[Ex4] - C23 - AP

Question 1

23-1. A patient’s anemia is described as having erythrocytes that demonstrate poikilocytosis. The
nurse would recognize the erythrocytes would be:
a. pale in color.
b. present in various sizes.
c. able to assume various shapes.
d. live only a few days.

Answer 1

ANS: C
Poikilocytosis means the erythrocytes are able to assume various shapes; it does not refer to
color, size, and life span.

Question 2

23-2. A newborn is diagnosed with congenital intrinsic factor deficiency. Which of the following
types of anemia will the nurse see documented on the chart?
a. Iron deficiency
b. Pernicious
c. Sideroblastic
d. Hemolytic

Answer 2

ANS: B
A lack of the intrinsic factor leads to pernicious anemia. Iron deficiency anemia is not related
to the intrinsic factor. Pernicious anemia is due to the lack of the intrinsic factor; sideroblastic
anemia is not related to the intrinsic factor. Hemolytic anemia results from destruction of
cells.

Question 3

23-3. When a nurse is reviewing lab results and notices that the erythrocytes contain an abnormally
low concentration of hemoglobin, the nurse calls these erythrocytes:
a. hyperchromic.
b. hypochromic.
c. macrocytic.
d. microcytic.

Answer 3

ANS: B
Hypochromic erythrocytes have low concentrations of hemoglobin. Hyperchromic
erythrocytes have high concentrations of hemoglobin. Macrocytic and microcytic refer to cell
size.

Question 4

23-4. A 5 year old was diagnosed with normocytic-normochromic anemia. Which type of anemia
does the nurse suspect the patient has?
a. Sideroblastic
b. Hemolytic
c. Pernicious
d. Iron deficiency

Answer 4

ANS: B

Hemolytic anemia is an example of normocytic-normochromic anemia. Sideroblastic anemia
is an example of microcytic hypochromic anemia. Pernicious anemia is an example of a
macrocytic anemia. Iron deficiency anemia is an example of microcytic hypochromic anemia.

Question 5

23-5. After initial compensation, what hemodynamic change should the nurse monitor for in a
patient who has a reduction in the number of circulating erythrocytes?
a. Increased viscosity of blood
b. Decreased cardiac output
c. Altered coagulation
d. Hyperdynamic circulatory state

Answer 5

ANS: D
After initial compensation, the blood flows faster and more turbulently than normal blood,
causing a hyperdynamic circulatory state. Blood viscosity decreases rather than increases.
Cardiac output increases. Alteration in coagulation does not occur.

Question 6

23-6. A 25-year-old female has a heavy menses during which she loses a profuse amount of blood.
Which of the following adaptations should the nurse expect?
a. Movement of fluid into the cell
b. Decreased cardiac output
c. Decreased oxygen release from hemoglobin
d. Peripheral vasoconstriction

Answer 6

ANS: D
When the anemia is severe or acute in onset (e.g., hemorrhage), the initial compensatory
mechanism is peripheral blood vessel constriction, diverting blood flow to essential vital
organs. Fluid moves into the vascular space, not the cell. Blood volume increases; thus,
cardiac output increases. There is an increase in hemoglobin release of oxygen.

Question 7

23-7. A 60-year-old patient diagnosed with emphysema experiences a rapid and pounding heart,
dizziness, and fatigue with exertion. Which respiratory assessment findings indicate the
respiratory system is compensating for the increased oxygen demand?
a. Bronchoconstriction
b. Increased rate and depth of breathing
c. Dyspnea
d. Activation of the renin-angiotensin response

Answer 7

ANS: B
The rate and depth of breathing increase in an effort to increase oxygen availability
accompanied by an increase in the release of oxygen from hemoglobin. Bronchodilation
occurs, not constriction. Dyspnea is not a compensatory mechanism but a side effect of the
body’s attempt to increase oxygen. The respiratory system does not activate the
renin-angiotensin response; the kidneys are involved.

Question 8

23-8. A 2-year-old malnourished child is diagnosed with vitamin B12 and folate deficiencies. A
blood smear suggests the deficiency is macrocytic and normochromic. The nurse would
expect the hemoglobin to be:
a. normal.
b. sporadic.
c. low.
d. high.

Answer 8

ANS: A
The macrocytic (megaloblastic) anemias are characterized by unusually large stem cells
(megaloblasts) in the marrow that mature into erythrocytes that are unusually large in size
(macrocytic), thickness, and volume. The hemoglobin content is normal, thus allowing them
to be classified as normochromic.

Question 9

23-9. A 45 year old is diagnosed with macrocytic, normochromic anemia. The nurse suspects the
most likely cause of this condition is:
a. defective DNA synthesis.
b. abnormal synthesis of hemoglobin.
c. defective use of vitamin C.
d. blocked protein synthesis.

Answer 9

ANS: A
These anemias are the result of ineffective erythrocyte DNA synthesis; hemoglobin is normal.
These anemias are not related to use of vitamin C or blocked protein synthesis.

Question 10

23-10. A 35-year-old female is diagnosed with vitamin B12 deficiency anemia (pernicious anemia).
The most likely cause is a decrease in:
a. ferritin.
b. gastric enzymes.
c. intrinsic factor.
d. erythropoietin.

Answer 10

ANS: C
The underlying alteration in pernicious anemia (PA) is the absence of intrinsic factor (IF), an
enzyme required for gastric absorption of dietary vitamin B12, a vitamin essential for nuclear
maturation, and DNA synthesis in red blood cells. PA is not due to a decrease in ferritin,
gastric enzymes, or erythropoietin but to a lack of intrinsic factor.

Question 11

23-11. A 58-year-old female presents in the clinic with fatigue, weight loss, and tingling in her
fingers. Laboratory findings show low hemoglobin and hematocrit, a high mean corpuscular
volume, and normal plasma iron. These assessment findings are consistent with which type of
anemia?
a. Hemolytic anemia
b. Pernicious anemia
c. Iron deficiency anemia
d. Aplastic anemia

Answer 11

ANS: B
Pernicious anemia is manifested by tingling paresthesias of feet and fingers. The
symptomology is not associated with hemolytic, iron deficiency, or aplastic anemias.

Question 12

23-12. Which individual should the nurse assess initially for a vitamin B12 deficiency anemia?
a. A 3-year-old female who is a fussy eater
b. A 26-year-old female in the second trimester of her first pregnancy
c. A 47-year-old male who had a gastrectomy procedure
d. A 64-year-old male with a history of duodenal ulcers

Answer 12

ANS: C

With removal of the stomach, the intrinsic factor is also removed, leading to an inability to
absorb B12; thus, the person with removal of the stomach is at greatest risk. Being a fussy
eater, being pregnant, and having a history of duodenal ulcers are not risk factors for vitamin
B12 deficiency anemia.

Question 13

23-13. A 65 year old experienced loss of appetite, weight loss, lemon-yellow skin, liver enlargement,
and a beefy red tongue shortly before her death. Autopsy suggested pernicious anemia, and
the cause of death would most likely reveal:
a. brain hypoxia.
b. liver hypoxia.
c. heart failure.
d. kidney failure.

Answer 13

ANS: C
When the hemoglobin has decreased to 7–8 grams per deciliter, the individual experiences the
classic symptoms of anemia: weakness, fatigue, paresthesias of feet and fingers, difficulty
walking, loss of appetite, abdominal pain, weight loss, and a sore tongue that is smooth and
beefy red. The skin may become lemon yellow (sallow), which is caused by a combination of
pallor and jaundice. Hepatomegaly, indicating right-sided heart failure, may be present in the
elderly. The symptoms are not associated with brain or liver hypoxia, or kidney failure.

Question 14

23-14. A 40-year-old male’s history includes being a vegetarian and abusing alcohol. Which of the
following factors put him at greatest risk for developing folate deficiency anemia?
a. Being vegetarian
b. Being alcoholic
c. Age
d. Gender

Answer 14

ANS: B
Folate deficiency occurs more often in alcoholics and individuals who are malnourished
because of fad diets or diets low in vegetables. Being alcoholic promotes the greatest risk,
since this disorder is diet related. A diet high in vegetables would help prevent folate
deficiency. Age is not a factor in folate deficiency. Gender is not a factor in folate deficiency.

Question 15

23-15. A patient who demonstrates chronic gastrointestinal bleeding is diagnosed with anemia. What
is the primary cause of the patient’s anemia?
a. Vitamin B12 deficiency
b. Iron deficiency
c. Folate deficiency
d. Bone marrow failure

Answer 15

ANS: B
A continuous loss of blood is one of the most common causes of iron deficiency anemia
(IDA). Gastrointestinal bleeding does not lead to vitamin B12 deficiency, folate deficiency, or
bone marrow failure.

Question 16

23-16. The nurse will check which of the following tests to directly measure iron stores?
a. Serum ferritin
b. Transferrin saturation
c. Bone marrow biopsy
d. Total iron-binding capacity

Answer 16

ANS: C
Iron stores are measured directly by bone marrow biopsy, not serum ferritin, transferrin
saturation, and total iron-binding capacity.

Question 17

23-17. A 21-year-old female was recently diagnosed with iron deficiency anemia. In addition to
fatigue and weakness, which of the following clinical signs and symptoms would she most
likely exhibit?
a. Hyperactivity
b. Spoon-shaped nails
c. Gait problems
d. Petechiae

Answer 17

ANS: B
Iron deficiency anemia is manifested by fingernails that become brittle and spoon shaped or
concave. It does not involve hyperactivity, gait problems, or petechiae.

Question 18

23-18. A 21-year-old woman was recently diagnosed with iron deficiency anemia. Her hematocrit is
32%. Which of the following treatments would the nurse expect to be prescribed for her?
a. Iron replacement
b. Splenectomy
c. A bone marrow transplant
d. No treatment is necessary

Answer 18

ANS: A
Iron replacement therapy is required and very effective. Initial doses are 150–200 milligrams
per day and are continued until the serum ferritin level reaches 50 milligrams per liter. Neither
a splenectomy nor a bone marrow transplant is indicated.

Question 19

23-19. A 45-year-old male is diagnosed with sideroblastic anemia. When he asks what the most
likely cause of this disease is, what is the nurse’s best response?
a. Ineffective iron uptake and abnormal hemoglobin production
b. Misshapen erythrocytes with low hemoglobin
c. Decreased levels of tissue iron with megaloblastic erythrocytes
d. Premature erythrocyte destruction and erythropoietin deficiency

Answer 19

ANS: A
Sideroblastic anemia is due to ineffective iron uptake and hemoglobin production.
Erythrocytes are neither misshapen, premature, nor destroyed in sideroblastic anemia.
Sideroblastic anemia is not associated with decreased levels of tissue iron with megaloblastic
erthrocytes.

Question 20

23-20. A 50-year-old female was diagnosed with sideroblastic anemia. Which of the following
assessment findings would most likely occur?
a. Bronze-colored skin
b. Decreased iron
c. Normochromic erythrocytes
d. Aplastic bone marrow

Answer 20

ANS: A

The skin of the patient with sideroblastic anemia is bronze in color. The patient with
sideroblastic anemia shows signs of iron overload. The erythrocytes of individuals with
sideroblastic anemia are hypochromic. The bone marrow is not aplastic but contains ringed
sideroblasts.

Question 21

23-21. Lab results showing high iron, bilirubin, and transferrin and low hemoglobin and hematocrit
would support a diagnosis of which form of anemia?
a. Pernicious
b. Folate deficiency
c. Iron deficiency
d. Sideroblastic

Answer 21

ANS: D
Individuals with sideroblastic anemia may show signs of iron overload (hemosiderosis),
including mild to moderate enlargement of the liver (hepatomegaly) and spleen
(splenomegaly). High levels of iron indicate sideroblastic anemia, not pernicious anemia,
folate deficiency, or iron deficiency anemia.

Question 22

23-22. Considering anemia, what effect do vitamin B12 and folate deficiencies have on red blood
cells?
a. They are unable to differentiate into erythrocytes.
b. They contain malformed hemoglobin molecules.
c. O2-carrying capacity is decreased.
d. Their life span is shorter.

Answer 22

ANS: D
These deficiencies lead to defective erythrocytes that die prematurely, which decreases their
numbers in the circulation, causing anemia. These deficiencies do not cause the RBCs to lack
differentiation, contain malformed hemoglobin, or experience diminished O2-carrying
capacity.

Question 23

23-23. Aplastic anemia is caused by:
a. iron deficiency.
b. excess levels of erythropoietin.
c. hemolysis.
d. stem cell deficiency.

Answer 23

ANS: D
In aplastic anemia, erythrocyte stem cells are underdeveloped, defective, or absent; iron is not
deficient, there are no excess levels of erythropoietin, nor do cells undergo hemolysis.

Question 24

23-24. A 57-year-old male presents to his primary care provider for red face, hands, feet, ears, and
headache and drowsiness. A blood smear reveals an increased number of erythrocytes,
indicating:
a. polycythemia vera (PV).
b. leukemia.
c. sideroblastic anemia.
d. hemosiderosis.

Answer 24

ANS: A

PV is characterized by excessive proliferation of erythrocyte precursors in the bone marrow.
Leukemia is not manifested by changes in erythrocytes. Sideroblastic anemia is characterized
by sideroblastic rings. Hemosiderosis is iron overload.

Question 25

23-25. A 67-year-old female is admitted to the emergency department with a diagnosis of
polycythemia vera. Upon taking the history, the patient will most likely report:
a. hyperactivity.
b. decreased blood pressure.
c. chest pain.
d. a pale skin color.

Answer 25

ANS: C
Coronary blood flow may be affected, precipitating angina. Patients will experience signs of
interrupted blood flow due to increased blood viscosity. They will not experience
hyperactivity. Blood pressure will be increased, not decreased. The skin will be red over the
face hands, feet, and ears.

Question 26

23-26. A 68-year-old is admitted to the emergency department with a diagnosis of polycythemia vera
(PV). A nurse realizes the patient’s symptoms are mainly the result of:
a. a decreased erythrocyte count.
b. rapid blood flow to the major organs.
c. increased blood viscosity.
d. vessel injury.

Answer 26

ANS: C
The symptoms of PV are due to increased blood viscosity, the erythrocyte count is elevated,
there will be decreased blood flow to tissues and organs but vessel injury does not occur.

Question 27

23-27. A patient is admitted to the emergency department with a diagnosis of polycythemia vera
(PV). Which treatment should the nurse discuss with the patient?
a. Therapeutic phlebotomy
b. Restoration of blood volume by plasma expanders
c. Administration of packed red blood cells
d. Iron replacement therapy

Answer 27

ANS: A
Treatment of PV is phlebotomy to reduce red cell mass and blood volume; increasing blood
volume will increase symptoms as will the administration of additional cells and iron
replacement therapy.

Question 28

23-28. A 70 year old is brought to the emergency department, where he dies shortly thereafter.
Autopsy reveals polycythemia vera (PV). His death was most likely the result of:
a. acute renal failure.
b. cerebral thrombosis.
c. sepsis.
d. acute leukemia.

Answer 28

ANS: B
Fifty percent of individuals with PV die within 18 months of the onset of initial symptoms
because of thrombosis or hemorrhage, not renal failure, infection and sepsis, and acute
leukemia.

Question 29

23-29. When the nurse sees a diagnosis of hereditary hemochromatosis on the chart, the nurse knows
this is a disorder of:
a. intravascular coagulation.
b. iron overload.
c. leukocytosis.
d. granulocytosis.

Answer 29

ANS: B
Iron overload can be primary, as in hereditary hemochromatosis. Hemochromatosis is not
associated with coagulation, leukocytosis, or granulocytosis.

Question 30

23-30. A 67-year-old male was diagnosed with polycythemia vera (PV) but refused treatment. His
condition is at risk for converting to:
a. chronic lymphocytic leukemia.
b. Burkitt lymphoma.
c. multiple myeloma.
d. acute myeloid leukemia.

Answer 30

ANS: D
A significant potential outcome of PV is the conversion to acute myeloid leukemia (AML),
occurring spontaneously in 10% of individuals and generally being resistant to conventional
therapy. Neither chronic lymphocytic leukemia, Burkitt lymphoma, nor multiple myeloma is a
significant outcome of PV.

Question 31

23-31. Leukocytosis can be defined as:
a. a normal leukocyte count.
b. a high leukocyte count.
c. a low leukocyte count.
d. another term for leukopenia.

Answer 31

ANS: B
Leukocytosis is present when the count is higher than normal. It is not another term for
leukopenia.

Question 32

23-32. What is the most likely cause of the eosinophilia?
a. Parasitic invasion and allergic reactions
b. Viral and bacterial infections
c. Stress and anxiety reactions
d. Fungal infections and delayed hypersensitivity

Answer 32

ANS: A
Parasitic invasions and allergic disorders are associated with eosinophilia. Viral infections do
not lead to eosinophilia nor do stress and anxiety reactions or fungal infections.

Question 33

23-33. A 15-year-old female presents with splenomegaly, hepatomegaly, and lymph node
enlargement. She is diagnosed with infectious mononucleosis. What should the nurse tell the
patient about the recovery time?
a. 72 hours
b. 3–5 days
c. A few weeks
d. 6 months

Answer 33

ANS: C
Infectious mononucleosis (IM) is usually self-limiting, and recovery occurs in a few weeks;
severe clinical complications are rare (5%). Fatigue may last for 1–2 months after resolution
of other symptoms.

Question 34

23-34. A 35-year-old male with hyperthyroidism begins treatment to decrease thyroid activity. A
nurse monitors for which of the following conditions that could result secondary to the
treatment?
a. Eosinophilia
b. Basophilia
c. Monocytosis
d. Lymphocytosis

Answer 34

ANS: B
Basophilia results from antithyroid therapy. Antithyroid therapy is not associated with
eosinophilia, monocytosis, or lymphocytosis.

Question 35

23-35. A 15-year-old male is diagnosed with infectious mononucleosis (IM). When the patient asks
how he got this disease, how should the nurse respond? The most likely cause is:
a. adenovirus.
b. Epstein-Barr virus (EBV).
c. cytomegalovirus (CMV).
d. Toxoplasma gondii.

Answer 35

ANS: B
Infectious mononucleosis (IM) is an acute infection of B lymphocytes (B cells) with EBV. IM
is not associated with adenovirus, cytomegalovirus, or T. gondii.

Question 36

23-36. A 15-year-old male with infectious mononucleosis is being given instructions on how to
prevent the spread of this infection to others. Which statement represents a correct
instruction?
a. Wear a surgical mask when others are in the room.
b. Do not share drinking glasses or eating utensils.
c. Avoid all contact with other people.
d. No precautions are necessary.

Answer 36

ANS: B
Transmission of mononucleosis is usually through saliva from close personal contact. The
virus also may be secreted in other mucosal secretions of the genital, rectal, and respiratory
tract, as well as blood. A surgical mask is not necessary because the disorder is not airborne.
The patient does not need to avoid all contact, but precautions should be taken.

Question 37

23-37. A 10 year old is diagnosed with leukemia. The nurse assesses for which other condition that
could be associated with his disease?
a. Down syndrome
b. Hemophilia
c. Hyperthyroidism
d. Pheochromocytoma

Answer 37

ANS: A

There is also an increased incidence of leukemia in association with other hereditary
abnormalities such as Down syndrome, not hemophilia, hyperthyroidism, and
pheochromocytoma.

Question 38

23-38. A 5 year old is diagnosed with acute leukemia. The patient will mostly likely be treated with:
a. bone marrow transplant.
b. immunotherapy.
c. chemotherapy.
d. localized radiation therapy.

Answer 38

ANS: C
Chemotherapy, used in various combinations, is the treatment of choice for leukemia.
Neither bone marrow transplant, immunotherapy, nor localized radiation therapy is considered
the treatment of choice for leukemia.

Question 39

23-39. A 35-year-old female is diagnosed with lymphadenopathy. Which assessment finding will
help confirm this diagnosis?
a. Small, hard lymph nodes
b. Disordered lymph nodes
c. Nonpalpable, nontender lymph nodes
d. Enlarged lymph nodes

Answer 39

ANS: D
Lymphadenopathy is evidenced by enlarged lymph nodes, not small, hard, disordered, or
nonpalpable nodes.

Question 40

23-40. A 35-year-old male has enlarged lymph nodes in the neck and a mediastinal mass. He was
diagnosed with Hodgkin lymphoma. Which of the following abnormal cells would the nurse
expect to find with this disease?
a. Merkel cell
b. Schwann cell
c. Reed-Sternberg cell
d. Kupffer cell

Answer 40

ANS: C
Hodgkin lymphoma is manifested by Reed-Sternberg cells, not Merkel cells, Schwann cells,
and Kupffer cells.

Question 41

23-41. The people from which country have the lowest risk for Hodgkin lymphoma?
a. United States
b. Japan
c. Denmark
d. Netherlands

Answer 41

ANS: B
Japan has the lowest rate of Hodgkin lymphoma. The United States, the Netherlands, and
Denmark have among the highest rates.

Question 42

23-42. A 62 year old reports experiencing regular night sweats and unintentionally losing weight.
Physical exam reveals enlarged neck lymph nodes that do not appear to be painful. These
findings support a diagnosis of which type of cancer?

a. Epstein-Barr virus
b. Hodgkin lymphoma
c. Acute leukemia
d. Burkitt lymphoma

Answer 42

ANS: B
The patient has symptoms of Hodgkin lymphoma. About a third of individuals will have some
degree of systemic symptoms. Intermittent fever, without other symptoms of infection,
drenching night sweats, itchy skin (pruritus), and fatigue are relatively common. The patient
with Epstein-Barr virus does not have night sweats. The patient with acute leukemia does not
have night sweats or enlarged lymph nodes. The patient with Burkitt lymphoma does not have
enlarged lymph glands or night sweats.

Question 43

23-43. A 10 year old presents with abdominal swelling, night sweats, fever, and weight loss. He is
diagnosed with Burkitt lymphoma. Upon obtaining the history, which of the following is the
most likely cause?

a. Cytomegalovirus (CMV)
b. Adenovirus
c. Human papillomavirus (HPV)
d. Epstein-Barr virus (EBV)

Answer 43

ANS: D
EBV is associated with almost all cases of Burkitt lymphoma. Burkitt lymphoma is not
associated with CMV, adenovirus, or HPV.

Question 44

23-44. A patient diagnosed with multiple myeloma reports severe pain. This pain can be attributed to:
a. neuropathic infiltrations.
b. destruction of bone tissue.
c. tissue hypoxia.
d. accumulation of toxic proteins.

Answer 44

ANS: B
Multiple myeloma is a B-cell cancer characterized by the proliferation of malignant plasma
cells that infiltrate the bone marrow and aggregate into tumor masses throughout the skeletal
system; thus, the pain is related to bone destruction, not neuropathic infiltrations, tissue
hypoxia, or accumulation of toxic proteins.

Question 45

23-45. For a patient experiencing hypersplenism, the nurse expects the erythrocytes to be:
a. proliferated.
b. activated.
c. sequestered.
d. infected.

Answer 45

ANS: C
Hypersplenism results in sequestering, not proliferation, activation, or infection, of the blood
cells.

Question 46

23-46. Thrombocytopenia may be:
a. transient or consistent.
b. normal or abnormal.
c. congenital or acquired.
d. active or inactive.

Answer 46

ANS: C
The condition may also be either congenital or acquired and may be either primary or
secondary to other conditions. It is not referred to as transient or consistent, normal or
abnormal, or active or inactive.

Question 47

23-47. A 30 year old presents with hematuria, menorrhagia, and bleeding gums, and is diagnosed
with immune thrombocytic purpura (ITP). A nurse realizes the most likely cause is:
a. allergy-induced platelet lysis.
b. an immune response to hypersplenism.
c. antibody destruction of platelets.
d. T-cell injury to megakaryocytes.

Answer 47

ANS: C
The majority of cases of ITP are due to immune-driven destruction of platelets. It is not due to
allergies, hypersplenism, or T-cell injury.

Question 48

23-48. A patient is diagnosed with primary thrombocythemia. A nurse would expect the blood smear
to reveal _____ platelets.
a. defective
b. fragmented
c. consumed
d. overproduced

Answer 48

ANS: D
Thrombocythemia is characterized by a platelet count more than 400,000 platelets per cubic
millimeter of blood and is symptomatic when the count exceeds 1,000,000 platelets per cubic
millimeter, at which time the risk for intravascular clotting (thrombosis) is high.
Thrombocythemia is characterized by a high platelet count, not a defective one, a fragmented
one, or a consumed one.

Question 49

23-49. An IV drug user was diagnosed with hepatitis C 5 years ago. The patient is now experiencing
impaired blood clotting. The nurse suspects a decrease in which of the following vitamins?
a. K
b. D
c. E
d. B12

Answer 49

ANS: A
Lack of vitamin K, not D, E, or B12, interferes with clotting.

Question 50

23-50. A nurse checks individuals with liver disease for clotting problems because:
a. the liver is often the site of platelet pooling.
b. clotting factors are produced in the liver.
c. high levels of bilirubin interfere with the clotting system.
d. treatment medications for liver failure cause fibrinolysis.

Answer 50

ANS: B
Clotting factors are produced by the liver; the liver is not the site of platelet pooling. Bilirubin
does not interfere with clotting. The treatment of liver failure does not affect clotting.

Question 51

23-51. A 40 year old develops disseminated intravascular coagulation (DIC). Upon obtaining the
history, which finding is the most likely cause of this condition?
a. Snakebite
b. Blood transfusion
c. Sepsis
d. Immune thrombocytopenic purpura (ITP)

Answer 51

ANS: C
Sepsis is one of the most common conditions associated with DIC. While snake venom, blood
transfusions, and ITP may cause DIC, sepsis is the most likely cause.

Question 52

23-52. In disseminated intravascular coagulation (DIC), the nurse assesses for active bleeding after
intravascular clotting because:
a. prothrombin is activated.
b. clotting factors are depleted.
c. inflammatory mediators are released.
d. tissue factor (TF) is inactivated.

Answer 52

ANS: B
Intravascular clotting leads to depletion of clotting factors. DIC is due to depletion of clotting
factors, not activation of prothrombin. Activation of clotting associated with DIC leads to
inflammation, but inflammation does not cause DIC. TF is activated during DIC.