Complex Health Challenges I - Hematological Disorders

Which finding is associated with a "shift to the left"? A. Active infection or inflammation B. Iron deficiency C. Bleeding disorder D. Nausea and vomiting

A A "shift to the left," when many immature cells (immature neutrophils/bands) are present in the blood, indicates active infection or inflammation.

Which anatomical location of the abdomen houses the spleen? A. Upper left quadrant B. Upper right quadrant C. Lower left quadrant D. Lower right quadrant

A

Which blood cell test is associated with risk of spontaneous hemorrhage if its counts fall below 10 × 109/L? A. Platelet count B. Hemoglobin C. White blood cells D. Red blood cell indices

A

Which characterization describes myelodysplastic syndrome (MDS)? A. Patients with MDS have peripheral blood cytopenia and hypercellular bone marrow exhibiting dysplastic changes. B. Patients with MDS have peripheral blood cytopenia and hypocellular bone marrow exhibiting dysplastic changes. C. Patients with MDS typically have a genetic disorder affecting the quality of their bone marrow. D. MDS is the most common form of hematological disorder in Canada for all age groups.

A

Which classification system is the most accurate means of identifying anemias? A. Morphological system B. Etiological classification C. NYHA classification system D. ABO system

A

Which education will the nurse provide to the patient with hemophilia? A. "Minor scrapes can be managed at home. If you have blood in your urine, cuts requiring stitches, or a head injury, you will need to seek medical attention immediately." B. "Be sure to avoid dark leafy greens in your diet. These contain vitamin K, which will interfere with your heparin." C. "You can play soccer and football as long as you wear the proper safety equipment." D. "When performing dental hygiene, floss aggressively to prevent gum infections."

A

Which statement about anemia in older adults is accurate? A. A slight decrease in HB occurs in healthy women between ages 70 and 88. B. Cytokine dysregulation is the most common cause of anemia in the older adults. C. Anemia is common in older adults. D. Anemia prevalence decreases after age 65.

A

Which treatment is priority for anemia caused by chronic blood loss? A. Identify source and stop the bleed B. Identify source and administer packed RBCs C. Administer vitamin B12 supplements D. Apply pressure to the source to stop the bleed

A

Which type of bone marrow is present in the flat and irregular bones? A. Red (hematopoietic) B. Yellow (adipose) C. Red (adipose) D. Yellow (hematopoietic)

A

Which lymph node assessment finding is abnormal? A. Fixed (not moveable) B. Size 0.5 cm C. Nontender D. Firm texture

A A fixed lymph node is considered an abnormal finding. A normal lymph node is movable on palpation. Lymph nodes between 0.5 and 1.0 cm are considered normal. A nontender lymph node is considered normal. A firm texture lymph node is considered normal, but a hard node is suggestive of malignancy.

Which diagnostic test evaluates the morphological features of the blood cells? A. Peripheral blood smear B. Reticulocyte count C. Oxygen saturation D. Platelet count

A A peripheral blood smear assesses the morphological features (shape and appearance) of the blood cells. Reticulocyte count measures the amount of immature red blood cells in the circulation. Oxygen saturation measures the amount of oxygen the hemoglobin is carrying in the blood. A platelet count measures the number of platelets in the blood and is related to clotting functions.

Which patient exhibits signs and symptoms of hemochromatosis? A. A 47-year-old male with fatigue, weight loss, bronzing, and elevated total iron binding capacity (TIBC) B. A 25-year-old female with fatigue, swollen tongue, and tachycardia C. A 35-year-old male vegan with fatigue, constipation, and pallor D. An 8-month-old female with delayed growth, jaundice, and dark-coloured urine

A Fatigue, weight loss, bronzing, and elevated TIBC are indicative of hemochromatosis. Arthralgia, erectile dysfunction, and abdominal pain are also early signs. Blood chemistry will show elevates serum iron and serum ferritin.

Which finding during the assessment may trigger concerns about pernicious anemia? A. Patient has a history of recent gastric bypass surgery and reports excessive fatigue. B. Patient reports episodes of hematuria over the past week. C. Patient has a complete blood count (CBC) showing pancytopenia. D. Patient reports frequent episodes of epistaxis.

A Gastric bypass surgery diverts digestion away from the stomach, which also impairs intrinsic factor production and absorption. This results in pernicious anemia.

Which hematological assessment statement is accurate? A. Liver enlargement is measured by the number of centimetres it can be palpated below the rib border. B. Lymph node assessment should begin at the groin C. The spleen size can be assessed using gentle palpation of the abdomen D. Assess for petechiae by looking at the mucous membranes

A Lymph node assessment begins at the head and neck, not at the groin. The spleen is not usually palpable due to its deep location in the abdomen. Petechiae are assessed on the skin surface. A skin assessment of the whole body should be completed.

Which clinical situation may increase the risk of blood transfusion reaction? A. Multiple blood transfusions B. Iron-deficiency anemia C. Completing a cross and match blood test prior to the transfusion D. Low red blood cell (RBC) count

A Risk for transfusion reaction increase with the number of blood transfusions completed. Iron-deficiency may be an indication for blood transfusions in some situations, but it is not a direct risk for blood transfusion reaction. Completing a type, cross and match blood test prior to a blood transfusion helps to ensure the correct blood type is used. This reduces the risk of blood transfusion reaction. Low (RBC) count may be an indication for a blood transfusion, but it is not a direct risk for blood transfusion reaction.

Which sickle cell disorder causes the most severe symptoms? A. Sickle cell anemia B. Sickle cell-thalassemia C. Sickle cell-HbC disease D. Sickle cell trait

A Sickle cell anemia, the most severe of the SCD syndromes, occurs when a person is homozygous for HbS (HbSS). The person has inherited HbS from both parents.

Which patient would be classified as having Hodgkin's disease stage II B? A. A patient with lymphoma in two or more lymph nodes above the diaphragm with B symptoms present. B. A patient with lymph node involvement above and below the diaphragm and no B symptoms. C. A patient with lymph nodes involved on both sides of the diaphragm and in the liver, with no B symptoms. D. A patient with a single lymph node involved and experiencing B symptoms.

A Stage II involves two or more lymph nodes on one side of diaphragm. "B" indicates that B symptoms are present.

Which statement by the nurse demonstrates an understanding of the progression of Hodgkin's disease? A. "Hodgkin's disease typically begins in the cervical lymph nodes and can remain there before progressing." B. "Hodgkin's disease that begins in abdominal lymph nodes rarely spreads further." C. "Hodgkin's disease relapse is typically confined to a few lymph nodes and does not infiltrate other organs." D. "Hodgkin's disease begins in the spleen and quickly moves into the adjacent lymph nodes."

A The disease starts in a single location and then spreads along adjacent lymphatics. It starts in the cervical lymph nodes in 60-70% of patients. When the disease begins above the diaphragm, it remains confined to lymph nodes for a variable time.

Which clinical manifestation may be observed in patients with sickle cell anemia? Select all that apply. One, some, or all responses may be correct. A. Pain that ranges from mild to extreme B. Renal failure C. Development of autosplenectomy D. Acute chest syndrome E. Occurrence of priapism F. Cyanosis related to hemolysis

A, B, C, D, E Pain that ranges from mild to extreme Pain episodes can affect any area of the body or several sites simultaneously, with the most-commonly affected areas being the back, chest, extremities, and abdomen. Renal failure Kidneys may be injured from the increased blood viscosity and the lack of O2, which can lead to renal failure. Development of autosplenectomy The spleen becomes smaller due to repeated scarring that occurs during sickle cell episodes. Acute chest syndrome Acute chest syndrome is a term used to describe acute pulmonary complications that include pneumonia, tissue infarction, and fat embolism. Occurrence of priapism Priapism (persistent penile erection) may occur if penile veins become occluded. Cyanosis related to hemolysis Jaundice, not cyanosis, is related to hemolysis associated with sickle cell anemia, causing a yellow tone in the skin, sclera, and mucus membranes.

Which nursing care should be prioritized when caring for a patient recovering from a bone marrow biopsy? Select all that apply. One, some, or all responses may be correct. A. Assess for excess bleeding B. Provide analgesics C. Administer sedatives D. Monitor vital signs E. Avoid pressure on the site of puncture for 24 hours

A, B, D

n which organ can iron be stored? Select all that apply. One, some, or all responses may be correct. A. Liver B. Spleen C. Lungs D. Bone marrow E. Duodenum

A, B, D Approximately two-thirds of the body's iron is found as the heme part of the hemoglobin molecule in red blood cells. One-third is stored as ferritin and hemosiderin in the liver, bone marrow, spleen, and macrophages.

Which treatment is used when hemophilia causes bleeding into a joint? Select all that apply. One, some, or all responses may be correct. A. Pack the joint in ice. B. Give acetaminophen for pain control. C. Give aspirin for pain control. D. Encourage mobilization of the affected area. E. Implement weight-bearing movement immediately.

A, B, D When hemophilia causes bleeding into a joint, packing the joint in ice helps reduce inflammation. Analgesics are given to reduce severe pain (e.g., acetaminophen [Tylenol], codeine) when hemophilia causes bleeding into a joint. Encourage mobilization of the affected area through range of-motion exercises and physical therapy when hemophilia causes bleeding into a joint.

Which hereditary disorder should be assessed in relation to hematological concerns? Select all that apply. One, some, or all responses may be correct. A. Sickle cell anemia B. Hemophilia C. Asplenia D. Thalassemia E. Hemochromatosis

A, B, D, E

Which skin assessment finding is indicative of a bleeding disorder? Select all that apply. One, some, or all responses may be correct. A. Petechiae B. Purpura C. Digit clubbing D. Ecchymosis E. Spider nevus

A, B, D, E

Which factor is known to have a role in the development of non-Hodgkin's lymphoma (NHL)? Select all that apply. One, some, or all responses may be correct. A. Chromosomal translocations B. H. pylori C. Obesity D. Pesticides E. Herbicides F. COVID-19

A, B, D, F

Which finding is associated with multiple myeloma (MM)? Select all that apply. One, some, or all responses maybe correct. A. Elevated levels of calcium in the blood B. Presence of destroyed bone and thinning of bone tissue C. Absence of Bence Jones protein in urine D. M protein present in blood and urine E. Abnormally low serum creatinine F. High levels of β2microglobulin and low levels of albumin in the blood

A, B, D, F

Which blood test is needed to reduce transfusion reaction prior to a blood transfusion? Select all that apply. One, some, or all responses may be correct. A. Screen B. Bilirubin C. Crossmatch D. Group E. Blood smear

A, C, D

Which treatment plan will the nurse anticipate for the patient diagnosed with Hodgkin's lymphoma Stage I B? A. Initiation of treatment with radiation therapy B. Four to six cycles of chemotherapy C. Four to six cycles of chemotherapy D. Six to eight cycles of chemotherapy

B Patients with early-stage but unfavourable prognostic features (e.g., the presence of B symptoms) or intermediate-stage disease will receive four to six cycles of chemotherapy.

Which organ is adversely affected in hemolytic anemia? Select all that apply. One, some or all responses may be correct. A. Spleen B. Bladder C. Liver D. Kidneys E. Small intestine F. Lungs

A, C, D The spleen and the liver may enlarge because of their hyperactivity related to macrophage phagocytosis of the defective erythrocytes. Jaundice is likely due to increased levels of bilirubin. When an RBC is hemolyzed, the Hb molecule is released and filtered by the kidneys. The accumulation of Hb molecules can obstruct the renal tubules and lead to acute tubular necrosis. A major focus of treatment of hemolysis, no matter its cause, is to maintain renal function.

Which component is part of the lymph system? Select all that apply. One, some, or all responses may be correct. A. Fluid B. Digits C. Capillaries D. Ducts E. Nodes

A, C, D, E

Which nutrient is necessary for erythropoiesis? Select all that apply. One, some, or all responses may be correct. A. Folic acid B. Fat C. Cobalamin D. Amino acids E. Pyridoxine F. Vitamin A

A, C, D, E

Which action does the nurse take when caring for a patient with disseminated intravascular coagulation (DIC)? Select all that apply. One, some, or all responses may be correct. A. Administer blood products. B. Assess for polyuria. C. Assess for external bleeding. D. Assess for signs of internal bleeding. E. Provide prompt administration of prescribed therapies.

A, C, D, E Administration of blood products to replace lost volume, treat anemia, and otherwise support the cardiovascular system may be necessary when caring for a patient in DIC. Administration of blood products to replace lost volume, treat anemia, and otherwise support the cardiovascular system may be necessary when caring for a patient in DIC. Assessing for signs of internal bleeding such as increased heart rate, increasing abdominal girth, altered mental status are nursing interventions necessary when caring for a patient in DIC. Appropriate nursing interventions are essential to the survival of a patient in DIC, including providing prompt administration of prescribed therapies.

Which etiology is a cause of iron-deficiency anemia? Select all that apply. One, some, or all responses may be correct. A. Blood loss B. Folic acid deficiency C. Inadequate dietary intake D. Malabsorption E. Vitamin B12 deficiency F. Hemolysis

A, C, D, F

Which scenario may lead to the diagnosis of myelodysplastic syndrome (MDS) in a patient? Select all that Apply. One, some, or all responses may be correct. A. Irregular results on a routine CBC B. Found during chest X-ray for pneumonia C. Uncovered during evaluation of anemia symptoms D. Screening for folate deficiency E. Full-body MRI F. Discovered during treatment of infection and bleeding

A, C, F

Which body organ involves hematopoiesis? A. Spleen B. Bone Marrow C. Lymph Nodes D. Gallbladder

B

Which primary role do neutrophils serve? A. Phagocytosis B. Coagulation C. Oxygen transport D. Allergic response

B

Which laboratory value is a measure of the packed cell volume of red blood cells (RBCs) expressed as a percentage of the total blood volume? A. Platelet count B. Hematocrit C. Reticulocyte count D. White blood cell (WBC) count

B Platelet count is a measurement of number of platelets available to maintain platelet clotting functions. Reticulocyte count is the number of immature RBCs released from the bone marrow into the blood. WBC count is the measurement of total number of leukocytes.

Which statement by the nurse demonstrates understanding of autotransfusion and autologous transfusion? A. "Autologous transfusion uses blood donated by the patient's friends and family." B. "Autotransfusion occurs during surgery when the patient's blood is collected, filtered, and returned to the body." C. "Autologous transfusion uses automation to decrease the likelihood of patient-to-product mismatches." D. "Autotransfusion is the process of automatically transfusing all surgical patients who experience blood loss greater than 500 mL."

B Autologous donation occurs when a person donates blood before a planned surgical procedure; the patient receives their own blood if a transfusion is needed. Autotransfusion is a method for replacing blood volume involves safely and aseptically collecting, filtering, and returning the patient's own blood that is lost during a major surgical procedure or from a traumatic injury.

Which description is the defining characterization of disseminated intravascular coagulation (DIC)? A. Powerful coagulation triggered by tissue factor release leading to enhanced platelet aggregation B. Profuse bleeding resulting from the depletion of platelets and clotting factors C. Stable clot formation at injury sites D. Rapid dehydration due to polyuria

B Disseminated intravascular coagulation (DIC) is a serious bleeding and thrombotic disorder that results from abnormally initiated and accelerated clotting and anticlotting processes that occur in response to disease or injury. It is characterized by the profuse bleeding resulting from the depletion of platelets and clotting factors. Tissue factor release is one potential trigger for DIC, but it is not the defining characterization of the disease. In DIC, clot formation is unstable, predisposing the patient to hemorrhage. Rapid dehydration due to polyuria is not related to DIC.

Which responsibility does the nurse have when caring for a patient in an acute exacerbation of polycythemia vera (PV)? A. Support NPO order B. Monitoring fluid intake and output C. Encourage complete bed rest D. Promote decreased food intake

B Fluid intake and output must be evaluated during hydration therapy to avoid fluid overload and underhydration. Fluid overload further complicates the circulatory congestion while underhydration can cause the blood to become even more viscous.

Which safety precaution will the nurse take when administering a blood transfusion? A. Warm blood products in the microwave to prevent patient chilling. B. Perform a dual check of the blood component with another licensed nurse. C. Use Y-tubing with the PRBCs on one limb and dextrose on the other limb to dilute the infusion. D. Check the patient's vital signs prior to beginning the transfusion and then every 30 minutes for 4 hours.

B Improper product-to-patient identification causes 90% of hemolytic transfusion reactions. The nurse must follow the policy and procedures of the institution where care is being provided. Many institutions have implemented a dual checking system with two licensed individuals checking patient identification with the labelled blood component. If blood products requiring warming, a specific blood-warming device is used. Never microwave blood products as it will cause hemolysis and destroy the product. Dextrose is never used in conjunction with RBCs because it will cause hemolysis. Only normal saline is used during a blood transfusion. Patient vital signs are checked prior to initiation and then 15 minutes after the transfusion starts. The nurse should observe the patient periodically throughout the transfusion (e.g., every 30 minutes) and up to 1 hour after the transfusion.

Which type of anemia is characterized by normocytic, normochromic, hypoproliferative RBCs? A. Iron deficiency anemia B. Anemia of chronic disease C. Pernicious anemia D> Sickle cell anemia

B In anemia of chronic disease, RBCs are normal in size and colour, but are under produced. Conditions such as cancer, autoimmune disorders, and infection are some of the causes.

Which explanation provides accurate education to patients about multiple myeloma (MM)? A. MM is the most common cancer diagnosed in women. B. MM tumours produce monoclonal antibodies that override healthy antibody cells. C. Multiple myeloma starts in the lymph system. D. Chronic cough is often the first symptom.

B In multiple myeloma, instead of a variety of plasma cells producing antibodies to fight different infections, myeloma tumours produce monoclonal antibodies. These cells are ineffective and even harmful as they do not fight infections, but infiltrate the bone marrow.

Which recommendation to the patient maximizes absorption of oral iron supplements? A. "Take your iron tablets in the morning with a glass of milk at least 30 minutes before breakfast." B. "Take your iron tablets in the morning with a glass of orange juice about an hour before breakfast." C. "Take your iron tablets first thing in the morning with a glass of milk." D. "Take your iron tablets in the morning with a glass of orange juice about an hour after breakfast."

B Iron is best absorbed in an acidic environment. It should be taken about an hour before meals when the duodenal mucosa is most acidic. Taking iron with vitamin C (ascorbic acid) or orange juice enhances iron absorption.

Which statement about leukemia demonstrates the nurse's knowledge? A. "Leukemia is more common in women." B. "Leukemia is characterized by the replacement of bone marrow with leukocyte precursors." C. "Leukemia is a terminal disease." D. "Leukemia is a specific type of cancer."

B Leukemia is characterized by diffuse replacement of bone marrow with proliferating leukocyte precursors. Loss of regulation in cell division results in accumulation of dysfunctional cells. Males account for about 60% of all new cases. Many types of leukemia are treatable. Untreated, it follows a progressive course that is eventually fatal. Leukemia is a broad, not specific, term given to a group of malignant diseases that affect the blood and blood-forming tissues of the bone marrow, lymph system, and spleen.

Which statement made by the nurse indicates an understanding of the clinical manifestations of anemia from acute blood loss? A. "The patient lost a lot of blood through trauma; she will need to be on a high iron diet." B. "The patient reports feeling lightheaded, and blood pressure dropped when standing. Hemoglobin and hematocrit are normal, but we need to prepare for transfusion of PRBCs." C. "The patient's RBC, hemoglobin, and hematocrit levels are normal. She has recovered from yesterday's blood loss in surgery." D. "The patient received lactated Ringer's solution to replace the volume of blood lost during trauma. We've prevented the onset of anemia symptoms."

B Loss of RBCs is not reflected in laboratory data immediately during acute blood loss. Values may seem normal or high for 2 to 3 days. Once the plasma is replaced, the RBC mass is less concentrated and the RBC, Hb, and Hct levels are low, reflecting the actual blood loss. Orthostatic hypotension and lightheadedness are signs and a blood transfusion may be indicated.

. Which intervention will the nurse perform when caring for a patient with non-Hodgkin's lymphoma (NHL)? Select all that apply. One, some, or all responses may be correct. A. Enforcing bed rest orders B. Educating on radioactive antibody therapy C. Providing pain management D. Administering blood transfusions E. Advocating for aggressive treatment of indolent NHL

B, C The nurse would educate the NHL patient on monoclonal antibody ibritumomab tiuxetan (Zevalin) therapy. The medication contains a radioactive particle than can kill cancer cells. Adverse effects of the medication include pancytopenia. Nurses must be aware of the precautions to take in caring for these patients and must educate patients about safety issues to minimize the risk of radiation exposure to staff and others. The nursing care for NHL is similar to that for Hodgkin's lymphoma. It is largely focused on managing conditions related to the disease, pancytopenia, and other adverse effects of therapy (e.g., pain caused by the tumour, spinal cord compression, tumour lysis syndrome).

Which factor contributes to the physical destruction of RBCs in acquired hemolytic anemia? Select all that apply. One, some, or all responses may be correct. A. Oxidative medication B. Hemodialysis C. Extracorporeal circulation D. Prosthetic heart valves E. Isoimmune reactions F. Passage through radiated blood vessels

B, C, D, F Hemodialysis causes disruption of the RBC membrane, which results in hemolysis. Extracorporeal circulation used in cardiopulmonary bypass causes disruption of the RBC membrane, leading to hemolysis. Prosthetic heart valves cause disruption of the RBC membrane, which leads to hemolysis. The high amount of force needed to push blood through radiated blood vessels can cause fragmentation, destroying RBCs.

Which intervention prevents a blood transfusion reaction? Select all that apply. One, some, or all responses may be correct. A. Application topical hydrocortisone B. Administration of antihistamines C. Infusion of 1L normal saline per unit of PBRC D. Infusion of 10% calcium gluconate E. Inject heparin into fresh-frozen plasma (FFP) prior to transfusing F. Warm blood prior to transfusion

B, D, F Administration of antihistamines may help prevent allergic reactions. Epinephrine or corticosteroids may be used to treat a severe reaction. reactions result from the recipient's sensitivity to plasma proteins of the donor's blood. These reactions are more common in an individual with a history of allergies. Citrate toxicity can occur when large quantities of blood products are used. Calcium binds to the citrate meaning citrate toxicity is likely to develop when blood is transfused at a rate of 1 unit in 10 minutes. Hypocalcemia can be prevented or reversed by the infusion of 10% calcium gluconate. Hypothermia and cardiac dysrhythmias can result from rapid infusion of large quantities of cold blood. Blood-warming equipment prevents this problem.

Which intervention by the nurse is part of caring for a patient with leukemia? Select all that apply. One, some, or all responses may be correct. A. Give the patient and family handouts and websites about coping with leukemia. B. Provide education on the prognosis, treatment plan, and treatment goals. C. Assume that the oncology team has addressed all of the patient's concerns. D. Provide complete physical and psychological care to the patient. E. Perform astute ongoing assessments.

B, E

Which form of lymphoma commonly includes fever, night sweats, and weight loss as symptoms? A. Burkitt lymphoma B. Non-Hodgkin's lymphoma (NHL) C. Hodgkin's disease D. Mantle cell lymphoma (MCL)

C

Which intervention is appropriate for the long-term survivor of leukemia? A. Enroll the patient at a local gym to regain strength B. Assure the patient that, once a long-term care plan is established, the patient can manage leukemia on their own C. Support the patient's mindset about regaining health and learning how to cope with fear of relapse D. Encourage patient to enjoy time and activities alone until they can make new friends

C

Which rationale explains the use of multi-drug therapy in treating leukemia? A. Using multi-drug therapy is experimental and has show improved results over single drug therapy. B. Using multiple generic drugs is less expensive that using one name-brand drug. C. Multiple drug therapy is more effective and less toxic than single drug therapy. D. Multi-drug therapy eliminates the need for radiation therapy.

C

Which red blood cell (RBC) test is increased in the event of hemoconcentration? A. White blood cells B. RBC indices C. Hemoglobin D. Prothrombin time

C

Which response does the nurse provide when the patient asks why she has small, flat, red spots on her skin? A. "Those are scars caused by leaked white cells. They settle into the skin and result in scar tissue." B. "Those are the start of fever blisters. They are caused very high temperatures when your body is fighting an infection." C. "Those are petechiae. They are very tiny hemorrhages that happen when your platelet count is low and red cells leak out of blood vessels and into skin." D. "Those are normal signs of aging and nothing to worry about."

C

Which treatments are used in managing multiple myeloma (MM)? A. Complete bed rest B. Fluid restrictions C. Bisphosphonate administration D. Routine plasmapheresis

C

Which patient would be unlikely to benefit from iron supplements? A. Patient experiencing acute blood loss B. Patient in second trimester of pregnancy C. Patient with hereditary hemochromatosis D. Patient with limited access to healthy foods

C A patient with hereditary hemochromatosis has excessive amounts of iron in the body. Iron supplements would increase the iron load and cause harm to the patient.

Which statement accurately describes the coagulation and anticoagulation process? A. Coagulation is achieved through antithrombin activity. B. Clotting is encouraged through anticoagulants. C. Anticoagulants including heparin and protein C support clot dissolution. D. Antithrombin encourages the blood clot to remain stable and intact

C Anticoagulation, not coagulation, is achieved through antithrombin activity. Anticoagulants interfere with clotting, encouraging clot dissolution, not clotting formation. Antithrombin keeps blood fluid by antagonizing thrombin (which is a powerful anticoagulant).

Which therapy is appropriate for low-risk patients with MDS? A. Whole blood transfusions B. Radiation C. Myeloid growth factors D. High intensity chemotherapy

C Low-risk patients often can be treated with myeloid growth factors (e.g., G-CSF), in addition to EPO and immunomodulators, such as lenalidomide (Revlimid). Whole blood transfusions are not part of therapy for low-risk MDS. Radiation is not used to treat MDS; chemotherapy may be used for some patients. High intensity chemotherapy and haematopoietic stem cell transplantation (HSCT) are used in about 30% of all high-risk patients. It is not used for low-risk patients.

Which symptom is the major manifestation in patients with multiple myeloma (MM)? A. Serum hyperviscosity syndrome B. Polyuria C. Skeletal pain D. Renal impairment

C Multiple myeloma develops slowly and insidiously. The patient often does not manifest symptoms until the disease is advanced, at which time skeletal pain is the major manifestation.

Which nursing diagnosis would be appropriate for a patient with thrombocytopenia? A. Potential for melena as evidenced by high dietary fibre intake B. Potential for excessive clotting as evidenced by inherent coagulopathy C. Potential for epistaxis as evidenced by decrease in platelets D. Potential for impaired oral mucous membrane integrity as evidenced by increased platelets

C Potential for epistaxis as evidenced by decrease in platelets is an appropriate nursing diagnosis for a patient with thrombocytopenia. Impaired clotting leads to risk of increased bleeding. Melena would be related to impaired clotting ability, not a high fibre diet. Potential for bleeding (not clotting) as evidenced by inherent coagulopathy is appropriate for the patient with thrombocytopenia because the condition leads to low platelet count, thus a decreased ability to clot. Potential for impaired oral mucous membrane integrity as evidenced by decreased platelets (not increased platelets) is appropriate for a patient with thrombocytopenia because the condition leads to abnormal clotting.

Which manifestation of anemia occurs with severe anemia? A. Heart palpitations B. Fatigue C. Sensitivity to cold D. Exertional dyspnea

C Sensitivity to cold occurs in the severe level of anemia when hemoglobin is at 60 g/L or less.

Which thrombocytopenia is the most common type of acquired thrombocytopenia? A. Heparin-induced thrombocytopenia and thrombosis syndrome B. Heparin-induced thrombocytopenia C. Immune thrombocytopenic purpura (ITP) D. Thrombotic thrombocytopenic purpura

C The most common acquired thrombocytopenia is a syndrome of abnormal destruction of circulating platelets termed immune thrombocytopenic purpura (ITP).

Which patient does the nurse anticipate will benefit from autologous donation for blood transfusion? A. The patient who will require substantial blood product support during a major surgical procedure B. The patient scheduled for a minor surgery not expected to require any blood product support C. The patient with a rare blood type D. The patient requiring surgery for massive trauma

C The patient with a rare blood type would benefit from autologous donation as matching the patient's specific needs would be difficult. A non-matched transfusion could lead to significant complications.

Place in order the sequence of the blood clotting process. A. Fibrin clot development B. Platelet plug formation C. Vascular injury and sub-endothelial exposure D. Clot retraction and dissolution

C, B, A, D Hemostasis is the stopping of blood flow. This process is important in minimizing blood loss when body structures are injured. The sequence of events is as follows: (1) vascular injury and subendothelial exposure; (2) platelet plug formation involving adhesion, aggregation, and activation; (3) fibrin clot development; and (4) clot retraction and dissolution.

Which cell type is a granulocyte? Select all that apply. One, some, or all responses may be correct. A. Erythrocytes B. Lymphocytes C. Basophils D. Neutrophils E. Thrombocytes

C, D

Which electrolyte is important to monitor in the patient receiving a blood transfusion? Select all that apply. One, some, or all responses may be correct. A. Phosphorus B. Sodium C. Potassium D. Calcium E. Chloride F. Magnesium

C, D Hyperkalemia results when potassium leaks from RBCs in stored blood. Mild to severe signs and symptoms can occur, including flaccid paralysis of the cardiac or respiratory muscles and cardiac arrest. Potassium must be monitored closely due to the potential for causing cardiac arrythmia and death. Patients receiving blood are at increased risk for hypocalcemia because citrate (a preservative added to the blood) can bind to the patient's calcium, inactivating calcium, and causing hypocalcemia. Hypocalcemia symptoms manifest as muscle tremors and ECG changes that indicate abnormal cardiac rhythms. Calcium must be monitored closely due to the potential for causing cardiac arrythmia and death.

Which intervention will the nurse employ to manage pain in a patient with multiple myeloma (MM)? Select all that apply. One, some, or all responses may be correct. A. Administering opioids B. Administering allopurinol C. Applying braces to patient D. Exercising caution when moving or ambulating the patient E. Ensuring proper hydration F. Administering acetaminophen

C, D, F Braces, especially for the spine, may help control pain for patients with MM. Because of the potential for pathological fractures, the nurse must be careful when moving and ambulating the patient with MM. A slight twist or strain in the wrong area may be sufficient to cause a fracture. Analgesics, such as nonsteroidal anti-inflammatory medications, acetaminophen, or an acetaminophen-opioid combination, may be more effective than opioids alone in diminishing bone pain for patients with MM.

Which anemia is caused by impaired DNA synthesis and characterized by macrocytic RBCs? Select all that apply. One, some, or all responses may be correct. A. Sickle cell disease B. Iron deficiency anemia C. Cobalamin deficiency anemia D. Thalassemia E. Folic acid deficiency anemia F. Erythroleukemia

C, E, F

Which part of the hematopoietic system is responsible for removing old and defective red blood cells (RBCs) from circulation as well as filtration and the reuse of iron? A. Lymph nodes B. Platelets C. Duodenum D. Spleen

D

Which percentage of the blood is made up by plasma? A. 15% B. 20% C. 45% D. 55%

D

Which sign is a potential gastrointestinal system sign of anemia? A. Cheilitis B. Sore throat C. Diarrhea D. Glossitis

D

Which comment from the nurse demonstrates an understanding of aplastic anemia? A. "It is the most common type of anemia." B. "It can only be caused by certain medications and toxins." C. "It is a disease in which the patient has pancytopenia and hypercellular bone marrow." D. "It is most often due to autoimmune activity by cytotoxic T cells that destroy hematopoietic stem cells."

D About 70% of aplastic anemias are due to autoimmune activity by autoreactive T lymphocytes. These cytotoxic T cells target and destroy the patient's own hematopoietic stem cells.

Which treatment is the only cure for thalassemia major? A. Chelation therapy B. Blood transfusion C. Intravenous deferoxamine D. Stem cell transplant

D Hematopoietic stem cell transplantation (HSCT) is the only cure for thalassemia major, but it is a reasonable option for only a small number of patients. Obstacles to transplant include access, donor availability, and the procedural risk. Chelation therapy can be used to decrease accumulation of iron in the blood. Ascorbic acid supplementation may be used to increase urine excretion of iron. Chelation therapy is not a cure. Regular transfusions and proper iron chelation therapy remain the mainstay of therapy for thalassemia major. Transfusions are administered to keep the Hb level at approximately 100 g/L to foster the patient's own erythropoiesis without spleen enlargement. Transfusion is not a cure. Intravenous (IV) or subcutaneous deferoxamine is a chelation agent that aids in avoiding iron overload. It is not a cure.

Which X-linked genetic disorder is caused by a deficiency in factor IX? A. Hepatitis C B. Hemophilia A C. Von Willebrand disease D. Hemophilia B

D Hemophilia B is an X-linked deficiency in factor IX. It occurs mostly in men, but women can be carriers of the trait. Hepatitis C is a liver disorder that is not related to X-linked genetics. Hemophilia A is an X-linked deficiency in factor VIII. It occurs mostly in men, but women can be carriers of the trait. Von Willebrand disease is a genetic disorder involving a deficiency of the von Willebrand coagulation protein, not a deficiency in factor IX.

Which description defines leukostasis? A. Bone marrow failure due to overcrowding of the marrow by abnormal cells. B. Solid masses can result from collections of leukemic cells. C. Accumulation of abnormal WBC in the patient's organs. D. High leukemia WBC count in the peripheral blood can cause the blood to thicken.

D High leukemia WBC count in the peripheral blood can cause the blood to thicken and potentially block circulatory pathways. This is called leukostasis and can be life-threatening. Bone marrow failure due to abnormal cells and inadequate normal production of marrow cells is leukemia, not leukostasis. These solid masses are called chloromas, not leukostasis. Leukemic cells, not leukostasis, may infiltrate the patient's organs, leading to conditions such as splenomegaly, hepatomegaly, bone pain, and more.

Which cause is the most common cause of neutropenia? A. Aplastic anemia B. Parasitic infection C. Hypersplenism D. Immunosuppressive therapy

D The most common cause of neutropenia is iatrogenic resulting from widespread use of chemotherapeutic and immunosuppressive therapy in the treatment of cancer and autoimmune diseases.

Which hematological history includes the assessment of alcohol and illicit drug use? A. Social and occupational history B. Activities of daily living C. Neurological history D. Self-care history

D The self-care history includes assessing for alcohol, illicit drug, or cigarette use in partial completion of the hematological history. The social and occupational health history includes past or present exposure to chemicals, radiation and the patient's usual roles, responsibilities, and support systems, but does not include the alcohol intake and illicit drug use. The activities of daily living assessment include feelings of chronic fatigue, weakness, apathy, malaise, dyspnea, palpitations, and changes in a patient's ability to perform activities of daily living, but does not include the alcohol intake and illicit drug use. The neurological history includes any joint pain, paresthesias, numbness, and tingling. It also has any changes in vision, hearing, taste, or mental status, but does not include the alcohol intake and illicit drug use.