Ch. 29
The nurse reviews the laboratory reports of four patients. Which patient displays a common diagnostic indicated by an increase in the neutrophil count? Correct1 Patient 1 2 Patient 2 Incorrect3 Patient 3 4 Patient 4 Neutrophils are granular leukocytes that are involved in acute inflammatory responses. They engulf pathogens and die in one to two days. If there is an infection or sepsis, an increase in neutrophil count acts as a common diagnostic indicator. Therefore Patient 1, with postoperative sepsis, would have an increased neutrophil count. Eosinophils are granular leukocytes that engulf antigen-antibody complexes formed during an allergic response. An increase in eosinophil count is seen in patients with neoplastic disorders such as Hodgkin's lymphoma, dermatitis, and connective tissue disorder.
Correct 1 1. postoperative sepsis
The nurse is obtaining the family history of a patient. Which conditions should the nurse inquire about in order to obtain information regarding existing hematologic conditions? Select all that apply. 1 Anemia 2 Influenza 3 Hemophilia 4 Conjunctivitis 5 Clotting disorders
Correct 1, 3, 5 When taking a family history, it is important to explore hematologic conditions such as anemia, hemophilia (a bleeding disorder), and other clotting disorders. Information about influenza and conjunctivitis is not relevant to hematologic conditions.
Which component in the picture represents the process in which the binding of plasmin results in degradation of a clot? 1 Plasmin 2 Fibrin clot 3 Fibrinolysis 4 Plasminogen activator
Correct 3 The given figure indicates the fibrinolytic system. Number 3 refers to the fibrinolysis process, in which binding of plasmin results in degradation of the clot. Plasminogen is degraded to plasmin, which is depicted as number 2 in the figure. Number 4 is a fibrin clot, in which red blood cells, platelets, and proteins are aggregated together. Number 1 is the plasminogen activator; it helps degrade plasminogen. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.
What is the function of fibrinolysis? 1 To maintain the blood in fluid form 2 To indicate a condition of pancytopenia 3 To ensure adequacy of red blood cell production 4 To remove defective and damaged red blood cells
Correct1 Fibrinolysis is the process of fibrin clot dissolution. This process maintains the blood in fluid form after the clot is resolved. Reticulocytes are immature red blood cells, which provide accurate information about the adequacy of red blood cells. Hemolysis removes damaged red blood cells with the help of monocytes and macrophages. Pancytopenia is a condition that manifests as a marked decrease in number of red blood cells, white blood cells, and platelets.
A nurse reviews the lab report of a patient that shows the white blood cell count is 15 × 109/L. Which condition is the patient likely experiencing? 1 Infection 2 Neutropenia 3 Risk of bleeding 4 Thrombocytopenia
Correct1 A patient's medical report shows the white blood cell count to be 15 × 109/L. The normal range for a white blood cell count is between 4 × 109/L to 11 × 109/L. Elevations in white blood cell count are associated with infection, because white blood cells (WBCs) are immune cells. Neutropenia is a condition in which the absolute neutrophil count (ANC) is less than 1000 cells/µL. It does not increase the risk of bleeding. Thrombocytopenia is a condition in which platelet counts fall below 100,000/µL.
Which coagulation factor converts prothrombin to thrombin? 1 Factor X 2 Factor XI 3 Factor XII 4 Factor XIII
Correct1 Factor X is also called Stuart-Prower factor. Its action is to convert factor II, prothrombin, to thrombin. Factor XI is known as plasma thromboplastin antecedent. Factor XI activates Christmas factor in the presence of calcium ions. Hageman factor is another name for factor XII. Hageman factor activates factor IX to stimulate the intrinsic pathway. Factor XIII is also known as fibrin-stabilizing factor. Fibrin-stabilizing factor cross-links fibrin strands. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question.
The nurse reviews the medical records of four patients. Which patient is at risk for an alteration in the hematologic system that could lead to lymphedema? 1 Patient 1 2 Patient 2 3 Patient 3 4 Patient 4
Correct1 Lymphedema is the accumulation of lymphatic fluid due to an obstruction in the lymphatic flow or system. A mastectomy (the surgical removal of breast tissue) also involves the dissection of the axillary lymph nodes. This can obstruct the lymphatic flow, which can lead to lymphedema. Therefore Patient 1 is at risk for developing lymphedema. Gastrectomies, splenectomies, and hepatectomies do not involve the resectioning or dissection of lymph nodes. Test-Taking Tip: The lymphatic system consists of lymph fluid, lymphatic capillaries, ducts, and lymph nodes that carry fluid from the interstitial spaces to the blood. this helps in selecting the correct answer.
A nurse is reviewing the laboratory reports of a patient. Which parameter would require further investigation? 1 Hematocrit of 38% 2 Total WBC count of 3000/µL 3 Platelet count of 200,000/µL 4 Hemoglobin level of 13.0 g/dL
Correct2 A normal WBC count is 4,000-11,000/µL. A count less than 4000/µL indicates bone marrow depression and severe or chronic illness, and needs further investigation. A hemoglobin level of 13.0 g/dL is a normal value. A hematocrit of 38% is within the normal range. A normal platelet count ranges from 150,000 to 400,000/µL, and a platelet count of 200,000/µL is within normal limits.
During the admission assessment, the nurse discovers that the patient has used illicit drugs. Related to the hematologic system, what question should the nurse next ask the patient? 1 "Do you have any blood in your stools?" 2 "What agent and when did you last use it?" 3 "Have you had any surgeries causing pain?" 4 "Do you have shortness of breath with activity?"
Correct2 Although asking about blood in the stools, painful surgeries, or shortness of breath with activity are appropriate questions related to the hematologic system, the only one related specifically to illicit drug use is asking about what agent and when it was last used. The route and frequency also should be assessed.
Which process is stimulated by hypoxia? 1 Hemolysis 2 Erythropoiesis 3 Hematopoiesis 4 Thrombocytosis
Correct2 Erythropoiesis is the production of red blood cells. A patient with a low red blood cell count will have low levels of oxygen, resulting in hypoxia. Therefore erythropoiesis is stimulated to increase the available oxygen. Hemolysis is degradation of red blood cells, which occurs due to bacterial infection or autoimmune disorders. Hematopoiesis is the formation of blood cell components and is not associated with hypoxia. Thrombocytosis is an increase in the platelet count, which is seen in response to bleeding.
A patient with anemia presents with a heart rate of 120 beats/minute. As what should the nurse document the heart rate? 1 Bradycardic 2 Tachycardic 3 Hypotensive 4 Hypertensive
Correct2 If a patient is tachycardic, the heart rate is above 100 beats/minute, which may occur in anemic patients as a compensatory mechanism to increase cardiac output. If a patient is bradycardic, the heart rate is below 60 beats/minute. Hypertensive and hypotensive refer to blood pressure readings, not the heart rate. STUDY TIP: Laughter is a great stress reliever. Watching a short program that makes you laugh, reading something funny, or sharing humor with friends helps decrease stress.
Which blood coagulation factor acts as a source to form clot? 1 Calcium 2 Fibrinogen 3 Prothrombin 4 Proaccelerin
Correct2 Manufactured in the liver, fibrinogen (also known as clotting factor I) acts as a source of fibrin and helps to form clots. Calcium (coagulation factor IV) is required at several points in the coagulation cascade. Known as coagulation factor II, prothrombin is converted to thrombin and activates fibrinogen. Proaccelerin is coagulation factor V, which binds with coagulation factor X to activate prothrombin.
A patient has a hemoglobin level of 20 g/dL. What could be the cause of this condition? 1 Anemia 2 Dehydration 3 Hemorrhage 4 Hemodilution
Correct2 The normal levels of hemoglobin are 11.7 to 17.3 g/dL. The patient has a hemoglobin level of 20 g/dL, which indicates an increase in hemoglobin levels or hemoconcentration. The patient with dehydration will have hemoconcentration. The patient with anemia, hemorrhage, and hemodilution will have a low red blood cell count due to blood loss.
Which component forms an adhesive bridge between platelets and vascular subendothelial structures in the clotting process? 1 Serotonin 2 Platelet factor III 3 Von Willebrand factor 4 Adenosine diphosphate
Correct3 Clotting is a process that prevents excessive bleeding during an injury. During plug formation, the platelets stick to one another and form clumps. The von Willebrand factor is an important component in forming an adhesive bridge between platelets and vascular subendothelial structures. Serotonin and platelet factor III are substances formed from platelets during an agglutination or aggregation reaction; these chemicals facilitate coagulation. Adenosine diphosphate is released from platelets during an agglutination reaction; it increases adhesiveness. Test-Taking Tip: Blood clotting is an important process that prevents excessive bleeding when a blood vessel is injured. Read carefully to answer the question.
What is the percentage of lymphocytes in the blood? 1 2% to 4% 2 4% to 8% 3 20% to 40% 4 50% to 70%
Correct3 Lymphocytes are agranular leukocytes that form the basis of cellular and humoral immune responses. They constitute 20 percent to 40 percent of the white blood cells in the blood. Eosinophils are granular leukocytes; they constitute about 2 percent to 4 percent of leukocytes. Monocytes are agranular leukocytes that are approximately 4 percent to 8 percent of the white blood cells in the blood. Neutrophils are the most common granular leukocytes; they constitute about 50 percent to 70 percent of the white blood cells.
Which cells ingest dead cells, tissue debris, and defective red blood cells? 1 Basophils 2 Eosinophils 3 Monocytes 4 Thrombocytes
Correct3 Monocytes are phagocytic; they ingest dead cells, tissue debris, and defective red blood cells. Basophils stimulate antigens in response to tissue injury. Eosinophils activate in response to allergies and engulf antigen-antibody complex. Thrombocytes (platelets) help in clot formation.
On assessment, a nurse finds that a patient has a smooth and shiny tongue surface. The oral mucosa is thin and appears red from decreased papillae. The patient has a hemoglobin level of 8.0 mg/dL. What is the likely diagnosis of the patient? 1 Epistaxis 2 Jaundice 3 Pernicious anemia 4 Lymphadenopathy
Correct3 Pernicious anemia manifests as low hemoglobin levels. The signs may include a smooth and shiny tongue surface and a thin mucosa that appears red due to decreased papillae. Yellow appearance of the sclera is a symptom of jaundice due to deposition of bilirubin. Spontaneous bleeding from the nares is a sign of epistaxis. Lymph nodes which are enlarged (greater than 1 cm) and tender to touch are symptoms of lymphadenopathy.
Which term refers to the resident macrophages in the liver? 1 Mast cells 2 Osteoclasts 3 Kupffer cells 4 Megakaryocyte
Correct3 Special names are given to macrophages that reside in different tissues. The resident macrophages in the liver are called Kupffer cells. Mast cells are similar to basophils and are present in the connective tissue. Osteoclasts reside in the bone. A megakaryocyte is a differentiated stem cell that fragments into platelets.
A nurse is assessing a patient with chronic kidney disease. The nurse finds that the patient has pallor, and the blood reports are suggestive of anemia. What could be the most likely cause of anemia? 1 Excess blood loss 2 Decreased intake of iron 3 Decreased thyroid gland activity 4 Decreased erythropoietin production
Correct4 Erythropoietin is a hormone secreted by the kidneys that stimulates the bone marrow cells to produce red blood cells (RBCs). Chronic kidney disease causes a reduction in erythropoietin production, which ultimately leads to a decreased production of RBCs. This results in anemia. Excessive blood loss results in anemia, but is not a likely cause in this patient. A decreased iron intake causes anemia, but is less likely in this patient. Hypothyroidism can indirectly lead to anemia, but it is not a cause in this patient, because the patient does not suffer from thyroid abnormality. The cause of anemia in this patient is related to the kidney disease.
Which condition is the most common cause for hematemesis? 1 Thalassemia 2 Sickle cell disease 3 Pernicious anemia 4 Peptic ulcer disease
Correct4 Hematemesis is bright red, brown, or black vomitus, associated with an underlying disease like peptic ulcer disease. Thalassemia is a hereditary autosomal disorder characterized by the abnormal growth of red blood cells or hemoglobin. Sickle cell anemia is a hereditary disorder, which manifests as a distorted shape of hemoglobin. Pernicious anemia is a deficiency in the production of red blood cells due to lack of vitamin B12.
A patient has impaired intracranial regulation and hypoxemia. The primary health care provider prescribes red blood cell indices for the patient, and the patient later asks the nurse to explain the purpose of the test. What should the nurse tell the patient? 1 To test the size and shape of the red blood cells 2 To measure the packed cell volume in the blood 3 To measure the number of circulating red blood cells 4 To measure the gas-carrying capacity of the red blood cells
Correct4 Hemoglobin saturation results in hypoxemia and compromises brain function, causing the patient to experience difficulty with intracranial regulation. Red blood cell indices are special indicators that reflect red blood cell volume, color, and hemoglobin saturation. Hematocrit value gives the measure of packed cell volume of red blood cells. Hematocrit value is generally three times the hemoglobin value. Red blood cell morphology provides information regarding the size and shape of the patient's red blood cells. Total red blood cell count gives the number of circulating red blood cells. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.
The nurse is performing a health history and physical examination on a newly admitted patient. Significant information obtained from the physical examination that relates to the hematologic system includes what? 1 Bladder surgery 2 Early menopause 3 Multiple pregnancies 4 The presence of petechiae
Correct4 Note any petechiae or ecchymotic areas on the skin and, if present, document the frequency, size, and cause. The location of petechiae can indicate an accumulation of blood in the skin or mucous membranes. Small vessels leak under pressure, and the platelet numbers are insufficient to stop the bleeding. Petechiae are more likely to occur where clothing constricts the circulation. Bladder surgery, multiple pregnancies, and early menopause do not relate to the hematologic system. STUDY TIP: In the first pass through the exam, answer what you know and skip what you do not know. Answering the questions, you are sure of increases your confidence and saves time. This is buying you time to devote to the questions with which you have more difficulty.
A patient complains of numbness in the hands and feet. On further assessment, the nurse finds that the patient has poor coordination and balance. Which laboratory finding does the nurse suspect to be the cause for the patient's condition? 1 Bilirubin 2 mg/dL 2 Folic acid 10 ng/dL 3 Hemoglobin 10 g/dL 4 Cobalamin 150 pg/mL
Correct4 Paresthesias of the feet and hands and poor coordination and balance due to ataxia are the clinical manifestations of vitamin B12 (Cobalamin), or folic acid, deficiency. The normal value of cobalamin is 200 to 835 pg/mL. Cobalamin (vitamin B12) of 150 pg/mL is less than the normal value, which indicates vitamin B12 deficiency. The normal range of total bilirubin is 0.2 to 1.2 mg/dL. A bilirubin level of 2 mg/dL indicates jaundice or liver dysfunction. The normal range of folic acid is 3 to 16 ng/mL. The patient's folic acid is within the normal range and does not indicate folic acid deficiency. A normal range for hemoglobin is 11 to 16 g/dL in females and 13.2 to 17.3 mg/dL in males. Hemoglobin of 10 g/dL indicates anemia in the patient. The patient with anemia may experience tachycardia, palpitations, pallor, and cyanosis.
A patient suspected for malignancy is scheduled for a PET scan to highlight areas with increased metabolism. What is the appropriate nursing intervention in this situation? 1 Applying pressure dressing after the procedure 2 Administering preprocedure analgesic to the patient 3 Instructing the patient to drink four to five glasses of water and void before the test 4 Instructing the patient not to have anything by mouth except water and medications at least four hours before the test
Correct4 Positron emission tomography (PET) is a radiologic study and a valuable diagnostic tool that detects malignancy because it highlights areas with increased metabolism. The nursing intervention for this patient would be to instruct him or her to avoid anything by mouth except for water and medications for at least four hours before the test. Application of pressure dressing is useful for the patient after a bone marrow biopsy to reduce bleeding at the site. Administering analgesics before the procedure is beneficial in a bone marrow biopsy to enhance the patient's comfort and cooperation. The nurse should instruct the patient undergoing a bone scan to drink four to five glasses of water and void before the test.
After performing the bone marrow aspiration, the nurse finds that the patient has bleeding at the site of aspiration. Which is the best nursing intervention in this situation? 1 Administering warfarin to the patient. 2 Administering ibuprofen to the patient. 3 Ask the patient to sleep on a soft bed. 4 Ask the patient to sleep on the site for 30 minutes.
Correct4 The nurse would ask the patient to sleep on the site of aspiration. This action reduces bleeding due to the application of pressure on the site. Warfarin is an anticoagulant, which increases bleeding. Therefore the patient would have excess bleeding after taking warfarin. Ibuprofen is a nonsteroidal antiinflammatory drug used to help reduce pain. However, it is not effective in reducing bleeding. A soft bed will not apply as much pressure to the site. Hence the nurse asks the patient to roll a towel and apply pressure to the site if sleeping on soft bed.
