Study Guide 2: Hematologic Disorder

Nursing interventions are focused on five goals:

-managing pain -preventing and managing infection -promoting coping skills -minimizing deficient knowledge -monitoring/managing potential complications

List three of six possible complications of sickle cell crises:

-stroke -infection -renal failure -heart failure -impotence -pulmonary hypertension

Each 100 mL of blood should normally contain _____g of hemoglobin.

15 g

Women of childbearing years need an additional _____ daily of iron to replace that loss during menstration.

2 mg

The average life expectancy for someone with sickle cell anemia is ______ years.

42 to 48 years

The volume of blood in humans is about _____ L.

5 to 6

Thrombocytes

Another term for platelets

The nurse advises a patient who is iron deficient to take extra vitamin ______, which is known for increasing iron absorption.

C

Albumin

a plasma protein primarily responsible for the maintenance of fluid balance

Lymphocytes

a protein that forms the basis of blood

Absense of intrinsic factor is associated with a B12 deficiency, because the vitamin cannot bind to be transported for absorption in the: a. duodenum b. ileum c. jejunum d. stomach

b. ileum Rationale: Vitamin B12 deficiency has 3 primary etiologies: Autoimmune: Pernicious anemia is an autoimmune condition in which antibodies to intrinsic factor are produced. Anti-intrinsic factor antibodies bind to and inhibit the effects of intrinsic factor, resulting in an inability of B12 to be absorbed by the terminal ileum.

Tonika, a 15-year-old with sickle cell disease, is admitted to the hospital for treatment of sickle cell crises. On the basis of the knowledge of the inheritance of the sickle cell gene (HBS), the nurse expects the patient to be of ______ descent. a. African b. Indian c. Middle Eastern d. Mediterranean

a. African

Blood cell formation (hematopoiesis) occurs in the _______.

bone marrow

On assessment, the nurse notes that the patient's face and skull bones are enlarged. She knows this is a compensatory response to: ____________.

bone marrow expansion to offset anemia

The recommended minimum hemoglobin level for a woman to donate blood is: a. 8.0 g/dL b. 10.5 g/dL c. 12.5 g/dL d. 14 g/dL

c. 12.5 g/dL

A physician prescribes one tablet of ferrous sulfate daily for a 15-year-old girl who experiences heavy flow during her menstrual cycle. The nurse advises the patient and her mother that this over-the-counter preparation must be taken for how many months for iron replenishment to occur? a. 1 to 2 months b. 3 to 5 months c. 6 to 12 months d. Longer than 12 months

c. 6 to 12 months Rationale: Several oral iron preparations—ferrous sulfate, fer- rous gluconate, and ferrous fumarate—are available for treating iron deficiency anemia. The hemoglobin level may increase in only a few weeks, and the anemia can be corrected in a few months. Iron store replenishment takes much longer, so it is important that the patient continue taking the iron for as long as 6 to 12 months. (Brunner and Suddarth)

Bleeding and petechiae do not usually occur with thrombocytopenia until the platelet count falls below 50,000/mm3. The normal value for blood platelets is: a. 50,000 to 100,000/mm3 b. 100,000 to 150,000/mm3 c. between 150,000 and 350,000/mm3 d. greater than 350,000/mm3

c. between 150,000 and 350,000/mm3

Neutrophils

fully mature WBC capable of phagocytosis; primary defense against bacterial infeciton

The principal function of the erythrocyte, which is composed primarily of ______, is to:_________.

hemoglobin; transport oxygen between the lungs and the tissues

Distinguish between primary and secondary polycythemia.

primary polycythemia or polycythemia vera is a proliferative disorder in which all cells are nonresponsive to normal control mechanisms; secondary polycythemia is caused by excessive production of erythropoietin

The major function of leukocytes is to:_________; the major function of neutrophils is: ___________.

protect the body from invasion by bacteria and other foreign entities; phagocytosis

Bone marrow

the site of blood cell formation

Erythrocyte

the term for red blood cell

Fibrinogen

a clotting factor present in plasma

The 5-year survival time for those who receive treatment and are younger than 65 years of age averages: a. 35% b. 55% c. 75% d. 95%

a. 35%

A person can usually tolerate a gradual reduction in hemoglobin until the level reaches: a. 5.0 to 5.5 g/dL b. 4.0 to 4.5 g/dL c. 3.0 to 3.5 g/dL d. 2.0 to 2.5 g/dL

a. 5.0 to 5.5 g/dL

Ian, a 24-year-old graduate student, was recently diagnosed as having Hodgkin's lymphoma. He sought medical attention because of an annoying pruritus and a small enlargement on the right side of his neck. Ian's disease is classified as Hodgkin's paragranuloma. The nurse knows that this classification is associated with: a. a minimal degree of cellular differentiation in the affected nodes b. an excessive production of the Reed-Sternberg cell, the diagnostic atypical cell of Hodgkin's disease c. nodular sclerosis, which reflects advanced malignancy d. replacement of the involved lymph nodes by tumor cells

a. a minimal degree of cellular differentiation in the affected nodes

A diagnostic sign of pernicious anemia is: a. a smooth, sore, red tongue b. exertional dyspnea c. pale mucous membranes d. weakness

a. a smooth, sore, red tongue Rationale: According to the NHLBI, pernicious anemia causes the tongue's surface to look smooth and appear red instead of the pinkish color of a normal tongue. The tongue might also appear thick or beefy in texture. Some tongues might even be swollen or appear to have cracks.

All inherited forms of sickle cell anemia would include all of the following EXCEPT: a. autoimmune hemolytic b. G-6-PD deficiency c. thalassemia d. sickle cell anemia

a. autoimmune hemolytic *inherited forms include G-6-PD deficiency, thalassemia, sickle cell anemia

A patient with chronic renal failure is being examined by the nurse practitioner for anemia. The nurse knows to review the laboratory data for a decreased hemoglobin level, red blood cell count, and: a. decreased level of erythropoietin b. decreased total iron-binding capacity c. increased mean corpuscular volume d. increased reticulocyte count

a. decreased level of erythropoietin

A nurse who cares for a patient who has experienced bone marrow aspiration or biopsy should be aware of the most serious hazard of: a. hemorrhage b. infection c. shock d. splintering of bone fragments

a. hemorrhage

Administration technique should include all of the following EXCEPT:

administering the unit in combination with dextrose in water if the patient needs additional carbohydrates *should include: adding 50 to 100 mL or 0.9% NaCl to the packed cells to dilute the solution and speed up delivery of the transfusion; administering the unit of blood over 1 to 2 hours; squeezing the bag of blood every 20 to 30 minutes during administration to mix the cell

Plasma proteins consist primarily of: _______ and ________.

albumin and globulins

The common feature of the leukemias is: a. a compensatory polycythemia stimulated by thrombocytopenia b. an unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements c. increased blood viscosity, resulting from an overproduction of white cells d. reduced plasma volume in response to a reduced production

b. an unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements

The classic presenting symptom of multiple myeloma is: a. debilitating fatigue b. bone pain in the back of the ribs c. gradual muscle paralysis d. severe thrombocytopenia

b. bone pain in the back of the ribs

The major form of therapy that frequently results in remission is: a. bone marrow transplantation b. chemotherapy c. radiation d. surgical intervention

b. chemotherapy

A nurse should know that a diagnosis of hemolytic anemia is associated with all of the following EXCEPT: a. abnormality in the circulation of plasma b. decrease in the reticulocyte count c. defect in the erythrocyte d. elevated indirect bilirubin

b. decrease in the reticulocyte count *is associated with abnormality in the circulation of plasma, defect in the erythrocyte, and elevated indirect bilirubin

A potential blood donor would be rejected if he or she: a. had a history of infectious disease exposure within the past 2 to 4 months b. had close contact with a hemodialysis patient within the past 6 months c. had donated blood within the past 3 to 6 months d. had received a blood transfusion 9 to 12 months before the blood donation time

b. had close contact with a hemodialysis patient within the past 6 months

A positive diagnosis of Hodgkin's lymphoma depends on: a. enlarged, firm, and painful lymph nodes b. histologic analysis of an enlarged lymph node c. progressive anemia d. the presence of generalized pruritus

b. histologic analysis of an enlarged lymph node

A patient diagnosed with neutropenia (low neutrophil level) resulting from increased destruction of neutrophils would most likely have: a. aplastic anemia b. infectious hepatitis c. leukemia d. a lymphoma

b. infectious hepatitis

Multiple myeloma: a. can be diagnosed by roentgenograms that show bone lesion destruction b. is a malignant disease of plasma cells that affects bone and soft tissue c. is suspected in any person who evidences albuminuria d. is associated with all of the above

b. is a malignant disease of plasma cells that affects bone and soft tissue

An elderly patient presents to the physician's office with a complaint of exhaustion. The nurse, aware of the most common hematologic condition affecting the elderly, knows to check the patient's: a. white blood cell count b. red blood cell count c. thrombocyte count d. levels of plasma proteins

b. red blood cell count

The most frequent symptom and complication of anemia is: a. bleeding gums b. ecchymosis c. fatigue d. jaundice

c. fatigue Rationale: Anemia is a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body's tissues. Having anemia, also referred to as low hemoglobin, can make you feel tired and weak. There are many forms of anemia, each with its own cause.

Ian's diagnosis of stage I Hodgkin's lymphoma implies that the disease: a. has disseminated diffusely to one or more extrahepatic sites b. involves multiple nodes and is confined to one side of the diaphragm c. is limited to a single node or a single intralymphatic organ or site d. is present above and below the diaphragm and may include spleen involvement

c. is limited to a single node or a single intralymphatic organ or site

Myeloid and lymphoid stem cells produce specific types of blood cells. The nurse knows, when evaluating blood tests, that myeloid stem cells differentiate into all of the following types of blood cells EXCEPT: a. erythrocytes b. leukocytes c. lymphocytes d. platelets

c. lymphocytes *do differentiate into erythrocytes, leukocytes, platelets

The nurse begins to design a nutritional packet of information for a patient diagnosed with iron deficiency anemia. The nurse would recommend an increase intake of: a. fresh citrus fruits b. milk and cheese c. organ meats d. whole-grain breads

c. organ meats Rationale: Organ meats are extremely nutritious. Popular types include liver, kidneys, brain, and heart — all of which are high in iron. For example, a 3.5-ounce (100-gram) serving of beef liver contains 6.5 mg of iron, or 36% of the DV ( 14 ). Organ meats are also high in protein and rich in B vitamins, copper, and selenium.

In the normal blood-clotting cycle, the final formation of a clot will occur: a. during the platelet phase b. during the vascular phase c. when fibrin reinforces the platelet plug d. when the plasmin system produces fibrinolysis

c. when fibrin reinforces the platelet plug

Hypoprothrombinemia, in the absence of gastrointestinal or biliary dysfunction, may be caused by a deficiency in vitamin: a. A b. B12 c. C d. K

d. K

During a routine assessment of a patient diagnosed with anemia, the nurse notes the patient's beefy red tongue. The nurse knows that this is a sign of what kind of anemia? a. Autoimmune b. Folate deficiency c. Iron deficiency d. Megaloblastic

d. Megaloblastic Rationale: Vitamin B12 deficiency results in megaloblastic anemia and may present as glossitis. The appearance of the tongue in vitamin B12 deficiency is described as "beefy" or "fiery red and sore". There may be linear or patchy red lesions.

The physician expects that the patient has a deficiency in the leukocyte responsible for cell-mediated immunity. The nurse knows to check the white blood cell count for: a. basophils b. monocytes c. plasma cells d. T lymphocytes

d. T lymphocytes Rationale: Cellular immunity is mediated by T lymphocytes, also called T cells. Their name refers to the organ from which they're produced: the thymus. This type of immunity promotes the destruction of microbes residing in phagocytes, or the killing of infected cells to eliminate reservoirs of infection.

A characteristic symptom that results from insufficient blood cell production is: a. bleeding tendencies b. fatigue c. susceptibility to infection d. all of the above

d. all of the above

Polycythemia vera is characterized by bone marrow overactivity, resulting in the clinical manifestations of: a. angina b. claudication c. thrombophlebitis d. all of the above

d. all of the above

Sickle-shaped erythrocytes cause: a. cellular blockage in small vessels b. decreased organ perfusion c. tissue ischemia and infarction

d. all of the above

Nursing assessment for a patient with leukemia should include observation for: a. fever and infection b. dehydration c. petechiae and ecchymoses d. all of the above.

d. all of the above.

The cause of aplastic anemia may: a. be related to drugs, chemicals, or radiation damage b. result from the body's T cells attacking the bone marrow c. result from certain infections d. be related to all of the above

d. be related to all of the above

A nurse expects an adult patient with sickle cell anemia to have a hemoglobin value of: a. near 3 g/dL b. near 5 g/dL c. between 5 and 7 g/dL d. between 7 and 10 g/dL

d. between 7 and 10 g/dL

A person with sickle cell trait would: a. be advised to avoid fluid loss and dehydration b. be protected from crisis under ordinary circumstances c. experience hemolytic jaundice d. have chronic anemia

d. have chronic anemia

The major cause of death in patients with acute myeloid leukemia is believed to be: a. anemia b. dehydration c. embolus d. infection

d. infection

Hemophilia is a hereditary bleeding disorder that: a. has a higher incidence among males b. is associated with joint bleeding, swelling, and damage c. is related to a genetic deficiency of a specific blood-clotting factor d. is associated with all of the above

d. is associated with all of the above

The Schilling test is used to diagnose: a. aplastic anemia b. iron deficiency anemia c. megaloblastic anemia d. pernicious anemia

d. pernicious anemia Rationale: The Schilling test was a medical procedure used to determine whether you were absorbing vitamin B12 properly. Due to recent advances in laboratory techniques, the Schilling test is not currently used . In the past, doctors might have chosen to order this test if you had vitamin B12 deficiency, or pernicious anemia.

The nurse expects that Ian's course of treatment will involve: a. a combination of chemotherapy and radiation b. a drug regimen of nitrogen mustard, vincristine, and a steroid c. chemotherapy with vincristine alone d. radiotherapy to the specific node over a space of

d. radiotherapy to the specific node over a space of 2 to 4 months

The nurse understands that Tonika's abdominal pain is probably caused by involvement of the organ most commonly responsible for sequestration crises in young adults, which is the: a. kidney b. liver c. pancreas d. spleen

d. spleen

The nurse notes that a patient, who is a vegetarian, has an abnormal number of megaloblasts. The nurse suspects a deficiency in: a. iron b. zinc c. vitamin C d. vitamin B12

d. vitamin B12 Rationale: The most common causes of megaloblastic anemia are deficiency of either cobalamin (vitamin B12) or folate (vitamin B9). These two vitamins serve as building blocks and are essential for the production of healthy cells such as the precursors to red blood cells.

The nurse understands that the shape of the red blood cell is altered with this disease. Instead of being round, biconcave, and disclike in appearance, it can be described as ______, _______, _________, and __________; the hemoglobin value is usually __________ g/dL.

deformed, rigid, sickle-shaped, and crystal-like formation; 7 to 10 g/dL.

A patient is admitted with essential thrombocytopenia due to decreased platelet production. The nurse knows that the diagnosis is most likely:

disseminated intravascular coagulation (DIC)

The nurse is aware that a transfusion reaction, if it occurs, will probably occur:

during the first 15 to 30 mins of the transfusion

Secondary polycythemia is caused by: __________, which may be in response to ____________.

erthropoietin; reduced oxygen

Jerry is to receive one unit of packed red cells because he has a hemoglobin level of 8 g/dL and a diagnosis of gastrointestinal bleeding. Before initiating the transfusion, the nurse needs to check:

for the abnormal presence of gas bubbles and cloudiness in the blood bag; that the blood has been typed and cross-matched; that the recipient's blood numbers match the donor's blood numbers

John is a 51-year-old accountant recently diagnosed with acute myeloid leukemia. Acute myeloid leukemia results from a defect in the ______ and has a peak incidence at ______ years. The 5-year survival prognosis for those older than 65 is about ____%.

hematopoietic stem cell; 67; 4%

The thalassemias (hereditary anemias) are characterized by: ___________, ________, _________, and ________________.

hypochromia, microcytosis, hemolysis, and anemia

A bone marrow specimen is diagnostic if it shows an excess of:

immature blast cells (>30%)

Hemoglobin

makes up 95% of the mass of the red blood cell

Red bone marrow activity is confirmed in adults to the _____, _____, ______, and ________.

ribs, vertebrae, pelvis, and sternum

If a transfusion reaction occurs, the nurse should:

stop the transfusion immediately and keep the vein patent with a saline or dextrose solution

A cardiac response to chronic anemia includes:

tachycardia, heart murmurs, and cardiomegaly

T cells

term used to describe T lymphocytes

Hemostasis

the balance between clot formation and clot dissolution

Plasma

the fluid portion of blood

Phagocytosis

the ingestion and digestion of bacteria by neutrophils

Monocytes

the largest classification of leukocytes

RES

the letters used for the term reticuloendothelial system

Lymphocytes

the mature form of white blood cells; integral component of the immune system

Hematopoiesis

the process of continually replacing red blood cells

Hemostasis

the process of stopping bleeding from a severed blood vessel

Spleen

the site of activity for most macrophages

The two most common areas used for bone marrow aspirations in an adult are: ________ and ________.

the sternum and iliac crest

The severe pain that occurs during sickle cell crises is the result of:

tissue hypoxia and necrosis due to inadequate blood flow to a specific organ or tissue