Med Surg - Chapter 40 - Care of Patients with Hematologic Problems

Which type of leukemia most commonly has its onset during adulthood? 1 Acute lymphocytic leukemia (ALL) 2 Acute myelogenous leukemia (AML) 3 Chronic lymphocytic leukemia (CLL) 4 Chronic myelogenous leukemia (CML)

2 Acute myelogenous leukemia (AML) AML is the most common form of adult-onset leukemia. ALL is the most common in children. CLL is the most common chronic form of adult leukemia. CML is a rarer form of adult leukemia.

Which symptom is a sign that the patient is experiencing circulatory overload when receiving a blood transfusion? 1 Fever 2 Confusion 3 Tachycardia 4 Hypotension

2 Confusion Signs of transfusion-associated circulatory overload include confusion, bounding pulse, distended jugular veins, dyspnea, and restlessness. Fever and tachycardia are signs of bacterial transfusion reactions, not circulatory overload. Hypertension, not hypotension, is a sign of circulatory overload.

A patient diagnosed with thrombotic thrombocytopenic purpura should be assessed for which complications? Select all that apply. 1 Septicemia 2 Renal failure 3 Myocardial infarction 4 Right-sided heart failure 5 Cerebrovascular accident

2 Renal failure 3 Myocardial infarction 5 Cerebrovascular accident Renal failure, myocardial infarction, and cerebrovascular accidents occur from tissue ischemia resulting from platelet aggregation and clotting. Septicemia and right-sided heart failure are not complications of thrombotic thrombocytopenic purpura.

Which laboratory value indicates hemophilia? 1 Increased platelet count 2 Decreased platelet count 3 Increased partial thromboplastin time 4 Increased time for platelet plug formation

3 Increased partial thromboplastin time Abnormal partial thromboplastin time (aPTT) indicates the time needed for clotting. Thus an increased partial thromboplastin time is an indicator hemophilia. Increased platelet count indicates thrombocytosis. A decreased platelet count indicates thrombocytopenia. Increased time taken for platelet plug formation indicates a platelet disorder.

Which transfusion procedure often causes transfusion-induced reactions like fever and chills? 1 Plasma transfusion 2 Single donor platelet transfusion 3 Pooled donor platelet transfusion 4 Washed red blood cell transfusion

3 Pooled donor platelet transfusion Pooled donor platelet transfusions can cause fever and chills if the patient undergoing platelet transfusion has any history of platelet transfusion reactions. Plasma transfusions, washed red blood cell transfusion, and single donor platelet transfusion do not often cause fever and chills.

Which blood component is responsible for providing immunity? 1 Red blood cells 2 Platelets 3 White blood cells 4 Albumin

3 White blood cells White blood cells (WBCs) are responsible for providing immunity and starting the inflammatory response. Red blood cells (RBCs) carry oxygen and carbon dioxide and are responsible for gas exchange in the capillaries. Platelets are important for blood clotting. Albumin is a plasma protein and helps maintain oncotic pressure in the vascular compartment.

The nurse is teaching a patient with newly diagnosed anemia about conserving energy. What should the nurse tell the patient? Select all that apply. 1 "Provide yourself with four to six small, easy-to-eat meals daily." 2 "Perform your care activities in groups to conserve your energy." 3 "Stop activity when shortness of breath or palpitations are present." 4 "Allow others to perform your care during periods of extreme fatigue." 5 "Drink small quantities of protein shakes and nutritional supplements daily." 6 "Perform a complete bath daily to reduce your chance of getting an infection."

1 "Provide yourself with four to six small, easy-to-eat meals daily." 3 "Stop activity when shortness of breath or palpitations are present." 4 "Allow others to perform your care during periods of extreme fatigue." 5 "Drink small quantities of protein shakes and nutritional supplements daily." It is critical to have others help the anemic patient who extremely tired. Although it may be difficult for him or her to ask for help, this practice should be stressed to the patient. Drinking small protein or nutritional supplements will help rebuild the patient's nutritional status. Having four to six small meals daily is preferred over three large meals; this practice conserves the body's expenditure of energy used in digestion and assimilation of nutrients. Stopping activities when strain on the cardiac or respiratory system is noted is critical. A complete bath should be performed only every other day; on days in between, the patient can be taught to take a "mini" sponge bath, which will conserve energy and still be safe in preventing the risks for infection. Care activities should be spaced every hour or so rather than in groups to conserve energy; the time just before and after meals should be avoided.

A registered nurse (RN) from pediatrics has "floated" to the medical-surgical unit. Which patient should be assigned to the float nurse? 1 42-year-old with sickle cell disease receiving a transfusion of packed red blood cells 2 50-year-old with pancytopenia needing assessment of risk factors for aplastic anemia 3 55-year-old with folic acid deficiency anemia caused by alcohol abuse who needs counseling 4 60-year-old with newly diagnosed polycythemia vera who needs teaching about the disease

1 42-year-old with sickle cell disease receiving a transfusion of packed red blood cells Because sickle cell disease is commonly diagnosed during childhood, the pediatric nurse will be familiar with the disease and with red blood cell transfusion; therefore he or she should be assigned to the patient with sickle cell disease. Aplastic anemia, folic acid deficiency, and polycythemia vera are problems more commonly seen in adult patients who should be cared for by nurses who are more experienced in caring for adults.

Which condition is contraindicated for acute normovolemic hemodilution autologous blood transfusion therapy? 1 Anemia 2 Obesity 3 Liver failure 4 Cardiac failure

1 Anemia Acute normovolemic hemodilution is a type of autologous blood transfusion therapy. This therapy involves the withdrawal of a patient's red blood cells and volume replacement just before a surgical procedure. This type of autologous transfusion is not used with anemia. Obese and cardiac failure patients can receive this therapy to avoid the risk of transfusion reactions. Liver failure patients are not contraindicated with this therapy.

A diagnosis of autoimmune thrombocytopenic purpura is made after detection of what finding in the blood? 1 Antiplatelet antibodies 2 Elevated platelet counts 3 Elevated red blood cells 4 Low hemoglobin and hematocrit

1 Antiplatelet antibodies Antiplatelet antibodies are consistent with the autoimmune form of thrombocytopenic purpura. Platelet counts would not be elevated. Red blood cell counts would not be diagnostic for thrombocytopenic purpura. Low hemoglobin and hematocrit may occur, but they are not diagnostic for thrombocytopenic purpura.

The nurse is caring for a female patient who has been receiving prophylactic heparin following surgery 10 days ago. The patient has swelling and tenderness in the right leg, and laboratory results show low platelets. What drugs are most likely to be prescribed for this patient? Select all that apply. 1 Argatroban (Acova) 2 Rituximab (Rituxan) 3 Lepirudin (Refludan) 4 Carfilzomib (Kyprolis) 5 Azathioprine (Imuran) 6 Bortezomib (Velcade)

1 Argatroban (Acova) 3 Lepirudin (Refludan) Swelling and tenderness in the legs, along with low platelets, are signs of deep vein thrombosis (DVT). For the postsurgical female patient who received heparin for more than one week and presents with DVT, heparin-induced thrombocytopenia is the likely diagnosis. Drug management for HIT is with a direct thrombin inhibitor such as argatroban (Acova) and lepirudin (Refludan). Azathioprine (Imuran) and rituximab (Rituxan) are corticosteroids used to inhibit production of antiplatelet autoantibodies in idiopathic thrombocytopenic purpura (ITP). Carfilzomib (Kyprolis) and bortezomib (Velcade) are protease inhibitors used to treat multiple myeloma.

A 56-year-old patient admitted with a diagnosis of acute myelogenous leukemia (AML) is prescribed intravenous cytosine arabinoside for 7 days and an infusion of daunorubicin for the first 3 days. An infection develops. What knowledge does the nurse use to determine that the appropriate antibiotic has been prescribed for this patient? 1 Checking the culture and sensitivity test results 2 Evaluating the patient's white blood cell (WBC) count level 3 Evaluating the patient's liver function tests (LFTs) and serum creatinine levels 4 Recognizing that vancomycin is the drug of choice used to treat all infections in patients with AML

1 Checking the culture and sensitivity test results Checking the culture and sensitivity test results to be certain that the requested antibiotic is effective against the organism causing the infection is the best action to take. Drug therapy is the main defense against infections that develop in patients undergoing therapy for AML. Agents used depend on the patient's sensitivity to various antibiotics for the organism causing the infection. Although LFTs and kidney function tests may be influenced by antibiotics, these tests do not determine the effectiveness of the antibiotic. Although the WBC count is elevated in infection, this test does not influence which antibiotic will be effective in fighting the infection. Vancomycin may not be effective in all infections; culturing of the infection site and determining the organism's sensitivity to a cohort of drugs are needed, which will provide data on drugs that are capable of eradicating the infection in this patient.

Which signs are neurologic manifestations of acute leukemia? Select all that apply. 1 Fever 2 Fatigue 3 Headache 4 Hematuria 5 Ecchymoses

1 Fever 2 Fatigue 3 Headache Fever, fatigue, and headache are neurologic manifestations of acute leukemia. Hematuria is a renal manifestation of acute leukemia. Ecchymoses is an integumentary manifestation of acute leukemia.

The nurse is caring for a patient with sickle cell disease (SCD). Which action is most effective in reducing the potential for sepsis in this patient? 1 Frequent and thorough handwashing 2 Administering prophylactic drug therapy 3 Taking vital signs every 4 hours, day and night 4 Monitoring laboratory values to look for abnormalities

1 Frequent and thorough handwashing Prevention and early detection strategies are used to protect the patient in sickle cell crisis from infection. Frequent and thorough handwashing is of the utmost importance. Drug therapy is a major defense against infections that develop in the patient with sickle cell disease, but is not the most effective way that the nurse can reduce the potential for sepsis. Continually assessing the patient for infection and monitoring the daily complete blood count (CBC) with differential white blood cell (WBC) count is early detection, not prevention. Taking vital signs every 4 hours will help with early detection of infection, but is not prevention.

Which clotting disorder may be caused by X-linked inheritance? 1 Hemophilia A 2 Hemophilia C 3 Von Willebrand disease 4 Heparin-induced thrombocytopenia

1 Hemophilia A Hemophilia A, a deficiency of factor IX, shows X-linked recessive pattern of inheritance. Hemophilia C is a deficiency of factor XI that is an autosomal pattern of inheritance involving lack of functional clotting factor XI. Von Willebrand disease is caused by the presence of an abnormal gene. Heparin-induced thrombocytopenia is a clotting disorder involving an unexplained drop in platelet count after heparin treatment.

Which intravenous solution is compatible for administration with blood products? 1 Normal saline 2 Lactated Ringer's 3 Dextrose in water 4 Dextrose solution

1 Normal saline Normal saline solution is compatible and can be used as a solution for administration with blood products. Solutions such as lactated Ringer's, dextrose in water, and dextrose solution are not compatible with blood products because they may cause clotting or hemolysis of blood cells.

The nurse knows that a patient with a B-negative blood type can receive which blood product? 1 O-negative 2 A-negative 3 AB-positive 4 B-positive

1 O-negative A patient with B-negative blood can receive either type B-negative or type O-negative blood. A patient with a negative Rh factor must also receive blood with a negative Rh factor due to the potential for an infusion reaction to the Rh antigen. Receiving either A-negative or AB-positive puts the patient at risk for a reaction because the patient has antibodies against the A antigen. Receiving B-positive blood puts the patient at risk for an infusion reaction to the Rh factor.

The nurse is caring for a patient diagnosed with idiopathic thrombocytopenic purpura (ITP). What manifestations of this diagnosis should the patient be assessed for? Select all that apply. 1 Petechiae 2 Ecchymosis 3 Hypotension 4 Abdominal pain 5 Mucosal bleeding

1 Petechiae 2 Ecchymosis 5 Mucosal bleeding Petechiae, ecchymosis, and mucosal bleeding are manifestations of idiopathic thrombocytopenic purpura (ITP). Hypotension and abdominal pain are not common findings in ITP.

Which type of transfusion is preferred to replace blood volume and clotting factors? 1 Plasma transfusions 2 Platelet transfusions 3 White blood cell transfusions 4 Red blood cell (RBC) transfusions

1 Plasma transfusions Plasma transfusions are given to replace blood volume and clotting factors because these contain the clotting factors that promote coagulation. Patients suffering from platelet disorders may receive a platelet transfusion. Patients with problems that destroy RBCs or impair RBC maturation may require RBC transfusions. Patients who have sepsis or neutropenic infection may require white blood cell transfusions.

Which type of transfusion therapy may be safe even if the ABO factors are incompatible? 1 Pooled platelets 2 Fresh frozen plasma 3 Packed red blood cells 4 Washed red blood cells

1 Pooled platelets ABO compatibility is not necessary during platelet transfusions because platelets do not contain antigens that can evoke an antigen-antibody reaction. Transfusions of packed red blood cells (RBCs) and washed RBCs require ABO compatibility determination. Fresh frozen plasma contains the donor's ABO antibodies, which could react with the recipient's RBC antigens.

The nurse is caring for a patient who is in sickle cell crisis. Which nursing action is a priority? 1 Provide pain medications as needed. 2 Apply cool compresses to the patient's forehead. 3 Increase food sources of iron in the patient's diet. 4 Encourage the patient's use of two methods of birth control.

1 Provide pain medications as needed. Analgesics are needed to treat sickle cell pain. The nurse would provide pain medications as needed. Cool compresses do not help the patient in sickle cell crisis. Warm soaks or compresses can help reduce pain perception. Increasing iron in the diet and discussing birth control are not priorities for the patient in sickle cell crisis.

Which patient is at increased risk for development of hemophilia? 1 The son of the woman who is a carrier 2 The son of the father who has hemophilia 3 The daughter of a woman who is a carrier 4 The daughter of a father who has hemophilia

1 The son of the woman who is a carrier Hemophilia is an X-linked recessive trait; therefore the son of a mother who is a carrier is more likely to develop hemophilia. The son of a father with hemophilia will not develop hemophilia. The daughter of a mother who is a carrier may also be a carrier. The daughter of the father with hemophilia will be a carrier.

The nurse educator is teaching a nursing student about the transfusion of blood products. Which statement made by the student nurse regarding the transfusion of red blood cells indicates effective learning? 1 "Do not administer any other solution with the blood product." 2 "Red blood cell transfusions should be completed within 4 hours of removal from refrigeration." 3 "Increasing the speed of administration during the first 15 minutes of the transfusion is necessary." 4 "Once the blood product has been released from the blood bank, it should be immediately transfused into the recipient's body within a few seconds."

2 "Red blood cell transfusions should be completed within 4 hours of removal from refrigeration." Red blood cell transfusions should be performed within 4 hours of after removal from the refrigeration. If the transfusion time extends longer than four hours, it may lead to infections in the recipient. Hemolytic reaction may occur if saline is not administered with the blood product. Increasing the rate of administration of the drug may lead to fluid overload. After the blood product is released from the blood bank, it must be transfused within 4 hours, not immediately.

A patient with anemia is prescribed a transfusion of packed red blood cells (PRBCs) to be administered over 4 hours. What is the approximate volume to be transfused? 1 100 to 150 mL 2 200 to 250 mL 3 300 to 350 mL 4 400 to 450 mL

2 200 to 250 mL Anemia is usually treated by administering 200 mL (200 - 250 mL) of packed red blood cells over 4 hours. A volume of 100 to 150 mL is below the range of the required volume of 200 to 250 mL and may not be sufficient for the patient to recover. A volume of 300 mL or higher is above the required range.

A nurse is counseling a patient who wishes to donate blood for autologous use during surgery. The nurse advises the patient that the blood can be stored for how long? 1 30 days 2 40 days 3 50 days 4 60 days

2 40 days A patient who is donating blood for autologous use during or after surgery should be advised that this blood can be stored for up to 40 days. The blood is collected after multiple donations, divided into its component parts, and stored for later use. If the patient has a rare blood type, the blood can be frozen for up to 10 years. Discarding blood after 30 days is not appropriate because the blood can still be used for the patient. Blood can not be used 50 or 60 days after donation.

The nurse assesses the patient with which hematologic problem first? 1 32-year-old with pernicious anemia who needs a vitamin B 12 injection 2 81-year-old with thrombocytopenia and an increase in abdominal girth 3 67-year-old with acute myelocytic leukemia with petechiae on both legs 4 40-year-old with iron deficiency anemia who needs a Z-track iron injection

2 81-year-old with thrombocytopenia and an increase in abdominal girth An increase in abdominal girth in a patient with thrombocytopenia indicates possible hemorrhage; this warrants further assessment immediately. The 32-year-old with pernicious anemia, the 40-year-old with iron deficiency anemia, and the 67-year-old with acute myelocytic leukemia do not indicate any acute complications, so the nurse can assess them after assessing the patient with thrombocytopenia.

A patient develops urticaria, itching, bronchospasm, and anaphylaxis 24 hours after a blood transfusion therapy. What could be the possible reason behind this? 1 Febrile transfusion reactions 2 Allergic transfusion reactions 3 Hemolytic transfusion reactions 4 Acute pain transfusion reactions

2 Allergic transfusion reactions Allergic reactions usually occur during or up to 24 hours after a transfusion. The common manifestations include utricaria, itching, bronchospasm, or anaphylaxis. Febrile transfusion reactions are characterized by the formation of anti-white blood cell antibodies. Hemolytic transfusion reactions are characterized by dissemination intravascular coagulation and circulatory collapse. Acute pain transfusion reactions are manifested as severe chest pain, back pain, joint pain, hypertension, and redness.

A patient who has undergone bone marrow transplantation 21 days prior is receiving growth factors. The patient's blood test reveals mixed chimerism with a greater percentage of donor cells than 1 week prior. How does the nurse interpret this result? 1 Graft failure seems likely. 2 Engraftment appears to be successful. 3 The patient should have 100% donor cells. 4 The patient will probably need an increased dose of growth factor.

2 Engraftment appears to be successful. Patients who undergo bone marrow transplantation can expect engraftment to occur 12 to 28 days after the transplant. Progressive chimerism (presence of donor cells) indicates engraftment; graft failure would be indicated by regressive chimerism. It is not necessarily expected for the patient to have 100% donor cells this early after transplant, and there is no indication for increasing growth factor.

What laboratory reports should be used to assess a patient diagnosed with idiopathic thrombocytopenic purpura who is symptomatic? Select all that apply. 1 Potassium 2 Hematocrit 3 Hemoglobin 4 Magnesium 5 White blood cell count

2 Hematocrit 3 Hemoglobin Hemoglobin and hematocrit may be low in a patient with symptomatic idiopathic thrombocytopenic purpura. Potassium and magnesium are not related to the diagnosis of ITP. White blood cell count is not indicated.

A patient with a large, painless lymph node has a biopsy that reveals Reed-Sternberg cells. Which form of cancer does this finding indicate? 1 Multiple myeloma 2 Hodgkin's lymphoma 3 Non-Hodgkin's lymphoma 4 Acute myelogenous leukemia

2 Hodgkin's lymphoma Reed-Sternberg cells are indicative of Hodgkin's lymphoma. Acute myelogenous leukemia is characterized by atypical blood cells. A diagnosis of multiple myeloma begins with a positive finding of a serum monoclonal protein in the blood. Non-Hodgkin's lymphoma includes all lymphoid cancers that do not have the Reed-Sternberg cell.

A nurse is caring for a patient with a gastrointestinal (GI) bleed and a history of thrombocytopenia. The physician orders a transfusion. The nurse prepares for which type of transfusion? 1 Plasma 2 Platelets 3 White blood cells (WBCs) 4 Packed red blood cells (PRBCs)

2 Platelets Platelet transfusions are indicated for patients with thrombocytopenia who are actively bleeding. A WBC transfusion is rarely used but is indicated for neutropenic patients with active infections. PRBC is transfused when a patient is actively bleeding. However, this patient also has a deficiency of platelets due to the history of thrombocytopenia, which would require replacement of platelets. Plasma transfusions are usually administered to replace blood volume and clotting factors.

The nurse is caring for a patient with multiple sclerosis who presents with a petechial rash on the upper chest and neck. Laboratory results show low platelets, hemoglobin, and hematocrit, as well as high megakaryocytes in the bone marrow. What drugs are most likely to be prescribed for this patient? Select all that apply. 1 Argatroban (Acova) 2 Rituximab (Rituxan) 3 Lepirudin (Refludan) 4 Azathioprine (Imuran) 5 Carfilzomib (Kyprolis) 6 Bortezomib (Velcade)

2 Rituximab (Rituxan) 4 Azathioprine (Imuran) A petechial rash with low platelets, hemoglobin, and hematocrit and high megakaryocytes in bone marrow, along with the presence of another autoimmune disease like multiple sclerosis, indicate idiopathic thrombocytopenic purpura (ITP). Azathioprine (Imuran) and rituximab (Rituxan) are corticosteroids used to inhibit production of antiplatelet autoantibodies in ITP. Drug management for heparin-induced thrombocytopenia is with a direct thrombin inhibitor such as argatroban (Acova) and lepirudin (Refludan). Carfilzomib (Kyprolis) and bortezomib (Velcade) are protease inhibitors used to treat multiple myeloma.

Why is filtered tubing used during infusion of blood products? 1 To reduce hemolysis 2 To remove aggregates 3 To prevent fluid overload 4 To avoid blood borne pathogens

2 To remove aggregates Filtered tubing is used during the administration of blood product to remove aggregates and possible contaminants during the infusion. Hemolysis is prevented by diluting the blood products with normal saline only. Fluid overload is prevented by maintaining an adequate infusion rate if signs of fluid volume overload are present. Bloodborne pathogens are prevented by proper handling of the equipment.

A patient recently diagnosed with polycythemia vera (PV) has a serum hemoglobin of 20 g/dL, elevated leukocytes and platelets, a purplish flushed appearance, and reports intense itching. A family member asks the nurse if the patient will get better. How does the nurse respond? 1 "This is a temporary and easily treatable condition." 2 "Most people with this disease will die within 2 years." 3 "With aggressive management, people can live for over 10 years." 4 "Because these symptoms are severe, this episode will probably be fatal."

3 "With aggressive management, people can live for over 10 years." PV is a type of cancer of the red blood cells. With aggressive treatment, patients can live for 10 to 15 years. Without treatment, most patients die within 2 years. PV is not a temporary condition and requires aggressive treatment. Because these symptoms are severe, this episode will probably be fatal is not a true statement.

A patient with multiple myeloma reports bone pain that is unrelieved by analgesics. How does the nurse respond to this patient's problem? 1 "Ask your doctor to prescribe more medication." 2 "I'll turn on some soothing classical music for you." 3 "Would you like to try some relaxation techniques?" 4 "It is too soon for additional medication to be given."

3 "Would you like to try some relaxation techniques?" Because most patients with multiple myeloma have local or generalized bone pain, analgesics and alternative approaches for pain management, such as relaxation techniques, are used for pain relief. This also offers the patient a choice. Before prescribing additional medication, other avenues should be explored to relieve this patient's pain. Even if it is too soon to give additional medication, telling that to the patient is not helpful because it dismisses the patient's pain concerns. Although music therapy can be helpful, this response does not give the patient a choice.

Which laboratory parameter helps to differentiate between classic hemophilia and Christmas disease? 1 Platelet count 2 Prothrombin time 3 Coagulation factor 4 Partial prothromboplastin time

3 Coagulation factor Lack of factor VII causes hemophilia A and lack of factor XI causes hemophilia B; thus the coagulation factor can be used to differentiate between classic hemophilia and Christmas disease. The difference in the platelet count indicates thrombocytopenia. Platelet count would not be beneficial in the differentiation of hemophilia and Christmas disease. Prothrombin time is tested in a patient who has symptoms of bleeding disorders. Partial prothromboplastin time indicates a deficiency of one or more of the coagulation factors in the patient's plasma but would not differentiate between hemophilia and Christmas disease.

A patient presents to the emergency department with a new onset of bruising and a petechial rash around the upper chest and arms. The patient's lab demonstrates a platelet count of 51,000 platelets per milliliter. What action by the nurse is most appropriate? 1 Administer corticosteroids 2 Plan for bone marrow aspiration 3 Implement bleeding precautions 4 Examine the patient's history for recent virus

3 Implement bleeding precautions Implementing bleeding precautions is priority for a patient with new bruising, petechial rash, and a platelet count of 51,000 per mL. Administering corticosteroids is not indicated because the platelet count is above 50,000. Bone marrow aspiration may be done, but it is not a priority. It is important to examine the patient's history for recent virus; however, implementing bleeding precautions is the priority.

In caring for a patient with sickle cell disease, what does the nurse suggest can help with preventing future sickle cell crises? 1 Pap smear 2 Colonoscopy 3 Influenza vaccine 4 Testicular examination

3 Influenza vaccine Influenza and pneumococcal vaccines will prevent infections, which often precipitate sickle cell crisis. Cancer screenings such as Pap smear, colonoscopy, and testicular exam are important in all individuals; however, influenza and pneumonia are common and easily preventable.

What symptom is priority for the nurse to assess for in a patient diagnosed with hemophilia A? 1 Confusion 2 Chest pain 3 Joint swelling 4 Renal function tests

3 Joint swelling Joint swelling in a patient with hemophilia A is an indication of bleeding in the joints, which should be addressed immediately. Confusion is not as important as assessing for joint swelling. Chest pain is not a common finding with hemophilia. Renal function tests are not indicated.

What findings are consistent with a diagnosis of hemophilia? Select all that apply. 1 Renal failure 2 Platelet clumping 3 Long-term joint problems 4 Tendency to bruise easily 5 Excessive bleeding from minor cuts

3 Long-term joint problems 4 Tendency to bruise easily 5 Excessive bleeding from minor cuts Patients with hemophilia have a tendency to bruise easily, have excessive bleeding from minor cuts, and may have long-term joint problems due to bleeding in the joint spaces. Renal failure and platelet clumping are not associated with hemophilia.

What clinical manifestation is associated with hemolytic transfusion reactions? 1 Vomiting 2 Anorexia 3 Low back pain 4 Thrombocytopenia

3 Low back pain Low back pain is the clinical manifestation associated with hemolytic transfusion reactions. Anorexia, vomiting, and thrombocytopenia are associated with transfusion-associated graft-versus-host disease.

What is a possible complication if a filtered, straight, long tubing with a 19-gauge needle is used to transfuse pooled platelets? 1 Hemolysis 2 Fluid overload 3 Occlusion of the lumen of tubing 4 Occlusion of the lumen of catheter

3 Occlusion of the lumen of tubing Platelet infusions should not be administered with the standard blood administration set because the filter traps the platelets. In addition, the longer tubing increases the blockage of the lumen of the tubing due to adherence of the platelets to the lumen. Hemolysis does not occur due to the administration set. An increase in the infusion rate can cause fluid overload in the patient. Occlusion of the lumen of catheter occurs due to decrease in the size of the needle.

A 32-year-old patient recovering from a sickle cell crisis is to be discharged. The nurse says, "You and all patients with sickle cell disease are at risk for infection because of your decreased spleen function. For this reason, you will most likely be prescribed an antibiotic before discharge." Which drug does the nurse anticipate the health care provider will request? 1 Cefaclor 2 Gentamicin 3 Penicillin V 4 Vancomycin

3 Penicillin V Prophylactic therapy with twice-daily oral penicillin reduces the incidence of pneumonia and other streptococcal infections and is the correct drug to use. It is a standard protocol for long-term prophylactic use in patients with sickle cell disease (SCD). Cefaclor and vancomycin are antibiotics more specific for short-term use and would be inappropriate for this patient. Gentamicin is a drug that can cause liver and kidney damage with long-term use.

What treatment does the nurse expect a patient diagnosed with hemophilia to receive? 1 Rituximab 2 Corticosteroids 3 Synthetic factor VIII 4 Packed red blood cells

3 Synthetic factor VIII Synthetic factor VIII is administered to replace the clotting factor missing in the patient with hemophilia. Rituximab and corticosteroids are indicated for patients with idiopathic thrombocytopenic purpura. Administration of red blood cells is not indicated.

The nurse is preparing to administer a bone marrow transplant using peripheral blood stem cells (PBSCs) to a patient with leukemia. Which action is necessary for safe administration of this product? 1 Stopping the infusion if the patient develops red urine 2 Infusing the bone marrow through a peripheral catheter 3 Thawing the peripheral blood stem cells prior to infusion 4 Using blood administration tubing to infuse the stem cells

3 Thawing the peripheral blood stem cells prior to infusion PBSCs are frozen and must be thawed prior to administration. PBSCs should be infused through the patient's central catheter. Red urine will occur secondary to the breakage of red blood cells in the infused stem cells and is not an indication for stopping the infusion. Blood administration tubing should not be used because stem cells can catch in the filter, resulting in fewer stem cells reaching the patient.

Which platelet disorder involves the failure of blood to clot after a trauma, in spite of having the ability to form blood clots? 1 Hemophilia 2 Heparin-induced thrombocytopenia 3 Thrombotic thrombocytopenic purpura 4 Autoimmune thrombocytopenic purpura

3 Thrombotic thrombocytopenic purpura In patients with thrombotic thrombocytopenic purpura, platelets clump together abnormally in the capillaries while few remain in circulation. Because few platelets are in circulation, the blood may not be able to form clots after trauma. Hemophilia is a genetic disorder caused by clotting factor deficiencies. Heparin-induced thrombocytopenia is an immunity-mediated clotting disorder that causes an unexplained drop in the platelet count. Autoimmune thrombocytopenic purpura causes the production of antibodies against one's own platelets.

What type of transfusion reaction is characterized by rapid onset of dyspnea and hypoxia within 6 hours of transfusion? 1 Hemolytic transfusion reactions 2 Acute pain transfusion reaction (APTR) 3 Transfusion-related acute lung injury (TRALI) 4 Transfusion-associated graft-versus-host disease (TA-GVHD)

3 Transfusion-related acute lung injury (TRALI) TRALIs are characterized by a rapid onset of dyspnea and hypoxia within 6 hours of the transfusion. This transfusion reaction occurs when donor blood contains antibodies against the recipient's neutrophil antigens, human leukocyte antigen, or both. Hemolytic transfusion reactions occur because of an ABO incompatibility. Apprehension, headache, chest pain, low back pain, tachycardia, and tachypnea are clinical manifestations of hemolytic transfusion reactions. APTR are manifested as severe chest pain, back pain, joint pain, hypertension, and redness of the head and neck. TA-GVHD occurs when the donors T-cell lymphocytes attack host tissue. Thrombocytopenia, anorexia, nausea, vomiting, chronic hepatitis, weight loss, and recurrent infection are symptoms of transfusion-related acute lung injury.

The nurse is teaching a patient who has just been diagnosed with polycythemia vera (PV) about long-term management of this disease. Which statement by the patient indicates a need for further teaching? 1 "I should drink at least 3 liters of fluid each day." 2 "I will exercise slowly only if my provider approves." 3 "I may need to have treatments 5 times each week." 4 "I should floss my teeth to promote good dental health."

4 "I should floss my teeth to promote good dental health." Patients with PV should avoid flossing to prevent oral bleeding. Patients may need pheresis 2 to 5 times weekly to decrease the numbers of red blood cells and decrease blood viscosity. Patients should remain hydrated and should be taught to consume at least 3 liters of fluid daily. Patients should only exercise on their provider's advice and should do so slowly.

What patient is at a lower risk for febrile transfusion reactions? 1 A patient receiving a platelet transfusion 2 A patient who has received multiple blood transfusions 3 A patient receiving a white blood cell (WBC) transfusion 4 A patient receiving leukocyte-reduced red blood cell transfusion

4 A patient receiving leukocyte-reduced red blood cell transfusion Febrile transfusion reactions occur most often in patients with anti-WBC antibodies. Leukocyte-reduced red blood cells are least antigenic and do not cause febrile transfusion reactions. Febrile transfusion reactions occur most often in the patient with anti-WBC antibodies, which can develop after multiple transfusions, WBC transfusions, and platelet transfusions. The patient develops chills, tachycardia, fever, hypotension, and tachypnea. Giving leukocyte-reduced blood or single-donor HLA-matched platelets reduces the risk for this type of reaction. WBC filters may be used to trap WBCs and prevent their infusion into the patient.

A patient with sickle cell anemia is admitted for treatment of a vasoocclusive crisis. In addition to administering oxygen, which intervention will help reduce hypoxia in this patient? 1 Giving iron supplements 2 Providing analgesic medication 3 Encouraging strenuous exercise 4 Administering intravenous (IV) fluids

4 Administering intravenous (IV) fluids Dehydration can cause increased sickling of HbS cells and can also make occlusion worse, causing more tissue ischemia. Patients should be taught to consume 3 to 4 L of fluid daily as a maintenance measure, and hospitalized patients should be given IV fluids. Patients should engage in mild, low-impact exercise. Iron supplements will not improve hypoxia since iron deficiency is not the underlying problem. Analgesics are given for pain, but do not directly affect oxygenation.

A patient who has had stem cell implantation after unsuccessful chemotherapy with an alkylating agent has had a sudden increase in weight. Which physical assessment does the nurse expect in this patient? 1 Unusual skin lesions 2 Abnormal breath sounds 3 Bleeding of the mouth and gums 4 Ascites with right upper quadrant pain

4 Ascites with right upper quadrant pain Patients who receive alkylating agents are at risk for liver damage; this can increase the risk of vasoocclusive disease after hematopoietic stem cell transplantation. Symptoms include weight gain, jaundice, right upper quadrant pain, liver enlargement, and ascites. The assessment of lung sounds may help detect signs of infection in neutropenic patients. Patients who have thrombocytopenia are at risk for bleeding. Unusual skin lesions occur with graft-versus-host disease.

The nurse is caring for a patient diagnosed with septic shock. The patient develops bleeding from puncture sites after a blood draw. What complications does the nurse suspect? 1 Hemophilia A 2 Hemophilia B 3 Von Willebrand's disease 4 Disseminated intravascular coagulation

4 Disseminated intravascular coagulation Disseminated intravascular coagulation often occurs with septic shock and is identified by excessive bleeding. Hemophilias A and B and von Willebrand's disease are not commonly found in septic patients.

Which changes should be monitored during the first 15 to 30 minutes in a patient who is undergoing blood transfusion? 1 Hyperkalemia 2 Fluid overload 3 Febrile reaction 4 Hemolytic reaction

4 Hemolytic reaction Hemolytic reaction may occur during the infusion of the first 50 mL of the blood. Therefore the nurse should remain with the patient for the first 15 to 30 minutes in order to monitor for hemolytic reaction. The use of frozen samples or samples that are more than a week old may lead to hyperkalemia. The nurse monitors an older patient's vital signs every 15 minutes throughout the transfusion to check for signs of fluid overload. Fluid overload may also occur as a result of rapid transfusion. Febrile reaction is observed after multiple transfusions, or during white blood cell and platelet transfusions.

Which data is least required when initiating a transfusion process? 1 Patient's band name 2 Patient's date of birth 3 Patient's band number 4 Patient's room number

4 Patient's room number According to The Joint Commission's National Patient safety goals, the patient's room number is not an acceptable form of identification. As per the safety goals, the patient's identification is based on the patient's band name, band number, and identification of the blood component. The date of birth is part of the standard identification process.

Which clotting factor is deficient in patients with hemophilia B? 1 Thrombin 2 Fibrinogen 3 Prothrombin 4 Plasma thromboplastin

4 Plasma thromboplastin Plasma thromboplastin (factor IX) is deficient in patients with hemophilia B. Thrombin helps convert fibrinogen to fibrin strands and catalyzes other coagulated reactions. Fibrinogen (factor I) and prothrombin (factor II) are not deficient in cases of hemophilia B.

What disorder is classified by less than 150,000 platelets per microliter? 1 Leukemia 2 Hemophilia 3 Leukocytopenia 4 Thrombocytopenia

4 Thrombocytopenia Thrombocytopenia is characterized by a platelet count of less than 150,000 platelets per microliter. Leukemia, hemophilia, and leukocytopenia are not diagnosed based on platelet counts of less than 150,000.

What clotting factor deficiencies cause hemophilia? Select all that apply. 1 I 2 II 3 V 4 VIII 5 IX

4 VIII 5 IX Deficiency of clotting factor VIII is hemophilia A, and deficiency of clotting factor IX leads to hemophilia B. Clotting factor I is fibrinogen, clotting factor II is prothrombin, and clotting factor V is proaccelerin factor, none of which are associated with hemophilia.

A patient has pallor; jaundice; a smooth, beefy-red tongue; has been experiencing difficulty with balance and reports tingling of the hands and feet. The patient's lab work indicates macrocytic anemia. The nurse notifies the provider of these findings and anticipates an order for which medication? 1 Steroids 2 Folic acid 3 Iron dextran 4 Vitamin B 12

4 Vitamin B 12 This patient exhibits symptoms of vitamin B12 deficiency anemia, characterized by the symptoms described, and should receive vitamin B 12. Symptoms of folic acid deficiency anemia are similar, but folic acid deficiency anemia does not cause neurologic symptoms. Unless the underlying deficiency of B 12 is addressed, giving iron will not be effective, since B 12 is necessary for synthesizing red blood cells. Steroids are typically given for immunodeficiency anemia.

While performing an admission assessment on a 55-year-old woman, the nurse notes a serum hemoglobin level that indicates anemia. What does the nurse ask this patient about first? 1 If she consumes red meat regularly 2 If she is still having menstrual periods 3 Whether she takes a vitamin supplement 4 Whether she has noticed blood in her stools

4 Whether she has noticed blood in her stools Any adult with iron deficiency should be evaluated for abnormal bleeding, especially from the gastrointestinal tract, so the nurse should ask about blood in her stools. Dietary intake of iron should be assessed, but this is a less common cause of iron deficiency anemia. Blood loss from periods is not as likely in an older woman. A vitamin B 12 deficiency results in pernicious anemia, so asking whether she takes a vitamin supplement is important, but still does not address how she got anemia.

Which type of transfusion requires more stringent monitoring every 15 minutes throughout the transfusion? 1 Plasma transfusions 2 Platelet transfusions 3 Red blood cell transfusions 4 White blood cell transfusions

4 White blood cell transfusions Strict monitoring is required for every 15 minutes for up to 60 minutes throughout a white blood cell transfusion because white blood cells contain many antigens that may react with the recipient immune system. During plasma transfusions, the first 15 minutes are crucial. A platelet transfusion is done when the platelet count is below 10,000 mm 3. The vital signs should be monitored during the first 15 minutes and again after the transfusion. During red blood cell transfusion, the patient should be monitored for hemolytic reactions for the first 15 to 30 minutes.