CH 28: Assessment of Hematologic Function and Treatment Modalities
A nurse is transfusing whole blood to a client with impaired renal function. During the transfusion, the client tells the nurse, "I feel very short of breath all of a sudden." What is the nurse's primary action? A) Stop the infusion. B) Assess the client's vital signs. C) Slow the infusion. D) Call the health care provider.
A)
A client is experiencing symptoms of myelodysplastic syndrome (MDS). The nurse prepare the client for which type of test to aid in diagnosing this condition? A) Complete blood count B) Bone marrow aspiration and biopsy C) Hemoglobin D) Hematocrit
B
A client is scheduled for surgery to remove an abdominal mass. The nurse knows that which reason hemodilution would be contraindicated as a method to provide blood to the client during the surgery? A) Previous thyroidectomy B) History of renal disease C) Takes medications for seasonal allergies D) Treatment for osteoarthritis
B
Which type of lymphocyte is responsible for cellular immunity? A) Plasma cell B) T lymphocyte C) B lymphocyte D) Basophil
B
A client reports feeling faint after donating blood. What is the nurse's best action? A) Assist the client into high-Fowler's position. B) Ambulate client with assistance. C) Place the client in Trendelenburg position. D) Keep client in recumbent position to rest.
D
Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called A) blast cells. B) monocytes. C) mast cells. D) megaloblasts.
D
A client comes into the emergency department reporting an enlarged tongue. The tongue appears smooth and beefy red in color. The nurse also observes a 5-cm incision on the upper left quadrant of the abdomen. When questioned, the client states, "I had a partial gastrostomy 2 years ago." Based on this information, the nurse attributes these symptoms to which problem? A) Vitamin B12 deficiency B) Folic acid deficiency C) Vitamin A deficiency D) Vitamin C deficiency
A
A client receiving a blood transfusion reports shortness of breath, appears anxious, and has a pulse of 125 beats/minute. What is the best action for the nurse to take after stopping the transfusion and awaiting further instruction from the health care provider? A) Ensure there is an oxygen delivery device at the bedside. B) Administer prescribed PRN anti-anxiety agent. C) Remove the intravenous line. D) Place the client in a recumbent position with legs elevated.
A
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? A) Hemorrhage B) Splintering of bone fragments C) Shock D) Blood transfusion reaction
A
A client with heart failure is prescribed to receive 2 units of packed red blood cells. Which actions will the nurse take to decrease the client's risk of developing transfusion-associated circulatory overload? Select all that apply. A) Provide furosemide as prescribed before the transfusion B) Restrict the intake of oral fluids C) Place feet in a dependent position D) Reduce the rate of transfusion to 100 mL/hr E) Elevate the head of the bed
A, C, D, and E
The nurse is preparing teaching for a client with myelodysplastic syndromes (MDS). Which topics will the nurse include in the teaching for this client? Select all that apply. A) Infection prevention B) Dietary changes C) Need for frequent laboratory monitoring D) Risk for bleeding E) Methods to reduce fatigue
A, C, D, and E
Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following? A) Kidney B) Liver C) Large intestine D) Pancreas
B
The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly? A) Respiratory rate of 10 breaths/minute B) Crackles auscultated bilaterally C) Pain and tenderness in calf area D) Oral temperature of 97°F
B
Which client is not a candidate to be a blood donor according to the American Red Cross? A) 18-year-old male weighing 52 kg B) 26-year-old female with hemoglobin 11.0 g/dL C) 86-year-old male with blood pressure 110/70 mm Hg D) 50-year-old female with pulse 95 beats/minute
B
Which is a symptom of severe thrombocytopenia? A) Inflammation of the mouth B) Petechiae C) Inflammation of the tongue D) Dyspnea
B
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? A) Apply supplemental oxygen to maintain the client's oxygenation. B) Use an electric razor when assisting client with shaving. C) Elevate the client's head of the bed. D) Where a mask when entering the client's room.
B
A client seeks medical attention for the spontaneous development of bruises over the arms and legs. Which laboratory tests will the nurse anticipate being prescribed for this client? Select all that apply. A) Bilirubin B) International normalized ratio C) Complete blood count D) Activated partial prothrombin time E) Blood urea nitrogen
B, C, and D
Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? A) Neutrophil B) Monocyte C) Lymphoid stem cell D) Myeloid stem cell
D
A nurse is assigned to care for a patient with ascites, secondary to cirrhosis. The nurse understands that the fluid accumulation in the peritoneal cavity results from a combination of factors including an alteration in oncotic pressure gradients and increased capillary permeability. Therefore, the nurse monitors the serum level of the plasma protein responsible for maintaining oncotic pressure, which is: A) Fibrinogen. B) Albumin. C) Prothrombin. D) Globulin.
B
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 A) has leukopenia. B) may be developing an infection. C) has thrombocytopenia. D) may be developing anemia.
B
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? A) 110,000/mm3 B) 45,000/mm3 C) 90,000/mm3 D) 200,000 /mm3
B
A nurse, caring for a client with human immunodeficiency virus (HIV), reviews the client's differential WBC count. What type of WBC will the nurse check the level of? A) Leukocytes B) T lymphocytes C) B lymphocytes D) Monocytes
B
A patient with chronic kidney disease is being examined by the nurse practitioner for anemia. The nurse has reviewed the laboratory data for hemoglobin and RBC count. What other test results would the nurse anticipate observing? A) Increased mean corpuscular volume B) Decreased level of erythropoietin C) Increased reticulocyte count D) Decreased total iron-binding capacity
B
The nurse is administering 2 units of packed RBCs to an older adult patient who has a bleeding duodenal ulcer. The patient begins to experience difficulty breathing and the nurse assesses crackles in the lung bases, jugular vein distention, and an increase in blood pressure. What action by the nurse is necessary if the reaction is severe? (Select all that apply.) A) Continue the infusion but slow the rate down. B) Place the patient in an upright position with the feet dependent. C) Administer oxygen. D) Administer diuretics as prescribed. E) Discontinue the transfusion.
B, C, D, and E
A client is returning home after having a bone marrow aspiration and biopsy. Which statement indicates that teaching by the nurse has been effective? A) "I can resume my normal activities." B) "I should take aspirin if I have any pain." C) "The area might ache for 1 to 2 days." D) "I can go to the gym to lift weights later."
C
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? A) The kidneys sense low oxygen levels in the blood and produce hemoglobin, stimulating the marrow to produce more red blood cells. B) The bone marrow is stimulated by low oxygen levels in the blood to produce erythropoietin, maturing the red blood cells. C) The kidneys sense low oxygen levels in the blood and produce erythropoietin, stimulating the bone marrow to produce more red blood cells. D) The brain senses low oxygen levels in the blood and produces hemoglobin, which binds to more red blood cells.
C
The nurse is working at a blood donation clinic. What teaching should the nurse provide to the donor immediately after blood donation? A) Remove the band-aid after 5 minutes. B) Hold the involved arm below the heart. C) Remain for observation after eating and drinking. D) Sit up promptly after the needle is removed.
C
The physician orders a transfusion with packed red blood cells (RBCs) for a client 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? A) Assess the client 30 minutes after the start of the initial transfusion B) Administer the blood as soon as it arrives C) Verify the client's identity according to hospital policy D) Premedicate the client with acetaminophen
C
What food should the nurse recommend for a client diagnosed with vitamin B12 deficiency? A) Citrus fruit B) Whole-grain bread C) Lean meat D) Green vegetables
C
Which blood cell type is matched correctly with its function? A) B lymphocyte: Secretes immunoglobulin B) Plasma cell: Cell-mediated immunity C) Leukocyte: Fights infection D) T lymphocyte: Humoral immunity
C
Which type of leukocyte contains histamine and is an important part of hypersensitivity reactions? A) Neutrophil B) Plasma cell C) Basophils D) B lymphocyte
C
Place the clotting cascade in the correct order. A) Fibrin B) Thrombin C) Prothrombin activator D) Fibrinogen E) Prothrombin
C, E, B, D, then A
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? A) Add the morphine to the blood to be slowly administered. B) Inject the morphine into a distal port on the blood tubing. C) Administer the morphine into the closest tubing port to the client for fast delivery. D) Disconnect the blood tubing, flush with normal saline, and administer morphine.
D
A client with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this client? A) Eltrombopag B) Thrombopoietin C) GM-CSF D) Erythropoietin
D
The nurse is administering a blood transfusion to a client over 4 hours. After 2 hours, the client reports 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 client? A) The client is having an allergic reaction to the blood. B) The client is experiencing vascular collapse. C) The client is having decrease in tissue perfusion from a shock state. D) The client is having a febrile nonhemolytic reaction.
D
Place the following steps in order when determining the type and severity of a transfusion reaction. Use all options. A) Send the tubing and container to the blood bank. B) Assess the client. C) Notify the blood bank. D) Stop the transfusion. E) Notify the health care provider.
D, B, E, C, then A
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 reason? A) Lack of erythropoietin B) Increases the effectiveness of dialysis C) Preparation for likely nephrectomy D) Hypervolemia
A
A client who had a splenectomy a year ago is having a routine examination. Which follow-up question will the nurse ask as a priority? A) "Have you gotten a flu shot this year?" B) "Have you had any unexplained episodes of bleeding?" C) "How many fruits and vegetables do you eat each day?" D) "Are you taking more than three medications?"
A
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? A) 4:00 pm B) 3:00 pm C) 2:00 pm D) 6:00 pm
A
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? A) "I understand your concern. The blood is carefully screened but is not completely risk free." B) "You will have to decide if refusing the blood transfusion is worth the risk to your health." C) "I agree that you should be concerned with the safety of the blood, but it is important that you have this transfusion." D "The blood is carefully screened, so there is no possibility of you contracting any illness or disease from the blood."
A
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? A) Epoetin alpha B) Romiplostim C) Chelation therapy D) Eltrombopag
C
A nurse administers blood products to a client with Hodgkin disease. During the administration, the nurse notes the client has a fever and diffuse reddened skin rash. From what condition does the nurse suspect the client is suffering? A) Delayed hemolytic reaction B) Bacterial contamination C) Graft-versus-host disease D) Creutzfeldt-Jakob disease
C
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? A) Rh-positive mother; Rh-negative child B) Rh-negative mother; Rh-negative child C) Rh-negative mother; Rh-positive child D) Rh-positive mother; Rh-positive child
C
After withdrawing the needle from blood donor's arm, the site begins to bleed excessively. What is the nurse's first action? A) Lower the arm below the level of the heart. B) Apply a tourniquet above the antecubital fossa. C) Hold firm pressure on the venipuncture site. D) Assist the client into an erect position.
C
A client with severe anemia is admitted to the hospital. Because of religious beliefs, the client is refusing blood transfusions. The nurse anticipates pharmacologic therapy with which drug to stimulate the production of red blood cells? A) Eltrombopag B) Filgrastim C) Sargramostim D) Epoetin alfa
D
A nurse practitioner reviewed the blood work of a male client suspected of having microcytic anemia. The nurse suspected occult bleeding. Which laboratory result would indicate an initial stage of iron deficiency? A) Total iron-binding capacity: 300 g/dL B) Hemoglobin: 16 g/dL C) Serum iron: 100 g/dL D) Serum ferritin: 15 ng/mL
D
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? A) Plasma cells B) Basophils C) Monocytes D) T lymphocytes
D
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? A) Isometric exercise decreases the workload of the heart and restores oxygenated blood flow. B) Isometric exercise programs are inclusive of all muscle groups and have an aerobic effect to increase the heart rate. C) This type of exercise increases arterial circulation as it returns to the heart. D) Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.
D
A nurse cares for a client with myelodysplastic syndrome who requires frequent PRBC transfusions. What blood component does the nurse recognize as being most harmful if accumulated in the tissues due to chronic blood transfusions? A) Potassium B) Iron C) Hemoglobin D) Calcium
B
A nursing instructor in a BSN program is preparing for a lecture on disorders of the hematopoietic system. Included in the lecture are conditions caused by reduced levels or absence of blood-clotting proteins. Which of the following is the instructor most likely referring to? A) Pancytopenia B) Coagulopathy C) Aplastic anemia D) Sickle cell disease
B
A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse know is the most likely clinical disorder the patient is being treated for? A) Sickle cell anemia B) Essential thrombocythemia C) Extreme leukocytosis D) Renal transplantation
B
A client is diagnosed with extreme thrombocytosis. The nurse knows this condition is a result of which elevated blood cell count? A) Erythrocytes B) Eosinophils C) Platelets D) Neutrophils
C
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? A) Calcium B) White blood cell count C) Iron D) Potassium
C
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? A) Hemophilia B) Hodgkin lymphoma C) Leukemia D) Hypoproliferative anemia
A
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? A) "The condition is likely caused by a vitamin B12 deficiency." B) "The condition is likely caused by a folate deficiency." C) "The condition causes abnormally small red blood cells." D) "The condition causes abnormally rigid red blood cells."
A
Which term describes the percentage of blood volume that consists of erythrocytes? A) Hematocrit B) Hemoglobin C) Erythrocyte sedimentation rate (ESR) D) Differentiation
A
A preoperative client is discussing blood donation with the nurse. Which statement by the client indicates to the nurse the need for further teaching? A) "I should expect blood withdrawal to take about 15 minutes." B) "I could donate my own blood in case I need a transfusion." C) "My family will donate blood, because it's safer." D) "Donated blood is tested for blood type and infections."
C
The client's CBC with differential reveals small-shaped hemoglobin molecules. The nurse expects to administer which medication to this client? A) Folate B) Vitamin B12 C) Iron D) Fresh frozen plasma
C
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? A) Plasma cells B) Monocytes C) T lymphocytes D) Basophils
C
Place the order of the steps of primary hemostasis in correct order. A) Circulating inactive clotting factors convert to active forms. B) The severed blood vessel constricts. C) An unstable hemostatic plug is formed. D) The circulating platelets aggregate at the site and adhere to the vessel.
B, D, C, then A
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? A) Oxygen therapy B) Anticoagulation therapy C) Iron chelation therapy D) Therapeutic phlebotomy
C
Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils? A) Phagocytosis B) Production of antibodies called immunoglobulin (Ig) C) Destruction of tumor cells D) Rejection of foreign tissue
A
The client is to receive a unit of packed red blood cells. What is the nurse's first action? A) Observe for gas bubbles in the unit of packed red blood cells. B) Check the label on the unit of blood with another registered nurse. C) Ensure that the intravenous site has a 20-gauge or larger needle. D) Verify that the client has signed a written consent form.
D
