Which action is a priority when a nurse is preparing to administer a transfusion of platelets quizlet?
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Medical Language for Modern Health Care4th EditionDavid M Allan, Rachel Basco 2,732 solutions 1. A nurse caring for a client with sickle cell disease (SCD) reviews the clients laboratory work. Which finding a. Creatinine: 2.9 mg/dL a. Creatinine: 2.9 mg/dL An elevated creatinine indicates kidney damage, which occurs in SCD. A hematocrit level of 30% is an expected finding, as is a
slightly elevated white blood cell count. A sodium level of 147 mEq/L, although 2. A client hospitalized with sickle cell crisis frequently asks for opioid pain medications, often shortly after a. Give the client pain medication if it is time for
another dose. a. Give the client pain medication if it is time for another dose. Clients with sickle cell crisis often have severe pain that is managed with up to 48 hours of IV opioid analgesics. Even if the client is addicted and drug seeking, he or she is
still in extreme pain. If the client can receive another dose of medication, the nurse should provide it. The other options are judgmental and do not 3. A client in sickle cell crisis is dehydrated and in the emergency department. The nurse plans to start an IV. Which fluid choice is best? a. 0.45% normal saline a. 0.45% normal saline Because clients in sickle cell crisis are often dehydrated, the fluid of choice is a hypotonic solution such as 4. A client presents to the emergency department in sickle cell crisis. What intervention by the nurse takes a.
Administer oxygen. a. Administer oxygen. All actions are appropriate, but remembering the ABCs, oxygen would come first. The main problem in a 5. A client has a serum ferritin level of 8 ng/mL and microcytic red blood cells. What action by the nurse is best? a. Encourage high-protein foods. b. Perform a Hemoccult test on the clients stools. This client has laboratory findings indicative of iron deficiency anemia. The most common cause of this disorder is blood loss, often from the GI tract. The nurse should perform a Hemoccult test on
the clients stools. High-protein foods may help the condition, but dietary interventions take time to work. That still does not 6. A client has Crohns disease. What type of anemia is this client most at risk for developing? a. Folic acid deficiency a. Folic acid deficiency Malabsorption syndromes such as Crohns disease leave a client prone to folic acid deficiency. Fanconis anemia, hemolytic anemia, and vitamin B12 anemia are not related to Crohns disease. 7. A nurse in a hematology clinic is working with four clients who have polycythemia vera. Which client a. Client with a blood pressure of 180/98 mm Hg b. Client who reports shortness of breath Clients with polycythemia vera often have clotting abnormalities due to the hyperviscous blood with sluggish flow. The client reporting shortness of breath may have a pulmonary embolism and should be seen first. The 8. A nursing student is caring for a client with leukemia. The student asks why the client is still at risk for infection when the clients white blood cell count (WBC) is high. What response by the registered nurse is best? a. If the WBCs are high, there already is an infection present. d. Those WBCs are abnormal and dont provide protection. In leukemia, the WBCs are abnormal and do not provide protection to the client against infection. The other statements are not accurate. 9. The family of a neutropenic client reports the client is not acting right. What
action by the nurse is the a. Ask the client about pain. b. Assess the client for infection. Neutropenic clients often do not have classic manifestations of infection, but infection is the most common cause of death in neutropenic clients. The nurse should assess for infection. The nurse should assess for pain but this is not the priority. The nurse should take the clients vital signs instead of delegating them since the client has had a change in status. Laboratory results may be inconclusive. 10. A nurse is caring for a client who is about to receive a bone marrow transplant. To best help the client cope a. Arrange a visitation schedule among friends and family. c. Help the client find things to hope for each day of recovery. Providing hope is an essential nursing function during treatment for any disease process, but especially during the recovery period after bone marrow transplantation, which can take up to 3 weeks. The nurse can
help the 11. A nursing student is struggling to understand the process of graft-versus-host disease. What explanation by the nurse instructor is best? a. Because of immunosuppression, the donor cells take over. d. The donors cells are actually attacking the clients cells. Graft versus host disease is an autoimmune-type process in which the donor cells recognize the clients cells as foreign and begin attacking them. The other answers are not accurate. 12. The nurse is caring for a client with leukemia who has the priority problem of fatigue. What action by the client best indicates that an important goal for this problem has been met? a. Doing activities of daily living (ADLs) using rest periods a. Doing activities of daily living (ADLs) using rest periods Fatigue is a common problem for clients with leukemia. This client is managing his or her own ADLs using rest periods, which indicates an understanding of fatigue and how to control it. Helping to plan an activity 13. A nurse is caring for a young male client with lymphoma who is to begin treatment. What teaching topic is a. Genetic testing c. Sperm banking All teaching topics are important to the client with lymphoma, but for a young male, sperm banking is of particular concern if the client is going to have radiation to the lower abdomen or pelvis. 14. A client has been admitted after sustaining a humerus fracture that occurred when picking up the family a. Bence-Jones protein in urine a. Bence-Jones protein in urine This client has possible multiple myeloma. A positive Bence-Jones protein finding would correlate with this 15. A client with multiple myeloma demonstrates worsening bone density on diagnostic scans. About what a. Bortezomib (Velcade) d. Zoledronic acid (Zometa) All the options are drugs used to treat multiple myeloma, but the drug used specifically for bone manifestations is zoledronic acid (Zometa), which is a bisphosphonate. This drug class inhibits bone resorption and is used to 16. A client with autoimmune idiopathic thrombocytopenic purpura (ITP) has had a splenectomy and
returned a. Preparing to administer a blood transfusion d. Taking a set of vital signs and notifying the surgeon While some bloody drainage on a new surgical dressing is expected, a saturated dressing is not. This client is already at high risk of bleeding due to the ITP. The nurse should assess vital signs for shock and notify the surgeon immediately. The client may or may not need a transfusion. Reinforcing the dressing is an appropriate action, but the nurse needs to do more than document afterward. Removing the dressing increases the risk of infection; plus, it is not needed since the nurse knows where the bleeding is coming from. 17. A client has a platelet count of 9000/mm3. The nurse finds the client confused and mumbling. What action a. Calling the Rapid Response Team a. Calling the Rapid Response Team With a platelet count this low, the client is at high risk
of spontaneous bleeding. The most disastrous complication would be intracranial bleeding. The nurse needs to call the Rapid Response Team as this client has manifestations of a sudden neurologic change. The nurse should not delegate the vital signs as the client is 18. A nurse is preparing to administer a blood transfusion. What action is most important? a. Correctly identifying client using two identifiers b. Ensuring informed consent is obtained if required If the facility requires informed consent for transfusions, this action is most important because it precedes the other actions taken during the transfusion. Correctly identifying the client and blood product is a National Patient Safety Goal, and is the most important action after obtaining informed consent. Ringers lactate is not used to transfuse blood. The nurse does not need to stay with the client for the duration of the transfusion. 19. A nurse is preparing to hang a blood transfusion. Which action is most important? a. Documenting the transfusion d. Putting on a pair of gloves To prevent bloodborne illness, the nurse should don a pair of gloves prior to hanging the blood. Documentation is important but not the priority at this point. NPO status and isolation are not needed.
20. A client receiving a blood transfusion develops anxiety and low back pain. After stopping the transfusion, what action by the nurse is most important? a. Documenting the events in the clients medical record b. Double-checking the client and blood product identification This client had a hemolytic transfusion reaction, most commonly caused by blood type or Rh incompatibility. 21. A client has thrombocytopenia. What client statement
indicates the client understands self-management of a. I brush and use dental floss every day. c. I usually put ice on bumps or bruises. The client should be taught to apply ice to areas of minor trauma. Flossing is not recommended. Hard foods should be avoided. The client should wear well-fitting shoes when ambulating. 22. A client has a sickle cell crisis with extreme lower extremity pain. What comfort measure does the nurse a. Apply ice packs to the clients legs. c. Keep the lower extremities warm. During
a sickle cell crisis, the tissue distal to the occlusion has decreased blood flow and ischemia, leading to pain. Due to decreased blood flow, the clients legs will be cool or cold. The UAP can attempt to keep the 23. A client admitted for sickle cell crisis is distraught after learning her
child also has the disease. What a. Both you and the father are equally responsible for passing it on. b. I can see you are upset. I can stay here with you a while if you like. The best
response is for the nurse to offer self, a therapeutic communication technique that uses presence. 24. A client with sickle cell disease (SCD) takes hydroxyurea (Droxia). The client presents to the clinic reporting an increase in fatigue. What laboratory result should the nurse report immediately? a. Hematocrit: 25% d. White blood cell count: 38,000/mm3 Although individuals with SCD often have elevated white blood cell (WBC) counts, this extreme elevation could indicate leukemia, a complication of taking hydroxyurea. The nurse should
report this finding immediately. Alternatively, it could indicate infection, a serious problem for clients with SCD. Hematocrit and 25. A nurse is caring for four clients with leukemia. After hand-off report, which client should the nurse see a. Client who had two bloody diarrhea stools this
morning a. Client who had two bloody diarrhea stools this morning The client who had two bloody diarrhea stools that morning may be hemorrhaging in the gastrointestinal (GI) 26. A client has frequent hospitalizations for leukemia and is worried about functioning as a parent to four small children. What action by the nurse would be most helpful? a. Assist the client to make sick day plans for household responsibilities. a. Assist the client to make sick day plans for household responsibilities. While all options are reasonable choices, the best option is to help the client make sick day plans, as that is more comprehensive and inclusive than the other options, which focus on a single item. 27. A client has been treated for a deep vein thrombus and today presents to the clinic with petechiae. a. Enoxaparin (Lovenox) c. Unfractionated heparin This client has manifestations of heparin-induced thrombocytopenia. Enoxaparin, salicylates, and warfarin do not cause this condition. 28. The nurse assesses a clients oral cavity and makes the discovery shown in the photo below: What action by the nurse is most appropriate? a. Encourage the client to have genetic testing. d. Teach the client about cobalamin therapy. This condition is known as glossitis, and is characteristic of B12 anemia. If the anemia is a pernicious anemia, 1. A nurse working with clients with sickle cell
disease (SCD) teaches about self-management to prevent a. Dehydration a. Dehydration Several factors cause red blood cells to sickle in SCD, including dehydration, extreme stress, high altitudes, 2. A student studying leukemias learns the risk factors for developing this disorder. Which risk factors does a. Chemical exposure a. Chemical exposure Chemical and ionizing radiation exposure and viral infections are known risk factors for developing leukemia. Eating genetically modified food and receiving vaccinations are not known risk factors. 3. A client has Hodgkins lymphoma, Ann Arbor stage Ib. For what manifestations should the nurse assess the client? (Select all that apply.) a. Headaches b. Night sweats In this stage, the disease is located in a single lymph node region or a single nonlymph node site. The client displays night sweats, persistent fever, and weight loss. Headache and urinary problems are not related. 4. A client has a platelet count of 25,000/mm3. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Assist with oral hygiene using a firm toothbrush. c. Help the client choose soft foods from the menu. This client has thrombocytopenia and requires bleeding precautions. These include oral hygiene with a softbristled 5. A student nurse is helping a registered nurse with a blood transfusion. Which actions by the student are most appropriate? (Select all that apply.) a. Hanging the blood product using normal saline and a filtered tubing set a.
Hanging the blood product using normal saline and a filtered tubing set Correct actions prior to beginning a blood transfusion include hanging the product with saline and the correct 6. A student nurse is learning about blood transfusion compatibilities. What information does this include? a. Donor blood type A can donate to recipient blood type AB. a. Donor blood type A can donate to recipient blood type AB. Blood type A can be donated to people who have blood types A or AB. Blood type O can be given to anyone. 7. A client with chronic anemia has had many blood transfusions. What medications does the nurse anticipate a. Azacitidine (Vidaza) b. Darbepoetin alfa (Aranesp) Darbepoetin alfa and epoetin alfa
are both red blood cell colony-stimulating factors that will help increase the 8. A nurse is preparing to administer a blood transfusion to an older adult. Understanding age-related changes, a. Assess vital signs more often. a. Assess vital signs more often. The older adult needs vital signs monitored as often as every 15 minutes for the duration of the transfusion because changes may be the only indication of a
transfusion-related problem. To prevent fluid overload, the nurse obtains a prescription to hold other running IV fluids during the transfusion. The other options are not 9. A client has heparin-induced thrombocytopenia (HIT). The student nurse asks how this is treated. About a. Argatroban (Argatroban) a. Argatroban (Argatroban) The standard drugs used to treat HIT are argatroban, bivalirudin, and lepirudin. The other drugs are not used. 10. A client has received a bone marrow transplant and is waiting for engraftment. What actions by the nurse a. Not allowing any visitors until engraftment c. Placing
the client in protective precautions The client waiting for engraftment after bone marrow transplant has no white cells to protect him or her against infection. The client is on protective precautions and visitors are taught hand hygiene. No fresh flowers or plants are allowed due to the standing water in the vase or container that may harbor organisms. Limiting SG 1. The nurse is assessing a patient who is newly diagnosed with anemia. Which assessment findings are typical of this disorder? Select all that apply. a. Dyspnea on exertion a. Dyspnea on exertion SG 2. A patient with sickle cell crisis is admitted to the hospital. Which questions does the nurse ask the patient to elicit information about the cause of the current crisis? Select all that apply. a. "Have you recently traveled on an airplane?" a. "Have you recently traveled on an airplane?" SG 3. A patient is scheduled to undergo diagnostic testing for sickled cell anemia. Which educational brochure is the nurse most likely to provide to the patient? a. "What to Expect During a Bone Marrow Biopsy" d. "How Is Hemoglobin S Used to Confirm My Diagnosis?" SG 4. The student nurse is caring for a patient in sickle cell crisis. Which action by the student nurse warrants intervention by the supervising nurse? a. Turning down the thermostat to a cooler temperature. a. Turning down the thermostat to a cooler temperature. SG 5. The nurse has taught the patient about dietary modifications for his vitamin B12 deficiency anemia. Which statement by the patient indicates that additional teaching is needed? a. "Dairy products are a good source of vitamin B12." c. "Leafy green vegetables interfere with my therapy." SG 6. Which patient is most likely to have severe manifestations of sickle cell disease even when triggering conditions are mild? a. Mother and father both have hemoglobin S gene alleles. a. Mother and father both have hemoglobin S gene alleles. SG 7. The nurse is caring for a patient in sickle cell crisis. What are the priority interventions for this patient? Select all that apply. a. Managing pain a. Managing pain SG 8. The unlicensed assistive personnel (UAP) is assisting in the care of a patient in sickle cell crisis. Which action by the UAP requires intervention by the supervising nurse? a. Elevating the head of the bed to 25
degrees c. Obtaining the blood pressure with an external cuff SG 9. A patient admitted for sickle cell crisis is being discharged home. Which statement by the patient indicates the need for further post-discharge instructions? a. "I will walk rather
than jog every morning". b. "I will visit my friends in Denver." SG 10. A patient has polycythemia vera. Which action by unlicensed assistive personnel requires intervention by the supervising nurse? a. Assisting the patient to floss his teeth a. Assisting the patient to floss his teeth SG 11. Which abnormal vital sign is the nurse most likely to see in a patient who has polycythemia vera? a. Elevated temperature c. Increased blood pressure SG 12. Which food should a patient with a low white blood cell count be encouraged to eat? a. Fresh blueberries d. Baked chicken SG 13. The nurse is caring for a patient with acute leukemia. Which signs/symptoms is the nurse most likely to observe during the assessment? Select all that apply. a. Hematuria a. Hematuria SG 14. In caring for a patient with acute leukemia, what is the priority collaborative problem? a. Protecting the patient from infection a. Protecting the patient from infection SG 15. The nurse is helping a patient prepare for induction therapy for acute leukemia. What information will the nurse give to the patient? a. A donor is needed for hematopoietic stem cell transplantation. b. Prolonged hospitalization is common to protect against infection. SG 16. Which factors are associated with an increased risk for non-Hodgkin's lymphoma? Select all that apply. a. Immunosuppressive disorders a. Immunosuppressive disorders SG 17. Which disorder poses the greatest risk of infection for the patient? a. Sickle
cell crisis a. Sickle cell crisis SG 18. Which medication increases the risk for the patient to develop infection? a. Glucocorticoids a. Glucocorticoids SG 19. The nurse is caring for a patient with thrombocytopenia. Which order does the nurse question? a. Test all urine and stool for occult blood. c. Administer enemas. SG 20. A patient has the signs/symptoms of hereditary hemochromatosis. The health care provider asks the nurse to immediately report relevant laboratory results, so the diagnosis can be confirmed. Which laboratory result is the health care provider waiting for? a. Complete blood count b. Blood ferritin level SG 21. The home care nurse is visiting a patient who had a stem cell transplant. Which observation by the nurse requires immediate action? a. The patient's grandson is
visiting after receiving a measles, mumps, and rubella vaccine. a. The patient's grandson is visiting after receiving a measles, mumps, and rubella vaccine. SG 22. A patient has been taught how to care for his central venous catheter at home. Which statement by the patient indicates that further instruction is necessary? a. "I will flush the catheter with heparin once a day and after infusions." a. "I will flush the catheter with heparin once a day and after infusions." SG 23. The nurse has instructed a patient at risk for bleeding about techniques to manage bleeding. Which statements by the patient indicate that teaching has been successful? Select all that apply. a. "I will take a stool softener to prevent straining during a bowel movement." a. "I will take a stool softener to prevent straining during a bowel movement." SG 24. The new registered nurse is giving a blood transfusion to a patient. Which statement by the new nurse indicates the need for action by the supervising nurse? a. "I will complete the red blood cell transfusion within 6 hours." a. "I will complete the red blood cell transfusion within 6 hours." SG 25. The new registered nurse is identifying a patient for blood transfusion. Which action by the new nurse warrants intervention by the supervising nurse? a. Checks the health care provider's order before the blood transfusion. c. Cross-checks the patient's room number as a form of identification. SG 26. A patient with lymphoma requires a hematopoietic stem cell transplant, and a donor is being sought. Which type of transplant is likely to yield the best results? a. Partially HLA-matched unrelated donor. b. HLA-identical twin sibling. SG 27. The home health nurse is visiting a patient who was recently treated for leukemia. The patient says he feels fine and has been carefully following all discharge instructions. The patient's temperature is 1°F (or 0.5°C) above baseline. What should then nurse do? a. Tell the patient to recheck the temperature in 4 hours. c. Initiate standard infection control and call the health care provider. SG 28. During an employee health physical assessment, the patient reports noticing a large lymph node about a month ago. The patient states, "it doesn't hurt so I just ignored it." What questions would the nurse ask to find out if the patient has any of the constitutional symptoms of lymphoma? Select all that apply. a. "Have you had any unplanned weight loss?" a. "Have you had any unplanned weight loss?" SG 29. Which hematologic disorder is most likely to cause the patient to have joint problems? a.
Thrombocytopenia c. Hemophilia SG 30. A patient is at high risk for the development of venoocclusive disease. What assessments does the nurse perform for early detection of this disorder? Select all that apply. a. Joint pain b. Weight gain SG 31. Which person is most likely to benefit from a referral for genetic counseling? a. Young woman who has an older brother who has hemophilia A a. Young woman who has an older brother who has hemophilia A SG 32. The nurse hears in report that the patient is diagnosed with autoimmune thrombocytopenic purpura. Which instruction is the nurse most likely to give to unlicensed assistive personnel? a. Handle the patient very gently to minimize bruising. a. Handle the patient very gently to minimize bruising. SG 33. Which patient has the greatest risk for developing a febrile transfusion reaction? a. Patient is an older adult, and transfusion was given too rapidly. c. Patient has received multiple blood transfusions for chronic bleeding. SG 34. Which electrolyte imbalance can occur related to a blood transfusion? a. Hyponatremia b. Hyperkalemia SG 35. A patient is receiving a red blood cell transfusion through a double-lumen peripherally inserted central catheter. The patient has two other peripheral IVs: one is capped and the other has D5/.45 NS running at a rate of 50mL/hr. What can be given concurrently through the line that is selected for the red cell transfusion? a. Normal saline a. Normal saline SG 36. Which blood product is most likely to have stricter monitoring policies requiring that a physician be present on the unit during administration? a. Packed red blood cell transfusion
b. White blood cell transfusion SG 37. To avoid transfusion reaction, the nurse is carefully monitoring the patient during a blood transfusion. When are hemolytic reactions to blood transfusion most likely to occur? a. 1 mL is sufficient c. Within the first 50mL SG 38. Which types of medications are used as premedication to prevent a reaction for patients receiving a stem cell transfusion? a. Vitamin K and a diuretic c. Diphenhydramine and acetaminophen SG 39. An older patient is receiving a blood transfusion. Which signs/symptoms suggest that the patient is experiencing transfusion-associated circulatory overload? a. Hypertension, bounding pulse, and distended neck veins a. Hypertension, bounding pulse, and distended neck veins SG 40. Then nurse is performing the immediate post-procedure care for a bone marrow donor. What is the priority assessment that the nurse will perform? a. Monitoring for activity intolerance. c. Monitoring for fluid loss. SG 41. The experienced nurse is supervising a new graduate nurse during administration of a blood product. In which circumstance would the experienced nurse intervene? a. New graduate nurse
prepares to use blood administration tubing to infuse stems cells. a. New graduate nurse prepares to use blood administration tubing to infuse stems cells. SG 42. Which outcome statement indicates successful engraftment of transplanted cells in the patient's bone marrow? a. There is no evidence of graft-versus-host disease. b. White blood cell, red blood cell, and platelet counts are rising. SG 43. The nurse would measure abdominal girth to monitor for which complication of hematopoietic stem cell transplantation? a. Failure to engraft c. Venoocclusive disease SG 44. A patient reports fatigue, bone pain, and frequent bacterial infections. Further investigation reveals anemia and hypercalcemia, and x-ray findings show bone thinning with areas of bone loss that resemble Swiss cheese. The signs/symptoms and diagnostic findings are consistent with which disorder? a. Acute leukemia b. Multiple myeloma SG 45. A patient with acute leukemia has been receiving an erythropoiesis-stimulating agent (ESA). The nurse sees that the hemoglobin level is 10.5mg/dL. Why does the nurse call the health care provider to have the ESA discontinued? a. The hemoglobin level is below normal limits, and this increases the risk for side effects. c. ESAs can cause hypertension and increase the risk for myocardial infarction. SG 46. The nurse has just received a handoff report and is planning care for several patients who must receive blood products during the shift. Which patient will require the most monitoring for the longest period of time? a. Young woman needs a unit of packed red blood cells for a
hemoglobin of 5mg/dL. d. Patient with thrombotic thrombocytopenic purpura needs fresh frozen plasma. SG 47. What instructions would the home health nurse give to the home health aide about helping a patient who needs to conserve energy? a. Assist the patient to complete activities and exercises when he gets short of breath. d. Offer 4-6 small, easy-to-eat meals rather than serving three large meals. SG 48. The patient is diagnosed with hereditary hemochromatosis. Which therapy does the nurse expect will be prescribed for this patient? a. Interferon alfa therapy to control RBC production. c. Phlebotomy to reduce overall iron load of the blood SG 49. Which lab values would the nurse expect to see for a patient with sickle cell disease? Select all that apply. a. 80% hemoglobin S a. 80% hemoglobin S SG 50. What is the first priority intervention when the nurse recognizes that a patient is having a transfusion reaction? a. Stop the transfusion. a. Stop the transfusion
SG 51. A patient scheduled for surgery tells the nurse that he is fearful of the possibility of needing a blood transfusion. What is the nurse's best response? a. "Have you spoken with your health care provider about a family member donating blood for your transfusion?" c. "Autologous transfusion, where you donate your own blood for later transfusion, may be an option for you." Which action is a priority when a nurse is preparing to administer a transfusion of platelets?The nurse should obtain the client's vital signs immediately before starting a blood product infusion. The nurse should obtain the client's vital signs again after 15 min of infusion time.
Which is an essential nursing action prior to starting a blood transfusion?The patient's blood pressure, pulse, respirations, and temperature must be taken and recorded within 60 minutes prior to the transfusion. The pretransfusion vital signs provide a baseline for comparison data obtained during and after transfusion.
When administering a transfusion the blood should initially be started slowly to?4. When administering a transfusion, the blood should initially be started slowly to: Detect transfusion reactions and intervene early before too much blood is transfused.
Which action would the nurse take when administering a transfusion of 2 units of packed red blood cells Prbcs to a client quizlet?Wait 2 hours between infusing the two units of packed RBC's. Rationale: If possible, the nurse should wait 2 hr to elapse after the administration of the first unit of packed RBCs before beginning to infuse the second unit. This will decrease the client's risk of fluid overload.
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