Nokea
An older adult client is exhibiting many of the characteristic signs and symptoms of iron deficiency. In addition to a complete blood count, what diagnostic assessment should the nurse anticipate?
- A. Stool for occult blood
- B. Bone marrow biopsy
- C. Lumbar puncture
- D. Urinalysis
Correct Answer: A
Rationale: Iron deficiency in the adult generally indicates blood loss (e.g., from bleeding in the GI tract or heavy menstrual flow). Bleeding in the GI tract can be preliminarily identified by testing stool for the presence of blood. A bone marrow biopsy would not be undertaken for the sole purpose of investigating an iron deficiency. Lumbar puncture and urinalysis would not be clinically relevant.
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A nurse is caring for a patient who undergoing preliminary testing for a hematologic disorder. What sign or symptom most likely suggests a potential hematologic disorder?
- A. Sudden change in level of consciousness (LOC)
- B. Recurrent infections
- C. Anaphylaxis
- D. Severe fatigue
Correct Answer: D
Rationale: The most common indicator of hematologic disease is extreme fatigue. This is more common than changes in LOC, infections, or anaphylaxis.
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.
The nurses review of a patients most recent blood work reveals a significant increase in the number of band cells. The nurses subsequent assessment should focus on which of the following?
- A. Respiratory function
- B. Evidence of decreased tissue perfusion
- C. Signs and symptoms of infection
- D. Recent changes in activity tolerance
Correct Answer: C
Rationale: Ordinarily, band cells account for only a small percentage of circulating granulocytes, although their percentage can increase greatly under conditions in which neutrophil production increases, such as infection. This finding is not suggestive of problems with oxygenation and subsequent activity intolerance.
Through the process of hematopoiesis, stem cells differentiate into either myeloid or lymphoid stem cells. Into what do myeloid stem cells further differentiate?
- A. Leukocytes
- B. Natural killer cells
- C. Cytokines
- D. Platelets
- E. Erythrocytes
Correct Answer: A,D,E
Rationale: Myeloid stem cells differentiate into three broad cell types: erythrocytes, leukocytes, and platelets. Natural killer cells and cytokines do not originate as myeloid stem cells.
A nurse is educating a patient about the role of B lymphocytes. The nurses description will include which of the following physiologic processes?
- A. Stem cell differentiation
- B. Cytokine production
- C. Phagocytosis
- D. Antibody production
Correct Answer: D
Rationale: B lymphocytes are capable of differentiating into plasma cells. Plasma cells, in turn, produce antibodies. Cytokines are produced by NK cells. Stem cell differentiation greatly precedes B lymphocyte production.