When removing a contaminated gown, what should be the first thing touched by the nurse?

Correct Answer: A

Rationale: When removing a contaminated gown, the nurse should ensure the first thing touched is the waist tie and neck tie at the back of the gown. This procedure helps prevent contamination by ensuring that the outer surface of the gown, which is likely to be contaminated, is not touched during removal. By touching the back ties first, the nurse minimizes the risk of transferring any contaminants to themselves or the environment.

Correct Answer: A

Rationale: Massaging a reddened area can cause further tissue damage by increasing pressure on already compromised skin. The other options, such as using specialized mattresses, adhering to repositioning schedules, and maintaining good skin care, are all recommended strategies to prevent pressure ulcers by reducing pressure and friction on vulnerable areas of the skin.

Correct Answer: B

Rationale: Before administering a blood transfusion, it is crucial to perform blood typing and cross-matching to ensure compatibility between the donor's blood and the recipient's blood. This process helps prevent adverse reactions such as transfusion reactions, which can be life-threatening. Prothrombin and coagulation time, bleeding and clotting time, as well as CBC and electrolyte levels are important tests in other clinical contexts, but for blood transfusions, blood typing and cross-matching are essential to ensure patient safety.

Correct Answer: B

Rationale: A platelet count is primarily used to assess the risk of bleeding. Platelets play a crucial role in blood clotting, so a low platelet count can lead to an increased risk of bleeding. Monitoring platelet levels helps healthcare providers evaluate a patient's ability to form clots and manage bleeding.

Correct Answer: D

Rationale: The correct answer is D (25,000/mm³) because leukocytosis is clinically defined as a white blood cell (WBC) count significantly higher than the normal range, which typically spans **4,500–11,000/mm³** in adults. A count of 25,000/mm³ is **well above this upper limit**, strongly indicating an abnormal proliferation of WBCs, often due to infections (e.g., bacterial), inflammatory conditions, leukemia, or severe stress. This level of elevation is unambiguous and requires immediate clinical investigation. **Why the other choices are incorrect:** - **A (4,500/mm³):** This falls at the **lower end of the normal range** (4,500–11,000/mm³) and does not suggest leukocytosis. In fact, it could indicate leukopenia (low WBC count) if it were any lower, but at this value, it is simply within the normal spectrum. - **B (7,000/mm³):** This is **squarely within the normal range** and represents a healthy WBC count. While minor fluctuations can occur due to factors like exercise or mild infections, this value does not raise clinical concern for leukocytosis. - **C (10,000/mm³):** Although this is at the **upper threshold of normal**, it does not definitively indicate leukocytosis. Some individuals may have baseline WBC counts near this level without pathology. Only persistent or markedly elevated counts (typically >11,000/mm³) are diagnostically significant. **Key distinctions:** - **Normal vs. Abnormal:** Leukocytosis requires a clear deviation from the reference range. While slight elevations (e.g., 10,500/mm³) may sometimes be labeled as leukocytosis in clinical contexts, **25,000/mm³ is unequivocally pathological**. - **Clinical Context Matters:** Stress, medications, or pregnancy can cause mild WBC increases, but extreme counts (like 25,000/mm³) often point to severe infections (e.g., sepsis), hematologic disorders, or tissue damage. - **Differential Diagnosis:** Lower values (A–C) might not warrant intervention, whereas D demands further tests (e.g., peripheral smear, differential count) to identify the underlying cause. This explanation underscores the importance of understanding both the numerical thresholds and the clinical implications of WBC counts in diagnosing leukocytosis.