The family members of an elderly patient are wondering why his ...

[ARLKQ]

The family members of an elderly patient are wondering why his blood counts are not rising after his last GI bleed. They state, He has always bounced back after one of these episodes, but this time it isn't happening.
 
  Do you know why? The nurse will respond based on which of the following pathophysiological principles?
  A)
  Everything slows down when you get older. You just have to wait and see what happens.
  B)
  Due to stress, the red blood cells of older adults are not replaced as promptly as younger people.
  C)
  The doctor may start looking for another cause of his anemia, maybe cancer of the bone.
  D)
  Don't worry about it. We can always give him more blood.

Question 2

In which of the following individuals would a clinician most suspect multiple myeloma as a diagnosis?
 
  A)
  A 40-year-old man who has had three broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated
  B)
  A 68-year-old former coal miner who has white cell levels exponentially higher than normal ranges
  C)
  An 81-year-old male resident of a long-term care home who has an uncommon bacterial pneumonia and who is unable to produce a fever
  D)
  A 70-year-old woman whose blood work reveals large numbers of immature granulocytes

[mcinincha279]

Answer to Question 1

Ans:
B

Feedback:

In older adults, the number of progenitor cells declines. During a stress situation such as bleeding, the red blood cells of older adults are not replaced as promptly as those of their younger counterparts. Given the scenario, the patient is obviously bleeding from the GI tract. There is no reason to suspect the patient has bone cancer. Answer choice D is a nontherapeutic communication technique. The nurse is trying to pacify the family and not really addressing their concern.

Answer to Question 2

Ans:
A

Feedback:

The main sites involved in multiple myeloma are the bones and bone marrow. In addition to the abnormal proliferation of marrow plasma cells, there is proliferation and activation of osteoclasts that lead to bone resorption and destruction. This increased bone resorption predisposes the individual to pathologic fractures and hypercalcemia. Many patients also present with renal insufficiency. Leukostasis, susceptibility to infection, and disorders of granulocyte development are not hallmarks of multiple myeloma.