Module 9: Heme/Immune

What do erythrocytes transport?

oxygen and carbon dioxide

A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The physician begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption? A. intrinsic factor B. hydrochloric acid C. liver enzyme D. histamine

A

A pigment containing Iron that occurs with the breakdown of hemoglobin A. hemosiderin B. hypochromia

A

Asthma, allergic rhinitis, and anaphylaxis fall into this category of hypersensitivity reaction A. Type I B. Type II C. Type III D. Type IV

A

Lymphocyte cells that can cause graft rejection, kill foreign cells, of suppress production of antibodies A. T cells B. Monocytes C. B cells

A

A patient is suspected to have anemia. What lab tests would you expect the HCP to order to confirm this diagnosis? Select all that apply A. MCV (mean corpuscular volume) B. TIBC (total iron-binding capacity) C. CMP D. BUN E. BNP

AB (also H&H, ferritin, iron, B12, RBCs)

Which of the following are potential complications of anemia? Select all that apply A. Heart failure B. Paresthesias C. Constipation D. Trigeminal neuralgia E. Depressed mood

ABE

Match the term with the correct definition A. normocytic B. red blood cells of varying size C. red blood cells of normal size D. red blood cells that are smaller than normal E. microcytosis F. poikilocytosis

AC, BF, DE

Erythropoietin (a hormone needed for erythropoiesis) is produced by the.. A. Parathyroid gland B. Kidneys C. Bone marrow D. Pancreas

B

Which iron-rich foods should a nurse encourage an anemic client requiring iron therapy to eat? A. Shrimp and tomatoes B. Lamb and peaches C. Cheese and bananas D. Lobster and squash

B

All of the following may lead to hypoproliferative anemia except... A. Iron deficiency B. Sickle cell disease C. Decreased erythropoietin D. Folate deficiency

B (Hypoproliferative anemia = resulting from defective RBC production)

An antigen is a protein developed by the body in response to an allergen A. True B. False

B (that's an antibody)

Which of the following food items are good sources of folate? Select all that apply A. Eggs B. Green, leafy vegetables C. Liver D. Root vegetables E. Citrus fruits

BC

With which chronic diseases are the anemias of inflammation most common? Select all that apply A. PCOS B. Rheumatoid arthritis C. Crohn's disease D. Cancer

BC

What should the nurse include in her teaching about iron supplements? Select all that apply A. Take with a glass of milk or other forms of vitamin D B. Take iron on an empty stomach C. Take iron with food D. Eat foods high in fiber to minimize constipation E. Call your PCP if you notice your stools become dark in color

BD (vitamin C increases absorption and stools are expected to be darker w/ iron)

A client develops a facial rash and urticaria after receiving penicillin. Which laboratory value does the nurse expect to be elevated? A. IgA B. IgB C. IgG D. IgE

D

A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client? A. Sore tongue, dyspnea, and weight gain B. Pallor, bradycardia, and reduced pulse pressure C. Angina pectoris, double vision, and anorexia D. Pallor, tachycardia, and a sore tongue

D

When the bone marrow cells lack development A. hypochromia B. microcytosis C. polycythemia D. aplasia

D

Major goals for a patient w/ anemia may include...

Decreased fatigue, adequate nutrition, adequate tissue perfusion, compliance w/ prescribed therapy

The nurse is teaching a client about the symptoms of anaphylaxis. Which client statements indicate no further teaching is needed? Select all that apply A. If I start having difficulty breathing, I need to get help right away B. If I experience recurrent diarrhea after eating, I will need to call my doctor C. Peripheral tingling is a symptom of anaphylaxis reaction

A

A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client? A. Use the smallest needle possible for injections B. Maintain accurate fluid intake and output records C. Limit visits by family members D. Encourage the client to use a wheelchair

A (Because thrombocytopenia alters coagulation, it poses a high risk of bleeding)

The nurse cares for a client with iron deficiency anemia. What findings will the nurse expect to find when reviewing the client's CBC results? Select all that apply A. Decreased MCV B. Fragmented RBCs C. Decreased reticulocytes D. Increased reticulocytes

AC (MCV = mean corpuscular volume)

A nurse is teaching a client how to use their EpiPen autoinjector. What client statement indicates the teaching is understood? Select all that apply A. The needle needs to be at a 90-degree angle B. The EpiPen autoinjector should be held against the injection site for 20 seconds C. After I administer the injection, I will massage the area for 10 seconds D. The EpiPen autoinjector needs to be pointed downward

ACD (Massaging the area for 10 secs increases the speed of absorption)

Which of the following patients might be at risk for vitamin B12 deficiency? Select all that apply A. Pt's w/ Crohn's disease B. Strict vegetarians C. Pt's s/p gastrectomy D. Smokers E. Diabetics on metformin

ACE

The nurse cares for several clients with hematological conditions. Which assessment needs will the nurse prioritize for the client with aplastic anemia? Select all that apply A. Infection B. Oxygenation C. Perfusion D. Bleeding

AD

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy? A. "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." B. "I will receive parenteral vitamin B12 therapy for the rest of my life." C. "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal." D. "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear."

B (because a client with pernicious anemia lacks intrinsic factor, oral vitamin B12 can't be absorbed)

The daily white blood cell (WBC) count in a client with aplastic anemia drops overnight from 3,900 to 2,900/µl (3.9 to 2.9 X 109/L). Which is the appropriate nursing intervention? A. Call the laboratory to verify the report B. Call the primary care provider, and request that the client be placed in reverse isolation C. Continue to monitor the patient D. Document the finding

B (because the normal defenses are ineffective and place the client at risk for infection)

Lymphocyte cells that are important in producing antibodies A. T cells B. Monocytes C. B cells

C

_____ is the most common type of anemia in all age groups A. Autoimmune anemia B. Folate deficiency C. Iron deficiency D. Cancer

C (affects 1/8 people worldwide)

Which of the following could cause hemolytic anemia? Select all that apply A. Trauma B. Vitamin B12 deficiency C. Hypersplenism (hemolysis) D. Drug-induced anemia

CD (Hemolytic = resulting from RBC destruction)

A patient comes to the clinic with pruritus and nasal congestion after eating shrimp for lunch. The nurse is aware that the patient may be having an anaphylactic reaction to the shrimp. These symptoms typically occur within how many hours after exposure? A. 6 hours B. 12 hours C. 24 hours D. 2 hours

D

A client with sickle cell anemia has a.... A. normal hematocrit B. normal blood smear C. high hematocrit D. low hematocrit

D (a pt w/ sickle cell anemia has a low hematocrit and sickled cells on the smear. A pt w/ sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear)