Flashcards in LA#2 (Hematological Challenges) Chapters 8, 32,33 of Med Surg Deck (87)
Which of the following patients does the nurse deduce is seeing an alternative medical practitioner?
a. A patient who prevents and treats migraine headaches with acupuncture
b. A patient who uses progressive relaxation to control the nausea of cancer chemotherapy
c. A patient who supplements chiropractic manipulation for low back pain with muscle relaxants
d. A patient who takes vitamin and mineral supplements as treatment for gastrointestinal malabsorption
Alternative therapies are those used instead of conventional Western medical practice. This patient is using acupuncture instead of taking medications to prevent or treat migraine.
A patient with high blood pressure asks the nurse about the use of fish oil supplements to help lower blood pressure. Which is the nurse’s best response?
a. “Some evidence exists that fish oil supplements are helpful in treating hypertension.”
b. “Fish oil supplements are helpful for treating rheumatoid arthritis.”
c. “No clear evidence exists that fish oil supplements are helpful.”
d. “Discuss the use of fish oil supplements with the hospital dietitian.”
Good evidence exists that fish oil is helpful in treating hypertension as well as preventing cardiovascular disease.
Which therapy is appropriate for the nurse to suggest for a patient with fibromyalgia?
c. Magnetic therapy
d. Therapeutic touch
Acupuncture may be useful in the treatment of fibromyalgia, whereas the research related to therapeutic touch is inconclusive.
Which of the following should the nurse assess to evaluate the effect of aromatherapy on a patient after surgery?
a. Incision for signs of infection
b. Intake and output
c. Blood pressure and pulse
d. Breath sounds
Aromatherapy is used for stress reduction, and a decrease in the patient’s blood pressure and pulse would indicate that the aromatherapy was effective.
Which of the following is used to gently lift and knead the muscle?
a. Simple massage
d. Circular massage
Pétrissage is a kneading stroke, used to gently knead and lift muscles, often used following effleurage.
The nurse is using imagery as a technique for pain management with a patient who has rheumatoid arthritis. What should the nurse tell the patient to promote reinforcement of the image of a pleasant scene by the patient?
a. “Tell me what you hear, smell, or feel at this place.”
b. “Place your pain in the image of a form you can destroy.”
c. “Bring what you hear and sense in your present environment into your image of the scene.”
d. “If your scene is distressing to you, continue its visualization until you can overcome the distress.”
Imagery uses one’s mind to create images that have a calming effect on the body. Outcomes may include reduction of anxiety, relaxation, enhanced immunity, and changes in hormonal responses.
Which one of the following patients is most likely to use complementary and alternative therapies?
a. A patient who is a vegetarian
b. A patient who is of Asian heritage
c. A patient who is an older adults with a chronic condition
d. A patient who is pregnant
Older adults with non–life-threatening, chronic conditions are most likely to use complementary and alternative therapies.
A patient with chronic headaches seeks treatment from a nurse trained in therapeutic touch. What does the nurse explain to the patient that therapeutic touch involves?
a. The use of the practitioner’s hands to assess and redirect energy
b. The forceful, passive movement of joints to restore structural and functional imbalances
c. Application of pressure with the fingers at points on the body where energy is obstructed
d. Manipulation of soft tissue and small joints that alters the length and tone of myofascial tissue
Therapeutic touch is a method of detecting and balancing human energy. It involves the conscious use of the practitioner’s hands to direct or modulate human energy.
A patient comes to an outpatient clinic and requests an acupuncturist for treatment of her asthma. In responding to the patient’s request, what does the nurse recognize about the effect of acupuncture on asthma?
a. Asthma is a disorder that should not be treated with acupuncture because of the risk for respiratory complications.
b. Acupuncture needles stimulate or block specific superficial nerves that cause alterations in physiological function.
c. Research has indicated that asthma patients may benefit from the effects of acupuncture.
d. The patient must have a strong belief in the concepts of health and disease held by traditional Chinese medicine for treatment to be effective.
Some research has indicated that acupuncture improves lung function, which would benefit the patient with asthma.
A patient always seems to develop an upper respiratory tract infection in the spring, and he asks if any herbal preparation is available that would help him. Which one of the following recommended herbs should the nurse suggest?
c. Ginkgo biloba
d. St. John’s wort
Good scientific evidence exists to suggest that echinacea prevents upper respiratory tract infections, and strong evidence suggests that it is also beneficial in the treatment of upper respiratory tract infections.
A patient tells the nurse that she has been taking melatonin every day. The nurse would ask questions about which of the following during assessment, to evaluate the effectiveness of this herb for its intended use?
a. Glucose levels
b. Sleep habits
c. Bruising or bleeding tendencies
d. Bowel habits
Melatonin use as a sleep enhancement has been informed by scientific evidence; therefore, the nurse would want to assess sleep habits.
During a routine health examination, the patient tells the nurse that she uses a variety of herbal therapies to maintain her health. In discussing her use of herbs, what should the nurse caution the patient about?
a. Most herbs are toxic and carcinogenic and should be used only when proven effective.
b. Herbs are not any better than conventional drugs in maintaining health and may be more unsafe.
c. Herbs should be purchased only from manufacturers with a history of quality control of their products.
d. Because herbal therapies may mask the symptoms of serious disease, frequent medical evaluation is required during their use.
The quality of herb preparations can vary, so it is important that patients purchase herbal remedies from reputable manufacturers. Health Canada (2011) advises Canadians to use only herbal products that have been approved for sale under the Natural Health Products regulations. If the product has been assessed, it will have a Drug Identification Number or Natural Products Number on its label. This certifies that the product has passed a review of formulation, labelling, and instructions for use.
Which of the following is a commonly used herb for treating nausea and vomiting during pregnancy?
d. Milk thistle
Ginger is commonly used for treating nausea and vomiting during pregnancy.
Which of the following is true regarding healing touch?
a. It has strong ties to religious beliefs.
b. It is a physician-based program.
c. It assists the patient to self-heal.
d. The nurse determines its effectiveness.
Healing touch is a nurse-based program that is an organized system designed to assist the patient to self-heal.
Which of the following cells function to provide protection from parasitic infections?
Eosinophils function in the allergic response, phagocytosis, and protection from parasitic infections.
While obtaining a health history from a patient with numerous petechiae on the skin, the nurse asks the patient specifically about the patient’s use of which of the following drugs?
a. Antiseizure medications
b. Oral contraceptives
c. Aspirin compounds
d. Antihypertensive agents
Salicylates interfere with platelet function and can lead to petechiae and ecchymoses.
Which one of the following hematological findings would the nurse question in a 78-year-old patient?
a. White blood cell (WBC) count 3500 cells/microlitre
b. Hematocrit 37%
c. Platelets 450,000 cells/microlitre
d. Hemoglobin 7.3 mmol/L (11.8 g/dL)
The total WBC count is not usually affected by aging, and the low WBC count here would indicate that the patient’s immune function may be compromised.
The physician performs a bone marrow aspiration from the posterior iliac crest on a patient with pancytopenia. Following the procedure, what should the nurse do?
a. Apply a topical antimicrobial agent to the site.
b. Administer an analgesic to control pain at the site.
c. Apply pressure over the site for 5 to 10 minutes.
d. Position the patient supine with a small pillow at the aspiration site.
Because the patient has pancytopenia and is at increased risk for bleeding, pressure should be applied for at least 5 to 10 minutes at the site of the aspiration.
During physical assessment of a patient, the nurse suspects a chronic, severe iron-deficiency anemia on finding which of the following?
a. Yellowed sclera
b. Shiny, smooth tongue
c. Gum bleeding and tenderness
d. Loss of position and vibratory sensation in the extremities
Loss of the papillae of the tongue occurs with chronic iron deficiency.
A patient is found to have leukopenia, anemia, neutropenia, and thrombocytopenia. Which drug classification is known to exhibit these hematological alterations?
c. H2-receptor blockers
d. Trimethoprim–sulfamethoxazole (Septra)
Hematological alterations with the use of trimethoprim–sulfamethoxazole include leukopenia, anemia, neutropenia, and thrombocytopenia.
The nurse reviews the results of coagulation testing for a patient with a bleeding disorder. Which of the following diagnostic tests is most valuable in evaluating the intrinsic coagulation process?
a. Bleeding time
b. Prothrombin time
c. Fibrin split products
d. Activated partial thromboplastin time (aPTT)
aPTT testing is an assessment of intrinsic coagulation by measuring factors I, II, V, VIII, IX, X, XI, and XII.
When evaluating the red blood cell (RBC) indices of a patient, what does the nurse know is indicated by a low mean corpuscular volume (MCV)?
a. RBCs of small size
b. A decrease in RBCs
c. Decreased saturation of RBCs with hemoglobin
d. Decreased weight of the amount of hemoglobin or RBCs
The MCV is low when the RBCs are smaller than normal.
While examining the lymph nodes during physical assessment, about which of the following findings would the nurse be most concerned?
a. Firm inguinal nodes in a patient with an infected foot
b. Inability to palpate any superficial lymph nodes
c. 1-cm mobile and nontender axillary node
d. 2-cm nonpainful supraclavicular node
Enlarged and nontender nodes are most suggestive of malignancy, such as lymphoma.
Which of the following is a normal age-related change in hematological studies?
a. MCV slightly decreased
b. Hemoglobin slightly increased in men
c. Ferritin level increased
d. Erythrocyte sedimentation rate (ESR) decreased
Ferritin level is increased as a result of normal age-related changes. MCV is slightly increased. Hemoglobin is slightly decreased in men. ESR is increased significantly.
How would the nurse document a physical assessment finding of a small group of conditions characterized by ecchymosis on the skin and mucous membranes?
d. Spider nevus
A physical assessment finding of a small group of conditions characterized by ecchymosis or other small hemorrhages in skin and mucous membranes is purpura.
The history and physical examination for a newly admitted patient states that the complete blood count shows a “shift to the left.” What is the priority nursing assessment?
a. Elevated temperature
b. Low oxygen saturation
c. Pallor and weakness
d. Cool extremities
The term shift to the left indicates that the number of immature polymorphonuclear neutrophils, or bands, is elevated and is a sign of severe infection, including an elevated temperature.
Approximately what percentage of the composition of blood is plasma?
Approximately 55% of blood is plasma. Blood cells compose about 45% of blood.
Which one of the following cells is a WBC?
b. Band cell
WBCs include basophils, eosinophils, neutrophils, monocytes, and lymphocytes.
A patient with a history of iron-deficiency anemia who has not taken iron supplements for several years is experiencing increased fatigue and dizziness. What would the nurse expect the patient’s laboratory findings to include?
a. Hematocrit 0.38 (38%)
b. Red blood cell (RBC) count 4,500,000/µL
c. Hemoglobin (Hb) 86 g/L
d. Normal RBC indices
The patient’s clinical manifestations indicate moderate anemia, which is consistent with an Hb of 60 to 100 g/L.