# A 38-year-old patient with unexplained pancytopenia is scheduled for a bone marrow biopsy to evaluate for possible myelodysplastic syndrome. Which nursing intervention is most important to implement before the procedure?

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> subject: Adult Health

## 문제

A 38-year-old patient with unexplained pancytopenia is scheduled for a bone marrow biopsy to evaluate for possible myelodysplastic syndrome. Which nursing intervention is most important to implement before the procedure?

A 62-year-old patient with suspected leukemia is scheduled for a bone marrow biopsy to confirm the diagnosis and determine the specific type of blood disorder.

## 보기

1. Verify that informed consent has been obtained and documented **✔ 정답**
2. Administer prophylactic antibiotics as ordered
3. Position the patient in a supine position
4. Apply topical anesthetic to the biopsy site

**정답: 1**

## 해설

Verifying informed consent is the most critical pre-procedure intervention, as it is a legal and ethical requirement for any invasive procedure like bone marrow biopsy. Other interventions (antibiotics, positioning, anesthetic) are secondary without proper consent.

## 심화 해설

Clinical Context and Rationale

Before any invasive procedure such as a bone marrow biopsy, the nurse's primary responsibility is ensuring patient safety through legal and ethical preparation. A bone marrow biopsy involves penetrating the bone (typically the posterior iliac crest) with a large-bore needle to aspirate liquid marrow and obtain a solid core specimen. This procedure carries risks including bleeding, infection, and pain, and it is performed to diagnose conditions like myelodysplastic syndrome or leukemia when unexplained pancytopenia is present.

Why Informed Consent is the Priority

Verifying that informed consent has been obtained and documented is the most critical pre-procedure nursing intervention. This is a legal and ethical mandate that must be completed before any invasive diagnostic test. The consent process ensures the patient understands the purpose of the biopsy, the steps involved, potential complications (such as bleeding, infection, or pain), and alternative options. Without verified consent, the procedure cannot legally proceed. The nurse acts as a patient advocate by confirming the consent form is signed, dated, and witnessed, and that the patient can verbalize understanding of what will occur.

Analysis of Other Options

Administering prophylactic antibiotics is not a standard pre-procedure intervention for bone marrow biopsy. This procedure is performed under sterile technique, and routine antibiotic prophylaxis is not indicated unless the patient has specific risk factors such as severe neutropenia or a prosthetic joint, which are not mentioned in the scenario. Positioning the patient is an important step but occurs after consent verification and final procedural time-out. The position—typically prone or lateral decubitus for a posterior iliac crest approach—is secondary to ensuring legal preparation. Applying a topical anesthetic is insufficient for the deep bone penetration involved in marrow aspiration; local anesthetic (e.g., lidocaine) is injected by the provider performing the procedure, and this step occurs after consent is confirmed and the patient is positioned.

Pathophysiology and Procedural Connection

In suspected myelodysplastic syndrome or leukemia, the bone marrow biopsy provides definitive diagnostic information by revealing cellular morphology, blast percentages, and cytogenetic abnormalities. The patient with pancytopenia—a reduction in all three blood cell lines (erythrocytes, leukocytes, thrombocytes)—is at heightened risk for bleeding and infection due to thrombocytopenia and neutropenia. This underlying risk reinforces the importance of pre-procedure safety checks, including coagulation studies and platelet count review, but the consent verification remains the foundational step that must precede all others. The procedure itself involves the provider inserting a needle into the bone marrow cavity, aspirating fluid, and obtaining a core sample, which is then sent for pathology review.

## 임상 시나리오

Pre-Procedure Verification for Bone Marrow BiopsyPrioritizing Legal and Ethical Safety in Invasive Diagnostics
The most critical nursing action before a bone marrow biopsy is to verify that informed consent has been obtained and documented. This is a legal mandate that must precede any other intervention, including sedation or positioning.

The nurse must confirm the form is signed, dated, and witnessed, and that the patient can verbalize understanding of the procedure, its purpose, and potential complications like bleeding or infection. The procedure cannot legally proceed without this verification.

CautionDo not administer pre-procedural sedation or prepare the biopsy site until informed consent is confirmed. Routine prophylactic antibiotics are not indicated for this sterile procedure, and topical anesthetics are inadequate; a local anesthetic is injected by the provider after consent is verified.

## 핵심 개념

- **Informed Consent** — A legal and ethical process ensuring the patient understands the procedure, risks, benefits, and alternatives before agreeing to treatment.
- **Bone Marrow Biopsy** — An invasive diagnostic procedure using a needle to obtain a core of bone marrow, typically from the posterior iliac crest, to evaluate blood disorders.
- **Pancytopenia** — A condition characterized by a reduction in all three major blood cell lines: red blood cells, white blood cells, and platelets.

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