In-Class Questions Hematology System

Question 1

Which statement about hematologic changes associated with aging is true?
A. The older adult has increased blood volume
B. The older adult has increased levels of plasma proteins
C. Platelet counts decrease with age
D. Antibody levels and responses are lower and slower in older adults

Answer 1

Answer: D
Most times things decreased with aging

Question 2

Decreased overall blood volume
Lower levels of plasma proteins
Bone Marrow produces less blood cells
Hemoglobin levels in men and women fall after middle age
Immune responses change

Answer 2

What are some other hematological changes with aging?

Question 3

Could be related to decrease in protein intake - not eat as much as age; shake for extra protein; higher risk for infection

Answer 3

Lower levels of plasma proteins

Question 4

RBC and WBC counts decrease - decreased IR; not see high fever or response as fast
Platelet counts do not change with age

Answer 4

Bone Marrow produces less blood cells

Question 5

Could be related to decrease in iron intake

Answer 5

Hemoglobin levels in men and women fall after middle age

Question 6

WBC counts may be lower
WBC count does not rise as high in response to infection in older adults
Increased risk for swelling and bleeding; not respond as quickly to an infection
Antibody levels and responses are lower and slower in older adults
Lymphocytes become less reactive to antigens

Answer 6

Immune responses change

Question 7

The patient reports a history of splenectomy. Based on this information, what is the nurse most likely to assess for?
A.Signs of bleeding
B.Signs of infection
C.Digestive problems
D.Jaundice of the skin

Answer 7

Answer: B

Question 8

An experienced nurse is supervising a new graduate who is assessing a patient with a suspected hematologic problem. The experienced nurse would intervene if the new nurse performed which action?
A.Auscultated the heart for abnormal heart sounds or irregular rhythm
B.Palpated the abdomen to attempt to locate an enlarged spleen
C.Assessed joints for swelling or pain
D.Assessed the skin for petechiae and ecchymoses

Answer 8

Answer: B
Not palpate to find enlarged spleen: hemorrhage and risk for rupture: not typically palpable

Question 9

Spleen
Liver

Answer 9

Accessory organs of blood formation

Question 10

Destroys old or imperfect RBCs
Breaks down the hemoglobin
Stores platelets
Antibody production and filters antigens
After a splenectomy patients have reduced immune functions - higher risk for infection

Answer 10

Spleen

Question 11

Produces prothrombin and other blood clotting factors
Cirrhosis - high risk for bleeding
Assists in the forming of Vitamin K in the intestines
Stores blood cells
Stores iron in the form of ferritin

Answer 11

Liver

Question 12

When assessing the patient with darker skin for pallor and cyanosis, which area would the nurse examine?
A.Chest and abdomen
B.General appearance of face
C.Fingertips and toes
D.Oral mucous membranes

Answer 12

Answer: D

Question 13

Skin
Head & Neck
Respiratory
Cardiovascular
Kidney & Urinary
Musculoskeletal
Abdominal
Central Nervous System

Answer 13

Physical assessment

Question 14

Inspect skin and mucous membranes for pallor
Assess nail beds for pallor or cyanosis: Not quite as reliable in nail beds; Pallor of the gums, conjunctivae, and palmar creases indicates decreased hemoglobin levels and poor tissue oxygenation
Inspect for petechiae (pin prick bruises) and ecchymoses

Answer 14

Skin

Question 15

Check for pallor or ulceration of the oral mucosa
Inspect and palpate all diff lymph node areas

Answer 15

Head & Neck

Question 16

Assess respirations and dyspnea at rest and on exertion
Assess for fatigue
Orthopnea
O2 carried by blood - issues with resp sys - think anemia

Answer 16

Respiratory

Question 17

PERFUSION
Assess pulses
BP
Abnormal heart sounds
Irregular rhythms

Answer 17

Cardiovascular

Question 18

Assess urine for hematuria

Answer 18

Kidney & Urinary

Question 19

Rib or sternal tenderness may occur with leukemia
Assess range of joint motion, document any swelling or joint pain

Answer 19

Musculoskeletal

Question 20

Evaluate spleen: Normal adult spleen is usually not palpable; Enlarged spleen may occur with many hematologic problems
Stool specimen to check for occult blood testing

Answer 20

Abdominal

Question 21

Neurologic checks and checks of cognitive function

Answer 21

Central Nervous System

Question 22

Which of the following interventions should the nurse implement for bleeding precautions? (SATA)
A.Assess skin and mucous membranes
B.Inspect stool and urine
C.Measure abdominal girth
D.Offer soft bristle tooth brush
E.Offer to shave patient with razor
F.Monitor lab values

Answer 22

Answer: A, B, C, D, F
Increased abdominal girth - internal bleeding
Soft bristle - not want gums bleed

Question 23

Composed of plasma and cells
Plasma is an extracellular fluid with plasma proteins
Blood cells

Answer 23

Blood components

Question 24

Albumin: maintain osmotic pressure of blood
Globulins: transport of antibodies
Fibrinogen: important in clotting

Answer 24

Plasma is an extracellular fluid with plasma proteins

Question 25

RBCs WBCs Platelets

Answer 25

Blood cells

Question 26

Largest proportion of blood Produce hemoglobin which carries oxygen and carbon dioxide Iron is important component of hemoglobin

Answer 26

RBCs

Question 27

Role in inflammation and infection protection

Answer 27

WBCs

Question 28

Smallest blood cell Stick to injured vessel walls and aggregate to assist clotting Stored in spleen

Answer 28

Platelets

Question 29

Decrease RBC, Hgb, Hct: Bleeding, anemia, hemorrhage Decrease WBC - suppression bone marrow Increase WBC - infection, inflammation Decrease platelet - bleeding RBC Hemoglobin Hematocrit WBC Platelets

Answer 29

Lab profile

Question 30

4.2-6.1

Answer 30

RBC

Question 31

12- 18

Answer 31

Hemoglobin

Question 32

37%-52%

Answer 32

Hematocrit

Question 33

5,000-10,000

Answer 33

WBC

Question 34

150,000-400,000

Answer 34

Platelets

Question 35

All of the following is true about bone marrow aspiration, EXCEPT: A.It is performed to evaluate patient’s blood cells and hematologic status B.It is performed in OR C.Biopsy could be obtained D.It could provide a differential diagnosis

Answer 35

Answer: B Can do at bedside or IR or office; not OR - not gen anesthesia

Question 36

Local anesthetic is used and may feel stinging or burning sensation Mild tranquilizer or a rapid-acting sedative could be used Heavy sensation of pressure and pushing while the needle is being inserted Usually use the iliac crest; sternum if need more Patient should be placed in the prone or side-lying position Emotional support if doing this; feel heavy pressure when into bone marrow

Answer 36

What is involved in the procedure? - Bone marrow aspiration and biopsy

Question 37

Hold pressure briefly to site Cover the site with a dressing after bleeding is controlled Give mild analgesic for discomfort Apply ice bag to the needle site to limit bruising Observe site every 2 hours for 24 hours for signs of bleeding, bruising, and s/s infection Advise the patient to avoid contact sports or any activity that might result in trauma to the site for 48 hours - avoid trauma to sight

Answer 37

What are the nursing interventions post procedure? - Bone marrow aspiration and biopsy

Question 38

The nurse understands that anemia is a reduction in the number of which of the following? (Select all that apply) A.WBCs B.RBCs C.Platelets D.Hemoglobin E.Hematocrit F.Neutrophils

Answer 38

Answer: B, D, E One of those three things; amount RBCs or amount of Hgb/Hct

Question 39

Deficiency in one of the components needed to make a fully functional RBC Decrease in RBC production Increased in RBC destruction RBC loss

Answer 39

Types or causes of anemias - Anemia

Question 40

Ex. Iron deficiency; Folic acid deficiency; vitamin B12 deficiency

Answer 40

Deficiency in one of the components needed to make a fully functional RBC

Question 41

Ex. aplastic anemia

Answer 41

Decrease in RBC production

Question 42

Ex. hemolytic anemia

Answer 42

Increased in RBC destruction

Question 43

Ex. GI bleed

Answer 43

RBC loss

Question 44

What is the most common manifestation of anemia? A. Fatigue B. Long bone pain C. Weight gain D. Loss of appetite E. Headache

Answer 44

Answer: A Very tired and not know why

Question 45

What are integumentary manifestations of anemia? (SATA) A.Flushed cheeks B.Cyanosis C.Pallor D.Cool skin E.Intolerance of cold F.Dry flaky skin

Answer 45

Answer: C, D, E Cyanosis severe and later sign - gen paler; not as common

Question 46

What are CV manifestations of anemia? (SATA) A.Tachycardia B.Bradycardia C.Hypertension D.Orthostatic hypotension E.Systemic edema

Answer 46

Answer: A, D

Question 47

What are respiratory manifestations of anemia? (SATA) A.Dyspnea on exertion B.Orthopnea C.Decreased SaO2 D.Nagging cough E.Decreased breath sounds F.Tachypnea

Answer 47

Answer: A, C, F May also have dyspnea at rest Decreased O2 and trying to compensated for that

Question 48

What are neurologic manifestations of anemia? (SATA) A.Neuropathy B.Somnolence C.Fatigue D.Headache E.Confusion F.Delirium

Answer 48

Answer: B, C, D, E Somnolence - excessive need for sleep Fatigue and could need if more severe for somnolence Depends on how low O2 - may have confusion - more low O2 sat

Question 49

Integumentary Cardiovascular Respiratory Neurologic

Answer 49

Anemia: CM

Question 50

Pallor Cool to the touch Intolerance of cold temperatures Nails become brittle and become concave over time

Answer 50

Integumentary

Question 51

Tachycardia Murmurs and gallops when anemia is severe Orthostatic hypotension - get up slowly; SAFETY

Answer 51

Cardiovascular

Question 52

Dyspnea on exertion Decreased oxygen saturation levels

Answer 52

Respiratory

Question 53

Fatigue and somnolence Headache

Answer 53

Neurologic

Question 54

The nurse is caring for four patients. Which of these patients has the most common risk factor for anemia? A.Patient on vegan diet B.Patient with history of exposure to radiation C.Patient with lower GI bleed D.Patient with anorexia

Answer 54

Answer: C

Question 55

Dietary problems - deficiencies Genetic disorders Bone marrow disease Excessive bleeding

Answer 55

Can result from - Risk factors for anemia

Question 56

GI bleeding

Answer 56

Most common reason for anemia in adults - Risk factors for anemia

Question 57

What is the most common type of anemia

Answer 57

Iron Deficiency Anemia

Question 58

Causes: When iron deficient the stores will decrease first Labs: Clinical Manifestations: Treatment: Chronic anemia signs more mild compared to acute - s/s more often

Answer 58

Iron Deficiency Anemia

Question 59

Blood loss Poor GI absorption of iron Inadequate iron in diet

Answer 59

Causes: - Iron Deficiency Anemia

Question 60

Hbg/Hct & RBC decreased in CBC - not producing enough RBC or not have products to produce RBC Ferritin decreased < 10ng/mL (12-300 normal) MCV (mean corpuscular volume), MCH (mean corpuscular hemoglobin) and MCHC (mean corpuscular hemoglobin concentration) decreased

Answer 60

Labs: - Iron Deficiency Anemia

Question 61

Weakness and pallor Fatigue Reduced exercise tolerance Fissures at the corners of the mouth - sores, red cracks at corners of mouth

Answer 61

Clinical Manifestations: - Iron Deficiency Anemia

Question 62

Increase iron in food - red meat, beans, eggs, green leafy veggies Iron supplements IV or IM iron - severe malabsorption issue; monitor closely Blood transfusion - low Hgb

Answer 62

Treatment: - Iron Deficiency Anemia

Question 63

Which of the following are risk factors for pernicious anemia? A.Infections and chemotherapy B.Sickle cell disease C.Gastric resection and small bowel resection D.Blood loss and poor iron absorption

Answer 63

Answer: C

Question 64

Causes: Clinical manifestations: Treatment:

Answer 64

Vitamin B12 Deficiency anemia

Question 65

Vegan diets or diets lacking dairy products GI disorders: small bowel resection, chronic diarrhea, diverticuli, tapeworm, overgrowth of intestinal bacteria Anemia resulting from failure to absorb vitamin B12 (pernicious anemia) secondary to gastritis Intrinsic factor is a substance normally secreted by the gastric mucosa, which is needed for intestinal absorption of vitamin B12

Answer 65

Causes: - Vitamin B12 Deficiency anemia

Question 66

Pallor Jaundice Glossitis (a smooth, beefy-red tongue) Fatigue Weight loss Paresthesias in the feet and hands - neuro s/s - B12 imp for norm functioning of NS Poor balance - neuro s/s - B12 imp for norm functioning of NS

Answer 66

Clinical manifestations: - Vitamin B12 Deficiency anemia

Question 67

Increase vitamin B12 in diet Vitamin B12 injections

Answer 67

Treatment: - Vitamin B12 Deficiency anemia

Question 68

Which of the following is treatment for folic acid deficiency anemia? (SATA) A.Blood products transfusion B.Cyanocobalamin injections IM C.Iron supplements IV D.Epoetin alfa injections SQ E.Folic acid tablets PO F.Lentil, spinach and broccoli G.Salmon, cantaloupe and eggs

Answer 68

Answer: E, F Increase that

Question 69

Common causes: Clinical manifestations: Treatment:

Answer 69

Folic acid deficiency anemia

Question 70

Poor nutrition: Chronic alcohol abuse Malabsorption Drugs (anticonvulsants, oral contraceptives)

Answer 70

Common causes: - Folic acid deficiency anemia

Question 71

similar to those of Vitamin B12 deficiency, but nervous system functions remain normal because folic acid deficiency does not affect nerve function

Answer 71

Clinical manifestations: - Folic acid deficiency anemia

Question 72

Diet rich in foods containing folic acid and vitamin B12: leafy green vegetables, citrus fruits, beans, breads, cereal, rice, pasta Folic acid replacement

Answer 72

Treatment: - Folic acid deficiency anemia

Question 73

A deficiency in RBC, WBC and platelets? A. Aplastic anemia B. Pancytopenia C. Neutropenia D. Thrombocytopenia

Answer 73

Answer: B

Question 74

Deficiency of circulating red blood cells because of failure of the bone marrow to produce these cells Pancytopenia Causes: Patient will have manifestations of severe anemia

Answer 74

Aplastic anemia

Question 75

Injury to the stem cells in the bone marrow

Answer 75

Deficiency of circulating red blood cells because of failure of the bone marrow to produce these cells - Aplastic anemia

Question 76

Deficiency of RBCs, WBCs (leukopenia)and platelets (thrombocytopenia)

Answer 76

Pancytopenia - Aplastic anemia

Question 77

Long-term exposure to toxic agents Drugs Ionizing radiation Viral infection Unknown

Answer 77

Causes: - Aplastic anemia

Question 78

Treatment Hematopoietic stem cell transplantation with donor cells Immunosuppressive therapy medications Splenectomy

Answer 78

Aplastic anemia: interventions

Question 79

Assess for bone marrow failure Close monitoring of CBC Infection prevention Bleeding precautions Blood transfusions

Answer 79

Treatment - Aplastic anemia: interventions

Question 80

Weakness, pallor, petechiae, ecchymosis Poor oxygenation

Answer 80

Assess for bone marrow failure

Question 81

When the anemia causes disability or when bleeding is life threatening because of low platelet counts

Answer 81

Blood transfusions

Question 82

Best treatment

Answer 82

Hematopoietic stem cell transplantation with donor cells - Aplastic anemia: interventions

Question 83

If spleen is enlarged either destroying normal RBCs or suppressing their development

Answer 83

Splenectomy - Aplastic anemia: interventions