EAQ Ch 30 Nursing Assessment: Hematologic System

40 (The patient has a serum iron level of 120 mcg/dL and total iron binding capacity is 300 mcg/dL. The formula to calculate transferrin saturation level = (serum iron level/TIBC) x 100 = (120/300) x 100 = 40%. Text Reference - p. 628)

Laboratory reports indicate that a patient has a serum iron level of 120 mcg/dL and total iron binding capacity is 300 mcg/dL. What is the transferrin saturation level of the patient? Record your answer using a whole number. _________%

pancytopenia

Condition where there is a marked decrease in the number of RBCs, WBCs, and platelets.

3 (An individual with type A blood has A antigens, not A antibodies, on his RBCs. An AB transfusion would result in agglutination, but he may be transfused with either type A or type O blood. Text Reference - p. 628)

A blood type and crossmatch has been prescribed for a male patient who is experiencing an upper gastrointestinal bleed. The results of the blood work indicate that the patient has type A blood. Which description explains what this means? 1 The patient can be transfused with type AB blood. 2 The patient may only receive a type A transfusion. 3 The patient has A antigens on his red blood cells (RBCs). 4 Antibodies are present on the surface of the patient's RBCs

3 (In acute leukemia, a complete blood count shows a large number of immature blast white blood cells present in the blood. Pancytopenia is associated with a marked decrease in the number of red blood cells, white blood cells, and platelets. Neutropenia is a condition in which the absolute neutrophil count is less than 1000 cells/μL. Thrombocytopenia is a condition in which the platelet counts falls below 100,000/μL. Text Reference - p. 625)

A nurse is reviewing a patient's laboratory reports, which show a large number of immature blast white blood cells in the blood. Which condition is likely to be found in the patient? 1 Pancytopenia 2 Neutropenia 3 Acute leukemia 4 Thrombocytopenia

1 (A patient's medical report shows the white blood cell count to be 15 × 10{9}/L. The normal range for a white blood cell count is between 4 × 10{9}/L to 11 × 10{9}/L. Elevations in white blood cell count are associated with infection, because white blood cells (WBCs) are immune cells. Neutropenia is a condition in which the absolute neutrophil count (ANC) is less than 1000 cells/μL. It does not increase the risk of bleeding. Thrombocytopenia is a condition in which platelet counts fall below 100,000/μL. Text Reference - p. 626)

A nurse reviews the lab report of a patient that shows the white blood cell count is 15 × 10{9}/L. Which condition is the patient likely experiencing? 1 Infection 2 Neutropenia 3 Risk of bleeding 4 Thrombocytopenia

2 (Basophils respond to allergies and stimulate antigens in response to tissue injury. Platelets aid in clot formation. Monocytes are phagocytic cells that ingest dead cells and debris. Lymphocytes respond to cellular or humoral immune responses. Text Reference - p. 616)

A patient experiences a skin allergy after contact with weeds. Which cells respond to this type of reaction? 1 Platelets 2 Basophils 3 Monocytes 4 Lymphocytes

4 (After bone marrow aspiration, if bleeding is present at the site, the patient should be advised to lie on the affected side for 30 to 60 minutes to maintain pressure on the site. If the bed is too soft, the patient can lie on a rolled towel to provide additional pressure. Walking, sitting, and standing do not help to maintain pressure on the site. Text Reference - p. 630)

A patient who has undergone bone marrow aspiration is being monitored by the nurse. The nurse observes that bleeding is present at the needle aspiration site. Which action should the nurse advise the patient to perform? 1 Walking for 10 to 15 minutes 2 Sitting for 30 to 40 minutes 3 Standing for 30 to 40 minutes 4 Lying on the side for 30 to 60 minutes

2 (If a patient is tachycardic, the heart rate is above 100 beats/minute, which may occur in anemic patients as a compensatory mechanism to increase cardiac output. If a patient is bradycardic, the heart rate is below 60 beats/minute. Hypertensive and hypotensive refer to blood pressure readings, not the heart rate. STUDY TIP: Laughter is a great stress reliever. Watching a short program that makes you laugh, reading something funny, or sharing humor with friends helps decrease stress. Text Reference - p. 624)

A patient with anemia presents with a heart rate of 120 beats/minute. As what should the nurse document the heart rate? 1 Bradycardic 2 Tachycardic 3 Hypertensive 4 Hypotensive

3 (The patient's complete blood count is suppressed. There is a marked decrease in the number of RBCs, WBCs, and platelets. This condition is called pancytopenia. Leukopenia is a condition in which white blood cells count less than 4000/μL. Neutropenia is a condition in which the absolute neutrophil count (ANC) is less than 1000 cells/μL. Thrombocytopenia is condition in which platelet counts falls below 100,000/μL. Text Reference - p. 625)

A patient's complete blood count is RBC 1.8 × 10{6}/μL, WBC 2 × 10{9}/L, platelets 90 × 10{9}/L. How should the nurse interpret the test results? 1 Leukopenia 2 Neutropenia 3 Pancytopenia 4 Thrombocytopenia

4 (In a pregnant woman with Type O negative blood type, the mother's anti-D antibodies can cross the placenta and attack the red blood cells (RBC) of a fetus that is Rh-positive. This can lead to hemolysis of the RBCs. A pregnant woman with O negative should receive Rho(D) immune globulin (RhoGAM) injections to prevent the formation of anti-D antibodies. Antibiotics and herbal medicines may not affect antibody production. Folic acid preparation can help in preventing neural tube defects, but do not affect antibody production. Text Reference - p. 627)

A pregnant woman has Type O negative blood type. A nurse understands that the patient can have complications related to pregnancy if the fetus is Type O positive blood. How should the nurse prevent complications in the patient? 1 Obtain a prescription for antibiotics 2 Advise her to take herbal medicine 3 Instruct her to take folic acid preparation 4 Administer Rho(D) immune globulin (RhoGAM) injections

1 (Pernicious anemia manifests as low hemoglobin levels. The signs may include a smooth and shiny tongue surface and a thin mucosa that appears red due to decreased papillae. Yellow appearance of the sclera is a symptom of jaundice due to deposition of bilirubin. Spontaneous bleeding from the nares is a sign of epistaxis. Lymph nodes which are enlarged (greater than 1 cm) and tender to touch are symptoms of lymphadenopathy. Text Reference - p. 622)

On assessment, a nurse finds that a patient has a smooth and shiny tongue surface. The oral mucosa is thin and appears red from decreased papillae. The patient has a hemoglobin level of 8.0 mg/dL. What is the likely diagnosis of the patient? 1 Pernicious anemia 2 Jaundice 3 Epistaxis 4 Lymphadenopathy

1 (The red blood cell plasma membranes are more fragile in an older person. This may account for a slight decrease in the mean corpuscular hemoglobin concentration (MCHC) of the red blood cells. Microcytosis is a condition in which the mean corpuscular hemoglobin level is decreased. Spherocytosis is a condition in which the corpuscular hemoglobin concentration increases. Erythrocytosis is a disease state in which the proportion of blood volume occupied by red blood cells increases. Text Reference - p. 625)

The laboratory report of an elderly patient shows slight decrease in the mean corpuscular hemoglobin concentration. The nurse recognizes that what could be the reason for the decrease? 1 Aging 2 Microcytosis 3 Spherocytosis 4 Erythrocytosis

1,4,2,3 (For bone marrow aspiration, the skin over the puncture site is cleansed with a bactericidal agent; then the skin, subcutaneous tissue, and periosteum are infiltrated with a local anesthetic agent. The bone marrow needle is inserted through the cortex of the bone. The stylet of the needle is then removed, the hub is attached to a 10-mL syringe, and 0.2 to 0.5 mL of the fluid marrow is aspirated. Text Reference - p. 630 Test-Taking Tip: In this question type, you are asked to prioritize (put in order) the options presented. For example, you might be asked the steps of performing a nursing action or skill such as those involved in medication administration.)

The nurse is assisting the health care provider in performing a bone marrow aspiration. The nurse expects the health care provider to perform the procedures in what order? 1. Cleanse the site with a bactericidal agent. 2. Insert the bone marrow needle through the bone cortex. 3. Remove the stylet and attach the syringe for aspiration. 4. Infiltrate the skin and periosteum with local anesthetic.

1 (As a result of the aging process, hematologic values may change but are considered normal for the older adult. The serum iron level may be decreased. Ferratin levels are increased, total iron-binding capacity may be decreased, and ESR is increased. Text Reference - p. 619)

The nurse is reviewing the hematologic study report of a 70-year-old patient. Which finding should the nurse consider normal for this patient? 1 Decreased serum iron 2 Decreased ferritin 3 Increased total iron-binding capacity 4 Decreased erythrocyte sedimentation rate (ESR)

1 (Lymphedema is the accumulation of lymphatic fluid due to an obstruction in the lymphatic flow or system. A mastectomy (the surgical removal of breast tissue) also involves the dissection of the axillary lymph nodes. This can obstruct the lymphatic flow, which can lead to lymphedema. Therefore, Patient 1 is at risk for developing lymphedema. Gastrectomies, splenectomies, and hepatectomies do not involve the resectioning or dissection of lymph nodes. Test-Taking Tip: The lymphatic system consists of lymph fluid, lymphatic capillaries, ducts, and lymph nodes that carry fluid from the interstitial spaces to the blood. This helps in selecting the correct answer. Text Reference - p. 618)

The nurse reviews the medical records of four patients. Which patient is at risk for an alteration in the hematologic system that could lead to lymphedema?

2 (The sterile pressure dressing is applied after a bone marrow biopsy to ensure hemostasis. If bleeding is present, the patient will lie on the site and may need a rolled towel for additional pressure; thus, this patient will not be in the prone position. The analgesic should have been administered preprocedure. Metal objects would be removed for a magnetic resonance imaging (MRI), not a bone marrow biopsy. Text Reference - p. 630)

The thrombocytopenic patient has had a bone marrow biopsy taken from the posterior iliac crest. What nursing care is the priority for this patient after this procedure? 1 Position the patient prone 2 Apply a pressure dressing 3 Administer analgesic for pain 4 Return metal objects to the patient

2 (Hemostasis is a process that arrests bleeding. The vascular response is the first response to bleeding. Lysis of a clot is the counter mechanism to keep blood in its fluid state. This process occurs after the clot formation. Plasma clotting factors bind to platelet plugs and form a complex clot. The platelets aggregate to form a clump, which reduces the risk of bleeding. However, this takes place after vascular response. Text Reference - p. 616)

What is the first process that occurs during normal hemostasis? 1 Lysis of the clot 2 Vascular response 3 Plasma clotting factor 4 Platelet plug formation

3 (Red blood cells (RBCs) transport oxygen and carbon dioxide by binding those chemicals to the iron component of hemoglobin. Platelets initiate the blood coagulation process. Phagocytosis (the process of engulfing and destroying unwanted organisms) is the primary function of granular leukocytes. Leukocytes play an important role in protecting the body against infections. Text Reference - p. 615)

What is the primary function of red blood cells (RBCs)? 1 Initiating the blood coagulation process 2 Ingesting and destroying unwanted organisms 3 Transporting oxygen and carbon dioxide 4 Protecting the body against infections and foreign invaders

4 (When infections are severe, such as in septicemia, more granulocytes are released from the bone marrow as a compensatory mechanism. To meet the increased demand, many young, immature polymorphonuclear neutrophils (bands) are released into circulation. WBCs usually are reported in order of maturity (initially with the less mature forms on the left side of a written report). Hence, the term "shift to the left" is used to denote an increase in the number of bands. Thrombocytosis occurs with inflammation and some malignant disorders. A decreased number of red blood cells indicates anemia. A decreased ESR is not indicative of septicemia. Text Reference - p. 627)

When assessing laboratory values of a patient admitted with septicemia, what should the nurse expect to find? 1 Increased platelet count 2 Decreased red blood cell count 3 Decreased erythrocyte sedimentation rate (ESR) 4 Increased bands in the white blood cell (WBC) differential (shift to the left)

3

Which cells ingest dead cells, tissue debris, and defective red blood cells? 1 Basophils 2 Eosinophils 3 Monocytes 4 Thrombocytes

1 (Factor X is also called Stuart-Prower factor. Its action is to convert factor II, prothrombin, to thrombin. Factor XI is known as plasma thromboplastin antecedent. Factor XI activates Christmas factor in the presence of calcium ions. Hageman factor is another name for factor XII. Hageman factor activates factor IX to stimulate the intrinsic pathway. Factor XIII is also known as fibrin-stabilizing factor. Fibrin-stabilizing factor cross-links fibrin strands. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. Text Reference - p. 618)

Which coagulation factor converts prothrombin to thrombin? 1 Factor X 2 Factor XI 3 Factor XII 4 Factor XIII

1 (Transferrin is a plasma protein that acts as a carrier for iron; the synthesis of this protein occurs in the liver. The spleen is the site for the synthesis of red blood cells during fetal development. Bone marrow is the site for maturation of red blood cells. Macrophages help to store ferritin, a storage form of iron. Text Reference - p. 616)

Which organ acts as a site for the synthesis of iron carrier proteins? 1 Liver 2 Spleen 3 Bone marrow 4 Macrophages

2 (Erythropoiesis is the production of red blood cells. A patient with a low red blood cell count will have low levels of oxygen, resulting in hypoxia. Therefore, erythropoiesis is stimulated to increase the available oxygen. Hemolysis is degradation of red blood cells, which occurs due to bacterial infection or autoimmune disorders. Hematopoiesis is the formation of blood cell components and is not associated with hypoxia. Thrombocytosis is an increase in the platelet count, which is seen in response to bleeding. Text Reference - p. 615)

Which process is stimulated by hypoxia? 1 Hemolysis 2 Erythropoiesis 3 Hematopoiesis 4 Thrombocytosis

3 (Special names are given to macrophages that reside in different tissues. The resident macrophages in the liver are called Kupffer cells. Mast cells are similar to basophils and are present in the connective tissue. Osteoclasts reside in the bone. A megakaryocyte is a differentiated stem cell that fragments into platelets. Text Reference - p. 616)

Which term refers to the resident macrophages in the liver? 1 Mast cells 2 Osteoclasts 3 Kupffer cells 4 Megakaryocyte

4 (Methylmalonic acid (MMA) is an indirect test for cobalamin (vitamin B12) because MMA metabolism requires cobalamin. It helps to differentiate cobalamin deficiency from folic acid deficiency. The normal value of methylmalonic acid is less than 0.2 μmol/L. Therefore, a high methylmalonic acid level of 0.4 μmol/L indicates reduced metabolism due to a deficiency of cobalamin. Because the patient has a low hemoglobin level of 10 g/dL, the nurse infers that the patient has vitamin B12-deficiency anemia. The patient with hemolytic anemia will have high bilirubin levels and have a positive Coombs test. The patient with iron deficiency anemia will have decreased serum iron, ferritin, and an increased total iron binding capacity. The patient with folic acid deficiency anemia will have a value of folic acid less than 3 to16 ng/mL. Text Reference - p. 628)

While reviewing the laboratory test results of a patient, the nurse finds that the patient's methylmalonic acid (MMA) level is 0.4 μmol/L and hemoglobin is 10 mg/dL. What does the nurse infer from this finding? 1 The patient has hemolytic anemia. 2 The patient has iron-deficiency anemia. 3 The patient has folic acid deficiency anemia. 4 The patient has vitamin B12-deficiency anemia.