Chapter 29: Hematologic System Introduction

Linton: Medical-Surgical Nursing, 7th Edition

MULTIPLE CHOICE

1. Which is considered an approximate normal hematocrit value?

a. Three times the hemoglobin value
b. The same as the hemoglobin value
c. Four times lower than the red blood cell count
d. Same as the red blood cell count
ANS: A
Hematocrit is approximately three times the hemoglobin value.

DIF: Cognitive Level: Knowledge REF: p. 533|p. 535

OBJ: 3 TOP: Normal Laboratory Values
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. A nurse is caring for a patient receiving a transfusion and assesses that the patient is wheezing
and is complaining of back pain. What nursing action should take place after stopping the
transfusion?
a. Discontinue the intravenous (IV) transfusion.
b. Notify the charge nurse.
c. Administer heparin.
d. Raise the patient’s head.
ANS: B
The charge nurse should be notified immediately after the transfusion is stopped. The charge
nurse will notify the physician and the laboratory or blood bank. The head of the bed should
be raised to aid in respiration, and oxygen should be administered in high doses. The blood
tubing and bag should not be discarded because the blood bank will want it to check the
accuracy of the typing.

DIF: Cognitive Level: Application REF: p. 539 OBJ: 4

TOP: Blood Transfusion Reactions KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

3. A nurse is taking the history of a patient who has come in for evaluation of large areas of
purpura on her limbs. The patient reports using alternative therapy for her menopausal
symptoms. What alternative therapy is most likely responsible for the patient’s symptoms?
a. Black cohosh
b. Valerian
c. Lavender
d. Rosemary
ANS: A
Black cohosh interferes with blood clotting.

DIF: Cognitive Level: Comprehension REF: p. 533 OBJ: 2

TOP: Alternative Remedies KEY: Nursing Process Step: Assessment
 MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

4. To what level should the platelet count rise when the patient with a platelet count of
20,000/mm3 receives 1 unit of platelets?
a. 25,000 to 30,000/mm3
b. 35,000 to 40,000/mm3
c. 45,000 to 50,000/mm3
d. 55,000 to 100,000/mm3
ANS: A
Platelet transfusions are given when the platelet count falls below 20,000/mm3. One unit is
expected to raise the count by 5000 to 10,000/mm3.

DIF: Cognitive Level: Knowledge REF: p. 538 OBJ: 4

TOP: Platelet Transfusion KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

5. When a nurse is preparing to give ferrous sulfate (Feosol) to a home health care patient, what
is the most appropriate nursing action to implement?
a. Mix the drug with a high-protein milkshake.
b. Give it undiluted with a small snack.
c. Mix it with coffee or cola to disguise the bitter taste.
d. Dilute it and offer through a straw and a few crackers.
ANS: D
Patients should avoid taking iron with milk or caffeine because both inhibit drug absorption.
The liquid form of the drug is offered with food in a diluted form through a straw to prevent
staining the teeth.

DIF: Cognitive Level: Application REF: p. 541 OBJ: 4

TOP: Administration of Feosol KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

6. A nurse is completing an initial assessment on a new patient being seen in the hospital clinic.
The presentation of this female patient includes vague symptoms of tiredness and large areas
of ecchymosis. Which question is most important for the nurse to ask?
a. “Are you allergic to anything?”
b. “Do your gums easily bleed?”
c. “How many hours do you sleep?”
d. “How frequent are your periods?”
ANS: B
Bleeding gums are indicative of general bleeding tendencies. Sleep and frequency of
menstrual periods are not significant, but the heaviness of the period is significant. History
can reveal information pertinent to assisting the physician in making a diagnosis.

DIF: Cognitive Level: Application REF: p. 531 OBJ: 2

TOP: Assessment of Patients with Hematologic Disorders
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
7. A nurse is assessing a patient 20 minutes after a bone marrow biopsy. Which statement by the
patient is cause for the most concern?
a. “There is fresh blood on my dressing.”
b. “I am thirsty.”
c. “My hip feels bruised where they stuck the needle.”
d. “I had a sharp pain in my leg when they pulled the needle out.”
ANS: A
Fresh blood on the pressure dressing 20 minutes after the aspiration needs to be addressed.
Usually, redressing with a pressure dressing and an ice pack is sufficient. Feelings of bruising
and pain on extraction are to be expected. Thirst is of no clinical significance.

DIF: Cognitive Level: Application REF: p. 535 OBJ: 3

TOP: Diagnostic Tests KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

8. At 1000 a nurse receives 2 units of blood for a patient to be transfused. What is the most
appropriate nursing action?
a. Set up 1 unit for the infusion to start by 1030 and send the other unit back until the
first one has infused.
b. Set up both units to infuse at the same time and to start at 1100.
c. Set up one unit for infusion and place the other in the refrigerator for the later
infusion.
d. Send both units back and ask for a reissue of 1 unit only.
ANS: A
Blood must be started within 30 minutes of its receipt after it has been checked by two
licensed staff members. In many settings, licensed practical nurses do not start the blood but
can set up the infusion. The best option is to send the second unit back immediately, with an
explanation that it will be called for later. One unit of blood usually takes about 2 to 4 hours to
infuse.

DIF: Cognitive Level: Application REF: p. 538 OBJ: 4

TOP: Transfusion Protocol KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

9. A nurse is giving iron dextran intramuscularly (IM). Why should the nurse implement the Z-
track method?
a. Makes the injection less painful
b. Prevents staining of the skin
c. Prevents postinjection pain
d. Allows another injection to be given at the same location
ANS: B
The Z-track method only ensures that no iron will be staining the skin after injection. The
amount of pain is the same and, after all IM injections, the needle is cleaned on withdrawal.
Injections are never given at recent injection sites.

DIF: Cognitive Level: Comprehension REF: p. 541 OBJ: 4

TOP: Z-Track Method KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
 10. What is the major difference between fresh-frozen plasma (FFP) and cryoprecipitate (CPP)?
a. FFP contains more albumin.
b. FFP has a longer infusion time.
c. FFP contains no platelets.
d. FFP has a very high probability of causing an allergic reaction.
ANS: C
FFP contains no platelets.

DIF: Cognitive Level: Knowledge REF: p. 537 OBJ: 3

TOP: FFP versus CPP KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

MULTIPLE RESPONSE

1. What medical history information is significant to potential bleeding problems? (Select all that
apply.)
a. Drinks two glasses of wine a day
b. Eats red meat three times a week
c. Takes nonsteroidal anti-inflammatory drugs (NSAIDs) for the relief of arthritic
pain four times a day
d. Has hepatitis B
e. Had a cardiac valve replaced 6 months earlier
ANS: C, D, E
NSAIDs and liver disorders enhance the probability of bleeding. The valve replacement of a
few months earlier suggests that the patient is using anticoagulant drugs.

DIF: Cognitive Level: Comprehension REF: p. 531 OBJ: 2

TOP: Factors Predisposing to Bleeding Tendency
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

COMPLETION

1. A nurse plans the interventions to prepare a patient for a bone marrow aspiration. _____
(Place the options in the correct sequence. Do not separate answers with a space or
punctuation. Example: ABCD.)
a. Assist the patient to lie on his or her abdomen and drape the hip and lower limbs.
b. Confirm the presence of laboratory personnel to stain the specimen.
c. Apply a pressure dressing and help the patient lie on his or her back.
d. Ensure that a signed permission form is obtained.
e. Explain that the procedure will take about 30 minutes.

ANS:
EDABC
The appropriate sequence is the following: (1) explain the procedure; (2) when the patient
indicates an understanding, obtain a signed permission form; (3) assist the patient to lie on his
or her abdomen and drape the hip and lower extremities; (4) confirm the presence of
laboratory personnel to stain the specimen; and (5) apply a pressure dressing and help the
patient lie on his or her back.

DIF: Cognitive Level: Application REF: p. 535 OBJ: 3

TOP: Bone Marrow Aspiration Preparation
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control