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.
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A patient receiving blood begins complaining of severe chest pain and a feeling of warmth. What should the nurse do first?
- A. Call the physician.
- B. Administer diuretics as ordered.
- C. Discontinue the blood transfusion.
- D. Assess vital signs and cardiovascular status.
Correct Answer: C
Rationale: The correct first step is to discontinue the blood transfusion (Choice C) because the patient is experiencing symptoms of a transfusion reaction, such as chest pain and warmth. Stopping the transfusion is crucial to prevent further harm. Calling the physician (Choice A) can be done after discontinuing the transfusion. Administering diuretics (Choice B) is not appropriate for this situation. Assessing vital signs and cardiovascular status (Choice D) should be done after stopping the transfusion to monitor the patient's condition.
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,
A nurse works in a gerontology clinic. What age-related change(s) related to the hematologic system will the nurse expect during health assessment? (Select all that apply.)
- A. Dentition deteriorates with more cavities.
- B. Nail are stron and smooth
- C. Progressive loss or thinning of hair occurs.
- D. Sclerae begin to turn yellow or pale.
Correct Answer: C
Rationale: Rationale:
C: Progressive loss or thinning of hair occurs in the geriatric population due to age-related changes in the hair follicles. As individuals age, the hair follicles shrink, leading to hair thinning or loss.
Incorrect Choices:
A: Dentition deteriorating with more cavities is related to oral health, not the hematologic system.
B: Strong and smooth nails are not directly related to age-related changes in the hematologic system.
D: Sclerae turning yellow or pale is indicative of potential liver dysfunction, not a direct age-related change in the hematologic system.
A nurse is caring for a client who is about to begin alteplase therapy to treat pulmonary embolism. Which of the following drugs should the nurse have available in the event of a severe adverse reaction?
- A. Vitamin K
- B. Aminocaproic acid
- C. Protamine
- D. Deferoxamine
Correct Answer: B
Rationale: The correct answer is B: Aminocaproic acid. This drug is a fibrinolytic inhibitor that can be used to manage bleeding complications associated with alteplase therapy. It helps to prevent excessive bleeding by inhibiting the breakdown of blood clots. Having aminocaproic acid available is crucial in case the client experiences severe bleeding as a result of alteplase therapy.
A: Vitamin K is used to reverse the effects of warfarin, a blood thinner, and is not indicated for managing bleeding due to alteplase therapy.
C: Protamine is used to reverse the effects of heparin, not alteplase, and is not indicated for managing bleeding due to alteplase therapy.
D: Deferoxamine is an antidote for iron poisoning and is not indicated for managing bleeding due to alteplase therapy.
In summary, aminocaproic acid is the correct choice as it helps manage bleeding complications associated with alteplase therapy
A 3-month-old female presents to the emergency room with vomiting and abdominal distension. She has a left-side abdominal mass, and an abdominal ultrasound confirms an 8-cm mass arising from the left kidney. Liver lesions are also noted. Nephrectomy is performed and reveals a histologic diagnosis of malignant rhabdoid tumor of the kidney (MRTK). Which of the following is not a true statement about the management of this patient?
- A. Most patients with rhabdoid tumor of the kidney present in infancy.
- B. Most patients with rhabdoid tumor of the kidney present with metastatic (stage III or IV) disease.
- C. She has an excellent prognosis with surgery, chemotherapy, and radiation.
- D. Germline testing for SMARCB1/INI1 mutation on chromosome 22 is recommended, with brain MRI every 3 months until she is 5 years old, if testing is germline positive for SMARCB1/INI1.
Correct Answer: C
Rationale: The correct answer is C: She has an excellent prognosis with surgery, chemotherapy, and radiation.
Rationale:
1. Malignant rhabdoid tumor of the kidney (MRTK) is an aggressive cancer with poor prognosis.
2. Even with aggressive treatment, including surgery, chemotherapy, and radiation, the prognosis is generally poor due to high rates of recurrence and metastasis.
3. Therefore, stating that the patient has an excellent prognosis with the mentioned treatments is not true.
Summary of other choices:
A: Most patients with rhabdoid tumor of the kidney present in infancy - True, MRTK commonly presents in infancy.
B: Most patients with rhabdoid tumor of the kidney present with metastatic (stage III or IV) disease - True, MRTK often presents with metastatic disease.
D: Germline testing for SMARCB1/INI1 mutation on chromosome 22 is recommended, with brain MRI every 3 months until she is