A nurse suspects that a client may have aplastic anemia based on clinical manifestations and assessment. Which one of the following lab results would be consistent with this diagnosis?

Hemoglobin level of 15 g/dL (range 12 to 16 g/dL)

Platelet level of 275,000/mm3 (range 150,000-400,000 per mm3)

White blood cell count 1100 cells/mm3 (range 5000-10,000 cells/mm3)

Erythrocyte count 5.1 cells/mL (range 4.2-5.4 cells/mL)

Answer and Explanation

The Correct Answer is C

Reasoning:

Choice A reason: A hemoglobin level of 15 g/dL is within the normal range and not consistent with aplastic anemia, which causes pancytopenia, including low hemoglobin due to bone marrow failure. Normal hemoglobin suggests adequate red blood cell production, ruling out aplastic anemia as the primary diagnosis.

Choice B reason: A platelet level of 275,000/mm3 is normal and does not support aplastic anemia, which involves bone marrow failure, leading to thrombocytopenia (low platelets). Normal platelet counts indicate intact megakaryocyte function, inconsistent with the pancytopenia characteristic of aplastic anemia’s bone marrow suppression.

Choice C reason: A white blood cell count of 1100 cells/mm3 indicates leukopenia, a hallmark of aplastic anemia. Bone marrow failure reduces production of all blood cell lines, including leukocytes, leading to low white cell counts, increasing infection risk, and supporting the diagnosis of aplastic anemia in this context.

Choice D reason: An erythrocyte count of 5.1 cells/mL is normal and not indicative of aplastic anemia, which causes anemia through reduced red blood cell production. Normal erythrocyte counts suggest preserved erythropoiesis, which is inconsistent with the pancytopenia expected in aplastic anemia’s bone marrow failure.

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Correct Answer is D

Explanation

Reasoning:

Choice A reason: Continuous oxygen therapy is not a standard preventive measure for sickle cell crises. Oxygen is used during acute crises to treat hypoxia from vaso-occlusion, but daily hydration is more effective for prevention, as it reduces blood viscosity and sickling, making this inappropriate.

Choice B reason: Avoiding all sports is overly restrictive for sickle cell anemia. Moderate exercise can be safe with proper hydration and rest. Complete avoidance does not directly prevent crises and may reduce quality of life, whereas hydration directly addresses the risk of sickling and vaso-occlusion.

Choice C reason: Avoiding activities causing shortness of breath is partially correct, as overexertion can trigger hypoxia and crises. However, it is less specific than hydration, which directly reduces blood viscosity and sickling, preventing crises more effectively across various situations, not just during exertion.

Choice D reason: Drinking at least 8 glasses of water daily is critical in sickle cell anemia to prevent crises. Adequate hydration reduces blood viscosity, preventing red blood cell sickling and vaso-occlusion. Dehydration increases sickling risk, making consistent fluid intake a key preventive strategy for this client.

A. A client with extensive burns B. A client who has a diagnosis of acute respiratory distress syndrome C. A client who suffered multiple trauma in a workplace accident D. A client who is being treated for septic shock

Correct Answer is D

Explanation

Reasoning:

Choice A reason: Extensive burns can trigger DIC through tissue damage and inflammation, releasing procoagulants that activate clotting. However, the risk is lower than in septic shock, as burns primarily cause localized injury, and systemic coagulopathy is less intense unless complicated by secondary infection or severe hypoperfusion.

Choice B reason: Acute respiratory distress syndrome (ARDS) may contribute to DIC through inflammation and hypoxia, but it is not the primary driver. ARDS affects lung function, and coagulopathy is secondary to underlying causes like sepsis, which has a more direct and potent effect on widespread clotting activation.

Choice C reason: Multiple trauma increases DIC risk through tissue injury and blood loss, activating coagulation pathways. However, septic shock has a higher risk due to systemic infection driving intense inflammatory and coagulative responses, consuming platelets and clotting factors more aggressively, leading to a greater likelihood of DIC.

Choice D reason: Septic shock poses the highest DIC risk, as systemic infection triggers massive cytokine release and endothelial damage, activating the coagulation cascade. This leads to widespread microthrombi, consuming platelets and clotting factors, causing both thrombosis and bleeding, making septic shock the most likely precipitant in ICU clients.

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A nurse suspects that a client may have aplastic anemia based on clinical manifestations and assessment. Which one of the following lab results would be consistent with this diagnosis?

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Explanation

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