N406 Exam 2 PrepU Questions (BLOOD)

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? A. Coagulopathy B. Aplastic anemia C. Pancytopenia D. Sickle cell disease

A. Coagulopathy The term coagulopathy refers to conditions in which a component that is necessary to control bleeding is missing or inadequate.

A nurse is assessing a client with multiple myeloma. Due to this condition, what will this client be at risk for? A. chronic liver failure. B. acute heart failure. C. pathologic bone fractures. D. hypoxemia.

C. pathologic bone fractures. Clients with multiple myeloma are at risk for pathologic bone fractures secondary to diffuse osteoporosis and osteolytic lesions. Also, clients are at risk for renal failure secondary to myeloma proteins by causing renal tubular obstruction. Liver failure and heart failure aren't usually sequelae of multiple myeloma. Hypoxemia isn't usually related to multiple myeloma.

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? A. "DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs." B. "DIC occurs when the immune system attacks platelets and causes massive bleeding." C. "DIC is a complication of an autoimmune disease that attacks the body's own cells." D. "DIC is caused when hemolytic processes destroy erythrocytes."

A. "DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs." The inflammatory response initiates the process of inflammation and coagulation. The natural anticoagulant pathways within the body are simultaneously impaired, and the fibrinolytic system is suppressed, allowing a massive amount of tiny clots forms in the microcirculation. As the platelets and clotting factors form microthrombi, coagulation fails. Thus, the paradoxical result of excessive clotting is bleeding. Decline in organ function is usually a result of excessive clot formation (with resultant ischemia to all or part of the organ).

Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? A. Pancytopenia B. Anemia C. Leukopenia D. Thrombocytopenia

A. Pancytopenia Pancytopenia may be congenital or acquired. Anemia refers to decreased red cell mass. Leukopenia refers to a less-than-normal amount of WBCs in circulation. Thrombocytopenia refers to a lower-than-normal platelet count.

For a client with Hodgkin disease who has developed neutropenia, what is an appropriate nursing intervention to include in the care plan? A. Monitoring temperature every 4 hours B. Omitting fresh fruits and vegetables from the diet C. Positioning the client to increase lung expansion D. Avoiding intramuscular (IM) injections

A. Monitoring temperature every 4 hours For a client with neutropenia, monitoring temperature every 4 hours is essential. If the client develops a fever, the client is considered to have an infection and is usually admitted to the hospital. Cultures of blood, urine, and sputum, as well as a chest x-ray, are obtained.

A nurse cares for a client with early Hodgkin lymphoma. While assessing the client, the nurse will most likely find painless enlargement of which lymph node? A. Axillary B. Cervical C. Inguinal D. Popliteal

B. Cervical Non painful swelling of the cervical lymph nodes is the earliest symptom of Hodgkin lymphoma.

A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client? A. Pallor, bradycardia, and reduced pulse pressure B. Pallor, tachycardia, and a sore tongue C. Sore tongue, dyspnea, and weight gain D. Angina pectoris, double vision, and anorexia

B. Pallor, tachycardia, and a sore tongue Pallor, tachycardia, and a sore tongue are all characteristic findings in pernicious anemia. Other clinical manifestations include anorexia; weight loss; a smooth, beefy red tongue; a wide pulse pressure; palpitations; angina pectoris; weakness; fatigue; and paresthesia of the hands and feet. Bradycardia, reduced pulse pressure, weight gain, and double vision aren't characteristic findings in pernicious anemia.

A client is diagnosed with extreme thrombocytosis. The nurse knows this condition is a result of which elevated blood cell count? A. Neutrophils B. Platelets C. Erythocytes D. Eosinophils

B. Platelets Extreme thrombocytosis is an elevation in platelets.

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? A. Fresh frozen plasma B. Normal saline solution C. Lactated Ringer's solution D. Packed red blood cells (RBCs)

D. Packed red blood cells (RBCs) In a trauma situation, the first blood product given is unmatched (O negative) packed RBCs. Fresh frozen plasma is commonly used to replace clotting factors. Normal saline or lactated Ringer's solution is used to increase volume and blood pressure; however, too much colloid will hemodilute the blood and doesn't improve oxygen-carrying capacity as well as packed RBCs do.

A patient had gastric bypass surgery 3 years ago and now, experiencing fatigue, visits the clinic to determine the cause. The patient takes pantoprazole for the treatment of frequent heartburn. What type of anemia is this patient at risk for? A. Aplastic anemia B. Iron deficiency anemia C. Sickle cell anemia D. Pernicious anemia

D. Pernicious anemia A deficiency of vitamin B 12 can occur in several ways. Inadequate dietary intake is rare but can develop in strict vegans (who consume no meat or dairy products). Faulty absorption from the GI tract is a more common cause. This occurs in conditions such as Crohn's disease, or after ileal resection or gastrectomy.

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? A. It will remove the major site of red blood cell (RBC) destruction. B. It will reduce the destruction of platelets by macrophages. C. It will increase production of platelets by the bone marrow. D. It will increase red blood cell (RBC) production to compensate for blood loss.

A. It will remove the major site of red blood cell (RBC) destruction. For clients with autoimmune hemolytic anemia, if corticosteroids do not produce remission, a splenectomy (i.e., removal of the spleen) may be performed because it removes the major site of RBC destruction.

Which of the following is considered an antidote to heparin? A. Protamine sulfate B. Vitamin K C. Narcan D. Ipecac

A. Protamine sulfate Protamine sulfate, in the appropriate dosage, acts quickly to reverse the effects of heparin. Vitamin K is the antidote to warfarin (Coumadin). Narcan is the drug used to reverse signs and symptoms of medication-induced narcosis. Ipecac is an emetic used to treat some poisonings.

A nurse cares for clients with hematological disorders and notes that women are diagnosed with hemochromatosis at a much lower rate than men. What is the primary reason for this? A. Women lose iron through menstrual cycles B. Women rarely manifest the gene expression C. Women have lower hemoglobin levels D. Women require grater folic acid supplementation

A. Women lose iron through menstrual cycles Hemochromatosis is a genetic condition where excess iron is absorbed in the GI tract and deposited in various organs, making them dysfunctional. Women are often less affected than men because women lose excess iron through their menstrual cycles. The other answer choices are not correct reasons why women are impacted less than men with hemochromatosis.

A client has a history of sickle cell anemia with several sickle cell crises over the past 10 years. What blood component results in sickle cell anemia? A. hemoglobin S B. hemoglobin F C. hemoglobin A D. hemoglobin M

A. hemoglobin S Hemoglobin A (HbA) normally replaces fetal hemoglobin (HbF) about 6 months after birth. In people with sickle cell anemia, however, an abnormal form of hemoglobin, hemoglobin S (HbS), replaces HbF. HbS causes RBCs to assume a sickled shape under hypoxic conditions.

The nurse is caring for a client with an exacerbation of sickle cell disease (SCD). Which finding indicates to the nurse that the client is experiencing a liver complication from this condition? A. Fatigue B. Weakness C. Abdominal pain D. Glucose intolerance

C. Abdominal pain Sickle cell disease (SCD) is an autosomal recessive disorder caused by inheritance of the sickle hemoglobin (HbS) gene. It is associated with severe hemolytic anemia. The HbS gene results in production of a defective hemoglobin molecule that causes the erythrocyte to change shape when exposed to low oxygen tension. The erythrocyte usually has a round, biconcave, pliable shape which in SCD becomes rigid and sickle shaped. Complications of SCD can affect all body systems. Evidence that the client is experiencing a complication in the liver would be the development of abdominal pain. Fatigue and weakness indicate complications involving the central nervous system and heart. Glucose intolerance is not identified as a complication of SCD.

A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify? A. Potential hepatic dysfunction indicated by decreased blood urea nitrogen (BUN) and creatinine levels B. Low levels of urine constituents normally excreted in the urine C. Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels D. Electrolyte imbalance that could affect the blood's ability to coagulate properly

C. Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels Low preoperative HCT and Hb levels indicate the client may require a blood transfusion before surgery. If the HCT and Hb levels decrease during surgery because of blood loss, the potential need for a transfusion increases. Possible renal failure is indicated by elevated BUN or creatinine levels. Urine constituents aren't found in the blood. Coagulation is determined by the presence of appropriate clotting factors, not electrolytes.

A young female client has pale nailbeds. Her hemoglobin count is 10.2 gm/dL and her hematocrit count is 30%. She reports fatigue and states, "I'm tired all the time." The client also reports excessive menstrual flow. The nurse assesses further and determines the client's diet is balanced and provides adequate calories. The client is prescribed supplemental iron therapy. The highest nursing diagnosis is A. Fatigue related to diminished oxygen-carrying capacity of the blood B. Altered nutrition: less than body requirements, related to inadequate intake of nutrients C. Altered tissue perfusion related to diminished oxygen-carrying capacity of the blood D. Deficient knowledge related to new information with no previous experience

C. Altered tissue perfusion related to diminished oxygen-carrying capacity of the blood All the nursing diagnoses are appropriate for this client who is experiencing anemia. Physiological needs take priority per Maslow's hierarchy of needs. Under physiological needs, airway, breathing, and then circulation take priority. Altered tissue perfusion would be classified under circulation, thus making it the priority over the other diagnoses listed.

A unit of packed red blood cells has been prescribed for a client with low hemoglobin and hematocrit levels. The nurse notifies the blood bank of the order, and a blood specimen is drawn from the client for typing and cross-matching. The nurse receives a telephone call from the blood bank and is informed that he unit of blood is ready for administration. Arrange the actions in order of priority that the nurse should take to administer the blood. (Letter A is the first and letter F is the last action.) a) hang the bag of blood b) obtain the unit of blood from the bank c) ensure that an informed consent has been signed d) verify the physician's order for the blood transfusion e) insert an 18 or 19-gauge IV catheter into the client f) ask a licensed nurse to assist in confirming blood compatibility and verifying client identity.

D, C, E, B, F, A The nurse would first verify the physician's order for the blood transfusion and ensure that the client has been informed about the procedure and has signed an informed consent. Once this has been done, the nurse would ensure that at least an 18- or 19-gauge intravenous needle is inserted into the client. Blood has a thicker and stickier consistency than intravenous solutions and using an 18- or 19-gauge catheter ensures that the bore of the catheter is large enough to prevent damage to the blood cells. Next, the blood is obtained from the blood bank, once the nurse is sure that the client has been informed and has an adequate access for administering the blood. Once the blood has been obtained, two registered nurses, or one registered and a licensed practical nurse (depending on agency policy), must together check the label on the blood product against the client's identification number, blood group, and complete name. This minimizes the risk of error in checking information on the blood bag and thereby minimizes the risk of harm or injury to the client. The nurse should measure vital signs and assess lung sounds and then hang the transfusion."`

A client with polycythemia vera presents to the primary care clinic for an annual physical. Which health care provider prescriptions does the nurse recognize as preventive measures to prevent thrombosis in the client? Select all that apply. A. Statin therapy B. Beta blocker therapy C. Anti-dysrhythmia therapy D. Nitrate therapy E. Iron therapy

A, B Aggressive management of atherosclerosis, by treating hypertension and hyperlipidemia, is important in diminishing the risk of thrombosis in the client with polycythemia vera. Statin therapy decreases cholesterol levels while beta blockers decrease blood pressure. Iron therapy would make the client worse, not better. Nitrates and anti-dysrhythmia drugs are not primarily used in the treatment of polycythemia vera.

You're providing discharge teaching to a patient about pernicious anemia. Which statement by the patient indicates they did NOT understand the discharge teaching? A. "Pernicious anemia is caused by not consuming enough Vitamin B12." B. "Pernicious anemia causes the red blood cells to appear very large and oval." C. "Treatment for pernicious anemia includes a series of intramuscular injections of Vitamin B12."

A.

A client is hospitalized 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin at home, which is now discontinued. To prevent the formation of blood clots, which action should the nurse take? A. Administer the prescribed enoxaparin (Lovenox). B. Encourage a diet high in vitamin K. C. Have the client limit physical activity. D. Monitor partial thromboplastin (PTT) time.

A. Administer the prescribed enoxaparin (Lovenox). Clients who are prescribed warfarin at home and need to have a major invasive procedure stop taking warfarin prior to the procedure. Low molecular weight heparin, such as enoxaparin, may be used until the procedure is performed. The client will continue with a diet that has a daily consistent amount of vitamin K. The client needs to ambulate frequently throughout the day. Prothrombin (PT) time is monitored, not PTT, when warfarin had been administered.

A client comes to the walk-in clinic complaining of weakness and fatigue. While assessing this client, the nurse finds evidence of petechiae and ecchymoses. The nurse notes that the spleen appears enlarged. What would the nurse suspect is wrong with this client? A. Aplastic anemia B. Pernicious anemia C. Iron-deficiency anemia D. Agranulocytosis

A. Aplastic anemia Clients with aplastic anemia experience all the typical characteristics of anemia (weakness and fatigue). In addition, they have frequent opportunistic infections plus coagulation abnormalities that are manifested by unusual bleeding, small skin hemorrhages called petechiae, and ecchymoses (bruises). The spleen becomes enlarged with an accumulation of the client's blood cells destroyed by lymphocytes that failed to recognize them as normal cells, or with an accumulation of dead transfused blood cells. The blood cell count shows insufficient numbers of blood cells. A bone marrow aspiration confirms that the production of stem cells is suppressed. This scenario does not describe a client with pernicious anemia, iron-deficiency anemia, or agranulocytosis.

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? A. Beans, dried fruits, and leafy, green vegetables B. Fruits high in vitamin C, such as oranges and grapefruits C. Berries and orange vegetables D. Dairy products

A. Beans, dried fruits, and leafy, green vegetables Food sources high in iron include organ meats (e.g., beef or calf liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy and green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.

Which is a symptom of hemochromatosis? A. Bronzing of the skin B. Inflammation of the mouth C. Inflammation of the tongue D. Weight gain

A. Bronzing of the skin Clients with hemochromatosis exhibit symptoms of weakness, lethargy, arthralgia, weight loss, and loss of libido early in the illness trajectory. The skin may appear hyperpigmented from melanin deposits or appear bronze in color.

A nurse prepares a client for a bone marrow biopsy who is suspected of having acute myeloid leukemia. What results from the bone marrow biopsy does the nurse expect? A. Excess of immature leukocytes B. Excess of immature erythrocytes C. Deficiency of neutrophils D. Deficiency of erythrocytes

A. Excess of immature leukocytes The bone marrow biopsy of a client with acute myeloid leukemia will reveal an excess of immature leukocytes.

A teenaged client with hemophilia sustains a leg laceration after falling off a skateboard and is brought to the emergency department. The laceration is bleeding profusely even with direct pressure to the site. What does the nurse anticipate will be prescribed for administration to control bleeding? A. Fresh frozen plasma B. A colloid solution such as hetastarch (Hespan) C. A crystalloid solution such as lactated Ringer's D. Albumin

A. Fresh frozen plasma Treatment includes transfusion of fresh blood, frozen plasma, factor VIII concentrate, and anti-inhibitor coagulant complex for hemophilia A, factor IX concentrate for hemophilia B, factor XI for hemophilia C, and the application of thrombin or fibrin to the bleeding area. Other measures used to help control bleeding are the administration of fresh frozen plasma, aminocaproic acid that helps to hold a clot in place once it has formed, direct pressure over the bleeding site, and cold compresses or ice packs. Hetastarch, lactated Ringer's, or albumin will not control the bleeding related to hemophilia.

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? A. Induction therapy B. Supportive therapy C. Antimicrobial therapy D. Standard therapy

A. Induction therapy Despite advances in understanding of the biology of AML, substantive advances in treatment response rates and survival rates have not occurred for decades, with the exception of advances made in treating APL (see later discussion). Even for patients with subtypes that have not benefited from advances in treatment, cure is still possible. The overall objective of treatment is to achieve complete remission, in which there is no evidence of residual leukemia in the bone marrow. Attempts are made to achieve remission by the aggressive administration of chemotherapy, called induction therapy, which usually requires hospitalization for several weeks.

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following? A. Liver B. Pancreas C. Kidney D. Large intestine

A. Liver Albumin is produced by the liver. Albumin is not produced in the pancreas, kidney, or large intestine.

A nursing instructor is evaluating a student caring for a neutropenic client. The instructor concludes that the nursing student demonstrates accurate knowledge of neutropenia based on which intervention? A. Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential B. Monitoring the client's breathing and reviewing the client's arterial blood gases C. Monitoring the client's heart rate and reviewing the client's hemoglobin D. Monitoring the client's blood pressure and reviewing the client's hematocrit

A. Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential Clients with neutropenia often do not exhibit classic signs of infection. Fever is the most common indicator of infection, yet it is not always present. No definite symptoms of neutropenia appear until the client develops an infection. A routine CBC with differential can reveal neutropenia before the onset of infection.

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. Monocyte D. Neutrophil

A. Myeloid stem cell The myeloid stem cell is responsible not only for all nonlymphoid white blood cells, but also for the production of red blood cells and platelets. Lymphoid cells produce either T or B lymphocytes. A monocyte is large WBC that becomes a macrophage when is leaves the circulation and moves into body tissues. A neutrophil is a fully mature WBC capable of phagocytosis.

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? A. Rh-negative mother; Rh-negative child B. Rh-positive mother; Rh-negative child C. Rh-negative mother; Rh-positive child D. Rh-positive mother; Rh-positive child

A. Rh-negative mother; Rh-negative child A mother who is Rh negative and gives birth to an Rh positive child is at greatest risk for a febrile nonhemolytic reaction because exposure to an Rh-positive fetus raises antibody levels in the Rh negative mother. An Rh-negative mother can carry an Rh-negative child without being at greatest risk for a febrile nonhemolytic reaction; however, these mothers are often treated prophylactically. An Rh-positive mother may carry either an Rh-positive or Rh-negative child without increased risk.

A nurse is caring for a client with thalassemia who is being transfused. What is the nurse's role during a transfusion? A. To closely monitor the rate of administration B. To administer vitamin B12 injections C. To instruct the client to rest immediately if chest pain develops D. To assess for enlargement and tenderness over the liver and spleen

A. To closely monitor the rate of administration In a client with thalassemia, when transfusions are necessary, the nurse closely monitors the rate of administration. Assessing for enlargement and tenderness over the liver and spleen, advising rest, or administering vitamin B12 injections are not indicated for thalassemia.

A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from? Select all that apply. A. Infection B. Blood loss C. Abnormal erythrocyte production D. Destruction of normally formed red blood cells E. Inadequate formed white blood cells

B, C, D Most anemias result from (1) blood loss, (2) inadequate or abnormal erythrocyte production, or (3) destruction of normally formed red blood cells. The most common types include hypovolemic anemia, iron-deficiency anemia, pernicious anemia, folic acid deficiency anemia, sickle cell anemia, and hemolytic anemias. Although each form of anemia has unique manifestations, all share a common core of symptoms. Anemia does not result from infection or inadequate formed white blood cells.

The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? A. "Acute leukemia develops slowly." B. "Chronic leukemia develops slowly." C. "In chronic leukemia, the minority of leukocytes are mature." D. "In acute leukemia there are not many undifferentiated cells."

B. "Chronic leukemia develops slowly." Chronic leukemia develops slowly, and the majority of leukocytes produced are mature. Acute leukemia develops quickly and the majority of leukocytes are undifferentiated cells.

A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention? A. Assess the client's skin. B. Assess the client's hemoglobin and platelets. C. Assess the client's pulse and blood pressure. D. Check the client's history.

B. Assess the client's hemoglobin and platelets Clients with AML may develop pallor from anemia and a tendency to bleed because of a low platelet count. Assessing the client's hemoglobin and platelets will help to determine whether this is the cause of the symptoms. This would be the priority above assessing pulses, blood pressure, history, or skin

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? A. Abnormal blood cells deposit in small vessels. B. Bone marrow expands. C. Lymph nodes expand. D. Abnormal blood cells crystalize.

B. Bone marrow expands. In acute myeloid leukemia, bone pain is caused when the bone marrow expands.

You are caring for a 13-year-old diagnosed with sickle cell anemia. The client asks you what they can do to help prevent sickle cell crisis. What would be an appropriate answer to this client? A. Avoid any sports that tire you out. B. Drink at least 8 glasses of water every day. C. Avoid any activity that makes you short of breath. D. Stay on oxygen therapy 24/7.

B. Drink at least 8 glasses of water every day. During the physical examination, observe the client's appearance, looking for evidence of dehydration, which may have triggered a sickle cell crisis. Clients are taught moderation, not avoidance of activities. Most clients with sickle cell disease are not on oxygen therapy 24/7.

A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia? A. Nights sweats, weight loss, and diarrhea B. Dyspnea, tachycardia, and pallor C. Nausea, vomiting, and anorexia D. Itching, rash, and jaundice

B. Dyspnea, tachycardia, and pallor Signs of iron deficiency anemia include dyspnea, tachycardia, and pallor, as well as fatigue, listlessness, irritability, and headache. Night sweats, weight loss, and diarrhea may signal acquired immunodeficiency syndrome. Nausea, vomiting, and anorexia may be signs of hepatitis B. Itching, rash, and jaundice may result from an allergic or hemolytic reaction.

A client with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this client? A. GM-CSF B. Erythropoietin C. Eltrombopag D. Thrombopoietin

B. Erythropoietin Erythropoietin (epoetin alfa [Epogen, Procrit]) is an effective alternative treatment for clients with chronic anemia secondary to diminished levels of erythropoietin, as in chronic renal disease. This medication stimulates erythropoiesis.

A client with a diagnosis of pernicious anemia comes to the clinic reporting of numbness and tingling in his arms and legs. What do these symptoms indicate? A. Loss of vibratory and position senses B. Neurologic involvement C. Severity of the disease D. Insufficient intake of dietary nutrients

B. Neurologic involvement In clients with pernicious anemia, numbness and tingling in the arms and legs and ataxia are the most common signs of neurologic involvement. Some affected clients lose vibratory and position senses. Jaundice, irritability, confusion, and depression are present when the disease is severe. Insufficient intake of dietary nutrients is not indicated by these symptoms

A client with multiple myeloma presents to the emergency department and reports excessive thirst and constipation. Family members report that the client has been confused for the last day. Which laboratory value is most likely responsible for this client's symptoms? A. Platelet count 300,000/mm3 B. Serum calcium level 13.8 mg/dl C. Serum sodium level of 133 mEq/L D. Hemoglobin of 9.8 g/dl

B. Serum calcium level 13.8 mg/dl Excessive thirst, constipation, dehydration, confusion, and altered mental state are possible signs of hypercalcemia. Hypercalcemia is common in multiple myeloma because of the increased bone destruction. A platelet count of 300,000/mm3 is normal and wouldn't cause the client's symptoms. A sodium level of 133 mEq/L is slightly decreased but wouldn't cause confusion and excessive thirst. A hemoglobin of 9.8 g/dl level is slightly low but isn't likely responsible for the client's symptoms.

A client at the clinic has just been diagnosed with iron deficiency anemia. What would you recommend the client consume to promote the absorption of iron? A. Vitamin E B. Meat, egg yolks, oysters, and shellfish C. Rich sources of vitamin C D. Sources of vitamin B12

C. Rich sources of vitamin C Sources of vitamin C such as citrus fruits and juices, strawberries, green peppers, and tomatoes enhance the absorption of nonheme iron. To maximize nonheme iron absorption, the client should consume a rich source of vitamin C at every meal. Meat, egg yolks, oysters, and shellfish are the sources of heme iron whose absorption is influenced by body need. Vitamin E and sources of vitamin B12 do not promote the absorption of iron.

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? A. 2:00 pm B. 3:00 pm C. 4:00 pm D. 6:00 pm

C. 4:00 pm When packed red blood cells (PRBCs) or whole blood is transfused, the blood should be administered within a 4-hour period because warm room temperatures promote bacterial growth.

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia? A. Implement neutropenic precautions B. Eliminate direct contact with others who are infectious C. Apply prolonged pressure to needle sites or other sources of external bleeding D. Monitor temperature at least once per shift

C. 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.

Which blood cell type is matched correctly with its function? A. T lymphocyte: Humoral immunity B. Plasma cell: Cell-mediated immunity C. Leukocyte: Fights infection D. B lymphocyte: Secretes immunoglobulin

C. Leukocyte: Fights infection Various blood cell types have unique, major functions. Leukocytes fight infection, T lymphocytes are integral in cell-mediated immunity, plasma cells secrete immunoglobulin, and B lymphocytes are integral in humoral immunity.

Which statement best describes the function of stem cells in the bone marrow? A. They are active against hypersensitivity reactions. B. They defend against bacterial infection. C. They produce all blood cells. D. They produce antibodies against foreign antigens.

C. They produce all blood cells. All blood cells are produced from undifferentiated precursors called pluripotent stem cells in the bone marrow. Other cells produced from the pluripotent stem cells help defend against bacterial infection, produce antibodies against foreign antigens, and are active against hypersensitivity reactions.

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? A. "Avoid smoking for 1 day."' B. "Increase fluid intake for a week." C. "Eat healthy meals for a few days." D. "Avoid heavy lifting for several hours."

D. "Avoid heavy lifting for several hours." After a blood donation, the client should be instructed to avoid heavy lifting for several hours. Smoking cessation should be taught, not just one hour after a blood donation. Fluid intake should be increased for 2 days not one week. Healthy meals should be ingested for at least 2 weeks after the donation.

A patient with end-stage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia? A. Potassium level of 5.2 mEq/L B. Magnesium level of 2.5 mg/dL C. Calcium level of 9.4 mg/dL D. Creatinine level of 6 mg/100 mL

D. Creatinine level of 6 mg/100 mL The degree of anemia in patients with end-stage renal disease varies greatly; however, in general, patients do not become significantly anemic until the serum creatinine level exceeds 3 mg/100 mL.

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? A. Preparation for likely nephrectomy B. Increases the effectiveness of dialysis C. Hypervolemia D. Lack of erythropoietin

D. Lack of erythropoietin The kidneys produce erythropoietin, a hormone that stimulates red blood cell production. A lack of this hormone is the most likely reason for blood transfusion due to the acute kidney failure. There is no indication for a nephrectomy in this question. A blood transfusion will not necessarily increase the effectiveness of dialysis. Transfusing a client with hypervolemia could lead to circulatory overload.

During a routine assessment of a patient diagnosed with anemia, the nurse observes the patient's beefy red tongue. The nurse is aware that this is a sign of what kind of anemia? A. Autoimmune B. Folate deficiency C. Iron deficiency D. Megaloblastic

D. Megaloblastic A beefy, red, sore tongue is a characteristic indicator of megaloblastic anemia. The nurse should assess for other signs such as fatigue, hypotension, and tachycardia. Safety issues should also be assessed because balance, coordination, and gait are affected.

An adult client has been diagnosed with iron-deficiency anemia. What nursing diagnosis is most likely to apply to this client's health status?

Fatigue related to decreased oxygen-carrying capacity Explanation: Fatigue is the major assessment finding common to all forms of anemia. Anemia does not normally result in acute pain or fluid deficit. The client may have an increased risk of infection due to impaired immune function, but fatigue is more likely.

A nurse is caring for an asymptomatic client with acute myelogenous leukemia. The client has a total white blood cell (WBC) count of 0, a platelet count of 3,000 mm2, and a hemoglobin level of 9 mg/dl. He has a single lumen central venous catheter in place and the physician has ordered the nurse to administer imipenem cilastatin (Primaxin) 500 mg every 8 hours, transfuse 1 unit packed red blood cells (RBCs), give amphotericin B (Fungizone) 40 mg I.V. over 4 hours, and transfuse 2 pheresis units of platelets. In what order should the nurse infuse these medications and blood products?

Platelets, imipenem cilastatin, amphotericin B, packed RBCs Although the client is currently asymptomatic, a platelet count of 3,000 mm2 puts him at risk for spontaneous hemorrhage, the most immediate and serious risk he faces. A WBC count of 0 clearly indicates neutropenia; the client needs an antibiotic and antifungal therapy to prevent infection. Although the client is anemic, he's currently asymptomatic. The absence of clinical manifestations makes his need for a transfusion less urgent.

A nurse is caring for a client who is undergoing preliminary testing for a hematologic disorder. What sign or symptom most likely suggests a potential hematologic disorder?

Severe fatigue Explanation: The most common indicator of hematologic disease is extreme fatigue. This is more common than changes in LOC, infections, or anaphylaxis.

A nurse is planning nutritional teaching for a client who is experiencing fatigue due to iron deficiency anemia. Which of the following foods should the nurse recommend to the client? a. 1.5oz of raisins b. 8oz black tea c. 1 cup canned black beans d. 8oz whole milk

c. 1 cup canned black beans

A nurse remains with a client to observe for any adverse reactions after initiating a transfusion of packed RBCs. The client becomes apprehensive and tachycardic, reporting headache and low back pain. The nurse should recognize that these findings indicate which of the following transfusion reactions? a. Febrile b. Hemolytic c. Allergic d. Bacterial

c. Allergic

A nurse is planning care for a client who has idiopathic thrombocytopenic purpura (ITP). Which of the following manifestations is most appropriate for the nurse to monitor? a. Elevated WBC b. Fever c. Ecchymosis d. Fatigue

c. Ecchymosis

A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see?

hypercalcemia Calcium is released when bone is destroyed, causing hypercalcemia. Multiple myeloma doesn't affect potassium, sodium, or magnesium levels.

A client with megaloblastic anemia reports mouth and tongue soreness. What instruction will the nurse give the client regarding eating while managing the client's symptoms? A. "Eat small amounts of bland, soft foods frequently." B. "Eat larger amounts of bland, soft foods less frequently." C. "Eat cold, bland foods with a large amount of water." D. "Eat low-fiber blended foods only."

A. "Eat small amounts of bland, soft foods frequently." Because the client with megaloblastic anemia often reports mouth and tongue soreness, the nurse should instruct the client to eat small amounts of bland, soft foods frequently. The other answer choices do not factor in the client's mouth soreness or need for nutrition.

A client reports feeling tired, cold, and short of breath at times. Assessment reveals tachycardia and reduced energy. What would the nurse expect the physician to order? A. CBC B. antibiotic C. chest radiograph D. ECG

A. CBC Most clients with iron-deficiency anemia have reduced energy, feel cold all the time, and experience fatigue and dyspnea with minor physical exertion. The heart rate usually is rapid even at rest. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased. A CBC would be ordered.

A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor? A. Decreased level of erythropoietin B. Decreased total iron-binding capacity C. Increased mean corpuscular volume D. Increased reticulocyte count

A. Decreased level of erythropoietin As renal function decreases, erythropoietin, which is produced by the kidney, also decreases. Because erythropoietin is produced outside the kidney, some erythropoiesis continues, even in patients whose kidneys have been removed. However, the number of red blood cells produced is small and the degree of erythropoiesis is inadequate.

A client has been diagnosed with polycythemia vera. What is the best instruction for the nurse to give to this client? A. Take a daily multivitamin with iron supplement B. Maintain adequate blood pressure control C. Drink alcohol to decrease blood viscosity D. Bath in tepid or cool water to control itching

B. Maintain adequate blood pressure control The client with polycythemia vera needs to control blood pressure, because of the increased risk for thrombosis or hemorrhage. Iron supplements can stimulate red blood cell production. Ingestion of alcohol may cause bleeding. Bathing in cool or tepid water may control itching, but this is not as high a priority as preventing thrombosis or hemorrhage.

The nurse is caring for a client with acute myeloid leukemia (AML) with high uric acid levels. What medication does the nurse anticipate administering that will prevent crystallization of uric acid and stone formation? A. Allopurinol B. Filgrastim C. Hydroxyurea D. Asparaginase

A. Allopurinol Massive leukemic cell destruction from chemotherapy results in the release of intracellular electrolytes and fluids into the systemic circulation. Increases in uric acid levels, potassium, and phosphate are seen; this process is referred to as tumor lysis (cell destruction) syndrome. The increased uric acid and phosphorus levels make the client vulnerable to renal stone formation and renal colic, which can progress to acute renal failure. Clients require a high fluid intake, and prophylaxis with allopurinol (Zyloprim) to prevent crystallization of uric acid and subsequent stone formation.

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? A. Iron B. Calcium C. Potassium D. White blood cell count

A. Iron Therapeutic phlebotomy is the removal of a certain amount of blood under controlled conditions. A client with an elevated hematocrit from polycythemia vera can usually be managed by periodically removing 1 unit (about 500 mL) of whole blood. Over time, this process can produce iron deficiency, Therapeutic phlebotomy does not affect the calcium or potassium levels or the white blood cell count.

he nurse cares for an older adult client with unprovoked back pain and increased serum protein. Which hematologic neoplasm does the nurse suspect the client has? A. Chronic myeloid leukemia B. Multiple myeloma C. Hodgkin lymphoma D. Non-Hodgkin lymphoma

B. Multiple myeloma Any older adult with unprovoked or unexplained back pain and increased protein in the serum should be assessed for multiple myeloma. Bone pain occurs because of bone breakdown and the malignant cells of multiple myeloma increase the serum protein levels.

Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents? A. Hypochromic B. Normocytic C. Microcytic D. Hyperchromic

A. Hypochromic An RBC that has pale or lighter cellular contents is hypochromic. A normocytic RBC is normal or average in size. A microcytic RBC is smaller than normal. Hyperchromic is used to describe an RBC that has darker cellular contents.

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. Basophils B. Neutrophils C. Eosinophils D. Monocytes

B. Neutrophils Neutrophils, the most abundant type of white blood cell, are the first of the WBCs to respond to infection or inflammation. The normal value is 3,000 to 7,000/cmm (males) and 1,800 to 7,700/cmm (females).

A nurse is caring for a client with iron deficiency anemia. Which food or beverage will the nurse suggest to the client to eat or drink when taking supplemental iron? A. Milk B. Orange juice C. Leafy green vegetables D. Kidney beans

B. Orange juice Vitamin C found in orange juice improves the absorption of iron. The other answer choices are not the best for improving absorption of iron

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? A. Stroke B. Tissue infarction C. Congestive heart failure D. Pulmonary embolus

C. Congestive heart failure The symptoms exhibited by this client are indicative of congestive heart failure. Complications include hypertension, congestive heart failure, stroke, tissue and organ infarction, and hemorrhage. Stroke would present with headache, aphasia, and/or numbness in extremities. Tissue infarction would involve extremity discoloration or an organ failure. Pulmonary embolism would be associated with chest pain.

After chemotherapy for AML, what interventions will best help to prevent renal complications? Select all that apply. A. Increase hydration. B. Administer allopurinol. C. Administer rasburicase. D. Administer potassium therapy. E. Encourage exercise.

A, B, C Increased uric acid and phosphorus concentrations after chemotherapy for AML can lead to renal calculi formation. Increasing hydration and administering allopurinol (a uricosuric) will help to eliminate the uric acid. Rasburicase is an enzyme that can also decrease uric acid. Administration of potassium is not indicated, as concentrations are elevated after chemotherapy. Exercise is not initially encouraged because the client could have weakness and cramping during this time.

Which medication is the antidote to warfarin? A. Vitamin K B. Protamine sulfate C. Aspirin D. Clopidogrel

A. Vitamin K The antidote for warfarin is vitamin K. Protamine sulfate is the antidote for heparin. Aspirin and clopidogrel are both antiplatelet medications.

Which term refers to a form of white blood cell involved in immune response? A. Granulocyte B. Lymphocyte C. Spherocyte D. Thrombocyte

B. Lymphocyte Both B and T lymphocytes respond to exposure to antigens. Granulocytes include basophils, neutrophils, and eosinophils. A spherocyte is a red blood cell without central pallor, seen with hemolysis. A thrombocyte is a platelet.

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: A. Albumin. B. Globulin. C. Fibrinogen. D. Prothrombin.

A. Albumin Albumin, only produced in the liver, is essential for maintaining oncotic pressure in the vascular system. A decrease in oncotic pressure due to low albumin causes fluid to leak into the peritoneal cavity.

Which is the major function of neutrophils? A. Rejection of foreign tissue B. Phagocytosis C. Destruction of tumor cells D. Production of immunoglobulins

B. Phagocytosis Once a neutrophil is released from the marrow into the circulation, it stays there for only about 6 hours before it migrates into the body tissues to perform its function of phagocytosis (ingestion and digestion of bacteria and particles). Neutrophils die there within 1 to 2 days. T lymphocytes are responsible for rejection of foreign tissue and destruction of tumor cells. Plasma cells produce antibodies called immunoglobulins.

The nurse notes that a client with essential thrombocythemia has a headache and a platelet count of 1 million/mm3 (1 million/ ×109/L). Which additional neurologic findings will the nurse expect to assess in this client? Select all that apply. A. Diplopia B. Dizziness C. Paresthesias D. Facial paralysis E. Transient ischemic attacks

A, B, C, E Essential thrombocythemia, also called primary thrombocythemia, is a rare, chronic, Philadelphia chromosome-negative myeloproliferative disorder characterized by an increased production of megakaryocytes. A marked increase in platelet production occurs. One of the most common neurologic symptoms of essential thrombocythemia is headaches. Other neurological manifestations that may be related to compromised blood flow include diplopia, dizziness, paresthesias, and transient ischemic attacks. Facial paralysis is not a symptom of essential thrombocytopenia.

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? A. "I will eat a spinach salad with lunch and dinner." B. "I will eat a meat source such as chicken or pork with each meal." C. "I will increase my daily intake of orange vegetables such as sweet potatoes and carrots." D. "I will eat more dairy products such as milk, yogurt, and ice cream every day."

B. "I will eat a meat source such as chicken or pork with each meal." Vitamin B12 is found only in foods of animal origin. The other choices do not include meats. Dairy products contain large amounts of Calcium and vitamin D. Orange vegetables contain large amounts of vitamin A.

A pregnant woman is hospitalized as the result of sickle-cell crisis. Which finding indicates the outcome has been achieved for this client? A. Reports joint pain less than 3 on a scale of 0 to 10 B. Takes hydroxyurea during her pregnancy C. Exhibits a temperature more than 100.3°F D. Describes the importance of staying cool

A. Reports joint pain less than 3 on a scale of 0 to 10 An expected outcome for a client experiencing a sickle-cell crisis is control and reduction of pain. Hydroxyurea is contraindicated in pregnancy because of the risk it poses for congenital abnormalities. An indication that the client is free from infection is exhibiting a normal temperature; 100.3°F is an elevated temperature. To minimize crises, the client needs to stay warm not cool.

Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia? A. Have the client use a soft toothbrush and electric razor, avoid using enemas, and watch for signs of bleeding. B. Put on a mask, gown, and gloves when entering the client's room. C. Provide a clear liquid, low-sodium diet. D. Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing.

D. Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing. Neutropenia occurs when the absolute neutrophil count falls below 1,000/mm3, reflecting a severe risk of infection. The nurse should provide a low-bacterial diet, which means eliminating fresh fruits and vegetables, avoiding invasive procedures such as enemas, and practicing frequent hand washing. Using a soft toothbrush, avoiding straight-edged razors and enemas, and monitoring for bleeding are precautions for clients with thrombocytopenia. Putting on a mask, gown, and gloves when entering the client's room are reverse isolation measures. A neutropenic client doesn't need a clear liquid diet or sodium restrictions.

Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils? A. Phagocytosis B. Rejection of foreign tissue C. Destruction of tumor cells D. Production of antibodies called immunoglobulin (Ig)

A. Phagocytosis The major function of neutrophils is phagocytosis. T lymphocytes are responsible for rejection of foreign tissue and destruction of tumor cells. Plasma cells produce antibodies call immunoglobulin.

The nurse expects which assessment finding when caring for a client with a decreased hemoglobin level? A. Bright red venous blood. B. Elevated temperature. C. Decreased oxygen level. D. Increased bruising.

C. Decreased oxygen level. Hemoglobin carries oxygen; a decreased hemoglobin level results in decreased oxygen. An elevated temperature is a sign of infection and can result from decreased white blood cells. Arterial blood is more oxygen saturated and brighter red in color than venous blood. Increased bruising results from a decreased platelet level, not decreased hemoglobin.

The nurse is discussing disorders of the hematopoietic system when a client asked about erythrocytosis. What disease will the nurse mention with a primary characteristic of erythrocytosis? A. polycythemia vera B. sickle cell disease C. aplastic anemia D. pernicious anemia

A. polycythemia vera Polycythemia vera is associated with a rapid proliferation of blood cells produced by the bone marrow. In sickle cell disease, HbS causes RBCs to assume a sickled shape under hypoxic conditions. Aplastic anemia has a deficiency of erythrocytes. Sickle cell disease and the anemias do not have the characteristics of erythrocytosis.

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? A. The dead red blood cells release excess uric acid. B. The dead red blood cells occlude the small vessels in the joints. C. Excess red blood cells produce extracellular toxins that build up. D. Excess red blood cells cause vascular injury in the joints.

A. The dead red blood cells release excess uric acid. 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.

The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care? A. "Treatment is simple and consists of single-drug therapy." B. "Intrathecal chemotherapy is used primarily as preventive therapy." C. "The goal of therapy is palliation." D. "Side effects are rare with therapy."

B. "Intrathecal chemotherapy is used primarily as preventive therapy." Intrathecal chemotherapy is a key part of the treatment plan to prevent invasion of the central nervous system. The therapy uses multiple drugs, with many side effects. The goal of therapy is remission.

The nurse is assisting the client with multiple myeloma to ambulate. What is the most important nursing intervention to help prevent fractures in the client? A. Increase mobility. B. Provide adequate hydration. C. Promote safety. D. Encourage adequate nutrition.

C. Promote safety. Safety is paramount because any injury, no matter how slight, can result in a fracture. Mobility, hydration, and nutrition are important, but will not prevent fractures.

Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)? A. A 24-year-old female taking oral contraceptives B. A 40-year-old patient with a history of hypertension C. A 52-year-old patient with acute kidney injury D. A 72-year-old patient with a history of cancer

D. A 72-year-old patient with a history of cancer Primary MDS tends to be a disease of people older than 70 years. Because the initial findings are so subtle, the disease may not be diagnosed until later in the illness trajectory, if at all. Thus, the actual incidence of MDS is not known.

A client who is undergoing chemotherapy for AML reports pain in the low back. What is the nurse's first action? A. Refer the client to a chiropractor. B. Place heating pads on the client's back. C. Administer pain medication, as ordered. D. Assess renal function.

D. Assess renal function. Chemotherapy results in the destruction of cells and tumor lysis syndrome. Uric acid and phosphorus concentrations increase, and the client is susceptible to renal failure. The nurse should assess renal function if the client complains of low-back pain, as this could be indicative of kidney stone formation. Heating pads, pain medication, and referrals could be instituted once the cause of the pain is determined. The priority is further assessment to rule out important problems.

A client is seen in the emergency department with severe pain related to a sickle cell crisis. What does the nurse understand is occurring with this client? A. The client has a decreased tolerance of pain related to the chronic nature of the illness. B. Bone marrow decreases the erythrocyte production causing decrease in hypoxia. C. Overhydration enlarges the red blood cells. D. Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.

D. Vascular occlusion in small vessels decreasing blood and oxygen to the tissues. The person with sickle cell disease repeatedly suffers from two major problems: (1) episodes of sickle cell crisis from vascular occlusion, which develops rapidly under hypoxic conditions, and (2) chronic hemolytic anemia. During a sickle cell crisis, the sickle-shaped cells lodge in small blood vessels, where they block the flow of blood and oxygen to the affected tissue. The vascular occlusion induces severe pain in the ischemic tissue. The client may have increased tolerance for pain due to the chronic nature of the illness. Bone marrow increases the erythrocyte production. Underhydration increases the client's risk of developing a vaso-occlusive crisis.

A client is being tested for acute myeloid leukemia (AML). The nurse knows that which diagnostic test will be used as the hallmark for the diagnosis? A. Clotting factors B. Bone marrow analysis C. Complete blood count D. Alkaline phosphatase level

B. Bone marrow analysis To confirm the diagnosis of AML, laboratory studies need to be performed. A bone marrow analysis shows an excess or more than 20% of blast cells which is the hallmark of the diagnosis. Clotting factors are not used to diagnose AML. The complete blood count (CBC) commonly shows a decrease in both erythrocytes and platelets but is not as specific as the bone marrow analysis. The alkaline phosphatase level measures a liver enzyme.

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? A. WBC count of 4,200 cells/uL B. Hematocrit of 38% C. Platelet count of 9,000/mm3 D. Creatinine level of 1.0 mg/dL

C. Platelet count of 9,000/mm3 Complications of AML include bleeding and infection, which are the major causes of death. The risk of bleeding correlates with the level and duration of platelet deficiency (thrombocytopenia). The low platelet count can cause ecchymoses (bruises) and petechiae. Major hemorrhages also may develop when the platelet count drops to less than 10,000/mm3.

A client was admitted to the hospital with a pathologic pelvic fracture. The client informs the nurse that he has been having a strange pain in the pelvic area for a couple of weeks that was getting worse with activity prior to the fracture. What does the nurse suspect may be occurring based on these symptoms? A. Hemolytic anemia B. Polycythemia vera C. Leukemia D. Multiple myeloma

D. Multiple myeloma The first symptom usually is vague pain in the pelvis, spine, or ribs. As the disease progresses, the pain becomes more severe and localized. The pain intensifies with activity and is relieved by rest. When tumors replace bone marrow, pathologic fractures develop. Hemolytic anemia does not result in pathologic fractures nor does polycythemia vera or leukemia.

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? A. Monocytes B. B lymphocytes C. Leukocytes D. T lymphocytes

D. T lymphocytes Lymphocytes (T cells, B cells, and natural killer cells) are WBCs that are the major components of the body's immune response. T cells are primarily responsible for cell-mediated immunity, whereas B cells are involved in antibody production.

Clients with multiple myeloma have abnormal plasma cells that proliferate in the bone marrow where they release osteoclast-activating factor, resulting in the formation of osteoclasts. What is the most common complication of the pathology resulting from this process? A. Pathologic fractures B. Osteoporosis C. Calcified bones D. Increased mobility

A. Pathologic fractures Osteoclasts are cells that break down and remove bone cells, which results in increased blood calcium and pathologic fractures.

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? A. Polycythemia B. Vitamin B12 deficiency C. Thrombocytopenia D. Hemochromatosis

D. Hemochromatosis Hemochromatosis is an autosomal recessive disease of excessive iron absorption. This results in bronze or gray-tan skin, especially over scars. The other answer choices are hematological conditions; however, these do not cause the skin to turn a gray-tan color.

What food should the nurse recommend for a client diagnosed with vitamin B12 deficiency? A. Whole-grain bread B. Citrus fruit C. Green vegetables D. Lean meat

D. Lean meat Vitamin B12 is only found in foods of animal origin. Therefore, whole-grain bread, green vegetables, and citrus fruit do not contain this vitamin.

The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly? A. Crackles auscultated bilaterally B. Respiratory rate of 10 breaths/minute C. Oral temperature of 97°F D. Pain and tenderness in calf area

A. Crackles auscultated bilaterally Increasing the flow rate of a blood transfusion too rapidly can result in circulatory overload. Fluid overload can be manifested by crackles in the lungs. A decreased respiratory rate and decreased temperature are not manifestations of fluid overload. Pain and tenderness in the calf area may indicate a thrombosis which is not as common a manifestation as fluid overload.

Which type of lymphocyte is responsible for cellular immunity? A. B lymphocyte B. Plasma cell C. T lymphocyte D. Basophil

C. T lymphocyte T lymphocytes are responsible for delayed allergic reactions, rejection of foreign tissue (e.g., transplanted organs), and destruction of tumor cells. This process is known as cellular immunity. B lymphocytes are responsible for humoral immunity. A plasma cell secretes immunoglobulin. A basophil contains histamine and is an integral part of hypersensitivity reactions.

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? A. Use an electric razor when assisting client with shaving. B. Elevate the client's head of the bed. C. Where a mask when entering the client's room. D. Apply supplemental oxygen to maintain the client's oxygenation.

A. Use an electric razor when assisting client with shaving. Petechiae are associated with severe thrombocytopenia, placing the client at risk for bleeding. The nurse should use an electric razor when assisting the client with shaving. Elevating the head of the bed and applying supplemental oxygen would be appropriate for a client with decreased oxygenation. Wearing a mask when entering the client's room would be appropriate for a client with neutropenia, not thrombocytopenia.

The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? A. Osteopathic tumors destroy bone causing fractures. B. Osteoclasts break down bone cells so pathologic fractures occur. C. Osteolytic activating factor weakens bones producing fractures. D. Osteosarcomas form producing pathologic fractures.

B. Osteoclasts break down bone cells so pathologic fractures occur. The abnormal plasma cells proliferate in the bone marrow, where they release osteoclast-activating factor. This, in turn, causes osteoclasts to break down bone cells, resulting in increased blood calcium and pathologic fractures. The plasma cells also form single or multiple osteolytic (bone-destroying) tumors that produce a "punched-out" or "honeycombed" appearance in bones such as the spine, ribs, skull, pelvis, femurs, clavicles, and scapulae. Weakened vertebrae lead to compression of the spine accompanied by significant pain. The other options are distractors for this question.

A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the health care provider immediately because the client probably is experiencing which problem? A. A hemolytic reaction to mismatched blood B. A hemolytic reaction to Rh-incompatible blood C. A hemolytic allergic reaction caused by an antigen reaction D. A hemolytic reaction caused by bacterial contamination of donor blood

C. A hemolytic allergic reaction caused by an antigen reaction Hemolytic allergic reactions are fairly common and may cause chills, fever, urticaria, tachycardia, dyspnea, chest pain, hypotension, and other signs of anaphylaxis a few minutes after blood transfusion begins. Although rare, a hemolytic reaction to mismatched blood can occur, triggering a more severe reaction and, possibly, leading to disseminated intravascular coagulation. A hemolytic reaction to Rh-incompatible blood is less severe and occurs several days to 2 weeks after the transfusion. Bacterial contamination of donor blood causes a high fever, nausea, vomiting, diarrhea, abdominal cramps and, possibly, shock.

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 Iron overload is a complication unique to people who have had long-term PRBC transfusion. Over time, the excess iron deposits in body tissues can cause organ damage, particularly in the liver, heart, testes, and pancreas.

The nurse is assessing a client admitted with a deep vein thrombosis with an elevated red blood cell count. The admitting diagnosis is polycythemia vera. What is the hallmark clinical sign of PV? A. splenomegaly B. weight gain C. peripheral edema D. pale body color

A. splenomegaly Splenomegaly is the hallmark of PV. Patients typically have a ruddy complexion and splenomegaly. Symptoms result from increased blood volume (headache, dizziness, tinnitus, fatigue, weight loss, paresthesias, and blurred vision). Edema, pale body color, and weight gain are not classic symptoms of PV.

A patient will need a blood transfusion for the replacement of blood loss from the gastrointestinal tract. The patient states, "That stuff isn't safe!" What is the best response from the nurse? A. "I agree that you should be concerned with the safety of the blood, but it is important that you have this transfusion." B. "The blood is carefully screened, so there is no possibility of you contracting any illness or disease from the blood." C. "I understand your concern. The blood is carefully screened but is not completely risk free." D. "You will have to decide if refusing the blood transfusion is worth the risk to your health."

C. "I understand your concern. The blood is carefully screened but is not completely risk free." Despite advances in donor screening and blood testing, certain diseases can still be transmitted by transfusion of blood components

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. Place the client in a recumbent position with legs elevated. B. Remove the intravenous line. C. Ensure there is an oxygen delivery device at the bedside. D. Administer prescribed PRN anti-anxiety agent.

C. Ensure there is an oxygen delivery device at the bedside The client is exhibiting signs of circulatory overload. After stopping the transfusion and notifying the healthcare provider, the nurse should place the client in a more upright position with the legs dependent to decrease workload on the heart. The IV line is kept patent in case emergency medications are needed. Oxygen and morphine may be needed to treat severe dyspnea. Administering an anti-anxiety agent is not a priority action over ensuring oxygen is available.

The hospitalized client is experiencing gastrointestinal bleeding with a platelets at 9,000/mm³. The client is receiving prednisone and azathioprine. What action will the nurse take? A. Use contact precautions with this client. B. Perform a neurologic assessment with vital signs. C. Request a prescription of diphenoxylate and atropine for loose stools. D. Teach the client to vigorously floss the teeth to prevent infections.

B. Perform a neurologic assessment with vital signs. With platelets less than 10,000/mm³ there is a risk for spontaneous bleeding, including within the cranial vault. The nurse performs a neurologic examination to assess for this possibility. Though the client is receiving immunosuppressants, it is not necessary to use contact precautions with this client. Contact precautions are used with clients who have known or suspected transmittable illnesses. Diphenoxylate and atropine can cause constipation and inhibit accurate assessment of the client's gastrointestinal bleeding. If the client strains when having a bowel movement, the client could bleed even more. The client is not to floss vigorously; doing so can cause bleeding.

A client with multiple myeloma reports severe paresthesia in the feet. When planning care for the client, which priority nursing diagnosis will the nurse choose? A. Acute pain B. Risk for falls C. Impaired tissue integrity D. Sensory-perception disturbance

B. Risk for falls A client with paresthesia in the feet is at risk for falls due to impaired sensation. Acute pain, impaired tissue integrity, and sensory-perception disturbance are all nursing diagnoses that are appropriate for the client; however, risk for falls is priority.

For a client with Hodgkin lymphoma, who is at a risk for ineffective airway clearance and impaired gas exchange, the nurse places the client in a high Fowler's position to A. reduce deficits in the blood oxygen concentration. B. detect compromised ventilation. C. increase lung expansion. D. anticipate the need for airway management.

C. increase lung expansion. For a client with Hodgkin disease who is at a risk for ineffective airway clearance and impaired gas exchange, the nurse keeps the neck in the midline and places the client in a high Fowler's position if respiratory distress develops. Avoiding unnecessary pressure on the trachea and positioning for increased lung expansion improve air exchange. The nurse administers oxygen, per the physician's orders, to reduce deficits in the blood oxygen concentration. The nurse assesses the client's respiratory status during each shift to detect compromised ventilation. The nurse places an endotracheal tube, a laryngoscope, and a bag-valve mask at the bedside for intubation if the need for the airway management arises.

A client who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action? A. Ask the client whether they have recently fallen. B. Evaluate the client's INR. C. Keep the client on bed rest. D. Evaluate the client's platelet count.

D. Evaluate the client's platelet count. Complications of AML include bleeding. The risk of bleeding correlates with the level and duration of platelet deficiency. Major hemorrhages may develop when the platelet count drops to less than 10,000/mm3. The bleeding is usually unrelated to falling. Keeping the client on bed rest will not prevent bleeding when the client has a low platelet count. Assessment for other areas of bleeding is also a priority intervention.

A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever? A. Pancytopenia B. Thrombocytopenia C. Anemia D. Neutropenia

D. Neutropenia Fever and infection result from a decrease in neutrophils (neutropenia). Decreased red blood cells (anemia) cause weakness, fatigue, dyspnea on exertion, and pallor in AML. Pancytopenia, an overall decrease in all blood components, is not cause of fever in clients with AML. Decreased platelet count (thrombocytopenia) causes petechiae and bruising in AML.

The nurse suspects that a client has multiple myeloma based on the client's major presenting symptom and the analysis of laboratory results. What classic symptom for multiple myeloma does the nurse assess for? A. Debilitating fatigue B. Bone pain in the back of the ribs C. Gradual muscle paralysis D. Severe thrombocytopenia

B. Bone pain in the back of the ribs Although patients can have asymptomatic bone involvement, the most common presenting symptom of multiple myeloma is bone pain, usually in the back or ribs. Unlike arthritic pain, the bone pain associated with myeloma increases with movement and decreases with rest; clients may report that they have less pain on awakening but the pain intensity increases during the day.

A client is awaiting test results to diagnose Hodgkin lymphoma. The nurse knows that which result is the hallmark for the diagnosis of this condition? A. Increased basophils B. Reed-Sternberg cells C. Elevated platelet count D. Misshaped red blood cells

B. Reed-Sternberg cells The malignant cell of Hodgkin lymphoma is the Reed-Sternberg cell, a gigantic tumor cell that is morphologically unique and thought to be of immature lymphoid origin. These cells arise from the B lymphocyte. They may have more than one nucleus and often have an owl-like appearance. The presence of Reed-Sternberg cells is the pathologic hallmark and essential diagnostic criterion. Basophils, platelets, or red blood cells are not used to diagnose Hodgkin lymphoma.

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called A. blast cells. B. megaloblasts. C. mast cells. D. monocytes.

B. megaloblasts. Megaloblasts are abnormally large erythrocytes. Blast cells are primitive WBCs. Mast cells are cells found in connective tissue involved in defense of the body and coagulation. Monocytes are large WBCs that become macrophages when they leave the circulation and move into body tissues.

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? A. "The condition is likely caused by a folate deficiency." B. "The condition causes abnormally small red blood cells." C. "The condition is likely caused by a vitamin B12 deficiency." D. "The condition causes abnormally rigid red blood cells."

C. "The condition is likely caused by a vitamin B12 deficiency." Vitamin B12 combines with intrinsic factor produced in the stomach. The vitamin B12 -intrinsic factor complex is absorbed in the distal ileum. Clients who have had a partial or total gastrectomy may have limited amounts of intrinsic factor, and the absorption of vitamin B12 may be diminished. Megaloblastic anemia may be caused by a folate deficiency; however, the client's history of gastrectomy indicates the likely cause is a vitamin B12 deficiency. Megaloblastic anemia causes large erythrocytes (RBCs), not small or rigid.

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? A. The client is having an allergic reaction to the blood. B. The client is experiencing vascular collapse. C. The client is having decrease in tissue perfusion from a shock state. D. The client is having a febrile nonhemolytic reaction.

D. The client is having a febrile nonhemolytic reaction The signs and symptoms of a febrile nonhemolytic transfusion reaction are chills (minimal to severe) followed by fever (more than 1°C elevation). The fever typically begins within 2 hours after the transfusion is begun. Although the reaction is not life threatening, the fever, and particularly the chills and muscle stiffness, can be frightening to the client.

A client is returning home after having a bone marrow aspiration and biopsy. Which statement indicates that teaching by the nurse has been effective? A. "I can resume my normal activities." B. "The area might ache for 1 to 2 days." C. "I should take aspirin if I have any pain." D. "I can go to the gym to lift weights later."

B. "The area might ache for 1 to 2 days." Potential complications of either bone marrow aspiration or biopsy include bleeding and infection. After the marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing. Most clients have no discomfort after a bone marrow aspiration, but the site of a biopsy may ache for 1 or 2 days. The client should be instructed to perform no rigorous activity for 1 to 2 days. Aspirin-containing analgesics should be avoided immediately after the procedure as this might cause or aggravate bleeding. Rigorous exercise should be avoided for 1 to 2 days.

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? A. The kidneys sense low oxygen levels in the blood and produce erythropoietin, stimulating the bone marrow to produce more red blood cells. B. The bone marrow is stimulated by low oxygen levels in the blood to produce erythropoietin, maturing the red blood cells. C. The brain senses low oxygen levels in the blood and produces hemoglobin, which binds to more red blood cells. D. The kidneys sense low oxygen levels in the blood and produce hemoglobin, stimulating the marrow to produce more red blood cells.

A. The kidneys sense low oxygen levels in the blood and produce erythropoietin, stimulating the bone marrow to produce more red blood cells. If normally functioning kidneys detect low levels of blood oxygen, they produce more of the hormone erythropoietin (EPO). As EPO levels increase, the bone marrow responds by producing more erythrocytes (red blood cells). EPO is not made by the bone marrow. Hemoglobin, an iron-rich protein that allows erythrocytes to transport oxygen, is synthesized in the erythrocytes as they mature.

The nurse is administering packed red blood cell (RBC) transfusions for a patient with myelodysplastic syndrome (MDS). The patient has had several transfusions and is likely to receive several more. What is a priority for the nurse to monitor related to the transfusions? A. Creatinine and blood urea nitrogen (BUN) levels B. Iron levels C. Magnesium levels D. Potassium levels

B. Iron levels For most patients with MDS, transfusions of RBCs may be required to control the anemia and its symptoms. These patients can develop iron overload from the repeated transfusions; this risk can be diminished with prompt initiation of chelation therapy (see following Nursing Management section).

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. Decreased level of erythropoietin B. Decreased total iron-binding capacity C. Increased mean corpuscular volume D. Increased reticulocyte count

A. Decreased level of erythropoietin Differentiation of the primitive myeloid stem cell into an erythroblast is stimulated by erythropoietin, a hormone produced primarily by the kidney. If the kidney detects low levels of oxygen, as occurs when fewer red cells are available to bind oxygen (i.e., anemia), or with people living at high altitudes with lower atmospheric oxygen concentrations, erythropoietin levels increase. The increased erythropoietin then stimulates the marrow to increase production of erythrocytes. The entire process of erythropoiesis typically takes 5 days (Cook, Ineck, & Lyons, 2011). For normal erythrocyte production, the bone marrow also requires iron, vitamin B12, folate, pyridoxine (vitamin B6), protein, and other factors. A deficiency of these factors during erythropoiesis can result in decreased red cell production and anemia.

A client with leukemia has developed a cough and increased fatigue. What is the primary nursing intervention? A. Evaluate the client for potential infection. B. Administer an antitussive. C. Place a cooling blanket on the client. D. Medicate the client to relieve pain.

A. Evaluate the client for potential infection The client with leukemia has a lack of mature and normal granulocytes to fight infection. For this reason, the client is susceptible to infection. The primary nursing intervention is to evaluate for potential infection if the client has a cough and increased fatigue. Administering an antitussive would not be appropriate before determining the cause of the cough. A cooling blanket would not be needed if the client does not have a fever. Medicating the client to relieve pain would come after the assessment phase.

A nurse is completing a detailed health history and assessment in the electronic medical record (EMR) for a client with a disorder of the hematopoietic system. Which symptom is the most commonly reported in association with hematologic diseases? A. Extreme fatigue B. Severe headaches C. Dyspnea D. Blurred vision

A. Extreme fatigue When assessing a client with a disorder of the hematopoietic system, it is essential to assess for the most common symptom in hematologic diseases, which is extreme fatigue.

When assessing a female client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential? A. Health history, such as bleeding, fatigue, or fainting B. Menstrual history C. Age and gender D. Lifestyle assessments, such as exercise routines

A. Health history, such as bleeding, fatigue, or fainting When assessing a client with a disorder of the hematopoietic or the lymphatic system, it is essential to assess the client's health history. An assessment of drug history is essential because some antibiotics and cancer drugs contribute to hematopoietic dysfunction. Aspirin and anticoagulants may contribute to bleeding and interfere with clot formation. Because industrial materials, environmental toxins, and household products may affect blood-forming organs, the nurse needs to explore exposure to these agents. Age, gender, menstrual history, or lifestyle assessments, such as exercise routines and habits, do not directly affect the hematopoietic or lymphatic system.

When assessing a client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential? A. Health history, such as bleeding, fatigue, or fainting B. Menstrual history C. Age and gender D. Lifestyle assessments, such as exercise routines

A. Health history, such as bleeding, fatigue, or fainting When assessing a client with a disorder of the hematopoietic or the lymphatic system, it is essential to assess the client's health history. An assessment of drug history is essential because some antibiotics and cancer drugs contribute to hematopoietic dysfunction. Aspirin and anticoagulants may contribute to bleeding and interfere with clot formation. Because industrial materials, environmental toxins, and household products may affect blood-forming organs, the nurse needs to explore exposure to these agents. Menstrual history, age, gender, and lifestyle assessments, such as exercise routines and habits, do not directly affect the hematopoietic or lymphatic system.

Which term refers to the percentage of blood volume that consists of erythrocytes? A. Hematocrit B. Differentiation C. Erythrocyte sedimentation rate (ESR) D. Hemoglobin

A. Hematocrit Hematocrit is the percentage of blood volume consisting of erythrocytes. Differentiation is development of functions and characteristics that differ from those of the parent stem cell. ESR is a laboratory test that measures the rate of settling of RBCs; an elevated rate is indicative of inflammation. Hemoglobin is the iron-containing protein of RBCs.

A client with chronic lymphocytic leukemia (CLL) wants to have treatment for the condition. Which medication will the nurse question for this client? A. Heparin B. Ipilimumab C. Dexamethasone D. Vincristine

A. Heparin Commonly prescribed pharmacological therapies for chronic lymphocytic leukemia (CLL) include immunotherapy agents (ipilimumab), corticosteroids (dexamethasone), and chemotherapeutic agents (vincristine). Clients with CLL are at risk of bleeding, and therefore the use of anticoagulants (heparin) is contraindicated.

A client with severe anemia reports symptoms of tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Laboratory test results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which nursing diagnoses is most appropriate for this client? A. Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit B. Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients C. Risk for falls related to complaints of dizziness D. Fatigue related to decreased hemoglobin and hematocrit

A. Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit The symptoms indicate impaired tissue perfusion due to a decrease in the oxygen-carrying capacity of the blood. Cardiac status should be carefully assessed. When the hemoglobin level is low, the heart attempts to compensate by pumping faster and harder in an effort to deliver more blood to hypoxic tissue. This increased cardiac workload can result in such symptoms as tachycardia, palpitations, dyspnea, dizziness, orthopnea, and exertional dyspnea. Heart failure may eventually develop, as evidenced by an enlarged heart (cardiomegaly) and liver (hepatomegaly) and by peripheral edema.

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? A. Verify the client's identity according to hospital policy B. Administer the blood as soon as it arrives C. Premedicate the client with acetaminophen D. Assess the client 30 minutes after the start of the initial transfusion

A. Verify the client's identity according to hospital policy Acute hemolytic transfusion reactions are preventable. Improper identification is responsible for the majority of hemolytic transfusion reactions. Meticulous attention to detail in labeling blood samples and blood components and accurately identifying the recipient cannot be overemphasized. It is the nurse's responsibility to ensure that the correct blood component is transfused to the correct client. The nurse must assess the client during the initial start of the transfusion and frequently, if the nurses delays the assessment time for 30 minutes the client may have begun to experience acute hemolytic transfusion reaction, this puts the client's safety at risk.

A nurse is providing teaching to a client who will undergo chemotherapy and radiation prior to hematopoietic stem cell transplantation (HSCT) for acute myeloid leukemia (AML). What statement will the nurse use to describe the purpose of the chemotherapy and radiation? A. "These therapies shrink your tumor to ensure the stem cell transplant is more effective." B. "These therapies destroy the ability of your body to produce blood cells inside your bone marrow." C. "These therapies destroy the bone marrow in an effort to shrink it and decrease your pain." D. "These therapies decrease your immune system to decrease the risk of allergic reaction."

B. "These therapies destroy the ability of your body to produce blood cells inside your bone marrow." The treatment goal of chemotherapy and radiation therapy is the destruction of hematopoietic function of the client's bone marrow. The client is then "rescued" with the infusion of the donor stem cells to reinitiate blood cell production. AML is a cancer of the blood and does not have a mass effect/tumor that other cancers may cause. Also, these therapies are not used to decrease a client's pain or to decrease the risk of allergic reaction.