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Chapter 28 Assessment of Hematologic Function and Treatment Modalities
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Chapter 28 Assessment of Hematologic Function and Treatment Modalities
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Chapter 28 Assessment of Hematologic Functionand Treatment Modalities
1. A patient with a hematologic disorder asks the nurse how the body forms blood cells.
The nurse should describe a process that takes place where?
A) In the spleen
B) In the kidneys
C) In the bone marrow
D) In the liver
Ans: C
Feedback:
Bone marrow is the primary site for hematopoiesis. The liver and spleen may be involved during
embryonic development or when marrow is destroyed. The kidneys release erythropoietin,
which stimulates the marrow to increase production of red blood cells (RBCs). However, blood
cells are not primarily formed in the spleen, kidneys, or liver.
2. A man suffers a leg wound which causes minor blood loss. As a result of bleeding, the process
of primary hemostasis is activated. What occurs in primary hemostasis?
A) Severed blood vessels constrict.
B) Thromboplastin is released.
C) Prothrombin is converted to thrombin.
D) Fibrin is lysed. Ans: A
Feedback:
Primary hemostasis involves the severed vessel constricting and platelets collecting at
the injury site. Secondary hemostasis occurs when thromboplastin is released, prothrombin
converts to thrombin, and fibrin is lysed.
,3. A patient has come to the OB/GYN clinic due to recent heavy menstrual flow. Because of the
patient's consequent increase in RBC production, the nurse knows that the patient may need to
increase her daily intake of what substance?
A) Vitamin E
B) Vitamin D C) Iron
D) Magnesium
Ans: C
Feedback:
To replace blood loss, the rate of red cell production increases. Iron is incorporated into
hemoglobin. Vitamins E and D and magnesium do not need to be increased when RBC
production is increased.
4. The nurse is planning the care of a patient with a nutritional deficit and a diagnosis of
megaloblastic anemia. The nurse should recognize that this patient's health problem is due to
what?
A) Production of inadequate quantities of RBCs
B) Premature release of immature RBCs
C) Injury to the RBCs in circulation
D) Abnormalities in the structure and function RBCs
Ans: D
Feedback:
Vitamin B12 and folic acid deficiencies are characterized by the production of abnormally large
erythrocytes called megaloblasts. Because these cells are abnormal, many are sequestered
(trapped) while still in the bone marrow, and their rate of release is decreased. Some of these
cells actually die in the marrow before they can be released
into the circulation. This results in megaloblastic anemia. This pathologic process does
not involve inadequate production, premature release, or injury to existing RBCs.
, 5. A nurse is caring for a patient who undergoing preliminary testing for a hematologic disorder.
What sign or symptom most likely suggests a potential hematologic disorder? A) Sudden
change in level of consciousness (LOC)
B) Recurrent infections
C) Anaphylaxis
D) Severe fatigue
Ans: D
Feedback:
The most common indicator of hematologic disease is extreme fatigue. This is more
common than changes in LOC, infections, or analphylaxis.
6. The nurse caring for a patient receiving a transfusion notes that 15 minutes after the infusion of
packed red blood cells (PRBCs) has begun, the patient is having difficulty breathing and
complains of severe chest tightness. What is the most appropriate initial action for the nurse to
take?
A) Notify the patient's physician.
B) Stop the transfusion immediately. C) Remove the patient's IV access.
D) Assess the patient's chest sounds and vital signs. Ans: B
Feedback:
Vascular collapse, bronchospasm, laryngeal edema, shock, fever, chills, and jugular
vein distension are severe reactions. The nurse should discontinue the transfusion immediately,
monitor the patient's vital signs, and notify the physician. The blood container and tubing
should be sent to the blood bank. A blood and urine specimen may be needed if a transfusion
reaction or a bacterial infection is suspected. The patient's IV access should not be removed.
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