Med Surg Exam 2

A client with severe anemia is admitted to the hospital. Because of religious beliefs, the client is refusing blood transfusions. The nurse anticipates pharmacologic therapy with which drug to stimulate the production of red blood cells? a. sargramostim b. epoetin alfa c. filgrastim d. eltrombopag

b. epoetin alfa

When a nurse is planning discharge teaching for a client admitted with sickle cell crisis, which information should the nurse include in the teaching? a. drink only one caffeinated beverage daily b. take a daily multivitamin with iron c. limit fluids to 2 quarts a day d. receive pneumococcal and annual influenza vaccinations

d. receive pneumococcal and annual influenza vaccinations

Which statement best describes the function of fibrinogen? A. Functions primarily as an immunological agent. B. Helps maintain osmotic pressure. C. Helps prevent or modify some types of infectious diseases. D. Plays a key role in forming blood clots.

D. Plays a key role in forming blood clots.

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

a. Hematocrit

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

a. T lymphocyte

A client admitted to the hospital in preparation for a splenectomy to treat autoimmune hemolytic anemia asks the nurse about the benefits of splenectomy. Which statement best explains the expected effect of splenectomy? a. it will remove the major site of red blood cell destruction b. it will increase red blood cell production to compensate for blood loss c. it will increase production of platelets by the bone marrow d. It will reduce the destruction of platelets by macrophages

a. it will remove the major site of red blood cell destruction

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

a. megaloblasts

Which is a symptom of Cooley anemia? a. inflammation of the tongue b. bronzing of the skin c. inflammation of the mouth d. dyspnea

b. bronzing of the skin

The nurse is completing a pretransfusion assessment to determine a female client's history of previous transfusions as well as previous reactions to transfusions. Which is the most important information to obtain from this client before the transfusion? a. family history of transfusion reactions b. number of pregnancies c. age d. diagnosis

b. number of pregnancies

For a client diagnosed with pernicious anemia, the nurse emphasizes the importance of lifelong administration of a. vitamin c b. vitamin B12 c. folic acid d. vitamin A

b. vitamin B12

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

c. Petechiae

Which type of hemolytic anemia is categorized as inherited disorder? a. cold agglutinin disease b. autoimmune hemolyytic anemia c. sickle cell anemia d. hypersplenism

c. sickle cell anemia

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

d. Administer acetaminophen 500mg, as ordered

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

d. Myeloid stem cell Myeloid stem cells are responsible not only for all nonlympohoid white blood cells (WBC) but also for the production of red blood cells and platelets.

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? a. fruits high in vitamin C, such as oranges and grapefruits b. beans, dried fruits, and leafy, green vegetables c. berries and orange vegetables d. diary products

b. beans, dried fruits, and leafy, green vegetables

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

b. lymphocyte

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

c. myeloid stem cell

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

c. resume the transfusion

The nurse recognizes that the most common cause of iron deficiency anemia in an adult is a. chronic alcoholism b. lack of dietary iron c. iron malabsorption d. bleeding

d. bleeding

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

d. monitor for edema at least once per shift.

The physician orders a transfusion with packed red blood cells (RBCs) for a client hospitalized with severe iron deficiency anemia. When blood is administered, what is the most important action the nurse can take to prevent a transfusion reaction? a. stays with the client during the first 15 minutes of the transfusion b. administer the blood as soon as it arrives c. premeditate the client with acetaminophen d. verify the client's identity according to hospital policy

d. verify the client's identity according to hospital policy

Which medication is the antidote to warfarin? a. protamine sulfate b. aspirin c. clopidogrel d. vitamin K

d. vitamin K

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 1200 pm by what time must the infusion be completed? a. 300pm b. 400pm c. 600pm d. 200pm

b. 400pm when packed red blood cells or whole blood is transfused, the blood should be administered within a 4 hour period because warm room temperatures promote bacterial growth.

The most common cause of iron deficiency anemia in men and postmenopausal women is a. chronic alcoholism b. bleeding c. iron malabsorption d. menorrhagia

b. bleeding the most common cause of iron deficiency anemia in men and postmenopausal women is bleeding from ulcers, gastritis, inflammatory bowel disease or GI tumors. Menorrhagia is the most common cause in premenopausal women. Iron malabsorption in another cause, which is seen in clients with celiac disease. Clients with chronic alcoholism often have chronic blood loss from the GI tract.

A client with disseminated intravascular coagulation (DIC) has a critically low fibrinogen level and is beginning to hemorrhage. To increase the amount of fibrinogen in the body, the nurse anticipates administering which blood product? a. albumin b. cryoprecipitate c. packed red blood cells d. fresh frozen plasma

b. cryoprecipitate Cryoprecipitate is given to replace fibrinogen and factors V and VII; fresh-frozen plasma is administered to replace other coagulation factors.

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

b. megaloblasts

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? a. "DIC is a complication of an autoimmune disease that attacks the body's own cells." b. "DIC occurs when the immune system attacks platelets and causes massive bleeding" c. "DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs" d. "DIC is caused when hemolytic processes erythrocytes."

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

During the re view of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding? a. elevated red blood cell (RBC) count b. elevated hematocrit concentration c. low ferritin level concentration d. enlarged mean corpuscular volume (MCV)

c. low ferritin level concentration the most consistent indicator of iron deficiency anemia is a low ferritin level, which reflects low iron stores. As the anemia progresses, the MCV which measures the size of the erythrocytes also decreases. hematocrit and RBC levels are also low in relation to the hemoglobin concentration

When assessing a client with a disorder of the hematopoietic or the lymphatic system, which assessment is the most essential? a. menstrual history b. age and gender c. lifestyle assessments, such as exercise routines d. health history, such as bleeding, fatigue or fainting

d. health history, such as bleeding, fatigue, or fainting

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

d. hematocrit

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

d. lymphocyte Both T and B lyymphocytes respond to exposure to antigens.

For a client with Hodgkin disease who has developed neutropenia, what is the most appropriate nursing intervention to include in the care plan? a. omitting fresh fruits and vegetables from the diet b. avoiding intramuscular (IM) injections c. positioning the client to increase lung expansion d. monitoring temperate every 4 hours

d. monitoring temperate every 4 hours

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? a. monitoring the client's heart rate and reviewing the client's hemoglobin b. monitoring the client's breathing and reviewing the client's arterial blood gases c. monitoring the client's blood pressure and reviewing the client's hematocrit d. Monitoring the client's temperature and revewing the client's complete blood count (CBC) with differential.

d. monitoring the client's temperature and reviewing the client's complete blood count with differential

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

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

A client who has idiopathic thrombocytopenia purpura (ITP) has a critically low platelet count. Which nursing intervention will be included in the care of plan for this client? a. place the client in a private room b. enforce strict contact isolation c. administer eltrombopag d. administer epoetin alfa

c. administer eltrombopag

Which type of sickle cell crisis occurs as a result of infection with the human parvovirus? a. sequestration crisis b. acute chest syndrome c. aplastic crisis d. sickle cell crisis

c. aplastic crisis aplastic crisis results from infection with the human parvovirus. Sequestration crisis results when other organs pool the sickled cells. Sickle cell crisis results from tissue hypoxia and necrosis due to inadequate blood flow to a specific region of tissue or organ. Acute chest syndrome in manifested by a rapidly decreasing hemoglobin concentration, tachycardia, fever, and bilateral infiltrated seen on a chest x-ray.

which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia? a. monitor temperature at least once per shift b. eliminate direct contact with others who are infectious c. apply prolonged pressure to needle sites or other sources of external bleeding d. implement neutropenic precautions

c. apply prolonged pressure to needle sites or other sources of external bleeding

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? a. implementing neutropenic precautions b. monitoring temperature at least once per shift c. applying prolonged pressure to needle sites or other sources of external bleeding d. eliminating direct contact with others who are infectious

c. applying prolonged pressure to needle sites or other sources of external bleeding.

The nurse should advice a client with iron deficiency anemia to take which action to prevent staining of the teeth? a. take iron with or immediately after meals b. dilute liquid preparations of iron with juice and drink with a straw c. Avoid taking iron simultaneously with an antacid d. do not combine iron with other prescribed or over-the-counter medications

b. dilute liquid preparations or iron with juice and drink with a straw

A client was admitted to the hospital with the following lab values: hemoglobin 5 g/dL, leukocyte count 2000/mm3, and a platelet count of 48,000/mm3; abnormally shaped erythrocytes and hypersegmeneted neutrophils were seen. The platelet appear abnormally large. A bone marrow biopsy was competed and revealed hyperplasia. Based on this information, the nurse determines that client most likely has which diagnosis? a. sickle cell anemia b. folic acid deficiency c. thalassemia d. hemolytic anemia

b. folic acid deficiency

A nurse 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 a. may be developing anemia b. may be developing an infection c. has thrombocytopenia d. has leukopenia

b. may be developing an infection

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

c. megaloblasts Megaloblasts are abnormally large erythrocytes. Blast cells are primitive white blood cells. Mast cells are cells found in connective tissue involved in defense of the body coagulation. Monocytes are large WBCs that become macrophages when they leave the circulation and move into body tissues.

During a blood transfusion with packed red blood cells (RBCs), a client reports chills, low back pain, and nausea. What priority action should the nurse take? a. discontinue the infusion immediately and notify the physician b. observe for additional symptoms and notify the physician c. slow the infusion rate and continue to monitor the client every 15 minutes. d. discontinue the infusion immediately and maintain the IV line with normal saline solution using new IV tubing.

d. discontinue the infusion immediately and maintain the IV line with normal saline solution using the new IV tubing.

After teaching a client about taking daily oral iron preparations for a moderate iron deficiency anemia, which statement by the client indicates to the nurse that additional instruction is needed? a. "I will call the doctor if my stools turn black" b. "I will occasionally take a stool softener if I feel constipated" c. "I will take the iron with orange juice about an hour before eating" d. "I will increase my fluid and fiber intake while I am taking the iron tablets"

a. "I will call the doctor if may stools turn black" Iron replacement therapy may change the color of stool, usually to dark green or black. Iron is best absorbed on an empty stomach, so the client is instructed to take the supplement an hour before meals. Many clients have difficulty tolerating iron supplements because of GI side effects primarily constipation. Limit GI side effects by adding a stool softener or increasing dietary fiber and fluids. Taking iron-rich foods with a source of vitamin C (like orange juice) enhances the absorption of iron.

A client is brought to the ED reporting fatigue, large amounts of bruising on the extremities, and abdominal pain localized in the left upper quadrant. A health history reveals the client has been treated for a sore throat three times in the past 2 months. Laboratory tests indicate severe anemia, significant neutropenia, and thrombocytopenia. Based on the symptoms, what could be the client's diagnosis. a. sickle cell anemia b. iron deficiency anemia c. aplastic anemia d. hemolytic anemia

c. aplastic anemia Aplastic anemia can be congenital or acquired, but most cases are idiopathic.

When assessing a client with anemia, which assessment is essential? a. age and gender b. family history c. health history, including menstrual history in women d. lifestyle assessments, such as exercise routines

c. health history, including menstrual history in women.

A patient with sickle cell anemia has a a. normal blood smear b. high hematocrit c. low hematocrit d. normal hematocrit

c. low hematocrit A client with sickle cell anemia has a low hematocrit and sickled cells on the smear. A client with sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear.

Which is a symptom of hemochromatosis? a. weight gain b. inflammation of the tongue c. inflammation of the mouth d. bronzing of the skin

d. bronzing of the skin Clients with hemochromatosis exhibit symptoms of weakness, lethargy, arthralgia, weight loss, and loss of libido early in the illness trajectory.

Which his the major function of neutrophils? a. production of immunoglobulins b. rejection of foreign tissue c. phagocyytosis d. destruction of tumor cells

c. phagocytosis

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

c. transfusion related acute lung injury

A client with sickle cell crisis is admitted to the hospital in severe pain. While caring for the client during the crisis, which is the priority nursing intervention? a. teaching the client about increasing dietary intake of high-protein, high calorie foods b. limiting the client's intake of oral and IV fluids c. encouraging the client to ambulate as much as tolerated d. administering and evaluating the effectiveness of opioid analgesics

d. administering and evaluating the effectiveness or opioid analgesics

A nurse is completing a detailed health history and assessment in the electronic medical record (EMR) for a client with a disorder of the hematopoietic system. Which symptom is the most commonly reported in association with hematologic diseases? a. blurred vision b. severe headaches c. dyspnea d. extreme fatigue

d. extreme fatigue

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? a. Vitamin B12 deficiency b. Vitamin A deficiency c. Vitamin C deficiency d. folic acid deficiency

a. vitamin b12 deficiency

A client with severe anemia reports symptoms of tachycardia, palpitations, exertion dyspnea, cool extremities, and dizziness with ambulation. Laboratory test results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which nursing diagnosis is most appropriate for this client? a. fatigue related to decreased hemoglobin and hematocrit b. risk for falls related to complaints of dizziness c. ineffective tissue perfusion related to inadequate hemoglobin and hematocrit d. imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients

c. ineffective tissue perfusion related to inadequate hemoglobin and hematocrit

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

d. apply pressure over the site for 5-7 minutes

which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? a. pancytopenia b. thhrombocytopenia c. anemia d. leukopenia

a. pancytopenia pancytopenia is defined as an abnormal decrease in WBCs, RBCs and platelets. The condition may be conginital or acquired. Anemia refers to decreased red cell mass/ Leukopenia refers to a less than normal amount of WBCs in circulation. Thrombocytopenia refers to a lower-than-normal platelet count.

Which medication is the antidote to warfarin? a. protamine sulfate b. vitamin k c. aspirin d. copidrogel

b. vitamin k

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

D. the liver and spleen can resume production of blood cells through extramedullaryy hematopoiesis.