Prep U chapter 32

Vitamin B12 deficiency

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?

Bone marrow aspiration and biopsy

A client is experiencing symptoms of myelodysplastic syndrome (MDS). The nurse prepare the client for which type of test to aid in diagnosing this condition?

Type O

A client is in the hospital with a bleeding gastric ulcer and requires a blood transfusion. He has been typed and crossmatched for 2 units of packed red blood cells and found to have type O blood. What type of blood will the nurse administer to this client?

"Avoid heavy lifting for several hours."

A client is preparing to leave the blood bank after donating a unit of blood. Which teaching will the nurse provide to the client at this time?

History of renal disease

A client is scheduled for surgery to remove an abdominal mass. The nurse knows that which reason hemodilution would be contraindicated as a method to provide blood to the client during the surgery?

Ensure there is an oxygen delivery device at the bedside.

A client receiving a blood transfusion reports shortness of breath, appears anxious, and has a pulse of 125 beats/minute. What is the best action for the nurse to take after stopping the transfusion and awaiting further instruction from the health care provider?

Disconnect the blood tubing, flush with normal saline, and administer morphine.

A client receiving a unit of packed red blood cells (PRBCs) has been prescribed morphine 1 mg intravenously now for pain. What is the best method for the nurse to administer the morphine?

Administer acetaminophen 500 mg po, as ordered

A client with Hodgkin disease had a bone marrow biopsy yesterday and reports aching at the biopsy site, rated a 5 (on a 1-10 scale). After assessing the biopsy site, which nursing intervention is most appropriate?

Chelation therapy

A client with a history of sickle cell anemia has developed iron overload from repeated blood transfusions. What treatment does the nurse anticipate will be prescribed?

Skin rash Diarrhea Abdominal cramping

A client with myelodysplastic syndromes (MDS) routinely takes oral chelation therapy. Which assessment findings indicate to the nurse that the client is experiencing side effects from this treatment? Select all that apply.

"The condition is likely caused by a vitamin B12 deficiency."

A nurse cares for a client with megaloblastic anemia who had a total gastrectomy three years ago. What statement will the nurse include in the client's teaching regarding the condition?

Iron

A nurse cares for a client with myelodysplastic syndrome who requires frequent PRBC transfusions. What blood component does the nurse recognize as being most harmful if accumulated in the tissues due to chronic blood transfusions?

Rh-negative mother; Rh-positive child

A nurse cares for several mothers and babies in the postpartum unit. Which mother does the nurse recognize as being most at risk for a febrile nonhemolytic reaction?

Albumin.

A nurse is assigned to care for a patient with ascites, secondary to cirrhosis. The nurse understands that the fluid accumulation in the peritoneal cavity results from a combination of factors including an alteration in oncotic pressure gradients and increased capillary permeability. Therefore, the nurse monitors the serum level of the plasma protein responsible for maintaining oncotic pressure, which is:

Hemorrhage

A nurse is caring for a patient who has had a bone marrow aspiration with biopsy. What complication should the nurse be aware of and monitor the patient for?

5

A nurse is preparing a dose of furosemide for an older adult with heart failure. The health care provider orders furosemide 1 mg/kg to be given intravenously. The client weighs 50 kg. The concentration of the drug is 40 mg/4mL (10 mg/mL). How many milliliters would the nurse administer? Record your answer using a whole number.

may be developing an infection.

A nurse is reviewing a client's morning laboratory results and notes a left shift in the band cells. Based on this result, the nurse can interpret that the client

T lymphocytes

A nurse, caring for a client with human immunodeficiency virus (HIV), reviews the client's differential WBC count. What type of WBC will the nurse check the level of?

Coagulopathy

A nursing instructor in a BSN program is preparing for a lecture on disorders of the hematopoietic system. Included in the lecture are conditions caused by reduced levels or absence of blood-clotting proteins. Which of the following is the instructor most likely referring to?

Essential thrombocythemia

A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse know is the most likely clinical disorder the patient is being treated for?

Decreased level of erythropoietin

A patient with chronic kidney disease is being examined by the nurse practitioner for anemia. The nurse has reviewed the laboratory data for hemoglobin and RBC count. What other test results would the nurse anticipate observing?

Hold firm pressure on the venipuncture site.

After withdrawing the needle from blood donor's arm, the site begins to bleed excessively. What is the nurse's first action?

Iron

The client's CBC with differential reveals small-shaped hemoglobin molecules. The nurse expects to administer which medication to this client?

Smooth tongue

The nurse expects which assessment finding of the oral cavity when the client is diagnosed with pernicious anemia?

Decreased oxygen level.

The nurse expects which assessment finding when caring for a client with a decreased hemoglobin level?

The client is having a febrile nonhemolytic reaction.

The nurse is administering a blood transfusion to a client over 4 hours. After 2 hours, the client reports chills and has a fever of 101°F, an increase from a previous temperature of 99.2°F. What does the nurse recognize is occurring with this client?

Iron

The nurse is caring for a client who has a unit of whole blood removed every 6 weeks as treatment for polycythemia vera. Which laboratory test will the nurse monitor to determine if the procedure is adversely affecting the client?

The kidneys sense low oxygen levels in the blood and produce erythropoietin, stimulating the bone marrow to produce more red blood cells.

The nurse is caring for a client with hypoxia. What does the nurse understand is true regarding the client's oxygen level and the production of red blood cells?

Anemia

The nurse is obtaining the health history of a client suspected of having a hematological condition. The nurse notes the client has a history of alcohol abuse. Which clinical presentation is related to alcohol consumption?

Apply pressure over the site for 5-7 minutes

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?

Use an electric razor when assisting client with shaving.

While caring for a client, the nurse notes petechiae on the client's trunk and lower extremities. What precaution will the nurse take when caring for this client?

Platelets

A client is diagnosed with extreme thrombocytosis. The nurse knows this condition is a result of which elevated blood cell count?

Factor V Leiden

A nurse is caring for a client who has been diagnosed with an autosomal dominant hematologic disorder. Which disease does the nurse suspect?

"The area might ache for 1 to 2 days."

A client is returning home after having a bone marrow aspiration and biopsy. Which statement indicates that teaching by the nurse has been effective?

Phagocytosis

Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils?

Stop the transfusion Notify the primary health care provider Administer diphenhydramine as prescribed

A client receiving a unit of packed red blood cells develops hives and generalized itching. Which actions will the nurse take to help this client? Select all that apply.

Intraoperative blood salvage

A client scheduled for hip replacement surgery did not have enough time to have autologous donations completed. The nurse knows that which action will be performed if the client requires blood during the surgery?

Explain the time frame needed for autologous donation.

A client wants to donate blood before his or her abdominal surgery next week. What should be the nurse's first action?

Erythropoietin

A client with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this client?

Lean meat

What food should the nurse recommend for a client diagnosed with vitamin B12 deficiency?

Myeloid stem cell

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets?

Lack of erythropoietin

A client in acute renal failure has been prescribed 2 units of packed red blood cells (PRBCs). The nurse explains to the client that the blood transfusion is most likely needed for which reason?

"My family will donate blood, because it's safer."

A preoperative client is discussing blood donation with the nurse. Which statement by the client indicates to the nurse the need for further teaching?

Assist the client in identifying appropriate subcutaneous injection sites.

G-CSF (filgrastim) is prescribed for a client with bone marrow suppression. What medication administration teaching should the nurse provide to the client?

Neutrophils

The body responds to infection by increasing the production of white blood cells (WBCs). The nurse should evaluate the differential count for what type of WBCs, which are the first WBCs to respond to an inflammatory event?

Disposing of the blood container and tubing in biohazard waste.

The charge nurse should intervene when observing a new nurse perform which action after a client has suffered a possible hemolytic blood transfusion reaction?

Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.

The nurse is instructing the client with polycythemia vera how to perform isometric exercises such as contracting and relaxing the quadriceps and gluteal muscle during periods of inactivity. What does the nurse understand is the rationale for this type of exercise?

Lateral position with one leg flexed

The nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. What position will the nurse place the patient in?

Risk for bleeding Infection prevention Methods to reduce fatigue Need for frequent laboratory monitoring

The nurse is preparing teaching for a client with myelodysplastic syndromes (MDS). Which topics will the nurse include in the teaching for this client? Select all that apply.

Remain for observation after eating and drinking.

The nurse is working at a blood donation clinic. What teaching should the nurse provide to the donor immediately after blood donation?

Crackles auscultated bilaterally

The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly?

Verify the client's identity according to hospital policy

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?

megaloblasts.

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called

Dietary intake Medication use Ethnicity Herbal supplements

When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply.

26-year-old female with hemoglobin 11.0 g/dL

Which client is not a candidate to be a blood donor according to the American Red Cross?

Petechiae

Which is a symptom of severe thrombocytopenia?

Hematocrit

Which term describes the percentage of blood volume that consists of erythrocytes?

Basophils

Which type of leukocyte contains histamine and is an important part of hypersensitivity reactions?

T lymphocyte

Which type of lymphocyte is responsible for cellular immunity?