PrepU Hemotology
The nurse provides care for an older adult client, diagnosed with anemia, who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine the cause of the client's blood loss, which is the priority nursing action? A. Observe the client's stools for blood. B. Evaluate the client's dietary intake. C. Monitor the client's body temperature. D. Monitor the client's blood pressure.
A. Observe the client's stools for blood. If an older adult is anemic, blood loss from the gastrointestinal (GI) or genitourinary (GU) tracts is suspected. Observing the stool for blood will determine if the source of the client's bleeding is in the GI tract. Iron-deficiency anemia is unusual in older adults because the body does not eliminate excessive iron, thus increasing total body iron stores and necessitating maintenance of hydration. If evaluation of the GI and GU tracts does not reveal a source of bleeding, evaluating the client's diet may be appropriate; however, this is not the priority nursing action. Monitoring the client's body temperature and BP will assist the nurse in determining the source of the client's blood loss, but these are not priority nursing actions.
While assessing a client, the nurse will recognize what as the most obvious sign of anemia? A. Pallor B. Tachycardia C. Flow murmurs D. Jaundice
A. Pallor On physical examination, pallor is the most common and obvious sign of anemia. Other findings may include tachycardia and flow murmurs. Patients with hemolytic anemia may exhibit jaundice and splenomegaly.
A client with sickle cell anemia has a A. low hematocrit. B. high hematocrit. C. normal hematocrit. D. normal blood smear.
A. low hematocrit. A client with sickle cell anemia has a low hematocrit and sickled cells on the smear. A client with sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear.
A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia? A. Nights sweats, weight loss, and diarrhea B. Dyspnea, tachycardia, and pallor C. Nausea, vomiting, and anorexia D. Itching, rash, and jaundice
B. Dyspnea, tachycardia, and pallor Signs of iron deficiency anemia include dyspnea, tachycardia, and pallor, as well as fatigue, listlessness, irritability, and headache. Night sweats, weight loss, and diarrhea may signal acquired immunodeficiency syndrome. Nausea, vomiting, and anorexia may be signs of hepatitis B. Itching, rash, and jaundice may result from an allergic or hemolytic reaction.
During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding? A. Elevated hematocrit concentration B. Enlarged mean corpuscular volume (MCV) C. Low ferritin level concentration D. Elevated red blood cell (RBC) count
C. Low ferritin level concentration The most consistent indicator of iron deficiency anemia is a low ferritin level, which reflects low iron stores. As the anemia progresses, the MCV, which measures the size of the erythrocytes, also decreases. Hematocrit and RBC levels are also low in relation to the hemoglobin concentration.
Which is a symptom of hemochromatosis? A. Bronzing of the skin B. Inflammation of the mouth C. Inflammation of the tongue D. Weight gain
A. Bronzing of the skin Clients with hemochromatosis exhibit symptoms of weakness, lethargy, arthralgia, weight loss, and loss of libido early in the illness trajectory. The skin may appear hyperpigmented from melanin deposits or appear bronze in color.
A client reports feeling tired, cold, and short of breath at times. Assessment reveals tachycardia and reduced energy. What would the nurse expect the physician to order? A. CBC B. antibiotic C. chest radiograph D. ECG
A. CBC Most clients with iron-deficiency anemia have reduced energy, feel cold all the time, and experience fatigue and dyspnea with minor physical exertion. The heart rate usually is rapid even at rest. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased. A CBC would be ordered.
A thin client is prescribed iron dextran intramuscularly. What is most important action taken by the nurse when administering this medication? A. Employs the Z-track technique B. Uses a 23-gauge needle C. Injects into the deltoid muscle D. Rubs the site vigorously
A. Employs the Z-track technique When iron medications are given intramuscularly, the nurse uses the Z-track technique to avoid local pain and staining of the skin. The gluteus maximus muscle is used. The nurse avoids rubbing the site vigorously and uses a 18- or 20-gauge needle.
When assessing a client with anemia, which assessment is essential? A. Health history, including menstrual history in women B. Family history C. Age and gender D. Lifestyle assessments, such as exercise routines
A. Health history, including menstrual history in women When assessing a client with anemia, it is essential to assess the client's health history. Women should be questioned about their menstrual periods (e.g., excessive menstrual flow, other vaginal bleeding) and the use of iron supplements during pregnancy.
The thalassemias are a group of hereditary anemias characterized by which of the following? Select all that apply. A. Hypochromia B. Extreme microcytosis C. Hemolysis D. Anemia E. Thrombocytopenia
A. Hypochromia B. Extreme microcytosis C. Hemolysis D. Anemia The thalassemias are a group of hereditary anemias characterized by hypochromia, extreme microcytosis, destruction of blood elements (hemolysis), and variable degrees of anemia. Thrombocytopenia is not associated with thalassemias.
Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents? A. Hypochromic B. Normocytic C. Microcytic D. Hyperchromic
A. Hypochromic 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.
