Chapter 28- Hematologic Function
A client is returning home after having a bone marrow aspiration and biopsy. Which statement indicates that teaching by the nurse has been effective? "I can resume my normal activities." "The area might ache for 1 to 2 days." "I can go to the gym to lift weights later." "I should take aspirin if I have any pain."
"The area might ache for 1 to 2 days."
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 causes abnormally small red blood cells." "The condition is likely caused by a folate deficiency." "The condition causes abnormally rigid red blood cells." "The condition is likely caused by a vitamin B12 deficiency."
"The condition is likely caused by a vitamin B12 deficiency."
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 typically donate blood 4 to 6 weeks before the surgery." "You typically donate blood the day of the surgery." "You will likely not need the blood that is donated." "You will be prescribed calcium to replace what is lost during donation."
"You typically donate blood 4 to 6 weeks before the surgery."
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? 110,000/mm3 200,000 /mm3 90,000/mm3 45,000/mm3
45,000/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? 2:00 pm 6:00 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
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: Albumin. Fibrinogen. Prothrombin. Globulin.
Albumin
Which type of leukocyte contains histamine and is an important part of hypersensitivity reactions? Plasma cell Neutrophil B lymphocyte Basophils
Basophils
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? Hemoglobin Bone marrow aspiration and biopsy Hematocrit Complete blood count
Bone marrow aspiration and biopsy
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? Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart. Isometric exercise decreases the workload of the heart and restores oxygenated blood flow. Isometric exercise programs are inclusive of all muscle groups and have an aerobic effect to increase the heart rate. This type of exercise increases arterial circulation as it returns to the heart.
Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart
The nurse expects which assessment finding when caring for a client with a decreased hemoglobin level? Elevated temperature. Increased bruising. Decreased oxygen level. Bright red venous blood.
Decreased oxygen level
When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply. Medication use Ethnicity Dietary intake Herbal supplements Hair color
Dietary intake Medication use Ethnicity Herbal supplements
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? Administer prescribed PRN anti-anxiety agent. Place the client in a recumbent position with legs elevated. Ensure there is an oxygen delivery device at the bedside. Remove the intravenous line.
Ensure there is an oxygen delivery device at the bedside
A client with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this client? GM-CSF Thrombopoietin Eltrombopag Erythropoietin
Erythropoietin
A client wants to donate blood before his or her abdominal surgery next week. What should be the nurse's first action? Tell the client that 2 units of blood will be needed. Provide the client with a list of the nearest donation centers. Explain the time frame needed for autologous donation. Remind the client to take supplemental iron before donation.
Explain the time frame needed for autologous donation
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 Blood transfusion reaction Splintering of bone fragments Hemorrhage
Hemorrhage
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? Takes medications for seasonal allergies Treatment for osteoarthritis Previous thyroidectomy History of renal disease
History of renal disease
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? Oxygen therapy Anticoagulation therapy Iron chelation therapy Therapeutic phlebotomy
Iron chelation therapy
The nurse should notify the healthcare provider before administering fresh frozen plasma (FFP) based on which assessment finding? Strong pedal pulses Jugular venous distention White sclera Absence of tenting skin turgor
Jugular venous distention
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? Preparation for likely nephrectomy Lack of erythropoietin Hypervolemia Increases the effectiveness of dialysis
Lack of erythropoietin
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? Lateral position with one leg flexed Lithotomy position Jackknife position Supine with head of the bed elevated 30 degrees
Lateral position with one leg flexed
Which blood cell type is matched correctly with its function? T lymphocyte: Humoral immunity B lymphocyte: Secretes immunoglobulin Leukocyte: Fights infection Plasma cell: Cell-mediated immunity
Leukocyte: Fights infection
Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following? Kidney Liver Large intestine Pancreas
Liver
What does the nurse recognize as secondary sites of hematopoiesis that is unique to embryonic development? Select all that apply. Liver Pancreas Kidney Bone marrow Spleen
Liver Spleen
Which term refers to a form of white blood cell involved in immune response? Spherocyte Thrombocyte Granulocyte Lymphocyte
Lymphocyte
Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? Myeloid stem cell Neutrophil Lymphoid stem cell Monocyte
Myeloid stem cell
The nurse is completing a pretransfusion assessment to determine a female client's history of previous transfusions as well as previous reactions to transfusions. Which is the most important information to obtain from this client before the transfusion? Age Family history of transfusion reactions Diagnosis Number of pregnancies
Number of pregnancies
Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils? Production of antibodies called immunoglobulin (Ig) Phagocytosis Destruction of tumor cells Rejection of foreign tissue
Phagocytosis
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.) Administer diuretics as prescribed. Administer oxygen. Place the patient in an upright position with the feet dependent. Continue the infusion but slow the rate down. Discontinue the transfusion.
Place the patient in an upright position with the feet dependent. Administer diuretics as prescribed. Discontinue the transfusion. Administer oxygen.
A client is diagnosed with extreme thrombocytosis. The nurse knows this condition is a result of which elevated blood cell count? Platelets Erythocytes Neutrophils Eosinophils
Platelets
The nurse is working at a blood donation clinic. What teaching should the nurse provide to the donor immediately after blood donation? Remove the band-aid after 5 minutes. Hold the involved arm below the heart. Sit up promptly after the needle is removed. Remain for observation after eating and drinking.
Remain for observation after eating and drinking
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-negative mother; Rh-negative child Rh-positive mother; Rh-negative child Rh-negative mother; Rh-positive child Rh-positive mother; Rh-positive child
Rh-negative mother; Rh-positive child
Which type of lymphocyte is responsible for cellular immunity? T lymphocyte Basophil Plasma cell B lymphocyte
T lymphocyte
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 Plasma cells T lymphocytes Monocytes
T lymphocytes
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 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 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 erythropoietin, stimulating the bone marrow to produce more red blood cells.
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
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? Vitamin A deficiency Vitamin B12 deficiency Vitamin C deficiency Folic acid deficiency
Vitamin B12 deficiency
Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called monocytes. blast cells. mast cells. megaloblasts.
megaloblasts.
