Chapter 07: Care of the Patient with a Blood or Lymphatic Disorder (adult health)

Question 1

The element that makes up 55% of the blood is

a. plasma.
b. RBCs.
c. WBCs.
d. platelets.

Answer 1

a. plasma.

Plasma constitutes 55% of the blood’s volume; the remaining 45% is composed of the blood cells and platelets.

Question 2

A patient has a test ordered to determine why he is having fatigue and soreness of the tongue. A test that will measure the absorption of radioactive vitamin B12 is

a. gastric analysis.
b. Schilling test.
c. peripheral smear.
d. red cell indices.

Answer 2

b. Schilling test.

The Schilling test is a laboratory blood test for diagnosing pernicious anemia. The test measures the absorption of radioactive vitamin B12.

Question 3

In an adult, erythrocytes are continuously produced in the

a. yellow bone marrow.
b. lymphatic system.
c. spleen.
d. red bone marrow.

Answer 3

d. red bone marrow

Erythrocytes are continuously produced in the red bone marrow, principally in the vertebrae, ribs, and sternum.

Question 4

Which is a normal blood value for eosinophils?

a. 0%
b. 3%
c. 6%
d. 12%

Answer 4

b. 3%

Normal values of eosinophils are 1% to 4%.

Question 5

Which is a normal blood value for lymphocytes?

a. 5%
b. 10%
c. 30%
d. 60%

Answer 5

c. 30%

Normal values of lymphocytes are 20% to 40%.

Question 6

The spleen stores how many milliliters of blood that can be released in emergencies?

a. 500 mL (1 pint)
b. 1500 mL (3 pints)
c. 100 mL (1/5 pint)
d. 2000 mL (4 pints)

Answer 6

a. 500 mL (1 pint)

The spleen stores 1 pint of blood, which can be released during emergencies.

Question 7

Which nursing intervention does the nurse plan for a patient who has multiple myeloma?

a. Maintaining fluid intake of 3 to 4 L/day to dilute calcium load
b. Limiting activity to prevent pathological fractures
c. Administering narcotic analgesics continuously to control bone pain
d. Assessing for changes in size and characteristics of lymph nodes

Answer 7

a. Maintaining fluid intake of 3 to 4 L/day to dilute calcium load

Increase fluid intake to 3000 to 4000 mL/day.

Question 8

When developing a care plan for a patient just diagnosed with leukemia, which two nursing diagnoses are the most appropriate to use?

a. Deficient knowledge and Hopelessness
b. Risk for infection and Risk for injury
c. Ineffective coping and Chronic pain
d. Fatigue and Chronic pain

Answer 8

c. Ineffective coping and Chronic pain

Coping mechanisms may be strained because of pain, change of body image, or fear of death.

Question 9

A patient is to begin taking iron supplements. The nurse evaluates the patient’s understanding of the use of this drug. Which indicates that she has an adequate knowledge base?

a. Using antidiarrheal drugs if she has diarrhea
b. Understanding that black stools may occur
c. Checking her gums for bleeding
d. Brushing her teeth with a soft-bristled brush

Answer 9

b. Understanding that black stools may occur

An oral iron supplement may turn the stool black.

Question 10

A patient, age 24, is admitted with idiopathic thrombocytopenic purpura and a platelet count of 18,000/mm3. An appropriate nursing intervention would be to

a. monitor the administration of cryoprecipitate.
b. administer vitamin B12.
c. institute bleeding precautions.
d. use the Z-track method for DexFerrum administration.

Answer 10

c. institute bleeding precautions.

Significant risk for serious bleeding occurs when the count is below 20,000/mm3.

Question 11

The patient, age 35, is admitted with aplastic anemia. He asks the nurse what aplastic anemia is. An accurate response would be that

a. the activity of the bone marrow is depressed.
b. the bone marrow fails to produce lymphocytes.
c. the bone marrow fails to produce red blood cells.
d. red cells are absent as a result of chronic blood loss.

Answer 11

a. the activity of the bone marrow is depressed.

Aplastic anemia or aplasia (a hematological term for a failure of the normal process of cell generation and development) has two etiologic classifications: congenital and acquired. All three major blood elements (RBCs, WBCs, platelets) are reduced or absent.

Question 12

The patient has agranulocytosis with a neutrophil count of 10%. The most important nursing intervention would be

a. restoring fluid volume deficit.
b. providing oxygen per mask.
c. instituting bleeding precautions.
d. avoiding infection.

Answer 12

d. avoiding infection.

Nursing interventions are directed toward protecting the patient from potential sources of infection. Neutrophils ingest bacteria and dispose of dead tissue. They are the primary phagocytic cells involved in acute inflammatory response.

Question 13

A patient, age 52, is admitted with thrombocytopenia. The most important nursing intervention to prevent hemorrhage in this patient is to

a. prevent trauma and falling.
b. avoid catheterization.
c. monitor vitals every hour.
d. begin immunocompromised (neutropenic) precautions.

Answer 13

a. prevent trauma and falling.

An understanding of the disease process and causative agents is necessary in forming a knowledge base for self-care and prevention of trauma and infection. Instruction on signs and symptoms, as well as preventive measures, must be given.

Question 14

Hematological diseases are often associated with skin impairment. Petechiae and ecchymoses are seen in

a. iron-deficiency anemia.
b. pernicious anemia.
c. hemophilia A.
d. agranulocytosis.

Answer 14

c. hemophilia A.

In hemophilia A, the more common type which represents 85% of the total incidence, antihemophilic factor VIII is absent. This factor is essential for conversion of prothrombin to thrombin through thromboplastin component.

Question 15

The typical medical treatment of polycythemia vera involves

a. transfusion of packed cells.
b. therapeutic phlebotomy.
c. cryoprecipitate infusion.
d. appendectomy.

Answer 15

b. therapeutic phlebotomy.

Repeated phlebotomy decreases blood viscosity.

Question 16

A patient, age 23, is admitted with enlarged lymph nodes, decreased production of RBCs, thrombocytopenia, and a severe increase in his WBC count. A bone-marrow aspiration shows abnormal lymphocytes present. These abnormalities are present in which disease?

a. Thrombocytopenia
b. Hemophilia
c. Acute leukemia

Answer 16

c. Acute leukemia

Bone marrow biopsy shows immature leukocytes. Chest radiographic examination may show mediastinal node and lung involvement and bone changes. Sickle cell anemia, hemophilia, and thrombocytopenia do not usually have elevated WBC count.

Question 17

The patient, age 44, has polycythemia vera. The nurse recognizes that the primary pathophysiologic feature of this disorder is

a. hyperproduction of erythropoietin.
b. capillary fragility and hemorrhage.
c. fatty infiltration of the bone marrow.
d. increase in red blood cells and hemoglobin and hyperviscosity.

Answer 17

d. increase in red blood cells and hemoglobin and hyperviscosity.

Polycythemia vera is characterized by erythrocytosis (an abnormal increase in the number of circulating red blood cells) and also increased production of granulocytes and platelets.

Question 18

Many older adults suffer from conditions such as colonic diverticula, hiatal hernia, and ulcerations that can cause occult bleeding. Older adults with these conditions should be observed for

a. leukemia.
b. iron deficiency anemia.
c. sickle cell anemia.
d. polycythemia.

Answer 18

b. iron deficiency anemia.

Blood loss is a major cause of iron deficiency in adults. The major sources of chronic blood loss are from the GI and genitourinary systems.

Question 19

The nurse is administering a blood transfusion to an older adult for hypovolemic shock. During the transfusion, which nursing intervention would be the most important?

a. Prevention of infection
b. Balanced nutritional diet with sodium reduction
c. Cardiopulmonary function assessment
d. Monitoring of hemoglobin and hematocrit levels

Answer 19

c. Cardiopulmonary function assessment

Administer blood products with caution because older adults are at increased risk of developing congestive heart failure. Careful assessment of cardiopulmonary function and intake and output is essential.

Question 20

The spleen is a highly vascularized organ located in the left upper quadrant of the abdominal cavity. The main functions of the spleen are (Select all that apply)

a. Serve as reservoir for blood
b. Destroy worn-out RBCs
c. Promote phagocytosis
d. Responsible for development of T Lymphocytes
e. Continuously produce RBCs during lifetime

Answer 20

a. Serve as reservoir for blood
b. Destroy worn-out RBCs
c. Promote phagocytosis

The spleen stores 1 pint of blood, which can be released during emergencies, such as hemorrhage, in less than 60 seconds. The main functions of the spleen are (1) to serve as a reservoir for blood; (2) to form lymphocytes, monocytes, and plasma cells; (3) to destroy worn-out RBCs; (4) to remove bacteria by phagocytosis (engulfing and digesting); and (5) to produce RBCs before birth (the spleen is believed to produce RBCs after birth only in cases of extreme hemolytic anemia).

Question 21

_____________ are leukocytes which destroy and remove cellular waste, bacteria, and solid particles.

Answer 21

Neutrophils

(granular circulating leukocytes essential for phagocytosis, the process by which bacteria, cellular debris, and solid particles are destroyed and removed) ingest bacteria and dispose of dead tissue.

Question 22

The organ that forms lymphocytes is the

Answer 22

spleen

are to serve as a reservoir for blood; form lymphocytes, monocytes, and plasma cells; destroy worn-out RBCs; remove bacteria by phagocytosis; and produce RBCs before birth.

Question 23

Replaces iron stores needed for RBC development

a. Folic acid
b. Ferrous sulfate
c. Vitamin B12
d. Neupogen

Answer 23

b. Ferrous sulfate

Question 24

Needed for adequate nerve functioning

a. Folic acid
b. Ferrous sulfate
c. Vitamin B12
d. Neupogen

Answer 24

c. Vitamin B12

Question 25

Stimulates proliferation and differentiation of neutrophils

a. Folic acid
b. Ferrous sulfate
c. Vitamin B12
d. Neupogen

Answer 25

d. Neupogen

Question 26

Needed for erythropoiesis

a. Folic acid
b. Ferrous sulfate
c. Vitamin B12
d. Neupogen

Answer 26

a. Folic acid

Question 27

Where are Leukocytes/White Blood Cells (WBC) derived from?

Answer 27

derived from hemocytoblasts in the red bone marrow.

Question 28

What is the “life-cycle” of RBC’s?

Answer 28

RBC’s live in circulation 120 days. The aging cell is then broken down in the spleen and converted into billirubin which is excreted in bile into the intestines.

Question 29

What is the normal range for a White Blood Cell (WBC) count?

Answer 29

5,000-10,000

Question 30

What are the functions of Neutrophils?

Answer 30

+++FIRST RESPONDER+++ - attracted by chemicals to damaged tissue and are the first WBC to respond to tissue damage. They engulf bacteria and cellular debris by phagaocytosis.

Question 31

glossitis

Answer 31

inflammation of the tongue

Question 32

pagophagia

Answer 32

desire to eat ice, clay or starches

Question 33

leukemia

Answer 33

-is a malignant disorder
excess of leukocytes accumulates in the bone marrow and lymph nodes
increased susceptibility to infection results

Question 34

hemolysis

Answer 34

breakdown of red blood cells

Question 35

intervention for hypoxia

Answer 35

place the patient in a sitting position

Question 36

disseminated intravascular disease DIC

Answer 36

is a grave coagulopathy resulting from the overstimulation of clotting and anticlotting processes in response to disease or injury, including septicemia, obstetric complication, malignancies, tissue trauma, transfusion reaction, burns, shock, and snake bites

Question 37

A nurse is collecting data on a 12-month-old child with iron deficiency anemia. Which of the following findings would the nurse expect to note in this child?

1. Bradycardia
2. Tachycardia
3. Hyperactivity
4. A reddened appearance to the cheeks

Answer 37

2. Tachycardia

Rationale: Clinical manifestations of iron deficiency anemia will vary with the degree of anemia but usually include extreme pallor with porcelain-like skin, tachycardia, lethargy, and irritability.

Question 38

A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic, and the nurse prepares to implement protective isolation procedures. Which interventions would the nurse initiate? Select all that apply.

1. Restrict all visitors.
2. Place the child on a low-bacteria diet.
3. Change dressings using sterile technique.
4. Encourage the consumption of fresh fruits and vegetables.
5. Perform meticulous handwashing before caring for the child.
6. Allow fresh-cut flowers in the room as long as they are kept in a vase with fresh water.

Answer 38

2. Place the child on a low-bacteria diet.
3. Change dressings using sterile technique.
4. Perform meticulous handwashing before caring for the child.

Rationale: For the hospitalized neutropenic child, flowers or plants should not be kept in the room because standing water and damp soil harbor Aspergillus and Pseudomonas, to which these children are very susceptible. Fruits and vegetables not peeled before being eaten harbor molds and should be avoided until the white blood cell count rises. The child is placed on a low-bacteria diet. Dressings are always changed with sterile technique. Not all visitors need to be restricted, but anyone who is ill should not be allowed in the child’s room. Meticulous handwashing is required before caring for the child. Additionally, gloves, a mask, and a gown are worn (per agency policy).

Question 39

A nurse is monitoring the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse prepares to implement bleeding precautions if the child becomes thrombocytopenic and the platelet count is less than:

1. 20,000/mm3
2. 100,000/mm3
3. 120,000/mm3
4. 150,000/mm3

Answer 39

1. 20,000/mm3

Rationale: If a child is severely thrombocytopenic, with a platelet count of less than 20,000/mm3, precautions need to be taken because of the increased risk of bleeding. The precautions include limiting activity that could result in head injury, using soft toothbrushes or Toothettes, checking urine and stools for blood, and administering stool softeners to prevent straining with constipation. Additionally, suppositories and rectal temperatures are avoided. The normal platelet count ranges from 150,000 to 400,000/mm3.

Question 40

A nursing student is assigned to care for a child with hemophilia. The nursing instructor reviews the plan of care with the student and asks the student to describe the characteristics of this disorder. Which statement by the student indicates a need for further research?

1. Hemophilia is inherited in a recessive manner via a genetic defect on the X chromosome.
2. Males inherit hemophilia from their fathers.
3. Females inherit the carrier status from their fathers.
4. Hemophilia A results from deficiency of factor VIII.

Answer 40

2. Males inherit hemophilia from their fathers.

Rationale: Males inherit hemophilia from their mothers, and females inherit the carrier status from their fathers. Some females who are carriers have an increased tendency to bleed, and, although it is rare, females can have hemophilia if their fathers have the disorder and their mothers are carriers of the genetic disorder. Hemophilia is inherited in a recessive manner via a genetic defect on the X chromosome. Hemophilia A results from a deficiency of factor VIII. Hemophilia B (Christmas disease) is a deficiency of factor IX.

Question 41

A nurse is reviewing the laboratory results of a child with aplastic anemia and notes that the white blood cell (WBC) count is 2000/L and the platelet count is 150,000/mm3. Which of the following nursing interventions will the nurse incorporate into the plan of care?

1. Maintain strict isolation precautions.
2. Encourage the child to use a soft toothbrush.
3. Avoid unnecessary injections.
4. Encourage quiet play activities.

Answer 41

1. Maintain strict isolation precautions.

Rationale: The normal WBC ranges from 5000 to 10,000/L and the normal platelet count ranges from 150,000 to 400,000/mm3. Strict isolation procedures would be required if the WBC count were low to protect the child from infection. Precautionary measures to prevent bleeding should be taken when a child has a low platelet count. These include no injections, no rectal temperatures, use of a soft toothbrush, and abstinence from contact sports or activities that could cause an injury.

Question 42

A nurse tells the client with leukemia that allopurinol (Zyloprim) has been added to the medication list. The client is currently receiving busulfan (Myleran). When the client asks the purpose of the new medication, the nurse responds that the allopurinol is intended to prevent:

1. Alopecia
2. Diabetes
3. Arthritis
4. Hyperuricemia

Answer 42

4. Hyperuricemia

Rationale: Busulfan is an antineoplastic agent used in the treatment of acute myelocytic leukemia and in the palliative treatment of chronic myelogenous leukemia. This therapy can cause blood dyscrasias, leading to hyperuricemia. The client is then at risk of experiencing uric acid nephropathy, renal stones, and acute renal failure. Allopurinol, an antigout medication, is used with chemotherapy to prevent or treat this complication of therapy. It also may be used in mouthwash following fluorouracil (Adrucil) therapy to prevent stomatitis. Allopurinol is not used to prevent alopecia or diabetes.