Nursing Elites

1. The nurse notes scleral jaundice in a patient being admitted with hemolytic anemia. The nurse will plan to check the laboratory results for the

• A. Schilling test
• B. bilirubin level
• C. gastric analysis
• D. stool occult blood

Correct answer: B

Rationale: The correct answer is B: bilirubin level. Jaundice, characterized by scleral jaundice, is caused by the elevation of bilirubin levels associated with red blood cell hemolysis. Checking the bilirubin level in the laboratory results will help assess the severity of jaundice in the patient. Choices A, C, and D are incorrect because the Schilling test is used to assess vitamin B12 absorption, gastric analysis is used to evaluate gastric function, and stool occult blood is used to detect hidden blood in the stool, which are not directly related to evaluating jaundice in a patient with hemolytic anemia.

2. A patient in the emergency department complains of back pain and difficulty breathing 15 minutes after a transfusion of packed red blood cells is started. The nurse's first action should be to

• A. administer oxygen therapy at a high flow rate
• B. obtain a urine specimen to send to the laboratory
• C. notify the healthcare provider about the symptoms
• D. disconnect the transfusion and infuse normal saline

Correct answer: D

Rationale: The patient's symptoms, back pain, and difficulty breathing after the transfusion indicate a possible acute hemolytic reaction, a severe transfusion reaction. The priority action in this situation is to discontinue the transfusion immediately to prevent further complications. Infusing normal saline helps maintain the patient's intravascular volume and prevent renal damage. Administering oxygen or obtaining a urine specimen is not the most urgent action and could delay essential treatment. Notifying the healthcare provider is important but should come after ensuring the patient's safety by stopping the blood transfusion.

3. A 62-year-old man with chronic anemia is experiencing increased fatigue and occasional palpitations at rest. The nurse would expect the patient's laboratory test findings to include

• A. an RBC count of 4,500,000/μL.
• B. a hematocrit (Hct) value of 38%.
• C. normal red blood cell (RBC) indices.
• D. a hemoglobin (Hgb) of 8.6 g/dL.

Correct answer: B

Rationale: The correct answer is B. In chronic anemia, the hematocrit (Hct) value is a crucial indicator of the proportion of red blood cells in the blood. A hematocrit value of 38% indicates a lower than normal level of red blood cells, which aligns with the patient's symptoms of fatigue and palpitations. Choices A, C, and D are incorrect because a low RBC count, normal RBC indices, and a hemoglobin level of 8.6 g/dL do not specifically address the decreased red blood cell mass associated with chronic anemia.

4. The nurse notes pallor of the skin and nail beds in a newly admitted patient. The nurse should ensure that which laboratory test has been ordered?

• A. Platelet count
• B. Neutrophil count
• C. Hemoglobin level
• D. White blood cell count

Correct answer: C

Rationale: The correct answer is C, 'Hemoglobin level.' Pallor of the skin and nail beds is a sign of anemia, which is characterized by a low hemoglobin level. Anemia is a condition where there is a decreased number of red blood cells or hemoglobin in the blood, leading to reduced oxygen-carrying capacity. Checking the hemoglobin level would help confirm the presence and severity of anemia, guiding further diagnostic and treatment interventions. Choices A, B, and D are incorrect because platelet count, neutrophil count, and white blood cell count are not typically associated with the pallor of the skin and nail beds, which are more indicative of an underlying anemic condition.

5. The complete blood count (CBC) indicates that a patient is thrombocytopenic. Which action 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: A

Rationale: The correct action to include in the plan of care for a thrombocytopenic patient is to avoid intramuscular injections. Thrombocytopenia is a condition characterized by a decreased number of platelets, which are essential for blood clotting. Intramuscular injections can pose a risk of bleeding in patients with low platelet counts. Encouraging increased oral fluids (choice B) is beneficial for hydration but does not directly address the risk of bleeding associated with thrombocytopenia. Checking temperature every 4 hours (choice C) is important for monitoring infection but does not specifically address the risk of bleeding. Increasing intake of iron-rich foods (choice D) is more related to addressing anemia, not the primary concern of bleeding in thrombocytopenia.

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