Ch. 30 Workbook Questions

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Priority Decision: A patient is undergoing a contrast computed tomography (CT) of the spleen. What is most important for the nurse to ask the patient before the test? a. Iodine sensitivity b. Prior blood transfusions c. Phobia of confined spaces d. Internal metal implants or appliances

a

After a woman had a right breast mastectomy, her right arm became severely swollen. What hematologic problem caused this? a. Lymphedema b. Right-sided heart failure c. Wound on her right hand d. Refusal to use her right arm

a Lymphedema is the obstruction of lymph flow that results in accumulation of lymph fluid for the pt in the right arm following a right-sided breast mastectomy. The other options are not hematologic problems that would cause extreme swelling.

Which component of normal hemostasis involves the processes of protein C and protein S and plasminogen? a. Lysis of clot b. Vascular response c. Plasma clotting factors d. Platelet plug formation

a Protein C and protein S are examples of anticoagulants that are involved in the lysis of clots. Fibrinolysis is also achieved by thrombin-activating conversion of plasminogen to plasmin, which attacks fibrin or fibrinogen and splits it into smaller elements known as fibrin split products (FSPs) or fibrin degradation products (FDPs).

Using light pressure with the index and middle fingers, the nurse cannot palpate any of the patient's superficial lymph nodes. How should the nurse respond to this assessment? a. Record this finding as normal b. Reassess the lymph nodes using deeper pressure c. Ask the patient about any history of radiation therapy d. Notify the health care provider that x-rays of the nodes will be necessary.

a Superficial lymph nodes are evaluated by light palpation but they are not normally palpable. It may be normal to find small (<1.0cm), mobile, firm, nontender nodes. Deep lymph nodes are detected radiographically.

During the nursing assessment of a patient with anemia, what specific information should the nurse ask the patient about? a. Stomach surgery b. Recurring infections c. Corticosteroid therapy d. Oral contraceptive use

a The parietal cells of the stomach secrete intrinsic factor, a substance necessary for the absorption of cobalamin (vitamin B12), and if all or part of the stomach is removed, the lack of intrinsic factor can lead to impaired RBC production and pernicious anemia. Recurring infections indicate decreased WBCs and immune response and corticosteroid therapy may cause a neutrophilia and lymphopenia. Oral contraceptive use is strongly associated with changes in blood coagulation.

What are the characteristics of neutrophils (select all that apply)? a. Also known as "segs" b. Band is immature cell c. First WBC at injury site d. Arises from megakaryocyte e. Increased in individuals with allergies f. 50% to 70% of WBCs

a, b, c, f These characteristics are evident with neutrophils. Platelets arise from megakaryocytes & are stored in the spleen. Eosinophils are increased in individuals with allergies and made up 2% to 4% of WBCs.

A patient with a bone marrow disorder has an overproduction of myeloblasts. The nurse would expect the results of a complete blood count (CBC) to include an increase in which cell types (select all that apply)? a. Basophils b. Eosinophils c. Monocytes d. Neutrophils e. Lymphocytes

a, b, d The myeloblast is a committed hematopoietic cell found in the bone marrow from which granulocytes develop. A disorder in which myeloblasts are overproduced would result in increased basophils, eosinophils, and neutrophils.

Which nutrients are essential for red blood cell production (select all that apply)? a. Iron b. Folic acid c. Vitamin C d. Vitamin D e. Vitamin B12 f. Carbohydrates

a, b, e Although all of the listed nutrients are helpful, iron, folic acid, and cobalamin (vitamin B12) are essential for erythropoiesis.

A patient who was in a car accident had abdominal trauma. Which organs may be damaged and contribute to altered function of the hematologic system (select all that apply)? a. Liver b. Spleen c. Stomach d. Gallbladder e. Lymph nodes

a, b, e The abdominal organs that are primarily involved in hematologic function are the liver, spleen, and lymph nodes. The liver filters the blood, produces procoagulants, and stores iron. The spleen removes old and defective erythrocytes and filters for reuse. The lymph nodes filter pathogens and foreign particles from lymphatic circulation.

Which cells are classified as granulocytes (select all that apply)? a. Basophil b. Monocyte c. Eosinophil d. Neutrophil e. Lymphocyte

a, c, d Basophils, eosinophils, & neutrophils are the granulocytic leukocytes. Lymphocytes are the agranular leukocytes that form the basis of the cellular and humoral immune responses. Monocytes are agranulocytes that are potent phagocytic cells.

Number the components of normal hemostasis in the order of occurrence, beginning with 1 for the first component and ending with 4 for the last component. _________a. Lysis of clot _________b. Vascular response _________c. Plasma clotting factors _________d. Platelet plug formation

a. 4 b. 1 c. 3 d. 2

If a patient with blood type O Rh+ is given AB Rh- blood, which would the nurse expect to happen? a. The patient's Rh factor will react with the RBCs of the donor blood. b. The anti-A and anti-B antibodies in the patient's blood will hemolyze the donor blood. c. The anti-A and anti-B antibodies in the donor blood will hemolyze the patient's blood. d. No adverse reaction is expected because the patient has no antibodies against the donor blood.

b

A patient with a hematologic disorder has a smooth, shiny, red tongue. Which lab result would the nurse expect to see? a. Neutrophils 45% b. Hgb 9.6 g/dL (96 g/L) c. WBC count 13,500/uL d. RBC count 6.4 x 10(power of 6)/uL

b A smooth, shiny, reddened tongue is an indication of iron-deficiency anemia or pernicious anemia that would be reflected by a decreased hemoglobin level. The decreased neutrophils would be indicative of neutropenia. The increased WBC count could be indicative of an infection and the increased RBC count of polycythemia.

Lab test results indicate increased fibrin split products (FSPs). An appropriate nursing action is to monitor the patient for a. fever. b. bleeding. c. faintness. d. thrombotic episodes.

b During fibrinolysis by plasmin, the fibrin clot is split into smaller molecules known as FSPs or FDPs. Increased FSPs impair platelet aggregation, reduce prothrombin, and prevent fibrin stabilization and lead to bleeding.

During physical assessment of a patient with thrombocytopenia, what would the nurse expect to find? a. Sternal tenderness b. Petechiae and purpura c. Jaundiced sclera and skin d. Tender, enlarged lymph nodes

b Petechiae are small, flat, red, or reddish-brown pinpoint microhemorrhages that occur on the skin when platelet levels are low. When petechiae are numerous, they group, causing reddish bruises known as purpura. Sternal tenderness is associated with leukemias. Jaundice occurs when anemias are of a hemolytic origin, resulting in accumulation of bile pigments from RBCs. Enlarged tender lymph nodes are associated with infection or cancer.

Molecular cytogenetics and gene analysis may be done to diagnose, stage, and help to determine treatment options for various hematologic disorders. Which sites are preferred to obtain the sample for this testing (select all that apply)? a. Skin sample b. Lymph node c. Bone marrow d. Arterial blood e. Inner cheek mucosa

b, c

The patient's lab results show a marked decrease in RBCs, WBCs, and platelets. What term should the nurse use when reporting the results to the physician? a. Hemolysis b. Leukopenia c. Pancytopenia d. Thrombocytosis

c

When teaching a patient about a bone marrow examination, what should the nurse explain? a. The procedure will be done under general anesthesia because it is so painful. b. The patient will not have any pain after the area at the puncture site is anesthetized. c. The patient will experience a brief, very sharp pain during aspiration of the bone marrow. d. There will be no pain during the procedure, but an ache will be present several days afterward.

c

A patient is being treated with chemotherapy. The nurse revises the patient's care plan based on which result? a. WBC count 4000/uL b. RBC count 3.8 x 10(power of 6)/uL c. Platelets 50,000/uL d. Hematocrit (Hct) 39%

c Any platelet count <150,000/uL is considered thrombocytopenia and could place the patient at risk for bleeding, necessitating special considerations in nursing care. Chemotherapy may cause bone marrow suppression and a depletion of all blood cells. The other factors are all within normal range.

When reviewing the results of an 83-year-old patient's blood tests, which finding would be of most concern to the nurse? a. Platelets 150,000/uL b. Serum iron 50 mcg/dL c. Partial thromboplastin time (PTT) 60 seconds d. Erythrocyte sedimentation rate (ESR) 35 mm in 1 hour

c As a person ages the partial thromboplastin time (PTT) is normally decreased, so an abnormally high PTT of 60 seconds is an indication that bleeding could readily occur. Platelets are unaffected by aging and 150,000/uL is a normal count. Serum iron levels are decreased and the erythrocyte sedimentation rate (ESR) is significantly increased with aging, as are reflected in these values.

An increase in which blood cell indicates an increased rate of erythropoiesis? a. Basophil b. Monocyte c. Reticulocyte d. Lymphocyte

c Increased reticulocytes, or immature RBCs, indicate an increased rate of erythropoiesis or stimulation of erythrocyte (RBC) production by the bone marrow. Basophils release granules that increase allergic and inflammatory responses and are stimulated by granulocyte colony-stimulating factor. Monocytes may become tissue macrophages. Lymphocytes are primarily responsible for the immune response.

A lymph node biopsy is most often performed to diagnose a. leukemia. b. cause of lymphedema. c. hemorrhagic tendencies. d. neoplastic cells in lymph nodes.

d