NURS 6320 Group 9 ch 29, 30, 32, 36

Crisis occurs in association with certain drugs or infection.

Hyperhemolytic crisis

Which term is used to describe a red-purple discoloration caused by diffuse hemorrhage into the skin tissue? a. Petechiae c. Ecchymosis b. Hematoma d. Purpura

ANS: D Diffuse hemorrhage into skin tissues that is visible through the skin causes a red-purple discoloration identified as a purpura. None of the other options are used to identify this symptom.

Compensatory erythropoiesis is compromised, thus limiting the number of erythrocytes that are replaced.

Aplastic crisis, a transient cessation in red blood cell production that results in acute anemia, occurs as a result of a viral infection. The virus causes a temporary shutdown of red blood cell production in the bone marrow, or reticulocytosis.

Large amounts of blood become acutely pooled in the liver and spleen.

In sequestration crisis, large amounts of blood become acutely pooled in the liver and spleen.

Blood flow is impaired by tangled masses of rigid, sickled cells

Vasoocclusive crisis (thrombotic crisis) begins with sickling in the microcirculation. As blood flow is obstructed by tangled masses of rigid, sickled cells, vasospasm occurs and a log jam effect brings all blood flow through the vessel to a halt.

Which assessment findings are clinical manifestations of aortic stenosis? (Select all that apply.) a. Jugular vein distention b. Bounding pulses c. Hypotension d. Angina e. Syncope

ANS: D, E The classic manifestations of aortic stenosis are angina, syncope, and heart failure. None of the other options are associated with aortic stenosis.

Which of the following is characterized by what is referred to as pathognomonic pentad of symptoms? a. Acute idiopathic thrombotic thrombocytopenic purpura b. Essential (primary) thrombocythemia (ET) c. Immune thrombocytopenic purpura (ITP) d. Thrombotic thrombocytopenic purpura (TTP)

ANS: A Acute idiopathic thrombotic thrombocytopenic purpura is characterized by a pathognomonic pentad of symptoms that includes extreme thrombocytopenia (fewer than 20,000 platelets/mm3), intravascular hemolytic anemia, ischemic signs and symptoms most often involving the central nervous system (approximately 65% exhibit memory disturbances, behavioral irregularities, headaches, or coma), kidney failure (affecting approximately 65% of individuals), and fever (present in approximately 33% of individuals The other options do not demonstrate these symptoms.

What is the reason most children diagnosed with sickle cell anemia are not candidates for either bone marrow or stem cell transplants? a. Well-matched stem cell donors are difficult to find. b. The child is usually too weak to survive the procedure. c. The child's immune system will not appropriately respond to the antirejection medications. d. Although effective for adults, neither procedure has been proven effective for children.

ANS: A Bone marrow or stem cell transplants can cure sickle cell anemia. However, the only reason these procedures are not currently an option for most children is because well-matched stem cell donors are often difficult to find.

Cystic fibrosis is caused by which process? a. Autosomal recessive inheritance c. Infection b. Autosomal dominant inheritance d. Malignancy

ANS: A Cystic fibrosis is an autosomal recessive inherited disorder that is associated with defective epithelial ion transport. None of the other options cause cystic fibrosis.

Which statement best describes heparin-induced thrombocytopenia (HIT)? a. Immunoglobulin G immune-mediated adverse drug reaction that reduces circulating platelets b. Hematologic reaction to heparin in which the bone marrow is unable to produce sufficient platelets to meet the body's needs c. Immunoglobulin E-mediated allergic drug reaction that reduces circulating platelets d. Cell-mediated drug reaction in which macrophages process the heparin and platelet complexes that are then destroyed by activated cytotoxic T cells

ANS: A Heparin is a common cause of drug-induced thrombocytopenia. HIT is an immune-mediated, adverse drug reaction caused by immunoglobulin G antibodies that leads to increased platelet consumption and a decrease in platelet counts. None of the other options accurately describe HIT.

What factors contribute to the development of orthostatic hypotension? (Select all that apply.) a. Altered body chemistry b. Drug action of certain antihypertensive agents c. Prolonged immobility d. Effects of aging on postural reflexes e. Any condition that produces volume overload

ANS: A, B, C, D Orthostatic hypotension may be acute or chronic. Acute orthostatic hypotension (temporary type) may result from (1) altered body chemistry, (2) drug action (e.g., antihypertensives, antidepressants), (3) prolonged immobility caused by illness, (4) starvation, (5) physical exhaustion, (6) any condition that produces volume depletion (e.g., massive diuresis, potassium or sodium depletion), and (7) venous pooling (e.g., pregnancy, extensive varicosities of the lower extremities). Older adults are susceptible to this type of orthostatic hypotension, in which postural reflexes are slowed as part of the aging process

What are the common triggers for sickle cell crisis? (Select all that apply.) a. Fever b. Infection c. Dehydration d. Alkalosis e. Exposure to the cold

ANS: A, B, C, E Crises can be prevented by avoiding fever, infection, acidosis, dehydration, constricting clothes, and exposure to cold.

What is the chance with each pregnancy that a child born to two parents with the sickle trait will have sickle cell disease (SCD)? a. 20% c. 33% b. 25% d. 50%

ANS: B A 25% chance exists with each pregnancy that a child born to two parents with sickle cell trait will have SCD. Genetic counseling enables people with SCD or with the sickle cell trait to make informed decisions about transmitting this genetic disorder to their offspring

In systolic heart failure, what effect does the renin-angiotensin-aldosterone system (RAAS) have on stroke volume? a. Increases preload and decreases afterload. b. Increases preload and increases afterload. c. Decreases preload and increases afterload. d. Decreases preload and decreases afterload.

ANS: B Activation of the RAAS not only causes an increase in preload and afterload, but it also causes direct toxicity to the myocardium. This selection is the only option that accurately identifies the effect that the RAAS has on stroke volume in this situation.

Sickle cell disease (SCD) is what type of inherited disorder? a. Autosomal dominant c. X-linked dominant b. Autosomal recessive d. X-linked recessive

ANS: B SCD is an inherited autosomal recessive disorder that is expressed as sickle cell anemia, sickle cell-thalassemia disease, or sickle cell-hemoglobin C (HbC) disease, depending on mode of inheritance. This selection is the only option that accurately identifies the mode of inheritance for the stated disorder.

Which manifestations of vasoocclusive crisis are associated with sickle cell disease (SCD) in infants? a. Atelectasis and pneumonia b. Edema of the hands and feet c. Stasis ulcers of the hands, ankles, and feet d. Splenomegaly and hepatomegaly

ANS: B Symmetric, painful swelling of the hands and feet (hand-foot syndrome) caused by infarction in the small vessels of the extremities is often the initial manifestation of SCD in infants. This selection is the only option that accurately identifies the manifestations of a vasoocclusive crisis associated with SCD in infancy.

What are the abnormalities in cytokines found in children with cystic fibrosis (CF)? a. Deficit of interleukin (IL)-1 and an excess of IL-4, IL-12, and interferon-alpha (IFN-α) b. Deficit of IL-6 and an excess of IL-2, IL-8, and granulocyte colony-stimulating factor (G-CSF) c. Deficit of IL-10 and an excess of IL-1, IL-8, and TNF-α d. Deficit of IL-3 and an excess of IL-14, IL-24, and colony-stimulating factor (CSF)

ANS: C Abnormal cytokine profiles have been documented in CF airway fluids, including deficient IL-10 and excessive IL-1, IL-8, and TNF-α, all changes conducive to promoting inflammation. This selection is the only option that accurately identifies the abnormalities in cytokines observed in children with CF.

Which statement best describes cystic fibrosis? a. Obstructive airway disease characterized by reversible airflow obstruction, bronchial hyperreactivity, and inflammation b. Respiratory disease characterized by severe hypoxemia, decreased pulmonary compliance, and diffuse densities on chest x-ray imaging c. Pulmonary disorder involving an abnormal expression of a protein-producing viscous mucus that obstructs the airways, pancreas, sweat ducts, and vas deferens d. Pulmonary disorder characterized by atelectasis and increased pulmonary resistance as a result of a surfactant deficiency

ANS: C Cystic fibrosis is best described as a pulmonary disorder involving an abnormal expression of a protein-producing viscous mucus that obstructs the airways, pancreas, sweat ducts, and vas deferens. This selection is the only option that accurately describes cystic fibrosis.

Hemoglobin S (HbS) is formed in sickle cell disease as a result of which process? a. Deficiency in glucose 6-phosphate dehydrogenase (G6PD) that changes hemoglobin A (HbA) to HbS. b. Genetic mutation in which two amino acids (histidine and leucine) are missing. c. Genetic mutation in which one amino acid (valine) is replaced by another (glutamic acid). d. Autoimmune response in which one amino acid (proline) is detected as an antigen by abnormal immunoglobulin G (IgG).

ANS: C HbS is formed by a genetic mutation in which one amino acid (valine) replaces another (glutamic acid) (see Figure 30-5, A). This selection is the only option that accurately identifies how HbS is formed in sickle cell disease.

Which statement relates to immune thrombocytopenic purpura (ITP)? a. ITP is formed in conditions of low flow and is made up of mostly red cells with larger amounts of fibrin and few platelets. b. An alteration of multipotent stem cells, resulting in an excess production of platelets, causes ITP. c. Mononuclear phagocytes in the spleen remove antibody-coated platelets from circulation. d. Arterial clots are made up of mostly platelet aggregates held together by fibrin strands

ANS: C ITP involves the antigen usually forming immune complexes with circulating antibodies, and it is thought that the immune complexes bind to Fc receptors on platelets, leading to their destruction in the spleen. None of the other options are accurately related to ITP.

What term is used to identify thrombi that occlude arterioles and capillaries and are made up of platelets with minimal fibrin and erythrocytes? a. Essential (primary) thrombocythemia (ET) b. Acute idiopathic thrombotic thrombocytopenic purpura c. Thrombotic thrombocytopenic purpura (TTP) d. Immune thrombocytopenic purpura (ITP)

ANS: C Of the available options, only TTP is characterized by thrombotic microangiopathy in which platelets aggregate and cause occlusion of arterioles and capillaries in the microcirculation.

Sickle cell disease is classified as a(an): a. Inherited X-linked recessive disorder b. Inherited autosomal recessive disorder c. Disorder initiated by hypoxemia and acidosis d. Disorder that is diagnosed equally in men and women

ANS: C Sickling is an occasional, intermittent phenomenon that can be triggered or sustained by one or more of the following stressors: decreased oxygen tension (PO2) of the blood (hypoxemia), increased hydrogen ion concentration in the blood (decreased pH), increased plasma osmolality, decreased plasma volume, and low temperature (see Figure 30-7). This selection is the only option that accurately identifies the classification of the stated disorders

Immune thrombocytopenia (ITP) is a(n) _____ condition in adults and a(n) _____ condition in children. a. Acute; acute c. Acute; chronic b. Chronic; chronic d. Chronic; acute

ANS: D ITP may be acute or chronic. The acute form is frequently observed in children. Chronic ITP is more commonly observed in adults, with the highest prevalence in women between 20 and 40 years of age.