Test Bank Unit 6 : Understanding Medical-Surgical Nursing 6th Edition Linda S. Williams Paula D. Hopper ||Chapter 27 -28

Test Bank Unit 6: Understanding Medical-Surgical Nursing 6th Edition Linda S. Williams Paula D. Hopper Chapter 27. Hematologic and Lymphatic System Function, Assessment, and Therapeutic Measures Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The nurse is concerned that a patient is demonstrating signs of red blood cell production. What laboratory value did the nurse most likely use to make this decision? a. Iron b. Bilirubin c. Thrombin d. Intrinsic factor 2. The nurse notes that a patient’s gaping wound is developing a blood clot. Which body substance is responsible for this clot formation? a. Plasma b. Platelets c. Red blood cells d. White blood cells 3. A nurse is preparing to assist with a bone marrow biopsy. Which anatomical site should the nurse anticipate will be used to obtain the specimen? a. Ribs b. Humerus c. Posterior iliac crest d. Long bones in the legs 4. The nurse is reviewing the parts of the complete blood count and differential with a patient. Where should the nurse state that neutrophils, eosinophils, and basophils are produced? a. Spleen b. Thymus c. Lymph nodes d. Red bone marrow 5. The nurse is explaining the role of red blood cells with oxygen transport in the body with a nursing student. Which term should the nurse use to describe hemoglobin that has given up its oxygen to the body’s cells? a. Reduced b. Detached c. Oxyhemoglobin d. Hypoxyhemoglobin 6. A patient is admitted to determine why red blood cells are being quickly destructed in the body. What finding should the nurse associate with this patient’s health problem? a. Jaundice b. Bleeding c. Diarrhea d. Cyanosis 7. A patient has an altered level of T and B cells. The nurse realizes that these cells are members of which cell type? a. Platelets b. Eosinophils c. Lymphocytes d. Red blood cells 8. A patient with a bleeding disorder is prescribed an infusion of plasma. What should the nurse explain as being the purpose of this infusion? a. Contains clotting factors b. Carries oxygen to the tissues c. Supports cellular metabolism d. Removes waste products from cells 9. A patient with abdominal injuries from a motor vehicle crash is scheduled for surgery to remove the spleen. What bodily function will be affected by the removal of this organ? a. Filtration of waste products b. Removal of old red blood cells from circulation c. Clearance of mucous in the tracheobronchial tree d. Facilitation of glucose to be used by the cell for energy 10. The nurse is documenting findings after completing data collection with a patient. What term should the nurse use to document a large area of discoloration from hemorrhage under the skin? a. Pallor b. Rubor c. Petechiae d. Ecchymosis 11. The nurse is assessing a patient with chronic lung disease. Which finding indicates long-term hypoxia? a. Pallor b. Dyspnea c. Clubbed fingertips d. Pulmonary crackles 12. The nurse is caring for a patient having a bone marrow biopsy. What nursing action is the most important following the biopsy? a. Observe for bleeding. b. Encourage oral fluids. c. Administer an analgesic for pain. d. Monitor the puncture site for infection. 13. A patient has a bone marrow aspiration from the posterior iliac crest. Before the procedure, the patient’s vital signs were: blood pressure 132/82 mm Hg and pulse 88 beats/min. One hour after the procedure, the blood pressure is 108/70 mm Hg and pulse is 96 beats/min. Which assessment is the least important for the patient at this time? a. Observe the puncture site. b. Check the patient’s most recent complete blood count report. c. Ask the patient about feelings of lightheadedness or dizziness. d. Determine if the patient had any medications before the procedure. 14. A patient who is taking warfarin (Coumadin) 5 mg daily has an international normalized ratio (INR) of 2.5. It is time to administer the next dose of Coumadin. What should the nurse do? a. Notify the physician STAT. b. Hold the dose of Coumadin. c. Prepare to administer vitamin K. d. Administer the daily Coumadin as ordered. 15. The nurse is staying with a patient who has been started on a blood transfusion. Which assessment should the nurse perform during a blood product infusion to detect a reaction? a. Vital signs b. Skin turgor c. Bowel sounds d. Pupil reactivity 16. The nurse is monitoring a patient receiving a blood product and is concerned that the blood is going to deteriorate before it is complete infused. What is the maximum time that blood can hang during infusion before it begins to deteriorate? a. 1 hour b. 2 hours c. 3 hours d. 4 hours 17. A patient receiving blood begins complaining of severe chest pain and a feeling of warmth. What should the nurse do first? a. Call the physician. b. Administer diuretics as ordered. c. Discontinue the blood transfusion. d. Assess vital signs and cardiovascular status. 18. A patient is prescribed to receive 2 units of packed red blood cells. What approach should the nurse use to ensure that the correct blood will be provided to this patient? a. Check the patient’s arm band. b. Check the order on the medical record. c. Follow the organization’s verification process. d. Assume the correct blood was provided by the blood bank. 19. A patient is being prepared to receive a prescribed blood transfusion. What is the best way that the LPN can assist the health team to prevent a transfusion reaction? a. Monitor vital signs every 15 minutes. b. Warm blood to 98.6°F (37°C) before infusion. c. Administer diphenhydramine (Benadryl) before the infusion. d. Assist the registered nurse (RN) to identify correctly the patient and the blood product. 20. A patient receiving blood complains of dyspnea. The nurse auscultates the patient’s lungs and finds crackles that were not present before the start of the transfusion. Which type of reaction should the nurse suspect? a. Urticarial b. Hemolytic c. Anaphylactic d. Circulatory overload 21. The nurse is caring for a patient who has a white blood cell (WBC) count of 8000/mm3 . What concern should the nurse have about this finding? a. The patient has an infection. b. The patient is at risk for infection. c. The patient has a hematological disorder. d. There is no concern; this is a normal finding. 22. The nurse is reviewing the results of a patient’s arterial blood gas analysis. What should the nurse recognize as being a normal blood pH? a. 7.29 b. 7.31 c. 7.38 d. 7.48 23. An older adult patient is receiving a transfusion of packed red blood cells after being injured in a car accident. On assessment, the nurse notes a new finding of bounding pulse, crackles, and increasing dyspnea. What should the nurse do first, after stopping the transfusion? a. Assess vital signs. b. Raise the head of the bed. c. Encourage the patient to deep breathe and cough. d. Administer prn diphenhydramine (Benadryl) as ordered. 24. A patient who underwent lymphangiography the day before asks the licensed practical nurse (LPN), “Why does my urine look blue?” What should the LPN respond to this patient’s concern? a. “It is nothing to be concerned about.” b. “I will notify the RN and physician immediately.” c. “This indicates that the procedure found abnormal results.” d. “The dye used in the procedure may cause bluish skin and urine for 2 days.” 25. A patient is prescribed a transfusion of washed packed red blood cells. What should the nurse realize as being the rationale for the using this type of blood? a. Reduces the risk of hypothermia b. Cleans the blood cells of impurities c. Reduces the risk of a febrile reaction d. Removes potential harmful particles from the blood 26. A patient reports severe abdominal cramping and diarrhea. Assessment reveals a temperature of 102°F (38.8°C) and pulse of 82 beats/min. Results of a complete blood count reveal lower than normal segmented and banded neutrophils and higher than normal lymphocytes. Which type of infection does the nurse suspect this patient is most likely experiencing? a. Viral b. Fungal c. Parasitic d. Bacterial 27. The nurse is reviewing the activated partial thromboplastin time for a patient receiving heparin. Which value indicates that the medication is within the therapeutic range? a. 2.5 to 9.5 minutes b. 9.5 to 11.3 seconds c. 1.5 to 2.0 times normal d. 2.0 to 3.0 times normal 28. The nurse is assisting with the preparation of a blood transfusion for a patient. Which type of fluid should the nurse select to transfuse with the blood? a. 0.9% normal saline b. Dextrose 5% and water c. Dextrose 5% and 0.9% normal saline d. Dextrolse 5% and 0.45% normal saline 29. A female patient’s hematocrit level is 50% and oxygen saturation is 98% on room air. What should the nurse suspect as being the cause for this patient’s hematocrit level? a. Dehydration b. Chronic renal failure c. Bone marrow suppression d. Bleeding esophageal varices 30. A patient has a platelet count of 75,000 /mm3 . What action should the nurse take to support this patient? a. Restrict blood draws. b. Place in protective isolation. c. Wear a mask when entering the room. d. Document rectal temperatures to be taken. 31. The nurse is assisting with the collection of data from a patient with a hematologic disorder. On which body system should the nurse expect to focus when collecting this data? a. Respiratory b. Genitourinary c. Cardiovascular d. All body systems Multiple Response Identify one or more choices that best complete the statement or answer the question. 32. The nurse is evaluating laboratory values for a group of patients. Which values should the nurse identify as being within normal limits? (Select all that apply.) a. An adult male with Hct = 35% b. An adult female with Hct = 40% c. An adult male with Hgb = 12.8 g/100 mL d. An adult female with Hgb = 11.5 g/100 mL e. An adult male with RBC = 4 million/mm3 f. An adult female with RBC = 5 million/mm3 33. The nurse is reviewing the contents of blood plasma prior to participating in a seminar for nursing students. What should the nurse include as proteins in the plasma? (Select all that apply.) a. Iron b. Albumin c. Globulin d. Fibrinogen e. Electrolytes f. Hemoglobin 34. A patient with a bleeding disorder is considering surgery to have the spleen removed. What should the nurse explain as being functions of the spleen in a healthy adult? (Select all that apply.) a. Storage of platelets b. Formation of bilirubin c. Production of red blood cells d. Production of neutrophils and eosinophils e. Production of lymphocytes and monocytes f. Phagocytosis of worn blood cells and platelets 35. A patient with type O+ blood is to receive 4 units of packed red blood cells. Which type of blood should the nurse expect to see prepared for this patient? (Select all that apply.) a. Type A+ b. Type AB- c. Type O+ d. Type Oe. TypeBf. Type A36. While receiving a unit of packed red blood cells, the patient begins to experience hives around the neck and upper chest. What actions should the nurse perform because of this reaction? (Select all that apply.) a. Stop the transfusion. b. Notify the health care provider (HCP). c. Return the blood to the blood bank. d. Administer prescribed antihistamines. e. Restart the infusion and carefully monitor. 37. A patient receiving a unit of packed red blood cells as treatment for anemia begins to vomit and experience extreme gastrointestinal cramping. What should the nurse do? (Select all that apply.) a. Stop the transfusion. b. Administer intravenous (IV) heparin. c. Prepare to provide cardiopulmonary resuscitation (CPR) if necessary. d. Stay with the patient and call for help. e. Flush the blood tubing with normal saline.