Nokea
A patient with advanced leukemia is responding poorly to treatment. The nurse finds the patient tearful and trying to express his feelings, but he is clearly having difficulty. What is the nurse's most appropriate action?
- A. Tell him that you will give him privacy and leave the room.
- B. Offer to call pastoral care.
- C. Ask if he would like you to sit with him while he collects his thoughts.
- D. Tell him that you can understand how he's feeling.
Correct Answer: C
Rationale: The correct answer is C: Ask if he would like you to sit with him while he collects his thoughts. This is the most appropriate action because it shows empathy and support for the patient's emotional distress. By offering to sit with the patient, the nurse acknowledges the patient's feelings and provides a comforting presence. This can help the patient feel understood and supported during a difficult time.
Choices A and D are incorrect because they do not actively offer emotional support or show empathy towards the patient. Choice A may make the patient feel abandoned, and choice D may come across as insincere or dismissive of the patient's emotions.
Choice B, offering to call pastoral care, is also not the most appropriate action in this scenario because the patient may need immediate emotional support from the nurse. Pastoral care can be considered later if the patient expresses a desire for spiritual or religious support.
You may also like to solve these questions
Which of the following is not true in thrombasthenia:
- A. prolonged bleeding time
- B. normal plat .Count
- C. plat .Aggregation defect
- D. prolonged clotting time
Correct Answer: D
Rationale: In thrombasthenia, there is a deficiency or dysfunction of the glycoprotein IIb/IIIa receptor complex on platelets, leading to impaired platelet aggregation. This results in prolonged bleeding time due to ineffective platelet plug formation (choice A). Platelet count is typically normal (choice B). Platelet aggregation is defective (choice C). However, clotting time is not affected in thrombasthenia as it primarily involves platelet function, not the clotting factors involved in coagulation (choice D). Therefore, the correct answer is D.
The International Normalized Ratio (INR) was developed for the purpose of
- A. Monitoring heparin therapy
- B. Monitoring oral anticoagulant therapy
- C. Screening for intrinsic clotting system abnormalities
- D. Standardizing the monitoring of warfarin therapy
Correct Answer: D
Rationale: The correct answer is D because the International Normalized Ratio (INR) was specifically developed to standardize the monitoring of warfarin therapy. INR allows for consistent interpretation of prothrombin time results across different laboratories, ensuring accurate dosing of warfarin. Choice A is incorrect because heparin therapy is typically monitored using activated partial thromboplastin time (aPTT). Choice B is incorrect as INR, not aPTT, is used for monitoring oral anticoagulant therapy such as warfarin. Choice C is incorrect as INR is not used for screening clotting system abnormalities, but rather for monitoring anticoagulant therapy.
A patient's complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding?
- A. Have you had a recent weight loss?
- B. Do you have any history of lung disease?
- C. Have you noticed any dark or bloody stools?
- D. What is your dietary intake of meats and protein?
Correct Answer: B
Rationale: The correct answer is B: Do you have any history of lung disease? A high hemoglobin and hematocrit could indicate polycythemia, which can be secondary to chronic hypoxia from lung disease. Asking about lung disease helps determine if there is an underlying cause of the elevated levels.
Incorrect Choices:
A: Recent weight loss is more relevant for anemia.
C: Dark or bloody stools are more indicative of gastrointestinal bleeding and iron deficiency anemia.
D: Dietary intake of meats and protein is not directly related to the elevated hemoglobin and hematocrit levels.
A 4-year-old boy is pale with intermittent jaundice and splenomegaly. Laboratory results are as follows: RBC 4.85 M/mcL (N); Hgb 8.6 g/dL (L); Hct 25.8% (L); MCV 81.6 (N); MCHC 38% (H); RDW 20% (H); Retic 7% (H). What are the two best tests to distinguish autoimmune hemolytic anemia from hereditary spherocytosis?
- A. Free erythrocyte protoporphyrin and IgG levels
- B. Hemoglobin electrophoresis and direct antiglobulin test (DAT)
- C. Lactate dehydrogenase (LDH) and modified Russell viper venom test
- D. Red cell distribution width (RDW) and mean corpuscular hemoglobin concentration (MCHC)
Correct Answer: E
Rationale: As the correct answer is not provided, I'll provide a step-by-step rationale for each choice:
A: Free erythrocyte protoporphyrin and IgG levels are not specific tests for distinguishing between autoimmune hemolytic anemia and hereditary spherocytosis.
B: Hemoglobin electrophoresis and direct antiglobulin test (DAT) can help differentiate between these two conditions as autoimmune hemolytic anemia is associated with a positive DAT, while hereditary spherocytosis typically has a negative DAT.
C: Lactate dehydrogenase (LDH) and modified Russell viper venom test are not specific tests for distinguishing between autoimmune hemolytic anemia and hereditary spherocytosis.
D: Red cell distribution width (RDW) and mean corpuscular hemoglobin concentration (MCHC) are not typically used to distinguish between autoimmune hemolytic anemia and hereditary spherocytosis.
Therefore, the best tests
A patient has a bone marrow aspiration from the posterior iliac crest. Before the procedure, the patient's vital signs were: blood pressure 132/82 mm Hg and pulse 88 beats/min. One hour after the procedure, the blood pressure is 108/70 mm Hg and pulse is 96 beats/min. Which assessment is the least important for the patient at this time?
- A. Observe the puncture site.
- B. Check the patient's most recent complete blood count report.
- C. Ask the patient about feelings of lightheadedness or dizziness.
- D. Determine if the patient had any medications before the procedure.
Correct Answer: B
Rationale: The correct answer is B because the patient's vital signs have changed post-procedure, indicating a potential complication. Checking the complete blood count report is the least important at this time as it does not immediately impact the patient's current condition.
A: Observing the puncture site is important to assess for bleeding or infection.
C: Asking about lightheadedness or dizziness is crucial to monitor for signs of hypovolemia or shock.
D: Determining medications taken before the procedure is essential to identify any potential interactions or adverse effects.
In summary, monitoring vital signs, assessing the puncture site, and checking for symptoms of hypovolemia or shock are more critical post-procedure than reviewing the complete blood count report.