Cancer

A client with an apparent clotting disorder is admitted to hospital. His health record reveals that he has been treated for complications of chronic alcoholism for the past 10 years. The nurse should suspect what cause of his clotting disorder?

Vitamin K deficiency

The nurse is reviewing the client's laboratory report. Select the report that represents a normal value for leukocytes.

6500 cells/mL

In immune thrombocytopenia purpura (ITP), the client has what type of disorder that primarily destroys which blood component?

Autoimmune; platelets

The nurse reviews the lab results of a client who has a thrombocyte count of 60,000/µL. The client is at risk for:

Bleeding

Hemophilia A is a hereditary blood disorder caused by inadequate activity or absence of:

Factor VIII

A patient who has received chemotherapy has a steadily decreasing white blood cell count. The nurse anticipates administering which of the following to increase the neutrophil count?

Granulocyte colony-stimulating factor

The nurse caring for a client with myelogenous leukemia anticipates that the client will have abnormalities in which of the following? Select all that apply.

Granulocytes Erythocytes Thrombocytes

A patient is preparing to undergo a bone marrow biopsy to verify a diagnosis of acute leukemia. Which of the following should the nurse report to the physician before the procedure? Select all that apply.

History of hemophilia Low platelet count as indicated on morning lab work

The pathologist notes that the client has Reed-Sternberg cells. He knows that these cells are a diagnostic hallmark for which of the following disorders?

Hodgkin lymphoma

A patient with a history of acquired idiopathic thrombocytopenic purpura (ITP) arrives at the emergency department complaining of fatigue, shortness of breath, and multiple nosebleeds during the previous week. The platelet level is 10,000/μL, and the hemoglobin is significantly below normal. The nurse would anticipate which of the following interventions?

Immune globulin infusion

Which of the following is the main job of lymphocytes?

Immune reaction

Many different proteins, enzymes, and hormones are involved in maintaining hemostasis. Which protein is required for platelet adhesion?

von Willebrand factor

When collecting a client's history the client states that he is receiving treatment to maintain remission from leukemia. What does the nurse document that the client is receiving?

Maintenance therapy

A nurse is reviewing a client's complete blood count (CBC) which indicates thrombocytopenia. Based on this result which action should the nurse include in the plan of care

Place the client on bleeding precautions.

A client is undergoing a diagnostic workup to rule out multiple myeloma. Which of the following diagnostic findings would confirm the diagnosis of multiple myeloma?

Plasma cells greater than 10% on bone marrow biopsy

The nurse knows that the second step of hemostasis is which of the following?

Platelet plug

The nurse is caring for a client with leukemia that is having difficulty with blood clotting after having several transfusions with packed red blood cells. What does the nurse anticipate infusing for this client to assist with controlling the bleeding?

Platelets

A nurse is assessing a child brought to the clinic with multiple petechiae and excessive bruising covering his body. Laboratory tests reveal a low platelet count. The nurse is aware that these clinical manifestations are caused due to of which of the following pathological processes?

Platelets function to form the platelet plug to help control bleeding after injury. Without enough platelets, the blood cannot clot properly and bleeding occurs.

A client has an impaired platelet function that may have developed from inheritance, drugs, disease, or extracorporeal circulation. The health care provider would document this as:

Thrombocytopathia

A nurse is treating a client with aplastic anemia. Due to the replacement of normal bone marrow with malignant cells, the nurse teaches the client to prevent scratches, scrapes, and cuts. What root cause likely underlies the client's increased risk for hemorrhage?

Thrombocytopenia

Stem cell transplantation has been shown to provide potential cures for diseases such as aplastic anemia and the leukemias. What are the sources of stem cells used for transplant?

Umbilical cord blood and bone marrow

The coagulation cascade is the third component of the hemostatic process. The other two are: (Select all that apply.)

Vessel spasm Platelet aggregation

A 20-year-old client has presented for care because she has a cervical lymph node on the right side of her neck that is firm and enlarged, and has been so for several weeks. Palpation of the node is painless. The nurse should document this assessment finding and anticipate:

facilitating the client's lymph node biopsy.

Blood coagulation is initiated by either of two pathways. The intrinsic pathway requires circulating ________ to begin the step-wise coagulation cascade.

factor XII

The father of a 2-year-old boy recently diagnosed with hemophilia A asks the nurse how to prevent complications for his son. The best response would be:

"Avoid administering aspirin and nonsteroidal anti-inflammatory drugs."

The leukemia most commonly found in children and adolescents is recognized as:

Acute lymphocytic leukemia (ALL)

Which of the following types of white blood cells are related to the connective tissue mast cells and respond in allergic and hypersensitivity reactions?

Basophils

Definitive diagnosis of multiple myeloma includes the triad of bone marrow plasmacytosis, lytic bone lesions, and what?

Bence-Jones proteins in the urine

A client has been admitted for immune thrombocytopenic purpura. The client has not responded to corticosteroid treatment. The priority nursing intervention for this client would include which of the following treatment measures?

Insert an intravenous catheter, so immune globulin can be administered in a timely manner.

The pediatrician knows that the most common cause of cancer in children is which of the following?

Leukemia

The nurse is conducting patient education for a client who is scheduled to undergo diagnostic testing for non-Hodgkin's lymphoma (NHL). The nurse includes information on which of the following?

Lymph node biopsy

The admitting nurse on a hospital medical-surgical unit is admitting a 90-year-old patient with a history of congestive heart failure, coronary artery disease, prostate cancer, diabetes, and hypercholesteremia. The nurse realizes that the client is at high risk for thromboembolic complications due to a medical history with conditions that could increase platelet function. Which of the following conditions would contribute to this risk? Select all that apply.

Diabetes Hypercholesteremia Prostate cancer

A nurse is caring for a client receiving heparin therapy who has developed heparin-induced thrombocytopenia. Which of the nursing interventions does the nurse anticipate?

Discontinuation of heparin therapy

A client is admitted to the hospital with a diagnosis of deep vein thrombosis and started on intravenous heparin therapy. Seven days later, the client's lab values identify a rapid decrease in platelets. The health care provider recognizes this as:

Drug-induced thrombocytopenia

A nurse is evaluating laboratory results of a patient diagnosed with a parasitic infection. The tests reveal a large group of cells that are membrane bound with granules in their cytoplasm that are aiding in the destruction of the parasite. Which of the following cells is the nurse evaluating?

Eosinophil

A 16-year-old male client who has been diagnosed with infectious mononucleosis asks the health care provider what caused the condition. The best response would be:

Epstein-Barr virus (EBV)

A patient comes to the clinic with symptoms of fatigue, fever, severe joint pain, and headache. Based on these symptoms, the nurse anticipates that the physician will order which of the following laboratory tests? Select all that appl

Erythrocyte sedimentation rate (ESR) White blood cell count (WBC)

There are two pathways that can be activated by the coagulation process. One pathway begins when factor XII is activated. The other pathway begins when there is trauma to a blood vessel. What are these pathways?

Extrinsic and intrinsic pathways

The nurse's plan of care for a client with multiple myeloma should include interventions to prevent which of the following?

Fractures

The nurse is caring for a postsurgical client who is recovering from knee replacement surgery secondary to rheumatoid arthritis. When planning the client's care, the nurse should include what action?

Frequent assessment for signs of thrombosis or hemorrhage.

A patient being treated for polymyalgia rheumatica (PMR) comes to the clinic for a follow-up visit. The current erythrocyte sedimentation rate (ESR) rate has decreased from 60 mm/hour to 30 mm/hour and the patient is afebrile, denies any headaches, and reports a decrease in joint pain and fatigue. Based on these findings, the nurse anticipates which of the following changes to the treatment plan?

Gradually decrease the current dosage of prednisone and repeat ESR in 2 weeks.

Which of the following clients likely faces the highest risk of an acquired hypocoagulation disorder and vitamin K deficiency? A client who:

Has a diagnosis of liver failure secondary to alcohol abuse

A client with acute leukemia has developed gout. The nurse is aware that this results from:

Hyperuricemia

A patient is admitted to the emergency department with a diagnosis of polycythemia. The nurse plans to assess for symptoms related to which of the following problems?

Increased blood viscosity

A 69-year-old client who is obese and has a diagnosis of angina pectoris has been prescribed clopidogrel (Plavix) by his primary care provider. The client asks, "Why do I need this medication? It won't help my chest pain." The best response would be this medication:

Prevents the blood cells from forming a clot in your heart vessels

Heparin is an anticoagulant given by injection to prevent the formation of blood clots. How does heparin work?

Promotes the inactivation of clotting factors

A 10-month-old infant has begun to take his first steps and his mother has brought him for assessment because of swelling in his ankles and knees. The mother also states that he was eager to walk but has now regressed and cries when she tries to encourage it. The clinician should:

assess the child for signs and symptoms of hemophilia A.

A nurse on an oncology floor is treating a client who is anemic following chemotherapy. The drugs being administered are designed to increase the number of red blood cells in circulation. These drugs are likely agonists of:

cytokines.

The parent of a 5 year old who was admitted with a sudden onset of purpura following the flu and who was diagnosed with acute idiopathic thrombocytopenic purpura (ITP) is very concerned that the child will have ITP for the rest of his life. The best response for the nurse to make is which of the following?

"It is usually self-limiting."

A 9-year-old child has been home from summer camp for 2 weeks and complains of sore throat, low-grade fever, and enlarged cervical lymph nodes. After testing, it is determined the child has Epstein-Barr virus (EBV)-associated infectious mononucleosis. The parent asks the nurse how the child acquired this type of infection. Which of the following is the nurse's best response?

"The infection is acquired primarily through contact with infected oral secretions."

A client tells the nurse that he has recently begun to take over-the-counter (OTC) calcium supplements to ensure that his blood will clot. The best response by the nurse would be:

"This is not necessary, unless it has been prescribed by your health care provider."

Which person should the charge nurse assign as a roommate for a client diagnosed with aplastic anemia?

A client in traction with a broken femur

The globulins that make up part of the plasma of the blood have three distinct purposes. What are the gamma globulins?

Antibodies of the immune system

A client asks, "What do these basophils and mast cells do in the body?" The health care provider responds that they:

Are involved when you have an allergic reaction

A client's laboratory report shows the presence of the Philadelphia chromosome. The health care provider would recognize this as:

Chronic myelogenous leukemia (CML)

The nurse is planning a prevention program for infectious mononucleosis. The best target audience for the program is which of the following?

College students living in a dorm

What are the components of blood? (Select all that apply.)

Enzymes Electrolytes

The client is undergoing diagnostic workup for possible Hodgkin type of lymphoma. Which of the following laboratory results would confirm the diagnosis of Hodgkin lymphoma?

Reed-Sternberg cells

A patient with a diagnosis of myelogenous leukemia is being admitted to the hospital with an exacerbation of Crohn's disease. Laboratory results include a white blooc cell count of 200,000/μL and a platelet count of 600,000/μL. The nursing assessment reveals swelling and pain in the right leg. The nurse suspects the presence of which of the following conditions?

Secondary thrombocytosis

Which of the following is the name of the fluid that remains after blood clots?

Serum

A 26-year-old female client has a neutrophil count of less than 500 ?L. The nurse would interpret this as:

Severe neutropenia

A client with chronic myelogenous leukemia (CML) has been diagnosed with terminal blast crisis. Which of the following clinical manifestations should the nurse focus the assessment on for this client? Select all that apply.

Shortness of breath and progressive dyspnea Headache and lethargy Increasing confusion

The most recent blood work of a client with a diagnosis of acute myelogenous leukemia (AML) reveals thrombocytopenia. Where is the client most likely to experience abnormal bleeding as a result of low platelets?

Skin and mucous membranes

A client diagnosed with pancytopenia due to aplastic anemia is scheduled for which of the following treatments that can correct bone marrow deficiencies?

Stem cell transplant

Which of the following factors differentiates chronic leukemias from acute leukemias?

The leukemic cells are more fully differentiated than in acute leukemias.

A mother brings her child to the pediatric clinic because of irritability, loss of appetite, low-grade fever, pallor, and leg pain. Blood tests reveal anemia, thrombocytopenia, and an elevated leukocyte count with atypical lymphocytes. A diagnosis of acute lymphocytic leukemia (ALL) is confirmed with bone marrow studies. The child undergoes aggressive high-dose chemotherapy with plans for a possible stem cell transplant. Which of the following questions is most appropriate for the nurse to ask the mother?

"When your child was born, did you save the umbilical cord blood in a blood bank?"

The nursing caring for a 62-year-old client with diffuse large B-cell lymphoma plans care based on the knowledge that this client's lymphoma is:

aggressive.

A geriatrician is following a number of clients on a subacute geriatric medical unit, some of whom require diagnostic blood work. Which client would be most likely to have an erythrocyte sedimentation rate (ESR) screening test ordered?

A man with rheumatoid arthritis and pneumonia.

A client with a diagnosis of hemophilia A has been admitted with bilateral knee pain. The nurse should anticipate performing what intervention during the client's treatment?

Administration of factor VIII and implementation of fall prevention measures

A patient comes to the clinic with a runny nose and scratchy throat. The nurse is evaluating the white blood cell count, which shows an elevated number of white blood cells and an increased percentage of eosinophils. Which of the following is the most likely cause of the symptoms?

Allergic reaction

Anticoagulant drugs prevent thromboembolic disorders. How does warfarin, one of the anticoagulant drugs, act on the body?

Alters vitamin K, reducing its ability to participate in the coagulation of the blood

The cloning of the genes for most of the hematopoietic growth factors has been accomplished. The recombinant proteins that are produced are used in a wide range of clinical problems. What diseases have these proteins been used to fight?

Aplastic anemia and the anemia of kidney failure

A patient comes to the clinic following exposure to chicken pox. The patient states he had chicken pox as a child but was worried about getting sick again. Which of the following statements best explains humoral-mediated immunity to the patient?

B lymphocytes (B cells) in the body produce antibodies to fight infections. Once exposed, the cells retain memory and are able to quickly fight off pathogens during re-exposure and prevent the disease from reoccurring.

A patient is suspected of having acute leukemia. Which of the following diagnostic tests does the nurse prepare for to verify that diagnosis?

Bone marrow biopsy

Which of the following is the first symptom of multiple myeloma that a patient typically presents with on a visit to the primary care provider?

Bone pain

The nurse's review of a client's laboratory results indicates that inflammation is absent and platelet levels are low. Which test was performed to provide the platelet count?

Complete blood count

A patient comes to the clinic with symptoms of fatigue, fever, severe joint pain, and headache. A laboratory results reveal an erythrocyte sedimentation rate (ESR) rate of 60 mm/hour, and a diagnosis of polymyalgia rheumatica (PMR), an inflammatory disease, is confirmed. The nurse anticipates which of the following medications will be prescribed to manage this disease process?

Corticosteroids, such as prednisone

Thrombocytosis is used to describe elevations in the platelet count above 1,000,000/μL. It is either a primary or a secondary thrombocytosis. Secondary thrombocytosis can occur as a reactive process due to what?

Crohn disease

Regulation of blood cells is thought to be controlled in part by which of the following hormonelike growth factors?

Cytokines

A client is admitted with a suspected diagnosis of Hodgkin lymphoma (HL). Select the diagnostic manifestation that would confirm the diagnosis.

Presence of Reed-Sternberg cells

Although the usual site for a bone marrow test is the posterior iliac crest, other sites include the anterior iliac crest and the sternum. What are the dangers of using the sternum for a bone marrow test in children?

Danger of perforating the mediastinum and heart

The nurse is caring for a client who has a low levels of T lymphocytes. The nurse plans care for a client with which of the following?

Decreased immune response

A 57-year-old man is diagnosed with thrombocytopenia. The nurse knows that thrombocytopenia refers to a decrease in the number of circulating platelets. The nurse also knows that thrombocytopenia can result from what?

Decreased platelet production

A nurse is caring for a newborn that has developed a low platelet count. Which of the following could be the cause?

Decreased thrombopoietin (TPO)

A newborn has a clotting disorder that results in the body being unable to produce fibrin. Which of the following could be the cause?

Deficiency of fibrinogen

A nursing professor is teaching nursing students about the immune system. The instructor knows that teaching has been successful when a student correctly identifies which of the following as being roles of the monocyte? Select all that apply.

Development of immune granulomas Engulf foreign material Functions as a macrophage in the tissues Function as an antigen-presenting cell

Granulocytes are derived from which of the following cell types?

Myeloid stem cells

Which of the following is the most common leukocyte in normal blood?

Neurophilic granulocyte

The physician reviews a client's lab results and notes that the neutrophil count is 900/uL. This is known as which of the following?

Neutropenia

A patient undergoing chemotherapy has a critically low platelet count. The nurse expects to administer which of the following to stimulate platelet cell production?

Oprelvekin (Neumega) which is a thrombopoietin

A woman is suspected of having non-Hodgkin lymphoma (NHL). Which aspect of her condition would help to rule out Hodgkin lymphoma?

The lymph nodes involved are in many locations in the lymphatic system.

"Infants are not born with the normal intestinal bacteria that synthesize vitamin K for clotting."

The mother of a newborn infant questions why her baby needs a vitamin K injection immediately after birth. The best response by the nurse would be:

The nurse is reviewing the results of a client's complete blood count and differential. The results of this test will inform the nurse of what aspects of the client's current status? Select all that apply

The proportion of each type of white cell in the client's blood The number of platelets that are present in each unit of blood

A 6-year-old child is having a stem cell transplant using umbilical cord blood. What benefit does the nurse understand that this type of transplant will have for the child?

This type of transplant creates less risk of graft-versus host disease

A client was started on a protocol for the prevention of deep vein thrombosis shortly after admission and has been receiving 5000 units of heparin twice daily for the last week. An immune response to this treatment may increase the client's chance of developing which health problem?

Thrombocytopenia

A client suffered a laceration in his workshop and lost a significant amount of blood. The clots that formed have begun to retract. The process of clot dissolution has begun, which starts with:

activation of plasminogen.

A client with a long-standing diagnosis of human immunodeficiency virus (HIV) has recently developed neutropenia and been admitted to a hospital. Which of the following measures should be prioritized by the nurses who are providing his care?

Vigilant handwashing to protect against severe bacterial infections

To form a platelet plug, platelets must adhere to the vessel inner layer. For this to occur, which protein molecule is required?

Von Willebrand factor

A nurse is reviewing the laboratory data for a hospitalized client. The nurse would be most concerned about which finding?

White blood cell (WBC) count of 2800/µL

The nurse is reviewing the complete blood count (CBC) and white blood cell (WBC) differential of a client admitted with lower right abdominal pain. Which laboratory results are the most important for the nurse to communicate to the health care provider?

White blood cells (WBCs) 18,500/µL

A nurse is caring for a client in the intensive care unit who has sustained severe trauma and now has developed disseminated intravascular coagulation (DIC). The nurse is aware that the client is experiencing:

Widespread coagulation and bleeding in the vascular compartment