Anatomy of Hematologic System

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A 35-year-old male is admitted to the hospital complaining of severe headaches, vomiting, and testicular pain. His blood work shows reduced numbers of platelets, leukocytes, and erythrocytes, with a high proportion of immature cells. The nurse caring for this patient suspects a diagnosis of what?

  • A. AML
  • B. CML
  • C. MDS
  • D. ALL
Correct Answer: D

Rationale: The correct answer is D: ALL (Acute Lymphoblastic Leukemia). In this scenario, the patient presents with symptoms of headaches, vomiting, testicular pain, and abnormal blood work showing reduced platelets, leukocytes, and erythrocytes with a high proportion of immature cells. These findings are characteristic of ALL, a type of leukemia that primarily affects lymphoid cells. The combination of symptoms and blood work results suggests a rapid and aggressive proliferation of immature lymphoid cells, leading to bone marrow failure and symptoms such as anemia, thrombocytopenia, and leukopenia. AML (choice A) primarily affects myeloid cells, not lymphoid cells. CML (choice B) typically presents with elevated leukocyte count and presence of the Philadelphia chromosome. MDS (choice C) is a group of disorders characterized by ineffective hematopoiesis leading to cytopenias, but does not typically present with the rapid onset of symptoms seen in this case

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A nurse is monitoring a client following ferrous sulfate administration. The nurse should monitor the client for which of the following adverse effects?

  • A. Phlebitis
  • B. Dark
  • C. orange-colored stools
  • D. Constipation
Correct Answer: D

Rationale: The correct answer is D: Constipation. Ferrous sulfate is an iron supplement commonly associated with gastrointestinal side effects, including constipation. Iron can cause constipation by slowing down bowel movements. Phlebitis (A) is inflammation of a vein and is not a common adverse effect of ferrous sulfate. Dark (B) or orange-colored stools (C) are expected side effects of iron supplements due to the change in color caused by the iron, but they are not harmful. Constipation (D) is the most concerning adverse effect to monitor for as it can lead to discomfort and potential complications if left untreated.

A nurse is teaching a client about taking ferrous sulfate to treat iron deficiency anemia. Which of the following instructions should the nurse include? (Select All)

  • A. Eat iron-enriched foods.
  • B. Spread the dosage across each day.
  • C. Take the drug on an empty stomach.
  • D. Report dark green or black stools.
Correct Answer: A

Rationale: The correct answer is A: Eat iron-enriched foods. Iron-enriched foods help increase iron levels in the body, supporting the treatment of iron deficiency anemia. The rationale is that consuming foods rich in iron can complement the effects of ferrous sulfate, aiding in the replenishment of iron stores.

Summary:
- B: Spreading the dosage throughout the day can help with better absorption, but it is not the priority instruction.
- C: Taking the drug on an empty stomach can enhance absorption, but it may also cause stomach upset.
- D: Reporting dark green or black stools is important to monitor for possible gastrointestinal bleeding, but it is not an instruction for taking ferrous sulfate.

A 17-year-old patient is referred to you for a platelet count of 1,200,000/mm3. On history, she notes that she often has numbness and tingling in her hands and feet and has frequent epistaxis. She is otherwise well-appearing and has no recent infections. On her exam, you note splenomegaly. What do you expect to see on further evaluation?

  • A. Elevated C-reactive protein
  • B. Low ferritin
  • C. A hypocellular bone marrow
  • D. Low von Willebrand factor activity
Correct Answer: D

Rationale: The correct answer is D: Low von Willebrand factor activity. This patient likely has Essential Thrombocythemia, a disorder characterized by excessive production of platelets by the bone marrow. This condition can lead to abnormal bleeding and clotting. The patient's symptoms of numbness, tingling, epistaxis, and splenomegaly are consistent with this diagnosis. Low von Willebrand factor activity is expected in Essential Thrombocythemia due to platelet dysfunction. Elevated C-reactive protein, low ferritin, and a hypocellular bone marrow are not typically associated with Essential Thrombocythemia and are less likely to be seen in this patient.

During haemostasis, prostacyclin

  • A. Cleaves prothrombin into thrombin
  • B. Causes vasodilation
  • C. Stimulates platelet aggregation
  • D. Activates fibrinolysis
Correct Answer: B

Rationale: Prostacyclin is a vasodilator, which means it causes blood vessels to widen, leading to decreased blood pressure and increased blood flow. During haemostasis, this vasodilation helps in maintaining blood flow and preventing platelet aggregation in the damaged area. Option A is incorrect because prostacyclin does not cleave prothrombin into thrombin. Option C is incorrect as prostacyclin inhibits platelet aggregation. Option D is incorrect because prostacyclin does not directly activate fibrinolysis. In summary, the correct answer is B because prostacyclin's vasodilation function plays a crucial role in haemostasis by preventing excessive clot formation and maintaining blood flow.

A nurse is reviewing the medication record of a client who is receiving alteplase following an acute myocardial infarction (MI). Which of the following medications should the nurse expect the client to be taking in addition to the alteplase?

  • A. Protamine
  • B. Desmopressin
  • C. Ferrous sulfate
  • D. Heparin
Correct Answer: D

Rationale: The correct answer is D: Heparin. Following an acute MI, a client receiving alteplase may also be prescribed heparin to prevent re-thrombosis and further clot formation. Alteplase is a thrombolytic agent that works by breaking down clots, while heparin is an anticoagulant that helps prevent new clots from forming. Protamine (choice A) is used to reverse the effects of heparin, not typically administered alongside alteplase. Desmopressin (choice B) is used for conditions like diabetes insipidus, unrelated to MI treatment. Ferrous sulfate (choice C) is an iron supplement, not indicated in this scenario.

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