Exam 2: Pathophysiology

Transport, waste removal, immunity, and homeostasis (acid-base balance, body temperature, blood pressure)

What are the functions of blood? 

pulmonary

The ______ circulation allows the exchange of oxygen and carbon dioxide in the lungs

systemic

The _____ circulation provides for exchange of nutrients and wastes between the blood and the cells throughout the body.

Arteries

Blood vessels that transport blood away from the heart into the lungs or to body tissues

Arterioles

The smaller branches of arteries that control the amount of blood flowing into the capillaries in specific areas through the degree of contraction of smooth muscle in the vessel walls. 

Capillaries 

very small vessels organized in numerous networks that form the microcirculation

Venules

Smaller branches of veins that conduct blood from the capillary beds towards the heart

Veins

Blood vessels that collect blood from venules to the heart

Arteries

Which has a thicker wall: arteries or veins?

Hematocrit

The proportion of cells in blood, which indicates the viscosity of the blood

42-52%

What is the average hematocrit for males?

37-48%

What is the average hematocrit for females? 

b, d

What might a low hematocrit suggest? Select all that apply 

a. High viscosity blood 

b. Anemia 

c. High blood pressure 

d. Blood loss

a, d

What might a high hematocrit suggest? Select all that apply

a. dehydration 

b. Infection 

c. Hypoxia 

d. excess red blood cells 

Plasma

The clear yellowish fluid remaining after the cells have been removed

Serum

The fluid and solutes remaining after the cells and fibrinogen have been removed from the plasma

Platelets

Cell fragments in the blood used for clotting

INR

Lab value used to measure blood clotting; specifically measures the effectiveness of warfarin

PTT

Lab value that measures the intrinsic clotting pathway; used to monitor heparin

Hematocrit

Measure for the percentage of RBCs in the blood

Cholesterol

Waxy, fat-like substance found in all cells in the body. Elevated levels increase risk for atherosclerosis. 

HDL

Good cholesterol that is protective against heart disease

LDL

Bad cholesterol that contributes to plaque buildup

Triglycerides

a type of fat (lipid) found in your blood, essential for energy storage. It is elevated in metabolic syndrome and atherosclerosis.

Hemoglobin

Molecule in the blood that carries oxygen. Low in anemia 

Ck

Lab value that indicates muscle damage. Increased number indicates muscle injury (which include injury from MI)

Troponin

Heart muscle damage indicator. Increases during an MI and peaks at around 12-24 hrs

BNP

Indicator of congestive heart failure. Increased numbers indicate ventricular stretch and fluid overload.

Atrial Natriuretic Peptide

Hormone released from the atria in response to fluid volume overload. Causes vasodilation and sodium & water excretion which leads to decreased blood volume and BP

C-Reactive Protein (CRP)

Marker for systemic inflammation. It is elevated in infection, autoimmune disease, and atherosclerosis.

Iron

needed for RBC production for hemoglobin synthesis

Vitamin B12

Needed for RBC production for DNA synthesis in RBCs.

Folate

Needed for RBC formation

Vitamin K

Vitamin required for the liver to synthesize clotting factors

Calcium

Substance vital in the clotting cascade

Swollen lymph nodes, fatigue, and sore throat

What are signs and symptoms of mononucleosis?

Iron deficiency anemia

Most common anemia; has microcytic hypochromic RBCs

Polycythemia vera

Condition where there is too many RBCs, which causes increased clot risk and thick blood.

Folate deficiency anemia

Macrocytic anemia common in alcoholics and pregnancy

Pernicious anemia

A B12 deficiency due to lack of intrinsic factor

Aplastic anemia 

Bone marrow failure that leads to pancytopenia 

Leukemia

Cancer of WBCs; abnormal cells crowd out normal cells

Multiple myeloma

Cancer of plasma cells; bone pain, anemia, hypercalcemia

Lymphoma

Cancer of lymph tissue. Hodgkins has Reed-Sternberg cells

Pulmonary: crackles, shortness of breath, orthopnea, fatigue

Signs and symptoms of left-sided CHF

Systemic: edema, JVD, ascites, liver congestion

Signs and symptoms of right-sided CHF

Peripheral artery disease

Caused by atherosclerosis in limb arteries. Can cause intermittent claudication (pain, cramping, or fatigue in the muscles), cool extremities, or poor pulses. 

stop smoking (if smoker), exercise, and antiplatelet therapy

What can be used to managed peripheral artery disease? 

Peripheral venous disorders

Includes varicose veins, chronic venous insufficiency, and DVT. Can cause edema, warmth, skin changes, and ulcers.

Elevation, compression, anticoagulants

What can be used to treat peripheral venous disorders

Buerger’s disease

Inflammatory disease of small arteries/veins mainly seen in young male smokers and can cause pain, ulcers, and gangrene. 

Pericardial effusion

Fluid in pericardial sac; can lead to tamponade

Pericarditis

Inflammation of pericardium; chest pain relieved by leaning forward

Constrictive pericarditis

Chronic thickening of pericardium; restricts heart movement

Myocardial ischemia

Temporary lack of blood flow in the heart leading to angina

Myocardial Infarction

Prolonged myocardial ischemia leading to necrosis of heart tissue

Fatigue, pallor, brittle nails, and stomatitis (inflammation of mucous membranes in the mouth)

What are the symptoms of iron-deficiency anemia

Neuropathy, glossitis (large red tongue), and fatigue

What are symptoms of pernicious anemia 

Stomatitis (inflammation of mucous membranes in mouth), cheilosis (inflammation and painful cracking at corners of the mouth), and malnourished appearance

What are the symptoms of folate deficiency anemia?

Fatigue, infection, and bleeding

What are the symptoms of aplastic anemia?

Jaundice, splenomegaly, pain crises

What are the symptoms of hemolytic anemia?

vaso-occlusive crises, pain, anemia

What are the symptoms of sickle cell disease

Increased blood viscosity, risk of clots, ruddy complexion, and itching after hot baths

What are the symptoms of polycythemia vera?

Secondary polycythemia

Compensatory increase in RBCs due to chronic hypoxia (COPD, high altitude, smoking)

Hemophilia A

X-linked recessive disorder with factor VIII deficiency; causes prolonged bleeding and joint hemorrhage.

DIC (Disseminated Intravascular Coagulation)

Uncontrolled clotting and bleeding triggered by sepsis, trauma, or obstetric complications

d

A female patient is diagnosed with pernicious anemia. In teaching the patient, the nurse includes which of the following explanations for why the patient needs to take medication for the rest of her life?

a.     “You are not getting enough folic acid from your food, so you need to take folic acid daily”

b.     “You must be losing blood from somewhere, and you need to be on iron supplements.”

c.     “You are not getting enough vitamin D needed for absorption of vitamin B12.”

d.     “You are missing the intrinsic factor in the stomach that is needed for absorption of the vitamin B12.”

b, c, e

The nurse is caring for a patient in sickle cell crisis. What are priority interventions for this patient? (Select all that apply.)

a. Assessing nutrition

b. Managing hydration

c. Assessing oxygenation and circulation

d. Giving platelets

e. Managing pain

a

Erythrocytes of a person with sickle cell anemia may become sickled due to which of the following?

a. Patient has hypoxia

b. Patient is overhydrated

c. Patient exercises regularly

d. Patient has pH of 7.40

b

The patient is diagnosed with infectious mononucleosis. Which of the following is a sign or symptom of this disease?

a. Thrombocytopenia

b. Swollen lymph nodes

c. Elevated hemoglobin and hematocrit

d. Diarrhea

a

What is the most likely cause of lymphadenopathy?

a. Exudate is trapped in the lymph nodes, causing them to be enlarged

b. The lymph nodes have been removed

c. The patient has cancer

d. Nothing is wrong. Enlarged lymph nodes are always normal.

d

A patient has a history of gastrointestinal bleeding and a platelet count of 55,000 cells/mm3. Which action by the nurse is most appropriate after seeing the laboratory results?

a. Reporting the abnormally high count to the doctor

b. Placing the normal report in the client’s medical record

c. Monitoring the patient for infection

d. Reporting the abnormally low count to the doctor

a

What is the most common symptom of anemia?

a. Fatigue

b. Weight gain

c. Pain

d. Anorexia

b

A patient reports fatigue, bone pain, and frequent bacterial infections. Tests show that the patient has anemia and hypercalcemia, and X-ray findings show bone lesions. The signs/symptoms and diagnostic findings are consistent with which disorder?

a. Acute leukemia

b. Multiple myeloma

c. AIDS

d. Non-Hodgkins lymphoma

c

A patients lab results show Reed-Sternberg cells. This would indicate that the patient has:

a. Non-Hodgkin’s lymphoma

b. Leukemia

c. Hodgkin’s lymphoma

d. Multiple myeloma

d

Impaired hemostasis can be caused by the lack of which vitamin?

a. Vitamin A

b. Vitamin D

c. Vitamin C

d. Vitamin K

a, d, e

A client with anemia due to chemotherapy has a hemoglobin level of 7.0 grams/dL. Which of the following client complaints would indicate to the nurse that the client has tissue hypoxia related to anemia? Select all that apply.

a. Dizziness

b. Thirst and polyuria

c. Skin warm and dry to the touch

d. Fatigue and weakness

e. Dyspnea

c

For the client diagnosed with iron-deficiency anemia, the nurse should recommend an increased intake of which of the following foods?

a. Fresh citrus fruits

b. Milk and cheese

c. Organ meats

d. whole-grain breads

b

Which of the following is a feature common to both acute and chronic leukemia?

a. Compensatory polycythemia stimulated by thrombocytopenia

b. unregulated accumulation of white blood cells in the bone marrow

c. Increased blood viscosity resulting from an overproduction of white cells

d. Reduced plasma volume in response to a reduced production of cellular components

d

The nurse would teach a client with sickle cell trait that he or she:

a. Should avoid fluid loss or over hydration

b. Is at great risk of sickle cell crisis under triggering conditions

c. Can expect to experience chronic anemia

d. Should receive genetic counseling before starting a family

b

A patient with leukemia has labs that indicate the patient is neutropenic. The nurse should assess for:

a. bleeding

b. fever

c. hypotension

d. weight loss

c

A client asks the nurse why vitamin B12 is important for RBC formation. The nurse includes in a response that vitamin B12 deficiency causes which change in RBCs?

a. Decreased mean corpuscular volume (MCV)

b. Increased hemoglobin

c. Decreased DNA synthesis in the RBC

d. RBC is smaller in shape and deficient in hemoglobin

b

A nurse is discussing the role of hypoxia in RBC production with a client. Which client statement reflects an accurate understanding of this information?

a. “Hypoxia stimulates the hemoglobin content of the RBC to increase.”

b. “Hypoxia stimulates the release of erythropoietin in the kidneys.”

c. ”Reticulocytes become erythrocytes faster with hypoxia.”

d. “RBC destruction is increase with hypoxia, thereby stimulating RBC production.”

d

The nurse is teaching a client about measures to increase the absorption of the prescribed oral iron preparation. Which of the following instructions would the nurse give to the client?

a. Take the medication with milk

b. Take the iron with meal

c. Take the iron shortly after meals

d. Take the pill with a drink that contains vitamin C

a, b, e

The nurse is caring for a client with a diagnosis of disseminated intravascular coagulopathy (DIC). The client’s spouse asks why heparin has been ordered. The nurse’s response would incorporate which of the following points? Select all that apply.

a. Maintaining tissue perfusion

b. Preventing occlusion in the microcirculation

c. Preserving the myocardium

d. Dissolving clots that have formed in the large vessels

e. Preventing deep vein thrombosis (DVT) in the legs

c

Which statement about hematologic changes associated with aging is true?

a. The older adult has increased blood volume

b. the older adult has increased levels of plasma proteins

c. Platelet counts decrease with age

d. Antibody levels and responses are lower and slower in older adults

a

Which symptom is the single most common symptom of anemia?

a. Fatigue

b. Dizziness

c. Palpitations

d. Bruising

d

Severe anemia causes enlargement of which chamber of the heart?

a. Right atrium

b. Right ventricle

c. Left atrium

d. Left ventricle

b

The student nurse is caring for the patient with sickle cell crisis. Which action by the student nurse causes the supervising nurse to intervene?

a. Encouraging the patient to drink fluids

b. Keeping the patient’s room cold

c. Using distraction and relaxation techniques

d. Positioning painful areas of the patient with support

b, e

The nurse is caring for the patient with acute leukemia. All of the following are characteristics that the nurse would expect to see in this patient except?

a. Hematuria

b. Increased RBC’s

c. Joint pain

d. Fatigue

e. Weight Gain

f. Edema

g. Orthostatic hypotension

h. Lymph node enlargement

Leukemia

Uncontrolled proliferation of the WBCs

Multiple myeloma 

Proliferation of B cells that causes tumors in the skeletal system

Hodgkin’s lymphoma

A cancer of the lymphoid tissue that has the reed-Sternberg cell

Non-hodgkins lymphoma

A cancer of the lymphocytes and patients has a longer life expectancy

Heparin induced thrombocytopenia

Caused by a medication that leads to thrombocytopenia

Disseminated intravascular coagulation (DIC)

A disorder where proteins that control blood clotting become overactive

d

A patient has an increased afterload. What does the nurse recognize as a potential cause?

a. fluid volume deficit

b. Hemorrhage

c. Mitral valve regurgitation

d. Hypertension

c

A patient is being discharged home after being treated for congestive heart failure (CHF). What should he be taught about the best way to monitor his fluid balance?

a. Monitor blood pressure

b. Limit sodium intake

c. Weigh himself daily

d. Keep track of intake and output

b

An older adult man enters the emergency department with reports of back pain and fatigue. The patient is found to have a blood pressure of 138/82 mmHg. His pulse is 120, and his hematocrit and hemoglobin are both low. The nurse palpates the abdomen, which is soft and nontender, but notes a pulsating mass and auscultates an abdominal bruit. The nurse concludes that the patient’s manifestations are compatible with which of the following?

a. Hypertension

b. Abdominal aortic aneurysm

c. Lymphoma

d. Congestive heart failure