HESI Med Surg Hematological

Correct Answer: C. A client undergoing cancer treatment.

Explanation:

Cancer treatments, especially chemotherapy and radiation therapy, have significant effects on the hematopoietic system (bone marrow suppression) and the lymphatic system (immune suppression or lymph node involvement). These treatments can lead to anemia, leukopenia, thrombocytopenia, and increased risk of infection. Therefore, it is essential for the nurse to ask detailed questions about side effects, recent infections, bleeding tendencies, and fatigue when a client is undergoing cancer treatment.

Why the Other Options Are Incorrect:

A. A client who does not eat at night.

While meal timing can affect general nutrition, this detail alone does not directly relate to specific hematopoietic or lymphatic system symptoms.

B. A female client, age 50, yet childless.

Being childless at age 50 may have relevance in some reproductive or hormonal assessments, but it does not have a direct link to hematopoietic or lymphatic system concerns.

D. A female client who has melanin-related skin problem.

Skin pigmentation issues may involve dermatological or endocrine concerns but are not directly associated with hematopoietic or lymphatic system disorders.

Summary:

A client undergoing cancer treatment because cancer therapies directly impact the hematopoietic and lymphatic systems, requiring careful and detailed assessment. The other options are not closely related to these systems and would not warrant the same level of focused inquiry.

Correct Answer: Neurologic involvement

Explanation:

Pernicious anemia is a type of vitamin B12 deficiency anemia, and one of its common manifestations is neurological involvement. Numbness and tingling in the arms and legs, also known as "paresthesia," are classic signs of nerve damage that can occur in pernicious anemia due to a lack of vitamin B12, which is essential for proper nerve function. This condition can lead to nerve degeneration and neurological symptoms, including the sensation of tingling and numbness, and, if untreated, can lead to more severe nerve damage.

Why the Other Options Are Incorrect:

Loss of vibratory and position senses

While loss of vibratory and position senses can occur with pernicious anemia due to neurological involvement, the primary concern here is the presence of numbness and tingling, which is more directly associated with neurologic involvement. Loss of vibratory and position senses are specific manifestations of neuropathy that can develop later in the disease, but they are not the primary description of the symptoms presented.

Severity of the disease

The symptoms of numbness and tingling do not necessarily correlate with the severity of the disease. They are more indicative of the onset of neurological complications due to prolonged B12 deficiency. Therefore, these symptoms are not a reliable indicator of the overall severity of the disease, but rather the type of complications the client may be experiencing.

Insufficient intake of dietary nutrients

While pernicious anemia is caused by a deficiency in vitamin B12, this is often due to malabsorption (related to intrinsic factor production), not insufficient intake alone. Therefore, the tingling and numbness are more indicative of neurologic involvement from B12 deficiency rather than just dietary insufficiency.

Summary:

The correct answer is B. Neurologic involvement. Numbness and tingling in the arms and legs in a client with pernicious anemia most likely indicate the neurological complications associated with vitamin B12 deficiency. Early detection and treatment of B12 deficiency are important to prevent irreversible nerve damage.

Correct answer: A. 3.6 and 5.4 million/mm³

Explanation:

The normal range of erythrocytes (red blood cells) for adults typically falls between approximately 3.6 and 5.4 million/mm³. This range can vary slightly depending on the laboratory standards, gender, and environmental factors like altitude, but generally, adult females have counts closer to 3.6–5.0 million/mm³ and males 4.2–5.4 million/mm³. The primary role of erythrocytes is to carry oxygen from the lungs to the body tissues and assist in returning carbon dioxide to the lungs for exhalation.

Why the Other Options Are Incorrect:

B. 5.6 and 8.4 million/mm³.

This range is too high for the normal adult erythrocyte count. Values in this range might suggest polycythemia or may be seen at very high altitudes but are not standard for the general adult population.

C. 7.2 and 9.3 million/mm³.

This is also an abnormally high range and does not reflect the normal erythrocyte count for adults. Such levels would be pathologic in most circumstances.

D. 8.2 and 10.7 million/mm³.

This option reflects an extremely elevated erythrocyte count, far above normal limits, which would indicate a serious pathological condition if ever seen in an adult.

Summary:

The correct answer is A. 3.6 and 5.4 million/mm³, which reflects the normal range of erythrocytes in adults. The other options provide values that are significantly above the normal range and would not be considered typical for a healthy adult.

Correct answer: D. Examine for any signs of physical injury.

Explanation:

For a client with a lymphatic system disorder, the main priority is to assess for any physical signs of bleeding, bruising, or trauma. Many lymphatic disorders, especially those affecting blood components (such as lymphoma or conditions with impaired platelet function), can increase the risk of bleeding or injury. Early detection of these signs is crucial for prompt intervention and safety.

Why the Other Options Are Incorrect:

A. Examine the color and quantity of urine.

This might be important if there is concern about kidney involvement or fluid balance, but it is not directly linked to the primary concerns of lymphatic disorders.

B. Inspect the tonsils for size and appearance.

While the lymphatic system includes tonsils, and enlarged tonsils might indicate localized infection or inflammation, this does not address the broader risks (such as bleeding or bruising) associated with systemic lymphatic disorders.

C. Frequently examine and record blood pressure.

Monitoring blood pressure is important for general health but is not the main priority in the context of lymphatic system disorders unless there is a specific complication like hypovolemia or shock.

Summary:

Examine for any signs of physical injury because the nurse's highest priority is to identify signs of bleeding or trauma, which are key concerns in lymphatic system disorders. The other options are either too focused on specific areas or do not directly address the most urgent risks.

Correct answer: D. Fever and sore throat

Explanation:

Leucopenia refers to a decrease in white blood cells, particularly neutrophils, which play a key role in the body's defense against infection. When a client is leucopenic, their ability to fight infections is impaired, making them more susceptible to bacterial and viral infections. Therefore, fever and sore throat are classic signs of infection and are important indicators that the client might be developing an infection due to their suppressed immune system. Prompt recognition of these signs is critical to prevent severe infections.

Why the Other Options Are Incorrect:

A. Unusual or easy bleeding.

This is more indicative of thrombocytopenia (low platelet count), not leucopenia. Thrombocytopenia increases the risk of bleeding, while leucopenia increases infection risk.

B. Oozing from injection sites.

Similar to option A, this relates more to impaired clotting due to low platelets or coagulation issues rather than leucopenia.

C. Dark, tarry stools.

This typically indicates gastrointestinal bleeding (melena), which is associated with bleeding disorders or gastrointestinal lesions, not with leucopenia.

Summary:

The correct answer is D. Fever and sore throat, because these are hallmark signs of infection that can result from leucopenia due to the client's reduced white blood cell count. The other options are associated with bleeding tendencies, which are not directly related to leucopenia.

Correct Answer: Fragile tissues and altered clotting mechanisms may result in hemorrhage.

Explanation:

Leukemia is associated with bone marrow suppression, leading to decreased production of platelets and clotting factors. This results in increased fragility of blood vessels and tissues, making bleeding more likely even from minor trauma. Using an electric razor reduces the risk of cuts or nicks, which could lead to excessive bleeding due to these impaired clotting mechanisms.

Why the Other Options Are Incorrect:

Trauma and microabrasions may contribute to anemia.

While trauma can worsen anemia in some cases, the primary issue with using a razor is the risk of bleeding, not trauma or microabrasions leading directly to anemia. Anemia in leukemia patients results from decreased production of red blood cells due to the disease itself, not from trauma.

The client is at risk for spontaneous and uncontrolled bleeding.

This is true for patients with leukemia due to low platelet counts, but the focus of the electric razor recommendation is to prevent cuts or abrasions, not to directly address the issue of spontaneous bleeding. The goal is to minimize trauma that could trigger bleeding.

The client is at risk for infection from microorganisms.

While leukemia patients are immunocompromised and at risk for infections, the recommendation to use an electric razor is primarily aimed at preventing bleeding from cuts. Infection prevention would involve other measures, such as hand hygiene and avoiding exposure to pathogens, but the electric razor recommendation specifically addresses the risk of bleeding.

Summary:

Fragile tissues and altered clotting mechanisms may result in hemorrhage. The primary concern for leukemia patients is avoiding cuts that could lead to bleeding due to impaired clotting ability. The electric razor minimizes this risk.

Correct answer: C. Signs of leukopenia and thrombocytopenia

Explanation:

C. Signs of leukopenia and thrombocytopenia

Medications that depress the hematopoietic system can lead to reduced production of blood cells, which may result in leukopenia (low white blood cell count) and thrombocytopenia (low platelet count). Leukopenia increases the risk of infections, while thrombocytopenia increases the risk of bleeding and bruising. These are critical signs to monitor for in clients receiving medications that affect the hematopoietic system.

Why the Other Options Are Incorrect:

A. Signs of leukocytosis

Leukocytosis refers to an increased white blood cell count, often a sign of infection or inflammation, not typically associated with medications that depress the hematopoietic system. In fact, these medications are more likely to cause leukopenia (a decrease in white blood cells).

B. Signs of painful joints and discomfort

While joint pain can occur due to various conditions, it is not directly related to the depression of the hematopoietic system. Medications that suppress hematopoiesis typically cause issues related to blood cell counts rather than joint pain.

D. Signs of hemolysis

Hemolysis (destruction of red blood cells) may be associated with certain conditions or medications, but it is not the primary concern when medications are depressing the hematopoietic system. The key signs to monitor are related to the suppression of blood cell production (leukopenia and thrombocytopenia), rather than hemolysis.

Summary:

The correct answer is C. Signs of leukopenia and thrombocytopenia, as these are the primary concerns when medications depress the hematopoietic system. Monitoring for leukocytosis, joint pain, or hemolysis is less relevant in this context.

Correct answer: D. The spleen removes erythrocytes after 120 days, and the liver removes severely damaged erythrocytes.

Explanation:

D. The spleen removes erythrocytes after 120 days, and the liver removes severely damaged erythrocytes.

The spleen plays a critical role in filtering out aged or damaged erythrocytes (red blood cells) from circulation. Erythrocytes typically have a lifespan of about 120 days. Once they are no longer functional, the spleen removes them from the bloodstream. The liver also plays a role in breaking down severely damaged erythrocytes. Both organs are important in recycling components such as iron and bilirubin.

Why the Other Options Are Incorrect:

A. The spleen helps in creating mature erythrocytes.

This is incorrect because the spleen does not play a role in creating mature erythrocytes. Erythrocytes are produced in the bone marrow, where hematopoietic stem cells differentiate into mature red blood cells.

B. The liver generates erythropoietin which regulates the rate of erythrocyte production.

This is partially true, but it's not the liver's primary role. Erythropoietin is primarily produced in the kidneys, not the liver. The hormone erythropoietin regulates erythrocyte production in the bone marrow in response to low oxygen levels.

C. The spleen stores the iron component of hemoglobin from erythrocytes and returns it to the red marrow.

While the spleen does play a role in recycling iron, this description is not fully accurate. The spleen breaks down hemoglobin, and the iron from the hemoglobin is released and stored in the liver, not primarily returned to the bone marrow. The liver then releases iron as needed for new erythrocyte production.

Summary:

The correct answer is D. The spleen removes erythrocytes after 120 days, and the liver removes severely damaged erythrocytes, as this accurately describes the roles of the spleen and liver in erythrocyte metabolism. The other options contain either inaccuracies or incomplete information regarding these organ functions.

The correct answers are:

Chronic myelocytic

Acute lymphocytic

Acute myelocytic

Detailed explanation of the correct answers:

Chronic myelocytic: Chronic myelocytic leukemia (CML) is a form of leukemia that starts in the bone marrow and involves the overproduction of myeloid cells, often marked by the Philadelphia chromosome. This is a key type of leukemia studied in pathophysiology.

Acute lymphocytic: Acute lymphocytic leukemia (ALL) is a type of leukemia that originates in the bone marrow and spreads quickly. It affects the lymphoid cells and is one of the most common forms of leukemia in children, though it can also occur in adults.

Acute myelocytic: Acute myelocytic leukemia (AML) is another aggressive form of leukemia that starts in the bone marrow. It is characterized by the rapid proliferation of myeloid cells and can develop quickly, requiring prompt treatment.

Why Other Options are Incorrect:

Acute pernicious: There is no such thing as "acute pernicious" leukemia. Pernicious anemia is a condition related to vitamin B12 deficiency, not a form of leukemia.

Chronic aplastic: Aplastic anemia refers to a condition where the bone marrow fails to produce blood cells, but it is not a type of leukemia. It is a distinct hematologic disorder, separate from leukemia.

Summary:

The forms of leukemia you would study in pathophysiology are chronic myelocytic leukemia, acute lymphocytic leukemia, and acute myelocytic leukemia. Pernicious anemia and aplastic anemia are not types of leukemia.