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Advanced Pathophysiology > Chapter 3: Hematopoeisis > Flashcards

Chapter 3: Hematopoeisis Flashcards

1
Q
  1. With the exception of the first two steps, what is required in all steps of the clotting process?
    A) Calcium
    B) Prothrombin
    C) Tissue factor
    D) Plasminogen
A

A) Calcium

calcium ions are responsible for fully activating several coagulation factors, including coagulation factor XIII (FXIII).

Accelerating clot formation
Calcium ions speed up the formation of a visible clot when thrombin is added to plasma or fibrinogen.

Making clots less soluble
Calcium chloride makes clots less soluble in 30% urea.

Promoting platelet adherence
Calcium is required for factor VHI-von Wille-brand factor to facilitate platelet adherence.

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2
Q
  1. The first step of hemostasis occurs as a:
    A) fibrin clot.
    B) platelet plug.
    C) clot retraction.
    D) vessel spasm.
A

D) vessel spasm.

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3
Q
  1. To form a platelet plug, platelets are attracted to the damaged vessel, and then platelet_____occurs.
    A) adhesion
    B) fibrinolysis
    C) thrombosis
    D) thromboxane A2
A

A) adhesion

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4
Q
  1. Blood coagulation is initiated by either of two pathways. The intrinsic pathway requires circulating to begin the step-wise coagulation cascade.
    A) protein C
    B) thrombin
    C) factor XII
    D) tissue factor
A

C) factor XII

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5
Q
  1. Increased platelet function, and consequent hypercoagulability, can be caused by:
    A) factor V mutation.
    B) platelet insensitivity.
    C) vascular wall damage.
    D) decreased platelet numbers.
A

C) vascular wall damage.

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6
Q
  1. Immune thrombocytopenia purpura (ITP) is a/an_____disorder that destroy____.

A) allergic; fibrinogen
B) alloimmune; factor VIII
C) autoimmune; platelets
D) immunoglobulin; B cells

A

C) autoimmune; platelets

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7
Q
  1. Thrombotic thrombocytopenic purpura (TTP) causes which of the following manifestations? Select all that apply.
    A) Purpura
    B) Jaundice
    C) Petechiae
    D) Erythema
    E) Confusion
A

A) Purpura
C) Petechiae
E) Confusion

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8
Q
  1. Hemophilia A is a hereditary blood disorder caused by inadequate activity or absent:
    A) factor VIII.
    B) prothrombin.
    C) vWF complex.
    D) intrinsic factor.
A

A) factor VIII.

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9
Q

10 In persons with a bleeding disorder caused by vascular defects, laboratory
. tests will most often reveal:
A) normal values.
B) hypocalcemia.
C) polycythemia.
D) thrombocytopenia.

A

A) normal values.

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10
Q
  1. Disseminated intravascular coagulation (DIC) is characterized by:
    A) headaches.
    B) platelet loss.
    C) hypertension.
    D) hemorrhage.
A

D) hemorrhage.

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11
Q

11 Removal of a patients peripheral intravenous catheter resulted in brief
. bleeding and the loss of a small amount of blood. Which of the following processes occurred during the formation of the platelet plug that helped to stop blood flow?
A) Activation of factor X
B) Conversion of prothrombin to thrombin
C) Release of von Willebrand factor from the epithelium
D) Conversion of fibrinogen to fibrin threads

A

C) Release of von Willebrand factor from the epithelium

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12
Q

12 A 69-year-old patient who is obese and has a diagnosis of angina pectoris
. has been prescribed clopidogrel (Plavix) by his primary care provider. The patients medication achieves its therapeutic effect in which of the following ways?
A) Prevention of platelet aggregation
B) Activation of plasminogen
C) Inhibition of the intrinsic clotting pathway
D) Deactivation of factor X

A

A) Prevention of platelet aggregation

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13
Q

13 A public health nurse is conducting a health promotion campaign under the
. auspices of the local community center. Which of the following measures that the nurse is promoting are likely to influence the participants risk of hypercoagulability disorders? Select all that apply.
A) Smoking cessation
B) Blood glucose screening
C) Weight management
D) Cholesterol screening and management
E) Blood pressure screening and management

A

A) Smoking cessation
B) Blood glucose screening
C) Weight management
D) Cholesterol screening and management
E) Blood pressure screening and management

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14
Q

14 During a patients admission assessment prior to reduction mammoplasty
. surgery, the nurse notes a reference to a Leiden mutation in the patients history. The nurse would recognize the patients increased risk for
A) Hemorrhage
B) Myocardial infarction
C) Hemophilia A or B
D) Deep vein thrombosis

A

D) Deep vein thrombosis

An inherited blood-clotting disorder due to a change in of the blood’s factor V protein.
Factor V Leiden (FAK-tur five LIDE-n) increases the chance of having clumps of blood, known as clots. This can be life-threatening. Women with the disorder risk developing blood clots during pregnancy or when taking the hormone estrogen.

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15
Q

15 The most recent blood work of a patient with a diagnosis of acute
. myelogenous leukemia (AML) reveals thrombocytopenia. Where is the patient most likely to experience abnormal bleeding as a result of low platelets?
A) In the brain
B) Skin and mucous membranes
C) Sclerae of the eyes
D) Nephrons and ureters

A

B) Skin and mucous membranes

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16
Q

16 A patient was started on a protocol for the prevention of deep vein
. thrombosis shortly after admission, and has been receiving 5000 units of heparin twice daily for the last 5 days. An immune response to this treatment may increase the patients chance of developing which health problem?
A) Antiphospholipid syndrome
B) Disseminated intravascular coagulation (DIC)
C) Von Willebrand disease
D) Thrombocytopenia

A

D) Thrombocytopenia

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17
Q

17 In light of the presence of numerous risk factors for coronary artery disease,
. a patients primary care provider has recommended that he take low-dose aspirin once daily. Doing so will reduce the patients risk of myocardial infarction by altering which of the following stages of hemostasis?
A) Vessel spasm
B) Platelet plug formation
C) Blood coagulation
D) Clot lysis

A

B) Platelet plug formation

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18
Q

18 A 23-year-old female patient has been diagnosed with von Willebrand
. disease following a long history of heavy periods and occasional nosebleeds.
Which of the patients following statements demonstrates a sound understanding of her new diagnosis?
A) Im really disappointed that I wont be able to do sports anymore.
B) I read on a website that I might have to get blood transfusions from time to time.
C) Ill make sure to take Tylenol instead of aspirin when I get aches and pains.
D) I hope my insurance covers the injections that Ill need to help my blood clot.

A

C) Ill make sure to take Tylenol instead of aspirin when I get aches and pains.

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19
Q

19 Which of the following patients likely faces the highest risk of an acquired
. hypocoagulation disorder and vitamin K deficiency?
A) A patient who has a diagnosis of liver failure secondary to alcohol abuse
B) A patient who has chronic renal failure as a result of type 1 diabetes mellitus
C) A patient who is immunocompromised as a result of radiation therapy for the treatment of lung cancer
D) A patient with dehydration and hypokalemia that have resulted from Clostridium difficileassociated diarrhea

A

A) A patient who has a diagnosis of liver failure secondary to alcohol abuse

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20
Q

20 A healthy, primiparous (first-time) mother delivered a healthy infant several
. hours ago, but the mother has experienced postpartum hemorrhage. Which of the following disorders is most likely to underlie the patients excessive bleeding after delivery?
A) Disseminated intravascular coagulation
B) Hemophilia A
C) Von Willebrand disease
D) Thrombotic thrombocytopenic purpura (TTP)

A

A) Disseminated intravascular coagulation

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21
Q
  1. Which of the following coenzymes is(are) necessary for normal red blood cell nuclear maturation and DNA synthesis pathway?
    A) Vitamin D
    B) Folate
    C) Calcium
    D) Vitamin B12 (cobalamin)
    E) Both folate and vitamin B12 (cobalamin)
A

E) Both folate and vitamin B12 (cobalamin)

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22
Q
  1. von Willebrand factor is directly involved in:
    A) platelet adhesion and aggregation.
    B) platelet production.
    C) formation of the fibrin clot.
    D) Clot dissolution
A

A) platelet adhesion and aggregation.

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23
Q
  1. are two important cofactors necessary in the coagulation cascade.
    A) Fibrinogen and von Willebrand factor
    B) Thromboxane A2 and calcium
    C) Fibrin and thrombin
    D) Fibrinogen and calcium
A

D) Fibrinogen and calcium

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24
Q
  1. A 50-year-old man is having an acute myocardial infarction and will be administered recombinant tissue plasminogen activator (t-PA). The medication activates plasminogen in order to:
    A) decrease platelet adhesion.
    B) increase clotting time.
    C) promote fibrinolysis.
    D) promote coronary vasodilation.
A

C) promote fibrinolysis.

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25
Q
  1. A 25-year-old woman comes in complaining of night sweats and at times gets chills. She is losing weight unintentionally. She has no other complaints. A lymph node in her neck that measures 3 cm and is painless is palpated. The most likely diagnosis is:
    A) non-Hodgkin lymphoma.
    B) Hodgkin lymphoma.
    C) Burkitt lymphoma.
    D) multiple myeloma.
A

B) Hodgkin lymphoma.

Hodgkin lymphoma usually starts in the upper body, such as the neck, chest, or armpits. Non-Hodgkin lymphoma can start in lymph nodes anywhere in the body

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26
Q
  1. In Hodgkin lymphoma, B cells can become defective as a result of:
    A) T-cell inactivation of B cells.
    B) premature apoptosis due to lack of differentiation.
    C) errors in immunoglobulin gene arrangements.
    D) enhanced conversion into plasma B memory cells.
A

C) errors in immunoglobulin gene arrangements.

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27
Q
  1. A 30-year-old man is complaining of cough, difficulty breathing, and fatigue that he has had for about a month. The cough is nonproductive and he denies fever. He attributes his symptoms to his asthma, which he had as a child. He borrowed an inhaler like he would use for his asthma but he states it doesn’t seem to be working. A chest X-ray reveals a mediastinal mass and mediastinal nodes. Based on these findings, which type of cancer is the most likely diagnosis?
    A) Hodgkin lymphoma
    B) Non-Hodgkin lymphoma
    C) Myelodysplastic syndrome
    D) Ewing sarcoma
A

A) Hodgkin lymphoma

28
Q
  1. Which of the following is a characteristic of non-Hodgkin lymphoma in comparison to Hodgkin lymphoma?
    A) It accounts for only 10% of all lymphomas.
    B) Reed-Sternberg cells are generally present.
    C) Multiple lymph nodes are usually involved.
    D) Incidence is higher in young adults.
A

C) Multiple lymph nodes are usually involved.

29
Q
  1. A mother brings in her 7-year-old son for an evaluation. The mother states her son has not been eating well. When questioned, the boy states he is not eating because he feels “bumps” in his neck and like his face is getting big. The mother notes that his face looks different. The family just moved from Africa. The vital signs are normal and his height and weight are appropriate for his age. Physical exam findings are unremarkable except for enlarged tonsils and asymmetrical facial bone distortion and nontender, enlarged lymph nodes palpated in his head and neck region. Based on these findings, which type of childhood lymphoma is the most likely diagnosis?
    A) Burkitt lymphoma
    B) Large-cell lymphoma
    C) Lymphoblastic lymphoma
    D) Hodgkin lymphoma
A

A) Burkitt lymphoma

Endemic: This is the most common type of Burkitt lymphoma. It typically affects children living in central Africa and is linked to the Epstein-Barr virus. This is the virus that causes mononucleosis. Children who have endemic Burkitt lymphoma usually develop tumors in their jaws or their facial bones.

Burkitt lymphoma is a type of B-cell non-Hodgkin lymphoma. It’s a rare type of cancer that often starts in people’s organs like their bellies (abdomen) or spleens. This condition typically affects children and, less frequently, younger adults.

30
Q
  1. Abnormal immunoglobulins known as M proteins and free light chains produced by plasma cells are characteristic of:
    A) non-Hodgkin lymphoma.
    B) multiple myeloma.
    C) myelodysplastic syndrome.
    D) acute myelogenous leukemia
A

B) multiple myeloma.

Abnormal immunoglobulin/ abnormal antibody (monoclonal protein = m protein)

31
Q
  1. Most lymphomas arise in:
    A) T cells.
    B) Reed-Sternberg cells.
    C) B cells.
    D) NK cells.
A

C) B cells.

32
Q
  1. A 66-year-old black man comes in complaining of back pain. Diagnostic tests are done and include an X-ray, a complete blood count with differential, and a comprehensive metabolic panel (e.g., glucose, potassium, calcium, albumin). Which findings are consistent with multiple myeloma?
    A) Hypocalcemia
    B) High platelet level
    C) High neutrophil count
    D) Diffuse well-defined “punched out” lytic lesions
A

D) Diffuse well-defined “punched out” lytic lesions

Multiple myeloma= altered B cell in bone marrow -> differentiate into abnormal plasma cell -> returns to bone marrow, releases cytokines -> decrease osteoblast, increase osteoclast

Hypercalcemia
Renal failure
Anemia
Bone lesions

33
Q
  1. A patient with myelodysplastic syndrome is at risk for the development of which of the following types of hematologic cancer?
    A) Acute myelogenous leukemia
    B) Acute lymphocytic leukemia
    C) Multiple myeloma
    D) Chronic lymphocytic leukemia
A

A) Acute myelogenous leukemia

1/3 MDS may develop AML

34
Q
  1. Which chromosomal abnormality is commonly associated with chronic myelogenous leukemia?
    A) Nondisjunction of chromosome 21
    B) Defects in the TP53 tumor suppressor gene
    C) Inversion at chromosome 22
    D) Translocation of chromosome 9 and 22 leading to a fusion protein known as BCR-ABL
A

D) Translocation of chromosome 9 and 22 leading to a fusion protein known as BCR-ABL

35
Q
  1. Abnormalities in which immature precursor leukocyte cells are associated with leukemia are known as:
    A) bands.
    B) blasts.
    C) reticulocytes.
    D) granulocytes.
A

B) blasts.

36
Q
  1. A 5-year-old child is brought in by his parents who report that she has not been eating well, and they think she is losing weight even though her belly looks bloated. They also noticed that she is limping when she walks. Physical examination reveals a pale, quiet girl. Small bruises are noted on her shins and upper arms. Her heart sounds and lung sounds are normal. She has hepatomegaly and splenomegaly. The remainder of the exam is normal. Which type of hematologic cancer should be suspected?
    A) Acute lymphoblastic leukemia
    B) Acute myelogenous leukemia
    C) Myeloblastic syndrome
    D) Non-Hodgkin lymphoma
A

A) Acute lymphoblastic leukemia

37
Q
  1. Iron-deficiency anemia is characterized by red blood cells that are:
    A) normocytic and normochromic.
    B) microcytic and hypochromic.
    C) macrocytic and normochromic.
    D) microcytic and normochromic.
A

B) microcytic and hypochromic.

38
Q
  1. A 60-year-old woman is diagnosed with iron deficiency anemia. The transferrin level is high with this type of anemia because:
    A) the microcytic RBCs are defective.
    B) there is not enough iron to bind.
    C) the body is trying to deliver more iron.
    D) more iron is stored.
A

C) the body is trying to deliver more iron.

39
Q
  1. A 5-year-old male child has a bleeding disease that is characterized by areas of hemorrhage in the joints and muscles after minor injuries. Laboratory tests reveal a deficiency of a coagulation factor active in the early phase of blood coagulation (formation of intrinsic thromboplastin). What is the most likely diagnosis?
    A) Thrombocytopenia
    B) Hemophilia
    C) Disseminated intravascular coagulation syndrome
    D) Protein C deficiency
A

B) Hemophilia

40
Q
  1. A 55-year-old woman has a hypochromic, microcytic anemia. The most likely cause is:
    A) vitamin B12 or folic acid deficiency.
    B) hemolysis of red blood cells due to autoantibodies.
    C) iron deficiency resulting from chronic gastrointestinal blood loss.
    D) replacement of bone marrow by metastatic tumor.
A

C) iron deficiency resulting from chronic gastrointestinal blood loss.

41
Q
  1. Which of the following is a common feature of all forms of leukemia?
    A) Reduction in leukocytes leading to bone marrow destruction
    B) Proliferation of malignant lymphocytes altering leukocyte production
    C) Tumor cell masses in the bone marrow that usually result in bone destruction
    D) Uncontrolled proliferation of malignant leukocytes causing an overcrowding of bone marrow and abnormal hematopoiesis
A

D) Uncontrolled proliferation of malignant leukocytes causing an overcrowding of bone marrow and abnormal hematopoiesis

42
Q
  1. A patient is diagnosed with a vitamin B12 deficiency. What dietary recommendations should be made to increase his B12 levels?
    A) Increase red meat consumption.
    B) Consume more lactose free products.
    C) Increase vegetable and reduce meat consumption.
    D) Increase fiber consumption.
A

A) Increase red meat consumption.

43
Q
  1. Parents just learned that their infant son has sickle cell anemia based on newborn screening. They want to know what kind of symptoms he might get from the disease. What would the parents be told?
    A) Symptoms at first usually consists of low back pain.
    B) Your baby’s hands and feet may swell.
    C) Your baby may become insensitive to pain.
    D) Your baby may develop a heart murmur.
A

B) Your baby’s hands and feet may swell.

44
Q
  1. Which of the following triggers can precipitate a sickle cell crisis?
    A) Fever
    B) Overhydration
    C) Dehydration
    D) Stress
    E) Fever, dehydration, and stress
A

E) Fever, dehydration, and stress

45
Q
  1. True or False? Large amounts of folic acid are stored in the body for long periods of time.
A

False

46
Q
  1. Sue is fatigued and some blood tests are done. Her results include Hct 40%; Hgb 8g/dL; WBC 8,000; platelets 175,000. The nurse should interpret Sues blood work as indicative of:
    A) high platelets/thrombocytosis.
    B) low WBC count/granulocytopenia.
    C) low hemoglobin/anemia.
    D) high hematocrit/polycythemia.
A

C) low hemoglobin/anemia.

47
Q
  1. Manifestations of anemia that are directly due to the diminished oxygen- carrying capacity of hemoglobin include:
    A) fatigue.
    B) bleeding.
    C) bone pain.
    D) pale skin.
A

A) fatigue.

48
Q
  1. When an Rh-negative mother has been sensitized and is pregnant with an Rh-positive fetus, what happens to the fetus?
    A) Bilirubin deficiency
    B) Nothing, this is normal
    C) Plasma volume depletion
    D) Profound red cell hemolysis
A

D) Profound red cell hemolysis

49
Q
  1. The patient is an average-sized adult and has abnormal microcytic hypochromic red blood cells due to a long-term, chronic disease. Which of the following CBC results is characteristic of her type of anemia?
    A) Hematocrit 44%
    B) Reticulocytes 1.5%
    C) Band cells 3,000/mL
    D) Hemoglobin 8 g/dL
A

D) Hemoglobin 8 g/dL

50
Q
  1. Megaloblastic anemias caused by folic acid or vitamin B12 deficiencies can seriously affect RBC production. This is because both are necessary for
    synthesis and .
    A) iron; hemoglobin adhesion
    B) DNA; red blood cell maturation
    C) thrombin; platelet aggregation
    D) protein; reticulocyte maturation
A

B) DNA; red blood cell maturation

51
Q
  1. Polycythemia develops in patients with lung disease as a result of:
    A) hyperventilation.
    B) chronic hypoxia.
    C) decreased blood viscosity.
    D) excessive respiratory fluid loss.
A

B) chronic hypoxia.

52
Q
  1. Which of the following types and characteristics of anemia are correctly matched?
    A) Hemolytic; abnormal iron uptake
    B) Iron deficiency; early RBC death
    C) Folate; decreased erythropoiesis
    D) Blood loss; bone marrow expansion
A

C) Folate; decreased erythropoiesis

53
Q
  1. Conditions that predispose to sickling of hemoglobin in persons with sickle cell anemia include:
    A) impaired red blood cell maturation.
    B) increased iron content of blood.
    C) decreased oxygen saturation.
    D) increased intravascular volume.
A

C) decreased oxygen saturation.

54
Q
  1. An elevated level of unconjugated bilirubin, due to hemolysis of RBCs, results in a high level of iron released and:
    A) diarrhea.
    B) cyanosis.
    C) numbness.
    D) jaundice.
A

D) jaundice.

55
Q

10 Hemolytic anemia is characterized by excessive red blood cell destruction
. and compensatory:
A) hypoactive bone marrow.
B) increased erythropoiesis.
C) iron retention in the body.
D) shrinkage of the spleen.

A

B) increased erythropoiesis.

56
Q

11 A 48-year-old male patient, who normally enjoys good health, has been
. admitted to the hospital for the treatment of polycythemia vera. The nurse who is providing care for the patient should prioritize assessments aimed at the early identification of which of the following health problems?
A) Orthostatic hypotension
B) Hyperventilation and respiratory alkalosis
C) Vasculitis
D) Thromboembolism

A

D) Thromboembolism

57
Q

12 Which of the following patients is most susceptible to experiencing the
. effects of inadequate erythropoiesis?
A) A patient who has developed renal failure as a result of longstanding hypertension
B) A patient who recently experienced an ischemic stroke and who remains bedridden
C) A patient whose heavy alcohol use has culminated in a diagnosis of pancreatitis
D) A patient whose estimated blood loss during recent surgery was 700 mL.

A

A) A patient who has developed renal failure as a result of longstanding hypertension

The kidney is the organ primarily responsible for regulation of erythropoiesis. Renal failure is associated with a decreased erythropoietin output resulting in a hypoproliferative anemia. Accompanying the uremic state is a moderate degree of hemolysis which also contributes to the development of anemia

58
Q

13 A 72-year-old woman with complaints of increasing fatigue has completed a
. series of fecal occult blood tests that indicate the presence of blood in her stool. Which of the following health problems is likely to accompany this patients gastrointestinal bleed?
A) Hemolytic anemia
B) Aplastic anemia
C) Iron-deficiency anemia
D) Megaloblastic anemia

A

C) Iron-deficiency anemia

59
Q

14 Hemoglobin solubility results and hemoglobin electrophoresis have resulted
. in a diagnosis of sickle cell anemia in an African American infant. The parents of the child should be aware that their child is at a significant risk for which of the following health problems? Select all that apply.
A) Acute pain
B) Stroke
C) Respiratory disease
D) Autoimmune diseases
E) Fractures

A

A) Acute pain
B) Stroke
C) Respiratory disease

60
Q

15 The pathologic effects of the thalassemias are primarily due to which of the
. following pathophysiologic processes?
A) Impaired hemoglobin synthesis
B) Impaired folic acid absorption
C) Erythropoietin deficiency
D) Loss of iron

A

A) Impaired hemoglobin synthesis

Thalassemia = mutated hgb gene
Hemolytic anemia

61
Q

16 Which of the following individuals likely faces the highest risk of
. megaloblastic anemia?
A) A 69-year-old woman who takes ASA four times daily to treat her arthritis
B) A 44-year-old man who lost approximately 500 mL of blood in a workplace accident
C) A 21-year-old college student who lives a vegan lifestyle
D) An infant who is exclusively fed commercial baby formula

A

C) A 21-year-old college student who lives a vegan lifestyle

Megaloblastic = low folate or vitamin b12 (pernicious anemia)

62
Q

17 For which of the following health problems is stem cell transplantation likely to be of therapeutic benefit?
A) Aplastic anemia
B) b-Thalassemias
C) Chronic disease anemias
D) Secondary polycythemia

A

A) Aplastic anemia

63
Q

18 A 68-year-old patient with an 80 pack/year history of smoking was
. diagnosed with emphysema 18 months ago. The patients most recent scheduled blood work showed red blood cell indices, a problem that suggests the need for which of the following interventions?
A) Vitamin B12 supplements
B) Increased supplementary oxygen therapy
C) Hemodialysis or peritoneal dialysis
D) Scheduled erythropoietin injections

A

B) Increased supplementary oxygen therapy

64
Q

19 Which of the following trends in the hematologic status of a 6-week-old
. infant most clearly warrants medical intervention?
A) Decreasing red blood cell counts
B) Increasing HgA levels
C) Decreasing hematocrit and mean corpuscular volume (MCV)
D) Increasing white blood cell counts

A

D) Increasing white blood cell counts

65
Q

20 A mother has brought her 2-week-old infant to the emergency department
. due to the babys persistent and increasing jaundice. Blood testing reveals that the infants unconjugated bilirubin level is 28 mg/dL and assessment does not reveal neurologic deficits. The infants weight is normal and the mother claims to have had no significant difficulty feeding the infant. The most likely treatment for this infant will be:
A) phototherapy.
B) packed red blood cell transfusion.
C) phlebotomy.
D) intravenous antibiotics.

A

A) phototherapy.

Advanced Pathophysiology (12 decks)

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