Chapter 9 Hematology Part 2

32) Which of the following situations would NOT result in anemia? A) Blood loss B) Destruction of red blood cells C) Increased production of erythropoietin D) Iron deficiency Answer: C Diff: 2 Page Ref: 383 Standard: Medicine (Hematology) Objective: 5 33) Your patient is a 26-year-old African-American male who is alert but in severe distress, complaining of pain in his hands and feet, as well as abdominal pain. The pain began this morning but has progressed from an initial rating of 5/10 to a 9/10 at the present time. The patient has a history of sickle cell anemia and denies any trauma. Physical examination reveals cool, diaphoretic skin; pain with palpation to all four abdominal quadrants; splenomegaly; and a priapism. HR = 132, BP = 140/90, RR = 16. Select the most appropriate acute diagnosis and treatment for this patient. A) Sickle cell vaso occlusive crisis; administer high-concentration oxygen, IV therapy with isotonic crystalloids, and narcotics for pain control B) Sickle cell trait; administer oxygen according to pulse oximetry readings, and give a 500 mL bolus of isotonic crystalloid solution C) Sickle cell occlusive crisis; administer oxygen by nonrebreathing mask, isotonic crystalloids, and aspirin D) Sickle cell disease; administer oxygen according to pulse oximetry readings, start an IV of normal saline, and administer ketorolac for pain Answer: A Diff: 3 Page Ref: 384-385 Standard: Medicine (Hematology) Objective: 5, 6, 7 34) Your patient is suffering from end-stage liver disease. In which of the following ways would impairment of the hematologic system most likely be evident? A) Jaundice B) Polycythemia resulting in a florid appearance C) Vaso-occlusive crisis resulting in joint pain D) Leukocytosis Answer: A Diff: 3 Page Ref: 381 Standard: Medicine (Hematology) Objective: 5 166 35) Your patient is taking an immunosuppressant drug to prevent rejection of a transplanted kidney. As a consequence, the patient is more prone to: A) prolonged blood clotting time. B) aplastic anemia. C) infection. D) polycythemia. Answer: C Diff: 2 Page Ref: 375 Standard: Medicine (Hematology) Objective: 5 36) Your patient is undergoing chemotherapy and is complaining of bleeding from the gums and blood in his stool. Which of the following will best address the patient's problem? A) Stopping the chemotherapy B) Administering platelets C) Administering erythropoietin D) Administering vitamin K Answer: B Diff: 3 Page Ref: 382 Standard: Medicine (Hematology) Objective: 5, 6, 7 37) In an emergency situation if you administer blood to a patient whose blood type is unknown, you should administer type ________ blood. A) A positive B) O negative C) B positive D) A negative Answer: B Diff: 2 Page Ref: 377-378 Standard: Medicine (Hematology) Objective: 3, 7 38) Your patient has type A+ blood. Which of the following statements about the patient's blood is TRUE? A) The patient produces anti-A antibodies. B) The blood cells lack Rh antigens. C) There are type A antigens on the surface of the red blood cells. D) The patient can only receive A+ blood if a transfusion is needed. Answer: C Diff: 3 Page Ref: 377-378 Standard: Medicine (Hematology) Objective: 3 167 39) In which of the following situations is hemolytic disease of the newborn most likely to occur? A) An Rh positive mother delivers a first Rh negative newborn B) An Rh positive mother delivers a second Rh negative newborn C) An Rh negative mother delivers a first Rh positive newborn D) An Rh negative mother delivers a second Rh positive newborn Answer: D Diff: 3 Page Ref: 378 Standard: Medicine (Hematology) Objective: 3, 5 40) Which of the following medications would be most useful in the event of a transfusion reaction? A) Aspirin B) Diphenhydramine C) Magnesium sulfate D) Furosemide Answer: B Diff: 2 Page Ref: 379 Standard: Medicine (Hematology) Objective: 6, 7 41) Your patient has a history of pernicious anemia. If not treated, your primary concern for this patient should be: A) hypovolemia. B) prolonged blood clotting time. C) hypoxia. D) infection. Answer: C Diff: 2 Page Ref: 383-384 Standard: Medicine (Hematology) Objective: 5, 6, 7 42) Which of the following is TRUE concerning sickle cell anemia? A) It is a hereditary disease involving abnormal hemoglobin. B) It is a hereditary disease involving lack of intrinsic factor. C) It is an autoimmune disease in which the body destroys its own hemoglobin. D) It is an acquired disease in which the body cannot absorb iron. Answer: A Diff: 2 Page Ref: 384 Standard: Medicine (Hematology) Objective: 2, 5 168 43) Your patient is an 18-year-old female suffering from sickle cell crisis. Which of the following is the best course of treatment for this patient? A) High-concentration oxygen, IV NS KVO, diphenhydramine B) High-concentration oxygen, IV bolus of NS C) High-concentration oxygen, IV bolus of NS, morphine sulfate D) High-concentration oxygen, IV NS KVO Answer: C Diff: 3 Page Ref: 384-385 Standard: Medicine (Hematology) Objective: 6, 7 44) Which of the following statements regarding polycythemia is most accurate? A) It decreases the patient's risk of infection. B) It decreases the ability of blood to clot. C) It increases the patient's risk of infection. D) It increases the patient's risk of thrombosis and congestive heart failure. Answer: D Diff: 3 Page Ref: 385 Standard: Medicine (Hematology) Objective: 5 45) Which of the following statements regarding hemophilia is most accurate? A) Hemophilia is a hereditary abnormality of the platelets. B) Hemophilia is a hereditary lack of certain proteins needed in the clotting cascade. C) Hemophilia is a hereditary disease that causes fibrin clots to dissolve prematurely. D) Hemophilia is a hereditary disease in which the body is unable to produce vitamin K. Answer: B Diff: 2 Page Ref: 387 Standard: Medicine (Hematology) Objective: 2, 5 46) What ethnicity is most likely to suffer from sickle cell disease? A) Native American B) Asian C) African American D) Caucasian Answer: C Diff: 2 Page Ref: 384 Standard: Medicine (Hematology) Objective: 2 169 47) You are caring for a patient with a known history of sickle cell disease. The patient has severe abdominal and back pain. The patient is tachycardic and tachypneic. The blood pressure is normal. What should be one of the paramedic's first interventions? A) Administer oxygen B) Initiate an IV C) Give oral analgesics D) Put the patient in a supine position Answer: A Diff: 2 Page Ref: 384-385 Standard: Medicine (Hematology) Objective: 6, 19 48) The study of blood and blood-forming organs is called: A) oncology. B) hematology. C) homeostasis. D) palliative care. Answer: B Diff: 1 Page Ref: 369 Standard: Medicine (Hematology) Objective: 1 49) Hemophilia A is an example of a ________ disorder. A) genetically acquired B) environmentally acquired C) intrinsically endued D) extrinsically endued Answer: A Diff: 1 Page Ref: 387 Standard: Medicine (Hematology) Objective: 1, 2 50) The organ that is most responsible for producing erythropoietin is the: A) bone marrow. B) liver. C) kidney. D) spleen. Answer: C Diff: 1 Page Ref: 370 Standard: Medicine (Hematology) Objective: 3 170 51) A complete hemoglobin molecule can carry up to: A) three oxygen molecules. B) six oxygen molecules. C) four oxygen molecules. D) two oxygen molecules. Answer: C Diff: 2 Page Ref: 371 Standard: Medicine (Hematology) Objective: 3 52) Causes of the inflammatory process include all of the following EXCEPT: A) infection. B) chemical exposure. C) trauma. D) psychosocial factors. Answer: D Diff: 1 Page Ref: 375 Standard: Medicine (Hematology) Objective: 3 53) Hemostasis is maintained by which three mechanisms? A) Vascular spasm, platelet plugs, fibrin clots B) Fibrin, platelets, hemoglobin C) Von Willebrand's factor, fibrin, platelets D) Factor VIII, factor VII, factor III Answer: A Diff: 1 Page Ref: 376 Standard: Medicine (Hematology) Objective: 3 54) Fibrinolytics are effective against: A) any clot. B) clots containing fibrin. C) occlusions only in the heart. D) occlusions only in the brain. Answer: B Diff: 2 Page Ref: 377 Standard: Medicine (Hematology) Objective: 3 171 55) You are transporting a patient to a tertiary trauma center. The patient is receiving blood and has sustained trauma the local center cannot handle. You notice that the patient has begun to develop tachycardia, hives, and a fever. You suspect: A) hypovolemia B) a normal response to a transfusion. C) transfusion reaction. D) anaphylaxis. Answer: C Diff: 2 Page Ref: 379 Standard: Medicine (Hematology) Objective: 4, 5 56) You suspect that your patient is having a transfusion reaction. The patient's care plan should include: A) dobutamine, diphenhydramine, albuterol. B) dopamine, diphenhydramine, IV fluid bolus. C) IV fluid. D) diphenhydramine alone. Answer: B Diff: 2 Page Ref: 379 Standard: Medicine (Hematology) Objective: 6, 7 57) A patient complains of atraumatic bleeding of the gums. You suspect: A) halitosis. B) dentalgia. C) a hematologic disorder. D) gingivitis. Answer: C Diff: 2 Page Ref: 382 Standard: Medicine (Hematology) Objective: 4, 5 58) You are caring for a patient who is complaining of diffuse musculoskeletal pain, shortness of breath, and atraumatic priapism. You suspect: A) sickle cell vaso occlusive crisis. B) sickle cell hematologic crisis. C) Acute lymphocytic leukemia (ALL). D) AML. Answer: A Diff: 2 Page Ref: 384 Standard: Medicine (Hematology) Objective: 4, 5 172 59) You respond to a patient complaining of shortness of breath. Upon your arrival, the patient tells you that she has been experiencing headaches, vertigo, and now itching. She says her doctor had called with a lab result of her latest test. Her hematocrit is reported as 60. You suspect: A) congestive heart failure (CHF). B) sickle cell disease. C) thrombocytopenia. D) polycythemia. Answer: D Diff: 2 Page Ref: 385 Standard: Medicine (Hematology) Objective: 4, 5 173