Surg 2 Test 1
Using a penlight and tongue blade, the nurse inspects the client's tonsils for size and appearance. Tonsils are present and extend medially toward the uvula. How should the nurse grade these findings?
2
Which client is not a candidate to be a blood donor according to the American Red Cross?
26-year-old female with hemoglobin 11.0 g/dL
Using a penlight and tongue blade, the nurse inspects the client's tonsils for size and appearance. Tonsils are present and touch the uvula. How should the nurse grade these findings?
3
An instructor asks students approximately how long platelets last? What would the students correctly identify?
7.5 days
Plasma
90% water, 10% protein
A nurse has participated in organizing a blood donation drive at a local community center. Which client would most likely be disallowed from donating blood?
A client whose blood pressure is 78/49 mm Hg
Blood Groups
A, B, AB, O
A 66-year-old man underwent a successful partial gastrectomy for the treatment of stomach cancer 3 years ago. The man had a scheduled follow-up appointment with his primary caregiver and had blood work completed. The results of the man's blood work indicated anemia. The nurse who is contributing to the patient's care should recognize that this patient's anemia may be attributable to what factor?
Decreased vitamin B12 absorption
A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse know is the most likely clinical disorder the patient is being treated for?
Essential thrombocythemia
Lymph node biopsy/node dissection
Examining for presence of abnormal cells Local vs general anesthesia Lymphedema can be a complication
A client has a leukocyte count of 13,000/mm3. How would the nurse document the client's condition?
Leukocytosis
increased number of leukocytes
Leukocytosis
Other Transfusion Complications
Moderate Chilling Circulatory Overload HypocalcemiaHIV and Hepatitis B virus Transmission
A nurse cares for several mothers and babies in the postpartum unit. Which mother does the nurse recognize as being most at risk for a febrile nonhemolytic reaction?
Rh-negative mother; Rh-positive child
Which term is used to refer to a primitive cell that is capable of self-replication and differentiation?
Stem Cell
Bone Marrow Aspiration
Sternum or iliac crest Local anesthesia Preop considerations Consent Nursing Responsibilities
Splenectomy
Surgical removal of the spleenPostoperative concerns/complications
Leukopenia
decreased number of leukocytes
Hematopoiesis
manufacture and development of blood cells
Red Marrow
manufactures blood cells and hemoglobin
Yellow Marrow
manufactures blood cells under intense stimulation
lymphatic system
maturation of lymphocytes
A nurse is reviewing a client's morning laboratory results and notes a left shift in the band cells. Based on this result, the nurse can interpret that the client
may be developing an infection.
Pluripotential stem cells
myeloid and lymphoid stem cells
Granulocytes
neutrophils, eosinophils, basophils
Platelets
thrombocytes
Structures in hematopoietic system
Bone marrow Blood Lymphatic system
Basophils
active in allergic reactions
Plasma Proteins
albumins, globulins, fibrinogen
Platelet life span
approximately 7.5 days; produced in red bone marrow
Plasma
blood cells, protein, clotting factors, vitamins, glucose, lipids, electrolytes, minerals, enzymes, and hormones
erythropoietin
hormone released by kidney
Erythroblasts
immature erythrocytes
Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following?
liver
Lymph nodes
lymphatic system consists of vessels that drain tissue fluid (lymph
Agranulocytes
lymphocytes and monocytes
Lymph fluid
passes through the node—macrophages attack and engulf substances
Bone marrow
soft tissue fills spaces in interior of long and spongy bones
Erythrocytes
transport O2 and remove CO2 from the tissues
Plasma proteins
transport protein
A nurse in the ED is caring for a trauma client following a motor vehicle accident. The client's blood donor card indicates type AB blood. People with type AB blood are:
universal recipients.
Antigen
present or not present
Globulins
prevent and modify infections
Neutrophils
primary component of inflammatory response
Thymus gland
produces lymphocytes during fetal development
Erythropoiesis
production of erythrocytes; regulated by erythropoietin—hormone released by kidney
A client has an increased number of eosinophils. Which of the following disorders would the nurse expect the client to have?
Allergy
Transfusion Reactions
Incompatibility reaction Febrile Reaction Septic Reaction Allergic Reaction
Lymphatics
circulates interstitial fluid and carries it to the veins; filters and destroys pathogens and removes other harmful substances.
White blood cells and their function
engulf invading microorganisms and cellular debris and manufactures antibodies normal level is 5,000 to 10,000
Fibrogen
forming blood clots
Albumin
helps maintain osmotic pressure
types of Bone Marrow
red marrow and yellow marrow
Bilirubin
residual pigment from destroyed erythrocytes
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?
"I will eat a meat source such as chicken or pork with each meal."
A client has been scheduled for a bone marrow aspiration and admits to the nurse being worried about the pain involved with the procedure. Which statement by the nurse when providing client education would be most accurate?
"Most people feel some brief, sharp pain when the marrow is aspirated."
A patient with a recent history of hematologic abnormalities has been scheduled for a bone marrow biopsy. The patient has expressed to the nurse, "That sounds like an incredibly painful experience." How should the nurse best respond to this patient's concern?
"There is some pressure and pain when the doctor removes the marrow, but this should only be short-lasting."
Blood and Blood Products
Albumin Packed red blood cells (PRBC) Platelets Fresh frozen plasma (FFP) Cryoprecipitate
Bone Marrow/Stem cell transplant
Allogenic vs autologous Rejection of the transplant
A public health nurse is planning community teaching for a group of older adults regarding aging and hematological conditions. What condition will the nurse identify as most common among this population?
Anemia
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?
Apply pressure over the site for 5-7 minutes
A client's low hemoglobin level has necessitated transfusion of packed red blood cells. Prior to administration, which action should the nurse perform?
Assess the client's vital signs to establish baselines.
Which of the following cells are capable of differentiating into plasma cells?
B lymphocytes
A 75-year-old woman visited her health care provider for an annual check-up. She told the doctor that she feels exhausted all the time and barely has the energy to go out of her home, run errands, and visit friends. The nurse expects that the health care provider will order which of the following lab studies based on the most common hematologic condition affecting the elderly?
CBC
A client with myelodysplastic syndromes (MDS) receives routine blood transfusions. Which treatment will the nurse expect to be prescribed to prevent the development of iron overload?
Chelation therapy
A client on the medical unit is receiving a unit of packed red blood cells (PRBCs). Difficult intravenous (IV) access has necessitated a slow infusion rate, and the nurse notes that the infusion began 4 hours ago. Which action by the nurse is the most appropriate?
Discontinue the remainder of the PRBC transfusion, and inform the health care provider.
The nurse is working with a patient who has a hematological disorder. The nurse is aware that, in the process of hematopoiesis, stem cells differentiate into either myeloid or lymphoid stem cells. Into what broad cell types do myeloid stem cells differentiate? Select all that apply.
Erythrocytes Leukocytes Platelets
Components of blood plasma
Erythrocytes: red blood cells (RBCs) Leukocytes: white blood cells (WBCs ) Platelets: thrombocytes; forms loose blood clot
Types of leukocytes
Granulocytes Agranulocytes
A client is scheduled for surgery to remove an abdominal mass. The nurse knows that which reason hemodilution would be contraindicated as a method to provide blood to the client during the surgery?
History of renal disease
Hematopoietic System #1
Immune response
Eosinophils
Increase in allergic, dermatologic and parasitic infections
The nurse educating a client with anemia is describing the process of red blood cell production. When the client's kidneys sense a low level of oxygen in circulating blood, which physiologic response is initiated?
Increased levels of erythropoietin
A patient who has long-term packed RBC (PRBC) transfusions has developed symptoms of iron toxicity that affect liver function. What immediate treatment should the nurse anticipate preparing the patient for that can help prevent organ damage?
Iron chelation therapy
Which term refers to a form of white blood cell involved in immune response?
Lymphocyte
Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets?
Myeloid stem cell
Which type of white blood cell (WBC) is the most numerous?
Neutrophil
While hospitalized, a client accidentally injures his finger and begins to bleed. What substance does the nurse recognize as naturally rushing to the site of injury before any other action takes place?
Platelets
A client's diagnosis of atrial fibrillation has prompted the primary care provider to prescribe warfarin. When assessing the therapeutic response to this medication, which action by the nurse is the most appropriate?
Review the client's international normalized ratio (INR).
For any reaction
STOP THE TRANSFUSION!!! MONITOR THE PATIENT CLOSELY, INFORM THE MDSAVE THE BLOOD AND TUBING AND GIVE BACK TO BLOOD BANK IF DISCONTINUING.
A nurse is caring for a client who is undergoing preliminary testing for a hematologic disorder. Which sign or symptom of a hematologic disorder is most common?
Severe fatigue
The nurse expects which assessment finding of the oral cavity when the client is diagnosed with pernicious anemia?
Smooth tongue
Which type of lymphocyte is responsible for cellular immunity?
T lymphocyte
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?
The kidneys sense low oxygen levels in the blood and produce erythropoietin, stimulating the bone marrow to produce more red blood cells.
Blood administration
Use of NSS ONLY Infused within 30 minutes of receiving from blood bank Completed within 4 hours of starting
Spleen
both hematopoietic and immune functions; emergency reservoir of blood and removes bacteria and old or damaged red blood cells from circulation
Blood transfusion
both type and Rh compatible; typed and crossmatched
Hemoglobin
carries oxygen to cells of body Adult: 12.0 to 17.4 g/dL
Blood
consists of cells suspended in plasma
Blood groups
determined by heredity
Schilling test
diagnose pernicious anemia, macrocytic anemia, malabsorption syndromes
Leukocytes
engulf invading microorganisms and cellular debris and manufacturing antibodies
Which cells have the major function of transporting O2 to and removing CO2 from tissues?
erythrocytes
A client is diagnosed with extreme thrombocytosis. The nurse knows this condition is a result of which elevated blood cell count?
platelets
Which cells are also known as thrombocytes?
platelets
Which cells have the lifespan of approximately 7.5 days, and one-third of their population remains in the spleen (unless needed to fight significant bleeding)?
platelets
Rh factor
positive: protein present; if absent—Rh negative