The nurse is triaging several patients in an urgent care center. One patient states that he has hemophilia and is bleeding, with no apparent signs of bleeding. Which priority action by the nurse is most appropriate at this time?
Have the patient take a number and stay in the waiting area.
Place the patient in an examination room immediately and notify the physician of a potential bleeding crisis.
Send the patient for routine x-rays to locate the source of bleeding and place him in an examination room.
Palpate the suspected area of bleeding for tenderness and edema.
The Correct Answer is B
A. Have the patient take a number and stay in the waiting area. Delaying care could lead to worsening of a potentially life-threatening bleeding episode. Hemophilia patients should be assessed promptly.
B. Place the patient in an examination room immediately and notify the physician of a potential bleeding crisis. Hemophilia patients are at risk of internal bleeding, which may not always be visible externally. Rapid assessment is essential to prevent complications from internal bleeding.
C. Send the patient for routine x-rays to locate the source of bleeding and place him in an examination room. X-rays may not immediately detect bleeding in soft tissues. The physician should evaluate the patient first.
D. Palpate the suspected area of bleeding for tenderness and edema. Palpating could worsen bleeding or cause pain, and the nurse should focus on ensuring the patient is seen promptly by the physician.
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Correct Answer is C
Explanation
A. Cryoprecipitates: Cryoprecipitates contain fibrinogen, factor VIII, von Willebrand factor, and factor XIII, and are typically used for patients with specific factor deficiencies, such as hemophilia or fibrinogen deficiency, rather than general clotting disorders.
B. Frozen Packed Red Blood Cells (PRBCs): PRBCs are primarily used to treat anemia and to increase oxygen-carrying capacity, not to correct clotting factor deficiencies.
C. Fresh frozen plasma (FFP): Fresh frozen plasma (FFP) contains clotting factors and is administered to patients with clotting disorders to help manage bleeding by replenishing these factors.
D. Platelets: Platelets are administered to patients with thrombocytopenia or platelet dysfunction, not to replace clotting factors as needed in general clotting disorders.
Correct Answer is C
Explanation
A. Red blood cells (RBCs) 5.0 million/mm³ (F 4.2–5.4; M 4.7–6.1): This RBC count is within normal limits and does not indicate a concern related to thrombocytopenia.
B. Hemoglobin 14.5 g/100 mL (F 12–16; M 14–18): Hemoglobin is within normal limits and is not an immediate concern for a patient with ITP, as thrombocytopenia primarily affects platelets, not hemoglobin levels.
C. Platelets 50,000/mm³ (150,000–400,000): A platelet count of 50,000/mm³ is significantly below the normal range and poses a risk for bleeding, which is the primary concern in ITP (immune thrombocytopenic purpura).
D. White blood cells (WBCs) 7,400/mm³ (5,000–10,000): The WBC count is normal and not directly related to thrombocytopenia in ITP, which specifically affects platelets.