Chapter 39 Assessment of the Hematologic System PDF

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TestBank-Medical-SurgicalNursing:ConceptsforInterprofessionalCollaborativeCare9e

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Chapter39:AssessmentoftheHematologicSystem MULTIPLECHOICE 1.Anursingstudentwantstoknowwhyclientswithchronicobstructivepulmonarydiseasetendtobe polycythemic.Whatresponsebythenurseinstructorisbest? a.Itisduetosideeffectsofmedicationsforbronchodilation. b.Itisfromoveractivebonemarrowinresponsetochronicdisease. c.Itcombatstheanemiacausedbyanincreasedmetabolicrate. d.Itcompensatesfortissuehypoxiacausedbylungdisease. ANS:D Inresponsetohypoxia,moreredbloodcellsaremadesomoreoxygencanbecarriedanddeliveredtotissues. Thisisaphysiologicprocessinresponsetothedisease;itisnotamedicationsideeffect,theresultof overactivebonemarrow,oraresponsetoanemia. DIF:Remembering/KnowledgeREF:797 KEY:Hematologicsystem|pathophysiology MSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation 2.Aclientisreceivingrivaroxaban(Xarelto)andasksthenursetoexplainhowitworks.Whatresponsebythe nurseisbest? a.Itinhibitsthrombin. b.Itinhibitsfibrinogen. c.Itthinsyourblood. d.ItworksagainstvitaminK. ANS:A Rivaroxabanisadirectthrombininhibitor.ItdoesnotworkonfibrinogenorvitaminK.Itisnotablood thinner,althoughmanyclientscallanticoagulantsbythisname. DIF:Understanding/ComprehensionREF:801 KEY:Hematologicsystem|anticoagulants MSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:PharmacologicalandParenteralTherapies 3.Thehealthcareprovidertellsthenursethataclientistobestartedonaplateletinhibitor.Aboutwhatdrug doesthenurseplantoteachtheclient? a.Clopidogrel(Plavix) b.Enoxaparin(Lovenox) c.Reteplase(Retavase) d.Warfarin(Coumadin) ANS:A Clopidogrelisaplateletinhibitor.Enoxaparinisanindirectthrombininhibitor.Reteplaseisafibrinolytic agent.WarfarinisavitaminKantagonist. DIF:Remembering/KnowledgeREF:801 KEY:Hematologicsystem|anticoagulants MSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:PharmacologicalandParenteralTherapies 4.Anurseisassessingadark-skinnedclientforpallor.Whatactionisbest? a.Assesstheconjunctivaoftheeye. b.Havetheclientopenthehandwidely. c.Lookattheroofoftheclientsmouth. d.Palpateforareasofmildswelling.

TestBank-Medical-SurgicalNursing:ConceptsforInterprofessionalCollaborativeCare9e

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ANS:A Toassesspallorindark-skinnedpeople,assesstheconjunctivaoftheeyeorthemucousmembranes.Looking attheroofofthemouthcanrevealjaundice.Openingthehandwidelyisnotrelatedtopallor,norispalpating formildswelling. DIF:Applying/ApplicationREF:801 KEY:Hematologicsystem|nursingassessment|anemia MSC:IntegratedProcess:NursingProcess:Assessment NOT:ClientNeedsCategory:PhysiologicalIntegrity:ReductionofRiskPotential 5.Ahospitalizedclienthasaplateletcountof58,000/mm3.Whatactionbythenurseisbest? a.Encouragehigh-proteinfoods. b.Instituteneutropenicprecautions. c.Limitvisitorstohealthyadults. d.Placetheclientonsafetyprecautions. ANS:D Withaplateletcountbetween40,000and80,000/mm3,clientsareatriskofprolongedbleedingevenafter minortrauma.Thenurseshouldplacetheclientonsafetyprecautions.High-proteinfoods,whilehealthy,are notthepriority.Neutropenicprecautionsarenotneededastheclientswhitebloodcellcountisnotlow. Limitingvisitorswouldalsobemorelikelyrelatedtoalowwhitebloodcellcount. DIF:Applying/ApplicationREF:802 KEY:Hematologicsystem|clientsafety|laboratoryvalues MSC:IntegratedProcess:NursingProcess:Implementation NOT:ClientNeedsCategory:SafeandEffectiveCareEnvironment:SafetyandInfectionControl 6.Aclientishavingabonemarrowbiopsytoday.Whatactionbythenursetakespriority? a.Administerpainmedicationfirst. b.Ensurevalidconsentisonthechart. c.Havetheclientshowerinthemorning. d.Premedicatetheclientwithsedatives. ANS:B Abonemarrowbiopsyisaninvasiveprocedurethatrequiresinformedconsent.Painmedicationandsedation areimportantcomponentsofcareforthisclientbutdonottakepriority.Theclientmayormaynotneedorbe abletoshower. DIF:Applying/ApplicationREF:805 KEY:Hematologicsystem|informedconsent MSC:IntegratedProcess:NursingProcess:Implementation NOT:ClientNeedsCategory:SafeandEffectiveCareEnvironment:ManagementofCare 7.Anurseiscaringforfourclients.Afterreviewingtodayslaboratoryresults,whichclientshouldthenurse seefirst? a.Clientwithaninternationalnormalizedratioof2.8 b.Clientwithaplateletcountof128,000/mm3 c.Clientwithaprothrombintime(PT)of28seconds d.Clientwitharedbloodcellcountof5.1million/L ANS:C AnormalPTis11to12.5seconds.Thisclientisathighriskofbleeding.Theothervaluesarewithinnormal limits. DIF:Applying/ApplicationREF:805 KEY:Hematologicsystem|laboratoryvalues MSC:IntegratedProcess:NursingProcess:Analysis NOT:ClientNeedsCategory:PhysiologicalIntegrity:ReductionofRiskPotential

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8.Aclientishavingabonemarrowbiopsyandisextremelyanxious.Whatactionbythenurseisbest? a.Assessclientfearsandcopingmechanisms. b.Reassuretheclientthisisacommontest. c.Sedatetheclientpriortotheprocedure. d.Telltheclientheorshewillbeasleep. ANS:A Assessingtheclientsspecificfearsandcopingmechanismshelpsguidethenurseinprovidingholisticcaretha bestmeetstheclientsneeds.Reassurancewillbehelpfulbutisnotthebestoption.Sedationisusuallyused. Theclientmayormaynotbetotallyasleepduringtheprocedure. DIF:Applying/ApplicationREF:805 KEY:Hematologicsystem|psychosocialresponse|caring|anxiety|support MSC:IntegratedProcess:Caring NOT:ClientNeedsCategory:PsychosocialIntegrity 9.Aclientishavingaradioisotopicimagingscan.Whatactionbythenurseismostimportant? a.Assesstheclientforshellfishallergies. b.Placetheclientonradiationprecautions. c.Sedatetheclientbeforethescan. d.Teachtheclientabouttheprocedure. ANS:D Thenurseshouldensurethatteachingisdoneandtheclientunderstandstheprocedure.Contrastdyeisnot used,soshellfish/iodineallergiesarenotrelated.Theclientwillnotberadioactiveanddoesnotneedradiation precautions.Sedationisnotusedinthisprocedure. DIF:Applying/ApplicationREF:776 KEY:Hematologicsystem|patienteducation MSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:ReductionofRiskPotential MULTIPLERESPONSE 1.Astudentnurselearnsthatthespleenhasseveralfunctions.Whatfunctionsdotheyinclude?(Selectallthat apply.) a.Breaksdownhemoglobin b.Destroysoldordefectiveredbloodcells(RBCs) c.FormsvitaminKforclotting d.Storesextraironinferritin e.Storesplateletsnotcirculating ANS:A,B,E FunctionsofthespleenincludebreakingdownhemoglobinreleasedfromRBCs,destroyingoldordefective RBCs,andstoringtheplateletsthatarenotincirculation.FormingvitaminKforclottingandstoringextrairon inferritinarefunctionsoftheliver. DIF:Remembering/KnowledgeREF:797 KEY:HematologicsystemMSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation 2.Anolderclientasksthenursewhypeoplemyagehaveweakerimmunesystemsthanyoungerpeople.What responsesbythenursearebest?(Selectallthatapply.) a.Bonemarrowproducesfewerbloodcells. b.Youmayhavedecreasedlevelsofcirculatingplatelets. c.Youhavelowerlevelsofplasmaproteinsintheblood. d.Lymphocytesbecomemorereactivetoantigens. e.Spleenfunctiondeclinesafterage60.

TestBank-Medical-SurgicalNursing:ConceptsforInterprofessionalCollaborativeCare9e

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ANS:A,C Theagingadulthasbonemarrowthatproducesfewercellsanddecreasedbloodvolumewithfewerplasma proteins.Plateletnumbersremainunchanged,lymphocytesbecomelessreactive,andspleenfunctionstaysthe same. DIF:Understanding/ComprehensionREF:798 KEY:HematologicsystemMSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:HealthPromotionandMaintenance 3.Anursingstudentlearnsthatmanydrugscanimpairtheimmunesystem.Whichdrugsdoesthisinclude? (Selectallthatapply.) a.Acetaminophen(Tylenol) b.AmphotericinB(Fungizone) c.Ibuprofen(Motrin) d.Metformin(Glucophage) e.Nitrofurantoin(Macrobid) ANS:B,C,E AmphotericinB,ibuprofen,andnitrofurantoinallcandisruptthehematologic(immune)system. Acetaminophenandmetformindonot. DIF:Remembering/KnowledgeREF:801 KEY:Hematologicsystem|adverseeffects MSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:PharmacologicalandParenteralTherapies 4.Anurseworksinagerontologyclinic.Whatage-relatedchangescausethenursetoalterstandard assessmenttechniquesfromthoseusedforyoungeradults?(Selectallthatapply.) a.Dentitiondeteriorateswithmorecavities. b.Nailbedsmaybethickenedordiscolored. c.Progressivelossofhairoccurswithage. d.Scleraebegintoturnyelloworpale. e.Skinbecomesdryastheclientages. ANS:B,C,E Commonfindingsinolderadultsincludethickenedordiscolorednailbeds,dryskin,andthinninghair.The nurseadaptstothesechangesbyalteringassessmenttechniques.Havingmoredentalcariesandchangesinthe scleraearenotnormalage-relatedchanges. DIF:Remembering/KnowledgeREF:800 KEY:Hematologicsystem|olderadult|nursingassessment MSC:IntegratedProcess:NursingProcess:Assessment NOT:ClientNeedsCategory:HealthPromotionandMaintenance...