chapter 21,22,23,24
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."
A 23-year-old female client has been diagnosed with von Willebrand disease following a long history of "heavy periods" and occasional nosebleeds. Which of the client's statements demonstrates a sound understanding of the new diagnosis?
"I'll make sure to take acetaminophen instead of aspirin when I get aches and pains."
Erythrocyte sedimentation rate
"My child's stem cells are not able to grow and divide."
A woman who has given birth 12 hours ago is displaying signs and symptoms of disseminated intravascular coagulation (DIC). The client's husband is confused as to why a disease of excessive coagulation can result in bleeding. Which of the nurse's explanations best characterizes DIC?
"So much clotting takes place that there are no available clotting components left and bleeding ensues."
A nurse is assessing a client presenting with symptoms of fatigue, fever, severe joint pain, and headache. Laboratory results reveal an erythrocyte sedimentation rate (ESR) rate of 60 mm/hour. The client asks what the blood test results mean. What is the most appropriate explanation for the nurse to provide?
"The ESR tests for the presence of inflammation in the body."
The health care provider suspects a client may have developed a leukemia that originates from the B cells. Which cancers would the nurse associate with B cell lymphocytes?
(AlL) (CLL)
A client with rheumatoid arthritis has been diagnosed with a secondary immune-associated neutropenia called Felty syndrome. The nurse should be assessing this client for which clinical manifestation of Felty syndrome? Select all that apply.
1.Upper left quadrant pain on palpation. 2.An area of diminished breath sounds related to pneumonia.
A female client with a diagnosis of psoriatic arthritis is currently taking a course of prednisone for the control of symptoms related to inflammation. Which erythrocyte sedimentation rate (ESR) would indicate that the medication course has decreased the inflammation within normal limits?
10mm/hr
The nurse is teaching a client who experienced blood loss during surgery. The nurse teaches the client that the bone marrow must continuously produce red blood cells because the average lifespan of a red blood cell is approximately how long?
4 months
A client is diagnosed with infectious mononucleosis. When was this client most likely infected with the Epstein-Barr virus (EBV)?
4 to 8 weeks earlier
The nurse is preparing a client for bone marrow biopsy for suspected leukemia. The client tells the nurse, "I already know all the risks and what to expect. I had a bone marrow aspiration a month ago." How should the nurse respond?
A bone marrow biopsy is more invasive than the aspirate. It uses a larger needle to obtain a larger sample so it carries some increased risks.
A geriatrician is following a number of clients on a subacute geriatric medical unit, some of whom require diagnostic blood work. Which client would be most likely to have an erythrocyte sedimentation rate (ESR) screening test ordered?
A man with rheumatoid arthritis and pneumonia.
A student asks a nurse educator why a platelet will stick in the injured site but not in the normal uninjured blood vessel. What would be the best response?
Adhesion occurs when the platelet receptor binds to von Willebrand factor (vWF) at the injury site.
The globulins that make up part of the plasma of the blood have three distinct purposes. What are the gamma globulins?
Antibodies of the immune system
How does low-dose aspirin therapy impact clot formation?
Aspirin is a platelet aggregation inhibitor.
A client presents to the emergency clinic not feeling well. Which report leads the health care provider to suspect the client may have acute leukemia?
BLEEDING FROM THE GUM NOT RELATING TO BRUSHING the teeth
The nurse reviews the lab results of a client who has a thrombocyte count of 60 ×103/µL (60 ×109/L). The client is at risk for:
Bleeding
With the exception of the first two steps, what element is required in all steps of the clotting process?
Calcium
A client's laboratory report shows the presence of the Philadelphia chromosome. Which diagnosis should the nurse suspect the client has developed?
Chronic myelogenous leukemia (CML)
Which client likely has the highest risk of developing an acquired hypocoagulation disorder and vitamin K deficiency?
Client with a diagnosis of liver failure secondary to alcohol use disorder
Pluripotent stem cells form an invaluable source of reserve cells for the entire hematopoietic system. Between these cells and the unipotent cells are several levels of differentiation. What are these unipotent cells called?
Colony-forming units
A client comes to the clinic with symptoms of fatigue, fever, severe joint pain, and headache. A laboratory results reveal an erythrocyte sedimentation rate (ESR) rate of 60 mm/hour, and a diagnosis of polymyalgia rheumatica (PMR) is confirmed. The nurse anticipates which medications will be prescribed to manage this disease process?
Corticosteroids, such as prednisone
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
During a client's admission assessment prior to surgery, the nurse notes a reference to a factor V Leiden mutation in the client's history. The nurse assesses this client for an increased risk of developing which postsurgical complication?
Deep vein thrombosis
A healthy, primiparous (first-time) mother delivered a healthy infant several hours ago, but the mother has experienced postpartum hemorrhage. Which disorder should the nurse assess for as a priority when considering possible causes of excessive bleeding after delivery?
Disseminated intravascular coagulation
A nurse is evaluating laboratory results of a client diagnosed with a parasitic infection. The tests reveal a large group of cells that are membrane-bound with granules in their cytoplasm that are aiding in the destruction of the parasite. Which cell is the nurse evaluating?
Eosinophil
A client presented to the emergency department with symptoms of fever, abdominal pain and diarrhea following a vacation out of the country. A helminthic parasite infection is suspected. Which lab result should the nurse evaluate?
Eosinophils
Which gene for the hematopoietic growth factors has been cloned and its recombinant protein is now used to treat anemia of kidney failure and cancer?
Epoetin alfa (EPO)
Endemic Burkitt lymphoma occurs in regions of Africa where what other infections are common?
Epstein-Barr and malaria
The nurse is caring for a client with systemic lupus erythematosus (SLE). What laboratory test will the nurse examine to determine the client's level of systemic inflammation?
Erythrocyte sedimentation rate
Which diagnostic lab test is used to diagnose the presence of inflammation?
Erythrocyte sedimentation rate
A client with hemophilia type A comes to the emergency department with severe pain and swelling in the right knee. To reduce musculoskeletal damage, the nurse anticipates the administration of:
Factor VIII replacement therapy
A client has developed disseminated intravascular coagulation (DIC), which the health care providers think was initiated by the intrinsic pathway, requiring which substance to begin the step-wise coagulation cascade?
Factor XII
Aplastic anemia is the result of which condition?
Failure of multipotent stem cells to grow
The nurse is caring for a postsurgical client who is recovering from knee replacement surgery secondary to rheumatoid arthritis. When planning the client's care, the nurse should include what action?
Frequent assessment for signs of thrombosis or hemorrhage.
In the ICU, a postsurgical client has developed sepsis and is being treated with multiple medications. During the mid-morning assessment, which finding leads the nurse to suspect the client may be developing a complication called disseminated intravascular coagulation (DIC)?
Hemorrhage from the surgical site requiring deep pressure dressings
A client is suspected of having lymphoma and is having diagnostic tests performed to determine the type of lymphoma. Which form of lymphoma does the nurse recognize has the classic symptoms of pruritus and intermittent fevers associated with night sweats?
Hodgkin lymphoma (HL)
A client diagnosed with hyperthyroidism is prescribed propylthiouracil. A month later, the client's complete blood count with differential reveals neutropenia. What is the term used to describe this drug reaction?
Idiosyncratic
The nurse is assessing lab values of a client with disseminated intravascular coagulation (DIC). The nurse would anticipate which abnormal laboratory result?
Increased prothrombin time (PT)
A client undergoes a splenectomy following an automobile accident. The nurse monitors for which anatomical change most likely to occur following surgery?
Increased white blood cell (WBC) count
A client diagnosed with acute lymphocytic leukemia (ALL) is receiving treatment planning for an outcome of remission. Which therapy phase of treatment does the nurse determine the client is currently experiencing?
Induction
Which cytokines support the proliferation of stem cells in the human body?
Interleukins, interferons, and tumor necrosis factor
A nurse observes a thin gray line between the red blood cells and the plasma in a centrifuged sample of blood. What is the nurse's best understanding of this phenomenon?
It is the location of the white blood cells in a spun sample.
Which statement is correct about the type of hepatitis that is often seen in cases of infectious mononucleosis?
It resolves without causing permanent liver damage.
Which factor differentiates chronic leukemias from acute leukemias?
Leukemic cells are more fully differentiated in chronic than in acute leukemias.
A student nurse is taking microbiology and reviewing various types of cells. From which cell type are granulocytes derived?
Myeloid stem cells
Granulocytes are derived from which cell type?
Myeloid stem cells
Which is the most common leukocyte in normal blood?
Neutrophils
A client is admitted to the hospital with an elevated temperature and flank pain. When reviewing the complete blood count (CBC), which level is the most important for the nurse to communicate to the health care provider?
Neutrophils 85%
When a white blood cell with differential count reveals an acute infection, which statement is correct regarding the client's neutrophils?
Neutrophils are the first white blood cell to elevate in an acute infection.
Which statement accurately describes a component of the hematopoietic system?
Neutrophils are the most prevalent white blood cell.
the undifferentiated blast cells accumulate in the bone marrow, suppressing the remaining progenitor cells.
Night sweats Weight loss Pruritus
A 40-year-old client has been admitted to the cardiac intensive care unit after having an anterior wall myocardial infarction (MI). The nurse is reviewing modifiable risk factors with the client to avoid the redevelopment of thromboembolic complications, possibly leading to a second MI. Which of the following increases this risk?
Oral contraceptives
The nurse is reviewing hospital discharge instructions with a client who has been diagnosed with secondary thrombocytosis and who also suffers from chronic ulcerative colitis, making anticoagulation inadvisable. The nurse stresses that the client should avoid:
Oral contraceptives Smoking Immobilization
Which intervention would be most appropriate by the nurse caring for a client in the neutropenic phase of cyclic neutropenia?
Perform/assist with oral care
A client with a medical history of HIV is admitted with a diagnosis of thrombotic thrombocytopenic purpura (TTP). The nurse notes the client 's admission blood tests reveals a platelet level of 10,000/μL and low red blood cells. The nurse would anticipate giving which emergency treatment?
Plasmapheresis
The nurse is caring for a client with leukemia who 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 nurse is assessing a child brought to the clinic with multiple petechiae and excessive bruising covering his body. Laboratory tests reveal a low platelet count. The nurse is aware that these clinical manifestations are caused due to which pathological process?
Platelets function to form the platelet plug to help control bleeding after injury. Without enough platelets, the blood cannot clot properly and bleeding occurs.
The entire hematopoietic system, including the precursor erythroids, myelocytes, lymphocytes, and megakaryocytes are derived from a small population of cells. These cells are known as:
Pluripotent stem cells
A client's history documents the presence of a myelocytic leukemia. The nurse interprets this to mean that the leukemia is:
Predominant cell is myelocytic
A 69-year-old client who is obese and has a diagnosis of angina pectoris has been prescribed clopidogrel by the primary health care provider. The client asks, "Why do I need this medication? It won't help my chest pain." Which response by the nurse is the best explanation?
Prevents the blood cells from forming a clot in your heart vessels
A client is suspected of having Hodgkin lymphoma. Which classic assessment findings would confirm Hodgkin lymphoma?
Pruritus and night fevers
Which factors have been identified as having a negative effect on platelet function? Select all that apply.
Smoking Diabetes mellitus
Chronic lymphocytic leukemia (CLL) commonly causes hypogammaglobulinemia. This makes clients with CLL more susceptible to infection. What is the most common infectious organism that attacks clients with CLL?
Staphylococcus aureus
The nurse is reviewing the results of a client's complete blood count and differential. The results of this test will inform the nurse of what aspects of the client's current status? Select all that apply.
The proportion of each type of white cell in the client's blood The number of platelets that are present in each unit of blood
The erythrocyte sedimentation rate is a commonly performed blood test used for monitoring the clinical course of a disease. It is a measurement of how rapidly red blood cells will aggregate and drop to the bottom of a tube as a sediment in anticoagulated blood. What influences the rate of fall that would give information about the clinical course of a disease?
The rate of fall is faster in the presence of fibrinogen that is increased in an inflammatory disease.
A nurse is treating a client with aplastic anemia. Due to the replacement of normal bone marrow with malignant cells, the nurse teaches the client to prevent scratches, scrapes, and cuts. What root cause likely underlies the client's increased risk for hemorrhage?
Thrombocytopenia
A client has been diagnosed with leukemia and the care team is describing the etiology and pathogenesis of this disease to the client. Which topic should be included in the discussion?
Translocation of genes regulating blood cell development is sometimes implicated.
Drug-induced neutropenia is a disease that has significantly increased in incidence over the last several decades. What is the attributing factor in the increased incidence of drug-induced neutropenia?
Treatment of cancer by chemotherapeutic drugs
In a course of chronic myelogenous leukemia (CML), which clinical manifestations will the client experience in the accelerated phase? Select all that apply.
Weight loss Low-grade fever Abdominal fullness
A nurse is reviewing laboratory data for an older adult client. Which laboratory value should the nurse be most concerned about?
White blood cell (WBC) count 3500/mL
The process of clot retraction squeezes serum from the clot, thereby joining the edges of the broken vessel. Through the action of actin and myosin, filaments in platelets contribute to clot retraction. Failure of clot retraction is indicative of:
a low platelet count.
The nurse is evaluating a client's blood work results. About which laboratory result should the nurse notify the health care provider because it falls outside normal parameters?
absolute neutrophil count 950/μl (0.95 x 109/l)
The nurse is caring for a client with chronic myelogenous leukemia (CML) and notes that the client has splenomegaly and an increased basophil count as well as night sweats, bone pain, and a low grade fever. The nurse interprets the symptoms as indicating that the client is in which phase of the clinical course of CML?
accelerated
A client asks, "What do these basophils and mast cells do in the body?" The health care provider responds that they:
are involved when you have an allergic reaction.
The nurse is conducting risk factor analysis for leukemia on a group of clients. Which client has the highest genetic risk for leukemia?
child with down syndrome
A client receives a complete blood count as part of presurgery admission labs and is diagnosed with lymphocytosis. The nurse's plan of care should include interventions related to potential diagnosis for which disease associated with lymphocytosis?
chronic
A client is prescribed the recumbent granulocyte colony-stimulating factor (CSF) filgrastim. The nurse evaluates the effectiveness by monitoring which laboratory value?
complete blood count (CBC)/differential
The nurse is caring for a client with cyclic neutropenia. The nurse understands that this is which type of neutropenia?
congential
The nurse evaluating a client's blood work notes that the client's white blood cells are 9000/μL (9.0 x 109/L). The nurse should
continue to monitor the client's blood work results.
A home health care nurse is visiting a client who was recently discharged from the hospital taking. The client is on warfarin therapy following a massive pulmonary embolism. The client asks why more frequent blood tests are being done, considering an antibiotic was started. The best response from the nurse would be that antibiotics can:
decrease intestinal flora.
Leukemias are classified according to the predominant cell type. The nurse anticipates which effect from a leukemia affecting the products of myeloid stem cells (myelogenous)?
decrease platelet level increase risk for bleeding
The nurse is caring for a client who has a low level of T lymphocytes. The nurse plans care for a client with:
decreased immune response
A postpartum client develops uncontrolled postpartum bleeding, oozing from IV sites, a blood pressure of 82/40 mm Hg, and respiratory distress. Which complication does the nurse suspect is occurring?
disseminated intravascular coagulation (DIC)
The nurse caring for a client in the induction therapy phase understands that the intent of the therapy is to:
elicit a remission
A client has an elevated erythrocyte sedimentation rate (ESR). The nurse assesses the client for which pathophysiologic evidence based on this result?
evidence of an inflammatory process or infection
Which topic should the nurse include in the discharge teaching plan for a client with Felty syndrome?
handwashing
The nurse is working with a client awaiting a kidney transplant. The nurse teaches the client about what testing to determine an organ match (histocompatibility)?
human leukima antigen type
A nurse practitioner is providing care for a client with low levels of the plasma protein gamma globulin. The nurse would recognize that the client is at risk of developing which health problem?
infection
A critical care nurse is preparing a case study on the treatment of acute coronary syndrome (ACS), which describes glycoprotein factor (GPIIb/IIIa) inhibitors and their role in decreasing thrombosis by:
interfering with the ability of platelets to bind to one another.
The nurse notes a client's hemoglobin is 10.0 g/dL (100 g/L) and examines the red blood cell (RBC) indices. The nurse suspects what type of anemia based on the findings?
iron deficiency
An adult client's blood work and biopsies indicate that he has proliferating osteoclasts that are producing large amounts of IgG. What is the man's most likely diagnosis?
multiple myeloid
A Vietnam War vet tells the nurse that he was exposed to Agent Orange during the war and he is concerned about his risk for cancer. The nurse responds that one cancer associated with Agent Orange exposure is:
multiple myelomia
Acute lymphocytic leukemia (ALL) and acute myelocytic leukemia (AML) are two distinct disorders with similar presenting clinical features. What clinical feature do ALL and AML share?
night sweat
A group of nursing students were studying for their pathophysiology exam by quizzing each other about disorders of WBCs and lymphoid tissue. When asked to name the first chromosomal abnormality that identifies cancer, one student correctly answered:
phildaehila
Which is considered a component(s) of blood? Select all that apply
plasma erythrocytes platelets eosinophils
Multiple myeloma is a malignancy of what part/type of cells or lymphoid system?
plasma cell
A client has been experiencing anemia and thrombocytopenia. Subsequent diagnostic testing has revealed the presence of immature granulocyte types and the Philadelphia chromosome. This client is likely to experience:
prolong chronic phase of leukemia
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:
renal disease
Kostmann syndrome is a severe congenital neutropenia. Which disorder/infection is characteristic of this condition?
severe bacterial infection
A 26-year-old client has an absolute neutrophil count of less than 500 cells/mm3 (0.50 x 109/L) Which interpretation of this lab value is accurate?
severe neutropenia
A client's history and physical documents the presence of an indolent lymphoma. The nurse plans care for which type of lymphoma?
slow growing
A client diagnosed with pancytopenia due to aplastic anemia is scheduled for which treatment that can correct bone marrow deficiencies?
stem cell transplant
Cytokines that affect hematopoiesis in bone marrow are called colony-stimulating factors (CSFs) based on their ability to perform which function in the body
stimulate growth for blood cells
A client with Von Willebrand disease type 3 comes to the clinic for an examination. Which problem reported by this client is most important for the nurse to communicate to the physician?
tarry tool
The results of a client's most recent blood work indicate neutropenia. Which intervention will the nurse prioritize?
teaching the client about infection control measures, such as handwashing
What is the name of the region of the lymph nodes that contain most of the T cells?
the The paracortex
A child has been home from camp for 2 weeks and reports a sore throat, low-grade fever, and enlarged cervical lymph nodes. After testing, it is determined the child has Epstein-Barr virus (EBV)-associated infectious mononucleosis. The parent asks, "How did my child acquire this type of infection?" Which is the best response by the nurse?
the infection is acquired primarily through contact with infected oral secretions."
A nurse is working with an 8-year-old client diagnosed with AML. The nurse plans the client's care in the knowledge that thrombocytopenia and associated bleeding are risks because:
the undifferentiated blast cells accumulate in the bone marrow, suppressing the remaining progenitor cells.
A client diagnosed with autosomal dominant von Willebrand factor disease (vWF) is experiencing mild to moderate bleeding. The health care provider would classify the diagnosis as:
type 2
A client 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 client that the compression stockings are essential in preventing:
venous thrombous
A client with an apparent clotting disorder is admitted to hospital. His health record reveals that he has been treated for complications of chronic alcoholism for the past 10 years. The nurse should suspect what cause of his clotting disorder?
vitamin k deficiency
The nurse is providing a client with education on taking the medication clozapine. The nurse includes the importance of:
weekly blood work
