Chapter 32 prep u hematology

1. The client is a young, thin woman who is prescribed iron dextran intramuscularly. The nurse, when administering the medication, Employs the Z-track technique Uses a 23-gauge needle Injects into the deltoid muscle Rubs the site vigorously

When iron medications are given intramuscularly, the nurse uses the Z-track technique to avoid local pain and staining of the skin. The gluteus maximus muscle is used. The nurse avoids rubbing the site vigorously and uses a 189- or 20-gauge needle.

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? Decreased total iron-binding capacity Decreased level of erythropoietin Increased reticulocyte count Increased mean corpuscular volume

Increased reticulocyte count

A nurse is caring for a patient who has had a bone marrow aspiration with biopsy. What complication should the nurse be aware of and monitor the patient for? Hemorrhage Blood transfusion reaction Shock Splintering of bone fragments

Hemorrhage Hazards of either bone marrow aspiration or biopsy include bleeding and infection. The risk of bleeding is somewhat increased if the patient's platelet count is low or if the patient has been taking a medication (e.g., aspirin) that alters platelet function.

7. Which of the following terms refers to a form of white blood cell involved in immune response? Lymphocyte Spherocyte Granulocyte Thrombocyte

Lymphocyte

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? Supine with head of the bed elevated 30 degrees Jackknife position Lateral position with one leg flexed Lithotomy position

Lateral position with one leg flexed

The nurse begins a routine blood transfusion of packed red blood cells (PRBCs) at 1100. To ensure client safety, the unit of blood should be completely transfused by what time? 1500 1115 1600 1530

1500

10. The nurse expects which assessment finding when caring for a client with a decreased hemoglobin level? Increased bruising. Decreased oxygen level. Bright red venous blood. Elevated temperature.

Decreased oxygen level.

After withdrawing the needle from blood donor's arm, the site begins to bleed excessively. What is the nurse's first action? Assist the client into an erect position. Hold firm pressure on the venipuncture site. Lower the arm below the level of the heart. Apply a tourniquet above the antecubital fossa.

Hold firm pressure on the venipuncture site Excessive bleeding at the venipuncture site may be caused by not applying enough pressure at the site. Applying a tourniquet will exacerbate the bleeding. After applying pressure, the arm should be raised above heart level. Helping the client into an erect position will not help stop the bleeding.

The nurse is screening donors for blood donation. The client who is an acceptable donor for blood is the client who Reports having a cold 1 month ago that resolved quickly Received a blood transfusion within 1 year Has a history of viral hepatitis as a teenager 10 years ago Had a dental extraction 2 days ago for caries in a tooth

Reports having a cold 1 month ago that resolved quickly

5. A nursing instructor in a BSN program is preparing for a lecture on disorders of the hematopoietic system. Included in the lecture are conditions caused by reduced levels or absence of blood-clotting proteins. Which of the following is the instructor most likely referring to? Pancytopenia Coagulopathy Sickle cell disease Aplastic anemia

Coagulopathy

The nurse obtains a unit of blood for the client, Donald D. Smith. The name on the label on the unit of blood reads Donald A. Smith. All the other identifiers are correct. The nurse Asks the client if he was ever known as Donald A. Smith Administers the unit of blood Refuses to administer the blood Checks with Blood Bank first and then administers the blood with their permission

Refuses to administer the blood

9. Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called which of the following? Monocytes Megaloblasts Mast cells Blast cells

Megaloblasts

The body responds to infection by increasing the production of white blood cells (WBCs). The nurse knows to evaluate the differential count for the level of __________, the first WBCs to respond to an inflammatory event. Eosinophils Neutrophils Basophils Monocytes

Neutrophils

The nurse is completing a pretransfusion assessment to determine the history of previous transfusions as well as previous reactions to transfusions for a female patient. From the following list, what is the most important information to obtain from this patient prior to the transfusion? Family history of transfusion reactions Patient age Number of pregnancies Patient diagnosis

Number of pregnancies 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 disease

8 Which cell of haematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? Neutrophil Myeloid stem cell Monocyte Lymphoid stem cell

Myeloid stem cell

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? "You will have to decide if refusing the blood transfusion is worth the risk to your health." "I understand your concern. The blood is carefully screened but is not completely risk free." "The blood is carefully screened, so there is no possibility of you contracting any illness or disease from the blood." "I agree that you should be concerned with the safety of the blood, but it is important that you have this transfusion."

"I understand your concern. The blood is carefully screened but is not completely risk free."

4. Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following? Large intestine Liver Kidney Pancreas

Liver

Which client is not a candidate for blood donation according to the American Heart Association? 18 year old male weighing 52 kg. 50 year old female with pulse 95 beats/minute 26 year old female with hemoglobin 11.0 g/dL 86 year old male with blood pressure 110/70 mmHg

26 year old female with hemoglobin 11.0 g/dL Clients must meet the following criteria to be eligible as blood donors: body weight at least 50 kg; pulse rate regular between 50 and 100 bpm; systolic BP 90 to 180 mmHg and diastolic 50 to 100 mmHg; hemoglobin level at least 12.5 g/dL for women. There is no upper age limit to donation.

In normal blood, monocytes account for approximately what percentage of the total leukocyte count? 20% 15% 5% 10%

5%

A female patient has a hemoglobin of 6.4 g/dL and is preparing to have a blood transfusion. Why would it be important for the nurse to obtain information about the patient's history of pregnancy prior to the transfusion? If the patient has never been pregnant, it increases the risk of reaction. Obtaining information about gravidity and parity is routine information for all female patients. If the patient has been pregnant, she may have developed allergies. A high number of pregnancies can increase the risk of reaction.

A high number of pregnancies can increase the risk of reaction.

13. 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? Administer the ordered paracetamol 500 mg po Reposition the patient to a high Fowler's position and continue to monitor the pain Notify the physician Administer the ordered aspirin (ASA) 325 mg po

Administer the ordered paracetamol 500 mg po Aspirin-containing analgesic agents should be avoided it the immediate post-procedure period because they can aggravate or potentiate bleeding.

11. 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: Prothrombin. Albumin. Globulin. Fibrinogen.

Albumin

2. The physician performs a bone marrow biopsy from the posterior iliac crest on a patient with pancytopenia. What intervention should the nurse perform following the procedure? Pack the wound with half-inch sterile gauze Administer a topical analgesic to control pain at the site Apply pressure over the site for 5-7 minutes Elevate the head of the bed to 45 degrees

Apply pressure over the site for 5-7 minutes

6. The nurse is instructing the client with polycythemia vera how to perform isometric exercises such as contracting and relaxing the quadriceps and gluteal muscle during periods of inactivity. What does the nurse understand is the rationale for this type of exercise? Isometric exercise decreases the workload of the heart and restores oxygenated blood flow. Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart. Isometric exercise programs are inclusive of all muscle groups and have an aerobic effect to increase the heart rate. This type of exercise increases arterial circulation as it returns to the heart.

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

The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly? Oral temperature of 97°F Respiratory rate of 10 breaths/minute Crackles auscultated bilaterally Pain and tenderness in calf area

Crackles auscultated bilaterally Increasing the flow rate of a blood transfusion too rapidly can result in circulatory overload. Fluid overload can be manifested by crackles in the lungs. A decreased respiratory rate and decreased temperature are not manifestations of fluid overload. Pain and tenderness in the calf area may indicate a thrombosis which is not as common a manifestation as fluid overload.

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? Essential thrombocythemia Renal transplantation Extreme leukocytosis Sickle cell anemia

Essential thrombocythemia 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.

The nurse caring for a client with acute liver failure should expect which assessment finding? Elevated albumin level Elevated blood pressure Decreased pulse Generalized edema

Generalized edema People with impaired hepatic function may have low concentrations of albumin, with a resultant decreased in osmotic pressure and the development of edema. Albumin is produced by the liver; the level would be decreased, not increased in liver failure. Albumin is important to maintain fluid balance in the vascular system. Its presence in plasma keeps fluid in the vascular space. With impaired hepatic function and low levels of albumin, the client is more likely to suffer hypotension and tachycardia as a result of hypovolem

The nurse should provide further teaching about post bone-marrow biopsy procedures when the client makes which of the following statements? "I should not take aspirin-containing products for pain relief." "I may feel some aching in my hip for 1-2 days." "I'll ask someone to drive me home when I awake from general anesthesia." "I will keep the sterile dressing on until my doctor tells me it's okay to remove it."

I'll ask someone to drive me home when I awake from general anesthesia." 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.

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.) Serial chest x-rays Intra-aortic balloon pump Intubation and mechanical ventilation Oxygen Fluid support

Intubation and mechanical ventilation Oxygen Fluid support

The client's CBC with differential reveals small-shaped hemoglobin molecules. The nurse expects to administer which medication to this client? Fresh frozen plasma Vitamin B12 Folate Iron

Iron 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 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? Therapeutic phlebotomy Iron chelation therapy Anticoagulation therapy Oxygen therapy

Iron chelation therapy

The nurse reviewing laboratory results of a client recovering from abdominal surgery notices an elevated number of reticulocytes. What is the nurse's first action? Document the findings as expected results. Perform an abdominal assessment. Hold the prescribed blood transfusion. Notify the healthcare provider.

Perform an abdominal assessment. The bone marrow can release immature forms of erythrocytes, called reticulocytes, into the circulation in response to bleeding. The nurse should assess this client's abdomen, because the client is recovering from abdominal surgery. The nurse should assess and gather more data before notifying the healthcare provider. A blood transfusion would not be held if internal bleeding is expected.

Which of the following is a symptom of severe thrombocytopenia? Dyspnea Petechiae Inflammation of the mouth Inflammation of the tongue

Petechiae Patients with severe thrombocytopenia have petechiae (i.e. pinpoint hemorrhagic lesions, usually more prominent on the trunk or anterior aspects of the lower extremities).

The nurse is working at a blood donation clinic. What teaching should the nurse provide to the donor immediately after blood donation? Remain for observation after eating and drinking. Sit up promptly after the needle is removed. Hold the involved arm below the heart. Remove the band-aid after 5 minutes.

Remain for observation after eating and drinking. After blood donation, the donor receives food and fluids and is asked to remain for observation. After the needle is removed, donors are asked to hold the involved arm straight up, and firm pressure is applied with sterile gauze for 2 to 3 minutes. A firm bandage is then applied. The donor remains recumbent until he or she feels able to sit up, usually within a few minutes.

A nurse is reviewing a patient's morning lab results and notes a left shift in the band cells. Based on this observation, what interpretation can the nurse make from these results? The patient has thrombocytopenia. The patient may be developing anemia. The patient has leukopenia. The patient may be developing an infection.

The patient may be developing an infection

3. The client is to receive a unit of packed red blood cells. The first intervention of the nurse is to Observe for gas bubbles in the unit of packed red blood cells. Verify that the client has signed a written consent form. Check the label on the unit of blood with another registered nurse. Ensure that the intravenous site has a 20-gauge or larger needle

Verify that the client has signed a written consent form.

A nurse is teaching a patient 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 of the following patient statements? "I will eat a meat source such as chicken or pork with each meal." "I will increase my daily intake of orange vegetables such as sweet potatoes and carrots." "I will eat more dairy products such as milk, yogurt, and ice cream every day." "I will eat a spinach salad with lunch and dinner."

"I will eat a meat source such as chicken or pork with each meal."

A client in end-stage renal disease is prescribed epoetin alfa (Epogen) and oral iron supplements. Before administering the next dose of epoetin alfa and oral iron supplement, the nurse Questions the administration of both medications Ensures the client has completed dialysis treatment Assesses the hemoglobin level Holds the epoetin alfa if the BUN is elevated

Assesses the hemoglobin level Erythropoietin with oral iron supplements can raise hematocrit levels in the client with end-stage renal disease. The nurse should check the hemoglobin prior to administration of erythropoietin, because too high a hemoglobin level can put the client at risk for heart failure, myocardial infarction, and cerebrovascular accident. Erythropoietin may be administered during dialysis treatments. The BUN will be elevated in the client with end-stage renal disease.

A client in acute renal failure has been prescribed 2 units of packed red blood cells (PRBCs). The nurse explains to the client that the blood transfusion is most likely needed for which of the following reasons? Hypervolemia Preparation for likely nephrectomy Lack of erythropoietin Increases the effectiveness of dialysis

Lack of erythropoietin The kidneys produce erythropoietin, a hormone that stimulates red blood cell production. A lack of this hormone is the most likely reason for blood transfusion due to the acute kidney failure. There is no indication for a nephrectomy in this question. A blood transfusion will not necessarily increase the effectiveness of dialysis. Transfusing a client with hypervolemia could lead to circulatory overload.

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

Obtain appropriate blood specimens. Collect a urine sample to detect hemoglobin. Document the reaction according to policy. 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.

A client involved in a motor vehicle accident arrives at the emergency department unconscious and severely hypotensive. The nurse suspects he has several fractures in the pelvis and legs. Which parenteral fluid is the best choice for the client's current condition? Fresh frozen plasma Normal saline solution Packed red blood cells (RBCs) Lactated Ringer's solution

Packed red blood cells (RBCs) In a trauma situation, the first blood product given is unmatched (O negative) packed RBCs. Fresh frozen plasma is commonly used to replace clotting factors. Normal saline or lactated Ringer's solution is used to increase volume and blood pressure; however, too much colloid will hemodilute the blood and doesn't improve oxygen-carrying capacity as well as packed RBCs do.

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. Serum iron: 100 ?g/dL Serum ferritin: 15 ng/mL Hemoglobin: 16 g/dL Total iron-binding capacity: 300 ?g/dL

Serum ferritin: 15 ng/mL 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 a blood transfusion to a patient over 4 hours. After 2 hours, the patient complaints of 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 patient? The patient is having decrease in tissue perfusion from a shock state. The patient is having a febrile nonhemolytic reaction. The patient is having an allergic reaction to the blood. The patient is experiencing vascular collapse.

The patient is having a febrile nonhemolytic reaction. 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 patient.

14. The physician orders a transfusion with packed red blood cells (RBCs) for a patient 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? Premedicate the patient with acetaminophen (Tylenol) Administer the blood as soon as it arrives Verify the patient identification according to hospital policy Stay with the patient during the first 15 minutes of the transfusion

Verify the patient identification according to hospital policy 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 patient.