Hematological

Question 1

Patho of sickle cell dz

Answer 1

Autosomal recessive
Alterations in hemoglobin occur due to certain conditions
RBCs forced into stiffened and elongated crescents (sickles)
Sickled cells clump together -> occlude small blood vessels -> ischemia and possible organ damage

Question 2

S+S of sickle cell dz

Answer 2

Periodic exacerbations
Tachycardia
Leukocytosis
Anemia
Increased reticulocyte

Question 3

Nursing interventions of sickle cell dz

Answer 3

Diet: high protein, high calorie, multi-vitamin w/o iron
Folic acid: helps make new RBCs
Hydration - aggressive IV and oral hydration
Infx prevention
Oxygen
Pain control

Question 4

Risk factors of cervical cancer

Answer 4

HPV infx
Multiple sex partners
Early onset of sexual activity
Hx of STIs
Oral contraceptives
Immunosuppression

Question 5

S+S of cervical cancer

Answer 5

Asymptomatic
Postcoital or intermenstrual bleeding
Increased vaginal
Increased vaginal discharge
Inguinal lymphadenopathy
Pelvic or low back pain

Question 6

Hemophilia patho

Answer 6

Genetic bleeding disorder
X-linked recessive transmission
Causes prolonged, excessive bleeding

Question 7

S+S of hemophilia

Answer 7

Hemarthrosis -> joint destruction
Unilateral joint erythema and swelling, limited ROM, tingling in joints
Severe bruising
GI bleed: blood in stool or urine
Intracranial bleeding: lethargy, HA, irritability

Question 8

Lab values of hemophilia

Answer 8

Normal platelet count
Absent factor VII or factor IX
Prolonged PTT

Question 9

Tx of hemophilia

Answer 9

Factor VIII/IX replacement: life-long tx
Injection precautions: SQ; apply firm pressure and ice at site for 5 min
Bleeding and fall precautions
Reduce hemarthrosis: elevate joints above heart
RICE

Question 10

Hodgkin lymphoma S+S and tx

Answer 10

S+S: painless lymphadenopathy
Mediastinal mass and hepatosplenomegaly
Fever, night sweats, weight loss, generalized pruritus
Severe pain after alcohol intake

Tx: chemotherapy and external beam radiation therapy

Question 11

Complications of Hodgkin lymphoma

Answer 11

Tumor lysis syndrome and superior vena cava

Question 12

Polycytemia vera discharge labs

Answer 12

Increased hemoglobin and/or hematocrit
Increased RBCs, WBCs, platelets

Question 13

Tx for polycythemia

Answer 13

Therapeutic phlebotomy

Question 14

Polycythemia vera pt teaching

Answer 14

Elevate legs and feet while sitting
Support stocking
Increase fluid intake during exercise and hot weather
Report signs of DVT

Question 15

Immune thrombocytopenic purpura teaching

Answer 15

Use soft-bristle toothbrushes
Avoid activities that may cause trauma
Wear nonskid footwear
Take stool softeners and laxatives as needed
Use electric razors

Question 16

aPTT lab values

Answer 16

For heparin receiving: 1.5-2x = 46-70 secs
20-30 secs

Question 17

Drugs associated w/ orthostatic hypotension

Answer 17

Most antihypertensive meds
Antipsychotics and antidepressants
Diuretics
Vasodilator meds
Narcotics

Question 18

INR > 5 (tx)

Answer 18

Requires warfarin dose adjustment
Vitamin K administration

Question 19

Tumor lysis syndrome

Answer 19

Oncologic emergency that occurs when cancer tx destroys large number of cancer cells -> massive release of components into circulation
Results in hyperuricemia and AKI

Question 20

HELLP syndrome

Answer 20

Hemolysis
Elevated liver enzymes
Low platelet count
S+S: RUQ pain, malaise, nausea

Question 21

Polycytemia vera labs

Answer 21

Labs: increased RBCs, WBCs, platelets
Increased risk for DVT

Question 22

Live vaxx

Answer 22

MMR (measles, mumps, and rubella)
Rotavirus
Yellow fever
Varicella, zoster

Question 23

What meds do sickle cell pts need?

Answer 23

Folic acid
HYDRATION