Ch. 37- Concepts of Care for Paitents with Hematologic Problems

A nurse caring for a client with sickle cell disease (SCD) reviews the client’s laboratory test results. Which finding would the nurse

report to the primary health care provider?

• Creatinine: 2.9 mg/dL (256 mcmol/L)

• Hematocrit: 30%

• Sodium: 146 mEq/L (146 mmol/L)

• White blood cell count: 12,000/mm3 (12 × 109/L)

Answer explanation

An elevated creatinine indicates kidney damage, which occurs in SCD. A hematocrit level of 30% is an expected finding, as is a

slightly elevated white blood cell count due to chronic inflammation. A sodium level of 146 mEq/L (146 mmol/L), although

slightly high, is not concerning.

The nurse is assessing a client in sickle cell disease (SCD) crisis. What priority client problem will the nurse expect?

• Infection

• Pallor

• Pain

• Fatigue

Answer explanation

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.

A client in sickle cell crisis is dehydrated and in the emergency department. The nurse plans to start an IV. Which fluid choice is

best?

• 0.45% normal saline

• 0.9% normal saline

• Dextrose 50% (D50)

• Lactated Ringer’s solution

Answer explanation

Because clients in sickle cell crisis are often dehydrated, the fluid of choice is a hypotonic solution such as 0.45% normal saline.

0.9% normal saline and lactated Ringer’s solution are isotonic. D50 is hypertonic and not used for hydration.

A client presents to the emergency department in sickle cell disease crisis. What intervention by the nurse takes priority?

• Administer oxygen.

• Initiate pulse oximetry.

• Give pain medication.

• Start an IV line.

Answer explanation

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.

A client hospitalized with sickle cell disease crisis frequently asks for opioid pain medications, often shortly after receiving a dose.

The nurses on the unit believe that the client is drug seeking. When the client requests pain medication, what action by the nurse is

best?

• Give the client pain medication if it is time for another dose.

• Instruct the client not to request pain medication too early.

• Request the primary health care provider leave a prescription for a placebo.

• Tell the client that it is too early to have more pain medication.

Answer explanation

Clients with sickle cell crisis often have severe pain that is managed with up to 48 hours of IV opioid analgesics. Even if the client

is addicted and drug seeking, he or she is still in extreme pain. If the client can receive another dose of medication, the nurse would

provide it. The other options are judgmental and do not address the client’s pain. Giving a placebo is unethical.

The nurse is caring for a client experiencing sickle cell disease crisis. Which priority action would help prevent infection?

• Administering prophylactic antibiotics

• Monitoring the client’s temperature

• Checking the client’s white blood cell count

• Performing frequent handwashing

Answer explanation

Frequent and thorough handwashing is the most important intervention that helps prevent infection. Antibiotics are not usually used

to prevent infection. Monitoring the client’s temperature or white blood cell count helps to detect the presence of infection, but

prevent it.

A nurse in a hematology clinic is working with four clients who have polycythemia vera. Which client would the nurse assess first?

• Client with a blood pressure of 180/98 mm Hg

• Client who reports shortness of breath

• Client who reports calf tenderness and swelling

• Client with a swollen and painful left great toe

Answer explanation

Clients with polycythemia vera often have clotting abnormalities due to the hyperviscous blood with sluggish flow. The client

reporting shortness of breath may have a pulmonary embolism and should be seen first. The client with a swollen calf may have a

deep vein thrombosis and should be seen next. High blood pressure and gout symptoms are common findings with this disorder.

The nurse is teaching a client who has pernicious anemia about necessary dietary changes. Which statement by the client indicates

understanding about those changes?

• “I’ll increase animal proteins like fish and meat.”

• “I’ll work on increasing my fats and carbohydrates.”

• “I’ll avoid eating green leafy vegetables.

• “I’ll limit my intake of citrus fruits.”

Answer explanation

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.

An assistive personnel is caring for a client with leukemia and asks why the client is still at risk for infection when the white blood

cell count (WBC) is high. What response by the nurse is correct?

• “If the WBCs are high, there already is an infection present.”

• “The client is in a blast crisis and has too many WBCs.”

• “There must be a mistake; the WBCs should be very low.”

• “Those WBCs are abnormal and don’t provide protection.”

Answer explanation

In leukemia, the WBCs are abnormal and do not provide protection to the client against infection. The other statements are not

accurate.

The family of a neutropenic client reports that the client “is not acting right.” What action by the nurse is the priority?

• Ask the client about pain.

• Assess the client for infection.

• Take a set of vital signs.

• Review today’s laboratory results.

Answer explanation

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.