Hematology
The nurse is assessing a client’s nutrition-metabolic pattern related to hematological health. Which of the following assessments should the nurse implement?
A) Inspect the skin for petechiae
B) Ask the client about joint pain.
C) Assess for vitamin C deficiency.
D) Determine if the client can perform ADLs.
A) Inspect the skin for petechiae
Any changes in the skin’s texture or colour should be explored when assessing the client’s nutrition-metabolic pattern related to hematological health. The presence of petechiae or ecchymotic areas could be indicative of hematological deficiencies related to poor nutritional intake or related causes.
The nurse is caring for a client who is to receive a transfusion of two units of packed red blood cells. After obtaining the first unit from the blood bank, the nurse should ask which of the following health team members to assist in checking the unit before administration?
A) Unit secretary
B) A phlebotomist
C) A physician’s assistant
D) Another registered nurse
D) Another registered nurse
Before hanging a transfusion, the registered nurse must check the unit with another RN or with a licensed practical nurse, depending on employer policy.
The nurse is caring for an older-adult client with pneumonia whose blood pressure is 160/70 mm Hg. Which of the following age-related changes contributes to this finding?
A) Stenosis of the heart valves
B) Decreased adrenergic sensitivity
C) Increased parasympathetic activity
D) Loss of elasticity in arterial vessels
D) Loss of elasticity in arterial vessels
An age-related change that increases the risk of systolic hypertension is a loss of elasticity in the arterial walls. Because of the increasing resistance to flow, pressure is increased within the blood vessel and hypertension results.
The nurse is teaching a client with hypertension that uncontrolled hypertension may damage organs in the body. Which of the following mechanisms is the primary reason?
A) Hypertension promotes atherosclerosis and damage to the walls of the arteries
B) Hypertension causes direct pressure on organs, resulting in necrosis and replacement of cells with scar tissue.
C) Hypertension causes thickening of the capillary membranes, leading to hypoxia of organ systems.
D) Hypertension increases blood viscosity, which contributes to intravascular coagulation and tissue necrosis distal to occlusions.
A) Hypertension promotes atherosclerosis and damage to the walls of the arteries
Hypertension is a major risk factor for the development of atherosclerosis by mechanisms not yet fully known. However, once atherosclerosis develops, it damages the walls of arteries and reduces circulation to target organs and tissues.
The nurse is caring for a client with heart failure who is prescribed furosemide (diuretic). Which of the following problems should the nurse monitor in the client?
A) Hyperkalemia
B) Ototoxicity
C) Bradycardia
D) Paroxysmal nocturnal dyspnea
B) Ototoxicity
Problems in using loop diuretics include reduction in serum potassium levels, ototoxicity, and possible allergic reaction in the client who is sensitive to sulpha-type drugs.
The nurse is assessing laboratory values on a client admitted with septicemia. Which of the following findings should the nurse anticipate?
A) Increased platelets
B) Decreased RBCs
C) Decreased erythrocyte sedimentation rate (ESR)
D) Increased WBC differential
D) Increased WBC differential
When infections are severe, such as in septicemia, more granulocytes are released from the bone marrow as a compensatory mechanism. To meet the increased demand, many young, immature polymorphonuclear neutrophils (bands) are released into circulation. WBCs are usually reported in order of maturity, with the less mature forms on the left side of a written report. Hence, the term shift to the left is used to denote an increase in the number of bands.
The nurse is preparing to administer an ordered blood transfusion to a client. Which of the following intravenous solutions should the nurse use when priming the blood tubing?
A) Lactated Ringer’s
B) 5% dextrose in water
C) 0.9% sodium chloride
D) 0.45% sodium chloride
C) 0.9% sodium chloride
The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It is also used to flush the blood tubing after the infusion is complete to ensure the client receives the blood that is left in the tubing when the bag is empty.
The nurse is auscultating a client’s heart and assesses the presence of a murmur. Which of the following physiological changes has occurred to result in a heart murmur?
A) Increased viscosity of the client’s blood
B) Turbulent blood flow across a heart valve
C) Friction between the heart and the myocardium
D) A deficit in heart conductivity that impairs normal contractility
B) Turbulent blood flow across a heart valve
Turbulent blood flow across the affected valve results in a murmur. A murmur is not a direct result of variances in blood viscosity, conductivity, or friction between the heart and myocardium.
The nurse is caring for a client admitted with a history of hypertension. The client’s medication history includes hydrochlorothiazide (diuretic) daily for the past 10 years. Which of the following parameters would indicate the optimal intended effect of this drug therapy?
A) Weight loss of 1 kg
B) Blood pressure 128/86
C) Absence of ankle edema
D) Output of 600 mL per shift
B) Blood pressure 128/86
Hydrochlorothiazide may be used alone as monotherapy to manage hypertension or in combination with other medications if not effective alone. After the first few weeks of therapy, the diuretic effect diminishes, but the antihypertensive effect remains. Since the client has been taking this medication for 10 years, the most direct measurement of its intended effect would be the blood pressure.
A client with a recent diagnosis of heart failure (HF) has been prescribed furosemide (diuretic) in an effort to accomplish which of the following outcomes?
A) Reduce preload
B) Decrease afterload
C) Increase contractility
D) Promote vasodilation
A) Reduce preload
Diuretics such as furosemide are used in the treatment of heart failure (HF) to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do not directly influence contractility, afterload, or vessel tone.
The nurse is reviewing a client’s laboratory results and notes an elevated neutrophil level. Which of the following symptoms should the nurse recognize as being related to this diagnostic finding?
A) Hypoxia
B) Bacterial Infection
C) Viral Infection
D) Hypocoagulation
B) Bacterial Infection
An increase in neutrophil count most commonly occurs in response to infection or inflammation. Hypoxemia and coagulation do not directly affect neutrophil production.
Before beginning a transfusion of RBCs, which of the following actions by the nurse should be of highest priority to avoid an error during this procedure?
A) Check the identifying information on the unit of blood against the client’s ID bracelet.
B) Select new primary IV tubing primed with lactated Ringer’s solution to use for the transfusion.
C) Remain with the client for 60 minutes after beginning the transfusion to watch for signs of a transfusion reaction.
D) Add the blood transfusion as a secondary line to the existing IV and use the IV controller to maintain correct flow.
A) Check the identifying information on the unit of blood against the client’s ID bracelet.
The client’s identifying information (name, date of birth, medical record number) on the ID bracelet should exactly match the information on the blood bank tag that has been placed on the unit of blood. If any information does not match, the transfusions should not be hung because of possible error and risk to the client.
The nurse is assessing the cardiovascular status of a client and performs auscultation. Which of the following practices should the nurse implement into the assessment during auscultation?
A) Position the client supine.
B) Ask the client to hold his or her breath.
C) Palpate the radial pulse while auscultating the apical pulse.
D) Use the bell of the stethoscope when auscultating S1 and S2.
C) Palpate the radial pulse while auscultating the apical pulse
In order to detect a pulse deficit, simultaneously palpate the radial pulse when auscultating the apical area. The diaphragm is more appropriate than the bell when auscultating S1 and S2. A sitting or side-lying position is most appropriate for cardiac auscultation. It is not necessary to ask the client to hold his or her breath during cardiac auscultation.
The nurse is reviewing medication instructions with a client who has hypertension and is being discharged. Which of the following statements would be best for the nurse to make when discussing metolazone (diuretic)?
A) “A fast heart rate is an adverse effect to watch for while taking metolazone.”
B) “Stop the drug and notify your doctor if you experience any nausea or vomiting.”
C) “Because this drug may affect the lungs in large doses, it may also help your breathing.”
D) “Make position changes slowly, especially when going from lying down to a standing position.”
D) “Make position changes slowly, especially when going from lying down to a standing position.”
Metolazone is a diuretic and can cause orthostatic hypotension. For this reason, the client should be instructed to rise slowly, especially when moving from a recumbent to a standing position.
***SELECT ALL THAT APPLY***
A client admitted with heart failure (HF) appears very anxious and complains of shortness of breath. Which of the following nursing actions would be appropriate to alleviate this client’s anxiety?
A) Position client in a semi-Fowler’s position.
B) Administer ordered morphine sulphate.
C) Position client on left side with head of bed flat.
D) Instruct client on the use of relaxation techniques.
E) Use a calm, reassuring approach while talking to client.
A) Position client in a semi-Fowler’s position.
B) Administer ordered morphine sulphate.
D) Instruct client on the use of relaxation techniques.
E) Use a calm, reassuring approach while talking to client.
Morphine sulphate reduces anxiety and may assist in reducing dyspnea. Relaxation techniques and a calm reassuring approach will also serve to reduce anxiety. The client should be positioned in semi-Fowler’s position to improve ventilation.
The nurse is caring for older-adult clients on a subacute, geriatric medical unit. Which of the following effects is aging likely to have on hematological function?
A) Hypercoagulability
B) Decreased Hemoglobin
C) Decreased Blood Volume
D) Decreased WBC
B) Decreased Hemoglobin
Older adults frequently experience decreased hemoglobin levels as a result of changes to erythropoiesis. Decreased blood volume, decreased WBCs, and alterations in coagulation are not considered to be normal, age-related hematological changes.
Which of the following clients is most likely to experience anemia with an etiology of increased destruction of red blood cells?
A) A 32-year-old African man who has a diagnosis of sickle cell disease
B) A 59-year-old man whose alcoholism has precipitated folic acid deficiency
C) A 30-year-old woman with a history of “heavy periods” accompanied by anemia
D) A 3-year-old child whose impaired growth and development is attributable to thalassemia
A) A 32-year-old African man who has a diagnosis of sickle cell disease
The etiology of sickle cell anemia involves increased hemolysis. Thalassemias and folic acid deficiencies cause a decrease in erythropoiesis, whereas the anemia surrounding menstruation is a direct result of blood loss.
The nurse is admitting a client to the emergency room who has symptoms of chest pain. Which of the following components of subsequent blood work is most clearly indicative of a myocardial infarction (MI)?
A) CK-MB
B) Troponin
C) Myoglobin
D) C-reactive protein
B) Troponin
Troponin is the biomarker of choice in the diagnosis of myocardial infarction (MI), with sensitivity and specificity that exceed those of CK-MB and myoglobin. CRP levels are not used to diagnose acute MI.
The nurse is caring for a client with hypertension who is scheduled to receive a dose of atenolol (beta blocker). The nurse should withhold the dose and consult the primary care provider for which of the following vital signs taken just before administration?
A) Pulse 48 beats/minute
B) Respirations 24 breaths/minute
C) Blood pressure 118/74 mm Hg
D) Oxygen saturation 93%
A) Pulse 48 beats/minute
Because atenolol is a α1-adrenergic blocking agent, it can cause hypotension and bradycardia as adverse effects. The nurse should withhold the dose and consult with the prescriber for parameters regarding pulse rate limits.
The nurse is admitting a client and notes clubbing of the client’s fingers. Based on this finding, which of the following disease processes should the nurse assess in the client?
A) Endocarditis
B) Acute renal failure
C) Myocardial infarction
D) Chronic thrombo-phlebitis
A) Endocarditis
Clubbing of the fingers is a loss of the normal angle between the base of the nail and the skin. This finding can be found in endocarditis, congenital defects, and prolonged oxygen deficiency.
***SELECT ALL THAT APPLY***
The nurse is caring for a client who has undergone a splenectomy as a result of injuries suffered in a motor vehicle accident. Which of the following phenomena is likely to result from the absence of the client’s spleen? (Select all that apply.)
A) Impaired fibrinolysis
B) Increased platelet levels
C) Increased eosinophil levels
D) Fatigue and cold intolerance
E) Impaired immunological function
B) Increased platelet levels
E) Impaired immunological function
Splenectomy can result in increased platelet levels and impaired immunological function as a consequence of the loss of storage and immunological functions of the spleen. Fibrinolysis, fatigue, and cold intolerance are less likely to result from the loss of the spleen since coagulation and oxygenation are not primary responsibilities of the spleen.
The nurse is caring for a client with a diagnosis of polycythemia vera. Which of the following actions should the nurse anticipate?
A) Encourage deep-breathing exercises and coughing.
B) Assist with or perform phlebotomy at the bedside
C) Teach the client how to maintain a low-activity lifestyle
D) Perform thorough and regularly scheduled neurological assessments
B) Assist with or perform phlebotomy at the bedside
Primary polycythemia may often require phlebotomy in order to reduce blood volume. The increased risk of thrombus formation that accompanies the disease requires regular exercises and ambulation. Deep-breathing and coughing exercises do not directly address the etiology or common sequelae of polycythemia, and neurological manifestations are not typical.
***SELECT ALL THAT APPLY***
Which of the following cardiovascular effects of aging should the nurse anticipate when providing care for older adults?
A) Arterial stiffening
B) Increased blood pressure
C) Increased amplitude of QRS complex
D) Decreased maximal heart rate
E) Increased recovery time from activity
A) Arterial stiffening
B) Increased blood pressure
D) Decreased maximal heart rate
E) Increased recovery time from activity
Well-documented cardiovascular effects of the aging process include arterial stiffening, possible increased blood pressure, and an increased amount of time that is required for recovery from activity. Maximal heart rate tends to decrease with age. Amplitude of QRS complex decreases rather than increase.
***MATH QUESTION***
The nurse is caring for a client newly diagnosed with heart failure (HF). The client is to receive a first dose of digoxin 0.125 mg IV push. An ampule containing 0.25 mg/mL is available. How many millilitres should the nurse draw up to administer the dose?
A) 0.5 mL
B) 0.6 mL
C) 1.2 mL
D) 1.4 mL
A) 0.5 mL
0.125 mg (dose desired) ÷ 0.25 mg/mL (dose available) = 0.5 mL.
The nurse is conducting a complete physical assessment on a client admitted with infective endocarditis. Which of the following findings is significant?
A) Respiratory rate of 18 and heart rate of 90
B) Regurgitant murmur at the mitral valve area
C) Heart rate of 94 and capillary refill time of 2 seconds
D) Point of maximal impulse palpable in fourth intercostal space
B) Regurgitant murmur at the mitral valve area
A regurgitant murmur would indicate valvular disease, which can be a complication of endocarditis. All the other findings are within normal limits.