Mod. 1 Hematopoietic Function Flashcards
A patient presents with recurrent bacterial infections and laboratory findings reveal profound neutropenia. Which of the following conditions is most likely responsible for these findings?
A) Aplastic anemia
B) Chronic myeloid leukemia (CML)
C) Myelodysplastic syndrome
D) Severe congenital neutropenia (Kostmann syndrome)
D) Severe congenital neutropenia (Kostmann syndrome)
Rationale: Severe congenital neutropenia (Kostmann syndrome) is a genetic disorder characterized by a near-total absence of neutrophils, leading to recurrent bacterial infections. Aplastic anemia results in pancytopenia, CML is associated with leukocytosis rather than neutropenia, and myelodysplastic syndrome can cause cytopenias but typically in an older population.
A patient with polycythemia vera is at increased risk for which of the following complications?
A) Disseminated intravascular coagulation (DIC)
B) Iron-deficiency anemia
C) Aplastic crisis
D) Myelofibrosis
D) Myelofibrosis
Rationale: Polycythemia vera is a myeloproliferative disorder that leads to an overproduction of erythrocytes, causing increased blood viscosity. Over time, the bone marrow can become fibrotic, leading to extramedullary hematopoiesis. DIC is more commonly seen in conditions like sepsis, iron-deficiency anemia is not associated with erythrocytosis, and aplastic crisis is more characteristic of parvovirus B19 infection in patients with hemolytic anemias.
A 65-year-old patient presents with fatigue, pallor, and a hemoglobin of 7.2 g/dL. The peripheral blood smear reveals macrocytic, oval RBCs with hypersegmented neutrophils. Which of the following is the most likely underlying cause?
A) Iron-deficiency anemia
B) Vitamin B12 deficiency
C) Anemia of chronic disease
D) Sickle cell disease
B) Vitamin B12 deficiency
Rationale: Macrocytic anemia with hypersegmented neutrophils is a hallmark of vitamin B12 deficiency, which is often due to pernicious anemia or malabsorption. Iron-deficiency anemia typically presents with microcytosis, anemia of chronic disease is usually normocytic or microcytic, and sickle cell disease presents with hemolytic anemia, not macrocytosis.
A patient undergoing chemotherapy develops severe thrombocytopenia. Which of the following interventions should be prioritized to minimize bleeding risk?
A) Administration of recombinant erythropoietin
B) Immediate bone marrow transplant
C) Administration of desmopressin (DDAVP)
D) Platelet transfusion if platelet count is below 10,000/µL
D) Platelet transfusion if platelet count is below 10,000/µL
Rationale: Severe thrombocytopenia (<10,000/µL) significantly increases the risk of spontaneous bleeding, warranting platelet transfusion. Recombinant erythropoietin is used for anemia, not thrombocytopenia. Bone marrow transplant is a long-term option, and desmopressin is primarily used for von Willebrand disease, not chemotherapy-induced thrombocytopenia.
A patient presents with spontaneous gingival bleeding and a platelet count of 20,000/µL. The blood smear shows large, immature platelets, and there is no evidence of hemolysis. Which of the following is the most likely diagnosis?
A) Idiopathic thrombocytopenic purpura (ITP)
B) Thrombotic thrombocytopenic purpura (TTP)
C) Disseminated intravascular coagulation (DIC)
D) Heparin-induced thrombocytopenia (HIT)
A) Idiopathic thrombocytopenic purpura (ITP)
Rationale: ITP is an autoimmune disorder characterized by isolated thrombocytopenia due to platelet destruction. The presence of large, immature platelets suggests increased bone marrow platelet production in response to peripheral destruction. TTP presents with microangiopathic hemolytic anemia, DIC involves widespread clotting and bleeding with schistocytes, and HIT is associated with recent heparin exposure.
A patient with severe liver disease presents with increased bleeding tendency. Which of the following best explains the coagulopathy in this condition?
A) Decreased production of clotting factors
B) Hyperactive fibrinolysis
C) Platelet dysfunction due to uremia
D) Vitamin B12 deficiency
A) Decreased production of clotting factors
Rationale: The liver produces most of the clotting factors involved in the coagulation cascade. Severe liver disease impairs synthesis, leading to coagulopathy. Hyperactive fibrinolysis is not the primary cause, platelet dysfunction due to uremia occurs in renal failure, and vitamin B12 deficiency causes megaloblastic anemia rather than coagulopathy.
A patient with deep vein thrombosis (DVT) is started on warfarin therapy. The nurse should educate the patient about which of the following dietary considerations?
A) Increase intake of dark leafy greens
B) Maintain a consistent intake of vitamin K-rich foods
C) Completely avoid foods containing vitamin K
D) Increase intake of vitamin C to enhance warfarin’s effect
B) Maintain a consistent intake of vitamin K-rich foods
Rationale: Warfarin acts by inhibiting vitamin K-dependent clotting factors. Sudden increases or decreases in dietary vitamin K can affect warfarin’s effectiveness, so patients should maintain a consistent intake rather than avoid vitamin K completely. Vitamin C does not enhance warfarin’s effect.
Which of the following statements best describes the function of plasmin in hemostasis?
A) Plasmin facilitates platelet adhesion to the injury site
B) Plasmin promotes fibrin clot formation
C) Plasmin degrades fibrin clots to prevent excessive clotting
D) Plasmin activates the extrinsic coagulation pathway
C) Plasmin degrades fibrin clots to prevent excessive clotting
Rationale: Plasmin is responsible for breaking down fibrin clots in a process called fibrinolysis. It prevents excessive clot formation and ensures normal circulation. It does not promote platelet adhesion, form fibrin clots, or activate the extrinsic coagulation pathway.
A nurse is assessing a patient with multiple myeloma. Which laboratory finding would be most consistent with this condition?
A) Elevated hematocrit
B) Hypercalcemia
C) Thrombocytosis
D) Decreased total protein
B) Hypercalcemia
Rationale: Multiple myeloma is characterized by increased osteoclast activity, leading to bone destruction and hypercalcemia. Hematocrit may be low due to anemia, thrombocytosis is not a feature, and total protein is usually elevated due to monoclonal immunoglobulin production.
