NUR 202 Hematology

A client is prescribed 325 mg/day of oral ferrous sulfate. The nurse includes in client teaching, "Take your iron pill

1 hour before breakfast"

Which client is most at risk for developing disseminated intravascular coagulation (DIC)?

A client with an amniotic fluid embolism

A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute haemolytic reaction would occur when giving:

A-positive blood to an A-negative client. An acute haemolytic reaction occurs when there is an ABO or Rh incompatibility. For example, giving A blood to a B client would cause a haemolytic reaction. Likewise, giving Rh-positive blood to an Rh-negative client would cause a haemolytic reaction. It's safe to give Rh-negative blood to an Rh-positive client if there is a blood type compatibility. O-negative blood is the universal donor and can be given to all other blood types. AB clients can receive either A or B blood as long as there isn't an Rh incompatibility.

A client is hospitalised 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin at home, which is now discontinued. To prevent the formation of blood clots, it is important for the nurse to

Administer the prescribed enoxaparin (Lovenox).

Which of the following nursing interventions should be incorporated into the plan of care to manage the delayed clotting process due to thrombocytopenia in a patient with leukaemia?

Applying prolonged pressure to needle sites or other sources of external bleeding

A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client?

Because thrombocytopenia alters coagulation, it poses a high risk of bleeding. To help prevent capillary bleeding, the nurse should use the smallest needle possible when administering injections.

A young male client is diagnosed with glucose-6-phosphate dehydrogenase deficiency (G-6-PD). The nurse reviews his recent activities and most emphatically recommends the following:

Consult a physician about ingesting trimethoprim/sulfamethoxazole (Bactrim) for a urinary tract infection.

A male client has been receiving a continuous infusion of weight-based heparin for more than 4 days. The client's PTT is at a level that requires an increase of heparin by 100 units per hour. The client has the laboratory findings shown above. The most important action of the nurse is to

Consult with the physician about discontinuing heparin. Platelet counts may decrease with heparin therapy, and this client's platelet count has decreased. The client may have heparin-induced thrombocytopenia (HIT). Treatment of HIT includes discontinuing the heparin.

A patient was admitted to the hospital with the following lab values: hemoglobin 5 g/dL, abnormally shaped erythrocytes, leukocyte count 2000/mm3 with hypersegmented neutrophils and a platelet count of 48,000/mm3. The platelets appear abnormally large. A bone marrow biopsy was competed and revealed hyperplasia. Based on this information, the nurse determines that patient most likely has which of the following diagnoses?

Folic acid deficiency

A patient has been diagnosed with thrombocytopenia. What are the primary nursing interventions while instituting corticosteroid therapy in this patient?

Gradually taper the dose and frequency of medication.

A male client has a hemoglobin count of 10.2 gm/dl, a hematocrit value of 36%, and a low ferritin level. What question should the nurse ask first?

Have you experienced abdominal pain?

The nurse is talking with the parents of a toddler who was diagnosed with hemophilia A. The nurse teaches the parents

How to administer factor VIII intravenously at the first sign of bleeding

Which of the following are immunosuppressants that prevent the patient's lymphocytes from destroying the stem cells in a patient diagnosed with aplastic anemia?

Immunosuppressants, including cyclosporine, corticosteroids, ATG, and cyclophosphamide, prevent the patient's lymphocytes from destroying the stem cells.

In adults, bone marrow is usually aspirated from which area?

In adults, bone marrow is usually aspirated from the posterior iliac crest and rarely from the sternum. Bone marrow is not aspirated from the femur or ankle.

A patient admitted to the hospital in preparation for a splenectomy for treatment of autoimmune haemolytic anaemia asks the nurse about the benefits of the splenectomy. Which of the following statements best explains the expected effect of the splenectomy?

It will remove the major site of red blood cell (RBC).

Which of the following terms refers to a form of white blood cell involved in immune response?

Lymphocyte

Which of the following terms refers to an abnormal decrease in white blood cells, red blood cells, and platelets?

Pancytopenia

Which of the following is considered an antidote to heparin?

Protamine sulphate

Which type of lymphocyte is responsible for cell-mediated immunity?

T lymphocyte

A patient with sickle cell anemia has a

The patient with sickle cell anemia has a low hematocrit and sickled cells on the smear. The patient with sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear.

A client with sepsis is experiencing disseminated intravascular coagulation (DIC). The client is bleeding from mucous membranes, venipuncture sites, and the rectum. Blood is present in the urine. The nurse establishes the nursing diagnosis of Risk for deficient fluid volume related to bleeding. The most appropriate and measurable outcome for this client is that the client exhibits

Urine output greater than or equal to 30 mL/hour

The most common cause of iron deficiency anaemia in men and postmenopausal women is

bleeding from ulcers, gastritis, inflammatory bowel disease or GI tumors.

Which of the following are assessment findings associated with thrombocytopenia?

bleeding gums, epistaxis, hematemesis, hypotension, and tachypnea.

Which is the following is the most obvious sign of anaemia?

pallor is the most common and obvious sign of anaemia. Other findings may include tachycardia and flow murmurs.

The major function of neutrophils is

phagocytosis.

When teaching a patient with iron deficiency anaemia about appropriate food choices, the nurse will encourage the patient to increase the dietary intake of which of the following foods?

Food sources high in iron include organ meats (e.g., beef or calf's liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.

After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/mm3. What term should the nurse use to describe this low platelet count?

Thrombocytopenia. A normal platelet count is 140,000 to 400,000/mm3 in adults.

A female client with the beta-thalassaemia trait plans to marry a man of Italian ancestry who also has the trait. Which client statement indicates that she understands the teaching provided by the nurse?

Two people with the beta-thalassaemia trait have a 25% chance of having a child with thalassaemia major, a potentially life-threatening disease.

The thalassaemia's are a group of hereditary anaemias characterised by which of the following?

• Hypochromia• Extreme microcytosis • Haemolysis • Anaemia

Which of the following is accurate regarding the use of corticosteroids for immune haemolytic anaemia? Select all that apply.

• They decrease the macrophages ability to clear the antibody-coated RBCs. • If the haemoglobin returns to normal, the corticosteroid dose can be lowered.

A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the physician immediately because the client probably is experiencing which problem?

A haemolytic allergic reaction caused by an antigen reaction

For a client diagnosed with idiopathic thrombocytopenia purpura (ITP), which nursing intervention is appropriate?

Administering stool softeners, as ordered, to prevent straining during defecation

Which of the following is a symptom of Haemochromatosis?

Bronzing of the skin

A patient's family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which of the following statements made by the nurse correctly explains the cause of DIC?

DIC is caused by an abnormal activation of clotting pathway causing excessive amounts of tiny clots to form inside organs.

Which cell of haematopoiesis is responsible for the production of red blood cells (RBCs) and platelets?

Myeloid stem cell

A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. She reports that she first felt pain after manually opening her garage door and that she is taking prednisone daily. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain?

Osteoporosis

A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia?

Signs of iron deficiency anemia include dyspnea, tachycardia, and pallor, as well as fatigue, listlessness, irritability, and headache.

A home care nurse visits a client diagnosed with atrial fibrillation who is ordered warfarin (Coumadin). The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching?

The client requires additional teaching if he states that he'll eat four servings of dark green vegetables every day. Dark, green vegetables contain vitamin K, which reverses the effects of warfarin. The client should limit his intake to one to two servings per day.

For a patient diagnosed with pernicious anaemia, the nurse emphasises the importance of lifelong administration of which of the following?

Vitamin B12

During preparation for bowel surgery, a client receives an antibiotic to reduce intestinal bacteria. The nurse knows that hypoprothrombinemia may occur as a result of antibiotic therapy interfering with synthesis of which vitamin?

Vitamin K

Which of the following medications is the antidote to Warfarin?

Vitamin K

A client with idiopathic thrombocytopenic purpura (ITP), an autoimmune disorder, is admitted to an acute care facility. Concerned about hemorrhage, the nurse monitors the client's platelet count and observes closely for signs and symptoms of bleeding. The client is at greatest risk for cerebral hemorrhage when the platelet count falls below:

10,000/?l.