lewis hemotology adults

An appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia is to

a.

provide a diet high in vitamin K.

b.

alternate periods of rest and activity.

c.

teach the patient how to avoid injury.

d.

place the patient on protective isolation.

B

Nursing care for patients with anemia should alternate periods of rest and activity to encourage activity without causing undue fatigue. There is no indication that the patient has a bleeding disorder, so a diet high in vitamin K or teaching about how to avoid injury is not needed. Protective isolation might be used for a patient with aplastic anemia, but it is not indicated for hemolytic anemia.

It is important for the nurse providing care for a patient with sickle cell crisis to

a.

limit the patients intake of oral and IV fluids.

b.

evaluate the effectiveness of opioid analgesics.

c.

encourage the patient to ambulate as much as tolerated.

d.

teach the patient about high-protein, high-calorie foods.

B

Pain is the most common clinical manifestation of a crisis and usually requires large doses of continuous opioids for control. Fluid intake should be increased to reduce blood viscosity and improve perfusion. Rest is usually ordered to decrease metabolic requirements. Patients are instructed about the need for dietary folic acid, but high-protein, high-calorie diets are not emphasized.

Which statement by a patient indicates good understanding of the nurses teaching about prevention of sickle cell crisis?

a.

Home oxygen therapy is frequently used to decrease sickling.

b.

There are no effective medications that can help prevent sickling.

c.

Routine continuous dosage narcotics are prescribed to prevent a crisis.

d.

Risk for a crisis is decreased by having an annual influenza vaccination.

D

Because infection is the most common cause of a sickle cell crisis, influenza, Haemophilus influenzae, pneumococcal pneumonia, and hepatitis immunizations should be administered. Although continuous dose opioids and oxygen may be administered during a crisis, patients do not receive these therapies to prevent crisis. Hydroxyurea (Hydrea) is a medication used to decrease the number of sickle cell crises.

Which instruction will the nurse plan to include in discharge teaching for the patient admitted with a sickle cell crisis?

a.

Take a daily multivitamin with iron.

b.

Limit fluids to 2 to 3 quarts per day.

c.

Avoid exposure to crowds when possible.

d.

Drink only two caffeinated beverages daily.

C

Exposure to crowds increases the patients risk for infection, the most common cause of sickle cell crisis. There is no restriction on caffeine use. Iron supplementation is generally not recommended. A high-fluid intake is recommended.

The nurse caring for a patient with type A hemophilia being admitted to the hospital with severe pain and swelling in the right knee will

a.

immobilize the joint.

b.

apply heat to the knee.

c.

assist the patient with light weight bearing.

d.

perform passive range of motion to the knee.

A

The initial action should be total rest of the knee to minimize bleeding. Ice packs are used to decrease bleeding. Range of motion (ROM) and weight-bearing exercise are contraindicated initially, but after the bleeding stops, ROM and physical therapy are started.

Which information obtained by the nurse caring for a patient with hemophilia should be immediately communicated to the health care provider?

a.

The platelet count is 160,000/L.

b.

The patient is difficult to arouse.

c.

There are purpura on the oral mucosa.

d.

There are large bruises on the patients back.

B

Difficulty in arousing the patient may indicate a cerebral hemorrhage, which is life threatening and requires immediate action. The other information should be documented and reported but would not be unusual in a patient.

A postoperative patient receiving a transfusion of packed red blood cells develops chills, fever, headache, and anxiety 35 minutes after the transfusion is started. After stopping the transfusion, what action should the nurse take?

a.

Draw blood for a new crossmatch.

b.

Send a urine specimen to the laboratory.

c.

Administer PRN acetaminophen (Tylenol).

d.

Give the PRN diphenhydramine (Benadryl).

C

The patients clinical manifestations are consistent with a febrile, nonhemolytic transfusion reaction. The transfusion should be stopped and antipyretics administered for the fever as ordered. A urine specimen is needed if an acute hemolytic reaction is suspected. Diphenhydramine (Benadryl) is used for allergic reactions. This type of reaction does not indicate incorrect crossmatching.

A patient in the emergency department complains of back pain and difficulty breathing 15 minutes after a transfusion of packed red blood cells is started. The nurses first action should be to

a.

administer oxygen therapy at a high flow rate.

b.

obtain a urine specimen to send to the laboratory.

c.

notify the health care provider about the symptoms.

d.

disconnect the transfusion and infuse normal saline.

D

The patients symptoms indicate a possible acute hemolytic reaction caused by the transfusion. The first action should be to disconnect the transfusion and infuse normal saline. The other actions also are needed but are not the highest priority.

Which problem reported by a patient with hemophilia is most important for the nurse to communicate to the physician?

a.

Leg bruises

b.

Tarry stools

c.

Skin abrasions

d.

Bleeding gums

B

Melena is a sign of gastrointestinal bleeding and requires collaborative actions such as checking hemoglobin and hematocrit and administration of coagulation factors. The other problems indicate a need for patient teaching about how to avoid injury, but are not indicators of possible serious blood loss.

When a patient with splenomegaly is scheduled for splenectomy, which action will the nurse include in the preoperative plan of care?

a.

Discourage deep breathing to reduce risk for splenic rupture.

b.

Teach the patient to use ibuprofen (Advil) for left upper quadrant pain.

c.

Schedule immunization with the pneumococcal vaccine (Pneumovax).

d.

Avoid the use of acetaminophen (Tylenol) for 2 weeks prior to surgery.

C

Asplenic patients are at high risk for infection with Pneumococcus and immunization reduces this risk. There is no need to avoid acetaminophen use before surgery, but nonsteroidal antiinflammatory drugs (NSAIDs) may increase bleeding risk and should be avoided. The enlarged spleen may decrease respiratory depth and the patient should be encouraged to take deep breaths.