custom adaptive quiz exam1

The nurse is completing an assessment on a couple seeking genetic counseling for sickle cell anemia. Both prospective parents carry sickle cell traits. The nurse recognizes that the couple has what chance of having a child who develops the disease?

25%

A client is receiving warfarin for a pulmonary embolism. Which drug is often contraindicated when taking warfarin?

Acetylsalicylic acid can cause decreased platelet aggregation, increasing the risk for undesired bleeding that may occur with administration of anticoagulants.

The parents of a 3-month old infant who is breastfed ask the nurse how to prevent nutritional anemia. What is the best response by the nurse?

Baby cereal or an iron supplement should be given around 4 months of age.

When a Schilling test is prescribed for a client suspected of having cobalamin deficiency because of pernicious anemia, what should the nurse plan to do?

Collect a 24-hour to 48-hour urine specimen

Which diagnostic study is used to detect deep vein thrombosis in the client's lower extremities?

Duplex venous doppler records an ultrasound of the veins, including blood flow abnormalities of the lower extremities

The nurse teaching a health awareness class identifies which situation as being the highest risk factor for the development of a deep vein thrombosis (DVT)?

Inactivity

For which clinical manifestations indicating that the client may be experiencing a pulmonary embolus should the nurse assess the client? Select all that apply.

Increased temperature Decreased oxygen saturation level Sudden onset of shortness of breath sharp chest pain crakles hemoptysis feeling of impeding doom

The nurse is caring for a client with iron deficiency anemia that has decreased hemoglobin and hematocrit levels. The nurse expects to identify what other abnormal laboratory level?

Increased total iron-binding capacity (TIBC)

When discussing the therapeutic regimen of vitamin B 12 for pernicious anemia with a client, what teaching does the nurse provide?

Intramuscular injections once a month will maintain control.

Which is the most important assessment for the nurse to make after a client has a femoropopliteal bypass for peripheral vascular disease?

LE color and temperature, part of the neurovascular assessment, provides data about current perfusion of the extremity and the possibility of graft occlusion/blockage.

Which medication will cause the nurse to monitor the client closely for hemolytic anemia?

Methyldopa

A client with a diagnosis of anemia is receiving packed red blood cells. What is the most important action by the nurse when administering the transfusion?

Monitoring the client's response, particularly within the first 10 minutes

How does the nurse explain physiologic anemia to a pregnant client?

Plasma volume increases

What nursing care to prevent a crisis is the same for school-aged children with sickle cell anemia and celiac disease?

Protecting the child from infection

A client had part of the ileum surgically removed. The nurse monitors the client closely for anemia. What is the rationale for the nurse's action?

Vitamin B12 (cobalamin) combines with intrinsic factor, a substance secreted by the parietal cells of the gastric mucosa, and is absorbed in the ileum.

How is hemophilia inherited?

X-linked recessive trait, daughters who have the gene are carriers, and sons with the gene have the condition.

A child with beta-thalassemia (Cooley anemia) is admitted to the ambulatory care unit for a transfusion. What instruction should the nurse include in the plan of care?

-Children with a chronic illness such as hemolytic anemia should not be exposed to the additional stress of infection.

pernicious anemia

deficiency of intrinsic factor, which is necessary for vitamin B 12 use.

Factor VIII is administered

once in the morning on designated days. The half-life of factor VIII is short.

Deferasirox AND deferiprone

oral chelating agents

Clopidogrel

platelet aggregate inhibitor and is used to reduce the risk of a brain attack.

A client with chronic kidney disease is receiving medication to manage anemia. Which primary goal should the nurse include in the care plan from this information?

prevention of chronic fatigue

A nurse is developing a teaching plan for a child who has anemia as a result of inadequate nutrition. In addition to iron, which nutrients should the nurse include that are necessary for red blood cell synthesis? Select all that apply.

protein vit. c

The school nurse is assessing a 10-year-old boy with hemophilia who has fallen while playing in the schoolyard. At which site does the nurse expect to find internal bleeding?

weight-bearing joints, especially the knees, are the most common site of bleeding.

Warfarin

long-acting oral anticoagulant, is started after the acute stage has subsided; it is continued for 2 to 3 months.

A client is receiving heparin sodium intravenously at 1500 units/hour. The concentration in the bag is 25,000 units/500 milliliters. The nurse determines that how many milliliters will infuse during the nurse's 8-hour shift? Record your answer using a whole number. ___ mL

30 ml

The mother of an 11-month-old infant reports that the baby has allergies. After an assessment, the primary healthcare provider also suspects anemia. Which questions would the primary healthcare provider most likely ask the mother? Select all that apply.

Do you use 2% cow's milk? Do you use whole cow's milk? Do you use alternate milk products?

During a period of heavy play activity, a first-grader with a known history of anemia complains of feeling "woozy." What should be the school nurse's initial response?

Sitting the child on a chair until the dizziness subsides

A 1-year-old child is found to have nutritional iron-deficiency anemia. What nursing interventions are most important in the care of an infant with iron-deficiency anemia? Select all that apply.

Conserving the infant's energy Protecting the infant from infection Teaching the parents about nutrition

Folic acid

necessary coenzyme in the formation of heme, the iron-containing protein in hemoglobin.

What is the priority nursing action when caring for a client with disseminated intravascular coagulation?

-Avoid giving intramuscular injections -Massive amounts of clots formed in the microcirculation deplete platelets and clotting factors, leading to bleeding; -the trauma of an injection may cause excessive bleeding.

A nurse is caring for two clients; one has polycythemia and the other has prolonged anemia. What do these clients have in common?

-Increased cardiac workload -With anemia, the heart works harder to compensate for the reduced oxygen-carrying ability of the blood. With polycythemia, the heart works harder to propel more viscous blood through the circulatory system.

A client has been experiencing extreme fatigue lately. The nurse suspects anemia and examines the client to identify additional clinical manifestations to support this inference. Which locations on the client's body should the nurse assess? Select all that apply.

-Nail beds lose their pink coloration because of reduced hemoglobin. -A reduced amount of hemoglobin decreases pink color of the lining of the eyelids (conjunctiva). -Palms of the hands will become pale because of the decreased hemoglobin.

IDA labs

-hgb/hct low -hypochromic -microcytic -Serum ferritin: low -TIBC: elevated -low retic count

A client develops iron-deficiency anemia. Which of the client's laboratory test results should the nurse expect to be decreased?

Ferritin level , a form of stored iron

What should the plan of care include to minimize the potential for a sickling episode in a child with sickle cell anemia?

Promoting adequate oxygenation

Which diagnostic test would the nurse consider to be the gold standard for diagnosis of pulmonary embolism?

Pulmonary angiography

A nurse is performing health screenings of toddlers in a culturally diverse neighborhood. Which child should the nurse consider at risk for beta-thalassemia (Cooley anemia)?

Two-year-old child of Greek descent with a large abdomen

A client has been diagnosed with anemia. Which decreased hormone level may be the cause?

Erythropoietin

Which adverse effect of heparin may be seen during pregnancy?

Osteoporosis

Deferoxamine

intravenous medication that chelates with the iron and reduces iron overload or hemochromatosis in the client in less time

A healthcare provider prescribes supplemental oral iron therapy for a child with iron-deficiency anemia. What side effect will the nurse tell the parents to anticipate?

Greenish-black stool

A client is receiving epoetin for the treatment of anemia associated with chronic renal failure. Which client statement indicates to the nurse that further teaching about this medication is necessary?

"I realize it is important to take this medication because it will cure my anemia."

The nurse is providing teaching to the parents of a preschool-age client who is prescribed iron supplements for iron-deficiency anemia. Which parental statements indicate the need for further education? Select all that apply.

"We will mix the iron with black tea to enhance absorption." "We will mix the iron with milk to enhance absorption.

hemolytic anemia

-autoimmune disorder in which red blood cells are destroyed and removed from the bloodstream before the end of their normal life span. -It may result after administration of methyldopa.

The nurse is preparing a blood transfusion for a client with renal failure. Why does anemia often complicate renal failure?

Decrease in erythropoietin

A nurse is caring for a 6-year-old child with sickle cell anemia. What is the priority nursing intervention to prevent thrombus formation?

Encouraging fluids

A child has been diagnosed with hemophilia type A after experiencing excessive bleeding from a minor trauma. The parents ask what symptoms of bleeding they should be looking for in the future. What symptoms should the nurse list? Select all that apply.

Epistaxis Hematuria Hemarthrosis Easy bruising Dark-colored tarry stools

Which type of cytokine is used to treat anemia related to chronic kidney disease?

Erythropoietin

A client is seen in the clinic with sickle cell anemia. The parents of the client ask how their child got sickle cell anemia. What is an accurate explanation?

If both parents are carriers, the odds are one in four that an offspring will get the disease, and one in four that an offspring will be disease free.

A 3.5-year-old child with severe iron deficiency anemia is seen by a nurse in the clinic. In addition to weakness and fatigue, what should the nurse expect the child to exhibit?

Increased pulse rate leads to tachycardia as the body tries to compensate.

When reviewing the results of a toddler's complete blood count, a nurse concludes on the basis of decreased hemoglobin and hematocrit levels that the child has iron-deficiency anemia. Which other laboratory findings are indicative of iron-deficiency anemia? Select all that apply.

Microcytic red blood cells Slightly reduced reticulocyte count

A school-aged child with sickle cell anemia is admitted to the pediatric unit in a vaso-occlusive crisis. The nurse's priority is to relieve the excruciating pain. What interventions should be implemented after the pain is under control? Select all that apply.

Rehydration Oxygen therapy

What points should be considered when a client with a respiratory disorder undergoes a spiral-computed tomography (CT) scan to diagnose a pulmonary embolism? Select all that apply.

The test involves the administration of a contrast medium. Clients should have their hydration levels assessed. Clients are instructed to lie still on a hard table.

An older adult with peripheral vascular disease has stopped smoking, and the client's children want to make the home environment safe. What should the home healthcare nurse emphasize when providing instructions?

Use measures that can prevent thermal injuries

Heparin

medication of choice during the acute phase of a deep vein thrombosis; it prevents conversion of fibrinogen to fibrin and of prothrombin to thrombin.

majority of pulmonary emboli begin as deep vein thromboses in what area?

pelvis and thighs because of the extensive vascular network in the region

A nurse provides teaching regarding vitamin B 12 injections to a client with pernicious anemia. What statement by the client indicates that teaching was understood?

"I must take this monthly for the rest of my life."

Beta Thalassemia

-common in children who are black or of Mediterranean descent (Italian, Greek, Syrian); -an enlarged abdomen may be the result of hepatomegaly or splenomegaly. -bronze skin as a result of hemosiderosis if the excess iron is not chelated

A 10-year-old child with sickle cell anemia is admitted to the unit in vaso-occlusive crisis (VOC). After the child has been given the prescribed analgesic, which intervention is the priority to minimize the effects of the crisis?

-kidneys of children with sickle cell anemia do not concentrate urine as well as do healthy kidneys, i -t is important to maintain adequate hydration. -Hydration with IV fluids supplementing oral fluids can minimize the occurrence of a crisis because hemodilution helps prevent sickling.

An underweight client has autoimmune hemolytic anemia that has been unresponsive to corticosteroids, and a splenectomy is scheduled. For what complication should the nurse assess the client in the immediate postoperative period?

hemorrhage because of the vascularity of the spleen

A nurse is preparing to discharge a school-aged child who has undergone splenectomy for β-thalassemia (Cooley anemia). What information should the discharge teaching include?

high fever report to hcp asap

The laboratory report of a school-aged child with celiac disease reveals that the child has anemia. What does the nurse suspect as the most likely causes of the anemia? Select all that apply.

incomplete absorption of iron and folic acid

While counseling the parents of an adolescent with anemia related to an inadequate diet, a nurse explains that several different nutrients, including protein, iron, and vitamin B 12, are involved. What other nutrient should the nurse include in the teaching?

folic acid

A low-molecular-weight heparin (e.g., enoxaparin)

is not administered during the acute stage; it may be administered later to prevent future deep vein thromboses.

Which iron-rich foods should the nurse recommend for a toddler-age client who is diagnosed with iron deficiency anemia? Select all that apply.

chicken broccoli lean steak

A 12-year-old child with sickle cell anemia is admitted during a vaso-occlusive crisis. What is the priority of care for this child?

relieving pain

Anemia of chronic disease

results in a decrease in the production of red blood cells (RBCs) in response to chronic inflammation