Ch 28: Hematological Assessment of Hematologic Function and Treatment Modalities

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

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

A patient who has long-term packed RBC transfusions develops symptoms of iron toxicity that affect liver function. Which immediate treatment will the nurse prepare the patient for that may help prevent organ damage? a) Iron chelation therapy b) Oxygen therapy c) Therapeutic phlebotomy d) Anticoagulation therapy

a) Iron chelation therapy

The nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. Which position will the nurse place the patient in? a) Lateral position with one leg flexed b) Lithotomy position c) Supine with head of the bed elevated 30 degrees d) Jackknife position

a) Lateral position with one leg flexed

The nurse is administering two units of packed RBCs to an older adult patient with a bleeding duodenal ulcer. The patient begins to experience difficulty breathing and the nurse assesses crackles in the lung bases, jugular vein distention, and an increase in blood pressure. Which action by the nurse is a priority? (select all that apply) a) Continue the infusion but slow the rate down b) Place the patient in an upright position with the feet dependent c) Administer diuretics as prescribed d) Discontinue the transfusion e) Administer oxygen

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

An older adult patient presents to the clinic reporting feeling "exhausted all the time". The nurse will assess which laboratory values that commonly associate with this patient's symptoms? a) WBC count b) RBC count c) Thrombocyte count d) Levels of plasma protein

b) RBC count

A patient receiving plasma develops transfusion-related acute lung injury (TRALI) 4 hours after the transfusion. Which type of aggressive therapy will the patient receive to prevent death from the injury? (select all that apply) a) Performance of serial chest x-rays b) Supplemental oxygen c) Provision of intravenous fluid support d) Intubation and mechanical ventilation e) Intra-aortic balloon pump

b) Supplemental oxygen c) Provision of intravenous fluid support d) Intubation and mechanical ventilation

A female patient has a hemoglobin of 6.4 mg/dL and is preparing to have a blood transfusion. Why would it be important for the nurse to obtain information about the patient's history of pregnancy prior to the transfusion? a) A high number of pregnancies can increase risk of reaction b) If the patient has never been pregnant, it increases the risk of reaction c) Obtaining information about gravidity and parity is routine information for all female patients d) If the patient has been pregnant, she may have developed allergies

a) A high number of pregnancies can increase risk of reaction

A patient with chronic kidney disease is identified as having anemia. Which laboratory test results will the nurse likely observe? a) Decreased levels of erythropoietin b) Decreased total iron-binding capacity c) Increased mean corpuscular volume d) Increased reticulocyte count

a) Decreased levels of erythropoietin

A patient is undergoing plateletpheresis at the outpatient clinic. Which does the nurse identify as the most likely clinical disorder the patient is being treated for? a) Essential thrombocytothemia b) Extreme leukocyotsis c) Sickle cell disease d) Renal transplantation

a) Essential thrombocytothemia

A nurse is caring for a patient having a bone marrow aspiration with biopsy. Which complication will the nurse monitor for? a) Hemorrhage b) Infection c) Shock d) Splintering of bone fragments

a) Hemorrhage

A patient with chronic kidney disease has chronic anemia. Which pharmacological alternative to blood transfusion may be used for this patient? a) GM-CSF b) Erythropoietin c) Eltrombopag d) Thrombopoietin

b) Erythropoietin

A patient develops a hemolytic reaction to a blood transfusion. Which priority actions will the nurse perform? (select all that apply) a) Administer diphenhydramine b) Begin iron chelation therapy c) Obtain appropriate blood specimens d) Collect a urine sample to detect hemoglobin e) Document the reaction according to policy

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

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

d) Febrile nonhemolytic reactions

The patient has a deficiency in the leukocyte responsible for cell-mediated immunity. Which findings in the white blood cell count will the nurse identify that correlate with this deficiency? a) Basophils b) Monocytes c) Plasma Cells d) T lymphocytes

d) T lymphocytes

The nurse is administering a blood transfusion to a patient over 4 hours. After 2 hours, the patient reports chills and has a fever of 101F, an increase from a previous temperature of 99.2F. Which does the nurse identify the patient is experiencing? a) The patient is having an allergic reaction to the blood b) The patient is experiencing vascular collapse c) The patient is having decrease in tissue perfusion from a shock state d) The patient is having a febrile nonhemolytic reaction

d) The patient is having a febrile nonhemolytic reaction