Med-Surg Chapter 29

A patient who has undergone bone marrow aspiration is being monitored by the nurse. The nurse observes that bleeding is present at the needle aspiration site. Which action should the nurse advise the patient to perform?

After bone marrow aspiration, if bleeding is present at the site, the patient should be advised to lie on the affected side for 30 to 60 minutes to maintain pressure on the site. If the bed is too soft, the patient can lie on a rolled towel to provide additional pressure. Walking, sitting, and standing do not help to maintain pressure on the site.

The nurse is reviewing the hematologic study report of a 70-year-old patient. Which finding should the nurse consider normal for this patient?

As a result of the aging process, hematologic values may change but are considered normal for the older adult. The serum iron level may be decreased. Ferritin levels are increased, total iron-binding capacity may be decreased, and ESR is increased.

A patient experiences a skin allergy after contact with weeds. Which cells respond to this type of reaction?

Basophils respond to allergies and stimulate antigens in response to tissue injury. Platelets aid in clot formation. Monocytes are phagocytic cells that ingest dead cells and debris. Lymphocytes respond to cellular or humoral immune responses.

A nurse is caring for a patient who is a smoker. Which tests determine the effect of smoking on the hematologic system? Select all that apply.

Cigarette smoking increases low-density lipoprotein, cholesterol, and levels of CO2. It leads to hypoxia and altering of the anticoagulant properties of the endothelium. Smoking increases platelet reactivity, plasma fibrinogen, and hematocrit. Hence diagnostic studies such as fibrinogen, hematocrit, and platelet count are suggested. Biopsy study is required for malignancy detection. Skeletal x-ray study is used for the detection of lytic lesions associated with multiple myeloma.

Which component forms an adhesive bridge between platelets and vascular subendothelial structures in the clotting process?

Clotting is a process that prevents excessive bleeding during an injury. During plug formation, the platelets stick to one another and form clumps. The von Willebrand factor is an important component in forming an adhesive bridge between platelets and vascular subendothelial structures. Serotonin and platelet factor III are substances formed from platelets during an agglutination or aggregation reaction; these chemicals facilitate coagulation. Adenosine diphosphate is released from platelets during an agglutination reaction; it increases adhesiveness.

When assessing a patient's elimination patterns to determine the presence of hematologic conditions, the nurse should note which findings as important. Select all that apply.

Dark-colored urine or black-colored stools could mean presence of blood in urine or stool; decreased urine output may mean some abnormality and needs to be noted. Offensive sweating and excessive hunger and thirst are not related to elimination patterns in hematologic conditions.

On assessment, the nurse finds that a patient has an angioma with a round, red central portion and branching radiations on the face. A lab report shows an increase in estrogen levels. How should the nurse document the findings?

Development of an angioma with a round red central portion and branching radiations is called spider nevus. It is most commonly found on the face and can be due to an increase in the level of estrogen. Pruritus manifests as an unpleasant cutaneous sensation that provokes the desire to rub or scratch the skin. Epistaxis is spontaneous bleeding from the nares. Cyanosis refers to bluish discoloration of the skin and mucous membranes.

A patient is scheduled for a bone scan. A nurse explains the procedure to the patient. Which statements made by the patient indicate effective learning? Select all that apply.

During the bone scan the patient should lie down for better imaging. The patient should be advised to drink four to six glasses of water and then void before the imaging. This would help in visualization of the pelvic bones. The patient does not need to lie down in a small chamber or remove all metal objects. These interventions would be necessary for a magnetic resonance imaging (MRI). Presence of surgical staples interferes with an MRI, because they may obstruct the view; however, they do not interfere with the bone scan.

An elderly patient is diagnosed with pneumonia. The nurse reviews the patient's laboratory report, which reveals a normal WBC count. What are the likely reasons that the lab result does not correspond to the diagnosis of pneumonia? Select all that apply.

Elderly patients usually show only a minimal elevation in the total WBC count. It may be due to decreased T-cell function and humoral antibody response related to aging. The laboratory reports may not be erroneous, because infections in elderly patients do not manifest as a high WBC count. There may not be any error in obtaining the sample. The elderly patient usually has a decreased bone marrow reserve of granulocyte, due to suppression of bone marrow.

A patient experiences an allergic response. Which blood cell engulfs the associated antigen-antibody complex to reduce the allergic response?

Eosinophils are granulocytes that show phagocytic function and engulf antigen-antibody complex to reduce allergic response. Basophils are granulocyte cells that respond to allergic responses by releasing antigen within the granules. Mast cells respond to allergies by contracting smooth muscles and increasing the permeability of blood vessels. Lymphocytes are cells that respond to humoral or cellular immune responses.

A nurse is taking a clinical history of a patient who has hematologic problems. Which questions should the nurse ask? Select all that apply

Evaluation of the hematologic system is based on a thorough health history. It is important to know whether the patient had prior hematologic problems. Asking the patient about herbal therapy is important because herbal therapy can interfere with clotting. The risk of transfusion reaction and iron overload increases with the number of blood transfusions. People with a family history of hematologic problems have a much greater risk of developing them. If the patient has any difficulty performing daily activities, it indicates weakness due to compromised blood circulation. A history of fracture does not help to determine the hematologic status.

The nurse is assisting the health care provider in performing a bone marrow aspiration. The nurse expects the health care provider to perform the procedures in what order?

For bone marrow aspiration, the skin over the puncture site is cleansed with a bactericidal agent; then the skin, subcutaneous tissue, and periosteum are infiltrated with a local anesthetic agent. The bone marrow needle is inserted through the cortex of the bone. The stylet of the needle is then removed, the hub is attached to a 10-mL syringe, and 0.2 to 0.5 mL of the fluid marrow is aspirated.

Which condition is the most common cause for hematemesis?

Hematemesis is bright red, brown, or black vomitus, associated with an underlying disease like peptic ulcer disease. Thalassemia is a hereditary autosomal disorder characterized by the abnormal growth of red blood cells or hemoglobin. Sickle cell anemia is a hereditary disorder, which manifests as a distorted shape of hemoglobin. Pernicious anemia is a deficiency in the production of red blood cells due to lack of vitamin B12.

A nurse recalls that which factor is responsible for maintaining acid-base balance in the body?

Hemoglobin acts as a buffer and plays a role in maintaining acid-base balance. White blood cells help in immune function. Prothrombin is a coagulation factor and helps in clotting. Platelets help in clotting.

Which component of the blood helps maintain acid-base balance?

Hemoglobin acts as a buffer that maintains blood acid-base balance. Platelets promote blood coagulation. Albumin is a plasma protein that helps to maintain oncotic pressure of blood. Leukocytes combat the invasion of pathogens.

A 65-year-old adult with anemia experiences hypoxemia and poor intestinal iron absorption. The nurse recognizes that a low hemoglobin level that is common in the older population may be contributing to the patient's condition. Which other contributing factor should the nurse assess in the patient?

Hemoglobin levels commonly decrease in both men and women after middle age. However, the nurse should also check for signs of gastrointestinal bleeding. Total serum iron and total iron binding capacity are decreased in older adults but do not account for potential alterations due to disease process and do not result in anemia. Stomatitis is an inflammation of the mucous lining of any of the structures in the mouth, which may involve the cheeks, gums, tongue, lips, throat, and roof or floor of the mouth. Severe iron deficiency anemia can lead to stomatitis, but stomatitis does not cause anemia.

A patient has impaired intracranial regulation and hypoxemia. The primary health care provider prescribes red blood cell indices for the patient, and the patient later asks the nurse to explain the purpose of the test. What should the nurse tell the patient?

Hemoglobin saturation results in hypoxemia and compromises brain function, causing the patient to experience difficulty with intracranial regulation. Red blood cell indices are special indicators that reflect red blood cell volume, color, and hemoglobin saturation. Hematocrit value gives the measure of packed cell volume of red blood cells. Hematocrit value is generally three times the hemoglobin value. Red blood cell morphology provides information regarding the size and shape of the patient's red blood cells. Total red blood cell count gives the number of circulating red blood cells.

What is the first process that occurs during normal hemostasis?

Hemostasis is a process that arrests bleeding. The vascular response is the first response to bleeding. Lysis of a clot is the counter mechanism to keep blood in its fluid state. This process occurs after the clot formation. Plasma clotting factors bind to platelet plugs and form a complex clot. The platelets aggregate to form a clump, which reduces the risk of bleeding. However, this takes place after vascular response.

A patient with anemia presents with a heart rate of 120 beats/minute. As what should the nurse document the heart rate?

If a patient is tachycardic, the heart rate is above 100 beats/minute, which may occur in anemic patients as a compensatory mechanism to increase cardiac output. If a patient is bradycardic, the heart rate is below 60 beats/minute. Hypertensive and hypotensive refer to blood pressure readings, not the heart rate.

A pregnant woman has Type O negative blood type. A nurse understands that the patient can have complications related to pregnancy if the fetus is Type O positive blood. How should the nurse prevent complications in the patient?

In a pregnant woman with Type O negative blood type, the mother's anti-D antibodies can cross the placenta and attack the red blood cells (RBC) of a fetus that is Rh-positive. This can lead to hemolysis of the RBCs. A pregnant woman with O negative should receive Rho(D) immune globulin (RhoGAM) injections to prevent the formation of anti-D antibodies. Antibiotics and herbal medicines may not affect antibody production. Folic acid preparation can help in preventing neural tube defects, but do not affect antibody production.

The patient has anemia and has had laboratory tests done to diagnose the cause. Which results should the nurse know indicate a lack of nutrients needed to produce new red blood cells (RBCs)? Select all that apply.

Increased homocysteine and MMA, along with decreased cobalamin, indicate cobalamin deficiency, which is a nutrient needed for RBC production. Decreased reticulocytes indicate low bone marrow activity in producing RBCs, not available nutrients. Elevated ESR is related to an increased inflammatory process, not anemia.

The nurse is evaluating a patient with a history of idiopathic thrombocytopenic purpura (ITP) who had a heart catheterization this morning via the right femoral groin. The complete blood count (CBC) shows a platelet count of 100,000/uL, and the nurse notes swelling of the right groin. What is the priority nursing action?

Low platelets as seen ITP may result in a decreased ability to clot; the right groin swelling may indicate the blood vessel is bleeding internally. Stopping the bleeding is the nurse's first priority, and this can be done by applying pressure. Notifying the charge nurse for help can be accomplished while holding pressure. Paging the cardiology resident on call, taking vital signs, and lowering the head of bed can happen once pressure has been applied to the groin.

What is the percentage of lymphocytes in the blood?

Lymphocytes are agranular leukocytes that form the basis of cellular and humoral immune responses. They constitute 20 percent to 40 percent of the white blood cells in the blood. Eosinophils are granular leukocytes; they constitute about 2 percent to 4 percent of leukocytes. Monocytes are agranular leukocytes that are approximately 4 percent to 8 percent of the white blood cells in the blood. Neutrophils are the most common granular leukocytes; they constitute about 50 percent to 70 percent of the white blood cells.

While reviewing the laboratory test results of a patient, the nurse finds that the patient's methylmalonic acid level is 0.4 µmol/L and hemoglobin is 10 mg/dL. What does the nurse infer from this finding?

Methylmalonic acid (MMA) is an indirect test for cobalamin (vitamin B12) because MMA metabolism requires cobalamin. It helps to differentiate cobalamin deficiency from folic acid deficiency. The normal value of methylmalonic acid is less than 0.2 µmol/L. Therefore a high methylmalonic acid level of 0.4 µmol/L indicates reduced metabolism due to a deficiency of cobalamin. Because the patient has a low hemoglobin level of 10 g/dL, the nurse infers that the patient has vitamin B12-deficiency anemia. The patient with hemolytic anemia will have high bilirubin levels and have a positive Coombs test. The patient with iron deficiency anemia will have decreased serum iron and ferritin, and an increased total iron binding capacity. The patient with folic acid deficiency anemia will have a value of folic acid less than 3 to 16 ng/mL.

Which cells ingest dead cells, tissue debris, and defective red blood cells?

Monocytes are phagocytic; they ingest dead cells, tissue debris, and defective red blood cells. Basophils stimulate antigens in response to tissue injury. Eosinophils activate in response to allergies and engulf antigen-antibody complex. Thrombocytes (platelets) help in clot formation.

The nurse is caring for a patient suspected to have multiple myeloma. Which diagnostic tests does the nurse suspect to be beneficial for this patient? Select all that apply.

Multiple myeloma is cancer of the bone marrow. A bone scan is used to evaluate the structures of bones in patients with multiple myeloma. A skeletal x-ray is used to detect lytic lesions associated with multiple myeloma. Bence Jones protein is found in patients with multiple myeloma. A negative finding is considered normal. Computed tomography is a noninvasive radiologic examination using a computer-assisted x-ray to evaluate the lymph nodes. Magnetic resonance imaging is a procedure that produces sensitive images of soft tissue. It is used to evaluate spleen, liver, and lymph nodes.

A patient complains of numbness in the hands and feet. On further assessment, the nurse finds that the patient has poor coordination and balance. Which laboratory finding does the nurse suspect to be the cause for the patient's condition?

Paresthesias of the feet and hands and poor coordination and balance due to ataxia are the clinical manifestations of vitamin B12 (Cobalamin), or folic acid, deficiency. The normal value of cobalamin is 200 to 835 pg/mL. Cobalamin (vitamin B12) of 150 pg/mL is less than the normal value, which indicates vitamin B12 deficiency. The normal range of total bilirubin is 0.2 to 1.2 mg/dL. A bilirubin level of 2 mg/dL indicates jaundice or liver dysfunction. The normal range of folic acid is 3 to 16 ng/mL. The patient's folic acid is within the normal range and does not indicate folic acid deficiency. A normal range for hemoglobin is 11 to 16 g/dL in females and 13.2 to 17.3 mg/dL in males. Hemoglobin of 10 g/dL indicates anemia in the patient. The patient with anemia may experience tachycardia, palpitations, pallor, and cyanosis.

On assessment, a nurse finds that a patient has a smooth and shiny tongue surface. The oral mucosa is thin and appears red from decreased papillae. The patient has a hemoglobin level of 8.0 mg/dL. What is the likely diagnosis of the patient?

Pernicious anemia manifests as low hemoglobin levels. The signs may include a smooth and shiny tongue surface and a thin mucosa that appears red due to decreased papillae. Yellow appearance of the sclera is a symptom of jaundice due to deposition of bilirubin. Spontaneous bleeding from the nares is a sign of epistaxis. Lymph nodes which are enlarged (greater than 1 cm) and tender to touch are symptoms of lymphadenopathy.

What is the primary function of red blood cells (RBCs)?

Red blood cells (RBCs) transport oxygen and carbon dioxide by binding those chemicals to the iron component of hemoglobin. Platelets initiate the blood coagulation process. Phagocytosis (the process of engulfing and destroying unwanted organisms) is the primary function of granular leukocytes. Leukocytes play an important role in protecting the body against infections.

A patient is diagnosed with anemia with suspected bone marrow depression. The nurse anticipates that which test will be prescribed to evaluate the rate and adequacy of erythrocyte production?

Reticulocytes are immature erythrocytes. A reticulocyte count indicates the rate at which new RBCs appear in the circulation. These cells usually develop into mature RBCs within 48 hours of release into the circulation. A reticulocyte count helps to evaluate the rate and adequacy of erythrocyte production. Platelet count indicates the status of the clotting mechanism. Total RBC count is suggestive of oxygen carrying capacity of the blood. Mean corpuscular volume helps to determine the relative size of the RBCs.

A patient reports small vessel occlusions causing a purple, mottled appearance of the face, nose, and fingers. The nurse suspects that the patient is experiencing what disorder?

Small vessel occlusions causing a purple, mottled appearance of the face, nose, fingers, or toes are the symptoms of erythrocytosis. It is a condition in which the proportion of blood volume occupied by red blood cells increases. Leukopenia is a condition in which the white blood cells count less than 4000/µL. Neutropenia is a condition in which the absolute neutrophil count (ANC) is less than 1000 cells/µL. Thrombocytopenia is a condition in which platelet counts falls below 100,000/µL.

After assessing the laboratory reports of a patient, the nurse concludes that the patient has impaired platelet function. Which finding supports the nurse's conclusion?

The clot retraction is the reflection of the time it takes to retract or shrink the clot from the sides of the test tube. This normally takes between 1 and 24 hours. However, the patient has a clot retraction time of 48 hours, indicating abnormal platelet function. The normal thrombin time is 17 to 23 seconds and the patient has a thrombin time of 22 seconds. This indicates that the patient has normal thrombin activity. The normal prothrombin time is 11 to 16 seconds and the patient has a prothrombin time of 15 seconds. This indicates that the patient has normal results and no involvement of the extrinsic system. The activated clotting time indicates coagulation status and the normal activated clotting time is 70 to 120 seconds. The patient has an activated clotting time of 2 minutes, indicating that the patient has normal coagulation.

Arrange the sequence followed by the nurse to examine the lymph nodes of the patient.

The posterior auricular nodes are present near the neck. The subscapular nodes are located at the arm. The epitrochlear nodes are located near the trachea. The inguinal lymph nodes are located in the groin area. Therefore the nurse first assesses the posterior auricular nodes, followed by the subscapular nodes, then the epitrochlear nodes, and finally, the inguinal lymph nodes.

A patient is diagnosed with thrombocytopenia and a lymph node biopsy has been scheduled. Which primary nursing interventions should be performed after the procedure? Select all that apply.

Thrombocytopenia refers to a low platelet count, which can predispose to bleeding. Therefore direct pressure should be applied to the biopsy site to ensure hemostasis. The site should be observed for bleeding, because the patient has a high risk of bleeding. The vital signs should be monitored for early detection of complications. Changing the dressing and inspecting the site for healing are not primary interventions; they can be performed later once the patient is stable.

When assessing laboratory values of a patient admitted with septicemia, what should the nurse expect to find?

When infections are severe, such as in septicemia, more granulocytes are released from the bone marrow as a compensatory mechanism. To meet the increased demand, many young, immature polymorphonuclear neutrophils (bands) are released into circulation. WBCs usually are reported in order of maturity (initially with the less mature forms on the left side of a written report). Hence the term "shift to the left" is used to denote an increase in the number of bands. Thrombocytosis occurs with inflammation and some malignant disorders. A decreased number of red blood cells indicates anemia. A decreased ESR is not indicative of septicemia.

The nurse is obtaining the family history of a patient. Which conditions should the nurse inquire about in order to obtain information regarding existing hematologic conditions? Select all that apply.

When taking a family history, it is important to explore hematologic conditions such as anemia, hemophilia (a bleeding disorder), and other clotting disorders. Information about influenza and conjunctivitis is not relevant to hematologic conditions.

A patient with a history of a well-balanced nutritional intake is diagnosed with anemia. To determine potential exposure to chemicals, which questions should the nurse include in the history-taking? Select all that apply.

While checking for a history of chemical exposure, the nurse asks whether the patient has worked in the military or not. Many Vietnam War veterans were exposed to a toxin-containing defoliant. This toxin increases the risk of leukemia and lymphoma. Therefore the nurse should ask if the patient has been in the military. A patient's occupation may cause exposure to chemicals like benzene, lead, naphthalene, and phenylbutazone. These chemicals are commonly used by potters, dry cleaners, and individuals involved with occupations that use adhesives. Some illnesses may cause a change in appetite and affect eating habits. Information about appetite and diet helps to determine dietary habits, but does not help in determining chemical exposure history. The dietary pattern of the patient is good, so there is no need to take a dietary history.

A nurse is performing the skin assessment of a patient. How would the nurse examine the entire body in a systematic manner?

While performing skin assessment, the nurse should examine the skin over the entire body in a systematic manner. Starting with the face and oral cavity and moving downward over the body helps to avoid missing any area. Light palpation is used for superficial lymph nodes evaluation. The lymph nodes evaluation is started at the head and neck. Pads of the fingers are used for light palpation of superficial lymph nodes.

The nurse reviews the laboratory reports of a patient and expects that the patient has a low hepcidin level. Which finding helps the nurse reach this conclusion?

hepcidin is a protein that regulates the circulation of iron levels in the body. A patient who has reduced serum iron will have decreased hepcidin levels. The normal serum iron range is 50 to 170 mcg/dL. Thus, a serum iron level of 40 mcg/dL indicates low hepcidin. The normal range of homocysteine is 3.7 to 10.4 µmol/L. The normal range of hemoglobin is 11.7 to 16.0 g/dL. Methylmalonic acid is used to test cobalamin levels. The normal level of methylmalonic acid is less than 2.4 mcg/dL.

A nurse is providing preprocedural teaching to a patient who is scheduled for a bone marrow aspiration. Arrange the steps of performing a bone marrow aspiration in the correct order.

A bone marrow aspiration involves obtaining bone marrow for cytologic and chromosomal investigations. The bone marrow is usually aspirated from the posterior iliac crest. During a bone marrow aspiration, the skin over the puncture site is prepared by using a bactericidal agent. A local anesthetic agent is then infiltrated into the skin, subcutaneous tissue, and periosteum. Following this, a bone marrow needle is inserted into the bone through the cortex. The stylet of the needle is then removed and the hub is attached to 10-mL syringe. The bone marrow is then aspirated. A volume of 0.2 to 0.5 mL is sufficient for laboratory investigations.

Which coagulation factor activates factor XI and is responsible for the initiation of the intrinsic pathway?

Also known as coagulation factor XII, the Hageman factor activates factor XI to initiate the intrinsic pathway of blood coagulation during an injury. The Stuart factor (coagulation factor X) activates the conversion of prothrombin to thrombin. Labile factor is coagulation factor V; it binds with factor X to activate prothrombin. Antihemophilic factor is coagulation factor VIII; it works with factor IX and calcium to activate factor X.

When assessing a patient's nutritional-metabolic pattern related to hematologic health, what should the nurse do?

Any changes in the skin's texture or color should be explored when assessing the patient's nutritional-metabolic pattern related to hematologic health. The presence of petechiae or ecchymotic areas could be indicative of hematologic deficiencies related to poor nutritional intake or related causes. Asking the patient about joint pain, assessing for vitamin C deficiency, and determining if the patient can perform ADLs are not specific to the nutritional-metabolic pattern related to hematologic health

A patient is diagnosed with a vitamin B12 deficiency. Which symptoms would the nurse find in the patient?

Cobalamin deficiency can affect the production of red blood cells (RBCs). A deficiency of RBCs in the blood circulation can manifest as numbness sensation, impaired muscle movement, and extreme sensitivity in nerves. Lacking physical strength or energy is the sign of low Hgb level (anemia). Pain in the pelvis, ribs, spine, and sternum are the symptoms of multiple myeloma. Abnormal sensitivity to touch or pressure on the sternum is a sign of leukemia.

The nurse is performing a health history and physical examination on a newly admitted patient. Significant information obtained from the physical examination that relates to the hematologic system includes what?

Note any petechiae or ecchymotic areas on the skin and, if present, document the frequency, size, and cause. The location of petechiae can indicate an accumulation of blood in the skin or mucous membranes. Small vessels leak under pressure, and the platelet numbers are insufficient to stop the bleeding. Petechiae are more likely to occur where clothing constricts the circulation. Bladder surgery, multiple pregnancies, and early menopause do not relate to the hematologic system.

Which laboratory finding is abnormal due to the aging process?

The effects of aging on hematologic studies include increased ferritin, increased mean cell volume (MCV), increased ESR, decreased serum iron, and decreased total iron binding capacity. A total iron binding capacity (TIBC) of 200 mcg/dL indicates a lower than normal value. The normal range of TIBC is 250 to 425 mcg/dL. The patient's ferritin, serum iron, and MCV values are normal. The normal ranges are ferritin 10 to 250 ng/mL, serum iron 50 to 175 mcg/dL, and MCV 80 to 100 fL.

The nurse is assessing a patient with a hematologic disorder and finds a red central portion with branching radiations on the patient's face, neck, and chest. Which laboratory finding does the nurse associate with the patient's condition?

The presence of a red central portion with radiating branches on the face, neck, and chest indicates that the patient has spider nevus. An increase in estrogen level dilates blood vessels; hence the patient will have swollen blood vessels resulting in spider nevus. A patient with a bleeding disorder will have reduced platelet count because blood coagulation is reduced. An increase in thyroid hormone levels increases the body's metabolism. However, it does not result in spider nevus or the dilation of blood vessels. A patient with an infection will have an increase in the white blood cell count

The nurse is reviewing the laboratory results of a patient and notes that the fibrinogen levels are at 150 mg/dL. The nurse will monitor the patient closely for which problem?

The reference level for fibrinogen is 200 to 400 mg/dL. A decrease in fibrinogen indicates that the patient possibly is predisposed to bleeding. A decrease in fibrinogen does not lead to increased risk for clot formation or for disseminated intravascular coagulation.

The thrombocytopenic patient has had a bone marrow biopsy taken from the posterior iliac crest. What nursing care is the priority for this patient after this procedure?

The sterile pressure dressing is applied after a bone marrow biopsy to ensure hemostasis. If bleeding is present, the patient will lie on the site and may need a rolled towel for additional pressure; thus this patient will not be in the prone position. The analgesic should have been administered preprocedure. Metal objects would be removed for a magnetic resonance imaging (MRI), not a bone marrow biopsy.

A nurse is caring for a patient that has a platelet count below 100,000/µL. The nurse should monitor the patient for what complications?

Thrombocytopenia is a condition in which the platelet counts falls below 100,000/µL. Normal platelet counts are between 150,000 and 400,000/µL. Leukemia is a type of cancer of the blood or bone marrow characterized by an abnormal increase of immature white blood cells. Leukopenia is a condition in which the white blood cell count is less than 4000/µL. Neutropenia is a condition in which the absolute neutrophil count (ANC) is less than 1000 cells/µL.

A nurse is reviewing the laboratory reports of a patient. Which parameter would require further investigation?

A normal WBC count is 4,000-11,000/µL. A count less than 4000/µL indicates bone marrow depression and severe or chronic illness, and needs further investigation. A hemoglobin level of 13.0 g/dL is a normal value. A hematocrit of 38% is within the normal range. A normal platelet count ranges from 150,000 to 400,000/µL, and a platelet count of 200,000/µL is within normal limits.

A patient presents with a white blood cell (WBC) count of 8000/µL, and the differential WBC count shows that the lymphocyte proportion is reduced to 10%. Which is the most appropriate action that the nurse should consider?

A patient may have a normal WBC count of 8000/µL, but the differential count may show that the proportion of lymphocytes is reduced to 10%, which is an abnormal finding and demands further investigation. Multivitamin supplements for an abnormal finding such as this would not be effective. Follow-up after two weeks is not recommended.

A nurse reviews the lab report of a patient that shows the white blood cell count is 15 × 109/L. Which condition is the patient likely experiencing?

A patient's medical report shows the white blood cell count to be 15 × 109/L. The normal range for a white blood cell count is between 4 × 109/L to 11 × 109/L. Elevations in white blood cell count are associated with infection, because white blood cells (WBCs) are immune cells. Neutropenia is a condition in which the absolute neutrophil count (ANC) is less than 1000 cells/µL. It does not increase the risk of bleeding. Thrombocytopenia is a condition in which platelet counts fall below 100,000/µL.

The nurse is caring for a patient diagnosed with an allergy. Which cells in the body may have compromised functioning?

A primary function of eosinophils is to engulf antigen-antibody complexes formed during an allergic response. Basophils show response in inflammation and allergic reactions. They respond by releasing substances within the granules. Thrombocytes initiate the clotting process by producing an initial platelet plug in the early phases of the process. The main function of granulocytes is phagocytosis

A patient is brought to an emergency department in an unconscious condition. The hemoglobin level of the patient is 20 g/dL. How should the nurse interpret the lab result?

The hemoglobin level in a normal healthy adult is 11 to 17 g/dL. The hemoglobin level may increase as a result of hemoconcentration as found in dehydration. A patient with anemia would have a low hemoglobin level due to decreased production of RBCs. A patient with internal hemorrhage would not have a high hemoglobin level of 20 g/dL; the patient would have a low hemoglobin level due to loss of intravascular volume. A patient with fluid volume excess would have a low hemoglobin level due to hemodilution.

After reviewing the medical records of a patient with a bleeding disorder, the nurse finds that the patient underwent an ileal resection. Which reason does the nurse suspect behind this finding?

The ileum is the site of cobalamin absorption, essential for proper functioning of the red blood cells. Therefore the patient with an ileal resection will have a bleeding disorder due to impaired cobalamin absorption. The duodenum is the site for iron absorption. Therefore the patient with a duodenal excision will have impaired iron absorption that results in a bleeding disorder. The patient with a partial or total gastrectomy will have a loss of parietal cells, which reduces the intrinsic factor levels. A patient who underwent a gastric bypass will have reduced parietal surface area, because the duodenum is bypassed.

The laboratory report of an elderly patient shows slight decrease in the mean corpuscular hemoglobin concentration. The nurse recognizes that what could be the reason for the decrease?

The red blood cell plasma membranes are more fragile in an older person. This may account for a slight decrease in the mean corpuscular hemoglobin concentration (MCHC) of the red blood cells. Microcytosis is a condition in which the mean corpuscular hemoglobin level is decreased. Spherocytosis is a condition in which the corpuscular hemoglobin concentration increases. Erythrocytosis is a disease state in which the proportion of blood volume occupied by red blood cells increases.

A patient who underwent splenectomy has a platelet count of 500,000/µL. The nurse recognizes that due to the absence of the spleen, the increased number is due to the impairment of which major function of spleen?

The spleen has four major functions: storage, filtration, immunologic, and hematopoietic. The spleen acts as a storage site for red blood cells and platelets. Thus a patient with a splenectomy has higher circulating levels of platelets due to impaired storage function. If there is a high level of old and defective red blood cells, then the filtration function is affected. The spleen's immunologic function is demonstrated by a rich supply of lymphocytes, monocytes, and stored immunoglobulins. The spleen's hematopoietic function is demonstrated by a failure to produce red blood cells during fetal development.

A patient has undergone a splenectomy. The nurse recalls that this surgery can cause what changes in the hematologic system?

The spleen is an important component of the hematologic system and is involved in hematopoietic, filtration, immunologic, and storage functions. The platelets are stored in the spleen. If the spleen is removed, it may result in higher circulating levels of platelets than in a person with spleen. Removal of the spleen does not affect hemoglobin levels because the production of RBCs does not take place in the spleen. Also, it does not affect the phagocytosis mechanism. It does not evoke inflammation and allergic reactions; these are the function of the basophils, which are not affected by the removal of the spleen.

The nurse reviews a laboratory report of a patient that shows a mean corpuscular hemoglobin concentration (MCHC) of 27%. In which condition is the MCHC lower than the normal range?

The mean corpuscular hemoglobin concentration (MCHC) is 27%, which is lower than the normal range. The normal range of the mean corpuscular hemoglobin concentration is 32% to 37%. A decrease in this is termed hypochromia. Macrocytosis is a condition in which the mean corpuscular hemoglobin level is high. Spherocytosis is a condition in which the corpuscular hemoglobin concentration increases. Erythrocytosis is a condition in which the proportion of blood volume occupied by the red blood cells increases. It implies that the blood contains a greater number of red blood cells

What is the function of factor XI (plasma thromboplastin antecedent)?

Factor XI is plasma thromboplastin antecedent, which activates factor IX (Christmas factor) in the presence of calcium. Factor XIII is the fibrin-stabilizing factor; it cross-links fibrin strands to stabilize the fibrin clot during hemostasis. Factor X is called the Stuart-power factor; it activates factor II in order to convert prothrombin to thrombin. Factor VIII is an antihemophilic factor that works with factor IX and calcium to activate factor X.

What is the function of fibrinolysis?

Fibrinolysis is the process of fibrin clot dissolution. This process maintains the blood in fluid form after the clot is resolved. Reticulocytes are immature red blood cells, which provide accurate information about the adequacy of red blood cells. Hemolysis removes damaged red blood cells with the help of monocytes and macrophages. Pancytopenia is a condition that manifests as a marked decrease in number of red blood cells, white blood cells, and platelets.

Which stem cell differentiates to form neutrophils?

Myeloblasts differentiate to form neutrophilic metamyelocytes, which further differentiate to create band cells. Band cells divide and give rise to neutrophils. Monoblasts create monocytes. Erythroblasts differentiate to form erythrocytes, or red blood cells. Megakaryoblasts differentiate to form thrombocytes, or platelets.

The nurse is assessing four patients in a clinical care setting. Which patient does the nurse suspect has neutropenia?

Neutropenia is a condition in which the absolute neutrophil count (ANC) is less than 1000 cells/µL. The absolute neutrophil count is determined by multiplying the total WBC count by the percentage of neutrophils. The ANC of a patient with WBC of 9000/µL and 10% neutrophils is 900 cells/µL. Therefore the nurse suspects neutropenia in this patient. The ANC of a patient who has a WBC of 5000/µL and 30% neutrophils is 1500 cells/µL, which does not indicate neutropenia. The ANC of a patient with a WBC of 7000/µL and 30% neutrophils is 2100 cells/µL, which is normal. Therefore the nurse does not suspect neutropenia in this patient. The ANC of patient who has a WBC of 10,000/µL and 10% neutrophils is 2000 cells/µL, which is normal and does not indicate neutropenia.

A patient suspected for malignancy is scheduled for a PET scan to highlight areas with increased metabolism. What is the appropriate nursing intervention in this situation?

Positron emission tomography (PET) is a radiologic study and a valuable diagnostic tool that detects malignancy because it highlights areas with increased metabolism. The nursing intervention for this patient would be to instruct him or her to avoid anything by mouth except for water and medications for at least four hours before the test. Application of pressure dressing is useful for the patient after a bone marrow biopsy to reduce bleeding at the site. Administering analgesics before the procedure is beneficial in a bone marrow biopsy to enhance the patient's comfort and cooperation. The nurse should instruct the patient undergoing a bone scan to drink four to five glasses of water and void before the test.

Which term refers to the resident macrophages in the liver?

Special names are given to macrophages that reside in different tissues. The resident macrophages in the liver are called Kupffer cells. Mast cells are similar to basophils and are present in the connective tissue. Osteoclasts reside in the bone. A megakaryocyte is a differentiated stem cell that fragments into platelets.

A 30-year-old patient has undergone a splenectomy as a result of injuries suffered in a motor vehicle accident. Which phenomena are likely to result from the absence of the patient's spleen? Select all that apply.

Splenectomy can result in increased platelet levels and impaired immunologic function as a consequence of the loss of storage and immunologic functions of the spleen. Fibrinolysis, fatigue, and cold intolerance are less likely to result from the loss of the spleen because coagulation and oxygenation are not primary responsibilities of the spleen.

The laboratory reports of a patient reveal a hemoglobin level of 9 mg/dL, a serum iron level of 40 mcg/dL, an indirect bilirubin level of 1 mg/dL, a vitamin B12 level of 250 pg/mL, and a folic acid level of 14 ng/mL. Which other finding will the nurse observe in the patient's report?

The normal range for hemoglobin is 11 to 16 g/dL in females and 13.2 to 17.3 mg/dL in males. Hemoglobin of 9 g/dL indicates anemia. The normal range of serum iron is 50 to 175 mcg/dL. The patient has 40 mcg/dL of serum iron, which indicates iron-deficiency anemia. The values of indirect bilirubin, folic acid, and vitamin B12 are within the normal range. The transferrin saturation is decreased in iron-deficiency anemia. The normal range of transferrin saturation is 15% to 50% but the patient has low transferrin saturation of 10% because of iron-deficiency anemia. A positive Coombs test can be observed in the patient with hemolytic anemia. The normal range for homocysteine is 3.7 to 10.4 µmol/L in females and 5.2 to 12.9 µmol/L in males. High homocysteine of 15 µmol/L is observed in patients with folic acid and cobalamin deficiency. A normal range for methylmalonic acid is 0.2 µmol/L. An increased methylmalonic acid level of 0.3 µmol/L is observed in patients with cobalamin deficiency.