Hematology

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A nurse is teaching a patient with a vitamin B12 deficiency about appropriate food choices to increase the amount of B12 ingested with each meal. The nurse knows the teaching is effective based on which of the following patient statements?

"I will eat a meat source such as chicken or pork with each meal." Vitamin B12 is found only in foods of animal origin.

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?

"I will receive parenteral vitamin B12 therapy for the rest of my life."

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?

"I will receive parenteral vitamin B12 therapy for the rest of my life." Explanation: Because a client with pernicious anemia lacks intrinsic factor, oral vitamin B12 can't be absorbed. Therefore, parenteral vitamin B12 therapy is recommended and required for life.

A home care nurse visits a client diagnosed with atrial fibrillation who is ordered warfarin (Coumadin). The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching?

"I'll eat four servings of fresh, dark green vegetables every day."

A female client with the beta-thalassemia trait plans to marry a man of Italian ancestry who also has the trait. Which client statement indicates that she understands the teaching provided by the nurse?

"I'll see a genetic counselor before starting a family."

Parents arrive to the clinic with their young child and inform the nurse the child has just been diagnosed with sickle cell disease. The parents ask the nurse how this could have happened and which one of them is the carrier. What is the best response by the nurse?

"The child must inherit two defective genes, one from each parent."

A client with idiopathic thrombocytopenic purpura (ITP) is admitted to an acute care facility. The nurse monitors the client's platelet count and observes closely for signs and symptoms of bleeding. The client is at greatest risk for cerebral hemorrhage when the platelet count falls below what number?

10,000/?l.

Delayed hemolytic reactions usually occur within _________ days after transfusion, when the level of antibody has been increased to the extent that a reaction can occur.

normal platelet count

150,000-300,000

normal INR

2-3 (if mechanical valves want thinner)

A health care provider prescribes one tablet of ferrous sulfate daily for a 15-year-old girl who experiences heavy blood flow during her menstrual cycle. The nurse advises the patient and her parent that this over-the-counter preparation must be taken for how many months before stored iron replenishment can occur?

6 to 12 months

A nurse is caring for a client who will undergo total knee replacement and will have an autologous transfusion. Which statement will the nurse include when teaching the client about the transfusion?

"You typically donate blood 4 to 6 weeks before the surgery."

The nurse is educating a patient with iron deficiency anemia about food sources high in iron and how to enhance the absorption of iron when eating these foods. What can the nurse inform the client would enhance the absorption? A. Eating calf's liver with a glass of orange juice B. Eating leafy green vegis with a glass of water C. Eating apple slices with carrots D. Eating a steak with mushrooms.

The nurse observes a coworker eating frequently. The nurse encourages the coworker to have an examination and diagnostic workup with the HCP. What type of anemia is the nurse concerned the coworker may have? A. Iron deficiency B. Megaloblastic C. Sickle Cell D. Aplastic

Alcoholism Intestinal disorders

A 67-year-old client at the free clinic where you practice nursing has a history of seizures and presents with severe fatigue, frequent headaches, and a sore and beefy red tongue. Which of the following could be causing her current condition? Select all that apply.

Assesses the hemoglobin level

A client in end-stage renal disease is prescribed epoetin alfa (Epogen) and oral iron supplements. Before administering the next dose of epoetin alfa and oral iron supplement, the nurse

Ensure there is an oxygen delivery device at the bedside.

Chelation therapy

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?

A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the health care provider immediately because the client probably is experiencing which problem?

A hemolytic allergic reaction caused by an antigen reaction

A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the physician immediately because the client probably is experiencing which problem?

A hemolytic allergic reaction caused by an antigen reaction

Hemophilia

A hereditary disease where blood does not coagulate to stop bleeding

A high number of pregnancies can increase the risk of reaction.

DIC 101

- increased HR, decreased bp - impaired gas exchange -decreased perfusion, shock -abd distention -occult blood in stool/emesis (gi bleeding) -watch gums for bleeding -monitor output (the nurse not the aide!) -blood clots kill kidneys -gangrene from bad circulation to feet/hands -pulmonary emboli

potential problems of DIC

-Kidney injury -Gangrene -Pulmonary embolism or hemorrhage -Acute respiratory distress syndrome -Stroke

treatment for neutropenia

-Neupogen -steroids -immunoglobulins

causes of DIC

-Sepsis -Trauma -Shock -Cancer -Abruptio placentae -toxins -allergic reactions

how do we treat DIC?

-heparin or LMWH -pt may need intubated, they cant get 02 -Eliminate the underlying condition -replace fluids and electrolytes -replace coagulation factors -bring up blood pressure

Antithrombin deficiency

-inherited deficiency of antithrombin -hypercoaguability, reduced increase in PTT after administration of heparin so cannot give heparin bc it works to activate antithrombin

what happens with DIC?

-leads to massive bleeding hemostasis is altered causing massive clotting and microcirculation. As clotting factors are consumed, bleeding occurs. Symptoms are related to tissue ischemia and bleeding

how do we treat bleeding disorders and what do we teach the pt?

-treat with PRBCs, FFP, platelets, albumin (give them what they are lacking) -teach the pt to use an electric razor, a soft bristle tooth brush, not to leave the blood pressure cuff on for longer than necessary (should only go 20-30 higher than normal systolic pressure) -hold pressure longer with shots/ivs -pt needs to report things like gum bleeding

A client is prescribed 325 mg/day of oral ferrous sulfate. The nurse includes in client teaching, "Take your iron pill

1 hour before breakfast"

causes of neutropenia

1) Drug toxicity (chemotherapy/pt on radiation) 2) Severe infection (go into tissue to fight infection) 3) aplastic anemia

acquired thrombophilia

1. Antiphospholipid syndrome --> antibody to a protein (B2 glycoprotein) **In vitro --> prolongs aPTT time --> not corrected by mixing study** **In vivo --> predisposes to clots --> strong correlation b/w antiphospholipid syndrome and recurring pregnancy loss** 2. Cancer 3. Pregnancy 4. Smoking

The charge nurse should intervene when observing a new nurse perform which action after a client has suffered a possible hemolytic blood transfusion reaction?

Disposing of the blood container and tubing in biohazard waste. The blood container and tubing should be returned to the blood bank for repeat typing and culture, and the blood bank should be notified of the reaction.

You are caring for a 13-year-old diagnosed with sickle cell anemia. The client asks you what they can do to help prevent sickle cell crisis. What would be an appropriate answer to this client?

Drink at least 8 glasses of water every day.

The patient may be developing an infection.

A nurse is reviewing a patient's morning lab results and notes a left shift in the band cells. Based on this observation, what interpretation can the nurse make from these results?

T lymphocytes

A nurse, caring for a patient with human immunodeficiency virus (HIV), reviews the patient's differential WBC count to check the level of which of the following?

The liver and spleen can resume production of blood cells through extramedullary haematopoiesis.

A nursing instructor is reviewing the role and function of stem cells in the bone marrow with a group of nursing students. Following the explanation, the instructor asks the students to use their knowledge of anatomy and physiology to determine an alternate way in which adults with diseases that causes marrow destruction can resume production of blood cells. Which of the students' explanations is correct?

Vitamin B12 deficiency

A patient comes into the emergency room with complaints of 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 patient states, "I had a partial gastrostomy 2 years ago." Based on this information, the nurse attributes these symptoms to which of the following problems?

Obtain appropriate blood specimens. Collect a urine sample to detect hemoglobin. Document the reaction according to policy

A patient develops a hemolytic reaction to a blood transfusion. What actions should the nurse take after this occurs? (Select all that apply.)

Essential thrombocythemia

A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse know is the most likely clinical disorder the patient is being treated for?

Administer eltrombopag (Promacta)

A patient who has idiopathic thrombocytopenia purpura (ITP) has a critically low platelet count. Which nursing intervention will be included in the care plan for a patient with ITP?

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

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?

Administer the ordered paracetamol 500 mg po

A patient with Hodgkin's disease had a bone marrow biopsy yesterday and is complaining of aching, rated at a 5 (on a 1-10 scale), at the biopsy site. After assessing the biopsy site, which of the following nursing interventions is most appropriate?

4:00 pm

A patient with a history of congestive heart failure has an order to receive one unit of packed red blood cells (RBCs). If the nurse hangs the blood at 12:00 pm, by what time must the infusion be completed?

Febrile nonhemolytic reactions

A patient with chronic anemia has had many blood transfusions over the last 3 years. What type of transfusion reaction should the nurse monitor for that is commonly found in patients who frequently receive blood transfusions?

Decreased level of erythropoietin

A client is hospitalized 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin at home, which is now discontinued. To prevent the formation of blood clots, which action should the nurse take?

Administer the prescribed enoxaparin (Lovenox).

A client with sickle cell crisis is admitted to the hospital in severe pain. While caring for the client during the crisis, which is the priority nursing intervention?

Administering and evaluating the effectiveness of opioid analgesics

For a client diagnosed with idiopathic thrombocytopenia purpura (ITP), which nursing intervention is appropriate?

Administering stool softeners, as ordered, to prevent straining during defecation

For a client diagnosed with idiopathic thrombocytopenia purpura (ITP), which nursing intervention is appropriate?

Administering stool softeners, as ordered, to prevent straining during defecation Explanation: The nurse should take measures to prevent bleeding because the client with ITP is at increased risk for bleeding. Straining at stool causes the Valsalva maneuver, which may raise intracranial pressure (ICP), thus increasing the risk for intracerebral bleeding.

Liver

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following?

A client being treated for iron deficiency anemia with ferrous sulfate continues to be anemic despite treatment. The nurse should assess the client for use of which medication?

Aluminum hydroxide

RBC count

An older adult patient presents to the physician's office with a complaint of exhaustion. The nurse, aware of the most common hematologic condition affecting the elderly, knows that which laboratory values should be assessed?

Which of the following is the most common hematologic condition affecting elderly patients

Anemia

A client comes to the walk-in clinic complaining of weakness and fatigue. While assessing this client, the nurse finds evidence of petechiae and ecchymoses. The nurse notes that the spleen appears enlarged. What would the nurse suspect is wrong with this client?

Aplastic anemia

A client comes to the walk-in clinic reporting weakness and fatigue. While assessing this client, the nurse finds evidence of petechiae and ecchymoses and notes that the spleen appears enlarged. What would the nurse suspect is wrong with this client?

Aplastic anemia

The physician performs a bone marrow biopsy from the posterior iliac crest on a patient with pancytopenia. What intervention should the nurse perform following the procedure?

Apply pressure over the site for 5-7 minutes

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia?

Apply prolonged pressure to needle sites or other sources of external bleeding

A nurse caring for a client who has hemophilia is getting ready to take the client's vital signs. What should the nurse do before taking a blood pressure?

Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints.

A client in end-stage renal disease is prescribed epoetin alfa (Epogen) and oral iron supplements. Before administering the next dose of epoetin alfa and oral iron supplement, the nurse

Assesses the hemoglobin level

A client in end-stage renal disease is prescribed epoetin alfa (Epogen) and oral iron supplements. Before administering the next dose of epoetin alfa and oral iron supplement, the nurse Questions the administration of both medications Ensures the client has completed dialysis treatment Holds the epoetin alfa if the BUN is elevated Assesses the hemoglobin level

Assesses the hemoglobin level

A client in end-stage renal disease is prescribed epoetin alfa and oral iron supplements. Before administering the next dose of epoetin alfa and oral iron supplement, what is the priority action taken by the nurse?

Assesses the hemoglobin level Explanation: Erythropoietin (epoetin alfa [Epogen]) with oral iron supplements can raise hematocrit levels in the client with end-stage renal disease.

what do we worry about with DIC

Assessing for pulses watch the skin b/c they can have breakdown, bruising and bleeding

The client has been diagnosed with myelodysplastic syndrome with an absolute neutrophil count less than 1000/mm³ and is being admitted to the hospital. The nurse

Assigns the client to a private room

G-CSF (filgrastim [Neupogen]) is prescribed for a client with bone marrow suppression. What medication administration teaching should the nurse provide to the client? Take this medication by mouth at bedtime each night. Neupogen is taken intramuscularly on a weekly basis. Assist the client in identifying appropriate subcutaneous injection sites. Do not eat before arriving to receive the intravenous administration of Neupogen.

Assist the client in identifying appropriate subcutaneous injection sites.

A patient had gastric bypass surgery 3 years ago and now, experiencing fatigue, visits the clinic to determine the cause. The patient takes pantoproazole for the treatment of frequent heartburn. What type of anemia is this patient at risk for? A. aplastic B. Iron deficiency C. Sickle cell D. Pernicious

The nurse is assessing a patient who comes to the clinic reporting feeling constantly tired and very weak. The patient also has a very sore tongue, and upon observing the patients oral cavity, the nurse notices the tongue is beefy red. What type of anemia does the nurse know these symptoms indicate? A. Iron deficiency B. Megaloblastic C. Sickle Cell Disease D. Aplastic

A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from?

Blood loss Abnormal erythrocyte production Destruction of normally formed red blood cells

A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from? Select all that apply.

Blood loss Abnormal erythrocyte production Destruction of normally formed red blood cells

____________ is the primary site for hematopoiesis, a process of continuous blood cell formation.

Bone Marrow

A nurse cares for a client suspected of having iron deficient anemia. Which diagnostic test will the nurse expect the health care provider to order in order to definitively diagnose the condition?

Bone marrow aspiration

Which is a symptom of Cooley anemia?

Bronzing of the skin

Which is a symptom of hemochromatosis?

Bronzing of the skin

Which is a symptom of hemochromatosis?

Bronzing of the skin Explanation: Clients with hemochromatosis exhibit symptoms of weakness, lethargy, arthralgia, weight loss, and loss of libido early in the illness trajectory. The skin may appear hyperpigmented from melanin deposits or appear bronze in color.

A patient ESRD is taking recombinant erythropoietin for the tx of anemia. What lab study does the nurse determine will have to be assessed at least monthly related to this Rx? A. K B. Cr C. Hg D. Folate

A patient describes numbness in the arms and hands with a tingling sensation and frequent stumbling when walking. What vitamin deficiency does the nurse determine may contribute to some of these symptoms? A. Thiamine B. Folate C. B12 D. Iron

The nurse is assessing a patient who is a strict vegetarian. What type of anemia is the nurse aware that this patient is at risk for? A. Iron deficiency B. Aplastic C. Megaloblastic D. Sickle Cell

The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include a nutritional assessment for this patient? A. It is part of the required assessment B. It Is important for the nurse to determine what type of foods the patient will eat C. It may indicate deficiencies in essential nutrients D. It will determine what type of anemia the patient has

Which of the following vitamins enhance the absorption of iron?

Which client is not a candidate for blood donation according to the American Heart Association?

Clients must meet the following criteria to be eligible as blood donors: body weight at least 50 kg; pulse rate regular between 50 and 100 bpm; systolic BP 90 to 180 mmHg and diastolic 50 to 100 mmHg; hemoglobin level at least 12.5 g/dL for women. There is no upper age limit to donation.

A nursing instructor in a BSN program is preparing for a lecture on disorders of the hematopoietic system. Included in the lecture are conditions caused by reduced levels or absence of blood-clotting proteins. Which of the following is the instructor most likely referring to?

Coagulopathy

A nurse working with clients diagnosed with sickle cell disease notices that sickle cell crisis cases increase in the winter months. What is the primary pathophysiological reason for this?

Colder temperatures slows the blood flow.

The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions?

Dilute the liquid preparation with another liquid such as juice and drink with a straw.

Which initial intervention should a nurse perform for a client with external bleeding?

Direct pressure

A client receiving a unit of packed red blood cells (PRBCs) has been prescribed morphine 1 mg intravenously now for pain. What is the best method for the nurse to administer the morphine?

Disconnect the blood tubing, flush with normal saline, and administer morphine.

You are caring for a 13-year-old diagnosed with sickle cell anemia. The client asks you what they can do to help prevent sickle cell crisis. What would be an appropriate answer to this client?

Drink at least 8 glasses of water every day. Explanation: During the physical examination, observe the client's appearance, looking for evidence of dehydration, which may have triggered a sickle cell crisis. Clients are taught moderation, not avoidance of activities. Most clients with sickle cell disease are not on oxygen therapy 24/7.

The nurse and the client are discussing some strategies for ingesting iron to combat the client's iron-deficiency anemia. Which is among the nurse's strategies?

Drink liquid iron preparations with a straw.

Eating calf's liver with a glass of orange juice

Ensure there is an oxygen delivery device at the bedside.

The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia?

Erythrocytes that are microcytic and hypochromic

When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply.

Ethnicity Medication use Herbal supplements Dietary intake

T or F- The average lifespan of a normal circulating erythrocyte is 60 days or about 2 months.

False

T or F- The most common type of blood transfusion reaction is an allergic reaction that causes urticaria.

False

T or F- To be considered a blood donor, a man must have a minimum hemoglobin level of 12 g/dL.

False

A nurse is reviewing the various manifestations of anemia across the lifespan and notes a significant difference in how the older adult client responds to anemia versus a younger individual. Which concepts related to aging and the response to anemia does the nurse recognize?

Fatigue is often greater than in younger clients. Heart rate does not increase as much as in younger clients. Confusion is often greater than in younger clients.

A client was admitted to the hospital with the following laboratory values: hemoglobin 5 g/dL, leukocyte count 2000/mm3, and a platelet count of 48,000/mm3; abnormally shaped erythrocytes and hypersegmented neutrophils were seen. The platelets appear abnormally large. A bone marrow biopsy was competed and revealed hyperplasia. Based on this information, the nurse determines that client most likely has which diagnosis?

Folic acid deficiency

The nurse caring for a client with acute liver failure should expect which assessment finding?

Generalized edema

A patient has been diagnosed with thrombocytopenia. What are the primary nursing interventions while instituting corticosteroid therapy in this patient?

Gradually taper the dose and frequency of medication. Explanation: For a patient with thrombocytopenia, he or she gradually tapers the dose and frequency of steroid medication before discontinuing it to avoid adrenal insufficiency or crisis.

Which of the following is the percentage of blood volume consisting of erythrocytes?

Haematocrit

A male client has a hemoglobin count of 10.2 gm/dl, a hematocrit value of 36%, and a low ferritin level. What question should the nurse ask first?

Have you experienced abdominal pain? Explanation: The laboratory data support that the client has iron-deficiency anemia. The most common cause of iron-deficiency anemia in men is bleeding from ulcers, gastritis, inflammatory bowel disease, or gastrointestinal tumors

A client with severe anemia reports symptoms of tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Laboratory test results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which nursing diagnoses is most appropriate for this client?

Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit

A client is receiving chemotherapy for cancer. The nurse reviews the client's laboratory report and notes that he has thrombocytopenia. To which nursing diagnosis should the nurse give the highest priority?

Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI

The nurse observes a co-worker who always seems to be eating a cup of ice. The nurse encourages the co-worker to have an examination and diagnostic workup with the health care provider. What type of anemia is the nurse concerned the co-worker may have?

Iron deficiency anemia

The nurse observes a co-worker who always seems to be eating a cup of ice. The nurse encourages the co-worker to have an examination and diagnostic workup with the physician. What type of anemia is the nurse concerned the co-worker may have?

Iron deficiency anemia

The nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. What position will the nurse place the patient in?

Lateral position with one leg flexed

The nurse is providing health education to an older adult client who has low red blood cell levels. To promote red blood cell production, the nurse should encourage intake of what foods? Select all that apply.

Leafy green vegetables Nuts and seeds Lean meats

What food should the nurse recommend for a client diagnosed with vitamin B12 deficiency?

Lean meat

Which blood cell type is matched correctly with its function?

Leukocyte: Fights infection

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following?

Liver

G-CSF (filgrastim [Neupogen]) is prescribed for a client with bone marrow suppression. What medication administration teaching should the nurse provide to the client?

Neupogen is administered subcutaneously on a daily basis.

A client with a diagnosis of pernicious anemia comes to the clinic and reports numbness and tingling in the arms and legs. What do these symptoms indicate?

Neurologic involvement

A client with a diagnosis of pernicious anemia comes to the clinic complaining of numbness and tingling in his arms and legs. What do these symptoms indicate?

Neurologic involvement

A client with a diagnosis of pernicious anemia comes to the clinic complaining of numbness and tingling in their arms and legs. What do these symptoms indicate?

Neurologic involvement

The nurse is caring for an older adult client who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine where the blood loss is coming from, what intervention can the nurse provide?

Observe stools for blood. Explanation: Iron-deficiency anemia is unusual in older adults. Normally, the body does not eliminate excessive iron, causing total body iron stores to increase with age and necessitating maintenance of hydration. If an older adult is anemic, blood loss from the gastrointestinal or genitourinary tracts is suspected

A client with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse?

Obtain the pain medication and delay the bath and position change until the medication reaches its peak.

Resume the transfusion

One hour after a transfusion of packed red cells is started; a patient develops redness on his trunk and complains of itching. The nurse stops the red blood cell (RBC) infusion and administers the ordered diphenhydramine (Benadryl) 25 mg po. Thirty minutes later, the redness and itching is gone. What is the next action the nurse should take?

A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. She reports that she first felt pain after manually opening her garage door and that she is taking prednisone daily. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain?

Osteoporosis

A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. The client is taking prednisone daily and reported feeling pain after manually opening the garage door. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain?

Osteoporosis Explanation: Hypertension, osteoporosis, muscle wasting, and truncal obesity are all adverse effects of long-term corticosteroid therapy; however, osteoporosis commonly causes compression fractures of the spine. Hypertension, muscle wasting, and truncal obesity aren't likely to cause severe back pain.

A client involved in a motor vehicle accident arrives at the emergency department unconscious and severely hypotensive. The nurse suspects the client has several fractures in the pelvis and legs. Which parenteral fluid is the best choice for the client's current condition?

Packed red blood cells (RBCs)

Which is the following is the most obvious sign of anemia?

Pallor

A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client?

Pallor, tachycardia, and a sore tongue

The nurse is completing a physical assessment on a client's lymphatic system. The nurse should palpate for enlarged nodes in which areas? Select all that apply.

Palpable lymph node areas include: popliteal, inguinal, submental, and neck.

Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets?

Pancytopenia

The nurse's role in the management of polycythemia vera is primarily that of an educator. Choose the best health promotion advice that a nurse could give.

Participate in regular phlebotomy procedures to decrease blood viscosity.

A nurse cares for a client who has had a bone marrow aspiration. In addition to the client's aspiration site, what locations on the body does the nurse recognize as having bone marrow? Select all that apply.

Pelvis, Ribs, Vertebrae, Sternum

The nurse reviewing laboratory results of a client recovering from abdominal surgery notices an elevated number of reticulocytes. What is the nurse's first action?

Perform an abdominal assessment.

Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils?

Phagocytosis

Which of the following best describes the function of fibrinogen?

Plays a key role in forming blood clots

The client is planned to have a splenectomy. The nurse should prepare which medication to administer to this client?

Pneumococcal vaccine. Without a spleen, the client's risk of infection is greatly increased. The pneumococcal vaccine should be administered, preferable before splenectomy.

A client awaiting a bone marrow aspiration asks the nurse to explain where on the body the procedure will take place. What body part does the nurse identify for the client?

Posterior iliac crest

In adults, bone marrow is usually aspirated from which area?

Posterior iliac crest

A client tells the nurse that he would like to donate blood before his abdominal surgery next week. What should be the nurse's first action?

Preoperative autologous donations are ideally collected 4 to 6 weeks before surgery.

Which of the following is considered an antidote to heparin?

Protamine sulphate

An older adult client presents to the health care provider's office and reports exhaustion. The nurse, aware of the most common hematologic condition affecting the elderly, knows that which laboratory values should be assessed?

RBC count

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?

Refuse to administer the blood

The nurse is working at a blood donation clinic. What teaching should the nurse provide to the donor immediately after blood donation?

Remain for observation after eating and drinking.

The nurse is screening donors for blood donation. The client who is an acceptable donor for blood is the client who Reports having a cold 1 month ago that resolved quickly Has a history of viral hepatitis as a teenager 10 years ago Had a dental extraction 2 days ago for caries in a tooth Received a blood transfusion within 1 year

Reports having a cold 1 month ago that resolved quickly

A pregnant woman is hospitalized as the result of sickle-cell crisis. A finding that indicates the outcome has been achieved for this client is that the client

Reports joint pain less than 3 on a scale of 0 to 10

The nurse is preparing the patient for a test to determine the cause of vitamin B12 deficiency. The patient will receive a small oral dose of radioactive vitamin B12 followed by a large parenteral dose of nonradioactive vitamin B12. What test is the patient being prepared for?

Schilling test Explanation: The classic method of determining the cause of vitamin B12 deficiency is the Schilling test, in which the patient receives a small oral dose of radioactive vitamin B12, followed in a few hours by a large, nonradioactive parenteral dose of vitamin B12 (this aids in renal excretion of the radioactive dose).

The nurse expects which assessment finding of the oral cavity when the client is diagnosed with pernicious anemia?

Smooth tongue

Place the following procedural steps in order for transfusing a unit of packed red blood cells (PRBCs).

Start an intravenous line. Obtain the unit of PRBCs from the blood bank. Double check the labels with another nurse to ensure correct ABO group and Rh type. Initiate the blood transfusion within 30 minutes of receipt. Monitor closely for signs of a transfusion reaction.

The term that is used to refer to a primitive cell, capable of self-replication and differentiation, is which of the following?

Stem cell

Which of the following terms refers to a primitive cell, capable of self-replication and differentiation?

Stem cell

Place the following steps in order when determining the type and severity of a transfusion reaction. Use all options.

Stop the transfusion. Assess the client. Notify the health care provider. Notify the blood bank. Send the tubing and container to the blood bank.

A nurse, caring for a client with human immunodeficiency virus (HIV), reviews the client's differential WBC count. What type of WBC will the nurse check the level of?

T lymphocytes

Which type of lymphocyte is responsible for cellular immunity?

T lymphocytes

Which type of lymphocyte is responsible for cellular immunity?

T lymphocytes are responsible for delayed allergic reactions, rejection of foreign tissue (e.g., transplanted organs), and destruction of tumor cells.

A client is prescribed 325 mg/day of oral ferrous sulfate. What does the nurse include in client teaching?

Take 1 hour before breakfast

A client with chronic anemia has received multiple transfusions. Which client action would the nurse be concerned about relative to the client's condition?

Takes over-the-counter iron supplements

Neutrophils

The body responds to infection by increasing the production of white blood cells (WBCs). The nurse knows to evaluate the differential count for the level of __________, the first WBCs to respond to an inflammatory event.

The nurse is caring for a client with hypoxia. What does the nurse understand is true regarding the client's oxygen level and the production of red blood cells?

The kidneys sense low oxygen levels in the blood and stimulate erythropoietin, stimulating the marrow to produce more red blood cells.

The liver and spleen can resume production of blood cells through extramedullary haematopoiesis.

The patient is having a febrile nonhemolytic reaction.

The nurse is administering a blood transfusion to a patient over 4 hours. After 2 hours, the patient complaints of chills and has a fever of 101°F, an increase from a previous temperature of 99.2°F. What does the nurse recognize is occurring with this patient?

Decreased hematocrit

The nurse is caring for a client who had undergone hemodilution during surgery. Immediately after surgery, the nurse expects to see which lab result?

Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.

Lateral position with one leg flexed

The nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. What position will the nurse place the patient in?

Refuses to administer the blood

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. The nurse

A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn's disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for?

The onset of a bacterial infection

A nurse is reviewing a patient's morning lab results and notes a left shift in the band cells. Based on this observation, what interpretation can the nurse make from these results?

The patient may be developing an infection.

Verify the patient identification according to hospital policy

The physician orders a transfusion with packed red blood cells (RBCs) for a patient hospitalized with severe iron deficiency anemia. When blood is administered, what is the most important action the nurse can take to prevent a transfusion reaction?

While caring for a client, the nurse notes petechiae on the client's trunk and lower extremities. What precaution will the nurse take when caring for this client?

Use an electric razor when assisting client with shaving.

A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client?

Use the smallest needle possible for injections.

A client is seen in the emergency department with severe pain related to a sickle cell crisis. What does the nurse understand is occurring with this client?

Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.

Verify the patient identification according to hospital policy

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?

Vitamin B12 deficiency

A patient comes into the emergency room with complaints of an enlarged tongue. The tongue appears smooth and beefy red in colour. The nurse also observes a 5-cm incision on the upper left quadrant of the abdomen. When questioned, the patient states, "I had a partial gastrostomy 2 years ago." Based on this information, the nurse attributes these symptoms to which of the following problems?

Vitamin B12 deficiency

Which medication is the antidote to warfarin?

Vitamin K

Myeloid stem cell

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

26 year old female with hemoglobin 11.0 g/dL

Which client is not a candidate for blood donation according to the American Heart Association?

A client wants to donate blood before his or her abdominal surgery next week. What should be the nurse's first action? a. explain the time frame needed for autologous donation b. remind the client to take supplemental iron before donation c. provide the client with a list of the nearest donation centers d. tel the client that 2 units of blood will be needed.

a. explain the time frame needed for autologous donation preoperative autologous donations are ideally collected 4-6 weeks before surgery

A nurse cares for a client with myelodysplastic syndrome who requires frequent PRBC transfusions. What blood component does the nurse recognize as being most harmful if accumulated in the tissues due to chronic blood transfusions? a.iron b. calcium c. hemoglobin d. potassium

a. iron

Which statement best describes the function of fibrinogen? a. plays a key role in forming blood clots b. functions primarily as an immunological agent c. helps prevent or modify some types of infectious diseases d. helps maintain osmotic pressure

a. plays a key role in forming blood clots

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:

albumin

Plasma proteins consist primarily of __________ and globulins.

albumin

Hemophilia A is the most common of the three types of hemophilia. What is diminished in the less serious form of hemophilia A, known as von Willebrand's disease?

amount and quality of factor VIII

thrombocytosis

an abnormal increase in the number of platelets in the circulating blood -bleeding, or infection can cause more platelets to be produced

When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply. a. hair color b. medicaiton use c. ethnicity d. dietary intake e. herbal supplements

dietary intake use of herbal supplements medications

DIC

disseminated intravascular coagulation -not a disease but a disorder

if you cant find a pts pulse what do you do?

first try the dopler

A client has a history of sickle cell anemia with several sickle cell crises over the past 10 years. What blood component results in sickle cell anemia?

hemoglobin S

sickle cell has bleeding

in the joints, hemophilia does not

protein c&s

inactivate factors V and VIII; enhance fibrinolysis prone to blood clots

Major goals of DIC

include maintenance of hemodynamic status, maintenance of intact skin and oral mucosa, maintenance of fluid balance, maintenance of tissue perfusion, enhanced coping, and absence of complications

with what level of platelets do we see things like bleeding and petechia?

less than 20,000

if someone tells your something is right

listen to them "i dont know what but something is wrong"

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following?

liver

A client with sickle cell anemia has a

low hematocrit.

Thrombocytopenia

low platelet count

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called

megaloblasts.

An increase in _______________ may be seen in patients exposed to a bacterial infection.

neutrophils

The body responds to infection by increasing the production of white blood cells (WBCs). The nurse should evaluate the differential count for what type of WBCs, which are the first WBCs to respond to an inflammatory event?

neutrophils

A client is being admitted to the hospital with abdominal pain, anemia, and bloody stools. He complains of feeling weak and dizzy. He has rectal pressure and needs to urinate and move his bowels. The nurse should help him:

onto the bedpan.

Which of the following is a symptom of severe thrombocytopenia?

petechiae (i.e. pinpoint hemorrhagic lesions, usually more prominent on the trunk or anterior aspects of the lower extremities).

Basophils

which type of leukocyte contains histamine and is an important part of hypersensitivity reactions?

When teaching about the advantages of autologous blood transfusion to a client, the nurse should include which information?

• The primary advantage is prevention of viral infections. • It is safer for clients with a history of transfusion reactions. • If not needed immediately, the blood can be frozen for future use.

The nurse recognizes the most common cause of iron deficiency anemia in an adult is which of the following?

Bleeding

Which of the following are assessment findings associated with thrombocytopenia?

Bleeding gums Epistaxis Hematemesis

A client's family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC?

"DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs."

A client with megaloblastic anemia reports mouth and tongue soreness. What instruction will the nurse give the client regarding eating while managing the client's symptoms?

"Eat small amounts of bland, soft foods frequently."

The nurse is collecting data for a client who has been diagnosed with iron-deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia?

"I have difficulty breathing when walking 30 feet."

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?

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

After teaching a client about taking daily oral iron preparations for a moderate iron deficiency anemia, which statement by the client indicates to the nurse that additional instruction is needed?

"I will call the doctor if my stools turn black."

A client with a history of congestive heart failure has an order to receive 1 unit of packed red blood cells (RBCs). If the nurse hangs the blood at 12:00 pm, by what time must the infusion be completed?

4 pm

4pm. When packed red blood cells (PRBCs) or whole blood is transfused, the blood should be administered within a 4-hour period because warm room temperatures promote bacterial growth.

A nurse is preparing a dose of furosemide for an older adult with heart failure. The health care provider orders furosemide 1 mg/kg to be given intravenously. The client weighs 50 kg. The concentration of the drug is 40 mg/4mL (10 mg/mL). How many milliliters would the nurse administer? Record your answer using a whole number.

In normal blood, monocytes account for approximately what percentage of the total leukocyte count?

Which patient does the nurse recognize as being most likely to be affected by sickle cell disease?

A 14-year-old African American boy

A nurse provides nutritional information for a patient diagnosed with an iron-deficiency anemia. What education should the nurse provide?

Increase the intake of green, leafy vegetables.

A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving:

A-positive blood to an A-negative client.

A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify?

Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels

A client with sickle cell disease informs the nurse that he is having chest pain. The nurse hears the client coughing, wheezing, and breathing rapidly. What does the nurse suspect is occurring with this client?

Acute chest syndrome

A patient with sickle cell disease is brought to the emergency department by a parent. The patient has a fever of 101.6°F, heart rate of 116, and a respiratory rate of 32. The nurse auscultates bilateral wheezes in both lung fields. What does the nurse suspect this patient is experiencing?

Acute chest syndrome

Administer acetaminophen 500 mg po, as ordered

The nurse is talking with the parents of a toddler who was diagnosed with hemophilia A. What instruction should the nurse give to the parents?

Administer factor VIII intravenously at the first sign of bleeding

Administer the ordered paracetamol 500 mg po. After the marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing. Most patients have no discomfort after a bone marrow aspiration, but the site of a biopsy may ache for 1 or 2 days. Warm tub baths and a mild analgesic agent (e.g., paracetamol) may be useful. Aspirin-containing analgesic agents should be avoided it the immediate post-procedure period because they can aggravate or potentiate bleeding.

Administer the prescribed enoxaparin (Lovenox).

A patient describes numbness in the arms and hands with a tingling sensation. The patient also frequently stumbles when walking. What vitamin deficiency does the nurse determine may cause some of these symptoms?

B12

Patients who have had a partial or total gastrectomy may have limited amounts of intrinsic factor, therefore the absorption of vitamin _______ may be diminished.

B12

The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency?

B12

Which type of leukocyte contains histamine and is an important part of hypersensitivity reactions?

Basophils

Which type of leukocyte contains histamine and is an important part of hypersensitivity reactions? Plasma cell Basophils B lymphocyte Neutrophil

Basophils

When teaching a client with iron deficiency anemia about appropriate food choices, the nurse encourages the client to increase the dietary intake of which foods?

Beans, dried fruits, and leafy, green vegetables

A client with multiple myeloma reports pain along the spinal column. The client is prescribed naproxen (Aleve) and oxycodone. Prior to administering these medications, the nurse

Checks the client's BUN and creatinine

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?

Chelation therapy

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 Hepatitis B immunization Chelation therapy Red blood cell phenotyping

Chelation therapy

A young male client is diagnosed with glucose-6-phosphate dehydrogenase deficiency (G-6-PD). The nurse reviews his recent activities and most emphatically recommends the following:

Consult a physician about ingesting trimethoprim/sulfamethoxazole (Bactrim) for a urinary tract infection.

A male client has been receiving a continuous infusion of weight-based heparin for more than 4 days. The client's PTT is at a level that requires an increase of heparin by 100 units per hour. The client has the laboratory findings shown above. The most important action of the nurse is to

Consult with the physician about discontinuing heparin.

Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.

The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly?

Crackles auscultated bilaterally

A patient with ESKD has developed anemia. What lab finding does the nurse understand to be significant in this stage of anemia? A. K 5.2 B. Mg 2.5 C. Ca 9.4 D. Cr 6

When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply.

Dietary intake, ethnicity, use of herbal supplements, and medication use are factors for which the nurse should assess.

"DIC occurs when the immune system attacks platelets and causes massive bleeding."

DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs."

The nurse cares for a client with iron deficiency anemia. What findings will the nurse expect to find when reviewing the client's CBC results? Select

Decreased MCV Decreased reticulocytes

The nurse is caring for a client who had undergone hemodilution during surgery. Immediately after surgery, the nurse expects to see which lab result?

Decreased hematocrit

The nurse is caring for a client who had undergone hemodilution during surgery. Immediately after surgery, the nurse expects to see which lab result? Decreased hematocrit Elevated erythrocyte concentration Elevated creatinine Critically low arterial oxygen saturation

Decreased hematocrit

A patient with chronic renal failure is examined by the nurse practitioner for anemia. The nurse knows to review the laboratory data for a decreased hemoglobin level, red blood cell count, and which of the following?

Decreased level of erythropoietin

The nurse expects which assessment finding when caring for a client with a decreased hemoglobin level?

Decreased oxygen level.

A nurse cares for a client with a hematological disorder and malnutrition. What is the nurse's best understanding of how the client's nutritional status may worsen the client's hematological condition?

Decreased protein stores lead to decreased immune response

A nurse cares for several clients with anemia and notes that all the clients have different types of anemia. What is the nurse's best understanding of how anemias are classified, based on the deficiency of erythrocytes?

Defective production of erythrocytes Destruction of erythrocytes Loss of erythrocytes

When assessing a client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential?

Health history, such as bleeding, fatigue, or fainting

A patient has a probable diagnosis of polycythemia vera. The nurse reviews the patient's lab work for which diagnostic indicator?

Hematocrit of 60%

A client complains of extreme fatigue. Which system should the nurse suspect is most likely affected?

Hematological

A patient with ESRD is taking recombinant erythropoietin for the treatment of anemia. What laboratory study does the nurse understand will have to be assessed at least monthly related to this medication?

Hemoglobin level

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?

Hemorrhage

Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents?

Hypochromic

Splenic sequestration is diagnosed in a client admitted with splenomegaly. What is the priority of care for this client?

Hypovolemia

A nurse is caring for a client with a history of GI bleeding, sickle cell anemia, and a platelet count of 22,000/μl. The client, who is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hour, complains of severe bone pain and is scheduled to receive a dose of morphine sulfate. For which administration route should the nurse question an order?

I.M.

A client receiving a blood transfusion experiences an acute hemolytic reaction. What is the nurse's priority intervention?

Immediately stop the transfusion, infuse normal saline solution, call the health care provider, and notify the blood bank.

A client receiving a blood transfusion experiences an acute hemolytic reaction. Which nursing intervention is the most important?

Immediately stop the transfusion, infuse normal saline solution, call the physician, and notify the blood bank.

When teaching about the advantages of autologous blood transfusion to a client, the nurse should include which information? Select all that apply.

It is safer for clients with a history of transfusion reactions. If not needed immediately, the blood can be frozen for future use. The primary advantage is prevention of viral infections.

It may indicate deficiencies in essential nutrients.

A client admitted to the hospital in preparation for a splenectomy to treat autoimmune hemolytic anemia asks the nurse about the benefits of splenectomy. Which statement best explains the expected effect of splenectomy?

It will remove the major site of red blood cell (RBC) destruction.

A client complains of feeling faint after donating blood. What is the nurse's best action?

Keep client in recumbent position to rest. Trendelenburg position is not recommended after blood donation.

Lack of erythropoietin

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?

Lack of erythropoietin

Which iron-rich foods should a nurse encourage an anemic client requiring iron therapy to eat?

Lamb and peaches

During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding?

Low ferritin level concentration

Which of the following terms refers to a form of white blood cell involved in immune response?

Lymphocyte

Which term refers to a form of white blood cell involved in immune response?

Lymphocyte

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called which of the following?

Megaloblasts

Which of the following nursing interventions should be incorporated into the plan of care for a patient with impaired liver function and low albumin levels?

Monitor for edema at least once per shift

A nursing instructor is evaluating a student caring for a neutropenic client. The instructor concludes that the nursing student demonstrates accurate knowledge of neutropenia based on which intervention?

Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential

Which cell of haematopoiesis 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

After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/mm3. What term should the nurse use to describe this low platelet count?

Thrombocytopenia

A nurse is caring for a client with thalassemia who is being transfused. What is the nurse's role during a transfusion?

To closely monitor the rate of administration

A nurse is doing a physical examination of a child with sickle cell anemia. When the child asks why the nurse auscultates the lungs and heart, what would be best the response by the nurse?

To detect the abnormal sounds suggestive of acute chest syndrome and heart failure

One hour after the completion of a fresh frozen plasma transfusion, a patient complains of shortness of breath and is very anxious. The patient's vital signs are BP 98/60, HR 110, temperature 99.4°F, and SaO2 88%. Auscultation of the lungs reveals posterior coarse crackles to the mid and lower lobes bilaterally. Based on the symptoms, the nurse suspects the patient is experiencing which of the following problems?

Transfusion-related acute lung injury (TRALI) is a potentially fatal, idiosyncratic reaction that is defined as the development of acute lung injury occurring within 6 hours after a blood transfusion. It is more likely to occur when plasma and platelets are transfused. Onset is abrupt (usually within 6 hours of transfusion, often within 2 hours). Signs and symptoms include acute shortness of breath, hypoxia (arterial oxygen saturation [SaO2] less than 90%; pressure of arterial oxygen [PaO2] to fraction of inspired oxygen [FIO2] ratio of less than 300), hypotension, fever, and eventual pulmonary edema.

Causes of bleeding disorders

Trauma Platelet abnormality Coagulation factor abnormality

T or F- The patient, who is experiencing severe circulatory overload due to too much blood infusing too quickly, should be placed in an upright position with the feet in a dependent position.

True

T or F- The primary function of lymphocytes is to attack foreign material.

True

Phagocytosis

Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils?

When evaluating a patient's symptoms that are consistent with a diagnosis of leukemia, the nurse is aware that a common feature of all leukemias is which of the following?

Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements

When evaluating a patient's symptoms that are consistent with a diagnosis of leukemia, the nurse is aware that all leukemias have which common feature?

Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements

A nurse on a hematology/oncology floor is caring for a client with aplastic anemia. Which would not be included in the client's discharge instructions?

Use a disposable razor when shaving.

The nurse cares for a client with a coagulation factor deficiency who is actively bleeding. Which blood component replacement does the nurse anticipate administering? a. FFP b. PRBCs c. IV gamma-globulin d. antithrombin III

a. FFP

A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse know is the most likely clinical disorder the patient is being treated for? a) Essential thrombocythemia b) Extreme leukocytosis c) Sickle cell anemia d) Renal transplantation

a. essential thrombocythemia platelet pheresis is used to remove platelets from the blood in patients with extreme thrombocytosis or essential thrombocythemia or in a single-donor platelet transfusion

When teaching about the advantages of autologous blood transfusion to a client, the nurse should include which information? Select all that apply. a. It resolves anemia for clients with a hemoglobin less than 11g/dL. b. The primary advantage is prevention of viral infections. c. If not needed immediately, the blood can be frozen for future use. d. It is safer for clients with a history of transfusion reactions. e. Blood can be transfused to family members and close relatives.

b, d, c

A client complains of extreme fatigue. Which system should the nurse suspect is most likely affected? a. respiratory b. hematological c. integumentary d. neurological

b. hematological

Which term refers to a form of white blood cell involved in immune response? a. granulocyte b. lymphocyte c. throbocyte d. spherocyte

b. lymphocyte

if you have liver disease then you have problems with

bleeding such as petechia, bruises and third spacing

Which client is not a candidate for blood donation according to the American Heart Association? a. 50 year old female with a pulse of 95 beats/minute b. 18 year old male weighing 52kg c. 26 year old female with hemoglobin 11.0g/dl d. 86 year old male with blood pressure 110/70mmHg

c. 26 Year old female with hemoglobin 1.0g/dl body weight- at least 50kg pulse- 50-100 bpm Bp (90/50) - (180/100) hemoglobin at least 12.5g/dl for women NO AGE LIMIT

Which blood cell type is matched correctly with its function? a. plasma cell: cell-mediated immunity b. Blymphocyte: secretes immunoglobulin c. Leukocute: fights infection d. T lymphocyte: humoral immunity

c. Leukocyte: fights infection

Which type of lymphocyte is responsible for cellular immunity? a. B lymphocyte b. plasma cell c. T lymphocyte d. basophil

c. T lymphocyte

The nurse is caring for a client who had undergone hemodilution during surgery. Immediately after surgery, the nurse expects to see which lab result? a. elevated erythrocyte concentration b. elevated creatinine c. decreased hematocrit d. critically low arterial oxygen saturation

c. decreased hematocrit hematocrit is the percentage of red blood cells in the blood

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

c. megaloblasts

A preoperative client is discussing blood donation with the nurse. Which statement by the client indicates to the nurse the need for further teaching? a. I should expect blood withdrawal to take about 15 minutes b. i could donate my own blood in case i need a transfusion c. my family will donate blood, because its safer d. donated blood is tested for blood type and infections

c. my family will donate blood because its safer

Which is the major function of neutrophils? a. production of immunoglobins b. rejection of foreign tissue c. phagocytosis d. destruction of tumor cells

c. phagocytosis

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? a. call the health care provider b. slow the infusion c. stop the infusion d. assess the clients vital signs

c. stop the infusion

secondary polycythemia

caused by other conditions going on: Sleep apnea Dehydration Smoking COPD/emphysema High altitude

aplastic anemia

characterized by an absence of all formed blood elements caused by the failure of blood cell production in the bone marrow

Neutropenia

deficiency of neutrophils (2000 or less) -normal is 5-10,000

An client has pernicious anemia and has been receiving treatment for several years. Which symptom may be confused with another condition in older adults?

dementia

The nurse expects which assessment finding of the oral cavity when the client is diagnosed with pernicious anemia?

smooth tounge

platelets are removed by the

spleen

stop the infusion

Place the following steps in order when determining the type and severity of a transfusion reaction. Use all options. 1. send the tubing and container to the blood bank 2. assess the client 3. notify the blood bank 4. stop the transfusion 5. notify the health care provider

stop the infusion assess the client notify the health care provider notify the blood bank send the tubing and container to the blood bank

Number of pregnancies

the nurse is completing a pretransfusion assessment to determine the history of previous transfusions as well as previous reactions to transfusions for a female patient. From the following list, what is the most important information to obtain from this patient prior to the transfusion?

thrombotic prone

to getting clots

polycythemia vera

too many erythrocytes (RBCs); blood becomes too thick to flow easily through blood vessels

what nursing things do we want to avoid with DIC pts?

trauma procedures that increase risk of bleeding actives that would increase intracranial pressure

with polycythemia we have to

treat the cause -use a CPAP -can do phlebotomy to remove some of the RBCs

A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse know is the most likely clinical disorder the patient is being treated for?

Essential thrombocythemia

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? Iron chelation therapy Therapeutic phlebotomy Oxygen therapy Anticoagulation therapy

Iron chelation therapy

Which blood cell type is matched correctly with its function? B lymphocyte: Secretes immunoglobulin T lymphocyte: Humoral immunity Plasma cell: Cell-mediated immunity Leukocyte: Fights infection

Leukocyte: Fights infection

The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly? a. pain and tenderness in the calf area b. crackles auscultated bilaterally c. oral temperature of 97 degrees d. respiratory rate of 10 breaths/minute

b. crackles auscultated bilaterally increasing the flow rate of a blood transfusion too rapidly can result in circulatory overload

b. neutrophils

The nurse expects which assessment finding of the oral cavity when the client is diagnosed with pernicious anemia? a. ulcerations of oral mucosa b. smooth tongue c. angular cheilosis d. enlarged gums

b. smooth tongue

A patient with chronic kidney disease is being examined by the nurse practitioner for anemia. The nurse has reviewed the laboratory data for hemoglobin and RBC count. What other test results would the nurse anticipate observing? a. increased mean corpuscular volume b. increased reticulocyte count c. decreased level of erythropoietin d. decreasd total iron-binding capacity

c. decreased level of erythropoietin

Which term refers to the percentage of blood volume that consists of erythrocytes? a. differentiation b. erythrocyte sedimentation rate (ESR) c. hemoglobin d. hematocrit

d. hematocrit

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? a. splintering of bone fragments b. blood transfusion reaction c. shock d. hemorrhage

d. hemorrhage

The nurse is instructing the client with polycythemia vera how to perform isometric exercises such as contracting and relaxing the quadriceps and gluteal muscle during periods of inactivity. What does the nurse understand is the rationale for this type of exercise? This type of exercise increases arterial circulation as it returns to the heart. Isometric exercise programs are inclusive of all muscle groups and have an aerobic effect to increase the heart rate. Isometric exercise decreases the workload of the heart and restores oxygenated blood flow. Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.

Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.

A nurse cares for several mothers and babies in the postpartum unit. Which mother does the nurse recognize as being most at risk for a febrile nonhemolytic reaction? Rh-positive mother; Rh-positive child Rh-positive mother; Rh-negative child Rh-negative mother; Rh-positive child Rh-negative mother; Rh-negative child

Rh-negative mother; Rh-positive child

The nurse begins a routine blood transfusion of packed red blood cells (PRBCs) at 1100. To ensure client safety, the unit of blood should be completely transfused by what time? a. 1500 b. 1530 c. 1600 d. 1115

Should not exceed four hours because it risks bacterial proliferation

The physician believes that the patient has a deficiency in the leukocyte responsible for cell-mediated immunity. What should the nurse check the WBC count for? Basophils Monocytes T lymphocytes Plasma cells

T lymphocytes

The nurse is administering a blood transfusion to a client over 4 hours. After 2 hours, the client reports chills and has a fever of 101°F, an increase from a previous temperature of 99.2°F. What does the nurse recognize is occurring with this client?

The client is having a febrile nonhemolytic reaction.

A nurse is caring for a client who will undergo total knee replacement and will have an autologous transfusion. Which statement will the nurse include when teaching the client about the transfusion? "You typically donate blood 4 to 6 weeks before the surgery." "You will likely not need the blood that is donated." "You typically donate blood the day of the surgery." "You will be prescribed calcium to replace what is lost during donation."

"You typically donate blood 4 to 6 weeks before the surgery."

RBC count

The client is to receive a unit of packed red blood cells. The first intervention of the nurse is to Verify that the client has signed a written consent form. Observe for gas bubbles in the unit of packed red blood cells. Ensure that the intravenous site has a 20-gauge or larger needle. Check the label on the unit of blood with another registered nurse.

Verify that the client has signed a written consent form.

The client is to receive a unit of packed red blood cells. What is the nurse's first action?

Verify that the client has signed a written consent form.

A nurse is reviewing a client's morning laboratory results and notes a left shift in the band cells. Based on this result, the nurse can interpret that the client may be developing anemia. has leukopenia. has thrombocytopenia. may be developing an infection.

may be developing an infection.

Which term refers to the percentage of blood volume that consists of erythrocytes? Hemoglobin Hematocrit Erythrocyte sedimentation rate (ESR) Differentiation

Hematocrit

A nurse is reviewing a client's morning laboratory results and notes a left shift in the band cells. Based on this result, the nurse can interpret that the client

may be developing an infection.

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? "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." "You will have to decide if refusing the blood transfusion is worth the risk to your health."

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

A nurse is teaching a client with a vitamin B12 deficiency about appropriate food choices to increase the amount of B12 ingested with each meal. The nurse knows the teaching is effective based on which statement by the client? "I will eat a meat source such as chicken or pork with each meal." "I will eat a spinach salad with lunch and dinner." "I will eat more dairy products such as milk, yogurt, and ice cream every day." "I will increase my daily intake of orange vegetables such as sweet potatoes and carrots."

"I will eat a meat source such as chicken or pork with each meal."

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 is likely caused by a vitamin B12 deficiency."

Place the order of the steps of primary hemostasis in correct order. 1-The severed blood vessel constricts. 2-The circulating platelets aggregate at the site and adhere to the vessel. 3-Circulating inactive clotting factors convert to active forms. 4-An unstable hemostatic plug is formed.

1-The severed blood vessel constricts 2-The circulating platelets aggregate at the site and adhere to the vessel. 4-An unstable hemostatic plug is formed. 3-Circulating inactive clotting factors convert to active forms.

The nurse begins a routine blood transfusion of packed red blood cells (PRBCs) at 1100. To ensure client safety, the unit of blood should be completely transfused by what time? 1600 1530 1500 1115

1500

Place the following procedural steps in order for transfusing a unit of packed red blood cells (PRBCs). 1-Initiate the blood transfusion within 30 minutes of receipt. 2-Start an intravenous line. 5-Monitor closely for signs of a transfusion reaction. 3-Obtain the unit of PRBCs from the blood bank. 4-Double check the labels with another nurse to ensure correct ABO group and Rh type.

2-Start an intravenous line. 3-Obtain the unit of PRBCs from the blood bank. 4-Double check the labels with another nurse to ensure 1-Initiate the blood transfusion within 30 minutes of receipt. 5-Monitor closely for signs of a transfusion reaction.

Which client is not a candidate for blood donation according to the American Heart Association? 86 year old male with blood pressure 110/70 mmHg 50 year old female with pulse 95 beats/minute 18 year old male weighing 52 kg. 26 year old female with hemoglobin 11.0 g/dL

26 year old female with hemoglobin 11.0 g/dL

Place the steps of fibrin clot breakdown in correct order. 1-Digestion of fibrinogen and fibrin 2-Formation of plasmin 3-Release of fibrin degradation products 4-Activation of plasminogen

4-Activation of plasminogen 2-Formation of plasmin 1-Digestion of fibrinogen and fibrin 3-Release of fibrin degradation products

4:00 pm

A female patient has a hemoglobin of 6.4 g/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 high number of pregnancies can increase the risk of reaction. If the patient has never been pregnant, it increases the risk of reaction. Obtaining information about gravidity and parity is routine information for all female patients. If the patient has been pregnant, she may have developed allergies.

A high number of pregnancies can increase the risk of reaction.

Albumin.

The nurse is obtaining the health history of a client suspected of having a hematological condition. The nurse notes the client has a history of alcohol abuse. Which clinical presentation is related to alcohol consumption?

Anemia

The physician performs a bone marrow biopsy from the posterior iliac crest on a client with pancytopenia. What intervention should the nurse perform after the procedure? Elevate the head of the bed to 45 degrees Pack the wound with half-inch sterile gauze Administer a topical analgesic to control pain at the site Apply pressure over the site for 5-7 minutes

Apply pressure over the site for 5-7 minutes

A client with Hodgkin disease had a bone marrow biopsy yesterday and reports aching at the biopsy site, rated a 5 (on a 1-10 scale). After assessing the biopsy site, which nursing intervention is most appropriate? a. administer acetaminiophen 500 mg po, as ordered b. administer aspirin (ASA) 325 mg po, as ordered c. notify the physician d., reposition the client to a high fowler position and continue to monitor the pain

Aspirin containing analgesic agents should be avoided post-procedure because they can aggravate or potentiate bleeding

The nurse is instructing the client with polycythemia vera how to perform isometric exercises such as contracting and relaxing the quadriceps and gluteal muscle during periods of inactivity. What does the nurse understand is the rationale for this type of exercise? a. contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart b. isometric exercise programs are inclusive of all muscle groups and have an aerobic effect to increase the heart rate c. this type of exercise increases arterial circulation as it returns to the heart d. isometric exercise decreases the workload of the heart and restores oxygenated blood flow

Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart

The client is a young, thin woman who is prescribed iron dextran intramuscularly. The nurse, when administering the 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

A client receiving a blood transfusion complains of shortness of breath, appears anxious, and has a pulse of 125 beats/minute. What is the best action for the nurse to take after stopping the transfusion and awaiting further instruction from the healthcare provider? Remove the intravenous line. Place the client in a recumbent position with legs elevated. Ensure there is an oxygen delivery device at the bedside. Administer prescribed PRN anti-anxiety agent.

Ensure there is an oxygen delivery device at the bedside.

A client with severe anemia is admitted to the hospital. Because of religious beliefs, the client is refusing blood transfusions. The nurse anticipates pharmacologic therapy with which drug to stimulate the production of red blood cells?

Epoetin alfa

A client with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this client?

Erythropoietin

A patient with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this patient? Eltrombopag (Promacta) Erythropoietin (Epogen) GM-CSF (Leukine) Thrombopoietin (TPO)

Erythropoietin (Epogen)

The nurse cares for a client with a coagulation factor deficiency who is actively bleeding. Which blood component replacement does the nurse anticipate administering? IV gamma-globulin FFP Antithrombin III PRBCs

FFP

Febrile nonhemolytic reactions

The nurse caring for a client with acute liver failure should expect which assessment finding? Generalized edema Elevated albumin level Decreased pulse Elevated blood pressure

Generalized edema

A nurse administers blood products to a client with Hodgkin disease. During the administration, the nurse notes the client has a fever and diffuse reddened skin rash. From what condition does the nurse suspect the client is suffering? Delayed hemolytic reaction Bacterial contamination Creutzfeld-Jakob disease Graft-versus-host disease

Graft-versus-host disease

A client complains of extreme fatigue. Which system should the nurse suspect is most likely affected? Neurological Respiratory Integumentary Hematological

Hematological

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? Splintering of bone fragments Blood transfusion reaction Shock Hemorrhage

Hemorrhage

Iron chelation therapy

The nurse should notify the healthcare provider before administering fresh frozen plasma (FFP) based on which assessment finding? Jugular venous distention White sclera Absence of tenting skin turgor Strong pedal pulses

Jugular venous distention

A client complains of feeling faint after donating blood. What is the nurse's best action? Place the client in Trendelenburg position. Assist the client into high-Fowler's position. Ambulate client with assistance. Keep client in recumbent position to rest.

Keep client in recumbent position to rest.

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 of the following reasons? Preparation for likely nephrectomy Lack of erythropoietin Hypervolemia Increases the effectiveness of dialysis

Lack of erythropoietin

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

Lateral position with one leg flexed

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following? Liver Large intestine Pancreas Kidney

Liver

Which term refers to a form of white blood cell involved in immune response? Granulocyte Lymphocyte Thrombocyte Spherocyte

Lymphocyte

Which nursing intervention should be incorporated into the plan of care for a client with impaired liver function and a low albumin concentration? Implement neutropenic precautions Monitor temperature at least once per shift Apply prolonged pressure to needle sites or other sources of external bleeding Monitor for edema at least once per shift

Monitor for edema at least once per shift

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

Myeloid stem cell

A nurse working in hematology reviews the characteristics of stem cells and their role in disease. Which statements does the nurse understand is true regarding stem cells? Select all that apply. Myeloid stem cells produce erythrocytes. There is a limited supply throughout the life cycle. They have the ability to self-replicate. Lymphoid stem cells produce lymphocytes. There is a continuous supply throughout the life cycle.

Myeloid stem cells produce erythrocytes. They have the ability to self-replicate. Lymphoid stem cells produce lymphocytes. There is a continuous supply throughout the life cycle.

Neutrophils

A nurse cares for an older adult client with acute myeloid leukemia (AML). What concept does the nurse understand leads to the increased risk of an older adult acquiring myeloid malignancies such as AML?

Older adults acquire damage to the DNA of stem cells over time.

A patient receiving plasma develops transfusion-related acute lung injury (TRALI) 4 hours after the transfusion. What type of aggressive therapy does the nurse anticipate the patient will receive to prevent death from the injury? (Select all that apply.) Fluid support Serial chest x-rays Intra-aortic balloon pump Intubation and mechanical ventilation Oxygen

Oxygen Fluid support Intubation and mechanical ventilation

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

Petechiae

Which is the major function of neutrophils? Destruction of tumor cells Phagocytosis Rejection of foreign tissue Production of immunoglobulins

Phagocytosis

The client is planned to have a splenectomy. The nurse should prepare which medication to administer to this client?

Pneumococcal vaccine

The client is planned to have a splenectomy. The nurse should prepare which medication to administer to this client? Factor VIII Aspirin Immunoglobulin G (IgG) Pneumococcal vaccine

Pneumococcal vaccine

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. The nurse Checks with Blood Bank first and then administers the blood with their permission Administers the unit of blood Asks the client if he was ever known as Donald A. Smith Refuses to administer the blood

Refuses to administer the blood

One hour after a transfusion of packed red blood cells (RBCs) is started, a client develops redness on the trunk and reports itching. The nurse stops the RBC infusion and administers diphenhydramine 25 mg po, as ordered. Thirty minutes later, the redness and itching are gone. What action should the nurse take next? Resume the transfusion Position the client in an upright position with the feet in a dependent position Send the blood back to the blood bank Obtain blood and urine samples from the client

Resume the transfusion

A nurse cares for several mothers and babies in the postpartum unit. Which mother does the nurse recognize as being most at risk for a febrile nonhemolytic reaction?

Rh-negative mother; Rh-positive child

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. Call the health care provider. Slow the infusion. Stop the infusion.

Stop the infusion.

The nurse began transfusing the first unit of packed red blood cells (PRBCs) fifteen minutes ago. The client begins complaining of shortness of breath, nausea, and is restless. What is the nurse's priority action? Notify the primary care provider. Discontinue the intravenous line. Flush the blood tubing with normal saline. Stop the infusion.

Stop the infusion.

Which type of lymphocyte is responsible for cellular immunity? B lymphocyte T lymphocyte Basophil Plasma cell

T lymphocyte

A nurse is caring for a client with a diagnosis of lymphocytopenia. Which assessment finding will the nurse consider most concerning when caring for this client?

Temperature of 37.7 degrees Celsius

One hour after the completion of a fresh frozen plasma transfusion, a client reports shortness of breath and is very anxious. The client's vital signs are BP 98/60, HR 110, temperature 99.4°F, and SaO2 88%. Auscultation of the lungs reveals posterior coarse crackles to the mid and lower lobes bilaterally. Based on the symptoms, the nurse suspects the client is experiencing which problem? Exacerbation of congestive heart failure Transfusion-related acute lung injury Delayed hemolytic reaction Bacterial contamination of blood

Transfusion-related acute lung injury

A client receiving a blood transfusion reports shortness of breath, appears anxious, and has a pulse of 125 beats/minute. What is the best action for the nurse to take after stopping the transfusion and awaiting further instruction from the health care provider? a. ensure there is an oxygen delivery device at the bedside b. remove the intravenous line c. adminster prescribed PRN anti-anxiety agent d. place the client in a recumbent position with legs elevated

a. ensure there is an oxygen delivery device at the bedside

The nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. What position will the nurse place the patient in? a. lateral position with one leg flexed b. jackknife position c. lithotomy position d. supine with head of the bed elevated at 30 degrees

a. lateral position with one leg flexed bone marrow aspiration procedure requires that the superior iliac crest be used because there are no vital organs or vessels near by. either lateral position with one leg flexed or in prone position

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? a. myeloid stem cell b. lymphoid stem cell c. neutrophil d. monocyte

a. myeloid stem cell

Which is a symptom of severe thrombocytopenia? a. petechiae b. dyspnea c. inflammation of the mouth d. inflammation of the tongue

a. petechiae

c. coagulopathy

A client receiving a unit of packed red blood cells (PRBCs) has been prescribed morphine 1 mg intravenously now for pain. What is the best method for the nurse to administer the morphine? a. administer the morphine into the closest tubing port to the client for fast delivery b. inject the morphine into a distal port on the blood tubing c. disconnect the blood tubing, flush with normal saline, and administer morphine d/ add the morphine to the blood to be slowly administered

c. disconnect the blood tubing, flush with normal saline, and administer morphine

While caring for a client, the nurse notes petechiae on the client's trunk and lower extremities. What precaution will the nurse take when caring for this client? a. wear a mask when entering the clients room b. elevate the clients head of the bed c. use an electric razor when assisting the client shaving d. apply supplemental oxygen to maintain the clients oxygenation

c. use an electric razor when assisting the client with shaving

A nursing instructor is reviewing the role and function of stem cells in the bone marrow with a group of nursing students. After providing the explanation, the instructor asks the students to use their knowledge of anatomy and physiology to determine an alternate way in which adults with diseases that destroy marrow can resume production of blood cells. Which explanation by the students is correct? a. fat found in yellow bone marrow can be replaced by active marrow when more blood cell production is required b. the remaining stem cells have the ability to continue with the process of self-replication, creating an endless supply c. the three cell types- erythrocytes, leukocytes and platelets- can resume production of stem cells d. the liver and spleen can resume production of blood cells through extramedullary haematopoiesis.

d. the liver and spleen can resume production of blood cells through extramedullary haematopoiesis

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

megaloblasts.

An 84-year-old woman is to receive 2 units of packed red blood cells. During the transfusion of the first unit at 125 mL/hour, the client reports shortness of breath 30 minutes into the process. The client exhibits the vital signs shown in the accompanying table. The best nursing intervention is to: Pre-Transfusion: 97.6F, HR72, Resp18, BP 108/72 15 Minutes: 97.6F, HR76, Resp18, BP 110/72 30 Minutes: 97.8F, HR88, Resp28, BP132/84 obtain blood and urine specimens for a transfusion reaction administer oxygen through nasal cannula at 2 L/minute contact the physician and obtain an order for diphenhydramine (Benadryl) slow the rate of the transfusion and obtain an order for furosemide (Lasix)

Hematology

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