Surg 2 Test 1

Using a penlight and tongue blade, the nurse inspects the client's tonsils for size and appearance. Tonsils are present and extend medially toward the uvula. How should the nurse grade these findings?

2

Which client is not a candidate to be a blood donor according to the American Red Cross?

26-year-old female with hemoglobin 11.0 g/dL

Using a penlight and tongue blade, the nurse inspects the client's tonsils for size and appearance. Tonsils are present and touch the uvula. How should the nurse grade these findings?

3

An instructor asks students approximately how long platelets last? What would the students correctly identify?

7.5 days

Plasma

90% water, 10% protein

A nurse has participated in organizing a blood donation drive at a local community center. Which client would most likely be disallowed from donating blood?

A client whose blood pressure is 78/49 mm Hg

Blood Groups

A, B, AB, O

A 66-year-old man underwent a successful partial gastrectomy for the treatment of stomach cancer 3 years ago. The man had a scheduled follow-up appointment with his primary caregiver and had blood work completed. The results of the man's blood work indicated anemia. The nurse who is contributing to the patient's care should recognize that this patient's anemia may be attributable to what factor?

Decreased vitamin B12 absorption

A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse know is the most likely clinical disorder the patient is being treated for?

Essential thrombocythemia

Lymph node biopsy/node dissection

Examining for presence of abnormal cells Local vs general anesthesia Lymphedema can be a complication

A client has a leukocyte count of 13,000/mm3. How would the nurse document the client's condition?

Leukocytosis

increased number of leukocytes

Leukocytosis

Other Transfusion Complications

Moderate Chilling Circulatory Overload HypocalcemiaHIV and Hepatitis B virus Transmission

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

Which term is used to refer to a primitive cell that is capable of self-replication and differentiation?

Stem Cell

Bone Marrow Aspiration

Sternum or iliac crest Local anesthesia Preop considerations Consent Nursing Responsibilities

Splenectomy

Surgical removal of the spleenPostoperative concerns/complications

Leukopenia

decreased number of leukocytes

Hematopoiesis

manufacture and development of blood cells

Red Marrow

manufactures blood cells and hemoglobin

Yellow Marrow

manufactures blood cells under intense stimulation

lymphatic system

maturation of lymphocytes

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

may be developing an infection.

Pluripotential stem cells

myeloid and lymphoid stem cells

Granulocytes

neutrophils, eosinophils, basophils

Platelets

thrombocytes

Structures in hematopoietic system

Bone marrow Blood Lymphatic system

Basophils

active in allergic reactions

Plasma Proteins

albumins, globulins, fibrinogen

Platelet life span

approximately 7.5 days; produced in red bone marrow

Plasma

blood cells, protein, clotting factors, vitamins, glucose, lipids, electrolytes, minerals, enzymes, and hormones

erythropoietin

hormone released by kidney

Erythroblasts

immature erythrocytes

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following?

liver

Lymph nodes

lymphatic system consists of vessels that drain tissue fluid (lymph

Agranulocytes

lymphocytes and monocytes

Lymph fluid

passes through the node—macrophages attack and engulf substances

Bone marrow

soft tissue fills spaces in interior of long and spongy bones

Erythrocytes

transport O2 and remove CO2 from the tissues

Plasma proteins

transport protein

A nurse in the ED is caring for a trauma client following a motor vehicle accident. The client's blood donor card indicates type AB blood. People with type AB blood are:

universal recipients.

Antigen

present or not present

Globulins

prevent and modify infections

Neutrophils

primary component of inflammatory response

Thymus gland

produces lymphocytes during fetal development

Erythropoiesis

production of erythrocytes; regulated by erythropoietin—hormone released by kidney

A client has an increased number of eosinophils. Which of the following disorders would the nurse expect the client to have?

Allergy

Transfusion Reactions

Incompatibility reaction Febrile Reaction Septic Reaction Allergic Reaction

Lymphatics

circulates interstitial fluid and carries it to the veins; filters and destroys pathogens and removes other harmful substances.

White blood cells and their function

engulf invading microorganisms and cellular debris and manufactures antibodies normal level is 5,000 to 10,000

Fibrogen

forming blood clots

Albumin

helps maintain osmotic pressure

types of Bone Marrow

red marrow and yellow marrow

Bilirubin

residual pigment from destroyed erythrocytes

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 eat a meat source such as chicken or pork with each meal."

A client has been scheduled for a bone marrow aspiration and admits to the nurse being worried about the pain involved with the procedure. Which statement by the nurse when providing client education would be most accurate?

"Most people feel some brief, sharp pain when the marrow is aspirated."

A patient with a recent history of hematologic abnormalities has been scheduled for a bone marrow biopsy. The patient has expressed to the nurse, "That sounds like an incredibly painful experience." How should the nurse best respond to this patient's concern?

"There is some pressure and pain when the doctor removes the marrow, but this should only be short-lasting."

Blood and Blood Products

Albumin Packed red blood cells (PRBC) Platelets Fresh frozen plasma (FFP) Cryoprecipitate

Bone Marrow/Stem cell transplant

Allogenic vs autologous Rejection of the transplant

A public health nurse is planning community teaching for a group of older adults regarding aging and hematological conditions. What condition will the nurse identify as most common among this population?

Anemia

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?

Apply pressure over the site for 5-7 minutes

A client's low hemoglobin level has necessitated transfusion of packed red blood cells. Prior to administration, which action should the nurse perform?

Assess the client's vital signs to establish baselines.

Which of the following cells are capable of differentiating into plasma cells?

B lymphocytes

A 75-year-old woman visited her health care provider for an annual check-up. She told the doctor that she feels exhausted all the time and barely has the energy to go out of her home, run errands, and visit friends. The nurse expects that the health care provider will order which of the following lab studies based on the most common hematologic condition affecting the elderly?

CBC

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?

Chelation therapy

A client on the medical unit is receiving a unit of packed red blood cells (PRBCs). Difficult intravenous (IV) access has necessitated a slow infusion rate, and the nurse notes that the infusion began 4 hours ago. Which action by the nurse is the most appropriate?

Discontinue the remainder of the PRBC transfusion, and inform the health care provider.

The nurse is working with a patient who has a hematological disorder. The nurse is aware that, in the process of hematopoiesis, stem cells differentiate into either myeloid or lymphoid stem cells. Into what broad cell types do myeloid stem cells differentiate? Select all that apply.

Erythrocytes Leukocytes Platelets

Components of blood plasma

Erythrocytes: red blood cells (RBCs) Leukocytes: white blood cells (WBCs ) Platelets: thrombocytes; forms loose blood clot

Types of leukocytes

Granulocytes Agranulocytes

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

Hematopoietic System #1

Immune response

Eosinophils

Increase in allergic, dermatologic and parasitic infections

The nurse educating a client with anemia is describing the process of red blood cell production. When the client's kidneys sense a low level of oxygen in circulating blood, which physiologic response is initiated?

Increased levels of erythropoietin

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

Which term refers to a form of white blood cell involved in immune response?

Lymphocyte

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets?

Myeloid stem cell

Which type of white blood cell (WBC) is the most numerous?

Neutrophil

While hospitalized, a client accidentally injures his finger and begins to bleed. What substance does the nurse recognize as naturally rushing to the site of injury before any other action takes place?

Platelets

A client's diagnosis of atrial fibrillation has prompted the primary care provider to prescribe warfarin. When assessing the therapeutic response to this medication, which action by the nurse is the most appropriate?

Review the client's international normalized ratio (INR).

For any reaction

STOP THE TRANSFUSION!!! MONITOR THE PATIENT CLOSELY, INFORM THE MDSAVE THE BLOOD AND TUBING AND GIVE BACK TO BLOOD BANK IF DISCONTINUING.

A nurse is caring for a client who is undergoing preliminary testing for a hematologic disorder. Which sign or symptom of a hematologic disorder is most common?

Severe fatigue

The nurse expects which assessment finding of the oral cavity when the client is diagnosed with pernicious anemia?

Smooth tongue

Which type of lymphocyte is responsible for cellular immunity?

T lymphocyte

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.

Blood administration

Use of NSS ONLY Infused within 30 minutes of receiving from blood bank Completed within 4 hours of starting

Spleen

both hematopoietic and immune functions; emergency reservoir of blood and removes bacteria and old or damaged red blood cells from circulation

Blood transfusion

both type and Rh compatible; typed and crossmatched

Hemoglobin

carries oxygen to cells of body Adult: 12.0 to 17.4 g/dL

Blood

consists of cells suspended in plasma

Blood groups

determined by heredity

Schilling test

diagnose pernicious anemia, macrocytic anemia, malabsorption syndromes

Leukocytes

engulf invading microorganisms and cellular debris and manufacturing antibodies

Which cells have the major function of transporting O2 to and removing CO2 from tissues?

erythrocytes

A client is diagnosed with extreme thrombocytosis. The nurse knows this condition is a result of which elevated blood cell count?

platelets

Which cells are also known as thrombocytes?

platelets

Which cells have the lifespan of approximately 7.5 days, and one-third of their population remains in the spleen (unless needed to fight significant bleeding)?

platelets

Rh factor

positive: protein present; if absent—Rh negative