Unit4: Ch 21 - Blood Cells and the Hematopoietic System

Question 1

A 5th grade elementary student asks the school nurse how much blood is in an entire body. A 5th grade elementary student asks the school nurse how much blood is in an entire
body. The nurse should respond that the average grown-up adult has
A) 2 to 4 cups of blood in his or her body.
B) 3 pints of blood in total.
C) 3 to 4 quarts of blood in his or her body.
D) 5 to 6 L of blood throughout his or her body

Answer 1

Ans: D
Feedback:
The total volume of blood in the average adult is about 5 to 6 L, and it circulates
throughout the body within the confines of the circulatory system.

Question 2

A hospital laboratory technician is performing routine blood analysis as part of an
inpatient’s assessment and is examining the sample in a test tube following processing in
a centrifuge and the addition of an anticoagulant. Which of the following observations
would the technician most likely interpret as an anomaly?
A) The bottom layer of blood in the tube accounts for around one third of the total
volume.
B) The middle layer of cells appears white to gray in color.
C) The top layer of cells is too thin to visualize without microscopy.
D) The yellowish fluid on the top of the sample appears to constitute around one half
of the total volume

Answer 2

Ans: A
Feedback:
The body layer of cells in a centrifuged blood sample consists of erythrocytes and
should constitute around 42% to 47% of the total blood volume. The middle cell layer of
leukocytes should appear whitish gray, and the thrombocytes above that layer are
frequently not discernable. The plasma layer should account for around 55% of the total
blood volume

Question 3

During science class, a student asks, “What’s the difference between plasma and serum
in the blood?” The nurse responds that the primary difference between plasma and
serum is that plasma contains
A) fibrinogen.
B) heparin.
C) white blood cells.
D) hydrogen ions.

Answer 3

Ans: A
Feedback:
The major difference between plasma and serum is the presence of fibrinogen in the
plasma from an anticoagulated centrifuged whole-blood specimen. When blood is
removed from the body for testing, it clots within 30 to 60 minutes. The clot contains
the blood’s cellular components enmeshed in an insoluble fibrin network (formed by the
polymerization of soluble plasma protein fibrinogen). The remaining fluid portion is the
yellow liquid serum. This serum no longer contains fibrinogen because the fibrinogen
originally present in uncoagulated blood was used up in the formation of the blood clot.
Heparin, WBC, and hydrogen ions are incorrect.

Question 4

A student makes the statement to a colleague, “Blood plasma is essentially just a carrier
for the formed elements like red blood cells and white blood cells.” What would be the
most accurate response to this statement?
A) “That’s not really true. Plasma is crucial in the immune and inflammatory
responses.”
B) “Actually, plasma plays a significant role in nutrient and waste transport.”
C) “Not really. Plasma also contributes to the processes of protein synthesis and
hematopoiesis.”
D) “Actually, plasma is integral to the proper function of the liver and maintenance
of acid–base balance.”

Answer 4

Ans: B
Feedback:
Plasma proteins are integral to transport. They are not noted to contribute to the
inflammatory response, hematopoiesis, protein synthesis, or liver function

Question 5

The blood work of a 44-year-old male patient with a diagnosis of liver disease
secondary to alcohol abuse indicates low levels of albumin. Which of the following
phenomena would a clinician be most justified in anticipating?
A) Impaired immune function
B) Acid–base imbalances
C) Impaired thermoregulation
D) Fluid imbalances

Answer 5

Ans: D
Feedback:
Albumin plays a central role in the maintenance of osmotic pressure and fluid balance.
Immune function, acid–base balance, and thermoregulation are not functions of
albumin.

Question 6

A nurse practitioner is providing care for a client with low levels of the plasma protein
gamma globulin. The nurse would recognize that the client is at risk of developing
which of the following health problems?
A) Jaundice
B) Anemia
C) Infections
D) Blood clots

Answer 6

Ans: C
Feedback:
The gamma globulins, antiboNdiUesRoSfIthNeGimTmB.unCeOsyMstem, protect against infectious
diseases. Because alpha globulin transports bilirubin, a defect in this plasma protein
might lead to jaundice; a defect of beta globulin, which transports iron, could be
associated with anemia; and a defect of fibrinogen could result in blood clots.

Question 7

Which of the following statements best conveys a characteristic of red blood cells?
A) They lack organelles and soluble enzymes.
B) They contribute to the maintenance of blood pH.
C) They help maintain the body’s fluid balance.
D) They are self-replicating.

Answer 7

Ans: B
Feedback:
Erythrocytes contribute to acid–base balance through the production of bicarbonate and
hydrogen ions. They contain soluble enzymes but are neither self-replicating nor
involved in fluid balance

Question 8

When looking at a granulocyte under a microscope, the anatomy student would describe
it as a cell
A) lacking granules.
B) having a kidney-shaped nucleus.
C) having no nuclei.
D) shaped like a sphere with multilobar nuclei.

Answer 8

Ans: D
Feedback:
Granulocytes are spherical and have distinctive multilobar nuclei. They are all
phagocytic cells that are identifiable because of their cytoplasmic granules. Answers A,
B, and C are incorrect. Agranulocytes lack granular cytoplasm. Monocytes have a large
amount of cytoplasm and a nucleus in the shape of a kidney. Erythrocytes lack a cell
nucleus.

Question 9

Following an injury resulting in a small cut from a knife, the first cells to go to the area
of the cut would be the
A) neutrophils.
B) erythrocytes.
C) albumin.
D) basophils.

Answer 9

Ans: A
Feedback:
Neutrophils are very mobile and are the first cells to go to an area of tissue damage.
Erythrocytes (RBCs) contain an O2-carrying protein that functions in the transport of
oxygen. Albumin, a plasma protein, does not pass through the pores in the capillary wall
to enter the interstitial fluid and therefore contributes to the plasma osmotic pressure and
maintenance of blood volume. Basophil granules contain heparin, an anticoagulant;
histamine, a vasodilator; and other mediators of inflammation

Question 10

A 29-year-old construction worker got a sliver under his fingernail 4 days ago. The
affected finger is now reddened, painful, swollen, and warm to touch. Which of the
following hematological processes is most likely occurring in the bone marrow in
response to the infection?
A) Proliferation of immature neutrophils
B) High circulatory levels of myeloblasts
C) Increased segmented neutrophil production
D) Phagocytosis by myelocytes

Answer 10

Ans: A
Feedback:
A part of the immune response is the proliferation of neutrophils in response to
infectious organisms. Neutrophilia is an increase in immature neutrophils (“bands”)
most commonly seen in acute infections and tissue injuries that promote the accelerated
release of neutrophils and their precursors into the circulation. Myeloblasts are not
normally found in circulation, and segmented neutrophils would not yet have reached
maturity (takes approximately 2 weeks to mature). Myelocytes do not perform
phagocytosis.

Question 11

When talking about the lifespan of various blood components, the students should know
that once a neutrophil moves into tissue, it lives approximately for how long?
A) 12 hours
B) 24 hours
C) 2 days
D) 4 days

Answer 11

Ans: D
Feedback:
After release from the marrow, the neutrophils spend only approximately 4 to 8 hours in
the circulation before moving into the tissues. They survive in the tissues for
approximately 4 to 5 days. They die in the tissues by discharging their phagocytic
function.

Question 12

When talking about the various types of granulocytes, which granule contains heparin,
an anticoagulant?
A) Neutrophils
B) Eosinophils
C) Basophils
D) Lymphocytes

Answer 12

Ans: C
Feedback:
The basophils have granules that contain heparin, an anticoagulant; histamine, a
vasodilator; and other mediators of inflammation

Question 13

A physician is explaining to a 40-year-old male patient the importance of completing his
course of antibiotics for the treatment of tuberculosis. The physician explains the
damage that could occur to lung tissue by Mycobacterium tuberculosis. Which of the
following phenomena would underlie the physician’s explanation?
A) Tissue destruction results from neutrophil deactivation.
B) Nonspecific macrophage activity leads to pulmonary tissue destruction and
resulting hemoptysis.
C) Macrophages form a capsule around the Mycobacterium tuberculosis bacteria,
resulting in immune granulomas.
D) Neutrophils are ineffective against the Mycobacterium tuberculosis antigens

Answer 13

Ans: C
Feedback:
Immune granulomas are caused by insoluble particles (Mycobacterium tuberculosis)
that are capable of inciting a cell-mediated immune response. Neutrophils are
deactivated, self-destructive, nor ineffective in cases of tuberculosis

Question 14

A couple who is expecting their first child has been advised by friends to consider
harvesting umbilical cord blood in order to have a future source of stem cells. The
couple has approached their caregiver with this request and is seeking clarification of
exactly why stem cells are valuable and what they might expect to gain from harvesting
it. How can their caregiver best respond to the couple’s enquiry? Stem cells can
A) “help correct autoimmune diseases and some congenital defects.”
B) “be used to regenerate damaged organs the need ever arise.”
C) “be used as source of reserve cells for the entire blood production system.”
D) “help treat some cancers and anemias, but they must come from your child
himself or herself.”

Answer 14

Ans: C
Feedback:
The proliferative potential and self-renewal of stem cells make them a compensatory
mechanism and reserve source for the entire hematopoietic system. While they could be
of possible use in certain autoimmune conditions or in cases of organ failure, these
statements do not capture their essence. Stem cells can also come from a
histocompatible donor.

Question 15

Which of the following statements best captures an aspect of the process of
hematopoiesis?
A) Colony-stimulating factors (CSFs) produce cytokines that activate progenitor
cells.
B) Progenitor cells differentiate into precursor cells.
C) Various subtypes of pluripotent stem cells eventually differentiate into the cellular
components of blood.
D) Self-replicating precursor cells differentiate into specific CSFs.

Answer 15

Ans: B
Feedback:
During hematopoiesis, progenitor cells differentiate into precursor cells, which in turn
differentiate into the cellular components of blood. Cytokine stimulation precedes and
regulates the process, and there are no different subtypes of pluripotent stem cells.
Precursor cells are not self-replicating

Question 16

Which of the following colony-stimulating factors (CSFs) is given to ESRD patients to
help with their chronic anemia?
A) Erythropoietin (EPO)
B) Thrombopoietin (TPO)
C) Neupogen
D) Interleukin

Answer 16

Ans: A
Feedback:
The CSFs that act on committed progenitor cells include erythropoietin (EPO), which
stimulates RBC production. TPO stimulates platelets. Neupogen is for white blood cell
production. Interleukin is a cytokine utilized as an immune response agent

Question 17

A nurse is providing care for several patients on an acute medical unit of a hospital.
Which of the following patients would be most likely to benefit from hematopoietic
growth factors?
A) A 51-year-old female patient with liver failure secondary to hepatitis
B) A 61-year-old female patient with end-stage renal cancer
C) A 55-year-old obese male patient with peripheral neuropathy secondary to
diabetes
D) A 44-year-old man with a newly diagnosed brain tumor

Answer 17

Ans: B
Feedback:
Hematopoietic growth factors are commonly used in cases of kidney disease and cancer.
Erythropoietin (EPO) is a colony-stimulating factor that stimulates red blood cell
production. As a review, erythropoietin is an essential hormone for red cell production.
Without it, definitive erythropoiesis does not take place. Under hypoxic conditions, the
kidney will produce and secrete erythropoietin to increase the production of red blood
cells. With cancer of the kidney, the kidney is unable to perform its normal function.
They are not as clearly indicated in cases of liver disease, diabetes, or brain tumors.

Question 18

A geriatrician is following a number of clients on a subacute geriatric medical unit,
some of whom require diagnostic blood work. Which of the following clients would be
most likely to have an erythrocyte sedimentation rate (ESR) screening test ordered? An
adult with
A) a diagnosis of of Alzheimer disease and depression
B) orthostatic hypotension and syncopal episodes.
C) congestive heart failure.
D) systemic lupus erythematosus.

Answer 18

Ans: D
Feedback:
Inflammatory diseases, such as systemic lupus erythematosus, are a common indicator
for an ESR test. The other health problems noted are less commonly marked by
inflammatory processes

Question 19

An oncologist has ordered a bone marrow biopsy for a client and is explaining the
reasons for the test and what the client might expect during the test. Which of the
following explanations best reflects an aspect of a bone marrow biopsy?
A) “I’ll take a sample of your bone marrow from your breastbone or your spine.”
B) “I will be harvesting a sample of your stem cells for examination.”
C) “I need a more accurate count of your blood components than normal blood work
is able to provide.”
D) “I need to get samples of the types of blood cells that your body is producing.”

Answer 19

Ans: D
Feedback:
Bone marrow biopsy can be used to detect abnormal cell production and gain samples.
A sample would be taken most likely from the iliac crest, and the biopsy would not
focus on pluripotent stem cells. Bone marrow biopsy is not used for simple
quantification of blood cellular components.

Question 20

Following a bone marrow biopsy, which of the following assessments would indicate
the patient is experiencing a complication as a result of this diagnostic procedure?
A) BP 90/60, heart rate 132, excess bleeding, and hematoma noted at the insertion
site
B) BP 130/80, oxygen saturation 95%, and crackles heard on inspiration
C) Respiratory rate 24 and complaining of pain at insertion site
D) Heart rate regular 64 beats/minute and temperature 99.6°F orally

Answer 20

Ans: A
Feedback:
The major hazard of a bone marrow biopsy is the risk of hemorrhage. This is usually
seen by a decrease in BP, tachycardia, edema from blood pooling in the tissues, etc. All
of the other answers are s/s other than shock. Crackles in the lungs correlate with
fluid/secretions in the lungs. A bone marrow aspiration is usually performed on the
posterior iliac crest and should not cause an elevated respiratory rate. A low-grade fever
is not considered a complication