Deck 9: Hematology

Question 1

Dehydration is most likely to result in:

A) thrombocytopenia.
B) leukocytosis.
C) increased number of white blood cells and platelets.
D) increased prothrombin time.

Answer 1

increased number of white blood cells and platelets.

Question 2

Which of the following situations would result in a right shift of the oxygen-hemoglobin dissociation curve?

A) Hypothermia
B) Hyperventilation
C) Sepsis
D) Increase in 2,3-BPG

Answer 2

Increase in 2,3-BPG

Question 3

Prehospital treatment for a hemophiliac patient who is bleeding is to:

A) contact online medical control for factor VIII infusion.
B) provide aggressive IV therapy with isotonic crystalloids.
C) control bleeding with direct pressure.
D) administer IV colloid solutions.

Answer 3

control bleeding with direct pressure.

Question 4

Which of the following statements about immunity is TRUE?

A) T cells mature in the bone marrow.
B) Lymphocytes are the primary cells involved in the immune response.
C) Humoral immunity uses cytotoxic chemicals to destroy pathogens.
D) Cell-mediated immunity uses antibody formation to combat pathogens.

Question 5

A smoker who also takes supplemental vitamin K would be expected to:

A) have a higher incidence of polycythemia.
B) have enhanced clotting ability.
C) have a lower risk of developing pulmonary embolism.
D) be unable to generate active forms of clotting factors II, VII, IX, and X.

Question 6

A patient with hemophilia has suffered a large and deep laceration to the right forearm after cutting it on a mirror, which fell while he was hanging it. The wound is hemorrhaging a steady amount of dark red blood. Given the history of hemophilia, your immediate action on reaching the patient's side and putting on gloves would be to:

A) request that the ED have Factor VIII standing by on your arrival.
B) start an IV and administer a 1 L NS bolus.
C) apply a tourniquet proximal to the wound.
D) apply direct pressure with a bulky dressing.

Question 7

Of the following, which would be the most likely dysfunction experienced by a patient with multiple myeloma?

A) Increased T cell production
B) Decreased T cell production
C) Decreased blood cell production
D) Increased blood cell production

Question 8

Patients with lymphoma are most likely to experience abnormal function of:

A) thrombocytes.
B) stem cells from which malignancy arises.
C) erythrocytes.
D) neutrophils.

Question 9

Humoral and cell-mediated immunity differ in that cell-mediated immunity uses:

A) B cells, which generate effector cells to combat such invaders as intracellular organisms, while cellular immunity uses T cells that reside in lymph tissue and produce antibodies to combat foreign invaders.
B) T cells, which generate effector cells to combat such invaders as intracellular organisms, while humoral immunity uses B cells that reside in lymph tissue and produce antibodies to combat foreign invaders.
C) B cells, which generate effector cells to combat such invaders as intracellular organisms, while humoral immunity uses T cells that reside in lymph tissue and produce antibodies to combat foreign invaders.
D) T cells, which reside in lymph tissue and produce antibodies to combat foreign invaders, while humoral immunity uses B cells that generate effector cells to combat such invaders as intracellular organisms.

Question 10

A cat scratches a patient on the arm. Twenty-four hours later, the area is swollen and red. What additional signs or symptoms is the patient most likely to exhibit?

A) Fever and hypotension
B) Loss of appetite
C) Pain and warmth at the injury site
D) Urticaria

Question 11

The more acidic the blood is, the more readily hemoglobin:

A) binds carbon dioxide.
B) releases oxygen.
C) releases carbon dioxide.
D) binds oxygen.

Question 12

Which of the following is NOT a difference between cellular and humoral immunity?

A) Humoral immunity uses memory cells, while cell-mediated immunity does not.
B) T cells mature in the thymus gland, but B cells mature in lymph tissue.
C) T cells use cytotoxins to destroy pathogens, while B cells use antibodies.
D) Cellular immunity concerns itself with pathogens in cells and tissue; humoral concerns itself with pathogens in the lymph.

Question 13

Your patient is a 23-year-old female who is 6 hours postpartum after a traumatic delivery resulting in a massive blood transfusion. She is to be transferred from a community hospital to a specialty hospital for further care. She is unconscious and intubated, with a number of intravenous lines. Your physical examination reveals a purpuric rash over the chest and abdomen and mottling of the fingers and toes and all of the venous access sites are oozing blood. In addition, auscultation of the lung fields reveals rales to the dependent regions. HR = 112, BP = 82/60, RR = 12 via ventilator. Which of the following best describes the patient's condition and treatment needs, in addition to continued ventilation and fluid administration?

A) DIC; type O negative blood
B) Idiopathic hemophilia; corticosteriods
C) DIC; fresh frozen plasma and platelet administration
D) Idiopathic hemophilia; factor VIIa administration

Question 14

Which of the following statements about disseminated intravascular coagulation (DIC) is TRUE?

A) The bleeding typical of DIC is a result of an increased fibrinogen level.
B) DIC most commonly results from hemophilia, hypertension, and severe tissue injury.
C) Causes of DIC include reduced fibrinogen levels, consumption of coagulation factors, and thrombocytopenia.
D) Activated thrombin converts fibrinogen to fibrin in the circulating blood.

Question 15

Your patient is a 22-year-old male complaining of a two-day history of a sore throat. He denies difficulty breathing, nausea, vomiting, or chest pain. He has no medical history and takes no medications. HR = 72, BP = 120/78, RR = 12, SaO₂ = 99%. Physical examination reveals cool, dry skin. Which of the following findings would be most likely?

A) Rhonchi upon auscultation of the lungs
B) Swelling of the cervical lymph nodes
C) Generalized erythema
D) Positive Murphy's sign

Question 16

In a patient with a hematological disease resulting in production of high numbers of abnormal red blood cells, which of the following would you be most likely to find?

A) Splenomegaly
B) Fever
C) Hepatomegaly
D) Florid skin

Question 17

Which of the following would directly result in decreased fibrinolysis?

A) Increased factor X
B) Decreased plasminogen secretion
C) Increased plasmin secretion
D) Hypercalcemia

Question 18

All of the following are components of the inflammatory process EXCEPT:

A) vasodilation.
B) increased capillary permeability.
C) increased blood flow.
D) decreased chemotaxis.

Question 19

When a patient receives a laceration, the clotting process that occurs is primarily mediated by the ________ pathway.

A) platelet
B) common
C) extrinsic
D) intrinsic

Question 20

Which of the following statements about sickle cell disease is FALSE?

A) Patients with chronic sickle cell disease have chronic hemolytic anemia.
B) Sickled red blood cells have longer life spans than normal red blood cells.
C) Sickle hemoglobin has a flawed chemical structure that results in erythrocyte deformity when oxygen levels are low.
D) Splenomegaly is a common problem of sickle cell disease.

Question 21

A patient has a hematocrit of 48 percent and a hemoglobin of 15 g/dl. Which of the following statements is TRUE?

A) His hemoglobin is high, but his hematocrit is normal.
B) Both are within the normal range for an adult male or female.
C) His hematocrit and hemoglobin are both low.
D) Both are within the normal range for an adult male.

Question 22

Your patient is suffering from end-stage liver disease. In which of the following ways would impairment of the hematologic system most likely be evident?

A) Jaundice
B) Polycythemia resulting in a florid appearance
C) Vaso-occlusive crisis resulting in joint pain
D) Leukocytosis

Question 23

Which of the following statements about leukemia is TRUE?

A) Infections secondary to low levels of circulating neutrophils are common.
B) The pediatric mortality rate is greater than 50 percent.
C) Leukemia is a disease of children and young adults, not older adults.
D) Leukemias are cancers of erythrocytes.

Question 24

Which of the following situations would result in a more rapid response by the immune system to an infection?

A) First-time exposure to an antigen with memory T cell activation
B) First-time exposure to an antigen with memory B cell activation
C) First-time exposure to an antigen
D) Second exposure to an antigen with memory B cell activation

Question 25

Your patient is undergoing chemotherapy and is complaining of bleeding from the gums and blood in his stool. Which of the following will best address the patient's problem?

A) Stopping the chemotherapy
B) Administering platelets
C) Administering erythropoietin
D) Administering vitamin K

Question 26

Which of the following situations would result in erythropoietin secretion?

A) CVA
B) Hypoxia
C) Alkalemia
D) Hemophilia

Question 27

A male will express hemophilia if he acquires ________ chromosome(s).

A) defective X and Y
B) one defective X
C) two defective X
D) one defective Y

Question 28

Which of the following situations would NOT result in anemia?

A) Blood loss
B) Destruction of red blood cells
C) Increased production of erythropoietin
D) Iron deficiency

Question 29

For a patient with hemophilia B, which of the following statements is TRUE?

A) The patient's father had hemophilia B, and the mother was a carrier of the defective gene.
B) The patient's father had hemophilia B, and the mother was unaffected.
C) The patient's father was a carrier for the defective gene, and her mother did not carry the defective gene.
D) The patient's mother was a carrier for the defective gene, and her father did not carry the defective gene.

Question 30

In an emergency situation if you administer blood to a patient whose blood type is unknown, you should administer type ________ blood.

A) A positive
B) O negative
C) B positive
D) A negative

Question 31

In the presence of calcium, thrombin will encourage:

A) fibrin clot formation.
B) prothrombin activation.
C) platelet aggregation.
D) plasminogen release.

Question 32

In which of the following situations is hemolytic disease of the newborn most likely to occur?

A) An Rh positive mother delivers a first Rh negative newborn
B) An Rh positive mother delivers a second Rh negative newborn
C) An Rh negative mother delivers a first Rh positive newborn
D) An Rh negative mother delivers a second Rh positive newborn

Question 33

You are pruning a rosebush and puncture the skin on your thumb with a thorn. The next day you note that the area is swollen. Which of the following best explains the swelling that has occurred?

A) Humoral immunity activation results in localized tissue damage and edema of the tissue surrounding the injury site.
B) Localized vasodilation and increased capillary permeability result in plasma leakage into the tissue surrounding the injury site.
C) Cell-mediated immunity activation results in chemotaxis and increased capillary permeability.
D) There is an infection, resulting in edema to the surrounding tissue.

Question 34

Which of the following is NOT a goal of the inflammatory process?

A) To produce antibodies to combat pathogens
B) To ward off damage from microorganisms or trauma
C) To facilitate repair of the tissues
D) To localize the damage

Question 35

Which of the following statements about leukocytes is FALSE?

A) Leukocytes follow chemical signals to an infection site.
B) Leukocytes protect against foreign invaders.
C) Leukocytes engulf and destroy foreign invaders via leukopoiesis.
D) Leukocytes can travel through blood vessel walls into the surrounding tissues.

Question 36

Which of the following circumstances would result in activation of the coagulation cascade via the intrinsic pathway?

A) Development of a plaque in a coronary artery resulting in turbulent blood flow
B) Administration of warfarin
C) Blunt-force trauma
D) Penetrating trauma resulting in soft-tissue damage

Question 37

Your patient is a 26-year-old African-American male who is alert but in severe distress, complaining of pain in his hands and feet, as well as abdominal pain. The pain began this morning but has progressed from an initial rating of 5/10 to a 9/10 at the present time. The patient has a history of sickle cell anemia and denies any trauma. Physical examination reveals cool, diaphoretic skin; pain with palpation to all four abdominal quadrants; splenomegaly; and a priapism. HR = 132, BP = 140/90, RR = 16. Select the most appropriate acute diagnosis and treatment for this patient.

A) Sickle cell vaso occlusive crisis; administer high-concentration oxygen, IV therapy with isotonic crystalloids, and narcotics for pain control
B) Sickle cell trait; administer oxygen according to pulse oximetry readings, and give a 500 mL bolus of isotonic crystalloid solution
C) Sickle cell occlusive crisis; administer oxygen by nonrebreathing mask, isotonic crystalloids, and aspirin
D) Sickle cell disease; administer oxygen according to pulse oximetry readings, start an IV of normal saline, and administer ketorolac for pain

Question 38

Your patient has type A⁺ blood. Which of the following statements about the patient's blood is TRUE?

A) The patient produces anti-A antibodies.
B) The blood cells lack Rh antigens.
C) There are type A antigens on the surface of the red blood cells.
D) The patient can only receive A⁺ blood if a transfusion is needed.

Question 39

Your patient is taking an immunosuppressant drug to prevent rejection of a transplanted kidney. As a consequence, the patient is more prone to:

A) prolonged blood clotting time.
B) aplastic anemia.
C) infection.
D) polycythemia.

Question 40

Which of the following medications would be most useful in the event of a transfusion reaction?

A) Aspirin
B) Diphenhydramine
C) Magnesium sulfate
D) Furosemide

Question 41

Causes of the inflammatory process include all of the following EXCEPT:

A) infection.
B) chemical exposure.
C) trauma.
D) psychosocial factors.

Question 42

You suspect that your patient is having a transfusion reaction. The patient's care plan should include:

A) dobutamine, diphenhydramine, albuterol.
B) dopamine, diphenhydramine, IV fluid bolus.
C) IV fluid.
D) diphenhydramine alone.

Question 43

A patient complains of atraumatic bleeding of the gums. You suspect:

A) halitosis.
B) dentalgia.
C) a hematologic disorder.
D) gingivitis.

Question 44

Hemophilia A is an example of a ________ disorder.

A) genetically acquired
B) environmentally acquired
C) intrinsically endued
D) extrinsically endued

Question 45

Fibrinolytics are effective against:

A) any clot.
B) clots containing fibrin.
C) occlusions only in the heart.
D) occlusions only in the brain.

Question 46

What ethnicity is most likely to suffer from sickle cell disease?

A) Native American
B) Asian
C) African American
D) Caucasian

Question 47

The organ that is most responsible for producing erythropoietin is the:

A) bone marrow.
B) liver.
C) kidney.
D) spleen.

Question 48

Your patient is an 18-year-old female suffering from sickle cell crisis. Which of the following is the best course of treatment for this patient?

A) High-concentration oxygen, IV NS KVO, diphenhydramine
B) High-concentration oxygen, IV bolus of NS
C) High-concentration oxygen, IV bolus of NS, morphine sulfate
D) High-concentration oxygen, IV NS KVO

Question 49

You respond to a patient complaining of shortness of breath. Upon your arrival, the patient tells you that she has been experiencing headaches, vertigo, and now itching. She says her doctor had called with a lab result of her latest test. Her hematocrit is reported as 60. You suspect:

A) congestive heart failure (CHF).
B) sickle cell disease.
C) thrombocytopenia.
D) polycythemia.

Question 50

The study of blood and blood-forming organs is called:

A) oncology.
B) hematology.
C) homeostasis.
D) palliative care.

Question 51

Which of the following statements regarding hemophilia is most accurate?

A) Hemophilia is a hereditary abnormality of the platelets.
B) Hemophilia is a hereditary lack of certain proteins needed in the clotting cascade.
C) Hemophilia is a hereditary disease that causes fibrin clots to dissolve prematurely.
D) Hemophilia is a hereditary disease in which the body is unable to produce vitamin K.

Question 52

Which of the following is TRUE concerning sickle cell anemia?

A) It is a hereditary disease involving abnormal hemoglobin.
B) It is a hereditary disease involving lack of intrinsic factor.
C) It is an autoimmune disease in which the body destroys its own hemoglobin.
D) It is an acquired disease in which the body cannot absorb iron.

Question 53

You are caring for a patient who is complaining of diffuse musculoskeletal pain, shortness of breath, and atraumatic priapism. You suspect:

A) sickle cell vaso occlusive crisis.
B) sickle cell hematologic crisis.
C) Acute lymphocytic leukemia (ALL).
D) AML.

Question 54

Which of the following statements regarding polycythemia is most accurate?

A) It decreases the patient's risk of infection.
B) It decreases the ability of blood to clot.
C) It increases the patient's risk of infection.
D) It increases the patient's risk of thrombosis and congestive heart failure.

Question 55

You are transporting a patient to a tertiary trauma center. The patient is receiving blood and has sustained trauma the local center cannot handle. You notice that the patient has begun to develop tachycardia, hives, and a fever. You suspect:

A) hypovolemia
B) a normal response to a transfusion.
C) transfusion reaction.
D) anaphylaxis.

Question 56

You are caring for a patient with a known history of sickle cell disease. The patient has severe abdominal and back pain. The patient is tachycardic and tachypneic. The blood pressure is normal. What should be one of the paramedic's first interventions?

A) Administer oxygen
B) Initiate an IV
C) Give oral analgesics
D) Put the patient in a supine position

Question 57

Your patient has a history of pernicious anemia. If not treated, your primary concern for this patient should be:

A) hypovolemia.
B) prolonged blood clotting time.
C) hypoxia.
D) infection.

Question 58

Hemostasis is maintained by which three mechanisms?

A) Vascular spasm, platelet plugs, fibrin clots
B) Fibrin, platelets, hemoglobin
C) Von Willebrand's factor, fibrin, platelets
D) Factor VIII, factor VII, factor III

Question 59

A complete hemoglobin molecule can carry up to:

A) three oxygen molecules.
B) six oxygen molecules.
C) four oxygen molecules.
D) two oxygen molecules.