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Exam 1: Hematologic Disorders Detailed Questions And Expert Answers
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Exam 1: Hematologic Disorders Detailed Questions And Expert Answers
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Exam 1: Hematologic Disorders Detailed QuestionsAnd Expert Answers
The nurse is preparing to teach a client with iron deficiency anemia about the diet
to follow after discharge. Which of the following foods should be included in the
diet?
a. Eggs
b. Lettuce
c. Citrus Fruits
d. Cheese - ANS A
A rich source of iron is needed in the diet, and eggs are high in iron. Other foods
high in iron include organ and muscle (dark) meats; shellfish, shrimp, and tuna;
enriched, whole-grain, and fortified cereals and breads; legumes, nuts, dried fruits,
and beans; oatmeal; and sweet potatoes. Dark green leafy vegetables and citrus
fruits are good sources of vitamin C. Cheese is a good source of calcium.
The nurse would instruct the client to eat which of the following foods to obtain
the best supply of vitamin B12?
A. Whole grains
B. Green leafy vegetables
C. Meats and dairy products
D. Broccoli and Brussels sprouts - ANS C
,Good sources of vitamin B12 include meats and dairy products. Whole grains are a
good source of thiamine. Green leafy vegetables are good sources of niacin, folate,
and carotenoids (precursors of vitamin A). Broccoli and Brussels sprouts are good
sources of ascorbic acid (vitamin C).
The nurse has just admitted a 35-year-old female client who has a serum B12
concentration of 800 pg/ml. Which of the following laboratory findings would cue
the nurse to focus the client history on specific drug or alcohol abuse?
A. Total bilirubin, 0.3 mg/dL
B. Serum creatinine, 0.5 mg/dL
C. Hemoglobin, 16 g/dL
D. Folate, 1.5 ng/mL - ANS D
The normal range of folic acid is 1.8 to 9 ng/mL, and the normal range of vitamin
B12 is 200 to 900 pg/mL. A low folic acid level in the presence of a normal vitamin
B12 level is indicative of a primary folic acid-deficiency anemia. Factors that affect
the absorption of folic acid are drugs such as methotrexate, oral contraceptives,
antiseizure drugs, and alcohol. The total bilirubin, serum creatinine, and
hemoglobin values are within normal limits.
The nurse understands that the client with pernicious anemia will have which
distinguishing laboratory findings?
A. Schilling's test, elevated
B. Intrinsic factor, absent
,C. Sedimentation rate, 16 mm/hour
D. RBCs 5.0 million - ANS B
The defining characteristic of pernicious anemia, a megaloblastic anemia, is lack of
the intrinsic factor, which results from atrophy of the stomach wall. Without the
intrinsic factor, vitamin B12 cannot be absorbed in the small intestines, and folic
acid needs vitamin B12 for DNA synthesis of RBCs. The gastric analysis was done to
determine the primary cause of the anemia. An elevated excretion of the injected
radioactive vitamin B12, which is protocol for the first and second stage of the
Schilling test, indicates that the client has the intrinsic factor and can absorb
vitamin B12 into the intestinal tract. A sedimentation rate of 16 mm/hour is
normal for both men and women and is a nonspecific test to detect the presence
of inflammation. It is not specific to anemias. An RBC value of 5.0 million is a
normal value for both men and women and does not indicate anemia.
The nurse devises a teaching plan for the patient with aplastic anemia. Which of
the following is the most important concept to teach for health maintenance?
A. Eat animal protein and dark leafy vegetables each day
B. Avoid exposure to others with acute infection
C. Practice yoga and meditation to decrease stress and anxiety
D. Get 8 hours of sleep at night and take naps during the day - ANS B
Clients with aplastic anemia are severely immunocompromised and at risk for
infection and possible death related to bone marrow suppression and
pancytopenia. Strict aseptic technique and reverse isolation are important
measures to prevent infection. Although diet, reduced stress, and rest are valued
in supporting health, the potentially fatal consequence of an acute infection places
it as a priority for teaching the client about health maintenance. Animal meat and
, dark green leafy vegetables, good sources of vitamin B12 and folic acid, should be
included in the daily diet. Yoga and meditation are good complimentary therapies
to reduce stress. Eight hours of rest and naps are good for spacing and pacing
activity and rest.
A client comes into the health clinic 3 years after undergoing a 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 fluids."
B. "I have been gargling with warm salt water for my sore tongue."
C. "I have 3 to 4 loose stools per day."
D. "I take a vitamin B12 tablet every day." - ANS D
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.
Replacement of fluids and electrolytes is important when the client has continuous
multiple loose stools on a daily basis. Warm salt water is used to soothe sore
mucous membranes. Crohn's disease and small bowel resection may cause several
loose stools a day.
A vegetarian client was referred to a dietitian for nutritional counseling for
anemia. Which client outcome indicates that the client does not understand
nutritional counseling? The client:
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