Nurs. 107 Ch 28 Prep-U & Nclex questions

Which of the following cells are capable of differentiating into plasma cells? A) B lymphocytes B) Neutrophils C) Eosinophils D) T lymphocytes

A) B lymphocytes Explanation: B lymphocytes are capable of differentiating into plasma cells. Plasma cells, in turn, produce antibodies called immunoglobulins (Ig), which are protein molecules that destroy foreign material by several mechanisms. T lymphocytes, eosinophils, and neutrophils do not differentiate into plasma cells.

A client is diagnosed with extreme thrombocytosis. The nurse knows this condition is a result of which elevated blood cell count? A) Platelets B) Erythrocytes C) Neutrophils D) Eosinophils

A) Platelets Explanation: Extreme thrombocytosis is an elevation in platelets.

A nurse is reviewing a client's most recent platelet count and identifies the need to institute bleeding precautions. Which result would the nurse most likely have noted? A) 110,000/mm3 B) 45,000/mm3 C) 200,000 /mm3 D) 90,000/mm3

B) 45,000/mm3 Explanation: Bleeding precautions are recommended for clients with a platelet count of less than 50,000/mm3.

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

D) 5% Explanation: Monocytes account for approximately 5% of the total leukocyte count. The other percentages are incorrect.

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) Myelodysplastic syndrome B) Thrombocytopenia C) Neutropenia D) Anemia

D) 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.

Place the following procedural steps in order for transfusing a unit of packed red blood cells (PRBCs). 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.

1. Start an intravenous line. 2. Obtain the unit of PRBCs from the blood bank. 3. Double check the labels with another nurse to ensure correct ABO group and Rh type. 4. Initiate the blood transfusion within 30 minutes of receipt. 5. Monitor closely for signs of a transfusion reaction. Explanation: The nurse should first start an intravenous line, obtain the PRBCs, double check labels, start the transfusion, and then monitor for a reaction.

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

A) "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.

A client is experiencing symptoms of myelodysplastic syndrome (MDS). The nurse prepare the client for which type of test to aid in diagnosing this condition? A) Bone marrow aspiration and biopsy B) Complete blood count C) Hemoglobin D) Hematocrit

A) Bone marrow aspiration and biopsy Explanation: The official diagnosis of MDS is based on the results of a bone marrow aspiration (to assess dysplasia) and biopsy (to assess characteristics of the affected cells). These tests help in determining prognosis, risk of leukemic transformation, and in some clients, the most effective therapy. Hematocrit, hemoglobin, and complete blood count are not used to definitively diagnose MDS.

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

A) Ethnicity B) Dietary intake D) Herbal supplements E) Medication use 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.

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? A) Iron B) Potassium C) Calcium D) Hemoglobin

A) 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.

What food should the nurse recommend for a client diagnosed with vitamin B12 deficiency? A) Lean meat B) Citrus fruit C) Green vegetables D) Whole-grain bread

A) Lean meat Explanation: Vitamin B12 is only found in foods of animal origin. Therefore, whole-grain bread, green vegetables, and citrus fruit do not contain this vitamin.

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? A) Administer the blood as soon as it arrives B) Verify the client's identity according to hospital policy C) Assess the client 30 minutes after the start of the initial transfusion D) Premedicate the client with acetaminophen

B) 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.

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 kidneys sense low oxygen levels in the blood and stimulate hemoglobin, stimulating the marrow to produce more 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 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. Explanation: If the kidney detects low levels of oxygen, as occurs when fewer red cells are available to bind oxygen (as with anemia), erythropoietin levels increase, stimulating the marrow to produce more erythrocytes (red blood cells).

A client is in the hospital with a bleeding gastric ulcer and requires a blood transfusion. He has been typed and crossmatched for 2 units of packed red blood cells and found to have type O blood. What type of blood will the nurse administer to this client? A) Type B B) Type A C) Type O D) Type AB

C) Type O Explanation: Those with type O blood can only receive type O blood. Clients with all other blood types can receive type O blood provided the Rh factor is compatible.

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? A) Fat found in yellow bone marrow can be replaced by active marrow when more blood cell production is required. B) The three cell types—erythrocytes, leukocytes, and platelets—can resume production of stem cells. C) The remaining stem cells have the ability to continue with the process of self-replication, creating an endless supply. D) The liver and spleen can resume production of blood cells through extramedullary hematopoiesis.

D) 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

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following? A) Liver B) Pancreas C) Kidney D) Large intestine

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

A client seeks medical attention for the spontaneous development of bruises over the arms and legs. Which laboratory tests will the nurse anticipate being prescribed for this client? Select all that apply. A) Bilirubin B) Activated partial prothrombin time C) Complete blood count D) Blood urea nitrogen E) International normalized ratio

B) Activated partial prothrombin time C) Complete blood count E) International normalized ratio Explanation: For most hematologic conditions, continued monitoring via specific blood tests is required because it is very important to assess for changes in test results over time. Tests commonly used include the complete blood count, which identifies the total number of blood cells, hemoglobin, hematocrit, and RBC indices. The international normalized ratio and activated partial thromboplastin time are used to evaluate clotting ability. Bilirubin is used to measure liver function. BUN is a renal function test.

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) Thrombocytopenia B) Hemochromatosis C) Polycythemia D) Vitamin B12 deficiency

B) Hemochromatosis Explanation: Hemochromatosis is an autosomal recessive disease of excessive iron absorption. This results in bronze or gray-tan skin, especially over scars. The other answer choices are hematological conditions; however, these do not cause the skin to turn a gray-tan color.

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) Therapeutic phlebotomy B) Iron chelation therapy C) Anticoagulation therapy D) Oxygen therapy

B) 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.

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

B) 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.

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

A nurse is assisting a client into position prior to bone marrow aspiration. Which position will the nurse place the client prior to the procedure? A) Knee-chest B) Prone C) Trendelenburg D) Supine

B) Prone Explanation: Prior to the bone marrow aspiration, the nurse should place the client in either the prone position or lateral position with one leg flexed. The aspiration usually is performed on the anterior iliac crest. It would not be appropriate for the nurse to place the client in supine, knee-chest, or Trendelenburg positions.

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? A) Where a mask when entering the client's room. B) Use an electric razor when assisting client with shaving. C) Apply supplemental oxygen to maintain the client's oxygenation. D) Elevate the client's head of the bed.

B) 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.

A nurse administers blood products to a client with Hodgkin disease. During the administration, the nurse notes the client has a fever and diffuse reddened skin rash. From what condition does the nurse suspect the client is suffering? A) Creutzfeldt-Jakob disease B) Bacterial contamination C) Graft-versus-host disease D) Delayed hemolytic reaction

C) Graft-versus-host disease Explanation: Graft-versus-hold disease (GVHD) occurs in only severely immunocompromised recipients (such as those with Hodgkin disease). The transfused lymphocytes attack the host lymphocytes or body tissues; symptoms or signs may include fever, diffuse reddened skin rash, nausea, vomiting, and diarrhea. The other answer choices are complications that can occur as a result of blood transfusion; however, these do not present with a diffuse reddened skin rash.

A client is being treated for chronic myeloid leukemia (CML). Which medication will the nurse expect to be prescribed for this client? A) Prednisone B) Calcium carbonate C) Imatinib mesylate D) Dilantin

C) Imatinib mesylate Explanation: The goal of treatment for CML is to control the disease, either by obtaining remission or by keeping the client in the chronic phase for as long as possible. The use of tyrosine kinase inhibitors, such as imatinib mesylate (TKIs), has significantly improved treatment and long-term survival for patients with CML. The TKI imatinib mesylate is considered to be standard of care for clients with CML. TKIs work by blocking the signals within the leukemic cells that express the BCR-ABL protein. This inhibition prevents a series of chemical reactions that cause the cells to grow and divide, thus inducing complete remission at the cellular level. Antacids such as calcium carbonate, corticosteroids such as prednisone, and antiseizure such as Dilantin medications decrease the effects of TKIs and are not used control CML.

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.

1. Stop the transfusion. 2. Assess the client. 3. Notify the health care provider. 4. Notify the blood bank. 5. 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.

The client is diagnosed with polycythemia vera. The nurse prepares the client for which procedure? A) Phlebotomy B) Blood transfusion C) Apheresis D) Platelet infusion

A) Phlebotomy Explanation: Polycythemia vera is a condition in which the blood contains a large amount of red blood cells, increasing the viscosity of the blood. Phlebotomy is a preferred treatment to rid the circulation of excess red blood cells. Apheresis is a process in which platelets and leukocytes are removed from the blood. Blood and platelet infusions can exacerbate this condition.

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 increase my daily intake of orange vegetables such as sweet potatoes and carrots." B) "I will eat a meat source such as chicken or pork with each meal." C) "I will eat a spinach salad with lunch and dinner." D) "I will eat more dairy products such as milk, yogurt, and ice cream every day."

B) "I will eat a meat source such as chicken or pork with each meal." Explanation: Vitamin B12 is found only in foods of animal origin. The other choices do not include meats. Dairy products contain large amounts of Calcium and vitamin D. Orange vegetables contain large amounts of vitamin A.

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? A) Leukocytes B) Monocytes C) T lymphocytes D) B lymphocytes

C) 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.

A client is prescribed to receive 2 units of fresh frozen plasma (FFP). Place in order the steps the nurse will take to administer this blood product to the client. 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.

1. Ensure a 22-gauge catheter is in place 2. Obtain the FFP from the blood bank 3. Double-check the blood labels with another nurse 4. Begin infusion 5. Observe the client for signs of an adverse reaction 6. Monitor vital signs at the conclusion of the transfusion 7. Flush the intravenous line with saline after the transfusion Explanation: When administering fresh frozen plasma, a 22-gauge or larger catheter should be in place before obtaining the FFP from the blood bank. The label on the FFP should be checked with another nurse before beginning the transfusion. Each unit of FFP should be infused between 30 and 60 minutes to prevent clumping of the platelets during the transfusion. The client should be closely observed during the transfusion for any signs of an adverse reaction. At the conclusion of the transfusion, the client's vital signs should be measured and compared with baseline measurements. The intravenous line should be flushed with saline afterwards to remove any blood components from the tubing.

A client receiving a unit of packed red blood cells develops hives and generalized itching. Which actions will the nurse take to help this client? Select all that apply. A) Notify the primary health care provider B) Stop the transfusion C) Administer diphenhydramine as prescribed D) Apply oxygen via a face mask E) Slow the rate of the transfusion

A) Notify the primary health care provider B) Stop the transfusion C) Administer diphenhydramine as prescribed Explanation: Some clients develop urticaria (hives) or generalized itching during a transfusion; the cause is thought to be a sensitivity reaction to a plasma protein within the blood component being transfused. Symptoms of an allergic reaction are urticaria, itching, and flushing. The reactions are usually mild and respond to antihistamines. The nurse should stop the transfusion and notify the primary health care provider of the client's symptoms. If the symptoms subside, the transfusion can be resumed. The client does not need oxygen. Slowing the rate of the transfusion would not help reduce the symptoms.

A patient with severe anemia is admitted to the hospital. Due to religious beliefs, the patient is refusing blood transfusions. The nurse anticipates drug therapy with which drug to stimulate the production of red blood cells? A) Eltrobopag (Promacta) B) Epoetin alfa (Epogen) C) Filgrastim (Neupogen) D) Sargramostim (Leukine)

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

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

B) Packed red blood cells (RBCs) Explanation: 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 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 folate deficiency." B) "The condition causes abnormally rigid red blood cells." C) "The condition is likely caused by a vitamin B12 deficiency." D) "The condition causes abnormally small red blood cells."

C) "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.

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) Oral temperature of 97°F C) Crackles auscultated bilaterally D) Pain and tenderness in calf area

C) 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.

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

D) 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.

Which type of leukocyte contains histamine and is an important part of hypersensitivity reactions? A) Neutrophil B) Plasma cell C) B lymphocyte D) Basophils

D) 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.

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? A) Aplastic anemia B) Pancytopenia C) Sickle cell disease D) Coagulopathy

D) Coagulopathy Explanation: The term coagulopathy refers to conditions in which a component that is necessary to control bleeding is missing or inadequate.

A nurse is completing a detailed health history and assessment in the electronic medical record (EMR) for a client with a disorder of the hematopoietic system. Which symptom is the most commonly reported in association with hematologic diseases? A) Dyspnea B) Blurred vision C) Severe headaches D) Extreme fatigue

D) Extreme fatigue Explanation: When assessing a client with a disorder of the hematopoietic system, it is essential to assess for the most common symptom in hematologic diseases, which is extreme fatigue.

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

A) It is safer for clients with a history of transfusion reactions. C) The primary advantage is prevention of viral infections. D) 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.

The nurse learns that a client has a family history of a hematologic condition. Which assessment findings indicate to the nurse that the client needs additional assessment for the condition? Select all that apply. A) Scattered bruises B) Peripheral edema C) Report of fatigue D) Report of frequent nosebleeds E) Diffuse mild abdominal pain

A) Scattered bruises C) Report of fatigue D) Report of frequent nosebleeds E) Diffuse mild abdominal pain Explanation: A careful health history and physical assessment can provide important information related to a client's known or potential hematologic diagnosis. Because many hematologic disorders are more prevalent in certain ethnic groups, assessments of ethnicity and family history are useful. The client's family history of a hematologic condition would guide the nurse during the assessment. Findings associated with a hematologic condition include evidence of bleeding such as scattered bruises. Fatigue is the most common symptom of a hematologic condition. Additional symptoms include abdominal pain and report of frequent nosebleeds. Peripheral edema is not identified as a specific symptom of a hematologic condition.

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

B) 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.

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? A) Eltrombopag B) Chelation therapy C) Epoetin alpha D) Romiplostim

B) 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.

Which term describes the percentage of blood volume that consists of erythrocytes? A) Differentiation B) Hematocrit C) Hemoglobin D) Erythrocyte sedimentation rate (ESR)

B) 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.

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? A) Iron B) Calcium C) Potassium D) White blood cell count

B) 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.

Which term refers to a form of white blood cell involved in immune response? A) Thrombocyte B) Lymphocyte C) Spherocyte D) Granulocyte

B) 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.

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) Eosinophils B) Neutrophils C) Monocytes D) Basophils

B) 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).

The nurse is completing a pretransfusion assessment to determine a female client's history of previous transfusions as well as previous reactions to transfusions. Which is the most important information to obtain from this client before the transfusion? A) Diagnosis B) Number of pregnancies C) Age D) Family history of transfusion reactions

B) Number of pregnancies Explanation: 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 diseases.

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) Animal fats B) Nuts and seeds C) Lean meats D) Organic foods E) Leafy green vegetables

B) Nuts and seeds C) Lean meats E) Leafy green vegetables Explanation: A healthy diet that includes lean meats, nuts, seeds and green vegetables can promote red cell production. Animal fats are not known to promote red cell production. Organic foods are not necessarily more likely to promote red cell synthesis.

Which is the major function of neutrophils? A) Rejection of foreign tissue B) Phagocytosis C) Destruction of tumor cells D) Production of immunoglobulins

B) 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.

One hour after a transfusion of packed red blood cells (RBCs) is started, a client develops redness on the trunk and reports itching. The nurse stops the RBC infusion and administers diphenhydramine 25 mg po, as ordered. Thirty minutes later, the redness and itching are gone. What action should the nurse take next? A) Send the blood back to the blood bank B) Resume the transfusion C) Obtain blood and urine samples from the client D) Position the client in an upright position with the feet in a dependent position

B) Resume the transfusion Explanation: Some clients develop urticaria (hives) or generalized itching during a transfusion. The cause of these reactions is thought to be a sensitivity reaction to a plasma protein within the blood component being transfused. Symptoms of an allergic reaction are urticaria, itching, and flushing. The reactions are usually mild and respond to antihistamines. If the symptoms resolve after administration of an antihistamine (e.g., diphenhydramine), the transfusion may be resumed.

A nurse is caring for a client with a diagnosis of lymphocytopenia. Which assessment finding will the nurse consider most concerning when caring for this client? A) Prothrombin time 12 seconds B) Temperature of 37.7 degrees Celsius C) Blood pressure 132/92 D) INR 0.9

B) Temperature of 37.7 degrees Celsius Explanation: Lymphocytopenia is a decrease in the number of lymphocytes. Lymphocytes help to fight foreign invaders, such as infectious organisms. A temperature of 37.7 degree Celsius is a Fahrenheit temperature of 99.9. A low-grade fewer may be indicative of an infection. The other answer choices do not suggest infection and are not the priority concern.

A client who had a splenectomy two years ago is having a routine examination. Which follow-up question will the nurse ask as a priority based on known long-term risks? A) "Have you had unexplained episodes of bleeding?" B) "Are you taking more than three medications?" C) "Have you gotten your vaccines this year?" D) "How many fruits and vegetables do you eat each day?"

C) "Have you gotten your vaccines this year?" Explanation: The surgical removal of the spleen, or splenectomy, is a possible treatment for some hematologic disorders. Afterwards, the platelet counts should normalize over time. Long-term risks after a splenectomy include a greater likelihood of developing a life-threatening infection. The Centers for Disease Control and Prevention recommends patients without spleens receive vaccines for influenza, pneumonia, and meningococci. The number of medications the client is taking does not increase the likelihood of developing an infection. The consumption of fruits and vegetables may help with the client's overall immunity but will not directly reduce the client's risk of developing an infection. Unexplained bleeding is an acute risk that diminishes over time; the long-term risk of infection is more likely for this client and therefore the priority question.

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

C) "I'll ask someone to drive me home when I awake from general anesthesia." Explanation: 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 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 have an increasing number of leukocytes over time. B) Older adults acquire damage to the bone marrow over time. C) Older adults acquire damage to the DNA of stem cells over time. D) Older adults are exposed to more infectious disease over time.

C) Older adults acquire damage to the DNA of stem cells over time. Explanation: Older adults acquire damage to the DNA of stem cells over time, increasing the chance of myeloid malignancies such as AML. The damage over time is to the stem cells themselves, not the bone marrow. Exposure to infectious disease does not increase the chance of developing myeloid malignancies.

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? A) Rh-negative mother; Rh-negative child B) Rh-positive mother; Rh-negative child C) Rh-negative mother; Rh-positive child D) Rh-positive mother; Rh-positive child

C) 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.

A client receiving a unit of packed red blood cells (PRBCs) has been prescribed morphine 1 mg intravenously now for pain. What is the best method for the nurse to administer the morphine? A) Administer the morphine into the closest tubing port to the client for fast delivery. B) Inject the morphine into a distal port on the blood tubing. C) Add the morphine to the blood to be slowly administered. D) Disconnect the blood tubing, flush with normal saline, and administer morphine.

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

A patient 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) Increased reticulocyte count C) Increased mean corpuscular volume D) Decreased level of erythropoietin

D) 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.

A client donated two units of blood to be used for transfusion during spinal fusion surgery. The client received one unit of autologous blood during the procedure but the second unit is not needed during the procedure. The nurse knows which action will come after the procedure is completed? A) Release the additional unit for use to the general population. B) Provide it to the client before discharge. C) Use the unit for platelets and albumin. D) Discard the additional unit.

D) Discard the additional unit. Explanation: In autologous donation, the client's own blood is collected for a future transfusion, particularly for an elective surgery where the potential for transfusion is high, such as an orthopedic procedure. If the blood is not used, it is discarded. The blood is not used for its components. The client will not be given the unit of blood unless it is required. The additional unit will not be released to the general population for use.

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

D) 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.

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) Antithrombin III B) IV gamma-globulin C) PRBCs D) FFP

D) FFP Explanation: Fresh frozen plasma has all the coagulation factors in it and is the blood component replacement therapy that will be used to replace blood from a client who is actively bleeding with a coagulation factor deficiency.

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

D) 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.

Which statement best describes the function of fibrinogen? A) Functions primarily as an immunological agent B) Helps maintain osmotic pressure C) Helps prevent or modify some types of infectious diseases D) Plays a key role in forming blood clots

D) Plays a key role in forming blood clots Explanation: Fibrinogen, the largest share of plasma protein, plays a key role in forming blood clots. It can be transformed from a liquid to fibrin, a solid that controls bleeding. Globulins function primarily as immunologic agents by preventing or modifying some types of infectious diseases. On the other hand, albumin helps maintain the osmotic pressure that retains fluid in the vascular compartment.

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 an allergic reaction to the blood. C) The client is having decrease in tissue perfusion from a shock state. D) The client is having a febrile nonhemolytic reaction.

D) 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.

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: A) has leukopenia. B) has thrombocytopenia. C) may be developing an infection. D) may be developing anemia.

D) 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.