Chapter 19: Structure and Function of the Hematologic System My Nursing Test Banks

Huether and McCance: Understanding Pathophysiology, 5th Edition

Chapter 19: Structure and Function of the Hematologic System

Test Bank

MULTIPLE CHOICE

1. A primary care provider is talking about plasma proteins synthesized by lymphocytes in the lymph nodes. What is the primary care provider describing?

a.

Antibodies

b.

Albumins

c.

Clotting factors

d.

Complement proteins

ANS: A

Antibodies are produced by plasma cells in the lymph nodes and other lymphoid tissues.

Albumins are specific types of plasma proteins.

Clotting factors describe a function of plasma proteins.

Complement proteins are a type of plasma proteins.

REF: p. 480

2. While reviewing lab results, the nurse recalls the most abundant cells in the blood are:

a.

Leukocytes

b.

Lymphocytes

c.

Erythrocytes

d.

Thrombocytes

ANS: C

Erythrocytes (red blood cells) are the most abundant cells of the blood, occupying approximately 48% of the blood.

Erythrocytes, not leukocytes, are the most abundant cells in the blood.

Erythrocytes, not lymphocytes, are the most abundant cells in the blood.

Erythrocytes, not thrombocytes, are the most abundant cells in the blood.

REF: p. 480

3. An adult patients blood sample is analyzed in a laboratory. Assuming a normal sample, which type of white blood cell accounts for the highest percentage?

a.

Neutrophils

b.

Eosinophils

c.

Basophils

d.

Lymphocytes

ANS: A

Neutrophils constitute about 55% of the total leukocyte count in adults.

The eosinophils, which have large, coarse granules, constitute only 1% to 4% of the normal leukocyte count in adults.

Basophils make up less than 1% of the leukocytes.

Lymphocytes constitute approximately 36% of the total leukocyte count.

REF: p. 480

4. A group of cells isolated in the laboratory have membrane-bound granules in their cytoplasm and they show phagocytic activity. Which of the following cells is most similar?

a.

Monocyte

b.

Macrophage

c.

Lymphocyte

d.

Eosinophils

ANS: D

Eosinophils, which have large, coarse granules, are capable of ameboid movement and phagocytosis.

Monocytes help fight infection.

Macrophages are mature monocytes.

Lymphocytes are the primary cells of the immune response.

REF: p. 480

5. While planning care for a patient with inflammation, which principle will the nurse remember? The predominant phagocyte of early inflammation is the:

a.

Eosinophil

b.

Lymphocyte

c.

Macrophage

d.

Neutrophil

ANS: D

Neutrophils are the chief phagocytes of early inflammation.

Eosinophils ingest antigen-antibody complexes and are induced by IgE-mediated hypersensitivity reactions to attack parasites.

Most lymphocytes transiently circulate in the blood and eventually reside in lymphoid tissues as mature T cells, B cells, or plasma cells.

Macrophages migrate out of the vessels in response to infection or inflammation, but are not the early responders.

REF: p. 480

6. A patient has researched white blood cells on the Internet. Which statement indicates the patient has a good understanding? _______________ contain preformed granules of vasoactive amines.

a.

Neutrophils

b.

Eosinophils

c.

Monocytes

d.

Basophils

ANS: D

Basophils have cytoplasmic granules that contain vasoactive amines (e.g., histamine) and an anticoagulant (heparin). Their function is similar to tissue mast cells.

Neutrophils are the chief phagocytes of early inflammation.

Eosinophils ingest antigen-antibody complexes and are induced by IgE-mediated hypersensitivity reactions to attack parasites.

Monocytes do not have amines, and their job it to help fight infection.

REF: p. 480

7. A nurse recalls that monocytes are blood cells that mature (differentiate) into:

a.

Macrophages

b.

Neutrophils

c.

Eosinophils

d.

Mast cells

ANS: A

Macrophages are mature monocytes.

Monocytes mature into macrophages, not neutrophils.

Monocytes mature into macrophages, not eosinophils.

Monocytes mature into macrophages, not mast cells.

REF: p. 481

8. A nurse is teaching the staff about platelets. Which information should the nurse include? In addition to playing a role in hemostasis, platelets have the ability to:

a.

Stimulate bone marrow production of erythrocytes

b.

Release biochemical mediators of inflammation

c.

Undergo cell division in response to bleeding

d.

Activate a humoral response

ANS: B

Platelets contain cytoplasmic granules capable of releasing proinflammatory biochemical mediators when stimulated by injury to a blood vessel.

Platelets assist with inflammation; they do not produce erythrocytes.

Platelets assist with inflammation; they do not undergo cell division in response to bleeding.

Platelets assist with inflammation; they do not activate the humoral response.

REF: p. 481

9. While planning care for a newborn, the pediatric nurse recalls the main site of hematopoiesis in the fetus is the:

a.

Bone marrow

b.

Liver

c.

Lymph nodes

d.

Spleen

ANS: D

The spleen is the largest of the lymphoid organs and is the site of fetal hematopoiesis.

The spleen, not the bone marrow, is the site of fetal hematopoiesis.

The spleen, not the liver, is the site of fetal hematopoiesis.

The spleen, not the lymph nodes, is the site of fetal hematopoiesis.

REF: p. 482

10. A 45-year-old female undergoes a splenectomy to remove a tumor. Which of the following assessment finding is most likely to occur following surgery?

a.

Leukocytosis

b.

Hypoglycemia

c.

Decreased red blood cell count

d.

Decreased platelets

ANS: A

Leukocytosis often occurs after splenectomy.

Elevated levels of leukocytes, not hypoglycemia, occur after splenectomy.

Elevated levels of leukocytes, not decreased levels of red blood cells, occur after splenectomy.

Elevated levels of leukocytes, not decreased platelets, occur after splenectomy.

REF: p. 482

11. During an infection, the nurse assesses the lymph nodes. Lymph nodes enlarge and become tender because:

a.

Lymphocytes are rapidly dividing.

b.

Edema accumulates within the fibrous capsule.

c.

Microorganisms are accumulating.

d.

The nodes are not functioning properly.

ANS: A

During an infection, the rate of proliferation of lymphocytes within the nodes is so great that the nodes enlarge and become tender.

Edema may be present, but the tenderness is due to proliferation of lymphocytes.

The tenderness is not due to the microorganisms, but to the proliferation of lymphocytes.

The tenderness is due to the normal function of the gland in response to the proliferation of lymphocytes.

REF: p. 482

12. After birth, red blood cells are normally made only in the:

a.

Liver

b.

Spleen

c.

Bone marrow

d.

Kidney

ANS: C

Red blood cells are produced in the bone marrow.

Red blood cells are produced in the bone marrow, not the liver.

Red blood cells are produced in the bone marrow, not the spleen.

Red blood bells are produced in the bone marrow, not the kidney.

REF: p. 485

13. A nurse is discussing a cell that can differentiate into any tissue type. Which term is the nurse describing?

a.

Hematopoietic

b.

Pluripotent

c.

Blastocyst

d.

Progenitor

ANS: B

A pluripotent cell can grow into different kinds of tissue: blood, nerves, heart, bone, and so forth.

A pluripotent cell, not a hematopoietic cell, can grow into different kinds of tissue: blood, nerves, heart, bone, and so forth.

A pluripotent cell can grow into different kinds of tissue: blood, nerves, heart, bone, and so forth. A blastocyst is an embryonic cell.

A pluripotent cell can grow into different kinds of tissue: blood, nerves, heart, bone, and so forth. A progenitor becomes a hematologic cell.

REF: p. 485

14. A hematologist is discussing hematopoiesis. Which information should be included? ________ participate in hematopoiesis.

a.

Colony-stimulating factors (CSFs)

b.

Eosinophils

c.

Basophils

d.

Neutrophils

ANS: A

Several cytokines participate in hematopoiesis, particularly CSFs (or hematopoietic growth factors).

Several cytokines participate in hematopoiesis, particularly CSFs (or hematopoietic growth factors); eosinophils do not play a role in hematopoiesis.

Several cytokines participate in hematopoiesis, particularly CSFs (or hematopoietic growth factors); basophils do not play a role in hematopoiesis.

Several cytokines participate in hematopoiesis, particularly CSFs (or hematopoietic growth factors); neutrophils do not play a role in hematopoiesis.

REF: p. 485

15. An unstable type of hemoglobin that cannot bind with oxygen is termed:

a.

Deoxyhemoglobin

b.

Oxyhemoglobin

c.

Methemoglobin

d.

Glycosylated hemoglobin

ANS: C

Without reactivation, the Fe3+-containing hemoglobin (methemoglobin) cannot bind oxygen.

Deoxyhemoglobin is reactivated hemoglobin whose oxygen has been released.

Binding of oxygen to ferrous iron temporally oxidizes Fe2+ to Fe3+ as in oxyhemoglobin.

Glycosylated hemoglobin is glucose bound to hemoglobin.

REF: p. 487

16. A staff member wants to know where the greatest proportion of iron is located. How should the nurse respond? The greatest proportion of total body iron is located in the:

a.

Erythrocytes

b.

Spleen pulp

c.

Bone marrow

d.

Liver tissue

ANS: A

Approximately 67% of total body iron is bound to heme in erythrocytes (hemoglobin) and muscle cells (myoglobin).

Approximately 67% of total body iron is bound to heme in erythrocytes (hemoglobin) and muscle cells (myoglobin), not the spleen pulp.

Approximately 67% of total body iron is bound to heme in erythrocytes (hemoglobin) and muscle cells (myoglobin), not the bone marrow.

Approximately 67% of total body iron is bound to heme in erythrocytes (hemoglobin) and muscle cells (myoglobin), not the liver tissue.

REF: p. 487

17. A student asks the instructor about recycled iron. What information should the instructor share? Recycled iron from macrophages is delivered to the bone marrow bound to:

a.

Ferritin

b.

Hemoglobin

c.

Hemosiderin

d.

Transferrin

ANS: D

Iron is transported in the blood bound to transferrin.

Iron is transported in the blood bound to transferrin, ferritin is the storage form of iron.

Iron is transported in the blood bound to transferrin, hemoglobin carries oxygen.

Iron is transported in the blood bound to transferrin, hemosiderin is also a storage form of iron.

REF: p. 488

18. A nurse is preparing to teach about erythropoietin. Which information should the nurse include? Erythropoietin is produced in the:

a.

Liver

b.

Bone marrow

c.

Kidneys

d.

Spleen

ANS: C

Erythropoietin is produced in the kidneys.

Erythropoietin is produced in the kidneys, not the liver.

Erythropoietin is produced in the kidneys, not the bone marrow.

Erythropoietin is produced in the kidneys, not the spleen.

REF: p. 486

19. Which condition will cause a patient to secrete erythropoietin?

a.

Low blood pressure

b.

Hypercarbia

c.

Inflammation

d.

Hypoxia

ANS: D

Hypoxia stimulates production of erythropoietin.

Hypoxia, not low blood pressure, stimulates production of erythropoietin.

Hypoxia, not hypercarbia, stimulates production of erythropoietin.

Hypoxia, not inflammation, stimulates production of erythropoietin.

REF: p. 486

20. After erythrocytes have circulated for about 120 days, they are removed by macrophages, which are mainly in the:

a.

Liver

b.

Spleen

c.

Appendix

d.

Bone marrow

ANS: B

Aged or damaged erythrocytes are removed from the bloodstream by macrophages of the MPS chiefly in the spleen.

Aged or damaged erythrocytes are removed from the bloodstream by macrophages of the MPS chiefly in the spleen, not the liver.

Aged or damaged erythrocytes are removed from the bloodstream by macrophages of the MPS chiefly in the spleen, not the appendix.

Aged or damaged erythrocytes are removed from the bloodstream by macrophages of the MPS chiefly in the spleen, not the bone marrow.

REF: p. 482

21. Which electrolyte will the nurse check to ensure normal platelet functioning?

a.

Sodium

b.

Potassium

c.

Magnesium

d.

Calcium

ANS: D

Calcium is necessary for many of the intracellular signaling mechanisms that control platelet activation.

Calcium, not sodium, is necessary for many of the intracellular signaling mechanisms that control platelet activation.

Calcium, not potassium, is necessary for many of the intracellular signaling mechanisms that control platelet activation.

Calcium, not magnesium, is necessary for many of the intracellular signaling mechanisms that control platelet activation.

REF: p. 491

22. Which of the following nutritional components will the nurse encourage a patient to consume as it is needed for erythropoiesis?

a.

Cobalamin

b.

Vitamin B1

c.

Vitamin D

d.

Zinc

ANS: A

Cobalamin is necessary for erythropoiesis.

Cobalamin or vitamin B12 is necessary for erythropoiesis, not B1.

Cobalamin is necessary for erythropoiesis, not vitamin D.

Cobalamin is necessary for erythropoiesis, not zinc.

REF: p. 487

23. A newborn baby is diagnosed with a blood disorder in which her platelet count is low. Which of the following does the nurse suspect could be the reason?

a.

Increased megakaryocytes

b.

Increased platelet cell division

c.

Decreased thrombopoietin

d.

Decreased spleen function

ANS: C

Thrombopoietin (TPO), a hormone growth factor, is the main regulator of the circulating platelet mass, thus, a deficiency of TPO can lead to decreased platelets.

TPO is the factor necessary for platelet production; megakaryocytes are platelet precursors, so if they are elevated, the platelets would be as well.

Increased cell division would lead to increased platelets.

Platelets are produced in the bone marrow, not the spleen.

REF: pp. 481-482

24. A nurse is caring for a patient who cannot clot. Which end product of the clotting cascade is this patient unable to make?

a.

Collagen

b.

Fibrinogen

c.

Thrombin

d.

Fibrin

ANS: D

Fibrin is the end product of the coagulation cascade.

Fibrin, not collagen, is the end product of the coagulation cascade.

Fibrin, not fibrinogen, is the end product of the coagulation cascade.

Fibrin, not thrombin, is the end product of the coagulation cascade.

REF: p. 491

25. A nurse is discussing fibrinolysis. Which information should the nurse share? Fibrinolysis is mediated by:

a.

Heparin

b.

Fibrinogen

c.

Plasmin

d.

Albumin

ANS: C

Plasmin is an enzyme that promotes fibrinolysis by degrading fibrin and fibrinogen into fibrin degradation products.

Plasmin mediates fibrinolysis, not heparin.

Plasmin mediates fibrinolysis, not fibrinogen.

Plasmin mediates fibrinolysis, not albumin.

REF: p. 496

26. A newborn baby has a clotting disorder that results in her body being unable to produce thrombin. Which of the following phases of platelet degranulation would be impossible?

a.

Subendothelial exposure

b.

Adhesion

c.

Activation

d.

Aggregation

ANS: D

Without thrombin, aggregation cannot occur.

Without thrombin, aggregation, not subendothelial exposure, cannot occur.

Without thrombin, aggregation, not adhesion, cannot occur.

Without thrombin, aggregation, not activation, cannot occur.

REF: pp. 491-492

27. While checking lab results, the nurse remembers the normal leukocyte count is:

a.

1,000-2,000/mm3

b.

5,000-10,000/mm3

c.

4.2-6.2 million/mm3

d.

1.2-2.2 million/mm3

ANS: B

5,000-10,000/mm3 is the normal leukocyte count.

1,000-2,000/mm3 is an abnormally low leukocyte count.

4.2-6.2 million/mm3 is the normal erythrocyte count.

1.2-2.2 million/mm3 would indicate anemia.

REF: p. 479

MULTIPLE RESPONSE

1. When a staff member asks how erythrocytes can carry oxygen, which of the following properties should the nurse describe that allow erythrocytes to function as gas carriers? (Select all that apply.)

a.

Biconcavity

b.

Reversible deformability

c.

Undergoes mitotic division

d.

Presence of many mitochondria

e.

Presence of a nucleus

ANS: A, B

Erythrocytes are small disks that are biconcave in shape and have the capacity to be reversibly deformed. They cannot undergo mitotic division and do not have many mitochondria. Erythrocytes do not have a nucleus.

REF: p. 480

2. A nurse is caring for an elderly patient. Which of the following are true regarding the hematological system and aging? (Select all that apply.)

a.

Total serum iron is decreased.

b.

Total iron-binding capacity is decreased.

c.

Intestinal iron absorption is decreased.

d.

Lymphocyte function is unchanged.

e.

Platelet aggregation is unchanged.

ANS: A, B, C

Total serum iron, total iron-binding capacity, and intestinal iron absorption are all decreased somewhat in elderly persons. Lymphocyte function decreases with age. Platelet adhesiveness probably increases.

REF: pp. 496-497

COMPLETION

1. When an aide asks a nurse how many oxygen molecules can hemoglobin carry, what is the nurses best response? Hemoglobin molecules carry _____ oxygen molecules.

ANS:

4

four

An individual hemoglobin molecule with its four hemes can carry four oxygen molecules.

REF: p. 487

Mosby items and derived items 2012 Mosby, Inc., an imprint of Elsevier Inc.

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