Lewis Chapter 33: Hematological Conditions Flashcards
In a severely anemic client, what would the nurse expect to find?
a. Dyspnea at rest and tachycardia
b. Cyanosis and pulmonary edema
c. Cardiomegaly and pulmonary fibrosis
d. Ventricular dysrhythmias and wheezing
A.
When obtaining assessment data from a client with a microcytic, hypochromic anemia, what would the nurse question the client about?
a. Folic acid intake
b. Dietary intake of iron
c. History of gastric surgery
d. History of sickle cell anemia
B.
Nursing interventions for a client with severe anemia related to peptic ulcer disease include which of the following? (Select all that apply.)
a. Giving instructions in high-iron diet
b. Taking vital signs every 8 hours
c. Monitoring stools for occult blood
d. Teaching self-injection of erythropoietin
e. Administering cobalamin (vitamin B12) injections
A, C.
Which nursing management actions apply for a client in sickle cell crisis? (Select all that apply.)
a. Monitoring CBC
b. Providing optimal pain management and O2 therapy
c. Administering blood transfusions if required and iron chelation
d. Recommending rest as needed and deep-vein thrombosis (DVT) prophylaxis
e. Administering IV iron and a diet high in iron content
A.
Which is a complication of the hyperviscosity of polycythemia?
a. Thrombosis
b. Cardiomyopathy
c. Pulmonary edema
d. Disseminated intravascular coagulation (DIC)
A.
When caring for a client with thrombocytopenia, the patient teaching should include which instruction?
a. To wipe their nose gently instead of blowing
b. To be careful when shaving with a safety razor
c. To continue with physical activities to stimulate thrombopoiesis
d. To avoid acetylsalicylic acid because it may mask the fever that occurs with thrombocytopenia
A.
The nurse would anticipate that a client with von Willebrand disease who is undergoing surgery would be treated with administration of von Willebrand factor (vWF) and which of the following?
a. Thrombin
b. Factor VI
c. Factor VII
d. Factor VIII
D.
What physiological process occurs in a person with DIC?
a. The coagulation pathway is genetically altered, leading to thrombus formation in all major blood vessels.
b. An underlying disease depletes hemolytic factors in the blood, leading to diffuse thrombotic episodes and infarcts.
c. A disease process stimulates coagulation processes with resultant thrombosis, as well as depletion of clotting factors, leading to diffuse clotting and hemorrhage.
d. An inherited predisposition causes a deficiency of clotting factors that leads to overstimulation of coagulation processes in the vasculature.
C.
Which of the following is (are) a priority nursing action when caring for a hospitalized client with a new-onset temperature of 39°C and severe neutropenia? (Select all that apply.)
a. Administering the prescribed antibiotic STAT
b. Drawing peripheral and central line blood cultures
c. Ensuring ongoing monitoring of the client’s vital signs for septic shock
d. Taking a full set of vital signs and notifying the health care provider immediately
e. Administering transfusions of WBCs to decrease immunogenicity
A, B, C, D.
Because myelodysplastic syndrome arises from the pluripotent hematopoietic stem cell in the bone marrow, which laboratory results would the nurse expect to find?
a. An excess of T cells
b. An excess of platelets
c. A deficiency of granulocytes
d. A deficiency of all cellular blood components
D.
Which is the most common type of leukemia in older persons?
a. Acute myelocytic leukemia
b. Acute lymphocytic leukemia
c. Chronic myelocytic leukemia
d. Chronic lymphocytic leukemia
D.
Why are multiple medications often used in combinations to treat leukemia and lymphoma?
a. There are fewer toxic and adverse effects.
b. The chance that one medication will be effective is increased.
c. The medications are more effective and cause fewer adverse effects.
d. The medications work by different mechanisms to maximize killing of cancerous cells.
D.
What is the major difference between Hodgkin’s lymphoma and non-Hodgkin’s lymphoma?
a. Hodgkin’s lymphoma occurs only in young adults.
b. Hodgkin’s lymphoma is considered potentially curable.
c. Non-Hodgkin’s lymphoma can manifest in multiple organs.
d. Non-Hodgkin’s lymphoma is treated only with radiation therapy.
C.
A patient with multiple myeloma becomes confused and lethargic. What indications would the nurse expect from the diagnostic results?
a. Hyperkalemia
b. Hyperuricemia
c. Hypercalcemia
d. CNS myeloma
C.
What would the nurse expect to find when reviewing a client’s hematological laboratory values after a splenectomy?
a. Deceased WBC count
b. RBC abnormalities
c. Decreased hemoglobin
d. Increased platelet count
D.
Which complications of transfusions can be decreased by the use of leukocyte depletion or reduction of red blood cell transfusion?
a. Chills and hemolysis
b. Leukostasis and neutrophilia
c. Fluid overload and pulmonary edema
d. Transmission of cytomegalovirus and fever
D.
Which classification system is the most accurate means of identifying anemias?
A. Morphological system
B. Etiological classification
C. NYHA classification system
D. ABO system
A. Morphological system
The morphological system is the most accurate means of classifying anemias. However, it is easier to discuss patient care by focusing on the cause or etiology of the anemia.
Which sign is a potential gastrointestinal system sign of anemia?
A. Cheilitis
B. Sore throat
C. Diarrhea
D. Glossitis
D. Glossitis
Glossitis, which is a swollen, smooth, red tongue, is a gastrointestinal sign of anemia.
Which statement about anemia in older adults is accurate?
A. A slight decrease in HB occurs in healthy women between ages 70 and 88.
B. Cytokine dysregulation is the most common cause of anemia in the older adults.
C. Anemia is common in older adults.
D. Anemia prevalence decreases after age 65.
A. A slight decrease in HB occurs in healthy women between ages 70 and 88.
A slight decrease in HB that occurs in healthy woman between ages 70 and 88 is a normal finding. Men of the same age have a decrease of about 10 g/L.
Which etiology is a cause of iron-deficiency anemia? Select all that apply. One, some, or all responses may be correct.
A. Blood loss
B. Folic acid deficiency
C. Inadequate dietary intake
D. Malabsorption
E. Vitamin B12 deficiency
F. Hemolysis
A, C, D, F.
Blood loss is a common cause of iron-deficiency anemia in adults. GI bleed is a major cause of blood loss.
Inadequate dietary intake may be the cause of iron deficiency anemia in some individuals who have higher than average intake needs.
Malabsorption is a cause of iron-deficiency anemia for people who have had certain types of GI surgeries or syndromes.
Hemolysis is a potential cause of iron-deficiency anemia.
Which recommendation to the patient maximizes absorption of oral iron supplements?
A. “Take your iron tablets in the morning with a glass of milk at least 30 minutes before breakfast.”
B. “Take your iron tablets in the morning with a glass of orange juice about an hour before breakfast.”
C. “Take your iron tablets first thing in the morning with a glass of milk.”
D. “Take your iron tablets in the morning with a glass of orange juice about an hour after breakfast.”
B. “Take your iron tablets in the morning with a glass of orange juice about an hour before breakfast.”
Iron is best absorbed in an acidic environment. It should be taken about an hour before meals when the duodenal mucosa is most acidic. Taking iron with vitamin C (ascorbic acid) or orange juice enhances iron absorption.
Which treatment is the only cure for thalassemia major?
A. Chelation therapy
B. Blood transfusion
C. Intravenous deferoxamine
D. Stem cell transplant
D. Stem cell transplant
Hematopoietic stem cell transplantation (HSCT) is the only cure for thalassemia major, but it is a reasonable option for only a small number of patients. Obstacles to transplant include access, donor availability, and the procedural risk.
Match the classification of megaloblastic anemia to its related cause.
Gastric bypass, pernicious anemia, intrinsic factor deficiency
-Cobalamin deficiency
Celiac disease, Crohn’s disease, poor diet
-Folic acid deficiency
Defective folate metabolism, defective transport of cobalamin
=Inborn errors
Alkylating agents, folate antagonists, metabolic inhibitors
-Medication-induced DNA suppression
Which type of anemia is characterized by normocytic, normochromic, hypoproliferative RBCs?
A. Iron deficiency anemia
B. Anemia of chronic disease
C. Pernicious anemia
D. Sickle cell anemia
B. Anemia of chronic disease
In anemia of chronic disease, RBCs are normal in size and colour, but are under produced. Conditions such as cancer, autoimmune disorders, and infection are some of the causes.
Which treatment is priority for anemia caused by chronic blood loss?
A. Identify source and stop the bleed
B. Identify source and administer packed RBCs
C. Administer vitamin B12 supplements
D. Apply pressure to the source to stop the bleed
A. Identify source and stop the bleed
Identifying source and stopping the bleed is the appropriate treatment for anemia caused by chronic blood loss.
Which clinical manifestation may be observed in patients with sickle cell anemia? Select all that apply. One, some, or all responses may be correct.
A. Pain that ranges from mild to extreme
B. Renal failure
C. Development of autosplenectomy
D. Acute chest syndrome
E. Occurrence of priapism
F. Cyanosis related to hemolysis
A, B, C, D, E.
Pain episodes can affect any area of the body or several sites simultaneously, with the most-commonly affected areas being the back, chest, extremities, and abdomen.
Kidneys may be injured from the increased blood viscosity and the lack of O2, which can lead to renal failure.
The spleen becomes smaller due to repeated scarring that occurs during sickle cell episodes.
Acute chest syndrome is a term used to describe acute pulmonary complications that include pneumonia, tissue infarction, and fat embolism.
Priapism (persistent penile erection) may occur if penile veins become occluded.
Which factor contributes to the physical destruction of RBCs in acquired hemolytic anemia? Select all that apply. One, some, or all responses may be correct.
A. Oxidative medication
B. Hemodialysis
C. Extracorporeal circulation
D. Prosthetic heart valves
E. Isoimmune reactions
F. Passage through radiated blood vessels
B, C, D, F.
Hemodialysis causes disruption of the RBC membrane, which results in hemolysis.
Extracorporeal circulation used in cardiopulmonary bypass causes disruption of the RBC membrane, leading to hemolysis.
Prosthetic heart valves cause disruption of the RBC membrane, which leads to hemolysis.
The high amount of force needed to push blood through radiated blood vessels can cause fragmentation, destroying RBCs.
Which responsibility does the nurse have when caring for a patient in an acute exacerbation of polycythemia vera (PV)?
A. Support NPO order
B. Monitoring fluid intake and output
C. Encourage complete bed rest
D. Promote decreased food intake
B. Monitoring fluid intake and output
Fluid intake and output must be evaluated during hydration therapy to avoid fluid overload and underhydration. Fluid overload further complicates the circulatory congestion while underhydration can cause the blood to become even more viscous.
Which manifestation of anemia occurs with severe anemia?
A. Heart palpitations
B. Fatigue
C. Sensitivity to cold
D. Exertional dyspnea
C. Sensitivity to cold
Sensitivity to cold occurs in the severe level of anemia when hemoglobin is at 60 g/L or less.
Which finding during the assessment may trigger concerns about pernicious anemia?
A. Patient has a history of recent gastric bypass surgery and reports excessive fatigue.
B. Patient reports episodes of hematuria over the past week.
C. Patient has a complete blood count (CBC) showing pancytopenia.
D. Patient reports frequent episodes of epistaxis.
A. Patient has a history of recent gastric bypass surgery and reports excessive fatigue.
Gastric bypass surgery diverts digestion away from the stomach, which also impairs intrinsic factor production and absorption. This results in pernicious anemia.
Which patient would be unlikely to benefit from iron supplements?
A. Patient experiencing acute blood loss
B. Patient in second trimester of pregnancy
C. Patient with hereditary hemochromatosis
D. Patient with limited access to healthy foods
C. Patient with hereditary hemochromatosis
A patient with hereditary hemochromatosis has excessive amounts of iron in the body. Iron supplements would increase the iron load and cause harm to the patient.
Which nutrient is necessary for erythropoiesis? Select all that apply. One, some, or all responses may be correct.
A. Folic acid
B. Fat
C. Cobalamin
D. Amino acids
E. Pyridoxine
F. Vitamin A
A, C, D, E.
Folic acid is necessary for the synthesis of DNA and RNA as an essential function in erythropoiesis. Another function is maturation of RBCs. Foods rich in folic acid include leafy green vegetable, okra, liver, meat, fish, legumes, whole grains, and orange juice.
Cobalamin (Vitamin B12) plays a role in erythropoiesis. It is essential for DNA synthesis, RBC maturation, and folate metabolism. Cobalamin is found in red meats, eggs, enriched grain products, dairy products, fish, and soy beverages.
Amino acids play a role in erythropoiesis. It is necessary for hemoglobin and plasma membrane synthesis and structure. It is found in foods such as eggs, milk, poultry, fish, legumes, nuts, and soy
Pyridoxine (Vitamin B6) is necessary for hemoglobin synthesis as a part of erythropoiesis. It is found in foods like meats, wheat germ, legumes, potatoes, cornmeal, bananas, nuts, and fish.
