Nokea
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).
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The nurse is reviewing the laboratory results of clotting study tests for the patient. Which of the following findings should the nurse identify as abnormal?
- A. Activated clotting time 118 seconds
- B. Activated partial thromboplastin time 40 seconds
- C. D-dimer 200 mg/L
- D. Fibrinogen 5 g/L
- E. Prothrombin time 21 seconds
Correct Answer: B,D,E
Rationale: The activated partial thromboplastin time is elevated (normal: 25-35 seconds), fibrinogen is elevated (normal: 2-4 g/L), and the prothrombin time is elevated (normal: 11-16 seconds). The activated clotting time is within normal limits (70-120 seconds). The D-dimer is within normal limits (< 250 ng/mL).
The nurse is providing discharge teaching to a patient who has had an emergency splenectomy following an automobile accident. Which of the following events should the nurse inform the patient that they are at an increased risk of developing?
- A. Infection
- B. Lymphedema
- C. Persistent anemia
- D. Prolonged bleeding
Correct Answer: A
Rationale: The spleen plays a major role in immune function. Splenectomy increases the risk for infection, especially with gram-positive bacteria. The risks for lymphedema, bleeding, and anemia are not increased after splenectomy.
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.
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.
The nurse is caring for a patient who had an intraoperative hemorrhage 12 hours ago. Which of the following laboratory results should the nurse anticipate?
- A. Hematocrit of 45%
- B. Hemoglobin of 132 g/L
- C. Decreased white blood cell (WBC) count
- D. Elevated reticulocyte count
Correct Answer: D
Rationale: Hemorrhage causes the release of more immature RBCs from the bone marrow into the circulation. The hematocrit and hemoglobin levels are normal. The WBC count is not affected by bleeding.