HESI Med Surg Hematological

Correct Answer: C. Albumin

Explanation:

Albumin is the most abundant plasma protein, making up about 60% of total plasma proteins. It is essential for maintaining colloid osmotic pressure, which helps keep fluid within the vascular compartment. Albumin also plays a critical role in transporting various substances, including hormones, fatty acids, and drugs.

Why the Other Options Are Incorrect:

A. Platelets

Platelets are cellular components of blood involved in clotting, not plasma proteins. They are essential for hemostasis but are not part of the plasma protein content.

B. Fibrinogen

Fibrinogen is a plasma protein important for blood clotting, but it constitutes only about 4% of the total plasma protein content, making it far less abundant than albumin.

D. Globulins

Globulins are a diverse group of proteins involved in immune responses and transport functions. They make up about 36% of plasma proteins but are still less abundant than albumin.

Summary:

The correct answer is C. Albumin, which is the most abundant protein in plasma and plays a key role in maintaining oncotic pressure and transporting substances. The other options either are not plasma proteins or are present in smaller amounts than albumin.

Correct Answer: To closely monitor the rate of administration

Explanation:

During a transfusion, especially in clients with thalassemia, it is critical to monitor the rate of blood administration to avoid complications such as volume overload or transfusion reactions. Thalassemia patients often require multiple transfusions, which increases the risk of iron overload and other complications. Therefore, ensuring the correct transfusion rate is essential to minimize these risks.

Why the Other Options Are Incorrect:

To administer vitamin B12 injections

Vitamin B12 is important for red blood cell production, but it is not directly related to the transfusion process in a patient with thalassemia. The primary concern during transfusion is managing the transfusion itself, not administering B12.

To instruct the client to rest immediately if chest pain develops

While chest pain during a transfusion may be a sign of a transfusion reaction, the nurse's role is to assess the situation, stop the transfusion, and notify the healthcare provider immediately. Simply instructing the client to rest is not sufficient action in the case of a potential reaction.

To assess for enlargement and tenderness over the liver and spleen

Although liver and spleen enlargement may occur over time in patients with thalassemia, particularly due to iron overload, it is not directly related to the transfusion process. Monitoring the transfusion for immediate complications takes precedence.

Summary:

To closely monitor the rate of administration. Monitoring the transfusion rate is critical in preventing complications in thalassemia patients. The other options either focus on long-term issues or actions not directly related to the transfusion process.

Correct Answer: Rich sources of vitamin C

Explanation:

Vitamin C (ascorbic acid) significantly enhances the absorption of non-heme iron (the form of iron found in plant-based foods and iron supplements). Consuming foods rich in vitamin C alongside iron-rich foods improves the efficiency of iron absorption by reducing iron to a more absorbable form in the digestive tract. Examples of vitamin C-rich foods include citrus fruits, strawberries, bell peppers, and broccoli.

Why the Other Options Are Incorrect:

Vitamin E

While vitamin E is important for overall health, it does not play a direct role in promoting the absorption of iron. Iron absorption is primarily influenced by vitamin C and not by vitamin E.

Meat, egg yolks, oysters, and shellfish

While meat, egg yolks, oysters, and shellfish are good sources of heme iron (the form of iron more readily absorbed by the body), this option does not specifically address enhancing iron absorption. The client might already be consuming iron from these sources, but to further enhance absorption, combining them with vitamin C would be more effective.

Sources of vitamin B12

Vitamin B12 is important for red blood cell production but does not directly influence the absorption of iron. Iron deficiency anemia typically requires iron supplementation or dietary changes, not vitamin B12.

Summary:

Rich sources of vitamin C, as vitamin C enhances the absorption of non-heme iron. Other options may provide iron or support overall health, but they do not have the same effect on iron absorption as vitamin C.

Correct Answer: Helps retain fluid in the vascular compartment.

Explanation:

Albumin plays a crucial role in maintaining the osmotic pressure in the blood vessels. Because albumin molecules are large and do not easily pass through the capillary walls, they create an osmotic pull that helps retain fluid within the vascular compartment. This process is important for maintaining blood volume and preventing excessive fluid from leaking into the tissues, which could lead to edema.

Why the Other Options Are Incorrect:

Helps push oxygen into the tissues of the body.

While albumin is important in maintaining fluid balance, it does not have a direct role in the transport of oxygen. Oxygen is carried by red blood cells through hemoglobin, not by albumin.

Retains leukocytes in the vascular compartment.

Albumin does not have a significant role in retaining leukocytes (white blood cells) in the vascular compartment. Leukocytes move freely through the bloodstream and can exit the capillaries during immune responses, but this process is controlled by other factors, not albumin.

Absorbs carbon dioxide from the tissues for transport to the lungs.

Carbon dioxide is carried in the blood primarily by bicarbonate ions and hemoglobin, not albumin. While albumin can bind to small amounts of carbon dioxide, it is not the main protein responsible for its transport.

Summary:

Helps retain fluid in the vascular compartment because albumin creates the osmotic pressure that keeps fluid in the blood vessels. The other options describe functions unrelated to albumin's primary role.

CorrectAnswer: Osteoclasts break down bone cells so pathologic fractures occur.

This answer is correct because in multiple myeloma, the overactivity of osteoclasts leads to bone breakdown, weakening the bones and making them more susceptible to fractures. The osteoclasts are responsible for reabsorbing bone tissue, which can result in the formation of bone lesions and fractures.

Why Other Options are Wrong:

Osteopathic tumors destroy bone causing fractures.

While tumors can cause bone destruction, the primary mechanism in multiple myeloma involves osteoclast activity, not tumors themselves.

Osteolytic activating factor weakens bones producing fractures.

Osteolytic activity is indeed involved in bone weakening, but the primary action occurs via osteoclast activation rather than an activating factor alone.

Osteosarcomas form producing pathologic fractures.

Osteosarcomas are a different form of bone cancer, not typically associated with multiple myeloma.

Summary:

In multiple myeloma, osteoclasts play a crucial role in bone breakdown, leading to fractures. Therefore, it’s important to monitor for bone fractures in these patients.

Correct Answer: Coagulopathies are bleeding disorders that involve platelets or clotting factors.

Explanation:

Coagulopathies refer to a group of disorders that affect the blood clotting process, leading to either excessive bleeding or abnormal clotting. These conditions often involve platelets (the cells responsible for initiating clot formation) or clotting factors (proteins in the blood that help form clots). Hemophilia, von Willebrand disease, and certain types of disseminated intravascular coagulation (DIC) are common examples of coagulopathies.

In these disorders, there is either a deficiency or dysfunction of the necessary components (platelets or clotting factors) involved in the coagulation cascade, leading to bleeding complications.

Why the Other Options Are Incorrect:

Coagulopathies are bleeding disorders that are characterized by abnormalities in the numbers and types of red blood cells in the body.

This description is incorrect because coagulopathies are not primarily related to abnormalities in red blood cells. Red blood cell disorders (like anemia) affect oxygen transport, not blood clotting. Coagulopathies are specifically linked to issues with platelets and clotting factors, not red blood cells.

Coagulopathies are bleeding disorders that are characterized by a deficiency of globulins in the plasma.

Globulins are a class of proteins in plasma, but coagulopathies are specifically related to platelet or clotting factor deficiencies. Deficiencies in globulins are typically seen in conditions like immunodeficiencies or liver diseases, not in coagulopathies.

Coagulopathies are bleeding disorders that involve the destruction of stem cells in the bone marrow.

This description is more accurate for disorders like aplastic anemia or certain forms of leukemia, which involve a reduction in the production of blood cells, including platelets. However, coagulopathies focus on defects in the clotting process, not the destruction of stem cells.

Summary:

Coagulopathies involve disorders affecting platelets or clotting factors, leading to abnormal bleeding. Therefore, the correct definition is Coagulopathies are bleeding disorders that involve platelets or clotting factors.

Correct Answer: The manufacture and development of blood cells

Explanation:

Hematopoiesis is the process by which blood cells are produced and developed. This includes the formation of red blood cells (erythrocytes), white blood cells (leukocytes), and platelets (thrombocytes), which all originate from hematopoietic stem cells in the bone marrow. The process is essential for maintaining the balance of blood cells in the body.

Why the Other Options Are Incorrect:

The production of lymphatic fluid in the body

This refers to the process involved in lymph formation and circulation, not hematopoiesis. Lymph is produced by the lymphatic system, not by the bone marrow or the hematopoietic process.

The making of red blood cells and lymph

Hematopoiesis is concerned with the creation of blood cells, not lymph. While red blood cells are part of hematopoiesis, lymph production occurs separately in the lymphatic system.

The development of lymph in the bone marrow

Lymph development is not a function of the bone marrow. Lymph is produced by the lymphatic system, primarily from tissues such as lymph nodes, not as part of hematopoiesis.

Summary:

The manufacture and development of blood cells, which is the definition of hematopoiesis. The other options refer to processes outside the scope of hematopoiesis, such as lymph production and development.

Correct Answer: Reduced urine output

Explanation:

In acute hypovolemic anemia, which results from severe blood loss, the body tries to conserve fluid and maintain perfusion to vital organs. As a result, kidney function is often impaired due to decreased blood volume and reduced renal perfusion, leading to decreased urine output (oliguria). This is an important sign to monitor in clients with acute blood loss.

Why the Other Options Are Incorrect:

Malabsorption disorders

Malabsorption disorders are not directly related to acute blood loss or hypovolemic anemia. These disorders affect nutrient absorption in the gastrointestinal system over time, but they do not typically result in acute symptoms of blood loss.

Postural hypotension

While postural hypotension is a common sign of hypovolemic anemia, it is not as immediately observed in all cases, especially in the early stages. It can become more pronounced later as the body's compensatory mechanisms fail, but it is not the most direct sign to assess initially compared to reduced urine output.

Fatigue

Fatigue is indeed a symptom of anemia, but in the case of acute hypovolemic anemia due to severe blood loss, the body will focus on conserving fluid and perfusion, which makes reduced urine output a more specific and immediate indicator of the condition.

Summary:

Reduced urine output. This is a direct and important symptom of acute hypovolemic anemia, indicating the body’s attempt to conserve blood and fluid. While postural hypotension and fatigue can occur, reduced urine output is a key finding that requires immediate attention in acute blood loss scenarios.

Correct Answer: In the lymph node

Explanation:

Macrophages are located in the lymph nodes, where they play an important role in the immune response. They act as antigen-presenting cells and work by engulfing and digesting foreign substances such as bacteria, viruses, and other pathogens that have entered the body. In the lymph nodes, macrophages filter lymph fluid and trap harmful invaders before presenting them to other immune cells, which leads to a stronger immune response.

Why the Other Options Are Incorrect:

At the site of trauma

While macrophages do migrate to the site of trauma or infection to perform phagocytosis and contribute to the immune response, their action of attacking and destroying pathogens often happens within the lymph nodes first. At the trauma site, they clear debris and pathogens, but their main immune function, including antigen presentation, starts in the lymph nodes.

In the vascular system

Macrophages do circulate in the bloodstream but do not actively destroy foreign substances within the vascular system itself. Their main function is to travel to infected or damaged tissues where they can then perform their immune functions.

In the thymus

The thymus is where T lymphocytes mature, but macrophages do not perform their main immune functions there. The thymus is not the site where macrophages destroy foreign substances.

Summary:

In the lymph node because this is where macrophages filter lymph, engage with foreign substances, and perform their immune functions. The other options involve sites where macrophages may function but are not the primary location for attacking and destroying pathogens.