Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders - N266 Sp2019

A client being treated for iron deficiency anemia with ferrous sulfate continues to be anemic despite treatment. The nurse should assess the client for use of which medication?

Aluminum hydroxide

Which of the following is the most common hematologic condition affecting elderly patients

Anemia

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?

Creatinine level of 6 mg/100 mL

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

Which of the following is considered an antidote to heparin?

Protamine sulphate

A nurse is doing a physical examination of a child with sickle cell anemia. When the child asks why the nurse auscultates the lungs and heart, what would be best the response by the nurse?

To detect the abnormal sounds suggestive of acute chest syndrome and heart failure

Pancytopenia

abnormal decrease in WBCs, RBCs, and platelets

Erythroid cells

any cell that is or will become a mature RBC

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

megaloblasts.

Normochromic

normal RBC color, indicating normal amount of hemoglobin

Normocytic

normal size of RBC

Hypochromia

pallor within the RBC caused by decreased hemoglobin content

Cytokines

proteins produced by leukocytes that are vital to regulation of hematopoiesis, apoptosis, and immune responses

Reticulocytes

slightly immature RBCs, usually only 1% of total circulating RBCs

Spherocytes

small, spherically shaped erythrocytes

Microcytosis

smaller-than-normal RBCs

Petechiae

tiny capillary hemorrhages

Leukemia

uncontrolled proliferation of WBCs, often immature

Poikilocytosis

variation in shape of RBCs

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 female client with the beta-thalassemia trait plans to marry a man of Italian ancestry who also has the trait. Which client statement indicates that she understands the teaching provided by the nurse?

"I'll see a genetic counselor before starting a family."

Polycythemia

excess RBCs

A home care nurse visits a client diagnosed with atrial fibrillation who is ordered warfarin. The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching?

"I'll eat four servings of fresh, dark green vegetables every day."

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?

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

A male client has been receiving a continuous infusion of weight-based heparin for more than 4 days. The client's PTT is at a level that requires an increase of heparin by 100 units per hour. The client has the laboratory findings shown above. What is the most important action for the nurse to take?

Consult with the physician about discontinuing heparin.

Place the pathophysiological processes in order for how sickle cell disease leads to fatigue.

Decreased hemoglobin in RBC Inflamed vascular endothelium Increased inflammatory cytokines Decreased muscle strength

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

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?

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?

Direct pressure

The nurse and the client are discussing some strategies for ingesting iron to combat the client's iron-deficiency anemia. Which is among the nurse's strategies?

Drink liquid iron preparations with a straw.

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

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.

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?

Low ferritin level concentration

A client with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse?

Obtain the pain medication and delay the bath and position change until the medication reaches its peak.

A patient had gastric bypass surgery 3 years ago and now, experiencing fatigue, visits the clinic to determine the cause. The patient takes pantoprazole for the treatment of frequent heartburn. What type of anemia is this patient at risk for?

Pernicious anemia

When a nurse is planning discharge teaching for a client admitted with sickle cell crisis, which information should the nurse include in the teaching?

Receive pneumococcal and annual influenza vaccinations

The nurse is screening donors for blood donation. Which client is an acceptable donor for blood?

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

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

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.

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?

Thrombocytopenia

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 seen in the emergency department with severe pain related to a sickle cell crisis. What does the nurse understand is occurring with this client?

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

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

Absolute Neutrophil Count (ANC)

a calculation of the number of circulating neutrophils, derived from the total white blood cells (WBCs) and the percentage of neutrophils counted in a microscope's visual field

Erythrocyte

a cellular component of blood involved in the transport of oxygen and carbon dioxide; (synonym: RBC)

Lymphopenia

a lymphocyte count less than 1500/mm3

Megaloblastic anemia

a type of anemia characterized by the presence of abnormally large, nucleated RBCs

The most common cause of iron deficiency anemia in men and postmenopausal women is

bleeding.

Haptoglobin

blood protein synthesized by liver; binds free hemoglobin released from erythrocytes, which is then removed by the reticuloendothelial system

Anemia

decreased red blood cell (RBC) count

Hemolysis

destruction of RBCs; can occur within or outside of the vasculature

Thrombocytosis

higher-than-normal platelet count

Erythropoietin

hormone produced primarily by the kidney; necessary for erythropoiesis

Hemosiderin

iron-containing pigment derived from the breakdown of hemoglobin

Aplasia

lack of cellular development (e.g., of cells within the bone marrow)

A client with sickle cell anemia has a

low hematocrit.

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?

"I have difficulty breathing when walking 30 feet."

Neutropenia

lower-than-normal number of neutrophils

Thrombocytopenia

lower-than-normal platelet count

A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the health care provider immediately because the client probably is experiencing which problem?

A hemolytic allergic reaction caused by an antigen reaction

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?

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

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

A client receiving a blood transfusion experiences an acute hemolytic reaction. What is the nurse's priority intervention?

Immediately stop the transfusion, infuse normal saline solution, call the health care provider, and notify the blood bank.

A nurse provides nutritional information for a patient diagnosed with an iron-deficiency anemia. What education should the nurse provide?

Increase the intake of green, leafy vegetables.