Chapters 30 and 31 Study guide Questions Flashcards Preview

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Flashcards in Chapters 30 and 31 Study guide Questions Deck (28)
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1
Q

During physical assessment of a patient with thrombocytopenia, what would the nurse expect to find?

a. Sternal tenderness
b. Petechiae and purpura
c. Jaundiced sclera and skin
d. Tender, enlarged lymph nodes

A

b. Petechiae are small, flat, red, or reddish-brown pinpoint microhemorrhages that occur on the skin when platelet levels are low. When petechiae are numerous, they
group, causing reddish bruises known as purpura. Sternal tenderness is associated with leukemias. Jaundice occurs when anemias are of a hemolytic origin, resulting in
accumulation of bile pigments from RBCs. Enlarged, tender lymph nodes are associated with infection or cancer.

2
Q

If a patient with blood type O Rh+ is given AB Rh– blood, what would the nurse expect to happen?

a. The patient’s Rh factor will react with the RBCs of the donor blood.
b. The anti-A and anti-B antibodies in the patient’s blood will hemolyze the donor blood.
c. The anti-A and anti-B antibodies in the donor blood will hemolyze the patient’s blood.
d. No adverse reaction is expected because the patient has no antibodies against the donor blood.

A

b. A patient with type O Rh+ blood has no A or B antigens on the RBC but does have anti-A and anti-B antibodies in the blood and has an Rh antigen. Type AB Rh− blood has both A and B antigens on the RBC but no Rh antigen and no anti-A or anti-B antibodies. If the type AB Rh− blood is given to the patient with type O Rh+ blood, the antibodies in the patient’s blood will react with the antigens in the donor blood, causing hemolysis of the donor cells. There will be no Rh reaction because the donor blood has no Rh antigen.

3
Q

The patient’s laboratory results show a marked decrease in RBCs, WBCs, and platelets. What term should the nurse
use when reporting the results to the physician?
a. Hemolysis
b. Leukopenia
c. Pancytopenia
d. Thrombocytosis

A

c. Pancytopenia is decreased RBCs, WBCs, and
platelets. Hemolysis is RBC destruction. Leukopenia is WBC <4000/μL. Thrombocytosis is increased
platelets and thrombocytopenia is decreased
platelets.

4
Q
  1. Which statements accurately describe thrombocytopenia (select all that apply)?
    a. Patients with platelet deficiencies can have internal or external hemorrhage.
    b. The most common acquired thrombocytopenia is thrombotic thrombocytopenic purpura (TTP).
    c. Immune thrombocytopenic purpura (ITP) is characterized by increased platelet destruction by the spleen.
    d. TTP is characterized by decreased platelets, decreased RBCs, and enhanced aggregation of platelets.
    e. A classic clinical manifestation of thrombocytopenia that the nurse would expect to find on physical examination
    of the patient is ecchymosis.
A

a, c, d. Immune thrombocytopenic purpura (ITP) is characterized by increased platelet destruction by the spleen. Thrombotic thrombocytopenic purpura (TTP)
has decreased platelets and RBCs with enhanced agglutination of the platelets. Platelet deficiencies lead to superficial site bleeding. ITP is the most common acquired thrombocytopenia. Petechiae, not ecchymosis, is a common manifestation of thrombocytopenia.

5
Q
A patient has a platelet count of 50,000/μL and is diagnosed with ITP. What does the nurse anticipate that initial
treatment will include?
a. Splenectomy 
b. Corticosteroids 
c. Administration of platelets
d. Immunosuppressive therapy
A

b. Corticosteroids are used in initial treatment of ITP because they suppress the phagocytic response of splenic macrophages, decreasing platelet destruction. They also depress autoimmune antibody formation and reduce capillary fragility and bleeding time. All of the other therapies may be used but only in patients who are unresponsive to corticosteroid therapy.

6
Q

Priority Decision: A patient is admitted to the hospital for evaluation and treatment of thrombocytopenia. Which
action is most important for the nurse to implement?
a. Taking the temperature every 4 hours to assess for fever
b. Maintaining the patient on strict bed rest to prevent injury
c. Monitoring the patient for headaches, vertigo, or confusion
d. Removing the oral crusting and scabs with a soft brush four times a day

A

c. The major complication of thrombocytopenia is hemorrhage and it may occur in any area of the body. Cerebral hemorrhage may be fatal and evaluation of mental status for central nervous system (CNS) alterations to identify CNS bleeding is very important. Fever is not a common finding in thrombocytopenia. Protection from injury to prevent bleeding is an important nursing intervention but strict bed rest is not indicated. Oral care is performed very gently with minimum friction and soft swabs.

7
Q

The nurse caring for a patient with heparin-induced thrombocytopenia (HIT) identifies risk for bleeding as the
priority nursing diagnosis. Identify at least five nursing interventions that should be implemented.
a.
b.
c.
d.
e.

A

Any five of these are appropriate:
Discontinue heparin administration and expect a direct or indirect thrombin inhibitor to be ordered.
Monitor for signs and symptoms of bleeding (check IV sites, wounds, any secretions).
Monitor ordered coagulation studies.
Avoid injections.
Use an electric razor.
Protect the patient from trauma.
Administer ordered blood products.
Instruct the patient and caregiver to avoid aspirin and other anticoagulants.
Instruct the patient to avoid high-contact activities (many sports).

8
Q

In reviewing the laboratory results of a patient with hemophilia A, what would the nurse expect to find?

a. An absence of factor IX
b. A decreased platelet count
c. A prolonged bleeding time
d. A prolonged partial thromboplastin time (PTT)

A

d. A prolonged partial thromboplastin time (PTT) occurs when there is a deficiency of clotting factors, such as factor VIII associated with hemophilia A. Factor IX is deficient in hemophilia B and prolonged bleeding time and decreased platelet counts are associated with platelet deficiencies.

9
Q
A patient with hemophilia comes to the clinic for treatment. What should the nurse anticipate that he or she will need
to administer?
a. Whole blood 
b. Thromboplastin
c. Factor concentrates
d. Fresh frozen plasma
A

c. Although whole blood and fresh frozen plasma contain the clotting factors that are deficient in hemophilia, specific factor concentrates have been developed that are more pure and safer in preventing infection transmission. Thromboplastin is factor III and is not deficient in patients with hemophilia.

10
Q

A patient with hemophilia is hospitalized with acute knee pain and swelling. What is an appropriate nursing
intervention for the patient?
a. Wrapping the knee with an elastic bandage
b. Placing the patient on bed rest and applying ice to the joint
c. Administering nonsteroidal antiinflammatory drugs (NSAIDs) as needed for pain
d. Gently performing range-of-motion (ROM) exercises to the knee to prevent adhesions

A

b. During an acute bleeding episode in a joint, it is important to rest the involved joint totally and slow bleeding with application of ice. Drugs that decrease platelet aggregation, such as aspirin or nonsteroidal antiinflammatory drugs (NSAIDs), should not be used for pain. As soon as bleeding stops, mobilization of the affected area is encouraged with range-of-motion (ROM) exercises and physical therapy.

11
Q
Which bleeding disorder affects both genders, is autosomal dominant, and will have laboratory results showing
prolonged bleeding time?
a. Hemophilia A 
b. Hemophilia B 
c. Thrombocytopenia
d. von Willebrand disease
A

d. This description is characteristic of von Willebrand disease with prolonged bleeding time occurring because of defective platelets, which does not occur with either type of hemophilia. Although inherited thrombocytopenia is believed to be autosomal dominant, the number of platelets is decreased.

12
Q

Number in sequence the events that occur in disseminated intravascular coagulation (DIC).

a. Activation of fibrinolytic system
b. Uncompensated hemorrhage
c. Widespread fibrin and platelet deposition in capillaries and arterioles
d. Release of fibrin-split products
e. Fibrinogen converted to fibrin
f. Inhibition of normal blood clotting
g. Production of intravascular thrombin
h. Depletion of platelets and coagulation factors

A
  1. Production of intravascular thrombin
  2. Fibrinogen converted to fibrin
  3. Widespread fibrin and platelet deposition in capillaries and arterioles
  4. Depletion of platelets and coagulation factors
  5. Activation of fibrinolytic system
  6. Release of fibrin-split products
  7. Inhibition of normal blood clotting
  8. Uncompensated hemorrhage
13
Q

A patient has a WBC count of 2300/μL and a neutrophil percentage of 40%.

a. Does the patient have leukopenia?
b. What is the patient’s neutrophil count?
c. Does the patient have neutropenia?
d. Is the patient at risk for developing a bacterial infection? If so, why?

A

a. Yes, as the WBC count is below 4000/μL.
b. The neutrophil count is 2300 × 40% = 920/μL.
c. Yes, as the neutrophil count is less than 1000/μL.
d. Yes, the patient is at moderate risk of infection with
opportunistic pathogens and nonpathogenic organisms
from normal body flora.

14
Q

What is the most important method for identifying the presence of infection in a neutropenic patient?

a. Frequent temperature monitoring
b. Routine blood and sputum cultures
c. Assessing for redness and swelling
d. Monitoring white blood cell (WBC) count

A

a. An elevated temperature is of most significance in
recognizing the presence of an infection in the neutropenic patient because there is no leukocytic response to injury. When the WBC count is depressed, the normal phagocytic mechanisms of infection are impaired and the classic signs of inflammation may not occur. Cultures are indicated if the temperature is elevated but are not used to monitor for infection.

15
Q

What is a major method of preventing infection in the patient with neutropenia?

a. Prophylactic antibiotics
b. A diet that eliminates fresh fruits and vegetables
c. High-efficiency particulate air (HEPA) filtration rooms
d. Strict hand washing by all persons in contact with the patient

A

d. Despite its seeming simplicity, hand washing before, during, and after care of the patient with neutropenia is the major method to prevent transmission of harmful pathogens to the patient. IV antibiotics are administered when febrile episodes occur. Some oral antibiotics may
be used prophylactically in some neutropenic patients. High-efficiency particulate air (HEPA) filtration and laminar airflow (LAF) rooms may reduce the number of aerosolized pathogens but they are expensive and LAF use is controversial.

16
Q

Which leukemia is seen in 80% of adults with acute leukemia and exhibits proliferation of precursors of
granulocytes?
a. Acute lymphocytic leukemia (ALL)
b. Chronic lymphocytic leukemia (CLL)
c. Acute myelogenous leukemia (AML)d. Chronic myelogenous leukemia (CML)

A

c. Acute myelogenous leukemia (AML) is seen in 80%
of adults with acute leukemia and is characterized by hyperplasia of the bone marrow with uncontrolled proliferation of myeloblasts, the precursors of granulocytes. Acute lymphocytic leukemia (ALL), the other acute leukemia, is most common in children and is characterized by small, immature lymphocytes, primarily of B-cell origin, proliferated in the bone marrow. Fever, bleeding, and central nervous system manifestations are also common with ALL. The other two leukemias are chronic in onset and the maturity of WBCs.

17
Q

Which statements accurately describe chronic lymphocytic leukemia (select all that apply)?

a. Most common leukemia of adults
b. Only cure is bone marrow transplant
c. Neoplasm of activated B lymphocytes
d. Increased incidence in survivors of atomic bombs
lymphocytese.
e. Philadelphia chromosome is a diagnostic hallmark
f. Mature-appearing but functionally inactive

A

a, c, f. Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults. It is a neoplasm of activated B lymphocytes that are mature appearing but functionally inactive. As it progresses, pressure on nerves from enlarged lymph nodes causes pain and paralysis. Mediastinal node enlargement leads to pulmonary symptoms. The other characteristics are related to chronic myelogenous leukemia (CML).

18
Q

What is the underlying cause of lymphadenopathy, splenomegaly, and hepatomegaly in leukemia?

a. The development of infection at these sites
b. Increased compensatory production of blood cells by these organs
c. Infiltration of the organs by increased numbers of WBCs in the blood
d. Normal hypertrophy of the organs in an attempt to destroy abnormal cells

A

c. Almost all leukemias cause some degree of hepatosplenomegaly because of infiltration of these organs as well as the bone marrow, lymph nodes, bones, and central nervous system by excessive WBCs in the blood.

19
Q

A patient with acute myelogenous leukemia is considering a hematopoietic stem cell transplant and asks the nurse what is involved. What is the best response the nurse can give the patient?
a. “Your bone marrow is destroyed by radiation and new bone marrow cells from a matched donor are injected into your bones.”
b. “A specimen of your bone marrow may be aspirated and treated to destroy any leukemic cells and then reinfused when your disease becomes worse.”
c. “Leukemic cells and bone marrow stem cells are eliminated with chemotherapy and/or total-body radiation and new bone marrow cells from a donor are infused.”
d. “During chemotherapy and/or total-body irradiation to destroy all of your blood cells, you may be given
transfusions of red blood cells and platelets to prevent complications.”

A

c. Whether the donor bone marrow is from a human leukocyte antigen (HLA)-matched donor or taken from the patient during a remission for later use, hematopoietic stem cell transplant always involves the use of chemotherapy and/or total-body radiation to eliminate leukemic cells
and the patient’s bone marrow stem cells totally before IV infusion of the donor cells. A severe pancytopenic period follows the transplant, during which the patient must be
in protective isolation and during which RBC and platelet transfusions may be given.

20
Q

Indicate whether the following characteristics are associated with Hodgkin’s lymphoma (HL), non-Hodgkin’s lymphoma (NHL), or both (B).

a. Affects all ages
b. Presence of Reed-Sternberg cells
c. Associated with Epstein-Barr virus
d. Multiple histopathologic classifications
e. Treated with radiation and chemotherapy
f. Originates in lymph nodes in most patients
g. Greater than 85% cure rate in stage I disease
h. Often widely disseminated at time of diagnosis
i. Ingested alcohol-induced pain at the site of disease
j. Primary initial clinical manifestation is painless lymph node enlargement

A

a. non-Hodgkin’s lymphoma (NHL)
b. Hodgkin’s lymphoma
c. Both
d. non-Hodgkin’s lymphoma (NHL)
e. Both
f. Hodgkin’s lymphoma
g. Hodgkin’s lymphoma
h. non-Hodgkin’s lymphoma (NHL)
i. Hodgkin’s lymphoma
j. Both

21
Q

What characteristics should the nurse be aware of in planning care for the patient with Hodgkin’s lymphoma?
a. Staging of Hodgkin’s lymphoma is not important to predict prognosis.
b. Nursing management of the patient undergoing treatment for Hodgkin’s lymphoma includes measures to prevent infection.
c. Hodgkin’s lymphoma is characterized by proliferation of malignant activated B cells that destroy the kidneys.
d. An important nursing intervention in the care of patients with Hodgkin’s lymphoma is increasing fluids to manage
hypercalcemia.

A

b. The patient is monitored for infection as leukopenia and thrombocytopenia may develop from the disease or usually as a consequence of treatment. Staging of Hodgkin’s disease is important to determine treatment. Multiple myeloma is characterized by proliferation of malignant activated B cells that destroy the bones. The intervention of increasing fluid to manage hypercalcemia is used with multiple myeloma.

22
Q
Following a splenectomy for the treatment of ITP, the nurse would expect the patient’s laboratory test results to
reveal which of the following?
a. Decreased RBCs 
b. Decreased WBCs 
c. Increased platelets
d. Increased immunoglobulins
A

c. Splenectomy may be indicated for treatment for ITP and when the spleen is removed, platelet counts increase significantly in most patients. In any of the disorders
in which the spleen removes excessive blood cells, splenectomy will most often increase peripheral RBC, WBC, and platelet counts.

23
Q

Priority Decision: While receiving a unit of packed RBCs, the patient develops chills and a temperature of 102.2°F
(39°C). What is the priority action for the nurse to take?
a. Stop the transfusion and instill normal saline.
b. Notify the health care provider and the blood bank.
c. Add a leukocyte reduction filter to the blood administration set.
d. Recognize this as a mild allergic transfusion reaction and slow the transfusion.

A

a. Chills and fever are symptoms of an acute hemolytic or febrile transfusion reaction and if these develop, the nurse should stop the transfusion, infuse saline through the IV line, notify the health care provider and blood bank immediately, recheck the ID tags, and monitor vital signs and urine output. The addition of a leukocyte reduction filter may prevent a febrile reaction but is not helpful once the reaction has occurred. Mild and transient allergic reactions indicated by itching and hives might permit restarting the transfusion after treatment with antihistamines.

24
Q

A patient with thrombocytopenia with active bleeding is to receive two units of platelets. To administer the platelets,
what should the nurse do?
a. Check for ABO compatibility.
b. Agitate the bag periodically during the transfusion.
c. Take vital signs every 15 minutes during the procedure.
d. Refrigerate the second unit until the first unit has transfused.

A

b. Because platelets adhere to the plastic bags, the bag should be gently agitated throughout the transfusion. Platelets do not have A, B, or Rh antibodies and ABO compatibility is not a consideration. Baseline vital signs should be taken before the transfusion is started and the nurse should stay with the patient during the first 15 minutes. Platelets are stored at room temperature and should not be refrigerated.

25
Q

Which type of transfusion reaction occurs with leukocyte or plasma protein incompatibility and may be avoided withnleukocyte reduction filters?

a. Febrile reaction
b. Allergic reaction
c. Acute hemolytic reaction
d. Massive blood transfusion reaction

A

a. Febrile nonhemolytic reaction is the most common transfusion reaction. Allergic reactions occur with sensitivity to foreign plasma proteins and can be treated prophylactically with antihistamines. Acute hemolytic reactions are related to the infusion of ABO-incompatible blood or components with 10 mL or more of RBCs. Massive blood transfusion reactions occur when patients receive more RBCs or blood than the total blood volume.

26
Q

Which characteristics are related to an acute hemolytic transfusion reaction (select all that apply)?

a. ABO incompatibility
b. Hypothermia common
c. Destruction of donor RBCs
d. Acute kidney injury occurs
e. Hypocalcemia and hyperkalemia
f. Epinephrine used for severe reaction

A

a, c, d. ABO incompatibility, destruction of donor RBCs, and acute kidney injury may occur in an acute hemolytic transfusion reaction. Hypothermia, hypocalcemia, and hyperkalemia are most likely to occur in massive blood transfusion reactions. Epinephrine may be used for severe allergic transfusion reactions and the infusion may be
restarted after treatment with antihistamines in mild cases.

27
Q

Delegation Decision: While administering an infusion of packed RBCs, which actions can the RN delegate to
unlicensed assistive personnel (UAP) (select all that apply)?
a. Verify that the IV is patent.
b. Obtain the blood products from the blood bank.
c. Obtain vital signs before and after the first 15 minutes.
d. Monitor the blood transfusion rate and adjust as needed.
e. Assist the RN with checking patient identification and blood product identification data.

A

b, c. All other actions are the responsibility of the RN. The
licensed practical nurse may be able to assist with the ID
checks (depending on the state and the facility policy).

28
Q

Priority Decision: The nurse is preparing to administer a blood transfusion. Number the actions in order of priority
(1 is first priority action; 10 is last priority action).
a. Verify the order for the transfusion.
b. Ensure that the patient has a patent 18-gauge IV.
c. Prime the transfusion tubing and filter with normal saline.
d. Verify that the physician has discussed risks, benefits, and alternatives with the patient.
e. Obtain the blood product from the blood bank.
f. Ask another licensed person (nurse or MD) to assist in verifying the product identification and the
patient identification.
g. Document outcomes in the patient record. Document vital signs, names of personnel, and starting and
ending times.
h. Adjust the infusion rate and continue to monitor the patient every 30 minutes for up to an hour after the
product is infused.
i. Infuse the first 50 mL over 15 minutes, staying with the patient.
j. Obtain the patient’s vital signs before starting the transfusion

A

(1 is first priority action; 10 is last priority action)

  1. Verify the order for the transfusion.
  2. Verify that the physician has discussed risks, benefits, and alternatives with the patient.
  3. Ensure that the patient has a patent 18-gauge IV.
  4. Prime the transfusion tubing and filter with normal saline.
  5. Obtain the blood product from the blood bank.
  6. Ask another licensed person (nurse or MD) to assist in verifying the product identification and the
    patient identification.
  7. Obtain the patient’s vital signs before starting the transfusion
  8. Infuse the first 50 mL over 15 minutes, staying with the patient.
  9. Adjust the infusion rate and continue to monitor the patient every 30 minutes for up to an hour after the
    product is infused.
  10. Document outcomes in the patient record. Document vital signs, names of personnel, and starting and
    ending times