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Professional Nursing Concepts I Nursing: N2320 > Respiratory (Exam Two) > Flashcards

Respiratory (Exam Two) Flashcards

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1
Q

Describe atopy.

A

Genetic predisposition to develop an allergic response to common allergens

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2
Q

Which immunoglobulin is assessed in relation to allergens and allergic responses?

A

IgE

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3
Q

Atopy is a major ______ ________ for asthma.

A

Risk factor

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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

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5
Q

What is occurring within the lungs when a patient has asthma?

A
  • Airways are chronically inflamed
  • Airways are narrow
  • Air gets trapped
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6
Q

List the causes of asthma.

A
  • Heredity/Genetics
  • Airborne allergies
  • Pollution
  • Smoking
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7
Q

List the risk factors for developing asthma.

A
  • Heredity/Genetic predisposition
  • Male gender in childhood
  • Obesity
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8
Q

List the signs and symptoms of asthma.

A
  • Dyspnea
  • Tachypnea
  • Wheezing
  • Chest tightness
  • Cough
  • Prolonged expiration
  • Use of accessory muscles
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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!
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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

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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

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12
Q

List the conditions involved in an asthma triad.

A
  • Nasal polyps
  • Asthma
  • Sensitivity to salicylic acid (aspirin/ NSAIDS)
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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
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14
Q

What class(s) of drug(s) should be avoided in patients with asthma and COPD?

A
  • Non-selective beta blockers

- ACE inhibitors

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15
Q

List non-selective beta blockers.

A
  • Propranolol
  • Nadolol
  • Carvedilol
  • Labetalol
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16
Q

List ACE inhibitors.

A
  • Lisinopril
  • Enalapril
  • Captopril
  • Quinapril
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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

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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
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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

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20
Q

Peak flow results that are 80% to 100% of the patients personal best are in what zone?

A

Green zone

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21
Q

Peak flow results that are 50% to 80% of the patients personal best are in what zone?

A

Yellow zone

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22
Q

Peak flow results that are 50% or less of the patients personal best are in what zone?

A

Red zone

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23
Q

Peak flow results that are in the red zone indicate what?

A
  • Serious problem
  • Interventions needed
  • Additional medications needed
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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)

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25
Q

What diagnostic study is used to diagnose asthma and COPD?

A

Spirometry

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26
Q

List the steps in which a spirometry test is performed.

A
  • Test
  • Administer bronchodilator
  • Wait 15 minutes
  • Test again
  • Compare results
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27
Q

A patient is having an acute asthma exacerbation. What is the desired outcome for this patient after receiving treatment?

A

Maintaining oxygen saturation >90%

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28
Q

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?

A
  • Respiratory alkalosis

- Due to hyperventilation and hypoxia

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29
Q

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?

A
  • Respiratory acidosis

- Due to fatigue and decreased respiratory rate

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30
Q

The nurse knows that a patient in respiratory alkalosis related to a prolonged asthma attack is at an increased risk for what?

A

Respiratory failure

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31
Q

What can the nurse do when a patient has an ineffective breathing pattern?

A

Encourage pursed lip breathing

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32
Q

Pursed lip breathing will be ineffective if the patient does what? The nurse should educate the patient to do what instead?

A
  • Puffs out their cheeks

- Relax their face

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33
Q

A patients oxygen saturation is 86% and they are displaying signs of respiratory distress. The nurse knows to not do what during this event?

A

-Do not leave the patient!

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34
Q

List bronchodilators/short-acting beta agonists (SABA) commonly given during an acute asthma exacerbation.

A
  • Albuterol

- Inhaled ipratropium

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35
Q

List the common side effects of bronchodilators/short-acting beta agonists (SABA).

A
  • Tremors
  • Tachycardia
  • Anxiety
  • Palpitations
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36
Q

Which inhaled corticosteroid is the most common and considered the most effective at treating inflammation in patients with persistent asthma?

A

Fluticasone (Flovent)

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37
Q

Why is IV magnesium sulfate administered during a severe and life-threatening asthma exacerbation?

A
  • Relaxes smooth muscle

- Enhances effects of bronchodilators

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38
Q

What is the drug class of Montelukast (Singulair)?

A

Leukotriene Receptor Antagonist (LTRA)

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39
Q

Which drug is often considered as a last resort for controlling asthma? Why?

A
  • Montelukast (Singulair)

- Causes vivid nightmares, out-of-body experiences, and behavioral issues

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40
Q

Caffeine increases the absorption of which drug?

A

Theophylline

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41
Q

What is the therapeutic range for theophylline?

A

10 to 20 mcg/mL

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42
Q

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?

A

Theophylline toxicity

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43
Q

List the signs and symptoms of theophylline toxicity. Which signs and symptoms are associated with chronic theophylline toxicity?

A
  • Nausea
  • Vomiting
  • Tachycardia
  • Seizures (chronic)
  • Dysrhythmias (chronic)
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44
Q

List long-acting beta-agonists commonly prescribed for asthma control.

A
  • Salmeterol
  • Formoterol
  • Arformoterol
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45
Q

Long-acting beta-agonists are used in combination with what other medication for asthma control?

A

Inhaled corticosteroids

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46
Q

What medication is given when high doses of corticosteroids are ineffective for a patient with asthma? What is the purpose of this drug?

A
  • Omalizumab (Xolair)

- Reduces sensitivity to allergens

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47
Q

List the side effects of omalizumab.

A
  • Flushing of skin
  • Dizziness
  • Anaphylactic reaction
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48
Q

The side effects of omalizumab (Xolair) may mimic what type of reaction? What is needed if this reaction occurs?

A
  • Anaphylactic reaction

- STAT intervention!

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49
Q

What is alpha-1 antitrypsin (AAT)? What is the relationship between alpha-1 antitrypsin and COPD?

A
  • Protein produced in liver
  • Aids in protecting lung tissue

-Severely low levels of serum AAT will genetically predispose a person to COPD

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50
Q

Individuals who smoke and have HIV are at the greatest risk for developing what disease?

A

COPD

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51
Q

Define chronic bronchitis.

A

Presence of cough and sputum for at least 3 months in each of two consecutive years

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52
Q

Define emphysema.

A

The destruction of alveoli

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53
Q

What education should the nurse provide to COPD patient about diet, mealtimes, and exercise?

A
  • 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
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54
Q

When are patients with COPD most likely to seek out medical care?

A
  • Experience difficulty breathing at rest

- Air hunger

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55
Q

A COPD patient is experiencing respiratory distress. What are the primary nursing interventions used to prevent air trapping and promote gas exchange?

A
  • Tripod positioning/high-Fowlers
  • Pursed lip breathing
  • Apply oxygen
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56
Q

____________ is an increase in red blood cells (RBCs) and the bodies attempt to compensate for chronic hypoxemia.

A

Polycythemia

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57
Q

What clinical manifestation would be indicative of cor pulmonale?

A

Peripheral edema of ankles

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58
Q

Hemoglobin concentrations may reach _________ as a late manifestation of COPD.

A

20 g/dL or more

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59
Q

An elevated PCO2 level is known as what?

A

Hypercapnia

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60
Q

What does FEVI measure?

A

Forced expiratory volume in one minute

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61
Q

List the diagnostic studies used to determine how COPD affects a patients everyday life.

A
  • COPD assessment test (CAT)

- Clinical COPD questionnaire (CCQ)

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62
Q

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?

A

Supplemental oxygen

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63
Q

Describe the ABG’s of a COPD patient.

A
  • Normal or low pH
  • Elevated CO2
  • Elevated HCO3

-Respiratory acidosis with metabolic alkalosis compensation!

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64
Q

A patient with COPD has been placed on supplemental oxygen. What is the best response by the nurse to encourage compliance by the patient?

A

Supplemental oxygen is a positive measure, it will improve the patients quality of life

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65
Q

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?

A
  • Call the HCP

- SOB may be due to underlying condition

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66
Q

List the factors that determine the amount/rate of supplemental oxygen needed by a patient.

A
  • ABGs
  • Oxygen saturation
  • Work of breathing
  • Respiratory assessment
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67
Q

List the best methods for evaluating improvement in gas exchange.

A
  • ABGs

- Oxygen saturation

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68
Q

Cystic fibrosis is an _________ _________ ________.

A

Autosomal recessive disorder

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69
Q

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
A
  1. 25%
  2. 50%
  3. 25%
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70
Q

Patients with cystic fibrosis are deficient in which enzymes?

A
  • Amylase
  • Lipase
  • Protease
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71
Q

Enzyme deficiency in a patient with cystic fibrosis will lead to a ________ in absorption of nutrients.

A

Decrease

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72
Q

Describe the etiology of cystic fibrosis diabetes.

A
  • Pancreas produces insulin
  • Pancreas cannot keep up with carbohydrate intake
  • Pancreas responds too late
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73
Q

Will a patient with cystic fibrosis diabetes have symptoms more closely matching DMI or DMII?

A

Both DMI and DMII

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74
Q

Describe the characteristics of secretions that are low in sodium and water.

A
  • Very very thick
  • Very sticky
  • Highly concentrated
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75
Q

Why are cystic fibrosis patients more susceptible to antibiotic resistance?

A

Given a lot of antibiotics due to chronic respiratory infections

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76
Q

What is the average age for diagnosis of cystic fibrosis? What is the most common first indicator of cystic fibrosis?

A
  • 5 months old

- Meconium ileus

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77
Q

List signs and symptoms of cystic fibrosis.

A
  • Elevated salt in sweat
  • Cough
  • Thick/sticky mucus
  • Wheezing
  • Foul smelling, greasy stools
  • Constipation
  • Recurrent lung infections
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78
Q

List atypical symptoms of cystic fibrosis.

A
  • Pancreatitis

- Infertility

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79
Q

List complications that result from cystic fibrosis.

A
  • Diabetes
  • Infertility
  • Pneumothorax
  • Respiratory failure
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80
Q

What test is commonly used to diagnose cystic fibrosis?

A

Sweat chloride test

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81
Q

Patients with cystic fibrosis will secrete ____ _______ the amount of sodium and chloride in their sweat when compared to a person without cystic fibrosis.

A

Four times

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82
Q

Sweat chloride values of ________ are considered positive for cystic fibrosis.

A

> 60 mmol/L

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83
Q

The nurse should educate a cystic fibrosis patient on what type of dietary measures?

A
  • Take enzymes before meals and snacks to breakdown food
  • Incorporate fat soluble vitamins
  • Increase sodium intake during episodes of increased sweating
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84
Q

What is included in the hematological system?

A
  • Blood
  • Bone marrow
  • Spleen
  • Lymphatic system
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85
Q

List abnormal assessment findings of the lymph nodes.

A
  • Tender
  • Large
  • Hard
  • Fixed
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86
Q

Lymph nodes that are hard and fixed often indicate what complication?

A

Malignancy

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87
Q

What are bands? When are these present?

A
  • Immature neutrophils

- During severe infection

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88
Q

The absolute neutrophil count (ANC) is composed of what?

A
  • Bands

- Segs

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89
Q

Describe the term “shift to the left”.

A

-High absolute neutrophil count (ANC) indicates too many immature cells

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90
Q

A neutrophil count less then ______ indicates sepsis.

A

<500

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91
Q

What does a peripheral smear diagnostic study examine?

A

Morphology or shape of cells

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92
Q

A platelet count <100,000 is indicative of what condition?

A

Thrombocytopenia

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93
Q

What type of antibodies are present in plasma of Group A blood cells?

A

Anti-B

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94
Q

What type of antibodies are present in plasma of Group B blood cells?

A

Anti-A

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95
Q

What type of antibodies are present in plasma of Group AB blood cells?

A

None

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96
Q

What type of antibodies are present in plasma of Group O blood cells?

A

Anti-A and Anti-B

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97
Q

What type of antigens are present on Group A red blood cells?

A

A antigen

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98
Q

What type of antigens are present on Group B red blood cells?

A

B antigen

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99
Q

What type of antigens are present on Group AB red blood cells?

A

A and B antigens

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100
Q

What type of antigens are present on Group O red blood cells?

A

No antigens

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101
Q

What blood type is considered the universal donor?

A

O negative (O-)

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102
Q

What blood type is considered the universal recipient?

A

AB positive (AB+)

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103
Q

It is imperative that the nurse know the patients blood types prior/during what procedures/instances?

A
  • Blood transfusions
  • Surgery
  • Pregnancy
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104
Q

The patient has A+ blood. As the nurse, you know the patient can receive what type(s) of blood?

A

O+
O-
A+
A-

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Perfectly
105
Q

The patient has A- blood. As the nurse, you know the patient can receive what type(s) of blood?

A

O-

A-

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106
Q

The patient has B+ blood. As the nurse, you know the patient can receive what type(s) of blood?

A

O-
O+
B-
B+

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107
Q

The patient has B- blood. As the nurse, you know the patient can receive what type(s) of blood?

A

O-

B-

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108
Q

The patient has O+ blood. As the nurse, you know the patient can receive what type(s) of blood?

A

O-

O+

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109
Q

The patient has O- blood. As the nurse, you know the patient can receive what type(s) of blood?

A

O-

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110
Q

The patient has AB+ blood. As the nurse, you know the patient can receive what type(s) of blood?

A 
O-
O+
A-
A+
B-
B+
AB-
AB+
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111
Q

The patient has AB- blood. As the nurse, you know the patient can receive what type(s) of blood?

A

O-
A-
B-
AB-

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112
Q

The patient has A+ blood. As the nurse, you know the patient can donate what type(s) of blood?

A

A+

AB+

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113
Q

The patient has A- blood. As the nurse, you know the patient can donate what type(s) of blood?

A

A-
A+
AB-
AB+

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114
Q

The patient has B+ blood. As the nurse, you know the patient can donate what type(s) of blood?

A

B+

AB+

115
Q

The patient has B- blood. As the nurse, you know the patient can donate what type(s) of blood?

A

B-
B+
AB-
AB+

116
Q

The patient has AB+ blood. As the nurse, you know the patient can donate what type(s) of blood?

A

AB+

117
Q

The patient has AB- blood. As the nurse, you know the patient can donate what type(s) of blood?

A

AB-

AB+

118
Q

The patient has O+ blood. As the nurse, you know the patient can donate what type(s) of blood?

A

O+
A+
B+
AB+

119
Q

The patient has O- blood. As the nurse, you know the patient can donate what type(s) of blood?

A 
O-
O+
A-
A+
B-
B+
AB-
AB+
120
Q 
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

A, B, C, D

121
Q 
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
A

D. A patient with AB- blood

122
Q

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.

A

D. A person with AB+ blood can only donate to other people with either AB+ or AB- blood.

123
Q 
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-
A

C, D

124
Q

T/F: Agglutination can occur when Type A blood is given to a person with Type O blood.

A

True

125
Q

Transfusion reactions are defined as what?

A

Adverse events

126
Q 
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

A, F

127
Q

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.

A

B. The patient will need to receive RhoGAM during this visit to prevent hemolytic disease of the newborn.

128
Q

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.

A

False.

Rh positive patients can receive BOTH negative and positive blood, while Rh negative patients can receive ONLY negative blood.

129
Q

What should be verified by the nurse(s) prior to transfusing blood?

A 
Time
Route
Amount
Medication 
Patient
Expiration 
Documentation
130
Q

The nurse knows to specifically document what piece of information when transfusing blood?

A

Correct unit number of blood pack

131
Q

When might an acute blood transfusion reaction occur?

A
  • During the transfusion

- At bedside

132
Q

When might a delayed blood transfusion reaction occur?

A

Days to weeks after the infusion

133
Q

What assessment data is priority during a blood transfusion?

A
  • Strict input/output

- Auscultation of lung sounds

134
Q

A patient deficient in immunoglobulin A is receiving a blood transfusion. The nurse will closely monitor this patient for what type of reaction?

A

Anaphylactic reaction

135
Q

What causes septic reactions to occur during blood transfusions?

A
  • Bacteria

- Contaminated donor blood

136
Q

Describe a TRALI transfusion reaction.

A

Donor blood releases mediators that cause pulmonary edema

137
Q

Patients with these conditions are at an increased risk for developing a TRALI transfusion reaction.

A
  • Post-op
  • Have current infection
  • Inflammatory disease
  • Recipient of chronic blood transfusions
138
Q

What are the first signs and symptoms that a patient is going to have a reaction to a transfusion or become septic?

A
  • Fever

- Chills

139
Q

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?

A

Stop the transfusion

140
Q

What sign or symptom may be the only indication of respiratory distress in a patient receiving a blood transfusion?

A

Shortness of breath

141
Q

What is the priority nursing interventions if a patient becomes hypothermic during a blood transfusion?

A

Warm the patient using heated blankets

142
Q

List the signs and symptoms of a blood transfusion reaction.

A
  • Fever
  • Chills
  • Itching
  • Hives
  • Headache
  • Flushing
143
Q

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?

A

Hemolytic reaction

144
Q

Describe the treatment for a blood transfusion reaction.

A
  • Stop the transfusion
  • Keep IV open with NS
  • Monitor vitals every 15 minutes
  • Post-transfusion blood sample
  • Treat signs and symptoms
145
Q

How is a post-transfusion blood sample performed? What must specifically be included with the sample?

A
  • 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
Q

What is the preferred site of a bone marrow biopsy?

A

Posterior iliac crest

147
Q

List nursing interventions for a bone marrow biopsy.

A
  • Apply pressure
  • Monitor vital signs
  • Assess for bleeding
  • Educate
148
Q

If a patient has active bleeding after a bone marrow biopsy, the nurse knows to educate the patient to do what?

A

Lay on the site

149
Q

What is the normal range for white blood cells (WBC)?

A

5,000 - 10,000

150
Q

What is the normal range for red blood cells (RBC)?

A

4.2 - 6.1

151
Q

What is the normal range for hemoglobin?

A

12.0 - 18.0

152
Q

What is the normal range for hematocrit?

A

37% - 52%

153
Q

What is the normal range for platelets?

A

150,000 - 400,000

154
Q

What is the normal range for neutrophils?

A

2,500 - 8,000

155
Q

What is the normal range for lymphocytes?

A

1,000 - 4,000

156
Q

What is the normal range for monocytes?

A

100 - 700

157
Q

What is the normal range for eosinophils?

A

50 - 500

158
Q

What is the normal range for basophils?

A

25 - 100

159
Q

What laboratory value(s) are assessed to determine if anemia is present?

A
  • Hemoglobin
  • Hematocrit
  • Red blood cells
160
Q

What laboratory value determines the severity of anemia.

A

Hemoglobin

161
Q

List causes of anemia in the geriatric population.

A
  • Iron deficiency
  • Bleeding
  • Cancer of blood
  • Renal insufficiency
162
Q

Patients with anemia often appear jaundice due to what?

A
  • Breakdown of red blood cells (RBC)

- Release of bilirubin

163
Q

Mild anemia is indicated by a hemoglobin level of what?

A

10 - 12

164
Q

Moderate anemia is indicated by a hemoglobin level of what?

A

6 - 10

165
Q

Severe anemia is indicated by a hemoglobin level of what?

A

<6

166
Q

How long do red blood cells (RBC) live?

A

120 days

167
Q

List the causes of iron-deficiency anemia.

A
  • Hemolysis
  • Inadequate dietary intake
  • Malabsorption
  • Bleeding
168
Q

____ of blood contains _____ of iron.

A

2 mL of blood contains 1 mg of iron

169
Q

Where is iron absorbed?

A

Duodenum

170
Q

How much blood is lost during a woman’s menstrual cycle? How much iron does it equate to?

A
  • 45 mL blood loss

- 22 mg iron loss

171
Q

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?

A

Iron-deficiency anemia

172
Q

What is the most common sign or symptom of iron deficiency anemia?

A

Glossitis (swollen tongue)

173
Q

List foods rich in iron.

A
  • Green leafy vegetables
  • Eggs
  • Legumes
  • Chicken
  • Liver
  • Enriched breads and cereals
174
Q

In order for proper absorption to take place, the nurse should educate the patient on what when taking their iron supplement?

A
  • One hour before meals

- Take with Vitamin C/orange juice

175
Q

What does ferritin indicate?

A

How much iron is stored in the body

176
Q

Total iron binding capacity (TIBC) will be __________ in a patient with iron deficiency anemia.

A

High

177
Q

Ferritin and serum iron will be ________ in a patient with iron deficiency anemia.

A

Low

178
Q

WIC advises expecting or new mothers to do what in order to absorb iron?

A

Cook on cast iron skillet

179
Q

After being prescribed iron pills, how long should the patient wait before having another complete blood count (CBC) panel evaluated by their HCP?

A

2 to 3 months

180
Q

Describe thalassemia.

A

Decreased hemoglobin due to decrease in erythrocyte production

181
Q

What decreases erythrocyte production in thalassemia?

A

Absent or reduced globulin

182
Q

Describe the appearance of red blood cells (RBC) in thalassemia major.

A
  • Small (microcytosis)

- Pale (hypochromatic)

183
Q

When do symptoms of thalassemia major usually appear?

A

By age 2

184
Q

List the treatment options for thalassemia minor. Explain.

A
  • No treatment

- Body adapts to low hemoglobin levels

185
Q

List the treatment options for thalassemia major.

A
  • Blood transfusions with chelating agents
  • Medication
  • Splenectomy
186
Q

What is the cure for thalassemia major?

A

Hematopoietic stem cell transplantation

187
Q

Why are chelating agents administered if a patient is receiving chronic blood transfusions?

A
  • Chronic blood transfusions cause iron overload

- Chelating agents help filter out iron

188
Q

What is the cause of megaloblastic anemia? Describe the red blood cells in individuals with this condition.

A
  • Deficiency in Vitamin B12
  • Deficiency in folic acid

-Large, fragile red blood cells

189
Q

What medication is infamous for causing folic acid deficiency?

A

Methotrexate

190
Q

What is the treatment for folic acid deficiency caused by methotrexate?

A

Supplemental folic acid

191
Q

What is needed in order for the body to secrete intrinsic factor?

A

Hydrochloric acid

192
Q

____________ ______ is decreased in megaloblastic anemia.

A

Hydrochloric acid

193
Q

What is the primary treatment for a patient with megaloblastic anemia?

A

Cobalamin (Vitamin B12)

194
Q

Describe the process of cobalamin (Vitamin B12) treatment.

A
  • 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
Q

Is megaloblastic anemia reversible?

A

Reversed with ongoing treatment

196
Q

What long-standing complication may result from megaloblastic anemia? Can it be resolved?

A
  • Neuromuscular complications

- Often not reversible

197
Q

Describe pancytopenia.

A

Lack in production of all blood cells (RBC, WBC, platelets)

198
Q

Pancytopenia is associated with what type of anemia?

A

Aplastic anemia

199
Q

A patient with aplastic anemia only has blood _________.

A

Plasma

200
Q

A neutropenic patient is admitted for a slight elevation in temperature. What is the nurses primary concern? What is the priority nursing intervention?

A
  • Sepsis

- Notify HCP immediately

201
Q

List the priority nursing concerns for a patient with critical aplastic anemia.

A
  • Infection/sepsis

- Bleeding/hemorrhage

202
Q

What diagnostic study is used to determine if a patient with aplastic anemias bone marrow is hypocellular with an increased fat content?

A

Bone marrow biopsy

203
Q

List nursing management to prevent infection in a patient with neutropenia?

A
  • Temperature checks every 4 hours
  • Monitor for decrease in urine output
  • Neutropenic precautions
204
Q

A patient with aplastic anemia is admitted to the medical floor. The nurse can anticipate giving which medication(s) or performing which procedure/intervention?

A
  • Cyclosporine
  • Corticosteroids
  • Blood transfusion
205
Q

Any elevation in temperature of a neutropenic patient can lead to what condition(s)?

A
  • Sepsis

- Septic shock

206
Q

Immature red blood cells are known as what?

A

Reticulocytes

207
Q

Reticulocytes are low in what type of anemia?

A

Aplastic anemia

208
Q

What causes the shape of sickle cells in sickle cell anemia?

A

Low oxygen

209
Q

If a patient is in sickle cell crisis, what is the priority nursing intervention?

A

Apply oxygen

210
Q

Initially, sickle cell events can be reversed with what treatment?

A

Oxygen therapy

211
Q

What is the most common cause of a sickle cell crisis?

A

Viral or bacterial infection

212
Q

A positive sickling test is indicated by what?

A

Presence of hemoglobin S

213
Q

What is the cause of severe pain in sickle cell anemia?

A

Tissue hypoxia

214
Q

What are the signs and symptoms of a vaso-occlusive crisis?

A
  • Impede blood flow
  • Tissue necrosis
  • Thick blood
215
Q

In order to help prevent infection in a sickle cell patient, what should the nurse educate the patient on?

A
  • Hand hygiene
  • Avoid sick individuals
  • Avoid large crowds
216
Q

The nurse should educate a patient with sickle cell anemia on what type of interventions for disease management?

A
  • Avoid extreme temperatures
  • Encourage fluids
  • Pain management
217
Q

How is pain managed in a patient with sickle cell anemia?

A

Opioid analgesics

218
Q

What type of pain medication is most effective for patients with sickle cell anemia?

A

Continuous (PCA pump) opioid analgesics

219
Q

Most patients with sickle cell disease will die from what condition?

A

Respiratory failure

220
Q

An individual with sickle cell anemia should take what type of supplements?

A
  • Vitamin B12

- Folic acid

221
Q

What is polycythemia?

A

Increased number of red blood cells (RBC)

222
Q

What laboratory value is used to diagnose polycythemia?

A

Hematocrit

223
Q

Bone marrow is ___________ in a patient with polycythemia.

A

Hyperactive

224
Q

What type of supplement or medication is contraindicated in a patient with polycythemia?

A

Iron

225
Q

During an acute polycythemia event, what priority assessment is monitored by the nurse? Why?

A
  • Strict intake and output

- Ensures patient is not retaining excess fluid

226
Q

What is the most common cause of thrombocytopenia?

A

Ingestion of high doses of antiplatelet/anticoagulant medications

227
Q

Thrombocytopenia causes what?

A

Prolonged or spontaneous bleeding

228
Q

In order to prevent bleeding in a patient with thrombocytopenia, what should the nurse limit?

A

Invasive procedures

229
Q

List signs and symptoms of internal bleeding related to thrombocytopenia.

A
  • Occult blood
  • Difficult to arouse
  • Tachycardia
  • Hypotension
  • Pale
  • Altered mental status
230
Q

List locations within the body where bleeding that is difficult to detect may occur due to thrombocytopenia.

A
  • Joints
  • Eyes
  • Brain
231
Q

The nurse will expect a thrombocytopenia patients platelet count to be less than what value if they experience prolonged bleeding?

A

<50,000

232
Q

The nurse will expect a thrombocytopenia patients platelet count to be less than what value if they are hemorrhaging?

A

<20,000

233
Q

What criteria must be met in order to transfuse platelets?

A
  • Platelet laboratory value <10,000

- Patient is actively bleeding

234
Q

What is the priority nursing intervention for a patient with thrombocytopenia?

A
  • Prevent or control hemorrhage

- Evaluate any bleeding

235
Q

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?

A

Emergency!

236
Q

How do women with thrombocytopenia manage blood loss from menstrual bleeding?

A

Utilize hormone therapy to stop menstrual cycle

237
Q

List nursing management for a patient with thrombocytopenia.

A
  • Avoid IM injections
  • Limit invasive procedures
  • Closely monitor laboratory values
  • Evaluate any bleeding
  • Prevent/control hemorrhage
238
Q

What is disseminated intravascular coagulation (DIC)?

A

Serious bleeding caused by abnormal clotting

239
Q

What is the most common cause of disseminated intravascular coagulation (DIC).

A

Undiagnosed, untreated sepsis

240
Q

Describe clotting laboratory values in a patient with disseminated intravascular coagulation (DIC).

A
  • Prolonged bleeding times

- Low platelet count

241
Q

What type of transfusion will a patient with disseminated intravascular coagulation (DIC) receive?

A
  • Platelets

- Fresh frozen plasma

242
Q

List the signs and symptoms of disseminated intravascular coagulation (DIC).

A
  • Bloody stools
  • Hematuria
  • Hemoptysis
243
Q

Where is bleeding primarily located in a patient with disseminated intravascular coagulation (DIC)?

A
  • Bleeding in every part of body

- Not specific to one location

244
Q

Severe neutropenia is indicated by a value of _____ ____ ___ cells.

A

Less than 500 cells

245
Q

What is the first indicator of infection?

A

Temperature change

246
Q

If temperature is elevated above baseline in a patient with neutropenia, what is the priority nursing intervention?

A

Notify HCP!

247
Q

In a patient with neutropenia, when should antibiotic therapy start after noticing a change in baseline temperature?

A

Within an hour of temperature rise

248
Q

When should a blood culture be obtained in relation to antibiotic therapy?

A

Prior to antibiotic therapy

249
Q

What medication is given in patients with neutropenia to stimulate granulocytes and, ultimately, neutrophil production?

A

Neupogen

250
Q

Describe the administration of Neupogen.

A
  • Self-administered by patient

- IM or Sub-Q

251
Q

If a cancer patient is receiving chemotherapy and becomes neutropenic, is chemotherapy stopped or continued?

A
  • Stopped for neutrophil value <500

- Should resume chemotherapy and begin administering Neupogen

252
Q

What type of education should a nurse provide to a neutropenic patient?

A
  • Hand hygiene
  • Avoid crowds
  • Avoid sick individuals
  • Mask wearing
253
Q

How is leukemia classified? How many different types of leukemia are there?

A
  • Four types

- Classified by type of white blood cell (WBC) involved

254
Q

Describe leukostasis.

A
  • High white blood cell (WBC) count
  • Causes blood to thicken
  • Blocks circulatory pathways
255
Q

What diagnostic test or panel is used to diagnose leukemia?

A

CBC with differential

256
Q

List the types of treatments for leukemia.

A
  • Chemotherapy
  • Radiation
  • Corticosteroids
  • Stem cell transplant
257
Q

What diagnostic tests are used to determine the presence of leukemic cells outside of blood and bone marrow?

A
  • Lumbar puncture

- CT scan

258
Q

Radiation therapy for leukemia may be specific to what areas?

A
  • Bones
  • Spleen
  • Liver
259
Q

What is the goal of a stem cell transplant in a patient with leukemia?

A

Eliminate all leukemic cells

260
Q

What is the goal of a stem cell transplant in a patient with leukemia?

A

Eliminate all leukemic cells

261
Q

What is the difference between Hodgkin’s lymphoma and non-Hodgkins lymphoma? In which type does this appear?

A
  • Presence of Reed-Sternberg cells

- Reed-Sternberg present in Hodgkins lymphoma

262
Q

How is Hodgkins lymphoma diagnosed?

A

Peripheral blood smear

263
Q

Abnormalities in lymphocytes puts the patient at an increased risk for developing what?

A

Infection

264
Q

Individuals with what disease have a higher incidence of being diagnosed with Hodgkin’s lymphoma?

A

HIV

265
Q

How does Hodgkin’s lymphoma spread?

A

Lymphatic pathways

266
Q

Hodgkin’s lymphoma will stay confined to lymph nodes for an extended period of time if it originates where?

A

Above the diaphragm

267
Q

Hodgkin’s lymphoma will spread quickly if it originates where?

A

Below the diaphragm

268
Q

Describe stage one of Hodgkin’s lymphoma.

A

1 node involved

269
Q

Describe stage two of Hodgkin’s lymphoma.

A
  • 2 or more nodes involved

- Only on one side of diaphragm

270
Q

Describe stage three of Hodgkin’s lymphoma.

A

Lymph nodes above and below diaphragm are involved

271
Q

Describe stage four of Hodgkin’s lymphoma.

A

Outside of diaphragm

272
Q

Describe stage four A Hodgkin’s lymphoma.

A
  • Outside of diaphragm

- Asymptomatic

273
Q

Describe stage four B Hodgkin’s lymphoma.

A
  • Outside of diaphragm

- Systemic symptoms present

274
Q

An elevated calcium level in a patient with Hodgkin’s lymphoma indicate what?

A

Bones are involved

275
Q

A person with Hodgkins lymphoma may experience what after consuming a small amount of alcohol?

A

Pain at site of disease

276
Q

List signs and symptoms of Hodgkin’s lymphoma.

A
  • Jaundice
  • Palpable masses in abdomen
  • Impaired renal function
  • Paraplegia
  • Bone pain
277
Q

Hodgkin’s lymphoma is generally _________ unless ______ _______ ___ ______.

A

Hodgkin’s lymphoma is generally painless unless pressure is exerted on nerves.

278
Q

The most common secondary complications of Hodgkins lymphoma include what?

A
  • Lung cancer

- Breast cancer

279
Q

What is the main treatment for Hodgkins lymphoma? Is maintenance treatment necessary?

A
  • Chemotherapy

- No

280
Q

Hodgkins lymphoma may cause which body system(s) to have dysfunction?

A
  • Endocrine
  • Cardiac
  • Pulmonary
281
Q

When may secondary cancers from Hodgkin’s lymphoma appear?

A

Up to 10 years after treatment

282
Q

The nurse should be sensitive when discussing what topic with a patient who has Hodgkins lymphoma?

A

Possible infertility

283
Q

What age range(s) have the highest diagnosis of Hodgkins lymphoma?

A
  • Preteens/teens
  • Early 20’s
  • Childbearing
284
Q

What is hemolysis?

A

Destruction of red blood cells (RBC)

Professional Nursing Concepts I Nursing: N2320 (9 decks)

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