ch 28 hemo

Question 1

a client with a hematologic disorder asks the nurse how the body forms blood cells. the nurse understands that this process primarily takes place in which location

Answer 1

bone marrow

Question 2

a client suffered a leg wound which causes minor blood loss. as a result of bleeding, the process of primary hemostasis is activated. what will occur during this process?

Answer 2

severed blood vessels constrict

Question 3

a client has come to the ob clinic due to recent heavy menstrual blood flow. because of the client’s consequent increase in RBC, the nurse would recommend what supplement

Answer 3

iron

Question 4

the nurse is planning the care of a client with a nutritional deficit and a diagnosis of megaloblastic anemia. the nurse should recognize that this client’s health problem is due to which issue with RBC

Answer 4

abnormalities in the structure and function

Question 5

a nurse is caring for a client who is undergoing preliminary testing for a hematologic disorder. which sign or symptom of a hematologic disorder is most common

Answer 5

severe fatigue

Question 6

the nurse is caring for a client receiving a transfusion notes that 15 minutes after the infusion of packed RBCs has begun, the client is having difficulty breathing and reports severe chest tightness. what is the most appropriate initial action for the nurse to take?

Answer 6

stop the transfusion immediately

Question 7

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

Answer 7

all body fluids

Question 8

the nurse is caring for a client 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

Answer 8

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

Answer 9

-leukocytes

-platelets

-erythrocytes

Question 10

a client’s 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?

Answer 10

plasmin

Question 11

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

Answer 11

prevention of viral infections from another persons blood

Question 12

a client has been diagnosed with a lymphoid stem cell defect. this client has the potential for a problem involving which of the following

Answer 12

plasma cells

Question 13

the nurse is describing normal erythrocyte physiology to a client who has a diagnosis of anemia. the nurse should explain that the erythrocytes consist primarily of which substance?

Answer 13

hemoglobin

Question 14

the nurse educating a client with anemia is describing the process of red blood cell production. when the client’s kidneys sense a low level of oxygen in circulating blood, which physiologic response is initiated.

Answer 14

increased level 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

Answer 15

stool for occult blood

Question 16

a client is being treated for the effects of a long-standing vitamin b 12 deficiency. which aspect of the client’s health history would most likely predispose the client to this deficiency?

Answer 16

the client is a vegan

Question 17

the nurse’s review of a clients most recent blood work reveals a significant increase in the number of band cells. the nurse’s subsequent assessment should focus on which of the following?

Answer 17

signs and symptoms of infection

Question 18

a nurse is educating a client about the role of b lymphocytes. the nurse’s description will include which of the following physiologic processes

Answer 18

antibody production

Question 19

a clients most recent blood work reveals low levels of albumin. this assessment finding should suggest the possibility of what nursing diagnosis

Answer 19

risk for imbalanced fluid volume

Question 20

a client has sustained a cut to the hand, immediately initiating the process of hemostasis. following vasoconstriction, which event in the process of hemostasis will take place

Answer 20

platelets will aggregate at the injury site

Question 21

the nurse is providing care for a 73 year old client who has a hematologic disorder. which change in hematologic function is age related

Answer 21

older adults are less able to increase blood cell production when demand suddenly increases

Question 22

a client’s health history reveals daily consumption of two to three bottles of wine. the nurse would consider increased risk for which hematologic disorder when planning assessments and interventions for this client?

Answer 22

anemia

Question 23

a client’s diagnosis of atrial fibrillation has prompted the primary care provider to prescribe warfarin. when assessing the therapeutic response to this medication, which action by the nurse is the most appropriate ?

Answer 23

review the client’s international normalized ration (INR)

Question 24

a client has been scheduled for a bone marrow aspiration and admitted to the nurse being worried about the pain involved with the procedure. which statement by the nurse when providing client education would be the most accurate?

Answer 24

most people feel some brief sharp pain when the marrow is aspirated

Question 25

a client is scheduled for a splenectomy. during discharge education, which teaching point should the nurse prioritize?

Answer 25

reporting any signs or symptoms of infection promptly

Question 26

the nurse’s brief review of a client’s electronic health record indicates that the client regularly undergoes therapeutic phlebotomy. which of the following rationales for this procedure is most plausible

Answer 26

the client may chronically produce excess red blood cells

Question 27

a nurse has participated in organizing a blood donation drive at a local community center. which client would most likely be disallowed from donating blood

Answer 27

a client whose blood pressure is 78/49

Question 28

a nurse at a blood donation clinic has completed the collection of blood from a client. the client reports feeling light headed and appears pale. which action by the nurse is most appropriate

Answer 28

help the client to sit, with head lowered below knees

Question 29

a client’s low hemoglobin level has necessitated transfusion of packed red blood cells. prior to administration, which action should the nurse perform?

Answer 29

assess the client’s vital signs to establish baselines

Question 30

a client on the medical unit is receiving a unit of packed red blood cells (PRBCs). difficult IV access has necessitated a slow infusion rate, and the nurse notes that infusion began 4 hours ago. which action by the nurse is the most appropriate?

Answer 30

discontinue the remainder of the PRBC transfusion, and inform the healthcare provider

Question 31

two units of packed red blood cells have been prescribed for a client who has experienced a GI bleed. the client is highly reluctant to receive a transfusion stating i am scared of getting aids. how should the nurse respond

Answer 31

donated blood is screened for HIV and the risk of contraction is very low

Question 32

a client is in the ICU after a medical error resulted in an acute hemolytic transfusion reaction. what was the etiology of this client’s adverse reaction

Answer 32

the donor blood was incompatible with the client

Question 33

an interdisciplinary team has been commissioned to create policies and procedures aimed at preventing acute hemolytic transfusion reactions. what action has the greater potential to reduce the risk of this reaction

Answer 33

be vigilant in identifying the client and the blood component

Question 34

a client is receiving a blood transfusion and reports a new onset of slight dyspnea. the nurse’s rapid assessment reveals bilateral lung crackles and elevated bp. what is the most appropriate action

Answer 34

slow the infusion rate and monitor the client closely

Question 35

a client lives with a diagnosis of sickle cell disease and receives frequent blood transfusions. the nurse should recognize the client’s consequent risk for what complication of treatment?

Answer 35

iron overload

Question 36

a client is receiving the first two prescribed units of PRBCs. shortly after the initiation of the transfusion, the client reports chills and experiences a sharp increase in temp. what is the priority action

Answer 36

discontinue the transfusion

Question 37

fresh frozen plasma (FFP) has been prescribed for a hospital client. prior to administration of this blood product, the nurse should prioritize which client education

Answer 37

s/s of transfusion reaction

Question 38

the nurse is preparing to administer a unit of platelets to an adult client. when administering this blood product, which of the following actions should the nurse perform

Answer 38

administer the platelets as rapidly as the client can tolerate

Question 39

which of the following circumstances would most clearly warrant autologous blood donation

Answer 39

the client has elective surgery pending

Question 40

a client is scheduled to undergo a bone marrow aspiration. when preparing the client for the procedure, which action would the nurse do first?

Answer 40

ensure informed consent has been obtained