Path: Alterations of hematologic function

If a client has an Epstein-Barr virus infection, which lymphoma should the nurse monitor for in this client? 1. Burkitt lymphoma 2. Hodgkin lymphoma 3. Non-Hodgkin lymphomas 4. Reed-Sternberg lymphoma

1. Epstein-Barr virus infection is found in over 90% of Burkitt lymphomas. Epstein-Barr virus infection is less strongly linked to Hodgkin lymphoma. Non-Hodgkin lymphomas and Hodgkin lymphoma are not associated with Epstein-Barr virus infection. Hodgkin lymphoma produces Reed-Sternberg cells.

Among the findings (see chart), which data will help the nurse determine the source of the client's thrombocytopenia? 1. Thrombus in the leg 2. Heparin for the thrombus 3. Love of folic acid-rich foods 4. Previous bacterial infection

2. Heparin is the most common cause of drug-induced thrombocytopenia, an immune-mediated adverse drug reaction caused by immunoglobulin G antibodies primarily against the heparinplatelet factor 4 complex. Thrombus in the leg is a result of thrombocythemia. Folate (folic acid) would decrease the risk of thrombocytopenia. Thrombocytopenia may occur in relationship to acute viral infections, not bacterial infections.

Which factor increases a client's risk for leukemia? 1. Hepatitis A 2. Ionizing radiation 3. High alcohol intake 4. Sedentary lifestyle

2. Increased risk has been linked to cigarette smoke, exposure to benzene, and ionizing radiation. Large doses of ionizing radiation particularly result in an increased incidence of myelogenous leukemia. Infections with human immunodeficiency virus (HIV) or hepatitis C, not A, virus increase the risk for leukemia. Alcohol intake and sedentary lifestyle have not been identified as risk factors for leukemia.

A nurse closely monitors a client, who had gastric bypass surgery, for the development of pernicious anemia. What is the rationale for the nurse's actions? Incorrect1 Vitamin B12 is absorbed in the stomach. 2 Vitamin B12 stores are in the adipose tissue. 3 Postoperative antibodies to intrinsic factor are produced. Correct4 Intrinsic factor production by the gastric epithelium is reduced.

Pernicious anemia is caused by vitamin B12 deficiency from lack of intrinsic factor. Vitamin B12 absorption in the distal ileum requires intrinsic factor, which is secreted by parietal cells in the stomach. Removal of gastric tissue decreases intrinsic factor production. Vitamin B12 is water soluble, rather than fat soluble. Pernicious anemia does not involve antibodies to intrinsic factor. Test-Taking Tip: Work with a study group to create and take practice tests. Think of the kinds of questions you would ask if you were composing the test. Consider what would be a good question, what would be the right answer, and what would be other answers that would appear right but would in fact be incorrect.

Which client with acute lymphoblastic leukemia (ALL) carries the worst prognosis? 1. One with the presence of TEL 2. One with the presence of LYL 3. One with the presence of AML1 4. One with the presence of the Philadelphia chromosome

The presence of the Philadelphia chromosome (observed in about 5% of children with ALL, in 30% of adults with ALL, and occasionally in acute myelogenous leukemia) is a poor prognostic indicator. ALL does not have categories with the names TEL, LYL, or AML1.

A client was admitted to the burn unit with deep partial thickness burns over 20% of the body and has been stabilized. What would be an expected finding of laboratory blood tests? 1. Neutrophilic 2. Eosinophilia 3. Monocytopenia 4. Lymphocytopenia

1. An increase in neutrophils (neutrophilia or granulocytosis) occurs to protect the body from infection following severe burns. Eosinopenia, not eosinophilia, is observed in the stress response for burns, trauma, shock, surgery, and mental distress. Lymphocytopenia can occur in immunodeficiency syndrome, radiation, or chemotherapy. Monocytopenia occurs in hairy cell leukemia and prednisone therapy.

A client has hereditary sideroblastic anemias. Which response indicates that pyridoxine therapy was effective? 1. Reticulocytosis 2. Decreased hemoglobin 3. Increased iron 4. Thrombocytopenia

1. An optimal response is reticulocytosis with normal levels of hemoglobin and free erythrocyte protoporphyrin returning within 1 to 2 months. Increased iron occurs with iron supplements in iron deficiency anemia. Thrombocytopenia is a decreased level of platelets and does not occur with sideroblastic anemia.

A nurse is assessing a client with suspected lymphoblastic lymphoma. Which assessment finding will help confirm this diagnosis? 1. Bence Jones protein 2. Reed-Sternberg cells 3. Palpable nontender abdominal mass 4. Painless enlarged lymph nodes in the neck

4. The first sign of lymphoblastic lymphoma is usually a painless lymphadenopathy in the neck. A mediastinal mass, not an abdominal mass, can occur in clients with lymphoblastic lymphoma. Multiple myeloma has Bence Jones protein. Hodgkin lymphoma has Reed-Sternberg cells.

What are the causes of development of iron deficiency anemia? Select all that apply. A. Pica B. Menorrhagia C .Drinking hot tea D .Gastric bypass E. Copper deficiency

A,B,D. Iron deficiency anemia (IDA) is a common type of anemia with low levels of erythrocytes and hemoglobin. Pica involves the craving and eating of nonnutritional substances such as chalk, dirt, or paper and leads to IDA. In females, menorrhagia is a common cause of IDA. An individual who undergoes gastric surgery may have IDA due to reduced absorption of iron. Drinking hot tea causes pernicious anemia in a patient. Copper deficiency causes sideroblastic anemia.

A nurse is caring for a client who has the most common consumptive thrombohemorrhagic disorder in the clinical setting. The nurse is caring for which client? 1. One with disseminated intravascular coagulation 2. One with hereditary thrombophilia 3. One with polycythemia vera 4. One with leukemia

1. Disseminated intravascular coagulation most commonly is used in the clinical setting to describe a pathologic condition that is associated with hemorrhage and thrombosis (consumptive thrombohemorrhagic disorders). Hereditary thrombophilias increase the risk of developing thrombosis and is a type of thromboembolic disorder, not a hemorrhagic disorder. Polycythemia vera is a type of myeloproliferative red blood cell disorder, not a thrombohemorrhagic disorder. Leukemia is an uncontrolled proliferation of leukocytes, not a platelet disorder. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers.

A client is taking a thiazide agent. Which sign or symptom is essential for the new nurse to report to the registered nurse? 1. Petechiae 2. Sore throat 3. Low-grade fever 4. Pica

1. Drugs such as thiazides, estrogens, and chemotherapeutic agents can cause thrombocytopenia. Thrombocytopenia causes skin manifestations (i.e., petechiae, ecchymoses, and larger purpuric spots) or frank bleeding from mucous membranes. A sore throat and fever are common in infectious mononucleosis. Bleeding takes priority over infection. Eating disorders such as pica—the craving and eating of nonnutritional substances, such as dirt, chalk, and paper—occur in iron deficiency anemia.

Besides bleeding, what other condition should the nurse assess for in a client with heparin-induced thrombocytopenia? 1. Thrombosis 2. Iron overload 3. Lymphadenopathy 4. Microcytic-hypochromic anemia

1. Heparin-induced thrombocytopenia (HIT) is the primary hematologic pathosis related to heparin therapy; however, more than 30% of persons with HIT are also at risk for thrombosis. HIT does not cause microcytic-hypochromic anemia (small, abnormally shaped erythrocytes and reduced hemoglobin concentration), iron overload (excess of iron in the body), or lymphadenopathy (enlarged lymph nodes).

A nurse is creating a brochure that compares non-Hodgkin with Hodgkin lymphoma. Which information should the nurse list under the non-Hodgkin side? 1. It occurs primarily in children. 2. Multiple peripheral nodes are affected. 3. B symptoms are common. 4. Extranodal involvement is rare.

2. Non-Hodgkin lymphoma has multiple peripheral nodes. Non-Hodgkin occurs primarily in middle age, not in childhood. B symptoms are uncommon in non-Hodgkin lymphoma. Extranodal involvement is common, not rare.

A client has impaired hemostasis. Which factor should the nurse consider when planning care for this client? 1. Dietary deficiency of iron 2. Dietary excess of iron 3. Dietary deficiency of vitamin K 4. Dietary excess of vitamin K

3. Impaired hemostasis, or the inability to promote coagulation and the development of a stable fibrin clot, is commonly associated with liver dysfunction, which may be caused by either specific liver disorders or lack of vitamin K, not an excess. A deficiency of dietary iron leads to iron deficiency anemia, whereas an excess leads to iron overload. Test-Taking Tip: Get a good night's sleep before an exam. Staying up all night to study before an exam rarely helps anyone. It usually interferes with the ability to concentrate.

The nurse is reviewing laboratory reports and notices that a client has the presence of fragmented red blood cells (schizocytes) on a routine blood smear. Which condition will the nurse most likely observe written in the chart? 1. Multiple myeloma 2. Hodgkin lymphoma 3. Infectious mononucleosis 4. Thrombotic thrombocytopenic purpura

4. A routine blood smear in thrombotic thrombocytopenic purpura will usually show fragmented red blood cells (schizocytes) produced by shear forces when erythrocytes are in contact with the fibrin mesh in clots that form in blood vessels. Typically, one class of immunoglobulin (the M protein produced by the myeloma cell) is greatly increased, whereas the others are suppressed in multiple myeloma. Hodgkin lymphoma is characterized by the presence of Reed-Sternberg cells. Serologic tests to determine a heterophile antibody response are necessary to diagnose Epstein-Barr virus infection in infectious mononucleosis.

A nurse is caring for a client with thrombocytopenia. Which pathophysiologic process is causing the thrombocytopenia? 1. Decreased reticulocytes 2. Decreased hemoglobin 3. Increased platelet production 4. Increased platelet consumption

4. Thrombocytopenia results from decreased platelet production, increased consumption, or both. Decreased reticulocytes can lead to a decrease in erythrocytes, not thrombocytes. Decreased hemoglobin occurs in anemia, not thrombocytopenia. Decreased platelet production, although not certain, is likely. Increased platelet production is unlikely, and it is not the cause of the thrombocytopenia. STUDY TIP: Enhance your time-management abilities by designing a study program that best suits your needs and current daily routines by considering issues such as the following: (1) Amount of time needed; (2) Amount of time available; (3) "Best" time to study; (4) Time for emergencies and relaxation.

Upon searching for best practices in caring for clients with leukemias, the nurse found that which retrovirus is now widely accepted as a cause of some leukemias? 1. Human T cell leukemia/lymphoma virus-1 (HTLV-1) 2. Human T cell leukemia/lymphoma virus-2 (HTLV-2) 3. Human T cell leukemia/lymphoma virus-3 (HTLV-3) 4. Human T cell leukemia/lymphoma virus-4 (HTLV-4)

1. It is now widely accepted that some types of leukemia are caused by infection with the human T cell leukemia/lymphoma virus-1 (HTLV-1), not HTLV-2, HTLV-3, or HTLV-4.

A client has hereditary hemochromatosis (HH). The nurse will plan care focused on which goal? 1. Decrease iron 2. Decrease copper 3. Increase blood transfusions 4. Increase oral intake of folic acid

1. The primary goal in treatment for HH is to decrease iron overload. Copper deficiency can lead to reversible sideroblastic anemia, not HH. Phlebotomy is the treatment of choice for HH, not blood transfusions, which would make the condition worse. Folic acid (folate) is a treatment for folate deficiency anemia, not HH.

A nurse is planning care for a client with disseminated intravascular coagulation (DIC). What pathophysiologic process occurs in this client? 1. Natural anticoagulants are greatly diminished 2. Tissue factor pathway inhibitor is stimulated 3. Tissue thromboplastin is greatly reduced 4. Rate of fibrinolysis is stimulated

1.Not only is the clotting system extensively activated in DIC, but also the predominant natural anticoagulants (tissue factor pathway inhibitor, antithrombin III, protein C) are greatly diminished. The rate of fibrinolysis is also diminished in DIC, not stimulated. Tissue factor pathway inhibitor is diminished, not stimulated. There is excessive and widespread exposure of tissue thromboplastin, not a reduction. Test-Taking Tip: Calm yourself by closing your eyes, putting down your pencil (or computer mouse), and relaxing. Deep-breathe for a few minutes (or as needed, if you feel especially tense) to relax your body and to relieve tension.

A nurse is caring for a client with anemia. Which possible causes should the nurse consider while planning care? Select all that apply. 1.Thrombosis 2. Dehydration 3 .Blood loss 4. Altered production of erythrocytes 5. Increased erythrocyte destruction

3,4,5. The causes of anemia are (1) altered production of erythrocytes, (2) blood loss, (3) increased erythrocyte destruction, or (4) a combination of these. Thrombosis does not cause anemia but does cause clots. With dehydration, the hematocrit increases because of the decreased intravascular volume, not because of anemia.

A nurse is caring for an adult client who has the most common type of adult leukemia. The nurse is caring for which client? 1. A client with acute lymphocytic leukemia (ALL) 2. A client with acute myelogenous leukemia (AML) 3. A client with chronic lymphocytic leukemia (CLL) 4. A client with chronic myelogenous leukemia (CML)

3. CLL and AML (35% and 29% of adult leukemias, respectively) are the most common types in adults. The most common leukemia in children is ALL. CML accounts for about 11% of adult leukemias.

A client has polycythemia vera. Which action should the nurse take? 1. Administer iron supplements 2. Administer blood transfusion 3. Administer hydroxyurea therapy 4. Administer vitamin B12 injections

3. Hydroxyurea, a nonalklating myelosuppressive, is the drug of choice due to lower incidence of leukemia and thrombosis. Iron supplements would make polycythemia worse; iron is administered for iron-deficiency anemia. Blood transfusions would make the condition worse; phlebotomies are used. Vitamin B12 is given for pernicious anemia, not polycythemia vera.

A client has infectious mononucleosis (IM). Which leukocyte is infected with the Epstein-Barr virus (EBV)? 1. Monocyte 2. Neutrophil 3. B lymphocyte 4. T lymphocyte

3. IM is an acute infection of B lymphocytes with EBV. It does not infect monocytes, neutrophils, or T lymphocytes.

A nurse is caring for an adult with chronic myelogenous leukemia (CML). Which information from the medical record does the nurse recognize as a diagnostic marker for CML? 1. Splenomegaly present 2. Erythrocyte count and hemoglobin low 3. Philadelphia chromosome present 4. WBC count and granulocyte levels elevated

3. The Philadelphia chromosome is a useful diagnostic marker for CML and is observed in 95% of individuals with CML. Splenomegaly is present in numerous hematologic disorders. Anemia is common with CML but has numerous other causes. An elevated WBC count is characteristic of all types of leukemia.

Which mechanism of action does aspirin have on a client's platelet function? 1. Activation of vitamin K 2. Inhibition of vitamin K 3. Activation of cyclooxygenase function 4. Inhibition of cyclooxygenase function

4. Aspirin is the drug most commonly used to affect platelets; it works by irreversibly inhibiting, not activating, cyclooxygenase functioning for several days after administration. Aspirin does not affect vitamin K.

A client has infectious mononucleosis. Which assessment findings will the nurse probably observe? Select all that apply. 1 . Fever 2 . Fatigue 3 . Sore throat 4 . Thrombocytopenia 5 . Enlarged cervical lymph nodes

1,2,3,5. The individual with infectious mononucleosis commonly presents with the classic group of symptoms: fever, sore throat, cervical lymph node enlargement, and fatigue. The blood of affected individuals contains an increased, not decreased, number of platelets (thrombocytosis, not thrombocytopenia), and many white blood cells have atypical forms.

A client has aplastic anemia. While the nurse is obtaining the client's history, which findings will be typical? Select all that apply. 1 .Renal failure 2 . Excessive suntanning 3. Industrial toxins exposure 4 . Radiation treatments 5. Marathon running

1,3,4. Bone marrow failure in aplastic anemia can arise from renal failure, exposure to industrial toxins, and high-dose ionizing radiation. Sun exposure and running in marathons do not cause aplastic anemia.

A nurse is teaching the staff about the principal causes of acquired platelet disorders. Which principal causes should the nurse include? Select all that apply. 1. Drugs 2. Birth defects 3. Systemic conditions 4 .Congenital alterations 5 . Hematologic alterations

1,3,5. Acquired disorders of platelet function are more common than the congenital disorders and may be categorized by the three principal causes: (1) drugs, (2) systemic conditions, and (3) hematologic alterations. Birth defects are congenital disorders (whether hereditary or due to teratogens); they are present at birth, not acquired afterward.

A nurse is caring for a client with anemia. Which possible causes could lead to the development of anemia in a client? Select all that apply. 1. Blood loss 2. Blood transfusion 3 . Decreased leukocytes 4 .Impaired erythrocyte production 5 .Increased red cell destruction

1,4,5,The proximate causes of anemia are (1) altered production of erythrocytes, (2) blood loss, (3) increased erythrocyte destruction, or (4) a combination of all three. Behind those proximate causes may lie various distal causes, such as genetics, malnutrition, or trauma. Blood transfusion can treat or prevent anemia, not cause it. Decreased erythrocytes (red blood cells), not leukocytes (white blood cells), characterize anemia.

A client has polycythemia vera. When the nurse is obtaining the history, which finding is typical? 1. Intense itching when taking a shower 2. History of decreased blood pressure 3. Client has lived in a higher altitude 4. Dehydration

1. A unique feature of polycythemia vera (primary polycythemia), helpful in diagnosis, is the development of intense, painful itching that is intensified by heat or exposure to water (aquagenic pruritus), such that individuals avoid exposure to water, particularly warm water when bathing or showering. Increased blood volume does increase (not decrease) blood pressure in polycythemia vera. Secondary polycythemia is a physiologic response resulting from erythropoietin secretion caused by hypoxia. This hypoxia is noted in individuals living at higher altitudes (>10,000 ft). Relative polycythemia results from hemoconcentration associated with dehydration.

A client has just completed radiation and chemotherapy for head and neck cancer and is hospitalized because of hemorrhaging from the gums and extreme weakness and fatigue. Blood work shows that the client is severely anemic in addition to being severely deficient in platelets and white blood cells. Which type of anemia will the nurse most likely observe written in the chart? 1. Aplastic 2. Hemolytic 3. Sickle cell 4. Sideroblastic

1. Aplastic anemia may occur as a result of radiation and drug exposure such as cancer chemotherapy. The stem cells in the bone marrow are damaged, causing insufficient production of red blood cells, platelets, and white blood cells. Hemolytic anemia occurs from excessive destruction of red blood cells from various causes but usually affects the red blood cells only. When platelets and white blood cells are affected it is termed aplastic, not hemolytic, sickle cell or sideroblastic. Sickle cell causes the red blood cells to sickle. Sideroblastic anemia results from inefficient iron uptake, resulting in abnormal hemoglobin synthesis.

A client has thrombocytopenia as a result of increased platelet consumption. The nurse is caring for which client? 1. One with heparin-induced thrombocytopenia 2. One with a nutritional deficiency 3. One with chronic renal failure 4. One with aplastic anemia

1. Heparin-induced thrombocytopenia results from increased platelet consumption. Thrombocytopenia that results from decreased platelet production is usually the result of nutritional deficiencies, chronic renal failure, or aplastic anemia. STUDY TIP: Rest is essential to the body and brain for good performance; think of it as recharging the battery. A run-down battery provides only substandard performance. For most students, it is better to spend 7 hours sleeping and 3 hours studying than to cut sleep to 6 hours and study 4 hours. The improvement in the rested mind's efficiency will balance out the difference in the time spent studying. Knowing your natural body rhythms is necessary when it comes to determining the amount of sleep needed for personal learning efficiency.

The client presents to the emergency department with burning on the soles of the feet and in the toes, which becomes more severe after standing for a short time. The feet and toes are warm and red upon examination, and findings are more pronounced on the left side. The client also complains of episodes of dizziness, headaches, and double vision. What would be the most appropriate method used to diagnose this condition? 1. Complete blood count 2. Testing for antiplatelet antibodies 3. Activated partial thromboplastin time 4. History of bleeding and associated symptoms

1. Initial diagnosis of essential thrombocythemia is not difficult; as many as two thirds of cases are diagnosed from a routine complete blood cell count. Essential thrombocythemia occurs from a defective receptor, not from antibodies; therefore, testing for antiplatelet antibodies would be ineffective. Activated partial thromboplastin time diagnoses inherited thrombophilias. History of bleeding and associated symptoms is helpful in idiopathic thrombocytopenic purpura but not in essential thrombocythemia, which usually presents with clotting, not bleeding. Test-Taking Tip: Be aware that information from previously asked questions may help you respond to other examination questions.

A client has thrombotic thrombocytopenic purpura. The nurse should prepare the client for which prescribed initial treatment? 1. Plasma exchange with fresh frozen plasma 2. Hydroxyurea (Hydrea) 3. Anagrelide (Agrylin) 4. Splenectomy

1. Plasma exchange with fresh frozen plasma, which replenishes functional ADAMTS13 (ADAM metallopeptidase with thrombospondin type 1 motif, 13), is the treatment of choice, achieving a 70% to 80% response rate. Nonresponse to conventional therapy may require a splenectomy; however, postoperative hemorrhage remains a dangerous complication. Hydroxyurea, a nonalkylating myelosuppressive agent, is used to suppress platelet production and is used to treat thrombocythemia, not thrombocytopenia. Anagrelide is now the drug of choice for thrombocythemia.

A nurse is talking about tissue factor pathway inhibitor, antithrombin III, and protein C. What type of substances is the nurse describing? 1. Natural anticoagulants 2. Natural clotting factors 3. Natural inflammatory cytokines 4. Natural heterophilic antibodies

1. Predominant natural anticoagulants include tissue factor pathway inhibitor, antithrombin III, and protein C. Some of the natural clotting factors include factors V, VII, VIII, IX, and X. Natural inflammatory cytokines include interleukins (IL-6) and TNF-α. Heterophilic antibodies are a heterogeneous group of IgM antibodies that are agglutinins against nonhuman red blood cells and can be used to preliminarily detect infectious mononucleosis. Test-Taking Tip: Answer every question because, on the NCLEX exam, you must answer a question before you can move on to the next question.

A client has a form of anemia caused by altered heme synthesis in erythroid cells. Which form of anemia will the nurse observe documented in the chart? 1. Sideroblastic 2. Pernicious 3. Aplastic 4. Folate

1. Sideroblastic anemias have various causes but share the commonality of altered heme synthesis in the erythroid cells in bone marrow. Normocytic-normochromic anemias are characterized by erythrocytes that are relatively normal in size and hemoglobin content but insufficient in number, as in aplastic anemia. Pernicious and folate anemias cause large red blood cells, producing macrocytic anemia, but they do not affect heme synthesis.

The adult client is undergoing a second round of chemotherapy for metastatic cancer. When the nurse checks the indwelling intravenous line, there is oozing from the central line site, bleeding from the nose and gums, ecchymotic lesions on the hip, and symmetric cyanosis of the fingers and toes. What does the symmetric cyanosis of the extremities indicate? 1. Macrovascular thrombosis 2. Multisystem organ failure 3. Erythrocyte damage 4. Digital ischemia

1. Symmetric cyanosis of the fingers and toes (blue finger/toe syndrome), nose, and breasts may be observed and indicates macrovascular thrombosis. Indicators of multisystem dysfunction include changes in level of consciousness or behavior, confusion, seizure activity, oliguria, hematuria, hypoxia, hypotension, hemoptysis, chest pain, and tachycardia. Jaundice most likely results from red cell destruction rather than liver dysfunction; symmetric cyanosis indicates macrovascular thrombosis, not red cell damage. Digital ischemia is characterized by warm, congested, red extremities with a burning sensation, particularly on the forefoot sole and toes.

While planning care for a client with anemia, which principle should the nurse remember? 1. Tissue hypoxia is the primary alteration. 2. Triad of Virchow will direct nursing care. 3. Lack of Vitamin K leads to anemia. 4. Malignant plasma cells infiltrate bone marrow.

1. The fundamental alteration of anemia is a reduced oxygen-carrying capacity of the blood resulting in tissue hypoxia. Triad of Virchow is associated with thromboembolic disorders. Vitamin K is needed for clotting; a lack of Vitamin B12 is associated with anemia. Multiple myeloma is a B cell cancer characterized by the proliferation of malignant plasma cells that infiltrate the bone marrow and aggregate into tumor masses throughout the skeletal system. Test-Taking Tip: Practicing a few relaxation techniques may prove helpful on the day of an examination. Relaxation techniques such as deep breathing, imagery, head rolling, shoulder shrugging, rotating and stretching of the neck, leg lifts, and heel lifts with feet flat on the floor can effectively reduce tension while causing little or no distraction to those around you. It is recommended that you practice one or two of these techniques intermittently to avoid becoming tense. The more anxious and tense you become, the longer it will take you to relax.

A client has Burkitt lymphoma. Which chromosomal alteration is most associated with this disorder? 1. Translocation between chromosomes 8 and 14 2. Mutations in the HFE gene on chromosome 6 3. Recombination of chromosome 11 4. Trisomy of chromosome 21

1. The most common translocation (75% of individuals) in Burkitt lymphoma is between chromosomes 8 (containing the c-myc gene) and 14 (containing the immunoglobulin heavy chain genes). Hereditary hemochromatosis is caused by two genetic base-pair alterations, C282Y and H63D. These are mutations in the HFE gene on chromosome 6. In about half of multiple myeloma cases, one of the chromosomal partners is 14 (site of genes for the immunoglobulin heavy chain), which recombines with a number of other chromosomal sites of oncogenes, most commonly 11(q13), 4(p16), 16(q23), 20(q11), and 6(p25), resulting in probable dysregulation of the oncogenes. Trisomy 21 is Down syndrome.

A nurse is teaching about inheritance in leukemia. Which information should the nurse include? 1. There is a significant tendency for leukemia to reappear in families. 2. Chronic leukemias are usually inherited in an autosomal recessive pattern. 3. Acute leukemias that arise in childhood have autosomal dominant inheritance. 4. Inherited genetic defects make leukemia certain without nutritional modifications.

1. There is a statistically significant tendency for leukemia to reappear in families. The exact cause of leukemia is unknown, but genetic translocation and environmental factors have been implicated. STUDY TIP: Establish your study priorities and the goals by which to achieve these priorities. Write them out and review the goals during each of your study periods to ensure focused preparation efforts.

A client has hereditary hemochromatosis (HH). Which nursing action should the nurse implement? 1. Prepare the client for a phlebotomy 2. Administer iron supplements 3. Offer food high in vitamin C 4. Check white blood cell count

1. Treatment of HH is simple and consists of phlebotomy of 550 ml of whole blood, which is equivalent to 200 to 250 mg of iron. Individuals with HH should be instructed to refrain from taking iron and vitamin C supplements and consuming raw shellfish. White blood cell count is not affected by HH; the red blood cells are affected. Test-Taking Tip: Be alert for grammatical inconsistencies. If the response is intended to complete the stem (an incomplete sentence) but makes no grammatical sense to you, it might be a distractor rather than the correct response. Question writers typically try to eliminate these inconsistencies.

A client has neutrophilia. What are some possible causes of this condition? Select all that apply. 1 .Late inflammation 2 .Early inflammation 3 .Early stage of infection 4 . Late stage of infection 5. Absolute neutrophil count <5000/mm3 6. Absolute neutrophil count >7500/mm3

2, 3, 6. Neutrophilia is seen in the early, not late, stages of infection or inflammation and is established when the absolute count exceeds 7500/mm3, not less than 5000/mm3.

A nurse is teaching the staff about non-Hodgkin lymphoma. Which information should the nurse include regarding cells that can become malignant in non-Hodgkin lymphoma? Select all that apply. 1 . Neutrophils 2. T lymphocytes 3 .B lymphocytes 4 .Natural killer cells 5 .Eosinophils

2,3,4. Non-Hodgkin lymphoma includes a group of different lymphomas that may arise from B or T lymphocytes or natural killer cells. Neutrophils and eosinophils do not become malignant in non-Hodgkin lymphoma.

A nurse is teaching about the components of the triad of Virchow. Which information should the nurse include? Select all that apply. 1.Lack of fibrin in the blood 2 .Abnormalities of blood flow 3. Hypercoagulable state 4. Vitamin K deficiency 5. Endothelial injury

2,3,5. The risk for developing spontaneous thrombi is related to several factors, referred to as the triad of Virchow: (1) injury to the blood vessel endothelium, (2) abnormalities of blood flow, and (3) hypercoagulability of the blood. Lack of fibrin in the blood and vitamin K deficiency would lead to bleeding, not clotting. Test-Taking Tip: Prepare for exams when and where you are most alert and able to concentrate. If you are most alert at night, study at night. If you are most alert at 2 am, study in the early morning hours. Study where you can focus your attention and avoid distractions. This may be in the library or in a quiet corner of your home. The key point is to keep on doing what is working for you. If you are distracted or falling asleep, you may want to change when and where you are studying.

Upon reviewing the laboratory results, the nurse finds that a client's white blood cell count indicates a shift to the left. How should the nurse interpret this finding? 1. The client's white blood cell count is greater than the red blood cell count. 2. The client's immature neutrophil count is increased, owing to a bacterial infection. 3. The client's main blood circulatory pathway is through the left side of the heart. 4. The client's major circulatory blood cell supply has shifted to the left side of the body.

2. During acute bacterial infection, larger numbers of immature neutrophils (bands) are released into the blood, which is termed a "shift to the left." A shift to the left does not mean that the white blood cell count is greater than the red blood cell count. A blood cell supply (whether white cells or all cells) shifting to the left side of the body is not a realistic situation and is not descriptive of the term "shift to the left." The blood circulatory pathway being through the left side of the heart describes cardiac circulation, not the term "shift to the left." 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.

A 6-year-old child presents with ecchymosis, prolonged bleeding upon minor trauma, low-grade fever, weight loss, headache, and fatigue. These symptoms manifested after the child's recovery from a viral infection. The child is diagnosed with acute idiopathic thrombocytopenic purpura (ITP). Which treatment will be included in the plan of care initially? 1. There is no treatment for this condition 2. Glucocorticoids (such as prednisone) 3. Anti-Rho(D) (RhoGAM) 4. Splenectomy

2. Initial therapy for ITP is glucocorticoids (e.g., prednisone), which suppress the immune response and prevent sequestering and further destruction of platelets. Although there is treatment for ITP, it is palliative, not curative. Anti-Rho(D) (RhoGAM) has been used with limited success to treat individuals who are Rh-positive, but it is not used initially. If platelet counts do not increase appropriately, splenectomy is considered to remove the site of platelet destruction. Test-Taking Tip: Notice how the subjects of the questions are related and, through that relationship, the answers to some of the questions you skipped may be provided within other questions of the test.

A client has idiopathic thrombocytopenic purpura. The nurse should prepare the client for which prescribed initial treatment? 1.Hydroxyurea (Hydrea) 2. Prednisone (Deltasone) 3.Splenectomy 4. Strongly immunosuppressive agents

2. Initial therapy for idiopathic thrombocytopenic purpura is glucocorticoids (e.g., prednisone), which suppress the immune response and prevent sequestering and further destruction of platelets. Splenectomy may be considered if the other measures are unsuccessful; however, there are risks and relapses associated with the surgery. Aggressive immunosuppressive medications such as azathioprine or cyclophosphamide are reserved for those who are refractory to other treatment and are severely thrombocytopenic. Hydroxyurea, a nonalkylating myelosuppressive agent, is used to suppress platelet production and for the treatment of thrombocythemia, not thrombocytopenia.

A client has relative polycythemia. The nurse will focus care primarily on resolving which condition? 1. Hemorrhage 2. Dehydration 3. High altitude changes 4. Coronary heart failure

2. Relative polycythemia results from hemoconcentration of the blood associated with dehydration. Posthemorrhagic anemia would focus on hemorrhage. Absolute secondary polycythemia would focus on high altitudes and coronary heart failure.

A client has reversible sideroblastic anemia. The nurse will focus care primarily on which condition? 1. Genetics 2. Alcoholism 3. Hemorrhage 4. Excessive folate

2. Reversible sideroblastic anemia is associated with alcoholism, resulting from nutritional folate deficiencies. Genetics is associated with hereditary sideroblastic anemia, not reversible sideroblastic anemia. Hemorrhage is associated with posthemorrhagic anemia. Reversible sideroblastic anemia is associated with nutritional deficiencies of folate, not an excess.

A nurse in a prenatal clinic is working with four women who are all early in their third trimester. Which woman is at highest risk for becoming anemic and therefore needs the most frequent monitoring and careful teaching? 1. One who has low blood pressure 2. One who has rheumatoid arthritis 3. One who is having her second child 4. One who has heartburn after eating

2. Rheumatoid arthritis is associated with anemia of chronic inflammation, which gives this woman an additional risk for anemia; all of these pregnant women have increased risk for both iron deficiency anemia and folate deficiency anemia, because the demand for both nutrients is elevated during pregnancy. Low blood pressure does not increase the risk of anemia. Heartburn does not increase the risk of anemia.

A nurse is reviewing laboratory results from a client with multiple myeloma. What would the nurse expect to find? 1.Hyperkalemia 2. Hypercalcemia 3. Hypernatremia 4. Erythrocytosis

2. The common presentation of multiple myeloma is characterized by elevated levels of calcium in the blood (hypercalcemia), renal failure, anemia (lack of erythrocytes, not erythrocytosis), and bone lesions. Hyperkalemia (increased potassium) and hypernatremia (increased sodium) are not generally observed.

The nurse is reviewing objective and subjective data from the physical examination of a middle-aged female client. Which assessment finding helps distinguish between pernicious anemia and folate deficiency anemia? 1. Sore tongue 2. Extreme fatigue 3. Paresthesia of the feet and fingers 4. Mucous membranes moist, pinkish-red

3 The distinguishing difference between pernicious and folate anemias is neurologic symptoms (paresthesia of the feet and fingers). Sore tongue and extreme fatigue occur in both pernicious and folate deficiency anemias. Mucous membranes that are moist, pinkish-red are a normal finding.

A nurse is caring for a client that developed heparin-induced thrombocytopenia (HIT). Which pathophysiologic mechanism caused this condition? 1.Pooling of platelets in the spleen 2.Lysis of megakaryocytes in bone marrow 3.Platelet aggregation and thrombus formation 4. Release of deformed platelets that are unable to form clots

3. HIT involves antibodies that activate platelet aggregation and thrombus formation. HIT does not cause platelets to pool in the spleen, and it does not cause lysis of megakaryocytes or release of deformed platelets. 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.

A 6-year-old child presents with ecchymosis, prolonged bleeding upon minor trauma, low-grade fever, weight loss, headache, and fatigue. These symptoms manifested after the child's recovery from a viral infection. What is the most likely cause of these clinical signs? 1. Multiple myeloma 2. Lymphoblastic lymphoma 3. Acute idiopathic thrombocytopenic purport 4. Chronic idiopathic thrombocytopenic purpura

3. Acute idiopathic thrombocytopenic purpura is more commonly seen in children, usually secondary to infections (especially viral), or other immune conditions such as systemic lupus erythematosus that cause large amounts of antigen to be present in the blood. Idiopathic thrombocytopenic purpura may be either acute or chronic in nature. Chronic idiopathic thrombocytopenic purpura is more commonly seen in adults, especially women between 20 and 40 years old. It is associated with the presence of autoantibodies against platelet-associated antigens and tends to get progressively worse. The common presentation of multiple myeloma is characterized by elevated levels of calcium in the blood (hypercalcemia), renal failure, anemia, and bone lesions. It rarely occurs before the age of 40. Lymphoblastic lymphoma is painless lymphadenopathy in the neck. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Example: If you are being asked to identify a diet that is specific to a certain condition, your knowledge about that condition would help you choose the correct response (e.g., cholecystectomy = low-fat, high-protein, low-calorie diet).

The client presents to the emergency department with burning on the soles of the feet and in the toes, which becomes more severe after standing for a short time. The feet and toes are warm and red upon examination, and findings are more pronounced on the left side. The client also complains of episodes of dizziness, headaches, and double vision. The nurse will most likely observe which condition written in the chart? 1. Multiple myeloma 2. Lymphoblastic lymphoma 3. Essential (primary) thrombocythemia 4. Idiopathic (immune) thrombocytopenic purpura

3. Essential (primary) thrombocythemia presents with warm, congested, red extremities and a burning sensation, especially on the forefoot soles and toes, characteristic of digital ischemia. Digital ischemia is more common in the lower extremities, and often only one side is involved. The common presentation of multiple myeloma is characterized by elevated levels of calcium in the blood (hypercalcemia), renal failure, anemia, and bone lesions; it rarely occurs before the age of 40. Lymphoblastic lymphoma is painless lymphadenopathy in the neck. Idiopathic (immune) thrombocytopenic purpura presents with initial manifestations ranging from minor bleeding problems (development of petechiae and purpura) over the course of several days to major hemorrhage from mucosal sites (epistaxis, hematuria, menorrhagia, bleeding gums).

A client has liver disease. Which clotting factor will be the first to decline in this client? 1. Factor II 2. Factor V 3. Factor VII 4. Factor IX

3. Liver disease causes reductions in clotting factors that mirror the amount of liver cell damage. Factor VII is the first to decline, owing to rapid turnover, followed by decreases in levels of factor II and X. Factor IX levels usually do not decline until liver damage is severe. Decline in levels of factor V is a direct reflection of hepatocyte damage. Test-Taking Tip: Eat breakfast or lunch before an exam. Avoid greasy, heavy foods and overeating. This will help keep you calm and give you energy.

Which of these people should the nurse recognize as being at the highest risk for developing a folate deficiency anemia? 1.Vegetarians 2. Menstruating women 3. People who abuse alcohol 4. Infants lacking the intrinsic factor

3. People who abuse alcohol are at high risk for folate deficiency anemia. Vegetables are an excellent source of folate. Menstruating women are at risk for iron deficiency anemia; pregnant women are predisposed to folate deficiency anemia. Lack of intrinsic factor causes pernicious anemia.

A nurse monitors a client with multiple myeloma for renal failure. Which rationale supports the nurse's action? 1. Reed-Sternberg cells secrete toxins that cause necrosis of renal tubular cells. 2. Excessive white blood cells clog the glomeruli and reduce glomerular filtration. 3. Bence Jones proteins are excreted in the urine and can damage renal tubular cells. 4. Lack of erythropoietin causes poor oxygenation and ischemia of renal tubular cells.

3. Renal failure is a complication of multiple myeloma because Bence Jones proteins are excreted in the urine and can damage renal tubular cells. Reed-Sternberg cells are not characteristic of multiple myeloma but rather are associated with Hodgkin lymphoma. Excessive white blood cells do not clog glomeruli in multiple myeloma. Lack of erythropoietin is not characteristic of multiple myeloma but can be a cause of anemia. Test-Taking Tip: Look for answers that focus on the client or are directed toward feelings.

A client has a suspected infection with the Epstein-Barr virus. The nurse should be prepared to teach the client about which test? 1. Ferritin 2. D-dimer 3. Monospot 4. Red blood cell count

3. Tests used to detect heterophilic antibodies include Monospot or heterphile antibody test. Heterophilic antibodies are a heterogeneous group of IgM antibodies that are agglutinins against nonhuman red blood cells. Ferritin tests for iron-deficiency anemia. D-dimer is used for disseminated intravascular coagulation. Red blood cell count tests for anemia or polycythemia. 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.

he nurse will assess for clinical manifestations of iron deficiency anemia in which stage of the disorder? 1.Stage I 2. Stage II 3. Stage III 4. Stage IV

3. The manifestations of IDA appear in stage III when there is an insufficient iron supply and diminished hemoglobin synthesis. Stage III begins when the hemoglobin-deficient red cells enter the circulation to replace normal, aged erythrocytes that have been destroyed. In stage I, the body's iron stores for red cell production and hemoglobin synthesis are depleted. Red cell production proceeds normally with the hemoglobin content of red cells also remaining normal. In stage II, insufficient amounts of iron are transported to the marrow and iron-deficient red cell production begins. There is no stage IV.

A client is recovering from a life-threatening motor vehicle accident in which massive crushing injuries occurred 10 days ago. Three hours into the shift, the nurse notes acrocyanosis and hematuria and finds that all previous puncture sites and wounds are now oozing blood and will not stop bleeding. What is the nurse's most appropriate response at this time? 1. Apply pressure dressings to all sites and monitor. 2. Obtain a complete blood count immediately. 3. Notify the primary healthcare provider immediately.

3. The most appropriate response is to notify the primary healthcare provider now, because this is a new development classic of disseminated intravascular coagulation (DIC), which is a medical emergency. Pressure dressings will not help in this situation, because the bleeding will not stop and affects internal as well as external sites. The total picture is that of DIC, and a complete blood count will not let the nurse know the clotting factors or bleeding times. Vitamin K is not given in DIC. The treatment of choice for DIC is fresh frozen plasma and possibly heparin, because the client is not septic at this time. Test-Taking Tip: Notice how the subjects of the questions are related and, through that relationship, the answers to some of the questions you skipped may be provided within other questions of the test.

A nurse notices on a client's laboratory report that a "shift-to-the-left" phenomenon occurred. How should the nurse interpret this finding? 1. There are increased numbers of circulating red blood cells. 2. There are decreased numbers of circulating red blood cells. 3. The demand for circulating mature neutrophils exceeds the supply. 4. The number of circulating mature neutrophils exceeds the supply.

3. When the demand for circulating mature neutrophils exceeds the supply, immature, not mature, neutrophils and other leukocytes are released from the bone marrow resulting in the phenomenon known as a leukemoid reaction or "shift-to-the-left" phenomenon. An increased number of red blood cells is termed polycythemia while a lack of red blood cells is anemia. Test-Taking Tip: After you have eliminated one or more choices, you may discover that two of the options are very similar. This can be very helpful, because it may mean that one of these look-alike answers is the best choice and the other is a very good distractor. Test both of these options against the stem. Ask yourself which one completes the incomplete statement grammatically and which one answers the question more fully and completely. The option that best completes or answers the stem is the one you should choose. Here, too, pause for a few seconds, give your brain time to reflect, and recall may occur.

A client has aplastic anemia. Which of these should the nurse monitor for in this client? 1. Deep vein thrombosis 2.Elevated bilirubin levels 3. Decreased potassium levels 4. Increased risk of infection

4. Bone marrow failure in aplastic anemia causes leukopenia, increasing susceptibility to infection. Decreased platelet production in aplastic anemia results in decreased ability to form clots. Elevated bilirubin is seen in hemolytic conditions. Decreased potassium levels do not occur with aplastic anemia. Test-Taking Tip: Avoid taking a wild guess at an answer. However, should you feel insecure about a question, eliminate the alternatives that you believe are definitely incorrect, and reread the information given to make sure you understand the intent of the question. This approach increases your chances of randomly selecting the correct answer or getting a clearer understanding of what is being asked. Although there is no penalty for guessing on the NCLEX examination, the subsequent question will be based, to an extent, on the response you give to the question at hand; that is, if you answer a question incorrectly, the computer will adapt the next question accordingly based on your knowledge and skill performance on the examination up to that point.

A nurse assesses the client with anemia for a heart murmur. When the client asks why the nurse is checking the heart, how should the nurse respond? 1. An increased heart rate in anemia causes low blood pressure; that low pressure causes a heart murmur. 2. A decreased oxygen content of blood from the anemia can cause a heart murmur. 3. Increased intravascular volume from anemia causes pressure on heart valves; that pressure is heard as a heart murmur. 4. The thinner blood from anemia flows faster and more turbulently than normal blood, causing a murmur.

4. Decreased blood viscosity due to anemia causes turbulence when blood circulates through heart valves; turbulence is heard as a murmur. Hypotension (low blood pressure), hypoxia, and hypertension (high blood pressure) are not the cause of murmurs associated with anemia.

A nurse notices a shift to the left in the laboratory reports. Which action is most appropriate for the nurse to take? 1.Prepare the client for discharge 2. Weigh the client daily 3. Administer blood pressure medication to the client 4. Monitor the client's temperature every 4 hours

4. During infection, inflammation, or leukemia, premature release of the immature neutrophils is responsible for the phenomenon known as a shift-to-the-left or leukemoid reaction. Discharge is not appropriate at this time, because an infection, inflammation, or leukemia is present. Infection, inflammation, and leukemia do not respond to blood pressure medication or weighing.

A client has low platelet levels, low red blood cell levels, and low white blood cell levels. Which term should the nurse use to describe this condition during report? 1. Anisocytosis 2. Hypoxemia 3. Glossitis 4. Pancytopenia

4. Pancytopenia is a reduction in all cellular components of the blood. Anisocytosis is excessive variation in the size of red blood cells. Hypoxemia is reduced oxygen level in the blood. Glossitis occurs in iron deficiency anemia.

Which information should the nurse include in a teaching session about pernicious anemia? 1. It is caused by a viral infection. 2. It is generally diagnosed by age 16 years. 3. It is the result of the increased production of intrinsic factor. 4. It is associated with end-stage type A chronic atrophic gastritis.

4. Pernicious anemia is associated with end-stage type A chronic atrophic gastritis, an autoimmune disorder, not a viral infection. It generally occurs in people over the age of 30, not 16, and is due to the absence of, not an increase of, intrinsic factor. Test-Taking Tip: Come to your test prep with a positive attitude about yourself, your nursing knowledge, and your test-taking abilities. A positive attitude is achieved through self-confidence gained by effective study. This means (a) answering questions (assessment), (b) organizing study time (planning), (c) reading and further study (implementation), and (d) answering questions (evaluation).

A nurse is teaching the staff about the gene associated with chronic myeloid leukemia (CML). Which gene should the nurse include? 1.RB 2. TP53 3. BRCA1 4. BCR-ABL

4. The BCR-ABL fusion gene occurs on the Philadelphia chromosome and is associated with CML. The Philadelphia chromosome results from a reciprocal translocation between the long arms of chromosomes 9 and 22. A unique protein (BCR-ABL protein) is encoded from two genes (BCR from chromosome 22 and ABL1 from chromosome 9) that are abnormally linked (thus forming a fusion gene) at the junction of translocation. TP53 and RB are associated with some cancers but not with CML. BRCA1 is associated with an increase in breast cancer in women.

The adult client is undergoing a second round of chemotherapy for metastatic cancer. When the nurse checks the indwelling intravenous line, there is oozing from the central line site, bleeding from the nose and gums, ecchymotic lesions on the hip, and symmetric cyanosis of the fingers and toes. The client becomes confused and begins to display seizure activity. Which is the best method for thrombosis control? 1.Heparin 2. Antifibrinolytic drugs 3. Replacement of anticoagulants (antithrombin III, protein C) 4. Replacement of deficient coagulation factors, elements, and platelets

4. The best method in this client situation is the replacement of deficient coagulation factors, elements, and platelets. Thrombosis control in disseminated intravascular coagulation (DIC) is difficult. Replacement of deficient coagulation factors, elements, and platelets is becoming more common as treatment. Heparin seems to be effective only if the DIC is caused by acute promyelocytic leukemia or retention of a dead fetus. Heparin is also contraindicated when there is evidence of postoperative bleeding, peptic ulcer, or central nervous system bleeding (seizures and confusion). Replacement of anticoagulants (antithrombin III, protein C) seems to be effective in DIC caused by sepsis, which this client did not have. Antifibrinolytic drugs may be used in life-threatening bleeding not controlled by blood component therapy; this would be used if replacement therapy did not work. Test-Taking Tip: Choose the best answer for questions asking for a single answer. More than one answer may be correct, but one answer may contain more information or more important information than another answer.

The client presents to the emergency department with abdominal pain, a history of weight loss, sallow skin, weakness, difficulty in walking, and tremors in hands and feet. What is the most likely diagnosis the nurse will observe written in the chart? 1. Folate deficiency anemia 2. Iron deficiency anemia 3. Sideroblastic anemia 4. Pernicious anemia

4. The client has the classic clinical manifestations of pernicious anemia. When the hemoglobin level has decreased to 7 to 8 g/dl, the individual experiences the classic symptoms of anemia: weakness, fatigue, paresthesias of feet and fingers, difficulty walking, loss of appetite, abdominal pain, weight loss, and a sore tongue that is smooth and beefy red. The skin may become "lemon yellow" (sallow), caused by a combination of pallor and jaundice. Folate deficiency anemia has similar clinical manifestations of pernicious anemia but it does not have the neurological manifestations. Iron deficiency anemia produces koilonychias and glossitis. Sideroblastic anemia may present with iron overload, liver and spleen enlargement, and bronze-tinted skin, not sallow skin.

A client's anemia most commonly is classified using which criteria? 1. Causes of the anemia 2. Treatment of the anemia 3. Alterations that affect the shape of the erythrocyte 4. Changes that affect the cell's size and hemoglobin content

4. The most common classification of anemias is based on the changes that affect the cell's size and hemoglobin content. While anemias can be classified by their cause or by the changes that affect shape, this is not the most common criteria. Classification does not relate to treatment.

A client presents with petechiae, easy bruising, bleeding gums, and a platelet count of 75,000/mm3. Which diagnosis will the nurse observe written in the chart? 1. Anemia 2. Leukopenia 3. Neutropenia 4. Thrombocytopenia

4. Thrombocytopenia produces all of these symptoms and usually occurs with a platelet count below 100,000/mm3. Neutropenia exists when the neutrophil count is less than 2000/mm3, resulting in frequent infections. Leukopenia, of which neutropenia is one type, is a decrease in white blood cells; all forms of leukopenia put the individual at risk for infections. Anemia is a decrease in red blood cells, hemoglobin, and hematocrit; it affects the body's ability to transport oxygen, causing fatigue and ultimately hypoxia.