NURS-202 Exam 5 - Hematology and Neuro 2022 EXAM QUESTIONS AND ANSWERS 100% CORRECT

NURS-202 Exam 5 - Hematology and Neuro 2022 what is a left shift? ***need to know per lecture*** Correct Answer: increased number of immature neutrophils AKA band cells what are bands in relation to a CBC? Correct Answer: young neutrophils what does "more band building" mean? Correct Answer: more shift to the left, more young neutrophils what is the first clue that an infection is starting? Correct Answer: shift to the left what could cause a left shift? ***need to know per lecture*** Correct Answer: infection physical stress (ex: surgery) inflammation when reading labs, what does SEGS represent? Correct Answer: mature neutrophils "segmental neutrophils" what are thrombocytes? Correct Answer: platelets what percentage of blood is plasma vs RBCs? Correct Answer: RBC 45% plasma 55% what are the three types of protein found in plasma? Correct Answer: albumin (maintains blood volume and binds to substances) globulins (main proteins of antibodies) fibrinogen (activated by thrombin, forms fibrin clots) what can happen if a patient has low albumin? Correct Answer: leads to leaky vessels which can lead to third spacing, edema what can cause low albumin? Correct Answer: AKI malnutrition hemorrhage burns liver disease hemoglobin vs hematocrit per lecture ***need to know per lecture*** Correct Answer: hematocrit measures the percentage of blood that is RBCs hemoglobin measures how many RBCs you have hemoglobin protein carries oxygen - without sufficient hemoglobin, won't have enough oxygen function and anatomy of the spleen Correct Answer: vascular and lymph tissues, located in ULQ of abdomen functions: filters blood stores blood and platelets aids in antigen production aids in initiation of B&T lymphocytes white pulp: where immune functions occur red pulp: where filtration occurs can you live without your spleen? Correct Answer: yes, but will be at higher risk of infection why do we need to assess/palpate the spleen for patients with sickle cell anemia? Correct Answer: sickle cells can get stuck in the spleen and cause it to rupture - will have lots of pain with palpation how long do normal RBCs live? which organ removes them from the blood? Correct Answer: 120 days the spleen the primary function of erythrocytes is __________ ***need to know per lecture*** Correct Answer: respiration what are the two pathways in the clotting cascade? which one is faster? Correct Answer: intrinsic (blood or vessel injury) & extrinsic (external tissue damage) extrinsic is faster, skips some steps in the clotting cascade PT or PTT - which goes with intrinsic or extrinsic clotting cascade? Correct Answer: extrinsic monitored by PT intrinsic monitored by PTT PT vs INR vs PTT ***need to know per lecture*** Correct Answer: PT measures how long it takes a clot to form (we use to monitor oral anticoag therapy - warfarin/coumadin) INR is used to standardize PT lab results PTT evaluates all clotting factors of intrinsic pathway except platelets (we use to monitor response to anticoag therapies - heparin) what could increased INR indicate? Correct Answer: DIC taking salicylates cirrhosis hepatitis vitamin K deficiency what does high vs low INR mean? Correct Answer: high INR = takes a long time to clot = bleeding risk low INR = clots fast = clot risk what is a normal INR? what do we want INR at for someone taking warfarin/coumadin? Correct Answer: normal is 1.1 or less if on warfarin/coumadin, we want to be at 2-3 how long do platelets live? Correct Answer: 4-7 days how long does aspirin affect blood clotting for? Correct Answer: it irreversibly inhibits platelet aggregation for the entirety of a platelet's life, which is 4-7 days what do we use bone marrow biopsy for vs a bone marrow aspiration? ***need to know per lecture*** Correct Answer: biopsy - diagnosis of leukemia aspiration - check if treatment is working and/or look for bone marrow suppression how can drinking alcohol cause/affect hematological issues? Correct Answer: 90% of alcohol is metabolized in the liver and damage to the liver increases the risk for hematological problems assessment considerations for hematological assessment Correct Answer: history: nutrition past medical hx chronic disease medications and herbs: --- goldenseal and green tea can reduce the effect of anticoags --- aspirin inhibits platelet aggregation --- penicillins, cephalosporins, vancomycin may cause neutropenia physical assessment lab profile examination of bone marrow what are the best sites to use for bone marrow aspiration or biopsy? what is something to remember about this procedure? ***need to know per lecture*** Correct Answer: iliac crest is best can also use sternum it is very painful! risk for osteomyelitis! nursing management for bone marrow aspiration ***need to know per lecture*** Correct Answer: watch for signs of infection - can get osteomyelitis (bone pain, fever, purulent drainage) apply pressure to the site for 5-10 minutes after assess VS frequently apply a sterile pressure dressing instruct patient to rest for several hours monitor for sx of bleeding and infx for 24 hours reinforce dressing if needed, do not remove for 24 hours assess for pain specimens labeled and brought to lab - not tubed, usually in person age related changes to the hematological system ***need to know per lecture*** Correct Answer: blood volume decrease lower levels of plasma number of cells is gradually reduced lean body mass decreases fat tissue increases until around age 60 bone mass and intracellular fluids decrease nutrition needs change (ex: after menopause iron requirements are the same for men and women) decrease in total body water is there a change in platelets with aging? is there a change in hematocrit with aging? ***need to know per lecture*** Correct Answer: no and no what is the protein that stores iron? Correct Answer: ferritin what does a decrease in ferritin indicate? Correct Answer: iron deficiency teaching points for iron supplementation ***need to know per lecture*** Correct Answer: don't take with calcium or dairy vitamin c can increase absorption don't lay down for 30 mins after taking expect black stools may cause nausea, constipation, abdominal discomfort normal H&H Correct Answer: Hemoglobin 14-18 male 12-16 female Hematocrit 42-51 male 38-44 female why is iron so important? Correct Answer: it is essential to the formation and function of hemoglobin dietary teaching for iron ***need to know per lecture*** Correct Answer: Good sources: red meat green leafy veggies dried fruits dried beans fortified cereals eggs oatmeal sweet potatoes beets cook w/ cast iron skillets Avoid: alcohol coffee tea (increase GI motility and decrease absorption of iron) The nurse correlates which clinical manifestations with a diagnosis of iron-deficiency anemia? (Select all that apply.) A. Decreased temperature B. Decreased heart rate C. Increased blood pressure D. Increased heart rate E. Increased respiratory rate Correct Answer: D, E what is the most common type of anemia? Correct Answer: iron deficiency anemia 2. During an assessment, which finding does the nurse correlate with iron-deficiency anemia? A. Red, beefy gums B. Loss of teeth C. Red, swollen, tender tongue D. Xerostomia Correct Answer: C symptoms of iron deficiency anemia ***need to know per lecture*** Correct Answer: fatigue pallor tachycardia tachypnea SOB pale gums pale conjunctiva difficulty focusing sore muscles pink/red urine red, swollen, smooth, shiny, painful tongue (glossitis) spoon-shaped nails (koilonychias) growth issues in children (cognitive impairment) The nurse assesses for which clinical manifestation as a compensatory mechanism for iron-deficiency anemia? A.Increased respiratory rate B.Increased blood pressure C.Decreased temperature D.Decreased pulse rate Correct Answer: A A patient is scheduled to have a serum iron level in 1 month. The nurse includes which instructions about this test? A. "You will need to fast for 12 hours before the test." B. "This sample needs to be drawn in the morning." C. "Continue to take your iron supplements." D. "This test will require three different samples taken at hourly intervals." Correct Answer: B iron levels vary throughout the day, usually lower in the evening so we draw them in the morning we want them to stop taking iron 24hr before the test there is no need to fast what is the cause of B12 anemia? risk factors? ***need to know per lecture*** Correct Answer: B12 deficiency - either due to lack of intake or inability to absorb it risk factors lack of intrinsic factor vegan/vegetarian diet older adults low socioeconomic status chronic alcohol use autoimmune disorders (AIDS, thyroiditis, graves) long term use gastric meds GI resection crohn's disease celiac disease what is pernicious anemia? treatment? ***need to know per lecture*** Correct Answer: anemia caused by B12 deficiency due to lack of intrinsic factor which is necessary for absorption of B12. autoimmune disease ***prevention is key! gets worse the longer they are deficient*** treatment - B12 injections daily x1 week then weekly x5-6 weeks then monthly for life (SubQ or IM) complications of pernicious anemia / B12 deficiency ***need to know per lecture*** Correct Answer: anemia (pallor, fatigue, SOB, tachycardia, tachypnea) GI disorders dysfunction of peripheral nerves, spinal cord, brain -peripheral neuropathy -spinal cord degeneration -paresthesia hands/feet -Lhermitte's sign -confusion -depression, mood swings -impaired taste, stinging on tongue -impaired balance -visual disturbances -dementia -tinnitis What is Lhermitte's sign? Correct Answer: flexion of neck causes electric shock sensation can be seen in B12 deficiency / pernicious anemia what age does sickle cell usually appear? why? ***need to know per lecture*** Correct Answer: 6 months this is when they change over from fetal hemoglobin management of sickle cell anemia ***need to know per lecture*** Correct Answer: no cure - treatment is prevention and symptom management pain management and hydration are key! hydration can prevent sickle crisis but can also open up vessels during a crisis and help to decrease pain opioids for pain during a crisis transfusions avoid high altitudes, avoid dehydration what is the most common inherited blood disorder? Correct Answer: sickle cell anemia clinical manifestations of sickle cell anemia? ***need to know per lecture*** Correct Answer: fatigue pallor SOB tachycardia tachypnea SOB pain in joints, chest, abd fever delayed wound healing hand-foot syndrome jaundice pain and swelling with vaso-occlusion of blood vessels s/sx of sickle cell crisis ***need to know per lecture*** Correct Answer: changes in LOC headache dizziness sensorimotor deficits seizures neuro changes A patient with sickle cell disease is admitted with splenic sequestration. The blood pressure is 86/40 mm Hg, and heart rate is 124 beats/min. Which of these actions will the nurse take first? 1.Complete a head-to-toe assessment 2.Draw blood for type and cross-match 3.Infuse normal saline at 250 mL/hr 4.Ask the patient about vaccination history. Correct Answer: 3 - rehydration is the priority patients with sickle cell are at an increased risk for _