Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy? "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear." "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal." "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." "I will receive parenteral vitamin B12 therapy for the rest of my life."

"I will receive parenteral vitamin B12 therapy for the rest of my life."

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

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

A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving: A-positive blood to an A-negative client. O-negative blood to an O-positive client. O-positive blood to an A-positive client. B-positive blood to an AB-positive client.

A-positive blood to an A-negative client.

A client with sickle cell disease informs the nurse that he is having chest pain. The nurse hears the client coughing, wheezing, and breathing rapidly. What does the nurse suspect is occurring with this client? Vaso-occlusive crisis Pneumocystis pneumonia Acute chest syndrome Acute muscular strain

Acute chest syndrome

A client is hospitalized 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin at home, which is now discontinued. To prevent the formation of blood clots, which action should the nurse take? Administer the prescribed enoxaparin (Lovenox). Encourage a diet high in vitamin K. Have the client limit physical activity. Monitor partial thromboplastin (PTT) time.

Administer the prescribed enoxaparin (Lovenox)

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

Anemia

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

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

The nurse is planning care for a client with severe fatigue secondary to anemia. What concept will the nurse use as the basis for planning interventions? Assisting in prioritizing activities. Determining what days to be active. Keeping long activity periods to build client stamina. Encouraging early and frequent activities.

Assisting in prioritizing activities

A patient describes numbness in the arms and hands with a tingling sensation. The patient also frequently stumbles when walking. What vitamin deficiency does the nurse determine may cause some of these symptoms? Thiamine Folate B12 Iron

B12

The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency? B12 C A Folate

B12

When teaching a client with iron deficiency anemia about appropriate food choices, the nurse encourages the client to increase the dietary intake of which foods? Beans, dried fruits, and leafy, green vegetables Fruits high in vitamin C, such as oranges and grapefruits Berries and orange vegetables Dairy products

Beans, dried fruits, and leafy, green vegetables

Which is a symptom of Cooley anemia? Bronzing of the skin Inflammation of the mouth Inflammation of the tongue Dyspnea

Bronzing of the skin

The nurse is educating a client about iron supplements. The nurse teaches that what vitamin enhances the absorption of iron? C A D E

C

A client with multiple myeloma reports pain along the spinal column. The client is prescribed naproxen (Aleve) and oxycodone. Prior to administering these medications, the nurse Checks the client's BUN and creatinine Instructs the client not to lift more than 20 pounds Teaches the client to bend at the back when lifting objects Questions the physician about the use of both medications

Checks the client's BUN and creatinine

A client is being treated for DIC and the nurse has prioritized the nursing diagnosis of Risk for Deficient Fluid Volume Related to Bleeding. How can the nurse best determine if goals of care relating to this diagnosis are being met? Assess for edema. Assess skin integrity frequently. Assess the client's level of consciousness frequently. Closely monitor intake and output.

Closely monitor intake and output.

A patient with end-stage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia? Potassium level of 5.2 mEq/L Magnesium level of 2.5 mg/dL Calcium level of 9.4 mg/dL Creatinine level of 6 mg/100 mL

Creatinine level of 6 mg/100 mL

A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor? Decreased level of erythropoietin Decreased total iron-binding capacity Increased mean corpuscular volume Increased reticulocyte count

Decreased level of erythropoietin

The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions? Do not take medication with orange juice because it will delay absorption of the iron. Iron may cause indigestion and should be taken with an antacid such as Mylanta. Dilute the liquid preparation with another liquid such as juice and drink with a straw. Discontinue the use of iron if your stool turns black.

Dilute the liquid preparation with another liquid such as juice and drink with a straw. To avoid staining teeth

The nurse is educating a patient with iron deficiency anemia about food sources high in iron and how to enhance the absorption of iron when eating these foods. What can the nurse inform the client would enhance the absorption? Eating calf's liver with a glass of orange juice Eating leafy green vegetables with a glass of water Eating apple slices with carrots Eating a steak with mushrooms

Eating calf's liver with a glass of orange juice

A thin client is prescribed iron dextran intramuscularly. What is most important action taken by the nurse when administering this medication? Employs the Z-track technique Uses a 23-gauge needle Injects into the deltoid muscle Rubs the site vigorously

Employs the Z-track technique

A patient with chronic anemia has had many blood transfusions over the last 3 years. What type of transfusion reaction should the nurse monitor for that is commonly found in patients who frequently receive blood transfusions? Allergic reactions Acute hemolytic reaction Circulatory overload Febrile nonhemolytic reactions

Febrile nonhemolytic reactions

When assessing a client with anemia, which assessment is essential? Health history, including menstrual history in women Family history Age and gender Lifestyle assessments, such as exercise routines

Health history, including menstrual history in women

A patient has a probable diagnosis of polycythemia vera. The nurse reviews the patient's lab work for which diagnostic indicator? Hematocrit of 60% Erythrocyte count of 6.5 m/?L Leukocyte count of 11,500/mm3 Platelet value of 350,000/mm3

Hematocrit of 60%

Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents? Hypochromic Normocytic Microcytic Hyperchromic

Hypochromic

A client with severe anemia reports symptoms of tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Laboratory test results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which nursing diagnoses is most appropriate for this client? Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients Risk for falls related to complaints of dizziness Fatigue related to decreased hemoglobin and hematocrit

Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit

A client is receiving chemotherapy for cancer. The nurse reviews the client's laboratory report and notes that he has thrombocytopenia. To which nursing diagnosis should the nurse give the highest priority? Activity intolerance Impaired tissue integrity Impaired oral mucous membranes Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI

Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI

The nurse observes a co-worker who always seems to be eating a cup of ice. The nurse encourages the co-worker to have an examination and diagnostic workup with the health care provider. What type of anemia is the nurse concerned the co-worker may have? Iron deficiency anemia Megaloblastic anemia Sickle cell anemia Aplastic anemia

Iron deficiency anemia

A client admitted to the hospital in preparation for a splenectomy to treat autoimmune hemolytic anemia asks the nurse about the benefits of splenectomy. Which statement best explains the expected effect of splenectomy? It will remove the major site of red blood cell (RBC) destruction. It will reduce the destruction of platelets by macrophages. It will increase production of platelets by the bone marrow. It will increase red blood cell (RBC) production to compensate for blood loss.

It will remove the major site of red blood cell (RBC) destruction

During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding? Elevated hematocrit concentration Enlarged mean corpuscular volume (MCV) Low ferritin level concentration Elevated red blood cell (RBC) count

Low ferritin level concentration

A nursing instructor is evaluating a student caring for a neutropenic client. The instructor concludes that the nursing student demonstrates accurate knowledge of neutropenia based on which intervention? Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential Monitoring the client's breathing and reviewing the client's arterial blood gases Monitoring the client's heart rate and reviewing the client's hemoglobin Monitoring the client's blood pressure and reviewing the client's hematocrit

Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential

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

Neurologic involvement

A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. The client is taking prednisone daily and reported feeling pain after manually opening the garage door. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain? Hypertension Osteoporosis Muscle wasting Truncal obesity

Osteoporosis

A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client? Pallor, bradycardia, and reduced pulse pressure Pallor, tachycardia, and a sore tongue Sore tongue, dyspnea, and weight gain Angina pectoris, double vision, and anorexia

Pallor, tachycardia, and a sore tongue

A nurse is caring for a client with severe anemia. The client is tachycardic and reports dizziness and exertional dyspnea. What signs and symptoms might develop if this client goes into heart failure? Peripheral edema Nausea and vomiting Migraine Fever

Peripheral edema

Which of the following is considered an antidote to heparin? Protamine sulfate Vitamin K Narcan Ipecac

Protamine sulfate

The nurse is screening donors for blood donation. Which client is an acceptable donor for blood? Has a history of viral hepatitis as a teenager 10 years ago Received a blood transfusion within 1 year Reports having a cold 1 month ago that resolved quickly Had a dental extraction 2 days ago for caries in a tooth

Reports having a cold 1 month ago that resolved quickly

A client is prescribed 325 mg/day of oral ferrous sulfate. What does the nurse include in client teaching? Take 1 hour before breakfast Take with dairy products Decrease intake of fruits and juices Decrease intake of dietary fiber

Take 1 hour before breakfast

A client with chronic anemia has received multiple transfusions. Which client action would the nurse be concerned about relative to the client's condition? Takes over-the-counter iron supplements Eliminates use of alcohol Takes 60 grams of protein each day Takes a daily multiple vitamin pill

Takes over-the-counter iron supplements

A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn's disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for? The onset of a bacterial infection Bleeding Abdominal pain Diarrhea

The onset of a bacterial infection

A client is treated for anemia. What is the nurse's best understanding about the correlation between anemia and the client's iron stores? There is a strong correlation between iron stores and hemoglobin levels. There is a strong correlation between iron stores and hemoglobin characteristics. There is an inverse relationship between iron stores and hemoglobin levels. There is a weak correlation between iron stores and hemoglobin levels.

There is a strong correlation between iron stores and hemoglobin levels.

After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/mm3. What term should the nurse use to describe this low platelet count? Anemia Leukopenia Thrombocytopenia Neutropenia

Thrombocytopenia

A nurse is caring for a client with thalassemia who is being transfused. What is the nurse's role during a transfusion? To closely monitor the rate of administration To administer vitamin B12 injections To instruct the client to rest immediately if chest pain develops To assess for enlargement and tenderness over the liver and spleen

To closely monitor the rate of administration

When evaluating a patient's symptoms that are consistent with a diagnosis of leukemia, the nurse is aware that all leukemias have which common feature? Compensatory polycythemia stimulated by thrombocytopenia Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements Increased blood viscosity, resulting from an overproduction of white cells Reduced plasma volume in response to a reduced production of cellular elements

Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements

A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client? Limit visits by family members. Encourage the client to use a wheelchair. Use the smallest needle possible for injections. Maintain accurate fluid intake and output records.

Use the smallest needle possible for injections.

A client is seen in the emergency department with severe pain related to a sickle cell crisis. What does the nurse understand is occurring with this client? The client has a decreased tolerance of pain related to the chronic nature of the illness. Bone marrow decreases the erythrocyte production causing decrease in hypoxia. Overhydration enlarges the red blood cells. Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.

Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.

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

Vitamin K

Which medication is the antidote to warfarin? Vitamin K Protamine sulfate Aspirin Clopidogrel

Vitamin K

A nurse cares for clients with hematological disorders and notes that women are diagnosed with hemochromatosis at a much lower rate than men. What is the primary reason for this? Women lose iron through menstrual cycles Women rarely manifest the gene expression Women have lower hemoglobin levels Women require grater folic acid supplementation

Women lose iron through menstrual cycles

A client has a history of sickle cell anemia with several sickle cell crises over the past 10 years. What blood component results in sickle cell anemia? hemoglobin S hemoglobin F hemoglobin A hemoglobin M

hemoglobin S

An client has pernicious anemia and has been receiving treatment for several years. What is the client lacking that results in pernicious anemia? intrinsic factor vitamin B extrinsic factor hemoglobin

intrinsic factor

A client admitted to the hospital with abdominal pain, anemia, and bloody stools reports feeling weak and dizzy. The client has rectal pressure and needs to urinate and move their bowels. The nurse should help them: to the bathroom. to the bedside commode. onto the bedpan. to a standing position so he can urinate.

onto the bedpan

A client with megaloblastic anemia reports mouth and tongue soreness. What instruction will the nurse give the client regarding eating while managing the client's symptoms? "Eat small amounts of bland, soft foods frequently." "Eat larger amounts of bland, soft foods less frequently." "Eat cold, bland foods with a large amount of water." "Eat low-fiber blended foods only."

"Eat small amounts of bland, soft foods frequently."