Nokea
The nurse is caring for a patient with von Willebrand disease who is admitted to the hospital for minor knee surgery. Which of the following laboratory information should the nurse assess?
- A. Platelet count
- B. Bleeding time
- C. Thrombin time
- D. Prothrombin time
Correct Answer: B
Rationale: The bleeding time is affected by von Willebrand disease. Platelet count, prothrombin time, and thrombin time are normal in von Willebrand disease.
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The nurse is caring for a patient with anemia who is experiencing increased fatigue and occasional palpitations at rest. Which of the following laboratory findings should the nurse expect?
- A. Normal red blood cell (RBC) indices
- B. Hematocrit (Hct) of 38%
- C. Hemoglobin (Hb) of 86 g/L
- D. RBC count of 4.5 x 10^12/L
Correct Answer: C
Rationale: The patient's clinical manifestations indicate moderate anemia, which is consistent with an Hb of 60-100 g/L. The other values are all within the range of normal.
All of these patients call the outpatient clinic and ask to make an appointment as soon as possible. Which of the following patients should the nurse schedule to be seen first?
- A. 19-year-old with no previous health problems who has a nontender lump in the axilla
- B. 46-year-old with sickle cell anemia who says 'that my eyes always look sort of yellow'
- C. 21-year-old with hemophilia who wants to learn how to self-administer factor VII replacement
- D. 50-year-old with early-stage persistent lymphocytic leukemia who has complaints of persistent fatigue
Correct Answer: A
Rationale: The patient's age and presence of a nontender axillary lump suggest possible lymphoma, which needs rapid diagnosis and treatment. The other patients have questions about treatment or symptoms that are consistent with their diagnosis but do not need to be seen urgently.
The nurse is caring for a patient with idiopathic aplastic anemia. Which of the following collaborative problems should the nurse include when developing the care plan?
- A. Potential complication: seizures
- B. Potential complication: infection
- C. Potential complication: neurogenic shock
- D. Potential complication: pulmonary edema
Correct Answer: B
Rationale: Because the patient with aplastic anemia has pancytopenia, the patient is at risk for infection and bleeding. There is no increased risk for seizures, neurogenic shock, or pulmonary edema.
The nurse is caring for a patient with polycythemia vera. Which of the following actions should the nurse implement during treatment?
- A. Place the patient on bed rest.
- B. Administer iron supplements.
- C. Avoid use of aspirin products.
- D. Monitor fluid intake and output.
Correct Answer: D
Rationale: Monitoring hydration status is essential in polycythemia vera to prevent thrombosis due to increased blood viscosity. Aspirin therapy is used to decrease risk for thrombosis. The patient should be encouraged to ambulate to prevent deep vein thrombosis (DVT). Iron is contraindicated in patients with polycythemia vera.
Which of the following nursing actions should the nurse include in the plan of care for a patient admitted with multiple myeloma?
- A. Monitor fluid intake and output.
- B. Administer calcium supplements.
- C. Assess lymph nodes for enlargement.
- D. Limit weight bearing and ambulation.
Correct Answer: A
Rationale: A high fluid intake and urine output helps prevent the complications of kidney stones caused by hypercalcemia and renal failure caused by deposition of Bence Jones protein in the renal tubules. Weight bearing and ambulation are encouraged to help bone retain calcium. Lymph nodes are not enlarged with multiple myeloma. Calcium supplements will further increase the patient's calcium level and are not used.