Nurse 3 Module 6 ANEMIA
A client comes to the walk-in clinic complaining of weakness and fatigue. While assessing this client, the nurse finds evidence of petechiae and ecchymoses. The nurse notes that the spleen appears enlarged. What would the nurse suspect is wrong with this client? Beta Thalassemia Major Aplastic Anemia Iron-Deficiency Anemia Megaloplastic Anemia
Aplastic anemia
The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency? B12 C A Folate
B12 Explanation: The medication metformin (Glucophage) increases the client's risk for developing B12 deficiency because the medication inhibits the absorption of B12. Reference: Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 917
Which of the following are assessment findings associated with thrombocytopenia? Select all that apply. Bleeding gums Epistaxis Hematemesis Bradypnea Hypertension
Bleeding gums Epistaxis Hematemesis
A client receiving a unit of packed red blood cells (PRBCs) has been prescribed morphine 1 mg intravenously now for pain. What is the best method for the nurse to administer the morphine? Add the morphine to the blood to be slowly administered. Inject the morphine into a distal port on the blood tubing. Administer the morphine into the closest tubing port to the client for fast delivery. Disconnect the blood tubing, flush with normal saline, and administer morphine
Disconnect the blood tubing, flush with normal saline, and administer morphine. Explanation: Never add medications to blood or blood products. The transfusion must be temporarily stopped in order to administer the morphine. Reference: Chapter 28: Assessment of Hematologic Function and Treatment Modalities - Page 901
A client receiving a blood transfusion reports shortness of breath, appears anxious, and has a pulse of 125 beats/minute. What is the best action for the nurse to take after stopping the transfusion and awaiting further instruction from the health care provider? Place the client in a recumbent position with legs elevated. Remove the intravenous line. Ensure there is an oxygen delivery device at the bedside. Administer prescribed PRN anti-anxiety agent.
Ensure there is an oxygen delivery device at the bedside. Explanation: The client is exhibiting signs of circulatory overload. After stopping the transfusion and notifying the healthcare provider, the nurse should place the client in a more upright position with the legs dependent to decrease workload on the heart. The IV line is kept patent in case emergency medications are needed. Oxygen and morphine may be needed to treat severe dyspnea. Administering an anti-anxiety agent is not a priority action over ensuring oxygen is available.
A 68-year-old man comes to the physician complaining of fatigue for the last several weeks. He has been feeling dizzy and short of breath when climbing the stairs to his 2nd-floor apartment. He has not visited a physician in years because he has "always felt healthy." He has no paresthesias, cognitive impairment, joint pains, or abnormal bleeding episodes. Temperature is 37.0°C (98.6°F), pulse is 96/min, respirations are 14/min, and blood pressure is 144/88 mmHg. Physical examination shows conjunctival pallor. The neck is nontender, and no mass is palpated. Oropharyngeal examination reveals an enlarged, erythematous tongue, and no gingival pigmentation is noted. Laboratory investigations show a hemoglobin level of 9.9 g/dL. A stool guaiac test is positive. Which of the following is the likely pathophysiology of this patient's condition? Impaired heme synthesis due to decreased substrate availability Overproduction of cytokines Defective globin synthesis Impaired heme synthesis due to enzyme inhibition Destruction of myeloid stem cells
Impaired heme synthesis due to decreased substrate availability Explanation: This elderly male is presenting with fatigue and dyspnea, along with physical examination findings of conjunctival pallor and glossitis. The low hemoglobin and positive fecal occult blood test (FOBT) raise concern for iron-deficiency anemia secondary to an underlying gastrointestinal malignancy. Given this patient has not visited a physician in many years, he likely missed opportunities to be screened for colon cancer via colonoscopy. Iron is an integral substrate involved in the synthesis of heme. Therefore, chronic blood loss can result in iron-deficiency anemia. Regardless of the cause, laboratory testing in patients with iron-deficiency anemia will demonstrate decreased hemoglobin levels, microcytosis (decreased mean corpuscular volume), hypochromia (decreased mean corpuscular hemoglobin), and decreased reticulocyte count.
Which of the following are assessment findings associated with thrombocytopenia? Select all that apply. Bleeding gums Epistaxis Hematemesis Bradypnea Hypertension
Bleeding gums Epistaxis Hematemesis Pertinent findings of thrombocytopenia include: bleeding gums, epistaxis, hematemesis, hypotension, and tachypnea. Reference: Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 932
The nurse is assessing a female client with a hemoglobin of 6.8 g/dL (68 g/L). Which symptoms would the nurse expect to find? Select all that apply. Pink skin and mucous membranes Dyspnea Headache Faintness Bradycardia
Dyspnea Headache Faintness In anemia, the oxygen-carrying capacity of hemoglobin is reduced, causing tissue hypoxia. Tissue hypoxia can give rise to fatigue, weakness, dyspnea and sometimes angina. Hypoxia of brain tissue results in headache, faintness and dim vision. Redistribution of blood from cutaneous tissues or a lack of hemoglobin causes pallor of the skin and mucous membranes. Tachycardia and palpitation may occur as the body tries to compensate with an increase in cardiac output. Reference: Chapter 23: Disorders of Red Blood Cells - Page 572-573
A 50-year-old client is reporting that the client's oral B12 is not working. The nurse knows that the vitamin may have a decreased absorption rate when taken with other substances. The nurse would begin the history by asking which questions? (Select all that apply.) "Do you drink alcohol?" "Do you take a PPI medication?" "Do you take colchicine?" "Are you constipated?" "Do you use neomycin?"
"Do you use neomycin?" "Do you drink alcohol?" "Do you take colchicine?" Alcohol, neomycin, and colchicine may decrease the absorption level of oral vitamin B12. Constipation would not affect the absorption level of oral vitamin B12. Reference: Chapter 49: Drugs Used to Treat Anemias - Page 861
A health care provider prescribes one tablet of ferrous sulfate daily for a 15-year-old girl who experiences heavy blood flow during her menstrual cycle. The nurse advises the patient and her parent that this over-the-counter preparation must be taken for how many months before stored iron replenishment can occur? 1 to 2 months 3 to 5 months 6 to 12 months Longer than 12 months
6 to 12 months Explanation: Ferrous sulfate can increase hemoglobin levels in a few weeks, and anemia may be corrected in a few months. However, it takes 6 to 12 months for stored iron replenishment to occur. Reference: Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 915
A client being treated for iron deficiency anemia with ferrous sulfate (Ferasol) continues to be anemic despite treatment. What IV treatments are available for iron supplementation?
Ferric Gluconate Iron Sucrose
A nurse administers blood products to a client with Hodgkin disease. During the administration, the nurse notes the client has a fever and diffuse reddened skin rash. From what condition does the nurse suspect the client is suffering? Creutzfeldt-Jakob disease Delayed hemolytic reaction Graft-versus-host disease Bacterial contamination
Graft-versus-host disease Explanation: Graft-versus-hold disease (GVHD) occurs in only severely immunocompromised recipients (such as those with Hodgkin disease). The transfused lymphocytes attack the host lymphocytes or body tissues; symptoms or signs may include fever, diffuse reddened skin rash, nausea, vomiting, and diarrhea. The other answer choices are complications that can occur as a result of blood transfusion; however, these do not present with a diffuse reddened skin rash.
What would a nurse identify as a contraindication for iron therapy? (Select all that apply.) Hemolytic anemia Peptic ulcer disease Colitis Nasal ulcers Leukopenia
Hemolytic anemia Peptic ulcer disease Colitis Explanation: Patients with hemolytic anemia may develop iron toxicity with iron therapy. Patients with peptic ulcer disease may experience irritation of the tissues and exacerbate the condition with iron therapy. Patients with colitis may experience increased tissue irritation, exacerbating the condition when iron is used. Nasal ulcers require cautious use of intranasal cyanocobalamin. Leukopenia is a contraindication for the use of hydroxyurea for sickle cell anemia. Reference: Chapter 49: Drugs Used to Treat Anemias - Page 868
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 Explanation: Hemolytic allergic reactions are fairly common and may cause chills, fever, urticaria, tachycardia, dyspnea, chest pain, hypotension, and other signs of anaphylaxis a few minutes after blood transfusion begins. Although rare, a hemolytic reaction to mismatched blood can occur, triggering a more severe reaction and, possibly, leading to disseminated intravascular coagulation. A hemolytic reaction to Rh-incompatible blood is less severe and occurs several days to 2 weeks after the transfusion. Bacterial contamination of donor blood causes a high fever, nausea, vomiting, diarrhea, abdominal cramps and, possibly, shock
For which health problem is stem cell transplantation likely to be of therapeutic benefit? Aplastic anemia alpha-thalassemia Anemia resulting from a chronic disease Secondary polycythemia
Aplastic anemia Explanation: The etiology of aplastic anemia involves depression of the bone marrow, a problem that can sometimes be treated by stem cell transplantation. Polycythemia, alpha-thalassemia, and anemias caused by chronic diseases are not amenable to stem cell transplantation. Beta-thalassemia (not alpha) has a potential to be cured from stem cell transplantation. Reference: Chapter 23: Disorders of Red Blood Cells - Page 579
Which type of sickle crisis occurs as a result of infection with the human parvovirus? Sequestration crisis Aplastic crisis Sickle cell crisis Acute chest syndrome
Aplastic crisis Explanation: Aplastic crisis results from infection with the human parvovirus. Sequestration crisis results when other organs pool the sickled cells. Sickle cell crisis results from tissue hypoxia and necrosis due to inadequate blood flow to a specific region of tissue or organ. Acute chest syndrome is manifested by a rapidly decreasing hemoglobin concentration, tachycardia, fever, and bilateral infiltrates seen on chest x-ray. Reference: Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 919-920
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 physician immediately because the client probably is experiencing which problem? acute hemolytic delayed hemolytic hemolytic allergic reaction caused by an antigen reaction febrile non-hemolytic caused by bacterial contamination
A hemolytic allergic reaction caused by an antigen reaction
A client had a bone marrow biopsy yesterday and reports aching at the biopsy site, rated a 5 (on a 1-10 scale). After assessing the biopsy site, which nursing intervention is most appropriate? Reposition the client to a high Fowler position and continue to monitor the pain Administer aspirin (ASA) 325 mg po, as ordered Administer acetaminophen 500 mg po, as ordered Notify the physician
Administer acetaminophen 500 mg po, as ordered >>>After a marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing. Most clients have no discomfort after a bone marrow biopsy, but the site of a biopsy may ache for 1 or 2 days. Warm tub baths and a mild analgesic agent (e.g., acetaminophen) may be useful. Aspirin-containing analgesic agents should be avoided it the immediate post-procedure period because they can aggravate or potentiate bleeding.
A nurse working with clients diagnosed with sickle cell disease notices that sickle cell crisis cases increase in the winter months. What is the primary pathophysiological reason for this? Colder temperatures slows the blood flow. Colder temperatures worsens sickling. Colder temperatures increases vessel pressures. Colder temperatures impairs oxygen uptake.
Colder temperatures slows the blood flow
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 Iron is best absorbed with vitamin C.
A client is prescribed an intravenous dose of iron dextran. What is the nurse's best action? Ensures that epinephrine is available Realizes that use of this medication will produce a false-positive when checking stool for blood Informs the client that one dose will reverse iron-deficiency anemia Checks the client's hemoglobin level the following day
Ensures that epinephrine is available Explanation: When iron is given intravenously, the nurse should have emergency medications, such as epinephrine, available in case of anaphylaxis. Iron preparations will not cause a false-positive on stool analysis for occult blood. One dose of iron will not reverse iron-deficiency anemia; in fact, several doses of iron are required to replenish the client's deficient iron stores. The client's hemoglobin levels may increase in a few weeks.
A client with severe anemia is admitted to the hospital. Because of religious beliefs, the client is refusing blood transfusions. The nurse anticipates pharmacologic therapy with which drug to stimulate the production of red blood cells? Filgrastim Sargramostim Epoetin alfa Eltrombopag
Epoetin alfa
g/L) tells the nurse that "my bones ache and my sternum is tender." The nurse understands which physiologic factor is playing a role in this client's discomfort? Erythropoiesis Tissue hypoxia Reduction in hemoglobin Extravascular hemolysis
Erythropoiesis Explanation: In anemia, erythropoiesis is accelerated and may be recognized by diffuse bone pain and sternal tenderness. The other options do not cause bone discomfort.
A client wants to donate blood before his or her abdominal surgery next week. What should be the nurse's first action? Provide the client with a list of the nearest donation centers. Explain the time frame needed for autologous donation. Remind the client to take supplemental iron before donation. Tell the client that 2 units of blood will be needed
Explain the time frame needed for autologous donation. Explanation: Preoperative autologous donations are ideally collected 4 to 6 weeks before surgery. The nurse should first explain that time frame to this client. Surgery is scheduled in one week which means that autologous blood donation may not be an option for this client. A list of donation centers can be provided to the client; and even though iron is recommended and 2 units of blood may be suggested, the first action is to tell the client about the needed time frame for donation.
A patient with sickle cell anemia is to begin treatment for the disease with hydroxyurea. What does the nurse inform the patient will be the benefits of treatment with this medication? Select all that apply. Fewer painful episodes of sickle cell crisis Ability to reverse the damage done from sickling of cells Lower incidence of acute chest syndrome Decreased need for blood transfusions Decreased need for other analgesic medications
Fewer painful episodes of sickle cell crisis Lower incidence of acute chest syndrome Decreased need for blood transfusions Explanation: Hydroxyurea is a chemotherapy agent that is effective in increasing fetal hemoglobin (i.e., hemoglobin F) levels in patients with sickle cell anemia, thereby decreasing the formation of sickled cells. Patients who receive hydroxyurea appear to have fewer painful episodes of sickle cell crisis, a lower incidence of acute chest syndrome, and less need for transfusions. However, whether hydroxyurea can prevent or reverse actual organ damage remains unknown. Reference: Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 921
Select the option that best describes the pathogenesis of the anemia in a client with beta-thalassemia. Heinz bodies impair DNA synthesis and damage the red blood cell (RBC) membrane. Increased levels of hemoglobin (hyperchromia) occur. Premature destruction of cells occurs due to rigid, nondeformable membranes. Hemoglobin becomes sickled (HbS) when deoxygenation occurs.
Heinz bodies impair DNA synthesis and damage the red blood cell (RBC) membrane. Explanation: In this form of thalassemia, Heinz bodies impair DNA synthesis and cause damage to the red cell membrane. All of the other options occur with sickle cell anemia, not with thalassemia. Reference: Chapter 23: Disorders of Red Blood Cells - Page 576
Splenic sequestration is diagnosed in a client admitted with splenomegaly. What is the priority of care for this client? Infection Hypovolemia Hyperthermia Hypertension
Hypovolemia Explanation: If the spleen is enlarged, a greater proportion of red cells and platelets can be sequestered. With less red blood cells in circulation, the client can become hypovolemic resulting in shock. Decreased white blood cells in circulation, not red blood cells, increases the chance of infection. Decreased circulatory volume results in hypotension, not hypertension. Hyperthermia is not a result of decreased red blood cells in circulation.
During a routine assessment of a patient diagnosed with anemia, the nurse observes the patient's beefy red tongue. The nurse is aware that this is a sign of what kind of anemia? Autoimmune Folate deficiency Iron deficiency Megaloblastic
Megaloblastic Explanation: A beefy, red, sore tongue is a characteristic indicator of megaloblastic anemia. The nurse should assess for other signs such as fatigue, hypotension, and tachycardia. Safety issues should also be assessed because balance, coordination, and gait are affected due to B12 deficiency NEUROLOGICAL implications. Reference: Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 917
A client with a diagnosis of pernicious anemia comes to the clinic complaining of numbness and tingling in his arms and legs. What do these symptoms indicate?
Neurologic involvement
A patient receiving plasma develops transfusion-related acute lung injury (TRALI) 4 hours after the transfusion. What type of aggressive therapy does the nurse anticipate the patient will receive to prevent death from the injury? (Select all that apply.) Serial chest x-rays Oxygen Fluid support Intubation and mechanical ventilation Intra-aortic balloon pump
Oxygen Fluid support Intubation and mechanical ventilation Explanation: Transfusion-related acute lung injury (TRALI) is a potentially fatal, idiosyncratic reaction that is defined as the development of acute lung injury occurring within 6 hours after a blood transfusion. Aggressive supportive therapy (e.g., oxygen, intubation, fluid support) may prevent death.
Which is the following is the most obvious sign of anemia? Pallor Fatigue Jaundice Iron Deficiency
Pallor is the most OBVIOUS sign
The client is planned to have a splenectomy. The nurse should prepare which medication to administer to this client? Aspirin Immunoglobulin G (IgG) Pneumococcal vaccine Factor VIII
Pneumococcal vaccine Explanation: Without a spleen, the client's risk of infection is greatly increased. The pneumococcal vaccine should be administered, preferable before splenectomy. Aspirin should not be administered due to the increased risk of bleeding. IgG is administered to client with increased chance of bacterial infections but is not routinely given to client undergoing splenectomy, as is the pneumococcal vaccine. Factor VII is given to treat bleeding disorders.
The nurse is administering a blood transfusion to a client over 4 hours. After 2 hours, the client reports chills and has a fever of 101°F, an increase from a previous temperature of 99.2°F. What does the nurse recognize is occurring with this client? -The client is having an allergic reaction to the blood. -The client is experiencing vascular collapse. -The client is having decrease in tissue perfusion from a shock state. -The client is having a febrile nonhemolytic reaction
The client is having a febrile nonhemolytic reaction. Explanation: The signs and symptoms of a febrile nonhemolytic transfusion reaction are chills (minimal to severe) followed by fever (more than 1°C elevation). The fever typically begins within 2 hours after the transfusion is begun. Although the reaction is not life threatening, the fever, and particularly the chills and muscle stiffness, can be frightening to the client. Reference: Chapter 28: Assessment of Hematologic Function and Treatment Modalities - Page 902
A client who was previously diagnosed with Glucose-6-Phosphate Dehydrogenase presents to the emergency room with pallor, jaundice, and hemoglobinuria develop. Labs show elevated reticulocyte count and special stains of peripheral blood show Heinz bodies (degraded hemoglobin) within the erythrocytes. What priority question would the nurse ask the client in assessing the cause of this hemolytic episode? Have you been stressed out lately? Have you started a new exercise program? What medications have you taken in the past few days? Have you experienced a recent trauma?
What medications have you taken in the past few days? Recent exposure to oxidant drugs are the most common cause of hemolytic episode of G6PD. The nurse must quickly identify the cause of the episode as a priority.
A client, currently prescribed epoetin alfa, has recent blood work that reveals a hemoglobin level of 12.8 g/dL. What action does this assessment finding necessitate regarding the epoetin alfa? temporarily withholding administration administering an unscheduled dose changing the route of administration requesting a change in the dosage
temporarily withholding administration Explanation: Epoetin increases risks of myocardial infarction and stroke, especially if it is used to achieve hemoglobin levels greater than 12 g/dL (120 g/L). The U.S. Food and Drug Administration (FDA) has issued a black box warning advising prescribers to avoid using hematopoietic growth factors in clients with hemoglobin values of 12 g/dL (120 g/L). Administration of the drug should consequently be discontinued on a temporary basis. None of the other options would safely address the client's current health issue. Reference: Chapter 49: Drugs Used to Treat Anemias - Page 866
All cells of the body age and are replaced in a natural order. When RBCs age, they are destroyed in the spleen. During this process, the iron from their hemoglobin is released into the circulation and returned to: the bone marrow for incorporation into new RBCs. to the liver to bind with oxygen. to the lungs to bind with oxygen. to the muscles to be stored for strength
to the bone marrow for incorporation into new RBCs. Explanation: When RBCs age and are destroyed in the spleen, the iron from their hemoglobin is released into the circulation and returned to the bone marrow for incorporation into new RBCs, or to the liver and other tissues for storage. Iron is not bound to RBCs in the liver. Iron does not bind with oxygen in the lung without first being incorporated into an RBC. Iron is stored in tissues of the body, but not for strength, only for its oxygen-binding capacity. Reference: Chapter 23: Disorders of Red Blood Cells - Page 563
A patient with chronic renal failure is examined by the nurse practitioner for anemia. The nurse knows to review the laboratory data for a decreased hemoglobin level, red blood cell count, and which of the following?
Decreased level of erythropoietin
Amniocentesis has suggested that a couple's first child will be born with sickle cell disease. The parents are unfamiliar with the health problem and their caregiver is explaining the complexities. Which statement by the parents would suggest a need for further teaching or clarification? "Our baby's red cells are prone to early destruction because of their weak membranes." "Not all of his or her red cells will be sickled, but low oxygen levels can cause them to become so." "Sickled cells can block his or her blood vessels, especially in the abdomen, chest, and bones." "Our son or daughter likely won't show the effects of sickling until he or she is school-aged because of the different hemoglobin in babies."
Our son or daughter likely won't show the effects of sickling until he or she is school-aged because of the different hemoglobin in babies." Explanation: Fetal hemoglobin in the infant is replaced by 8 or 10 weeks of age and manifestations of sickle cell disease can begin at this time. Early destruction, low oxygen levels, and sickled cells all convey aspects of sickle cell disease. Reference: Chapter 23: Disorders of Red Blood Cells - Page 575
A 7-year-old boy presents to the physician with his parent due to severe abdominal pain for the past several days. The patient states the pain occurs "randomly" while playing,and would often go away on its own. His last bowel movement was 3 days ago. The parent reports being called to meet with the boy's teacher several times in the last 2 months due to the boy's poor academic performance and inability to sit still. He also states that other children at the patient's school have had similar symptoms. Vital signs are within normal limits. Physical examination shows pale conjunctiva. Oropharyngeal examination reveals lines of hyperpigmentation on the gingiva. The abdomen is slightly distended and tender to palpation. The boy is showing signs of beta thalassemia major lead poisoning febrile non-hemolytic transfusion reaction Sickle Cell Crisis
He most likely has lead poisoning. Patients may also present with a purple-blue line that is visible at the margin of the gums (Burton line). On a peripheral smear, lead poisoning can manifest with basophilic stippling. This finding arises since lead inhibits RNA degeneration, which causes ribosomes to aggregate and remain visible in erythrocytes as blue stipples. Additionally, lead inhibits several key enzymes involved in heme synthesis, resulting in microcytic anemia.
Which conditions predispose a person with sickle cell anemia to develop sickling of hemoglobin? Impaired red blood cell maturation Increased iron content of blood Decreased oxygen saturation Increased intravascular volume
Decreased oxygen saturation Explanation: Low oxygen in the tissues will cause red blood cells to take on the sickle shape in persons with sickle cell anemia. Sickle cell disease is a disorder of hemoglobin S and does not affect red blood cell maturation. The iron content is not affected by the sickling, but the capacity to carry the iron can be an effect of the affected RBCs. Dehydration can cause sickling by increasing the concentration of hemoglobin. Reference: Chapter 23: Disorders of Red Blood Cells - Page 574
Dyspnea, stomatitis (inflammation of the mouth), and glossitis (inflammation of the tongue) are symptoms of Megaloblastic Anemia Thalassemia Autoimmune Hemolytic Anemia Hemochromatosis
Megaloblastic Anemia
A 2-year-old boy is brought to the clinician by his parents due to easy fatigability and growth delay. They recently immigrated to the United States. The mother did not receive any prenatal care in her home country. The child was born at term by a normal vaginal delivery. He is at the 30th percentile for length and below the 10th percentile for weight. Temperature is 37.2°C (98.9°F), pulse is 115/min, respirations are 25/min, and blood pressure is 85/60 mmHg. Abdominal examination shows hepatosplenomegaly. Hematological tests and hemoglobin electrophoresis show: low hemoglobin and absent HbA1 on hemoglobin electrophoresis. Which of the following is the most likely diagnosis? aLpha-thalassemia maior Hemoglobin H disease Beta thalassemia minor Beta thalassemia major Sickle cell trait Sickle cell disease
Beta thalassemia major explanation: This patient is presenting with growth delay, fatigability, and hepatosplenomegaly (indicating extramedullary hematopoiesis). He also has laboratory investigations showing a low hemoglobin and absent HbA1 on hemoglobin electrophoresis. As a result, he most likely has -thalassemia major. Clinical features of -thalassemia major include symptoms and signs of severe anemia due to ineffective erythropoiesis and extravascular hemolysis such as fatigability, failure to thrive, high-output heart failure, and pallor. There may also be jaundice and dark urine from extravascular hemolysis. Patients may have evidence of extramedullary hematopoiesis including hepatosplenomegaly and craniofacial abnormalities such as thickened facial bones ("chipmunk facies"). Skull radiographs may show a translucent medullary space with hair-like projections ("hair on end" or "crew cut" appearance).
Which conditions predispose a person with sickle cell anemia to develop sickling of hemoglobin? Impaired red blood cell maturation Increased iron content of blood Decreased oxygen saturation Increased intravascular volume
Decreased oxygen saturation Explanation: Low oxygen in the tissues will cause red blood cells to take on the sickle shape in persons with sickle cell anemia. Sickle cell disease is a disorder of hemoglobin S and does not affect red blood cell maturation. The iron content is not affected by the sickling, but the capacity to carry the iron can be an effect of the affected RBCs. Dehydration can cause sickling by increasing the concentration of hemoglobin.
A nurse cares for several clients with anemia and notes that all the clients have different types of anemia. What is the nurse's best understanding of how anemias are classified, based on the deficiency of erythrocytes? Select all that apply. Shape of erythrocytes Defective production of erythrocytes Quantity of erythrocytes Destruction of erythrocytes Loss of erythrocytes
Defective production of erythrocytes Destruction of erythrocytes Loss of erythrocytes A physiologic approach classifies anemia according to whether the deficiency in erythrocytes is caused by a defect in their production (i.e., hypoproliferative anemia), by their destruction (i.e., hemolytic anemia), or by their loss (i.e., bleeding). Shape and quantity of erythrocytes are not categories of classifications of anemia. Chapter 29: Management of Patients with Nonmalignant Hematologic Disorders - Page 910
When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply. Dietary intake Medication use Ethnicity Herbal supplements Hair color
Dietary intake Medication use Ethnicity Herbal supplements Dietary intake, ethnicity, use of herbal supplements, and medication use are factors for which the nurse should assess. Hair color is not considered a factor in determining causes of hematological disorders. Reference: Chapter 28: Assessment of Hematologic Function and Treatment Modalities - Page 891
A nurse is performing an initial assessment and notes the client's skin is a gray-tan color, especially on the scars of the client's arms. Which hematological condition does the nurse suspect? Polycythemia Vitamin B12 deficiency Thrombocytopenia Hemochromatosis
Hemochromatosis Explanation: Hemochromatosis is an autosomal recessive disease of excessive iron absorption. This results in bronze or gray-tan skin, especially over scars. The other answer choices are hematological conditions; however, these do not cause the skin to turn a gray-tan color. Reference: Chapter 28: Assessment of Hematologic Function and Treatment Modalities - Page 893
A 75-year-old man comes to his primary care physician for a routine visit. Five months ago, his wife died from a stroke. The patient reports feeling depressed, and he has been consuming large quantities of vodka on a daily basis. He previously ate a balanced diet. However, he has had little motivation to cook since his wife passed away, and he currently eats crackers and beef jerky purchased from a convenience store. His temperature is 37.2°C (99.0°F), blood pressure is 117/81 mmH‹ pulse is 71/min, and respiratory rate is 12/min. Complete blood count reveals a hemoglobin of 9.2 g/dL and a mean corpuscular volume (MCV) of 110 um3. A peripheral smear is ordered and show immature, hypersegmented neutrophils (greater than 5 lobes). Which of the following is the most likely explanation for this patient's findings? A Iron deficiency secondary to bleeding in the gastrointestinal tract Impaired DNA synthesis resulting from vitamin B12 deficiency Impaired DNA synthesis resulting from vitamin B9 deficiency
Impaired DNA synthesis resulting from vitamin B9 deficiency Explanation: Patients with folate deficiency present with macrocytic megaloblastic anemia and hypersegmented neutrophils. Causes of folate deficiency include poor diet, medication side-effects, and excessive alcohol consumption. Patients can present with fatigue, pallor, and glossitis. The work-up includes obtaining a blood smear, bone marrow study, and homocysteine levels.
A client receiving a unit of packed red blood cells develops hives and generalized itching. Which actions will the nurse take to help this client? Select all that apply. Stop the transfusion Apply oxygen via a face mask Notify the primary health care provider Slow the rate of the transfusion Administer diphenhydramine as prescribed
STOP NOTIFY HCP ADMINISTER ANTIHISTAMINE Some clients develop urticaria (hives) or generalized itching during a transfusion; the cause is thought to be a sensitivity reaction to a plasma protein within the blood component being transfused. Symptoms of an allergic reaction are urticaria, itching, and flushing. The reactions are usually mild and respond to antihistamines. The nurse should stop the transfusion and notify the primary health care provider of the client's symptoms. If the symptoms subside, the transfusion can be resumed. The client does not need oxygen. Slowing the rate of the transfusion would not help reduce the symptoms.
What does the nurse do FIRST when determining the type and severity of a transfusion reaction. Notify the health care provider Stop the transfusion Send the tubing and container to the blood bank. Assess the client. Notify the blood bank.
Stop the transfusion. then: Assess the client. Notify the health care provider. Notify the blood bank. Send the tubing and container to the blood bank. It is important for the nurse to take the proper steps when determining the type and severity of a transfusion reaction. The priority action is to stop the infusion and then assess the client. Next, the health care provider will be notified, followed by the blood bank. Finally, the nurse should send the tubing and container to the blood bank for analysis. Reference: Chapter 28: Assessment of Hematologic Function and Treatment Modalities - Page 906
An infant from parents of Mediterranean decent has been diagnosed with a severe form of β-thalassemia anemia. The nurse caring for this infant knows that the infant will most likely receive which medical treatment? Transfusion therapy Iron sulfate supplements Stem cell transplant Warfarin, a blood thinner to decrease clot formation
Transfusion therapy Explanation: Persons who are homozygous for the trait (thalassemia major) have severe, transfusion-dependent anemia that is evident at 6 to 9 months of age when the hemoglobin switches from HbF to HbA. If transfusion therapy is not started early in life, severe growth retardation occurs in children with the disorder. Iron and blood thinners will not be therapeutic for this client. Stem cell transplantation is a potential cure for low-risk clients, particularly in younger persons with no complications of the disease or its treatment, and has excellent results. Reference: Chapter 23: Disorders of Red Blood Cells - Page 576
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. Explanation: 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. 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. The client may have increased tolerance for pain due to the chronic nature of the illness. Bone marrow increases the erythrocyte production. Underhydration increases the client's risk of developing a vaso-occlusive crisis.
