Anemia Test Questions (copied From Chapter 43: Hematologic – Flashcards
Unlock all answers in this set
Unlock answersquestion
A 26-year-old female has thalassemia minor. What should be limited in her diet to avoid hepatotoxicity? a. Vitamin C b. Vitamin B12 c. Folic Acid d. Multi-vitamin with Iron
answer
d. Multi-vitamin with Iron Rationale: A patient with thalassemia minor has a disease characterized by overproduction of one chain of the hemoglobin molecule. Beta thalassemia patients usually require no specific therapy. These patients are asymptomatic, but may be chronically, mildly anemic. They should avoid an iron overload by supplementation, but, generally, are able to safely take iron when iron deficiency anemia and the thalassemia co-exist.
question
A female patient has been diagnosed with Glucose-6-phosphate dehydrogenase deficiency (G6PD). What should be done to prevent lysis of red cells in this patient? a. Avoid aspirin and sulfa drugs b. Minimize iron consumption in her diet c. Receive immunizations timely d. Consume adequate amounts of water daily
answer
a. Avoid aspirin and sulfa drugs Rationale: G6PD deficiency is an X-linked disorder. This mean it is carried on the X chromosome. Both male and female infants may exhibit this. G6PD is the most common enxymatic disorder of red blood cells in humans. These patients should avoid certain substances like aspirin, sulfa drugs, and fava beans because consumption can precipitate lysis of red blood cells. Timely immunizations and adequate daily water consumption are beneficial to all patients but not specifically those with G6PD.
question
Which anemia is described as a macrocytic anemia? a. Folic acid deficiency anemia b. Thalassemia c. Iron deficiency anemia d. Sickle cell anemia
answer
a. Folic acid deficiency anemia Rationale: Folic acid and Vitamin B12 deficiency anemias are characterized by macrocytic red cells. Thalassemia and iron deficiency anemias are microcytic anemias. Sickle-cell anemia is characterized by sickle-shaped red cells; hence the name, sickle cell anemia.
question
Which anemias are described as microcytic, hypochromic anemia? a. Vitamin B12 and iron deficiency anemia b. Folic acid and iron deficiency anemia c. Iron deficiency anemia and thalassemia d. Sickle cell anemia and anemia if chronic disease
answer
c. Iron deficiency anemia and thalassemia Rationale: Iron deficiency anemia is characterized by small (microcytic), pale (hypochromic) red cells. Thalassemia is a microcytic, hypochromic anemia also. There is a strong familial component. Folic acid and Vitamin B12 deficiency anemias are characterized by macrocytic red cells. Sickle-cell anemia is characterized by sickle-shaped red cells. Hence, the name sickle cell anemia.
question
A 65-year-old man is being treated with oral medications for hypertension, hyperlipidemia, diabetes, and osteoarthritis. The most likely reason for his iron deficiency anemia is oral treatment for a. hypertension b. hyperlipidemia c. diabetes d. osteoarthritis
answer
d. osteoarthritis Rationale: Osteoarthritis is often treated with analgesics and non-steroid anti-inflammatory drugs (NSAIDs). NSAIDs can be associated with GI bleeding, especially when they are taken chronically. This patient should be screened for blood in his stool. The other diseases listed, as well as the treatments for them, or not associated with iron deficiency anemia.
question
A patient is being treated for iron deficiency anemia. Iron is better absorbed a. with food b. on an empty stomach c. with a food rich in Vitamin C d. in the evening
answer
b. on an empty stomach Rationale: Iron is better absorbed on an empty stomach. This is the most efficient way to absorb iron. However, it is poorly tolerated on an empty stomach and many times patients have to eat something in order to tolerate oral forms of iron. If this is the case, it should be taken with a food rich in Vitamin C since this enhances iron absorption. Time of day does not affect iron absorption.
question
Which choice below can be attributed to the two most common causes of iron deficiency anemia in adults? a. Bleeding in the gastrointestinal tract and through loss of bone mass b. Aging and menses c. Poor diet and lack of adequate iron intake d. Gynecologic losses and bleeding in the gastrointestinal tract
answer
d. Gynecologic losses and bleeding in the gastrointestinal tract Rationale: The most common body systems associated with blood loss are the gynecologic tract (GYN) and the gastrointestinal (GI) tract in patients of all ages. In women of menstruating age, the GYN tract is a common source of blood loss, especially when menses is heavy. The GI tract is more likely to be the source of blood loss when adults are iron deficient, especially if they possess risk factors for iron deficiency anemia, such as chronic aspirin or NSAID use.
question
Lead toxicity can be associated with a. folic acid deficiency anemia b. anemia of chronic disease c. sideroblastic anemia d. vitamin B12 deficiency
answer
c. sideroblastic anemia Rationale: Sideroblastic anemia occurs when iron is unable to be incorporated into the hemoglobin molecule despite there being adequate amounts of iron available. An iron deficiency anemia results. This can be due to an inherited enzyme deficiency, it can be acquired as in the case of lead toxicity, or it can be of idiopathic origin. Lead can produce a sideroblastic anemia because it prevents iron from being incorporated into the heme portion of the hemoglobin molecule. Sideroblasts may be visible on blood smear. They represent and accumulation of iron in the cell's mitochondria.
question
An example of macrocytic anemia is a. iron deficiency anemia b. pernicious anemia c. anemia of chronic disease d. sideroblastic anemia
answer
b. pernicious anemia Rationale: A macrocytic anemia indicates that size of red blood cells is larger than expected, hence, the prefix, macro. Iron deficiency anemia produces microcytic anemia. Anemia of chronic disease can produce a microcytic or normocytic anemia, but usually a normocytic anemia is evident. Sideroblastic anemia produces a microcytic anemia.
question
A patient is found to have an anemia. The patient's MCH is normal. The patient's anemia can be described as a. macrocytic b. normocytic c. macrochromic d. normochromic
answer
d. normochromic Rationale: The MCH, mean corpuscular hemoglobin, indicates the degree of hemoglobin incorporation into red blood cells. If this is normal, it is described as a normochromic anemia. If the MCH is decreased, the anemia is described as a hypochromic anemia. When the MCH is increased, the anemia is described as hyperchromic. Macrochromic does not describe red blood cells. Microcytic and normocytic describe size of red blood cells and is indicated by the MCV.
question
MCH
answer
Mean cell hemoglobin concentration ? in microcytic anemias;
question
A patient is found to have an anemia. The patient's MCV is normal. The patient's anemia can be described as a. macrocytic b. normocytic c. macrochromic d. normochromic
answer
b. normocytic Rationale: The MCV, mean corpuscular volume, indicates the size of the red cells. If this is normal, it is described as a normocytic anemia. If the MCV is decreased, the anemia is described as a microcytic anemia. When the MCV is increased, the anemia is described as microcytic. Macrochromic does not describe red blood cells. Normochromic describes the degree of hemoglobin incorporated into red cells and is indicated by the MCH.
question
A 75-year-old patient who has multiple chronic diseases has been in very poor health for a decade. What type of anemia is he most likely to exhibit? a. Iron deficiency and folic acid b. Folic acid and pernicious c. Iron deficiency and anemia of chronic disease d. Thalassemia and Vitamin B12
answer
b. Folic acid and pernicious Rationale: Having multiple chronic illnesses does increase the likelihood of having folic acid deficiency. Pernicious anemia, secondary to Vitamin B12 deficiency, is commonly seen in older patients with chronic illnesses too. Many patients have both concurrently. Patients with folic acid deficiency and/or Vitamin B12 deficiency are more likely to be elderly, in poor health, and have poor diets. It may also be seen in patients who consume excessive amounts of alcohol. Nothing in history indicates this as the etiology.
question
An obese 78-year-old male with poorly controlled hypertension and diabetes has a normocytic, normochromic anemia. This anemia is likely a. iron deficiency b. associated with chronic disease c. pernicious anemia d. folic acid deficiency anemia
answer
b. associated with chronic disease Rationale: This is a classic anemia of chronic disease. This is especially evident when chronic diseases are poorly controlled. It is most frequently characterized by a normocytic, normochromic anemia. Iron deficiency anemia is microcytic, hypochromic anemia. Iron deficiency anemia is microcytic, hypochromic. Pernicious anemia is associated with B12 deficiency, and folic acid deficiency anemia are both macrocytic anemias.
question
A patient with pernicious anemia may be observed to have a. darkening of the skin b. joint aches c. glossitis d. thrombocytopenia
answer
c. glossitis Rationale: Glossitis is an inflammation of the tongue with a change in its usual color. It may be tender also. This is commonly observed in patients who have a Vitamin B12 deficiency anemia (precarious anemia). The tongue can appear pale, bright red, or swollen. Glossitis is not seen in all patients with pernicious anemia, but this finding should prompt the healthcare provider to assess Vitamin B12 and folate levels. Pernicious anemia is not associated with any of the other choices in this question.
question
A patient has CBC results that indicate a microcytic, hypochromic anemia. The nurse practitioner should suspect a. pernicious anemia b. iron deficiency anemia c. vitamin B12 deficiency d. sickle cell anemia
answer
b. iron deficiency anemia Rationale: Iron deficiency anemia is characterized by a microcytic, hypochromic anemia. Pernicious anemia, caused usually by a Vitamin B12 deficiency, is a macrocytic anemia. Sickle-cell anemia is characterized by sickle-shaped cells.
question
An older adult has suspected vitamin B12 deficiency. Which of the following lab indices is most indicative of a vitamin B12 deficiency? a. Increased MCV b. Increased MCH c. Decreased hematocrit d. Thrombocytosis
answer
a. Increased MCV Rationale: A Vitamin B12 deficiency can produce an anemia called pernicious anemia. This is most commonly found in older adults and is characterized by macrocytosis, and increased MCV. In other words, the red cells are larger than expected. An increased MCH may be seen in a Vitamin B12 deficiency, but this is unusual. A decreased hematocrit will be seen in most anemias, but this is not specific to a B12 deficiency. Thrombocytosis refers to an increased number of platelets in the blood stream.
question
Which white cell should be present in the greatest number in a patient who is healthy today? a. Neutrophils b. Basophils c. Eosinophils d. Lymphocytes
answer
a. Neutrophils Rationale: Neutrophils usually comprise 60-70% of white cells in a patient who has no infection. Other names for neutrophils are "polys", also known as polymorphonuclear leukocytes; or "segs", also known as segmented neutrophils. Any of these terms can be used because they all refer to the same white cells.
question
A patient is having an allergic reaction to seafood. Which white cell will probably be increased? a. Neutrophils b. Lymphocytes c. Eosinophils d. Basophils
answer
c. Eosinophils Rationale: In a CBC, the white cell that increases during an allergic reaction is the eosinophil. Generally, the percentage of eosinophils in a normal CBC is 2-4%. Increases in eosinophils are observed in patients with allergic reactions as well as patients with parasitic infections.
question
What hallmark finding is associated with both B12 and folate deficiencies? a. Glossitis b. Macrocytosis c. Memory loss d. An MCV ; 80 fL
answer
b. Macrocytosis
question
Which adult female patient has an anemia? a. Hgb = 14.4 b. Hct = 35.2 c. Hgb = 13.5 d. Hct = 40.1
answer
b. Hct = 35.2
question
The laboratory identifies metamyelocytes in a 50-year-old patient who had a CBC performed. What might be an expected finding in this patient? a. Splenomegaly b. Elevated liver function studies c. Decreased uric acid level d. Decreased platelet count
answer
a. Splenomegaly :
question
A measure of the degree of variation of red cell size is indicated by a. RDW b. MCHC c. MCV d. MCH
answer
a. RDW
question
The nurse is planning care for a client who has a platelet count of 30,000/mm3. Which intervention does the nurse include in this client's plan of care? a. Bleeding Precautions b. Vital signs every 4 hours c. Isolation Precautions d. Oxygen by nasal cannula
answer
ANS: A The normal platelet count ranges between 150,000 and 400,000/mm3. This client is at extreme risk for bleeding. Although it is necessary to notify the provider, the nurse would first protect the client by instituting Bleeding Precautions. The other interventions are not related to the low platelet count.
question
The nurse is performing an admission assessment on a 46-year-old client, who states, "I have been drinking a 12-pack of beer every day for the past 20 years." Which laboratory abnormality does the nurse correlate with this history? a. Decreased bleeding time b. Elevated red blood cell (RBC) count c. Decreased white blood cell (WBC) count d. Elevated prothrombin time (PT)
answer
ANS: D The liver is the site for production of prothrombin and most of the blood-clotting factors. If the liver is damaged because of chronic alcoholism, it is unable to produce these clotting factors. Therefore, the PT could become elevated, which would reflect deficiency of some clotting factors. The WBC would not be elevated in this situation because no infection is present. Bleeding time would likely increase. The client's RBC count most likely would not be affected unless the client was bleeding, in which case it would decrease.
question
The nurse is caring for a client who is receiving chemotherapy for cancer. Which intervention does the nurse implement for this client? a. Maintain strict Standard Precautions. b. Monitor the client's pulse oximetry. c. Administer the prescribed iron. d. Assess the client's fibrinogen level.
answer
ANS: A The client who is receiving chemotherapy drugs that suppress the bone marrow will be at risk for a decreased white blood cell (WBC) count and infection. The nurse will be most therapeutic by adhering to Standard Precautions to prevent infection, such as handwashing. The nurse will not expect the fibrinogen level to be affected by this therapy. Iron is not typically administered with chemotherapy because this is bone marrow suppression, so the administration of epoetin (Epogen) or filgrastim (Neupogen) is most effective. Monitoring the pulse oximetry is part of routine care and probably would not need to be done continuously.
question
A female client is admitted with the medical diagnosis of anemia. The nurse assesses for which potential cause? a. Daily intake of aspirin b. Smoking history c. Diet high in meat and fat d. Heavy menses
answer
ANS: D Iron levels can be low because intake of iron is too low, or because loss of iron through bleeding is excessive. A premenopausal woman may be having unusually heavy menses sufficient to cause excessive loss of blood and iron. Smoking and aspirin do not cause iron deficiency. A diet high in meat provides iron.
question
A client who has a chronic vitamin B12 deficiency is admitted to the hospital. When obtaining the client's health history, which priority question does the nurse ask this client? a. "Are you having blood in your stools?" b. "Do you bruise easily?" c. "Do you notice any changes in your memory?" d. "Are you having any pain?"
answer
ANS: C Vitamin B12 deficiency impairs cerebral, olfactory, spinal cord, and peripheral nerve function. Severe chronic deficiency may cause permanent neurologic degeneration. The other options are not symptoms of vitamin B12 deficiency.
question
The nurse is caring for four clients with hematologic-type problems. Which client does the nurse prioritize to see first? a. 60-year-old female with decreased erythropoietin b. 18-year-old female with decreased protein levels c. 82-year-old male with an increased thromboxane level d. 36-year-old male with increased lymphocytes
answer
ANS: A The kidney releases more erythropoietin when tissue oxygenation levels are low. This growth factor then stimulates the bone marrow to increase red blood cell (RBC) production, which improves tissue oxygenation and prevents hypoxia. Hypoxia causes the body to increase its respiratory rate to overcome decreased oxygenation of the tissues. All these clients are important, but the woman with decreased erythropoietin takes priority because of her risk for hypoxia.
question
The nurse is caring for a client who is receiving heparin therapy. How does the nurse evaluate the therapeutic effect of the therapy? a. Monitor the partial thromboplastin time (PTT). b. Monitor fibrin degradation products. c. Assess bleeding time. d. Evaluate platelets.
answer
ANS: A The PTT assesses the intrinsic clotting cascade. Heparin therapy is monitored by the PTT. Platelets are monitored by the platelet count laboratory value, bleeding time evaluates vascular and platelet activity during hemostasis, and fibrin degradation products help assess for fibrinolysis.
question
The nurse is planning discharge teaching for a client who has a splenectomy. Which statement does the nurse include in this client's teaching plan? a. "Do not eat raw fruits or vegetables." b. "Avoid environmental allergens." c. "Avoid crowds and people who are sick." d. "Do not play contact sports."
answer
ANS: C The spleen is the major site of B-lymphocyte maturation and antibody production. Those who undergo splenectomies for any reason have a decreased antibody-mediated immune response and are particularly susceptible to viral infections. Eating raw fruits and vegetables places the client at risk for bacterial infections. The body responds to environmental allergens with an unspecific inflammatory process. The client is not at risk for bleeding or injury due to contact sports.
question
The nurse observes yellow-tinged sclera in a client with dark skin. Based on this assessment finding, what does the nurse do next? a. Inspect the client's hard palate. b. Examine the soles of the client's feet. c. Assess the client's pulses. d. Auscultate the client's lung sounds.
answer
ANS: A Jaundice can best be observed in clients with dark skin by inspecting the oral mucosa, especially the hard palate, for yellow discoloration. Because sclera may have subconjunctival fat deposits that show a yellow hue, and because foot calluses may appear yellow, neither of these areas should be used to assess for jaundice. The client's pulse and lung sounds have no correlation with an assessment of jaundice.
question
The nurse is assessing a 75-year-old male client. Which blood value indicates that the client is experiencing normal changes associated with aging? a. White blood cell (WBC) count, 5000/mm3 b. Platelet count, 100,000/mm3 c. Hemoglobin, 13.0 g/dL d. Prothrombin time (PT), 14 seconds
answer
ANS: C Hemoglobin levels in men and women fall after middle age. Therefore, this client's hemoglobin value would be considered part of the aging process. Platelet counts and blood-clotting times are not age related; the client's platelet count and PT are elevated for some other reason. The WBC count shown is normal.
question
The nurse is caring for a client who has a decreased serum iron level. Which intervention does the nurse prioritize for this client? a. Family assessment b. Cardiac assessment c. Administration of vitamin K d. Dietary consult
answer
ANS: D Diets can alter cell quality and affect blood clotting. Diets low in iron can cause anemia and decrease the function of all red blood cells. The question does not say that the hemoglobin is low enough to affect the cardiac function. Family assessment may be important in finding out any genetic or family lifestyle causes of the low serum iron level. However, the first intervention that the nurse can provide is to have the client's dietary habits evaluated and changed so that iron levels can increase. Vitamin K is involved with clotting, not with iron stores.
question
The nurse is assessing the following laboratory results of a client before discharge: Hemoglobin 15 g/dL, Hematocrit 45%, White blood cell (WBC) count 2000/mm3, Platelet count 250,000/mm3 Which instruction does the nurse include in this client's discharge teaching plan? a. "Avoid contact sports." b. "Perform good hand hygiene." c. "Eat a diet high in iron." d. "Do not take any aspirin."
answer
ANS: B A normal WBC count is 5000 to 10,000/mm3. A white blood cell count of 2000/mm3 is low and makes this client at risk for infection. Good handwashing technique is the best way to prevent the transmission of infection. The other laboratory results are all within normal limits.
question
The nurse is assessing a client with numerous areas of bruising. Which question does the nurse ask to determine the cause of this finding? a. "Are you a vegetarian?" b. "Do you take aspirin?" c. "How often do you take Tylenol?" d. "How often do you exercise?"
answer
ANS: B Platelet aggregation is essential for blood clotting. An inability to clot blood when an injury occurs can result in bleeding, which would cause bruising. Aspirin is a drug that interferes with platelet aggregation and has the ability to "plug" an extrinsic event, such as trauma. Vitamin K found in green vegetables enhances clotting factors, which would improve the ability to stop bleeding associated with an extrinsic event. Acetaminophen (Tylenol) and exercise do not inhibit clotting factors.
question
The nurse is monitoring a client with liver failure. Which assessments does the nurse perform when monitoring for bleeding in this client? (Select all that apply.) a. Stool b. Hair c. Urine d. Gums e. Lung sounds
answer
ANS: A, C, D The liver is the site for production of clotting factors. Without these factors, the client is at risk for bleeding. Common areas of bleeding include the gums and mucous membranes, bladder, and gastrointestinal tract. Lung sounds and hair are part of the assessment but are not essential in the presence of liver failure and hematologic abnormalities.
question
The nurse is assessing a client with liver failure. Which assessment is the highest priority for this client? a. Auscultation for bowel sounds b. Assessing for signs of bleeding c. Monitoring of blood pressure hourly d. Assessing for deep vein thrombosis
answer
ANS: B All these options are important in assessment of the client, but the most important action is assessment for signs of bleeding. The liver is the site of production of prothrombin and most of the blood-clotting factors. Clients with liver failure run a high risk of having problems with bleeding.
question
The nurse is teaching a client who is receiving sodium warfarin (Coumadin). Which topics does the nurse include in the teaching plan? (Select all that apply.) a. Use of a safety razor and soft toothbrush b. Blood testing regimen c. Using acetaminophen (Tylenol) for minor pain d. Foods high in vitamin K e. Daily exercise and weight management
answer
ANS: A, B, C, D The client on warfarin will need to know which foods are high in vitamin K because vitamin K intake must be consistent to avoid interfering with the anticoagulant properties of warfarin. Clients should not take aspirin or NSAIDs for minor pain owing to their anticoagulant properties. Clients must use safety razors and soft toothbrushes to avoid bleeding episodes. The client on warfarin needs regular blood tests for prothrombin time (PT) and international normalized ratio (INR). Daily exercise and weight management are not specifically important to this client.
question
The nurse is obtaining the health history of a client who has iron deficiency anemia. Which factor in this client's history does the nurse correlate with this diagnosis? a. History of bleeding ulcer b. Eating a meat-free diet c. Family history of sickle cell disease d. History of leukemia
answer
ANS: B A diet high in protein and iron helps keep the client's levels of iron within normal limits. Meat is a good source of protein and iron. A bleeding ulcer could cause anemia but would not cause iron deficiency. Sickle cell disease causes sickle cell anemia. Leukemia causes a decrease in white blood cells.
question
The nurse helps to ambulate a client who has anemia. Which clinical manifestation indicates that the client is not tolerating the activity? a. Pulse oximetry reading of 95% b. Respiratory rate of 20 breaths/min c. Heart rate of 110 beats/min d. Blood pressure of 120/90 mm Hg
answer
ANS: C The red blood cells contain thousands of hemoglobin molecules. The most important feature of hemoglobin is its ability to combine loosely with oxygen. A low hemoglobin level can cause decreased oxygenation to the tissues, thus causing a compensatory increase in heart rate. The other options are close to normal range and are not indicative of not tolerating this activity.
