Med Surg Chapter 36 Assessment of the Hematologic System & 37 Concepts of Care for Patients with Hematologic Problems Ignatavicius, Chapter 55: Anticoagulant, Antiplatelet, and Thrombolytic Drugs Burchum: Lehne’s Pharmacology for Nursing Care, 11th E…

A client with multiple myeloma demonstrates worsening bone density on diagnostic scans. About what drug does the nurse plan to teach this client? a. Bortezomib b. Dexamethasone c. Thalidomide d. Zoledronic acid

ANS: D All the options are drugs used to treat multiple myeloma, but the drug used specifically for bone manifestations is zoledronic acid, which is a bisphosphonate. This drug class inhibits bone resorption and is used to treat osteoporosis as well.

A patient has been receiving heparin while in the hospital to treat deep vein thromboses and will be discharged home with a prescription for enoxaparin [Lovenox]. The nurse provides teaching for the nursing student who asks about the advantages of enoxaparin over heparin. Which statement by the student indicates a need for further teaching? a. "Enoxaparin does not require coagulation monitoring." b. "Enoxaparin has greater bioavailability than heparin." c. "Enoxaparin is more cost-effective than heparin." d. "Enoxaparin may be given using a fixed dosage."

"Enoxaparin is more cost-effective than heparin."

A patient has been taking warfarin [Coumadin] for atrial fibrillation. The provider has ordered dabigatran etexilate [Pradaxa] to replace the warfarin. The nurse teaches the patient about the change in drug regimen. Which statement by the patient indicates understanding of the teaching? a. "I may need to adjust the dose of dabigatran after weaning off the warfarin." b. "I should continue to take the warfarin after beginning the dabigatran until my INR is greater than 3." c. "I should stop taking the warfarin 3 days before starting the dabigatran." d. "I will stop taking the warfarin and will start taking the dabigatran when my INR is less than 2."

"I will stop taking the warfarin and will start taking the dabigatran when my INR is less than 2."

The nurse is teaching the parent of a young child about administering ferrous sulfate to the child at home. Which teaching point should receive the highest priority? "Give the liquid iron with a straw to reduce tooth staining." "Store the ferrous sulfate in a childproof container and keep it out of the child's reach." "This medicine may cause the child's stool to look dark green or black." "Do not give iron with any other medications or vitamins."

"Store the ferrous sulfate in a childproof container and keep it out of the child's reach."

A nursing student, who is preparing to care for a postoperative patient with deep vein thrombosis, asks the nurse why the patient must take heparin rather than warfarin. Which response by the nurse is correct? a. "Heparin has a longer half-life." b. "Heparin has fewer adverse effects." c. "The onset of warfarin is delayed." d. "Warfarin prevents platelet aggregation."

"The onset of warfarin is delayed."

The nurse is teaching a patient with vitamin B12 deficiency caused by a previous gastrectomy and lack of intrinsic factor. Which statement by the nurse is the most appropriate to include in the teaching plan? "Because your body does not have intrinsic factor, vitamin B12 injections will be required." "If you increase your intake of animal protein foods, you may be able to avoid injections." "You may be prescribed a high dose of oral vitamin B12." "You will need to return to the clinic each month for your vitamin B12 injections."

"You may be prescribed a high dose of oral vitamin B12."

After 3 weeks of therapy with oral ferrous sulfate, a patient calls the clinic nurse, complaining of continuous nausea and vomiting with this drug. Which is the most appropriate response to this patient? "This may indicate a serious adverse effect of this drug. You need to come into the clinic." "Try to take your medication with meals. This should reduce your nausea and vomiting." "You may need a lower dose, I will contact your primary healthcare provider and call you back." "Try taking an antacid just before taking your medication. This can help reduce stomach acid, which causes nausea."

"You may need a lower dose, I will contact your primary healthcare provider and call you back."

The nurse is caring for a client experiencing sickle cell disease crisis. Which priority action would help prevent infection? a. Administering prophylactic antibiotics b. Monitoring the client's temperature c. Checking the client's white blood cell count d. Performing frequent handwashing

ANS: D Frequent and thorough handwashing is the most important intervention that helps prevent infection. Antibiotics are not usually used to prevent infection. Monitoring the client's temperature or white blood cell count helps to detect the presence of infection, but prevent it.

A patient has vitamin B12 deficiency following a subtotal gastrectomy. The nurse understands the patient has which type of anemia? Microcytic Iron deficiency Hemolytic Megaloblastic

Megaloblastic

A 12-year-old female patient is admitted to the hospital before sinus surgery. The nurse preparing to care for this patient notes that the admission hemoglobin is 10.2 gm/dL, and the hematocrit is 32%. The nurse will ask the child's parents which question about their daughter? a. "Does she eat green, leafy vegetables?" b. "Has she begun menstruating?" c. "Is she a vegetarian?" d. "Is there a chance she might be pregnant?"

b. "Has she begun menstruating?"

A client presents to the emergency department in sickle cell disease crisis. What intervention by the nurse takes priority? a. Administer oxygen. b. Initiate pulse oximetry. c. Give pain medication. d. Start an IV line.

ANS: A All actions are appropriate, but remembering the ABCs, oxygen would come first. The main problem in a sickle cell crisis is tissue and organ hypoxia, so providing oxygen helps halt the process.

A nurse caring for a client with sickle cell disease (SCD) reviews the client's laboratory test results. Which finding would the nurse report to the primary health care provider? a. Creatinine: 2.9 mg/dL (256 mcmol/L) b. Hematocrit: 30% c. Sodium: 146 mEq/L (146 mmol/L) d. White blood cell count: 12,000/mm3 (12 109/L)

ANS: A An elevated creatinine indicates kidney damage, which occurs in SCD. A hematocrit level of 30% is an expected finding, as is a slightly elevated white blood cell count due to chronic inflammation. A sodium level of 146 mEq/L (146 mmol/L), although slightly high, is not concerning.

A client is having a bone marrow aspiration and biopsy and is extremely anxious. What action by the nurse is the most appropriate? a. Assess the client's fears and coping mechanisms. b. Reassure the client that this is a common test. c. Sedate the client prior to the procedure. d. Tell the client that he or she will be asleep.

ANS: A Assessing the client's specific fears and coping mechanisms helps guide the nurse in providing holistic care that best meets the client's needs. Reassurance will be helpful but is not the best option. Sedation is usually used. The client may or may not be totally asleep during the procedure.

A client in sickle cell crisis is dehydrated and in the emergency department. The nurse plans to start an IV. Which fluid choice is best? a. 0.45% normal saline b. 0.9% normal saline c. Dextrose 50% (D50) d. Lactated Ringer's solution

ANS: A Because clients in sickle cell crisis are often dehydrated, the fluid of choice is a hypotonic solution such as 0.45% normal saline. 0.9% normal saline and lactated Ringer's solution are isotonic. D50 is hypertonic and not used for hydration.

A patient tells a nurse that she is thinking about getting pregnant and asks about nutritional supplements. What will the nurse recommend? a. A balanced diet high in green vegetables and grains b. 400 to 800 mg of folic acid per day c. A multivitamin with iron d. Vitamin B12 supplements

b. 400 to 800 mg of folic acid per day

The nurse is teaching a client who has pernicious anemia about necessary dietary changes. Which statement by the client indicates understanding about those changes? a. "I'll increase animal proteins like fish and meat." b. "I'll work on increasing my fats and carbohydrates." c. "I'll avoid eating green leafy vegetables. d. "I'll limit my intake of citrus fruits."

ANS: A Clients who have pernicious anemia have a Vitamin B12 deficiency and need to consume foods high in Vitamin B12, such as animal and plant proteins, citrus fruits, green leafy vegetables, and dairy products. While carbohydrates and fats can provide sources of energy, they do not supply the necessary nutrient to improve anemia.

A client hospitalized with sickle cell disease crisis frequently asks for opioid pain medications, often shortly after receiving a dose. The nurses on the unit believe that the client is drug seeking. When the client requests pain medication, what action by the nurse is best? a. Give the client pain medication if it is time for another dose. b. Instruct the client not to request pain medication too early. c. Request the primary health care provider leave a prescription for a placebo. d. Tell the client that it is too early to have more pain medication.

ANS: A Clients with sickle cell crisis often have severe pain that is managed with up to 48 hours of IV opioid analgesics. Even if the client is addicted and drug seeking, he or she is still in extreme pain. If the client can receive another dose of medication, the nurse would provide it. The other options are judgmental and do not address the client's pain. Giving a placebo is unethical.

The nurse is caring for a patient with leukemia who has severe fatigue. What action by the client best indicates that an important outcome to manage this problem has been met? a. Doing activities of daily living (ADLs) using rest periods b. Helping plan a daily activity schedule c. Requesting a sleeping pill at night d. Telling visitors to leave when fatigued

ANS: A Fatigue is a common problem for clients with leukemia. This client is managing his or her own ADLs using rest periods, which indicates an understanding of fatigue and how to control it. Helping to plan an activity schedule is a lesser indicator. Requesting a sleeping pill does not help control fatigue during the day. Asking visitors to leave when tired is another lesser indicator. Managing ADLs using rest periods demonstrates the most comprehensive management strategy.

A nurse is caring for four clients with leukemia. After hand-off report, which client would the nurse assess first? a. Client who had two bloody diarrhea stools this morning. b. Client who has been premedicated for nausea prior to chemotherapy. c. Client with a respiratory rate change from 18 to 22 breaths/min. d. Client with an unchanged lesion to the lower right lateral malleolus.

ANS: A The client who had two bloody diarrhea stools that morning may be hemorrhaging in the gastrointestinal (GI) tract and should be assessed first to monitor for or avoid the client from going into hypovolemic shock. The client with the slight change in respiratory rate may have an infection or worsening anemia and should be seen next. If the client's respiratory rate was greater than 28 to 30 breaths/min, the client may need the initial assessment. Marked tachypnea is an early sign of a deteriorating client condition. The other two clients are not a priority at this time.

A client has been admitted after sustaining a humerus fracture that occurred when picking up the family cat. What test result would the nurse correlate to this condition? a. Bence-Jones protein in urine b. Epstein-Barr virus: positive c. Hemoglobin: 18 mg/dL (180 mmol/L) d. Red blood cell count: 8.2 million/mcL (8.2 1012/L)

ANS: A This client has possible multiple myeloma. A positive Bence-Jones protein finding would correlate with this condition. The Epstein-Barr virus is a herpesvirus that causes infectious mononucleosis and some cancers. A hemoglobin of 18 mg/dL (180 mmol/L) is slightly high for a male and somewhat high for a female; this can be caused by several conditions, and further information would be needed to correlate this value with a specific medical condition. A red blood cell count of 8.2 million/mcL (8.2 1012/L) is also high, but again, more information would be needed to correlate this finding with a specific medical condition.

A nurse is assessing a dark-skinned client for pallor. What nursing assessment is best to assess for pallor in this client? a. Assess the conjunctiva of the eye. b. Have the patient open the hand widely. c. Look at the roof of the patient's mouth. d. Palpate for areas of mild swelling.

ANS: A To assess pallor in dark-skinned people, assess the conjunctiva of the eye or the mucous membranes. Looking at the roof of the mouth can reveal jaundice. Opening the hand widely is not related to pallor, nor is palpating for mild swelling.

A client has a platelet count of 9000/mm3 (9 109/L). The nurse finds the client confused and mumbling. What nursing action takes priority at this time? a. Call the Rapid Response Team. b. Take a set of vital signs. c. Institute bleeding precautions. d. Place the client on bedrest.

ANS: A With a platelet count this low, the client is at high risk of spontaneous bleeding. The most disastrous complication would be intracranial bleeding. The nurse needs to call the Rapid Response Team as this client has manifestations of a sudden neurologic change. Bleeding precautions will not address the immediate situation. Placing the client on bedrest is important, but the critical action is to call for immediate medical attention.

A client is having a bone marrow aspiration and biopsy. What action by the nurse takes priority? a. Administer pain medication first. b. Ensure that valid consent is in the medical record. c. Have the client shower in the morning. d. Premedicate the client with sedatives.

ANS: B A bone marrow aspiration and biopsy is an invasive procedure that requires informed consent. Pain medication and sedation are important components of care for this client but do not take priority. The client may or may not need or be able to shower.

A nurse in a hematology clinic is working with four clients who have polycythemia vera. Which client would the nurse assess first? a. Client with a blood pressure of 180/98 mm Hg b. Client who reports shortness of breath c. Client who reports calf tenderness and swelling d. Client with a swollen and painful left great toe

ANS: B Clients with polycythemia vera often have clotting abnormalities due to the hyperviscous blood with sluggish flow. The client reporting shortness of breath may have a pulmonary embolism and should be seen first. The client with a swollen calf may have a deep vein thrombosis and should be seen next. High blood pressure and gout symptoms are common findings with this disorder.

A nurse is preparing to administer a blood transfusion. What action is most important? a. Correctly identify client using two identifiers. b. Ensure that informed consent is obtained. c. Hang the blood product with Ringer's lactate. d. Stay with the client for the entire transfusion.

ANS: B If the facility requires informed consent for transfusions, this action is most important because it precedes the other actions taken during the transfusion. Correctly identifying the client and blood product is a National Patient Safety Goal, and is the most important action after obtaining informed consent. Ringer's lactate is not used to transfuse blood. The nurse does not need to stay with the client for the duration of the transfusion.

The family of a neutropenic client reports that the client "is not acting right." What action by the nurse is the priority? a. Ask the client about pain. b. Assess the client for infection. c. Take a set of vital signs. d. Review today's laboratory results.

ANS: B Neutropenic clients often do not have classic manifestations of infection, but infection is the most common cause of death in neutropenic clients. The nurse would definitely assess for infection. The nurse would assess for pain but this is not the priority.

The nurse is assessing a client who has probable lymphoma. What is the most common early assessment finding for clients with this disorder? a. Weight gain b. Enlarged painless lymph node(s) c. Fever at night d. Nausea and vomiting

ANS: B The first change that is noted for clients with probable lymphoma is one or more enlarged lymph nodes. The other findings are either not common in clients with lymphoma or later findings.

The nurse is assessing an older client for any potential hematologic health problem. Which assessment finding is the most significant and would be reported to the primary health care provider? a. Poor skin turgor on both forearms b. Multiple petechiae and large bruises c. Dry, flaky skin on arms and legs d. Decreased body hair distribution

ANS: B The presence of multiple petechiae and large bruises indicate a possible problem with blood clotting. Older adults typically have poor skin turgor and dry, flaky skin due to decreased body fluid as a result of aging. They also lose body hair or have thinning hair as a normal change of aging.

A client receiving a blood transfusion develops anxiety and low back pain. After stopping the transfusion, what action by the nurse is most important? a. Document the events in the client's medical record. b. Double-check the client and blood product identification. c. Place the client on strict bedrest until the pain subsides. d. Review the client's medical record for known allergies.

ANS: B This client most likely had a hemolytic transfusion reaction, most commonly caused by blood type or Rh incompatibility. The nurse should double-check all identifying information for both the client and blood type. Documentation occurs after the client is stable. Bedrest may or may not be needed. Allergies to medications or environmental items are not related.

A nurse is caring for four clients. After reviewing today's laboratory results, which client would the nurse assess first? a. Client with an international normalized ratio of 2.8 b. Client with a platelet count of 128,000/mm3 (128 109/L). c. Client with a prothrombin time (PT) of 28 seconds d. Client with a red blood cell count of 5.1 million/mcL (5.1 1012/L)

ANS: C A normal PT is 11 to 12.5 seconds. This client is at high risk of bleeding with a PT of 28 seconds. The other values are within normal limits.

A nurse is caring for a young male client with lymphoma who is to begin treatment. What teaching topic is a priority? a. Genetic testing b. Infection prevention c. Sperm banking d. Treatment options

ANS: C All teaching topics are important to the client with lymphoma, but for a young male, sperm banking is of particular concern if the client is going to have radiation to the lower abdomen or pelvis.

A nurse is caring for a client who is about to receive a bone marrow transplant. To best help the client cope with the long recovery period, what action by the nurse is best? a. Arrange a visitation schedule among friends and family. b. Explain that this process is difficult but must be endured. c. Help the client find things to hope for each day of recovery. d. Provide plenty of diversionary activities for this time.

ANS: C Providing hope is an essential nursing function during treatment for any disease process, but especially during the recovery period after bone marrow transplantation, which can take up to 3 weeks. The nurse can help the client look ahead to the recovery period and identify things to hope for during this time. Visitors are important to clients, but may pose an infection risk. Telling the client that the recovery period must be endured does not acknowledge his or her feelings. Diversionary activities are important, but not as important as instilling hope.

What is the nurse's priority when caring for a client who just completed a bone marrow aspiration and biopsy? a. Teach the client to avoid activity for 24 to 48 hours to prevent infection. b. Administer a nonsteroidal anti-inflammatory drug (NSAID) to promote comfort. c. Check the pressure dressing frequently for signs of excessive or active bleeding. d. Report the laboratory results to the primary health care provider.

ANS: C The client having a bone marrow aspiration and biopsy has a puncture wound from the large needle used to extract the bone marrow. Therefore, the client is at risk for bleeding. A NSAID should not be given because it can cause bleeding. Avoiding activity helps to prevent bleeding, not infection, and reporting the results of the biopsy is not the responsibility of the nurse.

A client has thrombocytopenia. What statement indicates that the client understands self-management of this condition? a. "I brush and use dental floss every day." b. "I chew hard candy for my dry mouth." c. "I usually put ice on bumps or bruises." d. "Nonslip socks are best when I walk."

ANS: C The client should be taught to apply ice to areas of minor trauma. Flossing is not recommended. Hard foods should be avoided. The client should wear well-fitting shoes when ambulating.

The nurse is assessing a client in sickle cell disease (SCD) crisis. What priority client problem will the nurse expect? a. Infection b. Pallor c. Pain d. Fatigue

ANS: C The priority expected client problem for clients experiencing sickle cell disease crisis is pain, often concentrated in the legs, arms, and joints. Clients may also be fatigued and pale but these symptoms are not a priority for care. Infection is not expected but can occur in clients who have SCD crisis.

A client asks about the process of graft-versus-host disease. What explanation by the nurse is correct? a. "Because of immunosuppression, the donor cells take over." b. "It's like a transfusion reaction because no perfect matches exist." c. "The patient's cells are fighting donor cells for dominance." d. "The donor's cells are actually attacking the patient's cells."

ANS: D Graft-versus-host disease is an autoimmune-type process in which the donor cells recognize the client's cells as foreign and begin attacking them. The other answers are not accurate.

An assistive personnel is caring for a client with leukemia and asks why the client is still at risk for infection when the white blood cell count (WBC) is high. What response by the nurse is correct? a. "If the WBCs are high, there already is an infection present." b. "The client is in a blast crisis and has too many WBCs." c. "There must be a mistake; the WBCs should be very low." d. "Those WBCs are abnormal and don't provide protection."

ANS: D In leukemia, the WBCs are abnormal and do not provide protection to the client against infection. The other statements are not accurate.

Which statement by a client with leukemia indicates a need for further teaching by the nurse? a. "I will use a soft-bristled toothbrush and avoid flossing." b. "I will not take aspirin or any aspirin product." c. "I will use an electric shaver instead of my manual one." d. "I will take a daily laxative to prevent constipation."

ANS: D The client experiencing leukemia needs to prevent injury to prevent bleeding, including avoiding hard-bristled toothbrushes, floss, aspirin, and straight or manual safety razors. However, although constipation can cause hemorrhoids or rectal bleeding, laxatives can cause fluid and electrolyte imbalances and abdominal cramping. Stool softeners would be a better option to allow the passage of soft stool.

A client is having a radioisotopic imaging scan. What action by the nurse is most important? a. Assess the client for shellfish allergies. b. Place the client on radiation precautions. c. Sedate the client before the scan. d. Teach the client about the procedure.

ANS: D The nurse should ensure that teaching is done and the client understands the procedure. Contrast dye is not used, so shellfish/iodine allergies are not related. The client will not be radioactive and does not need radiation precautions. Sedation is not used in this procedure.

The nurse assesses a client's oral cavity as seen in the photo below: What action by the nurse is most appropriate? a. Encourage the client to have genetic testing. b. Instruct the client on high-fiber foods. c. Place the client in protective precautions. d. Teach the client about cobalamin therapy.

ANS: D This condition is known as glossitis, and is characteristic of B12 anemia. If the anemia is a pernicious anemia, it is treated with cobalamin. Genetic testing is not a priority for this condition. The client does not need high-fiber foods or protective precautions.

A nurse is preparing to administer a blood transfusion. Which action is most important? a. Document the transfusion. b. Place the client on NPO status. c. Place the client in isolation. d. Put on a pair of gloves.

ANS: D To prevent bloodborne illness, the nurse should don a pair of gloves prior to hanging the blood. Documentation is important but not the priority at this point. NPO status and isolation are not needed.

A hospitalized client has a platelet count of 58,000/mm3 (58 109/L). What action by the nurse is most appropriate? a. Encourage high-protein foods. b. Institute neutropenic precautions. c. Limit visitors to healthy adults. d. Place the client on safety precautions.

ANS: D With a platelet count between 40,000 and 80,000/mm3 (40 and 80 109/L), clients are at risk of prolonged bleeding even after minor trauma. The nurse would place the client on safety or bleeding precautions as the most appropriate action. High-protein foods, while healthy, are not the priority. Neutropenic precautions are not needed as the patient's white blood cell count is not low. Limiting visitors would also be more likely related to a low white blood cell count.

Which nursing action should prevent an adverse effect of a liquid iron preparation? Administer the iron preparation through a dropper. Administer the liquid iron preparation along with vitamin C. Administer the liquid buccally to delay absorption and lessen adverse effects. Mix the liquid iron preparation with an antacid for patients with underlying peptic ulcer disease.

Administer the iron preparation through a dropper.

Which is the priority nursing intervention for a patient receiving parenteral iron dextran (INFeD) infusion? The medication must be administered by deep subcutaneous injection. An intravenous test dose of 25 mg over 5 minutes must be administered. Erythropoietin must also be given when a patient is receiving parenteral iron dextran. After administration of a test dose of intramuscular (IM) iron dextran, the patient must be observed for 15 minutes before the full therapeutic dose is given.

An intravenous test dose of 25 mg over 5 minutes must be administered.

A patient is admitted to the hospital with unstable angina and will undergo a percutaneous coronary intervention. Which drug regimen will the nurse expect to administer to prevent thrombosis in this patient? a. Aspirin, clopidogrel, omeprazole b. Aspirin, heparin, abciximab [ReoPro] c. Enoxaparin [Lovenox], prasugrel [Effient], warfarin [Coumadin] d. Heparin, alteplase, abciximab [ReoPro

Aspirin, heparin, abciximab [ReoPro]

The nurse is taking a medication history on a newly admitted patient. The patient reports taking folic acid and vitamin B12. The nurse notifies the provider because of the concern that folic acid can: a. cause fetal malformation. b. mask the signs of vitamin B12 deficiency. c. negatively affect potassium levels. d. worsen megaloblastic anemia.

b. mask the signs of vitamin B12 deficiency.

The nurse is caring for a patient with anemia. What is a common cause of iron deficiency in the United States? Decreased intestinal uptake of iron Chronic blood loss through the GI tract Vegetarian eating patterns Rapid growth during adolescence

Chronic blood loss through the GI tract

For which medication order should the nurse notify the healthcare provider? Cyanocobalamin 100 mcg intravenously (IV) every month Folic acid 1 mg orally daily × 2 weeks; then folic acid 400 mcg orally daily Iron dextran [INFeD] test dose 25 mg (IV) over 5 minutes Sodium-ferric gluconate complex [Ferrlecit] 125 mg in 100 mL NSS to run intravenously over 15 minutes

Cyanocobalamin 100 mcg intravenously (IV) every month

A patient will begin taking dabigatran etexilate [Pradaxa] to prevent stroke. The nurse will include which statement when teaching this patient? a. Dabigatran should be taken on an empty stomach to improve absorption. b. It is important not to crush, chew, or open capsules of dabigatran. c. The risk of bleeding with dabigatran is less than that with warfarin [Coumadin]. d. To remember to take dabigatran twice daily, a pill organizer can be useful.

Dabigatran should be taken on an empty stomach to improve absorption.

A postoperative patient reports pain in the left lower extremity. The nurse notes swelling in the lower leg, which feels warm to the touch. The nurse will anticipate giving which medication? a. Aspirin b. Clopidogrel [Plavix] c. Enoxaparin [Lovenox] d. Warfarin [Coumadin]

Enoxaparin [Lovenox]

The nurse is administering iron dextran (INFeD) by intravenous (IV) infusion to a patient with iron deficiency. Which is the priority nursing action during the administration of this drug? Ensure that epinephrine is available as needed. Assess the lung sounds and respiratory rate. Monitor the blood urea nitrogen and creatinine levels. Use Y-connector tubing to connect to the primary line.

Ensure that epinephrine is available as needed.

Which organ regulates the body's iron stores? Intestines Kidneys Liver Bloodstream

Intestines

A patient is receiving cyanocobalamin for the treatment of pernicious anemia. Which electrolyte should the nurse monitor as a result of this treatment? Sodium Calcium Chloride Potassium

Potassium

A patient being treated for pernicious anemia with cyanocobalamin reports new onset of muscle weakness and states, "My heart is skipping beats." Which laboratory value most likely is contributing to these new symptoms? Serum chloride level of 98 mEq/L Serum sodium level of 133 mEq/L Serum glucose level of 185 mg/dL Serum potassium level of 2.3 mEq/L

Serum potassium level of 2.3 mEq/L

A 50-year-old female patient asks a nurse about taking aspirin to prevent heart disease. The patient does not have a history of myocardial infarction. Her cholesterol and blood pressure are normal, and she does not smoke. What will the nurse tell the patient? a. Aspirin is useful only for preventing a second myocardial infarction. b. She should ask her provider about using a P2Y12 ADP receptor antagonist. c. She should take one 81-mg tablet per day to prevent myocardial infarction. d. There is most likely no protective benefit for patients of her age.

There is most likely no protective benefit for patients of her age.

A patient who takes warfarin [Coumadin] is brought to the emergency department after accidentally taking too much warfarin. The patient's heart rate is 78 beats/min, and the blood pressure is 120/80 mm Hg. A dipstick urinalysis is normal. The patient does not have any obvious hematoma or petechiae and does not complain of pain. The nurse will anticipate an order for: a. vitamin K (phytonadione). b. protamine sulfate. c. a PTT. d. a PT and an INR.

a PT and an INR

A patient with renal failure is undergoing chronic hemodialysis. The patient's hemoglobin is 10.6 gm/dL. The provider orders sodium-ferric gluconate complex (SFGC [Ferrlecit]). What will the nurse expect to do? a. Administer the drug intravenously with erythropoietin. b. Give a test dose before each administration of the drug. c. Have epinephrine on hand to treat anaphylaxis if needed. d. Infuse the drug rapidly to achieve maximum effects quickly.

a. Administer the drug intravenously with erythropoietin.

The patient with which of the following is most at risk for folic acid deficiency? a. Alcoholism b. Sprue c. Gastrectomy d. Peptic ulcer disease

a. Alcoholism

A patient with vitamin B12 deficiency is admitted with symptoms of hypoxia, anemia, numbness of hands and feet, and oral stomatitis. The nurse expects the prescriber to order which of the following therapies? a. IM cyanocobalamin and folic acid b. IM cyanocobalamin and antibiotics c. PO cyanocobalamin and folic acid d. PO cyanocobalamin and blood transfusions

a. IM cyanocobalamin and folic acid

A patient is receiving oral iron for iron deficiency anemia. Which antibiotic drug, taken concurrently with iron, would most concern the nurse? a. Tetracycline b. Cephalosporin c. Metronidazole [Flagyl] d. Penicillin

a. Tetracycline

A patient who has recently immigrated to the United States from an impoverished country appears malnourished. The patient's folic acid levels are low, and the vitamin B12 levels are normal. The nurse expects this patient's treatment to include: a. a diet high in folic acid. b. intramuscular folic acid. c. oral folic acid and vitamin B12. d. oral folic acid supplements.

a. a diet high in folic acid.

A nurse is reviewing a patient's most recent blood count and notes that the patient has a hemoglobin of 9.6 gm/dL and a hematocrit of 33%. The nurse will notify the provider and will expect initial treatment to include: a. determining the cause of the anemia. b. giving intravenous iron dextran. c. giving oral carbonyl iron [Feosol]. d. teaching about dietary iron.

a. determining the cause of the anemia.

A patient with atrial fibrillation is receiving warfarin [Coumadin]. The nurse notes that the patient's INR is 2.7. Before giving the next dose of warfarin, the nurse will notify the provider and: a. administer the dose as ordered. b. request an order to decrease the dose. c. request an order to give vitamin K (phytonadione). d. request an order to increase the dose.

administer the dose as ordered.

A nurse is caring for a patient after hip replacement surgery. The patient has been receiving iron replacement therapy for 2 days. The nurse notes that the patient's stools appear black. The patient is pale and complains of feeling tired. The patient's heart rate is 98 beats per minute, respirations are 20 breaths per minute, and the blood pressure is 100/50 mm Hg. The nurse will contact the provider to: a. report possible gastrointestinal hemorrhage. b. request a hemoglobin and hematocrit (H&H). c. request an order for a stool guaiac. d. suggest giving a hypertonic fluid bolus.

b. request a hemoglobin and hematocrit (H&H).

The nurse has just received an order for tenecteplase [TNKase] for a patient experiencing an acute myocardial infarction. The nurse should administer this drug: a. by bolus injection. b. by infusion pump over 24 hours. c. slowly over 90 minutes. d. via monitored, prolonged infusion.

by bolus injection

A patient is diagnosed with moderate vitamin B12 deficiency. The nurse reviews the laboratory work and notes that the plasma B12 is low; also, a Schilling test reveals B12 malabsorption. The provider orders oral cyanocobalamin 500 mcg per day. The nurse will contact the provider to: a. discuss IM dosing. b. request an order for folic acid. c. suggest an increased dose. d. suggest platelet transfusion therapy.

c. suggest an increased dose.

A patient who is taking clopidogrel [Plavix] calls the nurse to report black, tarry stools and coffee-ground emesis. The nurse will tell the patient to: a. ask the provider about using aspirin instead of clopidogrel. b. consume a diet high in vitamin K. c. continue taking the clopidogrel until talking to the provider. d. stop taking the clopidogrel immediately.

continue taking the clopidogrel until talking to the provider.

A patient who has been prescribed oral ferrous sulfate reports taking extra doses for the past few months. The patient's serum iron level is 560 mcg/dL. What will the nurse expect the provider to order for this patient? a. Discontinuing the ferrous sulfate and rechecking the iron level in 1 month b. Gastric lavage and treatment for acidosis and shock c. Giving oral deferasirox [Exjade] d. Giving parenteral deferoxamine [Desferal]

d. Giving parenteral deferoxamine [Desferal]

A patient is admitted to the hospital. The patient's initial laboratory results reveal megaloblastic anemia. The patient complains of tingling of the hands and appears confused. The nurse suspects what in this patient? a. Celiac disease b. Folic acid deficiency c. Iron deficiency anemia d. Vitamin B12 deficiency

d. Vitamin B12 deficiency

A patient was given a 30-day supply of Feosol and has been taking the drug for 4 weeks for iron deficiency anemia. The patient's initial hemoglobin was 8.9 gm/dL. The nurse notes that the hemoglobin has risen to 9.7 gm/dL. What will the nurse ask the patient about? a. Dietary iron intake b. Gastrointestinal (GI) upset c. Whether stools have been tarry or black d. Whether the prescription needs to be refilled

d. Whether the prescription needs to be refilled

A nurse caring for a patient receiving heparin therapy notes that the patient has a heart rate of 98 beats/min and a blood pressure of 110/72 mm Hg. The patient's fingertips are purplish in color. A stat CBC shows a platelet count of less than 100,000 mm3 . The nurse will: a. administer oxygen and notify the provider. b. discontinue the heparin and notify the provider. c. request an order for protamine sulfate. d. request an order for vitamin K (phytonadione).

discontinue the heparin and notify the provider

A patient is admitted to the emergency department with chest pain. An electrocardiogram shows changes consistent with an evolving myocardial infarction. The patient's cardiac enzymes are pending. The nurse caring for this patient will expect to: a. administer aspirin when cardiac enzymes are completed. b. give alteplase [Activase] within 2 hours. c. give tenecteplase [TNKase] immediately. d. obtain an order for an INR.

give alteplase [Activase] within 2 hours

A patient who has taken warfarin [Coumadin] for a year begins taking carbamazepine. The nurse will anticipate an order to: a. decrease the dose of carbamazepine. b. increase the dose of warfarin. c. perform more frequent aPTT monitoring. d. provide extra dietary vitamin K

increase the dose of warfarin

A postoperative patient will begin anticoagulant therapy with rivaroxaban [Xarelto] after knee replacement surgery. The nurse performs a history and learns that the patient is taking erythromycin. The patient's creatinine clearance is 50 mL/min. The nurse will: a. administer the first dose of rivaroxaban as ordered. b. notify the provider to discuss changing the patient's antibiotic. c. request an order for a different anticoagulant medication. d. request an order to increase the dose of rivaroxaban.

notify the provider to discuss changing the patient's antibiotic.

A patient who is taking warfarin [Coumadin] has just vomited blood. The nurse notifies the provider, who orders laboratory work revealing a PT of 42 seconds and an INR of 3.5. The nurse will expect to administer: a. phytonadione (vitamin K1) 1 mg IV over 1 hour. b. phytonadione (vitamin K1) 2.5 mg PO. c. protamine sulfate 20 mg PO. d. protamine sulfate 20 mg slow IV push.

phytonadione (vitamin K1) 1 mg IV over 1 hour

A patient is receiving heparin postoperatively to prevent deep vein thrombosis. The nurse notes that the patient has a blood pressure of 90/50 mm Hg and a heart rate of 98 beats/min. The patient's most recent aPTT is greater than 90 seconds. The patient reports lumbar pain. The nurse will request an order for: a. a repeat aPTT to be drawn immediately. b. analgesic medication. c. changing heparin to aspirin. d. protamine sulfate.

protamine sulfate

A patient who takes warfarin for atrial fibrillation undergoes hip replacement surgery. On the second postoperative day, the nurse assesses the patient and notes an oxygen saturation of 83%, pleuritic chest pain, shortness of breath, and hemoptysis. The nurse will contact the provider to report possible and request an order for . a. congestive heart failure; furosemide [Lasix] b. hemorrhage; vitamin K (phytonadione) c. myocardial infarction; tissue plasminogen activator (tPA) d. pulmonary embolism; heparin

pulmonary embolism; heparin