A nurse is discussing a granulocyte. Which type of cell is the nurse describing? Neutrophil (Neutrophils, eosinophils and basophils are types of granulocytes) A patient has a decreased number of leukocytes. Which term will the nurse use to describe this finding? Leukopenia (Leukopenia is present when the count is lower than normal) A nurse wants to talk about the most common granulocyte cell. Which type of cells will the nurse describe? Neutrophils (Neutrophilia is another term that may be used to describe granulocytosis because neutrophils are the most numerous of the granulocytes) A patient has a shift to the left or left shift. What other term can the nurse use to describe this finding? Leukemoid reaction (Premature release of the immature cells is responsible for the phenomenon known as a shift to the left or leukemoid reaction) A patient has rheumatoid arthritis and the neutrophils are being sequestered in the spleen. Which diagnosis will the nurse observe documented on the chart? Felty syndrome (Abnormal neutrophil distribution and sequestration are associated with hypersplenism and a pseudoneutropenia, which in the presence of rheumatoid arthritis constitute Felty syndrome.) A patient has monocytopenia. Which history data is significant for the monocytopenia? Uses prednisone/glucocorticoid therapy (Monocytopenia, a decrease in monocytes, is rare but has been identified with hairy cell leukemia and prednisone/glucocorticoid therapy) A patient has an infection with the Epstein Barr virus. Which lab result will be elevated? Lymphocytes (Lymphocytosis is rare in acute bacterial infections and is seen most commonly in acute viral infections, particularly those caused by the Epstein-Barr virus (EBV), a causative agent in infectious mononucleosis) Which information should the nurse include when discussing the pathophysiology of infectious mononucleosis? An infection of B lymphocytes caused by the Epstein-Barr virus (Infectious mononucleosis is an infection of B lymphocytes caused by the Epstein-Barr virus (EBV).) A patient has chronic leukemia. Which cell is most affected? Mature cells (In chronic leukemia, the predominant cell is more mature but does not function normally) Which information should the nurse include when describing the pathophysiology of chronic myelogenous leukemia (CML)? A specific chromosomal translocation called the Philadelphia chromosome (CML is more common in middle-aged to older adults and is frequently associated with a specific chromosomal translocation, called the Philadelphia chromosome.) Which staging classification system can the nurse use to help classify the stage of Hodgkin disease? Cotswold (Hodgkin disease is further classified by its clinical stage, called the Cotswold Stage.) A patient has recently been diagnosed with Lymphoblastic lymphoma (LL). Which initial assessment is typical of this disease? Painless swollen lymph nodes in the neck (The first sign of LL is usually a painless lymphadenopathy in the neck.) A patient has heparin induced thrombocytopenia. Which treatment should the nurse implement? Stop the heparin (Treatment is the withdrawal of heparin and use of alternative anticoagulants.) A child is admitted with acute idiopathic thrombocytopenic purpura (ITP). Which history data is significant for ITP? Recently had a viral infection (Acute ITP is usually secondary to infections (particularly viral).) A patient is admitted to the Emergency department with thrombotic thrombocytopenic purpura (TTP). Which principle should guide nursing care? This is a life-threatening multisystem disorder (Thrombotic thrombocytopenia purpura (TTP) is a life-threatening multisystem disorder.) Which information is important for the nurse to remember about essential thrombocythemia? Along with increased platelets, there may also be an increase in: red blood cells. (Along with increased platelets, there may be a concomitant increase in the number of red cells.) A patient has a vitamin K deficiency. Which assessment is priority? Monitoring for: hemorrhage. (Most individuals with a vitamin K deficiency will experience easy bruising and excessive bleeding.) Which patient should the nurse assess first for bleeding problems? A patient with: liver disease. (Patients with liver disease and a vitamin K deficiency are prone to bleeding.) A patient is septic. Which complication should the nurse monitor for in this patient? Disseminated intravascular coagulation (DIC) (Infectious disease, particularly involving sepsis, is the most common condition associated with DIC.) Which principle should the nurse use to guide nursing care of a patient with disseminated intravascular coagulation (DIC)? Tissue ischemia, clotting and significant hemorrhage occur (The end result of this complex series of pathophysiologic events called DIC is both tissue ischemia and significant hemorrhage with clotting.) Which assessment finding indicates that a patient may be experiencing disseminated intravascular coagulation (DIC)? Bleeding from IV site (Acute DIC presents with rapid development of hemorrhaging (oozing) from venipuncture sites, arterial lines, or surgical wounds or development of ecchymotic lesions (purpura, petechiae) and hematomas.) A nurse is describing Virchow Triad. Which of the following is an example of endothelial injury? Smoking (Endothelial injury is caused by radiation injury, exogenous chemical agents (e.g., toxins from cigarette smoke), endogenous agents (e.g., cholesterol), bacterial toxins or endotoxins, or immunologic mechanisms.) Erythrocytes Hemoglobin, Reticulocytes, Oxygen-carrying capacity, RBC’s Leukocytes Myeloblasts, immune protection, granulocytes, WBC’s Thrombocytes Hemostasis, megakaryocytes, adhesion and aggretation, platelets Hematocrit (Hct) The percentage of blood volume composed of RBC’s – decreased in all anemias. Hemoglobin Concentration of hemoglobin in RBC’s – decreased in all anemias. Reticulocyte Count Number of immature erythrocytes in blood – decreased in disorders that decrease erythropoiesis; increased in hemmorhage and hemolytic anemias. Mean Corpuscular Volume (MCV) Indicates the size of the erythrocytes – used to differentiate macrocytic (increased MCV), microcytic (decreased MCV), and normocytic (normal MCV) anemias. Mean Corpuscular Hemoglobin (MCH) and Hemoglobin Concentration (MCHC) Indicates the amount of hemoglobin in the RBC’s – used to differentiate hypochromic (decreased MCH and MCHC) from normochromic (normal MCH and MCHC) anemias. Blood smear Provides actual visualization of RBC morphology – used to visualize specific morphologies, such as sickle cells or schistocytes (hemolysis). Anemias conditions where there are too few erythrocytes or an insufficient volume of erythrocytes in the blood. It’s a reduction in the total number of circulating erythrocytes or a decrease in the quality or quantity of hemoglobin. Anemias are classified by their causes or by the changes that effect size, shape or substance of the erythrocyte. Most causes are: altered production of erythrocytes, increased loss of erythrocytes (hemmorhage), increased destruction of erythrocytes (hemolysis) – or a combination of all three. Albumin about 60% of total plasma protein. Macrocytic (megaloblastic anemias) are characterized by unusually large stem cells (megaloblasts) in the bone marrow that mature into erythrocytes that are unusually large in size (macrocytic), thickness, and volume. Pernicious anemias (PA) is the most common type of megaloblastic anemia, is caused by vitamin B12 deficiency, which often accompanies the end stage of type A chronic atrophic (autoimmune) gastritis. Folate deficient anemia results from inadequate dietary folate intake. This condition commonly occurs in individuals with a history of alcohol abuse and individuals who are malnourished. Pregnancy and lactation increase the body’s requirements for dietary folate and so predispose these individuals to this type of anemia. Microcytic-Hypochromic anemia Disorders that affect erythropoiesis result not only in decreased numbers of erythrocytes but also in a change in their morphologic appearance. Iron deficiency anemia is the most common form of anemia in the world. Sideroblastic anemia are a group of disorders characterized by anemia caused by inadequate cellular iron uptake in the bone marrow and disordered DNA synthesis with resultant microcytic-hypochromic erythrocyte formation. Normocytic-normochromic anemias the erythrocytes are of relatively normal in size and hemoglobin content but insufficient in number. Some of these anemias are the result of hemolysis of erythrocytes and may be characterized by specific abnormal red cell shapes. Aplastic anemia refers to a condition that arises from failure of the bone marrow stem cells. Although there are rare congenital causes, aplastic anemia is most often an acquired disorder Posthemmorhagic anemia causes acute anemia through the sudden loss of blood with normal iron stores. Hemorrhage can be obvious (e.g., bleeding externally from an open wound or hematemesis) or hidden (e.g., internal bleeding into the thoracic or abdominal cavities). Acquired hemolytic anemia are characterized by premature destruction of red blood cells. These anemias can be inherited or acquired. Sickle Cell disease one of the most important inherited types of hemolytic anemia, is an autosomal recessive disorder that causes an abnormality in hemoglobin synthesis. Anemia of chronic disease occurs in association with underlying inflammatory conditions, such as chronic infections (for example, HIV disease or hepatitis), rheumatologic diseases, and malignancies. A nurse is describing white blood cells. Which term should the nurse use when discussing white blood cells? Leukocytes – Leukocyte is the medical term for white blood cells. A primary care provider tells the nurse that a patient has a shift to the left or left shift. Which type of patient will the nurse be caring for? One with a: bacterial infection. – Neutrophilia and a left shift are most commonly associated with bacterial infection. While reviewing lab results a nurse finds a patient with a neutrophil count of 1900/mm3. What term will the nurse use to describe this finding? Neutropenia – Neutropenia is a condition associated with a reduction in circulating neutrophils and exists clinically when the neutrophil count is less than 2000/mm3. A patient has acquired immunodeficiency syndrome (AIDS). Which lab report should the nurse monitor closely in this patient? Lymphocyte counts – Lymphocytopenia is a major problem in acquired immunodeficiency syndrome (AIDS). Which statement indicates an adolescent patient understands the discharge teaching for infectious mononucleosis? I will avoid strenuous activity – Rest with avoidance of strenuous activity and contact sports is indicated. A patient has acute leukemia. A nurse recalls the cell most affected by this disease is a: blast cell. – Acute leukemia is characterized by undifferentiated or immature cells, usually a blast cell. A patient has acute leukemia and develops anemia. Which assessment findings are supportive of the diagnosis for anemia? Fatigue, dizziness, and pallor – Fatigue, dizziness, shortness of breath, and pallor are indicative of anemia. A patient has lymphoblastic lymphoma. Which organ is most affected? Thymus – The disease arises from a clone of relatively immature T cells that becomes malignant in the thymus. The nurse discovers a patient has a low platelet count. Which term should the nurse use to describe this finding? Thrombocytopenia – Thrombocytopenia is defined as a platelet count below 150,000/mm3 of blood. When a nurse observes a platelet count of 9,000/mm3, which condition must the nurse monitor for in this patient? Spontaneous bleeding – Spontaneous bleeding without trauma can occur with counts ranging from 10,000/mm3 to 15,000/mm3. A patient has heparin induced thrombocytopenia (HIT). What should the nurse assess for in this patient? Pulmonary embolism – Venous thrombosis is more common and results in deep venous thrombosis and pulmonary emboli. Which patient should the nurse assess first? A patient with: thrombotic thrombocytopenic purpura – Thrombotic thrombocytopenia purpura (TTP) is a life-threatening multisystem disorder that is characterized by thrombotic microangiopathy. Which of the following terms can the nurse use to describe thrombocythemia? Thrombocytosis – Thrombocythemia (also called thrombocytosis) is defined as a platelet count greater than 400,000/mm3 of blood. Which information should the nurse include when discussing vitamin K and hemostasis? Vitamin K is required for prothrombin synthesis. – Vitamin K, a fat-soluble vitamin, is required for the synthesis of prothrombin; the procoagulant factors II, VII, IX, and X; and the anticoagulant factors (proteins C and S). A nurse is asked why patients with liver disease have bleeding problems. What is the nurses best answer? The bleeding problems are caused from: thrombocytopenia and abnormal platelet functioning. – Thrombocytopenia and thrombocytopathies are manifestations of liver disease. Which information should the nurse include when describing the pathophysiology of disseminated intravascular coagulation (DIC)? Clotting and hemorrhaging occur – In the presence of DIC, a seeming paradox exists; that is, systemic clotting in the presence of bleeding. What term should the nurse use to describe a leukocyte count that is higher than normal? Leukocytosis – Leukocytosis is an elevated leukocyte count which often occurs in response to infection and physiologic stressors. A patient has an increase in the production of neutrophils in response to an infection. What term should the nurse use to describe this response? Neutrophilia – An increase in the production of neutrophils in response to infection is called neutrophilia, or a left shift, or shift to the left. A patient has eosinophilia. Which of the following conditions does the nurse suspect the patient is experiencing? Parasitic infections – Eosinophils are active in allergic reactions (type I hypersensitivities), malignancy, and parasitic infections. A patient has mononucleosis and asks the nurse which virus causes this disease. How should the nurse respond? Epstein-Barr virus – Mononucleosis is caused by infection of the B lymphocytes by Epstein-Barr virus and results in a severe and prolonged upper respiratory tract infection. Which of the following assessment findings are typical in a patient with infectious mononucleosis? Fatigue and enlarged cervical lymph nodes – At the time of diagnosis, the individual commonly presents with the classic group of symptoms: fever, sore throat, cervical lymph node enlargement, and fatigue. A patient is admitted with acute lymphocytic leukemia (ALL). The nurse is most likely providing care to a: child – ALL accounts for almost 74% of all new cases of leukemia in children. Which information indicates the nurse has a good understanding of the important difference between acute and chronic leukemias? In chronic leukemia the cancerous cells are more differentiated than in acute leukemia. – Chronic leukemia involves mutations in stem cells that are more differentiated than those in acute leukemia. Unlike cells in acute leukemia, chronic leukemic cells are well differentiated and can be readily identified. Which symptoms should the nurse assess for in a patient with Hodgkin lymphoma? Night sweats, low-grade fevers, and weight loss – Inflammatory cytokines released by Hodgkin lymphoma tumors often cause night sweats, low-grade fevers, and weight loss. Following a splenectomy, the nurse must monitor this patient who has a higher risk of: acquiring infections. – The spleen is a secondary lymphoid organ and contains lymphocytes and residential macrophages. Individuals who have had their spleen removed are at increased risk of acquiring infections. A patient develops heparin-induced thrombocytopenia (HIT). Which principle should the nurse use to provide care? In these types of patients, the administration of heparin induces: platelet aggregation and thrombus formation. – HIT occurs when heparin induces a paradoxical reaction resulting in platelet aggregation and thrombus formation. Consumption of platelets in the thrombi leads to thrombocytopenia and increased risk of bleeding. A nurse is describing the pathophysiology of thrombotic thrombocytopenic purpura (TTP). Which information should the nurse include? ITP involves: a microangiopathic condition with platelet aggregation. – A microangiopathic (disease of small blood vessels) condition prevails, with platelet aggregation causing occlusion of arterioles and capillaries in the microcirculation. TTP is a microangiopathic. When the nurse is reviewing lab reports, which finding is typical of a patient experiencing thrombocythemia? Increased platelet count – Thrombocythemia is characterized by excessive clot formation due to an elevated platelet count. Which statement indicates the nurse has a good understanding of hemophilia? Hemophilia is caused by: an inherited clotting factor deficiency. – Hemophilia is a bleeding disorder caused by specific clotting factor deficiencies. Which vitamin deficiency will cause the patient to have decreased clotting capabilities and increased risk of bleeding? K – Vitamin K is required for normal clotting factor synthesis by the liver.