Chapter 30 Hematologic System

90 The patient has hematocrit 40% and red blood cell count 4.4 x 106 cells/μL. The formula to calculate mean corpuscular volume = Hct x 10/ RBC x 106 = 40 x 10/4.4 x 106 x 106 = 90 fL. Text Reference - p. 628

A 20-year-old male patient has hematocrit of 40 percent and a red blood cell count 4.4 x 106 cells/μL. What is the mean corpuscular volume of the patient? Record your answer using a whole number. ______ fL

2, 5 Splenectomy can result in increased platelet levels and impaired immunologic function as a consequence of the loss of storage and immunologic functions of the spleen. Fibrinolysis, fatigue, and cold intolerance are less likely to result from the loss of the spleen because coagulation and oxygenation are not primary responsibilities of the spleen. Text Reference - p. 618

A 30-year-old patient has undergone a splenectomy as a result of injuries suffered in a motor vehicle accident. Which phenomena are likely to result from the absence of the patient's spleen? Select all that apply. 1 Impaired fibrinolysis 2 Increased platelet levels 3 Increased eosinophil levels 4 Fatigue and cold intolerance 5 Impaired immunologic function

3 Hemoglobin levels commonly decrease in both men and women after middle age. However, the nurse should also check for signs of gastrointestinal bleeding. Total serum iron and total iron binding capacity are decreased in older adults but do not account for potential alterations due to disease process and do not result in anemia. Stomatitis is an inflammation of the mucous lining of any of the structures in the mouth, which may involve the cheeks, gums, tongue, lips, throat, and roof or floor of the mouth. Severe iron deficiency anemia can lead to stomatitis, but stomatitis does not cause anemia. Text Reference - p. 619

A 65-year-old adult with anemia experiences hypoxemia and poor intestinal iron absorption. The nurse recognizes that a low hemoglobin level that is common in the older population may be contributing to the patient's condition. Which other contributing factor should the nurse assess in the patient? 1 Decreased total serum iron 2 Stomatitis 3 Gastrointestinal bleeding 4 Decreased total iron binding capacity

4 Erythropoietin is a hormone secreted by the kidneys that stimulates the bone marrow cells to produce red blood cells (RBCs). Chronic kidney disease causes a reduction in erythropoietin production, which ultimately leads to a decreased production of RBCs. This results in anemia. Excessive blood loss results in anemia, but is not a likely cause in this patient. A decreased iron intake causes anemia, but is less likely in this patient. Hypothyroidism can indirectly lead to anemia, but it is not a cause in this patient, because the patient does not suffer from thyroid abnormality. The cause of anemia in this patient is related to the kidney disease. Text Reference - p. 614

A nurse is assessing a patient with chronic kidney disease. The nurse finds that the patient has pallor, and the blood reports are suggestive of anemia. What could be the most likely cause of anemia? 1 Excess blood loss 2 Decreased intake of iron 3 Decreased thyroid gland activity 4 Decreased erythropoietin production

2 A hard and fixed lymph node is an abnormal finding and warrants further investigation. Hard or fixed nodes suggest malignancy. Palpated nodes which are mobile, firm, and nontender are considered normal. Tender nodes usually indicate inflammation. Vitamin deficiency does not affect lymph nodes. Text Reference - p. 620

A nurse is performing a physical assessment of a patient and finds that the lymph nodes are hard and fixed. How should the nurse interpret the finding? 1 It is a normal finding. 2 It suggests malignancy. 3 It indicates inflammation. 4 It signifies vitamin deficiency.

3, 5, 2, 1, 4 A bone marrow aspiration involves obtaining bone marrow for cytological and chromosomal investigations. The bone marrow is usually aspirated from the posterior iliac crest. During a bone marrow aspiration, the skin over the puncture site is prepared by using a bactericidal agent. A local anesthetic agent is then infiltrated into the skin, subcutaneous tissue, and periosteum. Following this, a bone marrow needle is inserted into the bone through the cortex. The stylet of the needle is then removed and the hub is attached to 10-mLsyringe. The bone marrow is then aspirated. A volume of 0.2 to 0.5 mL is sufficient for laboratory investigations. Text Reference - p. 630

A nurse is providing preprocedural teaching to a patient who is scheduled for a bone marrow aspiration. Arrange the steps of performing a bone marrow aspiration in the correct order. 1. The stylet of the needle is then removed. 2. A bone marrow needle is inserted through the cortex of the bone. 3. The skin over the puncture site is cleansed with a bactericidal agent. 4. The hub is attached to a 10-mL syringe, and 0.2 to 0.5 mL of the fluid marrow is aspirated. 5. The skin, subcutaneous tissue, and periosteum are infiltrated with a local anesthetic agent.

3 In acute leukemia, a complete blood count shows a large number of immature blast white blood cells present in the blood. Pancytopenia is associated with a marked decrease in the number of red blood cells, white blood cells, and platelets. Neutropenia is a condition in which the absolute neutrophil count is less than 1000 cells/μL. Thrombocytopenia is a condition in which the platelet counts falls below 100,000/μL. Text Reference - p. 625

A nurse is reviewing a patient's laboratory reports, which show a large number of immature blast white blood cells in the blood. Which condition is likely to be found in the patient? 1 Pancytopenia 2 Neutropenia 3 Acute leukemia 4 Thrombocytopenia

1, 3, 5 Hemolysis means the destruction of RBCs. The most common sites of hemolysis in the body are the liver, spleen, and bone marrow. Kidneys filter the blood to produce urine, and are not involved in hemolysis. The stomach acts to help in digestion, and it is not involved in hemolysis. Text Reference - p. 614

A nurse provides education to a group of nursing students related to specific parts of the body that are involved in the process of hemolysis. Which body parts should be included in the teaching? Select all that apply. 1 Liver 2 Kidney 3 Spleen 4 Stomach 5 Bone marrow

3 Hemoglobin acts as a buffer and plays a role in maintaining acid-base balance. White blood cells help in immune function. Prothrombin is a coagulation factor and helps in clotting. Platelets help in clotting. Text Reference - p. 614

A nurse recalls that which factor is responsible for maintaining acid-base balance in the body? 1 White blood cells 2 Prothrombin 3 Hemoglobin 4 Platelets

1 A patient's medical report shows the white blood cell count to be 15 × 109/L. The normal range for a white blood cell count is between 4 × 109/L to 11 × 109/L. Elevations in white blood cell count are associated with infection, because white blood cells (WBCs) are immune cells. Neutropenia is a condition in which the absolute neutrophil count (ANC) is less than 1000 cells/μL. It does not increase the risk of bleeding. Thrombocytopenia is a condition in which platelet counts fall below 100,000/μL.

A nurse reviews the lab report of a patient that shows the white blood cell count is 15 × 109/L. Which condition is the patient likely experiencing? 1 Infection 2 Neutropenia 3 Risk of bleeding 4 Thrombocytopenia

4 Hemoglobin saturation results in hypoxemia and compromises brain function, causing the patient to experience difficulty with intracranial regulation. Red blood cell indices are special indicators that reflect red blood cell volume, color, and hemoglobin saturation. Hematocrit value gives the measure of packed cell volume of red blood cells. Hematocrit value is generally three times the hemoglobin value. Red blood cell morphology provides information regarding the size and shape of the patient's red blood cells. Total red blood cell count gives the number of circulating red blood cells. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 625

A patient has impaired intracranial regulation and hypoxemia. The primary health care provider prescribes red blood cell indices for the patient, and the patient later asks the nurse to explain the purpose of the test. What should the nurse tell the patient? 1 To measure the packed cell volume in the blood 2 To test the size and shape of the red blood cells 3 To measure the number of circulating red blood cells 4 To measure the gas-carrying capacity of the red blood cells

2, 5 During the bone scan the patient should lie down for better imaging. The patient should be advised to drink four to six glasses of water and then void before the imaging. This would help in visualization of the pelvic bones. The patient does not need to lie down in a small chamber or remove all metal objects. These interventions would be necessary for a magnetic resonance imaging (MRI). Presence of surgical staples interferes with an MRI, because they may obstruct the view; however, they do not interfere with the bone scan. Text Reference - p. 629

A patient is scheduled for a bone scan. A nurse explains the procedure to the patient. Which statements made by the patient indicate effective learning? Select all that apply. 1 "I will have to lie down in a small chamber during the test." 2 "I will have to maintain a lying down position during the procedure." 3 "I should remove all metal objects before the procedure." 4 "I should not have surgical staples inside my body as they can interfere with the procedure." 5 "I should drink four to six glasses of water and then void before the imaging."

2 Spontaneous bleeding from the nares indicates epistaxis in the patient, which can occur due to a low platelet count. The normal platelet count is 150,000 to 400,000/μL; therefore, a platelet count of 100,000/μL in the laboratory reports indicates a low count. A hemoglobin level of 18 g/dL and a RBC count of 6 million/μL indicate polycythemia, which causes flushing of the skin and visual abnormalities. A WBC count of 3500/μL indicates leukopenia, which is associated with bone marrow depression, severe or chronic illness, and some types of leukemia. Test-Taking Tip: Bleeding occurs due to abnormal clotting. Recollect the clotting process and components of blood involved in coagulation process to choose the correct option. Text Reference - p. 623

A patient reports bleeding from the nostrils. Upon further interaction, the patient reports that bleeding was spontaneous and started after lifting a heavy box from the ground. Which finding would the nurse expect in the laboratory reports of this patient? 1 A hemoglobin level of 18 g/dL 2 A platelet count of 100,000/μL 3 A white blood cell (WBC) count of 3500/μL 4 A red blood cell count (RBC) of 6 million cells/μL

3 Small vessel occlusions causing a purple, mottled appearance of the face, nose, fingers, or toes are the symptoms of erythrocytosis. It is a condition in which the proportion of blood volume occupied by red blood cells increases. Leukopenia is a condition in which the white blood cells count less than 4000/μL. Neutropenia is a condition in which the absolute neutrophil count (ANC) is less than 1000 cells/μL. Thrombocytopenia is a condition in which platelet counts falls below 100,000/μL. Text Reference - p. 623

A patient reports small vessel occlusions causing a purple, mottled appearance of the face, nose, and fingers. The nurse suspects that the patient is experiencing what disorder? 1 Leukopenia 2 Neutropenia 3 Erythrocytosis 4 Thrombocytopenia

4 After bone marrow aspiration, if bleeding is present at the site, the patient should be advised to lie on the affected side for 30 to 60 minutes to maintain pressure on the site. If the bed is too soft, the patient can lie on a rolled towel to provide additional pressure. Walking, sitting, and standing do not help to maintain pressure on the site. Text Reference - p. 630

A patient who has undergone bone marrow aspiration is being monitored by the nurse. The nurse observes that bleeding is present at the needle aspiration site. Which action should the nurse advise the patient to perform? 1 Walking for 10 to 15 minutes 2 Sitting for 30 to 40 minutes 3 Standing for 30 to 40 minutes 4 Lying on the side for 30 to 60 minutes

1 The spleen has four major functions: storage, filtration, immunologic, and hematopoietic. The spleen acts as a storage site for red blood cells and platelets. Thus, a patient with a splenectomy has higher circulating levels of platelets due to impaired storage function. If there is a high level of old and defective red blood cells, then the filtration function is affected. The spleen's immunologic function is demonstrated by a rich supply of lymphocytes, monocytes, and stored immunoglobulins. The spleen's hematopoietic function is demonstrated by a failure to produce red blood cells during fetal development. Text Reference - p. 618

A patient who underwent splenectomy has a platelet count of 500,000/μL. The nurse recognizes that due to the absence of the spleen, the increased number is due to the impairment of which major function of spleen? 1 Storage 2 Filtration 3 Immunologic 4 Hematopoietic

2, 4 In PET scan, a nuclear tracer substance is injected and is taken up by metabolically active cells. Before the test, the nurse should ensure that IV access is available, because it is required for injection of the tracer substance. Patients should have nothing by mouth except water and medications for at least four hours before the test, and IV solutions containing glucose can be held. Avoiding water, stopping medications, and feeding the patient before the test are not recommended. Text Reference - p. 629

A patient will have a positron emission tomography (PET) scan for diagnostic studies. Which actions should the nurse perform prior to the scan? Select all that apply. 1 Give IV fluids containing glucose. 2 Ensure IV access is available for injection. 3 Avoid water and stop medications. 4 Stop oral intake of food four hours before the test. 5 Administer the test directly after a meal.

1, 4 While checking for a history of chemical exposure, the nurse asks whether the patient has worked in the military or not. Many Vietnam War veterans were exposed to a toxin-containing defoliant. This toxin increases the risk of leukemia and lymphoma. Therefore, the nurse should ask if the patient has been in the military. A patient's occupation may cause exposure to chemicals like benzene, lead, naphthalene, and phenylbutazone. These chemicals are commonly used by potters, dry cleaners, and individuals involved with occupations that use adhesives. Some illnesses may cause a change in appetite and affect eating habits. Information about appetite and diet helps to determine dietary habits, but does not help in determining chemical exposure history. The dietary pattern of the patient is good, so there is no need to take a dietary history. Text Reference - p. 621

A patient with a history of a well-balanced nutritional intake is diagnosed with anemia. To determine potential exposure to chemicals, which questions should the nurse include in the history-taking? Select all that apply. 1 "Have you worked in the military?" 2 "Is your appetite affected?" 3 "What kind of diet do you follow?" 4 "Does your occupation expose you to hazardous substances?" 5 "Has your present illness caused a change in your eating habits?"

2 If a patient is tachycardic, the heart rate is above 100 beats/minute, which may occur in anemic patients as a compensatory mechanism to increase cardiac output. If a patient is bradycardic, the heart rate is below 60 beats/minute. Hypertensive and hypotensive refer to blood pressure readings, not the heart rate. STUDY TIP: Laughter is a great stress reliever. Watching a short program that makes you laugh, reading something funny, or sharing humor with friends helps decrease stress. Text Reference - p. 624

A patient with anemia presents with a heart rate of 120 beats/minute. As what should the nurse document the heart rate? 1 Bradycardic 2 Tachycardic 3 Hypertensive 4 Hypotensive

1 Positron emission tomography is an imaging technique that traces the malignancy based on increased glucose consumption. A patient with diabetes will have altered glucose levels, which will alter the test results. Therefore, the nurse reschedules the patient's medication five to six hours before the test. A patient with hypertension will not have any alteration in metabolism. Therefore, the patient can drink water and medication before the test. Peptic ulcer disease may result in bright red vomitus. However, it does not cause any alteration of metabolism. Rheumatoid arthritis is an autoimmune disorder, which results in anemia but does not alter metabolism. Test-Taking Tip: PET is an imaging technique useful to diagnose cancer cells. Recall the working of this technique, how can you distinguish cancer cells and tumor cells. This would help you to correlate with the condition. Text Reference - p. 620

A patient with leukemia is scheduled for a positron emission tomography. The nurse makes changes in the medication schedule so that the patient receives medication five to six hours before the test. What could be the reason behind this intervention? 1 The patient has diabetes. 2 The patient has hypertension. 3 The patient has peptic ulcer disease. 4 The patient has rheumatoid arthritis.

3 The patient's complete blood count is suppressed. There is a marked decrease in the number of RBCs, WBCs, and platelets. This condition is called pancytopenia. Leukopenia is a condition in which white blood cells count less than 4000/μL. Neutropenia is a condition in which the absolute neutrophil count (ANC) is less than 1000 cells/μL. Thrombocytopenia is condition in which platelet counts falls below 100,000/μL. Text Reference - p. 625

A patient's complete blood count is RBC 1.8 × 106/μL, WBC 2 × 109/L, platelets 90 × 109/L. How should the nurse interpret the test results? 1 Leukopenia 2 Neutropenia 3 Pancytopenia 4 Thrombocytopenia

1 The clot retraction is the reflection of the time it takes to retract or shrink the clot from the sides of the test tube. This normally takes between 1 and 24 hours. However, the patient has a clot retraction time of 48 hours, indicating abnormal platelet function. The normal thrombin time is 17 to 23 seconds and the patient has a thrombin time of 22 seconds. This indicates that the patient has normal thrombin activity. The normal prothrombin time is 11 to 16 seconds and the patient has a prothrombin time of 15 seconds. This indicates that the patient has normal results and no involvement of the extrinsic system. The activated clotting time indicates coagulation status and the normal activated clotting time is 70 to 120 seconds. The patient has an activated clotting time of 2 minutes, indicating that the patient has normal coagulation. Text Reference - p. 627

After assessing the laboratory reports of a patient, the nurse concludes that the patient has impaired platelet function. Which finding supports the nurse's conclusion? 1 A clot retraction of 48 hours 2 A thrombin time of 22 seconds 3 A prothrombin time of 15 seconds 4 An activated clotting time of 2 minutes

4 The nurse would ask the patient to sleep on the site of aspiration. This action reduces bleeding due to the application of pressure on the site. Warfarin is an anticoagulant, which increases bleeding. Therefore, the patient would have excess bleeding after taking warfarin. Ibuprofen is a nonsteroidal antiinflammatory drug used to help reduce pain. However, it is not effective in reducing bleeding. A soft bed will not apply as much pressure to the site. Hence, the nurse asks the patient to roll a towel and apply pressure to the site if sleeping on soft bed. Text Reference - p. 628

After performing the bone marrow aspiration, the nurse finds that the patient has bleeding at the site of aspiration. Which is the best nursing intervention in this situation? 1 Administering warfarin to the patient 2 Administering ibuprofen to the patient 3 Asking the patient to sleep on a soft bed 4 Asking the patient to sleep on the site for 30 minutes

2 The ileum is the site of cobalamin absorption, essential for proper functioning of the red blood cells. Therefore, the patient with an ileal resection will have a bleeding disorder due to impaired cobalamin absorption. The duodenum is the site for iron absorption. Therefore, the patient with a duodenal excision will have impaired iron absorption that results in a bleeding disorder. The patient with a partial or total gastrectomy will have a loss of parietal cells, which reduces the intrinsic factor levels. A patient who underwent a gastric bypass will have reduced parietal surface area, because the duodenum is bypassed. Text Reference - p. 620

After reviewing the medical records of a patient with a bleeding disorder, the nurse finds that the patient underwent an ileal resection. Which reason does the nurse suspect behind this finding? 1 Impaired iron absorption 2 Impaired cobalamin absorption 3 Decrease of intrinsic factor levels 4 Decrease of parietal cell surface area

3 Elderly patients may have low normal levels of hemoglobin. Aging leads to a decreased absorption of iron from the intestines. A low iron level leads to lower levels of hemoglobin in the elderly patients. Hepcidin is produced by the liver and is a key regulator of iron balance. Its production is not affected by aging. Elderly patients usually have a decreased iron-binding capacity, which also leads to low hemoglobin levels. Erythropoeitin secreted from the kidneys helps in the synthesis of hemoglobin; however, aging does not affect erythropoietin secretion. Text Reference - p. 618

An elderly patient has low hemoglobin levels. The patient is otherwise healthy and has no signs of gastrointestinal bleeding. The nurse recognizes that what could be the reason for the low hemoglobin level? 1 Low level of hepicidin 2 Increase in iron-binding capacity 3 Decrease in intestinal absorption of iron 4 Decrease in erythropoietin secretion from the kidneys

2, 3 Elderly patients usually show only a minimal elevation in the total WBC count. It may be due to decreased T-cell function and humoral antibody response related to aging. The laboratory reports may not be erroneous, because infections in elderly patients do not manifest as a high WBC count. There may not be any error in obtaining the sample. The elderly patient usually has a decreased bone marrow reserve of granulocyte, due to suppression of bone marrow. Text Reference - p. 618

An elderly patient is diagnosed with pneumonia. The nurse reviews the patient's laboratory report, which reveals a normal WBC count. What are the likely reasons that the lab result does not correspond to the diagnosis of pneumonia? Select all that apply. 1 The laboratory reports are erroneous. 2 The patient has decreased T-cell function. 3 The patient has decreased humoral antibody response. 4 The blood sample might not have been obtained properly. 5 The patient has increased bone marrow reserve of granulocyte.

40 The patient has a serum iron level of 120 mcg/dL and total iron binding capacity is 300 mcg/dL. The formula to calculate transferrin saturation level = (serum iron level/TIBC) x 100 = (120/300) x 100 = 40%. Text Reference - p. 628

Laboratory reports indicate that a patient has a serum iron level of 120 mcg/dL and total iron binding capacity is 300 mcg/dL. What is the transferrin saturation level of the patient? Record your answer using a whole number. _________%

2 An increase in the neutrophil count most commonly occurs in response to infection or inflammation. Hypoxemia and coagulation do not affect directly neutrophil production. Text Reference - p. 627

Results of a patient's most recent blood work indicate an elevated neutrophil level. The nurse should recognize that this diagnostic finding most likely suggests which problem? 1 Hypoxemia 2 An infection 3 A risk of hypocoagulation 4 An acute thrombotic event

3 The normal range for hemoglobin is 11 to16 g/dL in females and 13.2 to 17.3 mg/dL in males. Hemoglobin of 9 g/dL indicates anemia. The normal range of serum iron is 50 to 175 mcg/dL. The patient has 40 mcg/dL of serum iron, which indicates iron-deficiency anemia. The values of indirect bilirubin, folic acid, and vitamin B12 are within the normal range. The transferrin saturation is decreased in iron-deficiency anemia. The normal range of transferrin saturation is 15 to 50% but the patient has low transferrin saturation of 10% because of iron-deficiency anemia. A positive Coombs test can be observed in the patient with hemolytic anemia. The normal range for homocysteine is 3.7 to 10.4 μmol/L in females and 5.2 to 12.9 μmol/L in males. High homocysteine of 15 μmol/L is observed in patients with folic acid and cobalamin deficiency. A normal range for methylmalonic acid is <0.2 μmol/L. An increased methylmalonic acid level of 0.3 μmol/L is observed in patients with cobalamin deficiency. Text Reference - p. 628

The laboratory reports of a patient reveal a hemoglobin level of 9 mg/dL, a serum iron level of 40 mcg/dL, an indirect bilirubin level of 1 mg/dL, a vitamin B12 level of 250 pg/mL, and a folic acid level of 14 ng/mL. Which other finding will the nurse observe in the patient's report? 1 Positive coombs test 2 Homocysteine 15 μmol/L 3 Transferrin saturation of 10% 4 Methylmalonic acid 0.3 μmol/L

1 The effects of physiologic aging on clotting studies are increased D-dimer, increased erythrocyte sedimentation rate (ESR), increased fibrinogen and decreased activated partial thromboplastin time (aPTT). The normal value of D-dimer is less than 250 ng/mL. The patient has a D-dimer value of 260 ng/mL, which is an increased level. The patient's other lab results are normal. The normal value of fibrinogen is 200 to 400 mg/dL. The normal ESR value is less than 30 mm/hour. The normal aPTT is 25 to 35 seconds. Text Reference - p. 619

The nurse assesses the laboratory report of an elderly patient. Which finding is abnormal due to the aging process as recognized by the nurse? 1 D-dimer of 260 ng/mL 2 Fibrinogen of 300 mg/dL 3 Erythrocyte sedimentation rate (ESR) of 20 mm/hour 4 Activate partial thromboplastin time (aPTT) of 30 second

1 The presence of a red central portion with radiating branches on the face, neck, and chest indicates that the patient has spider nevus. An increase in estrogen level dilates blood vessels; hence, the patient will have swollen blood vessels resulting in spider nevus. A patient with a bleeding disorder will have reduced platelet count because blood coagulation is reduced. An increase in thyroid hormone levels increases the body's metabolism. However, it does not result in spider nevus or the dilation of blood vessels. A patient with an infection will have an increase in the white blood cell count. Text Reference - p. 623

The nurse is assessing a patient with a hematologic disorder and finds a red central portion with branching radiations on the patient's face, neck, and chest. Which laboratory finding does the nurse associate with the patient's condition? 1 Elevated estrogen level 2 Elevated platelet count 3 Elevated thyroid hormone level 4 Elevated white blood cell count

3 Neutropenia is a condition in which the absolute neutrophil count (ANC) is less than 1000 cells/μL. The absolute neutrophil count is determined by multiplying the total WBC count by the percentage of neutrophils. The ANC of a patient with WBC of 9000/μL and 10% neutrophils is 900 cells/μL. Therefore, the nurse suspects neutropenia in this patient. The ANC of a patient who has a WBC of 5000/μL and 30% neutrophils is 1500 cells/μL, which does not indicate neutropenia. The ANC of a patient with a WBC of 7000/μL and 30% neutrophils is 2100 cells/μL, which is normal. Therefore, the nurse does not suspect neutropenia in this patient. The ANC of patient who has a WBC of 10,000/μL and 10% neutrophils is 2000 cells/ μL, which is normal and does not indicate neutropenia. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 626

The nurse is assessing four patients in a clinical care setting. Which patient does the nurse suspect has neutropenia? 1 A patient with a WBC of 5000/μL and 30% neutrophils 2 A patient with a WBC of 7000/μL and 30% neutrophils 3 A patient with a WBC of 9000/μL and 10% neutrophils 4 A patient with a WBC of 10,000/μL and 10% neutrophils

3 The normal value for MCV is 80 to 100 fL and the normal value for MCH is 27 to 34 pg. Microcytosis is a condition in which red blood cells are unusually small. Low MCV or low MCH values indicate microcytosis or hypochromia. Therefore, the red blood cell indices of patient 3 with an MCH value of 25 pg and MCV value of 76 fL indicate microcytosis. Patient 1 has an MCH of 27 pg and MCV of 85 fL, which are within the normal range and do not indicate microcytosis. Patient 2 has an MCH of 30 pg and MCV of 80 fL, which are within the normal range. Patient 4 has an MCH of 40 pg and MCV of 105 fL, higher than the normal range. Therefore, this indicates macrocytosis. Text Reference - p. 626

The nurse is assessing laboratory reports that include the red blood cell indices of four patients in a clinical care setting. Which patient's red blood cell indices reflect microcytosis? 1 Patient 1 2 Patient 2 3 Patient 3 4 Patient 4

2 An increase in neutrophils in the blood is a common diagnostic indicator of infection and tissue injury. An increase in neutrophils is not seen with inflammation, allergic reaction, or cancer. Text Reference - p. 627

The nurse is assessing the laboratory work of an individual and notes an elevated neutrophil level in the blood. The nurse suspects that possibly the patient is experiencing which problem? 1 Cancer 2 Infection 3 Inflammation 4 Allergic reaction

2 A primary function of eosinophils is to engulf antigen-antibody complexes formed during an allergic response. Basophils show response in inflammation and allergic reactions. They respond by releasing substances within the granules. Thrombocytes initiate the clotting process by producing an initial platelet plug in the early phases of the process. The main function of granulocytes is phagocytosis. Text Reference - p. 615

The nurse is caring for a patient diagnosed with an allergy. Which cells in the body may have compromised functioning? 1 Basophils 2 Eosinophils 3 Thrombocytes 4 Granulocytes

1, 2, 3 Multiple myeloma is cancer of the bone marrow. A bone scan is used to evaluate the structures of bones in patients with multiple myeloma. A skeletal x-ray is used to detect lytic lesions associated with multiple myeloma. Bence Jones protein is found in patients with multiple myeloma. A negative finding is considered normal. Computed tomography is a noninvasive radiologic examination using a computer-assisted x-ray to evaluate the lymph nodes. Magnetic resonance imaging is a procedure that produces sensitive images of soft tissue. It is used to evaluate spleen, liver, and lymph nodes. Text Reference - p. 629

The nurse is caring for a patient suspected to have multiple myeloma. Which diagnostic tests does the nurse suspect to be beneficial for this patient? Select all that apply. 1 Bone scan 2 Skeletal x-ray 3 Bence Jones protein 4 Computed tomography 5 Magnetic resonance imaging

2 ABO incompatibilities result from hemolysis of the RBCs. RBCs agglutinate when a serum antibody is present to react with the antigen on the RBC membrane. Patient 2 from blood group B has a B antigen on RBCs and anti-A serum antibodies. Agglutination occurs in the blood of this patient if he or she receives a blood transfusion from a donor from blood group A or AB. Patient 1 from blood group A has the A antigen on the RBCs and anti-B antibodies in the serum. Therefore, a blood group A patient can receive blood only from donors from group A or O. Patient 3 with AB blood group has both A and B antigens on the RBCs and does not have anti-A or anti-B antibodies. Therefore, the patient from the AB blood group can receive blood from any group. A patient from the AB blood group is called a universal recipient. Patient 4 from the O blood group does not have either A or B antigens on the surface of RBCs but has anti-A and anti-B antibodies in the serum. Therefore, patient 4 can receive blood from only from a group O donor. Text Reference - p. 626

The nurse is caring for four patients receiving blood transfusions. Which patient is at risk for agglutination? 1 Patient 1 2 Patient 2 3 Patient 3 4 Patient 4

1, 3, 5 When taking a family history, it is important to explore hematologic conditions such as anemia, hemophilia (a bleeding disorder), and other clotting disorders. Information about influenza and conjunctivitis is not relevant to hematologic conditions. Text Reference - p. 620

The nurse is obtaining the family history of a patient. Which conditions should the nurse inquire about in order to obtain information regarding existing hematologic conditions? Select all that apply. 1 Anemia 2 Influenza 3 Hemophilia 4 Conjunctivitis 5 Clotting disorders

1 As a result of the aging process, hematologic values may change but are considered normal for the older adult. The serum iron level may be decreased. Ferratin levels are increased, total iron-binding capacity may be decreased, and ESR is increased. Text Reference - p. 619

The nurse is reviewing the hematologic study report of a 70-year-old patient. Which finding should the nurse consider normal for this patient? 1 Decreased serum iron 2 Decreased ferritin 3 Increased total iron-binding capacity 4 Decreased erythrocyte sedimentation rate (ESR)

2 ANC neutropenia indicates an increased risk of developing infection. Platelet count, total RBC count, and MCHC are in the normal range. Text Reference - p. 627

The nurse is reviewing the hematologic test results of a patient with leukemia. Which test result places the patient at high risk for developing infection? 1 Platelet count 150,000/μL 2 Absolute neutrophil count (ANC) 500 cells/μL 3 Total red blood cell (RBC) count 4.3 × 106/μL 4 Mean corpuscular hemoglobin concentration (MCHC) 35%

2 Eosinophils are granulocytes that phagocytize antigen-antibody complexes formed during an allergic response. The normal eosinophil count is 2% to 4% of all white blood cells (WBCs). The dry cough, lymphocyte result, and acetaminophen use do not indicate allergies. Text Reference - p. 616

The nurse is reviewing the objective data from a patient with suspected allergies. Which assessment finding does the nurse know indicates allergies? 1 Dry cough 2 Eosinophil result 3 Lymphocyte result 4 Acetaminophen use

2 Normal parameters for an adult female include: white blood cell (WBC) 4000-11,000/μL; red blood cell (RBC) 3.8-5.1 × 106/μL; Hgb 11.7-16.0 g/dL; Hct 35%-47%; platelet count 150,000-400,000/μL. The WBC count is elevated, indicating that the patient may have an infection. The patient is not neutropenic. The patient is not at risk for bleeding and does not have anemia. STUDY TIP: Determine whether you are a "lark" or an "owl." Larks, day people, do best getting up early and studying during daylight hours. Owls, night people, are more alert after dark and can remain up late at night studying, catching up on needed sleep during daylight hours. It is better to work with natural biorhythms than to try to conform to an arbitrary schedule. You will absorb material more quickly and retain it better if you use your most alert periods of each day for study. Of course, it is necessary to work around class and clinical schedules. Owls should attempt to register in afternoon or evening lectures and clinical sections; larks do better with morning lectures and day clinical sections. Text Reference - p. 627

The nurse is taking care of a female patient who has the following complete blood count results. Which result would cause the most concern? Refer to the chart. 1 The patient is neutropenic. Correct2 The patient may have an infection. 3 The patient is at risk for bleeding. 4 The patient is at fall risk because of anemia

2 The mean corpuscular hemoglobin concentration (MCHC) is 27%, which is lower than the normal range. The normal range of the mean corpuscular hemoglobin concentration is 32% to 37%. A decrease in this is termed hypochromia. Macrocytosis is a condition in which the mean corpuscular hemoglobin level is high. Spherocytosis is a condition in which the corpuscular hemoglobin concentration increases. Erythrocytosis is a condition in which the proportion of blood volume occupied by the red blood cells increases. It implies that the blood contains a greater number of red blood cells. Text Reference - p. 625

The nurse reviews a laboratory report of a patient that shows a mean corpuscular hemoglobin concentration (MCHC) of 27%. In which condition is the MCHC lower than the normal range? 1 Macrocytosis 2 Hypochromia 3 Spherocytosis 4 Erythrocytosis

1 Neutrophils are granular leukocytes that are involved in acute inflammatory responses. They engulf pathogens and die in one to two days. If there is an infection or sepsis, an increase in neutrophil count acts as a common diagnostic indicator. Therefore, Patient 1, with postoperative sepsis, would have an increased neutrophil count. Eosinophils are granular leukocytes that engulf antigen-antibody complexes formed during an allergic response. An increase in eosinophil count is seen in patients with neoplastic disorders such as Hodgkin's lymphoma, dermatitis, and connective tissue disorder. Text Reference - p. 616

The nurse reviews the laboratory reports of four patients. Which patient displays a common diagnostic indicator by an increase in the neutrophil count? 1 Patient 1 2 Patient 2 3 Patient 3 4 Patient 4

1 Lymphedema is the accumulation of lymphatic fluid due to an obstruction in the lymphatic flow or system. A mastectomy (the surgical removal of breast tissue) also involves the dissection of the axillary lymph nodes. This can obstruct the lymphatic flow, which can lead to lymphedema. Therefore, Patient 1 is at risk for developing lymphedema. Gastrectomies, splenectomies, and hepatectomies do not involve the resectioning or dissection of lymph nodes. Test-Taking Tip: The lymphatic system consists of lymph fluid, lymphatic capillaries, ducts, and lymph nodes that carry fluid from the interstitial spaces to the blood. This helps in selecting the correct answer. Text Reference - p. 618

The nurse reviews the medical records of four patients. Which patient is at risk for an alteration in the hematologic system that could lead to lymphedema? 1 Patient 1 2 Patient 2 3 Patient 3 4 Patient 4

1, 3, 4 Increased homocysteine and MMA, along with decreased cobalamin, indicate cobalamin deficiency, which is a nutrient needed for RBC production. Decreased reticulocytes indicate low bone marrow activity in producing RBCs, not available nutrients. Elevated ESR is related to an increased inflammatory process, not anemia. Text Reference - p. 616

The patient has anemia and has had laboratory tests done to diagnose the cause. Which results should the nurse know indicate a lack of nutrients needed to produce new red blood cells (RBCs)? Select all that apply. 1 Increased homocysteine 2 Decreased reticulocyte count 3 Decreased cobalamin (vitamin B12) 4 Increased methylmalonic acid (MMA) 5 Elevated erythrocyte sedimentation rate (ESR)

2 The sterile pressure dressing is applied after a bone marrow biopsy to ensure hemostasis. If bleeding is present, the patient will lie on the site and may need a rolled towel for additional pressure; thus, this patient will not be in the prone position. The analgesic should have been administered preprocedure. Metal objects would be removed for a magnetic resonance imaging (MRI), not a bone marrow biopsy. Text Reference - p. 630

The thrombocytopenic patient has had a bone marrow biopsy taken from the posterior iliac crest. What nursing care is the priority for this patient after this procedure? 1 Position the patient prone 2 Apply a pressure dressing 3 Administer analgesic for pain 4 Return metal objects to the patien

3 Lymphocytes are agranular leukocytes that form the basis of cellular and humoral immune responses. They constitute 20 percent to 40 percent of the white blood cells in the blood. Eosinophils are granular leukocytes; they constitute about 2 percent to 4 percent of leukocytes. Monocytes are agranular leukocytes that are approximately 4 percent to 8 percent of the white blood cells in the blood. Neutrophils are the most common granular leukocytes; they constitute about 50 percent to 70 percent of the white blood cells. Text Reference - p. 615

What is the percentage of lymphocytes in the blood? 1 2 percent to 4 percent 2 4 percent to 8 percent 3 20% to 40% 4 50% to 70%

2, 3, 4 Dark-colored urine or black-colored stools could mean presence of blood in urine or stool; decreased urine output may mean some abnormality and needs to be noted. Offensive sweating and excessive hunger and thirst are not related to elimination patterns in hematologic conditions. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses. Text Reference - p. 621

When assessing a patient's elimination patterns to determine the presence of hematologic conditions, the nurse should note which findings as important. Select all that apply. 1 Offensive sweating 2 Dark-colored urine 3 Black-colored stools 4 Decreased urine output 5 Excessive hunger and thirst

3 Hemoglobin levels begin to decrease in both men and women after middle age, with low normal levels seen in most older people. Platelet levels are unchanged. The total white blood cell (WBC) count and differential generally are not affected by aging. The ESR is increased with aging. Text Reference - p. 619

When reviewing laboratory results of an 83-year-old patient who came to the clinic for annual blood work, the nurse would expect to find 1 Decreased platelet count 2 Increased leukocyte count 3 Decreased hemoglobin levels 4 Decreased erythrocyte sedimentation rate (ESR)

2 Manufactured in the liver, fibrinogen (also known as clotting factor I) acts as a source of fibrin and helps to form clots. Calcium (coagulation factor IV) is required at several points in the coagulation cascade. Known as coagulation factor II, prothrombin is converted to thrombin, and activates fibrinogen. Proaccelerin is coagulation factor V, which binds with coagulation factor X to activate prothrombin. Text Reference - p. 618

Which blood coagulation factor acts as a source to form clot? 1 Calcium 2 Fibrinogen 3 Prothrombin 4 Proaccelerin

3 Monocytes are phagocytic; they ingest dead cells, tissue debris, and defective red blood cells. Basophils stimulate antigens in response to tissue injury. Eosinophils activate in response to allergies and engulf antigen-antibody complex. Thrombocytes (platelets) help in clot formation. Text Reference - p. 616

Which cells ingest dead cells, tissue debris, and defective red blood cells? 1 Basophils 2 Eosinophils 3 Monocytes 4 Thrombocytes

3 Clotting is a process that prevents excessive bleeding during an injury. During plug formation, the platelets stick to one another and form clumps. The von Willebrand factor is an important component in forming an adhesive bridge between platelets and vascular subendothelial structures. Serotonin and platelet factor 3 are substances formed from platelets during an agglutination or aggregation reaction; these chemicals facilitate coagulation. Adenosine diphosphate is released from platelets during an agglutination reaction; it increases adhesiveness. Test-Taking Tip: Blood clotting is an important process that prevents excessive bleeding when a blood vessel is injured. Read carefully to answer the question. Text Reference - p. 617

Which component forms an adhesive bridge between platelets and vascular subendothelial structures in the clotting process? 1 Serotonin 2 Platelet factor 3 3 Von Willebrand factor 4 Adenosine diphosphate

3 The given figure indicates the fibrinolytic system. Number 3 refers to the fibrinolysis process, in which binding of plasmin results in degradation of the clot. Plasminogen is degraded to plasmin, which is depicted as number 2 in the figure. Number 4 is a fibrin clot, in which red blood cells, platelets, and proteins are aggregated together. Number 1 is the plasminogen activator; it helps degrade plasminogen. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 618

Which component in the picture represents the process in which the binding of plasmin results in degradation of a clot? 1 Plasmin 2 Fibrin clot 3 Fibrinolysis 4 Plasminogen activator

4 Hemoglobin acts as a buffer that maintains blood acid-base balance. Platelets promote blood coagulation. Albumin is a plasma protein that helps to maintain oncotic pressure of blood. Leukocytes combat the invasion of pathogens. Text Reference - p. 615

Which component of the blood helps maintain acid-base balance? 1 Platelets 2 Albumin 3 Leukocytes 4 Hemoglobin

1, 2, 4 The last phase of hemostasis is the lysis of the clot, which allows the blood to return to a fluid state. Protein C, protein S, and antithrombin III factor all function as anticoagulants that help to lyse the clot. Proconvertin is factor VII, which activates factor IX and factor X to form a thrombin clot. Hageman factor is factor XII; it starts the intrinsic pathway to activate clot formation. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. Text Reference - p. 618

Which components play a major role in the last phase of hemostasis? Select all that apply. 1 Protein C 2 Protein S 3 Proconvertin 4 Antithrombin III 5 Hageman factor

4 Hematemesis is bright red, brown, or black vomitus, associated with an underlying disease like peptic ulcer disease. Thalassemia is a hereditary autosomal disorder characterized by the abnormal growth of red blood cells or hemoglobin. Sickle cell anemia is a hereditary disorder, which manifests as a distorted shape of hemoglobin. Pernicious anemia is a deficiency in the production of red blood cells due to lack of vitamin B12. Text Reference - p. 620

Which condition is the most common cause for hematemesis? 1 Thalassemia 2 Sickle cell disease 3 Pernicious anemia 4 Peptic ulcer disease

4 The effects of aging on hematologic studies include increased ferritin, increased mean cell volume (MCV), increased ESR, decreased serum iron, and decreased total iron binding capacity. A total iron binding capacity (TIBC) of 200 mcg/dL indicates a lower than normal value. The normal range of TIBC is 250 to 425 mcg/dL. The patient's ferritin, serum iron, and MCV values are normal. The normal ranges are ferritin 10 to 250 ng/mL, serum iron 50 to 175 mcg/dL, and MCV 80 to 100 fL. Test-Taking Tip: Recollecting the effects of physiological aging on the hematologic system and correlating them with normal laboratory values will help you choose the correct answer. Text Reference - p. 619

Which laboratory finding is abnormal due to the aging process? 1 Ferritin level of 200 μg/L 2 Serum iron level of 150 mcg/dL 3 Mean cell volume of (MCV) 90 fL 4 Total iron-binding capacity (TIBC) of 200 mcg/dL

1 Transferrin is a plasma protein that acts as a carrier for iron; the synthesis of this protein occurs in the liver. The spleen is the site for the synthesis of red blood cells during fetal development. Bone marrow is the site for maturation of red blood cells. Macrophages help to store ferritin, a storage form of iron. Text Reference - p. 616

Which organ acts as a site for the synthesis of iron carrier proteins? 1 Liver 2 Spleen 3 Bone marrow 4 Macrophages

2 Myeloblasts differentiate to form neutrophilic metamyelocytes, which further differentiate to create band cells. Band cells divides and give rise to neutrophils. Monoblasts creates monocytes. Erythroblasts differentiate to form erythrocytes, or red blood cells. Megakaryoblasts differentiate to form thrombocytes, or platelets. Text Reference - p. 614

Which stem cell differentiates to form neutrophils? 1 Monoblast 2 Myeloblast 3 Erythroblast 4 Megakaryoblast

3 A smooth, shiny tongue surface can be observed in patients with pernicious anemia. A pallor of the gingival and mucosal membrane is observed due to low hemoglobin level. Patients with neutropenia may have gingival and mucosal ulceration, swelling, or bleeding. Patients with polycythemia may have decreased visual acuity and transient episodic redness of the skin. A patient with elevated estrogen levels may have spider nevus, a form of telangiectasia. Text Reference - p. 623

While assessing a patient, the nurse finds a smooth and shiny tongue surface. What does the nurse infer from these findings? 1 The patient has neutropenia. 2 The patient has polycythemia. 3 The patient has pernicious anemia. 4 The patient has elevated estrogen levels.

2 In patients with red blood cell (RBC) disorders the skin may be pale or pasty, or it may have a cyanotic tinge in severe anemia. Yellowing of the skin, or jaundice, is caused by an accumulation of bile pigment caused by rapid or excessive hemolysis or liver damage. Flushed skin in the face and neck areas may indicate an increase in hemoglobin (polycythemia) or congestion of the capillaries. Erythrocytosis often produces small vessel occlusions, causing a purple, mottled appearance of the face, nose, fingers, or toes. Text Reference - p. 623

While assessing the skin of a patient with anemia, the nurse would look for which manifestations? 1 Yellow appearance of the skin 2 Color pale or with a cyanotic tinge 3 Flushed, red skin of the face and neck 4 Purple, mottled appearance of face, nose, or fingers

4 Methylmalonic acid (MMA) is an indirect test for cobalamin (vitamin B12) because MMA metabolism requires cobalamin. It helps to differentiate cobalamin deficiency from folic acid deficiency. The normal value of methylmalonic acid is less than 0.2 μmol/L. Therefore, a high methylmalonic acid level of 0.4 μmol/L indicates reduced metabolism due to a deficiency of cobalamin. Because the patient has a low hemoglobin level of 10 g/dL, the nurse infers that the patient has vitamin B12-deficiency anemia. The patient with hemolytic anemia will have high bilirubin levels and have a positive Coombs test. The patient with iron deficiency anemia will have decreased serum iron, ferritin, and an increased total iron binding capacity. The patient with folic acid deficiency anemia will have a value of folic acid less than 3 to16 ng/mL. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. Text Reference - p. 628

While reviewing the laboratory test results of a patient, the nurse finds that the patient's methylmalonic acid level is 0.4 μmol/L and hemoglobin is 10 mg/dL. What does the nurse infer from this finding? 1 The patient has hemolytic anemia. 2 The patient has iron-deficiency anemia. 3 The patient has folic acid deficiency anemia. 4 The patient has vitamin B12-deficiency anemia