Chapter 07: Care of the Patient with a Blood or Lymphatic Disorder (adult health) Flashcards Preview

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Flashcards in Chapter 07: Care of the Patient with a Blood or Lymphatic Disorder (adult health) Deck (42)
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1

The element that makes up 55% of the blood is
a. plasma.
b. RBCs.
c. WBCs.
d. platelets.

a. plasma.

Plasma constitutes 55% of the blood’s volume; the remaining 45% is composed of the blood cells and platelets.

2

A patient has a test ordered to determine why he is having fatigue and soreness of the tongue. A test that will measure the absorption of radioactive vitamin B12 is
a. gastric analysis.
b. Schilling test.
c. peripheral smear.
d. red cell indices.

b. Schilling test.

The Schilling test is a laboratory blood test for diagnosing pernicious anemia. The test measures the absorption of radioactive vitamin B12.

3

In an adult, erythrocytes are continuously produced in the
a. yellow bone marrow.
b. lymphatic system.
c. spleen.
d. red bone marrow.

d. red bone marrow

Erythrocytes are continuously produced in the red bone marrow, principally in the vertebrae, ribs, and sternum.

4

Which is a normal blood value for eosinophils?
a. 0%
b. 3%
c. 6%
d. 12%

b. 3%

Normal values of eosinophils are 1% to 4%.

5

Which is a normal blood value for lymphocytes?
a. 5%
b. 10%
c. 30%
d. 60%

c. 30%

Normal values of lymphocytes are 20% to 40%.

6

The spleen stores how many milliliters of blood that can be released in emergencies?
a. 500 mL (1 pint)
b. 1500 mL (3 pints)
c. 100 mL (1/5 pint)
d. 2000 mL (4 pints)

a. 500 mL (1 pint)

The spleen stores 1 pint of blood, which can be released during emergencies.

7

Which nursing intervention does the nurse plan for a patient who has multiple myeloma?
a. Maintaining fluid intake of 3 to 4 L/day to dilute calcium load
b. Limiting activity to prevent pathological fractures
c. Administering narcotic analgesics continuously to control bone pain
d. Assessing for changes in size and characteristics of lymph nodes

a. Maintaining fluid intake of 3 to 4 L/day to dilute calcium load

Increase fluid intake to 3000 to 4000 mL/day.

8

When developing a care plan for a patient just diagnosed with leukemia, which two nursing diagnoses are the most appropriate to use?
a. Deficient knowledge and Hopelessness
b. Risk for infection and Risk for injury
c. Ineffective coping and Chronic pain
d. Fatigue and Chronic pain

c. Ineffective coping and Chronic pain

Coping mechanisms may be strained because of pain, change of body image, or fear of death.

9

A patient is to begin taking iron supplements. The nurse evaluates the patient’s understanding of the use of this drug. Which indicates that she has an adequate knowledge base?
a. Using antidiarrheal drugs if she has diarrhea
b. Understanding that black stools may occur
c. Checking her gums for bleeding
d. Brushing her teeth with a soft-bristled brush

b. Understanding that black stools may occur

An oral iron supplement may turn the stool black.

10

A patient, age 24, is admitted with idiopathic thrombocytopenic purpura and a platelet count of 18,000/mm3. An appropriate nursing intervention would be to
a. monitor the administration of cryoprecipitate.
b. administer vitamin B12.
c. institute bleeding precautions.
d. use the Z-track method for DexFerrum administration.

c. institute bleeding precautions.

Significant risk for serious bleeding occurs when the count is below 20,000/mm3.

11

The patient, age 35, is admitted with aplastic anemia. He asks the nurse what aplastic anemia is. An accurate response would be that
a. the activity of the bone marrow is depressed.
b. the bone marrow fails to produce lymphocytes.
c. the bone marrow fails to produce red blood cells.
d. red cells are absent as a result of chronic blood loss.

a. the activity of the bone marrow is depressed.

Aplastic anemia or aplasia (a hematological term for a failure of the normal process of cell generation and development) has two etiologic classifications: congenital and acquired. All three major blood elements (RBCs, WBCs, platelets) are reduced or absent.

12

The patient has agranulocytosis with a neutrophil count of 10%. The most important nursing intervention would be
a. restoring fluid volume deficit.
b. providing oxygen per mask.
c. instituting bleeding precautions.
d. avoiding infection.

d. avoiding infection.

Nursing interventions are directed toward protecting the patient from potential sources of infection. Neutrophils ingest bacteria and dispose of dead tissue. They are the primary phagocytic cells involved in acute inflammatory response.

13

A patient, age 52, is admitted with thrombocytopenia. The most important nursing intervention to prevent hemorrhage in this patient is to
a. prevent trauma and falling.
b. avoid catheterization.
c. monitor vitals every hour.
d. begin immunocompromised (neutropenic) precautions.

a. prevent trauma and falling.

An understanding of the disease process and causative agents is necessary in forming a knowledge base for self-care and prevention of trauma and infection. Instruction on signs and symptoms, as well as preventive measures, must be given.

14

Hematological diseases are often associated with skin impairment. Petechiae and ecchymoses are seen in
a. iron-deficiency anemia.
b. pernicious anemia.
c. hemophilia A.
d. agranulocytosis.

c. hemophilia A.

In hemophilia A, the more common type which represents 85% of the total incidence, antihemophilic factor VIII is absent. This factor is essential for conversion of prothrombin to thrombin through thromboplastin component.

15

The typical medical treatment of polycythemia vera involves
a. transfusion of packed cells.
b. therapeutic phlebotomy.
c. cryoprecipitate infusion.
d. appendectomy.

b. therapeutic phlebotomy.

Repeated phlebotomy decreases blood viscosity.

16

A patient, age 23, is admitted with enlarged lymph nodes, decreased production of RBCs, thrombocytopenia, and a severe increase in his WBC count. A bone-marrow aspiration shows abnormal lymphocytes present. These abnormalities are present in which disease?
a. Thrombocytopenia
b. Hemophilia
c. Acute leukemia

c. Acute leukemia

Bone marrow biopsy shows immature leukocytes. Chest radiographic examination may show mediastinal node and lung involvement and bone changes. Sickle cell anemia, hemophilia, and thrombocytopenia do not usually have elevated WBC count.

17

The patient, age 44, has polycythemia vera. The nurse recognizes that the primary pathophysiologic feature of this disorder is
a. hyperproduction of erythropoietin.
b. capillary fragility and hemorrhage.
c. fatty infiltration of the bone marrow.
d. increase in red blood cells and hemoglobin and hyperviscosity.

d. increase in red blood cells and hemoglobin and hyperviscosity.

Polycythemia vera is characterized by erythrocytosis (an abnormal increase in the number of circulating red blood cells) and also increased production of granulocytes and platelets.

18

Many older adults suffer from conditions such as colonic diverticula, hiatal hernia, and ulcerations that can cause occult bleeding. Older adults with these conditions should be observed for
a. leukemia.
b. iron deficiency anemia.
c. sickle cell anemia.
d. polycythemia.

b. iron deficiency anemia.

Blood loss is a major cause of iron deficiency in adults. The major sources of chronic blood loss are from the GI and genitourinary systems.

19

The nurse is administering a blood transfusion to an older adult for hypovolemic shock. During the transfusion, which nursing intervention would be the most important?
a. Prevention of infection
b. Balanced nutritional diet with sodium reduction
c. Cardiopulmonary function assessment
d. Monitoring of hemoglobin and hematocrit levels

c. Cardiopulmonary function assessment

Administer blood products with caution because older adults are at increased risk of developing congestive heart failure. Careful assessment of cardiopulmonary function and intake and output is essential.

20

The spleen is a highly vascularized organ located in the left upper quadrant of the abdominal cavity. The main functions of the spleen are (Select all that apply)
a. Serve as reservoir for blood
b. Destroy worn-out RBCs
c. Promote phagocytosis
d. Responsible for development of T Lymphocytes
e. Continuously produce RBCs during lifetime

a. Serve as reservoir for blood
b. Destroy worn-out RBCs
c. Promote phagocytosis

The spleen stores 1 pint of blood, which can be released during emergencies, such as hemorrhage, in less than 60 seconds. The main functions of the spleen are (1) to serve as a reservoir for blood; (2) to form lymphocytes, monocytes, and plasma cells; (3) to destroy worn-out RBCs; (4) to remove bacteria by phagocytosis (engulfing and digesting); and (5) to produce RBCs before birth (the spleen is believed to produce RBCs after birth only in cases of extreme hemolytic anemia).

21

_____________ are leukocytes which destroy and remove cellular waste, bacteria, and solid particles.

Neutrophils

(granular circulating leukocytes essential for phagocytosis, the process by which bacteria, cellular debris, and solid particles are destroyed and removed) ingest bacteria and dispose of dead tissue.

22

The organ that forms lymphocytes is the

spleen

are to serve as a reservoir for blood; form lymphocytes, monocytes, and plasma cells; destroy worn-out RBCs; remove bacteria by phagocytosis; and produce RBCs before birth.

23

Replaces iron stores needed for RBC development
a. Folic acid
b. Ferrous sulfate
c. Vitamin B12
d. Neupogen

b. Ferrous sulfate

24

Needed for adequate nerve functioning
a. Folic acid
b. Ferrous sulfate
c. Vitamin B12
d. Neupogen

c. Vitamin B12

25

Stimulates proliferation and differentiation of neutrophils

a. Folic acid
b. Ferrous sulfate
c. Vitamin B12
d. Neupogen

d. Neupogen

26

Needed for erythropoiesis

a. Folic acid
b. Ferrous sulfate
c. Vitamin B12
d. Neupogen

a. Folic acid

27

Where are Leukocytes/White Blood Cells (WBC) derived from?

derived from hemocytoblasts in the red bone marrow.

28

What is the "life-cycle" of RBC's?

RBC's live in circulation 120 days. The aging cell is then broken down in the spleen and converted into billirubin which is excreted in bile into the intestines.

29

What is the normal range for a White Blood Cell (WBC) count?

5,000-10,000

30

What are the functions of Neutrophils?

+++FIRST RESPONDER+++ - attracted by chemicals to damaged tissue and are the first WBC to respond to tissue damage. They engulf bacteria and cellular debris by phagaocytosis.