Chapter 19: PrepU - Nursing Assessment: Hematologic Function
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? 1- Basophils 2- Neutrophils 3- Eosinophils 4- Monocytes
2
Which client is not a candidate for blood donation according to the American Heart Association? 1- 86 year old male with blood pressure 110/70 mmHg 2- 50 year old female with pulse 95 beats/minute 3- 26 year old female with hemoglobin 11.0 g/dL 4- 18 year old male weighing 52 kg.
3
A nurse is reading a journal article about white blood cells and how they function. The nurse demonstrates understanding of the article by identifying which white blood cell as a granulocyte? Select all that apply. 1- monocytes 2- lymphocytes 3- eosinophils 4- basophils 5- neutrophils
3,4,5
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? 1- Hemorrhage 2- Blood transfusion reaction 3- Shock 4- Splintering of bone fragments
1
A nurse is providing care to a cancer client. Which protein in plasma functions primarily as immunologic agents? 1- Gamma globulins 2- Albumin 3- Fibrinogen 4- Beta globulins
1
A patient's most recent complete blood count (CBC) reveals that her mean corpuscular volume (MCV) is well below reference ranges. The nurse should identify what potential contributing factor for this phenomenon? 1- The woman has an iron deficiency. 2- The woman has been exposed to carbon monoxide at some point in the past. 3- The woman is experiencing nephrotoxicity. 4- The woman's oxygen demands are currently lower than normal.
1
Dennis Morgan, a 49-year-old chef, is a client of the primary care group where you practice nursing. Dennis has been studying up on blood cell production since the development of his blood disorder. At each appointment, he tries to fool you, his nurse, with blood cell trivia. His latest question: "Which of the following cell types are produced from pluripotential stem cells?" Your response is: 1- All options are correct. 2- Erythrocytes 3- Platelets 4- Lymphocytes
1
Normal platelet count
150,000-400,000
Which term refers to a form of white blood cell involved in immune response? 1- Granulocyte 2- Lymphocyte 3- Spherocyte 4- Thrombocyte
2
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? 1- Notify the physician 2- Administer aspirin (ASA) 325 mg po, as ordered 3- Administer acetaminophen 500 mg po, as ordered 4- Reposition the client to a high Fowler position and continue to monitor the pain
3
A nurse is reviewing the complete blood count with differential for a client with severe allergies. Which white blood cell would the nurse expect to be elevated? 1- neutrophil 2- monocyte 3- eosinophil 4- lymphocyte
3
A public health nurse is planning community teaching for a group of older adults regarding aging and hematological conditions. What condition will the nurse identify as most common among this population? 1- Leukemia 2- Thalassemia 3- Anemia 4- Lymphopenia
3
Normal RBC count
4-6 million
Thrombocytopenia
deficiency of clotting cells
A client is scheduled to undergo a bone marrow aspiration and biopsy. The nurse understands that which site would most likely be used? 1- posterior iliac crest 2- sternum 3- rib 4- femur
1
Granulocytes
neutrophils, eosinophils, basophils
A 44-year-old man with a longstanding diagnosis of AIDS has been admitted to the hospital with an absolute neutrophil count (ANC) of 385/mm3. When planning the patient's care, what action should the nurse prioritize? 1- Placing the patient on protective isolation precautions 2- Obtaining the patient's blood type and cross-match in anticipation of transfusion 3- Providing the patient with supplementary oxygen by simple face mask 4- Padding hard surfaces on the patient's bed to reduce the risk of injury
1
A client informs the nurse that he is having a difficult time coping with seasonal allergies and has taken some over-the-counter medications to assist with control of symptoms. What results would indicate to the nurse that the client does have allergies? 1- Elevated eosinophils 2- Elevated basophils 3- Elevated monocytes 4- Elevated neutrophils
1
A client's family member asks what hematopoiesis is. What should the nurse tell the family member? 1- The manufacture and development of blood cells 2- The production of lymphatic fluid in the body 3- The making of red blood cells and lymph 4- The development of lymph in the bone marrow
1
The nurse should provide further teaching about post bone-marrow biopsy procedures when the client makes which statement? 1- "I'll ask someone to drive me home when I awake from general anesthesia." 2- "I should not take aspirin-containing products for pain relief." 3- "I may feel some aching in my hip for 1-2 days." 4- "I will keep the sterile dressing on until my doctor tells me it's okay to remove it."
1
Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? 1- Myeloid stem cell 2- Lymphoid stem cell 3- Monocyte 4- Neutrophil
1
Which cells are called white blood cells? 1- Leukocytes 2- Lymphocytes 3- Erythrocytes 4- Platelets
1
Which cells have the lifespan of approximately 7.5 days and one-third of their population remains in the spleen (unless needed to fight significant bleeding)? 1- Platelets 2- Leukocytes 3- Erythrocytes 4- Lymphocytes
1
Which cells have the major function of transporting O2 to and removing CO2 from tissues? 1- erythrocytes 2- platelets 3- leukocytes 4- lymphocytes
1
Which is a symptom of severe thrombocytopenia? 1- Petechiae 2- Inflammation of the mouth 3- Inflammation of the tongue 4- Dyspnea
1
Which protein in plasma functions primarily as immunologic agents? 1- Gamma globulins 2- Albumin 3- Fibrinogen 4- Beta globulins
1
Which type of leukocyte contains histamine and is an important part of hypersensitivity reactions? 1- Basophils 2- B lymphocyte 3- Plasma cell 4- Neutrophil
1
While performing a morning assessment of an elderly patient on a subacute medical unit, the nurse notes petechiae on a patient's lower extremities. When checking this patient's most recent blood work, the nurse should pay particular attention to the patient's level of: 1- Platelets 2- Neutrophils 3- Iron 4- Albumin
1
A 75-year-old woman visited her health care provider for an annual check-up. She told the doctor that she feels exhausted all the time and barely has the energy to go out of her home, run errands, and visit friends. The nurse expects that the health care provider will order which of the following lab studies based on the most common hematologic condition affecting the elderly? 1- White blood count 2- Complete blood count 3- Thrombocyte count 4- Level of B lymphocytes
2
A nurse is preparing a review class about hematologic problems for a group of nurses working at the clinic. As part of the class, the nurse is describing the process by which the body continuously replenishes the supply of blood cells. The nurse is describing which process? 1- hemostasis 2- hematopoiesis 3- neutropenia 4- phagocytosis
2
A patient has asked the nurse about the clotting cascade, and the nurse explains that plasminogen is a component necessary in the clotting cascade. Where in the body is plasminogen present? 1- Myocardial muscle tissue 2- All body fluids 3- Cerebral tissue 4- Renal cells
2
A patient with a diagnosis of HIV exhibits a decreased level of T lymphocytes. What consequence does this state present for this patient? 1- The patient will be incapable of mounting a response to allergens. 2- The patient is particularly susceptible to infection. 3- The patient has diminished oxygen-carrying capacity. 4- The patient will be unable to maintain hemostasis.
2
The nurse is aware that a patient has been diagnosed with thrombocytopenia. Which of the following is the most typical first indicator of the diagnosis that a patient will exhibit? 1- Fatigue 2- Petechiae 3- Hypotension 4- Tachycardia
2
The nurse is caring for a client with a lymphatic system disorder. What physical assessment is a priority for the nurse to perform? 1- Examine the color and quantity of urine. 2- Inspect the tonsils for size and appearance. 3- Frequently examine and record blood pressure. 4- Examine for any signs of physical injury.
2
When administering a blood transfusion to a client with multiple traumatic injuries, the nurse monitors closely for evidence of a transfusion reaction. Shortly after the transfusion begins, the client complains of chest pain, nausea, and itching. When urticaria, tachycardia, and hypotension develop, the nurse stops the transfusion and notifies the physician. The nurse suspects which type of hypersensitivity reaction? 1- Type I (immediate, anaphylactic) hypersensitivity reaction 2- Type II (cytolytic, cytotoxic) hypersensitivity reaction 3- Type III (immune complex) hypersensitivity reaction 4- Type IV (cell-mediated, delayed) hypersensitivity reaction
2
Which finding should a nurse identify as requiring further investigation? 1- Red blood cell (RBC) count of 4.9 million/mm3 2- Platelet count of 115,000/mm3 3- White blood cell (WBC) count of 7,000/mm3 4- Hematocrit of 45%
2
The nurse is reviewing a client's laboratory test results and notes that the client's hematocrit is increased. The nurse suspects hemoconcentration related to dehydration. Which assessment finding would support the nurse's suspicion? Select all that apply. 1- increased pulse pressure 2- elevated urine specific gravity 3- tachycardia 4- weight gain 5- slow skin turgor
2,3,5
Albumin is a protein in the plasma portion of the blood. Under normal conditions, albumin cannot pass through the wall of a capillary. What significance is this for the vascular compartment? 1- Helps push oxygen into the tissues of the body 2- Retains leukocytes in the vascular compartment 3- Helps retain fluid in the vascular compartment 4- Absorbs carbon dioxide from the tissues for transport to the lungs
3
The nurse is observing the skin of a client who is taking medications that depress the hematopoietic system and notices multiple areas of ecchymosis on the arms; bleeding for a prolonged period after an IV was started; and reports of black, tarry stool. What does the nurse understand may be a side effect of this medication that the client displays? 1- Leukocytosis 2- Leukopenia 3- Thrombocytopenia 4- Neutropenia
3
The nurse is preparing the client for a bone marrow aspiration at the posterior iliac crest. What would be the best position for the nurse to place the client in for the test? 1- Head of the bed in a 90° semi-Fowler's position 2- Prone position 3- On the side opposite the aspiration site 4- Lithotomy position
3
The nurse is providing patient education in anticipation of the patient's scheduled bone marrow aspiration and biopsy. When teaching the patient about care after the procedure, the nurse should encourage the patient to do which of the following? 1- Take aspirin to alleviate pain. 2- Remain on bed rest for 24 to 36 hours after the procedure. 3- Avoid bathing until the site heals. 4- Avoid the use of oral analgesics.
3
A client will be having a bone marrow aspiration to determine the status of bloodcell formation. What role does the nurse have during the test? 1- Inject the anesthetic so the client will have no sensation of pain. 2- The nurse explains the procedure to the client and obtains the informed consent. 3- The nurse sets up the equipment for the physician and then must leave the room to allow for privacy. 4- The nurse assists the physician and supports the client during the procedure.
4
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? 1- Monocytes 2- B lymphocytes 3- Leukocytes 4- T lymphocytes
4
Both the liver and the spleen have a role in erythrocyte metabolism. How would this role best be described? 1- The spleen helps in creating mature erythrocytes. 2- The liver generates erythropoietin which regulates the rate of erythrocyte production. 3- The spleen stores the iron component of hemoglobin from erythrocytes and returns it to the red marrow. 4- The spleen removes erythrocytes after 120 days, and the liver removes severely damaged erythrocytes.
4
Plasma proteins play an essential role in maintaining water balance and blood pressure. Select the laboratory analysis that a nurse should review to check the levels of the most abundant plasma protein. 1- Fibrinogen 2- Prothrombin 3- Gamma globulin 4- Albumin
4
What factor in plasma can be transformed from a liquid to a solid? 1- Globulins 2- Albumin 3- Leukocytes 4- Fibrinogen
4
Why would it be important for the nurse to obtain information regarding dietary history of a client with a possible abnormality of the hematopoietic or lymphatic system? 1- It could determine if the illness is self-induced by nutritional starvation. 2- If the client has impaired protein intake, it will cause diseases of the hematopoietic system. 3- Altered nutrition is the cause of abnormalities of the hematopoietic and lymphatic system. 4- Compromised nutrition interferes with production of blood cells and hemoglobin.
4
In the surgical group where you practice nursing, knowledge regarding hematopoiesis is used frequently in regards to client post-surgical care. Which of the following is true for the variation in the normal number of erythrocytes? 1- People who engage in strenuous activity have an increased number of erythrocytes 2- Infants have fewer erythrocytes than adults 3- Women have more erythrocytes than men 4- People who live at higher altitudes have a decreased number of erythrocytes
1
The nurse is caring for a client with hypoxia. What does the nurse understand is true regarding the client's oxygen level and the production of red blood cells? 1- The kidneys sense low oxygen levels in the blood and stimulate erythropoietin, stimulating the marrow to produce more red blood cells. 2- The bone marrow is stimulated by low oxygen levels in the blood and stimulates erythropoietin, maturing the red blood cells. 3- The brain senses low oxygen levels in the blood and stimulates hemoglobin, which binds to more red blood cells. 4- The kidneys sense low oxygen levels in the blood and stimulate hemoglobin, stimulating the marrow to produce more red blood cells.
1
The nurse is caring for a client who is undergoing bone marrow aspiration to determine the blood cell formation status. What nursing intervention should the nurse provide to the client during the test? 1- Administer oral radioactive vitamin B12 to the client. 2- Administer a nonradioactive B12 injection. 3- Collect urine for 24 to 48 hours after the client receives the nonradioactive B12. 4- Support the client and monitor the status.
4
The nurse is inspecting the tonsils for a client with a fever and sore throat. The nurse observes purulent exudate on the surface of the tonsils. What does this finding indicate to the nurse? 1- Filariasis 2- Thrush 3- An abscess 4- Tonsillitis
4