Chapters 21 & 22

The nurse is caring for a client with thrombotic thrombocytopenic purpura (TTP) and notices a yellow discoloration of the client's sclera. Which are likely possible causes of this finding? Select all that apply. A. Accelerated intravascular hemolysis B. Hypoperfusion of the liver C. Elevated levels of nitrogenous wastes (uremia) D. Side effect of hepatotoxic medication E. Viral hepatitis

A. Accelerated intravascular hemolysis B. Hypoperfusion of the liver

The nurse notes eosinophilia on the client's laboratory results. The nurse should interview the client about a history of which conditions? Select all that apply. A. Asthma B. Exposure to parasites C. Allergic reactions D. Viral infection E. Bacterial infection

A. Asthma B. Exposure to parasites C. Allergic reactions

Following a bone marrow biopsy, which assessment would indicate the client is experiencing a complication as a result of this diagnostic procedure? A. BP 90/60, heart rate 132, excess bleeding, and hematoma noted at insertion site. B. BP 130/80, oxygen saturation 95%, crackles heard on inspiration. C. Respiratory rate 24, complaining of pain at insertion site. D. Heart rate regular 64 bpm, temperature 99.6°F (37.5°C) orally.

A. BP 90/60, heart rate 132, excess bleeding, and hematoma noted at insertion site.

From the current health histories, which client(s) is at risk for developing secondary forms of immune thrombocytopenic purpura (ITP)? Select all that apply. A. Female client in the first trimester reporting abdominal cramping B. Middle-aged client scheduled for gastroscopy to confirm Helicobactor pylori C. Former IV drug user recently diagnosed with hepatitis C virus D. Older adult female undergoing testing for cause of joint discomfort E. Adolescent admitted for facial burns when the "vape" (cigarette) exploded in the mouth

B. Middle-aged client scheduled for gastroscopy to confirm Helicobactor pylori C. Former IV drug user recently diagnosed with hepatitis C virus

Which statements best captures an aspect of the process of hematopoiesis? A. Colony-stimulating factors (CSFs) produce cytokines that activate progenitor cells. B. Progenitor cells differentiate into precursor cells. C. Various subtypes of pluripotent stem cells eventually differentiate into the cellular components of blood. D. Self-replicating precursor cells differentiate into specific CSFs.

B. Progenitor cells differentiate into precursor cells.

A hospital client is receiving intravenous infusion of heparin for treatment of a pulmonary embolus. Which phenomenon is most likely occurring, resulting in the drug's therapeutic effect? A. Inhibition of vitamin K synthesis in the liver B. Suppression of fibrin formation C. Deactivation of the intrinsic clotting pathway D. Inhibition of ADP-induced platelet aggregation

B. Suppression of fibrin formation

A client asks the health care provider why his lower legs look purple. The health care provider will base the response on which pathophysiologic principle? A. Too much trauma breaks capillaries and they bleed into the tissue. B. The bruising around the ankles is due to the fact that it is a dependent area where the capillary pressure is higher. C. There is a problem with the plasminogen levels. D. Morbid obesity causes veins to enlarge and bleed into tissues due to stress the abdomen is placing on the vascular system.

B. The bruising around the ankles is due to the fact that it is a dependent area where the capillary pressure is higher.

Which statement best conveys a characteristic of red blood cells? A. They lack organelles and soluble enzymes. B. They contribute to the maintenance of blood pH. C. They help maintain the body's fluid balance. D. They are self-replicating.

B. They contribute to the maintenance of blood pH.

The nurse is caring for a client with sepsis who has developed disseminated intravascular coagulation (DIC). Which assessments should the nurse prioritize? Select all that apply. A. Platelet count B. Urine output C. Level of consciousness D. Weight E. Oxygen saturation

B. Urine output C. Level of consciousness E. Oxygen saturation

A 44-year-old female client presents to the emergency department with abnormal bleeding and abdominal pain that is later attributed to gallbladder disease. Which diagnosis would the medical team be most justified in suspecting as a cause of the client's bleeding? A. Excess calcium B. Vitamin K deficiency C. Hemophilia B D. Idiopathic immune thrombocytopenic purpura (ITP)

B. Vitamin K deficiency

From the assigned team of clients, which client is at highest risk for the development of endothelial damage that may lead to disseminated intravascular coagulation (DIC)? A. Client who had an automobile accident client and sustained three broken ribs resulting in a small pneumothorax B. Adolescent clilent who developed blisters on the back from sunbathing requiring pain medication C. Client with chronic obstructive pulmonary disease (COPD) who is diagnosed with pneumonia, most likely from a virus D. Client on a monitor displaying frequent premature ventricular contractions (PCVs)

C. Client with chronic obstructive pulmonary disease (COPD) who is diagnosed with pneumonia, most likely from a virus

A nurse practitioner is providing care for a client with low levels of the plasma protein gamma globulin. The nurse would recognize that the client is at risk of developing which health problem? A. Jaundice B. Anemia C. Infections D. Blood clots

C. Infections

A client has been suffering from fatigue and the health care provider suspects anemia. Which test results will the health care provider consult when investigating the cause of the anemia? A. Red blood cell (RBC) B. Hemoglobin C. RBC indices D. Hematocrit

C. RBC indices

A 5-year-old needs to undergo a bone marrow biopsy. When educating the parents, which site should the nurse state is the most commonly used? A. sternum B. spinous C. posterior iliac crest D. anterior iliac crest

C. posterior iliac crest

A 36-year old woman with a diagnosis of antiphospholipid syndrome is receiving a scheduled checkup from her nurse practitioner. Which teaching point would the nurse most likely prioritize? A. "It's important for you to do regular physical activity and maintain a healthy body weight." B. "Good nutrition and blood sugar control are important in your case." C. "You'll need to avoid taking nonsteroidal anti-inflammatory drugs when you have menstrual cramps." D. "We need to ensure your birth control pills don't contain estrogen."

D. "We need to ensure your birth control pills don't contain estrogen."

When talking about the lifespan of various blood components, the students should know that once a neutrophil moves into tissue, it lives approximately how long? A. 12 hours. B. 24 hours. C. 2 days. D. 4 days.

D. 4 days.

A fifth-grade elementary student asks the school nurse how much blood is in an entire body. The nurse should respond that the average grown-up adult has: A. 2 to 4 cups of blood in the body B. 3 pints of blood total C. 3 to 4 quarts of blood in the body D. 5 to 6 liters of blood throughout the body

D. 5 to 6 liters of blood throughout the body

A medical student is familiarizing herself with recent overnight admissions to an acute medical unit of a university hospital. Which client would the student recognize as least likely to have a diagnosis of antiphospholipid syndrome in his or her medical history? A. A 66-year-old obese male with left-sided hemiplegia secondary to a cerebrovascular accident B. A 90-year-old female resident of a long-term care facility who has been experiencing transient ischemic attacks C. A 30-year-old female with a diagnosis of left leg deep vein thrombosis and a pulmonary embolism D. A 21-year-old male with a diagnosis of cellulitis and suspected endocarditis secondary to intravenous drug use

D. A 21-year-old male with a diagnosis of cellulitis and suspected endocarditis secondary to intravenous drug use

In which client would diagnostic investigations be least likely to reveal increased thrombopoietin production? A. An 81-year-old woman with diagnoses of rheumatoid arthritis and failure to thrive B. A 55-year-old man with dehydration secondary to Crohn disease C. A 66-year-old woman with a diagnosis of lung cancer with bone metastases D. A 21-year-old woman awaiting bone marrow transplant for myelogenous leukemia

D. A 21-year-old woman awaiting bone marrow transplant for myelogenous leukemia

The blood work of a 44-year-old male client with a diagnosis of liver disease secondary to alcohol abuse indicates low levels of albumin. Which phenomenon would a clinician be most justified in anticipating? A. Impaired immune function B. Acid-base imbalances C. Impaired thermoregulation D. Fluid imbalances

D. Fluid imbalances

The school nurse has several children with hemophilia A. After recess, one hemophilia student comes to the school nurse complaining of pain in the knee from falling on the playground. The nurse notes there is swelling in the knee and pain on palpation. The nurse should: A. administer some NSAIDs to relieve the pain. B. wrap the knee in an ace bandage for compression. C. apply some warm compresses to the knee. D. notify parents to pick up the child and possibly administer Factor VIII.

D. notify parents to pick up the child and possibly administer Factor VIII.

When looking at a granulocyte under a microscope, the anatomy student would describe it as: A. lacking granules. B. having a kidney-shaped nucleus. C. having no nuclei. D. shaped like a sphere with multilobar nuclei.

D. shaped like a sphere with multilobar nuclei.

A geriatrician is following a number of clients on a subacute geriatric medical unit, some of whom require diagnostic blood work. Which client would be most likely to have an erythrocyte sedimentation rate (ESR) screening test ordered? An adult with: A. a diagnosis of Alzheimer disease and depression. B. orthostatic hypotension and syncopal episodes. C. congestive heart failure. D. systemic lupus erythematosus.

D. systemic lupus erythematosus.

A client arrives for a scheduled bone marrow aspiration and biopsy. The nurse explains to the client that which position(s) is best for accessing the posterior iliac crest for aspiration? Select all that apply. A. Supine B. Lateral decubitus C. Prone D. Trendelenburg E. Legs extended

B. Lateral decubitus C. Prone

A 30-year-old woman who has given birth 12 hours prior is displaying signs and symptoms of disseminated intravascular coagulation (DIC). The client's husband is confused as to why a disease of coagulation can result in bleeding. Which statement by the nurse best characterizes DIC? A. "So much clotting takes place that there are no available clotting components left, and bleeding ensues." B. "Massive clotting causes irritation, friction, and bleeding in the small blood vessels." C. "Excessive activation of clotting causes an overload of vital organs, resulting in bleeding." D. "These same hormones and bacteria that cause clotting also cause bleeding."

A. "So much clotting takes place that there are no available clotting components left, and bleeding ensues."

After assessment, the nurse asks how long the client has had red, pinpoint hemorrhages on the lower legs. The client responds, "This is the first time I have noticed this. What is wrong with me that is causing these small hemorrhages?" Which response by the nurse is most accurate? A. "These hemorrhages are called petechiae and occur when platelets are deficit." B. "More than likely, you bumped something and these are a result of trauma to the vessel." C. "Your platelets are developing a deformity as they are being produced by the bone marrow." D. "You might have a pooling of all your platelets in the spleen. I will assess for that next."

A. "These hemorrhages are called petechiae and occur when platelets are deficit."

A child with leukemia hears the health care provider tell the parents that the child has "pancytopenia." This child asks the nurse, "What does 'pancy' mean? Am I going to die?" Which response by the nurse is most appropriate for this 10-year-old child? A. "This means the chemotherapy has lowered your blood counts including red blood cells, white blood cells and platelets. You are very sick, but we are working hard to make you healthy again." B. "This means the chemotherapy is attacking your bone marrow and your body has to find a way to fight back. No, you are not going to die." C. "This is very serious and could possibly lead to death if you start bleeding badly." D. "This is just a way of saying that you are sick and need to rest more.Your medicine is fighting your cancer cells so that you will not die."

A. "This means the chemotherapy has lowered your blood counts including red blood cells, white blood cells and platelets. You are very sick, but we are working hard to make you healthy again."

A client with severe anemia asks, "What happens if my bone marrow cannot produce sufficient numbers of red blood cells due to my bleeding?" Which response(s) by the nurse correctly identifies the organs that can resume hematopoiesis? Select all that apply. A. Kidneys B. Liver C. Pancreas D. Spleen E. Gall bladder

B. Liver D. Spleen

Which clients would be at risk for developing nonthrombocytopenic purpura? Select all that apply. A. Child adopted from India and displaying malaise, lethargy, and petechiae all over the body associated with suspected scurvy. B. 73-year-old client admitted with concussion that resulted from a fall C. 55-year-old client diagnosed with Cushing disease displaying bruises, weight gain with a buffalo hump, and "moon" face D. 15-year-old with insulin-dependent diabetes who has hypoglycemia and is displaying irritability with headaches and tachycardia E. Pregnant mother experiencing headaches and proteinuria

A. Child adopted from India and displaying malaise, lethargy, and petechiae all over the body associated with suspected scurvy. C. 55-year-old client diagnosed with Cushing disease displaying bruises, weight gain with a buffalo hump, and "moon" face

During science class, a student asks, "What is the difference between plasma and serum in the blood?" The nurse responds that the primary difference between plasma and serum is that plasma contains: A. Fibrinogen B. Heparin C. White blood cells D. Hydrogen ions

A. Fibrinogen

The health care provider is ordering a complete blood count (CBC). What information should the nurse expect to be able to gather from the results? Select all that apply. A. If the client has anemia B. The presence of leukocytosis C. If the client is deficient in clotting factors D. If there are common vitamin deficiencies E. Presence of thrombocytopenia

A. If the client has anemia B. The presence of leukocytosis E. Presence of thrombocytopenia

Following a course of measles, a 5-year-old girl developed scattered bruising over numerous body surfaces and was diagnosed with immune thrombocytopenic purpura (ITP). As part of her diagnostic workup, blood work was performed. Which result is most likely to be considered unexpected by the health care team? A. Increased thrombopoietin levels B. Decreased platelet count C. Normal vitamin K levels D. Normal leukocyte levels

A. Increased thrombopoietin levels

Misinterpreting her physician's instructions, a 69-year-old woman with a history of peripheral artery disease has been taking two 325 mg tablets of aspirin daily. How has this most likely affected her hemostatic status? A. Irreversible acetylation of platelet cyclooxygenase activity has occurred. B. The client's prostaglandin TXA2 levels are abnormally high. C. She is at risk of developing secondary immune thrombocytopenic purpura (ITP). D. The binding of an antibody to platelet factor 4 produces immune complexes.

A. Irreversible acetylation of platelet cyclooxygenase activity has occurred.

An adult female, newly diagnosed with possible leukemia, arrives for a bone marrow biopsy. The admission laboratory work includes: red blood cell count (RBC): 3.4 ×106 /μL (3.4 ×1012/L); white blood cell count (WBC): 2,500/μL (2.5 ×109 /L); platelet count of 80 ×103 /μL (80 ×109 /L); all below normal values. What assessment is the highest priority for this client? A. Monitoring for any type of bleeding. B. Forcing fluids to maintain renal function. C. Checking breath sounds twice a day for signs of pneumonia. D. Assessing heart sounds for any new murmurs.

A. Monitoring for any type of bleeding.

Following an injury resulting in a small cut from a knife, the first cells to go to the area of the cut would be the: A. Neutrophils B. Erythrocytes C. Albumin D. Basophils

A. Neutrophils

When discussing the sequence of clot dissolution, the science instructor will talk about which item that begins the process? A. Plasminogen B. Dabigatran C. Platelets D. α2-plasmin inhibitor

A. Plasminogen

A 71-year-old male client with a history of myocardial infarction (MI) and peripheral vascular disease (PVD) has been advised by his family physician to begin taking 81 mg aspirin once daily. Which statement best captures an aspect of the underlying rationale for the physician's suggestion? A. Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin. B. Aspirin helps to inhibit ADP action and minimizes platelet plug formation. C. Aspirin can reduce unwanted platelet adhesion by inhibiting TXA2 synthesis. D. Aspirin inhibits the conversion of fibrinogen into fibrin and consequent platelet plug formation.

A. Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin.

A 29-year-old construction worker got a sliver under his fingernail 4 days ago. The affected finger is now reddened, painful, swollen, and warm to the touch. Which of the following hematologic processes is most likely occurring in the bone marrow in response to the infection? A. Proliferation of immature neutrophils B. High circulatory levels of myeloblasts C. Increased segmented neutrophil production D. Phagocytosis by myelocytes

A. Proliferation of immature neutrophils

A hospital laboratory technician performing routine blood analysis as part of an inpatient's assessment is examining the sample in a test tube following processing in a centrifuge and the addition of an anticoagulant. Which observation would the technician most likely interpret as an anomaly? A. The bottom layer of blood in the tube accounts for around 40% to 45% of the total volume. B. The middle layer of cells appears white to grey in color. C. The top layer of cells is too thin to visualize without microscopy. D. The yellowish fluid on the top of the sample appears to constitute around one- quarter of the total volume.

A. The bottom layer of blood in the tube accounts for around 40% to 45% of the total volume.

A client with leukemia begins hemorrhaging from every orifice. The physician is concerned that the client has developed disseminated intravascular coagulation (DIC). The nurse should anticipate which order to be prescribed for this client? Select all that apply. A. Transfuse 2 units of platelets. B. Transfuse fresh frozen plasma. C. Give aspirin twice/day. D. Administer IV ketorolac STAT. E. Place in reverse isolation.

A. Transfuse 2 units of platelets. B. Transfuse fresh frozen plasma.

The nurse is collecting a blood sample for an ordered CBC. The required tube contains EDTA so the nurse will: A. invert the tube several times to prevent the blood from coagulating. B. place the tube immediately on ice to preserve the action of the EDTA on the sample. C. Invert the tube several times to promote clotting so serum can be fully separated. D. Avoid inverting the tube to prevent hemolysis, which could affect the accuracy of the results.

A. invert the tube several times to prevent the blood from coagulating.

The nurse is caring for a client who has been on an oral corticosteroid for several years for an autoimmune condition. The nurse notes several bruises of different stages of resolution on the client. What is the nurse's best response to this finding? A. Request an order for vitamin K to prevent life-threatening hemorrhage. B. Interview the client regarding side effects of corticosteroid therapy. C. Obtain a STAT order for repeat platelet count and international normalized ratio (INR). D. Complete a thorough pain assessment related to the bruising.

B. Interview the client regarding side effects of corticosteroid therapy.

A student makes the statement to a colleague, "Blood plasma is essentially just a carrier for the formed cells like red blood cells and white blood cells." What would be the most accurate response to this statement? A. "That's not really true. Plasma is crucial in the immune and inflammatory responses." B. "Actually, plasma plays a significant role in nutrient and waste transport." C. "Not really. Plasma also contributes to the processes of protein synthesis and hematopoiesis." D. "Actually, plasma is integral to the proper function of the liver and maintenance of acid-base balance."

B. "Actually, plasma plays a significant role in nutrient and waste transport."

A blood sample is ordered to be collected in a plasma-separator tube, but the nurse can only find serum-separator tubes available. The nurse should be most concerned about the accuracy of which results if the serum-separator tube is used? A. Albumin and total protein levels B. Fibrinogen and clotting factor levels C. Immunoglobulin analysis D. Electrolyte measurements

B. Fibrinogen and clotting factor levels

While being on subcutaneous heparin injections for deep vein thrombosis during the third trimester of her pregnancy, a client begins to experience major side effects. Her OB physician has called in a specialist who thinks the client is experiencing heparin-induced thrombocytopenia. The nurse should anticipate which order? A. Order to decrease the dose of heparin from 5000 units bid to 3000 units bid. B. Immediately discontinue the heparin therapy. C. A switch to warfarin 2.5 mg once/day. D. Infusion of FFP stat.

B. Immediately discontinue the heparin therapy.

Two nursing students are attempting to differentiate between the presentations of immune thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP). Which of the students' statements best captures an aspect of the two health problems? A. "Both diseases can result from inadequate production of thrombopoietin by megakaryocytes. B. "ITP can be either inherited or acquired, and if it's acquired, it involves an enzyme deficiency." C. "Both of them involve low platelet counts, but in TTP there can be more, not less, hemostasis. D. "TTP can be treated with plasmapheresis, but ITP is best addressed with transfusion of fresh frozen plasma."

C. "Both of them involve low platelet counts, but in TTP there can be more, not less, hemostasis.

Which teaching point would be most appropriate with a client who has a recent diagnosis of Von Willebrand disease? A. "It's important that you avoid trauma." B. "Your disease affects your platelet function rather than clot formation." C. "Make sure that you avoid taking aspirin." D. "Clotting factor VIII can help your body compensate for the difficulty in clotting."

C. "Make sure that you avoid taking aspirin."

A surgeon is explaining to the parents of a 6-year-old boy the rationale for the suggestion of removing the boy's spleen. Which teaching point would be most accurate? A. "We believe that your son's spleen is causing the destruction of many of his blood platelets, putting him at a bleeding risk." B. "Your son's spleen is inappropriately destroying the platelets from his blood and needs to be removed." C. "Your son's spleen is holding on to too many of his platelets so they're not available for clotting." D. "We think that his spleen is inhibiting the production of platelets by his bone marrow."

C. "Your son's spleen is holding on to too many of his platelets so they're not available for clotting."

The nurse is counseling a client who is going for major surgery and must stop taking aspirin to reduce the risk for bleeding. The nurse knows aspirin decreases platelet activity for the duration of the platelet's lifespan. How many days prior to the surgery should the nurse tell the client to stop taking aspirin? A. 2 B. 5 C. 10 D. 14

C. 10

When talking about the various types of granulocytes, which granule contains heparin, an anticoagulant? A. Neutrophils. B. Eosinophils. C. Basophils. D. Lymphocytes.

C. Basophils.