Brunner Review Ch. 28

Which term refers to a form of white blood cell involved in immune response? a. Lymphocyte b. Spherocyte c. Thrombocyte d. Granulocyte

A Rationale: Both B and T lymphocytes respond to exposure to antigens. Granulocytes include basophils, neutrophils, and eosinophils. A spherocyte is a red blood cell without central pallor, seen with hemolysis. A thrombocyte is a platelet.

Which term describes the percentage of blood volume that consists of erythrocytes? a. Hematocrit b. Hemoglobin c. Erythrocyte sedimentation rate (ESR) d. Differentiation

A Rationale: Hematocrit is the percentage of blood volume consisting of erythrocytes. Differentiation is the development of functions and characteristics that differ from those of the parent stem cell. ESR is a laboratory test that measures the rate of settling of red blood cells (RBCs); an elevated rate is indicative of inflammation. Hemoglobin is the iron-containing protein of RBCs.

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? a. Severe headaches b. Extreme fatigue c. Blurred vision d. Dyspnea

B Rationale: When assessing a client with a disorder of the hematopoietic system, it is essential to assess for the most common symptom in hematologic diseases, which is extreme fatigue.

Which is a symptom of severe thrombocytopenia? a. Inflammation of the tongue b. Dyspnea c. Petechiae d. Inflammation of the mouth

C Rationale: Clients with severe thrombocytopenia have petechiae, which are pinpoint hemorrhagic lesions, usually more prominent on the trunk or anterior aspects of the lower extremities.

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? a. Neutrophil b. Monocyte c. Myeloid stem cell d. Lymphoid stem cell

C Rationale: The myeloid stem cell is responsible not only for all nonlymphoid white blood cells, but also for the production of red blood cells and platelets. Lymphoid cells produce either T or B lymphocytes. A monocyte is large WBC that becomes a macrophage when is leaves the circulation and moves into body tissues. A neutrophil is a fully mature WBC capable of phagocytosis.

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

D Rationale: T lymphocytes are responsible for delayed allergic reactions, rejection of foreign tissue (e.g., transplanted organs), and destruction of tumor cells. This process is known as cellular immunity. B lymphocytes are responsible for humoral immunity. A plasma cell secretes immunoglobulin. A basophil contains histamine and is an integral part of hypersensitivity reactions.

A client who has idiopathic thrombocytopenia purpura (ITP) has a critically low platelet count. Which nursing intervention will be included in the care plan for this client? a. Place the client in a private room b. Enforce strict contact isolation c. Administer epoetin alfa d. Administer eltrombopag

D Rationale: Thrombopoietin (TPO) is a cytokine that is necessary for the proliferation of megakaryocytes and subsequent platelet formation. Nonimmunogenic second-generation thrombopoietic growth factors (romiplostim and eltrombopag) were recently approved for the treatment of idiopathic thrombocytopenia purpura.

Which term refers to the percentage of blood volume that consists of erythrocytes? a. Erythrocyte sedimentation rate (ESR) b. Hematocrit c. Hemoglobin d. Differentiation

B Rationale: Hematocrit is the percentage of blood volume consisting of erythrocytes. Differentiation is development of functions and characteristics that differ from those of the parent stem cell. ESR is a laboratory test that measures the rate of settling of RBCs; an elevated rate is indicative of inflammation. Hemoglobin is the iron-containing protein of RBCs.

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

D Rationale: Fibrinogen, the largest share of plasma protein, plays a key role in forming blood clots. It can be transformed from a liquid to fibrin, a solid that controls bleeding. Globulins function primarily as immunologic agents by preventing or modifying some types of infectious diseases. On the other hand, albumin helps maintain the osmotic pressure that retains fluid in the vascular compartment.

A nurse is reviewing a client's morning laboratory results and notes a left shift in the band cells. Based on this result, the nurse can interpret that the client... a. may be developing anemia. b. has leukopenia. c. has thrombocytopenia. d. may be developing an infection.

D Rationale: Less mature granulocytes have a single-lobed, elongated nucleus and are called band cells. Ordinarily, band cells account for only a small percentage of circulating granulocytes, although their percentage can increase greatly under conditions in which neutrophil production increases, such as infection. An increased number of band cells is sometimes called a left shift or shift to the left. Anemia refers to decreased red cell mass. Leukopenia refers to a less-than-normal amount of white blood cells in circulation. Thrombocytopenia refers to a lower-than-normal platelet count.

Which is the major function of neutrophils? a. Production of immunoglobulins b. Rejection of foreign tissue c. Destruction of tumor cells d. Phagocytosis

D Rationale: Once a neutrophil is released from the marrow into the circulation, it stays there for only about 6 hours before it migrates into the body tissues to perform its function of phagocytosis (ingestion and digestion of bacteria and particles). Neutrophils die there within 1 to 2 days. T lymphocytes are responsible for rejection of foreign tissue and destruction of tumor cells. Plasma cells produce antibodies called immunoglobulins.

The physician orders a transfusion with packed red blood cells (RBCs) for a client hospitalized with severe iron deficiency anemia. When blood is administered, what is the most important action the nurse can take to prevent a transfusion reaction? a. Administer the blood as soon as it arrives b. Premedicate the client with acetaminophen c. Verify the client's identity according to hospital policy d. Assess the client 30 minutes after the start of the initial transfusion

C Rationale: Acute hemolytic transfusion reactions are preventable. Improper identification is responsible for the majority of hemolytic transfusion reactions. Meticulous attention to detail in labeling blood samples and blood components and accurately identifying the recipient cannot be overemphasized. It is the nurse's responsibility to ensure that the correct blood component is transfused to the correct client. The nurse must assess the client during the initial start of the transfusion and frequently, if the nurses delays the assessment time for 30 minutes the client may have begun to experience acute hemolytic transfusion reaction, this puts the client's safety at risk.

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

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

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? a. Position the client in an upright position with the feet in a dependent position b. Send the blood back to the blood bank c. Resume the transfusion d. Obtain blood and urine samples from the client

C Rationale: Some clients develop urticaria (hives) or generalized itching during a transfusion. The cause of these reactions is thought to be a sensitivity reaction to a plasma protein within the blood component being transfused. Symptoms of an allergic reaction are urticaria, itching, and flushing. The reactions are usually mild and respond to antihistamines. If the symptoms resolve after administration of an antihistamine (e.g., diphenhydramine), the transfusion may be resumed.

During a blood transfusion with packed red blood cells (RBCs), a client reports chills, low back pain, and nausea. What priority action should the nurse take? a. Slow the infusion rate and continue to monitor the client every 15 minutes b. Discontinue the infusion immediately and notify the physician c. Discontinue the infusion immediately and maintain the IV line with normal saline solution using new IV tubing d. Observe for additional symptoms and notify the physician

C Rationale: The following steps are taken to determine the type and severity of the reaction: Stop the transfusion. Maintain the IV line with normal saline solution through new IV tubing, administered at a slow rate. Assess the client carefully. Notify the physician. Continue to monitor the client's vital signs and respiratory, cardiovascular, and renal status. Notify the blood bank that a suspected transfusion reaction has occurred. Send the blood container and tubing to the blood bank for repeat typing and culture.

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? a. 18:00:00 b. 15:00:00 c. 16:00:00 d. 14:00:00

C Rationale: When packed red blood cells (PRBCs) or whole blood is transfused, the blood should be administered within a 4-hour period because warm room temperatures promote bacterial growth.

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

A Rationale: In adults with disease that destroy marrow or cause fibrosis or scarring, the liver and spleen can also resume production of blood cells through a process known as extramedullary hematopoiesis.

The nurse is completing a pretransfusion assessment to determine a female client's history of previous transfusions as well as previous reactions to transfusions. Which is the most important information to obtain from this client before the transfusion? a. Number of pregnancies b. Age c. Family history of transfusion reactions d. Diagnosis

A Rationale: The history should include the type of reaction, its manifestations, the interventions required, and whether any preventive interventions were used in subsequent transfusions. The nurse assesses the number of pregnancies a woman has had because a high number can increase her risk of reaction due to antibodies developed from exposure to fetal circulation. Other concurrent health problems should be noted, with careful attention paid to cardiac, pulmonary, and vascular diseases.

Which term refers to a form of white blood cell involved in immune response? a. Spherocyte b. Lymphocyte c. Granulocyte d. Thrombocyte

B Rationale: Both B and T lymphocytes respond to exposure to antigens. Granulocytes include basophils, neutrophils, and eosinophils. A spherocyte is a red blood cell without central pallor, seen with hemolysis. A thrombocyte is a platelet.

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? a. Sargramostim b. Epoetin alfa c. Filgrastim d. Eltrombopag

B Rationale: Erythropoietin (epoetin alfa) is an effective alternative treatment for clients with chronic anemia secondary to diminished levels of erythropoietin. This medication stimulates erythropoiesis. Filgratism ( Neupogen) and Sargramostim stimulate granulocytosis( increasing WBC count) , Eltrombopag (Promacta) is used to treat aplastic anemia and thrombocytopenia.

The nurse recognizes that the most common cause of iron deficiency anemia in an adult is a. iron malabsorption. b. bleeding. c. lack of dietary iron. d. chronic alcoholism.

B Rationale: Iron deficiency in adults generally indicates blood loss (e.g., from bleeding in the gastrointestinal (GI) tract or heavy menstrual flow). Lack of dietary iron is rarely the sole cause of iron deficiency anemia in adults. The source of iron deficiency should be investigated promptly because iron deficiency in an adult may be a sign of bleeding in the GI tract or colon cancer.

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? a. Lymphoid stem cell b. Myeloid stem cell c. Monocyte d. Neutrophil

B Rationale: Myeloid stem cells are responsible not only for all nonlymphoid white blood cells (WBC) but also for the production of red blood cells and platelets. Lymphoid cells produce either T or B lymphocytes. A monocyte is large WBC that becomes a macrophage when is leaves the circulation and moves into body tissues, and not responsible for RBC production.. A neutrophil is a fully mature WBC capable of phagocytosis and not responsible for RBC production.

A nurse is teaching a client with a vitamin B12 deficiency about appropriate food choices to increase the amount of B12 ingested with each meal. The nurse knows the teaching is effective based on which statement by the client? a. "I will increase my daily intake of orange vegetables such as sweet potatoes and carrots." b. "I will eat a meat source such as chicken or pork with each meal." c. "I will eat a spinach salad with lunch and dinner." d. "I will eat more dairy products such as milk, yogurt, and ice cream every day."

B Rationale: Vitamin B12 is found only in foods of animal origin. The other choices do not include meats. Dairy products contain large amounts of Calcium and vitamin D. Orange vegetables contain large amounts of vitamin A.

A client with Hodgkin disease had a bone marrow biopsy yesterday and reports aching at the biopsy site, rated a 5 (on a 1-10 scale). After assessing the biopsy site, which nursing intervention is most appropriate? a. Notify the physician b. Reposition the client to a high Fowler position and continue to monitor the pain c. Administer acetaminophen 500 mg po, as ordered d. Administer aspirin (ASA) 325 mg po, as ordered

C Rationale: After a marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing. Most clients have no discomfort after a bone marrow biopsy, but the site of a biopsy may ache for 1 or 2 days. Warm tub baths and a mild analgesic agent (e.g., acetaminophen) may be useful. Aspirin-containing analgesic agents should be avoided it the immediate post-procedure period because they can aggravate or potentiate bleeding.

Which nursing intervention should be incorporated into the plan of care for a client with impaired liver function and a low albumin concentration? a. Monitor temperature at least once per shift b. Implement neutropenic precautions c. Monitor for edema at least once per shift d. Apply prolonged pressure to needle sites or other sources of external bleeding

C Rationale: Albumin is particularly important for the maintenance of fluid balance within the vascular system. Capillary walls are impermeable to albumin, so its presence in the plasma creates an osmotic force that keeps fluid within the vascular space. Clients with impaired hepatic function may have low concentrations of albumin, with a resultant decrease in osmotic pressure and the development of edema.

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? a. Vitamin C deficiency b. Vitamin A deficiency c. Vitamin B12 deficiency d. Folic acid deficiency

C Rationale: Because vitamin B12 is found only in foods of animal origin, strict vegetarians may ingest little vitamin B12. Vitamin B12 combines with intrinsic factor produced in the stomach. The vitamin B12-intrinsic factor complex is absorbed in the distal ileum. Clients who have had a partial or total gastrectomy may have limited amounts of intrinsic factor, and therefore the absorption of vitamin B12 may be diminished. The effects of either decreased absorption or decreased intake of vitamin B12 are not apparent for 2-4 years. This results in megaloblastic anemia. Some symptoms are a smooth, beefy red, enlarged tongue and cranial nerve deficiencies.

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? a. Administer a topical analgesic to control pain at the site b. Pack the wound with half-inch sterile gauze c. Apply pressure over the site for 5-7 minutes d. Elevate the head of the bed to 45 degrees

C Rationale: Hazards of either bone marrow aspiration or biopsy include bleeding and infection. The risk of bleeding is somewhat increased if the client's platelet count is low or if the client has been taking a medication (e.g., aspirin) that alters platelet function. After the marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing.

One hour after the completion of a fresh frozen plasma transfusion, a client reports shortness of breath and is very anxious. The client's vital signs are BP 98/60, HR 110, temperature 99.4°F, and SaO2 88%. Auscultation of the lungs reveals posterior coarse crackles to the mid and lower lobes bilaterally. Based on the symptoms, the nurse suspects the client is experiencing which problem? a. Delayed hemolytic reaction b. Exacerbation of congestive heart failure c. Bacterial contamination of blood d. Transfusion-related acute lung injury

D Rationale: Transfusion-related acute lung injury (TRALI) is a potentially fatal, idiosyncratic reaction that is defined as the development of acute lung injury within 6 hours after a blood transfusion. It is more likely to occur when plasma and platelets are transfused. Onset is abrupt (usually within 6 hours of transfusion, often within 2 hours). Signs and symptoms include acute shortness of breath, hypoxia (arterial oxygen saturation [SaO2] less than 90%; pressure of arterial oxygen [PaO2] to fraction of inspired oxygen [FIO2] ratio less than 300), hypotension, fever, and eventual pulmonary edema.