Ch 32 - Hematopoietic Disorders

A client's blood work shows an anemia that was not present at the last clinic visit 6 months ago. Which questions should the nurse ask this client? Select all that apply. 1. "Have you had a significant dietary change in the last 6 months?" 2. "Do you handle chemicals in your new job?" 3. "Have your stools changed in appearance?" 4. "Have you been eating more carbohydrates than usual?" 5. "Are your menstrual periods heavier than normal for you?"

1. "Have you had a significant dietary change in the last 6 months?" 2. "Do you handle chemicals in your new job?" 3. "Have your stools changed in appearance?" 5. "Are your menstrual periods heavier than normal for you?" Rationale 1: Dietary changes may significantly influence production of red blood cells. Rationale 2: Chemicals can cause RBC destruction. Rationale 3: Change to dark tarry stool, red stools, or much looser stools could indicate blood loss. Rationale 4: There is no connection between carbohydrate ingestion and anemia. Rationale 5: Heavy menstrual flow is a leading cause of blood loss anemia in women.

The client is pregnant and has been told by her physician that she needs cyanocobalamin (Nascobal). She asks the nurse, "Will this hurt my baby?" What is the best response by the nurse? 1. "No, this medication will not hurt your baby as long as you take it with ascorbic acid." 2. "No, this is safe as long as long as you take it in pill form; it is a Pregnancy Category A drug, which means it is safe for your baby." 3. "No, this medication will not hurt your baby as long as you take the pills only in the third trimester." 4. "No, this is safe in either pill or injectable form; it is a Pregnancy Category A drug which means it is safe for your baby."

2. "No, this is safe as long as long as you take it in pill form; it is a Pregnancy Category A drug, which means it is safe for your baby." Rationale 1: Ascorbic acid affects the stability of cyanocobalamin (Nascobal) and should not be used concomitantly with cyanocobalamin. Rationale 2: Cyanocobalamin (Nascobal), oral formulation, is a Pregnancy Category A drug, but it is a Pregnancy Category C when used parenterally. Rationale 3: There is no evidence to support that oral cyanocobalamin (Nascobal) is teratogenic during the first or second trimesters. Rationale 4: Cyanocobalamin (Nascobal) is a Pregnancy Category C when used parenterally.

The client complains of constipation while receiving ferrous sulfate (Feosol). What is the best plan by the nurse to assist the client in resolving this common side effect? 1. Plan to teach the client about which laxatives are the safest to use. 2. Plan to teach the client to increase fluids and high-fiber foods in the diet. 3. Plan to teach the client to self-administer Fleets enemas. 4. Plan to teach the client to increase exercise.

2. Plan to teach the client to increase fluids and high-fiber foods in the diet. Rationale 1: The use of laxatives will make the bowel lazy and contribute to constipation. Rationale 2: Constipation is a common side effect of ferrous sulfate; therefore, an increase in dietary fiber may be indicated. Rationale 3: The use of Fleets enemas will make the bowel lazy and contribute to constipation. Rationale 4: Increasing exercise will help relieve constipation but is not as effective as other interventions.

The nurse teaches a class on iron-deficiency anemia to a group of pregnant clients. The nurse evaluates that additional learning is needed when the clients make which statement? 1. "Most iron in our bodies is stored on hemoglobin in the red blood cell." 2. "Transferrin is a protein that transports iron to places in our bodies where it is needed." 3. "We need extra iron because when our red blood cells die, all their iron is excreted from the body." 4. "The most common cause of nutritional anemia is iron deficiency."

3. "We need extra iron because when our red blood cells die, all their iron is excreted from the body." Rationale 1: Most iron in our bodies is stored on hemoglobin in the red blood cell. Rationale 2: Transferrin is a protein that transports iron to places in our bodies where it is needed. Rationale 3: After erythrocytes die, nearly all of the iron in their hemoglobin is incorporated into transferrin and recycled for later use. Rationale 4: The most common cause of nutritional anemia is iron deficiency.

A nurse is preparing to administer ferrous sulfate IM to a client with anemia. What should the nurse consider when giving this injection? Select all that apply. 1. Give the injection in the deltoid muscle. 2. Iron is best absorbed if given subcutaneously. 3. Iron is irritating to the tissues. 4. The z-track method should be used. 5. Iron preparations should be administered through a needle gauge 16 or larger.

3. Iron is irritating to the tissues. 4. The z-track method should be used. Rationale 1: The injection should be given deep IM in a larger muscle. Rationale 2: Iron should be given deep IM. Rationale 3: Iron is irritating to tissues. Rationale 4: Z-track injection reduces leakage into the tissues and is the preferred method of IM injection of iron. Rationale 5: There is no indication of need to use a large diameter needle for injection.

The process for regulating hematopoiesis occurs via 1. white bone marrow. 2. hematopoietic stem cell. 3. hormones. 4. essential vitamins and nutrient

3. hormones. Rationale 1: Hematopoiesis occurs primarily in red bone marrow. Rationale 2: The process of hematopoiesis begins with a stem cell. Rationale 3: Regulation of hematopoiesis occurs through messages from hormones. Rationale 4: Hematopoiesis occurs primarily in red bone marrow, and requires B vitamins, vitamin C, copper, iron, and other nutrients.

The nurse is teaching a class on how red blood cell formation is regulated by the body to a group of clients who have AIDS. The nurse evaluates that learning has occurred when the clients make which statements? 1. "Red blood cell formation is regulated through chemicals called colony-stimulating factors that come from white blood cells." 2. "Red blood cell formation is regulated through messages from the hormone, secretin, which is located in the kidney." 3. "Red blood cell formation is regulated through specific liver enzymes and a process called hemochromatosis." 4. "Red blood cell formation is regulated through messages from the hormone erythropoietin."

4. "Red blood cell formation is regulated through messages from the hormone erythropoietin." Rationale 1: Colony-stimulating factors affect white blood cell production. Rationale 2: Secretin stimulates the pancreas to release a fluid that neutralizes stomach acid and aids in digestion; it has nothing to do with red blood cell formation. Rationale 3: Hemochromatosis refers to excess iron accumulation in the body, not to red blood cell formation. Rationale 4: Regulation of hematopoiesis occurs through messages from hormones such as erythropoietin.

A patient is being treated for an iron overdose after taking a bottle of over-the-counter multiple vitamins with iron. Which information will the nurse provide to the family about treatment of this overdose? Select all that apply. 1. "The antidote for iron overdose is a folic acid." 2. "The antidote is given via a retention enema." 3. "We will know that the antidote is working when the patient's urine turns a bluish color." 4. "Success of this medication depends on the patient having good kidney function." 5. "Iron overdose is extremely dangerous."

4. "Success of this medication depends on the patient having good kidney function." 5. "Iron overdose is extremely dangerous." Rationale 1: The antidote for iron overdose is deferoxamine (Desferal). Rationale 2: The antidote is give parenterally. Rationale 3: If the drug is working, the urine will turn a rusty color. Rationale 4: The antidote binds to iron, which is then removed by the kidney. Rationale 5: Iron overdose is very toxic.

A patient has been prescribed ferrous sulfate (Feosol). What should the nurse teach the patient about taking this medication? 1. Take this medication with milk. 2. It is okay to take this medication along with your other medications, such as calcium. 3. Take this medication with orange juice. 4. Take this medication with water.

4. Take this medication with water. Rationale 1: Taking with milk would decrease absorption. Rationale 2: Several medications can increase or decrease absorption. Rationale 3: Taking with orange juice can increase gastric irritations. Rationale 4: While taking this medication with food or other drinks will reduce gastric irritation, the absorption will also be decreased significantly

The nurse is using this diagram to explain why the patient is receiving a drug that modifies hematopoiesis. Mark the cells that would be increased by administering oprelvekin (Neumega). Image on page 482

Site A ( platelets) Rationale: Oprelvekin (Neumega) is the drug most frequently used to enhance platelet production. Platelets arise from megakaryoblasts.

A 19-year-old athlete is admitted to the emergency department in hypertensive crisis. It is determined that this patient has been "blood doping" to prepare for a championship game. How does the nurse explain this practice to the patient's parents? Select all that apply. 1. "Having additional red blood cells may put an athlete at an advantage as more oxygen is available for cells." 2. "This process may include transfusion of blood products." 3. "Some athletes take epoetin alfa to increase their competitive edge." 4. "Blood doping helps to increase white blood cells that help to repair tissue damage." 5. "The injection of blood deep into muscles is thought to improve their strength."

1. "Having additional red blood cells may put an athlete at an advantage as more oxygen is available for cells." 2. "This process may include transfusion of blood products." 3. "Some athletes take epoetin alfa to increase their competitive edge." Rationale 1: The rationale behind blood doping is that increasing numbers of RBCs will increase hemoglobin and oxygen-carrying capacity. Rationale 2: Some athletes withdraw their own blood and then have it retransfused. Rationale 3: Taking epoetin alfa increases RBC levels. Rationale 4: Blood doping does not focus on increasing WBCs. Rationale 5: Blood doping does not include intramuscular injection of blood.

The client is receiving medication for the treatment of anemia. The nurse has taught the client about this drug and about anemia. The nurse evaluates that learning has occurred when the client makes which statement? 1. "My anemia could be caused by blood loss somewhere, but there are other causes too." 2. "My anemia was caused by drinking too many carbonated beverages with caffeine." 3. "There are many causes for anemia; mine was caused by heart failure and fluid overload." 4. "I think my anemia occurred when I started that vegetarian diet."

1. "My anemia could be caused by blood loss somewhere, but there are other causes too." Rationale 1: The three categories of blood loss are hemorrhage, increased erythrocyte destruction, and impaired erythrocyte production. Rationale 2: Anemia is not caused by too much caffeine. Rationale 3: Anemia is not caused by heart failure or fluid overload. Rationale 4: A well-balanced vegetarian diet will not result in anemia.

The client calls the nurse and is very frantic. "I think something is wrong! My stools are black, and they have never been this color before!" The client is receiving ferrous sulfate (Feosol). What is the best response by the nurse? 1. "This is an expected side effect of ferrous sulfate (Feosol); it is okay." 2. "This sounds serious; you may have started bleeding again." 3. "Do you have hemorrhoids? That could be the problem." 4. "I will speak with your doctor and call you right back."

1. "This is an expected side effect of ferrous sulfate (Feosol); it is okay." Rationale 1: Ferrous sulfate (Feosol) will turn stools a harmless, dark green or black color; this is an expected side effect of the medication. Rationale 2: To tell a client that this sounds serious is non-therapeutic, as the nurse should know that black stools are an expected side effect of the drug. Rationale 3: Hemorrhoids are unlikely the problem; they would cause bright red color in the stool. Rationale 4: There is no need to call the physician; this is an expected side effect of the drug.

The client had stomach cancer and a surgical removal of his stomach several years ago. The physician prescribed cyanocobalamin (Nascobal). The client stopped this drug several months ago. What will the nurse most likely assess in this client? 1. Memory loss, numbness in the limbs, and depression 2. A gradual decrease in red blood cell counts 3. Jaundice and tarry stools 4. Low hemoglobin and hematocrit counts

1. Memory loss, numbness in the limbs, and depression Rationale 1: The most common cause of vitamin B12 deficiency (pernicious anemia) is absence of intrinsic factor, a protein secreted by stomach cells. This protein is required for vitamin B12 to be absorbed from the intestine. Symptoms of pernicious anemia involve the nervous system and include memory loss, confusion, tingling or numbness in the limbs, and mood disturbances. Rationale 2: A decrease in red blood cells does not occur with pernicious anemia. Rationale 3: Jaundice and tarry stools do not occur with pernicious anemia. Rationale 4: Low hemoglobin and hematocrit counts do not occur with pernicious anemia.

A client is scheduled to have chemotherapy Thursday at 9 a.m. Filgrastim (Neupogen) has also been ordered. The nurse should plan which dosing time for the Neupogen? Select all that apply. 1. No later than 9 a.m. on Wednesday 2. At the time of the chemotherapy infusion 3. Immediately following the chemotherapy 4. No earlier than 9 a.m. Friday 5. Immediately before the chemotherapy

1. No later than 9 a.m. on Wednesday 4. No earlier than 9 a.m. Friday Rationale 1: Neupogen should be given at least 24 hours before chemotherapy. Rationale 2: The effectiveness of the Neupogen will be diminished by the chemotherapy. Rationale 3: The effectiveness of the Neupogen will be diminished by the chemotherapy. Rationale 4: Neupogen should be given no earlier than 24 hours after chemotherapy. Rationale 5: The effectiveness of the Neupogen will be diminished by the chemotherapy.

The physician has ordered sargramostim (Leukine) intravenously for the client. What is a priority plan by the nurse prior to administering this drug? 1. Plan to monitor the client's ECG readings. 2. Plan to insert a Foley catheter and monitor urine output. 3. Plan to administer 10% oxygen during the infusion. 4. Plan to have a white blood cell (WBC) count drawn every 30 minutes.

1. Plan to monitor the client's ECG readings. Rationale 1: Sargramostim (Leukine) may cause abnormal ST-segment depression. Rationale 2: There is no need to monitor urine output during the infusion. Rationale 3: There is no need to administer oxygen during the infusion. Rationale 4: There is no need to have a white blood cell (WBC) count drawn every 30 minutes.

The physician has prescribed epoetin alfa (Epogen) for the client. What is the priority assessment by the nurse? 1. The client's blood pressure 2. The client's report of a headache, indicating a stroke 3. The client's ability to use the proper injection techniques for self-administration 4. The client's hemoglobin and hematocrit levels

1. The client's blood pressure Rationale 1: The most serious adverse effect of epoetin alfa (Epogen) is hypertension, which can raise blood pressure to dangerous levels, and which occurs in as many as 30% of clients receiving the drug. Rationale 2: Clients are at risk for a stroke, but this is a complication of uncontrolled hypertension; blood pressure assessment is a priority. Rationale 3: Assessment of hypertension takes precedence over injection techniques. Rationale 4: Hemoglobin and hematocrit levels should be assessed, but they are not as high a priority as blood pressure.

A client has been treated with an erythropoiesis-stimulating factor. Which client assessment would the nurse interpret as indicating the goal of this treatment has been reached? Select all that apply. 1. The client's hemoglobin values have risen. 2. The client reports less shortness of breath on exertion. 3. The client has not had an episode of epistaxis in over 3 weeks. 4. The client reports enjoying a walk with family for the first time in months. 5. The client has not had a fever since treatment began.

1. The client's hemoglobin values have risen. 2. The client reports less shortness of breath on exertion. 4. The client reports enjoying a walk with family for the first time in months. Rationale 1: The purpose of this therapy is to increase red blood cells, which would increase hemoglobin. Rationale 2: Since the client has more RBCs, more oxygen can be carried to tissues. Rationale 3: This drug supports RBC production, not platelet production. Rationale 4: Increase in activity level indicates treatment success. Rationale 5: This treatment supports red blood cell production, not white blood cell production.

The mechanism of action of colony-stimulating factors, such as filgrastim (Neupogen), is to 1. increase neutrophil production. 2. supplement iron in the body. 3. replace vitamin B12 factor. 4. increase erythrocyte production.

1. increase neutrophil production. Rationale 1: The primary mechanism of action is to increase neutrophil production and phagocytosis in chemotherapy clients. Rationale 2: Anti-anemic iron supplements increase iron in the body. Rationale 3: Anti-anemic vitamin supplements increase B12 in the body. Rationale 4: Hematopoietic growth factors increase erythrocytes in the bone marrow.

In monitoring clients receiving erythropoiesis-stimulating agents, it is most important for the nurse to monitor for 1. thromboembolus. 2. TIA (transient ischemic attack). 3. MI (myocardial infarction). 4. stroke.

1. thromboembolus Rationale 1: Clients are at greater risk for thrombolytic disease, which can result in MI, stroke, and TIA. Rationale 2: Transient ischemic attack can occur as a result of thromboembolic disease. Rationale 3: Myocardial infarction can occur as a result of thromboembolic disease. Rationale 4: Stroke can occur as a result of thromboembolic disease

Colony-stimulating factors (CSFs) are named according to 1. type of blood cell stimulated. 2. type of hormone secreted. 3. type of homeostatic control. 4. type of stem cell stimulated.

1. type of blood cell stimulated. Rationale 1: CSFs are named according to types of blood cells stimulated. Rationale 2: The type of hormone is responsible for hematopoiesis regulation. Rationale 3: Homeostatic control is influenced by hormones and growth factors. Rationale 4: The type of stem cell stimulated is responsible for hematopoiesis.

The nurse is teaching a patient how to self-administer an erythropoiesis-stimulating drug. Which instruction should the nurse include? Select all that apply. 1. "Shake the vial to mix the contents before use." 2. "Draw up what is needed and discard the rest of the vial." 3. "Place your stock of medication in your refrigerator." 4. "Hold the vial in your hand a few minutes before drawing up the medication." 5. "Give the medication deeply into a muscle."

2. "Draw up what is needed and discard the rest of the vial." 3. "Place your stock of medication in your refrigerator." 4. "Hold the vial in your hand a few minutes before drawing up the medication." Rationale 1: The vial should not be shaken as this may deactivate the medication. Rationale 2: Vials are single use, and any medication remaining should be discarded. Rationale 3: Medication should be kept in the refrigerator. Rationale 4: The vial should be warmed before use. Rationale 5: The medication should be injected into the subcutaneous tissue.

The client receives filgrastim (Neupogen). He asks the nurse, "That is such a funny name; where do you suppose it comes from?" What is the best response by the nurse? 1. "It comes from the interleukins it stimulates; this one stimulates neuocytes." 2. "It comes from the blood cell it stimulates; this one stimulates neutrophils." 3. "It comes from the stem cells it stimulates, such as filgrastims." 4. "It is a complicated process; the drug companies are secretive about it."

2. "It comes from the blood cell it stimulates; this one stimulates neutrophils." Rationale 1: There aren't any interleukins named neuocytes. Rationale 2: Colony-stimulating factors (CSFs) are named according to the types of blood cells that they stimulate. Granulocyte colony-stimulating factor (G-CSF) increases the production of neutrophils, the most common type of granulocyte. Rationale 3: There aren't any stem cells named filgrastims. Rationale 4: Naming of drugs is not a complicated process.

The client receives epoetin alfa (Epogen) subcutaneously, and says to the nurse, "My doctor said I have anemia. Are there little red blood cells in that shot?" What are the best responses by the nurse? 1. "No, we do not give blood for anemia anymore." 2. "No, this medication stimulates your body to make red blood cells." 3. " Yes, this small amount of red blood cells will stimulate your bone marrow to produce more cells in the kidney." 4. 4. "No, this medication promotes clotting so you will not lose even more red blood cells."

2. "No, this medication stimulates your body to make red blood cells." Rationale 1: Blood transfusions are given if anemia is severe. Rationale 2: The nurse should explain how the epoetin alfa (Epogen) works. Rationale 3: Epoetin alfa (Epogen) is not red blood cells. Rationale 4: Epoetin alfa (Epogen) is not a clot promoter.

A client is to receive darbepoetin alfa (Aranesp) adjunctive medication during chemotherapy. The client says, "Not another drug. Why do I need this one?" How should the nurse respond? Select all that apply. 1. "I know you are tired of drugs, but this is just one more." 2. "This drug will help you grow red blood cells." 3. "This drug will help keep you from getting infections." 4. "This is an erythropoiesis-stimulating factor." 5. "This drug will help you get more oxygen around to your tissues so you feel better."

2. "This drug will help you grow red blood cells." 5. "This drug will help you get more oxygen around to your tissues so you feel better." Rationale 1: This response does not answer the client's question. Rationale 2: Darbepoetin alfa (Aranesp) is an erythropoiesis-stimulating factor. Rationale 3: Darbepoetin alfa (Aranesp) does not increase immunity. Rationale 4: The nurse should explain the medication in terms the client can understand. Rationale 5: Darbepoetin alfa (Aranesp) stimulates production of red blood cells, which carry oxygen. Getting additional oxygen to the tissues helps the client feel better.

The client is receiving chemotherapy for cancer. The physician has prescribed oprelvekin (Neumega). The nurse has completed medication education and evaluates it as effective when the client makes which statement? 1. "This medication will help my chemotherapy work better." 2. "This medication will help increase my platelet count." 3. "This medication will help me regain the weight I have lost." 4. "This medication will help increase my red blood cell count."

2. "This medication will help increase my platelet count." Rationale 1: Oprelvekin (Neumega) does not enhance the effectiveness of chemotherapy. Rationale 2: Oprelvekin (Neumega) is used to stimulate the production of platelets in clients who are at risk for thrombocytopenia caused by cancer chemotherapy. Rationale 3: Oprelvekin (Neumega) does not promote weight gain. Rationale 4: Oprelvekin (Neumega) does not increase red blood cell count.

The client has chronic alcoholism. He asks the nurse why his doctor put him on folic acid (Folvite) since he promised the doctor that he would stop drinking. What is the best response by the nurse? 1. "You should ask your doctor since you promised him that you would not drink anymore." 2. "You have been drinking instead of eating, and alcohol interferes with folate metabolism in your liver." 3. "You need folic acid to make up for the vitamin B12 deficiency that was caused by your alcoholism." 4. "You need folic acid because you have not been compliant with taking your vitamins and attending Alcoholics Anonymous (AA) meetings."

2. "You have been drinking instead of eating, and alcohol interferes with folate metabolism in your liver." Rationale 1: Referring the client back to the physician is inappropriate; the nurse can answer this question. Rationale 2: Insufficient folic acid can manifest itself as anemia. This is often observed in chronic alcoholism, since alcoholics consume alcohol instead of eating nutritious foods. Alcohol interferes with folate metabolism in the liver. Rationale 3: Folic acid anemia is not caused by a vitamin B12 deficiency. Rationale 4: The client needs folic acid because his liver cannot metabolize folate, not because he has missed his vitamins and Alcoholics Anonymous (AA) meetings.

Per classification of anemias, the morphology for pernicious anemia or folate-deficiency anemia results in 1. hematocytic-hematochromic erythrocytes. 2. microcytic-hypochromic erythrocytes. 3. macrocytic-normochromic erythrocytes. 4. normocytic-normochromic erythrocytes.

3. macrocytic-normochromic erythrocytes. Rationale 1: Hematocytic-hematochromic erythrocytes do not classify anemias. Rationale 2: Microcytic-hypochromic erythrocytes classify iron-deficiency anemia or thalassemia. Rationale 3: Macrocytic-normochromic erythrocytes classify pernicious and folate-deficiency anemia. Rationale 4: Normocytic-normochromic erythrocytes classify aplastic, hemorrhagic, sickle-cell, and hemolytic anemia.

The client receives chemotherapy as therapy for cancer. The physician orders epoetin alfa (Procrit) subcutaneously. The client asks the nurse if this drug is also chemotherapy. What is the best response by the nurse? 1. "No, but it works with your chemotherapy to make it more effective." 2. "No, this drug helps to counteract the nausea and vomiting caused by your chemotherapy." 3. "No, it will stimulate your immune system to help you battle the cancer." 4. "No, this drug will help prevent anemia that can be caused by your chemotherapy."

4. "No, this drug will help prevent anemia that can be caused by your chemotherapy." Rationale 1: Epoetin alfa (Procrit) is prescribed to treat anemia associated with chemotherapy; it does not make the chemotherapy more effective. Rationale 2: Epoetin alfa (Procrit) is prescribed to treat anemia associated with chemotherapy; it does not counteract nausea and vomiting. Rationale 3: Epoetin alfa (Procrit) is prescribed to treat anemia associated with chemotherapy; it does not stimulate the immune system. Rationale 4: Epoetin alfa (Procrit) is given to clients undergoing cancer chemotherapy to counteract the anemia caused by antineoplastic agents.