Nokea
A female patient's hematocrit level is 50% and oxygen saturation is 98% on room air. What should the nurse suspect as being the cause for this patient's hematocrit level?
- A. Dehydration
- B. Chronic renal failure
- C. Bone marrow suppression
- D. Bleeding esophageal varices
Correct Answer: A
Rationale: The correct answer is A: Dehydration. When a patient is dehydrated, their blood volume decreases, leading to a relative increase in the concentration of red blood cells and hematocrit level. In this case, the patient's high hematocrit level of 50% indicates hemoconcentration due to dehydration. Oxygen saturation being normal suggests that the body is compensating for the decreased blood volume by maintaining adequate oxygen delivery.
Summary of incorrect choices:
B: Chronic renal failure would likely result in anemia due to decreased erythropoietin production.
C: Bone marrow suppression would lead to a decrease in red blood cell production, causing anemia.
D: Bleeding esophageal varices would result in acute blood loss and a decreased hematocrit level.
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A nurse is caring for four clients. After reviewing today's laboratory results, which client should the nurse see first?
- A. Client with an international normalized ratio of 2.8
- B. Client with a platelet count of 128000/mm³
- C. Client with a prothrombin time (PT) of 28 seconds
- D. Client with a red blood cell count of 5.1 million/L
Correct Answer: C
Rationale: The correct answer is C. The nurse should see the client with a prothrombin time (PT) of 28 seconds first because PT measures the time it takes for blood to clot. A PT of 28 seconds is prolonged, indicating potential bleeding risk. This requires immediate attention to prevent complications.
Choice A: A client with an international normalized ratio of 2.8 may indicate anticoagulant therapy but is not as urgent as a prolonged PT.
Choice B: A platelet count of 128,000/mm³ is low but doesn't necessarily require immediate intervention compared to a prolonged PT.
Choice D: A red blood cell count of 5.1 million/L is within normal range and does not indicate an urgent issue related to clotting or bleeding.
Non thrombocytopenic purpura is seen in all except:
- A. vasculitis
- B. uraemia
- C. hereditary haemorrhagic telangiectasia
- D. SLE
Correct Answer: D
Rationale: The correct answer is D: SLE. Non-thrombocytopenic purpura is characterized by skin bleeding without low platelet count. SLE does not typically cause this type of purpura, as it primarily affects multiple organs through immune complex deposition. Vasculitis, uraemia, and hereditary hemorrhagic telangiectasia can all lead to non-thrombocytopenic purpura due to various mechanisms involving blood vessel inflammation, kidney dysfunction, or genetic defects in blood vessel formation, respectively.
A patient with pancytopenia has a bone marrow aspiration from the left posterior iliac crest. Which action would be important for the nurse to take after the procedure?
- A. Elevate the head of the bed to 45 degrees.
- B. Apply a sterile 2-inch gauze dressing to the site.
- C. Use a half-inch sterile gauze to pack the wound.
- D. Have the patient lie on the left side for 1 hour.
Correct Answer: D
Rationale: The correct answer is D. Having the patient lie on the left side for 1 hour after a bone marrow aspiration helps to prevent bleeding by applying pressure to the site. This position helps to promote clotting and reduces the risk of hematoma formation. Elevating the head of the bed (choice A) is not necessary for this procedure. Applying a sterile 2-inch gauze dressing (choice B) is important but does not address the immediate post-procedure care. Using a half-inch sterile gauze to pack the wound (choice C) is not recommended as it may disrupt the clotting process.
A nurse is caring for a client who recently started alteplase therapy. The nurse should monitor the client for which of the following adverse effects?
- A. Bronchodilation
- B. Headache
- C. Edema
- D. Hypertension
Correct Answer: B
Rationale: The correct answer is B: Headache. Alteplase is a thrombolytic medication that can cause cerebral bleeding, leading to headaches. Monitoring for headaches is crucial as it can indicate a serious adverse effect. Bronchodilation (A) is not associated with alteplase therapy. Edema (C) is not a common adverse effect of alteplase. Hypertension (D) is a potential adverse effect, but it is not as specific or common as headaches in this context.
A 12-year-old girl presents to your clinic with significant menstrual bleeding at the onset of menarche and is noted to have a hemoglobin of 9.9, although she is not symptomatic from her anemia. Her mother reports that she has a history of epistaxis when she was a child with some episodes lasting 30 minutes and that she also has heavy menstrual bleeding. Which of the following tests will lead to the most likely diagnosis?
- A. Factor XI level
- B. Factor X level
- C. Factor XIII level
- D. Ristoectin cofactor activity
Correct Answer: D
Rationale: The correct answer is D: Ristoectin cofactor activity. This patient's history of significant menstrual bleeding, epistaxis, and low hemoglobin suggests a congenital bleeding disorder. Ristoectin cofactor activity is a test for von Willebrand disease (VWD), a common inherited bleeding disorder characterized by a deficiency or dysfunction of von Willebrand factor. VWD typically presents with mucocutaneous bleeding, such as epistaxis and menorrhagia.
Choice A: Factor XI level is not the most likely diagnosis as Factor XI deficiency (Hemophilia C) typically presents with bleeding after surgery or trauma, not mucocutaneous bleeding.
Choice B: Factor X level is not the most likely diagnosis as Factor X deficiency presents with bleeding that is more severe and can cause hemarthrosis, not typically seen in this patient.
Choice C: Factor XIII level is not the most likely diagnosis as Factor XIII deficiency leads to delayed wound healing and poor clot formation,