NUR 202 Hematology

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

Basophils

A client in end-stage renal disease is prescribed epoetin alfa (Epogen) and oral iron supplements. Before administering the next dose of epoetin alfa and oral iron supplement, the nurse

Assesses the hemoglobin level

Which of the following nursing interventions should be incorporated into the plan of care for a patient with impaired liver function and low albumin levels?

Monitor for edema at least once per shift

When teaching about the advantages of autologous blood transfusion to a client, the nurse should include which information?

• The primary advantage is prevention of viral infections. • It is safer for clients with a history of transfusion reactions. • If not needed immediately, the blood can be frozen for future use.

The nurse recognizes the most common cause of iron deficiency anemia in an adult is which of the following?

Bleeding

Which of the following terms refers to a primitive cell, capable of self-replication and differentiation?

Stem cell

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." Vitamin B12 is found only in foods of animal origin.

A patient with a history of congestive heart failure has an order to receive one 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?

4pm. When packed red blood cells (PRBCs) or whole blood is transfused, the blood should be administered within a 4-hour period because warm room temperatures promote bacterial growth.

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

5%

A patient with Hodgkin's disease had a bone marrow biopsy yesterday and is complaining of aching, rated at a 5 (on a 1-10 scale), at the biopsy site. After assessing the biopsy site, which of the following nursing interventions is most appropriate?

Administer the ordered paracetamol 500 mg po. After the marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing. Most patients have no discomfort after a bone marrow aspiration, but the site of a biopsy may ache for 1 or 2 days. Warm tub baths and a mild analgesic agent (e.g., paracetamol) may be useful. Aspirin-containing analgesic agents should be avoided it the immediate post-procedure period because they can aggravate or potentiate bleeding.

The physician performs a bone marrow biopsy from the posterior iliac crest on a patient with pancytopenia. What intervention should the nurse perform following the procedure?

Apply pressure over the site for 5-7 minutes

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

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

Clients must meet the following criteria to be eligible as blood donors: body weight at least 50 kg; pulse rate regular between 50 and 100 bpm; systolic BP 90 to 180 mmHg and diastolic 50 to 100 mmHg; hemoglobin level at least 12.5 g/dL for women. There is no upper age limit to donation.

The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly?

Crackles auscultated bilaterally

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

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

Decreased oxygen level.

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, ethnicity, use of herbal supplements, and medication use are factors for which the nurse should assess.

A client receiving a unit of packed red blood cells (PRBCs) has been prescribed morphine 1 mg 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.

The charge nurse should intervene when observing a new nurse perform which action after a client has suffered a possible hemolytic blood transfusion reaction?

Disposing of the blood container and tubing in biohazard waste. The blood container and tubing should be returned to the blood bank for repeat typing and culture, and the blood bank should be notified of the reaction.

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

Generalized edema

Which of the following is the percentage of blood volume consisting of erythrocytes?

Haematocrit

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

Hematological

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

Hypovolemia

A client complains of feeling faint after donating blood. What is the nurse's best action?

Keep client in recumbent position to rest. Trendelenburg position is not recommended after blood donation.

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

What food should the nurse recommend for a client diagnosed with vitamin B12 deficiency?

Lean meat

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

Lymphocyte

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called which of the following?

Megaloblasts

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

Myeloid stem cell

G-CSF (filgrastim [Neupogen]) is prescribed for a client with bone marrow suppression. What medication administration teaching should the nurse provide to the client?

Neupogen is administered subcutaneously on a daily basis.

The nurse is completing a physical assessment on a client's lymphatic system. The nurse should palpate for enlarged nodes in which areas? Select all that apply.

Palpable lymph node areas include: popliteal, inguinal, submental, and neck.

The nurse reviewing laboratory results of a client recovering from abdominal surgery notices an elevated number of reticulocytes. What is the nurse's first action?

Perform an abdominal assessment.

Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils?

Phagocytosis

Which of the following best describes the function of fibrinogen?

Plays a key role in forming blood clots

The client is planned to have a splenectomy. The nurse should prepare which medication to administer to this client?

Pneumococcal vaccine. Without a spleen, the client's risk of infection is greatly increased. The pneumococcal vaccine should be administered, preferable before splenectomy.

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?

Preoperative autologous donations are ideally collected 4 to 6 weeks before surgery.

The nurse expects which assessment finding of the oral cavity when the client is diagnosed with pernicious anemia?

Smooth tongue

The term that is used to refer to a primitive cell, capable of self-replication and differentiation, is which of the following?

Stem cell

Which type of lymphocyte is responsible for cellular immunity?

T lymphocytes are responsible for delayed allergic reactions, rejection of foreign tissue (e.g., transplanted organs), and destruction of tumor cells.

A nursing instructor is reviewing the role and function of stem cells in the bone marrow with a group of nursing students. Following 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 causes marrow destruction can resume production of blood cells. Which of the students' explanations is correct?

The liver and spleen can resume production of blood cells through extramedullary haematopoiesis.

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 may be developing an infection.

One hour after the completion of a fresh frozen plasma transfusion, a patient complains of shortness of breath and is very anxious. The patient's vital signs are BP 98/60, HR 110, temperature 99.4°F, and SaO2 88%. Auscultation of the lungs reveals posterior coarse crackles to the mid and lower lobes bilaterally. Based on the symptoms, the nurse suspects the patient is experiencing which of the following problems?

Transfusion-related acute lung injury (TRALI) is a potentially fatal, idiosyncratic reaction that is defined as the development of acute lung injury occurring within 6 hours after a blood transfusion. It is more likely to occur when plasma and platelets are transfused. Onset is abrupt (usually within 6 hours of transfusion, often within 2 hours). Signs and symptoms include acute shortness of breath, hypoxia (arterial oxygen saturation [SaO2] less than 90%; pressure of arterial oxygen [PaO2] to fraction of inspired oxygen [FIO2] ratio of less than 300), hypotension, fever, and eventual pulmonary edema.

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?

Verify the patient identification according to hospital policy

A patient comes into the emergency room with complaints of an enlarged tongue. The tongue appears smooth and beefy red in colour. The nurse also observes a 5-cm incision on the upper left quadrant of the abdomen. When questioned, the patient states, "I had a partial gastrostomy 2 years ago." Based on this information, the nurse attributes these symptoms to which of the following problems?

Vitamin B12 deficiency

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

liver

Which of the following is a symptom of severe thrombocytopenia?

petechiae (i.e. pinpoint hemorrhagic lesions, usually more prominent on the trunk or anterior aspects of the lower extremities).