Patho Quiz 3 Chapter 11,12,13

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."

Which of the following patient complaints should prompt a clinician to order a diagnostic work-up for multiple myeloma?

"Lately my bones just seem to ache so bad, and nothing seems to help."

To maintain hematocrit levels in people with kidney failure, the nurse should be prepared to:

Administer a subcutaneous injection of recombinant human erythropoietin (rhEPO).

Leukocytes consist of three categories of cells that have different roles in the inflammatory an immune responses. Which of the following leukocytes is correctly matched with its function?

Eosinophils; allergic reaction

A female patient comes to the clinic with symptoms of fatigue and heavy menses over the last 6 months. Laboratory tests reveal a microcytic hemochromic anemia. Based on these results, the nurse anticipates teaching the patient about which type of anemia?

Iron deficiency anemia

Which of the following factors differentiates chronic leukemias from acute leukemias?

The leukemic cells are more fully differentiated than in acute leukemias

Following peripheral blood testing and a bone marrow biopsy, a client has been diagnosed with chronic myelogenous leukemia. Which of the following is most likely to have preceded the client's diagnosis?

The presence of a Philadelphia chromosome

Immune thrombocytopenia purpura (ITP) is a/an ___ disorder that destroys ___.

autoimmune; platelets

Polycythemia develops in patients with lung disease as a result of:

chronic hypoxia

Hemolytic anemia is characterized by excessive red blood cell destruction and compensatory:

increased erythropoiesis

A client refuses to take the 81 mg of aspirin ordered by the physician, stating, "I do not have any pain." The best response by the nurse would be:

"The 81 mg of aspirin daily will help protect you from a stroke or a heart attack."

The nurse is assessing a client diagnosed with anemia and notes that the client's skin and mucous membranes are pale. The nurse interprets this as:

Insufficient hemoglobin

Disseminated intravascular coagulation (DIC) is characterized by:

hemorrhage

Leukemias are classified according to the predominant cell type. The myelogenous cell type of leukemia can:

interfere with thromobcyte cell maturation

An elevated level of unconjugated bilirubin, due to hemolysis of RBC's, results in high level of iron released and:

jaundice

Increased platelet function, and consequent hyper coagulability, can be caused by:

vascular wall damage

The first step of hemostasis occurs as a:

vessel spasm

Which of the following individuals likely faces the highest risk of megaloblastic anemis?

A 21 year old college student who lives a vegan lifestyle

Which of the following patients likely faces the highest risk of an acquired hypocoagulation disorder vitamin K deficiency?

A patient who has a diagnosis of liver failure secondary to alcohol abuse

A patient comes to the clinic with a runny nose and scratchy throat. The nurse is evaluating the white blood cell count, which shows an elevated number of white blood cells and an increased percentage of eosinophils. Which of the following is the most likely cause of the symptoms?

Allergic reaction

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 The clinical manifestations and red cell changes associated with blood loss anemia depend on the rate of hemorrhage and whether the bleeding loss is internal or external. The effects of acute blood loss are mainly due to loss of intravascular volume, which can lead to cardiovascular collapse and shock. Hemolytic anemia is characterized by the premature destruction of red cells. The usual reason for iron deficiency in adults in the Western world is chronic blood loss. Aplastic anemia describes a disorder of pluripotential bone marrow stem cells.

With the exception of the first two steps, what is required in all steps of the clotting process?

Calcium

Megaloblastic anemias caused by folic acid or vitamin B12 deficiencies can seriously affect RBC production. This is because both are necessary for ___ synthesis and ___.

DNA; red blood cell maturation

The nurse reading a client's history and physical notes that the client has a history of leukopenia. The nurse interprets this to mean that the client has which of the following?

Decreased leukocytes

A healthy, primiparous (first time) mother delivered a healthy infant several hours ago, but the mother has experienced postpartum hemorrhage. Which of the following disorders is most likely to underlie the patient's excessive bleeding after delivery?

Disseminated intravascular coagulation

A client is admitted to the hospital with a diagnosis of deep vein thrombosis and started on intravenous heparin therapy. Seven days later, the client's lab values identify a rapid decrease in platelets. The health care provider recognizes this as

Drug-induced thrombocytopenia

The 16 year old boy has enlarged lymph nodes and a sore throat. His girlfriend was recently diagnosed with infectious mononucleosis, which is caused by ___ and commonly transmitted in ____.

Epstein Barr virus; saliva

The client is an average-sized adult and has abnormal microcytic hypochromic red blood cells due to a long-term, chronic disease. Which of the following complete blood count (CBC) results is characteristic of her type of anemia?

Hemoglobin 8 g/dL

The patient is an average sized adult and has abnormal microcytic hypochromic red blood cells due to a long-term, chronic disease. Which of the following CBC results is characteristic of her type of anemia?

Hemoglobin 8g/dL

Which of the following would help a nurse best describe a finding of hypertrophy on a lab report?

Increased size of the cell

A 68 year old patient with an 80 pack/year history of smoking was diagnosed with emphysema 18 months ago. The patient's most recent scheduled blood work showed red blood cell indices, a problem that suggests the need for which of the following interventions?

Increased supplementary oxygen therapy

Following a lecture on hemostasis, a nursing student accidently cuts her hand while preparing supper for her family. She watches the laceration very closely. Sure enough, the first thing she notes is:

Initially, it takes a few seconds for blood to appear as a result of vessel spasm.

A 72 year old woman with complaints of increasing fatigue has completed a series of fecal occult blood tests that indicate the presence of blood in her stool. Which of the following health problems is likely to accompany this patient's gastrointestinal bleed?

Iron-deficiency anemia

The nurse is caring for a client with an elevated serum bilirubin level. The nurse recognizes a high bilirubin level may result in which of these?

Jaundice

Sue is fatigued, and some blood tests are done. Her results include Hct 40%; Hgb 8g/dL; WBC 8000; and platelets 175,000. The nurse should interpret Sue's blood work as indicative of:

Low hemoglobin/anemia

A nurse sends a blood sample to the lab for analysis. Assuming the sample is normal, the nurse anticipates which of the following white blood cells (WBCs) will account for the highest percentage?

Neutrophils

A nurse orienting to the surgical suite is studying medications that affect platelet function and notes that the most common medications are which of the following?

Nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin

A 16 year old girl has been brought to her primary health care provider by her mother due to the daughter's recent malaise and lethargy. Which of the following assessments should the clinician perform in an effort to confirm or rule out infectious mononucleosis?

Palpating the patient's lymph nodes.

A nurse is reviewing a client's complete blood count (CBC) which indicates thrombocytopenia. Based on this result which action should the nurse include in the plan of care?

Place the client on bleeding precautions.

A nurse is caring for a patient who recently received GPIIb/IIIa inhibitors and is concerned that the patient has developed thrombocytopenia as demonstrated by which of the following?

Platelet count less than 50,000/μL

Which of the following anatomical sites would the nurse expect to monitor when caring for an adult patient who has just had a bone marrow aspiration performed?

Posterior iliac crest

A client is admitted with a suspected diagnosis of Hodgkin lymphoma (HL). Select the diagnostic manifestation that would confirm the diagnosis.

Presence of Reed-Sternberg cells

A client laboratory report indicates neutropenia. The nurse is aware the client is at greatest risk for development of infection. The most important area for the nurse to assess would be:

Skin Neutrophils provide the first line of defense against organisms that inhabit the skin and gastrointestinal tract. Thus, skin infections and ulcerative necrotizing lesions of the mouth are common types of infection in neutropenia.

A patient was started on a protocol for the prevention of deep vein thrombosis shortly after admission, and has been receiving 5000 units of heparin twice daily for the last 5 days. An immune response to this treatment may increase the patient's chance of developing which health problem?

Thrombocytopenia

a 48 year old patient, who normally enjoys good health, has bee admitted to the hospital for the treatment of polycythemia vera. The nurse who is providing care for the patient should prioritize assessments aimed at the early identification of which of the following health problems?

Thromboembolism

A client cuts herself with a sharp knife while cooking dinner. The client describes how the wound started bleeding and had a red appearance almost immediately. The nurse knows that in the vascular stage of acute inflammation, the vessels:

Vasodilate causing the area to become congested causing the red color and warmth

A patient with a long standing diagnosis of human immunodeficiency virus (HIV) has recently developed neutropenia and been admitted to a hospital. Which of the following measures should be prioritized by the nurses who are providing his care?

Vigilant infection control and handwashing

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

The nurse is reviewing the complete blood count (CBC) and white blood cell (WBC) differential of a client admitted with lower right abdominal pain. Which laboratory results are the most important for the nurse to communicate to the health care provider?

White blood cells (WBCs) 18,500/µL

To form a platelet plug, platelets are attracted to the damaged vessel, and the platelet ___ occurs.

adhesion

Manifestations of anemia that are directly due to the diminished oxygen-carrying capacity of hemoglobin include:

fatigue

The pathologic effects of the thalassemias are primarily due to which of the following pathophysiologic processes?

impaired hemoglobin synthesis

Sue is fatigued and some blood tests are done. He results include Hct 40%, Hgb 8g/dL; WBC 8000, platelets 175,000. The nurse should interpret Sue's blood work as indicative of:

low hemoglobin/anemia

A patient has been diagnosed with non-Hodgkin lymphoma (NHL), a form of malignancy that most likely originated in which of the following sites?

lymph nodes

A mother has brought her 2 week old infant to the emergency department due to the baby's persistent and increasing jaundice. Blood testing reveals that the infant's unconjugated bilirubin level is 28 mg/dL and assessment does not reveal neurologic deficits. The infant's weight is normal and the mother claims to have had no significant difficulty feeding the infant. The most likely treatment for this infant will be:

phototherapy

Multiple myeloma is a malignancy of:

plasma cells

a 69 year old patient who is obese and has a diagnosis of angina pectoris has been prescribed clopidogrel (Plavix) by his primary care provider. The patient's medication achieves its therapeutic effect in which of the following ways?

prevention of platelet aggregation

Cytokines that affect hematopoiesis in bone marrow are called colony stimulating factors (CSF's) based on their ability to:

regulate blood cells