Deck 17: Hematological and Immune Disorders

Question 1

Erythrocytes (RBCs)are generated from precursor stem cells under the influence of a growth factor called

A) reticulocytes.
B) hemoglobin.
C) 2,3-DPG.
D) erythropoietin.

Answer 1

erythropoietin.

Question 2

The nurse is caring for a patient with cirrhosis of the liver.The nurse notes fresh blood starting to ooze from the patient's rectum and intravenous site.The nurse contacts the provider expecting a prescription for

A) an infusion of protein S factor.
B) blood work to evaluate protein C level.
C) a laboratory test to determine factor X level.
D) vitamin K injections.

Answer 2

vitamin K injections.

Question 3

Two types of specific immune responses exist: humoral immunity and cell-mediated immunity.These responses

A) are mutually exclusive.
B) are nonspecific immune responses.
C) are producers of antigens.
D) work together to provide immunity.

Answer 3

work together to provide immunity.

Question 4

The nurse is caring for a patient receiving chemotherapeutic agents and notices that the patient's neutrophil count is low.The nurse realizes that

A) the patient has a bacterial infection.
B) a shift to the left is occurring.
C) chemotherapeutic agents alter the ability to fight infection.
D) neutrophils have a long life span and multiply slowly.

Question 5

In vivo,the primary activator of the coagulation cascade occurs via the

A) intrinsic pathway.
B) extrinsic pathway.
C) common pathway.
D) either intrinsic or extrinsic pathway.

Question 6

The nurse understands that immunosurveillance is a function of

A) helper T lymphocytes.
B) suppressor T lymphocytes.
C) T4 lymphocytes.
D) killer T lymphocytes.

Question 7

The ratio of helper T4 cell to suppressor T cells is normally 2:1.A lower-than-normal ratio may indicate acquired immunodeficiency syndrome (AIDS).This is because T4 cells

A) enhance humoral immune response.
B) suppress the humoral response.
C) suppress the cell-mediated response.
D) are a feature of an autoimmune disease.

Question 8

Erythrocytes (RBCs)are flexible biconcave disks without nuclei whose primary component is an oxygen-carrying molecule called

A) erythropoietin.
B) a reticulocyte.
C) hemoglobin.
D) 2,3-DPG

Question 9

A patient with a history of pulmonary embolism is being worked up for a potential coagulopathy that increases the risk for clotting.The nurse understands that the provider may request a test for

A) factor VII deficiency.
B) factor X deficiency.
C) protein C deficiency.
D) factor IX deficiency.

Question 10

When examining the patient's laboratory values,the nurse notices an elevation in the eosinophil count.The nurse realizes that eosinophils become elevated

A) with acute bacterial infections.
B) in response to allergens and parasites.
C) when the spleen is removed.
D) in situations that do not require phagocytosis.

Question 11

The process by which the body actively produces cells and mediators that result in the destruction of the antigen is called

A) passive immunity.
B) active immunity.
C) autoimmunity.
D) recognition of self as nonself.

Question 12

The process in which antibody and complement proteins attach to the target cell and enhance the phagocyte's ability to engulf the target cell is known as

A) opsonization.
B) phagocytosis.
C) the lymphoreticular system.
D) the portal circulation.

Question 13

Common to both the intrinsic and the extrinsic pathway is

A) factor XII.
B) factor VII.
C) factor X.
D) subendothelial collagen.

Question 14

Although monocytes may circulate for only 36 hours,they can survive for months or even years as tissue macrophages.Monocytes found in the liver are called

A) alveolar macrophages.
B) Kupffer's cells.
C) histiocytes.
D) monokines.

Question 15

Cellular immunity is mediated by

A) B lymphocytes.
B) T lymphocytes.
C) immunoglobulins.
D) suppressor B cells.

Question 16

The nurse is caring for a patient who has undergone a splenectomy and notices that the patient's platelet count has increased.The nurse realizes that the increase is due to

A) platelet response to infection.
B) stimulation secondary to erythropoietin.
C) the patient's inability to store platelets.
D) the platelet's 120-day life cycle.

Question 17

With minor vessel injury,primary hemostasis is achieved

A) after several minutes.
B) with fibrin to solidify the platelet plug.
C) usually within seconds.
D) as a permanent solution.

Question 18

The nurse examines the patient's complete blood count with differential analysis and notices that the patient's neutrophils are elevated but that the lymphocytes are lower than normal.The drop in lymphocyte count in the differential is most likely due to

A) the increase in neutrophil count.
B) a new viral infection.
C) a decreased number of "bands."
D) the lack of immature neutrophils.

Question 19

Lymphocytes are made up of B cells and T cells.B cells

A) mature in lymphoid tissue.
B) mediate humoral immunity.
C) migrate to the thymus gland.
D) destroy virus-infected cells.

Question 20

Of the four major blood components,plasma

A) is made up of circulating ions.
B) comprises about 55% of blood volume.
C) is transported to the cells by serum proteins.
D) comprises about 45% of blood volume.

Question 21

The patient is admitted with reports of chronic fatigue and shortness of breath.The nurse notices that the patient is tachycardic and has multiple bruises and petechiae on the body and arms.The patient also complains of frequent nosebleeds.The nurse should evaluate the patient's ___________________

A) complete blood count.
B) hemoglobin and hematocrit.
C) electrolyte values.
D) blood culture results.

Question 22

The nurse is evaluating the patient's laboratory values and notes an IgG level of 240 mg/dL.The nurse realizes that this patient is a candidate for

A) no change in therapy because the level is normal.
B) an immunoglobulin infusion.
C) gene replacement therapy.
D) increased doses of immunosuppressive medications.

Question 23

The patient has a total white blood cell ( WBC )count of 600 cells/microliter.The differential shows a normal neutrophil level of 70% with 5% bands.This patient

A) is at low risk for infection.
B) is at mild risk for infection.
C) is at moderate risk for infection.
D) is at severe risk for infection.

Question 24

When caring for a patient with HIV,the nurse should

A) not focus on the mouth, as infections of the mouth are rare.
B) assure the patient that infections are not a major problem at this point.
C) inform the patient that the disease does not affect the respiratory system.
D) monitor the patient's medication regimen.

Question 25

The patient is being seen for complaints of general malaise,fatigue,and shortness of breath since having a cold 6 weeks earlier.The nurse should expect the provider to request a

A) lymph node biopsy.
B) differential blood count only.
C) complete blood count ( CBC ) with differential.
D) bone marrow biopsy.

Question 26

A reduction in the number of circulating RBCs or hemoglobin,which leads to inadequate oxygenation of tissues,is known as

A) polycythemia.
B) anemia.
C) iron deficiency.
D) an increase in hemoglobin.

Question 27

The nurse understands that when clots break down in a patient with a hematological disorder,which value will increase?

A) Hemoglobin
B) White blood cell count
C) Vitamin K
D) Fibrin split products

Question 28

The nurse notes that the patient's neutrophil count is less than 500 cells/microliter.The nurse realizes that this patient is

A) is at low risk for infection.
B) is at mild risk for infection.
C) is at moderate risk for infection.
D) is at severe risk for infection.

Question 29

The patient is admitted with multiple myeloma.The nurse assesses the patient and is aware that the symptom most unique to this disease is

A) fever.
B) night sweats.
C) bone pain.
D) lymph node enlargement.

Question 30

The nurse is assessing a patient being admitted with fatigue and shortness of breath as well as abdominal tenderness.The nurse notes that the patient is jaundiced; the physical examination reports an enlarged liver.The nurse suspects that the patient has

A) aplastic anemia.
B) hemolytic anemia.
C) sickle cell anemia.
D) anemia due to acute blood loss.

Question 31

The patient is complaining of severe joint pain,as well as fatigue and shortness of breath.The nurse notices that the patient's joints are swollen and the legs are edematous.The nurse realizes that these are symptoms of

A) anemia reflective of low volume.
B) aplastic anemia.
C) hemolytic anemia.
D) sickle cell anemia.

Question 32

Cases of primary immunodeficiency are usually related to

A) aging.
B) nutritional deficiencies.
C) malignancies.
D) a single gene defect.

Question 33

The patient has yellow skin and low hemoglobin and hematocrit levels.The nurse should look for

A) an elevated bilirubin level.
B) a low reticulocyte count.
C) sickled cells.
D) low white blood cell and platelet counts.

Question 34

Critical to caring for the immunocompromised patient is the understanding that

A) the immunocompromised patient has normal white blood cell ( WBC ) physiology.
B) the immunosuppression involves a single element or process.
C) infection is the leading cause of death in these patients.
D) immune incompetence is symptomatic even without pathogen exposure.

Question 35

Desired patient outcomes for immunocompromised patient related to medical and nursing interventions include absence of infection,negative cultures,and an absolute neutrophil count of

A) less than 500 cells/microliter.
B) 500 to 1000 cells/microliter.
C) 1000 to 1500 cells/microliter.
D) 1500 cells/microliter or higher.

Question 36

The patient comes to the hospital complaining of headache,fever,and sore throat for the past 2 weeks and is concerned about acquired immune deficiency syndrome (AIDS).The patient's blood work shows the presence of HIV antibodies.The nurse should explain that

A) HIV symptoms will continue throughout the patient's life.
B) HIV is an acute disease with a short prognosis.
C) HIV infection and AIDS are considered chronic diseases.
D) very few people with HIV develop AIDS.

Question 37

The patient is admitted for chemotherapy,but the nurse notices laboratory values indicating that the patient is immunosuppressed.The nurse should

A) place the patient in a single room with a HEPA filtration system.
B) tell staff that hand washing is not recommended when working with this patient.
C) start as many intravenous lines as possible to provide potential antibiotics.
D) avoid the use of antimicrobial soaps when bathing and providing perineal care.

Question 38

The patient is admitted with neutropenia.The nurse should assess the patient frequently for

A) signs of systemic infection.
B) a drop in temperature from its normal set point.
C) the absence of chills.
D) bradycardia.

Question 39

The patient is diagnosed with lymphoma but has a normal white blood cell ( WBC )count.The nurse understands that this patient

A) has normal WBC function as the WBC is normal.
B) will have increased bruising and bleeding.
C) is at risk for infection.
D) is at risk for an allergic reaction.

Question 40

The patient's white blood cell ( WBC )level is 4000 cells/microliter.The differential shows a neutrophil count of 65% and a band level of 5%.The absolute neutrophil count is

A) 4000 cells/microliter.
B) 3000 cells/microliter.
C) 2800 cells/microliter.
D) 2600 cells/microliter.

Question 41

The patient's platelet count is 35,000/microliter.The provider prescribes administration of 10 units of single-donor platelets.After transfusion,the nurse can expect the patient's platelet count to be

A) between 85,000/microliter and 135,000/microliter.
B) between 50,000/microliter and 75,000/microliter.
C) greater than 150,000/microliter.
D) between 150,000/microliter and 185,000/microliter.

Question 42

The nurse is caring for a patient diagnosed with anemia.This morning's hematocrit level is 24%.Platelet level is 200,000/microliter.The nurse can expect to

A) continue monitoring the patient, as this hematocrit is normal.
B) administer platelets to help control bleeding.
C) give fresh frozen plasma to decrease prothrombin time.
D) provide RBC transfusion because this level is below the normal threshold.

Question 43

Accepted treatments for disseminated intravascular coagulation ( DIC )may require (Select all that apply.)

A) platelet infusions.
B) administration of fresh frozen plasma.
C) cryoprecipitate.
D) packed RBCs.
E) heparin.

Question 44

Numbers of white blood cells (WBCs)are increased in circumstances of (Select all that apply.)

A) inflammation.
B) allergy.
C) invasion by pathogenic organisms.
D) malnutrition.
E) immune diseases.

Question 45

The patient has a platelet count of 9,000/microliter.The nurse realizes that

A) this is a normal platelet level.
B) spontaneous bleeding may occur.
C) the patient is at great risk for fatal hemorrhage.
D) this level is considered slightly low.

Question 46

Causes of anemia include which of the following: (Select all that apply.)

A) hypoxic states.
B) blood loss.
C) impaired production of red blood cells.
D) increased destruction of red blood cells.
E) chronic obstructive pulmonary disease.

Question 47

The nurse is caring for an elderly patient who is being admitted for anemia of unknown cause.The patient has been on multiple medications at home for various ailments.In assessing the patient's medication list,the nurse notes medications that may alter hemostasis,including which of the following: (Select all that apply.)

A) aminoglycosides.
B) antiplatelet agents.
C) cephalosporins.
D) vasoconstrictors.
E) sulfonamides.

Question 48

The patient is admitted with anemia caused by blood loss and thrombocytopenia and has a platelet count of 22,000/microliter.The patient is scheduled for a transfusion of RBCs and a transfusion of platelets.The nurse should

A) give the RBCs before the platelets.
B) give the platelets before the RBCs.
C) use local therapies to stop the bleeding.
D) give the platelets and RBCs at the same time.

Question 49

The patient is admitted with anemia and active bleeding.The nurse suspects intravascular disseminated coagulation ( DIC ).Definitive diagnosis of DIC is made by evidence of

A) a decrease in fibrin degradation products.
B) an increased D-dimer level.
C) thrombocytopenia.
D) low fibrinogen levels.

Question 50

Autoimmunity can result from (Select all that apply.)

A) recognition of tissue as "self."
B) injury to tissues.
C) infection.
D) malignancy.
E) unknown causes.

Question 51

Inflammation is initiated by cellular injury and (Select all that apply.)

A) is necessary for tissue repair.
B) inhibits the process called chemotaxis.
C) is harmful when uncontrolled.
D) is less efficient when complement proteins are present.
E) occurs when mediators cause vasoconstriction.

Question 52

Exudate formation at the inflammatory site functions to (Select all that apply.)

A) opsonize bacteria.
B) dilute toxins.
C) deliver proteins.
D) attach to the target cell.
E) carry away toxins.

Question 53

In caring for the patient who has a coagulopathy,the nurse should (Select all that apply.)

A) assess fluids for occult blood.
B) observe for oozing and bleeding and remove clots that form.
C) limit invasive procedures.
D) take temperatures rectally to increase accuracy.
E) weigh dressings to assess blood loss.

Question 54

The nurse is assessing a patient being admitted for anemia.The nurse sees no overt signs of bleeding.The nurse understands that

A) all patients with bleeding disorders demonstrate active bleeding.
B) many patients have bleeding that is not obvious.
C) mucous membranes have a high threshold for bleeding.
D) capillaries in mucous membranes lie deep in the membrane.

Question 55

When dealing with hematological malignancies,therapies that have significant management roles include which of the following: (Select all that apply.)

A) chemotherapy.
B) biotherapy.
C) bone marrow transplantation.
D) surgery.
E) radiation.

Question 56

Secondary immunodeficiency involves the loss of a previously functional immune defense system,which can be caused by (Select all that apply.)

A) a single gene defect.
B) AIDS.
C) aging.
D) nutritional deficiencies.
E) immunosuppressive therapies.