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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 can be indicative of chronic hypoxia, often seen in lung diseases like COPD. The nurse should ask about lung disease to explore the possibility of chronic hypoxia as the underlying cause. Choices A, C, and D are incorrect as they do not directly relate to the potential cause of elevated hemoglobin and hematocrit levels in this scenario.
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You are consulted on a 4-year-old girl who is newly diagnosed with standard-risk pre-B acute lymphoblastic leukemia. After reviewing her previous complete blood examinations, you note she has had a platelet count ranging from 80,000 to 100,000 cells/mcL over the past 2 years. Her father mentions that he has also been told he has mild thrombocytopenia. You suspect the child may have a cancer predisposition syndrome. Which sample should you send for analysis, and which gene is most likely implicated?
- A. Skin fibroblasts to evaluate the RUNXI gene
- B. Skin fibroblasts to evaluate the ETV6 gene
- C. Buccal swab to evaluate the RUNXI gene
- D. Buccal swab to evaluate the ETV6 gene
Correct Answer: B
Rationale: The correct answer is B: Skin fibroblasts to evaluate the ETV6 gene. In this scenario, the child's history of persistent thrombocytopenia and the father's mild thrombocytopenia suggest a possible familial predisposition to hematologic disorders. ETV6 gene mutations are associated with inherited thrombocytopenia and predisposition to hematologic malignancies such as acute lymphoblastic leukemia. Skin fibroblasts are typically used for genetic testing, as they contain the individual's complete genetic information. Choice A is incorrect because the RUNXI gene is not typically associated with thrombocytopenia or leukemia predisposition. Choices C and D are incorrect because buccal swabs may not provide sufficient genetic material for comprehensive analysis, and the ETV6 gene is more relevant in this context.
A client is having a radioisotopic imaging scan. What action by the nurse is most important?
- A. Assess the client for shellfish allergies.
- B. Place the client on radiation precautions.
- C. Sedate the client before the scan.
- D. Teach the client about the procedure.
Correct Answer: D
Rationale: The correct answer is D because educating the client about the procedure is crucial for informed consent, reducing anxiety, and promoting cooperation during the scan. This empowers the client to understand what to expect and how to prepare. Assessing for shellfish allergies (A) is not directly related to the scan. Placing the client on radiation precautions (B) is unnecessary as the exposure is minimal, and sedating the client (C) should only be considered if medically indicated, not as a routine practice.
A nurse is administering epoetin intravenously to a client who has renal failure. Which of the following actions should the nurse take?
- A. Shake the vial before using.
- B. Administer via IV bolus over 1 to 3 min.
- C. Dilute the drug first with D5W.
- D. Save the used vial for the next dose.
Correct Answer: B
Rationale: The correct answer is B: Administer via IV bolus over 1 to 3 min. This is the correct action because epoetin is typically administered intravenously over a specified time frame to prevent adverse reactions such as rapid changes in blood pressure or heart rate. Shaking the vial before using (option A) is unnecessary and may lead to frothing. Diluting the drug with D5W (option C) is not recommended for administration as an IV bolus. Saving the used vial for the next dose (option D) is incorrect and violates medication safety protocols. Administering via IV bolus over 1 to 3 min ensures safe and effective delivery of the medication.
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.
The health care provider tells the nurse that a client is to be started on a platelet inhibitor. About what drug does the nurse plan to teach the client?
- A. Clopidogrel (Plavix)
- B. Enoxaparin (Lovenox)
- C. Reteplase (Retavase)
- D. Warfarin (Coumadin)
Correct Answer: A
Rationale: The correct answer is A: Clopidogrel (Plavix). Platelet inhibitors like Clopidogrel work by preventing blood clots by inhibiting platelet aggregation. Clopidogrel is commonly used to reduce the risk of heart attack and stroke. Enoxaparin (Lovenox) is a low molecular weight heparin used to prevent blood clots. Reteplase (Retavase) is a thrombolytic agent used to dissolve blood clots. Warfarin (Coumadin) is an anticoagulant that works by inhibiting clotting factors in the liver, but it does not directly target platelets like Clopidogrel.