all cellular blood components

d. deficiency of all cellular blood components (Myelodysplastic syndrome (MDS) commonly manifests as infection and bleeding. It is caused by inadequate numbers of ineffective functioning circulating granulocytes or platelets.)

The nurse would anticipate that a pt with von Willebrand disease undergoing surgery would be treated with admin of vWF and: a. thrombin b. factor VI c. factor VII d. factor VIII

d. factor VIII (von Willebrand disease involves deficiency of the von Willebrand coagulation protein, variable factor VIII deficiencies, and platelet dysfunction. Treatment includes administration of von Willebrand factor and factor VIII.)

When reviewing the patient's hematologic lab values after a splenectomy, the nurse would expect to find: a. leukopenia b. RBC abnormalities c. decreased hemoglobin d. increased platelet count

d. increased platelet count (Splenectomy can have a dramatic effect in increasing peripheral RBCs, WBCs, and platelet counts.)

Multiple drugs are often used in combinations to treat leukemia and lymphoma because a. there are fewer toxic and SE b. the chance that one drug will be effective is increased c. the drugs are more effective without causing SE d. the drugs work by different mechanisms to maximize the killing of malignant cells

d. the drugs work by different mechanisms to maximize the killing of malignant cells (Combination therapy is the mainstay of treatment for leukemia. The three purposes for using multiple drugs are to (1) decrease drug resistance, (2) minimize the drug toxicity to the patient by using multiple drugs with varying toxic effects, and (3) interrupt cell growth at multiple points in the cell cycle.)

Complications of transfusions that can be decreased by the use of leukocyte depletion or reduction of RBC transfusion are a. chills and hemolysis b. leukostasis and neutrophilia c. fluid overload and pulmonary edema d. transmission of cytomegalovirus and fever

d. transmission of cytomegalovirus and fever (Infectious viruses, such as HIV, human herpesvirus, hepatitis B & C type 6 (HCV-6), Epstein-Barr virus (EBV), human T-cell leukemia virus type 1 (HTLV-1), cytomegalovirus (CMV), & other agents, such as the agent that causes malaria, can be transmitted by blood transfusion. Leukocyte-reduced blood products drastically reduce the risk for viral infections associated with blood transfusions, including CMV.)

Which bleeding disorder affects both genders, is autosomal dominant, and will have laboratory results showing prolonged bleeding time? a. Hemophilia A b. Hemophilia B c. Thrombocytopenia d. von Willebrand disease

d. von Willebrand disease (This description is characteristic of von Willebrand disease with prolonged bleeding time occurring because of defective platelets, which does not occur with either type of hemophilia. Although inherited thrombocytopenia is believed to be autosomal dominant, the number of platelets is decreased.)