1.            The nurse is caring for a patient who is being discharged after an emergency splenectomy following an automobile accident. Which instructions should the nurse include in the discharge teaching?

a.            Watch for excess bruising.

b.            Check for swollen lymph nodes.

c.             Take iron supplements to prevent anemia.

d.            Wash hands and avoid persons who are ill.

ANS: D

Splenectomy increases the risk for infection, especially with gram-positive bacteria. The risks for lymphedema, bleeding, and anemia are not increased after a person has a splenectomy.

2.            The nurse assesses a patient who has numerous petechiae on both arms. Which question should the nurse ask the patient?

a.            Do you take salicylates?

b.            Are you taking any oral contraceptives?

c.             Have you been prescribed antiseizure drugs?

d.            How long have you taken antihypertensive drugs?

ANS: A

Salicylates interfere with platelet function and can lead to petechiae and ecchymoses. Antiseizure drugs may cause anemia, but not clotting disorders or bleeding. Oral contraceptives increase a persons clotting risk. Antihypertensives do not usually cause problems with decreased clotting.

3.            A nurse reviews the laboratory data for an older patient. The nurse would be most

concerned about which finding?

a.            Hematocrit of 35%

b.            Hemoglobin of 11.8 g/dL

c.             Platelet count of 400,000/L

d.            White blood cell (WBC) count of 2800/L

ANS: D

Because the total WBC count is not usually affected by aging, the low WBC count in this patient would indicate that the patients immune function may be compromised and the underlying cause of the problem needs to be investigated. The platelet count is normal. The slight decrease in hemoglobin and hematocrit are not unusual for an older patient.

4.            A patient with pancytopenia has a bone marrow aspiration from the left posterior iliac crest. Which action would be important for the nurse to take after the procedure?

a.            Elevate the head of the bed to 45 degrees.

b.            Apply a sterile 2-inch gauze dressing to the site.

c.             Use a half-inch sterile gauze to pack the wound.

d.            Have the patient lie on the left side for 1 hour.

ANS: D

To decrease the risk for bleeding, the patient should lie on the left side for 30 to 60 minutes. After a bone marrow biopsy, the wound is small and will not be packed with gauze. A pressure dressing is used to cover the aspiration site. There is no indication to elevate the patients head.

5.            The nurse assesses a patient with pernicious anemia. Which assessment finding would the nurse expect?

a.            Yellow-tinged sclerae

b.            Shiny, smooth tongue

c.             Numbness of the extremities

d.            Gum bleeding and tenderness

ANS: C

Extremity numbness is associated with cobalamin (vitamin B12) deficiency or pernicious anemia. Loss of the papillae of the tongue occurs with chronic iron deficiency. Yellow-tinged sclera is associated with hemolytic anemia and the resulting jaundice. Gum bleeding and tenderness occur with thrombocytopenia or neutropenia.

6.            A patients complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding?

a.            Have you had a recent weight loss?

b.            Do you have any history of lung disease?

c.             Have you noticed any dark or bloody stools?

d.            What is your dietary intake of meats and protein?

ANS: B

The hemoglobin and hematocrit results indicate polycythemia, which can be associated with chronic obstructive pulmonary disease (COPD). The other questions would be appropriate for patients who are anemic.

7.            The nurse is reviewing laboratory results and notes an aPTT level of 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication?