nurse correlates these findings to which condition?
A. Thrombocytopenia
B. Thrombocytosis
C. Vitamin B12 deficiency anemia
D. Iron-deficiency anemia
Answer: C
Rationale: In addition to symptoms of anemia, including shortness of breath, fatigue, and dizziness,
vitamin B12 deficiency leads to neurologic clinical manifestations such as peripheral neuropathy,
confusion, depression, impaired taste, impaired equilibrium, and visual disturbances.
The nurse observes petechiae and purpura on a newly admitted patient and correlates these findings to which diagnostic
result?
A. Hematocrit: 27%
B. Platelets: 7,000/ µL
C. White blood cells: 5,000/mm3
D. Prothrombin time: 20 sec
Answer: B
Rationale: The normal platelet count is 100,000 to 300,000 and with low platelet counts (7000
in this example), the patient is at increased risk of bleeding. Hematocrit reflects the percentage of red blood cells. White blood count is used to assess for
infection and inflammation. The normal Prothrombin time is 10 to 14 seconds, and a prolonged PT may indicate a lack of clotting factors.
A nurse caring for a patient receiving chemotherapy receives a laboratory result of WBC 1.1
10³/mm3. What is the primary goal for the nurse?
A. Protect the patient from infection
B. Institute isolation precautions
C. Have the patient wear a face mask
D. Restrict the number of visitors the patient
receives
Answer: A
Rationale: Due to the extremely low white blood cell count, the patient is at increased risk of infection due to lack of mature cells to destroy contaminants.
Standard precautions should be effective, and the patient is not required to wear a face mask
unless out in crowds. Visitors should wash hands and not get in close proximity to patients, but
restrictions are not required.
The nurse in an outpatient clinic is scanning the laboratory reports that were just faxed to the office.
A PT reported as an INR of 2.5 is evidence of an appropriate therapeutic outcome for:
A. Mr. Jellicoe, who is undergoing warfarin (Coumadin) therapy
B. Mr. Patterson, who just received 24 hours of subcutaneous heparin injections
C. Mrs. Kerensky, who is scheduled for a liver biopsy
D. Mrs. Monroe, who has a diet rich in vitamin K
Answer: A
Rationale: The INR is used to evaluate the effectiveness of warfarin (Coumadin) therapy and is considered therapeutic when between 2.0 and 3.0. The
INR is not used to assess effectiveness of heparin therapy. This is a high INR and would be a contraindication
for a liver biopsy due to increased
chance of hemorrhage. Increased INR is associated with vitamin K deficiency