CH 34: Coordinating Care for Patients with Hematological Disorder

An older adult patient with renal failure is diagnosed with anemia. Based on this data, which cause of anemia will the nurse include in the plan?

1. Loss of the kidney hormone erythropoietin

2. A loss of appetite related to elevated blood urea nitrogen (BUN) and creatinine levels

3. The renal dialysis used to treat the chronic renal failure

4. Loss of blood through the urine because the failing kidney does not function properly

ANS: 1

loss of kidney hormone EPO: kidney makes EPO —> stimulates marrow to produce RBCs.

Renal failure = ↓ EPO

The nurse conducts a teaching session for a patient who is diagnosed with iron deficiency anemia. Which patient statement indicates to the nurse a need for additional teaching?

1. “I will add beets to my salad.”

2. “I will increase my intake of meats.”

3. “I will eat an egg each day for breakfast.”

4. “I will include dark-green vegetables in my diet.”

ANS 3:

egg a day for breakfast: eggs are richer with vitamin B₁₂, not iron.

The nurse prepares to administer the prescribed intramuscular injection (IM) iron to a patient. Which is the priority action for this task?

1. Using the Z-track method

2. Assessing for tachycardia

3. Applying pressure to the injection site

4. Monitoring the patient for cardiotoxic effects

ANS: 1

z-track method: prevents leakage into tissue —> prevents straining

The nurse is evaluating a patient’s understanding of dietary needs to treat anemia. Which patient statement indicates a need for additional teaching?

1. “I will eat more fruits and vegetables, especially green leafy ones, to get more iron in my diet.”

2. “I will need to include more protein foods in my diet such as meats, dried beans, and whole-grain breads.”

3. “I will decrease foods high in vitamin C because they decrease the absorption of iron.”

4. “I will take vitamins with extra iron in addition to eating a balanced diet with meat to correct my anemia.”

ANS: 3

decrease vitamin C foods because it decreases absorption of iron: this is the opposite. vitamin C increases iron absorption.

WRONG:

(1) more fruits/veggies esp. green leafy, (2) more protein foods, (4) iron vitamins + balanced diet: are all ways to increase iron

The home healthcare nurse is preparing a care plan for a patient with severe anemia. The patient currently lives alone and states, “I can’t even walk to the kitchen without getting winded.” What would be the priority nursing diagnosis for this patient?

1. Self Care Deficit

2. Activity Intolerance

3. Impaired Mobility

4, anxiety

ANS: 2

Activity intolerance: key problem is physiologic limitation due to low oxygen carrying capacirt

A nurse is providing discharge instructions to a patient with iron deficiency anemia who is experiencing glossitis. Which patient statement indicates the need for further education?

1. “I will monitor my lips and tongue daily.”

2. “I will use an alcohol-based mouthwash twice per day.”

3. “I will apply a petroleum-based lubricating ointment to my lips.”

4. “I will use a soft toothbrush when brushing my teeth each day.”

ANS: 2

i will use an alcohol-based mouthwash twice per day: alcohol worsens oral irritation/drying

WRONG:

(1) Monitor lips/tongue daily, (3) petroleum ointment on lips, (4) soft toothbrush are all correct

The nurse is instructing a patient with iron deficiency anemia about appropriate menu choices. Which diet choice indicates that teaching has been effective?

1. Tofu with mixed vegetables in curry, milk, whole-wheat bun

2. Broiled fish, lettuce salad, grapefruit half, carrot sticks

3. Pork chop, mashed potatoes and gravy, cauliflower, tea

4. Roast beef, steamed spinach, tomato soup, orange juice

ANS: 4

roast beef, steamed spinach, tomato soup, orange juice:

Beef: iron

Spinach: folate/iron support

orange juice: vitamin C increases absorption

❌ 1 Includes milk (calcium) and isn’t focused on high iron
❌ 2 Low iron overall
❌ 3 Tea can inhibit iron absorption; lacks vitamin C assist

The nurse is providing discharge teaching for a patient with iron deficiency anemia. The patient has been prescribed ferrous sulfate and has been told to increase the intake of foods that are naturally high in iron. Which patient statement indicates the need for additional teaching?

1. “I will increase my intake of green leafy vegetables.”

2. “I will increase my fluid intake while I am taking ferrous sulfate.”

3. “I will take my ferrous sulfate tablet on an empty stomach.”

4. “I will increase dried beans in my diet.”

ANS: 3

take ferrous sultafe table on empty stomach: taking iron with a meal can reduce GI irritation and improve tolerance/adherence

❌ 1 Green leafy vegetables = good iron source
❌ 2 Increase fluids helps constipation
❌ 4 Dried beans = good iron source

The nurse develops the nursing diagnosis “Risk for Bleeding related to lack of intrinsic factor” for the patient with which hematological disorder?

1. Iron deficiency anemia

2. Pernicious anemia

3. Folic acid deficiency anemia

4. Glucose-6-phosphate dehydrogenase (G6PD) deficiency

ANS: 2

Pernicious anemia: intrinsic fator lack → B₁₂ absorption problem → pernicious anemia

A patient complaining of mouth soreness had gastric bypass surgery 1 year ago. During the assessment, the nurse notes the patient’s tongue is beefy, red, and smooth and the patient’s skin appears yellowish. The nurse correlates these findings to a decreased value of which diagnostic test?

1. Vitamin B6 levels

2. Vitamin B12 levels

3. Platelet count

4. Iron levels

ANS: 2

Vitamin B12 levels: classic B12 deficiency pattern with absorption issues post bypass

WRONG:

❌ 1 B6 not typical for this presentation
❌ 3 Platelet count doesn’t explain beefy tongue + jaundice
❌ 4 Iron levels = different anemia pattern

A patient experiencing fatigue, pallor, and dyspnea on exertion has a complete blood count completed. The nurse correlates these clinical manifestations to which hematological disorder?

1. Polycythemia

2. Thrombocytopenia

3. Neutropenia

4. Anemia

ANS: 4

Anemia: core anemia manifestations

=fatigue, pallor, and dyspnea with work are symptoms of anemia

WRONG:

❌ 1 Polycythemia = too many RBCs
❌ 2 Thrombocytopenia = bleeding risk
❌ 3 Neutropenia = infection risk

The nurse provides care for a patient who is diagnosed with a folic acid deficiency anemia. Which clinical manifestation requires healthcare provider notification?

1. Pallor

2. Eupnea

3. Confusion

4. Tachycardia

ANS: 3

Confusion sigals poor tissue perfusion/worsening severity

Vitamin B9 / Folic acid delivers oxygen to the brain. so once the anemia is caused by folic acid, worsening conditions signs that are needed to be reported is confusion, since this is. major telling of folic acid deficiency anemia

patient in sickle cell crisis reports taking a recent skiing trip that caused a respiratory infection from the cold weather. Which nursing diagnosis is a priority for this patient?

1. Fluid Volume Excess

2. Impaired Mobility

3. Knowledge Deficit

4. Acute Pain

ANS: 4

Acute pain: vaco-occlusion —> severe painis primary phyiologic priority here

WRONG:

❌ 1 Fluid Volume Excess (more likely deficit risk)
❌ 2 Impaired Mobility could occur secondary
❌ 3 Knowledge Deficit may exist (altitude/cold exposure), but is not the main priority

The nurse provides care to a patient who is admitted for a sickle cell disease (SCD) crisis. Which is the priority prescription for the nurse to implement when providing patient care?

1. Administering oxygen

2. Administering antipyretics

3. Administering pain medication

4. Administering intravenous fluid

ANS: 1

administering oxygen: ABCs —> treat hypoxia first to reduce sickling severity

WRONG:

❌ 2 Antipyretics helpful but not first
❌ 3 Pain meds important but after oxygen if oxygenation issue
❌ 4 IV fluids important but after oxygen per ABC prioritization

A patient is admitted to the emergency department in a sickle cell crisis. The nurse assesses the patient and documents the following clinical findings: temperature 102°F, O2 saturation of 89%, and complaints of severe abdominal pain. Based on the assessment findings, which intervention is the greatest priority?

1. Apply oxygen per nasal cannula at 3 L/minute.

2. Assess and document peripheral pulses.

3. Administer morphine sulfate 10 mg IM.

4. Administer Tylenol 650 mg by mouth.

ANS: 1

oxygen NC 3 L/minute

O₂ sat 89% = hypoxia —> immediate ABC intervention

WRONG:

❌ 2 Pulses: assessment important but after stabilizing oxygenation
❌ 3 Morphine: addresses pain but after oxygen started
❌ 4 Tylenol: addresses fever but not first over hypoxia

A nurse is planning care for a patient with sickle cell disease. The nurse should contact the provider about which prescribed intervention?

1. Administer ordered analgesic medications around the clock

2. Place patient in position of comfort

3. Use heat or cold packs as tolerated

4. Support the patient’s joints and extremities with pillows

ANS: 3

use heats/cold packs as tolerated: CONTRAINDICATED

cold: SICKLING — rapid transformation of red blood cells to stiff, crescent shapes due to reduced blood flow (vasoconstriction) and low oxygen levels

heat: burn with risk of ischemia

WRONG:

❌ 1 Around-the-clock analgesics = appropriate
❌ 2 Position of comfort = appropriate
❌ 4 Pillow support of joints/extremities = appropriate

Which is the priority teaching point for the nurse to include in the discharge instructions for the patient being discharged after treatment for sickle cell crisis?

1. Rapid weaning of pain medications

2. A diet high in protein

3. Adequate hydration

4. Restriction of activities

ANS: 3

Adequate hydration: prevents dehydration-triggered sickling/crisis

WRONG:

❌ 1 Rapid weaning pain meds: after a crisis, pain meds should be decreased gradually based on the patient’s pain, not “rapidly”
❌ 2 High protein diet not required (balanced diet)
❌ 4 Normal activities not necessarily restricted

A patient diagnosed with aplastic anemia is admitted to the hospital. In teaching the patient and family about this disease process, what information does the nurse include?

1. “Aplastic anemia causes a proliferation of white blood cells.”

2. “Aplastic anemia is characterized by abnormally shaped red blood cells.”

3. “Aplastic anemia is caused by the bone marrow producing inadequate cells.”

4. “Aplastic anemia is a disorder that occurs after a viral illness.”

ANS: 3

Bone marrow producing inadequate cells

WRONG:

❌ 1 Proliferation of WBCs: leukemia concept
❌ 2 Abnormally shaped RBCs: sickle cell concept
❌ 4 “Occurs after viral illness”: not supported in your rationale set

Which statement by a 65-year-old patient diagnosed with aplastic anemia secondary to chemotherapy indicates the need for further teaching?

1. “I am looking forward to getting a bone marrow transplant.”

2. “I will be receiving medications that stimulate my bone marrow.”

3. “I may need blood transfusions.”

4. “I need to get my counts up to improve energy and decrease the risk of infection.”

ANS: 1

looking forward for bone marrow transplant: older adults over 60 are often not transplant candidates. chemo-related is commonly treated with marrow-stimulating meds/support

The nurse monitors for which diagnostic result in the patient with glucose-6-phosphate dehydrogenase (G6PD) deficiency?

1. Decreased reticulocyte count

2. Presence of Heinz bodies

3. White blood cells in the urine

4. Elevated platelets

ANS: 2

Presence of Heinz Bodies: key smear finding

WRONG:

❌ 1 Retic count is typically increased, not decreased
❌ 3 WBC in urine unrelated
❌ 4 Platelets not elevated as the hallmark

The nurse correlates appropriate secondary polycythemia to which of the following conditions?

1. Renal disease

2. Cancer

3. High altitudes

4. Cold temperatures

ANS: 3

high altitudes: low oxygen tension —> compensatory ↑ RBC production

WRONG:

❌ 1 Renal disease ❌ 2 Cancer → more consistent with inappropriate secondary polycythemia (excess EPO) in your rationale set
❌ 4 Cold temperatures not associated

A patient diagnosed with polycythemia is prescribed radiation, and asks the rationale for this treatment. Which response by the nurse is accurate?

1. “It stimulates red blood cell production.”

2. “It suppresses the bone marrow.”

3. “It provides vitamin supplementation.”

4. “It decreases the risk of transfusion reactions.”

ANS: 2

supresses the bone marrow: this decreases RBC production

WRONG:

❌ 1 Stimulates RBC production = opposite
❌ 3 Vitamin supplementation not the mechanism
❌ 4 Not about transfusion reactions

In administering cryoprecipitate to a patient diagnosed with idiopathic thrombocytopenia purpura, the nurse recognizes which of the following actions as the rationale for this treatment?

1. Increases plasma volume

2. Prevents platelet destruction

3. Provides clotting factors

4. Promotes platelet production

ANS: 3

provides clotting factors: cryoprecipirate is clotting-factor rich (factor VII)

WRONG:

❌ 4 Doesn’t stimulate platelet production

The nurse is planning care for a patient with acute myeloid leukemia (AML). Which is the priority nursing diagnosis to minimize the risk of complications associated with this diagnosis?

1. Risk for Bleeding

2. Impaired Mobility

3. Imbalanced Nutrition

4. Fluid Volume Excess

ANS: 1

risk for bleeding: thrombocytopenia common —> bleeding risk

In providing care for a patient with malignant lymphoma, the nurse correlates which clinical manifestations to the development of superior vena cava syndrome?

1. Decreased peripheral pulses

2. Decreased reflexes

3. Tachycardia

4. Shortness of breath

ANS: 4

shortness of breath: SVC compression —> venous congestion + respiratory distress

TERM: SVC syndrome
→ main issue is venous congestion and impaired venous return, not a primary heart-rate abnormality

—> the hallmark findings are upper body swelling and respiratory symptoms, not changes in heart rate

WRONG;

❌ 1 Decreased peripheral pulses not typical
❌ 2 Decreased reflexes not related
❌ 3 Tachycardia is not a clssic or defining manifestation of SVC syndrome, and it does not directly reflect the pathopgysiology of vena cava compression

The nurse correlates which diagnostic finding to a diagnosis of multiple myeloma?

1. Serum calcium 8.5 mg/dL

2. Serum creatinine 2.2 mg/dL

3. Hemoglobin 18 g/dL

4. Serum BUN 15 mg/dL

ANS: 2

serum creatinine 2.2 mg/dL: CRAB: renal insufficiency is common

multiple myeloma is the cancer of overproduction of abnormal antibofdies (M proteins) and light chains (bence jones proteins)

THESE PROTEINS ARE TOXIC TO THE KI8DNEY, so creatinine levels will be high

❌ 1 Calcium 8.5 = normal/low (myeloma tends toward high calcium)
❌ 3 Hemoglobin 18 = high (myeloma tends toward anemia)
❌ 4 BUN 15 = normal

A patient with a history of anemia has started a vegan diet. Which addition to meals should the nurse recommend to help ensure that this patient has adequate amounts of iron in the diet? Select all that apply.

1. Legumes

2. Orange juice

3. Brewer’s yeast

4. Okra

5. Peas

ANS: 1,2,5

✅ 1 Legumes: nonheme iron
✅ 2 Orange juice: vitamin C boosts adaptation
✅ 5 Peas: nonheme iron

WRONG:

❌ 3 Brewer’s yeast (more associated with B12 support in your rationale)
❌ 4 Okra (not a strong iron source per your table)

A nurse educator is teaching a group of patients about prevention of sickle cell crises. What should the nurse instruct about the precipitating factors that could contribute to a sickle cell crisis? Select all that apply.

1. Increased fluid intake

2. Altitude

3. Fever

4. Vomiting

5. Regular exercise

✅ 2 Altitude (low O2)
✅ 3 Fever (↑ metabolic demand, dehydration risk)
✅ 4 Vomiting (dehydration)

WRONG:

❌ 1 Increased fluids helps prevent crisis
❌ 5 Regular exercise generally recommended as tolerated

The nurse correlates which diagnostic results to the patient with pancytopenia? Select all that apply.

1. Decreased reticulocyte count

2. Increased immature neutrophils

3. Platelets 100,000 103 /mm3–

4. RBC 3.2 million cells/mm3

5. WBC 12.0 103 /mm3–

✅ 1 Decreased retic count — it means that there is now less new RBCs
✅ 3 Platelets 100,000/mm³ (low)
✅ 4 RBC 3.2 million/mm³ (low)

TERM: reticulocyte count
→ number of new red blood cells produced from the bone marrow

❌ 2 Increased immature neutrophils = infection response pattern
❌ 5 WBC 12,000/mm³ = elevated, not “pancytopenia”

The nurse provides discharge instructions to a patient who is neutropenic. Which patient statements indicate the need for additional teaching? Select all that apply.

1. “My plants are being moved outside.”

2. “I will avoid eating raspberries and blackberries.”

3. “I will use a humidifier to moisten the air at night.”

4. “I will wash all raw vegetables before eating them.”

5. “My prescribed antibiotic can be stopped once I feel better.”

✅ 3 Humidifier at night (standing water breeds mold/bacteria)
✅ 5 Stop antibiotic when feel better (must complete full course)

WRONG:

❌ 1 Plants moved outside = correct (no live plants indoors)
❌ 2 Avoid raspberries/blackberries = correct (hard to wash)
❌ 4 Wash raw vegetables = correct

The nurse monitors for which clinical manifestations in the patient diagnosed with malignant lymphoma? Select all that apply.

1. Night sweats

2. High fevers

3. Swollen lymph nodes

4. Painful lymph nodes

5. Weight loss

✅ 1 Night sweats
✅ 3 Swollen lymph nodes (painless)
✅ 5 Weight loss

❌ 2 High fevers (classically low-grade in your rationale)
❌ 4 Painful lymph nodes (classically painless)