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Lewis Ch 30 Hematologic System NCLEX
Terms in this set (66)
What are the characteristics of neutrophils (select all that apply)?
a. Also known as "segs"
b. Band is immature cell
c. First WBC at injury site
d. Arises from megakaryocyte
e. Increased in individuals with allergies
f. 50% to 70% of white blood cells (WBCs)
a, b, c, f. These characteristics are evident with neutrophils. Platelets arise from megakaryocytes and are stored in the spleen. Eosinophils are increased in individuals with allergies and make up 2% to 4% of WBCs.
2. An increase in which blood cell indicates an increased rate of erythropoiesis?
2. c. Increased reticulocytes, or immature RBCs, indicate an increased rate of erythropoiesis or stimulation of erythrocyte (RBC) production by the bone marrow. Basophils release granules that increase allergic and inflammatory responses and are stimulated by granulocyte colony-stimulating factor. Monocytes may become tissue macrophages. Lymphocytes are primarily responsible for the immune response.
3. Which cells are classified as granulocytes (select all that apply)?
a, c, d. Basophils, eosinophils, and neutrophils are the
granulocytic leukocytes. Lymphocytes are the agranular leukocytes that form the basis of the cellular and humoral immune responses. Monocytes are agranulocytes that are potent phagocytic cells.
4. After a woman had a right breast mastectomy, her right arm became severely swollen. What hematologic problem caused this?
b. Right-sided heart failure
c. Wound on her right hand
d. Refusal to use her right arm
4. a. Lymphedema is the obstruction of lymph flow that
results in accumulation of lymph fluid for the patient in the right arm following a right-sided breast mastectomy. The other options are not hematologic problems that would cause extreme swelling.
5. Which nutrients are essential for red blood cell production (select all that apply)?
b. Folic acid
c. Vitamin C
e. Cobalamin aka: Vitamin B12
d. Vitamin D
5. a, b, e. Although all of the listed nutrients are helpful, iron, folic acid, and cobalamin (vitamin B12) are essential for erythropoiesis.
6. Components of normal hemostasis in the order of occurrence, beginning with the first component and ending with the last component.
a. Lysis of clot
b. Vascular response
c. Plasma clotting factors
d. Platelet plug formation
b, d, c, a.
7. Which component of normal hemostasis involves the processes of protein C and protein S and plasminogen?
a. Lysis of clot
b. Vascular response
c. Plasma clotting factors
d. Platelet plug formation
7. a. Protein C and protein S are examples of anticoagulants that are involved in the lysis of clots. Fibrinolysis is also achieved by thrombin-activating conversion of plasminogen to plasmin, which attacks fibrin or fibrinogen and splits it into smaller elements known as fibrin split products (FSPs) or fibrin degradation products (FDPs).
8. A patient who was in a car accident had abdominal trauma. Which organs may be damaged and contribute to altered function of the hematologic system (select all that apply)?
e. Lymph nodes
8. a, b, e. The abdominal organs that are primarily involved in hematologic function are the liver, spleen, and lymph nodes. The liver filters the blood, produces procoagulants, and stores iron. The spleen removes old and defective erythrocytes and filters iron for reuse. The lymph nodes filter pathogens and foreign particles from lymphatic circulation.
9. Laboratory test results indicate increased fibrin split products (FSPs). An appropriate nursing action is to monitor the patient for
d. thrombotic episodes
b. During fibrinolysis by plasmin, the fibrin clot is split
into smaller molecules known as FSPs or FDPs. Increased FSPs impair platelet aggregation, reduce prothrombin, and prevent fibrin stabilization and lead to bleeding.
When reviewing the results of an 83-year-old patient's blood tests, which finding would be of most concern to the nurse?
a. Platelets 150,000/μL
b. Serum iron 50 mcg/dL
c. Partial thromboplastin time (PTT) 60 seconds
d. Erythrocyte sedimentation rate (ESR) 35 mm in 1 hour
10. c. As a person ages the partial thromboplastin time
(PTT) is normally decreased, so an abnormally high PTT of 60 seconds is an indication that bleeding could readily occur. Platelets are unaffected by aging and 150,000/μL is a normal count. Serum iron levels are decreased and the erythrocyte sedimentation rate (ESR)
is significantly increased with aging, as are reflected in
11. A patient with a bone marrow disorder has an overproduction of myeloblasts. The nurse would expect the results of a complete blood count (CBC) to include an increase in which cell types (select all that apply)?
11. a, b, d. The myeloblast is a committed hematopoietic cell found in the bone marrow from which granulocytes develop. A disorder in which myeloblasts are overproduced would result in increased basophils, eosinophils, and neutrophils.
12. During the nursing assessment of a patient with anemia, what specific information should the nurse ask the patient about?
a. Stomach surgery
b. Recurring infections
c. Corticosteroid therapy
d. Oral contraceptive use
12. a. The parietal cells of the stomach secrete intrinsic factor, a substance necessary for the absorption of cobalamin (vitamin B12), and if all or part of the stomach is removed, the lack of intrinsic factor can lead to impaired RBC production and pernicious anemia. Recurring infections indicate decreased WBCs and immune response and corticosteroid therapy may cause a neutrophilia and lymphopenia. Oral contraceptive use is strongly associated with changes in blood coagulation.
14. Using light pressure with the index and middle fingers, the nurse cannot palpate any of the patient's superficial lymph nodes. How should the nurse respond to this assessment?
a. Record this finding as normal.
b. Reassess the lymph nodes using deeper pressure.
c. Ask the patient about any history of radiation therapy.
d. Notify the health care provider that x-rays of the nodes will be necessary.
a. Superficial lymph nodes are evaluated by light palpation but they are not normally palpable. It may be normal to find small (<1.0 cm), mobile, firm, nontender nodes. Deep lymph nodes are detected radiographically.
15. During physical assessment of a patient with thrombocytopenia, what would the nurse expect to find?
a. Sternal tenderness
b. Petechiae and purpura
c. Jaundiced sclera and skin
d. Tender, enlarged lymph nodes
15. b. Petechiae are small, flat, red, or reddish-brown pinpoint microhemorrhages that occur on the skin when platelet levels are low. When petechiae are numerous, they group, causing reddish bruises known as purpura. Sternal tenderness is associated with leukemias. Jaundice occurs when anemias are of a hemolytic origin, resulting in accumulation of bile pigments from RBCs. Enlarged, tender lymph nodes are associated with infection or cancer.
16. A patient with a hematologic disorder has a smooth, shiny, red tongue. Which laboratory result would the nurse expect to see?
a. Neutrophils 45%
b. Hgb 9.6 g/dL (96 g/L)
c. WBC count 13,500/μL
d. Red blood cell (RBC) count 6.4 × 106/μL
16. b. A smooth, shiny, reddened tongue is an indication of iron-deficiency anemia or pernicious anemia that would be reflected by a decreased hemoglobin level. The decreased neutrophils would be indicative of neutropenia. The increased WBC count could be indicative of an infection and the increased RBC count of polycythemia.
17. A patient is being treated with chemotherapy. The nurse revises the patient's care plan based on which result?
a. WBC count 4000/μL
b. RBC count 3.8 × 106/μL
c. Platelets 50,000/μL
d. Hematocrit (Hct) 39%
c. Any platelet count <150,000/μL is considered thrombocytopenia and could place the patient at risk for bleeding, necessitating special consideration in nursing care. Chemotherapy may cause bone marrow suppression and a depletion of all blood cells. The other factors are all within normal range.
19. If a patient with blood type O Rh+ is given AB Rh- blood, what would the nurse expect to happen?
a. The patient's Rh factor will react with the RBCs of the donor blood.
b. The anti-A and anti-B antibodies in the patient's blood will hemolyze the donor blood.
c. The anti-A and anti-B antibodies in the donor blood will hemolyze the patient's blood.
d. No adverse reaction is expected because the patient has no antibodies against the donor blood.
b. A patient with type O Rh+ blood has no A or B antigens on the RBC but does have anti-A and anti-B antibodies in the blood and has an Rh antigen. Type AB Rh− blood has both A and B antigens on the RBC but no Rh antigen and no anti-A or anti-B antibodies. If the type AB Rh− blood is given to the patient with type O Rh+ blood, the antibodies in the patient's blood will react with the antigens in the donor blood, causing hemolysis of the donor cells. There will be no Rh reaction because the donor blood has no Rh antigen.
20. Priority Decision: A patient is undergoing a contrast computed tomography (CT) of the spleen. What is most important for the nurse to ask the patient about before the test?
a. Iodine sensitivity
b. Prior blood transfusions
c. Phobia of confined spaces
d. Internal metal implants or appliances
20. a. A contrast CT scan involves the use of an iodine-based dye that could cause a reaction if the patient is sensitive to iodine. Metal implants or internal, appliances and claustrophobia should be determined before magnetic resonance imaging (MRI). Prior blood transfusions are not a factor in this diagnostic test.
21. When teaching a patient about a bone marrow examination, what should the nurse explain?
a. The procedure will be done under general anesthesia because it is so painful.
b. The patient will not have any pain after the area at the puncture site is anesthetized.
c. The patient will experience a brief, very sharp pain during aspiration of the bone marrow.
d. There will be no pain during the procedure, but an ache will be present several days afterward.
21. c. The aspiration of bone marrow content is done with local anesthesia at the site of the puncture but the
aspiration causes a suction pain that is quite painful but
very brief. There generally is no residual pain following
22. A lymph node biopsy is most often performed to diagnose
b. cause of lymphedema.
c. hemorrhagic tendencies.
d. neoplastic cells in lymph nodes.
22. d. Lymph node biopsy is usually done to determine
whether malignant cells are present in lymph nodes and can be used to diagnose lymphomas as well as metastatic spread from any malignant tumor in the body. Leukemias may infiltrate lymph nodes but biopsy of the nodes is more commonly used to detect any type of neoplastic cells.
23. The patient's laboratory results show a marked decrease in RBCs, WBCs, and platelets. What term should the nurse use when reporting the results to the physician?
23. c. Pancytopenia is decreased RBCs, WBCs, and platelets. Hemolysis is RBC destruction. Leukopenia is WBC <4000/μL. Thrombocytosis is increased platelets and thrombocytopenia is decreased platelets.
24. Molecular cytogenetics and gene analysis may be done to diagnose, stage, and help to determine treatment options for various hematologic disorders. Which sites are preferred to obtain the sample for this testing (select all that apply)?
a. Skin sample
b. Lymph node
c. Bone marrow
d. Arterial blood
e. Inner cheek mucosa
24. b, c. Bone marrow and lymph node biopsies are preferred methods to obtain the sample for gene analysis. If a large number of abnormal cells are circulating in the blood, peripheral blood may be used. The other options will not provide the desired information.
MCH - Mean Corpuscular Hemoglobin
Average weight of Hemoglobin to RBC's.
(Hgbx10)/(RBCx10 to the 6th power)
WNL - 27 to 34
Decreased = microcytosis
Increased = macrocytosis
Red blood cells are unusually small.
Red blood cells that are larger than normal.
MCV - Mean corpuscular Volume
Determine relative size of RBCs
(Hctx10)/(RBCx10 to the 6th power)
WNL - 80-100
Decreased = microcytosis
Increased - macrocytosis
MCV changes with aging
May be slightly increased
MCHC - Mean Corpuscular hemoglobin
RBC saturation to Hgb.
Decreased = hypochromia
Increased = scherocytosis
MCHC changes with aging
May be slightly decreased
RBCs have less color than normal when examined under a microscope
auto-hemolytic anemia characterized by the production of spherocytes - red blood cells (RBCs), or erythrocytes, that are sphere-shaped, rather than bi-concave disk shaped.
Hemoglobin WNL - female
11.7 to 16.0
Hemoglobin WNL - male
13.2 to 17.3
Hemoglobin changes with aging
remain normal, with possible decline in men.
Hematocrit WNL - female
35 to 47%
Hematocrit WNL - male
150,000 to 400,000
Platelets in aging
Unchanged but possible increase in adhesiveness
RBCs WNL - female
3.8 to 5.1
RBCs WNL - male
4.3 to 5.7
erythropoietin in aging
may be decreased
Erythrocyte sedimentation rate (ESR) WNL
Settling of RBCs in 1 hour.
< 30 mm/hr. (some gender variations)
Measurement of immature RBCs, a reflection of bone marrow activity in producing RBCs. WNL - 0.5 to 1.5%
White Blood Cells WNL
4000 to 11,000
WBC count in aging
Diminished response to infections
Marked decrease in RBCs, WBCs & platelets.
Hematopoietic cell found in bone marrow that granulocytes develop from.
What white blood cells are granulocytes?
The Phil's - eosinophils, basophils & neutrophils
What is "shift to the left"?
Severe infections where high numbers of granulocytes are released, resulting in many young, immature neutrophils (bands) released. Less mature forms appear on the left side of the written report from the lab.
0.50 to 0.70
Condition in which Neutrophils are less than 1000
50 - 175
0 to 0.02
0.20 to 0.40
0.04 to 0.08
0 to 0.4
Serum iron in aging
Electrolyte Review - Potassium - important in cardiac function
3.5 to 5.0
Electrolyte Review - Sodium - important in cardiac function
135 to 145
Electrolyte Review - Calcium - important in cardiac function
4.5 to 5.5
Activated Partial Thromboplastin Time (aPTT)
Assessment of intrinsic coagulation by measuring the clotting factors 25-35 seconds
Partial Thromboplastin Time in aging
Clotting factors in aging
May be elevated
What is aPTT measured with
Patients using heparin. (Therapeutic range is longer and calculated using prescribed range.)
International normalization ratio
Standardized system of reporting PT based on a reference calibration model and calculated by comparing the PT with a control value - WNL while receiving anticoagulants - 2-3
What is different about INR when a patient has an artificial heart valve?
Patient's INR is maintained at a ratio of 2.5 to 3.5 to reduce risk of thrombus formation on artificial valve.
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