Chapter 32: Assessment of Hematologic Function and Treatment Modalities

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?

"I understand your concern. The blood is carefully screened but is not completely risk free."

The nurse should provide further teaching when a preoperative client considering blood donation makes which of the following statements?

"My family will donate blood, because it's safer."

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.

A client in end-stage renal disease is prescribed epoetin alfa (Epogen) and oral iron supplements. Before administering the next dose of epoetin alfa and oral iron supplement, the nurse ...

Assesses the hemoglobin level

Which term describes the percentage of blood volume that consists of erythrocytes?

Hematocrit

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 of the following reasons?

Lack of erythropoietin

Which type of lymphocyte is responsible for cellular immunity?

T lymphocyte

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

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

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

Which type of leukocyte contains histamine and is an important part of hypersensitivity reactions?

Basophils

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

Which is a symptom of severe thrombocytopenia?

Petechiae

Which is the major function of neutrophils?

Phagocytosis

The client is diagnosed with polycythemia vera. The nurse prepares the client for which procedure?

Phlebotomy

Which statement best describes the function of fibrinogen?

Plays a key role in forming blood clots

An older adult patient presents to the physician's office with a complaint of exhaustion. The nurse, aware of the most common hematologic condition affecting the elderly, knows that which laboratory values should be assessed?

RBC count

The nurse obtains a unit of blood for the client, Donald D. Smith. The name on the label on the unit of blood reads Donald A. Smith. All the other identifiers are correct. The nurse ...

Refuses to administer the blood

The nurse is screening donors for blood donation. The client who is an acceptable donor for blood is the client who ...

Reports having a cold 1 month ago that resolved quickly

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.

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called ...

megaloblasts.

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.

The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly?

Crackles auscultated bilaterally

Post transfusion, the donor stands up immediately after the needle is withdrawn. The nurse should be alert for which vital sign change?

Decreased blood pressure.

A client receiving a blood transfusion complains of 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 healthcare provider?

Ensure there is an oxygen delivery device at the bedside.

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

The client is a young, thin woman who is prescribed iron dextran intramuscularly. The nurse, when administering the medication?

Employs the Z-track technique

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 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

A nurse practitioner reviewed the blood work of a male patient suspected of having microcytic anemia. The nurse suspected occult bleeding. Identify the laboratory result that would indicate this initial stage of iron deficiency.

Serum ferritin: 15 ng/mL

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.

The nurse is administering 2 units of packed RBCs to an older adult patient who has a bleeding duodenal ulcer. The patient begins to experience difficulty breathing and the nurse assesses crackles in the lung bases, jugular vein distention, and an increase in blood pressure. What action by the nurse is necessary if the reaction is severe? (Select all that apply.)

- Place the patient in an upright position with the feet dependent. - Administer diuretics as prescribed. - Discontinue the transfusion. - Administer oxygen.

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

A 67-year-old client at the free clinic where you practice nursing has a history of seizures and presents with severe fatigue, frequent headaches, and a sore and beefy red tongue. Which of the following could be causing her current condition? Select all that apply.

- Alcoholism - Intestinal disorders

When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply.

- Dietary intake - Medication use - Ethnicity - Herbal supplements

Place the following procedural steps in order for transfusing a unit of packed red blood cells (PRBCs).

1. Start an intravenous line. 2. Obtain the unit of PRBCs from the blood bank. 3. Double check the labels with another nurse to ensure correct ABO group and Rh type. 4. Initiate the blood transfusion within 30 minutes of receipt. 5. Monitor closely for signs of a transfusion reaction.

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

The nurse expects which assessment finding when caring for a client with a decreased hemoglobin level?

Decreased oxygen level.

A client is prescribed an intravenous dose of iron dextran. The nurse ...

Ensures that epinephrine is available

A client with severe anemia is admitted to the hospital. Because of religious beliefs, the client is refusing blood transfusions. The nurse anticipates pharmacologic therapy with which drug to stimulate the production of red blood cells?

Epoetin alfa

A patient with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this patient?

Erythropoietin (Epogen)

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

A client tells the nurse that he would like to donate blood before his abdominal surgery next week. What should be the nurse's first action?

Explain the time frame needed for autologous donation.

A nurse is completing a detailed health history and assessment in the electronic medical record (EMR) for a client with a disorder of the hematopoietic system. Which symptom is the most commonly reported in association with hematologic diseases?

Extreme fatigue

The client's CBC with differential reveals small-shaped hemoglobin molecules. The nurse expects to administer which medication to this client?

Iron

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

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

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following?

Liver

Which term refers to a form of white blood cell involved in immune response?

Lymphocyte

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets?

Myeloid stem cell

The body responds to infection by increasing the production of white blood cells (WBCs). The nurse knows to evaluate the differential count for the level of __________, 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

The nurse began transfusing the first unit of packed red blood cells (PRBCs) fifteen minutes ago. The client begins complaining of shortness of breath, nausea, and is restless. What is the nurse's priority action?

Stop the infusion.

A nurse, caring for a patient with human immunodeficiency virus (HIV), reviews the patient's differential WBC count to check the level of which of the following?

T lymphocytes

The physician believes that the patient has a deficiency in the leukocyte responsible for cell-mediated immunity. What should the nurse check the WBC count for?

T lymphocytes

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?

The liver and spleen can resume production of blood cells through extramedullary haematopoiesis.

The nurse is administering a blood transfusion to a patient over 4 hours. After 2 hours, the patient complaints of chills and has a fever of 101°F, an increase from a previous temperature of 99.2°F. What does the nurse recognize is occurring with this patient?

The patient is having a febrile nonhemolytic reaction.

The client is to receive a unit of packed red blood cells. The first intervention of the nurse is to

Verify that the client has signed a written consent form.

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