MLQ Ch. 32
A client comes into the emergency department reporting an enlarged tongue. The tongue appears smooth and beefy red in color. The nurse also observes a 5-cm incision on the upper left quadrant of the abdomen. When questioned, the client states, "I had a partial gastrostomy 2 years ago." Based on this information, the nurse attributes these symptoms to which problem? A. Vitamin B12 deficiency B. Folic acid deficiency C. Vitamin C deficiency D. Vitamin A deficiency
A
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. Sickle cell anemia C. Extreme leukocytosis D. Renal transplantation
A
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 reason? A. Hypervolemia B. Lack of erythropoietin C. Preparation for likely nephrectomy D. Increases the effectiveness of dialysis
B
Which type of lymphocyte is responsible for cellular immunity? A. Basophil B. B lymphocyte C. T lymphocyte D. Plasma cell
C
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 vitamin B12 deficiency." B. "The condition causes abnormally small red blood cells." C. "The condition is likely caused by a folate deficiency." D. "The condition causes abnormally rigid red blood cells."
A
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. Therapeutic phlebotomy C. Oxygen therapy D. Anticoagulation therapy
A
G-CSF (filgrastim) is prescribed for a client with bone marrow suppression. What medication administration teaching should the nurse provide to the client? A. Assist the client in identifying appropriate subcutaneous injection sites. B. Do not eat before arriving to receive the intravenous administration of filgrastim. C. Take this medication by mouth at bedtime each night. D. Filgrastim is taken intramuscularly on a weekly basis.
A
Splenic sequestration is diagnosed in a client admitted with splenomegaly. What is the priority of care for this client? A. Hypovolemia B. Infection C. Hypertension D. Hyperthermia
A
The nurse cares for a client with a coagulation factor deficiency who is actively bleeding. Which blood component replacement does the nurse anticipate administering? A. FFP B. PRBCs C. Antithrombin III D. IV gamma-globulin
A
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? A. Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart. B. Isometric exercise programs are inclusive of all muscle groups and have an aerobic effect to increase the heart rate. C. This type of exercise increases arterial circulation as it returns to the heart. D. Isometric exercise decreases the workload of the heart and restores oxygenated blood flow.
A
A client develops a hemolytic reaction to a blood transfusion. What actions should the nurse take after this occurs? Select all that apply. A. Document the reaction according to policy B. Obtain appropriate blood specimens C. Collect a urine sample to detect hemoglobin D. Administer diphenhydramine E. Begin iron chelation therapy
A, B, C
The nurse is completing a physical assessment on a client's lymphatic system. The nurse should palpate for enlarged nodes in which areas? Select all that apply. A. Inguinal B. Neck C. Popliteal D. Spinal E. Submental
A, B, C, E
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. Blood transfusion reaction B. Hemorrhage C. Shock D. Splintering of bone fragments
B
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. Vitamin B12 deficiency B. Hemochromatosis C. Thrombocytopenia D. Polycythemia
B
A nurse practitioner reviewed the blood work of a male client suspected of having microcytic anemia. The nurse suspected occult bleeding. Which laboratory result would indicate an initial stage of iron deficiency? A. Total iron-binding capacity: 300 g/dL B. Serum ferritin: 15 ng/mL C. Hemoglobin: 16 g/dL D. Serum iron: 100 g/dL
B
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. Sickle cell anemia B. Essential thrombocythemia C. Extreme leukocytosis D. Renal transplantation
B
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. "You will have to decide if refusing the blood transfusion is worth the risk to your health." B. "I understand your concern. The blood is carefully screened but is not completely risk free." C. "The blood is carefully screened, so there is no possibility of you contracting any illness or disease from the blood." D. "I agree that you should be concerned with the safety of the blood, but it is important that you have this transfusion."
B
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 total iron-binding capacity B. Decreased level of erythropoietin C. Increased reticulocyte count D. Increased mean corpuscular volume
B
Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following? A. Large intestine B. Liver C. Kidney D. Pancreas
B
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. Monocytes D. Eosinophils
B
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 experiencing vascular collapse. B. The client is having a febrile nonhemolytic reaction. C. The client is having an allergic reaction to the blood. D. The client is having decrease in tissue perfusion from a shock state.
B
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. Decreased hematocrit C. Critically low arterial oxygen saturation D. Elevated creatinine
B
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? A. Isometric exercise programs are inclusive of all muscle groups and have an aerobic effect to increase the heart rate. B. Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart. C. Isometric exercise decreases the workload of the heart and restores oxygenated blood flow. D. This type of exercise increases arterial circulation as it returns to the heart.
B
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. Jackknife position B. Lateral position with one leg flexed C. Supine with head of the bed elevated 30 degrees D. Lithotomy position
B
The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly? A. Respiratory rate of 10 breaths/minute B. Crackles auscultated bilaterally C. Pain and tenderness in calf area D. Oral temperature of 97°F
B
Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils? A. Destruction of tumor cells B. Phagocytosis C. Rejection of foreign tissue D. Production of antibodies called immunoglobulin (Ig)
B
A client with a history of sickle cell anemia has developed iron overload from repeated blood transfusions. What treatment does the nurse anticipate will be prescribed? A. Hepatitis B immunization B. Red blood cell phenotyping C. Chelation therapy D. White blood cell filter
C
The client is to receive a unit of packed red blood cells. What is the nurse's first action? A. Check the label on the unit of blood with another registered nurse. B. Ensure that the intravenous site has a 20-gauge or larger needle. C. Verify that the client has signed a written consent form. D. Observe for gas bubbles in the unit of packed red blood cells.
C
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 brain senses low oxygen levels in the blood and stimulates hemoglobin, which binds to 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 kidneys sense low oxygen levels in the blood and stimulate erythropoietin, stimulating the marrow to produce 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.
C
The nurse is obtaining the health history of a client suspected of having a hematological condition. The nurse notes the client has a history of alcohol abuse. Which clinical presentation is related to alcohol consumption? A. Thrombocytopenia B. Neutropenia C. Anemia D. Myelodysplastic syndrome
C
Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? A. Lymphoid stem cell B. Monocyte C. Myeloid stem cell D. Neutrophil
C
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. Organic foods B. Animal fats C. Leafy green vegetables D. Nuts and seeds E. Lean meats
C, D, E
A client verbalizes fear of infection from a blood transfusion. What is the nurse's best response? A. "There is no need for testing unless you have a history of a transfusion reaction." B. "Blood typing is more important than testing for infection." C. "The risk of transmission of HIV is so low, there's no need to worry." D. "Every unit of donated blood is typed and tested for antibodies to infections."
D
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. Reposition the client to a high Fowler position and continue to monitor the pain B. Administer aspirin (ASA) 325 mg po, as ordered C. Notify the physician D. Administer acetaminophen 500 mg po, as ordered
D
A client with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this client? A. GM-CSF B. Eltrombopag C. Thrombopoietin D. Erythropoietin
D
A nurse cares for an older adult client with acute myeloid leukemia (AML). What concept does the nurse understand leads to the increased risk of an older adult acquiring myeloid malignancies such as AML? A. Older adults acquire damage to the bone marrow over time. B. Older adults have an increasing number of leukocytes over time. C. Older adults are exposed to more infectious disease over time. D. Older adults acquire damage to the DNA of stem cells over time.
D
A nurse is teaching a client 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 statement by the client? A. "I will eat a spinach salad with lunch and dinner." B. "I will eat more dairy products such as milk, yogurt, and ice cream every day." C. "I will increase my daily intake of orange vegetables such as sweet potatoes and carrots." D. "I will eat a meat source such as chicken or pork with each meal."
D
An older adult client presents to the health care provider's office and reports 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. Levels of plasma proteins C. Thrombocyte count D. RBC count
D
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. Administer a topical analgesic to control pain at the site B. Elevate the head of the bed to 45 degrees C. Pack the wound with half-inch sterile gauze D. Apply pressure over the site for 5-7 minutes
D
Which client is not a candidate for blood donation according to the American Heart Association? A. 86 year old male with blood pressure 110/70 mmHg B. 18 year old male weighing 52 kg. C. 50 year old female with pulse 95 beats/minute D. 26 year old female with hemoglobin 11.0 g/dL
D
