Chapter 30: Introduction to the Hematopoietic and Lymphatic Systems

A client's diagnosis of atrial fibrillation has prompted the primary care provider to prescribe warfarin, an anticoagulant. When assessing the therapeutic response to this medication, what is the nurse's most appropriate action? Assess for signs of myelosuppression. Review the client's platelet level. Assess the client's capillary refill time. Review the client's international normalized ratio (INR).

Review the client's international normalized ratio (INR).

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-negative child Rh-positive mother; Rh-negative child Rh-negative mother; Rh-positive child Rh-positive mother; Rh-positive child

Rh-negative mother; Rh-positive child

A nurse is transfusing whole blood to a client with impaired renal function. During the transfusion, the client tells the nurse, "I feel very short of breath all of a sudden." What is the nurse's primary action? Assess the client's vital signs. Stop the infusion. Call the health care provider. Slow the infusion.

Stop the infusion

When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply. Dietary intake Medication use Ethnicity Herbal supplements Hair color

Dietary intake Medication use Ethnicity Herbal supplements

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? Filgrastim Sargramostim Epoetin alfa Eltrombopag

Epoetin alfa

A nurse cares for a client with iron-deficiency anemia. Which treatment will the nurse anticipate the client receiving? Oral iron supplementation Intravenous iron supplementation Chemical chelation therapy Immunoglobulin therapy

Oral iron supplementation

Which type of lymphocyte is responsible for cellular immunity? B lymphocyte Plasma cell T lymphocyte Basophil

T lymphocyte

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. universal donors. only able to receive type A and type B blood. only able to receive type O blood.

universal recipients.

The nurse is describing normal RBC physiology to a client who has a diagnosis of anemia. The nurse should explain that the RBCs consist primarily of which of the following? Plasminogen Hemoglobin Hematocrit Fibrin

Hemoglobin

After withdrawing the needle from blood donor's arm, the site begins to bleed excessively. What is the nurse's first action? Apply a tourniquet above the antecubital fossa. Lower the arm below the level of the heart. Assist the client into an erect position. Hold firm pressure on the venipuncture site.

Hold firm pressure on the venipuncture site

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? Lateral position with one leg flexed Lithotomy position Supine with head of the bed elevated 30 degrees Jackknife position

Lateral position with on leg flexed

Which cells are called white blood cells? leukocytes lymphocytes erythrocytes platelets

Leukocytes

A client has a leukocyte count of 13,000/mm3. How would the nurse document the client's condition? Leukocytosis Leukopenia Leukotoxic Hemolysis

Leukocytosis

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following? Liver Pancreas Kidney Large intestine

Liver

Knowledge regarding hematopoiesis is essential in postsurgical client care. Which statement about the variation in the normal number of erythrocytes is true? People who engage in strenuous activity have an increased number of erythrocytes. Infants have fewer erythrocytes than adults. Women have more erythrocytes than men. People who live at higher altitudes have a decreased number of erythrocytes.

People who engage in strenuous activity have an increased number of erythrocytes.

Which cells are also known as thrombocytes? platelets erythrocytes leukocytes plasma

Platelets

An older adult client presents to the health care provider's office and reports exhaustion. The nurse, aware of the most common hematologic condition affecting the elderly, knows that which laboratory values should be assessed? WBC count RBC count Thrombocyte count Levels of plasma proteins

RBC count

A nurse is caring for a client who is undergoing preliminary testing for a hematologic disorder. What sign or symptom most likely suggests a potential hematologic disorder? Sudden change in level of consciousness (LOC) Recurrent infections Anaphylaxis Severe fatigue

Severe fatigue

Which of the following in a client's health history would the nurse recognize as potentially compromising the client's blood cell volume? Splenectomy Tonsillectomy Hysterectomy Appendectomy

Splenectomy

Which term is used to refer to a primitive cell that is capable of self-replication and differentiation? Band cell Spherocyte Reticulocyte Stem cell

Stem cell

A client with a disorder of the erythrocytes asks the nurse to explain what role these cells play. What would the nurse accurately explain to the client? Transport O2 to and remove CO2 from the tissues Carry oxygen to the cells of the body Engulf invading microorganisms and cellular debris, and manufacture antibodies Participate in clotting blood

Transport O2 to and remove CO2 from the tissues

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. may be developing anemia. has leukopenia. has thrombocytopenia.

may be developing an infection.

An adult client reports that it is taking longer than usual for minor cuts and injuries to clot. Which of the following questions would the nurse most likely ask the client? "Are you regularly taking aspirin?" "Are you eating sugary foods lately?" "Do you have a history of allergy or asthma?" "Have you been tested for hemophilia?"

"Are you regularly taking aspirin?"

A patient will need a blood transfusion for the replacement of blood loss from the gastrointestinal tract. The patient states, "That stuff isn't safe!" What is the best response from the nurse? "I agree that you should be concerned with the safety of the blood, but it is important that you have this transfusion." "The blood is carefully screened, so there is no possibility of you contracting any illness or disease from the blood." "I understand your concern. The blood is carefully screened but is not completely risk free." "You will have to decide if refusing the blood transfusion is worth the risk to your health."

"I understand your concern. The blood is carefully screened but is not completely risk free."

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? "You'll be given painkillers before the test, so there won't likely be any pain?" "You'll feel some pain when the needle enters your skin, but none when the needle enters the bone because of the absence of nerves in bone." "Most people feel some brief, sharp pain when the needle enters the bone." "I'll be there with you, and I'll try to help you keep your mind off the pain."

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

The nurse is caring for a client who had undergone hemodilution during surgery. Immediately after surgery, the nurse expects to see which lab result? Elevated erythrocyte concentration Elevated creatinine Critically low arterial oxygen saturation Decreased hematocrit

Decreased hematocrit

Which cells have the major function of transporting O2 to and removing CO2 from tissues? erythrocytes platelets leukocytes lymphocytes

Erythrocytes

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 Blood transfusion reaction Shock Splintering of bone fragments

Hemorrhage

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? Use an electric razor when assisting client with shaving. Elevate the client's head of the bed. Where a mask when entering the client's room. Apply supplemental oxygen to maintain the client's oxygenation.

Use an electric razor when assisting client with shaving.

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? Vitamin A deficiency Vitamin C deficiency Folic acid deficiency Vitamin B12 deficiency

Vitamin B12 deficiency

The nurse begins a routine blood transfusion of packed red blood cells (PRBCs) at 1100. To ensure client safety, the unit of blood should be completely transfused by what time? 1115 1500 1530 1600

1500

When reviewing a client's chart, the nurse notes that the client's tonsils are listed as grade 3. How does the nurse interpret this finding? The client's tonsils are not present. The client's tonsils are touching each other. The client's tonsils are touching the uvula. The client's tonsils are red and inflamed.

The client's tonsils are touching the uvula.

A patient with a diagnosis of HIV exhibits a decreased level of T lymphocytes. What consequence does this state present for this patient? The patient will be incapable of mounting a response to allergens. The patient is particularly susceptible to infection. The patient has diminished oxygen-carrying capacity. The patient will be unable to maintain hemostasis.

The patient is particularly susceptible to infection.

A client is being treated for chronic anemia and has questions about the condition. Which client statement indicates the need for further client education? "Red bone marrow is found primarily in the distal end of my long bones." "Red bone marrow is found primarily in my ribs." "Red bone marrow is found primarily in my skull." "Red bone marrow is found primarily in my breastbone."

"Red bone marrow is found primarily in the distal end of my long bones."

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? 86-year-old male with blood pressure 110/70 mm Hg 50-year-old female with pulse 95 beats/minute 26-year-old female with hemoglobin 11.0 g/dL 18-year-old male weighing 52 kg

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? 1 2 3 4

3

An instructor asks students approximately how long platelets last? What would the students correctly identify? 72 hours 7.5 days 75 days Lifetime

7.5 days

A nurse is reviewing blood count values for a female client. Which value would necessitate notifying the client's health care provider? 70,000/mm3 platelets 4,800,000/mm3 RBCs 8,200/mm3 WBCs All values are within the normal range.

70,000/mm3 platelets

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: Albumin. Globulin. Fibrinogen. Prothrombin.

Albumin

Plasma proteins play an essential role in maintaining water balance and blood pressure. Select the laboratory analysis that a nurse should review to check the levels of the most abundant plasma protein. Fibrinogen Prothrombin Gamma globulin Albumin

Albumin

Which cell types are produced from pluripotential stem cells? All options are correct. erythrocytes platelets lymphocytes

All options are correct

A client has an increased number of eosinophils. Which of the following disorders would the nurse expect the client to have? Allergy Liver failure Hemophilia Pediculosis pubis

Allergy

A nurse is educating a client about the role of B lymphocytes. The nurse's description will include which of the following physiologic processes? Stem cell differentiation Cytokine production Phagocytosis Antibody production

Antibody production

A client's low hemoglobin level has necessitated transfusion of PRBCs. Prior to administration, what action should the nurse perform? Have the client identify his or her blood type in writing. Ensure that the client has granted verbal consent for transfusion. Assess the client's vital signs to establish baselines. Facilitate insertion of a central venous catheter.

Assess the client's vital signs to establish baselines.

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? White blood cell filter Hepatitis B immunization Red blood cell phenotyping Chelation therapy

Chelation therapy

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? White blood count Complete blood count Thrombocyte count Level of B lymphocytes

Complete blood count

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 Decreased total iron-binding capacity Increased mean corpuscular volume Increased reticulocyte count

Decreased level of erythropoietin

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? A recurrence of the man's cancer Paralytic ileus Infection Decreased vitamin B12 absorption

Decreased vitamin B12 absorption

An 8-year-old client is scheduled to undergo a tonsillectomy for chronic tonsillitis. The symptoms given below are related to tonsil disorders. The nurse caring for this client should know that which of the following symptoms is specifically related to tonsillitis? Difficulty swallowing Headache Swelling and pain behind the ear Difficulty breathing unless sitting upright

Difficulty swallowing

A client on the medical unit is receiving a unit of PRBCs. Difficult IV access has necessitated a slow infusion rate and the nurse notes that the infusion began 4 hours ago. What is the nurse's most appropriate action? Apply an icepack to the blood that remains to be infused. Discontinue the remainder of the PRBC transfusion and inform the health care provider. Disconnect the bag of PRBCs, cool for 30 minutes and then administer. Administer the remaining PRBCs by the IV direct (IV push) route.

Discontinue the remainder of the PRBC transfusion and inform the health care provider.

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 Extreme leukocytosis Sickle cell anemia Renal transplantation

Essential thrombocythemia

Which of the following reports from the client during the health history would lead the nurse to suspect that the client has a disorder of the hematopoietic or lymphatic system? Select all that apply. Experiences prolonged bleeding from an obvious injury. Has unexplained blood loss, as in rectal bleeding, nosebleeds, bleeding gums, or vomiting blood. Feels fatigued with normal activities. Rarely bruises. Feels discomfort in the stomach.

Experiences prolonged bleeding from an obvious injury. Has unexplained blood loss, as in rectal bleeding, nosebleeds, bleeding gums, or vomiting blood. Feels fatigued with normal activities.

Which of the following signs would the nurse recognize as signs of leukopenia? Select all that apply. Fever Sore throat Chills Oozing from injection sites Dark, tarry stools

Fever Sore throat Chills

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. Administer supplementary oxygen by nasal prongs. Obtain a full set of vital signs. Inform a physician or other primary care provider.

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

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 Calcium Hemoglobin Potassium

Iron

The client's CBC with differential reveals small-shaped hemoglobin molecules. The nurse expects to administer which medication to this client? Iron Vitamin B12 Folate Fresh frozen plasma

Iron

The nurse is caring for a client who has developed scar tissue in many of the areas that normally produce blood cells. What organs can become active in blood cell production by the process of extramedullary hematopoiesis? Spleen and kidneys Kidneys and pancreas Pancreas and liver Liver and spleen

Liver and spleen

Which term refers to a form of white blood cell involved in immune response? Granulocyte Lymphocyte Spherocyte Thrombocyte

Lymphocyte

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? Myeloid stem cell Lymphoid stem cell Monocyte Neutrophil

Myeloid stem cell

Which type of white blood cell (WBC) is the most numerous? Neutrophil Lymphocyte Eosinophil Basophil

Neutrophil

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? Basophils Neutrophils Eosinophils Monocytes

Neutrophils

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 leukocytes erythrocytes lymphocytes

Platelets

A client is admitted to a healthcare facility with minor lacerations on the leg. The nurse caring for this client observes swelling in the tissues surrounding the affected area. A blood clot is suspected. The nurse should know that which of the following is the first step when the formation of a blood clot begins? Prothrombin activator starts to react with additional calcium ions Platelets break down and migrate to the injured area Thrombin converts the plasma protein fibrinogen into threads The threads of fibrin form a net to entrap RBCs and platelets

Platelets break down and migrate to the injured area

An individual has accidentally cut his hand, immediately initiating the process of hemostasis. Following vasoconstriction, what event in the process of hemostasis will take place? Fibrin will be activated at the bleeding site. Platelets will aggregate at the injury site. Thromboplastin will form a clot. Prothrombin will be converted to thrombin.

Platelets will aggregate at the injury site.

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? Monocytes B lymphocytes Leukocytes T lymphocytes

T lymphocytes

A client is visiting the physician and has signs and symptoms consistent with anemia. Why would the nurse ask the client about recent travel to foreign countries. The agent that causes malaria following the bite of an infected mosquito invades erythrocytes and causes anemia. Poor sanitation and food-handling practices in foreign countries may have exposed the client to anemia-causing pathogens. The client likely was exposed to an infectious disease during air or sea travel. Allergens in foreign environments can often lead to anemia.

The agent that causes malaria following the bite of an infected mosquito invades erythrocytes and causes anemia.

A client is being treated for the effects of a longstanding vitamin B12 deficiency. What aspect of the client's health history would most likely predispose her to this deficiency? The client has irregular menstrual periods. The client is a vegan. The client donated blood 60 days ago. The client frequently smokes marijuana.

The client is a vegan.

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? The client is having an allergic reaction to the blood. The client is experiencing vascular collapse. The client is having decrease in tissue perfusion from a shock state. The client is having a febrile nonhemolytic reaction.

The client is having febrile nonhemolytic reaction

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 stimulate erythropoietin, stimulating the marrow to produce more red blood cells. The bone marrow is stimulated by low oxygen levels in the blood and stimulates erythropoietin, maturing the red blood cells. The brain senses low oxygen levels in the blood and stimulates hemoglobin, which binds to more red blood cells. The kidneys sense low oxygen levels in the blood and stimulate hemoglobin, stimulating the marrow to produce more red blood cells.

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

A client is scheduled for a splenectomy. During discharge education, what teaching point should the nurse prioritize? The importance of adhering to prescribed immunosuppressant therapy The need to report any signs or symptoms of infection promptly The need to ensure adequate folate, iron, and vitamin B12 intake The importance of limiting activity postoperatively to prevent hemorrhage

The need to report any signs or symptoms of infection promptly

The nurse is reviewing a client's laboratory results and notes that her hemoglobin level is 15 g/dL. What action should the nurse take next? Document the finding as normal. Notify the physician because the client requires further testing. Record the result and recommend a retest in 6 weeks. Ask the client if she has had excessive menstruation or is lacking iron in her diet.

Document the finding as normal