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A man suffers a leg wound which causes minor blood loss. As a result of bleeding, the process of primary hemostasis is activated. What occurs in primary hemostasis?
- A. Severed blood vessels constrict.
- B. Thromboplastin is released.
- C. Prothrombin is converted to thrombin.
- D. Fibrin is lysed.
Correct Answer: A
Rationale: Primary hemostasis involves the severed vessel constricting and platelets collecting at the injury site. Secondary hemostasis occurs when thromboplastin is released, prothrombin converts to thrombin, and fibrin is lysed.
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A patients wound has begun to heal and the blood clot which formed is no longer necessary. When a blood clot is no longer needed, the fibrinogen and fibrin will be digested by which of the following?
- A. Plasminogen
- B. Thrombin
- C. Prothrombin
- D. Plasmin
Correct Answer: D
Rationale: The substance plasminogen is required to lyse (break down) the fibrin. Plasminogen, which is present in all body fluids, circulates with fibrinogen and is therefore incorporated into the fibrin clot as it forms. When the clot is no longer needed (e.g., after an injured blood vessel has healed), the plasminogen is activated to form plasmin. Plasmin digests the fibrinogen and fibrin. Prothrombin is converted to thrombin, which in turn catalyzes the conversion of fibrinogen to fibrin so a clot can form.
A patient has been diagnosed with a lymphoid stem cell defect. This patient has the potential for a problem involving which of the following?
- A. Plasma cells
- B. Neutrophils
- C. Red blood cells
- D. Platelets
Correct Answer: A
Rationale: A defect in a myeloid stem cell can cause problems with erythrocyte, leukocyte, and platelet production. In contrast, a defect in the lymphoid stem cell can cause problems with T or B lymphocytes, plasma cells (a more differentiated form of B lymphocyte), or natural killer (NK) cells.
A patient has been scheduled for a bone marrow biopsy and admits to the nurse that she is worried about the pain involved with the procedure. What patient education is most accurate?
- A. Youll be given painkillers before the test, so there wont likely be any pain?
- B. Youll feel some pain when the needle enters your skin, but none when the needle enters the bone because of the absence of nerves in bone.
- C. Most people feel some brief, sharp pain when the needle enters the bone.
- D. Ill be there with you, and Ill try to help you keep your mind off the pain.
Correct Answer: C
Rationale: Patients typically feel a pressure sensation as the needle is advanced into position. The actual aspiration always causes sharp, but brief pain, resulting from the suction exerted as the marrow is aspirated into the syringe; the patient should be warned about this. Stating, Ill try to help you keep your mind off the pain may increase the patients fears of pain, because this does not help the patient know what to expect.
A patient with a hematologic disorder asks the nurse how the body forms blood cells. The nurse should describe a process that takes place where?
- A. In the spleen
- B. In the kidneys
- C. In the bone marrow
- D. In the liver
Correct Answer: C
Rationale: Bone marrow is the primary site for hematopoiesis. The liver and spleen may be involved during embryonic development or when marrow is destroyed. The kidneys release erythropoietin, which stimulates the marrow to increase production of red blood cells (RBCs). However, blood cells are not primarily formed in the spleen, kidneys, or liver.
A patient is scheduled for a splenectomy. During discharge education, what teaching point should the nurse prioritize?
- A. The importance of adhering to prescribed immunosuppressant therapy
- B. The need to report any signs or symptoms of infection promptly
- C. The need to ensure adequate folic acid, iron, and vitamin B12 intake
- D. The importance of limiting activity postoperatively to prevent hemorrhage
Correct Answer: B
Rationale: After splenectomy, the patient is instructed to seek prompt medical attention if even relatively minor symptoms of infection occur. Often, patients with high platelet counts have even higher counts after splenectomy, which can predispose them to serious thrombotic or hemorrhagic problems. However, this increase is usually transient and therefore often does not warrant additional treatment. Dietary modifications are not normally necessary and immunosuppressants would be strongly contraindicated.