Chapter 41: Assessment of Hematologic System NCLEX Exam with suitable question and answers
Chapter 41: Assessment of Hematologic System NCLEX Exam with suitable question and answers 1. The nurse is planning care for a client who has a platelet count of 30,000/mm3. Which intervention does the nurse include in this client's plan of care? a. Bleeding Precautions b. Vital signs every 4 hours c. Isolation Precautions d. Oxygen by nasal cannula: ANS: A The normal platelet count ranges between 150,000 and 400,000/mm3. This client is at extreme risk for bleeding. Although it is necessary to notify the provider, the nurse would first protect the client by instituting Bleeding Precautions. The other interventions are not related to the low platelet count. 2. The nurse is performing an admission assessment on a 46-year-old client, who states, "I have been drinking a 12-pack of beer every day for the past 20 years." Which laboratory abnormality does the nurse correlate with this history? a. Decreased bleeding time b. Elevated red blood cell (RBC) count c. Decreased white blood cell (WBC) count d. Elevated prothrombin time (PT): ANS: D The liver is the site for production of prothrombin and most of the blood-clotting factors. If the liver is damaged because of chronic alcoholism, it is unable to produce these clotting factors. Therefore, the PT could become elevated, which would reflect deficiency of some clotting factors. The WBC would not be elevated in this situation because no infection is present. Bleeding time would likely increase. The client's RBC count most likely would not be affected unless the client was bleeding, in which case it would decrease
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chapter 41 assessment of hematologic system nclex