NCLEX Questions Hematology Answers and Rationale

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1.    Answer C. The three criteria for a client to be diagnosed with AIDS are the following:
•    HIV positive
•    CD4+ T-cell count below 200 cells/microliter
•    Have one or more specific conditions that include acute infection of HIV

2.    Answer D. Keyword: MOST EASILY. Rationale: HIV is MOST EASILY transmitted in blood, semen and vaginal secretions. However, it has been noted to be found in fecal materials, urine, saliva, tears and breast milk.

3.    Answer A. Keyword: BEST TIME. Rationale: To determine if a preexisting infection is present a test should be done immediately and is repeated again in 3 months time (12 weeks) to detect seroconversion as a result of the needle stick.

4.    Answer B. Keyword: FIRST. Rationale: The ELISA test is the first screening test for HIV. A Western blot test confirms a positive ELISA test. Other blood tests that support the diagnosis of HIV include CD4+ and CD8 + counts, CBC, immunoglobulin levels, p24 antigen assay, and quantitative ribonucleic acid assays.

5.    Answer B. Keyword: MAIN REASON. Rationale: HIV was identified in 1983, thus, A is incorrect. By 1988 two strains of HIV existed, HIV-1 and HIV-2. Viruses spread rapidly and mature easily but these factors don’t affect the potential for development against HIV. Mutating too easily makes it hard to create a vaccine against it.

6.    Answer C. Rationale: HIV is a retrovirus that has a ribonucleic acid dependent reverse transcriptase.

7.    Answer D.  Keyword: STIMULATING THE PRODUCTION OF RBC. Rationale: Kidneys produce and release the hormone erythropoietin that is responsible for initiating the production of RBCs in the red marrow, thus, the correct answer is D. The Red Marrow is the site of RBC production. The spleen is responsible for removing the damage RBC.

8.    Answer A. Rationale: Anemia is characterized by a decreased in the number of RBCs.

9.    Answer C. Keyword: PRECURSOR. Rationale: the precursor of RBC is the stem cells in the red marrow.

10.    Answer A. Rationale: Stem cells – erythroblast- reticulocyte – erythrocytes. Erythropoietin is the hormone that stimulates red blood cell production in the red marrow. Mature red blood cells are formed from stem cells in the bone marrow. With the presence of erythropoietin, red cell pathway starts to form proerythroblast from stem cells. At this point the cell still contains nucleus. However, as the development progresses the nucleus becomes smaller and the cytoplasm becomes basophilic due to the presence of ribosome, thus the cell is now called basophilic erythroblast. As the cell becomes older it also becomes smaller and eventually when it begins to produce hemoglobin it is now termed as polychromatic erythroblast. Later on the cytoplasm will become more eosinophilic and the cell is now called orthochromatic erythroblast, which will then extrude its nucleus as the cells slowly fill with hemoglobin before entering the circulation as reticulocytes. Reticulocytes will mature to form the anucleated red blood cells.

11.    Answer C. Keyword: TRUE. Rationale: Kidneys produce and release the hormone erythropoietin that is responsible for initiating the production of RBCs in the red marrow. Red blood cells are anucleated cells (without nucleus) and have a life span of 120 days or 4 months.

12.    Answer A. Keyword: PASSES/CROSSES THE PLACENTA. Rationale: There is only one immunoglobulin that passes or crosses that placenta, the IgG. IgG starts to cross the placenta at the first trimester of pregnancy.  However, the largest amount of IgG transfer is noted during the third trimester of pregnancy. This type of immunoglobulin provides the fetus a passive immunity to possible bacterial and viral infections. However, the passive immunity it provides is only temporary. The immunity gradually disappears at about 6 to 8 months of life. The gradual disappearance of passive immunity, leads to the gradual production of larger quantities of immunoglobulin to replace the IgG from the mother.

13.    Answer C. Keyword: FIRST IMMUNOGLOBULIN PRODUCED BY THE BODY. Rationale: IgM is the first immunoglobulin produced by the body when the neonate is distressed, has acquired an infection or is challenged. When a newborn is exposed to environmental antigens, production of IgM rapidly increases. This type of immunoglobulin provides protection from gram-negative bacteria. IgM cannot cross the placental barrier.  In cases where large amount of IgM is found in the placenta, possible exposure to infection in the utero is probable

14.    Answer B. Keyword: HEMOGLOBIN SYNTHESIS. Rationale: Dietary elements are essential for RBC production. The following are needed by the red marrow to produce erythrocytes:
•    Iron – for hemoglobin synthesis
•    Folic Acid – for DNA synthesis
•    Vitamin B12 – for DNA synthesis

15.    Answer D. Keyword: MOST AT RISK. Rationale: The elderly are most at risk for anemia often due to financial concerns affecting protein intake or poor dentition that interferes with chewing meat.

16.    Answer B. Keyword: DECREASED NUMBER OF PLATELETS. Rationale: thrombocytopenia is a decreased number of platelets. Thrombocytosis is an excess in the number of platelets. Thrombocytopathy is a platelet dysfunction. Thrombectomy is the surgical removal of a thrombus.

17.    Answer C. Rationale: TO IMPROVE PLATELET COUNT. Rationale: Corticosteroid therapy can decrease antibody production and phagocytosis of the antibody-coated platelets, retaining more functioning platelets. Methotrexate can cause thrombocytopenia. Vitamin K is used to treat an excessive anticoagulable state from warfarin overload, and ASA decreases platelet aggregation.

18.     Answer A. Keyword: B-CELLS. Rationale: B-Cells are responsible for humoral or immunoglobulin mediated immunity. T-cells are responsible for cell-mediated immunity. There is such thing as antigen-mediated immunity.

19.    Answer D. Rationale: The life span of a normal platelet is 7-10 days. However, in idiopathic thrombocytopenia the life span is reduced to 1-3 days.

20.    Answer D. Keyword: PRIMARILY. Rationale: SLE is a chronic, inflammatory, autoimmune disorder affecting primarily the connective tissues. It also affects the skin and kidneys and may affect the pulmonary, cardiac, neural and renal systems.

21.    Answer C. Keyword: NEUROLOGICAL INVOLVEMENT. Rationale: neurologic involvement may be shown by:
•    Psychosis
•    Seizures
•    Headaches

22.    Answer A. Keyword: CLASSIC SIGN. Rationale: Although all these symptoms can be signs of SLE, the classic sign is the butterfly rash over the cheeks and nose.

23.    Answer B. Keyword: SUPPORTS THE DIAGNOSIS. Rationale: lab findings for clients with SLE usually show:
•    Pancytopenia
•    Elevated ANA titer
•    Decreased serum complement levels

24.    Answer C. Keyword: AVOID. Rationale: a low-bacteria diet would be indicated. Raw fruits and vegetables are excluded in the client’s diet.

25.    Answer C. Keyword: AVERAGE LENGTH OF TIME. Rationale: epidemiologic studies show the average time from initial contact with HIV to the development of AIDS is 10 years.

by: Daisy Jane, RN

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