prepU Hematologic

Question 1

The client is diagnosed with polycythemia vera. The nurse prepares the client for which procedure?

a) Phlebotomy
b) Blood transfusion
c) Apheresis
d) Platelet infusion

Answer 1

a) Phlebotomy

Polycythemia vera is a condition in which the blood contains a large amount of red blood cells, increasing the viscosity of the blood.

Phlebotomy is a preferred treatment to rid the circulation of excess red blood cells.

Apheresis is a process in which platelets and leukocytes are removed from the blood.

Blood and platelet infusions can exacerbate this condition.

Question 2

A patient with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this patient?

a) GM-CSF (Leukine)
b) Thrombopoietin (TPO)
c) Eltrombopag (Promacta)
d) Erythropoietin (Epogen)

Answer 2

d) Erythropoietin (Epogen)

Erythropoietin (epoetin alfa [Epogen, Procrit]) is an effective alternative treatment for patients with chronic anemia secondary to diminished levels of erythropoietin, as in chronic renal disease.

This medication stimulates erythropoiesis.

Question 3

Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils?

a) Phagocytosis
b) Destruction of tumor cells
c) Rejection of foreign tissue
d) Production of antibodies called immunoglobulin (Ig)

Answer 3

a) Phagocytosis

The major function of neutrophils is phagocytosis.

T lymphocytes are responsible for rejection of foreign tissue and destruction of tumor cells.

Plasma cells produce antibodies call immunoglobulin

Question 4

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

a) Neutrophil
b) Lymphoid stem cell
c) Myeloid stem cell
d) Monocyte

Answer 4

c) Myeloid stem cell

The myeloid stem cell is responsible not only for all nonlymphoid white blood cells, but also for the production of red blood cells and platelets.

Lymphoid cells produce either T or B lymphocytes.

A monocyte is large WBC that becomes a macrophage when is leaves the circulation and moves into body tissues.

A neutrophil is a fully mature WBC capable of phagocytosis.

Question 5

The nurse should notify the healthcare provider before administering fresh frozen plasma (FFP) based on which assessment finding?

a) Absence of tenting skin turgor
b) Strong pedal pulses
c) Jugular venous distention
d) White sclera

Answer 5

c) Jugular venous distention

During the pre-transfusion assessment, the nurse should carefully inspect for any signs of cardiac failure, such as jugular venous distention.

The sclera should be examined for icterus; white is an expected finding. Weak pedal pulses would be a sign of cardiac failure.

Tenting skin turgor is a sign of dehydration; low vascular volume would be a cause for transfusion, not a contraindication.

Question 6

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called which of the following?

a) Blast cells
b) Monocytes
c) Megaloblasts
d) Mast cells

Answer 6

c) Megaloblasts

Megaloblasts are abnormally large erythrocytes.

Blast cells are primitive WBCs.

Mast cells are cells found in connective tissue involved in defense of the body and coagulation.

Monocytes are large WBCs that become macrophages when they leave the circulation and move into body tissues.

Question 7

The physician performs a bone marrow biopsy from the posterior iliac crest on a patient with pancytopenia. What intervention should the nurse perform following the procedure?

a) Administer a topical analgesic to control pain at the site
b) Elevate the head of the bed to 45 degrees
c) Pack the wound with half-inch sterile gauze
d) Apply pressure over the site for 5–7 minutes

Answer 7

d) Apply pressure over the site for 5–7 minutes

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

The risk of bleeding is somewhat increased if the patient’s platelet count is low or if the patient has been taking a medication (e.g., aspirin) that alters platelet function.

After the marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing.

Question 8

A client complains of extreme fatigue. Which system should the nurse suspect is most likely affected?

a) Integumentary
b) Hematological
c) Neurological
d) Respiratory

Answer 8

b) Hematological

The most common symptom in hematologic diseases is extreme fatigue.

Question 9

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

a) Folic acid deficiency
b) Vitamin B₁₂ deficiency
c) Vitamin A deficiency
d) Vitamin C deficiency

Answer 9

b) Vitamin B₁₂ deficiency

Because vitamin B12 is found only in foods of animal origin, strict vegetarians may ingest little vitamin B12.

Vitamin B₁₂ combines with intrinsic factor produced in the stomach. The vitamin B₁₂–intrinsic factor complex is absorbed in the distal ileum.

People who have had a partial or total gastrectomy may have limited amounts of intrinsic factor, and therefore the absorption of vitamin B₁₂ may be diminished. The effects of either decreased absorption or decreased intake of vitamin B12 are not apparent for 2–4 years.

This results in megaloblastic anemia. Some symptoms are smooth, beefy red, enlarged tongue and cranial nerve deficiencies

Question 10

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 of the following reasons?

a) Increases the effectiveness of dialysis
b) Preparation for likely nephrectomy
c) Hypervolemia
d) Lack of erythropoietin

Answer 10

d) Lack of erythropoietin

The kidneys produce erythropoietin, a hormone that stimulates red blood cell production. A lack of this hormone is the most likely reason for blood transfusion due to the acute kidney failure. There is no indication for a nephrectomy in this question. A blood transfusion will not necessarily increase the effectiveness of dialysis. Transfusing a client with hypervolemia could lead to circulatory overload.

Question 11

The body responds to infection by increasing the production of white blood cells (WBCs). The nurse knows to evaluate the differential count for the level of __________, the first WBCs to respond to an inflammatory event.

a) Eosinophils
b) Monocytes
c) Basophils
d) Neutrophils

Answer 11

d) Neutrophils

Question 12

Which type of lymphocyte is responsible for cellular immunity?

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

Answer 12

c) T lymphocyte

T lymphocytes are responsible for delayed allergic reactions, rejection of foreign tissue (e.g., transplanted organs), and destruction of tumor cells. This process is known as cellular immunity.

B lymphocytes are responsible for humoral immunity.

A plasma cell secretes immunoglobulin.

A basophil contains histamine and is an integral part of hypersensivity reactions.

Question 13

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) White blood cell filter
c) Red blood cell phenotyping
d) Hepatitis B immunization

Answer 13

a) Chelation therapy

Chelation therapy is prescribed to treat iron overload.

Hepatitis B immunization helps immunize against hepatitis B.

Red blood cell phenotyping helps decreased sensitization.

A white blood cell filter protects against cytomegalovirus and some sensitization and febrile reactions.

Question 14

Which of the following terms refers to a form of white blood cell involved in immune response?

a) Thrombocyte
b) Spherocyte
c) Lymphocyte
d) Granulocyte

Answer 14

c) Lymphocyte

Mature lymphocytes are the principal cells of the immune system, producing antibodies and identifying other cells and organisms as “foreign.”

Both B and T lymphocytes respond to exposure to antigens.

Granulocytes include basophils, neutrophils, and eosinophils.

A spherocyte is a red blood cell without central pallor, seen with hemolysis. A thrombocyte is a platelet.

Question 15

A client tells the nurse that he would like to donate blood before his abdominal surgery next week. What should be the nurse’s first action?

a) Explain the time frame needed for autologous donation.
b) Provide the client with a list of the nearest donation centers.
c) Remind the client to take supplemental iron before donation.
d) Tell the client that 2 units of blood will be needed.

Answer 15

a) Explain the time frame needed for autologous donation.

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 16

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

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

Answer 16

b) Remain for observation after eating and drinking.

After blood donation, the donor receives food and fluids and is asked to remain for observation. After the needle is removed, donors are asked to hold the involved arm straight up, and firm pressure is applied with sterile gauze for 2 to 3 minutes. A firm bandage is then applied. The donor remains recumbent until he or she feels able to sit up, usually within a few minutes.

Question 17

The nurse expects which assessment finding when caring for a client with a decreased hemoglobin level?

a) Elevated temperature.
b) Bright red venous blood.
c) Increased bruising.
d) Decreased oxygen level.

Answer 17

d) Decreased oxygen level.

Hemoglobin carries oxygen; a decreased hemoglobin level results in decreased oxygen.

An elevated temperature is a sign of infection and can result from decreased white blood cells.

Arterial blood is more oxygen saturated and brighter red in color than venous blood.

Increased bruising results from a decreased platelet level, not decreased hemoglobin.

Question 18

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 decreases the workload of the heart and restores oxygenated blood flow.
b) Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.
c) This type of exercise increases arterial circulation as it returns to the heart.
d) Isometric exercise programs are inclusive of all muscle groups and have an aerobic effect to increase the heart rate.

Answer 18

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

Isometric exercise induce contraction of skeletal muscle so that it compresses the walls of veins and increases the circulation of venous blood as it returns to the heart. Isometric exercises do not have an aerobic effect and should not increase the heart rate; although, it may increase blood pressure. Isometric exercise does not decrease the workload of the heart. Arterial flow moves blood flow away from the heart after being oxygenated.

Question 19

The nurse obtains a unit of blood for the client, Donald D. Smith. The name on the label on the unit of blood reads Donald A. Smith. All the other identifiers are correct. The nurse

a) Asks the client if he was ever known as Donald A. Smith
b) Administers the unit of blood
c) Checks with Blood Bank first and then administers the blood with their permission
d) Refuses to administer the blood

Answer 19

d) Refuses to administer the blood

To ensure a safe transfusion, all components of the identification must be correct. The nurse should refuse to administer the blood and notify the Blood Bank about the discrepancy. The Blook Bank should then take the necessary steps to correct the name on the label on the unit of blood.

Question 20

One hour after the completion of a fresh frozen plasma transfusion, a patient complains of shortness of breath and is very anxious. The patient’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 patient is experiencing which of the following problems?

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

Answer 20

c) 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 occurring 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 of less than 300), hypotension, fever, and eventual pulmonary edema.

Question 21

The client is a young, thin woman who is prescribed iron dextran intramuscularly. The nurse, when administering the medication,

a) Rubs the site vigorously
b) Employs the Z–track technique
c) Uses a 23–gauge needle
d) Injects into the deltoid muscle

Answer 21

b) Employs the Z–track technique

When iron medications are given intramuscularly, the nurse uses the Z–track technique to avoid local pain and staining of the skin.

The gluteus maximus muscle is used. The nurse avoids rubbing the site vigorously and uses a 189– or 20–gauge needle.

Question 22

The physician believes that the patient has a deficiency in the leukocyte responsible for cell-mediated immunity. What should the nurse check the WBC count for?

a) Plasma cells
b) T lymphocytes
c) Basophils
d) Monocytes

Answer 22

b) T lymphocytes

T lymphocytes are responsible for cell-mediated immunity, in which they recognize material as “foreign,” acting as a surveillance system.

Question 23

An older adult patient presents to the physician’s office with a complaint of exhaustion. The nurse, aware of the most common hematologic condition affecting the elderly, knows that which laboratory values should be assessed?

a) RBC count
b) WBC count
c) Levels of plasma proteins
d) Thrombocyte count

Answer 23

a) RBC count

A decreased red blood cell count is indicative of anemia, a common condition in older adults that results in fatigue.

Question 24

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) Prothrombin.
c) Albumin.
d) Globulin.

Answer 24

c) Albumin.

Albumin, only produced in the liver, is essential for maintaining oncotic pressure in the vascular system.

A decrease in oncotic pressure due to low albumin causes fluid to leak into the peritoneal cavity.

Question 25

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) Iron chelation therapy
b) Therapeutic phlebotomy
c) Oxygen therapy
d) Anticoagulation therapy

Answer 25

a) Iron chelation therapy

Iron overload is a complication unique to people who have had long-term PRBC transfusions. One unit of PRBCs contains 250 mg of iron.

Patients with chronic transfusion requirements can quickly acquire more iron than they can use, leading to iron overload. Over time, the excess iron deposits in body tissues and can cause organ damage, particularly in the liver, heart, testes, and pancreas.

Promptly initiating a program of iron chelation therapy can prevent end-organ damage from iron toxicity.

Question 26

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

a) Iron
b) Folate
c) Vitamin B12
d) Fresh frozen plasma