Pathophysiology 6th Edition Banasik Test Bank

Chapter 13: Alterations in Oxygen Transport Banasik:

Pathophysiology, 6th Edition

MULTIPLE CHOICE

1. The primary source of erythropoietin is provided by the

a. bone marrow.
b. kidney.
c. lung.
d. liver.

ANS: B
Erythropoietin is a hormone that is secreted into the bloodstream by the kidney. Bone
marrow is not responsible for the production of erythropoietin. Hypoxia from low
hemoglobin levels causes a decrease in tissue oxygen tension in the kidney, thereby
releasing the hormone erythropoietin. The liver is not associated with erythropoietin
production.

2. Which condition is associated with an elevated reticulocyte count?

a. Renal disease
b. Aplastic anemia
c. Hypertension
d. Hemolytic anemia

ANS: D
Hemolytic anemia is associated with an increased number of circulating reticulocytes or
reticulocytosis. Anemia of chronic renal failure is not associated with reticulocytosis.
Legendessays.com Rather, it occurs from failure of the renal endocrine
function. Aplastic anemia is a stem cell disorder that is characterized by pancytopenia, a
decrease in red cells, white cells, and platelets. Hypertension is not related to reticulocytosis.

3. The strength of the bond between oxygen and hemoglobin is known as the a. Bohr effect.
b. oxygen-hemoglobin affinity.
c. dissociation curve.
d. hemoglobin synthesis.

ANS: B
The strength of the bond between oxygen and hemoglobin is called the oxygen-hemoglobin
affinity. Hemoglobin saturation is higher when oxygen infinity is increased, and saturation

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is lower when affinity is decreased. The Bohr effect occurs when the oxyhemoglobin
dissociation curve experiences a shift resulting from changes in PCO2 and H+ concentration.
The dissociation curve describes the relationship between the partial pressure of oxygen and
hemoglobin saturation. Hemoglobin synthesis occurs in the immature red cell.

4. An increase in hemoglobin affinity for oxygen occurs with

a. hyperthermia.
b. shift to the right.
c. elevated PCO2.
d. shift to the left.

ANS: D
An increase in oxygen affinity is known as a shift to the left on the dissociation curve.
Hyperthermia does not have an effect on the hemoglobin affinity. Elevation in PCO2 is seen
with changes in pH. A decrease in the oxygen affinity is associated with a shift to the right
on the oxyhemoglobin dissociation curve.

5. What is necessary for red blood cell production?

a. Phosphate
b. Iron
c. Magnesium
d. Calcium

ANS: B
Immature red blood cells produce hemoglobin, which is composed of two pairs of
polypeptide chains, the globins. Each globin has an attached heme molecule that contains
iron. Dietary iron is transported through the plasma on the RBC membrane. Phosphates are
not a necessary component of red blood cell production. Magnesium is not a part of the
production of red blood cells. Calcium is not involved in red blood cell production.

6. Red blood cells differ from other cell types in the body, because they
a. contain cytoplasmic proteins.
b. have no cytoplasmic organelles.
c. have a longer life span.
d. contain glycolytic enzymes.

ANS: B LEGENDESSAYS.COM
Red blood cells have no cytoplasmic organelles, nucleus, mitochondria, or ribosomes.
Therefore, RBCs cannot synthesize protein or carry out oxidative reactions. Red blood cells
are not capable of synthesizing protein because of their lack of organelles. Red blood cells

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live for 80 to 120 days in the circulation and then die and are replaced. Red blood cells do
not contain glycolytic enzymes.

7. Which characteristic is indicative of hemolytic anemia?

a. Increased total iron-binding capacity
b. Increased heart rate
c. Hypovolemia
d. Jaundice

ANS: D
Jaundice is a classic clinical manifestation of hemolytic anemia. The total iron-binding
capacity in hemolytic anemia is not increased. Hemolytic anemia is not generally associated
with an increased heart rate unless there is aplastic crisis associated with infection.
Hypovolemia is not an indication of hemolytic anemia.

8. A low mean corpuscular hemoglobin concentration (MCHC) and mean corpuscular volume
(MCV) are characteristic of which type of anemia? a. Vitamin B12 deficiency
b. Folate deficiency
c. Iron deficiency
d. Erythropoietin deficiency

ANS: C
Iron-deficiency anemia is characterized by a low hemoglobin concentration and low mean
corpuscular volume. Vitamin B12 deficiency anemia is characterized by a high concentration
of MCV and a normal level of MCHC. Folate deficiency anemia is characterized by a
normal mean corpuscular hemoglobin concentration and a high mean corpuscular volume.
Erythropoietin deficiency creates hypoxia from a low hemoglobin level.

9. The arterial oxygen content (CaO2) for a patient with PaO2 100 mm Hg, SaO2 95%, and
hemoglobin 15 g/dL is _____ mL oxygen/dL. a. 19.4
b. 1909.8
c. 210
d. 21.05

ANS: A
A hemoglobin level of 15 divided by 100 equals 0.15. Multiply by 1.34 mL and then
multiply by saturation on 95%. The result is 19.1% oxyhemoglobin. Then add 0.3% volume
dissolved in plasma to get the total content of oxygen/dL. The arterial blood oxygen content
is the amount of oxygen carried in the arterial blood. 1909.8 is an incorrect answer if the
formula is followed correctly. 210 is incorrect when the formula is applied correctly. 21.05
is an incorrect response if the formula is applied correctly.

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10. Most carbon dioxide is transported in the bloodstream as

a. carboxyhemoglobin.
b. bicarbonate ion.

c. dissolved carbon dioxide.NU

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d. carbonic acid.

ANS: B
Approximately 90% of the CO2 in the arterial blood and 60% of the CO2 in the venous
blood are transported as bicarbonate. Carbon dioxide is not transported as
carboxyhemoglobin. Some of the remaining carbon dioxide binds with protein to form
carbaminohemoglobin for CO2 transport, but dissolved carbon dioxide is not the primary
means of bloodstream transportation. Carbonic acid is disassociated into hydrogen and
bicarbonate ions for elimination by the lungs and kidneys.

11. The most appropriate treatment for secondary polycythemia is

a. volume expansion with saline.
b. measured to improve oxygenation.
c. phlebotomy.
d. chemotherapy.

ANS: B
Secondary polycythemia is because of chronic hypoxemia with a resultant increase in
erythropoietin production. The goal of treatment is aimed at measures to reduce hypoxemia
and improve oxygenation by implementing oxygen therapy. IV fluids may be used to treat
relative polycythemia, because it is related to dehydration. Phlebotomy or increases in
laboratory studies do not have an effect on secondary polycythemia. Polycythemia is not
treated with chemotherapeutic agents.

12. A laboratory test finding helpful in confirming the diagnosis of iron-deficiency anemia is
a. elevated total iron-binding capacity.
b. elevated MCHC and MCV.
c. elevated total and indirect bilirubin.
d. positive direct or indirect Coombs test.

ANS: A
In iron-deficiency anemia, the total iron-binding capacity is elevated. The red cell indices of
MCHC and MCV are decreased in iron-deficiency anemia. Total and indirect bilirubin
levels are not utilized in diagnosing iron-deficiency anemia. Coombs testing is not utilized
in obtaining a diagnosis of iron-deficiency anemia.

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13. Excessive red cell lysis can be detected by measuring the serum
a. hemoglobin.
b. methemoglobin.
c. bilirubin.
d. erythropoietin.

ANS: C
Any condition causing increased red cell destruction increases the total load of bilirubin to
be cleared, which leads to increased serum bilirubin levels and possible jaundice. Red cell
destruction does not lead to changes in the hemoglobin level. Methemoglobin is formed
when iron of the hemoglobin molecule is oxidized to the ferric state. Erythropoietin is
secreted in response to hypoxia.

14. Red blood cells obtain nearly all their energy from metabolism of
a. glucose. LEGENDESSAYS.COM
b. fats.
c. proteins.
d. acetyl coenzyme A.

ANS: A
For RBCs to survive and perform efficiently, they must have a source of energy. Essential
for red blood cell viability is the glucose that is used for metabolism. RBC membrane
structures are formed from double layer of phospholipids. Fats do not provide energy to red
blood cells. A protein network on the surface of the membrane is important for cell
structure, but does not provide energy for red blood cell production and maintenance. Acetyl
coenzyme A is not a factor in providing energy to the red blood cells.

15. What laboratory finding is usually found in aplastic anemia?

a. Leukocytosis
b. Thrombocythemia
c. Neutrophilia
d. Pancytopenia

ANS: D
Aplastic anemia is a stem cell disorder affecting the bone marrow mass. It is usually caused
by toxic, radiant, or immunologic injury to the bone marrow stem cells, which causes a
decrease in red cells, white cells, and platelets, or pancytopenia. Thrombocythemia causes
an increased number of platelets and is not found in aplastic anemia. Leukocytosis indicates

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a higher white blood count and is not found in aplastic anemia. The presence of neutrophils
in laboratory findings does not indicate a diagnosis of aplastic anemia.

16. The most effective therapy for anemia associated with kidney failure is
a. iron administration.
b. high-protein diet.
c. erythropoietin administration.
d. vitamin B12 and folate administration.

ANS: C
Therapy in anemia of chronic renal failure consists of dialysis and erythropoietin
administration. The use of erythropoietin stimulating agents is to increase hemoglobin
values to ensure adequate oxygen-carrying capacity. Iron, folate, and vitamin B12
replacement are initiated if necessary. Iron administration is utilized in iron-deficiency
anemia. A high-protein diet is not the treatment of choice in the patient with renal failure,
and a high-protein diet may be contraindicated. Vitamin B12 and folate are prone to
nutritional anemias and receive replacement to adequate levels if necessary. However,
dialysis and erythropoietin are more effective.

17. Pernicious anemia is caused by a lack of

a. iron.
b. intrinsic factor.
c. folate. LEGENDESSAYS.COM
d. erythropoietin.

ANS: B
The fundamental defect causing pernicious anemia is the lack of intrinsic factor. Without it,
vitamin B12 cannot be absorbed. Iron deficiency does not lead to pernicious anemia. Rather,
it is the most common cause of anemia and is the result of unavailability of iron for
hemoglobin synthesis. Pernicious anemia and folate deficiency are similar in etiology. Both
are caused by a disruption in DNA synthesis of blast cells in bone marrow. Erythropoietin is
necessary for the production of red cells.

18. The cause of the most common form of anemia is

a. acute bleeding.
b. iron deficiency.
c. protein malnutrition.
d. chronic disease.

ANS: B

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Iron deficiency is the most common nutritional deficiency in the world and the most
common cause of anemia. Acute blood loss anemia is the result of trauma or disease
processes and is highly treatable. Plasma proteins formed in the liver are an essential factor
in regulating blood volume. It is important to determine the underlying cause of the anemia
so that treatment and control are effective.

19. Thalassemia may be confused with iron-deficiency anemia, because they are both a.
hyperchromic.
b. microcytic.
c. genetic.
d. responsive to iron therapy.

ANS: B
Both thalassemia and iron-deficiency anemia reveal hypochromic, microcytic red cells.
Thalassemia and iron-deficiency red cells are hypochromic. Genetics play a role in
thalassemia, and are found primarily in Asian individuals. Iron-deficiency anemia is
responsive to iron therapy, but thalassemia patients have increased iron absorption.

20. Patients who experience anemic episodes when exposed to certain drugs most likely have a.
thalassemia.
b. spherocytosis.
c. sickle cell anemia.
d. glucose-6-phosphate dehydrogenase deficiency.

ANS: D
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a RBC intracellular defect.
Usually this anemia is first recognized during or after an infectious illness or exposure to
certain drugs. Thalassemia does not carry a manifestation associated with pharmacologic
agents. Spherocytosis is a hereditary anemia with manifestations of jaundice. Episodes of
sickle cell anemia are associated with recurrent painful episodes related to organ
dysfunction.

MULTIPLE RESPONSE LEGENDESSAYS.COM

1. A patient is diagnosed with aplastic anemia. The nurse expects to find what patient symptoms
upon assessment? (Select all that apply.) a. Lethargy
b. Heart palpitations
c. Transient murmurs
d. Bradycardia
e. Orthopnea

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ANS: A, B, C
The symptoms of aplastic anemia are because of the gradual fall of red blood cells and
include weakness, fatigue, lethargy, pallor, dyspnea, palpitations, onset of transient
murmurs, and the tachycardia of anemia. Bradycardia is not a common symptom of aplastic
anemia. Orthopnea is not a common symptom of aplastic anemia.

2. The nurse is educating a patient diagnosed with anemia of chronic renal failure about the
disease. Which statements made by the nurse are correct regarding the patient’s treatment?
(Select all that apply.)
a. “Since your glomerular filtration is 13 mL/min, you’ll be started on dialysis.”
b. “Your hematocrit is 29%, so you’re going to start on erythropoietin therapy.”
c. “Your hemoglobin is 9 g/dL, so you’ll need erythropoietin therapy.”
d. “We need to get your hemoglobin up to at least 15 g/dL”
e. “You’re going to need iron, folate, and B12 therapy to help improve your blood
counts.”

ANS: A, B, C, E
Therapy for anemia of chronic renal failure consists of dialysis when the glomerular
filtration rate is less than 15 mL/min, and erythropoietin is administered to achieve the
target hematocrit of 33% to 36% and hemoglobin of 11 to 12 g/dL. Patient replacement of
iron, folate, and B12 to adequate levels is also recommended. Using erythropoiesis-
stimulating agents to increase hemoglobin values to greater than 12 g/dL is not routinely
recommended.

3. Anemia related to vitamin B12 or folate deficiency is characterized by what laboratory features?
(Select all that apply.)
a. RBC counts of 775,000 to 900,000 cells/mm3
b. RBC counts of 500,000 to 750,000 cells/mm3
c. WBC counts of 3000 to 4000 cells/mm3
d. WBC counts of 4000 to 5000 cells/mm3
e. Platelet counts of 60,000 cells/mm3

ANS: B, D
Anemia related to vitamin B12 or folate deficiency is characterized by low RBC counts of
500,000 to 750,000 cells/mm3. Anemia related to vitamin B12 or folate deficiency is
characterized by low WBC counts of 4000 to 5000 cells/mm3. Anemia related to vitamin
B12 or folate deficiency is characterized by low RBC counts of 500,000 to 750,000, not
775,000 to 900,000 cells/mm3. Anemia related to vitamin B12 or folate deficiency is
characterized by low WBC counts of 4000 to 5000 cells/mm3, not 3000 to 4000 cells/mm3.
Anemia related to vitamin B12 or folate deficiency is characterized by low platelet counts of
50,000 cells/mm3.

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LEGENDESSAYS.COM
4. Regarding iron-deficiency anemia, what laboratory features are typically decreased? (Select all
that apply.)
a. MCV
b. MCH
c. MCHC
d. WBC
e. Thrombocytes

ANS: A, B, C
In iron-deficiency anemia, the red cells are smaller and paler than normal cells as a result of
the decreased amount of hemoglobin and are described as hypochromic, microcytic red
cells. The red cell indices MCV, MCH, and MCHC are decreased. White cell counts in iron-
deficiency anemia are usually normal. Thrombocyte counts in iron-deficiency anemia are
usually normal.

5. One of the cardinal features of sickle cell anemia includes acute and chronic dysfunction of
which organs? (Select all that apply.) a. Spleen
b. Bones
c. Brain
d. Lungs
e. Stomach

ANS: A, B, C, D
Acute and chronic organ dysfunction of the spleen, bones, brain, kidneys, lungs, skin, and
heart are found in sickle cell anemia. Dysfunction of the stomach is not found in sickle cell
anemia.

6. A newborn patient is diagnosed with hemolytic disease. The nurse may expect to find what
signs and symptoms? (Select all that apply.) a. Petechial hemorrhages
b. Hepatomegaly
c. Splenomegaly
d. Kernicterus
e. Erythema

ANS: A, B, C, D
The clinical manifestations of hemolytic disease in the newborn are jaundice, petechial
hemorrhages, hepatomegaly, splenomegaly, heart failure, kernicterus, and diffuse
intervascular coagulation. Jaundice, not erythema, is found in the newborn diagnosed with
hemolytic disease.

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7. Hapten mechanisms are found in which medications? (Select all that apply.) a. Ibuprofen
b. Narcotics
c. Penicillin
d. Cephalosporins
e. Tetracycline

ANS: C, D, E
In the hapten mechanism, which is seen with penicillin, cephalosporins, and tetracycline, the
LEGENDESSAYS.COM drug combines with a component of the RBC membrane
and an antibody is developed against the drug. Hapten mechanism is not seen in ibuprofen
or narcotics.
TRUE/FALSE

1. The anemia resulting from a deficiency of either vitamin B12 (cobalamin) or folate is caused by a
disruption in DNA synthesis of the blast cells in the bone marrow that produces very large
abnormal bone marrow cells called megaloblasts.

ANS: T
Megaloblasts are large abnormal bone marrow cells.

2. Vaccination for pneumococcal pneumonia should be performed before 1 year of age in patients
with sickle cell anemia.

ANS: F
Vaccination for pneumococcal pneumonia should be performed before 2 years of age in
patients with sickle cell anemia and booster vaccinations given 3 to 5 years later.

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