med-surg midterm hemtological
Which nursing intervention is most appropriate for a client with multiple myeloma?
Preventing bone injury, the nurse should focus on relieving pain, preventing bone injury and infection, and maintaining hydration.
"The most common signs and symptoms of leukemia related to bone marrow involvement are which of the following? "A. Petechiae, fever, fatigue B. Headache, papilledema, irritability C. Muscle wasting, weight loss, fatigue D. Decreased intracranial pressure, psychosis, confusion"
"A. Petechiae, fever, fatigue
The father of a 2-year-old boy recently diagnosed with hemophilia A asks the nurse how to prevent complications for his son. The best response would be:
"Avoid administering aspirin and nonsteroidal anti-inflammatory drugs."
The nurse is preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching? a) "I put her legs up on pillows when her knees start to hurt." b) "I bought the medication to give to her when she says she is in pain." c) "She loves popsicles, so I'll let her have them as a snack or for dessert." d) "She has been down, but playing in soccer camp will cheer her up."
"She has been down, but playing in soccer camp will cheer her up." Following a sickle cell crisis, the child should avoid extremely strenuous activities that may cause oxygen depletion. Fluids are encouraged, pain management will be needed, and the child's legs may be elevated to relieve discomfort, so these are all statements that indicate an understanding of caring for the child who has had a sickle cell crisis.
phlebotomy is used as a therapeutic treatment for what?
- polycythemia
administration of platelet rate
100-120ml/hr
Which of the following is the most common hematologic condition affecting elderly patients a) Thrombocytopenia b) Anemia c) Bandemia d) Leukopenia
Anemia
client with a history of atrial fibrillation has experienced a TIA. In an effort to reduce the risk of cerebrovascular accident (CVA), the nurse anticipates the medical treatment to include which of the following?
Anticoagulant therapy
An elderly client asks the nurse why so many older people develop anemia. The best response would be:
Chronic disease
12. A home health nurse is caring for a patient with multiple myeloma. Which of the following interventions should the nurse prioritize when addressing the patient's severe bone pain? A) Implementing distraction techniques B) Educating the patient about the effective use of hot and cold packs C) Teaching the patient to use NSAIDs effectively D) Helping the patient manage the opioid analgesic regime
D) Helping the patient manage the opioid analgesic regime
To detect cyanosis in clients with dark skin, the nurse should assess which area?
Oral mucosa
The nurse is aware that chronic lymphocytic leukemia (CLL), a common malignancy in those older than 60, has an early stage and a late stage. The nurse assesses a patient for late stage CLL by looking for: a) Lymphadenopathy. b) Thrombocytopenia. c) Hepatomegaly. d) Splenomegaly.
Thrombocytopenia.
When evaluating a patient's symptoms that are consistent with a diagnosis of leukemia, the nurse is aware that a common feature of all leukemias is which of the following?
Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements
The physician orders a transfusion with packed red blood cells (RBCs) for a client hospitalized with severe iron deficiency anemia. When blood is administered, what is the most important action the nurse can take to prevent a transfusion reaction?
Verify the client's identity according to hospital policy
Therapeutic phlebotomy purpose
decrease RBC and hemotocrit and iron
What is the pain management for SEVERE pain due to hemophilia
opiods
what is therapeutic phlebotomy used for?
patients with elevated hematocrits (polycythemia vera) or excessive iron absorption (hemochromatosis)
What is the pain management for MILD pain due to hemophilia?
tylenol
Choice Multiple question - Select all answer choices that apply. The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child includes which of the following. Select all that apply. a) Promoting exercise and activity b) Administering analgesics c) Administering oxygen d) Maintaining fluid intake e) Preventing injury and bleeding episodes
• Administering oxygen • Administering analgesics • Maintaining fluid intake Explanation: Treatment for a crisis is supportive for each presenting symptom, and bed rest is indicated. Oxygen may be administered. Analgesics are given for pain. Dehydration and acidosis are vigorously treated. Prognosis is guarded, depending on the severity of the disease.
A client is receiving radiation therapy for lesions in the abdomen from non-Hodgkin's lymphoma. Because of the effects of the radiation treatments, the nurse now assesses for a) Hair loss b) Diarrheal stools c) Adventitous lung sounds d) Laryngeal edema
B
A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in his care should be given priority? a) Encouraging him to take deep breaths hourly b) Maintaining a fluid intravenous line c) Beginning active range-of-motion exercises d) Seeing that he ingests a protein-rich diet
B
the client's primary care physician is reviewing assessment data of a client and suspects a diagnosis of acute leukemia. to confirm the diagnosis, which of the following tests would be performed?
Bone marrow analysis
When developing the postoperative plan of care for a child with sickle cell anemia who has undergone a splenectomy, which of the following would the nurse identify as the priority? a) Impaired skin integrity b) Risk for delayed growth and development c) Risk for infection d) Deficient fluid volumE
C
Which medication is indicated for the patient with atrial fibrillation who is at high risk for stroke?
Coumadin
Of the following types of hemolytic anemia, which is categorized as inherited disorder?
Sickle cell anemia
The nurse expects which assessment finding when caring for a client with a decreased hemoglobin level?
decreased oxygen levels
Leukemia signs and symptoms
-Fatigue, weakness, pallor, weight loss -Dyspnea on exertion -Ecchymosed skin and nosebleeds -Fever (flu like symptoms) -Headache, nausea, vomiting
A client with a diagnosis of hemophilia A has been admitted with bilateral knee pain. The nurse should anticipate performing what intervention during the client's treatment?
Administration of factor VIII and implementation of fall prevention measures
The most common complications of transfusion are:
Febrile nonhemolytic reactions and chill-rigor reactions
Which term refers to the percentage of blood volume that consists of erythrocytes?
Hematocrit
A black client with asthma seeks emergency care for acute respiratory distress. Because of this client's dark skin, the nurse should assess for cyanosis by inspecting the: a) lips. b) earlobes. c) mucous membranes. d) nail beds.
Mucous membranes
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 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." - "I'll report unexplained or severe bruising to my doctor right away." - "I'll use an electric razor to shave." -"I'll watch my gums for bleeding when I brush my teeth."
The client requires additional teaching if he states that he'll eat four servings of dark green vegetables every day. Dark, green vegetables contain vitamin K, which reverses the effects of warfarin. The client should limit his intake to one to two servings per day.
Review basic CBC testing and what they mean i.e., Hgb, Hct
The most common test used for routine screening of hematological function is the complete blood count (CBC). This diagnostic test provides a highly informative profile of data on multiple blood values, identifying the total number of blood cells (leukocytes, erythrocytes, and platelets) as well as the Hb, Hct, and RBC indices (mean corpuscular volume [MCV], mean corpuscular hemoglobin [MCH], and mean corpuscular hemoglobin concentration.
What are some nursing interventions for a DECREASED RBC/Hct/Hgb count?
-Assess for signs and symptoms of anemia such as pallor, fatigue, weakness, chills, tachycardia, syncope, dyspnea, hypotension, and inability to concentrate -Assess for source of blood loss or inablity to make RBC's
transfusion administration rate
2-5ml for first 15 min and then increase monitor closely for first 15-30 min administration time cannot exceed 4 hours without increase risk for infection
Which client is not a candidate for blood donation according to the American Heart Association?
26 year old female with hemoglobin 11.0 g/dL Clients must meet the following criteria to be eligible as blood donors: body weight at least 50 kg; pulse rate regular between 50 and 100 bpm; systolic BP 90 to 180 mmHg and diastolic 50 to 100 mmHg; hemoglobin level at least 12.5 g/dL for women. There is no upper age limit to donation.
A patient with a history of atrial fibrillation has contacted the clinic saying that she has accidentally overdosed on her prescribed warfarin (Coumadin). The nurse should recognize the possible need for what antidote? A) IVIG B) Factor X C) Vitamin K D) Factor VII
Ans: C Feedback: Vitamin K is administered as an antidote for warfarin toxicity.
Administration of platelets: rate
Not a slow administration like it is with blood 10 ml per minute
The school nurse has several children with hemophilia A. After recess, one hemophilia student comes to the school nurse complaining of pain in their knee from falling on the playground. The nurse notes there is swelling in the knee and pain on palpation. The nurse should:
Notify parents to pick up child and possibly administer Factor VIII.
"Sickle cell anemia will be on midterm":
Sickle cell shape= limited oxygenation; cell goes through change when lack of oxygenation; clumps RBC's together
A patient is starting warfarin (Coumadin) therapy as part of treatment for atrial fibrillation. The nurse will follow which principles of warfarin therapy? (Select all that apply.) a. Teach proper subcutaneous administration. b. Administer the oral dose at the same time every day. c. Assess carefully for excessive bruising or unusual bleeding. d. Monitor laboratory results for a target INR of 2 to 3.
b. Administer the oral dose at the same time every day. c. Assess carefully for excessive bruising or unusual bleeding. d. Monitor laboratory results for a target INR of 2 to 3.
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 - Potential hepatic dysfunction indicated by decreased blood urea nitrogen (BUN) and creatinine levels - Electrolyte imbalance that could affect the blood's ability to coagulate properly - Low levels of urine constituents normally excreted in the urine
Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels
A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify which of the following as a factor? a) Pallor b) Infection c) Fluid overload d) Respiratory distreSS
B
During a blood transfusion a client develops chills and a headache, what is the priority nursing action A) cover the client B) stop the transfusion at once C) notify the physician immediately D) decrease the rate of blood infusion
B) stop the transfusion because chills, headache, and nausea are all signs of transfusion reaction
A nurse is caring for a client with multiple myeloma. Which nursing intervention is most appropriate for this client? a) Monitoring respiratory status b) Restricting fluid intake c) Balancing rest and activity d) Preventing bone injury
Preventing bone pain
An older adult client presents to the health care provider's office and reports exhaustion. The nurse, aware of the most common hematologic condition affecting the elderly, knows that which laboratory values should be assessed?
RBC count Explanation: A decreased red blood cell count is indicative of anemia, a common condition in older adults that results in fatigue.
A 59-year-old patient is on warfarin therapy. On follow-up visits to the clinic, the nurse will assess the patient's:
Vitamin K
You care for a 4-year-old with sickle cell anemia. A physical finding you might expect to see in him is a) increased growth of long bones. b) slightly yellow sclerae. c) enlarged mandibular growth. d) depigmented areas on the abdomen
B
In caring for a child with sickle cell disease, the highest priority goal is which of the following? a) The family caregivers' anxiety will be reduced. b) The child's skin integrity will be maintained. c) The family will verbalize understanding of of the disease crisis. d) The child's fluid intake will improve
D
A client with multiple myeloma reports uncomfortable muscle cramping. Which nursing interventions will the nurse implement in response to the client's report of symptoms? Select all that apply. - Encourage hydration - Warn client to avoid extremes in temperatures - Warn client to avoid abrupt position change - Encourage range of motion exercises - Encourage ambulation
Encourage hydration Encourage ambulation
A patient is taking warfarin (Coumadin) to prevent clot formation related to atrial fibrillation. How are the effects of the warfarin (Coumadin) monitored?
PT and INR
About ten minutes after the nurse begins an infusion of packed RBCs, the patient complains of chills, chest and back pain, and nausea. His face is flushed, and he's anxious. Which is the priority nursing action? 1. Administering antihistamines STAT for an allergic reaction. 2. Notifying the physician of a possible transfusion reaction. 3. Obtaining a urine and serum specimen to send to the lab immediately. 4. Stopping hte transfusion and maintaining a patent IV catheter."
4. Stopping hte transfusion and maintaining a patent IV catheter."
33. The home health nurse is performing a home visit for an oncology patient discharged 3 days ago after completing treatment for non-Hodgkin lymphoma. The nurse's assessment should include examination for the signs and symptoms of what complication? A) Tumor lysis syndrome (TLS) B) Syndrome of inappropriate antiduretic hormone (SIADH) C) Disseminated intravascular coagulation (DIC) D) Hypercalcemia
Ans:A TLS is a potentially fatal complication that occurs spontaneously or more commonly following radiation, biotherapy, or chemotherapy-induced cell destruction of large or rapidly growing cancers such as leukemia, lymphoma, and small cell lung cancer. DIC, SIADH and hypercalcemia are less likely complications following this treatment and diagnosis.
Question: A group of newly hired nurses who will be working on the pediatric unit are attending an in-service program about sickle cell disease. During the program, the nurse manager describes the steps for managing sickle cell pain. Place these steps in the sequence in which the nurse manager would describe them. -Believe the child's report of pain. -Provide rest in a quiet area. -Give medications and use distraction. -Look for complications or cause of pain. -Assess the pain. -Administer fluids.
Assess the pain. Believe the child's report of pain. Look for complications or cause of pain. Give medications and use distraction. Provide rest in a quiet area. Administer fluids.
Packed red blood cells have been prescribed for a client with a low hemoglobin and hematocrit levels. The nurse takes the client's temperature before hanging the blood transfusion and records 100.6 degrees orally. Which of the following is the appropriate nursing action? A) Begin the transfusion as prescribed B) Delay hanging blood and notify the physician C) Administer an antihistamine and begin the transfusion D) Administer two tablets of Tylenol and begin the transfusion"
B) Delay hanging blood and notify the physician
A client with leukemia has developed a cough and increased fatigue. What is the primary nursing intervention? A) Medicate the client to relieve pain. B) Place a cooling blanket on the client. C) Evaluate the client for potential infection. D) Administer an antitussive.
C
The nurse is caring for a 2-year-old with sickle cell anemia and describing the acute and chronic manifestations of sickle cell anemia to his mother. Which statement by the mother indicates a need for further teaching? a) "Aplastic crisis is a life-threatening acute manifestation of sickle cell anemia." b) "Delayed growth and development and delayed puberty are chronic manifestations." c) "The acute manifestations, like splenic sequestration, are most often life-threatening." d) "Bone infarction, dactylitis, and recurrent pain episodes are acute manifestations.
C
14. A patient with non-Hodgkin's lymphoma is receiving information from the oncology nurse. The patient asks the nurse why she should stop drinking and smoking and stay out of the sun. What would be the nurse's best response? A) Everyone should do these things because they're health promotion activities that apply to everyone. B) You don't want to develop a second cancer, do you? C) You need to do this just to be on the safe side. D) It's important to reduce other factors that increase the risk of second cancers.
D) It's important to reduce other factors that increase the risk of second cancers. The nurse should encourage patients to reduce other factors that increase the risk of developing second cancers, such as use of tobacco and alcohol and exposure to environmental carcinogens and excessive sunlight. The other options do not answer the patient's question, and also make light of the patient's question
A client with multiple myeloma is complaining about pain. What instructions will the nurse give the client to help to reduce pain during activity? - Limit activity to once a day. - Do not lift more than 10 pounds. - Stay in bed as much as possible. - Limit fluids to prevent going to the bathroom.
Do not lift more than 10 pounds
Leukemia: Signs/symptoms and nursing assessment
Leukemia:"Blood cancer"; WBCs multiply uncontrollably within bone marrow; Clinical Manifestations: Swelling, pain in lymph glands of neck, axillae, groin and LUQ of abdomen; Neutropenia (Patients may be symptomatic or asymptomatic)
The nurse cares for an older adult client with unprovoked back pain and increased serum protein. Which hematologic neoplasm does the nurse suspect the client has?
Multiple myeloma
Therapeutic phlebotomy: Reasons for
Therapeutic phlebotomy is a procedure or blood draw in which approximately 450-500 mls of blood are drawn out of the body. Must use a large bore cannula so blood cells are not damaged.
A child is diagnosed with sickle-cell anemia. Which component of the blood, the one responsible for the transport of oxygen, is defective in this disorder? a) Hemoglobin b) Thrombocytes (platelets) c) Plasma d) Leukocytes (white blood cells)
A
urse is caring for a client who is taking an oral anticoagulant. The nurse should teach the client to: A) report incidents of diarrhea. B) take aspirin for pain relief. C) avoid foods high in vitamin K. D) use a straight razor when shaving.
C) avoid foods high in vitamin K.
What are some nursing interventions for an INCREASED RBC/Hct/Hgb count?
-Assess for signs and symptoms of fluid volume deficit such as poor skin turgor, dry mucous membranes, thirst, decreased LOC -Assess for signs of DVT/Thrombophlebitis such as warmth, redness, edema, and Homan's sign -Increase fluids to 2,000 mL per day -Provide activity (ROM, leg exercises, ambulation)
Place the following steps in order when determining the type and severity of a transfusion reaction. Use all options.
-Stop the transfusion. -Assess the client. -Notify the health care provider. -Notify the blood bank. -Send the tubing and container to the blood bank.
A nurse is caring for a client with breast cancer who has been undergoing chemotherapy. Blood tests indicate a low platelet count. A platelet transfusion is prescribed, and the nurse obtains the platelets from the blood bank. After following the pretransfusion protocol, the nurse administers the transfusion over: 1. 2 hours 2. 4 hours 3. 6 hours 4. 15-30 minutes
4. 15-30 minutes
A client was admitted to the hospital with a pathologic pelvic fracture. The client informs the nurse that he has been having a strange pain in the pelvic area for a couple of weeks that was getting worse with activity prior to the fracture. What does the nurse suspect may be occurring based on these symptoms? A) Multiple myeloma B) Leukemia C) Hemolytic anemia D) Polycythemia vera
A)Multiple myeloma The first symptom usually is vague pain in the pelvis, spine, or ribs. As the disease progresses, the pain becomes more severe and localized. The pain intensifies with activity and is relieved by rest. When tumors replace bone marrow, pathologic fractures develop. Hemolytic anemia does not result in pathologic fractures nor does polycythemia vera or leukemia.)
A patient's low prothrombin time (PT) was attributed to a vitamin K deficiency and the patient's PT normalized after administration of vitamin K. When performing discharge education in an effort to prevent recurrence, what should the nurse emphasize? A) The need for adequate nutrition B) The need to avoid NSAIDs C) The need for constant access to factor concentrate D) The need for meticulous hygiene
Ans: A Feedback: Vitamin K deficiency is often the result of a nutritional deficit. NSAIDs do not influence vitamin K synthesis and clotting factors are not necessary to treat or prevent a vitamin K deficiency. Hygiene is not related to the onset or prevention of vitamin K deficiency
For a client with Hodgkin lymphoma, who is at a risk for ineffective airway clearance and impaired gas exchange, the nurse places the client in a high Fowler's position to
Increase lung expansion
A patient who is receiving warfarin (Coumadin) has blood in his urinary drainage bag. What medication will likely be ordered by the physician?
Vitamin K
A client with multiple myeloma reports pain along the spinal column. The client is prescribed naproxen (Aleve) and oxycodone. Prior to administering these medications, the nurse - Teaches the client to bend at the back when lifting objects - - Questions the physician about the use of both medications - Checks the clients's BUN and creatinine - Instructs the client not to lift more than 20 pounds
Checks the clients's BUN and creatinine
What is a therapeutic blood draw?
One common procedure nurses perform is therapeutic phlebotomy, where about 500 ml of blood is removed through a large-bore needle over 15-30 minutes. The procedure is ordered as a treatment for hereditary hemochromatosis, polycythemia vera, and secondary polycythemia.
The nurse is teaching an inservice program to a group of nurses on the topic of children diagnosed with sickle cell anemia. The nurses in the group make the following statements. Which statement is most accurate regarding sickle cell anemia? a) "The disease is most often seen in individuals of Asian decent." b) "The trait or the disease is seen in one generation and skips the next generation." c) "If the trait is inherited from both parents the child will have the disease." d) "Males are much more likely to have the disease than females."
C
A nurse is assessing an 8-year-old child brought to the emergency department by his mother. The child has a history of sickle-cell anemia and reports acute back pain and joint pain. His mucous membranes are dry; skin turgor is poor. Capillary refill is slowed and nail beds are pale. The child is diagnosed with sickle-cell crisis. Which nursing diagnosis would the nurse most likely identify as a priority? a) Acute pain related to effects of sickling b) Deficient fluid volume related to clustering of sickled cells c) Ineffective peripheral tissue perfusion related to the effects of sickled cells d) Ineffective coping related to chronic illness
A Although ineffective peripheral tissue perfusion and deficient fluid volume would apply, acute pain would be the priority. Once pain is relieved, the child is able to relax, thus reducing the metabolic demand for oxygen and helping to end the sickling. There is no information to correlate with a nursing diagnosis of ineffective coping.
The nurse is administering meperidine as ordered for pain management for a 10-year-old boy in sickle cell crisis. The nurse would be alert for: a) seizures. b) leg ulcers. c) priapism. d) behavioral addiction.
A The most common types of hemophilia are factor VIII deficiency and factor IX deficiency, which are inherited as sex-linked recessive traits, with transmission to male offspring by carrier females.
The patient has been admitted with a diagnosis of possible leukemia. Which findings would be commonly discovered in this patient's admission assessment? (Select all that apply.) a. reports of fatigue and weakness b. an elevation in the leukocytes, especially neutrophils c. signs of bruising easily d. recent weight gain e. increased numbers of infections
A. report signs of fatigue and weakness, C. Signs of Bruising, E. increased numbers of infections. General manifestations of leukemia result from anemia, infection, and bleeding. The patient would complain of fatigue and weakness, and would show signs of bruising. Leukemic cells replace normal hematopoietic elements, preventing the formation of mature leukocytes. Neutrophil count would be decreased. Because of an increased metabolism, weight loss could occur.
A patient with hemophilia reports mild joint pain. Which over-the-counter medication should the nurse recommend to this patient? A. Ibuprofen [Motrin] B. Acetaminophen [Tylenol] C. Enteric-coated aspirin D. Ginkgo biloba
Answer: B Acetaminophen Rationale: For mild bleeding-related pain, acetaminophen (Tylenol) is the drug of choice for patients with hemophilia. Aspirin and ibuprofen can increase the risk of bleeding for patients with hemophilia; also, these drugs can induce gastrointestinal ulceration and bleeding. Ginkgo biloba is a dietary supplement used to treat claudication from peripheral arterial disease. Ginkgo may cause spontaneous bleeding, and patients with hemophilia should avoid taking ginkgo.
An otherwise healthy 33-year-old woman experienced debilitating and persistent fatigue over a period of several weeks and was subsequently diagnosed with acute myeloid leukemia (AML). The woman has been admitted to the hospital for treatment. The nurse who is providing care for this patient should prioritize which of the following assessments? A) Assessing the woman for thrombosis and embolism B) Assessing the woman for signs and symptoms of infection C) Assessing the woman's heart rate, rhythm, and circulation D) Assessing the woman for signs and symptoms of fluid volume overload
Assessing the woman for signs and symptoms of infection
The nurse is providing family education for the prevention or early recognition of vaso-occlusive events in sickle cell anemia. Which response by a family member indicates a need for further teaching? a) "We must be compliant with vaccinations and prophylactic penicillin." b) "We must watch for unusual headache, loss of feeling, or sudden weakness." c) "We should call the doctor for any fever over 100°F." d) "We need to seek medical attention for abdominal pain." "We should call the doctor for any fever over 100°F."
C Explanation: The nurse must emphasize that ANY febrile illness requires immediate attention. Fever causes dehydration, which can trigger problems in a child with sickle cell anemia. Seeking medical attention for abdominal pain; watching for unusual headache, loss of feeling, or sudden weakness; and compliance with vaccinations are appropriate.
The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly? Oral temperature of 97°F Respiratory rate of 10 breaths/minute Crackles auscultated bilaterally Pain and tenderness in calf area
Crackles auscultated bilaterally Increasing the flow rate of a blood transfusion too rapidly can result in circulatory overload. Fluid overload can be manifested by crackles in the lungs. A decreased respiratory rate and decreased temperature are not manifestations of fluid overload. Pain and tenderness in the calf area may indicate a thrombosis which is not as common a manifestation as fluid overload.
The charge nurse should intervene when observing a new nurse perform which action after a client has suffered a possible hemolytic blood transfusion reaction?
Disposing of the blood container and tubing in biohazard waste. The blood container and tubing should be returned to the blood bank for repeat typing and culture, and the blood bank should be notified of the reaction.
The nurse is performing an assessment on a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae. What laboratory study should the nurse be concerned about? -WBC count of 4,200 cells/mcL -Hematocrit of 38% -Platelet count of 9,000/mm3 -Creatinine level of 1.0 mg/dL
Platelet count of 9,000/mm3 (p. 553)
The nurse is providing care for an older adult who has a hematologic disorder. What age related change in hematologic function should the nurse integrate into care planning? Bone marrow in older adults produces a smaller proportion of healthy, functional blood cells. Older adults are less able to increase blood cell production when demand suddenly increases. Stem cells in older adults eventually lose their ability to differentiate. The ratio of plasma to erythrocytes and lymphocytes increases with age. Bone marrow in older adults produces a smaller proportion of healthy, functional blood cells.
ANS: B) Older adults are less able to increase blood cell production when demand suddenly increases. Feedback: Due to a variety of factors, when an older person needs more blood cells, the bone marrow may not be able to increase production of these cells adequately. Stem cell activity continues throughout the lifespan, although at a somewhat decreased rate. The proportion of functional cells does not greatly decrease and the relative volume of plasma does not change significantly.
To prevent further sickle cell crisis, you would advise the parents of a child with sickle cell anemia to: a) prevent the child from drinking an excess amount of fluids per day. b) administer an iron supplement daily. c) notify a health care provider if the child develops an upper respiratory infection. d) encourage the child to participate in school activities, such as long-distance running.
C notify a health care provider if the child develops an upper respiratory infection. Reduction of oxygen and dehydration lead to increased sickling of cells. Early prevention of these with respiratory illness is important.
38. The clinical nurse educator is presenting health promotion education to a patient who will be treated for non-Hodgkin lymphoma on an outpatient basis. The nurse should recommend which of the following actions? A) Avoiding direct sun exposure in excess of 15 minutes daily B) Avoiding grapefruit juice and fresh grapefruit C) Avoiding highly crowded public places D) Using an electric shaver rather than a razor
C) Avoiding highly crowded public places The risk of infection is significant for these patients, not only from treatment-related myelosuppression but also from the defective immune response that results from the disease itself. Limiting infection exposure is thus necessary. The need to avoid grapefruit is dependent on the patient's medication regimen. Sun exposure and the use of razors are not necessarily contraindicated
The nurse is caring for an older adult client who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine where the blood loss is coming from, what intervention can the nurse provide? Observe stools for blood. Observe the gums for bleeding after the client brushes teeth. Observe the sputum for signs of blood. Observe client for facial droop
Correct response: A) Observe stools for blood. Explanation: Iron-deficiency anemia is unusual in older adults. Normally, the body does not eliminate excessive iron, causing total body iron stores to increase with age and necessitating maintenance of hydration. If an older adult is anemic, blood loss from the gastrointestinal or genitourinary tracts is suspected. Observing the stool for blood will help detect blood from GI loss. Bleeding gums may indicate periodontal disease, or anticoagulation from medication is not related to age. Blood in sputum can be an indicator of various lung disorders that may affect all age groups. Facial droop may indicate an impending stroke or Bell's palsy and would not be a reason for blood loss.
The nurse is administering 2 units of packed RBCs to an older adult patient who has a bleeding duodenal ulcer. The patient begins to experience difficulty breathing and the nurse assesses crackles in the lung bases, jugular vein distention, and an increase in blood pressure. What action by the nurse is necessary if the reaction is severe? (Select all that apply.) a) Administer diuretics as prescribed. b) Place the patient in an upright position with the feet dependent. c) Discontinue the transfusion. d) Administer oxygen. e) Continue the infusion but slow the rate down.
• Administer diuretics as prescribed. • Discontinue the transfusion. • Administer oxygen. • Place the patient in an upright position with the feet dependent. Correct Explanation: Signs of circulatory overload include dyspnea, orthopnea, tachycardia, and sudden anxiety. Jugular vein distention, crackles at the base of the lungs, and an increase in blood pressure can also occur. If the transfusion is continued, pulmonary edema can develop, as manifested by severe dyspnea and coughing of pink, frothy sputum. If fluid overload is mild, the transfusion can often be continued after slowing the rate of infusion and administering diuretics. However, if the overload is severe, the patient is placed upright with the feet in a dependent position, the transfusion is discontinued, and the primary provider is notified. Oxygen and morphine may be needed to treat severe dyspnea (see Chapter 29).
A client with leukemia is being discharged from the hospital to hospice care. Which statement by the client indicates the client has not achieved the goal for the nursing diagnosis Spiritual Distress? A) "I do not understand why this happened to me." B) "I know I am going to die. I want to say good-bye to my family." C) "I am going to call my clergy to pray with me." D) "I have resources within myself that I can depend on."
ANS: A) "I do not understand why this happened to me." The statement "I do not understand why this happened to me" indicates that the client is not accepting of the consequences of his health problems and impending death. The other statements indicate the client has plans that would result in spiritual well-being or harmony.)
The blood bank notifies the nurse that the two units of blood ordered for an anemic patient are ready for pick up. Which action should the nurse take to prevent an adverse effect during this procedure? A. Immediately pick up both units of blood from the blood bank. B. Infuse the blood slowly for the first 15 minutes of the transfusion. C. Regulate the flow rate so that each unit takes at least 4 hours to transfuse. D. Set up the Y-tubing of the blood set with dextrose in water as the flush solution.
B. Infuse the blood slowly for the first 15 minutes of the transfusion. (no more than 5ml/hr) Because a transfusion reaction is more likely to occur at the beginning of a transfusion, the nurse should initially infuse the blood at a rate no faster than 2 mL/min and remain with the patient for the first 15 minutes after hanging a unit of blood. Only one unit of blood can be picked up at a time, must be infused within 4 hours, and cannot be hung with dextrose.
A client is suspected of having leukemia and is having a series of laboratory and diagnostic studies performed. What does the nurse recognize as the hallmark signs of leukemia? Select all that apply. - Fatigue from anemia - Frequent infections - Nausea and vomiting - Easy bruising - Diarrhea
Easy bruising fatigue from anemia
