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TEST BANK FOR RODAK'S HEMATOLOGY 6TH EDITION BY WALENGA Download Full Test bank from link Below Nursylab 1# Nursing Materials Seller of 2021
1. Chapter 01-01 Hematology is the study of: *a. blood cells. b. serum electrolytes. c. plasma hormone levels. d. bacteria in the blood. General Feedback: Hematology is the study of blood cells—red blood cells, white blood cells, and platelets. Plasma and serum electrolytes and hormone levels are evaluated in various subdivisions of clinical chemistry, and bacteria are evaluated in clinical microbiology.
2. Chapter 01-02 The morphology of blood cells is important to evaluate: a. every time a complete blood count (CBC) is requested on a patient. b. when an instrument-generated flag is obtained. *c. when a profiling instrument result is abnormal. d. when the white count is elevated. General Feedback: Every laboratory must determine—based on its instrumentation, needs of the clinician and other parameter flags that alert the medical laboratory scientist to the necessity for further evaluation—when it is URSINGTBMany .COMinstrument-generated flags, necessary to evaluate cell N morphology. although useful, may not require review. If an automated CBC does not suggest the need, no reason exists to evaluate the blood film, even if the white count is elevated.
3. Chapter 01-03 Who is ultimately responsible for determining the specimen integrity before analysis? *a. Medical laboratory professional b. Nursing staff c. Phlebotomist d. Specimen-processing personnel General Feedback: The medical laboratory scientist is responsible for ensuring the integrity of a specimen before analysis. Only he or she can judge whether the specimen is acceptable so that valid results can be obtained. Acceptable criteria include such things as type of specimen for the test ordered (e.g., blood, serum, urine); appropriate additive present (if needed) and amount of specimen relative to the additive; time interval since obtained; and presence or absence of hemolysis, lipemia, and other similar conditions. None of the other personnel named have the education and understanding to fully make that judgment.
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4. Chapter 01-04 Hematocrit is also called: a. white cell count. b. bone marrow examination. c. red blood cell (RBC) count. *d. packed red cell volume. General Feedback: Historically the hematocrit was determined by centrifuging an aliquot of anticoagulated whole blood under specified conditions (e.g., centrifugal force, capillary tube length, and bore diameter) and then determining the ratio of the space occupied by the packed red cells compared with that of the entire blood volume in the capillary tube, often expressed as a percentage. Hence, it is also called the packed red cell volume.
5. Chapter 01-05 The primary function of platelets is to: a. defend the body against bacterial invasion. b. carry oxygen to tissues. *c. facilitate blood clotting. d. regulate acid-base balance. General Feedback: Whenever disruption occurs to a blood vessel so that bleeding URSINGTtoB.stop COMthe bleeding in small results, platelets respond N initially vessels; they also play an integral role in facilitating the formation of a blood clot. White cells defend against bacterial invasion; red cells (i.e., hemoglobin) carry oxygen to tissues; and a complex interaction of plasma electrolytes, proteins, and carbon dioxide participates in acid-base balance.
6. Chapter 01-06 Which of the following can be evaluated only through the microscopic examination of a stained blood film? a. White blood cell (WBC) count b. Reticulocyte count c. Hemoglobin concentration *d. Presence or absence of cytoplasmic inclusions General Feedback: Making and staining a blood film and then placing it under a microscope allow the medical laboratory scientist to evaluate the morphology of blood cells and examine them for the presence or absence of blood cell inclusions. These inclusions are important for cell identification and, when abnormal inclusions are present, sometimes provide “clues” as to the cause of disease. All the other parameters mentioned are or can be performed using an automated hematology instrument, including reticulocyte counting.
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7. Chapter 01-07 Upon centrifugation of a blood specimen, the layer between the red blood cells and plasma is called the: a. hematocrit. *b. buffy coat. c. serum. d. platelet pellet. General Feedback: When blood is centrifuged, the layer between the red cells and plasma is called the buffy coat. This layer consists of both white blood cells and platelets. The hematocrit is the packed cell volume that reflects the number of red blood cells. The serum is the liquid portion of the blood formed from a clotted blood sample. The platelet pellet is a special layer of platelets that is required for platelet function studies. This layer of platelets is prepared from a whole blood specimen using specific centrifugation time and speed.
8. Chapter 01-08 Select the term that describes a low white blood cell count. *a. Leukopenia b. Leukocytosis c. Neutropenia d. Leukemia
NURSINGTB.COM General Feedback: The term leukopenia refers to a low total white blood cell count. Leukocytosis is a term that describes an increase in white blood cell count. Neutropenia is a low cell count that is specific to the neutrophils. Leukemia is cancer of the blood cells, most often white blood cells.
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2. Chapter 02-02 A patient’s white blood cells (WBCs) are counted on an automated cell counter 10 times. The mean white count is 8000/mL, and the standard deviation (SD) is 300. What is the coefficient of variation (CV)? a. 0.04% b. 2.6% *c. 3.8% d. 26% General Feedback: % CV = (SD/mean) × 100 = (300/8000) × 100 = 3.8%.
3. Chapter 02-03 What does the CV calculated in Question 2 describe about the white cell counts? a. Accuracy b. Reliability c. Proper calibration *d. Precision General Feedback: The CV is a measure of precision, or how well a result can be reproduced. It allows comparisons of assays with different means and is a unitless number, although usually expressed as a percentage. Accuracy is how close a result is to the true value; proper calibration is NUReliability RSINGTB.C required to obtain accuracy. isOM how well a method holds both accuracy and precision over time.
4. Chapter 02-04 A patient specimen is analyzed on an instrument known to be in control from previous assays performed on a calibrated instrument and gives a hemoglobin result of 13.2 g/dL. Two hours later it is evaluated on another instrument that is being evaluated for purchase by the laboratory. The result is 11.8 g/dL. This result, when compared with the first, is: a. acceptable agreement. b. reportable. c. precise agreement. *d. inaccurate. General Feedback: This result is inaccurate compared with the first because it is significantly different. Precision is not known, because multiple results are needed to determine precision; in addition, precision must be determined using the same instrument, not between instruments. Because it is not accurate, it cannot be reported.
5. Chapter 02-05 Which is true regarding reference ranges?
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a. Should be derived from reference books b. Need to be determined only for adults c. Can be established by running the test procedure on 10 healthy people *d. Are ranges of values for an analyte in normal healthy people General Feedback: Reference ranges should be determined by evaluating a group of perhaps as many as 120 normal healthy people for the same analyte. If the analyte differs in different groups, based on data such as age and sex, it must be determined for each group if at all possible.
6. Chapter 02-06 A test that is positive in all patients who have the disease but also in some who do not have the disease is: *a. sensitive. b. specific. c. precise. d. reliable. General Feedback: Sensitivity (diagnostic) is defined by the number of people with the disease who test positive. In this case, all patients with the disease have a positive result, so the test is very sensitive. The test, however, is not specific because it is also positive in some people who do not have the disease. Reliability refers to the URSover INGTtime. B.COPrecision M performance stability of a N test evaluates reproducibility of the result if repeated multiple times on a specimen.
7. Chapter 02-07 The antinuclear antibody (ANA) test is positive in almost all people who have systemic lupus erythematosus (SLE). It is also positive in some patients who do not have SLE. The antideoxyribonucleic acid (antiDNA) test is positive only in people with SLE but not in all who do. Which of the following is true? *a. The ANA test is a good screening test, and anti-DNA test is a good confirmatory test. b. The anti-DNA test is a good screening test, and the ANA test is a good confirmatory test. c. Both are good screening tests for SLE. d. Neither of these tests is valid. General Feedback: Because almost all patients with SLE have a positive ANA test, it is a good screening test (if the result is negative, it practically rules out this diagnosis for a patient). However, because the ANA test is also positive in other patients, the anti-DNA test is a good confirmatory test, because only patients with SLE have a positive result. In practice, the ANA test is done first; if it is positive, then the anti-DNA test is done as follow-up. If a patient is positive with both tests, then his or her diagnosis is SLE.
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8. Chapter 02-08 A purchased hemoglobin standard is used to adjust a hemoglobinometer. This standard is being used as a: a. control. b. precision check. c. delta check. *d. calibrator. General Feedback: Standards are used to calibrate instruments. Controls are used to routinely evaluate the accuracy of a method once it is calibrated. Precision is a measure of reproducibility, whereas delta checks compare a patient result with a previous result (same test on the same patient). This can only be done for a test result that essentially does not vary significantly from testing time to testing time.
9. Chapter 02-09 The tubing that brings the lyse reagent to the hemoglobin cuvette on an automated cell counter is pinched and not delivering any reagent. All hemoglobin values are greater than 20 g/dL. This represents what type of error? a. Random b. Imprecision *c. Constant systematic NURSINGTB.COM d. Proportional systematic General Feedback: A constant systematic error is one in which the magnitude of the error remains the same throughout the range of the test measurement. The error is proportional if the magnitude varies relative to the result. This is not a random error, which happens only infrequently and is not predictable. Precision requires multiple measurements of the same specimen and evaluates the ability to consistently reproduce the result.
10. Chapter 02-10 One of two controls that have been evaluated over the last 28 days gives a result on day 29 between 2 and 3 SDs of the mean; the other control is within 2 SDs of its mean. What is the correct procedure to follow? a. Ignore the result unless it happens again the next day. *b. Rerun the control and, if acceptable, continue with patients. c. Recalibrate the instrument. d. Open new vials of controls and repeat both controls. General Feedback: One control is acceptable, whereas the other is a warning that the method may be going out of control. The test option in this case is to repeat the analysis of the control, and if it is acceptable, continue with patient analysis, reporting the results. The instrument
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does not appear to need recalibration because one control is acceptable and the other is within 3 SDs (1 result of 20 can acceptably be within ±3 SDs). If the repeat on the “out of control” vial is still out between 2 and 3 SDs, then a new vial of that control should be opened and analyzed. The control that was acceptable does need to be repeated.
11. Chapter 02-11 The control values for both controls for the prothrombin test were ranging between the mean and ±1 SD for the first 19 days of use. Starting on day 20, the values for both were consistently between +1 and +2 SDs. This is an example of a: *a. shift. b. trend. c. random error. d. predictable error. General Feedback: If all results are consistently different from the previous in the same direction, it indicates a shift in the methodology has occurred. A trend would show a gradual change over time. This is neither a predictable error nor a random error because it is consistent.
12. Chapter 02-12 Which would most likely be associated with the situation described in NURSINGTB.COM Question 11? a. Operator error b. Fading light source c. Miscalibrated instrument *d. Starting a new lot number of thromboplastin reagent General Feedback: Shifts can occur when a new reagent is introduced. A fading light source would lead to trend error. If the instrument were calibrated incorrectly, both controls should be out; likewise, operator error would result in both controls being unacceptable.
13. Chapter 02-13 Which group of patients should not be included in establishing moving averages using red cell indices? *a. Chemotherapy patients b. Female patients c. Obstetric patients d. Surgical patients General Feedback: The moving average method works well in institutions that assay specimens from generalized populations that contain minimal numbers of sickle cell or oncology patients. This method is not restricted in female, obstetric, or surgical patients.
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14. Chapter 02-14 A laboratory comparing its results to those of other laboratories on the same specimen is an example of: a. precision monitoring. b. internal quality assessment. *c. external quality assessment. d. delta checks. General Feedback: When results are compared with those of another laboratory, this is part of external quality assessment. Internal quality assessment is done totally within one laboratory. Delta checks compare a patient result with a previous result on the same patient. Precision is determined by multiple analysis of the same specimen.
15. Chapter 02-15 The best way to prevent errors in the laboratory is to: a. purchase high-quality instruments from reputable vendors. *b. hire professionals with integrity. c. have quality management. d. perform external quality control procedures. General Feedback: NURSINGTB.COM Competent professional staff that act with integrity can ensure that the best-quality results are routinely obtained for patients. A high-quality instrument is effective only when it is correctly calibrated and maintained. Management, although ultimately responsible, relies on the laboratory personnel to be aware of potential problems in assays. External quality control programs do not guarantee the daily validity of patient results.
16. Chapter 02-16 A laboratory gets numerous complaints regarding the length of time it takes hematology results to get to the emergency department. What would be an appropriate response? *a. Make this a quality assurance project. b. Ignore the complaints. c. Explain why it takes so long. d. Tell the employees to work faster. General Feedback: Quality assurance evaluates the process from the time a test is ordered until it is reported to the correct patient chart. One of the responsibilities of a clinical laboratory is to get results to physicians and other caretakers in a timely manner; the acceptable turnaround time for a particular procedure will vary depending on the reason it is ordered. Obviously, an emergency department has a need for rapid turnaround time. Complaints from caregivers should never be ignored; it probably is not reasonable to tell employees to work
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faster, and explaining why it takes so long will not help provide good patient care.
17. Chapter 02-17 The precision limits of a method are defined by: a. the mean. *b. the SD. c. sensitivity. d. specificity. General Feedback: Evaluating the same specimen multiple times and applying statistics to the results determine precision or reproducibility. The SD describes the precision. The mean is the average result (assuming a gaussian distribution). Sensitivity describes how well a test identifies positive patients, whereas specificity is how well it identifies only positive patients.
18. Chapter 02-18 A clinical laboratory scientist performs 30 replicate hemoglobin determinations on a single blood sample. When statistics are used to determine the precision of the method, the mean is 13.8 g/dL and 1 SD is 0.1 g/dL. This means that 95.5% of the results on this specimen lie: a. between 13.4 and 14.2 g/dL. NURSINGTB.COM *b. between 13.6 and 14.0 g/dL. c. between 13.5 and 14.1 g/dL. d. between 13.7 and 13.9 g/dL. General Feedback: Because 1 SD is 0.1 g/dL, 2 SD = 0.2 g/dL. Thus 95.5% of the results lie between 13.6 (±2 SDs) and 14.0 (+2 SDs).
19. Chapter 02-19 The following hemoglobin results, reported in g/dL, are obtained on a hospitalized patient on 3 consecutive days: Day 1 Day 2 Day 3 14.3 11.5 14.4
The SD for this hemoglobin method was calculated in Question 18. A delta check was obtained on day 2. Controls were run as appropriate each day and were all within limits for this procedure. What is the most probable reason for the day 2 result when compared with those for days 1 and 3? a. It is within the 95.5% confidence levels for this test. *b. It may represent an error in patient identification. c. The patient had a major blood loss between days 1 and 2. d. It is within the 99% confidence levels for this test.
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General Feedback: The results for days 1 and 3 are statistically the same result (i.e., they are within the 95.5% confidence levels for this procedure and are therefore precise). The result for day 2 is clearly very significantly different, thus giving a delta check (the only possible explanation of those given here is that a patient identification error occurred and the specimen on day 2 is from a different patient). Delta checks are designed to help pick up this kind of critical error. If it had been within the 99% confidence limits, it would have been within 3 SDs, or no less than 14.0 g/dL. Because the results from day 1 and day 3 are the same, blood loss with a drop in hemoglobin cannot explain the day 2 results.
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1. Chapter 03-01 What component of the erythrocyte is most responsible for its cytoskeleton and cellular integrity? a. Glycocalyx *b. Cytoskeletal protein c. Nucleus d. Golgi apparatus General Feedback: Cytoskeletal proteins are found on the inner cytoplasmic side of the membrane and form the lattice of the cytoskeleton.
2. Chapter 03-02 What cellular component of the erythrocyte is its control center? a. Heterochromatin b. Golgi apparatus *c. Nucleus d. Cytoplasm General Feedback: The nucleus is the control center of the cell, is responsible for all its chemical reactions, and is the site of deoxyribonucleic acid (DNA) replication and transcription.
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3. Chapter 03-03 How does the genetically active portion of the nuclear chromatin look when stained with Wright stain? a. Condensed, darkly stained b. Clumped, dark purple c. Ropelike, pink or red *d. Diffuse, uncondensed and pale blue General Feedback: The genetically active portion of the nuclear chromatin, composed of DNA plus supporting proteins, appears diffuse and uncondensed and stains pale blue with Wright stain. It is also called euchromatin. Chromatin, which is condensed and stains darkly, is also called heterochromatin; it is the genetically inactive portion of the nucleus.
4. Chapter 03-04 What cellular component “directs traffic” for smooth functioning? a. Mitochondria b. Ribosomes *c. Golgi apparatus d. Nucleoli General Feedback:
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The Golgi apparatus directs traffic in the cell, where it is responsible for modifying, sorting, and packaging macromolecules for secretion or delivery to other organelles within the cell.
5. Chapter 03-05 If the cytoplasm of a cell is very basophilic or dark blue when stained with Wright stain, it contains: a. low concentration of lysosomes. *b. large number of ribosomes. c. small number of ribosomes. d. high concentration of lysosomes. General Feedback: Ribosomes, which are made up of ribonucleic acid (RNA), stain dark blue or basophilic with Wright stain. If a cell’s cytoplasm contains many ribosomes, it will stain very blue.
6. Chapter 03-06 Protein synthesis occurs in what part of a cell? *a. Ribosomes b. Nucleus c. Mitochondria d. Lysosomes
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General Feedback: Protein synthesis occurs on ribosomes, found in rough endoplasmic reticulum.
7. Chapter 03-07 What cellular component is responsible for energy production and metabolic processes? a. Ribosomes b. Nucleus *c. Mitochondria d. Lysosomes General Feedback: Mitochondria are responsible for energy production and metabolic processes of a cell.
8. Chapter 03-08 Lysosomes are found in the cytoplasm of many cells and contain: a. cholesterol. *b. hydrolytic enzymes. c. glycoproteins. d. RNA.
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General Feedback: Lysosomes contain hydrolytic enzymes.
9. Chapter 03-09 What cellular structures appear as granules with Wright stain? a. Ribosomes b. Golgi bodies c. Mitochondria *d. Lysosomes General Feedback: With Wright stain, lysosomes are visualized as azurophilic granules.
10. Chapter 03-10 The nucleolus of a cell is composed of: a. hydrolytic enzymes. b. glycoproteins. *c. RNA. d. lipids. General Feedback: The nucleolus is composed of ribosomal RNA, DNA, and proteins in loose fibrillar form and is found within the nucleus of a cell.
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11. Chapter 03-11 Where are surface markers that help in cell identification found? *a. Cell membrane b. Golgi complex c. Rough endoplasmic reticulum d. Nucleus General Feedback: Surface markers are found on the cell membrane and are primarily composed of glycoproteins. Cluster differentiation (CD) numbers are used to identify them.
12. Chapter 03-12 A cell that is actively synthesizing protein has: *a. more nucleoli. b. more heterochromatin. c. fewer ribosomes. d. fewer mitochondria. General Feedback:
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