UNIT 1 CHAPTER 37 HEMATOLOGIC DISEASES, ANEMIA, IRON DEFIENCY ETC..

Question 1

What is Anemia?

Answer 1

decrease in red blood cells, hemoglobin, and hematocrit

Affects gas exchange and perfusion(low oxygenation in the body due to low hemoglobin)

Varies from MILD(ASYMPONMATIC) to LIFE-THREATENING(SYMPTOMATIC)

Question 2

What is Sickle Cell Anemia

Answer 2

Care of the Patient in Sickle Cell Crisis
* Administer oxygen.
* Administer prescribed pain medication.
* Hydrate the patient with normal saline IV and with beverages of choice (without caffeine) orally.

Care of the Patient in Sickle Cell Crisis
* Administer oxygen.
* Administer prescribed pain medication.
* Hydrate the patient with normal saline IV and with beverages of choice (without caffeine) orally.
* Remove any constrictive clothing.
* Encourage the patient to keep extremities extended to promote venous return.
* Do not raise the knee position of the bed.
* Elevate the head of the bed no more than 30 degrees.
* Keep room temperature at or above 72°F (22.2°C).
* Avoid taking blood pressure with a standard or automatic external arm cuff.
* Check circulation in extremities every hour:
* Pulse oximetry of fingers and toes * Peripheral pulses
* Capillary refill

Question 3

What is Iron Deficiency Anemia

Answer 3

It is a decreased iron supply that results from blood loss, poor GI absorption of iron, and an inadequate diet

Question 4

What is Pernicious Anemia

Answer 4

Pernicious anemia Anemia resulting from failure to absorb vitamin B12, caused by a deficiency of intrinsic factor (a substance normally secreted by the gastric mucosa), which is needed for intestinal absorption of vitamin B12.

Pernicious anemia is a type of autoimmune disorder. All
autoimmune problems may have a genetic predisposition and may be present in other family members.

Question 5

What is Vitamin B12 Anemia

Answer 5

Causes of vitamin B12 (also known as cobalamin) deficiency include
vegan diets or other diets lacking proteins, small bowel resection, chronic diarrhea, diverticula, tapeworm, or overgrowth of intestinal bacteria. Anemia resulting from failure to absorb vitamin B12 (pernicious anemia)
is caused by a deficiency of intrinsic factor (a substance normally secreted by the gastric mucosa), which is needed for intestinal absorption of vitamin B12.

Specific symptoms include pallor and jaundice, glossitis (a smooth, beefy-red tongue) (Fig. 37.2), fatigue, and weight loss. Patients may also have paresthesias (abnormal nerve sensations) in the feet and hands and poor balance because vitamin B12 helps maintain nerve
function.

Question 6

What is Folic Acid Anemia

Question 7

Which of the following can be a cause of the Sickel Cell Crisis? Select All that Apply
A. Loose clothing
B. Passive Range of motion
C. cold weather
D. high altitudes
E. Hypoxia
F. Dehydration
G. Relaxing excersice
H. SCD USE

Answer 7

C. cold weather
D. high altitudes
E. Hypoxia
F. Dehydration
H. SCD USE

Question 8

What is hypoxia, and what can it cause? Hint.. first letter of the word starts with an (A)

Answer 8

decreased oxygen levels in the tissues

causes
anemia

Question 9

What Patient is at Risk to become Vitamin B-12 Deficient?
A. Patient Who has just gone through a Gastrectomy
B. Patient who has just gotten a knee replacememt
C. Patient who was admitted for shortness of breathe
D. A patient who suffers from insomnia

Answer 9

A. Patient Who has just gone through a Gastrectomy

LOSS OF INTRINSIC FACTOR

Question 10

1. A 43-year-old African American male is admitted with sickle cell anemia. The nurse plans to assess circulation in the lower extremities every two hours. Which of the following outcome criteria would the nurse use?
   A. Body temperature of 99°F or less
   B. Toes moved in active range of motion
   C. Sensation reported when soles of feet are touched
   D. Capillary refill of < 3 seconds

Answer 10

D. Capillary refill of < 3 seconds

Question 11

2. A 30-year-old male from Haiti is brought to the emergency department in sickle cell crisis. What is the best position for this client?
   A. Side-lying with knees flexed
   B. Knee-chest
   C. High Fowler’s with knees flexed
   D. Semi-Fowler’s with legs extended on the bed

Answer 11

D. Semi-Fowler’s with legs extended on the bed

FLEXING JOINTS AND MUSCLES CAUSES VASOCONSTRICTION- INCREASES RISK FOR SICKLE CELL CRISIS

Question 12

3. A 25-year-old male is admitted in sickle cell crisis. Which of the following interventions would be of highest priority for this client?
   A. Taking hourly blood pressures with mechanical cuff
   B. Encouraging fluid intake of at least 200mL per hour
   C. Position in high Fowler’s with knee gatch raised
   D. Administering Tylenol as ordered

Answer 12

B. Encouraging fluid intake of at least 200mL per hour

Question 13

6. The nurse is instructing a client with iron-deficiency anemia.
   Which of the following meal plans would the nurse expect the client to select?
   A. Roast beef, gelatin salad, green beans, and peach pie
   B. Chicken salad sandwich, coleslaw, French fries, ice
   cream
   C. Egg salad on wheat bread, carrot sticks, lettuce salad, raisin pie
   D. Pork chop, creamed potatoes, corn, and coconut cake

Answer 13

C. Egg salad on wheat bread, carrot sticks, lettuce salad, raisin pie

IRON RICH FOODS
Dietary consult
Encourage – Iron rich foods such as
organ meats, red meat, egg yolks,
cereals, green leafy vegetables,
kidney beans, and raisin

Question 14

7. Clients with sickle cell anemia are taught to avoid activities that cause hypoxia and hypoxemia. Which of the following activities would the nurse recommend?
   A. A family vacation in the Rocky Mountains
   B. Chaperoning the local boys club on a snow-skiing trip
   C. Traveling by airplane for business trips
   D. A bus trip to the Museum of Natural History

Answer 14

D. A bus trip to the Museum of Natural History

Question 15

8. The nurse is conducting an admission assessment of a client with vitamin B12 deficiency. Which finding reinforces the diagnosis of
   B12 deficiency?
   A. Enlarged spleen
   B. Elevated blood pressure
   C. Pica
   D. smooth, beefy-red tongue

Answer 15

D. Beefy tongue

Question 16

10. The nurse is conducting a physical assessment on a client with anemia. Which of the following clinical manifestations would be most indicative of the anemia?
    A. BP 146/88
    B. Respirations 28 shallow
    C. Weight gain of 10 pounds in six months
    D. Pink complexion

Answer 16

B. Respirations 28 shallow

Question 17

With which types of anemia does the nurse ask the client about the presence of the disorder in other family members? Select all that apply.
A. Sickle cell anemia
B. Folic acid deficiency anemia
C. Glucose-6-phosphate dehydrogenase deficiency anemia
D. Iron deficiency anemia
E. Pernicious anemia
F. Vitamin B12 deficiency anemia

Answer 17

A. Sickle cell anemia
C. Glucose-6-phosphate dehydrogenase deficiency
E. Pernicious anemia

Question 18

A client returning to the clinic 7 weeks after hematopoietic stem cell transplantation for leukemia has a total white blood cell (WBC) count of
5200/mm3 (5.2 × 109/L) and a neutrophil count of 3000/mm3 (3 × 109/L). What is the nurse’s priority action in view of these values?
A. Notify the oncology health care provider immediately.
B. Assess the client for other symptoms of infection.
C. Document the laboratory report as the only action.
D. Obtain a urine specimen, sputum specimen, and chest x-ray.

Answer 18

C. Document the laboratory report as the only action.

KNOW YOUR RANGES FOR WBC

Question 19

The family of a client receiving a blood transfusion report with distress to the nurse that although the blood bag hanging has the client’s name on it,the bag label says B negative and the client’s blood type is B positive. What is the nurse’s priority action?
A. Alert the blood bank and Rapid Response Team about a potential error.
B. Thank the family for being alert and preventing a serious complication.
C. Explain that a person who is Rh positive can receive Rh negative blood.
D. Immediately go and stop the infusion but keep the IV line open with normal saline.

Answer 19

C. Explain that a person who is Rh positive can receive Rh negative blood.

+ types blood can recieve - and + blood types

Question 20

2. Which intervention is a priority for the nurse to teach the client with polycythemia vera to prevent harm related to injury as a result of impaired platelet function?
   A. Wear gloves and socks outdoors in cool weather.
   B. Elevate your feet whenever you are seated.
   C. Drink at least 3 L of liquids per day.
   D. Use a soft-bristle toothbrush.

Answer 20

D. Use a soft-bristle toothbrush.

Question 21

2. The nurse is assessing a client in sickle cell disease (SCD) crisis. What priority client problem will the nurse expect?
   a. Infection
   b. Pallor
   c. Pain
   d. Fatigue

Answer 21

ANS: C
The priority expected client problem for clients experiencing sickle cell disease crisis is pain, often concentrated in the legs, arms, and joints. Clients may also be fatigued and pale but these symptoms are not a priority for care. Infection is not expected but can occur in clients who have SCD crisis.

Question 22

4. A client presents to the emergency department in sickle cell disease crisis. What intervention by the nurse takes priority?
   a. Administer oxygen.
   b. Initiate pulse oximetry.
   c. Give pain medication.
   d. Start an IV line.

Answer 22

ANS: A
All actions are appropriate, but remembering the ABCs, oxygen would come first. The main problem in a sickle cell crisis is tissue and organ hypoxia, so providing oxygen helps halt the process.

Question 23

8. The nurse is teaching a client who has pernicious anemia about necessary dietary changes. Which statement by the client indicates understanding about those changes?
   a. increase animal proteins like fish and meat.
   b. work on increasing my fats and carbohydrates.
   c. avoid eating green leafy vegetables.
   d. limit my intake of citrus fruits.

Answer 23

ANS: A
Clients who have pernicious anemia have a Vitamin B12 deficiency and need to consume foods high in Vitamin B12, such as animal and plant proteins, citrus fruits, green leafy vegetables, and dairy products. While carbohydrates and fats can provide sources of energy, they do not supply the necessary nutrient to improve anemia.

Question 24

10. The family of a neutropenic client reports that the client is not acting right. What action by the nurse is the priority?
    a. Ask the client about pain.
    b. Assess the client for infection.
    c. Take a set of vital signs.
    d. Review today’s laboratory results.

Answer 24

b. Assess the client for infection.

Neutropenic clients often do not have classic manifestations of infection, but infection is the most common cause of death in neutropenic clients. The nurse would definitely assess for infection. The nurse would assess for pain but this is not the priority.

Question 25

Types of Blood Products and their Use
Blood Product Use
Fresh Frozen Plasma (FFP) Replace clotting factors and blood volume

Packed red blood cells Replace RBC, usually from trauma or surgery

Platelet transfusions Replace platelets, usually for active bleeding and/or scheduled invasive procedures

WBC transfusions Can be given to neutropenic clients (this is rare)

Answer 25

Types of Blood Products and their Use
Blood Product Use
Fresh Frozen Plasma (FFP) Replace clotting factors and blood volume

Packed red blood cells Replace RBC, usually from trauma or surgery

Platelet transfusions Replace platelets, usually for active bleeding and/or scheduled invasive procedures

WBC transfusions Can be given to neutropenic clients (this is rare)