Hematology Exam 3

The maternity nurse is caring for a client with abruptio placentae and is monitoring her for disseminated intravascular coagulation. Which assessment findings are most likely associated with disseminated intravascular coagulation? Select all that apply. 1. Hematuria 2. Prolonged clotting times 3. Increased platelet count 4. Swelling of the calf of one leg 5. Petechiae, oozing from injection sites, and hematuria

1. Hematuria 2. Prolonged clotting times 5. Petechiae, oozing from injection sites, and hematuria Rationale: Disseminated intravascular coagulation (DIC) is a state of diffuse clotting in which clotting factors are consumed, leading to widespread bleeding. Platelets are decreased because they are consumed by the process. Coagulation studies show no clot formation (and are thus normal to prolonged), and fibrin plugs may clog the microvasculature diffusely, rather than in an isolated area. The presence of petechiae, oozing from injection sites, and hematuria are signs associated with DIC.

A client who had surgery 3 days earlier is receiving heparin sulfate by subcutaneous injection every 12 hours. In planning for the client's morning care, the priority nursing intervention is which action? 1. Allow the client to sit only at the bedside. 2. Assist the client to shave using an electric razor. 3. Monitor the prothrombin time (PT) every 4 hours. 4. Tell the client that brushing the teeth is not allowed.

2. Assist the client to shave using an electric razor. Rationale: Clients receiving heparin are at risk for bleeding. An electric razor rather than a straight blade razor is used for shaving. Page 422 in IGGY

A nurse is assessing a dark-skinned client for the presence of petechiae. Which body area is the best for the nurse to check in this client? 1. Sclera 2. Oral mucosa 3. Soles of the foot 4. Palms of the hand

2. Oral mucosa Rationale: In a dark-skinned client, petechiae are best observed in the conjunctivae and oral mucosa. Jaundice would best be noted in the sclera of the eye. Cyanosis is best noted on the palms of the hands and soles of the feet. Page 863 in IGGY

The nurse is assigned to care for a client who was just admitted to the hospital for the treatment of iron overload. The nurse anticipates that the health care provider will prescribe which medication to treat the iron overload? 1. Granisetron 2. Ketoconazole 3. Deferoxamine 4. Terbinafine (Lamisil)

3. Deferoxamine Rationale: Deferoxamine is a medication used to treat iron overload. Page 875

A home care nurse is visiting a client who was discharged to home with a prescription for continued administration of enoxaparin (Lovenox) subcutaneously. What is the nurse's priority assessment for this client? 1. Constipation 2. Fear of needles 3. Nausea or vomiting 4. Bleeding gums or bruising

4. Bleeding gums or bruising Rationale: Enoxaparin is an anticoagulant. An adverse effect of anticoagulant therapy is bleeding. Accordingly, the nurse questions the client about signs and symptoms that could indicate bleeding, such as bleeding gums, bruising, hematuria, or dark tarry stools.

A client who is due for a dose of warfarin (Coumadin) has a prothrombin time (PT) of 28 seconds. After analyzing this test result, what should the nurse do? 1. Give double the dose. 2. Administer the next dose. 3. Give half of the next dose. 4. Call the health care provider (HCP).

4. Call the health care provider (HCP). Rationale: The PT is one test that may be used to monitor warfarin therapy. The international normalized ratio is another laboratory test used to monitor warfarin therapy. A PT of 28 seconds represents an elevated value. The therapeutic PT for a client receiving warfarin is 1.5 times the normal PT (9.5 to 11.5 seconds). The nurse should withhold the next dose and notify the HCP. A medication dose should not be changed without a specific prescription

The nurse is preparing to administer filgrastim (Neupogen) by intravenous (IV) infusion. Which nursing action is appropriate for administering this medication? 1. Shake the solution before drawing it up. 2. Dilute the medication in normal (0.9%) saline. 3. Discard the medication if it has been refrigerated. 4. Dilute the medication in 5% dextrose in water (D5W).

4. Dilute the medication in 5% dextrose in water (D5W). Rationale: Filgrastim (Neupogen) may be administered by continuous IV infusion. It is diluted only with D5W when administered by the IV route. The solution should not be shaken. It should be stored in a refrigerator and should be discarded if it has been exposed to room temperature for more than 6 hours.

A client with chronic kidney disease is anemic. The nurse plans care, knowing that this problem is caused by the client's insufficient production of which substance? 1. Renin 2. Aldosterone 3. Angiotensin I 4. Erythropoietin

4. Erythropoietin Rationale: Clients with chronic kidney disease do not manufacture adequate amounts of erythropoietin, which is a glycoprotein needed to synthesize red blood cells. Page 1471

The nurse is monitoring a client who is receiving epoetin alfa (Epogen, Procrit) for adverse effects of the medication. Which finding indicates an adverse effect? 1. Diarrhea 2. Depression 3. Bradycardia 4. Hypertension

4. Hypertension Rationale: Epoetin alfa generally is well tolerated. The most significant adverse effect is hypertension. Occasionally a tachycardia may occur as a side effect. This medication also may cause an improved sense of well-being.

The nurse is reviewing the laboratory test results for a client who is receiving filgrastim (Neupogen). Which reported value would indicate an effective response to this medication? 1. Hematocrit of 42% 2. Blood glucose level of 120 mg/dL 3. Platelet count of 150,000 cells/mm3 4. Neutrophil count of 10,000 cells/mm3

4. Neutrophil count of 10,000 cells/mm3 Rationale: Filgrastim (Neupogen) is used to promote the growth of neutrophils and enhance the function of mature neutrophils. Treatment is continued until the absolute neutrophil count reaches 10,000 cells/mm3.

Enoxaparin sodium (Lovenox) is prescribed for a client after hip replacement surgery. What should the nurse prepare to have available in the event that an overdose of the medication occurs? 1. Adrenalin 2. Vitamin K 3. Epinephrine 4. Protamine sulfate

4. Protamine sulfate Rationale: Enoxaparin sodium is an anticoagulant. Accidental overdose of this medication may lead to bleeding complications. The antidote is protamine sulfate.

The nurse is developing a plan of care for the client with multiple myeloma and includes which priority intervention in the plan? 1. Encouraging fluids 2. Providing frequent oral care 3. Coughing and deep breathing 4. Monitoring the red blood cell count

1. Encouraging fluids Rationale: Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. The nurse should administer fluids in adequate amounts to maintain a urine output of 1.5 to 2 L/day; this requires about 3 L of fluid intake per day. The fluid is needed not only to dilute the calcium overload but also to prevent protein from precipitating in the renal tubules

The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which would the nurse expect to note specifically in this disorder? 1. Increased calcium level 2. Increased white blood cells 3. Decreased blood urea nitrogen level 4. Decreased number of plasma cells in the bone marrow

1. Increased calcium level Rationale: Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia caused by the release of calcium from the deteriorating bone tissue, and an elevated blood urea nitrogen level.

In a client receiving heparin, which laboratory finding should be the cause for greatest concern? 1. Platelet count of 100,000 cells/mm3 2. International normalized ratio of 1.2 3. Red blood cell count of 4.2 million cells/mm3 4. Activated partial thromboplastin time (aPTT) of 60 seconds

1. Platelet count of 100,000 cells/mm3 Rationale: The platelet count indicates that the client receiving heparin is at risk for heparin-induced thrombocytopenia (HIT). HIT should be suspected whenever platelet counts fall below normal. If severe thrombocytopenia develops (platelet count less than 100,000 cells/mm3), heparin should be discontinued. The aPTT in option 4 represents an expected finding for heparin therapy. Option 2 is not a value measured for heparin therapy but is used to measure a response to warfarin (Coumadin) therapy, and the red blood cell count in option 3 is normal.

A clinic nurse is reviewing the record of a client with a suspected diagnosis of pernicious anemia. The nurse anticipates that which diagnostic test will be prescribed by the client's health care provider? 1. Schilling test 2. Clotting time 3. Bone marrow biopsy 4. White blood cell differential

1. Schilling test Rationale: The Schilling test is used to determine the cause of vitamin B12 deficiency, which leads to pernicious anemia. This test involves the use of a small oral dose of radioactive B12, followed by a large nonradioactive intramuscular (IM) dose. The IM dose helps flush the oral dose into the urine if it was absorbed. A 24-hour urine collection is performed to measure the amount of radioactivity in the urine.

The nurse monitors the client for which condition as a complication of polycythemia vera? 1. Thrombosis 2. Hypotension 3. Cardiomyopathy 4. Pulmonary edema

1. Thrombosis Rationale: Polycythemia vera is a disorder of the bone marrow. It results in excessive production of white blood cells, red blood cells, and platelets. Clients with polycythemia vera are also more likely to form blood clots that can cause thrombi, strokes, myocardial infarctions, and abnormal bleeding. Clients with polycythemia are hypertensive Page 879 in IGGY

The nurse is reviewing the health care provider's prescriptions for a client admitted to the hospital with a diagnosis of idiopathic autoimmune hemolytic anemia. The nurse prepares the client for treatment of this disorder, understanding that which may be recommended? Select all that apply. 1. Transfusions 2. Splenectomy 3. Radiation therapy 4. Corticosteroid medication 5. Immunosuppressive agents

1. Transfusions 2. Splenectomy 4. Corticosteroid medication 5. Immunosuppressive agents Rationale: Idiopathic autoimmune hemolytic anemia is treated with corticosteroids. Other treatments that may be prescribed as necessary include transfusions, splenectomy, and, occasionally, immunosuppressive medications Page 876

The nurse is reviewing the progress notes for a client admitted to the nursing unit with a suspected diagnosis of leukemia. The nurse notes that the diagnosis of leukemia has been confirmed. The nurse interprets that results have been reported to the health care provider for which diagnostic test? 1. Platelet count 2. Bone marrow biopsy 3. White blood cell count 4. Complete blood cell count

2. Bone marrow biopsy Rationale: Bone marrow aspiration or biopsy allows examination of blast cells and other hypercellular activity.

When obtaining assessment data from a client with a microcytic normochromic anemia, which should the nurse question the client about? 1. Folic acid intake 2. Dietary intake of iron 3. A history of gastric surgery 4. A history of sickle cell anemia

2. Dietary intake of iron Rationale: Microcytic normochromic anemias involve the presence of small, pale-colored red blood cells. Causes are iron deficiency anemia, thalassemia, and lead poisoning. Page 876-877

A client with atrial fibrillation who is receiving maintenance therapy of warfarin sodium (Coumadin) has a prothrombin time (PT) of 35 seconds. On the basis of the prothrombin time, the nurse anticipates which prescription? 1. Adding a dose of heparin sodium 2. Holding the next dose of warfarin 3. Increasing the next dose of warfarin 4. Administering the next dose of warfarin

2. Holding the next dose of warfarin A therapeutic PT level is 1.5 to 2 times higher than the normal level. Because the value of 35 seconds is high (and perhaps near the critical range), the nurse should anticipate that the client would not receive further doses at this time. Page 865 in IGGY Page 672 in Kee Hayes

A client receiving heparin sodium by continuous intravenous (IV) infusion removes the tubing from the pump to change his hospital gown. The nurse is concerned that the client received a bolus of medication. After requesting a prescription for a stat partial thromboplastin time (PTT), the nurse should check for availability of which medication in the medication cart? 1. Vitamin K 2. Protamine sulfate 3. Enoxaparin (Lovenox) 4. Aminocaproic acid (Amicar)

2. Protamine sulfate Rationale: If the tubing is removed from an IV pump and the tubing is not clamped, the client will receive a bolus of the solution and the medication contained in the solution. The client who receives a bolus dose of heparin is at risk for bleeding. If the results of the next PTT are extremely high, a dose of protamine sulfate, the antidote for heparin, may be prescribed.

The nurse is reviewing the laboratory test results for a client with a diagnosis of leukemia who is receiving chemotherapy. The nurse notes that the client's platelet count is 20,000 cells/mm3. The nurse should prepare to implement which specific action based on this finding? 1. Remove the fresh flowers from the client's room. 2. Remove the rectal thermometer from the client's room. 3. Instruct family members to wear a mask when entering the client's room. 4. Call the dietary department to report that the client will be on a low-bacteria diet.

2. Remove the rectal thermometer from the client's room. Rationale: When the client's platelet count is low, he or she is at risk for bleeding. Rectal temperatures should not be taken on the client who is at risk for bleeding because the thermometer could cause an alteration in the delicate rectal membranes and lead to bleeding. Page 421 and 881 in IGGY

A client is brought to the emergency department having experienced blood loss related to an arterial laceration. Fresh-frozen plasma is prescribed and transfused to replace fluid and blood loss. The nurse understands that which is the rationale for transfusing fresh-frozen plasma to this client? 1. To treat the loss of platelets 2. To promote rapid volume expansion 3. Because a transfusion must be done slowly 4. Because it will increase the hemoglobin and hematocrit levels

2. To promote rapid volume expansion Rationale: Fresh-frozen plasma is often used for volume expansion as a result of fluid and blood loss. It does not contain platelets, so it is not used to treat any type of low platelet count disorder. It is rich in clotting factors and can be thawed quickly and transfused quickly. It will not specifically increase the hemoglobin and hematocrit level. Page 897 and 900 in IGGY

The nurse is providing instructions to the client receiving external radiation therapy. Which statement, if made by the client, indicates the need for further instruction? 1. "I will dry affected areas with patting motions." 2. "I will wear soft clothing over the affected site." 3. "I will use a washcloth to wash the affected area." 4. "I need to make sure I carry my purse on the unaffected side."

3. "I will use a washcloth to wash the affected area." Rationale: External radiation therapy requires markings to be placed on the skin so that therapy can be aimed at the affected areas. The hand rather than a washcloth should be used to wash the area to avoid irritation. The nurse should instruct the client undergoing external radiation therapy to dry affected areas with a patting (rather than rubbing) motion so as not to disrupt the markings on the skin. Soft clothing should be worn so that the affected area is not irritated. The client should be sure to carry her purse on the unaffected side.

The nurse is evaluating the results of laboratory studies for a client receiving epoetin alfa (Epogen, Procrit). When should the nurse expect to note a therapeutic effect of this medication? 1. Immediately 2. 3 days after therapy 3. 2 weeks after therapy 4. After 1 week of therapy

3. 2 weeks after therapy Rationale: Epoetin alfa stimulates erythropoiesis. It takes 2 to 6 weeks after initiation of therapy before a clinically significant increase in hematocrit is observed. Therefore this medication is not intended for clients who require immediate correction of severe anemia, and it is not a substitute for emergency blood transfusions.

A client with chronic kidney disease was started on epoetin alfa (Epogen, Procrit) 2 months earlier. In evaluating the therapeutic effectiveness of the medication, the nurse should expect the client to exhibit which finding? 1. A decrease in blood pressure 2. An increase in white blood cells 3. An increase in serum hematocrit 4. A decrease in serum creatinine levels

3. An increase in serum hematocrit Rationale: Epoetin alfa stimulates red blood cell production. Initial effects should be seen within 1 to 2 weeks, and the hematocrit reaches normal levels (30% to 33%) in 2 to 3 months.

The nurse is reviewing the laboratory test results for a client with a diagnosis of thrombocytopenia purpura. The nurse should expect the results for platelet aggregation to be at which level? 1. Normal 2. Increased 3. Decreased 4. Insignificant

3. Decreased Rationale: The adherence of platelets to one another is defined as platelet aggregation. Platelets usually aggregate in less than 5 minutes. This test determines abnormalities in the rate and percentages of platelet aggregation. Decreased platelet aggregation may occur in persons with infectious mononucleosis, idiopathic thrombocytopenia purpura, acute leukemia, or von Willebrand's disease. Page 895 in IGGY

The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the nurse specifically note as a result of the massive cell destruction that occurred from the chemotherapy? 1. Anemia 2. Decreased platelets 3. Increased uric acid level 4. Decreased leukocyte count

3. Increased uric acid level Rationale: Hyperuricemia is especially common following treatment for leukemias and lymphomas because chemotherapy results in massive cell kill. Although options 1, 2, and 4 also may be noted, an increased uric acid level is related specifically to cell destruction.

The nurse should be prepared to institute bleeding precautions in the client receiving antineoplastic medication if which result was reported from the laboratory? 1. Clotting time 12 seconds 2. Ammonia level 28 mcg/dL 3. Platelet count 50,000 cells/mm3 4. White blood cell count (WBC) 4500 cells/mm3

3. Platelet count 50,000 cells/mm3 Rationale: Platelets are the building blocks of blood clots. The normal platelet count is 150,000 to 400,000 cells/mm3. Bleeding precautions should be instituted when the platelet count drops to a low level, as defined by agency policy. Bleeding precautions include avoiding all trauma, such as rectal temperatures or injections. Page 420 and 421 in IGGY Page 519 and 525 in Kee Hayes

Epoetin alfa (Epogen, Procrit) by the subcutaneous route is prescribed for a client. Which is the correct action for the nurse to implement? 1. Shake the vial before use. 2. Freeze the medication before use. 3. Refrigerate the medication until used. 4. Obtain syringes with 1½-inch needles from the pharmacy.

3. Refrigerate the medication until used. Rationale: Epoetin alfa (Epogen, Procrit) should be refrigerated at all times. The bottle should not be shaken and the medication should not be frozen because this will affect the chemical composition. Syringes with a 5/6-inch needle are used for subcutaneous injection.

A client is diagnosed with iron deficiency anemia, and ferrous sulfate (Feosol) is prescribed. The nurse should tell the client that it would be best to take the medication with which food? 1. Milk 2. Boiled egg 3. Tomato juice 4. Pineapple juice

3. Tomato juice Rationale: Ferrous sulfate is an iron preparation, and the client is instructed to take the medication with orange juice or another vitamin C-containing product or product high in ascorbic acid to increase the absorption of the iron. Among the options presented, tomato juice is highest in vitamin C and ascorbic acid. Milk and eggs inhibit absorption of iron. Kee and Hayes page 804

A client with iron deficiency anemia complains of feeling fatigued almost all of the time. The nurse should respond with which statement? 1. "The work of breathing is increased when the client is anemic." 2. "Blood flows more slowly when the hemoglobin or hematocrit is low." 3. "The body has to work harder to fight infection in the presence of anemia." 4. "Adequate amounts of hemoglobin are needed to carry oxygen for tissue metabolism."

4. "Adequate amounts of hemoglobin are needed to carry oxygen for tissue metabolism." Rationale: Oxygen is required to meet the metabolic needs of the body. With decreased hemoglobin, such as in iron deficiency anemia, the oxygen-carrying capacity of the blood is less than normal. The client feels the effects of this change as fatigue

The home care nurse is making a monthly visit to a client with a diagnosis of pernicious anemia who has been receiving a monthly injection of cyanocobalamin (vitamin B12). Before administering the injection, the nurse evaluates the effects of the medication and determines that a therapeutic effect is occurring if the client makes which statement? 1. "I feel really lightheaded." 2. "I no longer have any nausea." 3. "I have not had any pain in a month." 4. "I feel stronger and have a much better appetite."

4. "I feel stronger and have a much better appetite." Rationale: Cyanocobalamin is essential for DNA synthesis. It can take up to 3 years for the vitamin B12 stores to be depleted and for symptoms of pernicious anemia to appear. Symptoms can include weakness, fatigue, anorexia, loss of taste, and diarrhea. To correct deficiencies, a crystalline form of vitamin B12, cyanocobalamin, can be given intramuscularly.

A client has received a transfusion of platelets. The nurse evaluates that the client is benefiting most from this therapy if the client exhibits which finding? 1. Increased hematocrit level 2. Increased hemoglobin level 3. Decline of elevated temperature to normal 4. Decreased oozing of blood from puncture sites and gums

4. Decreased oozing of blood from puncture sites and gums Rationale: Platelets are necessary for proper blood clotting. The client with insufficient platelets may exhibit frank bleeding or oozing of blood from puncture sites, wounds, and mucous membranes. Increased hemoglobin and hematocrit levels would occur when the client has received a transfusion of red blood cells. An elevated temperature would decline to normal after infusion of granulocytes if those cells were instrumental in fighting infection in the body. Page 895-896 in IGGY

A client who was diagnosed with toxic shock syndrome (TSS) now exhibits petechiae, oozing from puncture sites, and coolness of the digits of the hands and feet. Clotting times determined for this client are prolonged. The nurse interprets these clinical signs as being most compatible with which condition? 1. Heparin overdose 2. Vitamin K deficiency 3. Factor VIII deficiency 4. Disseminated intravascular coagulopathy (DIC)

4. Disseminated intravascular coagulopathy (DIC) Rationale: TSS is caused by infection and often is associated with tampon use. The client's clinical signs in this question are compatible with DIC, which is a complication of TSS. The nurse assesses the client at risk and notifies the health care provider promptly when signs and symptoms of DIC are noted. Page 1614-1615

A client brought to the emergency department states that he has accidentally been taking two times his prescribed dose of warfarin (Coumadin) for the past week. After noting that the client has no evidence of obvious bleeding, the nurse plans to take which action? 1. Prepare to administer an antidote. 2. Draw a sample for type and crossmatch and transfuse the client. 3. Draw a sample for an activated partial thromboplastin time (aPTT) level. 4. Draw a sample for prothrombin time (PT) and international normalized ratio (INR).

4. Draw a sample for prothrombin time (PT) and international normalized ratio (INR). Rationale: The next action is to draw a sample for PT and INR level to determine the client's anticoagulation status and risk for bleeding. These results will provide information as to how to best treat this client (e.g., if an antidote such as vitamin K or a blood transfusion is needed). The aPTT monitors the effects of heparin therapy. Page 674 and 676-677 in Kee and Hayes

A client with leukemia is receiving busulfan (Myleran) and allopurinol (Zyloprim). The nurse should tell the client that the purpose of the allopurinol is to prevent which symptom? 1. Nausea 2. Alopecia 3. Vomiting 4. Hyperuricemia

4. Hyperuricemia Rationale: Allopurinol decreases uric acid production and reduces uric acid concentrations in serum and urine. In the client receiving chemotherapy, uric acid levels increase as a result of the massive cell destruction that occurs because of the chemotherapy. This medication prevents or treats hyperuricemia caused by chemotherapy.

A nursing student is assigned to an adult client who is scheduled for bone marrow aspiration. The coassigned nurse asks the nursing student about the possible sites that could be used for obtaining the bone marrow. The student demonstrates understanding of the procedure by identifying what as the correct aspiration site? 1. Ribs 2. Femur 3. Scapula 4. Iliac crest

4. Iliac crest Rationale: The most common sites for bone marrow aspiration in the adult are the iliac crest and the sternum. These areas are rich in bone marrow and are easily accessible for testing. Page 867 in IGGY

A client is receiving a continuous intravenous infusion of heparin sodium to treat deep vein thrombosis. The client's activated partial thromboplastin (aPTT) time is 65 seconds. The nurse anticipates that which action is needed? 1. Discontinuing the heparin infusion 2. Increasing the rate of the heparin infusion 3. Decreasing the rate of the heparin infusion 4. Leaving the rate of the heparin infusion as is

4. Leaving the rate of the heparin infusion as is Rationale: The normal aPTT varies between 30 and 40 seconds, depending on the type of activator used in testing. The therapeutic dose of heparin for treatment of deep vein thrombosis is to keep the aPTT between 1.5 and 2.5 times normal. This means that the client's value should not be less than 45 seconds or greater than 100 seconds. Thus the client's aPTT is within the therapeutic range and the dose should remain unchanged. Page 249 in IGGY

A client is diagnosed with multiple myeloma and the client asks the nurse about the diagnosis. The nurse bases the response on which description of this disorder? 1. Altered red blood cell production 2. Altered production of lymph nodes 3. Malignant exacerbation in the number of leukocytes 4. Malignant proliferation of plasma cells within the bone

4. Malignant proliferation of plasma cells within the bone Rationale: Multiple myeloma is a B-cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow Page 894 in IGGY

A client with a history of gastrointestinal bleeding has a platelet count of 300,000 cells/mm3. The nurse should take which action after seeing the laboratory results? 1. Report the abnormally low count. 2. Report the abnormally high count. 3. Place the client on bleeding precautions. 4. Place the normal report in the client's medical record.

4. Place the normal report in the client's medical record. Rationale: A normal platelet count ranges from 150,000 to 400,000 cells/mm3. The nurse should place the report containing the normal laboratory value in the client's medical record.

The nurse is preparing to administer filgrastim (Neupogen) to a client with a diagnosis of agranulocytosis. The client asks the nurse about the purpose of the medication. The nurse explains that this medication will have which action? 1. Prevent bleeding. 2. Prolong the clotting time. 3. Increase the red blood cell count. 4. Promote the growth of neutrophils.

4. Promote the growth of neutrophils. Rationale: Filgrastim is a granulocyte colony-stimulating factor produced by human recombinant DNA. It is administered to clients with agranulocytosis to promote the growth of neutrophils and enhance the function of mature neutrophils.

A client with liver dysfunction has low serum levels of fibrinogen and a prolonged prothrombin time (PT). Based on these findings, which actions should the nurse plan to promote the client's safety? Select all that apply. 1. Monitor serum potassium levels. 2. Weigh client daily, and monitor trends. 3. Monitor for symptoms of fluid retention. 4. Provide the client with a soft toothbrush. 5. Instruct the client to use an electric razor. 6. Monitor all secretions for frank or occult blood.

4. Provide the client with a soft toothbrush. 5. Instruct the client to use an electric razor. 6. Monitor all secretions for frank or occult blood. Rationale: Fibrinogen is produced by the liver and is necessary for normal clotting. A client who has insufficient levels is at risk for bleeding. The prothrombin time is prolonged when one or more of the clotting factors (II, V, VII, or X) is deficient, so the client's risk for bleeding is also increased. Page 856 and 859-860 in IGGY

The nurse is performing an assessment on a client with a diagnosis of pernicious anemia. Which finding would the nurse expect to note in this client? 1. Dyspnea 2. Dusky mucous membranes 3. Shortness of breath on exertion 4. Red tongue that is smooth and sore

4. Red tongue that is smooth and sore Rationale: Classic signs of pernicious anemia include weakness, mild diarrhea, and smooth, sore, red tongue. The client also may have nervous system signs and symptoms such as paresthesias, difficulty with balance, and occasional confusion. Page 877