HESI EXIST ADVANCED PATHOPHYSIOLOGY 2022 COMPLETE EXAM QUESTIONS AND VERIFIED
ANSWERS 2023-2024 LAT
A 5th grade elementary student asks the school
... [Show More] nurse how much blood is in an entire body. The nurse should respond that the average grown-up adult has
A) 2 to 4 cups of blood in his or her body.
B) 3 pints of blood in total.
C) 3 to 4 quarts of blood in his or her body.
D) 5 to 6 L of blood throughout his or her body. - CORRECT ANSWER-Ans: D Feedback:
The total volume of blood in the average adult is about 5 to 6 L, and it circulatesthroughout the body within the confines of the circulatory system.
A hospital laboratory technician is performing routine blood analysis as part of an inpatient's assessment and is examining the sample in a test tube following processing in a centrifuge and the addition of an anticoagulant. Which of the following observations would the technician most likely interpret as an anomaly?
A) The bottom layer of blood in the tube accounts for around one third of the total volume.
B) The middle layer of cells appears white to gray in color.
C) The top layer of cells is too thin to visualize without microscopy.
D) The yellowish fluid on the top of the sample appears to constitute around one half of the total volume - CORRECT ANSWER-Ans: A
Feedback:
The body layer of cells in a centrifuged blood sample consists of erythrocytes and should constitute around 42% to 47% of the total blood volume. The middle cell layer of leukocytes should appear whitish gray, and the thrombocytes above that layer are frequently not discernable. The plasma layer should account for around 55% of the total blood volume.
During science class, a student asks, "What's the difference between plasma and serum in the blood?" The nurse responds that the primary difference between plasma and serum is that plasma contains
A) fibrinogen.
B) heparin.
C) white blood cells.
D) hydrogen ions. - CORRECT ANSWER-Ans: A Feedback:
The major difference between plasma and serum is the presence of fibrinogen in the plasma from an anticoagulated centrifuged whole-blood specimen. When blood is removed from the body for testing, it clots within 30 to 60 minutes. The clot contains the blood's cellular components enmeshed in an insoluble fibrin network (formed by the polymerization of soluble plasma protein fibrinogen). The remaining fluid portion is the yellow liquid serum. This serum no longer contains fibrinogen because the fibrinogen originally present in uncoagulated blood was used up in the formation of the blood clot. Heparin, WBC, and hydrogen ions are incorrect.
A student makes the statement to a colleague, "Blood plasma is essentially just a carrier for the formed elements like red blood cells and white blood cells." What would be the most accurate response to this statement?
A) "That's not really true. Plasma is crucial in the immune and inflammatory responses."
B) "Actually, plasma plays a significant role in nutrient and waste transport."
C) "Not really. Plasma also contributes to the processes of protein synthesis and hematopoiesis."
D) "Actually, plasma is integral to the proper function of the liver and maintenance of acid-base balance." - CORRECT ANSWER-Ans: B
Feedback:
Plasma proteins are integral to transport. They are not noted to contribute to the inflammatory response, hematopoiesis, protein synthesis, or liver function
The blood work of a 44-year-old male patient with a diagnosis of liver disease secondary to alcohol abuse indicates low levels of albumin. Which of the following phenomena would a clinician be most justified in anticipating?
A) Impaired immune function
B) Acid-base imbalances
C) Impaired thermoregulation
D) Fluid imbalances - CORRECT ANSWER-Ans: D Feedback:
Albumin plays a central role in the maintenance of osmotic pressure and fluid balance. Immune function, acid-base balance, and thermoregulation are not functions of albumin.
A nurse practitioner is providing care for a client with low levels of the plasma protein gamma globulin. The nurse would recognize that the client is at risk of developing which of the following health problems?
A) Jaundice
B) Anemia
C) Infections
D) Blood clots - CORRECT ANSWER-Ans: C Feedback:
The gamma globulins, antibodies of the immune system, protect against infectious diseases. Because alpha globulin transports bilirubin, a defect in this plasma protein might lead to jaundice; a defect of beta globulin, which transports iron, could be associated with anemia; and a defect of fibrinogen could result in blood clots.
Which of the following statements best conveys a characteristic of red blood cells?
A) They lack organelles and soluble enzymes.
B) They contribute to the maintenance of blood pH.
C) They help maintain the body's fluid balance.
D) They are self-replicating. - CORRECT ANSWER-Ans: B Feedback:
Erythrocytes contribute to acid-base balance through the production of bicarbonate and hydrogen ions. They contain soluble enzymes but are neither self-replicating nor involved in fluid balanc
When looking at a granulocyte under a microscope, the anatomy student would describe it as a cell
A) lacking granules.
B) having a kidney-shaped nucleus.
C) having no nuclei.
D) shaped like a sphere with multilobar nuclei. - CORRECT ANSWER-Ans: D Feedback:
Granulocytes are spherical and have distinctive multilobar nuclei. They are all phagocytic cells that are identifiable because of their cytoplasmic granules. Answers A, B, and C are incorrect. Agranulocytes lack granular cytoplasm. Monocytes have a large amount of cytoplasm and a nucleus in the shape of a kidney. Erythrocytes lack a cell nucleus.
Following an injury resulting in a small cut from a knife, the first cells to go to the area of the cut would be the
A) neutrophils.
B) erythrocytes.
C) albumin.
D) basophils - CORRECT ANSWER-Ans: A Feedback:
Neutrophils are very mobile and are the first cells to go to an area of tissue damage. Erythrocytes (RBCs) contain an O2-carrying protein that functions in the transport of oxygen. Albumin, a plasma protein, does not pass through the pores in the capillary wall to enter the interstitial fluid and therefore contributes to the plasma osmotic pressure and maintenance of blood volume. Basophil granules contain heparin, an anticoagulant; histamine, a vasodilator; and other mediators of inflammation.
A 29-year-old construction worker got a sliver under his fingernail 4 days ago. The affected finger is now reddened, painful, swollen, and warm to touch. Which of the following hematological processes is most likely occurring in the bone marrow in response to the infection?
A) Proliferation of immature neutrophils
B) High circulatory levels of myeloblasts
C) Increased segmented neutrophil production
D) Phagocytosis by myelocytes - CORRECT ANSWER-Ans: A Feedback:
A part of the immune response is the proliferation of neutrophils in response to infectious organisms. Neutrophilia is an increase in immature neutrophils ("bands") most commonly seen in acute infections and tissue injuries that promote the accelerated release of neutrophils and their precursors into the circulation. Myeloblasts are not normally found in circulation, and segmented neutrophils would not yet have reached maturity (takes approximately 2 weeks to mature). Myelocytes do not perform phagocytosis.
When talking about the lifespan of various blood components, the students should know that once a neutrophil moves into tissue, it lives approximately for how long?
A) 12 hours
B) 24 hours
C) 2 days
D) 4 days - CORRECT ANSWER-Ans: D
Feedback:
After release from the marrow, the neutrophils spend only approximately 4 to 8 hours in the circulation before moving into the tissues. They survive in the tissues for approximately 4 to 5 days. They die in the tissues by discharging their phagocytic function.
When talking about the various types of granulocytes, which granule contains heparin, an anticoagulant?
A) Neutrophils
B) Eosinophils
C) Basophils
D) Lymphocytes - CORRECT ANSWER-Ans: C Feedback:
The basophils have granules that contain heparin, an anticoagulant; histamine, a vasodilator; and other mediators of inflammation.
A physician is explaining to a 40-year-old male patient the importance of completing his course of antibiotics for the treatment of tuberculosis. The physician explains the damage that could occur to lung tissue by Mycobacterium tuberculosis. Which of the following phenomena would underlie the physician's explanation?
A) Tissue destruction results from neutrophil deactivation.
B) Nonspecific macrophage activity leads to pulmonary tissue destruction and resulting hemoptysis.
C) Macrophages form a capsule around the Mycobacterium tuberculosis bacteria, resulting in immune granulomas.
D) Neutrophils are ineffective against the Mycobacterium tuberculosis antigens. - CORRECT ANSWER-Ans: C
Feedback:
Immune granulomas are caused by insoluble particles (Mycobacterium tuberculosis) that are capable of inciting a cell-mediated immune response. Neutrophils are deactivated, self-destructive, nor ineffective in cases of tuberculosis.
A couple who is expecting their first child has been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple has approached their caregiver with this request and is seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting it. How can their caregiver best respond to the couple's enquiry? Stem cells can
A) "help correct autoimmune diseases and some congenital defects."
B) "be used to regenerate damaged organs should the need ever arise."
C) "be used as source of reserve cells for the entire blood production system."
D) "help treat some cancers and anemias, but they must come from your child himself or herself." - CORRECT ANSWER-Ans: C
Feedback:
The proliferative potential and self-renewal of stem cells make them a compensatory mechanism and reserve source for the entire hematopoietic system. While they could be of possible use in certain autoimmune conditions or in cases of organ failure, these statements do not capture their essence. Stem cells can also come from a histocompatible donor.
Which of the following statements best captures an aspect of the process of hematopoiesis?
A) Colony-stimulating factors (CSFs) produce cytokines that activate progenitor cells.
B) Progenitor cells differentiate into precursor cells.
C) Various subtypes of pluripotent stem cells eventually differentiate into the cellular components of blood.
D) Self-replicating precursor cells differentiate into specific CSFs. - CORRECT ANSWER-Ans: B
Feedback:
During hematopoiesis, progenitor cells differentiate into precursor cells, which in turn differentiate into the cellular components of blood. Cytokine stimulation precedes and regulates the process, and there are no different subtypes of pluripotent stem cells.
Precursor cells are not self-replicating.
Which of the following colony-stimulating factors (CSFs) is given to ESRD patients to help with their chronic anemia?
A) Erythropoietin (EPO)
B) Thrombopoietin (TPO)
C) Neupogen
D) Interleukin - CORRECT ANSWER-Ans: A Feedback:
The CSFs that act on committed progenitor cells include erythropoietin (EPO), which stimulates RBC production. TPO stimulates platelets. Neupogen is for white blood cell production. Interleukin is a cytokine utilized as an immune response agent.
A nurse is providing care for several patients on an acute medical unit of a hospital. Which of the following patients would be most likely to benefit from hematopoietic growth factors?
A) A 51-year-old female patient with liver failure secondary to hepatitis
B) A 61-year-old female patient with end-stage renal cancer
C) A 55-year-old obese male patient with peripheral neuropathy secondary to diabetes
D) A 44-year-old man with a newly diagnosed brain tumor - CORRECT ANSWER-Ans: B
Feedback:
Hematopoietic growth factors are commonly used in cases of kidney disease and cancer. Erythropoietin (EPO) is a colony-stimulating factor that stimulates red blood cell production. As a review, erythropoietin is an essential hormone for red cell production. Without it, definitive erythropoiesis does not take place. Under hypoxic conditions, the kidney will produce and secrete erythropoietin to increase the production of red blood cells. With cancer of the kidney, the kidney is unable to perform its normal function.
They are not as clearly indicated in cases of liver disease, diabetes, or brain tumors. Feedback:
Hematopoietic growth factors are commonly used in cases of kidney disease and cancer. Erythropoietin (EPO) is a colony-stimulating factor that stimulates red blood cell production. As a review, erythropoietin is an essential hormone for red cell production. Without it, definitive erythropoiesis does not take place. Under hypoxic conditions, the kidney will produce and secrete erythropoietin to increase the production of red blood cells. With cancer of the kidney, the kidney is unable to perform its normal function.
They are not as clearly indicated in cases of liver disease, diabetes, or brain tumors.
A geriatrician is following a number of clients on a subacute geriatric medical unit, some of whom require diagnostic blood work. Which of the following clients would be most likely to have an erythrocyte sedimentation rate (ESR) screening test ordered? An adult with
A) a diagnosis of Alzheimer disease and depression
B) orthostatic hypotension and syncopal episodes.
C) congestive heart failure.
D) systemic lupus erythematosus. - CORRECT ANSWER-Ans: D Feedback:
Inflammatory diseases, such as systemic lupus erythematosus, are a common indicator for an ESR test. The other health problems noted are less commonly marked by inflammatory processes
An oncologist has ordered a bone marrow biopsy for a client and is explaining the reasons for the test and what the client might expect during the test. Which of the following explanations best reflects an aspect of a bone marrow biopsy?
A) "I'll take a sample of your bone marrow from your breastbone or your spine."
B) "I will be harvesting a sample of your stem cells for examination."
C) "I need a more accurate count of your blood components than normal blood work is able to provide."
D) "I need to get samples of the types of blood cells that your body is producing." - CORRECT ANSWER-Ans: D
Feedback:
Bone marrow biopsy can be used to detect abnormal cell production and gain samples. A sample would be taken most likely from the iliac crest, and the biopsy would not focus on pluripotent stem cells. Bone marrow biopsy is not used for simple quantification of blood cellular components.
Following a bone marrow biopsy, which of the following assessments would indicate the patient is experiencing a complication as a result of this diagnostic procedure?
A) BP 90/60, heart rate 132, excess bleeding, and hematoma noted at the insertion site
B) BP 130/80, oxygen saturation 95%, and crackles heard on inspiration
C) Respiratory rate 24 and complaining of pain at insertion site
D) Heart rate regular 64 beats/minute and temperature 99.6°F orally - CORRECT ANSWER-Ans: A
Feedback:
The major hazard of a bone marrow biopsy is the risk of hemorrhage. This is usually seen by a decrease in BP, tachycardia, edema from blood pooling in the tissues, etc. All of the other answers are s/s other than shock. Crackles in the lungs correlate with fluid/secretions in the lungs. A bone marrow aspiration is usually performed on the posterior iliac crest and should not cause an elevated respiratory rate. A low-grade fever is not considered a complication.
A hospital laboratory technologist is analyzing the complete blood count (CBC) of a patient. Which of the following statements best reflects an aspect of the platelets that would constitute part of the CBC?
A) Platelets originate with granulocyte colony-forming units (CFU).
B) The half-life of a platelet is typically around 8 to 12 days.
C) The -granules of platelets contribute primarily to vasoconstriction.
D) New platelets are released from the bone marrow into circulation. - CORRECT ANSWER-Ans: B
Feedback:
Platelets' half-life is typically around 8 to 12 days. They originate from megakaryocytes,and -granules facilitate vasoconstriction. New platelets are released from the spleen into circulation.
A 71-year-old male patient with a history of myocardial infarction (MI) and peripheral vascular disease (PVD) has been advised by his family physician to begin taking 81 mg aspirin once daily. Which of the following statements best captures an aspect of the underlying rationale for the physician's suggestion?
A) Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin.
B) Aspirin helps to inhibit ADP action and minimizes platelet plug formation.
C) Aspirin can reduce unwanted platelet adhesion by inhibiting TXA2 synthesis.
D) Aspirin inhibits the conversion of fibrinogen into fibrin and consequent platelet plug formation. - CORRECT ANSWER-Ans: A
Feedback:
Aspirin prevents platelet plug formation by inhibiting synthesis of prostaglandins that mediate clot formation. Aspirin does not influence ADP, TXA2 synthesis, or fibrinogen conversion.
A hospital client is receiving intravenous infusion of heparin for treatment of a pulmonary embolus. Which of the following phenomena is most likely to occur, resulting in the drug's therapeutic effect?
A) Inhibition of vitamin K synthesis in the liver
B) Suppression of fibrin formation
C) Deactivation of the intrinsic clotting pathway
D) Inhibition of ADP-induced platelet aggregation - CORRECT ANSWER-Ans: B Feedback:
Ultimately, heparin inhibits the clotting factors that mediate the formation of fibrin. It does not inhibit vitamin K synthesis, nor does it deactivate the intrinsic clotting pathway in particular. Heparin does not act on platelet plug formation.
When discussing the sequence of clot dissolution, the science instructor will talk about which item that begins the process?
A) Plasminogen
B) Dabigatran
C) Platelets
D) 2-plasmin inhibitor - CORRECT ANSWER-Ans: A Feedback:
As with clot formation, clot dissolution requires a sequence of steps controlled by activators and inhibitors. Plasminogen, the proenzyme for the fibrinolytic process, normally is present in the blood in its inactive form. It is converted to its active form, plasmin, by plasminogen activators formed in the vascular endothelium, liver, and kidneys. Dabigatran is an anticoagulant. Platelets actually help cells stick together or adhere.
In which of the following patients, would diagnostic investigations least likely reveal increased thrombopoietin production?
A) An 81-year-old woman with diagnoses of rheumatoid arthritis and failure to thrive
B) A 55-year-old man with dehydration secondary to Crohn disease
C) A 66-year-old woman with a diagnosis of lung cancer with bone metastases
D) A 21-year-old woman awaiting bone marrow transplant for myelogenous leukemia - CORRECT ANSWER-Ans: D
Feedback:
Diseases such as myelogenous leukemia and other cases of primary thrombocytosis result in abnormalities in the thrombopoietin receptor and platelet binding. Cases of secondary thrombocytosis have an etiology rooted in increased thrombopoietin production. The common underlying causes of secondary thrombocytosis include tissue damage due to surgery, infection, cancer, and chronic inflammatory conditions such as rheumatoid arthritis and Crohn disease.
A 44-year-old Caucasian woman is being treated in an airport infirmary after she developed a painful, swollen leg during a transatlantic flight in economy class. The woman is suspected of having deep vein thrombosis (DVT) and is questioning the paramedics about why this might be the case, given that she has twice previously had similar experiences. Which of the following teaching points by the airport medical staff would be most appropriate?
A) "A lot of Caucasian people have a genetic mutation that causes platelets to stick to their blood vessel walls."
B) "There is a genetic disorder that causes many Caucasians to form more clots in their blood vessels."
C) "A lot of Caucasians have an inherited inability to dissolve clots that form in their bodies."
D) "Your doctor might be able to tell you if you've inherited a predisposition to bleeding in your veins." - CORRECT ANSWER-Ans: C
Feedback:
All of the listed responses refer to the Leiden mutation, which is best characterized as an inhibition of normal clot dissolution due to factor V defects. It does not involve platelet aggregation or adhesion or excess bleeding. It is better characterized as decreased clot dissolution rather than increased clot formation.
A medical student is familiarizing herself with recent overnight admissions to an acute medical unit of a university hospital. Which of the following patients would the student recognize as least likely to have a diagnosis of antiphospholipid syndrome in his or her medical history?
A) A 66-year-old obese male with left-sided hemiplegia secondary to a cerebrovascular accident
B) A 90-year-old female resident of a long-term care facility who has been experiencing transient ischemic attacks
C) A 30-year-old female with a diagnosis of left leg deep vein thrombosis and a pulmonary embolism
D) A 21-year-old male with a diagnosis of cellulitis and suspected endocarditis secondary to intravenous drug use - CORRECT ANSWER-Ans: D
Feedback:
Stroke, transient ischemic attacks, deep vein thrombosis, and pulmonary emboli are all common manifestations of the hypercoagulability associated with antiphospholipid syndrome. Cellulitis, endocarditis, and other infectious processes are less likely to be correlated with antiphospholipid syndrome.
A 36-year-old woman with a diagnosis of antiphospholipid syndrome is receiving a scheduled checkup from her nurse practitioner. Which of the following teaching points would the nurse most likely prioritize?
A) "It's important for you to do regular physical activity and maintain a healthy body weight."
B) "Good nutrition and blood sugar control are important in your case."
C) "You'll need to avoid taking nonsteroidal anti-inflammatory drugs when you have menstrual cramps."
D) "You need to ensure your birth control pills don't contain estrogen." - CORRECT ANSWER-Ans: D
Feedback:
Estrogen-containing birth control pills can predispose individuals with antiphospholipid syndrome to a thrombotic event. Exercise, nutrition, and blood sugar control are not particularly associated with management of antiphospholipid syndrome, and nonsteroidal anti-inflammatory drugs have no noted relevance to the disease.
A patient asks the health care provider why his lower legs look purple. The health care provider will base her response on which pathophysiological principle?
A) Too much trauma breaks capillaries, and they bleed into the tissue.
B) The bruising around the ankles is due to the fact that it is a dependent area where the capillary pressure is higher.
C) There is a problem with his plasminogen levels.
D) Morbid obesity causes veins to enlarge and bleed into tissues due to stress the abdomen is placing on the vascular system. - CORRECT ANSWER-Ans: B Feedback:
Cutaneous bleeding is seen as pinpoint hemorrhages and purple areas of bruising in dependent areas where the capillary pressure is higher. There is no indication that the patient has experienced trauma to the area or is morbidly obese. Plasminogen helps with clot dissolution.
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) "We believe that your son's spleen is causing the destruction of many of his blood platelets, putting him at a bleeding risk."
B) "Your son's spleen is inappropriately filtering out the platelets from his blood and keeping them from normal circulation."
C) "Your son's spleen is holding on to too many of his platelets, so they're not available for clotting."
D) "We think that his spleen is inhibiting the production of platelets by his bone marrow."
- CORRECT ANSWER-Ans: C
Feedback:
A cause of thrombocytopenia is excessive sequestering of platelets by the spleen, necessitating splenectomy. The spleen would not be involved in destroying platelets, filtering them out from existing circulation, or inhibiting their production.
While being on subcutaneous heparin injections for deep vein thrombosis during her latter pregnancy, a patient begins to experience major side effects. Her OB-GYN physician has called in a specialist who thinks that the patient is experiencing
heparin-induced thrombocytopenia. The nurse should anticipate which of the following orders?
A) Decrease the dose of heparin from 5000 units b.i.d to 3000 units b.i.d
B) Immediately discontinue the heparin therapy
C) Switch to Coumadin 2.5 mg once/day
D) Infuse FFP stat - CORRECT ANSWER-Ans: B Feedback:
The treatment of HIT requires the immediate discontinuation of heparin therapy and the use of alternative anticoagulants to prevent thrombosis recurrence. Decreasing the dose will not stop HIT. Coumadin is contraindicated in pregnancy. FFP is not called for in this situation.
Following a course of measles, a 5-year-old girl developed scattered bruising over numerous body surfaces and was diagnosed with immune thrombocytopenic purpura (ITP). As part of her diagnostic workup, blood work was performed. Which of the following results is most likely to be considered unexpected by the health care team?
A) Increased thrombopoietin levels
B) Decreased platelet count
C) Normal vitamin K levels
D) Normal leukocyte levels - CORRECT ANSWER-Ans: A Feedback:
In ITP, thrombopoietin levels are not elevated. Platelet levels would be expected to be low, and vitamin K and leukocyte levels would be unlikely abnormal.
Two nursing students are attempting to differentiate between the presentations of immune thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP). Which of the students' following statements best captures an aspect of the two health problems?
A) "Both diseases can result from inadequate production of thrombopoietin by megakaryocytes."
B) "ITP can be either inherited or acquired, and if it's acquired, it involves an enzyme deficiency."
C) "Both of them involve low platelet counts, but in TTP, there can be more, not less, hemostasis.
D) "TTP can be treated with plasmapheresis, but ITP is best addressed with transfusion of fresh frozen plasma." - CORRECT ANSWER-Ans: C
Feedback:
TTP is marked by sudden and severe thrombotic involvement. Neither disease has an etiology of low thrombopoietin production, and TTP, not ITP, is rooted in an enzyme deficiency. ITP is normally treated with corticosteroids and/or immunoglobulins.
Misinterpreting her physician's instructions, a 69-year-old woman with a history of peripheral artery disease has been taking two 325 mg tablets of aspirin daily. How has this most likely affected her hemostatic status?
A) Irreversible acetylation of platelet cyclooxygenase activity has occurred.
B) The patient's prostaglandin (TXA2) levels are abnormally high.
C) She is at risk of developing secondary immune thrombocytopenic purpura (ITP).
D) The binding of an antibody to platelet factor IV produces immune complexes. - CORRECT ANSWER-Ans: A
Feedback:
Aspirin can cause inhibition of platelet aggregation that lasts for the life of the platelet. High TXA2 levels would be associated with increased coagulability. ITP would not result from aspirin intake, and binding of an antibody to platelet factor IV is associated with heparin-induced thrombocytopenia.
Which of the following teaching points would be most appropriate with a client who has a recent diagnosis of von Willebrand disease?
A) "It's important that you avoid trauma."
B) "Your disease affects your platelet function rather than clot formation."
C) "Make sure that you avoid taking aspirin."
D) "Clotting factor VIII can help your body compensate for the difficulty in clotting." - CORRECT ANSWER-Ans: C
Feedback:
No treatment other than the avoidance of aspirin is normally needed in the case of von Willebrand disease. Avoiding trauma and factor VIII therapy apply to hemophilia. Von Willebrand disease involves both the platelet and coagulation systems.
The school nurse knows several children with hemophilia A. After recess, one student with hemophilia comes to the school nurse complaining of pain in his knee from falling on the playground. The nurse notes there is swelling in the knee and pain on palpation. The nurse should
A) administer some NSAIDs to relieve the pain.
B) wrap the knee in an ace bandage for compression.
C) apply some warm compresses to the knee.
D) notify parents to pick up the child and possibly administer factor VIII. - CORRECT ANSWER-Ans: D
Feedback:
Prevention of trauma is important. ASA and other NSAIDs that affect platelet function should be avoided. Factor VIII replacement therapy administered at home has reduced the typical musculoskeletal damage. Wrapping with a bandage will not prevent damage. Warm compression will extend the bleed.
A 44-year-old female patient presents to the emergency department with abnormal bleeding and abdominal pain that is later attributed to gallbladder disease. Which of the following diagnoses would the medical team be most justified in suspecting as a cause of the patient's bleeding?
A) Excess calcium
B) Vitamin K deficiency
C) Hemophilia B
D) Idiopathic immune thrombocytopenic purpura (ITP) - CORRECT ANSWER-Ans: B Feedback:
Factors VII, IX, and X and prothrombin require the presence of vitamin K for normal activity. Vitamin K deficiency may result from impaired fat absorption caused by liver or gallbladder disease. Calcium, factors X and V, and platelet phospholipids combine to form prothrombin activator, which then converts prothrombin to thrombin. Excess calcium could result in increased formation of blood clots. Hemophilia B is a hereditary disorder. Half of the cases of ITP occur as an acute disorder in children; ITP in adults is a chronic disorder with insidious onset.
Which of the following patients would be at risk for developing nonthrombocytopenic purpura? Select all that apply.
A) A child adopted from India and displaying malaise, lethargy, and petechiae all over the body
B) A 73-year-old patient admitted with concussion that resulted from a fall
C) A 55-year-old patient diagnosed with Cushing disease displaying bruises, weight gain with a buffalo hump, and moon face
D) A 15-year-old insulin-dependent diabetic with hypoglycemia displaying irritability with headaches and tachycardia
E) A pregnant mother experiencing headaches and proteinuria - CORRECT ANSWER- Ans: A, C
Feedback:
Vascular disorders that cause bleeding include vitamin C deficiency (answer A), Cushing disease (answer C), senile purpura, and aging process. Answers B and D do not result in weak vessel walls initially. Pregnant mother experiencing headaches and proteinuria is associated with preeclampsia.
A 30-year-old woman who has given birth 12 hours prior is displaying signs and symptoms of disseminated intravascular coagulation (DIC). The client's husband is confused as to why a disease of coagulation can result in bleeding. Which of the nurse's following statements best characterizes DIC?
A) "So much clotting takes place that there are no available clotting components left, and bleeding ensues."
B) "Massive clotting causes irritation, friction, and bleeding in the small blood vessels."
C) "Excessive activation of clotting causes an overload of vital organs, resulting in bleeding."
D) "The same hormones and bacteria that cause clotting also cause bleeding." - CORRECT ANSWER-Ans: A
Feedback:
DIC hemorrhage results from an insufficiency of clotting proteins after large-scale coagulation. It is not a result of physical irritation, organ overload, or bacteria and hormones.
A newly diagnosed leukemia patient begins hemorrhaging from every orifice. The physician is concerned that the patient has developed disseminated intravascular coagulation (DIC). The nurse should anticipate which of the following orders to be prescribed for this patient? Select all that apply.
A) Transfuse 2 units of platelets.
B) Transfuse fresh frozen plasma.
C) Give aspirin twice per day.
D) Administer IV Toradol stat.
E) Place in reverse isolation. - CORRECT ANSWER-Ans: A, B Feedback:
The treatment of DIC is directed toward managing the primary disease, replacing clotting components, and preventing further activation of clotting mechanisms.
Transfusions of FFP, platelets, or fibrinogen-containing cryoprecipitate may correct the clotting factor deficiency. ASA would make the bleeding worse. Toradol is an NSAID and should be avoided in patients with a bleeding problem. Reverse isolation is implemented for patients with pancytopenia.
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." - CORRECT ANSWER-Ans: B
Feedback:
Ferritin is the protein-iron complex that is stored in tissues, especially the liver, and the serum levels can be used as an indicator of the need for iron supplements. It is not accurately characterized as an activated form of iron, nor does it mediate the actual use of iron by erythrocytes. Transferrin, not ferritin, is transported in plasma, and it is associated with iron storage.
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. - CORRECT ANSWER-Ans: C
Feedback:
Erythropoietin acts primarily in later stages of erythropoiesis to induce the erythrocyte colony-forming units to proliferate and mature through the normoblast stage into reticulocytes and mature erythrocytes. It does not act directly on the stem cells, nor does it play a role in the sensation of hypoxia. Reticulocytes already lack a cell nucleus.
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." - CORRECT ANSWER-Ans: D
Feedback:
Hematocrit measures the mass of erythrocytes in a given quantity of blood plasma. It does not measure the number of red cells, their size, or their production rate and age.
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- - CORRECT ANSWER-Ans: D
Feedback:
The client's blood type is A- and would necessitate A- or O- donor blood. Other types would induce a transfusion reaction.
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. - CORRECT ANSWER-Ans: C
Feedback:
An immediate hemolytic reaction usually is caused by ABO incompatibility. The signs include flushing of the face, urticaria (hives), headache, pain in the lumbar area, chills, fever, chest pain, tachycardia, hypotension, and dyspnea. If any of these actions occur, the transfusion should be stopped immediately. Access to a vein should be maintained because it may be necessary to infuse IV solutions to ensure diuresis. Slowing the rate of the blood infusion will not correct this hemolytic reaction and will only worsen the patient's condition. Of course, documentation after the above interventions are performed is vital. Rechecking the blood type infusing will not stop the hemolytic reaction. After corrective actions/interventions are taken, the blood bag is returned to the blood bank for further testing.
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. - CORRECT ANSWER-Ans: B Feedback:
Ongoing blood loss is associated with iron deficiency anemia due to the depletion of iron stores. She is unlikely to have a depleted blood volume or be at risk for shock, situations more commonly associated with traumatic, sudden blood loss. There would not likely be a delay in the release of reticulocytes.
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." - CORRECT ANSWER-Ans: D Feedback:
Fetal hemoglobin in the infant is replaced by 8 or 10 weeks of age, and manifestations of sickle cell disease can begin at this time. Answer choices A, B, and C all convey the aspects of sickle cell disease.
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 - CORRECT ANSWER-Ans: C Feedback:
Thalassemia can result in enlargement of the spleen and liver due to increased hematopoiesis and red cell destruction. It is associated with thrombotic events, not hypocoagulation, as well as iron excess. Neutropenia is not associated with thalassemia.
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." - CORRECT ANSWER-Ans: D
Feedback:
The Coombs test is used to diagnose immune hemolytic anemias. It detects the presence of antibody or complement on the surface of the red cell. Answer choice A refers to direct antiglobulin test (DAT). Answer choice B refers to blood smear test. Answer choice C refers to iron stores test.
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 - CORRECT ANSWER-Ans: B Feedback:
Although each of the above answers is associated with fatigue and rapid heartbeat, male adolescents are particularly susceptible to iron deficiency anemia. They have high iron requirements because of growth spurts and dietary deficiencies.
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 - CORRECT ANSWER-Ans: D Feedback:
It would be unusual to note decreased levels of erythropoietin concurrent with a diagnosis of anemia. Decreased MCV, hematocrit, and hemoglobin are congruent with the diagnosis, as are microcytic, hypochromic erythrocytes.
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." - CORRECT ANSWER-Ans: D
Feedback:
Formula and cereals for infants should be iron fortified to preclude iron deficiency anemia. Breast-feeding does not necessarily mitigate the need for iron supplementation, and cow's milk does not deplete existing iron stores but fails to provide sufficient levels of absorbable iron. Infants and children have significantly higher iron needs than do adults.
A client with a diagnosis of atrophic gastritis and consequent pernicious anemia is receiving high oral doses of vitamin B12. 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 - CORRECT ANSWER-Ans: A Feedback:
Increased red cell size is associated with vitamin B12 deficiency, and MCV would decrease with treatment. Increased bilirubin and folic acid levels would not be associated with resolution of pernicious anemia, and heme is not normally present or measured in a free circulatory form.
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. - CORRECT ANSWER-Ans: A, B, C Feedback:
The onset of aplastic anemia may be insidious or sudden. The initial presenting symptoms include weakness, fatigue, and pallor caused by the anemia. Petechiae and ecchymoses often occur on the skin, and bleeding from the nose, gums, vagina, or GI tract may occur due to decreased platelet levels. Spoon-shaped deformity of the fingernails is seen in iron deficiency anemia. Hemolysis and blood loss from renal dialysis treatments contribute to anemia associated with a deficiency of erythropoietin (which is normally produced in the kidneys).
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 - CORRECT ANSWER-Ans: A
Feedback:
Increases in erythropoietin production are associated with secondary polycythemia, and not polycythemia vera, a health problem that can be induced by the hypoxia resulting from smoking and lung disease. Dehydration is associated with relative polycythemia, and sudden blood loss would not manifest in increased erythropoietin production. [Show Less]