Elsevier Hematology Quizzz + Class Questions!
When evaluating the red cell indices of a patient, the nurse knows that a low MCV indicates... A) Small size of the RBCs B) Inadequate number of RBCs C) Low hemoglobin in the RBCs D) Hypochromic RBCs
A
A client develops iron-deficiency anemia. Which of the client's laboratory test results should the nurse expect to be decreased? A) Ferritin level B) Platelet count C) White blood cell count D) Total iron-binding capacity
A (Ferritin, a form of stored iron, is reduced with iron-deficiency anemia. Platelets will be within the expected range or increased with iron-deficiency anemia. Red, not white, blood cells are decreased with iron-deficiency anemia. Total iron-binding capacity will be increased with iron-deficiency anemia.)
The mother of a 13-year-old child with sickle cell anemia tells the nurse that the family is going camping by a lake this summer. She asks what activities are appropriate for her child. Which activity should the nurse suggest? A) Swimming in the lake B) Soccer with the family C) Climbing the mountain trails D) Motorboat rides around the lake
D
When caring for a patient who is receiving heparin, the nurse will monitor... A) Thrombin time B) Normalized ratio (INR) C) Fibrin split products D) Partial thromboplastin time (PTT)
D
A nurse provides teaching regarding vitamin B 12 injections to a client with pernicious anemia. What statement by the client indicates that teaching was understood? A) "I must take this monthly for the rest of my life." B) "I should take this vitamin, as needed, when feeling fatigued." C) "Once my symptoms subside, I can stop taking this vitamin." D) "I need to have this available for use during exacerbations of anemia."
A (Because the intrinsic factor does not return to gastric secretions even with therapy, B 12 injections will be required for the remainder of the client's life. Vitamin B 12 must be taken on a regular basis for the rest of the client's life.)
When reviewing the CBC for a patient admitted with an elevated temperature and flank pain, which information will be most important for the nurse to communicate to the health provider? A) Neutrophils 9,500 B) Hemolgobin 11.6 C) Hematocrit 37.6 D) Platelets 145,000
A
A client is seen in the clinic with sickle cell crisis. Which hemoglobin range will the nurse expect to find? A) 6-8 g/100 mL (60-80 mmol/L) B) 10-12 g/100 mL (100-120 mmol/L) C) 12-14 g/100 mL (120-140 mmol/L) D) 16-18 g/100 mL (160-180 mmol/L)
A (In sickle cell crisis, hemoglobin values are low, usually in the 6-8 g/100 mL (60-80 mmol/L) range showing many sickle-shaped cells, and the client also will have a low oxygen level. A level of 10-12 g/100 mL (100-120 mmol/L) is too high. A range of 12-14 g/100 mL (120-140 mmol/L) is a normal finding. 16-18 g/100 mL (160-180 mmol/L) may be indicative of dehydration rather than anemia.)
Which client statement indicates to the nurse that a client who is receiving cyanocobalamin (vitamin B 12) therapy for an intrinsic factor deficiency understands the treatment? A) "I should have a vitamin B 12 injection every month." B) "I'll take my B 12 vitamin every morning with my breakfast." C) "I'll have a salad every day because vitamin B 12 is in green vegetables." D) "I should feel better because my vitamin B 12 treatments will improve my aplastic anemia."
A (Vitamin B12 is administered via injection on a weekly or monthly basis. Vitamin B 12 is destroyed by stomach acid and therefore cannot be taken in pill form. Green vegetables are not an important source of vitamin B 12. Vitamin B 12 is found primarily in meat, fish, poultry, and eggs. Vitamin B 12 is prescribed for pernicious, not aplastic, anemia.)
A 60-year-old client with gastric cancer has a shiny tongue, paresthesias of the limbs, and ataxia. The laboratory results show cobalamin levels of 125 pg/mL. Which medication would the nurse consider to be a high priority for the client? A) Oral hydroxyurea B) Vitamin B 12 injections C) Oral iron supplements D) Erythropoietin injections
B (A shiny tongue, paresthesias of the limbs, ataxia, and cobalamin of 125 pg/mL (normal: 200- 835 pg/mL) are the manifestations of pernicious anemia. The client has pernicious anemia due to a vitamin B 12 deficiency and should be given vitamin B 12 injections. Vitamin B 12 cannot be given orally to a client with pernicious anemia because the client does not produce the intrinsic factors needed to absorb Vitamin B 12. Hydroxyurea is administered orally to clients with hemochromatosis. Oral iron supplements are given to clients with iron deficiency anemia. Erythropoietin injections are given to clients who have low red blood cells, hemoglobin, and hematocrit.)
A client with cirrhosis of the liver has a prolonged prothrombin time and a low platelet count. A regular diet is prescribed. What should the nurse instruct the client to do considering the client's condition? A) Avoid foods high in phytonadione. B) Check the pulse several times a day. C) Drink a glass of milk when taking aspirin. D) Report signs of bleeding no matter how slight.
D
What should the plan of care include to minimize the potential for a sickling episode in a child with sickle cell anemia? A) Providing an iron-rich diet B) Ensuring hemoconcentration C) Enforcing periods of quiet play D) Promoting adequate oxygenation
D (Low oxygen tension may precipitate sickling; therefore adequate oxygenation is desirable. Oral intake of iron may contribute to iron overload. Some children with sickle cell anemia receive frequent transfusions to suppress the production of red blood cells containing the sickle hemoglobin. Hemoconcentration results in increased viscosity, which promotes thrombus formation and sickling. Quiet play is desirable during a painful episode, but it is not used routinely to prevent a crisis.)
A 52-year-old patient has a new diagnosis of pernicious anemia. After teaching the patient about pernicious anemia, the nurse determines that the patient understands the disorder when the patient states... A) "I will need to take cobalamin (B12) either by shot or nasally for the rest of my life" B) "I will stop having a glass of wine with dinner" C) The numbness in my feet will go away once my hemoglobin level returns to normal" D) My diet should include more red meat or liver"
A
A 78-year-old client comes to the health clinic presenting with fatigue. The client's laboratory results indicate a hematocrit of 32.1% and a hemoglobin of 10.5 g/dL (105 mmol/L). Which is the most appropriate nursing intervention in response to these laboratory results? A) Conduct a complete nutritional assessment of the client B) Nothing, because these are expected values for this client's age C) Advise the client to come back to the clinic to have the test repeated in three months D) Investigate the cause of the anemia while understanding that mild anemia is an expected response to the aging process
A (A nutritional assessment starts the investigation for a cause of the client's anemia and is an independent function of the nurse. These are not expected values; an intervention is indicated. Medical treatment should be initiated first, and then the test should be repeated to determine the client's response to therapy; it is not within the legal function of the nurse to give medical advice. Anemia is not an expected response to the aging process.)
A child has been diagnosed with hemophilia type A after experiencing excessive bleeding from a minor trauma. The parents ask what symptoms of bleeding they should be looking for in the future. What symptoms should the nurse list? Select all that apply. A) Epistaxis B) Hematuria C) Hemarthrosis D) Easy bruising E) Frequent fevers F) Fast clotting of injuries G) Dark-colored tarry stools
ABCDG (Epistaxis, also known as nosebleeds, is a common symptom of a lack of clotting factor. Hematuria (blood in the urine) may be grossly apparent. The child may experience joint pain and deformities from bleeding into joints. Excessive bruising will occur from bleeding into tissue with seemingly minor injuries. Dark-colored tarry consistency stools are indicative of gastrointestinal bleeding. Frequent fevers are not associated with hemophilia. Prolonged clotting times occur with this condition.)
A client with a diagnosis of anemia is receiving packed red blood cells. What is the most important action by the nurse when administering the transfusion? A) Warning the client about the possibility of fluid overload B) Monitoring the client's response, particularly within the first 10 minutes C) Adjusting the client's transfusion flow rate so that it infuses at a consistent rate during the procedure D) Having the client tested for human immunodeficiency virus (HIV) before administering the blood transfusion
B (Transfusion reactions usually occur early during the administration of a blood transfusion (first 30 mL of blood); early detection of a transfusion reaction will permit a quick termination of the infusion. The risk of fluid overload is unlikely, and this information can be frightening. The donor's, not the recipient's, blood is tested for HIV. The flow rate should be slower during the first 10 to 15 minutes of the infusion to limit the amount of blood infused; this allows time to assess the client's response for signs and symptoms of a transfusion reaction before too much of the blood is infused.)
Two days after delivery a client has a temperature of 101° F (38.3° C), general malaise, anorexia, and chills. Which clinical finding does the nurse expect to identify on the client's laboratory report? A) Increased hemoglobin level B) Decreased C-reactive protein C) Increased white blood cell (WBC) count D) Right-shift differential WBC count
C (An increased WBC count is indicative of an infectious process. In postpartum clients hemoglobin values usually decrease because of the typical blood loss during the birth process. C-reactive protein is increased during an infectious process. A right-shift differential WBC count occurs in clients with liver disease and pernicious anemia; a shift to the left occurs in an infectious process and is related to an increase in immature neutrophils.)
The student nurse demonstrates correct understanding of anemia related to chronic disease with which statement? A) "Red blood cells appear normal in size and color; however, there is a decreased amount produced." B) "The red blood cells have an increased life span with a decrease in normal functioning." C) "Administration of vitamins B 12 and folate will help to treat this type of long-term anemia." D) "This is the mildest form of anemia and is easily corrected through administration of blood products."
A (Anemia of chronic disease results in a decrease in the production of red blood cells (RBCs) in response to chronic inflammation; the red blood cells are normal size, shape, and color. There is a decrease in the life span of the RBC, and the administration of folate or B 12 will not correct the anemia, as these levels are generally within normal limits. This form of anemia can be very severe, and treatment is directed at identification and management of the underlying cause.)
A client develops thrombophlebitis in the right calf. Bed rest is prescribed, and an IV of heparin is initiated. What drug action will the nurse include when describing the purpose of this drug to the client? A) Prevents extension of the clot B) Reduces the size of the thrombus C) Dissolves the blood clot in the vein D) Facilitates absorption of red blood cells
A (Heparin interferes with activation of prothrombin to thrombin and inhibits aggregation of platelets. Heparin does not reduce the size of a thrombus. Heparin does not dissolve blood clots in the veins. Heparin does not facilitate the absorption of red blood cells.)
Which leukocyte values should be assessed to determine the adequacy of a client's response to inflammation? Select all that apply. A) Monocytes B) Neutrophils C) Plasma cells D) T-helper cells E) Macrophages
ABE (In response to inflammation, monocytes destroy bacteria and cellular debris; neutrophils ingest and phagocytize microorganisms and foreign protein; and macrophages destroy bacteria and cellular debris. Plasma cells are a part of antibody-mediated immunity and secrete immunoglobulins in response to the presence of a specific antigen. T-helper cells are a part of cell-mediated immunity and enhance immune activity through the secretion of various factors, cytokines, and lymphokines.)
Which of the following signs are indications of hydration status during a sickle cell crisis? Select all that apply. A) Turgor of tissue B) Edema of the ankles C) Specific gravity of urine D) Amount of urinary output E) Texture of mucous membranes
AE (Loss of tissue elasticity (decreased tissue turgor) indicates dehydration. Skin that takes 30 or more seconds to return to its original position after being pinched (tenting) is a sign of dehydration. Dry mucous membranes indicate inadequate hydration; moist mucous membranes indicate adequate hydration. The problem is dehydration, not retention of fluid; ankle edema is associated with interstitial fluid accumulation around the ankles. The amount and specific gravity of urine are not reliable indicators of hydration because the kidneys' ability to concentrate urine is impaired in sickle cell anemia.)
A client had part of the ileum surgically removed. The nurse monitors the client closely for anemia. What is the rationale for the nurse's action? A) Folic acid is absorbed in the ileum. B) Cobalamin is absorbed in the ileum. C) Iron absorption is dependent on simultaneous bile salt absorption in the ileum. D) Copper, cobalt, and nickel are dependent on simultaneous bile salt absorption in the ileum.
B (Vitamin B12(cobalamin) combines with intrinsic factor, a substance secreted by the parietal cells of the gastric mucosa, and is absorbed in the ileum. Cobalamin is needed to make red blood cells. Folic acid and iron are not absorbed. Copper, cobalt, and nickel are not absorbed in the ileum.)
A 13-year-old child with sickle cell anemia is experiencing a painful episode (vaso-occlusive crisis). The nurse assesses the child, obtains the child's vital signs, and reviews the child's laboratory test results. What is the priority nursing intervention? A) Providing oxygen therapy B) Administering an analgesic C) Initiating a blood transfusion D) Monitoring intravenous fluids
B (The pain experienced by the vaso-occlusive crisis is caused by sickle-shaped red blood cells that block blood flow through tiny blood vessels to the chest, abdomen, joints, and bones. Pain management is priority. If the client has evidence of hypoxia, then oxygen should be administered. Although a blood transfusion may be needed to treat the anemia and intravenous fluid reduce the viscosity of the sickled blood, it will not immediately relieve the pain.)
A client is started on a continuous infusion of heparin. Which finding does the nurse use to conclude that the intervention is therapeutic? A) International normalized ratio (INR) is between 2 and 3 B) Prothrombin time (PT) is 2.5 times the control value C) Activated partial thromboplastin time (APTT) is double the control value D) Activated clotting time (ACT) is in the range of 70 to 120
C (Activated partial thromboplastin time should be 1.5 to 2.5 for the control of heparin therapy. INR and PT are used to evaluate therapeutic levels of warfarin. The ACT increases to a range of 150 to 200 when heparin reaches therapeutic levels.)
The nurse caring for a client with a systemic infection is aware that the assessment finding that is most indicative of a systemic infection is what? A) White blood cell (WBC) count of 8200/mm 3 (8.2 X 10 9/L) B) Bilateral 3+ pitting pedal edema C) Oral temperature of 101.3° F (38.5° C) D) Pale skin and nail beds
C (An elevated temperature of 101.3° F (38.5° C) is most indicative of a systemic infection. A WBC count of 8200/mm 3 (8.2 X 10 9/L) is within the normal range of 5000 to 10,000/mm 3 (5 to 10 X 10 9/L). Pedal edema is generally not related to an infectious process. Pale skin and nail beds may be related to an infectious process, but not necessarily.)
The laboratory values of a client with a new diagnosis of cancer of the esophagus include a hemoglobin of 7 g/dL (70 mmol/L), hematocrit of 25%, and red blood cell (RBC) count of 2.5 million/mm 3 (2.5 X 10 12/L). Which priority goal should the nurse add to the plan of care? A) The client will be free of injury. B) The client will remain pain free. C) The client will demonstrate improved nutrition. D) The client will maintain effective airway clearance.
C (Based on the presented data, improving nutritional status is the priority at this time. The decreased hemoglobin and hematocrit levels and RBC count may be a result of malnutrition; also, cancer of the esophagus can cause dysphagia and anorexia. Although maintaining the client's safety is a goal, it is not as high a priority as another concern based on the data provided in the question. The data given do not relate to the presence of pain. The data given do not relate to airway obstruction.)
What are the priority nursing interventions for a client with neutropenia in an emergency department? Select all that apply. A) Monitor for rashes and pruritus. B) Prepare an appropriate diet plan. C) Obtain blood cultures immediately. D) Teach hygiene measures to be followed. E) Administer antibiotic STAT as prescribed.
CE (Identifying the causative agent for neutropenia is important for starting treatment. Therefore the priority nursing intervention is to obtain blood cultures immediately and administer antibiotic STAT as prescribed to the client. The nurse can monitor for rashes and pruritus after administering the medication. The nurse can prepare a diet plan and teach hygiene measures after stabilizing the client.)
What does a shift to the left indicate in the white blood cell count differential? A) Heightened phagocytosis B) Functioning bone marrow C) Infection is being contained D) Immature neutrophils in the blood
D (A shift to the left in the white blood cell count differential indicates that immature neutrophils are being released into the blood. The immature neutrophils are not capable of phagocytizing. The bone marrow is unable to produce mature neutrophils, and the infection is continuing, not being contained.)
A client with small-cell lung cancer is receiving chemotherapy. A complete blood count is prescribed before each round of chemotherapy. Which component of the complete blood count is of greatest concern to the nurse? A) Platelets B) Hematocrit C) Red blood cells (RBCs) D) White blood cells (WBCs)
D (Antineoplastic drugs depress bone marrow, which causes leukopenia; the client must be protected from infection, which can be life threatening. RBCs diminish slowly and can be replaced with a transfusion of packed red blood cells. Platelets decrease as rapidly as WBCs, but complications can be limited with infusions of platelets.)
A child has been diagnosed with hemophilia type A after experiencing excessive bleeding from a minor trauma. The parents ask how this could happen in addition to many other questions. Hemophilia A is linked to a deficiency in what? A) Factor II B) Factor III C) Factor IX D) Factor VIII
D (Hemophilia type A, which is the most common type of hemophilia, is from a deficiency of Factor VIII. Factors II and III are distractors. Factor IX is associated with hemophilia type B.)
A client's laboratory report shows severe neutropenia and thrombocytopenia. Which medication may have caused this condition? A) Daclizumab B) Cyclosporine C) Methylprednisolone D) Mycophenolate mofetil
D (Mycophenolate mofetil is a cytotoxic drug that may cause neutropenia and thrombocytopenia. Daclizumab may cause hypersensitivity reaction and anaphylaxis. Cyclosporine may cause neurotoxicity, nephrotoxicity, and hypertension. Methylprednisolone may cause peptic ulcers, osteoporosis, and hyperglycemia.)
During a yearly physical examination a complete blood count (CBC) is performed to determine a client's hematologic status. Which laboratory result will the nurse check? A) Blood glucose B) Hemoglobin (Hb) C) C-reactive protein D) Blood urea nitrogen (BUN)
B (A CBC includes red blood cell (RBC) count and RBC indices, white blood cell (WBC) count and WBC differential count, Hb, hematocrit (Hct), and platelet count. A blood glucose level is not part of a CBC. The C-reactive protein level is not part of a CBC. BUN is not part of a CBC.)
What functions of leukocytes are involved in inflammation? Select all that apply. A) Destruction of bacteria and cellular debris B) Selective attack and destruction of non-self cells C) Release of vasoactive amines during allergic reactions D) Secretion of immunoglobulins in response to a specific antigen E) Enhancement of immune activity through secretion of various factors, cytokines, and lymphokines
AC (Leukocytes such as monocytes and eosinophils are involved in inflammation. Their functions include the destruction of bacteria and cellular debris and the release of vasoactive amines during allergic reactions to limit these reactions. Helper/inducer T-cells and cytotoxic cells selectively attack and destroy non-self cells and secrete immunoglobulins in response to the presence of a specific antigen. B-lymphocytes, or plasma cells, secrete immunoglobulins in response to the presence of a specific antigen. Helper/inducer T-cells are involved in cell-mediated immunity, enhancing immune activity through the secretion of various factors, cytokines, and lymphokines.)
A client is seen in the clinic with sickle cell anemia. A nurse teaches the client about sickle cell anemia. Which information from the client indicates a correct understanding of the condition? A) "I have abnormal platelets." B) "I have abnormal hemoglobin." C) "I have abnormal hematocrit." D) "I have abnormal white blood cells."
B (The client with sickle cell anemia has abnormal hemoglobin, hemoglobin S, causing the red blood cells to stiffen and elongate into a sickle. While it can affect hematocrit, it is really a result of the abnormal hemoglobin. The disorder affects hemoglobin rather than platelets or white blood cells.)
While reviewing a client's laboratory reports, the nurse finds a neutrophil count of 12,000/mm 3. Which condition may be present in this client? A) Influenza B) Pneumonia C) Immunosuppression D) Autoimmune disorder
B (The normal adult leukocyte count is 5,000 to 10,000/mm 3. A count of 12,000/mm 3 indicates an increased neutrophil level, which indicates the presence of an acute bacterial infection that could result in pneumonia or inflammation. Viral influenza may occur when the neutrophil count is low. Immunosuppression and autoimmune disorders may result from a decreased leukocyte count.)
A client with cancer develops pancytopenia during the course of chemotherapy. The client asks the nurse why this has occurred. What explanation will the nurse provide? A) Steroid hormones have a depressant effect on the spleen and bone marrow. B) Lymph node activity is depressed by radiation therapy used before chemotherapy. C) Noncancerous cells also are susceptible to the effects of chemotherapeutic drugs. D) Dehydration caused by nausea, vomiting, and diarrhea results in hemoconcentration.
C (Chemotherapy destroys erythrocytes, white blood cells, and platelets indiscriminately along with the neoplastic cells because these are all rapidly dividing cells that are vulnerable to the effects of chemotherapy. Stating that steroid hormones have a depressant effect on the spleen and bone marrow is not a true description of the side effects of steroids. Depressed lymph node activity as a result of radiation therapy used before chemotherapy is not the cause for fewer erythrocytes, white blood cells, and platelets. Although it is true that dehydration caused by nausea, vomiting, and diarrhea results in hemoconcentration, this does not explain pancytopenia.)
What medication does a nurse expect to administer to control bleeding in a child with hemophilia A? A) Albumin B) Fresh frozen plasma C) Factor VIII concentrate D) Factors II, VII, IX, X complex
C (Factor VIII is the missing plasma component necessary to control bleeding in a child with hemophilia A. Factor VIII is not provided by albumin. Although fresh frozen plasma does contain factor VIII, there is an insufficient amount in a plasma transfusion; a higher volume is required. A complex of factors II, VII, IX, and X is not useful in this situation.)
A client is receiving warfarin. The nurse explains the need for careful regulation of dietary intake of vitamin K. What is the rationale for the nurse's teaching? A) Vitamin K promotes platelet aggregation. B) Vitamin K promotes ionization of blood calcium. C) Vitamin K promotes fibrinogen formation by the liver. D) Vitamin K promotes prothrombin formation by the liver.
D (Vitamin K promotes the liver's synthesis of prothrombin, an important blood clotting factor, and will reverse the effects of warfarin. Platelet aggregation and fibrinogen formation by the liver are not promoted by vitamin K. Vitamin K does not affect calcium ionization.)
The nurse providing care for a client with a diagnosis of neutropenia reviews isolation procedures with the client's spouse. The nurse determines that the teaching was effective when the spouse states that protective environment isolation helps prevent the spread of infection in which direction? A) To the client from outside sources B) From the client to others C) From the client by using special techniques to destroy infectious fluids and secretions D) To the client by using special sterilization techniques for linens and personal items
A (Protective environment isolation implies that the activities and actions of the nurse will protect the client from infectious agents because the client's own immune defense ability is compromised (neutropenia). Protective environment isolation is also referred to as reverse isolation. "From the client to others," "From the client by using special techniques to destroy infectious fluids and secretions," and "To the client by using special sterilization techniques for linens and personal items" are incorrect concepts related to protective environment isolation.)
The hemoglobin levels of a 30-year-old female client are measured at 8 mg/dL (80 g/L). Which integumentary findings can be noticed in this client? Select all that apply. A) Pallor B) Clubbing C) Café au lait spots D) Brittle nails E) Koilonychia
ADE (Hemoglobin levels less than 12 mg/dL (120 g/L) in a female result in anemia. Integumentary manifestations of anemia include pallor, brittle nails, concave nails (koilonychias), and intolerance to cold temperatures. Clubbing is an integumentary manifestation of heart and lung diseases from chronic hypoxia. Café au lait spots are tan-brown patches that are usually nonpathogenic.)
A client is admitted with thrombocytopenia. Which specific nursing actions are appropriate to include in the plan of care for this client? Select all that apply. A) Avoid intramuscular injections B) Institute neutropenic precautions C) Monitor the white blood cell count D) Administer prescribed anticoagulants E) Examine the skin for ecchymotic areas
AE (Intramuscular injections should be avoided because of the increased risk of bleeding and possible hematoma formation. Decreased platelets increase the risk of bleeding, which leads to ecchymoses. Neutropenic precautions are for clients with decreased white blood cells (WBCs), not platelets. Thrombocytopenia refers to decreased platelets, not WBCs. Anticoagulants are contraindicated because of the increased bleeding risk.)
A client is diagnosed with pancytopenia caused by chemotherapy. What should a nurse teach the client about this complication? A) Begin a program of meticulous mouth care. B) Avoid traumatic injury and exposure to infection. C) Increase oral fluid intake to at least 3 L/day. D) Report unusual muscle cramps or tingling sensations in the extremities.
B (Reduced platelets increase the likelihood of uncontrolled bleeding; reduced lymphocytes increase the susceptibility to infection. Beginning a program of meticulous mouth care is helpful for stomatitis, not pancytopenia; aggressive oral hygiene may precipitate bleeding from the gums. Although fluids may be increased to flush out the toxic byproducts of chemotherapy, this will have no effect on pancytopenia. Unusual muscle cramps or tingling sensations in the extremities are signs of hypocalcemia and do not apply to pancytopenia.)
The healthcare team is caring for a client with neutropenia. Which task is delegated to unlicensed assistive personnel? A) Administering antibiotics B) Assisting with personal hygiene C) Monitoring for signs and symptoms of infection D) Teaching the client and caregivers about how to avoid infection
B (Unlicensed assistive personnel assisting with the client's personal hygiene. The licensed practical nurse administers antibiotics. Monitoring for signs and symptoms is performed by the licensed practical nurse. The registered nurse teaches the client and caregivers how to avoid infection.)
A client has been experiencing extreme fatigue lately. The nurse suspects anemia and examines the client to identify additional clinical manifestations to support this inference. Which locations on the client's body should the nurse assess? Select all that apply. A) Sclera B) Nail beds C) Conjunctivae D) Palms of hands E) Bony prominences
BCD (Nail beds lose their pink coloration because of reduced hemoglobin. A reduced amount of hemoglobin decreases pink color of the lining of the eyelids (conjunctiva). Palms of the hands will become pale because of the decreased hemoglobin. Sclera is observed for signs of jaundice, not anemia, when they become pale yellow to orange. Bony prominences are not assessed when a client has anemia. Bony prominences are examined for redness caused by pressure that, if prolonged, can lead to a break in the skin and development of pressure ulcers.)
The laboratory report of a client reveals that the platelet count is 60,000/µL (60 x 10 9/L). Which integumentary changes can be anticipated in this client? Select all that apply. A) Cyanosis B) Petechiae C) Varicosity D) Ecchymosis E) Hematoma
BDE (Normal blood platelet counts range between 150,000 and 400,000/µL (150-400 x 10 9/L). A count of less than 100,000/µL (100 x 10 9/L) is referred to as thrombocytopenia, which results in prolonged bleeding time. Petechiae, ecchymosis, and the formation of hematoma are the results of bleeding disorders. Cyanosis is caused by cardiorespiratory problems, vasoconstriction, asphyxiation, and deoxygenated blood. Varicosity is caused by interruption of venous return commonly found on lower legs with aging.)
An adolescent who has sickle cell anemia is recovering from a painful episode. What does the nurse see as the priority issue for this adolescent? A) Restriction of movement during periods of arthralgia B) Separation from family during periods of hospitalization C) Alteration in body image resulting from skeletal deformities D) Interruption of education as a result of multiple hospitalizations
C
The healthcare provider performs a bone marrow aspiration from the posterior iliac crest on a patient with pancytopenia. Following the procedure, the nurse should... A) Use half-inch sterile gauze to pack the wound B) Administer an analgesic to control the pain at the site C) Apply pressure over the site for 5 to 10 minutes D) Elevate the head of the bed to 30 degrees
C
A client who is in hypovolemic shock has a hematocrit value of 25%. What does the nurse anticipate that the primary healthcare provider will prescribe? A) Lactated Ringer solution B) Serum albumin C) Blood replacement D) High molecular dextran
C (Blood replacement is needed to increase the oxygen-carrying capacity of the blood; the expected hematocrit for women is 37% to 47% and for men is 42% to 52%. Lactated Ringer solution does not increase the oxygen-carrying capacity of the blood. Serum albumin helps maintain volume but does not affect the hematocrit level. Although dextran does expand blood volume, it decreases the hematocrit because it does not replace red blood cells.)
The nurse assesses a client for the development of pernicious anemia after reviewing the client's history. Which condition did the nurse most likely find in the history? A) Acute gastritis B) Diabetes mellitus C) Partial gastrectomy D) Unhealthy dietary habits
C (Removal of the fundus of the stomach (gastrectomy) destroys the parietal cells that secrete intrinsic factor (needed to combine with vitamin B 12 preliminary to its absorption in the ileum). Hemorrhaging may cause anemia; however, pernicious anemia occurs when the intrinsic factor is not produced. The beta cells of the pancreas are not involved in secretion of intrinsic factor. Dietary intake does not affect the production of intrinsic factor.)
A client is admitted with a higher than expected red blood cell (RBC) count. What physiologic alteration does the nurse expect will result from this clinical finding? A) Increased serum pH B) Decreased hematocrit C) Increased blood viscosity D) Decreased immune response
C (Viscosity, a measure of a fluid's internal resistance to flow, is increased as the number of red blood cells suspended in plasma increases. The number of cells does not affect the blood pH. The hematocrit will be higher. RBCs do not affect immunity.)
The nurse is making rounds on a client who has developed severe bone marrow depression after receiving chemotherapy for cancer. Which of these actions by the nurse is appropriate? Select all that apply. A) Monitor for signs of alopecia. B) Encourage an increase in fluids. C) Wash hands before entering the client's room. D) Advise use of a soft toothbrush for oral hygiene. E) Report an elevation in temperature immediately. F) Encourage the client to eat raw, fresh fruits and vegetables.
CDE (It is essential to prevent infection in a client with severe bone marrow depression; thorough hand-washing before touching the client or client's belongings is important. Thrombocytopenia occurs with most chemotherapy treatment programs; using a soft toothbrush helps prevent bleeding gums. Any temperature elevation in a client with neutropenia must be reported to the primary healthcare provider immediately because it may be a sign of infection. Although alopecia does occur with chemotherapy, it is not related to bone marrow suppression. Increasing fluids will neither reverse bone marrow suppression nor stimulate hematopoiesis. This is not related to bone marrow suppression. Clients who have severe bone marrow depression must avoid eating raw fruits and vegetables and undercooked meat, eggs, and fish to prevent possible exposure to microbes.)
An adolescent is admitted with an acute hemophilia episode. For what are rest, ice, compression, and elevation most helpful? A) Encouraging immobilization B) Decreasing swelling and inflammation C) Providing pain relief and reducing anxiety D) Controlling bleeding and retaining joint function
D (Rest, ice, compression, and elevation (RICE) therapy is implemented to support joints and prevent bleeding into joints. Reducing inflammation is not the goal of treatment for the hemophiliac process. Total immobilization is not required. Pain may be relieved to some degree but is not assured.)
The nurse is caring for a client with iron deficiency anemia that has decreased hemoglobin and hematocrit levels. The nurse expects to identify what other abnormal laboratory level? A) Macrocytic red blood cells (RBCs) B) Thrombocytopenia C) Decreased folate levels D) Increased total iron-binding capacity (TIBC)
D (TIBC may be elevated from 350 to 500 mcg/dL (82 µmol/L) (expected range is 250 to 460 mcg/dL [45-82 mcmol/L]) because the RBCs are compensating for the iron deficiency. The RBCs are microcytic, not macrocytic, because of their low iron content. A low platelet count is not associated with iron deficiency anemia. Decreased folate levels often are noted in vitamin B 12 anemias, such as occur with sprue and celiac diseases, as well as in folate deficiency anemia, but not in iron deficiency anemia.)
Which laboratory test will be elevated in a client with inflammatory arthritis? A) Leukocyte count B) Hemoglobin and hematocrit C) Blood urea nitrogen and creatinine D) Erythrocyte sedimentation rate (ESR)
D (The erythrocyte sedimentation rate (ESR) measures the rate at which red blood cells fall through plasma. This rate is most significantly affected by an increased number of acute-phase reactants, which occur with inflammation. An elevated ESR (>20 mm/hr) indicates inflammation or infection somewhere in the body. The ESR is chronically elevated with inflammatory arthritis. Leukocytes will be elevated when a bacterial infection is present. Hemoglobin and hematocrit are not used to determine the presence of inflammation. Blood urea nitrogen and creatinine levels are used to determine renal function.)
The nurse is caring for a client who is receiving therapy for vitamin B 12 deficiency. Which finding indicates that the therapy is having the desired effect? A) Normal serum electrolyte levels B) Healthy skin integrity C) Resolution of peripheral edema D) Improved hemoglobin and hematocrit levels
D (Vitamin B12is essential for appropriate maturation of red blood cells; therefore relieving the deficiency is expected to improve hemoglobin and hematocrit (H & H) levels and decrease hypoxia-related problems. This disorder is known as pernicious anemia. Normal serum electrolytes, healthy skin integrity, and resolution of peripheral edema, if present, would be secondary to improved hemoglobin and hematocrit levels.)
