chapter 21
The peripheral smear is a diagnostic test that:
The peripheral smear allows the study of the size, structure, and shape of RBCs.
The nurse assessing a differential sees an increase in immature neutrophils (bands) and is aware that this indicates:
An increase in immature neutrophils (bands) is called bandemia, and it indicates an overwhelming bacterial infection.
The 9-year-old child with leukemia who is on palliative care has drawn a picture of a boy under a huge black cloud that has lightning coming out of it. Which of the following would be an appropriate intervention for the nurse?
Asking what the child has drawn is a neutral and nonthreatening question. Drawings can give a clue to perceptions and emotions that a young child may not be able to verbalize. The nurse should not try to interpret the drawing
The nurse is aware that persons of the Jehovah's Witness faith accept which types of blood transfusions?
Autologous blood transfusions Jehovah's Witness followers are accepting of autologous blood transfusions and some will accept volume expanders such as colloids
B cells and T cells fit under which classification?
B cells and T cells, the major players in the antigen/antibody conflict, are both lymphocytes
How is pernicious anemia diagnosed?
BLOOD TEST RESULTS: 1. schilling test: radioactive vit. B 12 given PO and 24 hr urine collected 2. CBC AND BLOOD STUDIES TO DETECT ANEMIA
when a patient has bandemia
Bandemia is seen in patients who have serious bacterial infections, so the nurse is aware of the need to monitor for development of sepsis, which could lead to septic shock. Conditions such as dehydration or polycythemia vera increase the risk for deep vein thrombosis. Thrombocytopenia is a reduction of platelets. The basophils are involved in allergic response
In caring for a patient with multiple myeloma, what should the nurse include in the daily care?
Because of the constant threat of pathologic fractures, ambulation should be carefully supervised and assisted. Uric acid is increased and may crystalize in the kidney, but straining is not necessary. Analgesia is necessary for relief of bone pain.
What must a patient undergo before a bone marrow transplant?
Before the actual marrow transplant, the patient must undergo total body irradiation or chemotherapy to kill all the marrow cells and the leukemic cells. The patient is at a major risk for infection at this time.
medication that should stop before surgery
Blood thinners, aspirin, anti-inflammatory medications and vitamin E are likely to be discontinued before surgery
The nurse caring for a patient in the emergency room with suspected internal injuries will assess for hypovolemic shock, which is evidenced by (select all that apply):
Indicators of hypovolemia are restlessness, irritability, rapid thready pulse, increasing respirations, pale, cool moist skin, and hypotension, Should the blood loss continue, the patient could go into hypovolemic shock.
When the 14-year-old African American boy comes into the emergency room in sickle cell crisis, what should be the primary focus of care?
Pain control during the crisis is the focus. Continuous opioids are the mainstay of pain management. Certainly IV fluids to reduce viscosity of blood and oxygen for relief of dyspnea are important, but pain control is paramount in the acute phase
sign/symptom of sickle cell crisis
Pain is likely to be severe due to tissue ischemia. The other symptoms could also occur
The person with aplastic anemia is said to be _________________ because all three major blood elements (RBCs, WBCs, and platelets) are diminished or absent.
Persons with aplastic anemia are deficient in all three of the major blood elements, a condition known as pancytopenia.
The nurse caring for a patient with pernicious anemia should make provisions for:
Persons with pernicious anemia are especially sensitive to cold. The provision of a light blanket is beneficial.
What is the process by which certain cells engulf and digest microorganisms and cellular debris?
Phagocytosis is the process by which bacteria, cellular debris, and solid particles are destroyed and removed.
What would a nurse include in a teaching plan for a home health patient with a hemoglobin of 8.4 mg?
Severely anemic persons need to conserve their energy. Observing a rest period after a period of activity will reduce hypoxia. Oxygen may be used as necessary.
when caring for Jehovah's witnesses
Some Jehovah's Witnesses will accept volume expanders (colloids) and autologous blood. The health care team can administer blood to children without the consent of parents according to the US Supreme Court. It is however within the rights of a responsible and coherent adult to refuse treatment
Which of the following are "B" symptoms of a patient with Hodgkin disease? (Select all that apply.)
The "B" symptoms of Hodgkin disease are night sweats, fever, and weight loss. These symptoms are associated with a poor prognosis
The nurse examines the complete blood count (CBC) to assess (select all that apply):
The CBC gives information relative to RBC, WBC, hematocrit, hemoglobin, erythrocyte indexes, WBC differential, and examination of the peripheral blood cells
A patient who had a Schilling test shows a 20% excretion of the radioactive vitamin B12. What would this indicate?
The Schilling test is a laboratory blood test for diagnosing pernicious anemia. The normal reading 24 hours after the administration of radioactive vitamin B12 is 8% to 40%. The test measures the absorption of radioactive vitamin B12.
elevated hemoglobin and hematocrit
When patients are dehydrated, the hemoglobin and hematocrit appear higher than normal. Restoring fluid balance will yield normal results for hemoglobin and hematocrit. Platelet counts and prothrombin time should not be affected.
What are the most likely matches for a bone marrow transplant to a 10-year-old with leukemia? (Select all that apply.)
Specimens from twins, siblings, or self (autologous) while in remission are preferred
The nurse caring for a child with hemophilia who is hospitalized with hemarthrosis should include which of the following in the plan of care?
Splinting the affected knee is necessary to retain anatomic alignment while the pain is severe. Analgesia should be given as needed. Physical therapy and ROM are appropriate after pain has subsided.
The nurse is aware that a person with Hodgkin disease, who has two or more abnormal lymph nodes on the same side of the diaphragm and involvement of extranodal involvement on the same side of the diaphragm, would be in:
Stage II indicates that there are two or more abnormal lymph nodes on the same side of the diaphragm and extranodal involvement on the same side of the diaphragm
Bone marrow is a red, spongy material inside your bones that produces stem cells
Stem cells in the bone marrow produce blood cells — red cells, white cells and platelets
Erythropoietin
a hormone secreted by the kidneys that increases the rate of production of red blood cells in response to falling levels of oxygen in the tissues.
The typical medical treatment of polycythemia vera involves repeated phlebotomies and medications such as busulfan (Myleran) in order to:
inhibit bone marrow activity. Repeated phlebotomy decreases blood viscosity, and myelosuppressive agents such as busulfan (Myleran) are often given to inhibit bone marrow activity.
Because older adults suffer from conditions such as colonic diverticula, hiatal hernia, and ulcerations that can cause occult bleeding, the nurse should assess for symptoms of:
iron deficiency anemia. Blood loss is a major cause of iron deficiency in adults. The major sources of chronic blood loss are from the GI and genitourinary systems.
Hemoglobin
iron-containing protein in red blood cells that carries oxygen for delivery to cells
The nurse explains that a positron emission tomography (PET) has been ordered to
measure lymph node response to therapy The PET can measure the effect of therapy on diseased nodes.
The nurse explains that the treatment of hemophilia A has been revolutionized with the advent of the use of:
recombinant factor VIII. Recombinant factor VIII has been a major forward step in the treatment of hemophilia A
What does the elevation in the eosinophil count to 10% indicate?
Normal values of eosinophils are 1% to 4%. An elevation to 10% would indicate the presence of an allergic reaction.
The nurse explains that because it is a reliable and predictable indicator of the body's level of infection or recovery the _____________________ is a common diagnostic tool.
A differential white blood cell count is an examination in which the different kinds of WBCs are counted and reported as percentages of the total examined. It is a common diagnostic tool because of its reliability and the predictability of the body's response to infection or its progress in recovery.
Arrange the process of hemostasis in sequence. (Separate letters by a comma and space as follows: A, B, C, D) a. Release of clotting factor from injured tissue b. Formation of thrombin c. Formation of fibrin d. Trapping of RBC and platelets e. Clot f. Release of thromboplastin
A, F, B, C, D, E Clotting factors are released from the injured tissue causing the release of thromboplastin, which acts with calcium to form thrombin; fibrin is formed, which traps red cells and platelets to make the clot.
The home health nurse recommends to the mother of a 12-year-old child with leukemia that the child should have:
Children with leukemia should have an annual influenza vaccine and a pneumococcal vaccine every 5 years
Which patient statement from a 15-year-old girl with thrombocytopenia would require more assessment to report to the charge nurse?
Coke-colored urine is hematuria that should be documented and reported to the charge nurse. The purpura will fade as they are absorbed. Boredom and smelly stools are normal for a 14-year-old.
TREATMENT FOR PERNICIOUS ANEMIA
Vitamin B12 injections for life
Outline the sequence of the process that stimulates the increase in the production of red blood cells. (Separate letters by a comma and space as follows: A, B, C, D) a. Kidneys release erythropoietic factor b. Increase in red blood cell production c. Enzyme stimulates red bone marrow d. Oxygen delivery increased to the tissues e. Oxygen delivery decreased to the tissues f, Decrease in red blood cell production
E, A, C, B, D, F When the tissues of the body register a decrease of oxygen, the kidneys release the erythropoietic factor that stimulates the bone marrow to produce more RBCs, which increases the oxygen delivery to the tissues which then signals the bone marrow to decrease the RBC production.
In an adult, where are erythrocytes continuously produced?
Erythrocytes are continuously produced in the red bone marrow, principally in the vertebrae, ribs, and sternum.
Which of the following are necessary factors that support healthy erythropoiesis? (Select all that apply.)
Erythropoiesis, red blood cell production, is dependent on the availability of healthy bone marrow, dietary supply of copper and iron, amino acids, vitamins B12 and B2, folic acid, and pyridoxine.
The nurse clarifies that ____________ _______________ replaces iron stores needed for red blood cell production
Ferrous sulfate replaces iron stores needed for red blood cell production.
A 23-year-old male patient with hemophilia A says, "How can I keep my children from having hemophilia A?" Which of the following is the most informative response?
Hemophilia A is an X-linked trait. Females are carriers; therefore, the patient's daughter could pass the disease to her sons. The patient's sons are not at risk for hemophilia A.
The nurse explains that in the event of an invasion of an allergen, the basophils release a strong vasodilator, which is:
Histamine is released by the basophils during the invasion of an allergen
discuss six consideration for the administration of iron?
Iron supplements may be contraindicated in peptic ulcer disease. Side effects include gastrointestinal (GI) upset (nausea, vomiting), constipation or diarrhea, and green to black stools. Iron is absorbed best from the duodenum and proximal jejunum. Therefore enteric-coated or sustained-release capsules, which release iron farther down in the GI tract, are counterproductive; they are also more expensive. If side effects develop, the dose and type of iron supplement may be adjusted. Some people cannot tolerate ferrous sulfate because of the effects of the sulfate base. Ferrous gluconate may be an acceptable substitute. Iron is best absorbed in an acidic environment. To avoid binding the iron with food, iron should be taken about an hour before meals, when the duodenal mucosa is most acidic. Taking iron with vitamin C (ascorbic acid) or orange juice, which contains ascorbic acid, also enhances iron absorption. Do not administer with an antacid because it reduces the absorption of iron. If a dose is missed, continue with schedule; do not double a dose. Iron may interfere with absorption of oral tetracycline antibiotics and quinolones (Cipro, Levaquin, Noroxin). Do not take within 2 hours of each other. Dilute liquid iron preparations in juice or water, and administer with a straw to avoid staining teeth. Provide oral hygiene after taking. Check for constipation or diarrhea. Record color (iron turns stools green to black) and amount of stool. Iron is toxic, and caution must be taken to store iron preparations out of a child's reach.
When instructing the patient taking an oral liquid iron preparation, what should the nurse include?
Liquid iron preparations should be drunk through a straw to prevent tooth staining. All oral iron preparations should be taken before meals. Dairy products interfere with the absorption of iron
Fresh frozen plasma
Liquid portion of whole blood is separated from cells and frozen
The mother of a 4-year-old child with leukemia says to the nurse, "I don't understand why he is crying about his legs hurting." The nurse's most informative response would be based on the information that bone pain is related to:
Long bone pain is the result of bone marrow that is congested with immature white cells
what are two main function of the lymph glands
Lymph nodes (glands) have two functions: (1) to filter impurities from the lymph and (2) to produce lymphocytes (WBCs).
Neutrophils release ______________, an enzyme that destroys certain bacteria
Lysozyme is an enzyme released by the neutrophils that kills certain bacteria when the bacteria is recognized in the body.
_____________ are leukocytes that destroy and remove cellular waste, bacteria, and solid particles.
Neutrophils (granular circulating leukocytes essential for phagocytosis, the process by which bacteria, cellular debris, and solid particles are destroyed and removed) ingest bacteria and dispose of dead tissue.
Which mandatory practice is the most effective and significant nursing practice to prevent the spread of infection?
Strict and frequent handwashing by all people having contact with the patient Meticulous handwashing by medical and nursing personnel and strict asepsis are mandatory
The Reed-Sternberg cell is the hallmark diagnostic indicator for _______________ __________.
The Reed-Sternberg cell, large abnormal multinucleated cells in the lymph nodes, is diagnostic of Hodgkin disease
what are the three main functions of the blood
The blood performs three critical functions. First, it transports oxygen and nutrition to the cells and waste products away from the cells, and it transports hormones from endocrine glands to tissues and cells. Second, it regulates the acid-base balance (pH) with buffers, helps regulate body temperature because of its water content, and controls the water content of its cells as a result of dissolved sodium ions. Third, it protects the body against infection by transporting leukocytes and antibodies to the site of infection and prevents blood loss with special clotting mechanisms
Which of the following foods would the nurse recommend to a person with iron deficiency anemia as an excellent meat source for erythropoiesis?
The dark meat of poultry is a good meat source for erythropoiesis.
What is the average life span of an erythrocyte?
The life span of an RBC is 120 days. A WBC's life span is days to several years. Platelets live 5 to 9 days.
what are three functions of the lymphatic system
The lymphatic system has three basic functions: (1) maintenance of fluid balance, (2) production of lymphocytes, and (3) absorption and transportation of lipids from the intestine to the bloodstream
Which of the following would the nurse explain as the most common type of leukemia that affects children?
The most common type of leukemia that affects children is the fast-advancing ALL. This leukemia can also affect adults. Acute lymphocytic leukemia (ALL)
Hematocrit
The percent of the volume of whole blood that is composed of red blood cells as determined by separation of red blood cells from the plasma usually by centrifugation.
From which location would the bone marrow sample come in the aspiration of a 25-year-old patient?
The preferred site for bone marrow aspiration puncture in adults is the posterior iliac crest
The presence of excess bands in the peripheral blood that indicate severe infection is called
The presence of excess bands in the peripheral blood is called a shift to the left (i.e., a shift toward immature cells) and indicates severe infection.
Approximately how much blood is stored in the spleen that can be released in a hypovolemic emergency?
The spleen stores 1 pint of blood, approximately 500 mL, which can be released during emergencies
The spleen is a highly vascularized organ located in the left upper quadrant of the abdominal cavity. What are the main functions of the spleen? (Select all that apply.)
The spleen stores 1 pint of blood, which can be released during emergencies, such as hemorrhage, in less than 60 seconds. The main functions of the spleen are (1) to serve as a reservoir for blood; (2) to form lymphocytes, monocytes, and plasma cells; (3) to destroy worn-out RBCs; (4) to remove bacteria by phagocytosis (engulfing and digesting); and (5) to produce RBCs before birth (the spleen is believed to produce RBCs after birth only in cases of extreme hemolytic anemia).
what are five functions of the spleen
The spleen: (1) has a major role in homeostasis by destroying worn-out or defective RBCs; (2) is a reservoir for blood; (3) forms lymphocytes, monocytes, and plasma cells; (4) houses white blood cells in the lining of the hollow cavities within the spleen; (5) produces RBCs before birth (the spleen is believed to produce RBCs after birth only in cases of extreme hemolytic anemia).
hypovolemic shock
shock resulting from blood or fluid loss. Subtle changes in behavior such as restlessness or anxiety are considered early signs. Orthostatic blood pressure is manifest after patient loses 1000-1500 mL of blood. Decreased red cell count may not be evident in the early stages. Decreased urine output is a compensatory mechanism that indicates that blood is being shunted away from the kidneys in order to preserve the brain and heart.
