Ch. 32 Hematologic Function and Treatment

Question 1

Which cell of hematopoiesis is responsible for the production of RBCs and platelets?

A. Lymphoid Stem Cells
B. Myeloid Stem Cells
C. Neutrophils
D. Monocytes

Answer 1

Myeloid stem cells

Question 2

A client is in the hospital with a bleeding gastric ulcer and requires a blood transfusion. He has been typed and crossmatched for 2 units of packed RBCs and found to have type O blood. What type of blood will the nurse administer to this client?

Answer 2

Type O

Question 3

A client with severe anemia is admitted to the hospital. Because of religious beliefs, the client is refusing blood transfusions. The nurse anticipates pharmacologic therapy with which drug to stimulate the production of red blood cells?

A. Epoetin alpha
B. Sargramostim
C. Eltrombopag
D. Filgrastim

Answer 3

A. Epoetin alpha

Question 4

Which is a symptom of severe thrombocytopenia?

A. Inflammation of tongue
B. Inflammation of mouth
C. Petachiae
D. Dyspnea

Answer 4

C. Petachiae

Question 5

Which type of lymphocyte is responsible for cellular immunity?

A. T lymphocytes
B. Plasma cells
C. Basophil
D. B lymphocytes

Answer 5

A. T lymphocytes

Question 6

A client receiving a blood transfusion reports shortness of breath, appears anxious, and has a pulse of 125 beats/minute. What is the best action for the nurse to take after stopping the transfusion and awaiting further instruction from the health care provider?

A. Ensure O2 delivery device at bedside
B. Admin rx PRN anti-anxiety
C. PLace pt in recumbent position with legs elevated
D. Remove IV line

Answer 6

A. Ensure O2 delivery device at bedside

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.

Question 7

A nurse is caring for a patient who has had a bone marrow aspiration with biopsy. What complication should the nurse be aware of and monitor the patient for?

A. Shock
B. Blood transfusion rxn
C. Hemorrhage
D. Splintering of bone fragment

Answer 7

C. Hemorrhage

Hazards of either bone marrow aspiration or biopsy include bleeding and infection.

Question 8

The nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. What position will the nurse place the patient in?

A. Jackknife position
B. Lateral position with one leg flexed
C. Lithotomy position
D. Supine with HOB elevated 30 degrees

Answer 8

C. Lateral position with one leg flexed

Question 9

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

A. Thrombocyte
B. Spherocyte
C. Granulocyte
D. Lymphocyte

Answer 9

D. Lymphocyte

Question 10

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. 2pm
B. 3pm
C. 4pm
D. 6pm

Answer 10

C. 4pm

Question 11

A client wants to donate blood before his or her abdominal surgery next week. What should be the nurse’s first action?

A. Provide client with list of nearest donation centers
B. Explain time frame needed for autologous donations
C. Tell the client 2 units of blood will be needed
D. Remind the client to take supplemental iron before donation

Answer 11

B. Explain the time frame needed for autologous donations

Preoperative autologous donations are ideally collected 4 to 6 weeks before surgery. The nurse should first explain that time frame to this client. Surgery is scheduled in one week which means that autologous blood donation may not be an option for this client. A list of donation centers can be provided to the client; and even though iron is recommended and 2 units of blood may be suggested, the first action is to tell the client about the needed time frame for donation.

Question 12

A client receiving a unit of packed red blood cells (PRBCs) has been prescribed morphine 1 mg intravenously now for pain. What is the best method for the nurse to administer the morphine?

A. Add morphine to blood and slowly administer
B. Disconnect blood tubing, flush with NS, and admin morphine
C. Inject morphine into distal port on blood tubing
D. Admin morphine into closest tubing port to client for faster delivery

Answer 12

B. Disconnect blood tubing, flush with NS, and admin morphine

Question 13

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

Answer 13

D. Lack of erythropoietin

Question 14

A client with a history of sickle cell anemia has developed iron overload from repeated blood transfusions. What treatment does the nurse anticipate will be prescribed?

A. Chelation therapy
B. RBC phenotyping
C. HepB immunization
D. WBC filter

Answer 14

A. Chelation therapy

Chelation therapy is prescribed to treat iron overload

Question 15

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. Fibrinogen
B. Albumin
C. Globulin
D. Prothrombin

Answer 15

B. Albumin

Question 16

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. Wear a mask when entering patient’s room
C. Apply supplemental O2 to maintain oxygenation
D. Elevate client’s HOB

Answer 16

A. Use an electric razor when assisting client with shaving

Question 17

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

A. LI
B. Kidneys
C. Pancreas
D. Liver

Answer 17

d. liver

Question 18

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?

a. admin topical analgesic to control pain at site
b. pack wound with 1/2” sterile gauze
c. elevate HOB to 45 degrees
d. apply pressure over site for 5-7 min

Answer 18

d. apply pressure over site for 5-7 min

Question 19

The client’s CBC with differential reveals small-shaped hemoglobin molecules. The nurse expects to administer which medication to this client?

a. iron
b. B12
c. frozen plasma
d. folate

Answer 19

a. iron

With iron deficiency, the erythrocytes produced by the marrow are small and low in hemoglobin. Vitamin B12 and folate deficiencies are characterized by the production of abnormally large erythrocytes. Fresh frozen plasma are infused due to a low platelet level, not light-colored hemoglobin.

Reference:

Question 20

Which client is not a candidate for blood donation according to the American Heart Association?

a. 50F with HR 95 bpm
b. 18M that weighs 52 kg
c. 26F with hemoglobin 11.0 g/dl
d. 86M with BP 110/70 mmHg

Answer 20

c. 26F with hemoglobin 11.0 g/dl

Clients must meet the following criteria to be eligible as blood donors: body weight at least 50 kg; pulse rate regular between 50 and 100 bpm; systolic BP 90 to 180 mmHg and diastolic 50 to 100 mmHg; hemoglobin level at least 12.5 g/dL for women. There is no upper age limit to donation.

Question 21

The health care provider believes that the client has a deficiency in the leukocyte responsible for cell-mediated immunity. What should the nurse check the WBC count for?

a. basophils
b. t-lymph
c. monocytes
d. plasma cells

Answer 21

b. t-lymph

Question 22

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. monocytes
c. eosinophils
d. neutrophils

Answer 22

d. neutrophils

Question 23

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+ mom, rh+ child
b. rh- mom, rh- child
c. rh- mom, rh+ child
d. rh+ mom, rh- child

Answer 23

c. rh- mom, rh+ child

Question 24

Which blood cell type is matched correctly with its function?

a. b lymph - secretes IG
b. t lymph - humoral immunity
c. plasma cells - cell mediated immunity
d. leukocytes - fight infx

Answer 24

d. leukocytes fight infection

Question 25

The nurse is instructing the client with polycythemia vera how to perform isometric exercises such as contracting and relaxing the quadriceps and gluteal muscle during periods of inactivity. What does the nurse understand is the rationale for this type of exercise?

a. isometric exercise programs are inclusive of all muscle groups and have an aerobic effect to increase the HR
b. contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart
c. isometric exercise decreases the workload of the heart and restores oxygenated blood flow
d. this type of exercise increase arterial circulation as it returns to the heart

Answer 25

b. contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart

Question 26

A client comes into the emergency department reporting an enlarged tongue. The tongue appears smooth and beefy red in color. The nurse also observes a 5-cm incision on the upper left quadrant of the abdomen. When questioned, the client states, “I had a partial gastrostomy 2 years ago.” Based on this information, the nurse attributes these symptoms to which problem?

a. vit c deficiency
b. folic acid deficiency
c. b12 deficiency
d. vit a deficiency

Answer 26

b. b12 deficiency

Question 27

The nurse is caring for a client who had undergone hemodilution during surgery. Immediately after surgery, the nurse expects to see which lab result?

a. high creatinine
b. decreased hematocrit
c. high erythrocyte concentration
d. critically low arterial O2 sat

Answer 27

b. decreased hematocrit

Question 28

The nurse caring for a client with acute liver failure should expect which assessment finding?

a. high BP
b. high albumin
c. generalized edema
d. low pulse

Answer 28

c. generalized edema

People with impaired hepatic function may have low concentrations of albumin, with a resultant decreased in osmotic pressure and the development of edema. Albumin is produced by the liver; the level would be decreased, not increased in liver failure. Albumin is important to maintain fluid balance in the vascular system. Its presence in plasma keeps fluid in the vascular space. With impaired hepatic function and low levels of albumin, the client is more likely to suffer hypotension and tachycardia as a result of hypovolemia.

Question 29

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?

a. therapeutic phlebotomy
b. anticoag therapy
c. O2 therapy
d. iron chelation therapy

Answer 29

d. iron chelation therapy

Question 30

A client reports feeling faint after donating blood. What is the nurse’s best action?

a. assist to high fowlers
b. ambulate with assistance
c. place in trendelburg
d. keep in recumbent position to rest

Answer 30

d. keep in recumbent position to rest

Question 31

The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly?

a. pain and tenderness in calf
b. crackles auscultated bilaterally
c. RR 10
d. T 97F

Answer 31

b. 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.

Question 32

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

a. sickle cell
b. renal transplant
c. extreme leukocytosis
d. essential thrombocythemia

Answer 32

d. essential thrombocythemia

Platelet pheresis is used to remove platelets from the blood in patients with extreme thrombocytosis or essential thrombocythemia (temporary measure)or in a single-donor platelet transfusion.

Question 33

When administering a blood transfusion to a client with multiple traumatic injuries, the nurse monitors closely for evidence of a transfusion reaction. Shortly after the transfusion begins, the client complains of chest pain, nausea, and itching. When urticaria, tachycardia, and hypotension develop, the nurse stops the transfusion and notifies the physician. The nurse suspects which type of hypersensitivity reaction?

a. Type I (immediate, anaphylactic) hypersensitivity reaction
b. Type II (cytolytic, cytotoxic) hypersensitivity reaction
c. Type IV (cell-mediated, delayed) hypersensitivity reaction
d. Type III (immune complex) hypersensitivity reaction

Answer 33

b. Type II (cytolytic, cytotoxic) hypersensitivity reaction

ABO incompatibility, such as from an incompatible blood transfusion, is a type II hypersensitivity reaction. Transfusions of more than 100 ml of incompatible blood can cause severe and permanent renal damage, circulatory shock, and even death

Question 34

During a blood transfusion with packed red blood cells (RBCs), a client reports chills, low back pain, and nausea. What priority action should the nurse take?

a. Discontinue the infusion immediately and maintain the IV line with normal saline solution using new IV tubing b. Discontinue the infusion immediately and notify the physician
c. Slow the infusion rate and continue to monitor the client every 15 minutes
d. Observe for additional symptoms and notify the physician

Answer 34

a. Discontinue the infusion immediately and maintain the IV line with normal saline solution using new IV tubing

Question 35

A client with Hodgkin disease had a bone marrow biopsy yesterday and reports aching at the biopsy site, rated a 5 (on a 1–10 scale). After assessing the biopsy site, which nursing intervention is most appropriate?

a. Administer aspirin (ASA) 325 mg po, as ordered
b. Reposition the client to a high Fowler position and continue to monitor the pain c. Administer acetaminophen 500 mg po, as ordered
d. Notify the physician

Answer 35

c. Administer acetaminophen 500 mg po, as ordered

Question 36

Which type of lymphocyte is responsible for cellular immunity?

a. Basophil
b. T lymphocyte
c. Plasma cell
d. B lymphocyte

Answer 36

b. T lymphocyte

Question 37

Which type of leukocyte contains histamine and is an important part of hypersensitivity reactions?

a. Basophils
b. Plasma cell
c. Neutrophil
d. B lymphocyte

Answer 37

a. Basophils

Question 38

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

a. may be developing anemia.
b. has leukopenia.
c. has thrombocytopenia.
d. may be developing an infection.

Answer 38

d. may be developing an infection.

An increased number of band cells is sometimes called a left shift or shift to the left.

Question 39

When teaching about the advantages of autologous blood transfusion to a client, the nurse should include which information? Select all that apply.

a. The primary advantage is prevention of viral infections.
b. It is safer for clients with a history of transfusion reactions.
c. Blood can be transfused to family members and close relatives.
d. If not needed immediately, the blood can be frozen for future use.
e. It resolves anemia for clients with a hemoglobin less than 11g/dL.

Answer 39

a. The primary advantage is prevention of viral infections.
b. It is safer for clients with a history of transfusion reactions.
d. If not needed immediately, the blood can be frozen for future use.

Question 40

The nurse is obtaining the health history of a client suspected of having a hematological condition. The nurse notes the client has a history of alcohol abuse. Which clinical presentation is related to alcohol consumption?

a. Anemia
b. Neutropenia
c. Myelodysplastic syndrome
d. Thrombocytopenia

Answer 40

a. Anemia

Question 41

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. Potassium
c. Calcium
d. Hemoglobin

Answer 41

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.

Question 42

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 causes abnormally rigid red blood cells.”
b. “The condition causes abnormally small red blood cells.”
c. “The condition is likely caused by a folate deficiency.”
d. “The condition is likely caused by a vitamin B12 deficiency.”

Answer 42

d. “The condition is likely caused by a vitamin B12 deficiency.”

Question 43

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. Aplastic anemia
b. Coagulopathy
c. Sickle cell disease
d. Pancytopenia

Answer 43

b. coagulopathy

Question 44

When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply.

a. Medication use
b. Hair color
c. Dietary intake
d. Herbal supplements
e. Ethnicity

Answer 44

a. Medication use
c. Dietary intake
d. Herbal supplements
e. Ethnicity

Question 45

The nurse should provide further teaching about post bone-marrow biopsy procedures when the client makes which statement?

a. “I will keep the sterile dressing on until my doctor tells me it’s okay to remove it.”
b. “I’ll ask someone to drive me home when I awake from general anesthesia.”
c. “I should not take aspirin-containing products for pain relief.”
d. “I may feel some aching in my hip for 1-2 days.”

Answer 45

b. “I’ll ask someone to drive me home when I awake from general anesthesia.”

A bone marrow biopsy is usually performed with local anesthesia, not general.

Question 46

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 total iron-binding capacity
b. Decreased level of erythropoietin
c. Increased reticulocyte count
d. Increased mean corpuscular volume

Answer 46

b. Decreased level of erythropoietin

Question 47

Which nursing intervention should be incorporated into the plan of care for a client with impaired liver function and a low albumin concentration?

a. Monitor temperature at least once per shift
b. Implement neutropenic precautions
c. Monitor for edema at least once per shift
d. Apply prolonged pressure to needle sites or other sources of external bleeding

Answer 47

c. Monitor for edema at least once per shift

Question 48

Which is the major function of neutrophils?

a. Rejection of foreign tissue
b. Production of immunoglobulins
c. Phagocytosis
d. Destruction of tumor cells

Answer 48

c. Phagocytosis

Question 49

A preoperative client is discussing blood donation with the nurse. Which statement by the client indicates to the nurse the need for further teaching?

a. “I should expect blood withdrawal to take about 15 minutes.”
b. “My family will donate blood, because it’s safer.”
c. “I could donate my own blood in case I need a transfusion.”
d. “Donated blood is tested for blood type and infections.”

Answer 49

b. “My family will donate blood, because it’s safer.”

Question 50

A client is receiving platelets. In order to decrease the risk of circulatory overload in this client, what action should the nurse take?

a. Flush the intravenous line with a liter of saline between units.
b. Infuse each unit over 30-60 minutes per client tolerance.
c. Administer each unit slowly over 3-4 hours.
d. Monitor vital signs closely before transfusion and once per shift.

Answer 50

b. Infuse each unit over 30-60 minutes per client tolerance.

Infuse each unit of FFP over 30-60 minutes per client tolerance. Platelet clumping will occur if administered too slowly. Vital signs should be monitored before and throughout the transfusion, not just once per shift. A liter of saline is too large an amount to flush the intravenous line and would contribute to fluid overload.

Question 51

What food should the nurse recommend for a client diagnosed with vitamin B12 deficiency?

a. Green vegetables
b. Citrus fruit
c. Lean meat
d. Whole-grain bread

Answer 51

c. Lean meat

Question 52

A nurse practitioner reviewed the blood work of a male client suspected of having microcytic anemia. The nurse suspected occult bleeding. Which laboratory result would indicate an initial stage of iron deficiency?

a. Hemoglobin: 16 g/dL
b. Total iron-binding capacity: 300 g/dL
c. Serum iron: 100 g/dL
d. Serum ferritin: 15 ng/mL

Answer 52

d. Serum ferritin: 15 ng/mL

Microcytic anemia is characterized by small RBCs due to insufficient hemoglobin. Serum ferritin levels correlate to iron deficiency and decrease as an initial response to anemia before hemoglobin and serum iron levels drop.

Question 53

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. Premedicate the client with acetaminophen
b. Administer the blood as soon as it arrives
c. Verify the client’s identity according to hospital policy
d. Assess the client 30 minutes after the start of the initial transfusion

Answer 53

c. Verify the client’s identity according to hospital policy

Question 54

One hour after the completion of a fresh frozen plasma transfusion, a client reports shortness of breath and is very anxious. The client’s vital signs are BP 98/60, HR 110, temperature 99.4°F, and SaO2 88%. Auscultation of the lungs reveals posterior coarse crackles to the mid and lower lobes bilaterally. Based on the symptoms, the nurse suspects the client is experiencing which problem?

a. Bacterial contamination of blood
b. Exacerbation of congestive heart failure
c. Delayed hemolytic reaction
d. Transfusion-related acute lung injury

Answer 54

d. Transfusion-related acute lung injury

Transfusion-related acute lung injury (TRALI) is a potentially fatal, idiosyncratic reaction that is defined as the development of acute lung injury within 6 hours after a blood transfusion. It is more likely to occur when plasma and platelets are transfused. Onset is abrupt (usually within 6 hours of transfusion, often within 2 hours). Signs and symptoms include acute shortness of breath, hypoxia (arterial oxygen saturation [SaO2] less than 90%; pressure of arterial oxygen [PaO2] to fraction of inspired oxygen [FIO2] ratio less than 300), hypotension, fever, and eventual pulmonary edema.

Question 55

The nurse is working at a blood donation clinic. What teaching should the nurse provide to the donor immediately after blood donation?

a. Hold the involved arm below the heart.
b. Remain for observation after eating and drinking.
c. Sit up promptly after the needle is removed.
d. Remove the band-aid after 5 minutes.

Answer 55

b. Remain for observation after eating and drinking.

Question 56

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. Vitamin B12 deficiency
b. Thrombocytopenia
c. Polycythemia
d. Hemochromatosis

Answer 56

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.