Lewis 4th ed: Ch 33 Hematological Problems Flashcards
The nurse is caring for a client with anemia who is experiencing increased fatigue and occasional palpitations at rest. Which of the following laboratory findings should the nurse expect?
a. Normal RBC indices
b. Hematocrit of 38%
c. Hgb of 86 g/L
d. RBC count of 4.5 x 10^12/L
c. Hgb of 86 g/L
The clients clinical manifestations indicate moderate anemia, which is consistent with an Hgb of 60-100 g/L. The other values are all within normal range.
Which of the following menu choices indicate that the client understand the nurse’s teaching about best dietary choices for iron-deficiency anemia?
a. Omelet and whole wheat toast
b. Cantaloupe and cottage cheese
c. Strawberry banana fruit plate
d. Cornmeal muffin and orange juice
a. Omelet and whole wheat toast
Eggs and whole grain breads are high in iron.
The nurse I caring for a client who is receiving methotrexate and develops a megaloblastic anemia. Which of the following nutrients should the nurse include in the teaching plan?
a. Iron
b. Folic acid
c. Cobalamin (Vit B12)
d. Ascorbic acid (Vit C)
b. Folic acid
Methotrexate use can lead to folic acid deficiency. Supplementation with oral folic acid supplements is the usual treatment. the other nutrients would not correct folic acid deficiency, although they would be used to treat other types of anemia.
The nurse is teaching a client with a new diagnosis of pernicious anemia about the disorder. Which of the following client statements indicates that the teaching has been effective?
a. “ I need to start eating more red meat or liver”
b. “ I will stop having a glass of wine with dinner”
c. “ I will need to take a proton pump inhibitor like omeprazole.”
d. “I would rather use the nasal spray than have to get injections of vitamin b12”
d. “I would rather use the nasal spray than have to get injections of vitamin b12”
Since pernicious anemia prevents the absorption of vitamin b12, this client requires injections or intranasal administration of cobalamin.
Pernicious anemia occurs due to a lack of intrinsic factor, which is necessary for vitamin B12 absorption in the intestines. Without intrinsic factor, dietary B12 (from food or oral supplements) cannot be absorbed properly, leading to B12 deficiency and subsequent anemia.
Why Intranasal or IM (Intramuscular) B12?
Since the normal digestive route doesn’t work, B12 must be given in a way that bypasses the gastrointestinal tract:
Alcohol use does not cause cobalamin deficiency. Proton pump inhibitors decrease the absorption of vitamin b12. Eating more foods rich in vitamin b12 is not helpful because the lack of intrinsic facto prevents absorption of the vitamin.
The nurse is caring for a client who is hospitalized for treatment of severe hyemolytic anemia. Which of the following actions should the nurse implement?
a. Provide a diet high in vitamin K
b. Place the client on protective isolation.
c. Alternative periods of rest and activity.
d. Teach the client how to avoid injury.
c. Alternative periods of rest and activity.
Nursing care for clients with anemia should alternate periods of rest and activity without causing undue fatigue.
The correct answer is “c. Alternate periods of rest and activity” because severe hemolytic anemia causes fatigue due to reduced oxygen-carrying capacity in the blood. Managing energy levels by alternating rest and activity helps prevent exhaustion while maintaining mobility and function.
There is no indication that the client has a bleeding disorder, so a high vitamin K diet or teaching about how to avoid injury is not needed. Protective isolation might be used for a client with aplastic anemia, but it is not indicated for hemolytic anemia.
The nurse has finished teaching a client about taking oral ferrous sulphate. Which of the following client statements indicates that additionally instruction is needed?
a. “I will call the doctor if my stools start to turn back.”
b. “I will take a stool softener if i feel constipated occasionally.”
c. “I should take the iron with orange juice about an hour before eating.”
d. “I should increase my fluid and fibre intake while i am taking the iron tablets.”
a. “I will call the doctor if my stools start to turn back.”
It is normal for the stools to appear black when a client is taking iron and the client should not call the doctor about this. The other client statements are correct.
The nurse is caring for a client with idiopathic aplastic anemia. Which of the following collaborative problems should the nurse include when developing the care plan?
a. Potential complication: seizures
b. Potential complication: infection
c. Potential complication: neurogenic shock
d. Potential complication: pulmonary edema
Potential complication: infection
Because the client with aplastic anemia has pancytopenia, the client is at risk for infection and bleeding. There is no increased risk for seizures, neurogenic shock, or pulmonary edema.
The nurse is caring for a client with a sickle cell crisis. While caring for the client during the ciris, which of the following actions is priority?
a. Limit the client’s intake of oral and IV fluids
b. Evaluate the effectiveness of opioid analgesics.
c. Encourage the client to ambulate as much as tolerated.
d. Teach the client about high-protein, high calorie foods.
b. Evaluate the effectiveness of opioid analgesics.
Pain is the most common clinical manifestation of a crisis and usually requires large doses of continuous opioids for control. Fluid intake should be increased to reduce blood viscosity and improve perfusion. Rest is usually ordered to decrease metabolic requirements. Clients are instructed about the need for dietary folic acid, but high protein, high calorie diets are not emphasized.
Which of the following statements by a client with sickle cell anemia indicates good understanding of the nurse’s teaching about prevention of sickle cell crisis?
a. “Home oxygen therapy is frequently used to decrease sickling.”
b. “There are no effective medications that can help prevent a crisis”
c. “routine continuous dosage narcotics are prescribed to prevent a crisis”
d. “risk for a crisis can be lowered by having an annual influenza vaccination.”
d. “risk for a crisis can be lowered by having an annual influenza vaccination.”
Since infection is the most common cause of sickle cell crisis, influenza, Haemophilus influenzae, pneumococcal pneumonia, and hepatitis immunizations should be administered. Although continuous dose opioids and oxygen may be administered during a crisis, clients do not receive these therapies to prevent crisis. Hydroxyurea is used for many clients to decreased the number of sickle cell crises.
The nurse is planning discharge teaching for a client who was admitted with neutropenia. Which of the following instructions shuld the nurse include?
a. Limit fluids to 203 litres a day.
b. Include eggs and fish in the diet.
c. Avoid exposure to crowds as much as possible.
d. Drink only one or two caffeinated beverages daily.
c. Avoid exposure to crowds as much as possible.
Exposure to crowds increases the client’s risk for infection and should be avoided for the client with neutropenia. There is no restriction on caffeine use. Iron supplementation is generally not recommended. A high-fluid intake is recommended. Eggs and seafood are to be avoided.
The nurse is admitting a client with hemolytic anemia and notes jaundice of the sclerae. Which of the following laboratory results should the nurse assess?
a. Schilling test
b. Bilirubin level
c. Stool occult blood test
d. Gastric analysis testing.
b. Bilirubin level
Jaundice is caused by elevation of bilirubin level associated with RBC hemolysis. The other tests would not be helpful in monitoring or treating a hemolytic anemia.
The nurse is caring for a client who has been receiving a heparin infusion and warfarin for a DVT with a diagnosis of heparin-induced thrombocytopenia (HIT). Which of the following actions should the nurse include in the plan of care?
a. Use low molecular weight heparin only.
b. Flush all intermittent IV lines using normal saline.
c. Administer the warfarin at the scheduled time.
d. Teach the client about the purpose of platelet transfusions.
b. Flush all intermittent IV lines using normal saline.
All heparin is discontinued when the HIT is diagnosed. The client should be instructed to never receive heparin or low molecular weight weight heparin. Warfarin is usually not given until the platelet count has returned to 150 x 10^9/L . The platelet count does not drop low enough in HIT for platelet transfusions, and platelet transfusions increase the risk for thrombosis.
The nurse is caring for a client with an acute exacerbation of polycythemia vera. Which of the following actions should the nurse implement during treatment?
a. Place the client on bed rest.
b. Administer iron supplements.
c. Avoid use of Aspirin products.
d. Monitor fluid intake and output.
d. Monitor fluid intake and output.
Monitoring hydration status is important during an acute exacerbation because the client is at risk for fluid overload or under hydration. Aspirin therapy is used to decrease risk for thrombosis. The client should be encouraged to ambulate to prevent DVT. Iron is contraindicated in clients with polycythemia vera.
Which of the following nursing interventions should be included in the care plan for a client with immune thrombocytopenic purpura?
a. Assign the client to a private room.
b Avoid intramuscular injections.
c. Use rinses rather than a toothbrush for oral care.
d. Restrict activity to passive and active range of motion.
b Avoid intramuscular injections.
IM or SQ injections should be avoided because of the risk for bleeding. A soft toothbrush can be used for oral care. There is no need to restrict activity or place the client in a private room.
Which of the following laboratory information should the nurse monitor to detect heparin-induced thrombocytopenia (HIT) in a client who is receiving a continuous heparin infusion?
a. Prothrombin time
b. Erythrocyte count
c. Fibrinogen degradation products
d. Activated partial thromboplastin time
d. Activated partial thromboplastin time
Platelet aggregation in HIT causes neutralization of heparin, so that the activated partial thromboplastin time will be shorter and more heparin will be needed to maintain therapeutic levels. The other data will not be affected by HIT.
The nurse is admitting a client with type A hemophilia who has severe pain and swelling in the right knee. Which of the following actions should the nurse implement initially?
a. Immobilize the knee
b. Apply heat to the joint
c. Assist the client with light weight bearing
d. Perform passive range of motion to the knee
a. Immobilize the knee.
The initial action should be totally rest of the knee to minimize bleeding. Ice packs are used to decrease bleeding. ROM and weight-bearing exercise are contraindicated initially, but after the bleeding stops, ROM and physical therapy are started.
The nurse is caring for a client with von Willebrand disease who is admitted to the hospital for minor knee surgery. Which of the following laboratory information should the nurse assess?
a. Platelet count
b. Bleeding time
c. Thrombin time
d. Prothrombin time
b. Bleeding time
The bleeding time is affected by von Willebrand disease. Platelet count, prothrombin time, and thrombin time are normal in von Willebrand disease.
Von Willebrand disease is named after Dr. Erik Adolf von Willebrand, a Finnish physician who first identified and described the condition.
In 1924, Dr. von Willebrand examined a 5-year-old girl from the Åland Islands who experienced severe bleeding episodes. Intrigued by her symptoms, he conducted a comprehensive study of her family and discovered a hereditary bleeding disorder distinct from hemophilia. He initially termed this condition “hereditary pseudohemophilia” in his 1926 publication.
Over time, in recognition of his significant contributions to understanding this unique bleeding disorder, the medical community named the condition von Willebrand disease in his honor.
A routine CBC indicates that a client may have myelodysplastic syndrome. At this time, which of the following information should the nurse include in the teaching plan?
a. PRBC’s transfusion
b. Bone marrow biopsy
c. Filgrastim administration
d. Erythropoietin administration
b. Bone marrow biopsy
Bone marrow biopsy is needed to make the diagnosis and determines the specific type of myelodysplastic syndrome.
Which of the following actions should the nurse include in the care plan for a hospitalized client who is neutropenic?
a. Avoid any IM or SQ injections.
b. Check oral temp every 4 hours
c. Omit all fruits and vegetables from the diet.
d. Place a “No Visitors” sign on the client door.
b. Check oral temp every 4 hours
The earliest sign of infection is a neutropenic client is an elevation in temperature.
Which of the following laboratory tests should the nurse use to determine whether the prescribed filgrastim is effective in the treatment of a client who is receiving chemotherapy for acute lymphocytic leukemia?
a. Platelet count
b. Reticulocyte count
c. Total lymphocyte count
d. Absolute neutrophil count
d. Absolute neutrophil count
Filgrastim is a medication that stimulates the production of neutrophils, a type of white blood cell essential for fighting infections. It’s commonly used to treat or prevent neutropenia (low neutrophil count), especially in patients undergoing chemotherapy, bone marrow transplants, or with certain bone marrow disorders.
Understanding Neutrophil Counts:
• Normal Neutrophil Count: In healthy adults, the normal range is approximately 1,500 to 8,000 neutrophils per microliter (µL) of blood. 
• Neutropenia: This condition is defined by a decrease in neutrophil count and is categorized as:
• Mild Neutropenia: 1,000 to 1,500 neutrophils/µL
• Moderate Neutropenia: 500 to 1,000 neutrophils/µL
• Severe Neutropenia: fewer than 500 neutrophils/µL
Patients with neutropenia are at an increased risk of infections, as their immune system’s ability to combat pathogens is compromised. Filgrastim helps mitigate this risk by boosting neutrophil production, thereby enhancing the body’s defense against infections.
The nurse is caring for a client with acute myelogenous leukemia (AML) who has therapy prescribed and the client asks the nurse whether the planned chemotherapy will be worth undergoing. Which of the following responses by the nurse is best?
a. “If you do not want to have chemotherapy, there are other options for treatment such as stem cell transplantation.”
b. The decision about chemotherapy is one that you and the doctor need to make rather than asking what i would do.”
c. “You don’t need to make decision about treatment right now since leukemias in adults tend to progress quite slowly.”
d. “The adverse effects of the chemotherapy are difficult, but AML frequently does go into remission with chemotherapy.”
d. “The adverse effects of the chemotherapy are difficult, but AML frequently does go into remission with chemotherapy.”
The nurse is caring for a client who has a history of transfusion-related acute lung injury (TRALI) and is to receive a transfusion of PRBC’s. Which of the following actions should the nurse take to decrease the risk for TRALI for this client?
a. Infuse the PRBC’s slowly over 4 hours.
b. Transfuse only leukocyte-reduced PRBCs.
c. Administer the scheduled oral diuretic before the transfusion.
d. Give the PRN dose of antihistamine before starting the transfusion.
b. Transfuse only leukocyte-reduced PRBCs
What is TRALI?
• TRALI (Transfusion-Related Acute Lung Injury) is a life-threatening reaction that occurs after a blood transfusion.
• It happens when donor antibodies activate the recipient’s immune system, causing severe lung inflammation and fluid accumulation (pulmonary edema).
• TRALI is one of the leading causes of transfusion-related deaths but is rare.
Why Leukocyte-Reduced PRBCs?
• The correct answer (b. Transfuse only leukocyte-reduced PRBCs) is important because:
• Leukocytes (white blood cells) in transfused blood can carry antibodies that trigger TRALI.
• Leukocyte reduction removes most white blood cells, lowering the risk of immune activation.
• This is the best preventive measure for patients with a history of TRALI or at high risk.
The nurse is caring for a client with acute myelogenous leukemia who is considering the possibility of treatment with hematopoietic stem cell transplant (HSCT). Which of the following actions is best for the nurse to implement to assist the client with treatment decisions?
a. Emphasize the positive outcomes of bone marrow transplant.
b. Discuss the need for adequate insurance to cover post-HSCT care.
c. Ask the client whether there are any questions or concerns about HSCT.
d. Explain that a cure is not possible with any other treatment except HSCT.
c. Ask the client whether there are any questions or concerns about HSCT.
Offering the client an opportunity to ask questions or discuss concerns about HSCT will encourage the client to voice concerns about this treatment and also will allow the nurse to assess whether the client needs more information about the procedure.
Which of the following nursing actions should the nurse include in the plan of care for a client admitted with multiple myeloma?
a. Monitor fluid intake and output
b. Administer calcium supplements.
c. Assess lymph nodes for enlargement
d. limit weight bearing and ambulation.
a. Monitor fluid intake and output
A high fluid intake and urine output helps prevent the complications of kidney stones caused by hypercalcemia and renal failure caused be deposition of Bence Jones protein in the renal tubules. Weight bearing and ambulation are encouraged to help bone retain calcium. Lymph nodes are not enlarged with multiple myeloma. Calcium supplements will further increase the clients calcium level and are not used.
The nurse is caring for a client with non-hodgkin’s lymphoma who develops and platelet count of 38 x 10^9/L during chemotherapy. Which of the following actions should the nurse implement based on this findings/
a. Provide oral hygiene every 2 hours.
b. Check all stools for occult blood
c. Assess temp every 4 hours
d. Encourage fluids 3 000 mL / day.
b. Check all stools for occult blood
Because the client is at risk for spontaneous bleeding, the nurse should check stools for occult blood. A low platelet count does not require and increased fluid intake. Oral hygiene is important, but it is not necessary to provide oral care every 2 hours. The low platelet count does not increase risk for infection, so frequent temperature monitoring is not indicated.
The nurse is caring for a client with acute myelogenous leukemia who is receiving outpatient chemotherapy and develops an absolute neutrophil count of 0.9 x 10^9/ L. Which of the following actions by the nurse in the outpatient clinic is best?
a. Discuss the need for hospital admission to treat the neutropenia.
b. Plan to discontinue the chemotherapy until the neutropenia resolves.
c. Teach the client how to administer filgrastim injections at home.
d. Obtain a high efficiency particulate air (HEPA) filter for the client for home use/
c. Teach the client how to administer filgrastim injections at home.
Which of the following assessment data obtained by the nurse when caring for a client with thrombocytopenia should be immediately communicated to the health care provider?
a. The platelet count is 52 x 10^9/ L
b. the client is difficult to arouse
c. There are large bruises on. the back
d. There are purpura on the oral mucosa.
b. the client is difficult to arouse
When a febrile episode occurs in a client with neutropenia, at what time should antibiotic therapy be initiated?
a. Within 1 hour
b. After the causative agent is identified from the culture
c. Once the fever drops below 38 degrees.
d. For long term therapy over 3 months.
a. Within 1 hour
When a febrile episode occurs in a client with neutropenia, antibiotic therapy must be initiated immediately (within 1 hour), even before the determination by culture of a specific causative organism. Treatment does not wait until the fever dirps. Long-term therapy over 3 months is not required at this time.
The nurse is caring for a client receiving a transfusion of PRBCs who develops cills, fever, headache, and anxiety 30 minutes after the transfusion is started. After stopping the transfusion, which of the following actions is priority?
a. Draw blood for a new crossmatch.
b. Send a urine specimen.
c. Give the PRN diphenhydramine
d. Administer the PRN Acetaminophen
d. Administer the PRN Acetaminophen
The clients clinical masifestionations are consistent with a febrile, nonhemolytic transfusion reaction. The transfusion should be stopped and antipyretics administered for the fever as ordered. A urine specimen is needed if an acute hemolytic reaction is suspected. Diphenhydramine is used for allergic reactions. This type of reaction does not indicate incorrect crossmatching.
Fifteen minutes after a transfusion of PRBCs is started, a client has symptoms of back pain and dyspnea and a HR of 124 beats/min. Which of the following actions should the nurse implement initially?
a. Administer oxygen therapy at a high flow rate.
b. Obtain a urine specimen to send to the lab
c. Notify the health care provider about the symptoms.
d. Disconnect the transfusions and infuse normal saline.
d. Disconnect the transfusions and infuse normal saline.
Which of the following newly admitted clients should the nurse assign as a roommate for a client who has aplastic anemia?
a. A client with severe heart failure
b. A client who has viral pneumonia
c. A client who has right leg cellulitis
d. A client with multiple abdominal drains
a. A client with severe heart failure
A client with aplastic anemia is highly immunocompromised, so you want to avoid placing them with any roommate who has (or is at high risk for) infection. In other words, you need someone who does not have a contagious illness or an active infection.
The nurse is caring for a client with immune thrombocytopenic purpura (ITP) who has a prescription for the platelet transfusion. Which of the following client information indicates that the nurse should consult with a healthcare provider before administering platelets?
a. The platelet count is 42 x 10^9/L
b. Blood pressure is 94/56
c. Blood is oozing from the venipuncture site.
d. Petechiae are present on the chest and back.
d. Petechiae are present on the chest and back.
The hemophilia clinic nurse receives a call from a client with hemophilia to discuss all of these problems. Which of the following problems is most important to communicate to the healthcare provider?
a. Skin abrasions
b. Bleeding gums
c Multiple bruises
d. Dark tarry stools
d. Dark tarry stools
Melena is a sign of gastrointestinal bleeding and requires collaborative actions such a checking hemoglobin and hematocrit and administering coagulation factors.
The nurse is caring for a client with septicemia who develops prolonged bleeding from venipuncture sites and blood in the stools. Which of the following actions is most important for the nurse to take?
a. Notify the clients health care provider.
b. Avoid unnecessary venipuncturess
c. Apply sterile dressings to the sites.
d. Give prescribed proton pump inhibitors.
a. Notify the clients health care provider.
The nurse is caring for a client with myelodysplastic syndrome who has 20% blasts in marrow and the health care provider has prescribed high-intensity treatment. Which of the following treatments should the nurse prepare the client to receive?
a. Antibiotics
b. Antifungals
c. Chemotherapy
d. Blood transfusion
c. Chemotherapy
The correct answer is c. Chemotherapy because the client has myelodysplastic syndrome (MDS) with 20% blasts in the bone marrow, which indicates progression toward acute myeloid leukemia (AML).
Why Chemotherapy?
• MDS is a bone marrow disorder that leads to ineffective blood cell production.
• When blast cells reach 20% or more, it is considered acute myeloid leukemia (AML) rather than just MDS.
• High-intensity treatment is typically chemotherapy, aimed at reducing blast cells and controlling disease progression.
• In some cases, a stem cell transplant might be considered after chemotherapy.
The nurse is caring for a client with neutropenia who is started on an aminoglycoside. Which of the following common adverse effects should the nurse observe for in the client?
a. Rash
b. Ototoxicity
c. Fever
d. Pruritis
b. Ototoxicity
Adverse effect common to aminoglycosides include nephrotoxicity and ototoxicity.
The correct answer is b. Ototoxicity, which is a common adverse effect of aminoglycosides.
What are Aminoglycosides?
• A class of powerful antibiotics used to treat serious bacterial infections.
• Examples: Gentamicin, Amikacin, Tobramycin, Streptomycin.
• Often used for Gram-negative bacterial infections.
Why is Ototoxicity a Concern?
• Aminoglycosides can damage the inner ear (cochlea and vestibular system).
• Can cause hearing loss, tinnitus (ringing in ears), or balance issues.
• Irreversible damage if not detected early.
• Higher risk with prolonged use or high doses.
