126-145 hema

136 137

GENERAL ASSESSMENT, DIAGNOSTICS, AND NURSING PROCEDURES IRON-DEFICIENCY ANEMIA PERNICIOUS ANEMIA APLASTIC ANEMIA THALASSEMIA SICKLE CELL ANEMIA POLYCYTHEMIA VERA LEUKEMIA PLATELET DISORDERS HEMOPHILIAGENERAL ASSESSMENT, DIAGNOSTICS, AND NURSING PROCEDURES

1. The admitting diagnosis of Roberto is hereditary spherocytosis. He verbalized to the nurse that his father died with the same disorder and asks if he will be treated with the same treatment used on his father. The nurse is knowledgeable when she responds to Roberto that the usual treatment for hereditary spherocytosis is

a. Liver biopsy.b. Frequent blood transfusions.c. Bone marrow transplant.d. Splenectomy.2. If anemia is treated without confirming the underlying cause, and the client is particularly given with vitamin B9 or folic acid, the result will most likely be

a. disproportionate levels of folic acid may build up, causing toxicity.b. manifestations of pernicious anemia may be concealed, postponing treatment.c. intrinsic factor is damaged.d. red blood cell synthesis will be impeded3. A nurse doubled checked an order of fresh frozen plasma. She is aware that this blood product is frequently administered to treat which of the following conditions?

a. Hemophilia Ab. Disseminated intravascular coagulopathyc. Overwhelming sepsisd. Bone marrow suppression caused by chemotherapy4. In a primary care center, a client was brought with significant jaundice. Based on history, this client has hemolytic blood disorder. As a nurse, you will explain to the client that jaundice develops in this kind of disorder because of

a. Liver inflammationb. Hypoproteinemiac. Elevated plasma bilirubin leveld. Increased haptoglabin in plasma5. A bone marrow aspiration biopsy procedure was ordered for a child with suspected blood disorder. The nurse will prepare to administer the classic drugs called TAC (tetracycline, adrenaline, cocaine) using which route of administration?

a. Slow drip IV infusion 4 hours prior to the procedureb. Nasal spray of tetracycline and oral adrenaline and cocainec. Subcutaneous injection on the forearmd. Topical then covered with a dressing prior to the procedure6. Hemoglobin electrophoresis will most probably be ordered to which of your client in the hematologic unit?

a. A 36-year-old female client diagnosed with pernicious anemiab. A 14-year old boy who has sickle cell disease diagnosed 3 months agoc. A 7-year-old girl with acute lymphocytic leukemiad. A 28-year-old pregnant with iron deficiency anemia7. A client with severe burns in the face, neck and chest is brought to the emergency department. As a knowledgeable nurse responsible in carrying the order for laboratory test, you will expect elevation of which blood component?

a. Segmentersb. Lymphocytesc. Basophilsd. Band cells8. Another client has fever for several days with extensive sweating at night. The suspected diagnosis is Hodgkins disease. The nurse knows that the laboratory procedure that will confirm if the manifestations coincide with Hodgkins disease is

a. Monocyte count.b. Lymphocyte count.c. Erythrocyte count.d. Megakaryocyte count.9. During prioritization, which condition should the nurse evaluate lastly since this condition does not have the likelihood of bleeding tendencies?

a. aplastic anemiab. metastatic liver cancerc. idiopathic thrombocytopenic purpurad. pernicious anemiaIRON-DEFICIENCY ANEMIA

10. An adolescent who experiences menorrhagia for 6 months was diagnosed with iron deficiency anemia and is scheduled for discharge now. Ferrous gluconate therapy is prescribed as the drug regimen at home. The nurse should emphasize in the teaching plan the need to

a. Take the medication with table foods.

b. Take the medication before meals.

c. Take the medication with a glass of milk.

d. Take the medication with maalox.

11. Dende is a 7-year-old girl that frequently and recurrently has infections. The mother of Dende asks the nurse if the diagnosis of her child, which is iron deficiency anemia, has something to do with Dendes frequent infections. The response of the nurse should be rooted from the understanding that

a. Children with iron-deficiency anemia are equally as susceptible to infection as are other children.

b. Children with iron-deficiency anemia are less susceptible to infection than are other children.

c. Children with iron-deficiency anemia are more susceptible to infection than are other children.

d. Children with iron-deficiency anemia and the risk of infection is not related at all.

12. Ferrous sulfate was prescribed to a client with iron-deficiency anemia. After a month of continuous therapy, the client complains of hard stools and feeling incomplete defecation. To manage therapeutically while gaining clients participation through the clients own food selection within the treatment plan, the nurse will expect which food group that signifies that the client understands the diet?

a. Pasta, buttermilk, banana

b. Grits, orange juice, cheddar cheese

c. Strawberries, rice, mushrooms

d. oatmeal, green beans, celery

13. A nurse is discussing to the nursing students that red blood cells are produced during times of decreased oxygenation in the body. The nurse correctly discuss the rationale behind this condition when she verbalizes that

a. Hypoxia triggers the release of erythropoietin in the kidneys.b. Hypoxia leads to RBC destruction which in turn leads to RBC production.c. Hypoxia stimulates the elevation of hemoglobin content of the RBC.d. Hypoxia accelerates the development of reticulocytes to erythrocytes.14. A client with iron-deficiency anemia is being examined by the nurse for other manifestations of the illness. The nurse notes the presence of Vinson-Plummer syndrome when which triad is noticed?

a. Pica, stomatitis, cheilosisb. Atrophic glossitis, dysphagia, stomatitisc. Koilonychia, brittle nails, cheilosisd. Clubbing, easy fatigability, dysphagia15. Due to gastric discomfort, a client takes aluminum hydroxide, an antacid. After undergoing a laboratory work, anemia was added to the clients diagnosis and his physician orders ferrous sulfate therapy BID. It is of great significance if the nurse will educate the client about:

a. Simultaneously taking iron and antacids will lessen the irritating effect of iron therapy on the gastrointestinal mucosa.b. He should have the physician discontinue the antacids until his anemia is resolved.c. He should take iron on an empty stomach to prevent interference with iron absorption.d. Since there is no interaction between these agents he can take them when it is convenient.PERNICIOUS ANEMIA

16. In red blood cell formation, Kurapika asks the nurse why vitamin B12 is important. The accurate reply of the nurse should be based on the understanding that Vitamin B12 deficiency causes which of the subsequent transformation in the red blood cell?

a. RBC will become macrocytic and hyperchromicb. RBC will develop into microcytic and hypochromic

c. RBC will turn out to be smaller in shape and deficient in hemoglobind. RBC will lead to decreased mean corpuscular volume17. The nurse is discussing pernicious anemia to a group of nursing students assigned to her unit. She is correct if which of the following is listed in the risk factors of pernicious anemia?

a. parotitis.b. glossitis.c. gastritis,

d. arthritis.18. A client newly diagnosed of pernicious anemia. She is very anxious if the manifestations will be distressing. The nurse accurately replied that the symptoms will not be distressing and are based on the clients adherence to the treatment regimen and will expect to

a. Experience intermittent episodes of nausea and diaphoresis once therapy is started.b. Avoid eating foods that cause increased peristalsis and loose stool.c. Eat a diet high in iron so that symptoms will disappear.d. Have injections of vitamin B12 for the rest of his life.19. Vitamin B12 injection is being done to Recca for 6 months now. The client asks the nurse why another laboratory work is done to him other than the level of vitamin B12. The nurse will responds correctly when she says that in pernicious anemia, the primary diagnostic data that is assessed is

a. Guiaics test, blood negative

b. Gastric analysis, blue urine

c. Intrinsic factor, negative

d. Schillings test, prominent

20. The priority nursing care in a client admitted with pernicious anemia, taking into account the manifestations of the client would bea. Providing rest periods to alleviate fatigueb. Increasing fluid intake to solve dehydrationc. Prevention of infection to address leukopeniad. Increasing iron intake to lessen clubbingAPLASTIC ANEMIA

21. Vincent is diagnosed with aplastic anemia. The nurse assigned to Vincent needs to accomplish the background of the client so as to trace the probable cause of the disorder. The information that the nurse recognizes as being pertinent to this diagnosis is that the client is

a. Vincent has been a regular blood donor

b. Vincent was an assistant in the radiology unit for 20 years

c. Vincent has a history of transfusion reaction

d. Vincent has a father and grandfather of cancer

22. A client is receiving cephalexin intravenously. The nurse is alerted with the latest laboratory work done to the client because of a significant reduction in the count of red blood cells and platelets. The nurse should notify the physician regarding the continuation of the medication and will expect the physician to

a. Continue the next 2 doses and notify again for manifestations associated to the laboratory values.

b. Discontinue the drug and perform another CBC.

c. Proceed with administration of dose without delay.

d. Withhold drug and wait for the pending notification of physician regarding the lab results.

23. A nurse is caring for a client with aplastic anemia. History reveals no exposure to chemicals or radiation. The nurse suspects a serious viral infection in the past that could have led to the disorder. Which of the following medications in the clients history in relation to the suspected viral infection could have been the reason for the development of aplastic anemia?

a. Foscavir

b. Paroxetine

c. Chloramphenicol

d. Nystatin

THALASSEMIA

24. Gon, a 10-year-old boy suffers from Cooleys anemia. The nurse caring for Gon is watching out for the complication associated with this disorder as well as the probable risk of the treatment regimen. The nurse will most likely expect

a. Hypertrophy of the thymus and infection.

b. Hypertrophy of the thyroid and hypertension.

c. Chronic hypoxia and iron overload.

d. Polycythemia vera and thrombosis.

25. The nurse in the hematologic floor is assigned to a client with several disease conditions. In the chart, the diagnosis of Eugene, 13 years old, are hepatosplenomegaly secondary to thalassemia and prominent jaundice. The nurse making the nursing care plan for Eugene, should focus on which priority intervention?

a. Listening to his concerns about his hospitalization

b. Scheduling rest and activity to decreasing cardiac demands

c. Avoiding raw foods and fresh flowers in the room

d. Offering foods of his preference to increase his intake of calories

26. Eugenes latest diagnostic level for iron is elevated. As a knowledgeable nurse, you know that after physician notification, which drug is expected to be ordered as the antidote of iron?

a. Aminocaproic acid

b. Deferoxamine mesylate

c. Heparin sulfate

d. Chelation therapy

SICKLE CELL ANEMIA

27. A nurse is finishing the nursing care plan for the client assigned to her, who is a 16-year-old girl with sickle cell anemia. Which of the following nursing diagnoses should receive priority during a vasoocclusive crisis?

a. Alteration in comfortb. Decreased cardiac outputc. Ineffective airway clearanced. Unsuccessful individual coping28. Chi Chi is pregnant and went for her prenatal check up. The obstetrician was alerted by the latest laboratory work that Chi Chi has sickle cell anemia. Which comment of Chi Chi signifies the need for further instruction on sickle cell anemia during pregnancy?

a. I understand why folic acid is important for the red cell formation.b. I am careful to drink at least eight glasses of fluid every day.c. Ive stopped jogging so I wont be at risk for dehydration.d. I take an iron pill every day to help grow new red blood cells.29. Two weeks after Chi Chis prenatal visit, she suddenly collapses. Assessment reveals pallor and hypotension. The nurse doing the assessment correctly interpret this situation as

a. A vasoocclusive crisis is beginning.b. The client is experiencing a sequestration crisis.c. Systemic vasodilation has occurred.d. The client is bleeding.30. Bebe is an 8-year-old girl that has just recovered from a sickle cell crisis. As the nurse caring for Bebe, it is of great importance to give the parents of the child the need to

a. Isolate child from unknown sources of infectionb. Reinforce the basics of trait transmissionc. Avoid contact with all childrend. Restrict childs intake during the night31. In the emergency department, a 5-year-old boy is admitted due to severe abdominal pain. The suspected diagnosis is sickle cell anemia. Physical assessment reveals enlarged liver upon palpation, splenomegaly on x-ray, and anemia in complete blood count. These data points out to which type of crisis?

a. Hyperhemolytic crisis

b. Vasoocclusive crisisc. Sequestration crisis

d. Sickle cell crisis

32. The complication of sickle cell anemia in a 10 weeks gestation pregnant client is sickle cell crisis due to rapid need of the fetus with blood for development. Aggressive management of a sickle cell crisis includes which of the following measures?

a. Acetaminophen (Tylenol) for pain

b. Diuretic agents

c. Antihypertensive agent

d. IV fluids

POLYCYTHEMIA VERA

33. As a complication of polycythemia vera, a 78-year-old woman is admitted with cerebral arteriosclerosis. The woman is prescribed with heparin every 6 hours. The effectivity of this anticoagulant is best to conclude when which of the following is seen on the client?

a. A decreased viscosity of the bloodb. An APPT twice the usual valuec. An absence of ecchymotic areasd. A reduction of confusion34. Alfred is diagnosed with polycythemia vera. When the nurse assigned to the client is in the room, Alfred anxiously asks the nurse why his treatment is focused on preventing the development of coronary and cerebral thromboses. The nurses best response is based on the understanding that in polycythemia vera, there is

a. immaturity of red blood cells.b. fragility of the blood cells.c. increased blood viscosity.d. elevated blood pressure.35. After the physician explained to Alfred the mechanism of his diagnosis, Alfred verbalized to the nurse that he understand his condition and will comply religiously so as not to develop complications regarding thrombus formation. In relation to the possibility of thrombus formation, the nurse will now carry out which of the following order for polycythemia vera?

a. Perform phlebotomy of 500 mL of blood.b. Monitor for low hemoglobin and hematocrit.c. Assess for petechiae and purpura.d. Type and cross-match for a transfusion.36. The nurse is assessing a client who has been given a diagnosis of polycythemia vera. What characteristics will the nurse anticipate finding when assessing this client?

a. Hemoglobin below 13 mg/dl

b. Headaches, dyspnea, claudicationc. Increased fatigue and bleeding tendencies

d. Back pain, ecchymosis, and joint tenderness

LEUKEMIA

37. Mr. Spider receives intravenous fluids infusion and allopurinol before starting treatment for leukemia. The rationale in performing these interventions is to trim down which of the following risks of chemotherapy?

a. Mucositis.

b. DIC.

c. Pancytopenia.

d. Tumor lysis syndrome.

38. A 40-year-old client is diagnosed with acute myelogenous leukemia. He is now placed on neutropenia precautions. Concerning this problem, which vital teaching should the nurse tell the client?

a. Perform perineal care after every bowel movement.b. Some blood in the urine is not unusual.c. Eat plenty of fresh fruits and vegetables.d. Shave with an electric razor and use a soft toothbrush.39. A client receiving busulfan for chronic myelogenous leukemia is assigned to a newly hired nurse in the oncology department. The nurse noted in the latest laboratory work that the white blood cell count falls to between 10,000/mm3 and 25,000/mm3. After physician notification, the drug is stopped. The nurse is knowledgeable when she knows that the treatment will resume when

a. Lost hair begins to grow back.b. The client displays anemia.c. The WBC falls to 5,000/mm3.d. The WBC count rises to 50,000/mm3.40. Piccolo is a 4-year-old boy diagnosed with acute lymphocytic leukemia. He complains to his mother that he feels nauseated and experienced headache. All but one are related to the clinical manifestations, and the incorrect condition is

a. meningeal irritation.b. gastric distension.c. effects of radiation.d. chemotherapy side effects.41. A client for hospice care, due to end-staged leukemia, is being cared by Nurse Taguro. Nurse Taguro is aware that the patient is at risk even from the bacteria of his own body as an infection risk source. Which is the bacteria being pertained by Nurse Taguro?

a. Streptococcus viridansb. Beta-hemolytic streptococci

c. Pseudomonas aeruginosad. Streptococcus pneumoniae42. Lolo Jericho was diagnosed with chronic myeloid leukemia 6 months ago, and now revealed leukocytosis in recent laboratory values. The nurse caring for Lolo Jericho will most likely assess which of the following manifestations associated with Lolo Jerichos condition?

a. Right upper quadrant tenderness and nausea.b. Increased appetite and weight gain.c. Dyspnea and slight confusiond. Frothy sputum and jugular vein distention.43. A 6-year-old diagnosed with leukemia, is given with methotrexate via the spinal canal. The nurse explains to the parents that this drug was given

a. via intrathecal routeb. via lingual routec. via intraosseous routed. vial topical route44. Which of the following statements would the nurse use to describe to the parents why their child with leukemia is at risk for infections?

a. Play activities are too strenuous.

b. Ascorbic acid intake is reduced over a period of time.

c. The number of red blood cells is inadequate for carrying oxygen.

d. Immature white blood cells are incapable of handling an infectious process.

PLATELET DISORDERS

45. A clinic nurse suspects the diagnosis of disseminated vascular coagulopathy for a client who frequently experience coolness of the lower extremities and altered vital signs. After receiving the laboratory results of the client, which data will prompt the nurse to report to the physician immediately?

a. Hemoglobin 15 g/dL

b. Prothrombin time (PT) of 11 seconds

c. Fibrinogen level 110 mg/dL

d. Partial thromboplastin time (PTT) of 80 seconds

46. Bulma, a 22-year-old female client, is suspected to have idiopathic thrombocytopenia purpura (ITP). Which of the following questions during admission interview is the most appropriate the nurse to ask in relation to the disorder?

a. How often do you have migraine headaches?b. Do you become short of breath during activity?c. How heavy is your menstrual period?d. Do you have a history of deep vein thrombosis?47. After injuries sustained in an automobile collision, Master Pogi developed disseminated intravascular coagulation. Among the following activities, which requires immediate action of the nurse?

a. The client has oxygen per nasal cannula at 5 L/minb. The client has cool compresses to her kneesc. The client is resting on her right sided. The client has two pillows under her knees.48. The nurse in the emergency department is interviewing Goku regarding his past medical diagnosis. The nurse is alerted that the client has the potential for bleeding when which of the following conditions are experienced by Goku?

1. Takes ibuprofen for arthralgia TID

2. Undergone mitral valve replacement surgery 4 months ago

3. Cooks red meat every Sunday, Wednesday, and Saturday

4. Includes in his drinks, 2 glasses of wine daily

5. Has history of chronic hepatitis C

a. 1, 2, 3, 5

b. 1, 3, 4

c. 1, 2, 5

d. 1, 3, 4, 5

49. In cases of disorders that leads to thrombocytopenia, which of the following surgeries that a knowledgeable nurse understands to alleviate the condition?

a. cholecystectomyb. splenectomyc. appendectomyd. laminectomy50. ANSWER: B.

CONCEPT ILLUMINATION

A splenectomy may be done as treatment for thrombocytopenia, as a way of increasing the number of platelets in circulation. The other surgeries are not performed for thrombocytopenia.

HEMOPHILIA

51. The nurse is teaching the parents of Eugene, who has Hemophilia. Before the end of the shift, the nurse came back to assess the effectiveness of parent teaching concerning the transmission of Hemophilia. Parental perception is accurate when the mother will verbalize

a. Due to the measles I had in pregnancy, my son developed hemophilia.b. I am a carrier of Hemophilia and I can pass the genes to my son.

c. My two daughters need to be tested also for the possibility of acquiring my genes.d. Our daughters will not be carriers since my husband is not affected by the disease.52. Jeremiah, a 6-year-old client, admitted with hemophilia A. The nurse assigned to Jericho is teaching the mother the importance of injury prevention and the manifestations of internal bleeding. The nurse correctly discuss to the mother that hemarthrosis is a classic sign of hemophilia A and the early manifestation is

a. Cool, pale, clammy extremity

b. Ecchymosis formation around a joint

c. Instability of a long bone in passive movement

d. Childs reluctance to move a body part

53. The best nursing intervention to promote optimal functioning of a 12-year-old child with hemarthrosis is

a. Apply pressure to the area as needed.b. Apply warm compresses to the affected joint.c. Elevate and immobilize the affected joint.d. Institute passive range of motion to the affected joint during acute phase.54. A 14-year-old client named Beans is very competitive, but recently, he was diagnosed with hemophilia A. the child asked the nurse if he can still continue playing. The best comment of the nurse regarding the childs concern is to allow Beans to continue playing and can participate safely in the sport of

a. Basketball.b. Field hockery.c. Soccer.d. Swimming.55. Sakuragi, a 4-year-old boy, is for discharge after being admitted due to hemophilia. The nurse provides instructions regarding home care to the parents. The nurse will be alarmed that the parents did not understood clearly the teachings if which statement is made by one of the parents?

a. We will delay the immunizations of Sakuragi and cancel the scheduled dental appointments.b. We will make sure to pad corners of the furnitures in Sakuragis room.c. We will supervise Sakuragi closely especially when playing.d. We will remove household items that can easily fall over.

ANSWERS AND CONCEPT ILLUMINATIONS1. ANSWER: D.


A rarely common type of hemolytic anemia is called hereditary spherocytosis. This condition is characterized by an atypical permeability of the red blood cell and this allows the formation of spherically-shaped RBCs. Since the shape of the RBC is supposed to be biconcave, the abnormal-shaped RBC rapidly enters the spleen where they are destroyed. Due to the overwork of the spleen, splenomegaly is a danger that is why the treatment of choice is splenectomy.

2. ANSWER: B. CONCEPT ILLUMINATION

A result of absorption problems in the small intestine is folate deficiency. This problem is usually given with vitamin B12, and together with B9, both essential for cell growth and division and for the production of a strong stroma in the RBCs.

3. ANSWER: B.


Fresh frozen plasma contains abundant clotting factors. This has been the initial treatment of choice for disseminated intravascular coagulation (DIC). In DIC, clotting and bleeding occurs simultaneously. The purpose of fresh frozen plasma administration is to make clotting factors available for the bleeding tendencies. Hemophilia A particularly lacks clotting factor VIII. Sepsis and bone marrow suppression do not use fresh frozen plasma as a treatment regimen.

4. ANSWER: C.CONCEPT ILLUMINATION

When RBCs are broken down, the byproduct is hemoglobin which will be further broken down. The end result is increased bilirubin level. Bilirubin is a yellow substance that gives color to the urine and stool. When there is excessive level of bilirubin, it will be deposited in the skin causing yellow discoloration known as jaundice.

5. ANSWER: D.


Tetracycline, adrenaline, cocaine are commonly given topically then covered, over the site of the bone marrow aspiration. This will result to analgesia and mild anesthesia of the site.

6. ANSWER: B.


The client with sickle cell disease should undergo hemoglobin electrophoresis. This test will make a distinction between sickle cell disease and sickle cell trait. The other disorders are not required to undergo hemoglobin electrophoresis.

7. ANSWER: A.


Segmenters are the mature form of neutrophils. Neutrophil count is elevated in conditions with tissue necrosis that occurs in burns. Lymphocyte is elevated in viral infection and chronic bacterial infection. Basophils are capable of ingesting foreign particles that stimulate the release of histamine, like eosinophils. Band cells are immature neutrophils and are expected to be elevated in cases of immunosuppression.

8. ANSWER: A.


Hodgkins disease primary affects the cervical lymph nodes and leads to lymphoma or tumor formation in the lymphatics. The lymphocytes are the main WBC that thrives and matures in the lymphatic system. In case of Hodgkins disease or Hodgkins lymphoma, lymphocyte count is expected to be elevated. The other options are not affected in Hodgkins disease unless the tumor invades the other body parts, particularly the bones, where monocytes, erythrocytes, and megakaryocytes are formed. 9. ANSWER: D.


Pernicious anemia is experienced due to the deficiency or lack of intrinsic factor in the stomach that is needed for vitamin B12 absorption. This condition is associated with paresthesia and weakness. Platelet and clotting factors are not affected by this disorder, thus bleeding tendencies are unlikely to happen. Aplastic anemia is characterized by hypoactive bone marrow wherein platelet produced are decreased thus bleeding should be watched out. The liver is the site of formation of clotting factors, therefore if the liver is damaged due to cancer, the mechanism of clotting factor formation is altered, then bleeding could be experienced. Idiopathic thrombocytopenic purpura is the immune destruction of platelets by antiplatelet antibodies thus platelet count is also decreased which leads to bleeding.10. ANSWER: B.


Ferrous gluconate is preferred to be taken before meals or on an empty stomach. This same regimen is applied to ferrous fumarate. Ferrous sulfate on the other hand, is taken after meals but with vitamin C-rich drink for faster absorption.

11. ANSWER: A.CONCEPT ILLUMINATION

Iron deficiency anemia leads to decrease iron in the hemoglobin part of the RBC which carries the oxygen. Poor oxygenation of the body parts are experienced by the body leading to easy fatigability. Then again, susceptibility to infection is due to marked decreases in bone marrow functioning with microcytosis.

12. ANSWER: D.


The therapeutic diet for constipation and feeling of incomplete defection is high fiber diet. Fiber is a bulk-forming substance that prevents constipation. High fiber diet includes oatmeal, wheat, vegetables, and fruits.

13. ANSWER: A.


As compensatory mechanism to low oxygen level in the body, the body will perceive the need for RBC production. This condition triggers the release of erythropoietin in the kidneys that will stimulate the bone marrow to increase RBC production to recompense with hypoxia. 14. ANSWER: B.


All the mentioned manifestations can be seen in a client with iron deficiency anemia because of inadequate oxygenation in the body. The triad of Vinson-Plummer syndrome is remarkably in iron deficiency anemia as evidenced by atrophic glossitis or tongue inflammation, dysphagia or difficulty in swallowing, and stomatitis or mouth ulcers. 15. ANSWER: B.


Iron is best absorbed with the presence of acid. When antacid is taken with ferrous sulfate, the latter will not be absorbed and anemia will not be addressed. The nurse should have the physician discontinue the antacids until his anemia is resolved.

16. ANSWER: A.


Deficiency of Vitamin B12 in the body will lead to the development of abnormally large red blood cells termed as megaloblastic. This deficiency causes macrocytic and hyperchromic red blood cell, rather than the biconcave shape of a normal red blood cell. This shape predisposes the cells to a shorter lifespan. In this type of anemia, there is an increase in the MCV, not decreased. Microcytic and hypochromic, which is the same with smaller in shape and deficient in hemoglobin RBCs are seen in iron-deficiency anemia.

17. ANSWER: B.


Gastritis is the inflammation of the mucosal surface in the stomach. This will then lead to the alteration of production of intrinsic factor by the parietal cells. Intrinsic factor is necessary for Vitamin B12 absorption. If there is deficient Vitamin B12 available in the circulation, it is known as pernicious anemia. Parotitis is inflammation of the parotid gland. Glossitis is not a cause of pernicious anemia, but rather it is one of the manifestations of the disease. Arthritis is the inflammation of the joints.

18. ANSWER: D.


In pernicious anemia, because of the lack of intrinsic factor, even though the client increased the diet high in vitamin B 12, the problem will not be addressed. Injections of vitamin B12 are required for the rest of the clients life because the problem is the inability to absorb the vitamin from the ileum and hence the GI tract must be bypassed in order to get the B12 into the system. There are no side effects to B12 so nausea and diaphoresis do not occur. Degree of peristalsis and consistency of stool are unrelated to pernicious anemia. Eating a diet high in iron corrects symptoms of iron deficiency anemia.

19. ANSWER: C.


The lack of the intrinsic factor is the defining characteristic of pernicious anemia. This happens due to the atrophy of the gastric mucosa. Without the intrinsic factor, vitamin B12 cannot be absorbed in the small intestines, and folic acid needs vitamin B12 for DNA synthesis of RBCs. Schilling test, indicates that the client has the intrinsic factor and can absorb vitamin B12 into the intestinal tract. Guiaics test determines microscopic blood in the stool in clients with bleeding tendencies in the gastrointestinal system. Gastric analysis determines the presence of HCl acid based on the presence of blue urine. HCl acid indirectly determines intrinsic factor since both are produced by the parietal cells.

20. ANSWER: A.


Vitamin B12 is needed by folic acid for the DNA synthesis of RBC. Since in pernicious anemia, deficiency in vitamin B12 is pronounced, RBC production is altered leading to lack of oxygen to the cells resulting in hypoxia and fatigue. Clients with anemia require frequent rest periods until correction of process can be accomplished. Dehydration and leukopenia are not related to pernicious anemia. Clubbing is more common in iron-deficiency anemia that necessitates iron in the diet.

21. ANSWER: B.


The risk factors associated with the development of aplastic anemia are exposure to ionizing radiation, exposure to chemicals, and severe viral infection. Being a regular blood donor is related to iron-deficiency anemia. The most common anemia associated in transfusion reaction is hemolytic anemia. Aplastic anemia is not genetically transmitted.22. ANSWER: D.


Cephalexin is an antibiotic associated with the development of aplastic anemia. The physician should be notified as soon as the problem is identified. The other options are not appropriate nursing decisions regarding this medication.

23. ANSWER: C.


Chloramphenicol is a potent anti-infective agent, whose impact is on protein synthesis that may also affect bone marrow. Clients receiving chloramphenicol are at risk for developing aplastic anemia, characterized by bone marrow suppression. Clients should be assessed daily for using signs of bone marrow depression such as sore throat, petechiae, bleeding, and bruising.

24. ANSWER: C.CONCEPT ILLUMINATION

Cooleys anemia, also known as thalassemia major, is characterized by increased destruction of RBCs which in turn leads to anemia. The life span of the RBCs is supposed to be 120 days and in this disorder, it is lesser than expected. As compensatory mechanism of the body, production of RBC is increased but it cannot adequately produce enough mature cells to meet the bodys demands. This process results in chronic hypoxia and iron overload due to the treatment to increase iron to make new RBCs.

25. ANSWER: B.


In thalassemia, RBCs are sequestrated faster than normal. This leads to the overwork of the liver and spleen. Since RBCs are broken down faster, the byproduct which is bilirubin is elevated in the system leading to jaundice. The classic manifestation of decreased level of RBC is easy fatigability therefore the client will benefit if rest and activities are simultaneously done to alleviate fatigue at the same time decreasing the workload of the heart in compensating to hypoxia.

26. ANSWER: B.


It is expected in thalassemia that iron levels will be elevated due to excessive and fast RBC break down. Deferoxamine mesylate is given as antidote to elevated iron by increasing excretion of iron in the urine and feces.

27. ANSWER: A.


When sickled cells obstruct the blood vessels, known as vasoocclusive crises, the occlusion will result to ischemia and necrosis. Due to lack of oxygenation, anaerobic respiration takes place leading to the formation of lactic acidosis that is damaging to the cells. The affected extremities are most painful during this acute sickle cell crisis. Comfort is a priority.

28. ANSWER: D.


Sickle cell anemia is not given with iron, rather what needed is folic acid for red blood cell production. Adequate hydration is also necessary because dehydration is the predisposing factor for the development of the most crucial complication, which is vasoocclusive crisis.

29. ANSWER: B.CONCEPT ILLUMINATION

Sequestration crisis is evidenced by paleness and hypotension. Sequestration crisis takes place when the RBC rapidly enters the spleen and hastily broken down. Due to rapid loss of RBC, sudden hypoxia is experienced leading to pallor and hypotension.

30. ANSWER: A.


During the infection and stress of the sickle cell crisis, the bodys immune system is compromise. The parents should appreciate the need to isolate the child from known sources of infection for at least a few weeks after hospitalization, until the immune system is recovered. Fluids are not restricted. Hydration is necessary for hemodilution, which prevents sickling. Discussing about trait transmission is appropriate intervention following the initial diagnosis.

31. ANSWER: C.


Since most of the blood is directed into the spleen, this organ overworks leading to the increased in size or splenomegaly. The liver also compensates leading to its enlargement. Since both organ continuously work and enlarged, abdominal pain is experienced by the client. All of these findings support a sequestration crisis. Hyperhemolytic crisis is seen on clients due to ABO incompatibility. Vasoocclusive crisis is predisposed by dehydration and infection and is evidenced by pain. Sickle cell crisis is the general term for the entire crisis that happens in clients with sickle cell anemia.

32. ANSWER: D.


During organogenesis, the fetus rapidly needs blood and blood components for its growth. Sickle cell crisis is usually seen during this stage. This condition is managed by exchange transfusion, oxygen and IV fluids. The client usually needs a stronger analgesic than acetaminophen to control the pain of a crisis but in this scenario, the analgesic could cause teratogenic effects and should be cautioned. Antihypertensive drugs usually are not necessary. Diuretic will not be used unless fluid overload resulted.

33. ANSWER: B.


When administering heparin, the laboratory value that reflects its effectivity is the activated partial thromboplastin time. The normal level is 30 to 40 seconds in a client not taking the drug, but when under the medication, desired anticoagulant effectivity is evidence by 1.5 to 2 times normal. Heparin does not affect blood viscosity. While anticoagulants help prevent thrombi that could block cerebral circulation, they do not increase cerebral perfusion so will not affect existing confusion. Although absence of bleeding suggests that the drug has not reached toxic levels, it does not indicate its effectiveness.

34. ANSWER: C.


Polycythemia vera is characterized by elevated levels of RBC, WBC, and platelets. All of these blood components are increased than normal and will result in pathologically high concentrations of blood known as increased viscosity. When the blood is concentrated, coagulation easily takes place leading to thrombosis formation.

35. ANSWER: A.


Because of excessive blood components, the treatment for this disease is to remove the excess blood through phlebotomy. The blood that is usually removed is 500 mL at a time. More than this level, the body will perceive it as hemorrhage and will start to develop manifestations of shock. Hemoglobin and hematocrit are expected to be high, making option B incorrect. Petechiae and purpura are only seen in thrombocytopenia, but in polycythemia vera, platelet level is elevated. Blood transfusion is necessary only if shock developed.

36. ANSWER: B.


When all blood components are elevated, this is usually known as polycythemia vera. Due to elevated RBC, WBC, and platelets, the blood becomes concentrated and viscous making it easier for coagulation. Due to coagulation, thrombus and emboli are formed. The presence of occlusion is manifested by headache, dyspnea when it migrates to the lungs, and claudication or pain during activity. Hemoglobin is above 13 mg/dl in polycythemia vera. Fatigue is experienced when there is decreased in RBC count, as well as bleeding if platelet count is decreased. Back pain is experienced in hemolytic anemia, ecchymosis in platelet disorders, and joint tenderness in hemophilia.

37. ANSWER: D.


In leukemic clients, chemotherapy is one of the treatment regimens. After chemotherapy, tumor lysis syndrome may occur as a result of cellular destruction. This leads to the release of intracellular components such as uric acid, resulting in hyperuricemia. Hyperuricemia is managed with IV fluids and allopurinol.

38. ANSWER: A.


Neutropenia is a condition wherein the level of neutrophils is decreased. Neutrophils are the primary white blood cell that migrates to the area where the pathogen resides. When the value of this white blood cell is decreased, the client is at risk for acquiring and not being able to fight acute infection. Perineal care after each bowel movement, preferably with an antimicrobial soap, is performed to reduce bacteria on the skin, which can easily enter the body because of the absence of one of its primary defenses.

39. ANSWER: D.


The treatment using busulfan should resume when the WBC count rises to the normal value, which is 50,000/mm3. If lesser than this value, the client is at risk for infection and further myelosuppression. The other options, hair growth and anemia, are not the signal for the resumption of busulfan treatment.

40. ANSWER: B.


Acute lymphocytic leukemia (ALL) usually occurs in the very young population. This is characterized by fever, petechiae, recurrent infections and bruising. This condition is treated with chemotherapy and radiation therapy which leads to the manifestation of the client being nauseated. ALL could invade the central nervous system, and clients experience headaches and vomiting from meningeal irritation. Gastric distension is not related to ALL.

41. ANSWER: C.


Pseudomonas aeruginosa, like Escherichia coli, are internal bacteria in the body. They are capable of causing infection by attacking the body when the immune system is depressed.

42. ANSWER: C.


Leukocytosis or elevated WBC count is manifested by shortness of breath, dyspnea which in turn leads to confusion due to problem in oxygenation. Most of the WBCs thrive in the capillaries, inhibiting blood flow, leading to the alteration in oxygenation and problems in perfusion to the lungs and brain.

43. ANSWER: A.CONCEPT ILLUMINATION

Methotrexate is given via the spinal canal or known as intrathecal route. This route is directed to act in the central nervous system and is protected by the blood-brain barrier. Lingual route is done when the drug is placed under the tongue then the medication is absorbed directly into the blood stream. Intraosseous route is done when a needle is inserted in the medullary cavity of the long bone, most often the distal femur or proximal tibia. Topical route is done when medication is administered between the skin layers.

44. ANSWER: D.


The number of normal white blood cells that are capable of fighting an infection is reduced in leukemia. Although there is an increased number of immature WBCs, they are unable to combat infection. Therefore, a child with leukemia is subject to infection. The major morbidity and mortality factor associated with leukemia is infection resulting from the presence of granulocytopenia.

45. ANSWER: C.


Fribinogen is one the components of the clotting process, which is converted to fibrin or a clot. The normal fibrinogen level is 200-400mg/dL and declining value of this component means that fibrinogen is often used and clot formation occurs in the body. The physician should be notified for this sign of clotting. The other findings in the laboratory results are within normal range.

46. ANSWER: C.


In idiopathic thrombocytopenia purpura, the platelet count is decreased. Because of thrombocytopenia, bleeding tendencies are expected. The nurse should assess for any type of bleeding that may be occurring. A young female client would present with excessive menstrual bleeding known as menorrhagia.

47. ANSWER: D.


In disseminated intravascular coagulation, clotting occurs inside the blood vessel. When the client places pillows under the knees, this interrupts blood flow and may predispose to the development of clot in the area. The occlusion formed may cause ischemia. 48. ANSWER: C.


Ibuprofen is hepatotoxic and alters the mucosa of the gastric area, which can lead to peptic ulcers and liver affectation. Having history of chronic hepatitis C also alters the function of the liver in producing clotting factors. Valve replacement surgery necessitates the intake of anticoagulant drugs to prevent complications. All of these contribute to bleeding tendencies.

49. ANSWER: B.


A splenectomy may be done as treatment for thrombocytopenia, as a way of increasing the number of platelets in circulation. The other surgeries are not performed for thrombocytopenia.

50. ANSWER: B.


Hemophilia is an X-linked genetic disorder, wherein only females carry the genes and pass it only to their female children. The female child will then become a carrier. But male children are the manifestators of the signs and symptoms but they cannot carry the gene.

51. ANSWER: D.


Hemarthrosis is bleeding in the joints, which prevents the child from moving the area due to pain and tenderness. Therefore, an early sign of hemarthrosis would be the childs reluctance to move a body part. Hemarthrosis is a classic sign commonly seen in Hemophilia A. If the bleeding into the joint continues, the area becomes hot, swollen, and immobile, not cool, pale, and clammy. Ecchymosis formation around a joint would be difficult to assess. Instability of a long bone on passive movement is not associated with joint hemarthrosis.

52. ANSWER: C.


The joints should be elevated and immobilized during bleeding episodes. This will prevent crippling effects of joint degeneration, which is a specific problem with hemarthrosis. Pressure to the area must be applied for at least 10 to 15 minutes to allow for clot formation. Cold instead of warm packs or compresses are used to promote vasoconstriction to stop or minimize the bleeding. Passive range of motion exercises start after the acute phase. The response in option c is too general to be correct.

53. ANSWER: D.


Children with hemophilia are at risk for bleeding and injury. The most important precaution of clients with this disorder is to contact sports and to take precautions such as wearing elbow and knee pads and helmets with other sports. Swimming is the best sport for the child.

54. ANSWER: B.


The source of factor VIII concentrate is the large collection of human plasma. With this, the risk of hepatitis is always present. Clinical manifestations of hepatitis include yellowing of the skin, mucous membranes, and sclera. Use of factor VIII concentrate is not associated with abdominal distention, constipation or puffiness around the eyes.

55. ANSWER: A.


It is important to stress out that injury prevention the primary concern in hemophilia. Therefore, immunizations, dental hygiene, and routine well-child care need not to be delayed or cancelled. The parents are also instructed in the measures to implement in the event of blunt trauma, especially trauma involving the joints, and to apply prolonged pressure to superficial wounds until the bleeding has stopped.

126-145 hema

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