Chapter 30: Nursing Management: Hematologic Problems Flashcards
- A 62-year old man with chronic anemia is experiencing increased fatigue and occasional palpitations at rest. The nurse would expect the patients laboratory findings to include
a.
a hematocrit (Hct) of 38%.
b.
an RBC count of 4,500,000/mL.
c.
normal red blood cell (RBC) indices.
d.
a hemoglobin (Hgb) of 8.6 g/dL (86 g/L).
ANS: D
The patients clinical manifestations indicate moderate anemia, which is consistent with a Hgb of 6 to 10 g/dL. The other values are all within the range of normal.
- Which menu choice indicates that the patient understands the nurses teaching about best dietary choices for iron-deficiency anemia?
a.
Omelet and whole wheat toast
b.
Cantaloupe and cottage cheese
c.
Strawberry and banana fruit plate
d.
Cornmeal muffin and orange juice
ANS: A
Eggs and whole grain breads are high in iron. The other choices are appropriate for other nutritional deficiencies but are not the best choice for a patient with iron-deficiency anemia.
- A patient who is receiving methotrexate for severe rheumatoid arthritis develops a megaloblastic anemia. The nurse will anticipate teaching the patient about increasing oral intake of
a.
iron.
b.
folic acid.
c.
cobalamin (vitamin B12).
d.
ascorbic acid (vitamin C).
ANS: B
Methotrexate use can lead to folic acid deficiency. Supplementation with oral folic acid supplements is the usual treatment. The other nutrients would not correct folic acid deficiency, although they would be used to treat other types of anemia.
- A 52-year-old patient has a new diagnosis of pernicious anemia. The nurse determines that the patient understands the teaching about the disorder when the patient states, I
a.
need to start eating more red meat and liver.
b.
will stop having a glass of wine with dinner.
c.
could choose nasal spray rather than injections of vitamin B12.
d.
will need to take a proton pump inhibitor like omeprazole (Prilosec).
ANS: C
Because pernicious anemia prevents the absorption of vitamin B12, this patient requires injections or intranasal administration of cobalamin. Alcohol use does not cause cobalamin deficiency. Proton pump inhibitors decrease the absorption of vitamin B12. Eating more foods rich in vitamin B12 is not helpful because the lack of intrinsic factor prevents absorption of the vitamin.
- An appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia is to
a.
provide a diet high in vitamin K.
b.
alternate periods of rest and activity.
c.
teach the patient how to avoid injury.
d.
place the patient on protective isolation.
ANS: B
Nursing care for patients with anemia should alternate periods of rest and activity to encourage activity without causing undue fatigue. There is no indication that the patient has a bleeding disorder, so a diet high in vitamin K or teaching about how to avoid injury is not needed. Protective isolation might be used for a patient with aplastic anemia, but it is not indicated for hemolytic anemia.
- Which patient statement to the nurse indicates a need for additional instruction about taking oral ferrous sulfate?
a.
I will call my health care provider if my stools turn black.
b.
I will take a stool softener if I feel constipated occasionally.
c.
I should take the iron with orange juice about an hour before eating.
d.
I should increase my fluid and fiber intake while I am taking iron tablets.
ANS: A
It is normal for the stools to appear black when a patient is taking iron, and the patient should not call the doctor about this. The other patient statements are correct.
- Which collaborative problem will the nurse include in a care plan for a patient admitted to the hospital with idiopathic aplastic anemia?
a.
Potential complication: seizures
b.
Potential complication: infection
c.
Potential complication: neurogenic shock
d.
Potential complication: pulmonary edema
ANS: B
Because the patient with aplastic anemia has pancytopenia, the patient is at risk for infection and bleeding. There is no increased risk for seizures, neurogenic shock, or pulmonary edema.
- It is important for the nurse providing care for a patient with sickle cell crisis to
a.
limit the patients intake of oral and IV fluids.
b.
evaluate the effectiveness of opioid analgesics.
c.
encourage the patient to ambulate as much as tolerated.
d.
teach the patient about high-protein, high-calorie foods.
ANS: B
Pain is the most common clinical manifestation of a crisis and usually requires large doses of continuous opioids for control. Fluid intake should be increased to reduce blood viscosity and improve perfusion. Rest is usually ordered to decrease metabolic requirements. Patients are instructed about the need for dietary folic acid, but high-protein, high-calorie diets are not emphasized.
- Which statement by a patient indicates good understanding of the nurses teaching about prevention of sickle cell crisis?
a.
Home oxygen therapy is frequently used to decrease sickling.
b.
There are no effective medications that can help prevent sickling.
c.
Routine continuous dosage narcotics are prescribed to prevent a crisis.
d.
Risk for a crisis is decreased by having an annual influenza vaccination.
ANS: D
Because infection is the most common cause of a sickle cell crisis, influenza, Haemophilus influenzae, pneumococcal pneumonia, and hepatitis immunizations should be administered. Although continuous dose opioids and oxygen may be administered during a crisis, patients do not receive these therapies to prevent crisis. Hydroxyurea (Hydrea) is a medication used to decrease the number of sickle cell crises.
- Which instruction will the nurse plan to include in discharge teaching for the patient admitted with a sickle cell crisis?
a.
Take a daily multivitamin with iron.
b.
Limit fluids to 2 to 3 quarts per day.
c.
Avoid exposure to crowds when possible.
d.
Drink only two caffeinated beverages daily.
ANS: C
Exposure to crowds increases the patients risk for infection, the most common cause of sickle cell crisis. There is no restriction on caffeine use. Iron supplementation is generally not recommended. A high-fluid intake is recommended.
- The nurse notes scleral jaundice in a patient being admitted with hemolytic anemia. The nurse will plan to check the laboratory results for the
a.
Schilling test.
b.
bilirubin level.
c.
stool occult blood test.
d.
gastric analysis testing.
ANS: B
Jaundice is caused by the elevation of bilirubin level associated with red blood cell (RBC) hemolysis. The other tests would not be helpful in monitoring or treating a hemolytic anemia.
- A patient who has been receiving a heparin infusion and warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when her platelet level drops to 110,000/L. Which action will the nurse include in the plan of care?
a.
Use low-molecular-weight heparin (LMWH) only.
b.
Administer the warfarin (Coumadin) at the scheduled time.
c.
Teach the patient about the purpose of platelet transfusions.
d.
Discontinue heparin and flush intermittent IV lines using normal saline.
ANS: D
All heparin is discontinued when the HIT is diagnosed. The patient should be instructed to never receive heparin or LMWH. Warfarin is usually not given until the platelet count has returned to 150,000/L. The platelet count does not drop low enough in HIT for a platelet transfusion, and platelet transfusions increase the risk for thrombosis.
- A critical action by the nurse caring for a patient with an acute exacerbation of polycythemia vera is to
a.
place the patient on bed rest.
b.
administer iron supplements.
c.
avoid use of aspirin products.
d.
monitor fluid intake and output.
ANS: D
Monitoring hydration status is important during an acute exacerbation because the patient is at risk for fluid overload or underhydration. Aspirin therapy is used to decrease risk for thrombosis. The patient should be encouraged to ambulate to prevent deep vein thrombosis (DVT). Iron is contraindicated in patients with polycythemia vera.
- Which intervention will be included in the nursing care plan for a patient with immune thrombocytopenic purpura (ITP)?
a.
Assign the patient to a private room.
b.
Avoid intramuscular (IM) injections.
c.
Use rinses rather than a soft toothbrush for oral care.
d.
Restrict activity to passive and active range of motion.
ANS: B
IM or subcutaneous injections should be avoided because of the risk for bleeding. A soft toothbrush can be used for oral care. There is no need to restrict activity or place the patient in a private room.
- Which laboratory result will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)?
a.
Prothrombin time
b.
Erythrocyte count
c.
Fibrinogen degradation products
d.
Activated partial thromboplastin time
ANS: D
Platelet aggregation in HIT causes neutralization of heparin, so that the activated partial thromboplastin time will be shorter and more heparin will be needed to maintain therapeutic levels. The other data will not be affected by HIT.
- The nurse caring for a patient with type A hemophilia being admitted to the hospital with severe pain and swelling in the right knee will
a.
immobilize the joint.
b.
apply heat to the knee.
c.
assist the patient with light weight bearing.
d.
perform passive range of motion to the knee.
ANS: A
The initial action should be total rest of the knee to minimize bleeding. Ice packs are used to decrease bleeding. Range of motion (ROM) and weight-bearing exercise are contraindicated initially, but after the bleeding stops, ROM and physical therapy are started.
- A 28-year-old man with von Willebrand disease is admitted to the hospital for minor knee surgery. The nurse will review the coagulation survey to check the
a.
platelet count.
b.
bleeding time.
c.
thrombin time.
d.
prothrombin time.
ANS: B
The bleeding time is affected by von Willebrand disease. Platelet count, prothrombin time, and thrombin time are normal in von Willebrand disease.
- A routine complete blood count indicates that an active 80-year-old man may have myelodysplastic syndrome. The nurse will plan to teach the patient about
a.
blood transfusion
b.
bone marrow biopsy.
c.
filgrastim (Neupogen) administration.
d.
erythropoietin (Epogen) administration.
ANS: B
Bone marrow biopsy is needed to make the diagnosis and determine the specific type of myelodysplastic syndrome. The other treatments may be necessary if there is progression of the myelodysplastic syndrome, but the initial action for this asymptomatic patient will be a bone marrow biopsy.
- Which action will the admitting nurse include in the care plan for a 30-year old woman who is neutropenic?
a.
Avoid any injections.
b.
Check temperature every 4 hours.
c.
Omit fruits or vegetables from the diet.
d.
Place a No Visitors sign on the door.
ANS: B
The earliest sign of infection in a neutropenic patient is an elevation in temperature. Although unpeeled fresh fruits and vegetables should be avoided, fruits and vegetables that are peeled or cooked are acceptable. Injections may be required for administration of medications such as filgrastim (Neupogen). The number of visitors may be limited and visitors with communicable diseases should be avoided, but a no visitors policy is not needed.
