Chapter 29: Management of Patients With Nonmalignant Hematologic Disorders

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How are neutropenia levels measured/detected?

- Draw blood for a CBC w/differential- frequency based on suspected duration of the neutropenia. - To assess severity of neutropenia and risk for infection, nurses must assess the ANC.

What are triggers of sickle cell crisis?

1) Infection 2) By cold b/c of vasoconstriction that slows blood flow

Replenishing iron stores takes several months so it's important that patients continue taking oral iron supplements for ______-______ months

6-12

A nurse is planning care for a client who has a platelet count of 10,000/mm. Which of the following interventions should the nurse include in the plan of care? A) Apply prolonged pressure to puncture site after blood sampling B) Administer epoetin alfa as prescribed C) Place the client in a private room D) Have the client use an oral topical anesthetic before meals

A) Apply prolonged pressure to puncture site after blood sampling Indicates thrombocytopenia Epoetin alfa is for = anemia Private room = neutropenia Topical anesthetic = for mucositis

A nurse is caring for a client who has DIC. Which of the following medications should the nurse anticipate administering? A) Heparin B) Vitamin K C) Mefoxin D) Simvastatin

A) Heparin

The results of a patients most recent blood work and physical assessment are suggestive of immune thrombocytopenic purpura (ITP). This patient should undergo testing for which of the following potential causes? Select all that apply. A) Hepatitis B) Acute renal failure C) HIV D) Malignant melanoma E) Cholecystitis

A) Hepatitis C) HIV Feedback: Viral illnesses have the potential to cause ITP. Renal failure, malignancies, and gall bladder inflammation are not typical causes of ITP.

A patient comes to the clinic complaining of fatigue and the health interview is suggestive of pica. Laboratory findings reveal a low serum iron level and a low ferritin level. With what would the nurse suspect that the patient will be diagnosed? A) Iron deficiency anemia B) Pernicious anemia C) Sickle cell anemia D) Hemolytic anemia

A) Iron deficiency anemia Feedback: A low serum iron level, a low ferritin level, and symptoms of pica are associated with iron deficiency anemia. TIBC may also be elevated. None of the other anemias are associated with pica.

A patients absolute neutrophil count (ANC) is 440/mm3 . But the nurses assessment reveals no apparent signs or symptoms of infection. What action should the nurse prioritize when providing care for this patient? A) Meticulous hand hygiene B) Timely administration of antibiotics C) Provision of a nutrient-dense diet D) Maintaining a sterile care environment

A) Meticulous hand hygiene Feedback: Providing care for a patient with neutropenia requires that the nurse adhere closely to standard precautions and infection control procedures. Hand hygiene is central to such efforts. Prophylactic antibiotics are rarely used and it is not possible to provide a sterile environment for care. Nutrition is highly beneficial, but hand hygiene is the central aspect of care.

A patient with a history of cirrhosis is admitted to the ICU with a diagnosis of bleeding esophageal varices; an attempt to stop the bleeding has been only partially successful. What would the critical care nurse expect the care team to order for this patient? A) Packed red blood cells (PRBCs) B) Vitamin K C) Oral anticoagulants D) Heparin infusion

A) Packed red blood cells (PRBCs) Feedback: Patients with liver dysfunction may have life-threatening hemorrhage from peptic ulcers or esophageal varices. In these cases, replacement with fresh frozen plasma, PRBCs, and platelets is usually required. Vitamin K may be ordered once the bleeding is stopped, but that is not what is needed to stop the bleeding of the varices. Anticoagulants would exacerbate the patients bleeding.

A nurse is caring for a patient with severe anemia. The patient is tachycardic and complains of dizziness and exertional dyspnea. The nurse knows that in an effort to deliver more blood to hypoxic tissue, the workload on the heart is increased. What signs and symptoms might develop if this patient goes into heart failure? A) Peripheral edema B) Nausea and vomiting C) Migraine D) Fever

A) Peripheral edema Feedback: Cardiac status should be carefully assessed in patients with anemia. When the hemoglobin level is low, the heart attempts to compensate by pumping faster and harder in an effort to deliver more blood to hypoxic tissue. This increased cardiac workload can result in such symptoms as tachycardia, palpitations, dyspnea, dizziness, orthopnea, and exertional dyspnea. Heart failure may eventually develop, as evidenced by an enlarged heart (cardiomegaly) and liver (hepatomegaly), and by peripheral edema. Nausea, migraine, and fever are not associated with heart failure.

A nurse caring for a client who has disseminated intravascular coagulation (DIC). Which of the following lab values indicates the client's clotting factors are depleted? SATA A) Platelets 100,000/mm B) Fibrinogen levels 120 mg/dL C) Fibrin degradation products 4.3 mcg/dL D) D-dimer 0.03mcg/mL E) Sedimentation rate 38 mm/hr

A) Platelets 100,000/mm (levels are decreased) B) Fibrinogen levels 120 mg/dL (levels are decreased) In DIC fibrinogen and platelet levels are decreased

A nurse is planning care for a client who has Hgb 7.5g/dL and Hct 21.5%. Which of the following actions should the nurse include in the plan of care? A) Provide assistance w/ambulation B) Monitor oxygen saturation C) Weight the client weekly D) Obtain stool specimen for occult blood E) Schedule daily rest periods

A) Provide assistance w/ambulation B) Monitor oxygen saturation D) Obtain stool specimen for occult blood E) Schedule daily rest periods

A patients low prothrombin time (PT) was attributed to a vitamin K deficiency and the patients PT normalized after administration of vitamin K. When performing discharge education in an effort to prevent recurrence, what should the nurse emphasize? A) The need for adequate nutrition B) The need to avoid NSAIDs C) The need for constant access to factor concentrate D) The need for meticulous hygiene

A) The need for adequate nutrition Feedback: Vitamin K deficiency is often the result of a nutritional deficit. NSAIDs do not influence vitamin K synthesis and clotting factors are not necessary to treat or prevent a vitamin K deficiency. Hygiene is not related to the onset or prevention of vitamin K deficiency.

A patient with a recent diagnosis of ITP has asked the nurse why the care team has not chosen to administer platelets, stating, I have low platelets, so why not give me a transfusion of exactly what Im missing? How should the nurse best respond? A) Transfused platelets usually aren't beneficial because they're rapidly destroyed in the body. B) A platelet transfusion often blunts your body's own production of platelets even further. C) Finding a matching donor for a platelet transfusion is exceedingly difficult. D) A very small percentage of the platelets in a transfusion are actually functional.

A) Transfused platelets usually aren't beneficial because they're rapidly destroyed in the body. Feedback: Despite extremely low platelet counts, platelet transfusions are usually avoided. Transfusions tend to be ineffective not because the platelets are nonfunctional but because the patients antiplatelet antibodies bind with the transfused platelets, causing them to be destroyed. Matching the patients blood type is not usually necessary for a platelet transfusion. Platelet transfusions do not exacerbate low platelet production.

A nurse is providing discharge teaching to a client who had a gastrectomy for stomach cancer. Which of the following information should the nurse include in the teaching? SATA A) You will need a monthly injection of vitamin B12 for the rest of your life B) Using the nasal spray form of vitamin B12 on a daily basis can be an option C) An oral supplement of vitamin B12 taken on a daily basis can be an option D) You should increase your intake of animal proteins, legumes, and dairy products to increase your vitamin B12 in your diet E) Add soy milk fortified with vitamin B12 to your diet to decrease the risk of pernicious anemia

A) You will need a monthly injection of vitamin B12 for the rest of your life B) Using the nasal spray form of vitamin B12 on a daily basis can be an option

A condition characterized by a lower-than-normal hemoglobin concentration. Less than normal # of RBCs (erythrocytes) present in circulation. Less oxygen reaches the tissues, causing various symptoms.

Anemia

Diagnostic Tests for which condition? § Initial evaluation includes = hemoglobin, hematocrit, reticulocyte count, and RBC indices, including mean corpuscular volume (MCV), and red cell distribution (RDW) § Usually diagnosed/present with hemoglobin (Hg) values between 5-11g/dL § Other studies may include iron studies (serum iron level, total iron-binding capacity (TIBC), percent saturation, and ferritin) § Remaining CBC values useful in determining if anemia is isolated condition or associated w/another hematologic condition like leukemia § Bone-marrow aspiration/biopsy is used to diagnose aplastic anemia (failure of bone marrow to produce RBCs as well as platelets and WBCs) § The more quickly anemia develops, the more severe the symptoms

Anemia

Education for which conditon? § Teach the client and family about energy conservation and the risk of the client experiencing dizziness upon standing § Encourage exercise/physical activity with resting periods

Anemia

Follow up care for which condition? § If is severe, the erythrocytes that are lost/destroyed may be replaced w/a transfusion of packed red blood cells (RBCs) § Encourage increased dietary intake of deficient nutrient (iron, vitaminB12, or folic acid) § Administer medications as prescribed, at proper time for optimal absorption, and using appropriate technique § Teach client about the time frame for resolution (6-12 months of taking supplements)

Anemia

Nursing interventions for which condition? § Monitor for fatigue, pallor, dizziness, and shortness of breath § Help client manage anemia-related fatigue by scheduling activities w/rest periods in between and using energy saving measures (sitting during showers and ADLS) § Monitor Hgb values to determine response to medications. Be prepared to administer blood if prescribed. § Administer erythropoietic medications (darbepoetin alfa, epoetin alfa) and anti-anemic medications (ferrous sulfate)

Anemia

The more quickly_____________develops, the more severe the symptoms

Anemia

What condition am I ? Causes: Blood loss, inadequate RBC production, increased RBC destruction, deficiency in folic acid, iron, vitamin B12, erythropoietin.

Anemia

A patient with renal failure has decreased erythropoietin production. Upon analysis of the patients complete blood count, the nurse will expect which of the following results? A) An increased hemoglobin and decreased hematocrit B) A decreased hemoglobin and hematocrit C) A decreased mean corpuscular volume (MCV) and red cell distribution width (RDW) D) An increased MCV and RDW

B) A decreased hemoglobin and hematocrit Feedback: The decreased production of erythropoietin will result in a decreased hemoglobin and hematocrit. The patient will have normal MCV and RDW because the erythrocytes are normal in appearance.

A group of nurses are learning about the high incidence and prevalence of anemia among different populations. Which of the following individuals is most likely to have anemia? A) A 50-year-old African-American woman who is going through menopause B) An 81-year-old woman who has chronic heart failure C) A 48-year-old man who travels extensively and has a high-stress job D) A 13-year-old girl who has just experienced menarche

B) An 81-year-old woman who has chronic heart failure Feedback: The incidence and prevalence of anemia are exceptionally high among older adults, and the risk of anemia is compounded by the presence of heart disease. None of the other listed individuals exhibits high-risk factors for anemia, though exceptionally heavy menstrual flow can result in anemia.

A nurse is providing discharge education to a patient who has recently been diagnosed with a bleeding disorder. What topic should the nurse prioritize when teaching this patient? A) Avoiding buses, subways, and other crowded, public sites B) Avoiding activities that carry a risk for injury C) Keeping immunizations current D) Avoiding foods high in vitamin K

B) Avoiding activities that carry a risk for injury Feedback: Patients with bleeding disorders need to understand the importance of avoiding activities that increase the risk of bleeding, such as contact sports. Immunizations involve injections and may be contraindicated for some patients. Patients with bleeding disorders do not need to normally avoid crowds. Foods high in vitamin K may beneficial, not detrimental.

A night nurse is reviewing the next days medication administration record (MAR) of a patient who has hemophilia. The nurse notes that the MAR specifies both oral and subcutaneous options for the administration of a PRN antiemetic. What is the nurses best action? A) Ensure that the day nurse knows not to give the antiemetic. B) Contact the prescriber to have the subcutaneous option discontinued. C) Reassess the patients need for antiemetics. D) Remove the subcutaneous route from the patients MAR.

B) Contact the prescriber to have the subcutaneous option discontinued. Feedback: Injections must be avoided in patients with hemophilia. Consequently, the nurse should ensure that the prescriber makes the necessary change. The nurse cannot independently make a change to a patients MAR in most cases. Facilitating the necessary change is preferable to deferring to the day nurse.

A nurse is planning care for a client who is undergoing chemotherapy and is on neutropenic precautions. Which of the following interventions should be included in the plan of care? (SATA) A) Encourage a high-fiber diet B) Eliminate standing water in the room C) Have the client wear a mask when leaving the room D) Have client-specific equipment remain in the room E) Eliminate raw foods from the client's diet

B) Eliminate standing water in the room C) Have the client wear a mask when leaving the room D) Have client-specific equipment remain in the room E) Eliminate raw foods from the client's diet

A nurse is caring for a patient who has sickle cell anemia and the nurses assessment reveals the possibility of substance abuse. What is the nurses most appropriate action? A) Encourage the patient to rely on complementary and alternative therapies. B) Encourage the patient to seek care from a single provider for pain relief. C) Teach the patient to accept chronic pain as an inevitable aspect of the disease. D) Limit the reporting of emergency department visits to the primary health care provider.

B) Encourage the patient to seek care from a single provider for pain relief. Feedback: The patient should be encouraged to use a single primary health care provider to address health care concerns. Emergency department visits should be reported to the primary health care provider to achieve optimal management of the disease. It would inappropriate to teach the patient to simply accept his or her pain. Complementary therapies are usually insufficient to fully address pain in sickle cell disease.

A patient with poorly controlled diabetes has developed end-stage renal failure and consequent anemia. When reviewing this patients treatment plan, the nurse should anticipate the use of what drug? A) Magnesium sulfate B) Epoetin alfa C) Low-molecular weight heparin D) Vitamin K

B) Epoetin alfa Feedback: The availability of recombinant erythropoietin (epoetin alfa [Epogen, Procrit], darbepoetin alfa [Aranesp]) has dramatically altered the management of anemia in end-stage renal disease. Heparin, vitamin K, and magnesium are not indicated in the treatment of renal failure or the consequent anemia.

A patients blood work reveals a platelet level of 17,000/mm3 . When inspecting the patients integumentary system, what finding would be most consistent with this platelet level? A) Dermatitis B) Petechiae C) Urticaria D) Alopecia

B) Petechiae Feedback: When the platelet count drops to less than 20,000/mm3 , petechiae can appear. Low platelet levels do not normally result in dermatitis, urticaria (hives), or alopecia (hair loss).

A nurse is completing an integumentary assessment of a client who has anemia. Which of the following should the nurse suspect? A) Absent turgor B) Spoon-shaped nails C) Shiny, hairless legs D) Yellow mucous membranes

B) Spoon-shaped nails

A nurse in a clinic receives a phone call from a client seeking information about a new prescription for erythropoietin. Which of the following information should the nurse review with the client? A) The client needs an erythrocyte sedimentation rate (ESR) test weekly B) The client should have their hemoglobin checked twice a week C) Oxygen saturation levels should be monitored D) Folic acid production will increase

B) The client should have their hemoglobin checked twice a week (until targeted levels are reached)

A patients electronic health record notes that he has previously undergone treatment for secondary polycythemia. How should this aspect of the patients history guide the nurses subsequent assessment? A) The nurse should assess for recent blood donation. B) The nurse should assess for evidence of lung disease. C) The nurse should assess for a history of venous thromboembolism. D) The nurse should assess the patient for impaired renal function.

B) The nurse should assess for evidence of lung disease. Feedback: Any reduction in oxygenation, such as lung disease, can cause secondary polycythemia. Blood donation does not precipitate this problem and impaired renal function typically causes anemia, not polycythemia. A history of VTE is not a likely contributor.

A patient newly diagnosed with thrombocytopenia is admitted to the medical unit. After the admission assessment, the patient asks the nurse to explain the disease. What should the nurse explain to this patient? A) There could be an attack on the platelets by antibodies. B) There could be decreased production of platelets. C) There could be impaired communication between platelets. D) There could be an autoimmune process causing platelet malfunction.

B) There could be decreased production of platelets. Feedback: Thrombocytopenia can result from a decreased platelet production, increased platelet destruction, or increased consumption of platelets. Impaired platelet communication, antibodies, and autoimmune processes are not typical pathologies.

A patient is admitted to the hospital with pernicious anemia. The nurse should prepare to administer which of the following medications? A) Folic acid B) Vitamin B12 C) Lactulose D) Magnesium sulfate

B) Vitamin B12 Feedback: Pernicious anemia is characterized by vitamin B12 deficiency. Magnesium sulfate, lactulose, and folic acid do not address the pathology of this type of anemia.

A patient with a documented history of glucose-6-phosphate dehydrogenase deficiency has presented to the emergency department with signs and symptoms including pallor, jaundice, and malaise. Which of the nurses assessment questions relates most directly to this patients hematologic disorder? A) When did you last have a blood transfusion? B) What medications have taken recently? C) Have you been under significant stress lately? D) Have you suffered any recent injuries?

B) What medications have taken recently? Feedback: Exacerbations of glucose-6-phosphate dehydrogenase deficiency are nearly always precipitated by medications. Blood transfusions, stress, and injury are less common triggers.

Be careful of this when administering blood transfusions- check for gas bubbles, check expiration date, use within 30 mins of receiving from blood bank

Bacteremia

Presence of bacteria in the blood also known as:

Bacteremia

A client with several chronic health problems has been newly diagnosed with a qualitative platelet defect. What component of the patients previous medication regimen may have contributed to the development of this disorder? A) Calcium carbonate B) Vitamin B12 C) Aspirin D) Vitamin D

C) Aspirin Feedback: Aspirin may induce a platelet disorder. Even small amounts of aspirin reduce normal platelet aggregation, and the prolonged bleeding time lasts for several days after aspirin ingestion. Calcium, vitamin D, and vitamin B12 do not have the potential to induce a platelet defect.

A woman who is in her third trimester of pregnancy has been experiencing an exacerbation of iron- deficiency anemia in recent weeks. When providing the patient with nutritional guidelines and meal suggestions, what foods would be most likely to increase the woman's iron stores? A) Salmon accompanied by whole milk B) Mixed vegetables and brown rice C) Beef liver accompanied by orange juice D) Yogurt, almonds, and whole grain oats

C) Beef liver accompanied by orange juice Feedback: Food sources high in iron include organ meats, other meats, beans (e.g., black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron. All of the listed foods are nutritious, but liver and orange juice are most likely to be of benefit.

A nurse is caring for a client who has idiopathic thrombocytopenic purpura (ITP). The nurse should notify the provider and report possible small-vessel clotting when which of the following is assessed? A) Petechiae on upper chest B) Hypotension C) Cyanotic nail beds D) Severe headache

C) Cyanotic nail beds

A nurse is assessing a client and suspects the client is experiencing DIC. Which of the following physical findings should the nurse anticipate? A) Bradycardia B) Hypertension C) Epistaxis D) Xerostomia

C) Epistaxis = unexpected bleeding of gums/nose

A nurse is teaching a client who has a new prescription for ferrous sulfate. Which of the following information should the nurse include in the teaching? A) Stools will be dark red B) Take w/a glass of milk if GI distress occurs C) Foods high in vitamin C will promote absorption D) Take for 14 days

C) Foods high in vitamin C will promote absorption

A nurse is a long-term care facility is admitting a new resident who has a bleeding disorder. When planning this residents care, the nurse should include which of the following? A) Housing the resident in a private room B) Implementing a passive ROM program to compensate for activity limitation C) Implementing of a plan for fall prevention D) Providing the patient with a high-fiber diet

C) Implementing of a plan for fall prevention Feedback: To prevent bleeding episodes, the nurse should ensure that an older adult with a bleeding disorder does not suffer a fall. Activity limitation is not necessarily required, however. A private room is not necessary and there is no reason to increase fiber intake.

The nurse on the pediatric unit is caring for a 10-year-old boy with a diagnosis of hemophilia. The nurse knows that a priority nursing diagnosis for a patient with hemophilia is what? A) Hypothermia B) Diarrhea C) Ineffective coping D) Imbalanced nutrition: Less than body requirements

C) Ineffective coping Feedback: Most patients with hemophilia are diagnosed as children. They often require assistance in coping with the condition because it is chronic, places restrictions on their lives, and is an inherited disorder that can be passed to future generations. Children with hemophilia are not at risk of hypothermia, diarrhea, or imbalanced nutrition.

A nurse is planning the care of a patient with a diagnosis of sickle cell disease who has been admitted for the treatment of an acute vaso-occlusive crisis. What nursing diagnosis should the nurse prioritize in the patients plan of care? A) Risk for disuse syndrome related to ineffective peripheral circulation B) Functional urinary incontinence related to urethral occlusion C) Ineffective tissue perfusion related to thrombosis D) Ineffective thermoregulation related to hypothalamic dysfunction

C) Ineffective tissue perfusion related to thrombosis Feedback: There are multiple potential complications of sickle cell disease and sickle cell crises. Central among these, however, is the risk of thrombosis and consequent lack of tissue perfusion. Sickle cell crises are not normally accompanied by impaired thermoregulation or genitourinary complications. Risk for disuse syndrome is not associated with the effects of acute vaso-occlusive crisis.

A nurse is providing education to a patient with iron deficiency anemia who has been prescribed iron supplements. What should the nurse include in health education? A) Take the iron with dairy products to enhance absorption. B) Increase the intake of vitamin E to enhance absorption. C) Iron will cause the stools to darken in color. D) Limit foods high in fiber due to the risk for diarrhea.

C) Iron will cause the stools to darken in color. Feedback: The nurse will inform the patient that iron will cause the stools to become dark in color. Iron should be taken on an empty stomach, as its absorption is affected by food, especially dairy products. Patients should be instructed to increase their intake of vitamin C to enhance iron absorption. Foods high in fiber should be consumed to minimize problems with constipation, a common side effect associated with iron therapy.

The nurse is assessing a new patient with complaints of overwhelming fatigue and a sore tongue that is visibly smooth and beefy red. This patient is demonstrating signs and symptoms associated with what form of what hematologic disorder? A) Sickle cell anemia B) Hemophilia C) Megaloblastic anemia D) Thrombocytopenia

C) Megaloblastic anemia Feedback: A red, smooth, sore tongue is a symptom associated with megaloblastic anemia. Sickle cell disease, hemophilia, and thrombocytopenia do not have symptoms involving the tongue.

A young man with a diagnosis of hemophilia A has been brought to emergency department after suffering a workplace accident resulting in bleeding. Rapid assessment has revealed the source of the patients bleeding and established that his vital signs are stable. What should be the nurses next action? A) Position the patient in a prone position to minimize bleeding. B) Establish IV access for the administration of vitamin K. C) Prepare for the administration of factor VIII. D) Administer a normal saline bolus to increase circulatory volume.

C) Prepare for the administration of factor VIII. Feedback: Injuries in patients with hemophilia necessitate prompt administration of clotting factors. Vitamin K is not a treatment modality and a prone position will not be appropriate for all types and locations of wounds. A normal saline bolus is not indicated.

A nurse is admitting a patient with immune thrombocytopenic purpura to the unit. In completing the admission assessment, the nurse must be alert for what medications that potentially alter platelet function? Select all that apply. A) Antihypertensives B) Penicillins C) Sulfa-containing medications D) Aspirin-based drugs E) NSAIDs

C) Sulfa-containing medications D) Aspirin-based drugs E) NSAIDs Feedback: The nurse must be alert for sulfa-containing medications and others that alter platelet function (e.g., aspirin-based or other NSAIDs). Antihypertensive drugs and the penicillins do not alter platelet function.

A patient with a history of atrial fibrillation has contacted the clinic saying that she has accidentally overdosed on her prescribed warfarin (Coumadin). The nurse should recognize the possible need for what antidote? A) IVIG B) Factor X C) Vitamin K D) Factor VIII

C) Vitamin K Feedback: Vitamin K is administered as an antidote for warfarin toxicity.

If patient is STILL in pain AFTER meds have been been administered during sickle cell disease what should you do?

Call the provider to increase dose of pain medication/PCA pump

A patient comes into the clinic complaining of fatigue. Blood work shows an increased bilirubin concentration and an increased reticulocyte count. What would the nurse suspect the patient has? A) A hypoproliferative anemia B) A leukemia C) Thrombocytopenia D) A hemolytic anemia

D) A hemolytic anemia Feedback: In hemolytic anemias, premature destruction of erythrocytes results in the liberation of hemoglobin from the erythrocytes into the plasma; the released hemoglobin is converted in large part to bilirubin, and therefore the bilirubin concentration rises. The increased erythrocyte destruction leads to tissue hypoxia, which in turn stimulates erythropoietin production. This increased production is reflected in an increased reticulocyte count as the bone marrow responds to the loss of erythrocytes. Hypoproliferative anemias, leukemia, and thrombocytopenia lack this pathology and presentation.

An intensive care nurse is aware of the need to identify patients who may be at risk of developing disseminated intravascular coagulation (DIC). Which of the following ICU patients most likely faces the highest risk of DIC? A) A patient with extensive burns B) A patient who has a diagnosis of acute respiratory distress syndrome C) A patient who suffered multiple trauma in a workplace accident D) A patient who is being treated for septic shock

D) A patient who is being treated for septic shock Feedback: Sepsis is a common cause of DIC. A wide variety of acute illnesses can precipitate DIC, but sepsis is specifically identified as a cause.

A patient has been living with a diagnosis of anemia for several years and has experienced recent declines in her hemoglobin levels despite active treatment. What assessment finding would signal complications of anemia? A) Venous ulcers and visual disturbances B) Fever and signs of hyperkalemia C) Epistaxis and gastroesophageal reflux D) Ascites and peripheral edema

D) Ascites and peripheral edema Feedback: A significant complication of anemia is heart failure from chronic diminished blood volume and the hearts compensatory effort to increase cardiac output. Patients with anemia should be assessed for signs and symptoms of heart failure, including ascites and peripheral edema. None of the other listed signs and symptoms is characteristic of heart failure.

The medical nurse is aware that patients with sickle cell anemia benefit from understanding what situations can precipitate a sickle cell crisis. When teaching a patient with sickle cell anemia about strategies to prevent crises, what measures should the nurse recommend? A) Using prophylactic antibiotics and performing meticulous hygiene B) Maximizing physical activity and taking OTC iron supplements C) Limiting psychosocial stress and eating a high-protein diet D) Avoiding cold temperatures and ensuring sufficient hydration

D) Avoiding cold temperatures and ensuring sufficient hydration Feedback: Keeping warm and providing adequate hydration can be effective in diminishing the occurrence and severity of attacks. Hygiene, antibiotics, and high protein intake do not prevent crises. Maximizing activity may exacerbate pain and be unrealistic.

A patient 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? A) Assess for edema. B) Assess skin integrity frequently. C) Assess the patients level of consciousness frequently. D) Closely monitor intake and output.

D) Closely monitor intake and output. Feedback: The patient with DIC is at a high risk of deficient fluid volume. The nurse can best gauge the effectiveness of care by closely monitoring the patients intake and output. Each of the other assessments is a necessary element of care, but none addresses fluid balance as directly as close monitoring of intake and output.

An adult patient has been diagnosed with iron-deficiency anemia. What nursing diagnosis is most likely to apply to this patients health status? A) Risk for deficient fluid volume related to impaired erythropoiesis B) Risk for infection related to tissue hypoxia C) Acute pain related to uncontrolled hemolysis D) Fatigue related to decreased oxygen-carrying capacity

D) Fatigue related to decreased oxygen-carrying capacity Feedback: Fatigue is the major assessment finding common to all forms of anemia. Anemia does not normally result in acute pain or fluid deficit. The patient may have an increased risk of infection due to impaired immune function, but fatigue is more likely.

A nurse is teaching a newly licensed nurse about heparin-induced thrombocytopenia. Which of the following risk factors for this disorder should the nurse include in the teaching? A) Warfarin therapy for atrial fibrillation B) Placental abruption C) Systemic lupus erythematosus D) Heparin therapy for deep-vein thrombosis

D) Heparin therapy for deep-vein thrombosis

A patient, 25 years of age, comes to the emergency department complaining of excessive bleeding from a cut sustained when cleaning a knife. Blood work shows a prolonged PT but a vitamin K deficiency is ruled out. When assessing the patient, areas of ecchymosis are noted on other areas of the body. Which of the following is the most plausible cause of the patients signs and symptoms? A) Lymphoma B) Leukemia C) Hemophilia D) Hepatic dysfunction

D) Hepatic dysfunction Feedback: Prolongation of the PT, unless it is caused by vitamin K deficiency, may indicate severe hepatic dysfunction. The majority of hemophiliacs are diagnosed as children. The scenario does not describe signs or symptoms of lymphoma or leukemia.

A nurse in a clinic is caring for a client who has suspected anemia. Which of the following lab test results should the nurse expect? A) Iron 90mcg/dL B) RBC 6.5 million/uL C) WBC 4,800 mm D) Hgb 10g/dL

D) Hgb 10g/dL- below expected range of Hgb Male- 13.2-16.6 g/dL Female- 11.5-15g/dL

A patient is being treated on the medical unit for a sickle cell crisis. The nurses most recent assessment reveals an oral temperature of 100.5F and a new onset of fine crackles on lung auscultation. What is the nurses most appropriate action? A) Apply supplementary oxygen by nasal cannula. B) Administer bronchodilators by nebulizer. C) Liaise with the respiratory therapist and consider high-flow oxygen. D) Inform the primary care provider that the patient may have an infection.

D) Inform the primary care provider that the patient may have an infection. Feedback: Patients with sickle cell disease are highly susceptible to infection,thus any early signs of infection should be reported promptly. There is no evidence of respiratory distress, so oxygen therapy and bronchodilators are not indicated.

A nurse is reviewing the plan of care for a client who has leukemia and has developed thrombocytopenia. Which of the following actions should the nurse take first? A) Instruct the client to take rest periods throughout the day B) Encourage the client to reposition in bed every 2 hours C) Check temperature every 4 hours D) Monitor platelet counts

D) Monitor platelet counts Greatest risk of pt. w/thrombocytopenia is risk for injury due to bleeding. Nurse should institute bleeding precautions

A nurse is planning the care of a patient who has a diagnosis of hemophilia A. When addressing the nursing diagnosis of Acute Pain Related to Joint Hemorrhage, what principle should guide the nurses choice of interventions? A) Gabapentin (Neurontin) is effective because of the neuropathic nature of the patients pain. B) Opioids partially inhibit the patients synthesis of clotting factors. C) Opioids may cause vasodilation and exacerbate bleeding. D) NSAIDs are contraindicated due to the risk for bleeding.

D) NSAIDs are contraindicated due to the risk for bleeding. Feedback: NSAIDs may be contraindicated in patients with hemophilia due to the associated risk of bleeding. Opioids do not have a similar effect and they do not inhibit platelet synthesis. The pain associated with hemophilia is not neuropathic.

A critical care nurse is caring for a patient with autoimmune hemolytic anemia. The patient is not responding to conservative treatments, and his condition is now becoming life threatening. The nurse is aware that a treatment option in this case may include what? A) Hepatectomy B) Vitamin K administration C) Platelet transfusion D) Splenectomy

D) Splenectomy Feedback: A splenectomy may be the course of treatment if autoimmune hemolytic anemia does not respond to conservative treatment. Vitamin K administration is treatment for vitamin K deficiency and does not resolve anemia. Platelet transfusion may be the course of treatment for some bleeding disorders. Hepatectomy would not help the patient.

A patient with Von Willebrand disease (vWD) has experienced recent changes in bowel function that suggest the need for a screening colonoscopy. What intervention should be performed in anticipation of this procedure? A) The patient should not undergo the normal bowel cleansing protocol prior to the procedure. B) The patient should receive a unit of fresh-frozen plasma 48 hours before the procedure. C) The patient should be admitted to the surgical unit on the day before the procedure. D) The patient should be given necessary clotting factors before the procedure.

D) The patient should be given necessary clotting factors before the procedure. Feedback: A goal of treating vWD is to replace the deficient protein (e.g., vWF or factor VIII) prior to an invasive procedure to prevent subsequent bleeding. Bowel cleansing is not contraindicated and FFP does not reduce the patients risk of bleeding. There may or may not be a need for preprocedure hospital admission.

A patient with a pulmonary embolism is being treated with a heparin infusion. What diagnostic finding suggests to the nurse that treatment is effective? A) The patients PT is within reference ranges. B) Arterial blood sampling tests positive for the presence of factor XIII. C) The patients platelet level is below 100,000/mm3 . D) The patients activated partial thromboplastin time (aPTT) is 1.5 to 2.5 times the control value.

D) The patients activated partial thromboplastin time (aPTT) is 1.5 to 2.5 times the control value. Feedback: The therapeutic effect of heparin is monitored by serial measurements of the aPTT; the dose is adjusted to maintain the range at 1.5 to 2.5 times the laboratory control. Heparin dosing is not determined on the basis of platelet levels, the presence or absence of clotting factors, or PT levels.

Asystematic syndrome characterized by micro thromboses and bleeding. -The severity of this varies but it's potentially life-threatening!!!