CHAPTER 13 TAKEN PATHO FROMhttp://thepoint.lww.com/Book/Show
The staff educator is teaching the nurse orientee about red cell changes in the neonate. The educator knows that the orientee understands the neonatal changes and care when she states which of the following? a) "The physiologic anemia of the newborn can be treated with infant formula supplemented with iron." b) "The hemoglobin concentration falls after birth due to reduced red cell production and plasma dilution." c) "During the early neonatal period, there is a switch from HbA to HbF." d) "Neonatal red cells have a longer life span than those of older adults."
"The hemoglobin concentration falls after birth due to reduced red cell production and plasma dilution." The hemoglobin concentration falls after birth due to decreased red cell production and plasma dilution caused by increased blood volume with growth. Neonatal red cells have a shorter life span than those of an older adult. During the early neonatal period, there is a switch from HbF to HbA. The physiologic anemia of the newborn cannot be altered by nutritional supplements.
The lab technician is evaluating the student's knowledge of laboratory values for red blood cells. The technician knows the student has been studying when she correctly states which of the following? a) "Mean corpuscular volume (MCV) provides an index of the rate of red blood cell production." b) "The major components of blood are the red cell mass and plasma volume." c) "The hematocrit measures the red cell mass in a 200ml plasma volume." d) "The mean corpuscular hemoglobin concentration (MCHC) is the hemoglobin content in the blood."
"The major components of blood are the red cell mass and plasma volume." The major components of blood are the red cell mass and plasma volume. The MCV reflects the volume or size of the red cells. The MCHC is the concentration of hemoglobin in each cell. The hematocrit measures the red cell mass in a 100ml plasma volume
The nurse is teaching a 65-year-old client who is anemic. The client has a history of gastric bypass surgery and his lab work shows a cobalamin deficiency. Which of the following recommendations will help the client maintain an adequate level of cobalamin? a) "Eat a diet high in meat and cheese." b) "Eat a vegetarian diet and avoid dairy products." c) "You will need lifelong treatment consisting of intramuscular vitamin B12 injections." d) "Take normal doses of the vitamin for a few months."
"You will need lifelong treatment consisting of intramuscular vitamin B12 injections." Vitamin B12, or cobalamin, deficiency is seen in older adults due to malabsorption, which can be impacted by several factors, such as long-term proton pump inhibitors and metformin use or having had gastric bypass surgery. Vitamin B12 is found in all food of animal origin. Due to the malabsorption caused by the surgery, dietary intake will not be absorbed sufficiently. Lifelong treatment consists of intramuscular injections or high oral doses of vitamin B12.
Mature red blood cells have a life span of approximately how many days? a) 90 b) 120 c) 40 d) 240
120 Mature red blood cells have a life span of approximately 4 months, or 120 days.
Mature red blood cells have a life span of approximately: a) 10 days b) 30 days c) 120 days d) 90 days
120 days Normal red blood cells live 120 days.
The nursing is reviewing assessment data of four clients. Select the client who is at greatest risk for developing pernicious anemia. a) A client who has undergone partial gastrectomy b) A client who is recovering from a minor surgical procedure c) A client of Italian heritage d) A client diagnosed with a neoplastic disorder
A client who has undergone partial gastrectomy 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.
Which of the following is the most abundant type of plasma proteins? a) Beta globulin b) Fibrinogens c) Albumin d) Globulins
Albumin 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.
The provider is treating her client with regular blood transfusions and iron chelation therapy. The nurse knows the client has which type of anemia? a) Sickle cell disease b) Beta-thalassemia c) Deficiency of glucose-6-phosphate-dehydrogenase (G6PD) d) Alpha-thalassemia
Beta-thalassemia All of the above are hemolytic anemias. Iron overload is a major complication of beta-thalassemia. Iron chelation therapy can reduce the iron overload.
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. a) Iron deficiency b) Aplastic c) Hemolytic d) Blood loss
Blood loss 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.
After birth, red blood cells are normally made in which of the following locations? a) Kidneys b) Bone marrow c) Spleen d) Liver
Bone marrow 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
The provider examines a stained blood smear of a patient who is anemic and finds it to be abnormal. Which of the following tests can be performed to provide additional information about the maturity of cells and abnormal types? a) Red blood cell count b) Hematocrit c) Urinalysis d) Bone marrow aspiration
Bone marrow aspiration A stained blood smear provides information about the size, color and shape of red cells and the presence of immature or abnormal cells. If blood smear results are abnormal, examination of the bone marrow may be indicated. The other tests do not provide information about the size, color and shape of red cells.
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? a) Slow the rate of the blood infusion to 50 mL/hour. b) Discontinue the transfusion and begin an infusion of normal saline. c) Document the assessment as the only action. d) Re-check the type of blood infusing with the chart documentation of patient's blood type.
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 nurse is evaluating the laboratory values of a patient who developed a hemorrhage during surgery. Which of the following hematology results would the nurse expect to find? a) Hematocrit of 45% b) Decreased white blood cell (WBC) count c) Elevated reticulocyte count d) Hemoglobin 13.2 g/dL
Elevated reticulocyte count A reticulocyte is an immature red blood cell (RBC). A hemorrhage causes the release of more immature RBCs from the bone marrow into circulation.
The microbiology technician explains to the student that which of the following blood cells is the most common? a) Erythrocyte b) Platelet c) Neutrophil d) Lymphocyte
Erythrocyte The erythrocytes, 500 to 1000 times more numerous than other blood cells, are the most common type of blood cells.
The provider notes that the client's hemaglobin is 8.2g/dL. Which of the following supplements will the provider recommend to the client? a) Calcium carbonate b) Potassium chloride c) Ferrous sulfate d) Magnesium oxide
Ferrous sulfate Iron deficiency is a common, worldwide cause of anemia affecting people of all ages. The treatment of iron deficiency anemia in children and adults is directed toward controlling chronic blood loss, increasing dietary intake of iron, and administering supplemental iron. Ferrous sulfate is the usual oral replacement therapy.
Anemia refers to a deficiency of: a) Platelets b) Hemoglobin c) Blood plasma d) Folic acid
Hemoglobin 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 assessing a newly admitted client, noting pale skin and nail beds. Which of the following laboratory data should the nurse evaluate? a) White blood cell count b) Neutrophil count c) Red blood cell count d) Hemoglobin (Hgb) level
Hemoglobin (Hgb) level RBCs contain the oxygen-carrying protein, hemoglobin, that functions in the transport of oxygen. RBCs can concentrate hemoglobin in the cell fluid up to approximately 34 grams in each 100 mL of cells. Pallor of the skin or nail beds is a sign of anemia, which can be indicated by a low Hgb level
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? a) Tachycardia b) Low blood pressure c) Hypoxia d) Inflammation
Hypoxia 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.
The rate at which hemoglobin is synthesized depends on availability of which of the following?
Iron The rate at which hemoglobin is synthesized depends on the availabilty of iron for heme sythesis.
The rate at which hemoglobin is synthesized depends on availability of which of the following? a) Iron b) Oxygen c) Calcium d) Glucose
Iron 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? a) Aplastic anemia b) Sickle cell anemia c) Iron deficiency anemia d) Anemia related to kidney disease
Iron deficiency anemia 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? a) Splenectomy b) Continued monitoring with weekly laboratory tests c) Bone marrow transplant d) Iron replacement therapy
Iron replacement therapy Treatment for microcytic hemochromic anemia (iron deficiency anemia), is iron (ferrous sulfate) three times daily and follow-up monitoring
The nurse is educating a pregnant client about the importance of folic acid. Select the food that has the highest levels of folic acid. a) Kale b) Eggs c) Apples d) Carrots
Kale 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
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? a) Anemia b) Leukemia c) Thrombocytopenia d) Polycythemia
Polycythemia Unregulated overproduction of the red cell mass is termed polycythemia.
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: a) Polycythemia vera b) Hemolytic anemia c) Pernicious anemia d) Aplastic anemia
Polycythemia vera 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
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? a) Hemolytic anemia b) Hyperbilirubinemia c) Polycythemia vera d) Leukemia
Polycythemia vera 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
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? a) Radial artery b) Head of the femur c) Posterior iliac crest d) Antecubital space
Posterior iliac crest
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? a) Clavicle b) Anterior femur c) Posterior iliac crest d) Cervical spinous process
Posterior iliac crest 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.
When red blood cells age, which of the following organs are responsible for their destruction? a) Liver b) Spleen c) Kidneys d) Red bone marrow
Spleen When red blood cells age, they are destroyed in the spleen.
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. a) A decrease in the breakdown of red blood cells b) The inability of a newborn to produce bilirubin c) The inability of the immature liver to conjugate bilirubin d) Cirrhosis of the liver
The inability of the immature liver to conjugate bilirubin 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.
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: a) "They will look at your RBCs under a microscope to see if they have an irregular shape (poikilocytosis)." b) "They will be looking to see if you have enough ferritin in your blood." c) "They are looking for the presence of antibody or complement on the surface to the RBC." d) "They will wash your RBCs. Then mix the cells with a reagent to see if they clump together."
They are looking for the presence of antibody or complement on the surface to the RBC." 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.
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? a) Infection in the right leg b) Compartment syndrome in the right leg c) Edema in the right leg d) Thrombosis in the right leg
Thrombosis in the right leg 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? a) Iron sulfate supplements b) Transfusion therapy c) Warfarin, a blood thinner to decrease clot formation d) Stem cell transplant
Transfusion therapy 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.
The nurse is caring for a client who is a strict vegetarian; the client is at greatest risk for the development of: a) Vitamin B12 deficiency anemia b) Blood loss anemia c) Microcytic anemia d) Folic acid deficiency anemia
Vitamin B12 deficiency anemia 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.
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: a) Tissue hypoxia to the brain b) Insufficient hemoglobin c) Presence of systolic murmur d) Changes in blood viscosity
b) Insufficient hemoglobin 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.
Which of the following would be tested by a complete blood count (CBC)? a) Size and shape of blood cells b) Red blood cells and platelets c) Sodium and potassium d) Lymphocytes and neutrophils
b) Red blood cells and platelets 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. a) Presence of pain in the client's joints b) Acute chest syndrome c) Reduced oxygen tension while the client sleeps d) Rapid administration of intravenous fluids
c) Reduced oxygen tension while the client sleeps 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
If an Rh-negative mother is giving birth to an Rh-positive infant, the nurse should be prepared to administer: a) Antihistamines like Benadryl. b) Alpha interferon. c) Rh immune globulin. d) A monoclonal antibody like infliximab.
c) Rh immune globulin. The injection of Rh immune globulin prevents sensitization in Rh-negative mothers who have given birth to Rh-positive infants if administered at 28 weeks' gestation and within 72 hours of delivery, abortion, or genetic amniocentesis. Antihistamines, alpha interferon, or infliximab are not used in this situation
A client presents to the emergency department with severe menstrual bleeding where she is soaking three to 4 pads/hour. Following assessment, which of the following findings indicates that her body is trying to increase its cardiac output? Select all that apply. a) Light pink mucous membranes b) Deep respirations with expiratory wheezes c) Complaints of chest "palpitations" d) Pale bluish nail beds e) Heart rate 120 beats/minute
• Heart rate 120 beats/minute • Complaints of chest "palpitations" Anemia is frequently the result of tissue oxygen deficit, which is secondary to decreased circulating red blood cells (RBCs) or hemoglobin for oxygen delivery. The redistribution of the blood from cutaneous tissues or the lack of hemoglobin causes pallor of the skin, mucous membranes, conjunctivae, and nail beds. Tachycardia and palpitations may occur as the body tries to compensate with an increase in cardiac output.
A nursing instructor questions students on the removal of erythrocytes from the body. The instructor knows that the students understand when which of the following locations are identified at the site of removal by macrophages? Select all that apply. a) Thymus b) Spleen c) Liver d) Bone marrow e) Appendix
• Liver • Spleen • Bone marrow Ninety percent of erythrocytes, which originate in bone marrow, live approximately 120 days in the circulation and then are phagocytosed in the bone marrow, spleen, and liver.
The nurse is starting a blood transfusion for an anemic client. The nurse monitors the client for which of the following signs and symptoms of a transfusion reaction? Select all that apply. a) Bradycardia b) Pallor of the face c) Swollen, itchy areas on the skin d) Pain in the lumbar area e) Dyspnea
• Swollen, itchy areas on the skin • Pain in the lumbar area • Dyspnea The immediate hemolytic reaction usually is caused by ABO incompatibility. The signs and symptoms of such a reaction include sensation of heat along the vein where the blood is being infused, flushing of the face, urticaria (swollen, itchy areas on the skin), headache, pain in the lumbar area, chills, fever, constricting pain in the chest, cramping pain in the abdomen, nausea, vomiting, tachycardia, hypotension and dyspnea.
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? a) "The doctor may start looking for another cause of his anemia, maybe cancer of the bone." b) "Due stress, the red blood cells of older adults are not replaced as promptly as younger people." c) "Everything slows down when you get older. You just have to wait and see what happens." d) "Don't worry about it. We can always give him more blood."
"Due stress, the red blood cells of older adults are not replaced as promptly as younger people." 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.
