Hematology (Dynamic Quiz Questions)

a nursing is reviewing the lab results of a client who has end stage renal disease and reports fatigue. the clients hemoglobin level is 8. the nurse should expect a prescription for which of the following meds? a. erythropoietin b. erythromycin c. filgrastim d. calcitiol

a erythropoietin stimulates the production of RBCs and is used to treat anemia with chronic renal failure

a nurse is caring for a client who has an upper GI bleed and a hematocrit of 24%. Prior to initiating a transfusion of packed RBCs, which of the following actions should the nurse take? select all that apply a. assess and document the clients vital signs b. restart the IV with a 22 G needle c. verify with another nurse the blood type and Rh of the packed RBCs d. hang a bag of lactated ringers IV solution e. change IV tubing to a set that has a filter

a, c, e

a nurse is providing discharge teaching for a client who had a bone marrow transplant and has thrombocytopenia. which of the following statements indicates that the client understands the precautions he must take at home? a. I'll stick with soft foods for now b. my family will be bringing me fresh flowers today c. I'll use a new disposable razor each day d. I'll blow my nose more often to avoid nose bleeds

a. thrombocytopenia (low platelet count) is common after a bone marrow transplant. to prevent bleeding until the clients platelet count improves, the client should avoid hard foods that can cause mouth trauma

a nurse is teaching a client who has pernicious anemia. the nurse should encourage the client to increase consumption of which of the following foods? a. eggs b. squash c. kale d. tofu

a. encourage foods rich in vitamin B12 such as dairy products, animal protein, poultry, shellfish, and eggs

a nurse is teaching a client who has iron deficiency anemia. the nurse should encourage the client to increase consumption of which of the following foods? a. beef liver b. oranges c. turnips d. whole milk

a. encourage the client to increase consumption of iron rich foods, including meat, fish, and poultry - a 3 oz serving of beef liver contain 4.17 mg of iron

a nurse teaching a client who has iron deficiency anemia. the nurse should encourage the client to increase her consumption of which of the following foods? a. lentils b. avocados c. cabbage d. broccoli

a. the nurse should encourage the client to increase her consumption of iron rich foods, including meat, fish, poultry, and dried beans and peas. a 1 cup serving of lentils contains 3.6 mg of iron

a nurse is assessing a client who has isotonic dehydration. which of the following findings should the nurse expect? a. increased hematocrit level b. bradycardia c. distended neck veins d. decreased urine specific gravity

a. the nurse should expect the client to have an increased hematocrit level due to hemoconcentration caused by reduced plasma fluid volume

a nurse is reviewing a clients repeat lab results 4 hr after administering fresh frozen plasma (FFP). which of the following lab results should the nurse review a. prothrombin time b. WBC count c. platelet count d. hematocrit

a. the nurse should review the clients prothrombin time after the admin of FFP, which is plasma rich in clotting factors. FFP is administered to treat acute clotting disorders. the desired effect is a decrease in the prothrombin time

a nurse is planning care for a client who has acute myelogenous leukemia and a platelet count of 48,000. which of the following interventions should the nurse include? a. avoid IM injections b. assess the client for ecchymosis once per shift c. do not allow the client to have visitors d. encourage daily flossing between teeth

a. this clients platelet count of 48,000 indicates thrombocytopenia; therefore the nurse should avoid invasive procedures such as IM injection which can increase the clients risk of bleeding

a nurse is reviewing the lab findings of a client who has protein-calorie malnutrition. which of the following findings should the nurse expect? a. decreased albumin b. elevated hemoglobin c. elevated lymphocytes d. decreased cortisol

a. decreased albumin a decrease in albumin level can be an indication of long-term protein depletion. other potential conditions that result in decreased albumin levels include burns, wound drainage, and impaired hepatic function

a nurse is caring for a client who has a platelet count of 50,000. after discontinuing the clients peripheral IV site, which of the following actions should the nurse take? a. apply warm compresses b, apply pressure to the catheter removal sit for 5 min c, place the affected arm in a dependent position d. clean the insertion site with alcohol

b a platelet count below 100,000 indicates thrombocytopenia, which puts the client at risk for an increased risk of bleeding. by applying pressure to the site for at least 5 min, the nurse promotes coagulation and prevents additional blood loss

a nurse in a providers office is reviewing the medical records of a group of clients. which of the following clients is at risk for iron deficiency? select all that apply a. a client who is postmenopausal b. a client who is a vegetarian c. a middle adult male client d. a client who is pregnant e. a toddler who is overweight

b, d, e

a nurse is preparing to administer packed RBCs to a client who is anemic. which of the following actions should the nurse take? select all that apply a. insert a 23 G angiocatheter with an IV adapter b. check to determine the packed RBCs are less that 1 week old c. administer the packed RBCs over a 6 hr period d. ask another nurse to check the packed RBCs level against the medical record e. prime the transfusion tubing with 0.9% sodium chloride

b, d, e

a nurse is transfusing a unit of B pos fresh frozen plasma to a client whose blood type is O neg. which of the following actions should the nurse take? a. continue to monitor for manifestations of a transfusion reaction b. remove the unit of plasma immediately and start an IV infusion of normal saline soln c. continue the transfusion and repeat the type and crossmatch d. prepare to administer a dose of diphenhydramine IV

b. a client who receives FFP that is not compatible can experience a hemolytic transfusion reaction. the nurse should stop the transfusion and infuse 0.9% sodium chloride soln with new tubing

a nurse is planning care for a client who has thrombocytopenia. which of the following interventions should the nurse include in the plan of care? a. restrict fluid to 1000 ml per day b. measure the clients abdominal girth daily c. check IV sites every 4 hours for bleeding d. administer an enema as needed for constipation

b. nurse should measure to monitor for manifestations of internal bleeding. a client who has a reduced platelet count is at risk for bleeding due to delayed clotting

a nurse is caring for a client who has acute lymphocytic leukemia and reports a fever, chills, fatigue, and pallor over the past week. when checking the clients lab results, which of the following values should the nurse identify as contributing to the clients fatigue and pallor? a. magnesium 2.0 b. hgb 6.5 c. WBC count 9.6 d. creatinine 0.8

b. the expected reference range of hgb is 14 to 18 for men and 12 to 16 for women. typical manifestations of a low hgb level include fatigue,. headaches, pallor, dizziness, and tachycardia

a nurse is administering a unit of packed RBCs to a client who is postop. the client reports itching and hives 30 min after the infusion begins. which of the following actions should the nurse take first a. maintain IV access with 0.9% sodium chloride b. stop the infusion of blood c. send the blood container and tubing to the blood bank d. obtain a urine sample

b. using the urgent vs non urgent priority setting framework, the nurse should consider urgent needs the priority because they pose more of a threat to the client. the nurse might also need to use Maslow's hierarchy of needs, the ABC priority setting framework, and or nursing knowledge to identify which finding is the most urgent. the nurse should stop the infusion of blood bc the client ahs manifestations of an allergic rxn

a nurse is caring for a client who has a new diagnosis of pernicious anemia. the nurse should expect the clients provider to prescribe which of the following meds for this client a. ferrous sulfate b. epoetin alfa c. vitamin b12 d. folic acid

c.

a nurse is preparing to transfuse a unit of packed RBCs for a client who has anemia. which of the following actions should the nurse take first? a. hang an IV infusion of 0.9% sodium chloride with the blood b. compare the clients ID # with the # on the blood c. witness the informed consent document d. obtain pretransfusion vital signs

c.

a nurse is providing discharge teaching to a client who has aplastic anemia. which of the following statements indicates that the client understands the instructions? a. I need to stay active to prevent blood clots in my legs b. if I have a bad headache, I can take aspirin to get rid of it c. I should eliminate uncooked foods from my diet for now d. I should eat more iron fortified cereal to strengthen my blood

c. the client can help prevent infection by eating thoroughly cooked foods. fresh fruits, veggies, eggs, meat, and fish can harbor microbes that cooking destroys, so the client should avoid raw foods

a nurse is providing teaching to a client who has anemia and a new prescription for epoetin alfa. which of the following pieces of info should the nurse include in the teaching? a. hospitalization is required when administering each treatment b. the mac effect of the med will occur in 6 months c. HTN is a common adverse effect of this med d. blood transfusions are needed with each treatment

c. a common adverse effect of epoetin alfa is HTN because of the rise in production of erythrocytes and other blood cell types. epoetin alfa is a synthetic version of human erythropoietin. epoetin alfa is used to treat anemia associated with kidney disease or med therapy. it increases and maintains the red blood cell levels

a nurse is assessing the hematologic system of an older adult client. the nurse should report which of the following findings to the provider as a possible indication of a hematologic disorder a. pallor b. jaundice c. absence of hair on the legs d. poor nailbed capillary refill

c. a progressive loss of hair is common with aging. however, thinning or absence of hair on the extremities indicates poor arterial circulation to that area. the nurse should look for further indications for arterial insufficiency and report these findings to provider

a nurse is planning care for a client who has pernicious anemia. which of the following interventions should the nurse include in the plan? a. administer ferrous sulfate supplementation b. increase dietary intake of folic acid c. initiate weekly injections of vitamin B12 d. initiate a blood transfusion

c. nurse should initiate weekly injections of vitamin B12 for a client who has pernicious anemia and then decrease the injections to a monthly schedule. pernicious anemia is caused by a lack of intrinsic factor needed to absorb vitamin B12 form the GI tract

a client who has thrombocytopenia asks the nurse why platelets are so important. which of the following responses should the nurse make? a. platelets help the body fight infection b. platelets help break down clots in the body c. platelets plug breaks in blood vessels d. platelets produce the molecules that carry oxygen

c. platelets help maintain hemostasis and coagulation by plugging disruptions in the integrity of blood vessels. when an injury occurs to a blood vessel, platelets collect at the edge of the break and adhere to each other to plug the injured area and limit blood loss

a nurse is assessing a clinet who has pernicious anemia. which of the following findings should the nurse expect? a. thick, white coating on the clinets tongue b. decreases pulse rate c. paresthesia's in the hands and feet d. joint pain in the extremities

c. the nurse should identify that parethesias (tingling sensations) in the hands and feet is an expected finding of pernicious anemia. other manifestations include weight loss and fatugue

a nurse is providing discharge teaching to a client who has sickle cell crisis. which of the following statements indicates that the client understands the instructions? a. I should try to drink at least 2 L of fluid per day b. I can still fly out to visit my siter in colorado for a while c. physical activity is good for me, but I need to avoid overexertion d. I can still go skiing during the cold winter months

c. to help prevent a recurrence of sickle cell crisis, the clients should avoid overexertion from esp strenuous activites

a nurse is caring for a client who is in hypovolemic shock. while waiting for a unit of blood, the nurse should administer which of the following IV solns? a. 0.45% sodium chloride b. dextrose 5% in 0.9% sodium chloride c. dextrose 10% in water d. 0.9% sodium chloride

d solutions of 0.9 percent sodium chloiride, as well are lactated ringers soln are used for fluid volume replacement. sodium chloride is a physiologically isotonic soln that replaces lost volume in the bloodstream and is the only solution to use when infusing blood products

a nurse is caring for a client who has thrombocytopenia and develops epistaxis. which of the following actions should the nurse take? a. have the client gently blow clots from the nose every 5 min b. instruct the client to sit with his head hyperextended c. apply ice compresses to the back of the clients neck d. apply lateral pressure to the clients nose for 10 min

d the nurse should apply direct, lateral pressure to the nose for 10 min to control epistaxis. if after 10 min it continues, the client might require nasal packing or other interventions

a nurse is assessing a client for manifestations of aplastic anemia. which of the following findings should the nurse expect? a. plethoric appearance of facial skin b. glossitis and weight loss c. jaundice with an enlarged liver d. petechiae and eccymosis

d. a client who has aplastic anemia will have manifestations of petechiae and ecchymosis. dyspnea on exertion also can be present. in aplastic anemia, all 3 major blood components (RBC, WBC, and platelets) are reduced or absent, which is known as pancytopenia. manifestations usually develop gradually

a nurse is caring for a client who has pernicious anemia. which of the following factors should the nurse identify with this condition? a. iron deficiency b. hemolytic blood loss c. folic acid deficiency d. vitamin b12 deficiency

d. a client who has pernicious anemia is deficient in vitamin b12 due to a deficiency in an intrinsic factor normally supplied by the gastric mucosa that is essential for the absorption of vitamin b12

a nurse is reviewing lab values for an adult who has sickle cell anemia and a hx of receiving blood transfusions. for which of the following complications should the nurse monitor? a. hypokalemia b. lead poisoning c. hypercalcemia d. iron toxicity

d. a client who has received several blood transfusions is at a risk of hemosiderosis, which is excess storage of iron in the body. excessive iron can come from overuse of supplements or from receiving frequent blood transfusions as in sickle cell anemia

a nurse is admitting a client who is in sickle cell crisis. besides pain management, which of the following interventions should the nurse include in the clients plan of care? a. flexion of the extremities b. therapeutic hypothermia c. upright positioning d. ample hydration

d. a client who is in sickle cell crisis needs ample hydration (either IV, oral, or both) to shorten the duration of painful episodes. the nurse should plan to offer the client water, juice, or a fav beverage that does not contain caffeine

a nurse is preparing an in service presentation about the basics of hematology. which of the following factors provides a stimulus for the production of RBCs? a. venous stasis b. thrombocytopenia c. inflammation d. tissue hypoxia

d. in response to tissue hypoxia, the kidneys release erythropoietin, which stimulates the production of erythrocytes in the bone marrow

a nurse is assessing a clinet who is receiving a unit of whole blood. which of the following findings should the nurse identify as a manifestation of a hemolytic transfusion reaction? a. bradycardia b. paresthesia c. hypertention d. low back pain

d. low back pain is a manifestation of a hemolytic transfusion rxn. other manifestations include headache, CP, tachypnea, tachycardia, and dark urine

a nurse is planning care for a client during sickle cell crisis. which of the following interventions should the nurse include in the clients plan of care? a. maintain the clients knees and hips in a flexed position b. apply cold compresses to painful joints c. withhold opioids until the crisis is resolved d. encourage increased fluid intake

d. the nurse should encourage increased fluid intake to promote hydration because dehydration increases the viscosity of blood, which can aggravate sickling and client discomfort

a nurse observes tachycardia, dyspnea, a cough, and distended neck veins in a client who is receiving a transfusion of packed RBCs. which of the following interventions should the nurse use to prevent these manifestations with the clients next transfusion? a. warm the unit of blood to room temp before administering it b. administer acetaminophen prior to the blood transfusion c. give an antihistamine prior to the transfusion d. use a transfusion pump to regulate and maintain the transfusion at a slower rate

d. these are manifestations of a hypervolemic rxn due to circulatory overload, which likely occurs when the blood transfusion is too rapid for the clients size or status. to prevent this prob with future transfusions, th enurse should use a transfusion pump to regulate the transfusion at a slower rate