Deck 56: Caring for the Patient With Blood Disorders

Question 1

A patient is suspected of having iron deficiency anemia (IDA). Which laboratory value would the nurse evaluate as supporting this diagnosis?

A) High levels of ferritin
B) Low levels of serum transferrin
C) Increased total iron binding capacity (TIBC)
D) High hematocrit level

Answer 1

Increased total iron binding capacity (TIBC)

Question 2

A patient has been diagnosed with disseminated intravascular coagulation (DIC). The patient's condition has not improved after administration of fresh frozen plasma and platelets. Which therapy does the nurse anticipate?

A) Administration of heparin
B) Rapid infusion of intravenous normal saline
C) Bone marrow transplant
D) Surgical removal of the spleen

Answer 2

Administration of heparin

Question 3

The nurse preparing to provide care to a patient with thrombocytopenia would review the administration instructions for which category of medications?

A) Vitamin supplements
B) Erythropoietic agents
C) Immune-suppressive medications
D) Parenteral iron supplementation

Answer 3

Immune-suppressive medications

Question 4

A patient has been admitted for treatment of hemolytic anemia. Which assessment findings would the nurse immediately discuss with the health care provider?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Decreased amounts of very dark urine
B) Jaundice
C) Bradycardia
D) Liver palpated below the right costal margin
E) Itching

Question 5

A patient with anemia of chronic disease is prescribed erythropoietin (Epogen) 50 units per kilogram three times a week. The patient weighs 188 pounds. The home health nurse would be certain that at least _____ units of Epogen are available for this week's doses.

Question 6

The nurse is providing discharge instructions to a patient who has a clotting disorder. Which instructions should the nurse reinforce?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Brush teeth only once per day.
B) Avoid drinking carbonated beverages.
C) Monitor skin condition.
D) Shave with an electric razor.
E) Assess the color of stools with each bowel movement.

Question 7

A patient is being discharged after treatment for thrombocytopenia. Which topics should the nurse consider when developing discharge instructions?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Ensuring safety in the home environment
B) Recognizing the signs of cutaneous bleeding
C) Alerting the community pharmacist about the patient's condition
D) Reducing alcohol consumption and increasing thiazide medications
E) Developing a plan for physical exercise

Question 8

Which nursing intervention is appropriate for the patient diagnosed with heparin-induced thrombocytopenia who has the nursing diagnosis of Risk for Bleeding?

A) Avoid invasive procedures, such as rectal temperatures, urinary catheterizations, and parenteral injections.
B) Hold pressure on laboratory testing venipuncture sites for at least 15 mintues.
C) Give enemas to avoid straining during bowel movements.
D) Encourage frequent independent ambulation.

Question 9

A middle-aged female is experiencing numbness and tingling in her lower extremities as well as difficulty ambulating. The patient's recent complete blood count indicates large, oval-shaped red blood cells with thin membranes. Which therapy would the nurse anticipate discussing in the discharge plan?

A) A diet high in green, leafy vegetables, broccoli, wheat germ, and asparagus
B) A daily multivitamin with extra iron
C) Subcutaneous injections of erythropoietin for a few weeks
D) Lifelong intramuscular parenteral injections of vitamin B₁₂

Question 10

A patient has been hospitalized with hemophilia. Nursing management of this patient's care will include which interventions?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Administration of replacement factors
B) Providing education to the patient and family
C) Achieving a cure for the disorder
D) Managing pain
E) Environmental control of risk

Question 11

A patient is admitted with thrombocytopenia. Which assessment findings would the nurse expect?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Increased platelet count
B) Rashlike discoloration of the skin
C) Mucosal bleeding
D) Positive fecal occult test
E) A tendency to bleed after any invasive procedure

Question 12

A patient is admitted with a diagnosis of sickle-cell crisis. The nurse assesses a temperature of 102° F, O₂ saturation of 89%, and complaints of severe abdominal pain. Which prescription should the nurse implement first?

A) Give Tylenol (acetaminophen) 650 mg for elevated temperature.
B) Apply oxygen per nasal cannula at 3L/minute.
C) Administer morphine sulfate 4 mg IV.
D) Assess and document peripheral pulses.

Question 13

A child has been admitted with assessment findings suggestive of hemophilia. Which laboratory test would the nurse evaluate as supporting that diagnosis?

A) Decreased red blood cell count on CBC
B) Prolonged partial thromboplastin time (aPTT)
C) Decreased factor VI
D) A positive d-dimer

Question 14

A patient has been taking oral iron supplementation for one week. The nurse would evaluate this treatment as effective if laboratory results indicate an increase in which blood component?

A) Basophils
B) Eosinophils
C) Reticulocytes
D) Platelets

Question 15

A patient is admitted with immune thrombocytopenia purpura (ITP). How would the nurse explain the etiology of this disorder?

A) "You are producing antibodies against your own platelets."
B) "This is a disorder caused by an overproduction of neutrophils."
C) "You are having a reaction to heparin therapy."
D) "This disorder is caused by an overproduction of reticulocytes."

Question 16

After several doses of chemotherapy, a patient complains of fatigue, pallor, progressive weakness, exertional dyspnea, headache, and tachycardia. Which NANDA nursing diagnosis would the nurse list as the first priority?

A) Imbalanced Nutrition: Less than Body Requirements
B) Activity Intolerance
C) Powerlessness
D) Ineffective Coping

Question 17

A patient is admitted with a diagnosis of generalized anemia. The nurse would conduct assessment for which types of associated disorders?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Disorders that cause defective oxygenation in the lungs
B) Disorders that result in disruption in erythrocyte volume
C) Disorders that include airway obstruction as a major manifestation
D) Disorders that cause erythrocyte destruction
E) Disorders characterized by abnormal absorption of vitamin C

Question 18

A patient has been admitted to the emergency department with severe bleeding from a gunshot wound to the right thigh. The nurse would expect therapy to be based in part on which laboratory values?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Blood urea nitrogen (BUN)
B) Platelet count
C) WBC (white blood cell) count
D) Hematocrit
E) Hemoglobin

Question 19

A nurse is assigned to care for a female patient diagnosed with aplastic anemia. What are the expected outcomes of the nurse's interventions?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) The patient will list three sources of iron that should be included in the daily diet.
B) The patient will identify activities that increase her risk for falls.
C) The patient will demonstrate no complications from blood transfusions.
D) The patient will maintain a hematocrit level of 32%.
E) The patient will have regrowth of hair.

Question 20

Which statement would the nurse manager of a hematology clinic evaluate as indicating that a newly employed nurse understands the process of thrombopoiesis?

A) Thrombopoiesis is a response to extrinsic factors that initiates the clotting cascade.
B) Thrombopoiesis is the process that mitigates blood loss due to injury to any blood vessel.
C) Thrombopoiesis is the development of three blood cell lines.
D) Thrombopoiesis is platelet development from hematopoietic stem cells to fully mature platelets.

Question 21

A child is diagnosed with beta-thalassemia major. What should the nurse teach the child's parents?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "Monitor transfusion of packed red blood cells as ordered."
B) "Prepare yourselves for the care of a child who is seriously ill."
C) "Prioritize the child's activities to allow for rest."
D) "Your child will always be small, with a petite skeletal frame."
E) "Be alert for allergic reactions to common foods such as peanuts and strawberries."

Question 22

A patient who has iron deficiency anemia is prescribed approximately 200 mg of oral elemental iron to be taken daily in three individual doses with meals. The nurse would teach this patient to take ______ tablet(s) of over-the-counter ferrous sulfate for each dose.

Question 23

A review of laboratory results reveals a 30% decrease in platelet count from baseline in a patient receiving intermittent intravenous heparin therapy. What nursing action is indicated?

A) Have the laboratory rerun this test.
B) Skip one dose of heparin and have a PT/PTT drawn.
C) Discuss these findings with the health care provider.
D) Dilute the next heparin dose in normal saline and administer over at least 5 minutes.

Question 24

Review of a patient's medical record reveals a diagnosis of anemic hypoxia. Which condition would the nurse suspect was the underlying cause of this diagnosis?

A) Reduced production of erythropoietin
B) Airway obstruction
C) Pneumonia
D) Right-to-left shunt in the heart

Question 25

A patient has lost 800 mL of blood during surgery. The nurse calculates that the patient has lost _______ mg of iron.

Question 26

A 45-year-old patient with a history of chronic renal failure reports feeling so fatigued that he cannot work a full day at his job. The nurse would anticipate testing for levels of which substance most likely implicated in these findings?

A) Testosterone
B) Growth hormone
C) Erythropoietin
D) Magnesium

Question 27

A patient has no complaints when she comes to the clinic for a routine physical. Laboratory results reveal a hemoglobin level of

A) This patient has a normal hemoglobin level for an adult female.
B) The patient has lost some blood in the last few hours.
C) The patient should be encouraged to eat more iron-rich foods.
D) The patient has been bleeding slowly for an extended period.
E)2 g/dL. How should the nurse interpret this result?

Question 28

A person who weighs approximately 80 kg is brought to the emergency department with a stab wound. Which assessment findings would the nurse evaluate as indicating this patient has lost more than 30% of total blood volume?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Blood pressure 78 mmHg systolic
B) Heart rate 118 bpm
C) Dry, hot skin
D) Loss of consciousness when trying to sit up on the gurney
E) Slight restlessness with complaint of pain

Question 29

A patient is scheduled for a Schilling test to determine the cause of vitamin B₁₂ deficiency. What information should the nurse provide when preparing the patient for this test?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "The Schilling test will help to determine if you have a problem absorbing vitamin B₁₂."
B) "You will be given an oral dose of radioactive vitamin B₁₂ for part of this test."
C) "You will need to collect your urine for 6 hours after the test."
D) "You will be given a parenteral dose of vitamin B₁₂ for part of this test."
E) "Gastric endoscopy is included in this test."

Question 30

A patient has been prescribed over-the-counter oral iron supplementation. What medication information should the nurse provide?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Take the iron supplement right before bedtime.
B) Iron is absorbed better if taken with food or liquids that contain vitamin C
C) Iron may be constipating, so a stool softener may be necessary.
D) Take the iron at mealtime or with a snack to prevent heartburn.
E) Do not take iron with any dairy foods.

Question 31

A patient has been prescribed 100 mg of iron dextran IV push daily for 5 days. How should the nurse prepare to administer this medication?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Give a test dose of 25 mg slow IV push.
B) Plan on giving the medication over 10 to 15 minutes.
C) Dilute the iron is 20 mL of D5W prior to administration.
D) Report any patient complaint of nausea during or just after the injection.
E) Observe the patient for anorexia.

Question 32

A patient has been diagnosed with von Willebrand's disease (vWD). What patient education should the nurse provide?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) This disorder is inherited.
B) This disorder affects only women.
C) This disorder occurs more frequently than was once recognized.
D) This disorder can cause excessive bleeding or excessive clotting.
E) This disease can be cured with administration of von Willebrand's factor.

Question 33

A patient is prescribed desmopressin as treatment for von Willebrand's disease. Which nursing interventions are indicated for this patient?

A) Reduce sources of calcium in the diet.
B) Decrease fluid intake.
C) Monitor for development of gout.
D) Monitor for infection.