Exam 4: Wed 11/18 Key Points and practice questions

Question 1

True or False: Anemia may have no symptoms until hemoglobin and hematocrit fall below one half of normal.

Answer 1

True

Question 2

What are the early signs of anemia?

Answer 2

• weakness
• fatigue
• dyspnea

Question 3

What platelet level would be considered life threatening? What is the associated condition called?

Answer 3

Below 10,000

Thrombocytopenia

Question 4

What area of the body must you always inspect if you suspect or are aware of a hematological disorder?

Answer 4

nail beds and skin on hands

Question 5

If rapid onset of anemia occurs after major surgery, which of the following symptom patterns might develop?

a. continuous oozing of blood from the surgical site
b. exertional dyspnea and fatigue with increased heart rate
c. decreased heart rate
d. no obvious symptoms would be seen.

Answer 5

b

• can check vitals and O2sat to make sure patient isn’t “just tired”.
• patient may require surgeon to look at again to ensure no leaking internally
• patient may need a transfusion

Question 6

Chronic GI blood loss sometimes associated with NSAIDs can result in which of the following problems?

a. increased incidence of joint inflammation

b iron deficiency

c. decreased HR and bleeding
d. weight loss, fever, and loss of appetite

Answer 6

b

• most common problem with chronic blood loss
• not c because HR will increase if losing volume
• not d or a due to taking NSAIDs

Question 7

Under what circumstances would you consider asking a client about a recent change in altitude or elevation?

Answer 7

RBC count may have changed- answer from class

From book: When you live at an elevation of 3500 ft above sea level (or higher) and the pt. reports unknown origins of symptoms: headache, dizziness, fatigue, changes in sensation in hands and/or feet, tingling (polycythemia)

joint pain, swelling, loss of motion (sickle cell)

Question 8

Pre-op, clients cannot take aspirin or anti-inflmmatory meds because these:

a. decrease leukocytes
b. increase leukcytes
c. decrease platelets
d. increase platelets
e. none of the above

Answer 8

c

NSAIDs derease platelet levels

Dr. T said “e” in class, but she is wrong and was also contradicting on of her pp slides

Question 9

Skin color and nail bed changes may be observed in the client with:

a. thrombocytopenia reulting from chemo
b. pernicious anemia resulting from vit B12 deficiency
c. luekocytosis resulting from AIDS
d. All of the above

Answer 9

d

Question 10

In the case of a client with hemoarthrosis associated with hemophilia, what PT intervention would be contraindicated?

Answer 10

• any modalities with heat, includes continuous ultrasound b/c there is a heating component
• mobilizations- do not want to move tissue where there is a continued slow bleed

* at greater risk for contractures, if not balancing bleeding component and trying to not stress those tissues well.

Question 11

Bleeding under the skin, nosebleeds, bleeding gums, and black stools require medical evaluation as these may be indications of:

a. leukopenia
b. thrombocytopenia
c. polycythemia
d. sickle cell anemia

Answer 11

b

due to low blood count, easy bleeding with thrombocytopenia

Question 12

Describe two tests used to distinguish an iliopsoas bleed from a joint bleed

Answer 12

1. Pain with trunk flexion indicates more iliopsoas
2. Pain with hip rotation implicates joint issue

Question 13

What is the significance of nadir?

Answer 13

When blood counts, particularly WBC and platelets are at their lowest point, typically with chemotherapy

Question 14

When exercising a client with known anemia, what two measures can be used as guidelines for frequency, intensity, and duration of the program? (8)

Answer 14

• O2 sat
• Pt report
• hematocrit, hemoglobin- lab values
• RPE scale (rate of perceived exertion)
• pale palms with normal colored creases at heart level
• hands cold
• diastolic BP may be low
• diminished exercise tolerance