CHAPTER 40 Care of Patients With Hematologic Problems

Which patient statement indicates that stem cell transplantation that is scheduled to take place in his home is not a viable option? -'We live 5 miles from the hospital.' -'I will have lots of medicine to take.' -'I was a nurse, so I can take care of myself.' -'I don't feel strong enough, but my wife said she would help.'

'I was a nurse, so I can take care of myself.'

The registered nurse teaches a student nurse about the actions to be followed after an infusion of blood products. Which statement made by the student nurse shows ineffective understanding? -'I will safely dispose of the bag after infusion.' -'I will document every detail of the transfusion.' -'I will safely dispose of the tubing after infusion.' -'I will monitor the vital signs of the patient after the transfusion.'

'I will monitor the vital signs of the patient after the transfusion.'

The registered nurse teaches a student nurse about nursing actions to be taken before and during the transfusion therapy of pooled platelets in an older patient. Which statement made by the student nurse shows ineffective understanding? -'I will use a 19-gauge needle.' -'I will use a 2 hour infusion rate.' -'I will use additional platelet filters.' -'I will use a transfusion set with a small filter and shorter tubing.'

'I will use a 2 hour infusion rate.'

The nurse finds that the contents of the blood bag are cloudy and discolored and observes the presence of gas bubbles. What would the nurse infer from these findings? Select all that apply. -The blood bag has old blood. -The blood bag has bacterial growth. -The blood bag has frozen blood products. -The blood bag has packed red blood cells. -The contents of the blood bag are hemolyzed.

-The blood bag has bacterial growth. -The contents of the blood bag are hemolyzed.

A patient is prescribed a 200 mL infusion of packed red blood cells to be administered over 2 hours. What would be the consequence if the blood product is diluted with normal saline and infused at a rate of 3 mL/min? Allergy Clotting Hemolysis Fluid overload

Fluid overload

The nurse is teaching a patient about induction therapy for acute leukemia. Which patient statement indicates a need for additional education? -'I will need to avoid people with a cold or flu.' -'I will probably lose my hair during this therapy.' -'The goal of this therapy is to put me in remission.' -'After this therapy, I will not need to have any more.'

'After this therapy, I will not need to have any more.'

The provider has recommended chemotherapy for a patient diagnosed with chronic lymphocytic leukemia (CLL). What does the nurse tell the patient about this treatment? -'Chemotherapy is used to cure CLL.' -'Chemotherapy may produce remission of CLL.' -'Chemotherapy will slow the progression of CLL.' -'Chemotherapy prevents the development of acute lymphocytic leukemia (ALL).'

'Chemotherapy will slow the progression of CLL.'

The nurse is providing teaching for a patient who follows a lacto-ovo vegetarian diet. Which statement by the nurse is most appropriate regarding a sufficient intake of vitamin B 12? -'Egg yolks contain a high amount of vitamin B 12.' -'You should seriously consider eating meat again.' -'Avoid dairy products as they inhibit the absorption of vitamin B 12.' -'Try to eat fish, especially salmon, twice weekly because it is high in vitamin B 12.'

'Egg yolks contain a high amount of vitamin B 12.'

The nurse is educating a group of young women who have sickle cell disease (SCD). Which comment from a class member requires correction? -'The pneumonia vaccine is protection that I need.' -'Getting an annual 'flu shot' would be dangerous for me.' -'I must take my penicillin pills as prescribed, all the time.' -'Frequent handwashing is an important habit for me to develop.'

'Getting an annual 'flu shot' would be dangerous for me.'

The nurse is educating a patient who is taking an anticoagulant drug. Which patient statement indicates a need for further teaching? -'I should use an electric shaver.' -'I should avoid participating in any contact sports.' -'I should take aspirin whenever I have severe pain.' -'I should apply ice to any sites that may bruise for at least one hour.'

'I should take aspirin whenever I have severe pain.'

The nurse is providing teaching for a female patient diagnosed with hemophilia A. What statement by the patient indicates a need for further teaching? -'I will need to have infusions of factor VIII for the rest of my life.' -'There's a high chance I could pass hemophilia on to my children.' -'I will be able to use steroids to help my body create the clotting factors.' -'If I notice any swelling in my joints, I should contact my health care provider.'

'I will be able to use steroids to help my body create the clotting factors.'

A nurse reports having withheld intravenous opioid pain medication from a young African American patient who has sickle cell disease (SCD). The nurse states that she believes the patient is addicted. What is the nurse manager's most appropriate response? -'Opioids are very addictive; you made the right decision.' -'The patient is most likely experiencing pseudoaddiction.' -'The incidence of opioid addiction in SCD patients is actually rare.' -'We can talk to the health care provider about getting the patient a prescription for a different medication.'

'The incidence of opioid addiction in SCD patients is actually rare.'

The nurse is counseling a 65-year-old patient diagnosed with a myelodysplastic syndrome who has severe pancytopenia and a high number of blast cells. The patient wants to know if this will eventually cause cancer. How does the nurse respond? -'You have a low risk for developing cancer.' -'You have a high risk for developing cancer.' -'You have an intermediate risk for developing cancer.' -'This is curable and does not increase your risk for cancer.'

'You have a high risk for developing cancer.'

The nurse is teaching a patient with newly diagnosed anemia about conserving energy. What should the nurse tell the patient? Select all that apply. -'Provide yourself with four to six small, easy-to-eat meals daily.' -'Perform your care activities in groups to conserve your energy.' -'Stop activity when shortness of breath or palpitations are present.' -'Allow others to perform your care during periods of extreme fatigue.' -'Drink small quantities of protein shakes and nutritional supplements daily.' -'Perform a complete bath daily to reduce your chance of getting an infection.'

-'Provide yourself with four to six small, easy-to-eat meals daily.' -'Stop activity when shortness of breath or palpitations are present.' -'Allow others to perform your care during periods of extreme fatigue.' -'Drink small quantities of protein shakes and nutritional supplements daily.'

A diagnosis of autoimmune thrombocytopenic purpura is made after detection of what finding in the blood? -Antiplatelet antibodies -Elevated platelet counts -Elevated red blood cells -Low hemoglobin and hematocrit

-Antiplatelet antibodies

What interventions does the nurse include when planning care for a patient diagnosed with thrombocytopenia? Select all that apply. -Avoid venipuncture -Floss between teeth daily -Apply ice to areas of trauma -Use the smallest gauge needle possible -Measure abdominal girth three times daily

-Avoid venipuncture -Apply ice to areas of trauma -Use the smallest gauge needle possible

What laboratory reports should be assessed for complications secondary to thrombotic thrombocytopenic purpura? Select all that apply. -AST/ALT -Creatinine -Platelet count -White blood cells -Blood urea nitrogen (BUN)

-Creatinine -Blood urea nitrogen (BUN)

Which signs are neurologic manifestations of acute leukemia? Select all that apply. -Fever -Fatigue -Headache -Hematuria -Ecchymoses

-Fever -Fatigue -Headache

An 82-year-old patient with anemia is requested to receive 2 units of whole blood. Which assessment findings cause the nurse to discontinue the transfusion because it is unsafe for the patient? Select all that apply. -Hypotension -Hypertension -Decreased pallor -Rapid, bounding pulse -Flattened superficial veins -Capillary refill less than 3 seconds

-Hypotension -Hypertension -Rapid, bounding pulse

Which statements are true regarding blood group compatibility? Select all that apply. -Individuals with a positive Rh factor have the Rh antigen. -Individuals with blood type A have A antigens and anti-B antibodies. -Individuals with blood type B have B antigens and anti-A antibodies. -Individuals with blood type O have A and B antigens and no antibodies. -Individuals with blood type AB have A and B antigens and anti-A and B antibodies.

-Individuals with a positive Rh factor have the Rh antigen. -Individuals with blood type A have A antigens and anti-B antibodies. -Individuals with blood type B have B antigens and anti-A antibodies.

What are serious side effects of hydroxuria prescribed for a patient with sickle cell anemia? Select all that apply. -Stroke -Diarrhea -Leukemia -Cardiomyopathy -Bone marrow suppression

-Leukemia -Bone marrow suppression

What findings are consistent with a diagnosis of hemophilia? Select all that apply. -Renal failure -Platelet clumping -Long-term joint problems -Tendency to bruise easily -Excessive bleeding from minor cuts

-Long-term joint problems -Tendency to bruise easily -Excessive bleeding from minor cuts

What findings are consistent with a diagnosis of idiopathic thrombocytopenic purpura (ITP)? Select all that apply. -Low fibrin levels -Low platelet count -Decrease in factor IX -Antiplatelet antibodies -High megakaryocyte count

-Low platelet count -Antiplatelet antibodies -High megakaryocyte count

The nurse is caring for a patient diagnosed with idiopathic thrombocytopenic purpura (ITP). What manifestations of this diagnosis should the patient be assessed for? Select all that apply. Petechiae Ecchymosis Hypotension Abdominal pain Mucosal bleeding

-Petechiae -Ecchymosis -Mucosal bleeding

What is the focus of management of thrombotic thrombocytopenic purpura (TTP)? Select all that apply. -Prevention of infection -Destruction of antibodies -Increase of platelet production -Prevention of platelet clumping -Stopping the autoimmune process

-Prevention of platelet clumping -Stopping the autoimmune process

The nurse is caring for a patient who is in sickle cell crisis. Which nursing action is a priority? -Provide pain medications as needed. -Apply cool compresses to the patient's forehead. -Increase food sources of iron in the patient's diet. -Encourage the patient's use of two methods of birth control.

-Provide pain medications as needed.

A patient diagnosed with thrombotic thrombocytopenic purpura should be assessed for which complications? Select all that apply. -Septicemia -Renal failure -Myocardial infarction -Right-sided heart failure -Cerebrovascular accident

-Renal failure -Myocardial infarction -Cerebrovascular accident

The nurse is caring for a patient with multiple sclerosis who presents with a petechial rash on the upper chest and neck. Laboratory results show low platelets, hemoglobin, and hematocrit, as well as high megakaryocytes in the bone marrow. What drugs are most likely to be prescribed for this patient? Select all that apply. Argatroban (Acova) Rituximab (Rituxan) Lepirudin (Refludan) Azathioprine (Imuran) Carfilzomib (Kyprolis) Bortezomib (Velcade)

-Rituximab (Rituxan) -Azathioprine (Imuran)

A patient is prescribed anti Rh-immunoglobulin (RHoGAM) immediately after the delivery of her baby. What could have been the assessment? -The patient is Rh-positive and the baby is Rh-positive. -The patient is Rh-positive and the baby is Rh-negative. -The patient is Rh-negative and the baby is Rh-positive. -The patient is Rh-negative and the baby is Rh-negative.

-The patient is Rh-negative and the baby is Rh-positive.

What percentage of patients diagnosed with hemophilia account for the form of hemophilia called 'Christmas disease'? 20% 30% 50% 80%

20%

A nurse is counseling a patient who wishes to donate blood for autologous use during surgery. The nurse advises the patient that the blood can be stored for how long? 30 days 40 days 50 days 60 days

40 days

A registered nurse (RN) from pediatrics has 'floated' to the medical-surgical unit. Which patient should be assigned to the float nurse? -42-year-old with sickle cell disease receiving a transfusion of packed red blood cells -50-year-old with pancytopenia needing assessment of risk factors for aplastic anemia -55-year-old with folic acid deficiency anemia caused by alcohol abuse who needs counseling -60-year-old with newly diagnosed polycythemia vera who needs teaching about the disease

42-year-old with sickle cell disease receiving a transfusion of packed red blood cells

The nurse assesses the patient with which hematologic problem first? -32-year-old with pernicious anemia who needs a vitamin B 12 injection -81-year-old with thrombocytopenia and an increase in abdominal girth -67-year-old with acute myelocytic leukemia with petechiae on both legs -40-year-old with iron deficiency anemia who needs a Z-track iron injection

81-year-old with thrombocytopenia and an increase in abdominal girth

Which patient is at highest risk for development of idiopathic thrombocytopenic purpura? -A 30-year-old female with Hashimoto's thyroiditis -A 55-year-old female diagnosed with celiac disease -A 45-year-old male diagnosed with Sjögren's syndrome -An 18-year-old male newly diagnosed with diabetes type 1

A 30-year-old female with Hashimoto's thyroiditis

The nurse is caring for four patients. Which patient should the nurse assess first? -A patient diagnosed with hemophilia who is complaining of knee pain -A patient diagnosed with heparin-induced thrombocytopenia (HIT) who received argatroban -A patient diagnosed with idiopathic thrombocytopenic purpura (ITP) with platelet count of 9,000 mm 3 -A patient diagnosed with thrombotic thrombocytopenic purpura (TTP) who has just completed an infusion of fresh frozen plasma

A patient diagnosed with hemophilia who is complaining of knee pain

What patient is an ideal candidate for plasma transfusion therapy? -A patient with an albumin deficiency -A patient with an electrolyte deficiency -A patient with a hemoglobin deficiency -A patient with a prothrombin deficiency

A patient with a prothrombin deficiency

A patient who has chronic myelogenous leukemia (CML) is experiencing intermittent fevers, night sweats, and weight loss. The nurse explains to the patient that these symptoms indicate which phase of this type of leukemia? Blast phase Chronic phase Terminal phase Accelerated phase

Accelerated phase

A patient admitted to the hospital for vasoocclusive crisis with sickle cell disease (SCD) describes moderate to severe pain that is treated with intravenous opioid analgesics. The nurse notes that the provider has ordered routine administration of intravenous hydromorphone rather than a PRN schedule. Which action by the nurse is correct? -Contact the provider to verify that the order is correct -Explore possible drug-seeking behaviors of the patient -Suggest that the patient be evaluated for narcotic addiction -Administer the medication and monitor the patient's response

Administer the medication and monitor the patient's response

A patient with sickle cell anemia is admitted for treatment of a vasoocclusive crisis. In addition to administering oxygen, which intervention will help reduce hypoxia in this patient? -Giving iron supplements -Providing analgesic medication -Encouraging strenuous exercise -Administering intravenous (IV) fluids

Administering intravenous (IV) fluids

Which description most accurately explains induction chemotherapy for the treatment of acute leukemia? -A group of anti-infective agents given to prevent or treat infection -Transfusion of white blood cells to immediately provide infection-fighting capabilities -Aggressive combination of chemotherapy given to achieve a rapid, complete remission of symptoms -A larger-than-usual dose of a chemotherapeutic agent given to more quickly reach a therapeutic drug level

Aggressive combination of chemotherapy given to achieve a rapid, complete remission of symptoms

A patient develops urticaria, itching, bronchospasm, and anaphylaxis 24 hours after a blood transfusion therapy. What could be the possible reason behind this? -Febrile transfusion reactions -Allergic transfusion reactions -Hemolytic transfusion reactions -Acute pain transfusion reactions

Allergic transfusion reactions

A patient reports severe chest pain, back pain, joint pain, hypertension, and redness of the head and neck after receiving a transfusion therapy. The primary health care provider diagnoses it as an acute pain transfusion reaction (APTR). Which drug therapy would be beneficial to the patient? Diuretics Analgesics Antipyretics Antihistamines

Analgesics

Which condition is contraindicated for acute normovolemic hemodilution autologous blood transfusion therapy? Anemia Obesity Liver failure Cardiac failure

Anemia

The nurse is caring for a female patient who has been receiving prophylactic heparin following surgery 10 days ago. The patient has swelling and tenderness in the right leg, and laboratory results show low platelets. What drugs are most likely to be prescribed for this patient? Select all that apply. Argatroban (Acova) Rituximab (Rituxan) Lepirudin (Refludan) Carfilzomib (Kyprolis) Azathioprine (Imuran) Bortezomib (Velcade)

Argatroban (Acova) Lepirudin (Refludan)

A patient who has had stem cell implantation after unsuccessful chemotherapy with an alkylating agent has had a sudden increase in weight. Which physical assessment does the nurse expect in this patient? -Unusual skin lesions -Abnormal breath sounds -Bleeding of the mouth and gums -Ascites with right upper quadrant pain

Ascites with right upper quadrant pain

A patient is being treated for thrombotic thrombocytopenic purpura. What does the nurse anticipate administering to reduce the clumping of the platelets? Select all that apply. Aspirin Heparin Ibuprofen Alprostadil Immunosuppressants

Aspirin Alprostadil

Which nursing intervention is priority when caring for a patient diagnosed with thrombotic thrombocytopenic purpura? -Assessing for headache and confusion -Ensuring the patient is on strict bedrest -Monitoring platelet count every four hours -Using a soft-bristled toothbrush after flossing

Assessing for headache and confusion

Which disorder causes antiplatelet antibody formation even when platelet production is normal? -Hemophilia -Heparin-induced thrombocytopenia -Thrombotic thrombocytopenic purpura -Autoimmune thrombocytopenic purpura

Autoimmune thrombocytopenic purpura

Which type of unrelated transplant donor matches are most difficult to find for African American patients? Organ Blood Bone marrow Blood products

Bone marrow

A 56-year-old patient admitted with a diagnosis of acute myelogenous leukemia (AML) is prescribed intravenous cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. What is the major side effect of this therapy? -Nausea -Stomatitis -Liver toxicity -Bone marrow suppression

Bone marrow suppression

A 56-year-old patient admitted with a diagnosis of acute myelogenous leukemia (AML) is prescribed intravenous cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. An infection develops. What knowledge does the nurse use to determine that the appropriate antibiotic has been prescribed for this patient? -Checking the culture and sensitivity test results -Evaluating the patient's white blood cell (WBC) count level -Evaluating the patient's liver function tests (LFTs) and serum creatinine levels -Recognizing that vancomycin is the drug of choice used to treat all infections in patients with AML

Checking the culture and sensitivity test results

An older adult who is receiving rapid a whole blood transfusion develops hypertension, bounding pulse, distended neck veins, and confusion. What could be the cause of the patient's condition? Circulating overload Febrile transfusion reaction Allergic transfusion reaction Hemolytic transfusion reaction

Circulating overload

A patient develops fever, chills, and shock rapidly after initiation of infusion therapy. The primary health care provider diagnoses the condition as a bacterial infection and advises termination of the therapy. Which assessment finding supports the diagnosis? -Urticaria -Bounding pulse -Redness of the head and neck -Cloudiness of the product in the blood bag

Cloudiness of the product in the blood bag

Which laboratory parameter helps to differentiate between classic hemophilia and Christmas disease? -Platelet count -Prothrombin time -Coagulation factor -Partial prothromboplastin time

Coagulation factor

Which symptom is a sign that the patient is experiencing circulatory overload when receiving a blood transfusion? -Fever -Confusion -Tachycardia -Hypotension

Confusion

The nurse is caring for a patient diagnosed with idiopathic thrombocytopenic purpura (ITP). The patient's platelet count is 38,000/mm 3. What treatment does the nurse anticipate for this patient? Corticosteroids Platelet transfusion Fresh frozen plasma Haemophilus influenza vaccine

Corticosteroids

The nurse is teaching a patient with vitamin B 12 deficiency anemia about dietary intake. Which type of food does the nurse encourage the patient to eat? Grains Dairy products Leafy vegetables Starchy vegetables

Dairy products

Which laboratory value may be normal for an asymptomatic patient with sickle cell disease (SCD) during non-sickle cell crisis times? -Decreased hematocrit -Low reticulocyte count -Elevated hemoglobin A -Low white blood cell (WBC) count

Decreased hematocrit

The registered nurse teaches a student nurse about nursing interventions to be taken before starting transfusion therapy. Which intervention made by the student nurse shows ineffective understanding? -Verifying the medical prescription -Assessing laboratory values of the patient -Obtaining venous access using a central catheter -Diluting the blood products with normal saline before infusing

Diluting the blood products with normal saline before infusing

The nurse is caring for a patient diagnosed with septic shock. The patient develops bleeding from puncture sites after a blood draw. What complications does the nurse suspect? -Hemophilia A -Hemophilia B -Von Willebrand's disease -Disseminated intravascular coagulation

Disseminated intravascular coagulation

Which factor is a possible cause of sickle cell crisis in a patient with sickle cell disease? -Priapism -Dysuria with cloudy urine -Drinking 3000 mL of fluid yesterday -Taking a 50-mile car trip with the family 2 days ago

Dysuria with cloudy urine

A patient with leukemia has a blood pressure of 170/95 mm Hg along with a bounding pulse. The nurse suspects that these findings are most likely related to which hematologic changes in this patient? -Decreased platelets -Immature reticulocytes -Excessive red blood cells -Elevated white blood cells

Elevated white blood cells

The nurse is caring for a patient with polycythemia vera. Which nursing intervention is a priority for this patient? -Flossing between the teeth -Elevating the feet while sitting -Applying shapewear for support -Encouraging the patient to drink 1 L of water daily

Elevating the feet while sitting

Which intervention most effectively protects a patient with thrombocytopenia? -Taking rectal temperatures -Avoiding the use of dentures -Using warm compresses on trauma sites -Encouraging the use of an electric shaver

Encouraging the use of an electric shaver

A patient who has undergone bone marrow transplantation 21 days prior is receiving growth factors. The patient's blood test reveals mixed chimerism with a greater percentage of donor cells than 1 week prior. How does the nurse interpret this result? -Graft failure seems likely. -Engraftment appears to be successful. -The patient should have 100% donor cells. -The patient will probably need an increased dose of growth factor.

Engraftment appears to be successful.

A 50-year-old patient is diagnosed with chronic myelogenous leukemia (CML) and is told that the disease is in the chronic phase. The nurse notices that the patient has been crying and appears anxious. Which action by the nurse is correct? -Suggest that the patient discuss treatment and outcomes with the oncologist -Reassure the patient that treatment in this phase of CML is usually successful -Explore the patient's feelings about the diagnosis and expectations for the future -Ask a family member to be present to help minimize the patient's fear and anxiety

Explore the patient's feelings about the diagnosis and expectations for the future

What risk factors are associated with higher incidence of development of heparin-induced thrombocytopenia in patients? -Male patients -Presurgical thromboprophylaxis -Exposure to unfractionated heparin -Use of heparin longer than 1 month

Exposure to unfractionated heparin

A patient with a history of chronic alcohol abuse is pale and jaundiced. A review of the medical record reveals a low hemoglobin level with macrocytic red blood cells. This information may point to what nutrient deficiency? -Iron -Folic acid -Vitamin A -Vitamin B 12

Folic acid

Which statement indicates a failure of blood clotting as a result of hemophilia? -Formation of the fibrin mesh is inadequate to stop the bleeding. -The production of platelets from the bone marrow is inadequate. -Formation of the platelet plug takes place properly to stop the bleeding. -Constriction of the blood vessels does not take place to stop the bleeding.

Formation of the fibrin mesh is inadequate to stop the bleeding.

The nurse is caring for a patient with sickle cell disease (SCD). Which action is most effective in reducing the potential for sepsis in this patient? -Frequent and thorough handwashing -Administering prophylactic drug therapy -Taking vital signs every 4 hours, day and night -Monitoring laboratory values to look for abnormalities

Frequent and thorough handwashing

An African American patient taking a thiazide diuretic develops hemolytic anemia. The nurse notifies the provider and anticipates an order to test this patient for which type of anemia? Iron deficiency G6PD deficiency Immunohemolytic Sickle cell disease

G6PD deficiency

The nurse is teaching the family and patient newly diagnosed with leukemia about the disease's complications and its treatment. Which teaching point is essential for the nurse to emphasize? -Handwashing -Need for oxygen -Low-residue diet -Frequent rest periods

Handwashing

Which drug has a recombinant antihemophilic factor? Advate Alphanate Monarc-M Helixate FS

Helixate FS

What laboratory reports should be used to assess a patient diagnosed with idiopathic thrombocytopenic purpura who is symptomatic? Select all that apply. Potassium Hematocrit Hemoglobin Magnesium White blood cell count

Hematocrit Hemoglobin

What findings indicate significant blood loss in a patient diagnosed with idiopathic thrombocytopenic purpura? Select all that apply. Hematocrit 25% Hemoglobin 9 g/dL Antiplatelet antibodies Red blood cells 4.8 cells/mcL Platelet count of 65,000/mm 3

Hematocrit 25% Hemoglobin 9 g/dL

A young adult African-American patient receiving intravenous antibiotics for a urinary tract infection reports severe fatigue and pain in all extremities. The nurse assesses a heart rate of 110 beats/min, auscultates an S 3 heart sound, and notes an oxygen saturation of 86%. The patient has no previous history of disease. Which laboratory test will most likely help diagnose sickle cell disease in this patient? -Urinalysis -Blood culture -Complete blood count -Hemoglobin electrophoresis

Hemoglobin electrophoresis

Which changes should be monitored during the first 15 to 30 minutes in a patient who is undergoing blood transfusion? -Hyperkalemia -Fluid overload -Febrile reaction -Hemolytic reaction

Hemolytic reaction

Which clotting disorder may be caused by X-linked inheritance? -Hemophilia A -Hemophilia C -Von Willebrand disease -Heparin-induced thrombocytopenia

Hemophilia A

A patient with leukemia who is undergoing chemotherapy reports increasing fatigue. A family member tells the nurse that the patient has difficulty eating and asks what the patient should eat to help improve energy. What does the nurse recommend for this patient? -Vitamin and mineral supplements -Calorie-dense foods such as ice cream -Red meats and green, leafy vegetables -High-carbohydrate and high-protein foods

High-carbohydrate and high-protein foods

Which antihemophilic drug is obtained from animal serum? Hyate: C Koate-div Hemofil-M Monarc-M

Hyate: C

A patient presents to the emergency department with a new onset of bruising and a petechial rash around the upper chest and arms. The patient's lab demonstrates a platelet count of 51,000 platelets per milliliter. What action by the nurse is most appropriate? -Administer corticosteroids -Plan for bone marrow aspiration -Implement bleeding precautions -Examine the patient's history for recent virus

Implement bleeding precautions

A patient with iron deficiency anemia has a prescription for ferrous sulfate. Which finding by the nurse indicates a positive outcome from the medication? -Pale skin -Increased energy -Hematocrit of 27% -Macrocytic red blood cells reported on the complete blood count

Increased energy

Which assessment finding is consistent with polycythemia vera (PV)? Pallor Bleeding Oxygen toxicity Increased hematocrit

Increased hematocrit

Which laboratory value indicates hemophilia? -Increased platelet count -Decreased platelet count -Increased partial thromboplastin time -Increased time for platelet plug formation

Increased partial thromboplastin time

A patient who has been newly diagnosed with leukemia is admitted to the hospital. Avoiding which potential problem takes priority in the patient's nursing care plan? -Hypoxia -Infection -Hemorrhage -Fluid overload (overhydration)

Infection

In caring for a patient with sickle cell disease, what does the nurse suggest can help with preventing future sickle cell crises? -Pap smear -Colonoscopy -Influenza vaccine -Testicular examination

Influenza vaccine

A nurse is caring for a patient who received a blood transfusion four hours ago and is experiencing shortness of breath. Oxygen saturation is at 89%. What is the nurse's priority intervention? Prepare to administer a diuretic. Administer oxygen via nasal cannula. Administer intravenous diphenhydramine. Inform the physician and prepare for intubation.

Inform the physician and prepare for intubation.

The nurse is infusing platelets to a patient who is scheduled for a hematopoietic stem cell transplant (HSCT). What procedure does the nurse follow? -Infuse the transfusion over a 15- to 30-minute period. -Set up the infusion with the standard transfusion 'Y' tubing. -Allow the platelets to stabilize at the patient's bedside for 30 minutes. -Administer intravenous (IV) corticosteroids before starting the transfusion.

Infuse the transfusion over a 15- to 30-minute period. Rational: The volume of platelets—200 or 300 mL (standard amount)—needs to be infused rapidly over a 15- to 30-minute period.

A patient diagnosed with thrombocytopenia is advised transfusion therapy with platelets from a single donor. Which nursing intervention helps in improving the effectiveness of the therapy? -Using a straight filtered tubing -Ensuring the ABO compatibility -Assessing febrile reactions during infusion therapy -Initiating the therapy immediately after receiving the product.

Initiating the therapy immediately after receiving the product.

A recently admitted patient who is in sickle cell crisis requests 'something for pain.' What does the nurse administer? -Oral ibuprofen -Oral morphine sulfate -Intravenous (IV) hydromorphone -Intramuscular (IM) morphine sulfate

Intravenous (IV) hydromorphone

What medication is used to prevent the destruction of antibody-coated platelets in a patient with idiopathic thrombocytopenic purpura? -Rituximab -Corticosteroids -Platelet transfusion -Intravenous (IV) immunoglobulin

Intravenous (IV) immunoglobulin

A nurse is caring for a patient who has weakness, pallor, fatigue, reduced exercise tolerance, and fissures at the corners of the mouth. The nurse recognizes these symptoms are associated with which condition? -Aplastic anemia -Folic acid deficiency -Iron deficiency anemia -Vitamin B12 deficiency (pernicious) anemia

Iron deficiency anemia

Which clinical manifestations are associated with sickle cell crisis in a patient with sickle cell disease? Select all that apply. Jaundice Pallor Dyspnea Joint pain Low iron levels Bradycardia

Jaundice Pallor Dyspnea Joint pain

What symptom is priority for the nurse to assess for in a patient diagnosed with hemophilia A? -Confusion -Chest pain -Joint swelling -Renal function tests

Joint swelling

What medications may be given for treatment of heparin-induced thrombocytopenia (HIT)? Select all that apply. Lepirudin Factor VIII Bivalirudin Argatroban Azathioprine

Lepirudin Bivalirudin Argatroban

What should be assessed when ruling out intracranial bleeding in a patient diagnosed with idiopathic thrombocytopenic purpura (ITP)? Select all that apply. Petechiae Mental status Platelet count Neurologic function Splenic enlargement

Mental status Neurologic function

A patient will undergo testing of an involved lymph node, lactate dehydrogenase (LDH) levels, and beta2-microglobulin levels based on the World Health Organization (WHO) classification system. Which medical condition does the nurse suspect the patient has? Leukemia Multiple myeloma Hodgkin lymphoma Non-Hodgkin lymphoma (NHL)

Non-Hodgkin lymphoma (NHL)

The nurse is assessing a newly admitted patient with thrombocytopenia. Which factor needs immediate intervention? Nosebleed Reports of pain Increased temperature Decreased urine output

Nosebleed

A patient with leukemia has a platelet count of 7000/mm 3. Which intervention does the nurse implement to prevent injury? -Obtain an order for stool softeners -Take the patient's temperature rectally -Tell the patient to place a warm compress on any area of injury -Administer injections by the intramuscular rather than intravenous route

Obtain an order for stool softeners

Which would be an appropriate task to delegate to unlicensed assistive personnel (UAP) working on a medical-surgical unit? -Obtaining vital signs on a patient receiving a blood transfusion -Assisting a patient with folic acid deficiency in making diet choices -Assessing skin integrity on an anemic patient who fell during ambulation -Administering erythropoietin to a patient with myelodysplastic syndrome

Obtaining vital signs on a patient receiving a blood transfusion

Which assessment findings are consistent with a diagnosis of leukemia? Select all that apply. Pallor Weight gain Brown urine Hypertension Frequent colds Multiple bruises

Pallor Brown urine Frequent colds Multiple bruises

What are the typical clinical manifestations of anemia? Select all that apply. Pallor Fatigue Tachycardia Dyspnea on exertion Elevated temperature Decreased breath sounds

Pallor Fatigue Tachycardia Dyspnea on exertion

Which patient does the nurse identify as at risk for iron deficiency anemia? -Patient with systemic lupus erythematosus -Patient with a seizure disorder who takes valproate -Patient who has undergone a Roux-en-Y procedure for obesity -Patient who has received radiation therapy to the pelvis for ovarian cancer

Patient who has undergone a Roux-en-Y procedure for obesity

A 32-year-old patient recovering from a sickle cell crisis is to be discharged. The nurse says, 'You and all patients with sickle cell disease are at risk for infection because of your decreased spleen function. For this reason, you will most likely be prescribed an antibiotic before discharge.' Which drug does the nurse anticipate the health care provider will request? -Cefaclor -Gentamicin -Penicillin V -Vancomycin

Penicillin V

A patient with leukemia has raised red spots on the legs, but the nurse notes no injury or trauma. How does the nurse identify this finding? -Bullae -Petechiae -Hematuria -Hematoma

Petechiae

Which clotting factor is deficient in patients with hemophilia B? Thrombin Fibrinogen Prothrombin Plasma thromboplastin

Plasma thromboplastin

Where are the level defects that cause coagulation disorders? Select all that apply. Bladder Platelet Kidneys Vascular Clotting factor

Platelet Vascular Clotting factor

What treatment does the nurse anticipate for a patient with a platelet count of 8,000 mm 3? Azathioprine Corticosteroid Platelet transfusion Intravenous (IV) immunoglobulin

Platelet transfusion

The nurse is caring for a patient diagnosed with autoimmune idiopathic thrombocytopenic purpura (ITP). The patient's platelet count is 6,000/mm 3. What treatment should be administered first? Platelets Rituximab Azathioprine Dexamethasone

Platelets

A patient has aplastic anemia. The nurse regularly assesses which diagnostic test results? Select all that apply. Platelets D-dimer assay White blood cells Prothrombin time Hemoglobin/hematocrit B-type natriuretic peptide

Platelets White blood cells Hemoglobin/hematocrit

What vaccinations are recommended for a patient who is scheduled for a splenectomy? Select all that apply. Pertussis Hepatitis Pneumococcal Meningococcal Haemophilus influenza

Pneumococcal Meningococcal Haemophilus influenza

What lab result would the nurse expect to find in a patient diagnosed with hemophilia A? -Clumping of platelets -Prolonged bleeding time -Shortened prothrombin time (PT) -Prolonged activated partial thromboplastin time (aPTT)

Prolonged activated partial thromboplastin time (aPTT)

A patient with leukemia will begin induction therapy with a combination of chemotherapeutic agents. The nurse explains to the patient that induction therapy has which treatment goal? -Remission of all disease manifestations -Complete cure once remission is established -Prevention of infection and other complications -Maintenance of remission during chemotherapy

Remission of all disease manifestations

The complete blood count results for a patient with acute myelogenous leukemia shows a platelet count of 40,000/mm 3. Which activity would the nurse instruct the patient to perform? -Brush teeth vigorously twice daily. -Apply warm soaks to areas of trauma. -Wear soft-soled shoes to cushion the feet. -Report any abdominal distention immediately.

Report any abdominal distention immediately.

A patient with leukemia is admitted to the hospital with a temperature of 97.8° F (36.6° C). Later that evening, the patient's temperature is 99.0° F (37.2° C). Which action by the nurse is correct? -Administer an antipyretic medication -Encourage the patient to increase fluid intake -Report the temperature increase to the provider -Assure the patient that this is a normal temperature

Report the temperature increase to the provider

A patient who had gastrointestinal surgery has an oxygen saturation of 91%, a heart rate of 98 beats/min, and dyspnea with mild exertion, but has clear breath sounds and a normal respiratory effort. The patient's nail beds are pale. Which action does the nurse take next? -Notify the Rapid Response Team -Elevate the head of the bed to 30 degrees -Request an order for a complete blood count -Suggest that the patient increase oral fluid intake

Request an order for a complete blood count

The nurse assesses multiple patients who are receiving transfusions of blood components. Which assessment indicates the need for the nurse's immediate action? -Respiratory rate of 36 in a patient receiving red blood cells (RBCs) -Temperature of 99.1° F (37.3° C) for a patient with a platelet transfusion -Sleepiness in a patient who received diphenhydramine as a premedication -A partial thromboplastin time (PTT) that is 1.2 times normal in a patient who received a transfusion of fresh frozen plasma (FFP)

Respiratory rate of 36 in a patient receiving red blood cells (RBCs)

The nurse is to administer packed red blood cells to a patient. How does the nurse ensure proper patient identification? -Asks the patient's name -Checks the patient's armband -Verifies the patient's room number -Reviews all information with another registered nurse

Reviews all information with another registered nurse

The nurse is providing teaching to a patient scheduled for a splenectomy secondary to idiopathic thrombocytopenic purpura (ITP). What teaching is priority? -Risk for injury -Risk for infection -Risk for impaired tissue integrity -Risk for altered body temperature

Risk for infection

The nurse is teaching a patient with iron deficiency anemia about increasing the intake of dietary iron. The nurse considers the teaching successful when the patient makes which food selection? Roast beef Baked potato Low-fat turkey Citrus products

Roast beef

A patient has been diagnosed with immunohemolytic anemia. What does the nurse anticipate administering to the patient to treat this disorder? Steroids Immunoglobulin G Analgesic medications Packed red blood cells

Steroids

A patient who is receiving a blood transfusion suddenly exclaims to the nurse, 'I don't feel right!' What does the nurse do next? -Stop the transfusion. -Call the Rapid Response Team. -Slow the infusion rate of the transfusion. -Obtain vital signs and continue to monitor.

Stop the transfusion.

What treatment does the nurse expect a patient diagnosed with hemophilia to receive? Rituximab Corticosteroids Synthetic factor VIII Packed red blood cells

Synthetic factor VIII

The nurse is preparing to administer a bone marrow transplant using peripheral blood stem cells (PBSCs) to a patient with leukemia. Which action is necessary for safe administration of this product? -Stopping the infusion if the patient develops red urine -Infusing the bone marrow through a peripheral catheter -Thawing the peripheral blood stem cells prior to infusion -Using blood administration tubing to infuse the stem cells

Thawing the peripheral blood stem cells prior to infusion

Which patient is at increased risk for development of hemophilia? -The son of the woman who is a carrier -The son of the father who has hemophilia -The daughter of a woman who is a carrier -The daughter of a father who has hemophilia

The son of the woman who is a carrier Rationale: Hemophilia is an X-linked recessive trait

What disorder is classified by less than 150,000 platelets per microliter? Leukemia Hemophilia Leukocytopenia Thrombocytopenia

Thrombocytopenia

Which platelet disorder involves the failure of blood to clot after a trauma, in spite of having the ability to form blood clots? -Hemophilia -Heparin-induced thrombocytopenia -Thrombotic thrombocytopenic purpura -Autoimmune thrombocytopenic purpura

Thrombotic thrombocytopenic purpura

A patient who has undergone stem cell transplantation develops graft-versus-host disease (GVHD) and is prescribed cyclosporine. The nurse teaches the patient that this drug is given for which purpose? -To facilitate engraftment of donor cells -To inhibit immune activity of donor T-cells -To prevent host cells from attacking donor cells -To wipe out remaining host cells by myeloablation

To inhibit immune activity of donor T-cells

A 35-year-old female complains of bruises on her legs, arms, and thighs and has heavy menstrual bleeding. While taking the medical history of patient, the nurse finds that the patient had a history of frequent nose and gum bleeding. A complete blood count revealed the platelet count to be 10,000 mm 3. What should be the immediate intervention given to the patient? -Transfusing platelets -Providing low dosage of chemotherapy -Providing intravascular immunoglobulin and intravascular anti-rho -Providing corticosteroid therapy for inhibiting antiplatelet antibodies

Transfusing platelets

What type of transfusion reaction is characterized by rapid onset of dyspnea and hypoxia within 6 hours of transfusion? -Hemolytic transfusion reactions -Acute pain transfusion reaction (APTR) -Transfusion-related acute lung injury (TRALI) -Transfusion-associated graft-versus-host disease (TA-GVHD)

Transfusion-related acute lung injury (TRALI)

A patient who has undergone an allogeneic stem cell transplant is showing regressive chimerism 4 weeks after the graft. The nurse anticipates preparing the patient for which procedure? -Administration of corticosteroids -Transplantation of more stem cells -Conditioning with high-dose chemotherapy -Administration of granulocyte colony-stimulating factor

Transplantation of more stem cells

A patient has a glucose-6-phosphate dehydrogenase (G6PD) deficiency. The nurse teaches the patient to avoid which substance? -Vitamin K -Yellow food dye -Iron-containing vitamins -Trimethoprim-sulfamethoxazole

Trimethoprim-sulfamethoxazole

A patient with thrombocytopenia is being discharged. What information does the nurse incorporate into the teaching plan for this patient? -'Avoid large crowds.' -'Use a soft-bristled toothbrush.' -'Drink at least 2 liters of fluid per day.' -'Elevate your lower extremities when sitting.'

Use a soft-bristled toothbrush.'

The nurse is teaching a patient about pharmacologic and nonpharmacologic pain management during a sickle cell crisis. Which method does the nurse encourage? -Avoid taking opiate analgesics -Request acetaminophen for pain -Use a warm compress on swollen joints -Keep the room cool for maximum comfort

Use a warm compress on swollen joints

Which nursing action during the transfusion therapy of fresh frozen plasma may lead to complications? -Determining ABO compatibility -Using small filters with shorter tubing -Infusing fresh frozen plasma immediately after thawing -Infusing the products as rapidly as tolerated by the patient

Using small filters with shorter tubing

What clotting factor deficiencies cause hemophilia? Select all that apply. I II V VIII IX

VIII IX

What trigger is suspected in the production of autoimmune antibodies in autoimmune thrombocytopenic purpura? Age Virus Alcohol Family history

Virus

While performing an admission assessment on a 55-year-old woman, the nurse notes a serum hemoglobin level that indicates anemia. What does the nurse ask this patient about first? -If she consumes red meat regularly -If she is still having menstrual periods -Whether she takes a vitamin supplement -Whether she has noticed blood in her stools

Whether she has noticed blood in her stools

Which type of transfusion requires more stringent monitoring every 15 minutes throughout the transfusion? -Plasma transfusions -Platelet transfusions -Red blood cell transfusions -White blood cell transfusions

White blood cell transfusions

A patient recently diagnosed with polycythemia vera (PV) has a serum hemoglobin of 20 g/dL, elevated leukocytes and platelets, a purplish flushed appearance, and reports intense itching. A family member asks the nurse if the patient will get better. How does the nurse respond? 'This is a temporary and easily treatable condition.' 'Most people with this disease will die within 2 years.' 'With aggressive management, people can live for over 10 years.' 'Because these symptoms are severe, this episode will probably be fatal.'

With aggressive management, people can live for over 10 years.'

The registered nurse is teaching a novice nurse about transfusion in older patients. Which statement by the novice nurse indicates effective learning? -'Blood that is more than 1 week old should be used.' -'Large bore needles over 19 gauge should be used.' -'2 to 4 hours should be taken to administer one unit of blood.' -'Dextrose should be simultaneously administered while the transfusion is taking place.'

'2 to 4 hours should be taken to administer one unit of blood.'

The nurse is assessing the endurance level of a patient in a long-term care facility. What question does the nurse ask to get this information? -'What is your endurance level?' -'How much exercise do you get?' -'Are your feet or hands cold, even when you are in bed?' -'Do you feel more tired after you get up and go to the bathroom?'

'Do you feel more tired after you get up and go to the bathroom?'

A patient who is scheduled to undergo bone marrow transplant will have high-dose chemotherapy followed by total body irradiation (TBI) just prior to the transplant. Which statement by the patient indicates a need for further teaching about the purpose of this therapy? -'My bone marrow cells will be obliterated.' -'Any remaining leukemic cells will be destroyed.' -'Graft-versus-host disease will control the cancer.' -'My immune system will be replaced with the transplant.'

'Graft-versus-host disease will control the cancer.'

The nurse is providing discharge teaching for a patient who has repeated vasoocclusive episodes caused by sickle cell disease (SCD). Which statement by the patient indicates a need for further teaching? -'I can drink beer in moderation.' -'I should avoid strenuous exercise.' -'I will drink 3 to 4 liters of fluid daily.' -'I'll need an influenza vaccine every year.'

'I can drink beer in moderation.'

What statement by a patient diagnosed with hemophilia indicates a need for further teaching? -'I am using an electric shaver now.' -'I will avoid bending over at the waist.' -'I was taking a stool softener every day.' -'I have been flossing my teeth once a day.'

'I have been flossing my teeth once a day.'

The nurse is teaching a patient who has just been diagnosed with polycythemia vera (PV) about long-term management of this disease. Which statement by the patient indicates a need for further teaching? -'I should drink at least 3 liters of fluid each day.' -'I will exercise slowly only if my provider approves.' -'I may need to have treatments 5 times each week.' -'I should floss my teeth to promote good dental health.'

'I should floss my teeth to promote good dental health.'

A patient diagnosed with idiopathic thrombocytopenic purpura has received teaching about the diagnosis. What statement by the patient indicates a need for further teaching? -'My body is destroying my own platelets.' -'I should not have major issues with clotting.' -'My body makes a normal amount of platelets.' -'I may have developed this after a viral infection.'

'I should not have major issues with clotting.'

The nurse is discussing allogeneic stem cell transplantation with someone who is considering stem cell donation to a sibling with leukemia. What information does the nurse include about this procedure? -'Pheresis collection is painless and has no side effects for the donor.' -'The recipient receives hematopoietic growth factor prior to stem cell harvest.' -'Bone marrow donation is the most commonly used method and can be painful.' -'One to five pheresis procedures are necessary to harvest a sufficient number of cells.'

'One to five pheresis procedures are necessary to harvest a sufficient number of cells.'

A hematology unit is staffed by RNs, LPN/LVNs, and unlicensed assistive personnel (UAP). When the nurse manager is reviewing documentation of staff members, which entry indicates that the staff member needs education about his or her appropriate level of responsibility and patient care? -'Patient reporting increased shortness of breath; oxygen increased to 4 L by nasal cannula. M.N., UAP' -'Ambulated in hallway for 40 feet and denies shortness of breath at rest or with ambulation. T.Y., LPN' -'Abdominal pain relieved by morphine 4 mg IV; patient resting comfortably and denies problems. B.C., RN' -'Vital signs 37.0° C, heart rate 60, respiratory rate 20, blood pressure 110/68, and oximetry 98% on room air. L.D., UAP'

'Patient reporting increased shortness of breath; oxygen increased to 4 L by nasal cannula. M.N., UAP'

The nurse educator is teaching a nursing student about the transfusion of blood products. Which statement made by the student nurse regarding the transfusion of red blood cells indicates effective learning? -'Do not administer any other solution with the blood product.' -'Red blood cell transfusions should be completed within 4 hours of removal from refrigeration.' -'Increasing the speed of administration during the first 15 minutes of the transfusion is necessary.' -'Once the blood product has been released from the blood bank, it should be immediately transfused into the recipient's body within a few seconds.'

'Red blood cell transfusions should be completed within 4 hours of removal from refrigeration.'

A patient with leukemia is being discharged from the hospital. After hearing the nurse's instructions to keep regularly scheduled follow-up provider appointments, the patient says, 'I don't have transportation.' How does the nurse respond? -'You can take the bus.' -'I might be able to take you.' -'A pharmaceutical company might be able to help.' -'The local American Cancer Society may be able to help.'

'The local American Cancer Society may be able to help.'

The nurse is reinforcing information about genetic counseling to a patient with sickle cell disease (SCD) who has a healthy spouse. What information does the nurse include? -'Sickle cell disease will be inherited by your children.' -'The sickle cell trait will be inherited by your children.' -'Your children will have the disease, but your grandchildren will not.' -'Your children will not have the disease, but your grandchildren could.'

'The sickle cell trait will be inherited by your children.'

The nurse is counseling an African American couple who both have hemoglobin S (HbS). What does the nurse tell this couple about the risk of sickle cell disease for their children? -'There is a 50% chance for each child to have the sickle cell trait.' -'Each child will have a 50% chance of being born with sickle cell disease.' -'Since you both carry the sickle cell gene, your children will have sickle cell disease.' -'Since you both have the sickle cell trait, your children will not have sickle cell disease.'

'There is a 50% chance for each child to have the sickle cell trait.'

A patient who is pregnant with a girl has a family history of hemophilia. The patient knows she is a carrier and is worried that her daughter will be a carrier and/or be hemophilic. What can the nurse tell her? -'There's a 30% chance she will be a carrier but is unlikely to be hemophilic.' -'There's a 50% chance she will be a carrier but is unlikely to be hemophilic.' -'There's a 50% chance she will be a carrier, and if so, she is likely to be hemophilic.' -'There's a 30% chance she will be a carrier, and if so, she is likely to be hemophilic.'

'There's a 50% chance she will be a carrier but is unlikely to be hemophilic.'

A patient with multiple myeloma reports bone pain that is unrelieved by analgesics. How does the nurse respond to this patient's problem? -'Ask your doctor to prescribe more medication.' -'I'll turn on some soothing classical music for you.' -'Would you like to try some relaxation techniques?' -'It is too soon for additional medication to be given.'

'Would you like to try some relaxation techniques?'

The nurse is observing a student nurse prepare to administer a packed red blood cell (PRBC) infusion. What action by the student requires immediate intervention? -Use of Y-tubing and a blood filter to administer the infusion -Getting a second nurse to check that the patient's identification information matches the blood bag -Checking on the patient 30 minutes after hanging the transfusion -Redrawing the patient's blood type and cross-match 96 hours after the last draw

-Checking on the patient 30 minutes after hanging the transfusion

A patient diagnosed with septic shock should be assessed for which complication? -Hemophilia A -Disseminated intravascular coagulation -Idiopathic thrombocytopenic purpura (ITP) -Thrombotic thrombocytopenic purpura (TTP)

-Disseminated intravascular coagulation

What are the risk factors for the development of leukemia? Select all that apply. -Down syndrome -Ionizing radiation -Prematurity at birth -Chemical exposure -Bone marrow hypoplasia -Multiple blood transfusions

-Down syndrome -Ionizing radiation -Chemical exposure -Bone marrow hypoplasia

The primary health care provider prescribes a blood transfusion for a patient with anemia. What would be the consequences if the blood transfusion is performed along with the administration of lactated Ringer's solution? Select all that apply. -Allergic reactions -Formation of clots -Destruction of platelets -Destruction of red blood cells -Destruction of white blood cells

-Formation of clots -Destruction of red blood cells

Which types of transfusions do not require the recipient and donor to have the same blood type? Select all that apply. -Platelet transfusions -Plasma transfusions -Red blood cell transfusions -White blood cell transfusions -Washed red blood cell transfusions

-Platelet transfusions -White blood cell transfusions

Which patient does the nurse assign as a roommate for the patient with aplastic anemia? -23-year-old with sickle cell disease who has two draining leg ulcers -30-year-old with leukemia who is receiving induction chemotherapy -34-year-old with idiopathic thrombocytopenia who is taking steroids -28-year-old with glucose-6-phosphate deficiency (G6PD) anemia who is receiving mannitol

28-year-old with glucose-6-phosphate deficiency (G6PD) anemia who is receiving mannitol

A nurse is caring for a group of patients who are all about to receive transfusions. Which order requires correction? -Administer platelets with Ringer's lactate solution. -Transfuse white blood cells (WBCs) over 45 minutes. -Draw blood type and cross-match prior to administering plasma. -Check vital signs q15 min during transfusion of packed red blood cells (PRBCs).

Administer platelets with Ringer's lactate solution.

Which patient is at greatest risk for having a hemolytic transfusion reaction? -78-year-old patient -42-year-old patient with allergies -34-year-old patient with type O blood -58-year-old immune-suppressed patient

34-year-old patient with type O blood

What patient is at a lower risk for febrile transfusion reactions? -A patient receiving a platelet transfusion -A patient who has received multiple blood transfusions -A patient receiving a white blood cell (WBC) transfusion -A patient receiving leukocyte-reduced red blood cell transfusion

A patient receiving leukocyte-reduced red blood cell transfusion

Which patient is least likely to require red blood cell transfusion therapy? -A patient who sustained trauma. -A patient with problems that destroy RBCs. -A patient with a hemoglobin level of 8 g/dL. -A patient with impaired red blood cell maturation.

A patient with a hemoglobin level of 8 g/dL.

A patient who is donating stem cells via apheresis reports tingling in the fingers and toes and muscle cramping. Which action by the nurse is correct? -Slow the rate of the stem cell pheresis collection -Request an order for an anticoagulant medication -Contact the provider to request a calcium supplement -Monitor the patient closely for symptoms of hypotension

Contact the provider to request a calcium supplement

The primary health care provider advises the administration of diphenhydramine and acetaminophen to a patient before initiation of platelet transfusion therapy. What patient history supports the intervention? -Circulating overload -Febrile transfusion reactions -Allergic transfusion reactions -Hemolytic transfusion reactions

Febrile transfusion reactions.

Which intervention may increase the risk of fluid overload during transfusion therapy in older adults? -Administering blood slowly at an infusion rate of 2 to 4 hours per unit -Administering normal saline concurrently in a second intravenous site -Maintaining a gap of 2 full hours after administration of 1 unit before the next unit -Monitoring the patient's kidney function and fluid status before initiating the therapy

Administering normal saline concurrently in a second intravenous site

Which type of leukemia most commonly has its onset during adulthood? -Acute lymphocytic leukemia (ALL) -Acute myelogenous leukemia (AML) -Chronic lymphocytic leukemia (CLL) -Chronic myelogenous leukemia (CML)

Acute myelogenous leukemia (AML)

A patient with leukemia is undergoing hematopoietic stem cell transplantation using stem cells harvested from the patient prior to high-dose chemotherapy. Which type of transplantation procedure is being used for this patient? -Allogeneic -Syngeneic -Autologous -Engraftment

Autologous

While caring for a patient diagnosed with hemophilia, the nurse notices swelling around the ankle and knee. What action should the nurse take first? -Elevate the leg -Contact the health care provider -Wrap the leg with an ace bandage -Assess the patient for recent intake of aspirin

Contact the health care provider

A patient diagnosed with acute liver failure should be assessed for what coagulation disorder? -Hemophilia -Heparin-induced thrombocytopenia (HIT) -Idiopathic thrombocytopenic purpura (ITP) -Thrombotic thrombocytopenic purpura (TTP)

Hemophilia

What intervention performed during a transfusion reaction may further complicate the condition? -Stopping the transfusion and removing the blood tubing -Providing the access for infusions and flushing with normal saline -Returning the component bag, labels, and all tubing to the laboratory -Flushing the intravenous contents of the tubing with normal saline before removing

Flushing the intravenous contents of the tubing with normal saline before removing

Which blood product may be administered to a patient diagnosed with thrombotic thrombocytopenic purpura? Albumin Platelets Fresh frozen plasma Packed red blood cells

Fresh frozen plasma

What type of transfusion reaction is characterized by disseminating intravascular coagulation? -Febrile transfusion reactions -Bacterial transfusion reactions -Hemolytic transfusion reactions -Acute pain transfusion reactions

Hemolytic transfusion reactions

A patient with a large, painless lymph node has a biopsy that reveals Reed-Sternberg cells. Which form of cancer does this finding indicate? -Multiple myeloma -Hodgkin's lymphoma -Non-Hodgkin's lymphoma -Acute myelogenous leukemia

Hodgkin's lymphoma

A 32-year-old patient is recovering from a sickle cell crisis. His discomfort is controlled with pain medications, and he is to be discharged. What medication does the nurse expect to be prescribed for the patient before discharge? Heparin Warfarin Hydroxyurea Tissue plasminogen activator (t-PA)

Hydroxyurea Rationale: t-PA is used as a 'clot buster' in patients who have had ischemic strokes.

The nurse is assessing a patient who will be undergoing a hematopoietic stem cell transplantation. The medical history of the patient shows past allergic reactions to this type of transfusion therapy. What would be the correct line of treatment? -Infusion of pooled platelets -Infusion of white blood cells -Infusion of packed red blood cells -Infusion of leukocyte-reduced red blood cells

Infusion of leukocyte-reduced red blood cells

Which patient does the nurse consider at risk for folic acid deficiency anemia? -Patient with heart failure -Patient with Crohn's disease -Patient recovering from fracture of the tibia -Patient with a basal skin cancer of the nose

Patient with Crohn's disease

Which organ systems are usually the first to sustain long-term damage as a result of vasoocclusive crises associated with sickle cell disease? Select all that apply. Liver Heart Lungs Spleen Kidneys Central nervous system

Liver Spleen

What clinical manifestation is associated with hemolytic transfusion reactions? -Vomiting -Anorexia -Low back pain -Thrombocytopenia

Low back pain

The patient with which condition is at increased risk for developing cancer later in life? -Sickle cell disease -Pernicious anemia -Myelodysplastic syndrome -Polycythemia secondary to chronic obstructive pulmonary disease

Myelodysplastic syndrome

Which intravenous solution is compatible for administration with blood products? Normal saline Lactated Ringer's Dextrose in water Dextrose solution

Normal saline

The nurse knows that a patient with a B-negative blood type can receive which blood product? O-negative A-negative AB-positive B-positive

O-negative

The nurse is caring for a patient with neutropenia who has a suspected infection. Which intervention does the nurse implement first? -Obtain requested cultures -Place the patient on Bleeding Precautions -Initiate the administration of prescribed antibiotics -Hydrate the patient with 1000 mL of IV normal saline

Obtain requested cultures

The nurse is caring for a patient with sickle cell disease. Which drug in the patient's care plan indicates the need to carefully watch the patient's behavior? Opioids Hydroxyurea Anticoagulants Anti-inflammatory drugs

Opioids

A patient complains of cold intolerance, severe fatigue, and difficulty breathing. While taking the history of the patient, it is revealed that she has been experiencing excessive menstrual bleeding for a few months and has no history of allergic response. A complete blood count shows 5 g/dL of hemoglobin and a platelet count of 50,000 mm 3. Which type of transfusion is needed for the patient in the given scenario? -Packed red blood cells -Washed red blood cells -Platelets from a single donor -Platelets pooled from multiple donors

Packed red blood cells

Which patient's data indicates that the patient is in danger?

Patient A Rationale Patient A blood group A positive forms antibodies against type B blood. Due to the presence of antigen B in the AB positive blood group, agglutination occurs when it interacts with A positive blood. This reaction would have a lethal effect in patient A. Donors with O positive blood group are considered to be universal donors. Because blood type O does not contain antigens, it is compatible with any blood type. So, patient B with blood group B positive would not have a lethal reaction when receiving O positive blood. Likewise, Patient C who is receiving O positive blood would not have lethal reaction. Patient D with blood group B positive can safely receive B positive donor blood.

Which data is least required when initiating a transfusion process? Patient's band name Patient's date of birth Patient's band number Patient's room number

Patient's room number

A patient with neutropenia who is receiving amphotericin B therapy is prescribed white blood cell (WBC) transfusion therapy. Which intervention needs correction? -Placing a long filtered tubing for infusion -Infusing the WBC products at a slow rate -Stricter monitoring of the patient for transfusion reactions -Terminating the infusion of amphotericin B 4 to 6 hours before WBC transfusions

Placing a long filtered tubing for infusion

Which type of transfusion is preferred to replace blood volume and clotting factors? Plasma transfusions Platelet transfusions White blood cell transfusions Red blood cell (RBC) transfusions

Plasma transfusions

A nurse is caring for a patient with a gastrointestinal (GI) bleed and a history of thrombocytopenia. The physician orders a transfusion. The nurse prepares for which type of transfusion? -Plasma -Platelets -White blood cells (WBCs) -Packed red blood cells (PRBCs)

Platelets

A patient who is actively bleeding has a platelet count of 40,000 per microliter of blood. The patient has a history of febrile transfusion reactions. Which blood product would be safe for transfusion in this patient? -Pooled platelets -White blood cells -Platelets from a single donor -Leukocyte-reduced red blood cells

Platelets from a single donor

Which transfusion procedure often causes transfusion-induced reactions like fever and chills? -Plasma transfusion -Single donor platelet transfusion -Pooled donor platelet transfusion -Washed red blood cell transfusion

Pooled donor platelet transfusion

Which nursing intervention is effective in helping promote peripheral perfusion in a patient who has sickle cell disease? -Remove constrictive clothing -Elevate the head of the bed at least 30 degrees -Place pillows under the knees to elevate the legs -Keep the room temperature at or just below 72° F

Remove constrictive clothing

What is the priority for the nurse in caring for a patient with sickle cell anemia who is in crisis? -Improving nutrition -Restoring tissue perfusion -Correcting decreased cardiac output -Restoring normal hemoglobin and hematocrit

Restoring tissue perfusion

A patient reports anorexia, nausea, and vomiting. The laboratory findings of the patient show decreased levels of platelets and chronic hepatitis. The patient had received transfusion therapy 2 weeks before the manifestations appeared. What could be the possible reason behind the patient's condition? -Hemolytic transfusion reactions -Acute pain transfusion reaction (APTR) -Transfusion-related acute lung injury (TRALI) -Transfusion-associated graft-versus-host disease (TA-GVHD)

Transfusion-associated graft-versus-host disease (TA-GVHD)

What type of transfusion reaction can be prevented by using irradiated blood products? -Febrile transfusion reactions -Bacterial transfusion reactions -Hemolytic transfusion reactions -Transfusion-associated graft-versus-host disease (TA-GVHD)

Transfusion-associated graft-versus-host disease (TA-GVHD)

A patient develops chills, tachycardia, fever, hypotension, and tachypnea after the initiation of blood infusion therapy, due to anti-white blood cell (WBC) antibodies. What intervention before initiation of the therapy could have minimized the risk of this complication? -Using WBC filters -Using WBC reduced blood -Using single donor human leukocyte antigen (HLA) matched platelets -Administration of drugs such as acetaminophen and diphenhydramine

Using WBC reduced blood

A patient's laboratory report shows increased potassium serum levels after receiving whole-blood transfusion therapy. Which nursing intervention might have caused hyperkalemia? -Increasing the infusion rate -Co-administering a drug with blood products -Using an intravenous catheter larger than 19-gauge -Using an intravenous catheter smaller than 22-guage

Using an intravenous catheter smaller than 22-guage

A patient diagnosed with idiopathic thrombocytopenic purpura is scheduled for a splenectomy. What interventions are priority? -Vaccinations two weeks prior to surgery -Antibiotic therapy one week prior to surgery -Platelet counts 7 to 10 days prior to surgery -Hemoglobin and hematocrit levels 5 days prior to surgery

Vaccinations two weeks prior to surgery

What is the priority action performed by the nurse to avoid blood transfusion complications? -Use lactated Ringer's and dextrose in water for infusion. -Administer normal saline solution with the blood products. -Use of appropriate filters to remove the sediment formed in the stored blood. -Verify the patient's name and number, check blood compatibility, and note the expiration date.

Verify the patient's name and number, check blood compatibility, and note the expiration date.

The nurse is mentoring a recent graduate RN about administering blood and blood products. What does the nurse include in the data? -Verify with another RN all of the data on blood products. -Use a 22-gauge needle to obtain venous access when starting the infusion. -Obtain the patient's initial set of vital signs (VS) within the first 10 minutes of the infusion. -Remain with the patient who is receiving the blood for the first 5 minutes of the infusion.

Verify with another RN all of the data on blood products.

A patient has pallor; jaundice; a smooth, beefy-red tongue; has been experiencing difficulty with balance and reports tingling of the hands and feet. The patient's lab work indicates macrocytic anemia. The nurse notifies the provider of these findings and anticipates an order for which medication? -Steroids -Folic acid -Iron dextran -Vitamin B 12

Vitamin B 12