Hematology PrepU
The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? "In acute leukemia there are not many undifferentiated cells." "In chronic leukemia, the majority of leukocytes are mature." "Chronic leukemia develops slowly." "Acute leukemia develops slowly."
"Chronic leukemia develops slowly."
A patient describes numbness in the arms and hands with a tingling sensation. The patient also frequently stumbles when walking. What vitamin deficiency does the nurse determine may cause some of these symptoms? Thiamine B12 Iron Folate
B12 numbness in the arms and hands with a tingling sensation.
Which type of leukocyte contains histamine and is an important part of hypersensitivity reactions? Plasma cell Basophils B lymphocyte Neutrophil
Basophils
The nurse cares for a client with acute myeloid leukemia with severe bone pain. What pathophysiological concept does the nurse understand is the reason for the client's pain? Bone marrow expands. Lymph nodes expand. Abnormal blood cells crystalize. Abnormal blood cells deposit in small vessels.
Bone marrow expands. In acute myeloid leukemia, bone pain is caused when the bone marrow expands.
A client diagnosed with polycythemia vera has come into the clinic because he has developed a nighttime cough, fatigue, and shortness of breath. What complication would you suspect in this client? Stroke Pulmonary embolus Tissue infarction Congestive heart failure
Congestive heart failure
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? This type of exercise increases arterial circulation as it returns to the heart. Isometric exercise programs are inclusive of all muscle groups and have an aerobic effect to increase the heart rate. Isometric exercise decreases the workload of the heart and restores oxygenated blood flow. Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood 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 should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly? Oral temperature of 97°F Pain and tenderness in calf area Crackles auscultated bilaterally Respiratory rate of 10 breaths/minute
Crackles auscultated bilaterally
Which initial intervention should a nurse perform for a client with external bleeding? Application of a tourniquet Direct pressure Pressure point control Elevation of the extremity Direct pressu
Direct pressure
A client with severe anemia is admitted to the hospital. Because of religious beliefs, the client is refusing blood transfusions. The nurse anticipates pharmacologic therapy with which drug to stimulate the production of red blood cells?
Epoetin alfa
The nurse is caring for four clients on the medical-surgical unit of the hospital. What client is mostly likely to be receiving treatment for sickle cell crisis? A 19-year-old African American male A 36-year-old Eastern European female A 29-year-old Caucasian male A 24-year-old Native American female
A 19-year-old African American male
The nurses brief review of a patients electronic health record indicates that the patient regularly undergoes therapeutic phlebotomy. Which of the following rationales for this procedure is most plausible? A) The patient may chronically produce excess red blood cells. B) The patient may frequently experience a low relative plasma volume. C) The patient may have impaired stem cell function. D) The patient may previously have undergone bone marrow biopsy
A) The patient may chronically produce excess red blood cells. Treatment for Hemochromatosis, as well as decease Fit C, no iron sups
Which nursing diagnosis should a nurse expect to see in a care plan for a client in sickle cell crisis? Imbalanced nutrition: Less than body requirements related to poor intake Disturbed sleep pattern related to external stimuli Acute pain related to sickle cell crisis Impaired skin integrity related to pruritus
Acute pain related to sickle cell crisis
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?
Anemia
The nurse is talking with the parents of a toddler who was diagnosed with hemophilia A. The nurse teaches the parents How to administer factor VIII intravenously at the first sign of bleeding That nasal packing will be necessary for any nose bleeds To allow the toddler to participate in playground activities with other toddlers The importance of administering over-the-counter preparations for a cold
How to administer factor VIII intravenously at the first sign of bleeding
A patient with acute myeloid leukemia (AML) has a neutrophil count that persists at less than 100/mm3. What should the nurse cautiously monitor this patient for? Hypotension Abdominal cramps Seizure activity Infection
Infection
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?
Iron chelation therapy
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 of the following reasons? Preparation for likely nephrectomy Lack of erythropoietin Hypervolemia Increases the effectiveness of dialysis
Lack of erythropoietin
Which term refers to a form of white blood cell involved in immune response? Granulocyte Lymphocyte Thrombocyte Spherocyte
Lymphocyte
The body responds to infection by increasing the production of white blood cells (WBCs). The nurse knows to evaluate the differential count for the level of __________, the first WBCs to respond to an inflammatory event. Eosinophils Monocytes Basophils Neutrophils
Neutrophils
A patient is scheduled for a test to help confirm the diagnosis of acute myeloid leukemia (AML). Which of the following is the result that the nurse knows is consistent with the diagnosis? Platelet count of 300,000/mm3 Erythrocyte count of 5.8 m/?L Excess of immature blast cells Neutrophil reading of 60%
Excess of immature blast cells
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-positive child
Clinical assessment of a patient with AML includes observing for signs of infection, the major cause of death for AML. The nurse should assess for indicators of: Thrombocytopenia. Splenomegaly. Bone marrow expansion. Neutropenia.
Splenomegaly. Explanation:Acute myeloid leukemia starts inside the bone marrow and prevents the formation of white blood cells. A bone marrow analysis that shows greater than 30% of immature blast cells is indicative of an AML diagnosis.
A nurse, caring for a client with human immunodeficiency virus (HIV), reviews the client's differential WBC count. What type of WBC will the nurse check the level of?
T lymphocytes HIV can develop into many cancers- leukemia included
A client is treated for anemia. What is the nurse's best understanding about the correlation between anemia and the client's iron stores? There is a strong correlation between iron stores and hemoglobin characteristics. There is an inverse relationship between iron stores and hemoglobin levels. There is a strong correlation between iron stores and hemoglobin levels. There is a weak correlation between iron stores and hemoglobin levels.
There is a strong correlation between iron stores and hemoglobin levels.
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 B12 deficiency
What is the rationale for the classification of leukemia? Which bone marrow it arises from, red, or yellow Which bone marrow stem cell line is dysfunctional Whether it attacks younger or older people Whether it is acute or chronic
Which bone marrow stem cell line is dysfunctional
A nurse cares for clients with hematological disorders and notes that women are diagnosed with hemochromacytosis at a much lower rate than men. What is the primary reason for this? Women require grater folic acid supplementation Women have lower hemoglobin levels Women rarely manifest the gene expression Women lose iron through menstrual cycles
Women lose iron through menstrual cycles
Which statement best describes the function of fibrinogen? a. plays a key role in forming blood clots b. functions primarily as an immunological agent c. helps prevent or modify some types of infectious diseases d. helps maintain osmotic pressure
a. plays a key role in forming blood clots
A client complains of extreme fatigue. Which system should the nurse suspect is most likely affected? a. respiratory b. hematological c. integumentary d. neurological
b. hematological
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. Eosinophils b. neutrophils c. basophils d. monocytes
b. neutrophils
Which blood cell type is matched correctly with its function? a. plasma cell: cell-mediated immunity b. Blymphocyte: secretes immunoglobulin c. Leukocute: fights infection d. T lymphocyte: humoral immunity
c. Leukocyte: fights infection
Which type of lymphocyte is responsible for cellular immunity? a. B lymphocyte b. plasma cell c. T lymphocyte d. basophil
c. T lymphocyte
Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called a. monocytes b. blast cells c. megaloblasts d. mast cells
c. megaloblasts
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. hair color b. medicaiton use c. ethnicity d. dietary intake e. herbal supplements
dietary intake use of herbal supplements medications
Which of the following vitamins enhance the absorption of iron? D E A C
vitamin C
The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care? "Intrathecal chemotherapy is used primarily as preventive therapy." "The goal of therapy is palliation." "Treatment is simple and consists of single-drug therapy." "Side effects are rare with therapy."
"Intrathecal chemotherapy is used primarily as preventive therapy."
During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding? Elevated red blood cell (RBC) count Elevated hematocrit concentration Low ferritin level concentration Enlarged mean corpuscular volume (MCV)
Low ferritin levelmost consistent indicator of iron deficiency anemia is a low ferritin level, which reflects low iron stores
Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? Leukopenia Thrombocytopenia Anemia Pancytopenia
Pancytopenia
The nurse is performing an assessment on a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae. What laboratory study should the nurse be concerned about? Platelet count of 9,000/mm3 Creatinine level of 1.0 mg/dL Hematocrit of 38% WBC count of 4,200 cells/mcL
Platelet count of 9,000/mm3
A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention? Assess the client's hemoglobin and platelets. Assess the client's skin. Assess the client's pulse and blood pressure. Check the client's history.
Assess the client's hemoglobin and platelets.
The nurse is describing normal RBC physiology to a patient who has a diagnosis of anemia. The nurse should explain that the RBCs consist primarily of which of the following? A) Plasminogen B) Hemoglobin C) Hematocrit D) Fibrin
B) Hemoglobin Mature erythrocytes consist primarily of hemoglobin, which contains iron and makes up 95% of the cell mass. RBCs are not made of fibrin or plasminogen. Hematocrit is a measure of RBC volume in whole blood.
The most common cause of iron deficiency anemia in men and postmenopausal women is Chronic alcoholism. Bleeding. Iron malabsorption. Menorrhagia.
Bleeding.
A 48-year-old female recently diagnosed with leukemia presents with increased immature lymphocytes, decreased granulocytes, and normal erythrocytes. The client most likely has which type of leukemia? Chronic myelogenous leukemia Acute lymphocytic leukemia Acute myelogenous leukemia Chronic lymphocytic leukemia
Chronic lymphocytic leukemia
The nurse is planning the care of a patient with a nutritional deficit and a diagnosis of megaloblastic anemia. The nurse should recognize that this patients health problem is due to what? A) Production of inadequate quantities of RBCs B) Premature release of immature RBCs C) Injury to the RBCs in circulation D) Abnormalities in the structure and function RBCs
D) Abnormalities in the structure and function RBCs Vitamin B12 and folic acid deficiencies are characterized by the production of abnormally large erythrocytes called megaloblasts. Because these cells are abnormal, many are sequestered (trapped) while still in the bone marrow, and their rate of release is decreased. Some of these cells actually die in the marrow before they can be released into the circulation. This results in megaloblastic anemia. This pathologic process does not involve inadequate production, premature release, or injury to existing RBCs.
A nurse cares for several clients with anemia and notes that all the clients have different types of anemia. What is the nurse's best understanding of how anemias are classified, based on the deficiency of erythrocytes? Select all that apply. Shape of erythrocytes Loss of erythrocytes Destruction of erythrocytes Defective production of erythrocytes Quantity of erythrocytes
Defective production of erythrocytesDestruction of erythrocytesLoss of erythrocytes
A patient with chronic anemia has had many blood transfusions over the last 3 years. What type of transfusion reaction should the nurse monitor for that is commonly found in patients who frequently receive blood transfusions? Allergic reactions Acute hemolytic reaction Circulatory overload Febrile nonhemolytic reactions
Febrile nonhemolytic reactions
A patient has been diagnosed with thrombocytopenia. What are the primary nursing interventions while instituting corticosteroid therapy in this patient? Gradually taper the dose and frequency of medication. Eliminate aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). Examine the extremities for redness. Palpate the lymph nodes and tonsils every shift.
Gradually taper the dose and frequency of medication.
A patient with AML is having aggressive chemotherapy to attempt to achieve remission. The patient is aware that hospitalization will be necessary for several weeks. What type of therapy will the nurse explain that the patient will receive Standard therapy Induction therapy Supportive therapy Antimicrobial therapy
Induction therapy Attempts are made to achieve remission by the aggressive administration of chemotherapy, called induction therapy, which usually requires hospitalization for several weeks.
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?
Older adults acquire damage to the DNA of stem cells over time.
The nurse is administering a blood transfusion to a client over 4 hours. After 2 hours, the client reports chills and has a fever of 101°F, an increase from a previous temperature of 99.2°F. What does the nurse recognize is occurring with this client?
The client is having a febrile nonhemolytic reaction.
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 stimulate erythropoietin, stimulating the marrow to produce more red blood cells.
When evaluating a patient's symptoms that are consistent with a diagnosis of leukemia, the nurse is aware that a common feature of all leukemias is which of the following? Reduced plasma volume in response to a reduced production of cellular elements ncreased blood viscosity, resulting from an overproduction of white cells Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements Compensatory polycythemia stimulated by thrombocytopenia
Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements Explanation:The term leukemia means "white blood," which is used to describe the neoplastic proliferation of one hematopoietic cell type (granulocytes, monocytes, lymphocytes, and sometimes, erythrocytes and megakaryocytes).
A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse know is the most likely clinical disorder the patient is being treated for? a) Essential thrombocythemia b) Extreme leukocytosis c) Sickle cell anemia d) Renal transplantation
a. essential thrombocythemia platelet pheresis is used to remove platelets from the blood in patients with extreme thrombocytosis or essential thrombocythemia or in a single-donor platelet transfusion
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. calcium c. hemoglobin d. potassium
a. iron
Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? a. myeloid stem cell b. lymphoid stem cell c. neutrophil d. monocyte
a. myeloid stem cell
The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly? a. pain and tenderness in the calf area b. crackles auscultated bilaterally c. oral temperature of 97 degrees d. respiratory rate of 10 breaths/minute
b. crackles auscultated bilaterally increasing the flow rate of a blood transfusion too rapidly can result in circulatory overload
The nurse is caring for a client who had undergone hemodilution during surgery. Immediately after surgery, the nurse expects to see which lab result? a. elevated erythrocyte concentration b. elevated creatinine c. decreased hematocrit d. critically low arterial oxygen saturation
c. decreased hematocrit hematocrit is the percentage of red blood cells in the blood
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. increased mean corpuscular volume b. increased reticulocyte count c. decreased level of erythropoietin d. decreasd total iron-binding capacity
c. decreased level of erythropoietin
Which is the major function of neutrophils? a. production of immunoglobins b. rejection of foreign tissue c. phagocytosis d. destruction of tumor cells
c. phagocytosis
A nurse assesses a patient who has been diagnosed with DIC. Which of the following indicators are consistent with this diagnosis? Select all that apply. - Capillary fill time <3 seconds - Increased breath sounds - Cyanosis in the extremities - Polyuria - Increased blood urea nitrogen (BUN) and creatinine - Dyspnea and hypoxia
- Increased blood urea nitrogen (BUN) and creatinine - Dyspnea and hypoxia - Cyanosis in the extremities Urine output would be decreased in DIC, and capillary fill time would be more than 3 seconds; breath sounds would be decreased. Refer to Table 20-4 in the text.
A patient is being treated for the effects of a longstanding vitamin B12 deficiency. What aspect of the patients health history would most likely predispose her to this deficiency? A) The patient has irregular menstrual periods. B) The patient is a vegan. C) The patient donated blood 60 days ago. D) The patient frequently smokes marijuana
B) The patient is a vegan. Because vitamin B12 is found only in foods of animal origin, strict vegetarians may ingest little vitamin B12. Irregular menstrual periods, marijuana use, and blood donation would not precipitate a vitamin B12 deficiency.
A nurse is assessing a client with multiple myeloma. The nurse should keep in mind that clients with multiple myeloma are at risk for: Pathologic bone fractures. Chronic liver failure. Acute heart failure. Hypoxemia.
Pathologic bone fractures.
The client was admitted to the Emergency Department after an accident with a chain saw. The client is exhibiting signs and symptoms of acute hypovolemic anemia from severe blood loss. What signs and symptoms would the nurse assess for? - Reduced urine output - Malabsorption disorders - Fatigue - Postural hypotension
Reduced urine output Acute hypovolemic anemia from severe blood loss is evidenced by the signs and symptoms of hypovolemic shock, which include reduced urine output. The symptoms of chronic hypovolemic anemia include fatigue and postural hypotension. Clients with malabsorption disorders are at great risk of iron deficiency anemia.
A client has hereditary hemochromatosis. Laboratory test results indicate an elevated serum iron level, high transferrin saturation, and normal complete blood count (CBC). It is most important for the nurse to Instruct the client to limit iron intake in the diet. Educate about precautions to follow after a liver biopsy. Remove the prescribed one unit of blood. Inform the client to limit ingestion of alcohol.
Remove the prescribed one unit of blood.
Which medication is the antidote to warfarin and Heparin? Aspirin Vitamin K Protamine sulfate Clopidogrel
Vitamin K Warfarin is an oral anticoagulant, a drug that inhibits the clotting of blood. It prevents the formation of blood clots by reducing the production of factors by the liver that promote clotting, factors II, VII, IX, and X, and the anticoagulant proteins C and S. Conclusions: In patients receiving warfarin who have asymptomatic excessive prolongations in their INR results, 1 mg of oral vitamin K reliably reduces the INR to the therapeutic rangewithin 24 h. This therapy is more convenient, less expensive, and might be safer than parenteral vitamin K.
A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify? Electrolyte imbalance that could affect the blood's ability to coagulate properly Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels Potential hepatic dysfunction indicated by decreased blood urea nitrogen (BUN) and creatinine levels Low levels of urine constituents normally excreted in the urine
Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels
While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters? Platelet count, prothrombin time, and partial thromboplastin time Fibrinogen level, WBC, and platelet count Thrombin time, calcium levels, and potassium levels Platelet count, blood glucose levels, and white blood cell (WBC) count
Platelet count, prothrombin time, and partial thromboplastin time
An older adult patient presents to the physician's office with a complaint of exhaustion. The nurse, aware of the most common hematologic condition affecting the elderly, knows that which laboratory values should be assessed? Thrombocyte count Levels of plasma proteins WBC count RBC count
RBC count
A client in end-stage renal disease is prescribed epoetin alfa (Epogen) and oral iron supplements. Before administering the next dose of epoetin alfa and oral iron supplement, the nurse Ensures the client has completed dialysis treatment Assesses the hemoglobin level Questions the administration of both medications Holds the epoetin alfa if the BUN is elevated
Assesses the hemoglobin level
GOOD A patients electronic health record states that the patient receives regular transfusions of factor IX. The nurse would be justified in suspecting that this patient has what diagnosis? A) Leukemia B) Hemophilia C) Hypoproliferative anemia D) Hodgkins lymphoma What is the Medication(S) for Hemophilia?
B) Hemophilia Humane-P/Alphanate Aminioporic Acid Administration of clotting factors is used to treat diseases where these factors are absent or insufficient; hemophilia is among the most common of these diseases. Factor IX is not used in the treatment of leukemia, lymphoma, or anemia.
A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. She reports that she first felt pain after manually opening her garage door and that she is taking prednisone daily. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain? Muscle wasting Truncal obesity Osteoporosis Hypertension
Osteoporosis Corticosteriods can decrease bone, and immunosuppressive also causing aplastic anemia
GOOD A patient is being treated in the ICU after a medical error resulted in an acute hemolytic transfusion reaction. What was the etiology of this patients adverse reaction? A) Antibodies to donor leukocytes remained in the blood. B) The donor blood was incompatible with that of the patient. C) The patient had a sensitivity reaction to a plasma protein in the blood. D) The blood was infused too quickly and overwhelmed the patients circulatory system.
B) The donor blood was incompatible with that of the patient. A) Antibodies to donor leukocytes remained in the blood (THIS IS FEBRIL REACTION) C) The patient had a sensitivity reaction to a plasma protein in the blood. D) The blood was infused too quickly and overwhelmed the patients circulatory system. THIS IS TACO OVERLOAD
A client admitted to the hospital in preparation for a splenectomy to treat autoimmune hemolytic anemia asks the nurse about the benefits of splenectomy. Which statement best explains the expected effect of splenectomy? It will reduce the destruction of platelets by macrophages. It will increase production of platelets by the bone marrow. It will remove the major site of red blood cell (RBC) destruction. It will increase red blood cell (RBC) production to compensate for blood loss.
It will reduce the destruction of platelets by macrophages. It will increase production of platelets by the bone marrow. It will remove the major site of red blood cell (RBC) destruction. It will increase red blood cell (RBC) production to compensate for blood loss.
Which is a symptom of hemochromatosis? Inflammation of the tongue Weight gain Bronzing of the skin Inflammation of the mouth
Bronzing of the skin
A client's family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC? "DIC is a complication of an autoimmune disease that attacks the body's own cells." "DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs." "DIC occurs when the immune system attacks platelets and causes massive bleeding." "DIC is caused when hemolytic processes destroy erythrocytes."
"DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs."
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 is likely caused by a folate deficiency." "The condition is likely caused by a vitamin B12 deficiency." "The condition causes abnormally rigid red blood cells." "The condition causes abnormally small red blood cells."
"The condition is likely caused by a vitamin B12 deficiency."
The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has? A general reduction in all white blood cells A general reduction in neutrophils and basophils Too many erythrocytes A decrease in granulocytes
A general reduction in all white blood cells
Through the process of hematopoiesis, stem cells differentiate into either myeloid or lymphoid stem cells. Into what do myeloid stem cells further differentiate? Select all that apply. A) Leukocytes B) Natural killer cells C) Cytokines D) Platelets E) Erythrocytes
A) Leukocytes D) Platelets E) Erythrocytes Feedback:Myeloid stem cells differentiate into three broad cell types: erythrocytes, leukocytes, and platelets. Natural killer cells and cytokines do not originate as myeloid stem cells.
An older adult client is exhibiting many of the characteristic signs and symptoms of iron deficiency. In addition to a complete blood count, what diagnostic assessment should the nurse anticipate? A) Stool for occult blood B) Bone marrow biopsy C) Lumbar puncture D) Urinalysis
A) Stool for occult blood Iron deficiency in the adult generally indicates blood loss (e.g., from bleeding in the GI tract or heavy menstrual flow). Bleeding in the GI tract can be preliminarily identified by testing stool for the presence of blood. A bone marrow biopsy would not be undertaken for the sole purpose of investigating an iron deficiency. Lumbar puncture and urinalysis would not be clinically relevant.
Which of the following is the only curative treatment for chronic myeloid leukemia (CML)? - Idarubicin - Cytarabine - Allogeneic stem cell transplant - Imatinib
Allogeneic stem cell transplant Allogeneic stem cell transplantation remains the only curative treatment for CML. The efficacy of Imatinib as first-line treatment and the treatment-related mortality of stem cell transplant limits use of transplant to patients with high risk or relapsed disease, or in those patients who did not respond to therapy with TKI. Cytarabine and idarubicin are part of induction therapy for acute myeloid leukemia (AML).
Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia? - Apply prolonged pressure to needle sites or other sources of external bleeding. - Monitor temperature at least once per shift. - Eliminate direct contact with others who are infectious. - Implement neutropenic precautions.
Apply prolonged pressure to needle sites or other sources of external bleeding. For a client with leukemia, the nurse should apply prolonged pressure to needle sites or other sources of external bleeding. Reduced platelet production results in a delayed clotting process and increases the potential for hemorrhage. Implementing neutropenic precautions and eliminating direct contact with others are interventions to address the risk for infection.
When teaching a client with iron deficiency anemia about appropriate food choices, the nurse encourages the client to increase the dietary intake of which foods?Berries and orange vegetables Beans, dried fruits, and leafy, green vegetables Fruits high in vitamin C, such as oranges and grapefruits Dairy products
Beans, dried fruits, and leafy, green vegetables
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 programs are inclusive of all muscle groups and have an aerobic effect to increase the heart rate c. this type of exercise increases arterial circulation as it returns to the heart d. isometric exercise decreases the workload of the heart and restores oxygenated blood flow
Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart
A patient lives with a diagnosis of sickle cell anemia and receives frequent blood transfusions. The nurse should recognize the patients consequent risk of what complication of treatment? A) Hypovolemia B) Vitamin B12 deficiency C) Thrombocytopenia D) Iron overload
D) Iron overload frequent blood transfusions. Patients with chronic transfusion requirements can quickly acquire more iron than they can use, leading to iron overload. These individuals are not at risk for hypovolemia and there is no consequent risk for low platelet or vitamin B12 levels
A nurse is caring for a patient who undergoing preliminary testing for a hematologic disorder. What sign or symptom most likely suggests a potential hematologic disorder? A) Sudden change in level of consciousness (LOC) B) Recurrent infections C) Anaphylaxis D) Severe fatigue
D) Severe fatigue he most common indicator of hematologic disease is extreme fatigue. This is more common than changes in LOC, infections, or analphylaxis.
The nurse is caring for a client who had undergone hemodilution during surgery. Immediately after surgery, the nurse expects to see which lab result? Decreased hematocrit Elevated erythrocyte concentration Elevated creatinine Critically low arterial oxygen saturation
Decreased hematocrit
GOOD A client with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this client? Erythropoietin xc Aminocaproic Acid Vitamin K
Erythropoietin
A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? Hypercalcemia Hypernatremia Hypermagnesemia Hyperkalemia
Hypercalcemia Explanation: Calcium is released when bone is destroyed, causing hypercalcemia. Multiple myeloma doesn't affect potassium, sodium, or magnesium levels
The thalassemias are a group of hereditary anemias characterized by which of the following? Select all that apply. Hemolysis Thrombocytopenia Extreme microcytosis Hypochromia Anemia
HypochromiaExtreme microcytosisHemolysisAnemia
A patient receiving plasma develops transfusion-related acute lung injury (TRALI) 4 hours after the transfusion. What type of aggressive therapy does the nurse anticipate the patient will receive to prevent death from the injury? (Select all that apply.) Oxygen Fluid support Serial chest x-rays Intra-aortic balloon pump Intubation and mechanical ventilation
Oxygen Fluid support Intubation and mechanical ventilation
A patient with a diagnosis of immune thrombocytopenic purpura (ITP) is currently receiving IVIG for the treatment of her health condition. The nurse who is providing this patient's care is aware that ITP is a consequence of:- Platelet destruction and impaired platelet production resulting from an autoimmune process - Impaired liver function and the sequestering of platelets by hepatocytes - Hemolysis of platelets in individuals who lack immunity to the Epstein-Barr virus - Inappropriate platelet aggregation on the walls of the great vessels Platelet destruction and impaired platelet production resulting from an autoimmune process
Platelet destruction and impaired platelet production resulting from an autoimmune process
The nurse is assessing a patent with polycythemia vera. What skin assessment data would the nurse determine is a normal finding for this patient? Ruddy complexion Pale skin and mucous membranes Bronze skin tone Jaundice skin and sclera
Ruddy complexion Explanation: Polycythemia vera (sometimes called P vera), or primary polycythemia, is a proliferative disorder of the myeloid stem cells. Patients typically have a ruddy complexion and splenomegaly
A nurse is transfusing whole blood to a client with impaired renal function. During the transfusion, the client tells the nurse, "I feel very short of breath all of a sudden." What is the nurse's primary action? Assess the client's vital signs. Call the health care provider. Slow the infusion. Stop the infusion.
Stop the infusion.
A nurse is caring for a client with a diagnosis of lymphocytopenia. Which assessment finding will the nurse consider most concerning when caring for this client?
Temperature of 37.7 degrees Celsius Fever possible infection. Lymphocytes (he two main types of lymphocytes are B lymphocytes and T lymphocytes. B lymphocytes make antibodies, and T lymphocytes help kill tumor cells and help control immune responses.)
A client with polycythemia vera reports gouty arthritis symptoms in the toes and fingers. What is the nurse's best understanding of the pathophysiological reason for this symptom? The dead red blood cells occlude the small vessels in the joints. The dead red blood cells release excess uric acid. Excess red blood cells cause vascular injury in the joints. Excess red blood cells produce extracellular toxins that build up.
The dead red blood cells release excess uric acid. Explanation:There is a rapid proliferation of red blood cells from the marrow in polycythemia vera. However, these red blood cells die sooner than normal and the dead red blood cells release potassium and uric acid. This build up of uric acid in the blood leads to gouty arthritis symptoms
A patient is undergoing platelet Infusions at the outpatient clinic. What does the nurse know is the most likely clinical disorder the patient is being treated for? Thrombocythemia DIC ITP Anemia
Thrombocythemia
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? Exacerbation of congestive heart failure Transfusion-related acute lung injury Delayed hemolytic reaction Bacterial contamination of blood
Transfusion-related acute lung injury
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. ensure there is an oxygen delivery device at the bedside b. remove the intravenous line c. adminster prescribed PRN anti-anxiety agent d. place the client in a recumbent position with legs elevated
a. ensure there is an oxygen delivery device at the bedside
Which is a symptom of severe thrombocytopenia? a. petechiae b. dyspnea c. inflammation of the mouth d. inflammation of the tongue
a. petechiae
Which term refers to a form of white blood cell involved in immune response? a. granulocyte b. lymphocyte c. throbocyte d. spherocyte
b. lymphocyte
The nurse expects which assessment finding of the oral cavity when the client is diagnosed with pernicious anemia? a. ulcerations of oral mucosa b. smooth tongue c. angular cheilosis d. enlarged gums
b. smooth tongue
A nurse is transfusing whole blood to a client with impaired renal function. During the transfusion, the client tells the nurse, "I feel very short of breath all of a sudden." What is the nurse's primary action? a. call the health care provider b. slow the infusion c. stop the infusion d. assess the clients vital signs
c. stop the infusion
A patient with polycythemia vera is complaining of severe itching. What triggers does the nurse know can cause this distressing symptom? (Select all that apply.) Allergic reaction to the red blood cell increase Aspirin Exposure to water of any temperature Temperature change Alcohol consumption
• Temperature change • Alcohol consumption • Exposure to water of any temperature Pruritus is very common, occurring in up to 70% of patients with polycythemia vera (Saini, Patnaik & Tefferi, 2010) and is one of the most distressing symptoms of this disease. It is triggered by contact with temperature change, alcohol consumption, or, more typically, exposure to water of any temperature but seems to be worse with exposure to hot water
Which term refers to the percentage of blood volume that consists of erythrocytes? a. differentiation b. erythrocyte sedimentation rate (ESR) c. hemoglobin d. hematocrit
d. hematocrit hemoglobin- is the name if red blood cells that carry 02
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? a. splintering of bone fragments b. blood transfusion reaction c. shock d. hemorrhage
d. hemorrhage
A 63-year-old woman has been diagnosed with polycythemia vera (PV) after undergoing a series of diagnostic tests. When the woman's nurse is providing health education, what subject should the nurse prioritize? - Maintenance of long-term vascular access device - Lifestyle modifications and techniques for preventing thromboembolism - Strategies for managing activity - Nutritional modifications necessary for maintaining a low-iron diet
Lifestyle modifications and techniques for preventing thromboembolism The increased blood volume and viscosity that are the hallmarks of PV create a significant risk of thromboembolism. A vascular access device is not necessary for the treatment of PV, and a low-iron diet does not resolve the disease. Patients may experience fatigue, but this risk is superseded by that of thromboembolism.
