chapter 30

Which of the following signs would the nurse recognize as signs of thrombocytopenia? Select all that apply.

Dark, tarry stools Oozing from injection sites Bleeding of the gums

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?

Decreased level of erythropoietin

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

Iron

Plasma

Liquid part of blood

Neutrophils

WBC are a major component of the inflammatory response and defense against bacterial infection

leukopenia.

a decreased WBC number is called

Monocytes

also known as macrophages because they phagocytize large-sized debris, help combat severe infections and contribute to the immune response

Hematopoiesis

blood cell formation

lymphatics system

circulates interstitial fluid and carries it to the veins

yellow marrow

consists of fat cells and connective tissue

hemolysis

destruction of erythrocytes (RBC)

Spleen

is a reservoir of blood and contains phagocytes that engulf damaged erythrocytes and foreign substances.

lymph

is fluid with a composition similar to plasma.

Leukocytes (WBC)

(or WBCs) perform various protective functions such as engulfing invading microorganisms and cellular debris and manufacturing antibodies

Which of the following cells are capable of differentiating into plasma cells?

B lymphocytes

The client is diagnosed with polycythemia vera. The nurse prepares the client for which procedure?

Phlebotomy

leukocytes last?

is only 1 to 2 days

Albumin

, which is formed in the liver, is the most abundant protein in plasma. Under normal conditions, albumin cannot pass through a capillary wall.

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

Hematocrit

Splenic sequestration is diagnosed in a client admitted with splenomegaly. What is the priority of care for this client?

Hypovolemia

A nurse educator is lecturing a group of students on caring for patients with a hematopoietic disorder. The nurse begins the lecture by providing a definition of hematopoiesis. This term is best defined as the normal:

formation and development of blood cells.

lymph nodes

glandular tissue along the lymphatic network, are clustered in the axilla, groin, neck, and large vessels of the thorax and abdomen

Basophils

25-100

An elderly client has urinary incontinence at least once a day and is scheduled for a Schilling test. The nurse

Consults the physician about insertion of a Foley catheter

The nurse is providing care for an older adult who has a hematologic disorder. What age-related change in hematologic function should the nurse integrate into care planning?

Older adults are less able to increase blood cell production when demand suddenly increases.

Hemophilia

A hereditary disease where blood does not coagulate to stop bleeding

Erythropoietin

A hormone produced and released by the kidney that stimulates the production of red blood cells by the bone marrow.

Lymphocytes

1,000-4,000

Monocytes

6100-600

A nurse has participated in organizing a blood donation drive at a local community center. Which of the following individuals would most likely be disallowed from donating blood?

A woman whose blood pressure is 88/51 mm Hg

A patient with esophageal varices secondary to liver cirrhosis has received a transfusion of frozen plasma. The nurse is aware of the fact that plasma:

Accounts for the majority of the blood's volume in the body

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?

IRON

Hemoglobin (Hgb)

hemoglobin is 12.0 to 17.4 g/dL; last 120 days

leukocytosis

increased number of leukocytes (WBC) is called

Agranulocytes are divided into two groups:

lymphocytes and monocytes

Hematocrit

percentage of blood volume occupied by red blood cells

pluripotential stem cells

stem cell source of all blood cells in the bone marrow

Agranulocytes

that do not contain granules

phagocytosis and microphages

the ingestion and digestion of bacteria and foreign substance

Granulocytes. Granulocytes, also called polymorphonuclear leukocytes, are divided into

three subgroups: neutrophils, basophils, and eosinophils

Granulocytes

which contain cytoplasmic granules,

A client has been scheduled for a bone marrow biopsy and admits to the nurse that she is worried about the pain involved with the procedure. What client education is most accurate?

"Most people feel some brief, sharp pain when the needle enters the bone."

Myeloid stem cells are converted

(1) erythrocytes, which are red blood cells (RBCs); (2) several types of leukocytes, or white blood cells (WBCs); and (3) platelets, also known as thrombocytes because they help control bleeding by forming a loose blood clot

Thrombocytopenia results when there is excess bleeding as a result of trauma, injury, or surgery. The nurse should check the platelet count in patients with these conditions. The baseline reading that is of concern and requires continued monitoring, but does not warrant instituting bleeding precautions, is a count of:

120,000/mm3.

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

Neutrophils

3,000-7,000

Eosinophils

450-400

lymphocytes

A type of white blood cell that make antibodies to fight off infections

A client who has idiopathic thrombocytopenia purpura (ITP) has a critically low platelet count. Which nursing intervention will be included in the care plan for this client?

Administer eltrombopag

A client has an increased number of eosinophils. Which of the following disorders would the nurse expect the client to have? Select all that apply.

Allergy Parasitic infection

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

Assist the client in identifying appropriate subcutaneous injection sites.

A nurse is assisting with a bone marrow aspiration. Place the steps listed below in the correct sequence that the nurse would perform them from first to last.

Determine the site from which the physician intends to obtain the sample of bone marrow, for example, iliac crest or sternum. Position the client on his or her back or side to facilitate access to the aspiration site. Cleanse, clip hair, and drape the skin at the test site. Label the biopsy specimen in preservative and ensure its delivery to the laboratory.

A nurse is explaining the processes related to hemoglobin to a client with a clotting disorder. Place the steps in the correct order from first to last that the nurse would outline.

Erythrocytes pass through the lungs. Hemoglobin picks up oxygen and releases CO2. Oxygenated, bright red blood is carried by arteries, arterioles, and capillaries to all body tissues. Hemoglobin releases oxygen for use by the tissues. Dark red blood returns by way of the veins to the heart and lungs. CO2 is released and the blood is reoxygenated.

The nurse cares for a client with a coagulation factor deficiency who is actively bleeding. Which blood component replacement does the nurse anticipate administering?

FFP ( Fresh frozen plasma)

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

Factor V Leiden

The nurse caring for a client with acute liver failure should expect which assessment finding?

Generalized edema

A nurse administers blood products to a client with Hodgkin disease. During the administration, the nurse notes the client has a fever and diffuse reddened skin rash. From what condition does the nurse suspect the client is suffering?

Graft-versus-host disease

A nurse at a blood donation clinic has completed the collection of blood from a woman. The woman states that she feels "lightheaded" and she appears visibly pale. What is the nurse's most appropriate action?

Help her into a sitting position with her head lowered below her knees.

A nurse is performing an initial assessment and notes the client's skin is a gray-tan color, especially on the scars of the client's arms. Which hematological condition does the nurse suspect?

Hemochromatosis

A client's electronic health record states that the client receives regular transfusions of factor IX. The nurse would be justified in suspecting that this client has what diagnosis?

Hemophilia

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?

Hemorrhage

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.

Leukocytes Platelets Erythrocytes

A nurse cares for an older adult client with acute myeloid leukemia (AML). What concept does the nurse understand leads to the increased risk of an older adult acquiring myeloid malignancies such as AML?

Older adults acquire damage to the DNA of stem cells over time.

The nurse is aware that a patient has been diagnosed with thrombocytopenia. Which of the following is the most typical first indicator of the diagnosis that a patient will exhibit?

Petechiae

A client has been diagnosed with a lymphoid stem cell defect. This client has the potential for a problem involving which of the following?

Plasma cells

A client's wound has begun to heal and the blood clot which formed is no longer necessary. When a blood clot is no longer needed, the fibrinogen and fibrin will be digested by which of the following?

Plasmin

A client has undergone a bone marrow aspiration. Which of the following findings after the procedure would alert the nurse to the possibility of infection in the client? Select all that apply.

Purulent drainage at the site Fever Swelling at the site

A Schilling test has been ordered for a client suspected of having pernicious anemia. What will the nurse include when explaining the procedure?

Radioactive vitamin B12 is given orally, followed in 1 hour by an injection of nonradioactive B12.

A client suffers a leg wound which causes minor blood loss. As a result of bleeding, the process of primary hemostasis is activated. What will occur during this process?

Severed blood vessels constrict.

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

Smooth tongue

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?

T lymphocytes

Hemoglobin (Hgb)

an iron-containing pigment attached to erythrocytes

platelets (thrombocytes)

approximately 7.5 days. 150,000 to 350,000/mm3 platelets migrate to the injury site.

basophils

are also capable of phagocytosis; they are active in allergic contact dermatitis (immediate hypersensitivity) and some delayed hypersensitivity reactions.

Lymph enters

each node by way of the afferent lymph duct, passes through the node, and leaves by the efferent lymph duct

Plasmin

enzyme that dissolves clots

D-dimer test for fibrin

fibrin degradation products, and factor assays.

Leukocytes are divided into two categories;

granulocytes and agranulocytes

Band cells are

immature neutrophils (WBC )

erythroblasts

immature red blood cells

T lymphocytes

interact with foreign cells and release a substance called lymphokine

A woman recovering from a recent mastectomy is talking with her nurse about lymphedema. She asks the nurse to explain the purpose of the lymphatic system. The nurse would explain that the system of lymphatics circulates:

interstitial fluid and carries it to the veins.

red marrow

is found in the ribs, sternum, skull, clavicles, vertebrae, proximal ends of the long bones, and iliac crest.

bone marrow aspiration

is performed to determine the status of blood cell formation (Fig. 30-11). In this procedure, the physician applies local anesthesia and removes bone marrow from the posterior iliac crest or the sternum.

Plasma

is the liquid, or serum, portion of blood. It consists of 90% water and 10% proteins transports proteins (albumin, globulins, and fibrinogen) and clotting factors such as prothrombin, pigments, vitamins, glucose, lipids, electrolytes, minerals, enzymes, and hormones.

Schilling test

is used to determine the etiology of vitamin B12 (cobalamin) deficiency causing pernicious anemia. is used to determine the etiology of vitamin B12 (cobalamin) deficiency causing pernicious anemia.

Which cells have the lifespan of 1 to 2 days and perform phagocytosis?

leukocytes

Thrombocytopenia

low platelet count

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.

Elephantiasis is caused by

obstruction of lymphatic drainage a roundworm infection in which the lymphatic vessels become occluded

Eosinophils

phagocytize foreign material. Their numbers increase in allergies, some dermatologic disorders, and parasitic infections.

Fibrinogen

plays a key role in forming blood clots. It can be transformed from a liquid to fibrin, a solid that controls bleeding.

globulins function

primarily as immunologic agents; they prevent or modify some types of infectious diseases.

B lymphocytes (B cells)

produce antibodies against foreign antigens,

A nurse is assisting a client into position prior to bone marrow aspiration. Which position will the nurse place the client prior to the procedure?

prones

Erythrocytes

red blood cells transport oxygen (or RBCs) are flexible, anuclear (lacking a nucleus), biconcave disks covered by a thin membrane through which oxygen (O2) and carbon dioxide (CO2) pass freely.

petechiae

small, pinpoint hemorrhages

lymphokine

which enhances the actions of phagocytic cells

Lymphocytes are divided into B lymphocytes (or B cells)

which provide humoral immunity by producing antibodies (immunoglobulins), and T lymphocytes (or T cells), which provide cellular immunity (or cell-mediated response).