Nokea
The nurse is caring for a patient with pancytopenia of unknown origin who is confused and is scheduled for the following diagnostic tests. Which of the following tests should the nurse contact the patient's family member to obtain a signed consent form?
- A. ABO blood typing
- B. Bone marrow biopsy
- C. Abdominal ultrasound
- D. Complete blood count (CBC)
Correct Answer: B
Rationale: Bone marrow biopsy is a minor surgical procedure that requires the patient or guardian to sign a surgical consent form. The other procedures do not require a signed consent by the patient or family.
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The nurse is caring for a patient who is receiving heparin. Which of the following laboratory tests should the nurse monitor?
- A. Prothrombin time (PT)
- B. Fibrin degradation products (FDP)
- C. International normalized ratio (INR)
- D. Activated partial thromboplastin time (aPTT)
Correct Answer: D
Rationale: aPTT testing is used to determine whether heparin is at a therapeutic level. FDP is useful in diagnosis of problems such as disseminated intravascular coagulation (DIC). PT and INR are most commonly used to test for therapeutic levels of warfarin.
While examining the lymph nodes during physical assessment, the nurse would be most concerned about which of the following findings?
- A. A 2-cm nontender supraclavicular node
- B. A 1-cm mobile and nontender axillary node
- C. An inability to palpate any superficial lymph nodes
- D. Firm inguinal nodes in a patient with an infected foot
Correct Answer: A
Rationale: Enlarged and nontender nodes are most suggestive of malignancy such as lymphoma. Firm nodes are an expected finding in an area of infection. The superficial lymph nodes are usually not palpable in adults, but if they are palpable, they are normally 0.5-1 cm and nontender.
The nurse is reviewing the complete blood count (CBC) for a patient admitted with abdominal pain. Which of the following information will be most important for the nurse to communicate to the health care provider?
- A. Monocytes 4%
- B. Hemoglobin 116 g/L
- C. Platelet count 44 x 10^9/L
- D. White blood cells 13.5 x 10^9/L
Correct Answer: D
Rationale: The elevation in WBCs indicates that an abdominal infection may be the cause of the patient's pain and that further diagnostic testing is needed. The monocytes are at a normal level. The slight decreases in hemoglobin and platelet count also would be reported but would not require any immediate action.
The nurse is evaluating the red cell indices result of a patient's laboratory report. Which of the following interpretations is correct related to a low mean corpuscular volume (MCV)?
- A. Hypochromic red blood cells (RBCs)
- B. Inadequate numbers of RBCs
- C. Low hemoglobin in the RBCs
- D. Small size of the RBCs
Correct Answer: D
Rationale: The MCV is low when the RBCs are smaller than normal. Inadequate numbers of RBCs are an indication of anemia. Low levels of hemoglobin in the RBCs and hypochromic RBCs result in a low mean corpuscular hemoglobin (MCH).
The nurse is caring for a patient whose complete blood count (CBC) and differential indicate that the patient is neutropenic. Which of the following actions should the nurse include in the plan of care?
- A. Avoid intramuscular injections
- B. Encourage increased oral fluids
- C. Check temperature every 4 hours
- D. Increase intake of iron-rich foods
Correct Answer: C
Rationale: Neutropenic patients are at high risk for infection and sepsis and should be monitored frequently for signs of infection. The other actions would not address the patient's neutropenia.