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 case, the patient's symptoms of severe headaches, vomiting, testicular pain, reduced blood cell counts, and high proportion of immature cells indicate a rapidly progressing hematologic malignancy affecting lymphoid cells. AML (Choice A) primarily affects myeloid cells, not lymphoid cells. CML (Choice B) is a chronic myeloid disorder and presents differently with elevated leukocyte count and mature cells. MDS (Choice C) is a group of disorders characterized by abnormal blood cell production, but the presentation in this patient is more indicative of an acute leukemia.

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Plummer Vinson syndrome is not associated with:

  • A. angular stomatitis
  • B. splenomegaly
  • C. clubbing
  • D. post cricoid web
Correct Answer: C

Rationale: The correct answer is C: clubbing. Plummer Vinson syndrome is characterized by the triad of iron deficiency anemia, dysphagia, and esophageal webs. Clubbing is not a typical feature of Plummer Vinson syndrome. Angular stomatitis (A), splenomegaly (B), and post cricoid web (D) are commonly associated with Plummer Vinson syndrome due to chronic iron deficiency anemia. Clubbing is more commonly seen in conditions such as chronic respiratory or cardiac diseases, not in Plummer Vinson syndrome.

The nurse is assisting with the preparation of a blood transfusion for a patient. Which type of fluid should the nurse select to transfuse with the blood?

  • A. 0.9% normal saline
  • B. Dextrose 5% and water
  • C. Dextrose 5% and 0.9% normal saline
  • D. Dextrose 5% and 0.45% normal saline
Correct Answer: A

Rationale: The correct answer is A: 0.9% normal saline. When preparing a blood transfusion, it is essential to select a compatible fluid that will not cause hemolysis of the red blood cells. Normal saline is isotonic and compatible with blood, making it the ideal choice. Dextrose solutions can cause hemolysis and should not be used for blood transfusions. Choice B and C contain dextrose, which is not suitable for blood transfusions. Choice D contains a lower concentration of normal saline, which may not be as effective in maintaining the osmotic balance of the blood cells. Therefore, selecting 0.9% normal saline ensures the safety and integrity of the transfused blood.

What are the six dimensions of quality care according to the Institute of Medicine?

  • A. Safe, timely, effective, efficient, equitable, and person-centered
  • B. Safe, transparent, effective, efficient, equitable, and person-centered
  • C. Safe, timely, effective, low-cost, equitable, and person-centered
  • D. Safe, timely, effective, efficient, cutting-edge, and person-centered
Correct Answer: A

Rationale: The correct answer is A: Safe, timely, effective, efficient, equitable, and person-centered. This aligns with the six dimensions of quality care outlined by the Institute of Medicine. Safety ensures patient well-being, timeliness reduces delays, effectiveness means providing evidence-based care, efficiency minimizes waste, equity ensures fair access, and person-centered care considers individual preferences.

Choice B is incorrect because transparency is not included in the Institute of Medicine's six dimensions. Choice C is incorrect as "low-cost" is not a recognized dimension of quality care. Choice D is incorrect because "cutting-edge" is not part of the established dimensions of quality care.

The nurse is reviewing the results of a patient's arterial blood gas analysis. What should the nurse recognize as being a normal blood pH?

  • A. 7.29
  • B. 7.31
  • C. 7.38
  • D. 7.48
Correct Answer: C

Rationale: The correct answer is C: 7.38. Normal blood pH ranges from 7.35 to 7.45. A pH of 7.38 falls within this range, indicating a slightly alkaline (basic) pH, which is considered normal. Choices A, B, and D are all outside the normal range, indicating acidosis (A and B) or alkalosis (D). Therefore, C is the correct answer as it falls within the normal blood pH range.

Cooley's anemia is:

  • A. Sickle cell an.
  • B. thalassemia major
  • C. high ESR
  • D. aplastic an.
Correct Answer: B

Rationale: Cooley's anemia is another term for thalassemia major, a genetic disorder characterized by abnormal hemoglobin production leading to severe anemia. The correct answer is B because Cooley's anemia specifically refers to thalassemia major. Sickle cell anemia (A) is a different genetic disorder caused by abnormal hemoglobin shape. High ESR (C) is a nonspecific marker of inflammation and does not directly relate to Cooley's anemia. Aplastic anemia (D) is a condition where the bone marrow does not produce enough blood cells, not related to Cooley's anemia.

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