Hematologic Problems Quiz

The nurse is assessing an older client for any potential hematologic health problem. Which assessment finding is the most significant and would be reported to the primary health care provider?

• Multiple petechiae and large bruises

• Dry, flaky skin on arms and legs

• Poor skin turgor on both forearms

• Decreased body hair distribution

Answer explanation

The presence of multiple petechiae and large bruises indicate a possible problem with blood clotting. Older adults typically have poor skin turgor and dry, flaky skin due to decreased body fluid as a result of aging. They also lose body hair or have thinning hair as a normal change of aging.

A hospitalized client has a platelet count of 58,000/mm³ (58 × 10⁹/L). What action by the nurse is most appropriate?

• 
  Institute neutropenic precautions.

• Limit visitors to healthy adults.

• Place the client on safety precautions.

• Encourage high-protein foods.

Answer explanation

With a platelet count between 40,000 and 80,000/mm³ (40 and 80 × 10⁹/L), clients are at risk of prolonged bleeding even after minor trauma. The nurse would place the client on safety or bleeding precautions as the most appropriate action. High-protein foods, while healthy, are not the priority. Neutropenic precautions are not needed as the patient’s white blood cell count is not low. Limiting visitors would also be more likely related to a low white blood cell count.

What is the nurse’s priority when caring for a client who just completed a bone marrow aspiration and biopsy?

• Report the laboratory results to the primary health care provider.

• Check the pressure dressing frequently for signs of excessive or active bleeding.

• Administer a nonsteroidal anti-inflammatory drug (NSAID) to promote comfort.

• Teach the client to avoid activity for 24 to 48 hours to prevent infection.

Answer explanation

The client having a bone marrow aspiration and biopsy has a puncture wound from the large needle used to extract the bone marrow. Therefore, the client is at risk for bleeding. A NSAID should not be given because it can cause bleeding. Avoiding activity helps to prevent bleeding, not infection, and reporting the results of the biopsy is not the responsibility of the nurse.

Patients with a platelet value of 120,000/mm3 are at risk for excessive blood clotting.

• True

• False

The nurse is assessing a client experiencing anemia. Which laboratory findings will the nurse expect for this client? (Select all that apply.)

• Decreased serum iron

• Decreased white blood cell count

• Decreased hemoglobin

• Increased hematocrit

• Decreased red blood cell count

Answer explanation

Clients experiencing anemia have a decreased red blood cell count which leads to a decreased hemoglobin and hematocrit. For some clients, serum iron levels are also decreased. Anemia is not a problem involving platelets or white blood cells.

The nurse is assessing a client in sickle cell disease (SCD) crisis. What priority client problem will the nurse expect?

• Creatinine: 2.9 mg/dL (256 mcmol/L)

• Sodium: 146 mEq/L (146 mmol/L)

• White blood cell count: 12,000/mm³ (12 × 10⁹/L)

• Hematocrit: 30%

Answer explanation

An elevated creatinine indicates kidney damage, which occurs in SCD. A hematocrit level of 30% is an expected finding, as is a slightly elevated white blood cell count due to chronic inflammation. A sodium level of 146 mEq/L (146 mmol/L), although slightly high, is not concerning.

A nurse in a hematology clinic is working with four clients who have polycythemia vera. Which client would the nurse assess first?

• Client with a swollen and painful left great toe

• Client with a blood pressure of 180/98 mm Hg

• Client who reports calf tenderness and swelling

• 
  Client who reports shortness of breath

Answer explanation

Clients with polycythemia vera often have clotting abnormalities due to the hyperviscous blood with sluggish flow. The client reporting shortness of breath may have a pulmonary embolism and should be seen first. The client with a swollen calf may have a deep vein thrombosis and should be seen next. High blood pressure and gout symptoms are common findings with this disorder.

The nurse is teaching a client who has pernicious anemia about necessary dietary changes. Which statement by the client indicates understanding about those changes?

• “I’ll limit my intake of citrus fruits.”

• “I’ll avoid eating green leafy vegetables."

• “I’ll work on increasing my fats and carbohydrates.”

• “I’ll increase animal proteins like fish and meat.”

Answer explanation

Clients who have pernicious anemia have a Vitamin B₁₂ deficiency and need to consume foods high in Vitamin B₁₂, such as animal and plant proteins, citrus fruits, green leafy vegetables, and dairy products. While carbohydrates and fats can provide sources of energy, they do not supply the necessary nutrient to improve anemia.

A nurse is preparing to administer a blood transfusion. Which action is most important?

• Put on a pair of gloves.

• Place the client in isolation.

• Document the transfusion.

• Place the client on NPO status.

Answer explanation

To prevent bloodborne illness, the nurse should don a pair of gloves prior to hanging the blood. Documentation is important but not the priority at this point. NPO status and isolation are not needed.

A client has thrombocytopenia. What statement indicates that the client understands self-management of this condition?

• “I chew hard candy for my dry mouth.”

• “Nonslip socks are best when I walk.”

• “I brush and use dental floss every day.”

• “I usually put ice on bumps or bruises.”

Answer explanation

The client should be taught to apply ice to areas of minor trauma. Flossing is not recommended. Hard foods should be avoided. The client should wear well-fitting shoes when ambulating.