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A nurse is caring for four clients. After reviewing today's laboratory results, which client would the nurse assess first?
- A. Client with an international normalized ratio of 2.8
- B. Client with a platelet count of 128,000/mm3 (128 x 109/L).
- C. Client with a prothrombin time (PT) of 28 seconds
- D. Client with a red blood cell count of 5.1 million/mcl. (5.1 x 1012/L)
Correct Answer: C
Rationale: The correct answer is C: Client with a prothrombin time (PT) of 28 seconds. A PT measures the time it takes for blood to clot, indicating the client's clotting ability. A PT of 28 seconds is prolonged, suggesting a potential bleeding risk. This client should be assessed first to prevent any complications related to inadequate clotting.
A: Client with an international normalized ratio of 2.8 - Although an elevated INR indicates a risk of bleeding, it is not as time-sensitive as a prolonged PT.
B: Client with a platelet count of 128,000/mm3 - While low platelets can lead to bleeding, a prolonged PT is more critical for immediate assessment.
D: Client with a red blood cell count of 5.1 million/mcl - This value is within normal range and does not indicate an urgent issue related to clotting.
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You receive a phone call that a 3-year-old patient on long-term warfarin therapy for congenital heart disease has an international normalized ratio (INR) of 5.8. On further history, you learn the patient and several family members have had recent gastrointestinal illnesses, but the patient is recovering. His mother reports he is not experiencing bleeding symptoms. Which of the following interventions would be most reasonable in this clinical scenario?
- A. Hold 1 to 2 doses of warfarin and recheck INR
- B. Administer oral vitamin K therapy
- C. Administer fresh frozen plasma (FFP)
- D. Administer recombinant factor VIIa
Correct Answer: A
Rationale: The correct answer is A: Hold 1 to 2 doses of warfarin and recheck INR. In this scenario, the high INR indicates an increased risk of bleeding due to excess anticoagulation. However, since the patient is asymptomatic and the high INR is likely due to transient factors (gastrointestinal illness), the most appropriate initial step is to temporarily hold warfarin to allow the INR to normalize. Rechecking the INR after holding the doses will guide further management.
Choice B (Administer oral vitamin K therapy) is incorrect because the patient is not experiencing bleeding symptoms and oral vitamin K should be reserved for patients with active bleeding or high INR with bleeding symptoms. Choice C (Administer fresh frozen plasma) is inappropriate as the patient is not actively bleeding and FFP is typically reserved for acute bleeding situations. Choice D (Administer recombinant factor VIIa) is also incorrect as it is reserved for severe bleeding in patients on war
A nurse is caring for a client who is about to begin taking folic acid to treat megaloblastic anemia. The nurse should monitor which of the following laboratory values to determine therapeutic effectiveness?
- A. Amylase level
- B. Reticulocyte count
- C. C-reactive protein
- D. Creatinine clearance
Correct Answer: B
Rationale: The correct answer is B: Reticulocyte count. Reticulocytes are immature red blood cells. In megaloblastic anemia, there is a decrease in red blood cell production due to a deficiency in folic acid. Monitoring reticulocyte count helps determine if the folic acid treatment is increasing red blood cell production.
A: Amylase level is not relevant to monitoring the effectiveness of folic acid in treating megaloblastic anemia.
C: C-reactive protein is a marker for inflammation and not specific to monitoring anemia treatment.
D: Creatinine clearance is used to assess kidney function, not the effectiveness of folic acid in treating anemia.
Macrocytosis is a characteristic of all except:
- A. an. Of myxedema
- B. methotrexate induced
- C. chronic alcoholism induced liver dis.
- D. SLE
Correct Answer: D
Rationale: Macrocytosis is characterized by enlarged red blood cells. In Systemic Lupus Erythematosus (SLE), macrocytosis is not a typical finding. The other conditions listed - anemia of myxedema, methotrexate-induced macrocytosis, and macrocytosis due to chronic alcoholism-induced liver disease - are associated with macrocytosis due to various underlying mechanisms. Therefore, the correct answer is D, as macrocytosis is not a characteristic feature of SLE.
A patient is presented with weakness of legs, arms, trunk, tingling and numbness that progressively worsens. Peripheral blood smear shows macrocytic anemia. Which of the following is not the factor causing this condition?
- A. Chronic atrophic gastritis
- B. Ileal resection
- C. Tapeworm infestation
- D. Alcoholism
Correct Answer: C
Rationale: The correct answer is C: Tapeworm infestation. The symptoms described suggest vitamin B12 deficiency, which can lead to macrocytic anemia. Chronic atrophic gastritis can cause decreased intrinsic factor production, leading to impaired B12 absorption. Ileal resection can also affect B12 absorption as it is the site where B12 is absorbed. Alcoholism can lead to poor dietary intake and impaired B12 absorption. However, tapeworm infestation does not directly affect B12 absorption and would not be a likely cause of the described symptoms.
Which of the following will be present in chronic bacterial infection?
- A. Neutrophilia
- B. Basophilia
- C. Lymphocytosis
- D. Monocytosis
Correct Answer: D
Rationale: The correct answer is D: Monocytosis. In chronic bacterial infections, monocytosis occurs due to the increased presence of monocytes in response to the persistent infection. Monocytes differentiate into macrophages to help eliminate the bacteria. Neutrophilia (A) is more common in acute bacterial infections. Basophilia (B) is associated with conditions like chronic myeloid leukemia, not bacterial infections. Lymphocytosis (C) is often seen in viral infections or chronic inflammatory conditions, not specifically in chronic bacterial infections.