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Chapter 33: Management of Patients With Nonmalignant HematologicDisorders A nurse is caring for a patient who has sickle cell anemia and the nurses assessmepossibility of substance abuse. What is the nurses most appropriate action? nt reveals the A) Encourage the patient to rely on complementary and...

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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter33:ManagementofPatientsWithNonmalignantHematologic Disorders  1.

Anurseiscaringforapatientwhohassicklecellanemiaandthenursesassessmentrevealsthe possibilityofsubstanceabuse.Whatisthenursesmostappropriateaction?

A)

Encouragethepatienttorelyoncomplementaryandalternativetherapies.

B)

Encouragethepatienttoseekcarefromasingleproviderforpainrelief.

C)

Teachthepatienttoacceptchronicpainasaninevitableaspectofthedisease.

D)

Limitthereportingofemergencydepartmentvisitstotheprimaryhealthcareprovider.

Ans:

B Feedback: Thepatientshouldbeencouragedtouseasingleprimaryhealthcareprovidertoaddresshealthcare concerns.Emergencydepartmentvisitsshouldbereportedtotheprimaryhealthcareprovidertoachieve optimalmanagementofthedisease.Itwouldinappropriatetoteachthepatienttosimplyaccepthisor herpain.Complementarytherapiesareusuallyinsufficienttofullyaddresspaininsicklecelldisease.

2.

Apatientnewlydiagnosedwiththrombocytopeniaisadmittedtothemedicalunit.Aftertheadmission assessment,thepatientasksthenursetoexplainthedisease.Whatshouldthenurseexplaintothis patient?

A)

Therecouldbeanattackontheplateletsbyantibodies.

B)

Therecouldbedecreasedproductionofplatelets.

C)

Therecouldbeimpairedcommunicationbetweenplatelets.

D)

Therecouldbeanautoimmuneprocesscausingplateletmalfunction.

Ans:

B Feedback: Thrombocytopeniacanresultfromadecreasedplateletproduction,increasedplateletdestruction,or increasedconsumptionofplatelets.Impairedplateletcommunication,antibodies,andautoimmune processesarenottypicalpathologies.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

3.

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Acriticalcarenurseiscaringforapatientwithautoimmunehemolyticanemia.Thepatientisnot respondingtoconservativetreatments,andhisconditionisnowbecominglifethreatening.Thenurseis awarethatatreatmentoptioninthiscasemayincludewhat?

A)

Hepatectomy

B)

VitaminKadministration

C)

Platelettransfusion

D)

Splenectomy

Ans:

D Feedback: Asplenectomymaybethecourseoftreatmentifautoimmunehemolyticanemiadoesnotrespondto conservativetreatment.VitaminKadministrationistreatmentforvitaminKdeficiencyanddoesnot resolveanemia.Platelettransfusionmaybethecourseoftreatmentforsomebleedingdisorders. Hepatectomywouldnothelpthepatient.

4.

Anurseisprovidingeducationtoapatientwithirondeficiencyanemiawhohasbeenprescribediron supplements.Whatshouldthenurseincludeinhealtheducation?

A)

Taketheironwithdairyproductstoenhanceabsorption.

B)

IncreasetheintakeofvitaminEtoenhanceabsorption.

C)

Ironwillcausethestoolstodarkenincolor.

D)

Limitfoodshighinfiberduetotheriskfordiarrhea.

Ans:

C Feedback: Thenursewillinformthepatientthatironwillcausethestoolstobecomedarkincolor.Ironshouldbe takenonanemptystomach,asitsabsorptionisaffectedbyfood,especiallydairyproducts.Patients shouldbeinstructedtoincreasetheirintakeofvitaminCtoenhanceironabsorption.Foodshighinfiber shouldbeconsumedtominimizeproblemswithconstipation,acommonsideeffectassociatedwithiron therapy.

5.

Thenurseisassessinganewpatientwithcomplaintsofoverwhelmingfatigueandasoretonguethatis visiblysmoothandbeefyred.Thispatientisdemonstratingsignsandsymptomsassociatedwithwhat formofwhathematologicdisorder?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Sicklecellanemia

B)

Hemophilia

C)

Megaloblasticanemia

D)

Thrombocytopenia

Ans:

C

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Feedback: Ared,smooth,soretongueisasymptomassociatedwithmegaloblasticanemia.Sicklecelldisease, hemophilia,andthrombocytopeniadonothavesymptomsinvolvingthetongue. 6.

Apatientwithrenalfailurehasdecreasederythropoietinproduction.Uponanalysisofthepatients completebloodcount,thenursewillexpectwhichofthefollowingresults?

A)

Anincreasedhemoglobinanddecreasedhematocrit

B)

Adecreasedhemoglobinandhematocrit

C)

Adecreasedmeancorpuscularvolume(MCV)andredcelldistributionwidth(RDW)

D)

AnincreasedMCVandRDW

Ans:

B Feedback: Thedecreasedproductionoferythropoietinwillresultinadecreasedhemoglobinandhematocrit.The patientwillhavenormalMCVandRDWbecausetheerythrocytesarenormalinappearance.

7.

Apatientcomestothecliniccomplainingoffatigueandthehealthinterviewissuggestiveofpica. Laboratoryfindingsrevealalowserumironlevelandalowferritinlevel.Withwhatwouldthenurse suspectthatthepatientwillbediagnosed?

A)

Irondeficiencyanemia

B)

Perniciousanemia

C)

Sicklecellanemia

D)

Hemolyticanemia

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

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A Feedback: Alowserumironlevel,alowferritinlevel,andsymptomsofpicaareassociatedwithirondeficiency anemia.TIBCmayalsobeelevated.Noneoftheotheranemiasareassociatedwithpica.

8.

Apatientcomesintothecliniccomplainingoffatigue.Bloodworkshowsanincreasedbilirubin concentrationandanincreasedreticulocytecount.Whatwouldthenursesuspectthepatienthas?

A)

Ahypoproliferativeanemia

B)

Aleukemia

C)

Thrombocytopenia

D)

Ahemolyticanemia

Ans:

D Feedback: Inhemolyticanemias,prematuredestructionoferythrocytesresultsintheliberationofhemoglobinfrom theerythrocytesintotheplasma;thereleasedhemoglobinisconvertedinlargeparttobilirubin,and thereforethebilirubinconcentrationrises.Theincreasederythrocytedestructionleadstotissuehypoxia, whichinturnstimulateserythropoietinproduction.Thisincreasedproductionisreflectedinanincreased reticulocytecountasthebonemarrowrespondstothelossoferythrocytes.Hypoproliferativeanemias, leukemia,andthrombocytopenialackthispathologyandpresentation.

9.

Anurseiscaringforapatientwithsevereanemia.Thepatientistachycardicandcomplainsofdizziness andexertionaldyspnea.Thenurseknowsthatinanefforttodelivermorebloodtohypoxictissue,the workloadontheheartisincreased.Whatsignsandsymptomsmightdevelopifthispatientgoesinto heartfailure?

A)

Peripheraledema

B)

Nauseaandvomiting

C)

Migraine

D)

Fever

Ans:

A Feedback:

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Cardiacstatusshouldbecarefullyassessedinpatientswithanemia.Whenthehemoglobinlevelislow, theheartattemptstocompensatebypumpingfasterandharderinanefforttodelivermorebloodto hypoxictissue.Thisincreasedcardiacworkloadcanresultinsuchsymptomsastachycardia, palpitations,dyspnea,dizziness,orthopnea,andexertionaldyspnea.Heartfailuremayeventually develop,asevidencedbyanenlargedheart(cardiomegaly)andliver(hepatomegaly),andbyperipheral edema.Nausea,migraine,andfeverarenotassociatedwithheartfailure. 10. Apatientisadmittedtothehospitalwithperniciousanemia.Thenurseshouldpreparetoadminister whichofthefollowingmedications? A)

Folicacid

B)

VitaminB12

C)

Lactulose

D)

Magnesiumsulfate

Ans:

B Feedback: PerniciousanemiaischaracterizedbyvitaminB12deficiency.Magnesiumsulfate,lactulose,andfolic aciddonotaddressthepathologyofthistypeofanemia.

11. Apatientsbloodworkrevealsaplateletlevelof17,000/mm3.Wheninspectingthepatients integumentarysystem,whatfindingwouldbemostconsistentwiththisplateletlevel? A)

Dermatitis

B)

Petechiae

C)

Urticaria

D)

Alopecia

Ans:

B Feedback: Whentheplateletcountdropstolessthan20,000/mm3,petechiaecanappear.Lowplateletlevelsdonot normallyresultindermatitis,urticaria(hives),oralopecia(hairloss).

12. Anurseisadmittingapatientwithimmunethrombocytopenicpurpuratotheunit.Incompletingthe

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admissionassessment,thenursemustbealertforwhatmedicationsthatpotentiallyalterplatelet function?Selectallthatapply. A)

Antihypertensives

B)

Penicillins

C)

Sulfa-containingmedications

D)

Aspirin-baseddrugs

E)

NSAIDs

Ans:

C,D,E Feedback: Thenursemustbealertforsulfa-containingmedicationsandothersthatalterplateletfunction(e.g., aspirin-basedorotherNSAIDs).Antihypertensivedrugsandthepenicillinsdonotalterplateletfunction

13. Apatient,25yearsofage,comestotheemergencydepartmentcomplainingofexcessivebleedingfrom acutsustainedwhencleaningaknife.BloodworkshowsaprolongedPTbutavitaminKdeficiencyis ruledout.Whenassessingthepatient,areasofecchymosisarenotedonotherareasofthebody.Which ofthefollowingisthemostplausiblecauseofthepatientssignsandsymptoms? A)

Lymphoma

B)

Leukemia

C)

Hemophilia

D)

Hepaticdysfunction

Ans:

D Feedback: ProlongationofthePT,unlessitiscausedbyvitaminKdeficiency,mayindicateseverehepatic dysfunction.Themajorityofhemophiliacsarediagnosedaschildren.Thescenariodoesnotdescribe signsorsymptomsoflymphomaorleukemia.

14. ApatientwithahistoryofcirrhosisisadmittedtotheICUwithadiagnosisofbleedingesophageal varices;anattempttostopthebleedinghasbeenonlypartiallysuccessful.Whatwouldthecriticalcare nurseexpectthecareteamtoorderforthispatient?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Packedredbloodcells(PRBCs)

B)

VitaminK

C)

Oralanticoagulants

D)

Heparininfusion

Ans:

A

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Feedback: Patientswithliverdysfunctionmayhavelife-threateninghemorrhagefrompepticulcersoresophageal varices.Inthesecases,replacementwithfreshfrozenplasma,PRBCs,andplateletsisusuallyrequired. VitaminKmaybeorderedoncethebleedingisstopped,butthatisnotwhatisneededtostopthe bleedingofthevarices.Anticoagulantswouldexacerbatethepatientsbleeding. 15. Thenurseonthepediatricunitiscaringfora10-year-oldboywithadiagnosisofhemophilia.Thenurse knowsthataprioritynursingdiagnosisforapatientwithhemophiliaiswhat? A)

Hypothermia

B)

Diarrhea

C)

Ineffectivecoping

D)

Imbalancednutrition:Lessthanbodyrequirements

Ans:

C Feedback: Mostpatientswithhemophiliaarediagnosedaschildren.Theyoftenrequireassistanceincopingwith theconditionbecauseitischronic,placesrestrictionsontheirlives,andisaninheriteddisorderthatcan bepassedtofuturegenerations.Childrenwithhemophiliaarenotatriskofhypothermia,diarrhea,or imbalancednutrition.

16. Agroupofnursesarelearningaboutthehighincidenceandprevalenceofanemiaamongdifferent populations.Whichofthefollowingindividualsismostlikelytohaveanemia? A)

A50-year-oldAfrican-Americanwomanwhoisgoingthroughmenopause

B)

An81-year-oldwomanwhohaschronicheartfailure

C)

A48-year-oldmanwhotravelsextensivelyandhasahigh-stressjob

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D)

A13-year-oldgirlwhohasjustexperiencedmenarche

Ans:

B

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Feedback: Theincidenceandprevalenceofanemiaareexceptionallyhighamongolderadults,andtheriskof anemiaiscompoundedbythepresenceofheartdisease.Noneoftheotherlistedindividualsexhibits high-riskfactorsforanemia,thoughexceptionallyheavymenstrualflowcanresultinanemia. 17. Anadultpatienthasbeendiagnosedwithiron-deficiencyanemia.Whatnursingdiagnosisismostlikely toapplytothispatientshealthstatus? A)

Riskfordeficientfluidvolumerelatedtoimpairederythropoiesis

B)

Riskforinfectionrelatedtotissuehypoxia

C)

Acutepainrelatedtouncontrolledhemolysis

D)

Fatiguerelatedtodecreasedoxygen-carryingcapacity

Ans:

D Feedback: Fatigueisthemajorassessmentfindingcommontoallformsofanemia.Anemiadoesnotnormally resultinacutepainorfluiddeficit.Thepatientmayhaveanincreasedriskofinfectionduetoimpaired immunefunction,butfatigueismorelikely.

18. Apatienthasbeenlivingwithadiagnosisofanemiaforseveralyearsandhasexperiencedrecent declinesinherhemoglobinlevelsdespiteactivetreatment.Whatassessmentfindingwouldsignal complicationsofanemia? A)

Venousulcersandvisualdisturbances

B)

Feverandsignsofhyperkalemia

C)

Epistaxisandgastroesophagealreflux

D)

Ascitesandperipheraledema

Ans:

D Feedback:

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Asignificantcomplicationofanemiaisheartfailurefromchronicdiminishedbloodvolumeandthe heartscompensatoryefforttoincreasecardiacoutput.Patientswithanemiashouldbeassessedforsigns andsymptomsofheartfailure,includingascitesandperipheraledema.Noneoftheotherlistedsignsand symptomsischaracteristicofheartfailure. 19. Awomanwhoisinherthirdtrimesterofpregnancyhasbeenexperiencinganexacerbationofirondeficiencyanemiainrecentweeks.Whenprovidingthepatientwithnutritionalguidelinesandmeal suggestions,whatfoodswouldbemostlikelytoincreasethewomansironstores? A)

Salmonaccompaniedbywholemilk

B)

Mixedvegetablesandbrownrice

C)

Beefliveraccompaniedbyorangejuice

D)

Yogurt,almonds,andwholegrainoats

Ans:

C Feedback: Foodsourceshighinironincludeorganmeats,othermeats,beans(e.g.,black,pinto,andgarbanzo), leafygreenvegetables,raisins,andmolasses.Takingiron-richfoodswithasourceofvitaminC(e.g., orangejuice)enhancestheabsorptionofiron.Allofthelistedfoodsarenutritious,butliverandorange juicearemostlikelytobeofbenefit.

20. Apatientwithpoorlycontrolleddiabeteshasdevelopedend-stagerenalfailureandconsequentanemia. Whenreviewingthispatientstreatmentplan,thenurseshouldanticipatetheuseofwhatdrug? A)

Magnesiumsulfate

B)

Epoetinalfa

C)

Low-molecularweightheparin

D)

VitaminK

Ans:

B Feedback: Theavailabilityofrecombinanterythropoietin(epoetinalfa[Epogen,Procrit],darbepoetinalfa [Aranesp])hasdramaticallyalteredthemanagementofanemiainend-stagerenaldisease.Heparin, vitaminK,andmagnesiumarenotindicatedinthetreatmentofrenalfailureortheconsequentanemia.

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21. Anurseisplanningthecareofapatientwithadiagnosisofsicklecelldiseasewhohasbeenadmittedfor thetreatmentofanacutevaso-occlusivecrisis.Whatnursingdiagnosisshouldthenurseprioritizeinthe patientsplanofcare? A)

Riskfordisusesyndromerelatedtoineffectiveperipheralcirculation

B)

Functionalurinaryincontinencerelatedtourethralocclusion

C)

Ineffectivetissueperfusionrelatedtothrombosis

D)

Ineffectivethermoregulationrelatedtohypothalamicdysfunction

Ans:

C Feedback: Therearemultiplepotentialcomplicationsofsicklecelldiseaseandsicklecellcrises.Centralamong these,however,istheriskofthrombosisandconsequentlackoftissueperfusion.Sicklecellcrisesare notnormallyaccompaniedbyimpairedthermoregulationorgenitourinarycomplications.Riskfordisuse syndromeisnotassociatedwiththeeffectsofacutevaso-occlusivecrisis.

22. Apatientisbeingtreatedonthemedicalunitforasicklecellcrisis.Thenursesmostrecentassessment revealsanoraltemperatureof100.5Fandanewonsetoffinecracklesonlungauscultation.Whatisthe nursesmostappropriateaction? A)

Applysupplementaryoxygenbynasalcannula.

B)

Administerbronchodilatorsbynebulizer.

C)

Liaisewiththerespiratorytherapistandconsiderhigh-flowoxygen.

D)

Informtheprimarycareproviderthatthepatientmayhaveaninfection.

Ans:

D Feedback: Patientswithsicklecelldiseasearehighlysusceptibletoinfection,thusanyearlysignsofinfection shouldbereportedpromptly.Thereisnoevidenceofrespiratorydistress,sooxygentherapyand bronchodilatorsarenotindicated.

23. Themedicalnurseisawarethatpatientswithsicklecellanemiabenefitfromunderstandingwhat situationscanprecipitateasicklecellcrisis.Whenteachingapatientwithsicklecellanemiaabout strategiestopreventcrises,whatmeasuresshouldthenurserecommend? A)

Usingprophylacticantibioticsandperformingmeticuloushygiene

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B)

MaximizingphysicalactivityandtakingOTCironsupplements

C)

Limitingpsychosocialstressandeatingahigh-proteindiet

D)

Avoidingcoldtemperaturesanden...