HEMATOLOGICAL PART #4

The nurse who is about to begin a blood transfusion knows that blood cells start to deteriorate after a certain period of time. Which item is important to check regarding the age of blood cells before the transfusion is begun? 1) Expiration date 2) Presence of clots 3) Blood group and type 4) Blood identification number

1) Expiration date Rationale: The nurse notes the expiration date on the unit of blood to ensure that the blood is fresh. Blood cells begin to deteriorate over time, so safe storage is usually limited to 35 days. Careful notation of the expiration date by the nurse is an essential part of the verification process before hanging a unit of blood. The nurse also notes the blood identification (unit) number, blood group and type, and client's name. The nurse also inspects the unit of blood for leaks, abnormal color, clots, and bubbles and returns the unit to the blood bank if clots are noted.

The nurse has just received a prescription to transfuse a unit of packed red blood cells for an assigned client. Approximately how long will the nurse need to stay with the client to ensure that a transfusion reaction is not occurring? 1) 5 minutes 2) 15 mintues 3) 30 minutes 4) 45 mintues

2) 15 mintues Rationale: The nurse must remain with the client for the first 15 minutes of a transfusion, which is usually when a transfusion reaction may occur. This enables the nurse to detect a reaction and intervene quickly.

A client with severe blood loss resulting from multiple trauma requires rapid transfusion of several units of blood. The nurse asks another health team member to obtain which device for use during the transfusion procedure to help reduce the risk of cardiac dysrhythmias? 1) Infusion pump 2) Pulse oximeter 3) Cardiac monitor 4) Blood-warming device

4) Blood-warming device Rationale: If several units of blood are to be administered, a blood warmer should be used. Rapid transfusion of cool blood places the client at risk for cardiac dysrhythmias. To prevent this, the nurse warms the blood with a blood-warming device. Pulse oximetry and cardiac monitoring equipment are useful for the early assessment of complications but do not reduce the occurrence of cardiac dysrhythmias. Electronic infusion devices are not helpful in this case because the infusion must be rapid, and infusion devices generally are used to control the flow rate. In addition, not all infusion devices are made to handle blood or blood products

The nurse, listening to the morning report, learns that an assigned client received a unit of granulocytes the previous evening. The nurse makes a note to assess the results of which daily serum laboratory studies to assess the effectiveness of the transfusion? 1) Hematocrit level 2) Erythrocyte count 3) Hemoglobin level 4) White blood cell count

4) White blood cell count Rationale: The client who has neutropenia may receive a transfusion of granulocytes, or white blood cells. These clients often have severe infections and are unresponsive to antibiotic therapy. The nurse notes the results of follow-up white blood cell counts and differential to evaluate the effectiveness of the therapy. The nurse also continues to monitor the client for signs and symptoms of infection. Erythrocyte count and hemoglobin and hematocrit levels are determined after transfusion of packed red blood cells.

You receive a physician's order to transfuse fresh frozen plasma to a patient suffering from an acute blood loss. Which procedure is most appropriate for infusing this blood product? A. Infuse the fresh frozen plasma as rapidly as the patient will tolerate. B. Hang the fresh frozen plasma as a piggyback to the primary IV solution. C. Infuse the fresh frozen plasma as a piggyback to a primary solution of normal saline. D. Hand the fresh frozen plasma as a piggyback to a new bag of primary IV solution without KCl.

A. Infuse the fresh frozen plasma as rapidly as the patient will tolerate. The fresh frozen plasma should be administered as rapidly as possible and should be used within 2 hours of thawing. Fresh frozen plasma is infused using any straight-line infusion set. Any existing IV should be interrupted while the fresh frozen plasma is infused, unless a second IV line has been started for the transfusion.

Which foods should you encourage patients with folic acid deficiency to include in their daily food intake (select all that apply)? A. Ready-to-eat cereal B. Wheat tortillas C. Lentils D. Strawberries E. Potatoes

A. Ready-to-eat cereal B. Wheat tortillas C. Lentils Whole-grain foods and beans are high in folic acid

A client receiving a transfusion of packed red blood cells (PRBCs) begins to vomit. The client's blood pressure is 90/50 from a baseline of 125/78. The client's temperature is 100.8F orally from a baseline of 99.2F orally. The nurse determines that the client may be experiencing which complication of a blood transfusion? a. Septicemia b. Hyperkalemia c. Circulatory overload d. Delayed transfusion reaction

A. Septicemia Septicemia occurs with the transfusion of blood contaminated with microorganisms. Signs include chills, fever, vomiting, diarrhea, hypotension, and the development of shock. Hyperkalemia causes weakness, paresthesias, abdominal cramps, diarrhea, and dysrythmias. Circulatory overload causes cough, dyspnea, chest pain, wheezing, tachycardia, and hypertension. A delayed transfusion reaction can occur days or weeks after a tranfusion. Signs include fever, mild jaundice, and a decreased hematocrit level.

The Schilling test for pernicious anemia involves A. administration of radioactive cobalamin and measuring its excretion in the urine. B. blood cultures for organism identification. C. the measurement of serum iron. D. the administration of iron and blood assessment of total iron binding in 24 hours.

A. administration of radioactive cobalamin and measuring its excretion in the urine. Parietal cell function can be assssed with a Schilling test. After radioactive cobalamin is administered to the patient, the amount of cobalamin excreted in the urine is measured. An individual who cannot absorb cobalamin excretes only a small amount of this radioactive form.

You correctly identify which descriptions as characteristic of anemia of chronic disease (select all that apply) A. normocytic. B. normochromic. C. microcytic. D. hypochromic. E. proliferative.

A. normocytic. B. normochromic. Anemia of chronic disease, also called anemia of inflammation, is associated with an underproduction of RBCs and mild shortening of RBC survival. The RBCs are usually normocytic, normochromic, and hypoproliferative. The anemia is usually mild, but it can be more severe

"The nurse is preparing to initiate a blood transfusion. The client has a peripheral intravenous infusion in their left arm that the physician has ordered not be slowed or rate reduced. The nurse prepares to start another line in the right arm. The client asks the nurse to use the existing site to avoid the trauma of having another line started. Which of the following statements by the nurse is correct? A. ""That will be fine"" B. "I will need to infuse the blood through a separate IV line." C. "I will let the physician know about your preferences." D. "We will need to assess the line before I can make a determination about your request.""

Answer: B "Rationale: A blood infusion must be administered via a separate IV line. The other responses indicate to the client their request is being considered

The client has been diagnosed with a vitamin B12 deficiency. What would the nurse ask more about in the client history related to this finding? a. Seasonal allergies b. Diet c. Medications d. Exercise

B

Which finding allows you to identify the patient's anemia as folic acid deficiency rather than cobalamin deficiency? A. Loss of appetite B. Lack of neuromuscular symptoms C. Red tongue D. Change in nail shape

B. Lack of neuromuscular symptoms The absence of neurologic problems is an important diagnostic finding and differentiates folic acid deficiency from cobalamin deficiency.

When caring for a patient with metastatic cancer, you note a hemoglobin level of 8.7 g/dL and hematocrit of 26%. You place highest priority on initiating interventions that can reduce A. thirst. B. fatigue. C. headache. D. abdominal pain

B. fatigue. The patient with a low hemoglobin level and hematocrit is anemic and is most likely to experience fatigue. Fatigue develops because of the lowered oxygen-carrying capacity that leads to reduced tissue oxygenation with which to carry out cellular functions.

If the patient with DIC is actively bleeding, platelets are given to correct thrombocytopenia if the count is less than A. 150,000/μL. B. 100,000/μL. C. 50,000/μL. D. 30,000/μL.

C. 50,000/μL. Platelets usually are given to correct thrombocytopenia if the platelet count is less than 20,000/μL or is less than 50,000/μL if the patient is actively bleeding.

A patient with acute myelogenous leukemia will soon start chemotherapy. When you are teaching the patient about the induction stage of chemotherapy, what is the best explanation? A. The drugs are started slowly to minimize side effects. B. You will develop even greater bone marrow depression with risk for bleeding and infection. C. It will be necessary to have high-dose treatment every day for several months. D. During this time you will regain energy and become more resistant to infection.

C. It will be necessary to have high-dose treatment every day for several months. The chemotherapeutic treatment of acute leukemia is often divided into stages. The first stage, induction therapy, is the attempt to induce or bring about a remission. Induction is aggressive treatment that seeks to destroy leukemic cells in the tissues, peripheral blood, and bone marrow in order to eventually restore normal hematopoiesis on bone marrow recovery. During induction therapy a patient may become critically ill because the bone marrow is severely depressed by the chemotherapeutic agents.

A patient with multiple myeloma becomes confused and lethargic. You would expect that these clinical manifestations may be explained by diagnostic results that indicate A. hyperkalemia. B. hyperuricemia. C. hypercalcemia. D. CNS myeloma.

C. hypercalcemia. Bony degeneration in multiple myeloma causes calcium to be lost from bones, eventually causing hypercalcemia. Hypercalcemia may cause renal, GI, or neurologic manifestations such as polyuria, anorexia, confusion, and ultimately seizures, coma, and cardiac problems.

Which finding would you recognize as an indicator of chronic myelogenous leukemia (CML)? A. Presence of an abnormal LE cell B. Numerous immature lymphoblasts C. An elevated white blood cell count D. Presence of the Philadelphia chromosome

D. Presence of the Philadelphia chromosome CML is caused by excessive development of mature neoplastic granulocytes in the bone marrow. The excess neoplastic granulocytes move into the peripheral blood in massive numbers and ultimately infiltrate the liver and spleen. These cells contain a distinctive cytogenetic abnormality, the Philadelphia chromosome, which serves as a disease marker and results from translocation of genetic material between chromosomes 9 and 22.

Susan is exhibiting several of the general symptoms of anemia. The nurse asks if she has had any episodes of confusion and disorientation. Susan states, "Now that you mention it, I have had some afternoons where I have not felt like myself. I guess you could call it confused or disoriented. Why would I be feeling like that? Does anemia cause these symptoms?" What would be the nurse's best response? a. "Some types of anemia can cause these symptoms due to decreased oxygenation of the brain." b. "If you are having these symptoms it could mean that there is something going on more serious than anemia." c. "I doubt it is anything to worry about. You can mention it to the healthcare provider when they see you." d. "I will let the healthcare provider know right now of these symptoms."

a. "Some types of anemia can cause these symptoms due to decreased oxygenation of the brain." Rationale: Susan's symptoms of confusion and disorientation can be caused by decreased oxygenation of the brain. Fewer mature red blood cells and hemoglobin are available to oxygenate the brain and the rest of the body.

The nurse is picking up a unit of packed red blood cells at the hospital blood bank. After putting the pen down, the nurse glances at the clock, which reads 1:00. The nurse calculates that the transfusion must be started by: a. 1:30 b. 2:00 c. 2:30 d. 3:00

a. 1:30 Blood must be hung as soon as possible within 30 mintues after it is obtained from the blood bank.

The nurse is instructing a client with vitamin B12 anemia about dietary changes. What foods should be increased in this client's diet? Select all that apply. a. Meat b. Seafood c. Eggs d. Avocados e. Green leafy vegetables

a. Meat b. Seafood c. Eggs Rationale: Prevention of vitamin B12 deficiency is important, and animal proteins provide the only source of vitamin B12 in the world. Vitamin B12 has not been discovered in any plants. Dietary sources of vitamin B12 include meat, seafood, eggs, and dairy products.

Which symptoms should the nurse assess Johnston who has aplastic anemia for? a. Shortness of breath b. Constipation c. Bruising d. Infection e. Sleeplessness

a. Shortness of breath c. Bruising d. Infection Rationale: Aplastic anemia is typically associated with symptoms of low red blood cells, white blood cells, and platelets; therefore, symptoms include fatigue, shortness of breath, tachycardia, pallor, dizziness, headache, infections, bruising, nosebleeds, gum bleeding, and prolonged bleeding from cuts and other injuries.

A client requiring surgery is anxious about the possible need for a blood transfusion during or after the procedure. The nurse suggests to the client to do which of the following to reduce the risk of possible transfusion complications? a. give an autologous blood donation before the surgery b. ask a friend or family member to donate blood ahead of time c. take iron supplements before surgery to boost hemoglobin levels d. request that any donated blood be screened twice by the blood bank.

a. give an autologous blood donation before the surgery A donation of the client's own blood before a scheduled procedure is autologous. Donating autologous blood to be reinfused as needed during or after surgery reduces the risk of disease transmission and potential transfusion complications. The next most effective way is ask a family member to donate blood before surgery. Blood banks do not provide extra screening on request. Preoperative iron supplements are not helpful in replacing blood lost during the surgery.

The nurse is aware that a client with anemia could exhibit which generalized symptoms? Select all that apply. a. Hypersensitivity to light b. Dizziness c. Shortness of breath d. Bleeding gums e. Fatigue

b. Dizziness c. Shortness of breath e. Fatigue

As Susan is preparing to leave, the nurse is reviewing a teaching handout about increasing dietary folic acid. What should be included in the teaching plan? Select all that apply. a. Red meat b. Green leafy vegetables c. Fortified grains d. Dairy products e. Nuts

b. Green leafy vegetables c. Fortified grains e. Nuts Rationale: Green leafy vegetables, fortified grains and cereals, and nuts are sources of folate, which the body converts to folic acid. Red meat and dairy products are not good sources of folate

A client has a prescription to receive a unit of packed red blood cells. The nurse should obtain which of the following IV solutions form the IV storage area to hang with the blood product at the client's bedside? a. Lactated Ringer's b. 0.9% sodium chloride c. 5% dextrose in 0.9% sodium chloride d. 5% dextrose in 0.45% sodium chloride

c. 0.9% sodium chloride Sodium chloride 0.9% (normal saline) is a standard isotonic solution used to precede and follow infusion of blood products. Dextrose is not used because it could result in clumping and subsequent hemolysis of red blood cells. Lactated ringer's is not the solution of choice with this procedure.

A client has experienced a rash with pruritus during previous blood transfusions. The client asks the nurse whether it is safe to receive another transfusion. In formulating a response, the nurse incorporates the understanding that which medication will most likely be prescribed before the transfusion is begun? a. Ibuprofen (Motrin) b. Acetaminophen (Tylenol) c. Diphenhydramine (Benadryl) d. Acetylsalicylic Acid (ASA Aspirin)

c. Diphenhydramine (Benadryl) An urticarial reaction is characterized by a rash accompanied by pruritus. This type of transfusion reaction is prevented by pretreating the client with an antihistamine such as diphenhydramine. Acetaminophen and ASA are analgesics and ibuprofen is a NSAID

While completing a nursing history, the nurse learns that Susan is prescribed metformin and oral contraceptives. She is at risk for what type of anemia? a. Iron deficiency anemia b. Vitamin B12 anemia c. Folic acid deficiency d. Sickle cell anemia

c. Folic acid deficiency Rationale: The client who takes metformin, oral contraceptives, and certain chemotherapeutic agents may be at risk of folic acid deficiency. Other individuals at risk for this condition can include individuals with a history of gastrointestinal resections and individuals with a history of alcohol abuse.

The nurse is explaining the diagnosis of aplastic anemia to the client. The nurse would include which of these statements in the explanation? a. The client has a decreased number of red blood cells in the bloodstream. b. The client has a decrease in red blood cell production. c. The client is deficient in red blood cells, white blood cells, and platelets. d. The client has a lack of vitamin B12, known as extrinsic factor.

c. The client is deficient in red blood cells, white blood cells, and platelets

A nurse is caring for a client who has suspected anemia. Which of the following laboratory test results should the nurse expect? a - Iron 90 mcg/dL b - RBC 6.5 mill/uL c - WBC 4800 mm3 d - Hgb 10 g/dL

d - Hgb 10 g/dL

Johnston is a 22-year-old male with human immunodeficiency virus. He was born with the virus and has been maintained with medications since birth. He presents to the clinic today with extreme fatigue.The practitioner draws serum blood work and the results include decreased red blood cells, white blood cells, and platelets. What type of anemia could cause these results? a. Folic acid anemia b. B12 anemia c. Iron deficiency anemia d. Aplastic anemia

d. Aplastic anemia Rationale: Aplastic anemia, also called hypoplastic anemia, is a rare disease process that develops due to bone marrow depression or damage, and is often acquired secondary to infections, including hepatitis and human immunodeficiency virus. Blood work typically shows pancytopenia because of poor bone marrow function.

A client has received a transfusion of platelets. The nurse evaluates that the client is benefiting most from this therapy if the client exhibits which of the following? a. Increased hematocrit level b. Increased hemoglobin level c. Decline of elevated temperature to normal d. Decreased oozing of blood from puncture sites and gums

d. Decreased oozing of blood from puncture sites and gums Platelets are necessary for proper blood clotting. The client with insufficient platelets may exhibit frank bleeding or oozing of blood from puncture sites, wounds, and mucous membranes. Increased hemoglobin and hematocrit levels would occur when the client has received a transfusion of red blood cells. An elevated temperature would decline to normal after infusion of granulocytes if those cells were instrumental in fighting infection in the body.

Multiple drugs are often used in combinations to treat leukemia and lymphoma because A. there are fewer toxic side effects. B. the chance that one drug will be effective is increased. C. the drugs are more effective without causing side effects. D. the drugs work by different mechanisms to maximize killing of malignant cells.

D. the drugs work by different mechanisms to maximize killing of malignant cells. Combination therapy is the mainstay of treatment for leukemia. Multiple drugs are used to decrease drug resistance, minimize overall toxicity by using drugs with different toxic effects, and interrupt cell growth at multiple points in the cell cycle.

Packed red blood cells have been prescribed for a client with low hemoglobin and hematocrit levels. The nurse takes the client's temperature before hanging the blood transfusion and records 100.6F orally. Which of the following is the appropriate nursing action? a. Begin the transfusion as prescribed b. Delay hanging the blood and notify the physician c. Administer an antihistamine and begin the transfusion d. Administer two tablets of acetaminophen (Tylenol) and begin the transfusion

b. Delay hanging the blood and notify the physician If the client's temperature is higher than 100F the unit of blood should not be hung until the physician is notified and has the opportunity to give further prescriptions. The physician will likely prescribe that the blood be administered regardless of the temperature, but the decision is not within the nurse's scope of practice to make.

A nurse has an order to transfuse a unit of packed red blood cells to a client who does not currently have an IV line inserted. When obtaining supplies to start the IV infusion the nurse selects an angiocatheter with a size of: a. 18 gauge b. 21 gauge c. 22 gauge d. 24 gauge

a. 18 gauge The IV catheter used for a blood transfusion should be at least 18 or 19 gauge. Compared with IV solutions, blood has a thicker and stickier consistency, and use of an 18 or 19 gauge catheter will ensure that the bore of the catheter is large enough to prevent damage to the blood cells.

The nurse is aware that a patient who presents with anemia could exhibit which of these signs and symptoms of the disorder? Select all that apply. a. Fatigue b. Bradycardia c. Shortness of breath d. Bradypnea e. Pallor

a. Fatigue c. Shortness of breath e. Pallor Rationale: As the body's iron stores are depleted, the decreased hemoglobin levels lead to inadequate oxygenation of the body's tissues, or hypoxia. This oxygen deficiency manifests itself as fatigue and pallor, with the onset of tachycardia and tachypnea resulting from the heart and lungs attempting to compensate for the hypoxemia (oxygen deficiency of the blood). As hypoxia increases, the patient may become increasingly short of breath.

The nurse is performing an assessment on a client with a diagnosis of pernicious anemia. Which finding would the nurse expect to note in this client? a. Dyspnea b. Dusky mucous membranes c. Shortness of breath on exertion d. Red tongue that is smooth and sore

d. Red tongue that is smooth and sore Classic signs of pernicious anemia include weakness, mild diarrhea, and smooth, sore, red tongue. The client also may have nervous system signs and symptoms such as paresthesias, difficulty with balance, and occasional confusion.

The nurse is performing an assessment on a client with a diagnosis of anemia that developed as a result of blood loss after a traumatic injury. The nurse should expect to note which sign or symptom in the client as a result of the anemia? a. Bradycardia b. Muscle cramps c. Increased respiratory rate d. Shortness of breath with activity

d. Shortness of breath with activity The client with anemia is likely to experience shortness of breath and complain of fatigue because of the decreased ability of the blood to carry oxygen to the tissues to meet metabolic demands. The client is likely to have tachycardia, not bradycardia, as a result of efforts by the body to compensate for the effects of anemia.

A client requiring surgery is anxious about the possible need for a blood transfusion during or after the procedure. The nurse suggests to the client to take which action(s) to reduce the risk of possible transfusion complications? SELECT ALL THAT APPLY. 1) Ask a family member to donate blood ahead of time. 2) Give an autologous blood donation before the surgery. 3) Take iron supplements before surgery to boost hemoglobin levels. 4) Request that any donated blood be screened twice by the blood bank. 5) Take adequate amounts of vitamin C several days prior to the surgery date.

1) Ask a family member to donate blood ahead of time. 2) Give an autologous blood donation before the surgery. Rationale: A donation of the client's own blood before a scheduled procedure is autologous. Donating autologous blood to be reinfused as needed during or after surgery reduces the risk of disease transmission and potential transfusion complications. The next most effective way is to ask a family member to donate blood before surgery. Blood banks do not provide extra screening on request. Preoperative iron supplements are helpful for iron deficiency anemia but are not helpful in replacing blood lost during the surgery. Vitamin C enhances iron absorption, but also is not helpful in replacing blood lost during surgery.

Following infusion of a unit of packed red blood cells, the client has developed new onset of tachycardia, bounding pulses, crackles, and wheezes. Which action should the nurse implement FIRST? 1) Maintain bed rest with legs elevated 2) Place the client in high-Fowler's position 3) Increase the rate of infusion of intravenous fluids 4) Consult with the HCP regarding initiation of oxygen therapy.

2) Place the client in high-Fowler's position Rationale: New onset of tachycardia, bounding pulses, crackles and wheezes post-transfusion are evidence of fluid overload, a complication associated with blood transfusions. Placing the client in a high-Fowler's (upright) position will facilitate breathing. Measures that increase blood return to the heart, such as leg elevation and administration of intravenous fluids, should be avoided at this time. In addition, administration of fluids cannot be initiated without a prescription. Consulting with the HCP regarding administration of oxygen may be necessary, but positional changes take a short amount of time to do and should be initiated first.

A client is brought to the emergency department having experienced blood loss related to an arterial laceration. Fresh-frozen plasma is prescribed and transfused to replace fluid and blood loss. The nurse understands that which is the rationale for transfusing fresh-frozen plasma to this client? 1) To treat the loss of platelets 2) To promote rapid volume expansion 3) Because a transfusion must be done slowly 4) Because it will increase the hemoglobin and hematocrit levels

2) To promote rapid volume expansion Rationale: Fresh-frozen plasma is often used for volume expansion as a results of fluid and blood loss. It does not contain platelets, so it is not used to treat any type of low platelet count disorder. It is rich in clotting factors and can be thawed quickly and transfused quickly. It will not specifically increase the hemoglobin and hematocrit level.

The nurse enters a client's room to assess the client, who began receiving a blood transfusion 45 minutes earlier, and notes that the client is flushed and dyspneic. On assessment, the nurse auscultates the presence of crackles in the lung bases. The nurse determines that this client most likely is experiencing which complication of blood transfusion therapy? 1) Bacteriemia. 2) Hypovolemia. 3) Fluid overload 4) Transfusion reaction

Correct: 3 With fluid overload, the client has the presence of crackles in addition to dyspnea. An allergic reation, a type of blood transfusion reaction, would produce symptoms such as flushing, dyspnea, itching, and a generalized rash. Hypovolemia is not complication of blood transfusions. With bacteriemia, the client would have fever, a symptom not presented.

Which individual is at high risk for a cobalamin (vitamin B12) deficiency anemia? A. A 47-year-old man who had a gastrectomy (removal of the stomach) B. A 54-year-old man with a history of irritable bowel disease and ulcerative colitis C. A 26-year-old woman who complains of heavy menstrual periods D. A 15-year-old girl who is a vegetarian

A. A 47-year-old man who had a gastrectomy (removal of the stomach) There are many causes of cobalamin deficiency. The most common cause is pernicious anemia, a disease in which the gastric mucosa is not secreting intrinsic factor (IF) because of antibodies being directed against the gastric parietal cells or IF itself. Other causes of cobalamin deficiency include gastrectomy, gastritis, nutritional deficiency, chronic alcoholism, and hereditary enzymatic defects of cobalamin use.

You encourage the patient with cobalamin deficiency to seek treatment because untreated pernicious anemia may result in A. death. B. liver failure. C. heart failure. D. gastrectomy.

A. death. Without cobalamin administration, these individuals will die in 1 to 3 years.

A patient with severe pernicious anemia is being discharged home and requires routine injections of Vitamin B12. Which statement by the patient demonstrates they understood your instructions about their treatment regime?* A. "I will require one injection every 6 months until my Vitamin B12 levels are therapeutic and then I'm done." B. "Initially, I will need weekly injections of Vitamin B12 and then monthly injections for maintenance, which will be a lifelong regime." C. "I will only need vitamin B12 injections for a month and then I can take a low dose of oral vitamin B12." D. "When I start to feel weak and short of breath I need to call the doctor so I can schedule an appointment for a Vitamin B12 injection."

B

Caring for a patient with a diagnosis of polycythemia vera will likely require you to A. encourage deep breathing and coughing. B. assist with or perform phlebotomy at the bedside. C. teach the patient how to maintain a low-activity lifestyle. D. perform thorough and regularly scheduled neurologic assessments.

B. assist with or perform phlebotomy at the bedside. Primary polycythemia often requires phlebotomy to reduce blood volume. The increased risk of thrombus formation that accompanies the disease requires regular exercises and ambulation.

A patient with a diagnosis of hemophilia fell down an escalator earlier in the day and is now experiencing bleeding in her left knee joint. Your immediate response should include A. immediate transfusion of platelets. B. resting the patient's knee to prevent hemarthroses. C. assistance with intracapsular injection of corticosteroids. D. range-of-motion exercises to prevent thrombus formation.

B. resting the patient's knee to prevent hemarthroses. In patients with hemophilia, joint bleeding requires resting of the joint to prevent deformities from hemarthrosis. Clotting factors, not platelets or corticosteroids, are administered.

A client is brought to the emergency department having experienced blood loss related to an arterial laceration. Fresh-frozen plasma is prescribed and transfused to replace fluid and blood loss. The nurse understands that the rationale for transfusing fresh-frozen plasma in this client is: A. to treat the loss of platelets B. to promote rapid volume expansion C. That the transfusion must be done slowly D. That it will increase the hemoglobin and hematocrit levels.

B. to promote rapid volume expansion Fresh-frozen plasma is often used for volume expansion as a result of fluid and blood loss. It does not contain platelets, so it is not used to treat any type of low platelet count disorder. It is rich in clotting factors and can be thawed quickly and transfused quickly. It will not specifically increase the hemoglobin and hematocrit level.

"Which statement is the scientific rationale for infusing a unit of blood in less than four (4) hours? "1. The blood will coagulate if left out of the refrigerator for >four (4) hours. 2. The blood has the potential for bacterial growth if allowed to infuse longer. 3. The blood components begin to break down after four (4) hours. 4. The blood will not be affected; this is a laboratory procedure."

Correct 2 "1. Blood will coagulate if left out for an extended period of, but blood is stored with a preservative that prevents this and prolongs the life of the blood. 2. (CORRECT). Blood is a medium for bacterial growth, and any bacteria contaminating the unit will begin to grow if left outside of a controlled refrigerated temperature for longer than four (4) hours, placing the client at risk for septicemia. 3. Blood components are stable and do not break down after four (4) hours. 4. These are standard nursing and laboratory procedures to prevent the complication of septicemia."

The nurse has received a prescription to transfuse a client with a unit of packed red blood cells. Before explaining the procedure to the client, the nurse asks which initial question? a. "have you ever had a transfusion before?" b. "why do you think that you need the transfusion?" c. "have you ever gone into shock for any reason in the past?" e. "do you know the complications and risks of a transfusion?"

a. "have you ever had a transfusion before?" Asking the client about personal experience with transfusion therapy provides a good starting point for client teaching about this procedure. Options C and E are not helpful because they may elicit a fearful response from the client. Although determining whether the client knows the reason for the transfusion is important, option B is not an appropriate statement in terms of eliciting information from the client regarding an understanding of the need for the transfusion

Johnston is placed on bleeding precautions for his low platelet count. What should the nurse include with this? Select all that apply. a. Bladed razors b. Soft toothbrushes c. Frequent rotation of IV sites d. Direct pressure to venipuncture and injection sites e. Flossing

b. Soft toothbrushes d. Direct pressure to venipuncture and injection sites Rationale: Decreased platelets increase the risk of bleeding, and bleeding precautions include use of soft toothbrushes and direct pressure to venipuncture and injection sites until bleeding stops. Exposure to anything sharp or rough should be prevented.

The nurse has obtained a unit of blood from the blood bank and has checked the blood bag properly with another nurse. Just before beginning the transfusion, the nurse assesses which priority item? a. Vital signs b. Skin color c. Urine output D. Latest hematocrit level

A. vital signs A change in VS during the transfusion from baseline may indicate that a transfusion reaction is occurring. This is why the nurse assesses vital signs before the procedure and again after the first 15 minutes.

"The physician orders 2 units of packed RBCs to be administered to the client. At 0600 the night shift nurse initiates the first unit's transfusion before going off shift. At 1000 the day shift nurse notes the IV line has clotted off and the transfusion has not been completed. The nursing assessment revealed the transfusion was only approximately 75% complete. Which of the actions by the nurse is most appropriate? A. Advise the blood bank about the delay for the next unit. B. Restart another peripheral line with 0.9% NS and restart the blood transfusion with the remaining blood unit. C. Discontinue the transfusion. D. Document the amount infused thus far and continue the transfusion."

"Answer C Rationale: A unit of blood should be administered within a 4 hour period of time. The nurse should discontinue the transfusion, document the findings and notify the blood bank. The agency policy will need to be followed concerning the documentation process and notification of appropriate personnel. Continuing the transfusion with the "open" unit will expose the client to an increase risk of injury."

Priority nursing actions when caring for a hospitalized patient with new-onset temperature of 102.2° F and severe neutropenia include (select all that apply) A. administering the prescribed antibiotic STAT. B. drawing peripheral and central line blood cultures. C. ongoing monitoring of the patient's vital signs for septic shock. D. taking a full set of vital signs and notifying the physician immediately.

ALL answers are correct. Early identification of an infective organism is a priority, and samples for cultures should be obtained from various sites. In the febrile, neutropenic patient, antibiotics should be started immediately (within 1 hour). Cultures of the nose, throat, sputum, urine, stool, obvious lesions, and the blood may be indicated. Ongoing febrile episodes or a change in the patient's assessment (or vital signs) requires a call to the physician to order additional cultures, diagnostic tests, and antimicrobial therapies.

The care plan for a patient with aplastic anemia should include activities to minimize the risk for which complications? A. Dyspnea and pain B. Diarrhea and fatigue C. Nausea and malnutrition D. Infection and hemorrhage

D. Infection and hemorrhage You must assist the patient in reducing infection risk. The patient is susceptible to infection and is at risk for septic shock and death. Even a low-grade temperature (>100.4° F) should be considered a medical emergency. Thrombocytopenia manifests as a predisposition to bleeding evidenced by petechiae, ecchymosis, and epistaxis. Pain is not experienced nor is diarrhea. Nausea and malnutrition are not related to this disease except as a by-product of infection.

Johnston asks the nurse what he should expect as treatment for his aplastic anemia. What should the nurse say? a. Most symptoms will be resolved with dietary changes. b. Often blood transfusions are a part of the treatment for the anemia. c. Removal of your HIV medications will treat the aplastic anemia. d. There are medications that will cure your bone marrow disease.

b. Often blood transfusions are a part of the treatment for the anemia. Rationale: During the diagnostic evaluation phase of aplastic anemia, blood transfusions are a primary treatment. Other treatments focus on stimulating bone marrow with medications such as filgrastim (Neupogen) and epoetin-alfa (Epogen), as they stimulate bone marrow production of cells and relieve symptoms.

You are evaluating the laboratory data of the patient with suspected aplastic anemia. Which findings support this diagnosis? A. Reduced RBCs, reduced white blood cells (WBCs), and reduced platelets B. Reduced RBCs, normal WBCs, and normal platelets C. Normal RBCs, reduced WBCs, and reduced platelets D. Elevated RBCs, increased WBCs, and increased platelets

A. Reduced RBCs, reduced white blood cells (WBCs), and reduced platelets Because all marrow elements are affected, hemoglobin, WBC, and platelet values are decreased in aplastic anemia. Other RBC indices usually are norma

The nurse has discontinued a unit of blood that was infusing into a client because the client experienced a transfusion reaction. After documenting the incident appropriately, the nurse sends the blood bag and tubing to which of the following departments? a. Blood bank b. Risk management c. Environmental services d. Infection control

A. blood bank The nurse returns the blood transfusion bag containing any remaining blood to the blood bank. This allows the blood bank to complete any follow-up testing procedures needed once a transfusion reaction has been documented. The other option identify incorrect departments.

When providing care for a patient with thrombocytopenia, you instruct the patient to A. dab his or her nose instead of blowing. B. be careful when shaving with a safety razor. C. continue with physical activities to stimulate thrombopoiesis. D. avoid aspirin because it may mask the fever that occurs with thrombocytopenia.

A. dab his or her nose instead of blowing. Blowing the nose forcefully should be avoided; the patient should gently pat it with a tissue if needed. Patients with thrombocytopenia should avoid aspirin; aspirin reduces platelet adhesiveness, contributing to bleeding. Patients should not perform vigorous exercise or lift weights. If the patient is weak and at risk for falling, supervise the patient when out of bed. Patients should be instructed not to shave with a blade; an electric razor should be used.

In a severely anemic patient, you expect to find A. dyspnea and tachycardia. B. cyanosis and pulmonary edema. C. cardiomegaly and pulmonary fibrosis. D. ventricular dysrhythmias and wheezing.

A. dyspnea and tachycardia. Patients with severe anemia (hemoglobin <6 g/dL) exhibit the following cardiovascular and pulmonary manifestations: tachycardia, increased pulse pressure, systolic murmurs, intermittent claudication, angina, heart failure, myocardial infarction; tachypnea, orthopnea, dyspnea at rest.

A complication of the hyperviscosity of polycythemia is A. thrombosis. B. cardiomyopathy. C. pulmonary edema. D. disseminated intravascular coagulation (DIC).

A. thrombosis. Thrombosis is the most likely complication. The patient with polycythemia may experience angina, heart failure, intermittent claudication, and thrombophlebitis, which may be complicated by embolization. The most common and serious acute complication is stroke due to thrombosis.

Which findings do you expect to find for a patient with acute loss of blood? A. Weakness, lethargy, and warm, dry skin B. Restlessness, hyperthermia, and bradycardia C. Tachycardia, hypotension, and cool, clammy skin D. Widened pulse pressure, anxiety, and hypoventilation

C. Tachycardia, hypotension, and cool, clammy skin Tachycardia, hypotension, and cool, clammy skin can be found in a person who has had an acute loss of blood. These are manifestations of hypovolemic shock. A person with a bleeding peptic ulcer who had a 750-mL hematemesis (15% of a normal total blood volume) within the past 30 minutes may have postural hypotension. Because blood is shunted to major organs, the skin in the periphery is cool to the touch. Tachycardia is the body's attempt to maintain adequate cardiac output.

"The nurse is caring for a patient who is to receive a transfusion of two units of packed red blood cells. After obtaining the first unit from the blood bank, the nurse would ask which of the following health team members in the nurses' station to assist in checking the unit before adiminstration? A: Unit Secretary B: A Phlebotomist C: A Physician's Assistant D: Another Registered Nurse

Correct: D Before hanging a transfusion, the registered nurse must check the unit with ANOTHER RN or with a licensed practical (vocational) nurse, depending on agency policy. Checking blood products is not in the unit secretary's or phlebotimist's scope of practice. The physician assistant is not another RN or licensed practical nurse.

A patient with pernicious anemia is ordered to receive supplementary Vitamin B12. What is the best route to administer this medication for patients with this disorder?* A. Intravenous B. Orally C. Through a central line D. Intramuscular

D

The nurse determines that a client is having a transfusion reaction. After the nurse stops the transfusion, which action should be taken NEXT? 1) Remove the intravenous (IV) line. 2) Run a solution of 5% dextrose in water. 3) Run normal saline at a keep-vein-open rate. 4) Obtain a culture of the tip of the catheter device removed from the client.

3) Run normal saline at a keep-vein-open rate. Rationale: If the nurse suspects a transfusion reaction, the nurse stops the transfusion and infuses normal saline at a keep-vein-open rate pending further health care provider prescriptions. This maintains a patent IV access line and aids in maintaining the client's intravascular volume. The nurse would NOT remove the IV line because then there would be no IV access route. Obtaining a culture of the tip of the catheter device removed from the client is incorrect. First, the catheter should NOT be removed. Second, cultures are performed when infection, NOT transfusion reactions, is suspected. Normal saline is the solution of choice over solutions containing dextrose because saline does not cause red blood cells to clump.

The nurse is caring for Susan, a young adult female client, in the healthcare provider's office. She has symptoms of "feeling tired" and "having no energy."The nurse questions if Susan may be experiencing anemia. Which symptoms should the nurse evaluate for? Select all that apply. a. Fatigue b. Hypokalemia c. Pallor d. Tachycardia e. Constipation f. Tachypnea g. Dehydration h. Shortness of breath

a. Fatigue c. Pallor d. Tachycardia f. Tachypnea h. Shortness of breath Rationale: Common general signs and symptoms of most types of anemia include fatigue, pallor, tachycardia, tachypnea, and shortness of breath. The oxygen-carrying capacity of the blood is impacted by the decreased hemoglobin and lack of red blood cells. It is uncommon for a client with anemia to have hypokalemia, constipation, or dehydration directly related to the anemia.

The nurse understands that anemia has many possible etiologies. Which can cause anemia? Select all that apply. a. Diet low in vitamin D b. Reduction in the number of red blood cells c. Inability of the body to absorb vitamin B12 d. Reduction in hemoglobin e. Excess amount of folic acid in the body

b. Reduction in the number of red blood cells c. Inability of the body to absorb vitamin B12 d. Reduction in hemoglobin