Advanced med-surg hematology Questions with
Correct Answers
A client with a hematological disorder asks the nurse how the body
forms blood cells. The nurse understands that this process takes place
primarily in which location?
A. Spleen
B. Kidneys
C. Bone marrow
D. Liver Correct Answer-Ans: C
Bone marrow is the primary site for hematopoiesis. The liver and spleen
may be involved during embryonic development or when bone marrow
is destroyed. The kidneys release erythropoietin, which stimulates the
marrow to increase production of RBCs. However, blood cells are not
primarily formed in the spleen, kidneys or liver.
A client suffers with a leg wound which causes major blood loss. As a
result of the bleeding, the process of primary hemostasis is activated.
What will occur during this process?
A. Severed blood vessels constrict
B. Thromboplastin is released
C. Prothrombin is converted to thrombin
D. Fibrin is lysed Correct Answer-Ans: A
Primary hemostasis involves the severed vessel constricting and platelets
collecting at the injury site. Secondary hemostasis occurs when
thromboplastin is released, prothrombin converts to thrombin, and fibrin
is lysed.
,A client has come to the OB/GYN clinic due to heavy menstrual flow.
Because of the clients consequent increase in red cell production, the
nurse should recommend the client increase which daily intake of what
substance?
A. Vitamin E
B. Vitamin D
C. iron
D. Magnesium Correct Answer-Ans. C
To replace blood loss, the rate of red cell production increases. Iron is
incorporated into hemoglobin. Vitamin E and D and magnesium do not
need to be increased when RBC production is increased.
The nurse is planning the care of a client with a nutritional deficit and a
diagnosis of megaloblastic anemia. The nurse should recognize that this
client's health problem is due to which issue with the red blood cells?
A. Production of inadequate quantities of RBCs
B. Premature release of immature RBCs
C. Injury to the RBC's in circulation
D. Abnormalities in the structure and function of RBCs Correct Answer-
Ans. D
Vitamin B12 and folate deficiencies are characterized b the production
of abnormally large erythrocytes called megaloblasts. Because these
cells are abnormal, many are sequestered (trapped) while still in the
bone marrow, and their rate of release is decreased. Some of these cells
actually die in the marrow before they can be released into the
circulation. This results in megaloblastic anemia. This pathologic
,process does not involve inadequate production, premature release or
injury to existing RBCs.
A nurse is caring for a client who is undergoing preliminary testing for a
hematologic disorder. What sign and symptom of a hematological
disorder is most common?
A. Sudden change in LOC
B. recurrent infections
C. Anaphylaxis
D. Severe fatigue Correct Answer-Ans: D
The most common indicator of a hematologic disease is extreme fatigue.
This is more common than changes in LOC, infections, or anaphylaxis.
The nurse caring for a client receiving a transfusion notes that 15
minutes after the infusion of PRBCs has begun, the client is having
difficulty breathing and reports severe chest tightness. What is the most
appropriate initial action for the nurse to take?
A. Notify the client's health care provider
B. Stop the transfusion immediately
C. Remove the client's IV access
D. Assess the client's chest sounds and vital signs Correct Answer-Ans.
B
Vascular collapse, bronchospasm, laryngeal edema, shock, fever, chills,
and JVD are severe reactions. The nurse should discontinue the
transfusion immediately, monitor the client's v/s, and notify the HCP.
The blood container and tubing should be sent to the blood bank. A
blood and urine specimen may be needed if a transfusion reaction or
, bacterial infection is suspected. The client's IV access should not be
removed.
The nurse is describing the role of plasminogen in the clotting cascade.
Where in the body is plasminogen present?
A. Myocardial muscle tissue
B. All body fluids
C. Cerebral tissue
D. Venous and arterial vessel walls Correct Answer-Ans: B
Plasminogen, which is present in all body fluids, circulates with
fibrinogen. Plasminogen is found in body fluids not tissue.
The nurse is caring for a client who has developed scar tissue in many of
the areas that normally produce blood cells. What organs can become
active in blood cell production by the process of extramedullary
hematopoiesis?
A. Spleen and kidneys
B. Kidneys and pancreas
C. Pancreas and liver
D. Liver and spleen Correct Answer-Ans: D
In adults with disease that causes marrow destruction, fibrosis, or
scarring, the liver and spleen can also resume production of blood cells
by a process known as extramedullary hematopoiesis. The kidneys and
pancreas do not produce blood cells for the body.
Correct Answers
A client with a hematological disorder asks the nurse how the body
forms blood cells. The nurse understands that this process takes place
primarily in which location?
A. Spleen
B. Kidneys
C. Bone marrow
D. Liver Correct Answer-Ans: C
Bone marrow is the primary site for hematopoiesis. The liver and spleen
may be involved during embryonic development or when bone marrow
is destroyed. The kidneys release erythropoietin, which stimulates the
marrow to increase production of RBCs. However, blood cells are not
primarily formed in the spleen, kidneys or liver.
A client suffers with a leg wound which causes major blood loss. As a
result of the bleeding, the process of primary hemostasis is activated.
What will occur during this process?
A. Severed blood vessels constrict
B. Thromboplastin is released
C. Prothrombin is converted to thrombin
D. Fibrin is lysed Correct Answer-Ans: A
Primary hemostasis involves the severed vessel constricting and platelets
collecting at the injury site. Secondary hemostasis occurs when
thromboplastin is released, prothrombin converts to thrombin, and fibrin
is lysed.
,A client has come to the OB/GYN clinic due to heavy menstrual flow.
Because of the clients consequent increase in red cell production, the
nurse should recommend the client increase which daily intake of what
substance?
A. Vitamin E
B. Vitamin D
C. iron
D. Magnesium Correct Answer-Ans. C
To replace blood loss, the rate of red cell production increases. Iron is
incorporated into hemoglobin. Vitamin E and D and magnesium do not
need to be increased when RBC production is increased.
The nurse is planning the care of a client with a nutritional deficit and a
diagnosis of megaloblastic anemia. The nurse should recognize that this
client's health problem is due to which issue with the red blood cells?
A. Production of inadequate quantities of RBCs
B. Premature release of immature RBCs
C. Injury to the RBC's in circulation
D. Abnormalities in the structure and function of RBCs Correct Answer-
Ans. D
Vitamin B12 and folate deficiencies are characterized b the production
of abnormally large erythrocytes called megaloblasts. Because these
cells are abnormal, many are sequestered (trapped) while still in the
bone marrow, and their rate of release is decreased. Some of these cells
actually die in the marrow before they can be released into the
circulation. This results in megaloblastic anemia. This pathologic
,process does not involve inadequate production, premature release or
injury to existing RBCs.
A nurse is caring for a client who is undergoing preliminary testing for a
hematologic disorder. What sign and symptom of a hematological
disorder is most common?
A. Sudden change in LOC
B. recurrent infections
C. Anaphylaxis
D. Severe fatigue Correct Answer-Ans: D
The most common indicator of a hematologic disease is extreme fatigue.
This is more common than changes in LOC, infections, or anaphylaxis.
The nurse caring for a client receiving a transfusion notes that 15
minutes after the infusion of PRBCs has begun, the client is having
difficulty breathing and reports severe chest tightness. What is the most
appropriate initial action for the nurse to take?
A. Notify the client's health care provider
B. Stop the transfusion immediately
C. Remove the client's IV access
D. Assess the client's chest sounds and vital signs Correct Answer-Ans.
B
Vascular collapse, bronchospasm, laryngeal edema, shock, fever, chills,
and JVD are severe reactions. The nurse should discontinue the
transfusion immediately, monitor the client's v/s, and notify the HCP.
The blood container and tubing should be sent to the blood bank. A
blood and urine specimen may be needed if a transfusion reaction or
, bacterial infection is suspected. The client's IV access should not be
removed.
The nurse is describing the role of plasminogen in the clotting cascade.
Where in the body is plasminogen present?
A. Myocardial muscle tissue
B. All body fluids
C. Cerebral tissue
D. Venous and arterial vessel walls Correct Answer-Ans: B
Plasminogen, which is present in all body fluids, circulates with
fibrinogen. Plasminogen is found in body fluids not tissue.
The nurse is caring for a client who has developed scar tissue in many of
the areas that normally produce blood cells. What organs can become
active in blood cell production by the process of extramedullary
hematopoiesis?
A. Spleen and kidneys
B. Kidneys and pancreas
C. Pancreas and liver
D. Liver and spleen Correct Answer-Ans: D
In adults with disease that causes marrow destruction, fibrosis, or
scarring, the liver and spleen can also resume production of blood cells
by a process known as extramedullary hematopoiesis. The kidneys and
pancreas do not produce blood cells for the body.
