Nokea
A patient has been scheduled for a bone marrow biopsy and admits to the nurse that she is worried about the pain involved with the procedure. What patient education is most accurate?
- A. Youll be given painkillers before the test, so there wont likely be any pain?
- B. Youll feel some pain when the needle enters your skin, but none when the needle enters the bone because of the absence of nerves in bone.
- C. Most people feel some brief, sharp pain when the needle enters the bone.
- D. Ill be there with you, and Ill try to help you keep your mind off the pain.
Correct Answer: C
Rationale: Patients typically feel a pressure sensation as the needle is advanced into position. The actual aspiration always causes sharp, but brief pain, resulting from the suction exerted as the marrow is aspirated into the syringe; the patient should be warned about this. Stating, Ill try to help you keep your mind off the pain may increase the patients fears of pain, because this does not help the patient know what to expect.
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A nurse has participated in organizing a blood donation drive at a local community center. Which of the following individuals would most likely be disallowed from donating blood?
- A. A man who is 81 years of age
- B. A woman whose blood pressure is 88/51 mm Hg
- C. A man who donated blood 4 months ago
- D. A woman who has type 1 diabetes
Correct Answer: B
Rationale: For potential blood donors, systolic arterial BP should be 90 to 180 mm Hg, and the diastolic pressure should be 50 to 100 mm Hg. There is no absolute upper age limit. Donation 4 months ago does not preclude safe repeat donation and diabetes is not a contraindication.
A patient with a hematologic disorder asks the nurse how the body forms blood cells. The nurse should describe a process that takes place where?
- A. In the spleen
- B. In the kidneys
- C. In the bone marrow
- D. In the liver
Correct Answer: C
Rationale: Bone marrow is the primary site for hematopoiesis. The liver and spleen may be involved during embryonic development or when marrow is destroyed. The kidneys release erythropoietin, which stimulates the marrow to increase production of red blood cells (RBCs). However, blood cells are not primarily formed in the spleen, kidneys, or liver.
A patient has been diagnosed with a lymphoid stem cell defect. This patient has the potential for a problem involving which of the following?
- A. Plasma cells
- B. Neutrophils
- C. Red blood cells
- D. Platelets
Correct Answer: A
Rationale: A defect in a myeloid stem cell can cause problems with erythrocyte, leukocyte, and platelet production. In contrast, a defect in the lymphoid stem cell can cause problems with T or B lymphocytes, plasma cells (a more differentiated form of B lymphocyte), or natural killer (NK) cells.
The nurses brief review of a patients electronic health record indicates that the patient regularly undergoes therapeutic phlebotomy. Which of the following rationales for this procedure is most plausible?
- A. The patient may chronically produce excess red blood cells.
- B. The patient may frequently experience a low relative plasma volume.
- C. The patient may have impaired stem cell function.
- D. The patient may previously have undergone bone marrow biopsy.
Correct Answer: A
Rationale: Persistently elevated hematocrit is an indication for therapeutic phlebotomy. It is not used to address excess or deficient plasma volume and is not related to stem cell function. Bone marrow biopsy is not an indication for therapeutic phlebotomy.
A patient has come to the OB/GYN clinic due to recent heavy menstrual flow. Because of the patients consequent increase in RBC production, the nurse knows that the patient may need to increase her daily intake of what substance?
- A. Vitamin E
- B. Vitamin D
- C. Iron
- D. Magnesium
Correct Answer: C
Rationale: To replace blood loss, the rate of red cell production increases. Iron is incorporated into hemoglobin. Vitamins E and D and magnesium do not need to be increased when RBC production is increased.