Chapter 11 Patho
A nurse is reviewing a client's complete blood count (CBC) which indicates thrombocytopenia. Based on this result which action should the nurse include in the plan of care?
Place the client on bleeding precautions.
A 71-year-old male patient with a history of myocardial infarction (MI) and peripheral vascular disease (PVD) has been advised by his family physician to begin taking 81 mg aspirin once daily. Which of the following statements best captures an aspect of the underlying rationale for the physician's suggestion?
Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin.
A nurse is caring for a patient who recently received GPIIb/IIIa inhibitors and is concerned that the patient has developed thrombocytopenia as demonstrated by which of the following?
Platelet count less than 50,000/μL
The nurse is caring for a client with leukemia that is having difficulty with blood clotting after having several transfusions with packed red blood cells. What does the nurse anticipate infusing for this client to assist with controlling the bleeding?
Platelets
A patient presents to his physician with a red face, hands, feet, and ears; a headache; and drowsiness. A blood smear reveals an increased number of erythrocytes. Based on the laboratory results, the nurse prepares teaching material for which disease process?
Polycythemia
A client tells the nurse that the doctor told her she has too many red blood cells accompanied by elevated white cells and platelet counts. The nurse recognizes this as:
Polycythemia vera
A patient presents to the clinic with symptoms of elevated blood pressure, dizziness, red face, pain in fingers and toes, headache, and difficulty concentrating. A blood smear reveals an increased number of erythrocytes. Based on these findings, the nurse anticipates which of the following diagnoses?
Polycythemia vera
The nurse is preparing a client with suspected leukemia for a bone marrow and biopsy. What preferred site will the nurse be sure is accessible for the physician?
Posterior iliac crest
Which of the following anatomical sites would the nurse expect to monitor when caring for an adult patient who has just had a bone marrow aspiration performed?
Posterior iliac crest
A client is admitted with a suspected diagnosis of Hodgkin lymphoma (HL). Select the diagnostic manifestation that would confirm the diagnosis.
Presence of Reed-Sternberg cells
A young man has been diagnosed with hemophilia, and the nurse is planning his discharge teaching. The nurse knows to include what in her discharge teaching?
Prevent trauma to the body.
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:
Systemic lupus erythematosus.
A 42-year-old male client recently diagnosed with liver cancer is noted as at high risk for bleeding abnormalities. The nurse recognizes this risk as a result of:
The reduction of clotting factors synthesized in the liver
A 6-year-old child is having a stem cell transplant using umbilical cord blood. What benefit does the nurse understand that this type of transplant will have for the child?
This type of transplant creates less risk of graft-versus host disease
A nurse assessing a client with an acute exacerbation of polycythemia vera notes coolness to the right leg and foot, pale color and an absent right pedal pulse. Based on these findings the nurse suspects that the client has developed which of the following complications?
Thrombosis of the right leg
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?
Transfusion therapy
A patient in the hospital following a repair of a left hip fracture is refusing to wear the intermittent pneumatic compression stockings ordered by the physician. The nurse explains to the patient that the compression stockings are essential in preventing which of the following?
Venous thrombosis
The nurse is caring for a client who is a strict vegetarian; the client is at greatest risk for the development of:
Vitamin B12 deficiency anemia
To form a platelet plug, platelets must adhere to the vessel inner layer. For this to occur, which protein molecule is required?
Von Willebrand factor
The nurse is reviewing the complete blood count (CBC) and white blood cell (WBC) differential of a client admitted with lower right abdominal pain. Which laboratory results are the most important for the nurse to communicate to the health care provider?
White blood cells (WBCs) 18,500/µL
The nurse is caring for a client diagnosed with sickle cell disease. Select the most important factor for the nurse to be aware of that may cause the cells to sickle.
reduced oxygen tension while client sleeps
A client laboratory report indicates neutropenia. The nurse is aware the client is at greatest risk for development of infection. The most important area for the nurse to assess would be:
skin
With which of the following conditions are Bence Jones proteins not associated?
• Chronic lymphocytic leukemia • Chronic myelogenous leukemia • Hodgkin's lymphoma
Two years after chemotherapy and radiation therapy for lung cancer, a 72 year old patient notices that they seem to be extremely tired all the time. The physician suspects the patient may have developed aplastic anemia. The nurse assessing the patient will likely find which of the following clinical manifestations of aplastic anemia?
• Complaints of weakness and fatigue. • Small spots of skin hemorrhages over entire body. • Excess bleeding from gums and nose.
Which of the following symptoms of leukemia are directly related to a decrease in thrombocytes?
• Ecchymosis • Petechiae
The parents are ready to take their newly diagnosed hemophilia child home. Which of the following teaching aspects should the nurse discuss with them prior to discharge?
• Keep the child away from contact sports like football and wrestling. • Administration of factor VIII at home when bleeding occurs.
The nurse is performing an admission assessment on a client with the diagnosis of primary polycythemia. The nurse anticipates that the assessment will include:
• Plethora • Hypertension • Itching • Pain
Which of the following statements concerning red blood cells (RBCs) are correct?
• RBCs are the most abundant of the blood cells • RBCs are necessary for carbon dioxide transport.
A patient has been diagnosed with anemia. The physician suspects an immune hemolytic anemia and orders a Coombs test. The patient asks the nurse what this test will tell the doctor. The nurse replies:
"They are looking for the presence of antibody or complement on the surface to the RBC."
A 38-year-old female is considering the use of oral contraceptives as a method of birth control. She asks her health care provider if any risks would be involved. The best response would be:
"Yes, risks increase with age."
Which of the following is a function of plasma?
Carrying nutrients
A nurse is caring for a patient who suffered a massive heart attack followed by the development of congestive heart failure (CHF). As the nurse is reviewing with the patient medications taken at home, the patient states concern that the doctor discontinued the Nexium. The nurse explains that taking Nexium with some medications can cause adverse cardiac events. Which of the following medications would be of possible concern?
Clopidogrel
A client is admitted to the hospital with a diagnosis of deep vein thrombosis and started on intravenous heparin therapy. Seven days later, the client's lab values identify a rapid decrease in platelets. The health care provider recognizes this as:
Drug-induced thrombocytopenia
A patient has been placed on Bactrim as treatment for community-acquired methicillin-resistant Staphylococcus aureus MRSA for 10 days. After taking the medication for 8 day, the patient comes to the doctor's office complaining of multiple nosebleeds over the past day. Laboratory work shows a platelet count of 80,000/μL. The nurse practitioner suspects which of the following conditions?
Drug-induced thrombocytopenia
Infectious mononucleosis is a lymphoproliferative disorder caused by the Epstein-Barr virus (EBV) that is usually self-limiting and nonlethal. Which of the following complications can arise during this mostly benign disease?
Enlarged spleen
A 16-year-old male client who has been diagnosed with infectious mononucleosis asks the health care provider what caused the condition. The best response would be:
Epstein-Barr virus (EBV)
Aplastic anemia is the result of which of the following conditions?
Failure of multipotent stem cells to grow
The nurse's plan of care for a client with multiple myeloma should include interventions to prevent which of the following?
Fractures
A patient being treated for polymyalgia rheumatica (PMR) comes to the clinic for a follow-up visit. The current erythrocyte sedimentation rate (ESR) rate has decreased from 60 mm/hour to 30 mm/hour and the patient is afebrile, denies any headaches, and reports a decrease in joint pain and fatigue. Based on these findings, the nurse anticipates which of the following changes to the treatment plan?
Gradually decrease the current dosage of prednisone and repeat ESR in 2 weeks.
A lymph node biopsy pathology report notes the presence of Reed-Sternberg cells on a patient suspected of having a lymphoma. The nurse interprets the report as indicating which of the following?
Hodgkin's lymphoma
Which of the following is the main job of lymphocytes?
Immune reaction
A patient is admitted to the emergency department with a diagnosis of polycythemia. The nurse plans to assess for symptoms related to which of the following problems?
Increased blood viscosity
A patient diagnosed with acute lymphocytic leukemia (ALL) is receiving treatment. The patient is in the phase with the planned outcome of remission. Which of the following therapies does the nurse determine that the patient is in?
Induction
Following a lecture on hemostasis, a nursing student accidently cuts her hand while preparing supper for her family. She watches the laceration very closely. Sure enough, the first thing she notes is:
Initially, it takes a few seconds for blood to appear as a result of vessel spasm.
A client has been admitted for immune thrombocytopenic purpura. The client has not responded to corticosteroid treatment. The priority nursing intervention for this client would include which of the following treatment measures?
Insert an intravenous catheter, so immune globulin can be administered in a timely manner.
A female patient comes to the clinic with symptoms of fatigue and heavy menses over the last 6 months. Laboratory tests reveal a microcytic hemochromic anemia. Based on these results, the nurse anticipates teaching the patient about which type of anemia?
Iron deficiency anemia
A client's bone marrow study report reveals the findings of blast cells in the bone marrow. What does the nurse interpret this as indicating?
Leukemia
The pediatrician knows that the most common cause of cancer in children is which of the following?
Leukemia
A nurse orienting to the surgical suite is studying medications that affect platelet function and notes that the most common medications are which of the following?
Nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin
During science class, a student asks, What is the difference between plasma and serum in the blood? The nurse responds that the primary difference between plasma and serum is that plasma contains:
fibrinogen
Anemia refers to a deficiency of:
hemoglobin
While being on subcutaneous heparin injections for deep vein thrombosis during her latter pregnancy, a patient begins to experience major side effects. Her OB physician has called in a specialist who thinks the patient is experiencing heparin-induced thrombocytopenia. The nurse should anticipate which of the following orders?
immediately discontinue the heparin therapy
A nurse is caring for a client in the intensive care unit who has sustained severe trauma and now has developed disseminated intravascular coagulation (DIC). The nurse is aware that the client is experiencing:
Widespread coagulation and bleeding in the vascular compartment
A nursing student asks her instructor, "I don't understand this coagulation system. When we donate blood, what keeps it from clotting in the bag?" The instructor responds:
"Citrate is added to the blood bag, which prevents it from clotting."
The mother of a newborn infant questions why her baby needs a vitamin K injection immediately after birth. The best response by the nurse would be:
"Infants are not born with the normal intestinal bacteria that synthesize vitamin K for clotting."
The lab technician is evaluating the student's knowledge of laboratory values for red blood cells. The technician knows the student has been studying when she correctly states which of the following?
"The major components of blood are the red cell mass and plasma volume."
A client tells the nurse that he has recently begun to take over-the-counter (OTC) calcium supplements to ensure that his blood will clot. The best response by the nurse would be:
"This is not necessary, unless it has been prescribed by your health care provider."
In which of the following individuals would a clinician most suspect multiple myeloma as a diagnosis?
A 40 year-old man who has had 3 broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated.
A patient diagnosed with systemic lupus erythematosus (SLE) has been experiencing a low neutrophil count. How would this type of neutropenia be classified?
Acquired, autoimmune secondary neutropenia
Which of the following is the most abundant type of plasma proteins?
Albumin
Anticoagulant drugs prevent thromboembolic disorders. How does warfarin, one of the anticoagulant drugs, act on the body?
Alters vitamin K, reducing its ability to participate in the coagulation of the blood
The cloning of the genes for most of the hematopoietic growth factors has been accomplished. The recombinant proteins that are produced are used in a wide range of clinical problems. What diseases have these proteins been used to fight?
Aplastic anemia and the anemia of kidney failure
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?
BP 90/60, heart rate 132, excess bleeding and hematoma noted at insertion site.
When talking about the various types of granulocytes, which granule contains heparin, an anticoagulant?
Basophil
A client is ordered the recumbent granulocyte CSF filgrastim. The nurse evaluates the effectiveness by monitoring which of the following?
CBC/diff
The physician is examining a postmenopausal female and explains that which of the following is the most usual reason for iron deficiency in adults?
Chronic blood loss
An elderly client asks the nurse why so many older people develop anemia. The best response would be:
Chronic disease
The nurse is planning a prevention program for infectious mononucleosis. The best target audience for the program is which of the following?
College students living in a dorm
A nurse is caring for a client diagnosed with immune thrombocytopenic purpura (ITP). Which of the following medications does the nurse anticipate administering to treat this disorder?
Corticosteroids
To have stem cells for transplantation, clients are given specific agents to increase the quantity and migration of the cells from the bone marrow. What is the agent used to accomplish this?
Cytokine growth factor
The nurse is caring for a client who has a low levels of T lymphocytes. The nurse plans care for a client with which of the following?
Decreased immune response
There are two pathways that can be activated by the coagulation process. One pathway begins when factor XII is activated. The other pathway begins when there is trauma to a blood vessel. What are these pathways?
Extrinsic and intrinsic pathways
A patient has a hematocrit of 32% and is diagnosed with iron deficiency anemia. The nurse anticipates which of the following treatments to be prescribed?
Iron replacement therapy
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?
Mean corpuscular hemoglobin (MCV) 120 fL (high)
The physician reviews a client's lab results and notes that the neutrophil count is 900/uL. This is known as which of the following?
Neutropenia
Which of the following is the most common leukocyte in normal blood?
Neutrophilic granulocyte
The client explains to her new provider that she receives periodic phlebotomies to decrease their red blood cell mass. The provider believes the client may have which of the following?
Polycythemia vera
The nurse is caring for a client with multiple myeloma with Bence-Jones proteins. With this "light chain" form of the disease, it is important for the nurse to include assessment for which of the following?
Renal disease
If an Rh-negative mother is giving birth to an Rh-positive infant, the nurse should be prepared to administer:
Rh immune globulin.
Select the first stage of hemostasis.
Vessel spasm
The nursing caring for a 62-year-old client with diffuse large B-cell lymphoma plans care based on the knowledge that this client's lymphoma is:
agressive
first symptom of multiple myeloma
bone pain
The nurse is conducting patient education for a client who is scheduled to undergo diagnostic testing for non-Hodgkin's lymphoma (NHL). The nurse includes information on which of the following?
lymph node biopsy
A client has been diagnosed with aplastic anemia. The nurse is aware that the client's lab results will identify:
reduction of white blood cells
The nurse is caring for a client with chronic lung disease who has a history of smoking 2 packs of cigarettes per day for 25 years. The client is at high risk for the development of:
secondary polycythemia
The nurse is assessing a female patient with a hemoglobin of 6.8g/dL. Which of the following symptoms would the nurse expect to find?
• Dyspnea • Headache • Faintness
A new leukemia patient begins hemorrhaging from every orifice. The physician is concerned that the patient has developed Disseminated Intravascular Coagulation (DIC). The nurse should anticipate which of the following orders to be prescribed for this patient?
• Transfuse 2 units of platelets. • Transfuse fresh frozen plasma.
The parent of a 5 year old who was admitted with a sudden onset of purpura following the flu and who was diagnosed with acute idiopathic thrombocytopenic purpura (ITP) is very concerned that the child will have ITP for the rest of his life. The best response for the nurse to make is which of the following?
"It is usually self-limiting."
A client who had a pulmonary embolism is receiving IV heparin and has just begun taking his first dose of warfarin (Coumadin). The client asks the nurse, "How long will this pill take in order to prevent me from developing more clots. I would like to go home soon." The nurse responds:
"It usually takes 2 to 3 days for warfarin to become therapeutic, meaning your blood will be thin enough to prevent further clot formation."
Your ESRD patient is receiving two units of packed red blood cells for anemia (Hgb of 8.2). Twenty minutes into the first transfusion, the nurse observes the patient has a flushed face, hives over upper body trunk, and is complaining of pain in lower back. His vital signs include pulse rate of 110 and BP drop to 95/56. What is the nurse's priority action?
Discontinue the transfusion and begin an infusion of normal saline
A postpartum client develops uncontrolled postpartum bleeding, oozing from IV sites, a blood pressure of 82/40, and respiratory distress. Which of the following complications does the nurse suspect is occurring?
Disseminated intravascular coagulation
The client reports he has been noticing small amounts of blood in his stool for the last several weeks. The provider knows the client's red cell mass may reach which value without the occurrence of signs and symptoms?
50%
A client was involved in an auto accident and suffered massive internal injuries that resulted in a large blood loss. Select the type of anemia the client is at greatest risk to develop.
Blood loss
The nurse evaluating a client's bloodwork determines that a client has an increased risk for infection based on which of the following lab results?
Absoulute neutrophil count of 800/uL
After birth, red blood cells are normally made in which of the following locations?
Bone marrow
Which of the following statements most accurately conveys an aspect of lymphatic system activity?
B and T lymphocyte development begins in the bone marrow and ends in the peripheral lymphoid structures.
A patient is suspected of having acute leukemia. Which of the following diagnostic tests does the nurse prepare for to verify that diagnosis?
Bone marrow biopsy
A patient comes to the clinic following exposure to chicken pox. The patient states he had chicken pox as a child but was worried about getting sick again. Which of the following statements best explains humoral-mediated immunity to the patient?
B lymphocytes (B cells) in the body produce antibodies to fight infections. Once exposed, the cells retain memory and are able to quickly fight off pathogens during re-exposure and prevent the disease from reoccurring.
The nurse reading a client's history and physical notes that the client has a history of leukopenia. The nurse interprets this to mean that the client has which of the following?
Decreased leukocytes
A 57-year-old man is diagnosed with thrombocytopenia. The nurse knows that thrombocytopenia refers to a decrease in the number of circulating platelets. The nurse also knows that thrombocytopenia can result from what?
Decreased platelet production
A nurse is caring for a newborn that has developed a low platelet count. Which of the following could be the cause?
Decreased thrombopoietin (TPO)
A nurse working in an ambulatory care unit is working with a patient who has recently been diagnosed with a V Leiden mutation. The nurse tells the patient the importance of smoking cessation to avoid which of the following?
Deep-vein thrombosis (DVT)
An elderly patient is brought to the emergency department with garbled speech, unilateral facial drooping, and weakness. One hour after admission, the patient dies. An autopsy reveals the presence of polycythemia. Which of the following was the most likely cause of the patient's death?
cerebral thrombosis
