CBC Practice A &B: Level III Complete
Questions with 100% Correct Answers
Thrombocytopenia
Low blood platelet count.
NURSING CONSIDERATIONS
◯Monitor PLATELET count.
◯Monitor for petechiae, ecchymosis, bleeding of the gums, nosebleeds, and occult or frank blood in
stools, urine, or vomitus -every 4 hours!
◯Institute bleeding precautions.
■Avoid IVs and injections.
■Apply pressure for approximately 10 min after blood is obtained.
■Handle client gently, place on fall precautions, and avoid trauma.
◯Administer thrombopoietic medications such as oprelvekin to stimulate platelet production.
Monitor platelet count, and be prepared to administer platelets if the count falls below 10,000/mm3.
CLIENT EDUCATION
●Instruct the client and family how to manage active bleeding.
●Instruct the client about measures to prevent bleeding (use electric razor and soft-bristled
toothbrush, avoid blowing nose vigorously, ensure that dentures fit appropriately).
●Instruct the client to avoid the use of NSAIDs.
●Teach the client to prevent injury when ambulating (wear closed-toes shoes, remove tripping
hazards in the home) and apply cold if injury occurs
Anemia
NURSING CONSIDERATIONS
◯Monitor for fatigue, pallor, dizziness, and shortness of breath.
◯Help the client manage anemia-related fatigue by scheduling activities with rest periods in between
and using energy saving measures (resting elbows on table and sitting during showers and other
ADLs).
◯Administer erythropoietic medications (e.g.,darbepoetin alfa, Epoetin Alfa) and antianemic
medications (e.g., ferrous sulfate) as prescribed.
◯Monitor Hgb values to determine response to medications. Be prepared to administer blood if
prescribe
PT EDUCATION
◯report a SEVERE HEADACHE to the child's provider because it can be an indication of a stroke.
◯apply warm compresses to the affected joints to prevent vasoconstriction.
◯encourage the child to increase fluid intake to maintain hydration.
Sickle Cell Anemia
autosomol recessive genetic disorder. defective/malformed RBCs
S/S:
-severe pain
-SOB
-fatigue
-pallor
-jaundice
CRISIS LABS
-increased WBC and bilirubin
-decreased Hgb
,1st STAGE
Vaso-oclusive crisis (painful episode)
S/S:
*-hematuria (from ischemia to the kidneys)
-jaundice
-severe painful in hands, feet, abd, joints, and bones
-swelling of the hands, feet, and joints
-vision changes
2ND STAGE
Sequestration S/S:
-enlarged spleen and liver
-hypovolemia and at r/f hypovolemic shock
3RD STAGE
Aplastic crisis
-severe anemia trigguered by infection/virus
4TH STAGE
Hyperhemolytic crisis: (RBC distruction)
-jaundice
-reticulocytosis
5TH STAGE
Anemia
NURSING CARE
-administer IV fluids, O2, blood products, opioid analgesics around the clock, antibiotics for infections,
increase fluid intake, promote rest
Neutropenia r/t Chemotherapy
An abnormally low count of a type of white blood cell (neutrophils) due to bone marrow suppression
by cytotoxic medications
●The most significant adverse effect of chemotherapy
NURSING CONSIDERATIONS
●Monitor temperature 2x daily, white blood cell (WBC) count, and absolute neutrophil count (ANC).
●A fever greater than 37.8° C (100° F) should be reported to the provider immediately.
●Clients who have neutropenia might not develop a high fever or have purulent drainage even when
an infection is present.
●Monitor skin and mucous membranes for infection (breakdown, fissures, and abscess).
●Cultures should be obtained prior to initiating antimicrobial therapy.
●The risk of serious infection increases as the ANC falls. An ANC less than 1,000/mm3 indicates a
weak immune system. The nurse should implement neutropenic precautions, including placing the
client in a PRIVATE ROOM.
NEUTROPENIC PRECAUTIONS
●Have the client remain in the room unless he needs to leave for a diagnostic procedure or therapy.
In this case, place a mask on him during transport.
●Protect the client from possible sources of infection (plants, change water in equipment daily).
●Have client, staff, and visitors perform frequent hand hygiene. Restrict visitors who are ill.
●Avoid invasive procedures that could cause a break in tissue (rectal temperatures, injections,
indwelling urinary catheters) unless necessary.
●Keep dedicated equipment (blood pressure machine, thermometer, stethoscope) in the client's
room.
,●Administer colony-stimulating factors (filgrastim) as prescribed to stimulate WBC production.
CLIENT EDUCATION
●Encourage the client to avoid crowds while undergoing chemotherapy.
●Take temperature 2x daily. Report elevated temperature to the provider.
●Avoid food sources that could contain bacteria (fresh fruits and vegetables; undercooked/RAW
MEAT, fish, and eggs; pepper and paprika).
●refrigerate foods immediately after purchase from the grocery store and thaw frozen foods in the
refrigerator rather than at room temperature.
●avoid buffets and salad bars
●discard leftovers after a maximum of 4 days
●refrigerate food immediately after eating to prevent foodborne contamination. The client should
also reheat the food throughout and thoroughly prior to eating it again.
●Avoid yard work, gardening, or changing a pet's litter box.
●Avoid fluids that have been sitting at room temperature for longer than 1 hr.
*●Wash hands with an antimicrobial soap prior to eating.
●Wash all dishes in hot, soapy water or a dishwasher. ●Wash glasses and cups after each use.
●Wash toothbrush daily in the dishwasher or rinse in a bleach solution.
●Do not share toiletry or personal hygiene items with others.
●Report fever greater than 37.8° C (100° F) or other manifestations of bacterial or viral infections
immediately to the provider.
Radiation Therapy
Internal Radiation Therapy - this is done via placement in a body orifice (vagina) or body cavity
(abdomen) or delivered via IV such as with radionuclide iodine, which is absorbed by the thyroid
NURSING CONSIDERATIONS
●Place the client in a private room away from other clients when possible. Keep door closed as much
as possible.
●Place a sign on the door warning of the radiation source.
●Wear a dosimeter film badge that records personal amount of radiation exposure.
●Limit visitors to 30-min visits, and have visitors maintain a distance of 6 feet from the source.
●Visitors and health care personnel who are pregnant or under the age of 18 should not come into
contact with the client or radiation source.
●Wear a lead apron while providing care keeping the front of the apron facing the source of radiation.
●Keep a lead container in the client's room if the delivery method could allow spontaneous loss of
radioactive material. Tongs are available for placing radioactive material into this container.
●Follow protocol for proper removal of dressings and bed linens from the room
CLIENT EDUCATION
●Inform the client of the need to remain in an indicated position to prevent dislodgement of the
radiation implant.
●Instruct the client to call the nurse for assistance with elimination.
●Instruct the client and family about radiation precautions needed in health care and home
environments.
External Radiation Therapy - delivered in relatively small doses over the course of several weeks and
aimed at the body from an external source. Unlike internal radiation, the client is not radioactive and
is not hazardous to others.
NURSING CONSIDERATIONS
●The skin over the targeted area is marked with "tattoos" that guide the positioning of the external
radiation source.
, ●Provide a well-balanced diet that does not contain red meat. Radiation can cause dysgeusia (altered
taste), making foods such as red meat unpalatable.
●Help the client manage fatigue by scheduling activities with rest periods in between and using
energy-saving measures (sitting during showers and ADLs).
●Monitor for radiation injury to skin and mucous membranes and implement a skin care regimen.
◯Skin: blanching, erythema, desquamation, sloughing, hemorrhage
◯Mouth: mucositis, xerostomia (dry mouth)
◯Neck: difficulty swallowing
◯Abdomen: gastroenteritis
●Monitor CBC (possible decreased platelets and WBCs).
CLIENT EDUCATION
●Adverse effects depend on which part of the body is being exposed to the radiation and how much
radiation is being administered.
●Review nutrition considerations related to mucositis.
◯Avoid spicy, salty, acidic foods.
◯Hot foods might not be tolerated.
●Gently wash the skin over the irradiated area with mild soap and water. Dry the area thoroughly
using patting motions
.●Do not remove or wash off radiation tattoos (markings) used to guide therapy. Do not apply
powders, ointments, lotions, deodorants, or perfumes to the irradiated skin.
●Wear soft clothing. Avoid tight or constricting clothes.
●Do not expose the irradiated skin to sun or a heat source.
●Inspect skin for evidence of damage and report to the provider
Melanoma
NURSING ACTIONS: Instruct client to develop a body map (diagram of scars or lesions) and monitor
monthly for changes. Inspect skin between fingers and toes and on scalp
PREVENTION
Limit exposure to sunlight, especially between 1000 and 1500.●Apply sunscreen when near reflective
surfaces (sand, snow, water, concrete).●Use sunblock that has an SPF of at least 15, with both UVA
and UVB protection. Apply 30 min before exposure to sun. Sunblock should be reapplied at least
every 2 hr.●Wear protective clothing, hats, sunglasses, and lip balm that has an SPF of at least
15.●Avoid indoor tanning (tanning beds, booths, sunlamps).●Teach clients the "ABCDE" system to
evaluate moles.◯A: Asymmetry: One side does not match the other ◯B: Borders: Ragged, notched,
irregular, or blurrededges◯C: Color: Lack of uniformity in pigmentation (shades of tan, brown, or
black)◯D: Diameter: Width greater than 6 mm, or about the size of a pencil eraser or a pea ◯E:
Evolving: Or change in appearance (shape, size, color, height, texture) or condition
(bleeding,itching)●Because of the cumulative effects of sun damage over the lifespan, screening for
suspicious lesions is an essential part of the routine physical assessment of older adult clients
--Nonsurgical Tx Options: The nurse should instruct the client about targeted therapy. The medication
vemurafenib is an oral medication administered for the treatment of melanoma that can target
specific molecules and interfere with cell division and the growth and progression of the disease.
Leukemia
●Leukemias are cancers of white blood cells or of cells that develop into white blood cells. In
leukemia, the white blood cells are not functional. They invade and destroy bone marrow, and they
can metastasize to the liver, spleen, lymph nodes, testes, and brain
●Overgrowth of leukemic cells prevents growth of other blood components (platelets, erythrocytes,
mature leukocytes).
◯Lack of mature leukocytes leads to immunosuppression. Infection is the leading cause of death
among clients who have leukemia.
Questions with 100% Correct Answers
Thrombocytopenia
Low blood platelet count.
NURSING CONSIDERATIONS
◯Monitor PLATELET count.
◯Monitor for petechiae, ecchymosis, bleeding of the gums, nosebleeds, and occult or frank blood in
stools, urine, or vomitus -every 4 hours!
◯Institute bleeding precautions.
■Avoid IVs and injections.
■Apply pressure for approximately 10 min after blood is obtained.
■Handle client gently, place on fall precautions, and avoid trauma.
◯Administer thrombopoietic medications such as oprelvekin to stimulate platelet production.
Monitor platelet count, and be prepared to administer platelets if the count falls below 10,000/mm3.
CLIENT EDUCATION
●Instruct the client and family how to manage active bleeding.
●Instruct the client about measures to prevent bleeding (use electric razor and soft-bristled
toothbrush, avoid blowing nose vigorously, ensure that dentures fit appropriately).
●Instruct the client to avoid the use of NSAIDs.
●Teach the client to prevent injury when ambulating (wear closed-toes shoes, remove tripping
hazards in the home) and apply cold if injury occurs
Anemia
NURSING CONSIDERATIONS
◯Monitor for fatigue, pallor, dizziness, and shortness of breath.
◯Help the client manage anemia-related fatigue by scheduling activities with rest periods in between
and using energy saving measures (resting elbows on table and sitting during showers and other
ADLs).
◯Administer erythropoietic medications (e.g.,darbepoetin alfa, Epoetin Alfa) and antianemic
medications (e.g., ferrous sulfate) as prescribed.
◯Monitor Hgb values to determine response to medications. Be prepared to administer blood if
prescribe
PT EDUCATION
◯report a SEVERE HEADACHE to the child's provider because it can be an indication of a stroke.
◯apply warm compresses to the affected joints to prevent vasoconstriction.
◯encourage the child to increase fluid intake to maintain hydration.
Sickle Cell Anemia
autosomol recessive genetic disorder. defective/malformed RBCs
S/S:
-severe pain
-SOB
-fatigue
-pallor
-jaundice
CRISIS LABS
-increased WBC and bilirubin
-decreased Hgb
,1st STAGE
Vaso-oclusive crisis (painful episode)
S/S:
*-hematuria (from ischemia to the kidneys)
-jaundice
-severe painful in hands, feet, abd, joints, and bones
-swelling of the hands, feet, and joints
-vision changes
2ND STAGE
Sequestration S/S:
-enlarged spleen and liver
-hypovolemia and at r/f hypovolemic shock
3RD STAGE
Aplastic crisis
-severe anemia trigguered by infection/virus
4TH STAGE
Hyperhemolytic crisis: (RBC distruction)
-jaundice
-reticulocytosis
5TH STAGE
Anemia
NURSING CARE
-administer IV fluids, O2, blood products, opioid analgesics around the clock, antibiotics for infections,
increase fluid intake, promote rest
Neutropenia r/t Chemotherapy
An abnormally low count of a type of white blood cell (neutrophils) due to bone marrow suppression
by cytotoxic medications
●The most significant adverse effect of chemotherapy
NURSING CONSIDERATIONS
●Monitor temperature 2x daily, white blood cell (WBC) count, and absolute neutrophil count (ANC).
●A fever greater than 37.8° C (100° F) should be reported to the provider immediately.
●Clients who have neutropenia might not develop a high fever or have purulent drainage even when
an infection is present.
●Monitor skin and mucous membranes for infection (breakdown, fissures, and abscess).
●Cultures should be obtained prior to initiating antimicrobial therapy.
●The risk of serious infection increases as the ANC falls. An ANC less than 1,000/mm3 indicates a
weak immune system. The nurse should implement neutropenic precautions, including placing the
client in a PRIVATE ROOM.
NEUTROPENIC PRECAUTIONS
●Have the client remain in the room unless he needs to leave for a diagnostic procedure or therapy.
In this case, place a mask on him during transport.
●Protect the client from possible sources of infection (plants, change water in equipment daily).
●Have client, staff, and visitors perform frequent hand hygiene. Restrict visitors who are ill.
●Avoid invasive procedures that could cause a break in tissue (rectal temperatures, injections,
indwelling urinary catheters) unless necessary.
●Keep dedicated equipment (blood pressure machine, thermometer, stethoscope) in the client's
room.
,●Administer colony-stimulating factors (filgrastim) as prescribed to stimulate WBC production.
CLIENT EDUCATION
●Encourage the client to avoid crowds while undergoing chemotherapy.
●Take temperature 2x daily. Report elevated temperature to the provider.
●Avoid food sources that could contain bacteria (fresh fruits and vegetables; undercooked/RAW
MEAT, fish, and eggs; pepper and paprika).
●refrigerate foods immediately after purchase from the grocery store and thaw frozen foods in the
refrigerator rather than at room temperature.
●avoid buffets and salad bars
●discard leftovers after a maximum of 4 days
●refrigerate food immediately after eating to prevent foodborne contamination. The client should
also reheat the food throughout and thoroughly prior to eating it again.
●Avoid yard work, gardening, or changing a pet's litter box.
●Avoid fluids that have been sitting at room temperature for longer than 1 hr.
*●Wash hands with an antimicrobial soap prior to eating.
●Wash all dishes in hot, soapy water or a dishwasher. ●Wash glasses and cups after each use.
●Wash toothbrush daily in the dishwasher or rinse in a bleach solution.
●Do not share toiletry or personal hygiene items with others.
●Report fever greater than 37.8° C (100° F) or other manifestations of bacterial or viral infections
immediately to the provider.
Radiation Therapy
Internal Radiation Therapy - this is done via placement in a body orifice (vagina) or body cavity
(abdomen) or delivered via IV such as with radionuclide iodine, which is absorbed by the thyroid
NURSING CONSIDERATIONS
●Place the client in a private room away from other clients when possible. Keep door closed as much
as possible.
●Place a sign on the door warning of the radiation source.
●Wear a dosimeter film badge that records personal amount of radiation exposure.
●Limit visitors to 30-min visits, and have visitors maintain a distance of 6 feet from the source.
●Visitors and health care personnel who are pregnant or under the age of 18 should not come into
contact with the client or radiation source.
●Wear a lead apron while providing care keeping the front of the apron facing the source of radiation.
●Keep a lead container in the client's room if the delivery method could allow spontaneous loss of
radioactive material. Tongs are available for placing radioactive material into this container.
●Follow protocol for proper removal of dressings and bed linens from the room
CLIENT EDUCATION
●Inform the client of the need to remain in an indicated position to prevent dislodgement of the
radiation implant.
●Instruct the client to call the nurse for assistance with elimination.
●Instruct the client and family about radiation precautions needed in health care and home
environments.
External Radiation Therapy - delivered in relatively small doses over the course of several weeks and
aimed at the body from an external source. Unlike internal radiation, the client is not radioactive and
is not hazardous to others.
NURSING CONSIDERATIONS
●The skin over the targeted area is marked with "tattoos" that guide the positioning of the external
radiation source.
, ●Provide a well-balanced diet that does not contain red meat. Radiation can cause dysgeusia (altered
taste), making foods such as red meat unpalatable.
●Help the client manage fatigue by scheduling activities with rest periods in between and using
energy-saving measures (sitting during showers and ADLs).
●Monitor for radiation injury to skin and mucous membranes and implement a skin care regimen.
◯Skin: blanching, erythema, desquamation, sloughing, hemorrhage
◯Mouth: mucositis, xerostomia (dry mouth)
◯Neck: difficulty swallowing
◯Abdomen: gastroenteritis
●Monitor CBC (possible decreased platelets and WBCs).
CLIENT EDUCATION
●Adverse effects depend on which part of the body is being exposed to the radiation and how much
radiation is being administered.
●Review nutrition considerations related to mucositis.
◯Avoid spicy, salty, acidic foods.
◯Hot foods might not be tolerated.
●Gently wash the skin over the irradiated area with mild soap and water. Dry the area thoroughly
using patting motions
.●Do not remove or wash off radiation tattoos (markings) used to guide therapy. Do not apply
powders, ointments, lotions, deodorants, or perfumes to the irradiated skin.
●Wear soft clothing. Avoid tight or constricting clothes.
●Do not expose the irradiated skin to sun or a heat source.
●Inspect skin for evidence of damage and report to the provider
Melanoma
NURSING ACTIONS: Instruct client to develop a body map (diagram of scars or lesions) and monitor
monthly for changes. Inspect skin between fingers and toes and on scalp
PREVENTION
Limit exposure to sunlight, especially between 1000 and 1500.●Apply sunscreen when near reflective
surfaces (sand, snow, water, concrete).●Use sunblock that has an SPF of at least 15, with both UVA
and UVB protection. Apply 30 min before exposure to sun. Sunblock should be reapplied at least
every 2 hr.●Wear protective clothing, hats, sunglasses, and lip balm that has an SPF of at least
15.●Avoid indoor tanning (tanning beds, booths, sunlamps).●Teach clients the "ABCDE" system to
evaluate moles.◯A: Asymmetry: One side does not match the other ◯B: Borders: Ragged, notched,
irregular, or blurrededges◯C: Color: Lack of uniformity in pigmentation (shades of tan, brown, or
black)◯D: Diameter: Width greater than 6 mm, or about the size of a pencil eraser or a pea ◯E:
Evolving: Or change in appearance (shape, size, color, height, texture) or condition
(bleeding,itching)●Because of the cumulative effects of sun damage over the lifespan, screening for
suspicious lesions is an essential part of the routine physical assessment of older adult clients
--Nonsurgical Tx Options: The nurse should instruct the client about targeted therapy. The medication
vemurafenib is an oral medication administered for the treatment of melanoma that can target
specific molecules and interfere with cell division and the growth and progression of the disease.
Leukemia
●Leukemias are cancers of white blood cells or of cells that develop into white blood cells. In
leukemia, the white blood cells are not functional. They invade and destroy bone marrow, and they
can metastasize to the liver, spleen, lymph nodes, testes, and brain
●Overgrowth of leukemic cells prevents growth of other blood components (platelets, erythrocytes,
mature leukocytes).
◯Lack of mature leukocytes leads to immunosuppression. Infection is the leading cause of death
among clients who have leukemia.
