Hematologic System
A nurse is caring for a client that has developed disseminated intravascular coagulation from direct proteolytic activation of factor X. The nurse is caring for which client?
A client with a snake bite
How should the nurse reply when asked about the function of albumin?
Albumin regulates the passage of water and solutes through capillaries
A nurse is teaching the staff about the gene associated with chronic myeloid leukemia (CML). Which gene should the nurse include?
BCR-ABL
At what initial level does thrombocytopenia usually cause the client to become symptomatic?
Below 100,000/mm^3
When checking the laboratory report, the nurse notes that the client's bilirubin level is elevated. Which information verifies the nurse understands what this level indicates?
Bilirubin is an end product of erythrocyte destruction
A client's anemia most commonly is classified using which criteria?
Changes that affect the cell's size and hemoglobin content
The client who is noted to have a chronically elevated rate of bilirubin excretion should be monitored for which condition?
Cholelithiasis
A client has suspected deep venous thrombosis. Which laboratory test will the nurse check to help confirm the diagnosis?
D-dimer
A nurse is describing a nonnucleated cytoplasmic disk. The nurse is teaching the client about which cellular component of the blood?
Erythrocyte
A client who lived at high altitudes is checked by the nurse for secondary polycythemia. What is the rationale for the nurse's actions?
Erythropoietin secretion is stimulated by hypoxia
Which information assures the preceptor that the new nurse understands why an erythrocyte has a limited life span of 120 days?
Erythtocytes cannot undergo mitotic changes
Which treatment modalities are used for clients with hemostatic alterations occurring from liver disease?
Exchange transfusions, fresh frozen plasma (FFP), platelet concentrations added to FFP
A client has a blood clot that is naturally dissolved by the client's body. What is responsible for this process?
Fibrinolytic system
A nurse is caring for all of the listed clients. Which factor will the nurse recognize as increasing the risk for disseminated intravascular coagulation (DIC) the most?
Gram-negative sepsis
A nurse is caring for a client with polycythemia vera. Which pathophysiologic consequences should the nurse consider when planning care for this client?
Hypercoagulability, leading to tissue ischemia and possible organ infarction
Which mechanism of action does aspirin have on a client's platelet function?
Inhibition of cyclooxygenase function
A nurse closely monitors a client who had gastric bypass surgery for the development of pernicious anemia. What is the rationale for the nurse's actions?
Intrinsic factor production by the gastric epithelium is reduced
A client presents with pica. Which diagnosis will the nurse observe documented on the chart?
Iron deficiency anemia
A nurse is asked what anemia means. How should the nurse reply?
It is a decreased erythrocyte level in circulating blood
Which information from the client indicates successful teaching by the nurse regarding leukocytes?
Leukocytes protect against infection, neutrophils are the most numerous leukocytes, leukocytes are located in both tissue and circulating blood, leukocytes are involved in the removal of dead or injured cells
A nurse receives the following laboratory results for the client: erythrocytes, 5.1 million/mm 3; leukocytes, 27,000/mm 3; platelets, 250,000/mm 3; sodium (Na +), 142 mEq/l. Which blood level result will be a cause for concern?
Leukocytes, 27,000 cells/mm^3
A nurse notices a shift to the left in the laboratory reports. Which action is most appropriate for the nurse to take?
Monitor the client's temperature every 4 hours
A nurse is planning care for a client with disseminated intravascular coagulation (DIC). What pathophysiologic process occurs in this client?
Natural anticoagulants are greatly diminished
A nurse is assessing lymph nodes. Which finding is normal?
Nonpalpable lymph nodes
A client is newly diagnosed with Hodgkin lymphoma. On assessment, what will the nurse typically find?
Painless enlargement of lymph nodes
Which type of anemia is associated with the presence of macrocytic-normochromic erythrocytes?
Pernicious anemia
Which client is most predisposed to severe bleeding?
Platelet count less that 10,000 cells/mm^3
Which are the major organ systems that undergo the compensation effect during anemia?
Respiratory system, cardiovascular system
Which term should the nurse use to describe an immature red blood cell?
Reticulocyte
A client has hereditary sideroblastic anemias. Which response indicates that pyridoxine therapy was effective?
Reticulocytosis
A client has Hodgkin disease, and the spread of lymphoma has reached multiple extralymphatic organs and tissues. Which stage will the nurse observe written on the chart?
Stage IV
A client is experiencing hemostasis. How should the nurse interpret this finding?
The client's body is able to arrest bleeding
A nurse is asked what heparin-binding proteins do. How should the nurse respond?
They enhance clot formation at the injury site
A client has Bence Jones proteins. What should the nurse assess first?
Urinary output
What is the major activator of fibrinolysis in the client's extravascular compartment?
Urinokase-like plasminogen activator
A client has impaired hemostasis. Which factor should the nurse consider when planning care for this client?
dietary deficiency of Vitamin K
A client has an infection, and the lymph nodes are enlarged and tender. How should the nurse interpret this finding?
extensive increase in the proliferation of lymphocytes
Which measurement units will the nurse observe when a client's platelets are measured?
10^3/mm^3
The nurse is reviewing laboratory results for the hemoglobin level of a newborn's cord blood. Which finding is normal?
16.8 g/dl
A nurse is caring for a client that has decreased platelets. The nurse is caring for which client?
A client with thrombocytopenia
A client has infectious mononucleosis (IM). Which leukocyte is infected with the Epstein-Barr virus (EBV)?
B lymphocyte
A nurse monitors a client with multiple myeloma for renal failure. Which rationale supports the nurse's action?
Bence Jones proteins are excreted in the urine and can damage renal tubular cells.
A client has thrombotic thrombocytopenic purpura. Which blood test will allow a nurse to monitor schizocytes?
Blood smear
A client has multiple myeloma. According to the area where multiple myeloma forms tumor masses, which type of tissue will the nurse monitor?
Bones
Upon assessment of a client with iron deficiency anemia, the nurse found clinical manifestations that are unique to that condition. Which assessment findings did the nurse observe?
Brittle, malformed nails and angular stomatitis
The client has a blood vessel injury that is described as minor. The nurse should monitor for which occurrence?
Clotting within 3 to 5 minutes of injury
A client has multiple myeloma. Which treatment should the nurse be prepared to administer?
Corticosteroids, bisphosphonates
A nurse is explaining to a client how inappropriate coagulation can be triggered by vasculitis. Which information should the nurse include in the teaching session?
Damaged blood vessels activate platelets, inflammation of the blood vessels activates the coagulation cascade, blood clot formation can suppress normal clotting mechanisms in prolonged vasculitis, normal clot formation and breakdown mechanisms are disrupted by prolonged inflammation
A nurse is teaching the staff about the principal causes of acquired platelet disorders. Which principal causes should the nurse include?
Drugs, systemic conditions, hematologic alterations
A client has essential thrombocythemia. Which action should the nurse take?
Elevate extremity
The client presents to the emergency department with burning on the soles of the feet and in the toes, which becomes more severe after standing for a short time. The feet and toes are warm and red upon examination, and findings are more pronounced on the left side. The client also complains of episodes of dizziness, headaches, and double vision. The nurse will most likely observe which condition written in the chart?
Essential (primary) thrombocythemia
A child from east-central Africa has Burkitt lymphoma. Which finding will the nurse probably find upon assessment?
Facial mass around the jaw
A client has liver disease. Which clotting factor will be the first to decline in this client?
Factor VII
A nurse is reviewing laboratory results for a client's clot retraction test. Which blood property is the nurse assessing?
Fibrinogen quantity and use
Which information should the nurse include in a teaching session about folate?
Folate is essential for reducing blood levels of homocysteine, folate is an essential vitamin required for RNA and DNA synthesis within the erythrocyte
A 6-year-old child presents with ecchymosis, prolonged bleeding upon minor trauma, low-grade fever, weight loss, headache, and fatigue. These symptoms manifested after the child's recovery from a viral infection. The child is diagnosed with acute idiopathic thrombocytopenic purpura (ITP). Which treatment will be included in the plan of care initially?
Glucocorticoids (such as prednisone)
A nurse is talking about neutrophils, basophils, and eosinophils. Which type of cells is the nurse describing?
Granulocytes
Which term should the nurse use to describe blood cell production in a client?
Hematopoiesis
Which clients are at risk for absolute secondary polycythemia?
Individuals living in high altitudes, individuals living with coronary heart failure, individuals with chronic obstructive pulmonary disease, smokers with increased levels of carbon monoxide (CO)
Which information should the nurse include in a teaching session about pernicious anemia?
It is associated with end-stage type A chronic atrophic gastritis
Which information should the nurse include in the teaching session for chronic immune thrombocytopenic purpura?
It is more common in females, the chronic form gets progressively worse
A nurse is teaching about the type of mononuclear phagocyte that is located in the liver. Which type of cell is the nurse describing?
Kupffer cells
Which characteristics will help a nurse identify a client who has macrocytic anemia?
Large red blood cell size, Presence of megaloblasts
A client has multiple myeloma. Which laboratory results will the nurse typically observe?
M proteins, proteinuria, hypercalcemia, Bence Jones protein
Which information should the nurse include in a teaching session about the purposes of the continuous circulation of blood?
Maintaining acid-base balance, supporting cellular metabolism, removing cellular waste products, defending against invading infection
The adult client is undergoing a second round of chemotherapy for metastatic cancer. When the nurse checks the indwelling intravenous line, there is oozing from the central line site, bleeding from the nose and gums, ecchymotic lesions on the hip, and symmetric cyanosis of the fingers and toes. The client becomes confused and begins to display seizure activity. What do the change in level of consciousness and seizures indicate?
Multisystem organ failure
A client was admitted to the burn unit with deep partial thickness burns over 20% of the body and has been stabilized. What would be an expected finding of laboratory blood tests?
Neutrophilia
A nurse is teaching about progenitor cells for granulocytes. Which examples should the nurse use to describe fully matured cells from this type of progenitor cells?
Neutrophils and eosinophils
A nurse is checking laboratory results for a client with anemia caused by a single recent episode of acute blood loss. Which laboratory result will the nurse expect to find about the red blood cells?
Normocytic and normochromic
A client has low platelet levels, low red blood cell levels, and low white blood cell levels. Which term should the nurse use to describe this condition during report?
Pancytopenia
A nurse is teaching about cells from lymphoid lineage. Which examples should the nurse include in the teaching session?
Plasma cells, natural killer cells
The nurse is caring for a client recovering from a motor vehicle accident in which massive crushing injuries occurred, resulting in disseminated intravascular coagulation (DIC). What relevant blood tests are needed to diagnose DIC?
Platelet count, D-dimer assay, prothrombin time, fibrin degradation products test
A nurse is teaching about a formed element of the blood that lives about 8 to 11 days. Which element is the nurse describing?
Platelets
Which information from the staff indicates successful teaching by the nurse about platelets?
Platelets have no DNA, platelets are irregularly-shaped cytoplasmic fragments
A client with polycythemia vera has a ruddy, red color of the face, hands, feet, and ears. Which term should the nurse use to describe this finding?
Plethora
A client has the absolute primary form of polycythemia. Which term should the nurse use in report to describe this condition?
Polycythemia cera
A nurse is reviewing the laboratory results for a client's serum ferritin determination test. Which property of blood cells is the nurse assessing?
Potential deficiency of heme synthesis
A client has idiopathic thrombocytopenic purpura. The nurse should prepare the client for which prescribed initial treatment?
Prednisone (Deltasone)
A client has a form of anemia caused by altered heme synthesis in erythroid cells. Which form of anemia will the nurse observe documented in the chart?
Sideroblastic
Which laboratory result for a client will alert the nurse that spontaneous bleeding without trauma is possible?
The platelet count is 12,000 cells/mm^3
Which information assures the preceptor that the new nurse understands why an erythrocyte has a limited life span of 120 days?
The serum ferritin level is 50mg/l
A nurse assesses the client with anemia for a heart murmur. When the client asks why the nurse is checking the heart, how should the nurse respond?
The thinner blood from anemia flows faster and more turbulently than normal blood, causing a murmur
A client recovering from a life-threatening motor vehicle accident in which massive crushing injuries to the body occurred 10 days ago has developed classic clinical manifestations of disseminated intravascular coagulation (DIC). The family visits and demands to know what is happening and why their family member is bleeding. How should the nurse respond?
There has been widespread microscropic clotting that used all the clotting factors. This is a complication of the trauma experienced during the motor vehicle accident. We will be replacing the lost blood with fluids and blood products to maintain organ function.
A nurse is teaching about inheritance in leukemia. Which information should the nurse include?
There is a significant tendency for leukemia to reappear in families
A client presents with petechiae, easy bruising, bleeding gums, and a platelet count of 75,000/mm 3. Which diagnosis will the nurse observe written in the chart?
Thrombocytopenia
Which information should the nurse include in a teaching session about thrombopoietin?
Thrombopoetin is produced primarily in the liver Thrombopoetin induces platelet production in bone marrow Thrombopoetin is the main regulator of the circulating platelet numbers
Which clinical manifestations are typical of a client with essential (primary) thrombocythemia?
Thrombosis, hemorrhage, splenomegaly, ischemia in fingers and toes
A client has eosinophilia. Which type of allergic reaction did the client most likely experience?
Type I allergic disorders
Which clients should the nurse monitor for the development of disseminated intravascular coagulation (DIC)?
a client with sepsis, a client with major trauma, a client with hematologic cancer, a client with pregnancy complications
Which information from the client indicates teaching by the nurse was effective about white blood cells that are considered granulocytes?
basophils, neutrophils, eosinophils
A nurse finds that a client has the Philadelphia chromosome. Which disease will the nurse find documented on the chart?
chronic myelogenous leukemia
The adult client is undergoing a second round of chemotherapy for metastatic cancer. When the nurse checks the indwelling intravenous line, there is oozing from the central line site, bleeding from the nose and gums, and ecchymotic lesions on the hip. Which condition is most likely the cause of these clinical signs?
disseminated intravascular coagulation (DIC)
Medullary hematopoiesis in a client can be accelerated by which mechanisms?
faster proliferation of stem cells, faster differentation of daughter cells, conversion of yellow bone marrow to red bone marrow
Upon assessment of a client with acute idiopathic thrombotic thrombocytopenic purpura (TTP), what will the nurse probably find?
fever, kidney failure, memory disturbances, extreme thrombocytopenia
Which information from the staff indicates teaching by the nurse was successful regarding the causes of neutropenia?
reduced survival, abnormal distribution, decreased production, reaction to an overwhelming infection
A nurse is teaching the staff about sites in the adult body where hematopoiesis occurs. Which information from the staff indicates successful teaching?
ribs, mandible, vertebrae, flat pelvic bones
A 6-year-old child presents with ecchymosis, prolonged bleeding upon minor trauma, low-grade fever, weight loss, headache, and fatigue. These symptoms manifested after the child's recovery from a viral infection. The client is given prednisone and intravenous immunoglobulin to prevent bleeding, but the platelet count continues to drop. The subsequent plan of care will include which measures?
splenectomy, aggressive immunosuppressive medications
A client has neutropenia. Which conditions could cause this condition?
starvation, leukemia, hypersplenism
