Chapter 33--Nonmalignant Hematologic Disorders

Which statement by the nurse correctly explains the cause of DIC?

"DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs."

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."

The person with sickle cell disease repeatedly suffers from two major problems:

(1) episodes of sickle cell crisis from vascular occlusion, which develops rapidly under hypoxic conditions, and (2) chronic hemolytic anemia.

signs of anemia other than pallor

-tachycardia -flow murmurs

The hemoglobin of those who have sickle cell trait is about how much affected?

40%

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--antacids because they decrease iron absorption

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.

Before administering the next dose of epoetin alfa and oral iron supplement, what is the priority action taken by the nurse?

Assesses the hemoglobin level because too high a hemoglobin level can put the client at risk for heart failure, myocardial infarction, and cerebrovascular accident.

why is this neutropenia intervention important?

Clients with neutropenia often do not exhibit classic signs of infection, but a routine CBC with differential can reveal neutropenia before the onset of infection.

What finding would be an indicator of iron-deficiency anemia?

Erythrocytes that are microcytic and hypochromic

adverse effects of long-term corticosteroid therapy

Hypertension, osteoporosis, muscle wasting, and truncal obesity

who does beta-thalassemia usually occur in?

Italian, Greek, African, Asian, Middle Eastern, East Indian, and Caribbean descent.

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

A nurse is developing a care plan for a client with disseminated intravascular coagulation (DIC). Which nursing intervention should the nurse include?

Place a pressure-reducing mattress on the client's bed.

A pregnant woman is hospitalized as the result of sickle-cell crisis. Which finding indicates the outcome has been achieved for this client?

Reports joint pain less than 3 on a scale of 0 to 10

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

Two people with the beta-thalassemia trait have

a 25% chance of having a child with thalassemia major, a potentially life-threatening disease

type of anemia that can be congenital or acquired, but most cases are idiopathic.

aplastic anemia

Which is a symptom of hemochromatosis?

bronzing of the skin

Which of the following are immunosuppressants that prevent the patient's lymphocytes from destroying the stem cells in a patient diagnosed with aplastic anemia?

cyclosporine, corticosteroids, ATG, and cyclophosphamide

which type of food particularly decreases iron absorption?

dairy

when is erythropoietin usually administered?

during dialysis treatments

what supplement are sickle cell patients put on?

folic acid

Erythropoietin (epoetin alfa [Epogen]) with oral iron supplements can raise what levels?

hematocrit levels in the client with end-stage renal disease.

What laboratory study does the nurse understand will have to be assessed at least monthly related to taking erthropoeitin?

hemoglobin

what triggers aplastic anemia?

infection

what do pernicious anemia patients lack?

intrinsic factor to absorb vitamin B12

pica cravings are associated with what type of anemia?

iron deficiency

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?

manage pain

The nurse suspects the client may have thrombocytopenia. What should be the nurse's priority action?

notify the physician

in pernicious anemia what are the most common signs of neurologic involvement?

numbness and tingling in the arms and legs and ataxia

when should iron supplements be taken?

on an empty stomach

symptoms of aplastic anemia

purpura (bruising), retinal hemorrhages, significant neutropenia, and thrombocytopenia

Thrombocytopenia is evidenced by

purpura, small hemorrhages in the skin, mucous membranes, or subcutaneous tissues.

what happens during a sickle cell crisis?

the sickle-shaped cells lodge in small blood vessels, where they block the flow of blood and oxygen to the affected tissue. The vascular occlusion induces severe pain in the ischemic tissue.

What term should the nurse use to describe this low platelet count?

thrombocytopenia

The medication metformin (Glucophage) increases the client's risk for developing what deficiency?

vitamin B12

what enhances the absorption of iron?

vitamin C in citrus fruits

other symptoms of hemochromatosis

weakness, lethargy, arthralgia, weight loss, and loss of libido early in the illness trajectory