Unit 13 Study Guide
Once the granulocyte has entered the body tissues, about how long can they last before they die?
1-2 days
What is the normal lab value range for Platelets?
150-400,000/mm3
What is the normal lab value range for leukocytes (WBC)?
5,000-10,000/mm3
How much volume of blood does a normal human have?
5-6 L
How much of the body weight does blood make up?
7-10%
Where is erythropoietin primarily produced?
90% kidneys 10% liver
What is the most common symptom and complication of anemia?
Fatigue
What sort of condition would cause an increase in the number of immature granulocytes (band cells)?
Infection
What is the normal lab value range for Hematocrit? Men: ___% Women: ___%
Men: 40-52% Women: 37-47%
What is the most common cause of iron deficiency anemia in pre-menopausal women?
Menorrhagia (excessive menstrual bleeding) and pregnancy with an inadequate iron supplementation.
What is the normal lab value range for: Mild Neutropenia Moderate neutropenia Severe Neutropenia Normally, what should the neutrophil count be above?
Mild: 1,500-1,00/mm3 Moderate: 999-500/mm3 Severe: <500/mm3 Normal: >2,000/mm3
What are the primitive cells of the bone marrow called?
Stem Cells
T/F: Anemia is by far the most common hematologic condition, affecting one fourth of the world's population.
True
What medication is the antidote to warfarin? a. Protamine sulfate b. Clopidogrel c. Vitamin K d. Aspirin
c
With the exception of lymphocytes, all blood cells are derived from _____ stem cells.
myeloid
What can you tell patients to take with iron rich foods to enhance the absorption of the iron?
A source of vitamin C such as orange juice
What must happen immediately following a bone marrow aspiration?
After the marrow sample is obtained, pressure is applied to the site for several minutes. Then, the site is covered with a sterile dressing.
____, a condition in which the hemoglobin concentration is lower than normal, reflect the presence of fewer than normal erythrocytes within the circulation.
Anemia
Lymphoid stem cells produce either ___ or ___ lymphocytes.
B or T
Which leukocytes are the least numerous of their class? These contain histamine and heparin, and are released in response to allergens.
Basophils
How should we instruct patients to take iron?
Because iron is best absorbed on an empty stomach, the patient is instructed to take the supplement an hour before meals.
What is the most common cause of iron deficiency anemia in men and post menopausal women?
Bleeding (from ulcers, gastritis, inflammatory bowel disease, or G.I. tumors).
What is the site of hematopoiesis?
Bone Marrow
What are the most common test used to assess bone marrow function?
CBC (complete blood count) PBS (peripheral blood smear)
Medical & Nursing Management for Anemia:
Directed toward correct him or controlling the cause; if it is severe, the erythrocytes that are lost or destroyed may be replaced with a transfusion of PRBCs. Nursing interventions are directed at managing fatigue, maintaining adequate nutrition and perfusion, complying with prescribed therapy, and monitoring and managing potential complications.
_____ play a key role in the response to parasites or allergic diseases.
Eosinophils
What three broad types do myeloid stem cells differentiate into?
Erythrocytes Leukocytes Platelets
What three primary cells comprise blood?
Erythrocytes (RBC) Leukocytes (WBC) Thrombocytes (Platelets)
What are the two main subgroups of leukocytes? What do both of these groups do?
Granulocytes Agranulocytes They protect the body from infection and tissue injury.
_____ is the percentage of blood volume consisting of erythrocytes.
Hematocrit
Because most blood cells have a short lifespan, the need for the body to replenish its supply of cell sis continuous; this process is termed as _____.
Hematopoiesis
What type of anemia occurs when the body's iron stores are depleted and there is no iron available for hemoglobin synthesis? This anemia is the most common type of anemia in all age groups, and it is the most common anemia in the world.
Iron Deficiency Anemia
What genetic mutation might you see in someone diagnosed with polycythemia?
JAK-2 gene
Why do many patients have difficulty taking iron supplements?
Many patients have difficulty tolerating iron supplements because of G.I. side effects (diarrhea, constipation, epigastric discomfort, nausea, and vomiting).
What is the normal lab value for Hemoglobin? Men: ___g/dL Women: ___g/dL
Men: 14-18 g/dL Women: 12-16 g/dL
What is the normal lab value range for Red Blood Cells? Men: ___ x10^6/mm3 Women: ___ x10^6/mm3
Men: 4.5-5.5 x10^6/mm3 Women: 3.8-5.2 x10^6/mm3
What three main subgroups are granulocytes divided into? Which of the three are the most numerous?
Neutrophils Basophils Eosinophils Neutrophils are the most numerous of these cells of this class.
With iron deficiency anemia preventative education is important because iron deficiency anemia is common in menstruating and pregnant women. What are some food sources that are high in iron which you could recommend to patients?
Organ meats (beef or calfs liver, chicken liver), other red meats, beans (black, pinto, and garbanzo), green leafy vegetables, raisins, and molasses.
What is the function of neutrophils?
Phagocytosis (ingestion and digestion of bacteria and particles)
What is the fluid portion of blood?
Plasma
_____ refers to an increased number of erythrocytes (RBCs).
Polycythemia
What is the main difference between primary polycythemia and secondary polycythemia?
Primary polycythemia is a malignant condition. Secondary polycythemia is a benign condition.
What kind of complexion is seen in patients diagnosed with polycythemia?
Ruddy complexion Also may see LUQ pain
What is one of the hallmark signs of polycythemia? This is present in about 75% of patients with this condition.
Splenomegaly
1. Eosinophils 2. Lymphocytes
Tell what the following numbers on the diagram should be:
1. Granulocytes 2. Agranulocytes
Tell what the following numbers on the diagram should be:
1. Myeloid Stem Cell 2. Lymphoid Stem Cell 3. Erythrocytes 4. Leukocytes 5. Platelets 6. Granulocytes 7. Agranulocytes 8. B-Lymphocytes 9. T-Lymphocytes 10. Basophils 11. Neutrophils 12. Eosinophils 13. Monocytes 14. Lymphocytes
Test your Hematopoiesis knowledge!
Should you encourage patients to stop iron therapy once they become free of anemia?
The nurse should encourage the patient to continue iron therapy as long as it is prescribed, even if the symptoms of anemia resolved.
What is the main form of treatment used in patients with polycythemia to help achieve and improve survival?
Therapeutic Phlebotomy
What are the general signs and symptoms of anemia to watch for?
Weakness, fatigue Dizziness Pica (craving unusual items including: ice, starch, or dirt) *Dirt may be from craving iron
Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called: a. Megaloblasts b. Monocytes c. Mast cells d. Blast cells
a
What assessment finding indicates that the client has recovered from induction therapy? a. Neutrophil and platelet counts within normal limits b. Vital signs within normal ranges c. Absence of bone pain d. No evidence of edema
a
Which is a symptom of severe thrombocytopenia? a. Petechiae b. Inflammation of the mouth c. Dyspnea d. Inflammation of the tongue
a Clients with severe thrombocytopenia have petechiae, which are pinpoint hemorrhagic lesions, usually more prominent on the trunk or anterior aspects of the lower extremities.
A client is diagnosed with anemia. While the nurse is teaching about this condition, the client asks, "so where exactly are my red blood cells made?" Which response by the nurse would be most appropriate? a. Red blood cells are made as your blood flows through the body b. Most blood cells are formed in the bone marrow c. They are made in your spleen d. Your liver makes most of your red blood cells
b
A client who is being treated for AML has bruises on both legs. What is the nurses most appropriate action? a. Ask the client whether they have recently fallen b. Evaluate the clients platelet count c. Keep the client on bedrest d. Evaluate the clients INR
b
A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal? a. Place the client in reverse isolation b. Administer pain medication c. Maintain nutrition d. Address issues of negative body image
c
The nurse is teaching a client with acute lymphocytic leukemia (ALL) about therapy. What statement should be included in the plan of care? a. Treatment is simple and consists of single drug therapy b. The goal of therapy is palliation c. Side effects are rare with therapy d. Intrathecal chemo therapy is used primarily as preventative therapy
d
When assessing a female client with a disorder of the hematopoietic or lymphatic system, which assessment is most essential? a. Lifestyle assessments, such as exercise routines b. Menstrual history c. Age and gender d. Health history, such as bleeding, fatigue, or fainting
d
Which type of hemolytic anemia is categorized as inherited disorder? a. Cold agglutinin disease b. Hypersplenism c. Autoimmune hemolytic anemia d. Sickle cell anemia
d
Which statement best describes the function of fibrinogen? a. Plays a key role in forming blood clots b. Functions primarily as an immunologic agent c. Helps maintain osmotic pressure d. Helps prevent or modify some types of infectious diseases
a Fibrinogen, the largest share of plasma proteins, plays a key role in forming blood clots. It can be transformed from a liquid to fibrin, a solid that controls bleeding.
A client comes to the emergency department with a cut that is bleeding. The nurse understands that the clients extrinsic pathway for clotting is initiated with: a. Tissue injury b. Collagen exposure c. Conversion to thrombin d. Clotting factor activation
a Many factors are involved in the coagulation cascade that forms fibrin. When tissue is injured, the extrinsic pathway is activated by the release of thromboplastin from a tissue. As a result of the series of reactions, prothrombin is converted to thrombin, which, in turn, catalyzes the conversion of fibrinogen to fibrin.
A client is diagnosed with moderate neutropenia. When reviewing the clients medical record, the nurse would identify which absolute neutrophil count as supporting the diagnosis? a. 850/mm3 b. 1,510/mm3 c. 1,200/mm3 d. 450/mm3
a Mild: 1,500-1,00/mm3 Moderate: 999-500/mm3 Severe: <500/mm3 Normal: >2,000/mm3
A nurse is describing the immune response to a client diagnosed with an infection. When explaining how the body recognizes foreign cells that trigger an immune response, which structure with the nurse include? Select all that apply. a. lymph nodes b. plasma c. liver d. bone marrow d. spleen
a, c, d In the liver, spleen, lymph nodes, and other areas throughout the body, cells function to recognize foreign cells and trigger an immune response. The bone marrow or plasma are not involved.
The nurse is reviewing a clients laboratory test results and notes that the clients hematocrit is increased. The nurse suspects hemoconcentration related to dehydration. Which assessment finding would support the nurses suspicion? Select all that apply. a. slow skin turgor b. tachycardia c. weight gain d. increased pulse pressure e. elevated urine specific gravity
a, e A falsely elevated hematocrit is noted in conditions of fluid volume loss (such as dehydration). Since no single test confirms hemoconcentration, the nurse must assess for signs of fluid deficit, such as weight loss, dry mucous membranes, delayed skin turgor, orthostatic hypotension, decreased pulse pressure, decreasing urinary output with elevated urine specific gravity, and vital sign changes (tachycardia and decreasing blood pressure as volume is lost).
A client with sickle cell anemia has a: a. Normal blood smear b. Low hematocrit c. High hematocrit d. Normal hematocrit
b A client with sickle cell anemia has a low hematocrit and sickle cells on a smear. A client with a sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear.
A client with Hodgkin's disease had a bone marrow biopsy yesterday and reports aching at the biopsy site, rated a 5/10. After assessing the biopsy site, which nursing intervention is most appropriate? a. Re-position the client to a high Fowlers position and continue to monitor the pain b. Administer acetaminophen 500 mg PO, as ordered c. Administer aspirin (ASA) 325 mg PO, as ordered d. Notify the physician
b After a bone marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing. Most clients have no discomfort after a bone marrow biopsy, but the site of a biopsy may ache for 1 to 2 days. Warm tub baths and mild analgesics may be useful.
Which nursing intervention should be incorporated into the plan of care for a client with impaired liver function and low albumin concentration? a. Monitor temperature at least once per shift b. Monitor for edema at least once per shift c. Implement neutropenic precautions d. Apply prolonged pressure to needle sites or other sources of external bleeding
b Albumin is particularly important for the maintenance of fluid balance with the vascular system. Capillary walls are impermeable to albumin, so its presence in the plasma creates an osmotic force that keeps fluid within the vascular space. Clients with impaired hepatic function may have low concentrations of albumin, with a resultant decrease in osmotic pressure and the development of edema.
For a client diagnosed with pernicious anemia, the nurse emphasize the importance of lifelong administration of: a. Vitamin C b. Vitamin b-12 c. Vitamin A d. Folic Acid
b For a client with pernicious anemia, the nurse emphasize the importance of lifelong administration of vitamin B-12. The nurse teaches the client or a family member the proper method to administer vitamin B-12 injections.
Which term best describes the percentage of blood volume that consists of erythrocytes? a. Differentiation b. Hematocrit c. Erythrocyte sedimentation rate (ESR) d. Hemoglobin
b Hematocrit is the percentage of blood volume consisting of your erythrocytes.
The nurse recognizes that the most common cause of iron deficiency anemia in an adult is: a. Chronic alcoholism b. Bleeding c. Iron malabsorption d. Lack of dietary iron
b Iron deficiency in adults generally indicates blood loss.
Which type of lymphocyte is responsible for cellular immunity? a. B lymphocyte b. T lymphocyte c. Basophil d. Plasma cell
b T lymphocytes are responsible for delayed allergic reactions, rejection of foreign tissue, and destruction of tumor cells. This process is known as cellular immunity.
During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding? a. Enlarged mean corpuscular volume (MCV) b. Low ferritin level concentration c. Elevated red blood cell count d. Elevated hematocrit concentration
b The most consistent indicator of iron deficiency anemia is a low ferritin level, which reflects low iron stores. As the anemia progresses, the MCV, which measures the size of the erythrocytes, also decreases. Hematocrit and red blood cell levels are also low in relation to the hemoglobin concentration.
A nurse is reading a journal article about white blood cells and how they function. The nurse demonstrates understanding of the article by identifying which white blood cell as a granulocyte? Select all that apply. a. Monocytes b. Neutrophils c. Eosinophils d. Basophils e. Lymphocytes
b, c, d
The immature granulocyte has a single-lobed, elongated nucleus and is called a ___ cell.
band
A client who is undergoing chemotherapy for AML reports pain in the lower back. What is the nurses first action? a. Refer the client to a chiropractor b. Administer pain medication, as ordered c. Assess renal function d. Place heating pads on the clients back
c
A clients family member asked the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC? a. It is caused when hemolytic processes destroy erythrocytes b. It occurs when the immune system attacks platelets and causes massive bleeding c. It is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs d. It is a complication of an auto immune disease that attacks the bodies own cells
c
A nurse is preparing a review class about hematologic problems for a group of nurses working at the clinic. As part of the class, the nurse is describing the process by which the body continuously replenishes the supply of blood cells. The nurse is describing which process? a. Phagocytosis b. Hemostasis c. Hematopoiesis d. Neutropenia
c
A nursing instructor is evaluating a student caring for a neutropenic client. The instructor concludes that the nursing student demonstrates accurate knowledge of neutropenia based on which intervention? a. Monitoring the clients heart rate and reviewing the clients hemoglobin b. Monitoring the clients breathing and reviewing the clients arterial blood gases c. Monitoring the clients temperature and reviewing the clients complete blood cell count with differential d. Monitoring the clients blood pressure and reviewing the clients hematocrit
c
For a client with Hodgkin lymphoma, who is at risk for ineffective airway clearance and impaired gas exchange, the nurse places the client in a high Fowlers position to: a. Anticipate the need for airway management b. Reduce deficits in the blood oxygen concentration c. Increase lung expansion d. Detect compromised ventilation
c
The nurse should advise the client with iron deficiency anemia to take which action in order to prevent staining of the teeth? a. Do not combine iron with other prescribed or over-the-counter medication b. Avoid taking iron simultaneously with an antacid c. Dilute liquid preparation of iron with juice and drink with a straw d. Take iron with or immediately after meals
c
Which term refers to a form of white blood cell involved in immune response? a. Spherocyte b. Thrombocyte c. Lymphocyte d. Granulocyte
c
A nurse is reviewing the complete blood count with differential for a client with severe allergies. Which white blood cell with the nurse expect to be elevated? a. Neutrophil b. Monocyte c. Eosinophil d. Lymphocyte
c Eosinophils play a key role in response to parasitic and allergic diseases. The presence of certain microbes results in the release of the granular contents of the eosinophil, allowing for destruction and phagocytosis of the organism.
Which term refers to a form of white blood cell involved in immune response? a. Granulocyte b. Spherocyte c. Lymphocyte d. Thrombocyte
c Mature lymphocytes are the principal cells of the immune system, producing antibodies and identifying other cells and organisms as "foreign." Both B and T lymphocytes respond to exposure to antigens.
What is the major function of neutrophils? a. Production of immunoglobulins b. Destruction of tumor cells c. Phagocytosis d. Rejection of foreign tissue
c Once a neutrophil is released from the marrow into the circulation, it stays there for only about six hours before it migrate into the body tissues to perform its function of the phagocytosis.
Which of the following is a term used to describe the process of ingestion and digestion bacteria by cells. a. Apoptosis b. Poikilocytosis c. Phagocytosis d. Thrombocytosis
c Phagocytosis is the process of ingestion and digestion of bacteria by cells.
A client is scheduled to undergo a bone marrow aspiration and biopsy. The nurse understands that which site would most likely be used? a. rib b. femur c. sternum d. posterior iliac crest
d
A client with severe anemia reports symptoms of tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Laboratory test results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which nursing diagnosis is most appropriate for this client? a. Fatigue related to decreased hemoglobin and hematocrit b. Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients c. Risk for falls related to complaints of dizziness d. Ineffective tissue perfusion related to an adequate hemoglobin and hematocrit
d
A nurse is reviewing a clients white blood cell count with the client. As part of the discussion, the nurse explains about granulocytes and agranulocytes and their function. Which type of white blood cell with the nurse described as being most numerous? a. band cells b. basophils c. eosinophils d. neutrophils
d
The nurse is teaching a client about consolidation. What statement should be included in the teaching plan? a. Consolidation of the lungs is an expected effect of induction therapy b. Consolidation is the term used when a client does not tolerate chemotherapy c. Consolidation occurs as a side effect of chemotherapy d. Consolidation therapy is administered to reduce the chance of leukemia recurrence
d
When teaching a client with iron deficiency anemia about appropriate food choices, the nurse encourage the client to increase the dietary intake of which foods? a. Fruits high in vitamin C, such as oranges and grapefruits b. Dairy products c. Berries and orange vegetables d. Beans, dried fruits, and leafy, green vegetables
d
The physician performs a bone marrow biopsy from the posterior iliac crest on a client with pancytopenia. What intervention should the nurse perform after the procedure? a. Elevate the head of bed to 45° b. Pack the wound with half inch sterile gauze c. Administer a topical analgesic to control pain at the site d. Apply pressure over the site for 5 to 7 minutes
d Hazards of either bone marrow aspiration or biopsy include bleeding and infection. The risk of bleeding is somewhat increased if the clients platelet count is low or if the client has been taking a medication that alters platelet function. After the marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing.
A nursing instructor is reviewing the role and function of stem cells in the bone marrow with a group of nursing students. After providing the explanation, the instructor asks the students to use their knowledge of anatomy and physiology to determine an alternative way in which adults with diseases that destroyed bone marrow can resume production of blood cells. Which explanation by the student is correct? a. The three cell types (erythrocytes, leukocytes, and platelets) can resume production of stem cells. b. The remaining stem cells have the ability to continue with the process of self replication, creating an endless supply. c. Fat found in yellow bone marrow can be replaced by active marrow when more blood cell production is required. d. The liver and spleen can resume production of blood cells through extra-medullary hematopoiesis.
d In adults with diseases that destroy marrow or cause fibrosis or scarring, the liver and spleen can resume production of blood cells through a process known as extra-medullary hematopoiesis.
A nurse is reviewing a clients morning laboratory results and notes a left shift in the band cells. Based on this result, the nurse can interpret that the client: a. Has thrombocytopenia b. Has leukopenia c. May be developing anemia d. May be developing an infection
d Less mature granulocytes have a single-lobed, elongated nucleus and are called band cells. Ordinarily, band cells account for only a small percentage of circulating granulocytes, although their percentage can increase greatly under conditions in which neutrophil production increases, such as infection. An increased number of band cells is sometimes called a left shift or shift to the left.
Which cell of hematopoiesis is responsible for the production of red blood cells and platelets? a. Lymphoid stem cell b. Neutrophil c. Monocyte d. Myeloid stem cell
d The myeloid stem cell is responsible not only for all non-myeloid white blood cells, but also for the production of red blood cells and platelets.
A nurse is completing a detailed health history and assessment in the electronic medical record for a client with a disorder of the hematopoietic system. Which symptom is the most commonly reported in association with hematologic disease? a. Dyspnea b. Blurred vision c. Severe headaches d. Extreme fatigue
d When assessing a client with a disorder of the hematopoietic system, it is essential to assess for the most common symptom in hematologic disease, which is extreme fatigue.
When stimulated, stem cells can begin a process of _____. What are the two primary products of this process?
differentiation Either myeloid or lymphoid stem cells
Differentiation of the primitive myeloid stem cell of the marrow into a erythroblast is stimulated by _____.
erythropoietin
Mature erythrocytes (RBC) consist primarily of ____.
hemoglobin
To prevent excessive clotting, the body has a fibrinolytic mechanism that eventually dissolve clots (thrombi) formed within blood vessels. The balance between these two systems, clot formation and clock dissolution, or fibrinolysis, is called _____.
hemostasis