Deck 21: Alterations of Hematological Function

Question 1

A 45-year-old male is diagnosed with sideroblastic anemia. When he asks what the most likely cause of this disease is, what is the nurse's best response?

A) Ineffective iron uptake and abnormal hemoglobin production
B) Misshapen erythrocytes with low hemoglobin
C) Decreased levels of tissue iron with megaloblastic erythrocytes
D) Premature erythrocyte destruction and erythropoietin deficiency

Answer 1

Ineffective iron uptake and abnormal hemoglobin production

Question 2

A 50-year-old female was diagnosed with sideroblastic anemia. Which of the following assessment findings would most likely occur?

A) Bronze-coloured skin
B) Decreased iron
C) Normochromic erythrocytes
D) Aplastic bone marrow

Answer 2

Bronze-coloured skin

Question 3

A 65-year-old experienced loss of appetite, weight loss, lemon-yellow skin, liver enlargement, and a beefy red tongue shortly before her death. Autopsy suggested pernicious anemia, and the cause of death would most likely reveal:

A) brain hypoxia.
B) liver hypoxia.
C) heart failure.
D) kidney failure.

Answer 3

heart failure.

Question 4

A 21-year-old female was recently diagnosed with iron deficiency anemia. In addition to fatigue and weakness, which of the following clinical signs and symptoms would she most likely exhibit?

A) Hyperactivity
B) Spoon-shaped nails
C) Gait problems
D) Petechiae

Question 5

A patient who demonstrates chronic gastrointestinal bleeding is diagnosed with anemia. What is the primary cause of the patient's anemia?

A) Vitamin B₁₂ deficiency
B) Iron deficiency
C) Folate deficiency
D) Bone marrow failure

Question 6

A 21-year-old woman was recently diagnosed with iron deficiency anemia. Her hematocrit is 32%. Which of the following treatments would the nurse expect to be prescribed for her?

A) Iron replacement
B) Splenectomy
C) A bone marrow transplant
D) No treatment is necessary

Question 7

A 2-year-old malnourished child is diagnosed with vitamin B₁₂ and folate deficiencies. A blood smear suggests the deficiency is macrocytic and normochromic. What would the hemoglobin level be?

A) Normal
B) Sporadic
C) Low
D) High

Question 8

A nurse is reviewing laboratory results and notices that the erythrocytes contain an abnormally low concentration of hemoglobin. What term best describes these cells?

A) Hyperchromic
B) Hypochromic
C) Macrocytic
D) Microcytic

Question 9

What hemodynamic change should the nurse monitor for in a patient who has a reduction in the number of circulating erythrocytes?

A) Increased viscosity of blood
B) Decreased cardiac output
C) Altered coagulation
D) Hyperdynamic circulatory state

Question 10

A 5-year-old was diagnosed with normocytic-normochromic anemia. Which type of anemia does the nurse suspect the patient has?

A) Sideroblastic anemia
B) Hemolytic anemia
C) Pernicious anemia
D) Iron deficiency anemia

Question 11

A 40-year-old male's history includes being a vegetarian and abusing alcohol. Which of the following factors put him at greatest risk for developing folate deficiency anemia?

A) Being vegetarian
B) Being alcoholic
C) Age
D) Gender

Question 12

The nurse will check which of the following tests to directly measure iron stores?

A) Serum ferritin
B) Transferrin saturation
C) Bone marrow biopsy
D) Total iron-binding capacity

Question 13

A 45-year-old is diagnosed with macrocytic, normochromic anemia. What does the pathophysiology of this condition involve?

A) Defective DNA synthesis
B) Abnormal synthesis of hemoglobin
C) Defective use of vitamin C
D) Blocked protein synthesis

Question 14

A 35-year-old female is diagnosed with vitamin B₁₂ deficiency anemia (pernicious anemia). What is the most likely cause of this condition?

A) A decrease in ferritin
B) Lowered gastric enzymes
C) The absence of intrinsic factor
D) A decrease in erythropoietin

Question 15

Which individual should the nurse assess initially for a vitamin B₁₂ deficiency anemia?

A) A 3-year-old female who is a fussy eater
B) A 26-year-old female in the second trimester of her first pregnancy
C) A 47-year-old male who had a gastrectomy procedure
D) A 64-year-old male with a history of duodenal ulcers

Question 16

A newborn is diagnosed with congenital intrinsic factor (IF) deficiency. What type of anemia will the nurse see documented on the chart?

A) Iron deficiency anemia
B) Pernicious anemia
C) Sideroblastic anemia
D) Hemolytic anemia

Question 17

A 58-year-old female presents in the clinic with fatigue, weight loss, and tingling in her fingers. Laboratory findings show low hemoglobin and hematocrit, a high mean corpuscular volume, and normal plasma iron. These assessment findings are consistent with which type of anemia?

A) Hemolytic anemia
B) Pernicious anemia
C) Iron deficiency anemia
D) Aplastic anemia

Question 18

A patient's anemia is described as having erythrocytes that demonstrate poikilocytosis. What does this term mean?

A) The erythrocytes are pale in colour.
B) The erythrocytes present in various sizes.
C) Erythrocytes are able to assume various shapes.
D) They live only a few days.

Question 19

A 60-year-old patient diagnosed with emphysema experiences a rapid and pounding heart, dizziness, and fatigue with exertion. Which respiratory assessment findings indicate the respiratory system is compensating for the increased oxygen demand?

A) Bronchoconstriction
B) Increased rate and depth of breathing
C) Dyspnea
D) Activation of the renin-angiotensin response

Question 20

A 25-year-old female has a heavy menses during which she loses a profuse amount of blood. Which of the following adaptations should the nurse expect?

A) Movement of fluid into the cell
B) Decreased cardiac output
C) Decreased oxygen release from hemoglobin
D) Peripheral vasoconstriction

Question 21

Laboratory results showing high iron, bilirubin, and transferrin and low hemoglobin and hematocrit would support a diagnosis of which form of anemia?

A) Pernicious
B) Folate deficiency
C) Iron deficiency
D) Sideroblastic

Question 22

A 15-year-old female presents with splenomegaly, hepatomegaly, and lymph node enlargement. She is diagnosed with infectious mononucleosis. What should the nurse tell the patient about the recovery time?

A) 72 hours
B) 3 to 5 days
C) A few weeks
D) 6 months

Question 23

When the nurse sees a diagnosis of hereditary hemochromatosis on the chart, the nurse knows this is a disorder of:

A) intravascular coagulation.
B) iron overload.
C) leukocytosis.
D) granulocytosis.

Question 24

A 10-year-old is diagnosed with leukemia. What other condition is associated with this disease?

A) Down syndrome
B) Hemophilia
C) Hyperthyroidism
D) Pheochromocytoma

Question 25

A 70-year-old is brought to the emergency department, where he dies shortly thereafter. Autopsy reveals polycythemia vera (PV). What was his death most likely a result of?

A) Acute renal failure
B) Thrombosis
C) Sepsis
D) Acute leukemia

Question 26

What is leukocytosis?

A) A normal leukocyte count
B) A high leukocyte count
C) A low leukocyte count
D) Another term for leukopenia

Question 27

What is aplastic anemia caused by?

A) Iron deficiency
B) Excess levels of erythropoietin
C) Hemolysis
D) Stem cell deficiency

Question 28

A 57-year-old male presents to his primary care provider for red face, hands, feet, ears, and headache and drowsiness. A blood smear reveals an increased number of erythrocytes. What does this indicate?

A) Polycythemia vera (PV)
B) Leukemia
C) Sideroblastic anemia
D) Hemosiderosis

Question 29

A 68-year-old is admitted to the emergency department with a diagnosis of polycythemia vera (PV). In this condition, what are the symptoms a result of?

A) A decreased erythrocyte count
B) Rapid blood flow to the major organs
C) Increased blood viscosity
D) Vessel injury

Question 30

A patient is admitted to the emergency department with a diagnosis of polycythemia vera (PV). Which treatment should the nurse discuss with the patient?

A) Therapeutic phlebotomy
B) Restoration of blood volume by plasma expanders
C) Administration of packed red blood cells
D) Iron replacement therapy

Question 31

A 15-year-old male is diagnosed with infectious mononucleosis (IM). When the patient asks how he got this disease, how should the nurse respond? The most likely cause is:

A) The condition is caused by an adenovirus.
B) The disease is usually caused by the Epstein-Barr virus (EBV).
C) It is a disease caused by cytomegalovirus (CMV).
D) Toxoplasma gondii causes IM.

Question 32

A 35-year-old male has enlarged lymph nodes in the neck and a mediastinal mass. He was diagnosed with Hodgkin's lymphoma. Which of the following abnormal cells would the nurse expect to find with this disease?

A) Merkel cell
B) Schwann cell
C) Reed-Sternberg cell
D) Kupffer cell

Question 33

A 5-year-old is diagnosed with acute leukemia. What will the patient mostly likely be treated with?

A) Bone marrow transplant
B) Immunotherapy
C) Chemotherapy
D) Localized radiation therapy

Question 34

A 35-year-old female is diagnosed with lymphadenopathy. Which assessment finding will help confirm this diagnosis?

A) Small, hard lymph nodes
B) Disordered lymph nodes
C) Nonpalpable, nontender lymph nodes
D) Enlarged lymph nodes

Question 35

What is the most likely cause of eosinophilia?

A) Parasitic invasion and allergic reactions
B) Viral and bacterial infections
C) Stress and anxiety reactions
D) Fungal infections and delayed hypersensitivity

Question 36

A 67-year-old male was diagnosed with polycythemia vera (PV) but refused treatment. What is his condition at risk for converting to?

A) Chronic lymphocytic leukemia
B) Burkitt lymphoma
C) Multiple myeloma
D) Acute myeloid leukemia

Question 37

Considering anemia, what effect do vitamin B₁₂ and folate deficiencies have on red blood cells?

A) Stem cells are unable to differentiate into erythrocytes.
B) Erythrocytes contain malformed hemoglobin molecules.
C) O₂-carrying capacity is decreased in erythrocytes.
D) Erythrocyte life span is shorter.

Question 38

A 35-year-old male with hyperthyroidism begins treatment to decrease thyroid activity. A nurse monitors for which one of the following conditions that could result secondary to the treatment?

A) Eosinophilia
B) Basophilia
C) Monocytosis
D) Lymphocytosis

Question 39

A 67-year-old female is admitted to the emergency department with a diagnosis of polycythemia vera. Upon taking the history, what will the patient most likely report?

A) Hyperactivity
B) Decreased blood pressure
C) Intense itching when taking a hot shower
D) A pale skin colour

Question 40

A 15-year-old male with infectious mononucleosis is being given instructions on how to prevent the spread of this infection to others. Which statement represents a correct instruction?

A) Wear a surgical mask when others are in the room.
B) Do not share drinking glasses or eating utensils.
C) Avoid all contact with other people.
D) No precautions are necessary.

Question 41

For a patient experiencing hypersplenism, the nurse expects the erythrocytes to be:

A) proliferated.
B) activated.
C) sequestered.
D) infected.

Question 42

A 10-year-old presents with abdominal swelling, night sweats, fever, and weight loss. He is diagnosed with Burkitt lymphoma. Upon obtaining the history, which of the following is the most likely cause?

A) Cytomegalovirus (CMV)
B) Adenovirus
C) Human papillomavirus (HPV)
D) Epstein-Barr virus (EBV)

Question 43

A 15-year-old male is diagnosed with infectious mononucleosis. Which of the following assessment findings would he most likely demonstrate? (Select all that apply.)

A) Lymph node enlargement
B) Fever and sore throat
C) Rash on the trunk and extremities
D) Fatigue
E) Enlargement of liver and spleen

Question 44

A 30-year-old presents with hematuria, menorrhagia, and bleeding gums and is diagnosed with immune thrombocytic purpura (ITP). What is the most likely cause of this condition?

A) Allergy-induced platelet lysis
B) An immune response to hypersplenism
C) Antibody destruction of platelets
D) T-cell injury to megakaryocytes

Question 45

A patient is diagnosed with primary thrombocythemia. What would the blood smear reveal?

A) Defective platelets
B) Fragmented platelets
C) Platelets that have been consumed
D) An overproduction of platelets

Question 46

An IV drug user was diagnosed with hepatitis C 5 years ago. The patient is now experiencing impaired blood clotting. The nurse suspects a decrease in which of the following vitamins?

A) K
B) D
C) E
D) B₁₂

Question 47

A patient has microcytic hypochromic anemia. Which of the following pathogenic mechanisms may cause anemia in this patient? (Select all that apply.)

A) Decreased erythrocyte life span
B) Failure of mechanisms of compensatory erythropoiesis
C) Disturbances of the iron cycle
D) Increased basal metabolic rate
E) Swelling in the tissues

Question 48

A nurse realizes that a patient has thrombocytopenia when the platelet count is below _____ * 10⁹/L.

Question 49

A patient diagnosed with multiple myeloma reports severe pain. What is this pain attributed to?

A) Neuropathic infiltrations
B) Destruction of bone tissue
C) Tissue hypoxia
D) Accumulation of toxic proteins

Question 50

In disseminated intravascular coagulation (DIC), why does the nurse assess for active bleeding after intravascular clotting?

A) Prothrombin is activated.
B) Clotting factors are depleted.
C) Inflammatory mediators are released.
D) Tissue factor (TF) is inactivated.

Question 51

A 35-year-old male was diagnosed with hepatitis B. Further tests revealed neutropenia characterized by a neutrophil count less than _____ *10⁹/L.

Question 52

A nurse checks individuals with liver disease for clotting problems because:

A) the liver is often the site of platelet pooling.
B) clotting factors are produced in the liver.
C) high levels of bilirubin interfere with the clotting system.
D) treatment medications for liver failure cause fibrinolysis.

Question 53

Thrombocytopenia may be:

A) transient or consistent.
B) normal or abnormal.
C) congenital or acquired.
D) active or inactive.

Question 54

The people from which country have the lowest risk for Hodgkin's lymphoma?

A) United States
B) Japan
C) Denmark
D) Netherlands

Question 55

A 62-year-old reports experiencing regular night sweats and unintentionally losing weight. Physical examination reveals enlarged neck lymph nodes that do not appear to be painful. These findings support a diagnosis of which type of cancer?

A) Epstein-Barr virus
B) Hodgkin's lymphoma
C) Acute leukemia
D) Burkitt lymphoma

Question 56

A 40-year-old develops disseminated intravascular coagulation (DIC). Upon obtaining the history, which finding is the most likely cause of this condition?

A) Snakebite
B) Blood transfusion
C) Sepsis
D) Immune thrombocytopenic purpura (ITP)

Question 57

A patient wants to know about risk factors for acute leukemia. Which of the following should the nurse include? (Select all that apply.)

A) Cytomegalovirus (CMV) infection
B) Eating genetically modified food
C) Chemotherapy treatment for other cancers
D) Excessive ultraviolet radiation exposure
E) Ovarian cancer