Chapter 32 - PrepU

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."

A nurse cares for a client with megaloblastic anemia who had a total gastrectomy three years ago. What statement will the nurse include in the client's teaching regarding the condition?

"The condition is likely caused by a vitamin B12 deficiency."

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

The nurse is obtaining the health history of a client suspected of having a hematological condition. The nurse notes the client has a history of alcohol abuse. Which clinical presentation is related to alcohol consumption?

Anemia

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? a. administer acetaminiophen 500 mg po, as ordered b. administer aspirin (ASA) 325 mg po, as ordered c. notify the physician d., reposition the client to a high fowler position and continue to monitor the pain

Aspirin containing analgesic agents should be avoided post-procedure because they can aggravate or potentiate bleeding

Which type of leukocyte contains histamine and is an important part of hypersensitivity reactions?

Basophils

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. contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart b. isometric exercise programs are inclusive of all muscle groups and have an aerobic effect to increase the heart rate c. this type of exercise increases arterial circulation as it returns to the heart d. isometric exercise decreases the workload of the heart and restores oxygenated blood flow

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

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 client with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this client?

Erythropoietin

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 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

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following?

Liver

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.

The client is planned to have a splenectomy. The nurse should prepare which medication to administer to this client?

Pneumococcal vaccine

The nurse is working at a blood donation clinic. What teaching should the nurse provide to the donor immediately after blood donation?

Remain for observation after eating and drinking.

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?

Rh-negative mother; Rh-positive child

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. 1500 b. 1530 c. 1600 d. 1115

Should not exceed four hours because it risks bacterial proliferation

A nurse, caring for a client with human immunodeficiency virus (HIV), reviews the client's differential WBC count. What type of WBC will the nurse check the level of?

T lymphocytes

A nurse is caring for a client with a diagnosis of lymphocytopenia. Which assessment finding will the nurse consider most concerning when caring for this client?

Temperature of 37.7 degrees Celsius

The nurse is administering a blood transfusion to a client over 4 hours. After 2 hours, the client reports 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 client?

The client is having a febrile nonhemolytic reaction.

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 stimulate erythropoietin, stimulating the marrow to produce more red blood cells.

The client is to receive a unit of packed red blood cells. What is the nurse's first action?

Verify that the client has signed a written consent form.

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

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. FFP

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. ensure there is an oxygen delivery device at the bedside b. remove the intravenous line c. adminster prescribed PRN anti-anxiety agent d. place the client in a recumbent position with legs elevated

a. ensure there is an oxygen delivery device at the bedside

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? a) Essential thrombocythemia b) Extreme leukocytosis c) Sickle cell anemia d) Renal transplantation

a. essential thrombocythemia platelet pheresis is used to remove platelets from the blood in patients with extreme thrombocytosis or essential thrombocythemia or in a single-donor platelet transfusion

A client wants to donate blood before his or her abdominal surgery next week. What should be the nurse's first action? a. explain the time frame needed for autologous donation b. remind the client to take supplemental iron before donation c. provide the client with a list of the nearest donation centers d. tel the client that 2 units of blood will be needed.

a. explain the time frame needed for autologous donation preoperative autologous donations are ideally collected 4-6 weeks before surgery

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? a.iron b. calcium c. hemoglobin d. potassium

a. iron

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. lateral position with one leg flexed b. jackknife position c. lithotomy position d. supine with head of the bed elevated at 30 degrees

a. lateral position with one leg flexed bone marrow aspiration procedure requires that the superior iliac crest be used because there are no vital organs or vessels near by. either lateral position with one leg flexed or in prone position

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

a. myeloid stem cell

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

a. petechiae

Which statement best describes the function of fibrinogen? a. plays a key role in forming blood clots b. functions primarily as an immunological agent c. helps prevent or modify some types of infectious diseases d. helps maintain osmotic pressure

a. plays a key role in forming blood clots

When teaching about the advantages of autologous blood transfusion to a client, the nurse should include which information? Select all that apply. a. It resolves anemia for clients with a hemoglobin less than 11g/dL. b. The primary advantage is prevention of viral infections. c. If not needed immediately, the blood can be frozen for future use. d. It is safer for clients with a history of transfusion reactions. e. Blood can be transfused to family members and close relatives.

b, d, c

The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly? a. pain and tenderness in the calf area b. crackles auscultated bilaterally c. oral temperature of 97 degrees d. respiratory rate of 10 breaths/minute

b. crackles auscultated bilaterally increasing the flow rate of a blood transfusion too rapidly can result in circulatory overload

A client complains of extreme fatigue. Which system should the nurse suspect is most likely affected? a. respiratory b. hematological c. integumentary d. neurological

b. hematological

Which term refers to a form of white blood cell involved in immune response? a. granulocyte b. lymphocyte c. throbocyte d. spherocyte

b. lymphocyte

The body responds to infection by increasing the production of white blood cells (WBCs). The nurse should evaluate the differential count for what type of WBCs, which are the first WBCs to respond to an inflammatory event? a. Eosinophils b. neutrophils c. basophils d. monocytes

b. neutrophils

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

b. smooth tongue

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

c. 26 Year old female with hemoglobin 1.0g/dl body weight- at least 50kg pulse- 50-100 bpm Bp (90/50) - (180/100) hemoglobin at least 12.5g/dl for women NO AGE LIMIT

Which blood cell type is matched correctly with its function? a. plasma cell: cell-mediated immunity b. Blymphocyte: secretes immunoglobulin c. Leukocute: fights infection d. T lymphocyte: humoral immunity

c. Leukocyte: fights infection

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

c. T lymphocyte

A nursing instructor in a BSN program is preparing for a lecture on disorders of the hematopoietic system. Included in the lecture are conditions caused by reduced levels or absence of blood-clotting proteins. Which of the following is the instructor most likely referring to? a. aplastic anemia b. sickle cell disease c. coagulopathy d. pancytopenia

c. coagulopathy

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. decreased hematocrit d. critically low arterial oxygen saturation

c. decreased hematocrit hematocrit is the percentage of red blood cells in the blood

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? a. increased mean corpuscular volume b. increased reticulocyte count c. decreased level of erythropoietin d. decreasd total iron-binding capacity

c. decreased level of erythropoietin

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. administer the morphine into the closest tubing port to the client for fast delivery b. inject the morphine into a distal port on the blood tubing c. disconnect the blood tubing, flush with normal saline, and administer morphine d/ add the morphine to the blood to be slowly administered

c. disconnect the blood tubing, flush with normal saline, and administer morphine

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called a. monocytes b. blast cells c. megaloblasts d. mast cells

c. megaloblasts

A preoperative client is discussing blood donation with the nurse. Which statement by the client indicates to the nurse the need for further teaching? a. I should expect blood withdrawal to take about 15 minutes b. i could donate my own blood in case i need a transfusion c. my family will donate blood, because its safer d. donated blood is tested for blood type and infections

c. my family will donate blood because its safer

Which is the major function of neutrophils? a. production of immunoglobins b. rejection of foreign tissue c. phagocytosis d. destruction of tumor cells

c. phagocytosis

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? a. call the health care provider b. slow the infusion c. stop the infusion d. assess the clients vital signs

c. stop the infusion

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? a. wear a mask when entering the clients room b. elevate the clients head of the bed c. use an electric razor when assisting the client shaving d. apply supplemental oxygen to maintain the clients oxygenation

c. use an electric razor when assisting the client with shaving

Which term refers to the percentage of blood volume that consists of erythrocytes? a. differentiation b. erythrocyte sedimentation rate (ESR) c. hemoglobin d. hematocrit

d. hematocrit

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? a. splintering of bone fragments b. blood transfusion reaction c. shock d. hemorrhage

d. hemorrhage

A nursing instructor is reviewing the role and function of stem cells in the bone marrow with a group of nursing students. After providing the explanation, the instructor asks the students to use their knowledge of anatomy and physiology to determine an alternate way in which adults with diseases that destroy marrow can resume production of blood cells. Which explanation by the students is correct? a. fat found in yellow bone marrow can be replaced by active marrow when more blood cell production is required b. the remaining stem cells have the ability to continue with the process of self-replication, creating an endless supply c. the three cell types- erythrocytes, leukocytes and platelets- can resume production of stem cells d. the liver and spleen can resume production of blood cells through extramedullary haematopoiesis.

d. the liver and spleen can resume production of blood cells through extramedullary haematopoiesis

When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply. a. hair color b. medicaiton use c. ethnicity d. dietary intake e. herbal supplements

dietary intake use of herbal supplements medications

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.

Place the following steps in order when determining the type and severity of a transfusion reaction. Use all options. 1. send the tubing and container to the blood bank 2. assess the client 3. notify the blood bank 4. stop the transfusion 5. notify the health care provider

stop the infusion assess the client notify the health care provider notify the blood bank send the tubing and container to the blood bank