You are reviewing the complete blood count (CBC) for a client who has been admitted for knee arthroscopy. Which value is most important to report to the physician prior to surgery?

Correct Answer: A

Rationale: In this scenario, the most important value to report to the physician prior to surgery is option A) White blood cell count 16,000/mm³. A high white blood cell count (leukocytosis) can indicate an ongoing infection or inflammation in the body, which could increase the risk of complications during surgery. In the context of knee arthroscopy, where the risk of infection is a concern, an elevated white blood cell count should be promptly addressed by the physician to ensure the patient's safety. Option B) Hematocrit 33% is not as urgent to report before surgery as an elevated white blood cell count. While hematocrit levels can provide information about the patient's blood volume and oxygen-carrying capacity, a slight decrease in hematocrit is not typically a direct contraindication for surgery. Option C) Platelet count 426,000/mm³ is also not as critical to report immediately before surgery as an elevated white blood cell count. Platelet count is vital for blood clotting, but a slightly high platelet count is less likely to impact the immediate surgical outcomes compared to a high white blood cell count. Option D) Hemoglobin 10.9 g/dL, although it provides information about the patient's oxygen-carrying capacity, is not as urgent to report as an elevated white blood cell count in the context of preparing for surgery. While hemoglobin levels are important for assessing anemia and oxygen delivery, a slightly low hemoglobin level may not be an immediate concern for surgery unless it significantly affects the patient's overall health status. In an educational context, understanding the significance of various components of a complete blood count (CBC) and their implications in different clinical scenarios is crucial for healthcare providers to make informed decisions and provide safe patient care. Recognizing the importance of specific CBC values in preoperative assessments helps healthcare professionals identify potential risks and take appropriate actions to optimize patient outcomes.

Correct Answer: C

Rationale: In this scenario, the correct answer is option C: a 52-year-old client with chronic gastrointestinal bleeding who has returned to the unit after a colonoscopy. This assignment is best suited for a nurse who has floated from the post-anesthesia care unit (PACU) because this client may require close monitoring due to potential complications post-colonoscopy, such as bleeding, changes in vital signs, or need for immediate interventions. Nurses from the PACU are skilled in monitoring and managing clients post-procedure, making them ideal for this assignment. Option A (thalassemia major with deferoxamine infusion) would be better suited for a nurse familiar with administering specific medications and managing chronic conditions like thalassemia. Option B (multiple myeloma discharge teaching) requires knowledge of oncology and patient education. Option D (pernicious anemia admission) would benefit from a nurse experienced in managing hematological disorders and performing initial assessments. Educationally, understanding the rationale behind assigning specific patients to nurses based on their expertise is crucial for ensuring optimal patient outcomes and efficient use of staff resources. This question helps reinforce the importance of appropriate nurse-to-patient assignments based on individual patient needs and nurse competencies.

Correct Answer: B

Rationale: In this scenario, the immediate intervention required as the charge nurse is option B, where the LPN positions cold packs on the client's knees. This action is contraindicated in sickle cell crisis as cold can exacerbate vaso-occlusive pain and potentially worsen the client's condition. Option A is not the immediate concern as encouraging the client to use the ordered PCA (patient-controlled analgesia) is appropriate for managing severe pain in a sickle cell crisis. Option C, placing a 'No Visitors' sign, is not urgent and can be addressed later based on the client's condition and hospital policy. Option D, checking the client's temperature every 2 hours, is a routine nursing task and does not require immediate intervention in this situation. Educationally, this question highlights the importance of understanding the specific care needs of clients with sickle cell crisis. It emphasizes the need for nurses to have knowledge of appropriate interventions and contraindications to ensure safe and effective care for these patients. This scenario also underscores the significance of prompt intervention in critical situations to prevent potential harm to the client.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Transfuse Factor VII concentrate. The priority in a client with hemophilia A, a disorder where there is a deficiency in factor VIII, is to address the bleeding risk. Factor VII concentrate helps replace the deficient clotting factor, aiding in hemostasis and preventing further bleeding complications. This intervention is crucial in managing hemophilia-related bleeding, especially in the setting of a traumatic injury like a car accident. Option A) Transport to radiology for C-spine x-rays is not the priority as assessing the C-spine can wait until the bleeding risk is addressed. Option C) Type and cross-match for 4 units RBCs is not the priority as addressing the clotting factor deficiency takes precedence over potential blood transfusions. Option D) Infuse normal saline at 250 mL/hour is not the priority as it does not address the underlying issue of hemophilia and bleeding risk. Educationally, this question highlights the importance of prioritizing interventions based on the client's condition, emphasizing the critical nature of addressing the underlying pathophysiology in emergencies. Understanding the specific management strategies for clients with hemophilia is essential in providing safe and effective care in emergency situations.

Correct Answer: C

Rationale: The correct answer is C) The client's oxygen saturation is 87%. In a client with disseminated intravascular coagulation (DIC) associated with a gram-negative infection, a low oxygen saturation level of 87% indicates hypoxemia, which is a critical situation requiring immediate intervention. Hypoxemia can lead to tissue hypoxia, worsening the coagulation abnormalities in DIC. Therefore, addressing the oxygen saturation level is a priority to prevent further complications. Option A) There is no palpable radial or pedal pulse may suggest impaired circulation but does not address the immediate threat of hypoxemia in this scenario. Option B) The client complains of chest pain is concerning for a possible cardiac event, but hypoxemia takes precedence in the context of DIC and a gram-negative infection. Option D) There is mottling of the hands and feet is indicative of poor perfusion, which is important but not as immediately critical as addressing hypoxemia in this situation. In an educational context, understanding prioritization of care based on the client's condition is crucial for nurses, especially when dealing with complex conditions like DIC. Recognizing and addressing the most critical assessment findings promptly can significantly impact patient outcomes.