Ch 29-31

18. A child has sickle cell disease (SCD). What treatment or therapy does the healthcare professional discuss with the parents and child? 1. Hydroxyurea 2. Low-dose daily aspirin 3. Heparin injections 4. Genetic testing

A A common therapy for sickle cell disease is hydroxyurea which is an inhibitor of DNA synthesis. It increases HbF synthesis, which decreases the proportion of HbS. Aspirin is not used as the potential blood loss could worsen SCD. The same is true of heparin, plus blood clotting is not the major issue in the disorder. Genetic testing would not be used as a treatment or therapy. PTS: 1 DIF: Cognitive Level:

22. A patient has thalassemia major. After receiving multiple blood transfusions over the last several months, what complication does the healthcare professional assess the patient for? 1. Hemochromatosis 2. Iron deficiency anemia 3. Vitamin C depletion 4. Rh autoimmunity

A A complication of multiple blood transfusions is hemochromatosis (iron overload) which is a major cause of death in these patients. Iron deficiency anemia does not occur. Vitamin C depletion does not occur with transfusions. Rh autoimmunity is related to pregnant women and not blood transfusions. PTS: 1 DIF: Cognitive Level:

2. A patient has been diagnosed with acute lymphocytic leukemia (ALL) and asks the healthcare professional to describe it. What description by the professional is most accurate? 1. ALL is a progressive neoplasm defined by the presence of greater than 30% lymphoblasts in the bone marrow or blood. 2. In ALL, immature blasts cells replace normal myelocytic cells, megakaryocytes, and erythrocytes. 3. B cells fail to mature into plasma cells that synthesize immunoglobulins. 4. The translocation of genetic material from genes 9 and 22 create an abnormal, fused gene identified as BCR-ABL.

A ALL is a progressive neoplasm defined by the presence of greater than 30% lymphoblasts in the bone marrow or blood. Leukemia is a malignant disorder of leukocytes and does not involve immunoglobulins. The BCR-ABL gene has been identified in chronic myelogenous leukemia, not ALL. PTS: 1 DIF: Cognitive Level:

16. What period follows depolarization of the myocardium and represents a period during which no new cardiac potential can be propagated? a. Refractory 315 2. Hyperpolarization 3. Threshold 4. Sinoatrial (SA)

A During the absolute refractory period, no new cardiac action potential can be initiated by a stimulus. The other options do not reflect the time period in which no stimulation will produce a new cardiac potential. PTS: 1 DIF: Cognitive Level:

11. A healthcare professional has educated a student on folic acid. Which statement by the student indicates that more teaching is needed? 1. Folic acid absorption is dependent on the enzyme folacin. 2. Folic acid is stored in the liver. 3. Folic acid is essential for RNA and DNA synthesis within erythrocytes. 4. Folic acid is absorbed in the upper small intestine.

A Folic acid absorption is not dependent on the enzyme folacin. The professional would need to provide more teaching if the student made this statement. The other options are true statements regarding folic acid. PTS: 1 DIF: Cognitive Level:

11. When diagnosed with hemolytic disease of the fetus and newborn (HDFN), why does the newborn develop hyperbilirubinemia after birth but not in utero? 1. Excretion of unconjugated bilirubin through the placenta into the mother's circulation is no longer possible. 2. Hemoglobin does not breakdown into bilirubin in the intrauterine environment. 3. The liver of the fetus is too immature to conjugate bilirubin from a lipid-soluble to water-soluble form. 4. The destruction of erythrocytes producing bilirubin is greater after birth.

A Hyperbilirubinemia occurs in the neonate after birth because excretion of lipid-soluble unconjugated bilirubin through the placenta is no longer possible. HDFN is not related to hemoglobin failing to breakdown, an immature liver, or destruction of erythrocytes being greater after birth. PTS: 1 DIF: Cognitive Level:

30. A patient has leukemia. The healthcare professional explains to a patient about the significance of hyperdiploidy. What statement by the professional is most accurate? 1. It indicates a good prognosis. 2. It indicates a poor prognosis. 3. It limits treatment options. 4. Hyperdiploidy demonstrates remission.

A Hyperdiploidy (increased number of chromosome copies) is associated with a good prognosis. The other options are incorrect regarding the significance of hyperdiploidy. PTS: 1 DIF: Cognitive Level:

25. What does treatment for polycythemia vera involve? 1. Therapeutic phlebotomy and radioactive phosphorus 2. Restoration of blood volume by plasma expanders 3. Administration of cyanocobalamin 4. Blood transfusions

A In low-risk individuals, the recommended therapy is phlebotomy and low-dose aspirin, whereas radioactive phosphorus has been used to suppress erythropoiesis. Plasma expanders, cyanocobalamin, and blood transfusions are not treatments for this disease. PTS: 1 DIF: Cognitive Level:

21. A patient has microcytic, hypochromic anemia. Which type of treatment or procedure does the healthcare professional discuss as a potential cure with the patient? 1. Cord blood transplantation 2. Scheduled infusion of gamma globulins 3. Massive blood transfusions 4. Repeated injections of Rho-GAM

A Microcytic, hypochromic anemia is one manifestation of thalassemia. The only definitive cures for this disorder are allogeneic hematopoietic stem cell transplantation (HSCT) from a matched family or unrelated donor or cord blood transplantation from a related donor. Gamma globulins protect the body against infectious diseases. Blood transfusions can be used to correct low hemoglobin. Rho-GAM is used in postpartum women who are Rh-negative after delivering an Rh-positive baby to prevent development of maternal antibodies against the baby's blood. PTS: 1 DIF: Cognitive Level:

19. A student asks the professor what the most common pathophysiologic process is that triggers aplastic anemia (AA). What response by the professor is most accurate? 1. Autoimmune disease against hematopoiesis by activated cytotoxic T (Tc) cells 2. Malignancy of the bone marrow in which unregulated proliferation of erythrocytes crowd out other blood cells 3. Autoimmune disease against hematopoiesis by activated immunoglobulins 4. Inherited genetic disorder with recessive X-linked transmission

A Most cases of AA result from an autoimmune disease directed against hematopoietic stem cells. Tc cells appear to be the main culprits in this process. AA does not include proliferation of erythrocytes. The autoimmune process seems to be mediated by alterations in CD4+, CD8+, and Th-17 T-cell responses and reduced numbers of regulatory T cells. Only a small percentage of patients have an inherited or familial form. PTS: 1 DIF: Cognitive Level:

3. Which blood cell type is elevated at birth and through the preschool years, but decreases to adult levels afterward? 1. Monocytes 2. Platelets 3. Neutrophils 4. Lymphocytes

A Only monocyte counts are high in the newborn and through the preschool years. After this time period, they decrease to adult levels. PTS: 1 DIF: Cognitive Level:

8. A hospitalized patient's lab work is as follows: WBC 2000, bands 14.8%, and segmented neutrophils 5. The healthcare professional calculates the patient's absolute neutrophil count (ANC). What action does the professional take next? 1. Implements protocols to prevent life-threatening infections 2. Encourages the patient to limit any visitors for the present time 3. Does nothing; this is a normal ANC for the white cell count 4. Holds the patient's medications until the ANC returns to normal

A The ANC is calculated by multiplying the white blood cell count by the sum of the bands and segmented neutrophils. This patient's ANC is 396, placing him or her at extremely high risk of developing a life-threatening infection. Visitors may need to be limited but that will not protect the patient from all sources of infection. The patient's medications would not all be held because of this finding. PTS: 1 DIF: Cognitive Level:

23. The alpha- and beta-thalassemias are considered what types of inherited disorder? 1. Autosomal recessive 2. Autosomal dominant 3. X-linked recessive 4. X-linked dominant

A The alpha- and beta-thalassemias are inherited autosomal recessive disorders. PTS: 1 DIF: Cognitive Level:

11. The coronary sinus empties into which cardiac structure? 1. Right atrium 2. Left atrium 3. Superior vena cava 4. Aorta

A The cardiac veins empty only into the right atrium through another ostium, the opening of a large vein called the coronary sinus. PTS: 1 DIF: Cognitive Level:

10. How is the effectiveness of vitamin B12 therapy measured? 1. Reticulocyte count 2. Serum transferring 3. Hemoglobin 4. Serum vitamin B12

A The effectiveness of cobalamin replacement therapy is determined by a rising reticulocyte count. The other options are not used as indicators of the effectiveness of vitamin B12 therapy PTS: 1 DIF: Cognitive Level:

2. Which cardiac chambers have the thinnest wall and why? 1. The right and left atria; they are low-pressure chambers that serve as storage units and conduits for blood. 2. The right and left atria; they are not directly involved in the preload, contractility, or afterload of the heart. 3. The left ventricle; the mean pressure of blood coming into this ventricle is from the lung, which has a low pressure. 4. The right ventricle; it pumps blood into the pulmonary capillaries, which have a lower pressure compared with the systemic circulation.

A The two atria have the thinnest walls because they are low-pressure chambers that serve as storage units and conduits for blood that is emptied into the ventricles. The ventricles have thicker walls in order to pump blood against resistance. PTS: 1 DIF: Cognitive Level:

17. A healthcare professional is reviewing a patient's laboratory results and sees that the patient has a low reticulocyte count and a high iron level. Which type of anemia does the professional associate these findings with? 1. Folate deficiency anemia 2. Iron deficiency anemia 3. Hemolytic anemia 4. Anemia of chronic disease

A These results are characteristic of folate deficiency. Iron deficiency would manifest with normal reticulocyte count and high iron. Hemolytic anemia would show high reticulocyte count and normal or high iron levels. Anemia of chronic disease would have a normal reticulocyte count but low iron levels. PTS: 1 DIF: Cognitive Level:

10. A person comes to the healthcare clinic and reports night sweats and fever. The healthcare professional obtains a chest x-ray which shows a mediastinal mass. What other assessment or diagnostic test does the professional provide as a priority? 1. Listen to heart sounds. 2. Assess the patient's skin. 3. Arrange for familial DNA testing. 4. Test blood for anemia.

A This patient has signs of Hodgkin lymphoma (HL). Pericardial involvement can lead to pericardial friction rub and pericardial effusion. The professional should listen to the patient's heart for the sounds that characterize these conditions. The patient may demonstrate itchy skin lesions, but this would not take priority over heart sounds. Familial DNA testing would not be a priority. Anemia accompanies many healthcare conditions and so would be nonspecific for HL. PTS: 1 DIF: Cognitive Level:

28. A patient is 8 hours postoperative after a long orthopedic procedure. The student asks why this patient is at particular risk of developing a thromboembolism. What response by the healthcare professional is best? 1. Patients tend to have venous stasis from orthopedic operations. 2. Anesthetic agents often cause an immune response against clotting factors. 3. Endothelial damage occurs and repair is slowed by postoperative pain. 4. Atherosclerotic build up causes turbulent blood flow leading to clots.

A Thromboembolic events are caused by some component of Virchow triad: endothelial injury, abnormal blood flow, and hypercoagulability of the blood. Long operative procedures such as orthopedic cases promote venous stasis. Anesthetic agents are not implicated. Endothelial repair is not appreciably hindered by postoperative pain. Atherosclerotic buildup can lead to endothelial injury but that is not specific to this patient. PTS: 1 DIF: Cognitive Level:

4. Which of these describes how the body compensates for anemia? 1. Increasing rate and depth of breathing 2. Decreasing capillary vasoconstriction 3. Hemoglobin holding more firmly onto oxygen 4. Kidneys releasing more erythropoietin

A Tissue hypoxia from anemia creates additional demands and compensatory actions on the pulmonary and hematologic systems. The rate and depth of breathing increase in an attempt to increase the availability of oxygen. The body does not compensate by decreasing vasoconstriction, tightening the hemoglobin bonds with oxygen, or releasing more erythropoietin. PTS: 1 DIF: Cognitive Level:

13. What is the name of the disorder in which levels of bilirubin remain excessively high in the newborn and are deposited in the brain? 1. Kernicterus 2. Icterus neonatorum 3. Jaundice 4. Icterus gravis neonatorum

A Without replacement transfusions, during which the child receives Rh-negative erythrocytes, the bilirubin is deposited in the brain, a condition called kernicterus. This is the only condition where bilirubin is deposited in the brain. PTS: 1 DIF: Cognitive Level:

26. An adult patient has been hospitalized with thrombocytopenia with a platelet count of 8000/mm3. What action by the healthcare professional is most appropriate? 1. Tell the patient not to get out of bed without assistance. 2. Prepare the patient for transfusions of whole blood. 3. Educate the patient on side effects of heparin. 4. Nothing; this finding is normal in an adult.

A 290 Thrombocytopenia is a platelet count of less than 150,000/mm3. A platelet count of 8,000/mm3 is low enough to produce spontaneous bleeding, which would be devastating if it occurred in the brain. The healthcare professional should advise the patient not to get out of bed without assistance to help prevent falls. Whole blood is not needed since only platelets are deficient. The patient would not receive heparin as this would increase the chance of bleeding. A normal platelet count in an adult is 150,000 to 350,000/mm3. PTS: 1 DIF: Cognitive Level:

9. Occlusion of the left anterior descending artery during a myocardial infarction would interrupt blood supply to which structures? 1. Left and right ventricles and much of the interventricular septum 2. Left atrium and the lateral wall of the left ventricle 3. Upper right ventricle, right marginal branch, and right ventricle to the apex 4. Posterior interventricular sulcus and the smaller branches of both ventricles

A 313 The left anterior descending artery (LAD), also called the anterior interventricular artery, delivers blood to portions of the left and right ventricles and much of the interventricular septum. The circumflex artery supplies the left atrium and lateral wall of the left ventricle. The right coronary artery supplies the right ventricle and one of its branches is the right marginal branch. The interventricular sulcus and smaller branches of both ventricles are also supplied by the right coronary artery. PTS: 1 DIF: Cognitive Level:

4. The two major forms of leukemia, acute and chronic, are classified by which criteria? (Select all that apply.) 1. Predominant cell type 2. Rate of progression 3. Age of individual when cells differentiation occurs 4. Stage of cell development when malignancy first occurs 5. Serum level of leukocytes

A, B The current classification of leukemia is based on (1) the predominant cell of origin (either myeloid or lymphoid) and (2) the rate of progression. A person's age, stage of cell development at the onset of malignancy, and serum blood levels of leukocytes are not part of the classification of leukemias. PTS: 1 DIF: Cognitive Level:

5. What are the clinical manifestations of advanced non-African Burkitt lymphoma? (Select all that apply.) 1. Abdominal swelling 2. Night sweats 3. Fever 4. Weight gain 5. Dementia

A, B, C In non-African Burkitt lymphoma, the most common presentation is abdominal swelling. More advanced disease may exhibit night sweats, fever, and weight loss. Dementia is not associated with this disease. PTS: 1 DIF: Cognitive Level:

1. A healthcare professional is ilyssa laboratory results for a patient who has disseminated intravascular coagulation (DIC). What results would the professional consider consistent with this condition? (Select all that apply.) 1. Elevated d-dimer 2. Elevated creatinine 3. Decreased protein C 4. Decreased lactate dehydrogenase 5. Increased pH

A, B, C Lab results consistent with DIC include elevated d-dimer and creatinine (showing kidney damage), and decreased protein C. The lactate dehydrogenase would be elevated and the pH would be decreased. PTS: 1 DIF: Cognitive Level:

2. A pediatric patient presents with pallor, fatigue, fever, petechiae, and purpura. What diagnostic testing does the healthcare professional help prepare the patient for? (Select all that apply.) 1. Complete blood count 2. Renal function studies 3. Bone marrow biopsy 4. Chest x-ray 5. Joint fluid sampling

A, B, C, D This child has manifestations of a leukemia. Since hemoglobin and platelets may be low and white cells may be very high, a complete blood count will be done. Renal failure occurs frequently in ALL so renal function studies will be ordered. A bone marrow biopsy will be done in order to differentiate the type of leukemia the child has. A chest x-ray will be helpful to evaluate the cause of the fever which could be from an infection. Joint aspiration is not needed. PTS: 1 DIF: Cognitive Level:

MULTIPLE RESPONSE 1. What are the common triggers for sickle cell crisis? (Select all that apply.) 1. Fever 2. Infection 3. Dehydration 4. Alkalosis 5. Exposure to the cold

A, B, C, E Crises can be prevented by avoiding fever, infection, acidosis, dehydration, constricting clothes, and exposure to cold. PTS: 1 DIF: Cognitive Level:

3. The student studying pathophysiology learns which facts about leukemias? (Select all that apply.) 1. A single progenitor cell undergoes a malignant change. 2. Leukemia is a result of uncontrolled cellular proliferation. 3. Bone marrow becomes overcrowded. 4. Leukocytes are under produced. 5. Hematopoietic cell production is decreased.

A, B, C, E In the leukemias, a single progenitor cell undergoes malignant transformation. The common feature of all forms of leukemia is an uncontrolled proliferation of malignant leukocytes, causing an overcrowding of bone marrow and decreased production and function of normal hematopoietic cells. PTS: 1 DIF: Cognitive Level:

2. A healthcare professional is caring for five patients. Which one would the professional assess for disseminated intravascular coagulation (DIC) as the priority? (Select all that apply.) 1. Heat stroke 2. Severe pancreatitis 3. Term delivery 4. HELLP syndrome 5. Snake bite

A, B, D, E Common causes of DIC include heat stroke, severe pancreatitis, HELLP syndrome (and other OB complications), and snake bite. A normal term delivery would not put a patient at high risk for developing DIC. PTS: 1 DIF: Cognitive Level:

7. A student is learning about the functions of leukocytes. What statements about these cells are correct? (Select all that apply.) 1. Eosinophilia can result from parasitic infections. 2. Basophilia can be seen in hypersensitivity reactions. 3. Monocytosis is usually seen in acute infections. 4. Lymphocytosis occurs rapidly in bacterial infections. 5. Granulocytopenia can be a life-threatening condition.

A, B, E Eosinophilia can occur from parasitic infections or ingestion/inhalation of toxic particles. Basophilia occurs in hypersensitivity reactions because of the release of histamine. Monocytosis occurs in chronic infections or in the later stage of other infections. Lymphocytosis occurs in chronic infections, leukemia, lymphoma, and viral infections. Granulocytosis can be life- threatening if the person's defenses are so inadequate that sepsis results. PTS: 1 DIF: Cognitive Level:

6. A person has lab drawn and the white blood cell count is much higher than normal. The healthcare professional understands which facts about this finding? (Select all that apply.) 1. The person has leukocytosis. 2. The person has leukopenia. 3. The person may have an infection. 4. The person may have a myeloproliferative disorder. 5. the person needs a bone marrow biopsy.

A, C, D Leukocytosis is a higher than normal white blood cell count and can indicate physiological stress, an infection, or a malignancy such as a myeloproliferative disorder. Leukopenia is a lower than normal white cell count. Depending on the rest of the person's history and physical examination, a bone marrow biopsy may or may not be needed. PTS: 1 DIF: Cognitive Level:

MULTIPLE RESPONSE 1. Which classic clinical manifestations are symptoms of infectious mononucleosis (IM)? (Select all that apply.) 1. Lymph node enlargement 2. Hepatitis 3. Pharyngitis 4. Edema in the area of the eyes 5. Fever

A, C, E At the time of diagnosis, the individual usually has the classic triad of symptoms: fever, pharyngitis, and lymphadenopathy of the cervical lymph nodes. The triad does not include hepatitis or orbital edema. PTS: 1 DIF: Cognitive Level:

8. A student studying microbiology learns which facts about the Epstein-Barr virus (EBV)? (Select all that apply.) 1. Causative organism for infectious mononucleosis 2. Rare mutation may be seen in Burkitt Lymphoma. 3. Implicated in some nasopharyngeal cancers 4. Is only seen along with rare non-Hodgkin lymphomas 5. Immunodeficiency can lead to EBV-positive neoplasms.

A, C, E EBV has been implicated as a causative organism for infectious mononucleosis, Burkitt lymphoma, some rare non-Burkitt lymphomas, and nasopharyngeal cancer. PTS: 1 DIF: Cognitive Level:

20. A couple who both carry the sickle cell trait wish to have children. What does the healthcare professional tell them is the chance that each pregnancy will result in a child who has sickle cell disease (SCD)? a. 20% b. 25% c. 33% d. 50%

B A 25% chance exists with each pregnancy that a child born to two parents with sickle cell trait will have SCD. Genetic counseling enables people with SCD or with the sickle cell trait to make informed decisions about transmitting this genetic disorder to their offspring. PTS: 1 DIF: Cognitive Level:

18. In aplastic anemia (AA), pancytopenia develops as a result of what? 1. Suppression of erythropoietin to produce adequate amounts of erythrocytes 2. Suppression of the bone marrow to produce adequate amounts of erythrocytes, leukocytes, and thrombocytes 3. Lack of DNA to form sufficient quantities of erythrocytes, leukocytes, and thrombocytes 4. Lack of stem cells to form sufficient quantities of leukocytes

B AA is a critical condition characterized by pancytopenia, which is a reduction or absence of all three blood cell types, resulting from the failure or suppression of bone marrow to produce adequate amounts of blood cells. It is not related to lack of DNA. PTS: 1 DIF: Cognitive Level:

20. An allogenic bone marrow transplantation remains the preferred method for treating which anemia? 1. Polycythemia vera 2. Aplastic 3. Sideroblastic 4. Anemia of chronic disease (ACD)

B Bone marrow and, most recently, peripheral blood stem cell transplantation from a histocompatible sibling are the preferred treatments for the underlying bone marrow failure observed in aplastic anemias. This is not a treatment for polycythemia vera, sideroblastic anemia, or anemia of chronic disease. PTS: 1 DIF: Cognitive Level:

28. When does fetal erythrocyte production shift from the liver to the bone marrow? 1. Fourth month of gestation 2. Fifth month of gestation 3. Eighth month of gestation 4. At birth

B By the fifth month of gestation, hematopoiesis begins to occur in the bone marrow and increases rapidly until hematopoietic (red) marrow fills the entire bone marrow space. By the time of delivery, the bone marrow is the only significant site of hematopoiesis. PTS: 1 DIF: Cognitive Level:

18. What can shorten the conduction time of action potential through the atrioventricular (AV) node? 1. Parasympathetic nervous system 2. Catecholamines 3. Vagal stimulation 4. Sinoatrial node (SA)

B Catecholamines speed the heart rate, shorten the conduction time through the AV node, and increase the rhythmicity of the AV pacemaker fibers. The vagal nerve is part of the sympathetic nervous system and stimulation will decrease heart rate. The SA node is responsible for generating the electrical activity of the heart, but is not responsible for the time it takes for it to travel through the AV node. PTS: 1 DIF: Cognitive Level:

15. A healthcare professional works with recent refugees. A mother brings in her children who have been diagnosed with iron deficiency anemia. What action by the professional is most appropriate? 1. Educate the mother on an iron-rich diet. 2. Arrange to test for parasitic infections. 3. Explain the weekly iron infusions. 4. Teach the mother to give iron supplements.

B Children in developing countries often are affected by chronic parasite infestations that result in intestinal blood and iron loss that outpaces dietary intake. The professional should arrange testing for parasites in the newly arrived children. An iron-rich diet and iron supplements may be appropriate, but unless the cause is addressed, the problem will not be solved by those two actions. Weekly iron infusions are not needed. PTS: 1 DIF: Cognitive Level:

4. What is the process that ensures mitral and tricuspid valve closure after the ventricles are filled with blood? 1. Chordae tendineae relax, which allows the valves to close. 2. Increased pressure in the ventricles pushes the valves to close. 3. Trabeculae carneae contract, which pulls the valves closed. 4. Reduced pressure in the atria creates a negative pressure that pulls the valves closed.

B During ventricular relaxation, the two atrioventricular valves open and blood flows from the higher pressure atria to the relaxed ventricles. With increasing ventricular pressure, these valves close and prevent backflow into the atria as the ventricles contract. The chordae tendineae attach the bottom end of the AV valves to the papillary muscles. The endocardium covers beamlike projections of muscle tissue, called trabeculae carneae. The valves are not pulled closed by reduced atrial pressure. PTS: 1 DIF: Cognitive Level:

13. A patient in the healthcare clinic reports fatigue, weakness, and dyspnea, as well as pale conjunctiva of the eyes and brittle, concave nails. What assessment by the healthcare professional is most appropriate for the suspected anemia? 1. Blood pressure and apical pulse 2. Oral mucus membranes and tongue 3. Ability to swallow foods and liquids 4. Skin and sclera for normal coloration

B Early symptoms of iron deficiency anemia (IDA) include fatigue, weakness, and shortness of breath. Pale earlobes, palms, and conjunctivae are also common signs. Progressive IDA causes more severe alterations, with structural and functional changes apparent in epithelial tissue. The nails become brittle, thin, coarsely ridged, and spoon-shaped or concave (koilonychia) as a result of impaired capillary circulation. The tongue becomes red, sore, and painful. The healthcare professional should assess the patient's mouth and tongue. Blood pressure and pulse readings would not be specific for any one type of anemia. Dysphagia (difficulty swallowing) could indicate pernicious anemia. Jaundice (most often seen in the sclera and on the skin) would be a characteristic of hemolytic anemia, although it is not always noticed. PTS: 1 DIF: Cognitive Level:

3. The paresthesia that occurs in vitamin B12 deficiency anemia is a result of which of these? 1. Reduction in acetylcholine receptors in the postsynaptic nerves 2. Myelin degeneration in the spinal cord 3. Destruction of myelin in peripheral nerves 4. Altered function of neurons in the parietal lobe

B Effects on the nervous system can occur if a vitamin B12 deficiency causes anemia. Myelin degeneration may occur with the resultant loss of fibers in the spinal cord, producing paresthesia (numbness), gait disturbances, extreme weakness, spasticity, and reflex abnormalities. The paresthesia is not caused by reduction in acetylcholine receptors, destruction of myelin in peripheral nerves, or altered neuronal function in the parietal lobe. PTS: 1 DIF: Cognitive Level:

7. How is erythroblastosis fetalis defined? 1. Allergic disease in which maternal blood and fetal blood are antigenically incompatible 2. Alloimmune disease in which maternal blood and fetal blood are antigenically incompatible 3. Autoimmune disease in immature nucleated cells that are released into the bloodstream 4. Autosomal dominant hereditary disease

B Erythroblastosis fetalis, also known as hemolytic disease of the fetus and newborn (HDFN), is an alloimmune disease in which maternal blood and fetal blood are antigenically incompatible, causing the mother's immune system to produce antibodies against fetal erythrocytes. This selection is the only option that accurately defines erythroblastosis fetalis. PTS: 1 DIF: Cognitive Level:

29. A patient has been hospitalized for a large deep vein thrombosis and states he is the third person in his family to have this condition in the last 2 years. What response by the healthcare professional is most appropriate? 1. "This condition is not transmitted genetically." 2. "We can test your blood for factor V Leiden." 3. "Were they all men or both men and women?" 4. d. "Familial thromboses tend to be very severe."

B Factor V Leiden results from a single nucleotide mutation of guanine to adenine at nucleotide 1691 (G1691A) and is the most common hereditary thrombophilia. It is autosomal dominant so would not be confined to one sex. Most people with this disorder do not have clinically significant events. PTS: 1 DIF: Cognitive Level:

15. The healthcare professional explains to a student that glucose 6-phosphate dehydrogenase (G6PD) deficiency is what type of inherited disorder? 1. X-linked dominant 2. X-linked recessive 3. Autosomal dominant 4. Autosomal recessive

B G6PD deficiency is an inherited, X-linked recessive disorder. PTS: 1 DIF: Cognitive Level:

10. Which mother does the healthcare professional prepare to administer Rh immune globulin (Rho- GAM) to? 1. Is Rh-positive and the fetus is Rh-negative 2. Is Rh-negative and the fetus is Rh-positive 3. Has type A blood and the fetus has type O 4. Has type AB blood and the fetus has type B

B Hemolytic disease of the fetus and newborn (HDFN) can occur only if antigens on fetal erythrocytes differ from antigens on maternal erythrocytes. Maternal-fetal incompatibility exists only if the mother and fetus differ in ABO blood type or if the fetus is Rh-positive and the mother is Rh-negative. The healthcare professional would plan to administer Rho-GAM to the mother who is Rh-negative whose baby is Rh positive. PTS: 1 DIF: Cognitive Level:

27. A patient has primary immune thrombocytopenic purpura (ITP) and is hospitalized after a bleeding episode. What treatment does the healthcare provider anticipate being ordered for this patient? 1. Blood transfusions 2. Infusion of IVIG 3. Anticoagulants 4. Large doses of folic acid

B ITP is an autoimmune disorder of platelet consumption. In cases of bleeding, infusions of IV immune globulin are preferred with short bursts of steroids in severe disease. Blood transfusions will not be helpful; however platelet transfusions may be used. Anticoagulants would make the bleeding more dangerous for the patient. Folic acid does not help treat the underlying pathophysiology or relieve symptoms. PTS: 1 DIF: Cognitive Level:

14. An infant was born with hemolytic disease of the fetus and newborn (HDFN). What treatment does the healthcare professional anticipate for this baby? 1. Administration of intravenous fluids to dilute the blood 2. Replacement transfusion of Rh-positive blood not contaminated with anti-Rh antibodies 3. Performance of a splenectomy to prevent the destruction of abnormal erythrocytes 4. Replacement transfusion of Rh-negative erythrocytes

B If antigenic incompatibility of the mother's erythrocytes is not discovered in time to administer Rh immunoglobulin and the child is born with HDFN, then the treatment consists of exchange transfusions in which the neonate's blood is replaced with new Rh-positive blood that is not contaminated with anti-Rh antibodies. This treatment is administered during the first 24 hours of extrauterine life to prevent kernicterus. Kernicterus is not prevented by diluting the blood with IV fluids, splenectomy, or by giving Rh-negative blood. PTS: 1 DIF: Cognitive Level:

4. In a full-term infant, the normal erythrocyte life span is _____ days. 1. 30 to 50 2. 60 to 80 3. 90 to 110 4. 120 to 130

B In full-term infants, normal erythrocyte life span is 60 to 80 days. PTS: 1 DIF: Cognitive Level:

7. A patient has defective secretion of the intrinsic factor leading to anemia. What treatment option does the healthcare professional discuss with the patient? 1. Increasing iron sources in the diet such as red meat. 2. Vitamin B12 injections initially given once a week. 3. Having relatives tested for bone marrow donation. 4. Better control of the patient's underlying disorder.

B Intrinsic factor (IF) is responsible for B12 uptake from the gut. A lack of IF leads to pernicious anemia, which is treated with vitamin B12 injections for the rest of the person's life. The injections are weekly at first the monthly. Increasing dietary iron would help with iron- deficiency anemia. A bone marrow transplant might be used to treat aplastic anemia. Better control of an underlying medical condition would be important in anemia of chronic disease. PTS: 1 DIF: Cognitive Level:

22. A student asks the professor to explain the jaundice that accompanies hemolytic anemia. Which statement is by the professor is most accurate? 1. Erythrocytes are destroyed in the spleen. 2. Heme destruction exceeds the liver's ability to conjugate and excrete bilirubin. 3. The patient has elevations in aspartate transaminase (AST) and alanine transaminase (ALT). 4. The erythrocytes are coated with an immunoglobulin.

B Jaundice (icterus) is present when heme destruction exceeds the liver's ability to conjugate and excrete bilirubin. Jaundice is not as directly related to the destruction of the erythrocytes. It is also not related to liver enzyme elevation or being coated with an immunoglobulin. PTS: 1 DIF: Cognitive Level:

6. Local signs and symptoms of Hodgkin disease-related lymphadenopathy are a result of what? 1. Pressure and ischemia 2. Pressure and obstruction 3. Inflammation and ischemia 4. Inflammation and pressure

B Local symptoms caused by pressure and obstruction of the lymph nodes are the result of lymphadenopathy. The other options do not contribute to the lymphadenopathy associated with Hodgkin disease. PTS: 1 DIF: Cognitive Level:

4. A patient is admitted to the hospital with multiple myeloma (MM). Which diagnostic test should the healthcare professional assess as the priority? 1. Serum potassium level 2. Serum calcium level 3. Bone scan or limb x-rays 4. Bone marrow biopsy

B Many clinical manifestations of MM are due to hypercalcemia. Since calcium can affect cardiac conduction, the priority diagnostic test is serum calcium levels. Bone destruction does occur in MM, but obtaining images of bones is not a higher priority than the calcium. The patient already has been diagnosed with MM, so a bone marrow biopsy may not be needed at this time. Potassium and other electrolytes will be assessed but not as the priority. PTS: 1 DIF: Cognitive Level:

5. Which of these classified as a megaloblastic anemia? 1. Iron deficiency 2. Pernicious 3. Sideroblastic 4. Hemolytic

B Megaloblastic anemia is characterized by a low red blood cell count and larger-than-normal red blood cells. Pernicious anemia is the most common type of megaloblastic anemia. Iron deficiency is a hypochromic, microcytic anemia meaning the red blood cells are pale and small. The red blood cells in sideroblastic anemia are not abnormally large; they have an abnormal ring of iron around the nucleus of the RBC. Hemolytic anemia is normochromic, normocytic anemia caused by blood loss. PTS: 1 DIF: Cognitive Level:

13. A patient has a problem with Phase 0 of the cardiac cycle. What electrolyte imbalance would the healthcare professional associate most directly with this problem? a. Hyperkalemia 314 b. Hyponatremia c. Hypercalcemia d. Hypomagnesemia

B Phase 0 consists of depolarization and represents rapid sodium entry into the cell. A deficit of sodium could be a possible contributor. The other electrolyte disturbances would not be directly correlated to this problem. PTS: 1 DIF: Cognitive Level:

16. A healthcare professional is teaching a community group about inherited disorders. What pattern of inheritance does the professional describe for sickle cell disease? 1. Inherited X-linked recessive disorder 2. Inherited autosomal recessive disorder 3. Disorder initiated by hypoxemia and acidosis 4. Disorder that is diagnosed equally in men and women

B Sickle cell disease is an inherited autosomal recessive disorder. Sickling is an occasional, intermittent phenomenon that can be triggered or sustained by one or more of these stressors: decreased oxygen tension (PO2) of the blood (hypoxemia), increased hydrogen ion concentration in the blood (decreased pH), increased plasma osmolality, decreased plasma volume, and low temperature. However, this does not describe the inheritance pattern. PTS: 1 DIF: Cognitive Level:

5. What is the most common cause of insufficient erythropoiesis in children? 1. Folic acid deficiency 2. Iron deficiency 3. Hemoglobin abnormality 4. Erythrocyte abnormality

B Similar to the anemias of adulthood, ineffective erythropoiesis or premature destruction of erythrocytes causes the anemias of childhood. The most common cause of insufficient erythropoiesis is iron deficiency. The other options may be causes but are not common ones. PTS: 1 DIF: Cognitive Level:

19. Which manifestations of vasoocclusive crisis are associated with sickle cell disease (SCD) in children? 1. Atelectasis and pneumonia 2. Edema of the hands and feet 3. Stasis ulcers of the hands, ankles, and feet 4. Splenomegaly and hepatomegaly

B Symmetric, painful swelling of the hands and feet (hand-foot syndrome) caused by infarction in the small vessels of the extremities is often the initial manifestation of SCD in children. Acute chest syndrome manifests with cough, fever, and lung infiltrates and has a high mortality rate. Splenomegaly occurs in sequestration crises. Stasis ulcers are not a typical finding. PTS: 1 DIF: Cognitive Level:

1. In infectious mononucleosis (IM), what does the Monospot test detect? 1. Immunoglobulin E (IgE) 2. Immunoglobulin M (IgM) 3. Immunoglobulin G (IgG) 4. Immunoglobulin A (IgA)

B The Monospot test is used to diagnose infectious mononucleosis by detecting heterophile antibodies. These are a heterogeneous group of immunoglobulin M (IgM) antibodies that are agglutinins against nonhuman red blood cells and are present in IM. PTS: 1 DIF: Cognitive Level:

17. A patient has a disorder affecting ventricular depolarization. What ECG finding would the healthcare professional associate with this condition? 1. Shortened PR interval 2. Prolonged QRS interval 3. QT interval variability 4. Absence of P waves

B The QRS complex represents the sum of all ventricular muscle cell depolarizations. If a patient had ECG findings suggestive of problems with this activity, there would be prolongation of the QRS interval. The PR interval reflects the amount of time needed for the action potential to travel from the atrium to the ventricle. QT interval variability is normal. An absence of P waves would indicate a problem with the SA node. PTS: 1 DIF: Cognitive Level:

26. Which disease is an autosomal dominant inherited hemorrhagic disease? 1. Hemophilia A 2. von Willebrand disease 3. Christmas disease 4. Hemophilia B

B The bleeding disorder, von Willebrand disease, usually results from an inherited autosomal dominant trait; however, some cases demonstrate an autosomal recessive or compound heterozygous pattern. The pattern of inheritance depends on the type of mutation that is present. PTS: 1 DIF: Cognitive Level:

7. Oxygenated blood flows through which vessel? 1. Superior vena cava 2. Pulmonary veins 3. Pulmonary artery 4. Coronary veins

B The four pulmonary veins, two from the right lung and two from the left lung, carry oxygenated blood from the lungs to the left side of the heart. All other veins carry deoxygenated blood. The superior vena cava returns deoxygenated blood from systemic circulation to the right atrium. The pulmonary arteries carry deoxygenated blood from the right side of the heart into the lungs. PTS: 1 DIF: Cognitive Level:

14. A healthcare professional in an urban clinic is seeing a patient who has iron deficiency anemia (IDA). What question by the professional is most appropriate to assess for the cause of IDA? 1. "How many times a week do you have iron-rich foods?" 2. "Have you ever noticed any blood in your stool?" 3. "Do you have a history of heart valve replacement?" 4. "Have you had any recent viral infections?"

B The most common causes of IDA in well-developed countries are pregnancy and chronic blood loss. The healthcare professional would assess for any sources of blood loss. A dietary deficiency of iron may be the cause, but is not common in developed countries. A mechanical heart valve can lead to hemolytic anemia. Recent infections are not associated with iron deficiency anemia. PTS: 1 DIF: Cognitive Level:

5. A student asks the healthcare professional to explain the function of the papillary muscles. What response by the professional is best? 1. The papillary muscles close the semilunar valves. 2. These muscles prevent backward expulsion of the atrioventricular valves. 3. They open the atrioventricular valves. 4. The papillary muscles open the semilunar valves.

B The papillary muscles are extensions of the myocardium that pull the cusps of the AV valves together and downward at the onset of ventricular contraction, thus preventing their backward expulsion into the atria. They do not close the semilunar valves or open the AV valves or semilunar valves. PTS: 1 DIF: Cognitive Level:

1. Which statement made by a student indicates the healthcare professional needs to describe the pericardium again? 1. The pericardium is a double-walled membranous sac that encloses the heart. 2. It is made up of connective tissue and a surface layer of squamous cells. 3. The pericardium protects the heart against infection and inflammation from the lungs and pleural space. 4. It contains pain and mechanoreceptors that can elicit reflex changes in blood pressure and heart rate.

B The pericardium is made up of a surface layer of mesothelium over a thin layer of connective tissue. The healthcare professional would need to re-explain if the student stated the pericardium is made up of connective tissue and a layer of squamous cells. The other statements are accurate. PTS: 1 DIF: Cognitive Level:

6. How does hemolytic disease of the fetus and newborn (HDFN) cause acquired congenital hemolytic anemia? 1. HDFN develops when hypoxia or dehydration causes the erythrocytes to change shapes, which are then recognized as foreign and removed from circulation. 2. HDFN is an alloimmune disease in which the mother's immune system produces antibodies against fetal erythrocytes, which are recognized as foreign and removed from circulation. 3. HDFN develops when the polycythemia present in fetal life continues after birth, causing the excessive number of erythrocytes to be removed from circulation. 4. HDFN is an autoimmune disease in which the fetus's immune system produces antibodies against fetal erythrocytes, which are recognized as foreign and removed from circulation.

B HDFN is an alloimmune disease in which maternal blood and fetal blood are antigenically incompatible, causing the mother's immune system to produce antibodies against fetal erythrocytes. Fetal erythrocytes that have been attacked by (or bound to) maternal antibodies are recognized as foreign or defective by the fetal mononuclear phagocyte system and are removed from the circulation by phagocytosis, usually in the fetal spleen. The other statements do not correctly explain this pathology. PTS: 1 DIF: Cognitive Level:

29. A healthcare professional educates parents to monitor their child's dietary intake for sufficient iron during which period of time as the priority? 1. Between 2 months and 1 year 2. Between 6 months and 2 years 3. Between 12 months and 3 years 4. Between 18 months and 4 years

B Iron deficiency anemia is the most common blood disorder of infancy and childhood, with the highest incidence occurring between 6 months and 2 years of age. PTS: 1 DIF: Cognitive Level:

9. A patient has splenomegaly on physical examination. What does the healthcare professional understand about this condition? (Select all that apply.) 1. It may be normal so nothing further needs to be done 2. The patient may have an acute infection. 3. Splenomegaly can lead to hepatic failure. 4. Tumors or cysts can cause splenomegaly. 5. Some infiltrative processes can cause it.

B, D, E While splenomegaly may be normal in some persons, it should never be ignored and requires further investigation. Splenomegaly can be caused by acute inflammatory disorders, acute infection, congestive disorders (heart failure), infiltrative processes, and tumors or cysts. It does not specifically lead to hepatic failure. PTS: 1 DIF: Cognitive Level:

27. A patient in the hospital has been receiving heparin injections. The platelet count on admission was 222,000/mm3 and four days later is 113,000/mm3. What action by the healthcare professional is best? 1. Prepare to transfuse the patient with platelets. 2. Do nothing; this is an expected side effect. 3. Switch the heparin to lepirudin 4. Stop all the patient's medications.

C After initiating heparin in the hospital this patient's platelet count dropped by 51%. A drop in more than 50% of the platelet count is seen in more than 95% of patients with heparin-induced thrombocytopenia. The treatment is to withdraw the heparin and use alternatives such as lepirudin. If the platelet count were severely low, transfusion would be indicated. There is no need to stop all the patient's medications. PTS: 1 DIF: Cognitive Level:

23. Shortened erythrocyte life span, ineffective bone marrow response to erythropoietin, and altered iron metabolism describe the pathophysiologic characteristics of which type of anemia? 1. Aplastic 2. Sideroblastic 3. Anemia of chronic disease 4. Iron deficiency

C Anemia of chronic disease specifically results from a combination of (1) decreased erythrocyte life span, (2) suppressed production of erythropoietin, (3) ineffective bone marrow erythroid progenitor response to erythropoietin, and (4) altered iron metabolism and iron sequestration in macrophages. PTS: 1 DIF: Cognitive Level:

1. What term is used to describe the capacity of some erythrocytes to vary in size, especially in relationship to some anemias? a. Poikilocytosis b. Isocytosis c. Anisocytosis d. Microcytosis

C Anisocytosis means assuming various sizes and is a term used to describe erythrocytes in some anemias. Poikilocytosis is used to describe erythrocytes that can assume various shapes. Isocytosis and microcytosis are not terms that are associated with this condition. PTS: 1 DIF: Cognitive Level:

24. A patient has polycythemia vera and presents to the Emergency Department with plethora and neurological changes. The student asks the healthcare professional to explain the primary cause of these symptoms. What response by the professional is best? 1. Decreased erythrocyte count 2. Destruction of erythrocytes 3. Increased blood viscosity 4. Tissue destruction by macrophages

C As polycythemia vera progresses, many of the symptoms are related to the increased blood cellularity and viscosity. These include plethora, engorgement of the retinal and cerebral veins. Individuals also may experience headache, drowsiness, delirium, mania, psychotic depression, chorea, and visual disturbances. The symptoms of polycythemia vera are not related to decreased erythrocyte counts, destruction of erythrocytes, or tissue destruction by macrophages. PTS: 1 DIF: Cognitive Level:

6. The students learn that deficiencies in folate and vitamin B12 alter the synthesis of which of these? 1. RNA 2. Cell membrane 3. DNA 4. Mitochondria

C Deficiencies in folate and vitamin B12 result in defective erythrocyte precursor DNA synthesis. These deficiencies are not associated with alterations of RNA, cell membranes, or mitochondria. PTS: 1 DIF: Cognitive Level:

12. During the cardiac cycle, which structure directly delivers action potential to the ventricular myocardium? 1. Sinoatrial (SA) node 2. Atrioventricular (AV) node 3. Purkinje fibers 4. Bundle branches

C Each cardiac action potential travels from the SA node to the AV node to the bundle of His (AV bundle), through the bundle branches, and finally to the Purkinje fibers and the ventricular myocardium, where the impulse is stopped. PTS: 1 DIF: Cognitive Level:

2. Why does fetal hemoglobin have a greater affinity for oxygen than adult hemoglobin? 1. The fetus does not have its own oxygen supply and must rely on oxygen from the maternal vascular system. 2. The fetus has two -chains on the hemoglobin, rather than two -chains as in the adult. 3. Fetal hemoglobin interacts less readily with diphosphoglycerate (DPG), which inhibits hemoglobin-oxygen binding. 4. Fetal hemoglobin production occurs in the vessels and liver rather than in the bone marrow as in the adult.

C Fetal hemoglobin has greater affinity for oxygen than adult hemoglobin does because it interacts less readily with the enzyme, DPG, which inhibits hemoglobin-oxygen binding. The lack of independent oxygen supply, the type of chains on the hemoglobin, and the location of hemoglobin production do not impact fetal hemoglobin's ability to bind more readily to oxygen than do adult hemoglobin. PTS: 1 DIF: Cognitive Level:

17. Hemoglobin S (HbS) is formed in sickle cell disease as a result of which process? 1. Deficiency in glucose 6-phosphate dehydrogenase (G6PD) that changes hemoglobin A (HbA) to HbS. 2. Genetic mutation in which two amino acids (histidine and leucine) are missing. 3. Genetic mutation in which one amino acid (glutamate) is replaced by another (valine). 4. Autoimmune response in which one amino acid (proline) is detected as an antigen by abnormal immunoglobulin G (IgG).

C HbS is formed by a genetic mutation in which one amino acid (valine) replaces another (glutamic acid). G6PD deficiency is the most common RBC disorder in which RBCs are not protected against oxidative stress. HbS is not formed as the result of an autoimmune process. PTS: 1 DIF: Cognitive Level:

25. A student asks the professor why hemophilia A is seen mostly in men. The professor explains that hemophilia A is considered to be what type of inherited disorder? 1. Autosomal dominant 2. Autosomal recessive 3. X-linked recessive 4. X-linked dominant

C Hemophilia A (classic hemophilia) is inherited as an X-linked recessive disorder. That means that the genes for this disorder are carried on the X chromosome. In men, a single copy of the altered gene causes the condition. Females are carriers. PTS: 1 DIF: Cognitive Level:

16. A patient has hepatomegaly, bronze-colored skin, and cardiac dysrhythmias. What condition does the healthcare professional prepare to teach the patient about? 1. Aplastic anemia 2. Pernicious anemia 3. Hereditary hemochromatosis 4. Immune thrombocytopenia purpura

C Hereditary hemochromatosis presents with hepatomegaly, bronze-colored skin, and cardiac dysrhythmias. Aplastic anemia specifically presents with total bone marrow failure. Pernicious anemia can be characterized with neurocognitive dysfunction in addition to the classic signs of all anemias. ITP presents with minor signs of bleeding such as petechiae but soon show major bleeding. PTS: 1 DIF: Cognitive Level:

8. A healthcare professional tells a student that a patient has lost atrial kick. What would the student expect to see when examining this patient? 1. Improvement in atrial dysrhythmias 2. Increased blood pressure 3. Signs of decreased cardiac output 4. Elevations in serum troponin levels

C Left atrial contraction, the atrial kick, provides a significant increase of blood to the left ventricle. This would help to increase cardiac output. With the loss of this atrial kick, the student would expect to find signs of decreased cardiac output such as decreased blood pressure or tachycardia. Loss of atrial kick would not improve dysrhythmias or increase serum troponin levels which usually indicate myocardial damage. PTS: 1 DIF: Cognitive Level:

24. Hemophilia B is caused by a deficiency of which clotting factor? a. V b. VIII c. IX d. X

C Only factor IX deficiency causes hemophilia B (Christmas disease). Factor VIII causes hemophilia A or classic hemophilia. Elimination of coagulation factor IX leads to a very severe form of hemophilia A. Deficiency of factor V can lead to a tendency for hemorrhage but can also contain mutations that lead to thrombosis. PTS: 1 DIF: Cognitive Level:

5. Reed-Sternberg (RS) cells represent malignant transformation and proliferation of which of these? 1. Interleukin (IL)-1, IL-2, IL-5, and IL-6 2. Tumor necrosis factor-beta 3. B cells 4. T cells

C Reed-Sternberg cells are associated with Hodgkin lymphoma and represent a malignant transformation of B cells. They are not related to interleukins, tumor necrosis factor-beta, or T cells. PTS: 1 DIF: Cognitive Level:

14. A healthcare professional is caring for a patient who has a delay in electrical activity reaching the ventricle as seen on ECG. What ECG finding would the healthcare professional associate with this problem? 1. A prolonged ST interval 2. Variability in measurement with heart rate 3. PR interval measuring 0.28 sec 4. A QRS complex measuring 0.08 sec

C The PR interval is a measure of time from the onset of atrial activation to the onset of ventricular activation; it normally ranges from 0.12 to 0.20 sec. The PR interval represents the time necessary to travel from the sinus node through the atrium, the atrioventricular (AV) node, and the His-Purkinje system to activate ventricular myocardial cells. The measured PR of 0.28 sec is too long, signifying a delay in the conduction process from atrium to ventricle. The ST interval represents the time needed for ventricular depolarization. The QT interval is normally around 0.4 sec, but varies inversely with heart rate. The QRS measurement is within the normal range of less than or equal to 0.12 sec. PTS: 1 DIF: Cognitive Level:

9. A person has been diagnosed with acute lymphocytic leukemia (ALL) that is positive for the Philadelphia chromosome. What statement by the healthcare professional is most appropriate? 1. "This is good news and means the ALL is not very aggressive." 2. "This is a very rare finding in adults who have ALL." 3. "We are planning to get your disease in remission, but it will be hard." 4. "You will need colony-stimulating support during your treatment."

C The Philadelphia chromosome is seen in about 30% of adults with ALL and is a poor prognostic indicator. The healthcare professional should recognize this and reassure the patient that they will be doing everything they can to get the disease in remission. Colony-stimulating factor is given when the white blood cell count is too low, which can occur in nearly all neoplasms due to treatment. PTS: 1 DIF: Cognitive Level:

2. What is the fundamental physiologic manifestation of anemia? a. Hypotension b. Hyperesthesia c. Hypoxia d. Ischemia

C The fundamental physiologic manifestation of anemia is a reduced oxygen-carrying capacity of the blood, resulting in tissue hypoxia. Hypotension may result when the initial compensatory mechanism, vasoconstriction, fails to provide adequate perfusion to tissues. Ischemia may result if the oxygen deficit in tissues and organs is severe or prolonged. Hyperesthesia is not a finding. PTS: 1 DIF: Cognitive Level:

1. What is the cause of polycythemia in the fetus? 1. Fetal hemoglobin has a greater affinity for oxygen as a result of diphosphoglycerate (DPG). 2. The fetus has a different hemoglobin structure of two - and two -chains rather than two -and two -chains. 3. Increased erythropoiesis occurs in response to the hypoxic intrauterine environment. 4. The lungs of the fetus are undeveloped and unable to diffuse oxygen adequately to the pulmonary capillaries.

C The hypoxic intrauterine environment stimulates erythropoietin production in the fetus. Fetal polycythemia is not the result of hemoglobin having greater affinity for oxygen, different hemoglobin structure, or undeveloped lungs. PTS: 1 DIF: Cognitive Level:

21. What does the student learn about warm autoimmune hemolytic anemia? 1. Warm autoimmune hemolytic anemia occurs primarily in children. 2. It is self-limiting and rarely produces hemolysis. 3. Erythrocytes are bound to macrophages and sequestered in the spleen. 4. Immunoglobulin M coats erythrocytes and binds them to receptors on monocytes.

C The immunoglobulin G-coated red blood cells bind to the Fc receptors on monocytes and splenic macrophages and are removed by phagocytosis. This disease occurs mainly in people older than 40 years of age. It is one of the hemolytic anemias and destruction of red blood cells occurs by extravascular processes. The erythrocytes are bound to macrophages, not monocytes. PTS: 1 DIF: Cognitive Level:

12. Which anemia produces small, pale erythrocytes? 1. Folic acid 2. Hemolytic 3. Iron deficiency 4. Pernicious

C The microcytic-hypochromic anemias, which include iron deficiency anemia (IDA), are characterized by erythrocytes that are abnormally small (microcytic) and contain abnormally reduced amounts of hemoglobin (hypochromic). Folic acid and pernicious anemias are megaloblastic. Hemolytic anemia consists of normal red blood cells that are destroyed more frequently than normal. PTS: 1 DIF: Cognitive Level:

9. Which condition resulting from untreated pernicious anemia (PA) is fatal? 1. Brain hypoxia 2. Liver hypoxia 3. Heart failure 4. Renal failure

C Untreated PA is fatal, usually because of heart failure. PTS: 1 DIF: Cognitive Level:

9. A child has iron deficiency anemia. In addition to iron supplements, what else does the healthcare professional educate the parents on giving the child? 1. Vitamin A 2. Magnesium 3. Vitamin C 4. Zinc

C Vitamin C helps with absorption of iron, so the healthcare professional instructs the parents about giving it to the child with iron deficiency anemia. Vitamin A, magnesium, and zinc do not help promote the absorption of iron. PTS: 1 DIF: Cognitive Level:

3. Which chamber of the heart endures the highest pressures? 1. Right atrium 2. Left atrium 3. Left ventricle 4. Right ventricle

C Pressure is greatest in the left ventricle with a systolic range of 90 to 140 mmHg. The right ventricle is next with a systolic range of 15 to 28 mmHg, followed by the left and right atria, respectively. PTS: 1 DIF: Cognitive Level:

2. Early detection of acute leukemia would include which symptoms? (Select all that apply.) 1. Dizziness 2. Paresthesia 3. Anorexia 4. Bruising 5. Bone pain

C, D, E Signs and symptoms related to bone marrow depression include fatigue caused by anemia, bleeding resulting from thrombocytopenia (reduced numbers of circulating platelets), and fever caused by infection. Anorexia can occur in all varieties of acute leukemia and is associated with weight loss. Pain in the bones and joints is thought to result from leukemia infiltration with secondary stretching of the periosteum. The other options are not generally associated with acute leukemia. PTS: 1 DIF: Cognitive Level:

8. After a person has a subtotal gastrectomy for chronic gastritis, which type of anemia will result? 1. Iron deficiency 2. Aplastic 3. Folic acid 4. Pernicious

D A gastrectomy will lead to deficient intrinsic factor which is related to pernicious anemia. The gastrectomy would not lead to iron deficiency, aplastic, or folic acid anemia. PTS: 1 DIF: Cognitive Level:

10. Where are the coronary ostia located? 1. Left ventricle 2. Aortic valve 3. Coronary sinus 4. Aorta

D Coronary arteries receive blood through openings in the aorta, called the coronary ostia. PTS: 1 DIF: Cognitive Level:

7. Which virus is associated with Burkitt lymphoma in African children? 1. Cytomegalovirus 2. Adenovirus 3. Human papillomavirus 4. Epstein-Barr virus

D Epstein-Barr virus, found in nasopharyngeal secretions, is associated with Burkitt lymphoma in African children. The other viruses are not associated with this malignancy. PTS: 1 DIF: Cognitive Level:

12. The healthcare professional is caring for a woman whose baby died of hydrops fetalis. How does the professional explain this condition to a student? 1. Inherited condition where the RBC skeletal membrane is abnormal 2. Hyperbilirubinemia that occurs shortly after birth and can affect the brain 3. Hemolytic disease of the fetus and newborn 4. Severe intrauterine anemia that leads to edema of the entire body

D Fetuses with hydrops fetalis who do not survive anemia in utero are usually stillborn with gross edema in the entire body. The inherited abnormal RBC skeletal membrane is called spherocytosis. The hyperbilirubinemia is known as icterus gravis neonatorum. Erythroblastosis fetalis is another name for hemolytic disease of the fetus and newborn. PTS: 1 DIF: Cognitive Level:

15. The cardiac electrical impulse normally begins spontaneously in the sinoatrial (SA) node because of what reason? 1. It has a superior location in the right atrium. 2. It is the only area of the heart capable of spontaneous depolarization. 3. It has rich sympathetic innervation via the vagus nerve. 4. It depolarizes more rapidly than other automatic cells of the heart.

D The electrical impulse normally begins in the SA node because its cells depolarize more rapidly than other automatic cells at a rate of 60 to 100 beats/min. The SA node's location does not influence this activity. Other areas of the heart include the AV node and the Purkinje fibers. The vagus nerve causes the heart rate to slow as part of the parasympathetic nervous system. PTS: 1 DIF: Cognitive Level:

8. A newborn displays pallor, tachycardia, and has a systolic murmur. What hemoglobin value does the healthcare professional correlate with these manifestations? 1. 11 g/dL 2. 9 g/dL 3. 7 g/dL 4. 5 g/dL

D When the hemoglobin falls below 5 g/dL, pallor, tachycardia, and systolic murmurs may occur. PTS: 1 DIF: Cognitive Level:

6. During the cardiac cycle, why do the aortic and pulmonic valves close after the ventricles relax? 1. Papillary muscles relax, which allows the valves to close. 2. Chordae tendineae contract, which pulls the valves closed. 3. Reduced pressure in the ventricles creates a negative pressure, which pulls the valves closed. 4. Blood fills the cusps of the valves and causes the edges to merge, closing the valves.

D When the ventricles relax, blood fills the cusps and causes their free edges to meet in the middle of the vessel, closing the valve and preventing any backflow. The papillary muscles function in the tricuspid and mitral valves as do the chordae tendineae. Reduced pressure does not pull the valves closed. PTS: 1 DIF: Cognitive Level:

3. Which description is consistent with chronic myelogenous leukemia (CML)? 1. Defects exist in the ras oncogene, TP53 tumor-suppressor gene, and INK4A, the gene encoding a cell-cycle regulatory protein. 2. Leukocytosis and a predominance of blast cells characterize the bone marrow and peripheral blood. As the immature blasts increase, they replace normal myelocytic cells, megakaryocytes, and erythrocytes. 3. B cells fail to mature into plasma cells that synthesize immunoglobulins. 4. The translocation of genetic material from genes 9 and 22 creates an abnormal, fused protein identified as BCR-ABL1.

D The presence of the BCR-ABLI fusion gene distinguishes CML from other myeloproliferative disorders. PTS: 1 DIF: Cognitive Level: