Chapter 32 prep u hematology

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? 1500 1115 1600 1530

1500

A female patient has a hemoglobin of 6.4 g/dL and is preparing to have a blood transfusion. Why would it be important for the nurse to obtain information about the patient's history of pregnancy prior to the transfusion? If the patient has never been pregnant, it increases the risk of reaction. Obtaining information about gravidity and parity is routine information for all female patients. If the patient has been pregnant, she may have developed allergies. A high number of pregnancies can increase the risk of reaction.

A high number of pregnancies can increase the risk of reaction.

A nurse is teaching a patient 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 of the following patient statements? "I will eat a meat source such as chicken or pork with each meal." "I will increase my daily intake of orange vegetables such as sweet potatoes and carrots." "I will eat more dairy products such as milk, yogurt, and ice cream every day." "I will eat a spinach salad with lunch and dinner."

"I will eat a meat source such as chicken or pork with each meal."

The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly? Oral temperature of 97°F Respiratory rate of 10 breaths/minute Crackles auscultated bilaterally Pain and tenderness in calf area

Crackles auscultated bilaterally Increasing the flow rate of a blood transfusion too rapidly can result in circulatory overload. Fluid overload can be manifested by crackles in the lungs. A decreased respiratory rate and decreased temperature are not manifestations of fluid overload. Pain and tenderness in the calf area may indicate a thrombosis which is not as common a manifestation as fluid overload.

10. The nurse expects which assessment finding when caring for a client with a decreased hemoglobin level? Increased bruising. Decreased oxygen level. Bright red venous blood. Elevated temperature.

Decreased oxygen level.

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

Hold firm pressure on the venipuncture site Excessive bleeding at the venipuncture site may be caused by not applying enough pressure at the site. Applying a tourniquet will exacerbate the bleeding. After applying pressure, the arm should be raised above heart level. Helping the client into an erect position will not help stop the bleeding.

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.) Serial chest x-rays Intra-aortic balloon pump Intubation and mechanical ventilation Oxygen Fluid support

Intubation and mechanical ventilation Oxygen Fluid support

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

Lateral position with one leg flexed

7. Which of the following terms refers to a form of white blood cell involved in immune response? Lymphocyte Spherocyte Granulocyte Thrombocyte

Lymphocyte

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

Myeloid stem cell

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. Eosinophils Neutrophils Basophils Monocytes

Neutrophils

A client involved in a motor vehicle accident arrives at the emergency department unconscious and severely hypotensive. The nurse suspects he has several fractures in the pelvis and legs. Which parenteral fluid is the best choice for the client's current condition? Fresh frozen plasma Normal saline solution Packed red blood cells (RBCs) Lactated Ringer's solution

Packed red blood cells (RBCs) In a trauma situation, the first blood product given is unmatched (O negative) packed RBCs. Fresh frozen plasma is commonly used to replace clotting factors. Normal saline or lactated Ringer's solution is used to increase volume and blood pressure; however, too much colloid will hemodilute the blood and doesn't improve oxygen-carrying capacity as well as packed RBCs do.

Which of the following is a symptom of severe thrombocytopenia? Dyspnea Petechiae Inflammation of the mouth Inflammation of the tongue

Petechiae Patients with severe thrombocytopenia have petechiae (i.e. pinpoint hemorrhagic lesions, usually more prominent on the trunk or anterior aspects of the lower extremities).

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 Asks the client if he was ever known as Donald A. Smith Administers the unit of blood Refuses to administer the blood Checks with Blood Bank first and then administers the blood with their permission

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 and drinking. Sit up promptly after the needle is removed. Hold the involved arm below the heart. Remove the band-aid after 5 minutes.

Remain for observation after eating and drinking. After blood donation, the donor receives food and fluids and is asked to remain for observation. After the needle is removed, donors are asked to hold the involved arm straight up, and firm pressure is applied with sterile gauze for 2 to 3 minutes. A firm bandage is then applied. The donor remains recumbent until he or she feels able to sit up, usually within a few minutes.

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

The patient is having a febrile nonhemolytic reaction. The signs and symptoms of a febrile nonhemolytic transfusion reaction are chills (minimal to severe) followed by fever (more than 1°C elevation). The fever typically begins within 2 hours after the transfusion is begun. Although the reaction is not life threatening, the fever, and particularly the chills and muscle stiffness, can be frightening to the patient.

A nurse is reviewing a patient's morning lab results and notes a left shift in the band cells. Based on this observation, what interpretation can the nurse make from these results? The patient has thrombocytopenia. The patient may be developing anemia. The patient has leukopenia. The patient may be developing an infection.

The patient may be developing an infection

3. The client is to receive a unit of packed red blood cells. The first intervention of the nurse is to Observe for gas bubbles in the unit of packed red blood cells. Verify that the client has signed a written consent form. Check the label on the unit of blood with another registered nurse. Ensure that the intravenous site has a 20-gauge or larger needle

Verify that the client has signed a written consent form.

14. The physician orders a transfusion with packed red blood cells (RBCs) for a patient 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? Premedicate the patient with acetaminophen (Tylenol) Administer the blood as soon as it arrives Verify the patient identification according to hospital policy Stay with the patient during the first 15 minutes of the transfusion

Verify the patient identification according to hospital policy Acute hemolytic transfusion reactions are preventable. Improper identification is responsible for the majority of hemolytic transfusion reactions. Meticulous attention to detail in labeling blood samples and blood components and accurately identifying the recipient cannot be overemphasized. It is the nurse's responsibility to ensure that the correct blood component is transfused to the correct patient.

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 Hazards of either bone marrow aspiration or biopsy include bleeding and infection. The risk of bleeding is somewhat increased if the patient's platelet count is low or if the patient has been taking a medication (e.g., aspirin) that alters platelet function.

A patient develops a hemolytic reaction to a blood transfusion. What actions should the nurse take after this occurs? (Select all that apply.) Administer diphenhydramine (Benadryl). Begin iron chelation therapy. Document the reaction according to policy. Collect a urine sample to detect hemoglobin. Obtain appropriate blood specimens.

Obtain appropriate blood specimens. Collect a urine sample to detect hemoglobin. Document the reaction according to policy. If a hemolytic transfusion reaction or bacterial infection is suspected, the nurse does the following: obtains appropriate blood specimens from the patient; collects a urine sample as soon as possible to detect hemoglobin in the urine; and documents the reaction according to the institution's policy.

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? "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." "The blood is carefully screened, so there is no possibility of you contracting any illness or disease from the blood." "I agree that you should be concerned with the safety of the blood, but it is important that you have this transfusion."

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

The nurse should provide further teaching about post bone-marrow biopsy procedures when the client makes which of the following statements? "I should not take aspirin-containing products for pain relief." "I may feel some aching in my hip for 1-2 days." "I'll ask someone to drive me home when I awake from general anesthesia." "I will keep the sterile dressing on until my doctor tells me it's okay to remove it."

I'll ask someone to drive me home when I awake from general anesthesia." A bone marrow biopsy is usually performed with local anesthesia, not general. Aspirin can increased the risk of bleeding and should be avoided post procedure. The client should expect to feel some aching in the hip area for 1-2 days. A sterile dressing is applied upon completion of the procedure and should remain in place until the healthcare provider tells the client it is safe to remove.