Patho ch 13 RBC

Which of the following clients is most susceptible to experiencing the effects of inadequate erythropoiesis? A client: A. Who has developed renal failure as a result of long-standing hypertension B. Who recently experienced an ischemic stroke and who remains bedridden C. Whose heavy alcohol use has culminated in a diagnosis of pancreatitis D Whose estimated blood loss during recent surgery was 700 mL

A Kidney failure causes an absence of erythropoietin production. As a result, hypoxia does not result in erythropoiesis. Stroke, pancreatitis, and recent blood loss do not directly impair the body's ability to create new red blood cells.

An infant from parents of Mediterranean decent has been diagnosed with a severe form of β-thalassemia anemia. The nurse caring for this infant knows that the infant will likely receive which of the following medical treatments? A. Transfusion therapy B. Iron sulfate supplements C. Stem cell transplant D. Warfarin, a blood thinner to decrease clot formation

A Persons who are homozygous for the trait (thalassemia major) have severe, transfusion-dependent anemia that is evident at 6 to 9 months of age when the hemoglobin switches from HbF to HbA. If transfusion therapy is not started early in life, severe growth retardation occurs in children with the disorder. Iron and blood thinners will not be therapeutic for this client. Stem cell transplantation is a potential cure for low-risk clients, particularly in younger persons with no complications of the disease or its treatment, and has excellent results.

A mother has brought her 2-week-old infant to the emergency department due to the baby's persistent and increasing jaundice. Blood testing reveals that the infant's unconjugated bilirubin level is 28 mg/dL, and assessment does not reveal neurologic deficits. The infant's weight is normal, and the mother claims to have had no significant difficulty feeding the infant. The most likely treatment for this infant will be: A. Phototherapy B. Packed red blood cell transfusion C. Phlebotomy D. Intravenous antibiotics

A Phototherapy is the standard treatment for mild to moderate hyperbilirubinemia, with exchange transfusion an option for greater risks of kernicterus. Blood transfusions, phlebotomy, and antibiotics are not indicated in hyperbilirubinemia.

For which of the following health problems is stem cell transplantation likely to be of therapeutic benefit? A. Aplastic anemia B. β-Thalassemias C. Chronic disease anemias D. Secondary polycythemia

A The etiology of aplastic anemia involves depression of the bone marrow, a problem that can sometimes be treated by stem cell transplantation. β-Thalassemia, polycythemia, and anemias caused by chronic diseases are not amenable to stem cell transplantation.

The pathologic effects of the thalassemias are primarily due to which of the following pathophysiologic processes? A. Impaired hemoglobin synthesis B. Impaired folic acid absorption C. Erythropoietin deficiency D. Loss of iron

A The thalassemias are a heterogeneous group of inherited disorders caused by mutations that decrease the rate of α- or β-globin chains. The pathologic effects of the thalassemias are not direct results of impaired folic acid absorption or a lack of erythropoietin or iron.

Hemoglobin solubility results and hemoglobin electrophoresis have resulted in a diagnosis of sickle cell anemia in an African American infant. The parents of the child should be aware that their child is at a significant risk for which of the following health problems? Select all that apply. A. Acute pain B. Stroke C. Respiratory disease D. Autoimmune diseases E. Fractures

A, B, C Clients with sickle cell anemia are at significant risk for vasoocclusive pain crisis and acute chest syndrome. As well, increased blood viscosity creates a risk for stroke. Sickle cell disease is not associated with an increased risk for fractures or the development of autoimmune diseases.

Which of the following clients are at high risk for developing anemia? Select all that apply. A. A HIV-positive client who is experiencing frequent infection and elevated CD4+ counts B. A breast cancer client undergoing chemotherapy and radiation therapy C. A client who had a colectomy 3 weeks ago to remove adhesions and fecal impaction D. A COPD client with acute exacerbation requiring O2 therapy via C-PAP E. A middle-aged renal failure client who has hemodialysis three times/week

A, B, E Anemia often occurs as a complication of infections, inflammation, and cancer. The most common causes of chronic disease anemias are acute and chronic infections, including AIDS and osteomyelitis; cancers; autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, and inflammatory bowel disease; and chronic kidney disease. Postsurgical clients do experience some blood loss and may become anemic but not always. COPD clients do not routinely have low hemoglobin levels.

A client presents to the emergency department with severe menstrual bleeding where she is soaking three to 4 pads/hour. Following assessment, which of the following findings indicates that her body is trying to increase its cardiac output? Select all that apply. A. Heart rate 120 beats/minute B. Deep respirations with expiratory wheezes C. Light pink mucous membranes D. Complaints of chest "palpitations" E. Pale bluish nail beds

A, D Anemia is frequently the result of tissue oxygen deficit, which is secondary to decreased circulating red blood cells (RBCs) or hemoglobin for oxygen delivery. The redistribution of the blood from cutaneous tissues or the lack of hemoglobin causes pallor of the skin, mucous membranes, conjunctivae, and nail beds. Tachycardia and palpitations may occur as the body tries to compensate with an increase in cardiac output.

An infant (5 days old) has lab results revealing an elevated level of unconjugated bilirubin, due to hemolysis of RBCs. Because of this, which assessment findings would correlate with this abnormal lab result? Select all that apply. A. Difficulty to arouse (lethargy) B. Cyanosis in hands and feet C. Click in the right hip area when adducted D. Jaundice E. Rigidity and tremors

A, D Unconjugated bilirubin and iron cause yellowing of the skin, or jaundice. Hyperbilirubinemia places the neonate at risk for the development of a neurologic syndrome called kernicterus. This condition is caused by the accumulation of unconjugated bilirubin in brain cells. The manifestations of kernicterus may appear 2 to 5 days after birth in term infants or by day 7 in premature infants. Lethargy, poor feeding, and short-term behavioral changes may be evident in mildly affected infants. Severe manifestations include rigidity, tremors, ataxia, and hearing loss. Extreme cases cause seizures and death. Cyanosis relates to low oxygen levels in the blood (hypoxia) and a click in a hip usually is associated with a fracture.

Hemolytic anemia is characterized by excessive red blood cell destruction and compensatory: A. Hypoactive bone marrow B. Increased erythropoiesis C. Iron retention in the body D. Shrinkage of the spleen

B A compensatory response to hemolysis is to increase erythropoiesis, to increase RBC replacement. The bone marrow is hyperactive and releases an increased number of reticulocytes. Iron from the destroyed RBCs is retained, but this is not a compensatory function. The spleen will be abnormally hyperactive, causing hyperplasia and enlargement.

A 6-month-old infant was born with a murmur. The pediatrician is recommending valve replacement/repair surgery based on which of the following lab values indicating intravascular hemolysis? A. Increase in the number of red blood cells (polycythemia) B. Excess of hemoglobin in the blood plasma (hemoglobinemia) C. Elevated bilirubin levels D. Decreased number of reticulocytes

B Intravascular hemolysis is less common and occurs as a result of mechanical injury caused by defective cardiac valves, complement fixation in transfusion reactions, or exogenous toxic factors. Regardless of cause, intravascular hemolysis leads to hemoglobinemia, hemoglobinuria, and hemosiderinuria.

Megaloblastic anemias caused by folic acid or vitamin B12 deficiencies can seriously affect RBC production. Which of the following lab results would correlate with this diagnosis? A. Iron level of 70 μg/dL (normal) B. Mean corpuscular hemoglobin (MCV) 120 fL (high) C. Platelet count 200,000 (normal) D. Reticulocyte count 3.6% (high)

B Megaloblastic anemias are caused by impaired DNA synthesis that results in enlarged red cells (MCV >100 fL) due to impaired maturation and division. Folic acid and/or vitamin B12 do not have a critical role in normal iron and platelet levels or a high reticulocyte count.

Polycythemia develops in clients with lung disease as a result of: A. Hyperventilation B. Chronic hypoxia C. Decreased blood viscosity D. Excessive respiratory fluid loss

B Secondary polycythemia results from a physiologic increase in the level of erythropoietin, commonly as a compensatory response to hypoxia. Conditions causing hypoxia include living at high altitudes, chronic heart and lung disease, and smoking.

A 12-month-old infant is displaying pale skin, rapid heart rate, and increased respiratory rate. The parents bring the child to the clinic. Which statement by the parents points the health care worker to suspect iron deficiency anemia? A. "He has one to two bowel movements/day." B. "We give him regular cow's milk with all his meals and snacks." C. "He doesn't like to eat any vegetables." D. "His grandma feeds him cookies every time she comes to visit."

B The manifestations of iron deficiency anemia are related to impaired oxygen transport and lack of hemoglobin. Depending on the severity of the anemia, pallor, easy fatigability, dyspnea, and tachycardia may occur. Iron requirements are proportionally higher in infancy (3 to 24 months) than at any other age, although they are also increased in childhood and adolescence. In infancy, a diet consisting mainly of cow's milk, which is low in absorbable iron, is a main cause of iron deficiency anemia.

A 68-year-old client with an 80 pack/year history of smoking was diagnosed with emphysema 18 months ago. The client's most recent scheduled blood work showed excessive increase in production of red blood cell (erythrocytes), a problem that suggests the need for which of the following interventions? A. Vitamin B12 supplements B. Increased supplementary oxygen therapy C. Hemodialysis or peritoneal dialysis D. Scheduled erythropoietin injections

B Treatment of secondary polycythemia focuses relief of the underlying hypoxia. Secondary polycythemia increases in the production of erythropoietin, hence an increased production of erythrocytes. A vitamin B12 deficiency does not underlie secondary hypoxia, and dialysis is not a relevant treatment option. Erythropoietin injections would exacerbate the client's polycythemia.

2. Sue is fatigued, and some blood tests are done. Her results include Hct 40%; Hgb 8g/dL; WBC 8000; and platelets 175,000. The nurse should interpret Sue's blood work as indicative of: A. High platelets/thrombocytosis B. Low WBC count/granulocytopenia C. Low hemoglobin/anemia D. High hematocrit/polycythemia

C All of the laboratory values are within normal range except for the hemoglobin, which is low. Low hemoglobin is associated with iron deficiency anemia.

A 72-year-old woman with complaints of increasing fatigue has completed a series of fecal occult blood tests that indicate the presence of blood in her stool. Which of the following health problems is likely to accompany this client's gastrointestinal bleed? A. Hemolytic anemia B. Aplastic anemia C. Iron deficiency anemia D. Megaloblastic anemia

C Chronic blood loss does not affect blood volume but instead leads to iron deficiency anemia when iron stores are depleted. Such blood loss is not associated with hemolysis, aplastic anemia, or megaloblastic anemia.

Conditions that predispose to sickling of hemoglobin in persons with sickle cell anemia include: A. Impaired red blood cell maturation B. Increased iron content of blood C. Decreased oxygen saturation D. Increased intravascular volume

C Low oxygen in the tissues will cause red blood cells to take on the sickle shape in persons with sickle cell anemia. Sickle cell disease is a disorder of hemoglobin S and does not affect red blood cell maturation. The iron content is not affected by the sickling, but the capacity to carry the iron can be an effect of the affected RBCs. Dehydration can cause sickling by increasing the concentration of hemoglobin.

Which of the following individuals likely faces the highest risk of megaloblastic anemia? A. A 69-year-old woman who takes ASA four times daily to treat her arthritis B. A 44-year-old man who lost approximately 500 mL of blood in a workplace accident C. A 21-year-old college student who lives a vegan lifestyle D. An infant who is exclusively fed commercial baby formula

C Megaloblastic anemia is caused by a deficiency of vitamin B12, which is found in most animal products. Commercial infant formulas do not lack vitamin B12, and acute or chronic blood loss does not result in megaloblastic anemia.

An 85-year-old male has been brought to the emergency department by his family. Routine lab work reveals low hemoglobin of 8.7 g/dL. While taking a detailed history, which of the following statements by the client/family correlate with this anemia? Select all that apply. A. "I get up to the bathroom two to three times/night." B. "When I go food shopping, I have to sit down and rest after one or two aisles." C. "He seems to get confused once in a while." D. "Some nights I just don't feel like eating a big meal." E. "Every now and then, my big toes gets swollen and hurts real bad."

B, C Undiagnosed and untreated anemia can have severe consequences and is associated with increased risk of mortality, cardiovascular disease, lower functional ability, self-care deficits, cognitive disorders, and reduced bone density that increases the risk for fractures with falls. Nocturia, anorexia, nor gout signs/symptoms are related to anemia.

Which of the following clients are at risk of developing folic acid deficiency anemia? Select all that apply. A. A vegetarian who consumes no meats but gets protein from nuts/legumes B. A HIV-positive client who consumes "green juice" at least twice/day made with organic fruits and vegetables C. An elderly male with poor dietary habits who drinks approximately five alcoholic beverages/day D. A pregnant client with prolonged morning sickness lasting most of the day with nausea and frequent vomiting noted E. A toddler who wants to eat chicken nuggets and French fries but refuses to eat anything green

C, D Folic acid is readily absorbed from the intestine. It is found in vegetables (particularly the green leafy types), fruits, cereals, and meats. Much of the vitamin, however, is lost in cooking. The most common causes of folic acid deficiency are malnutrition or dietary lack, especially in the elderly or in association with alcoholism. Because pregnancy increases the need for folic acid 5- to 10-fold, a deficiency commonly occurs. Poor dietary habits, anorexia, and nausea are other reasons for folic acid deficiency during pregnancy. Studies have shown an association between folate deficiency and neural tube defects.

The client is an average-sized adult and has abnormal microcytic hypochromic red blood cells due to a long-term, chronic disease. Which of the following complete blood count (CBC) results is characteristic of her type of anemia? A. Hematocrit 44% B. Reticulocytes 1.5% C. Band cells 3000/mL D. Hemoglobin 8 g/dL

D Anemia of chronic disease is characterized by a low hemoglobin level, low hematocrit, and low reticulocyte count. The quantity of band cells, immature neutrophils released from the marrow, is unrelated to the anemia.

Which of the following trends in the hematologic status of a 6-week-old infant (born at 32 weeks' gestation) most clearly warrants medical intervention? A. Decreasing red blood cell counts B. Increasing HgA levels C. Decreasing mean corpuscular volume (MCV) D. Extremely low hematocrit

D Signs and symptoms include apnea, poor weight gain, pallor, decreased activity, and tachycardia. In infants born before 33 weeks' gestation or those with hematocrits below 33%, the clinical features are more evident. Decreasing red blood cell counts, hematocrit, and MCV are normal postnatal findings. Levels of HgA rise gradually following delivery.

A 48-year-old male client, who normally enjoys good health, has been admitted to the hospital for the treatment of polycythemia vera. The nurse who is providing care for the client should prioritize assessments aimed at the early identification of which of the following health problems? A. Orthostatic hypotension B. Hyperventilation C. Vasculitis D. Thromboembolism

D The increased blood viscosity that accompanies primary polycythemia creates a significant risk of thromboembolism. Hypertension, not hypotension, is also a common sign. Vasculitis and hyperventilation are unlikely to result directly from polycythemia vera

When an Rh-negative mother has been sensitized and is pregnant with an Rh-positive fetus, what happens to the fetus? A. Bilirubin deficiency B. Nothing, this is normal C. Plasma volume depletion D. Profound red cell hemolysis

D This situation is totally detrimental to the health of the fetus. Rh incompatibility and production of antibodies by the mother will result in life-threatening fetal red cell hemolysis. The bilirubin will be sufficiently elevated to cause brain damage. The infant will have massive edema from a lack of albumin production.