Chapter 30: Introduction to the Hematopoietic and Lymphatic Systems

An adult client reports that it is taking longer than usual for minor cuts and injuries to clot. Which of the following questions would the nurse most likely ask the client?

"Are you regularly taking aspirin?"

A patient will need a blood transfusion for the replacement of blood loss from the gastrointestinal tract. The patient states, "That stuff isn't safe!" What is the best response from the nurse?

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

The nurse 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?

1500

Which client is not a candidate for blood donation according to the American Heart Association?

26 year old female with hemoglobin 11.0 g/dL

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

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

The nurse is describing the role of plasminogen in the clotting cascade. Where in the body is plasminogen present?

All body fluids

A client's low hemoglobin level has necessitated transfusion of PRBCs. Prior to administration, what action should the nurse perform?

Assess the client's vital signs to establish baselines.

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 physician has arrived on the floor to perform a bone marrow aspiration. The nurse first

Ensures that the client has signed the informed consent form

A client needs increased production of red blood cells. Which of the following drugs would the nurse expect to be prescribed for the client?

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

Which of the following reports from the client during the health history would lead the nurse to suspect that the client has a disorder of the hematopoietic or lymphatic system? Select all that apply.

Experiences prolonged bleeding from an obvious injury. Has unexplained blood loss, as in rectal bleeding, nosebleeds, bleeding gums, or vomiting blood. Feels fatigued with normal activities.

A nurse at a blood donation clinic has completed the collection of blood from a woman. The woman states that she feels "lightheaded" and she appears visibly pale. What is the nurse's most appropriate action?

Help her into a sitting position with her head lowered below her knees.

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

Iron

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

Keep client in recumbent position to rest.

The nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. What position will the nurse place the patient in?

Lateral position with one leg flexed

Through the process of hematopoiesis, stem cells differentiate into either myeloid or lymphoid stem cells. Into what do myeloid stem cells further differentiate? Select all that apply.

Leukocytes Platelets Erythrocytes

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

Leukocytosis

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

Leukopenia

A nurse cares for an older adult client with acute myeloid leukemia (AML). What concept does the nurse understand leads to the increased risk of an older adult acquiring myeloid malignancies such as AML?

Older adults acquire damage to the DNA of stem cells over time.

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

RBC count

A nurse is caring for a client who is undergoing preliminary testing for a hematologic disorder. What sign or symptom most likely suggests a potential hematologic disorder?

Severe fatigue

The nurse's review of a client's most recent blood work reveals a significant increase in the number of band cells. The nurse's subsequent assessment should focus on which of the following?

Signs and symptoms of infection

Which type of lymphocyte is responsible for cellular immunity?

T lymphocyte

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

The need to report any signs or symptoms of infection promptly

A public health nurse is planning community teaching for a group of older adults regarding aging and hematological conditions. What condition will the nurse identify as most common among this population?

anemia

A client is being treated for chronic anemia and has questions about the condition. Which client statement indicates the need for further client education?

"Red blood cells are found primarily in the distal end of my long bones!"

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

Decreased oxygen level.

A 66-year-old man underwent a successful partial gastrectomy for the treatment of stomach cancer 3 years ago. The man had a scheduled follow-up appointment with his primary caregiver and had blood work completed. The results of the man's blood work indicated anemia. The nurse who is contributing to the patient's care should recognize that this patient's anemia may be attributable to what factor?

Decreased vitamin B12 absorption

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

Which cells are white blood cells with immune functions?

lymphocytes

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

Allergy

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

The nurse educating a client with anemia is describing the process of RBC production. When the client's kidneys sense a low level of oxygen in circulating blood, what physiologic response is initiated?

Increased production of erythropoietin

A patient who has long-term packed RBC (PRBC) transfusions has developed symptoms of iron toxicity that affect liver function. What immediate treatment should the nurse anticipate preparing the patient for that can help prevent organ damage?

Iron chelation therapy

An individual has accidentally cut his hand, immediately initiating the process of hemostasis. Following vasoconstriction, what 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.

A client's diagnosis of atrial fibrillation has prompted the primary care provider to prescribe warfarin, an anticoagulant. When assessing the therapeutic response to this medication, what is the nurse's most appropriate action?

Review the client's international normalized ratio (INR).

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

T lymphocytes

When reviewing a client's chart, the nurse notes that the client's tonsils are listed as grade 3. How does the nurse interpret this finding?

The client's tonsils are touching the uvula.

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.

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.

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

Neutrophils

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