Chapter21 Hemato

Question 1

Which assessment finding is considered a normal change in an older patients hematological system?

1. Mild anemia
2. Decrease in lymphocyte function
3. Decrease in platelet adhesiveness
4. Increased number of stem cells in the bone marrow

Answer 1

Correct Answer: 2

Rationale 1: Mild anemia is not a normal part of the aging process, and should be investigated and treated.
Reference: Page 590

Rationale 2: Changes in the hematologic system that occur with aging include a decrease in the functioning of lymphocytes, including cellular immunity.
Reference: Page 590

Rationale 3: Changes with aging include an increase in platelet adhesiveness.
Reference: Page 590

Rationale 4: Changes with aging include a slight decrease in the number of stem cells in the bone marrow.
Reference: Page 590

Question 2

While completing an assessment the nurse is concerned that an older patient is experiencing anemia. What did the nurse assess in this patient?

Standard Text: Select all that apply.

1. Pallor
2. Joint pain
3. Respiratory rate 14
4. Pulse 68 and regular
5. Dyspnea on exertion

Answer 2

Correct Answer: 1,2,5

Rationale 1: Manifestations of anemia in an older patient include pallor.
Reference: Page 590

Rationale 2: Manifestations of anemia in an older patient can include joint pain.
Reference: Page 590

Rationale 3: A respiratory rate of 14 is not a manifestation of anemia in an older patient.
Reference: Page 590

Rationale 4: A pulse rate of 68 is not a manifestation of anemia in an older patient. The heart rate would be increased if anemia were present.
Reference: Page 590

Rationale 5: Dyspnea on exertion is a manifestation of anemia in an older patient.
Reference: Page 590

Question 3

An older patient with chronic renal failure is exhibiting manifestations of anemia. Why is this occurring in the patient?

1. The result of renal dialysis
2. Loss of the kidney hormone erythropoietin
3. Loss of appetite related to elevated blood urea nitrogen (BUN) and creatinine levels
4. Loss of blood through the urine because the failing kidney does not function properly

Answer 3

Correct Answer: 2

Rationale 1: Hemodialysis does not cause anemia.
Reference: Page 594

Rationale 2: Anemia associated with renal failure is related to the loss of erythropoietin, which is produced by the healthy kidney and stimulates bone marrow to produce red blood cells.
Reference: Page 594

Rationale 3: Anemia is not caused by a loss of appetite or elevated blood urea nitrogen and creatinine levels.
Reference: Page 594

Rationale 4: Renal failure causes the loss of protein, not blood, through the urine.
Reference: Page 594

Question 4

An older patient is diagnosed with hemolytic anemia. What will the nurse teach the patient about this disorder?

1. It is caused by blood loss.
2. It will be treated with folic acid.
3. It causes the red blood cells to be misshaped.
4. It is associated with a drop in the number of immature red blood cells produced.

Answer 4

Correct Answer: 2

Rationale 1: Hemolytic anemia is more common with aging and is caused by premature destruction of red blood cells and not from blood loss.
Reference: Page 595

Rationale 2: All hemolytic anemias require treatment with folic acid because this vitamin is consumed by the increased bone marrow production of red blood cells in response to the anemia.
Reference: Page 595

Rationale 3: The red blood cell is of normal size and shape in hemolytic anemia.
Reference: Page 595

Rationale 4: Hemolytic anemia causes an increase in immature red blood cells because they are released early from the bone marrow to compensate for the premature destruction.
Reference: Page 595

Question 5

Which age-related change increases an older patients risk for pernicious anemia?

1. Laxative dependency
2. Increased incidence of cholelithiasis
3. Decreased hydrochloric acid in the stomach
4. Decreased peristalsis in the gastrointestinal tract

Answer 5

Correct Answer: 3

Rationale 1: Laxative use does not increase the older patients risk for developing pernicious anemia.
Reference: Page 596

Rationale 2: Cholelithiasis does not increase the older patients risk for developing pernicious anemia.
Reference: Page 596

Rationale 3: Pernicious anemia results when an older person lacks the needed intrinsic factor to absorb vitamin B12. A more common cause of low serum vitamin B12 results from the inability to split vitamin B12 from proteins in food. This inability may be the result of a deficiency of hydrochloric acid.
Reference: Page 596

Rationale 4: Decreased peristalsis in the gastrointestinal tract does not increase the older patients risk for developing pernicious anemia.
Reference: Page 596

Question 6

What will the nurse most likely assess in an older patient with a vitamin B12 deficiency?

Standard Text: Select all that apply.

1. Ataxia
2. Imbalanced walking
3. Nausea and vomiting
4. Cognitive impairment
5. Peripheral neuropathy

Answer 6

Correct Answer: 1,2,4,5

Rationale 1: The signs and symptoms of vitamin B12 deficiency include neurologic changes such as ataxia.
Reference: Page 596

Rationale 2: The signs and symptoms of vitamin B12 deficiency include neurologic changes such as difficulty walking and maintaining balance.
Reference: Page 596

Rationale 3: Nausea and vomiting are not associated with vitamin B12 deficiency.
Reference: Page 596

Rationale 4: The signs and symptoms of vitamin B12 deficiency include mental status changes and cognitive impairment.
Reference: Page 596

Rationale 5: The signs and symptoms of vitamin B12 deficiency include neurologic changes such as peripheral neuropathy manifested as numbness and tingling in the extremities.
Reference: Page 596

Question 7

An older patient is prescribed a blood transfusion of two units packed red blood cells. What should the nurse do when providing the blood to this patient?

Standard Text: Select all that apply.

1. Premedicate with an antihistamine.
2. Administer each unit over 2 to 4 hours.
3. Provide a diuretic between the two units as prescribed.
4. Carefully assess the intravenous access site for infiltration.
5. Monitor vital signs and urine output during the transfusion.

Answer 7

Correct Answer: 2,3,4,5

Rationale 1: An antihistamine is not routine provided to an older patient prior to administering a blood transfusion.
Reference: Page 597

Rationale 2: Transfusions for older people should be given slowly over a 2 to 4 hours period.
Reference: Page 597

Rationale 3: If several units of packed cells are to be infused often a diuretic is provided between units to prevent fluid overload and congestive heart failure.
Reference: Page 597

Rationale 4: Older people have more fragile veins. The intravenous site should be frequently assessed for signs of infiltration.
Reference: Page 597

Rationale 5: Because of the risk of heart failure from fluid overload the nurse should monitor the older patients vital signs and urinary output during the transfusion process.
Reference: Page 597

Question 8

The nurse is reviewing assessment data collected during a routine physical examination. Which finding should be investigated as a pathological process of the hematologic system?

1. WBC: 9000
2. Enlarged spleen
3. Hemoglobin: 15.0%
4. Pulse rate 86 beats per minute

Answer 8

Correct Answer: 2

Rationale 1: White blood cell count of 9000 is within normal limits for an adult.
Reference: Page 600

Rationale 2: An enlarged spleen is not a normal assessment finding and should be investigated further.
Reference: Page 600

Rationale 3: A hemoglobin level of 15% is within normal limits for an adult.
Reference: Page 600

Rationale 4: A pulse rate of 86 beats per minute is within normal limits for an adult.
Reference: Page 600

Question 9

An older patient is diagnosed with thalassemia. How will the nurse instruct the patient about this diagnosis?

Standard Text: Select all that apply.

1. There is no specific treatment.
2. Iron therapy is the best treatment.
3. A folate supplement may be prescribed.
4. Sulfonamides might need to be avoided.
5. It is an inherited disorder that can go undiagnosed until later in life.

Answer 9

Correct Answer: 1,3,5

Rationale 1: There is no specific treatment for thalassemia.
Reference: Page 594

Rationale 2: Iron replacement is not indicated and may result in iron overload.
Reference: Page 594

Rationale 3: It is recommended that a folate supplement be taken.
Reference: Page 594

Rationale 4: It is recommended that oxidative drugs such as sulfonamides be avoided.
Reference: Page 594

Rationale 5: Thalassemia is an inherited disorder and most undiagnosed adults will have the disease in a milder form that may go undiagnosed until later in life.
Reference: Page 594

Question 10

A patient is prescribed warfarin (Coumadin) for chronic atrial fibrillation. Which laboratory value will be used to monitor the effects of this medication?

1. Platelet count
2. Hematocrit and hemoglobin
3. Partial thromboplastin time (PTT)
4. PT reported as international normalized ratio (INR)

Answer 10

Correct Answer: 4

Rationale 1: The platelet count is not affected by warfarin and is not used to monitor the effects.
Reference: Page 602

Rationale 2: Warfarin does not affect the hematocrit and hemoglobin levels.
Reference: Page 602

Rationale 3: The partial thromboplastic time (PTT) is used to monitor the effects of heparin.
Reference: Page 602

Rationale 4: The PT, a measure of the time required for a firm fibrin clot to form after reagents have been added to the blood sample, is the standard measure of efficacy. It is commonly reported in an international normalized ratio (INR) because the World Health Organization urged the adoption of a standardized reagent so that all laboratories would report standardized results. Warfarin will prolong the INR.
Reference: Page 602

Question 11

The nurse has completed a physical assessment with an older patient. Which assessment finding suggests the presence of deep-venous thrombosis?

1. Two plus palpable pedal pulses
2. Shortness of breath after activity
3. Swelling in one leg with pitting edema
4. Bilateral calf tenderness after walking up a flight of stairs

Answer 11

Correct Answer: 3

Rationale 1: Two plus palpable pedal pulses is a normal assessment finding.
Reference: Page 601

Rationale 2: Shortness of breath that subsides after activity is considered a normal assessment finding.
Reference: Page 601

Rationale 3: The hallmark of DVT is the rapid onset of unilateral leg swelling with pitting edema.
Reference: Page 601

Rationale 4: Bilateral calf tenderness may be a normal reaction to exercise of climbing stairs.
Reference: Page 601

Question 12

An older patient receiving warfarin (Coumadin) alternate doses of 2.5 mg/5 mg has an INR of 6.3. What care should the nurse anticipate that this patient will need?

Standard Text: Select all that apply.

1. Prepare to begin a heparin infusion.
2. Administer vitamin K as prescribed.
3. Administer protamine sulfate as prescribed.
4. Withhold several doses of prescribed warfarin.
5. Administer an additional dose of warfarin as prescribed.

Answer 12

Correct Answer: 2,4

Rationale 1: The INR is used to measure the effects of warfarin. Heparin is not administered for an elevated INR.
Reference: Page 602

Rationale 2: Vitamin K is the antagonist for warfarin and will most likely be prescribed for the patient. For INRs between 5 and 9 the recommendation may be to administer vitamin K 1.0 to 2.5 mg by mouth.
Reference: Page 602

Rationale 3: Protamine sulfate is the antagonist for heparin and is not indicated for an elevated INR level caused by warfarin.
Reference: Page 602

Rationale 4: For INRs between 5 and 9, the recommendation may be to omit the next several doses of warfarin.
Reference: Page 602

Rationale 5: Administering an additional dose of warfarin will cause the INR to be further elevated.
Reference: Page 602

Question 13

An older patient is diagnosed with polycythemia vera. What care will this patient most likely be prescribed?

Standard Text: Select all that apply.

1. Ticlopidine
2. Splenectomy
3. Hydroxyurea
4. Chemotherapy
5. Periodic phlebotomy

Answer 13

Correct Answer: 3,5

Rationale 1: Ticlopidine is a potent inhibitor of platelet aggregation but is used in prevention of stroke and heart attack.

Rationale 2: Splenectomy is not indicated in the treatment of polycythemia vera.

Rationale 3: In polycythemia vera, hydroxyurea can decrease the risk of thrombosis.

Rationale 4: Chemotherapy is not indicated in the treatment of polycythemia vera.

Rationale 5: Periodic phlebotomy significantly decreases the risk of thrombosis.

Question 14

Which assessment finding would the nurse expect to find in an older patient suspected of having non-Hodgkins lymphoma?

1. Pitting edema in one leg
2. Ataxia and difficulty with walking
3. Severe bone pain in the lower back
4. Enlarged lymph nodes in the neck area

Answer 14

Correct Answer: 4

Rationale 1: Edema in one leg would be suspicious of a deep-venous thrombosis.
Reference: Page 599

Rationale 2: Ataxia and difficulty walking is not specifically associated with non-Hodgkins lymphoma.
Reference: Page 599

Rationale 3: Severe bone pain in the lower back is associated with the malignant condition multiple myeloma.
Reference: Page 599

Rationale 4: In non-Hodgkins lymphoma, the normal lymphoid tissue is replaced by malignant cells leading to infection and immunodeficiency. Symptoms include cervical lymph node enlargement.
Reference: Page 599

Question 15

Which laboratory finding would the nurse expect in an older patient diagnosed with multiple myeloma?

1. Increased calcium level
2. Increased white blood cells
3. Decreased blood urea nitrogen level
4. Decreased number of plasma cells in the bone marrow

Answer 15

Correct Answer: 4

Rationale 1: An elevated calcium level is not associated with multiple myeloma but may be seen in metastatic neoplasms.
Reference: Page 599

Rationale 2: An increase in white blood cells is not associated with multiple myeloma but may be seen with infections or other blood disorders.
Reference: Page 599

Rationale 3: A decreased blood urea nitrogen level is not associated with multiple myeloma and is not associated with any particular disease process.
Reference: Page 599

Rationale 4: Multiple myeloma is a malignancy that results from the overproduction and accumulation of immature plasma cells in the bone marrow, lymph nodes, spleen, and kidneys.
Reference: Page 599

Question 16

An older patients serum ferritin level is elevated. For which health problems will this laboratory value be elevated?

Standard Text: Select all that apply.

1. Alcoholism
2. Iron overload
3. Acute hepatitis
4. Metastatic cancer
5. Chronic inflammatory disorders

Answer 16

Correct Answer: 2,3,4,5

Rationale 1: Alcoholism does not cause an increase in serum ferritin level. Alcoholism can affect mean corpuscular volume.
Reference: Page 593

Rationale 2: Iron overload can cause an increase in serum ferritin level.
Reference: Page 593

Rationale 3: Acute hepatitis can cause an increase in serum ferritin level.
Reference: Page 593

Rationale 4: Metastatic cancer can cause an increase in serum ferritin level.
Reference: Page 593

Rationale 5: Chronic inflammatory disorders can cause an increase in serum ferritin levels.
Reference: Page 593

Question 17

The nurse is caring for a 65-year-old female patient with chronic renal failure. In reviewing the patients laboratory values, which result would the nurse expect to find?

1. Hemoglobin 9 g/dL
2. Hemoglobin 12 g/dL
3. Hemoglobin 15 g/dL
4. Hemoglobin 23 g/dL

Answer 17

Correct Answer: 1

Rationale 1: Chronic renal failure results in a two-fold increase in the chance of being diagnosed with anemia. A result of 9 g/dl is considered anemic for a female patient.

Rationale 2: Older women are considered anemic with a hemoglobin concentration below 12 g/dL.

Rationale 3: A hemoglobin level of 15 g/dL is considered normal.

Rationale 4: A hemoglobin level of 23 g/dL is considered elevated and would not be seen in the patient with chronic renal failure.

Question 18

The nurse provides discharge teaching to an older patient diagnosed with iron deficiency anemia. Which statement by the patient indicates additional instruction is needed?

1. I will take my ferrous sulfate tablet with my breakfast.
2. I will take my ferrous sulfate tablet on an empty stomach.
3. I will eat oatmeal for breakfast while I am taking my ferrous sulfate.
4. I will increase my fluid intake while I am taking my ferrous sulfate.

Answer 18

Correct Answer: 2

Rationale 1: To minimize gastrointestinal distress, ferrous sulfate should be taken with meals.
Reference: Page 593

Rationale 2: Ferrous sulfate should be taken with meals. This patient statement indicates that additional teaching is needed.
Reference: Page 593

Rationale 3: Ferrous sulfate increases the risk of constipation. Ingesting oatmeal could reduce the risk of developing constipation from this medication.
Reference: Page 593

Rationale 4: Ferrous sulfate increases the risk of constipation. Increasing fluids will help reduce the risk of developing constipation from this medication.
Reference: Page 593

Question 19

The nurse is preparing an educational program on hemolytic anemia for the residents of an assisted living center. Which potential causes should the nurse include in the program?

Standard Text: Select all that apply.

1. Insulin use
2. Aspirin use
3. Ibuprofen use
4. Anticoagulant use
5. Prosthetic heart valves

Answer 19

Correct Answer: 1,2,3,5

Rationale 1: Drugs capable of causing hemolytic anemia include insulin.
Reference: Page 595

Rationale 2: Drugs capable of causing hemolytic anemia include aspirin.
Reference: Page 595

Rationale 3: Drugs capable of causing hemolytic anemia include ibuprofen.
Reference: Page 595

Rationale 4: Drugs capable of causing hemolytic anemia do not include anticoagulants.
Reference: Page 595

Rationale 5: The causes of hemolytic anemia include mechanical factors such as with prosthetic heart valves.
Reference: Page 595

Question 20

An older patient is prescribed warfarin. What will the nurse include when teaching the patient about this medication?

1. There are no restrictions to alcohol intake.
2. Do not take any medications with aspirin or acetaminophen.
3. Herbal remedies can be continued when taking this medication.
4. This medication does not usually interact with other medications.

Answer 20

Correct Answer: 2

Rationale 1: Alcohol will interfere with warfarin and cause the INR to either increase with alcohol binging or be reduced with moderate alcohol intake.
Reference: Page 603

Rationale 2: Aspirin and acetaminophen will interact with warfarin and cause the INR to be prolonged.
Reference: Page 603

Rationale 3: Warfarin interacts with herbal remedies and may cause the INR to be either prolonged or reduced.
Reference: Page 603

Rationale 4: Warfarin interacts with many medications.
Reference: Page 603

Question 21

The nurse provides discharge teaching to an older patient recovering from a deep vein thrombosis. Which patient statement indicates that teaching has been effective?

1. I will limit my fluid intake.
2. I will rest several additional hours every day.
3. I will take my medication every day as prescribed.
4. I will only cross my legs when reading after dinner.

Answer 21

Correct Answer: 3

Rationale 1: The patient should be instructed to stay well hydrated and not limit fluid intake.
Reference: Page 602

Rationale 2: The patient should be instructed to avoid prolonged sitting and bed rest.
Reference: Page 602

Rationale 3: The patient should be instructed to keep on a regular medication schedule and not miss or skip any doses.
Reference: Page 602

Rationale 4: The patient should be instructed to not cross the legs.
Reference: Page 602

Question 22

An older patient recovering from a total hip replacement is demonstrating edema and pain in the operative limb. Which medication should the nurse prepare to administer to the patient?

1. Penicillin
2. Furosemide
3. Low-dose heparin
4. High-dose heparin

Answer 22

Correct Answer: 4

Rationale 1: The patients edema and pain are not caused by an infection so an antibiotic would not be indicated.
Reference: Page 602

Rationale 2: Furosemide is a diuretic which would not be indicated for unilateral limb edema.
Reference: Page 602

Rationale 3: Low-dose heparin therapy is given prophylactically after general and orthopedic surgery however this patient is demonstrating signs of a deep vein thrombosis.
Reference: Page 602

Rationale 4: High-dose heparin therapy is indicated for older adults with a deep vein thrombosis and those who have had total hip replacement.
Reference: Page 602

Question 23

The nurse is planning an inservice for nursing assistive personnel on ways to prevent the development of deep vein thrombosis in older patients. Which information should the nurse include in this presentation?

Standard Text: Select all that apply.

1. Turn bed-bound patients at least every 2 hours.
2. Maintain older patients on oral fluid restrictions.
3. Remind older patients to not elevate the legs when sitting.
4. Apply fitted support stockings to older patients as prescribed.
5. Assist older patients to walk as soon as possible after surgery.

Answer 23

Correct Answer: 1,4,5

Rationale 1: An intervention to prevent the formation of deep vein thrombosis in the older patient includes turning bed-bound patients at least every 2 hours.
Reference: Pages 601-602

Rationale 2: Oral fluid restriction is not an intervention to prevent the formation of deep vein thrombosis in the older patient.
Reference: Pages 601-602

Rationale 3: Older patients should be encouraged to elevate the legs when sitting to prevent the formation of deep vein thrombosis.
Reference: Pages 601-602

Rationale 4: An intervention to prevent the formation of deep vein thrombosis in the older patient includes applying fitted support stockings as prescribed.
Reference: Pages 601-602

Rationale 5: An intervention to prevent the formation of deep vein thrombosis in the older patient includes assisting to walk as soon as possible after surgery.
Reference: Pages 601-602

Question 24

An older patient with a history of peptic ulcer disease is diagnosed with a vitamin B12 deficiency. How are these two disorders related?

1. Peptic ulcer disease affects absorption of nutrients.
2. Peptic ulcer disease reduces the surface area of the stomach.
3. Medications used to treat peptic ulcer disease affect stomach acid.
4. Medications used to treat peptic ulcer disease block the absorption of vitamins.

Answer 24

Correct Answer: 3

Rationale 1: The use of gastric acid-blocking agents may contribute to the development of vitamin B12 deficiency because they block the acid environment needed to break down and release vitamin B12 in ingested food. Peptic ulcer disease does not affect the absorption of nutrients as a cause for the deficiency.
Reference: Page 596

Rationale 2: The use of gastric acid-blocking agents may contribute to the development of vitamin B12 deficiency because they block the acid environment needed to break down and release vitamin B12 in ingested food. Peptic ulcer disease does not reduce the surface area of the stomach as a cause for the deficiency.
Reference: Page 596

Rationale 3: The use of gastric acid-blocking agents may contribute to the development of vitamin B12 deficiency because they block the acid environment needed to break down and release vitamin B12 in ingested food.
Reference: Page 596

Rationale 4: The use of gastric acid-blocking agents may contribute to the development of vitamin B12 deficiency because they block the acid environment needed to break down and release vitamin B12 in ingested food. Gastric acid-blocking agents do not block the absorption of vitamins.
Reference: Page 596