Med Surg blood disorders
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. What is the most important action for the nurse to take?
Consult with the physician about discontinuing heparin
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 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."
A client with leukemia is being discharged from the hospital to hospice care. Which statement by the client indicates the client is not appropriately dealing with spiritual distress?
"I do not understand why this happened to me."
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."
Which statement indicates the client understands teaching about induction therapy for leukemia?
"I will be in the hospital for several weeks."
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 a diagnosis of thrombocytopenia has been admitted to your unit for IV corticosteroid treatment. As the nurse caring for this client, you would expect the physician's orders to include which of the following?
A tapering course of solumedrol at discharge
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 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 cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets?
Myeloid stem cell
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
Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets?
Pancytopenia
The nurse is discussing disorders of the hematopoietic system when a client asked about erythrocytosis. What disease will the nurse mention with a primary characteristic of erythrocytosis?
Polythacemia Vera
A young mother with a 2 year old and a 6 month old is experiencing fatigue related to anemia. The client states that she is having difficulty performing the activities needed for her job, family, and home. With what task is it most appropriate for the nurse to assist the client?
Prioritizing and balancing activities and rest
The nurse is assisting the client with multiple myeloma to ambulate. What is the most important nursing intervention to help prevent fractures in the client?
Promote safety.
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?
4:00
Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)?
A 72-year-old patient with a history of cancer
Which of the following is the most common hematologic condition affecting elderly patients
Anemia
Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process due to thrombocytopenia in a client with leukemia?
Applying prolonged pressure to needle sites or other sources of external bleeding
A 50-year-old woman was recently diagnosed with non-Hodgkin's lymphoma (NHL) and has begun a treatment regimen that includes simultaneous radiation therapy and chemotherapy. The combination of severe symptoms and aggressive therapy has necessitated admission to the hospital. When providing care for this patient, which of the following actions should the nurse implement?
Applying standard precautions conscientiously to reduce the patient's risk of infection
A client presents with peripheral neuropathy and hypoesthesia of the feet. What is the best nursing intervention?
Assess for signs of injury
A client with AML has pale mucous membranes and bruises on the legs. What is the primarynursing intervention?
Assess the client's hemoglobin and platelets
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
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 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
The nurse suspects that a client has multiple myeloma based on the client's major presenting symptom and the analysis of laboratory results. What classic symptom for multiple myeloma does the nurse assess for?
Bone pain in the back of the ribs
A client with acute myeloid leukemia (AML) receiving chemotherapy is treated for an acute renal injury. What is the nurse's best understanding of the pathophysiological reason behind the client's injury?
Chemotherapy causes an increase in kidney stone formation.
The nursing instructor is talking with their clinical group about coagulopathies. How should the instructor define coagulopathies?
Coagulopathies are bleeding disorders that involve platelets or clotting factors.
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? Select all that apply.
Confusion is often greater than in younger clients. Fatigue is often greater than in younger clients. Heart rate does not increase as much as in younger clients.
A patient with end-stage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia?
Creatinine level of 6 mg/100 mL
A nurse reviews the laboratory results of a client with polycythemia vera. Which findings will the nurse find? Select all that apply.
Decreased erythropoietin Increased hemoglobin
A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor?
Decreased level of erythropoietin
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 Medication use Ethnicity Herbal supplements
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
A thin client is prescribed iron dextran intramuscularly. What is most important action taken by the nurse when administering this medication?
Employs the Z-track technique
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
A client with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this client?
Erythropoietin
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 client who is being treated for AML has bruises on both legs. What is the nurse's mostappropriate action?
Evaluate the client's platelet count
A patient with acute myeloid leukemia (AML) is having hematopoietic stem cell transplantation (HSCT) with radiation therapy. In which complication do the donor's lymphocytes recognize the patient's body as foreign and set up reactions to attack the foreign host?
Graft-versus-host disease
A patient with End Stage Kidney Disease 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 client is scheduled for surgery to remove an abdominal mass. The nurse knows that which reason hemodilution would be contraindicated as a method to provide blood to the client during the surgery?
History of renal disease
A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see?
Hypercalcemia
Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents?
Hypochromic
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 mostappropriate for this client?
Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit
The client's CBC with differential reveals small-shaped hemoglobin molecules. The nurse expects to administer which medication to this client?
Iron
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
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 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?
It may indicate deficiencies in essential nutrients
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
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
Which term refers to a form of white blood cell involved in immune response?
Lymphocyte
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
The nurse cares for an older adult client with unprovoked back pain and increased serum protein. Which hematologic neoplasm does the nurse suspect the client has?
Multiple myeloma
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?
Neutrophil
What assessment finding best indicates that the client has recovered from induction therapy?
Neutrophil and platelet counts within normal limits
The nurse, caring for a client in the emergency room with a severe nosebleed, becomes concerned when the client asks for a bedpan. The nurse documents the stool as loose, tarry, and black looking. The nurse suspects the client may have thrombocytopenia. What should be the nurse's priority action?
Notify the physician
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
The hospitalized client is experiencing gastrointestinal bleeding with a platelets at 9,000/mm³. The client is receiving prednisone and azathioprine. What action will the nurse take?
Perform a neurologic assessment with vital signs.
The nurse is caring for a client who is developing hypovolemic shock from a duodenal ulcer bleed. What is the first intervention the nurse can provide to facilitate blood flow to the brain?
Place the client in a modified Trendelenburg position
A patient with a diagnosis of immune thrombocytopenic purpura (ITP) is currently receiving IVIG for the treatment of her health condition. The nurse who is providing this patient's care is aware that ITP is a consequence of:
Platelet destruction and impaired platelet production resulting from an autoimmune process
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 screening donors for blood donation. Which client is an acceptable donor for blood?
Reports having a cold 1 month ago that resolved quickly
A pregnant woman is hospitalized as the result of sickle-cell crisis. Which finding indicates the outcome has been achieved for this client?
Reports joint pain less than 3 on a scale of 0 to 10
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
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 client at the clinic has just been diagnosed with iron deficiency anemia. What would you recommend the client consume to promote the absorption of iron?
Rich sources of vitamin C
A nurse practitioner reviewed the blood work of a male client suspected of having microcytic anemia. The nurse suspected occult bleeding. Which laboratory result would indicate an initial stage of iron deficiency?
Serum ferritin: 15 ng/mL
A client is newly diagnosed with Hodgkin lymphoma. The nurse understands that the client's treatment will be based on what concept?
Staging of disease
Which term is used to refer to a primitive cell that is capable of self-replication and differentiation?
Stem cell
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 primaryaction?
Stop the infusion
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.
Which type of lymphocyte is responsible for cellular immunity?
T lymphocyte
The health care provider believes that the client has a deficiency in the leukocyte responsible for cell-mediated immunity. What should the nurse check the WBC count for?
T lymphocytes
A client is prescribed 325 mg/day of oral ferrous sulfate. What does the nurse include in client teaching?
Take 1 hour before breakfast
The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma?
The client with enlarged lymph nodes in the neck
When teaching about the advantages of autologous blood transfusion to a client, the nurse should include which information? Select all that apply.
The primary advantage is prevention of viral infections. It is safer for clients with a history of transfusion reactions. If not needed immediately, the blood can be frozen for future use.
A client is treated for anemia. What is the nurse's best understanding about the correlation between anemia and the client's iron stores?
There is a strong correlation between iron stores and hemoglobin levels
Which statement best describes the function of stem cells in the bone marrow?
They produce all blood cells.
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
Which is a symptom of hemochromatosis?
bronzing of the skin
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 nurse is assessing a client with multiple myeloma. Due to this condition, what will this client be at risk for?
pathologic bone fractures
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 nurse cares for clients with hematological disorders and notes that women are diagnosed with hemochromatosis at a much lower rate than men. What is the primary reason for this?
Women lose iron through menstrual cycles
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 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