Hematology Chap 32
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) Add the morphine to the blood to be slowly administered. b) Administer the morphine into the closest tubing port to the client for fast delivery. c) Inject the morphine into a distal port on the blood tubing. d) Disconnect the blood tubing, flush with normal saline, and administer morphine.
Disconnect the blood tubing, flush with normal saline, and administer morphine. Explanation: Never add medications to blood or blood products. The transfusion must be temporarily stopped in order to administer the morphine.
Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following? a) Pancreas b) Liver c) Large intestine d) Kidney
Liver Explanation: Albumin is produced by the liver. Albumin is not produced in the pancreas, kidney, or large intestine.
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? a) 2:00 pm b) 6:00 pm c) 3:00 pm d) 4:00 pm
4:00 pm Explanation: 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 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) Hepatitis B immunization b) Red blood cell phenotyping c) Chelation therapy d) White blood cell filter
Chelation therapy Explanation: Chelation therapy is prescribed to treat iron overload. Hepatitis B immunization helps immunize against hepatitis B. Red blood cell phenotyping helps decreased sensitization. A white blood cell filter protects against cytomegalovirus and some sensitization and febrile reactions
A client complains of extreme fatigue. Which system should the nurse suspect is most likely affected? a) Integumentary b) Neurological c) Hematological d) Respiratory
Hematological Explanation: The most common symptom in hematologic diseases is extreme fatigue.
Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils? a) Rejection of foreign tissue b) Phagocytosis c) Production of antibodies called immunoglobulin (Ig) d) Destruction of tumor cells
Phagocytosis Explanation: The major function of neutrophils is phagocytosis. T lymphocytes are responsible for rejection of foreign tissue and destruction of tumor cells. Plasma cells produce antibodies call immunoglobulin.
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? a) The patient is having a febrile nonhemolytic reaction. b) The patient is having an allergic reaction to the blood. c) The patient is experiencing vascular collapse. d) The patient is having decrease in tissue perfusion from a shock state.
The patient is having a febrile nonhemolytic reaction. Explanation: The signs and symptoms of a febrile nonhemolytic transfusion reaction are chills (minimal to severe) followed by fever (more than 1°C elevation). The fever typically begins within 2 hours after the transfusion is begun. Although the reaction is not life threatening, the fever, and particularly the chills and muscle stiffness, can be frightening to the patient
Which client is not a candidate for blood donation according to the American Heart Association? a) 26 year old female with hemoglobin 11.0 g/dL b) 86 year old male with blood pressure 110/70 mmHg c) 50 year old female with pulse 95 beats/minute d) 18 year old male weighing 52 kg.
26 year old female with hemoglobin 11.0 g/dL Explanation: 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 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) If the patient has never been pregnant, it increases the risk of reaction. b) If the patient has been pregnant, she may have developed allergies. c) Obtaining information about gravidity and parity is routine information for all female patients. d) A high number of pregnancies can increase the risk of reaction.
A high number of pregnancies can increase the risk of reaction. Explanation: The patient history is an important component of the pretransfusion assessment to determine the history of previous transfusions as well as previous reactions to transfusion. The history should include the type of reaction, its manifestations, the interventions required, and whether any preventive interventions were used in subsequent transfusions. The nurse assesses the number of pregnancies a woman has had, because a high number can increase her risk of reaction due to antibodies developed from exposure to fetal circulation.
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? a) Notify the physician b) Administer the ordered paracetamol 500 mg po c) Administer the ordered aspirin (ASA) 325 mg po d) Reposition the patient to a high Fowler's position and continue to monitor the pain
Administer the ordered paracetamol 500 mg po Explanation: 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.
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 a) Ensures the client has completed dialysis treatment b) Questions the administration of both medications c) Assesses the hemoglobin level d) Holds the epoetin alfa if the BUN is elevated
Assesses the hemoglobin level Explanation: Erythropoietin with oral iron supplements can raise hematocrit levels in the client with end-stage renal disease. The nurse should check the hemoglobin prior to administration of erythropoietin, because too high a hemoglobin level can put the client at risk for heart failure, myocardial infarction, and cerebrovascular accident. Erythropoietin may be administered during dialysis treatments. The BUN will be elevated in the client with end-stage renal disease.
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) Decreased total iron-binding capacity b) Decreased level of erythropoietin c) Increased reticulocyte count d) Increased mean corpuscular volume
Decreased level of erythropoietin Explanation: Differentiation of the primitive myeloid stem cell into an erythroblast is stimulated by erythropoietin, a hormone produced primarily by the kidney. If the kidney detects low levels of oxygen, as occurs when fewer red cells are available to bind oxygen (i.e., anemia), or with people living at high altitudes with lower atmospheric oxygen concentrations, erythropoietin levels increase. The increased erythropoietin then stimulates the marrow to increase production of erythrocytes. The entire process of erythropoiesis typically takes 5 days (Cook, Ineck, & Lyons, 2011). For normal erythrocyte production, the bone marrow also requires iron, vitamin B12, folate, pyridoxine (vitamin B6), protein, and other factors. A deficiency of these factors during erythropoiesis can result in decreased red cell production and anemia.
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? a) Remove the intravenous line. b) Place the client in a recumbent position with legs elevated. c) Administer prescribed PRN anti-anxiety agent. d) Ensure there is an oxygen delivery device at the bedside.
Ensure there is an oxygen delivery device at the bedside. Explanation: The client is exhibiting signs of circulatory overload. After stopping the transfusion and notifying the healthcare provider, the nurse should place the client in a more upright position with the legs dependent to decrease workload on the heart. The IV line is kept patent in case emergency medications are needed. Oxygen and morphine may be needed to treat severe dyspnea. Administering an anti-anxiety agent is not a priority action over ensuring oxygen is available.
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? a) Provide the client with a list of the nearest donation centers. b) Remind the client to take supplemental iron before donation. c) Explain the time frame needed for autologous donation. d) Tell the client that 2 units of blood will be needed.
Explain the time frame needed for autologous donation. Explanation: Preoperative autologous donations are ideally collected 4 to 6 weeks before surgery. The nurse should first explain that time frame to this client. Surgery is scheduled in one week which means that autologous blood donation may not be an option for this client. A list of donation centers can be provided to the client; and even though iron is recommended and 2 units of blood may be suggested, the first action is to tell the client about the needed time frame for donation.
The nurse should notify the healthcare provider before administering fresh frozen plasma (FFP) based on which assessment finding? a) Strong pedal pulses b) Absence of tenting skin turgor c) Jugular venous distention d) White sclera
Jugular venous distention Explanation: During the pre-transfusion assessment, the nurse should carefully inspect for any signs of cardiac failure, such as jugular venous distention. The sclera should be examined for icterus; white is an expected finding. Weak pedal pulses would be a sign of cardiac failure. Tenting skin turgor is a sign of dehydration; low vascular volume would be a cause for transfusion, not a contraindication.
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) Lithotomy position b) Supine with head of the bed elevated 30 degrees c) Lateral position with one leg flexed d) Jackknife position
Lateral position with one leg flexed Explanation: Bone marrow aspiration procedure. The posterior superior iliac crest is the preferred site for bone marrow aspiration and biopsy because no vital organs or vessels are nearby. The patient is placed either in the lateral position with one leg flexed or in the prone position.
A nurse practitioner reviewed the blood work of a male patient suspected of having microcytic anemia. The nurse suspected occult bleeding. Identify the laboratory result that would indicate this initial stage of iron deficiency. a) Serum iron: 100 ?g/dL b) Total iron-binding capacity: 300 ?g/dL c) Serum ferritin: 15 ng/mL d) Hemoglobin: 16 g/dL
Serum ferritin: 15 ng/mL Explanation: Microcytic anemia is characterized by small RBCs due to insufficient hemoglobin. Serum ferritin levels correlate to iron deficiency and decrease as an initial response to anemia before hemoglobin and serum iron levels drop.
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? a) Basophils b) Plasma cells c) Monocytes d) T lymphocytes
T lymphocytes Explanation: T lymphocytes are responsible for cell-mediated immunity, in which they recognize material as "foreign," acting as a surveillance system.
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? a) T lymphocytes b) Monocytes c) Leukocytes d) B lymphocytes
T lymphocytes Explanation: Lymphocytes (T cells, B cells, and natural killer cells) are WBCs that are the major components of the body's immune response. T cells are primarily responsible for cell-mediated immunity, whereas B cells are involved in antibody production
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? 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 liver and spleen can resume production of blood cells through extramedullary haematopoiesis. d) The three cell types—erythrocytes, leukocytes, and platelets—can resume production of stem cells.
The liver and spleen can resume production of blood cells through extramedullary haematopoiesis. Explanation: In adults with disease that causes marrow destruction, fibrosis, or scarring, the liver and spleen can also resume production of blood cells by a process known as extramedullary haematopoiesis.
