Ch. 21 Blood Cells and the Hematopoietic System

What are the components of blood? Select all that apply.

- Electrolytes - Enzymes

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?

Aplastic anemia and the anemia of kidney failure

Which type of white blood cells are related to the connective tissue mast cells and respond in allergic and hypersensitivity reactions?

Basophils

A client who has received chemotherapy has a steadily decreasing white blood cell count. To increase the neutrophil count, the nurse anticipates administering:

Granulocyte colony-stimulating factor

A client is admitted to the emergency department with a diagnosis of polycythemia. The nurse plans to assess for symptoms related to which problem?

Increased blood viscosity

Cytokines that affect hematopoiesis in bone marrow are called colony-stimulating factors (CSFs) based on their ability to perform which function in the body?

Stimulate growth of blood cells

Which statement about natural killer (NK) cells is the best explanation of their function when reviewing laboratory work for a 10-year-old child?

"The primary job of natural killer (NK) cells is to hunt down and destroy foreign cells in the body."

Which client requires the most rapid attention by the emergency department nurse?

A neutropenic client with a temperature of 101.8°F (38.8°C)

Which leukocyte is correctly matched with its function within the body?

Eosinophil—allergic reaction

Which function is the main job of lymphocytes?

Immune reaction

The nurse is caring for a pediatric client who will be having bone marrow aspiration from the posterior iliac crest. The parent asks why the sternum is not used to obtain the sample as this is the site used for another relative. How does the nurse respond?

In children, the sternal bone marrow cavity is much more shallow, increasing risk for damage to underlying organs.

Which type of cell is the most common leukocyte in normal blood?

Neutrophils

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?

Umbilical cord blood and bone marrow

A mother brings her child to the pediatric clinic because of irritability, loss of appetite, low-grade fever, pallor, and leg pain. Blood tests reveal anemia, thrombocytopenia, and an elevated leukocyte count with atypical lymphocytes. A diagnosis of acute lymphocytic leukemia (ALL) is confirmed with bone marrow studies. The child undergoes aggressive, high-dose chemotherapy with plans for a possible stem cell transplant. Which question is most appropriate for the nurse to ask the mother?

"When your child was born, did you save the umbilical cord blood in a blood bank?"

A client with chronic myelogenous leukemia (CML) has been diagnosed with terminal blast crisis. Which clinical manifestations should the nurse focus the assessment on for this client? Select all that apply.

- Shortness of breath and progressive dyspnea - Headache and lethargy - Increasing confusion

The nurse is reviewing the process of hematopoiesis from conception to adulthood with a student. The nurse outlines where blood cells are formed. Place each option in order from earliest to latest. Use all options.

- Yolk sac - Liver and spleen - Long bone marrow - Flat bone marrow

The nurse is reviewing the client's laboratory report. Select the report that represents a normal value for leukocytes.

6500 cells/mL (6.5 ×109/L)

Which person should the charge nurse assign as a roommate for a client diagnosed with aplastic anemia?

A client in traction with a broken femur

Which plasma protein is considered the most abundant type?

Albumin

A client 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. What is the most likely cause of the symptoms?

Allergic reaction

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

Which type of lymphocyte is involved with humoral-mediated immunity?

B lymphocytes

Select the option that best describes the production of T lymphocytes.

Bone marrow → thymus → lymph nodes

Which is considered a function of plasma?

Carrying nutrients

A nurse working in an emergency department is assigned to triage the following clients. Which client should the nurse evaluate first?

Client who has chemotherapy-induced neutropenia (decrease in neutrophil levels) and a temperature of 101.2°F (38.4°C)

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?

Complete blood count

Regulation of blood cells is thought to be controlled in part by which hormone-like growth factor?

Cytokines

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?

Danger of perforating the mediastinum and heart

A nurse is caring for a newborn that has developed a low platelet count. What could be the cause?

Decreased thrombopoietin (TPO)

A nurse is evaluating laboratory results of a client 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 cell is the nurse evaluating?

Eosinophil

A client 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 client is afebrile, denies any headaches, and reports a decrease in joint pain and fatigue. Based on these findings, the nurse anticipates which change to the treatment plan?

Gradually decrease the current dosage of prednisone and repeat ESR in 2 weeks.

A client undergoes a splenectomy following an automobile accident. The nurse monitors for which anatomical change most likely to occur following surgery?

Increased white blood cell (WBC) count

Which type of macrophages are found in the liver?

Kupffer cells

A physician is explaining to a 40-year-old male client 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 phenomenon would underlie the physician's explanation?

Macrophages form a capsule around the Mycobacterium tuberculosis bacteria, resulting in immune granulomas.

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

Neutrophils

A client is admitted to the hospital with an elevated temperature and flank pain. When reviewing the complete blood count (CBC), which level is the most important for the nurse to communicate to the health care provider?

Neutrophils 85%

When a white blood cell with differential count reveals an acute infection, which statement is correct regarding the client's neutrophils?

Neutrophils are the first white blood cell to elevate in an acute infection.

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.

The nurse is caring for a client with leukemia who 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?

Platelets

The nurse is reviewing a laboratory analysis of fluid collected from a client's wound. What characteristic does the nurse use to determine if the fluid was from the interstitial versus the intravascular space?

Presence of proteins supports that the fluid is from the intravascular space.

A client diagnosed with pancytopenia due to aplastic anemia is scheduled for which treatment that can correct bone marrow deficiencies?

Stem cell transplant

A client is diagnosed with acute leukemia. Which treatment therapy can be used to correct bone marrow failure and treat malignancies?

Stem cell transplant

The client's laboratory results indicate abnormalities. The nurse reviews the client's medical record for what possible cause of these results?

The client is prescribed a bone marrow-suppressing medication.

The nurse is teaching a client about how a vaccine can help create immunity to a virus. What information does the nurse provide?

The vaccine causes B lymphocytes to create antibodies against the virus.

A nurse is reviewing laboratory data for an older adult client. Which laboratory value should the nurse be most concerned about?

White blood cell (WBC) count 3500/mL

A nurse is reviewing the laboratory data for a hospitalized client. The nurse would be most concerned about which finding?

White blood cell (WBC) count of 2800/µL (2.80 x 109/L)

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?

White blood cells (WBCs) 18,500/µL (18.50 x 109/L)

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.

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:

cytokines