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UT Arlington NURS 5315 - Chapter 31 Exam

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Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 31: Alterations of Hematologic Function in ChildrenMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. What is the cause of polycythemia in the fetus?a. Fetal hemoglobin has a greater affinity for oxygen as a result of diphosphoglycerate (DPG).b. The fetus has a different hemoglobin structure of two α- and two γ-chains rather than two α-and two β-chains.c. Increased erythropoiesis occurs in response to the hypoxic intrauterine environment.d. The lungs of the fetus are undeveloped and unable to diffuse oxygen adequately to the pulmonary capillaries.ANS: CThe hypoxic intrauterine environment stimulates erythropoietin production in the fetus. Fetal polycythemia is not the result of hemoglobin having greater affinity for oxygen, different hemoglobin structure, or undeveloped lungs.PTS: 1 DIF: Cognitive Level: Remembering 2. Why does fetal hemoglobin have a greater affinity for oxygen than adult hemoglobin?a. The fetus does not have its own oxygen supply and must rely on oxygen from the maternal vascular system.b. The fetus has two γ-chains on the hemoglobin, rather than two β-chains as in the adult.c. Fetal hemoglobin interacts less readily with diphosphoglycerate (DPG), which inhibits hemoglobin-oxygen binding.d. Fetal hemoglobin production occurs in the vessels and liver rather than in the bone marrow as in the adult.ANS: CFetal hemoglobin has greater affinity for oxygen than adult hemoglobin does because it interacts less readily with the enzyme, DPG, which inhibits hemoglobin–oxygen binding. The lack of independent oxygen supply, the type of chains on the hemoglobin, and the location of hemoglobin production do not impact fetal hemoglobin’s ability to bind more readily to oxygen than do adult hemoglobin.PTS: 1 DIF: Cognitive Level: Remembering 3. Which blood cell type is elevated at birth and through the preschool years, but decreases to adult levels afterward?a. Monocytesb. Plateletsc. Neutrophilsd. LymphocytesANS: AOnly monocyte counts are high in the newborn and through the preschool years. After this time period, they decrease to adult levels.PTS: 1 DIF: Cognitive Level: Remembering 4. In a full-term infant, the normal erythrocyte life span is _____ days.a. 30 to 50b. 60 to 80c. 90 to 110d. 120 to 130ANS: BIn full-term infants, normal erythrocyte life span is 60 to 80 days.PTS: 1 DIF: Cognitive Level: Remembering 5. What is the most common cause of insufficient erythropoiesis in children?a. Folic acid deficiencyb. Iron deficiencyc. Hemoglobin abnormalityd. Erythrocyte abnormalityANS: BSimilar to the anemias of adulthood, ineffective erythropoiesis or premature destruction of erythrocytes causes the anemias of childhood. The most common cause of insufficient erythropoiesis is iron deficiency. The other options may be causes but are not common ones.PTS: 1 DIF: Cognitive Level: RememberingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 6. How does hemolytic disease of the fetus and newborn (HDFN) cause acquired congenital hemolytic anemia?a. HDFN develops when hypoxia or dehydration causes the erythrocytes to change shapes, which are then recognized as foreign and removed from circulation.b. HDFN is an alloimmune disease in which the mother’s immune system produces antibodies against fetal erythrocytes, which are recognized as foreign and removed from circulation.c. HDFN develops when the polycythemia present in fetal life continues after birth, causing the excessive number of erythrocytes to be removed from circulation.d. HDFN is an autoimmune disease in which the fetus’s immune system produces antibodies against fetal erythrocytes, which are recognized as foreign and removed from circulation.ANS: BHDFN is an alloimmune disease in which maternal blood and fetal blood are antigenically incompatible, causing the mother’s immune system to produce antibodies against fetal erythrocytes. Fetal erythrocytes that have been attacked by (or bound to) maternal antibodies are recognized as foreign or defective by the fetal mononuclear phagocyte system and are removed from the circulation by phagocytosis, usually in the fetal spleen. The other statements do not correctly explain this pathology.PTS: 1 DIF: Cognitive Level: Remembering 7. How is erythroblastosis fetalis defined?a. Allergic disease in which maternal blood and fetal blood are antigenically incompatibleb. Alloimmune disease in which maternal blood and fetal blood are antigenically incompatiblec. Autoimmune disease in immature nucleated cells that are released into the bloodstreamd. Autosomal dominant hereditary diseaseANS: BErythroblastosis fetalis, also known as hemolytic disease of the fetus and newborn (HDFN), is an alloimmune disease in which maternal blood and fetal blood are antigenically incompatible, causing the mother’s immune system to produce antibodies against fetal erythrocytes. This selection is the only option that accurately defines erythroblastosis fetalis.PTS: 1 DIF: Cognitive Level: Remembering 8. A newborn displays pallor, tachycardia, and has a systolic murmur. What hemoglobin value does the healthcare professional correlate with these manifestations?a. 11 g/dLb. 9 g/dLc. 7 g/dLd. 5 g/dLANS: DWhen the hemoglobin falls below 5 g/dL, pallor, tachycardia, and systolic murmurs may occur.PTS: 1 DIF: Cognitive Level: Understanding 9. A child has iron deficiency anemia. In addition to iron supplements, what else does the healthcare professional educate the parents on giving the child?a. Vitamin Ab. Magnesiumc. Vitamin Cd. ZincANS: CVitamin C helps with absorption of iron, so the healthcare professional instructs the parents about giving it to the child with iron deficiency anemia. Vitamin A, magnesium, and zinc do not help promote the absorption of iron.PTS: 1 DIF: Cognitive Level: Understanding 10. Which mother does the healthcare professional prepare to administer Rh immune globulin (Rho-GAM) to?a. Is Rh-positive and the fetus is Rh-negativeb. Is Rh-negative and the fetus is Rh-positivec. Has type A blood and the fetus has type Od. Has type AB blood and the fetus has type BANS: BHemolytic disease of the fetus and newborn (HDFN) can occur only if antigens on fetal erythrocytes differ from antigens on maternal erythrocytes. Maternal–fetal incompatibility exists only if the mother and fetus differ in ABO blood type or if the fetus


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