Chapter 20: Alterations of Hematologic Function

A nurse is caring for a client with anemia. Which possible causes should the nurse consider while planning care? Select all that apply.

(1) altered production of erythrocytes, (2) blood loss, (3) increased erythrocyte destruction, or (4) a combination of these. Thrombosis does not cause anemia but does cause clots. With dehydration, the hematocrit increases because of the decreased intravascular volume, not because of anemia.

A nurse is teaching about the components of the triad of Virchow. Which information should the nurse include? Select all that apply.

(1) injury to the blood vessel endothelium, (2) abnormalities of blood flow, and (3) hypercoagulability of the blood. Lack of fibrin in the blood and vitamin K deficiency would lead to bleeding, not clotting.

A client has acute lymphocytic leukemia. Which cell line most likely is affected?

(ALL) arise from the B lymphocyte cell line and about 15% from T lymphocytes. Monocytes are not affected. A very small group of ALL cases arise from neither B nor T lymphocytes and are called null cells.

types of hemoglobin

*Oxyhemoglobin (HBO2)-saturated, with four O2 molecule

blood lab values

- MCV: men 80-94; women 77-97 - Hemoglobin: men 14-17; women 12-16 g/dL - RBC count: men 4.2-5.4; women 3.6-5.0 million/cumm - hematocrit: men 42-52%; women 36-48% g/dL - reticulocyte count: 0.5-1.5%

hematopoiesis (erythropoiesis)

- RBC production - decrease O2 --> kidneys release hormone erythropoietin --> stimulate RBC production in bone marrow (myeloid tissue) - mechanism: stem cell --> stimulated by erythropoietin --> proerythroblast --> normoblast --> reticulocyte --> erythrocyte - substances required for normal development of RBC: protein, B12, folate, B6, B2 (riboflavin), vitC, Fe++

anemia

- low RBC or lack of sufficient hemoglobin - result in reduced oxygen carrying capacity of the blood - etiology: impaired erythrocyte function/development (insufficient iron), blood loss, increased RBC destruction, combo - diagnosis: mean corpuscular value (MCV), RBC count, RBC color, hematocrit, reticulocyte count - types: microcytic hypochromic, macrocytic hyperchromic, normocytic normochromic

erythrocyte

- mature red blood cells - most abundant cell in blood: blood volume 47% men, 42% women - primarily responsible for tissue oxygenation - contains Hgb protein (carry gases) - lifespan: 90-120 days - properties: reverse deformability, biconcave

hemoglobin breakdown

-when rbcs rupture, the released hemoglobin ingested by macrophages, globin chains of hemoglobin broken down into individual amino acids that are metabolized or used to build new proteins.

anemia classifications

1.) Morphology: size, shape, color of RB 1: will be classified as Macrocytic, Microcytic, or Normocytic what is MCV useful for

Which information indicates a nurse has an accurate understanding of iron deficiency anemia? Select all that apply.

A blood loss of 2 to 4 ml/day (corresponding to 1 to 2 mg of iron) is enough to cause iron deficiency anemia. It is common in children, owing to their extremely high need for iron for growth. Its incidence is not related to race but is increased in children and in people in poverty. Children under 2 years of age are often affected.

A client has a deficiency of intrinsic factor. The nurse is caring for which client?

A deficiency of intrinsic factor can result in pernicious anemia; it is a type of macrocytic anemia. Hemolytic anemia can result from hemolysis of red blood cells and can be either acquired or hereditary. Deficiency of iron results in iron deficiency anemia, a type of microcytic anemia.

Which clients with leukemia have the genetic translocation known as the Philadelphia chromosome? Select all that apply.

A genetic translocation known as the Philadelphia chromosome is found in 30% of adults with acute lymphocytic leukemia (ALL) and in 95% with chronic myelogenous (myelocytic) leukemia (CML). Chronic lymphocytic leukemia involves predominantly malignant transformation of B cells, not the Philadelphia chromosome. Lymphadenopathy is enlarged lymph nodes and is not a type of leukemia.

sickle cell anemia

A human genetic disease of red blood cells caused by the substitution of a single amino acid in the hemoglobin protein; it is the most common inherited disease among African Americans.

A client has thrombotic thrombocytopenic purpura. Which blood test will allow a nurse to monitor schizocytes?

A routine blood smear usually shows fragmented red cells (schizocytes) produced by shear forces when red cells are in contact with the fibrin mesh in clots that form in the vessels. The hematocrit is the percentage of erythrocytes in a given volume of plasma and is useful for determining whether anemia is present. Hemoglobin level helps in the diagnosis of anemia. A differential count determines the percentages of each type of white blood cell.

intrinsic factor

A substance produced by the mucosa of the stomach and intestines that is essential for the absorption of vitamin B12.

A client has polycythemia vera. When the nurse is obtaining the history, which finding is typical?

A unique feature of polycythemia vera (primary polycythemia), helpful in diagnosis, is the development of intense, painful itching that is intensified by heat or exposure to water (aquagenic pruritus), such that individuals avoid exposure to water, particularly warm water when bathing or showering. Increased blood volume does increase (not decrease) blood pressure in polycythemia vera. Secondary polycythemia is a physiologic response resulting from erythropoietin secretion caused by hypoxia. This hypoxia is noted in individuals living at higher altitudes (>10,000 ft). Relative polycythemia results from hemoconcentration associated with dehydration.

A nurse suspects a client has Felty syndrome. Which disease is associated with this syndrome?

Abnormal neutrophil distribution and sequestration are associated with hypersplenism and a pseudoneutropenia, which in the presence of rheumatoid arthritis constitute Felty syndrome. Anemia, leukemia, and systemic lupus erythematosus are not associated with Felty syndrome.

A client has acute leukemia. Which findings will the nurse find on assessment?

About 85% of acute lymphocytic leukemias (ALL) arise from the B lymphocyte cell line and about 15% from T lymphocytes. Monocytes are not affected. A very small group of ALL cases arise from neither B nor T lymphocytes and are called null cells.

The adult client is undergoing a second round of chemotherapy for metastatic cancer. When the nurse checks the indwelling intravenous line, there is oozing from the central line site, bleeding from the nose and gums, and ecchymotic lesions on the hip. Which condition is most likely the cause of these clinical signs?

Acute DIC presents rapidly with oozing from venipuncture sites and arterial sites, as well as ecchymotic lesions. Approximately 15% of clients with metastatic cancer or acute leukemia have symptoms of DIC. Iron deficiency anemia occurs gradually and presents with koilonychia, glossitis, and fatigue; it does not present with bleeding. The acute form of idiopathic thrombocytopenic purpura is frequently observed in children and typically lasts 1 to 2 months with a complete remission. The familial type of thrombotic thrombocytopenic purpura is the rarer type and is usually chronic, usually relapsing, and usually seen in children.

After an assessment the nurse suspects the client with sepsis is developing disseminated intravascular coagulation (DIC). What did the nurse find during the assessment?

Acute DIC presents with rapid development of hemorrhaging (oozing) from venipuncture sites, arterial lines, or surgical wounds or development of ecchymotic lesions (purpura, petechiae) and hematomas. Brittle, spoon-shaped nails occur with iron deficiency anemia. The term macrocytic refers to red blood cells that are larger than normal and occur with certain anemias. Ascites can occur with non-Hodgkin lymphoma.

Upon assessment of a client with acute idiopathic thrombotic thrombocytopenic purpura (TTP), what will the nurse probably find? Select all that apply.

Acute idiopathic TTP is characterized by a pentad of symptoms, including extreme thrombocytopenia (<20,000 cells/mm3), intravascular hemolytic anemia (not iron deficiency anemia), ischemic signs and symptoms most often involving the central nervous system (about 65% present with memory disturbances, behavioral irregularities, headaches, or coma), kidney failure (65%), and fever (33%).

Which treatment modalities are used for clients with hemostatic alterations occurring from liver disease? Select all that apply.

Administration of FFP is the ideal treatment, but not all persons can tolerate the needed volume to replace the deficient factors. Treatment in those cases may include the addition of exchange transfusions and platelet concentrations added to FFP. For hemostatic alterations in liver disease, whole blood is usually not administered, and neither is oral potassium.

Which statement by the client indicates that teaching was successful regarding the best definition of anemia?

All types of anemia involve a decreased number of circulating erythrocytes. Increased production of platelets is thrombocytosis. Increased excretion of potassium causes hypokalemia. A decreased amount of circulating plasma volume occurs in dehydration; anemia involves decreased amounts of hemoglobin.

A client was admitted to the burn unit with deep partial thickness burns over 20% of the body and has been stabilized. What would be an expected finding of laboratory blood tests?

An increase in neutrophils (neutrophilia or granulocytosis) occurs to protect the body from infection following severe burns. Eosinopenia, not eosinophilia, is observed in the stress response for burns, trauma, shock, surgery, and mental distress. Lymphocytopenia can occur in immunodeficiency syndrome, radiation, or chemotherapy. Monocytopenia occurs in hairy cell leukemia and prednisone therapy.

A client has hereditary sideroblastic anemias. Which response indicates that pyridoxine therapy was effective?

An optimal response is reticulocytosis with normal levels of hemoglobin and free erythrocyte protoporphyrin returning within 1 to 2 months. Increased iron occurs with iron supplements in iron deficiency anemia. Thrombocytopenia is a decreased level of platelets and does not occur with sideroblastic anemia.

Which information indicates a nurse has an accurate understanding of the difference between anemia in a client and polycythemia in a client?

Anemia is a decrease in erythrocytes, but polycythemia is increased mass of erythrocytes. Polycythemia can damage tissue. The statement that anemia can lead to disseminated intravascular coagulation but that polycythemia can lead to idiopathic thrombocytopenic purpura is not true. Polycythemia can be caused by a problem that arises in bone marrow.

A client has just completed radiation and chemotherapy for head and neck cancer and is hospitalized because of hemorrhaging from the gums and extreme weakness and fatigue. Blood work shows that the client is severely anemic in addition to being severely deficient in platelets and white blood cells. Which type of anemia will the nurse most likely observe written in the chart?

Aplastic anemia may occur as a result of radiation and drug exposure such as cancer chemotherapy. The stem cells in the bone marrow are damaged, causing insufficient production of red blood cells, platelets, and white blood cells. Hemolytic anemia occurs from excessive destruction of red blood cells from various causes but usually affects the red blood cells only. When platelets and white blood cells are affected it is termed aplastic, not hemolytic, sickle cell or sideroblastic. Sickle cell causes the red blood cells to sickle. Sideroblastic anemia results from inefficient iron uptake, resulting in abnormal hemoglobin synthesis.

Which mechanism of action does aspirin have on a client's platelet function?

Aspirin is the drug most commonly used to affect platelets; it works by irreversibly inhibiting, not activating, cyclooxygenase functioning for several days after administration. Aspirin does not affect vitamin K.

Which condition is a known cause of eosinophilia? Select all that apply. Asthma Correct Atopic dermatitis Correct Eczema Correct

Asthma, eczema, and atopic dermatitis may all increase eosinophils production resulting in eosinophilia. Prolonged infection may actually cause leucopenia, while poor protein intake has no known relationship to eosinophilia.

Which conditions will cause the nurse to monitor the client for eosinophilia? Select all that apply.

Asthma, parasitic infections, and hypersensitivity reactions may all increase eosinophil production, resulting in eosinophilia. Cushing syndrome can lead to eosinopenia. Poor protein intake has no known relationship to eosinophilia but can affect neutrophil production.

A nurse is caring for clients with malignant lymphomas. The nurse is caring for which clients? Select all that apply.

B cell neoplasm, Hodgkin disease, and natural killer cell neoplasm are the three major categories of lymphoid neoplasms (lymphomas). Acute myeloid leukemia and myeloproliferative disease are myeloid disorders.

A client is newly diagnosed with non-Hodgkin lymphoma. Which clinical manifestation will the nurse observe on assessment?

Because Hodgkin lymphoma is a malignancy of lymphocytes that reside in the lymph nodes, one of the first manifestations is lymphadenopathy (swollen lymph nodes). Dyspnea is associated with respiratory disorders. Bone pain and bleeding tendencies occur with leukemia.

A client has aplastic anemia. Which of these should the nurse monitor for in this client?

Bone marrow failure in aplastic anemia causes leukopenia, increasing susceptibility to infection. Decreased platelet production in aplastic anemia results in decreased ability to form clots. Elevated bilirubin is seen in hemolytic conditions. Decreased potassium levels do not occur with aplastic anemia.

A nurse is caring for an adult client who has the most common type of adult leukemia. The nurse is caring for which client?

CLL and AML (35% and 29% of adult leukemias, respectively) are the most common types in adults. The most common leukemia in children is ALL. CML accounts for about 11% of adult leukemias.

pernicious anemia

Caused by failure to absorb VitB12 because of a deficiency of intrinsic factor from the gastric mucosa. S/s: pallor, slight jaundice, glossitis, fatigue, weight loss, paresthesias of hands/feet, disturbances of balance and gait. Treatment: VitB12 IM monthly.

A client has immune thrombocytopenic purpura (ITP). Which information should the nurse remember when planning care for this client? Select all that apply.

Chronic ITP is more commonly observed in adults. Chronic ITP is an immune process that involves autoantibodies. The acute form of ITP is frequently observed in children and typically lasts 1 to 2 months with a complete remission. Initial manifestations are usually minor problems such as petechiae that progress to major hemorrhage from mucosal sites. Rarely will an individual present with internal bleeding. ITP is not a contagious disease.

A client has chronic idiopathic thrombocytopenic purpura. What is the primary pathophysiologic mechanism that occurs?

Chronic idiopathic thrombocytopenic purpura (ITP) is the primary form of the disease; it is associated with the presence of autoantibodies against platelet-associated antigens and tends to get progressively worse. Acute, not chronic, ITP often occurs secondary to viral infections and some medications. Lymphoblastic lymphoma arises from a clone of relatively immature T cells that becomes malignant in the thymus.

A client with polycythemia vera has a ruddy, red color of the face, hands, feet, and ears. Which term should the nurse use to describe this finding?

Circulatory alterations caused by the thick, sticky blood give rise to other manifestations, such as plethora (ruddy, red color of the face, hands, feet, ears, and mucous membranes) and engorgement of retinal and cerebral veins. In pernicious anemia, the skin may become "lemon yellow" (sallow), caused by a combination of pallor and jaundice. Symmetric cyanosis of fingers and toes (blue finger/toe syndrome), nose, and breast may be observed and indicates macrovascular thrombosis in a client with disseminated intravascular coagulation.

Which assessment findings by the nurse are diagnostic criteria that could indicate the client has an overactive spleen? Select all that apply.

Current diagnostic criteria for hypersplenism (overactive spleen) include: (1) anemia, leukopenia, thrombocytopenia, or combinations of these; (2) cellular bone marrow; (3) splenomegaly; and (4) improvement after a splenectomy. Leukopenia, not leukocytosis, is a recognized criterion for such a condition.

A nurse is caring for a client with disseminated intravascular coagulation (DIC). During the planning of care, which pathophysiologic mechanism should the nurse consider?

DIC is a result of widespread clot formation that consumes platelets and clotting factors, which leaves the client at risk for serious bleeding. As the result of extensive clotting, platelet and fibrinogen levels are decreased, not increased. Loss of red blood cells leads to anemia, not to DIC. Mast cell degranulation is not relevant to DIC, but it is relevant in allergic reactions.

A nurse assesses the client with anemia for a heart murmur. When the client asks why the nurse is checking the heart, how should the nurse respond? Correct 4 The thinner blood from anemia flows faster and more turbulently than normal blood, causing a murmur.

Decreased blood viscosity due to anemia causes turbulence when blood circulates through heart valves; turbulence is heard as a murmur. Hypotension (low blood pressure), hypoxia, and hypertension (high blood pressure) are not the cause of murmurs associated with anemia.

chelosis

Deep fissures at corners of mouth caused by saliva irritation or riboflavin (B2) deficiency?

A 6-year-old child presents with ecchymosis, prolonged bleeding upon minor trauma, low-grade fever, weight loss, headache, and fatigue. These symptoms manifested after the child's recovery from a viral infection. Which information would be useful for diagnosing the child's condition? Select all that apply.

Diagnosis of idiopathic thrombocytopenic purpura is based on a history of bleeding and associated symptoms (fever, weight loss, headache), evidence of infections, medication history, family history, and evidence of thrombosis. Helpful diagnostic tests include a peripheral blood smear and complete blood count. Testing for antiplatelet antibodies is not helpful.

A client is recovering from a life-threatening motor vehicle accident in which massive crushing injuries occurred 10 days ago. Previous puncture sites and wounds are now oozing blood and will not stop bleeding. Newly formed purpuric lesions with larger ecchymosis are on the back, buttocks, and upper legs. What hematologic complication should the nurse suspect?

Disseminated intravascular coagulation (DIC) is an acquired clinical syndrome characterized by widespread activation of coagulation, resulting in formation of fibrin clots in medium and small vessels throughout the body. The client had massive crushing injuries, which are associated with DIC. Some clotting factor defects are inherited and involve one single factor, such as the hemophilias and von Willebrand disease, caused by deficiencies of clotting factors. This occurred only after the accident, so it could not be inherited. Polycythemia vera is a chronic clonal alteration characterized by overproduction of red blood cells and splenomegaly. Reversible sideroblastic anemia is associated with alcoholism and results from nutritional deficiencies of folate.

A client has hemorrhage and thrombosis simultaneously. The nurse is caring for which client?

Disseminated intravascular coagulation is a pathosis that is associated with simultaneous hemorrhage and thrombosis. An embolus is a moving clot, circulating in the bloodstream. Burkitt lymphoma is a B cell tumor with unique clinical and epidemiologic features that accounts for 30% of childhood lymphomas worldwide. Hereditary hemochromatosis is a common autosomal recessive disorder of iron metabolism and is characterized by increased gastrointestinal iron absorption with subsequent tissue iron deposition.

A nurse is caring for a client that has developed disseminated intravascular coagulation from direct proteolytic activation of factor X. The nurse is caring for which client?

Disseminated intravascular coagulation may be induced by direct proteolytic activation of factor X. Sources of these proteases include snake venom, certain tumor cells, episodes of pancreatitis, and various stages of liver disease. Appendicitis (inflammation), dehydration (fluid and electrolyte imbalance), and a gunshot wound (direct tissue damage) do not cause proteolytic activation of factor X.

A nurse is caring for a client who has the most common consumptive thrombohemorrhagic disorder in the clinical setting. The nurse is caring for which client?

Disseminated intravascular coagulation most commonly is used in the clinical setting to describe a pathologic condition that is associated with hemorrhage and thrombosis (consumptive thrombohemorrhagic disorders). Hereditary thrombophilias increase the risk of developing thrombosis and is a type of thromboembolic disorder, not a hemorrhagic disorder. Polycythemia vera is a type of myeloproliferative red blood cell disorder, not a thrombohemorrhagic disorder. Leukemia is an uncontrolled proliferation of leukocytes, not a platelet disorder.

A client is taking a thiazide agent. Which sign or symptom is essential for the new nurse to report to the registered nurse?

Drugs such as thiazides, estrogens, and chemotherapeutic agents can cause thrombocytopenia. Thrombocytopenia causes skin manifestations (i.e., petechiae, ecchymoses, and larger purpuric spots) or frank bleeding from mucous membranes. A sore throat and fever are common in infectious mononucleosis. Bleeding takes priority over infection. Eating disorders such as pica—the craving and eating of nonnutritional substances, such as dirt, chalk, and paper—occur in iron deficiency anemia.

The laboratory analysis conducted on a client with acute-onset fever and malaise reveals an elevated neutrophil count. How should the nurse interpret this finding?

During an acute infection, neutrophilia, or an increase in the number of circulating neutrophils, occurs as the bone marrow releases stored neutrophils. Neutrophils are early responders to an acute bacterial infection and arrive in large numbers very quickly. Viral and protozoal infections usually cause a decrease in neutrophils. Parasitic infections do not generally result in an increase in neutrophils but do cause an increase in eosinophils.

A nurse notices a shift to the left in the laboratory reports. Which action is most appropriate for the nurse to take?

During infection, inflammation, or leukemia, premature release of the immature neutrophils is responsible for the phenomenon known as a shift-to-the-left or leukemoid reaction. Discharge is not appropriate at this time, because an infection, inflammation, or leukemia is present. Infection, inflammation, and leukemia do not respond to blood pressure medication or weighing.

A nurse is reviewing objective data from the physical examination of a 17-year-old teenager who is suspected of having infectious mononucleosis. Which assessment finding would be of greatest concern?

Enlarged spleen and liver, which occurs in 25% to 75% of those infected with infectious mononucleosis, can lead to splenic rupture. Although rare, it can occur spontaneously or as a result of mild trauma and is the most common cause of death related to infectious mononucleosis. Sore throat, manifested as inflamed mouth and throat, enlarged tonsils, and generalized lymph node enlargement are expected clinical manifestations with infectious mononucleosis and should not cause concern.

A client received erythropoietin. Which response will indicate the therapy was effective?

Erythropoietin stimulates production of erythrocytes. Granulocyte-macrophage colony-stimulating factor, C-CSF, and interleukin-3 stimulate production of neutrophils.

The client presents to the emergency department with burning on the soles of the feet and in the toes, which becomes more severe after standing for a short time. The feet and toes are warm and red upon examination, and findings are more pronounced on the left side. The client also complains of episodes of dizziness, headaches, and double vision. The nurse will most likely observe which condition written in the chart?

Essential (primary) thrombocythemia presents with warm, congested, red extremities and a burning sensation, especially on the forefoot soles and toes, characteristic of digital ischemia. Digital ischemia is more common in the lower extremities, and often only one side is involved. The common presentation of multiple myeloma is characterized by elevated levels of calcium in the blood (hypercalcemia), renal failure, anemia, and bone lesions; it rarely occurs before the age of 40. Lymphoblastic lymphoma is painless lymphadenopathy in the neck. Idiopathic (immune) thrombocytopenic purpura presents with initial manifestations ranging from minor bleeding problems (development of petechiae and purpura) over the course of several days to major hemorrhage from mucosal sites (epistaxis, hematuria, menorrhagia, bleeding gums).

A client has disseminated intravascular coagulation (DIC). While checking laboratory results, the nurse will notice an elevation in the serum level of which substance?

Fibrin degradation products are elevated in the plasma in 95% to 100% of DIC cases. The most commonly used combination of laboratory tests usually confirms thrombocytopenia or a rapidly decreasing platelet count on repeated testing, prolongation of clotting times, the presence of fibrin degradation products, and decreased levels of coagulation inhibitors. Circulating platelet levels are decreased because platelets are consumed in clots. Antithrombin III levels are initially low in DIC because thrombin is irreversibly complexed with activated clotting factors and antithrombin III.

A nurse is checking laboratory results for a client with anemia caused by a single recent episode of acute blood loss. Which laboratory result will the nurse expect to find about the red blood cells?

Five distinct anemias—aplastic, posthemorrhagic, hemolytic, sickle cell, and anemia of chronic inflammation—exemplify the diversity of the normocytic-normochromic anemias, characterized by erythrocytes that are relatively normal in size and hemoglobin content but insufficient in number. Erythrocytes in posthemorrhagic anemia are not microcytic, hypochromic, or macrocytic.

A nurse is caring for clients with normocytic-normochromic anemias. The nurse is caring for which clients? Select all that apply.

Five distinct anemias—aplastic, posthemorrhagic, hemolytic, sickle cell, and anemia of chronic inflammation—exemplify the diversity of the normocytic-normochromic anemias. These anemias have an insufficient number of erythrocytes that are relatively normal in size and hemoglobin content. Sideroblastic anemia is a microcytic-hypochromic anemia.

The nurse is conducting a health screening at a local health fair. Which populations are likely to be deficient in folate (folic acid)? Select all that apply.

Folate (folic acid) is an essential vitamin that must be obtained through dietary intake in humans. Deficiencies are most common in pregnant and lactating females, due to an increased demand, alcoholics, and those persons on fad diets that are low in vegetables. People with pica are more prone to iron deficiency anemia rather than folate deficiency anemia. Elderly individuals are not more prone to folate deficiency anemia. Females with menorrhagia (excessive menstrual bleeding) have iron-deficiency anemia.

Which information from the client indicates teaching by the nurse was effective about white blood cells that are considered granulocytes? Select all that apply.

Granulocytes (neutrophils, eosinophils, and basophils) are specialized leukocytes that contain granules within the cytoplasm of the cell. Monocytes are large phagocytic white blood cells found in the blood, which become macrophages as they migrate from the blood stream into the tissue. Lymphocytes are leukocytes involved in the immune response.

A nurse is caring for a client that developed heparin-induced thrombocytopenia (HIT). Which pathophysiologic mechanism caused this condition?

HIT involves antibodies that activate platelet aggregation and thrombus formation. HIT does not cause platelets to pool in the spleen, and it does not cause lysis of megakaryocytes or release of deformed platelets.

The most common source of drug-induced thrombocytopenia is:

Heparin is the most common cause of drug-induced thrombocytopenia because of its affect on the clotting of human blood. The other choices are not known to cause thrombocytopenia.

Among the findings (see chart), which data will help the nurse determine the source of the client's thrombocytopenia? Thrombus in leg, swelling and pain hx. previous bacterial infection, loves acid rich food heparin for the thrombus analagenecis for pain

Heparin is the most common cause of drug-induced thrombocytopenia, an immune-mediated adverse drug reaction caused by immunoglobulin G antibodies primarily against the heparinplatelet factor 4 complex. Thrombus in the leg is a result of thrombocythemia. Folate (folic acid) would decrease the risk of thrombocytopenia. Thrombocytopenia may occur in relationship to acute viral infections, not bacterial infections.

Which therapies are used to treat clients with sideroblastic anemia? Select all that apply.

Hereditary sideroblastic anemia initially is treated with pyridoxine therapy, which works in about one-third of those treated. Nonresponse to pyridoxine requires blood transfusions for symptom relief and to promote growth and development. Phlebotomy, or removal of blood from the circulation, is used in individuals with mild to moderate anemia without other complications (i.e., heart disease). Clients with sideroblastic anemia can have iron overload so iron supplements and iron dextran are contraindicated. Vitamin B12 injections are used for treatment of pernicious anemia. Intravenous administration of dextran is used for posthemorrhagic anemia.

A client is newly diagnosed with Hodgkin lymphoma. On assessment, what will the nurse typically find?

Hodgkin lymphoma (HL) is first characterized by painless enlargement of lymph nodes. In people with infectious mononucleosis, early flulike symptoms, such as headache, malaise, joint pain, and fatigue, may appear during the first 3 to 5 days, although some individuals are without symptoms. Anemia (not polycythemia) is often found in individuals with HL accompanied by a low serum iron level and reduced iron-binding capacity. In non-African Burkitt lymphoma the most common presentation is abdominal swelling.

A nurse observes Reed-Sternberg cells on a laboratory report. The nurse is caring for a client with which disease?

Hodgkin lymphoma. Reed-Sternberg cells are not characteristic of other white blood cell malignancy. Multiple myeloma has malignant plasma cells. Leukemias affect white blood cells.

A client has polycythemia vera. Which action should the nurse take?

Hydroxyurea, a nonalklating myelosuppressive, is the drug of choice due to lower incidence of leukemia and thrombosis. Iron supplements would make polycythemia worse; iron is administered for iron-deficiency anemia. Blood transfusions would make the condition worse; phlebotomies are used. Vitamin B12 is given for pernicious anemia, not polycythemia vera.

Which drugs will the nurse administer to a client with essential thrombocythemia? Select all that apply. Hydroxyurea (Hydrea) Aspirin Interferon alfa Anagrelide (Agrylin)

Hydroxyurea, a nonalkylating myelosuppressive agent, is used to suppress platelet production and at one time was the drug of choice for treating essential thrombocythemia. Other drugs used include aspirin and interferon alfa, both of which may cause hemorrhage. Anagrelide is the current drug of choice. It interferes with platelet maturation rather than platelet production, so it does not interfere with normal red and white cell production. Glucocorticosteroids are used in the treatment for thrombotic thrombocytopenic purpura and immune thrombocytopenic purpura. Heparin is used for thrombosis.

A nurse is teaching a health class about anemia. Which type of anemia should the nurse include in the teaching session that is the most common worldwide?

IDA is the most common type of anemia worldwide. Sickle cell, pernicious, and folate anemias are not the most common.

A client has infectious mononucleosis (IM). Which leukocyte is infected with the Epstein-Barr virus (EBV)?

IM is an acute infection of B lymphocytes with EBV. It does not infect monocytes, neutrophils, or T lymphocytes.

A 6-year-old child presents with ecchymosis, prolonged bleeding upon minor trauma, low-grade fever, weight loss, headache, and fatigue. These symptoms manifested after the child's recovery from a viral infection. The client is given prednisone and intravenous immunoglobulin to prevent bleeding, but the platelet count continues to drop. The subsequent plan of care will include which measures? Select all that apply.

If platelet counts do not increase appropriately, splenectomy is considered to remove the site of platelet destruction. If splenectomy is unsuccessful, more aggressive immunosuppressive medications (e.g., azathioprine, cyclophosphamide) are usually recommended. Hydroxyurea and anagrelide are given for essential thrombocythemia, not idiopathic thrombocytopenic purpura. Whole-blood transfusions are given for posthemorrhagic anemia.

A client has impaired hemostasis. Which factor should the nurse consider when planning care for this client?

Impaired hemostasis, or the inability to promote coagulation and the development of a stable fibrin clot, is commonly associated with liver dysfunction, which may be caused by either specific liver disorders or lack of vitamin K, not an excess. A deficiency of dietary iron leads to iron deficiency anemia, whereas an excess leads to iron overload.

The excess erythrocytes in polycythemia vera cause hyperviscosity of the blood, leading to clot formation, poor tissue perfusion, tissue ischemia, and even organ infarction. Polycythemia vera involves erythrocytes rather than platelets. Polycythemia vera involves normal erythrocytes, not deformed ones. There is not a decreased oxygen-carrying capacity of the erythrocytes; there are just too many.

In general, lymphadenopathy results from four types of conditions: (1) neoplastic disease, (2) immunologic or inflammatory conditions, (3) endocrine disorders, or (4) lipid storage diseases. Currently there is no research to support a connection between cardiac disease and lymphadenopathy.

Which assessment finding will help the nurse distinguish between pernicious anemia and folate deficiency anemia?

In individuals with folate deficiency anemia, clinical manifestations are similar to the malnourished appearance of individuals with pernicious anemia, except for the absence of neurologic symptoms (paresthesias of feet and fingers). Fatigue, weakness, and malnourished appearance are common to both.

compensatory mechanism for anemia

Increased HR, incrased stroke volume, arterial vasoconstriction, sodium & water retention, myocardial hypertrophy

Which factor increases a client's risk for leukemia?

Increased risk has been linked to cigarette smoke, exposure to benzene, and ionizing radiation. Large doses of ionizing radiation particularly result in an increased incidence of myelogenous leukemia. Infections with human immunodeficiency virus (HIV) or hepatitis C, not A, virus increase the risk for leukemia. Alcohol intake and sedentary lifestyle have not been identified as risk factors for leukemia.

The adult client is undergoing a second round of chemotherapy for metastatic cancer. When the nurse checks the indwelling intravenous line, there is oozing from the central line site, bleeding from the nose and gums, ecchymotic lesions on the hip, and symmetric cyanosis of the fingers and toes. The client becomes confused and begins to display seizure activity. What do the change in level of consciousness and seizures indicate?

Indicators of multisystem dysfunction include changes in level of consciousness or behavior, confusion, seizure activity, oliguria, hematuria, hypoxia, hypotension, hemoptysis, chest pain, and tachycardia. Symmetric cyanosis of the fingers and toes (blue finger/toe syndrome), nose, and breasts may be observed and indicates macrovascular thrombosis. The seizures and confusion indicate the client is developing multisystem failure from disseminated intravascular coagulation, not from epilepsy. If the problem was erythrocyte damage, jaundice would occur, not confusion and seizures.

The nurse should give which nutritional instructions to a client with hereditary hemochromatosis (HH)? Select all that apply.

Individuals with HH or iron overload should be counseled by the nurse to refrain from taking supplements of iron and vitamin C supplements and consuming raw shellfish; in addition, alcohol should be used in moderation. Taking supplements of iron and iron dextran injections will make the condition worse.

Which clients should the nurse monitor for the development of disseminated intravascular coagulation (DIC)? Select all that apply. A client with sepsis A client with major trauma A client with pregnancy complications A client with a hematologic cancer

Infection, particularly sepsis, can trigger the development of DIC. Major trauma and pregnancy complications are associated with the development of DIC. Most solid tumors and hematologic cancers may trigger DIC. DIC is an acquired, not inherited, condition.

Which statement regarding infectious mononucleosis (IM) is true? It is:

Infectious mononucleosis is typically caused by the herpes virus and EBV, which accounts for approximately 85% of IM cases. It usually affects young adults between 15 and 35 years of age. There is characteristically an increase in lymphocytes. The poxvirus has no known connection to IM.

A client has suspected essential thrombocythemia. Which laboratory test will the nurse check first?

Initial diagnosis is made with a CBC, and as many as two thirds of cases are diagnosed with a CBC. The D-dimer is used to diagnose disseminated intravascular coagulation (DIC). PT and aPTT may be used to diagnose effectiveness of anticoagulant therapy or to diagnose inherited thrombophilias.

transferrin

Initial diagnostic test of choice in a patient with hemochromatosis? The carrier protein that transports absorbed iron through the blood is

A client has iron deficiency anemia. Which finding will indicate to the nurse a therapeutic effect of the treatment? Correct 2 The serum ferritin level is 50 mg/L

Initial doses of iron supplementation are 150 to 200 mg/day and are continued until the serum ferritin level reaches 50 mg/L, indicating that adequate replacement has occurred. Splenomegaly indicates the anemia has not resolved. A rapid decrease in fatigue, lethargy, and other associated symptoms is generally seen within the first month of therapy. Phlebotomy is not indicated as a treatment for iron deficiency anemia.

A 6-year-old child presents with ecchymosis, prolonged bleeding upon minor trauma, low-grade fever, weight loss, headache, and fatigue. These symptoms manifested after the child's recovery from a viral infection. The child is diagnosed with acute idiopathic thrombocytopenic purpura (ITP). Which treatment will be included in the plan of care initially?

Initial therapy for ITP is glucocorticoids (e.g., prednisone), which suppress the immune response and prevent sequestering and further destruction of platelets. Although there is treatment for ITP, it is palliative, not curative. Anti-Rho(D) (RhoGAM) has been used with limited success to treat individuals who are Rh-positive, but it is not used initially. If platelet counts do not increase appropriately, splenectomy is considered to remove the site of platelet destruction.

A client has idiopathic thrombocytopenic purpura. The nurse should prepare the client for which prescribed initial treatment?

Initial therapy for idiopathic thrombocytopenic purpura is glucocorticoids (e.g., prednisone), which suppress the immune response and prevent sequestering and further destruction of platelets. Splenectomy may be considered if the other measures are unsuccessful; however, there are risks and relapses associated with the surgery. Aggressive immunosuppressive medications such as azathioprine or cyclophosphamide are reserved for those who are refractory to other treatment and are severely thrombocytopenic. Hydroxyurea, a nonalkylating myelosuppressive agent, is used to suppress platelet production and for the treatment of thrombocythemia, not thrombocytopenia.

hemoglobin (Hgb)

Iron containing pigment of red blood cells that carry oxygen from the blood through the body

What are the causes of development of iron deficiency anemia? Select all that apply.

Iron deficiency anemia (IDA) is a common type of anemia with low levels of erythrocytes and hemoglobin. Pica involves the craving and eating of nonnutritional substances such as chalk, dirt, or paper and leads to IDA. In females, menorrhagia is a common cause of IDA. An individual who undergoes gastric surgery may have IDA due to reduced absorption of iron. Drinking hot tea causes pernicious anemia in a patient. Copper deficiency causes sideroblastic anemia.

Which statement regarding iron deficiency anemia is true?

It is common in children due to their extremely high need for iron for growth. Incidence is not related to race but is increased in the children of homeless women most likely due to poor nutrition. It is most commonly found between the ages of 6 months and 2 years.

Which statement regarding immune thrombocytopenic purpura (ITP) is true?

It is more common in females between 20 and 40 years of age. It usually starts with minor problems such as petechiae and an initial platelet count of 150,000.

Upon searching for best practices in caring for clients with leukemias, the nurse found that which retrovirus is now widely accepted as a cause of some leukemias?

It is now widely accepted that some types of leukemia are caused by infection with the human T cell leukemia/lymphoma virus-1 (HTLV-1), not HTLV-2, HTLV-3, or HTLV-4.

A client has a higher-than-normal white blood cell count. Which term should the nurse use to describe this condition?

Leukocytosis is an increase in the number of leukocytes (white blood cells) in the blood. A decrease in the number of white blood cells is termed leukopenia. The neutrophil is the most numerous of the granulocytes, and the term granulocytosis is often used in place of the term neutrophilia. Granulocytosis is an increase in the number of granulocytes (neutrophils, eosinophils, basophils) in the blood.

A client has liver disease. Which clotting factor will be the first to decline in this client?

Liver disease causes reductions in clotting factors that mirror the amount of liver cell damage. Factor VII is the first to decline, owing to rapid turnover, followed by decreases in levels of factor II and X. Factor IX levels usually do not decline until liver damage is severe. Decline in levels of factor V is a direct reflection of hepatocyte damage.

The known causes of lymphadenopathy include: Select all that apply. neoplastic disease. Correct inflammatory condition. Correct lipid storage disease. Correct cardiac disease. Incorrect immunologic disorders. Correct

Lymphadenopathy may be caused by neoplastic disease, immunologic or inflammatory conditions, endocrine disorders, and lipid storage disease. Currently there is no research to support a connection between cardiac disease and lymphadenopathy.

A client has lymphoblastic lymphoma. Which is the characteristic cell or cell state associated with lymphoblastic lymphoma?

Lymphoblastic lymphoma arises from a clone of relatively immature T cells that becomes malignant in the thymus. Heterophilic antibodies are a group of heterogenous IgM antibodies that are agglutins against animal erythrocytes and are found in infectious mononucleosis. Bence- Jones protein is a free immunoglobin light chain present in the blood and urine of an individual with multiple myeloma that contributes to renal tubular cell damage. The Reed-Sternberg cell is a definitive diagnostic marker for Hodgkin lymphoma.

Which statement regarding lymphoma is true?

Lymphomas are initially identified by the presence of tender, lymph nodes that are enlarged enough to be palpated. They are the sixth most common cause of cancer death and are the result of injury to the DNA of the lymphoid tissue. Malignancy within the lymphatic tissue in the bone marrow is termed lymphocytic leukemia.

normocytic anemia

MCV 80-100 What size are the RBC in sickel cell

microcytic anemia

MCV < 80; iron deficient iron deficiency MC, anemic chronic disease, thalassemia, sideroblastic anemia

macrocytic anemia

MCV > 100; vitamin B12 and/or folate (vitamin B9) deficiency Anemia characterized by the presence of abnormally large red blood cells

Schilling's test

Measures the urine excretion of vitamin b 12 for Dx of pernicious anemia

pleomorphic cells

Mixed-type cancer cells. The cells that make up a mixed-tissue tumor.

A nurse is caring for clients who have monocytopenia. The nurse is caring for which clients? Select all that apply.

Monocytopenia, or a decrease in monocytes, is rare, but is associated with hairy cell leukemia and prednisone therapy. Tuberculosis and subacute bacterial endocarditis are associated with an increase in monocytes, or monocytosis. Myeloid metaplasia and chronic myeloid leukemia are associated with basophilia, an increase in basophils, seen in myeloproliferative disorders.

A client with folate deficiency anemia has cheilosis. Which area should the nurse assess primarily for cheilosis?

Mouth (scales and fissures of the mouth). Although pallor can be identified in the eyelids, it cannot identify cheilosis. Jaundice, sallowness, and cyanosis can be observed in the skin but cheilosis cannot be observed in the skin. Spoon shaped nails (koilonychias) can be observed with iron deficiency anemia but cheilosis does not involve the nails.

A client has malignant plasma cells with tumor masses all throughout the skeletal system. While giving report, which term can the nurse use to describe this condition?

Multiple myeloma is a B cell cancer characterized by the proliferation of malignant plasma cells that infiltrate the bone marrow and aggregate into tumor masses throughout the skeletal system. Hodgkin lymphoma is characterized by its progression from one group of lymph nodes to another and the presence of Reed-Sternberg cells. Natural killer cell neoplasm is a form of non-Hodgkin lymphoma. Acute lymphocytic leukemia affects white blood cells.

ataxia

Neurological sign consisting of lack of voluntary coordination of muscle movements. (Dysfunction of parts of the nervous system i.e - in cerebellum)

A client has neutropenia. Which conditions could cause this condition? Select all that apply.

Neutropenia can be caused from leukemia, starvation, and hypersplenism. Eosinophilia is associated with allergy. Neutrophilia can be caused from myeloproliferative disorder

A client has neutrophilia. What are some possible causes of this condition? Select all that apply. Early inflamation Early stage of infection and exceeds 7500/nm

Neutrophilia is seen in the early, not late, stages of infection or inflammation and is established when the absolute count exceeds 7500/mm3, not less than 5000/mm3.

The nurse is caring for a client recovering from a motor vehicle accident in which massive crushing injuries occurred, resulting in disseminated intravascular coagulation (DIC). What relevant blood tests are needed to diagnose DIC? Select all that apply.

No single laboratory test can be used to diagnose DIC. Diagnosis is based primarily on clinical symptoms and confirmed by a combination of laboratory tests. The most commonly used combinations of laboratory tests confirm thrombocytopenia or a rapidly decreasing platelet count on repeated testing, prolonged clotting times (prothrombin time), presence of fibrin degradation products, and decreased levels of coagulation inhibitors. The D-dimer assay is a widely used test for DIC. Troponin levels are specific to heart muscle damage, and liver enzymes are not relevant for DIC diagnosis.

A nurse is creating a brochure that compares non-Hodgkin with Hodgkin lymphoma. Which information should the nurse list under the non-Hodgkin side?A nurse is creating a brochure that compares non-Hodgkin with Hodgkin lymphoma. Which information should the nurse list under the non-Hodgkin side?

Non-Hodgkin lymphoma has multiple peripheral nodes. Non-Hodgkin occurs primarily in middle age, not in childhood. B symptoms are uncommon in non-Hodgkin lymphoma. Extranodal involvement is common, not rare.

A nurse is teaching the staff about non-Hodgkin lymphoma. Which information should the nurse include regarding cells that can become malignant in non-Hodgkin lymphoma? Select all that apply.

Non-Hodgkin lymphoma includes a group of different lymphomas that may arise from B or T lymphocytes or natural killer cells. Neutrophils and eosinophils do not become malignant in non-Hodgkin lymphoma.

A nurse is planning care for a client with disseminated intravascular coagulation (DIC). What pathophysiologic process occurs in this client?

Not only is the clotting system extensively activated in DIC, but also the predominant natural anticoagulants (tissue factor pathway inhibitor, antithrombin III, protein C) are greatly diminished. The rate of fibrinolysis is also diminished in DIC, not stimulated. Tissue factor pathway inhibitor is diminished, not stimulated. There is excessive and widespread exposure of tissue thromboplastin, not a reduction.

Which conditions can cause clients to develop pernicious anemia? Select all that apply.

Other causes of pernicious anemia include congenital deficiency of intrinsic factor, heavy alcohol ingestion, hot tea, cigarette smoking, and complete or partial removal of stomach (gastrectomy). Heavy ingestion of fatty foods does not lead to pernicious anemia but can lead to heart disease. Chronic obstructive pulmonary disease is not associated with pernicious anemia.

Which of these people should the nurse recognize as being at the highest risk for developing a folate deficiency anemia?

People who abuse alcohol are at high risk for folate deficiency anemia. Vegetables are an excellent source of folate. Menstruating women are at risk for iron deficiency anemia; pregnant women are predisposed to folate deficiency anemia. Lack of intrinsic factor causes pernicious anemia.

Which information should the nurse include in a teaching session about pernicious anemia?

Pernicious anemia is associated with end-stage type A chronic atrophic gastritis, an autoimmune disorder, not a viral infection. It generally occurs in people over the age of 30, not 16, and is due to the absence of, not an increase of, intrinsic factor.

A nurse notices that a Schilling test is prescribed by the primary healthcare provider. The nurse suspects the client has which anemia?

Pernicious anemia is diagnosed with a variety of tests, including serological studies, gastric biopsy, bone marrow aspiration, clinical findings, and the Schilling test. The Schilling test does not diagnose sickle cell (sickle shaped eyrthrocytes), iron deficiency (low iron levels), or folate deficiency (low folate levels) anemias.

Upon checking laboratory results, the nurse finds the client has anemia that produces large erythrocytes. The nurse is caring for which client?

Pernicious anemia is the most common type of macrocytic (large erythrocyte) anemia. Specific conditions for microcytic anemia include iron deficiency anemia, sideroblastic anemia, and thalassemia. Sickle cell anemia involves sickling of red blood cells.

vitamin B12

Pernicious anemia results from a deficiency of

cytic

Pertaining to a cell

hypochromic

Pertaining to deficiency in color; decrease in hemoglobin in red blood cells.

A client presents with pica. Which diagnosis will the nurse observe documented on the chart?

Pica (eating nonfood substances) is associated with iron deficiency anemia. Pica is not commonly associated with thalassemia (inherited autosomal recessive disorders), hemolytic anemias (acquired or hereditary), or folate deficiency anemia (alcoholics and malnourished individuals).

A client has thrombotic thrombocytopenic purpura. The nurse should prepare the client for which prescribed initial treatment?

Plasma exchange with fresh frozen plasma, which replenishes functional ADAMTS13 (ADAM metallopeptidase with thrombospondin type 1 motif, 13), is the treatment of choice, achieving a 70% to 80% response rate. Nonresponse to conventional therapy may require a splenectomy; however, postoperative hemorrhage remains a dangerous complication. Hydroxyurea, a nonalkylating myelosuppressive agent, is used to suppress platelet production and is used to treat thrombocythemia, not thrombocytopenia. Anagrelide is now the drug of choice for thrombocythemia.

Which term will the nurse use in report to describe a client's condition that causes abnormally high production of red blood cells?

Polycythemia is excessive red cell production. Anemia is a decrease in the number of red blood cells. Leukemia is an abnormally high production of white blood cells. Thrombocythemia is an increased platelet count.

Which term refers to an abnormally high production of red blood cells?

Polycythemia is the medical term for abnormally high production of red blood cells. Anemia is a decrease in the number of red blood cells. Hemolytic crisis is fulminate hemolytic anemia and can present with shock. Apoferritin is a protein implicated in altered iron met

A client has multiple myeloma. Which laboratory results will the nurse typically observe? Select all that apply.

Proteinuria is observed in 90% of individuals with multiple myeloma. Bence Jones protein is present in about 80% of multiple myeloma cases and may also lead to damage of the proximal tubules. The common presentation of multiple myeloma is characterized by elevated levels of calcium in the blood (hypercalcemia). Because of the large number of malignant plasma cells, the abnormal antibody, called the M protein, becomes the most prominent protein in the blood. A routine blood smear usually shows fragmented red cells (schizocytes) in a client with thrombotic thrombocytopenic purpura.

normochromic

RBC's with the proper amount of hemoglobin filling about half the cell is called

constituents of blood

RBC, WBC, platelets, IgG, protein bound organic solutes, protein bound drugs

A nurse is planning care for a client with disseminated intravascular coagulation (DIC). What is the most common pathophysiologic process that occurs in clients with DIC?

Regardless of the underlying disease that initiates DIC, the common pathway seems to be excessive and widespread exposure of tissue factor (TF or tissue thromboplastin). The rate of fibrinolysis is also diminished in DIC. In addition to initiation of clotting by tissue factor, DIC may be precipitated by direct proteolytic activation of factor X. The deposition of fibrin clots in the circulation interferes with blood flow, causing widespread organ hypoperfusion.

A client has relative polycythemia. The nurse will focus care primarily on resolving which condition?

Relative polycythemia results from hemoconcentration of the blood associated with dehydration. Posthemorrhagic anemia would focus on hemorrhage. Absolute secondary polycythemia would focus on high altitudes and coronary heart failure.

Microcytic-hypochromic anemia is known to be a result of disorders involving: Select all that apply. iron metabolism. Correct porphyrin synthesis. Correct globin synthesis. Correct vitamin absorption. Incorrect heme production. Correct

Research supports that microcytic-hypochromic anemia is a result of disorders involving iron metabolism, porphyrin synthesis, heme production, and globin synthesis. The inability to absorb vitamin B12 results in pernicious anemia, which is a microcytic-normochromic anemia.

A nurse in a prenatal clinic is working with four women who are all early in their third trimester. Which woman is at highest risk for becoming anemic and therefore needs the most frequent monitoring and careful teaching?

Rheumatoid arthritis is associated with anemia of chronic inflammation, which gives this woman an additional risk for anemia; all of these pregnant women have increased risk for both iron deficiency anemia and folate deficiency anemia, because the demand for both nutrients is elevated during pregnancy. Low blood pressure does not increase the risk of anemia. Heartburn does not increase the risk of anemia.

Which form of anemia is caused by altered heme synthesis in erythroid cells?

Sideroblastic anemias are a heterogeneous group of disorders characterized by anemia of varying severity due to a dysfunction in the erythroid cells that results in a faulty production of heme. Iron deficiency anemia is usually a result of pregnancy or caused by a continuous loss of blood. Microcytic-hypochromic anemia is caused by small erythrocytes that contain reduced amounts of hemoglobin. Megaloblastic anemia is caused by unusually large erythrocytes.

A client has a form of anemia caused by altered heme synthesis in erythroid cells. Which form of anemia will the nurse observe documented in the chart?

Sideroblastic anemias have various causes but share the commonality of altered heme synthesis in the erythroid cells in bone marrow. Normocytic-normochromic anemias are characterized by erythrocytes that are relatively normal in size and hemoglobin content but insufficient in number, as in aplastic anemia. Pernicious and folate anemias cause large red blood cells, producing macrocytic anemia, but they do not affect heme synthesis.

Which statement regarding iron deficiency is true?

Splenomegaly is evident in only 10% to 15% of children with iron deficiency anemia. If the condition is longstanding, the sutures may widen. Mild to moderate iron deficiency (hemoglobin 6 g/dl to 10 g/dl) may show some cellular changes. Hemoglobin less than 8 g/dl can demonstrate pallor, tachycardia, and a systolic murmur.

The nurse is assessing a pregnant client admitted to obstetrics for severe preeclampsia. Which clinical findings might suggest disseminated intravascular coagulation (DIC)?

Spontaneous bleeding from the gums is associated with DIC. DIC may occur in pregnant women with severe preeclampsia. Acute DIC presents with rapid development of hemorrhaging or oozing from venipuncture sites and other wounds, as well as the development of ecchymotic lesions, such as purpura, petechiae, and hematomas. The eyes, nose, and gums are sites of bleeding. The client had spontaneous bleeding of the gums and palatal petechiae, both signs of DIC. Hypotension occurs with DIC, not hypertension. Clear yellow urine is normal. A pulse of 96 is also normal.

A client has Hodgkin disease and the spread of lymphoma has reached multiple extralymphatic organs and tissues. Which stage will the nurse observe written on the chart?

Stage IV carries a poor prognosis and means that there is spread to one or more extralymphatic organs or tissues. In stage I, only a single area of lymph nodes is involved. In stage II, there are two or more areas of lymph nodes involved, all on the same side of the diaphragm. Dissemination to lymph nodes both above and below the diaphragm is stage III.

A client has essential thrombocythemia. Which action should the nurse take?

Standing, exercising, or applying heat precipitates the pain, which is relieved by elevation and cooling of the affected extremity. Poikilocytosis is a condition in which red blood cells assume various shapes.

ferritin

Storage form of iron in intestinal mucosa, liver, spleen, BM

A nurse is asked what anemia means. How should the nurse reply?

Strictly speaking, anemia is a reduction in the total number of circulating erythrocytes or a decrease in the quality or quantity of hemoglobin. An increased white cell count is leukocytosis, not anemia. A decreased circulating platelet count is thrombocytopenia, not anemia. Thrombocytes are platelets, not red blood cells.

A nurse is caring for a client with chronic lymphocytic leukemia (CLL). Which action by the nurse is most appropriate?

Suppression of normal antibody production is the most significant effect in CLL. Individuals are thus at risk for recurrent bacterial and other infections that are commonly sensitive to antibodies. Anemia (erythrocytopenia), thrombocytopenia, and neutropenia are typically present with overt CLL, not erythrocytosis or thrombocytosis. Hypernatremia (elevated sodium) is not associated with CLL.

The adult client is undergoing a second round of chemotherapy for metastatic cancer. When the nurse checks the indwelling intravenous line, there is oozing from the central line site, bleeding from the nose and gums, ecchymotic lesions on the hip, and symmetric cyanosis of the fingers and toes. What does the symmetric cyanosis of the extremities indicate?

Symmetric cyanosis of the fingers and toes (blue finger/toe syndrome), nose, and breasts may be observed and indicates macrovascular thrombosis. Indicators of multisystem dysfunction include changes in level of consciousness or behavior, confusion, seizure activity, oliguria, hematuria, hypoxia, hypotension, hemoptysis, chest pain, and tachycardia. Jaundice most likely results from red cell destruction rather than liver dysfunction; symmetric cyanosis indicates macrovascular thrombosis, not red cell damage. Digital ischemia is characterized by warm, congested, red extremities with a burning sensation, particularly on the forefoot sole and toes.

A client has a suspected infection with the Epstein-Barr virus. The nurse should be prepared to teach the client about which test?

Tests used to detect heterophilic antibodies include Monospot or heterphile antibody test. Heterophilic antibodies are a heterogeneous group of IgM antibodies that are agglutinins against nonhuman red blood cells. Ferritin tests for iron-deficiency anemia. D-dimer is used for disseminated intravascular coagulation. Red blood cell count tests for anemia or polycythemia.

A nurse is teaching the staff about the gene associated with chronic myeloid leukemia (CML). Which gene should the nurse include?

The BCR-ABL fusion gene occurs on the Philadelphia chromosome and is associated with CML. The Philadelphia chromosome results from a reciprocal translocation between the long arms of chromosomes 9 and 22. A unique protein (BCR-ABL protein) is encoded from two genes (BCR from chromosome 22 and ABL1 from chromosome 9) that are abnormally linked (thus forming a fusion gene) at the junction of translocation. TP53 and RB are associated with some cancers but not with CML. BRCA1 is associated with an increase in breast cancer in women.

A nurse is caring for an adult with chronic myelogenous leukemia (CML). Which information from the medical record does the nurse recognize as a diagnostic marker for CML?

The Philadelphia chromosome is a useful diagnostic marker for CML and is observed in 95% of individuals with CML. Splenomegaly is present in numerous hematologic disorders. Anemia is common with CML but has numerous other causes. An elevated WBC count is characteristic of all types of leukemia.

A nurse finds that a client has the Philadelphia chromosome. Which disease will the nurse find documented on the chart?

The Philadelphia chromosome is observed in 95% of those with chronic myelogenous leukemia and 30% of adults with acute lymphocytic leukemia. Monocytosis is often seen in chronic infections such as tuberculosis and subacute bacterial endocarditis. Abnormal neutrophil distribution and sequestration are associated with hypersplenism and a pseudoneutropenia, which in the presence of rheumatoid arthritis constitute Felty syndrome.

A client has the absolute primary form of polycythemia. Which term should the nurse use in report to describe this condition?

The absolute primary form of polycythemia is referred to as polycythemia vera. Polycythemia exists in two forms: relative and absolute. Relative polycythemia results from hemoconcentration of the blood associated with dehydration. Hereditary hemochromatosis is a common, inherited, autosomal recessive iron metabolism disorder that has increased absorption and deposition of iron in tissues. Normocytic-normochromic anemias have a deficiency of erythrocytes with a normal size and hemoglobin content.

The adult client is undergoing a second round of chemotherapy for metastatic cancer. When the nurse checks the indwelling intravenous line, there is oozing from the central line site, bleeding from the nose and gums, ecchymotic lesions on the hip, and symmetric cyanosis of the fingers and toes. The client becomes confused and begins to display seizure activity. Which is the best method for thrombosis control?

The best method in this client situation is the replacement of deficient coagulation factors, elements, and platelets. Thrombosis control in disseminated intravascular coagulation (DIC) is difficult. Replacement of deficient coagulation factors, elements, and platelets is becoming more common as treatment. Heparin seems to be effective only if the DIC is caused by acute promyelocytic leukemia or retention of a dead fetus. Heparin is also contraindicated when there is evidence of postoperative bleeding, peptic ulcer, or central nervous system bleeding (seizures and confusion). Replacement of anticoagulants (antithrombin III, protein C) seems to be effective in DIC caused by sepsis, which this client did not have. Antifibrinolytic drugs may be used in life-threatening bleeding not controlled by blood component therapy; this would be used if replacement therapy did not work

Neutropenia, a condition involving the blood's neutrophil count, is believed to be caused by its: Select all that apply. decreased production. Correct increased turnover. Correct abnormal distribution. Correct increased tendency to store vitamins. reaction to an overwhelming infection. Correct

The causes of neutropenia, in addition to an overwhelming infection, include decreased production, increased turnover, and abnormal distribution. Decreased vitamin intake can cause decreased production due to the lack of appropriate building blocks.

A client has heparin-induced thrombocytopenia (HIT). Which drug should the nurse prepare to administer?

The chance of blood clots can be diminished using thrombin inhibitors (e.g., argatroban, lepirudin). A switch to low-molecular-weight heparin is not indicated, and warfarin (Coumadin) should not be used until the symptoms of HIT have resolved, because of an increased risk of initiating skin necrosis. Hydroxyurea, a nonalkylating myelosuppressive agent, is used to suppress platelet production and at one time was the drug of choice for treating essential thrombocythemia.

A client has heparin-induced thrombocytopenia (HIT). Which drug should the nurse prepare to administer? Correct 3 Argatroban

The chance of blood clots can be diminished using thrombin inhibitors (e.g., argatroban, lepirudin). A switch to low-molecular-weight heparin is not indicated, and warfarin (Coumadin) should not be used until the symptoms of HIT have resolved, because of an increased risk of initiating skin necrosis. Hydroxyurea, a nonalkylating myelosuppressive agent, is used to suppress platelet production and at one time was the drug of choice for treating essential thrombocythemia.

Which information should the nurse include in the teaching session for chronic immune thrombocytopenic purpura? Select all that apply.

The chronic form is more common in women between 20 and 40 years of age and tends to get progressively worse. It usually starts with minor problems such as petechiae, not internal bleeding or bleeding from the nose and mouth.

Which statement regarding thrombotic thrombocytopenic purpura (TTP) is true? It is: Select all that apply. caused by platelet aggregates. Correct more common in females. Correct most commonly seen in infants. Incorrect occurring more frequently. Correct seldom life threatening

The condition is a result of platelet clumping seen most commonly in adult females. While reported cases of TTP are increasing, the cause is yet to be identified. It is rarely observed in infants and is certainly life threatening if not treated effectively and promptly.

A client has just completed radiation and chemotherapy for head and neck cancer. Blood work shows that the client is severely anemic in addition to being severely deficient in platelets and white blood cells. The client is given massive intravenous doses of cephalosporin to treat an infection. The erythrocyte count continues to drop. Additional labs show erythyroid hyperplasia in the blood smears and bone marrow biopsy. The client also has developed splenomegaly and jaundice. What is the most likely cause of the continued problem with the client's erythrocytes?

The continued drop in erythrocytes and the erythyroid hyperplasia in blood smears and the bone marrow biopsies with splenomegaly and jaundice indicate hemolytic anemia associated with antibiotic use. Septic shock would not have this effect on erythrocytes but would affect blood pressure. The client did not suddenly lose blood, leading to posthemorrhagic anemia. The client is suffering from acute, not chronic, inflammation.

Which condition is one of the current criteria for presence of an overactive spleen? Select all that apply. Anemia Correct Cellular bone marrow Correct Splenomegaly Correct Leukocytosis Thrombocytopenia Correct

The criteria for the diagnosis of an overactive spleen include anemia, thrombocytopenia, an enlarged spleen, and cellular bone marrow. Leukopenia, not leukocytosis, is a recognized criterion for such a condition.

The nurse is reviewing objective and subjective data from the physical examination of a middle-aged female client. Which assessment finding helps distinguish between pernicious anemia and folate deficiency anemia?

The distinguishing difference between pernicious and folate anemias is neurologic symptoms (paresthesia of the feet and fingers). Sore tongue and extreme fatigue occur in both pernicious and folate deficiency anemias. Mucous membranes that are moist, pinkish-red are a normal finding.

A nurse is caring for a client with polycythemia vera. Which pathophysiologic consequences should the nurse consider when planning care for this client?

The excess erythrocytes in polycythemia vera cause hyperviscosity of the blood, leading to clot formation, poor tissue perfusion, tissue ischemia, and even organ infarction. Polycythemia vera involves erythrocytes rather than platelets. Polycythemia vera involves normal erythrocytes, not deformed ones. There is not a decreased oxygen-carrying capacity of the erythrocytes; there are just too many.

Upon assessment of a client with iron deficiency anemia, the nurse observed the assessment finding shown (see picture). How would the nurse

The fingernails become brittle and "spoon-shaped" or concave (koilonychia) in iron deficiency anemia. Pallor is a paleness or whiteness of skin from lack of hemoglobin in anemias. Glossitis has a loss of papillae and flattening with soreness, redness, and burning. Spider hemorrhages would appear as dark lines in the nail beds.

A nurse is assessing a client with suspected lymphoblastic lymphoma. Which assessment finding will help confirm this diagnosis?

The first sign of lymphoblastic lymphoma is usually a painless lymphadenopathy in the neck. A mediastinal mass, not an abdominal mass, can occur in clients with lymphoblastic lymphoma. Multiple myeloma has Bence Jones protein. Hodgkin lymphoma has Reed-Sternberg cells.

While planning care for a client with anemia, which principle should the nurse remember?

The fundamental alteration of anemia is a reduced oxygen-carrying capacity of the blood resulting in tissue hypoxia. Triad of Virchow is associated with thromboembolic disorders. Vitamin K is needed for clotting; a lack of Vitamin B12 is associated with anemia. Multiple myeloma is a B cell cancer characterized by the proliferation of malignant plasma cells that infiltrate the bone marrow and aggregate into tumor masses throughout the skeletal system.

A client has infectious mononucleosis. Which assessment findings will the nurse probably observe? Select all that apply.

The individual with infectious mononucleosis commonly presents with the classic group of symptoms: fever, sore throat, cervical lymph node enlargement, and fatigue. The blood of affected individuals contains an increased, not decreased, number of platelets (thrombocytosis, not thrombocytopenia), and many white blood cells have atypical forms.

The nurse will assess for clinical manifestations of iron deficiency anemia in which stage of the disorder?

The manifestations of IDA appear in stage III when there is an insufficient iron supply and diminished hemoglobin synthesis. Stage III begins when the hemoglobin-deficient red cells enter the circulation to replace normal, aged erythrocytes that have been destroyed. In stage I, the body's iron stores for red cell production and hemoglobin synthesis are depleted. Red cell production proceeds normally with the hemoglobin content of red cells also remaining normal. In stage II, insufficient amounts of iron are transported to the marrow and iron-deficient red cell production begins. There is no stage IV.

A client's anemia most commonly is classified using which criteria?

The most common classification of anemias is based on the changes that affect the cell's size and hemoglobin content. While anemias can be classified by their cause or by the changes that affect shape, this is not the most common criteria. Classification does not relate to treatment.

Which form of leukemia is the most common in children?

The most common leukemia in children is ALL and represents 80% of the leukemia in children. All other forms are much more commonly diagnosed in adults.

A client has Burkitt lymphoma. Which chromosomal alteration is most associated with this disorder?

The most common translocation (75% of individuals) in Burkitt lymphoma is between chromosomes 8 (containing the c-myc gene) and 14 (containing the immunoglobulin heavy chain genes). Hereditary hemochromatosis is caused by two genetic base-pair alterations, C282Y and H63D. These are mutations in the HFE gene on chromosome 6. In about half of multiple myeloma cases, one of the chromosomal partners is 14 (site of genes for the immunoglobulin heavy chain), which recombines with a number of other chromosomal sites of oncogenes, most commonly 11(q13), 4(p16), 16(q23), 20(q11), and 6(p25), resulting in probable dysregulation of the oncogenes. Trisomy 21 is Down syndrome.

A client recovering from a life-threatening motor vehicle accident in which massive crushing injuries to the body occurred 10 days ago has developed classic clinical manifestations of disseminated intravascular coagulation (DIC). The family visits and demands to know what is happening and why their family member is bleeding. How should the nurse respond? Select all that apply.

The nurse needs to explain in basic terms the pathophysiology of what is causing the visible bleeding that has upset the family. DIC constitutes widespread microscopic clotting that is a potential complication of severe trauma. The loss of blood and clotting factors from the widespread clotting is preventing needed clotting of previous wounds. Treatment does include the replacement of blood products and fluids to maintain organ function. The platelet count will decrease. This is a serious, life-threatening complication requiring treatment.

Which statement regarding Hodgkin lymphoma is true?

The peak incidence occurs during the early 20s and 30s and again in the sixth and seventh decades of life. The incidence is greatest in whites and economically advantaged countries. There is an increase in Reed-Steinberg cells.

Which information from the client indicates teaching by the nurse was successful regarding Hodgkin lymphoma? Select all that apply.

The peak incidence occurs in the early 20s through the 30s and again in the sixth and seventh decades of life. Hodgkin lymphoma is characterized by its progression from one group of lymph nodes to another. There is an increase in Reed-Sternberg cells, not plasma cells. The incidence is greatest in whites and economically advantaged countries.

hematocrit

The percent of the volume of whole blood that is composed of red blood cells as determined by separation of red blood cells from the plasma usually by centrifugation.

The nurse is teaching a client about the primary component of fibrinolysis. Which component is the nurse describing?

The primary component of fibrinolysis is plasmin, which circulates in the blood as an inactive precursor, plasminogen. Plasminogen is activated to plasmin by many substances, including thrombin, fibrin, tissue plasminogen activator, and other molecules. Antithrombin III is the principal inhibitor of thrombin, preventing conversion of fibrinogen to fibrin. Protein C and protein S are natural anticoagulants.

A client has hereditary hemochromatosis (HH). The nurse will plan care focused on which goal?

The primary goal in treatment for HH is to decrease iron overload. Copper deficiency can lead to reversible sideroblastic anemia, not HH. Phlebotomy is the treatment of choice for HH, not blood transfusions, which would make the condition worse. Folic acid (folate) is a treatment for folate deficiency anemia, not HH.

Which factors involved in blood clotting are regulated by vitamin K? Select all that apply? II,III, IX, X Correct

The prothrombin factors that are affected by vitamin K include II, VII, IX, and X. There is no known relationship between vitamin K and factor VIII.

A nurse is caring for a client with anemia. Which possible causes could lead to the development of anemia in a client? Select all that apply.

The proximate causes of anemia are (1) altered production of erythrocytes, (2) blood loss, (3) increased erythrocyte destruction, or (4) a combination of all three. Behind those proximate causes may lie various distal causes, such as genetics, malnutrition, or trauma. Blood transfusion can treat or prevent anemia, not cause it. Decreased erythrocytes (red blood cells), not leukocytes (white blood cells), characterize anemia.

Which situation is a characteristic of the triad of Virchow? Select all that apply. Injury to endothelium Correct Abnormalities of blood flow Correct Hypercoagulability of the blood Correct Decreased clotting factors Incorrect Impaired vitamin A absorption

The triad of Virchow includes the factors that predispose to thrombus formation and include injury to the endothelium, abnormalities of blood flow, and hypercoagulability of the blood. The condition is not affected by either a decrease in clotting factor or poor vitamin A absorption.

A client has absolute primary polycythemia or polycythemia vera (PV). Which primary pathophysiological mechanism should the nurse consider when planning care?

The underlying cause of polycythemia vera remains unknown, with the most likely etiology thought to be an acquired genetic stem cell alteration of the erythropoietin receptor that causes the abnormal proliferation. Posthemorrhagic anemia is caused by sudden blood loss with normal iron stores. Polycythemia is a myeloproliferative red cell disorder, not a myelosuppressive disorder from chemically induced changes in the bone marrow. Secondary polycythemia is a physiologic increase in erythropoietin secretion by kidneys in response to an underlying systemic disorder.

A nurse is teaching about inheritance in leukemia. Which information should the nurse include?

There is a statistically significant tendency for leukemia to reappear in families. The exact cause of leukemia is unknown, but genetic translocation and environmental factors have been implicated.

Which statement regarding Burkitt lymphoma is true? It is:

This is a type of non-Hodgkin lymphoma and is the most common in children from east-central Africa and New Guinea. It is very fast growing and involves primarily the jaw and facial bones. It is associated with Epstein-Barr virus, not the HIV virus.

Which client is most predisposed to severe bleeding?

Thrombocytes fall below 10,000 cells/mm3 and can be fatal if it occurs in the gastrointestinal tract, respiratory tract, or central nervous system. Spontaneous bleeding without apparent trauma can occur with counts between 10,000 and 15,000 cells/mm3. Most clinicians do not consider the decrease significant unless it falls below 100,000 cells/mm3, and the risk for hemorrhage associated with minor trauma does not appreciably increase until the count falls below 50,000 cells/mm3.

A nurse reviews laboratory reports and notices that a client has a low platelet level. Which term should the nurse use to describe this finding?

Thrombocytopenia is a decrease in the number of platelets; an increase in the number of platelets is called thrombocythemia. Anemia is a low red blood cell level. Leukocytosis is an increase in white blood cells.

A nurse is caring for a client that has decreased platelets. The nurse is caring for which client?

Thrombocytopenia is defined as a platelet count below 150,000 cells/mm3, although it is not usually considered significant until the platelet count drops below 100,000 cells/mm3. Thrombocytosis or thrombocythemia is defined as a platelet count greater than 400,000 cells/mm3 and is an example of thromboproliferation. A thrombosis is a blood clot attached to the blood vessel wall.

A client presents with petechiae, easy bruising, bleeding gums, and a platelet count of 75,000/mm3. Which diagnosis will the nurse observe written in the chart?

Thrombocytopenia produces all of these symptoms and usually occurs with a platelet count below 100,000/mm3. Neutropenia exists when the neutrophil count is less than 2000/mm3, resulting in frequent infections. Leukopenia, of which neutropenia is one type, is a decrease in white blood cells; all forms of leukopenia put the individual at risk for infections. Anemia is a decrease in red blood cells, hemoglobin, and hematocrit; it affects the body's ability to transport oxygen, causing fatigue and ultimately hypoxia.

A nurse is caring for a client with thrombocytopenia. Which pathophysiologic process is causing the thrombocytopenia? Correct 4 Increased platelet consumption

Thrombocytopenia results from decreased platelet production, increased consumption, or both. Decreased reticulocytes can lead to a decrease in erythrocytes, not thrombocytes. Decreased hemoglobin occurs in anemia, not thrombocytopenia. Decreased platelet production, although not certain, is likely. Increased platelet production is unlikely, and it is not the cause of the thrombocytopenia.

A client has hereditary hemochromatosis (HH). Which nursing action should the nurse implement?

Treatment of HH is simple and consists of phlebotomy of 550 ml of whole blood, which is equivalent to 200 to 250 mg of iron. Individuals with HH should be instructed to refrain from taking iron and vitamin C supplements and consuming raw shellfish. White blood cell count is not affected by HH; the red blood cells are affected.

biconcavity

Two unique characteristics of erythrocytes

A nurse is explaining to a client how inappropriate coagulation can be triggered by vasculitis. Which information should the nurse include in the teaching session? Select all that apply.

Vasculitis (inflammation of the blood vessels), along with vessel damage, activates platelets, which in turn activate the coagulation cascade. In extensive or prolonged vasculitis, blood clot formation can suppress, not stimulate, mechanisms that normally control clot formation and dissolution, leading to clogging of the vessels.

Fe2+

What form of iron can bind oxygen

folate (vitamin B9)

What vitamin is involved mainly with the replacement of red blood cells and digestive tract cells

A nurse notices on a client's laboratory report that a "shift-to-the-left" phenomenon occurred. How should the nurse interpret this finding?

When the demand for circulating mature neutrophils exceeds the supply, immature, not mature, neutrophils and other leukocytes are released from the bone marrow resulting in the phenomenon known as a leukemoid reaction or "shift-to-the-left" phenomenon. An increased number of red blood cells is termed polycythemia while a lack of red blood cells is anemia.

Which laboratory result for a client will alert the nurse that spontaneous bleeding without trauma is possible?

With a platelet count between 10,000 and 15,000, spontaneous bleeding without trauma may result. Most individuals do not consider the decrease significant unless it falls below 100,000 cells/mm3, and the risk for hemorrhage associated with minor trauma does not appreciably increase until the count falls below 50,000 cells/mm3.

Spontaneous bleeding without trauma is possible when the platelet count is:

With a platelet count of less than 10,000, severe bleeding without trauma may result. It is unlikely that such a bleeding will occur at the other levels.

reverse deformability

ability of RBC to be flexible, change their shape as needed

koilonychias

abnormally thin nails, which have lost their convexity, becoming flat or even concave in shape; sign of hypochromic anemia

A nurse is reviewing laboratory results from a client with multiple myeloma. What would the nurse expect to find?

by elevated levels of calcium in the blood (hypercalcemia), renal failure, anemia (lack of erythrocytes, not erythrocytosis), and bone lesions. Hyperkalemia (increased potassium) and hypernatremia (increased sodium) are not generally observed.

chromic

color

A client who lived at high altitudes is checked by the nurse for secondary polycythemia. What is the rationale for the nurse's actions?

erythropoietin secretion caused by hypoxia. This hypoxia is noted in individuals living at higher altitudes (>10,000 ft), smokers with increased blood levels of carbon monoxide, and individuals with chronic obstructive pulmonary disease or coronary heart failure, or both. Anemia is a lack of red blood cells; polycythemia is too many red blood cells. Neutrophilia, an excess of neutrophils (a type of white blood cells), is not a cause for secondary polycythemia. Thrombocytopenia, a lack of platelets, is not a cause for secondary polycythemia.

menorrhagia

excess menstrual flow, MCC of iron deficiency in women

hemosiderin

golden yellow to brown pigment derived from the breakdown of hemoglobin in red blood cells insoluble iron storage compound produced by the body when iron exceeds the storage capacity of ferritin.

dysphagia

impaired ability to swallow; difficulty swallowing

stomatitis

inflammation of the mucus membrane of the mouth

glossitis

inflammation of the tongue that causes it to swell in size, change into different shades of red, and develop a smooth appearance on the surface. Inflammation of the tongue, can be caused by deficiency of vitamin B 12, full look acid and iron

spasticity

involuntary increase in muscle resistance that is dependent on velocity. Because individuals with spasticity cannot voluntarily relax their limbs, voluntary movement of an affected limb may be impossible

Which pathophysiologic mechanism occurs in a client with chronic lymphocytic leukemia (CLL)?

malignant transformation of B cells and failure of normal programmed cell death or apoptosis (not an increase), giving these cells an extended life and making the condition chronic. Null cell occurs in a small percentage of acute lymphocytic leukemia, not chronic.

Which type of anemia is associated with the presence of macrocytic-normochromic erythrocytes? 10 Pernicious anemia

occur in pernicious anemia due to a lack of vitamin B12. When abnormal genetic matter forms in erythroblasts, it leads to large, abnormal-shaped erythrocytes. Hemolytic anemia occurs as a result of the premature breakdown of the erythrocyte cell membrane, leading to normocytic-normochromic anemia. Sickle cell anemia occurs due to abnormal hemoglobin synthesis and abnormal shape of erythrocytes. Sideroblastic anemia occurs due to lack of iron uptake by erythroblasts and due to defective porphyrin and hemoglobin synthesis, leading to microcytic-hypochromic anemia.

A nurse is assessing a client using the criteria from the triad of Virchow. The nurse is assessing which client?

predispose to thrombus formation, which are injury to the endothelium, abnormalities of blood flow, and hypercoagulability of the blood. Anemia would be low numbers of red blood cells. Leukemia would be excessive production of white blood cells. Lymphomas would involve enlarged lymph nodes.

tongue papillae

small bumps near the tip of and base of the tongue, help animals manipulate food in their mouths

Which are the major organ systems that undergo the compensation effect during anemia? Select all that apply.

the respiratory, cardiovascular, and hematologic systems. Anemia occurs when the total number of red blood cells and hemoglobin count is reduced. A low level of hemoglobin relates to low-oxygen carrying capacity of the blood. Therefore, the workload on the heart and blood vessels increases to pump more blood. Anemia indirectly affects the nervous system, digestive system, and urinary system, which may cause an individual to have fatigue, low concentration, and low appetite.

chronic inflammation's role in anemia

what are some conditions that increase the level of gamma globulins (immunoglobulin)

total iron binding capacity (TIBC)

↑ iron deficiency; ↓ anemia chronic disease, sideroblastic anemia 250 - 460 mcg/dL A measure of available transferrin that is left unbound(to iron)Transferrin is used to transport iron in the body. Elevated if there is not enough iron to transport(as seen with iron def anemia). Normal TIBC seen with thalassemia, B12-deficiency, and folate-deficiciency anemi