ATI Hematology Questions
A nurse us preparing to administer 2units of packed RBCs to an older adult client. Which of the ff. actions should the nurse take? a. Administer each unit over 3 hr. b. Use an 18-gauge needle to obtain venous access. c. Use blood that is less than a month old. d. Obtain the client's vital signs every 30min throughout the transfusion.
A. The nurse should administer blood to an older adult client at a slower rate. Therefore, each unit should be administered over 2 to 4 hr. The nurse should use no larger than a 19-gauge needle to obtain venous access on an older adult client. The nurse should use blood that is less than a week old for older adult clients. Older blood cell membranes are more fragile and can break, releasing potassium into circulation. The nurse should obtain an older adult client's vital signs every 15 min throughout the transfusion.
A nurse is monitoring a client who is on telemetry. Which of the ff. findings on the ECG strip should the nurse recognize as normal sinus rhythm? a. The P wave falls before the QRS complex. b. The T wave is in the inverted position. c. The P-R interval measures 0.22 seconds. d. The QRS duration is 0.20 seconds.
A. The nurse should recognize that in normal sinus rhythm the P wave, representing atrial depolarization, falls before the QRS wave. In normal sinus rhythm, the T wave is upright. In normal sinus rhythm, the P-R interval has a constant duration between 0.12 and 0.20 seconds. In normal sinus rhythm, a QRS has a constant duration between 0.04 and 0.10 seconds.
A nurse is monitoring a client who is receiving a blood transfusion. Which of the ff finding indicates an allergic transfusion reactions? a. generalized urticaria b. Blood pressure 184/92 mm Hg c. Distended jugular veins d. Bilateral flank pain.
A. The nurse should recognize urticaria as an indicator of an allergic transfusion reaction. Other clinical manifestations include itching and signs of anaphylaxis with bronchospasm. Hypertension may be an indication of circulatory overload rather than an allergic reaction. Distended jugular veins may be an indication of circulatory overload rather than an allergic reaction. Bilateral flank pain may be an indication of a hemolytic transfusion reaction rather than an allergic reaction.
A nurse in an emergency department is preparing to administer alteplase accelerated therapy to a client who is having a myocardial infarction. Which of the following actions should the nurse plan to take? (Select all that apply) a. Administer the medication within 30min of the client's arrival to the department b. Reconstitute the medication with sterile Water. c. Administer a 15 mg IV bolus d. Tell the client that the purpose of the medication is to keep a new clot from forming. e. Assess the client for back pain.
Administer the medication within 30 min of the client's arrival to the department. The benefits of alteplase are greatly increased when administered as early as possible. Current recommendations are that the client is given alteplase within 30 min of arrival in the emergency department. Research shows a decrease in mortality and a reduction in the size of the infarction when alteplase is administered within 30 min. Reconstitute the medication with sterile water is correct. Alteplase is available as a powder. The nurse should use sterile water to reconstitute the medication. Administer the medication in a 15 mg IV bolus is correct. The nurse should administer an accelerated, or loading dose, to promote a rapid therapeutic effect of the medication. Tell the client that the purpose of the medication is to keep a new clot from forming is incorrect. The nurse should tell the client that the purpose of the medication is to dissolve the existing clot. The nurse will also administer anticoagulants to reduce the risk of new clot formation. Assess the client for back pain is correct. The nurse should assess the client for indications of bleeding, which include report of back pain, headache, changes in level of consciousness, and decreased levels of hematocrit and hemoglobin.
A nurse is creating a dietary plan for an adult female client who has a hemoglobin level of 9.8 g/dL. Which of the ff. foods should the nurse recommend? a. Carrots b. Raisins c. Maple Syrup d. Orange Juice
B. Foods high in iron are recommended to improve a low hemoglobin level. Raisins are a high source of iron. Foods high in iron are recommended to improve a low hemoglobin level. Carrots are not high in iron. Foods high in iron are recommended to improve a low hemoglobin level. Molasses, rather than maple syrup, is high in iron. Foods high in iron are recommended to improve a low hemoglobin level. Although orange juice is not high in iron, it does enhance the absorption of iron.
A nurse is caring for a client who recently had surgery for insertion of a permanent pacemaker. Which of the ff. prescriptions should the nurse clarify? a. Serim cardiac enzyme level b. MRI of the chest c. physical therapy d. Low-Sodium diet
B. A permanent pacemaker is a contraindication for MRI of the chest. The magnets in the machine can create electromagnetic interference and cause the pacemaker to malfunction. A permanent pacemaker is not a contraindication for the measurement of cardiac enzymes. A permanent pacemaker is not a contraindication for physical therapy. A permanent pacemaker is not a contraindication for a low-sodium diet. Limiting sodium intake is a general recommendation for clients who have cardiovascular problems.
A nurse is assessing a client who is receiving a blood transfusion. Which of the ff. finding is a manifestation of hemolytic transfusion reaction? a. HTN b. Report of low-back pain c. Pallor d. Report of metallic taste
B. Low-back pain, fever, and chills are manifestations of a hemolytic transfusion reaction. The nurse should discontinue the transfusion and administer 0.9% sodium chloride through new IV tubing. Hypotension is a manifestation of a hemolytic transfusion reaction. Flushing and tachycardia are manifestations of a hemolytic transfusion reaction. Tachypnea and hemoglobinuria are manifestations of a hemolytic transfusion reaction.
A nurse is providing discharge teaching to a client who has an implantable cardioverter/defribrillator (ICD). Which of the ff. information should the nurse include? a. the client cannot travel by air due to security screening b. the client should hold his cell phone on the side opposite the ICD c. the client should avoid the use of small electric devices. d. the client can carry his ICD in a small pocket.
B. The client should keep his cellular phone on the side opposite the ICD, as close proximity could interfere with the ICD's function. The client may travel by air but should inform security personnel of the presence of the ICD because metal detectors may sound an alarm. Small electrical devices do not affect the function of an ICD. The surgeon implants the ICD's generator under the client's skin in the left pectoral area.
A nurse is caring for who has esophageal varices and is hypotensive after vomiting 500mL of blood. Which of the following actions is the nurse's priority? a. Elevate the client's feet b. Increase the client's IV fluid rate c. Initiate a dopamine IV infusion for the client d. Administer a unit of packed RBCs.
B. When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority action is to increase the client's IV fluid rate. Providing fluid to the client will restore circulating volume and increase blood pressure. The nurse should elevate the client's feet to increase perfusion to the brain during the hypotensive episode, but this action is not the priority. The nurse might need to initiate a dopamine IV infusion to treat the client's hypotension, but this action is not the priority. The nurse should plan to administer a unit of packed RBCs to treat the hypotension and the blood loss, but this action is not the priority.
A nurse is caring for a client who has a prescription for one unit of packed RBCs. The nurse should plan to remain in the room with the client at which of the ff. times during the infusion to observe for a transfusion reaction? a. first 2min b. final 2min c. first 15min d. final 15min
C. The nurse should remain in the room during the first 15 min of the infusion, which is the most critical time period for monitoring a client for a transfusion reaction. Severe reactions usually occur during the infusion of the first 50 mL of blood.
A nurse is caring for a young female adult client who reports weakness, fatigue, and heavy menstrual periods. The client has a Hgb of 8 g/dL and a Hct of 28 g/dL. The nurse suspect which of the ff. types of anemia? a. Folic acid deficiency anemia b. Pernicious anemia c. Iron-deficiency anemia d. Sickle cell anemia
C. Iron-deficiency anemia results from poor gastrointestinal absorption of iron, a diet that is deficient in iron, or blood loss. The nurse should expect a client who has iron-deficiency anemia to have weakness, pallor, fatigue, reduced tolerance for activity, and cheilosis (ulcerations of the corners of the mouth). The nurse should expect a client who has folic acid deficiency to have pallor and jaundice; a smooth, beefy-red tongue (glossitis); fatigue; and weight loss. This type of anemia is caused by nutritional deficiencies, malabsorption syndromes (Crohn's disease), and medications (e.g., anticonvulsants, oral contraceptives). A client who has pernicious anemia is unable to absorb vitamin B12 due to a lack of intrinsic factors in the stomach. The nurse should expect this client to have pallor and jaundice; a smooth, beefy-red tongue (glossitis); fatigue; weight loss; and paresthesias to the hands and feet. Sickle cell anemia is an autosomal recessive disorder in which the RBCs develop a sickle shape following conditions in which decreased oxygen is available. These sickled cells then clump together and become fragile, causing tissue ischemia leading to eventual organ damage. Manifestations of sickle cel anemia include pain, pallor, cyanosis, dyspnea, fatigue, and weakness.
A nurse is caring for a client with a ventricular pacemaker who is on ECG monitoring. The nurse understands that the pacemaker is functioning properly when which of the ff. appears on the monitor strip? a. Pacemaker spikes after each QRS complex b. Pacemaker spikes before each P wave c. Pacemaker spikes before each QRS complex d. Pacemaker spikes with each T wave
C. The pacemaker fires, showing a spike on the monitor strip, which stimulates the ventricle, and the QRS complex appears, indicating that depolarization has occurred. This indicates improper functioning. This is seen with an atrial pacemaker. This indicates improper functioning.
A nurse is planning care for a client who is to receive packed RBCs. The nurse should plan for the total infusion time to not exceed which of the ff? a. 2hr b. 6hr c. 8hr d. 4hr
D. The nurse should infuse the packed RBCs for no longer than 4 hr due to temperature inconsistencies that develop over time and the possibility of bacterial contamination.
A nurse is teaching a client who has a new dx. of aplastic anemia. Which of the ff. information should the nurse include in the teaching? a. Aplastic anemia is associated with a decreased intake of iron. b. Aplastic anemia is associated with a decreased intake of iron. c. Aplastic anemia results in an inability to absorb vitamin B12. d. Aplastic anemia results from decreased bone marrow production of RBCs.
D. Aplastic anemia is a hypoproliferative anemia resulting from decreased production of RBC within the bone marrow. An inadequate intake of iron can result in iron deficiency anemia rather than aplastic anemia. Autoimmune hemolytic anemia, rather than aplastic anemia, is associated with an increased rate of RBC destruction. Pernicious anemia is seen in clients who lack the intrinsic factor responsible for vitamin B12 absorption.
A nurse at a blood donation center is screening clients for blood donation. The nurse should identify that which of the ff. clients must reschedule donation? a. a client who weighs 50kg (110 lbs) and plans to donate 450mL of blood. b. A client who is 14yrs. of age c. A client who is Rh-positive d. A client who has an oral temperature of 37.8 or (100 F)
D. A client who has an oral temperature that exceeds 37.5° C (99.6° F) defers eligibility to donate blood. The client should weigh at least 50 kg (110 lb) to donate 450 mL of blood. The client who is 14 years of age is not eligible to donate blood: however, a client who is 16 or 17 years of age with a parental consent is eligible to donate blood. Blood type does not affect eligibility to donate blood.
A nurse received a unit of packed RBCs from a blood bank and notes that the time is 1130. The nurse should begin the infusion at which of the ff. times? a. when the client has finished eating lunch b. when the client states he is ready to start the infusion c. 2 hr after obtaining blood from the blood bank d. As soon as the nurse can prepare the client and the administration set.
D. The nurse should infuse the blood as soon as possible and complete the procedure within 4 hr. The nurse should begin the infusion as soon as possible after obtaining the packed RBCs from the blood bank. This delay is unnecessary and can complicate the requirement to complete the infusion within 4 hr. This delay is unnecessary and increases the risk of bacterial contamination since the blood is out of the refrigerator. The nurse should infuse the blood as soon as possible after obtaining the packed RBCs from the blood bank.
A nurse is preparing to administer dabigatran to a client who has atrial fibrillation. The nurse should explain that the purpose of this medication is which of the following? a. to convert atrial fibrillation to sinus rhythm b. to dissolve clots in the bloodstream c. to slow the response of the ventricles to the fast atrial impulses d. to reduce the risk of stroke in clients who have atrial fibrillation.
D. Clients who have atrial fibrillation are at an increased risk for thrombus formation and subsequent embolization to the brain. Anticoagulants, such as dabigatran, help prevent thrombus formation. Antidysrhythmic medications such as diltiazem are used to slow the ventricular rate for clients who have atrial fibrillation. Thrombolytic medications, such as alteplase, are used to remove thrombi that have already formed. Beta-blockers such as carvedilol slow the heart rate.
A nurse is assessing a client who is postoperative and has anemia due to excess blood loss following surgery. Which of the following findings should the nurse expect? a. Fatigue b. Hypertension c. Bradycardia d. Diarrhea
a. Fatigue Fatigue The nurse should identify that the client who has anemia due to blood loss following surgery will experience fatigue. This is due to the body's decreased ability carry oxygen to vital tissues and organs. Constipation is a manifestation of anemia due to blood loss following surgery. Tachycardia is manifestation of anemia due to blood loss following surgery. Hypotension is manifestation of anemia due to blood loss following surgery.
A nurse is caring for a client who receives furosemide (Lasix) to treat heart failure. Which of the following laboratory values should the nurse monitor for this client due to this medication? a. potassium b. albumin c. cortisol d. bicarbonate
a. potassium Furosemide is a loop diuretic that promotes the excretion of potassium. The nurse should monitor the client's potassium level to watch for hypokalemia. Furosemide does not affect albumin levels. Furosemide does not affect cortisol levels, although it can lower serum sodium levels. Furosemide does not affect bicarbonate levels.
A nurse is caring for a client who has infective endocarditis. Which of the following manifestation is the priority for the nurse to monitor for? a. Anorexia b. Dyspnea c. Fever d. Malaise
b. Dyspnea When using the airway, breathing, circulation (ABC) approach to client care, the nurse determines the priority manifestation to monitor for is dyspnea. Dyspnea can be an indication of left-sided heart failure, or a pulmonary infarction due to embolization. Anorexia is a manifestation associated with infective endocarditis; however, another manifestation is a greater risk to the client, and therefore the priority. Fever is a manifestation associated with infective endocarditis; however, another manifestation is a greater risk to the client, and therefore the priority. Malaise is a manifestation associated with infective endocarditis; however, another manifestation is a greater risk to the client, and therefore the priority.
A nurse in a cardiac unit is caring for a client with acute right-sided heart failure. which of the following findings should the nurse expect? a. decreased BNP b. elevated CVP c. increased PAWP d. decreased specific gravity
b. Elevated CVP CVP is a measurement of the pressure in the right atria or ventricle at the end of diastole. An elevated CVP is indicative of heart failure. The BNP is a neurohormone that aids in the regulation of fluid balance by detecting increased stretch of the myocardium and triggering diuresis through sodium excretion via the kidneys. The BNP level is elevated in the client who has acute heart failure. Pulmonary pressure increases in left-sided heart failure because of the increased pressure and volume of blood in the left ventricle. Urinary specific gravity is increased in the client who has heart failure as a result of fluid retention by the body.
A nurse is preparing an in-service about the various supplements clients might use. Which of the ff. herbal supplements should the nurse include as potentially increasing the anticoagulant effects of aspirin and other oral anticoagulants? a. Valerian b. Feverfew c. Milk Thistle d. Saw Palmetto
b. Feverfew Feverfew can increase the risk of bleeding due to the suppression of platelet aggregation. Clients can use valerian to promote sleep and decrease restlessness from anxiety. Milk thistle reduces the effectiveness of oral contraceptives. Clients may use saw palmetto to relieve urinary and prostate symptoms, such as frequent urination and nocturia.
the nurse is collecting a medication history from a client who is scheduled to have a cardiac catheterization. Which of the following medications taken by the client interacts with contrast material and places the client at risk for acute kidney injury? a. Atorvastatin b. Metformin c. Nitroglycerin d. Carvedilol
b. Metformin Metformin interacts with contrast dye and can cause acute kidney damage. Atorvastatin is contraindicated for a client who has active hepatic disease, but it does not interact with contrast material. Nitroglycerin is contraindicated for a number of conditions including increased intracranial pressure, but it does not interact with contrast material. Carvedilol is contraindicated for a number of conditions including 2nd and 3rd degree heart block, but it does not interact with contrast material
A nurse is assessing a client who has infective endocarditis. Which of the following should be the priority for the nurse to report to the provider? a. Splinter hemorrhages to the nails b. Dyspnea c. fever d. Clusters of petechiae in the mouth
b. dyspnea The client who has infective endocarditis and develops dyspnea, tachycardia, or a cough might be developing heart failure or experiencing pulmonary emboli, two complications of the infection. Fine reddish-brown lines, called splinter hemorrhages, are an expected finding in the client who has infective endocarditis. Clients who have infective endocarditis might experience intermittent fevers, even after initiating antibiotic therapy. Petechiae are manifestations of infective endocarditis and can appear in clusters over different areas of the body, including the mucous membranes of the mouth, the palms of the hands, and soles of the feet.
A nurse is assessing a client who has atrial fibrillation. Which of the following pulse characteristics should the nurse expect? a. Slow b. Not palpable c. Irregular d. Bounding
c. Irregular With atrial fibrillation, multiple ectopic foci stimulate the atria to contract. The AV node is unable to transmit all of these impulses to the ventricles, resulting in a pattern of highly irregular ventricular contractions and thus an irregular pulse. Atrial fibrillation is an abnormal cardiac rhythm in which the atria are unable to effectively contract because of multiple rapid stimuli causing the atria to depolarize in an organized manner. The atrial rate can range from 300 to 600 bpm, with the ventricular rate being 120 to 200 bpm. The heart's contraction is not normal in the client who has atrial fibrillation. The atria quiver rather than contract, and the ventricles contract in a rapid, chaotic fashion. The ventricular response provides the client with a palpable pulse, although it may be difficult to count the rate. With atrial fibrillation, the amplitude of the client's pulse is highly variable. There is a decrease in ventricular filling, resulting in varying stroke volumes.
A nurse is caring for a client who is experiencing anaphylactic shock in response to the administration of penicillin. Which of the following medications should the nurse administer first? a. Dobutamine b. Methylprednisone c. Furosemide d. Epinephrine
d. Epinephrine The priority action the nurse should take when using the airway, breathing, circulation approach to client care is to administer epinephrine, a bronchodilator and vasopressor used for allergic reactions to reverse severe manifestations of anaphylactic shock. The nurse should administer dobutamine, a cardiac stimulant used when cardiac decompensation occurs due to anaphylactic shock; however, it is not the first medication the nurse should administer. The nurse should administer methylprednisolone, a corticosteroid, to decrease itching and severe rash; however, it is not the first medication the nurse should administer. The nurse should administer furosemide, a loop diuretic, to improve renal profusion during an anaphylactic crisis; however, it is not the first medication the nurse should administer.
A nurse is caring for a client who is recievig a unit of packed red blood cells. Fifteen minutes following the start of the transfusion, the nurse notes that the client is febrile, with chills and red-tinged urine. Which of the following transfusion reactions should the nurse suspect? a. Febrile b. Allergic c. Acute Pain d. Hemolytic
d. Hemolytic A hemolytic transfusion reaction occurs when antibodies in the recipient's blood react to foreign blood cells introduced by the transfusion. The antibodies bind to the foreign cells and destroy them in a process known as hemolysis. The destroyed cells are excreted by the kidneys (hemoglobinuria), causing the red-tinged urine. Hemolytic transfusion reactions can result in acute renal injury, disseminated intravascular coagulation, and circulatory collapse. A febrile transfusion reaction can occur in clients who have received multiple blood product transfusions. It is a response in which anti-white blood cell (WBC) antibodies react with the WBCs remaining in the blood product. This results in chills, fever, hypotension, tachycardia and tachypnea. Clients who have a history of multiple blood product transfusions may receive leukocyte reduced blood or single-donor HLA matched platelets along with a WBC filter to prevent febrile reactions. Allergic (anaphylactic) transfusion reactions occur most often in clients who have pre-existing allergies. It is thought to be the result of a reaction to the plasma protein contained in the blood product. Manifestations include urticaria, itching, and flushing. In extreme cases, bronchospasm and laryngeal edema, and shock may occur. Onset may occur as late as 24 hr following the transfusion. Clients who have a history of allergies may receive blood products in which the WBCs, plasma, and immunoglobulin A has been removed or the client may be pre-treated with antihistamines and corticosteroids. An acute pain transfusion reaction can occur during or following transfusion with blood products. It manifests as severe chest, joint, and back pain, along with hypertension and flushing of the face and neck. The client is often anxious. Acute pain transfusion reactions are treated symptomatically with medications for pain and rigors.
A nurse is reviewing the laboratory findings for a client who has idiopathic thrombocytopenia purpura (ITP). which of the following findings should the nurse expect to be decreased? a. WBC b. RBC c. Granulocytes d. Platelets
d. Platelets The nurse should recognize that ITP results from the destruction of platelets by antibodies; therefore, the nurse should expect a platelet level below the expected reference range. The nurse should not expect a decrease in the WBC. The nurse should not expect a decrease in the RBC. The nurse should not expect a decrease in the granulocytes.
A nurse is assessing a client who has left-sided heart failure. which of the following findings should the nurse expect? a. Jugular venous distention b. Abdominal distension c. Dependent edema d. Hacking cough
d. hacking cough A hacking cough is a manifestation of left-sided heart failure that occurs due to pulmonary congestion. Right-sided heart failure raises the pressure and volume within the jugular veins, making them visibly distended when the client is sitting or the head of the bed is elevated more than 30°. Abdominal distension is a manifestation of right-sided heart failure that occurs due to venous congestion. Dependent edema is a manifestation of right-sided heart failure. Pressing edematous skin with a finger leaves a transient indentation (pitting).
