Hematologic Disorders
The nurse is preparing to teach a client with iron deficiency anemia about
the diet
follow to discharge. Which of the following foods should be included
after
in the diet?
a.
Eggs
b.
Lettuce
c. Citrus
Fruits
d. Cheese correct
answersA
A rich source of iron is needed in the diet, and eggs are high in iron. Other
foodsinclude
iron high inorgan and muscle (dark) meats; shellfish, shrimp, and
tuna; enriched,
whole-grain, and fortified cereals and breads; legumes, nuts, dried fruits,
and beans;
oatmeal; and sweet potatoes. Dark green leafy vegetables and citrus
fruits areofgood
sources vitamin C. Cheese is a good source of
calcium.
The nurse would instruct the client to eat which of the following foods to
obtain the
supply best
of vitamin
B12?
A. Whole
grains
B. Green leafy
vegetables
C. Meats and dairy
products
D. Broccoli and Brussels sprouts correct
answersC
Good sources of vitamin B12 include meats and dairy products. Whole
grains are a of thiamine. Green leafy vegetables are good sources of niacin,
good source
folate, and (precursors of vitamin A). Broccoli and Brussels sprouts are
carotenoids
good
of sources
ascorbic acid (vitamin
C).
The nurse has just admitted a 35-year-old female client who has a
serum B12
concentration of 800 pg/ml. Which of the following laboratory findings
would to
nurse cue the the client history on specific drug or
focus
alcohol abuse?
A. Total bilirubin, 0.3
B. Serum creatinine, 0.5
mg/dL
mg/dL
C. Hemoglobin, 16
g/dL
D. Folate, 1.5 ng/mL correct
answersD
The normal range of folic acid is 1.8 to 9 ng/mL, and the normal range of
vitamin
200 B12pg/mL.
to 900 is A low folic acid level in the presence of a normal vitamin
B12 level is
indicative of a primary folic acid-deficiency anemia. Factors that affect the
absorption
folic acid areof drugs such as methotrexate, oral contraceptives, antiseizure
drugs, and
alcohol. The total bilirubin, serum creatinine, and hemoglobin values are
within normal
limit
s.
,The nurse understands that the client with pernicious anemia will
have which
distinguishing laboratory
findings?
A. Schilling's test,
elevated
B. Intrinsic factor,
absent
C. Sedimentation rate, 16
mm/hour
D. RBCs 5.0 million correct
answersB
The defining characteristic of pernicious anemia, a megaloblastic anemia, is
lack of the
intrinsic factor, which results from atrophy of the stomach wall. Without
the intrinsic
factor, vitamin B12 cannot be absorbed in the small intestines, and folic
acid needs
vitamin B12 for DNA synthesis of RBCs. The gastric analysis was done to
determine
primary the of the anemia. An elevated excretion of the injected
cause
radioactive
B12, which is vitamin
protocol for the first and second stage of the Schilling test,
indicates
the client that
has the intrinsic factor and can absorb vitamin B12 into the
intestinal tract.rate
sedimentation A of 16 mm/hour is normal for both men and
women and test
nonspecific is a to detect the presence of inflammation. It is not specific to
anemias.
RBC valueAn of 5.0 million is a normal value for both men and women
and does not
indicate
anemia.
The nurse devises a teaching plan for the patient with aplastic anemia.
Which of the
following is the most important concept to teach for health
maintenance?
A. Eat animal protein and dark leafy vegetables
each
B. dayexposure to others with acute
Avoid
infection
C. Practice yoga and meditation to decrease stress and
anxiety
D. Get 8 hours of sleep at night and take naps during the day correct
answersB
Clients with aplastic anemia are severely immunocompromised and at risk
and possible death related to bone marrow suppression and
for infection
pancytopenia.
aseptic technique Strict
and reverse isolation are important measures to
prevent infection.
Although diet, reduced stress, and rest are valued in supporting health, the
fatal consequence of an acute infection places it as a priority for
potentially
teaching
about the client
health maintenance. Animal meat and dark green leafy vegetables,
good
of sources
vitamin B12 and folic acid, should be included in the daily diet. Yoga and
meditation
are good complimentary therapies to reduce stress. Eight hours of rest
and naps
good are
for spacing and pacing activity
and rest.
A client comes into the health clinic 3 years after undergoing a resection of
the terminal
ileum complaining of weakness, shortness of breath, and a sore tongue.
Which client
statement indicates a need for intervention and client
teaching?
A. "I have been drinking plenty of
fluids."
B. "I have been gargling with warm salt water for my sore
tongue."
C. "I have 3 to 4 loose stools per
day."
D. "I take a vitamin B12 tablet every day." correct
answersD
Vitamin B12 combines with intrinsic factor in the stomach and is then
carriedwhere
ileum, to the it is absorbed in the bloodstream. In this situation, vitamin
B12 cannot be
,absorbed regardless of the amount of oral intake of sources of vitamin
B12 such
animal as
protein or vitamin B12 tablets. Vitamin B12 needs to be injected
every month,
because the ileum has been surgically removed. Replacement of fluids and
electrolytes
is important when the client has continuous multiple loose stools on a daily
basis.
salt Warm
water is used to soothe sore mucous membranes. Crohn's disease and
small bowel
resection may cause several loose stools
a day.
A vegetarian client was referred to a dietitian for nutritional counseling
for anemia.
Which client outcome indicates that the client does not understand
nutritional
counseling? The
client:
A. Adds dried fruit to cereal and baked
goods
B. Cooks tomato-based foods in iron
pots
C. Drinks coffee or tea with
meals
D. Adds vitamin C to all meals correct
answersC
Coffee and tea increase gastrointestinal motility and inhibit the absorption
of nonheme
iron. Clients are instructed to add dried fruits to dishes at every meal
because
fruits aredried
a nonheme or nonanimal iron source. Cooking in iron cookware,
especially
acid-based foods such as tomatoes, adds iron to the diet. Clients are
instructed
rich supplyto ofadd a
vitamin C to every meal because the absorption of iron is
increased
food when C or ascorbic acid is
with vitamin
consumed.
A client was admitted with iron deficiency anemia and blood-streaked
emesis. Which
question is most appropriate for the nurse to ask in determining the extent
of the client's
activity
intolerance?
A. "What activities were you able to do 6 months ago compared with
the present?"
B. "How long have you had this
problem?"
C. "Have you been able to keep up with all your usual
activities?"
D. "Are you more tired now than you used to be?" correct
It is difficult to determine activity intolerance without objectively
answersA
comparing
from one time activities
frame to another. Because iron deficiency anemia can
and
occur individual
graduallyendurance varies, the nurse can best assess the client's
activity
by askingtolerance
the client to compare activities 6 months ago and at the
present.
client how Asking
long aa problem has existed is a very open-ended question that
allowssubjectivity
much for too for any definition of the client's activity tolerance. Also,
not
the even
clientidentify
may that a "problem" exists. Asking the client whether he is
staying
of usualabreast
activities addresses whether the tasks were completed, not the
tolerance
client whileofthethe tasks were being completed or the resulting condition of the
client
the afterwere completed. Asking the client if he is more tired now than
tasks
usual does
address hisnotactivity tolerance. Tiredness is a subjective evaluation and
again canby
distorted befactors such as the gradual onset of the anemia or the
endurance of the
individua
l.
The primary purpose of the Schilling test is to measure the client's
ability to:
, A. Store vitamin
B12
B. Digest vitamin
B12
C. Absorb vitamin
B12
D. Produce vitamin B12 correct
answersC
Pernicious anemia is caused by the body's inability to absorb vitamin B12.
This
in results
a lack of intrinsic factor in the gastric juices. Schilling's test helps
diagnosebypernicious
anemia determining the client's ability to absorb
vitamin B12.
The nurse implements which of the following for the client who is starting
a Schilling
test
?
A. Administering methylcellulose (Citrucel)
B. Starting a 24- to 48 hour urine specimen collection
C. Maintaining NPO status
D. Starting a 72 hour stool specimen collection correct answersB
Urinary vitamin B12 levels are measured after the ingestion of radioactive
vitamin B12. A 24-to 48- hour urine specimen is collected after
administration of an oral dose of radioactively tagged vitamin B12 and an
injection of non-radioactive vitamin B12. In a healthy state of absorption,
excess vitamin B12 is excreted in the urine; in a malabsorption state or when
the intrinsic factor is missing, vitamin B12 is excreted in the feces. Citrucel is
a bulk-forming agent. Laxatives interfere with the absorption of vitamin B12.
The client is NPO 8 to 12 hours before the test but is not NPO during the test.
A stool collection is not part of the Schilling test. If stool contaminates the
urine collection, the results will be altered.
A client with pernicious anemia asks why she must take vitamin B12
injections
rest of herfor the
life. What is the nurse's best
response?
A. "The reason for your vitamin deficiency is an inability to absorb the
vitamin
the because
stomach is not producing sufficient
B. "The reason for your vitamin deficiency is an inability to absorb the
acid."
vitamin
the because
stomach is not producing sufficient intrinsic
factor."
C. "The reason for your vitamin deficiency is an excessive excretion of
the vitamin
because of kidney
dysfunction."
D. "The reason for your vitamin deficiency is an increased requirement for
the vitamin
because of rapid red blood cell production." correct
Most clients with pernicious anemia have deficient production of intrinsic
answersB
factor in the
stomach. Intrinsic factor attaches to the vitamin in the stomach and forms
a complex
that allows the vitamin to be absorbed in the small intestine. The stomach
is producing
enough acid, there is not an excessive excretion of the vitamin, and there is
production
not a rapid of RBCs in this
condition.
The nurse is assessing a client's activity intolerance by having the
client walk
treadmill foron5 aminutes. Which of the following indicates an abnormal
response?
A. Pulse rate increased by 20 bpm immediately after
the activity
The nurse is preparing to teach a client with iron deficiency anemia about
the diet
follow to discharge. Which of the following foods should be included
after
in the diet?
a.
Eggs
b.
Lettuce
c. Citrus
Fruits
d. Cheese correct
answersA
A rich source of iron is needed in the diet, and eggs are high in iron. Other
foodsinclude
iron high inorgan and muscle (dark) meats; shellfish, shrimp, and
tuna; enriched,
whole-grain, and fortified cereals and breads; legumes, nuts, dried fruits,
and beans;
oatmeal; and sweet potatoes. Dark green leafy vegetables and citrus
fruits areofgood
sources vitamin C. Cheese is a good source of
calcium.
The nurse would instruct the client to eat which of the following foods to
obtain the
supply best
of vitamin
B12?
A. Whole
grains
B. Green leafy
vegetables
C. Meats and dairy
products
D. Broccoli and Brussels sprouts correct
answersC
Good sources of vitamin B12 include meats and dairy products. Whole
grains are a of thiamine. Green leafy vegetables are good sources of niacin,
good source
folate, and (precursors of vitamin A). Broccoli and Brussels sprouts are
carotenoids
good
of sources
ascorbic acid (vitamin
C).
The nurse has just admitted a 35-year-old female client who has a
serum B12
concentration of 800 pg/ml. Which of the following laboratory findings
would to
nurse cue the the client history on specific drug or
focus
alcohol abuse?
A. Total bilirubin, 0.3
B. Serum creatinine, 0.5
mg/dL
mg/dL
C. Hemoglobin, 16
g/dL
D. Folate, 1.5 ng/mL correct
answersD
The normal range of folic acid is 1.8 to 9 ng/mL, and the normal range of
vitamin
200 B12pg/mL.
to 900 is A low folic acid level in the presence of a normal vitamin
B12 level is
indicative of a primary folic acid-deficiency anemia. Factors that affect the
absorption
folic acid areof drugs such as methotrexate, oral contraceptives, antiseizure
drugs, and
alcohol. The total bilirubin, serum creatinine, and hemoglobin values are
within normal
limit
s.
,The nurse understands that the client with pernicious anemia will
have which
distinguishing laboratory
findings?
A. Schilling's test,
elevated
B. Intrinsic factor,
absent
C. Sedimentation rate, 16
mm/hour
D. RBCs 5.0 million correct
answersB
The defining characteristic of pernicious anemia, a megaloblastic anemia, is
lack of the
intrinsic factor, which results from atrophy of the stomach wall. Without
the intrinsic
factor, vitamin B12 cannot be absorbed in the small intestines, and folic
acid needs
vitamin B12 for DNA synthesis of RBCs. The gastric analysis was done to
determine
primary the of the anemia. An elevated excretion of the injected
cause
radioactive
B12, which is vitamin
protocol for the first and second stage of the Schilling test,
indicates
the client that
has the intrinsic factor and can absorb vitamin B12 into the
intestinal tract.rate
sedimentation A of 16 mm/hour is normal for both men and
women and test
nonspecific is a to detect the presence of inflammation. It is not specific to
anemias.
RBC valueAn of 5.0 million is a normal value for both men and women
and does not
indicate
anemia.
The nurse devises a teaching plan for the patient with aplastic anemia.
Which of the
following is the most important concept to teach for health
maintenance?
A. Eat animal protein and dark leafy vegetables
each
B. dayexposure to others with acute
Avoid
infection
C. Practice yoga and meditation to decrease stress and
anxiety
D. Get 8 hours of sleep at night and take naps during the day correct
answersB
Clients with aplastic anemia are severely immunocompromised and at risk
and possible death related to bone marrow suppression and
for infection
pancytopenia.
aseptic technique Strict
and reverse isolation are important measures to
prevent infection.
Although diet, reduced stress, and rest are valued in supporting health, the
fatal consequence of an acute infection places it as a priority for
potentially
teaching
about the client
health maintenance. Animal meat and dark green leafy vegetables,
good
of sources
vitamin B12 and folic acid, should be included in the daily diet. Yoga and
meditation
are good complimentary therapies to reduce stress. Eight hours of rest
and naps
good are
for spacing and pacing activity
and rest.
A client comes into the health clinic 3 years after undergoing a resection of
the terminal
ileum complaining of weakness, shortness of breath, and a sore tongue.
Which client
statement indicates a need for intervention and client
teaching?
A. "I have been drinking plenty of
fluids."
B. "I have been gargling with warm salt water for my sore
tongue."
C. "I have 3 to 4 loose stools per
day."
D. "I take a vitamin B12 tablet every day." correct
answersD
Vitamin B12 combines with intrinsic factor in the stomach and is then
carriedwhere
ileum, to the it is absorbed in the bloodstream. In this situation, vitamin
B12 cannot be
,absorbed regardless of the amount of oral intake of sources of vitamin
B12 such
animal as
protein or vitamin B12 tablets. Vitamin B12 needs to be injected
every month,
because the ileum has been surgically removed. Replacement of fluids and
electrolytes
is important when the client has continuous multiple loose stools on a daily
basis.
salt Warm
water is used to soothe sore mucous membranes. Crohn's disease and
small bowel
resection may cause several loose stools
a day.
A vegetarian client was referred to a dietitian for nutritional counseling
for anemia.
Which client outcome indicates that the client does not understand
nutritional
counseling? The
client:
A. Adds dried fruit to cereal and baked
goods
B. Cooks tomato-based foods in iron
pots
C. Drinks coffee or tea with
meals
D. Adds vitamin C to all meals correct
answersC
Coffee and tea increase gastrointestinal motility and inhibit the absorption
of nonheme
iron. Clients are instructed to add dried fruits to dishes at every meal
because
fruits aredried
a nonheme or nonanimal iron source. Cooking in iron cookware,
especially
acid-based foods such as tomatoes, adds iron to the diet. Clients are
instructed
rich supplyto ofadd a
vitamin C to every meal because the absorption of iron is
increased
food when C or ascorbic acid is
with vitamin
consumed.
A client was admitted with iron deficiency anemia and blood-streaked
emesis. Which
question is most appropriate for the nurse to ask in determining the extent
of the client's
activity
intolerance?
A. "What activities were you able to do 6 months ago compared with
the present?"
B. "How long have you had this
problem?"
C. "Have you been able to keep up with all your usual
activities?"
D. "Are you more tired now than you used to be?" correct
It is difficult to determine activity intolerance without objectively
answersA
comparing
from one time activities
frame to another. Because iron deficiency anemia can
and
occur individual
graduallyendurance varies, the nurse can best assess the client's
activity
by askingtolerance
the client to compare activities 6 months ago and at the
present.
client how Asking
long aa problem has existed is a very open-ended question that
allowssubjectivity
much for too for any definition of the client's activity tolerance. Also,
not
the even
clientidentify
may that a "problem" exists. Asking the client whether he is
staying
of usualabreast
activities addresses whether the tasks were completed, not the
tolerance
client whileofthethe tasks were being completed or the resulting condition of the
client
the afterwere completed. Asking the client if he is more tired now than
tasks
usual does
address hisnotactivity tolerance. Tiredness is a subjective evaluation and
again canby
distorted befactors such as the gradual onset of the anemia or the
endurance of the
individua
l.
The primary purpose of the Schilling test is to measure the client's
ability to:
, A. Store vitamin
B12
B. Digest vitamin
B12
C. Absorb vitamin
B12
D. Produce vitamin B12 correct
answersC
Pernicious anemia is caused by the body's inability to absorb vitamin B12.
This
in results
a lack of intrinsic factor in the gastric juices. Schilling's test helps
diagnosebypernicious
anemia determining the client's ability to absorb
vitamin B12.
The nurse implements which of the following for the client who is starting
a Schilling
test
?
A. Administering methylcellulose (Citrucel)
B. Starting a 24- to 48 hour urine specimen collection
C. Maintaining NPO status
D. Starting a 72 hour stool specimen collection correct answersB
Urinary vitamin B12 levels are measured after the ingestion of radioactive
vitamin B12. A 24-to 48- hour urine specimen is collected after
administration of an oral dose of radioactively tagged vitamin B12 and an
injection of non-radioactive vitamin B12. In a healthy state of absorption,
excess vitamin B12 is excreted in the urine; in a malabsorption state or when
the intrinsic factor is missing, vitamin B12 is excreted in the feces. Citrucel is
a bulk-forming agent. Laxatives interfere with the absorption of vitamin B12.
The client is NPO 8 to 12 hours before the test but is not NPO during the test.
A stool collection is not part of the Schilling test. If stool contaminates the
urine collection, the results will be altered.
A client with pernicious anemia asks why she must take vitamin B12
injections
rest of herfor the
life. What is the nurse's best
response?
A. "The reason for your vitamin deficiency is an inability to absorb the
vitamin
the because
stomach is not producing sufficient
B. "The reason for your vitamin deficiency is an inability to absorb the
acid."
vitamin
the because
stomach is not producing sufficient intrinsic
factor."
C. "The reason for your vitamin deficiency is an excessive excretion of
the vitamin
because of kidney
dysfunction."
D. "The reason for your vitamin deficiency is an increased requirement for
the vitamin
because of rapid red blood cell production." correct
Most clients with pernicious anemia have deficient production of intrinsic
answersB
factor in the
stomach. Intrinsic factor attaches to the vitamin in the stomach and forms
a complex
that allows the vitamin to be absorbed in the small intestine. The stomach
is producing
enough acid, there is not an excessive excretion of the vitamin, and there is
production
not a rapid of RBCs in this
condition.
The nurse is assessing a client's activity intolerance by having the
client walk
treadmill foron5 aminutes. Which of the following indicates an abnormal
response?
A. Pulse rate increased by 20 bpm immediately after
the activity
