Study sets, textbooks, questions
Upgrade to remove ads
Chapter 25: Blood Cells and the Hematopoietic System
Terms in this set (48)
The nurse is caring for a client diagnosed with sickle cell disease. Select the most important factor for the nurse to be aware of that may cause the cells to sickle.
Reduced oxygen tension while the client sleeps
Factors associated with sickling include cold, stress, physical exertion, infection, dehydration and illnesses that cause hypoxia, dehydration, or acidosis. Even such trivial incidents as reduced oxygen tension induced by sleep may contribute to the sickling process. Pain and acute chest syndrome are complications of sickle cell disease.
A client tells the nurse that the doctor told her she has too many red blood cells accompanied by elevated white cells and platelet counts. The nurse recognizes this as:
Polycythemia vera is a neoplastic disease of the pluripotent cells of the bone marrow characterized by an absolute increase in total red blood cell (RBC) mass accompanied by elevated white cell and platelet counts. In pernicious anemia, the RBCs are not high in number but are larger in size. In aplastic and hemolytic anemia, there is a small number of RBCs.
A nurse assessing a client with an acute exacerbation of polycythemia vera notes coolness to the right leg and foot, pale color and an absent right pedal pulse. Based on these findings the nurse suspects that the client has developed which of the following complications?
Thrombosis in the right leg
Unregulated overproduction of the red cell mass is termed polycythemia. Thrombocytosis occurs when the bone marrow produces too many platelets.
Normal red blood cells live an average of about how many days?
Normal red blood cells live 120 days.
The client explains to her new provider that she receives periodic phlebotomies to decrease their red blood cell mass. The provider believes the client may have which of the following?
Primary polycythemia, or polycythemia vera, is characterized by an absolute increase in total red blood cell mass. The goal of treatment is to reduce blood viscosity. Withdrawing blood by periodic phlebotomy to reduce red blood cell volume can do this. Sickle cell and beta-thalassemias are treated with transfusions. Megaloblastic anemias, caused by vitamin B12 and folic acid deficiencies, are treated by replacement of these nutrients.
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
The red blood cell indices identified that it was a microcytic hemochromic anemia, specifically iron deficiency.
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. This is interpreted as:
Manifestation of dehydration
The hematocrit measures the red cell mass in a 100-mL plasma volume. The hematocrit may be deceptive because it varies with the quantity of extracellular fluid, rising with dehydration and falling with overexpansion of extracellular fluid volume. The client is manifesting an abnormal elevation as a result of fluid loss.
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.
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.
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
Vitamin B12 is found in all foods of animal origin. Dietary deficiency is rare and usually found only in strict vegetarians who avoid all dairy products as well as meat and fish. The hallmark of vitamin B12 deficiency is megaloblastic anemia. The other options are not affected by the client being a vegetarian.
The rate at which hemoglobin is synthesized depends on availability of which of the following?
The rate at which hemoglobin is synthesized depends on the availabilty of iron for heme sythesis.
An elderly client asks the nurse why so many older people develop anemia. The best response would be:
In most asymptomatic elderly persons, lower hemoglobin levels result from iron deficiency and anemia of chronic disease.
The nurse is reviewing the client's laboratory data showing an increased mean corpuscular volume (MCV) and a normal mean corpuscular hemoglobin concentration (MCHC). The client most likely has which of the following types of anemia?
Megaloblastic anemias are caused by impaired DNA synthesis that results in enlarged red cells (MCV >100 fL). The other types of anemia do not affect the MCV or MCHC.
Which of the following is the most abundant type of plasma proteins?
Albumin makes up approximately 54% of the plasma proteins. Although the others are made up plasma proteins, they are in the plasma in smaller numbers than is albumin.
A patient presents to his physician with a red face, hands, feet, and ears; a headache; and drowsiness. A blood smear reveals an increased number of erythrocytes. Based on the laboratory results, the nurse prepares teaching material for which disease process?
Unregulated overproduction of the red cell mass is termed polycythemia.
A patient presents to the clinic with symptoms of elevated blood pressure, dizziness, red face, pain in fingers and toes, headache, and difficulty concentrating. A blood smear reveals an increased number of erythrocytes. Based on these findings, the nurse anticipates which of the following diagnoses?
Polycythemia vera is a neoplastic disease of the pluripotent cells of the bone marrow characterized by an absolute increase in total red blood cell mass accompanied by elevated white cell and platelet counts. In polycythemia vera, the clinical manifestations are hypertension, headache, dizziness, inability to concentrate, and some difficulty with hearing and vision because of decreased cerebral blood flow. Venous stasis gives rise to a plethoric appearance or dusky redness, even cyanosis, particularly of the lips, fingernails, and mucous membranes. Because of the increased concentration of blood cells, the person may experience itching and pain in the fingers or toes, and the hypermetabolism may induce night sweats and weight loss.
Which of the following would be tested by a complete blood count (CBC)?
Red blood cells and platelets
A CBC is a commonly performed screening test that determines the number of red blood cells, white blood cells, and platelets per unit of blood. Lymphocytes and neutrophils may be included in the CBC if a differential of white blood cells was also ordered. Electrolytes and size/shape of blood cells are not part of a CBC.
The family of an elderly patient are 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 of the following pathophysiological principles?
"Due stress, the red blood cells of older adults are not replaced as promptly as younger people."
In older adults, the number of progenitor cells declines. During a stress situation such as bleeding, the red blood cells of older adults are not replaced as promptly as those of their younger counterparts. Given the scenario, the patient is obviously bleeding from the GI tract. There is no reason to suspect the patient has bone cancer. Answer D is a non-therapeutic communication technique. The nurse is trying to pacify the family and not really addressing their concern.
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.
The inability of the immature liver to conjugate bilirubin
Jaundice is a sign of increased bilirubin related to the increased red blood cell breakdown and the inability of the immature liver to conjugate bilirubin. Jaundice occurs from a large production of bilirubin, and a newborn would not have cirrhosis of the liver.
Mature red blood cells have a life span of approximately:
Mature red blood cells have a life span of approximately 4 months, or 120 days.
Anemia refers to a deficiency of:
Anemia is a condition of an abnormally low number of circulating red blood cells or hemoglobin level, or both. It is not a disease but a manifestation of a disease process or alteration in body function.
Your ESRD patient is receiving two units of packed red blood cells for anemia (Hgb of 8.2). Twenty minutes into the first transfusion, the nurse observes the patient has a flushed face, hives over upper body trunk, and is complaining of pain in lower back. His vital signs include pulse rate of 110 and BP drop to 95/56. What is the nurse's priority action?
Discontinue the transfusion and begin an infusion of normal saline.
An immediate hemolytic reaction usually is caused by ABO incompatibility. The signs include ...flushing of the face, urticaria [hives], headache, pain in the lumbar area, chills, fever, chest pain...tachycardia, hypotension and dyspnea. If any of these actions occur, the transfusion should be stopped immediately. Access to a vein should be maintained because it may be necessary to infuse IV solutions to ensure diuresis. Slowing the rate of the blood infusion will not correct this hemolytic reaction and will only worsen the patient's condition. Of course, documentation after the above interventions are performed is vital. Re-checking the blood type infusing will not stop the hemolytic reaction. After corrective actions/interventions are taken, the blood bag is returned to the blood bank for further testing.
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:
The redistribution of the blood from cutaneous tissues or a lack of hemoglobin causes pallor of the skin, mucous membranes, conjunctiva, and nail beds. Tissue hypoxia to the brain causes headache, faintness, and dim vision but is not the direct cause of pallor. Changes in blood viscosity may lead to a systolic murmur.
After birth, red blood cells are normally made in which of the following locations?
After birth, red cells are produced in the red bone marrow. Until a child is 5 years old, almost all bones produce red cells to meet the growth needs of a child, after which bone marrow activity gradually declines.
A nurse is monitoring a patient with anemia and low oxygen levels. The nurse knows that which of the following stimulates the secretion of erythropoietin?
Erythropoiesis is governed for the most part by tissue oxygen needs. Any condition that causes a decrease in the amount of oxygen that is transported in the blood produces an increase in red cell production. The oxygen content of the blood does not act directly on the bone marrow to stimulate red blood cell production. Instead, the decreased oxygen content is sensed by the peritubular cells in the kidneys, which then produce a hormone called erythropoietin
A patient has a hematocrit of 32% and is diagnosed with iron deficiency anemia. The nurse anticipates which of the following treatments to be prescribed?
Iron replacement therapy
Treatment for microcytic hemochromic anemia (iron deficiency anemia), is iron (ferrous sulfate) three times daily and follow-up monitoring.
The nurse is educating a pregnant client about the importance of folic acid. Select the food that has the highest levels of folic acid.
Folic acid is readily absorbed from the intestine. It is found in vegetables (particularly the green leafy types), fruits, cereals, and meats. Much of the vitamin, however, is lost in cooking. The most common causes of folic acid deficiency are malnutrition or dietary lack, especially in the elderly or in association with alcoholism.
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?
Posterior iliac crest
Usually, the posterior iliac crest is used in all people older than 12 to 18 months of age. Other sites include the anterior iliac crest, sternum, and spinous processes T10 through L4. The sternum is not commonly used in children because the cavity is too shallow and there is danger of mediastinal and cardiac perforation.
Which of the following statements concerning red blood cells (RBCs) are correct? Select all that apply.
• RBCs are the most abundant of the blood cells
• RBCs are necessary for carbon dioxide transport.
The most abundant of the blood cells, the erythrocytes, or RBCs, function in oxygen and carbon dioxide transport. The leukocytes, or white blood cells, serve various roles in immunity and inflammation. Platelets are small cell fragments that are involved in blood clotting.
A new mother and father are upset that their 2-day-old infant is requiring phototherapy for hyperbilirubinemia. The pediatrician who has followed the infant since birth is explaining the multiplicity of factors that can contribute to high serum bilirubin levels in neonates. Which of the following factors would the physician be most likely to rule out as a contributor?
Transitioning of hemoglobin F (HbF) to hemoglobin A (HbA)
Hemoglobin transition from HbF to HbA is not associated with hyperbilirubinemia. Breastfeeding, hypoxia, and immaturity of the young liver can contribute to hyperbilirubinemia.
The client with chronic kidney disease and congestive heart failure is weak and dyspneic. Lab work reveals a hemaglobin of 6.5g/dL. Which type of blood product will the provider order?
Packed red blood cells
Transfusion is suggested for people with hemaglobin levels < 7g/dL. Most anemias are treated with transfusions of red cell concentrates (packed red blood cells) which supply only the blood component that is deficient. Whole blood is utilized for acute, massive blood loss and would be avoided in this client due to the possibility of fluid volume overload. Albumin and plasma do not contain the needed red blood cells.
A patient has been diagnosed with anemia. The physician suspects an immune hemolytic anemia and orders a Coombs test. The patient asks the nurse what this test will tell the doctor. The nurse replies:
"They are looking for the presence of antibody or complement on the surface to the RBC."
The Coombs test is used to diagnose immune hemolytic anemias. It detects the presence of antibody or complement on the surface of the red cell. A= direct antiglobulin test (DAT). B=blood smear. C=Iron stores test.
An infant from parents of Mediterranean decent has been diagnosed with a severe form of β-thalassemia anemia. The nurse caring for this infant knows that the infant will likely receive which of the following medical treatments?
Persons who are homozygous for the trait (thalassemia major) have severe, transfusion-dependent anemia that is evident at 6 to 9 months of age when the hemoglobin switches from HbF to HbA. If transfusion therapy is not started early in life, severe growth retardation occurs in children with the disorder. Iron and blood thinners will not be therapeutic for this client. Stem cell transplantation is a potential cure for low-risk clients, particularly in younger persons with no complications of the disease or its treatment, and has excellent results.
Megaloblastic anemias caused by folic acid or vitamin B12 deficiencies can seriously affect RBC production. Which of the following lab results would correlate with this diagnosis?
Mean corpuscular hemoglobin (MCV) 120 fL (high)
Megaloblastic anemias are caused by impaired DNA synthesis that results in enlarged red cells (MCV >100 fL) due to impaired maturation and division. Folic acid and/or vitamin B12 do not have a critical role in normal iron and platelet levels or a high reticulocyte count.
An elderly patient is brought to the emergency department with garbled speech, unilateral facial drooping, and weakness. One hour after admission, the patient dies. An autopsy reveals the presence of polycythemia. Which of the following was the most likely cause of the patient's death?
Unregulated overproduction of the red cell mass is termed polycythemia, which causes a thickening of the blood and an increased risk of blood clots
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 of the following organs?
Sickle cell disease is an inherited disorder in which the person has abnormal hemoglobin S (HbS). The spleen is especially susceptible to damage by HbS. The congestion of the spleen predisposes the person to life-threatening infections caused by encapsulated organisms.
When red blood cells age, which of the following organs are responsible for their destruction?
When red blood cells age, they are destroyed in the spleen
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 of the following lab results?
Petechiae (small, punctate skin hemorrhages) and ecchymoses often occur on the skin, and bleeding from the nose, gums, vagina or gastrointestinal tract may be seen because of decreased platelet levels.
The practitioner knows the client has hemoglobin S (HbS). The practitioner explains to the client that which of the following are the major consequences of this disorder? Select all that apply.
• Chronic hemolytic anemia
• Blood vessel occlusion
Sickle cell disease is an inherited disorder in which an abnormal hemoglobin (hemoglobin S) can lead to chronic hemolytic anemia and blood vessel occlusion. The other options are not consequences of sickle cell disease.
A male client with chronic obstructive pulmonary disease has a hematocrit of 55 percent. The practitioner tells the client that he has which of the following?
Secondary polycythemia results from a physiologic increase in the level of erythropoietin, commonly as a compensatory response to hypoxia. Conditions causing hypoxia include chronic heart and lung disease. Polycythemia is an abnormally high total red blood cell mass with a hematocrit greater that 54 percent in men. Primary polycythemia or polycythemia vera is a neoplastic disease of the pluripotent cells of the bone marrow. In relative polycythemia, the hematocrit rises because of a loss of plasma volume without a corresponding decrease in red cells.
A previously healthy client was involved in a traumatic fall and lost a large amount of blood. The client is now stable and has a normal serum ferritin level. How long will it take for red cell concentration to return to normal?
3 to 4 weeks
If bleeding is controlled and sufficient iron stores (indicated by ferritin level) are available, the red cell concentration returns to normal within 3 to 4 weeks
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 couple who are expecting their first child has been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple has approached their caregiver with this request and is seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting them. How can their caregiver best respond to the couple's enquiry? Stem cells can:
"Be used as source of reserve cells for the entire blood production system."
The proliferative potential and self-renewal of stem cells makes them a compensatory mechanism and reserve source for the entire hematopoietic system. While they could be of possible use in certain autoimmune conditions or in cases of organ failure, these statements do not capture their essence. Stem cells can also come from a histocompatible donor.
The microbiology technician explains to the student that which of the following blood cells is the most common?
The erythrocytes, 500 to 1000 times more numerous than other blood cells, are the most common type of blood cells.
The neonate displays a yellow discoloration of her skin on the third day of life. The neonatologist explains this condition to the parents. Which of the following statements is most accurate?
"The increase in bilirubin, which causes the jaundice, is related to the increased red blood cell breakdown."
Physiologic jaundice appears in term infants on the second or third day of life. The increase in bilirubin is related to the increased red cell breakdown and the inability of the immature liver to conjugate bilirubin. Many factors cause elevated bilirubin levels in the neonate, including breastfeeding. Hyperbilirubinemia places the neonate at risk for development of a neurologic syndrome called kernicterus. Most neonatal jaundice resolves spontaneously within one week.
A 13-year-old African-American boy comes to the ER complaining of fatigue and a rapid heartbeat. In conversation with the father, it becomes apparent to you that the boy has grown 2 inches in the previous 5 months. What is the first problem the health care team would attempt to rule out?
Although each of the above answers is associated with fatigue and rapid heartbeat, male adolescents are particularly susceptible to iron-deficiency anemia. They have high iron requirements because of growth spurts and dietary deficiencies.
A 62-year-old female with a diagnosis of acute and chronic renal failure secondary to diabetes mellitus is receiving her weekly injection of epoetin, a supplementary form of erythropoietin. Which of the following statements best captures the necessity of this medication?
Erythropoietin causes the erythrocyte colony forming units to proliferate and mature.
Erythropoietin acts primarily in later stages of erythropoiesis to induce the erythrocyte colony forming units to proliferate and mature through the normoblast into reticulocytes and mature erythrocytes. It does not act directly on stem cells, not does it play a role in the sensation of hypoxia. Reticulocytes already lack a cell nucleus.
A patient with iron-deficiency anemia complains of feeling "tired all of the time." What does the nurse understand may be the cause of the fatigue that the patient is experiencing?
Impaired function of the electron transport chain
Although iron-deficiency anemia is characterized by decreased levels of hemoglobin, the iron-containing cytochromes in the electron transport chain in tissues such as skeletal muscle are affected as well. Thus, the fatigue that develops in iron-deficiency anemia results, in part, from impaired function of the electron transport chain.
The nursing is reviewing assessment data of four clients. Select the client who is at greatest risk for developing pernicious anemia.
A client who has undergone partial gastrectomy
Pernicious anemia results from vitamin B12 deficiency. Vitamin B12 is absorbed by a unique process. After release from the animal protein, it is bound to intrinsic factor, a protein secreted by the gastric parietal cells. Causes of this anemia include gastrectomy, ileal resection, inflammation or neoplasms in the terminal ileum, and malabsorption syndromes in which vitamin B12 and other B-vitamin compounds are poorly absorbed. The other options will not cause pernicious anemia.
Students also viewed
Patho Test #2
PATHO: Disorders of red blood cells Ch.13
Chapter 12: disorders of hemostasis; Chapter 13: d…
Sets found in the same folder
Patho exam 2 practice questions: blood flow
Patho Ch. 13, 14, & 15 Quiz
CH 12 Questions
Patho exam 2 practice questions: respiratory
Other sets by this creator
God's Promises Part 3
God's Promises Part 3
God's Promises Part 1
God's Promises Part 2
Recommended textbook solutions
The Human Body in Health and Disease
Gary A. Thibodeau, Kevin T. Patton
Clinical Reasoning Cases in Nursing
Julie S Snyder, Mariann M Harding
Principles and Foundations of Health Promotion and Education
Denise Seabert, James McKenzie
Clem Thompson, R T Floyd
Other Quizlet sets
Religion- Chapter 12
exam 3 questions
Cardiovascular Disease of Food Animals