In the process of admitting Mr. Johnson, the nurse observes multiple bruising, especially on the hands and forearms. These bruises are referred to as

Correct Answer: D

Rationale: In the scenario presented, the correct answer is D) ecchymoses. Ecchymoses are large, non-elevated bruises caused by the leakage of blood into the skin due to damaged blood vessels. This is a common manifestation in conditions such as thrombocytopenia or coagulopathies, where there is a decreased ability to clot blood, leading to easy bruising. Option A) erythropoiesis refers to the process of red blood cell production and is not directly related to bruising. Option B) leukoplakia is a condition affecting the mucous membranes, characterized by white patches, and is not associated with bruising. Option C) megakaryocytic hyperplasia is an increase in the production of platelet precursor cells, which would actually lead to increased platelet count and reduced bruising tendency. In an educational context, understanding the clinical significance of different types of bruising can help healthcare providers in diagnosing underlying conditions such as hematological disorders or coagulopathies. Recognizing ecchymoses can prompt further investigations to determine the cause and initiate appropriate management, highlighting the importance of keen observation and clinical assessment skills in patient care.

Correct Answer: B

Rationale: In the case of Mr. D. presenting with DIC due to pelvic and chest injuries, the correct preparation is intravenous heparin administration. DIC is characterized by widespread activation of coagulation pathways, leading to both thrombosis and hemorrhage. Heparin, an anticoagulant, helps prevent further clot formation in DIC by inhibiting clotting factors. Option A, administration of furosemide, is incorrect as it is a diuretic that does not address the underlying coagulation abnormalities in DIC. Option C, thoracentesis, is a procedure to remove fluid from the pleural space and is not directly related to managing DIC. Option D, gastroscopy, is a procedure to visualize the upper gastrointestinal tract and is not the appropriate intervention for DIC. Educationally, understanding the pathophysiology of DIC and the role of heparin in managing this condition is crucial for healthcare professionals, especially those in hematology/oncology. This knowledge helps in timely and appropriate management of patients like Mr. D. to improve outcomes and prevent further complications associated with DIC.

Correct Answer: C

Rationale: The correct answer is option C: The new RN primes the transfusion set using 5% dextrose in lactated Ringer's solution. This action is incorrect because blood products like PRBCs should only be infused using normal saline (0.9% sodium chloride) and never with dextrose solutions. Infusing blood products with dextrose can cause the red blood cells to hemolyze, leading to serious complications for the patient. Option A is not the best practice as there is no need to wait 20 minutes after obtaining PRBCs before starting the infusion. Timely administration is crucial for patients requiring blood transfusions. Option B is suboptimal because a larger gauge catheter (usually 18-20 gauge) is recommended for blood transfusions to prevent hemolysis and ensure a smooth flow of blood products. Option D is not ideal because it is important for the nurse to provide accurate and reassuring information to the patient about the transfusion process. Informing the patient about potential risks is part of informed consent and should be done in a supportive and educational manner. Educationally, this question highlights the importance of proper blood transfusion practices, including the choice of IV solution, catheter gauge selection, and patient education. Nurses must adhere to evidence-based guidelines to ensure patient safety and positive outcomes during blood transfusions.

Correct Answer: A

Rationale: The correct answer is A) Use Hemoccult slides to obtain stool specimens because this task involves collecting a sample for testing, which is within the scope of practice for a nursing assistant. Nursing assistants are trained to perform basic tasks like specimen collection under the supervision of licensed healthcare professionals. Option B) Having the client sign a colonoscopy consent form requires explanation of the procedure, potential risks, and benefits, which is beyond the nursing assistant's scope of practice. Option C) Administering PEG-ES bowel preparation involves medication administration, which should be done by a licensed nurse who has the knowledge and training to assess the client's response and manage any potential side effects. Option D) Checking for allergies to contrast dye or shellfish requires knowledge of allergies, potential reactions, and appropriate interventions, which should be done by a licensed healthcare provider who can make clinical judgments. Educationally, understanding the scope of practice for different healthcare team members is crucial for effective delegation and ensuring safe and efficient patient care. Nursing assistants play a vital role in supporting the healthcare team by performing delegated tasks within their scope of practice, contributing to optimal patient outcomes.

Correct Answer: A

Rationale: The correct answer is A) The client with digoxin toxicity. When a client presents with pancytopenia, it indicates a decrease in all three blood cell types (red blood cells, white blood cells, and platelets). Digoxin toxicity can cause bone marrow suppression leading to pancytopenia. By rooming the new client with digoxin toxicity, you are pairing them with a peer who shares a common underlying cause for their condition, potentially facilitating understanding and support between the two individuals. The other options are incorrect because they do not have a direct correlation to pancytopenia. The client with viral pneumonia is experiencing a respiratory infection, the client with shingles has a viral skin rash, and the client with cellulitis has a bacterial skin infection. These conditions do not typically cause pancytopenia and would not provide the same level of shared experience and potential mutual support as the client with digoxin toxicity. In an educational context, this question highlights the importance of understanding the underlying causes of hematologic disorders and their potential implications for patient care and management. It also emphasizes the significance of creating supportive environments for clients with similar health conditions to foster empathy, shared experiences, and potentially better outcomes through peer support.