Hematologic System 39 nclex questions

When caring for a patient with metastatic cancer, the nurse notes a hemoglobin level of 8.7 g/dl and hematocrit of 26%. The nurse would place highest priority on initiating interventions that will reduce which of the following? A. thirst B. fatigue C. headache D. abdominal pain

B. The patient with a low hemoglobin and hematocrit is anemic and would be most likely to experience fatigue. Fatigue develops because of the lowered oxygen-carrying capacity that leads to reduced tissue oxygenation to carry out cellular functions.

Which of the following patients is most likely to experience anemia with an etiology of increased destruction of red blood cells? A. An African American man who has a diagnosis of sickle cell disease B. A 59-year-old man whose alcoholism has precipitated folic acid deficiency C. A 30-year-old woman with a history of "heavy periods" accompanied by anemia D. A 3-year-old child whose impaired growth and development is attributable to thalassemia

A. The etiology of sickle cell anemia involves increased hemolysis. Thalassemias and folic acid deficiencies cause a decrease in erythropoiesis whereas the anemia surrounding menstruation is a direct result of blood loss.

The nurse and an unlicensed assistive personnel (UAP) are caring for clients on a medical unit. Which task should the nurse delegate to the UAP? 1. Check on the bowel movements of a client diagnosed with melena. 2. Take the vital signs of a client who received blood the day before. 3. Evaluate the dietary intake of a client who has been noncompliant with eating. 4. Shave the client diagnosed with severe hemolytic anemia.

2. Take the vital signs of a client who received blood the day before.

The nurse writes a diagnosis of altered tissue perfusion for a client diagnosed with anemia. Which interventions should be included in the plan of care? Select all that apply. 1. Monitor the client's hemoglobin and hematocrit. 2. Move the client to a room near the nurse's desk. 3. Limit the client's dietary intake of green vegetables. 4. Assess the client for numbness and tingling. 5. Allow for rest periods during the day for the client.

1,2,4,5

The client has a hematocrit of 22.3% and a hemoglobin of 7.7 g/dL. The HCP has ordered two (2) units of packed red blood cells to be transfused. Which interventions should the nurse implement? Select all that apply. 1. Obtain a signed consent. 2. Initiate a 22-gauge IV. 3. Assess the client's lungs. 4. Check for allergies. 5. Hang a keep-open IV of D5W

1,3,4

The client is being admitted with folic acid deficiency anemia. Which would be the most appropriate referral? 1. Alcoholics Anonymous. 2. Leukemia Society of America. 3. A hematologist. 4. A social worker.

1. Alcoholics Anonymous. Most clients diagnosed with folic acid deficiency anemia have developed the anemia from chronic alcohol abuse. Alcohol consumption increases the use of folates, and the alcoholic diet is usually deficient in folic acid. A referral to Alcoholics Anonymous would be appropriate

The nurse is assessing an African American client diagnosed with sickle cell crisis. Which assessment datum is most pertinent when assessing for cyanosis in clients with dark skin? 1. Assess the client's oral mucosa. 2. Assess the client's metatarsals. 3. Assess the client's capillary refill time. 4. Assess the sclera of the client's eyes.

1. Assess the client's oral mucosa.

Which sign/symptom should the nurse expect to assess in the client diagnosed with hemophilia A? 1. Epistaxis. 2. Petechiae. 3. Subcutaneous emphysema. 4. Intermittent claudication.

1. Epistaxis.

The client undergoing knee replacement surgery has a "cell saver" apparatus attached to the knee when he arrives in the post-anesthesia care unit (PACU). Which intervention should the nurse implement to care for this drainage system? 1. Infuse the drainage into the client when a prescribed amount fills the chamber. 2. Attach an hourly drainage collection bag to the unit and discard the drainage. 3. Replace the unit with a continuous passive motion unit and start it on low. 4. Have another nurse verify the unit number prior to reinfusing the blood.

1. Infuse the drainage into the client when a prescribed amount fills the chamber.

When assessing a patient's nutritional-metabolic pattern related to hematologic health, what should the nurse do? 1. Inspect the skin for petechiae. 2. Ask the patient about joint pain. 3. Assess for vitamin C deficiency. 4. Determine if the patient can perform ADLs.

1. Inspect the skin for petechiae. a. Any changes in the skin's texture or color should be explored when assessing the patient's nutritional-metabolic pattern related to hematologic health. The presence of petechiae or ecchymotic areas could be indicative of hematologic deficiencies related to poor nutritional intake or related causes. The other options are not specific to the nutritional-metabolic pattern related to hematologic health.

The client admitted with full-thickness burns may be developing DIC. Which signs/symptoms would support the diagnosis of DIC? 1. Oozing blood from the IV catheter site. 2. Sudden onset of chest pain and frothy sputum. 3. Foul-smelling, concentrated urine. 4. A reddened, inflamed central line catheter site.

1. Oozing blood from the IV catheter site.

The nurse writes a client problem of "activity intolerance" for a client diagnosed with anemia. Which intervention should the nurse implement? 1. Pace activities according to tolerance. 2. Provide supplements high in iron and vitamins. 3. Administer packed red blood cells. 4. Monitor vital signs every four (4) hours.

1. Pace activities according to tolerance.

Which sign would the nurse expect to assess in the client diagnosed with idiopathic thrombocytopenic purpura (ITP)? 1. Petechiae on the anterior chest, arms, and neck. 2. Capillary refill of less than three (3) seconds. 3. An enlarged spleen. 4. Pulse oximeter reading of 95%.

1. Petechiae on the anterior chest, arms, and neck.

A nurse is caring for a group of hospitalized clients. Which client is at greatest risk for infection and sepsis? 1. 18-year-old who had an emergency splenectomy 2. 22-year-old with recently diagnosed sickle cell anemia 3. 38-year-old with hemolytic anemia 4. 40-year-old alcoholic with liver disease

1. Removal of the spleen causes the client to have reduced immune function. Without a spleen, people are less able to remove disease-causing organisms. Sickle cell anemia causes pain and discomfort owing to the changed cell morphology. Acute pain, especially at joints, is the greatest threat to this client. A low red blood cell (RBC) count can contribute to a client's risk for infection, but this client is more at risk for low oxygen levels and ensuing fatigue.The liver plays a role in blood coagulation. This client is more at risk for coagulation problems than for infection.

The client with O+ blood is in need of an emergency transfusion but the laboratory does not have any O+ blood available. Which potential unit of blood could be given to the client? 1. The O- unit. 2. The A+ unit. 3. The B+ unit. 4. Any Rh+ unit.

1. The O- unit.

The charge nurse in the intensive care unit is making client assignments. Which client should the charge nurse assign to the graduate nurse who has just finished the three (3)-month orientation? 1. The client with an abdominal peritoneal resection who has a colostomy. 2. The client diagnosed with pneumonia who has acute respiratory distress syndrome. 3. The client with a head injury developing disseminated intravascular coagulation. 4. The client admitted with a gunshot wound who has an H&H of 7 and 22.

1. The client with an abdominal peritoneal resection who has a colostomy.

A client has a bone marrow biopsy done. Which nursing intervention is the priority postprocedure? 1.Applying pressure to the biopsy site 2. Inspecting the site for ecchymoses 3. Sending the biopsy specimens to the laboratory 4. Teaching the client about avoiding vigorous activity

1. The initial action should be to stop bleeding by applying pressure to the site. Inspecting for ecchymoses will be done after hemostasis has been achieved. Sending specimens to the laboratory will be done after hemostasis has been achieved. Teaching the client about activity levels will be done after hemostasis has been achieved.

The nurse is admitting a 24-year-old African American female client with a diagnosis of rule-out anemia. The client has a history of gastric bypass surgery for obesity four (4) years ago. Current assessment findings include height 5′5′′; weight 75 kg; P 110, R 27, and BP 104/66; pale mucous membranes and dyspnea on exertion. Which type of anemia would the nurse suspect the client has developed? 1. Vitamin B12 deficiency. 2. Folic acid deficiency. 3. Iron deficiency. 4. Sickle cell anemia.

1. Vitamin B12 deficiency.

During the admission assessment, the nurse discovers that the patient has used illicit drugs. Related to the hematologic system, what question should the nurse next ask the patient? 1. "Do you have any blood in your stools?" 2. "What agent and when did you last use it?" 3. "Have you had any surgeries causing pain?" 4. "Do you have shortness of breath with activity?"

10. "What agent and when did you last use it?" a. Although all these questions are appropriate related to the hematologic system, the only one related specifically to illicit drug use is asking about what agent and when it was last used. The route and frequency should also be assessed.

The thrombocytopenic patient has had a bone marrow biopsy taken from the posterior iliac crest. What nursing care is the priority for this patient after this procedure? 1. Position the patient prone. 2. Apply a pressure dressing. 3. Administer analgesic for pain. 4. Return metal objects to the patient.

11. Apply a pressure dressing. a. The sterile pressure dressing is applied after a bone marrow biopsy to ensure hemostasis. If bleeding is present, the patient will lie on the site and may need a rolled towel for additional pressure, thus this patient will not be in the prone position. The analgesic should have been administered preprocedure. Metal objects would be removed for an MRI, not a bone marrow biopsy.

The client's nephew has just been diagnosed with sickle cell anemia. The client asks the nurse, "How did my nephew get this disease?" Which statement would be the best response by the nurse? 1. "Sickle cell anemia is an inherited autosomal recessive disease." 2. "He was born with it and both his parents were carriers of the disease." 3. "At this time, the cause of sickle cell anemia is unknown." 4. "Your sister was exposed to a virus while she was pregnant."

2. "He was born with it and both his parents were carriers of the disease."

Which nursing interventions should the nurse implement when caring for a client diagnosed with hemophilia A? Select all that apply. 1. Instruct the client to use a razor blade to shave. 2. Avoid administering enemas to the client. 3. Encourage participation in noncontact sports. 4. Teach the client how to apply direct pressure if bleeding occurs. 5. Explain the importance of not flossing the gums

2,3,4

The client diagnosed with sickle cell anemia asks the nurse, "Should I join the Sickle Cell Foundation? I received some information from the Sickle Cell Foundation. What kind of group is it?" Which statement is the best response by the nurse? 1. "It is a foundation that deals primarily with research for a cure for SCA." 2. "It provides information on the disease and on support groups in this area." 3. "I recommend joining any organization that will help deal with your disease." 4. "The foundation arranges for families that have children with sickle cell to meet."

2. "It provides information on the disease and on support groups in this area."

The nurse is completing discharge teaching for the client diagnosed with a sickle cell crisis. The nurse recommends the client getting the flu and pneumonia vaccines. The client asks, "Why should I take those shots? I hate shots." Which statement by the nurse is the best response? 1. "These vaccines promote health in clients with chronic illnesses." 2. "You are susceptible to infections. These shots may help prevent a crisis." 3. "The vaccines will help your blood from sickling secondary to viruses." 4. "The doctor wanted to make sure that I discussed the vaccines with you."

2. "You are susceptible to infections. These shots may help prevent a crisis."

The nurse is transcribing the HCP's order for an iron supplement on the MAR. At which time should the nurse schedule the daily dose? 1. 0900. 2. 1000. 3. 1200. 4. 1630.

2. 1000.

Which laboratory result would the nurse expect in the client diagnosed with DIC? 1. A decreased prothrombin time (PT). 2. A low fibrinogen level. 3. An increased platelet count. 4. An increased white blood cell count

2. A low fibrinogen level.

The client diagnosed with sickle cell anemia comes to the emergency department complaining of joint pain throughout the body. The oral temperature is 102.4˚F and the pulse oximeter reading is 91%. Which action should the emergency room nurse implement first? 1. Request arterial blood gases STAT. 2. Administer oxygen via nasal cannula. 3. Start an IV with an 18-gauge angiocath. 4. Prepare to administer analgesics as ordered.

2. Administer oxygen via nasal cannula.

A nurse is assessing a client for hematologic function risks. The nurse seeks to determine whether there is a risk that cannot be reduced or eliminated. Which clinical health history question does the nurse ask to obtain this information? 1."Do you seem to have excessive bleeding or bruising?" 2. "Does anyone in your family bleed a lot?" 3. "Tell me what you eat in a day." 4. "Where do you work?"

2. An accurate family history is important because many disorders that affect blood and blood clotting are inherited. Genetics cannot be changed. Excessive bleeding or bruising is a symptom, not a risk.

A newly admitted client has an elevated reticulocyte count. Which disorder does the nurse suspect in this client? 1. Aplastic anemia 2. Hemolytic anemia 3. Infectious process 4. Leukemia

2. An elevated reticulocyte count in the anemic client indicates that the bone marrow is responding appropriately to a decrease in the total red blood cell (RBC) mass and is prematurely destroying red blood cells. Therefore more immature RBCs are in circulation. Aplastic anemia is associated with a low reticulocyte count. A high white blood cell count is expected in clients with infection, while a low WBC is expected in clients with leukemia

The client with hemophilia A is experiencing hemarthrosis. Which intervention should the nurse recommend to the client? 1. Alternate aspirin and acetaminophen to help with the pain. 2. Apply cold packs for 24 to 48 hours to the affected area. 3. Perform active range-of-motion exercise on the extremity. 4. Put the affected extremity in the dependent position.

2. Apply cold packs for 24 to 48 hours to the affected area.

The client diagnosed with anemia begins to complain of dyspnea when ambulating in the hall. Which intervention should the nurse implement first? 1. Apply oxygen via nasal cannula. 2. Get a wheelchair for the client. 3. Assess the client's lung fields. 4. Assist the client when ambulating in the hall.

2. Get a wheelchair for the client.

When assessing laboratory values on a patient admitted with septicemia, what should the nurse expect to find? 1. Increased platelets 2. Decreased red blood cells 3. Decreased erythrocyte sedimentation rate (ESR) 4. Increased bands in the white blood cell (WBC) differential (shift to the left)

2. Increased bands in the white blood cell (WBC) differential (shift to the left) a. When infections are severe, such as in septicemia, more granulocytes are released from the bone marrow as a compensatory mechanism. To meet the increased demand, many young, immature polymorphonuclear neutrophils (bands) are released into circulation. WBCs are usually reported in order of maturity (initially with the less mature forms on the left side of a written report). Hence, the term "shift to the left" is used to denote an increase in the number of bands. Thrombocytosis occurs with inflammation and some malignant disorders. Decreased red blood cells indicate anemia. Decreased ESR is not indicative of septicemia.

The client is admitted to the emergency department after a motor-vehicle accident. The nurse notes profuse bleeding from a right-sided abdominal injury. Which intervention should the nurse implement first? 1. Type and crossmatch for red blood cells immediately (STAT). 2. Initiate an IV with an 18-gauge needle and hang normal saline. 3. Have the client sign a consent for an exploratory laparotomy. 4. Notify the significant other of the client's admission.

2. Initiate an IV with an 18-gauge needle and hang normal saline.

A nurse is reviewing complete blood count (CBC) data for a 76-year-old client. Which decreased value causes concern because it is not age related? 1.Hemoglobin (Hgb) level 2. Platelet (thrombocyte) count 3. Red blood cell (RBC) count 4. White blood cell (WBC) response

2. Platelet counts do not generally change with age. Hemoglobin levels in men and women fall after middle age. Iron-deficient diets may play a role in this reduction. Total red blood cell (RBC) and white blood cell (WBC) counts (especially lymphocyte counts) are lower in older adults. The WBC count does not rise as high in response to infection in older adults as it does in younger people.

Which statement is the scientific rationale for infusing a unit of blood in less than four (4) hours? 1. The blood will coagulate if left out of the refrigerator for >four (4) hours. 2. The blood has the potential for bacterial growth if allowed to infuse longer. 3. The blood components begin to break down after four (4) hours. 4. The blood will not be affected; this is a laboratory procedure.

2. The blood has the potential for bacterial growth if allowed to infuse longer.

After reviewing the laboratory test results, the nurse calls the health care provider about which client? 1.44-year-old receiving warfarin (Coumadin) with an international normalized ratio (INR) of 3.0 2. 46-year-old with a fever and a white blood cell (WBC) count of 500/µl 3. 49-year-old with hemophilia and a platelet count of 150,000/mm3 4. 52-year-old who has had a hemorrhage with a reticulocyte count of 0.8%

2. This client is neutropenic and is at risk for sepsis unless interventions such as medications to improve WBC level and antibiotics are prescribed. The INR of 3.0 indicates a therapeutic Coumadin level. This platelet count is normal. An elevated reticulocyte count is expected after hemorrhage.

A nurse is teaching a client about what to expect during a bone marrow biopsy. Which statement by the nurse accurately describes the procedure? 1. "The doctor will place a small needle in your back and will withdraw some fluid." 2. "You may experience a crunching sound or a scraping sensation as the needle punctures your bone." 3. "You will be alone because the procedure is a sterile one; we cannot allow additional people to contaminate the area." 4. "You will be sedated, so you will not be aware of anything."

2. This description is accurate. Proper expectations minimize the client's fear during the procedure. A very large-bore needle is used for a bone marrow biopsy, not a small needle. The puncture is made in the hip or in the sternum, not the back. The nurse, or sometimes a family member, is available to the client for support during a bone marrow biopsy. The procedure is sterile at the site of the biopsy, but others can be present without contamination at the site. A local anesthetic agent is injected into the skin around the site. The client may also receive a mild tranquilizer or a rapid-acting sedative (such as lorazepam [Ativan]) but will not be completely sedated. Clients are aware of what is happening during the procedure.

A client with anemia asks the nurse, "Do most people have the same number of red blood cells?" How does the nurse respond? 1."No, they don't." 2. "The number varies with gender, age, and general health." 3. "Yes, they do." 4. "You have fewer red blood cells because you have anemia."'

2. This is the most educational and reasonable response to the client's question. the first option is true, but not informative.

The client is diagnosed with sickle cell crisis. The nurse is calculating the client's intake and output (I & O) for the shift. The client had 20 ounces of water, eight (8) ounces of apple juice, three (3) cartons of milk with four (4) ounces each, 1,800 mL of IV fluids for the last 12 hours, and a urinary output of 1,200. What is the client's total intake for this shift? _____________

3,000 mL. **The key is knowing that 1 ounce is equal to 30 mL. Then, 20 ounces (20 × 30) = 600 mL, 8 ounces (8 × 30) = 240 mL, and 4 ounces (4 × 30) = 120 × 3 cartons = 360 mL for a total of 600 + 240 + 360 = 1,200 mL of oral fluids. That, plus 1,800 mL of IV fluids, makes the total intake for this shift 3,000 mL.

The nurse is caring for the female client recovering from a sickle cell crisis. The client tells the nurse her family is planning a trip this summer to Yellowstone National Park. Which response would be best for the nurse? 1. "That sounds like a wonderful trip to take this summer." 2. "Have you talked to your doctor about taking the trip?" 3. "You really should not take a trip to areas with high altitudes." 4. "Why do you want to go to Yellowstone National Park?"

3. "You really should not take a trip to areas with high altitudes."

Which collaborative treatment would the nurse anticipate for the client diagnosed with DIC? 1. Administer oral anticoagulants. 2. Prepare for plasmapheresis. 3. Administer frozen plasma. 4. Calculate the intake and output.

3. Administer frozen plasma.

Results of a patient's most recent blood work indicate an elevated neutrophil level. The nurse should recognize that this diagnostic finding most likely suggests which problem? 1. Hypoxemia 2. An infection 3. A risk of hypocoagulation 4. An acute thrombotic event

3. An infection a. An increase in the neutrophil count most commonly occurs in response to infection or inflammation. Hypoxemia and coagulation do not directly affect neutrophil production.

The client diagnosed with menorrhagia complains to the nurse of feeling listless and tired all the time. Which scientific rationale would explain why these symptoms occur? 1. The pain associated with the menorrhagia does not allow the client to rest. 2. The client's symptoms are unrelated to the diagnosis of menorrhagia. 3. The client probably has been exposed to a virus that causes chronic fatigue. 4. Menorrhagia has caused the client to have decreased levels of hemoglobin.

4. Menorrhagia has caused the client to have decreased levels of hemoglobin.

A client on anticoagulant therapy is being discharged. Which statement indicates that the client has a correct understanding of this therapy's purpose or action? 1. "It is to dissolve blood clots." 2. "It might cause me to get injured more often." 3. "It should prevent my blood from clotting." 4. "It will thin my blood."

3. Anticoagulants work by interfering with one or more steps involved in the blood clotting cascade. Thus, these agents prevent new clots from forming and limit or prevent extension of formed clots. Anticoagulants do not cause any change in the thickness or viscosity of the blood. Anticoagulants do not cause more injuries but may cause more bleeding and bruising when someone is injured. Anticoagulants do not dissolve clots, rather fibrinolytics do.

Which nursing action does the RN delegate to unlicensed assistive personnel (UAP) who are assisting with the care of a female client with anemia? 1. Asking the client about the amount of blood loss with each menstrual period 2. Checking for sternal tenderness while applying fingertip pressure 3. Determining the respiratory rate before and after the client walks 20 feet 4. Monitoring her oral mucosa for pallor, bleeding, or ulceration

3. Assessment of respiratory rate before and after ambulation is within the scope of practice for UAP. UAP will report this information to the RN. Asking the client about the amount of blood loss with each menstrual period requires skilled assessment techniques and knowledge of normal parameters and should be done by the RN. Checking for sternal tenderness requires skilled assessment techniques and knowledge of normal parameters and should be done by the RN. Monitoring of oral mucosa requires skilled assessment techniques and knowledge of normal parameters and should be done by the RN.

The nurse is discharging a client diagnosed with anemia. Which discharge instruction should the nurse teach? 1. Take the prescribed iron until it is completely gone. 2. Monitor pulse and blood pressure at a local pharmacy weekly. 3. Have a complete blood count checked at the HCP's office. 4. Perform isometric exercise three (3) times a week.

3. Have a complete blood count checked at the HCP's office.

Which sign/symptom will the nurse expect to assess in the client diagnosed with a vaso-occlusive sickle cell crisis? 1. Lordosis. 2. Epistaxis. 3. Hematuria. 4. Petechiae.

3. Hematuria.

A clinic nurse is discharging a 20-year-old client who had a bone marrow aspiration performed. What does the nurse advise the client to do? 1. "Avoid contact sports or activity that may traumatize the site for 24 hours." 2. "Inspect the site for bleeding every 4 to 6 hours." 3. "Place an ice pack over the site to reduce the bruising." 4. "Take a mild analgesic, such as 2 aspirin, for pain or discomfort at the site."

3. Ice to the site will help limit bruising and tissue damage during the first 24 hours postprocedure. Contact sports and traumatic activity needs to be excluded for 48 hours, or 2 days.The site should be carefully monitored by the client every 2 hours for the first 24 hours following the procedure.A mild analgesic is appropriate, but it should be aspirin free. Acetaminophen (Tylenol) would be a good choice.

The client diagnosed with sickle cell anemia is experiencing a vaso-occlusive sickle cell crisis secondary to an infection. Which medical treatment should the nurse anticipate the HCP ordering for the client? 1. Administer meperidine (Demerol) intravenously. 2. Admit the client to a private room and keep in reverse isolation. 3. Infuse D5W 0.33% NS at 150 mL/hr via pump. 4. Insert a 22-French Foley catheter with a urimeter.

3. Infuse D5W 0.33% NS at 150 mL/hr via pump.

The HCP orders two (2) units of blood to be administered over eight (8) hours each for a client diagnosed with heart failure. Which intervention(s) should the nurse take? 1. Call the HCP to question the order because blood must infuse within four (4) hours. 2. Retrieve the blood from the laboratory and run each unit at an eight (8)-hour rate. 3. Notify the lab to split each unit into half-units and infuse each half for four (4) hours. 4. Infuse each unit for four (4) hours, the maximum rate for a unit of blood

3. Notify the lab to split each unit into half-units and infuse each half for four (4) hours.

A client with a low platelet count asks why platelets are important. How does the nurse answer? 1."Platelets make blood clots for you." 2. "Blood clotting is prevented by your platelets." 3. "The clotting process begins with your platelets." 4. "Your platelets finish the clotting process."

3. Platelets begin the blood clotting process by forming platelet plugs, but these platelet plugs are not clots and cannot provide complete hemostasis. Platelets do not clot blood. They are a part of the clotting process or cascade of coagulation.

Which is a potential complication that occurs specifically to a male client diagnosed with sickle cell anemia during a sickle cell crisis? 1. Chest syndrome. 2. Compartment syndrome. 3. Priapism. 4. Hypertensive crisis.

3. Priapism.

The charge nurse is making assignments on a medical floor. Which client should be assigned to the most experienced nurse? 1. The client diagnosed with iron-deficiency anemia who is prescribed iron supplements. 2. The client diagnosed with pernicious anemia who is receiving vitamin B12 intramuscularly. 3. The client diagnosed with aplastic anemia who has developed pancytopenia. 4. The client diagnosed with renal disease who has a deficiency of erythropoietin

3. The client diagnosed with aplastic anemia who has developed pancytopenia.

Which situation might cause the nurse to think that the client has von Willebrand's disease? 1. The client has had unexplained episodes of hematemesis. 2. The client has microscopic blood in the urine. 3. The client has prolonged bleeding following surgery. 4. The female client developed abruptio placentae

3. The client has prolonged bleeding following surgery.

The nurse is caring for the following clients. Which client should the nurse assess first? 1. The client whose partial thromboplastin time (PTT) is 38 seconds. 2. The client whose hemoglobin is 14 g/dL and hematocrit is 45%. 3. The client whose platelet count is 75,000 per cubic millimeter of blood. 4. The client whose red blood cell count is 4.8 × 106/mm3.

3. The client whose platelet count is 75,000 per cubic millimeter of blood. A platelet count of less than 100,000 per cubic millimeter of blood indicates thrombocytopenia.

The nurse is caring for clients on a medical floor. After the shift report, which client should be assessed first? 1. The client who is two thirds of the way through a blood transfusion and has had no complaints of dyspnea or hives. 2. The client diagnosed with leukemia who has a hematocrit of 18% and petechiae covering the body. 3. The client with peptic ulcer disease who called over the intercom to say that he is vomiting blood. 4. The client diagnosed with Crohn's disease who is complaining of perineal discomfort.

3. The client with peptic ulcer disease who called over the intercom to say that he is vomiting blood.

The nurse is working in a blood bank facility procuring units of blood from donors. Which client would not be a candidate to donate blood? 1. The client who had wisdom teeth removed a week ago. 2. The nursing student who received a measles immunization two (2) months ago. 3. The mother with a six (6)-week-old newborn. 4. The client who developed an allergy to aspirin in childhood.

3. The mother with a six (6)-week-old newborn.

The client diagnosed with iron-deficiency anemia is prescribed ferrous gluconate orally. Which should the nurse teach the client? 1. Take Imodium, an antidiarrheal, OTC for diarrhea. 2. Limit exercise for several weeks until a tolerance is achieved. 3. The stools may be very dark, and this can mask blood. 4. Eat only red meats and organ meats for protein.

3. The stools may be very dark, and this can mask blood.

Which client does the medical unit charge nurse assign to an LPN/LVN? 1.23-year-old scheduled for a bone marrow biopsy with conscious sedation 2. 35-year-old with a history of a splenectomy and a temperature of 100.9° F (38.3° C) 3. 48-year-old with chronic microcytic anemia associated with alcohol use 4. 62-year-old man with atrial fibrillation and an international normalized ratio (INR) of 6.6

3. This client has a chronic condition that is not considered life threatening. A bone marrow biopsy with conscious sedation requires more complex assessment or nursing care and should be assigned to RN staff members. A history of a splenectomy and a temperature require more complex assessment or nursing care and should be assigned to RN staff members. Atrial fibrillation and an international normalized ratio (INR) of 6.6 require more complex assessment or nursing care and should be assigned to RN staff members.

A nurse is assessing an adult client's endurance in performing ADLs. What question does the nurse ask the client? 1."Can you prepare your own meals?" 2."Has your weight changed by 5 pounds or more this year?" 3."How is your energy level-compared with last year?" 4."What medications do you take daily, weekly, monthly?"

3. This question from Gordon's Functional Health Pattern Assessment is an activity exercise question that correctly assesses endurance compared with self-assessment in the past. It is most likely to provide data about the client's ability and endurance with ADLs. The client may never have been able to prepare his or her own meals. This question does not really address endurance.

The student nurse asks the nurse, "What is sickle cell anemia?" Which statement by the nurse would be the best answer to the student's question? 1. "There is some written material at the desk that will explain the disease." 2. "It is a congenital disease of the blood in which the blood does not clot." 3. "The client has decreased synovial fluid that causes joint pain." 4. "The blood becomes thick when the client is deprived of oxygen."

4. "The blood becomes thick when the client is deprived of oxygen."

The unlicensed assistive personnel (UAP) asks the primary nurse, "How does someone get hemophilia A?" Which statement would be the primary nurse's best response? 1. "It is an inherited X-linked recessive disorder." 2. "There is a deficiency of the clotting factor VIII." 3. "The person is born with hemophilia A." 4. "The mother carries the gene and gives it to the son."

4. "The mother carries the gene and gives it to the son."

Which client would be most at risk for developing disseminated intravascular coagulation (DIC)? 1. A 35-year-old pregnant client with placenta previa. 2. A 42-year-old client with a pulmonary embolus. 3. A 60-year-old client receiving hemodialysis 3 days a week. 4. A 78-year-old client diagnosed with septicemia.

4. A 78-year-old client diagnosed with septicemia.

The nurse and an unlicensed assistive personnel (UAP) are caring for clients on an oncology floor. Which nursing task would be delegated to the UAP? 1. Assess the urine output on a client who has had a blood transfusion reaction. 2. Take the first 15 minutes of vital signs on a client receiving a unit of PRBCs. 3. Auscultate the lung sounds of a client prior to a transfusion. 4. Assist a client who received 10 units of platelets in brushing the teeth.

4. Assist a client who received 10 units of platelets in brushing the teeth.

The male client with sickle cell anemia comes to the emergency room with a temperature of 101.4˚F and tells the nurse that he is having a sickle cell crisis. Which diagnostic test should the nurse anticipate the emergency room doctor ordering for the client? 1. Spinal tap. 2. Hemoglobin electrophoresis. 3. Sickle-turbidity test (Sickledex). 4. Blood cultures.

4. Blood cultures.

The client is scheduled to have a total hip replacement in two (2) months and has chosen to prepare for autologous transfusions. Which medication would the nurse administer to prepare the client? 1. Prednisone, a glucocorticoid. 2. Zithromax, an antibiotic. 3. Ativan, a tranquilizer. 4. Epogen, a biologic response modifier

4. Epogen, a biologic response modifier

A 30-year-old patient has undergone a splenectomy as a result of injuries suffered in a motor vehicle accident. Which phenomena are likely to result from the absence of the patient's spleen (select all that apply)? 1. Impaired fibrinolysis 2. Increased platelet levels 3. Increased eosinophil levels 4. Fatigue and cold intolerance 5. Impaired immunologic function

4. Increased platelet levels; Impaired immunologic function a. Splenectomy can result in increased platelet levels and impaired immunologic function as a consequence of the loss of storage and immunologic functions of the spleen. Fibrinolysis, fatigue, and cold intolerance are less likely to result from the loss of the spleen since coagulation and oxygenation are not primary responsibilities of the spleen.

Which action does the RN delegate to unlicensed assistive personnel (UAP)? 1. Drawing a partial thromboplastin time (PTT) from a saline lock on a client with a pulmonary embolism 2. Performing a capillary fragility test to check vascular hemostatic function on a client with liver failure 3. Referring for counseling a client with a daily alcohol consumption of 12 beers a day 4. Reporting any bleeding noted when catheter care is given to a client with a history of hemophilia

4. Reporting findings during routine care is expected and required of unlicensed staff members. Drawing a partial thromboplastin time is more complex and should be done by licensed nursing staff. Performing a capillary fragility test is more complex and should be done by licensed nursing staff. Referring a client for alcohol counseling is more complex and should be done by licensed nursing staff.

The client receiving a unit of PRBCs begins to chill and develops hives. Which action should be the nurse's first response? 1. Notify the laboratory and health-care provider. 2. Administer the histamine-1 blocker, Benadryl, IV. 3. Assess the client for further complications. 4. Stop the transfusion and change the tubing at the hub.

4. Stop the transfusion and change the tubing at the hub.

A client with anemia asks, "Why am I feeling tired all the time?" How does the nurse respond? 1. "How many hours are you sleeping at night?" 2. "You are not getting enough iron." 3. "You need to rest more when you are sick." 4. "Your cells are delivering less oxygen than you need."

4. The single most common symptom of anemia is fatigue. This problem occurs because oxygen delivery to cells is less than is required to meet normal oxygen needs.

A nurse is starting the shift by making rounds. Which client does the nurse decide to assess first? 1.42-year-old with anemia who is reporting shortness of breath when ambulating down the hallway 2. 47-year-old who recently had a Rumpel-Leede test and is requesting a nurse to "look at the bruises on my arm" 3. 52-year-old who has just had a bone marrow aspiration and is requesting pain medication 4. 59-year old who has a nosebleed and is receiving heparin to treat a pulmonary embolism

4. This client may be experiencing the bleeding as a result of excessive anticoagulation and should be assessed for the severity of the situation before the other clients, whose conditions are stable, are assessed. regarding option number 3, Making clients wait for pain medication is not desirable, but in this scenario, the client who is bleeding is the higher priority. This client should be next on the nurse's "to do" list.

A nurse is assessing the nutritional status of a client with anemia. How does the nurse obtain information about the client's diet? 1.Asks the client to rate his or her diet on a scale of 1 (poor) to 10 (excellent) 2. Determines who prepares the client's meals and plans an interview with him or her 3. From a prepared list, finds out the client's food preferences 4. Has the client write down everything he or she has eaten for the past week

4. This method is the most accurate way to find out what the client likes and dislikes, as well as what the client has been eating. It will provide information about "junk" food intake, as well as about the client's protein, vitamin, and mineral intake. the third option method of dietary analysis provides a list of what the client enjoys eating, not necessarily what the client has been eating. The client may like steak but may be unable to afford it.

A client is scheduled for a bone marrow aspiration. What does the client's nurse do before taking the client to the treatment room for the biopsy? 1. Cleans the biopsy site with an antiseptic or povidone-iodine (Betadine) 2. Holds the client's hand and asks about concerns 3. Reviews the client's platelet (thrombocyte) count 4. Verifies that the client has given informed consent

4. Verifying informed consent must be done before the procedure can be performed. A signed permit must be on the client's chart. Cleaning the biopsy site is done before the procedure but is not the first thing that should be done. It is not done until consent is verified. It will be done just before the procedure is performed.

The nurse is providing care for older adults on a subacute, geriatric medicine unit. What effect is aging likely to have on hematologic function of older adults? 1. Thrombocytosis 2. Decreased hemoglobin 3. Decreased WBC count 4. Decreased blood volume

5. Decreased hemoglobin a. Older adults frequently experience decreased hemoglobin levels as a result of changes in erythropoiesis. Decreased blood volume, decreased WBCs, and alterations in platelet number are not considered to be normal, age-related hematologic changes.

A blood type and cross-match has been ordered for a male patient who is experiencing an upper gastrointestinal bleed. The results of the blood work indicate that the patient has type A blood. Which description explains what this means? 1. The patient can be transfused with type AB blood. 2. The patient may only receive a type A transfusion. 3. .The patient has A antigens on his red blood cells (RBCs). 4. Antibodies are present on the surface of the patient's RBCs.

6. The patient has A antigens on his red blood cells (RBCs). a. An individual with type A blood has A antigens, not A antibodies, on his RBCs. An AB transfusion would result in agglutination, but he may be transfused with either type A or type O blood.

The nurse is reviewing the objective data from a patient with suspected allergies. Which assessment finding does the nurse know indicates allergies? Table 1 Physical Examination Dry cough Pale skin Table 2 Laboratory results Neutrophils: 60% Eosinophils: 10% Basophils: 1% Lymphocytes: 20% Monocytes: 6% Table 3 Medications Acetaminophen 1000 mg every 12 hours Levothyroxine (Synthroid) 125 mcg each day 1. Dry cough 2. Eosinophil result 3. Lymphocyte result 4. Acetaminophen use

7. Eosinophil result a. Eosinophils are granulocytes that phagocytize antigen-antibody complexes formed during an allergic response. The normal eosinophil count is 2% to 4% of all WBCs. The dry cough, lymphocyte result, and acetaminophen use do not indicate allergies.

The client is diagnosed with congestive heart failure and anemia. The HCP ordered a transfusion of two (2) units of packed red blood cells. The unit has 250 mL of red blood cells plus 45 mL of additive. At what rate should the nurse set the IV pump to infuse each unit of packed red blood cells? ____________

74ml/hr Pumps are set at an hourly rate. The client in congestive heart failure should receive blood at the slowest possible rate to prevent the client from further complications of fluid volume overload. Each unit of blood must be infused within four (4) hours of initiation of the infusion. 250 mL + 45 mL = 295 mL 295 mL ÷ 4 = 73 3 /4 mL/hr, which rounded is 74 mL/hr

The patient has anemia and has had laboratory tests done to diagnose the cause. Which results should the nurse know indicates a lack of nutrients needed to produce new red blood cells (select all that apply)? 1. Increased homocysteine 2. Decreased reticulocyte count 3. Decreased cobalamin (vitamin B12) 4. Increased methylmalonic acid (MMA) 5. Elevated erythrocyte sedimentation rate (ESR)

8. Increased homocysteine; Decreased cobalamin (vitamin B12); Increased methylmalonic acid (MMA) a. Increased homocysteine and MMA along with decreased cobalamin (vitamin B12) indicate cobalamin deficiency, which is a nutrient needed for RBC production. Decreased reticulocytes indicate low bone marrow activity in producing RBCs, not available nutrients. Elevated ESR is related to an increased inflammatory process, not anemia.

The client received two (2) units of packed red blood cells of 250 mL with 63 mL of preservative each during the shift. There was 240 mL of saline remaining in the 500-mL bag when the nurse discarded the blood tubing. How many milliliters of fluid should be documented on the intake and output record? _____________

886ml/hr 250 mL + 63 mL = 313 mL per unit 313 + 313 = 626 mL 500 mL of saline - 240 mL remaining = 260 mL infused. 626 mL + 260 mL = 886 mL of fluid infused

In assessing the patient, which abnormal finding should the nurse relate to hemostasis abnormalities? 1. Purpura 2. Pruritus 3. Weakness 4. Pale conjunctiva

9. Purpura a. Purpura may occur when platelets or clotting factors are decreased and bleeding into the skin occurs. Pruritus is not related to hemostasis, but to hematologic cancers (e.g., lymphomas, leukemias) or increased bilirubin. Weakness and pale conjunctiva are not related to hemostasis unless a lot of bleeding leads to anemia with low Hgb level.

When assessing a patient's nutritional-metabolic pattern related to hematologic health, the nurse would: A. Insepct the skin for petechiae B. ask about joint pain C. assess for Vit C deficiency D. Determine if the pt can perform ADLs

A. Any changes in the skin's texture or color should be explored when assessing the patient's nutritional-metabolic pattern related to hematologic health. The presence of petechiae or ecchymotic areas could be indicative of hematologic deficiencies related to poor nutritional intake or related causes.

The nurse receives a physician's order to transfuse fresh frozen plasma to a patient suffering from an acute blood loss. Which of the following procedures is most appropriate for infusing this blood product? A. Infuse the fresh frozen plasma as rapidly as the patient will tolerate. B. Hang the fresh frozen plasma as a piggyback to the primary IV solution. C. Infuse the fresh frozen plasma as a piggyback to a primary solution of normal saline. D. Hang the fresh frozen plasma as a piggyback to a new bag of primary IV solution without KCl.

A. The fresh frozen plasma should be administered as rapidly as possible and should be used within 2 hours of thawing. Fresh frozen plasma is infused using any straight-line infusion set. Any existing IV should be interrupted while the fresh frozen plasma is infused, unless a second IV line has been started for the transfusion.

Before beginning a transfusion of RBCs, which of the following actions by the nurse would be of highest priority to avoid an error during this procedure? A. Check the identifying information on the unit of blood against the patient's ID bracelet. B. Select new primary IV tubing primed with lactated Ringer's solution to use for the transfusion. C. Remain with the patient for 60 minutes after beginning the transfusion to watch for signs of a transfusion reaction. D. Add the blood transfusion as a secondary line to the existing IV and use the IV controller to maintain correct flow.

A. The patient's identifying information (name, date of birth, medical record number) on the ID bracelet should exactly match the information on the blood bank tag that has been placed on the unit of blood. If any information does not match, the transfusions should not be hung because of possible error and risk to the patient.

Results of a patient's most recent blood work indicate an elevated neutrophil level. You recognize that this diagnostic finding most likely suggests: A. Hypoxemia B. an infection C. risk of hypocoagulation D. an acute thrombotic event

B. An increase in neutrophil count most commonly occurs in response to infection or inflammation. Hypoxemia and coagulation do not directly affect neutrophil production.

You are providing care for older adults on a subacute, geriatric medicine unit. Which of the following effects is aging likely to have on hematologic function of older adults? A. Hypercoagulability B. decreased hemoglobin C. decreased blood volume D. decreased WBC count

B. An individual with type A blood has A antigens, not A antibodies, on his RBCs. An AB transfusion would result in agglutination, but he may be transfused with either type A or type O.

Before starting a transfusion of packed red blood cells for an anemic patient, the nurse would arrange for a peer to monitor his or her other assigned patients for how many minutes when the nurse begins the transfusion? A. 5 B. 15 C. 30 D. 60

B. As part of standard procedure, the nurse remains with the patient for the first 15 minutes after starting a blood transfusion. Patients who are likely to have a transfusion reaction will more often exhibit signs within the first 15 minutes that the blood is infusing.

The blood bank notifies the nurse that the two units of blood ordered for an anemic patient are ready for pick up. The nurse should take which of the following actions to prevent an adverse effect during this procedure? A. Immediately pick up both units of blood from the blood bank. B. Correct Infuse the blood slowly for the first 15 minutes of the transfusion. C. Regulate the flow rate so that each unit takes at least 4 hours to transfuse. D. Set up the Y-tubing of the blood set with dextrose in water as the flush solution.

B. Because a transfusion reaction is more likely to occur at the beginning of a transfusion, the nurse should initially infuse the blood at a rate no faster than 2 ml/min and remain with the patient for the first 15 minutes after hanging a unit of blood.

A patient with a diagnosis of hemophilia had a fall down an escalator earlier in the day and is now experiencing bleeding in her left knee joint. The emergency nurse's immediate response to this should include A. Immediate transfusion of platelets. B. Resting the patient's knee to prevent hemarthroses. C. Assistance with intracapsular injection of corticosteroids. D. Range-of-motion exercises to prevent thrombus formation.

B. In patients with hemophilia, joint bleeding requires resting of the joint in order to prevent deformities from hemarthrosis. Clotting factors, not platelets or steroids, are administered. Thrombus formation is not a central concern in a patient with hemophilia.

Caring for a patient with a diagnosis of polycythemia vera will likely require the nurse to A. Encourage deep-breathing and coughing. B. Assist with or perform phlebotomy at the bedside. C. Teach the patient how to maintain a low-activity lifestyle. D. Perform thorough and regularly scheduled neurologic assessments.

B. Primary polycythemia may often require phlebotomy in order to reduce blood volume. The increased risk of thrombus formation that accompanies the disease requires regular exercises and ambulation. Deep-breathing and coughing exercises do not directly address the etiology or common sequelae of polycythemia, and neurologic manifestations are not typical.

The nurse notes a physician's order written at 10:00 am for two units of packed red blood cells to be administered to a patient who is anemic as a result of chronic blood loss. If the transfusion is picked up at 11:30 am, the nurse should plan to hang the unit no later than which of the following times? A. 11:45 am B. 12:00 noon C. 12:30 pm D. 15:30 pm

B. noon. The nurse must hang the unit of packed red blood cells within 30 minutes of signing them out from the blood bank.

A 30-year-old patient has undergone a splenectomy as a result of injuries suffered in a motor vehicle accident. Which of the following phenomena is likely to result from the absence of the patient's spleen (select all that apply)? Impaired fibrinolysis Increased platelet levels Increased eosinophil levels Fatigue and cold intolerance Impaired immunologic function

B., E.: Splenectomy can result in increased platelet levels and impaired immunologic function as a consequence of the loss of storage and immunologic functions of the spleen. Fibrinolysis, fatigue, and cold intolerance are less likely to result from the loss of the spleen since coagulation and oxygenation are not primary responsibilities of the spleen

Which of the following nursing interventions should the nurse prioritize in the care of a 30-year-old woman who has a diagnosis of immune thrombocytopenic purpura (ITP)? A. Administration of packed red blood cells B. Administration of clotting factors VIII and IX C. Administration of oral or intravenous corticosteroids D. Maintenance of reverse isolation and application of standard precautions

C. Common treatment modalities for ITP include corticosteroid therapy to suppress the phagocytic response of splenic macrophages. Blood transfusions, administration of clotting factors, and reverse isolation are not interventions that are indicated in the care of patients with ITP.

When preparing to administer an ordered blood transfusion, the nurse selects which of the following intravenous solutions to use when priming the blood tubing? A. Lactated Ringer's B. 5% Dextrose in water C. 0.9% NaCl D. 0.45% NaCl

C. The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It is also used to flush the blood tubing after the infusion is complete to ensure the patient receives blood that is left in the tubing when the bag is empty.

The nurse is caring for a patient who is to receive a transfusion of two units of packed red blood cells. After obtaining the first unit from the blood bank, the nurse would ask which of the following health team members in the nurses' station to assist in checking the unit before administration? A. unit secretary B. a phlebotomist C. a physician's assistant D. another RN

D. Before hanging a transfusion, the registered nurse must check the unit with another RN or with a licensed practical (vocational) nurse, depending on agency policy.

When assessing lab values on a patient admitted with septicemia, the nurse would expect to find A. Increased platelets. B. Decreased red blood cells. C. Decreased erythrocyte sedimentation rate (ESR). D. Increased bands in the white blood cell (WBC) differential (shift to the left).

D. When infections are severe, such as in septicemia, more granulocytes are released from the bone marrow as a compensatory mechanism. To meet the increased demand, many young, immature polymorphonuclear neutrophils (bands) are released into circulation. WBCs are usually reported in order of maturity, with the less mature forms on the left side of a written report. Hence, the term "shift to the left" is used to denote an increase in the number of bands.

The nurse is starting the shift by making rounds. Which client would the nurse assess first? a. A 59-year-old who has a nosebleed and is receiving heparin to treat a pulmonary embolism b. A 47-year-old who had a Rumpel-Leede test and asks the nurse to "look at the bruises on my arm" c. A 42-year-old with a diagnosis of anemia who reports shortness of breath when ambulating down the hallway d. A 52-year-old who just had a bone marrow aspiration and is requesting pain medication

a. a 50 year old who has a nosebleed and is receiving heparin to treat a pulmonary embolism After rounds, the nurse would first assess the 59-year-old client who has a nosebleed and is getting heparin to treat a pulmonary embolism. The client with the nosebleed may be experiencing the bleeding as a result of excessive anticoagulation and must be assessed first for the severity of the situation. The client waiting for pain medication would be next on the nurse's "to do" list. Making clients wait for pain medication is not desirable, but in this scenario, the client who is bleeding is the higher priority. The client who had a Rumpel-Leede test and the client with anemia are more stable and can be assessed later. The Rumpel-Leede test is a tourniquet test used to determine the presence of vitamin C deficiency or thrombocytopenia.

Which task does the nurse delegate to unlicensed assistive personnel (UAP) who is assisting with the care of a female client with anemia? a. Count the respiratory rate before and after ambulating 20 feet (6 m) b. Check for sternal tenderness while applying fingertip pressure c. Ask about the amount of blood loss with each menstrual period d. Monitor the oral mucosa for pallor, bleeding, or ulceration

a. count the respiratory rate before and after ambulating 20 feet Counting the respiratory rate before and after ambulation is within the scope of practice for a UAP. The UAP will report this information to the RN. Monitoring oral mucosa requires skilled assessment techniques and knowledge of normal parameters, asking the client about the amount of blood loss with each menstrual period, and checking for sternal tenderness would be done by the RN.

A client on anticoagulant therapy is being discharged. Which statement by the client indicates an understanding of the anticoagulants drug action? a. "It should prevent my blood from clotting." b. "It is used to dissolve blood clots." c. "It will thin my blood." d. "It might cause me to get injured more often."

a. it should prevent my blood from clotting The statement that shows the client understands anticoagulant drug action is, "it will prevent my blood from clotting." Anticoagulants work by interfering with one or more steps involved in the blood clotting cascade. Thus, these agents prevent new clots from forming and limit or prevent extension of formed clots. Anticoagulants do not cause any change in the thickness or viscosity of the blood. Anticoagulants do not dissolve clots, fibrinolytics do. Anticoagulants do not cause more injuries but may cause more bleeding and bruising when the client is injured.

The nurse is teaching a client who is preparing for discharge after a bone marrow aspiration. The nurse provides which discharge instructions to the client? a. "Place an ice pack over the site to reduce the bruising." b. "Avoid contact sports or activity that may traumatize the site for 24 hours." c. "Take a mild analgesic, such as two aspirin, for pain or discomfort at the site." d. "Inspect the site for bleeding every 4 to 6 hours."

a. place an ice pack over the site to reduce bruising Discharge instructions after a bone marrow include placing an ice pack over the site to reduce bruising. Ice to the site will help limit bruising and tissue damage during the first 24 hours after the procedure. The client must carefully monitor the site every 2 hours for the first 24 hours after the procedure. Contact sports and traumatic activity must be excluded for 48 hours, or 2 days. A mild analgesic is appropriate, but it needs to be aspirin-free. Acetaminophen (Tylenol) would be a good choice.

The nurse is reviewing complete blood count (CBC) data for a 76-year-old client. Which decreased laboratory value would be of greatest concern to the nurse because it is not age-related? a. Platelet (thrombocyte) count b. Red blood cell (RBC) count c. White blood cell (WBC) response d. Hemoglobin level

a. platelet (thrombocyte) count The decreased laboratory value of the greatest concern to the nurse is the 76-year-old client's platelet count. Platelet counts do not generally change with age. Hemoglobin levels in men and women fall after middle age. Iron-deficient diets may play a role in this reduction. Total RBC and WBC counts (especially lymphocyte counts) are lower in older adults. The WBC count does not rise as high in response to infection in older adults as it does in younger people.

A newly admitted client has an elevated reticulocyte count. Which condition does the nurse suspect in this client? a. Leukemia b. Hemolytic anemia c. Infectious process d. Aplastic anemia

b. hemolytic anemia The nurse suspects that the client has hemolytic anemia. An elevated reticulocyte count in an anemic client indicates that the bone marrow is responding appropriately to a decrease in the total red blood cell (RBC) mass and is prematurely destroying RBCs. Therefore, more immature RBCs are in circulation. A low white blood cell count is expected in clients with leukemia. Aplastic anemia is associated with a low reticulocyte count. A high white blood cell count is expected in clients with infection.

A client with a low platelet count asks the nurse, "Why are platelets important?" Which statement is the nurse's best response? a. "Your platelets finish the clotting process." b. "The clotting process begins with your platelets." c. "Blood clotting is prevented by your platelets." d. "Platelets will make your blood clot."

b. the clotting process begins with your platelets The nurse's best response to why platelets are important is that, "The clotting process begins with your platelets." Platelets begin the blood clotting process by forming platelet plugs, but these platelet plugs are not clots and cannot provide complete hemostasis. Platelets do not clot blood but are a part of the clotting process or cascade of coagulation. Platelets do not prevent the blood from clotting. Rather they function to help blood form clots. Platelets do not finish the clotting process, they begin it.

A client with anemia asks the nurse, "Why am I feeling tired all the time?" What is the nurse's best response? a. "How many hours are you sleeping at night?" b. "Your cells are delivering less oxygen than you need." c. "You are not getting enough iron." d. "When you are sick you need to rest more."

b. your cells are delivering less oxygen than you need The nurse's best response to the client complaining about feeling tired all the time is "Your cells are delivering less oxygen than you need." The single most common symptom of anemia is fatigue, which occurs because oxygen delivery to cells is less than is required to meet normal oxygen needs. While it may be true that the client isn't getting enough iron, it does not relate to the client's fatigue. The statement about the client needing rest because of being sick is simply not true. Although assessment of sleep and rest is good, it does not address the cause related to the diagnosis.

Which client does the medical unit charge nurse assign to a licensed practical nurse (LPN)/licensed vocational nurse (LVN)? a. A client scheduled for a bone marrow biopsy with conscious sedation b. A client with a history of a splenectomy and a temperature of 100.9°F (38.3°C) c. A client with chronic microcytic anemia associated with alcohol use d. A client with atrial fibrillation and an international normalized ratio of 6.6

c. a client with chronic microcytic anemia associated with alcohol use The medical unit charge nurse assigns the LPN/LVN a client with chronic microcytic anemia related to alcohol use. Chronic microcytic anemia is not considered life-threatening and is within the skill level of an LPN/LVN. The client with a bone marrow biopsy with conscious sedation, a history of splenectomy and a temperature, and atrial fibrillation require more complex assessment or nursing care and would be assigned to RN staff members.

A client has a bone marrow biopsy performed. What is the priority postprocedure nursing action? a. Inspect the site for ecchymosis b. Send the biopsy specimens to the laboratory c. Apply pressure to the biopsy site d. Teach the client to avoid vigorous activity

c. apply pressure to biopsy site The priority postprocedure action after a bone marrow biopsy would be to stop bleeding by applying pressure to the site. Inspecting for ecchymosis, sending specimens to the laboratory and teaching the client about activity levels will be done after hemostasis has been achieved.

The nurse is assessing a client for hematologic risks. Which health history question would the nurse ask to determine if the risk cannot be reduced or eliminated? a. "Where do you work?" b. "Do you seem to have excessive bleeding or bruising?" c. "Does anyone in your family bleed a lot?" d. "Tell me what you eat in a day."

c. does anyone in your family bleed a lot To determine if hematologic risks exist while obtaining a health history from a client, the nurse asks if anyone in the client's family bleeds a lot. An accurate family history is important because many disorders that affect blood and blood clotting are inherited. Genetics cannot be changed. Work habits can be a risk, such as working near radiation, but these are behaviors that can be changed. Diet can affect risk, but it is a health behavior that can be changed. Excessive bleeding or bruising is a symptom, not a risk.

The nurse is assessing an adult client's endurance in performing activities of daily living (ADLs). What question would the nurse ask the client? a. "Can you prepare your own meals every day?" b. "What medications do you take daily, weekly, and monthly?" c. "How is your energy level compared with last year?" d. "Has your weight changed by 5 pounds (2.3 kg) or more this year?"

c. how is your energy level compared with last year The question the nurse needs to ask the client about endurance in performing ADLs is "How is your energy level compared with last year"? Asking the client how his or her energy level compares with last year is an activity exercise question that correctly assesses endurance compared with self-assessment in the past. It is most likely to provide data about the client's ability and endurance for ADLs. The client may never have been able to prepare his or her own meals, and the ability to prepare meals does not really address endurance. The question about weight change addresses nutrition and metabolic needs, rather than ADL performance. The question about how often the client takes medication addresses nutrition and metabolic needs and focuses on health maintenance through the use of drugs, not on the client's ability to perform ADLs.

Which task does the nurse delegate to unlicensed assistive personnel (UAP)? a. Perform a capillary fragility test to check vascular hemostatic function on a client with liver failure b. Refer a client with a daily alcohol consumption of 12 beers for counseling c. Report any bleeding noted when catheter care is given to a client with a history of hemophilia d. Obtain a partial thromboplastin time from a saline lock on a client with a pulmonary embolism

c. report any bleeding noted when catheter care is given to a client with a history of hemophilia The task the nurse delegates to the UAP is to report any bleeding when catheter care is given to a client with a history of hemophilia. Reporting findings during routine care is expected and required of unlicensed staff members. Referring a client for alcohol counseling, drawing a partial thromboplastin time, and performing a capillary fragility test are more complex and would be done by licensed nursing staff.

A client with anemia asks the nurse, "Do most people have the same number of red blood cells?" Which is the nurse's best response to the client? a. "You have fewer red blood cells because you have anemia." b. "No, they don't." c. "The number varies with gender, age, and general health." d. "Yes, they do."

c. the number varies with gender, age, and general health The nurse's best response to the client with anemia about most people having the same number of blood cells is, "The number varies with gender, age, and general health." This statement is the most educational and reasonable response to the client's question. Responding "yes, they do." and "no, they don't." are not educational statements. Although telling the client that people do not have the same number of RBCs is true, it is not informative, and there is a better answer. While it may be true that the client has fewer red blood cells because of anemia, it does not answer the client's general question.

The nurse is teaching a client about what to expect during a bone marrow biopsy. Which statement by the nurse accurately describes the procedure? a. "You will be alone because the procedure is sterile; we cannot allow additional people to contaminate the area." b. "You will be sedated during the procedure, so you will not be aware of anything." c. "You may experience a crunching sound or a scraping sensation as the needle punctures your bone." d. "The doctor will place a small needle in your back and will withdraw some fluid."

c. you may experience a crunching sound or a scaling sensation as the needle punctures your bone When describing a bone marrow biopsy procedure to a client, it is accurate to describe a crunching sound or scraping sensation when the needle punctures the bone. Proper expectations minimize the client's fear during the procedure. A very large-bore needle is used for a bone marrow biopsy, not a small needle, and the puncture is made in the hip or in the sternum, not the back. A local anesthetic agent is injected into the skin around the site. The client may also receive a mild tranquilizer or a rapid-acting sedative (such as lorazepam [Ativan]) but will not be completely sedated. The nurse, or sometimes a family member, is available to the client for support during a bone marrow biopsy. The procedure is sterile at the site of the biopsy, but others can be present without contamination at the site.

After reviewing the laboratory test results, the nurse calls the primary care provider about which client? a. A 52-year-old who had a hemorrhage with a reticulocyte count of 0.8% b. A 49-year-old with hemophilia and a platelet count of 150,000/mm3 (150 × 109/L) c. A 44-year-old prescribed warfarin (Coumadin) with an international normalized ratio (INR) of 3.0 d. A 46-year-old with a fever and a white blood cell (WBC) count of 1500/mm3 (1.5 × 109/L)

d. a 46 yr old with a fever and a WBC count of 1500/mm3 The nurse calls the PCP about a 46-year-old client with a fever and a WBC of 1500/mm3 (1.5 × 109/L). This client is neutropenic and is at risk for sepsis unless interventions such as medications to improve the WBC level and antibiotics are prescribed. An elevated reticulocyte count in the 52-year-old is expected after hemorrhage. A platelet count of 150,000/mm3 (150 × 109/L) in the 49-year-old is normal. The INR of 3.0 in the 44-year-old indicates a therapeutic warfarin level.

The nurse is caring for a group of hospitalized clients. Which client is at highest risk for infection and sepsis? a. A client with cirrhosis of the liver b. A client with recently diagnosed sickle cell anemia c. A client with hemolytic anemia d. A client who had an emergency splenectomy

d. a client who had an emergency splenectomy The client who is at the highest risk for infection and sepsis is the client who had an emergency splenectomy. Removal of the spleen causes reduced immune function. Without a spleen, the client is less able to remove disease-causing organisms and is at increased risk for infection. A low red blood cell count with hemolytic anemia can contribute to a client's risk for infection, but this client is more at risk for low oxygen levels and ensuing fatigue. The liver plays a role in blood coagulation, so this client is more at risk for coagulation problems than for infection. Sickle cell anemia causes pain and discomfort because of the changed cell morphology, so acute pain, especially at joints, is the greatest threat to this client.

The nurse is assessing the nutritional status of a client with anemia. How does the nurse obtain information about the client's diet? a. who prepares the client's meals and plans an interview with him or her b. Asks the client to rate his or her diet on a scale of 1 (poor) to 10 (excellent) c. Uses a prepared list and finds out the client's food preferences d. Has the client write down everything he or she has eaten for the past week

d. has the client write down everything he or she has eaten for the past week The best way for the nurse to assess an anemic client's diet is to have the client write down everything he/she has eaten in the last week. Having the client provide a list of items eaten in the past week is the most accurate way to find out what the client likes and dislikes, as well as what the client has been eating. It will provide information about "junk" food intake, as well as protein, vitamin, and mineral intake. Determining food preferences from a prepared list provides information about what the client enjoys eating, not necessarily what the client has been eating. For instance, the client may like steak but may be unable to afford it. Rating scales are good for subjective data collection about some conditions such as pain, but the subjectivity of a response such as this does not provide the nurse with specific data needed to assess a diet. Interviewing the food preparer is time-consuming and poses several problems, such as whether a number of people are preparing meals, or if the client goes "out" for meals.

A client is scheduled for a bone marrow aspiration. What is the priority nursing action before this procedure is performed? a. Hold the client's hand and ask about concerns. b. Clean the biopsy site with an antiseptic or povidone-iodine (Betadine). c. Review the client's platelet (thrombocyte) count. d. Verify that the client has given informed consent.

d. verify that the client has given informed consent The priority nursing action before a scheduled bone marrow aspiration is done is for the nurse to verify that the client has been given informed consent. A signed permit must be on the client's chart. Cleaning the biopsy site is done before the procedure, but this is not done until consent is verified. Cleaning the site will be done just before the procedure is performed. Holding the client's hand and offering verbal support may be done during the procedure, but the procedure cannot be completed until the consent is signed. Reviewing the client's platelet count is not imperative.