Exam (elaborations)
Gerontological Nursing, 4e (Tabloski) Chapter 21 The Hematologic System
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Gerontological Nursing, 4e (Tabloski) Chapter 21 The Hematologic System
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Gerontological Nursing, 4e (Tabloski)Chapter 21 The Hematologic System
1) Whichrclinicalrfindingrbyrthernurserisrconsideredrnormalrinrtherolderradultrclient?
1. Arhemoglobinrofr10rg/dLrtwordaysrpost-jointrreplacement
2. Reportsrofrtherhandsrandrfeetrfeelingrextremelyrwarm
3. Skinrtearrwithrbruising,rre-bleeding,randrprolongedrhealingrtime
4. PoorrorrweakrpulseramplituderinrbilateralrlowerrextremitiesrA
nswer:r 1
Explanation:r1.rRedrbloodrcellrreserverandrreplacementrisrslowerrinrtherolderradultrclient.rAnem
iarafterrjointrsurgeryrisrsometimesrincreasedrandrprolonged.rTransfusionsrarerdonerforrsymptom
aticrclients.rThisrisrarnormalrfinding.
2. Thrombocythemiarisrtherstaterofrhavingrtoormanyrplateletsrinrtherblood,rresultingrinranrincr
easedrriskrofrhemorrhagerorrclot.rVaguersymptomsrincluderfeelingrofrburningrpainrandrredness
ronrhandsrandrfeet,rheadache,randrvisualrchanges.
3. Oncertherwoundrhasrstoppedrbleeding,ritrshouldrnotrbeginrbleedingragain.
4. Stasisrofrbloodrflowrorrreducedrcirculationrisrarfindingrassociatedrwithrarchronicrconditionrsuc
hrasratherosclerosis.
PagerRef:r569-
579rCognitiverLevel:r Analy
zing
ClientrNeed:r HealthrPromotionrandrMaintenancer
ClientrNeedrSub:rrAgingrProcess
Nurs/IntegrConc.:r NursingrProcess:rAssessment
LearningrOutcome:r 1.rDescriberage-relatedrchangesrthatraffectrhematologicrfunction.
1
Copyrightr©r2019rPearsonrEducation,rInc.
,2) Whilercompletingranrassessmentrthernurserisrconcernedrthatranrolderrclientrisrexperiencingrane
mia.rWhichrfindingsrarermostrconcerningrforranemia?rSelectrallrthatrapply.
1. Pale,rcool,randrdryrskin
2. Diffuserjointrandrbonerpain
3. Decreasedrinterestrinrmeals
4. Heartrrater112rbeats/minute
5. Dyspnearonrexertionr
Answer:r 2,r3,r4,r5
Explanation:r1.rManifestationsrofranemiarinranrolderrclientrincluderpallor.rHavingrarpalerskinrtonera
ndrexhibitingrpallorrarerdifferentrfindings,rhowever.rPale,rcool,rdryrskinrisrnotrspecificallyrconcernin
grforranemiarinrtherolderradultrclient.
2. Manifestationsrofranemiarinranrolderrclientrcanrincluderjointrpain.
3. Depression,rapathy,randrdecreasedrfoodrintakercanrbersignsrofranemiarinrtherolderradultrclient.
4. Tachycardia,rpalpitations,randrevenranginarcanrresultrfromrtherdecreasedrcardiacroutputrfromrane
mia.
5. Dyspnearonrexertionrisrarmanifestationrofranemiarinranrolderrclient.rPa
gerRef:r570-571
CognitiverLevel:r Analyzing
ClientrNeed:r PhysiologicalrIntegrity
ClientrNeedrSub:rPhysiologicalrAdaptationrNurs/
IntegrConc.:r NursingrProcess:rAssessment
LearningrOutcome:r 4.rInterpretruniquerpresentationsrofrhematologicrproblemsrinrtherolderrper
son.
2
Copyrightr©r2019rPearsonrEducation,rInc.
, 3) Anrolderrclientrwithrchronicrrenalrfailurerandrweeklyrdialysisrhasranemia.rWhichrinterventionrisr
mostrimportantrforrthernursertorimplementrforrthisrclient?
1. Frequentrbloodrpressurerassessment
2. Erythropoietinrinjection
3. Administerrferrousrsulfaterorally
4. Monitorrforrhematuriar
Answer:r 2
Explanation:r1.rAnemiarassociatedrwithrrenalrfailurerdoesrnotrcauserclinicallyrsignificantrchangesr
inrtherclient'srbloodrpressure,rwhenrmanagedrcorrectly,rbecausertherbodyrcompensatesrforrtherchro
nicallyrlowrlevel.
2. Anemiarassociatedrwithrrenalrfailurerisrrelatedrtortherlossrofrerythropoietin,rwhichrisrproducedrbyrt
herhealthyrkidneyrandrstimulatesrbonermarrowrtorproducerredrbloodrcells.rErythropoietinrisrreplaced
rviarinjectionronrarregularrbasisrforrthoserwithrrenalrinsufficiency.
3. Ironrreplacementrcanrberusefulrinranemia,rbutrironrdoesrnotrcorrectrthercauserforrtherclientrwith
rrenalrfailure.r Inrchronicrrenalrfailure,rironrstoresrarernormal.
4. Renalrfailurercausesrtherlossrofrprotein,rnotrblood,rthroughrtherurine.rIfrtherclientrproducesrurin
e,ritrmayrberdarklyrcolored,rmakingritrdifficultrtordeterminertherpresencerofrblood,randrurinalysisr
isrnotrindicatedrunlessrtherclientrexhibitsrovertrmanifestationsrofrhematuria.
PagerRef:r573
CognitiverLevel:r Analyzing
ClientrNeed:r PhysiologicalrIntegrity
ClientrNeedrSub:rPhysiologicalrAdaptationrNurs/
IntegrConc.:r NursingrProcess:rAssessment
LearningrOutcome:r 4.rInterpretruniquerpresentationsrofrhematologicrproblemsrinrtherolderrper
son.
3
Copyrightr©r2019rPearsonrEducation,rInc.
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