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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.
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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.
The nurse is providing care for an older adult who has a hematologic disorder. What age-related change in hematologic function should the nurse integrate into care planning?
- A. Bone marrow in older adults produces a smaller proportion of healthy, functional blood cells.
- B. Older adults are less able to increase blood cell production when demand suddenly increases.
- C. Stem cells in older adults eventually lose their ability to differentiate.
- D. The ratio of plasma to erythrocytes and lymphocytes increases with age.
Correct Answer: B
Rationale: Due to a variety of factors, when an older person needs more blood cells, the bone marrow may not be able to increase production of these cells adequately. Stem cell activity continues throughout the lifespan, although at a somewhat decreased rate. The proportion of functional cells does not greatly decrease and the relative volume of plasma does not change significantly.
Two units of PRBCs have been ordered for a patient who has experienced a GI bleed. The patient is highly reluctant to receive a transfusion, stating, Im terrified of getting AIDS from a blood transfusion. How can the nurse best address the patients concerns?
- A. All the donated blood in the United States is treated with antiretroviral medications before it is used.
- B. That did happen in some high-profile cases in the twentieth century, but it is no longer a possibility.
- C. HIV was eradicated from the US blood supply in the early 2000s.
- D. The chances of contracting AIDS from a blood transfusion in the United States are exceedingly low.
Correct Answer: D
Rationale: The patient can be reassured about the very low possibility of contracting HIV from the transfusion. However, it is not an absolute impossibility. Antiretroviral medications are not introduced into donated blood. The blood supply is constantly dynamic, due to the brief life of donated blood.
A patient is receiving a blood transfusion and complains of a new onset of slight dyspnea. The nurses rapid assessment reveals bilateral lung crackles and elevated BP. What is the nurses most appropriate action?
- A. Slow the infusion rate and monitor the patient closely.
- B. Discontinue the transfusion and begin resuscitation.
- C. Pause the transfusion and administer a 250 mL bolus of normal saline.
- D. Discontinue the transfusion and administer a beta-blocker, as ordered.
Correct Answer: A
Rationale: The patient is showing early signs of hypervolemia; the nurse should slow the infusion rate and assess the patient closely for any signs of exacerbation. At this stage, discontinuing the transfusion is not necessary. A bolus would worsen the patients fluid overload.
The nurse is describing normal RBC physiology to a patient who has a diagnosis of anemia. The nurse should explain that the RBCs consist primarily of which of the following?
- A. Plasminogen
- B. Hemoglobin
- C. Hematocrit
- D. Fibrin
Correct Answer: B
Rationale: Mature erythrocytes consist primarily of hemoglobin, which contains iron and makes up 95% of the cell mass. RBCs are not made of fibrin or plasminogen. Hematocrit is a measure of RBC volume in whole blood.