Nokea
Which of the following laboratory information should the nurse monitor to detect heparin-induced thrombocytopenia (HIT) in a patient who is receiving a continuous heparin infusion?
- A. Prothrombin time
- B. Erythrocyte count
- C. Fibrinogen degradation products
- D. Activated partial thromboplastin time
Correct Answer: D
Rationale: Platelet aggregation in HIT causes neutralization of heparin so that the activated partial thromboplastin time will be shorter and more heparin will be needed to maintain therapeutic levels. The other data will not be affected by HIT.
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The nurse is caring for a patient with myelodysplastic syndrome who has 20% blasts in marrow and the health care provider has prescribed high-intensity treatment. Which of the following treatments should the nurse prepare the patient to receive?
- A. Antibiotics
- B. Antifungals
- C. Chemotherapy
- D. A blood transfusion
Correct Answer: C
Rationale: Low-risk patients (<5% blasts in marrow) can often be treated with transfusions, antibiotics, antifungals, EPO, and hematopoietic growth factors. High-risk patients (<5% blasts in marrow) may be treated with single-agent chemotherapy (e.g., hydroxyurea) or intensive chemotherapy as in AML.
The nurse is caring for a patient who is hospitalized for treatment of severe hemolytic anemia. Which of the following actions should the nurse implement?
- A. Provide a diet high in vitamin K.
- B. Place the patient on protective isolation.
- C. Alternate periods of rest and activity.
- D. Teach the patient how to avoid injury.
Correct Answer: C
Rationale: Nursing care for patients with anemia should alternate periods of rest and activity to encourage activity without causing undue fatigue. There is no indication that the patient has a bleeding disorder, so a high vitamin K diet or teaching about how to avoid injury is not needed. Protective isolation might be used for a patient with aplastic anemia, but it is not indicated for hemolytic anemia.
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 who has a history of a transfusion-related acute lung injury (TRALI) and is to receive a transfusion of packed red blood cells (PRBCs). Which of the following actions should the nurse take to decrease the risk for TRALI for this patient?
- A. Infuse the PRBCs slowly over 4 hours.
- B. Transfuse only leukocyte-reduced PRBCs.
- C. Administer the scheduled oral diuretic before the transfusion.
- D. Give the PRN dose of antihistamine before starting the transfusion.
Correct Answer: B
Rationale: TRALI is caused by a reaction between the donor and the patient leukocytes that causes pulmonary inflammation and capillary leaking. The other actions may help prevent respiratory condition caused by circulatory overload or by allergic reactions, but they will not prevent TRALI.
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.