Chapter 46: Care of the Patient with a Blood or Lymphatic Disorder

46.Arrange the process of hemostasis in sequence. a. Release of clotting factor from injured tissue b. Formation of thrombin c. Formation of fibrin d. Trapping of RBC and platelets e. Clot f. Release of thromboplastin

A, F, B, C, D, E Clotting factors are released from the injured tissue causing the release of thromboplastin, which acts with calcium to form thrombin; fibrin is formed, which traps red cells and platelets to make the clot.

43.The nurse clarifies that ____________ _______________ replaces iron stores needed for red blood cell production.

ANS: Ferrous sulfate replaces iron stores needed for red blood cell production.

41._____________ are leukocytes that destroy and remove cellular waste, bacteria, and solid particles.

ANS: Neutrophils (granular circulating leukocytes essential for phagocytosis, the process by which bacteria, cellular debris, and solid particles are destroyed and removed) ingest bacteria and dispose of dead tissue.

42.The person with aplastic anemia is said to be _________________ because all three major blood elements (RBCs, WBCs, and platelets) are diminished or absent.

ANS: pancytopenic Persons with aplastic anemia are deficient in all three of the major blood elements, a condition known as pancytopenia.

17.The 9-year-old child with leukemia who is on palliative care has drawn a picture of a boy under a huge black cloud that has lightning coming out of it. Which of the following would be an appropriate intervention for the nurse? a. What is this picture about? b. Are you afraid of lightning? c. I bet this is a picture of you, isnt it? d. Is it about to rain in your picture?

ANS: A Asking what the child has drawn is a neutral and nonthreatening question. Drawings can give a clue to perceptions and emotions that a young child may not be able to verbalize. The nurse should not try to interpret the drawing.

30.Which mandatory practice is the most effective and significant nursing practice to prevent the spread of infection? a. Strict and frequent handwashing by all people having contact with the patient b. Placement of patients in private rooms with high-efficiency particulate air (HEPA) filtration c. Administration of combinations of prophylactic antibiotics d. Creation of a sterile environment for the patient with the use of laminar airflow rooms

ANS: A Meticulous handwashing by medical and nursing personnel and strict asepsis are mandatory.

21.The nurse caring for a child with hemophilia who is hospitalized with hemarthrosis should include which of the following in the plan of care? a. Splint the affected leg to maintain anatomic alignment b. Apply warm compresses to reduce hemorrhage in the joint c. Use analgesia sparingly d. Encourage vigorous ROM exercises several times a day to keep knee flexible

ANS: A Splinting the affected knee is necessary to retain anatomic alignment while the pain is severe. Analgesia should be given as needed. Physical therapy and ROM are appropriate after pain has subsided

25.Which of the following foods would the nurse recommend to a person with iron deficiency anemia as an excellent meat source for erythropoiesis? a. Dark meat of chicken b. Cured ham c. Pork chops d. Processed meat

ANS: A The dark meat of poultry is a good meat source for erythropoiesis.

6.The presence of excess bands in the peripheral blood that indicate severe infection is called: a. shift to the left. b. shift to the right. c. bone marrow aspiration. d. thrombocytosis.

ANS: A The presence of excess bands in the peripheral blood is called a shift to the left (i.e., a shift toward immature cells) and indicates severe infection

36.The spleen is a highly vascularized organ located in the left upper quadrant of the abdominal cavity. What are the main functions of the spleen? (Select all that apply.) a. Serve as reservoir for blood b. Destroy worn-out RBCs c. Promote phagocytosis d. Responsible for development of T lymphocytes e. Continuously produce RBCs during lifetime

ANS: A, B, C The spleen stores 1 pint of blood, which can be released during emergencies, such as hemorrhage, in less than 60 seconds. The main functions of the spleen are (1) to serve as a reservoir for blood; (2) to form lymphocytes, monocytes, and plasma cells; (3) to destroy worn-out RBCs; (4) to remove bacteria by phagocytosis (engulfing and digesting); and (5) to produce RBCs before birth (the spleen is believed to produce RBCs after birth only in cases of extreme hemolytic anemia)

37.The nurse examines the complete blood count (CBC) to assess (select all that apply): a. hematocrit. b. red cell count. c. differential white cell count. d. plasma level. e. blood type. f. hemoglobin.

ANS: A, B, C, F The CBC gives information relative to RBC, WBC, hematocrit, hemoglobin, erythrocyte indexes, WBC differential, and examination of the peripheral blood cells.

39.The nurse caring for a patient in the emergency room with suspected internal injuries will assess for hypovolemic shock, which is evidenced by (select all that apply): a. irritability. b. restlessness. c. slow bounding pulse. d. decreased respirations. e. pallor. f. hypotension.

ANS: A, B, E, F Indicators of hypovolemia are restlessness, irritability, rapid thready pulse, increasing respirations, pale, cool moist skin, and hypotension, Should the blood loss continue, the patient could go into hypovolemic shock.

22.In caring for a patient with multiple myeloma, what should the nurse include in the daily care? a. Provisions for limiting fluid intake to less than 1000 mL/day b. Provisions for close supervision and assistance when ambulating c. Provisions for straining all urine d. Provisions for limiting use of an analgesic

ANS: B Because of the constant threat of pathologic fractures, ambulation should be carefully supervised and assisted. Uric acid is increased and may crystalize in the kidney, but straining is not necessary. Analgesia is necessary for relief of bone pain.

16.What must a patient undergo before a bone marrow transplant? a. A thorough nutritional plan to support new marrow b. Total body irradiation to kill all the marrow cells c. A physical therapy program to strengthen the body d. Inhalation therapy to reduce possible pathogens in the lungs

ANS: B Before the actual marrow transplant, the patient must undergo total body irradiation or chemotherapy to kill all the marrow cells and the leukemic cells. The patient is at a major risk for infection at this time.

32.Because older adults suffer from conditions such as colonic diverticula, hiatal hernia, and ulcerations that can cause occult bleeding, the nurse should assess for symptoms of: a. leukemia. b. iron deficiency anemia. c. sickle cell anemia. d. polycythemia.

ANS: B Blood loss is a major cause of iron deficiency in adults. The major sources of chronic blood loss are from the GI and genitourinary systems

18.The home health nurse recommends to the mother of a 12-year-old child with leukemia that the child should have: a. the series for prevention of hepatitis B. b. an annual influenza vaccine. c. an annual pneumococcal vaccine. d. vitamin B12 shots.

ANS: B Children with leukemia should have an annual influenza vaccine and a pneumococcal vaccine every 5 years.

9.What does the elevation in the eosinophil count to 10% indicate? a. Anemia b. Allergy c. Infection d. Hypoxia

ANS: B Normal values of eosinophils are 1% to 4%. An elevation to 10% would indicate the presence of an allergic reaction

2.The nurse caring for a patient with pernicious anemia should make provisions for: a. frequent iced drinks. b. lightweight blanket. c. a fan to circulate the air. d. reverse isolation.

ANS: B Persons with pernicious anemia are especially sensitive to cold. The provision of a light blanket is beneficial.

27.The typical medical treatment of polycythemia vera involves repeated phlebotomies and medications such as busulfan (Myleran) in order to: a. stimulate bone marrow. b. inhibit bone marrow activity. c. increase hemoglobin. d. reduce gout.

ANS: B Repeated phlebotomy decreases blood viscosity, and myelosuppressive agents such as busulfan (Myleran) are often given to inhibit bone marrow activity.

23.The nurse is aware that a person with Hodgkin disease, who has two or more abnormal lymph nodes on the same side of the diaphragm and involvement of extranodal involvement on the same side of the diaphragm, would be in: a. stage I b. stage II c. stage III d. stage IV

ANS: B Stage II indicates that there are two or more abnormal lymph nodes on the same side of the diaphragm and extranodal involvement on the same side of the diaphragm.

7.A patient who had a Schilling test shows a 20% excretion of the radioactive vitamin B12. What would this indicate? a. The patient has a low reserve of iron and has iron deficiency anemia. b. The patient has a normal finding and does not have pernicious anemia. c. The patient has a deficiency of thrombocytes and has a clotting disorder. d. The patient has an excess of RBCs and has polycythemia.

ANS: B The Schilling test is a laboratory blood test for diagnosing pernicious anemia. The normal reading 24 hours after the administration of radioactive vitamin B12 is 8% to 40%. The test measures the absorption of radioactive vitamin B12.

35.What are the most likely matches for a bone marrow transplant to a 10-year-old with leukemia? (Select all that apply.) a. Uncle b. Self c. Mother d. Brother e. Sister f. Father

ANS: B, D, E Specimens from twins, siblings, or self (autologous) while in remission are preferred.

38.Which of the following are necessary factors that support healthy erythropoiesis? (Select all that apply.) a. Dietary magnesium b. Healthy bone marrow c. Adequate oxygen source d. Vitamin B12 e. Amino acids f. Vitamin B2

ANS: B, D, E, F Erythropoiesis, red blood cell production, is dependent on the availability of healthy bone marrow, dietary supply of copper and iron, amino acids, vitamins B12 and B2, folic acid, and pyridoxine.

40.Which of the following are B symptoms of a patient with Hodgkin disease? (Select all that apply.) a. Hematuria b. Night sweats c. Severe diarrhea d. Weight gain from edema e. Fever f. Persistent dry cough

ANS: B, E The B symptoms of Hodgkin disease are night sweats, fever, and weight loss. These symptoms are associated with a poor prognosis.

11.Approximately how much blood is stored in the spleen that can be released in a hypovolemic emergency? a. 100 mL b. 300 mL c. 500 mL d. 1000 mL

ANS: C The spleen stores 1 pint of blood, approximately 500 mL, which can be released during emergencies

3.The nurse assessing a differential sees an increase in immature neutrophils (bands) and is aware that this indicates: a. a significant hemorrhage. b. aplastic anemia. c. an overwhelming bacterial infection. d. beginning recovery from an infection.

ANS: C An increase in immature neutrophils (bands) is called bandemia, and it indicates an overwhelming bacterial infection.

4.B cells and T cells fit under which classification? a. Erythrocytes b. Basophils c. Lymphocytes d. Monocytes

ANS: C B cells and T cells, the major players in the antigen/antibody conflict, are both lymphocytes

20.A 23-year-old male patient with hemophilia A says, How can I keep my children from having hemophilia A? Which of the following is the most informative response? a. You need to select a very dependable mode of birth control. b. You can only pass hemophilia B to your sons. c. Your daughter may be a carrier and her children may have hemophilia A. Your son is not at risk. d. Your sons should have coagulation studies.

ANS: C Hemophilia A is an X-linked trait. Females are carriers; therefore, the patients daughter could pass the disease to her sons. The patients sons are not at risk for hemophilia A.

13.When instructing the patient taking an oral liquid iron preparation, what should the nurse include? a. Information relative to taking the iron with milk b. Information relative to the bowel movement color changing to dark red c. Information relative to taking preparation through a straw to prevent staining of teeth d. Information relative to taking a drug with meals or a snack

ANS: C Liquid iron preparations should be drunk through a straw to prevent tooth staining. All oral iron preparations should be taken before meals. Dairy products interfere with the absorption of iron.

14.When the 14-year-old African American boy comes into the emergency room in sickle cell crisis, what should be the primary focus of care? a. Instruct patient about transfusion procedure b. Starting of IV fluids c. Pain control d. Relief of dyspnea

ANS: C Pain control during the crisis is the focus. Continuous opioids are the mainstay of pain management. Certainly IV fluids to reduce viscosity of blood and oxygen for relief of dyspnea are important, but pain control is paramount in the acute phase.

1.What is the process by which certain cells engulf and digest microorganisms and cellular debris? a. Erythrocytosis b. Hematocrit c. Phagocytosis d. Hemostasis

ANS: C Phagocytosis is the process by which bacteria, cellular debris, and solid particles are destroyed and removed.

10.What would a nurse include in a teaching plan for a home health patient with a hemoglobin of 8.4 mg? a. Exercising for periods of 30 minutes daily b. Limiting fluid intake c. Alternating activity with rest periods d. Avoiding the use of oxygen

ANS: C Severely anemic persons need to conserve their energy. Observing a rest period after a period of activity will reduce hypoxia. Oxygen may be used as necessary.

31.What is the average life span of an erythrocyte? a. 7 days b. 60 days c. 120 days d. Up to several years

ANS: C The life span of an RBC is 120 days. A WBCs life span is days to several years. Platelets live 5 to 9 days.

28.Which of the following would the nurse explain as the most common type of leukemia that affects children? a. Chronic lymphocytic leukemia (CLL) b. Acute myeloid leukemia (AML) c. Acute lymphocytic leukemia (ALL) d. Chronic myeloid leukemia (CML)

ANS: C The most common type of leukemia that affects children is the fast-advancing ALL. This leukemia can also affect adults.

26.The peripheral smear is a diagnostic test that: a. assesses the level of hemoglobin. b. measures antibody production. c. examines the shape and structure of RBCs. d. identifies infection.

ANS: C The peripheral smear allows the study of the size, structure, and shape of RBCs.

34.From which location would the bone marrow sample come in the aspiration of a 25-year-old patient? a. Sternum b. Posterior superior iliac crest c. Posterior iliac crest d. Femur

ANS: C The preferred site for bone marrow aspiration puncture in adults is the posterior iliac crest.

2.The nurse explains that because it is a reliable and predictable indicator of the bodys level of infection or recovery the _____________________ is a common diagnostic tool. a. Hemoglobin b. Hematocrit c. Mean cell volume (MCV) d. Differential

ANS: D A differential white blood cell count is an examination in which the different kinds of WBCs are counted and reported as percentages of the total examined. It is a common diagnostic tool because of its reliability and the predictability of the bodys response to infection or its progress in recovery.

19.Which patient statement from a 15-year-old girl with thrombocytopenia would require more assessment to report to the charge nurse? a. I think these red spots on my skin are going away. b. I am so bored lying in bed I could scream. c. My bowel movement is brown and stinks. d. I have this really weird Coke-colored urine.

ANS: D Coke-colored urine is hematuria that should be documented and reported to the charge nurse. The purpura will fade as they are absorbed. Boredom and smelly stools are normal for a 14-year-old.

8.In an adult, where are erythrocytes continuously produced? a. Yellow bone marrow b. Lymphatic system c. Spleen d. Red bone marrow

ANS: D Erythrocytes are continuously produced in the red bone marrow, principally in the vertebrae, ribs, and sternum.

5.The nurse explains that in the event of an invasion of an allergen, the basophils release a strong vasodilator, which is: a. lysozyme. b. prothrombin. c. hematocrit. d. histamine.

ANS: D Histamine is released by the basophils during the invasion of an allergen.

29.The nurse is aware that persons of the Jehovahs Witness faith accept which types of blood transfusions? a. No type of blood transfusion b. Blood that has been blessed by their religious leader c. Transfusions only for persons who have not yet been baptized d. Autologous blood transfusions

ANS: D Jehovahs Witness followers are accepting of autologous blood transfusions and some will accept volume expanders such as colloids.

15.The mother of a 4-year-old child with leukemia says to the nurse, I dont understand why he is crying about his legs hurting. The nurses most informative response would be based on the information that bone pain is related to: a. Elevated WBCs in differential b. Long periods of inactivity c. Splenomegaly d. Bone marrow congested with white cells

ANS: D Long bone pain is the result of bone marrow that is congested with immature white cells

24.The nurse explains that a positron emission tomography (PET) has been ordered to: a. assess bone marrow depression. b. measure bone density. c. radiate and destroy diseased lymph nodes. d. measure lymph node response to therapy.

ANS: D The PET can measure the effect of therapy on diseased nodes.

47.Outline the sequence of the process that stimulates the increase in the production of red blood cells. a. Kidneys release erythropoietic factor b. Increase in red blood cell production c. Enzyme stimulates red bone marrow d. Oxygen delivery increased to the tissues e. Oxygen delivery decreased to the tissues f, Decrease in red blood cell production

E, A, C, B, D, F When the tissues of the body register a decrease of oxygen, the kidneys release the erythropoietic factor that stimulates the bone marrow to produce more RBCs, which increases the oxygen delivery to the tissues which then signals the bone marrow to decrease the RBC production.

45.The Reed-Sternberg cell is the hallmark diagnostic indicator for _______________ __________

Hodgkin disease The Reed-Sternberg cell, large abnormal multinucleated cells in the lymph nodes, is diagnostic of Hodgkin disease.

44.Neutrophils release ______________, an enzyme that destroys certain bacteria.

Lysozyme is an enzyme released by the neutrophils that kills certain bacteria when the bacteria is recognized in the body.