Module 5 - Chapter 28: Assessment of Hematologic Function and Treatment Modalities
A client is preparing to leave the blood bank after donating a unit of blood. Which teaching will the nurse provide to the client at this time? "Avoid heavy lifting for several hours." "Increase fluid intake for a week." "Avoid smoking for 1 day."' "Eat healthy meals for a few days."
"Avoid heavy lifting for several hours."
Which client is not a candidate to be a blood donor according to the American Red Cross? 86-year-old male with blood pressure 110/70 mm Hg 26-year-old female with hemoglobin 11.0 g/dL 18-year-old male weighing 52 kg 50-year-old female with pulse 95 beats/minute
26 year old female with hemoglobin 11.0 g/dL
A nurse is reviewing a client's most recent platelet count and identifies the need to institute bleeding precautions. Which result would the nurse most likely have noted? 90,000/mm3 110,000/mm3 200,000 /mm3 45,000/mm3
45,000/mm3
A nurse is preparing a dose of furosemide for an older adult with heart failure. The health care provider orders furosemide 1 mg/kg to be given intravenously. The client weighs 50 kg. The concentration of the drug is 40 mg/4mL (10 mg/mL). How many milliliters would the nurse administer? Record your answer using a whole number.
5 ml
In normal blood, monocytes account for approximately what percentage of the total leukocyte count? 15% 10% 5% 20%
5%
A client with Hodgkin disease had a bone marrow biopsy yesterday and reports aching at the biopsy site, rated a 5 (on a 1-10 scale). After assessing the biopsy site, which nursing intervention is most appropriate? Administer aspirin (ASA) 325 mg po, as ordered Administer acetaminophen 500 mg po, as ordered Notify the physician Reposition the client to a high Fowler position and continue to monitor the pain
Administer acetaminophen 500 mg po, as ordered
The physician performs a bone marrow biopsy from the posterior iliac crest on a client with pancytopenia. What intervention should the nurse perform after the procedure? Administer a topical analgesic to control pain at the site Pack the wound with half-inch sterile gauze Elevate the head of the bed to 45 degrees Apply pressure over the site for 5-7 minutes
Apply pressure over the site for 5-7 minutes
A client feels faint and becomes dizzy after donating a unit of blood. Which actions will the nurse perform at this time? Select all that apply. Observe the clent for 30 minutes Place the client's head lower than the knees Provide 1000 mL of fluid stat Assist the client to lie down Assess the client's apical heart rate
Assist the client to lie down Assess the client's apical heart rate Place the client's head lower than the knees Observe the clent for 30 minutes
Which type of leukocyte contains histamine and is an important part of hypersensitivity reactions? Neutrophil Basophils Plasma cell B lymphocyte
Basophils
The nurse recognizes that the most common cause of iron deficiency anemia in an adult is bleeding. chronic alcoholism. lack of dietary iron. iron malabsorption.
Bleeding
A client seeks medical attention for the spontaneous development of bruises over the arms and legs. Which laboratory tests will the nurse anticipate being prescribed for this client? Select all that apply. Complete blood count Activated partial prothrombin time Blood urea nitrogen Bilirubin International normalized ratio
Complete blood count International normalized ratio Activated partial prothrombin time
The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly? Pain and tenderness in calf area Respiratory rate of 10 breaths/minute Crackles auscultated bilaterally Oral temperature of 97°F
Crackles auscultated bilaterally
When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply. Hair color Herbal supplements Dietary intake Medication use Ethnicity
Dietary intake Medication use Ethnicity Herbal supplements
A client receiving a unit of packed red blood cells (PRBCs) has been prescribed morphine 1 mg intravenously now for pain. What is the best method for the nurse to administer the morphine? Inject the morphine into a distal port on the blood tubing. Administer the morphine into the closest tubing port to the client for fast delivery. Add the morphine to the blood to be slowly administered. Disconnect the blood tubing, flush with normal saline, and administer morphine.
Disconnect the blood tubing, flush with normal saline, and administer morphine.
Which blood cell type is matched correctly with its function? Leukocyte: Fights infection T lymphocyte: Humoral immunity B lymphocyte: Secretes immunoglobulin Plasma cell: Cell-mediated immunity
Leukocyte: Fights infection
Which nursing intervention should be incorporated into the plan of care for a client with impaired liver function and a low albumin concentration? Apply prolonged pressure to needle sites or other sources of external bleeding Implement neutropenic precautions Monitor temperature at least once per shift Monitor for edema at least once per shift
Monitor for edema at least once per shift
The nurse learns that a client has a family history of a hematologic condition. Which assessment findings indicate to the nurse that the client needs additional assessment for the condition? Select all that apply. Diffuse mild abdominal pain Report of frequent nosebleeds Report of fatigue Peripheral edema Scattered bruises
Scattered bruises Report of fatigue Diffuse mild abdominal pain Report of frequent nosebleeds
Place the following steps in order when determining the type and severity of a transfusion reaction. Use all options. Notify the blood bank. Send the tubing and container to the blood bank Stop the transfusion. Assess the client. Notify the health care provider.
Stop the transfusion. Assess the client. Notify the health care provider. Notify the blood bank. Send the tubing and container to the blood bank.
The nurse is caring for a client with hypoxia. What does the nurse understand is true regarding the client's oxygen level and the production of red blood cells? The kidneys sense low oxygen levels in the blood and produce erythropoietin, stimulating the bone marrow to produce more red blood cells. The kidneys sense low oxygen levels in the blood and produce hemoglobin, stimulating the marrow to produce more red blood cells. The brain senses low oxygen levels in the blood and produces hemoglobin, which binds to more red blood cells. The bone marrow is stimulated by low oxygen levels in the blood to produce erythropoietin, maturing the red blood cells.
The kidneys sense low oxygen levels in the blood and stimulate erythropoietin, stimulating the marrow to produce more red blood cells.
A nurse is teaching a client with a vitamin B12 deficiency about appropriate food choices to increase the amount of B12 ingested with each meal. The nurse knows the teaching is effective based on which statement by the client? "I will increase my daily intake of orange vegetables such as sweet potatoes and carrots." "I will eat a spinach salad with lunch and dinner." "I will eat more dairy products such as milk, yogurt, and ice cream every day." "I will eat a meat source such as chicken or pork with each meal."
"I will eat a meat source such as chicken or pork with each meal."
A client is returning home after having a bone marrow aspiration and biopsy. Which statement indicates that teaching by the nurse has been effective? "The area might ache for 1 to 2 days." "I can resume my normal activities." "I can go to the gym to lift weights later." "I should take aspirin if I have any pain."
"The area might ache for 1 to 2 days."
A nurse cares for a client with megaloblastic anemia who had a total gastrectomy three years ago. What statement will the nurse include in the client's teaching regarding the condition? "The condition is likely caused by a folate deficiency." "The condition is likely caused by a vitamin B12 deficiency." "The condition causes abnormally small red blood cells." "The condition causes abnormally rigid red blood cells."
"The condition is likely caused by a vitamin B12 deficiency."
A client with a history of congestive heart failure has an order to receive 1 unit of packed red blood cells (RBCs). If the nurse hangs the blood at 12:00 pm, by what time must the infusion be completed? 2:00 pm 3:00 pm 6:00 pm 4:00 pm
4:00 pm
A nurse is assigned to care for a patient with ascites, secondary to cirrhosis. The nurse understands that the fluid accumulation in the peritoneal cavity results from a combination of factors including an alteration in oncotic pressure gradients and increased capillary permeability. Therefore, the nurse monitors the serum level of the plasma protein responsible for maintaining oncotic pressure, which is: Albumin. Fibrinogen. Prothrombin. Globulin.
Albumin
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? Thrombocytopenia Myelodysplastic syndrome Neutropenia Anemia
Anemia
A client with a history of sickle cell anemia has developed iron overload from repeated blood transfusions. What treatment does the nurse anticipate will be prescribed? Chelation therapy Hepatitis B immunization Red blood cell phenotyping White blood cell filter
Chelation therapy
A client with myelodysplastic syndromes (MDS) receives routine blood transfusions. Which treatment will the nurse expect to be prescribed to prevent the development of iron overload? Eltrombopag Epoetin alpha Chelation therapy Romiplostim
Chelation therapy
A client seeks medical attention for the spontaneous development of bruises over the arms and legs. Which laboratory tests will the nurse anticipate being prescribed for this client? Select all that apply. Bilirubin Blood urea nitrogen Activated partial prothrombin time Complete blood count International normalized ratio
Complete blood count International normalized ratio Activated partial prothrombin time
A client seeks medical attention for the spontaneous development of bruises over the arms and legs. Which laboratory tests will the nurse anticipate being prescribed for this client? Select all that apply. International normalized ratio Activated partial prothrombin time Bilirubin Blood urea nitrogen Complete blood count
Complete blood count International normalized ratio Activated partial prothrombin time
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? Decreased total iron-binding capacity Increased mean corpuscular volume Increased reticulocyte count Decreased level of erythropoietin
Decreased level of erythropoietin
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? Increased mean corpuscular volume Decreased total iron-binding capacity Decreased level of erythropoietin Increased reticulocyte count
Decreased level of erythropoietin
A client donated two units of blood to be used for transfusion during spinal fusion surgery. The client received one unit of autologous blood during the procedure but the second unit is not needed during the procedure. The nurse knows which action will come after the procedure is completed? Use the unit for platelets and albumin. Discard the additional unit. Provide it to the client before discharge. Release the additional unit for use to the general population.
Discard the additional unit.
The charge nurse should intervene when observing a new nurse perform which action after a client has suffered a possible hemolytic blood transfusion reaction? Documenting the reaction in the client's medical record. Informing the client to leave a urine sample after the client's next void. Disposing of the blood container and tubing in biohazard waste. Notifying the blood bank of the reaction.
Disposing of the blood container and tubing in biohazard waste.
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? Eltrombopag Sargramostim Filgrastim Epoetin alfa
Epoetin alfa
The nurse cares for a client with a coagulation factor deficiency who is actively bleeding. Which blood component replacement does the nurse anticipate administering? PRBCs FFP IV gamma-globulin Antithrombin III
FFP
Which term refers to the percentage of blood volume that consists of erythrocytes? Erythrocyte sedimentation rate (ESR) Hemoglobin Hematocrit Differentiation
Hematocrit
Which term refers to the percentage of blood volume that consists of erythrocytes? Hemoglobin Erythrocyte sedimentation rate (ESR) Hematocrit Differentiation
Hematocrit
A nurse is performing an initial assessment and notes the client's skin is a gray-tan color, especially on the scars of the client's arms. Which hematological condition does the nurse suspect? Polycythemia Vitamin B12 deficiency Hemochromatosis Thrombocytopenia
Hemochromatosis
A client's electronic health record states that the client receives regular transfusions of factor IX. The nurse would be justified in suspecting that this client has what diagnosis? Hemophilia Leukemia Hypoproliferative anemia Hodgkin lymphoma
Hemophilia
A client is scheduled for surgery to remove an abdominal mass. The nurse knows that which reason hemodilution would be contraindicated as a method to provide blood to the client during the surgery?
History of renal disease
A patient who has long-term packed RBC (PRBC) transfusions has developed symptoms of iron toxicity that affect liver function. What immediate treatment should the nurse anticipate preparing the patient for that can help prevent organ damage? Iron chelation therapy Anticoagulation therapy Therapeutic phlebotomy Oxygen therapy
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 reason? Lack of erythropoietin Increases the effectiveness of dialysis Preparation for likely nephrectomy Hypervolemia
Lack of erythropoietin
The nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. What position will the nurse place the patient in? Lateral position with one leg flexed Supine with head of the bed elevated 30 degrees Jackknife position Lithotomy position
Lateral position with one leg flexed
Which term refers to a form of white blood cell involved in immune response? Lymphocyte Granulocyte Spherocyte Thrombocyte
Lymphocyte
A client involved in a motor vehicle accident arrives at the emergency department unconscious and severely hypotensive. The nurse suspects the client has several fractures in the pelvis and legs. Which parenteral fluid is the best choice for the client's current condition? Packed red blood cells (RBCs) Fresh frozen plasma Lactated Ringer's solution Normal saline solution
Packed red blood cells (RBCs)
Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils? Destruction of tumor cells Production of antibodies called immunoglobulin (Ig) Phagocytosis Rejection of foreign tissue
Phagocytosis
A client is diagnosed with extreme thrombocytosis. The nurse knows this condition is a result of which elevated blood cell count? Eosinophils Erythocytes Platelets Neutrophils
Platelets
The nurse is working at a blood donation clinic. What teaching should the nurse provide to the donor immediately after blood donation? Remove the band-aid after 5 minutes. Hold the involved arm below the heart. Remain for observation after eating and drinking. Sit up promptly after the needle is removed.
Remain for observation after eating and drinking.
A nurse cares for several mothers and babies in the postpartum unit. Which mother does the nurse recognize as being most at risk for a febrile nonhemolytic reaction? Rh-negative mother; Rh-positive child Rh-positive mother; Rh-negative child Rh-negative mother; Rh-negative child Rh-positive mother; Rh-positive child
Rh-negative mother; Rh-positive child
Place the following procedural steps in order for transfusing a unit of packed red blood cells (PRBCs): Double check the labels with another nurse to ensure correct ABO group and Rh type Initiate the blood transfusion within 30 minutes of receipt Monitor closely for signs of a transfusion reaction. Start an intravenous line Obtain the unit of PRBCs from the blood bank
Start an intravenous line Obtain the unit of PRBCs from the blood bank Double check the labels with another nurse to ensure correct ABO group and Rh type Initiate the blood transfusion within 30 minutes of receipt Monitor closely for signs of a transfusion reaction.
Place the following procedural steps in order for transfusing a unit of packed red blood cells (PRBCs). Obtain the unit of PRBCs from the blood bank. Double check the labels with another nurse to ensure correct ABO group and Rh type. Start an intravenous line. Initiate the blood transfusion within 30 minutes of receipt. Monitor closely for signs of a transfusion reaction.
Start an intravenous line. Obtain the unit of PRBCs from the blood bank. Double check the labels with another nurse to ensure correct ABO group and Rh type. Initiate the blood transfusion within 30 minutes of receipt. Monitor closely for signs of a transfusion reaction.
The health care provider believes that the client has a deficiency in the leukocyte responsible for cell-mediated immunity. What should the nurse check the WBC count for? T lymphocytes Basophils Monocytes Plasma cells
T lymphocytes
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? Prothrombin time 12 seconds INR 0.9 Temperature of 37.7 degrees Celsius Blood pressure 132/92
Temperature of 37.7 degrees celsius
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 experiencing vascular collapse. The client is having an allergic reaction to the blood. The client is having a febrile nonhemolytic reaction. The client is having decrease in tissue perfusion from a shock state.
The client is having a febrile nonhemolytic reaction.
The client is to receive a unit of packed red blood cells. What is the nurse's first action? Ensure that the intravenous site has a 20-gauge or larger needle. Verify that the client has signed a written consent form. Observe for gas bubbles in the unit of packed red blood cells. Check the label on the unit of blood with another registered nurse
Verify that the client has signed a written consent form
The client is to receive a unit of packed red blood cells. What is the nurse's first action? Verify that the client has signed a written consent form. Observe for gas bubbles in the unit of packed red blood cells. Ensure that the intravenous site has a 20-gauge or larger needle. Check the label on the unit of blood with another registered nurse.
Verify that the client has signed a written consent form.
The physician orders a transfusion with packed red blood cells (RBCs) for a client hospitalized with severe iron deficiency anemia. When blood is administered, what is the most important action the nurse can take to prevent a transfusion reaction? Premedicate the client with acetaminophen Administer the blood as soon as it arrives Verify the client's identity according to hospital policy Assess the client 30 minutes after the start of the initial transfusion
Verify the client's identity according to hospital policy
A client arrives for an appointment at the community blood bank to donate a unit of B- blood. The nurse knows that which reasons may be why the client cannot donate at this time? Select all that apply. Age 64 Hemoglobin 11.3 g/dL (113 g/L) Received a blood transfusion for surgery 2 years ago Returned from a trip to Africa a month ago Weight 48 kg (105.6 lbs.)
Weight 48 kg (105.6 lbs.) Hemoglobin 11.3 g/dL (113 g/L) Returned from a trip to Africa a month ago
A nursing instructor in a BSN program is preparing for a lecture on disorders of the hematopoietic system. Included in the lecture are conditions caused by reduced levels or absence of blood-clotting proteins. Which of the following is the instructor most likely referring to? Sickle cell disease Coagulopathy Pancytopenia Aplastic anemia
coagulopathy
A client wants to donate blood before his or her abdominal surgery next week. What should be the nurse's first action? Explain the time frame needed for autologous donation. Provide the client with a list of the nearest donation centers. Tell the client that 2 units of blood will be needed. Remind the client to take supplemental iron before donation.
explain the time frame needed for autologous donation
A nurse is caring for a patient who has had a bone marrow aspiration with biopsy. What complication should the nurse be aware of and monitor the patient for? Shock Hemorrhage Splintering of bone fragments Blood transfusion reaction
hemorrhage
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? Potassium Hemoglobin Iron Calcium
iron
The client's CBC with differential reveals small-shaped hemoglobin molecules. The nurse expects to administer which medication to this client? Folate Iron Vitamin B12 Fresh frozen plasma
iron
The nurse is caring for a client who has a unit of whole blood removed every 6 weeks as treatment for polycythemia vera. Which laboratory test will the nurse monitor to determine if the procedure is adversely affecting the client? Calcium White blood cell count Potassium Iron
iron
The nurse is providing health education to an older adult client who has low red blood cell levels. To promote red blood cell production, the nurse should encourage intake of what foods? Select all that apply. Lean meats Animal fats Leafy green vegetables Nuts and seeds Organic foods
leafy green vegetables lean meats nuts and seeds
A nurse is reviewing a client's morning laboratory results and notes a left shift in the band cells. Based on this result, the nurse can interpret that the client has leukopenia. may be developing an infection. may be developing anemia. has thrombocytopenia.
may be developing an infection.
A preoperative client is discussing blood donation with the nurse. Which statement by the client indicates to the nurse the need for further teaching? "I could donate my own blood in case I need a transfusion." "I should expect blood withdrawal to take about 15 minutes." "My family will donate blood, because it's safer." "Donated blood is tested for blood type and infections."
my family will donate blood because its safer
Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? Lymphoid stem cell Monocyte Myeloid stem cell Neutrophil
myeloid stem cell
Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? Monocyte Myeloid stem cell Lymphoid stem cell Neutrophil
myeloid stem cell
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? Eosinophils Neutrophils Basophils Monocyte
neutrophils
A nurse is assisting a client into position prior to bone marrow aspiration. Which position will the nurse place the client prior to the procedure? Prone Knee-chest Supine Trendelenburg
prone
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? Slow the infusion. Call the health care provider. Stop the infusion. Assess the client's vital signs.
stop the infusion
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? Bacterial contamination of blood Exacerbation of congestive heart failure Transfusion-related acute lung injury Delayed hemolytic reaction
transfusion-related acute lung injury
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? Delayed hemolytic reaction Exacerbation of congestive heart failure Bacterial contamination of blood Transfusion-related acute lung injury
transfusion-related acute lung injury
While caring for a client, the nurse notes petechiae on the client's trunk and lower extremities. What precaution will the nurse take when caring for this client? Where a mask when entering the client's room. Elevate the client's head of the bed. Apply supplemental oxygen to maintain the client's oxygenation. Use an electric razor when assisting client with shaving.
use an electric razor when assisting the client with shaving