Exam #2 - (CH 32 heme function & treatment)

d. T lymphocytes

1. The physician believes that the patient 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

b. Oxygen c. Fluid support d. Intubation and mechanical ventilation

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

a. Iron chelation therapy

11. A patient who has long-term packed RBC 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

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

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

b. Erythropoietin (Epogen)

14. A patient with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this patient? a. GM-CSF (Leukine) b. Erythropoietin (Epogen) c. Eltrombopag (Promacta) d. Thrombopoietin (TPO)

a. Essential thrombocythemia

15. 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

b. RBC count

2. An older adult patient presents to the physician's office with a complaint of exhaustion. The nurse, aware of the most common hematologic condition affecting the elderly, knows that which laboratory values should be assessed? a. WBC count b. RBC count c. Thrombocyte count d. Levels of plasma proteins

a. Hemorrhage

3. 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? a. Hemorrhage b. Infection c. Shock d. Splintering of bone fragments

a. Decreased level of erythropoietin

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

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? a. A high number of pregnancies can increase the risk of reaction. b. If the patient has never been pregnant, it increases the risk of reaction. c. Obtaining information about gravidity & parity is routine information for all female patients. d. If the patient has been pregnant, she may have developed allergies

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

6. 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."

d. Febrile non-hemolytic reactions

7. A patient with chronic anemia has had many blood transfusions over the last 3 years. What type of transfusion reaction should the nurse monitor for that is commonly found in patients who frequently receive blood transfusions? a. Allergic reactions b. Acute hemolytic reaction c. Circulatory overload d. Febrile non-hemolytic reactions

d. The patient is having a febrile non-hemolytic reaction.

8. 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? a. The patient is having an allergic reaction to the blood. b. The patient is experiencing vascular collapse. c. The patient is having decrease in tissue perfusion from a shock state. d. The patient is having a febrile non-hemolytic reaction.

b. Place the patient in an upright position with the feet dependent. c. Administer diuretics as prescribed. d. Discontinue the transfusion. e. Administer oxygen

9. 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. Continue the infusion but slow the rate down. b. Place the patient in an upright position with the feet dependent. c. Administer diuretics as prescribed. d. Discontinue the transfusion. e. Administer oxygen

a. Lateral position with one leg flexed

13. 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