Lewis 4th ed: Hematological System Flashcards
The nurse is providing discharge teaching to a client who has had an emergency splenectomy following an automobile accident. Which of the following findings should the nurse inform the client that they are at an increased risk of developing.
a. Infection
b. Lymphedema
c. Chronic anemia
d. Prolonged bleeding
a. Infection
The spleen plays a major role in immune function. Splenectomy increases the risk for infection, especially with gram-positive bacteria. The risks for lymphedema, bleeding, and anemia are not increased after splenectomy.
The nurse is obtaining a health history from a client and notes numerous petechiae. Which of the following assessments should the nurse anticipate?
a. Bruising on the skin
b. Pinpoint purplish-red lesions
c. Small focal red lesions
d. Brown spots on mucous membranes.
b. Pinpoint purplish-red lesions
Petechiae are small, purplish-red lesions. Ecchymosis is bruising on the skin. Small focal red lesions are telangiectasia. Purpura are small hemorrhages on the skin or mucous membranes resulting in a rash of purple, red, or brown spots.
The nurse is reviewing laboratory data for an older-adult client. Which of the following results should be of most concern?
a. WBC count of 3.5 x 10^9 /L
b. Hematocrit of 37%
c. Platelet count of 400 x 10^9/L
d. Hemoglobin of 118 g/L
a. WBC count of 3.5 x 10^9 /L
The total WBC count is not usually affected by aging, and the low WBC here would indicate that the client’s immune function may be compromised. The platelet count is normal. The slight decrease in hemoglobin and hematocrit is not unusual for an older client.
The health care provider performs a bone marrow aspiration from the left posterior iliac crest on a client with pancytopenia. Which of the following actions should the nurse implement following the procedure?
a. Elevate the head of the bed to 45 degrees.
b. Apply a sterile Band-Aid at the aspiration site.
c. Use half-inch sterile gauze to pack the wound.
d. Apply a pressure dressing on the aspiration site.
d. Apply a pressure dressing on the aspiration site.
A pressure dressing is used to cover the aspiration site. The wound after bone marrow biopsy is small and will not be packed with gauze. There is no indication that the head needs to be elevated for this client.
The nurse is caring for a client with chronic iron deficiency anemia. Which of the following assessment findings should the nurse anticipate?
a. Yellow-tinged sclerae
b. Shiny, smooth tongue
c. Numbness of the extremities
d. Gum bleeding and tenderness
b. Shiny, smooth tongue
Loss of papillae of the tongue occurs with chronic iron deficiency. Scleral jaundice is associated with hemolysis, gum bleeding and tenderness occur with thrombo-cytopenia or neutropenia, and extremity numbness is associated with vitamin B12 deficiency or pernicious anemia.
A clients CBC shows hemoglobin of 200 g/L and a hematocrit of 54%. Which of the following questions should the nurse ask to determine possible cause of this finding?
a. “Has there been any recent weight loss?”
b. “Do you have any problems with your vision?”
c. “What is your intake of fruits and vegetables?”
d. “Have you noticed any dark or bloody stools?”
b. “Do you have any problems with your vision?”
The hemoglobin and hematocrit results indicate polycythemia and polycythemia may cause visual abnormalities. The other questions will be appropriate for clients who are anemic.
The nurse is caring for client who is receiving heparin. Which of the following laboratory tests should nurse monitor?
a. Prothrombin time (PT)
b. Fibrin degradation products (FDP)
c. International normalized ratio (INR)
d. Activated partial thromboplastin time (aPTT)
d. Activated partial thromboplastin time (aPTT)
aPTT testing is used to determine whether heparin is at a therapeutic level. FDP is useful in diagnosis of problems such as disseminated intravascular coagulation (DIC). PT and INR are most commonly used to test for therapeutic levels of warfarin.
The nurse is evaluating the RBC indices result of a clients laboratory report. Which of the following interpretations is correct related to a low mean corpuscular volume (MCV)
a. Hypochromic RBC’s
b. Inadequate number r of RBC’s
c. Low hemoglobin in the RBC’s
d. Small size of the RBC’s
d. Small size of the RBC’s
The MCV is low when the RBC’s are smaller than normal. Inadequate numbers of RBC’s are an indication of anemia. Low levels of hemoglobin in the RBCs and hypochromic RBCs result in a low mean corpuscular hemoglobin (MCH).
Small RBV = low MCV
While examining the lymph nodes during physical assessment, the nurse would be most concerns about which of the following findings?
a. A 2cm nontender supraclavicular node
b. A 1cm mobile nontender axillary node
c. An inability to palpate any superficial lymph nodes
d. Firm inguinal nodes in a client with an infected foot.
a. A 2cm nontender supraclavicular node
Enlarged and nontender nodes are most suggestive of malignancy such as lymphoma. Firm nodes are an expected findings in an area of infection. The superficial lymph nodes are usually not palpable in adults, but if they are palpable, they are normally 0.5-1cm and nontender.
The nurse is caring for a client who had an intraoperative hemorrhage 12 hours ago. Which of the following laboratory results should the nurse anticipate.
a. Hematocrit of 45%
b. Hemoglobin of 132 g/L
c. Decreased WBC count
d. Elevated reticulocyte count
d. Elevated reticulocyte count
Hemorrhage causes the release of more immature RBC’s from the bone marrow into the circulation. The hematocrit and hemoglobin levels are normal. The WBC count is not affected by bleeding.
The nurse is caring for a client whose CBC and differential indicate that the client is neutropenic. Which of the following actions 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
c. check temperature every 4 hours
Neutropenic clients are at high risk for infection and sepsis and should be monitored frequently for signs of infection. The other actions would not address the clients neutropenia.
The nurse is caring for a newly admitted client whose CBC shows a “shift to the left”. Which of the following assessments should the nurse monitor in the plan of care?
a. Cool extremities
b. Pallor and weakness
c. Elevated temperature
d. Low oxygen saturation
c. Elevated temperature
The term “shift to the left” indicates that the number of immature polymorphonuclear neutrophils, or bands, is elevated and is a sign of severe infection. There is no indication that the client is at risk for hypoxemia, pallor or weakness, or cool extremities.
The health care provider orders an ultrasound of the spleen for a client who has been in a car accident. Which of the following actions should the nurse take before this procedure?
a. Check for any iodine allergy
b. Insert a large-bore IV catheter
c. Place the client on NPO status
d. Assist the client to a flat position
d. Assist the client to a flat position
The client is placed in a flat position before splenic ultrasound to ensure best view. The client does not have to be NPO or have an IV line. No iodine-containing materials are used for ultrasound.
The nurse is caring for a client with pancytopenia of unknown origin who is confused and is scheduled for the following diagnostic tests. Which of the following tests should the nurse contact the client’s family member to obtain a signed consent form?
a. ABO blood typing
b. Bone marrow biopsy
c. abdominal ultrasound
d. CBC
b. Bone marrow biopsy
The nurse is reviewing the CBC for a client admitted with abdominal pain. Which of the following information will be most important for the nurse to communicate to the health care provider?
a. Monocytes 4%
b. Hemoglobin 116 g/L
c. Platelet count 145 x 10^9/L
d. WBC 13.5 x 10^9/L
d. WBC 13.5 x 10^9/L
The elevation in WBC indicates that an abdominal infection may be the cause of the client’s pain and that further diagnostic testing is needed. The monocytes are at a normal level. The slight decreases in hgb and platelet count also would be reported but would not require any immediate action.
Low WBC - at risk for infection
High WBC - active infection
The nurse is reviewing the laboratory results of clotting study tests for the client. Which of the following findings should the nurse identify as abnormal?
a. activated clotting time 118 seconds
b. activated partial thromboplastin time 40 seconds
c. D-dimer 200 mcg/L
d. Fibrinogen 4 g/L
b. activated partial thromboplastin time 40 seconds
The activated partial thromboplastin time is elevated (normal: 25-35 seconds). Fibrinogen is within normal limits (2-4g/L). The activated clotting time is within normal limits (70-120 seconds). The D–dimer is within normal limits (<250mcg/L).
