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Lewis Chapter 30: Hematologic Problems Study Guide

Terms in this set (24)

A patient with a hemoglobin (Hgb) level of 7.8 g/dL (78 g/L) has cardiac palpitations, a heart rate of 102 bpm, and an increased reticulocyte count. Considering the severity of anemia, what other manifestation would the nurse expect the patient to exhibit?

A. Pallor
B. Dyspnea
C. A smooth tongue
D. Sensitivity to cold
B. Dyspnea
A 76 year-old woman has an Hgb of 7.3 g/dL and is experiencing ataxia, confusion, weakness, and fatigue upon admission to the hospital. What is the priority nursing intervention for this patient?

A. Provide a quiet, darkened room
B. Have the family stay with the patient
C. Keep top bedside rails up and the call bell in close reach
D. Question the patient about possible causes of anemia
C. Keep top bedside rails up and the call bell in close reach
During the physical assessment of the patient with severe anemia, which finding is of the most concern to the nurse?

A. Anorexia
B. Bone pain
C. Hepatomegaly
D. Dyspnea at rest
d. Dyspnea at rest
Which anemia is manifested with pancytopenia?

A. Thalassemia
B. Aplastic anemia
C. Megaloblastic anemia
D. Anemia of chronic disease
b. Aplastic anemia
Which descriptions are characteristics of iron-deficiency anemia? (Select all that apply.)

A. Lack of intrinsic factor
B. Autoimmune-related disorder
C. Most common type of anemia
D. Associated with chronic blood loss
E. May occur with removal of the stomach
F. May occur with removal of the duodenum
C,D,F
A 20-yea-old female patient is in the emergency department for anorexia and fatigue. She takes phenytoin (Dilantin) for a seizure disorder and oral contraceptives. For which type of anemia is she most at risk for?

A. Aplastic anemia
B. Hemolytic anemia
C. Iron-deficiency anemia
D. Folic acid deficiency anemia
D
When teaching the patient about a new prescription for oral iron supplements, what does the nurse teach the patient to do?

A. Increase fluid and dietary fiber intake
B. Take the iron preparations with meals
C. Use enteric-coated preparations taken with orange juice
D. Report the presence of black stools to the HCP
A
In teaching the patient with pernicious anemia about the disease, the nurse explains that it results from a lack of

A. Folic acid
B. Intrinsic factor
C. Extrinsic factor
D. Cobalamin intake
b. intrinsic factor
During the assessment of a patient with cobalamin deficiency, what manifestation would the nurse expect to find in the patient?

A. Icteric sclera
B. Hepatomegaly
C. Paresthesia of the hands and feet
D. Intermittent heartburn with acid reflux
c. Paresthesia of the hands and feet
The nurse determines that teaching about pernicious anemia has been effective when the patient says,

A. '"This condition can kill me unless I take injections of the vitamin for the rest of my life."
B. "My symptoms can be completely reversed after I take cobalamin (vitamin B12) supplement."
C. "If my anemia does not respond to cobalamin therapy, my only other alternative is bone marrow transplant."
D. "The least expensive and most convenient treatment of pernicious anemia is to use a diet with foods high in cobalamin."
A
The strict vegetarian is at highest risk for the development of which anemia?

A. Thalassemia
B. Iron-deficiency anemia
C. Folic acid deficiency anemia
D. Cobalamin deficiency anemia
d. Cobalamin deficiency anemia
A patient with aplastic anemia has impaired oral mucous membranes. This problem can be related to the effects of what deficiencies? (Select all that apply)

A. RBCs
B. Ferritin
C. Platelets
D. Coagulation factor VIII
E. White blood cells (WBCs)
a, c, e
Nursing interventions for the patient with aplastic anemia are directed toward the prevention of which complications?

A. Fatigue and dyspnea
B. Hemorrhage and infection
C. Thromboemboli and gangrene
D. Cardiac dysrhythmias and heart failure
b. Hemorrhage and infection
Which statements describe anemia related to blood loss?

A. A major concern is prevention of shock
B. This anemia is most frequently treated with increased dietary iron intake
C. In addition to the general symptoms of anemia, this patient also manifests jaundice
D. A patient who has acute blood loss may have postural hypotension and increased heart rate
E. Initial clinical symptoms are the most reliable way to evaluate the effect and degree of blood loss
A,D,E
What causes the anemia of sickle cell disease?

A. Intracellular hemolysis of sickled RBC
B. Accelerated breakdown of abnormal RBCs
C. Autoimmune antibody destruction of RBCs
D. Isoimmune antibody-antigen reactions with RBCs
B. Accelerated breakdown of abnormal RBCs
A patient with sickle cell anemia asks the nurse why the sickling crisis does not stop when oxygen therapy is started. Which explanation should the nurse give to the patient?

A. Sickling occurs in response to decreased blood viscosity, which is not affected by oxygen therapy
B. When RBCs sickle, they occlude small vessels, which causes more local hypoxia and more sickling
C. The primary problem during a sickle cell crisis is destruction of abnormal cells, resulting in fewer RBCs to carry oxygen
D. Oxygen therapy does not alter the shape of the abnormal erythrocytes but only allows for increased oxygen concentration in hemoglobin
B
What is a nursing intervention that is indicated for the patient during a sickle cell crisis?

A. Frequent ambulation
B. Application of anti embolism hose
C. Restriction of sodium and oral fluids
D. Administration of large doses of continuous opioid analgesics
D
During discharge teaching of a patient with newly diagnosed sickle cell disease, what should the nurse teach the patient to do?

A. Limit fluid intake
B. Avoid humid weather
C. Eliminate exercise from lifestyle
D. Seek early medical intervention for upper respiratory infections
d. Seek early medical intervention for upper respiratory infections
A 45-year-old patient has symptoms including arthralgia, impotence, weight loss, and liver enlargement. His laboratory results included elevated serum iron, total iron binding capacity (TIBC), and serum ferritin levels. Which disorder does this describe and which treatment will be used?

A. Thalassemia; combination chemotherapy
B. Hemochromatosis; deferoxamine (Desferal)
C. Myelodysplastic syndrome; blood transfusions
D. Delayed transfusion reaction; deferasirox (Exjade)
B
A patient has a WBC count of 2300/μL and a neutrophil percentage of 40%. Answer the following questions.

a. Does the patient have leukopenia?
b. What is the patient's neutrophil count?
c. Does the patient have neutropenia?
d. Is the patient at risk for developing a bacterial infection? If so, why?
A. Yes, as the WBC count is below 4000
B. 23000 x 40% = 920
C. Yes, as the ANC is < 1000
D. Yes, because normal body processes for fighting infection are impaired
What is the most important method to identify the presence of infection in a neutropenic patient?

A. Frequent temperature monitoring
B. Routine blood and sputum cultures
C. Assessing for redness and swelling
D. Monitoring WBC count
A. Frequent temperature monitoring
What is a major method of preventing infection in the patient with neutropenia?

A. Prophylactic antibiotics
B. A diet that eliminates fresh fruit and vegetables
C. High efficiency particulate air (HEPA) filtration
D. Strict hand washing by all persons in contact with the patient
D
What is the underlying cause of lymphadenopathy, Splenomegaly, and hepatomegaly in leukemia?

A. The development of infection at these sites
B. Increased compensatory production of blood cells by these organs
C. Infiltration of the organs by increased numbers of WBCs in the blood
D. Normal Hypertrophy of the organs in an attempt to destroy abnormal cells
c. Infiltration of the organs by increased numbers of WBCs in the blood
A patient with AML is considering a hematopoietic stem cell transplant and asks the nurse what is involved. What is the best response the nurse can give the patient?

A. "Your bone marrow is destroyed by radiation, and new bone marrow cells from a matched donor are injected into your bones."
B. "A specimen of your bone marrow may be aspirated and treated to destroy any leukemic cells and then reinfused when your disease becomes worse."
C. "Leukemic cells and bone marrow stem cells are eliminated with chemotherapy and/or total-body radiation, and new bone marrow cells from a donor are infused."
D. "During chemotherapy and/or total-body irradiation to destroy all of your blood cells, you may be given transfusions of RBCs and platelets to prevent complications."
C
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