Chapter 40: Care of Patients with Hematologic Problems Ignatavicius

Chapter 40: Care of Patients with Hematologic Problems Ignatavicius

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A nurse caring for a client with sickle cell disease (SCD) reviews the client’s laboratory work. Which finding should the nurse report to the provider?
   1. Creatinine: 2.9 mg/dL
   2. Hematocrit: 30%
   3. Sodium: 147 mEq/L
   4. White blood cell count: 12,000/mm³

ANS:   A

An elevated creatinine indicates kidney damage, which occurs in SCD. A hematocrit level of 30% is an expected finding, as is a slightly elevated white blood cell count. A sodium level of 147 mEq/L, although slightly high, is not concerning.

DIF:     Applying/Application                         REF: 801                     KEY: Hematologic system| laboratory values| anemias                              MSC:                         Integrated Process: Communication and Documentation  NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

2. A client hospitalized with sickle cell crisis frequently asks for opioid pain medications, often shortly after receiving a dose. The nurses on the unit believe the client is drug seeking. When the client requests pain medication, what action by the nurse is best?
   1. Give the client pain medication if it is time for another dose.
   2. Instruct the client not to request pain medication too early.
   3. Request the provider leave a prescription for a placebo.
   4. Tell the client it is too early to have more pain medication.

ANS:   A

Clients with sickle cell crisis often have severe pain that is managed with up to 48 hours of IV opioid analgesics. Even if the client is addicted and drug seeking, he or she is still in extreme pain. If the client can receive another dose of medication, the nurse should provide it. The other options are judgmental and do not address the client’s pain. Giving placebos is unethical.

DIF:     Applying/Application                         REF: 801                     KEY: Hematologic system| anemias| pain| caring                                       MSC:                         Integrated Process: Nursing Process: Implementation                                 NOT:                          Client Needs Category: Physiological Integrity: Physiological Adaptation

3. A client in sickle cell crisis is dehydrated and in the emergency department. The nurse plans to start an IV. Which fluid choice is best?
   1. 45% normal saline
   2. 9% normal saline
   3. Dextrose 50% (D50)
   4. Lactated Ringer’s solution

ANS:           A

Because clients in sickle cell crisis are often dehydrated, the fluid of choice is a hypotonic solution such as 0.45% normal saline. 0.9% normal saline and lactated Ringer’s solution are isotonic. D50 is hypertonic and not used for hydration.

DIF:            Applying/Application                         REF:    802                   KEY: Hematologic system| anemias| fluid and electrolyte imbalance| IV fluids| hydration MSC:      Integrated Process: Nursing Process: Analysis                                                    NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A client presents to the emergency department in sickle cell crisis. What intervention by the nurse takes priority?
   1. Administer oxygen.
   2. Apply an oximetry probe.
   3. Give pain medication.
   4. Start an IV line.

ANS:           A

All actions are appropriate, but remembering the ABCs, oxygen would come first. The main problem in a sickle cell crisis is tissue and organ hypoxia, so providing oxygen helps halt the process.

DIF:            Applying/Application                         REF:    802                   KEY: Hematologic system| anemias| oxygen| oxygen therapy  MSC:              Integrated Process: Nursing Process: Implementation                      NOT:                                                 Client Needs Category: Safe and Effective Care Environment: Management of Care

5. A client has a serum ferritin level of 8 ng/mL and microcytic red blood cells. What action by the nurse is best?
   1. Encourage high-protein foods.
   2. Perform a Hemoccult test on the client’s stools.
   3. Offer frequent oral care.
   4. Prepare to administer cobalamin (vitamin B12).

ANS:           B

This client has laboratory findings indicative of iron deficiency anemia. The most common cause of this disorder is blood loss, often from the GI tract. The nurse should perform a Hemoccult test on the client’s stools. High-protein foods may help the condition, but dietary interventions take time to work. That still does not determine the cause. Frequent oral care is not related. Cobalamin injections are for pernicious anemia.

DIF:            Applying/Application                         REF:    804                   KEY: Hematologic system| anemias| laboratory values                                     MSC: Integrated Process: Nursing Process: Implementation                                                      NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential