Chapter - 076 Assessment of Hematopoetic System

Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive
Outcomes, 7th Edition
Chapter 76: 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: Cognitive Level: Application REF: Text Reference: 2262, Table 76-3;
TOP: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
2. The nurse should anticipate an elevated hemoglobin level in

a. a client who lives in Colorado.
b. a dehydrated elderly gentleman being treated with intravenous (IV) fluids.
c. a 40-year-old woman with congestive heart failure.
d. a client with iron deficiency anemia.
ANS: a
Hemoglobin levels are frequently elevated in people who live in high altitudes.
DIF: Cognitive Level: Application REF: Text Reference: 2258

3. A client has a hematocrit (Hct) of 30%. The nurse interprets this to mean
a. the individual has fewer red blood cells than normal.
b. the blood is viscous and concentrated.
c. bleeding disorders are possible.
d. 30% of the blood will be plasma and plasma products.
ANS: a
Hematocrit measures the percent volume of red cells in whole blood. The normal value in adult
women is 37% to 45%.
DIF: Cognitive Level: Comprehension REF: Text Reference: 2262

Chapter 76: Assessment of the Hematopoietic System 2
4. When teaching the client about the procedure of a bone marrow aspiration, the nurse should
explain that it is used to
a. identify blood abnormalities.
b. determine long-term prognosis.
c. assess for presence of infection.
d. determine the red blood cell (RBC) indices.
ANS: a
Bone marrow aspiration and biopsy are used to assess and identify most blood dyscrasias (e.g.,
aplastic anemia, leukemias, pernicious anemia, thrombocytopenia).

TOP: Nursing Process Step: Intervention
5. The nurse explains to a client who is to undergo a bone marrow aspiration that the most
common site for withdrawal of bone marrow is
a. antecubital fossa.
b. long bones.
c. posterior iliac crests.
d. acetabulum.
ANS: c
Bone marrow samples are most commonly taken from the posterior iliac crests. Other sampling
sites include the sternum and the anterior iliac crests.

6. A client expresses concern over the discomfort expected during the bone marrow aspiration.
The nurse can best address these concerns by informing the client
a. “You will be asleep during the procedure.”
b. “There is no pain associated with bone marrow aspirations.”
c. “The pain during marrow aspiration is of short duration.”
d. “A local anesthetic will make you comfortable during the procedure.”
ANS: c
Because the marrow space itself cannot be anesthetized, removal of the marrow usually produces
moderate to severe pain of short duration. It stops as soon as suction on the marrow space is
stopped.

7. Following a client's bone marrow aspiration, the nursing intervention should be to
Elsevier items and derived items © 2005 by Elsevier Inc.

a. apply firm pressure to the area until bleeding stops.

b. provide a warm, moist compress to the site.
c. encourage the client to assume a supine position.
d. place an occlusive dressing on the area for 24 hours.
ANS: a
Following the procedure, apply pressure until the bleeding stops. A pressure dressing or a
sandbag might be necessary.

8. The nurse notes that a client has a higher than normal reticulocyte count. This would indicate
a. polycythemia vera.
b. increased erythrocyte production.
c. dehydration.
d. bone marrow depression.
ANS: b
An increase in the reticulocyte count indicates an increase in erythrocyte production, probably
because of excessive RBC destruction (hemolytic anemia) or loss (hemorrhage).
DIF: Cognitive Level: Analysis REF: Text Reference: 2264

9. The laboratory test result that would be most helpful to the nurse in the assessment of a client
with a bleeding disorder is
a. RBC count.
b. platelet count.
c. hematocrit.
d. differential count.
ANS: b
The platelet count is valuable in assessing the severity of thrombocytopenia (abnormally low
platelet count), which can result in spontaneous bleeding.

10. A client has severe anemia and is being treated with transfusion therapy. The nurse should be
alert for a complicaton of transfusion, such as
a. hearing loss.
b. liver damage.
c. flank pain.
d. sore throat.

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

11. The manifestation the nurse would question the client about that is characteristically
associated with anemia is
a. pruritus.
b. fatigue.
c. rash.
d. ruddy skin color.
ANS: b
Fatigue is the most common manifestation of anemia.

12. A client presents to the ambulatory care center seeking treatment for allergies. When
questioning the client about contact agents as allergic triggers, the nurse would inquire about
a. pollen.
b. molds and spores.
c. types of clothing fibers.
d. food additives.
ANS: c
Contact agents as allergic triggers include dyes in clothing, fibers, and cosmetics; metal in
jewelry; plant oils and secretions; topical drugs; and numerous chemicals.

13. The nurse assesses the client who underwent partial removal of the stomach a year ago for
the manifestations of
a. shortened bleeding times.
b. high white blood cell count.
c. low platelet count.
d. anemia.
ANS: d
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.


14. A client reports getting allergy manifestations when in the workplace. Further assessment
about airborne allergens should focus on
a. lighting.
b. food service vendor.
c. heating and cooling systems.
d. water supply.
ANS: c
Exposure to allergens at work may trigger reactions. Ask about the heating and cooling systems
if airborne allergens are suspected.

TOP: Nursing Process Step: N/A
MSC: NCLEX: Health Promotion and Maintenance
15. 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. skin eruptions.
b. conjunctivitis.
c. severe headaches.
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.

16. 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: b
For most clinical conditions that necessitate anticoagulation, the recommended INR is 2 to 3.5.
DIF: Cognitive Level: Knowledge REF: Text Reference: 2265


17. The laboratory result to which the nurse would look to confirm a diagnosis of disseminated
intravascular coagulation (DIC) is
a. prothrombin time.
b. partial thromboplastin time.
c. D-dimer.
d. reticulocyte count.
ANS: c
The D-dimer confirms the diagnosis of DIC.

18. The nurse discovers a client is taking the herb St. John’s wort. The nurse cautions that this
herb reduces the effectiveness of
a. prednisone.
b. theophylline.
c. lanoxin.
d. warfarin.
ANS: d
The anticoagulation properties of warfarin are diminished if taken in conjunction with St. John’s
wort.

19. The nurse schedules the time to access delayed type hypersensitivity (DTH) skin testing,
which is
a. 24 hours postinjection.
b. 36 hours postinjection.
c. 48 hours postinjection.
d. 72 hours postinjection.
ANS: c
A DTH should be read after 48 hours for the most reliable results.

20. A client with thrombocytopenia complains of a visual disturbance. The nurse is aware this
visual problem may be due to

a. occlusive emboli in the visual center of the brain.

b. severe anemia causing altered perfusion to the brain.
c. minute retinal hemorrhages.
d. bile pigment accumulation in the eye.
ANS: c
The reduced number of platelets make the thrombocytopenic clients at risk for hemorrhages.

21. A client with polycythemia vera will have a characteristic skin color that is
a. pale.
b. ruddy.
c. bronzed.
d. jaundiced.
ANS: b
The client with polycythemia vera has a ruddy complexion.


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Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive

Outcomes, 7th Edition

Chapter 76: Assessment of the Hematopoietic System

2. The nurse should anticipate an elevated hemoglobin level in

DIF: Cognitive Level: Application REF: Text Reference: 2258

DIF: Cognitive Level: Comprehension REF: Text Reference: 2262

DIF: Cognitive Level: Comprehension REF: Text Reference: 2265

DIF: Cognitive Level: Comprehension REF: Text Reference: 2265

DIF: Cognitive Level: Comprehension REF: Text Reference: 2265

7. Following a client's bone marrow aspiration, the nursing intervention should be to

Elsevier items and derived items © 2005 by Elsevier Inc.

a. apply firm pressure to the area until bleeding stops.

DIF: Cognitive Level: Application REF: Text Reference: 2265

DIF: Cognitive Level: Analysis REF: Text Reference: 2264

DIF: Cognitive Level: Analysis REF: Text Reference: 2265

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 2257

DIF: Cognitive Level: Analysis REF: Text Reference: 2255

DIF: Cognitive Level: Analysis REF: Text Reference: 2255

Elsevier items and derived items © 2005 by Elsevier Inc.

DIF: Cognitive Level: Analysis REF: Text Reference: 2256

DIF: Cognitive Level: Application REF: Text Reference: 2258

DIF: Cognitive Level: Analysis REF: Text Reference: 2258

DIF: Cognitive Level: Knowledge REF: Text Reference: 2265

Elsevier items and derived items © 2005 by Elsevier Inc.

TOP: Nursing Process Step: Assessment

DIF: Cognitive Level: Knowledge REF: Text Reference: 2265

DIF: Cognitive Level: Application REF: Text Reference: 2257

DIF: Cognitive Level: Application REF: Text Reference: 2268

Elsevier items and derived items © 2005 by Elsevier Inc.

a. occlusive emboli in the visual center of the brain.

DIF: Cognitive Level: Application REF: Text Reference: 2259

DIF: Cognitive Level: Knowledge REF: Text Reference: 2259

Elsevier items and derived items © 2005 by Elsevier Inc.

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