UNIT 2 Hematology

The nurse assesses a patient who has numerous petechiae on both arms. Which question should the nurse ask the patient?

• 1. “Are you taking any oral contraceptives?”

• 1. “Have you been prescribed antiseizure drugs?”

• 1. “Do you take medication containing salicylates?”

• 1. “How long have you taken antihypertensive drugs?”

Answer explanation

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 person’s clotting risk. Antihypertensives do not usually cause problems with decreased clotting.

A nurse reviews the laboratory data for an older adult. The nurse would be most concerned about which finding?

• 1. Hematocrit of 35%

• 1. Hemoglobin of 11.8 g/dL

• 1. Platelet count of 400,000/μL

• 1. White blood cell count of 2800/μL

Answer explanation

Because the total white blood cell (WBC) count is not usually affected by aging, the low WBC count in this patient would indicate that the patient’s immune function may be compromised, and the underlying cause of the problem needs to be investigated. The platelet count is normal. The slight decrease in hemoglobin and hematocrit are not unusual for an older patient.

The nurse assesses a patient with pernicious anemia. Which finding would the nurse expect?

• 1. Yellow-tinged sclerae

• 1. Shiny, smooth tongue

• 1. Tender, bleeding gums

• 1. Numbness of extremities

Answer explanation

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.

A patient’s 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?

• 1. “Have you had a recent weight loss?”

• 1. “Do you have any history of lung disease?”

• 1. “Have you noticed any dark or bloody stools?”

• 1. What is your dietary intake of meat and protein?

Answer explanation

The hemoglobin and hematocrit results indicate polycythemia, which can be associated with chronic obstructive pulmonary disease. The other questions would be appropriate for patients who are anemic.

The nurse is reviewing laboratory results and notes a patient’s activated partial thromboplastin time (aPTT) level is 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication?

• Aspirin

• Heparin
  

• Warfarin
  

• Erythropoietin

Answer explanation

The aPTT level 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.

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

• 1. Platelet count

• 1. Neutrophil count

• 1. Hemoglobin level

• 1. White blood cell count

Answer explanation

Pallor of the skin or nail beds is indicative of anemia, which would be indicated by a low Hgb level. Platelet counts indicate a person’s clotting ability. A neutrophil is a type of white blood cell that helps to fight infection.

The nurse examines the lymph nodes of a patient during a physical assessment. Which finding would be of most concern to the nurse?

• 1. A 2-cm nontender supraclavicular node

• 1. A 1-cm mobile and nontender axillary node

• 1. An inability to palpate any superficial lymph nodes

• 1. Firm inguinal nodes in a patient with an infected foot

Answer explanation

Enlarged and nontender nodes are suggestive of malignancies such as lymphoma. Firm nodes are an expected finding in a known 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.

A patient who had a total hip replacement had an intraoperative hemorrhage 14 hours ago. Which laboratory test result would the nurse expect?

• 1. Hematocrit of 46%

• 1. Hemoglobin of 13.8 g/dL

• 1. Elevated reticulocyte count

• 1. Decreased white blood cell count

Answer explanation

Hemorrhage causes the release of reticulocytes (immature red blood cells) from the bone marrow into circulation. The hematocrit and hemoglobin levels are normal. Bleeding does not affect the white blood cell count.

The complete blood count (CBC) indicates that a patient is thrombocytopenic. Which action should the nurse include in the plan of care?

• 1. Avoid intramuscular injections.

• 1. Encourage increased oral fluids.

• 1. Check temperature every 4 hours.

• 1. Increase intake of iron-rich foods.

Answer explanation

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.

The health care provider’s progress note for a patient states that the complete blood count (CBC) shows a “shift to the left.” Which assessment finding should the nurse expect?

• 1. Cool extremities

• 1. Pallor and weakness

• Elevated temperature

• Low oxygen saturation

Answer explanation

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 or weakness, or cool extremities.