Nokea
The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia?
- A. Erythrocytes that are microcytic and hypochromic
- B. Erythrocytes that are macrocytic and hyperchromic
- C. Clustering of platelets with sickled red blood cells
- D. An increased number of erythrocytes
Correct Answer: A
Rationale: A blood smear reveals erythrocytes that are microcytic (smaller than normal) and hypochromic (lighter in color than normal). It does not reveal macrocytic (larger than normal) or hyperchromic erythrocytes. Clustering of platelets with sickled red blood cells would indicate sickle cell anemia. An increase in the number of erythrocytes would indicate polycythemia vera.
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A client diagnosed with polycythemia vera has come into the clinic because they have developed a night-time cough, fatigue, and shortness of breath. From these clinical manifestations, what complication would the nurse suspect in this client?
- A. Stroke
- B. Tissue infarction
- C. Congestive heart failure
- D. Pulmonary embolus
Correct Answer: C
Rationale: The symptoms exhibited by this client are indicative of heart failure. Complications of polycythemia vera include hypertension, heart failure, stroke, tissue and organ infarction, and hemorrhage.
A client is seen in the emergency department with severe pain related to a sickle cell crisis. What does the nurse understand is occurring with this client?
- A. The client has a decreased tolerance of pain related to the chronic nature of the illness.
- B. Bone marrow decreases the erythrocyte production causing decrease in hypoxia.
- C. Overhydration enlarges the red blood cells.
- D. Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.
Correct Answer: D
Rationale: The person with sickle cell disease repeatedly suffers from two major problems: (1) episodes of sickle cell crisis from vascular occlusion, which develops rapidly under hypoxic conditions, and (2) chronic hemolytic anemia. During a sickle cell crisis, the sickle-shaped cells lodge in small blood vessels, where they block the flow of blood and oxygen to the affected tissue. The vascular occlusion induces severe pain in the ischemic tissue. The client may have increased tolerance for pain due to the chronic nature of the illness. Bone marrow increases the erythrocyte production. Underhydration increases the client's risk of developing a vaso-occlusive crisis.
A teenaged client with hemophilia sustains a leg laceration after falling off a skateboard and is brought to the emergency department. The laceration is bleeding profusely even with direct pressure to the site. What does the nurse anticipate will be prescribed for administration to control bleeding?
- A. Fresh frozen plasma
- B. A colloid solution such as hetastarch (Hespan)
- C. A crystalloid solution such as lactated Ringer's
- D. Albumin
Correct Answer: A
Rationale: Treatment includes transfusion of fresh blood, frozen plasma, factor VIII concentrate, and anti-inhibitor coagulant complex for hemophilia A, factor IX concentrate for hemophilia B, factor XI for hemophilia C, and the application of thrombin or fibrin to the bleeding area. Other measures used to help control bleeding are the administration of fresh frozen plasma, aminocaproic acid that helps to hold a clot in place once it has formed, direct pressure over the bleeding site, and cold compresses or ice packs. Hetastarch, lactated Ringer's, or albumin will not control the bleeding related to hemophilia.
A client with sickle cell disease informs the nurse that he is having chest pain. The nurse hears the client coughing, wheezing, and breathing rapidly. What does the nurse suspect is occurring with this client?
- A. Vaso-occlusive crisis
- B. Pneumocystis pneumonia
- C. Acute chest syndrome
- D. Acute muscular strain
Correct Answer: C
Rationale: One of the unique manifestations of sickle cell disease is 'acute chest syndrome,' a type of pneumonia triggered by decreased hemoglobin and infiltrates in the lungs. Acute chest syndrome is characterized by respiratory symptoms, such as coughing, wheezing, tachypnea, and chest pain. Vaso-occlusive crisis causes decrease in tissue perfusion and predisposes the client to pneumonia but is not the present problem with this client. Pneumocystis pneumonia is present in the client with HIV/AIDS or other immunocompromised clients. The client's symptoms do not correlate with a diagnosis of acute muscular strain.
A client who is diagnosed multiple myeloma experiences decreased production of red blood cells (RBCs). Which prescribed medication should the nurse prepare to administer to increase the production of erythrocytes?
- A. Filgrastim
- B. Pegfilgrastim
- C. Erythropoietin
- D. Dexamethasone
Correct Answer: C
Rationale: The medication erythropoietin can be used to stimulate the production of red blood cells; therefore, this is the prescribed medication that the nurse prepares to administer to the client. Filgrastim and pegfilgrastim promote proliferation of neutrophils, not erythrocytes. Dexamethasone is a corticosteroid that is prescribed for clients who are diagnosed with multiple myeloma to inhibit the inflammatory immune response.