Exam 6 Adult Health

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."

Which client is not a candidate to be a blood donor according to the American Red Cross?

26-year-old female with hemoglobin 11.0 g/dL

Using a penlight and tongue blade, the nurse inspects the client's tonsils for size and appearance. Tonsils are present and touch the uvula. How should the nurse grade these findings?

3

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

An instructor asks students approximately how long platelets last? What would the students correctly identify?

7.5 days

A nurse is discussing the difference between blood and plasma with a client. Which best represents the components of plasma?

90% water, 10% proteins, blood cells, clotting factors, hormones, enzymes

A nurse has participated in organizing a blood donation drive at a local community center. Which client would most likely be disallowed from donating blood?

A client whose blood pressure is 78/49 mm Hg

A client with Hodgkin disease had a bone marrow biopsy yesterday and reports aching at the biopsy site, rated a 5 (on a 1-10 scale). After assessing the biopsy site, which nursing intervention is most appropriate?

Administer acetaminophen 500 mg po, as ordered

A client who has idiopathic thrombocytopenia purpura (ITP) has a critically low platelet count. Which nursing intervention will be included in the care plan for this client?

Administer eltrombopag

Plasma proteins play an essential role in maintaining water balance and blood pressure. Select the laboratory analysis that a nurse should review to check the levels of the most abundant plasma protein.

Albumin

A nurse is assigned to care for a patient with ascites, secondary to cirrhosis. The nurse understands that the fluid accumulation in the peritoneal cavity results from a combination of factors including an alteration in oncotic pressure gradients and increased capillary permeability. Therefore, the nurse monitors the serum level of the plasma protein responsible for maintaining oncotic pressure, which is:

Albumin.

The 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

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

A volunteer wanting to donate blood for the first time wishes to know more about the various blood groups. The nurse educating the volunteer regarding the blood groups should mention which of the following as the determining factor that classifies blood into groups A, B, AB, and O?

Combinations of antigens and antibodies

A client's most recent blood work reveals a low level of albumin. Which is/are of greatest concern to the nurse related to the low albumin levels? Select all that apply.

Decrease in fluid volume Poor liver function

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

Decreased oxygen level.

An 8-year-old client is scheduled to undergo a tonsillectomy for chronic tonsillitis. The symptoms given below are related to tonsil disorders. The nurse caring for this client should know that which of the following symptoms is specifically related to tonsillitis?

Difficulty swallowing

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 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 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 nurse caring for a client with acute liver failure should expect which assessment finding?

Generalized edema

When describing normal red blood cell (RBC) physiology to a client, the nurse should explain that the RBCs consist primarily of which of the following?

Hemoglobin

A client's electronic health record states that the client receives regular transfusions of factor IX. The nurse would be justified in suspecting that this client has what diagnosis?

Hemophilia

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 client is scheduled for surgery to remove an abdominal mass. The nurse knows that which reason hemodilution would be contraindicated as a method to provide blood to the client during the surgery?

History of renal disease

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?

Iron

The nurse is caring for a client who has a unit of whole blood removed every 6 weeks as treatment for polycythemia vera. Which laboratory test will the nurse monitor to determine if the procedure is adversely affecting the client?

Iron

A client reports feeling faint after donating blood. What is the nurse's best action?

Keep client in recumbent position to rest.

Which blood cell type is matched correctly with its function?

Leukocyte: Fights infection

A client has a leukocyte count of 13,000/mm3. How would the nurse document the client's condition?

Leukocytosis

Which type of white blood cell (WBC) is the most numerous?

Neutrophil

Knowledge regarding hematopoiesis is essential in postsurgical client care. Which statement about the variation in the normal number of erythrocytes is true?

People who engage in strenuous activity have an increased number of erythrocytes.

Which is a symptom of severe thrombocytopenia?

Petechiae Clients with severe thrombocytopenia have petechiae, which are pinpoint hemorrhagic lesions, usually more prominent on the trunk or anterior aspects of the lower extremities.

When a blood clot is no longer needed, the fibrinogen and fibrin will be digested by which of the following?

Plasmin

A client is diagnosed with extreme thrombocytosis. The nurse knows this condition is a result of which elevated blood cell count?

Platelets

A client is scheduled for a splenectomy. During discharge education, which teaching point should the nurse prioritize?

Reporting any signs or symptoms of infection promptly

he nurse is preparing teaching for a client with myelodysplastic syndromes (MDS). Which topics will the nurse include in the teaching for this client? Select all that apply.

Risk for bleeding Infection prevention Mehtods to reduce fatigue Need for frequent laboratory monitoring

The nurse learns that a client has a family history of a hematologic condition. Which assessment findings indicate to the nurse that the client needs additional assessment for the condition? Select all that apply

Scattered bruises Report of fatigue Diffuse mild abdominal pain Report of frequent nosebleeds

Which term is used to refer to a primitive cell that is capable of self-replication and differentiation?

Stem cell

Place the following steps in order when determining the type and severity of a transfusion reaction. Use all options.

Stop the transfusion. Assess the client. Notify the health care provider. Notify the blood bank. Send the tubing and container to the blood bank.

The health care provider believes that the client has a deficiency in the leukocyte responsible for cell-mediated immunity. What should the nurse check the WBC count for?

T lymphocytes

A client is visiting the physician and has signs and symptoms consistent with anemia. Why would the nurse ask the client about recent travel to foreign countries.

The agent that causes malaria following the bite of an infected mosquito invades erythrocytes and causes anemia.

A client with a disorder of the erythrocytes asks the nurse to explain what role these cells play. What would the nurse accurately explain to the client?

Transport O2 to and remove CO2 from the tissues

While caring for a client, the nurse notes petechiae on the client's trunk and lower extremities. What precaution will the nurse take when caring for this client?

Use an electric razor when assisting client with shaving.

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

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.

Which cells have the lifespan of approximately 7.5 days, and one-third of their population remains in the spleen (unless needed to fight significant bleeding)?

platelets

The nurse is explaining the wound-healing process to a patient. Which best describes the function of fibrinogen?

plays a key role in forming blood clots

A nurse in the ED is caring for a trauma client following a motor vehicle accident. The client's blood donor card indicates type AB blood. People with type AB blood are:

universal recipients.

A nursing student is reviewing the processes involved in the transformation of T and B lymphocytes. Place the steps in order from first to last that the nurse would identify as the correct sequence.

Stem cells in bone marrow give rise to undifferentiated lymphocytes. Undifferentiated lymphocytes enter the blood. Some lymphocytes enter the thymus gland and become T lymphocytes; other lymphocytes remain in blood and become B lymphocytes. T lymphocytes re-enter blood. B lymphocytes and T lymphocytes tend to settle in lymphatic organs.

A nurse is caring for a client who is undergoing preliminary testing for a hematologic disorder. Which sign or symptom of a hematologic disorder is most common?

Severe fatigue

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?

Stop the infusion.

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 client has a leukocyte count of 3,000/mm3. How would the nurse document the client's condition?

Leukopenia

The nurse is assisting the physician to control the bleeding for a client who has had an insertion of a vascular access. What can the nurse obtain for the physician to use to control the bleeding?

A fibrin sponge

A client has an increased number of eosinophils. Which of the following disorders would the nurse expect the client to have?

Allergy

The nurse identifies the process of red blood cell (RBC) production and determines the kidneys sense a low level of oxygen in circulating blood. Which physiologic response is initiated?

An increase in the production of erythropoietin

A client's health history reveals daily consumption of two to three bottles of wine. The nurse should plan assessments and interventions appropriate to address the client's increased risk for what hematologic disorder?

Anemia

A nurse is educating a client about the role of B lymphocytes. The nurse's description will include which of the following physiologic processes?

Antibody production

G-CSF (filgrastim) is prescribed for a client with bone marrow suppression. What medication administration teaching should the nurse provide to the client?

Assist the client in identifying appropriate subcutaneous injection sites.

A client is experiencing symptoms of myelodysplastic syndrome (MDS). The nurse prepare the client for which type of test to aid in diagnosing this condition?

Bone marrow aspiration and biopsy

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

The nurse is aware that a patient has been diagnosed with thrombocytopenia. Which of the following is the most typical first indicator of the diagnosis that a patient will exhibit?

Petechiae

While hospitalized, a client accidentally injures his finger and begins to bleed. What substance does the nurse recognize as naturally rushing to the site of injury before any other action takes place?

Platelets

Following vasoconstriction, which event in the process of hemostasis will take place?

Platelets will aggregate at the injury site.

The nurse is assisting with preparation for a client about to undergo a Schilling test. Which of the following actions by the nurse is correct?

Prepare to collect urine from the client for 24 to 48 hours.

Which of the following in a client's health history would the nurse recognize as potentially compromising the client's blood cell volume?

Splenectomy

The nurse is caring for a client with hypoxia. What does the nurse understand is true regarding the client's oxygen level and the production of red blood cells?

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