HEMATOLOGICAL SAUNDERS HEALTH PROBLEMS QUESTIONS

The nurse is reviewing the complete blood count (CBC) laboratory results of a female adult client suspected of having iron deficiency anemia. The nurse reviews the results and determines that which results are consistent with this diagnosis? Select all that apply. 1. Hematocrit (Hct) 30% 2. Hemoglobin (Hgb) 8.8 g/dL 3. Platelet count 300,000 mm3 4. White blood count (WBC) 7500 mm3 5. Decreased mean corpuscular volume (MCV) 66 fL

1. Hematocrit (Hct) 30% 2. Hemoglobin (Hgb) 8.8 g/dL 5. Decreased mean corpuscular volume (MCV) 66 fL Rationale: Iron deficiency anemia is a low red blood cell count caused by inadequate iron intake or absorption from the diet or blood loss. The low Hgb and Hct indicate an anemia. The normal hemoglobin level for an adult female is 12 to 16 g/dL, and the normal hematocrit is 37% to 47%. The low MCV (normal 80 to 95 fL) indicates a microcytic anemia (red blood cells smaller than normal), which is consistent with iron deficiency anemia. The platelet count and the WBC count are within the normal ranges. The normal platelet count is 150,000 to 400,000 mm3. The normal WBC count is 5000 to 10,000 mm3.

The nurse is doing discharge teaching with a client who has sickle cell disease. The nurse reinforces instructions to the client to avoid which factors that could precipitate a sickle cell crisis? Select all that apply. 1. Infection 2. Mild exercise 3. Fluid overload 4. Warm weather 5. Emotional stress

1. Infection 5. Emotional stress Rationale: The client should avoid infections and emotional stress, which can increase metabolic demand and cause dehydration, precipitating a sickle cell crisis. The client should also avoid dehydration from other causes. Warm weather and mild exercise do not need to be avoided, but the client should take measures to avoid dehydration during these conditions. Fluids are important to prevent dehydration. Finally, the client should avoid being in areas of high altitude, or flying in a nonpressurized aircraft because of lesser oxygen tension in these areas.

The nurse is assigned to care for a pregnant client with a diagnosis of sickle cell anemia. The nurse plans care, knowing that which problem would receive highest priority? 1. Dehydration 2. Inability to perform activities 3. Verbalizing fear about delivery 4. Expressing concern about appearance

1. Dehydration Rationale: For the client with sickle cell anemia, dehydration will precipitate sickling of the red blood cells. Sickling can lead to life-threatening consequences for the pregnant woman and the fetus, such as an interruption of blood flow to the respiratory system and placenta. Although options 2, 3, and 4 may be components of the plan of care at some point, fluid volume deficit is the priority.

During the intrapartum period, the nurse assists the health care team to ensure appropriate intravenous (IV) fluid intake and oxygen consumption for the laboring client with sickle cell disease. Which rationale would the nurse provide to the client for these interventions? 1. "Adequate IV fluids and oxygen will stimulate and accelerate the labor process." 2. "Administering IV fluids and oxygen will reduce the need for analgesic administration." 3. "Providing adequate IV fluids and oxygen during the labor process will minimize the necessity of a cesarean delivery." 4. "Administering adequate IV fluids and oxygen during your labor will assist in preventing dehydration and hypoxemia, which can lead to sickling."

4. "Administering adequate IV fluids and oxygen during your labor will assist in preventing dehydration and hypoxemia, which can lead to sickling."

The nurse reinforces instructions to a pregnant client regarding the administration of iron. The nurse determines that the teaching is effective if the client states that she will take the iron with which food items? 1. Tea 2. Milk 3. Water 4. Tomato juice

4. Tomato juice Rationale: Foods containing ascorbic acid (vitamin C), such as tomato juice, may increase absorption of iron. Additionally, absorption of iron is affected by many substances. Calcium and phosphorus in milk and tannin in tea decrease iron absorption. Water will not act to increase the absorption of the iron.

A client has been diagnosed with pernicious anemia. In planning care for the client, the nurse anticipates that the client will be treated with which vitamin or mineral? 1. Iron 2. Folic acid 3. Thiamine 4. Vitamin B12

Rationale: Pernicious anemia is caused by a deficiency of the intrinsic factor, which results in the inability to absorb vitamin B12 in the intestine. Treatment consists of weekly at first and then monthly injections of vitamin B12. Thiamine is most often prescribed for the client with alcoholism. Iron is administered for iron deficiency anemia, and folic acid is prescribed for folic acid deficiency.

During the intrapartum period, the nurse is caring for a laboring client diagnosed with sickle cell disease. The nurse recognizes that which conditions are most likely to lead to a sickling crisis? Select all that apply. 1. Exertion 2. Infection 3. Hypoxemia 4. Dehydration 5. Analgesic administration

1. Exertion 2. Infection 3. Hypoxemia 4. Dehydration Rationale: Maintaining adequate IV fluid intake and administering oxygen via face mask will help ensure a safe environment for maternal and fetal health during labor when the mother has sickle cell disease. A variety of conditions, including exertion, infection, hypoxemia and dehydration can stimulate the sickling process during the intrapartum period. Administering pain medication will not cause a sickle cell crisis.

The nurse is planning interventions for counseling a maternity client newly diagnosed with sickle cell anemia. The nurse understands that the important psychosocial intervention at this time is which action? 1. Provide emotional support. 2. Avoid the topic of the disease. 3. Allow the client to be alone if she is crying. 4. Provide all information regarding the disease immediately.

1. Provide emotional support.

A registered nurse has just hung a 250-mL bag of packed red blood cells (PRBCs) on a client. The licensed practical nurse assisting in caring for the client plans to remain with the client for at least how many minutes following the start of the infusion? 1. 5 minutes 2. 15 minutes 3. 30 minutes 4. 60 minutes

2. 15 minutes Rationale: The nurse must remain with the client for the first 15 minutes of a transfusion, which is the most frequent period during which a transfusion reaction may occur. This enables the nurse to quickly detect a reaction and intervene quickly. Option 1 is not enough time to remain with the client. The time frames in options 3 and 4 are unnecessary.

The nurse is caring for a client following a total hip replacement. The client has been diagnosed with iron deficiency anemia. The nurse instructs the client to increase intake of which foods? Select all that apply. 1. Milk and yogurt 2. Clams and mussels 3. Apples and mangos 4. Potatoes and carrots 5. Lean beef and chicken liver

2. Clams and mussels 5. Lean beef and chicken liver Rationale: The client with iron deficiency anemia should increase intake of foods that are naturally high in iron. The best sources of dietary iron are red meat, liver and other organ meats, blackstrap molasses, clams, mussels, and oysters. Milk products are lowest in iron of all of the food sources listed. Potatoes, carrots, apples, and mangos are not rich sources of iron.

The nurse collects data from a pregnant client diagnosed with iron deficiency anemia during her third trimester for additional risk factors associated with the anemia. Which statement made by the client would the nurse question to receive more information? 1. "I will drink at least 6 to 8 glasses of water each day." 2. "I will take a nap each afternoon to help me feel more rested." 3. "I have had mild vaginal spotting twice since my last prenatal visit." 4. "I will continue to take the extra iron that was prescribed for me by the primary health care provider."

3. "I have had mild vaginal spotting twice since my last prenatal visit." Rationale: A variety of factors can further complicate the potential maternal and fetal effects of iron deficiency anemia during pregnancy. Such factors include geographic location, socioeconomic status, daily nutrition and fluid intake, compliance with supplemental medication regimens, and blood loss during pregnancy. A history of vaginal spotting may compromise maternal hemoglobin levels even further during the antenatal period. Drinking at least 6 to 8 glasses of water each day represents appropriate client behaviors during pregnancy to ensure adequate nutrition and fluid balance. Requiring an afternoon nap is not unusual during pregnancy.

The nurse is caring for a client with a suspected diagnosis of aplastic anemia. Which test would the nurse anticipate to be performed to confirm the diagnosis? 1. Schilling test 2. Sickle cell screen 3. Bone marrow aspiration 4. Complete blood cell count

3. Bone marrow aspiration Rationale: A bone marrow aspiration will identify aplastic anemia and will identify pancytopenia, a deficiency in erythrocytes, leukocytes, and thrombocytes, and confirm that the source of the problem is bone marrow dysfunction. A Schilling test is diagnostic for pernicious anemia. A sickle cell screen is diagnostic for sickle cell anemia. A complete blood cell count will identify anemia but may not identify the specific type and also the leukopenia and thrombocytopenia.

A client who is receiving a blood transfusion pushes the call light for the nurse. When entering the room, the nurse notes that the client is flushed, dyspneic, and complaining of generalized itching. How would the nurse correctly interpret these findings? 1. Bacteremia 2. Fluid overload 3. Hypovolemic shock 4. Transfusion reaction

4. Transfusion reaction Rationale: The signs and symptoms exhibited by the client are consistent with a transfusion reaction. With bacteremia, the client would have a fever, which is not part of the clinical picture presented. With fluid (circulatory) overload, the client would have crackles in addition to dyspnea. There is no correlation between the signs mentioned in the question and hypovolemic shock. The signs identified in the question are indicative of an allergic reaction, which is one type of blood transfusion reaction.

The nurse has conducted dietary teaching with the client diagnosed with iron deficiency anemia. The nurse determines that the client understands the information if the client states the intention to increase intake of which foods? Select all that apply. 1. Oysters 2. Spinach 3. Pineapple 4. Egg whites 5. Kidney beans 6. Refined white bread

1. Oysters 2. Spinach 5. Kidney beans

An adult female client has a hemoglobin level of 10.8 g/dL (108 g/L). The nurse interprets that this result is most likely caused by which condition noted in the client's history? 1. Dehydration 2. Heart failure 3. Iron deficiency anemia 4. Chronic obstructive pulmonary disease

3. Iron deficiency anemia Rationale: The normal hemoglobin level for an adult female client is 12 g/dL to 16 g/dL (120-160 g/L). Iron deficiency anemia can result in lower hemoglobin levels. Dehydration may increase the hemoglobin level by hemoconcentration. Heart failure and chronic obstructive pulmonary disease may increase the hemoglobin level as a result of the body's need for more oxygen-carrying capacity.

A client is seen in the clinic for a physical examination. Laboratory studies are performed and reveal that the hemoglobin and hematocrit are low, indicating the need for further diagnostic studies and possibly a blood transfusion. The client is a Jehovah's Witness and states he will never have a blood transfusion. Which would be an appropriate action by the clinic nurse? 1. Try to convince the client of the need for the transfusion. 2. Support the client's decision not to receive a blood transfusion. 3. Speak to the family regarding the need for a blood transfusion. 4. Discuss with the client the results of the low hemoglobin and hematocrit levels.

2. Support the client's decision not to receive a blood transfusion.

The nurse is assisting with caring for a client who will receive a unit of blood. Just before the infusion, it is most important for the nurse to check which item? 1. Vital signs 2. Skin color 3. Oxygen saturation 4. Latest hematocrit level

1. Vital signs Rationale: A change in the vital signs may indicate that a transfusion reaction is occurring. The nurse assesses the client's vital signs before the procedure to obtain a baseline every 15 minutes for the first half hour after beginning the transfusion and every half hour thereafter. Skin color, oxygen saturation, and most recent hematocrit may be checked but are not the most important.

A pregnant anemic client is concerned about her baby's condition following delivery. Which nursing response best supports the client? 1. "I wouldn't worry about your baby's health; complications from this condition are generally rare." 2. "Your baby will likely need to spend a few days in the neonatal intensive care unit for observation following delivery." 3. "Your baby will not have any problems if you follow all the advice the primary health care provider has given you during your pregnancy." 4. "The effects of anemia on your baby are difficult to predict, but let's review your plan of care to ensure you are providing the best nutrition and growth potential."

4. "The effects of anemia on your baby are difficult to predict, but let's review your plan of care to ensure you are providing the best nutrition and growth potential."

The nursing student is presenting a clinical conference and discusses the causative factors related to beta-thalassemia. Which group is at greatest risk of developing this disorder? 1. A child of Mexican descent 2. A child of Mediterranean descent 3. A child whose intake of iron is extremely poor 4. A child breast-fed by a mother with chronic anemia

2. A child of Mediterranean descent Rationale: Beta-thalassemia is an autosomal recessive disorder. This disorder is found primarily in individuals of Mediterranean descent. The disease also has been reported in Asian and African populations. Options 1, 3, and 4 are not risk factors for this disorder.

A client in labor has an underlying diagnosis of sickle cell anemia. During labor the client is at high risk for sickling crisis. The nurse would take which action to assist in preventing a crisis from occurring during labor? 1. Reassure the client. 2. Maintain strict asepsis. 3. Prevent bearing down. 4. Administer oxygen as prescribed.

4. Administer oxygen as prescribed. Rationale: During the labor process, the client is at high risk for being unable to meet the oxygen demands of labor and becoming unable to prevent sickling. An intervention to prevent sickle cell crisis during labor includes administering oxygen as needed. Options 1, 2, and 3 are accurate information but not for the situation described in the question

A client is receiving supplemental therapy with folic acid. The nurse evaluates the effectiveness of this therapy by monitoring the results of which laboratory study? 1. Blood glucose 2. Blood urea nitrogen 3. Alkaline phosphatase 4. Complete blood count

4. Complete blood count Rationale: Folic acid is necessary for red blood cell production and is classified as a vitamin and an anti anemic agent. The effectiveness of therapy can be measured by monitoring the results of periodic complete blood count levels, noting particularly the hematocrit level. Blood glucose, Blood urea nitrogen, and alkaline phosphatase are not associated with the use of this medication.

During an initial prenatal visit, the nurse notes that the primary health care provider documents that the client is experiencing iron deficiency anemia. Which client data support this finding? Select all that apply. 1. Reports of fatigue 2. Pink mucous membranes 3. Increased vaginal secretions 4. Hemoglobin level of 10.2 g/dL 5. Increased frequency of voiding

1. Reports of fatigue 2. Pink mucous membranes

Iron dextran is prescribed to be administered intramuscularly to a client. The nurse prepares the medication and determines that the appropriate method of administration is which? 1. Using the Z-track technique 2. Injecting into the deltoid muscle 3. Using a ⅝-inch needle on a large syringe 4. Applying heat to the injection site before administration

1. Using the Z-track technique

A pregnant client tells the nurse that she has been craving "unusual foods." On further data collection, the nurse discovers that the client has been ingesting daily amounts of white clay dirt from her backyard. Which laboratory result indicates a physiological consequence of a result of this practice? 1. Hematocrit 37% 2. Glucose 86 mg/dL 3. Hemoglobin 9.1 g/dL 4. White blood cell count 12,400/mm3

3. Hemoglobin 9.1 g/dL Rationale: Pica cravings often lead to iron deficiency anemia, resulting in a lowered hemoglobin. The other three laboratory values are within normal limits for the pregnant woman.

The nurse is caring for a client receiving chemotherapy and determines that the client has developed myelosuppression. Which laboratory value would support the client's diagnosis of myelosuppression? 1. Protein 7 g/dL 2. Magnesium 1.8 mg/dL 3. Hemoglobin 9.4 g/dL, hematocrit 26% 4. Blood urea nitrogen (BUN) 15 mg/dL, creatinine 0.9 mg/dL

3. Hemoglobin 9.4 g/dL, hematocrit 26% Rationale: The client has been diagnosed with myelosuppression, which is bone marrow depression. The correct option is the hemoglobin and hematocrit, which is decreased. Hemoglobin is the main component of erythrocytes. Hematocrit represents red blood cell mass and is an important measurement in the identification of blood abnormalities. Red blood cells are produced in the bone marrow. BUN and creatinine address renal function. Protein levels address the amount of albumin in serum and low levels reflect decreased functioning by the liver and/or poor protein intake. These other laboratory values are within normal range.

A client has experienced several episodes of sickle cell crisis. Which reinforced instructions would be included in the client's teaching plan to prevent recurrence? Select all that apply. 1. Vigorous exercise is encouraged to maintain cardiovascular function. 2. Iced liquids will combat dehydration and should be consumed regularly. 3. Wear shoes and socks when walking outside to prevent damage to the feet. 4. To prevent opioid tolerance, avoid taking pain medication at the beginning of the crisis 5. Recognize early symptoms of infection and contact the primary health care provider (PHCP).

3. Wear shoes and socks when walking outside to prevent damage to the feet. 5. Recognize early symptoms of infection and contact the primary health care provider (PHCP).