Respiratory (Exam Two) Flashcards
1
Q
Describe atopy.
A
Genetic predisposition to develop an allergic response to common allergens
2
Q
Which immunoglobulin is assessed in relation to allergens and allergic responses?
A
IgE
3
Q
Atopy is a major ______ ________ for asthma.
A
Risk factor
4
Q
A new nurse on the medical-surgical floor overhears another RN explain to a patient how people have a lower incidence of developing asthma when exposed to certain infections early in life, used fewer antibiotics, were around other children, or lived in rural areas or with pets. The new nurse knows the RN is explaining what concept?
A
Hygiene hypothesis
5
Q
What is occurring within the lungs when a patient has asthma?
A
- Airways are chronically inflamed
- Airways are narrow
- Air gets trapped
6
Q
List the causes of asthma.
A
- Heredity/Genetics
- Airborne allergies
- Pollution
- Smoking
7
Q
List the risk factors for developing asthma.
A
- Heredity/Genetic predisposition
- Male gender in childhood
- Obesity
8
Q
List the signs and symptoms of asthma.
A
- Dyspnea
- Tachypnea
- Wheezing
- Chest tightness
- Cough
- Prolonged expiration
- Use of accessory muscles
9
Q
The nurse knows what is happening if the patient with asthma has absent lung sounds?
A
- Bronchioles are completely constricted
- Minimal air flow
- EMERGENCY!
10
Q
Why is wheezing not a good indicator of the severity of an asthma attack?
A
- Loud wheezing is heard during minor attacks
- No wheezing is heard during severe attacks
11
Q
Accessory muscle use is indicative of what? The nurse knows the patient needs what if accessory muscle use is present?
A
- Respiratory distress
- STAT intervention
12
Q
List the conditions involved in an asthma triad.
A
- Nasal polyps
- Asthma
- Sensitivity to salicylic acid (aspirin/ NSAIDS)
13
Q
A patient with a known asthma triad develops wheezing 2 hours after ingesting food and drink that contain salicylic acid. What education should the nurse provide to this patient?
A
- Salicylic acid is found in certain foods which can result in latent wheezing upon digestion
- Educate patient to avoid these specific foods and drinks
14
Q
What class(s) of drug(s) should be avoided in patients with asthma and COPD?
A
- Non-selective beta blockers
- ACE inhibitors
15
Q
List non-selective beta blockers.
A
- Propranolol
- Nadolol
- Carvedilol
- Labetalol
16
Q
List ACE inhibitors.
A
- Lisinopril
- Enalapril
- Captopril
- Quinapril
17
Q
What is the priority nursing intervention for a patient who is scheduled for a spirometry study?
A
Hold bronchodilators 6 to 12 hours prior to study
18
Q
What does a peak expiratory flow rate (PEFR) measure?
A
- Maximum speed of expiration
- Airflow through the bronchioles
- Degree of obstruction
- Severity of condition
- Effectiveness of medications
19
Q
The nurse knows what about the results of a peak expiratory flow rate (PEFR)?
A
- High results when well
- Low results when airflow is constricted
20
Q
Peak flow results that are 80% to 100% of the patients personal best are in what zone?
A
Green zone
21
Q
Peak flow results that are 50% to 80% of the patients personal best are in what zone?
A
Yellow zone
22
Q
Peak flow results that are 50% or less of the patients personal best are in what zone?
A
Red zone
23
Q
Peak flow results that are in the red zone indicate what?
A
- Serious problem
- Interventions needed
- Additional medications needed
24
Q
List the nursing interventions for a patient who has a peak flow rate in the yellow zone.
A
Administer bronchodilator/short-acting-beta-agonist (SABA)
25
What diagnostic study is used to diagnose asthma and COPD?
Spirometry
26
List the steps in which a spirometry test is performed.
- Test
- Administer bronchodilator
- Wait 15 minutes
- Test again
- Compare results
27
A patient is having an acute asthma exacerbation. What is the desired outcome for this patient after receiving treatment?
Maintaining oxygen saturation >90%
28
The nurse examines the ABG results of a patient during the early phase of an asthma attack. The nurse expects this patient to be in what state? Why?
- Respiratory alkalosis
| - Due to hyperventilation and hypoxia
29
The nurse examines the ABG results of a patient who has been experiencing a prolonged asthma attack. The nurse expects this patient to be in what state? Why?
- Respiratory acidosis
| - Due to fatigue and decreased respiratory rate
30
The nurse knows that a patient in respiratory alkalosis related to a prolonged asthma attack is at an increased risk for what?
Respiratory failure
31
What can the nurse do when a patient has an ineffective breathing pattern?
Encourage pursed lip breathing
32
Pursed lip breathing will be ineffective if the patient does what? The nurse should educate the patient to do what instead?
- Puffs out their cheeks
| - Relax their face
33
A patients oxygen saturation is 86% and they are displaying signs of respiratory distress. The nurse knows to not do what during this event?
-Do not leave the patient!
34
List bronchodilators/short-acting beta agonists (SABA) commonly given during an acute asthma exacerbation.
- Albuterol
| - Inhaled ipratropium
35
List the common side effects of bronchodilators/short-acting beta agonists (SABA).
- Tremors
- Tachycardia
- Anxiety
- Palpitations
36
Which inhaled corticosteroid is the most common and considered the most effective at treating inflammation in patients with persistent asthma?
Fluticasone (Flovent)
37
Why is IV magnesium sulfate administered during a severe and life-threatening asthma exacerbation?
- Relaxes smooth muscle
| - Enhances effects of bronchodilators
38
What is the drug class of Montelukast (Singulair)?
Leukotriene Receptor Antagonist (LTRA)
39
Which drug is often considered as a last resort for controlling asthma? Why?
- Montelukast (Singulair)
| - Causes vivid nightmares, out-of-body experiences, and behavioral issues
40
Caffeine increases the absorption of which drug?
Theophylline
41
What is the therapeutic range for theophylline?
10 to 20 mcg/mL
42
A patient is admitted to the ED with a serum theophylline level of 27 mcg/mL, vomiting, and tachycardia. The nurse knows this patient is most likely suffering from what condition?
Theophylline toxicity
43
List the signs and symptoms of theophylline toxicity. Which signs and symptoms are associated with chronic theophylline toxicity?
- Nausea
- Vomiting
- Tachycardia
- Seizures (chronic)
- Dysrhythmias (chronic)
44
List long-acting beta-agonists commonly prescribed for asthma control.
- Salmeterol
- Formoterol
- Arformoterol
45
Long-acting beta-agonists are used in combination with what other medication for asthma control?
Inhaled corticosteroids
46
What medication is given when high doses of corticosteroids are ineffective for a patient with asthma? What is the purpose of this drug?
- Omalizumab (Xolair)
| - Reduces sensitivity to allergens
47
List the side effects of omalizumab.
- Flushing of skin
- Dizziness
- Anaphylactic reaction
48
The side effects of omalizumab (Xolair) may mimic what type of reaction? What is needed if this reaction occurs?
- Anaphylactic reaction
| - STAT intervention!
49
What is alpha-1 antitrypsin (AAT)? What is the relationship between alpha-1 antitrypsin and COPD?
- Protein produced in liver
- Aids in protecting lung tissue
-Severely low levels of serum AAT will genetically predispose a person to COPD
50
Individuals who smoke and have HIV are at the greatest risk for developing what disease?
COPD
51
Define chronic bronchitis.
Presence of cough and sputum for at least 3 months in each of two consecutive years
52
Define emphysema.
The destruction of alveoli
53
What education should the nurse provide to COPD patient about diet, mealtimes, and exercise?
- High calorie/high protein diet
- Schedule mealtimes and activities separate
- Don't drink large amount of fluids with meals
- Eat high calorie snacks in between meals and at bedtime
54
When are patients with COPD most likely to seek out medical care?
- Experience difficulty breathing at rest
| - Air hunger
55
A COPD patient is experiencing respiratory distress. What are the primary nursing interventions used to prevent air trapping and promote gas exchange?
- Tripod positioning/high-Fowlers
- Pursed lip breathing
- Apply oxygen
56
____________ is an increase in red blood cells (RBCs) and the bodies attempt to compensate for chronic hypoxemia.
Polycythemia
57
What clinical manifestation would be indicative of cor pulmonale?
Peripheral edema of ankles
58
Hemoglobin concentrations may reach _________ as a late manifestation of COPD.
20 g/dL or more
59
An elevated PCO2 level is known as what?
Hypercapnia
60
What does FEVI measure?
Forced expiratory volume in one minute
61
List the diagnostic studies used to determine how COPD affects a patients everyday life.
- COPD assessment test (CAT)
| - Clinical COPD questionnaire (CCQ)
62
A patient completes a 6-minute walk test and maintains a oxygen saturation of 86% on room air. The nurse knows this patient will require what?
Supplemental oxygen
63
Describe the ABG's of a COPD patient.
- Normal or low pH
- Elevated CO2
- Elevated HCO3
-Respiratory acidosis with metabolic alkalosis compensation!
64
A patient with COPD has been placed on supplemental oxygen. What is the best response by the nurse to encourage compliance by the patient?
Supplemental oxygen is a positive measure, it will improve the patients quality of life
65
A patient with COPD normally maintained on 1 LPM of supplemental O2 suddenly feels short of breath. The nurse should encourage the patient to do what? Why?
- Call the HCP
| - SOB may be due to underlying condition
66
List the factors that determine the amount/rate of supplemental oxygen needed by a patient.
- ABGs
- Oxygen saturation
- Work of breathing
- Respiratory assessment
67
List the best methods for evaluating improvement in gas exchange.
- ABGs
| - Oxygen saturation
68
Cystic fibrosis is an _________ _________ ________.
Autosomal recessive disorder
69
Both parents of a child are carriers of the cystic fibrosis gene, but neither parent has the disease. List the chances of the child being born with:
1. Normal genes
2. One normal and one abnormal gene
3. Two abnormal genes
1. 25%
2. 50%
3. 25%
70
Patients with cystic fibrosis are deficient in which enzymes?
- Amylase
- Lipase
- Protease
71
Enzyme deficiency in a patient with cystic fibrosis will lead to a ________ in absorption of nutrients.
Decrease
72
Describe the etiology of cystic fibrosis diabetes.
- Pancreas produces insulin
- Pancreas cannot keep up with carbohydrate intake
- Pancreas responds too late
73
Will a patient with cystic fibrosis diabetes have symptoms more closely matching DMI or DMII?
Both DMI and DMII
74
Describe the characteristics of secretions that are low in sodium and water.
- Very very thick
- Very sticky
- Highly concentrated
75
Why are cystic fibrosis patients more susceptible to antibiotic resistance?
Given a lot of antibiotics due to chronic respiratory infections
76
What is the average age for diagnosis of cystic fibrosis? What is the most common first indicator of cystic fibrosis?
- 5 months old
| - Meconium ileus
77
List signs and symptoms of cystic fibrosis.
- Elevated salt in sweat
- Cough
- Thick/sticky mucus
- Wheezing
- Foul smelling, greasy stools
- Constipation
- Recurrent lung infections
78
List atypical symptoms of cystic fibrosis.
- Pancreatitis
| - Infertility
79
List complications that result from cystic fibrosis.
- Diabetes
- Infertility
- Pneumothorax
- Respiratory failure
80
What test is commonly used to diagnose cystic fibrosis?
Sweat chloride test
81
Patients with cystic fibrosis will secrete ____ _______ the amount of sodium and chloride in their sweat when compared to a person without cystic fibrosis.
Four times
82
Sweat chloride values of ________ are considered positive for cystic fibrosis.
>60 mmol/L
83
The nurse should educate a cystic fibrosis patient on what type of dietary measures?
- Take enzymes before meals and snacks to breakdown food
- Incorporate fat soluble vitamins
- Increase sodium intake during episodes of increased sweating
84
What is included in the hematological system?
- Blood
- Bone marrow
- Spleen
- Lymphatic system
85
List abnormal assessment findings of the lymph nodes.
- Tender
- Large
- Hard
- Fixed
86
Lymph nodes that are hard and fixed often indicate what complication?
Malignancy
87
What are bands? When are these present?
- Immature neutrophils
| - During severe infection
88
The absolute neutrophil count (ANC) is composed of what?
- Bands
| - Segs
89
Describe the term "shift to the left".
-High absolute neutrophil count (ANC) indicates too many immature cells
90
A neutrophil count less then ______ indicates sepsis.
<500
91
What does a peripheral smear diagnostic study examine?
Morphology or shape of cells
92
A platelet count <100,000 is indicative of what condition?
Thrombocytopenia
93
What type of antibodies are present in plasma of Group A blood cells?
Anti-B
94
What type of antibodies are present in plasma of Group B blood cells?
Anti-A
95
What type of antibodies are present in plasma of Group AB blood cells?
None
96
What type of antibodies are present in plasma of Group O blood cells?
Anti-A and Anti-B
97
What type of antigens are present on Group A red blood cells?
A antigen
98
What type of antigens are present on Group B red blood cells?
B antigen
99
What type of antigens are present on Group AB red blood cells?
A and B antigens
100
What type of antigens are present on Group O red blood cells?
No antigens
101
What blood type is considered the universal donor?
O negative (O-)
102
What blood type is considered the universal recipient?
AB positive (AB+)
103
It is imperative that the nurse know the patients blood types prior/during what procedures/instances?
- Blood transfusions
- Surgery
- Pregnancy
104
The patient has A+ blood. As the nurse, you know the patient can receive what type(s) of blood?
O+
O-
A+
A-
105
The patient has A- blood. As the nurse, you know the patient can receive what type(s) of blood?
O-
| A-
106
The patient has B+ blood. As the nurse, you know the patient can receive what type(s) of blood?
O-
O+
B-
B+
107
The patient has B- blood. As the nurse, you know the patient can receive what type(s) of blood?
O-
| B-
108
The patient has O+ blood. As the nurse, you know the patient can receive what type(s) of blood?
O-
| O+
109
The patient has O- blood. As the nurse, you know the patient can receive what type(s) of blood?
O-
110
The patient has AB+ blood. As the nurse, you know the patient can receive what type(s) of blood?
```
O-
O+
A-
A+
B-
B+
AB-
AB+
```
111
The patient has AB- blood. As the nurse, you know the patient can receive what type(s) of blood?
O-
A-
B-
AB-
112
The patient has A+ blood. As the nurse, you know the patient can donate what type(s) of blood?
A+
| AB+
113
The patient has A- blood. As the nurse, you know the patient can donate what type(s) of blood?
A-
A+
AB-
AB+
114
The patient has B+ blood. As the nurse, you know the patient can donate what type(s) of blood?
B+
| AB+
115
The patient has B- blood. As the nurse, you know the patient can donate what type(s) of blood?
B-
B+
AB-
AB+
116
The patient has AB+ blood. As the nurse, you know the patient can donate what type(s) of blood?
AB+
117
The patient has AB- blood. As the nurse, you know the patient can donate what type(s) of blood?
AB-
| AB+
118
The patient has O+ blood. As the nurse, you know the patient can donate what type(s) of blood?
O+
A+
B+
AB+
119
The patient has O- blood. As the nurse, you know the patient can donate what type(s) of blood?
```
O-
O+
A-
A+
B-
B+
AB-
AB+
```
120
```
A patient needs 2 units of packed red blood cells. The patient is typed and crossmatched. The patient has A+ blood. As the nurse you know the patient can receive what type of blood? (SATA)
A. A-
B. O-
C. O+
D. A+
E. AB-
F. AB+
G. B+
```
A, B, C, D
121
```
A donor has AB- blood. Which patient or patients below can receive this type of blood safely?
A. A patient with O- blood
B. A patient with A- blood
C. A patient with B- blood
D. A patient with AB- blood
```
D. A patient with AB- blood
122
You’re educating a group of outpatients about ABO blood typing and compatibility. Which statement is INCORRECT?
A. A person with B- blood can donate to people with either B- or AB- blood.
B. A person with B- blood can receive blood from donors with O- and B- blood.
C. A person with O- blood can donate to every blood type regardless of the RH factor.
D. A person with AB+ blood can only donate to other people with either AB+ or AB- blood.
D. A person with AB+ blood can only donate to other people with either AB+ or AB- blood.
123
```
A person is O+. Select all the donor blood types this person could receive blood from: (SATA)
A. AB+
B. AB-
C. O+
D. O-
E. A+
F. A-
G. B+
H. B-
```
C, D
124
T/F: Agglutination can occur when Type A blood is given to a person with Type O blood.
True
125
Transfusion reactions are defined as what?
Adverse events
126
```
Your patient is scheduled for surgery and is ordered to be typed and crossmatched. The lab result shows your patient has B- blood. What type of blood can the patient receive during surgery, if needed? (SATA)
A. B-
B. B+
C. A-
D. A+
E. O+
F. O-
G. AB+
H. AB-
```
A, F
127
A 26 year old female is 27 weeks pregnant with her second child. The woman is A-. As the nurse you know that:
A. If the patient was A+ she would need to receive RhoGAM.
B. The patient will need to receive RhoGAM during this visit to prevent hemolytic disease of the newborn.
C. The baby will need to receive RhoGAM after it’s born.
D. Since the mother is A- the baby can be Rh positive, which could lead to an immune attack on the mother's body.
B. The patient will need to receive RhoGAM during this visit to prevent hemolytic disease of the newborn.
128
T/F: Patients who are Rh positive can only receive Rh positive blood, while patients who are Rh negative can only receive blood from donors who are Rh negative.
False.
Rh positive patients can receive BOTH negative and positive blood, while Rh negative patients can receive ONLY negative blood.
129
What should be verified by the nurse(s) prior to transfusing blood?
```
Time
Route
Amount
Medication
Patient
Expiration
Documentation
```
130
The nurse knows to specifically document what piece of information when transfusing blood?
Correct unit number of blood pack
131
When might an acute blood transfusion reaction occur?
- During the transfusion
| - At bedside
132
When might a delayed blood transfusion reaction occur?
Days to weeks after the infusion
133
What assessment data is priority during a blood transfusion?
- Strict input/output
| - Auscultation of lung sounds
134
A patient deficient in immunoglobulin A is receiving a blood transfusion. The nurse will closely monitor this patient for what type of reaction?
Anaphylactic reaction
135
What causes septic reactions to occur during blood transfusions?
- Bacteria
| - Contaminated donor blood
136
Describe a TRALI transfusion reaction.
Donor blood releases mediators that cause pulmonary edema
137
Patients with these conditions are at an increased risk for developing a TRALI transfusion reaction.
- Post-op
- Have current infection
- Inflammatory disease
- Recipient of chronic blood transfusions
138
What are the first signs and symptoms that a patient is going to have a reaction to a transfusion or become septic?
- Fever
| - Chills
139
A patients temperature prior to a blood transfusion was 97.6 degrees. Fifteen minutes after beginning the transfusion, the patients temperature increased to 98.8. What is the nurses priority intervention?
Stop the transfusion
140
What sign or symptom may be the only indication of respiratory distress in a patient receiving a blood transfusion?
Shortness of breath
141
What is the priority nursing interventions if a patient becomes hypothermic during a blood transfusion?
Warm the patient using heated blankets
142
List the signs and symptoms of a blood transfusion reaction.
- Fever
- Chills
- Itching
- Hives
- Headache
- Flushing
143
The nurse notices red urine in the foley bag of a patient receiving a blood transfusion. The nurse knows red urine is often an indication of what type of reaction?
Hemolytic reaction
144
Describe the treatment for a blood transfusion reaction.
- Stop the transfusion
- Keep IV open with NS
- Monitor vitals every 15 minutes
- Post-transfusion blood sample
- Treat signs and symptoms
145
How is a post-transfusion blood sample performed? What must specifically be included with the sample?
- All equipment and products used during transfusion is sent to blood bank to determine cause of reaction
- Must include patients blood sample post transfusion
146
What is the preferred site of a bone marrow biopsy?
Posterior iliac crest
147
List nursing interventions for a bone marrow biopsy.
- Apply pressure
- Monitor vital signs
- Assess for bleeding
- Educate
148
If a patient has active bleeding after a bone marrow biopsy, the nurse knows to educate the patient to do what?
Lay on the site
149
What is the normal range for white blood cells (WBC)?
5,000 - 10,000
150
What is the normal range for red blood cells (RBC)?
4.2 - 6.1
151
What is the normal range for hemoglobin?
12.0 - 18.0
152
What is the normal range for hematocrit?
37% - 52%
153
What is the normal range for platelets?
150,000 - 400,000
154
What is the normal range for neutrophils?
2,500 - 8,000
155
What is the normal range for lymphocytes?
1,000 - 4,000
156
What is the normal range for monocytes?
100 - 700
157
What is the normal range for eosinophils?
50 - 500
158
What is the normal range for basophils?
25 - 100
159
What laboratory value(s) are assessed to determine if anemia is present?
- Hemoglobin
- Hematocrit
- Red blood cells
160
What laboratory value determines the severity of anemia.
Hemoglobin
161
List causes of anemia in the geriatric population.
- Iron deficiency
- Bleeding
- Cancer of blood
- Renal insufficiency
162
Patients with anemia often appear jaundice due to what?
- Breakdown of red blood cells (RBC)
| - Release of bilirubin
163
Mild anemia is indicated by a hemoglobin level of what?
10 - 12
164
Moderate anemia is indicated by a hemoglobin level of what?
6 - 10
165
Severe anemia is indicated by a hemoglobin level of what?
<6
166
How long do red blood cells (RBC) live?
120 days
167
List the causes of iron-deficiency anemia.
- Hemolysis
- Inadequate dietary intake
- Malabsorption
- Bleeding
168
____ of blood contains _____ of iron.
2 mL of blood contains 1 mg of iron
169
Where is iron absorbed?
Duodenum
170
How much blood is lost during a woman's menstrual cycle? How much iron does it equate to?
- 45 mL blood loss
| - 22 mg iron loss
171
A patient with a history of gastric by-pass surgery was admitted to the surgical floor after having their duodenum removed. The nurse knows this patient is at an increased risk for what condition?
Iron-deficiency anemia
172
What is the most common sign or symptom of iron deficiency anemia?
Glossitis (swollen tongue)
173
List foods rich in iron.
- Green leafy vegetables
- Eggs
- Legumes
- Chicken
- Liver
- Enriched breads and cereals
174
In order for proper absorption to take place, the nurse should educate the patient on what when taking their iron supplement?
- One hour before meals
| - Take with Vitamin C/orange juice
175
What does ferritin indicate?
How much iron is stored in the body
176
Total iron binding capacity (TIBC) will be __________ in a patient with iron deficiency anemia.
High
177
Ferritin and serum iron will be ________ in a patient with iron deficiency anemia.
Low
178
WIC advises expecting or new mothers to do what in order to absorb iron?
Cook on cast iron skillet
179
After being prescribed iron pills, how long should the patient wait before having another complete blood count (CBC) panel evaluated by their HCP?
2 to 3 months
180
Describe thalassemia.
Decreased hemoglobin due to decrease in erythrocyte production
181
What decreases erythrocyte production in thalassemia?
Absent or reduced globulin
182
Describe the appearance of red blood cells (RBC) in thalassemia major.
- Small (microcytosis)
| - Pale (hypochromatic)
183
When do symptoms of thalassemia major usually appear?
By age 2
184
List the treatment options for thalassemia minor. Explain.
- No treatment
| - Body adapts to low hemoglobin levels
185
List the treatment options for thalassemia major.
- Blood transfusions with chelating agents
- Medication
- Splenectomy
186
What is the cure for thalassemia major?
Hematopoietic stem cell transplantation
187
Why are chelating agents administered if a patient is receiving chronic blood transfusions?
- Chronic blood transfusions cause iron overload
| - Chelating agents help filter out iron
188
What is the cause of megaloblastic anemia? Describe the red blood cells in individuals with this condition.
- Deficiency in Vitamin B12
- Deficiency in folic acid
-Large, fragile red blood cells
189
What medication is infamous for causing folic acid deficiency?
Methotrexate
190
What is the treatment for folic acid deficiency caused by methotrexate?
Supplemental folic acid
191
What is needed in order for the body to secrete intrinsic factor?
Hydrochloric acid
192
____________ ______ is decreased in megaloblastic anemia.
Hydrochloric acid
193
What is the primary treatment for a patient with megaloblastic anemia?
Cobalamin (Vitamin B12)
194
Describe the process of cobalamin (Vitamin B12) treatment.
- 1000 mg IM of Vitamin B12 given daily for two weeks
- Once hemoglobin is normal, Vitamin B12 given weekly
- Vitamin B12 given monthly for rest of patients life
195
Is megaloblastic anemia reversible?
Reversed with ongoing treatment
196
What long-standing complication may result from megaloblastic anemia? Can it be resolved?
- Neuromuscular complications
| - Often not reversible
197
Describe pancytopenia.
Lack in production of all blood cells (RBC, WBC, platelets)
198
Pancytopenia is associated with what type of anemia?
Aplastic anemia
199
A patient with aplastic anemia only has blood _________.
Plasma
200
A neutropenic patient is admitted for a slight elevation in temperature. What is the nurses primary concern? What is the priority nursing intervention?
- Sepsis
| - Notify HCP immediately
201
List the priority nursing concerns for a patient with critical aplastic anemia.
- Infection/sepsis
| - Bleeding/hemorrhage
202
What diagnostic study is used to determine if a patient with aplastic anemias bone marrow is hypocellular with an increased fat content?
Bone marrow biopsy
203
List nursing management to prevent infection in a patient with neutropenia?
- Temperature checks every 4 hours
- Monitor for decrease in urine output
- Neutropenic precautions
204
A patient with aplastic anemia is admitted to the medical floor. The nurse can anticipate giving which medication(s) or performing which procedure/intervention?
- Cyclosporine
- Corticosteroids
- Blood transfusion
205
Any elevation in temperature of a neutropenic patient can lead to what condition(s)?
- Sepsis
| - Septic shock
206
Immature red blood cells are known as what?
Reticulocytes
207
Reticulocytes are low in what type of anemia?
Aplastic anemia
208
What causes the shape of sickle cells in sickle cell anemia?
Low oxygen
209
If a patient is in sickle cell crisis, what is the priority nursing intervention?
Apply oxygen
210
Initially, sickle cell events can be reversed with what treatment?
Oxygen therapy
211
What is the most common cause of a sickle cell crisis?
Viral or bacterial infection
212
A positive sickling test is indicated by what?
Presence of hemoglobin S
213
What is the cause of severe pain in sickle cell anemia?
Tissue hypoxia
214
What are the signs and symptoms of a vaso-occlusive crisis?
- Impede blood flow
- Tissue necrosis
- Thick blood
215
In order to help prevent infection in a sickle cell patient, what should the nurse educate the patient on?
- Hand hygiene
- Avoid sick individuals
- Avoid large crowds
216
The nurse should educate a patient with sickle cell anemia on what type of interventions for disease management?
- Avoid extreme temperatures
- Encourage fluids
- Pain management
217
How is pain managed in a patient with sickle cell anemia?
Opioid analgesics
218
What type of pain medication is most effective for patients with sickle cell anemia?
Continuous (PCA pump) opioid analgesics
219
Most patients with sickle cell disease will die from what condition?
Respiratory failure
220
An individual with sickle cell anemia should take what type of supplements?
- Vitamin B12
| - Folic acid
221
What is polycythemia?
Increased number of red blood cells (RBC)
222
What laboratory value is used to diagnose polycythemia?
Hematocrit
223
Bone marrow is ___________ in a patient with polycythemia.
Hyperactive
224
What type of supplement or medication is contraindicated in a patient with polycythemia?
Iron
225
During an acute polycythemia event, what priority assessment is monitored by the nurse? Why?
- Strict intake and output
| - Ensures patient is not retaining excess fluid
226
What is the most common cause of thrombocytopenia?
Ingestion of high doses of antiplatelet/anticoagulant medications
227
Thrombocytopenia causes what?
Prolonged or spontaneous bleeding
228
In order to prevent bleeding in a patient with thrombocytopenia, what should the nurse limit?
Invasive procedures
229
List signs and symptoms of internal bleeding related to thrombocytopenia.
- Occult blood
- Difficult to arouse
- Tachycardia
- Hypotension
- Pale
- Altered mental status
230
List locations within the body where bleeding that is difficult to detect may occur due to thrombocytopenia.
- Joints
- Eyes
- Brain
231
The nurse will expect a thrombocytopenia patients platelet count to be less than what value if they experience prolonged bleeding?
<50,000
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The nurse will expect a thrombocytopenia patients platelet count to be less than what value if they are hemorrhaging?
<20,000
233
What criteria must be met in order to transfuse platelets?
- Platelet laboratory value <10,000
| - Patient is actively bleeding
234
What is the priority nursing intervention for a patient with thrombocytopenia?
- Prevent or control hemorrhage
| - Evaluate any bleeding
235
A patient arrives at the ED with a nose bleed. The nurse is informed the patient has thrombocytopenia. The nurse knows any type of bleeding in this patient is considered what?
Emergency!
236
How do women with thrombocytopenia manage blood loss from menstrual bleeding?
Utilize hormone therapy to stop menstrual cycle
237
List nursing management for a patient with thrombocytopenia.
- Avoid IM injections
- Limit invasive procedures
- Closely monitor laboratory values
- Evaluate any bleeding
- Prevent/control hemorrhage
238
What is disseminated intravascular coagulation (DIC)?
Serious bleeding caused by abnormal clotting
239
What is the most common cause of disseminated intravascular coagulation (DIC).
Undiagnosed, untreated sepsis
240
Describe clotting laboratory values in a patient with disseminated intravascular coagulation (DIC).
- Prolonged bleeding times
| - Low platelet count
241
What type of transfusion will a patient with disseminated intravascular coagulation (DIC) receive?
- Platelets
| - Fresh frozen plasma
242
List the signs and symptoms of disseminated intravascular coagulation (DIC).
- Bloody stools
- Hematuria
- Hemoptysis
243
Where is bleeding primarily located in a patient with disseminated intravascular coagulation (DIC)?
- Bleeding in every part of body
| - Not specific to one location
244
Severe neutropenia is indicated by a value of _____ ____ ___ cells.
Less than 500 cells
245
What is the first indicator of infection?
Temperature change
246
If temperature is elevated above baseline in a patient with neutropenia, what is the priority nursing intervention?
Notify HCP!
247
In a patient with neutropenia, when should antibiotic therapy start after noticing a change in baseline temperature?
Within an hour of temperature rise
248
When should a blood culture be obtained in relation to antibiotic therapy?
Prior to antibiotic therapy
249
What medication is given in patients with neutropenia to stimulate granulocytes and, ultimately, neutrophil production?
Neupogen
250
Describe the administration of Neupogen.
- Self-administered by patient
| - IM or Sub-Q
251
If a cancer patient is receiving chemotherapy and becomes neutropenic, is chemotherapy stopped or continued?
- Stopped for neutrophil value <500
| - Should resume chemotherapy and begin administering Neupogen
252
What type of education should a nurse provide to a neutropenic patient?
- Hand hygiene
- Avoid crowds
- Avoid sick individuals
- Mask wearing
253
How is leukemia classified? How many different types of leukemia are there?
- Four types
| - Classified by type of white blood cell (WBC) involved
254
Describe leukostasis.
- High white blood cell (WBC) count
- Causes blood to thicken
- Blocks circulatory pathways
255
What diagnostic test or panel is used to diagnose leukemia?
CBC with differential
256
List the types of treatments for leukemia.
- Chemotherapy
- Radiation
- Corticosteroids
- Stem cell transplant
257
What diagnostic tests are used to determine the presence of leukemic cells outside of blood and bone marrow?
- Lumbar puncture
| - CT scan
258
Radiation therapy for leukemia may be specific to what areas?
- Bones
- Spleen
- Liver
259
What is the goal of a stem cell transplant in a patient with leukemia?
Eliminate all leukemic cells
260
What is the goal of a stem cell transplant in a patient with leukemia?
Eliminate all leukemic cells
261
What is the difference between Hodgkin's lymphoma and non-Hodgkins lymphoma? In which type does this appear?
- Presence of Reed-Sternberg cells
| - Reed-Sternberg present in Hodgkins lymphoma
262
How is Hodgkins lymphoma diagnosed?
Peripheral blood smear
263
Abnormalities in lymphocytes puts the patient at an increased risk for developing what?
Infection
264
Individuals with what disease have a higher incidence of being diagnosed with Hodgkin's lymphoma?
HIV
265
How does Hodgkin's lymphoma spread?
Lymphatic pathways
266
Hodgkin's lymphoma will stay confined to lymph nodes for an extended period of time if it originates where?
Above the diaphragm
267
Hodgkin's lymphoma will spread quickly if it originates where?
Below the diaphragm
268
Describe stage one of Hodgkin's lymphoma.
1 node involved
269
Describe stage two of Hodgkin's lymphoma.
- 2 or more nodes involved
| - Only on one side of diaphragm
270
Describe stage three of Hodgkin's lymphoma.
Lymph nodes above and below diaphragm are involved
271
Describe stage four of Hodgkin's lymphoma.
Outside of diaphragm
272
Describe stage four A Hodgkin's lymphoma.
- Outside of diaphragm
| - Asymptomatic
273
Describe stage four B Hodgkin's lymphoma.
- Outside of diaphragm
| - Systemic symptoms present
274
An elevated calcium level in a patient with Hodgkin's lymphoma indicate what?
Bones are involved
275
A person with Hodgkins lymphoma may experience what after consuming a small amount of alcohol?
Pain at site of disease
276
List signs and symptoms of Hodgkin's lymphoma.
- Jaundice
- Palpable masses in abdomen
- Impaired renal function
- Paraplegia
- Bone pain
277
Hodgkin's lymphoma is generally _________ unless ______ _______ ___ ______.
Hodgkin's lymphoma is generally painless unless pressure is exerted on nerves.
278
The most common secondary complications of Hodgkins lymphoma include what?
- Lung cancer
| - Breast cancer
279
What is the main treatment for Hodgkins lymphoma? Is maintenance treatment necessary?
- Chemotherapy
| - No
280
Hodgkins lymphoma may cause which body system(s) to have dysfunction?
- Endocrine
- Cardiac
- Pulmonary
281
When may secondary cancers from Hodgkin's lymphoma appear?
Up to 10 years after treatment
282
The nurse should be sensitive when discussing what topic with a patient who has Hodgkins lymphoma?
Possible infertility
283
What age range(s) have the highest diagnosis of Hodgkins lymphoma?
- Preteens/teens
- Early 20's
- Childbearing
284
What is hemolysis?
Destruction of red blood cells (RBC)
