Chapter 32: Assessment of Hematologic Function and Treatment Modalities

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.

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The nurse is completing a physical assessment on a client's lymphatic system. The nurse should palpate for enlarged nodes in which areas? Select all that apply. - Popliteal - Inguinal - Spinal - Submental - Neck

Answer: - Popliteal - Inguinal - Submental - Neck

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: A.) Albumin. B.) Globulin. C.) Fibrinogen. D.) Prothrombin.

Answer: A.) Albumin.

The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly? A.) Crackles auscultated bilaterally B.) Respiratory rate of 10 breaths/minute C.) Oral temperature of 97°F D.) Pain and tenderness in calf area

Answer: A.) Crackles auscultated bilaterally

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? A.) Hemorrhage B.) Blood transfusion reaction C.) Shock D.) Splintering of bone fragments

Answer: A.) Hemorrhage Rationale: Hazards of either bone marrow aspiration or biopsy include bleeding and infection. The risk of bleeding is somewhat increased if the patient's platelet count is low or if the patient has been taking a medication (e.g., aspirin) that alters platelet function.

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following? A.) Liver B.) Pancreas C.) Kidney D.) Large intestine

Answer: A.) Liver

A nurse cares for a client with myelodysplastic syndrome who requires frequent PRBC transfusions. What blood component does the nurse recognize as being most harmful if accumulated in the tissues due to chronic blood transfusions? A.) Calcium B.) Iron C.) Hemoglobin D.) Potassium

Answer: B.) Iron Rationale: Iron overload is a complication unique to people who have had long-term PRBC transfusion. Over time, the excess iron deposits in body tissues can cause organ damage, particularly in the liver, heart, testes, and pancreas.

The nurse expects which assessment finding when caring for a client with a decreased hemoglobin level? A.) Bright red venous blood. B.) Elevated temperature. C.) Decreased oxygen level. D.) Increased bruising.

Answer: C.) Decreased oxygen level. Rationale: Hemoglobin carries oxygen; a decreased hemoglobin level results in decreased oxygen. An elevated temperature is a sign of infection and can result from decreased white blood cells. Arterial blood is more oxygen saturated and brighter red in color than venous blood. Increased bruising results from a decreased platelet level, not decreased hemoglobin.

When teaching about the advantages of autologous blood transfusion to a client, the nurse should include which information? Select all that apply. - The primary advantage is prevention of viral infections. - It is safer for clients with a history of transfusion reactions. - It resolves anemia for clients with a hemoglobin less than 11g/dL. - Blood can be transfused to family members and close relatives. - If not needed immediately, the blood can be frozen for future use.

Answer: - 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.

Which is a symptom of severe thrombocytopenia? A.) Petechiae B.) Inflammation of the mouth C.) Inflammation of the tongue D.) Dyspnea

Answer: A.) Petechiae

A 18-year-old client presents to the emergency department with a severe open fracture of the lower extremity. The health care provider tells the client that the client will need a blood transfusion. The client refuses, despite the advise of the health care provider. What does the nurse understand is the legal implication of the scenario? A.) The client has a right to refuse the transfusion. B.) The health care provider may first call the client's parents if the client refuses. C.) The client can only refuse the transfusion if the consent form has not been signed. D.) The health care provider may ask for a court order if the client refuses.

Answer: A.) The client has a right to refuse the transfusion.

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? A.) Preparation for likely nephrectomy B.) Increases the effectiveness of dialysis C.) Hypervolemia D.) Lack of erythropoietin

Answer: D.) Lack of erythropoietin

The nurse is working at a blood donation clinic. What teaching should the nurse provide to the donor immediately after blood donation? A.) Hold the involved arm below the heart. B.) Remove the band-aid after 5 minutes. C.) Sit up promptly after the needle is removed. D.) Remain for observation after eating and drinking.

Answer: D.) Remain for observation after eating and drinking.

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called A.) blast cells. B.) megaloblasts. C.) mast cells. D.) monocytes.

Answer: B.) megaloblasts.

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? A.) 2:00 pm B.) 3:00 pm C.) 4:00 pm D.) 6:00 pm

Answer: C.) 4:00 pm Rationale: 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.

Which blood cell type is matched correctly with its function? A.) T lymphocyte: Humoral immunity B.) Plasma cell: Cell-mediated immunity C.) Leukocyte: Fights infection D.) B lymphocyte: Secretes immunoglobulin

Answer: C.) Leukocyte: Fights 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? A.) Iron chelation therapy B.) Oxygen therapy C.) Therapeutic phlebotomy D.) Anticoagulation therapy

Answer; A.) Iron chelation therapy Rationale: Iron overload is a complication unique to people who have had long-term PRBC transfusions. One unit of PRBCs contains 250 mg of iron. Patients with chronic transfusion requirements can quickly acquire more iron than they can use, leading to iron overload. Over time, the excess iron deposits in body tissues and can cause organ damage, particularly in the liver, heart, testes, and pancreas. Promptly initiating a program of iron chelation therapy can prevent end-organ damage from iron toxicity.

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? A.) Add the morphine to the blood to be slowly administered. B.) Inject the morphine into a distal port on the blood tubing. C.) Administer the morphine into the closest tubing port to the client for fast delivery. D.) Disconnect the blood tubing, flush with normal saline, and administer morphine.

Answer: D.) Disconnect the blood tubing, flush with normal saline, and administer morphine. Rationale: Never add medications to blood or blood products. The transfusion must be temporarily stopped in order to administer the morphine.

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? A.) Essential thrombocythemia B.) Extreme leukocytosis C.) Sickle cell anemia D.) Renal transplantation

Answer: A.) Essential thrombocythemia Rationale: Platelet pheresis is used to remove platelets from the blood in patients with extreme thrombocytosis or essential thrombocythemia (temporary measure)or in a single-donor platelet transfusion.

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? A.) Place the client in a recumbent position with legs elevated. B.) Remove the intravenous line. C.) Ensure there is an oxygen delivery device at the bedside. D.) Administer prescribed PRN anti-anxiety agent.

Answer: C.) Ensure there is an oxygen delivery device at the bedside. Rationale: The client is exhibiting signs of circulatory overload. After stopping the transfusion and notifying the healthcare provider, the nurse should place the client in a more upright position with the legs dependent to decrease workload on the heart. The IV line is kept patent in case emergency medications are needed. Oxygen and morphine may be needed to treat severe dyspnea. Administering an anti-anxiety agent is not a priority action over ensuring oxygen is available.

Which type of lymphocyte is responsible for cellular immunity? A.) B lymphocyte B.) Plasma cell C.) T lymphocyte D.) Basophil

Answer: C.) T lymphocyte Rationale: T lymphocytes are responsible for delayed allergic reactions, rejection of foreign tissue (e.g., transplanted organs), and destruction of tumor cells. This process is known as cellular immunity. B lymphocytes are responsible for humoral immunity. A plasma cell secretes immunoglobulin. A basophil contains histamine and is an integral part of hypersensitivity reactions.

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? A.) The kidneys sense low oxygen levels in the blood and produce erythropoietin, stimulating the bone marrow to produce more red blood cells. B.) The bone marrow is stimulated by low oxygen levels in the blood to produce erythropoietin, maturing the red blood cells. C.) The brain senses low oxygen levels in the blood and produces hemoglobin, which binds to more red blood cells. D.) The kidneys sense low oxygen levels in the blood and produce hemoglobin, stimulating the marrow to produce more red blood cells.

Answer; A.) The kidneys sense low oxygen levels in the blood and produce erythropoietin, stimulating the bone marrow to produce more red blood cells.

The nurse should provide further teaching about post bone-marrow biopsy procedures when the client makes which statement? A.) "I'll ask someone to drive me home when I awake from general anesthesia." B.) "I should not take aspirin-containing products for pain relief." C.) "I may feel some aching in my hip for 1-2 days." D.) "I will keep the sterile dressing on until my doctor tells me it's okay to remove it."

Answer: A.) "I'll ask someone to drive me home when I awake from general anesthesia." Rationale: A bone marrow biopsy is usually performed with local anesthesia, not general. Aspirin can increased the risk of bleeding and should be avoided post procedure. The client should expect to feel some aching in the hip area for 1-2 days. A sterile dressing is applied upon completion of the procedure and should remain in place until the healthcare provider tells the client it is safe to remove.

Which of the following cells are capable of differentiating into plasma cells? A.) B lymphocytes B.) T lymphocytes C.) Eosinophils D.) Neutrophils

Answer: A.) B lymphocytes Rationale: B lymphocytes are capable of differentiating into plasma cells. Plasma cells, in turn, produce antibodies called immunoglobulins (Ig), which are protein molecules that destroy foreign material by several mechanisms. T lymphocytes, eosinophils, and neutrophils do not differentiate into plasma cells.

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? A.) Myeloid stem cell B.) Lymphoid stem cell C.) Monocyte D.) Neutrophil

Answer: A.) Myeloid stem cell Rationale: The myeloid stem cell is responsible not only for all nonlymphoid white blood cells, but also for the production of red blood cells and platelets. Lymphoid cells produce either T or B lymphocytes. A monocyte is large WBC that becomes a macrophage when is leaves the circulation and moves into body tissues. A neutrophil is a fully mature WBC capable of phagocytosis.

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? A.) Resume the transfusion B.) Obtain blood and urine samples from the client C.) Position the client in an upright position with the feet in a dependent position D.) Send the blood back to the blood bank

Answer: A.) Resume the transfusion Rationale: Some clients develop urticaria (hives) or generalized itching during a transfusion. The cause of these reactions is thought to be a sensitivity reaction to a plasma protein within the blood component being transfused. Symptoms of an allergic reaction are urticaria, itching, and flushing. The reactions are usually mild and respond to antihistamines. If the symptoms resolve after administration of an antihistamine (e.g., diphenhydramine), the transfusion may be resumed.

A client wants to donate blood before his or her abdominal surgery next week. What should be the nurse's first action? A.) Provide the client with a list of the nearest donation centers. B.) Explain the time frame needed for autologous donation. C.) Remind the client to take supplemental iron before donation. D.) Tell the client that 2 units of blood will be needed.

Answer: B.) Explain the time frame needed for autologous donation. Rationale: Preoperative autologous donations are ideally collected 4 to 6 weeks before surgery. The nurse should first explain that time frame to this client. Surgery is scheduled in one week which means that autologous blood donation may not be an option for this client. A list of donation centers can be provided to the client; and even though iron is recommended and 2 units of blood may be suggested, the first action is to tell the client about the needed time frame for donation.

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? A.) Basophils B.) Neutrophils C.) Eosinophils D.) Monocytes

Answer: B.) Neutrophils

A nurse is transfusing whole blood to a client with impaired renal function. During the transfusion, the client tells the nurse, "I feel very short of breath all of a sudden." What is the nurse's primary action? A.) Assess the client's vital signs. B.) Stop the infusion. C.) Call the health care provider. D.) Slow the infusion.

Answer: B.) Stop the infusion. Rationale: A client with impaired renal function is at increased risk for transfusion-associated circulatory overload (TACO). Signs of circulatory overload include dyspnea, orthopnea, tachycardia, an increase in blood pressure, and sudden anxiety. If the symptoms are mild, the nurse may be able to slow the infusion and administer diuretics; however, sudden shortness of breath should clue the nurse to immediately stop the infusion and sit the client upright with feet dangling. Next, the nurse will notify the health care provider after normal saline is infused into the site. Only after stopping the infusion will the nurse obtain the client's vital signs.

A patient will need a blood transfusion for the replacement of blood loss from the gastrointestinal tract. The patient states, "That stuff isn't safe!" What is the best response from the nurse? A.) "I agree that you should be concerned with the safety of the blood, but it is important that you have this transfusion." B.) "The blood is carefully screened, so there is no possibility of you contracting any illness or disease from the blood." C.) "I understand your concern. The blood is carefully screened but is not completely risk free." D.) "You will have to decide if refusing the blood transfusion is worth the risk to your health."

Answer: C.) "I understand your concern. The blood is carefully screened but is not completely risk free." Rationale: Despite advances in donor screening and blood testing, certain diseases can still be transmitted by transfusion of blood components (Chart 32-4).

A nurse cares for a client with megaloblastic anemia who had a total gastrectomy three years ago. What statement will the nurse include in the client's teaching regarding the condition? A.) "The condition is likely caused by a folate deficiency." B.) "The condition causes abnormally small red blood cells." C.) "The condition is likely caused by a vitamin B12 deficiency." D.) "The condition causes abnormally rigid red blood cells."

Answer: C.) "The condition is likely caused by a vitamin B12 deficiency."

Which client is not a candidate to be a blood donor according to the American Red Cross? A.) 86-year-old male with blood pressure 110/70 mm Hg B.) 50-year-old female with pulse 95 beats/minute C.) 26-year-old female with hemoglobin 11.0 g/dL D.) 18-year-old male weighing 52 kg

Answer: C.) 26-year-old female with hemoglobin 11.0 g/dL Rationale: Clients must meet a number of criteria to be eligible as blood donors, including the following: body weight at least 50 kg; pulse rate regular between 50 and 100 bpm; systolic BP 90-100 to 180 mm Hg and diastolic 50 to 100 mm Hg; hemoglobin level at least 12.5 g/dL. There is no upper age limit to donation.

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? A.) Notify the physician B.) Administer aspirin (ASA) 325 mg po, as ordered C.) Administer acetaminophen 500 mg po, as ordered D.) Reposition the client to a high Fowler position and continue to monitor the pain

Answer: C.) Administer acetaminophen 500 mg po, as ordered Rationale; After a marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing. Most clients have no discomfort after a bone marrow biopsy, but the site of a biopsy may ache for 1 or 2 days. Warm tub baths and a mild analgesic agent (e.g., acetaminophen) may be useful. Aspirin-containing analgesic agents should be avoided it the immediate post-procedure period because they can aggravate or potentiate bleeding.

A nursing instructor is reviewing the role and function of stem cells in the bone marrow with a group of nursing students. After providing the explanation, the instructor asks the students to use their knowledge of anatomy and physiology to determine an alternate way in which adults with diseases that destroy marrow can resume production of blood cells. Which explanation by the students is correct? A.) Fat found in yellow bone marrow can be replaced by active marrow when more blood cell production is required. B.) The remaining stem cells have the ability to continue with the process of self-replication, creating an endless supply. C.) The liver and spleen can resume production of blood cells through extramedullary hematopoiesis. D.) The three cell types—erythrocytes, leukocytes, and platelets—can resume production of stem cells.

Answer: C.) The liver and spleen can resume production of blood cells through extramedullary hematopoiesis.

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? A.) Vitamin A deficiency B.) Vitamin C deficiency C.) Folic acid deficiency D.) Vitamin B12 deficiency

Answer: D.) Vitamin B12 deficiency Rationale: Because vitamin B12 is found only in foods of animal origin, strict vegetarians may ingest little vitamin B12. Vitamin B12 combines with intrinsic factor produced in the stomach. 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. The effects of either decreased absorption or decreased intake of vitamin B12 are not apparent for 2-4 years. This results in megaloblastic anemia. Some symptoms are a smooth, beefy red, enlarged tongue and cranial nerve deficiencies.