Chapter 32 Quiz

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Question #1

A nurse cares for a client who has had a bone marrow aspiration. In addition to the client’s aspiration site, what locations on the body does the nurse recognize as having bone marrow? Select all that apply.,,

A Ribs

B Vertebrae

C Tibia

D Sternum

E Pelvis

Question #2

When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply.,,

A Medication use

B Dietary intake

C Herbal supplements

D Ethnicity

E Hair color

Question #3

A nurse is caring for a client who will undergo total knee replacement and will have an autologous transfusion. Which statement will the nurse include when teaching the client about the transfusion?

A “You will be prescribed calcium to replace what is lost during donation.”

B “You typically donate blood 4 to 6 weeks before the surgery.”

C “You typically donate blood the day of the surgery.”

D “You will likely not need the blood that is donated.”

Question #4

The nurse is caring for a client with hypoxia. What does the nurse understand is true regarding the client’s oxygen level and the production of red blood cells?

A The kidneys sense low oxygen levels in the blood and stimulate erythropoietin, stimulating the marrow to produce more red blood cells.

B The bone marrow is stimulated by low oxygen levels in the blood and stimulates erythropoietin, maturing the red blood cells.

C he brain senses low oxygen levels in the blood and stimulates hemoglobin, which binds to more red blood cells.

D The kidneys sense low oxygen levels in the blood and stimulate hemoglobin, stimulating the marrow to produce more red blood cells.

Question #5

A client with Hodgkin disease had a bone marrow biopsy yesterday and reports aching at the biopsy site, rated a 5 (on a 1–10 scale). After assessing the biopsy site, which nursing intervention is most appropriate?

A Administer acetaminophen 500 mg po, as ordered

B Notify the physician

C Administer aspirin (ASA) 325 mg po, as ordered

D Reposition the client to a high Fowler position and continue to monitor the pain

Question #6

Which nursing intervention should be incorporated into the plan of care for a client with impaired liver function and a low albumin concentration?

A Monitor temperature at least once per shift

B Monitor for edema at least once per shift

C Apply prolonged pressure to needle sites or other sources of external bleeding

D Implement neutropenic precautions

Question #7

Which is the major function of neutrophils?

A Destruction of tumor cells

B Phagocytosis

C Rejection of foreign tissue

D Production of immunoglobulins

Question #8

Which term describes the percentage of blood volume that consists of erythrocytes?

A Erythrocyte sedimentation rate (ESR)

B Differentiation

C Hematocrit

D Hemoglobin

Question #9

A nurse administers blood products to a client with Hodgkin disease. During the administration, the nurse notes the client has a fever and diffuse reddened skin rash. From what condition does the nurse suspect the client is suffering?

A Graft-versus-host disease

B Delayed hemolytic reaction

C Creutzfeld-Jakob disease

D Bacterial contamination

Question #10

A nurse cares for a client with myelodysplastic syndrome who requires frequent PRBC transfusions. What blood component does the nurse recognize as being most harmful if accumulated in the tissues due to chronic blood transfusions?

A Potassium

B Hemoglobin

C Iron

D Calcium

Question #11

While caring for a client, the nurse notes petechiae on the client’s trunk and lower extremities. What precaution will the nurse take when caring for this client?

A Use an electric razor when assisting client with shaving.

B Elevate the client’s head of the bed.

C Apply supplemental oxygen to maintain the client’s oxygenation.

D Where a mask when entering the client’s room.

Question #12

The nurse is administering a blood transfusion to a client over 4 hours. After 2 hours, the client reports chills and has a fever of 101°F, an increase from a previous temperature of 99.2°F. What does the nurse recognize is occurring with this client?

A The client is having decrease in tissue perfusion from a shock state.

B The client is having a febrile nonhemolytic reaction.

C The client is experiencing vascular collapse.

D The client is having an allergic reaction to the blood.

Question #13

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

A Vitamin B12

B Iron

C Folate

D Fresh frozen plasma

Question #14

A client receiving a blood transfusion reports shortness of breath, appears anxious, and has a pulse of 125 beats/minute. What is the best action for the nurse to take after stopping the transfusion and awaiting further instruction from the health care provider?

A Remove the intravenous line.

B Place the client in a recumbent position with legs elevated.

C Administer prescribed PRN anti-anxiety agent.

D Ensure there is an oxygen delivery device at the bedside.

Question #15

The nurse should be alert to which adverse assessment finding when transfusing a unit of packed red blood cells (PRBCs) too rapidly?

A Pain and tenderness in calf area

B Respiratory rate of 10 breaths/minute

C Oral temperature of 97°F

D Crackles auscultated bilaterally

Question #16

After withdrawing the needle from blood donor’s arm, the site begins to bleed excessively. What is the nurse’s first action?

A Assist the client into an erect position.

B Apply a tourniquet above the antecubital fossa.

C Lower the arm below the level of the heart.

D Hold firm pressure on the venipuncture site.

Question #17

A preoperative client is discussing blood donation with the nurse. Which statement by the client indicates to the nurse the need for further teaching?

A “Donated blood is tested for blood type and infections.”

B “I should expect blood withdrawal to take about 15 minutes.”

C “My family will donate blood, because it’s safer.”

D “I could donate my own blood in case I need a transfusion.”

Question #18

Which type of leukocyte contains histamine and is an important part of hypersensitivity reactions?

A Plasma cell

B B lymphocyte

C Neutrophil

D Basophils

Question #19

A nurse cares for a client with megaloblastic anemia who had a total gastrectomy three years ago. What statement will the nurse include in the client’s teaching regarding the condition?

A “The condition is likely caused by a folate deficiency.”

B “The condition causes abnormally small red blood cells.”

C “The condition causes abnormally rigid red blood cells.”

D “The condition is likely caused by a vitamin B12 deficiency.”

Question #20

The nurse is obtaining the health history of a client suspected of having a hematological condition. The nurse notes the client has a history of alcohol abuse. Which clinical presentation is related to alcohol consumption?

A Anemia

B Thrombocytopenia

C Neutropenia

D Myelodysplastic syndrome

Question #21

A nurse, caring for a client with human immunodeficiency virus (HIV), reviews the client’s differential WBC count. What type of WBC will the nurse check the level of?

A Monocytes

B Leukocytes

C T lymphocytes

D B lymphocytes

Question #22

A nurse is teaching a client with a vitamin B12 deficiency about appropriate food choices to increase the amount of B12 ingested with each meal. The nurse knows the teaching is effective based on which statement by the client?

A “I will eat a meat source such as chicken or pork with each meal.”

B “I will eat a spinach salad with lunch and dinner.”

C “I will eat more dairy products such as milk, yogurt, and ice cream every day.”

D “I will increase my daily intake of orange vegetables such as sweet potatoes and carrots.”

Question #23

Which type of lymphocyte is responsible for cellular immunity?

A Basophil

B B lymphocyte

C T lymphocyte

D Plasma cell

Question #24

A nurse is reviewing a client’s morning laboratory results and notes a left shift in the band cells. Based on this result, the nurse can interpret that the client

A may be developing an infection.

B may be developing anemia.

C has leukopenia.

D has thrombocytopenia.

Question #25

A Reposition the client to a high Fowler position and continue to monitor the pain

B Administer aspirin (ASA) 325 mg po, as ordered

C Administer acetaminophen 500 mg po, as ordered

D Notify the physician

Question #26

In normal blood, monocytes account for approximately what percentage of the total leukocyte count?

A 10%

B 20%

C 15%

D 5%

Question #27

A nurse cares for an older adult client with acute myeloid leukemia (AML). What concept does the nurse understand leads to the increased risk of an older adult acquiring myeloid malignancies such as AML?

A Older adults acquire damage to the bone marrow over time.

B Older adults are exposed to more infectious disease over time.

C Older adults have an increasing number of leukocytes over time.

D Older adults acquire damage to the DNA of stem cells over time.

Question #28

A nurse cares for several mothers and babies in the postpartum unit. Which mother does the nurse recognize as being most at risk for a febrile nonhemolytic reaction?

A Rh-positive mother; Rh-negative child

B Rh-negative mother; Rh-positive child

C Rh-negative mother; Rh-negative child

D Rh-positive mother; Rh-positive child

Question #29

A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse know is the most likely clinical disorder the patient is being treated for?

A Renal transplantation

B Essential thrombocythemia

C Extreme leukocytosis

D Sickle cell anemia

Question #30

The nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. What position will the nurse place the patient in?

A Lateral position with one leg flexed

B Jackknife position

C Lithotomy position

D Supine with head of the bed elevated 30 degrees

Question #31

A patient will need a blood transfusion for the replacement of blood loss from the gastrointestinal tract. The patient states, “That stuff isn’t safe!” What is the best response from the nurse?

A “I understand your concern. The blood is carefully screened but is not completely risk free.”

B “The blood is carefully screened, so there is no possibility of you contracting any illness or disease from the blood.”

C “You will have to decide if refusing the blood transfusion is worth the risk to your health.”

D “I agree that you should be concerned with the safety of the blood, but it is important that you have this transfusion.”

Question #32

Which client is not a candidate for blood donation according to the American Heart Association?

A 26 year old female with hemoglobin 11.0 g/dL

B 50 year old female with pulse 95 beats/minute

C 18 year old male weighing 52 kg.

D 86 year old male with blood pressure 110/70 mmHg

Question #33

The client is planned to have a splenectomy. The nurse should prepare which medication to administer to this client?

A Factor VIII

B Immunoglobulin G (IgG)

C Aspirin

D Pneumococcal vaccine

Question #34

A client receiving a unit of packed red blood cells (PRBCs) has been prescribed morphine 1 mg intravenously now for pain. What is the best method for the nurse to administer the morphine?

A Inject the morphine into a distal port on the blood tubing.

B Disconnect the blood tubing, flush with normal saline, and administer morphine.

C Add the morphine to the blood to be slowly administered.

D Administer the morphine into the closest tubing port to the client for fast delivery.

Question #35

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following?

A Pancreas

B Kidney

C Large intestine

D Liver

Question #36

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

A Lymphoid stem cell

B Monocyte

C Myeloid stem cell

D Neutrophil

Question #37

A nurse is transfusing whole blood to a client with impaired renal function. During the transfusion, the client tells the nurse, “I feel very short of breath all of a sudden.” What is the nurse’s primary action?

A Slow the infusion.

B Assess the client’s vital signs.

C Call the health care provider

D Stop the infusion.

Question #38

A 18-year-old client presents to the emergency department with a severe open fracture of the lower extremity. The health care provider tells the client that the client will need a blood transfusion. The client refuses, despite the advise of the health care provider. What does the nurse understand is the legal implication of the scenario?

A The health care provider may ask for a court order if the client refuses.

B The health care provider may first call the client’s parents if the client refuses.

C The client can only refuse the transfusion if the consent form has not been signed.

D The client has a right to refuse the transfusion.

Question #39

The nurse is caring for a client with hypoxia. What does the nurse understand is true regarding the client’s oxygen level and the production of red blood cells?

A The brain senses low oxygen levels in the blood and stimulates hemoglobin, which binds to more red blood cells.

B The kidneys sense low oxygen levels in the blood and stimulate erythropoietin, stimulating the marrow to produce more red blood cells

C The bone marrow is stimulated by low oxygen levels in the blood and stimulates erythropoietin, maturing the red blood cells.

D The kidneys sense low oxygen levels in the blood and stimulate hemoglobin, stimulating the marrow to produce more red blood cells.

Question #40

The body responds to infection by increasing the production of white blood cells (WBCs). The nurse should evaluate the differential count for what type of WBCs, which are the first WBCs to respond to an inflammatory event?

A Basophils

B Neutrophils

C Monocytes

D Eosinophils

Question #41

An older adult client presents to the health care provider’s office and reports 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

Question #42

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

A Apply pressure over the site for 5–7 minutes

B Pack the wound with half-inch sterile gauze

C Administer a topical analgesic to control pain at the site

D Elevate the head of the bed to 45 degrees

Question #43

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

A Folic acid deficiency

B Vitamin C deficiency

C Vitamin B12 deficiency

D Vitamin A deficiency

Question #44

Which is a symptom of severe thrombocytopenia?

A Inflammation of the tongue

B Dyspnea

C Petechiae

D Inflammation of the mouth

Question #45

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

B Isometric exercise programs are inclusive of all muscle groups and have an aerobic effect to increase the heart rate.

C This type of exercise increases arterial circulation as it returns to the heart.

D Isometric exercise decreases the workload of the heart and restores oxygenated blood flow.

Question #46

A nurse is caring for a client who has been diagnosed with an autosomal dominant hematologic disorder. Which disease does the nurse suspect?

A Sickle cell disease

B Factor V Leiden

C Hemochromatosis

D Thalassemia

Question #47

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

A Erythropoietin

B Eltrombopag

C GM-CSF

D Thrombopoietin

Question #48

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 Anticoagulation therapy

B Oxygen therapy

C Therapeutic phlebotomy

D Iron chelation therapy

Question #49

A nurse is caring for a patient who has had a bone marrow aspiration with biopsy. What complication should the nurse be aware of and monitor the patient for?

A Blood transfusion reaction

B Shock

C Hemorrhage

D Splintering of bone fragments

Question #50

The health care provider believes that the client has a deficiency in the leukocyte responsible for cell-mediated immunity. What should the nurse check the WBC count for?

A T lymphocytes

B Basophils

C Monocytes

D Plasma cells

Question #51

A Ensure there is an oxygen delivery device at the bedside.

B Administer prescribed PRN anti-anxiety agent.

C Place the client in a recumbent position with legs elevated.

D Remove the intravenous line.

Question #52

The nurse is caring for a client who had undergone hemodilution during surgery. Immediately after surgery, the nurse expects to see which lab result?

A Elevated erythrocyte concentration

B Elevated creatinine

C Decreased hematocrit

D Critically low arterial oxygen saturation

Question #53

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 Globulin.

B Fibrinogen.

C Prothrombin.

D Albumin.

Question #54

A client wants to donate blood before his or her abdominal surgery next week. What should be the nurse’s first action?

A Tell the client that 2 units of blood will be needed.

B Explain the time frame needed for autologous donation.

C Remind the client to take supplemental iron before donation.

D Provide the client with a list of the nearest donation centers.

Question #55

Which type of lymphocyte is responsible for cellular immunity?

A Basophil

B Plasma cell

C T lymphocyte

D B lymphocyte

Question #56

Which term refers to a form of white blood cell involved in immune response?

A Thrombocyte

B Lymphocyte

C Granulocyte

D Spherocyte

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