Chapter 31: Caring for Clients with Disorders of the Hematopoietic System

A patient with a diagnosis of immune thrombocytopenic purpura (ITP) is currently receiving IVIG for the treatment of her health condition. The nurse who is providing this patient's care is aware that ITP is a consequence of:

Platelet destruction and impaired platelet production resulting from an autoimmune process

A client 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?

Shortness of breath and peripheral edema

A client's low prothrombin time (PT) was attributed to low vitamin K levels and the client's PT normalized after administration of vitamin K. When performing discharge education in an effort to prevent recurrence, what should the nurse emphasize?

The need for adequate nutrition

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."

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 for the rest of my life."

A client 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 I'm missing?" How should the nurse best respond?

"Transfused platelets usually aren't beneficial because they're rapidly destroyed in the body."

A client 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 nurse's assessment questions relates most directly to this client's hematologic disorder?

"What medications have you taken recently?"

A client comes into the clinic reporting fatigue. Blood work shows an increased bilirubin concentration and an increased reticulocyte count. What should the nurse suspect the client has?

A hemolytic anemia

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a patient with leukemia?

Apply prolonged pressure to needle sites or other sources of external bleeding.

A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. She reports that she first felt pain after manually opening her garage door and that she is taking prednisone daily. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain?

Osteoporosis

Which is the following is the most obvious sign of anemia?

Pallor

A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client?

Pallor, tachycardia, and a sore tongue

The nurse on the pediatric unit is caring for a 10-year-old boy with a diagnosis of hemophilia. The nurse should assess carefully for indication of what nursing diagnosis?

Ineffective coping

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 physician. What type of anemia is the nurse concerned the co-worker may have?

Iron deficiency anemia

A client lives with a diagnosis of sickle cell disease and receives frequent blood transfusions. The nurse should recognize the client's consequent risk of what complication of treatment?

Iron overload

The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include a nutritional assessment for this patient?

It may indicate deficiencies in essential nutrients.

A 63-year-old woman has been diagnosed with polycythemia vera (PV) after undergoing a series of diagnostic tests. When the woman's nurse is providing health education, what subject should the nurse prioritize?

Lifestyle modifications and techniques for preventing thromboembolism

A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify?

Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels

A patient with sickle cell disease is brought to the emergency department by a parent. The patient has a fever of 101.6°F, heart rate of 116, and a respiratory rate of 32. The nurse auscultates bilateral wheezes in both lung fields. What does the nurse suspect this patient is experiencing?

Acute chest syndrome

A client with sickle cell crisis is admitted to the hospital in severe pain. While caring for the client during the crisis, which is the priority nursing intervention?

Administering and evaluating the effectiveness of opioid analgesics

When teaching a client with sickle cell disease about strategies to prevent crises, what measures should the nurse recommend?

Avoiding cold temperatures and ensuring sufficient hydration

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?

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

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

Which is a symptom of hemochromatosis?

Bronzing of the skin

Which of the following is a symptom of Cooley's anemia?

Bronzing of the skin

A client reports feeling tired, cold, and short of breath at times. Assessment reveals tachycardia and reduced energy. What would the nurse expect the physician to order?

CBC

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?

Closely monitor intake and output

Which initial intervention should a nurse perform for a client with external bleeding

Direct pressure

A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia?

Dyspnea, tachycardia, and pallor

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

The client is a young, thin woman who is prescribed iron dextran intramuscularly. The nurse, when administering the medication,

Employs the Z-track technique

A nurse is caring for a client who has sickle cell disease and the nurse's assessment reveals the possibility of substance abuse. What is the nurse's most appropriate action?

Encourage the client to seek care from a single provider for pain relief.

When assessing a client with anemia, which assessment is essential?

Health history, including menstrual history in women

A patient with ESRD is taking recombinant erythropoietin for the treatment of anemia. What laboratory study does the nurse understand will have to be assessed at least monthly related to this medication?

Hemoglobin level

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called

megaloblasts.

A nurse on a hematology/oncology floor is caring for a client with aplastic anemia. Which would not be included in the client's discharge instructions?

Use a disposable razor when shaving.

A client is admitted to the hospital with pernicious anemia. The nurse should prepare to administer which of the following medications?

Vitamin B12

A nurse cares for clients with hematological disorders and notes that women are diagnosed with hemochromacytosis at a much lower rate than men. What is the primary reason for this?

Women lose iron through menstrual cycles

A client has been diagnosed with Cooley's anemia, a severe form of beta-thalassemia. Which is a symptom of Cooley's anemia?

bronzing of the skin

A critical care nurse is caring for a client with immune hemolytic anemia. The client 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?

Splenectomy

A client 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?

The client should be given necessary clotting factors before the procedure.

The nurse is currently planning the care of a patient with multiple myeloma who is experiencing bone destruction. When reviewing the patient's most recent blood work, what value would the nurse pay particular attention to?

hypercalcemia

A client with sickle cell anemia has a

low hematocrit.