Complete Chapter 21/25 Blood Cells and the Hematopoietic System

List the elements of the hematopoietic system

1. All blood cells and their precursors 2. Bone marrow 3. Lymphoid tissues

Blood type B has what antigen and what antibodies?

1. Antigen B 2. Antibody anti-A

List the two types of agranulocytes

1. Lymphocytes 2. Monocytes

A nurse on an oncology floor is treating a client who is anemic following chemotherapy. The drugs being administered are designed to increase the number of red blood cells in circulation. These drugs are likely agonists of: trophic hormones. lymphokines. secondary hormones. cytokines.

cytokines. Explanation: RBC production is directed by cytokines and growth factors. Lymphokines are used for communication between lymphocytes, and trophic and secondary hormones are too broad an answer to this question.

What are the three pathways of coagulation?

extrinsic, intrinsic, common

When red blood cells age, which of the following organs are responsible for their destruction?

Spleen Explanation: When red blood cells age, they are destroyed in the spleen

What are the two categories of WBCs?

1. Granulocytes 2. Agranulocytes

Trace the lineage of monocytes, eosinophils, neutrophils, basophils, platelets and erythrocytes

1. Pluripotent stem cells 2. Myeloid stem cell

List all the cells that stem from lymphoid cells

1. T-cells 2. B-cells 3. NK cells

Define hematopoiesis

Formation of blood cells

A nurse is assessing a patient presenting with symptoms of fatigue, fever, severe joint pain, and headache. Laboratory results reveal an erythrocyte sedimentation rate (ESR) rate of 60 mm/hour. The patient asks what the blood test results mean. Which of the following is the most appropriate explanation for the nurse to provide? "The ESR tests for the presence of inflammation in the body." "Your ESR is high; this means you have an inflammatory disease." "I will ask your doctor to explain what the ESR test is used for." "The ESR tests for the presence of white blood cells in your body which can indicate an infection."

"The ESR tests for the presence of inflammation in the body." Explanation: In anticoagulated blood, red blood cells aggregate and are deposited to the bottom of a tube. The rate of fall is often increased in inflammatory diseases. Normal values are 0-15 mm/hour for men and 1-20 mm/hour for women. Increased sedimentation rate indicates inflammation and is used as a baseline and trend indicator in managing inflammatory disorders. The nurse can explain the purpose of the test but cannot medically diagnose a patient.

Blood type A has what antigens and what antibodies?

1. Antigen A 2. Antibody anti-B

Blood type AB has what antigen and what antibodies?

1. Antigen A and B 2. no antibodies

List the disorders of hematopoietic stem cells

1. Apiastic anemia: multipotent stem cells fail to grow and provide cells for differentiation 2. Pancytopenia: reduction in the number of all blood cell types 3. Leukopenia: too few WBCs, can indicate AIDS or bone marrow failure 4. Polycythemia: unregulated overproduction of red blood cells 5. Thrombocytosis: bone marrow produces too many thrombocytes 6. Leukemias: rep a spectrum of diseases characterized by an abnormal proliferatio of WBCs 7. Leukocytosis: too many WBCs can by due to infection, allergies, stress or cancer

What are the three types of lymphocytes and what are their functions?

1. B- lymphocytes make antibodies (adaptive immunity) 2. T - lymphocytes fight infection/cancer cells(adaptive immunity) 3. NK cells - cells of innate immunity

List the steps of an instrinsic path

1. Blood trauma (damaged endothelial cells and platelets) 2. Factor 12 is activated or Activated platelets form platelet phospholipids 3. Addition of calcium which activated factor 5 and 10 4. Production of prothrombinase 5. Transition into common path

List the steps of a common pathway

1. Calcium separates prothrombin into thrombin 2. Thrombrin activates calcium to form fibrinogen and activates factor to strengthen fibrin threads

Where does hematopoiesis originate in children? adults?

1. Children: Red marrow of long bones 2. Adults: Red marrow of pelvis, ribs and sternum

What is the structure and function of macrophages?

1. Dark stained nucleus in shape of a kidney 2. Role in chronic inflammation 3. Role in immune response by activating lymphocytes and presenting antigen to T-cells 4. Surround infected area and fuse together forming a granuloma

How is clotting prevented in blood vessels?

1. Endothelium makes Prostacyclin(PGI2) and Nitric Oxide(NO) for vasodilation and inhibition in platelet aggregation 2. Endothelium makes CD39 which breaks down ADP to AMP which also prevents platelet aggregation

List and define the hematopoetic growth factors

1. Erythropoietin(EPO): hormone produced by kidneys and stimulates synthesis of RBC 2. Thrombopoietin(TPO): hormone produced by liver and kidney and stimulates synthesis of platelets 3. Granulocyte-Colony Stimulating Factor(GCSF): cytokine that stimulates production of neutrophils 4. Granulocyte Monocyte-Colony Stimulating Factor(GM-CSF): cytokine that stimulates production of granulocytes and monocytes

What is the structure and function of basophils?

1. Involved in allergic and hypersensitivity reactions 2. Consists of heparin, histamine(vasodilator) and other mediators of inflammation 3. Dark blue granules that overshadow nucleus

What percentage of WBCs are lymphocytes? macrophages?

1. Lymphocytes = 20-30% 2. Macrophages = 3-8%

What happens in hemolytic disease of newborn and how is it treated?

1. Mom is RH- and baby is RH+. 2. Mom produces antibodies to RH factor during delivery 3. Mom gets pregnant again and baby is RH+ 4. RH antibodies of mom begin to attach blood of baby causing hemolysis 5. Mom is given rhogam which is an antibody that destroys RH+ cells in baby

What is the structure and function of lymphocytes?

1. Nucleus occupies most of cell 2. Function in lymph nodes or spleen to defend against microorganisms through immune response

What are the steps in platelet plug formation (step 2 of hemostasis)?

1. Platelet adhesion - Von Willebrand factor allows platelets to stick to damaged blood vessels 2. Platelet release reaction - release ADP and thromboxane A2 to activate other platelets(positive feedback) and serotonin and thromboxane A2 to cause vasoconstriction 3. Platelet aggregaton - ADP release makes platelets sticky

List the steps of an extrinsic path

1. Tissue trauma 2. Tissue factor 3. Addition of calcium which activates factor 5 and 10 4. Production of prothrombinase 5. Transition into common path

Describe the process of blood typing

1. drop of blood mixed with anti serum 2. agglutination indicates blood type

List the disorders of blood clotting

1. genetic (hemophilia A - factor 7 deficient/ hemophilia B - factor 9 deficient) 2. Embolisms - dislodged thrombus

Blood type O has what antigen and what antibodies?

1. no antigens 2. Antibodies anti-A and anti-B

What is the function and life span of red blood cells

Function: Carry oxygen to body's tissues Life Span: 120 days

The leukemia most commonly found in children and adolescents is recognized as: Acute myeloid leukemia (AML) Acute lymphocytic leukemia (ALL) Chronic lymphocytic leukemia (CLL) Chronic myelocytic leukemia (CML)

Acute lymphocytic leukemia (ALL) Explanation: Among children and adolescents, ALL is the most common type, accounting for 75% of leukemia cases. In adults 20 years of age and older, the most common types are CLL (38%) and AML (30%).

A patient comes to the clinic with a runny nose and scratchy throat. The nurse is evaluating the white blood cell count, which shows an elevated number of white blood cells and an increased percentage of eosinophils. Which of the following is the most likely cause of the symptoms? Allergic reaction Viral infection Fungal infection Bacterial infection

Allergic reaction Explanation: Eosinophils increase in number during allergic reactions and parasitic infections.

The globulins that make up part of the plasma of the blood have three distinct purposes. What are the gamma globulins? Antibodies of the immune system Transporters of iron and copper Transporters of bilirubin and steroids Autoantibodies of the immune system

Antibodies of the immune system Explanation: There are three types of globulins: the alpha globulins that transport bilirubin and steroids, the beta globulins that transport iron and copper, and the gamma globulins that constitute the antibodies of the immune system. Alpha globulins transport bilirubin and steroids. Beta globulins transport iron and copper. Autoantibodies are immunoglobulins that recognize an antigen on that person's own tissue.

The nurse is reviewing the laboratory results of a newborn. The infant has anemia, thrombocytopenia, and granulocytopenia (pancytopenia). Based on these results, the nurse anticipates the diagnosis of which type of anemia? Aplastic anemia Hemolytic anemia Sickle cell anemia Iron deficiency anemia

Aplastic anemia Explanation: Aplastic anemia develops when the multipotent stem cells fail to grow and provide cells for differentiation. The result is concomitant anemia, thrombocytopenia, and granulocytopenia (pancytopenia).

The cloning of the genes for most of the hematopoietic growth factors has been accomplished. The recombinant proteins that are produced are used in a wide range of clinical problems. What diseases have these proteins been used to fight? AIDS and autoimmune disorders Aplastic anemia and the anemia of kidney failure Anemia of cancer and Parkinson disease Aplastic anemia and the anemia of Huntington disease

Aplastic anemia and the anemia of kidney failure Explanation: The genes for most hematopoietic growth factors have been cloned, and their recombinant proteins have been generated for use in a wide range of clinical problems. They are used to treat bone marrow failure caused by chemotherapy or aplastic anemia, the anemia of kidney failure and cancer, hematopoietic neoplasms, infectious diseases such as AIDS, and congenital and myeloproliferative disorders. Autoimmune disorders, Parkinson disease, and Huntington disease are not anemic disorders, so the recombinant proteins have not been used in the treatment of these diseases.

A client asks, "What do these basophils and mast cells do in the body?" The health care provider responds that they: Are involved when you have an allergic reaction Stiffen your cell membranes so bacteria cannot enter Help your body to eliminate parasitic infections Help your body produce immune responses

Are involved when you have an allergic reaction Explanation: The basophil, which is a blood cell, is related to the connective tissue mast cell that contains similar granules. Both the basophils and mast cells are thought to be involved in allergic and hypersensitivity reactions. These cells do not stiffen the cell membranes. In parasitic infections, the eosinophils use surface markers to attach themselves to the parasite and then release hydrolytic enzymes that kill it. Lymphocytes migrate through the peripheral lymphoid organs, where they recognize antigens and participate in immune responses.

Which of the following types of lymphocyte is involved with humoral-mediated immunity? Helper T cells T lymphocytes B lymphocytes Natural killer cells (NKC)

B lymphocytes Explanation: B lymphocytes differentiate to form antibody-producing plasma cells and are involved in humoral-mediated immunity. T lymphocytes (helper T cells) activate other cells in the immune system and are involved in cell-mediated immunity. NKCs participate in innate or natural immunity.

A patient comes to the clinic following exposure to chicken pox. The patient states he had chicken pox as a child but was worried about getting sick again. Which of the following statements best explains humoral-mediated immunity to the patient? The body has natural immunity to prevent active diseases from occurring following expose to a pathogen. B lymphocytes (B cells) in the body produce antibodies to fight infections. Once exposed, the cells retain memory and are able to quickly fight off pathogens during re-exposure and prevent the disease from reoccurring. T cells in the body are natural killer cells that quickly attack and kill antigens in order to prevent infections. Monocytes in the body are activated in the presence of pathogens. They quickly engulf and destroy invading organisms, preventing infections from occurring.

B lymphocytes (B cells) in the body produce antibodies to fight infections. Once exposed, the cells retain memory and are able to quickly fight off pathogens during re-exposure and prevent the disease from reoccurring. Explanation: The B lymphocytes (B cells) differentiate to form antibody-producing plasma cells that retain memory and are involved in humoral-mediated immunity.

Which of the following types of white blood cells are related to the connective tissue mast cells and respond in allergic and hypersensitivity reactions? B lymphocytes Granulocytes Neutrophils Basophils

Basophils Explanation: The basophil is related to connective tissue mast cell because they contain similar granules and are believed to be involved in allergic and hypersensitivity reactions. Neutrophils, granulocytes, and B lymphocytes are not identified as being similar to mast cells.

A client presents to the emergency clinic not feeling well. Which of the following complaints leads the health care provider to suspect the client may have acute leukemia? Frequent nausea and vomiting for past week Bleeding from the gums, not related to brushing the teeth Muscle aches and pains in large muscle groups, especially while lying in bed Severe headache with associated photophobia

Bleeding from the gums, not related to brushing the teeth Explanation: Although ALL and AML are distinct disorders, they typically present with similar clinical features. Both are characterized by an abrupt onset of symptoms, including fatigue resulting from anemia; low-grade fever, night sweats, and weight loss due to the rapid proliferation and hypermetabolism of the leukemic cells; bleeding due to a decreased platelet count; and bone pain and tenderness due to bone marrow expansion. Nausea and vomiting, muscle aches, and headaches could be associated with other diagnoses like influenza.

Select the option that best describes the production of T lymphocytes. Bone marrow - thymus - lymph nodes Bone marrow - plasma cells - lymph nodes Plasma cells - lymph nodes - arteries Myocardial tissue - bone marrow - lymph nodes

Bone marrow - thymus - lymph nodes Explanation: T lymphocytes leave the bone marrow as precursor T lymphocytes and travel to the thymus, where they differentiate into CD4 helper T cells and CD8 cytotoxic T cells. T lymphocytes also travel to the lymph nodes. The first option describes the production of B lymphocytes. The other options do not describe B- or T-lymphocyte production.

T-cell lymphocytes leave the bone marrow and travel to the thymus. If successful, they differentiate into which of the following cells? Select all that apply. Epstein-Barr virus (EBV) CD8+ cytotoxic T cells CD4+ helper T cells Kupffer cells Hematopoietic stem cell

CD4+ helper T cells CD8+ cytotoxic T cells Explanation: The body's lymphatic system consists of the lymphatic vessels, lymphoid tissue, and lymph nodes, thymus, and spleen. T lymphocytes leave the bone marrow as precursor T lymphocytes travel to the thymus, where they differentiate into CD4+ helper T cells and CD8+ cytotoxic T cells, after which many of them move to lymph nodes, where they undergo further proliferation. Infectious mononucleosis is a self-limiting lymphoproliferative disorder caused by the Epstein-Barr virus (EBV), a member of the herpesvirus family. Kupffer cells of the liver are not a component of the lymphatic system. The human T-cell lymphotropic virus (HTLV-1), which is endemic in the southwestern islands of Japan, has been associated with adult T-cell leukemia/lymphoma.

What do patients with acute lymphocytic leukemia (ALL) involving the brain or spinal cord usually receive? CNS prophylaxis Induction therapy Consolidation therapy Maintenance therapy

CNS prophylaxis Explanation: CNS prophylaxis involves high doses of chemotherapeutic agents or cranial irradiation.

A client has a lymphoma that carries a risk of CNS involvement. The nurse anticipates the health care provider will prescribe: CNS prophylaxis Antibiotic therapy Antiseizure therapy Antiviral prophylaxis

CNS prophylaxis Explanation: Persons with lymphomas that carry a risk of CNS involvement usually receive CNS prophylaxis with high doses of chemotherapeutic agents or cranial irradiation. The other options would not benefit the client.

What ion plays an important role in clotting?

Ca 2+

The nurse's review of a client's laboratory results indicates that inflammation is absent and platelet levels are low. Which test was performed to provide the platelet count? Bone marrow aspiration Hematocrit Sedimentation rate Complete blood count

Complete blood count Explanation: The complete blood count provides the number and characteristics of red blood cells, leukocytes, and platelets. Hematocrit is simply the percentage of RBCs and sedimentation rate indicates inflammation. Bone marrow aspiration is used to examine the stem cells.

Describe the composition of plasma

Composition: 90% water, 6.5 to 8% proteins, and 2% other small molecular substances

Although the usual site for a bone marrow test is the posterior iliac crest, other sites include the anterior iliac crest and the sternum. What are the dangers of using the sternum for a bone marrow test in children? Potential for hemorrhage Danger of perforating the mediastinum and heart Potential for infection in the chest cavity ' Danger of perforating the lungs

Danger of perforating the mediastinum and heart Explanation: Usually, the posterior iliac crest is used in all persons older than 12 to 18 months of age. Other sites include the anterior iliac crest, sternum, and spinous processes T10 through L4. The sternum is not commonly used in children because the cavity is too shallow, and there is danger of mediastinal and cardiac perforation.

Cytokines that affect hematopoiesis in bone marrow are called colony-stimulating factors (CSFs) based on their ability to: Differentiate red cells Regulate blood cells Support lymphocytes Stimulate lymphocytes

Regulate blood cells Explanation: CSFs stimulate and regulate the growth of hematopoietic cell colonies from bone marrow precursors. Interleukins support the development of lymphocytes. CSFs do not have a role in differentiation. Lymphocyte stimulation occurs in the lymphoid tissues.

What are the components of blood? (Select all that apply.) Electrolytes Enzymes Ascites Bile

Electrolytes Enzymes Explanation: Blood is made up of plasma, plasma proteins, fixed elements or blood cells, and substances such as hormones, enzymes, electrolytes, and by-products of cellular waste. Ascites is an accumulation of intraperitoneal fluid containing large amounts of protein and electrolytes. Bile is a secretion of the liver that is stored in the gallbladder.

A nurse is evaluating laboratory results of a patient diagnosed with a parasitic infection. The tests reveal a large group of cells that are membrane bound with granules in their cytoplasm that are aiding in the destruction of the parasite. Which of the following cells is the nurse evaluating? Monocyte Lymphocyte Macrophage Eosinophil

Eosinophil Explanation: People who have helminthic parasites will have an increase in eosinophils in their complete blood count. The specific cytoplasmic granules of the eosinophils stain red with the acidic dye eosin. In parasitic infections, the eosinophils use surface markers to attach themselves to the parasite and then release hydrolytic enzymes that kill it.

Leukocytes consist of three categories of cells that have different roles in the inflammatory and immune responses. Which of the following leukocytes is correctly matched with its function? Monocytes—release heparin Eosinophils—allergic reactions Lymphocyte—phagocytosis Basophils—engulf antigens

Eosinophils—allergic reactions Explanation: Eosinophils, a type of granulocyte, increase in number during allergic reactions. Lymphocytes (agranulocytes) consist of three cell types that are not phagocytes but do have an important role in the immune response. Basophils and mast cells release heparin and histamine in response to allergens. Monocytes and macrophages are phagocytes that engulf antigens.

A client with acute leukemia has developed gout. The nurse is aware that this results from: Hyperuricemia Diet Alcohol Anorexia

Hyperuricemia Explanation: Hyperuricemia occurs as the result of increased proliferation or increased breakdown of purine nucleotides secondary to leukemic cell death that results from chemotherapy. It may increase before and during treatment. Prophylactic therapy with allopurinol, a drug that inhibits uric acid synthesis, is routinely administered. Diet will contribute to gout.

A patient being treated for polymyalgia rheumatica (PMR) comes to the clinic for a follow-up visit. The current erythrocyte sedimentation rate (ESR) rate has decreased from 60 mm/hour to 30 mm/hour and the patient is afebrile, denies any headaches, and reports a decrease in joint pain and fatigue. Based on these findings, the nurse anticipates which of the following changes to the treatment plan? Gradually decrease the current dosage of prednisone and repeat ESR in 2 weeks. No change of treatment; continue to monitor the patient with a follow-up visit in 1 month. Discontinue the current prednisone prescription and start an anti-inflammatory drug such as naproxen. Repeat ESR in 2weeks. The patient is cured, and no further treatment is necessary.

Gradually decrease the current dosage of prednisone and repeat ESR in 2 weeks. Explanation: The ESR is a screening test for monitoring the fluctuations in the clinical course of a disease such as PMR. Symptoms of this inflammatory disorder include fatigue, fever, pain, and headache, which are all a result of the systemic effects of cytokine release. An individual who is diagnosed with PMR will have an initial ESR drawn. If the ESR is >60, the person is diagnosed with a severe PMR. Generally, the person is prescribed prednisone, and then at follow-up visits, the dose of prednisone will be gradually decreased depending on the ESR and the person's symptoms.

A patient who has received chemotherapy has a steadily decreasing white blood cell count. The nurse anticipates administering which of the following to increase the neutrophil count? Mmacrophage colony-stimulating factor Thrombopoietin Erythropoietin Granulocyte colony-stimulating factor

Granulocyte colony-stimulating factor Explanation: Administration of granulocyte colony-stimulating factor promotes the proliferation of all neutrophils.

Which of the following is the main job of lymphocytes? Degranulation Phagocytosis Immune reaction Apoptosis

Immune reaction Explanation: Immune reaction is the main job of lymphocytes.

A patient is admitted to the emergency department with a diagnosis of polycythemia. The nurse plans to assess for symptoms related to which of the following problems? Increased risk of infection Inability to form blood clots Increased blood viscosity Decreased ability to carry oxygen to the cells

Increased blood viscosity Explanation: Unregulated overproduction of the red cell mass is termed polycythemia, which causes a thickening of the blood and an increased risk of blood clots.

A nurse observes a thin gray line between the red blood cells and the plasma in a centrifuged sample of blood. What is the nurse's best understanding of this phenomenon? It is the location of the white blood cells are in a spun sample. It is the border between RBCs and plasma in a spun sample. The line is the location of proteins in a spun sample. The line consists of hemolysed RBCs.

It is the location of the white blood cells are in a spun sample. Explanation: The buffy coat or thin gray line between the plasma and packed RBCs is the layer where WBCs reside in a spun sample (and is why they are called white blood cells). There is no blurry border between the layers in a spun sample. Proteins will not be visible and will not precipitate at the velocity a blood sample would be spun.

Which type of macrophages are found in the liver? Histiocytes Kupffer cells Microglial cells Monocytes

Kupffer cells Explanation: Rationale: Macrophages found in the liver are known as Kupffer cells. Histiocytes are macrophages found loose in connective tissue, and microglial cells are brain macrophages. Monocytes are referred to macrophages when they enter the tissues.

A 16-year-old girl has been brought to her primary care provider by her mother due to the daughter's recent malaise and lethargy. Which of the following assessments should the clinician perform in an effort to confirm or rule out infectious mononucleosis? Auscultating the client's lungs Palpating the client's lymph nodes Assessing the client's cranial nerve reflexes Assessing the client for bone pain

Palpating the client's lymph nodes Explanation: In cases of infectious mononucleosis, the lymph nodes are typically enlarged throughout the body, particularly in the cervical, axillary, and groin areas. Palpation of these nodes is a priority assessment in cases of suspected mononucleosis. Bone pain, adventitious lungs sounds, and abnormal cranial nerve reflexes do not accompany mononucleosis.

Which of the following is the most common leukocyte in normal blood? Neutrophilic granulocyte Lymphocyte Monocyte Platelet

Neutrophilic granulocyte Explanation: Neutrophilic granulocyte is the most common leukocyte in normal blood.

A nurse sends a blood sample to the lab for analysis. Assuming the sample is normal, the nurse anticipates which of the following white blood cells (WBCs) will account for the highest percentage? Neutrophils Eosinophils Monocytes Lymphocytes

Neutrophils Explanation: Neutrophils constitute 55-65% of the total WBCs.

A patient is admitted to the hospital with an elevated temperature and flank pain. When reviewing the complete blood count (CBC), which of the following levels is the most important for the nurse to communicate to the health care provider? Neutrophils 85% Hemoglobin 12.6 g/dL Platelets 150,000/mL Monocytes 3%

Neutrophils 85% Explanation: Neutrophils are very mobile and are the first cells to go to an area of tissue damage. The elevation in neutrophils indicates that the patient has an acute infection (such as pyelonephritis) that is causing the temperature elevation and flank pain.

A nurse is reviewing a client's complete blood count (CBC) which indicates thrombocytopenia. Based on this result which action should the nurse include in the plan of care? Place the client on bleeding precautions. Encourage increased oral fluids. Place the client on contact isolation. Increase intake of iron-rich foods.

Place the client on bleeding precautions. Explanation: Thrombocytopenia is a decreased number of platelets, which places the patient at high risk for bleeding.

The nurse is caring for a client with leukemia that is having difficulty with blood clotting after having several transfusions with packed red blood cells. What does the nurse anticipate infusing for this client to assist with controlling the bleeding? Whole blood Platelets Ringers Lactate solution Albumin

Platelets Explanation: Thrombocytes, or platelets, are circulating cell fragments of the large megakaryocytes that are derived from the myeloid stem cell. They function to form the platelet plug to help control bleeding after injury to a vessel wall. Their cytoplasmic granules release mediators required for the blood coagulation process. Thrombocytes have a membrane but no nucleus, cannot replicate, and, if not used, last approximately 10 days in the circulation before the phagocytic cells of the spleen remove them.

Which of the following anatomical sites would the nurse expect to monitor when caring for an adult patient who has just had a bone marrow aspiration performed?

Posterior iliac crest

Chronic leukemias are malignancies involving what type of abnormal blood cells in the marrow? Production of undifferentiated cells Proliferation of well-differentiated cells Uncontrolled growth of immature cells Replication of pluripotent precursor cells

Proliferation of well-differentiated cells Explanation: Chronic leukemias involve abnormal proliferation and growth of well-differentiated blood cell types. Acute leukemias are associated with proliferation of undifferentiated, immature, and precursor blood cells.

A 26-year-old female client has a neutrophil count of less than 500mL. The nurse would interpret this as: Severe neutropenia Moderate neutropenia Mild neutropenia Normal neutrophil count

Severe neutropenia Explanation: A moderate neutropenia diagnosis would be consistent with a count of 500 to 1000 mL. Normal count would be 5000 to 10,000 mL. Mild neutropenia would be 1000 mL and severe neutropenia at less than 500 mL.

A client diagnosed with pancytopenia due to aplastic anemia is scheduled for which of the following treatments that can correct bone marrow deficiencies? Whole blood transfusion Complete blood count (CBC) Stem cell transplant Bone marrow biopsy

Stem cell transplant Explanation: Aplastic anemia develops when the multipotent stem cells fail to grow and provide cells for differentiation. The result is concomitant anemia, thrombocytopenia, and granulocytopenia (pancytopenia). Potential cures for these and many other disorders use hematopoietic stem cells as part of the treatment. Stem cell transplants focus on correcting bone marrow failure, immunodeficiencies, hematologic defects and malignancies, and inherited errors of metabolism.

A patient is diagnosed with acute leukemia. Which of the following treatment therapies can be used to correct bone marrow failure and treat malignancies? Chemotherapy Radiation therapy Immunotherapy Stem cell transplant

Stem cell transplant Explanation: Many people with leukemia obtain stem cell transplants that greatly impact their ability to have a remission. Stem cell transplants focus on correcting bone marrow failure, immunodeficiencies, hematologic defects and malignancies, and inherited errors of metabolism.

How are hematopoietic cell diseases treated?

Stem cell transplantation through autologous or allogeneic

What are the steps of hemostasis?

Stop bleeding through 1. vascular spasm(artery constriction) 2. platelet plug formation 3. blood clotting

What vitamin is needed for clot retraction and why?

Vitamin K because it synthesizes factor 7, 9 , and 10. It's also lipid soluble which allows it to be absorbed with fats in intestine

When a white blood cell with differential count reveals an acute infection, which of the following is correct regarding the client's neutrophils? Neutrophils are not present during an acute infection that produces fever. Neutrophils are the first white blood cell to elevate in an acute infection. There are fewer neutrophils in the blood than other white blood cells. Neutrophils are only responsive in an allergic or parasitic infection.

There are fewer neutrophils in the blood than other white blood cells. Explanation: Neutrophils constitute 55% to 65% of the total numbers of white blood cells and are primarily responsible for maintaining normal host defenses against invading fever producing bacteria and fungi, cell debris, and a variety of foreign substances. Eosinophils are white blood cells that are responsive in an allergic or parasitic infection.

A 6-year-old child is having a stem cell transplant using umbilical cord blood. What benefit does the nurse understand that this type of transplant will have for the child? There are no side effects to this type of transplant. This type of transplant does not require an inpatient stay in the hospital. The child will not have to take any form of chemotherapy. This type of transplant creates less risk of graft-versus host disease

This type of transplant creates less risk of graft-versus host disease Explanation: Umbilical cord blood from HLA-matched donors is a transplant option for children and carries less risk of graft-versus-host disease. Stem cell transplants focus on correcting bone marrow failure, immunodeficiencies, hematologic defects and malignancies, and inherited errors of metabolism. Sources of the stem cells include bone marrow and umbilical cord blood, which replenish the recipient with a normal population of pluripotent stem cells. Stem cell transplants may be derived from the client (autologous) or from a histocompatible donor (allogeneic). Autologous transplants are often used to replenish stem cells after high-dose chemotherapy or irradiation

Stem cell transplantation has been shown to provide potential cures for diseases such as aplastic anemia and the leukemias. What are the sources of stem cells used for transplant? Peripheral blood cells and immature embryonic cells Bone marrow and immature neural cells Peripheral blood and yellow bone marrow Umbilical cord blood and bone marrow

Umbilical cord blood and bone marrow Explanation: Sources of the stem cells include bone marrow and umbilical cord blood. All replenish the recipient with a normal population of pluripotent stem cells. Immature embryonic cells do not necessarily contain stem cells. Immature neural cells are not stem cells. Yellow bone marrow does not make blood cells, so it would not contain stem cells.

A nurse is reviewing laboratory data for an elderly patient. Which of the following laboratory values should the nurse be most concerned about? Platelets 400,000/mL White blood cell (WBC) count 3500/mL Hematocrit 37% Hemoglobin 11.8 g/dL

White blood cell (WBC) count 3500/mL Explanation: Normal WBC count is 4.8-10.8 × 103/µL. The total WBC count is not usually affected by aging, and the low WBC here would indicate that the patient's immune function may be compromised. The platelet count is normal for an older patient. The slight decrease in hemoglobin and hematocrit are not unusual for an older patient.

A nurse is reviewing the laboratory data for a hospitalized client. The nurse would be most concerned about which finding? Eosinophils 1.5/ µL Red blood cells 4.0/µL Platelet count of 200,000/µL White blood cell (WBC) count of 2800/µL

White blood cell (WBC) count of 2800/µL Explanation: Leukocytes are crucial to our defense against disease. The low WBC count in this patient would indicate that the patient's immune function may be compromised and the underlying cause of the problem needs to be investigated.

The nurse is reviewing the complete blood count (CBC) and white blood cell (WBC) differential of a client admitted with lower right abdominal pain. Which laboratory results are the most important for the nurse to communicate to the health care provider? Monocytes 4% Basophils 2/µL Platelet count 168,000/µL White blood cells (WBCs) 18,500/µL

White blood cells (WBCs) 18,500/µL Explanation: Leukocytes are crucial to our defense against disease. The high WBC count in this would indicate that the patient has an inflammatory or infectious process ongoing, which may be the cause of the patient's pain, and that further diagnostic testing is needed.

Which of the following diagnostic test results are abnormal? Select all that apply. White blood cells: 3.8 × 109/L Platelets: 500 × 103 Red blood cells: 6.6 × 1012/L Bands: 4 Basophils: 1

White blood cells: 3.8 × 109/L Platelets: 500 × 103 Red blood cells: 6.6 × 1012/L Explanation: Normal ranges are white blood cell range from 4.8-10.8 × 103/μL (4.8-10.8 × 109/L); Platelets range from 150-400 × 103 while red blood cells range from 4.2-5.4 × 106/μL (4.2-5.4 × 1012/L) for males and 3.6-5.0 × 106/μL (3.6-5.0 × 1012/L) for females. The other options are within normal ranges.

Describe the composition of blood

1. 55% plasma 2. 45% cellular element (RBCs, thrombocytes, WBCs)

List the three types of granulocytes

1. Neutrophils 2. Eosinophils 3. Basophils

List all the cells that stem from myeloid stem cells

1. monocytes 2. eosinophils 3. neutrophils 4. basophils 5. platelets 6. erythrocytes

Describe the components of a complete blood count

1. number of RBCs, WBCs and thrombocytes per unit of blood 2. mean cell volume (average size of RBC) 3. mean cell hemoglobin (average amount of hemoglobin in a person's RBC) 4. hematocrit(% of RBC in blood) 5. mean corpuscular hemoglobin concentration (ratio of MCH:MCV)

The nursing is reviewing assessment data of four clients. Select the client who is at greatest risk for developing pernicious anemia.

A client who has undergone partial gastrectomy Explanation: Pernicious anemia results from vitamin B12 deficiency. Vitamin B12 is absorbed by a unique process. After release from the animal protein, it is bound to intrinsic factor, a protein secreted by the gastric parietal cells. Causes of this anemia include gastrectomy, ileal resection, inflammation or neoplasms in the terminal ileum, and malabsorption syndromes in which vitamin B12 and other B-vitamin compounds are poorly absorbed. The other options will not cause pernicious anemia.

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

Ans: C Feedback: The basophils have granules that contain heparin, an anticoagulant; histamine, a vasodilator; and other mediators of inflammation.

A client was involved in an auto accident and suffered massive internal injuries that resulted in a large blood loss. Select the type of anemia the client is at greatest risk to develop.

Blood loss Explanation: The clinical manifestations and red cell changes associated with blood loss anemia depend on the rate of hemorrhage and whether the bleeding loss is internal or external. The effects of acute blood loss are mainly due to loss of intravascular volume, which can lead to cardiovascular collapse and shock. Hemolytic anemia is characterized by the premature destruction of red cells. The usual reason for iron deficiency in adults in the Western world is chronic blood loss. Aplastic anemia describes a disorder of pluripotential bone marrow stem cells.

An elderly patient is brought to the emergency department with garbled speech, unilateral facial drooping, and weakness. One hour after admission, the patient dies. An autopsy reveals the presence of polycythemia. Which of the following was the most likely cause of the patient's death?

Cerebral thrombosis Explanation: Unregulated overproduction of the red cell mass is termed polycythemia, which causes a thickening of the blood and an increased risk of blood clots

An elderly client asks the nurse why so many older people develop anemia. The best response would be:

Chronic disease Explanation: In most asymptomatic elderly persons, lower hemoglobin levels result from iron deficiency and anemia of chronic disease.

The microbiology technician explains to the student that which of the following blood cells is the most common?

Erythrocyte The erythrocytes, 500 to 1000 times more numerous than other blood cells, are the most common type of blood cells.

Where do neutrophils originate?

Myeloblasts in bone marrow

What shape do erythrocytes have and why is this important?

They have a biconcabe shape which gives them a large surface area for oxygen and CO2 exchange

The practitioner knows the client has hemoglobin S (HbS). The practitioner explains to the client that which of the following are the major consequences of this disorder? Select all that apply.

• Chronic hemolytic anemia • Blood vessel occlusion Explanation: Sickle cell disease is an inherited disorder in which an abnormal hemoglobin (hemoglobin S) can lead to chronic hemolytic anemia and blood vessel occlusion. The other options are not consequences of sickle cell disease.

A couple who are expecting their first child has been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple has approached their caregiver with this request and is seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting them. How can their caregiver best respond to the couple's enquiry? Stem cells can:

"Be used as source of reserve cells for the entire blood production system." Explanation: The proliferative potential and self-renewal of stem cells makes them a compensatory mechanism and reserve source for the entire hematopoietic system. While they could be of possible use in certain autoimmune conditions or in cases of organ failure, these statements do not capture their essence. Stem cells can also come from a histocompatible donor.

The family of an elderly patient are wondering why his 'blood counts' are not rising after his last GI bleed. They state, "He has always bounced back after one of these episodes, but this time it isn't happening. Do you know why?" The nurse will respond based on which of the following pathophysiological principles?

"Due stress, the red blood cells of older adults are not replaced as promptly as younger people." Explanation: In older adults, the number of progenitor cells declines. During a stress situation such as bleeding, the red blood cells of older adults are not replaced as promptly as those of their younger counterparts. Given the scenario, the patient is obviously bleeding from the GI tract. There is no reason to suspect the patient has bone cancer. Answer D is a non-therapeutic communication technique. The nurse is trying to pacify the family and not really addressing their concern.

The neonate displays a yellow discoloration of her skin on the third day of life. The neonatologist explains this condition to the parents. Which of the following statements is most accurate?

"The increase in bilirubin, which causes the jaundice, is related to the increased red blood cell breakdown." Explanation: Physiologic jaundice appears in term infants on the second or third day of life. The increase in bilirubin is related to the increased red cell breakdown and the inability of the immature liver to conjugate bilirubin. Many factors cause elevated bilirubin levels in the neonate, including breastfeeding. Hyperbilirubinemia places the neonate at risk for development of a neurologic syndrome called kernicterus. Most neonatal jaundice resolves spontaneously within one week.

A patient has been diagnosed with anemia. The physician suspects an immune hemolytic anemia and orders a Coombs test. The patient asks the nurse what this test will tell the doctor. The nurse replies:

"They are looking for the presence of antibody or complement on the surface to the RBC." Explanation: The Coombs test is used to diagnose immune hemolytic anemias. It detects the presence of antibody or complement on the surface of the red cell. A= direct antiglobulin test (DAT). B=blood smear. C=Iron stores test.

List the major plasma proteins

1. Albumin 2. Globulins 3. Fibrinogen

Describe bone marrow aspiration and what it determines

1. Aspiration: special needle inserted into the bone marrow cavity, through which a sample of marrow is withdrawn 2. Determines type of cells present and their relative numbers

What is the structure and function of eosinophils?

1. Associated with allergic reactions 2. In parasitic infections, use surface markers to attach themselves to the parasite and release hydrolytic enzymes 3. Bilobed nucleus with granules that stain red

Describe bone marrow biopsy and what it determines

1. Biopsy: special biopsy needle inserted into the posterior iliac crest and removes bone marrow TISSUE and allows study of the architecture of the tissue 2. Determines marrow to fat ratio, presence of fibrosis, plasma cells, granulomas and cancer cells

What are the functions of plasma proteins?

1. Carry the cells that transport gasses 2. Aid in body defenses 3. Prevent blood loss

Describe the formation and function of platelets

1. Contribute to cell formation of the platelet plug to help control bleeding after injury to a vessel wall 2. Cell fragments of megakaryocytes that are enucleated with granules full of chemicals that help in clotting

Describe White cell Differential Count and what does it help determine

1. Determination of relative proportions of individual white cell types 2. Helps determine underlying cause of a condition

What is the structure and function of neutrophils?

1. First cell to arrive at site of infection(one of two major phagocytes) 2. Maintains normal host defenses against invading substances 3. Multilobed with pale lilac or tan colored granulated cytoplasm (polymorphonucleocytes)

What is the function of white blood cells

1. Immune response that protects against disease-causing microorganisms 2. Identify and destroy cancer cells 3. Inflammatory response and wound healing

What is the function of fibrinogen?

1. Makes up 7% of plasma proteins 2. converted to fibrin during clotting

What percentage of WBCs are neutrophils? Eosinophils? Basophils?

1. Neutrophils = 50-60% 2. Eosinophils = 1-3% 3. Basophils = .3-.5%

Trace the lineage of NK cells, T-cells and B-cells

1. Pluripotent stem cell 2. lymphoid stem cell

Describe erythrocyte sedimentation rate and how to interpret results

1. Used to detect infammation 2. In anticoagulated blood, RBCs aggregate and fall to the bottom of a tube, forming sediment 3. The ESR is the distance in millimeters that a red cell column travels in an hour 4. rate of fall of aggregates is accelerated in presence of fibrinogen and other plasma proteins that are often increased in inflammatory diseases

What is the function of the plasma protein globulin?

1. comprises 38% of plasma proteins 2. Alpha globulins - transport bilirubin and steroids 3. Beta globulins - transport iron and copper 4. Gamma globulins - constitute antibodies of immune system

What is the function of the plasma protein albumin?

1. comprises 54% of plasma proteins 2. contributes to plasma osmotic pressure and the maintenance of blood volume 3. serves as a carrier for certain substances

Normal red blood cells live an average of about how many days?

120 Explanation: Normal red blood cells live 120 days.

Mature red blood cells have a life span of approximately:

120 days Explanation: Mature red blood cells have a life span of approximately 4 months, or 120 days.

A previously healthy client was involved in a traumatic fall and lost a large amount of blood. The client is now stable and has a normal serum ferritin level. How long will it take for red cell concentration to return to normal?

3 to 4 weeks Explanation: If bleeding is controlled and sufficient iron stores (indicated by ferritin level) are available, the red cell concentration returns to normal within 3 to 4 weeks

Which of the following is the most abundant type of plasma proteins?

Albumin Explanation: Albumin makes up approximately 54% of the plasma proteins. Although the others are made up plasma proteins, they are in the plasma in smaller numbers than is albumin.

A hospital laboratory technician is performing routine blood analysis as part of an inpatient's assessment and is examining the sample in a test tube following processing in a centrifuge and the addition of an anticoagulant. Which of the following observations would the technician most likely interpret as an anomaly? A) The bottom layer of blood in the tube accounts for around one third of the total volume. B) The middle layer of cells appears white to gray 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 half of the total volume.

Ans: A Feedback: The body layer of cells in a centrifuged blood sample consists of erythrocytes and should constitute around 42% to 47% of the total blood volume. The middle cell layer of leukocytes should appear whitish gray, and the thrombocytes above that layer are frequently not discernable. The plasma layer should account for around 55% of the total blood volume.

During science class, a student asks, "What's 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

Ans: A Feedback: The major difference between plasma and serum is the presence of fibrinogen in the plasma from an anticoagulated centrifuged whole-blood specimen. When blood is removed from the body for testing, it clots within 30 to 60 minutes. The clot contains the blood's cellular components enmeshed in an insoluble fibrin network (formed by the polymerization of soluble plasma protein fibrinogen). The remaining fluid portion is the yellow liquid serum. This serum no longer contains fibrinogen because the fibrinogen originally present in uncoagulated blood was used up in the formation of the blood clot. Heparin, WBC, and hydrogen ions are incorrect.

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 touch. Which of the following hematological 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

Ans: A Feedback: A part of the immune response is the proliferation of neutrophils in response to infectious organisms. Neutrophilia is an increase in immature neutrophils ("bands") most commonly seen in acute infections and tissue injuries that promote the accelerated release of neutrophils and their precursors into the circulation. Myeloblasts are not normally found in circulation, and segmented neutrophils would not yet have reached maturity (takes approximately 2 weeks to mature). Myelocytes do not perform phagocytosis.

9. 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.

Ans: A Feedback: Neutrophils are very mobile and are the first cells to go to an area of tissue damage. Erythrocytes (RBCs) contain an O2-carrying protein that functions in the transport of oxygen. Albumin, a plasma protein, does not pass through the pores in the capillary wall to enter the interstitial fluid and therefore contributes to the plasma osmotic pressure and maintenance of blood volume. Basophil granules contain heparin, an anticoagulant; histamine, a vasodilator; and other mediators of inflammation.

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.

Ans: A Feedback: Neutrophils are very mobile and are the first cells to go to an area of tissue damage. Erythrocytes (RBCs) contain an O2-carrying protein that functions in the transport of oxygen. Albumin, a plasma protein, does not pass through the pores in the capillary wall to enter the interstitial fluid and therefore contributes to the plasma osmotic pressure and maintenance of blood volume. Basophil granules contain heparin, an anticoagulant; histamine, a vasodilator; and other mediators of inflammation.

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

Ans: A Feedback: The major hazard of a bone marrow biopsy is the risk of hemorrhage. This is usually seen by a decrease in BP, tachycardia, edema from blood pooling in the tissues, etc. All of the other answers are s/s other than shock. Crackles in the lungs correlate with fluid/secretions in the lungs. A bone marrow aspiration is usually performed on the posterior iliac crest and should not cause an elevated respiratory rate. A low-grade fever is not considered a complication.

A student makes the statement to a colleague, "Blood plasma is essentially just a carrier for the formed elements 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."

Ans: B Feedback: Plasma proteins are integral to transport. They are not noted to contribute to the inflammatory response, hematopoiesis, protein synthesis, or liver function.

Which of the following 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

Ans: B Feedback: During hematopoiesis, progenitor cells differentiate into precursor cells, which in turn differentiate into the cellular components of blood. Cytokine stimulation precedes and regulates the process, and there are no different subtypes of pluripotent stem cells. Precursor cells are not self-replicating.

Which of the following statements 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.

Ans: B Feedback: Erythrocytes contribute to acid-base balance through the production of bicarbonate and hydrogen ions. They contain soluble enzymes but are neither self-replicating nor involved in fluid balance.

A nurse is providing care for several patients on an acute medical unit of a hospital. Which of the following patients would be most likely to benefit from hematopoietic growth factors? A) A 51-year-old female patient with liver failure secondary to hepatitis B) A 61-year-old female patient with end-stage renal cancer C) A 55-year-old obese male patient with peripheral neuropathy secondary to diabetes D) A 44-year-old man with a newly diagnosed brain tumor

Ans: B Feedback: Hematopoietic growth factors are commonly used in cases of kidney disease and cancer. Erythropoietin (EPO) is a colony-stimulating factor that stimulates red blood cell production. As a review, erythropoietin is an essential hormone for red cell production. Without it, definitive erythropoiesis does not take place. Under hypoxic conditions, the kidney will produce and secrete erythropoietin to increase the production of red blood cells. With cancer of the kidney, the kidney is unable to perform its normal function. They are not as clearly indicated in cases of liver disease, diabetes, or brain tumors.

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 of the following health problems? A) Jaundice B) Anemia C) Infections D) Blood clots

Ans: C Feedback: The gamma globulins, antibodies of the immune system, protect against infectious diseases. Because alpha globulin transports bilirubin, a defect in this plasma protein might lead to jaundice; a defect of beta globulin, which transports iron, could be associated with anemia; and a defect of fibrinogen could result in blood clots.

A physician is explaining to a 40-year-old male patient the importance of completing his course of antibiotics for the treatment of tuberculosis. The physician explains the damage that could occur to lung tissue by Mycobacterium tuberculosis. Which of the following phenomena would underlie the physician's explanation? A) Tissue destruction results from neutrophil deactivation. B) Nonspecific macrophage activity leads to pulmonary tissue destruction and resulting hemoptysis. C) Macrophages form a capsule around the Mycobacterium tuberculosis bacteria, resulting in immune granulomas. D) Neutrophils are ineffective against the Mycobacterium tuberculosis antigens

Ans: C Feedback: Immune granulomas are caused by insoluble particles (Mycobacterium tuberculosis) that are capable of inciting a cell-mediated immune response. Neutrophils are deactivated, self-destructive, nor ineffective in cases of tuberculosis.

A couple who is expecting their first child has been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple has approached their caregiver with this request and is seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting it. How can their caregiver best respond to the couple's enquiry? Stem cells can A) "help correct autoimmune diseases and some congenital defects." B) "be used to regenerate damaged organs should the need ever arise." C) "be used as source of reserve cells for the entire blood production system." D) "help treat some cancers and anemias, but they must come from your child himself or herself."

Ans: C Feedback: The proliferative potential and self-renewal of stem cells make them a compensatory mechanism and reserve source for the entire hematopoietic system. While they could be of possible use in certain autoimmune conditions or in cases of organ failure, these statements do not capture their essence. Stem cells can also come from a histocompatible donor.

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

Ans: D Feedback: After release from the marrow, the neutrophils spend only approximately 4 to 8 hours in the circulation before moving into the tissues. They survive in the tissues for approximately 4 to 5 days. They die in the tissues by discharging their phagocytic function.

A geriatrician is following a number of clients on a subacute geriatric medical unit, some of whom require diagnostic blood work. Which of the following clients 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.

Ans: D Feedback: Inflammatory diseases, such as systemic lupus erythematosus, are a common indicator for an ESR test. The other health problems noted are less commonly marked by inflammatory processes

A 5th 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 his or her body. B) 3 pints of blood in total. C) 3 to 4 quarts of blood in his or her body. D) 5 to 6 L of blood throughout his or her body.

Ans: D Feedback: The total volume of blood in the average adult is about 5 to 6 L, and it circulates throughout the body within the confines of the circulatory system.`

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

Ans: D Feedback: Albumin plays a central role in the maintenance of osmotic pressure and fluid balance. Immune function, acid-base balance, and thermoregulation are not functions of albumin.

An oncologist has ordered a bone marrow biopsy for a client and is explaining the reasons for the test and what the client might expect during the test. Which of the following explanations best reflects an aspect of a bone marrow biopsy? A) "I'll take a sample of your bone marrow from your breastbone or your spine." B) "I will be harvesting a sample of your stem cells for examination." C) "I need a more accurate count of your blood components than normal blood work is able to provide." D) "I need to get samples of the types of blood cells that your body is producing."

Ans: D Feedback: Bone marrow biopsy can be used to detect abnormal cell production and gain samples. A sample would be taken most likely from the iliac crest, and the biopsy would not focus on pluripotent stem cells. Bone marrow biopsy is not used for simple quantification of blood cellular components.

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

Ans: D Feedback: Granulocytes are spherical and have distinctive multilobar nuclei. They are all phagocytic cells that are identifiable because of their cytoplasmic granules. Answers A, B, and C are incorrect. Agranulocytes lack granular cytoplasm. Monocytes have a large amount of cytoplasm and a nucleus in the shape of a kidney. Erythrocytes lack a cell nucleus.

After birth, red blood cells are normally made in which of the following locations?

Bone marrow Explanation: After birth, red cells are produced in the red bone marrow. Until a child is 5 years old, almost all bones produce red cells to meet the growth needs of a child, after which bone marrow activity gradually declines.

Your ESRD patient is receiving two units of packed red blood cells for anemia (Hgb of 8.2). Twenty minutes into the first transfusion, the nurse observes the patient has a flushed face, hives over upper body trunk, and is complaining of pain in lower back. His vital signs include pulse rate of 110 and BP drop to 95/56. What is the nurse's priority action?

Discontinue the transfusion and begin an infusion of normal saline. Explanation: An immediate hemolytic reaction usually is caused by ABO incompatibility. The signs include ...flushing of the face, urticaria [hives], headache, pain in the lumbar area, chills, fever, chest pain...tachycardia, hypotension and dyspnea. If any of these actions occur, the transfusion should be stopped immediately. Access to a vein should be maintained because it may be necessary to infuse IV solutions to ensure diuresis. Slowing the rate of the blood infusion will not correct this hemolytic reaction and will only worsen the patient's condition. Of course, documentation after the above interventions are performed is vital. Re-checking the blood type infusing will not stop the hemolytic reaction. After corrective actions/interventions are taken, the blood bag is returned to the blood bank for further testing.

A 62-year-old female with a diagnosis of acute and chronic renal failure secondary to diabetes mellitus is receiving her weekly injection of epoetin, a supplementary form of erythropoietin. Which of the following statements best captures the necessity of this medication?

Erythropoietin causes the erythrocyte colony forming units to proliferate and mature. Explanation: Erythropoietin acts primarily in later stages of erythropoiesis to induce the erythrocyte colony forming units to proliferate and mature through the normoblast into reticulocytes and mature erythrocytes. It does not act directly on stem cells, not does it play a role in the sensation of hypoxia. Reticulocytes already lack a cell nucleus.

Describe the function of plasma

Functions: 1. Transport vehicle for nutrients, chemical messengers, metabolites, etc. 2. Participates in electrolyte and acid-base balance 3. Contains the plasma proteins that contribute to the osmotic regulation of body fluids 4. Absorb and distribute much of the heat that is generated in the body

Anemia refers to a deficiency of:

Hemoglobin Explanation: Anemia is a condition of an abnormally low number of circulating red blood cells or hemoglobin level, or both. It is not a disease but a manifestation of a disease process or alteration in body function.

A nurse is monitoring a patient with anemia and low oxygen levels. The nurse knows that which of the following stimulates the secretion of erythropoietin?

Hypoxia Explanation: Erythropoiesis is governed for the most part by tissue oxygen needs. Any condition that causes a decrease in the amount of oxygen that is transported in the blood produces an increase in red cell production. The oxygen content of the blood does not act directly on the bone marrow to stimulate red blood cell production. Instead, the decreased oxygen content is sensed by the peritubular cells in the kidneys, which then produce a hormone called erythropoietin

A patient with iron-deficiency anemia complains of feeling "tired all of the time." What does the nurse understand may be the cause of the fatigue that the patient is experiencing?

Impaired function of the electron transport chain Explanation: Although iron-deficiency anemia is characterized by decreased levels of hemoglobin, the iron-containing cytochromes in the electron transport chain in tissues such as skeletal muscle are affected as well. Thus, the fatigue that develops in iron-deficiency anemia results, in part, from impaired function of the electron transport chain.

The nurse is assessing a client diagnosed with anemia and notes that the client's skin and mucous membranes are pale. The nurse interprets this as:

Insufficient hemoglobin Explanation: The redistribution of the blood from cutaneous tissues or a lack of hemoglobin causes pallor of the skin, mucous membranes, conjunctiva, and nail beds. Tissue hypoxia to the brain causes headache, faintness, and dim vision but is not the direct cause of pallor. Changes in blood viscosity may lead to a systolic murmur.

The rate at which hemoglobin is synthesized depends on availability of which of the following?

Iron Explanation: The rate at which hemoglobin is synthesized depends on the availabilty of iron for heme sythesis.

A female patient comes to the clinic with symptoms of fatigue and heavy menses over the last 6 months. Laboratory tests reveal a microcytic hemochromic anemia. Based on these results, the nurse anticipates teaching the patient about which type of anemia?

Iron deficiency anemia Explanation: The red blood cell indices identified that it was a microcytic hemochromic anemia, specifically iron deficiency.

A patient has a hematocrit of 32% and is diagnosed with iron deficiency anemia. The nurse anticipates which of the following treatments to be prescribed?

Iron replacement therapy Explanation: Treatment for microcytic hemochromic anemia (iron deficiency anemia), is iron (ferrous sulfate) three times daily and follow-up monitoring.

A 13-year-old African-American boy comes to the ER complaining of fatigue and a rapid heartbeat. In conversation with the father, it becomes apparent to you that the boy has grown 2 inches in the previous 5 months. What is the first problem the health care team would attempt to rule out?

Iron-deficiency anemia Explanation: Although each of the above answers is associated with fatigue and rapid heartbeat, male adolescents are particularly susceptible to iron-deficiency anemia. They have high iron requirements because of growth spurts and dietary deficiencies.

The nurse is educating a pregnant client about the importance of folic acid. Select the food that has the highest levels of folic acid.

Kale Explanation: Folic acid is readily absorbed from the intestine. It is found in vegetables (particularly the green leafy types), fruits, cereals, and meats. Much of the vitamin, however, is lost in cooking. The most common causes of folic acid deficiency are malnutrition or dietary lack, especially in the elderly or in association with alcoholism.

The practitioner is examining a client and notes that he has small, punctate skin hemorrhages on his abdomen and chest. This finding is suggestive of which of the following lab results?

Low platelets Explanation: Petechiae (small, punctate skin hemorrhages) and ecchymoses often occur on the skin, and bleeding from the nose, gums, vagina or gastrointestinal tract may be seen because of decreased platelet levels.

A 40-year-old client is admitted to the hospital after experiencing 3 days of extreme vomiting .The doctor reviews the lab results and notes that the hemoglobin and hematocrit are elevated. This is interpreted as:

Manifestation of dehydration Explanation: The hematocrit measures the red cell mass in a 100-mL plasma volume. The hematocrit may be deceptive because it varies with the quantity of extracellular fluid, rising with dehydration and falling with overexpansion of extracellular fluid volume. The client is manifesting an abnormal elevation as a result of fluid loss.

Megaloblastic anemias caused by folic acid or vitamin B12 deficiencies can seriously affect RBC production. Which of the following lab results would correlate with this diagnosis?

Mean corpuscular hemoglobin (MCV) 120 fL (high) Explanation: Megaloblastic anemias are caused by impaired DNA synthesis that results in enlarged red cells (MCV >100 fL) due to impaired maturation and division. Folic acid and/or vitamin B12 do not have a critical role in normal iron and platelet levels or a high reticulocyte count.

The nurse is reviewing the client's laboratory data showing an increased mean corpuscular volume (MCV) and a normal mean corpuscular hemoglobin concentration (MCHC). The client most likely has which of the following types of anemia?

Megaloblastic anemia Explanation: Megaloblastic anemias are caused by impaired DNA synthesis that results in enlarged red cells (MCV >100 fL). The other types of anemia do not affect the MCV or MCHC.

The client with chronic kidney disease and congestive heart failure is weak and dyspneic. Lab work reveals a hemaglobin of 6.5g/dL. Which type of blood product will the provider order?

Packed red blood cells Explanation: Transfusion is suggested for people with hemaglobin levels < 7g/dL. Most anemias are treated with transfusions of red cell concentrates (packed red blood cells) which supply only the blood component that is deficient. Whole blood is utilized for acute, massive blood loss and would be avoided in this client due to the possibility of fluid volume overload. Albumin and plasma do not contain the needed red blood cells.

What is blood without the cells called?

Plasma

A patient presents to his physician with a red face, hands, feet, and ears; a headache; and drowsiness. A blood smear reveals an increased number of erythrocytes. Based on the laboratory results, the nurse prepares teaching material for which disease process?

Polycythemia Explanation: Unregulated overproduction of the red cell mass is termed polycythemia.

A patient presents to the clinic with symptoms of elevated blood pressure, dizziness, red face, pain in fingers and toes, headache, and difficulty concentrating. A blood smear reveals an increased number of erythrocytes. Based on these findings, the nurse anticipates which of the following diagnoses?

Polycythemia vera Explanation: Polycythemia vera is a neoplastic disease of the pluripotent cells of the bone marrow characterized by an absolute increase in total red blood cell mass accompanied by elevated white cell and platelet counts. In polycythemia vera, the clinical manifestations are hypertension, headache, dizziness, inability to concentrate, and some difficulty with hearing and vision because of decreased cerebral blood flow. Venous stasis gives rise to a plethoric appearance or dusky redness, even cyanosis, particularly of the lips, fingernails, and mucous membranes. Because of the increased concentration of blood cells, the person may experience itching and pain in the fingers or toes, and the hypermetabolism may induce night sweats and weight loss.

The client explains to her new provider that she receives periodic phlebotomies to decrease their red blood cell mass. The provider believes the client may have which of the following?

Polycythemia vera Explanation: Primary polycythemia, or polycythemia vera, is characterized by an absolute increase in total red blood cell mass. The goal of treatment is to reduce blood viscosity. Withdrawing blood by periodic phlebotomy to reduce red blood cell volume can do this. Sickle cell and beta-thalassemias are treated with transfusions. Megaloblastic anemias, caused by vitamin B12 and folic acid deficiencies, are treated by replacement of these nutrients.

A client tells the nurse that the doctor told her she has too many red blood cells accompanied by elevated white cells and platelet counts. The nurse recognizes this as:

Polycythemia vera Explanation: Polycythemia vera is a neoplastic disease of the pluripotent cells of the bone marrow characterized by an absolute increase in total red blood cell (RBC) mass accompanied by elevated white cell and platelet counts. In pernicious anemia, the RBCs are not high in number but are larger in size. In aplastic and hemolytic anemia, there is a small number of RBCs.

The nurse is preparing a client with suspected leukemia for a bone marrow and biopsy. What preferred site will the nurse be sure is accessible for the physician?

Posterior iliac crest Explanation: Usually, the posterior iliac crest is used in all people older than 12 to 18 months of age. Other sites include the anterior iliac crest, sternum, and spinous processes T10 through L4. The sternum is not commonly used in children because the cavity is too shallow and there is danger of mediastinal and cardiac perforation.

Which of the following would be tested by a complete blood count (CBC)?

Red blood cells and platelets Explanation: A CBC is a commonly performed screening test that determines the number of red blood cells, white blood cells, and platelets per unit of blood. Lymphocytes and neutrophils may be included in the CBC if a differential of white blood cells was also ordered. Electrolytes and size/shape of blood cells are not part of a CBC.

The nurse is caring for a client diagnosed with sickle cell disease. Select the most important factor for the nurse to be aware of that may cause the cells to sickle.

Reduced oxygen tension while the client sleeps Explanation: Factors associated with sickling include cold, stress, physical exertion, infection, dehydration and illnesses that cause hypoxia, dehydration, or acidosis. Even such trivial incidents as reduced oxygen tension induced by sleep may contribute to the sickling process. Pain and acute chest syndrome are complications of sickle cell disease.

A male client with chronic obstructive pulmonary disease has a hematocrit of 55 percent. The practitioner tells the client that he has which of the following?

Secondary polycythemia Explanation: Secondary polycythemia results from a physiologic increase in the level of erythropoietin, commonly as a compensatory response to hypoxia. Conditions causing hypoxia include chronic heart and lung disease. Polycythemia is an abnormally high total red blood cell mass with a hematocrit greater that 54 percent in men. Primary polycythemia or polycythemia vera is a neoplastic disease of the pluripotent cells of the bone marrow. In relative polycythemia, the hematocrit rises because of a loss of plasma volume without a corresponding decrease in red cells.

What is blood without the clotting factor called?

Serum

The practitioner carefully monitors his client who exhibits hemoglobin S (HbS) genes. The practitioner know that the client is predisposed to life-threatening infection due to damage by HbS to which of the following organs?

Spleen Explanation: Sickle cell disease is an inherited disorder in which the person has abnormal hemoglobin S (HbS). The spleen is especially susceptible to damage by HbS. The congestion of the spleen predisposes the person to life-threatening infections caused by encapsulated organisms.

The nurse is caring for a 2-day-old newborn infant who appears lethargic and has a yellowish tint to the skin. Select the most likely cause of this newborn's signs and symptoms.

The inability of the immature liver to conjugate bilirubin Explanation: Jaundice is a sign of increased bilirubin related to the increased red blood cell breakdown and the inability of the immature liver to conjugate bilirubin. Jaundice occurs from a large production of bilirubin, and a newborn would not have cirrhosis of the liver.

Where are most plasma proteins synthesized?

The liver

A nurse assessing a client with an acute exacerbation of polycythemia vera notes coolness to the right leg and foot, pale color and an absent right pedal pulse. Based on these findings the nurse suspects that the client has developed which of the following complications?

Thrombosis in the right leg Explanation: Unregulated overproduction of the red cell mass is termed polycythemia. Thrombocytosis occurs when the bone marrow produces too many platelets.

An infant from parents of Mediterranean decent has been diagnosed with a severe form of β-thalassemia anemia. The nurse caring for this infant knows that the infant will likely receive which of the following medical treatments?

Transfusion therapy Explanation: Persons who are homozygous for the trait (thalassemia major) have severe, transfusion-dependent anemia that is evident at 6 to 9 months of age when the hemoglobin switches from HbF to HbA. If transfusion therapy is not started early in life, severe growth retardation occurs in children with the disorder. Iron and blood thinners will not be therapeutic for this client. Stem cell transplantation is a potential cure for low-risk clients, particularly in younger persons with no complications of the disease or its treatment, and has excellent results.

A new mother and father are upset that their 2-day-old infant is requiring phototherapy for hyperbilirubinemia. The pediatrician who has followed the infant since birth is explaining the multiplicity of factors that can contribute to high serum bilirubin levels in neonates. Which of the following factors would the physician be most likely to rule out as a contributor?

Transitioning of hemoglobin F (HbF) to hemoglobin A (HbA) Explanation: Hemoglobin transition from HbF to HbA is not associated with hyperbilirubinemia. Breastfeeding, hypoxia, and immaturity of the young liver can contribute to hyperbilirubinemia.

The nurse is caring for a client who is a strict vegetarian; the client is at greatest risk for the development of:

Vitamin B12 deficiency anemia Explanation: Vitamin B12 is found in all foods of animal origin. Dietary deficiency is rare and usually found only in strict vegetarians who avoid all dairy products as well as meat and fish. The hallmark of vitamin B12 deficiency is megaloblastic anemia. The other options are not affected by the client being a vegetarian.

Which of the following statements concerning red blood cells (RBCs) are correct? Select all that apply.

• RBCs are the most abundant of the blood cells • RBCs are necessary for carbon dioxide transport. Explanation: The most abundant of the blood cells, the erythrocytes, or RBCs, function in oxygen and carbon dioxide transport. The leukocytes, or white blood cells, serve various roles in immunity and inflammation. Platelets are small cell fragments that are involved in blood clotting.