Nokea
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
Correct Answer: A
Rationale: Cardiac status must 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.
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A patient with a history of atrial fibrillation has contacted the clinic saying that she has accidentally overdosed on her prescribed warfarin (Coumadin). The nurse should recognize the possible need for what antidote?
- A. IVIG
- B. Factor X
- C. Vitamin K
- D. Factor VIII
Correct Answer: C
Rationale: Vitamin K is administered as an antidote for warfarin toxicity.
A patient with poorly controlled diabetes has developed end-stage renal failure and consequent anemia. When reviewing this patient's 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
Correct Answer: B
Rationale: 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.
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
Correct Answer: D
Rationale: 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.
A patient with a recent diagnosis of ITP has asked the nurse why the care team has not chosen to administer platelets, stating, â??I have low platelets, so why not give me a transfusion of exactly what I'm missing?â?? How should the nurse best respond?
- A. Transfused platelets usually aren't beneficial because they're rapidly destroyed in the body.
- B. A platelet transfusion often blunts your body's own production of platelets even further.
- C. Finding a matching donor for a platelet transfusion is exceedingly difficult.
- D. A very small percentage of the platelets in a transfusion are actually functional.
Correct Answer: A
Rationale: Despite extremely low platelet counts, platelet transfusions are usually avoided. Transfusions tend to be ineffective not because the platelets are nonfunctional but because the patient's antiplatelet antibodies bind with the transfused platelets, causing them to be destroyed. Matching the patient's blood type is not usually necessary for a platelet transfusion. Platelet transfusions do not exacerbate low platelet production.
A group of nurses are learning about the high incidence of anemia prevalence of anemia among different populations. Which of the following patients would be the most likely to suffer from anemia a patient?
- A. A 50-year-old African American woman who is going through menopause
- B. An ?¾?????°?½?° ?? 80??80 elderly woman who has a diagnosis of heart failure
- C. A 48-year-old man who travels widely and has a high pressure job
- D. A 13-year-old girl who has just commenced menstruation
Correct Answer: B
Rationale: 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.