Sickle Cell Anemia NCLEX QUESTIONS (med surg final)

A newly admitted client has sickle cell crisis. The nurse is planning care based on assessment of the client. The client is complaining of severe pain in his feet and hands. The pulse oximetry is 89. Which of the following interventions would be implemented first? Assume that there are orders for each intervention.

a. Adjust the room temperature

b. Give a bolus of IV fluids

c. Start O2

d. Administer meperidine (Demerol) 75mg IV push

C

A 43-year-old African American male is admitted with sickle cell anemia. The nurse plans to assess circulation in the lower extremities every 2 hours. Which of the following outcome criteria would the nurse use?

A. Body temperature of 99°F or less

B. Toes moved in active range of motion

C. Sensation reported when soles of feet are touched

D. Capillary refill of < 3 seconds

D

A 25-year-old male is admitted in sickle cell crisis. Which of the following interventions would be of highest priority for this client?

A. Taking hourly blood pressures with mechanical cuff

B. Encouraging fluid intake of at least 200mL per hour

C. Position in high Fowler's with knee gatch raised

D. Administering Tylenol as ordered

B

A 14 year old girl has been hospitalized with Sickle Cell Anemia in vasoocclusive crisis. Which of these Nursing diagnoses should receive priority in the Nursing plan of care? --

A. Impaired social interaction --

B. Alteration in body image --

C. Pain --

D. Alteration in tissue perfusio

D

Which of the following foods would the nurse encourage the client in sickle cell crisis to eat? --

A. Peaches --

B. Cottage cheese --

C. Popsicles --

D. Lima beans

C

The male client with sickle cell anemia comes to the emergency room with a temperature of 101.4 F and tells the nurse that he is having a sickle cell crisis. Which diagnostic test should the nurse anticipate the emergency room doctor ordering for the client? --

A. Spinal tap. --

B. Hemoglobin electrophoresis. --

C. Sickle-turbidity test (Sickledex). --

D. Blood cultures.

D

A Client in crisis should:

1. Management of Pain

2. Administration of oxygen

3. Promoting Hydration to decrease blood viscocity

4. Monitor for

The nurse is teaching a group of parents whose children have sickle cell anemia. When a parent asks the cause of the symptoms, the nurse responds with which of the following?

"Sickled cells clump in the smaller blood vessels and obstruct blood flow."

Rationale:

All the symptoms of sickle cell are a result of the clumping of the sickled cells in the microvasculature, causing obstruction of blood flow. The other statements are inaccurate.

A child with suspected sickle cell disease (SCD) is in the clinic for laboratory studies. The parents ask the nurse what results will tell the physician that their child has SCD. The nurse responds that which of the following is increased in this disease?

Reticulocyte count

Rationale:

The reticulocyte count will be increased because the life span of sickled red blood cells is shortened. Hemoglobin, hematocrit, and platelet levels will be decreased.

A pregnant woman tells the nurse that there is a history of sickle cell disease in her family and she is afraid that the baby will have the disease. The nurse provides the client with which of the following information?

Both the mother and father must carry the gene for the baby to be affected.

Rationale:

Sickle cell is inherited as an autosomal recessive disorder. Both parents must carry the gene for the baby to be affected. The other statements are inaccurate.

The nurse is caring for a child who is in the hospital experiencing sickle cell crisis. The parents are asking the nurse which treatment will help cure the child. The nurse responds with which of the following?

Treatment is aimed at pain control, oxygen therapy, and hydration, but does not provide a cure.

Rationale:

Treatment for sickle cell crisis is pain control, oxygenation, and fluid resuscitation. There is no cure for sickle cell disease. The nurse teaches families how to prevent sickle cell crisis.

The nurse is admitting a 7-year-old client who is experiencing sickle cell crisis and plans care based on which of the following nursing diagnoses?

Delayed Growth and Development

Rationale:

The child with sickle cell disease is often developmentally delayed due to the effects of physical disability, pain, and inpatient hospital stays. The nurse would plan activities that help maintain developmental levels the child has reached. The child in sickle cell crisis does not experience ineffective airway clearance, bleeding, or constipation as a result of sickle cell disease. The child may have an illness that could cause one of these symptoms, but they are not common to children with sickle cell disease.

The 24-year old African American female client tells the nurse she has a brother with sickle cell disease. She is engage to be married and is concerned about giving this disease to her future children. which information is most important to provide too the client?

A. tell the client that she won't pass this on if she has never had symptoms

B. Encourage the client to discuss this concern with her fiance

C. Recommend that she and her fiance see a genetic counselor

D. Discuss the possibility of adopting children after she gets married.

C

The nurse is caring for a client in a sickle cell crisis. which is the pain regiment of choice to relieve the pain?

1. Frequent aspirin

2. Motrin

3. Demerol

4. Morphine

4. Morphine

the student nurse asks the nurse, "what is sickle cell anemia?" which statement by the nurse would be the best answer to the student's question?

1. There is some written material at the desk

2. it is a congenital disease of the blood

3. the client has decreased synovial fluid

4. the blood becomes thick when the client is deprived of oxygen

4. sickle cell anemia is a disorder of the client rbcs characterized by abnormally shaped red cells that sickle or clump together, leading to oxygen deprivation and resulting in crisis and severe pain.

the client's nephew has just been diagnosed with sickle cell anemia. the client asks the nurse, "how did my nephew get this disease? which statement would be the best response by the nurse?

1. sickle cell is an inherited autosomal recessive disorder

2. he was born with it and both his parents were carriers of the disease

3. at this time, the cause is unknown

4. your sister was exposed to a virus

2. explained in layman's terms

the client diagnosed with sickle cell anemia comes to the ED c/o joint pain throughout the body. Oral temp 102.4, SpO2 91%. Which action should the nurse implement first:

1. Request ABGs

2. Administer oxygen

3. Start IV

4.Administer analgesic

2

Client is experiencing vaso-occlusive sickle cell crisis secondary to infection. which medical tx should the nurse anticipate

1. administer demerol

2. admit the client to a private room

3. Infuse D5W

4. Insert a 22-french foley

3

Which s/s will the nurse expect to assess in the client diagnosed with a vaso-occlusive sickle cell crisis

1. lordosis

2.epistaxis

3. hematuria

4. petechia

3. Vaso-occlusive crisis, the most frequent crisis, is characterized by organ infarction, which will result in bloody urine secondary to kidney infarction.

A child is suspected of having sickle cell disease is seen in a clinic, and laboratory studies are performed. A nurse checks the laboratory results, knowing that which of the following would be increased in this disease?

1. platelet count

2. hematocrit level

3. reticulocyte count

4. Hemoglobin level

answer: 3

Rationale: A diagnosis is established based on a complete blood count, examination for sickled red blood cells in the peripheral smear, and hemoglobin electrophoresis. Laboratory studies will show decreased hemoglobin and hematocrit levels and a decreased platelet count, an INCREASED reticulocyte count and the presence of nucleated red blood cells. Increased reticulocyte counts occur in children with sickle cell disease because the life span of their sickled red blood cells is shortened.

A pediatric nursing instructor asks a nursing student to describe the cause of the clinical manifestations that occur in sickle cell disease. The student responds correctly by telling the instructor that

1. Sickled cells increase the blood flow through the body and cause a great deal of pain.

2. sickled cells mix with the unsickled cells and cause the immune system to become depressed.

3. bone marrow depression occurs because of the development of sickled cells.

4. sickled cells are unable to flow easily through the microvasculature and their clumping obstructs blood flow.

Answer: 4

Rationale: all of the clinical manifestations of sickle cell disease result from the sickled cells being unable to flow easily through the microvasculature, and their clumping obstructs blood flow. With re-oxygenation, most of the sickled red blood cells resume their normal shape. Options 1, 2, and 3 are incorrect statements.

A clinic nurse instructs the mother of a child with sickle cell disease about the precipitating factors related to pain crisis. Which of the following, if identified by the mother as e precipitating factor, indicates the need for further instructions?

1. infection

2. trauma

3. fluid overload

4. stress

answer: 3

Pain crisis may be precipitated by infection, dehydration, hypoxia, trauma, or physical or emotional stress. THe mother of a child with sickle cell disease should encourage fluid intake of 1.5-2 times the daily requirement to prevent dehydration!

A client with anemia has a nursing diagnosis of activity intolerance. Which of the following interventions will the nurse plan for this client?

1.Promote active and passive range-of-motion activities.

2.Space activities and plan rest periods.

3.Teach the client to change position slowly to prevent dizziness.

4. Teach the client the basics of good nutrition.

answer: Space activities and plan rest periods.

Rationale:

The client with activity intolerance tires easily, so it is best for the nurse to plan care and activities around periods of rest. Teaching good nutrition will not help the client to be less tired. Promoting range of motion does not address the issue of fatigue, nor does teaching the client to change position slowly.

The nurse notes that the client has a low red blood cell count and anticipates which of the following subjective manifestations on assessment?

1.Chest pain

2.Nausea

3.Sore throat

4. Fatigue

Answer:Fatigue

Rationale:

Fatigue would signify that the body's tissues are not receiving enough oxygenation. Sore throat is a sign of infection. Chest pain may indicate an impending myocardial infarction. Nausea is a symptom for many disease processes, but is not typical for anemia.

The nurse is reviewing laboratory findings for a 2-year-old being treated for anemia. Which of the findings is the best indication that goals for this client have been met?

1.The child is no longer cyanotic.

2.The reticulocyte count is rising.

3.The child is more active.

4.Stools are black, indicating iron intake.

Answer:

The reticulocyte count is rising.

Rationale:

An increase in the reticulocyte number means that the body is producing new RBC's. While improved oxygenation, increased activity, and indications of iron intake are desirable outcomes for the child with anemia, they are not laboratory data.

The nurse has admitted a child newly diagnosed with anemia of unknown origin. Which of the following is a priority intervention for the nurse to initiate?

1. Administer fluids to increase cardiac output.

2. Plan for safe care due to weakness.

3.Teach the client about foods with iron.

4. Assess pain level.

Answer:Plan for safe care due to weakness.

Rationale:

The client with anemia is weak and the nurse would address safe care due to weakness. Since the cause of the anemia is undetermined, the nurse would not administer fluids or complete nutritional teaching without additional information. Clients with anemia do not normally have pain; pain is assessed in every client, but is not the priority of care in this client.

The nurse is teaching a group of parents whose children have sickle cell anemia. When a parent asks the cause of the symptoms, the nurse responds with which of the following?

1."Sickled cells clump in the smaller blood vessels and obstruct blood flow."

2."Sickled cells cause bone marrow depression."

3."The sickled cells mix with normal cells, which causes the immune system to be depressed."

4."Sickled cells increase the blood flow through the body, which causes pain."

Your Answer:

"Sickled cells clump in the smaller blood vessels and obstruct blood flow."

Rationale:

All the symptoms of sickle cell are a result of the clumping of the sickled cells in the microvasculature, causing obstruction of blood flow. The other statements are inaccurate.

A child with suspected sickle cell disease (SCD) is in the clinic for laboratory studies. The parents ask the nurse what results will tell the physician that their child has SCD. The nurse responds that which of the following is increased in this disease?

1.Reticulocyte count

2.Hematocrit

3.Hemoglobin

4.Platelet count

Answer:

Reticulocyte count

Rationale:

The reticulocyte count will be increased because the life span of sickled red blood cells is shortened. Hemoglobin, hematocrit, and platelet levels will be decreased.

The nurse is instructing the mother of a child with sickle cell disease about the risk factors for precipitation of sickle cell crisis. Which of the following, if identified by the mother as a precipitating factor, indicates the need for further teaching?

1.Stress

2.Trauma

3.Fluid overload

4.Infection

Answer:

Fluid overload

Rationale:

Sickle cell crisis may be precipitated by dehydration, not fluid overload. Infection, trauma, and stress are all factors that may cause sickle cell crisis.

A pregnant woman tells the nurse that there is a history of sickle cell disease in her family and she is afraid that the baby will have the disease. The nurse provides the client with which of the following information?

1.Sickle cell is a male disease and would be passed on by the baby's father.

2.The baby needs only one parent to be a carrier to be affected.

3.Both the mother and father must carry the gene for the baby to be affected.

4.Genetic testing will be needed to determine if the baby is affected.

Answer:

Both the mother and father must carry the gene for the baby to be affected.

Rationale:

Sickle cell is inherited as an autosomal recessive disorder. Both parents must carry the gene for the baby to be affected. The other statements are inaccurate.

The nurse is caring for a child who is in the hospital experiencing sickle cell crisis. The parents are asking the nurse which treatment will help cure the child. The nurse responds with which of the following?

1. Treatment with an exchange transfusion of blood will cure the child.

2. Treatment with morphine will cure sickle cell disease.

3. There is no treatment for sickle cell crisis.

4. Treatment is aimed at pain control, oxygen therapy, and hydration, but does not provide a cure.

Answer:

Treatment is aimed at pain control, oxygen therapy, and hydration, but does not provide a cure.

Rationale:

Treatment for sickle cell crisis is pain control, oxygenation, and fluid resuscitation. There is no cure for sickle cell disease. The nurse teaches families how to prevent sickle cell crisis.

The nurse is admitting a 7-year-old client who is experiencing sickle cell crisis and plans care based on which of the following nursing diagnoses?

1. Risk for Bleeding

2. Ineffective Airway Clearance

3.Risk for Constipation

4. Delayed Growth and Development

answer:

Delayed Growth and Development

Rationale:

The child with sickle cell disease is often developmentally delayed due to the effects of physical disability, pain, and inpatient hospital stays. The nurse would plan activities that help maintain developmental levels the child has reached. The child in sickle cell crisis does not experience ineffective airway clearance, bleeding, or constipation as a result of sickle cell disease. The child may have an illness that could cause one of these symptoms, but they are not common to children with sickle cell disease.

The nurse is evaluating a child in sickle cell crisis who was at risk for a cerebrovascular accident. The nurse monitors the child by evaluating which of the following?

1.Renal system

2.Neurovascular system

3.Cardiovascular system

4.Gastrointestinal system

Correct Answer:

Neurovascular system

Rationale:

Symptoms of a cerebral vascular accident (CVA) are best noted with an assessment of the neurovascular system. While the other systems may provide some evidence of a CVA, it is the neurovascular system that gives the best informatio

The nurse is planning care for a child who is newly diagnosed with sickle cell disease. Which of the following would the nurse plan with the family to best promote the child's growth and development?

1.Renal health plan

2.Emergency care in the school setting

3.Nutritional support during hospitalizations

4. Individualized school health plan

Answer:

Individualized school health plan

Rationale:

Children with sickle cell disease will have sickle cell crises no matter how well the child is protected, and may miss a great deal of school. Planning ahead with the school system and parents to continue schooling during recuperation can help the child maintain developmental progress. Most schools are equipped to deal with emergencies that children have. Nutrition is important to development, but a long-range plan with the school will better promote development and learning. Renal health plan is not an appropriate answer.

A nurse is planning care for a client who has a Hgb of 7.5 and a Hct of 21.5. Which of the following should the nurse include in the plan of care? select all that apply

a. provide assistance with ambulation

monitor oxygen saturation

c. weigh client weekly

d. obtain stool specimen for occult blood

e. schedule daily rest periods

a,b,d,e

rationale: a client with anemia may be dizzy and should be assisted to prevent falls, o2 should be monitored due to decreased o2 carrying capacity in the blood, they should be weight dialy, stool testing is performed to id cause of anemia due to gi bleeding, a client may experience fatigue so rest period should be planned to conserve energy

A nurse is completing an integumentary assessment of a client who has anemia. which of the following is an expected finding

a. absent turgor

b. sppon shaped nails

c. shiny, hairless legs,

d. yellow mucous membranes

answer: b spoon shaped nails, pail nail beds and mucous membranes are all present iwithin these patients

A nurse in a clinic receives a phone call form a client seeking info about his new prescription for erythropoietin (epogen) which of the following inf o should be reviewed with the client.

a. the client needs an erythrocyte sedimentation rate test weekly (esr)

b. the client should have his hemoglobin checked twice a week

c. o2 saturation levels should be monitored

d. folic acid production will increase.

answer: hemoglobin/ hematocrit will be measured twice a week

bp is monitored for an increase, erythropoietin promotes increased production of rbc, it is evaluated by changes in hematocrit

During assessment of a patient with thrombocytopenia, the nurse would expet to find?

a. sternal tenderness

b. petechial and purpura

c. jaundiced sclera and skin

d. tender enlarged lymph nodes.

answer: b. petachiae and purpura

rationale: petechiae are small, flat, red, or red brown pinpoint microhemorrhages that occur ont eh skin when platelet levels are low and when they are numerous, they group causing reddish bruises known as purpura. jaundice occurs when anemias are of a hemolytic origin, resulting in accumulation of bile pigments from rbc, enlarged lymph nodes are associated with infection, sternal tendernesss w leukemias

On physical assessment of the patient with severe anemia the nurse would expect to fin?

a. nervousness and agitiation

b. fever and tenting of the skin

c. systolic murmur and tachycardia

d. bluish mucous membranes and reddened

answer: c. systolic murmors and tachycardia

tachycardia occurs in severe anemia as the body compensates for hypoxemia and the low viscosity of the blood contributes to the development of systolic murmurs and bruits. depression of the cns is common with fatigue, lethargy, and malaise, poor skin turgor may be present, but fever is not associated with anemia. skin and membranes ar pale with blue tinged to sclera

a nursing diagnosis that is appropriate for patients with moderate to sever anemia of any etiology is

a. impaired skin integrity related to edema and pruiortos b. disturbed body image related to changes in appearance and body function

c. imbalanced nutrition less than body requirements related to lack of knowledge of adequate nutrition

d. activity intolerance related to decreased hemoglobin and imbalance between o2 supply and demand

answer d:

pts with anemia have decreased hemoglobin and symptoms of hypoxemia, leading to activity intolerance. impaired skin integrity and body image disturbance may be appropriate for patients with jaundice from hemolytic anemias, and altered nutrition is indicated whn iron, folic acid, or vitamin b intake is deficint

The anemia that follows aute blood loss is morst frequently treated with increased dietary iron intake, true or false?

false- blood transfusions or iron supplements

The anemia of sickle cell disease is caused by

a. intravascular hemolysis of sickled rbc

b. accelerated breakdown of abnormal rbc

c. autoimmune antibody destruction of rbc

d. isoimmune antibody antien reactions with rbc

answer b.

a pt with sickle cell anemia asks the nurse why the sickling crisis does not stop when o2 therapy is started. the nurse explains that

a. sickling occurs in response to decreased blood viscosity, which os not affected by o2 therapy

b. when rbc sickle, they occlude small vessels, which cause more local hypoxia and more sickling

c. destruction of abnormal cells results in fewer rbc to carry o2

d. o2 therapy does not alter shape of abnormal erythrocytes, but allows increased o2 concentration in hemoglobin

answer b: during a crisis sickling cells clog small capillaries and resulting hemostasis promotes self perpetuating cycle of local hypoxia, deoxygenation, or more erythrocytes and more sickling. administration of o2 mau help further sickling, but additional o2 does not reach areas of local hypoxia caused by occluded vessels

a nursing intervention indiated for pt during a sickle cell crisis is

a.frequent ambulation

b. antiembolism hose

. restriction of sodium and oral fluids

d. administration of large doses of continuous narcotic analgesics

answer d

A patient has a platelet count of 50,000 and is diagnosied with immune thrombocytopenic purpura. the nurse would expect initial treatment to include

a. splenectomy

b. corticosteroids

c. administration of platelets

d immunosyppressive therapy

answer b. corticosteroids

They suppress phagocytic response of splenic macrophages, decreasing platelet function they also depress autoimmune antibody formation and reduce capillary fragility and bleeding time.

During care for patient with thrombocytopenia, the nurse

a. takes frequent temperatures to assess for fever

b. maintains the patient on strict bed rest to prevent injury

c. monitors patient for headaches, vertigo, or confusion

d. removes oral crusting and scabs with firm friction every two hours

answer: c

Rationale: the major complication of thrombocytopenia is hemorrhage, and it may occur in any area of the body. cerebral hemorrhage may be fatal and evaluation of mental status for cns alteration to id cns bleeding is very important. fever is not a common finding in thrombocytopenia. protection from injury to prevent bleeding is an important nursing intervention, but strict bed rest is not indicated. oral care is performed very gently with minimum friction and soft swabs

While receiving a unit of packed rbc, the pt develops chills and a temp of 102.2. The nurse

a. notifies physician and blood bank

b. stops transfusion and removes iv catheter

c. adds a leukocyte reduction filter to the blood administration set

d. recognizes this as a mild allergic transfusion reaction and slows the transfusion

answer a:

chills and fever are symptoms of an acute hemolytic or transfusion reaction if these develop the transfusion should be stopped, saline infused through the iv line, the physician and blood bank notified immediately, the id tags rechecked and vital signs and urine output monitored. addition of a leukocyte reduction filter may prevent a febrile reaction but is not helpful once the reaction has occurred. mild and transient allergic reactions indicated by itching and hives might permit restarting of transfusion after treatment with antihistamines.

A patient with thrombocytopenia with active bleeding has 2 units of platelets prescribed. To administer the platelets the nurse

a. checks for abo compatibility

b. agitates the bag periodically during the transfusion

c. takes vital signs every 15 minutes during the procedure

d. refrigerates the second unit until the first unit has transfused

answer: b agitates the bag periodically during the transfusion

platelets adhere to plastic bags and should be gently agitated throughout the transfusion. platelets do not have a b or rh antibodies and abo compatibility is not a consideration. baseline vital signs should be taken before the transfusion is started and the nurse should stay with patient during first 15 minutes platelets are stored at room temp and should not be refrigerated

What nursing care intervention should we implement for nutrition and hydration in cancer patients?

ongoing assessments, client teaching, initiating interventions to improve nutrition and hydration, antiemetic medications

How do we manage treatment side effets in cancer patients?

know side effets of medications you are administering and monitor for them for example myelosuppresion or suppression of blood cell production in the bone marrow

How many erythrocytes do we have and how long do they live

4.5-5.8 million per micro liter of blood and they last 120 days

Age-related changes that affect the hematologic system include: (Select all that apply.)

1.Bone marrow in the long bones decline.

2.The number of stem cells in the marrow increases.

3.Lymphocyte function, especially cellular immunity, decreases.

4.Platelet adhesiveness decreases.

Answer: 1. 3.

At about age 70, the amount of bone marrow in the long bones declines steadily; the number of stem cells in the marrow decreases; and lymphocyte function, especially cellular immunity, declines.

Anemia or insufficient hemoglobin content is common in older persons. The client's body compensates for the deficiency by:

1.Decreasing the respiratory and heart rates.

2.Increasing the heart and respiratory rates.

3.Shunting blood away from vital organs and skin.

4.Decreasing blood viscosity in order to supply oxygen to hypoxic tissues.

answer b

All anemias result in a loss of oxygen-carrying capacity of the blood, and produce generalized hypoxia. The body tries to compensate by raising the heart and respiratory rates, shunting blood to vital organs away from the skin, and increasing blood viscosity in order to supply oxygen to hypoxic tissues.

Because older persons can have severe anemia for a long period of time without detection, when diagnosed, quick reversal is warranted. Which of the following orders most likely would be prescribed at this time

a.Platelet transfusion and osmotic diuretic

b.Ferrous sulfate 325 mg orally three times a day

c. Packed red blood cells followed by oral furosemide (Lasix)

d. Erythropoietin (Procrit) injection twice per week

answer c

Older persons might have heart problem that are compounded by severe anemia. The physician can prescribe blood transfusions to reverse the severity of the anemia, and a diuretic such as furosemide (Lasix) orally between units to prevent fluid overload and the development of congestive heart failure (CHF).

An elderly client is admitted to the hospital Emergency Department (ED) with complaints of headache, visual disturbances, and burning pain, and erythema of the hands and feet. To accurately diagnose thrombocytopenia, the physician most likely will order:

a.Peripheral blood smear.

b.Allogenic bone marrow transplant.

c.Bone marrow aspiration.

d. Splenectomy.

.

Thrombocytopenia is characterized by an increased number of circulating platelets in the blood. Accurate diagnosis requires bone marrow aspiration. Allogenic bone marrow transplantation is prescribed for younger persons with myelofibrosis. A splenectomy may be prescribed for persons with myelofibrosis

When caring for a client with a diagnosis of thrombocytopenia, the nurse should plan to:

a.Discourage the use of stool softeners.

b.Assess temperature readings every six hours.

c.Avoid invasive procedures.

d. Encourage the use of a hard, brittle toothbrush.

answer c

Thrombocytopenia is characterized by an increased number of circulating platelets in the blood. Older persons with thrombocytopenia are at significantly increased risk of thrombosis, and careful monitoring of platelet levels and symptoms is indicated.

A client with thrombocytopenia presents to the primary care center. During assessment, the nurse notices petechiae. The nurse anticipates that which of the following laboratory results would support the presence of a hemostatic disorder?

a. Decreased erythrocyte count

b. A platelet count that is less than 150,000 uL

c. An elevated lymphocyte count

d. A hemoglobin value of 14 or more

answer: b?

1. Which of the following blood components is decreased in anemia

a. erythrocytes

b. granulocytes

c. leukocytes

d. platelets

ANswer a: anemia is defined as a decreased number of erythrocytes rbc, leukopenia ia decreased wbc, thrombocytopenia is decreased number of platelets

2.A client with anemia may be tired due to a tissue deficiency of which of the following substances

a. carbon dioxide.

b factor viiii

c. oxygen

d. t cell antibodies

Answer c: anemia stems from a decreased numbe rof rbc and the resulting deficiency in oxygen and body tissues. Clotting factors such as factor VIII relate to the bodys ability to form blood clots and aren't related to anemia, not is carbon dioxide of t antibodies.

3.which of the following ells is the precursor to the rbc

a. b cell

b.macrophage

c. stem cell

d. t cell

The precursor to rbc is the stem cell. b cells, macrophages and t cells and lymphocytes are not rbc precursors

4.which of the following symptoms is expected with hemoglobin of 10 g/dl?

a. none

b. pallor

c. palpitations

d. s.o.b

answer: a mild anemia usually has no clinical signs. Palpitations, shortness of breath, pallor are all associated with severe anemia

8.The nurse explains ot the parent of a 1 year old child admitted ot the hospital in a sickle cell crisis that the local tissue damage the child has on admission is caused by which of the following?

a. autoimmune reaction complicated by hypoxia

b. lack of o2 in the red blood cells

c. obstruction of circulation

d. elevated serum bilirubin concentration

answer c: characteristic sicle cells tend to cause log jams in capillaries. this results in poor circulation to local tissues, leading to ischemia and necrosis. The basic dfect in sickle cell disease is an abnormality in the structure of rbcs. the erythrocytes are sickle shaped, rough in texture, and rigid. sickle ell disease is an inherited disease not an autoimmune reaction. elevated serum bilirubin concentrations are assoiated with jaundice not insickle cell disease

17. A child suspected of having sickle cell disease is seen in a clinic, and lab studies are performed. a nurse checks the lab results knowing what would be increased in this disease.

a. platelet count

b. hematocrit level

c. reticulocyte count

d. hemoglobin level

answer c

diagnosis is established based on a cb, examination for sickled rb appear in peripheral smear, and hemoglobin electrophoresis. lab studies will show decreased hemoglobin and hematocrit levels and a decreased platelet count and increased reticulocyte count and presence of nucleated rbc, increased reticulocyte counts occur in children with sickle cell disease because the life span of their sickled rbc is shortned.

1. T he nurse is admitting a client suspected of

having sickle cell anemia. The client has a fever

of 38.9°C or 102°F, faint yellow-tinged sclera,

and is complaining of abdominal pain. Which

of the following clinical manifestations further

support this diagnosis? select all that apply.

1. R apid but regular breathing

2. P ale, dilute urine

3. S kin ulcers on the lower extremities

4. S wollen fingers

5. Pallor

6. Fatigue

answers: 3,4,5, 6 the lient with sickle cell anemia develops skin ulcers on the lower extremities form vaso-occlusive aspects of the disease. the client would have shortness of breath, and be fatigued and pale. they may have swollen fingers, hemolysis of rbc results in billrubinuria. the clients urine is dark olored

T he nurse making a care plan for a client with

severe thrombocytopenia should include which

of the following?

1. C areful examination of spinal fluid obtained

by lumbar puncture

2. A private room with reverse isolation

precautions

3. A void intramuscular administration of

medications

4. C areful monitoring of urinary output while

titrating the dosage of furosemide (Lasix)

answer3.

S evere thrombocytopenia is a platelet count of

, 10,000 to 20,000/mm3. The client with this

low number of platelets is at great risk of

bleeding from any invasive procedure.

Intramuscular injections can cause a hematoma

in the muscle and should be avoided if

possible. A lumbar puncture would put the

client at an unnecessary risk of bleeding.

A private room is not indicated unless there are

other reasons for isolation (infection,

neutropenia). Furosemide is a diuretic and not

used as therapy for thrombocytopenia.

W hich of the following should the nurse

include in the instructions provided to a client

with sickle cell anemia?

S elect all that apply:

[ ] 1. A dminister pain medications

[ ] 2. E ncourage fluids

[ ] 3. T reat the presence of infection

[ ] 4. A void informing others of the condition

[ ] 5. V igorous exercise is permitted

[ ] 6. I nform the client that the disorder is not

hereditary

answers. 1. 2. 3.

Recognition of the signs of a vaso-occlusive

crisis and knowledge of the measures to

prevent it are very important in keeping the

health of a client with sickle cell anemia in

control. It is essential to administer pain

medications, encourage fluids, and treat

infections. Individuals may fear the disease, but

educating friends of the client is a healthy

approach to the disease. Dehydration from

excessive exercise or heat can precipitate a

cycle of pain. Sickle cell anemia is a genetic

disorder, and counseling of couples before they

have offspring is recommended.

T he nurse has started a transfusion of packed

red blood cells. The nurse should immediately

stop the transfusion when which of the

following occurs?

1. Fever and back pain

2. D ry mouth

3. H ypothermia and pallor

4. H eart rate of 74 beats per minute

answer. 1.

Fever and back pain can occur in hemolytic

blood transfusion reaction caused by the

mismatch of blood types. If the transfusion is

not stopped immediately, the client could go

into shock and die. Dry mouth could be caused

by an antihistamine given as a premedication

or from dehydration, but it is not a reason to

stop the transfusion. Blood products expire in a

few hours and interruptions should be

minimized. A heart beat of 74 beats per minute

is not too high or too low. The client may also

spike a temperature and have flushed skin.

A nurse is reviewing the serum laboratory test

results for a client with sickle cell anemia.

Which parameter does the nurse anticipate

will be elevated?

1 Sodium

2 Hemoglobin-S

3 Hemoglobin A1c

4 Prothrombin time

answer 2

Sickle cell anemia is a severe anemia that affects African

Americans predominantly and is characterized by sickled hemoglobin,

or Hgb-S. The client must have two abnormal genes yielding hemoglobin-

S to have sickle cell anemia. A client could have sickle cell trait by

carrying one hemoglobin-A gene and one hemoglobin-S gene; then, the

client has a less severe form of sickle cell anemia. Options 1, 3, and 4

are unrelated to sickle cell anemia

A client is admitted to the hospital in sickle cell

crisis. The nurse monitors the client for which

clinical indicator of the disorder?

1 Pain

2 Diarrhea

3 Bradycardia

4 Blurred vision

answer: 1 pain

Sickle cell crisis usually causes severe pain in the bones and

joints along with joint swelling. The pain develops as a result of microvascular

occlusion from abnormal sickled hemoglobin that occurs with

hypoxia. Therapy includes pain management with opioid analgesics,

supplemental oxygen, and intravenous fluids. The remaining options

are not associated with sickle cell crisis.

A client in labor has a concurrent diagnosis of

sickle cell anemia. Which action has priority

to assist in preventing a sickling crisis from occurring

during labor?

1 Reassuring the client

2 Administering oxygen

3 Preventing bearing down

4 Maintaining strict asepsis

answer 2

During the labor process, the client with sickle cell anemia is at

high risk for being unable to meet the oxygen demands of labor. Administering

oxygen will prevent sickle cell crisis during labor. Options 1 and 4

are appropriate actions but are unrelated to sickle cell crisis. Option 3 is

inappropriate.

A nurse is planning interventions for counseling

a maternal client who has been newly

diagnosed with sickle cell anemia. Which of

the following would be the most important psychosocial

intervention at this time?

1 Provide emotional support.

2 Avoid the topic of the disease at all costs.

3 Allow the client to be alone if she is crying.

4 Provide the client with all of the information

answer 1

one of the most important roles as a nurse is providing emotional support to the clients and their family during the counseling pr0cess

Option 4 overwhelms the client with information while she is trying to

cope with the news of the disease. Option 3 is only appropriate if the client

requests to be alone; if this is not requested, the nurse is abandoning the

client in a time of need. Option 2, like option 4, is nontherapeutic.

A nurse is reviewing the physician's prescriptions

for a child who was admitted to the hospital

with vaso-occlusive pain crisis from

sickle cell anemia. Which of the following

physician prescriptions would the nurse

question?

1 Bedrest

2 Intravenous fluids

3 Supplemental oxygen

4 Meperidine hydrochloride (Demerol) for

pain

Answer: 4

Rationale: Meperidine hydrochloride is contraindicated for ongoing pain

management because of the increased risk of seizures associated with the

use of the medication. The management of vaso-occlusive pain generally

includes the use of strong opioid analgesics such as morphine sulfate or

hydromorphone (Dilaudid). These medications are usually most effective

when given as a continuous infusion or at regular intervals around the

clock. Options 1, 2, and 3 are appropriate prescriptions for treating

vaso-occlusive pain crisis.

The nurse cares for a client who is pale and

complains of fatigue, weakness, and dizziness.

Which serum laboratory test result is the

nurse's priority for planning care?

1 Hematocrit 43%

2 Sodium 130 mEq/L

3 Potassium 4.8 mEq/L

4 Hemoglobin of 7 g/dL

Answer: 4

Rationale: The client's hemoglobin level and sodium level are low; however,

the nurse uses the hemoglobin results to plan care because the client's

clinical indicators are consistent with anemia. The client is pale

because the serum hemoglobin is low; thus the client's tissues are perfused

with blood that has a low oxygen-carrying capacity. The client is weak and

dizzy because the blood does not carry enough oxygen to meet tissue

oxygen demands. While a client who is hyponatremic can also feel weak

and dizzy, a hyponatremic client is unlikely to be pale. The hematocrit and

the potassium levels are within normal limits.

The nurse admits a client who is in sickle cell

crisis to the hospital. Which does the nurse prepare

as the priority in the management of the

client?

1 Pain management

2 Fluid administration

3 Oxygen administration

4 Red blood cell transfusion

Answer: 3

Rationale: The priority nursing intervention for a client in sickle cell crisis

is to administer supplemental oxygen because the client is hypoxemic, and

as a result, the red blood cells change to the sickle shape. In addition,

oxygen is the priority because airway and breathing are more important

than circulatory needs. The nurse also plans for fluid therapy to promote

hydration and reverse the agglutination of sickled cells, opioid analgesics

for relief from severe pain, and, blood transfusions to increase the blood's

oxygen-carrying capacity.

4. Clients with sickle cell anemia are taught to avoid activities that cause hypoxia and hypoxemia. Which of the following activities would the nurse recommend?

A. A family vacation in the Rocky Mountains

B. Chaperoning the local boys club on a snow-skiing trip

C. Traveling by airplane for business trips

D. A bus trip to the Museum of Natural History

answer d

6. A newly admitted client has sickle cell crisis. The nurse is planning care based on assessment of the client. The client is complaining of severe pain in his feet and hands. The pulse oximetry is 92. Which of the following interventions would be implemented first? Assume that there are orders for each intervention.

A. Adjust the room temperature

B. Give a bolus of IV fluids

C. Start O2

D. Administer meperidine (Demerol) 75mg IV push

answer c

1. Which of the following foods would the nurse encourage the client in sickle cell crisis to eat?

A. Peaches

B. Cottage cheese

C. Popsicle

D. Lima beans

answer c

2. A 25-year-old male is admitted in sickle cell crisis. Which of the following interventions would be of highest priority for this client?

A. Taking hourly blood pressures with mechanical cuff

B. Encouraging fluid intake of at least 200mL per hour

C. Position in high Fowler's with knee gatch raised

D. Administering Tylenol as ordered

b

1. A 30-year-old male from Haiti is brought to the emergency department in sickle cell crisis. What is the best position for this client?

A. Side-lying with knees flexed

B. Knee-chest

C. High Fowler's with knees flexed

D. Semi-Fowler's with legs extended on the bed

answer d

2. A 43-year-old African American male is admitted with sickle cell anemia. The nurse plans to assess circulation in the lower extremities every 2 hours. Which of the following outcome criteria would the nurse use?

A. Body temperature of 99°F or less

B. Toes moved in active range of motion

C. Sensation reported when soles of feet are touched

D. Capillary refill of < 3 seconds

answer d

A client with thrombocytopenia,

secondary to leukemia, develops epistaxis.

The nurse should instruct the client to:

1. lie supine with his neck extended.

2. sit upright, leaning slightly forward.

3. blow his nose and then put lateral

pressure on his nose.

4. hold his nose while bending forward

at the waist.

Answer: 2. The upright position, leaning

slightly forward, avoids increasing the

vascular pressure in the nose and helps the

client avoid aspirating blood. Lying supine

won't prevent aspiration of the blood. Nose

blowing can dislodge any clotting that has

occurred. Bending at the waist increases

vascular pressure in the nose and promotes

bleeding rather than halting it.

A nurse has just finished assisting the physician

in placing a central intravenous (IV) line. Which

of the following is a priority intervention after

central line insertion?

1 Prepare the client for a chest radiograph.

2 Assess the client's temperature to monitor for

infection.

3 Label the dressing with the date and time of

catheter insertion.

4 Monitor the blood pressure (BP) to assess for

fluid volume overload.

Answer: 1

Rationale: A major risk associated with central line placement is the possibility

of a pneumothorax developing from an accidental puncture of the

lung. Assessing the results of a chest radiograph is one of the best methods

to determine if this complication has occurred and verify catheter tip

placement before initiating intravenous (IV) therapy. A temperature elevation

related to central line insertion would not likely occur immediately

after placement. Labeling the dressing site is important but is not the priority.

Although BP assessment is always important in assessing a client's

status after an invasive procedure, fluid volume overload is not a concern

until IV fluids are started.

A nurse evaluates the patency of a peripheral intravenous

(IV) site and suspects an infiltration.

Which does the nurse implement to determine

if the IV has infiltrated?

1 Strips the tubing and assesses for a blood

return

2 Checks the regional tissue for redness and

warmth

3 Increases the infusion rate and observes for

swelling

4 Gently palpates regional tissue for edema

and coolness

Answer: 4

Rationale: When assessing an IV for clinical indicators of infiltration, it is

important to assess the site for edema and coolness, signifying leakage of

the IV fluid into the surrounding tissues. Stripping the tubing will not

cause a blood return but will force IV fluid into the surrounding tissues,

which can increase the risk of tissue damage. Redness and warmth are

more likely to indicate infection or phlebitis. Increasing the IV flow rate

can further damage the tissues if the IV has infiltrated. Additionally, a physician's

prescription is needed to increase an IV flow rate

The nurse assesses a peripheral intravenous (IV)

dressing and notes that it is damp and the tape

is loose. The best nursing action is to:

1 Stop the infusion immediately.

2 Apply a sterile, occlusive dressing.

3 Ensure tight IV tubing connections.

4 Remove the IV and insert a new IV.

Answer: 3

Rationale: To determine subsequent nursing interventions, the nurse

checks all connections to ensure tight seals while the IV infuses to help

locate the source of the leak. If the leak is at the insertion site, the nurse

stops the infusion, removes the IV, and inserts a new IV catheter. The nurse

applies a new sterile occlusive dressing after resolving the source of the

leak.

The nurse understands that which of the following

are clinical indicators for intravenous (IV)

fluids? Select all that apply.

r 1 Syncope episodes

r 2 Bounding pulse rate

r 3 Chronic renal failure

r 4 Rapid, weak, and thready pulse

r 5 Serum electrolyte abnormalities

r 6 Abnormal serum and urine osmolality

levels

Answer: 4, 5, 6

Rationale: Common abnormal assessment findings of major body systems

offer clues to fluid and electrolyte imbalances. Intravenous fluid

and electrolyte therapies are commonly used to correct many fluid and

electrolyte imbalances in the body. Rapid, weak, and thready pulse is a

common assessment abnormality found with fluid and electrolyte imbalances.

Abnormal serum and urine osmolality are laboratory tests that are

helpful in identifying the presence of or risk of fluid, electrolyte, and acidbase

imbalances. Isolated episodes of syncope are not indicators for intravenous

therapy unless fluid and electrolyte imbalances are identified. A

bounding pulse rate is a manifestation of fluid volume excess; therefore

IV fluids are not indicated. Clients with chronic renal failure experience

the inability of the kidneys to regulate the body's water balance; fluid

restrictions may be used.

The nurse caring for a client receiving intravenous

therapy monitors for which signs of infiltration

at the catheter site of an intravenous (IV)

infusion? Select all that apply.

r 1 Slowing of the IV rate

r 2 Tenderness at the insertion site

r 3 Edema around the insertion site

r 4 Skin tightness at the insertion site

r 5 Warmth of skin at the insertion site

r 6 Fluid leaking from the insertion site

Answer: 1, 2, 3, 4, 6

Rationale: Infiltration is the leakage of an IV solution into the extravascular

tissue. Signs and symptoms include slowing of the IV rate; increasing

edema in or around the catheter insertion site; complaints of skin tightness,

burning, tenderness, or general discomfort at the insertion site;

blanching or coolness of the skin; and fluid leaking from the insertion site.

Priority Nursing Tip: Infiltration at an intravenous site produces coolness

of the skin, whereas phlebitis at an intravenous site produces warmth of

the skin

The nurse prepares to administer an intravenous

(IV) medication when the nurse notes that

the medication is incompatible with the IV solution.

Which is the best intervention for the

nurse to implement for safe medication

administration?

1 Ask the provider to prescribe a compatible

IV solution.

2 Start a new IV catheter for the incompatible

medication.

3 Collaborate with the provider for a new administration

route.

4 Flush tubing before and after administering

the medication with normal saline.

Answer: 4

Rationale: When giving a medication intravenously, if the medication is

incompatible with the IV solution, the tubing is flushed before and after

the medication with infusions of normal saline to prevent in-line precipitation

of the incompatible agents. Starting a new IV, changing the solution,

or changing the administration route are unnecessary because a

simpler, less risky, viable option exists.

The nurse prepares a client for discharge from

the hospital with a peripheral intravenous

(IV) site for home IV therapy. Which should

the nurse teach the client to help prevent phlebitis

and infiltration?

1 Massage the IV site daily.

2 Immobilize the extremity.

3 Stabilize the cannula with tape.

4 Cleanse the site daily with alcohol.

Answer: 3

Rationale: Providing IV therapy at home involves the same principles as

are used in the hospital. Protecting the IV site and securing it with tape

are extremely important to ensure that the IV site remains immobile to

reduce the risk of phlebitis and infiltration; however, the extremity does

not need to be immobilized. Massaging the site potentially contributes

to catheter movement and tissue damage. Alcohol skin preparation is used

during the catheter insertion; because of the potential for excessive drying

and client discomfort, alcohol is not used in IV site care. Immobilization

devices such as arm boards are used if a site is near a joint and the IV flow

rate is affected by joint movement.

The nurse assesses the client's peripheral intravenous

(IV) site and notes that it is cool, pale,

swollen, and not infusing. The nurse should

document in the client's record that which

of the following has probably occurred?

1 Phlebitis

2 Infection

3 Infiltration

4 Thrombosis

Answer: 3

Rationale: The infusion stops when the pressure in the tissue exceeds

the pressure in the tubing. The pallor, coolness, and swelling of the IV site

are the result of IV fluid infusing into the subcutaneous tissue. An IV site is

infiltrated when it becomes dislodged from the vein and is lying in

subcutaneous tissue, so the nurse concludes that the IV is infiltrated.

The nurse needs to remove the infiltrated catheter and insert a new IV.

The remaining options are likely to be accompanied by warmth at the site.

Options 1 and 2 also involve the site appearance as reddened.

The nurse prepares to access an implanted vascular

access port. Which should the nurse implement

first?

1 Palpate the vascular port.

2 Anchor the vascular port.

3 Cleanse the site with alcohol.

4 Apply a cool compress to the site.

Answer: 1

Rationale: Before accessing an implanted vascular access port, the nurse

must palpate the port to locate the center of the septum because the

nurse needs to know where to insert the needle to avoid more than

one needle stick for the client. The nurse then applies the cool compress

to the insertion site to ease any discomfort that occurs from the needle

stick, cleanses the site with alcohol, anchors the port with the nondominant

hand avoiding contamination of the septum, and accesses the site.

The nurse is caring for a child who has been admitted for a sickle cell crisis. Which of the following would the nurse do first to provide adequate pain management?

A) Administer a nonsteroidal anti-inflammatory drug as ordered.

B) Use guided imagery and therapeutic touch.

C) Administer meperidine as ordered.

D) Initiate pain assessment with a standardized pain scale.

D) Initiate pain assessment with a standardized pain scale.

The nurse is caring for a child who has been admitted for a sickle cell crisis. Which of the following would the nurse do first to provide adequate pain management?

A) Administer a nonsteroidal anti-inflammatory drug as ordered.

B) Use guided imagery and therapeutic touch.

C) Administer meperidine as ordered.

D) Initiate pain assessment with a standardized pain scale.

D) Initiate pain assessment with a standardized pain scale.

When providing care to a child with aplastic anemia, which nursing diagnosis most likely would be the priority?

A) Risk for injury

B) Imbalanced nutrition, less than body requirements

C) Ineffective tissue perfusion

D) Impaired gas exchange

A) Risk for injury

The mother of a 5-year-old girl brings the child to the clinic for an evaluation. The mother tells the nurse, "She seems to be so tired and irritable lately. And she looks so pale." Further assessment reveals pale conjunctiva and oral mucous membranes. The nurse suspects iron-deficiency anemia. Which additional finding would help provide additional evidence for this suspicion?

A) Spooned nails

B) Negative splenomegaly

C) Oxygen saturation: 99%

D) Bradycardia

A) Spooned nails

The nurse is assessing a child with aplastic anemia. Which of the following would the nurse expect to assess? Select all that apply.

A) Ecchymoses

B) Tachycardia

C) Guaiac-positive stool

D) Epistaxis

E) Severe pain

F) Warm tender joints

A) Ecchymoses

B) Tachycardia

C) Guaiac-positive stool

D) Epistaxis

The nurse is caring for a 16-year-old boy with acute myelogenous leukemia who is having chemotherapy and who has incomplete records for varicella zoster immunization. Which of the following will be the priority nursing diagnosis?

A) Pain related to adverse effects of treatment verbalized by the child

B) Nausea related to side effects of chemotherapy verbalized by the child

C) Constipation related to the use of opioid analgesics for pain

D) Risk for infection related to neutropenia and immunosuppression

D) Risk for infection related to neutropenia and immunosuppression

The nurse is caring for an 8-year-old girl who has been diagnosed with leukemia and will have a variety of tests, including a lumbar puncture, before beginning chemotherapy. Which of the following would be the priority?

A) Applying EMLA to the lumbar puncture site

B) Educating the child and family about the testing procedures

C) Administering promethazine as ordered for nausea

D) Educating the family about chemotherapy and its side effects

B) Educating the child and family about the testing procedures

The nurse is caring for a 13-year-old boy with acute myelogenous leukemia who is experiencing feelings of powerlessness due to the effects of chemotherapy. Which of the following interventions will best help the teen's sense of control?

A) Involving the boy in decisions whenever possible

B) Acknowledging the boy's feelings of anger with the disease

C) Providing realistic expectations of treatments and outcomes

D) Recognizing abilities that are unaffected by the disease

A) Involving the boy in decisions whenever possible

The nurse is assessing a 3-year-old boy whose parents brought him to the clinic when they noticed that the right side of his abdomen was swollen. Which of the following findings would suggest this child has a neuroblastoma?

A) The child has a maculopapular rash on his palms.

B) The parents report that their son is vomiting and not eating well.

C) The parents report that their son is irritable and not gaining weight.

D) Auscultation reveals wheezing with diminished lung sounds.

B) The parents report that their son is vomiting and not eating well.

The nurse is caring for a 9-year-old boy who is having chemotherapy. The nurse is developing a teaching plan for the child and family about nutrition. Which of the following would the nurse be least likely to include?

A) Emphasizing the intake of grains, fruits, and vegetables

B) Featuring high-fiber foods if opioid analgesics are being taken

C) Concentrating on consuming primarily high-calorie shakes and puddings

D) Avoiding milk products if diarrhea is a problem

C) Concentrating on consuming primarily high-calorie shakes and puddings