Exam 4

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy? - "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear." - "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal." - "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." - "I will receive parenteral vitamin B12 therapy for the rest of my life."

"I will receive parenteral vitamin B12 therapy for the rest of my life."

A client is to have a below-the-knee amputation. Prior to the surgery, what should the circulating nurse in the operating room do? - Insert a Foley catheter. - Start an intravenous infusion. - Initiate a time-out. - Verify that the surgeon possesses the degree of expertise needed.

Initiate a time-out

A nurse is managing the care of a client with osteoarthritis. Appropriate treatment strategies for osteoarthritis include - administration of opioids for pain control. - administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and initiation of an exercise program. - administration of monthly intra-articular injections of corticosteroids. - vigorous physical therapy for the joints.

administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and initiation of an exercise program

A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to - lie supine with their neck extended. - sit upright, leaning slightly forward. - blow their nose and then put lateral pressure on their nose. - hold their nose while bending forward at the waist.

sit upright, leaning slightly forward

A diet plan is developed for a client with gouty arthritis. The nurse should advise the client to limit his intake of - organ meats. - citrus fruits. - green vegetables. - fresh fish.

organ meats

A nurse is caring for a client who recently underwent a total hip replacement. The nurse should: - ease the client onto a low toilet seat. - allow the client's legs to be crossed at the knees when out of bed. - use soft chairs when the client is sitting out of bed. - limit hip flexion of the client's hip when he sits.

limit hip flexion of the client's hip when he sits

A nurse is interviewing a client about their past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? - duodenal ulcers - hemorrhoids - weight gain - polyps

polyps

What are important nursing priorities on the first postoperative day for a client who has had an open reduction and internal fixation (ORIF) after a right hip fracture? - supporting the leg to maintain adduction, ensuring adequate pain control, and maintaining bed rest - assessing the neurovascular status in the right leg, providing pain control, encouraging position changes, and early ambulation - assessing for skin integrity, enhancing nutritional status, and encouraging position changes while maintaining bed rest - reorienting frequently to prevent confusion and disorientation, restricting analgesics, and encouraging pursed-lip breathing

assessing the neurovascular status in the right leg, providing pain control, encouraging position changes, and early ambulation

A client has a 10-year history of rheumatoid arthritis and is concerned now that the client's child is experiencing some morning stiffness and pain. What would be the most appropriate response by the nurse? - "Rheumatoid arthritis does not have a genetic basis, so there is nothing to be concerned about." - "There is some evidence that a genetic basis for the disease may exist, so you might want to have your child evaluated." - "Have your child take aspirin for a few days to see if the stiffness is relieved." - "It is normal to have aches and pains, so your concern is probably unwarranted."

"There is some evidence that a genetic basis for the disease may exist, so you might want to have your child evaluated."

A client develops a facial rash and urticaria after receiving penicillin. Which laboratory value does the nurse expect to be elevated? - IgA - IgB - IgE - IgG

IgE

A client with aplastic anemia is instructed to eat foods rich in iron. The nurse should instruct the client to include which food in the diet to increase iron intake? - fresh fruits - cheese - dark green leafy vegetables - chicken breasts

dark green leafy vegetables

A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia? - nights sweats, weight loss, and diarrhea - dyspnea, tachycardia, and pallor - nausea, vomiting, and anorexia - itching, rash, and jaundice

dyspnea, tachycardia, and pallor

A nurse is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 47. Following the American Cancer Society (Canadian Cancer Society) guidelines, the nurse should recommend that the women - perform breast self-examination annually. - have a mammogram annually. - have a hormonal receptor assay annually. - have a physician conduct a clinical examination every 2 years.

have a mammogram annually

A client with cancer is receiving radiation therapy and develops thrombocytopenia. What is the priority nursing goal to prevent which effect of thrombocytopenia for this client? - pain related to spontaneous bleeding episodes - altered nutrition related to anemia - injury related to the decreased platelet count - skin breakdown related to decreased tissue perfusion

injury related to the decreased platelet count

A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The physician begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption? - intrinsic factor - hydrochloric acid - histamine - liver enzyme

intrinsic factor

The teaching plan for the client with rheumatoid arthritis includes rest promotion. What position of the involved joints should the nurse tell the client to avoid when at rest? - keeping all joints aligned - elevating the affected joints - lying in a prone position - maintaining the joints in a flexed position

maintaining the joints in a flexed position

A client asks the nurse what PSA is. The nurse should reply that it stands for - prostate-specific antigen, which is used to screen for prostate cancer. - protein serum antigen, which is used to determine protein levels. - pneumococcal strep antigen, which is a bacteria that causes pneumonia. - Papanicolaou-specific antigen, which is used to screen for cervical cancer.

prostate-specific antigen, which is used to screen for prostate cancer

A client with rheumatoid arthritis tells the nurse that she feels "quite alone" in adjusting to changes in her lifestyle. Which response by the nurse will be most effective? - referring the client and her husband for counseling to decrease her sense of isolation. - suggesting that the client develop a hobby to occupy her time. - telling the client about her community's arthritis support group. - recommending that the client discuss her feelings with her religious advisor

telling the client about her community's arthritis support group

A client diagnosed with idiopathic thrombocytopenia purpura needs a peripherally inserted central catheter (PICC) placed. When explaining the catheter to the client, the nurse explains that one advantage of a catheter is that it can be used: - to administer only blood products and I.V. fluids. - in clients with infections in the blood. - to provide long-term access to central veins. - for 2 weeks without being replaced.

to provide long-term access to central veins

A client with rheumatoid arthritis tells the nurse, "I know it's important to exercise my joints so that I won't lose mobility, but my joints are so stiff and painful that exercising is difficult." Which response by the nurse would be most appropriate? - "You're probably exercising too much. Decrease your exercise to every other day." - "Tell the health care provider about your symptoms. Maybe your analgesic medication can be increased." - "Stiffness and pain are part of the disease. Learn to cope by focusing on activities you enjoy." - "Take a warm tub bath or shower before exercising. This may help with your discomfort."

"Take a warm tub bath or shower before exercising. This may help with your discomfort."

A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 - S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurological symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period? - Discourage the client from doing any range-of-motion (ROM) exercises. - Have the client sit up in a chair as much as possible. - Logroll the client from side to side. - Elevate the head of the bed to 90 degrees.

Logroll the client from side to side

A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client? - Limit visits by family members. - Encourage the client to use a wheelchair. - Use the smallest needle possible for injections. - Maintain accurate fluid intake and output records.

Use the smallest needle possible for injections

A client received treatment with cytotoxic medications 24 hours ago. Which precautions are necessary when caring for the client? - Wear sterile gloves when emptying bedpans or urinals. - Use a bleach solution to clean bedpans or urinals after use. - Wear personal protective equipment when handling blood, body fluids, and feces. - Provide a urinal or bedpan to decrease the likelihood of soiling linens.

Wear personal protective equipment when handling blood, body fluids, and feces.

The nurse is making a room assignment for a client whose laboratory test result indicate pancytopenia. Which client should the nurse put into the same room with the client with pancytopenia? - a client with cellulitis - a client with digoxin toxicity - a client with shingles - a client with viral pneumonia

a client with digoxin toxicity

A client takes prednisone, as ordered, for rheumatoid arthritis. During follow-up visits, the nurse should assess the client for common adverse reactions to this drug, such as - tetany and tremors. - anorexia and weight loss. - fluid retention and weight gain. - abdominal cramps and diarrhea.

fluid retention and weight gain

The family of an older adult with terminal cancer asks about having hospice services. What should the nurse tell the family? Hospice care: - focuses only on the needs of the client. - can only be provided in the inpatient setting. - is staffed exclusively by professional health care workers. - focuses on supportive care for the client and family.

focuses on supportive care for the client and family

A 4-year-old child is having a sickle cell crisis. The initial nursing intervention should be to - place ice packs on the client's painful joints. - administer antibiotics. - provide oral and I.V. fluids. - administer folic acid supplements.

provide oral and I.V. fluids

A male client comes to the clinic with complaints of pain in his great toe. The client reports that the pain is worse at night. Assessment reveals tophi. The nurse suspects the client has: - osteoarthritis. - gouty arthritis. - rheumatoid arthritis. - reactive arthritis.

gouty arthritis

A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? - living a sedentary lifestyle to reduce the incidence of injury - stopping estrogen therapy - taking a 300-mg calcium supplement to meet dietary guidelines - initiating weight-bearing exercise routines

initiating weight-bearing exercise routines

The nurse is developing a care plan for a client who has leukemia. What instructions should the nurse include in the plan? Select all that apply: - Monitor temperature and report elevation. - Recognize signs and symptoms of infection. - Avoid crowds. - Maintain integrity of skin and mucous membranes. - Take a baby aspirin each day.

- Monitor temperature and report elevation - Recognize signs and symptoms of infection - Avoid crowds - Maintain integrity of skin and mucous membranes

A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process? - "It will get better and worse again." - "When it clears up, it will never come back." - "I'll definitely need surgery for this." - "It will never get any better than it is right now."

"It will get better and worse again."

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide concerning cast care? - "Cover the cast with a blanket until the cast dries." - "Keep your right leg elevated above heart level." - "Use a knitting needle to scratch itches inside the cast." - "A foul smell from the cast is normal."

"Keep your right leg elevated above heart level."

A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? - "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." - "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints." - "OA affects joints on both sides of the body. RA is usually unilateral." - "OA is more common in women. RA is more common in men."

"OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."

A client with osteoarthritis tells the nurse they are concerned that the disease will prevent them from doing their chores. Which suggestion should the nurse offer? - "Do all your chores in the morning, when pain and stiffness are least pronounced." - "Do all your chores after performing morning exercises to loosen up." - "Pace yourself and rest frequently, especially after activities." - "Do all your chores in the evening, when pain and stiffness are least pronounced."

"Pace yourself and rest frequently, especially after activities."

A client with the beta-thalassemia trait plans to marry a person of Italian ancestry who also has the trait. Which client statement indicates understanding of the teaching provided by the nurse? - "We should never plan to have children." - "I need to learn how to give myself vitamin B12 injections." - "We'll need more genetic counseling in the future." - "If my fiancé was of Middle Eastern descent, I wouldn't be worried about having children."

"We'll need more genetic counseling in the future."

A multidisciplinary oncology team of health care providers, nurses, and the social worker notes that a client who has been undergoing chemotherapy is now experiencing pancytopenia. When reviewing the laboratory data, which values support this diagnosis? Select all that apply: - decreased white blood cells - increased white blood cells - decreased platelets - increased platelets - decreased RBCs - increased RBCs

- decreased RBCs - decreased platelets - decreased white blood cells

The nurse is preparing to administer 500 mL of whole blood to a client. The blood is to be infused over 4 hours. The infusion tubing delivers 10 gtt/mL. How many drops of blood per minute must the nurse infuse to complete the infusion in 4 hours? Record your answer using a whole number.

21 gtt/min 500 mL/4 hours using tubing that has a drip factor of 10 gtt/ml, the nurse should first convert the 4 hours into minutes, and then use the following formula: 500 mL/240 minutes x 10 gtt/mL = 21 gtt/min

A client is receiving nonsteroidal anti-inflammatory drugs (NSAIDs) to manage the pain of rheumatoid arthritis. What information should the nurse give to the client about taking these medications? - Take NSAIDs at least three times per day. - Exercise the joints at least 1 hour after taking the medication. - Take antacids 1 hour after taking NSAIDs. - Take NSAIDs with food.

Take NSAIDs with food

The client asks the nurse to explain what it means that Hodgkin's disease is diagnosed at stage 1A. What should the nurse explain about the involvement of the disease? - involvement of a single lymph node - involvement of two or more lymph nodes on the same side of the diaphragm - involvement of lymph node regions on both sides of the diaphragm - diffuse disease of one or more extra lymphatic organs

involvement of a single lymph node

A client receiving a blood transfusion experiences an acute hemolytic reaction. Which nursing intervention is the most important? - Assess the temperature, blood pressure, and check for blood in the urine. Then stop the transfusion. - Slow the transfusion and monitor the client's vital signs. - Stop the transfusion, notify the blood bank, and administer antihistamines. - Stop the transfusion, infuse normal saline solution, and call the physician.

Stop the transfusion, infuse normal saline solution, and call the physician

A client has been diagnosed with osteoporosis after a bone density test and is asking what has caused it. Discussion of risk factors would include: - excessive sunlight exposure, adequate calcium intake, and lactose intolerance - regular exercise, low fat intake, and recurrent trauma to the bones through increased weight-bearing activities - heavy smoking, sedentary lifestyle, and high intake of carbonated drinks - diet deficient in vegetables and fruits, high intake of red meats, and increased alcohol intake

heavy smoking, sedentary lifestyle, and high intake of carbonated drinks

A nurse is caring for a client who complains of lower back pain. Which instruction should the nurse give to the client to prevent back injury? - "Bend over the object you're lifting." - "Narrow the stance when lifting." - "Push or pull an object using your arms." - "Stand close to the object you're lifting."

"Stand close to the object you're lifting."

During chemotherapy, an oncology client has a nursing diagnosis of Impaired oral mucous membrane related to decreased nutrition and immunosuppression secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is most likely to decrease the pain of stomatitis? - Recommending that the client discontinue chemotherapy - Providing a solution of viscous lidocaine for use as a mouth rinse - Monitoring the client's platelet and leukocyte counts - Checking regularly for signs and symptoms of stomatitis

Providing a solution of viscous lidocaine for use as a mouth rinse

The nurse is collaborating with the healthcare provider to develop a care plan to help control chronic pain in a client with cancer who is receiving hospice home care. Which plan would be most appropriate for managing the client's pain? - Administer analgesics on a regular basis, with the administration of additional analgesics for breakthrough pain. - Administer analgesics when the client reports pain greater than 5 out of 10. - Encourage the client to avoid intravenous pain medication until the client's condition has reached the terminal stage. - Administer analgesics when the client's vital signs indicate that the severity of the pain is increasing.

Administer analgesics on a regular basis, with the administration of additional analgesics for breakthrough pain