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Flashcards in Hematological Disorders Deck (131)
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121

An older patient relates that she has increased fatigue and a headache. The nurse identifies pale skin and glossitis on assessment. In response to these findings, which teaching will be helpful to the patient if she has microcytic, hypochromic anemia?


 


 


1. Take enteric-coated iron with each meal. 


2. Take cobalamin with green leafy vegetables.
 

3. Take the iron with orange juice one hour before meals.

 


4. Decrease the intake of the antiseizure medications to improve.
 

 

 

 

3. With microcytic, hypochromic anemia, there may be an iron, B6, or copper deficiency, thalassemia, or lead poisoning. The iron prescribed should be taken with orange juice one hour before meals as it is best absorbed in an acid environment. Megaloblastic anemias occur with cobalamin (vitamin B12) and folic acid deficiencies. Vitamin B12 may help RBC maturation if the patient has the intrinsic factor in the stomach. Green leafy vegetables provide folic acid for RBC maturation. Antiseizure drugs may contribute to aplastic anemia or folic acid deficiency, but the patient should not stop taking the medications. Changes in medications will be prescribed by the health care provider.

122

The patient with leukemia has acute disseminated intravascular coagulation (DIC) and is bleeding. What diagnostic findings should the nurse expect to find?


 


 


1. Elevated D-dimers 


2. Elevated fibrinogen
 


3. Reduced prothrombin time (PT)
 


4. Reduced fibrin degradation products (FDPs)
 

 

 

 

 

1. The D-dimer is a specific marker for the degree of fibrinolysis and is elevated with DIC. FDP is elevated as the breakdown products from fibrinogen and fibrin are formed. Fibrinogen and platelets are reduced. PT, PTT, aPTT, and thrombin time are all prolonged.

123

The nurse knows that hemolytic anemia can be caused by which extrinsic factors?


 


 

1. Chronic diseases or medications and chemicals


2. Trauma or splenic sequestration crisis 


3. Abnormal hemoglobin or enzyme deficiency
 

4. Macroangiopathic or microangiopathic factors

 

 

 

4. Macroangiopathic or microangiopathic extrinsic factors lead to acquired hemolytic anemias. Trauma or splenic sequestration crisis can lead to anemia from acute blood loss. Abnormal hemoglobin or enzyme deficiency are intrinsic factors that lead to hereditary hemolytic anemias. Chronic diseases or medications and chemicals can decrease the number of RBC precursors which reduce RBC production

124

A patient who has sickle cell disease has developed cellulitis above the left ankle. What is the nurse's priority for this patient?


 


 


1. Start IV fluids. 




2. Maintain oxygenation. 


3. Maintain distal warmth.
 


4. Check peripheral pulses.
 

 

 

 

 

2. Maintaining oxygenation is a priority as sickling episodes are frequently triggered by low oxygen tension in the blood which is commonly caused by an infection. Antibiotics to treat cellulitis, pain control, and fluids to reduce blood viscosity will also be used, but oxygenation is the priority

125

After the diagnosis of disseminated intravascular coagulation (DIC), what is the first priority of collaborative care?


 


 

1. Administer fresh frozen plasma


2. Administer heparin. 


3. Administer whole blood.
 

4. Treat the causative problem.

 

 

 

4. Treating the underlying cause of DIC will interrupt the abnormal response of the clotting cascade and reverse the DIC. Blood product administration occurs based on the specific component deficiencies and is reserved for patients with life-threatening hemorrhage. Heparin will be administered if the manifestations of thrombosis are present and the benefit of reducing clotting outweighs the risk of further bleeding.

126

The patient with cancer is having chemotherapy treatments and has now developed neutropenia. What care should the nurse expect to provide and teach the patient about (select all that apply)?


 


 

1. Private room with a high-efficiency particulate air (HEPA) filter


2. Strict hand washing 


3. Daily nasal swabs for culture
 


4. Monitor temperature every hour.
 

5. Daily skin care and oral hygiene

 


6. Encourage eating all foods to increase nutrients.
 

 

 

 

1. 2. 5. Strict hand washing and daily skin and oral hygiene must be done with neutropenia, because the patient is predisposed to infection from the normal body flora, other people, and uncooked meats, seafood, eggs, unwashed fruits and vegetables, and fresh flowers or plants. The private room with HEPA filtration reduces the aerosolized pathogens in the patient's room. Blood cultures and antibiotic treatment are used when the patient has a temperature of 100.4° F or more, but temperature is not monitored every hour.

127

A 57-year-old patient has been diagnosed with acute myelogenous leukemia (AML). The nurse explains to the patient that collaborative care will focus on what?


 


 


1. Leukapheresis 




2. Attaining remission 


3. One chemotherapy agent
 


4. Waiting with active supportive care
 

 

 

 

 

2. Attaining remission is the initial goal of collaborative care for leukemia. The methods to do this are decided based on age and cytogenetic analysis. The treatments include leukapheresis or hydroxyurea to reduce the WBC count and risk of leukemia–cell-induced thrombosis. A combination of chemotherapy agents will be used for aggressive treatment to destroy leukemic cells in tissues, peripheral blood, and bone marrow and minimize drug toxicity. In nonsymptomatic patients with chronic lymphocytic leukemia (CLL), waiting may be done to attain remission, but not with AML.

128

A patient will receive a hematopoietic stem cell transplant (HSCT). What is the nurse's priority after the patient receives combination chemotherapy before the transplant?


 


 


1. Prevent patient infection. 


2. Avoid abnormal bleeding.
 


3. Give pneumococcal vaccine.
 


4. Provide companionship while isolated.
 

 

 

 

 

1. After combination chemotherapy for HSCT, the patient's bone marrow is destroyed in preparation to receive the bone marrow graft. Thus the patient is immunosuppressed and is at risk for a life-threatening infection. The priority is preventing infection. Bleeding is not usually a problem. Giving the pneumococcal vaccine at this time should not be done, but should have been done previously. Providing companionship is not the primary role of the nurse, although the patient will need support during the time of isolation.

129

A 22-year-old female patient has been diagnosed with stage 1A Hodgkin's lymphoma. The nurse knows that which chemotherapy regimen is most likely to be prescribed for this patient?


 


 


1. Brentuximab vedotin (Adcetris)
 

2. Two to four cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine

 


3. Four to six cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine
 


4. BEACOPP: bleomycin, etoposide, doxorubicin (Adriamycin), cyclophosphamide, vincristine (Oncovin), procarbazine, and prednisone
 

 

 

 

2. The patient with stage favorable prognosis early-stage Hodgkin's lymphoma will receive two to four cycles of ABVD. The unfavorable prognostic featured (stage 1B) Hodgkin's lymphoma would be treated with four to six cycles of chemotherapy. Advanced-stage Hodgkin's lymphoma is treated more aggressively with more cycles or with BEACOPP. Brentuximab vedotin (Adcetris) is a newer agent that will be used to treat patients who have relapsed or refractory disease.

130

The patient is being treated for non-Hodgkin's lymphoma (NHL). What should the nurse first teach the patient about the treatment?


 


 


1. Skin care that will be needed 


2. Method of obtaining the treatment
 


3. Gastrointestinal tract effects of treatment
 

4. Treatment type and expected side effects

 

 

 

4. The patient should first be taught about the type of treatment and the expected and potential side effects. Nursing care is related to the area affected by the disease and treatment. Skin care will be affected if radiation is used. Not all patients will have gastrointestinal tract effects of NHL or treatment. The method of obtaining treatment will be included in the teaching about the type of treatment.

131

The patient is admitted with hypercalcemia, polyuria, and pain in the pelvis, spine, and ribs with movement. Which hematologic problem is likely to display these manifestations in the patient?


 


 


1. Multiple myeloma 


2. Thrombocytopenia
 


3. Megaloblastic anemia
 


4. Myelodysplastic syndrome
 

 

 

 

 

1. Multiple myeloma typically manifests with skeletal pain and osteoporosis that may cause hypercalcemia, which can result in polyuria, confusion, or cardiac problems. Serum hyperviscosity syndrome can cause renal, cerebral, or pulmonary damage. Thrombocytopenia, megaloblastic anemia, and myelodysplastic syndrome are not characterized by these manifestations.