Chapter 20: Alterations of Hematologic Function My Nursing Test Banks

Huether and McCance: Understanding Pathophysiology, 5th Edition

Chapter 20: Alterations of Hematologic Function

Test Bank

MULTIPLE CHOICE

1. A patients anemia is described as having erythrocytes that demonstrate anisocytosis. The nurse would recognize the erythrocytes would be:

a.

Pale in color

b.

Present in various sizes

c.

Able to assume various shapes

d.

Live only a few days

ANS: C

Anisocytosis means the erythrocytes are able to assume various shapes.

Anisocytosis means the erythrocytes are able to assume various shapes; it does not refer to color.

Anisocytosis means the erythrocytes are able to assume various shapes; it does not refer to size.

Anisocytosis means the erythrocytes are able to assume various shapes; it does not refer to life span.

REF: p. 501

2. A newborn is diagnosed with congenital intrinsic factor deficiency. Which of the following types of anemia will the nurse see documented on the chart?

a.

Iron deficiency anemia

b.

Pernicious anemia

c.

Sideroblastic anemia

d.

Hemolytic anemia

ANS: B

A lack of the intrinsic factor leads to pernicious anemia.

Iron deficiency anemia is not related to the intrinsic factor.

Pernicious anemia is due to the lack of the intrinsic factor, sideroblastic anemia is not related to the intrinsic factor.

Hemolytic anemia results from destruction of cells; pernicious is related to the lack of the intrinsic factor.

REF: p. 502

3. When a nurse is reviewing lab results and notices that the erythrocytes contain an abnormally low concentration of hemoglobin, the nurse calls these erythrocytes:

a.

Hyperchromic

b.

Hypochromic

c.

Macrocytic

d.

Microcytic

ANS: B

Hypochromic erythrocytes have low concentrations of hemoglobin.

Hyperchromic erythrocytes have high concentrations of hemoglobin.

Macrocytic refers to larger cell size, not hemoglobin concentration.

Microcytic refers to small cell size, not hemoglobin concentration.

REF: p. 501

4. A 5-year-old male was diagnosed with normocytic-normochromic anemia. Which of the following anemias does the nurse suspect the patient has?

a.

Sideroblastic anemia

b.

Hemolytic anemia

c.

Pernicious anemia

d.

Iron deficiency anemia

ANS: B

Hemolytic anemia is an example of normocytic-normochromic anemia.

Sideroblastic anemia is an example of microcytic hypochromic anemia.

Pernicious anemia is an example of a macrocytic anemia.

Iron deficiency anemia is an example of microcytic hypochromic anemia.

REF: p. 501

5. After initial compensation, what hemodynamic change should the nurse monitor for in a patient who has a reduction in the number of circulating erythrocytes?

a.

Increased viscosity of blood

b.

Decreased cardiac output

c.

Altered coagulation

d.

Hyperdynamic circulatory state

ANS: D

After initial compensation, the blood flows faster and more turbulently than normal blood, causing a hyperdynamic circulatory state.

Blood viscosity decreases rather than increases.

Cardiac output increases.

Alteration in coagulation does not occur.

REF: p. 501

6. A 25-year-old female has a heavy menses during which she loses a profuse amount of blood. Which of the following adaptations should the nurse expect?

a.

Movement of fluid into the cell

b.

Decreased cardiac output

c.

Decreased oxygen release from hemoglobin

d.

Peripheral vasoconstriction

ANS: D

When the anemia is severe or acute in onset (e.g., hemorrhage), the initial compensatory mechanism is peripheral blood vessel constriction, diverting blood flow to essential vital organs.

Fluid moves into the vascular space, not the cell.

Blood volume increases; thus, cardiac output increases.

There is an increase in hemoglobin release of oxygen.

REF: p. 501

7. A 60-year-old female emphysema patient experiences a rapid and pounding heart, dizziness, and fatigue with exertion. Which of the following respiratory assessment findings indicate the respiratory system is compensating for the increased oxygen demand?

a.

Bronchoconstriction

b.

Increased rate and depth of breathing

c.

Dyspnea

d.

Activation of the renin-angiotensin response

ANS: B

The rate and depth of breathing increase in an effort to increase oxygen availability accompanied by an increase in the release of oxygen from hemoglobin.

Bronchodilation occurs, not constriction.

Dyspnea is not a compensatory mechanism but a side effect of the bodys attempt to increase oxygen.

The respiratory system does not activate the renin-angiotensin response; the kidneys are involved.

REF: p. 501

8. A 2-year-old malnourished child has vitamin B12 and folate deficiencies. A blood smear suggests the deficiency is macrocytic and normochromic. The nurse would expect the hemoglobin to be:

a.

Normal

b.

Sporadic

c.

Low

d.

High

ANS: A

The macrocytic (megaloblastic) anemias are characterized by unusually large stem cells (megaloblasts) in the marrow that mature into erythrocytes that are unusually large in size (macrocytic), thickness, and volume. The hemoglobin content is normal, thus allowing them to be classified as normochromic.

The hemoglobin content is normal, not sporadic.

The hemoglobin content is normal, not low.

The hemoglobin content is normal, not high.

REF: p. 501

9. A 45-year-old male is diagnosed with macrocytic, normochromic anemia. The nurse suspects the most likely cause of this condition is:

a.

Defective DNA synthesis

b.

Abnormal synthesis of hemoglobin

c.

Defective use of vitamin C

d.

Blocked protein synthesis

ANS: A

These anemias are the result of ineffective erythrocyte deoxyribonucleic acid (DNA) synthesis.

These anemias are the result of ineffective erythrocyte DNA synthesis; hemoglobin is normal.

These anemias are the result of ineffective erythrocyte DNA synthesis; it is not related to use of vitamin C.

These anemias are the result of ineffective erythrocyte DNA synthesis; it is not due to blocked protein synthesis.

REF: p. 501

10. When a patient wants to know why vitamin B12 and folate deficiencies cause anemia, how should the nurse respond?

a.

Red blood cells are unable to differentiate into erythrocytes.

b.

Red blood cells have malformed hemoglobin molecules.

c.

Red blood cells have decreased O2-carrying capacity.

d.

Red blood cells have a shorter life span.

ANS: D

These deficiencies lead to defective erythrocytes that die prematurely, which decreases their numbers in the circulation, causing anemia.

These deficiencies lead to defective erythrocytes that die prematurely, which decreases their numbers in the circulation, causing anemia. It is not due to a lack of differentiation.

These deficiencies lead to defective erythrocytes that die prematurely, which decreases their numbers in the circulation, causing anemia. It is not due to malformed hemoglobin.

These deficiencies lead to defective erythrocytes that die prematurely, which decreases their numbers in the circulation, causing anemia. It is not due to decreased oxygen carrying capacity.

REF: p. 506

11. A 20-year-old female undergoes lab testing for anemia. Results show high iron, bilirubin, and transferrin and low hemoglobin and hematocrit. Which of the following is the most likely diagnosis to be documented on the chart?

a.

Pernicious anemia

b.

Folate deficiency anemia

c.

Iron deficiency anemia

d.

Sideroblastic anemia

ANS: D

Individuals with sideroblastic anemia may show signs of iron overload (hemosiderosis), including mild to moderate enlargement of the liver (hepatomegaly) and spleen (splenomegaly).

High levels of iron indicate sideroblastic anemia, not pernicious anemia.

High levels of iron indicate sideroblastic anemia, not folate deficiency.

High levels of iron indicate sideroblastic anemia, not iron deficiency anemia.

REF: p. 505

12. A 35-year-old female is diagnosed with vitamin B12 deficiency anemia (pernicious anemia). How should the nurse respond when the patient asks what causes pernicious anemia? A decrease in ______ is the most likely cause.

a.

Ferritin

b.

Gastric enzymes

c.

Intrinsic factor

d.

Erythropoietin

ANS: C

The underlying alteration in pernicious anemia (PA) is the absence of intrinsic factor (IF), an enzyme required for gastric absorption of dietary vitamin B12, a vitamin essential for nuclear maturation and DNA synthesis in red blood cells.

PA is not due to a decrease in ferritin, but a lack of the intrinsic factor.

PA is not due to a decrease in gastric enzymes, but a lack of the intrinsic factor.

PA is not due to a decrease in erythropoietin, but a lack of intrinsic factor.

REF: p. 501

13. Which of the following individuals should the nurse assess first for a vitamin B12 deficiency anemia?

a.

3-year-old female who is a fussy eater

b.

26-year-old female in the second trimester of her first pregnancy

c.

47-year-old male who had a gastrectomy procedure (removal of the stomach)

d.

64-year-old male with a history of duodenal ulcers and gastrointestinal bleeding

ANS: C

With removal of the stomach, the intrinsic factor is also removed, leading to an inability to absorb B12; thus, the person with removal of the stomach is at greatest risk.

With removal of the stomach, the intrinsic factor is also removed, leading to an inability to absorb B12; thus, the person with removal of the stomach is at greatest risk, not the person who is a fussy eater.

With removal of the stomach, the intrinsic factor is also removed, leading to an inability to absorb B12; thus, the person with removal of the stomach is at greatest risk, not the person who is pregnant.

With removal of the stomach, the intrinsic factor is also removed, leading to an inability to absorb B12; thus, the person with removal of the stomach is at greatest risk, not the person with ulcers.

REF: p. 503

14. A 65-year-old male experienced loss of appetite, weight loss, lemon-yellow skin, liver enlargement, and a beefy red tongue shortly before his death. Autopsy suggested pernicious anemia, and the cause of death would most likely reveal:

a.

Brain hypoxia

b.

Liver hypoxia

c.

Heart failure

d.

Kidney failure

ANS: C

When the hemoglobin has decreased to 7 to 8 g/dL, the individual experiences the classic symptoms of anemia: weakness, fatigue, paresthesias of feet and fingers, difficulty walking, loss of appetite, abdominal pain, weight loss, and a sore tongue that is smooth and beefy red. The skin may become lemon yellow (sallow), caused by a combination of pallor and jaundice. Hepatomegaly, indicating right-sided heart failure, may be present in the elderly.

The patient died of heart failure, not brain hypoxia.

The patient died of heart failure, not liver hypoxia.

The patient died of heart failure, not kidney failure.

REF: p. 503

15. A 40-year-old male vegetarian is diagnosed with folate deficiency anemia. He reports that he is an alcoholic. Which of the following factors put him at greatest risk for developing his disease?

a.

Being vegetarian

b.

Being alcoholic

c.

Age

d.

Gender

ANS: B

Folate deficiency occurs more often in alcoholics and individuals who are malnourished because of fad diets or diets low in vegetables.

A diet high in vegetables would help prevent folate deficiency.

Age is not a factor in folate deficiency. Being alcoholic promotes the greatest risk, since this disorder is diet related.

Gender is not a factor in folate deficiency. Being alcoholic promotes the greatest risk, since this disorder is diet related.

REF: p. 503

16. How should the nurse prepare a patient who is to receive a Schilling test for pernicious anemia?

a.

Administer radioactive cobalamin and measure its excretion in the urine.

b.

Measure antigen-antibody immune complexes.

c.

Measure serum ferritin and total iron-binding capacity.

d.

Administer folate and evaluate folate content in a blood serum sample.

ANS: A

The Schilling test is performed by administering radioactive cobalamin and then measuring its excretion in the urine. Low urinary excretion is significant for pernicious anemia (PA).

The Schilling test is performed by administering radioactive cobalamin and then measuring its excretion in the urine. Low urinary excretion is significant for PA. It does not involve the measurement of antigen-antibody complexes.

The Schilling test is performed by administering radioactive cobalamin and then measuring its excretion in the urine. Low urinary excretion is significant for PA. It does not involve the measurement of serum ferritin and total iron-binding capacity.

The Schilling test is performed by administering radioactive cobalamin and then measuring its excretion in the urine. Low urinary excretion is significant for PA. It does not involve the administration of folate.

REF: p. 503

17. A 67-year-old female has chronic gastrointestinal bleeding. A nurse recalls the primary cause of her anemia is:

a.

Vitamin B12 deficiency

b.

Iron deficiency

c.

Folate deficiency

d.

Bone marrow failure

ANS: B

A continuous loss of blood is one of the most common causes of iron deficiency anemia (IDA).

A continuous loss of blood is one of the most common causes of IDA; gastrointestinal bleeding does not lead to vitamin B12 deficiency.

A continuous loss of blood is one of the most common causes of IDA; gastrointestinal bleeding does not lead to folate deficiency.

A continuous loss of blood is one of the most common causes of IDA; gastrointestinal bleeding

does not lead to bone marrow failure.

REF: p. 504

18. A 34-year-old male presents in the emergency room with extreme fatigue and shortness of breath. His skin and sclera appear to have a yellowish discoloration. These assessment findings are consistent with which type of anemia?

a.

Posthemorrhagic anemia

b.

Iron deficiency anemia

c.

Aplastic anemia

d.

Hemolytic anemia

ANS: D

A yellow appearance to the skin and sclera are consistent with hemolytic anemia.

A yellow appearance to the skin and sclera are consistent with hemolytic anemia, not posthemorrhagic anemia.

A yellow appearance to the skin and sclera are consistent with hemolytic anemia, not iron deficiency anemia.

A yellow appearance to the skin and sclera are consistent with hemolytic anemia, not aplastic anemia.

REF: p. 501

19. A 58-year-old female presents in the clinic presenting with fatigue, weight loss, and tingling in her fingers. Laboratory findings show low hemoglobin and hematocrit, a high mean corpuscular volume, and normal plasma iron. These assessment findings are consistent with which type of anemia?

a.

Hemolytic anemia

b.

Pernicious anemia

c.

Iron deficiency anemia

d.

Aplastic anemia

ANS: B

Pernicious anemia is manifested by tingling paresthesias of feet and fingers.

Pernicious, not hemolytic, anemia is manifested by tingling paresthesias of feet and fingers.

Pernicious, not iron deficiency, anemia is manifested by tingling paresthesias of feet and fingers.

Pernicious, not aplastic, anemia is manifested by tingling paresthesias of feet and fingers.

REF: p. 501

20. The nurse will check which of the following tests to directly measure iron stores?

a.

Serum ferritin

b.

Transferrin saturation

c.

Bone marrow biopsy

d.

Total iron-binding capacity

ANS: C

Iron stores are measured directly by bone marrow biopsy.

Iron stores are measured directly by bone marrow biopsy, not serum ferritin.

Iron stores are measured directly by bone marrow biopsy, not transferrin saturation.

Iron stores are measured directly by bone marrow biopsy, not total iron-binding capacity.

REF: p. 504

21. A 21-year-old female was recently diagnosed with iron deficiency anemia. In addition to fatigue and weakness, which of the following clinical signs and symptoms would she most likely exhibit?

a.

Hyperactivity

b.

Spoon-shaped nails

c.

Gait problems

d.

Petechiae

ANS: B

Iron deficiency anemia is manifested by fingernails that become brittle and spoon shaped or concave.

Iron deficiency anemia is manifested by fingernails that become brittle and spoon shaped or concave. It does not involve hyperactivity.

Iron deficiency anemia is manifested by fingernails that become brittle and spoon shaped or concave. It does not involve gait problems.

Iron deficiency anemia is manifested by fingernails that become brittle and spoon shaped or concave. It does not involve petechiae.

REF: p. 504

22. A 21-year-old woman was recently diagnosed with iron deficiency anemia. Her hematocrit is 32%. Which of the following treatments would the nurse expect to be prescribed for her?

a.

Iron replacement

b.

Splenectomy

c.

A bone marrow transplant

d.

No treatment is necessary

ANS: A

Iron replacement therapy is required and very effective. Initial doses are 150 mg to 200 mg/day and are continued until the serum ferritin level reaches 50 mg/L.

Splenectomy is not indicated. Iron replacement therapy is required and very effective. Initial doses are 150 mg to 200 mg/day and are continued until the serum ferritin level reaches 50 mg/L.

A bone marrow transplant is not indicated. Iron replacement therapy is required and very effective. Initial doses are 150 mg to 200 mg/day and are continued until the serum ferritin level reaches 50 mg/L.

Treatment is indicated. Iron replacement therapy is required and very effective. Initial doses are 150 mg to 200 mg/day and are continued until the serum ferritin level reaches 50 mg/L.

REF: p. 504

23. A 45-year-old male is diagnosed with sideroblastic anemia. When he asks what the most likely cause of this disease is, what is the nurses best response?

a.

Ineffective iron uptake and abnormal hemoglobin production

b.

Misshapen erythrocytes with low hemoglobin

c.

Decreased levels of tissue iron with megaloblastic erythrocytes

d.

Premature erythrocyte destruction and erythropoietin deficiency

ANS: A

Sideroblastic anemia is due to ineffective iron uptake and hemoglobin production.

Erythrocytes are not misshapen in sideroblastic anemia; iron uptake is altered.

Iron is increased in sideroblastic anemia.

Erythrocytes are not destroyed in sideroblastic anemia; alteration in iron uptake occurs.

REF: p. 505

24. A 50-year-old female was diagnosed with sideroblastic anemia. Which of the following assessment findings would most likely occur?

a.

Bronze colored skin

b.

Decreased iron

c.

Normochromic erythrocytes

d.

Aplastic bone marrow

ANS: A

The skin of the patient with sideroblastic anemia is bronze in color.

The patient with sideroblastic anemia shows signs of iron overload.

The erythrocytes of individuals with sideroblastic anemia are hypochromic.

The bone marrow is not aplastic, but contains ringed sideroblasts.

REF: p. 505

25. A nurse is preparing to teach the staff about aplastic anemia. Which information should the nurse include? Aplastic anemia is caused by:

a.

Iron deficiency

b.

Excess levels of erythropoietin

c.

Hemolysis

d.

Stem cell deficiency

ANS: D

In aplastic anemia, erythrocyte stem cells are underdeveloped, defective, or absent.

In aplastic anemia, erythrocyte stem cells are underdeveloped, defective, or absent; iron is not deficient.

In aplastic anemia, erythrocyte stem cells are underdeveloped, defective, or absent. There are no excess levels of erythropoietin.

In aplastic anemia, erythrocyte stem cells are underdeveloped, defective, or absent. Cells do not undergo hemolysis.

REF: p. 506

26. A nurse recalls posthemorrhagic anemia can result in death when a patients blood loss is in excess of:

a.

20% to 29%

b.

30% to 39%

c.

40% to 49%

d.

50% to 59%

ANS: C

Death can occur if blood loss exceeds 40% to 49% of plasma volume.

Death can occur if blood loss exceeds 40% to 49% of plasma volume, not 20% to 29%.

Death can occur if blood loss exceeds 40% to 49% of plasma volume, not 30% to 39%.

Death can occur if blood loss exceeds 40% to 49% of plasma volume, not 50% to 59%.

REF: p. 506

27. A 57-year-old male presents to his primary care provider for red face, hands, feet, ears, and headache and drowsiness. A blood smear reveals an increased number of erythrocytes, indicating:

a.

Polycythemia vera (PV)

b.

Leukemia

c.

Sideroblastic anemia

d.

Hemosiderosis

ANS: A

PV is manifested by increased numbers of erythrocytes.

PV is characterized by excessive proliferation of erythrocyte precursors in the bone marrow. Leukemia is not manifested by changes in erythrocytes.

PV is characterized by excessive proliferation of erythrocyte precursors in the bone marrow. Sideroblastic anemia is characterized by sideroblastic rings.

PV is characterized by excessive proliferation of erythrocyte precursors in the bone marrow. Hemosiderosis is iron overload.

REF: p. 506

28. A 67-year-old female is admitted to the emergency department with a diagnosis of polycythemia vera. Upon taking the history, the patient will most likely report:

a.

Hyperactivity

b.

Decreased blood pressure

c.

Chest pain

d.

A pale skin color

ANS: C

Coronary blood flow may be affected, precipitating angina.

The patient will experience signs of interrupted blood flow due to increased blood viscosity. They will not experience hyperactivity.

Blood pressure will be increased, not decreased.

The skin will be red over the face hands, feet, and ears.

REF: p. 507

29. A 68-year-old female is admitted to the emergency department with a diagnosis of polycythemia vera (PV). A nurse realizes the patients symptoms are mainly the result of:

a.

A decreased erythrocyte count

b.

Rapid blood flow to the major organs

c.

Increased blood viscosity

d.

Vessel injury

ANS: C

The symptoms of PV are due to increased blood viscosity.

The symptoms of PV are due to increased blood viscosity, and the erythrocyte count is elevated.

The symptoms of PV are due to increased blood viscosity, and there will be decreased blood flow to tissues and organs.

The symptoms of PV are due to increased blood viscosity; vessel injury does not occur.

REF: p. 507

30. A 67-year-old female is admitted to the emergency department with a diagnosis of polycythemia vera (PV). Which treatment should the nurse discuss with the patient?

a.

Therapeutic phlebotomy

b.

Restoration of blood volume by plasma expanders

c.

Administration of packed red blood cells

d.

Iron replacement therapy

ANS: A

Treatment of PV is phlebotomy to reduce red cell mass and blood volume.

Treatment of PV is phlebotomy to reduce red cell mass and blood volume; increasing blood volume will increase symptoms.

Treatment of PV is phlebotomy to reduce red cell mass and blood volume; administration of additional cells will increase the problems.

Treatment of PV is phlebotomy to reduce red cell mass and blood volume; iron replacement will increase the symptoms.

REF: p. 507

31. A 70-year-old male is brought to the emergency department, where he dies shortly thereafter. Autopsy reveals polycythemia vera (PV). His death was most likely the result of:

a.

Acute renal failure

b.

Cerebral thrombosis

c.

Sepsis

d.

Acute leukemia

ANS: B

50% of individuals with PV die within 18 months of the onset of initial symptoms because of thrombosis or hemorrhage.

50% of individuals with PV die within 18 months of the onset of initial symptoms because of thrombosis or hemorrhage, not renal failure.

50% of individuals with PV die within 18 months of the onset of initial symptoms because of thrombosis or hemorrhage, not infection and sepsis.

50% of individuals with PV die within 18 months of the onset of initial symptoms because of thrombosis or hemorrhage, not acute leukemia.

REF: p. 508

32. A 67-year-old male was diagnosed with polycythemia vera (PV) but refused treatment. His condition is at risk for converting to:

a.

Chronic lymphocytic leukemia

b.

Burkitt lymphoma

c.

Multiple myeloma

d.

Acute myeloid leukemia

ANS: D

A significant potential outcome of PV is the conversion to acute myeloid leukemia (AML), occurring spontaneously in 10% of individuals and generally being resistant to conventional therapy.

A significant potential outcome of PV is the conversion to AML, not chronic lymphocytic leukemia.

A significant potential outcome of PV is the conversion to AML, not Burkitt lymphoma.

A significant potential outcome of PV is the conversion to AML, not multiple myeloma.

REF: p. 508

33. A staff member asks what leukocytosis means. How should the nurse respond? Leukocytosis can be defined as:

a.

A normal leukocyte count

b.

A high leukocyte count

c.

A low leukocyte count

d.

Another term for leukopenia

ANS: B

Leukocytosis is present when the count is higher than normal.

Leukocytosis is present when the count is higher than normal, not normal.

Leukocytosis is present when the count is higher than normal, not low.

Leukocytosis is present when the count is higher than normal. It is not another term for leukopenia.

REF: p. 508

34. A 20-year-old female has an increase in eosinophils. When the patient wants to know the most likely cause of the eosinophilia. What is the nurses best response?

a.

Parasitic invasion and allergic reactions

b.

Viral and bacterial infections

c.

Stress and anxiety reactions

d.

Fungal infections and delayed hypersensitivity

ANS: A

Parasitic invasion can lead to eosinophilia.

Viral infections do not lead to eosinophilia; parasitic invasions do.

Stress and anxiety reactions do not lead to eosinophilia; parasitic invasions do.

Fungal infections do not lead to eosinophilia; parasitic invasions do.

REF: p. 509

35. A 15-year-old female presents with splenomegaly, hepatomegaly, and lymph node enlargement. She is diagnosed with infectious mononucleosis. What should the nurse tell the patient about the recovery time?

a.

72 hours

b.

3 to 5 days

c.

A few weeks

d.

Six months

ANS: C

Infectious mononucleosis (IM) is usually self-limiting, and recovery occurs in a few weeks; severe clinical complications are rare (5%). Fatigue may last for 1 to 2 months after resolution of other symptoms.

Seventy-two hours is too short; the disorder may last a few weeks.

Three to five days is too short; the disorder may last a few weeks.

Six months is too long; the disorder may resolve in a few weeks.

REF: p. 511

36. A 35-year-old male with hyperthyroidism begins treatment to decrease thyroid activity. A nurse monitors for which of the following conditions that could result secondary to the treatment?

a.

Eosinophilia

b.

Basophilia

c.

Monocytosis

d.

Lymphocytosis

ANS: B

Basophilia results from antithyroid therapy.

Basophilia, not eosinophilia, results from antithyroid therapy.

Basophilia, not monocytosis, results from antithyroid therapy.

Basophilia, not lymphocytosis, results from antithyroid therapy.

REF: p. 509

37. A 15-year-old male is diagnosed with infectious mononucleosis. When the patient asks how he got this disease, how should the nurse respond? The most likely cause is:

a.

Adenovirus

b.

Epstein-Barr virus (EBV)

c.

Cytomegalovirus (CMV)

d.

Toxoplasma gondii

ANS: B

Infectious mononucleosis (IM) is an acute infection of B lymphocytes (B cells) with EBV.

IM is an acute infection of B cells with EBV, not adenovirus.

IM is an acute infection of B cells with EBV, not cytomegalovirus.

IM is an acute infection of B cells with EBV, not Toxoplasma gondii.

REF: p. 511

38. A 15-year-old male with infectious mononucleosis is being given instructions on how to prevent the spread of this infection to others. Which statement represents a correct instruction?

a.

Wear a surgical mask when others are in the room.

b.

Do not share drinking glasses or eating utensils.

c.

Avoid all contact with other people.

d.

No precautions are necessary.

ANS: B

Transmission of mononucleosis is usually through saliva from close personal contact. The virus also may be secreted in other mucosal secretions of the genital, rectal, and respiratory tract, as well as blood.

A surgical mask is not necessary because the disorder is not airborne.

The patient does not need to avoid all contact.

Precautions should be taken.

REF: p. 511

39. A 10-year-old male is diagnosed with leukemia. The nurse assesses for which other condition that could be associated with his disease?

a.

Down syndrome

b.

Hemophilia

c.

Hyperthyroidism

d.

Pheochromocytoma

ANS: A

There is also an increased incidence of leukemia in association with other hereditary abnormalities such as Down syndrome.

There is also an increased incidence of leukemia in association with other hereditary abnormalities such as Down syndrome, not hemophilia.

There is also an increased incidence of leukemia in association with other hereditary abnormalities such as Down syndrome, not hyperthyroidism.

There is also an increased incidence of leukemia in association with other hereditary abnormalities such as Down syndrome, not pheochromocytoma.

REF: p. 513

40. A 5-year-old female is diagnosed with acute leukemia. The nurse will most likely treat this patient with:

a.

Bone marrow transplant

b.

Immunotherapy

c.

Chemotherapy

d.

Localized radiation therapy

ANS: C

Chemotherapy, used in various combinations, is the treatment of choice for leukemia.

Bone marrow transplant may be used, but chemotherapy is the treatment of choice for leukemia.

Chemotherapy, used in various combinations, is the treatment of choice for leukemia; immunotherapy is not a treatment of choice.

Chemotherapy, used in various combinations, is the treatment of choice for leukemia; localized radiation therapy is not the treatment of choice.

REF: p. 513

41. An oncologist is discussing multiple myeloma. Which information should the oncologist include? Multiple myeloma can be defined as a neoplasm of:

a.

T cells

b.

B cells

c.

Immature plasma cells

d.

Mature red blood cells

ANS: B

Multiple myeloma is a B cell cancer.

Multiple myeloma is a B cell cancer, not T cells.

Multiple myeloma is a B cell cancer, not immature plasma cells.

Multiple myeloma is a B cell cancer, not mature red blood cells.

REF: p. 518 | p. 520

42. A 65-year-old male is diagnosed with multiple myeloma. He reports severe pain. This pain can be attributed to:

a.

Neuropathic infiltrations

b.

Destruction of bone tissue

c.

Tissue hypoxia

d.

Accumulation of toxic proteins

ANS: B

Multiple myeloma is a B cell cancer characterized by the proliferation of malignant plasma cells that infiltrate the bone marrow and aggregate into tumor masses throughout the skeletal system; thus, the pain is related to bone destruction.

Multiple myeloma is a B cell cancer characterized by the proliferation of malignant plasma cells that infiltrate the bone marrow; thus, pain is related to destruction of bone tissue, not neuropathic infiltrations.

Multiple myeloma is a B cell cancer characterized by the proliferation of malignant plasma cells that infiltrate the bone marrow; thus, pain is related to destruction of bone tissue, not tissue hypoxia.

Multiple myeloma is a B cell cancer characterized by the proliferation of malignant plasma cells that infiltrate the bone marrow; thus, pain is related to destruction of bone tissue, not accumulation of toxic proteins.

REF: p. 520

43. A 35-year-old female is diagnosed with lymphadenopathy. Which assessment finding will help confirm this diagnosis?

a.

Small, hard lymph nodes

b.

Disordered lymph nodes

c.

Nonpalpable, nontender lymph nodes

d.

Enlarged lymph nodes

ANS: D

Lymphadenopathy is evidenced by enlarged lymph nodes.

Lymphadenopathy is evidenced by enlarged lymph nodes, not small and hard nodes.

Lymphadenopathy is evidenced by enlarged lymph nodes, not disordered nodes.

Lymphadenopathy is evidenced by enlarged lymph nodes, not nonpalpable lymph nodes.

REF: p. 515

44. A 35-year-old male has enlarged lymph nodes in the neck and a mediastinal mass. He was diagnosed with Hodgkin lymphoma. Which of the following abnormal cells would the nurse expect to find with this disease?

a.

Merkel cell

b.

Schwann cell

c.

Reed-Sternberg cell

d.

Kupffer cell

ANS: C

Hodgkin lymphoma is manifested by Reed-Sternberg cells.

Hodgkin lymphoma is manifested by Reed-Sternberg cells, not Merkel cells.

Hodgkin lymphoma is manifested by Reed-Sternberg cells, not Schwann cells.

Hodgkin lymphoma is manifested by Reed-Sternberg cells, not Kupffer cells.

REF: p. 516

45. The people from which country have the lowest risk for Hodgkin lymphoma?

a.

United States

b.

Japan

c.

Denmark

d.

Great Britain

ANS: B

Japan has the lowest rate of Hodgkin lymphoma.

The United States has one of the highest rates.

Denmark has the one of the highest rates.

Great Britain is not ranked.

REF: p. 517

46. A 62-year-old female tells her health care provider she has been experiencing regular night sweats that cause her to wake up drenched. She also remarks that she has been unintentionally losing weight. Physical exam reveals enlarged lymph nodes on her neck that do not appear to be painful. She should be screened for which of the following cancers?

a.

Epstein-Barr virus

b.

Hodgkin lymphoma

c.

Acute leukemia

d.

Burkitt lymphoma

ANS: B

The patient has symptoms of Hodgkin lymphoma. About a third of individuals will have some degree of systemic symptoms. Intermittent fever, without other symptoms of infection, drenching night sweats, itchy skin (pruritus), and fatigue are relatively common.

The patient with Epstein-Barr virus does not have night sweats.

The patient with acute leukemia does not have night sweats or enlarged lymph nodes.

The patient with Burkitt lymphoma does not have enlarged lymph glands or night sweats.

REF: p. 517

47. A 10-year-old male presents with abdominal swelling, night sweats, fever, and weight loss. He is diagnosed with Burkitt lymphoma. Upon obtaining the history, which of the following is the most likely cause?

a.

Cytomegalovirus (CMV)

b.

Adenovirus

c.

Human papillomavirus (HPV)

d.

Epstein-Barr virus (EBV)

ANS: D

EBV is associated with almost all cases of Burkitt lymphoma.

EBV, not CMV, is associated with almost all cases of Burkitt lymphoma.

EBV, not adenovirus, is associated with almost all cases of Burkitt lymphoma.

EBV, not HPV, is associated with almost all cases of Burkitt lymphoma.

REF: p. 519

48. For a patient experiencing hypersplenism, the nurse expects the erythrocytes to be:

a.

Proliferated

b.

Activated

c.

Sequestered

d.

Infected

ANS: C

Hypersplenism results in sequestering of the blood cells.

Hypersplenism results in sequestering, not proliferation, of the blood cells.

Hypersplenism results in sequestering, not activation, of the blood cells.

Hypersplenism results in sequestering, not infection, of the blood cells.

REF: p. 521

49. Thrombocytopenia may be:

a.

Transient or consistent

b.

Normal or abnormal

c.

Congenital or acquired

d.

Active or inactive

ANS: C

The condition may also be either congenital or acquired and may be either primary or secondary to other conditions.

The condition may also be either congenital or acquired and may be either primary or secondary to other conditions. It is not referred to as transient or consistent.

The condition may also be either congenital or acquired and may be either primary or secondary to other conditions. It is not normal or abnormal.

The condition may also be either congenital or acquired and may be either primary or secondary to other conditions. It is not active or inactive.

REF: p. 523

50. A 30-year-old female presents with hematuria, menorrhagia, and bleeding gums. She is diagnosed with immune thrombocytic purpura (ITP). A nurse realizes the most likely cause is:

a.

Allergy-induced platelet lysis

b.

An immune response to hypersplenism

c.

Antibody destruction of platelets

d.

T cell injury to megakaryocytes

ANS: C

The majority of cases of ITP are due to immune driven destruction of platelets.

The majority of cases of ITP are due to immune driven destruction of platelets. It is not due to allergy.

The majority of cases of ITP are due to immune driven destruction of platelets. It is not due to hypersplenism.

The majority of cases of ITP are due to immune driven destruction of platelets. It is not due to T cell injury.

REF: p. 524

51. A 50-year-old female is diagnosed with primary thrombocythemia. A nurse would expect the blood smear to reveal _____ platelets.

a.

Defective

b.

Fragmented

c.

Consumed

d.

Overproduced

ANS: D

Thrombocythemia is characterized by a platelet count more than 400,000 platelets/mm3 of blood and is symptomatic when the count exceeds 1,000,000/ mm3, at which time the risk for intravascular clotting (thrombosis) is high.

Thrombocythemia is characterized by a high platelet count, not a defective one.

Thrombocythemia is characterized by a high platelet count, not a fragmented one.

Thrombocythemia is characterized by a high platelet count, not a consumed one.

REF: p. 525

52. A 52-year-old male IV drug user was diagnosed with hepatitis C 5 years ago. He is now experiencing impaired blood clotting. The nurse suspects a decrease in which of the following vitamins?

a.

K

b.

D

c.

E

d.

B12

ANS: A

Lack of vitamin K interferes with clotting.

Lack of vitamin K, not D, interferes with clotting.

Lack of vitamin K, not E, interferes with clotting.

Lack of vitamin K, not B12, interferes with clotting.

REF: p. 526

53. A nurse checks individuals with liver disease for clotting problems because:

a.

The liver is often the site of platelet pooling.

b.

Clotting factors are produced in the liver.

c.

High levels of bilirubin interfere with the clotting system.

d.

Treatment medications for liver failure cause fibrinolysis.

ANS: B

Clotting factors are produced by the liver.

Clotting factors are produced by the liver; the liver is not the site of platelet pooling.

Clotting factors are produced by the liver; bilirubin does not interfere with clotting.

Clotting factors are produced by the liver. The treatment of liver failure does not affect clotting.

REF: p. 526

54. A 40-year-old female develops disseminated intravascular coagulation (DIC). Upon obtaining the history, which finding is the most likely cause of this condition?

a.

Snake bite

b.

Blood transfusion

c.

Sepsis

d.

Immune thrombocytopenic purpura (ITP)

ANS: C

Sepsis is one of the most common conditions associated with DIC.

Snake venom may cause DIC, but sepsis is the most likely cause.

Blood transfusion may cause DIC, but sepsis is the most likely cause.

ITP may cause DIC, but sepsis is the most likely cause.

REF: p. 527

55. A nurse is teaching the staff about disseminated intravascular coagulation (DIC). Which information should the nurse include? The sequence of events in DIC is initiated by the release of:

a.

Histamine

b.

Fibrin

c.

Tissue factor

d.

Plasmin

ANS: C

Regardless of the underlying disease that initiates DIC, the common pathway appears to be excessive and widespread exposure of tissue factor.

Tissue factor, not histamine, initiates the cycle of DIC.

Tissue factor, not fibrin, initiates the cycle of DIC.

Tissue factor, not plasmin, initiates the cycle of DIC.

REF: p. 527

56. In disseminated intravascular coagulation (DIC), the nurse assesses for active bleeding after intravascular clotting because:

a.

Prothrombin is activated.

b.

Clotting factors are depleted.

c.

Inflammatory mediators are released.

d.

Tissue factor (TF) is inactivated.

ANS: B

Intravascular clotting leads to depletion of clotting factors.

DIC is due to depletion of clotting factors, not activation of prothrombin.

Activation of clotting associated with DIC leads to inflammation, but inflammation does not cause DIC.

TF is activated during DIC.

REF: p. 532

57. A 22-year-old female just delivered a healthy baby girl. She suffered from eclampsia during her pregnancy, and on the second postpartum day she complained of bleeding gums and bruising on her arms and legs. Hematology lab tests indicate that she had disseminated intravascular coagulation (DIC). Further review of lab tests by the nurse revealed an increase in:

a.

Platelets

b.

Hematocrit

c.

Fibrin degradation products (FDPs)

d.

Protein C

ANS: C

Patients with DIC have high levels of FDPs.

Platelets are decreased, not increased, in DIC.

Hematocrit would be decreased in patients with DIC.

Protein C would be decreased.

REF: p. 528

58. When the nurse sees a diagnosis of hereditary hemochromatosis on the chart, the nurse knows this is a disorder of:

a.

Intravascular coagulation

b.

Iron overload

c.

Leukocytosis

d.

Granulocytosis

ANS: B

Iron overload can be primary, as in hereditary hemochromatosis.

Hemochromatosis is a disorder of iron overload, not coagulation.

Hereditary hemochromatosis is a disorder of iron overload, not leukocytosis.

Hereditary hemochromatosis is a disorder of iron overload, not granulocytosis.

REF: p. 508

MULTIPLE RESPONSE

1. A patient has microcytic hypochromic anemia. Which of the following pathogenic mechanisms may cause anemia in this patient? (Select all that apply.)

a.

Decreased erythrocyte life span

b.

Failure of mechanisms of compensatory erythropoiesis

c.

Disturbances of the iron cycle

d.

Increased basal metabolic rate

e.

Swelling in the tissues

ANS: A, B, C

Causes of microcytic hypochromic anemia are decreased erythrocyte life span, failure of mechanisms of compensatory erythropoiesis, or disturbance of the iron cycle. Increased metabolic rate and swelling of tissues does not lead to anemia.

REF: p. 501

2. A 15-year-old male is diagnosed with infectious mononucleosis. Which of the following assessment findings would he most likely demonstrate? (Select all that apply.)

a.

Lymph node enlargement.

b.

Fever and sore throat

c.

Rash on the trunk and extremities

d.

Fatigue

e.

Enlargement of liver and spleen

ANS: A, B, D, E

At the time of diagnosis, the individual commonly presents with the classic group of symptoms: fever, sore throat, cervical lymph node enlargement, and fatigue; generalized lymph node enlargement also may develop, as well as enlargement of the spleen and liver.

REF: p. 511

3. A patient wants to know about risk factors for acute leukemia. Which of the following should the nurse include? (Select all that apply.)

a.

Cytomegalovirus (CMV) infection

b.

Eating genetically modified food

c.

Chemotherapy treatment for other cancers

d.

Excessive ultraviolet radiation exposure

e.

Ovarian cancer

ANS: C, D, E

Hepatitis C or HIV can predispose the patient to leukemia, not CMV. Drugs that cause bone marrow depression, such as chemotherapeutic agents, predispose an individual to leukemia; eating genetically modified food is not a predisposing factor. Excessive ultraviolet radiation exposure can predispose an individual to myelogenous leukemia. Acute leukemia also may develop secondary to certain acquired disorders, including ovarian cancer.

REF: p. 513

COMPLETION

1. A 35-year-old male was diagnosed with hepatitis B. Further tests revealed neutropenia characterized by a neutrophil count less than _____ per milliliter.

ANS: 2000

REF: p. 509

2. A nurse realizes a patient has thrombocytopenia when the platelet count is below _____ platelets per cubic millimeter.

ANS: 100,000

REF: p. 532

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

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