AH Chp 32 Prep U

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

1. Start IV 2. Obtain PRBCs from the blood bank. 3. Double check labels w. another RN to ensure correct ABO group + Rh type. 4. Initiate blood transfusion w.in 30 min 5. Monitor closely for signs of reaction

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

The patient is having a febrile nonhemolytic reaction.

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called which of the following? a. megaloblasts b. blast cell c. mast cell d. monocyte

a, megaloblast

A client receiving a unit of packed red blood cells (PRBCs) has been prescribed morphine 1 mg intravenously now for pain. What is the best method for the nurse to administer the morphine? a. Disconnect the blood tubing, flush with normal saline, and administer morphine. b. administer morphone through transufsion line c. add morphine to blood product

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

Which of the following terms refers to a form of white blood cell involved in immune response? a. lymphocyte b. granulocyte c. spherocyte d. thrombocyte

a. lymphocyte

Which cell of haematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? a. myeloid stem cell b. lymphoid stem cell c. monocyte d. neutroohil

a. myeloid stem cell

The nurse is screening donors for blood donation. The client who is an acceptable donor for blood is the client who a. pt diagnosed w. hepatitis at age 18, b. pt who had a blood transfusion 11 mo ago c. pt had a dental extraction 2 days ago d. pt had cold 1 mo ago

a. pt that had cold 1 mo ago Those excluded from donating blood have a history of viral hepatitis, report a blood transfusion within 12 months, and had a dental extraction within 72 hours.

Which client is not a candidate for blood donation according to the American Heart Association? a. 18 yr old, 52 kg b. 26 yr old, hemoglobin 11 g/dl c. 86 yr old, bp 110/70 d. 50 yr old w. pulse 96

b. 26 yr old, hemoglobin 11 g/dl hemoglobin needs to be at least 12.5 g/dL

Which type of lymphocyte is responsible for cellular immunity? a. B cell b. T cell c. plasma cell d. basophil

b. T cell

Which type of leukocyte contains histamine and is an important part of hypersensitivity reactions? a. eosinophil b. basophil c. neutrophil d. plasma cell

b. basophil

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following? a. kidney b. liver c. pancreas d. spleen

b. liver

The nurse should provide further teaching when a preoperative client considering blood donation makes which of the following statements? a. I will donate my blood for future transfusions b. my family will donate blood because its safer

b. my family will donate blood because its safer

A nurse practitioner reviewed the blood work of a male patient suspected of having microcytic anemia. The nurse suspected occult bleeding. Identify the laboratory result that would indicate this initial stage of iron deficiency. a. serum iron: 100g/dL b. serum ferritin: 15 ng/ml c. hemoglobin: 14 g/dL

b. serum ferritin: 15 ng/ml Serum ferritin levels correlate to iron deficiency

A nurse, caring for a patient with human immunodeficiency virus (HIV), reviews the patient's differential WBC count to check the level of which of the following? a. leukocytes b. t lymphocytes c. neutrophils d. plasma cells

b. t lymphocytes

A client verbalizes fear of infection from a blood transfusion. What is the nurse's best response? a. infections from transfusions are extremely rare b. this blood has been screened and therefore there is no risk of infection c. every unit of donated blood is typed and tested for antibodies to infections

c. every unit of donated blood is typed and tested for antibodies to infections

The nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. What position will the nurse place the patient in? a. lithotomy b. supine w. head of bed elevated c. jackknife d. lateral position w. 1 leg flexed

d. lateral position w. 1 leg flexed

The body responds to infection by increasing the production of white blood cells (WBCs). The nurse knows to evaluate the differential count for the level of __________, the first WBCs to respond to an inflammatory event. a. macrophage b. monocyte c. lymphocyte d. neutrophil

d. neutrophil

Which of the following is a symptom of severe thrombocytopenia? a. inflammation of mouth b. inflammation of tongue c. dyspnea d. petechia

d. petechia

Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils? a. rejection of foreign tissue b. destruction of tumor cells c. antibody production d. phagocytosis

d. phagocytosis

The nurse should notify the healthcare provider before administering fresh frozen plasma (FFP) based on which assessment finding? a. sclera is white b. presence of skin tenting c. pt has low vascular volume d. pt has jvd

d. pt has jvd

The nurse obtains a unit of blood for the client, Donald D. Smith. The name on the label on the unit of blood reads Donald A. Smith. All the other identifiers are correct. The nurse a. call blood bank to discuss discrepancy and administer blood when cleared by blood bank b. ask pt if they also go by Donald A. Smith c. administer blood d. refuse to administer blood

d. refuse to administer blood

The nurse is working at a blood donation clinic. What teaching should the nurse provide to the donor immediately after blood donation? a. have pt sit up in chair after donation b. remove bandage after 5 min c. keep arm below level of heart d. remain for observation after eating/drinking

d. remain for observation after eating/drinking

The nurse expects which assessment finding of the oral cavity when the client is diagnosed with pernicious anemia? a. angular cheilosis b. ulcerations of oral cavity c. inflammed gums d. smooth tongue

d. smooth tongue

The nurse began transfusing the first unit of packed red blood cells (PRBCs) fifteen minutes ago. The client begins complaining of shortness of breath, nausea, and is restless. What is the nurse's priority action? a. notify HCP b. administer antidote c. assess pt d. stop infusion

d. stop infusion

A patient will need a blood transfusion for the replacement of blood loss from the gastrointestinal tract. The patient states, "That stuff isn't safe!" What is the best response from the nurse? a. you should determine if the risk of not receiving blood transfusion is worth it b. the blood has been screened and therefore is safe c. the transfusion is needed regardless of risk of infection d. the blood is carefully screened but is not completely risk free

d. the blood is carefully screened but is not completely risk free

The client is to receive a unit of packed red blood cells. The first intervention of the nurse is to a. check label on unit of blood w. another RN b. check unit of blood for bubbles or cloudiness c. ensure IV site has 20 guage or larger needle d. verify that client has written consent form

d. verify that client has written consent form order: verify consent form is signed --> ensure IV site has 20 gauge or larger needle --> obtain unit of blood --> check label w. another RN --> observe for bubbles

A patient with chronic kidney disease is being examined by the nurse practitioner for anemia. The nurse has reviewed the laboratory data for hemoglobin and RBC count. What other test results would the nurse anticipate observing?

decreased level of erythropoietin

A nurse is completing a detailed health history and assessment in the electronic medical record (EMR) on a patient with a disorder of the hematopoietic system. Based on the patient's responses, which of the following symptoms is the most common complaint associated with hematologic diseases?

extreme fatigue

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 complains of extreme fatigue. Which system should the nurse suspect is most likely affected? a. heamtological b. neurological c. cardiovascular d. pulmonary

a. heamtological The most common symptom in hematologic diseases is extreme fatigue.

A nurse is reviewing a patient's morning lab results and notes a left shift in the band cells. Based on this observation, what interpretation can the nurse make from these results? a. pt has leukopenia b. pt may be developing an infection c. pt is anemia d. pt has thrombocytopenia

b. pt may be developing an infection

The nurse begins a routine blood transfusion of packed red blood cells (PRBCs) at 1100. To ensure client safety, the unit of blood should be completely transfused by what time? a. 1600 b. 1530 c. 1500 d. 1200

c. 1500

A patient with a history of congestive heart failure has an order to receive one unit of packed red blood cells (RBCs). If the nurse hangs the blood at 12:00 pm, by what time must the infusion be completed? a. 1 b. 2 c. 4 d. 6

c. 4 pt w. CHF needs slowest transfusion possible which is 4 hr

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

c. albumin

The physician performs a bone marrow biopsy from the posterior iliac crest on a patient with pancytopenia. What intervention should the nurse perform following the procedure? a. apply pressure over site for 5-7 min b. administer topical analgesic c. cover site w. sterile dressing d. pack site w. sterile guaze

a. apply pressure over site for 5-7 min apply pressure --> cover site w. sterile dressing

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? a. chelation therapy b. hep b immunization c. RBC phenotyping d. WBC filter

a. chelation therapy

The nurse should provide further teaching about post bone-marrow biopsy procedures when the client makes which of the following statements? a. "I will keep the sterile dressing on until my doctor tells me it's okay to remove it." b. "I'll ask someone to drive me home when I awake from general anesthesia." c. "I wont take aspirn after the procedure." d. "I should expect to feel some pain 1-2 days after."

b. "I'll ask someone to drive me home when I awake from general anesthesia." bone marrow biopsy is usually performed with local anesthesia, not general.

During a blood transfusion with packed red blood cells (RBCs), a patient begins to complain of chills, low back pain, and nausea. What priority action should the nurse take? a. Discontinue the infusion immediately and notify the physician b. Discontinue the infusion immediately and maintain the IV line with normal saline solution using new IV tubing c. slow transfusion and cont. to monitor d. notify provider

b. Discontinue the infusion immediately and maintain the IV line with normal saline solution using new IV tubing

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

Assesses the hemoglobin level

The nurse is instructing the client with polycythemia vera how to perform isometric exercises such as contracting and relaxing the quadriceps and gluteal muscle during periods of inactivity. What does the nurse understand is the rationale for this type of exercise? a. have aerobic effect and increase HR b. decrease workload of heart c. induce contraction of skeletal muscle which increases circulation of venous blood return

Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.

When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply. Dietary intake Medication use Ethnicity Herbal supplements Hair color

Dietary intake Medication use Ethnicity Herbal supplements

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

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

T lymphocyte

A client is prescribed an intravenous dose of iron dextran. The nurse a. Checks the client's hemoglobin level the following day b. Ensures that epinephrine is available c. be aware that iron prep will produce false pos lab result d. one dose will reverse iron deficiency anemia

b. Ensures that epinephrine is available

When administering a blood transfusion to a client with multiple traumatic injuries, the nurse monitors closely for evidence of a transfusion reaction. Shortly after the transfusion begins, the client complains of chest pain, nausea, and itching. When urticaria, tachycardia, and hypotension develop, the nurse stops the transfusion and notifies the physician. The nurse suspects which type of hypersensitivity reaction? a. type I (hypersensitivity, anaphylaxis) b. Type II (cytolytic, cytotoxic) hypersensitivity reaction c. Type III (immune complex) hypersensitivity reaction d. type IV

b. Type II (cytolytic, cytotoxic) A type I hypersensitivity reaction occurs in anaphylaxis, atopic diseases, and skin reactions. A type III hypersensitivity reaction occurs in Arthus reaction, serum sickness, systemic lupus erythematosus, and acute glomerulonephritis. A type IV hypersensitivity reaction occurs in tuberculosis, contact dermatitis, and transplant rejection. Reference:

A patient with Hodgkin's disease had a bone marrow biopsy yesterday and is complaining of aching, rated at a 5 (on a 1-10 scale), at the biopsy site. After assessing the biopsy site, which of the following nursing interventions is most appropriate? a. notify HCP b. administer ordered aspirin 325 mg po c. administer order paracetamol 500 mg d. reposition pt into high fowlers and reassess for pain

c. Administer the ordered paracetamol 500 mg po Aspirin-containing analgesic agents should be avoided in the immediate post-procedure period because they can aggravate or potentiate bleeding.

A patient comes into the emergency room with complaints of 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 patient states, "I had a partial gastrostomy 2 years ago." Based on this information, the nurse attributes these symptoms to which of the following problems? a. folic acid deficiency b. vit c deficiency c. b12 deficiency d. retinol deficiency

c. b12 deficiency

The nurse recognizes the most common cause of iron deficiency anemia in an adult is which of the following? a. lack of dietary iron b. malabsorption c. bleeding

c. bleeding

The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly? a. decreased RR b. decreased temp c. pain in calf d. crackles in lungs

d. crackles in lungs

The nurse is caring for a client who had undergone hemodilution during surgery. Immediately after surgery, the nurse expects to see which lab result? a. increased erythrocyte count b. elevated creatinine level c. low arterial oxygen saturation d. decreased hematocrit

d. decreased hematocrit adverse effects: elevated creatinin + low arterial O2 sat

The nurse expects which assessment finding when caring for a client with a decreased hemoglobin level? a. blood is bright red b. elevated temp c. increased bruising d. decreased oxygen level

d. decreased oxygen level

A client receiving a blood transfusion complains of shortness of breath, appears anxious, and has a pulse of 125 beats/minute. What is the best action for the nurse to take after stopping the transfusion and awaiting further instruction from the healthcare provider? a. lay client down + elevate legs b. remove IV line c. administer antianxiety med d. ensure O2 delivery system is at bedside

d. ensure O2 delivery system is at bedside stop transfusion --> notify HCP --> place pt in upright position w. legs dependent (decreases workload of heart)