Prep U Unit 7

The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan?

"Chronic leukemia develops slowly."

A client's family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC?

"DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs."

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?

"I will receive parenteral vitamin B12 therapy for the rest of my life."

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 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?

Disconnect the blood tubing, flush with normal saline, and administer morphine

The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has?

A general reduction in all white blood cells

The nurse and the client are discussing some strategies for ingesting iron to combat the client's iron-deficiency anemia. Which is among the nurse's strategies?

Drink liquid iron preparations with a straw.

A client with sickle cell crisis is admitted to the hospital in severe pain. While caring for the client during the crisis, which is the priority nursing intervention?

Administering and evaluating the effectiveness of opioid analgesics

A nurse is assigned to care for a patient with ascites, secondary to cirrhosis. The nurse understands that the fluid accumulation in the peritoneal cavity results from a combination of factors including an alteration in oncotic pressure gradients and increased capillary permeability. Therefore, the nurse monitors the serum level of the plasma protein responsible for maintaining oncotic pressure, which is:

Albumin.

A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia?

Dyspnea, tachycardia, and pallor

The physician performs a bone marrow biopsy from the posterior iliac crest on a client with pancytopenia. What intervention should the nurse perform after the procedure?

Apply pressure over the site for 5-7 minutes

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia?

Apply prolonged pressure to needle sites or other sources of external bleeding

A nurse caring for a client who has hemophilia is getting ready to take the client's vital signs. What should the nurse do before taking a blood pressure?

Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints.

The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency?

B12

The nurse suspects that a client has multiple myeloma based on the client's major presenting symptom and the analysis of laboratory results. What classic symptom for multiple myeloma does the nurse assess for?

Bone pain in the back of the ribs

Which is a symptom of hemochromatosis?

Bronzing of skin

The nurse is educating a client about iron supplements. The nurse teaches that what vitamin enhances the absorption of iron?

C

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

Erythropoietin

A nurse is completing a detailed health history and assessment in the electronic medical record (EMR) for a client with a disorder of the hematopoietic system. Which symptom is the most commonly reported in association with hematologic diseases?

Extreme fatigue

A nurse administers blood products to a client with Hodgkin disease. During the administration, the nurse notes the client has a fever and diffuse reddened skin rash. From what condition does the nurse suspect the client is suffering?

Graft-versus-host disease

When assessing a client with anemia, which assessment is essential?

Health history, including menstrual history in women

When assessing a female client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential?

Health history, such as bleeding, fatigue, or fainting

A client complains of extreme fatigue. Which system should the nurse suspect is most likely affected?

Hematological

A client with a history of sickle cell anemia has developed iron overload from repeated blood transfusions. What treatment does the nurse anticipate will be prescribed?

Chelation therapy

Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents?

Hypochromic

A nurse provides nutritional information for a patient diagnosed with an iron-deficiency anemia. What education should the nurse provide?

Increase the intake of green, leafy vegetables

A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor?

Decreased level of erythropoietin

A patient with acute myeloid leukemia (AML) has a neutrophil count that persists at less than 100/mm3. What should the nurse cautiously monitor this patient for?

Infection

A client in acute renal failure has been prescribed 2 units of packed red blood cells (PRBCs). The nurse explains to the client that the blood transfusion is most likely needed for which reason?

Lack of erythropoietin

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

Lateral position with one leg flexed

Which blood cell type is matched correctly with its function?

Leukocyte: Fights infection

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

Liver

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called

Megaloblasts

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?

Neutrophils

A patient receiving plasma develops transfusion-related acute lung injury (TRALI) 4 hours after the transfusion. What type of aggressive therapy does the nurse anticipate the patient will receive to prevent death from the injury? (Select all that apply.)

Oxygen Fluid support Intubation and mechanical ventilation

The hospitalized client is experiencing gastrointestinal bleeding with a platelets at 9,000/mm³. The client is receiving prednisone and azathioprine. What action will the nurse take

Perform a neurologic assessment with vital signs.

Which of the following is considered an antidote to heparin?

Protamine sulfate

An older adult client presents to the health care provider's office and reports exhaustion. The nurse, aware of the most common hematologic condition affecting the elderly, knows that which laboratory values should be assessed?

RBC count

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 client has hereditary hemochromatosis. Laboratory test results indicate an elevated serum iron level, high transferrin saturation, and normal complete blood count (CBC). What is most important action for the nurse to take?

Remove the prescribed one unit of blood.

One hour after a transfusion of packed red blood cells (RBCs) is started, a client develops redness on the trunk and reports itching. The nurse stops the RBC infusion and administers diphenhydramine 25 mg po, as ordered. Thirty minutes later, the redness and itching are gone. What action should the nurse take next?

Resume the transfusion

Which type of hemolytic anemia is categorized as inherited disorder?

Sickle cell anemia

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 lymphocyte

Which type of lymphocyte is responsible for cellular immunity?

T lymphocyte

The health care provider believes that the client has a deficiency in the leukocyte responsible for cell-mediated immunity. What should the nurse check the WBC count for?

T lymphocytes

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 assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma?

The client with enlarged lymph nodes in the neck.

After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/mm3. What term should the nurse use to describe this low platelet count?

Thrombocytopenia

A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client?

Use the smallest needle possible for injections.

A client is seen in the emergency department with severe pain related to a sickle cell crisis. What does the nurse understand is occurring with this client?

Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.

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 nurse cares for clients with hematological disorders and notes that women are diagnosed with hemochromatosis at a much lower rate than men. What is the primary reason for this?

Women lose iron through menstrual cycles

Which of the following is the most common hematologic condition affecting elderly patients

anemia

The most common cause of iron deficiency anemia in men and postmenopausal women is

bleeding

The nurse is caring for a client who had undergone hemodilution during surgery. Immediately after surgery, the nurse expects to see which lab result?

decreased hematocrit

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

decreased oxygen level

A patient with acute myeloid leukemia (AML) is having hematopoietic stem cell transplantation (HSCT) with radiation therapy. In which complication do the donor's lymphocytes recognize the patient's body as foreign and set up reactions to attack the foreign host?

graft-vs-host disease

Which term describes the percentage of blood volume that consists of erythrocytes?

hematocrit

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

iron

The nurse observes a co-worker who always seems to be eating a cup of ice. The nurse encourages the co-worker to have an examination and diagnostic workup with the health care provider. What type of anemia is the nurse concerned the co-worker may have?

iron-deficiency anemia

Which term refers to a form of white blood cell involved in immune response?

lymphocyte

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets?

myeloid stem cell

A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn's disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for?

onset of bacterial infection

A client involved in a motor vehicle accident arrives at the emergency department unconscious and severely hypotensive. The nurse suspects the client has several fractures in the pelvis and legs. Which parenteral fluid is the best choice for the client's current condition?

packed red blood cells

While assessing a client, the nurse will recognize what as the most obvious sign of anemia?

pallor

Which is a symptom of severe thrombocytopenia?

petechiae

Which is the major function of neutrophils?

phagocytosis

The nurse is performing an assessment on a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae. What laboratory study should the nurse be concerned about?

platelet count 9,000/mm3

A nurse is caring for a client with multiple myeloma. Which nursing intervention is most appropriate for this client?

prevent bone injury

A client verbalizes fear of infection from a blood transfusion. What is the nurse's best response?

"Every unit of donated blood is typed and tested for antibodies to infections."

The nurse is collecting data for a client who has been diagnosed with iron-deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia?

"I have difficulty breathing when walking 30 feet."

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."

Place the order of the steps of primary hemostasis in correct order.

1. The severed blood vessel constricts. 2. The circulating platelets aggregate at the site and adhere to the vessel. 3. An unstable hemostatic plug is formed. 4. Circulating inactive clotting factors convert to active forms.

The nurse begins a routine blood transfusion of packed red blood cells (PRBCs) at 1100. To ensure client safety, the unit of blood should be completely transfused by what time?

1500

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

A nurse is preparing a dose of furosemide for an older adult with heart failure. The health care provider orders furosemide 1 mg/kg to be given intravenously. The client weighs 50 kg. The concentration of the drug is 40 mg/4mL (10 mg/mL). How many milliliters would the nurse administer? Record your answer using a whole number.

5

A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the health care provider immediately because the client probably is experiencing which problem?

A hemolytic allergic reaction caused by an antigen reaction

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?

Ensure there is an oxygen delivery device at the bedside.

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

The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia?

Erythrocytes that are microcytic and hypochromic

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?

Iron

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

During preparation for bowel surgery, a client receives an antibiotic to reduce intestinal bacteria. The nurse knows that hypoprothrombinemia may occur as a result of antibiotic therapy interfering with synthesis of which vitamin?

Vitamin K

A nurse is transfusing whole blood to a client with impaired renal function. During the transfusion, the client tells the nurse, "I feel very short of breath all of a sudden." What is the nurse's primary action?

stop the infusion

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?

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

A nurse reviews the laboratory results of a client with polycythemia vera. Which findings will the nurse find? Select all that apply.

Decreased erythropoietin Increased hemoglobin

The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions?

Dilute the liquid preparation with another liquid such as juice and drink with a straw.

The nurse is educating a patient with iron deficiency anemia about food sources high in iron and how to enhance the absorption of iron when eating these foods. What can the nurse inform the client would enhance the absorption?

Eating calf's liver with a glass of orange juice

A thin client is prescribed iron dextran intramuscularly. What is most important action taken by the nurse when administering this medication?

Employs the Z-track technique

A client wants to donate blood before his or her abdominal surgery next week. What should be the nurse's first action?

Explain the time frame needed for autologous donation.

What assessment finding best indicates that the client has recovered from induction therapy?

Neutrophil and platelet counts within normal limits

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?

hemorrhage

A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see?

hypercalemia

A client with severe anemia reports symptoms of tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Laboratory test results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which nursing diagnoses is most appropriate for this client?

Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit

A client receiving a blood transfusion experiences an acute hemolytic reaction. What is the nurse's priority intervention?

Immediately stop the transfusion, infuse normal saline solution, call the health care provider, and notify the blood bank.

A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal?

maintain nutrition

Which statement best describes the function of stem cells in the bone marrow?

they produce all blood cells

A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify?

Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels

A client was admitted to the hospital with a pathologic pelvic fracture. The client informs the nurse that he has been having a strange pain in the pelvic area for a couple of weeks that was getting worse with activity prior to the fracture. What does the nurse suspect may be occurring based on these symptoms?

Multiple myeloma

The nursing instructor is discussing disorders of the hematopoietic system with the pre-nursing pathophysiology class. What disease would the instructor list with a primary characteristic of erythrocytosis?

Polycythemia vera

A client awaiting a bone marrow aspiration asks the nurse to explain where on the body the procedure will take place. What body part does the nurse identify for the client?

Posterior iliac crest

The nurse recognizes the clinical assessment of a patient with acute myeloid leukemia (AML) includes observing for signs of infection early. What nursing action will most likely help prevent infection?

Practice vigilant handwashing.

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

Which medication is the antidote to warfarin?

Vitamin K

A client is prescribed 325 mg/day of oral ferrous sulfate. What does the nurse include in client teaching?

take 1 hour before breakfast