An individual who lives at high altitude may normally have an increased RBC count because?
hypoxia caused by decreased atmospheric oxygen stimulates erythropoiesis
Malignant disorders that arise from granulocytic cells in the bone marrow will have the primary effect of causing?
decreased phagocytosis of bacteria
An anticoagulant such as warfarin (coumadin) that interferes with prothrombin production will alter the clotting mechanism during?
activation of thrombin
When reviewing laboratory results of an 83-year-old patient with an infection, the nurse would expect to find?
minimal leukocytosis
Significant information obtained from the patient's health history that relates to the hematologic system includes?
Jaundice
While assessing the lymph nodes, the nurse should?
lightly palpate superficial lymph nodes with the pads of the fingers
If a lymph node is palpated what is a normal finding?
Firm, mobile nodes
Nursing care for a patient immediately following a bone marrow biopsy and aspiration includes?
1. Administering analgesics as necessary
2. Instructing on need to lie still with a sterile pressure dressing intact
3. Monitoring vital signs and assessing the site for excess drainage or bleeding
In a severely anemic patient, the nurse would expect to find?
dyspnea and tachycardia
When obtaining assessment date from a patient with a microcytic, hypochromic anemia, the nurse would question the patient about?
dietary intake of iron
Nursing interventions for a patient with severe anemia related to peptic ulcer disease would include?
1. Monitoring stools for guaiac
2. instructions for high-iron diet
The nursing management of a patient in sickle cell crisis includes?
1. Monitoring of CBC
2. Blood transfusions if required and iron chelation
3. Optimal pain management and oxygen therapy
4. rest as needed and deep vein thrombosis prophylaxis
A complication of the hyperviscosity of polycythemia is?
thrombosis
When providing care for a patient with thrombocytopenia, the nurse should instruct the patient to?
dab his/her nose instead of blowing
The nurse would anticipate that a patient with von willebrand disease undergoing surgery would be treated with administration of vWF and?
Factor VIII
DIC is a disorder in which?
a disease process stimulates coagulation processes with resultant thrombosis, as well as depletion of clotting factors, leading to diffuse clotting and hemorrhage
Priority nursing actions when caring for a hospitalized patient with a new-onset temperature of 102.2 F and severe neutropenia includes?
1. administering the prescribed antibiotic STAT
2. drawing peripheral and central line blood cultures
3. ongoing monitoring of the patient's vital signs for septic shock
4. taking a full set of vital signs and notifying the physician immediately
Because myelodysplastic syndrome arises from the pluripotent hematopoietic stem cell in the bone marrow, laboratory results the nurse would expect to find include?
a deficiency of all cellular blood components
The most common type of leukemia in older adults is?
Chronic lymphocytic leukemia
Multiple drugs are often used in combinations to treat leukemia and lymphoma because?
the drugs work by different mechanisms to maximize killing of malignant cells
The nurse is aware that a major difference between Hodgkin's lymphoma and non-Hodgkin's lymphoma is that?
non-Hodgkin's lymphoma can manifest in multiple organs
A patient with multiple myeloma becomes confused and lethargic. The nurse would expect that these clinical manifestations may be explained by diagnostic results that indicate?
hypercalcemia
When reviewing the patient's hematologic laboratory values after a splenectomy, the nurse would expect to find?
increased platelet count
Complications of transfusions that can b decreased by the use of leukocyte depletion or reduction of RBC transfusion are?
transmission of cytomegalovirus and fever
A characteristic common to all hormones is that they?
influence cellular activity of specific target tissues
A patient is receiving radiation therapy for cancer of the kidney. The nurse monitors the patient for signs and symptoms of damage to the?
adrenal glands
A patient has a serum sodium level of 152 mEq/L. The normal hormonal response to this situation is?
Release of ADH
All cells in the body are believed to have intracellular receptors for?
thyroid hormone
When obtaining subjective data from a patient during assessment of the endocrine system, the nurse asks specifically about?
energy level
An appropriate technique to use during physical assessment of the thyroid gland is?
having the patient swallow water during inspection and palpation of the gland
Endocrine disorders often go unrecognized in the older adult because?
symptoms are often attributed to aging
An abnormal finding by the nurse during an endocrine assessment would be?
excessive facial hair on a woman
A patient has a total serum calcium level of 3mg/dl. If this finding reflects hypoparathyroidism, the nurse would expect further diagnostic testing to reveal?
decreased serum PTH
Polydipsia and polyuria related to diabetes mellitus are primarily due to?
fluid shifts resulting from the osmotic effect of hyperglycemia
When comparing the pathophysiology of type 1 and type 2 diabetes, which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with pneumonia?
the patient may have sufficient endogenous insulin to prevent ketosis but is at risk for the development of hyperosmolar hyperglycemic syndrome
Analyze the following diagnostic findgins for your patient with type 2 diabetes. Which result will need further assessment?
BP- 126/80
AIC 9%
FBG 130 mg/dL
LDL cholesterol 100 mg/dL
AIC 9%
Is the following statement made by a patient with type 2 diabetes correct? Yes or no?
"I am not supposed to have a meal or snack if I drink alcohol
Yes, correct
You are caring for a patient with newly diagnosed type 1 diabetes. What information is essential to include in your patient teaching before discharge from the hospital?
insulin administration
What is the priority action for the nurse to take if the patient with type 2 diabetes complains of blurred vision and irritability?
check the patient's blood glucose level
A diabetic patient has a serum glucose level of 824 mg/dL and is unresponsive. Following assessment of the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic syndrome based on the finding of?
Rapid, deep respirations
What are some appropriate therapies for patients with diabetes mellitus?
1. Use of statins to treat dyslipidemia
2. Use of ACE inhibitors to treat nephropathy
3. Use of laser photocoagulation to treat retinopathy
Following a hypophysectomy for acromegaly, postoperative nursing care should focus on?
frequent monitoring of serum and urine osmolality
A patient with a head injury develops SIADH. Symptoms the nurse would expect to find include?
Low urinary output and thirst
The health care provider prescribes levothyroxine for a patient with hypothyroidism. Following teaching regarding this drug, the nurse determines that further instruction is needed when the patient says?
I only need to take this drug until my symptoms are improved"
Need to take for LIFE
Following thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when the patient develops?
laryngeal stridor and tingling in the hands and feet
Important nursing interventions when caring for a patient with cushing syndrome include?
monitoring blood glucose levels
After an adrenalectomy for pheochromocytoma, the patient is most likely to experience?
marked fluctuations in blood pressure
To control the side effects of corticosteroid therapy, the nurse teaches the patient who is taking corticosteroids to?
increase calcium intake to 1500 mg/day
The nurse teaches the patient that the best time to take corticosteroids for replacement purposes is?
on arising and in the late afternoon
The nurse determines that the patient in acute adrenal insufficiency is responding favorably to treatment when?
the patient appears alert and oriented.
When assessing a patient who is returned to the surgical unit following a thyroidectomy, the nurse would be most concerned if the patient?
makes harsh, vibratory sounds when she breathes
An IV hydrocortisone infusion is started before a patient is taken to surgery for a bilateral adrenalectomy. The nurse explains to the patient that this is done to?
provide substances to respond to stress after removal of the adrenal glands
A patient has a serum calcium level of 14.8 mg/dL (7.4 mEq/L, 3.7 mmoL/L). The body's regulatory response to this state is?
increased secretion of calcitonin.
A patient with thyroid nodules is to undergo a thyroid scan with oral radioactive isotopes for diagnosis. The nurse explains to the patient that:
an allergy to iodine or shellfish is a contraindication to the test.
A patient is exhibiting signs of hypothyroidism. Which diagnostic test will the nurse expect to be done first?
thyroid-stimulating hormone (TSH)
Ideally, the goal of patient diabetes education is to
?
enable the patient to become the most active participant in the management of the diabetes.
A patient screened for diabetes at a clinic has a fasting plasma glucose of 120 mg/dL (6.7 mmoL/L). The nurse explains to the patient that this value:
reflects impaired glucose tolerance, which is an early stage of diabetes.
A patient with type 1 diabetes calls the clinic with complaints of nausea, vomiting, and diarrhea. It is most important that the nurse advise the patient to?
check the blood glucose level every 2- to 4- hours.
Cardiac monitoring is initiated for a patient in diabetic ketoacidosis. The nurse recognizes that this measure is important to identify?
dysrhythmias resulting from hypokalemia.
At an outpatient clinic, a 78-year-old woman is found to have a Hb of 8.7 g/dL (87 g/L) and a Hct of 35%. Based on the most common cause of these findings in the older adult, the nurse collects information regarding:
A history of any chronic diseases such as cancer or renal disease.
When assessing a patient's nutritional-metabolic pattern related to hematologic health, the nurse would?
Inspect the skin for petechiae.
When assessing lab values on a patient admitted with septicemia, the nurse would expect to find?
Increased bands in the white blood cell (WBC) differential (shift to the left).
Results of a patient's most recent blood work indicate an elevated neutrophil level. You recognize that this diagnostic finding most likely suggests?
an infection
A 30-year-old patient has undergone a splenectomy as a result of injuries suffered in a motor vehicle accident. Which phenomena is likely to result from the absence of the patient's spleen?
1. Increased platelet levels
2. Impaired immunologic function
You are providing care for older adults on a subacute, geriatric medicine unit. Which of the following effects is aging likely to have on hematologic function of older adults?
Decreased hemoglobin
A blood type and cross-match has been ordered for a male patient who is experiencing an upper gastrointestinal bleed. The results of the blood work indicate that the patient has type A blood. This means that?
The patient has A antigens on his red blood cells (RBCs).
When caring for a patient with metastatic cancer, the nurse notes a hemoglobin level of 8.7 g/dl and hematocrit of 26%. The nurse would place highest priority on initiating interventions that will reduce what?
Fatigue
The nurse is caring for a patient who is to receive a transfusion of two units of packed red blood cells. After obtaining the first unit from the blood bank, the nurse would ask which of the following health team members in the nurses' station to assist i
Another registered nurse
Before starting a transfusion of packed red blood cells for an anemic patient, the nurse would arrange for a peer to monitor his or her other assigned patients for how many minutes when the nurse begins the transfusion?
15 minutes
When preparing to administer an ordered blood transfusion, the nurse selects which of the following intravenous solutions to use when priming the blood tubing?
0.9% Sodium chloride
The nurse notes a physician's order written at 10:00 am for two units of packed red blood cells to be administered to a patient who is anemic as a result of chronic blood loss. If the transfusion is picked up at 11:30 am, the nurse should plan to hang the
12:00 noon
Must hang the transfusion within 30 minutes of signing for them from the blood bank
The nurse receives a physician's order to transfuse fresh frozen plasma to a patient suffering from an acute blood loss. Which of the following procedures is most appropriate for infusing this blood product?
Infuse the fresh frozen plasma as rapidly as the patient will tolerate.
Before beginning a transfusion of RBCs, which of the following actions by the nurse would be of highest priority to avoid an error during this procedure?
Check the identifying information on the unit of blood against the patient's ID bracelet.
The blood bank notifies the nurse that the two units of blood ordered for an anemic patient are ready for pick up. The nurse should take which of the following actions to prevent an adverse effect during this procedure?
Infuse the blood slowly for the first 15 minutes of the transfusion.
Which of the following patients is most likely to experience anemia with an etiology of increased destruction of red blood cells?
An African American man who has a diagnosis of sickle cell disease
Caring for a patient with a diagnosis of polycythemia vera will likely require the nurse to?
Assist with or perform phlebotomy at the bedside.
Which of the following nursing interventions should the nurse prioritize in the care of a 30-year-old woman who has a diagnosis of immune thrombocytopenic purpura (ITP)?
Administration of oral or intravenous corticosteroids
A patient with a diagnosis of hemophilia had a fall down an escalator earlier in the day and is now experiencing bleeding in her left knee joint. The emergency nurse's immediate response to this should include?
Resting the patient's knee to prevent hemarthroses.
When instructing a patient regarding a urine study for free cortisol, it is most important for the nurse to tell the patient to?
Try to avoid stressful situations during the collection period.
Which of the following assessment parameters is of highest priority when caring for a patient undergoing a water deprivation test?
patient weight
A patient has sought care because of a loss of 25 lb over the past 6 months, during which the patient claims to have made no significant dietary changes. The nurse should assess the patient for potential?
Thyroid disorders.
The surgeon was unable to save a patient's parathyroid gland during a radical thyroidectomy. The nurse should consequently pay particular attention to which of the following components of the patient's laboratory values?
Calcium levels
A patient's recent medical history is indicative of diabetes insipidus. The nurse would perform patient education related to which of the following diagnostic tests?
water deprivation test
A 54-year-old patient admitted with type 2 diabetes, asks the nurse what "type 2" means. Which of the following is the most appropriate response by the nurse?
With type 2 diabetes, insulin secretion is decreased and insulin resistance is increased.
The nurse caring for a 54-year-old patient hospitalized with diabetes mellitus would look for which of the following laboratory test results to obtain information on the patient's past glucose control?
Glycosylated hemoglobin level
The nurse has been teaching a patient with diabetes mellitus how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does which of the follo
Chooses a puncture site in the center of the finger pad
The nurse is teaching a 54-year-old patient with diabetes about proper composition of the daily diet. The nurse explains that the guideline for carbohydrate intake is which of the following?
Minimum of 130 g/day
The nurse is assigned to the care of a 64-year-old patient diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in management of the diabetes, which of the following should be the nurse's initi
Assess patient's perception of what it means to have diabetes.
The nurse is beginning to teach a diabetic patient about vascular complications of diabetes. Which of the following information would be appropriate for the nurse to include?
Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin.
The nurse is evaluating a 45-year-old patient diagnosed with type 2 diabetes mellitus. Which of the following symptoms reported by the patient is considered one of the classic clinical manifestations of diabetes?
Excessive thirst
A 54-year-old patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8:00 am. The nurse instructs the patient to only drink water after what time?
Midnight before the test
A patient is admitted with diabetes mellitus, has a glucose level of 380 mg/dl, and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which of the following respiratory patterns would the nurse expect to find?
Kussmaul respirations
The nurse is assisting a diabetic patient to learn dietary planning as part of initial management of diabetes. The nurse would encourage the patient to limit intake of which of the following foods to help reduce the percent of fat in the diet?
Cheese
Lab results are back for a 54-year-old patient with a 15-year history of diabetes. Which of the following lab results follows the expected pattern accompanying macrovascular disease as a complication of diabetes?
Increased triglyceride levels
The nurse has taught a patient admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. The nurse evaluates that the patient understands the principles of foot care if the patient makes which of the following statements?
I should look at the condition of my feet every day.
A patient is admitted with diabetes mellitus, malnutrition, and cellulitis. The patient's potassium level is 5.6 mEq/L. The nurse considers that what factors could be a contributing factor for this lab result?
1. The level may be increased as a result of dehydration that accompanies hyperglycemia.
2. The level is consistent with renal insufficiency that can develop with renal nephropathy.
3.The level may be raised as a result of metabolic ketoacidosis caused by
The patient received regular insulin 10 units subcutaneously at 8:30 pm for a blood glucose level of 253 mg/dl. The nurse plans to monitor this patient for signs of hypoglycemia at which of the following peak action times?
10:30 pm to 11:30 pm
The nurse is caring for a patient admitted with suspected hyperparathyroidism. Because of the potential effects of this disease on electrolyte balance, the nurse should assess this patient for which of the following manifestations?
lethargy and weakness
The nurse would monitor for which of the following adverse changes in the patient's laboratory values as a result of being treated with dexamethasone (Decadron)?
Increase in blood glucose values
The nurse is providing discharge instructions to a patient with diabetes insipidus. Which of the following instructions regarding desmopressin acetate (DDAVP) would be most appropriate?
The patient should alternate nostrils during administration to prevent nasal irritation.
The patient has an order to receive 45 mg of prednisone by mouth daily. Available are 10-mg tablets. How many tablets should the nurse prepare to give?
4.5
Which of the following is a nursing priority in the care of a patient with a diagnosis of hypothyroidism?
Patient teaching related to levothyroxine (Synthroid)
A patient has been taking oral prednisone for the past several weeks after having a severe reaction to poison ivy. The nurse has explained the procedure for gradual reduction rather than sudden cessation of the drug. What is the rationale for this approac
Prevention of adrenal insufficiency
The surgeon was unable to spare a patient's parathyroid gland during a thyroidectomy. Which of the following assessments should the nurse prioritize when providing postoperative care for this patient?
Monitoring the patient's serum calcium levels and assessing for signs of hypocalcemia