Hematologic Disorders NCLEX Quiz

1. Which of the following blood components is decreased in anemia?

Erythrocytes

Granulocytes

Leukocytes

Platelets

Anemia is a condition where there is a deficiency in the number of erythrocytes, also known as red blood cells. These cells are crucial for transporting oxygen from the lungs to the rest of the body. When erythrocyte levels are low, the body’s tissues and organs do not receive adequate oxygen, leading to symptoms such as fatigue, weakness, dizziness, and shortness of breath. Anemia can result from various causes, including iron deficiency, chronic diseases, or bone marrow problems. While granulocytes, leukocytes, and platelets are other blood components, they are not primarily affected in anemia. Treatment focuses on addressing the underlying cause and increasing red blood cell count.

Explanation

Anemia is a condition where there is a deficiency in the number of erythrocytes, also known as red blood cells. These cells are crucial for transporting oxygen from the lungs to the rest of the body. When erythrocyte levels are low, the body’s tissues and organs do not receive adequate oxygen, leading to symptoms such as fatigue, weakness, dizziness, and shortness of breath. Anemia can result from various causes, including iron deficiency, chronic diseases, or bone marrow problems. While granulocytes, leukocytes, and platelets are other blood components, they are not primarily affected in anemia. Treatment focuses on addressing the underlying cause and increasing red blood cell count.

2. A client with anemia may be tired due to a tissue deficiency of which of the following substances?

Carbon dioxide

Factor VIII

Oxygen

T-cell antibodies

Anemia causes fatigue and tiredness due to a deficiency of oxygen in the tissues. Erythrocytes, or red blood cells, are responsible for transporting oxygen from the lungs to the rest of the body. In anemia, there is a reduced number of red blood cells or hemoglobin, the protein in red blood cells that binds oxygen. Consequently, the body's tissues receive less oxygen, which is essential for energy production and cellular function. This lack of oxygen leads to symptoms such as fatigue, weakness, and shortness of breath. Carbon dioxide, Factor VIII, and T-cell antibodies do not play a primary role in causing these symptoms in anemia.

Explanation

Anemia causes fatigue and tiredness due to a deficiency of oxygen in the tissues. Erythrocytes, or red blood cells, are responsible for transporting oxygen from the lungs to the rest of the body. In anemia, there is a reduced number of red blood cells or hemoglobin, the protein in red blood cells that binds oxygen. Consequently, the body's tissues receive less oxygen, which is essential for energy production and cellular function. This lack of oxygen leads to symptoms such as fatigue, weakness, and shortness of breath. Carbon dioxide, Factor VIII, and T-cell antibodies do not play a primary role in causing these symptoms in anemia.

3. Which diagnostic findings are most likely for a client with aplastic anemia?

Decreased production of T-helper cells

Decreased levels of white blood cells, red blood cells, and platelets

Increased levels of WBCs. RBCs. and platelets

Reed-Sternberg cells and lymph node enlargement

Aplastic anemia is a condition characterized by the bone marrow's inability to produce sufficient amounts of all types of blood cells: white blood cells (WBCs), red blood cells (RBCs), and platelets. This pancytopenia results from the damage to or destruction of the hematopoietic stem cells in the bone marrow. Consequently, patients with aplastic anemia present with decreased levels of these blood components, leading to symptoms such as fatigue, increased susceptibility to infections, and easy bruising or bleeding. Decreased production of T-helper cells, increased levels of WBCs, RBCs, and platelets, and the presence of Reed-Sternberg cells (indicative of Hodgkin lymphoma) are not characteristic findings of aplastic anemia.

Explanation

Aplastic anemia is a condition characterized by the bone marrow's inability to produce sufficient amounts of all types of blood cells: white blood cells (WBCs), red blood cells (RBCs), and platelets. This pancytopenia results from the damage to or destruction of the hematopoietic stem cells in the bone marrow. Consequently, patients with aplastic anemia present with decreased levels of these blood components, leading to symptoms such as fatigue, increased susceptibility to infections, and easy bruising or bleeding. Decreased production of T-helper cells, increased levels of WBCs, RBCs, and platelets, and the presence of Reed-Sternberg cells (indicative of Hodgkin lymphoma) are not characteristic findings of aplastic anemia.

4. Which of the following cells is the precursor to the red blood cell (RBC)?

B cell

Macrophage

Stem cell

T cell

Stem cells, specifically hematopoietic stem cells found in the bone marrow, are the precursors to red blood cells (RBCs). These stem cells have the unique ability to differentiate into various types of blood cells, including erythrocytes. During the process of erythropoiesis, hematopoietic stem cells develop into erythroblasts, which then mature into reticulocytes and eventually become fully formed RBCs. B cells and T cells are types of lymphocytes involved in the immune response, while macrophages are large white blood cells that engulf and digest pathogens and cellular debris. Thus, stem cells are essential for the production and replenishment of RBCs, crucial for maintaining healthy oxygen levels in the body.

Explanation

Stem cells, specifically hematopoietic stem cells found in the bone marrow, are the precursors to red blood cells (RBCs). These stem cells have the unique ability to differentiate into various types of blood cells, including erythrocytes. During the process of erythropoiesis, hematopoietic stem cells develop into erythroblasts, which then mature into reticulocytes and eventually become fully formed RBCs. B cells and T cells are types of lymphocytes involved in the immune response, while macrophages are large white blood cells that engulf and digest pathogens and cellular debris. Thus, stem cells are essential for the production and replenishment of RBCs, crucial for maintaining healthy oxygen levels in the body.

5. Which of the following disorders results from a deficiency of factor VIII?

Sickle cell disease

Christmas disease

Hemophilia A

Hemophilia B

Hemophilia A is a genetic bleeding disorder caused by a deficiency of clotting factor VIII. This deficiency impairs the blood clotting process, leading to prolonged bleeding episodes following injuries or surgeries, and spontaneous bleeding, particularly into joints and muscles. Hemophilia A is typically inherited in an X-linked recessive pattern, meaning it primarily affects males, while females can be carriers. Christmas disease, also known as Hemophilia B, results from a deficiency of factor IX, not factor VIII. Sickle cell disease is a different genetic disorder that affects hemoglobin in red blood cells, leading to anemia and pain crises. Proper diagnosis and management of Hemophilia A are crucial to prevent bleeding complications and improve the patient's quality of life.

Explanation

Hemophilia A is a genetic bleeding disorder caused by a deficiency of clotting factor VIII. This deficiency impairs the blood clotting process, leading to prolonged bleeding episodes following injuries or surgeries, and spontaneous bleeding, particularly into joints and muscles. Hemophilia A is typically inherited in an X-linked recessive pattern, meaning it primarily affects males, while females can be carriers. Christmas disease, also known as Hemophilia B, results from a deficiency of factor IX, not factor VIII. Sickle cell disease is a different genetic disorder that affects hemoglobin in red blood cells, leading to anemia and pain crises. Proper diagnosis and management of Hemophilia A are crucial to prevent bleeding complications and improve the patient's quality of life.

6. A client with iron deficiency anemia is scheduled for discharge. Which instruction about prescribed ferrous gluconate therapy should the nurse include in the teaching plan?

Take the medication with an antacid.

Take the medication with a glass of milk.

Take the medication with cereal.

Take the medication on an empty stomach.

Ferrous gluconate, an iron supplement used to treat iron deficiency anemia, is best absorbed when taken on an empty stomach. This allows for maximum absorption of the iron into the bloodstream. Taking it with food, especially those containing calcium (like milk) or certain compounds (like antacids or cereal), can interfere with iron absorption. Therefore, the nurse should instruct the client to take ferrous gluconate one hour before or two hours after meals. If gastrointestinal upset occurs, the client can take it with a small amount of food, but this may reduce the effectiveness. Proper adherence to this instruction enhances the treatment's efficacy in correcting anemia.

Explanation

Ferrous gluconate, an iron supplement used to treat iron deficiency anemia, is best absorbed when taken on an empty stomach. This allows for maximum absorption of the iron into the bloodstream. Taking it with food, especially those containing calcium (like milk) or certain compounds (like antacids or cereal), can interfere with iron absorption. Therefore, the nurse should instruct the client to take ferrous gluconate one hour before or two hours after meals. If gastrointestinal upset occurs, the client can take it with a small amount of food, but this may reduce the effectiveness. Proper adherence to this instruction enhances the treatment's efficacy in correcting anemia.

7. Which of the following would the nurse identify as the priority nursing diagnosis during a toddler’s vaso-occlusive sickle cell crisis?

Ineffective coping is related to the presence of a life-threatening disease.

Decreased cardiac output related to abnormal hemoglobin formation

Pain related to tissue anoxia

Excess fluid volume related to infection

During a vaso-occlusive sickle cell crisis, the primary and most immediate concern is managing the severe pain caused by tissue anoxia (lack of oxygen). This pain results from the blockage of blood flow due to the sickled red blood cells obstructing the small blood vessels, which deprives the tissues of oxygen and nutrients. Addressing pain is crucial as it can be debilitating and significantly impacts the child's well-being and ability to cope with the disease. While decreased cardiac output, ineffective coping, and potential fluid volume issues are important considerations, pain management takes precedence to provide immediate relief and prevent further complications associated with the sickle cell crisis.

Explanation

During a vaso-occlusive sickle cell crisis, the primary and most immediate concern is managing the severe pain caused by tissue anoxia (lack of oxygen). This pain results from the blockage of blood flow due to the sickled red blood cells obstructing the small blood vessels, which deprives the tissues of oxygen and nutrients. Addressing pain is crucial as it can be debilitating and significantly impacts the child's well-being and ability to cope with the disease. While decreased cardiac output, ineffective coping, and potential fluid volume issues are important considerations, pain management takes precedence to provide immediate relief and prevent further complications associated with the sickle cell crisis.

8. Which of the following symptoms is expected with hemoglobin of 10 g/dl?

None

Pallor

Palpitations

Shortness of breath

A hemoglobin level of 10 g/dl is below the normal range for adults (typically 12-16 g/dl for women and 14-18 g/dl for men), indicating mild anemia. Pallor, or paleness of the skin and mucous membranes, is a common symptom associated with this condition. It occurs because there are fewer red blood cells available to deliver oxygen to tissues, leading to a pale appearance. While palpitations and shortness of breath can also be symptoms of anemia, they are more commonly associated with more severe cases. Mild anemia, like a hemoglobin level of 10 g/dl, often presents primarily with pallor and possibly mild fatigue. No symptoms at all might be seen in very mild cases, but pallor is typically the first noticeable sign.

Explanation

A hemoglobin level of 10 g/dl is below the normal range for adults (typically 12-16 g/dl for women and 14-18 g/dl for men), indicating mild anemia. Pallor, or paleness of the skin and mucous membranes, is a common symptom associated with this condition. It occurs because there are fewer red blood cells available to deliver oxygen to tissues, leading to a pale appearance. While palpitations and shortness of breath can also be symptoms of anemia, they are more commonly associated with more severe cases. Mild anemia, like a hemoglobin level of 10 g/dl, often presents primarily with pallor and possibly mild fatigue. No symptoms at all might be seen in very mild cases, but pallor is typically the first noticeable sign.

9. The nurse explains to the parents of a 1-year-old child admitted to the hospital in a sickle cell crisis that the child's local tissue damage on admission is caused by which of the following?

Autoimmune reaction complicated by hypoxia

Lack of oxygen in the red blood cells

Obstruction to circulation

Elevated serum bilirubin concentration.

In sickle cell crisis, the primary cause of local tissue damage is obstruction to circulation. Sickle cell disease causes red blood cells to become abnormally shaped (sickle-shaped), which makes them less flexible and more likely to stick together. This clumping can block blood flow in small blood vessels, leading to ischemia (lack of oxygen) and subsequent tissue damage. This blockage causes intense pain and can lead to complications such as organ damage. The lack of oxygen and the obstruction of blood flow are the direct causes of the symptoms seen during a sickle cell crisis. Autoimmune reactions and elevated bilirubin levels are not the primary factors causing the immediate tissue damage in this context.

Explanation

In sickle cell crisis, the primary cause of local tissue damage is obstruction to circulation. Sickle cell disease causes red blood cells to become abnormally shaped (sickle-shaped), which makes them less flexible and more likely to stick together. This clumping can block blood flow in small blood vessels, leading to ischemia (lack of oxygen) and subsequent tissue damage. This blockage causes intense pain and can lead to complications such as organ damage. The lack of oxygen and the obstruction of blood flow are the direct causes of the symptoms seen during a sickle cell crisis. Autoimmune reactions and elevated bilirubin levels are not the primary factors causing the immediate tissue damage in this context.

10. The mother asks the nurse why her child's hemoglobin was normal at birth, but now the child has S hemoglobin. Which of the following responses by the nurse is most appropriate?

"The placenta bars the passage of the hemoglobin S from the mother to the fetus."

"The red bone marrow does not produce hemoglobin S until several months after birth."

“Antibodies transmitted from you to the fetus provide the newborn with temporary immunity.”

“The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth.”

At birth, infants have a high concentration of fetal hemoglobin (HbF) in their blood, which is different from adult hemoglobin (HbA) and sickle hemoglobin (HbS). HbF has a higher affinity for oxygen and provides better oxygenation to the fetus. As the child grows, the production of HbF decreases, and HbS (in children with sickle cell disease) starts to be produced by the red bone marrow. This transition usually occurs several months after birth, which is why symptoms of sickle cell disease typically do not appear immediately after birth. The placenta does not block HbS, and antibodies from the mother provide immunity but do not affect hemoglobin types.

Explanation

At birth, infants have a high concentration of fetal hemoglobin (HbF) in their blood, which is different from adult hemoglobin (HbA) and sickle hemoglobin (HbS). HbF has a higher affinity for oxygen and provides better oxygenation to the fetus. As the child grows, the production of HbF decreases, and HbS (in children with sickle cell disease) starts to be produced by the red bone marrow. This transition usually occurs several months after birth, which is why symptoms of sickle cell disease typically do not appear immediately after birth. The placenta does not block HbS, and antibodies from the mother provide immunity but do not affect hemoglobin types.