Deck 32: Assessment of Hematologic Function and Treatment Modalities

Question 1

A patient with a hematologic disorder asks the nurse how the body forms blood cells. The nurse should describe a process that takes place where?

A) In the spleen
B) In the kidneys
C) In the bone marrow
D) In the liver

Answer 1

In the bone marrow

Question 2

A man suffers a leg wound which causes minor blood loss. As a result of bleeding, the process of primary hemostasis is activated. What occurs in primary hemostasis?

A) Severed blood vessels constrict.
B) Thromboplastin is released.
C) Prothrombin is converted to thrombin.
D) Fibrin is lysed.

Answer 2

Severed blood vessels constrict.

Question 3

A patient has come to the $\mathrm{OB} / \mathrm{GYN}$ clinic due to recent heavy menstrual flow. Because of the patients
Consequent increase in RBC production, the nurse knows that the patient may need to increase her daily intake of what substance?

A) Vitamin E
B) Vitamin D
C) Iron
D) Magnesium

Answer 3

Iron

Question 4

The nurse is planning the care of a patient with a nutritional deficit and a diagnosis of megaloblastic anemia. The nurse should recognize that this patients health problem is due to what?

A) Production of inadequate quantities of RBCs
B) Premature release of immature RBCs
C) Injury to the RBCs in circulation
D) Abnormalities in the structure and function RBCs

Question 5

A nurse is caring for a patient who undergoing preliminary testing for a hematologic disorder. What sign or symptom most likely suggests a potential hematologic disorder?

A) Sudden change in level of consciousness (LOC)
B) Recurrent infections
C) Anaphylaxis
D) Severe fatigue

Question 6

The nurse caring for a patient receiving a transfusion notes that 15 minutes after the infusion of packed red blood cells (PRBCs) has begun, the patient is having difficulty breathing and complains of severe chest tightness. What is the most appropriate initial action for the nurse to take?

A) Notify the patients physician.
B) Stop the transfusion immediately.
C) Remove the patients IV access.
D) Assess the patients chest sounds and vital signs.

Question 7

The nurse is describing the role of plasminogen in the clotting cascade. Where in the body is plasminogen present?

A) Myocardial muscle tissue
B) All body fluids
C) Cerebral tissue
D) Venous and arterial vessel walls

Question 8

The nurse is caring for a patient who has developed scar tissue in many of the areas that normally produce blood cells. What organs can become active in blood cell production by the process of extramedullary hematopoiesis?

A) Spleen and kidneys
B) Kidneys and pancreas
C) Pancreas and liver
D) Liver and spleen

Question 9

Through the process of hematopoiesis, stem cells differentiate into either myeloid or lymphoid stem cells. Into what do myeloid stem cells further differentiate? Select all that apply.

A) Leukocytes
B) Natural killer cells
C) Cytokines
D) Platelets
E) Erythrocytes

Question 10

A patients wound has begun to heal and the blood clot which formed is no longer necessary. When a blood clot is no longer needed, the fibrinogen and fibrin will be digested by which of the following?

A) Plasminogen
B) Thrombin
C) Prothrombin
D) Plasmin

Question 11

A patient undergoing a hip replacement has autologous blood on standby if a transfusion is needed. What is the primary advantage of autologous transfusions?

A) Safe transfusion for patients with a history of transfusion reactions
B) Prevention of viral infections from another persons blood
C) Avoidance of complications in patients with alloantibodies
D) Prevention of alloimmunization

Question 12

A patient has been diagnosed with a lymphoid stem cell defect. This patient has the potential for a problem involving which of the following?

A) Plasma cells
B) Neutrophils
C) Red blood cells
D) Platelets

Question 13

The nurse is describing normal RBC physiology to a patient who has a diagnosis of anemia. The nurse should explain that the RBCs consist primarily of which of the following?

A) Plasminogen
B) Hemoglobin
C) Hematocrit
D) Fibrin

Question 14

The nurse educating a patient with anemia is describing the process of RBC production. When the patients kidneys sense a low level of oxygen in circulating blood, what physiologic response is initiated?

A) Increased stem cell synthesis
B) Decreased respiratory rate
C) Arterial vasoconstriction
D) Increased production of erythropoietin

Question 15

An older adult client is exhibiting many of the characteristic signs and symptoms of iron deficiency. In addition to a complete blood count, what diagnostic assessment should the nurse anticipate?

A) Stool for occult blood
B) Bone marrow biopsy
C) Lumbar puncture
D) Urinalysis

Question 16

A patient is being treated for the effects of a longstanding vitamin $\mathrm{B}_{12}$ deficiency. What aspect of the patients health history would most likely predispose her to this deficiency?

A) The patient has irregular menstrual periods.
B) The patient is a vegan.
C) The patient donated blood 60 days ago.
D) The patient frequently smokes marijuana.

Question 17

The nurses review of a patients most recent blood work reveals a significant increase in the number of band cells. The nurses subsequent assessment should focus on which of the following?

A) Respiratory function
B) Evidence of decreased tissue perfusion
C) Signs and symptoms of infection
D) Recent changes in activity tolerance

Question 18

A nurse is educating a patient about the role of B lymphocytes. The nurses description will include which of the following physiologic processes?

A) Stem cell differentiation
B) Cytokine production
C) Phagocytosis
D) Antibody production

Question 19

A patients most recent blood work reveals low levels of albumin. This assessment finding should suggest the possibility of what nursing diagnosis?

A) Risk for imbalanced fluid volume related to low albumin
B) Risk for infection related to low albumin
C) Ineffective tissue perfusion related to low albumin
D) Impaired skin integrity related to low albumin

Question 20

An individual has accidentally cut his hand, immediately initiating the process of hemostasis. Following vasoconstriction, what event in the process of hemostasis will take place?

A) Fibrin will be activated at the bleeding site.
B) Platelets will aggregate at the injury site.
C) Thromboplastin will form a clot.
D) Prothrombin will be converted to thrombin.

Question 21

The nurse is providing care for an older adult who has a hematologic disorder. What age-related change in hematologic function should the nurse integrate into care planning?

A) Bone marrow in older adults produces a smaller proportion of healthy, functional blood cells.
B) Older adults are less able to increase blood cell production when demand suddenly increases.
C) Stem cells in older adults eventually lose their ability to differentiate.
D) The ratio of plasma to erythrocytes and lymphocytes increases with age.

Question 22

A clients health history reveals daily consumption of two to three bottles of wine. The nurse should plan assessments and interventions in light of the patients increased risk for what hematologic disorder?

A) Leukemia
B) Anemia
C) Thrombocytopenia
D) Lymphoma

Question 23

A patients diagnosis of atrial fibrillation has prompted the primary care provider to prescribe warfarin (Coumadin), an anticoagulant. When assessing the therapeutic response to this medication, what is the nurses most appropriate action?

A) Assess for signs of myelosuppression.
B) Review the patients platelet level.
C) Assess the patients capillary refill time.
D) Review the patients international normalized ratio (INR).

Question 24

A patient has been scheduled for a bone marrow biopsy and admits to the nurse that she is worried about the pain involved with the procedure. What patient education is most accurate?

A) Youll be given painkillers before the test, so there wont likely be any pain?
B) Youll feel some pain when the needle enters your skin, but none when the needle enters the bone because of the absence of nerves in bone.
C) Most people feel some brief, sharp pain when the needle enters the bone.
D) Ill be there with you, and Ill try to help you keep your mind off the pain.

Question 25

A patient is scheduled for a splenectomy. During discharge education, what teaching point should the nurse prioritize?

A) The importance of adhering to prescribed immunosuppressant therapy
B) The need to report any signs or symptoms of infection promptly
C) The need to ensure adequate folic acid, iron, and vitamin $\mathrm{B}_{12}$ intake
D) The importance of limiting activity postoperatively to prevent hemorrhage

Question 26

The nurses brief review of a patients electronic health record indicates that the patient regularly undergoes therapeutic phlebotomy. Which of the following rationales for this procedure is most plausible?

A) The patient may chronically produce excess red blood cells.
B) The patient may frequently experience a low relative plasma volume.
C) The patient may have impaired stem cell function.
D) The patient may previously have undergone bone marrow biopsy.

Question 27

A nurse has participated in organizing a blood donation drive at a local community center. Which of the following individuals would most likely be disallowed from donating blood?

A) A man who is 81 years of age
B) A woman whose blood pressure is $88 / 51 \mathrm{~mm} \mathrm{Hg}$
C) A man who donated blood 4 months ago
D) A woman who has type 1 diabetes

Question 28

A nurse at a blood donation clinic has completed the collection of blood from a woman. The woman states that she feels lightheaded and she appears visibly pale. What is the nurses most appropriate action?

A) Help her into a sitting position with her head lowered below her knees.
B) Administer supplementary oxygen by nasal prongs.
C) Obtain a full set of vital signs.
D) Inform a physician or other primary care provider.

Question 29

A patients low hemoglobin level has necessitated transfusion of PRBCs. Prior to administration, what action should the nurse perform?

A) Have the patient identify his or her blood type in writing.
B) Ensure that the patient has granted verbal consent for transfusion.
C) Assess the patients vital signs to establish baselines.
D) Facilitate insertion of a central venous catheter.

Question 30

A patient on the medical unit is receiving a unit of PRBCs. Difficult IV access has necessitated a slow infusion rate and the nurse notes that the infusion began 4 hours ago. What is the nurses most appropriate action?

A) Apply an icepack to the blood that remains to be infused.
B) Discontinue the remainder of the PRBC transfusion and inform the physician.
C) Disconnect the bag of PRBCs, cool for 30 minutes and then administer.
D) Administer the remaining PRBCs by the IV direct (IV push) route.

Question 31

Two units of PRBCs have been ordered for a patient who has experienced a GI bleed. The patient is highly reluctant to receive a transfusion, stating, Im terrified of getting AIDS from a blood transfusion. How can the nurse best address the patients concerns?

A) All the donated blood in the United States is treated with antiretroviral medications before it is used.
B) That did happen in some high-profile cases in the twentieth century, but it is no longer a possibility.
C) HIV was eradicated from the US blood supply in the early 2000s.
D) The chances of contracting AIDS from a blood transfusion in the United States are exceedingly low.

Question 32

A patient is being treated in the ICU after a medical error resulted in an acute hemolytic transfusion reaction. What was the etiology of this patients adverse reaction?

A) Antibodies to donor leukocytes remained in the blood.
B) The donor blood was incompatible with that of the patient.
C) The patient had a sensitivity reaction to a plasma protein in the blood.
D) The blood was infused too quickly and overwhelmed the patients circulatory system.

Question 33

An interdisciplinary team has been commissioned to create policies and procedures aimed at preventing acute hemolytic transfusion reactions. What action has the greatest potential to reduce the risk of this transfusion reaction?

A) Ensure that blood components are never infused at a rate greater than $125 \mathrm{~mL} / \mathrm{hr}$ .
B) Administer prophylactic antihistamines prior to all blood transfusions.
C) Establish baseline vital signs for all patients receiving transfusions.
D) Be vigilant in identifying the patient and the blood component.

Question 34

A patient is receiving a blood transfusion and complains of a new onset of slight dyspnea. The nurses rapid assessment reveals bilateral lung crackles and elevated BP. What is the nurses most appropriate action?

A) Slow the infusion rate and monitor the patient closely.
B) Discontinue the transfusion and begin resuscitation.
C) Pause the transfusion and administer a $250 \mathrm{~mL}$ bolus of normal saline.
D) Discontinue the transfusion and administer a beta-blocker, as ordered.

Question 35

A patient lives with a diagnosis of sickle cell anemia and receives frequent blood transfusions. The nurse should recognize the patients consequent risk of what complication of treatment?

A) Hypovolemia
B) Vitamin $B_{12}$ deficiency
C) Thrombocytopenia
D) Iron overload

Question 36

A patient is receiving the first of two ordered units of PRBCs. Shortly after the initiation of the transfusion, the patient complains of chills and experiences a sharp increase in temperature. What is the nurses priority action?

A) Position the patient in high Fowlers.
B) Discontinue the transfusion.
C) Auscultate the patients lungs.
D) Obtain a blood specimen from the patient.

Question 37

Fresh-frozen plasma (FFP) has been ordered for a hospital patient. Prior to administration of this blood product, the nurse should prioritize what patient education?

A) Infection risks associated with FFP administration
B) Physiologic functions of plasma
C) Signs and symptoms of a transfusion reaction
D) Strategies for managing transfusion-associated anxiety

Question 38

The nurse is preparing to administer a unit of platelets to an adult patient. When administering this blood product, which of the following actions should the nurse perform?

A) Administer the platelets as rapidly as the patient can tolerate.
B) Establish IV access as soon as the platelets arrive from the blood bank.
C) Ensure that the patient has a patent central venous catheter.
D) Aspirate 10 to $15 \mathrm{~mL}$ of blood from the patients IV immediately following the transfusion.

Question 39

Which of the following circumstances would most clearly warrant autologous blood donation?

A) The patient has type-O blood.
B) The patient has sickle cell disease or a thalassemia.
C) The patient has elective surgery pending.
D) The patient has hepatitis $\mathrm{C}$ .

Question 40

A patients electronic health record states that the patient receives regular transfusions of factor IX. The nurse would be justified in suspecting that this patient has what diagnosis?

A) Leukemia
B) Hemophilia
C) Hypoproliferative anemia
D) Hodgkins lymphoma