Question 1

The patient's platelet count is 35,000/microliter.The provider prescribes administration of 10 units of single-donor platelets.After transfusion,the nurse can expect the patient's platelet count to be

Accepted Answer

Medical treatment of thrombocytopenia includes infusions of platelets.Patients who require multiple platelet transfusions should be evaluated for single-donor platelet products,which permit administration of 6 to 10 units of platelets with exposure to the antigens of only one person.For every unit of single-donor platelets,the platelet count should increase by 5000 to 10,000/microliter.

Question 2

The nurse is caring for a patient diagnosed with anemia.This morning's hematocrit level is 24%.Platelet level is 200,000/microliter.The nurse can expect to

Accepted Answer

Transfusion thresholds are established based on laboratory values and patient-specific variables.In general,a threshold for RBC transfusion is considered a hematocrit of 28% to 31%,based on the patient's cardiovascular tolerance.If angina or orthostasis is present,a higher threshold may be maintained.The threshold for transfusing platelets is usually between 20,000 and 50,000/microliter.Cryoprecipitate is usually infused if the fibrinogen level is less than 100 mg/dL.Fresh frozen plasma is used to correct a prolonged prothrombin time and partial thromboplastin time or a specific factor deficiency.

Question 3

Accepted treatments for disseminated intravascular coagulation ( DIC )may require (Select all that apply.)

Accepted Answer

Administration of platelets is the highest priority for transfusion because they provide the clotting factors needed to establish an initial platelet plug from any bleeding site.Fresh frozen plasma is administered for fibrinogen replacement.It contains all clotting factors and antithrombin III; however,factor VIII is often inactivated by the freezing process,thus necessitating administration of concentrated factor VIII in the form of cryoprecipitate.Transfusions of packed RBCs are given to replace cells lost in hemorrhage.Although heparin's antithrombin activity prevents further clotting,it may increase the risk of bleeding and may cause further problems.Its use is controversial when it is administered to patients with DIC.

Question 4

Numbers of white blood cells (WBCs)are increased in circumstances of (Select all that apply.)

Accepted Answer

WBCs play a key role in the defense against infectious organisms and foreign antigens.Numbers of WBCs are increased in circumstances of inflammation,tissue injury,allergy,or invasion with pathogenic organisms.Numbers of WBCs are diminished in conditions of malnutrition,advancing age,and immune diseases.

Question 5

The patient has a platelet count of 9,000/microliter.The nurse realizes that

Accepted Answer

A quantitative deficiency of platelets is termed thrombocytopenia.By definition,this is a platelet count of less than 150,000/microliter.A value of 30,000/microliter is considered critically low,and spontaneous bleeding may occur.Fatal hemorrhage is a great risk when the count is less than 10,000/microliter.

Question 6

Causes of anemia include which of the following: (Select all that apply.)

Accepted Answer

Causes of anemia include (1)blood loss (acute or chronic),(2)impaired production of RBCs,(3)increased RBC destruction,or (4)a combination of these.Polycythemia,a disorder in which the number of circulating RBCs is increased,is seen less often but can affect hypoxic patients (e.g.,those with chronic obstructive pulmonary disease).

Question 7

The nurse is caring for an elderly patient who is being admitted for anemia of unknown cause.The patient has been on multiple medications at home for various ailments.In assessing the patient's medication list,the nurse notes medications that may alter hemostasis,including which of the following: (Select all that apply.)

Accepted Answer

Medications that may alter hemostasis include aminoglycosides,anticoagulants,antiplatelet agents,cephalosporins,histamine blockers,nitrates,sulfonamides,sympathomimetics,and vasodilators.

Question 8

The patient is admitted with anemia caused by blood loss and thrombocytopenia and has a platelet count of 22,000/microliter.The patient is scheduled for a transfusion of RBCs and a transfusion of platelets.The nurse should

Accepted Answer

When the patient's blood does not clot because of thrombocytopenia,administration of RBCs before platelets will result in RBC loss from disrupted vascular structures.Platelets should be given first.Local therapies to stop bleeding are used when systemic anticoagulation is necessary for treatment of another health condition (e.g.,myocardial infarction,ischemic stroke,or pulmonary embolism).Local procoagulants act by direct tissue contact and initiation of a surface clot.

Question 9

The patient is admitted with anemia and active bleeding.The nurse suspects intravascular disseminated coagulation ( DIC ).Definitive diagnosis of DIC is made by evidence of

Accepted Answer

Diagnosis of DIC is made based on recognition of pertinent risk factors,clinical symptoms,and the results of laboratory studies.Evidence of factor depletion in the form of thrombocytopenia and low fibrinogen levels is seen in the early phase; however,definitive diagnosis is made by evidence of excess fibrinolysis detectable by elevated fibrin degradation products,an increased D-dimer level,or a decreased antithrombin III level.

Question 10

Autoimmunity can result from (Select all that apply.)

Accepted Answer

In autoimmunity,the body abnormally sees self as nonself and an immune response is activated against those tissues.Autoimmunity can result from injury to tissues,infection,or malignancy,although in many cases the cause is not known.

Question 11

Inflammation is initiated by cellular injury and (Select all that apply.)

Accepted Answer

Inflammation is initiated by cellular injury,is necessary for tissue repair,and is harmful when uncontrolled.When cellular injury occurs,a process called chemotaxis generates both a mediator and a neutrophil response.Mediator substances (histamine,serotonin,kinins,lysosomal enzymes,prostaglandin,platelet-activating factor,clotting factors,and complement proteins)are released at the site of injury.These mediators cause vasodilation,increase blood flow,induce capillary permeability,and promote chemotaxis and phagocytosis by neutrophils.Inflammatory symptoms such as redness,heat,pain,and swelling are sequelae of these responses.Complement proteins enhance the antibody activity,phagocytosis,and inflammation.

Question 12

Exudate formation at the inflammatory site functions to (Select all that apply.)

Accepted Answer

Exudate formation at the inflammatory site has three functions: dilute toxins produced,deliver proteins and leukocytes to the site,and carry away toxins and debris.Once phagocytes have been attracted to an area by the release of mediators,a process called opsonization occurs,in which antibody and complement proteins attach to the target cell and enhance the phagocyte's ability to engulf the target cell.

Question 13

In caring for the patient who has a coagulopathy,the nurse should (Select all that apply.)

Accepted Answer

Nursing interventions specific to the patient with a coagulopathy include the following: weigh dressings to assess blood loss,assess fluids for occult blood,observe for oozing and bleeding from skin and mucous membranes,and leave clots undisturbed.Precautions such as limiting invasive procedures,including indwelling urinary catheters or rectal temperature measurement,are also important.

Question 14

The nurse is assessing a patient being admitted for anemia.The nurse sees no overt signs of bleeding.The nurse understands that

Accepted Answer

Although many patients with bleeding disorders demonstrate active bleeding from body orifices,mucous membranes,and open lesions or intravenous line sites,equal numbers of patients have less obvious bleeding.The most susceptible sites for bleeding are existing openings in the epithelial surfaces.Mucous membranes have a low threshold for bleeding because the capillaries lie close to the membrane surface,and minor injury may damage and expose vessels.Substantial blood loss can occur in any coagulopathy,resulting in hypovolemic shock.

Question 15

When dealing with hematological malignancies,therapies that have significant management roles include which of the following: (Select all that apply.)

Accepted Answer

Therapy commonly includes chemotherapy and biotherapy.Bone marrow transplantation is used in selected cases.Surgery may be performed to establish a pathological diagnosis by excisional or incisional biopsy but has no other significant role in the management of hematological malignancies.Radiation may be used to treat lymphoma when the disease is limited to single nodes or node groups.

Question 16

Secondary immunodeficiency involves the loss of a previously functional immune defense system,which can be caused by (Select all that apply.)

Accepted Answer

In primary immunodeficiency,the dysfunction exists in the immune system.Most primary immunodeficiencies are congenital disorders related to a single gene defect.Secondary or acquired immunodeficiency is the result of factors outside the immune system,is not related to a genetic defect,and involves the loss of a previously functional immune defense system.AIDS is the most notable secondary immunodeficiency disorder caused by an infection.Aging,dietary insufficiencies,malignancies,stressors (emotional,physical),immunosuppressive therapies,and certain diseases such as diabetes or sickle cell disease are additional examples of conditions that may be associated with acquired immunodeficiencies.

Quiz 17: Hematological and Immune Disorders