Disorders Of Hematologic & Lympathic Flashcards
1
Q
-Emia = blood
-penia = lack or deficiency
-osis = increased condition
A
-cytic = cell size
-chromic = hemoglobin content
-lysis = cell death
2
Q
Anemia
A
Deficiency in erythrocytes or hemoglobin due to:
Blood loss
Inadequate/abnormal erythrocyte production
RBC destruction
General symptoms:
Pallor, fatigue, weakness, dyspnea, dizziness, tachycardia, chest discomfort, headache, difficulty concentrating, orthostatic hypotension, thready pulse, decreased bowel sounds, constipation, amenorrhea, cool/clammy skin
3
Q
Hypovolemic Anemia:
A
Cause: blood volume loss (acute or chronic)
Labs: decreased RBCs, Hgb, Hct; microcytic, hypochromic RBCs; increased reticulocytes
Treatment: Blood transfusion, iron supplementation
4
Q
Pernicious Anemia:
A
Cause: lack of intrinsic factor —> decreased B12 absorption
Symptoms: glossitis, stomatitis, diarrhea, jaundice, ataxia, numbness/tingling
Labs: CBC, Hgb, Hct, MCV, Schilling test, bilirubin
Treatment: IM vitamin B12 (Cyanocobalamin)
5
Q
Folic Acid-Deficiency Anemia:
A
Cause: Inadequate folate intake (older adults, alcoholics, pregnancy, GI disorders)
Symptoms: Beefy red tongue, fatigue, headache, anorexia, lightheadedness
Labs: CBC, Hgb, Hct, MCV, serum folate
Treatment: Folic acid supplements, dietary changes
6
Q
Iron-Deficiency Anemia:
A
Cause: Insufficient dietary iron, blood loss, malabsorption
Symptoms: fatigue, cold intolerance, pale skin
Labs: CBC, ferritin, iron, TIBC, Hgb, Hct, MCV
Treatment: Iron supplements, dietary changes
7
Q
Hemolytic Anemia
A
Cause: RBC destruction (cardiopulmonary bypass, lead/arsenic poisoning, transduction reactions, malaria)
Symptoms: jaundice, splenomegaly
Treatment: transfusions
8
Q
Sickle Cell Disease:
A
Cause: Hemoglobin S —> sickled RBCs —> ischemia, infarction
Symptoms: pain, fever, joint swelling, anemia symptoms
Labs: CBC, sickledex, Hgb electrophoresis
Treatment: folic acid, hydroxyurea, blood transfusion, pain management, oxygen, deferoxamine
9
Q
Aplastic Anemia:
A
Cause: Bone marrow failure (toxins, chemo, antibiotics)
Symptoms: Pancytopenia, infections, bruising, petechiae
Labs: CBC, bone marrow aspiration
Treatment: Transfusions, antibiotics, corticosteroids, bone marrow transplant
10
Q
Polycythemia Vera:
A
Cause: Overproduction of RBCs, WBCs, platelets
Symptoms: Reddish skin, HTN, pruritus, gout, splenomegaly, stroke risk
Labs: CBC, uric acid, erythropoietin
Treatment: Phlebotomy, anticoagulants, chemo/radiation
11
Q
Leukemia:
A
Definition: Uncontrolled leukocyte production in bone marrow suppression—> decreased RBCs & platelets
Types:
Acute — abrupt onset: AML, ALL (children)
Chronic — slower progression: CLL, CML
Symptoms: infections, fatigue, bruising, hepatosplenomegaly
Treatment: Chemotherapy, transfusions, stem cell/bone marrow transplant
12
Q
Multiple Myeloma:
A
Malignancy of plasma cells in bone marrow
Symptoms: Bone pain, pathologic fractures, infections, hypercalcemia, renal failure
Treatment: Chemo, stem cell transplant, analgesics, Epogen, allopurinol
13
Q
Thrombocytopenia:
A
Platelet count <100,000
Symptoms: Purpura, spontaneous bleeding
Causes: Heparin-induced, idiopathic
Treatment: Stop heparin, corticosteroids, platelet transfusion, splenectomy
14
Q
Hemophilia (A, B, C)
A
Inherited clotting disorder (mostly in males)
Symptoms: Oozing, bleeding after trauma
Treatment: Clotting factors, plasma, blood transfusion
15
Q
Disseminated Intravascular Coagulation (DIC)
A
Excessive clotting —> depletion of platelets —> bleeding
Triggered by sepsis, trauma
16
Q
Lymphedema:
A
Cause: Impaired lymph drainage
Symptoms: Swelling, shiny thickened skin, oozing
Treatment: Symptomatic
17
Q
Hodgkin’s Disease:
A
Malignant Reed-Sternberg cells
Symptoms: Painless lymphadenopathy, night sweats, fever, pruritus, weight loss
Treatment: Chemo, radiation, transfusions
18
Q
Non-Hodgkin’s Lymphoma:
A
Diffuse lymph node enlargement (cervical, auxiliary, inguinal)
More common in immunosuppressed clients
Treatment: Chemo, radiation, monoclonal antibodies, stem cell transplant
19
Q
Lymphangitis & Lymphadenitis:
A
Cause: Bacterial infection (often streptococcal)
Symptoms: Red streaks, fever, tender/enlarged lymph nodes
Treatment: Broad-spectrum antibiotics
20
Q
What is the treatment for iron-deficiency anemia?
A
Iron supplementation (oral, IM, IV) and dietary iron intake
21
Q
What lab values help monitor iron-deficiency anemia treatment?
A
Hgb, Hct, MCV, serum iron, ferritin, total iron-binding capacity
22
Q
What medication is used for pernicious anemia?
A
IM vitamin B12 (Cyanocobalamin)
23
Q
What supplement is used for folic acid-deficiency anemia?
A
Oral folic acid; diet rich in folate
24
Q
What drug reduces sickling in sickle cell disease?
A
Hydroxyura
25
What drug removes excess iron from the body due to transfusions in sickle cell disease?
Deferoxiamine
26
What analgesics are used during a sickle cell crisis?
Narcotics, buprenorphine, nalbuphine
27
What supportive medication is used to stimulate RBC production in anemia from renal disease or cancer?
Erythropoietin (Epogen)
28
What is the primary treatment for leukemia?
Chemotherapy
29
What supportive meds are used during leukemia treatment?
Erythrocyte and platelet transfusions, antibiotics
30
What medication is used to reduce uric acid buildup in multiple myeloma?
Allopurinol
31
What types of meds are used for pain in multiple myeloma?
Narcotic analgesics
32
What is the treatment for thrombocytopenia (heparin-induced or idiopathic)?
Discontinue heparin, corticosteroids, platelet transfusions, whole blood, splenectomy
33
What is the treatment for hemophilia?
Clotting factor replacement, transfusions of frozen plasma or blood
34
What is the treatment focus in DIC?
Supportive therapy: manage bleeding and clotting, transfusions, treat the underlying cause
35
What medications are used in polycythemia Vera to manage blood viscosity and cellular overgrowth?
Anticoagulants, chemotherapy (antineoplastic drugs), radiophosphorus or radiation therapy
36
What is the treatment for Hodgkin’s and Non-Hodgkin’s lymphoma?
Radiation, chemotherapy, antibiotics, transfusions, immunotherapy (monoclonal antibodies)
37
What CBC findings are common in hypovolemic anemia?
Decreased RBCs, H&H
Increased reticulocytes, microcytic, hypochromic RBCs
38
What test confirms vitamin B12 deficiency?
Schilling test
39
What are key symptoms of a sickle cell crisis?
Pain, joint swelling, fever, jaundice, anemia symptoms
40
What happens to normal blood cells in leukemia?
Decreased due to crowding out by immature leukocytes
41
At what platelet count is spontaneous bleeding likely?
< 20,000
42
What is the priority nursing goal for a client with thrombocytopenia?
Prevent injury
43
What are signs of polycythemia Vera?
Reddish-purple skin, headache, pruritus, gout, HTN
44
What vitamin is essential for clotting and may be deficiency in liver diseases?
Vitamin K
45
What malignant cells are found in Hodgkin’s disease?
Reed-Sternberg cells
46
What are red streaks along lymph channels are a sign of?
Lymphangitis
47
A 38 year old woman presents with complaints of fatigue, pallor, and feeling cold all the time. Lab results show decreased hemoglobin, hematocrit, MCV, serum iron, and ferritin?
Which dietary recommendation should the nurse provide?
A. increase intake of dairy products
B. Eat more leafy green vegetables and red meat
C. Limit red meat to avoid excessive iron
D. Consumer more citrus fruits exclusively
B. Eat more leafy green vegetables and red meat
Leafy greens and red meat are high in iron, which helps replenish stores. Dairy can inhibit iron absorption
48
A 65 year old client has numbness in hands and feet, glossitis, and lab results reveal low vitamin B12.
What treatment should the nurse anticipate for this client?
A. Oral vitamin B12 supplements
B. IM vitamin B12 injections
C. Folic acid injections
D. Iron supplementation
B. IM vitamin B12 injections
Pernicious anemia is due to lack of intrinsic factor, so vitamin B12 must be given IM.
49
A 19 year old with known sickle cell disease presents with joint pain, fever, and severe back pain.
What is the priority nursing action?
A. Administer IV fluids
B. Administer pain medication
C. Apply ice to painful areas
D. Obtain blood cultures
B. Administer pain medication
Pain control is the first priority in a sickle cell crisis, followed by hydration and oxygenation
50
A client diagnosed with aplastic anemia has petechiae, bleeding gums, and frequent infections. Which lab result would the nurse expect?
A. Elevated RBC count
B. Decreased platelets and WBCs
C. Increased reticulocyte count
D. Elevated hematocrit
B. Decreased platelets and WBCs
Aplastic anemia involves pancytopenia—low RBCs, WBCs, and platelets
51
A patient with polycythemia Vera complains of dizziness, headache, and joint pain. The provider prescribes phlebotomy.
What is the primary goal of this treatment?
A. Reduce risk of infection
B. Increase platelet count
C. Decrease blood viscosity
D. Prevent anemia
C. Decrease blood viscosity
Phlebotomy reduces the number of RBCs, lowering blood viscosity and risk of thrombosis
52
A nurse is caring for a patient with thrombocytopenia. Which action is most appropriate?
A. Encourage frequent ambulation
B. Use a soft toothbrush or oral care
C. Administer IM injections for pain
D. Take rectal temperature every 4 hours
B. Use a soft toothbrush or oral care
Clients with thrombocytopenia are at risk for bleeding and should avoid trauma —including brushing teeth gently
53
A child with acute lymphocytic leukemia is receiving chemotherapy. What is the most important nursing action?
A. Monitor for bruising
B. Encourage intake of raw fruits and vegetables
C. Administer vaccines
D. Allow the child to play outside regularly
A. Monitor for bruising
Chemotherapy suppresses platelets and immune function; bruising indicates thrombocytopenia
54
Which finding is most concerning in a patient with multiple myeloma?
A. Back pain and fatigue
B. Hypercalcemia and confusion
C. Mild anemia
D. Occasional bruising
B. Hypercalcemia and confusion
Hypercalcemia can lead to serious complications like cardiac Dysrhythmias and altered mental status
55
A 7 year old with hemophilia A bumps his knee and reports mild pain. The area is swollen.
What is the nurse’s best action?
A. Apply heat and elevate the leg
B. Give aspirin for pain relief
C. Administer factor VIII
D. Massage the affected areas
C. Administer factor VIII
Administering the missing clotting factor (VIII) is priority to prevent bleeding complications
56
A client with Hodgkin’s lymphoma is undergoing chemotherapy. What is the most important intervention?
A. Monitor for signs of infections
B. Encourage exposure to sunlight
C. Administer routine vaccinations
D. Promote intake of raw vegetables
A. Monitor for signs of infections
Chemo suppresses immune function; infection prevention is essential
57
A client is undergoing induction chemotherapy for AML. They develop low back pain, elevated potassium, phosphate, and uric acid levels
A. Administer potassium supplements
B. Administer allopurinol
C. Provide IV fluids
D. Encourage high-protein diet
E. Administer rasburicase
B. Administer allopurinol
C. Provide IV fluids
E. Administer rasburicase
Allopurinol and rasburicase help prevent uric acid-related kidney damage in tumor lysis syndrome. IV fluids prevent renal calculus. Potassium is already elevated—supplementing it would be harmful.
58
A client reports weight loss, night sweats, and intermittent fever. Biopsy shows Reed-Sternberg cells.
A. Avoid prolonged sun exposure
B. Avoid NSAIDs
C. Stop smoking
D. Reduce alcohol consumption
E. Increase citrus fruit intake
A. Avoid prolonged sun exposure
C. Stop smoking
D. Reduce alcohol consumption
These reduce risk of secondary malignancies. Citrus and NSAIDS are unrelated in this context
59
A client with multiple myeloma reports back pain and is found to have hypercalcemia.
What is the priority complication to assess?
A. Fluid overload
B. Pathologic fractures
C. Constipation
D. Seizure activity
B. Pathologic fractures
Osteoclast-activating factors break down bone —> bone weakening —> pathologic fractures are common
60
A client with post mastectomy lymphedema has 4cm of swelling compared to the unaffected arm, heaviness, and pain.
What stage of lymphedema is this?
A. Grade I
B. Grade II
C. Grade III
D. Grade IV
B. Grade II
Grade II listed buildings= 4 to <8 cm difference + symptoms.
(Grade I is 2-4 cm without symptoms)
61
A client with chronic myeloid leukemia (CML) is being discharged on dasatinib.
What adverse effects should the nurse teach to report immediately? (Select all that apply)
A. Chills and fever
B. Decreased urine output
C. Constipation
D. Prolonged QT interval B
E. Increased appetite
A. Chills and fever
B. Decreased urine output
D. Prolonged QT interval B
These are signs of myelosuppression and serious cardiac/renal effect from tyrosine kinases inhibitors
62
A client with Hodgkin’s lymphoma develops respiratory distress and full feeling in the upper abdomen.
Which nursing interventions are priorities?
A. Place in high Fowler’s position
B. Assess respiratory status frequently
C. Encourage large meals
D. Keep neck in midline
E. Place endotracheal kit at bedside
A. Place in high Fowler’s position
B. Assess respiratory status frequently
D. Keep neck in midline
E. Place endotracheal kit at bedside
Enlarged mediastinal nodes can compromise airway. Anticipate need for intubation
63
A client with lymphadenitis has red streaks on the arm, pain, and fever
Which interventions will help reduce symptoms? (Select all that apply)
A. Elevate the limb
B. Apply ice packs
C. Administer broad-spectrum antibiotics
D. Apply warm soaks
E. Encourage strenuous activity
A. Elevate the limb
C. Administer broad-spectrum antibiotics
D. Apply warm soaks
Elevation and warmth reduce swelling and pain. Ice and strenuous activity are inappropriate
64
A client with chronic lymphocytic leukemia (CLL) presents with 10% weight loss in 6 months, drenching night sweats, and intermittent fever.
What are these findings called?
A. Reed-Sternberg symptoms
B. B symptoms
C. Blast crisis
D. Tumor lysis indicators
B. B symptoms
B symptoms are indicators of poor prognosis in CLL
65
A client with AML develops a fever during treatment.
What is the most likely cause?
A. thrombocytopenia
B. Neutropenia
C. Anemia
D. Hyperuricemia
B. Neutropenia
Neutropenia = low neutrophils = increased infection risk = fever
66
A teenage presents with sore throat, fatigue, and white exudate on tonsils. The provider suspects mono.
What test confirms the diagnosis?
A. CBC
B. ALT/AST
C. Monospot
D. TSH
C. Monospot
Monospot is the most common rapid test for Epstein-Barr virus
67
Iron-Deficiency anemia
Fatigue related to decreased oxygen-carrying capacity of the blood
Goal: Client will verbalize increased energy and participate in ADLs without excessive fatigue
Interventions: Monitor H&H levels; Administer prescribed iron supplements; teach about iron rich foods (red meat, leafy greens), encourage rest between activities
Rationale: Iron is needed for hemoglobin synthesis; rest conserves energy
Evaluation: Client reports increased energy, Hgb levels within normal limits
68
Pernicious Anemia
Imbalanced nutrition: less than body requirements related to malabsorption of vitamin B12
Goal: client will maintain adequate nutritional intake
Interventions: administer IM Cyanocobalamin as prescribed; Monitor CBC & vitamin B12 levels; educate about the need for lifelong therapy; assess for neurological symptoms (numbness, tingling)
Rationale: B12 deficiency affects RBC production & neurological function
Evaluation: Client demonstrates understanding of therapy and maintains stable labs
69
Aplastic Anemia
Risk for infection related to bone marrow suppression
Goal: client will remain free from signs of infection
Interventions: Monitor WBC count & temperature; use of neutropenia precaution (hand hygiene, avoid raw foods, limit visitors); administer antibiotics as ordered; education on infection prevention at home
Rationale: Bone marrow suppression reduces immune defense
Evaluation: client remains a febrile, WBC count stable, no signs of infection
70
Sickle Cell Disease
Acute pain related to sickling of red blood cells and tissue ischemia
Goal: Client will report pain relief as 3/10 or less on the pain scale
Interventions: Administer prescribed opioids or analgesics; provide oxygen therapy; encourage hydration (IV or PO); monitor for signs of crisis (pain, swelling, fever)
Rationale: Pain results from vaso-occlusion; hydration and oxygen reduce sickling.
Evaluation: client verbalizes pain relief, no new signs of crisis
71
Leukemia
Risk for bleeding related to decreased platelet production
Client will have no episodes of bleeding during hospitalization
Interventions: Monitor platelet count, signs of bleeding (gums, urine, stool); Avoid IM injections & invasive procedures; use soft toothbrush; electric razor; teach fall precautions
Rationale: Thrombocytopenia increases bleeding risk; precautions help prevent injury
Evaluation: No signs of bleeding observed; platelet count stabilizing
72
Multiple myeloma
Risk for injury related to bone demineralization and pathologic fractures
Goal: Will remain free from fractures during hospitalization
Interventions: Assess for bone pain and mobility issues; implement fall precautions; avoid heavy lifting or strenuous activities; monitor calcium levels
Rationale: Bone lesions weaken skeletal integrity; calcium imbalance can worsen symptoms
Evaluation: Client remains free from falls/fractures
73
Hodgkin’s lymphoma
Disturbed body image related to alopecia and physical changes from chemotherapy
Goal: Client will verbalize positive adaptation to body changes
Interventions: Provide emotional support and active listening; offer wigs, scarves, or hat; involve support group or counseling; encourage verbalization of feelings
Rationale: Supportive care helps clients cope with altered appearance
Evaluation: client expresses acceptance and engage in social activities
74
Lymphedema
Impaired tissue integrity related to fluid accumulation and compromised lymph drainage
Goal: Will demonstrate reduced edema and intact skin
Interventions: elevated affected limb; teach use of compression garments; provide skin care education to prevent infection; monitor for weeping, redness, or breakdown
Rationale: reducing edema helps prevent tissue damage and infection
Evaluation: swelling reduced; skin remains intact
75
A client with iron-deficiency anemia is prescribed ferrous sulfate PO. Which teaching point should the nurse include?
A. Take the medication with milk to reduce gastric irritation
B. Take the medication on an empty stomach with vitamin C
C. Limit intake of citrus fruits while on this medication
D. Avoid taking the medication if stools turn dark
B. Take the medication on an empty stomach with vitamin C
Vitamin C enhance iron absorption. Iron is best absorbed on an empty stomach, but can be taken with food if GI upset occurs. Milk interferes with absorption. Dark stools are expected.
76
A client with pernicious anemia asks why they must receive vitamin B12 injections instead of pills. What is the best response by the nurse?
A. Pills take too long to work compared to injections
B. Injections are less expensive and more convenient
C. Your body can’t absorb vitamin B12 through your stomach without intrinsic factor
D. You are allergic to the oral form of vitamin B12
C. Your body can’t absorb vitamin B12 through your stomach without intrinsic factor
Pernicious anemia results from a lack of intrinsic factor, which is necessary for GI absorption of B12. IM injections bypass the need for intrinsic factor
77
What is the expected therapeutic effect of hydroxyurea in a client with sickle cell disease?
A. Increases platelet production
B. Decreases the frequency of sickling crises
C. Prevents bone marrow suppression
D. Treats infection during crisis
B. Decreases the frequency of sickling crises
Hydroxyurea increases fetal hemoglobin production, which reduces the sickling of red cells and the frequency of crises
78
A client undergoing chemotherapy for AML is prescribed allopurinol. What is the primary purpose of this medication?
A. Prevents nausea and vomiting
B. Reduces bone pain
C. Prevents uric acid buildup from cell destruction
D. Enhances white blood cell production
C. Prevents uric acid buildup from cell destruction
Allopurinol prevents hyperuricemia and uric acid nephropathy related to tumor lysis syndrome by inhibiting xanthine oxidase
79
A nurse is reviewing a client’s new prescription for erythropoietin (Epogen). Which client statement requires immediate follow-up?
A. My legs and back feel sore
B. My blood pressure has been higher than usual
C. I feel tired all the time
D. I had flu-like symptoms after the injection
B. My blood pressure has been higher than usual
A rise in blood pressure is a potentially serious side effect of erythropoietin and can lead to cardiovascular events. Bone pain and flu-like symptoms are common and self-limiting
80
Anemia Medications
Ferrous sulfate (iron) = treats iron-deficiency anemia
Vitamin B12 (Cyanocobalamin) = IM treatment for pernicious anemia
Folic acid = supplement for folic acid-deficiency anemia
Erythropoietin (Epogen) = stimulates RBC production in CKD, myeloma, cancer
81
Sickle Cell Disease medications
Hydroxyurea = increases fetal Hgb, reduces sickling
Folic acid = supports RBC production
Vepoloxamer = reduces cell adhesion (experimental/advanced use)
Inhaled nitric oxide = reduces sickling
Deferoxamine = Chelates iron from frequent transfusions
Opioids (morphine, buprenorphine) = pain relief during crises
82
Leukemia & Myeloma medications
Chemotherapy agents = primary treatment
Allopurinol = prevents uric acid buildup-up (tumor lysis)
Rasburicase = lowers uric acid acutely
Analgesics = manage myeloma bone pain
Antibiotics = infection prevention during neutropenia
Dasatinib = TKI for CML
83
Coagulopathies medications
Clotting factors (VIII, IX…) = Hemophilia treatment
Plasma/blood transfusions = for bleeding & clotting support
Corticosteroids = for ITP (immune thrombocytopenia)
Heparin—STOPPED = cause of HIT
84
Lymphatic disorders medication
Broad-spectrum antibiotics = for Lymphangitis and lymphadenitis
Chemotherapy/radiation = for Hodgkin’s, Non-Hodgkin’s
Monoclonal antibodies = for advanced NHL
85
What test confirms sickle cell disease?
Sickledex test, hemoglobin electrophoresis
86
What is the hallmark symptom of folic acid deficiency anemia?
Beefy red tongue
87
What is the hallmark cell found in Hodgkin’s lymphoma?
Reed-Sternberg cells
88
Which leukemia has the slowest progression?
Chronic lymphocytic leukemia (CLL)
89
What is the main treatment for hemophilia A?
Factor VIII replacement therapy
90
What blood disorder involves excessive RBC production?
Polycythemia
91
What medication removes excess iron from blood transfusions?
Deferoxamine
92
What infection commonly causes Lymphangitis?
Streptococcal infections
