Hematology

Ethan, a nursing student, is reviewing the laboratory results of a patient named Aria. He finds that Aria's hemoglobin is 10 g/dL and the hematocrit is 30%. Ethan recognizes that Aria is at risk for which of the following?

• Prolonged bleeding

• Cellular hypoxia

• Impaired immunity

• Fluid retention

Samuel, a nursing student, is explaining to his friends Rohan and Hannah about aplastic anemia. He is using a real-world example of a person who has been recently diagnosed with aplastic anemia. What information should Samuel include in his explanation?

• He should say that aplastic anemia is associated with a decreased intake of iron.

• He should say that aplastic anemia results in an increased rate of RBC destruction.

• He should say that aplastic anemia results in an inability to absorb vitamin B12.

• He should say that aplastic anemia results from decreased bone marrow production of RBCs.

Answer explanation

INCORRECT

1) Aplastic anemia is associated with a decreased intake of iron.

Answer Rationale:

An inadequate intake of iron can result in iron deficiency anemia rather than aplastic anemia.

INCORRECT

2) Aplastic anemia results in an increased rate of RBC destruction.

Answer Rationale:

Autoimmune hemolytic anemia, rather than aplastic anemia, is associated with an increased rate of RBC destruction.

INCORRECT

3) Aplastic anemia results in an inability to absorb vitamin B12.

Answer Rationale:

Pernicious anemia is seen in clients who lack the intrinsic factor responsible for vitamin B12 absorption.

4) Aplastic anemia results from decreased bone marrow production of RBCs.

Answer Rationale:

Aplastic anemia is a hypoproliferative anemia resulting from decreased production of RBC within the bone marrow.

Nurse Anika is planning care for her patient, William, who has been diagnosed with pernicious anemia. Which of the following interventions should Anika plan to implement for William's care?

• Vitamin B₁₂ injections

• Iron supplements

• Blood transfusions

• Vitamin B₆ supplements

Answer explanation

CORRECT

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1) Vitamin B₁₂ injections

Answer Rationale:

The nurse should administer vitamin B₁₂ injections to treat pernicious anemia when diet fails to improve the anemia due to poor absorption.

INCORRECT

2) Iron supplements

Answer Rationale:

Iron supplements treat iron deficiency anemia, rather than pernicious anemia.

INCORRECT

3) Blood transfusions

Answer Rationale:

Blood transfusions do not resolve pernicious anemia.

INCORRECT

4) Vitamin B₆ supplements

Answer Rationale:

Vitamin B₆ supplements are not used to treat pernicious anemia as failure to absorb vitamin B₁₂ is the cause of the anemia.

Nurse Evelyn is caring for Anika, a young adult female who has been experiencing weakness, fatigue, and heavy menstrual periods. Anika's recent blood tests show a hemoglobin level of 8 g/dL and a hematocrit level of 28 g/dL. Based on these symptoms and results, Nurse Evelyn suspects which of the following types of anemia?

• Folic acid deficiency anemia

• Pernicious anemia

• Iron-deficiency anemia

• Sickle cell anemia

Answer explanation

INCORRECT

1) Folic acid deficiency anemia

Answer Rationale:

The nurse should expect a client who has folic acid deficiency to have pallor and jaundice; a smooth, beefy-red tongue (glossitis); fatigue; and weight loss. This type of anemia is caused by nutritional deficiencies, malabsorption syndromes (Crohn's disease), and medications (e.g., anticonvulsants, oral contraceptives).

INCORRECT

2) Pernicious anemia

Answer Rationale:

A client who has pernicious anemia is unable to absorb vitamin B₁₂ due to a lack of intrinsic factors in the stomach. The nurse should expect this client to have pallor and jaundice; a smooth, beefy-red tongue (glossitis); fatigue; weight loss; and paresthesias to the hands and feet.

3) Iron-deficiency anemia

Answer Rationale:

Iron-deficiency anemia results from poor gastrointestinal absorption of iron, a diet that is deficient in iron, or blood loss. The nurse should expect a client who has iron-deficiency anemia to have weakness, pallor, fatigue, reduced tolerance for activity, and cheilosis (ulcerations of the corners of the mouth).

INCORRECT

4) Sickle cell anemia

Answer Rationale:

Sickle cell anemia is an autosomal recessive disorder in which the RBCs develop a sickle shape following conditions in which decreased oxygen is available. These sickled cells then clump together and become fragile, causing tissue ischemia leading to eventual organ damage. Manifestations of sickle cel anemia include pain, pallor, cyanosis, dyspnea, fatigue, and weakness.

Nurse Abigail is caring for a child named Kai, who is currently experiencing a sickle cell crisis. Which of the following symptoms should Abigail expect to observe in Kai?

• High fever

• Bradycardia

• Pain

• Constipation

Answer explanation

INCORRECT

1) High fever

Answer Rationale:

A low grade fever is a manifestation of sickle cell crisis.

INCORRECT

2) Bradycardia

Answer Rationale:

Tachycardia is more common with sickle cell anemia than bradycardia.

3) Pain

Answer Rationale:

A client who is in sickle cell crisis has severe pain resulting from tissue hypoxia and necrosis.

INCORRECT

4) Constipation

Answer Rationale:

Sickle cell crisis generally affects the lungs and the liver, rather than the gastrointestinal tract.

Henry's younger sister, Olivia, has been diagnosed with sickle cell anemia and recently had an acute crisis episode. As a nurse, Evelyn is discharging Olivia and instructing Henry on how to care for her at home. Which of the following instructions should Evelyn include in her teaching to Henry?

• "Monitor Olivia's temperature daily."

• "Restrict Olivia's outdoor play activity to 1 hour per day."

• "Offer fluids to Olivia multiple times every day."

• "Apply cold compresses when Olivia expresses pain."

Answer explanation

INCORRECT

1) "Monitor your child's temperature daily."

Answer Rationale:

The parents need to check the child's temperature only when they suspect fever, and when they do, they should report it to the provider immediately. Fever is a manifestation of acute chest syndrome, a complication of sickle cell anemia.

INCORRECT

2) "Restrict outdoor play activity to 1 hour per day."

Answer Rationale:

The nurse should instruct the parent to restrict the child from playing contact sports.

3) "Offer fluids to your child multiple times every day."

Answer Rationale:

Preventing dehydration is an important step in preventing a sickle cell crisis. The nurse should provide the parents with a specific fluid goal for the child to reach each day.

INCORRECT

4) "Apply cold compresses when your child expresses pain."

Answer Rationale:

Heat applications can be soothing but cold compresses should be avoided because they cause vasoconstriction.

Nurse Mia is planning care for Benjamin, a patient who has leukemia and a platelet count of 130,000/mm³. Benjamin's sister, Lily, is concerned about his health. Which of the following interventions should Mia include in the plan of care to reassure Lily?

• Check Benjamin's IV site for bleeding every 8 hr.

• Limit Benjamin's IM injections.

• Obtain a rectal temperature for Benjamin every 8 hr.

• Check Benjamin for proteinuria.

Answer explanation

INCORRECT

1) Check the IV site for bleeding every 8 hr.

Answer Rationale:

The nurse should check the client's IV site for bleeding every 4 hr.

2) Limit IM injections.

Answer Rationale:

The nurse should plan to limit IM injections or venipunctures to prevent harm to the client. If venipuncture is necessary, the nurse should hold pressure to the site for 10 min afterward.

INCORRECT

3) Obtain a rectal temperature every 8 hr.

Answer Rationale:

The nurse should avoid procedures which could traumatize the rectal tissues and cause bleeding.

INCORRECT

4) Check the client for proteinuria.

Answer Rationale:

The nurse should check the client's urine and stool for blood.

Nurse Grace is assigned to care for Daniel, a patient diagnosed with autoimmune or idiopathic thrombocytopenic purpura (ITP). Daniel's friend, Anika, is reviewing his plan of care prior to visiting him. Anika should recognize that the priority concern in caring for Daniel is to monitor for

• side effects of immunosuppressants.

• constipation.

• fatigue.

• bleeding

Answer explanation

INCORRECT

1) side effects of immunosuppressants.

Answer Rationale:

Idiopathic thrombocytopenic purpura is an autoimmune disorder in which the platelets are destroyed by antibodies the client has developed. Treatment of this condition involves administration of medications to suppress the client’s immune function. While the nurse should monitor the client for side effects related to immunosuppressants, another assessment is the priority.

INCORRECT

2) constipation.

Answer Rationale:

The client who has ITP is at increased risk for bleeding and should be discouraged from straining when constipated or when passing stool. While the nurse should monitor the client for constipation, another assessment is the priority.

INCORRECT

3) fatigue.

Answer Rationale:

The client who has ITP develops fatigue that is not associated with the administration of the immunosuppressant therapy. While the nurse should monitor the client for fatigue, another assessment is the priority.

4) bleeding.

Answer Rationale:

Thrombocytopenia refers to a decreased platelet count, which puts the client at risk for bleeding. In ITP, the immune system destroys healthy platelets, thinking they are foreign bodies. Using the airway, breathing, circulation (ABC) priority-setting framework is the priority concern for the nurse when providing care for this client.

During a school health checkup, Nurse Jackson is explaining to students Mia and David about the manifestations of hemophilia A, as they both have a family history of the disorder. What should Nurse Jackson include in her explanation?

• Frequent rapid bleeding

• Tendency to bruise minimally

• Immediate clotting from a minor cut

• Disabling joint pain

Answer explanation

INCORRECT

1) Frequent rapid bleeding

Answer Rationale:

A client who has hemophilia A does not bleed more frequently or rapidly than a client who does not have a clotting disorder. However, a cut or trauma can cause the client to have prolonged, excessive bleeding due to a deficiency of factor VIII.

INCORRECT

2) Tendency to bruise minimally

Answer Rationale:

A client who has hemophilia A has increased bruising due to a deficiency of factor VIII.

INCORRECT

3) Immediate clotting from a minor cut

Answer Rationale:

A client who has hemophilia A has prolonged clotting due to a deficiency of factor VIII.

4) Disabling joint pain

Answer Rationale:

A client who has hemophilia A can have disabling joint pain over time, especially of the knee and hip, because of hemorrhage into the joints.

Nurse Harper is assessing a patient, Aiden, who has been diagnosed with disseminated intravascular coagulation (DIC). Emma, a medical student observing the case, asks Harper about the expected findings in Aiden's condition. Which of the following should Harper tell Emma to expect?

• Excessive thrombosis and bleeding

• Progressive increase in platelet production

• Immediate sodium and fluid retention

• Increased clotting factors

Answer explanation

CORRECT
1) Excessive thrombosis and bleeding

Answer Rationale:

The nurse should expect excessive thrombosis and bleeding of mucous membranes because both DIC impairs both coagulation and anticoagulation pathways.

INCORRECT

2) Progressive increase in platelet production

Answer Rationale:

The nurse should expect a decrease, rather than an increase, in the client's platelet count because of the increased platelet consumption involved in the rapid formation of multiple clots.

INCORRECT

3) Immediate sodium and fluid retention

Answer Rationale:

Changes in sodium and fluid retention are not findings associated with DIC. The capillary leak and hemorrhage caused by DIC results in fluid loss or hypovolemia.

INCORRECT

4) Increased clotting factors

Answer Rationale:

The nurse should expect a decrease, rather than an increase, because the formation of multiple small clots consumes clotting factors and fibrinogen faster than the body can produce them,