HEMO: Ignatavicius Ch 40: Care of Patients with Hematologic Problems Flashcards
A nurse caring for a client with sickle cell disease (SCD) reviews the clients laboratory work. Which finding should the nurse report to the provider?
a. Creatinine: 2.9 mg/dL
b. Hematocrit: 30%
c. Sodium: 147 mEq/L
d. White blood cell count: 12,000/mm3
a. Creatinine: 2.9 mg/dL
An elevated creatinine indicates kidney damage, which occurs in SCD. A hematocrit level of 30% is an expected finding, as is a slightly elevated white blood cell count. A sodium level of 147 mEq/L, although slightly high, is not concerning.
A client hospitalized with sickle cell crisis frequently asks for opioid pain medications, often shortly after receiving a dose. The nurses on the unit believe the client is drug seeking. When the client requests pain medication, what action by the nurse is best?
a. Give the client pain medication if it is time for another dose.
b. Instruct the client not to request pain medication too early. c. Request the provider leave a prescription for a placebo.
d. Tell the client it is too early to have more pain medication.
a. Give the client pain medication if it is time for another dose.
Clients with sickle cell crisis often have severe pain that is managed with up to 48 hours of IV opioid analgesics. Even if the client is addicted and drug seeking, he or she is still in extreme pain. If the client can receive another dose of medication, the nurse should provide it. The other options are judgmental and do not address the clients pain. Giving placebos is unethical.
A client in sickle cell crisis is dehydrated and in the emergency department. The nurse plans to start an IV. Which fluid choice is best?
a. 0.45% normal saline
b. 0.9% normal saline
c. Dextrose 50% (D50)
d. Lactated Ringers solution
a. 0.45% normal saline
Because clients in sickle cell crisis are often dehydrated, the fluid of choice is a hypotonic solution such as 0.45% normal saline. 0.9% normal saline and lactated Ringers solution are isotonic. D50 is hypertonic and not used for hydration.
A client presents to the emergency department in sickle cell crisis. What intervention by the nurse takes priority?
a. Administer oxygen.
b. Apply an oximetry probe.
c. Give pain medication.
d. Start an IV line.
a. Administer oxygen.
All actions are appropriate, but remembering the ABCs, oxygen would come first. The main problem in a sickle cell crisis is tissue and organ hypoxia, so providing oxygen helps halt the process.
A client has a serum ferritin level of 8 ng/mL and microcytic red blood cells. What action by the nurse is best?
a. Encourage high-protein foods.
b. Perform a Hemoccult test on the clients stools.
c. Offer frequent oral care.
d. Prepare to administer cobalamin (vitamin B12).
b. Perform a Hemoccult test on the clients stools.
This client has laboratory findings indicative of iron deficiency anemia. The most common cause of this disorder is blood loss, often from the GI tract. The nurse should perform a Hemoccult test on the clients stools. High-protein foods may help the condition, but dietary interventions take time to work. That still does not determine the cause. Frequent oral care is not related. Cobalamin injections are for pernicious anemia.
A client has Crohns disease. What type of anemia is this client most at risk for developing?
a. Folic acid deficiency
b. Fanconis anemia
c. Hemolytic anemia
d. Vitamin B12 anemia
a. Folic acid deficiency
Malabsorption syndromes such as Crohns disease leave a client prone to folic acid deficiency. Fanconis anemia, hemolytic anemia, and vitamin B12 anemia are not related to Crohns disease.
A nurse in a hematology clinic is working with four clients who have polycythemia vera. Which client should the nurse see first?
a. Client with a blood pressure of 180/98 mm Hg
b. Client who reports shortness of breath
c. Client who reports calf tenderness and swelling
d. Client with a swollen and painful left great toe
b. Client who reports shortness of breath
Clients with polycythemia vera often have clotting abnormalities due to the hyperviscous blood with sluggish flow. The client reporting shortness of breath may have a pulmonary embolism and should be seen first. The client with a swollen calf may have a deep vein thrombosis and should be seen next. High blood pressure and gout symptoms are common findings with this disorder.
A nursing student is caring for a client with leukemia. The student asks why the client is still at risk for infection when the clients white blood cell count (WBC) is high. What response by the registered nurse is best?
a. If the WBCs are high, there already is an infection present.
b. The client is in a blast crisis and has too many WBCs.
c. There must be a mistake; the WBCs should be very low.
d. Those WBCs are abnormal and dont provide protection.
d. Those WBCs are abnormal and dont provide protection.
In leukemia, the WBCs are abnormal and do not provide protection to the client against infection. The other statements are not accurate.
The family of a neutropenic client reports the client is not acting right. What action by the nurse is the priority?
a. Ask the client about pain.
b. Assess the client for infection.
c. Delegate taking a set of vital signs.
d. Look at todays laboratory results.
b. Assess the client for infection.
Neutropenic clients often do not have classic manifestations of infection, but infection is the most common cause of death in neutropenic clients. The nurse should assess for infection. The nurse should assess for pain but this is not the priority. The nurse should take the clients vital signs instead of delegating them since the client has had a change in status. Laboratory results may be inconclusive.
A nurse is caring for a client who is about to receive a bone marrow transplant. To best help the client cope with the long recovery period, what action by the nurse is best?
a. Arrange a visitation schedule among friends and family.
b. Explain that this process is difficult but must be endured.
c. Help the client find things to hope for each day of recovery.
d. Provide plenty of diversionary activities for this time.
c. Help the client find things to hope for each day of recovery.
Providing hope is an essential nursing function during treatment for any disease process, but especially during the recovery period after bone marrow transplantation, which can take up to 3 weeks. The nurse can help the client look ahead to the recovery period and identify things to hope for during this time. Visitors are important to clients, but may pose an infection risk. Telling the client the recovery period must be endured does not acknowledge his or her feelings. Diversionary activities are important, but not as important as instilling hope.
A nursing student is struggling to understand the process of graft-versus-host disease. What explanation by the nurse instructor is best?
a. Because of immunosuppression, the donor cells take over.
b. Its like a transfusion reaction because no perfect matches exist.
c. The clients cells are fighting donor cells for dominance.
d. The donors cells are actually attacking the clients cells.
d. The donors cells are actually attacking the clients cells.
Graft versus host disease is an autoimmune-type process in which the donor cells recognize the clients cells as foreign and begin attacking them. The other answers are not accurate.
The nurse is caring for a client with leukemia who has the priority problem of fatigue. What action by the client best indicates that an important goal for this problem has been met?
a. Doing activities of daily living (ADLs) using rest periods
b. Helping plan a daily activity schedule
c. Requesting a sleeping pill at night
d. Telling visitors to leave when fatigued
a. Doing activities of daily living (ADLs) using rest periods
Fatigue is a common problem for clients with leukemia. This client is managing his or her own ADLs using rest periods, which indicates an understanding of fatigue and how to control it. Helping to plan an activity schedule is a lesser indicator. Requesting a sleeping pill does not help control fatigue during the day. Asking visitors to leave when tired is another lesser indicator. Managing ADLs using rest periods demonstrates the most comprehensive management strategy.
A nurse is caring for a young male client with lymphoma who is to begin treatment. What teaching topic is a priority?
a. Genetic testing
b. Infection prevention
c. Sperm banking
d. Treatment options
c. Sperm banking
All teaching topics are important to the client with lymphoma, but for a young male, sperm banking is of particular concern if the client is going to have radiation to the lower abdomen or pelvis.
A client has been admitted after sustaining a humerus fracture that occurred when picking up the family cat. What test result would the nurse correlate to this condition?
a. Bence-Jones protein in urine
b. Epstein-Barr virus: positive
c. Hemoglobin: 18 mg/dL
d. Red blood cell count: 8.2/mm3
a. Bence-Jones protein in urine
This client has possible multiple myeloma. A positive Bence-Jones protein finding would correlate with this condition. The Epstein-Barr virus is a herpesvirus that causes infectious mononucleosis and some cancers. A hemoglobin of 18 mg/dL is slightly high for a male and somewhat high for a female; this can be caused by several conditions, and further information would be needed to correlate this value with a specific medical condition. A red blood cell count of 8.2/mm3 is also high, but again, more information would be needed to correlate this finding with a specific medical condition.
A client with multiple myeloma demonstrates worsening bone density on diagnostic scans. About what drug does the nurse plan to teach this client?
a. Bortezomib (Velcade)
b. Dexamethasone (Decadron)
c. Thalidomide (Thalomid)
d. Zoledronic acid (Zometa)
d. Zoledronic acid (Zometa)
All the options are drugs used to treat multiple myeloma, but the drug used specifically for bone manifestations is zoledronic acid (Zometa), which is a bisphosphonate. This drug class inhibits bone resorption and is used to treat osteoporosis as well.
A client with autoimmune idiopathic thrombocytopenic purpura (ITP) has had a splenectomy and returned to the surgical unit 2 hours ago. The nurse assesses the client and finds the abdominal dressing saturated with blood. What action is most important?
a. Preparing to administer a blood transfusion
b. Reinforcing the dressing and documenting findings
c. Removing the dressing and assessing the surgical site
d. Taking a set of vital signs and notifying the surgeon
d. Taking a set of vital signs and notifying the surgeon
While some bloody drainage on a new surgical dressing is expected, a saturated dressing is not. This client is already at high risk of bleeding due to the ITP. The nurse should assess vital signs for shock and notify the surgeon immediately. The client may or may not need a transfusion. Reinforcing the dressing is an appropriate action, but the nurse needs to do more than document afterward. Removing the dressing increases the risk of infection; plus, it is not needed since the nurse knows where the bleeding is coming from.
A client has a platelet count of 9000/mm3. The nurse finds the client confused and mumbling. What action takes priority?
a. Calling the Rapid Response Team
b. Delegating taking a set of vital signs
c. Instituting bleeding precautions
d. Placing the client on bedrest
a. Calling the Rapid Response Team
With a platelet count this low, the client is at high risk of spontaneous bleeding. The most disastrous complication would be intracranial bleeding. The nurse needs to call the Rapid Response Team as this client has manifestations of a sudden neurologic change. The nurse should not delegate the vital signs as the client is no longer stable. Bleeding precautions will not address the immediate situation. Placing the client on bedrest or putting the client back into bed is important, but the critical action is to call for immediate medical attention.
A nurse is preparing to administer a blood transfusion. What action is most important?
a. Correctly identifying client using two identifiers
b. Ensuring informed consent is obtained if required
c. Hanging the blood product with Ringers lactate
d. Staying with the client for the entire transfusion
b. Ensuring informed consent is obtained if required
If the facility requires informed consent for transfusions, this action is most important because it precedes the other actions taken during the transfusion. Correctly identifying the client and blood product is a National Patient Safety Goal, and is the most important action after obtaining informed consent. Ringers lactate is not used to transfuse blood. The nurse does not need to stay with the client for the duration of the transfusion.
- A nurse is preparing to hang a blood transfusion. Which action is most important?
a. Documenting the transfusion
b. Placing the client on NPO status
c. Placing the client in isolation
d. Putting on a pair of gloves
d. Putting on a pair of gloves
To prevent bloodborne illness, the nurse should don a pair of gloves prior to hanging the blood. Documentation is important but not the priority at this point. NPO status and isolation are not needed.
A client receiving a blood transfusion develops anxiety and low back pain. After stopping the transfusion, what action by the nurse is most important?
a. Documenting the events in the clients medical record
b. Double-checking the client and blood product identification
c. Placing the client on strict bedrest until the pain subsides
d. Reviewing the clients medical record for known allergies
b. Double-checking the client and blood product identification
This client had a hemolytic transfusion reaction, most commonly caused by blood type or Rh incompatibility. The nurse should double-check all identifying information for both the client and blood type. Documentation occurs after the client is stable. Bedrest may or may not be needed. Allergies to medications or environmental items is not related.
A client has thrombocytopenia. What client statement indicates the client understands self-management of this condition?
a. I brush and use dental floss every day.
b. I chew hard candy for my dry mouth.
c. I usually put ice on bumps or bruises.
d. Nonslip socks are best when I walk.
c. I usually put ice on bumps or bruises.
The client should be taught to apply ice to areas of minor trauma. Flossing is not recommended. Hard foods should be avoided. The client should wear well-fitting shoes when ambulating.
A client has a sickle cell crisis with extreme lower extremity pain. What comfort measure does the nurse delegate to the unlicensed assistive personnel (UAP)?
a. Apply ice packs to the clients legs.
b. Elevate the clients legs on pillows.
c. Keep the lower extremities warm.
d. Place elastic bandage wraps on the clients legs.
c. Keep the lower extremities warm.
During a sickle cell crisis, the tissue distal to the occlusion has decreased blood flow and ischemia, leading to pain. Due to decreased blood flow, the clients legs will be cool or cold. The UAP can attempt to keep the clients legs warm. Ice and elevation will further decrease perfusion. Elastic bandage wraps are not indicated and may constrict perfusion in the legs.
A client admitted for sickle cell crisis is distraught after learning her child also has the disease. What response by the nurse is best?
a. Both you and the father are equally responsible for passing it on.
b. I can see you are upset. I can stay here with you a while if you like.
c. Its not your fault; there is no way to know who will have this disease.
d. There are many good treatments for sickle cell disease these days.
b. I can see you are upset. I can stay here with you a while if you like.
The best response is for the nurse to offer self, a therapeutic communication technique that uses presence. Attempting to assign blame to both parents will not help the client feel better. There is genetic testing available, so it is inaccurate to state there is no way to know who will have the disease. Stating that good treatments exist belittles the clients feelings.
A client with sickle cell disease (SCD) takes hydroxyurea (Droxia). The client presents to the clinic reporting an increase in fatigue. What laboratory result should the nurse report immediately?
a. Hematocrit: 25%
b. Hemoglobin: 9.2 mg/dL
c. Potassium: 3.2 mEq/L
d. White blood cell count: 38,000/mm3
d. White blood cell count: 38,000/mm3
Although individuals with SCD often have elevated white blood cell (WBC) counts, this extreme elevation could indicate leukemia, a complication of taking hydroxyurea. The nurse should report this finding immediately. Alternatively, it could indicate infection, a serious problem for clients with SCD. Hematocrit and hemoglobin levels are normally low in people with SCD. The potassium level, while slightly low, is not as worrisome as the WBCs.
