Nokea
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).
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The nurse is caring for a newly admitted patient whose complete blood count (CBC) shows a 'shift to the left.' Which of the following assessments should the nurse monitor in the plan of care?
- A. Cool extremities
- B. Pallor and weakness
- C. Elevated temperature
- D. Low oxygen saturation
Correct Answer: C
Rationale: The term shift to the left indicates that the number of immature polymorphonuclear neutrophils, or bands, is elevated and is a sign of severe infection. There is no indication that the patient is at risk for hypoxemia, pallor or weakness, or cool extremities.
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 health care provider performs a bone marrow aspiration from the left posterior iliac crest on a patient with pancytopenia. Which of the following actions should the nurse implement following the procedure?
- A. Elevate the head of the bed to 45 degrees
- B. Apply a sterile Band-Aid at the aspiration site
- C. Use half-inch sterile gauze to pack the wound
- D. Apply a pressure dressing on the aspiration site
Correct Answer: D
Rationale: A pressure dressing is used to cover the aspiration site. The wound after bone marrow biopsy is small and will not be packed with gauze. There is no indication that the head needs to be elevated for this patient.
The health care provider orders an ultrasound of the spleen for a patient who has been in a car accident. Which of the following actions should the nurse take before this procedure?
- A. Check for any iodine allergy
- B. Insert a large-bore IV catheter
- C. Place the patient on NPO status
- D. Assist the patient to a flat position
Correct Answer: D
Rationale: The patient is placed in a flat position before splenic ultrasound. The patient does not have to be NPO or have an IV line. No iodine-containing materials are used for ultrasound.
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.