Chapter 21 The Hematologic System

Chapter 21  The Hematologic System

Complete Chapter Questions And Answers
 

Sample Questions

21.1•Normal changes in the hematologic system that occur with aging include

mild anemia.
decrease in platelet adhesiveness.
decrease in lymphocyte function.
increased number of stem cells in the bone marrow.
Answer: 3

Rationale: Changes in the hematologic system that occur with aging include a decrease in the functioning of lymphocytes, including cellular immunity. Mild anemia is not a normal part of the aging process, and should be investigated and treated. Changes with aging include an increase in platelet adhesiveness and a slight decrease in the number of stem cells in the bone marrow.
Assessment
Physiological Integrity
Application

21.2•Anemia is a common but not normal finding in the elderly client. Anemia will affect the older client in which way?

increasing the oxygen-carrying capacity of the blood
increasing skin pallor and dyspnea on exertion
decreasing pulse and respiratory rate
increasing tissue oxygenation
Answer: 2

Rationale:ADVANCE \r 0 Anemia causes the skin to appear pale and the client is more likely to experience fatigue and shortness of breath with exertion. ADVANCE \r 0All anemias result in loss of the oxygen-carrying capacity of the blood and generalized tissue hypoxia. The body will attempt to compensate for the anemia by increasing both the pulse and respiratory rate.
Assessment
Physiological Integrity
Analysis

21.3•Older clients with renal failure will develop anemia if untreated because of

loss of appetite related to elevated blood urea nitrogen (BUN) and creatinine levels.
the result of renal dialysis.
loss of blood through the urine because the failing kidney does not function properly.
loss of the kidney hormone erythropoietin.
Answer: 4

Rationale:ADVANCE \r 0 The anemia associated with renal failure is related to the loss of erythropoietin, which is produced by the healthy kidney and stimulates bone marrow to produce red blood cells. The anemia is not directly related to anorexia or hemodialysis although these factors may be somewhat associated with the anemia. Renal failure causes the loss of protein, not blood, through the urine.
Assessment
Physiological Integrity
Application

21.4•An older male client has been diagnosed with hemolytic anemia. Hemolytic anemia

is a result of loss of blood.
is associated with a decrease in the reticulocyte count.
causes the red blood cells to be microcytic.
always requires treatment with folic acid.
Answer: 4

Rationale:Hemolytic anemia is more common with aging and is caused by the premature destruction of the red blood cells. ADVANCE \r 0The normal life span of a red blood cell is 120 days. ADVANCE \r 0All hemolytic anemias require treatment with folic acid because this vitamin is consumed by the increased bone marrow production of red blood cells in response to the anemia. ADVANCE \r 0There is an increase in the reticulocyte (immature red blood cells) count because they are released early from the bone marrow to compensate. Hemolytic anemias are normocytic (red blood cells are normal size).
Diagnosis
Physiological Integrity
Analysis

21.5•Pernicious anemia occurs because of the lack of intrinsic factor that is necessary for the absorption of vitamin B12. Older clients are at risk for this anemia because of

a decrease in hydrochloric acid in the stomach.
decreased peristalsis in the gastrointestinal tract.
the tendency for older clients to be dependent on laxatives.
an increased incidence of cholelithiasis.
Answer: 1

Rationale: Older clients have less hydrochloric acid, which is necessary to break down proteins containing the vitamin B12. The client needs both the intrinsic and extrinsic factors to fully absorb vitamin B12 needed in the production of healthy red blood cells. Decreased peristalsis, dependence on laxatives, and cholelithiasis are not connected to the cause of pernicious anemia.
Diagnosis
Physiological Integrity
Application