Chapter 16: The Hematologic System My Nursing Test Banks

Chapter 16: The Hematologic System

MULTIPLE CHOICE

1. The stem cells in the marrow are stimulated to make blood cells by the erythropoietin- stimulating factor in the:

a.

brain.

b.

lung.

c.

kidney.

d.

liver.

ANS: C

The kidney secrets the erythropoietin-stimulating factor to stimulate the stem cells to make blood cells.

DIF: Cognitive Level: Comprehension REF: 332 OBJ: 2 (theory)

TOP: Erythropoiesis KEY: Nursing Process Step: NA

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. Red blood cells only live about _____ days.

a.

30

b.

90

c.

100

d.

120

ANS: D

Red blood cells live approximately 120 days.

DIF: Cognitive Level: Knowledge REF: 332 OBJ: 1 (theory)

TOP: Life of RBCs KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

3. The nurse explains that, in the event of a massive hemorrhagic episode, the _____ contracts and adds blood to the circulating volume.

a.

spleen

b.

liver

c.

pancreas

d.

bone marrow

ANS: A

The spleen has the ability to contract and add blood to the circulating volume in the event of massive hemorrhage.

DIF: Cognitive Level: Comprehension REF: 332 OBJ: 1 (clinical)

TOP: Spleen KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. The nurse evaluates the lab reports for the patients on the unit, and recognizes the report requiring the most immediate attention is for the patient with RBCs, _____ mil/mm3; WBCs, _____ mil/mm3; and Hb, _____ g/dL.

a.

4.2; 4500; 9.1

b.

5.9; 4500; 12.7

c.

6.0; 6000; 13.2

d.

7.6; 8000; 18.0

ANS: A

The low RBCs and low hemoglobin suggests possible anemia or blood loss. The normal range for adults is red blood cell (RBC) count 4.2 to 6.2 mil/mm3 ; white blood cell (WBC) count: 4500 to 11,000/mm3; and hemoglobin (Hb): females, 12.0 to 16.7 g/dL; males, 13.0 to 18.0 g/dL.

DIF: Cognitive Level: Analysis REF: 337 | Table 16-1

OBJ: 5 (theory) TOP: Blood Counts

KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

5. The nurse notes a rise in the eosinophil count and suspects the patient has a(n):

a.

bacterial infection.

b.

allergy.

c.

viral infection.

d.

blood dyscrasia.

ANS: B

In the event of an allergy or the infestation of pinworms, the eosinophil count will rise. Bacterial infection stimulates the production of neutrophils and segmented neutrophils; lymphocytes are increased with viral infections. Blood dyscrasia refers to an imbalance in numbers of types of cells or other pathologic conditions of the blood.

DIF: Cognitive Level: Application REF: 333 OBJ: 5 (theory)

TOP: Eosinophil Count KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

6. The nurse uses a visual aid to depict the several kinds of hemoglobin. The hemoglobin that changes the shape of the red blood cell (RBC) on which it resides is hemoglobin:

a.

A.

b.

A1c.

c.

F.

d.

S.

ANS: D

Hemoglobin S is the abnormal hemoglobin seen in people with sickle cell anemia. The hemoglobin changes the shape of the RBC to a sickle shape.

DIF: Cognitive Level: Comprehension REF: 336 OBJ: 1 (theory)

TOP: Hemoglobin S KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

7. The nurse is assessing an 82-year-old African American male with sickle cell anemia and notes the sclera of his eyes to be yellow. The nurse correctly interprets this finding as:

a.

sickle cell crisis.

b.

anemia.

c.

jaundice.

d.

a normal occurrence.

ANS: C

Because of the dark complexion of the African American, the sclera is the best place to assess for jaundice. Jaundice is a yellow discoloration of the skin and/or sclera of the eyes and is usually the result of excessive destruction of red blood cells (hemolysis). Jaundice may occur as a symptom of sickle cell disease or sickle cell crisis. Jaundice is not a normal finding.

DIF: Cognitive Level: Application REF: 332 OBJ: 7 (theory)

TOP: Assessing Jaundice KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. The nurse explains that jaundice is present as a result of the release of excessive _____ into the bloodstream.

a.

histamine

b.

bilirubin

c.

plasma

d.

platelets

ANS: B

Excessive levels of bilirubin in the blood (hyperbilirubinemia) from the increased hemolysis of red blood cells are responsible for jaundice.

DIF: Cognitive Level: Comprehension REF: 339 OBJ: 7 (theory)

TOP: Jaundice: Hyperbilirubinemia KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

9. When the patient with pernicious anemia says, I dont know why I am so tired, the nurse can clarify by saying that the fatigue is related to:

a.

lack of oxygen being carried to cells of the body.

b.

enlarged spleen, which makes breathing difficult.

c.

proliferation of white cells.

d.

excessive red cells that have decreased the blood pressure.

ANS: A

The fatigue experienced by people with anemia is related to the lack of oxygenation due to the lack of RBCs to carry the oxygen.

DIF: Cognitive Level: Application REF: 340 OBJ: 3 (clinical)

TOP: Fatigue Associated With Anemia KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

10. When the nurse observes melena, she is aware that a minimum of _____ to _____ mL of blood has been deposited into the GI tract.

a.

25; 50

b.

50; 75

c.

75; 100

d.

100; 120

ANS: B

For the symptom of melena (dark, tarry stools) to appear, a minimum of 50 to 75 mL of blood must have entered the GI tract.

DIF: Cognitive Level: Application REF: 343 | Clinical Cues

OBJ: 2 (clinical) TOP: Melena KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

11. The nurse reading a complete blood count notes there is an abnormal amount of bands, or immature granulocytes. From this assessment, the nurse suspects:

a.

an ongoing bacterial infection.

b.

an allergic reaction.

c.

impending anemia.

d.

an overwhelming viral infection.

ANS: A

Immature white blood cells are released when the more mature circulating cells have not been able to combat an ongoing bacterial infection. Eosinophils increase in response to allergic reactions, and red blood cells are associated with anemia. An increase in lymphocytes is seen with a viral infection.

DIF: Cognitive Level: Application REF: 336 | Clinical Cues

OBJ: 5 (theory) TOP: Significance of Bands: Bacterial Infection

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

12. The nurse cautions that often confused and irritable older adults are thought to have dementia when the real underlying problem is a blood-related:

a.

deficiency of WBCs resulting in infection.

b.

excess of WBCs resulting in joint pain.

c.

deficiency in RBCs resulting in hypoxia.

d.

massive RBC destruction resulting in hyperbilirubinemia.

ANS: C

Confusion and irritability caused by hypoxia is often mistaken for Alzheimers dementia.

DIF: Cognitive Level: Comprehension REF: 340 | Elder Care Points

OBJ: 5 (theory) TOP: Hypoxia vs. Dementia

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

13. The nurse is reviewing a patients assessment data upon admission to the acute care facility and observes signs of iron deficiency anemia that include:

a.

RBCs 5.0 mil/mm3.

b.

WBCs 5.0 mill/mm3.

c.

hemoglobin 14.0 g/dL.

d.

pale conjunctivae.

ANS: D

Pale conjunctivae are an indication of anemia.

DIF: Cognitive Level: Comprehension REF: 339 | Focused Assessment

OBJ: 7 (theory) TOP: Signs of Anemia

KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

14. Which nursing intervention is most appropriate following a bone marrow aspiration on the left posterior iliac crest from a patient with pernicious anemia?

a.

Assist the patient to walk for 10 minutes to stimulate circulation.

b.

Check the pulses in the leg and foot distal to the puncture.

c.

Turn the patient on the back and remove the pillow.

d.

Apply pressure to the site for 5 minutes with an ice pack.

ANS: D

Pressure is applied to the site for 5 minutes to prevent a hematoma since this patient is prone to bleeding. Additionally, the use of ice reduces swelling and increases vasoconstriction. Activity may increase the chance for bleeding. Checking the pulses would be appropriate if the procedure involved an arterial stick.

DIF: Cognitive Level: Application REF: 342 OBJ: 7 (clinical)

TOP: PostMarrow Aspiration Care KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

15. The patient who is taking radiation treatments has a platelet count of 100,000/mm3. The nurse should be alert for:

a.

significantly decreased blood pressure.

b.

hematuria.

c.

constipation.

d.

confusion and disorientation.

ANS: B

Abnormal bleeding is associated with a low platelet count since platelets are involved in the clotting process. Hematuria may result from bleeding within the urinary system. Blood pressure, constipation, and confusion or disorientation is not directly related to a low platelet count.

DIF: Cognitive Level: Application REF: 341 | Table 16-2

OBJ: 2 (theory) TOP: Low Platelet Count

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

16. The nurse reminds the patient with a bleeding disorder that the life span of the platelet is the shortest of all blood cells, approximately _____ days.

a.

10

b.

14

c.

30

d.

45

ANS: A

Platelets only live about 10 days.

DIF: Cognitive Level: Comprehension REF: 334 OBJ: 2 (theory)

TOP: Platelets: Life Span KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

17. The elderly patients daughter asks why her father seems to be catching so many colds. Which response by the nurse is the best?

a.

After the age of 60, the plasma volume decreases so there is less infection fighting ability.

b.

Bone marrow activity decreases by about 50% with aging, which lowers the immune response to infection.

c.

The elderly persons blood is more prone to clotting, so infection-fighting cells dont get to the source of infection quickly.

d.

His antibody response to vaccines is overactive.

ANS: B

The elderly patient is more prone to infection due to the decrease in bone marrow activity, which in turn reduces the immune response. Plasma volume does decrease after age 60, but the concern is decreased blood reserve volume in case of blood loss, not infection. The older adults blood is more prone to clotting due to platelet aggregation and alterations in clotting activity; this increases the risk for problems related to thrombosis, not infection. Lastly, the older adults antibody response to vaccines is decreased.

DIF: Cognitive Level: Analysis REF: 334 OBJ: 3 (theory)

TOP: Effects of Aging KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

18. When reviewing the hematologic system, the student nurse is correct when making which statement?

a.

African Americans have the highest incidence of sickle cell disease.

b.

Iatrogenic blood disorders are congenital in origin.

c.

Folic acid is directly related to synthesis of hemoglobin.

d.

Bruising in the elderly patient is of great concern.

ANS: A

African Americans do have the highest incidence of sickle cell disease. Iatrogenic blood disorders are brought on by medical treatment, such as bone marrow suppression. Iron, rather than folic acid, is directly related to hemoglobin synthesis; folic acid is related to RBC maturation. The elderly adult tends to bruise more due to the thinning of the skin and the increased fragility of the vessels; therefore, it is expected to see some bruising with these patients. Excessive bruising, however, in the elderly patient should be investigated.

DIF: Cognitive Level: Application REF: 334 | Cultural Considerations

OBJ: 3 (theory) TOP: Hematologic System Characteristics

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

MULTIPLE RESPONSE

19. The nurse explains that the function of blood includes: (Select all that apply.)

a.

absorbing nutrients.

b.

moving blood gases.

c.

regulating pH by buffering.

d.

regulating fluid distribution.

e.

regulating body temperature.

ANS: B, C, D, E

Blood transports, not absorbs, nutrients.

DIF: Cognitive Level: Comprehension REF: 331 OBJ: 1 (theory)

TOP: Blood: Function KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

20. The lymphatic system is composed of: (Select all that apply.)

a.

thymus.

b.

lymph glands.

c.

lymph channels.

d.

spleen.

e.

tonsils.

ANS: A, B, C, D

The tonsils are not considered a part of the lymphatic system.

DIF: Cognitive Level: Knowledge REF: 334 OBJ: 2 (theory)

TOP: Lymphatic System KEY: Nursing Process Step: NA

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

21. The nurse explains that age-related changes that occur in the hematologic system include: (Select all that apply.)

a.

decrease in blood volume.

b.

decrease in bone marrow production.

c.

decreased rate of blood cell production.

d.

increased immune response.

e.

increased clotting time.

ANS: A, B, C, E

The immune response is slower in the older adult.

DIF: Cognitive Level: Application REF: 334 OBJ: 3 (theory)

TOP: Blood: Age-Related Changes KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

22. To assure accuracy of a daily measurement of abdominal girth in a patient with ascites, the nurse will: (Select all that apply.)

a.

place marks on the lateral sides of the abdomen where the tape is placed.

b.

use the same tape every day.

c.

measure girth with the tape placed 1 inch above the umbilicus.

d.

measure the same area every day.

e.

measure girth at the same time every day.

ANS: A, B, D, E

Girth is measured at the level of the umbilicus.

DIF: Cognitive Level: Comprehension REF: 340 | Clinical Cues

OBJ: 2 (clinical) TOP: Measurement of Girth

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

23. To assess cyanosis in a patient with a dark complexion, the nurse should inspect the: (Select all that apply.)

a.

conjunctiva.

b.

gums.

c.

roof of the mouth.

d.

nail beds.

e.

palms of the hands.

ANS: B, C

A person with a dark complexion can be assessed for cyanosis by examining the gums and the roof of the mouth. Cyanosis is not usually apparent in the conjunctiva or palms of the hands. The nail beds tend to be darker in dark-skinned individuals so this would not render an accurate assessment of cyanosis.

DIF: Cognitive Level: Application REF: 339 | Focused Assessment

OBJ: 2 (clinical) TOP: Assessment: Cyanosis

KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

24. To help conserve energy for the severely anemic patient, the nurse will: (Select all that apply.)

a.

manage care so that the patient can have frequent rest periods.

b.

assist with activities of daily living.

c.

place personal care items close at hand.

d.

arrange for small meals with between-meal snacks.

e.

ensure that exercise sessions are planned during the morning.

ANS: A, B, C, D

Exercise sessions are not going to be planned for the severely anemic patient. By planning care using all the other options, the patient can be spared fatigue.

DIF: Cognitive Level: Comprehension REF: 343 OBJ: 3 (clinical)

TOP: Fatigue KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

COMPLETION

25. The normal range of hemoglobin is from _____ g/dL to _____ g/dL.

ANS:

12.0; 18.0

The normal range for hemoglobin is from 12.0 to 18.0 g/dL.

DIF: Cognitive Level: Knowledge REF: 332 OBJ: 2 (theory)

TOP: Hemoglobin: Normal Range KEY: Nursing Process Step: NA

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

26. In making an assessment of a patient with a bleeding disorder who has a dark complexion, the nurse should check the palms of the hands and the soles of the feet for _____________.

ANS:

petechiae

The small hemorrhages, petechiae, can be better assessed on people with a dark complexion by examining the palms of the hands and the soles of the feet.

DIF: Cognitive Level: Comprehension REF: 339 OBJ: 7 (theory)

TOP: Assessment for Petechiae KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

27. A female patient being seen in an outpatient clinic states she is having excessive menstruation and reports saturating four peri-pads per day. The nurse estimates the blood loss for this patient as ______ mL per day.

ANS:

200

The average amount of blood loss via menstruation is less than 80 mL. Each saturated pad or tampon is equal to about 50 mL of blood loss. Therefore, this patient is losing approximately 200 mL of blood per day.

DIF: Cognitive Level: Application REF: 335 | Clinical Cues

OBJ: 4 (theory) TOP: Menstruation Blood Loss

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

MATCHING

The student nurse is drawing a diagram of the phases of the monocyte cell to present to the nursing class. The student correctly diagrams the phases in which order of occurrence?

a.

Becomes a phagocyte

b.

Becomes a macrophage

c.

Engulfs bacteria

d.

Migrates into tissues

e.

Becomes a monocyte

f.

Becomes a leukocyte

28. Step 1

29. Step 2

30. Step 3

31. Step 4

32. Step 5

33. Step 6

28. ANS: F DIF: Cognitive Level: Analysis REF: 333

OBJ: 1 (theory) TOP: Monocyte Phases

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

29. ANS: E DIF: Cognitive Level: Analysis REF: 333

OBJ: 1 (theory) TOP: Monocyte Phases

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

30. ANS: B DIF: Cognitive Level: Analysis REF: 333

OBJ: 1 (theory) TOP: Monocyte Phases

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

31. ANS: D DIF: Cognitive Level: Analysis REF: 333

OBJ: 1 (theory) TOP: Monocyte Phases

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

32. ANS: A DIF: Cognitive Level: Analysis REF: 333

OBJ: 1 (theory) TOP: Monocyte Phases

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

33. ANS: C DIF: Cognitive Level: Analysis REF: 333

OBJ: 1 (theory) TOP: Monocyte Phases

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

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