Chapter 13: Disorders of Red Blood Cells Prep U

The family of an older adult client is wondering why his "blood counts" are not rising after his last GI bleed. They state, "He has always bounced back after one of these episodes, but this time it isn't happening. Do you know why?" The nurse will respond based on which pathophysiologic principle? "Due to stress, the red blood cells of older adults are not replaced as promptly as younger people." "The doctor may start looking for another cause of his anemia, maybe cancer of the bone." "Everything slows down when you get older. You just have to wait and see what happens." "Don't worry about it. We can always give him more blood."

"Due to stress, the red blood cells of older adults are not replaced as promptly as younger people."

The nurse is starting a blood transfusion on a client with anemia. Which manifestations of a transfusion reaction should the nurse be monitoring the client for? Select all that apply. Pallor of the face Pain in the lumbar area Dyspnea Swollen, itchy areas on the skin Bradycardia

Swollen, itchy areas on the skin Pain in the lumbar area Dyspnea

A community health nurse is conducting the nutritional component of a class for new mothers. Which teaching point would be most justified? "If you choose to feed your baby with formula, ensure that it is iron-fortified." "Be aware that cow's milk depletes your baby's supply of iron." "Iron supplementation is not necessary provided you are breast-feeding your infant." "Your infant needs the same amount of iron as you, but has far fewer sources for obtaining it."

"If you choose to feed your baby with formula, ensure that it is iron-fortified."

The nurse is providing dietary instruction for a client diagnosed with folic acid deficiency. Which information will help ensure the client ingests sufficient amounts of folic acid? Select all that apply. "Make sure all vegetables are cooked." "Increase the consumption of carbohydrates in your diet." "Increase the consumption of daily alcohol." "Include cereals in the daily diet." "Include green leafy vegetables in your diet."

"Include green leafy vegetables in your diet." "Include cereals in the daily diet."

The rate at which hemoglobin is synthesized depends on availability of which substance? Glucose Calcium Iron Oxygen

Iron

Accounting for age, illness, and risk factors, a transfusion is recommended when the hemoglobin is at which level? >8.5 g/dL (>85 g/L) <7.5 g/dL (<75 g/L) Between 7.5 and 8 g/dL (75 and 80 g/L) <7 g/dL (<70 g/L)

<7 g/dL (<70 g/L)

The burn client is hypotensive and has hypoproteinemia. Which blood component will be utilized in this client's treatment? Albumin Plasma Platelets-random Packed red blood cells

Albumin

The provider is treating her client with regular blood transfusions and iron chelation therapy. The nurse knows the client has which type of anemia? Sickle cell disease Beta-thalassemia Deficiency of glucose-6-phosphate-dehydrogenase (G6PD) Alpha-thalassemia

Beta-thalassemia

An oncology client is receiving an erythropoietin stimulating agent, epoetin alfa for severe anemia. The client reports severe bone pain (arthralgia). Knowing the basic pathophysiologic principles, how should the nurse explain the bone pain to this client? Bleeding is stimulating the rapid proliferation of replacement cells by the blood-forming cells in the bone marrow. The bone cells are not receiving enough oxgen; therefore, some of the cells are dying. Bleeding is causing vasoconstriction to all body tissues, which results in death of some tissues, such as is occurring within the bone. This is an adverse reaction to epoetin alfa.

Bleeding is stimulating the rapid proliferation of replacement cells by the blood-forming cells in the bone marrow.

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 Hemolytic Iron deficiency Aplastic

Blood loss

An older adult client arrives with garbled speech, unilateral facial drooping, and weakness and unfortunately dies. Laboratory work reveals hematocrit of 54% (0.54). Which complication of polycythemia could most likely be associated with this client's death? Cerebral thrombosis Acute leukemia Anaphylactic reaction Infection and sepsis

Cerebral thrombosis

The physician is examining a postmenopausal female and explains that which cause of iron deficiency is most common in adults? Premature destruction of red cells Chronic blood loss Folic acid deficiency Acute blood loss

Chronic blood loss

A client with iron-deficiency anemia reports feeling "tired all of the time." What does the nurse understand may be the cause of the fatigue that the client is experiencing? A decrease in lactic acid Increased diffusion of electrolytes Chronic blood loss with inadequate iron available for recycling Alteration in carbohydrate metabolism

Chronic blood loss with inadequate iron available for recycling

An older adult client asks the nurse why so many older people develop anemia. Which response by the nurse is most accurate? Increased erythropoiesis Cor pulmonale Stress Chronic disease

Chronic disease

The practitioner notes the client with hemolytic anemia has Raynaud phenomenon. What causes this type of anemia? Deficiency of glucose-6-phosphate dehydrogenase (G6PD) Cold-reacting antibodies Warm-reacting antibodies Prosthetic heart valve

Cold-reacting antibodies

The nurse is assessing a female client with a hemoglobin of 6.8 g/dL (68 g/L). Which symptoms would the nurse expect to find? Select all that apply. Headache Pink skin and mucous membranes Bradycardia Faintness Dyspnea

Dyspnea Headache Faintness

An adult client with good overall health has reported headaches and dizziness in recent weeks. The nurse's assessment reveals blood pressure of 158/99 mm Hg, which is unprecedented for the client. On observation, the client's skin appears reddened, though he denies feeling warm. The nurse should anticipate what further diagnostic finding? Elevated RBC, hemoglobin, and hematocrit. Further signs and symptoms of internal hemorrhage. Normal RBC, hemoglobin, and hematocrit with alterations in morphology. Abnormal RBC indices coupled with low platelets.

Elevated RBC, hemoglobin, and hematocrit.

The practitioner notes the client has a yellowish discoloration of the skin. Which lab result would the practitioner expect to see? Elevated unconjugated bilirubin Elevated conjugated bilirubin Decreased platelets Elevated red blood cells

Elevated unconjugated bilirubin

Select the option that best describes the pathogenesis of the anemia in a client with beta-thalassemia. Increased levels of hemoglobin (hyperchomia) occur. Heinz bodies impair DNA synthesis and damage the red blood cell (RBC) membrane. Hemoglobin becomes sickled (HbS) when deoxygenation occurs. Premature destruction of cells occurs due to rigid, nondeformable membranes.

Heinz bodies impair DNA synthesis and damage the red blood cell (RBC) membrane.

Which substance, when deficient, results in a diagnosis of anemia? Platelets Folic acid Blood plasma Hemoglobin

Hemoglobin

A nurse is assessing a client who displays pale skin and nail beds. Which laboratory data should the nurse evaluate? White blood cell count Erythrocyte sedimentation rate Hemoglobin level Neutrophil count

Hemoglobin level

A client arrives in the emergency department with symptoms of extreme fatigue, shortness of breath, and a yellowish discoloration to the skin. The nurse interprets these finding as being which type of anemia? Aplastic anemia Iron deficiency anemia Hemolytic anemia Pernicious anemia

Hemolytic anemia

A nurse is monitoring a client with anemia and low oxygen levels. The nurse knows that which condition stimulates the secretion of erythropoietin? Hypoxia Inflammation Tachycardia Low blood pressure

Hypoxia

An oncologist has ordered a bone marrow biopsy for a client and is explaining the reasons for the test and what the client might expect during the test. Which of the following explanations best reflects an aspect of a bone marrow biopsy? I need to get samples of the types of blood cells that your body is producing. I will be harvesting a sample of your stem cells for examination. I need a more accurate count of your blood components than normal blood work is able to provide. I'll take a sample of your bone marrow from your breastbone or your spine.

I need to get samples of the types of blood cells that your body is producing.

A nurse is teaching parents of an infant diagnosed with β-thalassemia about major complications of the disease. The nurse determines that the parents understand when they correctly identify which as a major complication of β-thalassemia? Infection Iron overload Vitamin B deficiency Intellectual disability

Iron overload

A client was recently diagnosed with iron deficiency anemia. The nurse anticipates which treatment to be prescribed? Iron supplementation and dietary teaching Bone marrow transplant Steroid therapy Red blood cell transfusion

Iron supplementation and dietary teaching

The nurse is educating a pregnant client about the importance of dietary folic acid to prevent anemia. Which food source will the nurse encourage because it is high in folic acid? Kale Eggs Carrots Cottage cheese

Kale

The practitioner is examining a client and notes that he has small, punctate skin hemorrhages on his abdomen and chest. This finding is suggestive of which lab result? Low neutrophils Low red blood cells Low platelets Low white blood cells

Low platelets

A 40-year-old client is admitted to the hospital after experiencing 3 days of extreme vomiting. The doctor reviews the lab results and notes that the hemoglobin and hematocrit are elevated. What is the likely cause of these abnormal lab findings? Extreme blood loss Normal consequence of aging Manifestation of dehydration Increased production of red cells by the body

Manifestation of dehydration

The student correctly associates macrocytic and enlarged red blood cells with which type of anemia? Normocytic Sickle cell Iron deficiency Megaloblastic

Megaloblastic

The client explains to her new provider that she receives periodic phlebotomies to decrease her red blood cell mass. The provider believes the client may have: Megaloblastic anemia Beta-thalassemia Sickle cell disease Polycythemia vera

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? Clavicle Anterior femur Posterior iliac crest Cervical spinous process

Posterior iliac crest

Which anatomical site would the nurse expect to monitor when caring for an adult client who has just had a bone marrow aspiration performed? Posterior iliac crest Head of the femur Radial artery Antecubital space

Posterior iliac crest

A client is diagnosed with anemia. Which laboratory test will the nurse evaluate to assist in determining the type of anemia involved? Red blood cell indices White blood cell differential Hemoglobin Hematocrit

Red blood cell indices

What of these would be tested by a complete blood count (CBC)? Sodium and potassium Size and shape of blood cells Red blood cells and platelets Lymphocytes and neutrophils

Red blood cells and platelets

The nurse is caring for a client diagnosed with sickle cell disease. For which factor should the nurse assess to prevent the cells from sickling? Rapid administration of intravenous fluids Presence of pain in the client's joints Reduced oxygen tension while the client sleeps Coughing and sneezing

Reduced oxygen tension while the client sleeps

A client has been diagnosed with aplastic anemia. The nurse correlates this diagnosis with which laboratory value? Reduction of white blood cells Relative polycythemia Decreased inflammatory cytokines Increased hemoglobin counts

Reduction of white blood cells

The anemic client is receiving erythopoietin. If there is a marked increase in red blood cell production, which lab result would increase? Platelets Lymphocytes Reticulocytes Neutrophils

Reticulocytes

If an Rh-negative mother is giving birth to an Rh-positive infant, the nurse should be prepared to administer: alpha interferon. a monoclonal antibody like infliximab. antihistamines like diphenhydramine. Rh immune globulin.

Rh immune globulin.

A male client with chronic obstructive pulmonary disease has a hematocrit of 55%. The practitioner tells the client that he has: Polycythemia vera Secondary polycythemia Relative polycythemia Primary polycythemia

Secondary polycythemia

The practitioner carefully monitors his client who exhibits hemoglobin S (HbS) genes. The practitioner know that the client is predisposed to life-threatening infection due to damage by HbS to which organ? Lungs Pancreas Spleen Heart

Spleen

When red blood cells age, which organ is responsible for their destruction? Spleen Liver Red bone marrow Kidneys

Spleen

A client with iron-deficiency anemia asks, "What does this low mean corpuscular volume (MCV) level mean?" Which response by the nurse is most accurate? This means your blood will thicken rapidly. This means that your red blood cells are pale in color. This means that you have a lot of fluid in your vessels diluting your red blood cells. The MCV is one red blood cell (RBC) index that indicates your RBCs are small cells.

The MCV is one red blood cell (RBC) index that indicates your RBCs are small cells.

The nurse is caring for a 2-day-old newborn infant who appears lethargic and has a yellowish tint to the skin. Select the most likely cause of this newborn's signs and symptoms. A decrease in the breakdown of red blood cells Cirrhosis of the liver The inability of the immature liver to conjugate bilirubin The inability of a newborn to produce bilirubin

The inability of the immature liver to conjugate bilirubin

When it is determined that a client's red blood cells (RBCs) have a biconcave shape, what will be the nurse's reaction? The nurse will arrange for bedside oxygen for the client to use as needed. The nurse will immediately notify the client's health care provider of this serious finding. The nurse will be concerned, as this is an indication of sickle cell anemia. The nurse will be pleased, as that shape allows for increased oxygen diffusion.

The nurse will be pleased, as that shape allows for increased oxygen diffusion.

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 Folic acid deficiency anemia Microcytic anemia Blood loss anemia

Vitamin B12 deficiency anemia

A 53-year-old man presents with inability to concentrate, itching in his fingers and toes, elevated blood pressure, and unexplained weight loss. He is diagnosed with primary polycythemia. The primary goal of his treatment will be to: reduce the mean size of his red blood cells. increase the amount of oxygen distributed by his red blood cells. reduce the viscosity of his blood. control his hypertension.

reduce the viscosity of his blood.

A neonate has been diagnosed with hyperbilirubinemia and has begun phototherapy. The infant's risk of encephalopathy will increase if: unconjugated bilirubin levels are not successfully reduced. conjugated bilirubin crosses the infant's blood-brain barrier. serum bilirubin cannot bind with RBC's for excretion. conjugated bilirubin reverts to unconjugated bilirubin.

unconjugated bilirubin levels are not successfully reduced.

The dietary student is studying folic acid deficiency. The faculty member knows the student is ready to teach clients about this topic when the student makes which statement? "The client should increase his intake of cooked, green, leafy vegetables." "Folate deficiency is not common in clients with neoplastic disease." "The 30-year-old client who is trying to become pregnant should evaluate her folic acid intake." "The client should have at least 200 micrograms in her daily diet."

"The 30-year-old client who is trying to become pregnant should evaluate her folic acid intake."

The staff educator is teaching the nurse orientee about red cell changes in the neonate. The educator knows that the orientee understands the neonatal changes and care when she states: "The physiologic anemia of the newborn can be treated with infant formula supplemented with iron." "During the early neonatal period, there is a switch from HbA to HbF." "The hemoglobin concentration falls after birth due to reduced red cell production and plasma dilution." "Neonatal red cells have a longer life span than those of older adults."

"The hemoglobin concentration falls after birth due to reduced red cell production and plasma dilution."

The neonate displays a yellow discoloration of her skin on the third day of life. The neonatologist explains this condition to the parents. Which statement is most accurate? "The increase in bilirubin, which causes the jaundice, is related to the increased red blood cell breakdown." "Hyperbilirubinemia places the neonate at risk for a cardiac condition known as kernicterus." "Most neonatal jaundice resolves spontaneously within 6 weeks." "Breast-feeding will not affect the bilirubin levels."

"The increase in bilirubin, which causes the jaundice, is related to the increased red blood cell breakdown."

The pathophysiology student is studying erythropoiesis. Which statement demonstrates understanding of this process? "The reticulocyte count serves as an index of erythropoietic activity of the bone marrow." "In a 30-year-old, red blood cell production takes place in the femur." "In a 4-year-old, red blood cells are produced mainly in the vertebrae, sternum, ribs, and pelvis." "Erythropoiesis refers to the production of red and white blood cells."

"The reticulocyte count serves as an index of erythropoietic activity of the bone marrow."

A client has been diagnosed with anemia. The physician suspects an immune hemolytic anemia and orders a Coombs test. The client asks the nurse what this test will tell the doctor. The nurse replies: "They will wash your RBCs. Then mix the cells with a reagent to see if they clump together." "They will look at your RBCs under a microscope to see if they have an irregular shape (poikilocytosis)." "They will be looking to see if you have enough ferritin in your blood." "They are looking for the presence of antibody or complement on the surface to the RBC."

"They are looking for the presence of antibody or complement on the surface to the RBC."

A nurse is teaching parents expecting their first child about the benefits of umbilical cord blood donation. The nurse determines teaching was effective based on which statement? "Donated cord blood has stem cells that can be used for cloning experimentation." "Umbilical cord blood can provide stem cells for transplantation." "Stem cells from umbilical cord blood can only be used on infants and children under the age of 5." "The stem cells found in umbilical cord blood can be used to regenerate DNA and heal many diseases."

"Umbilical cord blood can provide stem cells for transplantation."

The client presents with a reduction in red blood cells, white blood cells, and platelets. The practitioner is unable to determine the cause of the client's condition. Which type of anemia does the client have? Intrinsic hemolytic Extrinsic hemolytic Idiopathic aplastic Acquired hemolytic

Idiopathic aplastic