NURS-304 (M3) - Chapter 23: Disorders of Red Blood Cells

As part of his diagnostic workup, a 77-year-old male is having his ferritin level analyzed. Which explanation by the health care provider regarding the significance and rationale for this test is most accurate?

(a) "Ferritin is a stored form of iron that indirectly shows me whether you would benefit from iron pills."

(b) "Ferritin is a protein-iron complex that allows your red blood cells to make use of the iron that you consume in your diet."

(c) "Ferritin is the activated and usable form of iron that your red blood cells can use to transport oxygen."

(d) "Ferritin is the form of iron that is transported in your blood plasma to red blood cells that need it."

(a) "Ferritin is a stored form of iron that indirectly shows me whether you would benefit from iron pills."

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 statement best captures the necessity of this medication?

(a) Erythropoietin is necessary for the accurate sensation of hypoxia that stimulates erythropoiesis.

(b) Erythropoietin causes the erythrocyte colony-forming units to proliferate and mature.

(c) Erythropoietin is needed in order for stem cells to proliferate into committed erythroid precursors.

(d) Erythropoietin facilitates the extrusion of the reticulocyte nucleus and the formation of true erythrocytes.

(b) Erythropoietin causes the erythrocyte colony-forming units to proliferate and mature.

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) "Your hematocrit measures the average size of your red blood cells, and indirectly measures your oxygen-carrying capacity."

(b) "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."

(c) "The hematocrit measures the mass that your red blood cells account for in a quantity of your blood."

(d) "This result will tell your care provider about the number of red blood cells in a given quantity of your blood plasma."

(c) "The hematocrit measures the mass that your red blood cells account for in a quantity of your blood."

A client with a gastrointestinal bleed secondary to alcohol abuse and a hemoglobin level of 5.8 g/dL (58 g/L) has been prescribed 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 blood type would be least likely to produce a transfusion reaction?

(a) A-

(b) B+

(c) A+

(d) B-

(a) A-

Your client with end-stage renal disease is receiving 2 units of packed red blood cells for anemia (Hgb of 8.2 g/dL [82 g/L)). Twenty minutes into the first transfusion, the nurse observes the client has a flushed face, hives over upper body trunk, and is reporting 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) Recheck the type of blood infusing with the chart documentation of client's blood type.

(b) Discontinue the transfusion and begin an infusion of normal saline.

(c) Document the assessment as the only action.

(d) Slow the rate of the blood infusion to 50 mL/hour.

(b) Discontinue the transfusion and begin an infusion of normal saline.

A 66-year-old female client has presented to the emergency department because of several months of intermittently bloody stool which 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 situation is most likely?

(a) The client will be at risk for cardiovascular collapse or shock.

(b) She will have iron-deficiency anemia due to depletion of iron stores.

(c) She will have delayed reticulocyte release.

(d) 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.

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 statement by the parents would suggest a need for further teaching or clarification?

(a) "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."

(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 baby's red cells are prone to early destruction because of their weak membranes."

(a) "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."

A child has been diagnosed with thalassemia. Which of the following comorbidities may occur as a result of having thalassemia?

(a) Iron deficiency

(b) Neutropenia

(c) Splenomegaly

(d) Hypocoagulation

(c) Splenomegaly

A client has been diagnosed with anemia. The physician suspects an immune hemolytic anemia and orders a Coombs test. The client asks the nurse what this test will tell the doctor. The nurse replies:

(a) "They are looking for the presence of antibody or complement on the surface to the RBC."

(b) "They will look at your RBCs under a microscope to see if they have an irregular shape (poikilocytosis)."

(c) "They will wash your RBCs. Then mix the cells with a reagent to see if they clump together."

(d) "They will be looking to see if you have enough ferritin in your blood."

(a) "They are looking for the presence of antibody or complement on the surface to the RBC."

A community health nurse is conducting the nutritional component of a class for new mothers. Which teaching point would be most justified?

(a) "Your infant needs the same amount of iron as you, but has far fewer sources for obtaining it."

(b) "Iron supplementation is not necessary provided you are breast-feeding your infant."

(c) "Be aware that cow's milk depletes your baby's supply of iron."

(d) "If you choose to feed your baby with formula, ensure that it is iron-fortified."

(d) "If you choose to feed your baby with formula, ensure that it is iron-fortified."

A client with a diagnosis of atrophic gastritis and consequent pernicious anemia is receiving high oral doses of vitamin B12. Following completion of his treatment, which lab finding demonstrates improvement in this condition?

(a) Decreased free heme levels

(b) Increased folic acid levels

(c) Increased serum bilirubin

(d) A decrease in mean corpuscular volume

(d) A decrease in mean corpuscular volume

Two years after chemotherapy and radiation therapy for lung cancer, a 72-year-old client reports being extremely tired all the time. The physician suspects the client may have developed aplastic anemia. The nurse assessing the client will likely find which clinical manifestation of aplastic anemia? Select all that apply.

(1) Spoon-shaped deformity of the fingernails

(2) Hemolysis from renal dialysis treatments

(3) Complaints of weakness and fatigue

(4) Small spots of skin hemorrhages over entire body

(5) Excess bleeding from gums and nose

(3) Complaints of weakness and fatigue

(4) Small spots of skin hemorrhages over entire body

(5) Excess bleeding from gums and nose

Which client 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 21-year-old man with acute blood loss secondary to a motor vehicle accident 3 hours prior

(c) A 70-year-old woman admitted with dehydration secondary to an overdose of her potassium-wasting diuretic

(d) A 68-year-old man with a long-standing diagnosis of polycythemia vera

(a) A 71-year-old smoker admitted to hospital with exacerbation of his chronic obstructive pulmonary disease (COPD)

A 53-year-old man presents with inability to concentrate, itching in his fingers and toes, elevated blood pressure, and unexplained weight loss. He is diagnosed with primary polycythemia. What will be the primary goal of his treatment?

(a) To reduce the viscosity of his blood

(b) To reduce the mean size of his red cells

(c) To control his hypertension

(d) To increase the amount of oxygen distributed by his red blood cells

(a) To reduce the viscosity of his blood

New parents are upset their 2-day-old infant is requiring phototherapy for hyperbilirubinemia. Which factors would the pediatrician be most likely to rule out as a contributor to high bilirubin levels?

(a) The fact that the infant is being breast-fed

(b) Transitioning of hemoglobin F (HbF) to hemoglobin A (HbA)

(c) Hypoxia

(d) Hepatic immaturity of the infant

(b) Transitioning of hemoglobin F (HbF) to hemoglobin A (HbA)

If an Rh-negative mother is giving birth to an Rh-positive infant, the nurse should be prepared to administer:

(a) Rh immune globulin.

(b) alpha interferon.

(c) a monoclonal antibody like infliximab.

(d) antihistamines like diphenhydramine.

(a) Rh immune globulin.

The family of an older adult client is wondering why his "blood counts" are not rising after his last GI bleed. They state, "He has always bounced back after one of these episodes, but this time it isn't happening. Do you know why?" The nurse will respond based on which pathophysiologic principle?

(a) "Don't worry about it. We can always give him more blood."

(b) "The doctor may start looking for another cause of his anemia, maybe cancer of the bone."

(c) "Due to stress, the red blood cells of older adults are not replaced as promptly as younger people."

(d) "Everything slows down when you get older. You just have to wait and see what happens."

(c) "Due to stress, the red blood cells of older adults are not replaced as promptly as younger people."

The nurse is caring for a 30-year-old woman who is diagnosed with iron deficiency anemia. The client is confused how this condition developed because she ate many foods high in iron. How should the nurse respond?

(a) Some people have a condition that impairs the ability to use the iron they take in effectively.

(b) This iron deficiency anemia was most likely the result of chronic blood loss over a period of time.

(c) Diet deficiencies are the most common reason, so it is likely the intake was not sufficient.

(d) Iron deficiency anemia is actually more likely linked to deficits of vitamin B12 and folate in the diet.

(b) This iron deficiency anemia was most likely the result of chronic blood loss over a period of time.

The nurse is caring for a client with jaundice. What evidence will the nurse use to determine if the cause of the jaundice is due to a hemolytic condition?

(a) Elevated unconjugated bilirubin

(b) Decreased conjugated bilirubin

(c) Decreased hemoglobin

(d) Liver function tests

(a) Elevated unconjugated bilirubin

The nurse is caring for a teenager with sickle cell anemia. When comparing new laboratory results with the client's baseline, which results should the nurse prioritize as requiring intervention? Select all that apply.

(1) Elevated white blood cell count

(2) elevated serum bilirubin

(3) elevated serum osmolarity

(4) low pH on an arterial blood gas

(5) decreased hemoglobin

(1) Elevated white blood cell count

(3) elevated serum osmolarity

(4) low pH on an arterial blood gas

The nurse is reviewing the treatment plan with parents of a 6-month-old diagnosed with severe β-thalassemia. Which statements by the parents demonstrate they understand the treatment plan? Select all that apply.

(1) "Transfusions are needed to prevent skeletal abnormalities from developing."

(2) "Transfusions will need to begin once our child reaches 2 years of age."

(3) "A stem cell transplant may be used as part of the treatment plan."

(4) Oxygen therapy should be used to prevent organ damage from chronic hypoxia.

(5) "We will need to feed our child a diet high in iron to promote red blood cell production."

(1) "Transfusions are needed to prevent skeletal abnormalities from developing."

(3) "A stem cell transplant may be used as part of the treatment plan."

The nurse is assessing a client. What findings should the nurse apply as evidence of iron deficiency anemia? Select all that apply.

(1) Oral lesions

(2) Dyspnea on exertion

(3) Concave fingernails (koilonychia)

(4) Paresthesia of the feet and fingers

(5) Jaundice

(1) Oral lesions

(2) Dyspnea on exertion

(3) Concave fingernails (koilonychia)

The nurse is caring for neonates undergoing treatment for hyperbilirubinemia. Which assessment findings should the nurse prioritize? Select all that apply.

(1) rigidity

(2) reduction in feeding

(3) jaundice

(4) increase in urine output

(5) lethargy

(1) rigidity

(2) reduction in feeding

(5) lethargy

A female client arrives at the clinic reporting fatigue that is exhausting, bruising on the skin, and bleeding from the gums. Which diagnostic result(s) or history finding(s) correlates with a diagnosis of aplastic anemia?

Select all that apply.

(1) White blood cell (WBC) count

(1) White blood cell (WBC) count

When a Rh-negative mother becomes pregnant by a partner who is Rh-positive, which advanced treatment modality will decrease the risk of the fetus developing hemolytic disease?

(a) Discuss an intrauterine transfusion to the affected fetus.

(b) Perform aminocentesis to draw unconjugated bilirubin and immediate delivery if levels are high.

(c) Give mother gamma globuline-containing Rh antibody in the first trimester of pregnancy.

(d) Discuss options to prevent any further pregnancy.

(a) Discuss an intrauterine transfusion to the affected fetus.