Pathophysiology Chapter 29 Alterations of Erythrocytes, Platelets, and Hemostatic Function

Chapter 29: Alterations of Erythrocytes, Platelets, and Hemostatic Function

MULTIPLE CHOICE

1.            What term is used to describe the capacity of some erythrocytes to vary in size, especially in relationship to some anemias?

a.            Poikilocytosis

b.            Isocytosis

c.             Anisocytosis

d.            Microcytosis

2.            What is the fundamental physiologic manifestation of anemia?

a.            Hypotension

b.            Hyperesthesia

c.             Hypoxia

d.            Ischemia

3.            The paresthesia that occurs in vitamin B12 deficiency anemia is a result of which of these?

a.            Reduction in acetylcholine receptors in the postsynaptic nerves

b.            Myelin degeneration in the spinal cord

c.             Destruction of myelin in peripheral nerves

d.            Altered function of neurons in the parietal lobe

4.            Which of these describes how the body compensates for anemia?

a.            Increasing rate and depth of breathing

b.            Decreasing capillary vasoconstriction

c.             Hemoglobin holding more firmly onto oxygen

d.            Kidneys releasing more erythropoietin

5.            Which of these classified as a megaloblastic anemia?

a.            Iron deficiency

b.            Pernicious

c.             Sideroblastic

d.            Hemolytic

6.            The students learn that deficiencies in folate and vitamin B12 alter the synthesis of which of these?

a.            RNA

b.            Cell membrane

c.             DNA

d.            Mitochondria

7.            A patient has defective secretion of the intrinsic factor leading to anemia. What treatment option does the healthcare professional discuss with the patient?

a.            Increasing iron sources in the diet such as red meat.

b.            Vitamin B12 injections initially given once a week.

c.             Having relatives tested for bone marrow donation.

d.            Better control of the patient’s underlying disorder.

8.            After a person has a subtotal gastrectomy for chronic gastritis, which type of anemia will result?

a.            Iron deficiency

b.            Aplastic

c.             Folic acid

d.            Pernicious

9.            Which condition resulting from untreated pernicious anemia (PA) is fatal?

a.            Brain hypoxia

b.            Liver hypoxia

c.             Heart failure

d.            Renal failure

10.          How is the effectiveness of vitamin B12 therapy measured?

a.            Reticulocyte count

b.            Serum transferring

c.             Hemoglobin

d.            Serum vitamin B12

11.          A healthcare professional has educated a student on folic acid. Which statement by the student indicates that more teaching is needed?

 

a.            Folic acid absorption is dependent on the enzyme folacin.

b.            Folic acid is stored in the liver.

c.             Folic acid is essential for RNA and DNA synthesis within erythrocytes.

d.            Folic acid is absorbed in the upper small intestine.

12.          Which anemia produces small, pale erythrocytes?

a.            Folic acid

b.            Hemolytic

c.             Iron deficiency

d.            Pernicious

13.          A patient in the healthcare clinic reports fatigue, weakness, and dyspnea, as well as pale conjunctiva of the eyes and brittle, concave nails. What assessment by the healthcare professional is most appropriate for the suspected anemia?

a.            Blood pressure and apical pulse

b.            Oral mucus membranes and tongue

c.             Ability to swallow foods and liquids

d.            Skin and sclera for normal coloration

14.          A healthcare professional in an urban clinic is seeing a patient who has iron deficiency anemia (IDA). What question by the professional is most appropriate to assess for the cause of IDA?

a.            “How many times a week do you have iron-rich foods?”

b.            “Have you ever noticed any blood in your stool?”

c.             “Do you have a history of heart valve replacement?”

d.            “Have you had any recent viral infections?”

15.          A healthcare professional works with recent refugees. A mother brings in her children who have been diagnosed with iron deficiency anemia. What action by the professional is most appropriate?

a.            Educate the mother on an iron-rich diet.

b.            Arrange to test for parasitic infections.

c.             Explain the weekly iron infusions.

d.            Teach the mother to give iron supplements.

16.          A patient has hepatomegaly, bronze-colored skin, and cardiac dysrhythmias. What condition does the healthcare professional prepare to teach the patient about?

a.            Aplastic anemia

b.            Pernicious anemia

c.             Hereditary hemochromatosis

d.            Immune thrombocytopenia purpura

17.          A healthcare professional is reviewing a patient’s laboratory results and sees that the patient has a low reticulocyte count and a high iron level. Which type of anemia does the professional associate these findings with?

a.            Folate deficiency anemia

b.            Iron deficiency anemia

c.             Hemolytic anemia

d.            Anemia of chronic disease

18.          In aplastic anemia (AA), pancytopenia develops as a result of what?

a.            Suppression of erythropoietin to produce adequate amounts of erythrocytes

b.            Suppression of the bone marrow to produce adequate amounts of erythrocytes, leukocytes, and thrombocytes

c.             Lack of DNA to form sufficient quantities of erythrocytes, leukocytes, andthrombocytes

d.            Lack of stem cells to form sufficient quantities of leukocytes

19.          A student asks the professor what the most common pathophysiologic process is that triggers aplastic anemia (AA). What response by the professor is most accurate?

a.            Autoimmune disease against hematopoiesis by activated cytotoxic T (Tc) cells

b.            Malignancy of the bone marrow in which unregulated proliferation of erythrocytes crowd out other blood cells

c.             Autoimmune disease against hematopoiesis by activated immunoglobulins

d.            Inherited genetic disorder with recessive X-linked transmission

20.          An allogenic bone marrow transplantation remains the preferred method for treating which anemia?

a.            Polycythemia vera

b.            Aplastic

c.             Sideroblastic

d.            Anemia of chronic disease (ACD)

21.          What does the student learn about warm autoimmune hemolytic anemia?

a.            Warm autoimmune hemolytic anemia occurs primarily in children.

b.            It is self-limiting and rarely produces hemolysis.

c.             Erythrocytes are bound to macrophages and sequestered in the spleen.

d.            Immunoglobulin M coats erythrocytes and binds them to receptors on monocytes.

22.          A student asks the professor to explain the jaundice that accompanies hemolytic anemia. Which statement is by the professor is most accurate?

a.            Erythrocytes are destroyed in the spleen.

b.            Heme destruction exceeds the liver’s ability to conjugate and excrete bilirubin.

c.             The patient has elevations in aspartate transaminase (AST) and alanine transaminase (ALT).

d.            The erythrocytes are coated with an immunoglobulin.

23.          Shortened erythrocyte life span, ineffective bone marrow response to erythropoietin, and altered iron metabolism describe the pathophysiologic characteristics of which type of anemia?

a.            Aplastic

b.            Sideroblastic

c.             Anemia of chronic disease

 d.           Iron deficiency

24.          A patient has polycythemia vera and presents to the Emergency Department with plethora and neurological changes. The student asks the healthcare professional to explain the primary cause of these symptoms. What response by the professional is best?

a.            Decreased erythrocyte count

b.            Destruction of erythrocytes

c.             Increased blood viscosity

d.            Tissue destruction by macrophages

25.          What does treatment for polycythemia vera involve?

a.            Therapeutic phlebotomy and radioactive phosphorus

b.            Restoration of blood volume by plasma expanders

c.             Administration of cyanocobalamin

d.            Blood transfusions

26.          An adult patient has been hospitalized with thrombocytopenia with a platelet count of 8000/mm3. What action by the healthcare professional is most appropriate?

a.            Tell the patient not to get out of bed without assistance.

b.            Prepare the patient for transfusions of whole blood.

c.             Educate the patient on side effects of heparin.

d.            Nothing; this finding is normal in an adult.

27.          A patient in the hospital has been receiving heparin injections. The platelet count on admission was 222,000/mm3 and four days later is 113,000/mm3. What action by the healthcare professional is best?

a.            Prepare to transfuse the patient with platelets.

b.            Do nothing; this is an expected side effect.

c.             Switch the heparin to lepirudin

d.            Stop all the patient’s medications.

28.          A patient is 8 hours postoperative after a long orthopedic procedure. The student asks why this patient is at particular risk of developing a thromboembolism. What response by the healthcare professional is best?

a.            Patients tend to have venous stasis from orthopedic operations.

b.            Anesthetic agents often cause an immune response against clotting factors.

c.             Endothelial damage occurs and repair is slowed by postoperative pain.

d.            Atherosclerotic build up causes turbulent blood flow leading to clots.

29.          A patient has been hospitalized for a large deep vein thrombosis and states he is the third person in his family to have this condition in the last 2 years. What response by the healthcare professional is most appropriate?

a.            “This condition is not transmitted genetically.”

b.            “We can test your blood for factor V Leiden.”

 c.            “Were they all men or both men and women?”

d.            “Familial thromboses tend to be very severe.”

MULTIPLE RESPONSE

1.            A healthcare professional is evaluating laboratory results for a patient who has disseminated intravascular coagulation (DIC). What results would the professional consider consistent with this condition? (Select all that apply.)

a.            Elevated d-dimer

b.            Elevated creatinine

c.             Decreased protein C

d.            Decreased lactate dehydrogenase

e.            Increased pH

2.            A healthcare professional is caring for five patients. Which one would the professional assess for disseminated intravascular coagulation (DIC) as the priority? (Select all that apply.)

a.            Heat stroke

b.            Severe pancreatitis

c.             Term delivery

d.            HELLP syndrome

e.            Snake bite