Chapter 32: ASSESSMENT OF HEMATOLOGIC FXN & TREATMENT MODALITIES

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

MEGALOBLASTS

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

BASOPHILS

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

ADMINISTER ACETAMINOPHEN 500MG PO, AS ORDERED

The nurse is administering a blood transfusion to a patient over 4 hours. After 2 hours, the patient complaints of 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 patient?

THE PATIENT IS HAVING A FEBRILE NONHEMOLYTIC REACTION.

The nurse is screening donors for blood donation. The client who is an acceptable donor for blood is the client who:

REPORTS HAVING A COLD 1 MONTH AGO THAT RESOLVED QUICKLY

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 nurse is caring for a client who will undergo total knee replacement and will have an autologous transfusion. Which statement will the nurse include when teaching the client about the transfusion?

"YOU TYPICALLY DONATE BLOOD 4-6 BEFORE THE SURGERY."

A client is receiving platelets. In order to decreased the risk of circulatory overload in this client, the nurse should do which of the following?

INFUSE EACH UNIT OVER 30-60 MINUTES PER CLIENT TOLERANCE

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

The nurse should notify the healthcare provider before administering fresh frozen plasma (FFP) based on which assessment finding?

JUGULAR VENOUS DISTENTION

Which blood cell type is matched correctly with its function?

LEUKOCYTE: FIGHTS OFF INFECTION

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

DECREASED O2 LEVELS

The body responds to infection by increasing the production of white blood cells (WBCs). The nurse knows to evaluate the differential count for the level of __________, the first WBCs to respond to an inflammatory event.

NEUTROPHILS

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

PRONE

A nurse is caring for a client with diagnosis of lymphocytopenia. Which assessment finding will the nurse consider most concerning when caring for this client?

TEMPERATURE OF 37.7 DEGREES CELCIUS

The client is to receive a unit of packed red blood cells. The first intervention of the nurse is to

VERIFY THAT THE CLIENT HAS SIGNED A WRITTEN CONSENT FORM

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

A patient receiving plasma develops transfusion-related acute lung injury (TRALI) 4 hours after the transfusion. What type of aggressive therapy does the nurse anticipate the patient will receive to prevent death from the injury? (Select all that apply).

- OXYGEN - FLUID SUPPORT - INTUBATION & MECHANICAL VENTILATION

The nurse begins a routine blood transfusion of packed RBCs (PRBCs) at 1100. To ensure client safety, the unit of blood should be completely tranfused by what time?

1500

Which client is not a candidate for blood donation according to the American Heart Association?

26 YEAR OLD FEMALE WITH HEMOGLOBIN 11.0 G/DL

A client with a history of congestive heart failure has an order to receive 1 unit of packed red blood cells (RBCs). If the nurse hangs the blood at 12:00 pm, by what time must the infusion be completed?

4:00PM

In normal blood, monocytes account for approximately what percentage of the total leukocyte count?

5%

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:

ALBUMIN

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?

ANEMIA

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?

CHELATION THERAPY

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?

COAGULOPATHY

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?

CONTRACTION OF SKELETAL MUSCLE COMPRESSES THE WALLS OF VEINS AND INCREASES THE CIRCULATION OF VENOUS BLOOD AS IT RETURNS TO THE HEART

Post transfusion, the donor stands up immediately after the needle is withdrawn. The nurse should be alert for which vital sign change?

DECREASED BLOOD PRESSURE

The nurse is caring for a client who had undergone hemodilution during surgery. Immediately after surgery, the nurse expects to see which lab result?

DECREASED HEMATOCRIT

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

DISCONNECT THE BLOOD TUBING, FLUSH WITH NORMAL SALINE, AND ADMINISTER MORPHINE.

A client is a young, thin woman who is prescribed iron dextran intramuscularly. The nurse, when administering the medication:

EMPLOYS THE Z-TRACK TECHNIQUE

A client receiving a blood transfusion complains of 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 healthcare provider?

ENSURE THERE IS AN OXYGEN DELIVERY DEVICE AT THE BEDSIDE

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?

EPOETIN ALFA

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

ERYTHROPOIETIN (EPOGEN)

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

ERYTHROPOIETIN (EPOGEN)

A client verbalizes fear of infection from a blood transfusion. What is the nurse's best response?

EVERY UNIT OF DONATED BLOOD IS TYPED AND TESTED FOR ANTIBODIES TO INFECTIONS.

A client tells the nurse that he would like to donate blood before his abdominal surgery next week. What should be the nurse's first action?

EXPLAIN THE TIME FRAME NEEDED FOR AUTOLOGOUS DONATION

A nurse is completing a detailed health history and assessment in teh electronic medical record (EMR) for a client with a disorder of the hematopoietic system. Which symptom is the most commonly reported in association with hematologic diseases?

EXTREME FATIGUE

A nurse is completing a detailed health history and assessment in the electronic medical record (EMR) for a client with a disorder of the hematopoietic system. Which symptom is the most commonly reported in association with hematologic diseases?

EXTREME FATIGUE

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

FFP

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

GENERALIZED EDEMA

A client complains of extreme fatigue. Which system should the nurse suspect is most likely affected?

HEMATOLOGICAL

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

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

HOLD FIRM PRESSURE ON THE VENIPUNCTURE SITE

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

HYPOVOLEMIA

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 of the following reasons?

LACK OF ERYTHROPOIETIN

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

LATERAL POSITION WITH ONE LEG FLEXED

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following?

LIVER

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 RBCs and platelets?

MYELOID STEM CELL

A nurse cares for an older adult client with acute myeloid leukemia (AML). What concept dose 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

What is a symptom of severe thrombocytopenia?

PETECHIAE!!!

Which statement best describes the function of fibrinogen?

PLAYS A KEY ROLE IN FORMING BLOOD CLOTS

An older adult patient presents to the physician's office with a complaint of exhaustion. The nurse, aware of the most common hematologic condition affecting the elderly, knows that which laboratory values should be assessed?

RBCs COUNT

The nurse obtains a unit of blood for the client, Donald D. Smith. The name on the label on the unit of blood reads Donald A. Smith. All the other identifiers are correct. The nurse:

REFUSES TO ADMINISTER THE BLOOD

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

REMAIN FOR OBSERVATION AFTER EATING & DRINKING

A nurse reviews a client's laboratory results and notes the client has a decreased lymphocyte count. What nursing diagnosis will the nurse use when planning the client's care?

RISK FOR INFECTION

A nurse practitioner reviewed the blood work of a male patient suspected of having microcytic anemia. The nurse suspected occult bleeding. Identify the laboratory result that would indicate this initial stage of iron deficiency.

SERUM FERRITIN: 15ng/mL

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?

STOP THE INFUSION

The nurse began transfusing the first unit of packed red blood cells (PRBCs) fifteen minutes ago. The client begins complaining of shortness of breath, nausea, and is restless. What is the nurse's priority action?

STOP THE INFUSION

A nurse, caring for a patient with human immunodeficiency virus (HIV), reviews the patient's differential WBC count to check the level of which of the following?

T-LYMPHOCYTES

The physician believes that the patient has a deficiency in the leukocyte responsible for cell-mediated immunity. What should the nurse check the WBC count for?

T-LYMPHOCYTES

A 18-year-old client presents to the emergency department with a severe open fracture of the lower extremity. The health care provider tells the client that the client will need a blood transfusion. the client refuses, despite the advice of the health care provider. What does the nurse understand is the legal implication of the scenario?

THE CLIENT HAS A RIGHT TO REFUSE THE TRANSFUSION

A nursing instructor is reviewing the role and function of stem cells in the bone marrow with a group of nursing students. After providing the explanation, the instructor asks the students to use their knowledge of anatomy and physiology to determine an alternate way in which adults with diseases that destroy marrow can resume production of blood cells. Which explanation by the students is correct?

THE LIVER & SPLEEN CAN RESUME PRODUCTION OF BLOOD CELLS THROUGH EXTRAMEDULLARY

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

USE AN ELECTRIC RAZOR WHEN ASSISTING CLIENT WITH SHAVING

The client is to receive a unit of packed red blood cells. The first intervention of the nurse is to:

VERIFY THAT THE CLIENT HAS SIGNED A WRITTEN CONSENT FORM

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 gastronomy 2 years ago." Based on this information, the nurse attributes these symptoms to which problem?

VITAMIN B12 DEFICIENCY