chapter 28 HEMATOLOGIC fun & treatment

A nurse at a blood donation clinic has completed the collection of blood from a client. The client reports feeling "light-headed" and appears pale. Which action by the nurse is most appropriate?

A. Help the client to sit, with head lowered below knees. A donor who appears pale or complains of faintness should immediately lie down or sit with the head lowered below the knees. The client should be observed for another 30 minutes

Through the process of hematopoiesis, stem cells differentiate into either myeloid or lymphoid stem cells. Into what do myeloid stem cells further differentiate? Select all that apply.

A. Leukocytes D. Platelets E. Erythrocytes Myeloid stem cells differentiate into three broad cell types: erythrocytes, leukocytes, and platelets

A client's most recent blood work reveals low levels of albumin. This assessment finding should suggest the possibility of what nursing diagnosis?

A. Risk for imbalanced fluid volume related to low albumin Albumin is particularly important for the maintenance of fluid balance within the vascular system. Deficiencies nearly always manifest as fluid imbalances.

An older adult client is exhibiting many of the characteristic signs and symptoms of iron deficiency. In addition to a complete blood count, what diagnostic assessment should the nurse anticipate?

A. Stool for occult blood Iron deficiency in the adult generally indicates blood loss (e.g., from bleeding in the GI tract or heavy menstrual flow). Bleeding in the GI tract can be preliminarily identified by testing stool for the presence of blood

The nurse's brief review of a client's electronic health record indicates that the client regularly undergoes therapeutic phlebotomy. Which of the following rationales for this procedure is mostplausible?

A. The client may chronically produce excess red blood cells Persistently elevated hematocrit is an indication for therapeutic phlebotomy.

A nurse has participated in organizing a blood donation drive at a local community center. Which client would most likely be disallowed from donating blood?

B. A client whose blood pressure is 78/49 mm Hg For potential blood donors, systolic arterial blood pressure should be 80 to 180 mm Hg, and the diastolic pressure should be 50 to 100 mm Hg. There is no absolute upper age limit.

A client's health history reveals daily consumption of two to three bottles of wine. The nurse would consider increased risk for which hematologic disorder when planning assessments and interventions for this client?

B. Anemia Heavy alcohol use is associated with numerous health problems, including anemia.

The nurse is describing normal erythrocyte physiology to a client who has a diagnosis of anemia. The nurse should explain that the erythrocytes consist primarily of which substance?

B. Hemoglobin Mature erythrocytes consist primarily of hemoglobin, which contains iron and makes up 95% of the cell mass

The nurse is providing care for a 73-year-old client who has a hematologic disorder. Which change in hematologic function is age-related?

B. Older adults are less able to increase blood cell production when demand suddenly increases. Due to a variety of factors, when an older person needs more blood cells, the bone marrow may not be able to increase production of these cells adequately. Stem cell activity continues throughout the lifespan, although at a somewhat decreased rate.

A client undergoing a hip replacement has autologous blood on standby if a transfusion is needed. What is the primary advantage of autologous transfusions?

B. Prevention of viral infections from another person's blood Other secondary advantages include safe transfusion for clients with a history of transfusion reactions, prevention of alloimmunization, and avoidance of complications in clients with alloantibodies.

The nurse caring for a client receiving a transfusion notes that 15 minutes after the infusion of packed red blood cells (PRBCs) has begun, the client is having difficulty breathing and reports severe chest tightness. What is the most appropriate initial action for the nurse to take?

B. Stop the transfusion immediately. Vascular collapse, bronchospasm, laryngeal edema, shock, fever, chills, and jugular vein distension are severe reactions. The nurse should discontinue the transfusion immediately, monitor the client's vital signs, and notify the health care provider.

A client is being treated for the effects of a longstanding vitamin B12 deficiency. Which aspect of the client's health history would most likely predispose the client to this deficiency?

B. The client is a vegan. Because vitamin B12 is found only in foods of animal origin, vegans may ingest little vitamin B12.

A client is being treated in the ICU after a medical error resulted in an acute hemolytic transfusion reaction. What was the etiology of this client's adverse reaction?

B. The donor blood was incompatible with that of the client. An acute hemolytic reaction occurs when the donor blood is incompatible with that of the recipient. In the case of a febrile nonhemolytic reaction, antibodies to donor leukocytes remain in the unit of blood or blood component.

A client's low hemoglobin level has necessitated transfusion of packed red blood cells. Prior to administration, which action should the nurse perform?

C. Assess the client's vital signs to establish baselines. Prior to a transfusion, the nurse must take the client's temperature, pulse, respiration, and blood pressure to establish a baseline

A client with a hematologic disorder asks the nurse how the body forms blood cells. The nurse understands that this process takes place primarily in which location?

C. Bone marrow Bone marrow is the primary site for hematopoiesis

A client has come to the OB/GYN clinic due to recent heavy menstrual flow. Because of the client's consequent increase in red cell production, the nurse should recommend the client increase daily intake of what substance?

C. Iron To replace blood loss, the rate of red cell production increases. Iron is incorporated into hemoglobin.

The nurse's review of a client's most recent blood work reveals a significant increase in the number of band cells. The nurse's subsequent assessment should focus on which of the following?

C. Signs and symptoms of infection 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.

Which of the following circumstances would most clearly warrant autologous blood donation?

C. The client has elective surgery pending. Autologous blood donation is useful for many elective surgeries where the potential need for transfusion is high.

An interdisciplinary team has been commissioned to create policies and procedures aimed at preventing acute hemolytic transfusion reactions. What action has the greatest potential to reduce the risk of this transfusion reaction?

D. Be vigilant in identifying the client and the blood component. The most common causes of acute hemolytic reaction are errors in blood component labeling and client identification that result in the administration of an ABO-incompatible transfusion. Actions to address these causes are necessary in all health care settings.

Two units of packed red blood cells have been prescribed for a client who has experienced a gastrointestinal bleed. The client is highly reluctant to receive a transfusion, stating, "I'm terrified of getting acquired immunodeficiency syndrome (AIDS) from a blood transfusion." How can the nurse best address the client's concerns?

D. "Donated blood is screened for human immunodeficiency virus (HIV), and the risk of contraction is very low."

The nurse is planning the care of a client with a nutritional deficit and a diagnosis of megaloblastic anemia. The nurse should recognize that this client's health problem is due to which issue with the red blood cells (RBCs)?

D. Abnormalities in the structure and function of RBCs Vitamin B12 and folate deficiencies are characterized by the production of abnormally large erythrocytes called megaloblasts. Because these cells are abnormal, many are sequestered (trapped) while still in the bone marrow, and their rate of release is decreased. Some of these cells actually die in the marrow before they can be released into the circulation. This results in megaloblastic anemia.

A nurse is educating a client about the role of B lymphocytes. The nurse's description will include which of the following physiologic processes?

D. Antibody production B lymphocytes are capable of differentiating into plasma cells. Plasma cells, in turn, produce antibodies.

The nurse educating a client with anemia is describing the process of red blood cell production. When the client's kidneys sense a low level of oxygen in circulating blood, which physiologic response is initiated?

D. Increased levels of erythropoietin If the kidney detects low levels of oxygen, as occurs when fewer red blood cells are available to bind oxygen (i.e., anemia), erythropoietin levels increase.

A client lives with a diagnosis of sickle cell disease and receives frequent blood transfusions. The nurse should recognize the client's consequent risk of what complication of treatment?

D. Iron overload Clients with chronic transfusion requirements can quickly acquire more iron than they can use, leading to iron overload. These individuals are not at risk for hypovolemia and there is no consequent risk for low platelet or vitamin B12 levels.

A nurse is caring for a client who is undergoing preliminary testing for a hematologic disorder. Which sign or symptom of a hematologic disorder is most common?

D. Severe fatigue This is more common than changes in LOC, infections, or anaphylaxis.