Apply Your Knowledge
This chapter provided information regarding the care of clients with hematological disorders. The following questions test your knowledge regarding the safe, effective care and management of these clients. The nurse should also refer to the chapter content, key terms, diagnostics, and pharmacological agents sections to assist in answering these questions.
The nurse can best promote hydration in a 4-year-old with sickle cell anemia by which of the following?
- Telling the child how important it is to drink fluids
- Forcing fluids of bottled water every two hours
- Providing soup on the lunch and dinner meals
- Offering flavored ice pops or iced Slurpees
The nurse administering a blood transfusion suspects a reaction has occurred. Which signs and symptoms would the nurse expect with an allergic reaction to blood?
- Fever and chills
- Hypotension and tachycardia
- Rash and hives
- Decreased urinary output and hypertension
The nurse is caring for an adult with hemophilia. Which clinical manifestation causes the nurse the most concern?
- Hemarthrosis of the elbow
- Bruise of the ankle
- Oozing of blood at the IV site
- Unilateral numbness and lack of movement of arm
The nurse is contributing to a parent education program about sickle cell anemia. Which of the following information should the nurse recommend including?
- Apply cold to painful areas
- Limit fluid intake
- Increase activity during exacerbations
- Avoid high altitudes
Which should the nurse observe for as a complication of Factor VIII administration?
- Fluid volume excess
- Blood transfusion reaction
- Thrombus formation
Which of the following is not a named sickle cell anemia crisis?
- Splenic sequestration
A client receiving a blood transfusion exhibits lower back pain, fever, and dyspnea. What is the nurse's initial action?
- Stop the blood transfusion and keep the vein open with normal saline
- Administer epinephrine per unit protocol
- Notify the physician
- Obtain a set of vital signs
A client has been admitted with sickle cell anemia in crisis. Which physician prescription would the nurse anticipate?
- Restrict fluids 200mL/shift
- Ice to painful joints
- Start O2 at 3 L/min
- Ambulate in hall every two hours
A child is in the hospital with a diagnosis of thalassemia major. Multiple blood transfusions have been ordered along with a chelating agent. The father asks the nurse, "Why does my son get this drug every time he gets blood?" What does the nurse explain as the purpose of chelating drugs?
- Stabilize clots in the vascular system
- Decrease the chance of a blood reaction
- Eliminate iron excess
- Boost oxygen delivery to the cells
Which does the nurse recognize as the most accurate in diagnosing sickle cell anemia?
- Hemoglobin electrophoresis
- Partial thromboplastin time
- Complete blood count
Answers to Exam Questions
- Answer D is correct. A child will likely accept the fluids in this answer better than the others listed. The child is too young to understand the statement in answer A, so it is inappropriate. Answers B and C are good sources of fluids but would not be best or acceptable for a 3-year-old, so they are incorrect.
- Answer C is correct. Other symptoms include respiratory distress and anaphylaxis. Answer A describes febrile nonhemolytic reaction, so it is incorrect. Answer B occurs with hemolytic reaction and answer D is not associated with a blood transfusion reaction, so they are incorrect.
- Answer D is correct. The neurological symptoms could mean an intracranial bleed has occurred. The answers in A, B, and C are reasons for concern, but they are not the priority, so they are incorrect.
- Answer D is correct. High altitudes can increase oxygen consumption and trigger a crisis. The client should apply heat to painful areas, increase hydration, and rest during crisis making A, B, and C incorrect options.
- Answer C is correct. Factor VIII is a blood product, so the nurse would monitor for a transfusion reaction. Answer A is unlikely due to the small volume of fluid administered, so it is wrong. Answers B and D are not immediate concerns for this short-term infusion, so they are incorrect.
- Answer D is correct. Erythropoiesis is the formation of RBCs not related to sickle cell crisis. The answers in A, B, and C are types of sickle cell anemia crises, so they are incorrect.
- Answer A is correct. The nurse would first ensure that the patient doesn't get any more of the wrong blood due to displaying symptoms of a hemolytic blood reaction. Answers B, C, and D are proper actions with a blood transfusion reaction, but none is the initial action, so they are incorrect.
- Answer C is correct. It is not unusual for patients to receive oxygen to prevent additional sickling of cells. The answers in A and B are incorrect because these are contraindicated in sickle cell anemia. Answer D is not recommended for patients in sickle cell crisis, so it is incorrect.
- Answer C is correct. A chelating agent such as deferoxamine (Desferal) is given to eliminate excess iron. The answers in A, B, and D are not the action of chelating agents, so they are incorrect.
- Answer B is correct. Hemoglobin electrophoresis is the test that verifies the diagnosis of sickle cell and is the most accurate because it separates the different hemoglobins. Answer A is a screening tool that lacks the accuracy of electrophoresis, so it is incorrect. The answers in C and D are not directly related to sickle cell, so they are incorrect.