Exam 2 Patho Hematology
Hematology — RBCs + Hemostasis/Coagulation
Red Blood Cells (Chapter 13)
Increased RBC Production in High Altitude
A patient moves to a high-altitude location and develops increased RBC production.
Correct sequence:
C. Kidney senses hypoxia → releases EPO → bone marrow increases erythrocytes.
Location of Erythropoiesis
Primary occurrence of erythropoiesis:
B. Bone marrow.
Nucleus Expulsion during RBC Maturation
The nucleus is expelled at which stage:
C. Reticulocyte stage.
RBC Lifespan
Correct lifespan of RBCs:
B. RBCs circulate about 120 days and are removed by the spleen.
Function of the Spleen
The spleen is referred to as the “graveyard” of RBCs because it:
C. Removes aged/lysed/dead RBCs.
Reticulocytosis Situations
An increased reticulocyte count may be seen in:
A. Acute bleeding
B. Rapid RBC destruction
D. Excessive RBC loss with early release.
Decreased Reticulocyte Count
A decreased reticulocyte count most strongly suggests:
B. Bone marrow suppression.
Shape of RBCs
RBCs are biconcave primarily to:
B. Increase surface area for diffusion.
Color of RBCs
Why are RBCs red in color?
B. They contain large amounts of hemoglobin.
Oxygen Transport in Blood
Most oxygen in the blood is transported:
B. Attached to hemoglobin.
Oxygen Dissolved in Plasma
Approximately what percent of oxygen is dissolved in plasma?
D. 5%.
Nutrients for Healthy RBC Production
Required nutrients include:
A. Protein
B. Iron
C. Vitamin B12
D. Folic acid.
Composition of Hemoglobin
Hemoglobin is composed of:
B. Heme and globin.
Hemoglobin Metabolism Pigment Sequence
Hemoglobin metabolism leads to which pigment sequence?
B. Biliverdin → bilirubin.
Hyperbilirubinemia Findings
Hyperbilirubinemia can cause:
B. Jaundice.
Jaundice Presentation
Jaundice is most likely to present as:
A. Yellowing of the skin
B. Yellowing of the sclera
E. Yellowing of the white part of the eyes.
Composition of Adult Hemoglobin (HbA)
Adult hemoglobin (HbA) contains:
A. Two alpha and two beta polypeptide chains.
Maximum Oxygen Carried by Hemoglobin
Each hemoglobin molecule can carry a maximum of how many oxygen molecules?
C. 4.
Where Oxygen Attaches to Hemoglobin
Oxygen attaches to hemoglobin primarily in the:
B. Pulmonary capillaries.
Effect of Iron Deficiency on RBCs
Not enough iron results in RBCs that:
B. Have less hemoglobin and decreased oxygen-carrying capacity.
Hemoglobin F (HbF)
Hemoglobin F (HbF) is best described as:
B. Fetal hemoglobin replaced by HbA after birth.
Definition of Hemoglobinopathy
Hemoglobinopathy refers to:
B. Abnormal hemoglobin structure due to genetic mutation.
Sickle Cell Disease
Sickle cell disease involves RBCs becoming:
B. Crescent-moon shaped (“sickled”).
Iron Absorption Site
Iron is absorbed primarily in the:
B. Duodenum and upper jejunum.
Iron Transportation
Iron is transported in the blood mainly by:
B. Transferrin.
Iron Storage
Iron is stored primarily as:
B. Ferritin complexes.
Common Iron Storage Sites
Common iron storage sites include:
A. Bone marrow
B. Liver
C. Spleen.
Dietary Factor Increasing Iron Absorption
Which dietary factor increases iron absorption?
B. Vitamin C.
Dietary Factor Decreasing Iron Absorption
Which dietary factor decreases iron absorption?
C. Tannates in tea.
Iron during RBC Breakdown
When the spleen breaks down old RBCs, the iron is primarily:
C. Recycled.
Percentage of Whole Blood that is RBCs
Which value is the percentage of whole blood that is RBCs?
B. Hematocrit (Hct).
CBC Component Reflecting Clotting Ability
Which CBC component reflects clotting ability most directly?
B. Platelets.
Normal Reticulocyte Percentage
Reticulocytes normally make up about what percent of total RBCs?
C. 1%.
MCV Usage
MCV is used to evaluate:
B. RBC size.
Expected MCV in Microcytic RBCs
Microcytic RBCs would be expected with:
B. Decreased MCV.
Hypochromic RBCs Indication
Hypochromic RBCs most closely indicate:
B. Decreased hemoglobin per cell (pale RBCs).
Pattern of Low MCV and Color
A pattern of low MCV + low “color” is most consistent with:
B. Microcytic hypochromic anemia (iron deficiency).
Pattern of Normal MCV and MCHC
A pattern of normal MCV + normal MCHC is most consistent with:
A. Normocytic normochromic anemia; commonly blood loss.
Definition of Thalassemia
Thalassemia is best defined as:
B. Deficiency of one hemoglobin polypeptide chain.
Findings in Thalassemia
In thalassemia, findings/mechanisms consistent with the study guide include:
A. Reduced hemoglobin synthesis
B. Decreased RBC production
C. Excess chains can build up and damage RBC development
D. Heinz bodies may form
E. Bone marrow expansion may thin bone (osteopenia).
Most Severe Form of Beta Thalassemia
The most severe form of beta thalassemia is called:
B. Cooley’s anemia.
Platelets, Hemostasis & Coagulation (Chapter 14)
Sequence of Hemostasis
Hemostasis involves:
B. Vasoconstriction → platelet plug → coagulation.
Primary Hemostasis
Primary hemostasis refers mainly to:
B. Platelet aggregation/plug formation.
Secondary Hemostasis
Secondary hemostasis refers mainly to:
B. Coagulation cascade leading to fibrin formation.
Occlusive Thrombus Danger
An occlusive thrombus is dangerous because it can:
B. Obstruct blood flow in arteries or veins.
Origin of Platelets
Platelets come from:
B. Megakaryocytes.
Platelet Lifespan
Platelet lifespan is approximately:
C. 7–10 days.
Synthesis of Thrombopoietin
Thrombopoietin is synthesized primarily by the:
B. Liver.
Endothelial Injury and Platelet Function
Endothelial injury exposes collagen and releases vWF, which:
B. Attracts platelets to the injury site.
Intrinsic Pathway Measurement
The intrinsic pathway is measured by:
B. aPTT.
Respiratory Concepts — Structure, Function, Pathophysiology Anatomy, Defense, Gas Exchange
Right Lung Lobes
The right lung has:
C. 3 lobes.
Left Lung Lobes
The left lung has:
B. 2 lobes.
Aspiration Risk
Aspiration is more likely to affect the right lung because:
B. The right side has increased aspiration risk per anatomy emphasized.
Airflow Pathway to Gas Exchange Units
Correct pathway for airflow to gas exchange units is:
B. Trachea → bronchi → bronchioles → alveolar ducts → alveoli.
Mucociliary Escalator Composition
The mucociliary escalator consists of:
B. Ciliated pseudostratified epithelial cells and goblet cells.
Disruptors of Mucociliary Escalator
Disruptors of the mucociliary escalator include:
A. Smoking
B. Respiratory infections.
Location of Gas Exchange
Gas exchange occurs primarily at the:
B. Alveolar-capillary membrane.
Factors Impairing Gas Exchange
Gas exchange is impaired by:
A. Reduced surface area (e.g., emphysema concept)
B. Increased membrane thickness (e.g., edema/fibrosis concepts)
C. V/Q mismatch.
Normal PaO₂ Range
Normal PaO₂ range is:
C. 80–100 mmHg.
Normal PaCO₂ Range
Normal PaCO₂ range is:
B. 35–45 mmHg.
Pulse Oximetry (SpO₂) Estimate
Pulse oximetry (SpO₂) primarily estimates:
A. Hemoglobin saturation with oxygen.
Limitations of Pulse Oximetry
Limitations of pulse oximetry include:
A. Does not measure CO₂
B. Can be inaccurate with poor perfusion
C. Dark nail polish can interfere
D. Carbon monoxide poisoning can give falsely high SpO₂.
Suspicion of Hypoxia
A patient is restless, confused, tachycardic, and cyanotic; the nurse should suspect:
B. Hypoxia.
Erythropoietin (EPO) Production
EPO production is primarily from the:
B. Kidney (90%) and liver (10%).
Mechanics of Breathing, V/Q, Regulation
Primary Muscle of Inspiration
The primary muscle of inspiration is the:
B. Diaphragm.
Nerve Critical for Diaphragm Control
The nerve emphasized for diaphragm control is the:
B. Phrenic nerve.
Indication of Retractions
Retractions indicate:
B. Increased work of breathing and distress.
Definition of Ventilation (V)
Ventilation (V) refers to:
B. Air reaching alveoli.
Definition of Perfusion (Q)
Perfusion (Q) refers to:
B. Blood reaching alveoli.
Example of Pulmonary Embolism (PE)
A pulmonary embolism (PE) is a classic example of:
B. Ventilated but not perfused alveoli.
Hypoxic Pulmonary Vasoconstriction
Hypoxic pulmonary vasoconstriction occurs when:
B. An alveolus has low oxygen and nearby arterioles constrict.
Chronic Hypoxia Consequences
Chronic hypoxia can lead to:
A. Pulmonary hypertension.
Central Chemoreceptors Response
Central chemoreceptors primarily respond to changes in:
B. CO₂ and pH.
Peripheral Chemoreceptors Response
Peripheral chemoreceptors primarily respond to:
B. Decreased arterial oxygen.
Hypoxic Drive Activation
Hypoxic drive becomes strongly activated when PaO₂ falls below about:
C. 60 mmHg.
Common Cause of Hypercapnia
Hypercapnia most commonly results from:
B. Hypoventilation.
Respiratory Pathophysiology Terms & “Fluid Where It Shouldn’t Be”
Definition of Dyspnea
Dyspnea is best defined as:
B. Subjective shortness of breath.
Orthopnea Definition
Orthopnea refers to dyspnea that:
B. Worsens when lying flat.
Productive Cough
A cough that produces sputum is described as:
B. Productive.
Definition of Hemoptysis
Hemoptysis is:
B. Sputum containing blood.
Atelectasis Definition
Atelectasis is best defined as:
B. Collapse of a small number of alveoli.
Importance of Atelectasis Post-op
Atelectasis increases risk for:
B. Pneumonia.
Function of Incentive Spirometry
Incentive spirometry helps primarily by:
B. Reopening alveoli and reducing collapse.
Definition of Hypoxemia
Hypoxemia means:
B. Insufficient oxygen in the blood.
Definition of Hypoxia
Hypoxia means:
A. Insufficient oxygen for tissue needs.
Mild Hypoxemia SpO₂ Range
Mild hypoxemia generally around SpO₂:
C. 90–94%.
Moderate Hypoxemia SpO₂ Range
Moderate hypoxemia generally around SpO₂:
B. 85–89%.
Severe Hypoxemia SpO₂ Description
Severe hypoxemia generally:
D. <85%.
Acute Pharyngitis Definition
Acute pharyngitis is inflammation of the:
B. Pharynx.
Laryngitis Definition
Laryngitis is inflammation of the:
A. Larynx.
Bronchodilation Association
Bronchodilation is primarily associated with:
A. Sympathetic nervous system.
Bronchoconstriction Association
Bronchoconstriction is primarily associated with:
B. Parasympathetic nervous system.
Reduced Lung Compliance Definition
Reduced lung compliance means the lungs are:
A. Stiffer and harder to expand.
Pleural Membrane Function
The pleural membrane helps lung expansion mainly by maintaining:
B. Negative intrathoracic pressure.
Pleural Effusion Definition
Pleural effusion is best described as:
B. Fluid in the pleural cavity around the lung.
Pulmonary Edema Definition
Pulmonary edema is best described as:
B. Fluid at/around alveoli interfering with diffusion.
Common Cause of Pulmonary Edema
The most common cause of pulmonary edema is:
B. Left ventricular heart failure.
Nursing Priority for Pleural Effusion
A nursing priority for a patient with pleural effusion is to:
A. Position upright to support breathing and assess respiratory status.
Interpreting SpO₂ with Confusion
A patient’s SpO₂ reads 99% but the patient is confused; the best interpretation is:
B. Pulse oximetry is limited; assess clinically and consider ABG if indicated.
Findings Prompting Concern for Hypoxia
Findings that should prompt concern for hypoxia:
A. Confusion
B. Restlessness
C. Cyanosis
D. Tachycardia.