PREPPU: Assessment of Hematologic Function and Treatment Modalities
A 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." "I agree that you should be concerned with the safety of the blood, but it is important that you have this transfusion." "The blood is carefully screened, so there is no possibility of you contracting any illness or disease from the blood."
"I understand your concern. The blood is carefully screened but is not completely risk free."
A preoperative client is discussing blood donation with the nurse. Which statement by the client indicates to the nurse the need for further teaching? "I should expect blood withdrawal to take about 15 minutes." "I could donate my own blood in case I need a transfusion." "Donated blood is tested for blood type and infections." "My family will donate blood, because it's safer."
"My family will donate blood, because it's safer." Directed donations from friends and family members are not any safer than those provided by random donors. Withdrawal of 450 mL of blood usually takes about 15 minutes. Specimens from donated blood are tested to detect infections and to identify the specific blood type. Autologous blood donation is useful for many elective surgeries where the potential need for transfusion is high.
Which client is not a candidate to be a blood donor according to the American Red Cross? 26-year-old female with hemoglobin 11.0 g/dL 18-year-old male weighing 52 kg 50-year-old female with pulse 95 beats/minute 86-year-old male with blood pressure 110/70 mm Hg
26-year-old female with hemoglobin 11.0 g/dL Clients must meet a number of criteria to be eligible as blood donors, including the following: body weight at least 50 kg; pulse rate regular between 50 and 100 bpm; systolic BP 90-100 to 180 mm Hg and diastolic 50 to 100 mm Hg; hemoglobin level at least 12.5 g/dL. There is no upper age limit to donation.
A nurse is reviewing a client's most recent platelet count and identifies the need to institute bleeding precautions. Which result would the nurse most likely have noted to warrant these precautions? 45,000/mm3 90,000/mm3 200,000 /mm3 110,000/mm3
45,000/mm3
A nurse is reviewing a client's most recent platelet count and identifies the need to institute bleeding precautions. Which result would the nurse most likely have noted to warrant these precautions? 200,000 /mm3 90,000/mm3 110,000/mm3 45,000/mm3
45,000/mm3- Bleeding precautions are recommended for clients with a platelet count of less than 50,000/mm3.
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? 6:00 pm 2:00 pm 4:00 pm 3:00 pm
4:00 pm
A nurse is preparing a dose of furosemide for an older adult with heart failure. The health care provider orders furosemide 1 mg/kg to be given intravenously. The client weighs 50 kg. The concentration of the drug is 40 mg/4mL (10 mg/mL). How many milliliters would the nurse administer? Record your answer using a whole number.
5 1 mg/kg X 50 kg = 50 mg then divide by 10 mg/mL = 5 mL
Which of the following cells are capable of differentiating into plasma cells? T lymphocytes B lymphocytes Neutrophils Eosinophils
B lymphocytes
A client with myelodysplastic syndromes (MDS) receives routine blood transfusions. Which treatment will the nurse expect to be prescribed to prevent the development of iron overload? Romiplostim Chelation therapy Eltrombopag Epoetin alpha
Chelation therapy
The nurse expects which assessment finding when caring for a client with a decreased hemoglobin level? Bright red venous blood. Elevated temperature. Increased bruising. Decreased oxygen level.
Decreased oxygen level.
A client's electronic health record states that the client receives regular transfusions of factor IX. The nurse would be justified in suspecting that this client has what diagnosis? Hemophilia Hypoproliferative anemia Hodgkin lymphoma Leukemia
Hemophilia- Administration of clotting factors is used to treat diseases where these factors are absent or insufficient; hemophilia is among the most common of these diseases. Factor IX is not used in the treatment of leukemia, lymphoma, or anemia.
A client with hemophilia A is being treated for acute bleeding. Which preparations will the nurse expect to be prescribed for this client? Select all that apply. Humate P Factor VIII concentrate Alphanate Plasma albumin Factor IX concentrate
Humate P Alphanate Factor VIII concentrate Recombinant forms of factor VIII, such as Humate-P or Alphanate, are useful in the treatment of hemophilia A. Factor VIII concentrate (antihemophilic factor) is a lyophilized, freeze-dried concentrate of pooled fractionated human plasma used in treating hemophilia A. Plasma albumin is used to expand the blood volume in clients with hypovolemic shock. Factor IX concentrate is used treat hemophilia B.
The nurse is caring for a client who has a unit of whole blood removed every 6 weeks as treatment for polycythemia vera. Which laboratory test will the nurse monitor to determine if the procedure is adversely affecting the client? Calcium Iron White blood cell count Potassium
Iron Therapeutic phlebotomy is the removal of a certain amount of blood under controlled conditions. A client with an elevated hematocrit from polycythemia vera can usually be managed by periodically removing 1 unit (about 500 mL) of whole blood. Over time, this process can produce iron deficiency, Therapeutic phlebotomy does not affect the calcium or potassium levels or the white blood cell count.
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? Therapeutic phlebotomy Oxygen therapy Anticoagulation therapy Iron chelation therapy
Iron chelation therapy Iron overload is a complication unique to people who have had long-term PRBC transfusions. One unit of PRBCs contains 250 mg of iron. Patients with chronic transfusion requirements can quickly acquire more iron than they can use, leading to iron overload. Over time, the excess iron deposits in body tissues and can cause organ damage, particularly in the liver, heart, testes, and pancreas. Promptly initiating a program of iron chelation therapy can prevent end-organ damage from iron toxicity.
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? Jackknife position Supine with head of the bed elevated 30 degrees Lateral position with one leg flexed Lithotomy position
Lateral position with one leg flexed Bone marrow aspiration procedure. The posterior superior iliac crest is the preferred site for bone marrow aspiration and biopsy because no vital organs or vessels are nearby. The patient is placed either in the lateral position with one leg flexed or in the prone position.
Which blood cell type is matched correctly with its function? B lymphocyte: Secretes immunoglobulin Plasma cell: Cell-mediated immunity Leukocyte: Fights infection T lymphocyte: Humoral immunity
Leukocyte: Fights infection Various blood cell types have unique, major functions. Leukocytes fight infection, T lymphocytes are integral in cell-mediated immunity, plasma cells secrete immunoglobulin, and B lymphocytes are integral in humoral immunity.
Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following? Large intestine Liver Kidney Pancreas
Liver Albumin is produced by the liver. Albumin is not produced in the pancreas, kidney, or large intestine.
Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? Lymphoid stem cell Neutrophil Monocyte Myeloid stem cell
Myeloid stem cell Myeloid stem cells are responsible not only for all nonlymphoid white blood cells (WBC) but also for the production of red blood cells and platelets. Lymphoid cells produce either T or B lymphocytes. A monocyte is large WBC that becomes a macrophage when is leaves the circulation and moves into body tissues, and not responsible for RBC production.. A neutrophil is a fully mature WBC capable of phagocytosis and not responsible for RBC production.
Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? Myeloid stem cell Neutrophil Monocyte Lymphoid stem cell
Myeloid stem cell Myeloid stem cells are responsible not only for all nonlymphoid white blood cells (WBC) but also for the production of red blood cells and platelets. Lymphoid cells produce either T or B lymphocytes. A monocyte is large WBC that becomes a macrophage when is leaves the circulation and moves into body tissues, and not responsible for RBC production.. A neutrophil is a fully mature WBC capable of phagocytosis and not responsible for RBC production.
The body responds to infection by increasing the production of white blood cells (WBCs). The nurse should evaluate the differential count for what type of WBCs, which are the first WBCs to respond to an inflammatory event? Eosinophils Basophils Neutrophils Monocytes
Neutrophils Neutrophils, the most abundant type of white blood cell, are the first of the WBCs to respond to infection or inflammation. The normal value is 3,000 to 7,000/cmm (males) and 1,800 to 7,700/cmm (females).
Which is a symptom of severe thrombocytopenia? Petechiae Dyspnea Inflammation of the tongue Inflammation of the mouth
Petechiae Clients with severe thrombocytopenia have petechiae, which are pinpoint hemorrhagic lesions, usually more prominent on the trunk or anterior aspects of the lower extremities.
Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils? Phagocytosis Rejection of foreign tissue Production of antibodies called immunoglobulin (Ig) Destruction of tumor cells
Phagocytosis The major function of neutrophils is phagocytosis. T lymphocytes are responsible for rejection of foreign tissue and destruction of tumor cells. Plasma cells produce antibodies call immunoglobulin.
A nurse cares for several mothers and babies in the postpartum unit. Which mother does the nurse recognize as being most at risk for a febrile nonhemolytic reaction? Rh-positive mother; Rh-negative child Rh-negative mother; Rh-positive child Rh-positive mother; Rh-positive child Rh-negative mother; Rh-negative child
Rh-negative mother; Rh-positive child A mother who is Rh negative and gives birth to an Rh positive child is at greatest risk for a febrile nonhemolytic reaction because exposure to an Rh-positive fetus raises antibody levels in the Rh negative mother. An Rh-negative mother can carry an Rh-negative child without being at greatest risk for a febrile nonhemolytic reaction; however, these mothers are often treated prophylactically. An Rh-positive mother may carry either an Rh-positive or Rh-negative child without increased risk.
A client with myelodysplastic syndromes (MDS) routinely takes oral chelation therapy. Which assessment findings indicate to the nurse that the client is experiencing side effects from this treatment? Select all that apply. Skin rash Vomiting Abdominal cramping Diarrhea Hypertension
Skin rash Diarrhea Abdominal cramping
Place the following steps in order when determining the type and severity of a transfusion reaction. Use all options.
Stop the transfusion. Assess the client. Notify the health care provider. Notify the blood bank. Send the tubing and container to the blood bank.
Which type of lymphocyte is responsible for cellular immunity? B lymphocyte Basophil T lymphocyte Plasma cell
T lymphocyte T lymphocytes are responsible for delayed allergic reactions, rejection of foreign tissue (e.g., transplanted organs), and destruction of tumor cells. This process is known as cellular immunity. B lymphocytes are responsible for humoral immunity. A plasma cell secretes immunoglobulin. A basophil contains histamine and is an integral part of hypersensitivity reactions.
The health care provider believes that the client has a deficiency in the leukocyte responsible for cell-mediated immunity. What should the nurse check the WBC count for? Basophils Monocytes T lymphocytes Plasma cells
T lymphocytes T lymphocytes are responsible for cell-mediated immunity, in which they recognize material as "foreign," acting as a surveillance system
Place the order of the steps of primary hemostasis in correct order.
The severed blood vessel constricts. The circulating platelets aggregate at the site and adhere to the vessel. An unstable hemostatic plug is formed. Circulating inactive clotting factors convert to active forms.
One hour after the completion of a fresh frozen plasma transfusion, a client reports shortness of breath and is very anxious. The client'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 client is experiencing which problem? Exacerbation of congestive heart failure Transfusion-related acute lung injury Delayed hemolytic reaction Bacterial contamination of blood
Transfusion-related acute lung injury Transfusion-related acute lung injury (TRALI) is a potentially fatal, idiosyncratic reaction that is defined as the development of acute lung injury 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 less than 300), hypotension, fever, and eventual pulmonary edema.
While caring for a client, the nurse notes petechiae on the client's trunk and lower extremities. What precaution will the nurse take when caring for this client? Apply supplemental oxygen to maintain the client's oxygenation. Wear a mask when entering the client's room. Elevate the client's head of the bed. Use an electric razor when assisting client with shaving.
Use an electric razor when assisting client with shaving. Petechiae are associated with severe thrombocytopenia, placing the client at risk for bleeding. The nurse should use an electric razor when assisting the client with shaving. Elevating the head of the bed and applying supplemental oxygen would be appropriate for a client with decreased oxygenation. Wearing a mask when entering the client's room would be appropriate for a client with neutropenia, not thrombocytopenia.
A nurse is reviewing a client's morning laboratory results and notes a left shift in the band cells. Based on this result, the nurse can interpret that the client: has thrombocytopenia. may be developing an infection. may be developing anemia. has leukopenia.
may be developing an infection. Less mature granulocytes have a single-lobed, elongated nucleus and are called band cells. Ordinarily, band cells account for only a small percentage of circulating granulocytes, although their percentage can increase greatly under conditions in which neutrophil production increases, such as infection. An increased number of band cells is sometimes called a left shift or shift to the left. Anemia refers to decreased red cell mass. Leukopenia refers to a less-than-normal amount of white blood cells in circulation. Thrombocytopenia refers to a lower-than-normal platelet count.
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? Shock Hemorrhage Splintering of bone fragments Blood transfusion reaction
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 nurse cares for a client with megaloblastic anemia who had a total gastrectomy three years ago. What statement will the nurse include in the client's teaching regarding the condition? "The condition is likely caused by a folate deficiency." "The condition causes abnormally rigid red blood cells." "The condition causes abnormally small red blood cells." "The condition is likely caused by a vitamin B12 deficiency."
"The condition is likely caused by a vitamin B12 deficiency." Vitamin B12 combines with intrinsic factor produced in the stomach. The vitamin B12 -intrinsic factor complex is absorbed in the distal ileum. Clients who have had a partial or total gastrectomy may have limited amounts of intrinsic factor, and the absorption of vitamin B12 may be diminished. Megaloblastic anemia may be caused by a folate deficiency; however, the client's history of gastrectomy indicates the likely cause is a vitamin B12 deficiency. Megaloblastic anemia causes large erythrocytes (RBCs), not small or rigid.
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 Oral temperature of 97°F Pain and tenderness in calf area Respiratory rate of 10 breaths/minute
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.
The body responds to infection by increasing the production of white blood cells (WBCs). The nurse should evaluate the differential count for what type of WBCs, which are the first WBCs to respond to an inflammatory event? Neutrophils Eosinophils Basophils Monocytes
Neutrophils Neutrophils, the most abundant type of white blood cell, are the first of the WBCs to respond to infection or inflammation. The normal value is 3,000 to 7,000/cmm (males) and 1,800 to 7,700/cmm (females).
The nurse is caring for a client with hypoxia. What does the nurse understand is true regarding the client's oxygen level and the production of red blood cells? The bone marrow is stimulated by low oxygen levels in the blood to produce erythropoietin, maturing the red blood cells. The kidneys sense low oxygen levels in the blood and produce hemoglobin, stimulating the marrow to produce more red blood cells. The kidneys sense low oxygen levels in the blood and produce erythropoietin, stimulating the bone marrow to produce more red blood cells. The brain senses low oxygen levels in the blood and produces hemoglobin, which binds to more red blood cells.
The kidneys sense low oxygen levels in the blood and produce erythropoietin, stimulating the bone marrow to produce more red blood cells. If normally functioning kidneys detect low levels of blood oxygen, they produce more of the hormone erythropoietin (EPO). As EPO levels increase, the bone marrow responds by producing more erythrocytes (red blood cells). EPO is not made by the bone marrow. Hemoglobin, an iron-rich protein that allows erythrocytes to transport oxygen, is synthesized in the erythrocytes as they mature.
A client who had a splenectomy two years ago is having a routine examination. Which follow-up question will the nurse ask as a priority based on known long-term risks? "Are you taking more than three medications?" "How many fruits and vegetables do you eat each day?" "Have you had unexplained episodes of bleeding?" "Have you gotten your vaccines this year?"
"Have you gotten your vaccines this year?" The surgical removal of the spleen, or splenectomy, is a possible treatment for some hematologic disorders. Afterwards, the platelet counts should normalize over time. Long-term risks after a splenectomy include a greater likelihood of developing a life-threatening infection. The Centers for Disease Control and Prevention recommends patients without spleens receive vaccines for influenza, pneumonia, and meningococci. The number of medications the client is taking does not increase the likelihood of developing an infection. The consumption of fruits and vegetables may help with the client's overall immunity but will not directly reduce the client's risk of developing an infection. Unexplained bleeding is an acute risk that diminishes over time; the long-term risk of infection is more likely for this client and therefore the priority question.
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 will be prescribed calcium to replace what is lost during donation." "You will likely not need the blood that is donated." "You typically donate blood 4 to 6 weeks before the surgery." "You typically donate blood the day of the surgery."
"You typically donate blood 4 to 6 weeks before the surgery." With autologous donation, a client's own blood may be collected for future transfusion; this is an effective method for orthopedic surgery, where the likelihood of transfusion is high. Preoperative donation is ideally collected 4-6 weeks before surgery. The nurse will not tell the client that the blood will not be needed; orthopedic surgeries often require transfusion of blood. The client will be prescribed iron supplements during the donation time, not calcium.
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? Isometric exercise decreases the workload of the heart and restores oxygenated blood flow. Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart. This type of exercise increases arterial circulation as it returns to the heart. Isometric exercise programs are inclusive of all muscle groups and have an aerobic effect to increase the heart rate.
Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart. Isometric exercise induce contraction of skeletal muscle so that it compresses the walls of veins and increases the circulation of venous blood as it returns to the heart. Isometric exercises do not have an aerobic effect and should not increase the heart rate; although, it may increase blood pressure. Isometric exercise does not decrease the workload of the heart. Arterial flow moves blood flow away from the heart after being oxygenated.
The nurse is caring for a client with hypoxia. What does the nurse understand is true regarding the client's oxygen level and the production of red blood cells? The brain senses low oxygen levels in the blood and stimulates hemoglobin, which binds to more red blood cells. The kidneys sense low oxygen levels in the blood and stimulate erythropoietin, stimulating the marrow to produce more red blood cells. The kidneys sense low oxygen levels in the blood and stimulate hemoglobin, stimulating the marrow to produce more red blood cells. The bone marrow is stimulated by low oxygen levels in the blood and stimulates erythropoietin, maturing the red blood cells.
The kidneys sense low oxygen levels in the blood and produce erythropoietin, stimulating the bone marrow to produce more red blood cells. If normally functioning kidneys detect low levels of blood oxygen, they produce more of the hormone erythropoietin (EPO). As EPO levels increase, the bone marrow responds by producing more erythrocytes (red blood cells). EPO is not made by the bone marrow. Hemoglobin, an iron-rich protein that allows erythrocytes to transport oxygen, is synthesized in the erythrocytes as they mature.
The client is to receive a unit of packed red blood cells. What is the nurse's first action? Ensure that the intravenous site has a 20-gauge or larger needle. Verify that the client has signed a written consent form. Observe for gas bubbles in the unit of packed red blood cells. Check the label on the unit of blood with another registered nurse.
Verify that the client has signed a written consent form. All the options are interventions the nurse will do to ensure the blood transfusion is safe. The question asks about the first action of the nurse. The first action would be verifying that the client has signed a written consent form. Then, the nurse would ensure the intravenous site has a 20-gauge or larger needle. The nurse would proceed to obtain the unit of blood, check the blood with another registered nurse, and observe for gas bubbles in the unit of blood.
