Chapter 33, 42 Hematologic and Urologic Disorders

What should be a major focus in a teaching plan for a teenager with sickle cell anemia?

D. Maintain adequate hydration

Which is considered an approximate normal hematocrit value?

A. Three times the hemoglobin value

A nurse is caring for a patient who is having radiation treatment for cancer. How many days after the start of radiation should the nurse know that the threat of thrombocytopenia exists?

D. 12

A nurse is caring for a patient receiving a transfusion and assesses that the patient is wheezing and is complaining of back pain. What nursing action should take place after stopping the transfusion?

B. Notify the charge nurse

A patient receiving Epogen asks how soon as increase in the red blood cell count will occur. When should the nurse say that the initial increase ion red blood cells should be seen?

D. 2 weeks

What happens to the sickle-shaped red blood cells during a sickle cell crisis?

D. Obstruction of major arteries

A nurse is taking the history of a patient who has come in for evaluation of large areas of purpura on her limbs. The patient reports using alternative therapy for her menopausal symptoms. What alternative therapy is most likely responsible for the patien

A. Black cohosh

What information should a nurse be sure to include when preparing discharge plans for a patient recently diagnosed with pernicious anemia?

D. Providing sufficient rest periods throughout the day

What is the rationale for administering injections of vitamin B12 to patients with pernicious anemia?

B. The patient may lack the intrinsic factor necessary for vitamin B12 absorption

Which foods should a nurse include in a nutrition teaching plan for a patient with iron-deficiency anemia?

A. Beans and dried fruit

Based on a nursing assessment, what is an appropriate nursing diagnosis for patient with hemophilia?

A. Acute pain related to bleeding into closed spaces

A child with sickle cell anemia is prescribed the drug hydroxyurea. What effect from the drug should the patient expect to have?

D. Produce hemoglobin that resists sickling

A newborn infant has developed significant jaundice and has a positive Coombs test result resulting from high levels of bilirubin. What should a nurse be aware that these symptoms may indicate?

C. Hemolytic anemia

A 3-year-old African American child is diagnosed with sickle cell anemia. The parents know that sickle cell anemia is hereditary but do not understand why their child has the disease because neither of them has it. What is the most accurate information pr

D. Both parents were carriers of the sickle cell trait

To what level should the platelet count rise when the patient with a platelet count of 20,000/mm3 receives 1 unit of platelets?

A. 25,000 to 30,000/mm3

When a nurse is preparing to give ferrous sulfate (Feosol) to a home health care patient, what is the most appropriate nursing action to implement?

D. Dilute it and offer through a straw and a few crackers

A 35-year-old man is examined in an urgent care clinic. His presenting symptoms suggest polycythemia vera. Which extreme laboratory value would confirm this possible diagnosis?

A. High hemoglobin level

A 52-year-old man has a diagnosis of aplastic anemia. What information in the patient history is pertinent to this diagnosis?

C. 25-year employee in a chemical plant

A nurse is completing an initial assessment on a new patient being seen in the hospital clinic. The presentation of this female patient includes vague symptoms of tiredness and large areas of ecchymosis. Which question is most important for the nurse to a

B. "Do your gums easily bleed?

At the end of a shift, a nurse documents the effectiveness of parent teaching concerning the transmission of hemophilia. Which statement by the mother would best indicate an accurate parental perception?

A. "Hemophilia is a genetic disorder, and I am a carrier, although I do not have the disease.

What should a nurse be careful to observe for when assessing a patient with thrombocytopenia?

C. Petechiae on the skin and bleeding gums

A nurse is helping prepare a nursing care plan for a 90-lb, 82-year-old woman with iron-deficiency anemia with a hemoglobin of 5.2. What is the most appropriate nursing diagnosis?

D. Activity intolerance related to fatigue

A nurse is assessing a patient in 20 minutes after a bone marrow biopsy. Which statement by the patient is cause for the most concern?

A. "There is flesh blood on my dressing.

A nurse is caring for a patient with crushing injuries from an automobile accident notes that the patient is bleeding profusely from the nose, mouth, and rectum, as well as from the injuries. What should the nurse suspect as the cause of this patient's bl

B. Disseminated intravascular coagulation (DIC)

At 1000 a nurse receives 2 units of blood for a patient to be transfused. What is the most appropriate nursing action?

A. Set up 1 unit for the infusion to start by 1030 and send the other unit back until the first one has infused

A nurse is giving iron dextran intramuscularly (IM). Why should the nurse implement the Z-track method?

B. Prevents staining of the skin

What is the major difference between fresh-frozen plasma (FFP) and cryoprecipitate (CPP)?

C. FFP contains no platelets

What medical history information is significant to potential bleeding problems? (Select all that apply)

C. Takes NSAIDs for the relief of arthritic pain four times a day
D. Has hepatitis B
E. Had a cardiac valve replaced 6 months earlier

A nurse is assessing a patient with renal impairment. Which facial characteristic is a sign of fluid retention?

B. Periorbital edema

What laboratory value change should indicate to a nurse that a patient with renal failure has entered the oliguric stage?

A. Blood urea nitrogen (BUN) level rises

What should nursing care focus on when caring for a patient with a ureteral catheter in place after the removal of a kidney stone?

B. Assessing for patency

What is true about the urine osmolality when the kidney is adequately functioning?

A. Equal to the osmolality of the serum

Which urine test provides the most accurate measurement of renal function?

D. Creatinine

A nurse is caring for a patient after urinary diversion surgery. What postoperative nursing assessment is the priority?

D. Bowel sounds

A nurse is performing frequent catheterizations for residual urine. What causes the greatest concern for the nurse?

A. Introduction of pathogens into the bladder

A patient has a nephrostomy tube that has been inserted because of an obstruction in the ureter. What special precautions in the care of the nephrostomy tube should the nurse implement?

C. Being certain the tube is connected, not kinked, or not clamped to ensure that it continually drains

A patient comes to the medical clinic with complaints of urgency, frequency, pain in the area of the symphysis pubis, and dark cloudy urine. What should the nurse suspect that this patient has?

C. Cystitis, probably from bacterial contamination

A patient who has cystitis has been told to drink at least 30 mL for each kilogram of body weight. Her weight is 154 lb. How many mL/day should the nurse instruct the patient to drink?

B. 2100

A home health patient diagnosed with cystitis has been prescribed the medication phenazopyridine (Pyridium). When providing patient teaching, what should the nurse caution the patient about?

C. Staining of clothing

A nurse is collecting data from a hospital patient who has been admitted with pyelonephritis. He is acutely ill with a high fever, chills, nausea, and vomiting. He also has severe pain in the flank area. What is the primary goal of treatment?

D. Prevent further damage to his kidneys that could lead to renal failure

What is the usual cause of the autoimmune disease of acute glomerulonephritis?

B. Streptococcal infection

A nurse is caring for a patient with acute glomerulonephritis. What should the nurse be aware that the inflammation of the capillary loops in the glomeruli will to?

A. Moderate to high blood pressure

A 16-year-old patient with acute glomerulonephritis complains of boredom with bed rest and asks when he can become more active. He asks, "What has to happen for me to get off of bed rest?" What is the most accurate statement by the nurse?

D. Blood pressure drops to normal levels

What discharge teaching is appropriate for the nurse to provide to a patient who has had a lithotripsy?

B. Watch for stone debris in the urine in 1 to 4 weeks

Which outcome is most necessary for a patient with diagnosed with renal calculi?

D. Patient is able to describe measure to prevent recurrence of calculi

A nurse is caring for a patient with an atrioventricular (AV) fistula in the forearm and assesses that a trill is absent when palpating the venous side of the fistula. What action should the nurse implement?

D. Report to the charge nurse that the fistula is occluded

A patient on dialysis asks why he is receiving aluminum hydroxide gel (Amphopjel), a phosphate binder, for his renal disorder. What should the nurse explain regarding the action of that Amphojel?

B. Binds with phosphorous to increase the serum calcium level

Which statement by a patient on dialysis, taking gentammicin (Garamycin), should cause the nurse the most concern?

B. "Speak up! I cant hear you

A family member of a patient who has returned to the special unit after renal transplantation is alarmed by blood in the urine of the patient. What is the nurse's best explanation when explaining the reason for hematuria in this patient?

B. "It is a normal postoperative expectation

A 10-year-old boy tells a nurse that he wants to give his kidney to his grandfather. How many years of age should the nurse explain that kidney donors must be?

C. At least 18 years old

Erythroietin is a hormone produced by the kidney. What will a deficiency of erythropoietin in a patient in chronic renal failure result in?

C. Anemia as a result of the diminished number of red blood cells being produced

A patient with chronic renal failure is to begin renal dialysis treatment and asks for advice about which type of dialysis would be best. The patient is considering peritoneal dialysis because it is less expensive and has fewer dietary and fluid restricti

B. It gives more independence and more closely resembles normal kidney function

Why are patients diagnosed with chronic renal failure and on dialysis prone to injury?

A. Bone demineralization and peripheral neuropathy

A nurse assesses a Grey Turner sign in a patient who was admitted 2 days earlier after an automobile accident. What does this finding indicate?

A. Retroperitoneal bleeding and bruising over the flank

A nurse is planning the care for an older adult patient. Which age-related changed in kidney function should the nurse consider when providing care to this patient? (Select all that apply)

B. Sclerosis of renal blood vessels
C. Decreasing glomerular filtrations
D. Decreasing ability to concentrate or dilute urine
E. Decreasing erythropietin

A nurse is caring for a patient with a Foley catheter. What actions should the nurse implement to decrease this patient risk for infection? (Select all that apply)

A. Keep the bag below the level of the bed
B. Provide perineal care twice a day
D. Using standard precautions when handling urine and tubing

A female patient reports very painful urethritis. What should the home health care nurse question the patient about the use of? (Select all that apply)

A. Bubble bath
D. Vaginal sprays

A nurse reads the serum calcium laboratory report of a patient as 4.2 mEq/L. Which symptoms should the nurse anticipate that the patient might exhibit? (Select all that apply)

A. Irritability
B. Tingling sensations in limbs
C. Tetany