Anemia & Leukemia Questions
Anemia
1. Provide assessment findings inducating anemia in the following body systems:
Integumentary Pallor of skin, mucous membranes, conjunctiva & nail beds; petechia,
purpura, cheilosis, spoon-shaped nail, sore beefy red tongue
Gastrointestinal Anorexia, diarrhea, nausea, abdominal pain
Cardiovascular Tachycardia, palpitations
Respiratory Tachypnea, dyspnea on exertion
Musculoskeletal Fatigue, weakness, night cramps, joint pain
Neurologic Paresthesias, headache, dizziness, forgetfulness, pain, pica
2. What should a nurse teach a a client about taking oral iron supplementation?
-Stools will be black.
-May cause gastrointestinal distress. Take with food if this occurs.
-Take with vitamin C to increase absorption.
-Take 2 hrs. before or after milk or antacids.
-Increase fiber and fluids in diet to manage constipation.
3. Suggest three energy-conservation methods for a client with chronic anemia.
-Sit to bathe, dress, prepare food.
-Schedule rest periods between activities.
-Establish priorities for tasks.
-Perform priority tasks when rested.
-Decide which tasks can be performed by family and friends.
4. Complete the following table
Lab values
Type of anemia
Increased MCV, normal
Macroyctic anemia
MCH & MCHC
Decreased MCV, MCH,
MCHC
Microcytic, hypochromic
anemia
Normal MCV, MCH,
MCHC
Normocytic,
normochromic anemia
Common Cause
Vitamin B(12) deficiency
Folic acid deficiency
Alcoholism
Chronic blood loss
Iron deficiency anemia
Anemia of chronic disease
Acute blood loss
Sickle cell disease
5. Which anemias are the following clients most at risk to develop?
Toddlers:
Iron deficiency anemia
Teenagers:
Iron deficiency anemia
Pregnant women:
Iron deficiency anemia
Women of childbearing age:
Iron deficiency anemia, chronic blood loss
Older adult clients:
Iron deficiency anemia, chronic blood
loss, vitamin B(12) and folate deficiencies
6. A nurse is caring for a client in sickle cell crisis. Which of the following interventions
should the nurse expect to perform?
-Administer morphine.
-Administer normal saline.
-Provide blood transfusion to replace hemoglobin.
-Assess hand-grip strength.
The key interventions for a client in sickle cell crisis is to promote and maintain
oxygenation and tissue perfusion, hydrate the client to prevent excessive sickling of
the red blood cells, manage the client’s pain, and promote neurological function.
Clients with sickle cell anemia have problems with the shape of the red blood cells,
not the number, so a blood transfusion would not be indicated.
Leukemia
1. A client with leukemia develops thrombocytopenia following chemotherapy. Based
on this specific finding, which of the following nursing interventions is the highest
priority?
A. Encourage the client to turn, cough, and deep breathe every 2 hrs.
B. Monitor the client’s temperature every 4 hrs.
C. Monitor the client’s platelet counts.
D. Encourage the client to ambulate several times a day.
Thrombocytopenia is a decrease in platelet counts with a risk of bleeding. Bleeding
precautions are generally implemented for counts less than 50,000.
2. Which of the following nursing interventions and client instructions are appropriate in
caring for a client with pancytopenia?
-Restrict fresh fruits and vegetables in the diet.
-Restrict all visitors.
-Insert a Foley catheter to monitor intake and output.
-Restrict fluids.
-Report low-grade temperature.
-Hold firm pressure for 5 min. following necessary venipunctures.
-Report an ANC of 2,500.
-Administer epoetin alfa (Procrit) as prescribed.
Fresh fruits and vegetables pose a greater risk for introduction of bacteria into the
gastrointestinal systems. Clients with low WBC counts need to follow a low-bacteria
diet.
Not all visitors need to be restricted. Only those individuals who pose a significant
risk, such as individuals with infections, should be restricted.
Invasive procedures and indwelling catheters pose a risk for injury and for
infection. Limit whenever possible.
Fluids should be encouraged to maintain good renal function and to assist in
elimination of medications. Dehydration poses a greater risk for infection.
Clients are immunosuppressed, so a low-grade temperature may represent an
immune response to an infection. Nurses must be vigilant.
Due to low platelet counts, clients are at greater risk for bleeding. Firm pressure for
longer periods of time in indicated following invasive procedures.
An absolute neutrophil count (ANC) of 2,500 does not indicated a high risk for
infection. An ANC of less than 2,000 suggests an increased risk of infection. ANC
of less than 500 indicates a severe risk of infection.
Anemia is a probable consequence of the disease and/or treatment. Administration
of a colony stimulating factor can be vital in RBC production to counter
disease/treatment-induced anemia.
3. A client’s platelet count is 10,000. Based on this laboratory value, which of the
following is a priority nursing assessment?
A. Level of consciousness
B. Skin turgor
C. Bowel sounds
D. Breath sounds
The client is at a high risk for spontaneous bleeding, including the risk for a fatal
cerebral bleed, due to a platelet count less than 20,000. A change in a level of
consciousness can be an early sign of cerebral hemorrhage.
4. Match the following.
-Hodgkin’s lymphoma Reed-Sternberg cells
-Acute myelogenous leukemia (AML) Most common leukemia in adults
-Chronic lymphocytic leukemia (CLL) Most cases are in adults over 60