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WorksheetsExam 4 (Medsurg): Hematology
Total questions: 130
Worksheet time: 1hrs 6mins
What is the definition of hematopoiesis?
production of blood cells
destruction of blood cells
utilization of blood cells
storage of blood cells
Which organs and systems are considered blood-forming tissues?
Bone marrow, spleen, lymph system
Heart, lungs, kidneys, liver
Muscles, pancreas, bone marrow
Stomach, intestines, pancreas, spleen, lymph nodes
Where does hematopoiesis PRIMARILY occur?
Within the bone marrow
Within the liver
Within the spleen
Within the lymphatic system
Bone marrow produces which of the following?
RBCs, WBCs, and platelets
Plasma and lymph
Hormones and enzymes
Nerves and muscles
How many types of blood cells develop from nondifferentiated immature blood cells (stem cells)?
1
2
3
4
What is the soft material that fills the central core of bones called?
Marrow
Cartilage
Vasculature
Epiphysial Plate
What is the function of yellow bone marrow?
Adipose storage
Blood cell production
Calcium storage
Inflammatory mediator storage
Red bone marrow is _______.
Hematopoietic
Osteogenic
Adipose
Cartilaginous
SATA: In adults, red marrow is found in flat and irregular bones, such as?
the ends of long bones
the heads of long bones
vertebrae
ribs
scapulae
Blood is what percentage of total body weight?
2%
5%
8%
10%
Whole blood is made up of 55% ______ and 45% formed elements.
Plasma
Water
Hemoglobin
Red blood cells
PLASMA contains 7% proteins, 91% water, and other solutes. Which of the following is NOT a protein found in PLASMA?
A) Albumin
B) Globulin
C) Fibrinogen
D) Hemoglobin
What is the normal range of platelets in blood?
150k-400k/uL
50k-100k/uL
400k-600k/uL
10k-50k/uL
What is the normal range of erythrocytes (RBCs) in blood?
4-6 x 10^6/uL
1-2 x 10^6/uL
7-9 x 10^6/uL
10-12 x 10^6/uL
What is the normal range of leukocytes (WBCs) in blood?
4-11 x 10^3/uL
11-20 x 10^3/uL
1-4 x 10^3/uL
20-30 x 10^3/uL
Which type of leukocyte makes up 50-70% of WBCs?
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Which type of leukocyte makes up 20-40% of WBCs?
Lymphocytes
Neutrophils
Monocytes
Eosinophils
Which type of leukocyte makes up 4-8% of WBCs?
Monocytes
Neutrophils
Eosinophils
Basophils
Which type of leukocyte makes up 2-4% of WBCs?
Eosinophils
Neutrophils
Basophils
Lymphocytes
Which type of leukocyte makes up 0-2% of WBCs?
Basophils
Neutrophils
Lymphocytes
Monocytes
What percentage of blood is plasma?
55%
30%
70%
40%
45%
What percentage of blood is made up of true blood cells?
45%
25%
60%
80%
55%
Which blood cells are responsible for oxygen transport?
RBCs (Red Blood Cells)
WBCs (White Blood Cells)
Platelets
Plasma cells
Which blood cells are responsible for protection from infection?
WBCs (White Blood Cells)
RBCs (Red Blood Cells)
Platelets
Plasma cells
Which blood cells promote coagulation?
Thrombocytes/platelets
Erythrocytes/red blood cells
Leukocytes/white blood cells
Lymphocytes
What is hemoglobin composed of?
Iron + protein
Calcium + fat
Sodium + carbohydrate
Potassium + vitamin
Oxyhemoglobin is formed from which two components?
O2 + iron
CO2 + hemoglobin
O2 + plasma
CO2 + plasma
Erythropoiesis is PRIMARILY stimulated by which bodily condition?
Hypoxia
Hyperglycemia
Alkalosis
Hypercalcemia
Acidosis
Erythropoiesis is controlled by erythropoietin, which is created by the _______?
kidneys
liver
bone marrow
lymph nodes
heart
Reticulocytes mature into ______ and are a good indication of production rates.
RBCs
WBCs
Platelets
Plasma cells
Hemolysis removes abnormal, defective, damaged, and old ______ from circulation.
RBCs
WBCs
Platelets
Plasma
What is the most common form of leukocyte, making up 50-70% of all leukocytes?
Eosinophils
Neutrophils
Basophils
Lymphocytes
The primary function of neutrophils is ______.
Phagocytosis
Antibody production
Mediator signaling
Oxygen transport
Histamine inhibition
Mature neutrophil is segmented, called 'segs', with multiple segments in its ______.
nucleus
cytoplasm
membrane
cell wall
Immature neutrophils are called ______ due to their non-segmented appearance.
bands
blasts
reticulocytes
monocytes
An increase in percentage of bands is called a 'shift to the LEFT', meaning the bone marrow is releasing less-mature cells into circulation in response to a site of injury. SHIFTS TO THE LEFT OCCUR WITH:
Chronic infection
Acute infection
Massive hemorrhage
Autoimmune disease
Eosinophils make up what percentage of all leukocytes?
1-2%
2-4%
5-10%
10-20%
Granules in eosinophils contain ______.
HISTAMINE
HEPARIN
SEROTONIN
DOPAMINE
HEMOGLOBIN
These cells engulf antigen-antibody complexes formed during an ALLERGIC response.
Neutrophils
Eosinophils
Basophils
Monocytes
Which type of cell defends against parasites?
Eosinophils
Neutrophils
Basophils
Lymphocytes
Where are eosinophils found in large numbers?
In the lungs and GI tract
In the brain and spinal cord
In the heart and kidneys
In the skin and muscles
Basophils make up less than what percentage of all leukocytes?
2%
10%
5%
20%
Basophils have cytoplasmic granules that contain which substances?
Heparin, serotonin, and histamine
Insulin, glucagon, and somatostatin
Dopamine, norepinephrine, and epinephrine
Collagen, elastin, and keratin
What happens when basophils are stimulated by an antigen?
Basophils release their granules
Basophils produce antibodies
Basophils engulf bacteria
Basophils differentiate into macrophages
Lymphocytes make up what percentage of all leukocytes?
20% to 40%
5% to 10%
50% to 60%
70% to 80%
Which type of leukocyte forms the basis of cellular and humoral immune responses?
Lymphocytes
Erythrocytes
Platelets
Neutrophils
Basophils
What are the two subtypes of lymphocytes?
B cells and T cells
Neutrophils and Eosinophils
Macrophages and Monocytes
Basophils and Dendritic cells
Monocytes account for what percentage of all leukocytes?
4-8%
1-3%
10-15%
20-25%
Which type of cell is the second to arrive at a site of injury or infection?
Monocytes
Neutrophils
Lymphocytes
Basophils
When monocytes migrate into tissue, what do they become?
Macrophages
Neutrophils
Eosinophils
Basophils
Where are resident macrophages stored?
Spleen, lymph nodes, tonsils, and liver
Bone marrow, pancreas, and kidneys
Heart, lungs, and brain
Skin, muscles, and intestines
SATA: What are some functions of thrombocytes in the clotting process?
initiates clotting process
plugs openings in the capillary wall
are factors in clot shrinkage and retraction
regulated by thrombopoietin
release granules when stimulated by an antigen
What product of stem cells fragments into platelets?
Megakaryocyte
Megaerythrocyte
Leukocyte
Monocyte
Megaleukocyte
Hemostasis is defined as the ________ of bleeding.
arrest
increase
initiation
promotion
What is the immediate hemostatic response of injured blood vessels called?
Vasoconstrictive response
Inflammatory response
Platelet aggregation
Fibrinolytic response
Vasodilatory respone
Vasoconstriction reduces leakage of blood from the injured vessel by ________ the size of the vessel.
reducing
increasing
maintaining
expanding
Platelet plug formation is activated by exposure to ________ from the injured blood vessel.
interstitial collagen
elastin fibers
smooth muscle cells
endothelial cells
Platelet 'stickiness' is called ________.
adhesiveness
aggregation
coagulation
fibrinolysis
Formation of clumps is called ________ OR agglutination.
aggregation
diffusion
precipitation
sedimentation
Clotting factors form a ________ fibrin clot on the platelet plug.
visible
invisible
loose
microscopic
Clotting factors are labeled with both ________ and ________.
names; Roman numerals
letters; Arabic numbers
colors; Egyptian symbols
types; Navajo codes
Which enzyme is the most powerful in the coagulation process and converts fibrinogen to fibrin?
Thrombin
Pepsin
Amylase
Lipase
Anticoagulation occurs by two means: one of them is ________, which interferes with thrombin.
antithrombins
platelets
fibrinogens
erythrocytes
Fibrinolytic System: Plasminogen, with the help of plasminogen activators, becomes _______.
plasmin
fibrin
thrombin
prothrombin
Fibrinolytic System: Plasmin, with the help of RBCs and platelets, forms the fibrin clot via _______.
fibrinolysis
coagulation
aggregation
thrombosis
Fibrinolytic System: Once the fibrin clot is formed, excess fibrin degradation products are released from the site of injury and back into the _______.
bloodstream
lymphatic system
digestive tract
alveoli
Spleen: The spleen is located in the _______ (next to kidney).
ULQ (Upper Left Quadrant)
URQ (Upper Right Quadrant)
LLQ (Lower Left Quadrant)
LRQ (Lower Right Quadrant)
Spleen Function: The spleen is able to produce _______ during fetal development.
RBCs
Folic Acid
Insulin
Bile
Spleen Function: Filtration in the spleen removes old and damaged _______ from circulation.
RBCs
Platelets
WBCs
Plasma cells
Spleen Function: The spleen removes hemoglobin from RBCs and returns iron component to the _______ for reuse.
bone marrow
spleen
lymph nodes
pancreas
Spleen Function: Filters out bacteria, especially _______ organisms.
ENCAPSULATED
GRAM-POSITIVE
AEROBIC
ANAEROBIC
GRAM-NEGATIVE
Spleen Function: Contains a rich supply of lymphocytes, monocytes, and stored _______.
immune globulins
red blood cells
enzymes
megakaryocytes
Spleen Function: Storage: stores RBCs and approximately _______ of total mass of platelets.
30%
10%
50%
70%
For the body to acquire iron, it must first be:
ingested
created by the spleen
created by the bone marrow
recycled from dead white blood cells
Iron Metabolism: _______ and hemosiderin assist in iron storage.
Ferritin
Transformerin
Albumin
Hemoglobin
SATA: The lymphatic system consists of:
lymph fluid
lymphatic capillaries
lymphatic ducts
lymph nodes
lymphatic arteries
The lymph system ensures protein and fat from the GI tract and certain hormones are returned to the _______ system.
circulatory
digestive
respiratory
nervous
bone marrow
Fill in the blank: The lymph system returns excess interstitial fluid to the blood to prevent or reduce _______.
edema
anemia
hypertension
osteoporosis
Which of the following describes lymph fluid?
Clear fluid that circulates in the veins and arteries
Pale yellow interstitial fluid that has diffused through capillary walls
Red fluid found in arteries, arterioles, and veins
Blue fluid in the lymph nodes and in the thyroid glands
Lymph fluid circulates through special vasculature.
True
False
Fill in the blank: Too much interstitial fluid or reduced absorption leads to _______.
lymphedema
anemia
hypertension
thrombocytopenia
Fill in the blank: Lymphatic capillaries unite to form lymphatic vessels that carry all lymph fluid to the RIGHT lymphatic duct or the _______ duct.
THORACIC
BRONCHIAL
AORTIC
CAROTID
Fill in the blank: Lymphatic capillaries drain into _______ veins in the neck.
subclavian
jugular
carotid
brachial
Where is the largest concentration of lymph nodes found?
In the brain surrounding the hypothalamus
In the abdomen surrounding the GI tract
In the legs surrounding the femoral artery
In the arms surrounding the brachial artery
Fill in the blank: The primary function of lymph nodes is filtration of _______ and foreign particles carried by lymph fluid.
pathogens
hormones
enzymes
nutrients
The liver functions as a filter.
True
False
Fill in the blank: The liver produces all _______ essential to hemostasis and blood coagulation.
procoagulants
autoantibodies
hormones
anticoagulants
inflammatory mediators
Fill in the blank: The liver stores excess _______.
iron
bone marrow
platelets
neutrophils
basophils
What are the components involved in normal hemostasis?
Vascular endothelium, platelets, and coagulation factors
Red blood cells, plasma, and antibodies
Bone marrow, lymph nodes, and spleen
White blood cells, plasma, and platelets
Fill in the blank: Disruption of ANY of these components (vascular endothelium, platelets, and coagulation factors) may result in ______ or thrombotic disorders.
bleeding
infection
inflammation
allergy
Which of the following is a result of thrombocytopenia?
Increase in platelets
Reduction of platelets
Increase in red blood cells
Decrease in white blood cells
Thrombocytopenia results in abnormal hemostasis: prolonged or spontaneous ______.
bleeding
clotting
inflammation
hematapoeisis
Which of the following is primarily an acquired disorder commonly from ingestion of certain herbs or drugs (i.e. St. John's Wort)?
Thrombocytopenia
Leukopenia
Anemia
Polycythemia
During hemostasis, ______ gives time for a platelet response TO BEGIN and for the triggering of plasma clotting factors.
vasodilation
vasoconstriction
hematopoeisis
agglutination
aggregation
Clotting factors are ______ present in circulation in inactive forms until stimulated to initiate clotting through one of two pathways, which are the intrinsic and extrinsic pathways.
never
sometimes
rarely
always
How is the intrinsic clotting pathway activated?
massive hemorrhage
collagen exposure
phagocytosis
antigen recognition
How is the extrinsic clotting pathway initiated?
exposure to collagen
release of tissue factor or tissue thromboplastin from injured tissue
release of histamine and bradykinin from mediators
release of heparin, serotonin, and histamine from granules
Anticoagulation occurs by two means: one of which is ________, which results in the direct dissolution of the fibrin clot.
antithrombins
fibrinolysis
plasminogen
agglutination
fibrinogen
SATA: Geriatric patients have a diminished ability to recover from acute illnesses, as well as compensate for chronic diseases due to what factors of normal aging?
bone marrow alterations
decreased hemoglobin levels
decreased vascular integrity
reduced blood cell responsiveness
Thrombocytopenia can either be ______ or ______.
environmental, autoimmune
bacterial, viral
inherited, acquired
interstitial, extracellular
Which of the following is the MOST COMMON form of thrombocytopenia?
Thrombotic thrombocytopenia purpura (TTP)
Heparin-induced thrombocytopenia (HIT)
Warfarin-induced thrombocytopenia (WIT)
Immune thrombocytopenia purpura (ITP)
Immune thrombocytopenia purpura (ITP) is primarily a ______ disease and is defined as a syndrome of abnormal ______ of circulating platelets.
viral, genesis
congenital, destruction
autoimmune, destruction
congenital, genesis
bacterial, destruction
Thrombotic Thrombocytopenic Purpura (TTP) is a rare disorder that is associated with _______ aggregation of platelets that form into ________.
enhanced, microthrombi
diminished, microthrombi
enhanced, megakaryocytes
diminished, megakaryocytes
Thrombotic Thrombocytopenic Purpura (TTP) is caused by a deficiency of _______ enzymes.
RBC
WBC
Platelet
Plasma
Thrombotic Thrombocytopenic Purpura (TTP) is considered a MEDICAL EMERGENCY, AS BLEEDING AND CLOTTING CAN OCCUR SIMULTANEOUSLY (SIMILAR TO DIC).
True
False
Heparin-Induced Thrombocytopenia is associated with increased use of heparin. This type of thrombocytopenia creates a ____ feedback loop which can result in _____.
positive, bleeds
negative, bleeds
positive, clots
negative, clots
Heparin-Induced Thrombocytopenia is considered:
a moderate to severe disorder, requires hospitalization
a mild disorder which can be treated outpatient
a death sentence, go get the body bag ready
life threatening, requires prompt hospitalization and possible intensive care
Heparin-Induced Thrombocytopenia develops _______ days after heparin therapy is started.
2-3
3-5
5-10
7-14
One hallmark indicator of Heparin-Induced Thrombocytopenia is a platelet ______ of _____ from baseline.
spike, 50%
spike, 150%
drop, 50%
drop, 150%
SATA: What are some major complications of Heparin-Induced Thrombocytopenia?
Venous thrombosis
Arterial thrombosis
DVT
Pulmonary embolism
Massive hemorrhage
Patients with thrombocytopenia always exhibit signs and symptoms of the disorder.
True
False
What is the MOST COMMON symptom of thrombocytopenia?
DVT/PE
Microthrombi
Endothelial Injury
Mucosal/Cutaneous Bleeding
Ecchymoses is:
large lesions secondary to hemorrage
microhemorrages
small bruise formed from numerous petechiae
hangnail
What is THE hallmark diagnostic indicator of thrombocytopenia?
Decreased RBC count
Decreased WBC count
Decreased platelet count
Decreased serum plasma
A patient with thrombocytopenia suffering from prolonged bleeding will typically have a platelet count less than:
100,000
75,000
50,000
20,000
A patient with thrombocytopenia suffering from massive hemorrhage will typically have a platelet count less than:
100,000
75,000
50,000
20,000
Which medication should the RN AVOID giving to a patient with thrombocytopenia?
Ibuprofen
Naloxone
Labetalol
Aspirin
Prednisone
When treating Immune Thrombocytopenic Purpura (ITP), ________ are given to suppress phagocytic response of splenic macrophages, which results in an increased life span of platelets.
NSAIDs
Corticosteroids
TNF inhibitors
Anticoagulants
An enlarged spleen sequesters and ______ platelets, resulting in _____ available clotting ability in the circulation.
destroys, more
destroys, less
creates, more
creates, less
Platelet transfusions are used to increase platelet counts in life-threatening hemorrhages.
True
False
Platelet transfusions are _____ used prophylactically, due to antibody formation.
always
never
sometimes
rarely
Platelet transfusions are indicated for a platelet count less than ______/uL.
50,000
75,000
20,000
10,000
Untreated Thrombotic Thrombocytopenia Purpura (TTP) usually results in IRREVERSIBLE _____ FAILURE AND DEATH.
HEPATIC
RENAL
CARDIAC
RESPIRATORY
_________ can be used to aggressively reverse platelet consumption.
Tranexamic Acid
Vitamin K
Plasmapharesis
ECMO
A patient is diagnosed with Heparin-Induced Thrombocytopenia (HIT). How long should the RN and other providers stop the heparin therapy for?
at least 2 hours
at least 12 hours
at least 24 hours
at least 72 hours
permanently and forever
Patients recovering from Heparin-Induced Thrombocytopenia (HIT) can be started on Coumadin once their platelet count reaches 150,000/uL. What type of medication should the patient be switched to in the meantime for anticoagulation therapy?
direct thrombin inhibitor
tPA
warfarin
alteplase
tranexamic acid
Chemotherapeutic drugs can cause thrombocytopenia and bone marrow suppression.
True
False
In regards to a patient with thrombocytopenia, the RN should AVOID:
encouraging patients to seek prompt treatment for any and all bleeding
teaching self care measures to reduce bleeding risk
administering IM or SQ medications unless absolutely necessary
administering platelet transfusions
Blood component therapy is frequently used to manage hematologic diseases. This type of therapy is considered a _______ measure.
permanent
curative
non-effective
temporary
Blood component therapy can be done frequently for patients with hematologic diseases, as they are very safe and have negligible adverse effects.
True
False
