MS 1 Final Exam Review - Blood Flashcards
A thrombocytopenic patient had a bone marrow biopsy taken from the posterior iliac crest. Which nursing action is the priority for this patient after this procedure?
1 Position the patient prone.
2 Apply a pressure dressing.
3 Administer analgesic for pain.
4 Return metal objects to the patient.
2 Apply a pressure dressing.
The sterile pressure dressing is applied after a bone marrow biopsy to ensure hemostasis. If bleeding is present, then the patient will lie on the site and may need a rolled towel for additional pressure; thus this patient will not be in the prone position. The analgesic should have been administered preprocedure. Metal objects would be removed for an MRI, not a bone marrow biopsy.
The nurse and a student nurse are discussing a patient’s complete blood count (CBC), which shows red blood cells (RBCs) 1.8 × 106/µL, white blood cells (WBCs) 2 × 109/L, and platelets 90 × 109/L. Which response by the student indicates an understanding of the results?
1 “The laboratory results indicate leukopenia.”
2 “The laboratory results indicate neutropenia.”
3 “The laboratory results indicate pancytopenia.”
4 “The laboratory results indicate thrombocytopenia.”
3 “The laboratory results indicate pancytopenia.”
The patient’s complete blood count is suppressed. There is a marked decrease in the number of RBCs, WBCs, and platelets. This condition is called pancytopenia. Leukopenia is a condition in which WBCs count less than 4000/µL. Neutropenia is a condition in which the absolute neutrophil count (ANC) is less than 1000 cells/µL. Thrombocytopenia is a condition in which platelet counts falls below 100,000/µL.
A patient with a platelet count of 52,000/mm3 is diagnosed with thrombocytopenia. The nurse would expect which clinical manifestations? Select all that apply.
1 Weakness 2 Bruising 3 Dizziness 4 Vomiting 5 Petechiae
2 Bruising
5 Petechiae
A low platelet count, known as thrombocytopenia, may be accompanied by signs of hemorrhage, such as bruising and petechiae. A normal platelet count is 150,000 to 400,000/mm3. Weakness, dizziness, and vomiting are not directly associated with thrombocytopenia.
After noting that a patient with leukemia has thrombocytopenia, which action will the nurse plan to take?
1 Palpate lymph nodes for swelling.
2 Check temperature for elevation.
3 Inspect skin for bruising or petechiae.
4 Examine oral mucosa for ulceration.
3 Inspect skin for bruising or petechiae.
Since thrombocytopenia increases the risk for bleeding, the nurse will inspect the skin for bruises or petechiae. Lymphadenopathy is a common symptom of some leukemias but does not cause thrombocytopenia. Although patients with leukemia do have an increased risk for infection and fever, a low platelet count would not cause fever. Ulcers of the oral mucosa can occur due to poor immune function in leukemia but are not caused by thrombocytopenia.
The nurse is reviewing the process of erythropoiesis. Which statement about erythropoiesis would the nurse identify as being true?
1 “Erythropoiesis is inhibited by hypoxia.”
2 “Erythropoiesis is the production of platelets.”
3 “Erythropoietin is released primarily by the liver.”
4 “Erythropoietin causes increased erythrocyte production.”
4 “Erythropoietin causes increased erythrocyte production.”
Erythropoiesis is the process of red blood cell (RBC) production and is stimulated by hypoxia and controlled by erythropoietin, a glycoprotein growth factor synthesized and released primarily by the kidney. Erythropoietin stimulates the bone marrow to increase erythrocyte production.
Which strategy is most important for a nurse to include when planning care for a patient who has neutropenia?
1 Restricting all visitors
2 Placing the patient in a private room
3 Advising the patient to use only an electric shaver
4 Wearing a gown and gloves when in direct contact with the patient
2 Placing the patient in a private room
Neutropenia is the reduction in the number of neutrophils in the blood. This leaves a patient prone to infection. The risk of infection can be reduced by placing a patient in a private room. Restriction of all visitors is not necessary; however, visitors with signs and symptoms of infections, such as a cough or fever, should be restricted. Use of an electric shaver would be recommended for a patient taking anticoagulants but is not required for this condition. Wearing a gown and gloves when in direct contact with the patient is not necessary; however, meticulous hand hygiene is a must. If the patient is in protective isolation, a mask will need to be worn.
Which finding supports heparin-induced thrombocytopenia (HIT)?
1 A patient has a viral infection.
2 A patient has hemolytic anemia.
3 A patient has a platelet count of 100,000/µL.
4 A patient has systemic lupus erythematosus.
3 A patient has a platelet count of 100,000/µL.
Long-term heparin therapy can cause HIT that results in a decrease in the platelet count. A platelet count of 100,000/µL indicates HIT. Immune thrombocytopenic purpura (ITP) will be suspected if the patient has a viral infection. Thrombotic thrombocytopenic purpura (TTP) will be suspected if the patient has hemolytic anemia and an autoimmune disorder like systemic lupus erythematosus.
