Chapter 74 : Assessment of the Hematopoietic System Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 74 : Assessment of the Hematopoietic System

MULTIPLE CHOICE

1. In evaluating a young woman, the following laboratory result the nurse recognizes as abnormal is

a.

hemoglobin 13 g/dl.

b.

platelet count 20,000/mm3.

c.

red blood cell count 5 million/mm3.

d.

white blood cell count 6000/mm3.

ANS: B

Normal platelet count is 150,000/mm3.

DIF: Comprehension/Understanding REF: p. 2000 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Laboratory Values

2. The nurse should anticipate an elevated hemoglobin level in a

a.

40-year-old woman with congestive heart failure.

b.

client who lives in Colorado.

c.

client with iron deficiency anemia.

d.

dehydrated elderly client being given IV fluids.

ANS: B

Hemoglobin levels are frequently elevated in people who live in high altitudes (above 10,000 feet). The other three clients would not show an elevated hemoglobin level.

DIF: Comprehension/Understanding REF: p. 1996 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Laboratory Values

3. A client has a hematocrit (Hct) of 30%. The nurse interprets this to mean

a.

30% of the blood will be plasma and plasma products.

b.

bleeding disorders are possible.

c.

the blood is viscous and concentrated.

d.

the individual has fewer red blood cells than normal.

ANS: B

Hematocrit measures the percent volume of red cells in whole blood. The normal value in adult women is 37% to 45%.

DIF: Comprehension/Understanding REF: p. 2000 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Laboratory Values

4. A nurse is explaining the purpose of a bone marrow biopsy (BMB) to a client. The information the nurse provides is that a bone marrow biopsy is done to evaluate

a.

blood dyscrasias such as aplastic anemia or leukemia.

b.

hemoglobin and hematocrit production.

c.

specific parts of the white cell differentiation.

d.

total numbers and types of different lymphocytes.

ANS: A

Several blood dyscrasias can be identified through a BMB, including aplastic anemia, leukemia, pernicious anemia, and thrombocytopenia. The biopsy reveals the number, size, and shape of the RBCs, WBCs, and platelet precursors.

DIF: Comprehension/Understanding REF: p. 1999 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Laboratory Values

5. The nurse notes that a client has a higher than normal reticulocyte count. This would indicate

a.

bone marrow depression.

b.

dehydration.

c.

increased erythrocyte production.

d.

polycythemia vera.

ANS: C

An increase in the reticulocyte count indicates an increase in erythrocyte production, probably because of excessive RBC destruction (hemolytic anemia) or loss (hemorrhage).

DIF: Comprehension/Understanding REF: p. 2000 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Laboratory Values

6. The laboratory test result that would be most helpful to the nurse in the assessment of a client with a bleeding disorder is

a.

differential count.

b.

hematocrit.

c.

platelet count.

d.

RBC count.

ANS: C

Platelets have a key role in blood clotting. An abnormal platelet count would indicate bleeding problems originating from a platelet disorder.

DIF: Comprehension/Understanding REF: pp. 1999, 2000

OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Laboratory Values

7. A client has severe anemia and is being treated with transfusion therapy. The nurse should be alert for a complication of transfusion, such as

a.

flank pain.

b.

hearing loss.

c.

liver damage.

d.

sore throat.

ANS: A

Reactions to blood products include fever, chills, back or flank pain, shock, wheezing, headache, vomiting, or urticaria (hives).

DIF: Application/Applying REF: p. 1994 OBJ: Assessment

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Blood and Blood Products

8. The manifestation the nurse would question the client about that is characteristically associated with anemia is

a.

fatigue.

b.

pruritus.

c.

rash.

d.

ruddy skin color.

ANS: A

Fatigue is one of the most common manifestations of anemia. Other frequent complaints include paleness, weakness, bleeding disorders with petechiae, epistaxis, and bleeding gums, or recurrent infections and fever. A rash or pruritus could indicate an allergic manifestation.

DIF: Application/Applying REF: p. 1992 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

9. The nurse assesses the client who underwent partial removal of the stomach a year ago for the manifestations of

a.

anemia.

b.

high white blood cell count.

c.

low platelet count.

d.

shortened bleeding times.

ANS: A

Anemia may also occur following partial or total gastrectomy or removal of the terminal portion of the ileum because of the consequent reduction in absorption of vitamin B12.

DIF: Application/Applying REF: p. 1994 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

10. Several employees report allergic manifestations. The occupational health nurse would focus an investigation on the workplaces

a.

food service vendor.

b.

heating and cooling systems.

c.

lighting.

d.

water supply.

ANS: B

Exposure to allergens at work may trigger reactions. Ask about the heating and cooling systems if airborne allergens are suspected.

DIF: Application/Applying REF: p. 1996 OBJ: Assessment

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

11. The nurse reads that an assigned client has an immunodeficiency. The nurse reads further in the medical record, anticipating that the client also most likely has a history of

a.

conjunctivitis.

b.

severe headaches.

c.

skin eruptions.

d.

unexplained weight loss.

ANS: D

Clients with immunodeficiencies have a history of recurrent infections, especially of mucous membranes (e.g., oral cavity, anorectal area, genitourinary [GU] tract, respiratory tract); poor wound healing; diarrhea; and manifestations of systemic activation of the immune response.

DIF: Application/Applying REF: p. 1994 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

12. The nurse is monitoring the laboratory test results for a client receiving anticoagulation therapy. The nurse is aware that the International Normalized Ratio (INR) for most clinical conditions requiring anticoagulation is

a.

less than 1.

b.

1 to 2.

c.

2 to 3.5.

d.

3 to 5.5.

ANS: C

For most clinical conditions that necessitate anticoagulation, the recommended INR is 2 to 3.5.

DIF: Knowledge/Remembering REF: pp. 1999-2000

OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Laboratory Values

13. The nurse discovers a client is taking the herb St. Johns wort. The nurse cautions that this herb reduces the effectiveness of

a.

lanoxin.

b.

prednisone.

c.

theophylline.

d.

warfarin.

ANS: D

The anticoagulation properties of warfarin are diminished if taken in conjunction with St. Johns wort.

DIF: Comprehension/Understanding REF: p. 1996 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Interactions

MULTIPLE RESPONSE

1. A client presents to the ambulatory care center seeking treatment for allergies. When questioning the client, the nurse would inquire about (Select all that apply)

a.

a history of desensitization shots and their effectiveness.

b.

presence of fatigue, headaches, or weakness.

c.

previous anaphylactic reactions to food.

d.

seasonal variation in manifestations.

e.

triggers known to cause manifestations.

ANS: A, C, D, E

All four options are related to allergies. The client with allergies would most likely complain of rhinitis, sinusitis, urticaria, and pruritus, and not fatigue, headache, or weakness.

DIF: Application/Applying REF: p. 1994 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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