Blood Questions Flashcards
- A client with anemia may be tired due to a tissue deficiency of which of the following substances?
a. Carbon dioxide
b. Factor VIII
c. Oxygen
d. T-cell antibodies
ANSWER C.
Anemia stems from a decreased number of red blood cells and the resulting deficiency in oxygen and body tissues. Clotting factors, such as factor VIII, relate to the body’s ability to form blood clots and aren’t related to anemia, not is carbon dioxide of T antibodies.
- Which of the following blood components is decreased in anemia?
a. Erythrocytes
b. Granulocytes
c. Leukocytes
d. Platelets
ANSWER A.
Anemia is defined as a decreased number of erythrocytes (red blood cells). Leukopenia is a decreased number of leukocytes (white blood cells). Thrombocytopenia is a decreased number of platelets. Lastly, granulocytopenia is a decreased number of granulocytes (a type of white blood cells).
- Which of the following cells is the precursor to the red blood cell (RBC)?
a. B cell
b. Macrophage
c. Stem cell
d. T cell
ANSWER C.
The precursor to the RBC is the stem cell. B cells, macrophages, and T cells and lymphocytes, not RBC precursors.
- Which of the following symptoms is expected with hemoglobin of 10 g/dl?
a. None
b. Pallor
c. Palpitations
d. Shortness of breath
ANSWER A.
Mild anemia usually has no clinical signs. Palpitations, SOB, and pallor are all associated with severe anemia.
- Which of the following diagnostic findings are most likely for a client with aplastic anemia?
a. Decreased production of T-helper cells
b. Decreased levels of white blood cells, red blood cells, and platelets
c. Increased levels of WBCs, RBCs, and platelets
d. Reed-Sternberg cells and lymph node enlargement
ANSWER B.
In aplastic anemia, the most likely diagnostic findings are decreased levels of all the cellular elements of the blood (pancytopenia). T-helper cell production doesn’t decrease in aplastic anemia. Reed-Sternberg cells and lymph node enlargement occur with Hodgkin’s disease.
- A client with iron deficiency anemia is scheduled for discharge. Which instruction about prescribed ferrous gluconate therapy should the nurse include in the teaching plan?
a. “Take the medication with an antacid.”
b. “Take the medication with a glass of milk.”
c. “Take the medication with cereal.”
d. “Take the medication on an empty stomach.”
ANSWER D.
Preferably, ferrous gluconate should be taken on an empty stomach. Ferrous gluconae should not be taken with antacids, milk, or whole-grain cereals because these foods reduce iron absorption.
- Which of the following disorders results from a deficiency of factor VIII?
a. Sickle cell disease
b. Christmas disease
c. Hemophilia A
d. Hemophilia B
ANSWER C.
Hemophilia A results from a deficiency of factor VIII. Sickle cell disease is caused by a defective hemoglobin molecule. Christmas disease, also called hemophilia B, results in a factor IX deficiency.
- The nurse explains to the parents of a 1-year-old child admitted to the hospital in a sickle cell crisis that the local tissue damage the child has on admission is caused by which of the following?
a. Autoimmune reaction complicated by hypoxia
b. Lack of oxygen in the red blood cells
c. Obstruction to circulation
d. Elevated serum bilirubin concentration.
ANSWER C.
Characteristic sickle cells tend to cause “log jams” in capillaries. This results in poor circulation to local tissues, leading to ischemia and necrosis. The basic defect in sickle cell disease is an abnormality in the structure of RBCs. The erythrocytes are sickle-shaped, rough in texture, and rigid. Sickle cell disease is an inherited disease, not an autoimmune reaction. Elevated serum bilirubin concentrations are associated with jaundice, not sickle cell disease
- The mothers asks the nurse why her child’s hemoglobin was normal at birth but now the child has S hemoglobin. Which of the following responses by the nurse is most appropriate?
a. “The placenta bars passage of the hemoglobin S from the mother to the fetus.”
b. “The red bone marrow does not begin to produce hemoglobin S until several months after birth.”
c. “Antibodies transmitted from you to the fetus provide the newborn with temporary immunity.”
d. “The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth.”
ANSWER D.
Sickle cell disease is an inherited disease that is present at birth. However, 60% to 80% of a newborns hemoglobin is fetal hemoglobin, which has a structure different from that of hemoglobin S or hemoglobin A. Sickle cell symptoms usually occur about 4 months after birth, when hemoglobin S begins to replace the fetal hemoglobin. The gene for sickle cell disease is transmitted at the time of conception, not passed through the placenta. Some hemoglobin S is produced by the fetus near term. The fetus produces all its own hemoglobin from the earliest production in the first trimester. Passive immunity conferred by maternal antibodies is not related to sickle cell disease, but this transmission of antibodies is important to protect the infant from various infections during early infancy.
- Which of the following would the nurse identify as the priority nursing diagnosis during a toddler’s vasoocclusive sickle cell crisis?
a. Ineffective coping related to the presence of a life-threatening disease
b. Decreased cardiac output related to abnormal hemoglobin formation
c. Pain related to tissue anoxia
d. Excess fluid volume related to infection
ANSWER C.
For the child in a sickle cell crisis, pain is the priority nursing diagnosis because the sickled cells clump and obstruct the blood vessels, leading to occlusive and subsequent tissue ischemia. Although ineffective coping may be important, it is not the priority. Decreased cardiac output is not a problem with this type of vasoocclusive crisis. Typically, a sickle cell crisis can be precipitated by a fluid volume deficit or dehydration.
- A mother asks the nurse if her child’s iron deficiency anemia is related to the child’s frequent infections. The nurse responds based on the understanding of which of the following?
a. Little is known about iron-deficiency anemia and its relationship to infection in children.
b. Children with iron deficiency anemia are more susceptible to infection than are other children.
c. Children with iron-deficiency anemia are less susceptible to infection than are other children.
d. Children with iron-deficient anemia are equally as susceptible to infection as are other children.
ANSWER B.
Children with iron-deficiency anemia are more susceptible to infection because of marked decreases in bone marrow functioning with microcytosis.
- Which statements by the mother of a toddler would lead the nurse to suspect that the child has iron-deficiency anemia? Select all that apply.
a. “He drinks over 3 cups of milk per day.”
b. “I can’t keep enough apple juice in the house; he must drink over 10 ounces per day.”
c. “He refuses to eat more than 2 different kinds of vegetables.”
d. “He doesn’t like meat, but he will eat small amounts of it.”
e. “He sleeps 12 hours every night and take a 2-hour nap.”
ANSWERS A, B.
Toddlers should have between 2 and 3 cups of milk per day and 8 ounces of juice per day. If they have more than that, then they are probably not eating enough other foods, including iron-rich foods that have the needed nutrients.
- Which of the following foods would the nurse encourage the mother to offer to her child with iron deficiency anemia?
a. Rice cereal, whole milk, and yellow vegetables
b. Potato, peas, and chicken
c. Macaroni, cheese, and ham
d. Pudding, green vegetables, and rice
ANSWER B.
Potato, peas, chicken, green vegetables, and rice cereal contain significant amounts of iron and therefore would be recommended. Milk and yellow vegetables are not good iron sources. Rice by itself also is not a good source of iron.
- The physician has ordered several laboratory tests to help diagnose an infant’s bleeding disorder. Which of the following tests, if abnormal, would the nurse interpret as most likely to indicate hemophilia?
a. Bleeding time
b. Tourniquet test
c. Clot retraction test
d. Partial thromboplastin time (PTT)
ANSWER D.
PTT measures the activity of thromboplastin, which is dependent on intrinsic clotting factors. In hemophilia, the intrinsic clotting factor VIII (antihemiphilic factor) is deficient, resulting in a prolonged PTT. Bleeding time reflects platelet function; the tourniquet test measures vasoconstriction and platelet function; and the clot retraction test measures capillary fragility. All of these are unaffected in people with hemophilia.
- Which of the following assessments in a child with hemophilia would lead the nurse to suspect early hemarthrosis?
a. Child’s reluctance to move a body part
b. Cool, pale, clammy extremity
c. Eccymosis formation around a joint
d. Instability of a long bone in passive movement
ANSWER A.
Bleeding into the joints in the child with hemophilia leads to pain and tenderness, resulting in restricted movement. Therefore, an early sign of hemarthrosis would be the child’s reluctance to move a body part. If the bleeding into the joint continues, the area becomes hot, swollen, and immobile—not cool, pale, and clammy. Ecchymosis formation around a joint would be difficult to assess. Instability of a long bone on passive movement is not associated with joint hemarthrosis.
