Nokea
A child who has leukemia is to have a bone marrow biopsy performed. How will the child be positioned for this procedure?
- A. On his side with the top knee flexed
- B. Prone
- C. Modified Trendelenburg position
- D. On his back with his head elevated 30 degrees
Correct Answer: B
Rationale: The prone position is used for a bone marrow biopsy from the iliac crest to access the site safely.
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The client’s laboratory values are RBCs 5.5 (x106/mm3), WBCs 8.9 (x103/mm3), and platelets 189 (x103/mm3). Which intervention should the nurse implement?
- A. Prepare to administer packed red blood cells.
- B. Continue to monitor the client.
- C. Request an order for Neupogen, a biologic response modifier.
- D. Institute bleeding precautions.
Correct Answer: B
Rationale: Labs are normal (RBC 5.5, WBC 8.9, platelets 189); continue monitoring (B). Transfusions (A), Neupogen (C), and bleeding precautions (D) are unnecessary.
The male client with sickle cell anemia comes to the emergency department with a temperature of 101.4°F and tells the nurse that he is having a sickle cell crisis. Which diagnostic test should the nurse anticipate the emergency department doctor ordering for the client?
- A. Spinal tap.
- B. Hemoglobin electrophoresis.
- C. Sickle-turbidity test (Sickledex).
- D. Blood cultures.
Correct Answer: D
Rationale: Fever (101.4°F) in SCA crisis suggests infection; blood cultures (D) identify the cause. Spinal tap (A) is for meningitis, electrophoresis (B) confirms SCA, and Sickledex (C) screens for sickle trait.
The nurse is caring for the following clients. Which client should the nurse assess first?
- A. The client whose partial thromboplastin time (PTT) is 38 seconds.
- B. The client whose hemoglobin is 14 g/dL and hematocrit is 45%.
- C. The client whose platelet count is 75,000 per cubic millimeter of blood.
- D. The client whose red blood cell count is 4.8 x 106/mm3.
Correct Answer: C
Rationale: Platelets 75,000 (C) indicate thrombocytopenia, risking bleeding, a priority. PTT 38 (A) is therapeutic, Hb/Hct (B) are normal, and RBC 4.8 (D) is normal.
The nurse is assessing an African American client diagnosed with sickle cell crisis. Which assessment datum is most pertinent when assessing for cyanosis in clients with dark skin?
- A. Assess the client’s oral mucosa.
- B. Assess the client’s metatarsals.
- C. Assess the client’s capillary refill time.
- D. Assess the sclera of the client’s eyes.
Correct Answer: A
Rationale: Oral mucosa (A) is the best site to assess cyanosis in dark skin, showing dusky color. Metatarsals (B) and sclera (D) are less reliable, and capillary refill (C) assesses perfusion.
The client diagnosed with leukemia has received a bone marrow transplant. The nurse monitors the client’s absolute neutrophil count (ANC). What is the client’s neutrophil count if the WBCs are 2.2 (x103/mm3), neutrophils are 25%, and bands are 5%?
Correct Answer: 660
Rationale: ANC = WBC × (neutrophils% + bands%). WBC = 2,200/mm3, neutrophils = 25%, bands = 5%. ANC = 2,200 × (0.25 + 0.05) = 2,200 × 0.3 = 660/mm3.