Ch. 33: Assessment and Management of Patients with Hematologic Disorders

The recommended minimum hemoglobin level for a woman to donate blood is:

12.5 g/dL

Each 100 mL of blood should normally contain _____g of hemoglobin.

15 g

Women of childbearing years need an additional _____ daily of iron to replace that loss during menstration.

2 mg

The 5-year survival time for those who receive treatment and are younder than 65 years of age averages:

35%

The average life expectancy for someone with sickle cell anemia is ______ years.

42 to 48 years

The volume of blood in humans is about _____ L.

5 to 6

A person can usually tolerate a gradual reduction in hemoglobin until the level reaches:

5.0 to 5.5 g/dL

A physician prescribes one tablet of ferrous sulfate daily for a 15-year-old girl who experiences heavy flow during her menstrual cycle. The nurse advises the patient and her mother that this over-the-counter preparation must be taken for how many months for iron replenishment to occur?

6 to 12 months

Tonika, a 15-year-old with sickle cell disease, is admitted to the hospital for treatment of sickle cell crises. On the basis of the knowledge of the inheritance of the sickle cell gene (HBS), the nurse expects the patient to be of ______ descent.

African

Thrombocytes

Another term for platelets

The nurse advises a patient who is iron deficient to take extra vitamin ______, which is known for increasing iron absorption.

C

Hypoprothrombinemia, in the absence of gastrointestinal or biliary dysfunction, may be caused by a deficiency in vitamin:

K

During a routine assessment of a patient diagnosed with anemia, the nurse notes the patient's beefy red tongue. The nurse knows that this is a sign of what kind of anemia?

Megaloblastic

The physician expects that the patient has a deficiency in the leukocyte responsible for cell-mediated immunity. The nurse knows to check the white blood cell count for:

T lymphocytes

Fibrinogen

a clotting factor present in plasma

Ian, a 24-year-old graduate student, was recently diagnosed as having Hodgkin's lymphoma. He sought medical attention because of an annoying pruritus and a small enlargement on the right side of his neck. Ian's disease is classified as Hodgkin's paragranuloma. The nurse knows that this classification is associated with:

a minimal degree of cellular differentiation in the affected nodes

Albumin

a plasma protein primarily responsible for the maintenance of fluid balance

Lymphocytes

a protein that forms the basis of blood

A diagnostic sign of pernicious anemia is:

a smooth, sore, red tongue

Administration technique should include all of the following EXCEPT:

administering the unit in combination with dextrose in water if the patient needs additional carbohydrates *should include: adding 50 to 100 mL or 0.9% NaCl to the packed cells to dilute the solution and speed up delivery of the transfusion; administering the unit of blood over 1 to 2 hours; squeezing the bag of blood every 20 to 30 minutes during administration to mix the cell

Plasma proteins consist primarily of: _______ and ________.

albumin and globulins

The common feature of the leukemias is:

an unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements

Polycythemia vera is characterized by bone marrow overactivity, resulting in the clinical manifestations of:

angina, claudication, thrombophlebitis

All inherited forms of sickle cell anemia would include all of the following EXCEPT:

autoimmune hemolytic *inherited forms include G-6-PD deficiency, thalassemia, sickle cell anemia

The cause of aplastic anemia may:

be related to drugs, chemicals, or radiation damage result from the body's T cells attacking the bone marrow result from certain infections

Bleeding and petechiae do not usually occur with thrombocytopenia until the platelet count falls below 50,000/mm3. The normal value for blood platelets is:

between 150,000 and 350,000/mm3

A nurse expects an adult patient with sickle cell anemia to have a hemoglobin value of:

between 7 and 10 g/dL

A characteristic symptom that results from insufficient blood cell production is:

bleeding tendencies, fatigue, susceptibility to infection

Blood cell formation (hematopoiesis) occurs in the _______.

bone marrow

On assessment, the nurse notes that the patient's face and skull bones are enlarged. She knows this is a compensatory response to: ____________.

bone marrow expansion to offset anemia

The classic presenting symptom of multiple myeloma is:

bone pain in the back of the ribs

Sickle-shaped erythrocytes cause:

cellular blockage in small vessels, decreased organ perfusion, tissue ischemia and infarction

The major form of therapy that frequently results in remission is:

chemotherapy

A nurse should know that a diagnosis of hemolytic anemia is associated with all of the following EXCEPT:

decrease in the reticulocyte count *is associated with abnormality in the circulation of plasma, defect in the erythrocyte, and elevated indirect bilirubin

A patient with chronic renal failure is being examined by the nurse practitioner for anemia. The nurse knows to review the laboratory data for a decreased hemoglobin level, red blood cell count, and:

decreased level of erythropoietin

The nurse understands that the shape of the red blood cell is altered with this disease. Instead of being round, biconcave, and disclike in appearance, it can be described as ______, _______, _________, and __________; the hemoglobin value is usually __________ g/dL.

deformed, rigid, sickle-shaped, and crystal-like formation; 7 to 10 g/dL.

A patient is admitted with essential thrombocytopenia due to decreased platelet production. The nurse knows that the diagnosis is most likely:

disseminated intravascular coagulation (DIC)

The nurse is aware that a transfusion reaction, if it occurs, will probably occur:

during the first 15 to 30 mins of the transfusion

Secondary polycythemia is caused by: __________, which may be in response to ____________.

erthropoietin; reduced oxygen

The most frequent symptom and complication of anemia is:

fatigue

Nursing assessment for a patient with leukemia should include observation for:

fever and infection, dehydration, petechiae and ecchymoses

Jerry is to receive one unit of packed red cells because he has a hemoglobin level of 8 g/dL and a diagnosis of gastrointestinal bleeding. Before initiating the transfusion, the nurse needs to check:

for the abnormal presence of gas bubbles and cloudiness in the blood bag; that the blood has been typed and cross-matched; that the recipient's blood numbers match the donor's blood numbers

Neutrophils

fully mature WBC capable of phagocytosis; primary defense against bacterial infeciton

A potential blood donor would be rejected if he or she:

had close contact with a hemodialysis patient within the past 6 months

Hemophilia is a hereditary bleeding disorder that:

has a higher incidence among males, is associated with joint bleeding, swelling, and damage; is related to a genetic deficiency of a specific blood-clotting factor

A person with sickle cell trait would:

have chronic anemia

John is a 51-year-old accountant recently diagnosed with acute myeloid leukemia. Acute myeloid leukemia results from a defect in the ______ and has a peak incidence at ______ years. The 5-year survival prognosis for those older than 65 is about ____%.

hematopoietic stem cell; 67; 4%

A nurse who cares for a patient who has experienced bone marrow aspiration or biopsy should be aware of the most serious hazard of:

hemorrhage

A positive diagnosis of Hodgkin's lymphoma depends on:

histologic analysis of an enlarged lymph node

The thalassemias (hereditary anemias) are characterized by: ___________, ________, _________, and ________________.

hypochromia, microcytosis, hemolysis, and anemia

Absense of intrinsic factor is associated with a B12 deficiency, because the vitamin cannot bind to be transported for absorption in the:

ileum

A bone marrow specimen is diagnostic if it shows an excess of:

immature blast cells (>30%)

The major cause of death in patients with acute myeloid leukemia is believed to be:

infection

A patient diagnosed with neutropenia resulting from increased destruction of neutrophils would most likely have:

infectious hepatitis

Multiple myeloma:

is a malignant disease of plasma cells that affects bone and soft tissue

Ian's diagnosis of stage I Hodgkin's lymphoma implies that the disease:

is limited to a single node or a single intralymphatic organ or site

Myeloid and lymphoid stem cells produce specific types of blood cells. The nurse knows, when evaluating blood tests, that myeloid stem cells differentiate into all of the following types of blood cells EXCEPT:

lymphocytes *do differentiate into erythrocytes, leukocytes, platelets

Hemoglobin

makes up 95% of the mass of the red blood cell

Hemostasis

the balance between clot formation and clot dissolution

Plasma

the fluid portion of blood

Phagocytosis

the ingestion and digestion of bacteria by neutrophils

Monocytes

the largest classification of leukocytes

RES

the letters used for the term reticuloendothelial system

Lymphocytes

the mature form of white blood cells; integral component of the immune system

Hematopoiesis

the process of continually replacing red blood cells

Hemostasis

the process of stopping bleeding from a severed blood vessel

Spleen

the site of activity for most macrophages

Bone marrow

the site of blood cell formation

The two most common areas used for bone marrow aspirations in an adult are: ________ and ________.

the sternum and iliac crest

Erythrocyte

the term for red blood cell

The severe pain that occurs during sickle cell crises is the result of:

tissue hypoxia and necrosis due to inadequate blood flow to a specific organ or tissue

The nurse notes that a patient, who is a vegetarian, has an abnormal number of megaloblasts. The nurse suspects a deficiency in

vitamin B12

In the normal blood-clotting cycle, the final formation of a clot will occur:

when fibrin reinforces the platelet plug

T cells

term used to describe T lymphocytes

The principal function of the erythrocyte, which is composed primarily of ______, is to:_________.

hemoglobin; transport oxygen between the lungs and the tissues

Nursing interventions are focused on five goals:

managing pain, preventing and managing infection, promoting coping skills, minimizing deficient knowledge, and monitoring/managing potential complications

The nurse begins to design a nutritional packet of information for a patient diagnosed with iron deficiency anemia. The nurse would recommend an increase intake of:

organ meats

The Schilling test is used to diagnose:

pernicious anemia

Distinguish between primary and secondary polycythemia.

primary polycythemia or polycythemia vera is a proliferative disorder in which all cells are nonresponsive to normal control mechanisms; secondary polycythemia is caused by excessive production of erythropoietin

The major function of leukocytes is to:_________; the major function of neutrophils is: ___________.

protect the body from invasion by bacteria and other foreign entities; phagocytosis

The nurse expects that Ian's course of treatment will involve:

radiotherapy to the specific node over a space of 2 to 4 months

An elderly patient presents to the physician's office with a complaint of exhaustion. The nurse, aware of the most common hematologic condition affecting the elderly, knows to check the patient's:

red blood cell count

Red bone marrow activity is confirmed in adults to the _____, _____, ______, and ________.

ribs, vertebrae, pelvis, and sternum

The nurse understands that Tonika's abdominal pain is probably caused by involvement of the organ most commonly responsible for sequestration crises in young adults, which is the:

spleen

If a transfusion reaction occurs, the nurse should:

stop the transfusion immediately and keep the vein patent with a saline or dextrose solution

List three of six possible complications of sickle cell crises:

stroke, infection, renal failure, heart failure, impotence, and pulmonary hypertension

A cardiac response to chronic anemia includes:

tachycardia, heart murmurs, and cardiomegaly