Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders
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? A.) Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential B.) Monitoring the client's breathing and reviewing the client's arterial blood gases C.) Monitoring the client's heart rate and reviewing the client's hemoglobin D.) Monitoring the client's blood pressure and reviewing the client's hematocrit
ANswer: A.) Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential
A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from? Select all that apply. - Infection - Blood loss - Abnormal erythrocyte production - Destruction of normally formed red blood cells - Inadequate formed white blood cells
Answer: - Blood loss - Abnormal erythrocyte production - Destruction of normally formed red blood cells
Which of the following is the most common hematologic condition affecting elderly patients A.) Anemia B.) Thrombocytopenia C.) Leukopenia D.) Bandemia
Answer: A.) Anemia
The nurse is educating a client about iron supplements. The nurse teaches that what vitamin enhances the absorption of iron? A.) C B.) A C.) D D.) E
Answer: A.) C
Which of the following is considered an antidote to heparin? A.) Vitamin K B.) Protamine sulfate C.) Narcan D.) Ipecac
Answer: B.) Protamine sulfate
A client with sickle cell anemia has a A.) high hematocrit. B.) low hematocrit. C.) normal hematocrit. D.) normal blood smear.
Answer: B.) low hematocrit.
A nurse cares for a client with aplastic anemia. Which laboratory results will the nurse expect to find with this client? Select all that apply. - Neutrophil count 1200/microliter - Hemoglobin 7 g/dL - Platelets 35,000 microliters - White blood cell count 10,000/microliter - Neutrophil count 17,000/microliter
Answer: - Neutrophil count 1200/microliter - Hemoglobin 7 g/dL - Platelets 35,000 microliters Rationale: Aplastic anemia causes pancytopenia, or overall decrease to all myeloid stem cell-derived cells. Pancytopenia manifests as neutrophil count less than 1500/microliter, hemoglobin less than 10 g/dL, and platelets less than 50,000/microliter.
A client's family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC? A.) "DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs." B.) "DIC occurs when the immune system attacks platelets and causes massive bleeding." C.) "DIC is a complication of an autoimmune disease that attacks the body's own cells." D.) "DIC is caused when hemolytic processes destroy erythrocytes."
Answer: A.) "DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs."
A client in end-stage renal disease is prescribed epoetin alfa and oral iron supplements. Before administering the next dose of epoetin alfa and oral iron supplement, what is the priority action taken by the nurse? A.) Assesses the hemoglobin level B.) Questions the administration of both medications C.) Ensures the client has completed dialysis treatment D.) Holds the epoetin alfa if the BUN is elevated
Answer: A.) Assesses the hemoglobin level
The nurse is screening donors for blood donation. Which client is an acceptable donor for blood? A.) Has a history of viral hepatitis as a teenager 10 years ago B.) Received a blood transfusion within 1 year C.) Reports having a cold 1 month ago that resolved quickly D.) Had a dental extraction 2 days ago for caries in a tooth
Answer: C.) Reports having a cold 1 month ago that resolved quickly
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? A.) Anemia B.) Leukopenia C.) Thrombocytopenia D.) Neutropenia
Answer: C.) Thrombocytopenia
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? A.) Beans, dried fruits, and leafy, green vegetables B.) Fruits high in vitamin C, such as oranges and grapefruits C.) Berries and orange vegetables D.) Dairy products
Answer: A.) Beans, dried fruits, and leafy, green vegetables
The nurse is collecting data for a client who has been diagnosed with iron-deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia? A.) "I feel hot all of the time." B.) "I have a difficult time falling asleep at night." C.) "I have an increase in my appetite." D.) "I have difficulty breathing when walking 30 feet."
Answer: D.) "I have difficulty breathing when walking 30 feet."
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? A.) Limiting the client's intake of oral and IV fluids B.) Administering and evaluating the effectiveness of opioid analgesics C.) Encouraging the client to ambulate immediately D.) Limit foods that contain folic acid
Answer; B.) Administering and evaluating the effectiveness of opioid analgesics
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? A.) Potassium level of 5.2 mEq/L B.) Magnesium level of 2.5 mg/dL C.) Calcium level of 9.4 mg/dL D.) Creatinine level of 6 mg/100 mL
Answer; D.) Creatinine level of 6 mg/100 mL
Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? A.) Pancytopenia B.) Anemia C.) Leukopenia D.) Thrombocytopenia
Answer: A.) Pancytopenia
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? A.) The onset of a bacterial infection B.) Bleeding C.) Abdominal pain D.) Diarrhea
Answer: A.) The onset of a bacterial infection
Which medication is the antidote to warfarin? A.) Vitamin K B.) Protamine sulfate C.) Aspirin D.) Clopidogrel
Answer: A.) Vitamin K
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? A.) Determining what days to be active. B.) Assisting in prioritizing activities. C.) Keeping long activity periods to build client stamina. D.) Encouraging early and frequent activities.
Answer: B.) Assisting in prioritizing activities.
A client with a diagnosis of pernicious anemia comes to the clinic complaining of numbness and tingling in his arms and legs. What do these symptoms indicate? A.) Loss of vibratory and position senses B.) Neurologic involvement C.) Severity of the disease D.) Insufficient intake of dietary nutrients
Answer: B.) Neurologic involvement Rationale: In clients with pernicious anemia, numbness and tingling in the arms and legs and ataxia are the most common signs of neurologic involvement. Some affected clients lose vibratory and position senses. Jaundice, irritability, confusion, and depression are present when the disease is severe. Insufficient intake of dietary nutrients is not indicated by these symptoms
A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor? A.) Decreased level of erythropoietin B.) Decreased total iron-binding capacity C.) Increased mean corpuscular volume D.) Increased reticulocyte count
Answer: A.) Decreased level of erythropoietin
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.) A-positive blood to an A-negative client. B.) O-negative blood to an O-positive client. C.) O-positive blood to an A-positive client. D.) B-positive blood to an AB-positive client.
Answer: A.) A-positive blood to an A-negative client. Rationale: An acute hemolytic reaction occurs when there is an ABO or Rh incompatibility. For example, giving A blood to a B client would cause a hemolytic reaction. Likewise, giving Rh-positive blood to an Rh-negative client would cause a hemolytic reaction. It's safe to give Rh-negative blood to an Rh-positive client if there is a blood type compatibility. O-negative blood is the universal donor and can be given to all other blood types. AB clients can receive either A or B blood as long as there isn't an Rh incompatibility.
A client comes to the walk-in clinic complaining of weakness and fatigue. While assessing this client, the nurse finds evidence of petechiae and ecchymoses. The nurse notes that the spleen appears enlarged. What would the nurse suspect is wrong with this client? A.) Aplastic anemia B.) Pernicious anemia C.) Iron-deficiency anemia D.) Agranulocytosis
Answer: A.) Aplastic anemia Rationale: Clients with a plastic anemia experience all the typical characteristics of anemia (weakness and fatigue). In addition, they have frequent opportunistic infections plus coagulation abnormalities that are manifested by unusual bleeding, small skin hemorrhages called petechiae, and ecchymoses (bruises). The spleen becomes enlarged with an accumulation of the client's blood cells destroyed by lymphocytes that failed to recognize them as normal cells, or with an accumulation of dead transfused blood cells. The blood cell count shows insufficient numbers of blood cells. A bone marrow aspiration confirms that the production of stem cells is suppressed. This scenario does not describe a client with pernicious anemia, iron-deficiency anemia, or agranulocytosis.
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? A.) Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints. B.) Ask if taking a blood pressure has ever produced pain in the upper arm. C.) Ask if taking a blood pressure has ever caused bruising in the hand and wrist. D.) Ask if taking a blood pressure has ever produced the need for medication.
Answer: A.) Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints. Rationale: Due to the client's enhanced risk for bleeding, before taking a blood pressure, the nurse asks the client if the use of a blood-pressure cuff has ever produced bleeding under the skin or in the arm joints.
The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia? A.) Erythrocytes that are microcytic and hypochromic B.) Erythrocytes that are macrocytic and hyperchromic C.) Clustering of platelets with sickled red blood cells D.) An increased number of erythrocytes
Answer: A.) Erythrocytes that are microcytic and hypochromic Rationale: A blood smear reveals erythrocytes that are microcytic (smaller than normal) and hypochromic (lighter in color than normal). It does not reveal macrocytic (larger than normal) or hyperchromic erythrocytes. Clustering of platelets with sickled red blood cells would indicate sickle cell anemia. An increase in the number of erythrocytes would indicate polycythemia vera.
When assessing a client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential? A.) Health history, such as bleeding, fatigue, or fainting B.) Menstrual history C.) Age and gender D.) Lifestyle assessments, such as exercise routines
Answer: A.) Health history, such as bleeding, fatigue, or fainting
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? A.) Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit B.) Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients C.) Risk for falls related to complaints of dizziness D.) Fatigue related to decreased hemoglobin and hematocrit
Answer: A.) Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit
A client is treated for anemia. What is the nurse's best understanding about the correlation between anemia and the client's iron stores? A.) There is a strong correlation between iron stores and hemoglobin levels. B.) There is a strong correlation between iron stores and hemoglobin characteristics. C.) There is an inverse relationship between iron stores and hemoglobin levels. D.) There is a weak correlation between iron stores and hemoglobin levels.
Answer: A.) There is a strong correlation between iron stores and hemoglobin levels. Rationale: A strong correlation exists between laboratory values that measure iron stores and hemoglobin levels. After iron stores are depleted (as reflected by low serum ferritin levels), the hemoglobin level falls.
The nurse is caring for four clients on the medical-surgical unit of the hospital. What client is mostly likely to be receiving treatment for sickle cell crisis? A.) A 29-year-old European American male B.) A 19-year-old African American male C.) A 24-year-old Native American female D.) A 36-year-old Eastern European female
Answer: B.) A 19-year-old African American male
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? A.) Do not take medication with orange juice because it will delay absorption of the iron. B.) Iron may cause indigestion and should be taken with an antacid such as Mylanta. C.) Dilute the liquid preparation with another liquid such as juice and drink with a straw. D.) Discontinue the use of iron if your stool turns black.
Answer: C.) Dilute the liquid preparation with another liquid such as juice and drink with a straw.
The nurse is caring for a client with external bleeding. What is the nurse's priority intervention? A.) Elevation of the extremity B.) Pressure point control C.) Direct pressure D.) Application of a tourniquet
Answer: C.) Direct pressure
A nurse provides nutritional information for a patient diagnosed with an iron-deficiency anemia. What education should the nurse provide? A.) Decrease the intake of citrus fruits because they interfere with iron absorption. B.) Take an iron supplement with meals to reduce gastric irritation. C.) Increase the intake of green, leafy vegetables. D.) Decrease the intake of high-fat red meats, especially organ meats.
Answer: C.) Increase the intake of green, leafy vegetables. Rationale: Leafy greens, such as spinach, kale, swiss chard, collard and beet greens contain between 2.5-6.4 mg of iron per cooked cup. Clients should be encouraged to consume more green, leafy vegetables. Red meats, especially organ meats, are iron-rich foods and the client should not be discouraged from eating them. Vitamin C sources (citrus fruit and juices) enhance the absorption of iron, which should be taken 1 hour before or 2 hours after a meal.
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: A.) to the bathroom. B.) to the bedside commode. C.) onto the bedpan. D.) to a standing position so he can urinate.
Answer: C.) onto the bedpan.
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? A.) The client has a decreased tolerance of pain related to the chronic nature of the illness. B.) Bone marrow decreases the erythrocyte production causing decrease in hypoxia. C.) Overhydration enlarges the red blood cells. D.) Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.
Answer; D.) Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.
