Patho Chap 25

11. When talking about the lifespan of various blood components, the students should know that once a neutrophil moves into tissue, it lives approximately for how long? A) 12 hours B) 24 hours C) 2 days D) 4 days

D Feedback: After release from the marrow, the neutrophils spend only approximately 4 to 8 hours in the circulation before moving into the tissues. They survive in the tissues for approximately 4 to 5 days. They die in the tissues by discharging their phagocytic function.

5. The blood work of a 44-year-old male patient with a diagnosis of liver disease secondary to alcohol abuse indicates low levels of albumin. Which of the following phenomena would a clinician be most justified in anticipating? A) Impaired immune function B) Acid-base imbalances C) Impaired thermoregulation D) Fluid imbalances

D Feedback: Albumin plays a central role in the maintenance of osmotic pressure and fluid balance. Immune function, acid-base balance, and thermoregulation are not functions of albumin.

19. An oncologist has ordered a bone marrow biopsy for a client and is explaining the reasons for the test and what the client might expect during the test. Which of the following explanations best reflects an aspect of a bone marrow biopsy? A) "I'll take a sample of your bone marrow from your breastbone or your spine." B) "I will be harvesting a sample of your stem cells for examination." C) "I need a more accurate count of your blood components than normal blood work is able to provide." D) "I need to get samples of the types of blood cells that your body is producing."

D Feedback: Bone marrow biopsy can be used to detect abnormal cell production and gain samples. A sample would be taken most likely from the iliac crest, and the biopsy would not focus on pluripotent stem cells. Bone marrow biopsy is not used for simple quantification of blood cellular components.

8. When looking at a granulocyte under a microscope, the anatomy student would describe it as a cell A) lacking granules. B) having a kidney-shaped nucleus. C) having no nuclei. D) shaped like a sphere with multilobar nuclei.

D Feedback: Granulocytes are spherical and have distinctive multilobar nuclei. They are all phagocytic cells that are identifiable because of their cytoplasmic granules. Answers A, B, and C are incorrect. Agranulocytes lack granular cytoplasm. Monocytes have a large amount of cytoplasm and a nucleus in the shape of a kidney. Erythrocytes lack a cell nucleus.

18. A geriatrician is following a number of clients on a subacute geriatric medical unit, some of whom require diagnostic blood work. Which of the following clients would be most likely to have an erythrocyte sedimentation rate (ESR) screening test ordered? An adult with A) a diagnosis of Alzheimer disease and depression. B) orthostatic hypotension and syncopal episodes. C) congestive heart failure. D) systemic lupus erythematosus.

D Feedback: Inflammatory diseases, such as systemic lupus erythematosus, are a common indicator for an ESR test. The other health problems noted are less commonly marked by inflammatory processes.

1. A 5th grade elementary student asks the school nurse how much blood is in an entire body. The nurse should respond that the average grown-up adult has A) 2 to 4 cups of blood in his or her body. B) 3 pints of blood in total. C) 3 to 4 quarts of blood in his or her body. D) 5 to 6 L of blood throughout his or her body.

D Feedback: The total volume of blood in the average adult is about 5 to 6 L, and it circulates throughout the body within the confines of the circulatory system.

10. A 29-year-old construction worker got a sliver under his fingernail 4 days ago. The affected finger is now reddened, painful, swollen, and warm to touch. Which of the following hematological processes is most likely occurring in the bone marrow in response to the infection? A) Proliferation of immature neutrophils B) High circulatory levels of myeloblasts C) Increased segmented neutrophil production D) Phagocytosis by myelocytes

A Feedback: A part of the immune response is the proliferation of neutrophils in response to infectious organisms. Neutrophilia is an increase in immature neutrophils ("bands") most commonly seen in acute infections and tissue injuries that promote the accelerated release of neutrophils and their precursors into the circulation. Myeloblasts are not normally found in circulation, and segmented neutrophils would not yet have reached maturity (takes approximately 2 weeks to mature). Myelocytes do not perform phagocytosis.

9. Following an injury resulting in a small cut from a knife, the first cells to go to the area of the cut would be the A) neutrophils. B) erythrocytes. C) albumin. D) basophils.

A Feedback: Neutrophils are very mobile and are the first cells to go to an area of tissue damage. Erythrocytes (RBCs) contain an O2-carrying protein that functions in the transport of oxygen. Albumin, a plasma protein, does not pass through the pores in the capillary wall to enter the interstitial fluid and therefore contributes to the plasma osmotic pressure and maintenance of blood volume. Basophil granules contain heparin, an anticoagulant; histamine, a vasodilator; and other mediators of inflammation.

16. Which of the following colony-stimulating factors (CSFs) is given to ESRD patients to help with their chronic anemia? A) Erythropoietin (EPO) B) Thrombopoietin (TPO) C) Neupogen D) Interleukin

A Feedback: The CSFs that act on committed progenitor cells include erythropoietin (EPO), which stimulates RBC production. TPO stimulates platelets. Neupogen is for white blood cell production. Interleukin is a cytokine utilized as an immune response agent.

2. A hospital laboratory technician is performing routine blood analysis as part of an inpatient's assessment and is examining the sample in a test tube following processing in a centrifuge and the addition of an anticoagulant. Which of the following observations would the technician most likely interpret as an anomaly? A) The bottom layer of blood in the tube accounts for around one third of the total volume. B) The middle layer of cells appears white to gray in color. C) The top layer of cells is too thin to visualize without microscopy. D) The yellowish fluid on the top of the sample appears to constitute around one half of the total volume.

A Feedback: The body layer of cells in a centrifuged blood sample consists of erythrocytes and should constitute around 42% to 47% of the total blood volume. The middle cell layer of leukocytes should appear whitish gray, and the thrombocytes above that layer are frequently not discernable. The plasma layer should account for around 55% of the total blood volume.

3. During science class, a student asks, "What's the difference between plasma and serum in the blood?" The nurse responds that the primary difference between plasma and serum is that plasma contains A) fibrinogen. B) heparin. C) white blood cells. D) hydrogen ions.

A Feedback: The major difference between plasma and serum is the presence of fibrinogen in the plasma from an anticoagulated centrifuged whole-blood specimen. When blood is removed from the body for testing, it clots within 30 to 60 minutes. The clot contains the blood's cellular components enmeshed in an insoluble fibrin network (formed by the polymerization of soluble plasma protein fibrinogen). The remaining fluid portion is the yellow liquid serum. This serum no longer contains fibrinogen because the fibrinogen originally present in uncoagulated blood was used up in the formation of the blood clot. Heparin, WBC, and hydrogen ions are incorrect.

20. Following a bone marrow biopsy, which of the following assessments would indicate the patient is experiencing a complication as a result of this diagnostic procedure? A) BP 90/60, heart rate 132, excess bleeding, and hematoma noted at the insertion site B) BP 130/80, oxygen saturation 95%, and crackles heard on inspiration C) Respiratory rate 24 and complaining of pain at insertion site D) Heart rate regular 64 beats/minute and temperature 99.6°F orally

A Feedback: The major hazard of a bone marrow biopsy is the risk of hemorrhage. This is usually seen by a decrease in BP, tachycardia, edema from blood pooling in the tissues, etc. All of the other answers are s/s other than shock. Crackles in the lungs correlate with fluid/secretions in the lungs. A bone marrow aspiration is usually performed on the posterior iliac crest and should not cause an elevated respiratory rate. A low-grade fever is not considered a complication.

15. Which of the following statements best captures an aspect of the process of hematopoiesis? A) Colony-stimulating factors (CSFs) produce cytokines that activate progenitor cells. B) Progenitor cells differentiate into precursor cells. C) Various subtypes of pluripotent stem cells eventually differentiate into the cellular components of blood. D) Self-replicating precursor cells differentiate into specific CSFs.

B Feedback: During hematopoiesis, progenitor cells differentiate into precursor cells, which in turn differentiate into the cellular components of blood. Cytokine stimulation precedes and regulates the process, and there are no different subtypes of pluripotent stem cells. Precursor cells are not self-replicating.

7. Which of the following statements best conveys a characteristic of red blood cells? A) They lack organelles and soluble enzymes. B) They contribute to the maintenance of blood pH. C) They help maintain the body's fluid balance. D) They are self-replicating.

B Feedback: Erythrocytes contribute to acid-base balance through the production of bicarbonate and hydrogen ions. They contain soluble enzymes but are neither self-replicating nor involved in fluid balance.

17. A nurse is providing care for several patients on an acute medical unit of a hospital. Which of the following patients would be most likely to benefit from hematopoietic growth factors? A) A 51-year-old female patient with liver failure secondary to hepatitis B) A 61-year-old female patient with end-stage renal cancer C) A 55-year-old obese male patient with peripheral neuropathy secondary to diabetes D) A 44-year-old man with a newly diagnosed brain tumor

B Feedback: Hematopoietic growth factors are commonly used in cases of kidney disease and cancer. Erythropoietin (EPO) is a colony-stimulating factor that stimulates red blood cell production. As a review, erythropoietin is an essential hormone for red cell production. Without it, definitive erythropoiesis does not take place. Under hypoxic conditions, the kidney will produce and secrete erythropoietin to increase the production of red blood cells. With cancer of the kidney, the kidney is unable to perform its normal function. They are not as clearly indicated in cases of liver disease, diabetes, or brain tumors.

4. A student makes the statement to a colleague, "Blood plasma is essentially just a carrier for the formed elements like red blood cells and white blood cells." What would be the most accurate response to this statement? A) "That's not really true. Plasma is crucial in the immune and inflammatory responses." B) "Actually, plasma plays a significant role in nutrient and waste transport." C) "Not really. Plasma also contributes to the processes of protein synthesis and hematopoiesis." D) "Actually, plasma is integral to the proper function of the liver and maintenance of acid-base balance."

B Feedback: Plasma proteins are integral to transport. They are not noted to contribute to the inflammatory response, hematopoiesis, protein synthesis, or liver function.

13. A physician is explaining to a 40-year-old male patient the importance of completing his course of antibiotics for the treatment of tuberculosis. The physician explains the damage that could occur to lung tissue by Mycobacterium tuberculosis. Which of the following phenomena would underlie the physician's explanation? A) Tissue destruction results from neutrophil deactivation. B) Nonspecific macrophage activity leads to pulmonary tissue destruction and resulting hemoptysis. C) Macrophages form a capsule around the Mycobacterium tuberculosis bacteria, resulting in immune granulomas. D) Neutrophils are ineffective against the Mycobacterium tuberculosis antigens.

C Feedback: Immune granulomas are caused by insoluble particles (Mycobacterium tuberculosis) that are capable of inciting a cell-mediated immune response. Neutrophils are deactivated, self-destructive, nor ineffective in cases of tuberculosis.

12. When talking about the various types of granulocytes, which granule contains heparin, an anticoagulant? A) Neutrophils B) Eosinophils C) Basophils D) Lymphocytes

C Feedback: The basophils have granules that contain heparin, an anticoagulant; histamine, a vasodilator; and other mediators of inflammation.

6. A nurse practitioner is providing care for a client with low levels of the plasma protein gamma globulin. The nurse would recognize that the client is at risk of developing which of the following health problems? A) Jaundice B) Anemia C) Infections D) Blood clots

C Feedback: The gamma globulins, antibodies of the immune system, protect against infectious diseases. Because alpha globulin transports bilirubin, a defect in this plasma protein might lead to jaundice; a defect of beta globulin, which transports iron, could be associated with anemia; and a defect of fibrinogen could result in blood clots.

14. A couple who is expecting their first child has been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple has approached their caregiver with this request and is seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting it. How can their caregiver best respond to the couple's enquiry? Stem cells can A) "help correct autoimmune diseases and some congenital defects." B) "be used to regenerate damaged organs should the need ever arise." C) "be used as source of reserve cells for the entire blood production system." D) "help treat some cancers and anemias, but they must come from your child himself or herself."

C Feedback: The proliferative potential and self-renewal of stem cells make them a compensatory mechanism and reserve source for the entire hematopoietic system. While they could be of possible use in certain autoimmune conditions or in cases of organ failure, these statements do not capture their essence. Stem cells can also come from a histocompatible donor.