SPC Level 2 Exam 2- Anemia Adaptive Quiz

The nurse is teaching a patient about the administration of liquid iron supplements. Which response by the patient indicates the need for additional teaching? -"I will take my iron supplement with a straw." -"I will take my iron supplement at bedtime." -"I will take my iron supplement along with meals." -"I will take my iron supplement along with orange juice."

-"I will take my iron supplement along with meals." Iron is mostly absorbed in the form of ferrous sulfate. Ferrous sulfate chelates with food, impairing iron absorption. Iron supplements should be taken one hour before meals to ensure effective absorption. Iron supplements may stain the teeth, so they may be taken with a straw. The patient can take iron supplements at bedtime if he or she experiences abdominal discomfort. Orange juice is rich in vitamin C, which enhances iron absorption.

To prepare for a patient's transfusion of packed red blood cells, the nurse would select which IV solution to use for the procedure? -3% normal saline -Lactated Ringer's -5% dextrose in water -0.9% normal saline

-0.9% normal saline The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It is also used to flush the blood tubing after the infusion is complete to ensure that the patient receives blood that is left in the tubing when the bag is empty. 3% normal saline, Lactated Ringer's, and 5% dextrose in water are not compatible with blood products.

The nurse will begin a patient's transfusion of packed red blood cells at 1030. The nurse would plan to stay in the patient's room until which time? -1040 -1045 -1050 -1055

-1045 As part of standard procedure, the nurse remains with the patient for the first 15 minutes after hanging a blood transfusion. Patients who are likely to have a transfusion reaction more often will exhibit signs within the first 15 minutes that the blood is infusing. Ten minutes is not enough time to evaluate for adverse reactions; unless the patient is having an adverse reaction, it is not necessary to remain at the bedside for longer than 15 minutes.

Which patient is most likely to experience anemia related to an increased destruction of red blood cells? -A 59-year-old man whose alcoholism has precipitated folic acid deficiency -A 23-year-old African American man who has a diagnosis of sickle cell disease -A 30-year-old woman with a history of "heavy periods" accompanied by anemia A 3-year-old child whose impaired growth and -development is attributable to thalassemia

-A 23-year-old African American man who has a diagnosis of sickle cell disease A result of a sickling episode in sickle cell anemia involves increased hemolysis of the sickled cells. Anemia due to alcoholism can be due to impaired liver function or an enlarged spleen. Alcoholics often suffer from B1, B3, and B6, or thiamin, niacin and pyridoxine deficiencies. Anemia related to menstruation is a direct result of blood loss. Thalassemias and folic acid deficiencies cause a decrease in erythropoiesis.

Which potential side effect would the nurse include when teaching a patient about the administration of ferrous gluconate? -Hypotension -Constipation -Clay-colored stool -Abdominal swelling

-Constipation Iron supplements, such as ferrous gluconate, reduce peristalsis and result in constipation. Ferrous gluconate does not reduce BP and does not result in hypotension. Ferrous gluconate can cause gastrointestinal bleeding and black, tarry stools. Ferrous gluconate does not cause fluid accumulation in the peritoneal cavity or abdominal swelling.

A patient with thalassemia major that is receiving a blood transfusion shows signs of hemochromatosis. The nurse anticipates a prescription for which medication? -Methotrexate -Deferoxamine -Ferrous gluconate -Iron dextran complex

-Deferoxamine A patient with thalassemia major requires frequent blood transfusions and is at risk of iron toxicity. Deferoxamine chelates with the iron and reduces iron overload or hemochromatosis. Methotrexate is an anticancer drug, and it does not reduce iron overload. Iron supplements, such as ferrous gluconate and iron dextran complex, should not be administered to the patient because they further increase the risk of iron overload.

The nurse would place the highest priority on initiating interventions that will reduce which symptom in a patient with a gastrointestinal bleed, a hemoglobin of 8.7%, and a hematocrit of 26%? -Nausea -Dizziness -Headache -Constipation

-Dizziness The patient with a low hemoglobin and hematocrit (normal values 13.5% to 17% and 40% to 54%, respectively, for males) is anemic and would be most likely to experience fatigue and dizziness. This symptom develops because of the lowered oxygen-carrying capacity that leads to reduced tissue oxygenation to carry out cellular functions. Nausea, constipation, and headache are not associated with decreased hemoglobin and hematocrit levels.

Which interventions would the nurse provide a patient who has polycythemia? Select all that apply. -Monitoring liver function tests -Evaluating fluid intake and -Assessing the patient's nutritional status -Initiating active and passive leg exercises -Instructing the patient to avoid high altitudes

-Evaluating fluid intake and -Assessing the patient's nutritional status -Initiating active and passive leg exercises In polycythemia vera, laboratory findings show an elevated hemoglobin and red blood cell (RBC) count with microcytosis, as well as an elevated white blood cell (WBC) count with basophilia. Fluid intake and output should be evaluated to avoid fluid overload because this may further complicate circulatory congestion. Nutritional status should be assessed regularly because inadequate food intake may result in gastrointestinal symptoms, such as fullness, pain, and dyspepsia. Active and passive leg exercises should be initiated to prevent thrombus formation. Liver function tests should be monitored regularly in patients who require lifelong supplementation of iron. Patients with sickle cell disease should be advised to avoid high altitudes because this may lead to hypoxia.

A patient that is receiving treatment for thalassemia shows evidence of hemolysis. The nurse anticipates a prescription for which supplementation? -Zinc -Folic acid -Vitamin B12 -Ascorbic acid

-Folic acid Folic acid is given if there is any evidence of hemolysis in patients with thalassemia. Zinc supplementation is required in patients with thalassemia after chelation therapy because zinc levels may decline. Vitamin B12 supplementation is required for patients with megaloblastic anemias. Ascorbic acid supplementation may be needed during chelation therapy in patients receiving treatment for thalassemia because it increases urinary excretion of iron.

Which condition results in anemia due to synthesis of defective deoxyribonucleic acid (DNA) in the body? -Myelodysplasia -Fanconi syndrome -Folic acid deficiency -G6PD enzyme deficiency

-Folic acid deficiency Folic acid deficiency can cause the synthesis of defective DNA and result in anemia. A decreased number of red blood cell precursors results in anemia in patients with myelodysplasia and Fanconi syndrome. Increased red blood cell destruction can result in anemia in patients with G6PD enzyme deficiency.

Which laboratory report findings support the nurse's conclusion that a patient has thalassemia major? Select all that apply. -Increased bilirubin levels -Increased serum iron levels -Increased reticulocyte level -Increased mean corpuscular volume -Increased total iron-binding capacity

-Increased bilirubin levels -Increased serum iron levels -Increased reticulocyte level Thalassemia major is characterized by the presence of increased bilirubin levels, serum iron levels, and reticulocyte level. Thalassemia major is also characterized by the presence of decreased mean corpuscular volume and total iron-binding capacity.

The nurse recalls that hemolytic anemia can be caused by which extrinsic factors? -Infectious agent -Enzyme deficiency -Sickle cell disease -Membrane abnormalities

-Infectious agent Infectious agents, such as malaria, are extrinsic factors that can lead to acquired hemolytic anemias. Abnormal hemoglobin, such as sickle cell disease, and enzyme deficiencies are intrinsic factors that lead to hereditary (intrinsic) hemolytic anemias. Membrane abnormalities, such as paroxysmal nocturnal hemoglobinuria, cause increased red blood cell (RBC) destruction and are hereditary (intrinsic) factors.

Which action would the nurse take to safely infuse one unit of fresh frozen plasma (FFP) in a patient? -Infuse the FFP over 8 hours. -Infuse the FFP as rapidly as the patient will tolerate. -Administer the FFP as an IV piggyback to the primary IV solution. -Administer the FFP as an IV piggyback to lactated Ringer's solution.

-Infuse the FFP as rapidly as the patient will tolerate. The FFP should be administered as rapidly as possible and should be used within six hours. FFP is infused with the use of any straight-line infusion set. Any existing IV should be interrupted while the FFP is infusing, unless a second IV line has been started for the transfusion.

Which condition may cause a patient to develop anemia due to decreased hemoglobin synthesis? -Leukemia -Iron deficiency -Cobalamin deficiency -G6PD enzyme deficiency

-Iron deficiency Iron deficiency may cause anemia due to decreased hemoglobin synthesis. Leukemia may cause anemia due to a decreased number of red blood cell (RBC) precursors. Cobalamin deficiency may result in anemia due to defective deoxyribonucleic acid (DNA) synthesis. G6PD enzyme deficiency is hereditary and causes increased RBC destruction (hemolytic anemias).

The nurse understands that with repeated episodes of sickling, which organ is most affected? -Liver -Heart -Lungs -Stomach

-Lungs With repeated episodes of sickling, there is gradual involvement of all body systems and organs, especially the spleen, lungs, kidneys, and brain. Organs that have a need for large amounts of O2, like the lungs, are most often affected and form the basis for many of the complications of sickle cell disease (SCD). Although the liver, heart, and stomach may be affected, they are less so when compared to the lungs.

A patient that has sickle cell disease has developed cellulitis above the left ankle. Which action is the nurse's priority for this patient? -Maintain oxygenation. -Administer antibiotics. -Assess pain every 4 hours. -Start IV fluids.

-Maintain oxygenation. Maintaining oxygenation is a priority because sickling episodes frequently are triggered by low oxygen tension in the blood, which commonly is caused by an infection. Antibiotics to treat cellulitis, pain control, and fluids to reduce blood viscosity also will be used, but oxygenation is the priority.

The nurse suspects that a patient is experiencing microcytic, hypochromic anemia after noting which blood test results? -Mean corpuscular volume of 90 fL and mean corpuscular hemoglobin of 30 pg -Mean corpuscular volume of 70 fL and mean corpuscular hemoglobin of 20 pg -Mean corpuscular volume of 100 fL and mean corpuscular hemoglobin of 34 pg -Mean corpuscular volume of 120 fL and mean corpuscular hemoglobin of 40 pg

-Mean corpuscular volume of 70 fL and mean corpuscular hemoglobin of 20 pg Microcytic, hypochromic anemia is characterized by the presence of a mean corpuscular volume of less than 80 fL and a mean corpuscular hemoglobin of less than 27 pg. Normocytic and normochromic anemia are characterized by the presence of mean corpuscular volume between 80 and 100 fL and mean corpuscular hemoglobin between 27 and 34 pg. Macrocytic and normochromic anemia are characterized by the presence of mean corpuscular volume of greater than 100 fL and mean corpuscular hemoglobin of greater than 34 pg.

A patient has a hemoglobin level of 11 g/dL. The nurse determines that the patient has which level of severity of anemia? -Mild anemia -Severe anemia -Aplastic anemia -Moderate anemia

-Mild anemia In mild anemia, hemoglobin is in the range of 10-12 g/dL. In severe anemia, it is less than 6 g/dL. Aplastic anemia refers to a type of anemia caused by a decrease in red blood cell precursors. It does not refer to the severity of anemia. In moderate anemia, the hemoglobin it is in the range of 6-10 g/dL. Hemoglobin above 12 g/dL is considered normal (no anemia).

Which erythrocyte characteristic would the nurse expect to see in the laboratory findings for a patient who has experienced acute blood loss? -Microcytic -Normocytic -Hypochromic -Megaloblastic

-Normocytic Normocytic, normochromic erythrocytes are seen in patients with acute blood loss following an accident. Microcytic, hypochromic erythrocytes are seen in patients with iron-deficiency anemia, vitamin B6 deficiency, copper deficiency, thalassemia, or lead poisoning. Megaloblastic erythrocytes are seen in patients with vitamin B12 deficiency, folic acid deficiency, or liver disease.

Which patient would the nurse identify as the highest risk for sickle cell anemia? -Patient A -Patient B -Patient C -Patient D

-Patient A Sickle cell anemia is most common in African Americans. African Americans and people of Mediterranean origin are at the highest risk for thalassemia. Tay-Sachs disease is a rare, autosomal-recessive genetic metabolic disorder found in Ashkenazi Jews. Deficiency in red blood cell production due to a lack of vitamin B12 results in pernicious anemia and most commonly occurs in Scandinavians and African Americans.

Which patient would the nurse identify as most likely to have an increased heart rate? Patient A: 80 g/dL Patient B: 50 g/dL Patient C: 100 g/dL Patient D: 110 g/dL -Patient A -Patient B -Patient C -Patient D

-Patient B Hemoglobin content of less than 60 g/dL indicates severe anemia, which can result in tachycardia, or increased heart rate. Patient B is showing symptoms of tachycardia and increased pulse pressure. Patient A has a hemoglobin content between 60 and 100 g/dL, which indicates moderate anemia but is not associated with an increased heart rate. Patients C and D have a hemoglobin content between 100 and 120 g/dL, which indicates mild anemia.

The nurse assesses a patient with pernicious anemia and expects to find which classic sign of this condition? -Diarrhea -Indigestion -Flushed skin -Red, beefy tongue

-Red, beefy tongue The decreased absorption of vitamin B12 resulting from a lack of intrinsic factor causes a decrease in hemoglobin, hematocrit, and red blood cells. A smooth, red, enlarged or "beefy" appearance of the tongue may also be seen. Intrinsic factor is produced by the parietal cells of the stomach lining and is required to absorb vitamin B12 from the intestines. Causes of decreased intrinsic factor production include surgical alterations such as gastrectomy and autoimmune disease. Diarrhea, indigestion, and flushed skin appearance are not signs specifically associated with pernicious anemia.

Which condition is characterized by the presence of a high percentage of hemoglobin S (Hgb S) in the erythrocytes? -Thalassemia -Aplastic anemia -Sickle cell disease -Acquired hemolytic anemia

-Sickle cell disease Sickle cell disease is characterized by the presence of a high percentage of Hgb S in the erythrocytes. Thalassemia occurs due to the absence of reduced globulin protein. Aplastic anemia is a disease characterized by pancytopenia in which all the blood cell types decrease. Acquired hemolytic anemia results from hemolysis of red blood cells (RBCs) from extrinsic factors. It is characterized by increased mean corpuscular volume (MCV), reticulocytes, and bilirubin.

Which finding supports the nurse's conclusion that a patient has pernicious anemia? -Bleeding of the gums -Smooth, beefy-red tongue -Spoon-shaped concave nails -Fissures in corners of the mouth

-Smooth, beefy-red tongue Pernicious anemia is characterized by the presence of abdominal pain and a smooth, beefy-red tongue. Platelet function is reduced in the patient with leukemia; therefore bleeding from the gums is associated with leukemia. The presence of spoon-shaped, concave nails and fissures in the corners of the mouth is associated with iron-deficiency anemia.

Which instructions would the nurse include when teaching a patient about the administration of iron capsules? Select all that apply. -Take laxatives if needed. -Take the medication with orange juice. -Take the medication about one hour after meals. -The medication may cause the stools to become black. -Stop therapy when hemoglobin level returns to normal.

-Take laxatives if needed. -Take the medication with orange juice. -The medication may cause the stools to become black. Constipation is a common side effect, and the patient should be started on stool softeners or laxatives. The nurse should teach the patient to take iron capsules with orange juice or vitamin C to enhance iron absorption. The patient should be informed that use of iron preparations will make the stool appear black because the gastrointestinal (GI) tract excretes excess iron. Iron should be taken at least one hour before meals, when the duodenal mucosa is most acidic to enhance absorption; however, gastric side effects may necessitate ingesting iron with meals. To replenish the body's stores, the patient needs to take iron therapy for two to three months after the hemoglobin level returns to normal.

When a patient is prescribed iron tablets for the treatment of anemia, which measures ensure maximum absorption? Select all that apply. -Taking the tablet with food -Taking the tablet after exercise -Taking the tablet before exercise -Taking the tablet with orange juice -Taking the tablet an hour before meals

-Taking the tablet with orange juice -Taking the tablet an hour before meals Taking iron tablets an hour before food ensures maximum absorption because iron will not get bound to food. When iron binds with food, absorption of iron falls. Orange juice and ascorbic acid enhance iron absorption. Taking iron tablets with food can reduce iron absorption. Taking iron tablets before or after exercise does not affect absorption.

A patient's laboratory reports show a low mean corpuscular volume (MCV) and a high reticulocyte count. The nurse suspects which condition? -Thalassemia -Hemolytic anemia -Sickle cell anemia -Folic acid deficiency

-Thalassemia In thalassemia, a low MCV and a high reticulocyte count are observed. In hemolytic anemia, a normal MCV and increased reticulocytes are found. In sickle cell anemia, a normal MCV and low reticulocyte count are seen. An increased MCV and normal or low reticulocyte count occur due to a folic acid deficiency.

Which interventions would the nurse expect to be included in the plan of care for a patient with thalassemia major who is anemic and has a history of blood transfusions? Select all that apply. -Iron supplementation -Zinc supplementation -Oral deferasirox (Exjade) -Continued blood transfusions -Ascorbic acid supplementation

-Zinc supplementation -Oral deferasirox (Exjade) -Continued blood transfusions -Ascorbic acid supplementation The patient has thalassemia, is anemic, and has a history of blood transfusions. Oral deferasirox (Exjade) is a chelating agent that binds with iron to prevent iron overload. Such chelation therapy reduces zinc in the body, so zinc supplements should be administered. Blood transfusions are performed to keep the hemoglobin level at approximately 10 g/dL. Adequate hemoglobin promotes erythropoiesis and prevents spleen enlargement. Ascorbic acid supplements increase the excretion of iron in the urine, so they are administered during the chelation therapy. Blood transfusions and hemolysis lead to iron overload, so iron supplements should not be administered.

A patient is admitted in a state of shock with acute blood loss. The nurse reviews the patient's plan of care and would perform the interventions in which order? -Administer packed red blood cells (RBCs). -Provide supplemental iron. -Identify source of hemorrhage. -Replace blood volume.

1. Replace blood volume. 2. Identify source of hemorrhage. 3. Administer packed red blood cells (RBCs). 4. Provide supplemental iron Collaborative care is initially concerned with replacing blood volume to prevent shock. The source of the hemorrhage should then be identified to stop the blood loss. Once volume replacement is established, RBC loss is corrected by administering packed RBCs. The patient may also need supplemental iron because the availability of iron affects the marrow production of erythrocytes.