EAQ pt 2
What statement by a patient diagnosed with hemophilia indicates a need for further teaching?
"I have been flossing my teeth once a day."
The registered nurse teaches a student nurse about the actions to be followed after an infusion of blood products. Which statement made by the student nurse shows ineffective understanding?
"I will monitor the vital signs of the patient after the transfusion."
The registered nurse teaches a student nurse about nursing actions to be taken before and during the transfusion therapy of pooled platelets in an older patient. Which statement made by the student nurse shows ineffective understanding?
"I will use a 2 hour infusion rate."
Which patient does the charge nurse assign to an LPN/LVN?
48-year-old with chronic microcytic anemia associated with alcohol use
The nurse is starting the shift by making rounds. Which patient does the nurse assess first?
59-year-old who has a nosebleed and is receiving heparin to treat a pulmonary embolism
The nurse is caring for a group of hospitalized patients. Which patient is at greatest risk for infection and sepsis?
18-year-old who had an emergency splenectomy
What is the approximate rate of platelet production per day in a patient weighing 165 lbs?
187 billion
The nurse assesses the patient with which hematologic problem first?
81-year-old with thrombocytopenia and an increase in abdominal girth
What percentage of patients diagnosed with hemophilia account for the form of hemophilia called "Christmas disease"?
20%
A patient with anemia is prescribed a transfusion of packed red blood cells (PRBCs) to be administered over 4 hours. What is the approximate volume to be transfused?
200 to 250 mL
The nurse is caring for a patient diagnosed with idiopathic thrombocytopenic purpura (ITP). The patient's platelet count is 38,000/mm 3. What treatment does the nurse anticipate for this patient?
Corticosteroids
The registered nurse teaches a student nurse about nursing interventions to be taken before starting transfusion therapy. Which intervention made by the student nurse shows ineffective understanding?
Diluting the blood products with normal saline before infusing
A patient diagnosed with septic shock should be assessed for which complication?
Disseminated intravascular coagulation
Which organ systems are usually the first to sustain long-term damage as a result of vasoocclusive crises associated with sickle cell disease? Select all that apply.
Liver Spleen
What findings are consistent with a diagnosis of hemophilia? Select all that apply.
Long-term joint problems Tendency to bruise easily Excessive bleeding from minor cuts
What clinical manifestation is associated with hemolytic transfusion reactions?
Low back pain
According to the blood cell differentiation pathways, which cell is the precursor of the macrophage?
Myeloblast
The nurse is caring for a patient with neutropenia who has a suspected infection. Which intervention does the nurse implement first?
Obtain requested cultures
Which test is the patient required to take to calculate the international normalized ratio (INR)?
Prothrombin time (PT) test
A patient has undergone a splenectomy. The patient is at risk for what condition?
Sepsis
The nurse is preparing to administer a bone marrow transplant using peripheral blood stem cells (PBSCs) to a patient with leukemia. Which action is necessary for safe administration of this product?
Thawing the peripheral blood stem cells prior to infusion
The nurse finds that the contents of the blood bag are cloudy and discolored and observes the presence of gas bubbles. What would the nurse infer from these findings? Select all that apply.
The blood bag has bacterial growth. The contents of the blood bag are hemolyzed.
The prothrombin time (PT) of a patient's blood sample is 14 seconds. What does the nurse interpret from this lab result?
The patient is at an increased risk for bleeding.
The nurse is reviewing a patient's laboratory reports that reveal a decreased platelet aggregation. Which condition might this indicate?
Von Willebrand's disease
A patient diagnosed with idiopathic thrombocytopenic purpura has received teaching about the diagnosis. What statement by the patient indicates a need for further teaching?
"I should not have major issues with clotting."
The nurse is discussing allogeneic stem cell transplantation with someone who is considering stem cell donation to a sibling with leukemia. What information does the nurse include about this procedure?
"One to five pheresis procedures are necessary to harvest a sufficient number of cells."
Which patient does the nurse assign as a roommate for the patient with aplastic anemia?
28-year-old with glucose-6-phosphate deficiency (G6PD) anemia who is receiving mannitol
Which patient is at greatest risk for having a hemolytic transfusion reaction?
34-year-old patient with type O blood
The nurse is caring for four patients. Which patient should the nurse assess first?
A patient diagnosed with hemophilia who is complaining of knee pain
A patient who has chronic myelogenous leukemia (CML) is experiencing intermittent fevers, night sweats, and weight loss. The nurse explains to the patient that these symptoms indicate which phase of this type of leukemia?
Accelerated phase
Which type of unrelated transplant donor matches are most difficult to find for African American patients?
Bone marrow
A 56-year-old patient admitted with a diagnosis of acute myelogenous leukemia (AML) is prescribed intravenous cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. What is the major side effect of this therapy?
Bone marrow suppression
The nurse is observing a student nurse prepare to administer a packed red blood cell (PRBC) infusion. What action by the student requires immediate intervention?
Checking on the patient 30 minutes after hanging the transfusion
The nurse is teaching the family and patient newly diagnosed with leukemia about the disease's complications and its treatment. Which teaching point is essential for the nurse to emphasize?
Handwashing
What is the physiologic response to hypoxia?
Increase in formation of red blood cells.
Which assessment finding is consistent with polycythemia vera (PV)?
Increased hematocrit
A patient who has been newly diagnosed with leukemia is admitted to the hospital. Avoiding which potential problem takes priority in the patient's nursing care plan?
Infection
In which condition is the mean corpuscular volume decreased?
Iron deficiency anemia
The nurse knows that a patient with a B-negative blood type can receive which blood product?
O-negative
The nurse is caring for a patient with sickle cell disease. Which drug in the patient's care plan indicates the need to carefully watch the patient's behavior?
Opioids
What patient is at a lower risk for febrile transfusion reactions?
A patient receiving leukocyte-reduced red blood cell transfusion
Which patient is least likely to require red blood cell transfusion therapy?
A patient with a hemoglobin level of 8 g/dL.
What patient is an ideal candidate for plasma transfusion therapy?
A patient with a prothrombin deficiency
Which type of leukemia most commonly has its onset during adulthood?
Acute myelogenous leukemia (AML)
Which substances activates platelets and causes clumping? Select all that apply.
Adenosine diphosphate Calcium Collagen
A nurse is caring for a group of patients who are all about to receive transfusions. Which order requires correction?
Administer platelets with Ringer's lactate solution.
A patient admitted to the hospital for vasoocclusive crisis with sickle cell disease (SCD) describes moderate to severe pain that is treated with intravenous opioid analgesics. The nurse notes that the provider has ordered routine administration of intravenous hydromorphone rather than a PRN schedule. Which action by the nurse is correct?
Administer the medication and monitor the patient's response
A patient with sickle cell anemia is admitted for treatment of a vasoocclusive crisis. In addition to administering oxygen, which intervention will help reduce hypoxia in this patient?
Administering intravenous (IV) fluids
Which intervention may increase the risk of fluid overload during transfusion therapy in older adults?
Administering normal saline concurrently in a second intravenous site
Which description most accurately explains induction chemotherapy for the treatment of acute leukemia?
Aggressive combination of chemotherapy given to achieve a rapid, complete remission of symptoms
Which drug is known as a "clot buster"?
Alteplase
A patient reports severe chest pain, back pain, joint pain, hypertension, and redness of the head and neck after receiving a transfusion therapy. The primary health care provider diagnoses it as an acute pain transfusion reaction (APTR). Which drug therapy would be beneficial to the patient?
Analgesics
Which condition is contraindicated for acute normovolemic hemodilution autologous blood transfusion therapy?
Anemia
A patient with rheumatoid arthritis has been using azathioprine for a long time. Which conditions is the patient at risk for developing? Select all that apply.
Anemia Neutropenia Thrombocytopenia
A diagnosis of autoimmune thrombocytopenic purpura is made after detection of what finding in the blood?
Antiplatelet antibodies
A patient has a bone marrow biopsy done. Which nursing intervention is the priority postprocedure?
Applying pressure to the biopsy site
The nurse is caring for a female patient who has been receiving prophylactic heparin following surgery 10 days ago. The patient has swelling and tenderness in the right leg, and laboratory results show low platelets. What drugs are most likely to be prescribed for this patient? Select all that apply.
Argatroban (Acova) Lepirudin (Refludan)
A patient who has had stem cell implantation after unsuccessful chemotherapy with an alkylating agent has had a sudden increase in weight. Which physical assessment does the nurse expect in this patient?
Ascites with right upper quadrant pain
A patient is being treated for thrombotic thrombocytopenic purpura. What does the nurse anticipate administering to reduce the clumping of the platelets? Select all that apply.
Aspirin Alprostadil
Which nursing intervention is priority when caring for a patient diagnosed with thrombotic thrombocytopenic purpura?
Assessing for headache and confusion
Which disorder causes antiplatelet antibody formation even when platelet production is normal?
Autoimmune thrombocytopenic purpura
What interventions does the nurse include when planning care for a patient diagnosed with thrombocytopenia? Select all that apply.
Avoid venipuncture Apply ice to areas of trauma Use the smallest gauge needle possible
Chronologically arrange the events involved in bone marrow aspiration chronologically.
Bone marrow aspiration is performed if the hematological assessment is inappropriate in general blood tests. In this procedure, the test site is first cleaned by disinfectant. A local anesthesia is then injected around the test site. A small skin incision is made, and the needle is inserted through it with a twisting motion. Next, the marrow is aspirated for analysis, and then the needle is rapidly withdrawn, while the tissues are supported at the site. An external pressure is then applied to ensure hemostasis.
A 56-year-old patient admitted with a diagnosis of acute myelogenous leukemia (AML) is prescribed intravenous cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. An infection develops. What knowledge does the nurse use to determine that the appropriate antibiotic has been prescribed for this patient?
Checking the culture and sensitivity test results
An older adult who is receiving rapid a whole blood transfusion develops hypertension, bounding pulse, distended neck veins, and confusion. What could be the cause of the patient's condition?
Circulating overload
The student nurse starts the infusion of packed red blood cells in a patient who is already on intravenous (IV) antibiotic therapy; the infusion goes through the same IV line. What complication would be expected?
Clotting
A patient develops fever, chills, and shock rapidly after initiation of infusion therapy. The primary health care provider diagnoses the condition as a bacterial infection and advises termination of the therapy. Which assessment finding supports the diagnosis?
Cloudiness of the product in the blood bag
Which laboratory parameter helps to differentiate between classic hemophilia and Christmas disease?
Coagulation factor
Which symptom is a sign that the patient is experiencing circulatory overload when receiving a blood transfusion?
Confusion
A patient who is donating stem cells via apheresis reports tingling in the fingers and toes and muscle cramping. Which action by the nurse is correct?
Contact the provider to request a calcium supplement
The nurse is teaching a patient with vitamin B 12 deficiency anemia about dietary intake. Which type of food does the nurse encourage the patient to eat?
Dairy products
A patient has impaired liver function. For which life-threatening complication is this patient at risk?
Decreased clotting ability of the blood
Which laboratory value may be normal for an asymptomatic patient with sickle cell disease (SCD) during non-sickle cell crisis times?
Decreased hematocrit
The nurse is caring for a patient scheduled for a splenectomy. What procedural implication should the nurse share with the patient??
Decreased immune function
The nurse is assessing a patient with anemia for respiratory impairment. What does the nurse incorporate in the assessment?
Determine if the patient sleeps on two to three pillows at night.
What are the purposes of a prothrombin time (PT) test? Select all that apply.
Determines time taken for blood to clot Reflects the level of clotting factors II, V, VII, and X Indicates excess of vitamin K
Which action does the nurse delegate to unlicensed assistive personnel (UAP) who are assisting with the care of a female patient with anemia?
Determining the respiratory rate before and after the patient walks 20 feet
The nurse is caring for a patient diagnosed with septic shock. The patient develops bleeding from puncture sites after a blood draw. What complications does the nurse suspect?
Disseminated intravascular coagulation
What are the risk factors for the development of leukemia? Select all that apply.
Down syndrome Ionizing radiation Chemical exposure Bone marrow hypoplasia
Which factor is a possible cause of sickle cell crisis in a patient with sickle cell disease?
Dysuria with cloudy urine
How many oxygen molecules are transported by two molecules of hemoglobin? Record your answer using a whole number. ___ molecules
Each hemoglobin molecule consists of one iron molecule, which can transport up to four molecules of oxygen. Two hemoglobin molecules can transport up to eight molecules of oxygen.
A patient with leukemia has a blood pressure of 170/95 mm Hg along with a bounding pulse. The nurse suspects that these findings are most likely related to which hematologic changes in this patient?
Elevated white blood cells
Which intervention most effectively protects a patient with thrombocytopenia?
Encouraging the use of an electric shaver
The nurse is caring for a patient with chronic kidney disease. On reviewing the patient's laboratory results, the nurse finds that the red blood cell (RBC) count is greatly reduced. Which drug does the nurse anticipate the health care provider prescribing?
Epoetin alfa
The nurse recalls that the events of the erythrocyte growth pathway occur in what order? Put the steps in the correct order.
Erythrocyte growth pathway results in formation of erythrocytes through a series of events. Committed myeloid stem cell formation from the pluripotent cell initiates the erythrocyte growth pathway. Next, the proerythroblast forms from the committed myeloid stem cell. The basophilic erythroblast then forms from the proerythroblast. The proerythroblast then forms the polychromatic erythroblast. The orthochromatic erythroblast then forms from the polychromatic erythroblast. The orthochromatic erythroblast then forms the reticulocyte, which matures into erythrocytes in the body.
A 50-year-old patient is diagnosed with chronic myelogenous leukemia (CML) and is told that the disease is in the chronic phase. The nurse notices that the patient has been crying and appears anxious. Which action by the nurse is correct?
Explore the patient's feelings about the diagnosis and expectations for the future
What risk factors are associated with higher incidence of development of heparin-induced thrombocytopenia in patients?
Exposure to unfractionated heparin
Which clotting factor is absent in patients with hemophilia B?
Factor IX—plasma thromboplastin component
The primary health care provider advises the administration of diphenhydramine and acetaminophen to a patient before initiation of platelet transfusion therapy. What patient history supports the intervention?
Febrile transfusion reactions
Which signs are neurologic manifestations of acute leukemia? Select all that apply.
Fever Fatigue Headache
The nurse is caring for a patient with a thrombotic stroke in the emergency department. The nurse anticipates the administration of which drug to the patient within the first 6 hours?
Fibrinolytics
Which medication is used to resolve deep vein thrombosis (DVT)?
Fibrinolytics
A patient is prescribed a 200 mL infusion of packed red blood cells to be administered over 2 hours. What would be the consequence if the blood product is diluted with normal saline and infused at a rate of 3 mL/min?
Fluid overload
What intervention performed during a transfusion reaction may further complicate the condition?
Flushing the intravenous contents of the tubing with normal saline before removing
A patient with a history of chronic alcohol abuse is pale and jaundiced. A review of the medical record reveals a low hemoglobin level with macrocytic red blood cells. This information may point to what nutrient deficiency?
Folic acid
Which statement indicates a failure of blood clotting as a result of hemophilia?
Formation of the fibrin mesh is inadequate to stop the bleeding.
The nurse is caring for a patient with sickle cell disease (SCD). Which action is most effective in reducing the potential for sepsis in this patient?
Frequent and thorough handwashing
Which blood product may be administered to a patient diagnosed with thrombotic thrombocytopenic purpura?
Fresh frozen plasma
An African American patient taking a thiazide diuretic develops hemolytic anemia. The nurse notifies the provider and anticipates an order to test this patient for which type of anemia?
G6PD deficiency
The nurse is assessing the nutritional status of a patient with anemia. How does the nurse obtain information about the patient's diet?
Have the patient write down everything he or she has eaten for the past week
Which drug has a recombinant antihemophilic factor?
Helixate FS
What findings indicate significant blood loss in a patient diagnosed with idiopathic thrombocytopenic purpura? Select all that apply.
Hematocrit 25% Hemoglobin 9 g/dL
The student nurse is instructed by the primary health care provider to take a blood sample of the patient with possible hematological impairment. The patient encountered a complication after vein puncture. What could be the expected complication?
Hematoma
After reviewing a patient's hemoglobin electrophoresis reports, the nurse anticipates a diagnosis of sickle cell disease. Which data supports the nurse's suspicion? Select all that apply.
Hemoglobin S levels of 2% Hemoglobin A 2 levels of 1% Hemoglobin A 1 levels of 86%
A patient undergoing transfusion therapy presents with hypotension, tachycardia, and tachypnea after administration of 50 mL of the infusion. What should the nurse infer from these findings?
Hemolytic reaction
A patient diagnosed with acute liver failure should be assessed for what coagulation disorder?
Hemophilia
Which clotting disorder may be caused by X-linked inheritance?
Hemophilia A
A patient with a large, painless lymph node has a biopsy that reveals Reed-Sternberg cells. Which form of cancer does this finding indicate?
Hodgkin's lymphoma
Which antihemophilic drug is obtained from animal serum?
Hyate: C
A 32-year-old patient is recovering from a sickle cell crisis. His discomfort is controlled with pain medications, and he is to be discharged. What medication does the nurse expect to be prescribed for the patient before discharge?
Hydroxyurea
The nurse is transfusing 2 units of packed red blood cells (PRBCs) to a postoperative patient. What post-transfusion electrolyte imbalance should the nurse rule out?
Hyperkalemia
An 82-year-old patient with anemia is requested to receive 2 units of whole blood. Which assessment findings cause the nurse to discontinue the transfusion because it is unsafe for the patient? Select all that apply.
Hypotension Hypertension Rapid, bounding pulse
What does a high reticulocyte count indicate in regards to red blood cells (RBCs)?
Immature RBCs are being released.
A patient presents to the emergency department with a new onset of bruising and a petechial rash around the upper chest and arms. The patient's lab demonstrates a platelet count of 51,000 platelets per milliliter. What action by the nurse is most appropriate?
Implement bleeding precautions
Which laboratory value indicates hemophilia?
Increased partial thromboplastin time
The total iron-binding capacity (TIBC) for a patient is 200 mcg/dL. What is the significance of this result?
Indicates hemorrhage
Which statements are true regarding blood group compatibility? Select all that apply.
Individuals with a positive Rh factor have the Rh antigen. Individuals with blood type A have A antigens and anti-B antibodies. Individuals with blood type B have B antigens and anti-A antibodies.
In caring for a patient with sickle cell disease, what does the nurse suggest can help with preventing future sickle cell crises?
Influenza vaccine
A nurse is caring for a patient who received a blood transfusion four hours ago and is experiencing shortness of breath. Oxygen saturation is at 89%. What is the nurse's priority intervention?
Inform the physician and prepare for intubation.
The nurse is assessing a patient who will be undergoing a hematopoietic stem cell transplantation. The medical history of the patient shows past allergic reactions to this type of transfusion therapy. What would be the correct line of treatment?
Infusion of leukocyte-reduced red blood cells
A patient diagnosed with thrombocytopenia is advised transfusion therapy with platelets from a single donor. Which nursing intervention helps in improving the effectiveness of the therapy?
Initiating the therapy immediately after receiving the product
A recently admitted patient who is in sickle cell crisis requests "something for pain." What does the nurse administer?
Intravenous (IV) hydromorphone
What medication is used to prevent the destruction of antibody-coated platelets in a patient with idiopathic thrombocytopenic purpura?
Intravenous (IV) immunoglobulin
A nurse is caring for a patient who has weakness, pallor, fatigue, reduced exercise tolerance, and fissures at the corners of the mouth. The nurse recognizes these symptoms are associated with which condition?
Iron deficiency anemia
What effect does aspirin have on the blood?
It inhibits the production of thromboxane.
What symptom is priority for the nurse to assess for in a patient diagnosed with hemophilia A?
Joint swelling
What medications may be given for treatment of heparin-induced thrombocytopenia (HIT)? Select all that apply.
Lepirudin Bivalirudin Argatroban
What findings are consistent with a diagnosis of idiopathic thrombocytopenic purpura (ITP)? Select all that apply.
Low platelet count Antiplatelet antibodies High megakaryocyte count
What should be assessed when ruling out intracranial bleeding in a patient diagnosed with idiopathic thrombocytopenic purpura (ITP)? Select all that apply.
Mental status Neurologic function
The patient with which condition is at increased risk for developing cancer later in life?
Myelodysplastic syndrome
A patient will undergo testing of an involved lymph node, lactate dehydrogenase (LDH) levels, and beta2-microglobulin levels based on the World Health Organization (WHO) classification system. Which medical condition does the nurse suspect the patient has?
Non-Hodgkin lymphoma (NHL)
Which intravenous solution is compatible for administration with blood products?
Normal saline
The nurse is assessing a newly admitted patient with thrombocytopenia. Which factor needs immediate intervention?
Nosebleed
A patient with leukemia has a platelet count of 7000/mm 3. Which intervention does the nurse implement to prevent injury?
Obtain an order for stool softeners
What is a possible complication if a filtered, straight, long tubing with a 19-gauge needle is used to transfuse pooled platelets?
Occlusion of the lumen of tubing
A patient complains of cold intolerance, severe fatigue, and difficulty breathing. While taking the history of the patient, it is revealed that she has been experiencing excessive menstrual bleeding for a few months and has no history of allergic response. A complete blood count shows 5 g/dL of hemoglobin and a platelet count of 50,000 mm 3. Which type of transfusion is needed for the patient in the given scenario?
Packed red blood cells
Which assessment findings are consistent with a diagnosis of leukemia? Select all that apply.
Pallor Brown urine Frequent colds Multiple bruises
Which patient's data indicates that the patient is in danger?
Patient A
Which patient does the nurse identify as at risk for iron deficiency anemia?
Patient who has undergone a Roux-en-Y procedure for obesity
Which patient does the nurse consider at risk for folic acid deficiency anemia?
Patient with Crohn's disease
Which data is least required when initiating a transfusion process?
Patient's room number
A 32-year-old patient recovering from a sickle cell crisis is to be discharged. The nurse says, "You and all patients with sickle cell disease are at risk for infection because of your decreased spleen function. For this reason, you will most likely be prescribed an antibiotic before discharge." Which drug does the nurse anticipate the health care provider will request?
Penicillin V
The nurse is caring for a patient diagnosed with idiopathic thrombocytopenic purpura (ITP). What manifestations of this diagnosis should the patient be assessed for? Select all that apply.
Petechiae Ecchymosis Mucosal bleeding
A patient with neutropenia who is receiving amphotericin B therapy is prescribed white blood cell (WBC) transfusion therapy. Which intervention needs correction?
Placing a long filtered tubing for infusion
Which clotting factor is deficient in patients with hemophilia B?
Plasma thromboplastin
Which type of transfusion is preferred to replace blood volume and clotting factors?
Plasma transfusions
Where are the level defects that cause coagulation disorders? Select all that apply.
Platelet Vascular Clotting factor
The nurse is reviewing complete blood count (CBC) data for a 76-year-old patient. Which decreased value causes concern because it is not age-related?
Platelet (thrombocyte) count
What treatment does the nurse anticipate for a patient with a platelet count of 8,000 mm 3?
Platelet transfusion
Which types of transfusions do not require the recipient and donor to have the same blood type? Select all that apply.
Platelet transfusions White blood cell transfusions
A nurse is caring for a patient with a gastrointestinal (GI) bleed and a history of thrombocytopenia. The physician orders a transfusion. The nurse prepares for which type of transfusion?
Platelets
The nurse is caring for a patient diagnosed with autoimmune idiopathic thrombocytopenic purpura (ITP). The patient's platelet count is 6,000/mm 3. What treatment should be administered first?
Platelets
A patient who is actively bleeding has a platelet count of 40,000 per microliter of blood. The patient has a history of febrile transfusion reactions. Which blood product would be safe for transfusion in this patient?
Platelets from a single donor
Which statements about the role of platelets in the clotting of blood are correct? Select all that apply.
Platelets in the blood initiate the clotting process. Platelets are produced in the bone marrow. Each platelet has a life span of 1 to 2 weeks.
What vaccinations are recommended for a patient who is scheduled for a splenectomy? Select all that apply.
Pneumococcal Meningococcal Haemophilus influenza
Which type of transfusion therapy may be safe even if the ABO factors are incompatible?
Pooled platelets
What lab result would the nurse expect to find in a patient diagnosed with hemophilia A?
Prolonged activated partial thromboplastin time (aPTT)
A patient with an injury and having uncontrolled bleeding arrives at the hospital and is placed on anticoagulant therapy. Which elevated blood test result confirms the reason for uncontrolled bleeding?
Prothrombin time
The nurse is caring for a patient who is in sickle cell crisis. Which nursing action is a priority?
Provide pain medications as needed.
Deficiencies of protein C and protein S predispose an individual to which condition?
Pulmonary embolism
A patient with leukemia will begin induction therapy with a combination of chemotherapeutic agents. The nurse explains to the patient that induction therapy has which treatment goal?
Remission of all disease manifestations
Which nursing intervention is effective in helping promote peripheral perfusion in a patient who has sickle cell disease?
Remove constrictive clothing
A patient diagnosed with thrombotic thrombocytopenic purpura should be assessed for which complications? Select all that apply.
Renal failure Myocardial infarction Cerebrovascular accident
Which action does the nurse delegate to an unlicensed assistive personnel (UAP)?
Reporting any bleeding noted when catheter care is given to a patient with a history of hemophilia
The nurse assesses multiple patients who are receiving transfusions of blood components. Which assessment indicates the need for the nurse's immediate action?
Respiratory rate of 36 in a patient receiving red blood cells (RBCs)
The nurse is assessing the laboratory data of a male patient. Which blood test result would help to confirm the diagnosis of polycythemia vera?
Reticulocyte count of 13%
The nurse is to administer packed red blood cells to a patient. How does the nurse ensure proper patient identification?
Reviews all information with another registered nurse
The nurse is performing an abdominal assessment on a patient to detect an enlarged liver. Which area does the nurse palpate in this assessment?
Right upper quadrant of the abdomen
The nurse is providing teaching to a patient scheduled for a splenectomy secondary to idiopathic thrombocytopenic purpura (ITP). What teaching is priority?
Risk for infection
The nurse is caring for a patient with multiple sclerosis who presents with a petechial rash on the upper chest and neck. Laboratory results show low platelets, hemoglobin, and hematocrit, as well as high megakaryocytes in the bone marrow. What drugs are most likely to be prescribed for this patient? Select all that apply.
Rituximab (Rituxan) Azathioprine (Imuran)
The nurse is teaching a patient with iron deficiency anemia about increasing the intake of dietary iron. The nurse considers the teaching successful when the patient makes which food selection?
Roast beef
The nurse is assessing a patient with dark skin for jaundice. Which body area should the nurse inspect?
Roof of the mouth
An adult patient is scheduled to undergo a bone marrow aspiration procedure. Bone marrow may be aspirated from which sites of the body? Select all that apply.
Sternum Pelvic bone
A patient who is receiving a blood transfusion suddenly exclaims to the nurse, "I don't feel right!" What does the nurse do next?
Stop the transfusion.
What treatment does the nurse expect a patient diagnosed with hemophilia to receive?
Synthetic factor VIII
A patient is scheduled for radioisotopic imaging. What action does the nurse take when preparing the patient for this test?
Tell the patient that a radioactive isotope will be administered by IV.
A patient is prescribed anti Rh-immunoglobulin (RHoGAM) immediately after the delivery of her baby. What could have been the assessment?
The patient is Rh-negative and the baby is Rh-positive.
Which patient is at increased risk for development of hemophilia?
The son of the woman who is a carrier
Which platelet disorder involves the failure of blood to clot after a trauma, in spite of having the ability to form blood clots?
Thrombotic thrombocytopenic purpura
What rationale supports the nurse asking an anemic patient about personal resources, such as finances and social support?
To assess the nutrition status
A patient who has undergone stem cell transplantation develops graft-versus-host disease (GVHD) and is prescribed cyclosporine. The nurse teaches the patient that this drug is given for which purpose?
To inhibit immune activity of donor T-cells
Why is filtered tubing used during infusion of blood products?
To remove aggregates
A 35-year-old female complains of bruises on her legs, arms, and thighs and has heavy menstrual bleeding. While taking the medical history of patient, the nurse finds that the patient had a history of frequent nose and gum bleeding. A complete blood count revealed the platelet count to be 10,000 mm 3. What should be the immediate intervention given to the patient?
Transfusing platelets
A patient who has undergone an allogeneic stem cell transplant is showing regressive chimerism 4 weeks after the graft. The nurse anticipates preparing the patient for which procedure?
Transplantation of more stem cells
A patient has a glucose-6-phosphate dehydrogenase (G6PD) deficiency. The nurse teaches the patient to avoid which substance?
Trimethoprim-sulfamethoxazole
A patient develops chills, tachycardia, fever, hypotension, and tachypnea after the initiation of blood infusion therapy, due to anti-white blood cell (WBC) antibodies. What intervention before initiation of the therapy could have minimized the risk of this complication?
Using WBC reduced blood
A patient's laboratory report shows increased potassium serum levels after receiving whole-blood transfusion therapy. Which nursing intervention might have caused hyperkalemia?
Using an intravenous catheter smaller than 22-guage
Which nursing action during the transfusion therapy of fresh frozen plasma may lead to complications?
Using small filters with shorter tubing
What clotting factor deficiencies cause hemophilia? Select all that apply.
VIII IX
A patient diagnosed with idiopathic thrombocytopenic purpura is scheduled for a splenectomy. What interventions are priority?
Vaccinations two weeks prior to surgery
What is the priority action performed by the nurse to avoid blood transfusion complications?
Verify the patient's name and number, check blood compatibility, and note the expiration date.
The nurse is mentoring a recent graduate RN about administering blood and blood products. What does the nurse include in the data?
Verify with another RN all of the data on blood products.
What component in food may help to increase the rate of blood coagulation?
Vitamin K
Which drug is considered a "blood thinner"?
Warfarin
Which type of transfusion requires more stringent monitoring every 15 minutes throughout the transfusion?
White blood cell transfusions
Which blood component is responsible for providing immunity?
White blood cells
The registered nurse is teaching a novice nurse about transfusion in older patients. Which statement by the novice nurse indicates effective learning?
"2 to 4 hours should be taken to administer one unit of blood."
The nurse is teaching a patient about induction therapy for acute leukemia. Which patient statement indicates a need for additional education?
"After this therapy, I will not need to have any more."
The provider has recommended chemotherapy for a patient diagnosed with chronic lymphocytic leukemia (CLL). What does the nurse tell the patient about this treatment?
"Chemotherapy may produce remission of CLL."
The nurse is assessing the endurance level of a patient in a long-term care facility. What question does the nurse ask to get this information?
"Do you feel more tired after you get up and go to the bathroom?"
The nurse is assessing a patient for hematologic function risks and seeks to determine whether there is a risk that cannot be reduced or eliminated. Which clinical health history question does the nurse ask to obtain this information?
"Does anyone in your family bleed a lot?"
The nurse is providing teaching for a patient who follows a lacto-ovo vegetarian diet. Which statement by the nurse is most appropriate regarding a sufficient intake of vitamin B 12?
"Egg yolks contain a high amount of vitamin B 12."
The nurse is educating a group of young women who have sickle cell disease (SCD). Which comment from a class member requires correction?
"Getting an annual 'flu shot' would be dangerous for me."
The nurse is providing discharge teaching for a patient who has repeated vasoocclusive episodes caused by sickle cell disease (SCD). Which statement by the patient indicates a need for further teaching?
"I can drink beer in moderation."
The nurse is teaching a patient who has just been diagnosed with polycythemia vera (PV) about long-term management of this disease. Which statement by the patient indicates a need for further teaching?
"I should floss my teeth to promote good dental health."
The nurse is educating a patient who is taking an anticoagulant drug. Which patient statement indicates a need for further teaching?
"I should take aspirin whenever I have severe pain."
Which patient statement indicates that stem cell transplantation that is scheduled to take place in his home is not a viable option?
"I was a nurse, so I can take care of myself."
The nurse is providing teaching for a female patient diagnosed with hemophilia A. What statement by the patient indicates a need for further teaching?
"I will be able to use steroids to help my body create the clotting factors."
A patient on anticoagulant therapy is being discharged. Which statement indicates that the patient has a correct understanding of this therapy's purpose or action?
"It should prevent my blood from clotting."
A hematology unit is staffed by RNs, LPN/LVNs, and unlicensed assistive personnel (UAP). When the nurse manager is reviewing documentation of staff members, which entry indicates that the staff member needs education about his or her appropriate level of responsibility and patient care?
"Patient reporting increased shortness of breath; oxygen increased to 4 L by nasal cannula. M.N., UAP"
The nurse is teaching a patient with newly diagnosed anemia about conserving energy. What should the nurse tell the patient? Select all that apply.
"Provide yourself with four to six small, easy-to-eat meals daily." "Stop activity when shortness of breath or palpitations are present." "Allow others to perform your care during periods of extreme fatigue." "Drink small quantities of protein shakes and nutritional supplements daily."
A patient with a low platelet count asks why platelets are important. Which response by the nurse is correct?
"The clotting process begins with your platelets."
A nurse reports having withheld intravenous opioid pain medication from a young African American patient who has sickle cell disease (SCD). The nurse states that she believes the patient is addicted. What is the nurse manager's most appropriate response?
"The incidence of opioid addiction in SCD patients is actually rare."
A patient with anemia asks the nurse, "Do most people have the same number of red blood cells?" How does the nurse respond?
"The number varies with gender, age, and general health."
The nurse is reinforcing information about genetic counseling to a patient with sickle cell disease (SCD) who has a healthy spouse. What information does the nurse include?
"The sickle cell trait will be inherited by your children."
The nurse is counseling an African American couple who both have hemoglobin S (HbS). What does the nurse tell this couple about the risk of sickle cell disease for their children?
"There is a 50% chance for each child to have the sickle cell trait."
A patient who is pregnant with a girl has a family history of hemophilia. The patient knows she is a carrier and is worried that her daughter will be a carrier and/or be hemophilic. What can the nurse tell her?
"There's a 50% chance she will be a carrier but is unlikely to be hemophilic."
A patient with thrombocytopenia is being discharged. What information does the nurse incorporate into the teaching plan for this patient?
"Use a soft-bristled toothbrush."
A patient with multiple myeloma reports bone pain that is unrelieved by analgesics. How does the nurse respond to this patient's problem?
"Would you like to try some relaxation techniques?"
The nurse is counseling a 65-year-old patient diagnosed with a myelodysplastic syndrome who has severe pancytopenia and a high number of blast cells. The patient wants to know if this will eventually cause cancer. How does the nurse respond?
"You have a high risk for developing cancer."
The nurse is teaching a patient about what to expect during a bone marrow biopsy. Which statement by the nurse accurately describes the procedure?
"You may experience a crunching sound or a scraping sensation as the needle punctures your bone."
A patient with anemia asks, "Why am I feeling tired all the time?" How does the nurse respond?
"Your cells are delivering less oxygen than you need."
A nurse is counseling a patient who wishes to donate blood for autologous use during surgery. The nurse advises the patient that the blood can be stored for how long?
40 days
After reviewing the laboratory test results, the nurse calls the health care provider about which patient?
46-year-old with a fever and a white blood cell (WBC) count of 1500/mm 3
Which patient is at highest risk for development of idiopathic thrombocytopenic purpura?
A 30-year-old female with Hashimoto's thyroiditis
