hapter 28: Assessment of Hematologic Function and Treatment Modalities

A nurse is assigned to care for a patient with ascites, secondary to cirrhosis. The nurse understands that the fluid accumulation in the peritoneal cavity results from a combination of factors including an alteration in oncotic pressure gradients and increased capillary permeability. Therefore, the nurse monitors the serum level of the plasma protein responsible for maintaining oncotic pressure, which is: Prothrombin. Fibrinogen. Globulin. Albumin.

Albumin.

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 Anticoagulation therapy Oxygen therapy

Iron chelation therapy

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

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? Diagnosis Age Family history of transfusion reactions Number of pregnancies

Number of pregnancies

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

Petechiae

The nurse obtains a unit of blood for the client, Donald D. Smith. The name on the label on the unit of blood reads Donald A. Smith. All the other identifiers are correct. What action should the nurse take? Check with the blood bank first and then administer the blood with their permission Ask the client if he was ever known as Donald A. Smith Administer the unit of blood Refuse to administer the blood

Refuse to administer the blood

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? Assess the client's vital signs. Slow the infusion. Stop the infusion. Call the health care provider.

Stop the infusion.

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

Vitamin B12 deficiency

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

megaloblasts.

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." "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 agree that you should be concerned with the safety of the blood, but it is important that you have this transfusion."

"I understand your concern. The blood is carefully screened but is not completely risk free."

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

Chelation therapy

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? Shock Splintering of bone fragments Hemorrhage Blood transfusion reaction

Hemorrhage

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. Blood can be transfused to family members and close relatives. If not needed immediately, the blood can be frozen for future use. It resolves anemia for clients with a hemoglobin less than 11g/dL. It is safer for clients with a history of transfusion reactions.

It resolves anemia for clients with a hemoglobin less than 11g/dL. If not needed immediately, the blood can be frozen for future use.

A client in acute renal failure has been prescribed 2 units of packed red blood cells (PRBCs). The nurse explains to the client that the blood transfusion is most likely needed for which reason? Increases the effectiveness of dialysis Hypervolemia Preparation for likely nephrectomy Lack of erythropoietin

Lack of erythropoietin

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets?

Myeloid stem cell

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

Myeloid stem cell

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

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

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? Use the unit for platelets and albumin. Provide it to the client before discharge. Discard the additional unit. Release the additional unit for use to the general population.

Discard the additional unit.

A thin client is prescribed iron dextran intramuscularly. What is most important action taken by the nurse when administering this medication? Employs the Z-track technique Injects into the deltoid muscle Uses a 23-gauge needle Rubs the site vigorously

Employs the Z-track technique

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. 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.

Verify that the client has signed a written consent form.