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 that will explain the disease.” 2. “It is a congenital disease of the blood in which the blood does not clot.” 3. “The client has decreased synovial fluid that causes joint pain.” 4. “The blood becomes thick when the client is deprived of oxygen.”
4. Sickle cell anemia is a disorder of the red blood cells 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 anemia is an inherited autosomal recessive disease.” 2. “He was born with it and both his parents were carriers of the disease.” 3. “At this time, the cause of sickle cell anemia is unknown.” 4. “Your sister was exposed to a virus while she was pregnant.”
2. This explains the etiology in terms that a layperson could understand. When both parents are carriers of the disease, each pregnancy has a 25% chance of producing a child who has sickle cell anemia.
The client diagnosed with sickle cell anemia comes to the emergency department complaining of joint pain throughout the body. The oral temperature is 102.4F and the pulse oximeter reading is 91%. Which action should the emergency room nurse implement first? 1. Request arterial blood gases STAT. 2. Administer oxygen via nasal cannula. 3. Start an IV with an 18-gauge Angiocath. 4. Prepare to administer analgesics as ordered.
2. A pulse oximeter reading of less than 93% indicates hypoxia, which warrants oxygen administration.
The client diagnosed with sickle cell anemia is experiencing with a vasoocclusive sickle cell crisis secondary to an infection. Which medical treatment should the nurse anticipate the HCP ordering for the client? 1. Administer meperidine (Demerol) intravenously. 2. Admit the client to a private room and keep in reverse isolation. 3. Infuse D5W 0.33% NS at 150 mL/hr via pump. 4. Insert a 22-French Foley catheter with a urimeter.
3. Increased intravenous fluid reduces the viscosity of blood, thereby preventing further sickling as a result of dehydration.
The nurse is assessing an African American client diagnosed with sickle cell crisis. Which assessment data is most pertinent when assessing for cyanosis in clients with dark skin? 1. Assess the client’s oral mucosa. 2. Assess the client’s metatarsals. 3. Assess the client’s capillary refill time. 4. Assess the sclera of the client’s eyes.
1. To assess for cyanosis (blueness) in individuals with dark skin, the oral mucosa and conjunctiva should be assessed because cyanosis cannot be assessed in the lips or fingertips.
The client is diagnosed with sickle cell crisis. The nurse is calculating the client’s intake and output (I&O) for the shift. The client had 20 ounces of water, eight (8) ounces of apple juice, three (3) cartons of milk with four (4) ounces each, 1800 mL of IV for the last 12 hours, and a urinary output of 1200. What is the client’s total intake for this shift? ___________________
3000 mL. The key is knowing that 1 ounce is equal to 30 mL. Then, 20 ounces (20 x 30) = 600mL, 8 ounces (8 x 30) =240 mL, 4 ounces (4 x 30) = 120 x 3 cartons = 360 mL for a total of 600 + 240 + 360 = 1200 mL of oral fluids. That, plus 1800 mL of IV, makes the total intake for this shift 3000 mL.
The nurse is caring for the female client recovering from a sickle cell crisis. The client tells the nurse that her family is planning a trip this summer to Yellowstone National Park. Which response would be best for the nurse? 1. “That sounds like a wonderful trip to take this summer.” 2. “Have you talked to your doctor about taking the trip?” 3. “You really should not take a trip to areas with high altitudes.” 4. “Why do you want to go to Yellowstone National Park?”
3. High altitudes have decreased oxygen, which could lead to a sickle cell crisis.
Which is a potential complication that occurs specifically to a male client diagnosed with sickle cell anemia during a sickle cell crisis? 1. Chest syndrome. 2. Compartment syndrome. 3. Priapism. 4. Hypertensive crisis.
3. This is a term that means painful and constant penile erection that can occur in male clients with SCA during a sickle cell crisis.
The nurse is completing discharge teaching for the client diagnosed with a sickle cell crisis. The nurse recommends the client getting the flu and pneumonia vaccines. The client asks, “Why should I take those shots? I hate shots.” Which statement by the nurse is the best response? 1. “These vaccines promote health in clients with chronic illnesses.” 2. “You are susceptible to infections. These shots may help prevent a crisis.” 3. “The vaccines will help your blood from sickling secondary to viruses.” 4. “The doctor wanted to make sure that I discussed the vaccines with you.”
2. An individual with SCA has a reduction in splenic activity from infarcts occurring during crises. This situation progresses to the spleen no longer being able to function and this increases the client’s susceptibility to infection.
The client diagnosed with sickle cell anemia asks the nurse, “Should I join the Sickle Cell Foundation? I received some information from the Sickle Cell Foundation. What kind of group is it?” Which statement is the best response by the nurse? 1. “It is a foundation that deals primarily with research for a cure for SCA.” 2. “It provides information on the disease and on support groups in this area.” 3. “I recommend joining any organization that will help deal with your disease.” 4. “The foundation arranges for families that have children with sickle cell to meet.”
2. The Foundation’s mission is to provide information about the disease and about support groups in the area. This information helps decrease the client’s and significant others’ feelings of frustration and helplessness.
Which sign/symptom will the nurse expect to assess in the client diagnosed with a vasoocclusive sickle cell crisis? 1. Lordosis. 2. Epistaxis. 3. Hematuria. 4. Petechiae.
3. Vasoocclusive crisis, the most frequent crisis, is characterized by organ infarction, which will result in bloody urine secondary to kidney infarction.
The male client with sickle cell anemia comes to the emergency room with a temperature of 101.4F 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? 1. Spinal tap. 2. Hemoglobin electrophoresis. 3. Sickle-turbidity test (Sickledex). 4. Blood cultures.
4. The elevated temperature is the first sign of bacteremia. Bacteremia leads to a sickle cell crisis. Therefore, the bacteria must be identified so the appropriate antibiotics can be prescribed to treat the infection. Blood cultures assist in determining the type and source of infection so that it can be treated appropriately.
The client is diagnosed with severe iron-deficiency anemia. Which statement is the scientific rationale regarding oral replacement therapy? 1. Iron supplements are well tolerated without side effects. 2. There is no benefit from oral preparations; the best route is IV. 3. Oral iron preparations cause diarrhea if not taken with food. 4. Very little of the iron supplement will be absorbed by the body.
4. At best only about 20%–35% of the medication is absorbed through the gastrointestinal tract (GI) tract.
The client’s lab values are RBC 5.5 mm (106), WBC 8.9 mm (103), and platelets 189 mm (103). Which intervention should the nurse implement? 1. Prepare to administer packed red blood cells. 2. Continue to monitor the client. 3. Request an order for Neupogen, a biologic response modifier. 4. Institute bleeding precautions
2. All the lab values are within normal limits. The nurse should continue to monitor the client.
The client diagnosed with anemia is admitted to the emergency department with dyspnea, cool pale skin, and diaphoresis. Which assessment data warrant immediate intervention? 1. The vital signs are T 98.6 F, P 116, R 28, and BP 88/62. 2. The client is allergic to multiple antibiotic medications. 3. The client has a history of receiving chemotherapy. 4. ABGs are pH 7.35, PCO2 44, HCO3 22, PaO2 92.
1. The pulse of 116 and BP of 88/62 in addition to the other symptoms indicate the client is in shock. This is an emergency situation.
The client diagnosed with anemia has an Hgb of 6.1 g/dL. Which complication should the nurse assess for? 1. Decreased pulmonary functioning. 2. Impaired muscle functioning. 3. Congestive heart failure. 4. Altered gastric secretions.
General complications of severe anemia include heart failure, paresthesias, and confusion. The heart tries to compensate for the lack of oxygen in the tissues by becoming tachycardic. The heart will be able to maintain this compensatory mechanism for only so long and then will show evidence of failure.
The nurse writes a diagnosis of “activity intolerance” for a client diagnosed with anemia. Which intervention should the nurse implement? 1. Encourage isometric exercises. 2. Assist the client with ADLs. 3. Provide a high-protein diet. 4. Refer to the physical therapist.
2. The client with activity intolerance will need assistance to perform activities of daily living.
The client diagnosed with cancer has been undergoing systemic treatments and has red blood cell deficiency. Which signs and symptoms should the nurse teach the client to manage? 1. Nausea associated with cancer treatment. 2. Shortness of breath and fatigue. 3. Controlling mucositis and diarrhea. 4. The emotional aspects of having cancer.
2. Anemia causes the client to experience dyspnea and fatigue. Teaching the client to pace activities and rest often, to eat a balanced diet, and to cope with changes in lifestyle is needed.
The nurse is assisting the HCP with a bone marrow biopsy. Which intervention postprocedure has priority? 1. Apply pressure to site for five (5) to ten (10) minutes. 2. Medicate for pain with morphine slow IVP. 3. Maintain head of bed in a high Fowler’s position. 4. Apply oxygen via nasal cannula at 5 LPM.
1. After a bone marrow biopsy, it is important that the client form a clot to prevent bleeding. The nurse should hold direct pressure on the site for five (5) to ten (10) minutes.
The client diagnosed with end-stage renal disease (ESRD) has developed anemia. Which would the nurse anticipate the HCP prescribing for this client? 1. Place the client in reverse isolation. 2. Discontinue treatments until blood count improves. 3. Monitor CBC daily to assess for bleeding. 4. Give client erythropoietin, a biologic response modifier.
4. Erythropoietin is a biologic response modifier produced by the kidneys in response to a low red blood cell count in the body. It stimulates the body to produce more RBCs
The nurse is planning the care of a client diagnosed with aplastic anemia. Which interventions should be taught to the client? Select all that apply. 1. Avoid alcohol. 2. Pace activities. 3. Stop smoking. 4. Eat a balanced diet. 5. Use a safety razor.
1. Alcohol consumption interferes with the absorption of nutrients. 2. The client will be short of breath with activity and therefore should pace activities. 4. The client should eat a well-balanced diet to be able to manufacture blood cells.
The nurse is caring for a client in a sickle cell crisis. Which is the pain regimen of choice to relieve the pain? 1. Frequent aspirin (acetylsalicylic acid) and a nonnarcotic analgesic. 2. Motrin (ibuprofen), an NSAID, PRN. 3. Demerol (meperidine), a narcotic analgesic, every four (4) hours. 4. Morphine, a narcotic analgesic, every two (2) to three (3) hours PRN.
4. Morphine is the drug of choice for a crisis; it does not have a ceiling effect and can be given in large amounts and frequent doses.
The client is diagnosed with hereditary spherocytosis. Which treatment/procedure would the nurse prepare the client to receive? 1. Bone marrow transplant. 2. Splenectomy. 3. Frequent blood transfusions. 4. Liver biopsy.
2. Hereditary spherocytosis is a relatively common hemolytic anemia (1:5000 people) characterized by an abnormal permeability of the red blood cell, which permits it to become spherical in shape. The spheres are then destroyed by the spleen. A splenectomy is the treatment of choice.
Which is the primary goal of care for a client diagnosed with sickle cell anemia? 1. The client will call the HCP if feeling ill. 2. The client will be compliant with medical regimen. 3. The client will live as normal a life as possible. 4. The client will verbalize understanding of treatments.
3. The primary goal for any client coping with a chronic illness is that the client will be able to maintain as normal a life as possible
The client diagnosed with thalassemia, a hereditary anemia, is to receive a transfusion of packed RBCs. The cross-match reveals the presence of antibodies that cannot be cross-matched. Which precaution should the nurse implement when initiating the transfusion? 1. Start the transfusion at 10–15 mL per hour for 15–30 minutes. 2. Re–crossmatch the blood until the antibodies are identified. 3. Have the client sign a permit to receive uncrossmatched blood. 4. Have the unlicensed nursing assistant stay with the client.
1. It can be difficult to cross-match blood when antibodies are present. If imperfectly cross-matched blood must be transfused, the nurse must start the blood very slowly and stay with the client, monitoring frequently for signs of a hemolytic reaction.
The client is diagnosed with polycythemia vera. The nurse would prepare to perform which intervention? 1. Type and cross-match for a transfusion. 2. Assess for petechiae and purpura. 3. Perform phlebotomy of 500 mL of blood. 4. Monitor for low hemoglobin and hematocrit.
3. The client has too many red blood cells, which can cause as much damage as too few. The treatment for this disease is to remove the excess blood; 500 mL at a time is removed.
The client diagnosed with leukemia has had a bone marrow transplant. The nurse monitors the client’s absolute neutrophil count (ANC). Which is the client’s neutrophil count if the WBCs are 2.2 (103) mm, neutrophils are 25%, and bands are 5%.____________________
660 ANC. To determine the absolute neutrophils count, first the WBC count must be determined: 2.2 multiplied by 1000 (103 ) 2,200. Multiply that by 30 (25% neutrophils 5% bands) to obtain 6600 and divide that by 100 to determine the ANC of 660. The ANC is used to determine a client’s risk of developing an infection.
The client is diagnosed with leukemia and has leukocytosis. Which laboratory value would the nurse expect to assess? 1. An elevated hemoglobin. 2. A decreased sedimentation count. 3. A decreased red cell distribution width. 4. An elevated white blood cell count.
4. An elevated white blood cell count is what is being described in the term “leukocytosis”—“ leuko” means “white” and “cyto” refers to “cell.” Leukocytosis is the opposite of leukopenia.
The client is placed on neutropenia precautions. Which information should the nurse teach the client? 1. Shave with an electric razor and use a soft toothbrush. 2. Eat plenty of fresh fruits and vegetables. 3. Perform perineal care after every bowel movement 4. Some blood in the urine is not unusual.
3. Perineal care after each bowel movement, preferably with an antimicrobial soap, is performed to reduce bacteria on the skin.
The client is diagnosed with chronic myeloid leukemia and leukocytosis. Which signs/symptoms would the nurse expect to find when assessing this client? 1. Frothy sputum and jugular vein distention. 2. Dyspnea and slight confusion 3. Right upper quadrant tenderness and nausea. 4. Increased appetite and weight gain.
2. Clients with leukocytosis may be short of breath and somewhat confused as a result of decreased capillary perfusion to the lung and brain from excessive amounts of WBCs inhibiting blood flow through the capillaries.