Heme 1 EAQ
Which questions would the nurse ask a patient who has hematologic problems? Select all that apply. 1 "Have you ever had a fracture?" 2 "Are you taking any herbal products?" 3 "Have you ever received a blood transfusion?" 4 "Is there any family history of anemia, cancer, bleeding, or clotting problems?" 5 "Do you have any difficulty in performing daily activities because of a lack of energy?"
"Are you taking any herbal products?" "Have you ever received a blood transfusion?" "Is there any family history of anemia, cancer, bleeding, or clotting problems?" "Do you have any difficulty in performing daily activities because of a lack of energy?" Evaluation of the hematologic system is based on a thorough health history. It is important to know whether the patient had prior hematologic problems. Asking the patient about herbal therapy is important because herbal therapy can interfere with clotting. The risk of transfusion reaction and iron overload increases with the number of blood transfusions. People with a family history of hematologic problems have a much greater risk of developing them. If the patient has any difficulty performing daily activities, it indicates weakness due to compromised blood circulation. A history of fracture does not help to determine the hematologic status.
Related to the hematologic system, which question would the nurse ask a patient who reports illicit drug use? 1 "Do you have any blood in your stools?" 2 "What agent and when did you last use it?" 3 "Have you had any surgeries causing pain?" 4 "Do you have shortness of breath with activity?
"What agent and when did you last use it?" Although asking about blood in the stools, painful surgeries, or shortness of breath with activity are appropriate questions related to the hematologic system, the only answer related specifically to illicit drug use is asking about what agent and when it was last used. The route and frequency also should be assessed.
When completing an assessment of the hematologic system, which manifestations in the patient's elimination patterns would the nurse ask about? Select all that apply. 1 Dark-colored urine 2 Offensive sweating 3 Black-colored stools 4 Decreased urine output 5 Excessive hunger and thirst
Dark-colored urine Black-colored stools Decreased urine output Dark-colored urine or black-colored stools could indicate the presence of blood in the urine or stool; decreased urine output needs to be noted and followed up on. Offensive sweating and excessive hunger and thirst are not related to elimination patterns in the assessment of the hematologic system.
When reviewing laboratory results of an 83-year-old patient, which finding would the nurse expect? 1 Decreased platelet count 2 Increased leukocyte count 3 Decreased hemoglobin levels 4 Decreased erythrocyte sedimentation rate (ESR)
Decreased hemoglobin levels 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.
Laboratory reports indicate that a patient has a serum iron level of 120 mcg/dL and total iron binding capacity is 300 mcg/dL. Calculate the transferrin saturation level of the patient. Record your answer using a whole number. _________%
The patient has a serum iron level of 120 mcg/dL, and total iron-binding capacity (TIBC) is 300 mcg/dL. The formula to calculate transferrin saturation level = (serum iron level/TIBC) x 100 = (120/300) x 100 = 40%.
A 20-year-old male patient has hematocrit (Hct) of 40% and a red blood cell (RBC) count 4.4 x 106 cells/µL. Calculate the mean corpuscular volume of the patient. Record your answer using a whole number. ______ fL
The patient has hematocrit of 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.
Which test result places a patient with leukemia 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%
Absolute neutrophil count (ANC) 500 cells/µL Neutropenia indicates an increased risk of developing infection. Platelet count, total RBC count, and MCHC are in the normal range.
The nurse would inquire about which conditions when obtaining information about existing hematologic conditions? Select all that apply. 1 Anemia 2 Influenza 3 Hemophilia 4 Conjunctivitis 5 Clotting disorders
Anemia Hemophilia Clotting disorders
The nurse would perform which actions when caring for a patient who underwent a lymph node biopsy? Select all that apply. 1 Discharge the patient. 2 Apply pressure to the site. 3 Observe the site for bleeding. 4 Inspect the wound for infection. 5 Advise the patient to walk around.
Apply pressure to the site. Observe the site for bleeding. Inspect the wound for infection. After lymph node biopsy, the nurse should apply direct pressure to the affected area to achieve hemostasis, observe the site for bleeding, and monitor vital signs, especially if the platelet count is low. The nurse should also inspect the wound for healing and infection. Discharging the patient and advising the patient to walk around are not advisable.
Which laboratory finding would the nurse attribute to a patient's complaints of numbness in the hands and feet, and reporting poor coordination and balance? 1 Bilirubin 2 mg/dL 2 Folic acid 10 ng/dL 3 Hemoglobin 10 g/dL 4 Cobalamin 150 pg/mL
Cobalamin 150 pg/mL Paresthesia of the feet and hands and poor coordination and balance due to ataxia are the clinical manifestations of vitamin B12 (Cobalamin), or folic acid, deficiency. The normal value of cobalamin is 200 to 835 pg/mL. Cobalamin (vitamin B12) of 150 pg/mL is less than the normal value, which indicates vitamin B12 deficiency. The normal range of total bilirubin is 0.2 to 1.2 mg/dL. A bilirubin level of 2 mg/dL indicates jaundice or liver dysfunction. The normal range of folic acid is 3 to 16 ng/mL. The patient's folic acid is within the normal range and does not indicate folic acid deficiency. A normal range for hemoglobin is 11 to 16 g/dL in females and 13.2 to 17.3 mg/dL in males. Hemoglobin of 10 g/dL indicates anemia in the patient. The patient with anemia may experience tachycardia, palpitations, pallor, and cyanosis.
The nurse reviews the laboratory reports of a 20-year-old female patient and would anticipate providing education on the increase of meat, fish, and green leafy vegetables in the patient's diet based on which finding? 1 Hemolytic anemia 2 Low red blood cell count 3 Reduced hormonal secretion 4 Cobalamin and folic acid deficiency
Cobalamin and folic acid deficiency The normal homocysteine for a female patient ranges from 3.7 to 10.4 µmol/L. The patient has a homocysteine level 20 µmol/L, which is higher than normal. This indicates that the patient has a cobalamin and folic acid deficiency. The normal erythrocyte sedimentation rate (ESR) is less than 30 mm/hr. The test indicates a normal reading of 26 mm/hr, ruling out an inflammatory process in the body, which would be indicted by an elevated ESR. The patient has a negative Coombs test, which indicates the absence of antibodies and Rh factor, so the patient does not have hemolytic anemia. The normal erythropoietin levels range from 5 to 30 mU/mL, and the patient has an erythropoietin level of 20 mU/mL. This indicates that the patient has a normal red blood cell count.
Which occurrence would the nurse identify as being the most likely cause of anemia in a patient with chronic kidney disease? 1 Excess blood loss 2 Decreased intake of iron 3 Decreased thyroid gland activity 4 Decreased erythropoietin production
Decreased erythropoietin production 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 kidney disease.
Which finding in a hematologic study report of a 70-year-old patient would the nurse consider normal? 1 Decreased ferritin 2 Decreased serum iron 3 Increased total iron-binding capacity 4 Decreased erythrocyte sedimentation rate (ESR)
Decreased serum iron 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. Ferritin levels are increased, total iron-binding capacity may be decreased, and ESR is increased.
Which tests determine the effect of smoking on the hematologic system? Select all that apply. 1 Biopsy 2 Fibrinogen 3 Hematocrit 4 Platelet count 5 Skeletal x-ray
Fibrinogen Hematocrit Platelet count Cigarette smoking increases low-density lipoprotein, cholesterol, and levels of CO2. It leads to hypoxia and altering of the anticoagulant properties of the endothelium. Smoking increases platelet reactivity, plasma fibrinogen, and hematocrit. Hence, diagnostic studies such as fibrinogen, hematocrit, and platelet count are suggested. Biopsy study is required for malignancy detection. Skeletal x-ray study is used for the detection of lytic lesions associated with multiple myeloma.
The nurse would monitor a patient with fibrinogen levels of 150 mg/dL closely for which problem? 1 Increased risk of bleeding 2 Increased risk of clot formation 3 This result is within the normal parameters. 4 Increased risk for disseminated intravascular coagulation
Increased risk of bleeding The reference level for fibrinogen is 200 to 400 mg/dL. A decrease in fibrinogen indicates that the patient possibly is predisposed to bleeding. A decrease in fibrinogen does not lead to increased risk for clot formation. The results are abnormal; not normal. A decrease in fibrinogen does not lead to a risk for disseminated intravascular coagulation.
When assessing a patient's nutritional-metabolic pattern related to hematologic health, which action would the nurse take? 1 Inspect the skin for petechiae. 2 Ask the patient about joint pain. 3 Assess for vitamin C deficiency. 4 Determine whether the patient can perform activities of daily living (ADLs).
Inspect the skin for petechiae. Any changes in the skin's texture or color should be explored when assessing the patient's nutritional-metabolic pattern related to hematologic health. The presence of petechiae or ecchymotic areas could be indicative of hematologic deficiencies related to poor nutritional intake or related causes. Asking the patient about joint pain, assessing for vitamin C deficiency, and determining whether the patient can perform ADLs are not specific to the nutritional-metabolic pattern related to hematologic health.
The nurse observes bleeding at the bone marrow needle aspiration site. Which action would the nurse take next? 1 Instruct the patient to sit for 30 to 40 minutes. 2 Instruct the patient to walk for 10 to 15 minutes. 3 Instruct the patient to stand for 5 to 10 minutes. 4 Instruct the patient to lie on the affected side for 30 to 60 minutes
Instruct the patient to lie on the affected side for 30 to 60 minutes. 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. Sitting, walking, and standing do not help to maintain pressure on the site.
Which symptom would the nurse expect to find in a patient with vitamin B12 deficiency? 1 Lack of physical strength or energy 2 Pain in the pelvis, ribs, spine, and sternum 3 Abnormal sensitivity to touch or pressure on the sternum 4 Numbness sensation, impaired muscle movement, and extreme sensitivity in nerves
Numbness sensation, impaired muscle movement, and extreme sensitivity in nerves Cobalamin deficiency can affect the production of red blood cells (RBCs). A deficiency of RBCs in the blood circulation can manifest as a numbness sensation, impaired muscle movement, and extreme sensitivity in nerves. Lacking physical strength or energy is the sign of low hemoglobin level (anemia). Pain in the pelvis, ribs, spine, and sternum is the symptom of multiple myeloma. Abnormal sensitivity to touch or pressure on the sternum is a sign of leukemia.
Which patient's red blood cell indices reflect microcytosis? 1 Patient 1 2 Patient 2 3 Patient 3 4 Patient 4
Patient 3 The normal value for mean corpuscular volume (MCV) is 80 to 100 fL, and the normal value for mean corpuscular hemoglobin (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.
Based on the data, which patient has iron-deficiency anemia? 1 Patient A 2 Patient B 3 Patient C 4 Patient D
Patient A The normal range for total iron-binding capacity (TIBC) is 250 to 425 mcg/dL, the normal range for ferritin is 10 to 250 ng/mL, and normal range for transferrin is 190 to 380 mg/dL. Transferrin is the protein that binds to iron, and its level increases in iron-deficiency anemia. Ferritin is a major iron storage protein, and its concentration in the blood is directly related to iron storage. Therefore ferritin levels would be decreased in the case of iron-deficiency anemia. Total iron-binding capacity (TIBC) is the measurement of all proteins available for binding iron. TIBC increases in iron-deficiency anemia. Patient A has increased TIBC of 500 mcg/dL, transferrin 400 mg/dL, and decreased ferritin of 8 ng/mL. These findings indicate iron-deficiency anemia. Patients B, C, and D have normal TIBC, ferritin, and transferrin levels. Their reports do not indicate iron-deficiency anemia.
Which condition is the most common cause for hematemesis? 1 Thalassemia 2 Sickle cell disease 3 Pernicious anemia 4 Peptic ulcer disease
Peptic ulcer disease 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 that 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.
Which abnormal finding would the nurse relate to hemostasis abnormalities? 1 Pruritus 2 Purpura 3 Weakness 4 Pale conjunctiva
Purpura Purpura may occur when platelets or clotting factors are decreased and bleeding into the skin occurs. Pruritus is not related to hemostasis but to hematologic cancers (e.g., lymphomas, leukemias) or increased bilirubin. Weakness and pale conjunctiva are not related to hemostasis unless a lot of bleeding leads to anemia with a low hemoglobin level.
Which approach would the nurse use first when completing a skin assessment? 1 Start with the face. 2 Start with the neck. 3 Begin with light palpation. 4 Begin with the pads of the fingers.
Start with the face. While performing skin assessment, the nurse should examine the skin over the entire body in a systematic manner, starting with the face and oral cavity and moving downward over the body helps to avoid missing any area. Light palpation is used for superficial lymph nodes evaluation. The lymph nodes evaluation is started at the head and neck. Pads of the fingers are used for light palpation of superficial lymph nodes.
The nurse notes that a patient has a smooth and shiny tongue surface. The nurse would attribute these findings to which condition? 1 The patient has neutropenia. 2 The patient has polycythemia. 3 The patient has pernicious anemia. 4 The patient has elevated estrogen levels.
The patient has pernicious anemia. 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.
Arrange the order of assessment the nurse would use to examine the lymph nodes of a patient. 1.Epitrochlear nodes 2.Subscapular nodes 3.Inguinal lymph nodes 4.Posterior auricular nodes
The posterior auricular nodes are present near the neck. The subscapular nodes are located at the arm. The epitrochlear nodes are located near the trachea. The inguinal lymph nodes are located in the groin area. Therefore the nurse first assesses the posterior auricular nodes, followed by the subscapular nodes, then the epitrochlear nodes, and finally, the inguinal lymph nodes.
Which significant information obtained from a physical examination relates to the hematologic system? 1 Bladder surgery 2 Early menopause 3 Multiple pregnancies 4 The presence of petechiae
The presence of petechiae Note any petechiae or ecchymotic areas on the skin and, if present, document the frequency, size, and cause. The location of petechiae can indicate an accumulation of blood in the skin or mucous membranes. Small vessels leak under pressure, and the platelet numbers are insufficient to stop the bleeding. Petechiae are more likely to occur where clothing constricts the circulation. Bladder surgery, early menopause, and multiple pregnancies do not relate to the hematologic system.
Which complications would the nurse monitor for in a patient who has a platelet count below 100,000/µL? 1 Leukemia 2 Leukopenia 3 Neutropenia 4 Thrombocytopenia
Thrombocytopenia Thrombocytopenia is a condition in which the platelet counts falls below 100,000/µL. Normal platelet counts are between 150,000 and 400,000/µL. Leukemia is a type of cancer of the blood or bone marrow characterized by an abnormal increase of immature white blood cells. Leukopenia is a condition in which the white blood cell count is less than 4000/µL. Neutropenia is a condition in which the absolute neutrophil count (ANC) is less than 1000 cells/µL.
