Exam 4: Assessment and care of patients with hematologic problems (10 questions)

Question 1

Hematologic system physical assessment

Answer 1

• Pain

- Cardiovascular changes 
SOB, weakness, fatigue
Heart sounds
Cap refill
Pulses

• Skin changes
  pallor or cyanosis
  jaundice
• Renal and urinary
• Musculoskeletal
• Abdominal
• Central nervous system
• Psychosocial

Question 2

RBC abnormal significance

Answer 2

Elevated > 5.4 million (females) & > 6.1 million (males)
- erythrocytosis, polycythemia vera, severe dehydration

Decreased < 4.2 million (female) & < 4.7 (males)
- anemia hemorrhage, kidney disease

Question 3

WBC abnormal significance

Answer 3

Elevated > 10,000/mm3
- Infection, inflammation

Decreased < 5,000/mm3
- Immunosuppression, autoimmune disease

Question 4

MCV abnormal significance

Answer 4

Elevated > 95 fL
- macrocytic (large) RBCs, megaloblastic anemia

Decreased < 80 fL
- microcytic (small) RBCs, iron deficiency anemia

Question 5

MCH abnormal significance

Answer 5

Elevated > 31 pg/cell
- macrocytic (large) RBCs, megaloblastic anemia

Decreased < 27 pg/cell
- microcytic (small) RBCs, iron deficiency anemia

Question 6

TIBC abnormal significance

Answer 6

Elevated > 460 mcg/dL
- Iron deficiency anemia, polycythemia vera

Decreased < 250 mcg/dL
- malnutrition, cirrhosis, pernicious anemia

Question 7

Iron abnormal significance

Answer 7

Elevated > 160 mcg/dL (female) & > 180 mcg/dL (male)
- Hemochromatosis, iron excess, liver disorder, or lead toxicity

Decreased < 60 mcg/dL (females) & <80 mcg/dL (males)
- iron deficiency anemia, chronic blood loss, inadequate dietary intake of iron

Question 8

Platelets abnormal significance

Answer 8

Elevated > 400,000 mm3
- malignancy, polycythemia vera, rheumatoid arthritis

Decreased < 150,000 mm3
- enlarged spleen, hemorrhage, leukemia

Question 9

HGB abnormal significance

Answer 9

Elevated > 16 g/dL (females) & > 18 g/dL (males)
- erythrocytosis, COPD, severe dehydration

Decreased < 12 g/dL (female) & < 14 g/dL (male)
- anemia, hemorrhage, kidney disease

Question 10

HCT abnormal significance

Answer 10

Elevated > 47% (female) & > 52% (male)
- erythrocytosis, COPD, severe dehydration

Decreased < 37% (female) & 42% (male)
- anemia, hemorrhage, kidney disease

Question 11

APTT abnormal significance

Answer 11

Elevated > 40 seconds
- vitamin K deficiency, disseminated intravascular coagulation (DIC), liver disease, heparin administration

Decreased < 30 seconds
- extensive cancer

Question 12

PT abnormal significance

Answer 12

Elevated > 12.5 seconds
- liver disease, warfarin therapy, disseminated intravascular coagulation (DIC)

Decreased < 11 seconds
- vitamin K excess, pulmonary embolus, thrombophlebitits

Question 13

INR abnormal significance

Answer 13

Elevated > 1.1
- warfarin therapy

Decreased < 0.8
- cancer disorders

Question 14

D-Dimer abnormal significance

Answer 14

Positive result > 0.4 mcg/L
- disseminated intravascular coagulation (DIC), malignancy

Negative result
- can rule out pulmonary embolus or deep vein thrmbosis

Question 15

Fibrinogen abnormal significance

Answer 15

Elevated > 400 mg/dL
- acute inflammation, acute infection, heart disease

Decreased < 200 mg/dL
- liver disease, advanced cancer, malnutrition

Question 16

Fibrin degradation abnormal significance

Answer 16

Elevated > 10 mcg/mL
- disseminated intravascular coagulation (DIC), massive trauma resulting in fibrinolysis

Decreased
- anticoagulation therapy

Question 17

Bone Marrow Aspiration nursingpost op care

Answer 17

• apply pressure to site to prevent bleeding
• sterile dressing
• bedrest 30-60 min
• monitor signs of infection
• Ice
• mild analgesics
• avoid aspirin and anticoagulants

Question 18

Iron deficiency anemia symptoms

Answer 18

• Pallor, fatigue
• Numbness of extremities
• Dyspnea on exertion
• Sensitivity to cold
• Tachycardia
• Dizziness, syncope
• Headache
• Increased somnolence

Question 19

Iron deficiency anemia risk factors

Answer 19

Deficiency in components

- not enough iron in diet

Question 20

Iron deficiency anemia treatment: diet

Answer 20

• Red meat, organ meat, egg yolks, kidney beans, green leafy vegetables
• Nuts, dairy products, citrus fruit

Question 21

Iron deficiency anemia treatment: medication

Answer 21

• Ferrous sulfate orally
• Iron dextran parenterally
• Erythropoietin

Question 22

Sickle cell symptoms

Answer 22

• Pain
• Cardiac
• Priapism
• Skin changes
• Organ damage
• Liver, kidneys, CNS
• Joint damage

Question 23

Sickle cell diagnosis

Answer 23

Sickle cell test

- Evaluates the sickling of RBCs in the presence of decreased oxygen tension

Question 24

Sickle cell management

Answer 24

• Hydration
• Oxygenation
• Pain control

Question 25

Leukemia Treatment

Answer 25

• Chemotherapy
  Induction, Consolidation, Maintenance
• Bone marrow transplant

Question 26

Leukemia bone marrow transplant

Answer 26

Hemopoietic stem cell transplantation (HSCT)

• Requires chemotherapy to purge leukemia cells
• Transplant of new stem cells are infused and begin hematopoiesis

Types

• Autologous (Pt. own)
• Syngeneic (from relative)
• Allogeneic (matching donor)

Question 27

Lymphoma: Hodgkin’s

Answer 27

Begins in a subset of white blood cells called lymphocytes

• Reed-Sternberg cell present (usually derived from B lymphocytes, )

Question 28

Lymphoma: Non-Hodgkin’s

Answer 28

• Begins in a subset of white blood cells called lymphocytes

- Reed-Sternberg cell NOT present