Hematologic Disorders

Which patient is most likely to experience anemia related to an increased destruction of red blood cells? 1 A 59-year-old man whose alcoholism has precipitated folic acid deficiency Correct2 A 23-year-old African American man who has a diagnosis of sickle cell disease 3 A 30-year-old woman with a history of "heavy periods" accompanied by anemia 4 A 3-year-old child whose impaired growth and development is attributable to thalassemia

A result of a sickling episode in sickle cell anemia involves increased hemolysis of the sickled cells. Anemia due to alcoholism can be due to impaired liver function or an enlarged spleen. Alcoholics often suffer from B1, B3, and B6, or thiamin, niacin and pyridoxine deficiencies. Anemia related to menstruation is a direct result of blood loss. Thalassemias and folic acid deficiencies cause a decrease in erythropoiesis.

The nurse is caring for four patients receiving blood transfusions. Which patient is at risk for agglutination? 1 Patient 1 Correct2 Patient 2 Incorrect3 Patient 3 4 Patient 4

ABO incompatibilities result from hemolysis of the red blood cells (RBCs). RBCs agglutinate when a serum antibody is present to react with the antigen on the RBC membrane. Patient 2 from blood group B has a B antigen on RBCs and anti-A serum antibodies. Agglutination occurs in the blood of this patient if he or she receives a blood transfusion from a donor from blood group A or AB. Patient 1 from blood group A has the A antigen on the RBCs and anti-B antibodies in the serum. Therefore a blood group A patient can receive blood only from donors from group A or O. Patient 3 with AB blood group has both A and B antigens on the RBCs and does not have anti-A or anti-B antibodies. Therefore the patient from the AB blood group can receive blood from any group. A patient from the AB blood group is called a universal recipient. Patient 4 from the O blood group does not have either A or B antigens on the surface of RBCs but has anti-A and anti-B antibodies in the serum. Therefore Patient 4 can receive blood from only from a group O donor.

The nurse expects to observe which manifestations in a patient who experienced an acute blood loss of 2000 mL? Select all that apply. Correct1 Air hunger Correct2 Clammy skin 3 Lactic acidosis 4 Vasovagal syncope Correct5 Decreased central venous pressure

Air hunger, clammy skin, and a decreased central venous pressure are the clinical manifestations seen in a patient who has sustained 2000 mL of acute blood loss. Lactic acidosis may occur in cases of 2500 mL of acute blood loss. Rare vasovagal syncope may occur if 500 mL of acute blood loss occurs.

The nurse will begin a patient's transfusion of packed red blood cells at 1030. The nurse would plan to stay in the patient's room until which time? 1 1040 Correct2 1045 3 1050 4 1055

As part of standard procedure, the nurse remains with the patient for the first 15 minutes after hanging a blood transfusion. Patients who are likely to have a transfusion reaction more often will exhibit signs within the first 15 minutes that the blood is infusing. Ten minutes is not enough time to evaluate for adverse reactions; unless the patient is having an adverse reaction, it is not necessary to remain at the bedside for longer than 15 minutes.

Which laboratory test would provide information about the number of megakaryocytes in a patient with thrombocytopenia? 1 Prothrombin time (PT) 2 Peripheral blood smear 3 14C serotonin release assay Correct4 Bone marrow examination

Bone marrow examination is performed to rule out production problems such as leukemia, aplastic anemia, and other myeloproliferative disorders as the cause of thrombocytopenia. Therefore to confirm that the absence or decreased number of megakaryocytes to be the cause of thrombocytopenia, bone marrow examination will be done. PT will be tested to assess secondary hemostasis. A peripheral blood smear will be done to distinguish immune thrombocytopenic purpura (ITP) from congenital disorders. 14C serotonin release assay assists with the diagnosis of ITP.

Which type of deficiency causes hemophilia B in a patient? 1 Iron deficiency Correct2 Christmas factor deficiency 3 Anti-hemophilic factor deficiency 4 Von Willebrand coagulation protein deficiency

Christmas factor, or factor IX, is a clotting protein, and its deficiency causes hemophilia B; this leads to prolonged or spontaneous bleeding. Iron deficiency causes anemia. Anti-hemophilic factor, or factor VIII deficiency, causes hemophilia A. Von Willebrand coagulation protein deficiency causes von Willebrand disease.

A patient is admitted in a state of shock with acute blood loss. The nurse reviews the patient's plan of care and would perform the interventions in which order? Correct1.Replace blood volume. Correct2.Identify source of hemorrhage. Correct3.Administer packed red blood cells (RBCs). Correct4.Provide supplemental iron.

Collaborative care is initially concerned with replacing blood volume to prevent shock. The source of the hemorrhage should then be identified to stop the blood loss. Once volume replacement is established, RBC loss is corrected by administering packed RBCs. The patient may also need supplemental iron because the availability of iron affects the marrow production of erythrocytes.

Which instructions would the nurse include when teaching a patient about the administration of iron capsules? Select all that apply. Correct1 Take laxatives if needed. Correct2 Take the medication with orange juice. 3 Take the medication about one hour after meals. Correct4 The medication may cause the stools to become black. 5 Stop therapy when hemoglobin level returns to normal.

Constipation is a common side effect, and the patient should be started on stool softeners or laxatives. The nurse should teach the patient to take iron capsules with orange juice or vitamin C to enhance iron absorption. The patient should be informed that use of iron preparations will make the stool appear black because the gastrointestinal (GI) tract excretes excess iron. Iron should be taken at least one hour before meals, when the duodenal mucosa is most acidic to enhance absorption; however, gastric side effects may necessitate ingesting iron with meals. To replenish the body's stores, the patient needs to take iron therapy for two to three months after the hemoglobin level returns to normal.

Which medication may benefit a patient with immune thrombocytopenic purpura (ITP) by increasing the platelet production? 1 Danazol Correct2 Eltrombopag 3 Tranexamic acid 4 Desmopressin acetate

Eltrombopag is a thrombopoietin receptor agonist that acts by increasing platelet production. Danazol is an androgen that acts by increasing CD4+T cells. Tranexamic acid is an antifibrinolytic drug that acts by inhibiting plasminogen activation in the fibrin clot. Desmopressin acetate is a synthetic analog of vasopressin that acts on platelets and endothelial cells to release von Willebrand factor (vWF).

Which condition results in anemia due to synthesis of defective deoxyribonucleic acid (DNA) in the body? 1 Myelodysplasia 2 Fanconi syndrome Correct3 Folic acid deficiency 4 G6PD enzyme deficiency

Folic acid deficiency can cause the synthesis of defective DNA and result in anemia. A decreased number of red blood cell precursors results in anemia in patients with myelodysplasia and Fanconi syndrome. Increased red blood cell destruction can result in anemia in patients with G6PD enzyme deficiency.

Which drug is directly myelosuppressive and may induce thrombocytopenia? 1 Abciximab 2 Cimetidine Correct3 Ganciclovir 4 Haloperidol

Ganciclovir is an antiinfective drug that causes thrombocytopenia; it is directly myelosuppressive. Abciximab is a platelet glycoprotein inhibitor that causes thrombocytopenia. Cimetidine is a histamine H2-receptor antagonist that causes thrombocytopenia. Haloperidol is an antipsychotic drug that causes thrombocytopenia.

Which statement is true regarding hemophilia? 1 Hemophilia is not hereditary in nature. Correct2 Hemophilia can be treated by replacement therapy. 3 Hemophilia is an X-linked dominant genetic disorder. 4 Hemophilia B is the most common form of hemophilia.

Hemophilia decreases the clotting ability of the blood in a patient and can be treated by replacement therapy during acute phases of bleeding. Hemophilia is hereditary in nature. Hemophilia is an X-linked recessive genetic disorder. The most common form of hemophilia is hemophilia A.

Which patient is most likely to experience hemophilia? 1 Patient A 2 Patient B 3 Patient C Correct4 Patient D

Hemophilia involves the inability of the blood to clot. Partial thromboplastin time (PTT) is prolonged in a patient with hemophilia because of deficiency in intrinsic clotting system factor. The normal range of PTT is 25 to 35 seconds. Therefore a PTT of 50 seconds indicates hemophilia in the patient. The normal bleeding time is in the range of 3 to 10 minutes. A bleeding time of 7 minutes is a normal finding. The normal prothrombin time (PT) is in the range of 10 to 14 seconds. A PT of 20 seconds is abnormal, which is not a manifestation of hemophilia. In hemophilia, the extrinsic system is not involved and PT will be normal. The normal thrombin time is in the range of 12 to 14 seconds. In hemophilia, thrombin fibrinogen reaction is not impaired and thrombin time will be normal; therefore a thrombin time of 25 seconds is not a finding in hemophilia.

A patient has a hemoglobin level of 11 g/dL. The nurse determines that the patient has which level of severity of anemia? Correct1 Mild anemia 2 Severe anemia 3 Aplastic anemia 4 Moderate anemia

In mild anemia, hemoglobin is in the range of 10-12 g/dL. In severe anemia, it is less than 6 g/dL. Aplastic anemia refers to a type of anemia caused by a decrease in red blood cell precursors. It does not refer to the severity of anemia. In moderate anemia, the hemoglobin it is in the range of 6-10 g/dL. Hemoglobin above 12 g/dL is considered normal (no anemia).

Which interventions would the nurse provide a patient who has polycythemia? Select all that apply. Incorrect1 Monitoring liver function tests Correct2 Evaluating fluid intake and output Correct3 Assessing the patient's nutritional status Correct4 Initiating active and passive leg exercises 5 Instructing the patient to avoid high altitudes

In polycythemia vera, laboratory findings show an elevated hemoglobin and red blood cell (RBC) count with microcytosis, as well as an elevated white blood cell (WBC) count with basophilia. Fluid intake and output should be evaluated to avoid fluid overload because this may further complicate circulatory congestion. Nutritional status should be assessed regularly because inadequate food intake may result in gastrointestinal symptoms, such as fullness, pain, and dyspepsia. Active and passive leg exercises should be initiated to prevent thrombus formation. Liver function tests should be monitored regularly in patients who require lifelong supplementation of iron. Patients with sickle cell disease should be advised to avoid high altitudes because this may lead to hypoxia.

The nurse assesses a patient who has severe anemia and expects to find which manifestations? Select all that apply. Correct1 Vertigo Correct2 Dyspnea at rest 3 Sensitivity to heat Correct4 Jaundice and pruritus Correct5 Glossitis and smooth tongue

In severe anemia (Hgb less than 6 g/dL [60 g/L]), the patient has many clinical manifestations involving multiple body systems, including vertigo, dyspnea at rest, jaundice and pruritus, and glossitis and smooth tongue. The patient will not have sensitivity to heat, but rather a sensitivity to cold.Test-Taking Tip: Start by reading each of the answer options carefully. Usually, at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten.

The nurse is teaching a patient about the administration of liquid iron supplements. Which response by the patient indicates the need for additional teaching? 1 "I will take my iron supplement with a straw." Incorrect2 "I will take my iron supplement at bedtime." Correct3 "I will take my iron supplement along with meals." 4 "I will take my iron supplement along with orange juice."

Iron is mostly absorbed in the form of ferrous sulfate. Ferrous sulfate chelates with food, impairing iron absorption. Iron supplements should be taken one hour before meals to ensure effective absorption. Iron supplements may stain the teeth, so they may be taken with a straw. The patient can take iron supplements at bedtime if he or she experiences abdominal discomfort. Orange juice is rich in vitamin C, which enhances iron absorption.

To ensure maximum effectiveness of lifelong iron supplementation therapy, which intervention would the nurse include in the patient's plan of care? Select all that apply. Correct1 Monitor the patient for liver problems. 2 Assess the patient for psychologic problems. Correct3 Evaluate the patient's response to the therapy. 4 Discontinue the therapy after hemoglobin levels return to normal. Correct5 Continue the supplementation for two to three months after hemoglobin levels return to normal.

Long-term iron supplementation can cause liver dysfunction; therefore the patient should be evaluated for liver function abnormalities. While undergoing therapy, the nurse should evaluate the improvement in hemoglobin levels during every visit and should take necessary steps if hemoglobin levels do not improve. Iron therapy should be continued for two to three months after hemoglobin levels return to normal to replenish the iron stores in the body. Iron therapy is not associated with psychologic problems; hence, there is no need to monitor for psychologic changes. Iron supplementation should not be stopped once hemoglobin levels are back to normal.

The nurse suspects that a patient is experiencing microcytic, hypochromic anemia after noting which blood test results? 1 Mean corpuscular volume of 90 fL and mean corpuscular hemoglobin of 30 pg Correct2 Mean corpuscular volume of 70 fL and mean corpuscular hemoglobin of 20 pg 3 Mean corpuscular volume of 100 fL and mean corpuscular hemoglobin of 34 pg 4 Mean corpuscular volume of 120 fL and mean corpuscular hemoglobin of 40 pg

Microcytic, hypochromic anemia is characterized by the presence of a mean corpuscular volume of less than 80 fL and a mean corpuscular hemoglobin of less than 27 pg. Normocytic and normochromic anemia are characterized by the presence of mean corpuscular volume between 80 and 100 fL and mean corpuscular hemoglobin between 27 and 34 pg. Macrocytic and normochromic anemia are characterized by the presence of mean corpuscular volume of greater than 100 fL and mean corpuscular hemoglobin of greater than 34 pg.

Which erythrocyte characteristic would the nurse expect to see in the laboratory findings for a patient who has experienced acute blood loss? 1 Microcytic Correct2 Normocytic 3 Hypochromic 4 Megaloblastic

Normocytic, normochromic erythrocytes are seen in patients with acute blood loss following an accident. Microcytic, hypochromic erythrocytes are seen in patients with iron-deficiency anemia, vitamin B6 deficiency, copper deficiency, thalassemia, or lead poisoning. Megaloblastic erythrocytes are seen in patients with vitamin B12 deficiency, folic acid deficiency, or liver disease.

A patient with hemophilia has developed inhibitors to factors VIII and IX. The nurse recognizes that which replacement factor would be beneficial for the patient? 1 Xyntha 2 Alphanate 3 Mononine Correct4 NovoSeven

NovoSeven is a replacement factor that is beneficial for a patient who has developed inhibitors to factors VIII or IX. Xyntha and alphanate are replacement factors that are beneficial for a patient who has factor VIII deficiency. Mononine is a replacement factor that is beneficial for a patient who has factor IX deficiency.

Which instruction would be beneficial for the nurse to provide a patient diagnosed with pernicious anemia? 1 "Avoid consuming red meat and fish." 2 "Limit consuming milk and dairy products." 3 "Undergo frequent hepatitis A screenings." Correct4 "Undergo frequent gastrointestinal cancer screenings."

Pernicious anemia is characterized by decreased secretion of hydrochloric acid in the stomach due to autoimmune-mediated destruction of parietal cells and thereby causes an increased risk for gastric cancer. The patient with cobalamin deficiency can develop pernicious anemia, so the patient should consume foods such as red meat, fish, milk, and dairy products. Patients with thalassemia may contract hepatitis C from blood transfusions

Which finding supports the nurse's conclusion that a patient has pernicious anemia? 1 Bleeding of the gums Correct2 Smooth, beefy-red tongue 3 Spoon-shaped concave nails 4 Fissures in corners of the mouth

Pernicious anemia is characterized by the presence of abdominal pain and a smooth, beefy-red tongue. Platelet function is reduced in the patient with leukemia; therefore bleeding from the gums is associated with leukemia. The presence of spoon-shaped, concave nails and fissures in the corners of the mouth is associated with iron-deficiency anemia.

Which conditions warrant platelet administration for a patient experiencing thrombocytopenia? Select all that apply. 1 When refractory cases are observed Correct2 When the platelet count in the patient is 8,000/µL Incorrect3 When the patient does not respond to drug therapy Correct4 When there is anticipated bleeding before a procedure 5 When the patient has thrombotic thrombocytopenic purpura (TTP)

Platelet administration is indicated in a patient with a blood platelet count of 8,000/µL to maintain normal platelet count. Administering platelets is beneficial if a patient has anticipated bleeding before a procedure to prevent the risk of hemorrhage. Immunosuppressive therapy is indicated when refractory cases are observed. Splenectomy is indicated when the patient does not respond to drug therapy. Administration of platelets is contraindicated in a patient with TTP because it may lead to new von Willebrand factor-platelet complexes and increased clotting.

The nurse recalls that the events that lead to heparin-induced thrombocytopenia occur in which order? Correct1.Platelet factor 4 (PF4) binds to heparin. Correct2.Complex binds to heparin. Correct3.Complex binds to platelet surface. Correct4.Positive feedback loop is created. Correct5.Antibodies are created against the complex. Correct6.Antibodies are prematurely removed from circulation.

Platelet destruction and vascular endothelial injury are the two major responses to an immune-mediated response to heparin. Initially, PF4 binds to heparin. This complex then binds to the platelet surface, and more PF4 are released. Because of this, a positive feedback loop is created. Antibodies are created against the complex, and they are removed prematurely from circulation, leading to thrombocytopenia and platelet-fibrin thrombi.

Which laboratory test would the nurse anticipate being normal in a patient with von Willebrand disease? 1 Factor assays 2 Bleeding time Correct3 Prothrombin time 4 Partial thromboplastin time

Prothrombin time is normal; there is no involvement of extrinsic system. Partial thromboplastin time is prolonged because of deficiency in intrinsic clotting system factor. Bleeding time is prolonged because of structurally defective platelets. There will be a reduction of von Willebrand factor (vWF).

Which drug is a likely cause of thrombocytopenia? Correct1 Quinine 2 Vincristine 3 Ganciclovir 4 Acetaminophen

Quinine, which is used in many herbal preparations and tonic water, accelerates platelet destruction caused by drug-dependent antibodies. Antibodies attack the platelets when the offending agent binds to the platelet surface. Aspirin alters platelet aggregation. Antiinfectives such as ganciclovir and chemotherapeutic drugs such as vincristine decrease platelet count by myelosuppression. Acetaminophen does not affect blood coagulation in and of itself.

When thrombotic thrombocytopenic purpura (TTP) is left untreated, the nurse identifies that the patient is at risk for which complication? 1 Venous thrombosis 2 Acute hemarthrosis Correct3 Irreversible renal failure 4 Decreased platelet production

TTP causes irreversible renal failure because of prolonged vasoconstriction if left untreated in a patient. Venous thrombosis is observed in heparin-induced thrombocytopenia (HIT). Acute hemarthrosis is a complication of hemophilia. Decreased platelet production is the cause of immune thrombocytopenic purpura (ITP).

Which syndrome is caused by the deficiency of plasma enzyme ADAMTS13? 1 Immune thrombocytopenic purpura (ITP) 2 Heparin-induced thrombocytopenia (HIT) Correct3 Thrombotic thrombocytopenic purpura (TTP) 4 Disseminated intravascular coagulation (DIC)

TTP is caused due to the deficiency of plasma enzyme ADAMTS13. ITP is caused by decreased platelet production. Without the enzyme, unusually large amounts of von Willebrand factor will attach to activated platelets and promote platelet aggregation. Increased use of heparin causes HIT. Overstimulation of proteins involved in clotting factors can result in DIC.

Which assessment findings indicate that a patient may be experiencing thrombotic thrombocytopenic purpura (TTP)? Select all that apply. 1 Increased haptoglobin Correct2 Increased reticulocytes Correct3 Decreased hemoglobin 4 Decreased schistocytes 5 Decreased indirect bilirubin

TTP is characterized by hemolytic anemia, which increases reticulocytes because of bleeding. Hemoglobin is decreased in TTP because of bleeding. The laboratory reports that a patient with TTP will show decreased haptoglobin, increased schistocytes, and increased indirect bilirubin.

Which patient is most likely to experience thrombotic thrombocytopenic purpura (TTP)? 1 A 12-year-old male child 2 A 30-year old male adult 3 A 10-year-old female child Correct4 A 35-year old female adult

TTP is seen primarily in adults between 20 and 50 years of age, with a slight female predominance. Therefore a 35-year old female adult is more likely to have TTP. A 12-year-old male child, a 30-year old male adult, and a 10-year-old female child are less likely to have TTP than a 35-year old female adult.

To prepare for a patient's transfusion of packed red blood cells, the nurse would select which IV solution to use for the procedure? 1 3% normal saline 2 Lactated Ringer's 3 5% dextrose in water Correct4 0.9% normal saline

The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It is also used to flush the blood tubing after the infusion is complete to ensure that the patient receives blood that is left in the tubing when the bag is empty. 3% normal saline, Lactated Ringer's and 5% dextrose in water, are not compatible with blood products. Normal saline Normal saline is the only compatible solution to use with the blood or blood component. Crystalloid solutions and medications may cause agglutination and/or hemolysis of the blood or blood components.

The nurse would monitor a patient with thrombocytopenia for which major complication? 1 Fatigue 2 Weakness Correct3 Hemorrhage 4 Abdominal pain

The major complication of thrombocytopenia is hemorrhage. This occurs due to a decreased number of platelets in the blood, which results in excessive bleeding. Fatigue, weakness, and abdominal pain are minor complications of thrombocytopenia.

Which laboratory result indicates thrombocytopenia? Select all that apply. Correct1 Hemoglobin value is 9 g/dL. 2 Platelet count is 200,000/µL. Correct3 Bleeding time is 20 minutes. 4 Hematocrit value is 42%. Correct5 Levels of megakaryocytes are elevated.

The normal hemoglobin value is in the range of 12 to 13 g/dL. Therefore hemoglobin value of 9 g/dL is a result of thrombocytopenia. Thrombocytopenia is deficiency of platelets in the blood. The normal bleeding time is in the range of 3 to 10 minutes. Because platelets are involved in clotting, a deficiency of platelets increases the bleeding time. A bleeding time of 20 minutes is due to deficiency of platelets. When thrombocytopenia is caused by the destruction of platelets, the megakaryocyte count will be normal or increased in bone marrow examination. Thrombocytopenia is associated with a reduced hemoglobin level in the patient. The normal range of platelet count is in the range of 150,000 to 450,000/µL, so a platelet count of 200,000/µL is normal. The normal hematocrit value is in the range of 42% to 54%.

The nurse provides care for a patient with immune thrombocytopenic purpura (ITP) who has a platelet count of 90,000/mcL of blood. Which occurrence could be the reason for this condition? Incorrect1 Destruction of platelets Correct2 Decreased production of platelets 3 Enhanced aggregation of platelets 4 Increased consumption of platelets

The normal platelet count is in the range of 150,000 to 450,000 platelets/mcL of blood. A decreased blood platelet count indicates thrombocytopenia in the patient. A patient with ITP will have thrombocytopenia because of decreased platelet production. Ingestion of herbs results in thrombocytopenia by destroying the platelets. Enhanced aggregation of platelets is associated with thrombotic thrombocytopenic purpura (TTP). Increased consumption of platelets will cause heparin-induced thrombocytopenia (HIT).

The nurse presents information about hemophilia to a group of nursing students. Which information would the nurse include? Select all that apply. 1 Hemophilia A is transmitted by male carriers. Correct2 Hemophilia B is transmitted by female carriers. Correct3 Von Willebrand disease is seen in both genders. Correct4 Hemophilia A is displayed almost exclusively in men. Incorrect5 Hemophilia B is displayed almost exclusively in women

The nurse should include that hemophilia A is displayed almost exclusively in men, von Willebrand disease is seen in both genders, and hemophilia B is transmitted via female carriers. Hemophilia A is transmitted by female carriers, not male carriers. Hemophilia B is displayed almost exclusively in men, not women.

A patient with anemia experiences fatigue when performing activities of daily living. Which nursing intervention is appropriate to include in the patient's plan of care? 1 Encourage frequent visitors. Correct2 Assist the patient in prioritizing activities. 3 Assist the patient in walking immediately after meals. 4 Ensure that all physical activities are completed in the morning

The nurse should teach and assist the patient and caregiver to assign priority to activities to accommodate energy levels and promote tolerance for important activities. The caregiver should limit the number of visitors so that the patient receives adequate rest. The patient should be asked to avoid activity immediately after meals to reduce competition for oxygen supply to vital functions. Activities should be alternated with rest periods throughout the day rather than completed in the morning.

The nurse would place the highest priority on initiating interventions that will reduce which symptom in a patient with a gastrointestinal bleed, a hemoglobin of 8.7%, and a hematocrit of 26%? 1 Nausea Correct2 Dizziness 3 Headache 4 Constipation

The patient with a low hemoglobin and hematocrit (normal values 13.5% to 17% and 40% to 54%, respectively, for males) is anemic and would be most likely to experience fatigue and dizziness. This symptom develops because of the lowered oxygen-carrying capacity that leads to reduced tissue oxygenation to carry out cellular functions. Nausea, constipation, and headache are not associated with decreased hemoglobin and hematocrit levels.

A patient with neutropenia asks how the prescribed protective (reverse) isolation helps prevent the spread of organisms. Which response by the nurse is appropriate? 1 "It is designed to use special techniques to decrease discharge from your body." 2 "It is designed to use special techniques to handle your linens and personal items." Correct3 "It is designed to minimize the spread of germs to you from sources outside your environment." 4 "It is designed to minimize the spread of germs from you to health care personnel, visitors, and other patients."

The primary purpose of protective, or reverse, isolation is to reduce transmission of organisms to the patient from sources outside the patient's environment. The use of special techniques to destroy discharge or handle the patient's linen and personal items and preventing the spread from the patient to others are not the purpose of protective isolation.

Which laboratory result is consistent with a diagnosis of thrombocytopenia? 1 Hemoglobin 13 2 Hemoglobin 16 Correct3 Platelets 20,000/µL 4 Platelets 1,000,000/µL

Thrombocytopenia means that there are low levels of circulating platelets. A platelet count below 150,000/ µL is considered low. As such, a platelet count of 20,000/µL is consistent with a diagnosis of thrombocytopenia. A normal hemoglobin level is 12 to 17 g/dL, depending on the sex of the patient. Hemoglobin levels of 13 g/dL and 16 g/dL are normal.

The nurse is caring for a patient with a viral infection and recognizes that the patient is at risk for which type of thrombocytopenia? 1 Hereditary thrombocytopenia Correct2 Immune thrombocytopenic purpura (ITP) 3 Heparin-induced thrombocytopenia (HIT) 4 Thrombotic thrombocytopenic purpura (TTP)

Viral infections compromise the immune system and contribute to the development of ITP. Hereditary thrombocytopenia is observed in the patient with inherited thrombocytopenia. HIT is observed in the patient who is on long-term heparin therapy. TTP is observed in a patient with hemolytic anemia.

The nurse recognizes that patients with von Willebrand disease are at risk for prolonged bleeding times for which reason? 1 Adequate platelet production 2 Deficiency in intrinsic clotting system factor 3 Impairment of thrombin fibrinogen reaction Correct4 Variable factor VIII deficiencies and platelet dysfunction

Von Willebrand disease is characterized by a deficiency of the von Willebrand coagulation protein and variable factor VIII deficiencies and platelet dysfunction. Therefore the bleeding time is prolonged in the patient with von Willebrand disease. Adequate platelet production does not alter the normal bleeding time in a patient. Deficiency in intrinsic clotting system factor will alter the partial thromboplastin time (PTT). Impairment of thrombin fibrinogen reaction alters the thrombin time.

Which diagnostic test can detect destruction of circulating platelets as the cause of thrombocytopenia? 1 Hemoglobin Correct2 Bone marrow analysis 3 Prothrombin time (PT) 4 Peripheral blood smear

When destruction of circulating platelets is the cause, bone marrow analysis shows megakaryocytes (precursors of platelets) to be normal or increased, even though circulating platelets are reduced. Hemoglobin measures the amount of protein in the red blood cells that carries oxygen to the body's organs and tissues and transports carbon dioxide from the organs and tissues back to the lungs. PT is used to assess secondary hemostasis. Peripheral blood smear is used to distinguish acquired disorders from congenital disorders.