nursing 6 unit 5 Brunner med surg Chapter 33: Management of Patients With Nonmalignant Hematologic Disorders

A female client with the beta-thalassemia trait plans to marry a man of Italian ancestry who also has the trait. Which client statement indicates that she understands the teaching provided by the nurse? a) "If my fiancé was of Middle Eastern descent, I wouldn't be worried about having children." b) "I need to learn how to give myself vitamin B12 injections." c) "Thalassemia is treated with iron supplements." d) "I'll see a genetic counselor before starting a family."

"I'll see a genetic counselor before starting a family." Explanation: Two people with the beta-thalassemia trait have a 25% chance of having a child with thalassemia major, a potentially life-threatening disease. Iron supplements aren't used to treat thalassemia; in fact, they could contribute to iron overload. Vitamin B12 injections are used to treat pernicious anemia, not thalassemia. Thalassemia occurs primarily in people of Italian, Greek, African, Asian, Middle Eastern, East Indian, and Caribbean descent.

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 for the rest of my life." b) "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal." c) "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear." d) "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year."

:"I will receive parenteral vitamin B12 therapy for the rest of my life." Explanation: Because a client with pernicious anemia lacks intrinsic factor, oral vitamin B12 can't be absorbed. Therefore, parenteral vitamin B12 therapy is recommended and required for life.

When teaching a patient with iron deficiency anemia about appropriate food choices, the nurse will encourage the patient to increase the dietary intake of which of the following foods? a) Beans, dried fruits, and leafy green vegetables b) Berries and orange vegetables c) Dairy products d) Fruits high in vitamin C, such as oranges and grapefruits

Beans, dried fruits, and leafy green vegetables Explanation: Food sources high in iron include organ meats (e.g., beef or calf's liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.

A patient with end-stage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia? a) Calcium level of 9.4 mg/dL b) Creatinine level of 6 mg/100 mL c) Magnesium level of 2.5 mg/dL d) Potassium level of 5.2 mEq/L

Creatinine level of 6 mg/100 mL Explanation: The degree of anemia in patients with end-stage renal disease varies greatly; however, in general, patients do not become significantly anemic until the serum creatinine level exceeds 3 mg/100 mL

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? a) Decreased level of erythropoietin b) Increased reticulocyte count c) Increased mean corpuscular volume d) Decreased total iron-binding capacity

Decreased level of erythropoietin Explanation: As renal function decreases, erythropoietin, which is produced by the kidney, also decreases. Because erythropoietin is produced outside the kidney, some erythropoiesis continues, even in patients whose kidneys have been removed. However, the number of red blood cells produced is small and the degree of erythropoiesis is inadequate.

You are caring for a 13-year-old diagnosed with sickle cell anemia. The client asks you what they can do to help prevent sickle cell crisis. What would be an appropriate answer to this client? a) Drink at least 8 glasses of water every day. b) Avoid any sports that tire you out. c) Stay on oxygen therapy 24/7. d) Avoid any activity that makes you short of breath

Drink at least 8 glasses of water every day. Correct Explanation: During the physical examination, observe the client's appearance, looking for evidence of dehydration, which may have triggered a sickle cell crisis. Clients are taught moderation, not avoidance of activities. Most clients with sickle cell disease are not on oxygen therapy 24/7.

A male patient has a probable diagnosis of polycythemia vera. The nurse reviews the patient's lab work for which of the following diagnostic indicator? a) Platelet value of 350,000/mm3 b) Hematocrit of 60% c) Leukocyte count of 11,500/mm3 d) Erythrocyte count of 6.5 m/?L

Hematocrit of 60% Explanation: Although all results are elevated, the diagnostic indicator is the elevated hematocrit (normal = 42% to 52% for a male). These results are used in combination with other indicators (eg, splenomegaly) for a definitive diagnosis.

Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents? a) Hypochromic b) Microcytic c) Normocytic d) Hyperchromic

Hypochromic Explanation: An RBC that has pale or lighter cellular contents is hypochromic. A normocytic RBC is normal or average in size. A microcytic RBC is smaller than normal. Hyperchromic is used to describe an RBC that has darker cellular contents.

Which cell of haematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? a) Myeloid stem cell b) Neutrophil c) Monocyte d) Lymphoid stem cell

Myeloid stem cell Explanation: The myeloid stem cell is responsible not only for all non lymphoid white blood cells, but also for the production of red blood cells and platelets. Lymphoid cells produce either T or B lymphocytes. A monocyte is large WBC that becomes a macrophage when is leaves the circulation and moves into body tissues. A neutrophil is a fully mature WBC capable of phagocytosis.

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? a) Severity of the disease b) Neurologic involvement c) Loss of vibratory and position senses d) Insufficient intake of dietary nutrients

Neurologic involvement Explanation: In clients with pernicious anemia, numbness and tingling in the arms and legs and ataxia are the most common signs of neurologic involvement. Some affected clients lose vibratory and position senses. Jaundice, irritability, confusion, and depression are present when the disease is severe. Insufficient intake of dietary nutrients is not indicated by these symptoms

The nurse is preparing the patient for a test to determine the cause of vitamin B12 deficiency. The patient will receive a small oral dose of radioactive vitamin B12 followed by a large parenteral dose of nonradioactive vitamin B12. What test is the patient being prepared for? a) Bone marrow biopsy b) Magnetic resonance imaging (MRI) study c) Bone marrow aspiration d) Schilling test

Schilling test Correct Explanation: The classic method of determining the cause of vitamin B12 deficiency is the Schilling test, in which the patient receives a small oral dose of radioactive vitamin B12, followed in a few hours by a large, nonradioactive parenteral dose of vitamin B12 (this aids in renal excretion of the radioactive dose).

A nurse is preparing to discharge an adolescent with sickle cell anemia. What client need should the nurse emphasize in her discharge assessment? a) The need to have pain medication available b) The need for an adequate support structure c) The need to maintain good hydration d) The need to follow up with physician visits

The need for an adequate support structure Explanation: Because many psychosocial and physiological issues affect the life of an adolescent with a chronic illness, assuring the existence of a good support structure is the most essential element of care. Availability of pain medication and adequate support are both important considerations, but it's more important to emphasize the need for an adequate support structure. The need for good hydration and follow-up visits are important, but a good support structure will help the adolescent with this treatment.

A young male client is diagnosed with a mild form of hemophilia. He is experiencing bleeding in the joints with pain. In preparing the client for discharge, the nurse educates the client to a) Wear a medical identification bracelet. b) Take ibuprofen (Motrin) for joint pain. c) Undergo genetic testing and counseling. d) Take warm baths to lessen pain.

Wear a medical identification bracelet. Explanation: Clients with hemophilia should wear a medical identification bracelet about having this disease. Ibuprofen interferes with platelet aggregation and may increase the client's bleeding. A warm bath may lessen pain but increase bleeding. Genetic testing and counseling are not necessary for male clients, because females are the carriers of the genetic material for hemophilia.

Which of the following is the most common hematologic condition affecting elderly patients a) Thrombocytopenia b) Anemia c) Bandemia d) Leukopenia

b) Anemia

The client has been diagnosed with myelodysplastic syndrome with an absolute neutrophil count less than 1000/mm³ and is being admitted to the hospital. The nurse a) Changes the water in the humidifier for oxygen therapy every 48 hours b) Places the client in isolation and allows no visitors c) Allows unlicensed assistive personnel who reports having a sore throat to provide care d) Assigns the client to a private room

igns the client to a private room Explanation: The client with an absolute neutrophil count less than 1000/mm³ is to be placed in a private room. Staff with a sore throat or cold should not be assigned to provide care for this client. The client does not need to be placed in isolation, but other neutropenic precautions needs to be followed, such as allowing no visitors with infection. Water in oxygen humdifiers should be changed every 24 hours.

A client is being admitted to the hospital with abdominal pain, anemia, and bloody stools. He complains of feeling weak and dizzy. He has rectal pressure and needs to urinate and move his bowels. The nurse should help him: a) onto the bedpan. b) to a standing position so he can urinate. c) to the bedside commode. d) to the bathroom.

onto the bedpan. Explanation: A client who's dizzy and anemic is at risk for injury because of his weakened state. Assisting him with the bedpan would best meet his needs at this time without risking his safety. The client may fall if walking to the bathroom, left alone to urinate, or trying to stand up.

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? a) Eating apple slices with carrots b) Eating leafy green vegetables with a glass of water c) Eating calf's liver with a glass of orange juice d) Eating a steak with mushrooms

Eating calf's liver with a glass of orange juice Explanation: Food sources high in iron include organ meats (e.g., beef or calf's liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron

A pregnant woman is hospitalized as the result of sickle-cell crisis. A finding that indicates the outcome has been achieved for this client is that the client a) Reports joint pain less than 3 on a scale of 0 to 10 b) Takes hydroxyurea (Hydrea) during her pregnancy c) Exhibits a temperature less than 100.3°F d) Describes the importance of staying cool

Reports joint pain less than 3 on a scale of 0 to 10 Explanation: An expected outcome for a client experiencing a sickle-cell crisis is control of pain. Hydroxyurea is contraindicated in pregnancy because of the risk it poses for congenital abnormalities. An indication that the client is free from infection is exhibiting a normal temperature; 100.3°F is an elevated temperature. To minimize crises, the client needs to stay warm

Which nursing instructions help parents of a child with hemophilia provide a safe home environment for their child? a) "Establish a written emergency plan including what to do in specific situations and the names and phone numbers of emergency contacts." b) "Talk with your child about home safety and have him problem-solve hypothetical situations about his health." c) "Pad the corners of coffee tables when your child is a toddler and provide kneepads for sports when the child is older." d) "Be a role model to your child by wearing a helmet when riding a bike so your child will, too."

Correct response: "Establish a written emergency plan including what to do in specific situations and the names and phone numbers of emergency contacts." Explanation: Establishing a written emergency plan that includes what to do in specific situations helps the family provide safety measures for their child with hemophilia. Padding corners of furniture and using kneepads don't help provide a safe home environment for children of all ages. Telling the parents to be a role model by wearing a bike helmet is only applicable to children who are old enough to emulate their parent's behaviors. Having the child problem-solve hypothetical health situations doesn't help provide a safe environment; it addresses problem solving

The nurse is talking with the parents of a toddler who was diagnosed with hemophilia A. The nurse teaches the parents a) To allow the toddler to participate in playground activities with other toddlers b) The importance of administering over-the-counter preparations for a cold c) How to administer factor VIII intravenously at the first sign of bleeding d) That nasal packing will be necessary for any nose bleeds

How to administer factor VIII intravenously at the first sign of bleeding Explanation: Clients and families are taught to administer factor VIII intravenously. This helps to prevent bleeding episodes. Activities that minimize trauma are allowed for the toddler, and playground activities may place the toddler at risk for increased bleeding. Over-the-counter cold preparations are to be avoided, because they will interfere with platelet aggregation. Nasal packing is avoided, because when the nasal packing is removed, bleeding may occur.

The nurse's role in the management of polycythemia vera is primarily that of an educator. Choose the best health promotion advice that a nurse could give. a) Take aspirin daily to prevent clot formation. b) Use compression stockings when walking to prevent deep vein thrombosis (DVT). c) Take antiplatelets on a regular basis. d) Participate in regular phlebotomy procedures to decrease blood viscosity.

Participate in regular phlebotomy procedures to decrease blood viscosity. Explanation: Phlebotomy is a critical part of therapy and the only treatment that has demonstrated improved survival. Aspirin should be avoided, and antiplatelet therapy should be used with caution due to the risk of bleeding. Compression stockings are not necessary for walking but should be used for airplane travel.