Chapter 29 Assessment of Hematologic System PDF

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TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

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Chapter29:AssessmentofHematologicSystem TestBank MULTIPLECHOICE 1.Thenurseiscaringforapatientwhoisbeingdischargedafteranemergencysplenectomyfollowingan automobileaccident.Whichinstructionsshouldthenurseincludeinthedischargeteaching? a.

Watchforexcessbruising.

b.

Checkforswollenlymphnodes.

c.

Takeironsupplementstopreventanemia.

d.

Washhandsandavoidpersonswhoareill.

ANS:D Splenectomyincreasestheriskforinfection,especiallywithgram-positivebacteria.Therisksforlymphedema bleeding,andanemiaarenotincreasedafterapersonhasasplenectomy. DIF:CognitiveLevel:Apply(application)REF:592 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 2.Thenurseassessesapatientwhohasnumerouspetechiaeonbotharms.Whichquestionshouldthenurseask thepatient? a.

Doyoutakesalicylates?

b.

Areyoutakinganyoralcontraceptives?

c.

Haveyoubeenprescribedantiseizuredrugs?

d.

Howlonghaveyoutakenantihypertensivedrugs?

ANS:A Salicylatesinterferewithplateletfunctionandcanleadtopetechiaeandecchymoses.Antiseizuredrugsmay causeanemia,butnotclottingdisordersorbleeding.Oralcontraceptivesincreaseapersonsclottingrisk. Antihypertensivesdonotusuallycauseproblemswithdecreasedclotting. DIF:CognitiveLevel:Understand(comprehension)REF:eTable29-1 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 3.Anursereviewsthelaboratorydataforanolderpatient.Thenursewouldbemostconcernedaboutwhich finding? a.

Hematocritof35%

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b.

Hemoglobinof11.8g/dL

c.

Plateletcountof400,000/L

d.

Whitebloodcell(WBC)countof2800/L

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ANS:D BecausethetotalWBCcountisnotusuallyaffectedbyaging,thelowWBCcountinthispatientwould indicatethatthepatientsimmunefunctionmaybecompromisedandtheunderlyingcauseoftheproblemneed tobeinvestigated.Theplateletcountisnormal.Theslightdecreaseinhemoglobinandhematocritarenot unusualforanolderpatient. DIF:CognitiveLevel:Apply(application)REF:593 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 4.Apatientwithpancytopeniahasabonemarrowaspirationfromtheleftposterioriliaccrest.Whichaction wouldbeimportantforthenursetotakeaftertheprocedure? a.

Elevatetheheadofthebedto45degrees.

b.

Applyasterile2-inchgauzedressingtothesite.

c.

Useahalf-inchsterilegauzetopackthewound.

d.

Havethepatientlieontheleftsidefor1hour.

ANS:D Todecreasetheriskforbleeding,thepatientshouldlieontheleftsidefor30to60minutes.Afterabone marrowbiopsy,thewoundissmallandwillnotbepackedwithgauze.Apressuredressingisusedtocoverthe aspirationsite.Thereisnoindicationtoelevatethepatientshead. DIF:CognitiveLevel:Apply(application)REF:604 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 5.Thenurseassessesapatientwithperniciousanemia.Whichassessmentfindingwouldthenurseexpect? a.

Yellow-tingedsclerae

b.

Shiny,smoothtongue

c.

Numbnessoftheextremities

d.

Gumbleedingandtenderness

ANS:C

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Extremitynumbnessisassociatedwithcobalamin(vitaminB12)deficiencyorperniciousanemia.Lossofthe papillaeofthetongueoccurswithchronicirondeficiency.Yellow-tingedscleraisassociatedwithhemolytic anemiaandtheresultingjaundice.Gumbleedingandtendernessoccurwiththrombocytopeniaorneutropenia. DIF:CognitiveLevel:Apply(application)REF:596 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 6.Apatientscompletebloodcount(CBC)showsahemoglobinof19g/dLandahematocritof54%.Which questionshouldthenurseasktodeterminepossiblecausesofthisfinding? a.

Haveyouhadarecentweightloss?

b.

Doyouhaveanyhistoryoflungdisease?

c.

Haveyounoticedanydarkorbloodystools?

d.

Whatisyourdietaryintakeofmeatsandprotein?

ANS:B Thehemoglobinandhematocritresultsindicatepolycythemia,whichcanbeassociatedwithchronic obstructivepulmonarydisease(COPD).Theotherquestionswouldbeappropriateforpatientswhoareanemic DIF:CognitiveLevel:Apply(application)REF:599 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 7.ThenurseisreviewinglaboratoryresultsandnotesanaPTTlevelof28seconds.Thenurseshouldnotifythe healthcareproviderinanticipationofadjustingwhichmedication? a.

Aspirin

b.

Heparin

c.

Warfarin

d.

Erythropoietin

ANS:B Activatedpartialthromboplastintime(aPTT)assessesintrinsiccoagulationbymeasuringfactorsI,II,V,VIII, IX,X,XI,XII.aPTTisincreased(prolonged)inheparinadministration. aPTTisusedtomonitorwhetherheparinisatatherapeuticlevel(needstobegreaterthanthenormalrangeof 25to35sec).Prothrombintime(PT)andinternationalnormalizedratio(INR)aremostcommonlyusedtotest fortherapeuticlevelsofwarfarin(Coumadin).Aspirinaffectsplateletfunction.Erythropoietinisusedto stimulateredbloodcellproduction. DIF:CognitiveLevel:Apply(application)REF:600 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity

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8.Whenassessinganewlyadmittedpatient,thenursenotespalloroftheskinandnailbeds.Thenurseshould ensurethatwhichlaboratorytesthasbeenordered? a.

Plateletcount

b.

Neutrophilcount

c.

Whitebloodcellcount

d.

Hemoglobin(Hgb)level

ANS:D Palloroftheskinornailbedsisindicativeofanemia,whichwouldbeindicatedbyalowHgblevel.Platelet countsindicateapersonsclottingability.Aneutrophilisatypeofwhitebloodcellthathelpstofightinfection DIF:CognitiveLevel:Apply(application)REF:597 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 9.Thenurseexaminesthelymphnodesofapatientduringaphysicalassessment.Whichassessmentfinding wouldbeofmostconcerntothenurse? a.

A2-cmnontendersupraclavicularnode

b.

A1-cmmobileandnontenderaxillarynode

c.

Aninabilitytopalpateanysuperficiallymphnodes

d.

Firminguinalnodesinapatientwithaninfectedfoot

ANS:A Enlargedandnontendernodesaresuggestiveofmalignanciessuchaslymphoma.Firmnodesareanexpected findinginanareaofinfection.Thesuperficiallymphnodesareusuallynotpalpableinadults,butiftheyare palpable,theyarenormally0.5to1cmandnontender. DIF:CognitiveLevel:Apply(application)REF:596 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 10.Apatientwhohadatotalhipreplacementhadanintraoperativehemorrhage14hoursago.Which laboratoryresultwouldthenurseexpecttofind? a.

Hematocritof46%

b.

Hemoglobinof13.8g/dL

c.

Elevatedreticulocytecount

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

d.

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Decreasedwhitebloodcell(WBC)count

ANS:C Hemorrhagecausesthereleaseofreticulocytes(immatureredbloodcells)fromthebonemarrowinto circulation.Thehematocritandhemoglobinlevelsarenormal.TheWBCcountisnotaffectedbybleeding. DIF:CognitiveLevel:Understand(comprehension)REF:589 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 11.Thecompletebloodcount(CBC)indicatesthatapatientisthrombocytopenic.Whichactionshouldthe nurseincludeintheplanofcare? a.

Avoidintramuscularinjections.

b.

Encourageincreasedoralfluids.

c.

Checktemperatureevery4hours.

d.

Increaseintakeofiron-richfoods.

ANS:A Thrombocytopeniaisadecreasednumberofplatelets,whichplacesthepatientathighriskforbleeding. Neutropenicpatientsareathighriskforinfectionandsepsisandshouldbemonitoredfrequentlyforsignsof infection.Encouragingfluidintakeandiron-richfoodintakeisnotindicatedinapatientwith thrombocytopenia. DIF:CognitiveLevel:Apply(application)REF:600 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 12.Thehealthcareprovidersprogressnoteforapatientstatesthatthecompletebloodcount(CBC)showsa shifttotheleft.Whichassessmentfindingwillthenurseexpect? a.

Coolextremities

b.

Pallorandweakness

c.

Elevatedtemperature

d.

Lowoxygensaturation

ANS:C Thetermshifttotheleftindicatesthatthenumberofimmaturepolymorphonuclearneutrophils(bands)is elevatedandthatfindingisasignofinfection.Thereisnoindicationthatthepatientisatriskforhypoxemia, pallor/weakness,orcoolextremities. DIF:CognitiveLevel:Apply(application)REF:601

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TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 13.Thehealthcareproviderordersaliver/spleenscanforapatientwhohasbeeninamotorvehicleaccident. Whichactionshouldthenursetakebeforethisprocedure? a.

Checkforanyiodineallergy.

b.

Insertalarge-boreIVcatheter.

c.

PlacethepatientonNPOstatus.

d.

Assistthepatienttoaflatposition.

ANS:D Duringaliver/spleenscan,aradioactiveisotopeisinjectedIVandimagesfromtheradioactiveemissionare usedtoevaluatethestructureofthespleenandliver.AnindwellingIVcatheterisnotneeded.Thepatientis placedinaflatpositionbeforethescan. DIF:CognitiveLevel:Apply(application)REF:603 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 14.Apatientwithpancytopeniaofunknownoriginisscheduledforthefollowingdiagnostictests.Thenurse willprovideaconsentformtosignforwhichtest? a.

ABObloodtyping

b.

Bonemarrowbiopsy

c.

Abdominalultrasound

d.

Completebloodcount(CBC)

ANS:B Abonemarrowbiopsyisaminorsurgicalprocedurethatrequiresthepatientorguardiantosignasurgical consentform.Theotherproceduresdonotrequireasignedconsentbythepatientorguardian. DIF:CognitiveLevel:Apply(application)REF:603 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 15.Thenursereviewsthecompletebloodcount(CBC)andwhitebloodcell(WBC)differentialofapatient admittedwithabdominalpain.Whichinformationwillbemostimportantforthenursetocommunicatetothe healthcareprovider? a.

Monocytes4%

b.

Hemoglobin13.6g/dL

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c.

Plateletcount168,000/L

d.

Whitebloodcells(WBCs)15,500/L

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ANS:D TheelevationinWBCsindicatesthatthepatienthasaninflammatoryorinfectiousprocessongoing,which maybethecauseofthepatientspain,andthatfurtherdiagnostictestingisneeded.Themonocytesareata normallevel.Thehemoglobinandplateletcountsarenormal. DIF:CognitiveLevel:Apply(application)REF:601 OBJ:SpecialQuestions:PrioritizationTOP:NursingProcess:Assessment MSC:NCLEX:PhysiologicalIntegrity 16.Whichinformationshownintheaccompanyingfigureaboutapatientwhohasjustarrivedinthe emergencydepartmentismosturgentforthenursetocommunicatetothehealthcareprovider? a.

Plateletcount

b.

Whitebloodcellcount

c.

Historyofabdominalpain

d.

Bloodpressureandheartrate

ANS:A Theplateletcountisseverelydecreasedandplacesthepatientatriskforspontaneousbleeding.Theother informationisalsopertinent,butnotasindicativeoftheneedforrapidtreatmentastheplateletcount. DIF:CognitiveLevel:Analyze(analysis)REF:601 OBJ:SpecialQuestions:PrioritizationTOP:NursingProcess:Assessment MSC:NCLEX:PhysiologicalIntegrity...