CH 32: Hematologic function and treatment modalities
A client with a history of sickle cell anemia has developed iron overload from repeated blood transfusions. What treatment does the nurse anticipate will be prescribed?
Chelation therapy
The nurse is caring for a client who had undergone hemodilution during surgery. Immediately after surgery, the nurse expects to see which lab result?
Decreased hematocrit
Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets?
Myeloid stem cell
Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following?
Liver
A client reports feeling faint after donating blood. What is the nurse's best action?
Keep client in recumbent position to rest.
Which blood cell type is matched correctly with its function?
Leukocyte: Fights infection
Place the following steps in order when determining the type and severity of a transfusion reaction.
Stop the transfusion. Assess the client. Notify the health care provider. Notify the blood bank. Send the tubing and container to the blood bank.
A nurse is teaching a client with a vitamin B12 deficiency about appropriate food choices to increase the amount of B12 ingested with each meal. The nurse knows the teaching is effective based on which statement by the client?
"I will eat a meat source such as chicken or pork with each meal."
The nurse is caring for a client with hypoxia. What does the nurse understand is true regarding the client's oxygen level and the production of red blood cells?
The kidneys sense low oxygen levels in the blood and stimulate erythropoietin, stimulating the marrow to produce more red blood cells.
What does the nurse recognize as secondary sites of hematopoiesis that is unique to embryonic development? Select all that apply.
Liver Spleen
When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data?
Dietary intake Medication use Ethnicity Herbal supplements
A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse know is the most likely clinical disorder the patient is being treated for?
Essential thrombocythemia
The nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. What position will the nurse place the patient in?
Lateral position with one leg flexed
The nurse expects which assessment finding of the oral cavity when the client is diagnosed with pernicious anemia?
Smooth tongue
Which type of lymphocyte is responsible for cellular immunity?
T lymphocyte
A client receiving a unit of packed red blood cells (PRBCs) has been prescribed morphine 1 mg intravenously now for pain. What is the best method for the nurse to administer the morphine?
Disconnect the blood tubing, flush with normal saline, and administer morphine.
A client receiving a blood transfusion reports shortness of breath, appears anxious, and has a pulse of 125 beats/minute. What is the best action for the nurse to take after stopping the transfusion and awaiting further instruction from the health care provider?
Ensure there is an oxygen delivery device at the bedside.
A client with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this client?
Erythropoietin
Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils?
Phagocytosis
The nurse is completing a physical assessment on a client's lymphatic system. The nurse should palpate for enlarged nodes in which areas?
Popliteal Inguinal Submental Neck Explanation: Palpable lymph node areas include: popliteal, inguinal, submental, and neck. The spinal region does not contain palpable lymph nodes.
A nurse is preparing a dose of furosemide for an older adult with heart failure. The health care provider orders furosemide 1 mg/kg to be given intravenously. The client weighs 50 kg. The concentration of the drug is 40 mg/4mL (10 mg/mL). How many milliliters would the nurse administer? Record your answer using a whole number.
-5 Explanation: 1 mg/kg X 50 kg = 50 mg then divide by 10 mg/mL = 5 mL
The nurse cares for a client with a coagulation factor deficiency who is actively bleeding. Which blood component replacement does the nurse anticipate administering?
-FFP Explanation: Fresh frozen plasma has all the coagulation factors in it and is the blood component replacement therapy that will be used to replace blood from a client who is actively bleeding with a coagulation factor deficiency.
A nurse is caring for a patient who has had a bone marrow aspiration with biopsy. What complication should the nurse be aware of and monitor the patient for?
-Hemorrhage -Hazards of either bone marrow aspiration or biopsy include bleeding and infection.
A patient who has long-term packed RBC (PRBC) transfusions has developed symptoms of iron toxicity that affect liver function. What immediate treatment should the nurse anticipate preparing the patient for that can help prevent organ damage?
-Iron chelation therapy
A client develops a hemolytic reaction to a blood transfusion. What actions should the nurse take after this occurs? Select all that apply.
-Obtain appropriate blood specimens -Collect a urine sample to detect hemoglobin -Document the reaction according to policy
A nurse is caring for a client with a diagnosis of lymphocytopenia. Which assessment finding will the nurse consider most concerning when caring for this client?
-Temperature of 37.7 degrees Celsius -Lymphocytopenia is a decrease in the number of lymphocytes. Lymphocytes help to fight foreign invaders, such as infectious organisms. A temperature of 37.7 degree Celsius is a Fahrenheit temperature of 99.9. A low-grade fewer may be indicative of an infection
When teaching about the advantages of autologous blood transfusion to a client, the nurse should include which information?
-The primary advantage is prevention of viral infections. -It is safer for clients with a history of transfusion reactions. -If not needed immediately, the blood can be frozen for future use.
A nurse working in hematology reviews the characteristics of stem cells and their role in disease. Which statements does the nurse understand is true regarding stem cells?
-There is a continuous supply throughout the life cycle. -Lymphoid stem cells produce lymphocytes. -Myeloid stem cells produce erythrocytes. -They have the ability to self-replicate.
A client comes into the emergency department reporting an enlarged tongue. The tongue appears smooth and beefy red in color. The nurse also observes a 5-cm incision on the upper left quadrant of the abdomen. When questioned, the client states, "I had a partial gastrostomy 2 years ago." Based on this information, the nurse attributes these symptoms to which problem?
-Vitamin B12 deficiency -the vitamin B12-intrinsic factor complex is absorbed in the distal ileum. Clients who have had a partial or total gastrectomy may have limited amounts of intrinsic factor, and therefore the absorption of vitamin B12 may be diminished.
A nurse is reviewing a client's morning laboratory results and notes a left shift in the band cells. Based on this result, the nurse can interpret that the client
-may be developing an infection. -Less mature granulocytes have a single-lobed, elongated nucleus and are called band cells. An increased number of band cells is sometimes called a left shift or shift to the left.
The nurse begins a routine blood transfusion of packed red blood cells (PRBCs) at 1100. To ensure client safety, the unit of blood should be completely transfused by what time?
1500 Explanation: Administration time for PRBCs should not exceed 4 hours because of the increased risk of bacterial proliferation.
Which client is not a candidate for blood donation according to the American Heart Association?
26 year old female with hemoglobin 11.0 g/dL Explanation: Clients must meet the following criteria to be eligible as blood donors: body weight at least 50 kg; pulse rate regular between 50 and 100 bpm; systolic BP 90 to 180 mmHg and diastolic 50 to 100 mmHg; hemoglobin level at least 12.5 g/dL for women. There is no upper age limit to donation.
A client with a history of congestive heart failure has an order to receive 1 unit of packed red blood cells (RBCs). If the nurse hangs the blood at 12:00 pm, by what time must the infusion be completed?
4:00 pm When packed red blood cells (PRBCs) or whole blood is transfused, the blood should be administered within a 4-hour period because warm room temperatures promote bacterial growth.
In normal blood, monocytes account for approximately what percentage of the total leukocyte count?
5%
A client with Hodgkin disease had a bone marrow biopsy yesterday and reports aching at the biopsy site, rated a 5 (on a 1-10 scale). After assessing the biopsy site, which nursing intervention is most appropriate?
Administer acetaminophen 500 mg po, as ordered
A client who has idiopathic thrombocytopenia purpura (ITP) has a critically low platelet count. Which nursing intervention will be included in the care plan for this client?
Administer eltrombopag
A nurse is assigned to care for a patient with ascites, secondary to cirrhosis. The nurse understands that the fluid accumulation in the peritoneal cavity results from a combination of factors including an alteration in oncotic pressure gradients and increased capillary permeability. Therefore, the nurse monitors the serum level of the plasma protein responsible for maintaining oncotic pressure, which is:
Albumin.
The nurse is obtaining the health history of a client suspected of having a hematological condition. The nurse notes the client has a history of alcohol abuse. Which clinical presentation is related to alcohol consumption?
Anemia
The physician performs a bone marrow biopsy from the posterior iliac crest on a client with pancytopenia. What intervention should the nurse perform after the procedure?
Apply pressure over the site for 5-7 minutes
G-CSF (filgrastim) is prescribed for a client with bone marrow suppression. What medication administration teaching should the nurse provide to the client?
Assist the client in identifying appropriate subcutaneous injection sites.
Which of the following cells are capable of differentiating into plasma cells?
B lymphocytes
Which type of leukocyte contains histamine and is an important part of hypersensitivity reactions?
Basophils
A nursing instructor in a BSN program is preparing for a lecture on disorders of the hematopoietic system. Included in the lecture are conditions caused by reduced levels or absence of blood-clotting proteins. Which of the following is the instructor most likely referring to?
Coagulopathy
The nurse is instructing the client with polycythemia vera how to perform isometric exercises such as contracting and relaxing the quadriceps and gluteal muscle during periods of inactivity. What does the nurse understand is the rationale for this type of exercise?
Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.
A patient with chronic kidney disease is being examined by the nurse practitioner for anemia. The nurse has reviewed the laboratory data for hemoglobin and RBC count. What other test results would the nurse anticipate observing?
Decreased level of erythropoietin
The nurse expects which assessment finding when caring for a client with a decreased hemoglobin level?
Decreased oxygen level.
During a blood transfusion with packed red blood cells (RBCs), a client reports chills, low back pain, and nausea. What priority action should the nurse take?
Discontinue the infusion immediately and maintain the IV line with normal saline solution using new IV tubing
The charge nurse should intervene when observing a new nurse perform which action after a client has suffered a possible hemolytic blood transfusion reaction?
Disposing of the blood container and tubing in biohazard waste. Explanation: The blood container and tubing should be returned to the blood bank for repeat typing and culture, and the blood bank should be notified of the reaction.
A client wants to donate blood before his or her abdominal surgery next week. What should be the nurse's first action?
Explain the time frame needed for autologous donation.
A nurse administers blood products to a client with Hodgkin disease. During the administration, the nurse notes the client has a fever and diffuse reddened skin rash. From what condition does the nurse suspect the client is suffering?
Graft-versus-host disease Explanation: Graft-versus-hold disease (GVHD) occurs in only severely immunocompromised recipients (such as those with Hodgkin disease). The transfused lymphocytes attack the host lymphocytes or body tissues; symptoms or signs may include fever, diffuse reddened skin rash, nausea, vomiting, and diarrhea.
Which term describes the percentage of blood volume that consists of erythrocytes?
Hematocrit
A nurse is performing an initial assessment and notes the client's skin is a gray-tan color, especially on the scars of the client's arms. Which hematological condition does the nurse suspect?
Hemochromatosis
A client is receiving platelets. In order to decrease the risk of circulatory overload in this client, what action should the nurse take?
Infuse each unit over 30-60 minutes per client tolerance.
The client's CBC with differential reveals small-shaped hemoglobin molecules. The nurse expects to administer which medication to this client?
Iron
A client in acute renal failure has been prescribed 2 units of packed red blood cells (PRBCs). The nurse explains to the client that the blood transfusion is most likely needed for which reason?
Lack of erythropoietin
The nurse is providing health education to an older adult client who has low red blood cell levels. To promote red blood cell production, the nurse should encourage intake of what foods?
Leafy green vegetables Lean meats Nuts and seeds
What food should the nurse recommend for a client diagnosed with vitamin B12 deficiency?
Lean meat
Which term refers to a form of white blood cell involved in immune response?
Lymphocyte
Which nursing intervention should be incorporated into the plan of care for a client with impaired liver function and a low albumin concentration?
Monitor for edema at least once per shift Clients with impaired hepatic function may have low concentrations of albumin, with a resultant decrease in osmotic pressure and the development of edema.
The body responds to infection by increasing the production of white blood cells (WBCs). The nurse should evaluate the differential count for what type of WBCs, which are the first WBCs to respond to an inflammatory event?
Neutrophils
The nurse is completing a pretransfusion assessment to determine a female client's history of previous transfusions as well as previous reactions to transfusions. Which is the most important information to obtain from this client before the transfusion?
Number of pregnancies Explanation: The nurse assesses the number of pregnancies a woman has had because a high number can increase her risk of reaction due to antibodies developed from exposure to fetal circulation.
A client involved in a motor vehicle accident arrives at the emergency department unconscious and severely hypotensive. The nurse suspects the client has several fractures in the pelvis and legs. Which parenteral fluid is the best choice for the client's current condition?
Packed red blood cells (RBCs)
A nurse cares for a client who has had a bone marrow aspiration. In addition to the client's aspiration site, what locations on the body does the nurse recognize as having bone marrow?
Pelvis Ribs Vertebrae Sternum
Which is the major function of neutrophils?
Phagocytosis
The client is diagnosed with polycythemia vera. The nurse prepares the client for which procedure?
Phlebotomy
The client is planned to have a splenectomy. The nurse should prepare which medication to administer to this client?
Pneumococcal vaccine Without a spleen, the client's risk of infection is greatly increased.
A nurse is assisting a client into position prior to bone marrow aspiration. Which position will the nurse place the client prior to the procedure?
Prone
Place the clotting cascade in the correct order.
Prothrombin activator Prothrombin Thrombin Fibrinogen Fibrin
One hour after a transfusion of packed red blood cells (RBCs) is started, a client develops redness on the trunk and reports itching. The nurse stops the RBC infusion and administers diphenhydramine 25 mg po, as ordered. Thirty minutes later, the redness and itching are gone. What action should the nurse take next?
Resume the transfusion If the symptoms resolve after administration of an antihistamine (e.g., diphenhydramine), the transfusion may be resumed.
A nurse cares for several mothers and babies in the postpartum unit. Which mother does the nurse recognize as being most at risk for a febrile nonhemolytic reaction?
Rh-negative mother; Rh-positive child
A nurse practitioner reviewed the blood work of a male client suspected of having microcytic anemia. The nurse suspected occult bleeding. Which laboratory result would indicate an initial stage of iron deficiency?
Serum ferritin: 15 ng/mL
Place the following procedural steps in order for transfusing a unit of packed red blood cells (PRBCs).
Start an intravenous line. Obtain the unit of PRBCs from the blood bank. Double check the labels with another nurse to ensure correct ABO group and Rh type. Initiate the blood transfusion within 30 minutes of receipt. Monitor closely for signs of a transfusion reaction.
The health care provider believes that the client has a deficiency in the leukocyte responsible for cell-mediated immunity. What should the nurse check the WBC count for?
T lymphocytes
A nurse, caring for a client with human immunodeficiency virus (HIV), reviews the client's differential WBC count. What type of WBC will the nurse check the level of?
T lymphocytes Explanation: Lymphocytes (T cells, B cells, and natural killer cells) are WBCs that are the major components of the body's immune response.
One hour after the completion of a fresh frozen plasma transfusion, a client reports shortness of breath and is very anxious. The client's vital signs are BP 98/60, HR 110, temperature 99.4°F, and SaO2 88%. Auscultation of the lungs reveals posterior coarse crackles to the mid and lower lobes bilaterally. Based on the symptoms, the nurse suspects the client is experiencing which problem?
Transfusion-related acute lung injury
The client is to receive a unit of packed red blood cells. What is the nurse's first action?
Verify that the client has signed a written consent form.
The nurse recognizes that the most common cause of iron deficiency anemia in an adult is
bleeding.
Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called
megaloblasts.