NUR 314 Exam 2
A 36-yr-old patient suspected of having leukemia is scheduled for a bone marrow aspiration. What statement in the patient's health history requires immediate follow-up by the nurse? "I had a bad reaction to iodine before and almost died." "I am taking an antibiotic to treat a urinary tract infection." "I have rheumatoid arthritis and take aspirin for joint pain." "I have dialysis for chronic renal failure three times a week."
"I have rheumatoid arthritis and take aspirin for joint pain." Rationale: Complications of bone marrow aspiration are minimal, but there is a possibility of damaging underlying structures, especially if the sternum site is used. Other complications include hemorrhage, particularly if the pt is thrombocytopenic, & infection if the WBC count is low. The risk of hemorrhage is increased if the pt takes aspirin because it promotes bleeding by inhibiting platelet aggregation. Contrast dye is not used during a bone marrow aspiration. A bone marrow aspiration is *not* contraindicated in pts who have chronic renal failure on dialysis or a urinary tract infection on an antibiotic.
The nurse is planning health promotion teaching for a group of healthy older adults in a residential community. Which statement accurately describes expected hematologic effects of aging? "Platelet production increases with age and leads to easy bruising." "Anemia is common with aging because iron absorption is impaired." "Older adults with infections may have only a mild white blood cell count elevation." "Older adults often have poor immune function with a decreased number of lymphocytes."
"Older adults with infections may have only a mild white blood cell count elevation." Rationale: During an infection, the older adult may have only a minimal elevation in the total WBC count & may not have a fever. Presentation of infection can initially be nonspecific w/ disorientation, anorexia, & weakness. Platelets are unaffected by the aging process. However, changes in vascular integrity from aging can manifest as easy bruising. Iron absorption is not impaired in the older patient, but adequate nutritional intake of iron may be decreased. The total WBC count & differential are generally not affected by aging. However, a decrease in humoral antibody response and decrease in T-cell function may occur.
The nurse teaches a black man with sickle cell disease about symptom management and prevention of sickle cell crisis. The nurse determines further teaching is necessary if the patient makes which statement? "When I take a vacation, I should not go to the mountains." "I should avoid being with anyone who has a respiratory infection." "I may have severe pain during a crisis and need opioid analgesics." "When my vision is blurred, I will close my eyes and rest for an hour."
"When my vision is blurred, I will close my eyes and rest for an hour." Rationale: Blurred vision should be reported immediately and may indicate a detached retina or retinopathy. Hypoxia (at high altitudes) and infection are common causes of a sickle cell crisis. Severe pain may occur during a sickle cell crisis, and narcotic analgesics are indicated for pain management.
Macrocytic
*larger* than normal red blood cell size
When preparing to administer an ordered blood transfusion, which IV solution does the nurse use when priming the blood tubing? Lactated Ringer's 5% dextrose in water 0.9% sodium chloride 0.45% sodium chloride
0.9% sodium chloride Rationale: The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It is also used to flush the blood tubing after the infusion is complete to ensure the patient receives blood that is left in the tubing when the bag is empty. Dextrose and lactated Ringer's solutions cannot be used with blood because they will cause RBC hemolysis.
Hemoglobin range female
12-16 g/dL above 10.5 for pregnant women
The nurse notes a provider's order written at 10:00 AM for two units of packed red blood cells to be administered to a patient who is anemic as a result of chronic blood loss. If the transfusion is picked up at 11:30 AM, the nurse should plan to hang the unit no later than what time? 11:45 AM 12:00 noon 12:30 PM 3:30 PM
12:00 noon Rationale: The nurse *must hang the unit of packed red blood cells within 30 minutes* of signing them out from the blood bank.
Hemoglobin range for males
14-18 g/dL
Before starting a transfusion of packed red blood cells, the nurse would arrange for a peer to monitor their other assigned patients for how many minutes when the nurse begins the transfusion? 5 15 30 60
15 Rationale: As part of standard procedure, the nurse remains with the patient for the first 15 minutes after starting a blood transfusion. Patients who are likely to have a transfusion reaction will more often exhibit signs within the first 15 minutes that the blood is infusing. Monitoring during the transfusion will be every 30 to 60 minutes.
Normal platelet count
150,000-400,000
WBC count range
5,000-10,000/uL
Which patient is most likely to develop anemia related to an increased destruction of red blood cells? A 23-yr-old black man who has sickle cell disease A 59-yr-old man whose alcohol use caused folic acid deficiency A 13-yr-old child with impaired growth and development due to thalassemia A 50-yr-old woman with a history of "heavy periods" accompanied by anemia
A 23-yr-old black man who has sickle cell disease Rationale: A result of a sickling episode in sickle cell anemia involves increased hemolysis of the sickled cells. Thalassemias and folic acid deficiencies cause a decrease in erythropoiesis, whereas the anemia related to menstruation is a direct result of blood loss.
The nurse is assigned to care for several patients on a medical unit. Which patient should the nurse assess first? A 60-yr-old patient with a blood pressure of 92/64 mm Hg and hemoglobin of 9.8 g/dL A 50-yr-old patient with a respiratory rate of 26 breaths/minute and an elevated D-dimer A 40-yr-old patient with a temperature of 100.8°F (38.2°C) and a neutrophil count of 256/µL A 30-yr-old patient with a pulse of 112 beats/min and a white blood cell count of 14,000/µL
A 40-yr-old patient with a temperature of 100.8°F (38.2°C) and a neutrophil count of 256/µL Rationale: A low-grade fever greater than 100.4° F (38° C) in a patient with a *neutrophil count below 500/µL* is a medical emergency and may indicate an infection. An infection in a neutropenic patient could lead to septic shock and possible death if not treated immediately.
The nurse prepares to administer a blood transfusion to a patient. Which means of identity does the nurse use to ensure that the blood is administered to the correct patient? A. Compare the name and identification number on the blood tag with the name and identification number on the patient's ID wrist band. B. Compare the unit and room number of the patient with the unit and room number listed on the blood product tag. C. Ask the patient whether his or her name is on the blood product tag. D. Ask the patient's spouse if the patient is supposed to receive a blood transfusion.
A. Compare the name and identification number on the blood tag with the name and identification number on the patient's ID wrist band.
Nursing care for a patient immediately after a bone marrow biopsy and aspiration includes. SATA. A. Giving analgesics as needed. B. Preparing to start a blood transfusion. C. Giving pre procedure and post procedure antibiotic medications. D. Having the patient lie still to keep the sterile pressure dressing intact. E. Monitoring vital signs and assessing the site for excess drainage or bleeding.
A. Giving analgesics as needed. D. Having the patient lie still to keep the sterile pressure dressing intact. E. Monitoring vital signs and assessing the site for excess drainage or bleeding.
Significant information fro the patient's health history that relates to the hematologic system includes A. Jaundice B. Bladder surgery C. Early menopause D. Multiple pregnancies
A. Jaundice
When reviewing laboratory results of an older patient with an infection, the nurse would expect to find A. Mild leukocytosis B. Decreased platelet count C. Increased hemoglobin and hematocrit levels D. Decreased erythrocyte sedimentation rate (ESR)
A. Mild leukocytosis
When reviewing a patient hematologic laboratory values after a splenectomy, the nurse would expect to find A. red blood cell abnormalities B. increased white blood cell count C. decreased hemoglobin D. decreased platelet count
A. red blood cell abnormalities
universal recipient blood type
AB positive
The nurse is caring for a patient with a diagnosis of immune thrombocytopenic purpura (ITP). What is a priority nursing action in the care of this patient? Administration of packed red blood cells Administration of oral or IV corticosteroids Administration of clotting factors VIII and IX Maintenance of reverse isolation and application of standard precautions
Administration of oral or IV corticosteroids Rationale: Common treatment modalities for ITP include corticosteroid therapy to suppress the phagocytic response of splenic macrophages. Blood transfusions, administration of clotting factors, and reverse isolation are not interventions that are indicated in the care of patients with ITP. Standard precautions are used with all patients.
The nurse is caring for a 36-yr-old patient receiving phenytoin (Dilantin) to treat seizures resulting from a traumatic brain injury as a teenager. It is most important for the nurse to observe for which hematologic adverse effect of this medication? Anemia Leukemia Polycythemia Thrombocytosis
Anemia Rationale: Hematologic AEs of phenytoin include anemia, thrombocytopenia, leukopenia, granulocytopenia, agranulocytosis, & pancytopenia.
The nurse is caring for a patient who is to receive a transfusion of two units of packed red blood cells. After obtaining the first unit from the blood bank, the nurse would ask which health team member in the nurses' station to assist in checking the unit before administration? A. Unit secretary B. A physician's assistant C. Another registered nurse D. An unlicensed assistive personnel
Another registered nurse Rationale: Before hanging a transfusion, the registered nurse must check the unit with another RN or with a licensed practical (vocational) nurse, depending on agency policy. *2 RNs can check off OR 1 RN and 1 LNP (has to be at least 1 RN)*
The thrombocytopenic patient has had a bone marrow biopsy taken from the posterior iliac crest. What intervention is the priority for this patient after this procedure? Position the patient prone. Apply a pressure dressing. Administer analgesic for pain. Return metal objects to the patient.
Apply a pressure dressing. Rationale: The sterile pressure dressing is applied after a bone marrow biopsy to ensure hemostasis. If bleeding is present, the patient will lie on the site & may need a rolled towel for additional pressure, *not* be in prone position. The analgesic should have been administered preprocedure.
The nurse is caring for a patient with polycythemia vera. What is an important action for the nurse to initiate? Encourage deep breathing and coughing. Assist with or perform phlebotomy at the bedside. Teach the patient how to maintain a low-activity lifestyle. Perform thorough and regularly scheduled neurologic assessments.
Assist with or perform phlebotomy at the bedside. Rationale: Primary polycythemia vera often requires phlebotomy in order to reduce blood volume. The increased risk of thrombus formation that accompanies the disease requires regular exercises and ambulation. Deep breathing and coughing exercises do not directly address the etiology or common sequelae of polycythemia, and neurologic manifestations are not typical.
A patient has been diagnosed with acute myelogenous leukemia (AML). What should the nurse educate the patient that care will focus on? Leukapheresis Attaining remission One chemotherapy agent Waiting with active supportive care
Attaining remission Rationale: Attaining remission is the initial goal of care for leukemia. The methods to do this are decided based on age & cytogenetic analysis. The treatments include leukapheresis or hydroxyurea to reduce the white blood cell count and risk of leukemia-cell-induced thrombosis. A combination of chemotherapy agents will be used for aggressive treatment to destroy leukemic cells in tissues, peripheral blood, and bone marrow and minimize drug toxicity. In nonsymptomatic patients with chronic lymphocytic leukemia, waiting may be done to attain remission, but not with AML.
An anticoagulant such as warfarin that interferes with prothrombin production will the clotting mechanism during A. Platelet aggregation B. Activation of thrombin C. The release of tissue thromboplastin D. Stimulation of factor activation complex
B. Activation of thrombin
If a lymph node is palpated what is a normal finding? A. Hard, fixed nodes B. Firm, mobile nodes C. Enlarged, tender nodes D. Hard, nontender nodes
B. Firm, mobile nodes
A person who lives at a high altitude may normally have an increased Hgb and RBC count because: A. High altitudes cause vascular fluid loss, leading to hemoconcentration. B. Hypoxia caused by decreased atmospheric O2 stimulates erythropoiesis C. The function of the spleen in removing old RBCs is impaired at high altitudes D. Impaired production of platelets leads to proportionally higher red cell counts
B. Hypoxia caused by decreased atmospheric O2 stimulates erythropoiesis
A patient has been diagnosed with stage 1A Hodgkin's lymphoma. The nurse knows that which chemotherapy regimen is most likely to be prescribed for this patient? A. Brentuximab vedotin (Adcetris) B. Two to four cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine C. Four to six cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine D. BEACOPP: bleomycin, etoposide, doxorubicin (Adriamycin), cyclophosphamide, vincristine (Oncovin), procarbazine, and prednisone
B. Two to four cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine Rationale: The patient w/ a favorable prognosis early-stage Hodgkin's lymphoma (stage 1A) will receive two to four cycles of ABVD. The unfavorable prognostic featured (stage 1B) Hodgkin's lymphoma would be treated with four to six cycles of chemotherapy. Advanced-stage Hodgkin's lymphoma is treated more aggressively with more cycles or with BEACOPP. Brentuximab vedotin (Adcetris) is a newer agent that will be used to treat patients who have relapsed or refractory disease.Note: Some of acronyms for drug protocols use the brand/trade name of drugs (Adriamycin, Oncovin). These brand/trade names have been discontinued but the drugs are still available as generic drugs.
What is the most specific method of diagnosing a malignancy? A. Serum Laboratory Test B. MRI C. Biopsy D. CT Scan
C. Biopsy
While assessing the lymph nodes, the nurse should A. Apple gentle, firm pressure to deep lymph nodes B. Palpate the deep cervical and supraclavicular nodes last C. Lightly palpate superficial lymph nodes with the pads of the fingers D. Use the tips of the second, third, and fourth fingers to apply deep palpation
C. Lightly palpate superficial lymph nodes with the pads of the fingers
You are taking care of a male patient who has the following laboratory values from his CBC: WBC 6.5 x 103/uL Hgb 13.4 g/dL Hct 40% Platelets 50 x 10 3uL. What are you most concerned about? A. The patient is neutropenic B. The patient has an infection C. There is an increased risk for bleeding D. Fall risk precautions are needed due to anemia
C. There is an increased risk for bleeding low Hgb (<14%) low Hct (<42%) low platelet count (<150,000)
A patient with leukemia is admitted for severe hypovolemia after prolonged diarrhea. The platelet count is 43,000/µL. It is most important for the nurse to take which action? Insert two 18-gauge IV catheters. Administer prescribed enoxaparin. Monitor the patient's temperature every 2 hours. Check stools for presence of frank or occult blood.
Check stools for presence of frank or occult blood. Rationale: A platelet count below 150,000/µL indicates thrombocytopenia. Prolonged bleeding from trauma or injury does not usually occur until the platelet counts are below 50,000/µL. Bleeding precautions (e.g., check all secretions for frank and occult blood) are indicated for patients with thrombocytopenia. Injections (including IVs) should be avoided; however, when needed for critical fluids & medications, IV access should be provided through the *smallest bore devices* that are feasible. Enoxaparin, an anticoagulant administered subcutaneously, is *contraindicated* in patients with thrombocytopenia. Monitoring temperature would be indicated in a patient with leukopenia.
Before beginning a transfusion of packed red blood cells (PRBCs), which action by the nurse would be of highest priority to avoid an error during this procedure? Add the blood transfusion as a secondary line to the existing IV. Stay with the patient for 60 minutes after starting the transfusion. Check the identifying information on the unit of blood against the patient's ID bracelet. Prime new primary IV tubing with lactated Ringer's solution to use for the transfusion.
Check the identifying information on the unit of blood against the patient's ID bracelet. Rationale: The patient's identifying information (name, date of birth, medical record number) on the ID bracelet should exactly match the information on the blood bank tag that has been placed on the unit of blood. If any information does not match, the transfusions should not be hung because of possible error and risk to the patient. The transfusion is hung on blood transfusion tubing, not a secondary line, and cannot be hung with lactated Ringer's solution because it will cause RBC hemolysis. Usually, the patient will need continuous monitoring for 15 minutes after the transfusion is started, as this is the time most transfusion reactions occur. Then the patient should be monitored every 30 to 60 minutes during the administration.
Cancer arising from granulocytic cells in the bone marrow will have the primary effect of causing A. Risk for hemorrhage B. Altered oxygenation C. Decreased production of antibodies D. Decreased phagocytosis of bacteria
D. Decreased phagocytosis of bacteria
The nurse is providing care for older adults on a subacute, geriatric medical unit. What effect does aging have on hematologic function of older adults? Thrombocytosis Decreased hemoglobin Decreased WBC count Decreased blood volume
Decreased hemoglobin Rationale: Older adults often have decreased hemoglobin levels as a result of changes in erythropoiesis. Decreased blood volume, decreased WBCs, & alterations in platelet number are not considered to be normal, age-related hematologic changes.
The patient with leukemia has acute disseminated intravascular coagulation (DIC) and is bleeding. What diagnostic findings should the nurse expect to find? Elevated D-dimers Elevated fibrinogen Reduced prothrombin time (PT) Reduced fibrin degradation products (FDPs)
Elevated D-dimers Rationale: The D-dimer is a specific marker for the degree of fibrinolysis and is elevated with DIC. FDP is elevated as the breakdown products from fibrinogen and fibrin are formed. Fibrinogen and platelets are reduced. PT, PTT, aPTT, and thrombin time are all prolonged.
A patient has anemia related to inadequate intake of essential nutrients. Which intervention would be appropriate for the nurse to include in the plan of care for this patient? Plan for 30 minutes of rest before and after every meal. Encourage foods high in protein, iron, vitamin C, and folate. Teach the patient to select only soft, bland, and nonacidic foods. Give the patient a list of medications that inhibit iron absorption.
Encourage foods high in protein, iron, vitamin C, and folate. Rationale: Increased intake of protein, iron, folate, and vitamin C provides nutrients needed for maximum iron absorption and hemoglobin production. The other interventions do not address the patient's identified problem of inadequate intake of essential nutrients. Selection of foods that are soft, bland, and nonacidic is appropriate if the patient has oral mucosal irritation. Scheduled rest is an appropriate intervention if the patient has fatigue related to anemia. Providing information about medications that may inhibit iron absorption (antacids, tetracycline, soft drinks, tea, coffee, calcium, phosphorus, & magnesium salts) is important but does not address pt's problem of inadequate intake of essential nutrients.
The nurse is reviewing the objective data listed in the table below of a patient with suspected allergies. Which assessment finding indicates allergies? Physical examination: - Dry cough - Pale skin Laboratory results: - Neutrophils: 60% - Eosinophils: 10% - Basophils: 1% - Lymphocytes: 20% - Monocytes: 6% Medications: - Acetaminophen 1000 mg every 12 hours - Levothyroxine (Synthroid) 125 mcg each day
Eosinophil result Rationale: Eosinophils are granulocytes that phagocytize antigen-antibody complexes formed during an allergic response. The normal eosinophil count is 2% to 4% of all white blood cells. The dry cough, lymphocyte result, and acetaminophen use do not indicate allergies.
A patient has been diagnosed with Burkitt's lymphoma. In the initiation stage of cancer, the cells genetic structure is mutated. Exposure to what may have functioned as a carcinogen for this patient? Bacteria Sun exposure Most chemicals Epstein-Barr virus
Epstein-Barr virus Rationale: Burkitt's lymphoma consistently shows evidence of the presence of Epstein-Barr virus in vitro. Bacteria do not initiate cancer. Sun exposure causes cell alterations leading to melanoma and squamous and basal cell skin carcinoma. Long-term exposure to certain chemicals (e.g., ethylene oxide, chloroform, benzene) is known to initiate cancer.
When caring for a patient with metastatic cancer, the nurse notes a hemoglobin level of 8.7 g/dL and hematocrit of 26%. What associated clinical manifestations does the nurse anticipate observing? Thirst Fatigue Headache Abdominal pain
Fatigue Rationale: The patient w/ a low hemoglobin and hematocrit is anemic and would likely have fatigue. Fatigue develops because of the lowered oxygen-carrying capacity that leads to reduced tissue oxygenation to carry out cellular functions. Thirst, headache, and abdominal pain are not related to anemia.
The nurse receives a provider's order to transfuse fresh frozen plasma to a patient with acute blood loss. Which procedure is most appropriate for infusing this blood product? Hang the fresh frozen plasma with lactated Ringer's solution. Fresh frozen plasma must be given within 24 hours after thawing. Infuse the fresh frozen plasma at a rate of 50 mL/hr for the duration. Hang the fresh frozen plasma as a piggyback to a primary IV solution without KCl.
Fresh frozen plasma must be given within 24 hours after thawing. Rationale: The fresh frozen plasma should be administered as rapidly as possible & should be used within 24 hours of thawing to avoid a decrease in factors V and VIII. Fresh frozen plasma is infused using any straight-line infusion set. Any existing IV should be interrupted while the fresh frozen plasma is infused, unless a second IV line has been started for the transfusion.
The physician orders a patient with suspected iron-deficiency anemia a blood smear test to assess the quality of the red blood cells. How would the red blood cells appear if the patient had iron-deficiency anemia. Hyperchromic and macrocytic Hypochromic and macrocytic Hyperchromic and macrocytic Hypochromic and microcytic
Hypochromic and microcytic
When assessing laboratory values on a patient admitted with septicemia, what does the nurse expect to find? Increased platelets Increased red blood cells Decreased erythrocyte sedimentation rate (ESR) Increased bands in the white blood cell (WBC) differential
Increased bands in the white blood cell (WBC) differential Rationale: When infections are severe, such as in septicemia, more granulocytes are released from the bone marrow as a compensatory mechanism. To meet the increased demand, many young, immature polymorphonuclear neutrophils (bands) are released into circulation. WBCs are usually reported in order of maturity (initially w/ the less mature forms on the left side of a written report). Hence, the term "shift to the left" is used to denote an increase in the number of bands. Thrombocytosis occurs w/ inflammation & some malignant disorders. Increased red blood cells or decreased ESR is not indicative of septicemia.
The patient diagnosed with anemia had laboratory tests done. Which results indicate a lack of nutrients needed to produce new red blood cells (RBCs)? (Select all that apply.) Increased homocysteine Decreased reticulocyte count Decreased cobalamin (vitamin B12) Increased methylmalonic acid (MMA) Elevated erythrocyte sedimentation rate (ESR)
Increased homocysteine Decreased cobalamin (vitamin B12) Increased methylmalonic acid (MMA) Rationale: Increased homocysteine & MMA along w/ decreased cobalamin (vitamin B12) indicate cobalamin deficiency, which is a nutrient needed for RBC production. Decreased reticulocytes indicate low bone marrow activity in producing RBCs, not available nutrients.
A patient had a splenectomy for injuries sustained in a motor vehicle accident. Which phenomena are likely to result from the absence of the patient's spleen? (Select all that apply.) Impaired fibrinolysis Increased platelet levels Increased eosinophil levels Fatigue and cold intolerance Impaired immunologic function
Increased platelet levels Impaired immunologic function Rationale: Splenectomy can result in increased platelet levels & impaired immunologic function because of the loss of storage & immunologic functions of the spleen. Fibrinolysis, fatigue, & cold intolerance are less likely to result from the loss of the spleen since coagulation & oxygenation are not primary responsibilities of the spleen.
Results of a patient's most recent blood work indicate an elevated neutrophil level. The nurse recognizes that this diagnostic finding suggests which problem? Infection Hypoxemia Acute thrombotic event Risk of hypocoagulation
Infection Rationale: (A neutrophil is a type of WBC) An increase in the neutrophil count most commonly occurs in response to infection or inflammation. Hypoxemia and coagulation do *not* directly affect neutrophil production.
The blood bank notifies the nurse that 2 units of blood ordered for a patient is ready for pick up. Which action should the nurse take to prevent an adverse effect during this procedure? Immediately pick up both units of blood from the blood bank. Infuse the blood slowly for the first 15 minutes of the transfusion. Regulate the flowrate so that each unit takes at least 4 hours to transfuse. Set up the Y-tubing of the blood set with dextrose in water as the flush solution.
Infuse the blood slowly for the first 15 minutes of the transfusion. Rationale: Because a transfusion reaction is more likely to occur at the beginning of a transfusion, the nurse should initially infuse the blood at a rate no faster than 2 mL/min & remain w/ the patient for the first 15 minutes after hanging 1 unit of blood. Only *1 unit* of blood can be picked up at a time, it *must be infused within 4 hours*, and it *cannot* be hung with dextrose.
When evaluating a patient's nutritional-metabolic pattern related to hematologic health, what priority assessment should the nurse perform? Inspect the skin for petechiae. Ask the patient about joint pain. Assess for vitamin C deficiency. Determine if the patient can perform activities of daily living.
Inspect the skin for petechiae. Rationale: Any changes in the skin's texture or color should be explored when assessing the patient's nutritional-metabolic pattern related to hematologic health. The presence of petechiae or ecchymotic areas could be indicative of hematologic deficiencies related to poor nutritional intake or related causes.
The nurse knows that hemolytic anemia can be caused by which extrinsic factors? Trauma or splenic sequestration crisis Abnormal hemoglobin or enzyme deficiency Macroangiopathic or microangiopathic factors Chronic diseases or medications and chemicals
Macroangiopathic or microangiopathic factors Rationale: Macroangiopathic or microangiopathic extrinsic factors lead to acquired hemolytic anemias. Trauma or splenic sequestration crisis can lead to anemia from acute blood loss. Abnormal hemoglobin or enzyme deficiency are intrinsic factors that lead to hereditary hemolytic anemias. Chronic diseases or medications and chemicals can decrease the number of red blood cell (RBC) precursors which reduce RBC production.
A patient who has sickle cell disease has developed cellulitis above the left ankle. What is the nurse's priority for this patient? Start IV fluids. Maintain oxygenation. Maintain distal warmth. Check peripheral pulses.
Maintain oxygenation. Rationale: Maintaining oxygenation is a priority as sickling episodes are frequently triggered by low oxygen tension in the blood which is commonly caused by an infection. Antibiotics to treat cellulitis, pain control, and fluids to reduce blood viscosity will also be used, but oxygenation is the priority.
Which of the following information related to medication should the nurse include in the teaching plan for a patient who is positive for the human immunodeficiency virus (HIV)? Do not skip a dose. If a dose is missed, double the next dose. Wait until the next visit before reporting significant side effects Make sure to take your medication at the prescribed time each day. Take this medication at any time after eating
Make sure to take your medication at the prescribed time each day. Do not skip a daily dose of the medication or the virus has the potential to grow immunity?
You are assessing a new client with complaints of a sore, red, and smooth tongue. Based upon your assessment findings, you know that the patient is demonstrating symptoms associated with what? Hemolytic Anemia Megaloblastic Anemia Aplastic Anemia Blood Loss Anemia
Megaloblastic Anemia
The patient is admitted with hypercalcemia, polyuria, and pain in the pelvis, spine, and ribs with movement. Which hematologic problem would most likely cause these manifestations? Multiple myeloma Thrombocytopenia Megaloblastic anemia Myelodysplastic syndrome
Multiple myeloma Rationale: Multiple myeloma typically manifests with skeletal pain and osteoporosis that may cause hypercalcemia, which can result in polyuria, confusion, or cardiac problems. Serum hyperviscosity syndrome can cause renal, cerebral, or pulmonary damage. Thrombocytopenia, megaloblastic anemia, and myelodysplastic syndrome are not characterized by these manifestations.
universal donor blood type
O negative does not have any antigens
A patient with an acute peptic ulcer and major blood loss requires an immediate transfusion with packed red blood cells. Which task is appropriate for the registered nurse (RN) to delegate to unlicensed assistive personnel (UAP)? Confirm the IV solution is 0.9% saline. Obtain the vital signs before the transfusion is initiated. Monitor the patient for shortness of breath and back pain. Double-check the patient identity and verify the blood product.
Obtain the vital signs before the transfusion is initiated. Rationale: The RN may delegate tasks such as taking vital signs to UAP. Assessments (e.g., monitoring for signs of a blood transfusion reaction [shortness of breath and back pain]) are within the scope of practice of the RN and may not be delegated to UAP. The RN must also assume responsibility for ensuring the correct IV fluid is used with blood products. A licensed nurse must complete verification of the patient's identity and the blood product data.
petechiae
Petechiae are pinpoint, discrete deposits of blood less than 1 to 2 mm in the extravascular tissues and visible through the skin or mucous membranes
A patient will receive a hematopoietic stem cell transplant (HSCT). What is the nurse's priority after the patient receives combination chemotherapy before the transplant? Prevent patient infection. Avoid abnormal bleeding. Give pneumococcal vaccine. Provide companionship while isolated.
Prevent patient infection. Rationale: After combination chemotherapy for HSCT, the patient's bone marrow is destroyed in preparation to receive the bone marrow graft. Thus, the patient is immunosuppressed and is at risk for a life-threatening infection. The priority is preventing infection. Bleeding is not usually a problem. Giving the pneumococcal vaccine at this time should not be done; it should have been done previously. Providing companionship is not the primary role of the nurse, although the patient will need support during the time of isolation.
Which assessment finding would support the presence of a hemostasis abnormality? Purpura Pruritus Weakness Pale conjunctiva
Purpura Rationale: Purpura may occur when platelets or clotting factors are decreased and bleeding into the skin occurs. Pruritus is not related to hemostasis but to hematologic cancers (e.g., lymphomas, leukemias) or increased bilirubin. Weakness & pale conjunctiva are not related to hemostasis unless a lot of bleeding leads to anemia w/ low hemoglobin level.
A 62-yr-old patient with disseminated intravascular coagulation (DIC) after urosepsis has a platelet count of 48,000/μL. The nurse should assess the patient for which abnormality? Pallor Purpura Pruritus Palpitation
Purpura Rationale: The normal range for a platelet count is 150,000 to 400,000/μL. Purpura is caused by decreased platelets or clotting factors, resulting in small hemorrhages into the skin or mucous membranes. Pallor is decreased or absent coloration in the conjunctiva or skin. Pruritus is an intense itching sensation. Palpitation is a sensation of feeling the heart beat, flutter, or pound in the chest.
A patient with a diagnosis of hemophilia had a fall down an escalator earlier in the day and now has bleeding in the left knee joint. What should be the emergency nurse's immediate action? Immediate transfusion of platelets Resting the patient's knee to prevent hemarthroses Assistance with intracapsular injection of corticosteroids Range-of-motion exercises to prevent thrombus formation
Resting the patient's knee to prevent hemarthroses Rationale: In patients with hemophilia, joint bleeding requires resting of the joint to prevent deformities from hemarthrosis. Clotting factors, not platelets or corticosteroids, are administered. Thrombus formation is not a central concern in a patient with hemophilia.
A 70-yr-old man who has end-stage lung cancer is admitted to the hospital with confusion and oliguria for 2 days. Which finding would the nurse report immediately to the health care provider? Weight gain of 6 lb Nausea and vomiting Urine specific gravity of 1.004 Serum sodium level of 118 mEq/L
Serum sodium level of 118 mEq/L Rationale: Lung cancer cells are able to manufacture and release antidiuretic hormone (ADH) with resultant water retention and hyponatremia. Hyponatremia (serum sodium levels less than 135 mEq/L) may lead to central nervous system symptoms such as confusion, seizures, coma, and death. The other options listed are also symptoms of hyponatremia but are not as critical to report to the health care provider.
The nurse collects a nutritional history from a 22-yr-old woman who is planning to conceive a child in the next year. Which foods reported by the woman would indicate that her diet is high in folate and iron? Crab, fish, and tuna Milk, cheese, and yogurt Spinach, beans, and liver White rice, potatoes, and pasta
Spinach, beans, and liver Rationale: Normal intake of iron & folic acid is necessary for the development of RBCs, & normal levels before conception & in early pregnancy are particularly important for normal fetal development. Foods high in both folic acid & iron include liver, red meat, egg yolks, turkey or chicken giblets, beans, lentils, chickpeas, soybeans, spinach, & collard greens. In addition, enriched cereals, pasta, & breads are also high in both folic acid & iron (check the labels).
A patient with cancer is having chemotherapy treatments and has now developed neutropenia. What care should the nurse expect to provide and teach the patient about? (Select all that apply.) Strict hand washing. Daily nasal swabs for culture. Monitor temperature every hour. Daily skin care and oral hygiene. Encourage the patient to eat all foods to increase nutrients. Private room with a high-efficiency particulate air (HEPA) filter
Strict hand washing. Daily skin care and oral hygiene. Private room with a high-efficiency particulate air (HEPA) filter Rationale: Strict hand washing & daily skin & oral hygiene must be done w/ neutropenia, because the pt is predisposed to infection from the normal body flora; other people; and uncooked meats, seafood, & eggs; unwashed fruits and vegetables; and fresh flowers or plants. The private room w/ HEPA filtration reduces the aerosolized pathogens in the pt's room. Blood cultures & antibiotic treatment are used when the patient has a temperature of 100.4° F or more, but temperature is not monitored every hour.
The nurse is caring for a patient with microcytic, hypochromic anemia. What teaching should the nurse provide about medication therapy? Take enteric-coated iron with each meal. Take cobalamin with green leafy vegetables. Take the iron with orange juice 1 hour before meals. Decrease the intake of the antiseizure medications to improve.
Take the iron with orange juice 1 hour before meals. Rationale: With microcytic, hypochromic anemia may be caused by iron, vitamin B6, or copper deficiency; thalassemia; or lead poisoning. The iron prescribed should be taken with orange juice 1 hour before meals as it is best absorbed in an acid environment. Megaloblastic anemias occur w/ cobalamin (vitamin B12) & folic acid deficiencies. Vitamin B12 may help red blood cell (RBC) maturation if the patient has the intrinsic factor in the stomach. Green leafy vegetables provide folic acid for RBC maturation. Antiseizure drugs may contribute to aplastic anemia or folic acid deficiency, but the patient should not stop taking the medications.
A blood type and cross-match has been ordered for a patient who has an upper gastrointestinal bleed. The results of the blood work indicate that the patient has type A blood. Which description explains this result? The patient can be transfused with type AB blood. The patient may only receive a type A transfusion. The patient has A antigens on his red blood cells (RBCs). Antibodies are present on the surface of the patient's RBCs.
The patient has A antigens on his red blood cells (RBCs). Rationale: A person with type A blood has A antigens, not A antibodies, on his RBCs. An AB transfusion would result in agglutination, but he may be transfused with either type A or type O blood.
The nurse is preparing to perform an assessment for a newly admitted patient with a potential hematologic disorder and petechiae. What does the nurse anticipate finding when assessing this patient? Tiny purple spots on the skin Large ecchymotic areas on the skin Hyperkeratotic papules and plaques Small, raised red areas on the soles of the feet
Tiny purple spots on the skin Rationale: Petechiae present as tiny purple spots on the skin. Large ecchymotic areas are purpura (typically raised).
When teaching a patient who is HIV positive, the nurse should explain that the virus can be transmitted: Only once the diagnosis has been made To anyone having contact with blood or semen Only to another susceptible individual As soon as manifestations of illness appear
To anyone having contact with blood or semen Pt education regarding safe sex
The nurse is caring for a patient with a diagnosis of disseminated intravascular coagulation (DIC). What is the first priority of care? Administer heparin. Administer whole blood. Treat the causative problem. Administer fresh frozen plasma.
Treat the causative problem. Rationale: Treating the underlying cause of DIC will interrupt the abnormal response of the clotting cascade and reverse the DIC. Blood product administration occurs based on the specific component deficiencies and is reserved for patients with life-threatening hemorrhage. Heparin will be administered if the manifestations of thrombosis are present and the benefit of reducing clotting outweighs the risk of further bleeding.
A patient is being treated for non-Hodgkin's lymphoma (NHL). What should the nurse first teach the patient about the treatment? Skin care that will be needed Method of obtaining the treatment Treatment type and expected side effects Gastrointestinal tract effects of treatment
Treatment type and expected side effects Rationale: The patient should first be taught about the type of treatment & the expected & potential side effects. Nursing care is related to the area affected by the disease & treatment. Skin care will be affected if radiation is used. Not all patients will have gastrointestinal tract effects of NHL or treatment. The method of obtaining treatment will be included in the teaching about the type of treatment.
Microcytic
a *small* red blood cell size
Neutropenia
a decreased number of WBCs pt is at increased risk for infection
purpura
a rash of purple spots due to small blood vessels leaking blood into the skin, joints, intestines, or organs typically RAISED lesions
Thrombo
clot
Leukocytosis
elevated white blood cell (WBC) count
Cytosis
elevation abnormal condition of cells ?
Hematocrit levels
females 35%-47% males 42%-54%
polycythemia
increased number of erythrocytes (RBCs) and hemoglobin in the blood extra cells cause the blood to be thicker, which increases risk of blood clots
pantocytopenia
low RBC, low WBC, & low platelets
Megaloblastic
pertaining to abnormally large red blood cells found in pernicious anemia
A patient with thrombocytopenia secondary to sepsis has small, pinpoint deposits of blood visible through the skin on the anterior and posterior chest. The nurse will document this skin abnormality as: A. petechiae. B. erythema. C. ecchymosis. D. telangiectasia.
petechiae. Rationale: Petechiae are pinpoint, discrete deposits of blood less than 1 to 2 mm in the extravascular tissues and visible through the skin or mucous membranes. Erythema is redness occurring in patches of variable size and shape. Telangiectasia is visibly dilated, superficial, cutaneous small blood vessels. Ecchymosis is a large, bruise-like lesion caused by a collection of extravascular blood in the dermis and subcutaneous tissue.
Erythro
red
Penia
reduction deficiency
Leuko-
white
