Nokea
A client is having a bone marrow biopsy today. What action by the nurse takes priority?
- A. Administer pain medication first.
- B. Ensure valid consent is on the chart.
- C. Have the client shower in the morning.
- D. Premedicate the client with sedatives.
Correct Answer: B
Rationale: The correct answer is B: Ensure valid consent is on the chart. This is the priority because the client must provide informed consent before undergoing a bone marrow biopsy. Without valid consent, the procedure cannot proceed ethically or legally. Administering pain medication (choice A) or sedatives (choice D) may be important for the client's comfort but obtaining consent is essential. Having the client shower in the morning (choice C) is not directly related to the immediate safety or success of the biopsy.
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A laboratory finding of granulocytosis
- A. Complete absence of peripheral blood granulocytes and their precursors in the bone marrow
- B. Acute bacterial infections
- C. Myeloproliferative disorders
- D. Increased numbers of granulocytes in blood and bone marrow
Correct Answer: D
Rationale: The correct answer is D because granulocytosis refers to an increase in granulocytes in both blood and bone marrow. This finding is commonly seen in conditions such as infections and inflammatory processes. The other choices are incorrect because A describes agranulocytosis, B is a potential cause of granulocytosis, and C typically involves abnormal proliferation of myeloid cells rather than just granulocytes.
A 20-month-old otherwise healthy male presents late for his 18-month well child check. During his first year of life, he took iron-fortified formula and had a point-of-care hemoglobin (Hgb) of 12 g/dL at his 1-year well child check. His mother reports that he is a picky eater but loves milk and has recently become obsessive about chewing the corners of his cardboard books. Physical examination is normal except for a flow murmur. Which combination of laboratory test results listed below would most likely characterize this patient?
- A. Hgb 8.7 g/dL, mean corpuscular volume (MCV) 60 fL, serum ferritin 2 ng/mL
- B. Hgb 12.0 g/dL, MCV 80 fL, serum ferritin 30 ng/mL
- C. Hgb 9.2 g/dL, MCV 60 fL, serum ferritin 30 ng/mL
- D. Hgb 11.2 g/dL, MCV 90 fL, serum ferritin 7 ng/mL
Correct Answer: A
Rationale: The correct answer is A because it reflects iron deficiency anemia in a 20-month-old child who is a picky eater and has pica behavior. The low hemoglobin level of 8.7 g/dL indicates anemia. The MCV of 60 fL suggests microcytic anemia, typical of iron deficiency. The serum ferritin level of 2 ng/mL confirms low iron stores.
Choice B is incorrect as the hemoglobin level is normal, MCV is higher, and serum ferritin is not indicative of iron deficiency anemia.
Choice C is incorrect as the hemoglobin level is higher, and the MCV is not consistent with iron deficiency anemia.
Choice D is incorrect as the hemoglobin level is higher, MCV is too high for iron deficiency anemia, and the serum ferritin level does not support iron deficiency.
What is the nurse's priority when caring for a client who just completed a bone marrow aspiration and biopsy?
- A. Teach the client to avoid activity for 24 to 48 hours to prevent infection.
- B. Administer a nonsteroidal anti-inflammatory drug (NSAID) to promote comfort.
- C. Check the pressure dressing frequently for signs of excessive or active bleeding.
- D. Report the laboratory results to the primary health care provider.
Correct Answer: C
Rationale: The correct answer is C: Check the pressure dressing frequently for signs of excessive or active bleeding. This is the priority because post bone marrow aspiration and biopsy, there is a risk of bleeding due to the procedure. By checking the dressing, the nurse can assess for any signs of excessive bleeding or hematoma formation, which are crucial to prevent complications.
A: Teaching the client to avoid activity is important but not the priority immediately post-procedure.
B: Administering NSAIDs may not be appropriate as they can increase the risk of bleeding.
D: Reporting the lab results is important but not the priority over ensuring immediate post-procedure safety.
A 17-year-old patient is referred to you for a platelet count of 1,200,000/mm3. On history, she notes that she often has numbness and tingling in her hands and feet and has frequent epistaxis. She is otherwise well-appearing and has no recent infections. On her exam, you note splenomegaly. What do you expect to see on further evaluation?
- A. Elevated C-reactive protein
- B. Low ferritin
- C. A hypocellular bone marrow
- D. Low von Willebrand factor activity
Correct Answer: D
Rationale: The correct answer is D: Low von Willebrand factor activity. A platelet count of 1,200,000/mm3 suggests thrombocytosis, which can be seen in conditions like essential thrombocythemia. This condition is associated with low von Willebrand factor activity, leading to increased bleeding tendency despite high platelet counts. Numbness, tingling, epistaxis, and splenomegaly are common features of essential thrombocythemia. Elevated C-reactive protein is not typically associated with this condition. Low ferritin is more indicative of iron deficiency anemia, not thrombocytosis. A hypocellular bone marrow is not expected in essential thrombocythemia, as it is characterized by increased platelet production.
Which statement is correct regarding lymphocyte counts in infants versus adults?
- A. NK-cell numbers are lowest at birth and increase with age.
- B. B-cell numbers are highest at birth and decline with age.
- C. T-cell numbers in infants are higher than in adults.
- D. Infants have low lymphocyte counts that increase with age.
Correct Answer: C
Rationale: The correct answer is C because T-cell numbers in infants are indeed higher than in adults. This is due to the active development of the immune system in infants, leading to a higher proportion of T-cells.
A is incorrect because NK-cell numbers in infants are actually higher at birth and decrease with age.
B is incorrect because B-cell numbers are lower at birth and increase with age.
D is incorrect because infants do not have low lymphocyte counts; their immune system is actively developing, leading to higher lymphocyte counts compared to adults.