Nokea
The nurses review of a patients most recent blood work reveals a significant increase in the number of band cells. The nurses subsequent assessment should focus on which of the following?
- A. Respiratory function
- B. Evidence of decreased tissue perfusion
- C. Signs and symptoms of infection
- D. Recent changes in activity tolerance
Correct Answer: C
Rationale: Ordinarily, band cells account for only a small percentage of circulating granulocytes, although their percentage can increase greatly under conditions in which neutrophil production increases, such as infection. This finding is not suggestive of problems with oxygenation and subsequent activity intolerance.
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A patient is being treated for the effects of a longstanding vitamin B12 deficiency. What aspect of the patients health history would most likely predispose her to this deficiency?
- A. The patient has irregular menstrual periods.
- B. The patient is a vegan.
- C. The patient donated blood 60 days ago.
- D. The patient frequently smokes marijuana.
Correct Answer: B
Rationale: Because vitamin B12 is found only in foods of animal origin, strict vegetarians may ingest little vitamin B12. Irregular menstrual periods, marijuana use, and blood donation would not precipitate a vitamin B12 deficiency.
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 is being treated in the ICU after a medical error resulted in an acute hemolytic transfusion reaction. What was the etiology of this patients adverse reaction?
- A. Antibodies to donor leukocytes remained in the blood.
- B. The donor blood was incompatible with that of the patient.
- C. The patient had a sensitivity reaction to a plasma protein in the blood.
- D. The blood was infused too quickly and overwhelmed the patients circulatory system.
Correct Answer: B
Rationale: An acute hemolytic reaction occurs when the donor blood is incompatible with that of the recipient. In the case of a febrile nonhemolytic reaction, antibodies to donor leukocytes remain in the unit of blood or blood component. An allergic reaction is a sensitivity reaction to a plasma protein within the blood component. Hypervolemia does not cause an acute hemolytic reaction.
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.
A patients electronic health record states that the patient receives regular transfusions of factor IX. The nurse would be justified in suspecting that this patient has what diagnosis?
- A. Leukemia
- B. Hemophilia
- C. Hypoproliferative anemia
- D. Hodgkins lymphoma
Correct Answer: B
Rationale: Administration of clotting factors is used to treat diseases where these factors are absent or insufficient; hemophilia is among the most common of these diseases. Factor IX is not used in the treatment of leukemia, lymphoma, or anemia.