Harding Med-Surg Nursing Chapter 33: Assessment: Hematologic System

The nurse assesses a patient who has numerous petechiae on both arms. Which question

would the nurse ask the patient?

a. "Are you taking any oral contraceptives?"

b. "Have you been prescribed antiseizure drugs?"

c. "Do you take medication containing salicylates?"

d. "How long have you taken antihypertensive drugs?"

c. "Do you take medication containing salicylates?"

Petechiae (small purplish red pinpoint lesions) can indicate bleeding disorders or the effects of

drugs (such as salicylates) that interfere with platelet function. 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. Which finding would be of the most

concern to the nurse?

a. Hematocrit of 35%

b. Hemoglobin of 11.8 g/dL

c. Platelet count of 410,000/L

d. White blood cell count of 2800/L

d. White blood cell count of 2800/L

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 just over the high end of normal. The slight decrease in hemoglobin and hematocrit

are not unusual for an older patient.

A patient with pancytopenia will have a bone marrow aspiration from the left posterior iliac

crest. Which action would the nurse take after the procedure?

a. Elevate the head of the bed to 45 degrees.

b. Apply a sterile pressure dressing to the site.

c. Use a 1⁄2-in sterile gauze to pack the wound.

d. Have the patient lie in prone position for 1 hour.

b. Apply a sterile pressure dressing to the site.

A pressure dressing is used to cover the aspiration site and decrease the risk for bleeding.

After a bone marrow biopsy, the wound is small and will not be packed with gauze. There is

no indication to elevate the patient's head or have the patient lie prone, however, if bleeding is

present, have the patient lie supine for 30 to 60 minutes to keep pressure on the site.

The nurse assesses a patient who has pernicious anemia. Which finding would the nurse

expect?

a. Report of bone pain

b. Yellow-tinged sclerae

c. Tender, bleeding gums

d. Numbness of extremities

d. Numbness of extremities

Extremity numbness is associated with cobalamin (vitamin B12) deficiency or pernicious

anemia. Yellow-tinged sclera is associated with hemolytic anemia and the resulting jaundice.

Gum bleeding and tenderness occur with thrombocytopenia or neutropenia. Bone pain is

common with multiple myeloma.

A patient's complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of

54%. Which question would the nurse ask to determine possible causes of this finding?

a. "Have you had a recent weight loss?"

b. "Do you have a history of lung disease?"

c. "What is your dietary intake of protein?"

d. "Have you noticed any dark or bloody stools?"

b. "Do you have a history of lung disease?"

The hemoglobin and hematocrit results indicate polycythemia, which can be associated with

hypoxemia form lung problems such as chronic obstructive pulmonary disease. Questions

about weight loss, protein intake, and bleeding 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 would notify the health care provider in

anticipation of adjusting which medication?

a. Aspirin

b. Heparin

c. Warfarin

d. Erythropoietin

b. Heparin

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 30 to 40

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 would

plan to review which laboratory test result?

a. Platelet count

b. Neutrophil count

c. Hemoglobin level

d. White blood cell count

c. Hemoglobin level

Pallor of the skin or nail beds indicates anemia and a low hemoglobin 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?

a. A 2-cm nontender supraclavicular node

b. A 1-cm mobile and nontender axillary node

c. An inability to palpate any superficial lymph nodes

d. Firm inguinal nodes in a patient with an infected foot

a. A 2-cm nontender supraclavicular node

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?

a. Hematocrit of 46%

b. Hemoglobin of 13.8 g/dL

c. Elevated reticulocyte count

d. Decreased white blood cell count

c. Elevated reticulocyte count

Hemorrhage causes the release of reticulocytes (immature red blood cells) from the bone

marrow into circulation. Hematocrit and hemoglobin levels would be expected to fall below

normal after a hemorrhage. Bleeding does not affect the white blood cell count.

The complete blood count (CBC) indicates that a patient is thrombocytopenic. Which action

would the nurse include in the plan of care?

a. Avoid intramuscular injections.

b. Encourage increased oral fluids.

c. Check temperature every 4 hours.

d. Increase intake of iron-rich foods.

a. Avoid intramuscular injections.

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 increased polymorphonuclear neutrophils (bands). Which assessment finding

would the nurse expect?

a. Cool extremities

b. Pallor and weakness

c. Elevated temperature

d. Low oxygen saturation

c. Elevated temperature

An elevated number of immature polymorphonuclear neutrophils (bands) is a sign of

infection. A result of decreased hemoglobin and hematocrit would be associated with pallor

and weakness or cool extremities. The CBC would not show a direct association with oxygen

saturation, although a low hemoglobin results in less hemoglobin being available to be

saturated with oxygen.

The health care provider orders a liver and spleen ultrasound scan for a patient who has been

in a motor vehicle crash. Which action would the nurse take to prepare the patient for this

procedure?

a. Insert a urinary catheter.

b. Check for an iodine allergy.

c. Administer prescribed sedatives.

d. Assist the patient to a flat position.

d. Assist the patient to a flat position.

The patient is placed in a flat position before the scan. A urinary catheter and sedation are not

needed. No iodine contrast material is used.

The nurse is preparing a patient with pancytopenia of unknown origin for diagnostic tests.

Which test will require a signed consent form?

a. Bone marrow biopsy

b. Abdominal ultrasound

c. Complete blood count (CBC)

d. Activated partial thromboplastin time (aPTT)

a. Bone marrow biopsy

A bone marrow biopsy is a minor invasive surgical procedure that requires the patient or

guardian to sign a surgical consent form. The other procedures do not require a signed

consent.

The nurse reviews the laboratory test results of a patient admitted with abdominal pain. Which

information will be most important for the nurse to communicate to the health care provider?

a. Monocytes 4%

b. Hemoglobin 13.6 g/dL

c. Platelet count 168,000/L

d. White blood cell count 15,500/L

d. White blood cell count 15,500/L

The elevation in white blood cells indicates that the patient has an inflammatory or infectious

process and that further diagnostic testing is needed. The monocytes are at a normal level. The

hemoglobin and platelet counts are normal.

A patient has just arrived in the emergency department. Which information shown in the table below is most urgent for the nurse to communicate to the health care provider?

Assessment

BP 110/68

Pulse 98 beats/min

Brisk capillary refill

Multiple ecchymoses on

arms

Complete Blood Count

Hgb 10.6 g/dL

Hct 30%

WBC 5100/L

Platelets 19,500/L

Patient History

Occasional aspirin use

Abdominal pain 1 week

Large, dark stool this

morning

a. Heart rate

b. Platelet count

c. Abdominal pain

d. White blood cell count

b. Platelet count

The platelet count is severely decreased and places the patient at risk for spontaneous

bleeding. The other information is pertinent but not as indicative of the need for rapid

treatment as the platelet count.