Prioritization, Delegation, AssignmentHematologicalProblems Chp8 Questions
With Correct Answers 2023
1. You are reviewing the complete blood count for
... [Show More] a patient who has been admitted for
knee arthroscopy. Which value is most important to report to the physician before
surgery?
1. Hematocrit of 33%
2. Hemoglobin level of 10.9 g/dL
3. Platelet count of 426,000/mm3
4. White blood cell count of 16,000/mm3 - ANS-1. Ans: 4. White blood cell count of
16,000/mm3
Centers for Disease Control and Prevention (CDC) guidelines for the prevention of
surgical site infections indicate that surgery should be postponed when there is
evidence of a pre-existing infection such as an elevation in white blood cell count. The
other values are slightly abnormal, but would not be likely to cause postoperative
problems for knee arthroscopy. Focus: Prioritization
2. You are providing orientation for a new RN who is preparing to administer packed red
blood cells (PRBCs) to a patient who had blood loss during surgery. Which action by the
new RN requires that you intervene immediately?
1. Waiting 20 minutes after obtaining the PRBCs before starting the infusion
2. Starting an IV line for the transfusion using a 22-gauge catheter
3. Priming the transfusion set using 5% dextrose in lactated Ringer's solution
4. Telling the patient that the PRBCs may cause a serious transfusion reaction - ANS-2.
Ans: 3 Priming the transfusion set using 5% dextrose in lactated Ringer's solution
Normal saline, an isotonic solution, should be used when priming the IV line to avoid
causing hemolysis of red blood cells (RBCs). Ideally, blood products should be infused
as soon as possible after they are obtained; however, a 20-minute delay would not be
unsafe. Large-bore IV catheters are preferable for blood administration; if a smaller
catheter must be used, normal saline may be used to dilute the RBCs. Although the
new RN should avoid increasing patient anxiety by indicating that a serious transfusion
reaction may occur, this action is not as high a concern as using an inappropriate fluid
for priming the IV tubing. Focus: Prioritization
3. A 32-year-old patient with sickle cell anemia is admitted to the hospital during a sickle
cell crisis. Which action prescribed by the health care provider will you implement first?
1. Give morphine sulfate 4 to 8 mg IV every hour as needed.
2. Administer 100% oxygen using a nonrebreather mask.
3. Start a 14-gauge IV line and infuse normal saline at 200 mL/hr.
4. Give pneumococcal (Pneumovax) and Haemophilus influenzae (ActHIB) vaccines. -
ANS-3. Ans: 2 Administer 100% oxygen using a nonrebreather mask.
Hypoxia and deoxygenation of the RBCs are the most common cause of sickling, so
administration of oxygen is the priority intervention here. Pain control and hydration are
also important interventions for this patient and should be accomplished rapidly.
Vaccination may help prevent future sickling episodes by decreasing the risk of
infection, but it will not help with the current sickling crisis. Focus: Prioritization
4. These activities are included in the care plan for a 78-year-old patient admitted to the
hospital with anemia caused by possible gastrointestinal bleeding. Which activity can
you delegate to an experienced UAP?
1. Obtaining stool specimens for fecal blood test (Hemoccult) slides
2. Having the patient sign a colonoscopy consent form
3. Giving the prescribed polyethylene glycol electrolyte solution (GoLYTELY)
4. Checking for allergies to contrast dye or shellfish - ANS-4. Ans: 1. Obtaining stool
specimens for fecal blood test (Hemoccult) slides
An experienced UAP will have been taught how to obtain a stool specimen for the
Hemoccult slide test, because this is a common screening test for hospitalized patients.
Having the patient sign an informed consent form should be done by the physician who
will be performing the colonoscopy. Administering medications and checking for
allergies are within the scope of practice of licensed nursing staff. Focus: Delegation
5. As charge nurse, you are making the daily assignments on the medical-surgical unit.
Which patient is best assigned to a float nurse who has come from the postanesthesia
care unit (PACU)?
1. 30-year-old patient with thalassemia major who has an order for subcutaneous
infusion of deferoxamine (Desferal)
2. 43-year-old patient with multiple myeloma who requires discharge teaching
3. 52-year-old patient with chronic gastrointestinal bleeding who has returned to the unit
after a colonoscopy
4. 65-year-old patient with pernicious anemia who has just been admitted to the unit -
ANS-5. Ans: 3 52-year-old patient with chronic gastrointestinal bleeding who has
returned to the unit after a colonoscopy
A nurse who works in the PACU will be familiar with the monitoring needed for a patient
who has just returned from a procedure such as a colonoscopy, which requires
conscious sedation. Care of the other patients requires staff with more experience with
various types of hematologic disorders and would be better to assign to nursing
personnel who regularly work on the medical-surgical unit. Focus: Assignment
CONTINUES... [Show Less]