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Chapter 62
1. Identify the key items that define how the hematologic system functions.
Select all that apply.
1. The main component of the system is blood.
2. Blood is a type of connective tissue.
3. The hematologic system is a transport system that functions to provide nutrients to the
body.
4. The hematologic system is a transport system that functions to remove toxins from the
body.
5. The lymphatic and the reticuloendothelial/mononuclear phagocyte systems contribute to
the functions of the hematologic system.
Answer: 1. The main component of the system is blood.
2. Blood is a type of connective tissue.
3. The hematologic system is a transport system that functions to provide nutrients to the
body.
4. The hematologic system is a transport system that functions to remove toxins from the
body.
5. The lymphatic and the reticuloendothelial/mononuclear phagocyte systems contribute to
the functions of the hematologic system.
Rationale:
The main component of the system is blood. Blood, which is composed of a variety of cells
and supportive fluids, is an obvious component of the hematologic system. Blood is a type of
connective tissue. Blood is identified as a type of connective tissue that runs throughout the
body. The hematologic system is a transport system that functions to provide nutrients to the
body. It provides a transport system that delivers nutrition, oxygen, and secretory products
throughout the body. The hematologic system is a transport system that functions to remove
toxins from the body. Blood transports wastes to the kidneys and liver for disposal. The
lymphatic and the reticuloendothelial/mononuclear phagocyte systems contribute to the
functions of the hematologic system. The lymphatic system, the spleen, the liver and the
reticuloendothelial/mononuclear phagocyte system contribute to the overall function of the
hematological system. Second, the immunologic products of the hematologic system are
critical to the defense of the body.
2. As a client ages, what changes are expected in the hematologic system?
Select all that apply.
1. The amount of red marrow and the number of stem cells decrease with aging.
2. As stem cells decrease in number, they are gradually replaced by nonfunctional fat cells.

3. Hemoglobin levels tend to decrease after middle age, more so in men than women.
4. There may be some T-cell function loss that may account for a poor response to
immunizations.
5. Laboratory parameters change dramatically.
Answer: 1. The amount of red marrow and the number of stem cells decrease with aging.
2. As stem cells decrease in number, they are gradually replaced by nonfunctional fat cells.
3. Hemoglobin levels tend to decrease after middle age, more so in men than women.
4. There may be some T-cell function loss that may account for a poor response to
immunizations.
Rationale:
The amount of red marrow and the number of stem cells decrease with aging. The amount of
red marrow and the number of stem cells decrease with aging, but the marrow is not
completely depleted, even in very old adults. As stem cells decrease in number, they are
gradually replaced by nonfunctional fat cells. The remaining stem cells retain their functional
capacity to divide, but as they decrease in number, they are gradually replaced by
nonfunctional fat cells. Hemoglobin levels tend to decrease after middle age, more so in men
than women. It is recognized that hemoglobin levels tend to decrease after middle age, more
so in men than in women. There may be some T-cell function loss that may account for a
poor response to immunizations. It has been suggested that there may be some T-cell function
loss and that this may account for a poor response to immunizations. Laboratory parameters
change dramatically. Laboratory parameters as they relate to the hematologic system of aging
clients usually are not much different than those of a younger patient.
3. When assessing a client for hematologic system status, the nurse should consider the
following:
Select all that apply.
1. Family history
2. Presenting symptoms
3. Chief complaint
4. Prior episodes with bleeding
5. Physical examination findings
Answer: 1. Family history
2. Presenting symptoms
3. Chief complaint
4. Prior episodes with bleeding
5. Physical examination findings

Rationale:
Family history. Family history will assist the nurse in identifying potential susceptibilities to
hematologic disorders. Presenting symptoms. Assessment of presenting symptoms will help
pinpoint the source of problem. Chief complaint. Tells the nurse in the client’s own words and
perceptions what is wrong. Prior episodes with bleeding. Past history provides insight into
current problem. Physical examination findings. Physical examination may the pinpoint
source of problem.
4. What phrases best describe the characteristics of red blood cells?
Select all that apply.
1. Carry oxygen to tissues
2. Maintain the chemical integrity of hemoglobin
3. Assume a flexible disk shape that allows for optimal filling and transport to body tissues
4. Are terminally differentiated
5. Have a life span of approximately 90 days
Answer: 1. Carry oxygen to tissues
2. Maintain the chemical integrity of hemoglobin
3. Assume a flexible disk shape that allows for optimal filling and transport to body tissues
4. Are terminally differentiated
Rationale:
Carry oxygen to tissues. This is a primary function of blood as a transport system. Maintain
the chemical integrity of hemoglobin. The function of the red blood cells is to become filled
with hemoglobin, maintain the integrity of hemoglobin, and distribute it to the body’s tissues.
Assume a flexible disk shape that allows for optimal filling and transport to body tissues. The
shape facilitates filling and transport of nutrients. Are terminally differentiated. Red blood
cells can never divide. Have a life span of approximately 90 days. Actual life span is
approximately 120 days.
5. A client is admitted to the unit with a high count of lymphocytes. In reviewing the
laboratory findings, the nurse will expect to find the following in addition to the high
lymphocyte count:
Select all that apply.
1. A presence of T cells.
2. A presence of B cells.
3. A presence of natural killer cells (NK cells).
4. A presence of basophils.
5. A presence of thrombocytes.

Answer: 1. A presence of T cells.
2. A presence of B cells.
3. A presence of natural killer cells (NK cells).
Rationale:
A presence of T cells. Approximately 60% to 70% of blood lymphocytes are T cells. A
presence of B cells. Approximately 10% of blood lymphocytes are B cells. A presence of
natural killer cells (NK cells). Natural killer cells (NK cells) are a type of lymphocytes that
are functionally distinct from T and B cells. A presence of basophils. Basophils are a different
type of white blood cell than lymphocytes. A presence of thrombocytes. Thrombocytes are a
different type of cell that prevents blood from clotting.
6. A client with a family history of anemia is admitted to the unit. What type of blood cell
would be characteristic of an inherited type of anemia?
1. Sickle cell
2. Lymphocyte
3. Eosinophil
4. Reticulocyte
Answer: Sickle cell
Rationale:
The sickle cell is an abnormal cell, shaped like a sickle, and is unique to sickle cell anemia,
which may be inherited. Lymphocytes, platelets, and reticulocytes are normal cells present in
blood.
7. In the formation of platelets, the megakaryocyte:
1. Breaks into pieces called platelets.
2. Is a part of the formation of any cell type.
3. Is necessary for RBC formation.
4. Does not release platelets.
Answer: Breaks into pieces called platelets.
Rationale:
Megakaryocytes do break into pieces called platelets as part of the stem-cell-to-thrombocyte
formation process. The stem cell is the precursor cell of all blood components (red blood
cells, white blood cells, and platelets.) Megakaryocytes are not responsible for RBC
formation.
8. Which of the following explains the difference between primary hemostasis and secondary
hemostasis?
Select all that apply.

1. Primary hemostasis is characterized by vascular contraction.
2. Primary hemostasis is characterized by platelet adhesion.
3. Primary hemostasis is the stage in which a soft aggregate plug is formed.
4. Secondary hemostasis is responsible for stabilizing the soft clot and maintaining
vasoconstriction.
5. The coagulation cascade is activated during primary hemostasis.
Answer: 1. Primary hemostasis is characterized by vascular contraction.
2. Primary hemostasis is characterized by platelet adhesion.
3. Primary hemostasis is the stage in which a soft aggregate plug is formed.
4. Secondary hemostasis is responsible for stabilizing the soft clot and maintaining
vasoconstriction.
Rationale:
Primary hemostasis is characterized by vascular contraction. Primary hemostasis is
characterized by vascular contraction, platelet adhesion, and formation of a soft aggregate
plug. Primary hemostasis is characterized by platelet adhesion Primary hemostasis is
characterized by vascular contraction, platelet adhesion, and formation of a soft aggregate
plug. Primary hemostasis is the stage in which a soft aggregate plug is formed. Primary
hemostasis is characterized by vascular contraction, platelet adhesion, and formation of a soft
aggregate plug. Secondary hemostasis is responsible for stabilizing the soft clot and
maintaining vasoconstriction. The clot is stabilized during the secondary phase and is
initiated when the coagulation cascade is activated at the time of injury. The coagulation
cascade is activated during primary hemostasis. The coagulation cascade is activated during
secondary hemostasis.
9. Platelets aggregate in response to extrinsic factors that can be described as:
1. Trauma.
2. Bacteria.
3. Antibody−antigen reaction.
4. WBCs.
Answer: Trauma.
Rationale:
A blood vessel must incur an injury in order for hemostasis to be initiated. Extrinsic factors
refer to those outside of the blood vessel, such as an injury.
Bacteria, antibody−antigen reactions, and white blood cells would all represent circulating
proteins characteristic of intrinsic factors.
10. Physical examination related to the hematologic system of the adult client should include
inspection of the:

Select all that apply.
1. Skin.
2. Head and neck.
3. Chest.
4. Abdomen.
5. Feet and legs.
Answer: 1. Skin.
2. Head and neck.
3. Chest.
4. Abdomen.
Rationale:
Skin. Changes in skin color often indicate erythrocyte disorders such as anemia. Head and
neck. The structures of the head, particularly the eyes and mouth, provide useful evidence in
the evaluation of the patient. The neck should be inspected for signs of lymph node
enlargement or tenderness. Chest. Structures in the chest, heart, and lymph nodes yield clues
to hematologic system disorders; for example, tachycardia is a response to both infection and
anemia. Abdomen. Abdominal tenderness is a general complaint that might be indicative of
splenomegaly or hepatomegaly, both indicators of increased blood destruction. Feet and legs.
Feet and legs do not provide any specific clues to hematologic problems.
11. Identify the major way that alcohol consumption can affect the hematologic system.
1. Nutritional deficiencies
2. Alteration in the clotting mechanism
3. Acceleration of ethrocyte formation
4. Acceleration of phagocytosis
Answer: Nutritional deficiencies
Rationale:
Excessive alcohol use results in vitamin deficiencies and potentially GI damage that can
suppress hematopoiesis. Alcohol does not affect the clotting mechanism, erythocyte
formation, or phagocytosis.
12. When assessing an older adult for possible hematologic problems, the nurse should pay
particular attention to:
Select all that apply.
1. History of bleeding problems.
2. Presenting symptoms and chief complaint.

3. Presence of risk factors.
4. General physical appearance.
5. Laboratory parameters.
Answer: 1. History of bleeding problems.
2. Presenting symptoms and chief complaint.
3. Presence of risk factors.
4. General physical appearance.
Rationale:
History of bleeding problems. This provides clues as to possible current problems. Presenting
symptoms and chief complaint. These tell the nurse in the patient’s own words what is wrong
and alert the nurse to potential foci of current problems, for example, RBCs or WBCs.
Presence of risk factors. These make known an individual’s susceptibility to specific
disorders. General physical appearance. This conveys an impression of health status.
Laboratory parameters. There is usually not much difference in laboratory parameters of the
aging client and younger clients.
13. Which of the following describes the difference between the hemoglobin and hematocrit
values of a complete blood count?
1. Hemoglobin is the amount of functional, or iron-containing, protein of the red blood cell,
whereas hematocrit represents the percentage of hemoglobin in a given volume of blood.
2. Hemoglobin represents the percentage of functional protein of the red blood cell, whereas
hematocrit is an indicator of the amount of functional protein of the red blood cell.
3. Hemoglobin values vary between men and women, but hematocrit values do not vary
between men and women.
4. Hemoglobin values tend to be higher for males, and hematocrit values tend to be higher in
females.
Answer: Hemoglobin is the amount of functional, or iron-containing, protein of the red blood
cell, whereas hematocrit represents the percentage of hemoglobin in a given volume of blood.
Rationale:
Hemoglobin is the iron-containing protein that bonds with oxygen, allowing the red blood
cells to transport oxygen throughout the body. Normal values are higher for men than for
women. Hematocrit, sometimes called paced cell volume, measures the portion of blood
volume made up by red blood cells. Hematocrit values also tend to be higher in men than in
women.
14. Normal values of coagulation studies include:
Select all that apply.
1. Prothrombin time (PT): 12 to 15 seconds.

2. Thrombin time: 8 to 12 seconds.
3. Fibrinogen: 200 to 400 mg/dL.
4. Activated partial thromboplastin tme (aPTT): 60 seconds.
5. Bleeding time: less than 1 minute.
Answer: 1. Prothrombin time (PT): 12 to 15 seconds.
2. Thrombin time: 8 to 12 seconds.
3. Fibrinogen: 200 to 400 mg/dL.
Rationale:
Prothrombin time (PT): 12 to 15 seconds. This value is within the correct time parameters.
Thrombin time: 8 to 12 seconds. This time is within the normal parameters. Fibrinogen: 200
to 400 mg/dL. This value is within the normal parameters. Activated partial thromboplastin
time (aPTT): 60 seconds. This is too long; the normal value is 30 to 45 seconds. Bleeding
time: less than 1 minute. This is too short of a time period; normal parameters are 1 to 6
minutes.
15. The differential blood count measures:
1. The percent of the five types of white blood cells in a sample of 100 white blood cells.
2. Inflammation, infection, and response to therapy.
3. Volume of red blood cells in whole blood.
4. Number of thrombocytes in whole blood.
Answer: The percent of the five types of white blood cells in a sample of 100 white blood
cells
Rationale:
The differential count measures the amount of different types of white blood cells present in
the blood sample—neutrophils, lymphocytes, monocytes, eosinophils, and basophils.
Inflammation, infection, and response to therapy are measured by the total white blood cell
count. A hematocrit count measures the volume of red blood cells in whole blood. The
number of thrombocytes in whole blood is measured by a platelet count.
16. A decreased RBC count can be due to:
Select all that apply.
1. Bleeding that results in an abnormal loss of erythrocytes.
2. Abnormal destruction of erythrocytes.
3. Lack of needed hormones and elements for production of erythrocytes.
4. Bone marrow suppression.
5. An excessive production of hormones needed for the production of erythrocytes.

Answer: 1. Bleeding that results in an abnormal loss of erythrocytes.
2. Abnormal destruction of erythrocytes.
3. Lack of needed hormones and elements for production of erythrocytes.
4. Bone marrow suppression.
Rationale:
Bleeding that results in an abnormal loss of erythrocytes. This causes a lowering of RBC
count. Abnormal destruction of erythrocytes. This causes a lowering of RBC count. Lack of
needed hormones and elements for production of erythrocytes. This causes a lowering of
RBC count. Bone marrow suppression. This causes a lowering of RBC count. An excessive
production of hormones needed for the production of erythrocytes. This would cause an
increase in RBC count.
17. Identify which of the following disorders would result from a decrease in the number of
cells.
Select all that apply.
1. Thrombocytopenia
2. Leukopenia
3. Polycemia
4. Splenomegaly
5. Myeloma
Answer: 1. Thrombocytopenia
2. Leukopenia
Rationale:
Thrombocytopenia. This is the presence of relatively few platelets in blood. Leukopenia. This
is a decrease in the number of circulating white blood cells. Polycemia. This occurs when
excess red blood cells are produced as a result of an abnormality of the bone marrow.
Splenomegaly. This is an enlargement of the spleen. Myeloma. This is a form of bone cancer
caused by a caused by overproduction of immune cells in bone marrow.
18. A client’s assessment data indicates a potential bleeding problem. What laboratory studies
will be used to isolate the problem?
Select all that apply.
1. Platelet count
2. Prothrombin time (PT)
3. Bleeding time
4. Activated partial thromboplastin time (aPTT)

5. Fibrinogen split products
Answer: 1. Platelet count
2. Prothrombin time (PT)
3. Bleeding time
4. Activated partial thromboplastin time (aPTT)
Rationale:
Platelet count. The platelet count is a test that determines the number of platelets in the blood,
and depicts clotting potential. Prothrombin time (PT). Prothrombin time depicts extrinsic
coagulation factors. Bleeding time. Bleeding time reflects platelet interaction and capillary
constriction. Activated partial thromboplastin time (aPTT). aPTT reflects intrinsic
coagulation factors critical to the clotting cascade. Fibrinogen split products. This is useful in
detection of DIC, which is triggered by an injury or event leading to persistent activation of
the clotting cascade, not by a bleeding problem per se.
19. When a “shift to the left” occurs, the nurse should consider the possibility of the
following disorders:
Select all that apply.
1. Undetected infection.
2. Bone marrow disease.
3. Immune system insufficiencies.
4. Immunosuppressive therapies.
5. Presence of foreign cells in the bone marrow.
Answer: 1. Undetected infection
2. Bone marrow disease
3. Immune system insufficiencies
4. Immunosuppressive therapies
Rationale:
Undetected infection. A “shift to the left” is a compensatory mechanism to combat infection.
Bone marrow disease. A “shift to the left” may be indicative of bone marrow disease.
Immune system insufficiencies. A “shift to the left” may be indicative of immune system
insufficiencies caused by bone marrow disease. Immunosuppressive therapies. A “shift to the
left” may occur as a result of immunosuppressive therapies such as chemotherapy. Presence
of foreign cells in the bone marrow. A “shift to the left” is not indicative of the presence of
foreign cells in the marrow.
20. Which laboratory value is indicative of a “shift to the left”?
1. Increase in total white blood cell count

2. Increase in absolute neutrophils count (ANC)
3. Increase in platelets
4. Increase in erythrocytes
Answer: Increase in total white blood cell count
Rationale:
A “shift to the left” phenomenon represents an increase in the total white blood cell count.
The bone marrow is stimulated to release a large number of relatively immature cells and
juvenile cells as a compensatory mechanism to combat severe infection. An increase in
absolute neutrophils, platelets, and erythrocytes is not indicative of a “shift to the left.”
20. The health care provider should be notified immediately if a client experiences a “shift to
the left” in laboratory values because:
1. It is an indicator of risk for a severe infection.
2. It is an indicator of a potential bleeding problem.
3. It is an indicator of electrolyte imbalance.
4. It is an indicator of disruption of hemostasis.
Answer: It is an indicator of risk for a severe infection.
Rationale:
During a “shift to the left,” the bone marrow is stimulated to release a large number of
relatively immature cells and juvenile cells as a compensatory mechanism to combat severe
infection. In an otherwise healthy individual, this may signal an early sign of an otherwise
undetected infection, and the client may not have sufficient host defenses. A “shift to the left”
does not pertain to potential bleeding problems, electrolyte imbalance, or hemostasis
disruption.

Test Bank for Timby's Introductory Medical-Surgical Nursing
Loretta A Donnelly-Moreno, Brigitte Moseley
9781975172237, 9781975172268

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