N123 PrepU Ch.32: Assessment of Hematologic Function and Treatment Modalities

16. A client is diagnosed with extreme thrombocytosis. The nurse knows this condition is a result of which elevated blood cell count? Neutrophils Platelets Eosinophils Erythocytes

Platelets Explanation: Extreme thrombocytosis is an elevation in platelets.

9. Which client is not a candidate to be a blood donor according to the American Red Cross? 86-year-old male with blood pressure 110/70 mm Hg 18-year-old male weighing 52 kg 26-year-old female with hemoglobin 11.0 g/dL 50-year-old female with pulse 95 beats/minute

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

TEST 4

TEST 4

13. Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called monocytes. mast cells. blast cells. megaloblasts.

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.

18. 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 Sickle cell anemia Extreme leukocytosis 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.

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

Myeloid stem cell Explanation: The myeloid stem cell is responsible not only for all nonlymphoid white blood cells, 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. A neutrophil is a fully mature WBC capable of phagocytosis.

18. 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? "The condition is likely caused by a folate deficiency." "The condition is likely caused by a vitamin B12 deficiency." "The condition causes abnormally rigid red blood cells." "The condition causes abnormally small red blood cells."

"The condition is likely caused by a vitamin B12 deficiency." Explanation: 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.

2. Which is the major function of neutrophils? Rejection of foreign tissue Destruction of tumor cells Phagocytosis Production of immunoglobulins

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

15. Place the following steps in order when determining the type and severity of a transfusion reaction. Use all options. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. Notify the health care provider. Notify the blood bank. Stop the transfusion. Send the tubing and container to the blood bank. Assess the client.

Stop the transfusion. Assess the client. Notify the health care provider. Notify the blood bank. Send the tubing and container to the blood bank. Explanation: It is important for the nurse to take the proper steps when determining the type and severity of a transfusion reaction. The priority action is to stop the infusion and then assess the client. Next, the health care provider will be notified, followed by the blood bank. Finally, the nurse should send the tubing and container to the blood bank for analysis.

3. 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? Plasma cells T lymphocytes Monocytes Basophils

T lymphocytes Explanation: T lymphocytes are responsible for cell-mediated immunity, in which they recognize material as "foreign," acting as a surveillance system.

TEST 6

TEST 6

6. 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 has thrombocytopenia. may be developing an infection. has leukopenia. may be developing anemia.

may be developing an infection. Explanation: 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.

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

"I understand your concern. The blood is carefully screened but is not completely risk free." Explanation: Despite advances in donor screening and blood testing, certain diseases can still be transmitted by transfusion of blood components (Chart 32-4).

3. A preoperative client is discussing blood donation with the nurse. Which statement by the client indicates to the nurse the need for further teaching? "Donated blood is tested for blood type and infections." "I should expect blood withdrawal to take about 15 minutes." "I could donate my own blood in case I need a transfusion." "My family will donate blood, because it's safer."

"My family will donate blood, because it's safer." Explanation: Directed donations from friends and family members are not any safer than those provided by random donors. Withdrawal of 450 mL of blood usually takes about 15 minutes. Specimens from donated blood are tested to detect infections and to identify the specific blood type. Autologous blood donation is useful for many elective surgeries where the potential need for transfusion is high.

17. A client is returning home after having a bone marrow aspiration and biopsy. Which statement indicates that teaching by the nurse has been effective? "The area might ache for 1 to 2 days." "I can go to the gym to lift weights later." "I can resume my normal activities." "I should take aspirin if I have any pain."

"The area might ache for 1 to 2 days." Explanation: Potential complications of either bone marrow aspiration or biopsy include bleeding and infection. 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 clients have no discomfort after a bone marrow aspiration, but the site of a biopsy may ache for 1 or 2 days. The client should be instructed to perform no rigorous activity for 1 to 2 days. Aspirin-containing analgesics should be avoided immediately after the procedure as this might cause or aggravate bleeding. Rigorous exercise should be avoided for 1 to 2 days

5. 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? "You typically donate blood 4 to 6 weeks before the surgery." "You typically donate blood the day of the surgery." "You will likely not need the blood that is donated." "You will be prescribed calcium to replace what is lost during donation."

"You typically donate blood 4 to 6 weeks before the surgery." Explanation: 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.

20. A client with a history of congestive heart failure has an order to receive 1 unit of packed red blood cells (RBCs). If the nurse hangs the blood at 12:00 pm, by what time must the infusion be completed? 3:00 pm 6:00 pm 4:00 pm 2:00 pm

4:00 pm Explanation: When packed red blood cells (PRBCs) or whole blood is transfused, the blood should be administered within a 4-hour period because warm room temperatures promote bacterial growth.

8. A nurse is preparing a dose of furosemide for an older adult with heart failure. The health care provider orders furosemide 1 mg/kg to be given intravenously. The client weighs 50 kg. The concentration of the drug is 40 mg/4mL (10 mg/mL). How many milliliters would the nurse administer? Record your answer using a whole number. _____ mL

5 mL Explanation: 1 mg/kg X 50 kg = 50 mg then divide by 10 mg/mL = 5 mL

6. When teaching about the advantages of autologous blood transfusion to a client, the nurse should include which information? Select all that apply. The primary advantage is prevention of viral infections. It resolves anemia for clients with a hemoglobin less than 11g/dL. Blood can be transfused to family members and close relatives. It is safer for clients with a history of transfusion reactions. If not needed immediately, the blood can be frozen for future use.

Administer acetaminophen 500 mg po, as ordered Explanation: 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.

7. 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? Notify the physician Administer aspirin (ASA) 325 mg po, as ordered Administer acetaminophen 500 mg po, as ordered Reposition the client to a high Fowler position and continue to monitor the pain

Administer acetaminophen 500 mg po, as ordered Explanation: 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.

2. 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? Anemia Neutropenia Thrombocytopenia Myelodysplastic syndrome

Anemia Explanation: Individuals with a history of alcohol consumption may have anemia due to nutritional deficiencies. Myelodysplastic syndrome, neutropenia, and thrombocytopenia are not common findings in clients who consume or abuse alcohol.

17. 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? Pack the wound with half-inch sterile gauze Apply pressure over the site for 5-7 minutes Elevate the head of the bed to 45 degrees Administer a topical analgesic to control pain at the site

Apply pressure over the site for 5-7 minutes Explanation: 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.

13. G-CSF (filgrastim) is prescribed for a client with bone marrow suppression. What medication administration teaching should the nurse provide to the client? Take this medication by mouth at bedtime each night. Do not eat before arriving to receive the intravenous administration of filgrastim. Assist the client in identifying appropriate subcutaneous injection sites. Filgrastim is taken intramuscularly on a weekly basis.

Assist the client in identifying appropriate subcutaneous injection sites. Explanation: Filgrastim (Neupogen) is administered subcutaneously on a daily basis.

11. Which type of leukocyte contains histamine and is an important part of hypersensitivity reactions? B lymphocyte Basophils Neutrophil Plasma cell

Basophils Explanation: Basophils contain histamine and are an integral part of hypersensitivity reactions. B lymphocytes are responsible for humoral immunity. A plasma cell secretes immunoglobulins. The neutrophil functions in preventing or limiting bacterial infection via phagocytosis.

9. 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? Red blood cell phenotyping Chelation therapy White blood cell filter Hepatitis B immunization

Chelation therapy Explanation: Chelation therapy is prescribed to treat iron overload. Hepatitis B immunization helps immunize against hepatitis B. Red blood cell phenotyping helps decreased sensitization. A white blood cell filter protects against cytomegalovirus and some sensitization and febrile reactions.

16. A client with myelodysplastic syndromes (MDS) receives routine blood transfusions. Which treatment will the nurse expect to be prescribed to prevent the development of iron overload? Eltrombopag Romiplostim Chelation therapy Epoetin alpha

Chelation therapy Explanation: Iron overload is a problem for clients with MDS, especially in those who routinely receive PRBC transfusions (transfusion dependent). Surplus iron is deposited in cells within the reticuloendothelial system, and later in parenchymal organs. To prevent or reverse the complications of iron overload, iron chelation therapy is commonly implemented. Romiplostim and eltrombopag are used to stimulate the proliferation and differentiation of megakaryocytes into platelets within the bone marrow. Epoetin alpha may be used to improve anemia and decrease the need for blood transfusions.

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

Crackles auscultated bilaterally Explanation: 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.

7. Post transfusion, the donor stands up immediately after the needle is withdrawn. The nurse should be alert for which vital sign change? Decrease in BP Slow Pulse RR

Decreased blood pressure. Explanation: Because of the loss of blood volume, hypotension and syncope may occur when the donor assumes an erect position. The most likely vital sign change is decreased blood pressure. The respiratory rate and temperature should not be affected by a change in position. With hypotension and decreased blood volume, the pulse would increase, not decrease.

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

Decreased level of erythropoietin Explanation: 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.

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

Decreased oxygen level Explanation: Hemoglobin carries oxygen; a decreased hemoglobin level results in decreased oxygen. An elevated temperature is a sign of infection and can result from decreased white blood cells. Arterial blood is more oxygen saturated and brighter red in color than venous blood. Increased bruising results from a decreased platelet level, not decreased hemoglobin.

12. When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply. Hair color Herbal supplements Dietary intake Medication use Ethnicity

Dietary intake Medication use Ethnicity Herbal supplements 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.

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

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.

19. The charge nurse should intervene when observing a new nurse perform which action after a client has suffered a possible hemolytic blood transfusion reaction? Disposing of the blood container and tubing in biohazard waste. Informing the client to leave a urine sample after the client's next void. Notifying the blood bank of the reaction. Documenting the reaction in the client's medical record.

Disposing of the blood container and tubing in biohazard waste. Explanation: 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.

11. A client receiving a blood transfusion reports shortness of breath, appears anxious, and has a pulse of 125 beats/minute. What is the best action for the nurse to take after stopping the transfusion and awaiting further instruction from the health care provider? Administer prescribed PRN anti-anxiety agent. Ensure there is an oxygen delivery device at the bedside. Remove the intravenous line. Place the client in a recumbent position with legs elevated.

Ensure there is an oxygen delivery device at the bedside. Explanation: The client is exhibiting signs of circulatory overload. After stopping the transfusion and notifying the healthcare provider, the nurse should place the client in a more upright position with the legs dependent to decrease workload on the heart. The IV line is kept patent in case emergency medications are needed. Oxygen and morphine may be needed to treat severe dyspnea. Administering an anti-anxiety agent is not a priority action over ensuring oxygen is available.

6. 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? Filgrastim Sargramostim Eltrombopag Epoetin alfa

Epoetin alfa Explanation: Erythropoietin (epoetin alfa) is an effective alternative treatment for clients with chronic anemia secondary to diminished levels of erythropoietin. This medication stimulates erythropoiesis. Filgratism ( Neupogen) and Sargramostim stimulate granulocytosis( increasing WBC count) , Eltrombopag (Promacta) is used to treat aplastic anemia and thrombocytopenia.

2. A client with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this client? Thrombopoietin Eltrombopag GM-CSF Erythropoietin

Erythropoietin Explanation: Erythropoietin (epoetin alfa [Epogen, Procrit]) is an effective alternative treatment for clients with chronic anemia secondary to diminished levels of erythropoietin, as in chronic renal disease. This medication stimulates erythropoiesis.

9. A client wants to donate blood before his or her abdominal surgery next week. What should be the nurse's first action? Remind the client to take supplemental iron before donation. Explain the time frame needed for autologous donation. Tell the client that 2 units of blood will be needed. Provide the client with a list of the nearest donation centers.

Explain the time frame needed for autologous donation. Explanation: Preoperative autologous donations are ideally collected 4 to 6 weeks before surgery. The nurse should first explain that time frame to this client. Surgery is scheduled in one week which means that autologous blood donation may not be an option for this client. A list of donation centers can be provided to the client; and even though iron is recommended and 2 units of blood may be suggested, the first action is to tell the client about the needed time frame for donation.

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

Generalized edema Explanation: 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 hypovolemia.

2. The nurse assesses a client experiencing frequent nosebleeds. Which findings indicate to the nurse that additional assessment would be needed for thrombocytopenia? Select all that apply. Cloudy urine Ecchymoses on the skin Petechiae over lower extremities Conjunctival hemorrhage Headache

Headache Ecchymoses on the skin Conjunctival hemorrhage Petechiae over lower extremities Explanation: A history of nosebleeds (epistaxis) is a potential indication of thrombocytopenia. Additional findings associated with thrombocytopenia include a headache associated with central nervous system involvement. Ecchymoses, conjunctival hemorrhage, and petechiae over the lower extremities suggest thrombocytopenia is affecting the skin and associated structures of the head and neck. Cloudy urine would be associated with a urinary tract infection. Hematuria would be the finding if thrombocytopenia is affecting the genitourinary system.

7. Which term refers to the percentage of blood volume that consists of erythrocytes? Differentiation Hemoglobin Erythrocyte sedimentation rate (ESR) Hematocrit

Hematocrit Explanation: Hematocrit is the percentage of blood volume consisting of erythrocytes. Differentiation is 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 RBCs; an elevated rate is indicative of inflammation. Hemoglobin is the iron-containing protein of RBCs.

8. Which term describes the percentage of blood volume that consists of erythrocytes? Hematocrit Hemoglobin Differentiation Erythrocyte sedimentation rate (ESR)

Hematocrit Explanation: 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.

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? Blood transfusion reaction Splintering of bone fragments Shock Hemorrhage

Hemorrhage Explanation: 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.

17. A client is scheduled for surgery to remove an abdominal mass. The nurse knows that which reason hemodilution would be contraindicated as a method to provide blood to the client during the surgery? History of renal disease Takes medications for seasonal allergies Previous thyroidectomy Treatment for osteoarthritis

History of renal disease Explanation: Hemodilution is the removal of 1 to 2 units of blood after induction of anesthesia and replaced with a colloid or crystalloid solution. The blood is then reinfused after the surgery. The purpose of this approach is to reduce the amount of erythrocytes lost during the surgery because the intravenous fluids dilute the concentration of red blood cells and lowers the hematocrit. Hemodilution has been linked to tissue ischemia in the kidneys and would be contraindicated in the client with a history of renal disease. Hemodilution would not be contraindicated for a previous thyroidectomy, treatment for osteoarthritis, or medication used to treat seasonal allergies.

14. 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? Potassium Hemoglobin Calcium Iron

Iron Explanation: 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.

6. The nurse is caring for a client who has a unit of whole blood removed every 6 weeks as treatment for polycythemia vera. Which laboratory test will the nurse monitor to determine if the procedure is adversely affecting the client? Iron Calcium White blood cell count Potassium

Iron Explanation: Therapeutic phlebotomy is the removal of a certain amount of blood under controlled conditions. A client with an elevated hematocrit from polycythemia vera can usually be managed by periodically removing 1 unit (about 500 mL) of whole blood. Over time, this process can produce iron deficiency, Therapeutic phlebotomy does not affect the calcium or potassium levels or the white blood cell count.

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

Iron Explanation: 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.

14. 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 Oxygen therapy Anticoagulation therapy

Iron chelation therapy Explanation: 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.

20. A client reports feeling faint after donating blood. What is the nurse's best action? Place the client in Trendelenburg position. Ambulate client with assistance. Assist the client into high-Fowler's position. Keep client in recumbent position to rest.

Keep client in recumbent position to rest. Explanation: After blood donation, the donor should remain recumbent until he or she feels able to sit up. Donors who experience weakness or faintness should rest for a longer period. High-Fowler's position would not promote blood flow to the brain, and could cause the client to feel light-headed or faint. Ambulating a client who feels faint is not safe due to the high risk of falling. Trendelenburg position is not recommended after blood donation.

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

Lateral position with one leg flexed Explanation: Bone marrow aspiration procedure. The posterior superior iliac crest is the preferred site for bone marrow aspiration and biopsy because no vital organs or vessels are nearby. The patient is placed either in the lateral position with one leg flexed or in the prone position.

19. Which blood cell type is matched correctly with its function? Plasma cell: Cell-mediated immunity B lymphocyte: Secretes immunoglobulin Leukocyte: Fights infection T lymphocyte: Humoral immunity

Leukocyte: Fights infection Explanation: Various blood cell types have unique, major functions. Leukocytes fight infection, T lymphocytes are integral in cell-mediated immunity, plasma cells secrete immunoglobulin, and B lymphocytes are integral in humoral immunity.

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

Liver Explanation: Albumin is produced by the liver. Albumin is not produced in the pancreas, kidney, or large intestine.

8. Which term refers to a form of white blood cell involved in immune response? Spherocyte Lymphocyte Thrombocyte Granulocyte

Lymphocyte Explanation: Mature lymphocytes are the principal cells of the immune system, producing antibodies and identifying other cells and organisms as "foreign." 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.

15. Which nursing intervention should be incorporated into the plan of care for a client with impaired liver function and a low albumin concentration? Implement neutropenic precautions Monitor for edema at least once per shift Apply prolonged pressure to needle sites or other sources of external bleeding Monitor temperature at least once per shift

Monitor for edema at least once per shift Explanation: Albumin is particularly important for the maintenance of fluid balance within the vascular system. Capillary walls are impermeable to albumin, so its presence in the plasma creates an osmotic force that keeps fluid within the vascular space. Clients with impaired hepatic function may have low concentrations of albumin, with a resultant decrease in osmotic pressure and the development of edema.

19. 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? Eosinophils Basophils Neutrophils Monocytes

Neutrophils Explanation: 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).

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

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.

5. 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. Notify the healthcare provider. Perform an abdominal assessment. Hold the prescribed blood transfusion.

Perform an abdominal assessment. Explanation: 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.

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

Petechiae Explanation: Clients with severe thrombocytopenia have petechiae, which are pinpoint hemorrhagic lesions, usually more prominent on the trunk or anterior aspects of the lower extremities.

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

4. Place the clotting cascade in the correct order. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. Fibrin Fibrinogen Prothrombin Thrombin Prothrombin activator

Prothrombin activator Prothrombin Thrombin Fibrinogen Fibrin Explanation: There is an intrinsic and extrinsic clotting pathway with various clotting factors unique to each. However, the common clotting cascade is the end result in both pathways. Prothrombin activator form prothrombin, which forms thrombin, then fibrinogen, and finally fibrin.

14. 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. Hold the involved arm below the heart. Sit up promptly after the needle is removed. Remove the band-aid after 5 minutes.

Remain for observation after eating and drinking. Explanation: 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.

1. 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? Rh-negative mother; Rh-negative child Rh-negative mother; Rh-positive child Rh-positive mother; Rh-positive child Rh-positive mother; Rh-negative child

Rh-negative mother; Rh-positive child Explanation: 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.

10. A nurse is transfusing whole blood to a client with impaired renal function. During the transfusion, the client tells the nurse, "I feel very short of breath all of a sudden." What is the nurse's primary action? Stop the infusion. Slow the infusion. Assess the client's vital signs. Call the health care provider.

Stop the infusion. Explanation: A client with impaired renal function is at increased risk for transfusion-associated circulatory overload (TACO). Signs of circulatory overload include dyspnea, orthopnea, tachycardia, an increase in blood pressure, and sudden anxiety. If the symptoms are mild, the nurse may be able to slow the infusion and administer diuretics; however, sudden shortness of breath should clue the nurse to immediately stop the infusion and sit the client upright with feet dangling. Next, the nurse will notify the health care provider after normal saline is infused into the site. Only after stopping the infusion will the nurse obtain the client's vital signs.

7. Which type of lymphocyte is responsible for cellular immunity? Basophil Plasma cell T lymphocyte B lymphocyte

T lymphocyte Explanation: T lymphocytes are responsible for delayed allergic reactions, rejection of foreign tissue (e.g., transplanted organs), and destruction of tumor cells. This process is known as cellular immunity. B lymphocytes are responsible for humoral immunity. A plasma cell secretes immunoglobulin. A basophil contains histamine and is an integral part of hypersensitivity reactions.

17. 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? T lymphocytes B lymphocytes Leukocytes Monocytes

T lymphocytes Explanation: 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.

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20. 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? The client is having decrease in tissue perfusion from a shock state. The client is having an allergic reaction to the blood. The client is experiencing vascular collapse. The client is having a febrile nonhemolytic reaction.

The client is having a febrile nonhemolytic reaction. Explanation: 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.

9. 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? The client is experiencing vascular collapse. The client is having a febrile nonhemolytic reaction. The client is having an allergic reaction to the blood. The client is having decrease in tissue perfusion from a shock state.

The client is having a febrile nonhemolytic reaction. Explanation: 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.

15. 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? The bone marrow is stimulated by low oxygen levels in the blood to produce erythropoietin, maturing the red blood cells. The kidneys sense low oxygen levels in the blood and produce hemoglobin, stimulating the marrow to produce more red blood cells. The brain senses low oxygen levels in the blood and produces hemoglobin, which binds to more red blood cells. The kidneys sense low oxygen levels in the blood and produce erythropoietin, stimulating the bone marrow to produce more red blood cells.

The kidneys sense low oxygen levels in the blood and produce erythropoietin, stimulating the bone marrow to produce more red blood cells. Explanation: If normally functioning kidneys detect low levels of blood oxygen, they produce more of the hormone erythropoietin (EPO). As EPO levels increase, the bone marrow responds by producing more erythrocytes (red blood cells). EPO is not made by the bone marrow. Hemoglobin, an iron-rich protein that allows erythrocytes to transport oxygen, is synthesized in the erythrocytes as they mature.

1. A nursing instructor is reviewing the role and function of stem cells in the bone marrow with a group of nursing students. After providing the explanation, the instructor asks the students to use their knowledge of anatomy and physiology to determine an alternate way in which adults with diseases that destroy marrow can resume production of blood cells. Which explanation by the students is correct? The three cell types—erythrocytes, leukocytes, and platelets—can resume production of stem cells. Fat found in yellow bone marrow can be replaced by active marrow when more blood cell production is required. The liver and spleen can resume production of blood cells through extramedullary hematopoiesis. The remaining stem cells have the ability to continue with the process of self-replication, creating an endless supply.

The liver and spleen can resume production of blood cells through extramedullary hematopoiesis. Explanation: In adults with disease that destroy marrow or cause fibrosis or scarring, the liver and spleen can also resume production of blood cells through a process known as extramedullary hematopoiesis.

5. When teaching about the advantages of autologous blood transfusion to a client, the nurse should include which information? Select all that apply. The primary advantage is prevention of viral infections. It resolves anemia for clients with a hemoglobin less than 11g/dL. Blood can be transfused to family members and close relatives. It is safer for clients with a history of transfusion reactions. If not needed immediately, the blood can be frozen for future use.

The primary advantage is prevention of viral infections. It is safer for clients with a history of transfusion reactions. If not needed immediately, the blood can be frozen for future use. Explanation: The primary advantage of autologous transfusions is the prevention of viral infections from another person's blood. Other advantages include safe transfusion for client with a history of transfusion reactions; and if the blood is not required immediately, it can be frozen until the donor needs it. It is the policy of the American Red Cross that autologous blood is transfused only to the donor. Hemoglobin level less than 11g/dL is a contraindication to autologous blood donation.

5. While caring for a client, the nurse notes petechiae on the client's trunk and lower extremities. What precaution will the nurse take when caring for this client? Use an electric razor when assisting client with shaving. Elevate the client's head of the bed. Where a mask when entering the client's room. Apply supplemental oxygen to maintain the client's oxygenation.

Use an electric razor when assisting client with shaving. Explanation: Petechiae are associated with severe thrombocytopenia, placing the client at risk for bleeding. The nurse should use an electric razor when assisting the client with shaving. Elevating the head of the bed and applying supplemental oxygen would be appropriate for a client with decreased oxygenation. Wearing a mask when entering the client's room would be appropriate for a client with neutropenia, not thrombocytopenia.

12. The client is to receive a unit of packed red blood cells. What is the nurse's first action? 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. Explanation: All the options are interventions the nurse will do to ensure the blood transfusion is safe. The question asks about the first action of the nurse. The first action would be verifying that the client has signed a written consent form. Then, the nurse would ensure the intravenous site has a 20-gauge or larger needle. The nurse would proceed to obtain the unit of blood, check the blood with another registered nurse, and observe for gas bubbles in the unit of blood.

16. The physician orders a transfusion with packed red blood cells (RBCs) for a client 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? Administer the blood as soon as it arrives Verify the client's identity according to hospital policy Premedicate the client with acetaminophen Assess the client 30 minutes after the start of the initial transfusion

Verify the client's identity according to hospital policy Explanation: 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 client. The nurse must assess the client during the initial start of the transfusion and frequently, if the nurses delays the assessment time for 30 minutes the client may have begun to experience acute hemolytic transfusion reaction, this puts the client's safety at risk.

11. 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? Vitamin A deficiency Folic acid deficiency Vitamin C deficiency Vitamin B12 deficiency

Vitamin B12 deficiency Explanation: Because vitamin B12 is found only in foods of animal origin, strict vegetarians may ingest little vitamin B12. 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 therefore the absorption of vitamin B12 may be diminished. The effects of either decreased absorption or decreased intake of vitamin B12 are not apparent for 2-4 years. This results in megaloblastic anemia. Some symptoms are a smooth, beefy red, enlarged tongue and cranial nerve deficiencies.

6. 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 has thrombocytopenia. has leukopenia. may be developing anemia. may be developing an infection.

may be developing an infection. Explanation: 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.