Week 2; Acute Care of Hematologic Alterations

Question 1

Congenital heart disease primarily includes anatomic abnormalities present at birth. Two broad categories include:

Answer 1

Heart failure and hypoxemia

Question 2

Assessment of a child; heart rates for 1-3 y/o

Answer 2

80-120

Question 3

Assessment of a child; heart rates for 2-9 y/o

Answer 3

70-115

Question 4

Assessment of a child; heart rates for 9-14 y/o

Answer 4

65-109

Question 5

Assessment of a pediatric patient

Answer 5

HR higher, RR higher

Question 6

Failure to thrive or poor weight gain in a child is associated with

Answer 6

Heart disease, chest deformities, or enlarged heart.

Question 7

Cardiac cath has been become a routine dx and therapeutic procedure, especially in

Answer 7

neonates and children

Question 8

Teaching when caring for pediatric patients with HF

Answer 8

Important to teach developmental stage of patient, check families knowledge of illness-defining characteristics, understands definition of HF, states four characteristics, describes meds, expresses fears and concerns, shows appropriate rxn to illness

Question 9

Perfusion

Answer 9

Total arterial blood flow through the tissues (peripheral perfusion) and blood that is pumped by the heart (central perfusion)

Question 10

Perfusion

Answer 10

Total arterial blood flow through the tissues (peripheral perfusion) and blood that is pumped by the heart (central perfusion)

Question 11

Clotting

Answer 11

Complex, multi-step process by which blood forms a protein-based structure (clot)

Question 12

Bone marrow –

Answer 12

Produces RBC, WBC, and platelets. Also involved in immune response

Question 13

Blood components

Answer 13

Plasma proteins, RBC, white blood cells, platelets

Question 14

Plasma proteins include

Answer 14

albumin, globulins, fibrinogen

Question 15

Red blood cells (erythrocytes) –

Answer 15

Carry oxygen and carbon dioxide

Question 16

Accessory organs of blood formation

Answer 16

spleen and liver

Question 17

Leukocytes r/t inflammation

Answer 17

Neutrophils, macrophages, monocytes, eosinophils, basophils

Question 18

Intrinsic factors

Answer 18

Conditions such as circulating debris or venous stains within the blood itself that can activate platelets and trigger the clotting cascade

Question 19

Extrinsic factors

Answer 19

Trauma, inflammation, toxins, or foreign proteins

Question 20

Hematologic changes associated with aging

Answer 20

Decreased blood volume with lower levels of plasma proteins, bone marrow produces fewer blood cells, lower WBC count, lymphocytes have less rxn to antigens, loss of immune fxn, hemoglobin levels fall after middle-age

Question 21

Fibrinolysis

Answer 21

Process that dissolves the clot

Question 22

Hematologic assessment

Answer 22

•Age
•Gender
• Liver fxn
• Drug use (PRESCRIBED, OTC, ILLICIT)
• Dietary patterns
• Socioeconomic status
• Previous radiation therapy
• Occupation, hobbies
• Location of home
• Use of blood thinners, NSAIDS
• Nutrition status
• Family hx
• Current health problems

Question 23

Hematologic physical assessment

Answer 23

• SKIN – color, jaundice, bruising, petechiae,
turgor, itching
• Head and neck – pallor, palpate lymph nodes, oral mucosa ulceration
• Cardiovascular – JVD, edema, phlebitis, BP (lower w anemia)
• Kidney and urinary - Hematauria
• Musculoskeletal – ROM, pain
• ABD– distended, enlarged liver or spleen
• CNS– B12 deficiency causes nerve degeneration, parasthesia

Question 24

BP is lower with what condition?

Answer 24

Anemia

Question 25

B12 deficiency causes

Answer 25

nerve degeneration, parasthesia

Question 26

Hematology dx assessments

Answer 26

• PERIPHERAL BLOOD SMEAR
• CBC
• RETICULOCYTE COUNT – BONE MARROW FUNCTION
• PLATELET COUNT – NORMAL 150,00 TO 400,000
• HEMOGLOBIN ELECTROPHORESIS – DETECTS ABNORMAL
FORMS OF HEMOGLOBIN
• COOMBS’ TESTS (DIRECT AND INDIRECT) – BLOOD TYPING
• SERUM FERRITIN, TRANSFERRIN, AND TOTAL IRON BINDING
CAPACITY (TIBC)

Question 27

Platelet count range

Answer 27

150,00 TO 400,000

Question 28

Lab tests measuring bleeding and coagulation

Answer 28

Prothrombin time (PT), INR, PTT, anti-factor XA test, platelet aggregation

Question 29

INR

Answer 29

An INR (international normalized ratio) is a type of calculation based on PT test results. Prothrombin is a protein made by the liver. Range 2-3

Question 30

Hematologic imaging assessment

Answer 30

Radioisotopic imagine, standard x-ray

Question 31

Bone marrow aspiration and biopsy is used when

Answer 31

When other tests show abnormal findings that indicate a possible problem in blood cell production

Question 32

Bone marrow aspiration is usually done in

Answer 32

Iliac crest with a large bore needle, also can be done in sternum

Question 33

Bone marrow aspiration; prepping the patient

Answer 33

Explain steps and procedure, as this causes anxiety, educate pt

Question 34

Follow up care of bone marrow aspiration–

Answer 34

Apply pressure dressing, observe for 24 hrs for signs of bleeding, mild analgesic (NO ASPRIN), apply ice, inspect q 2 hrs, light activity for 48 hrs

Question 35

UPON ASSESSMENT, THE NURSE NOTICES THAT A PATIENT
HAS BLEEDING GUMS. THE PATIENT REPORTS INCREASED
FATIGUE, MALAISE, AND “CHILLS.” WHAT IS THE PRIORITY
NURSING INTERVENTION?
A. DOCUMENT ASSESSMENT FINDINGS.
B. NOTIFY THE HEALTH CARE PROVIDER OF THE
PATIENT’S SYMPTOMS.
C. OBTAIN VITAL SIGNS AND ADMINISTER ANTIPYRETIC
MEDICATIONS.
D. REVIEW LABORATORY ANALYSIS FOR SIGNS AND
SYMPTOMS OF BONE MARROW SUPPRESSION.

Answer 35

ANSWER D
• THE NURSE SHOULD INITIALLY REVIEW THE PATIENT’S
LABORATORY ANALYSIS FOR COLLECTIVE SIGNS OF
PANCYTOPENIA RELATED TO THE PATIENT’S REPORT AND
ASSESSMENT FINDINGS OF FATIGUE (ANEMIA), BLEEDING
GUMS (THROMBOCYTOPENIA), AND CHILLS
(NEUTROPENIA).
• LABORATORY DATA ARE NEEDED BEFORE INFORMING
THE HEATH CARE PROVIDER AND DECIDING WHETHER TO
ADMINISTER AN ANTIBIOTIC.
• OBTAINING BLOOD CULTURES PRIOR TO ANTIBIOTIC
ADMINISTRATION IS AN IMPORTANT INTERVENTION.
ANTIPYRETIC MEDICATIONS MAY BE PRESCRIBED TO
TREAT THE PATIENT’S SYMPTOMS (“CHILLS”).

Question 36

A PATIENT IS TRANSITIONING FROM IV HEPARIN THERAPY
TO ORAL WARFARIN. WHICH LABORATORY FINDING DOES
THE NURSE IDENTIFY THAT CONFIRMS WARFARIN
TREATMENT EFFICACY?

A. BLEEDING TIME OF 5 MINUTES
B. PROTHROMBIN TIME (PT) OF 18 SECONDS
C. INTERNATIONAL NORMALIZED RATIO (INR) OF 2.5
D. PARTIAL THROMBOPLASTIN TIME (PTT) OF 24.3
SECONDS

Answer 36

ANSWER C
• INR IS A MORE ACCURATE MEASURE OF
ANTICOAGULATION THERAPY BECAUSE OF VARIATIONS IN
PT VALUES ACROSS DIFFERENT LABORATORIES.
• THE GOAL OF WARFARIN THERAPY IS USUALLY TO
MAINTAIN THE PATIENT’S INR BETWEEN 2.0 AND 3.0
REGARDLESS OF THE ACTUAL PT IN SECONDS.

Question 37

WHAT IS THE MOST IMPORTANT PRECAUTION FOR THE
NURSE TO TEACH A CLIENT WHOSE PLATELET COUNTS
USUALLY RANGE BETWEEN 50,000 TO 60,000/MM3?
• A. DRINK AT LEAST 3 LITERS OF FLUIDS PER DAY
• B. TAKE A MULTIPLE VITAMIN THAT CONTAINS IRON
• C. AVOID ASPIRIN AND ASPIRIN-CONTAINING DRUGS
• D. INCREASE INTAKE OF DARK GREEN, LEAFY
VEGETABLES

Answer 37

ANSWER C
• AVOID ASPIRIN CONTAINING SUBSTANCES WHICH WILL
FURTHER AFFECT CLOTTING PARTICULARLY IN A PATIENT
WITH AN ALREADY LOW PLATELET COUNT

Question 38

What is the antidote for warfarin?

Answer 38

Vitamin K

Question 39

Antidote for heparin

Answer 39

protamine sulphate (PS)

Question 40

Sickle cell disease

Answer 40

Genetic hemoglobin disorder that causes RBC to be sickle shaped, rather than a round biconcave cell

Question 41

Sickle cell disease results in

Answer 41

• Chronic anemia
• Pain
• Disability
• Organ damage
• Increased risk for infxn
• Early death d/t poor perfusion
• Formation of abnormal hemoglobin chains
• Periodic episodes of sickle cell crisis

Question 42

Sickle cell disease is most common in

Answer 42

African Americans in US

Question 43

Sickle cell disease assessment: noticing

Answer 43

PAIN IS THE MOST COMMON SCD SYMPTOM
• CARDIOVASCULAR CHANGES
• RESPIRATORY CHANGES
• SKIN CHANGES
• ABDOMINAL CHANGES
• KIDNEY AND URINARY CHANGES
• MUSCULOSKELETAL CHANGES
• CENTRAL NERVOUS SYSTEM CHANGES

Question 44

Priority problems for pt with SCD

Answer 44

Pain d/t poor tissue oxygenation and joint destruction and potential for infxn, sepsis, multi-organ dysfunction and death

Question 45

Nursing interventions when caring for patient with SCD

Answer 45

Oxygen, pain meds, fluids, remove constrictive clothing, do not raise knee position of bed, elevate HOB no more than 30 degrees to decrease pressure on diaphragm, keep room at or above 72 degrees (warmth is soothing and cold promotes sickling), avoid taking BP with external cuff, check extremity circulating Q hr

Question 46

Check circulation by:

Answer 46

Pulse ox, cap refill, peripheral pulses, toe temp

Question 47

Planning and implementation for SCD

Answer 47

• MANAGE OXYGEN AND PAIN
• PREVENT SEPSIS
• CONTINUAL ASSESSMENT
• PREVENTION AND EARLY DETECTION STRATEGY
• DRUG THERAPY
• CARE COORDINATION AND TRANSITION MANAGEMENT

Question 48

Pain meds

Answer 48

• ONCE IV PAIN MEDS HAVE CAUSED RELIEF, PATIENT CAN GO
BACK TO ORAL PAIN MEDS.
• CONCERNS ABOUT SUBSTANCE ABUSE CAN LEAD TO
INADEQUATE PAIN TREATMENT IN THESE PATIENTS. OPIOID
ADDICTION IS RARE IN PATIENTS WITH SCD
• PATIENTS LABELED “DRUG SEEKING”
• BE AWARE OF YOUR OWN ATTITUDES.
• THIS IS A VERY PAINFUL DISEASE. ADDICTED PATIENTS IN
ACUTE PAIN CRISIS STILL NEED OPIOIDS.

Question 49

Hydroxyurea

Answer 49

SCD treatment, reduces sickling and pain episodes. Increases risk for leukemia, is teratogenic, and suppresses bone marrow fxn, including immunity.

Question 50

Preventing a sickle cell crisis

Answer 50

• DRINK 3-4 LITERS WATER EVERY DAY
• AVOID ALCOHOL
• AVOID CIGARETTES
• CONTACT PCP AT FIRST SIGN OF INFECTION
• FLU SHOT ANNUALLY
• AVOID EXTREME TEMPERATURES
• AVID PLANES WITH UNPRESSURIZED CABINS
• AVOID TRAVEL TO HIGH ALTITUDES
• AVOID STRENUOUS ACTIVITIES, ENGAGE IN LOW IMPACT
EXERCISE WHEN NOT IN CRISIS

Question 51

Anemia

Answer 51

Reduction of RBC, hemoglobin, or hematocrit. It is a clinical indicator of abnormal conditions, not a specific disease.

Question 52

Common causes of anemia

Answer 52

SCD, glucose 6-phosphate dehydrogenase, iron deficiency, vitamin b 12 deficiency, folic acid deficiency

Question 53

Polycythemia vera

Answer 53

Chronic disorder characterized by excessive production of RBC’s. As volume increases, blood viscosity and HGB concentration increases causing excessive workload on heart and congestion of organs. Poses risk for hemorrhage, stroke, HF, MI

Question 54

Polycythemia interventions

Answer 54

• PAIN MEDS
• HYDRATION
• PHLEBOTOMY TO MAINTAIN HEMATOCRIT OF LESS THAN
42% IN WOMEN AND 45% IN MEN
• ANTICOAGULANTS OR LOW DOSE ASPIRIN

Question 55

Lukemia

Answer 55

CANCER THAT RESULTS FROM A LOSS OF
NORMAL CELLULAR REGULATION LEADING TO
UNCONTROLLED PRODUCTION OF IMMATURE WBCS
(“BLAST” CELLS) IN THE BONE MARROW.

Question 56

Lukemia dx

Answer 56

Exam of cells obtained from bone marrow aspiration and biopsy.

Question 57

Priority problems for pts with acute myelogenous leukemia (AML)

Answer 57

Potential for infxn, possible injury d/t poor clotting from thrombocytopenia from chemo, fatigue d/t decreased gas exchange and increased energy demands.

Question 58

Most common type of leukemia in adults

Answer 58

ACUTE MYELOGENOUS LEUKEMIA (AML)

Question 59

Lukemia; infection prevention

Answer 59

Drug therapy, induction therapy, consolidation therapy, maintenance therapy, hematopoietic stem cell transplantation, minimize injury

Question 60

Care coordination for the patient with leukemia

Answer 60

HOME CARE MANAGEMENT
• INFUSION NURSES – TEACHING!
• SELF-MANAGEMENT EDUCATION
• PSYCHOSOCIAL PREPARATION
• HEALTH CARE RESOURCES – ONCOLOGISTS, ONCOLOGY
NURSES, SOCIAL WORKERS, PHYSICAL OR
OCCUPATIONAL THERAPISTS, SUPPORT GROUPS

Question 61

Malignant lymphomas include

Answer 61

• HODGKIN’S LYMPHOMA
• NON-HODGKIN’S LYMPHOMA

Question 62

Signs and sx of lymphoma

Answer 62

• LARGE BUT PAINLESS LYMPH NODE OR NODES
• FEVERS
• NIGHT SWEATS
• UNPLANNED WEIGHT LOSS
• MANY PATIENTS HAVE NO SYMPTOMS AT TIME OF
DIAGNOSIS

Question 63

Lymphoma treatment

Answer 63

•RADIATION OR CHEMO OR COMBO
• TEACHING ABOUT EFFECTS OF RADIATION AND/OR
CHEMO
• SYMPTOM MANAGEMENT AND LIFESTYLE MODIFICATIONS
• SPERM DONATION FOR YOUNG MALES

Question 64

What is one of the most treatable cancers?

Answer 64

HODGKIN’S LYMPHOMA

Question 65

Multiple myeloma

Answer 65

Cancer of WBC. B-lymphocyte called a plasma cell secretes antibodies, which are overgrown in bone marrow. Excessive antibodies are produced (gamma globulins) as well as excessive cytokines that destroy bone.

Question 66

Multiple myeloma risk factors

Answer 66

EXPOSURE TO RADIATION, TOXINS

Question 67

Multiple myeloma s/s

Answer 67

MANY TIMES NO SYMPTOMS WHEN DIAGNOSED
• FIRST SIGNS: FATIGUE, BRUISING, BONE PAIN

Question 68

Multiple myeloma dx

Answer 68

ELEVATED SERUM TOTAL PROTEIN OR DETECTION OF A
MONOCLONAL PROTEIN IN THE BLOOD OR URINE

Question 69

Multiple myeloma treatment

Answer 69

CHEMO, STEM CELL TRANSPLANT

Question 70

Multiple myeloma nursing implications

Answer 70

ASSESSMENT, TEACHING, PAIN
MANAGEMENT

Question 71

Thrombocytopenia

Answer 71

Low platelets, coagulation disorder

Question 72

Autoimmune thrombocytopenia purpura

Answer 72

Autoimmune disease with unknown trigger; clotting disorder

Question 73

THROMBOTIC THROMBOCYTOPENIA PURPURA

Answer 73

PLATELETS CLUMP TOGETHER N THE CAPILLARIES AND TOO FEW REMAIN IN
CIRCULATION, BLOOD FAILS TO CLOT WHEN TRAUMA OCCURS

Question 74

Management of coagulation disorders

Answer 74

PREVENTING CLUMPING AND STOPPING AUTOIMMUNE RESPONSE, ADMINISTERING FROZEN PLASMA TO REDUCE CLUMPING, ASPIRIN, IMMUNOSUPPRESSIVE

Question 75

Hemophilia

Answer 75

CLOTTING FACTOR DEFICIENCIES

Question 76

HEPARIN-INDUCED THROMBOCYTOPENIA (HIT)

Answer 76

• EXCESSIVE BLEEDING FROM MINOR CUTS, BRUISES OR
ABRASIONS, JOINT AND MUSCLE HEMORRHAGES
• MANAGED BY INFUSIONS OF SYNTHETIC FACTOR VIII
• HIT MANAGED BY A DIRECT THROMBIN INHIBITOR

Question 77

Disseminating intravascular clotting

Answer 77

DISRUPTION OF HEMOSTASIS CHARACTERIZED BY
WIDESPREAD INTRAVASCULAR CLOTTING AND BLEEDING. TRAUMATIC INJURY OR CAUSATIVE AGENT STARTS THE
CASCADE.

Question 78

DIC s/s

Answer 78

•TACHYCARDIA, HYPOTENSION, CIRCULATORY COLLAPSE
• TACHYPNEA
• ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)
• OLIGURIA, ANURIA
• GI BLEEDING
• BRUISING, CYANOSIS

Question 79

DIC treatment

Answer 79

TREATMENT IS GEARED TOWARD UNDERLYING CAUSE
• IF BLEEDING IS MAJOR MANIFESTATION – FRESH FROZEN
PLASMA OR PLATELETS TO RESTORE CLOTTING FACTORS.
HEPARIN MAY BE ADMINISTERED BUT IS CONTROVERSIAL
BECAUSE IT DISRUPTS CLOTTING BUT MAY BE NECESSARY IF
CLOTTING IS A MAIN CONCERN. PATIENTS WITH CHRONIC DIC
MAY BE PUT ON LONG TERM HEPARIN.
• FLUIDS, I&O
• MONITOR RESPIRATOR STATUS, O2 OR OTHER RESPIRATORY
SUPPORT
• NEURO ASSESSMENTS
• MONITOR OUTPUT, MAINTAIN CATHETER
• MONITOR FOR OCCULT BLOOD
• MEASURE ABDOMINAL GIRTH
• MONITOR SKILLS FOR EVIDENCE OF BLEEDING

Question 80

RBC TRANSFUSIONS—

Answer 80

GIVEN TO REPLACE CELLS LOST FROM TRAUMA OR SURGERY

Question 81

PLATELET TRANSFUSIONS—

Answer 81

GIVEN FOR LOW PLATELET COUNTS, ACTIVE BLEEDING, SCHEDULED FOR INVASIVE
PROCEDURE

Question 82

PLASMA TRANSFUSIONS—

Answer 82

GIVEN TO REPLACE BLOOD VOLUME AND CLOTTING FACTORS

Question 83

GRANULOCYTE (WBC) TRANSFUSIONS—

Answer 83

GIVEN (RARELY)
TO NEUTROPENIC PATIENTS

Question 84

UNIVERSAL DONOR IS TYPE __

Answer 84

O

Question 85

UNIVERSAL RECIPIENT IS TYPE __

Answer 85

AB

Question 86

Pre-transfusion therapy care

Answer 86

• VERIFY PRESCRIPTION WITH ANOTHER RN
• TEST DONOR’S/RECIPIENT’S BLOOD FOR COMPATIBILITY
(TYPE AND CROSS MATCH)
• VERIFY PATIENT’S IDENTITY WITH ANOTHER RN
• EXAMINE BLOOD BAG LABEL, ATTACHED TAG, AND
REQUISITION SLIP FOR ABO AND RH COMPATIBILITY WITH
THE PATIENT WITH ANOTHER RN
• CHECK EXPIRATION DATE WITH ANOTHER RN
• INSPECT BLOOD FOR DISCOLORATION, GAS BUBBLES,
CLOUDINESS

Question 87

During transfusion care

Answer 87

• PROVIDE PATIENT EDUCATION
• ASSESS VITAL SIGNS IMMEDIATELY BEFORE STARTING
INFUSION
• BEGIN TRANSFUSION SLOWLY, STAY WITH PATIENT FIRST 15
TO 30 MINUTES
• ASK PATIENT TO REPORT UNUSUAL SENSATIONS (FOR
EXAMPLE, CHILLS, SHORTNESS OF BREATH, HIVES, ITCHING)
• ADMINISTER BLOOD PRODUCT PER PROTOCOL
• ASSESS FOR HYPERKALEMIA
• BLOOD MUST BE STARTED WITHIN 30 MIN OF ARRIVAL FROM
BLOOD BANK AND COMPLETED WITHIN 4 HOURS. **CHECK
FACILITY POLICY

Question 88

Transfusion reactions

Answer 88

•FEBRILE
•HEMOLYTIC
•ALLERGIC
•BACTERIAL
•CIRCULATORY OVERLOAD
•TRANSFUSION-ASSOCIATED GRAFT-VERSUS-HOST
DISEASE (GVHD) – CAN OCCUR SEVERAL WEEKS LATER
• THE EARLIER A TRANSFUSION REACTION OCCURS, THE
MORE SEVERE IT TENDS TO BE. PROMPT IDENTIFICATION
MINIMIZES CONSEQUENCES.

Question 89

Care for a patient experiencing an infusion reaction

Answer 89

STOP TRANSFUSION, REMOVE BLOOD TUBING
• INFUSE NORMAL SALINE KVO – DO NOT FLUSH BLOOD TUBING!
• SAVE TUBING AND BLOOD – THIS WILL BE RETURNED TO BLOOD
BANK
• OXYGEN
• CONTACT MD WITH ASSESSMENT, CALL RAPID ACCESS TEAM IF
MODERATE TO SEVERE
• ANTIHISTAMINE – BENADRYL
• ANTIPYRETIC - ACETAMINOPHEN
• CORTICOSTEROIDS
• MEPERIDINE FOR RIGORS

Question 90

A 27-YEAR-OLD FEMALE WITH A HISTORY OF SICKLE CELL DISEASE
(SCD) COMES TO THE ED WITH ABDOMINAL PAIN THAT IS RATED AS A
“9” ON A 0-TO-10 SCALE. PHYSICAL ASSESSMENT SHOWS THAT SHE IS
GRIMACING AND GUARDING HER ABDOMEN AND HAS A FEVER OF 103º
F, A PALE YELLOW HARD PALATE, AND SEVERAL VERY SMALL ULCERS
ON HER LOWER EXTREMITIES.
WHAT IS THE PRIORITY PROBLEM THAT THE NURSE MUST
IMMEDIATELY ADDRESS?
A. ACUTE PAIN
B. HYPERTHERMIA
C. POTENTIAL FOR INFECTION
D. DECREASED TISSUE PERFUSION

Answer 90

ANS: A
THE PATIENT’S PAIN MUST BE CONTROLLED FIRST AND
FOREMOST. ALL OTHER PROBLEMS CAN BE ADDRESSED
AFTER THE ACUTE PAIN IS MANAGED.

Question 91

THIRTY MINUTES LATER, THE PATIENT IS DIAGNOSED
WITH ACUTE SICKLE CELL CRISIS. SHE CONTINUES TO
HAVE PAIN.
WHICH DRUGS DOES THE NURSE ANTICIPATE WOULD
BE PRESCRIBED FOR PAIN CONTROL AT THIS TIME?
(SELECT ALL THAT APPLY.)
A. MEPERIDINE IV PUSH PRN
B. ACETAMINOPHEN ORALLY OR RECTALLY
C. HYDROMORPHONE IV PUSH SCHEDULED DOSES
D. MORPHINE SULFATE IV PUSH SCHEDULED DOSES
E. MORPHINE SULFATE SR ORALLY OR IM SCHEDULED DOSES

Answer 91

ANSWER: C, D
A PATIENT IN SICKLE CELL CRISIS OFTEN STARTS WITH AT
LEAST 48 HOURS OF IV ANALGESIA. MORPHINE AND
HYDROMORPHONE (DILAUDID) ARE GIVEN IV ON A REGULAR
SCHEDULE, OR USING A PATIENT-CONTROLLED ANALGESIA
(PCA) PUMP.
ONCE RELIEF IS OBTAINED, THE IV DOSE CAN BE TAPERED
AND ORAL DRUGS MAY BE GIVEN. PRN DOSAGES SHOULD
BE AVOIDED BECAUSE THEY DO NOT PROVIDE ADEQUATE
PAIN RELIEF. IM INJECTIONS SHOULD BE AVOIDED BECAUSE
ABSORPTION IS IMPAIRED BY POOR PERFUSION AND
SCLEROSED SKIN.

Question 92

QUESTION 1
WHAT IS THE PRIORITY NURSING INTERVENTION
IN THE CARE OF AN OLDER PATIENT WITH A
HISTORY OF DIVERTICULAR DISEASE AND
PERNICIOUS ANEMIA?
A. PREVENTING FALLS
B. MONITORING INTAKE AND OUTPUT
C. TURNING THE PATIENT EVERY 2 HOURS
D. ENCOURAGING A DIET HIGH IN VITAMIN B12

Answer 92

ANSWER A
THE PATIENT WILL HAVE DIFFICULTY ABSORBING VITAMIN
B12 BECAUSE OF HIS OR HER DIVERTICULAR DISEASE AND
MAY HAVE DEVELOPED PARESTHESIA IN THE FEET,
INCREASING THE RISK FOR FALLS.
ANEMIA MAY ALSO INCREASE THE PATIENT’S SYMPTOM OF
WEAKNESS, THEREBY INCREASING FALL RISK. PREVENTING
FALLS IS A PRIORITY INTERVENTION IN THE CARE OF
OLDER PATIENTS.

Question 93

QUESTION 2
A PATIENT WITH POLYCYTHEMIA VERA IS
ADMITTED WITH REPORTS OF SHORTNESS OF
BREATH, HYPERTENSION, AND LOSS OF PULSES
IN HER RIGHT FOOT. WHICH IS THE PRIORITY
NURSING INTERVENTION?
A. ASSESS CURRENT HYDRATION STATUS
B. ADMINISTER PAIN MEDICATION
C. ELEVATE HER LOWER EXTREMITIES ON PILLOWS
D. EVALUATE THE PATIENT FOR HYPERTENSIVE CRISIS

Answer 93

ANSWER: A
POLYCYTHEMIA VERA, A FORM OF MALIGNANT RBC
HYPERPRODUCTION AND CLOTTING FACTOR DYSFUNCTION,
REQUIRES EVALUATION OF INTRAVASCULAR HYDRATION,
PREPARATION OF LABORATORY TESTS FOR POSSIBLE
THERAPEUTIC PHLEBOTOMY, AND ANTICOAGULANT THERAPY TO
DECREASE CLOTS.
PATIENTS WITH THIS DISEASE ARE AT RISK OF HYPERTENSION
AND EXPERIENCE POOR TISSUE OXYGENATION AS WELL,
REQUIRING ASSESSMENT. RAISING LOWER EXTREMITIES MAY
ASSIST WITH PERFUSION AND SYMPTOMS BUT WOULD NOT BE A
PRIORITY IN THIS SCENARIO.

Question 94

Sickle cell crisis: Vaso-occlusion (thrombotic)

Answer 94

Most common type of crisis. It may last for days or weeks.
Precipitated by dehydration, exposure to cold, acidosis, or localized hypoxia.
Caused by stasis of blood with clumping of cells in the microcirculation, ischemia, and infarction.
Thrombosis and infarction of local tissue may occur if the crisis is not reversed.
Cerebral occlusion can result in stroke, manifested by paralysis or other central nervous system complications. Extremely painful; symptoms include fever, tissue engorgement, painful swelling of joints in hands and feet, priapism, and severe abdominal pain.

Question 95

Sickle cell crisis: splenic sequestration

Answer 95

Life-threatening crisis; death can occur within hours. Caused by pooling of blood in the spleen; because the spleen can hold much of the body’s blood supply, cardiovascular collapse can result. It is most commonly seen in children and adolescents and may be seen in young adults.
Clinical manifestations include profound anemia, hypovolemia, and shock.

Question 96

Sickle cell crisis: aplastic crisis

Answer 96

Aplastic crisis is caused by diminished production and increased destruction of RBCs.
Often triggered by human parvovirus B19 viral infection.
Signs include profound anemia, pallor, and fatigue.

Question 97

Sickle cell crisis: acute chest syndrome

Answer 97

Acute chest syndrome is a common cause of hospitalization for patients with SCD.
Associated with a pediatric mortality rate of 2% and an adult mortality rate of 4%.
Pulmonary infiltrate of abnormal blood cells leads to lower respiratory tract symptoms.
Clinical manifestations include fever, cough, chest and back pain, dyspnea, and hypoxemia.
Pulmonary infection, infarction, and fat embolism may occur and can lead to pulmonary failure and death.

Question 98

SCD therapies

Answer 98

Bone marrow or hematopoietic stem cell transplantation, blood transfusion is the most common treatment, splenectomy, oxygenation, hydration, and analgesic administration, hydroxyurea
For children between 2 months and 5 years of age who are diagnosed with SCD, treatment often includes daily administration of prophylactic penicillin

Question 98

SCD therapies

Answer 98

Bone marrow or hematopoietic stem cell transplantation, blood transfusion is the most common treatment,

Question 99

Conditions That May Precipitate Disseminated Intravascular Coagulation Tissue Damage:
Trauma, such as:

Answer 99

burns, gunshot wounds, frostbite, head injury.

Question 100

Conditions That May Precipitate Disseminated Intravascular Coagulation Tissue Damage:
Obstetric complications:

Answer 100

septic abortion, abruptio placentae, amniotic fluid embolus, retained dead fetus

Question 101

Conditions That May Precipitate Disseminated Intravascular Coagulation Tissue Damage:
Neoplasms:

Answer 101

acute leukemia, adenocarcinomas, hemolysis, fat embolism

Question 102

Conditions That May Precipitate Disseminated Intravascular Coagulation Tissue Damage:
Vessel Damage;

Answer 102

Aortic aneurysm, acute glomerulonephritis, hemolytic uremic syndrome

Question 103

Conditions That May Precipitate Disseminated Intravascular Coagulation Tissue Damage:
Infections;

Answer 103

bacterial infection or sepsis, viral or mycotic infections, malaria