Which of the following would the nurse identify as the priority nursing diagnosis during a toddler’s vaso-occlusive sickle cell crisis?
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Solution
Pain related to tissue anoxia
For the child in a sickle cell crisis, pain is the priority nursing diagnosis because the sickled cells clump and obstruct the blood vessels, leading to occlusion and subsequent tissue ischemia.
Option A: Although ineffective coping may be important, it is not the priority.
Option B: Decreased cardiac output is not a problem with this type of vaso occlusive crisis.
Option D: Typically, a sickle cell crisis can be precipitated by a fluid volume deficit or dehydration.
The mothers asks the nurse why her child’s hemoglobin was normal at birth but now the child has S hemoglobin. Which of the following responses by the nurse is most appropriate?
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Solution
“The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth.”
Sickle cell disease is an inherited disease that is present at birth. However, 60% to 80% of a newborns hemoglobin is fetal hemoglobin, which has a structure different from that of hemoglobin S or hemoglobin A. Sickle cell symptoms usually occur about 4 months after birth, when hemoglobin S begins to replace the fetal hemoglobin.
Option A: The gene for sickle cell disease is transmitted at the time of conception, not passed through the placenta.
Option B: Some hemoglobin S is produced by the fetus near term. The fetus produces all its own hemoglobin from the earliest production in the first trimester.
Option C: Passive immunity conferred by maternal antibodies is not related to sickle cell disease, but this transmission of antibodies is important to protect the infant from various infections during early infancy.
The nurse explains to the parents of a 1-year-old child admitted to the hospital in a sickle cell crisis that the local tissue damage the child has on admission is caused by which of the following?
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Solution
Obstruction to circulation
Characteristic sickle cells tend to cause “log jams” in capillaries. This results in poor circulation to local tissues, leading to ischemia and necrosis.
Option A: Sickle cell disease is an inherited disease, not an autoimmune reaction.
Option B: The basic defect in sickle cell disease is an abnormality in the structure of RBCs. The erythrocytes are sickle-shaped, rough in texture, and rigid.
Option D: Elevated serum bilirubin concentrations are associated with jaundice, not sickle cell disease.
Which of the following disorders results from a deficiency of factor VIII?
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Solution
Hemophilia A
Hemophilia A results from a deficiency of factor VIII.
Option A: Sickle cell disease is caused by a defective hemoglobin molecule.
Option B: Christmas disease, also called hemophilia B, results in a factor IX deficiency.
A client with iron deficiency anemia is scheduled for discharge. Which instruction about prescribed ferrous gluconate therapy should the nurse include in the teaching plan?
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Solution
“Take the medication on an empty stomach.”
Preferably, ferrous gluconate should be taken on an empty stomach.
Options A, B, and C: Ferrous gluconate should not be taken with antacids, milk, or whole-grain cereals because these foods reduce iron absorption.
Which of the following diagnostic findings are most likely for a client with aplastic anemia?
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Solution
Decreased levels of white blood cells, red blood cells, and platelets
In aplastic anemia, the most likely diagnostic findings are decreased levels of all the cellular elements of the blood (pancytopenia).
Option A: T-helper cell production doesn’t decrease in aplastic anemia.
Option D: Reed-Sternberg cells and lymph node enlargement occur with Hodgkin’s disease.
Which of the following symptoms is expected with hemoglobin of 10 g/dl?
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Solution
None
Mild anemia usually has no clinical signs. Palpitations, SOB, and pallor are all associated with severe anemia.
Which of the following cells is the precursor to the red blood cell (RBC)?
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Solution
Stem cell
The precursor to the RBC is the stem cell. B cells, macrophages, and T cells and lymphocytes, not RBC precursors.
A client with anemia may be tired due to a tissue deficiency of which of the following substances?
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Solution
Oxygen
Anemia stems from a decreased number of red blood cells and the resulting deficiency in oxygen and body tissues. Clotting factors, such as factor VIII, relate to the body’s ability to form blood clots and aren’t related to anemia, not is carbon dioxide of T antibodies.
Which of the following blood components is decreased in anemia?
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Solution
Erythrocytes
Anemia is defined as a decreased number of erythrocytes (red blood cells).
Option B: Granulocytopenia is a decreased number of granulocytes (a type of white blood cells).
Option C: Leukopenia is a decreased number of leukocytes (white blood cells).
Option D: Thrombocytopenia is a decreased number of platelets.