Exam (elaborations)
Chapter 21 Alterations of Hematologic Function
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- Galen College Of Nursing
Chapter 21 Alterations of Hematologic Function
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Chapter 21: Alterations of Hematologic FunctionMULTIPLE CHOICE
1. A patient’s anemia is described as having erythrocytes that demonstrate poikilocytosis. The
nurse would recognize the erythrocytes would be:
a. pale in color.
b. present in various sizes.
c. able to assume various shapes.
d. live only a few days.
ANS: C
Poikilocytosis means the erythrocytes are able to assume various shapes; it does not refer
to color, size, and life span.
REF: p. 513
2. A newborn is diagnosed with congenital intrinsic factor deficiency. Which of the following
types of anemia will the nurse see documented on the chart?
a. Iron deficiency
b. Pernicious
c. Sideroblastic
d. Hemolytic
ANS: B
A lack of the intrinsic factor NleUadRsStoIpNerGniTciBou.sCaOneMmia. Iron
deficiency anemia is not related to the intrinsic factor. Pernicious anemia is due to the lack of
the intrinsic factor; sideroblastic
anemia is not related to the intrinsic factor. Hemolytic anemia results from destruction
of cells.
REF: p. 515
3. When a nurse is reviewing lab results and notices that the erythrocytes contain an
abnormally low concentration of hemoglobin, the nurse calls these erythrocytes:
a. hyperchromic.
b. hypochromic.
c. macrocytic.
d. microcytic.
ANS: B
Hypochromic erythrocytes have low concentrations of hemoglobin. Hyperchromic
erythrocytes have high concentrations of hemoglobin. Macrocytic and microcytic refer to cell
size.
REF: p. 517
4. A 5-year-old was diagnosed with normocytic-normochromic anemia. Which type of
anemia does the nurse suspect the patient has?
a. Sideroblastic
, b. Hemolytic
c. Pernicious
d. Iron deficiency
ANS: B
Hemolytic anemia is an example of normocytic-normochromic anemia. Sideroblastic anemia
is an example of microcytic hypochromic anemia. Pernicious anemia is an example of a
macrocytic anemia. Iron deficiency anemia is an example of microcytic hypochromic
anemia.
REF: p. 514, Table 21-1
5. After initial compensation, what hemodynamic change should the nurse monitor for in
a patient who has a reduction in the number of circulating erythrocytes?
a. Increased viscosity of blood
b. Decreased cardiac output
c. Altered coagulation
d. Hyperdynamic circulatory state
ANS: D
After initial compensation, the blood flows faster and more turbulently than normal blood,
causing a hyperdynamic circulatory state. Blood viscosity decreases rather than increases.
Cardiac output increases. Alteration in coagulation does not occur.
REF: p. 513 | p. 515
6. A 25-year-old female has a heavy menses during which she loses a profuse amount of blood.
Which of the following adaptations should the nurse expect?
a. Movement of fluid into thNe I G B.C M
U N T O
cRell S
b. Decreased cardiac output
c. Decreased oxygen release from hemoglobin
d. Peripheral vasoconstriction
ANS: D
When the anemia is severe or acute in onset (e.g., hemorrhage), the initial compensatory
mechanism is peripheral blood vessel constriction, diverting blood flow to essential
vital organs. Fluid moves into the vascular space, not the cell. Blood volume increases;
thus, cardiac output increases. There is an increase in hemoglobin release of oxygen.
REF: p. 515
7. A 60-year-old patient diagnosed with emphysema experiences a rapid and pounding
heart, dizziness, and fatigue with exertion. Which respiratory assessment findings indicate
the respiratory system is compensating for the increased oxygen demand?
a. Bronchoconstriction
b. Increased rate and depth of breathing
c. Dyspnea
d. Activation of the renin-angiotensin response
ANS: B
, The rate and depth of breathing increase in an effort to increase oxygen availability
accompanied by an increase in the release of oxygen from hemoglobin. Bronchodilation
occurs, not constriction. Dyspnea is not a compensatory mechanism but a side effect of the
body’s attempt to increase oxygen. The respiratory system does not activate the
renin-angiotensin response; the kidneys are involved.
REF: p. 515
8. A 2-year-old malnourished child is diagnosed with vitamin B12 and folate deficiencies.
A blood smear suggests the deficiency is macrocytic and normochromic. The nurse
would expect the hemoglobin to be:
a. normal.
b. sporadic.
c. low.
d. high.
ANS: A
The macrocytic (megaloblastic) anemias are characterized by unusually large stem cells
(megaloblasts) in the marrow that mature into erythrocytes that are unusually large in size
(macrocytic), thickness, and volume. The hemoglobin content is normal, thus allowing them
to be classified as normochromic.
REF: p. 515
9. A 45-year-old is diagnosed with macrocytic, normochromic anemia. The nurse suspects
the most likely cause of this condition is:
a. defective DNA synthesis. R I G B.CM
N
b. abnormal synthesis of hemUogloSbinN. T O
c. defective use of vitamin C.
d. blocked protein synthesis.
ANS: A
These anemias are the result of ineffective erythrocyte DNA synthesis; hemoglobin is normal.
These anemias are not related to use of vitamin C or blocked protein synthesis.
REF: p. 515
10. A 35-year-old female is diagnosed with vitamin B12 deficiency anemia (pernicious anemia).
The most likely cause is a decrease in:
a. ferritin.
b. gastric enzymes.
c. intrinsic factor.
d. erythropoietin.
ANS: C
The underlying alteration in pernicious anemia (PA) is the absence of intrinsic factor (IF),
an enzyme required for gastric absorption of dietary vitamin B12, a vitamin essential for
nuclear maturation, and DNA synthesis in red blood cells. PA is not due to a decrease in
ferritin, gastric enzymes, or erythropoietin but to a lack of intrinsic factor.
REF: p. 515
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