Chapter 28: Assessment of Hematologic Function and Treatment Modalities

The nurse is obtaining the health history of a client suspected of having a hematological condition. The nurse notes the client has a history of alcohol abuse. Which clinical presentation is related to alcohol consumption? a) Myelodysplastic syndrome b) Thrombocytopenia c) Anemia d) Neutropenia

Anemia Explanation: Individuals with a history of alcohol consumption may have anemia due to nutritional deficiencies. Myelodysplastic syndrome, neutropenia, and thrombocytopenia are not common findings in clients who consume or abuse alcohol.

The charge nurse should intervene when observing a new nurse perform which action after a client has suffered a possible hemolytic blood transfusion reaction? a) Notifying the blood bank of the reaction. b) Disposing of the blood container and tubing in biohazard waste. c) Informing the client to leave a urine sample after the client's next void. d) Documenting the reaction in the client's medical record.

Disposing of the blood container and tubing in biohazard waste. Explanation: 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. A urine sample is collected as soon as possible to detect hemoglobin in the urine. Documenting the client's reaction in the medical record is an appropriate action.

A client with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this client? a) Thrombopoietin b) Eltrombopag c) Erythropoietin d) GM-CSF

Erythropoietin Explanation: Erythropoietin (epoetin alfa [Epogen, Procrit]) is an effective alternative treatment for clients with chronic anemia secondary to diminished levels of erythropoietin, as in chronic renal disease. This medication stimulates erythropoiesis.

A client is diagnosed with extreme thrombocytosis. The nurse knows this condition is a result of which elevated blood cell count? a) Platelets b) Erythocytes c) Neutrophils d) Eosinophils

Platelets Explanation: Extreme thrombocytosis is an elevation in platelets.

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) Hypervolemia c) Preparation for likely nephrectomy d) Increases the effectiveness of dialysis

Lack of erythropoietin Explanation: The kidneys produce erythropoietin, a hormone that stimulates red blood cell production. A lack of this hormone is the most likely reason for blood transfusion due to the acute kidney failure. There is no indication for a nephrectomy in this question. A blood transfusion will not necessarily increase the effectiveness of dialysis. Transfusing a client with hypervolemia could lead to circulatory overload.

The nurse cares for a client with a coagulation factor deficiency who is actively bleeding. Which blood component replacement does the nurse anticipate administering? a) FFP b) IV gamma-globulin c) PRBCs d) Antithrombin III

FFP Explanation: Fresh frozen plasma has all the coagulation factors in it and is the blood component replacement therapy that will be used to replace blood from a client who is actively bleeding with a coagulation factor deficiency.

A client is preparing to leave the blood bank after donating a unit of blood. Which teaching will the nurse provide to the client at this time? a) "Eat healthy meals for a few days." b) "Increase fluid intake for a week." c) "Avoid heavy lifting for several hours." d) "Avoid smoking for 1 day."'

"Avoid heavy lifting for several hours." Explanation: After a blood donation, the client should be instructed to avoid heavy lifting for several hours. Smoking cessation should be taught, not just one hour after a blood donation. Fluid intake should be increased for 2 days not one week. Healthy meals should be ingested for at least 2 weeks after the donation.

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? a) "Are you taking more than three medications?" b) "Have you gotten your vaccines this year?" c) "Have you had unexplained episodes of bleeding?" d) "How many fruits and vegetables do you eat each day?"

"Have you gotten your vaccines this year?" Explanation: 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 teaching a client 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 statement by the client? a) "I will eat a spinach salad with lunch and dinner." b) "I will eat more dairy products such as milk, yogurt, and ice cream every day." c) "I will eat a meat source such as chicken or pork with each meal." d) "I will increase my daily intake of orange vegetables such as sweet potatoes and carrots."

"I will eat a meat source such as chicken or pork with each meal." Explanation: Vitamin B12 is found only in foods of animal origin. The other choices do not include meats. Dairy products contain large amounts of Calcium and vitamin D. Orange vegetables contain large amounts of vitamin 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 causes abnormally rigid red blood cells." b) "The condition is likely caused by a vitamin B12 deficiency." c) "The condition causes abnormally small red blood cells." d) "The condition is likely caused by a folate deficiency."

"The condition is likely caused by a vitamin B12 deficiency." Explanation: 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.

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."

"The condition is likely caused by a vitamin B12 deficiency." Explanation: 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.

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? a) "You typically donate blood the day of the surgery." b) "You typically donate blood 4 to 6 weeks before the surgery." c) "You will likely not need the blood that is donated." d) "You will be prescribed calcium to replace what is lost during donation."

"You typically donate blood 4 to 6 weeks before the surgery." Explanation: 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.

Place the steps of fibrin clot breakdown in correct order. Release of fibrin degradation products Formation of plasmin Digestion of fibrinogen and fibrin Activation of plasminogen

- Activation of plasminogen - Formation of plasmin - Digestion of fibrinogen and fibrin - Release of fibrin degradation products Explanation: As an injured vessel is repaired and again covered with endothelial cells, the fibrin clot is no longer needed. Plasminogen is needed to break down the fibrin. The fibrin clot breakdown begins with activation of plasminogen, which forms plasmin. Plasmin acts to digest fibrinogen and fibrin, which releases fibrin degradation products and completes the fibrin clot breakdown.

A client receiving a unit of packed red blood cells develops hives and generalized itching. Which actions will the nurse take to help this client? Select all that apply. a) Slow the rate of the transfusion b) Apply oxygen via a face mask c) Administer diphenhydramine as prescribed d) Notify the primary health care provider e) Stop the transfusion

- Administer diphenhydramine as prescribed - Notify the primary health care provider - Stop the transfusion Explanation: Some clients develop urticaria (hives) or generalized itching during a transfusion; the cause is thought to be a sensitivity reaction to a plasma protein within the blood component being transfused. Symptoms of an allergic reaction are urticaria, itching, and flushing. The reactions are usually mild and respond to antihistamines. The nurse should stop the transfusion and notify the primary health care provider of the client's symptoms. If the symptoms subside, the transfusion can be resumed. The client does not need oxygen. Slowing the rate of the transfusion would not help reduce the symptoms.

The nurse is providing health education to an older adult client who has low red blood cell levels. To promote red blood cell production, the nurse should encourage intake of what foods? Select all that apply. a) Animal fats b) Leafy green vegetables c) Organic foods d) Lean meats e) Nuts and seeds

- Leafy green vegetables - Lean meats - Nuts and seeds Explanation: A healthy diet that includes lean meats, nuts, seeds and green vegetables can promote red cell production. Animal fats are not known to promote red cell production. Organic foods are not necessarily more likely to promote red cell synthesis.

When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply. a) Medication use b) Herbal supplements c) Ethnicity d) Hair color e) Dietary intake

- Medication use - Herbal supplements - Ethnicity - Dietary intake Explanation: Dietary intake, ethnicity, use of herbal supplements, and medication use are factors for which the nurse should assess. Hair color is not considered a factor in determining causes of hematological disorders.

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) 50-year-old female with pulse 95 beats/minute c) 26-year-old female with hemoglobin 11.0 g/dL d) 86-year-old male with blood pressure 110/70 mm Hg

26-year-old female with hemoglobin 11.0 g/dL Explanation: 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 client with Hodgkin disease had a bone marrow biopsy yesterday and reports aching at the biopsy site, rated a 5 (on a 1-10 scale). After assessing the biopsy site, which nursing intervention is most appropriate? a) Administer acetaminophen 500 mg po, as ordered b) Reposition the client to a high Fowler position and continue to monitor the pain c) Notify the physician d) Administer aspirin (ASA) 325 mg po, as ordered

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

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) Prothrombin. b) Fibrinogen. c) Albumin. d) Globulin.

Albumin. Explanation: Albumin, only produced in the liver, is essential for maintaining oncotic pressure in the vascular system. A decrease in oncotic pressure due to low albumin causes fluid to leak into the peritoneal cavity.

The physician performs a bone marrow biopsy from the posterior iliac crest on a client with pancytopenia. What intervention should the nurse perform after the procedure? a) Pack the wound with half-inch sterile gauze b) Apply pressure over the site for 5-7 minutes c) Administer a topical analgesic to control pain at the site d) Elevate the head of the bed to 45 degrees

Apply pressure over the site for 5-7 minutes Explanation: Hazards of either bone marrow aspiration or biopsy include bleeding and infection. The risk of bleeding is somewhat increased if the client's platelet count is low or if the client has been taking a medication (e.g., aspirin) that alters platelet function. After the marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing.

Which type of leukocyte contains histamine and is an important part of hypersensitivity reactions? a) Plasma cell b) Neutrophil c) B lymphocyte d) Basophils

Basophils Explanation: Basophils contain histamine and are an integral part of hypersensitivity reactions. B lymphocytes are responsible for humoral immunity. A plasma cell secretes immunoglobulins. The neutrophil functions in preventing or limiting bacterial infection via phagocytosis.

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) Chelation therapy b) Epoetin alpha c) Romiplostim d) Eltrombopag

Chelation therapy Explanation: Iron overload is a problem for clients with MDS, especially in those who routinely receive PRBC transfusions (transfusion dependent). Surplus iron is deposited in cells within the reticuloendothelial system, and later in parenchymal organs. To prevent or reverse the complications of iron overload, iron chelation therapy is commonly implemented. Romiplostim and eltrombopag are used to stimulate the proliferation and differentiation of megakaryocytes into platelets within the bone marrow. Epoetin alpha may be used to improve anemia and decrease the need for blood transfusions.

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

Coagulopathy Explanation: The term coagulopathy refers to conditions in which a component that is necessary to control bleeding is missing or inadequate.

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) Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart. b) Isometric exercise decreases the workload of the heart and restores oxygenated blood flow. c) This type of exercise increases arterial circulation as it returns to the heart. d) 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. Explanation: 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 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

Crackles auscultated bilaterally Explanation: 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.

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) Decreased level of erythropoietin b) Increased reticulocyte count c) Increased mean corpuscular volume d) Decreased total iron-binding capacity

Decreased level of erythropoietin Explanation: Differentiation of the primitive myeloid stem cell into an erythroblast is stimulated by erythropoietin, a hormone produced primarily by the kidney. If the kidney detects low levels of oxygen, as occurs when fewer red cells are available to bind oxygen (i.e., anemia), or with people living at high altitudes with lower atmospheric oxygen concentrations, erythropoietin levels increase. The increased erythropoietin then stimulates the marrow to increase production of erythrocytes. The entire process of erythropoiesis typically takes 5 days (Cook, Ineck, & Lyons, 2011). For normal erythrocyte production, the bone marrow also requires iron, vitamin B12, folate, pyridoxine (vitamin B6), protein, and other factors. A deficiency of these factors during erythropoiesis can result in decreased red cell production and anemia.

The nurse expects which assessment finding when caring for a client with a decreased hemoglobin level? a) Bright red venous blood. b) Elevated temperature. c) Decreased oxygen level. d) Increased bruising.

Decreased oxygen level. Explanation: Hemoglobin carries oxygen; a decreased hemoglobin level results in decreased oxygen. An elevated temperature is a sign of infection and can result from decreased white blood cells. Arterial blood is more oxygen saturated and brighter red in color than venous blood. Increased bruising results from a decreased platelet level, not decreased hemoglobin.

A client donated two units of blood to be used for transfusion during spinal fusion surgery. The client received one unit of autologous blood during the procedure but the second unit is not needed during the procedure. The nurse knows which action will come after the procedure is completed? a) Provide it to the client before discharge. b) Discard the additional unit. c) Release the additional unit for use to the general population. d) Use the unit for platelets and albumin.

Discard the additional unit. Explanation: In autologous donation, the client's own blood is collected for a future transfusion, particularly for an elective surgery where the potential for transfusion is high, such as an orthopedic procedure. If the blood is not used, it is discarded. The blood is not used for its components. The client will not be given the unit of blood unless it is required. The additional unit will not be released to the general population for use.

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) Administer the morphine into the closest tubing port to the client for fast delivery. b) Inject the morphine into a distal port on the blood tubing. c) Disconnect the blood tubing, flush with normal saline, and administer morphine. d) Add the morphine to the blood to be slowly administered.

Disconnect the blood tubing, flush with normal saline, and administer morphine. Explanation: Never add medications to blood or blood products. The transfusion must be temporarily stopped in order to administer the morphine.

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) Administer prescribed PRN anti-anxiety agent. b) Remove the intravenous line. c) Ensure there is an oxygen delivery device at the bedside. d) Place the client in a recumbent position with legs elevated.

Ensure there is an oxygen delivery device at the bedside. Explanation: The client is exhibiting signs of circulatory overload. After stopping the transfusion and notifying the healthcare provider, the nurse should place the client in a more upright position with the legs dependent to decrease workload on the heart. The IV line is kept patent in case emergency medications are needed. Oxygen and morphine may be needed to treat severe dyspnea. Administering an anti-anxiety agent is not a priority action over ensuring oxygen is available.

A client wants to donate blood before his or her abdominal surgery next week. What should be the nurse's first action? a) Explain the time frame needed for autologous donation. b) Remind the client to take supplemental iron before donation. c) Tell the client that 2 units of blood will be needed. d) Provide the client with a list of the nearest donation centers.

Explain the time frame needed for autologous donation. Explanation: Preoperative autologous donations are ideally collected 4 to 6 weeks before surgery. The nurse should first explain that time frame to this client. Surgery is scheduled in one week which means that autologous blood donation may not be an option for this client. A list of donation centers can be provided to the client; and even though iron is recommended and 2 units of blood may be suggested, the first action is to tell the client about the needed time frame for donation.

Which term refers to the percentage of blood volume that consists of erythrocytes? a) Hemoglobin b) Differentiation c) Hematocrit d) Erythrocyte sedimentation rate (ESR)

Hematocrit Explanation: Hematocrit is the percentage of blood volume consisting of erythrocytes. Differentiation is development of functions and characteristics that differ from those of the parent stem cell. ESR is a laboratory test that measures the rate of settling of RBCs; an elevated rate is indicative of inflammation. Hemoglobin is the iron-containing protein of RBCs.

A nurse is performing an initial assessment and notes the client's skin is a gray-tan color, especially on the scars of the client's arms. Which hematological condition does the nurse suspect? a) Polycythemia b) Thrombocytopenia c) Vitamin B12 deficiency d) Hemochromatosis

Hemochromatosis Explanation: Hemochromatosis is an autosomal recessive disease of excessive iron absorption. This results in bronze or gray-tan skin, especially over scars. The other answer choices are hematological conditions; however, these do not cause the skin to turn a gray-tan color.

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) Leukemia b) Hodgkin lymphoma c) Hemophilia d) Hypoproliferative anemia

Hemophilia Explanation: Administration of clotting factor studies are used to identify diseases where these factors are absent or insufficient; hemophilia is among the most common of these diseases and is associated with Factor VII. Factor VII is not related to leukemia, lymphoma, or anemia.

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) Treatment for osteoarthritis b) Previous thyroidectomy c) History of renal disease d) Takes medications for seasonal allergies

History of renal disease Explanation: Hemodilution is the removal of 1 to 2 units of blood after induction of anesthesia and replaced with a colloid or crystalloid solution. The blood is then reinfused after the surgery. The purpose of this approach is to reduce the amount of erythrocytes lost during the surgery because the intravenous fluids dilute the concentration of red blood cells and lowers the hematocrit. Hemodilution has been linked to tissue ischemia in the kidneys and would be contraindicated in the client with a history of renal disease. Hemodilution would not be contraindicated for a previous thyroidectomy, treatment for osteoarthritis, or medication used to treat seasonal allergies.

A client scheduled for hip replacement surgery did not have enough time to have autologous donations completed. The nurse knows that which action will be performed if the client requires blood during the surgery? a) Intraoperative blood salvage b) Plasmapheresis c) Hemodilution d) Direct donation

Intraoperative blood salvage Explanation: Intraoperative blood salvage is a method for clients who are unable to donate blood before surgery and are having an orthopedic surgery. During the procedure, blood lost into a sterile cavity is suctioned into a cell-saver machine where is it is washed, filtered, and then infused into the client. Hemodilution is a transfusion method where 1 to 2 units of blood are removed after the induction of anesthesia and then reinfused after surgery. This approach has been linked to tissue ischemia of the kidneys. Plasmapheresis is the removal of plasma proteins and used for hyperviscosity syndromes and to treat some renal and neurologic diseases. It would not be applicable after joint replacement surgery. Direct donation is not routinely accepted by blood centers and would not be an action if the client requires blood during the surgery.

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) Iron b) Hemoglobin c) Potassium d) Calcium

Iron Explanation: Iron overload is a complication unique to people who have had long-term PRBC transfusion. Over time, the excess iron deposits in body tissues can cause organ damage, particularly in the liver, heart, testes, and pancreas.

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) Potassium b) White blood cell count c) Iron d) Calcium

Iron Explanation: 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.

The client's CBC with differential reveals small-shaped hemoglobin molecules. The nurse expects to administer which medication to this client? a) Folate b) Fresh frozen plasma c) Iron d) Vitamin B12

Iron Explanation: With iron deficiency, the erythrocytes produced by the marrow are small and low in hemoglobin. Vitamin B12 and folate deficiencies are characterized by the production of abnormally large erythrocytes. Fresh frozen plasma are infused due to a low platelet level, not light-colored hemoglobin.

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) Therapeutic phlebotomy c) Anticoagulation therapy d) Iron chelation therapy

Iron chelation therapy Explanation: 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.

A client reports feeling faint after donating blood. What is the nurse's best action? a) Keep client in recumbent position to rest. b) Place the client in Trendelenburg position. c) Ambulate client with assistance. d) Assist the client into high-Fowler's position.

Keep client in recumbent position to rest. Explanation: After blood donation, the donor should remain recumbent until he or she feels able to sit up. Donors who experience weakness or faintness should rest for a longer period. High-Fowler's position would not promote blood flow to the brain, and could cause the client to feel light-headed or faint. Ambulating a client who feels faint is not safe due to the high risk of falling. Trendelenburg position is not recommended after blood donation.

What food should the nurse recommend for a client diagnosed with vitamin B12 deficiency? a) Whole-grain bread b) Lean meat c) Green vegetables d) Citrus fruit

Lean meat Explanation: Vitamin B12 is only found in foods of animal origin. Therefore, whole-grain bread, green vegetables, and citrus fruit do not contain this vitamin.

Which blood cell type is matched correctly with its function? a) Leukocyte: Fights infection b) B lymphocyte: Secretes immunoglobulin c) Plasma cell: Cell-mediated immunity d) T lymphocyte: Humoral immunity

Leukocyte: Fights infection Explanation: 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? a) Pancreas b) Large intestine c) Liver d) Kidney

Liver Explanation: Albumin is produced by the liver. Albumin is not produced in the pancreas, kidney, or large intestine.

Which nursing intervention should be incorporated into the plan of care for a client with impaired liver function and a low albumin concentration? a) Apply prolonged pressure to needle sites or other sources of external bleeding b) Implement neutropenic precautions c) Monitor temperature at least once per shift d) Monitor for edema at least once per shift

Monitor for edema at least once per shift Explanation: Albumin is particularly important for the maintenance of fluid balance within the vascular system. Capillary walls are impermeable to albumin, so its presence in the plasma creates an osmotic force that keeps fluid within the vascular space. Clients with impaired hepatic function may have low concentrations of albumin, with a resultant decrease in osmotic pressure and the development of edema.

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? a) Lymphoid stem cell b) Neutrophil c) Myeloid stem cell d) Monocyte

Myeloid stem cell Explanation: 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? a) Monocytes b) Basophils c) Eosinophils d) Neutrophils

Neutrophils Explanation: 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).

A nurse cares for an older adult client with acute myeloid leukemia (AML). What concept does the nurse understand leads to the increased risk of an older adult acquiring myeloid malignancies such as AML? a) Older adults are exposed to more infectious disease over time. b) Older adults acquire damage to the DNA of stem cells over time. c) Older adults have an increasing number of leukocytes over time. d) Older adults acquire damage to the bone marrow over time.

Older adults acquire damage to the DNA of stem cells over time. Explanation: Older adults acquire damage to the DNA of stem cells over time, increasing the chance of myeloid malignancies such as AML. The damage over time is to the stem cells themselves, not the bone marrow. Exposure to infectious disease does not increase the chance of developing myeloid malignancies.

Which is a symptom of severe thrombocytopenia? a) Dyspnea b) Inflammation of the tongue c) Inflammation of the mouth d) Petechiae

Petechiae Explanation: 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? a) Rejection of foreign tissue b) Production of antibodies called immunoglobulin (Ig) c) Destruction of tumor cells d) Phagocytosis

Phagocytosis Explanation: 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.

The nurse is working at a blood donation clinic. What teaching should the nurse provide to the donor immediately after blood donation? a) Remain for observation after eating and drinking. b) Sit up promptly after the needle is removed. c) Remove the band-aid after 5 minutes. d) Hold the involved arm below the heart.

Remain for observation after eating and drinking. Explanation: After blood donation, the donor receives food and fluids and is asked to remain for observation. After the needle is removed, donors are asked to hold the involved arm straight up, and firm pressure is applied with sterile gauze for 2 to 3 minutes. A firm bandage is then applied. The donor remains recumbent until he or she feels able to sit up, usually within a few minutes.

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-negative mother; Rh-negative child b) Rh-negative mother; Rh-positive child c) Rh-positive mother; Rh-negative child d) Rh-positive mother; Rh-positive child

Rh-negative mother; Rh-positive child Explanation: 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 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) Serum ferritin: 15 ng/mL b) Total iron-binding capacity: 300 g/dL c) Serum iron: 100 g/dL d) Hemoglobin: 16 g/dL

Serum ferritin: 15 ng/mL Explanation: Microcytic anemia is characterized by small RBCs due to insufficient hemoglobin. Serum ferritin levels correlate to iron deficiency and decrease as an initial response to anemia before hemoglobin and serum iron levels drop.

Which type of lymphocyte is responsible for cellular immunity? a) T lymphocyte b) B lymphocyte c) Basophil d) Plasma cell

T lymphocyte Explanation: 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? a) Monocytes b) Basophils c) T lymphocytes d) Plasma cells

T lymphocytes Explanation: T lymphocytes are responsible for cell-mediated immunity, in which they recognize material as "foreign," acting as a surveillance system.

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 erythropoietin, stimulating the bone marrow to produce more red blood cells. b) The kidneys sense low oxygen levels in the blood and produce hemoglobin, stimulating the marrow to produce more red blood cells. c) The bone marrow is stimulated by low oxygen levels in the blood to produce erythropoietin, maturing the red blood cells. d) 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. Explanation: 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 nursing instructor is reviewing the role and function of stem cells in the bone marrow with a group of nursing students. After providing 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 destroy marrow can resume production of blood cells. Which explanation by the students is correct? a) Fat found in yellow bone marrow can be replaced by active marrow when more blood cell production is required. b) The liver and spleen can resume production of blood cells through extramedullary hematopoiesis. c) The three cell types—erythrocytes, leukocytes, and platelets—can resume production of stem cells. d) The remaining stem cells have the ability to continue with the process of self-replication, creating an endless supply.

The liver and spleen can resume production of blood cells through extramedullary hematopoiesis. Explanation: In adults with disease that destroy marrow or cause fibrosis or scarring, the liver and spleen can also resume production of blood cells through a process known as extramedullary hematopoiesis.

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? a) Bacterial contamination of blood b) Delayed hemolytic reaction c) Transfusion-related acute lung injury d) Exacerbation of congestive heart failure

Transfusion-related acute lung injury Explanation: 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? a) Where a mask when entering the client's room. b) Apply supplemental oxygen to maintain the client's oxygenation. c) Use an electric razor when assisting client with shaving. d) Elevate the client's head of the bed.

Use an electric razor when assisting client with shaving. Explanation: 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.

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) Premedicate the client with acetaminophen b) Administer the blood as soon as it arrives c) Verify the client's identity according to hospital policy d) Assess the client 30 minutes after the start of the initial transfusion

Verify the client's identity according to hospital policy Explanation: Acute hemolytic transfusion reactions are preventable. Improper identification is responsible for the majority of hemolytic transfusion reactions. Meticulous attention to detail in labeling blood samples and blood components and accurately identifying the recipient cannot be overemphasized. It is the nurse's responsibility to ensure that the correct blood component is transfused to the correct client. The nurse must assess the client during the initial start of the transfusion and frequently, if the nurses delays the assessment time for 30 minutes the client may have begun to experience acute hemolytic transfusion reaction, this puts the client's safety at risk.

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 C deficiency b) Vitamin A deficiency c) Vitamin B12 deficiency d) Folic acid deficiency

Vitamin B12 deficiency Explanation: Because vitamin B12 is found only in foods of animal origin, strict vegetarians may ingest little vitamin B12. 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 therefore the absorption of vitamin B12 may be diminished. The effects of either decreased absorption or decreased intake of vitamin B12 are not apparent for 2-4 years. This results in megaloblastic anemia. Some symptoms are a smooth, beefy red, enlarged tongue and cranial nerve deficiencies.

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) may be developing anemia. b) has thrombocytopenia. c) has leukopenia. d) may be developing an infection.

may be developing an infection. Explanation: 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.