yaa dad
1. What is a hemogram?
2. A client comes into the health clinic 3 years after undergoing 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 FL
b. I have 3-4 loose stools q, day
c. I take b12 everyday
1. Hemogram is a routinely ordered CBC measuring RBC, WBC, hgB, HCT, Platelets
2. I take b12 everyday ...
Vitamin B12 combines with intrinsic factor in the stomach and is then carried to the ileum, where 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 as animal protein or vitamin B12 tablets. Vitamin B12 needs to be injected every month, because the ileum has been surgically removed.
Anemia's are caused by several factors. What are these factors? SATA
a. destruction
b. sickle cell disease
c. gain
d. loss
e. production
a. destruction d. loss e. production
destruction.. low lifespan of RBC aka hemolysis.. <120 days... SCD 10-20 days
loss... acute: hemorrhage (aeb sudden drop in hgB & HCT) chronic: gi malig, heavy menses, erosive gastritis
production... bone marrow suppression: aplastic, drug induced, idopath chronic illness: inflammation, infection, malignancy nutritional: b12/ folic acid
Which part/s of this statement requires further education?
A client who is prescribed iron supplements is educated that vitamin c & calcium may help with absorption. The client is taught that if the supplement causes gi issues such as diarrhea they can take the supplement 1 hour before food.
..calcium may help with absorption
...such as diarrhea they can take the supplement 1 hour before food..... in general this supplement should be taken on an empty stomach 1 hour before food. If the supplement cause gi upset it may be taken with food. Educate the client that high fiber foods may decrease diarrhea.
1. Acute _____ is the #1 childhood cancer
2. Normal WBC count?
3. ANC normal value is?
1. acute lymphocytic ):
2. 4,500 - 11,000
3. 1,500 - 8,000
Which statement needs further education? SATA
a. Children with SCD have parents that both either have SCD or SCT
b. Parents who have SCT have a 1/2 chance that their child will have SCD
c. Those with SCD have hgBS rather than hgBA
d. Sickled RBC's have a lifespan equal to normal RBC's making them so dangerous
b. Parents who have SCT have a 1/2 chance that their child will have SCD.... 1/4 chance
d. Sickled RBC's have a lifespan equal to normal RBC's making them so dangerous... lifespace = 10-20 days
What am I ?
1. measures average size of RBC
1a. What is average RBC size?
2. measures the amount of hgB by weight in a single RBC
3. measures the average amount of hgB by % in a single RBC
1. MCV ..mean corpuscular VL
1a. 80-96 fl
2. MCH... mean corpuscular hemoglobin
3. MCHC... mean corpuscular hgB concentration
A client MCV indicates microlytic RBC's and the serum ferritin value is 5 ng/mL. The client also is fatigued and has cuts in the corner of his mouth. The nurse is ordered to start administration of ______. What should the nurse check before administration ? (this part open ended)
a. Ferric gluconate
b. vitamin C
c. cyanacobalamin
d. folic acid
a. Ferric gluconate
THE NURSE SHOULD CHECK/ TEST FOR ALLERGIES
....also note: 125 mg diluted in 100 ml saline, given over an hour or slow push
An adult client presents to the clinic with decreased exercise tolerance, and cracks around the lips. The client states they follow a vegan diet. What should the nurse suspect the next action is?
a. Iron sucrose admin
b. sensitivity test for ferric gluc admin
c. evaluation of possible gi bleed
d. education of the importance of iron in the diet
c. evaluation of possible gi bleed
...any adult suspected to have new onset of IDA should be evaluated for gi/ abnormal bleeding.
A client is being screened for Leukemia. The client has undergone a biopsy which is positive for diseased cells. The nurse knows what is next?
a. RN talk with client about confirmation of DX
b. Anergy text will be preformed
c. Spinal tap will be preformed to examine CSF
d. genetic & molecular tests will be done
c. Spinal tap will be preformed to examine CSF
....to determine if disease has spread to spine
A client who participates in the hospitals sickle cell program is in crisis and has come to the ER for TX. The client states she is here for a 24HR TX and will be flying to Colorado after TX.
Which part of the clients statement needs education?
What would this client's hydration TX plan look like?
a. TX is at least 48 hrs
b. Flying to Colorado could further exacerbate her crisis due to the high altitude
c. HYPOTONIC FL @ 250 mL over 4 HR OR 125 mL/HR if more hydration is needed.
..... hypo fL.... 0.25% NS, 0.45% NS, D5W
What am I?
1. Measures how fast reticulocytes made by bone marrow marrow are released in the blood.
1a. What is the normal % associated?
1b. What could a high % indicate?
2. Determines how much iron is in the blood
2a. what is the normal mcg/dL associated?
2b. What do high and low levels indicate?
1. Reticulocyte count
a. 0.5- 1.5%
b. Anemia??
2. TIBC... total iron binding capacity
a. 240-450 mcg/dL
b. high = low iron in blood... low= high iron in blood
A patient who has a history of crohn's disease presents to the ED with pallor, fatigue, and paresthesia of the hands and feet.
What medication would the nurse expect to be prescribed for this patient?
a. ferrous sulfate
b. cyanacobalamin
c. folic acid
d. serum ferritin
c. folic acid
@ 0.25- 1mg PO q. day
ANEMIA AT QUESTION: folic acid/ folate deficiency aeb crohn's (malabsorption), pallor, fatigue, paresthesia
What part of the scenario requires intervention?
A client who has been diagnosed with aplastic anemia and has a PMH of kidney transplant has been taking long term cyclosporine. The nurse notices a new onset of tremors and dry skin in this client. The nurse should knows the client must immediately stop taking the cyclosporine and places the client on neutropenic precautions.
...the client must immediately stop taking the cyclosporine
on long term cyclosporine tx monitor:
s/s infection, neutropenia, thrombocytopenia, monitor renal/hepatic fx, visual impairment, skin cancer
A patient presents with splenomegaly, itching, fevers, night sweats. The patient does not report any pain. The patient has a PMH of HIV.
1. Where would the nurse expect to see swollen lymph nodes?
2. What medications might be RX to the client?
1. neck, chest, underarms
contiguous spread...predictable
2. -bleomycin
- brentuximab
-clophosphamide
- dacarbazine
- vincristine
TRUE or FALSE
1. Hemolytic anemia is caused by the short lifespan of RBC's found in SCD
2. SCD crisis follows a strict pattern. Client's should be educated to learn their pattern to decrease tissue hypoxia
3. The nurse understands SCD can cause s/s that mock CVA. Frequent neuro checks are not required because the CVA is not an actual event.
4. In SCD HCT may be 20-30 % lower then normal & an increased reticulocyte may indicate anemia of long term duration
1. TRUE
2. FALSE... SCD crisis does not follow a pattern
3. FALSE... freq neuro checks are required because s/s of CVA can indicate and actual CVA
4. TRUE
Which of the following diagnostic findings are most likely for a client with aplastic anemia?
a. decreased production of t cells
b. decreased levels of WBC, RBC, platelets
c. increased levels of WBC, RBC, platelets
d. reed sternberg cells, lymph swelling
b. decreased levels of WBC, RBC, platelets
An oncology client has been receiving radiation treatment. The client has an RBC count of 3.5. The HCP ordered the client be given a blood transfusion. The nurse knows the monitor this client for which of the following? SATA
a. fL over load
b. s/s infection
c. thrombocytopenia
d. blood transfusion reactions
b. s/s infection
c. thrombocytopenia
d. blood transfusion reactions
*** what is the anemia of question?
aplastic aeb radiation and pancytopenia
A client stumbles into the ED with severe pallor, jaundice, and paresthesia. The client also reports recent weight loss. What assessments/ questions should the nurse expect the client to receive? SATA
a. HX of PPI use
b. HX of recent bowel movements
c. assessment of large bowel obstruction
d. Hydrogen and methane breath test
e. HX of ETOH use
also... what anemia is this?
a. HX of PPI use
b. HX of recent bowel movements
c. small...
d. Hydrogen and methane breath test
e. HX of ETOH use
...+ diet: vegan. low diary.. diverticula, gastrectomy
b12 anemia
1. A client with non-hodgkin's has been having chest pain and pressure. Why?
2. Where would you expect to see swelling?
3. Is this client going to be itchy?
4. Will the spread of disease follow a pattern?
1. SVC...superior vena cave syndrom
2. Abdominal swelling and possible pain
3. No itchy (that is for hodgkin's)
4. No pattern... "non contiguous spread", "disseminated"... the spread arises in various parts of the body, even in the groin & abdomen
The mothers asks the nurse why her child’s hemoglobin was normal at birth but now the child has S hemoglobin. Which of the following responses by the nurse is most appropriate?
a. the placenta bars passage of S
b. marrow dose not begin to produce S until months postpartum
c. antibodies transmitted from you to the fetus provide newborn with temporary immunity
d. the new born has a high concentration of fetal hemoglobin in the blood for some time after birth
d. the new born has a high concentration of fetal hemoglobin in the blood for some time after birth
Confirmation of tumor lysis syndrome will show what on a CBC? SATA
a. hypok
b. hyperuricemia
c. hypophosphate
d. hypercalcemia
b. hyperuricemia
HYPER K, PHO
HYPO CAL
....c & pho are always INVERSE
TRUE or FALSE
1. In b12 anemia there is a malfx of RBC synthesis. The RBC's being released are microlyic & not enough are being produced/ released.
2. Pernicious anemia is a type of b12 anemia. What makes them different is pernicious is an impairment of b12 uptake.
3. Cyanacobalamin is used to treat b12 anemias. Cyanacobalamin is given once a month until RBC level's become normal. Once this happens cyanacobalamin is given PO PRN.
1. FALSE... macrolytic/ megablastic are being released in fewer then normal #'s
2. TRUE
3. FALSE... given q. weekly, then q. monthly for life. May change to PO admin once levels normalize.
OPEN ENDED BISSSSHHHHH
1. Folic acid/ folate anemia is similar to b12. The causes differ. Folic may be caused by medication such as? Lack of which mentioned foods? Malabsorption by?
2. What is the pathophys of aplastic anemia?
1. Meds: anticonvulsants, oral contraceptives Food: leafy greens, nutz Malabsorption: Crohns, gastrectomy
2. Bone marrow suppression produces fewer RBC for circulation...what's this called?
(pancytopenia)
1. What is tumor lysis syndrome?
1a. Which lymphoma is this more common with?
2. Regional vs Systemic adenopathy?
3. Doxorubicin (Adriamycin) &
Dexamethasone are medications seen in which lymphoma?
1. This occurs with rapid tumor cell death, the treatment which triggered the lysis floods your bloodstream faster then body can get rid of them.
1a. non- hodgkin
2. Regional: can spread, painless Systemic: painless
3. Non- hodgkin
The nurse explains to the parents of a 1-year-old child admitted to the hospital in a sickle cell crisis that the local tissue damage the child has on admission is caused by which of the following?
a. an autoimmune reaction complicated by hypoxia
b. lack of 02 in the RBC
c. obstruction to circulation
d. elevated serum bilirubin concentration
c. obstruction to circulation