Which of the following sign is associated with anaemia?

Correct Answer: B

Rationale: The correct answer is B: Palmer pallor. Pallor refers to paleness of the skin, and Palmer pallor specifically refers to paleness of the palms. In the context of anaemia, a common symptom is pallor due to decreased red blood cells and oxygen-carrying capacity. Insomnia (choice A), fever (choice C), and angina (choice D) are not typically associated with anaemia. Insomnia is a sleep disorder, fever indicates an infection or inflammation, and angina is chest pain due to reduced blood flow to the heart. So, Palmer pallor is the most relevant sign to indicate anaemia among the given choices.

Correct Answer: A

Rationale: The correct answer is A: Jaundice. Jaundice is a yellowing of the skin and whites of the eyes due to high levels of bilirubin in the blood, which can occur when red blood cells are being destroyed rapidly. Bilirubin is a byproduct of the breakdown of red blood cells. Therefore, the presence of jaundice indicates excessive red blood cell destruction. Summary: - B: Bleeding is not directly related to the destruction of red blood cells. - C: Diarrhea does not typically indicate red blood cell destruction. - D: Cyanosis is a bluish discoloration of the skin due to lack of oxygen, not directly linked to red blood cell destruction.

Correct Answer: A

Rationale: The correct answer is A: Observe for bleeding. After a bone marrow biopsy, the most crucial nursing action is monitoring for bleeding, as this procedure can cause significant bleeding due to the penetration of bone. It is essential to assess for any signs of bleeding such as increased pain, swelling, bruising, or hematoma formation. Prompt identification and management of bleeding are vital to prevent complications such as hematoma formation or hemorrhage. Encouraging oral fluids (B) and administering analgesics (C) are important but not as critical as monitoring for bleeding. Monitoring the puncture site for infection (D) is also important but is a secondary concern compared to assessing for bleeding immediately post-procedure.

Correct Answer: C

Rationale: The correct answer is C: Follow the organization's verification process. This approach ensures patient safety by using a systematic verification process to match the blood product with the patient, including checking the patient's identification, verifying the order, and confirming the blood product before administration. Checking the patient's arm band (A) may not be sufficient for blood product verification. Checking the order on the medical record (B) is important but may not involve the necessary steps to ensure correct blood matching. Assuming the correct blood was provided (D) is dangerous and can lead to serious consequences if an error occurs.

Correct Answer: D

Rationale: The correct answer is D because the dye used in lymphangiography can cause bluish skin and urine for up to 2 days. This is a known side effect of the procedure and is not a cause for concern. Choice A is incorrect because dismissing the patient's concern without explanation is not appropriate. Choice B is incorrect because there is no need to notify the RN and physician immediately for this known side effect. Choice C is incorrect because the blue urine does not necessarily indicate abnormal results, but rather a normal reaction to the dye used.