Chapter 32: Assessment of Hematologic Function and Treatment Modalities

A client complains of extreme fatigue. Which system should the nurse suspect is most likely affected? A. Neurological B. Hematological C. Integumentary D. Respiratory

B

An older adult client presents to the health care provider's office and reports exhaustion. The nurse, aware of the most common hematologic condition affecting the elderly, knows that which laboratory values should be assessed? A. WBC count B. RBC count C. Thrombocyte count D. Levels of plasma proteins

B A decreased red blood cell count is indicative of anemia, a common condition in older adults that results in fatigue.

The client is to receive a unit of packed red blood cells. What is the nurse's first action? A. Check the label on the unit of blood with another registered nurse. B. Ensure that the intravenous site has a 20-gauge or larger needle. C. Observe for gas bubbles in the unit of packed red blood cells. D. Verify that the client has signed a written consent form.

D All the options are interventions the nurse will do to ensure the blood transfusion is safe. The question asks about the first action of the nurse. The first action would be verifying that the client has signed a written consent form. Then, the nurse would ensure the intravenous site has a 20-gauge or larger needle. The nurse would proceed to obtain the unit of blood, check the blood with another registered nurse, and observe for gas bubbles in the unit of blood.

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? A. Basophils B. Monocytes C. Plasma cells D. T lymphocytes

D T lymphocytes are responsible for cell-mediated immunity, in which they recognize material as "foreign," acting as a surveillance system.

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. What action should the nurse take? A. Administers the unit of blood B. Checks with Blood Bank first and then administers the blood with their permission C. Refuses to administer the blood D. Asks the client if he was ever known as Donald A. Smith

C To ensure a safe transfusion, all components of the identification must be correct. The nurse should refuse to administer the blood and notify the Blood Bank about the discrepancy. The Blook Bank should then take the necessary steps to correct the name on the label on the unit of blood.

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. White blood cell filter B. Hepatitis B immunization C. Red blood cell phenotyping D. Chelation therapy

D Chelation therapy is prescribed to treat iron overload. Hepatitis B immunization helps immunize against hepatitis B. Red blood cell phenotyping helps decreased sensitization. A white blood cell filter protects against cytomegalovirus and some sensitization and febrile reactions.

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. Elevated erythrocyte concentration B. Elevated creatinine C. Critically low arterial oxygen saturation D. Decreased hematocrit

D The added intravenous solutions used in hemodilution dilute the concentration of erythrocytes and lower the hematocrit. Adverse outcomes include tissue ischemia, particularly in the kidneys. These adverse outcomes can be manifested as low arterial oxygen saturation and elevated creatinine levels.

The nurse cares for a client with a coagulation factor deficiency who is actively bleeding. Which blood component replacement does the nurse anticipate administering? A. FFP B. PRBCs C. IV gamma-globulin D. Antithrombin III

A Fresh frozen plasma has all the coagulation factors in it and is the blood component replacement therapy that will be used to replace blood from a client who is actively bleeding with a coagulation factor deficiency.

A thin client is prescribed iron dextran intramuscularly. What is most important action taken by the nurse when administering this medication? A. Employs the Z-track technique B. Uses a 23-gauge needle C. Injects into the deltoid muscle D. Rubs the site vigorously

A When iron medications are given intramuscularly, the nurse uses the Z-track technique to avoid local pain and staining of the skin. The gluteus maximus muscle is used. The nurse avoids rubbing the site vigorously and uses a 189- or 20-gauge needle.

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called A. blast cells. B. megaloblasts. C. mast cells. D. monocytes.

B Megaloblasts are abnormally large erythrocytes. Blast cells are primitive WBCs. Mast cells are cells found in connective tissue involved in defense of the body and coagulation. Monocytes are large WBCs that become macrophages when they leave the circulation and move into body tissues.

Which client is not a candidate for blood donation according to the American Heart Association? A. 86 year old male with blood pressure 110/70 mmHg B. 50 year old female with pulse 95 beats/minute C. 26 year old female with hemoglobin 11.0 g/dL D. 18 year old male weighing 52 kg.

C Clients must meet the following criteria to be eligible as blood donors: body weight at least 50 kg; pulse rate regular between 50 and 100 bpm; systolic BP 90 to 180 mmHg and diastolic 50 to 100 mmHg; hemoglobin level at least 12.5 g/dL for women. There is no upper age limit to donation.

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. Isometric exercise programs are inclusive of all muscle groups and have an aerobic effect to increase the heart rate. B. Isometric exercise decreases the workload of the heart and restores oxygenated blood flow. C. This type of exercise increases arterial circulation as it returns to the heart. D. Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.

D Isometric exercise induce contraction of skeletal muscle so that it compresses the walls of veins and increases the circulation of venous blood as it returns to the heart. Isometric exercises do not have an aerobic effect and should not increase the heart rate; although, it may increase blood pressure. Isometric exercise does not decrease the workload of the heart. Arterial flow moves blood flow away from the heart after being oxygenated.

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following? A. Liver B. Pancreas C. Kidney D. Large intestine

A

The nurse should provide further teaching about post bone-marrow biopsy procedures when the client makes which statement? A. "I'll ask someone to drive me home when I awake from general anesthesia." B. "I should not take aspirin-containing products for pain relief." C. "I may feel some aching in my hip for 1-2 days." D. "I will keep the sterile dressing on until my doctor tells me it's okay to remove it."

A A bone marrow biopsy is usually performed with local anesthesia, not general. Aspirin can increased the risk of bleeding and should be avoided post procedure. The client should expect to feel some aching in the hip area for 1-2 days. A sterile dressing is applied upon completion of the procedure and should remain in place until the healthcare provider tells the client it is safe to remove.

A client in end-stage renal disease is prescribed epoetin alfa and oral iron supplements. Before administering the next dose of epoetin alfa and oral iron supplement, what is the priority action taken by the nurse? A. Assesses the hemoglobin level B. Questions the administration of both medications C. Ensures the client has completed dialysis treatment D. Holds the epoetin alfa if the BUN is elevated

A Erythropoietin (epoetin alfa [Epogen]) with oral iron supplements can raise hematocrit levels in the client with end-stage renal disease. The nurse should check the hemoglobin prior to administration of erythropoietin, because too high a hemoglobin level can put the client at risk for heart failure, myocardial infarction, and cerebrovascular accident. Erythropoietin may be administered during dialysis treatments. The BUN will be elevated in the client with end-stage renal disease.

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? A. Iron chelation therapy B. Oxygen therapy C. Therapeutic phlebotomy D. Anticoagulation therapy

A Iron overload is a complication unique to people who have had long-term PRBC transfusions. One unit of PRBCs contains 250 mg of iron. Patients with chronic transfusion requirements can quickly acquire more iron than they can use, leading to iron overload. Over time, the excess iron deposits in body tissues and can cause organ damage, particularly in the liver, heart, testes, and pancreas. Promptly initiating a program of iron chelation therapy can prevent end-organ damage from iron toxicity.

The nurse is providing health education to an older adult client who has low red blood cell levels. To promote red blood cell production, the nurse should encourage intake of what foods? Select all that apply. A. Leafy green vegetables B. Lean meats C. Nuts and seeds D. Animal fats E. Organic foods

A, B, C A healthy diet that includes lean meats, nuts, seeds and green vegetables can promote red cell production. Animal fats are not known to promote red cell production. Organic foods are not necessarily more likely to promote red cell synthesis.

A nurse cares for several mothers and babies in the postpartum unit. Which mother does the nurse recognize as being most at risk for a febrile nonhemolytic reaction? A. Rh-negative mother; Rh-negative child B. Rh-positive mother; Rh-negative child C. Rh-negative mother; Rh-positive child D. Rh-positive mother; Rh-positive child

C A mother who is Rh negative and gives birth to an Rh positive child is at greatest risk for a febrile nonhemolytic reaction because exposure to an Rh-positive fetus raises antibody levels in the Rh negative mother. An Rh-negative mother can carry an Rh-negative child without being at greatest risk for a febrile nonhemolytic reaction; however, these mothers are often treated prophylactically. An Rh-positive mother may carry either an Rh-positive or Rh-negative child without increased risk.

The nurse is screening donors for blood donation. Which client is an acceptable donor for blood? A. Has a history of viral hepatitis as a teenager 10 years ago B. Received a blood transfusion within 1 year C. Reports having a cold 1 month ago that resolved quickly D. Had a dental extraction 2 days ago for caries in a tooth

C Donors must meet certain requirements to be able to donate blood. A client should be in good health, such as the client who had a cold more than 1 month ago that resolved quickly. 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. The reason for exclusion is that they are at increased risk of transmitting an infectious disease.

A client receiving a blood transfusion reports 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 health care provider? A. Place the client in a recumbent position with legs elevated. B. Remove the intravenous line. C. Ensure there is an oxygen delivery device at the bedside. D. Administer prescribed PRN anti-anxiety agent.

C The client is exhibiting signs of circulatory overload. After stopping the transfusion and notifying the healthcare provider, the nurse should place the client in a more upright position with the legs dependent to decrease workload on the heart. The IV line is kept patent in case emergency medications are needed. Oxygen and morphine may be needed to treat severe dyspnea. Administering an anti-anxiety agent is not a priority action over ensuring oxygen is available.