Chapter 30: Introduction to the Hematopoietic and Lymphatic Systems
A nurse in the ED is caring for a trauma client following a motor vehicle accident. The client's blood donor card indicates type AB blood. People with type AB blood are: a. universal recipients. b. universal donors. c. only able to receive type A and type B blood. d. only able to receive type O blood.
a
Which of the following signs would the nurse recognize as signs of leukopenia? Select all that apply. a. Fever b. Sore throat c. Chills d. Oozing from injection sites e. Dark, tarry stools
a, b, c Signs of leukopenia are fever, sore throat, and chills. Oozing from injection sites and dark, tarry stools are signs of thrombocytopenia.
A client's health history reveals daily consumption of two to three bottles of wine. The nurse should plan assessments and interventions in light of the client's increased risk for what hematologic disorder? a. Leukemia b. Anemia c. Thrombocytopenia d. Lymphoma
b Heavy alcohol use is associated with numerous health problems, including anemia. Leukemia and lymphoma are not associated with alcohol use; RBC levels are typically affected more than platelet levels.
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. Filgrastim b. Sargramostim c. Epoetin alfa d. Eltrombopag
c
Using a penlight and tongue blade, the nurse inspects the client's tonsils for size and appearance. Tonsils are present and touch the uvula. How should the nurse grade these findings? a. 1 b. 2 c. 3 d. 4
c Visible tonsils that touch the uvula should be documented as "3."
A client has an increased number of eosinophils. Which of the following disorders would the nurse expect the client to have? a. Allergy b. Liver failure c. Hemophilia d. Pediculosis pubis
a Eosinophils phagocytize foreign material. Their numbers increase in allergies, some dermatologic disorders, and parasitic infections.
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? a. Iron chelation therapy b. Oxygen therapy c. Therapeutic phlebotomy d. Anticoagulation therapy
a Iron overload is a complication unique to people who have had long-term PRBC transfusions. One unit of PRBCs contains 250 mg of iron. Patients with chronic transfusion requirements can quickly acquire more iron than they can use, leading to iron overload. Over time, the excess iron deposits in body tissues and can cause organ damage, particularly in the liver, heart, testes, and pancreas. Promptly initiating a program of iron chelation therapy can prevent end-organ damage from iron toxicity.
Which cells are called white blood cells? a. leukocytes b. lymphocytes c. erythrocytes d. platelets
a Leukocytes are also called white blood cells (WBCs).
Which cells are white blood cells with immune functions? a. lymphocytes b. pluripotential stem cells c. erythrocytes d. platelets
a Lymphoid stem cells are converted to lymphocytes, WBCs with immune functions.
A nurse is educating a client about the role of B lymphocytes. The nurse's description will include which of the following physiologic processes? a. Stem cell differentiation b. Cytokine production c. Phagocytosis d. Antibody production
d B lymphocytes are capable of differentiating into plasma cells. Plasma cells, in turn, produce antibodies. Cytokines are produced by NK cells. Stem cell differentiation greatly precedes B lymphocyte production.
A nurse cares for a client with iron-deficiency anemia. Which treatment will the nurse anticipate the client receiving? a. Oral iron supplementation b. Intravenous iron supplementation c. Chemical chelation therapy d. Immunoglobulin therapy
a The primary treatment of iron-deficiency anemia is oral iron supplementation. Intravenous iron supplementation is not the primary treatment of iron-deficiency anemia. Chelation therapy and immunotherapy do not treat iron-deficiency anemia.
The client's CBC with differential reveals small-shaped hemoglobin molecules. The nurse expects to administer which medication to this client? a. Iron b. Vitamin B12 c. Folate d. Fresh frozen plasma
a With iron deficiency, the erythrocytes produced by the marrow are small and low in hemoglobin. Vitamin B12 and folate deficiencies are characterized by the production of abnormally large erythrocytes. Fresh frozen plasma are infused due to a low platelet level, not light-colored hemoglobin.
A Schilling test has been ordered for a client suspected of having pernicious anemia. What will the nurse include when explaining the procedure? a. Radioactive vitamin B12 is given orally, followed in 1 hour by an injection of nonradioactive B12. b. Nonradioactive vitamin B12 is given orally, followed in 1 hour by an injection of radioactive B12. c. Radioactive vitamin B12 is given orally, followed in 1 hour by another injection of radioactive B12. d. Nonradioactive vitamin B12 is given orally, followed in 1 hour by another injection of nonradioactive B12.
a A Schilling test is used to diagnose pernicious anemia, macrocytic anemia, and malabsorption syndromes. When this test is prescribed, radioactive vitamin B12 is given orally, followed in 1 hour by an injection of nonradioactive B12.
Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following? a. Liver b. Pancreas c. Kidney d. Large intestine
a Albumin is produced by the liver. Albumin is not produced in the pancreas, kidney, or large intestine.
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? a. White blood count b. Complete blood count c. Thrombocyte count d. Level of B lymphocytes
b Anemia is the most common hematologic condition affecting the elderly. It frequently results from iron or nutritional deficiencies, or the bone marrow's ability to respond to the body's need for red blood cells. A complete blood count is needed to assess the hemoglobin and hematocrit levels.
An instructor asks students approximately how long platelets last? What would the students correctly identify? a. 72 hours b. 7.5 days c. 75 days d. Lifetime
b Platelets (thrombocytes) are disklike, non-nucleated cell fragments with a life span of approximately 7.5 days.
The charge nurse should intervene when observing a new nurse perform which action after a client has suffered a possible hemolytic blood transfusion reaction? a. Notifying the blood bank of the reaction. b. Disposing of the blood container and tubing in biohazard waste. c. Informing the client to leave a urine sample after the client's next void. d. Documenting the reaction in the client's medical record.
b The blood container and tubing should be returned to the blood bank for repeat typing and culture, and the blood bank should be notified of the reaction. A urine sample is collected as soon as possible to detect hemoglobin in the urine. Documenting the client's reaction in the medical record is an appropriate action.
Thrombocytopenia results when there is excess bleeding as a result of trauma, injury, or surgery. The nurse should check the platelet count in patients with these conditions. The baseline reading that is of concern and requires continued monitoring, but does not warrant instituting bleeding precautions, is a count of: a. 20,000/mm3. b. 60,000/mm3. c. 85,000/mm3. d. 120,000/mm3.
d Excess bleeding may occur with a diagnosis of thrombocytopenia when the platelet count is between 50,000 and 100,000 mm3. Because of the risks for bleeding, patients must be monitored carefully.
A client's wound has begun to heal and the blood clot which formed is no longer necessary. When a blood clot is no longer needed, the fibrinogen and fibrin will be digested by which of the following? a. Plasminogen b. Thrombin c. Prothrombin d. Plasmin
d The substance plasminogen is required to lyse (break down) the fibrin. Plasminogen, which is present in all body fluids, circulates with fibrinogen and is therefore incorporated into the fibrin clot as it forms. When the clot is no longer needed (e.g., after an injured blood vessel has healed), the plasminogen is activated to form plasmin. Plasmin digests the fibrinogen and fibrin. Prothrombin is converted to thrombin, which in turn catalyses the conversion of fibrinogen to fibrin so a clot can form.
The nurse should provide further teaching about post bone-marrow biopsy procedures when the client makes which statement? a. "I'll ask someone to drive me home when I awake from general anesthesia." b. "I should not take aspirin-containing products for pain relief." c. "I may feel some aching in my hip for 1-2 days." d. "I will keep the sterile dressing on until my doctor tells me it's okay to remove it."
a A bone marrow biopsy is usually performed with local anesthesia, not general. Aspirin can increased the risk of bleeding and should be avoided post procedure. The client should expect to feel some aching in the hip area for 1-2 days. A sterile dressing is applied upon completion of the procedure and should remain in place until the healthcare provider tells the client it is safe to remove.
Which is a symptom of severe thrombocytopenia? a. Petechiae b. Inflammation of the mouth c. Inflammation of the tongue d. Dyspnea
a Clients with severe thrombocytopenia have petechiae, which are pinpoint hemorrhagic lesions, usually more prominent on the trunk or anterior aspects of the lower extremities.
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? a. Leukemia b. Thalassemia c. Anemia d. Lymphopenia
c Anemia is the most common hematological condition in older adults, particularly those admitted to hospitals and long-term care facilities.
A female patient has been diagnosed with an unusual delayed response to allergic agents, as well as a compromised immune system. Which of the following does the nurse identify as the WBC value that is consistent with this diagnosis? a. Basophils: 80/cmm b. Monocytes: 600/cmm c. T lymphocytes: 850/cmm d. Neutrophils: 5,500/cmm
c The primary function of T lymphocytes is to produce substances that aid in attacking and killing foreign cells by releasing lymphokines that enhance the activity of phagocytic cells. A deficiency of T lymphocytes leads to delayed responses to allergic substances. The normal value for T lymphocytes is 1,000 to 4,800/cmm.
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? a. The client is having an allergic reaction to the blood. b. The client is experiencing vascular collapse. c. The client is having decrease in tissue perfusion from a shock state. d. The client is having a febrile nonhemolytic reaction.
d The signs and symptoms of a febrile nonhemolytic transfusion reaction are chills (minimal to severe) followed by fever (more than 1°C elevation). The fever typically begins within 2 hours after the transfusion is begun. Although the reaction is not life threatening, the fever, and particularly the chills and muscle stiffness, can be frightening to the client.
Which of the following cells are capable of differentiating into plasma cells? a. B lymphocytes b. T lymphocytes c. Eosinophils d. Neutrophils
a B lymphocytes are capable of differentiating into plasma cells. Plasma cells, in turn, produce antibodies called immunoglobulins (Ig), which are protein molecules that destroy foreign material by several mechanisms. T lymphocytes, eosinophils, and neutrophils do not differentiate into plasma cells.
The nursing student is reviewing erythrocytes for an upcoming test. Which of the following would the nurse correctly identify as influencing erythrocyte count? a. Age b. Gender c. Altitude d. Exercise e. Body weight
a, b, c, d The normal number of erythrocytes varies with age, gender, and altitude but ranges between 3.6 and 5.4 million/mm3. Infants have more erythrocytes than adults; women have fewer erythrocytes than men. People who live at high altitudes or engage in strenuous activity have an increased number of erythrocytes to maximize the transport of oxygen and carbon dioxide.
Through the process of hematopoiesis, stem cells differentiate into either myeloid or lymphoid stem cells. Into what do myeloid stem cells further differentiate? Select all that apply. a. Leukocytes b. Natural killer cells c. Cytokines d. Platelets e. Erythrocytes
a, d, e Myeloid stem cells differentiate into three broad cell types: erythrocytes, leukocytes, and platelets. Natural killer cells and cytokines do not originate as myeloid stem cells.
Knowledge regarding hematopoiesis is essential in postsurgical client care. Which statement about the variation in the normal number of erythrocytes is true? a. People who engage in strenuous activity have an increased number of erythrocytes. b. Infants have fewer erythrocytes than adults. c. Women have more erythrocytes than men. d. People who live at higher altitudes have a decreased number of erythrocytes.
a People who engage in strenuous activity have an increased number of erythrocytes to maximize the transport of oxygen and carbon dioxide.
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. Extreme fatigue b. Severe headaches c. Dyspnea d. Blurred vision
a 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 cells have the major function of transporting O2 to and removing CO2 from tissues? a. erythrocytes b. platelets c. leukocytes d. lymphocytes
a The major function of erythrocytes is to transport O2 to the tissues and remove CO2 from the tissues.
A client with a hematologic disorder asks the nurse how the body forms blood cells. The nurse should describe a process that takes place where? a. In the spleen b. In the kidneys c. In the bone marrow d. In the liver
c Bone marrow is the primary site for hematopoiesis. The liver and spleen may be involved during embryonic development or when marrow is destroyed. The kidneys release erythropoietin, which stimulates the marrow to increase production of red blood cells (RBCs). However, blood cells are not primarily formed in the spleen, kidneys, or liver.
A client with a disorder of the erythrocytes asks the nurse to explain what role these cells play. What would the nurse accurately explain to the client? a. Transport O2 to and remove CO2 from the tissues b. Carry oxygen to the cells of the body c. Engulf invading microorganisms and cellular debris, and manufacture antibodies d. Participate in clotting blood
a Erythrocytes transport O2 to and remove CO2 from the tissues. Hemoglobin carries oxygen to the cells of the body. Leukocytes engulf invading microorganisms and cellular debris, and manufacture antibodies. Platelets participate in clotting blood.
When reviewing a client's chart, the nurse notes that the client's tonsils are listed as grade 3. How does the nurse interpret this finding? a. The client's tonsils are not present. b. The client's tonsils are touching each other. c. The client's tonsils are touching the uvula. d. The client's tonsils are red and inflamed.
A "3" would mean that the client's tonsils are touching the uvula.
An 8-year-old client is scheduled to undergo a tonsillectomy for chronic tonsillitis. The symptoms given below are related to tonsil disorders. The nurse caring for this client should know that which of the following symptoms is specifically related to tonsillitis? a. Difficulty swallowing b. Headache c. Swelling and pain behind the ear d. Difficulty breathing unless sitting upright
a When chronic tonsillitis is present, the client experiences difficulty in swallowing. Tonsillectomy is generally advised for enlarged, bacteria-loaded tonsils. Headache, swelling and pain behind the ear, and difficulty in breathing unless sitting upright are not symptoms of tonsils.
The nurse is providing health education to an older adult client who has low red blood cell levels. To promote red blood cell production, the nurse should encourage intake of what foods? Select all that apply. a. Leafy green vegetables b. Lean meats c. Nuts and seeds d. Animal fats e. Organic foods
a, b, c A healthy diet that includes lean meats, nuts, seeds and green vegetables can promote red cell production. Animal fats are not known to promote red cell production. Organic foods are not necessarily more likely to promote red cell synthesis.
Which of the following reports from the client during the health history would lead the nurse to suspect that the client has a disorder of the hematopoietic or lymphatic system? Select all that apply. a. Experiences prolonged bleeding from an obvious injury. b. Has unexplained blood loss, as in rectal bleeding, nosebleeds, bleeding gums, or vomiting blood. c. Feels fatigued with normal activities. d. Rarely bruises. e. Feels discomfort in the stomach.
a, b, c Signs of a disorder would include prolonged bleeding from an obvious injury; unexplained blood loss, as in rectal bleeding, nosebleeds, bleeding gums, or vomiting blood; and fatigue with normal activities. A client with a disorder of the hematopoietic or lymphatic system would bruise easily and have discomfort in the axilla, groin, or neck.
A client's health history reveals daily consumption of two to three bottles of wine. The nurse should plan assessments and interventions in light of the client's increased risk for what hematologic disorder? a. Leukemia b. Anemia c. Thrombocytopenia d. Lymphoma
b Heavy alcohol use is associated with numerous health problems, including anemia. Leukemia and lymphoma are not associated with alcohol use; RBC levels are typically affected more than platelet levels.
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? a. Basophils b. Neutrophils c. Eosinophils d. Monocytes
b Neutrophils, the most abundant type of white blood cell, are the first of the WBCs to respond to infection or inflammation. The normal value is 3,000 to 7,000/cmm (males) and 1,800 to 7,700/cmm (females).
A patient with esophageal varices secondary to liver cirrhosis has received a transfusion of frozen plasma. The nurse is aware of the fact that plasma: a. Acts solely as a solvent for the cellular components of the blood b. Accounts for the majority of the blood's volume in the body c. Plays a regulatory role in the process of erythropoiesis d. Primarily regulates the pH of blood and other body fluids
b Plasma is the fluid portion of blood; it is thin and colorless and contains various proteins, such as albumin, globulin, fibrinogen, and other factors necessary for clotting, as well as electrolytes, waste products, and nutrients. Approximately 55% of blood volume is plasma, and 45% consists of various cellular components. Plasma does not regulate erythropoiesis or pH.
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? a. "The condition is likely caused by a folate deficiency." b. "The condition causes abnormally small red blood cells." c. "The condition is likely caused by a vitamin B12 deficiency." d. "The condition causes abnormally rigid red blood cells."
c 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 the absorption of vitamin B12 may be diminished. Megaloblastic anemia may be caused by a folate deficiency; however, the client's history of gastrectomy indicates the likely cause is a vitamin B12 deficiency. Megaloblastic anemia causes large erythrocytes (RBCs), not small or rigid.
A nurse is performing an initial assessment and notes the client's skin is a gray-tan color, especially on the scars of the client's arms. Which hematological condition does the nurse suspect? a. Polycythemia b. Vitamin B12 deficiency c. Thrombocytopenia d. Hemochromatosis
d Hemochromatosis is an autosomal recessive disease of excessive iron absorption. This results in bronze or gray-tan skin, especially over scars. The other answer choices are hematological conditions; however, these do not cause the skin to turn a gray-tan color.
A nurse is caring for a client who is undergoing preliminary testing for a hematologic disorder. What sign or symptom most likely suggests a potential hematologic disorder? a. Sudden change in level of consciousness (LOC) b. Recurrent infections c. Anaphylaxis d. Severe fatigue
d The most common indicator of hematologic disease is extreme fatigue. This is more common than changes in LOC, infections, or anaphylaxis
A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse know is the most likely clinical disorder the patient is being treated for? a. Essential thrombocythemia b. Extreme leukocytosis c. Sickle cell anemia d. Renal transplantation
a Platelet pheresis is used to remove platelets from the blood in patients with extreme thrombocytosis or essential thrombocythemia (temporary measure)or in a single-donor platelet transfusion.
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)? a. platelets b. leukocytes c. erythrocytes d. lymphocytes
a Platelets have a life span of approximately 7.5 days. Two-thirds circulate in the blood and contribute to homeostasis. The remaining one-third is stored in the spleen, where they remain unless needed in cases of significant bleeding.
A nurse at a blood donation clinic has completed the collection of blood from a woman. The woman states that she feels "lightheaded" and she appears visibly pale. What is the nurse's most appropriate action? a. Help her into a sitting position with her head lowered below her knees. b. Administer supplementary oxygen by nasal prongs. c. Obtain a full set of vital signs. d. Inform a physician or other primary care provider.
a A donor who appears pale or complains of faintness should immediately lie down or sit with the head lowered below the knees. He or she should be observed for another 30 minutes. There is no immediate need for a physician's care. Supplementary oxygen may be beneficial, but may take too much time to facilitate before a syncopal episode. Repositioning must precede assessment of vital signs.
An adult client reports that it is taking longer than usual for minor cuts and injuries to clot. Which of the following questions would the nurse most likely ask the client? a. "Are you regularly taking aspirin?" b. "Are you eating sugary foods lately?" c. "Do you have a history of allergy or asthma?" d. "Have you been tested for hemophilia?"
a Aspirin and anticoagulants can contribute to bleeding and interfere with clot formation. Sugary foods, allergy, and asthma would not influence the client's clotting capacity. Hemophilia is a disorder of clotting, but it manifests from early in childhood as a genetic problem and would not suddenly appear in adulthood.
A client suffers a leg wound which causes minor blood loss. As a result of bleeding, the process of primary hemostasis is activated. What will occur during this process? a. Severed blood vessels constrict. b. Thromboplastin is released. c. Prothrombin is converted to thrombin. d. Fibrin is lysed.
a Primary hemostasis involves the severed vessel constricting and platelets collecting at the injury site. Secondary hemostasis occurs when thromboplastin is released, prothrombin converts to thrombin, and fibrin is lysed.
A nurse cares for a client who has had a bone marrow aspiration. In addition to the client's aspiration site, what locations on the body does the nurse recognize as having bone marrow? Select all that apply. a. Pelvis b. Ribs c. Vertebrae d. Sternum e. Tibia
a, b, c, d Bone marrow can be found in the pelvis, ribs, vertebrae, and sternum. Additionally, bone marrow is found on the spongy end of the femur and humerus long bones. The tibia does not have bone marrow.
When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply. a. Dietary intake b. Medication use c. Ethnicity d. Herbal supplements e. Hair color
a, b, c, d Dietary intake, ethnicity, use of herbal supplements, and medication use are factors for which the nurse should assess. Hair color is not considered a factor in determining causes of hematological disorders.
When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply. a. Dietary intake b. Medication use c. Ethnicity d. Herbal supplements e. Hair color
a, b, c, d Dietary intake, ethnicity, use of herbal supplements, and medication use are factors for which the nurse should assess. Hair color is not considered a factor in determining causes of hematological disorders.
A client is scheduled for a splenectomy. During discharge education, what teaching point should the nurse prioritize? a. The importance of adhering to prescribed immunosuppressant therapy b. The need to report any signs or symptoms of infection promptly c. The need to ensure adequate folate, iron, and vitamin B12 intake d. The importance of limiting activity postoperatively to prevent hemorrhage
b After splenectomy, the client is instructed to seek prompt medical attention if even relatively minor symptoms of infection occur. Often, clients with high platelet counts have even higher counts after splenectomy, which can predispose them to serious thrombotic or hemorrhagic problems. However, this increase is usually transient and therefore often does not warrant additional treatment. Dietary modifications are not normally necessary and immunosuppressants would be strongly contraindicated.
Which term refers to a form of white blood cell involved in immune response? a. Granulocyte b. Lymphocyte c. Spherocyte d. Thrombocyte
b 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 nurse is caring for a client who will undergo total knee replacement and will have an autologous transfusion. Which statement will the nurse include when teaching the client about the transfusion? a. "You typically donate blood the day of the surgery." b. "You will be prescribed calcium to replace what is lost during donation." c. "You typically donate blood 4 to 6 weeks before the surgery." d. "You will likely not need the blood that is donated."
c With autologous donation, a client's own blood may be collected for future transfusion; this is an effective method for orthopedic surgery, where the likelihood of transfusion is high. Preoperative donation is ideally collected 4-6 weeks before surgery. The nurse will not tell the client that the blood will not be needed; orthopedic surgeries often require transfusion of blood. The client will be prescribed iron supplements during the donation time, not calcium.
A 66-year-old man underwent a successful partial gastrectomy for the treatment of stomach cancer 3 years ago. The man had a scheduled follow-up appointment with his primary caregiver and had blood work completed. The results of the man's blood work indicated anemia. The nurse who is contributing to the patient's care should recognize that this patient's anemia may be attributable to what factor? a. A recurrence of the man's cancer b. Paralytic ileus c. Infection d. Decreased vitamin B12 absorption
d It is important for nurses to recall that patients 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, leading to anemia. Paralytic ileus would not be plausible; infection and cancer would be less likely causes for the patient's iron deficiency.
Which term is used to refer to a primitive cell that is capable of self-replication and differentiation? a. Band cell b. Spherocyte c. Reticulocyte d. Stem cell
d Stem cells may differentiate into myeloid or lymphoid stem cells. A band cell is a slightly immature neutrophil. A spherocyte is a red blood cell without central pallor. A reticulocyte is a slightly immature red blood cell.
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? a. Basophils b. Monocytes c. Plasma cells d. T lymphocytes
d T lymphocytes are responsible for cell-mediated immunity, in which they recognize material as "foreign," acting as a surveillance system.
A client's diagnosis of atrial fibrillation has prompted the primary care provider to prescribe warfarin, an anticoagulant. When assessing the therapeutic response to this medication, what is the nurse's most appropriate action? a. Assess for signs of myelosuppression. b. Review the client's platelet level. c. Assess the client's capillary refill time. d. Review the client's international normalized ratio (INR).
d The INR and aPTT serve as useful screening tools for evaluating a client's clotting ability and to monitor the therapeutic effectiveness of anticoagulant medications. The client's platelet level is not normally used as a short-term indicator of anticoagulation effectiveness. Assessing the client for signs of myelosuppression and capillary refill time does not address the effectiveness of anticoagulants.
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? a. Lateral position with one leg flexed b. Lithotomy position c. Supine with head of the bed elevated 30 degrees d. Jackknife position
a
A client's most recent blood work reveals low levels of albumin. This assessment finding should suggest the possibility of what nursing diagnosis? a. Risk for imbalanced fluid volume related to low albumin b. Risk for infection related to low albumin c. Ineffective tissue perfusion related to low albumin d. Impaired skin integrity related to low albumin
a Albumin is particularly important for the maintenance of fluid balance within the vascular system. Deficiencies nearly always manifest as fluid imbalances. Tissue oxygenation and skin integrity are not normally affected. Low albumin does not constitute a risk for infection.
A 18-year-old client presents to the emergency department with a severe open fracture of the lower extremity. The health care provider tells the client that the client will need a blood transfusion. The client refuses, despite the advise of the health care provider. What does the nurse understand is the legal implication of the scenario? a. The client has a right to refuse the transfusion. b. The health care provider may first call the client's parents if the client refuses. c. The client can only refuse the transfusion if the consent form has not been signed. d. The health care provider may ask for a court order if the client refuses.
a An 18-year-old client may refuse transfusion if the client is of sound mind and has been provided education on the risks and benefits of the transfusion. An 18-year-old client is considered an adult and does not require the consent of his or her parent.
A patient with chronic kidney disease is being examined by the nurse practitioner for anemia. The nurse has reviewed the laboratory data for hemoglobin and RBC count. What other test results would the nurse anticipate observing? a. Decreased level of erythropoietin b. Decreased total iron-binding capacity c. Increased mean corpuscular volume d. Increased reticulocyte count
a Differentiation of the primitive myeloid stem cell into an erythroblast is stimulated by erythropoietin, a hormone produced primarily by the kidney. If the kidney detects low levels of oxygen, as occurs when fewer red cells are available to bind oxygen (i.e., anemia), or with people living at high altitudes with lower atmospheric oxygen concentrations, erythropoietin levels increase. The increased erythropoietin then stimulates the marrow to increase production of erythrocytes. The entire process of erythropoiesis typically takes 5 days (Cook, Ineck, & Lyons, 2011). For normal erythrocyte production, the bone marrow also requires iron, vitamin B12, folate, pyridoxine (vitamin B6), protein, and other factors. A deficiency of these factors during erythropoiesis can result in decreased red cell production and anemia.
Which term describes the percentage of blood volume that consists of erythrocytes? a. Hematocrit b. Differentiation c. Erythrocyte sedimentation rate (ESR) d. Hemoglobin
a 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.
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? a. The kidneys sense low oxygen levels in the blood and stimulate erythropoietin, stimulating the marrow to produce more red blood cells. b. The bone marrow is stimulated by low oxygen levels in the blood and stimulates erythropoietin, maturing the red blood cells. c. The brain senses low oxygen levels in the blood and stimulates hemoglobin, which binds to more red blood cells. d. The kidneys sense low oxygen levels in the blood and stimulate hemoglobin, stimulating the marrow to produce more red blood cells.
a If the kidney detects low levels of oxygen, as occurs when fewer red cells are available to bind oxygen (as with anemia), erythropoietin levels increase, stimulating the marrow to produce more erythrocytes (red blood cells).
An older adult client is exhibiting many of the characteristic signs and symptoms of iron deficiency. In addition to a complete blood count, what diagnostic assessment should the nurse anticipate? a. Stool for occult blood b. Bone marrow biopsy c. Lumbar puncture d. Urinalysis
a Iron deficiency in the adult generally indicates blood loss (e.g., from bleeding in the GI tract or heavy menstrual flow). Bleeding in the GI tract can be preliminarily identified by testing stool for the presence of blood. A bone marrow biopsy would not be undertaken for the sole purpose of investigating an iron deficiency. Lumbar puncture and urinalysis would not be clinically relevant.
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? a. Iron b. Calcium c. Hemoglobin d. Potassium
a Iron overload is a complication unique to people who have had long-term PRBC transfusion. Over time, the excess iron deposits in body tissues can cause organ damage, particularly in the liver, heart, testes, and pancreas.
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 an infection. b. may be developing anemia. c. has leukopenia. d. has thrombocytopenia.
a 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 cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? a. Myeloid stem cell b. Lymphoid stem cell c. Monocyte d. Neutrophil
a 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 client has a leukocyte count of 13,000/mm3. How would the nurse document the client's condition? a. Leukocytosis b. Leukopenia c. Leukotoxic d. Hemolysis
a Normal leukocyte count is between 5,000 and 10,000/mm3. An increased number of leukocytes is called leukocytosis; a decreased number is called leukopenia. The other terms are distracters for this question.
Knowledge regarding hematopoiesis is essential in postsurgical client care. Which statement about the variation in the normal number of erythrocytes is true? a. People who engage in strenuous activity have an increased number of erythrocytes. b. Infants have fewer erythrocytes than adults. c. Women have more erythrocytes than men. d. People who live at higher altitudes have a decreased number of erythrocytes.
a People who engage in strenuous activity have an increased number of erythrocytes to maximize the transport of oxygen and carbon dioxide.
A nurse is discussing the difference between blood and plasma with a client. Which best represents the components of plasma? a. 90% water, 10% proteins, blood cells, clotting factors, hormones, enzymes b. 90% water, 8% proteins, vitamins, lipids, blood cells, electrolytes c. 80% water, 20% proteins, hormones, enzymes, clotting factors, glucose d. 85% water, 13% proteins, clotting factors, pigments, vitamins, glucose
a Plasma is the liquid, or serum, portion of blood. It consists of 90% water and 10% proteins. Besides blood cells, plasma contains and transports proteins (albumin, globulins, and fibrinogen), clotting factors such as prothrombin, pigments, vitamins, glucose, lipids, electrolytes, minerals, enzymes, and hormones.
A client suffers a leg wound which causes minor blood loss. As a result of bleeding, the process of primary hemostasis is activated. What will occur during this process? a. Severed blood vessels constrict. b. Thromboplastin is released. c. Prothrombin is converted to thrombin. d. Fibrin is lysed.
a Primary hemostasis involves the severed vessel constricting and platelets collecting at the injury site. Secondary hemostasis occurs when thromboplastin is released, prothrombin converts to thrombin, and fibrin is lysed.
Which of the following in a client's health history would the nurse recognize as potentially compromising the client's blood cell volume? a. Splenectomy b. Tonsilectomy c. Hysterectomy d. Appendectomy
a Surgery with lymph node removal or splenectomy may affect blood cell volume or lymphatic circulation.
The nurse is reviewing a client's laboratory results and notes that her hemoglobin level is 15 g/dL. What action should the nurse take next? a. Document the finding as normal. b. Notify the physician because the client requires further testing. c. Record the result and recommend a retest in 6 weeks. d. Ask the client if she has had excessive menstruation or is lacking iron in her diet.
a The nurse should document the finding as normal. In adults, the normal amount of hemoglobin is 12 to 17.4 g/dL.
A client's electronic health record states that the client receives regular transfusions of factor IX. The nurse would be justified in suspecting that this client has what diagnosis? a. Leukemia b. Hemophilia c. Hypoproliferative anemia d. Hodgkin lymphoma
b Administration of clotting factors is used to treat diseases where these factors are absent or insufficient; hemophilia is among the most common of these diseases. Factor IX is not used in the treatment of leukemia, lymphoma, or anemia.
A client's electronic health record states that the client receives regular transfusions of factor IX. The nurse would be justified in suspecting that this client has what diagnosis? a. Leukemia b. Hemophilia c. Hypoproliferative anemia d. Hodgkin lymphoma
b Administration of clotting factors is used to treat diseases where these factors are absent or insufficient; hemophilia is among the most common of these diseases. Factor IX is not used in the treatment of leukemia, lymphoma, or anemia.
A client on the medical unit is receiving a unit of PRBCs. Difficult IV access has necessitated a slow infusion rate and the nurse notes that the infusion began 4 hours ago. What is the nurse's most appropriate action? a. Apply an icepack to the blood that remains to be infused. b. Discontinue the remainder of the PRBC transfusion and inform the health care provider. c. Disconnect the bag of PRBCs, cool for 30 minutes and then administer. d. Administer the remaining PRBCs by the IV direct (IV push) route.
b Because of the risk of infection, a PRBC transfusion should not exceed 4 hours. Remaining blood should not be transfused, even if it is cooled. Blood is not administered by the IV direct route.
The nurse is providing care for an older adult who has a hematologic disorder. What age-related change in hematologic function should the nurse integrate into care planning? a. Bone marrow in older adults produces a smaller proportion of healthy, functional blood cells. b. Older adults are less able to increase blood cell production when demand suddenly increases. c. Stem cells in older adults eventually lose their ability to differentiate. d. The ratio of plasma to erythrocytes and lymphocytes increases with age.
b Due to a variety of factors, when an older person needs more blood cells, the bone marrow may not be able to increase production of these cells adequately. Stem cell activity continues throughout the lifespan, although at a somewhat decreased rate. The proportion of functional cells does not greatly decrease and the relative volume of plasma does not change significantly.
An individual has accidentally cut his hand, immediately initiating the process of hemostasis. Following vasoconstriction, what event in the process of hemostasis will take place? a. Fibrin will be activated at the bleeding site. b. Platelets will aggregate at the injury site. c. Thromboplastin will form a clot. d. Prothrombin will be converted to thrombin.
b Following vasoconstriction, circulating platelets aggregate at the site and adhere to the vessel and to one another, forming an unstable hemostatic plug. Events involved in the clotting cascade take place subsequent to this initial platelet action.
A nurse has participated in organizing a blood donation drive at a local community center. Which of the following individuals would most likely be disallowed from donating blood? a. A man who is 81 years of age b. A woman whose blood pressure is 88/51 mm Hg c. A man who donated blood 4 months ago d. A woman who has type 1 diabetes
b For potential blood donors, systolic arterial BP should be 90 to 180 mm Hg, and the diastolic pressure should be 50 to 100 mm Hg. There is no absolute upper age limit. Donation 4 months ago does not preclude safe repeat donation and diabetes is not a contraindication.
Which nursing intervention should be incorporated into the plan of care for a client with impaired liver function and a low albumin concentration? a. Implement neutropenic precautions b. Apply prolonged pressure to needle sites or other sources of external bleeding c. Monitor for edema at least once per shift d. Monitor temperature at least once per shift
c
A nurse cares for several mothers and babies in the postpartum unit. Which mother does the nurse recognize as being most at risk for a febrile nonhemolytic reaction? a. Rh-negative mother; Rh-negative child b. Rh-positive mother; Rh-negative child c. Rh-negative mother; Rh-positive child d. Rh-positive mother; Rh-positive child
c A mother who is Rh negative and gives birth to an Rh positive child is at greatest risk for a febrile nonhemolytic reaction because exposure to an Rh-positive fetus raises antibody levels in the Rh negative mother. An Rh-negative mother can carry an Rh-negative child without being at greatest risk for a febrile nonhemolytic reaction; however, these mothers are often treated prophylactically. An Rh-positive mother may carry either an Rh-positive or Rh-negative child without increased risk.
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. Administer aspirin (ASA) 325 mg po, as ordered c. Administer acetaminophen 500 mg po, as ordered d. Reposition the client to a high Fowler position and continue to monitor the pain
c 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.
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? a. "I agree that you should be concerned with the safety of the blood, but it is important that you have this transfusion." b. "The blood is carefully screened, so there is no possibility of you contracting any illness or disease from the blood." c. "I understand your concern. The blood is carefully screened but is not completely risk free." d. "You will have to decide if refusing the blood transfusion is worth the risk to your health."
c Despite advances in donor screening and blood testing, certain diseases can still be transmitted by transfusion of blood components (Chart 32-4).
An elderly client has urinary incontinence at least once a day and is scheduled for a Schilling test. The nurse a. Assists the client in wearing an incontinence pad b. Collects one voiding of urine following a dose of radioactive iron c. Consults the physician about insertion of a Foley catheter d. Instructs the client to collect as much urine as possible
c For a Schilling test to be accurate, all urine must be collected 24 hours after administration of an oral dose of radioactive iron. The Foley catheter would ensure this. None of the other options would ensure all urine will be collected.
An elderly client has urinary incontinence at least once a day and is scheduled for a Schilling test. The nurse a. Assists the client in wearing an incontinence pad b. Collects one voiding of urine following a dose of radioactive iron c. Consults the physician about insertion of a Foley catheter d. Instructs the client to collect as much urine as possible
c For a Schilling test to be accurate, all urine must be collected 24 hours after administration of an oral dose of radioactive iron. The Foley catheter would ensure this. None of the other options would ensure all urine will be collected.
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. Pack the wound with half-inch sterile gauze b. Administer a topical analgesic to control pain at the site c. Apply pressure over the site for 5-7 minutes d. Elevate the head of the bed to 45 degrees
c 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.
A client's low hemoglobin level has necessitated transfusion of PRBCs. Prior to administration, what action should the nurse perform? a. Have the client identify his or her blood type in writing. b. Ensure that the client has granted verbal consent for transfusion. c. Assess the client's vital signs to establish baselines. d. Facilitate insertion of a central venous catheter.
c Prior to a transfusion, the nurse must take the client's temperature, pulse, respiration, and BP to establish a baseline. Written consent is required and the client's blood type is determined by type and cross match, not by the client's self-declaration. Peripheral venous access is sufficient for blood transfusion.
The nurse is caring for a client who has developed scar tissue in many of the areas that normally produce blood cells. What organs can become active in blood cell production by the process of extramedullary hematopoiesis? a. Spleen and kidneys b. Kidneys and pancreas c. Pancreas and liver d. Liver and spleen
d In adults with disease that causes marrow destruction, fibrosis, or scarring, the liver and spleen can also resume production of blood cells by a process known as extramedullary hematopoiesis. The kidneys and pancreas do not produce blood cells for the body.
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? a. Monocytes b. B lymphocytes c. Leukocytes d. T lymphocytes
d Lymphocytes (T cells, B cells, and natural killer cells) are WBCs that are the major components of the body's immune response. T cells are primarily responsible for cell-mediated immunity, whereas B cells are involved in antibody production.