Question 1

A patient is diagnosed with anemia and asks the nurse what nutrients are important for red blood cell (RBC) formation. The nurse bases an answer on the understanding that which of the following nutrients are essential for production of healthy red cells?

Accepted Answer

Iron is a key component of hemoglobin, the protein in RBCs that carries oxygen. Folic acid and vitamin B12 are necessary for the production of DNA in new RBCs. Without these nutrients, RBCs are unable to mature and function properly, leading to anemia. Vitamin C can also aid in the absorption of iron from the diet. While vitamins A, D, E, and minerals like calcium and phosphorus are important for overall health, they do not play as direct a role in RBC formation as iron, folic acid, and vitamin B12. Selenium and aluminum are not necessary for RBC production.

Question 2

A patient with thrombocytopenia is having pain. If each of the following medications is ordered, which should the nurse choose to administer?

Accepted Answer

Acetaminophen with codeine has a lower risk of causing bleeding complications compared to the other medications listed, making it the safest option for a patient with thrombocytopenia. Meperidine and morphine can cause histamine release and increase bleeding risk, while oxycodone with aspirin contains aspirin which is a platelet inhibitor and is contraindicated in patients with thrombocytopenia.

Question 3

A patient with iron-deficiency anemia was placed on oral iron therapy. Which of the following tests would the nurse review to determine the effectiveness of this intervention?

Accepted Answer

Hemoglobin and hematocrit are the best choices to determine the effectiveness of oral iron therapy for iron-deficiency anemia, as they are direct measures of the patient's red blood cell count and oxygen-carrying capacity. Electrolytes, BUN, creatinine, TCT, PT, WBC, and platelet counts are not typically used to monitor anemia or iron therapy.

Question 4

A patient is admitted in sickle cell crisis with symptoms of dyspnea and leg pain. The patient's significant other asks, "I don't really understand why he is hurting so badly." Which of the following responses by the nurse is best?

Accepted Answer

Pain during sickle cell crisis is caused by clumping of abnormal red blood cells, leading to obstruction of blood flow through capillaries. This leads to tissue ischemia and pain. The other options are not accurate explanations for the pain during sickle cell crisis.

Question 5

Which nursing intervention is most likely to cause acute complications in a patient with disseminated intravascular coagulation?

Accepted Answer

Administering intramuscular meperidine (Demerol) for pain can worsen coagulation abnormalities and increase the risk of bleeding in patients with disseminated intravascular coagulation. Strict bedrest may be necessary to prevent further injury or bleeding, and a diet high in fat and sodium may be inappropriate for other health reasons but would not likely cause acute complications in this patient. Allowing a family member with a respiratory infection to visit may increase the patient's risk of infection but is not directly related to acute complications of disseminated intravascular coagulation.

Question 6

The nurse is preparing to give an injection of iron (Imferon) to a patient with anemia. What is the rationale for using the Z-track method for injection?

Accepted Answer

The Z-track method is used to prevent discoloration of the tissue at the injection site, which can occur with iron injections.

Question 7

Which nursing diagnosis is most common in a patient with anemia?

Accepted Answer

Activity intolerance related to tissue hypoxia is the most common nursing diagnosis in a patient with anemia. Anemia is a condition in which the body lacks sufficient healthy red blood cells to carry oxygen to the body's tissues, resulting in tissue hypoxia. This can lead to fatigue, weakness, and shortness of breath, limiting the patient's ability to perform daily activities.

Question 8

A patient is admitted to the hospital with hypertension and vertigo related to polycythemia vera. For which of the following treatments should the nurse prepare the patient?

Accepted Answer

Therapeutic phlebotomy is the treatment of choice for polycythemia vera, as it reduces the number of red blood cells and helps to alleviate the symptoms of hypertension and vertigo. Injection of colony-stimulating factors may be used in certain cases of polycythemia vera, but it is not typically the first-line treatment. Splenectomy and myelogram are not indicated for this condition.

Question 9

A patient with aplastic anemia is to receive an injection of erythropoietin (Epogen). The patient asks what the injection is intended to do. Which of the following responses by the nurse is best?

Accepted Answer

Erythropoietin (Epogen) is a hormone that stimulates the production of red blood cells by the bone marrow. This will help to counteract the anemia caused by aplastic anemia, which is characterized by decreased production of all three blood cell types (red blood cells, white blood cells, and platelets). Option A is incorrect because erythropoietin does not work like a blood transfusion, which directly provides red blood cells to the patient. Option B is incorrect because aplastic anemia is not caused by a protein attacking the patient's blood cells. Option D is incorrect because erythropoietin does not directly provide energy to the patient; it helps to increase the oxygen-carrying capacity of the blood so that the patient can feel less tired and fatigued.

Question 10

Which laboratory study does the nurse monitor to help evaluate the effectiveness of treatment for polycythemia vera (PV)?

Accepted Answer

Hematocrit is a measurement of the percentage of red blood cells in the blood. In individuals with PV, the hematocrit is typically elevated due to an overproduction of red blood cells. Monitoring the hematocrit can help evaluate the effectiveness of treatment, as a decrease in hematocrit indicates a decrease in red blood cell production.

Question 11

Which of the following manifestations might first alert the nurse to the possibility of disseminated intravascular coagulation?

Accepted Answer

Petechiae are a classic sign of disseminated intravascular coagulation (DIC) because it is a condition in which clotting factors are consumed leading to bleeding as well as small clots throughout the body. Weakness or paralysis on one side or absence of pulses in extremities are not specific to DIC. Increasing blood pressure and pulse may occur with many conditions and are not specific to DIC.

Question 12

The nurse is caring for a patient with a bleeding disorder. Which of the following medication orders should the nurse question?

Accepted Answer

Aspirin is an antiplatelet medication and can increase the risk of bleeding in a patient with a bleeding disorder. The nurse should question this medication order and discuss with the healthcare provider about alternatives or adjusting the dose. Digoxin, thyroid hormone, and morphine are not contraindicated in patients with bleeding disorders.

Question 13

The nurse is caring for a patient with thrombocytopenia. Which activity should be avoided?

Accepted Answer

Intramuscular injections can cause trauma and bleeding, which can be dangerous for a patient with thrombocytopenia. Visits from family members, eating fresh fruits and vegetables, and ambulation may pose some risk but are generally safe activities as long as the patient is monitored carefully.

Question 14

Which of the following individuals is most likely to present with signs or symptoms of sickle cell anemia?

Accepted Answer

Sickle cell anemia is most common in individuals of African descent. Therefore, a 1-year-old boy who is African American is the most likely to present with signs or symptoms of sickle cell anemia.

Question 15

Which blood component is deficient in a patient with anemia?

Accepted Answer

Anemia is a condition in which the body lacks sufficient healthy red blood cells or hemoglobin. Therefore, a patient with anemia will have a deficiency of red blood cells.

Question 16

Which nursing intervention best helps prevent complications in a patient with polycythemia?

Accepted Answer

Encouraging 3 L of water intake daily helps prevent complications by diluting the blood and reducing the risk of blood clots. Monitoring intake and output is also important, but it does not address the underlying issue of high red blood cell count. Avoiding injections for pain and maintaining bedrest are not necessarily indicated interventions for polycythemia.

Question 17

The nurse is caring for a patient with a clotting disorder. Which of the following blood products would the nurse anticipate being ordered?

Accepted Answer

Cryoprecipitates contain clotting factors and fibrinogen which can be used to treat clotting disorders. Normal saline, albumin, and packed white blood cells do not contain the necessary components to treat a clotting disorder.

Question 18

The nurse is providing dietary teaching to an individual with iron-deficiency anemia. Which of the following statements, if made by the patient, indicates that teaching has been effective?

Accepted Answer

Orange juice contains vitamin C, which can enhance the absorption of iron from plant-based sources. Red meat is a good source of heme iron, which is more easily absorbed than non-heme iron found in plant-based sources.

Question 19

The nurse is teaching a patient with sickle cell anemia how to prevent crises. Which foods should the nurse teach the patient to avoid?

Accepted Answer

Alcoholic beverages should be avoided as they can lead to dehydration, which can trigger a sickle cell crisis.

Question 20

What is the rationale for providing warm compresses and blankets for a patient with sickle cell crisis?

Accepted Answer

Warm compresses and blankets help to prevent vasoconstriction and impaired circulation by promoting vasodilation and increasing blood flow to affected areas. This can help to alleviate pain and reduce the risk of tissue damage. Additionally, warm temperatures may help to improve the elasticity of sickled cells, reducing the likelihood of further sickling and potential complications. However, it is important to note that other interventions such as hydration, pain management, and oxygen therapy may also be necessary in the management of sickle cell crisis.

Quiz 28: Nursing Care of Patients With Hematologic and Lymphatic Disorders