Hematologic Disorders
The mother of a newborn infant questions why her baby needs a vitamin K injection immediately after birth. The best response by the nurse would be
"Infants are not born with the normal intestinal bacteria that synthesize vitamin K for clotting."
A client refuses to take the 81 mg of aspirin ordered by the physician, stating, "I do not have any pain." The best response by the nurse would be:
"The 81 mg of aspirin daily will help protect you from a stroke or a heart attack."
A child with leukemia hears the health care provider tell the parents that the child has "pancytopenia." This child asks the nurse, "What does 'pancy' mean? Am I going to die?" Which response by the nurse is most appropriate for this 10-year-old child?
"This means the chemotherapy has lowered your blood counts including red blood cells, white blood cells and platelets. You are very sick, but we are working hard to make you healthy again."
Which clients are at risk of developing folic acid deficiency anemia? Select all that apply.
- An older adult male with poor dietary habits who drinks approximately five alcoholic beverages/day - A pregnant client with prolonged morning sickness lasting most of the day with nausea and frequent vomiting noted
In a client with DIC, microemboli form, causing obstruction of blood vessels and tissue hypoxia. Common clinical signs may be due to what? Select all that apply.
- Circulatory failure - Renal failure - Respiratory failure
Which clinical manifestations are associated with acute leukemia? Select all that apply.
- Fever - Epistaxis - Bleeding gums - Bone pain
What interventions will the nurse perform for the newborn with neonatal jaundice? Select all that apply.
- Frequent feeding - Phototherapy
Which therapies are part of the treatment for acute lymphocytic leukemia (ALL)? Select all that apply.
- Induction - Intensification - Maintenance
A child has Down syndrome and has recently experienced unexplained nosebleeds. Blood tests identify blast cells in the peripheral smear. In addition to nosebleeds, acute leukemia typically manifests which other symptoms?
- Infection - Fatigue - Thrombocytopenia
Which statements about acquired agranulocytosis are correct? Select all that apply.
- It is usually caused by drugs. - It is usually caused by autoimmune disease. - The major clinical problem is viral infections.
What is the typical life span of mature red blood cells?
120 days
The nurse is caring for a client with chronic myelogenous leukemia (CML) and notes that the client has splenomegaly and an increased basophil count as well as night sweats, bone pain, and a low grade fever. The nurse interprets the symptoms as indicating that the client is in which phase of the clinical course of CML?
Accelerated
A client diagnosed with systemic lupus erythematosus (SLE) has been experiencing a low neutrophil count. How would this type of neutropenia be classified?
Acquired, autoimmune secondary neutropenia
The health care provider suspects a client may have developed a leukemia that originates from the B cells. Which cancers would the nurse associate with B cell lymphocytes?
Acute lymphocytic leukemia (ALL) and chronic lymphocytic leukemia (CLL)
Anticoagulant drugs prevent thromboembolic disorders. How does warfarin, one of the anticoagulant drugs, act on the body?
Alters vitamin K, reducing its ability to participate in the coagulation of the blood
Which substance, when deficient, results in a diagnosis of anemia?
Anemia
After birth, red blood cells are normally made in which location?
Bone marrow
An older adult client arrives with garbled speech, unilateral facial drooping, and weakness and unfortunately dies. Laboratory work reveals hematocrit of 54% (0.54). Which complication of polycythemia could most likely be associated with this client's death?
Cerebral thrombosis
The nurse is caring for a client with cyclic neutropenia. The nurse understands that this is which type of neutropenia?
Congenital
Bilirubin is measured in the blood and reported on the laboratory results using which terms?
Direct and indirect
A client has been placed on sulfamethoxazole/trimethoprim as treatment for community-acquired methicillin-resistant Staphylococcus aureus (MRSA) for 10 days. After taking the medication for 8 days, the client comes to the health care provider's office complaining of multiple nosebleeds over the past day. Laboratory work shows a platelet count of 80,000/μL. The nurse practitioner suspects which condition?
Drug-induced thrombocytopenia
The nurse is conducting a staff in-service program on non-Hodgkin lymphomas. The nurse should include that essentially all people with Burkitt lymphoma have evidence of infection with:
EBV
An adult client with good overall health has reported headaches and dizziness in recent weeks. The nurse's assessment reveals blood pressure of 158/99 mm Hg, which is unprecedented for the client. On observation, the client's skin appears reddened, though he denies feeling warm. The nurse should anticipate what further diagnostic finding?
Elevated RBC, hemoglobin, and hematocrit
Endemic Burkitt lymphoma occurs in regions of Africa where what other infections are common?
Epstein-Barr and malaria
A client has been diagnosed with inherited hypercoagulability. Select the most likely cause.
Factor V gene mutation
Hemophilia A is a hereditary blood disorder caused by inadequate activity or absence of which blood component?
Factor VIII
Which topic should the nurse include in the discharge teaching plan for a client with Felty syndrome?
Handwashing
The client is an average-sized adult and has abnormal microcytic hypochromic red blood cells due to a long-term, chronic disease. Which complete blood count (CBC) result is characteristic of this type of anemia?
Hemoglobin 7.8 g/dL (78 g/L)
When an Rh-negative mother gives birth to an Rh-positive infant, the mother usually produces antibodies that will attack any subsequent pregnancies in which the fetus is Rh positive. When subsequent babies are Rh positive, erythroblastosis fetalis occurs. What is another name for erythroblastosis fetalis?
Hemolytic disease of the newborn
A client arrives reporting fevers, chills, and night sweats. Upon assessment, the health care provider palpates an enlarged supraclavicular lymph node and suspects the client may have developed which disease?
Hodgkin lymphoma (HL)
A client is suspected of having leukemia and is having diagnostic tests performed to determine the type of leukemia. Which form of leukemia does the nurse recognize has the classic symptoms of pruritus and intermittent fevers associated with night sweats?
Hodgkin lymphoma (HL)
A client with chronic idiopathic thrombocytopenia purpura (ITP) asks the nurse what causes all the nosebleeds that have been occurring. Which response by the nurse would be most accurate?
Immune cells are destroying the platelets
The nurse is educating a pregnant client about the importance of dietary folic acid to prevent anemia. Which food source will the nurse encourage because it is high in folic acid?
Kale
A client's bone marrow study report reveals the findings of blast cells in the bone marrow. What does the nurse interpret this as indicating?
Leukemia
A student nurse is taking microbiology and reviewing various types of cells. From which cell type are granulocytes derived?
Myeloid stem cells
The granulocyte cell lines are derived from:
Myeloid stem cells
Which intervention would be most appropriate by the nurse caring for a client in the neutropenic phase of cyclic neutropenia?
Perform/assist with oral care
A 75-year-old client with a history of heart valve replacement arrives at the outpatient clinic with multiple red pinpoint lesions. The nurse identifies the lesions as:
Petechiae
Progenitor cells, or parent cells, for the production of myeloid and lymphoid cells are derived from:
Pluripotent stem cells
A client presents to his physician with a red face, hands, feet, and ears; a headache; and drowsiness. A blood smear reveals an increased number of erythrocytes. Based on the laboratory results, the nurse prepares teaching material for which disease process?
Polycythemia
A client presents to the clinic with symptoms of elevated blood pressure, dizziness, red face, pain in fingers and toes, headache, and difficulty concentrating. A blood smear reveals an increased number of erythrocytes. Based on these findings, the nurse anticipates which diagnosis?
Polycythemia vera
A client tells the nurse that the doctor told her she has too many red blood cells accompanied by elevated white cells and platelet counts. The nurse recognizes this as:
Polycythemia vera
The nurse is preparing a client with suspected leukemia for a bone marrow and biopsy. What preferred site will the nurse be sure is accessible for the physician?
Posterior iliac crest
A client's history documents the presence of a myelocytic leukemia. The nurse interprets this to mean that the leukemia is:
Predominant cell is myelocytic
Following peripheral blood testing and a bone marrow biopsy, a client has been diagnosed with chronic myelogenous leukemia. Which abnormality is most likely to have preceded the client's diagnosis?
Presence of a Philadelphia chromosome
A 26-year-old client has an absolute neutrophil count of less than 500 cells/mm3 (0.50 x 109/L) Which interpretation of this lab value is accurate?
Severe neutropenia
A client's history and physical documents the presence of an indolent lymphoma. The nurse plans care for which type of lymphoma?
Slow-growing
The nurse planning care for a client with acute lymphoblastic leukemia (ALL) should include the use of:
Soft bristle toothbrush
The practitioner carefully monitors his client who exhibits hemoglobin S (HbS) genes. The practitioner know that the client is predisposed to life-threatening infection due to damage by HbS to which organ?
Spleen
A client with iron-deficiency anemia asks, "What does this low mean corpuscular volume (MCV) level mean?" Which response by the nurse is most accurate?
The MCV is one red blood cell (RBC) index that indicates your RBCs are small cells.
The parents of a newborn are concerned because the infant's skin has a yellow color. What education should the nurse discuss with the parents?
The parents need to be taught about hyperbilirubinemia and common treatment modalities.
A nurse is assessing a client and finds these results: - Areas of bruising (purpura) on the client's arms and legs - Pinpoint hemorrhages (petechiae) on the legs - Pinpoint hemorrhages (petechiae) in the mouth - Platelets level of 90,000/μL (90 ×109/L) What condition should the nurse suspect the client is exhibiting?
Thrombocytopenia
A normally healthy client is diagnosed with polycythemia vera. The nurse should prioritize assessments aimed at the early identification of which complication associated with this diagnosis?
Thromboembolism
Thalassemia can be classed as major or minor. If therapy for thalassemia major is not started in infants who present with this disease, severe growth retardation will occur. At 6 months of age, which therapy must be started?
Transfusion
A client has been diagnosed with leukemia and the care team is describing the etiology and pathogenesis of this disease to the client. Which topic should be included in the discussion?
Translocation of genes regulating blood cell development is sometimes implicated.
The nurse is providing a client with education on taking the medication clozapine. The nurse includes the importance of:
Weekly blood work
A 10-month-old infant has begun to take his first steps and his mother has brought him for assessment because of swelling in his ankles and knees. The mother also states that he was eager to walk but has now regressed and cries when she tries to encourage it. The clinician should:
assess the child for signs and symptoms of hemophilia A
The nurse evaluating a client's blood work notes that the client's white blood cells are 9000/μL (9.0 x 109/L). The nurse should:
continue to monitor the client's blood work results.
A client who is being treated for small-cell lung cancer has been placed in protective isolation due to neutropenia. The most likely cause of this client's neutropenia is:
the effects of chemotherapy on white blood cell development.
A 42-year-old male client recently diagnosed with liver cancer is noted as at high risk for bleeding abnormalities. The nurse recognizes this risk as a result of:
the reduction of clotting factors synthesized in the liver.
A nurse is working with an 8-year-old client diagnosed with AML. The nurse plans the client's care in the knowledge that thrombocytopenia and associated bleeding are risks because:
the undifferentiated blast cells accumulate in the bone marrow, suppressing the remaining progenitor cells.
Many different proteins, enzymes, and hormones are involved in maintaining hemostasis. Which protein is required for platelet adhesion?
von Willebrand factor
