lymphocytic leukemia (CLL)
A patient diagnosed with low-risk chronic lymphocytic leukemia (CLL) has recently developed thrombocytopenia. One of the medications utilized to treat this would be Answers:
A. cisplatin, a chemotherapeutic.
B. vincristine, a Vinca alkaloid.
C. dexamethasone, a corticosteroid.
D. doxorubicin, a cytotoxic antibiotic.
Two nursing students are attempting to differentiate between the presentations of immune thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP). Which of the students’ following statements best captures an aspect of the two health problems? Answers:
A. “ITP can be either inherited or acquired, and if it’s acquired, it involves an enzyme deficiency.”
B. “Both of them involve low platelet counts, but in TTP, there can be more, not less, hemostasis.
C. “TTP can be treated with plasmapheresis, but ITP is best addressed with transfusion of fresh frozen plasma.”
D. “Both diseases can result from inadequate production of thrombopoietin by megakaryocytes.”
A physician is explaining to a 40-year-old male patient the importance of completing his course of antibiotics for the treatment of tuberculosis. The physician explains the damage that could occur to lung tissue by Mycobacterium tuberculosis. Which of the following phenomena would underlie the physician’s explanation?
A. Tissue destruction results from neutrophil deactivation.
B. Neutrophils are ineffective against the Mycobacterium tuberculosis antigens.
C. Macrophages form a capsule around the Mycobacterium tuberculosis bacteria, resulting in immune granulomas.
D. Nonspecific macrophage activity leads to pulmonary tissue destruction and resulting hemoptysis.
A teenager, exposed to West Nile virus a few weeks ago while camping with friends, is admitted with headache, fever, and nuchal rigidity. The teenager is also displaying some lethargy and disorientation. The nurse knows which of the following medical diagnoses listed below may be associated with these clinical manifestations?
B. Lyme disease
C. Rocky Mountain spotted fever
D. Spinal infection
A patient has been diagnosed with anemia. The physician suspects an immune hemolytic anemia and orders a Coombs test. The patient asks the nurse what this test will tell the doctor. The nurse replies,
A. “They are looking for the presence of antibody or complement on the surface of the RBC.”
B. “They will look at your RBCs under a microscope to see if they have an irregular shape (poikilocytosis).”
C. “They will wash your RBCs and then mix the cells with a reagent to see if they clump together.”
D. “They will be looking to see if you have enough ferritin in your blood.”
A 29-year-old construction worker got a sliver under his fingernail 4 days ago. The affected finger is now reddened, painful, swollen, and warm to touch. Which of the following hematological processes is most likely occurring in the bone marrow in response to the infection?
A. Phagocytosis by myelocytes
B. Increased segmented neutrophil production
C. High circulatory levels of myeloblasts
D. Proliferation of immature neutrophils
A surgeon is explaining to the parents of a 6-year-old boy the rationale for the suggestion of removing the boy’s spleen. Which of the following teaching points would be most accurate?
A.“We think that his spleen is inhibiting the production of platelets by his bone marrow.”
B.“We believe that your son’s spleen is causing the destruction of many of his blood platelets, putting him at a bleeding risk.”
C.“Your son’s spleen is holding on to too many of his platelets, so they’re not available for clotting.”
D.“Your son’s spleen is inappropriately filtering out the platelets from his blood and keeping them from normal circulation.”
Question 39 A nurse practitioner is providing care for a client with low levels of the plasma protein gamma globulin. The nurse would recognize that the client is at risk of developing which of the following health problems?
B. Blood clots
A 32-year-old woman presents at her neighborhood health clinic complaining of weakness and a feeling of abdominal fullness. She reports that 6 months earlier she noticed that she had difficulty in maintaining the high level of energy she has relied on during her aerobic workouts over the past few years. Because she felt that she was in overall good health, but knew that women often need additional iron, she added a multiple vitamin with iron and some meat and leafy greens to her diet. She followed her plan carefully but had no increase in energy. Upon examination, her spleen is noted to be enlarged. Which of the following is most likely to be the cause?
B. Accelerated CML
C. Infectious mononucleosis
D. Stage A Hodgkin disease
A nurse is providing care for several patients on an acute medical unit of a hospital.Which of the following patients would be most likely to benefit from hematopoietic growth factors?
A. A 61-year-old female patient with end-stage renal cancer
B. A 55-year-old obese male patient with peripheral neuropathy secondary to diabetes
C. A 51-year-old female patient with liver failure secondary to hepatitis
D. A 44-year-old man with a newly diagnosed brain tumor
Misinterpreting her physician’s instructions, a 69-year-old woman with a history of peripheral artery disease has been taking two 325 mg tablets of aspirin daily. How has this most likely affected her hemostatic status?
A. The binding of an antibody to platelet factor IV produces immune complexes.
B. The patient’s prostaglandin (TXA2) levels are abnormally high.
C. Irreversible acetylation of platelet cyclooxygenase activity has occurred.
D. She is at risk of developing secondary immune thrombocytopenic purpura (ITP).
Question 43 Which of the following teaching points would be most appropriate with a client who has a recent diagnosis of von Willebrand disease?
A. “Make sure that you avoid taking aspirin.”
B. “Your disease affects your platelet function rather than clot formation.”
C. “Clotting factor VIII can help your body compensate for the difficulty in clotting.”
D. “It’s important that you avoid trauma.”
A nurse at a long-term care facility provides care for an 85-year-old man who has had recent transient ischemic attacks (TIAs). Which of the following statements best identifies future complications associated with TIAs? TIAs
A. are caused by small bleeds that can be a warning sign of an impending stroke.
B. are a relatively benign sign that necessitates monitoring but not treatment.
C. are an accumulation of small deficits that may eventually equal the effects of a full CVA. D. resolve rapidly but may place the client at an increased risk for stroke.
Following a motor vehicle accident 3 months prior, a 20-year-old female who has been in a coma since her accident has now had her condition declared a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her parents?
A. “If you or the care team notices any spontaneous eye opening, then we will change our treatment plan.”
B. “Your daughter has lost all her cognitive functions as well as all her basic reflexes.”
C. “Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change.”
D. “Your daughter’s condition is an unfortunate combination with total loss of consciousness but continuation of all other normal brain functions.”
A couple who is expecting their first child has been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple has approached their caregiver with this request and is seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting it. How can their caregiver best respond to the couple’s enquiry? Stem cells can
A. “be used as source of reserve cells for the entire blood production system.”
B. “help treat some cancers and anemias, but they must come from your child himself or herself.”
C. “be used to regenerate damaged organs should the need ever arise.”
D. “help correct autoimmune diseases and some congenital defects.”
Question 47 A surgeon is explaining to the parents of a 6-year-old boy the rationale for the suggestion of removing the boy’s spleen. Which of the following teaching points would be most accurate?
A. “Ferritin is a protein–iron complex that allows your red blood cells to make use of the iron that you consume in your diet.”
B. “Ferritin is the activated and usable form of iron that your red blood cells can use to transport oxygen.”
C. “Ferritin is the form of iron that is transported in your blood plasma to red blood cells that need it.”
D. “Ferritin is a stored form of iron that indirectly shows me whether you would benefit from iron pills.”
A 13-year-old African American boy comes to the ER complaining of fatigue and a rapid heartbeat. In conversation with the father, it becomes apparent to you that the boy has grown 2 inches in the previous 5 months. What is the first problem the health care team would attempt to rule out?
A. Aplastic anemia
B. Sickle cell anemia
D. Iron deficiency anemia
In which of the following patients, would diagnostic investigations least likely reveal increased thrombopoietin production?
A. A 55-year-old man with dehydration secondary to Crohn disease
B. An 81-year-old woman with diagnoses of rheumatoid arthritis and failure to thrive
C. A 66-year-old woman with a diagnosis of lung cancer with bone metastases
D. A 21-year-old woman awaiting bone marrow transplant for myelogenous leukemia
A hospital laboratory technologist is analyzing the complete blood count (CBC) of a patient. Which of the following statements best reflects an aspect of the platelets that would constitute part of the CBC?
A. New platelets are released from the bone marrow into circulation.
B. The half-life of a platelet is typically around 8 to 12 days.
C. Platelets originate with granulocyte colony–forming units (CFU).
D. The α-granules of platelets contribute primarily to vasoconstriction.