25 the nurse is monitoring a patient who is receiving

25.
The nurse is monitoring a patient who is receiving a blood transfusion. Which finding(s)
would lead the nurse to stop the infusion? ( Select all that apply. )
a. Report of chills
b. Headache
c. Back pain
d. Report of a rash
e. Fever
ANS: B, C, D, E
Headache, back pain, rash, and fever are findings that indicate a reaction to the transfusion;
the transfusion should be stopped. The nurse should then infuse saline solution into the line to
keep the intravenous line patent. Report of chills correlates to the infusion of the chilled
blood. The transfusion is not stopped; the patient is given a blanket.
MEDICAL SURGICAL NURSING CONCEPTS AND PRACTICE 3RD EDITION DEWIT TEST BANK
PTS: 1 DIF: Cognitive Level: Application REF: 362, Table 16-7
OBJ: 7 (theory) TOP: Transfusion: Complications
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
COMPLETION
26.
The nurse is aware that bone marrow transplantation (BMT) is a treatment alternative for
aplastic anemia for people under the age of ____________________.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 350
OBJ: 1 (clinical) TOP: Aplastic Anemia: Treatment
KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance
27.
When assessing a complete blood count (CBC) of a patient with acute lymphocytic leukemia
(ALL), the nurse would anticipate large numbers of immature white cells, called
____________________.

blasts
Immature white cells are released from the bone marrow in response to the body’s need for
more effective WBCs. Immature WBCs are known as blasts.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 353
OBJ: 5 (theory) TOP: ALL: CBC KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
28.
The patient with acute myelogenous leukemia (AML) has a volume of blood extracted by
machine, white cells are extracted in the machine, and the blood is then returned to the patient.
This process is called ____________________.
MEDICAL SURGICAL NURSING CONCEPTS AND PRACTICE 3RD EDITION DEWIT TEST BANK
PTS: 1 DIF: Cognitive Level: Comprehension REF: 363
OBJ: 2 (clinical) TOP: BMT: Engraftment
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
NURSINGTB.COM
NURSINGTB.COM
PTS: 1 DIF: Cognitive Level: Comprehension REF: 354
OBJ: 5 (theory) TOP: Leukapheresis
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
29.
The nurse explains to a person who has undergone bone marrow transplantation (BMT) that
engraftment takes up to ____________________ weeks.