Chapter 16, Care of Patients with Hematologic Disorders: Disorders of the Hematologic System

Question 1 of 10

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Which type of hematologic disorder would the nurse associate with a patient’s thin, concave (spoon-shaped) nails with raised edges?

• • LeukemiaLeukemia is a cancer that particularly affects the white blood cells.
• • Pernicious anemiaPernicious anemia is an autoimmune disease in which intrinsic factor is missing from the gastric juices. Absence of the intrinsic factor prevents absorption of vitamin B₁₂. Pernicious anemia is associated with neurologic signs and symptoms.
• • Polycythemia veraPolycythemia vera is a disorder that involves the excessive production of red blood cells. It is associated with a reddish face, purplish lips, fatigue, weakness, dizziness, headache, an enlarged spleen, a congested liver, and an increase in the number of white blood cells.
• Correct
  • Iron deficiency anemiaIron deficiency anemia is most associated with thin, concave (spoon-shaped) nails with raised edges.

Question 2 of 10

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The nurse recalls that which occurrence leads to a low red blood cell (RBC) count in a patient with end-stage renal disease (ESRD)?

• • Inadequate food intakePatients with ESRD may have dietary restrictions, but this does not necessarily lead to inadequate intake.
• • Nutrient absorption problemsLack of nutrient absorption is seen in pernicious anemia.
• • A build-up of toxic substances that suppress the bone marrowESRD does not produce toxic substances.
• Correct
  • A lack of production of erythropoietinWith ESRD, a lack of production of erythropoietin by the kidneys leads to decreased production or RBCs.

Question 3 of 10

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How would the nurse respond when a patient who takes a proton pump inhibitor asks why a B₁₂ supplement is recommended?

• • “The supplement will assist with any further gastric discomfort.”A B₁₂ supplement will not impact gastric discomfort.
• Correct
  • “The supplement may prevent you from developing anemia.”Patients who take medications over a long period that suppress gastric acid secretion (proton pump inhibitors) must be watched for signs of megaloblastic anemia. Supplementation with vitamin B₁₂ may help prevent this problem.
• • “B₁₂ will provide you with extra energy.”Energy is not the primary reason for taking the supplement.
• • “B₁₂ is recommended for all patients over the age of 50.”B₁₂ supplements are not necessary for all patients over the age of 50 (or any specific age).

Question 4 of 10

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The nurse anticipates that which laboratory test will be prescribed for a patient who presents with a 2-week history of headache, shortness of breath with activity, and fatigue?

• • Basic metabolic panel (BMP)A BMP provides fluid/electrolyte/kidney function information that may not be needed for this patient.
• • Liver enzymesSigns that the liver may be impacted would be jaundice and iced-tea colored urine. Liver enzymes would not be diagnostic for this patient based on the presenting signs and symptoms.
• • Blood urea nitrogen (BUN)/creatinine/glomerular filtration rate (GFR)BUN, creatinine, and GFR tests may help evaluate kidney function, but they are not diagnostic for this patient based on the presenting symptoms.
• Correct
  • Complete blood count (CBC)Headache, shortness of breath, and fatigue are all indicative of anemia. A CBC will assist in diagnosis.

Question 5 of 10

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Which patient statement indicates understanding of education related to iron supplementation?

• • “I will take my iron supplement late at night to avoid having it close to a meal.”Iron supplements should be taken 1 hour before or 2 hours after a meal.
• Correct
  • “I will check with my pharmacist to see if any of my medications interfere with iron absorption.”Some medications interfere with iron absorption and should be verified.
• • “I will not eat or drink any acidic fruits or fruit juices while taking my iron supplement.”Acidic fruits and fruit juices contain vitamin C, which will enhance iron absorption.
• • “I will reduce my fluid intake while taking my iron supplement.”Iron supplements frequently cause constipation, so fluid intake should not be reduced.

Question 6 of 10

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The nurse suspects which type of anemia based on a patient with seizure disorder who presents with lethargy, extreme sensitivity to cold, and pallor?

• Correct
  • Aplastic anemiaSome anticonvulsants lead to aplastic anemia, so this would be a potential cause.
• • Sickle cell anemiaSickle cell anemia is related to genetic factors and unrelated.
• • Megaloblastic anemiaMegaloblastic anemia results from a deficit of intrinsic factor and is unrelated.
• • Anemia from blood lossThe patient is not presenting with any injuries or indication of anemia associated with blood loss.

Question 7 of 10

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Which complication would the nurse suspect when a patient admitted with a sickle cell crisis reports painful swelling of all four extremities?

• • Heart failureAlthough lower extremity swelling may occur with heart failure, heart failure is not a common complication of sickle cell crises. It also would not likely result in swelling of the hands.
• • Rheumatoid arthritisRheumatoid arthritis may cause swelling and discomfort in the joints, but it is not a complication of sickle cell crisis.
• • AnaphylaxisAnaphylaxis would result in diffuse swelling as well as potential airway blockage.
• Correct
  • Hand-foot syndromeSickled cells can lead to bone infarction of the hands and feet called hand-foot syndrome.

Question 8 of 10

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Which information would the nurse include when teaching a class about acute lymphocytic leukemia (ALL)?

• • “ALL is almost always fatal when it occurs in children.”There is an overall survival rate of greater than 85% for children with ALL.
• • “Diagnosis of ALL is made when abnormally shaped red blood cells are evident.”Sickle cell disease, not ALL, occurs when there are abnormally shaped red blood cells.
• Correct
  • “ALL occurs most commonly in children.”ALL occurs most commonly in children.
• • “About 90% of patients with ALL have the Philadelphia chromosome.”About 90% of patients with chronic myelogenous leukemia have the Philadelphia chromosome.

Question 9 of 10

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Which teaching is a priority when the caregiver of a patient who is receiving treatment for leukemia asks about medication management at home?

• Correct
  • “Oral chemotherapy requires special handling.”It is significant to explain the need for special handling of chemotherapy to protect the caregiver.
• • “Wash all surfaces in the area in which medications are placed in a pill organizer case.”The caregiver should be reminded about cleanliness of the work environment, but that is not the priority.
• • “A list of medications should be kept in a file on your computer.”Maintaining a list on the computer allows for easy access to the information, but it is not the priority.
• • “The phone number of the pharmacy who dispenses the oral chemotherapy should be written down and easily accessible.”The phone number of the pharmacy should be easily accessible, but it is not the priority.

Question 10 of 10

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The nurse identifies which priority intervention when a patient with chronic myelogenous leukemia who is receiving chemotherapy develops an increased temperature?

• • Draw blood cultures and report the results to the health care provider (HCP).Results for blood cultures may not be available for 1 to 2 days. Without other orders, there could be delays in care.
• Correct
  • Immediately begin broad-spectrum antibiotics.Immediately starting broad-spectrum antibiotics is important because of the patient’s compromised immune system.
• • Continue to monitor and contact the HCP if other symptoms occur.Continuing to monitor the patient could cause delays in treating a potential infection.
• • Give acetaminophen around-the-clock to control temperature.Acetaminophen around-the-clock may not be necessary and does not treat the underlying cause of the temperature.