Chapter 32: Assessment of Hematologic Function and Treatment Modalities

The nurse is caring for a client who had undergone hemodilution during surgery. Immediately after surgery, the nurse expects to see which lab result? a) Elevated erythrocyte concentration b) Elevated creatinine c) Critically low arterial oxygen saturation d) Decreased hematocrit

Decreased hematocrit Explanation: The added intravenous solutions used in hemodilution dilute the concentration of erythrocytes and lower the hematocrit. Adverse outcomes include tissue ischemia, particularly in the kidneys. These adverse outcomes can be manifested as low arterial oxygen saturation and elevated creatinine levels

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? a) Administer the morphine into the closest tubing port to the client for fast delivery. b) Inject the morphine into a distal port on the blood tubing. c) Disconnect the blood tubing, flush with normal saline, and administer morphine. d) Add the morphine to the blood to be slowly administered.

Disconnect the blood tubing, flush with normal saline, and administer morphine. Explanation: Never add medications to blood or blood products. The transfusion must be temporarily stopped in order to administer the morphine.

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

Essential thrombocythemia Explanation: 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 of the following is the percentage of blood volume consisting of erythrocytes? a) Erythrocyte sedimentation rate (ESR) b) Differentiation c) Hemoglobin d) Haematocrit

Haematocrit Explanation: Hematocrit is the percentage of blood volume consisting of erythrocytes. Differentiation is development of functions and characteristics that are different from those of the parent stem cell. ESR is a lab test that measures the rate of settling of RBCs and elevation is indicative of inflammation. Hemoglobin is the iron-containing protein of RBCs.

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called which of the following? a) Mast cells b) Megaloblasts c) Blast cells d) Monocytes

Megaloblasts Explanation: 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.

The major function of neutrophils is which of the following? a) Phagocytosis b) The rejection of foreign tissue c) Destruction of tumor cells d) The production of antibodies called immunoglobulin (Ig)

Phagocytosis Explanation: Once the neutrophil is released into the circulation from the marrow, 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 here within 1 to 2 days. T lymphocytes are responsible for rejection of foreign tissue and destruction of tumor cells. Plasma cells produce antibodies call immunoglobulin.

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.) a) Oxygen b) Serial chest x-rays c) Intubation and mechanical ventilation d) Fluid support e) Intra-aortic balloon pump

• Oxygen • Fluid support • Intubation and mechanical ventilation Explanation: Transfusion-related acute lung injury (TRALI) is a potentially fatal, idiosyncratic reaction that is defined as the development of acute lung injury occurring within 6 hours after a blood transfusion. Aggressive supportive therapy (e.g., oxygen, intubation, fluid support) may prevent death.

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: a) Prothrombin. b) Globulin. c) Albumin. d) Fibrinogen.

Albumin. Correct Explanation: Albumin, only produced in the liver, is essential for maintaining oncotic pressure in the vascular system. A decrease in oncotic pressure due to low albumin causes fluid to leak into the peritoneal cavity.

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

Discontinue the infusion immediately and maintain the IV line with normal saline solution using new IV tubing Explanation: 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 patient carefully. Notify the physician. Continue to monitor the patient's vital signs and respiratory, cardiovascular, and renal status. Notify the blood bank that a suspected transfusion reaction has occurred and send the blood container and tubing to the blood bank for repeat typing and culture

A patient develops a hemolytic reaction to a blood transfusion. What actions should the nurse take after this occurs? (Select all that apply.) a) Begin iron chelation therapy. b) Administer diphenhydramine (Benadryl). c) Document the reaction according to policy. d) Collect a urine sample to detect hemoglobin. e) Obtain appropriate blood specimens.

• Obtain appropriate blood specimens. • Collect a urine sample to detect hemoglobin. • Document the reaction according to policy. Explanation: If a hemolytic transfusion reaction or bacterial infection is suspected, the nurse does the following: obtains appropriate blood specimens from the patient; collects a urine sample as soon as possible to detect hemoglobin in the urine; and documents the reaction according to the institution's policy

Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils? a) Production of antibodies called immunoglobulin (Ig) b) Destruction of tumor cells c) Rejection of foreign tissue d) Phagocytosis

Phagocytosis Explanation: The major function of neutrophils is phagocytosis. T lymphocytes are responsible for rejection of foreign tissue and destruction of tumor cells. Plasma cells produce antibodies call immunoglobulin.

A client is prescribed an intravenous dose of iron dextran. The nurse a) Checks the client's hemoglobin level the following day b) Realizes that use of this medication will produce a false-positive when checking stool for blood c) Ensures that epinephrine is available d) Informs the client that one dose will reverse iron-deficiency anemia

Ensures that epinephrine is available Explanation: When iron is given intravenously, the nurse should have emergency medications, such as epinephrine, available in case of anaphylaxis. Iron preparations will not cause a false-positive on stool analysis for occult blood. One dose of iron will not reverse iron-deficiency anemia; in fact, several doses of iron are required to replenish the client's deficient iron stores. The client's hemoglobin levels may increase in a few weeks.

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

Administer the ordered paracetamol 500 mg po Explanation: After the marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing. Most patients have no discomfort after a bone marrow aspiration, but the site of a biopsy may ache for 1 or 2 days. Warm tub baths and a mild analgesic agent (e.g., paracetamol) may be useful. Aspirin-containing analgesic agents should be avoided it the immediate post-procedure period because they can aggravate or potentiate bleeding.

A nurse practitioner reviewed the blood work of a male patient suspected of having microcytic anemia. The nurse suspected occult bleeding. Identify the laboratory result that would indicate this initial stage of iron deficiency. a) Serum ferritin: 15 ng/mL b) Total iron-binding capacity: 300 ?g/dL c) Serum iron: 100 ?g/dL d) Hemoglobin: 16 g/dL

Serum ferritin: 15 ng/mL Correct Explanation: Microcytic anemia is characterized by small RBCs due to insufficient hemoglobin. Serum ferritin levels correlate to iron deficiency and decrease as an initial response to anemia before hemoglobin and serum iron levels drop

The nurse is administering 2 units of packed RBCs to an older adult patient who has a bleeding duodenal ulcer. The patient begins to experience difficulty breathing and the nurse assesses crackles in the lung bases, jugular vein distention, and an increase in blood pressure. What action by the nurse is necessary if the reaction is severe? (Select all that apply.) a) Administer diuretics as prescribed. b) Place the patient in an upright position with the feet dependent. c) Discontinue the transfusion. d) Administer oxygen. e) Continue the infusion but slow the rate down.

• Administer diuretics as prescribed. • Discontinue the transfusion. • Administer oxygen. • Place the patient in an upright position with the feet dependent. Correct Explanation: Signs of circulatory overload include dyspnea, orthopnea, tachycardia, and sudden anxiety. Jugular vein distention, crackles at the base of the lungs, and an increase in blood pressure can also occur. If the transfusion is continued, pulmonary edema can develop, as manifested by severe dyspnea and coughing of pink, frothy sputum. If fluid overload is mild, the transfusion can often be continued after slowing the rate of infusion and administering diuretics. However, if the overload is severe, the patient is placed upright with the feet in a dependent position, the transfusion is discontinued, and the primary provider is notified. Oxygen and morphine may be needed to treat severe dyspnea (see Chapter 29).

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) Hair color b) Herbal supplements c) Dietary intake d) Ethnicity e) Medication use

• Dietary intake • Medication use • Ethnicity • Herbal supplements Correct Explanation: 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.