exam 2

The complete blood count (CBC) indicates that a patient is thrombocytopenic. Which action should the nurse include in the plan of care?

Avoid intramuscular injections.

An older adult with chronic human immunodeficiency virus (HIV) infection who takes medications for coronary artery disease and hypertension has chosen to begin early antiretroviral therapy (ART). Which information will the nurse include in patient teaching?

Many drugs interact with antiretroviral medications.

A patient who has non-Hodgkin's lymphoma is receiving combination treatment with rituximab (Rituxan) and chemotherapy. Which patient assessment finding requires the most rapid action by the nurse?

Lip swelling

Which of these patients who have arrived at the human immunodeficiency virus (HIV) clinic should the nurse assess first?

Patient who has had 10 liquid stools in the last 24 hours

Which patient should the nurse assess first?

Patient who is sneezing after subcutaneous immunotherapy

The nurse will most likely prepare a medication teaching plan about antiretroviral therapy (ART) for which patient?

Patient who tested positive for HIV 2 years ago and now has cytomegalovirus (CMV) retinitis

A patient who is human immunodeficiency virus (HIV)-infected has a CD4+ cell count of 400/µL. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient?

Patient's ability to follow a complex medication regimen

Immediately after the nurse administers an intracutaneous injection of an allergen on the forearm, the patient complains of itching at the site, weakness, and dizziness. What action should the nurse take first?

Place a tourniquet above the site.

The physician has ordered sargramostim (Leukine) intravenously for the client. What is a priority plan by the nurse prior to administering this drug?

Plan to monitor the client's ECG readings.

The client complains of constipation while receiving ferrous sulfate (Feosol). What is the best plan by the nurse to assist the client in resolving this common side effect?

Plan to teach the client to increase fluids and high-fiber foods in the diet.

What instructions about plasmapheresis should the nurse include in the teaching plan for a patient diagnosed with systemic lupus erythematosus (SLE)?

Plasmapheresis removes antibody-antigen complexes from circulation.

Which information shown in the table below about a patient who has just arrived in the emergency department is most urgent for the nurse to communicate to the health care provider? Assessment Complete Blood Count Patient History · BP 110/68 · Pulse 98 beats/min · Brisk capillary refill · Multiple ecchymoses on arms · Hgb 10.6 g/dL · Hct 30% · WBC 5100/µL · Platelets 19,500/µL · Occasional aspirin use · Abdominal pain x 1 week · Large, dark stool this morning

Platelet count

A patient with immune thrombocytopenic purpura (ITP) has an order for a platelet transfusion. Which information indicates that the nurse should consult with the health care provider before obtaining and administering platelets?

Platelet count is 42,000/mL.

Which collaborative problem will the nurse include in a care plan for a patient admitted to the hospital with idiopathic aplastic anemia?

Potential complication: infection

The nurse is preparing to discharge a client on an antiretroviral agent. Which instruction should the nurse include?

Practice good handwashing.

The nurse designs a program to decrease the incidence of human immunodeficiency virus (HIV) infection in the adolescent and young adult populations. Which information should the nurse assign as the highest priority?

Prevention of HIV transmission between sexual partners

The nurse is teaching a class on how red blood cell formation is regulated by the body to a group of clients who have AIDS. The nurse evaluates that learning has occurred when the clients make which statements?

Red blood cell formation is regulated through messages from the hormone erythropoietin."

A patient informed of a positive rapid antibody test result for human immunodeficiency virus (HIV) is anxious and does not appear to hear what the nurse is saying. What action by the nurse is most important at this time?

Remind the patient about the need to return for retesting to verify the results.

A nurse has obtained donor tissue typing information about a patient who is waiting for a kidney transplant. Which results should be reported to the transplant surgeon?

Results of patient-donor crossmatching are positive

Which statement by a patient indicates good understanding of the nurse's teaching about prevention of sickle cell crisis?

Risk for a crisis is decreased by having an annual influenza vaccination."

When a patient with splenomegaly is scheduled for splenectomy, which action will the nurse include in the preoperative plan of care?

Schedule immunization with the pneumococcal vaccine (e.g., Pneumovax).

Which information obtained by the nurse assessing a patient admitted with multiple myeloma is most important to report to the health care provider?

Serum calcium level is 15 mg/dL.

Which patient information is most important for the nurse to monitor when evaluating the effectiveness of deferoxamine (Desferal) for a patient with hemochromatosis?

Serum iron level

The registered nurse (RN) caring for an HIV-positive patient admitted with tuberculosis can delegate which action to unlicensed assistive personnel (UAP)?

Stock the patient's room with the necessary personal protective equipment.

A patient is being treated for an iron overdose after taking a bottle of over-the-counter multiple vitamins with iron. Which information will the nurse provide to the family about treatment of this overdose?

Success of this medication depends on the patient having good kidney function." Iron overdose is extremely dangerous."

A patient has been prescribed ferrous sulfate (Feosol). What should the nurse teach the patient about taking this medication?

Take this medication with water.

The client has just begun highly active antiretroviral therapy (HAART) for the treatment of acquired immune deficiency syndrome (AIDS). Which teaching point is a priority for this client?

Taking medications as scheduled is vital to successful treatment.

Which problem reported by a patient with hemophilia is most important for the nurse to communicate to the health care provider?

Tarry stools

A patient who has acute myelogenous leukemia develops an absolute neutrophil count of 850/µL while receiving outpatient chemotherapy. Which action by the outpatient clinic nurse is most appropriate?

Teach the patient to administer filgrastim (Neupogen) injections.

The client receives acyclovir (Zovirax) as treatment for herpes simplex type 1 virus (genital herpes). What is the best expected outcome for this client?

The client will report decreased pain using the approved pain scale.

The physician has prescribed epoetin alfa (Epogen) for the client. What is the priority assessment by the nurse?

The client's blood pressure

A client has been treated with an erythropoiesis-stimulating factor. Which client assessment would the nurse interpret as indicating the goal of this treatment has been reached?

The client's hemoglobin values have risen. The client reports less shortness of breath on exertion. The client reports enjoying a walk with family for the first time in months.

Ten days after receiving a bone marrow transplant, a patient develops a skin rash. What would the nurse suspect is the cause of the rash?

The donor T cells are attacking the patient's skin cells.

The nurse teaches clients with acquired immune deficiency syndrome (AIDS) about the importance of taking their medications as prescribed. What does the nurse recognize as the primary factor for medication noncompliance in the acquired immune deficiency syndrome (AIDS) population?

The necessity of having to take multiple medications throughout the day

"After a couple of years I will be able to stop taking the cyclosporine."

The patient drinks grapefruit juice every day.

Which assessment finding should the nurse caring for a patient with thrombocytopenia communicate immediately to the health care provider?

The patient is difficult to arouse.

The nurse is caring for a patient who is human immunodeficiency virus (HIV) positive and taking antiretroviral therapy (ART). Which information is most important for the nurse to address when planning care?

The patient reports missing some doses of zidovudine (AZT).

A patient with human immunodeficiency virus (HIV) infection has developed Mycobacterium avium complex infection. Which outcome would be appropriate for the nurse to include in the plan of care?

The patient will maintain intact perineal skin

Which patient requires the most rapid assessment and care by the emergency department nurse?

The patient with neutropenia who has a temperature of 101.8° F

A patient who is receiving immunotherapy has just received an allergen injection. Which assessment finding is most important to communicate to the health care provider? a. The patient's IgG level is increased. b. The injection site is red and swollen. c. The patient's symptoms did not improve in 2 months. d. There is a 2-cm wheal at the site of the allergen injection.

There is a 2-cm wheal at the site of the allergen injection.

A client is to receive darbepoetin alfa (Aranesp) adjunctive medication during chemotherapy. The client says, "Not another drug. Why do I need this one?" How should the nurse respond?

This drug will help you grow red blood cells." This drug will help you get more oxygen around to your tissues so you feel better."

The primary purpose of agents for herpes viruses is to

prevent viral DNA synthesis.

The client receives efavirenz (Sustiva) as treatment for acquired immune deficiency syndrome (AIDS). The nurse assesses the client for which serious adverse effect?

rash

The purpose of general pharmacotherapy for human immunodeficiency virus (HIV)/AIDS is to

relieve symptoms for a longer period of time.

The nurse provides discharge instructions to a patient who has an immune deficiency involving the T lymphocytes. Which health screening should the nurse include in the teaching plan for this patient?

screening for malignancies

In monitoring clients receiving erythropoiesis-stimulating agents, it is most important for the nurse to monitor for

thromboembolus.

Colony-stimulating factors (CSFs) are named according to

type of blood cell stimulated.

Which information about intradermal skin testing should the nurse teach to a patient with possible allergies?

"Plan to wait in the clinic for 20 to 30 minutes after the testing."

The nurse does health teaching with a client who has acquired immune deficiency syndrome (AIDS) and who has been started on antiviral medications. The nurse recognizes that teaching has been effective when the client makes which statement?

"I will still need to take precautions to avoid spreading the virus to others."

A patient who collects honey to earn supplemental income has developed a hypersensitivity to bee stings. Which statement, if made by the patient, would indicate a need for additional teaching?

"I will take oral antihistamines before going to work."

The client receives filgrastim (Neupogen). He asks the nurse, "That is such a funny name; where do you suppose it comes from?" What is the best response by the nurse?

"It comes from the blood cell it stimulates; this one stimulates neutrophils."

The nurse teaches a patient about drug therapy after a kidney transplant. Which statement by the patient would indicate a need for further instructions?

"After a couple of years I will be able to stop taking the cyclosporine."

A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse, "I feel obsessed with morbid thoughts about dying." Which response by the nurse is appropriate?

"Can you tell me more about the thoughts that you are having?"

A patient who uses injectable illegal drugs asks the nurse about preventing acquired immunodeficiency syndrome (AIDS). Which response by the nurse is best?

"Consider participating in a needle-exchange program."

The nurse is teaching a patient how to self-administer an erythropoiesis-stimulating drug. Which instruction should the nurse include?

"Draw up what is needed and discard the rest of the vial." "Place your stock of medication in your refrigerator." "Hold the vial in your hand a few minutes before drawing up the medication."

The client has acquired immune deficiency syndrome (AIDS) and has just learned she is pregnant. She tearfully asks the nurse if her baby will die of acquired immune deficiency syndrome (AIDS). What is the nurse's best response?

"Drug therapy can help prevent your child from contracting the virus."

A 19-year-old athlete is admitted to the emergency department in hypertensive crisis. It is determined that this patient has been "blood doping" to prepare for a championship game. How does the nurse explain this practice to the patient's parents?

"Having additional red blood cells may put an athlete at an advantage as more oxygen is available for cells." "This process may include transfusion of blood products." "Some athletes take epoetin alfa to increase their competitive edge."

A 52-yr-old patient has a new diagnosis of pernicious anemia. The nurse determines that the patient understands the teaching about the disorder when the patient states,

"I could choose nasal spray rather than injections of vitamin B12."

A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ T-cell count of less than 200 cells/mL. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct?

"The patient has developed acquired immunodeficiency syndrome (AIDS)."

A patient who has acute myelogenous leukemia (AML) asks the nurse whether the planned chemotherapy will be worth undergoing. Which response by the nurse is appropriate?

"The side effects of chemotherapy are difficult, but AML frequently goes into remission with chemotherapy."

A patient has developed chronic hepatitis after being exposed to hepatitis C. The nurse is discussing treatment of this condition. What information should the nurse include?

"There are some new medications that help keep the HCV virus from reproducing in your system." "Most current research supports the use of multidrug therapy."

A nurse manager is discussing employment requirements with a group of potential employees. One person says, "I am not certain I want to get a hepatitis shot." What information should the nurse provide?

"Working in a hospital puts you at higher risk for being exposed to hepatitis B." Children get this immunization before they are 2 years old."

A patient has recovered from hepatitis B. Which discharge information should the nurse provide?

"You are now immune to getting hepatitis B again." "Chronic hepatitis B may take years to develop."

The client asks the nurse why there aren't better drugs for human immunodeficiency virus (HIV) infection when so much money is spent on research. What is the best response by the nurse?

. "Developing new drugs is difficult because the virus mutates so readily."

The client is pregnant and has been told by her physician that she needs cyanocobalamin (Nascobal). She asks the nurse, "Will this hurt my baby?" What is the best response by the nurse?

. "No, this is safe as long as long as you take it in pill form; it is a Pregnancy Category A drug, which means it is safe for your baby."

The client receives epoetin alfa (Epogen) subcutaneously, and says to the nurse, "My doctor said I have anemia. Are there little red blood cells in that shot?" What are the best responses by the nurse?

. "No, this medication stimulates your body to make red blood cells."

A pregnant woman who is HIV positive is taking zidovudine. She is very concerned about her infant and says, "My doctor said they won't even test my baby until she is 2 weeks old. I wish they would do it when she is born." What responses, by the nurse, are indicated?

. "Since you are taking zidovudine, a test at birth will not be accurate." "The tests are much more accurate when your baby gets to be 2 weeks old." . "You can expect your baby to be tested at 1 month of age." . "Testing will continue until your baby is 1 year old."

A nurse is preparing an education session for a group of public school teachers regarding prevention of influenza. What topics should be included in this session?

. They need to discuss immunization with their personal health care providers due to contact with children. Encourage students and staff to stay home if they are ill. Encourage frequent handwashing for all students and staff.

The nurse is educating a patient about the development of red blood cells. The nurse would list the steps of this development in which correct order? 1. Action of erythropoietin 2. Proerythroblast 3. Stem cell 4. Reticulocyte 5. Erythrocyte

3,2,4,1,5

The nurse is discussing the seriousness of a patient's hepatitis C diagnosis. The nurse says, "One of the problems you will face is that about ________% of patients with hepatitis C go on to develop chronic hepatitis.

70

The nurse examines the lymph nodes of a patient during a physical assessment. Which assessment finding would be of most concern to the nurse?

A 2-cm nontender supraclavicular node

Several patients call the outpatient clinic and ask to make an appointment as soon as possible. Which patient should the nurse schedule to be seen first?

A 23-yr-old with no previous health problems who has a nontender lump in the axilla

After receiving change-of-shift report for several patients with neutropenia, which patient should the nurse assess first?

A 33-yr-old with a fever of 100.8° F (38.2° C)

A clinic patient is experiencing an allergic reaction to an unknown allergen. Which action is appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/LVN)?

Administer a skin test by the cutaneous scratch method.

The charge nurse is assigning semiprivate rooms for new admissions. Which patient could safely be assigned as a roommate for a patient who has acute rejection of an organ transplant?

A patient who is recovering from an anaphylactic reaction to a bee sting

Which patient should the nurse assign as the roommate for a patient who has aplastic anemia?

A patient with chronic heart failure

Which action will the nurse include in the plan of care for a patient who has thalassemia major?

Administer iron chelation therapy as needed.

A patient who is receiving an IV antibiotic develops wheezes and dyspnea. In which order should the nurse implement these prescribed actions? (Put a comma and a space between each answer choice [A, B, C, D, E]). a. Discontinue the antibiotic. b. Give diphenhydramine IV. c. Inject epinephrine IM or IV. d. Prepare an infusion of dopamine. e. Provide 100% oxygen using a nonrebreather mask.

A, E, C, B, D

Which laboratory test will the nurse use to determine whether filgrastim (Neupogen) is effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy?

Absolute neutrophil count

Which laboratory result will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)?

Activated partial thromboplastin time

Which drug is most likely to be ordered for the client with herpes simplex virus?

Acyclovir (Zovirax)

A postoperative patient receiving a transfusion of packed red blood cells develops chills, fever, headache, and anxiety 35 minutes after the transfusion is started. After stopping the transfusion, what action should the nurse take?

Administer PRN acetaminophen (Tylenol).

A patient in the health care provider's office for allergen testing using the cutaneous scratch method develops itching and swelling at the skin site. Which action should the nurse take first?

Administer a dose of epinephrine.

Which action for a patient with neutropenia is appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/LVN)?

Administering subcutaneous filgrastim (Neupogen) injection

A patient is admitted to the hospital with acute rejection of a kidney transplant. Which intervention will the nurse prepare for this patient?

Administration of immunosuppressant medications

Which information about a patient population would be most useful to help the nurse plan for human immunodeficiency virus (HIV) testing needs?

Age

A patient is anxious and reports difficulty breathing after being stung by a wasp. What is the nurse's priority action?

Assess the patient's airway.

The health care provider orders a liver and spleen scan for a patient who has been in a motor vehicle crash. Which action should the nurse take before this procedure?

Assist the patient to a flat position.

Which instruction will the nurse plan to include in discharge teaching for a patient admitted with a sickle cell crisis?

Avoid exposure to crowds when possible.

Which intervention will be included in the nursing care plan for a patient with immune thrombocytopenic purpura?

Avoid intramuscular (IM) injections.

A patient with pancytopenia of unknown origin is scheduled for the following diagnostic tests. The nurse will provide a consent form to sign for which test?

Bone marrow biopsy

Which laboratory test best evaluates HIV disease?

CD4 count

Which finding about a patient with polycythemia vera is most important for the nurse to report to the health care provider?

Calf swelling and pain

Which action will the admitting nurse include in the care plan for a patient who has neutropenia?

Check temperature every 4 hours.

Which nursing action will be most useful in assisting a college student to adhere to a newly prescribed antiretroviral therapy (ART) regimen?

Check the patient's class schedule to help decide when the drugs should be taken.

An older adult patient who is having an annual check-up tells the nurse, "I feel fine, and I don't want to pay for all these unnecessary cancer screening tests!" Which information should the nurse plan to teach this patient?

Consequences of aging on cell-mediated immunity

The nurse reviewing a clinic patient's medical record notes that the patient missed the previous appointment for weekly immunotherapy. Which action by the nurse is appropriate?

Consult with the health care provider about giving a lower allergen dose.

The nurse plans a presentation for community members about how to decrease the risk for antibiotic-resistant infections. Which information will the nurse include in the teaching plan (select all that apply)?

Continue taking antibiotics until all of the prescription is gone. Antibiotics may sometimes be prescribed to prevent infection. Hand washing is effective in preventing many viral and bacterial infections.

A young adult female patient who is human immunodeficiency virus (HIV) positive has a new prescription for efavirenz (Sustiva). Which information is most important to include in the medication teaching plan?

Continue to use contraception while taking this medication.

A patient who has been receiving IV heparin infusion and oral warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when the platelet level drops to 110,000/µL. Which action will the nurse include in the plan of care?

Discontinue the heparin infusion.

A patient treated for human immunodeficiency virus (HIV) infection for 6 years has developed fat redistribution to the trunk with wasting of the arms, legs, and face. What recommendation will the nurse give to the patient?

Discuss a change in antiretroviral therapy.

A patient's complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding?

Do you have any history of lung disease?"

The nurse assesses a patient who has numerous petechiae on both arms. Which question should the nurse ask the patient?

Do you take medication containing salicylates?"

The nurse taking a health history learns that the patient, who has worked in rubber tire manufacturing, has allergic rhinitis and multiple food allergies. Which action by the nurse is correct?

Document the patient's history and teach about clinical manifestations of a type I latex allergy.

A patient who had a total hip replacement had an intraoperative hemorrhage 14 hours ago. Which laboratory test result would the nurse expect?

Elevated reticulocyte count

The health care provider's progress note for a patient states that the complete blood count (CBC) shows a "shift to the left." Which assessment finding will the nurse expect?

Elevated temperature

Eight years after seroconversion, a human immunodeficiency virus (HIV)-infected patient has a CD4+ cell count of 800/µL and an undetectable viral load. What is the priority nursing intervention at this time?

Encourage adequate nutrition, exercise, and sleep.

The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute human immunodeficiency virus (HIV) infection. Which action would be appropriate for the nurse to take?

Explain to the patient that this is an expected finding.

The nurse should assess the patient undergoing plasmapheresis for which clinical manifestation?

Extremity numbness

The client receives zidovudine (Retrovir) for treatment of human immunodeficiency virus (HIV) infection. The nurse would increase assessment surveillance for which adverse reactions from this treatment?

Fatigue and generalized weakness New onset headache Liver palpable on physical examination

The nurse accidentally sticks herself with a needle after starting an intravenous (IV) line on a client with acquired immune deficiency syndrome (AIDS). The nurse tells the supervisor about the accident. What is the best initial response by the supervisor to decrease anxiety in the nurse?

Fortunately, the chances of you contracting human immunodeficiency virus (HIV) after the stick are very small."

A client has been prescribed oseltamivir (Tamiflu) after complaining of influenza-like symptoms. What information should the nurse provide for this client?

Get this prescription filled and begin taking the medication immediately. This is an expensive medication.

A patient with pancytopenia has a bone marrow aspiration from the left posterior iliac crest. Which action would be important for the nurse to take after the procedure?

Have the patient lie on the left side for 1 hour.

A client's blood work shows an anemia that was not present at the last clinic visit 6 months ago. Which questions should the nurse ask this client?

Have you had a significant dietary change in the last 6 months?" Do you handle chemicals in your new job?" Have your stools changed in appearance?" Are your menstrual periods heavier than normal for you?"

The nurse notes pallor of the skin and nail beds in a newly admitted patient. The nurse should ensure that which laboratory test has been ordered?

Hemoglobin level

The nurse is reviewing laboratory results and notes a patient's activated partial thromboplastin time (aPTT) level of 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication?

Heparin

The nurse is caring for a patient infected with human immunodeficiency virus (HIV) who has just been diagnosed with asymptomatic chronic HIV infection. Which prophylactic measures will the nurse include in the plan of care (select all that apply)?

Hepatitis B Pneumococcal vaccine influenza virus vaccine

A nurse is preparing to administer prescribed medication to a client exposed to hepatitis A. Which information should the nurse provide to this client?

I am giving you hepatitis A immunoglobulin (HAIg). This injection may keep you from contracting hepatitis A.

Which statement by a patient would alert the nurse to a risk for decreased immune function?

I had my spleen removed after a car accident."

Which patient statement to the nurse indicates a need for additional instruction about taking oral ferrous sulfate?

I will call my health care provider if my stools turn black."

A patient is being evaluated for possible atopic dermatitis. The nurse expects elevation of which laboratory value

IgE

The client receives acyclovir (Zovirax) for treatment of genital herpes. What is a priority assessment by the nurse?

Increased serum creatinine

A patient with septicemia develops prolonged bleeding from venipuncture sites and blood in the stools. Which action is most important for the nurse to take?

Infuse normal saline 500 mL over 30 minutes.

A nurse is preparing to administer ferrous sulfate IM to a client with anemia. What should the nurse consider when giving this injection?

Iron is irritating to the tissues. The z-track method should be used.

Which action will the nurse include in the plan of care for a patient admitted with multiple myeloma?

Monitor fluid intake and output.

A pregnant woman with asymptomatic chronic human immunodeficiency virus (HIV) infection is seen at the clinic. The patient states, "I am very nervous about making my baby sick." Which information will the nurse include when teaching the patient?

Most infants born to HIV-positive mothers are not infected with the virus.

The client is receiving medication for the treatment of anemia. The nurse has taught the client about this drug and about anemia. The nurse evaluates that learning has occurred when the client makes which statement?

My anemia could be caused by blood loss somewhere, but there are other causes too."

Following successful treatment of Hodgkin's lymphoma for a 55-yr-old woman, which topic will the nurse include in patient teaching?

Need for follow-up appointments to screen for malignancy

Which patient exposure by the nurse is most likely to require postexposure prophylaxis when the patient's human immunodeficiency virus (HIV) status is unknown?

Needle stick with a needle and syringe used for a venipuncture

The nurse has obtained the health history, physical assessment data, and laboratory results shown in the accompanying figure for a patient admitted with aplastic anemia. Which information is most important to communicate to the health care provider? History Physical Assessment Laboratory Results · Fatigue, which has increased over last month · Frequent constipation · Conjunctiva pale pink, moist · Multiple bruises · Clear lung sounds · Hct 33% · WBC 1500/µL · Platelets 70,000/µL

Neutropenia

A client is scheduled to have chemotherapy Thursday at 9 a.m. Filgrastim (Neupogen) has also been ordered. The nurse should plan which dosing time for the Neupogen?

No later than 9 a.m. on Wednesday No earlier than 9 a.m. Friday

The client receives chemotherapy as therapy for cancer. The physician orders epoetin alfa (Procrit) subcutaneously. The client asks the nurse if this drug is also chemotherapy. What is the best response by the nurse?

No, this drug will help prevent anemia that can be caused by your chemotherapy."

The nurse assesses a patient with pernicious anemia. Which assessment finding would the nurse expect?

Numbness of the extremities

The health care provider asks the nurse whether a patient's angioedema has responded to prescribed therapies. Which assessment should the nurse perform?

Observe for swelling of the patient's lips and tongue.

The nurse is planning to administer a transfusion of packed red blood cells (PRBCs) to a patient with blood loss from gastrointestinal hemorrhage. Which action can the nurse delegate to unlicensed assistive personnel (UAP)?

Obtain the temperature, blood pressure, and pulse before the transfusion.

Which menu choice indicates that the patient understands the nurse's teaching about recommended dietary choices for iron-deficiency anemia?

Omelet and whole wheat toast

The nurse prepares to administer the following medications to a hospitalized patient with human immunodeficiency (HIV). Which medication is most important to administer at the scheduled time?

Oral saquinavir (Invirase)

The client calls the nurse and is very frantic. "I think something is wrong! My stools are black, and they have never been this color before!" The client is receiving ferrous sulfate (Feosol). What is the best response by the nurse?

This is an expected side effect of ferrous sulfate (Feosol); it is okay."

The client is receiving chemotherapy for cancer. The physician has prescribed oprelvekin (Neumega). The nurse has completed medication education and evaluates it as effective when the client makes which statement?

This medication will help increase my platelet count."

The client with acquired immune deficiency syndrome (AIDS) asks the nurse why he must take so many medications. What is the best response by the nurse?

To decrease the possibility of the virus developing resistance to the medications."

A patient who has a history of a transfusion-related acute lung injury (TRALI) is to receive a transfusion of packed red blood cells (PRBCs). Which action by the nurse will decrease the risk for TRALI for this patient?

Transfuse only leukocyte-reduced PRBCs.

A client has just recovered from a long course of therapy for shingles. The client says, "What can I do to keep from having that again?" What information should the nurse provide?

Try to find healthy outlets for your stress. Try to keep as physically healthy as possible. Try to keep your immune system strong by taking good care of your physical and emotional health.

The nurse provides care for clients with acquired immune deficiency syndrome (AIDS). Which laboratory test is the best indicator of effective treatment with antiviral medications?

Viral load

To evaluate the effectiveness of antiretroviral therapy (ART), which laboratory test result will the nurse review?

Viral load testing

The nurse educates clients with acquired immune deficiency syndrome (AIDS) about the nature of viruses. The nurse evaluates that learning has occurred when the clients make which responses?

Viruses are nonliving particles." Viruses can infect plants as well as animals." "A virion is a mature virus." Viruses are intracellular parasites."

The nurse is caring for a patient who is being discharged after an emergency splenectomy following a motor vehicle crash. Which instructions should the nurse include in the discharge teaching?

Wash hands and avoid persons who are ill.

The nurse teaches a class on iron-deficiency anemia to a group of pregnant clients. The nurse evaluates that additional learning is needed when the clients make which statement?

We need extra iron because when our red blood cells die, all their iron is excreted from the body."

The nurse reviews the laboratory test results of a patient admitted with abdominal pain. Which information will be most important for the nurse to communicate to the health care provider?

White blood cell (WBC) count 15,500/µL

A nurse reviews the laboratory data for an older patient. The nurse would be most concerned about which finding?

White blood cell (WBC) count of 2800/µL

The client had stomach cancer and a surgical removal of his stomach several years ago. The physician prescribed cyanocobalamin (Nascobal). The client stopped this drug several months ago. What will the nurse most likely assess in this client?

You have been drinking instead of eating, and alcohol interferes with folate metabolism in your liver."

The nurse is advising a clinic patient who was exposed a week ago to human immunodeficiency virus (HIV) through unprotected sexual intercourse. The patient's antigen and antibody test has just been reported as negative for HIV. What instructions should the nurse give to this patient?

You will need to be retested in 2 weeks."

The nurse plans to teach a client with human immunodeficiency virus (HIV) infection about zidovudine (Retrovir). What will the best plan by the nurse include?

Zidovudine (Retrovir) will need to be stopped if bone marrow depression occurs. Zidovudine (Retrovir) will slow the disease, but not cure it. Zidovudine (Retrovir) therapy frequently results in the development of anemia.

A 62-year old man with chronic anemia is experiencing increased fatigue and occasional palpitations at rest. The nurse would expect the patient's laboratory test findings to include

a hemoglobin (Hgb) of 8.6 g/dL (86 g/L).

An appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia is to

alternate periods of rest and activity.

A patient who has acute myelogenous leukemia (AML) is considering treatment with a hematopoietic stem cell transplant (HSCT). The best approach for the nurse to assist the patient with a treatment decision is to

ask whether there are questions or concerns about HSCT.

The nurse notes scleral jaundice in a patient being admitted with hemolytic anemia. The nurse will plan to check the laboratory results for the

bilirubin level.

A young adult who has von Willebrand disease is admitted to the hospital for minor knee surgery. The nurse will review the coagulation survey to check the

bleeding time

A routine complete blood count for an active older man indicates possible myelodysplastic syndrome. The nurse will plan to teach the patient about

bone marrow biopsy.

Which example should the nurse use to explain an infant's "passive immunity" to a new mother?

breastfeeding

An appropriate nursing intervention for a patient with non-Hodgkin's lymphoma whose platelet count drops to 18,000/µL during chemotherapy is to

check all stools for occult blood.

A patient in the emergency department complains of back pain and difficulty breathing 15 minutes after a transfusion of packed red blood cells is started. The nurse's first action should be to

disconnect the transfusion and infuse normal saline.

It is important for the nurse providing care for a patient with sickle cell crisis to

evaluate the effectiveness of opioid analgesics.

A patient who is receiving methotrexate for severe rheumatoid arthritis develops a megaloblastic anemia. The nurse will anticipate teaching the patient about increasing oral intake of

folic acid.

A patient seeks care in the emergency department after sharing needles for heroin injection with a friend who has hepatitis B. To provide immediate protection from infection, what medication will the nurse expect to administer?

gamma globulin

According to the Center for Disease Control and Prevention (CDC) guidelines, which personal protective equipment will the nurse put on before assessing a patient who is on contact precautions for Clostridium difficile diarrhea (select all that apply)?

gown gloves

The process for regulating hematopoiesis occurs via

hormones.

The nurse is caring for a patient with type A hemophilia being admitted to the hospital with severe pain and swelling in the right knee. The nurse should

immobilize the knee joint.

The mechanism of action of colony-stimulating factors, such as filgrastim (Neupogen), is to

increase neutrophil production.

The nurse is aware that the major characteristic of viruses is that they are

intracellular parasites

Per classification of anemias, the morphology for pernicious anemia or folate-deficiency anemia results in

macrocytic-normochromic erythrocytes.

An expected action by the nurse caring for a patient who has an acute exacerbation of polycythemia vera is to

monitor fluid intake and output

The nurse is caring for a client receiving darunavir (Prezista). The nurse would observe for adverse effects of

nausea