Chapter 23 Disorders of Red Blood Cells PrepU

A client is experiencing fatigue and laboratory results reveal: Hct 40% (0.40); Hgb 8 g/dL (80 g/L); WBC 8000 (8 x 10⁹/L); and platelets 175,000/ µL (175 ×10⁹/L). The nurse would interpret these results as indicative of which diagnosis?

1. Low hemoglobin/anemia

2. High platelets/thrombocytosis

3. High hematocrit/polycythemia

4. Low white blood cell (WBC) count/granulocytopenia

1

A client tells the nurse that the health care provider told them they have too many red blood cells accompanied by elevated white cells and platelet counts. The nurse recognizes this as:

1. Hemolytic anemia

2. Polycythemia vera

3. Aplastic anemia

4. Pernicious anemia

2

A client is experiencing fatigue and laboratory results reveal: Hct 40% (0.40); Hgb 8 g/dL (80 g/L); WBC 8000 (8 x 10⁹/L); and platelets 175,000/ µL (175 ×10⁹/L). The nurse would interpret these results as indicative of which diagnosis?

1. Low hemoglobin/anemia

2. High platelets/thrombocytosis

3. High hematocrit/polycythemia

4. Low white blood cell (WBC) count/granulocytopenia

1

A client tells the nurse that the health care provider told them they have too many red blood cells accompanied by elevated white cells and platelet counts. The nurse recognizes this as:

1. Hemolytic anemia

2. Polycythemia vera

3. Aplastic anemia

4. Pernicious anemia

2

The pathophysiology student is studying erythropoiesis. Which statement demonstrates understanding of this process?

1. "In a 30-year-old, red blood cell production takes place in the femur."

2. "The reticulocyte count serves as an index of erythropoietic activity of the bone marrow."

3. "Erythropoiesis refers to the production of red and white blood cells."

4. "In a 4-year-old, red blood cells are produced mainly in the vertebrae, sternum, ribs, and pelvis."

2

A nursing instructor questions students on the removal of erythrocytes from the body. The instructor knows the students understand when they correctly identify which anatomic locations are the site of removal of aged RBCs by phagocytosis? Select all that apply.

1. Bone marrow

2. Spleen

3. Liver

4. Thymus

5. Appendix

1,2,3

RBCs are destroyed by large phagocytic cells found in spleen, liver, bone marrow, and lymph nodes

The nurse is assessing an 83-year-old adult client for signs and symptoms of anemia. What normal, age-related change increases this client's risk for anemia?

1. Aplastic anemia is common in older adults and the risks increase with each decade.

2. Up to 20% of the RBCs in older adults are incapable of carrying oxygen.

3. Blood cells are not replaced as quickly as they are in younger clients.

4. Gastrointestinal “microbleeds” are common after age 75.

3

A client presents to the clinic with symptoms of elevated blood pressure, dizziness, red face, pain in fingers and toes, headache, and difficulty concentrating. A blood smear reveals an increased number of erythrocytes. Based on these findings, the nurse anticipates which diagnosis?

1. Hemolytic anemia

2. Hyperbilirubinemia

3. Polycythemia vera

4. Leukemia

3

The neonate displays a yellow discoloration of their skin on the second day of life. The neonatologist explains this condition to the parents. Which statement is most accurate?

1. "Breast-feeding will not affect the bilirubin levels."

2. "Most neonatal jaundice resolves spontaneously after about 6 weeks."

3. "Hyperbilirubinemia places the neonate at risk for a cardiac condition known as kernicterus."

4. "The increase in bilirubin, which causes the jaundice, is related to the increased red blood cell breakdown."

4

A nurse is monitoring a client with anemia and low oxygen levels. The nurse knows that which condition stimulates the secretion of erythropoietin?

1. Inflammation

2. Tachycardia

3. Low blood pressure

4. Hypoxia

4

The client with chronic kidney disease and heart failure is weak and dyspneic. Laboratory work reveals a hemoglobin of 6.5 g/dl (65 g/l). Which type of blood product will nurse expect the health care provider to order?

1. packed red blood cells

2. albumin

3. whole blood

4. plasma

1

A client with iron-deficiency anemia reports feeling "tired all of the time." What does the nurse understand may be the cause of the fatigue that the client is experiencing?

1. Increased diffusion of electrolytes

2. Alteration in carbohydrate metabolism

3. Chronic blood loss with inadequate iron available for recycling

4. A decrease in lactic acid

3

The nurse is caring for a 2-day-old newborn infant who appears lethargic and has a yellowish tint to the skin. Select the most likely cause of this newborn’s signs and symptoms.

1. The inability of the immature liver to conjugate bilirubin

2. The inability of a newborn to produce bilirubin

3. Cirrhosis of the liver

4. A decrease in the breakdown of red blood cells

1

A client comes to the clinic with symptoms of fatigue and heavy menses over the past 6 months. Laboratory tests reveal a microcytic hypochromic anemia. Based on these results, the nurse anticipates teaching the client about which type of anemia?

1. iron-deficiency anemia

2. sickle-cell anemia

3. anemia related to kidney disease

4. aplastic anemia

1

When a 3-day-old full-term infant has an elevated bilirubin level of 18 mg/dL (307.87 μmol/L), the nurse will expect to support which intervention?

1. Decreasing or holding breast-feeding

2. Phototherapy

3. Retesting again in 4 hours

4. Exchange blood transfusion

2

Sickle cell anemia is marked by the characteristic sickling of red blood cells. This causes both chronic hemolytic anemia and occlusion of blood vessels. Which are considered to be triggers of an episode of sickling? Select all that apply.

1. Heat

2. Dehydration

3. Alkalosis

4. Infection

5. Stress

2,4,5

The nurse is caring for of a 6-month-old infant diagnosed with iron deficiency anemia. The nurse determines further teaching is necessary when the parent states:

1. "I know this anemic condition can be resolved with good nutrition."

2. "I need to feed my baby cereals with fortified iron."

3. "I must stop breast-feeding my baby because of the anemia."

4. "I need to decrease my baby's intake of whole milk to provide the best nutrition."

3

When an Rh-negative client has been sensitized and is pregnant with an Rh-positive fetus, what happens to the fetus?

1. Bilirubin deficiency

2. Profound red cell hemolysis

3. Plasma volume depletion

4. Nothing, this is normal

2

The staff development nurse is teaching a class of orientees about care of the geriatric client. Which statement is accurate about red blood cell changes with aging?

1. "The decline in hemoglobin levels in older adults is greater in females than males."

2. "Anemia in older adults is treated by placing them all on erythropoietin."

3. "The location of bone cells involved in red cell production shifts toward the axial skeleton."

4. "During a stress reaction, red cells of older adults are replaced as promptly as those of their younger counterparts."

3

An older adult client arrives with garbled speech, unilateral facial drooping, and weakness and unfortunately dies. Laboratory work reveals hematocrit of 54% (0.54). Which complication of polycythemia could most likely be associated with this client's death?

1. Acute leukemia

2. Infection and sepsis

3. Cerebral thrombosis

4. Anaphylactic reaction

3

A nurse assessing a client with an acute exacerbation of polycythemia vera notes coolness to the right leg and foot, pale color, and an absent right pedal pulse. Based on these findings the nurse suspects that the client has developed which complication?

1. infection in the right leg

2. compartment syndrome in the right leg

3. edema in the right leg

4. thrombosis in the right leg

4

The rate at which hemoglobin is synthesized depends on availability of which substance?

1. Iron

2. Calcium

3. Oxygen

4. Glucose

1

What interventions will the nurse perform for the newborn with neonatal jaundice? Select all that apply.

1. Frequent feeding

2. Phototherapy

3. Tube feedings

4. Urinary catheter insertion

1,2

A person with type A blood who exhibits the D antigen would be considered to have which blood type?

1. AB–

2. A–

3. O+

4. A+

4

The pathologic effects of the thalassemias are primarily due to which pathophysiologic process?

1. Erythropoietin deficiency

2. Impaired hemoglobin synthesis

3. Impaired folic acid absorption

4. Loss of iron

2

An adult client with good overall health has reported headaches and dizziness in recent weeks. The nurse's assessment reveals blood pressure of 158/99 mm Hg, which is unprecedented for the client. On observation, the client's skin appears reddened, though they deny feeling warm. The nurse should anticipate what further diagnostic finding?

1. Abnormal RBC indices coupled with low platelets.

2. Elevated RBC, hemoglobin, and hematocrit.

3. Further signs and symptoms of internal hemorrhage.

4. Normal RBC, hemoglobin, and hematocrit with alterations in morphology.

2

Which types and characteristics of anemia are correctly matched?

1. Iron deficiency; early red blood cell (RBC) death

2. Hemolytic; abnormal iron uptake

3. Blood loss; bone marrow expansion

4. Folate; decreased erythropoiesis

4

A nurse is evaluating the laboratory values of a client who developed a hemorrhage during surgery. Which hematology laboratory results would the nurse expect to find?

1. Hematocrit of 45% (0.45)

2. Decreased white blood cell (WBC) count

3. Elevated reticulocyte count

4. Hemoglobin 13.2 g/dL (132 g/L)

3

The client explains to their new provider that they receive periodic phlebotomies to decrease their red blood cell mass. The provider believes the client may have:

1. Megaloblastic anemia

2. Beta-thalassemia

3. Sickle cell disease

4. polycythemia vera

4

The nurse is caring for a client who is a strict vegetarian; the client is at greatest risk for the development of:

1. Folic acid deficiency anemia

2. Microcytic anemia

3. Blood loss anemia

4. Vitamin B₁₂ deficiency anemia

4

B12 comes primarily from meat

An older adult client asks the nurse why so many older people develop anemia. Which response by the nurse is most accurate?

1. Chronic disease

2. Cor pulmonale

3. Increased erythropoiesis

4. Stress

1

The destruction of old blood cells is facilitated by a group of large phagocytic cells found in which anatomic location? Select all that apply.

1. Bone marrow

2. Kidneys

3. Liver

4. Lungs

5. Lymph nodes

1,3,5

they’re found in the spleen, liver, bone marrow, and lymph nodes

A client with iron-deficiency anemia asks, "What does this low mean corpuscular volume (MCV) level mean?" Which response by the nurse is most accurate?

1. This means your blood will thicken rapidly.

2. The MCV is one red blood cell (RBC) index that indicates your RBCs are small cells.

3. This means that your red blood cells are pale in color.

4. This means that you have a lot of fluid in your vessels diluting your red blood cells.

2

A client presents to their health care provider with a red face, hands, feet, and ears; a headache; and drowsiness. A blood smear reveals an increased number of erythrocytes. Based on the laboratory results, the nurse prepares teaching material for which disease process?

1. Leukemia

2. Thrombocytopenia

3. Polycythemia

4. Anemia

3

The burn client is hypotensive and has hypoproteinemia. Which blood component will be utilized in this client's treatment?

1. Plasma

2. Packed red blood cells

3. Platelets-random

4. Albumin

4

An 85-year-old client has been brought to the emergency department where lab work reveals a low hemoglobin of 8.7 g/dL (87 g/L). While taking a detailed history, which statements by the client/family correlate with this anemia? Select all that apply.

1. “When I go food shopping, I have to sit down and rest after one or two aisles.”

2. “I get up to the bathroom two to three times per night.”

3. “They seem to get confused once in a while.”

4. “Some nights I just don’t feel like eating a big meal.”

5. “Every now and then, my big toe gets swollen and it hurts real bad.”

1,3

An older adult with an 80 pack/year history of smoking is diagnosed with emphysema. Recent blood work shows excessive production of red blood cells (erythrocytes), a problem that suggests the need for which intervention?

1. Scheduled erythropoietin injections

2. Continuous supplementary oxygen therapy

3. Vitamin B₁₂ supplements

4. Hemodialysis or peritoneal dialysis

2

All cells of the body age and are replaced in a natural order. When RBCs age, they are destroyed in the spleen. During this process, the iron from their hemoglobin is released into the circulation and returned:

1. to the lungs to bind with oxygen.

2. to the liver to bind with oxygen.

3. to the muscles to be stored for strength.

4. to the bone marrow for incorporation into new RBCs.

4

A nurse is preparing a client for a blood transfusion. They know that a client with type A blood is said to have which type of antibodies?

1. B

2. A and B

3. A

4. Neither A nor B

1

A pregnant client at their first prenatal visit reports to the nurse that they are always tired. The nurse knows that fatigue is one symptom of anemia. What other manifestations of anemia should the nurse assess for? Select all that apply.

1. Faintness

2. Ruddy skin

3. Bradycardia

4. Dim vision

1,4

A client has been diagnosed with aplastic anemia. The nurse correlates this diagnosis with which laboratory value?

1. Relative polycythemia

2. Reduction of white blood cells

3. Decreased inflammatory cytokines

4. Increased hemoglobin counts

2

Polycythemia vera is characterized by which clinical manifestations? Select all that apply.

1. Dusky red appearance

2. Chest pain

3. Hypertension

4. Hemoglobin level 12.5 g/dL (125 g/L)

5. Risk for blood clots

1,2,3,5

A nurse is teaching parents expecting their first child about the benefits of umbilical cord blood donation. The nurse determines teaching was effective based on which statement?

1. "Umbilical cord blood can provide stem cells for transplantation."

2. "Donated cord blood has stem cells that can be used for cloning experimentation."

3. "Umbilical cord blood has stem cells that can generate red blood cells for transfusion."

4. "Stem cells from umbilical cord blood can only be used on infants and children under the age of 5."

1

The surgical nurse is administering a unit of packed red blood cells to the postoperative client. Which of the following is the most common transfusion reaction?

1. Constricting pain in the chest

2. Dyspnea

3. Febrile reaction

4. Tachycardia

3

Which manifestations of leukemia are directly related to a decrease in thrombocytes? Select all that apply.

1. Petechiae

2. Ecchymosis

3. Frequent infections

4. Abdominal pain

5. Nausea

1,2

When red blood cells age, which organ is responsible for their destruction?

1. Liver

2. Kidneys

3. Red bone marrow

4. Spleen

4

The nurse is performing an admission assessment on a client with the diagnosis of primary polycythemia. The nurse anticipates which clinical findings? Select all that apply.

1. Pain in fingers

2. Pale skin

3. Hypertension

4. Hypotension

5. Plethoric appearance of the lips

6. Itching

1,3,5,6

The nurse is assessing a client who is receiving a transfusion of red blood cells.

For each finding, click to specify if the finding is consistent with transfusion-associated circulatory overload (TACO), transfusion-related acute lung injury (TRALI), or acute hemolytic transfusion reaction (AHTR). Each finding may support more than one type of transfusion reaction.

TACO, TRALI, AHTR

Hypotension

Elevated central venous pressure

Tachypnea

Hypoxemia

Bilateral lung crackles

Fever

The nurse is teaching a client about the signs and symptoms of anemia. If the client has a diminished oxygen-carrying capacity of hemoglobin (Hgb), then which manifestation should be assessed?

1. Fatigue

2. Bone pain

3. Pale skin

4. Bleeding

1

The nurse is starting a blood transfusion on a client with anemia. Which manifestations of a transfusion reaction should the nurse be monitoring the client for? Select all that apply.

1. Pallor of the face

2. Swollen, itchy areas on the skin

3. Pain in the lumbar area

4. Bradycardia

5. Dyspnea

2,3,5

Which trend in the hematologic status of a 6-week-old infant (born at 32 weeks’ gestation) most clearly warrants medical intervention?

1. Extremely low hematocrit

2. Decreasing mean corpuscular volume (MCV)

3. Decreasing red blood cell counts

4. Increasing HgA levels

1

An infant from parents of Mediterranean decent has been diagnosed with a severe form of β-thalassemia anemia. The nurse caring for this infant knows that the infant will most likely receive which medical treatment?

1. Iron sulfate supplements

2. Stem cell transplant

3. Warfarin, a blood thinner to decrease clot formation

4. Transfusion therapy

4

A 40-year-old client is admitted to the hospital after experiencing 3 days of extreme vomiting. The health care provider reviews the lab results and notes that the hemoglobin and hematocrit are elevated. What is the likely cause of these abnormal lab findings?

1. Extreme blood loss

2. Normal consequence of aging

3. Increased production of red cells by the body

4. Manifestation of dehydration

4

The client presents with a reduction in red blood cells, white blood cells, and platelets. The practitioner is unable to determine the cause of the client's condition. Which type of anemia does the client have?

1. Acquired hemolytic

2. Intrinsic hemolytic

3. Idiopathic aplastic

4. Extrinsic hemolytic

3

Which client is most susceptible to experiencing the effects of inadequate erythropoiesis?

1. Client with acute kidney injury as a result of longstanding hypertension

2. Client with ischemic stroke who remains bedridden

3. Client with alcohol use disorder and a diagnosis of pancreatitis

4. Surgical client whose estimated blood loss during the procedure was 700 mL

1

The client with a history of gastrectomy presents with severe anemia, mild jaundice, and spastic ataxia. The lab work demonstrates an elevated mean corpuscular volume (MCV). The practitioner suspects the client has which type of anemia?

1. Pernicious

2. Iron deficiency

3. Sickle cell

4. Chronic blood loss

1

The practitioner is examining a client who is fatigued and has a hemoglobin of 8.7 g/dL (87 g/L). Before ordering treatment, which lab will the practitioner order?

1. Transferrin

2. Ferritin

3. Indirect bilirubin

4. Direct bilirubin

2

The anemic client is receiving erythropoietin. If there is a marked increase in red blood cell production, which lab result would increase?

1. Platelets

2. Lymphocytes

3. Reticulocytes

4. Neutrophils

3

A client with a gastrointestinal bleed has been prescribed two units of packed red blood cells. Ten minutes after starting the transfusion, the client's temperature has risen from 37.2°C to 38.2°C. The client's other vital signs remain largely unchanged. What is the nurse's best action?

1. Stop the transfusion and administer a bolus of normal saline.

2. Slow the transfusion and administer antipyretics.

3. Stop the transfusion and inform the health care provider STAT.

4. Stop the transfusion, remove the IV cannula, and retain the blood and tubing.

2

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. Hemoglobin level of 12.5 g/dL (125 g/L)

2. White blood cell (WBC) count <1,000/µL (1 ×10⁹/L)

3. Completed chemotherapy for leukemia in the past year

4. Platelet count 50 ×10³/µL (50 ×10⁹/L)

5. Recent bout with mononucleosis viral infection

2,3,4,5

Which individuals likely are at the highest risk of megaloblastic anemia?

1. An infant who is exclusively fed commercial baby formula

2. A 21-year-old college student who has a poor diet that does not include meat sources

3. A 69-year-old who takes aspirin four times daily to treat arthritis

4. A 44-year-old who lost approximately 500 mL of blood in a workplace accident

2

A pediatric nurse is treating a 2-day-old infant for jaundice. The treatment involves exposing the infant's skin to fluorescent light at 420-470 nm wavelengths. What does the light do to the bilirubin?

1. The light causes vasoconstriction and forces more of the bilirubin out of the liver for metabolism.

2. It converts the bilirubin into a soluble form that is easily excreted in the stool and urine.

3. Fluorescent light activates the liver to increase its metabolism of bilirubin.

4. The light bleaches the bilirubin, causing it to naturally break down.

2

An infant (5 days old) has lab results revealing an elevated level of unconjugated bilirubin due to hemolysis of RBCs. Because of this, which assessment findings would correlate with this abnormal lab result? Select all that apply.

1. Rigidity and tremors

2. Click in the right hip area when adducted

3. Jaundice

4. Difficulty to arouse (lethargy)

5. Cyanosis in hands and feet

3,4

A client who has had a right total knee replacement has experienced a moderate, non-life-threatening loss of blood during the procedure. Which type of blood replacement would be beneficial?

1. Intraoperative blood salvage

2. Anonymous donor blood transfusion

3. Donation of their sibling's blood transfusion

4. Donation of their child's blood transfusion

1

The client who has recently undergone treatment with chemotherapy and radiation has a reduction in all three hematopoietic cell lines. This is known as:

1. Neutropenia

2. Thrombocytopenia

3. Anemia

4. Pancytopenia

4

The student correctly associates macrocytic and enlarged red blood cells with which type of anemia?

1. Iron deficiency

2. Megaloblastic

3. Normocytic

4. Sickle cell

2

Which conditions predispose a person with sickle cell anemia to develop sickling of hemoglobin?

1. Increased iron content of blood

2. Impaired red blood cell maturation

3. Increased intravascular volume

4. Decreased oxygen saturation

4

A client presents to the emergency department with severe menstrual bleeding where they are soaking three to four pads/hour. Following assessment, which findings indicate that their body is trying to increase its cardiac output? Select all that apply.

1. Pale bluish nail beds

2. Light pink mucous membranes

3. Reports of chest “palpitations”

4. Deep respirations with expiratory wheezes

5. Heart rate 120 beats/minute

3,5

A nurse is caring for a client admitted with a complete blood count (CBC) that shows a low red blood cell count, low hemoglobin, and low hematocrit levels. Which question should the nurse ask to help determine a possible cause for these findings?

1. “Do you have a family history of any blood disease?”

2. “Do you eat red meat at least once a week?”

3. “Have you noticed any dark or bloody stools recently?”

4. “Have you experienced any nausea or vomiting recently?”

3

Which client(s) is at high risk for developing anemia as a complication of their chronic disease? Select all that apply.

1. client with chronic kidney disease who has hemodialysis 3 times/week

2. client who had a colectomy 3 weeks ago to remove adhesions and fecal impaction

3. client with chronic obstructive pulmonary disease who has acute exacerbation requiring oxygen therapy via continuous positive airway pressure

4. client who is HIV-positive and who is experiencing frequent infection and elevated CD4⁺ counts

5. client with breast cancer undergoing chemotherapy and radiation therapy

1,4,5

A client undergoing emergent open heart surgery receives an autologous transfusion that has been collected from the operative site. This type of collection is known as which of the following?

1. Hemodilution

2. Predeposit

3. Intraoperative salvage

4. Phlebotomy

3

Accounting for age, illness, and risk factors, a transfusion is recommended when the hemoglobin is at which level?

1. <7 g/dL (<70 g/L)

2. <7.5 g/dL (<75 g/L)

3. Between 7.5 and 8 g/dL (75 and 80 g/L)

4. >8.5 g/dL (>85 g/L)

1

The microbiology technician explains to the student that which blood cell is the most common?

1. Lymphocyte

2. Neutrophil

3. Platelet

4. Erythrocyte

4

A nurse is teaching parents of an infant diagnosed with β-thalassemia about major complications of the disease. The nurse determines that the parents understand when they correctly identify which as a major complication of β-thalassemia?

1. Iron overload

2. Intellectual disability

3. Infection

4. Vitamin B deficiency

1