Ch. 19 - Nursing Assessment: Hematologic Function
A nurse caring for a patient with severe neutropenia would be primarily concerned about the patient's susceptibility to which of the following?
Bacterial infections Explanation: Severe neutropenia is diagnosed with a neutrophil count below 500/mL. At this level, the body has few reserves to fight off infections, especially Staphylococcus aureus.
A nurse caring for a patient with severe neutropenia would be primarily concerned about the patient's susceptibility to which of the following?
Bacterial infections Severe neutropenia is diagnosed with a neutrophil count below 500/mL. At this level, the body has few reserves to fight off infections, especially Staphylococcus aureus.
A client is seeing the physician at the clinic and tells the nurse he is fatigued and short of breath with minimal exertion. What lab study may reflect a decrease in transport of oxygen?
Erythrocyte count Erythrocytes function is to transport oxygen. Leukocytes protect against infection. Platelets participate in clotting blood, and albumin affects intravascular osmotic pressure.
A nurse is reviewing a client's white blood cell count with the client. As part of the discussion, the nurse explains about granulocytes and agranulocytes and their function. Which type of white blood cell would the nurse describe as being most numerous?
neutrophils Explanation: Granulocytes are divided into three main subgroups: eosinophils, basophils, and neutrophils. Neutrophils are the most numerous cells of this class. Band cells account for only a small percentage of circulating granulocytes, although their percentage can increase greatly under conditions in which neutrophil demand increases, such as infection.
A client is scheduled to undergo a bone marrow aspiration and biopsy. The nurse understands that which site would most likely be used?
posterior iliac crest Explanation: In adults, bone marrow is usually aspirated from the posterior iliac crest. The aspirate provides a sample of cells. Aspirate alone may be adequate for evaluating certain conditions, such as anemia. However, in most cases, a biopsy is also performed. Biopsy samples are taken from the posterior iliac crest; occasionally, an anterior iliac approach is required. The sternum can be used to obtain an aspirate but should not be used to obtain a biopsy because of its proximity to vital organs.
Which type of lymphocyte is responsible for cellular immunity?
T lymphocyte Explanation: T lymphocytes are responsible for delayed allergic reactions, rejection of foreign tissue (e.g., transplanted organs), and destruction of tumor cells. This process is known as cellular immunity. B lymphocytes are responsible for humoral immunity. A plasma cell secretes immunoglobulin. A basophil contains histamine and is an integral part of hypersensitivity reactions.
A client will be having a bone marrow aspiration to determine the status of blood cell formation. What role does the nurse have during the test?
The nurse assists the physician and supports the client during the procedure. Explanation: The nurse assists the physician, supports the client during the procedure, and monitors the client's status afterward. Injecting anesthetic agents is beyond the scope of practice for the nurse. The physician obtains informed consent for the procedure, and the nurse witnesses the signature. The nurse should not leave the room because the client requires monitoring during and after the procedure.
A patient's most recent complete blood count (CBC) reveals that her mean corpuscular volume (MCV) is well below reference ranges. The nurse should identify what potential contributing factor for this phenomenon?
The woman has an iron deficiency. With iron deficiency, bone marrow iron stores are rapidly depleted; hemoglobin synthesis is depressed, and the erythrocytes produced by the marrow are small and low in hemoglobin. This is known as microcytic anemia (characterized by small red blood cells). Part of a standard complete blood count (CBC) includes the mean corpuscular volume (MCV), which measures the size of the RBCs. In microcytic anemia, a small (< 82 µm3) MCV is seen.
A nurse is reviewing the admission blood work of an adult woman who presented with complaints of progressive fatigue over the past several weeks. The woman's subsequent blood work is indicative of iron-deficiency anemia. What assessment question by the nurse most directly addresses the potential cause of the woman's iron deficiency?
"Have you seen any blood when you have had a bowel movement in recent weeks?" In the adult, lack of dietary iron is rarely the sole cause of iron-deficiency anemia. Iron deficiency in the adult generally indicates that blood has been lost from the body (e.g., from bleeding in the gastrointestinal [GI] tract or heavy menstrual flow). The source of iron deficiency should be investigated promptly, because iron deficiency in an adult may be a sign of bleeding in the GI tract or colon cancer. Renal function and infection do not typically result in an iron deficiency.
A client with Hodgkin disease had a bone marrow biopsy yesterday and reports aching at the biopsy site, rated a 5 (on a 1-10 scale). After assessing the biopsy site, which nursing intervention is most appropriate?
Administer acetaminophen 500 mg po, as ordered After a marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing. Most clients have no discomfort after a bone marrow biopsy, but the site of a biopsy may ache for 1 or 2 days. Warm tub baths and a mild analgesic agent (e.g., acetaminophen) may be useful. Aspirin-containing analgesic agents should be avoided it the immediate post-procedure period because they can aggravate or potentiate bleeding.
Plasma proteins play an essential role in maintaining water balance and blood pressure. Select the laboratory analysis that a nurse should review to check the levels of the most abundant plasma protein.
Albumin comprises 60% of the plasma proteins in the blood. The globulins comprise 35% and fibrinogen is 4%.
A patient has asked the nurse about the clotting cascade, and the nurse explains that plasminogen is a component necessary in the clotting cascade. Where in the body is plasminogen present?
All body fluids Explanation: Plasminogen, which is present in all body fluids, circulates with fibrinogen. Plasminogen is found in body fluids, not tissue.
The nurse is obtaining the health history of a client suspected of having a hematological condition. The nurse notes the client has a history of alcohol abuse. Which clinical presentation is related to alcohol consumption?
Anemia Explanation: Individuals with a history of alcohol consumption may have anemia due to nutritional deficiencies. Myelodysplastic syndrome, neutropenia, and thrombocytopenia are not common findings in clients who consume or abuse alcohol.
The physician performs a bone marrow biopsy from the posterior iliac crest on a client with pancytopenia. What intervention should the nurse perform after the procedure?
Apply pressure over the site for 5-7 minutes Explanation: Hazards of either bone marrow aspiration or biopsy include bleeding and infection. The risk of bleeding is somewhat increased if the client's platelet count is low or if the client has been taking a medication (e.g., aspirin) that alters platelet function. After the marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing.
Which client is not a candidate to be a blood donor according to the American Red Cross?
Correct response: 26-year-old female with hemoglobin 11.0 g/dL Explanation: Clients must meet a number of criteria to be eligible as blood donors, including the following: body weight at least 50 kg; pulse rate regular between 50 and 100 bpm; systolic BP 90-100 to 180 mm Hg and diastolic 50 to 100 mm Hg; hemoglobin level at least 12.5 g/dL. There is no upper age limit to donation.
A client is diagnosed with moderate neutropenia. When reviewing the client's medical record, the nurse would identify which absolute neutrophil count as supporting this diagnosis?
Correct response: 850/mm3 Explanation: Neutropenia severity is classified using the following guidelines: ANC 1,500 to 1,000/mm3 indicates mild neutropenia; ANC 999 to 500/mm3 indicates moderate neutropenia; ANC of less than 500/mm3 indicates severe neutropenia. Normally, the neutrophil count is greater than 2,000/mm3.
A nurse is assigned to care for a patient with ascites, secondary to cirrhosis. The nurse understands that the fluid accumulation in the peritoneal cavity results from a combination of factors including an alteration in oncotic pressure gradients and increased capillary permeability. Therefore, the nurse monitors the serum level of the plasma protein responsible for maintaining oncotic pressure, which is:
Correct response: Albumin. Explanation: Albumin, only produced in the liver, is essential for maintaining oncotic pressure in the vascular system. A decrease in oncotic pressure due to low albumin causes fluid to leak into the peritoneal cavity.
A 75-year-old woman visited her health care provider for an annual check-up. She told the doctor that she feels exhausted all the time and barely has the energy to go out of her home, run errands, and visit friends. The nurse expects that the health care provider will order which of the following lab studies based on the most common hematologic condition affecting the elderly?
Correct response: Complete blood count Explanation: Anemia is the most common hematologic condition affecting the elderly. It frequently results from iron or nutritional deficiencies, or the bone marrow's ability to respond to the body's need for red blood cells. A complete blood count is needed to assess the hemoglobin and hematocrit levels.
A 66-year-old man underwent a successful partial gastrectomy for the treatment of stomach cancer 3 years ago. The man had a scheduled follow-up appointment with his primary caregiver and had blood work completed. The results of the man's blood work indicated anemia. The nurse who is contributing to the patient's care should recognize that this patient's anemia may be attributable to what factor?
Correct response: Decreased vitamin B12 absorption Explanation: It is important for nurses to recall that patients who have had a partial or total gastrectomy may have limited amounts of intrinsic factor, and therefore the absorption of vitamin B12 may be diminished, leading to anemia. Paralytic ileus would not be plausible; infection and cancer would be less likely causes for the patient's iron deficiency.
A client is diagnosed with extreme thrombocytosis. The nurse knows this condition is a result of which elevated blood cell count?
Correct response: Platelets Explanation: Extreme thrombocytosis is an elevation in platelets.
A patient with a diagnosis of HIV exhibits a decreased level of T lymphocytes. What consequence does this state present for this patient?
Correct response: The patient is particularly susceptible to infection. Explanation: Because T cells directly kill foreign substances, a T-cell deficit renders an individual susceptible to infection. A patient with low T cells does not necessarily have a decreased ability to carry oxygen, form clots, or respond to allergens.
Which cells have the major function of transporting O2 to and removing CO2 from tissues?
Correct response: erythrocytes Explanation: The major function of erythrocytes is to transport O2 to the tissues and remove CO2 from the tissues.
A nurse is reviewing a client's white blood cell count with the client. As part of the discussion, the nurse explains about granulocytes and agranulocytes and their function. Which type of white blood cell would the nurse describe as being most numerous?
Correct response: neutrophils Explanation: Granulocytes are divided into three main subgroups: eosinophils, basophils, and neutrophils. Neutrophils are the most numerous cells of this class. Band cells account for only a small percentage of circulating granulocytes, although their percentage can increase greatly under conditions in which neutrophil demand increases, such as infection.
Which cells are also known as thrombocytes?
Correct response: platelets Explanation: Platelets are also known as thrombocytes because they help control bleeding by forming a loose blood clot.
The nurse expects which assessment finding when caring for a client with a decreased hemoglobin level?
Decreased oxygen level. Hemoglobin carries oxygen; a decreased hemoglobin level results in decreased oxygen. An elevated temperature is a sign of infection and can result from decreased white blood cells. Arterial blood is more oxygen saturated and brighter red in color than venous blood. Increased bruising results from a decreased platelet level, not decreased hemoglobin.
When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply.
Dietary intake Medication use Ethnicity Herbal supplements Dietary intake, ethnicity, use of herbal supplements, and medication use are factors for which the nurse should assess. Hair color is not considered a factor in determining causes of hematological disorders.
What factor in plasma can be transformed from a liquid to a solid?
Fibrinogen Explanation: Fibrinogen plays a key role in forming blood clots. It can be transformed from a liquid to fibrin, a solid that controls bleeding. The other components of plasma cannot be converted from a liquid to a solid.
Albumin is a protein in the plasma portion of the blood. Under normal conditions, albumin cannot pass through the wall of a capillary. What significance is this for the vascular compartment?
Helps retain fluid in the vascular compartment Under normal conditions, albumin cannot pass through a capillary wall. Consequently, albumin helps maintain the osmotic pressure that retains fluid in the vascular compartment. Albumin does not push oxygen into the tissues of the body or absorb carbon dioxide for transport to the lungs. Albumin also does not retain leukocytes in the vascular compartment.
A nurse is caring for a patient who has had a bone marrow aspiration with biopsy. What complication should the nurse be aware of and monitor the patient for?
Hemorrhage Hazards of either bone marrow aspiration or biopsy include bleeding and infection. The risk of bleeding is somewhat increased if the patient's platelet count is low or if the patient has been taking a medication (e.g., aspirin) that alters platelet function.
The nurse is caring for a patient with a hematologic disorder. The patient asks the nurse where the body forms blood cells. Where should the nurse tell the patient that blood cells are formed?
In the bone marrow Bone marrow is the primary site for hematopoiesis. The liver and spleen may be involved during embryonic development or when marrow is destroyed. The kidneys release erythropoietin, which stimulates the marrow to increase production of RBCs. Blood cells are not formed in the spleen, the kidneys, or the liver.
The nurse is caring for a client with a lymphatic system disorder. What physical assessment is a priority for the nurse to perform?
Inspect the tonsils for size and appearance. Explanation: In a client with a disorder of the lymphatic system, the nurse inspects the tonsils for size and appearance. Urine color and quantity, blood pressure, or physical injuries may be assessed, but do not have a direct correlation to the lymphatic system. However, the nurse may check the client's pulse because a rapid pulse rate may indicate reduced erythrocytes or inadequate hemoglobin levels and may examine the skin adjacent to the lymph node for redness, streaking, and swelling.
A client in acute renal failure has been prescribed 2 units of packed red blood cells (PRBCs). The nurse explains to the client that the blood transfusion is most likely needed for which reason?
Lack of erythropoietin The kidneys produce erythropoietin, a hormone that stimulates red blood cell production. A lack of this hormone is the most likely reason for blood transfusion due to the acute kidney failure. There is no indication for a nephrectomy in this question. A blood transfusion will not necessarily increase the effectiveness of dialysis. Transfusing a client with hypervolemia could lead to circulatory overload.
The nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. What position will the nurse place the patient in?
Lateral position with one leg flexed Explanation: Bone marrow aspiration procedure. The posterior superior iliac crest is the preferred site for bone marrow aspiration and biopsy because no vital organs or vessels are nearby. The patient is placed either in the lateral position with one leg flexed or in the prone position.
Which cells are called white blood cells?
Leukocytes Explanation: Leukocytes are also called white blood cells (WBCs).
The nurse is caring for a patient whose bone marrow has been replaced by scar tissue in much of the areas that produce blood cells for the body. What organs can become active in blood cell production by the process of extramedullary hematopoiesis?
Liver and spleen In adults with disease that causes marrow destruction, fibrosis, or scarring, the liver and spleen can also resume production of blood cells by a process known as extramedullary hematopoiesis. The kidneys and pancreas do not produce blood cells for the body.
Which term refers to a form of white blood cell involved in immune response?
Lymphocyte Explanation: Both B and T lymphocytes respond to exposure to antigens. Granulocytes include basophils, neutrophils, and eosinophils. A spherocyte is a red blood cell without central pallor, seen with hemolysis. A thrombocyte is a platelet.
Which term refers to a form of white blood cell involved in immune response?
Lymphocyte Both B and T lymphocytes respond to exposure to antigens. Granulocytes include basophils, neutrophils, and eosinophils. A spherocyte is a red blood cell without central pallor, seen with hemolysis. A thrombocyte is a platelet.
A nurse cares for a client with iron-deficiency anemia. Which treatment will the nurse anticipate the client receiving?
Oral iron supplementation The primary treatment of iron-deficiency anemia is oral iron supplementation. Intravenous iron supplementation is not the primary treatment of iron-deficiency anemia. Chelation therapy and immunotherapy do not treat iron-deficiency anemia.
Which is a symptom of severe thrombocytopenia?
Petechiae Clients with severe thrombocytopenia have petechiae, which are pinpoint hemorrhagic lesions, usually more prominent on the trunk or anterior aspects of the lower extremities.
Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils?
Phagocytosis Explanation: The major function of neutrophils is phagocytosis. T lymphocytes are responsible for rejection of foreign tissue and destruction of tumor cells. Plasma cells produce antibodies call immunoglobulin.
Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils?
Phagocytosis The major function of neutrophils is phagocytosis. T lymphocytes are responsible for rejection of foreign tissue and destruction of tumor cells. Plasma cells produce antibodies call immunoglobulin.
A 44-year-old man with a longstanding diagnosis of AIDS has been admitted to the hospital with an absolute neutrophil count (ANC) of 385/mm3. When planning the patient's care, what action should the nurse prioritize?
Placing the patient on protective isolation precautions Explanation: ANC <500/mm3 indicates severe neutropenia. Patients with severe neutropenia are at significantly increased risk for developing opportunistic infections and sepsis and may require protective isolation precautions (i.e., a positive pressure room). Neutropenia does not necessitate red blood cell transfusion, oxygen supplementation, or special precautions against injury.
A client is diagnosed with extreme thrombocytosis. The nurse knows this condition is a result of which elevated blood cell count?
Platelets Explanation: Extreme thrombocytosis is an elevation in platelets.
Which cells have the lifespan of approximately 7.5 days and one-third of their population remains in the spleen (unless needed to fight significant bleeding)?
Platelets Platelets have a life span of approximately 7.5 days. Two-thirds circulate in the blood and contribute to homeostasis. The remaining one-third is stored in the spleen, where they remain unless needed in cases of significant bleeding.
A nurse is assisting a client into position prior to bone marrow aspiration. Which position will the nurse place the client prior to the procedure?
Prone Explanation: Prior to the bone marrow aspiration, the nurse should place the client in either the prone position or lateral position with one leg flexed. The aspiration usually is performed on the anterior iliac crest. It would not be appropriate for the nurse to place the client in supine, knee-chest, or Trendelenburg positions.
The nurse is preparing teaching for a client with myelodysplastic syndromes (MDS). Which topics will the nurse include in the teaching for this client? Select all that apply.
Risk for bleeding Infection prevention Mehtods to reduce fatigue Need for frequent laboratory monitoring Caring for clients with MDS can be challenging because the illness is unpredictable. Clients with MDS need extensive education about the risk for bleeding and the risk for infection to include signs and symptoms, measures to avoid the development, and actions to take if symptoms occur. Fatigue is often a debilitating symptom for the client with MDS and clients would benefit from learning how to live with this symptom. Laboratory values need to be monitored closely to anticipate the need for transfusion and to determine response to treatment with growth factors. The client with MDS does not need teaching on dietary changes.
Which term is used to refer to a primitive cell that is capable of self-replication and differentiation?
Stem cell Explanation: Stem cells may differentiate into myeloid or lymphoid stem cells. A band cell is a slightly immature neutrophil. A spherocyte is a red blood cell without central pallor. A reticulocyte is a slightly immature red blood cell.
The nurse is caring for a client who is undergoing bone marrow aspiration to determine the blood cell formation status. What nursing intervention should the nurse provide to the client during the test?
Support the client and monitor the status. When a client undergoes a bone marrow aspiration, the nurse assists the physician, supports the client during the procedure, and monitors the condition afterward. The client needs to be administered oral radioactive vitamin B12 or a nonradioactive B12 injection in case of the Schilling test, which helps in determining pernicious anemia and macrocytic anemia. Collecting urine for 24 to 48 hours after administering nonradioactive B12 is also applicable to the Schilling test.
A female patient has been diagnosed with an unusual delayed response to allergic agents, as well as a compromised immune system. Which of the following does the nurse identify as the WBC value that is consistent with this diagnosis?
T lymphocytes: 850/cmm Explanation: The primary function of T lymphocytes is to produce substances that aid in attacking and killing foreign cells by releasing lymphokines that enhance the activity of phagocytic cells. A deficiency of T lymphocytes leads to delayed responses to allergic substances. The normal value for T lymphocytes is 1,000 to 4,800/cmm.
The nurse is caring for a client with hypoxia. What does the nurse understand is true regarding the client's oxygen level and the production of red blood cells?
The kidneys sense low oxygen levels in the blood and produce erythropoietin, stimulating the bone marrow to produce more red blood cells. If normally functioning kidneys detect low levels of blood oxygen, they produce more of the hormone erythropoietin (EPO). As EPO levels increase, the bone marrow responds by producing more erythrocytes (red blood cells). EPO is not made by the bone marrow. Hemoglobin, an iron-rich protein that allows erythrocytes to transport oxygen, is synthesized in the erythrocytes as they mature.
A client's family member asks what hematopoiesis is. What should the nurse tell the family member?
The manufacture and development of blood cells Hematopoiesis is the manufacture and development of blood cells. It also considers the lymphatic system, which includes the thymus gland and spleen; this system assists in the maturation of certain lymphocytes. Hematopoiesis is not the production of lymphatic fluid or the development of lymph in the bone marrow.
The nurse is observing the skin of a client who is taking medications that depress the hematopoietic system and notices multiple areas of ecchymosis on the arms; bleeding for a prolonged period after an IV was started; and reports of black, tarry stool. What does the nurse understand may be a side effect of this medication that the client displays?
Thrombocytopenia Signs of thrombocytopenia include unusual or easy bleeding; oozing from injection sites; bleeding gums; and dark, tarry stools. Leukocytosis would cause fever as well as other signs and symptoms of infection. Leukopenia symptoms are fever, sore throat, and chills. Neutropenia reduces the client's ability to fight infection and makes susceptible to microorganisms.
A client comes into the emergency department reporting an enlarged tongue. The tongue appears smooth and beefy red in color. The nurse also observes a 5-cm incision on the upper left quadrant of the abdomen. When questioned, the client states, "I had a partial gastrostomy 2 years ago." Based on this information, the nurse attributes these symptoms to which problem?
Vitamin B12 deficiency Explanation: Because vitamin B12 is found only in foods of animal origin, strict vegetarians may ingest little vitamin B12. Vitamin B12 combines with intrinsic factor produced in the stomach. The vitamin B12-intrinsic factor complex is absorbed in the distal ileum. Clients who have had a partial or total gastrectomy may have limited amounts of intrinsic factor, and therefore the absorption of vitamin B12 may be diminished. The effects of either decreased absorption or decreased intake of vitamin B12 are not apparent for 2-4 years. This results in megaloblastic anemia. Some symptoms are a smooth, beefy red, enlarged tongue and cranial nerve deficiencies.
A nurse is reading a journal article about white blood cells and how they function. The nurse demonstrates understanding of the article by identifying which white blood cell as a granulocyte? Select all that apply.
eosinophils basophils neutrophils Granulocytes are defined by the presence of granules in the cytoplasm of the cell. Granulocytes are divided into three main subgroups: eosinophils, basophils, and neutrophils. Monocytes and lymphocytes are leukocytes with granule-free cytoplasm—hence the term agranulocyte.
A nurse is preparing a review class about hematologic problems for a group of nurses working at the clinic. As part of the class, the nurse is describing the process by which the body continuously replenishes the supply of blood cells. The nurse is describing which process?
hematopoiesis Explanation: Because most blood cells have a short lifespan, the need for the body to replenish its supply of cells is continuous; this process is termed hematopoiesis (the formation and production of blood cells). Hemostasis refers to prevention of blood loss from intact vessels as well as the termination of bleeding when blood vessels are damaged. Neutropenia refers to a deficiency of neutrophils, a type of white blood cell. Phagocytosis refers to the ingestion and digestion of bacteria and particles by white blood cells.
A nurse is reviewing a client's white blood cell count with the client. As part of the discussion, the nurse explains about granulocytes and agranulocytes and their function. Which type of white blood cell would the nurse describe as being most numerous?
neutrophils Explanation: Granulocytes are divided into three main subgroups: eosinophils, basophils, and neutrophils. Neutrophils are the most numerous cells of this class. Band cells account for only a small percentage of circulating granulocytes, although their percentage can increase greatly under conditions in which neutrophil demand increases, such as infectio
Which cells are also known as thrombocytes?
platelets Platelets are also known as thrombocytes because they help control bleeding by forming a loose blood clot.
The nurse is explaining the wound-healing process to a patient. Which best describes the function of fibrinogen?
plays a key role in forming blood clots Explanation: Fibrinogen, the largest share of plasma protein, plays a key role in forming blood clots. It can be transformed from a liquid to fibrin, a solid that controls bleeding.
An older adult with a history of decreased self-care has been admitted to the geriatric medical unit after being found in state of dehydration and malnutrition by paramedics. The admission assessment of the patient included a complete blood count, which revealed several hematological abnormalities, including a hematocrit of 61%. The nurse should consequently assess the patient for signs and symptoms of:
spontaneous clotting and thromboembolism Explanation: A hematocrit greater than 60% is associated with spontaneous clotting. This finding is not commonly associated with neurological changes or activity intolerance.
The nurse is assisting the physician with obtaining a sample to determine the status of blood cell formation. What type of procedure will the nurse have prepared the client for?
A bone marrow aspiration A bone marrow aspiration is performed to determine the status of blood cell formation. In this procedure, the physician applies local anesthesia and removes bone marrow from the posterior iliac crest or the sternum. The marrow is examined for the types and percentage of immature and maturing blood cells.
A 66-year-old man underwent a successful partial gastrectomy for the treatment of stomach cancer 3 years ago. The man had a scheduled follow-up appointment with his primary caregiver and had blood work completed. The results of the man's blood work indicated anemia. The nurse who is contributing to the patient's care should recognize that this patient's anemia may be attributable to what factor?
Decreased vitamin B12 absorption Explanation: It is important for nurses to recall that patients who have had a partial or total gastrectomy may have limited amounts of intrinsic factor, and therefore the absorption of vitamin B12 may be diminished, leading to anemia. Paralytic ileus would not be plausible; infection and cancer would be less likely causes for the patient's iron deficiency.
Both the liver and the spleen have a role in erythrocyte metabolism. How would this role best be described?
The spleen removes erythrocytes after 120 days, and the liver removes severely damaged erythrocytes. Explanation: Erythrocytes circulate in the blood for about 120 days, after which the spleen removes them; the liver removes severely damaged erythrocytes. The rate of erythrocyte production is regulated by erythropoietin, a hormone released by the kidneys. The spleen does not store the iron component and also does not help in creating mature erythrocytes.
