The nurse is reviewing lab results for a patient and the white blood cell (WBC) count is elevated at 12,000. Which of the following is a cause of increasing WBC count? (Select all that apply)

Trauma

Hyperglycemia

Infection

Inflammation

Steroid Injection

Answer and Explanation

Correct Answer : A,C,D

A.   Trauma can cause an elevated WBC count as part of the body’s response to injury. The immune system reacts to tissue damage by increasing WBC production to facilitate healing and fight potential infections.
B.   Hyperglycemia itself does not directly cause an elevated WBC count. However, it may be associated with conditions like diabetes, where infections are more common. Therefore, while hyperglycemia can occur concurrently with elevated WBC counts, it is not a direct cause of the increase.
C.   Infection is one of the most common causes of an elevated WBC count. The body responds to infections (bacterial, viral, etc.) by increasing WBC production to help combat the invading pathogens.
D.   Inflammation, whether due to autoimmune conditions, allergies, or other causes, can also lead to an increase in WBC count. The inflammatory process triggers the immune response, resulting in elevated levels of white blood cells.
E.   While steroid injections can influence WBC counts, they often cause a redistribution of white blood cells rather than an increase in production. Corticosteroids can cause a decrease in certain types of white blood cells (like lymphocytes) but may increase neutrophils due to a release from the bone marrow.

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Correct Answer is B

Explanation

A. Diabetes Insipidus is primarily related to issues with the production of vasopressin (ADH) or the body's response to it, which is not directly caused by CKD. CKD may lead to fluid retention and imbalances, but it does not typically cause recurrent bouts of diabetes insipidus.
B. In CKD, the kidneys lose their ability to produce erythropoietin, a hormone that stimulates red blood cell production in the bone marrow. Patients often require erythropoiesis-stimulating agents (ESAs) like erythropoietin injections to manage anemia associated with CKD.
C. CKD patients are often hyperkalemic (high potassium levels) rather than hypokalemic. As kidney function declines, the kidneys struggle to excrete potassium, leading to elevated levels, which can cause serious complications.
D. CKD patients often experience hypocalcemia (low calcium levels) due to several factors, including decreased activation of vitamin D and imbalances in phosphate levels. While some patients may experience transient hypercalcemia due to treatments or dietary factors, chronic hypercalcemia is not typical in CKD.

A. Morphine Sulfate 4 mg IV ATC B. Fentanyl 25 mcg/hr transdermal patch Now C. Ibuprofen 800 mg PO D. Hydromorphone liquid 5 mg PO

Correct Answer is A

Explanation

A. Morphine is a strong opioid analgesic that is effective for managing severe pain, especially in acute situations like a vaso-occlusive crisis. Administering it intravenously allows for rapid onset of pain relief, which is critical given the severity of the patient’s symptoms. Continuous dosing (ATC—around the clock) ensures that pain is managed effectively.
B. Fentanyl patches are typically used for chronic pain management and take time to reach effective levels in the bloodstream (up to 12 hours or longer). In the case of acute severe pain from a vaso- occlusive crisis, this option would not provide immediate relief.
C. While ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can help relieve mild to moderate pain, it is not adequate for severe pain management. Additionally, in the setting of sickle cell disease, patients may be at risk for renal issues, making high doses of NSAIDs potentially harmful.
D. Hydromorphone is also a strong opioid analgesic; however, administering it orally may not be effective for severe pain management in an acute situation. IV administration of opioids is preferred for immediate and potent pain relief during a vaso-occlusive crisis.

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The nurse is reviewing lab results for a patient and the white blood cell (WBC) count is elevated at 12,000. Which of the following is a cause of increasing WBC count? (Select all that apply)

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