Question 1

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 ___________________

Accepted Answer

In addition to the general symptoms of anemia,unique disorders have their own classic clinical features.The patient with aplastic anemia may have bruising,nosebleeds,petechiae,and a decreased ability to fight infections.These effects result from thrombocytopenia and decreased WBC counts,which occur when the bone marrow fails to produce blood cells.The CBC with differential,which includes a platelet count,would allow for evaluation of all aspects of aplastic anemia.Hemoglobin and hematocrit help to assess for blood loss,but assessment of cause (e.g.,low platelets)is more important.Electrolyte values and blood culture results are not relevant to this scenario.

Question 2

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

Accepted Answer

Medical therapy is directed at reversing the cause of the immune dysfunction and preventing infectious complications.In primary immunodeficiencies,B-cell and T-cell defects are treated with specific replacement therapy or bone marrow transplantation.IgG blood levels of less than 300 mg/dL warrant immunoglobulin infusion.Gene replacement therapy may soon be a realistic curative treatment option for some disorders.In secondary immunodeficiencies,the underlying causative condition is treated.For example,malnutrition is corrected,or doses of immunosuppressive medications are adjusted.For this patient,immunosuppressive medications should be discontinued or doses lowered.

Question 3

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

Accepted Answer

The differential demonstrates the percentage of each type of WBC circulating in the bloodstream.The absolute neutrophil count is calculated by multiplying the total WBC count (without a decimal point)by the percentages (with decimal points)of polymorphonuclear leukocytes (polys; also called segs or neutrophils)and bands (immature neutrophils).
WBC $\times$ (segs + bands)
600 * (0.70 + 0.05)
600 * 0.75 = 450 cells/microliter
This gives an actual number that is translated into the categories of mild,moderate,or severe neutropenia.Neutropenia is classified based on the patient's predicted risk for infection: mild (1000-1500 cells/microliter),moderate (500-1000 cells/microliter),and severe (<500 cells/microliter).

Question 4

When caring for a patient with HIV,the nurse should

Accepted Answer

Nursing assessment includes evaluation of the neurological status,mouth,respiratory status,abdominal symptoms,and peripheral sensation.As with all immunosuppressed patients,those with HIV infection must be protected from infection.These patients provide additional clinical challenges because of their multisystemic,clinical complications.For unclear reasons,persons with HIV infection have a higher propensity for adverse drug reactions than other patient groups and require careful monitoring of all medication regimens.

Question 5

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

Accepted Answer

The first screening diagnostic tests performed to detect hematological or immunological dysfunction are a complete blood count (CBC)with differential and a coagulation profile.The CBC evaluates the cellular components of blood.The CBC reports the total RBC count and RBC indices,hematocrit,hemoglobin,WBC count and differential,platelet count,and cell morphologies.The most invasive microscopic examinations of the bone marrow or lymph nodes are reserved for circumstances when laboratory tests are inconclusive or when an abnormality in cellular maturation is suspected (e.g.,aplastic anemia,leukemia,or lymphoma).A differential laboratory test is not done without the CBC first.A bone marrow biopsy is unwarranted; it would be performed only if preliminary studies indicated a hematological problem.

Question 6

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

Accepted Answer

The term anemia refers to a reduction in the number of circulating RBCs or hemoglobin,which leads to inadequate oxygenation of tissues.Polycythemia,a disorder in which the number of circulating RBCs is increased,is seen less often but can affect hypoxic patients (e.g.,those with chronic obstructive pulmonary disease).Iron-deficiency anemia is the most common type of anemia.

Question 7

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

Accepted Answer

When plasmin digests fibrinogen,fragments known as fibrin split products,or fibrin degradation products,are produced and function as potent anticoagulants.Fibrin split products are not normally present in the circulation but are seen in some hematological disorders as well as with thrombolytic therapy.Vitamin K is necessary for synthesis of factors II,VII,IX,and X,which are needed for clotting to occur.Hemoglobin may decrease if the patient is bleeding,and WBCs are not relevant to this scenario.

Question 8

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

Accepted Answer

Neutropenia is defined as an absolute neutrophil count of less than 1500 cells/microliter of blood.Neutropenia may occur as a result of inadequate production or excess destruction of neutrophils.Patients with low neutrophil counts are predisposed to infections because of the body's reduced phagocytic ability.Neutropenia is classified based on the patient's predicted risk for infection: mild (1000-1500 cells/microliter),moderate (500-1000 cells/microliter),and severe (<500 cells/microliter).

Question 9

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

Accepted Answer

Bone pain is common in multiple myeloma,whereas lymph node enlargement is more representative of lymphoma.Fever is particularly difficult to interpret because it may be a manifestation of the disease process or may accompany an infectious complication.General signs and symptoms such as fatigue,malaise,myalgias,activity intolerance,and night sweats are nonspecific indicators of immune disease.

Question 10

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

Accepted Answer

Assessment of the patient with hemolytic anemia may reveal jaundice,abdominal pain,and enlargement of the spleen or liver.These findings result from the increased destruction of RBCs,their sequestration (abnormal distribution in the spleen and liver),and the accumulation of breakdown products.The patient with aplastic anemia may have bruising,nosebleeds,petechiae,and a decreased ability to fight infections.These effects result from thrombocytopenia and decreased WBC counts,which occur when the bone marrow fails to produce blood cells.Patients with sickle cell anemia may have joint swelling or pain,and delayed physical and sexual development.Decreased circulating volume is manifested by clinical findings reflective of low blood volume (e.g.,low right atrial pressure)and the effects of gravity on the lack of volume (e.g.,orthostasis).

Question 11

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

Accepted Answer

Patients with sickle cell anemia may have joint swelling or pain,and delayed physical and sexual development.In crisis,the sickle cell patient often has decreased urine output,peripheral edema,and signs of uremia because renal tissue perfusion is impaired as a result of sluggish blood flow.Decreased circulating volume is manifested by clinical findings reflective of low blood volume (e.g.,low right atrial pressure)and the effects of gravity on the lack of volume (e.g.,orthostasis).The patient with aplastic anemia may have bruising,nosebleeds,petechiae,and a decreased ability to fight infections.These effects result from thrombocytopenia and decreased WBC counts,which occur when the bone marrow fails to produce blood cells.Assessment of the patient with hemolytic anemia may reveal jaundice,abdominal pain,and enlargement of the spleen or liver.These findings result from the increased destruction of RBCs,their sequestration (abnormal distribution in the spleen and liver),and the accumulation of breakdown products.

Question 12

Cases of primary immunodeficiency are usually related to

Accepted Answer

Most primary immunodeficiencies are congenital disorders related to a single gene defect.Secondary or acquired immunodeficiency is the result of factors outside the immune system,is not related to a genetic defect,and involves the loss of a previously functional immune defense system.Aging,dietary insufficiencies,malignancies,stressors (emotional,physical),immunosuppressive therapies,and certain diseases such as diabetes or sickle cell disease are examples of conditions that may be associated with acquired immunodeficiencies.

Question 13

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

Accepted Answer

Laboratory findings in anemia include a decreased RBC count and decreased hemoglobin and hematocrit values.The reticulocyte count is usually increased,indicating a compensatory increased RBC production with release of immature cells.This patient's jaundice is indicative of hemolytic anemia.Patients with hemolytic anemia also have an increased bilirubin level.In sickle cell disease,a stained blood smear reveals sickled cells.In aplastic anemia,the reticulocyte,platelet,RBC,and WBC counts are decreased because the marrow fails to produce any cells.

Question 14

Critical to caring for the immunocompromised patient is the understanding that

Accepted Answer

Infection is the leading cause of death in the immunocompromised patient.The immunocompromised patient is one with defined quantitative or qualitative defects in WBCs or immune physiology.The defect may be congenital or acquired,and may involve a single element or multiple processes.Regardless of the cause,the physiological outcome is immune incompetence,with lack of normal inflammatory,phagocytic,antibody,or cytokine responses.Immune incompetence is often asymptomatic until pathogenic organisms invade the body and create infection.

Question 15

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

Accepted Answer

Nursing care of patients with neutropenia is the same as for all immunocompromised patients.Desired patient outcomes related to medical and nursing interventions include absence of infection,negative cultures,and an absolute neutrophil count of 1500 cells/microliter or higher.

Question 16

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

Accepted Answer

Seroconversion is manifested by the presence of HIV antibodies and usually occurs 2 to 4 weeks after the initial infection.Symptoms associated with seroconversion include flulike symptoms such as fever,sore throat,headache,malaise,and nausea and usually last 1 to 2 weeks.The earlier stages of HIV infection may last as long as 10 years and may produce few or no symptoms,although viral particles are actively replacing normal cells.AIDS is the final stage of HIV infection.It is estimated that 99% of untreated HIV-infected individuals will progress to AIDS.Treatment regimens with combined antiviral drug regimens are controlling the progression to AIDS.HIV infection and AIDS are now considered,for many infected individuals,chronic diseases.

Question 17

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

Accepted Answer

Nursing interventions focus on protecting the patient from infection.Research studies support the use of high-efficiency particulate air (HEPA)filtration and laminar airflow in single-patient rooms for prevention of infection with airborne microorganisms.Nurses should diligently ensure adequate hygiene measures that include general bathing with antimicrobial soaps,oral care,and perineal care.Hand washing is paramount for staff,patients,and visitors.Nursing staff members play an important role in limiting breaks in skin integrity and ensuring sterile technique when procedures are unavoidable.

Question 18

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

Accepted Answer

There are no specific signs or symptoms of a low neutrophil count.Every body system is examined for physical findings of infection.Typical signs may not be evident.Pain such as sore throat or urethral discomfort may be indicative of an infected site.Areas of heavy bacterial colonization (e.g.,oral mucosa,perineal area,and venipuncture and catheter sites)have the highest risk of infection; however,the most common clinical infections are sepsis and pneumonia.Additional signs or symptoms of systemic infection include a rise in temperature from its normal set point,chills,and accompanying tachycardia.

Question 19

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

Accepted Answer

Malignant diseases involving WBCs are termed leukemia,lymphoma,and plasma cell neoplasm (multiple myeloma).Regardless of the specific neoplastic disorder,a deficiency of functional WBCs is a common problem.Despite normal serum cell counts,WBC activity is always impaired,and infection is the most common complication of all these disorders.

Question 20

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

Accepted Answer

The differential demonstrates the percentage of each type of WBC circulating in the bloodstream.The absolute neutrophil count is calculated by multiplying the total WBC count (without a decimal point)by the percentages (with decimal points)of polymorphonuclear leukocytes (polys; also called segs or neutrophils)and bands (immature neutrophils).
WBC $\times$ (segs + bands)
This gives an actual number that is translated into the categories of mild,moderate,or severe neutropenia.

Quiz 17: Hematological and Immune Disorders