Deck 26: Disorders of Blood Flow

Question 1

A surgeon is explaining to the parents of a 6-year-old boy the rationale for the suggestion of removing the boy's spleen. Which of the following teaching points would be most accurate?

A) "Ferritin is the activated and usable form of iron that your red blood cells can use to transport oxygen."
B) "Ferritin is a stored form of iron that indirectly shows me whether you would benefit from iron pills."
C) "Ferritin is a protein-iron complex that allows your red blood cells to make use of the iron that you consume in your diet."
D) "Ferritin is the form of iron that is transported in your blood plasma to red blood cells that need it."

Answer 1

"Ferritin is a stored form of iron that indirectly shows me whether you would benefit from iron pills."

Question 2

A 62-year-old female with a diagnosis of acute and chronic renal failure secondary to diabetes mellitus is receiving her weekly injection of epoetin, a supplementary form of erythropoietin. Which of the following statements best captures the necessity of this medication?

A) Erythropoietin is needed in order for stem cells to proliferate into committed erythroid precursors.
B) Erythropoietin is necessary for the accurate sensation of hypoxia that stimulates erythropoiesis.
C) Erythropoietin causes the erythrocyte colony-forming units to proliferate and mature.
D) Erythropoietin facilitates the extrusion of the reticulocyte nucleus and the formation of true erythrocytes.

Answer 2

Erythropoietin causes the erythrocyte colony-forming units to proliferate and mature.

Question 3

A client with a diagnosis of hemolytic anemia has gone to a community-based laboratory for follow-up blood work. The lab technician confirms with the client that hematocrit is one of the components of the blood work. The client replies, "I thought the point of the blood work was to see how many red blood cells I have today." How could the technician best respond to the client's statement?

A) "This result will tell your care provider about the number of red blood cells in a given quantity of your blood plasma."
B) "Your hematocrit measures the average size of your red blood cells and indirectly measures your oxygen-carrying capacity."
C) "The result will indicate how many of your red blood cells are new and young and will indicate your body's production rate of red cells."
D) "The hematocrit measures the mass that your red blood cells account for in a quantity of your blood."

Answer 3

"The hematocrit measures the mass that your red blood cells account for in a quantity of your blood."

Question 4

A client with a gastrointestinal bleed secondary to alcohol abuse and a hemoglobin level of 5.8 g/dL has been ordered a transfusion of packed red blood cells. The client possesses type B antibodies but lacks type D antigens on his red cells. Transfusion of which of the following blood types would be least likely to produce a transfusion reaction?

A) B^-
B) B⁺
C) A⁺
D) A^-

Question 5

Your ESRD patient is receiving 2 units of packed red blood cells for anemia (Hgb of 8.2). Twenty minutes into the first transfusion, the nurse observes the patient has a flushed face, hives over upper body trunk, and is complaining of pain in lower back. His vital signs include pulse rate of 110 and BP drop to 95/56. What is the nurse's priority action?

A) Slow the rate of the blood infusion to 50 mL/hour.
B) Document the assessment as the only action.
C) Discontinue the transfusion and begin an infusion of normal saline.
D) Recheck the type of blood infusing with the chart documentation of patient's blood type.

Question 6

A 66-year-old female patient has presented to the emergency department because of several months of intermittently bloody stool that has recently become worse. The woman has since been diagnosed with a gastrointestinal bleed secondary to overuse of nonsteroidal anti-inflammatory drugs that she takes for her arthritis. The health care team would realize that which of the following situations is most likely to occur?

A) The woman has depleted blood volume due to her ongoing blood loss.
B) She will have iron deficiency anemia due to depletion of iron stores.
C) The patient will be at risk for cardiovascular collapse or shock.
D) She will have delayed reticulocyte release.

Question 7

Amniocentesis has suggested that a couple's first child will be born with sickle cell disease. The parents are unfamiliar with the health problem, and their caregiver is explaining the complexities. Which of the following statements by the parents would suggest a need for further teaching or clarification?

A) "Our baby's red cells are prone to early destruction because of his or her weak membranes."
B) "Not all of his or her red cells will be sickled, but low oxygen levels can cause them to become so."
C) "Sickled cells can block his or her blood vessels, especially in the abdomen, chest, and bones."
D) "Our son or daughter likely won't show the effects of sickling until he or she is school-aged because of the different hemoglobin in babies."

Question 8

A child has been diagnosed with thalassemia. Which of the following comorbidities may occur as a result of having thalassemia?

A) Hypocoagulation
B) Iron deficiency
C) Splenomegaly
D) Neutropeniabb

Question 9

A patient has been diagnosed with anemia. The physician suspects an immune hemolytic anemia and orders a Coombs test. The patient asks the nurse what this test will tell the doctor. The nurse replies,

A) "They will wash your RBCs and then mix the cells with a reagent to see if they clump together."
B) "They will look at your RBCs under a microscope to see if they have an irregular shape (poikilocytosis)."
C) "They will be looking to see if you have enough ferritin in your blood."
D) "They are looking for the presence of antibody or complement on the surface of the RBC."

Question 10

A 13-year-old African American boy comes to the ER complaining of fatigue and a rapid heartbeat. In conversation with the father, it becomes apparent to you that the boy has grown 2 inches in the previous 5 months. What is the first problem the health care team would attempt to rule out?

A) Sickle cell anemia
B) Iron deficiency anemia
C) Thalassemia
D) Aplastic anemia

Question 11

A 22-year-old female who adheres to a vegan diet has been diagnosed with iron deficiency anemia. Which of the following components of her diagnostic blood work would be most likely to necessitate further investigation?

A) Decreased mean corpuscular volume (MCV)
B) Decreased hemoglobin and hematocrit
C) Microcytic, hypochromic red cells
D) Decreased erythropoietin levels

Question 12

A community health nurse is conducting a class on the nutritional component for new mothers. Which of the following teaching points would be most justified?

A) "Iron supplementation is not necessary provided you are breast-feeding your infant."
B) "Be aware that cow's milk depletes your baby's supply of iron."
C) "Your infant needs the same amount of iron as you but has far fewer sources for obtaining it."
D) "If you choose to feed your baby with formula, ensure that it is iron fortified."

Question 13

A client with a diagnosis of atrophic gastritis and consequent pernicious anemia is ^{receiving high oral doses of vitamin B}12^{. Which of the following changes would be most} likely expected by his care provider at the completion of his treatment?

A) Decreased mean corpuscular volume
B) Increased serum bilirubin
C) Increased folic acid levels
D) Decreased free heme levels

Question 14

Two years after chemotherapy and radiation therapy for lung cancer, a 72-year-old patient notices that he seems to be extremely tired all the time. The physician suspects the patient may have developed aplastic anemia. The nurse assessing the patient will likely find which of the following clinical manifestations of aplastic anemia? Select all that apply.

A) Complaints of weakness and fatigue
B) Small spots of skin hemorrhages over the entire body
C) Excess bleeding from gums and nose
D) Spoon-shaped deformity of the fingernails
E) Hemolysis from renal dialysis treatments.

Question 15

Which of the following patients would be most likely to be experiencing an increase in renal erythropoietin production?

A) A 71-year-old smoker admitted to hospital with exacerbation of his chronic obstructive pulmonary disease (COPD)
B) A 70-year-old woman admitted with dehydration secondary to an overdose of her potassium-wasting diuretic
C) A 68-year-old man with a long-standing diagnosis of polycythemia vera
D) A 21-year-old man with acute blood loss secondary to a motor vehicle accident 3 hours prior

Question 16

A 53-year-old man presents with inability to concentrate, itching in his fingers and toes, elevated blood pressure, and unexplained weight loss. He is diagnosed with primary polycythemia. What will be the primary goal of his treatment?

A) To control his hypertension
B) To increase the amount of oxygen distributed by his red blood cells
C) To reduce the mean size of his red cells
D) To reduce the viscosity of his blood

Question 17

A new mother and father are upset that their 2-day-old infant is requiring phototherapy for hyperbilirubinemia. The pediatrician who has followed the infant since birth is explaining the multiplicity of factors that can contribute to high serum bilirubin levels in neonates. Which of the following factors would the physician be most likely to rule out as a contributor?

A) The fact that the infant is being breast-fed
B) Hypoxia
C) Hepatic immaturity of the infant
D) Transitioning of hemoglobin F (HbF) to hemoglobin A (HbA)

Question 18

Which of the following nursing interventions would be a priority when caring for a newborn who is receiving phototherapy for high bilirubin levels? Select all that apply.

A) Frequent monitoring of temperature
B) Keeping diapers dry and clean
C) Maintaining oral intake to prevent dehydration
D) Putting lotion on his skin frequently to prevent drying/cracking of skin
E) Applying sunscreen to prevent ultraviolet radiation

Question 19

If an Rh-negative mother is giving birth to an Rh-positive infant, the nurse should be prepared to administer

A) antihistamines like Benadryl.
B) alpha interferon.
C) Rh immune globulin.
D) a monoclonal antibody like infliximab.

Question 20

The family members of an elderly patient are wondering why his "blood counts" are not rising after his last GI bleed. They state, "He has always bounced back after one of these episodes, but this time it isn't happening. Do you know why?" The nurse will respond based on which of the following pathophysiological principles?

A) "Everything slows down when you get older. You just have to wait and see what happens."
B) "Due to stress, the red blood cells of older adults are not replaced as promptly as younger people."
C) "The doctor may start looking for another cause of his anemia, maybe cancer of the bone."
D) "Don't worry about it. We can always give him more blood."