Hematologic System

Question 1

A patient is being discharged after an emergency splenectomy following a motor vehicle crash. Which instructions should the nurse include in the discharge teaching?

a. Check often for swollen lymph nodes.
b. Watch for excess bleeding or bruising.
c. Take iron supplements to prevent anemia.
d. Wash hands and avoid persons who are ill.

Answer 1

ANS: D
Splenectomy increases the risk for infection, especially with gram-positive bacteria.

The risks for lymphedema, bleeding, and anemia are not increased after a person has a splenectomy.

Question 2

The nurse assesses a patient who has numerous petechiae on both arms. Which question should the nurse ask the patient?

a. “Are you taking any oral contraceptives?”
b. “Have you been prescribed antiseizure drugs?”
c. “Do you take medication containing salicylates?”
d. “How long have you taken antihypertensive drugs?”

Answer 2

ANS: C
Salicylates interfere with platelet function and can lead to petechiae and ecchymoses.

• Antiseizure drugs may cause anemia but not clotting disorders or bleeding. Oral contraceptives increase a person’s clotting risk.
• Antihypertensives do not usually cause problems with decreased clotting.

Salicylates are used for inflammation, pain ASPIRIN*

Question 3

A nurse reviews the laboratory data for an older adult. The nurse would be most concerned about which finding?

a. Hematocrit of 35%
b. Hemoglobin of 11.8 g/dL
c. Platelet count of 400,000/μL
d. White blood cell count of 2800/μL

Answer 3

ANS: D
Because the total white blood cell (WBC) count is not usually affected by aging, the low WBC count in this patient would indicate that the patient’s immune function may be compromised, and the underlying cause of the problem needs to be investigated.

The platelet count is normal.
The slight decrease in hemoglobin and hematocrit are not unusual for an older patient.

PLT: 150-400
HCT: ( F - 37-47 ) ( M: 42-52 )
Hgb: 12-16 female
Hgb: 14-18 Male

Question 4

A patient with pancytopenia will have a bone marrow aspiration from the left posterior iliac crest. Which action would be important for the nurse to take after the procedure?

a. Elevate the head of the bed to 45 degrees.
b. Use a 1 2 -in sterile gauze to pack the wound.
c. Have the patient lie on the left side for 1 hour.
d. Apply a sterile 2-in gauze dressing to the site.

Answer 4

ANS: C
To decrease the risk for bleeding, the patient should lie on the left side for 30 to 60 minutes.

• After a bone marrow biopsy, the wound is small and will not be packed with gauze.
• A pressure dressing is used to cover the aspiration site. There is no indication to elevate the patient’s head.

Question 5

The nurse assesses a patient with pernicious anemia. Which finding would the nurse expect?

a. Yellow-tinged sclerae
b. Shiny, smooth tongue
c. Tender, bleeding gums
d. Numbness of extremities

Answer 5

ANS: D
Extremity numbness is associated with cobalamin (vitamin B12) deficiency or pernicious anemia.

• Loss of the papillae of the tongue occurs with chronic iron deficiency. -Yellow-tinged sclera is associated with hemolytic anemia and the resulting jaundice.
• Gum bleeding and tenderness occur with thrombocytopenia or neutropenia.

Pernicious Anemia - B12 deficiency, cytoblastic anemia, weak cell shell.

Question 6

A patient’s complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding?

a. “Have you had a recent weight loss?”
b. “Do you have any history of lung disease?”
c. “Have you noticed any dark or bloody stools?”
d. “What is your dietary intake of meat and protein?”

Answer 6

ANS: B
The hemoglobin and hematocrit results indicate polycythemia, which can be associated with chronic obstructive pulmonary disease.

-The other questions would be appropriate for patients who are anemic.

PLT: 150-400
HCT: ( F - 37-47 ) ( M: 42-52 )
Hgb: 12-16 female
Hgb: 14-18 Male

Question 7

The nurse is reviewing laboratory results and notes a patient’s activated partial thromboplastin time (aPTT) level is 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication?

a. Aspirin
b. Heparin
c. Warfarin
d. Erythropoietin

Answer 7

ANS: B
The aPTT level is increased (prolonged) in heparin administration. aPTT is used to monitor whether heparin is at a therapeutic level (needs to be greater than the normal range of 25 to 35 sec).

Prothrombin time (PT) and international normalized ratio (INR) are most commonly used to test for therapeutic levels of warfarin (Coumadin).

Aspirin affects platelet function. Erythropoietin is used to stimulate red blood cell production.

Question 8

The nurse notes pallor of the skin and nail beds in a newly admitted patient. The nurse should ensure that which laboratory test has been ordered?

a. Platelet count
b. Neutrophil count
c. Hemoglobin level
d. White blood cell count

Answer 8

ANS: C
Pallor of the skin or nail beds is indicative of anemia, which would be indicated by a low Hgb level.

• Platelet counts indicate a person’s clotting ability.
• A neutrophil is a type of white blood cell that helps to fight infection.

Question 9

The nurse examines the lymph nodes of a patient during a physical assessment. Which finding would be of most concern to the nurse?

a. A 2-cm nontender supraclavicular node
b. A 1-cm mobile and nontender axillary node
c. An inability to palpate any superficial lymph nodes
d. Firm inguinal nodes in a patient with an infected foot

Answer 9

ANS: A
Enlarged and nontender nodes are suggestive of malignancies such as lymphoma.

• Firm nodes are an expected finding in a known area of infection.
• The superficial lymph nodes are usually not palpable in adults, but if they are palpable, they are normally 0.5 to 1 cm and nontender.

Question 10

10. A patient who had a total hip replacement had an intraoperative hemorrhage 14 hours ago. Which laboratory test result would the nurse expect?
    a. Hematocrit of 46%
    b. Hemoglobin of 13.8 g/dL
    c. Elevated reticulocyte count
    d. Decreased white blood cell count

Answer 10

ANS: C
Hemorrhage causes the release of reticulocytes (immature red blood cells) from the bone marrow into circulation.

The hematocrit and hemoglobin levels are normal.
Bleeding does not affect the white blood cell count.

Hct: F: 36.1-44.3 M: 40.7-50.3
Hgb: 12.1-15.1 13.8-17.2

Question 11

The complete blood count (CBC) indicates that a patient is thrombocytopenic. Which action should the nurse include in the plan of care?

a. Avoid intramuscular injections.
b. Encourage increased oral fluids.
c. Check temperature every 4 hours.
d. Increase intake of iron-rich foods.

Answer 11

ANS: A
Thrombocytopenia is a decreased number of platelets, which places the patient at high risk for bleeding.

• Neutropenic patients are at high risk for infection and sepsis and should be monitored frequently for signs of infection.
• Encouraging fluid intake and iron-rich food intake is not indicated in a patient with thrombocytopenia.

Question 12

The health care provider’s progress note for a patient states that the complete blood count (CBC) shows a “shift to the left.” Which assessment finding should the nurse expect?

a. Cool extremities
b. Pallor and weakness
c. Elevated temperature
d. Low oxygen saturation

Answer 12

ANS: C
The term “shift to the left” indicates that the number of immature polymorphonuclear neutrophils (bands) is elevated and that finding is a sign of infection.

There is no indication that the patient is at risk for hypoxemia, pallor or weakness, or cool extremities.

Question 13

The health care provider orders a liver and spleen scan for a patient who has been in a motor vehicle crash. Which action should the nurse take to prepare the patient for this procedure?

a. Check for any iodine allergy.
b. Insert a large-bore IV catheter.
c. Administer prescribed sedatives.
d. Assist the patient to a flat position.

Answer 13

ANS: D
During a liver and spleen scan, a radioactive isotope is injected IV, and images from the radioactive emission are used to evaluate the structure of the spleen and liver. An indwelling IV catheter and sedation are not needed. The patient is placed in a flat position before the scan.

Question 14

A patient with pancytopenia of unknown origin is scheduled for diagnostic tests. The nurse will ensure a consent form was signed before which test?

a. Bone marrow biopsy
b. Abdominal ultrasound
c. Complete blood count (CBC)
d. Activated partial thromboplastin time (aPTT)

Answer 14

ANS: A
A bone marrow biopsy is a minor surgical procedure that requires the patient or guardian to sign a surgical consent form.

-The other procedures do not require a signed consent.

Question 15

The nurse reviews the laboratory test results of a patient admitted with abdominal pain. Which information will be most important for the nurse to communicate to the health care provider?

a. Monocytes 4%
b. Hemoglobin 13.6 g/dL
c. Platelet count 168,000/μL
d. White blood cell count 15,500/μL

Answer 15

ANS: D
The elevation in white blood cells indicates that the patient has an inflammatory or infectious process ongoing, which may be the cause of the patient’s pain, and that further diagnostic testing is needed.

• The monocytes are at a normal level.
• The hemoglobin and platelet counts are normal.

PLT: 150-400
HCT: ( F - 37-47 ) ( M: 42-52 )
Hgb: 12-16 female
Hgb: 14-18 Male

Question 16

Which information shown in the table below about a patient who has just arrived in the emergency department is most urgent for the nurse to communicate to the health care provider?
a. Heart rate
b. Platelet count
c. Abdominal pain
d. White blood cell count
Complete Blood Count

Patient History
• BP 110/68
• Pulse 98 beats/min
• Brisk capillary refill
• Multiple ecchymoses on arms
• Hgb 10.6 g/dL
• Hct 30%
• WBC 5100/μL
• Platelets 19,500/μL
• Occasional aspirin use
• Abdominal pain x 1 week • Large, dark stool this morning

Answer 16

ANS: B
The platelet count is severely decreased and places the patient at risk for spontaneous bleeding. The other information is also pertinent but not as indicative of the need for rapid treatment as the platelet count.

PLT: 150-400
HCT: ( F - 37-47 ) ( M: 42-52 )
Hgb: 12-16 female
Hgb: 14-18 Male