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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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A patient is being prepared to receive a prescribed blood transfusion. What is the best way that the LPN can assist the health team to prevent a transfusion reaction?
- A. Monitor vital signs every 15 minutes.
- B. Warm blood to 98.6°F (37°C) before infusion.
- C. Administer diphenhydramine (Benadryl) before the infusion.
- D. Assist the registered nurse (RN) to identify correctly the patient and the blood product.
Correct Answer: D
Rationale: Correct Answer: D
Rationale:
1. Identifying the patient and blood product is crucial to prevent transfusion reactions.
2. Matching the patient's identity with the blood product minimizes risk of incompatibility.
3. This step ensures the right blood type and product are administered, preventing serious reactions.
4. LPNs play a key role in assisting the RN in verifying and confirming patient and blood product identity.
Summary:
A: Monitoring vital signs is important but doesn't directly prevent transfusion reactions.
B: Warming blood can improve patient comfort but does not prevent reactions.
C: Administering Benadryl addresses possible allergic reactions but doesn't prevent incompatibility issues.
A patient is prescribed a transfusion of washed packed red blood cells. What should the nurse realize as being the rationale for the using this type of blood?
- A. Reduces the risk of hypothermia
- B. Cleans the blood cells of impurities
- C. Reduces the risk of a febrile reaction
- D. Removes potential harmful particles from the blood
Correct Answer: C
Rationale: The correct answer is C because washing packed red blood cells reduces the risk of a febrile reaction by removing white blood cells, plasma proteins, and other substances that could lead to an immune response. Choice A is incorrect as hypothermia is not a primary concern with washed packed red blood cells. Choice B is incorrect as the process does not cleanse blood cells of impurities. Choice D is incorrect as the main purpose of washing blood cells is to reduce the risk of adverse reactions, not to remove harmful particles.
Dengue is a common vector-borne disease prevalent in tropical countries. Which of the following statement is true for dengue fever?
- A. It is caused by a DNA virus
- B. The vector once infected with the virus remains infective for life
- C. The vector prefers polluted water for propagation
- D. Joint symptoms are commoner in dengue fever compared to chikungunya
Correct Answer: B
Rationale: The correct answer is B because the Aedes mosquito, the vector for dengue fever, remains infective for life once it is infected with the dengue virus. This is due to the virus establishing a lifelong infection in the mosquito's salivary glands. The other choices are incorrect because: A) Dengue is caused by an RNA virus, not a DNA virus. C) The Aedes mosquito prefers clean, stagnant water for breeding, not polluted water. D) Joint symptoms are commoner in chikungunya, not dengue fever.
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 individuals with familial thrombocytopenia and a history of malignancy, ETV6 gene mutations are often implicated. Sending skin fibroblasts for analysis allows for genetic testing to identify any ETV6 gene mutations that may be present. Skin fibroblasts are commonly used for genetic testing as they provide a stable and reliable source of DNA.
Choice A (Skin fibroblasts to evaluate the RUNXI gene) is incorrect because RUNXI gene mutations are not typically associated with familial thrombocytopenia and cancer predisposition syndromes. Choice C (Buccal swab to evaluate the RUNXI gene) is also incorrect for the same reason. Choice D (Buccal swab to evaluate the ETV6 gene) is incorrect because buccal swabs may not provide enough genetic material for comprehensive testing of the ETV6 gene, which is
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: Check the patient's most recent complete blood count report. This assessment is the least important at this time because changes in vital signs post-bone marrow aspiration are more indicative of immediate complications such as bleeding or shock, which require prompt attention. Checking the complete blood count report would not provide immediate actionable information in this acute situation.
Summary:
A: Observing the puncture site is important for signs of bleeding or infection.
C: Asking the patient about lightheadedness or dizziness is crucial to assess for signs of hypovolemia or shock.
D: Determining if the patient had any medications before the procedure is essential to identify possible adverse drug interactions.