Mod 12 EAQs

A patient who is in acute sickle cell crisis cries and reports a pain level of "10" on a 1 to 10 scale. The nurse identifies that which type of medication is most appropriate for the patient? A. Acetaminophen (Tylenol) oral tablets every six hours. B. Oral morphine tablets, every four hours, as needed (PRN) C. intravenous meperidine (Demerol), every four hours, PRN D. Hydromorphone (Dilaudid) via patient-controlled analgesia (PCA)

AND D Hydromorphone (Dilaudid) Via patient-controlled analgesia (PCA) Rationale: During an acute sickle cell crisis, optimal pain control usually includes large doses of continuous (rather than PRN) opioid analgesics along with breakthrough analgesia, often in the form of PCA. Morphine and hydromorphone are the drugs of choice. Acetaminophen is appropriate for minor pain or fever, not for severe pain. Meperidine is contraindicated because high doses can lead to the accumulation of a toxic metabolite, normeperidine, which can cause seizures.

The nurse recalls that hemolytic anemia can be caused by which extrinsic factors? A. Infectious agent B. Enzyme deficiency C. Sickle cell disease D. Membrane abnormalities

ANS A Infectious agent Rationale: Infectious agents, such as malaria, are c extrinsic factors that can lead to acquired hemolytic anemias. Membrane abnormalities, such as paroxysmal nocturnal hemoglobinuria, cause increased RBC destruction and are hereditary (intrinsic) factors, Abnormal hemoglobin, such as sickle cell disease, and enzyme deficiencies are intrinsic factors that lead to hereditary (intrinsic) hemolytic anemias.

The nurse provides discharge teaching to a patient with sickle cell disease (SCD). Which statements made by the patient indicates understanding of the teaching? Select all that apply. A. "I should avoid high altitudes." B. "I should drink orange juice quite often." C. "I can safely consume uncooked seafood." D. "I shouldn't receive the pneumococcal injection." E. "I should start screening for retinopathy at age 10."

ANS A. "I should avoid high altitudes." B. "I should start screening for retinopathy at age ." Rationale: Patients with SCD should avoid crises, but avoiding activities that cause hypoxia. Regular screenings for retinopathy are recommended. The pneumococcal injection is recommended to prevent infection. Eating uncooked seafood increases the risk of infection; this type of product is rich in iron and should be avoided. The patient should not drink orange juice too often, because orange juice is rich in Vitamin C.

The nurse recognizes that which condition is depicted in the figure? A. Acute hemarthrosis B. Severe ecchymosis C. Heparin-induced thrombocytopenia (HIT) D. Acute idiopathic thrombocytopenic purpura

ANS A. Acute Hemarthrosis Rationale: Acute hemarthrosis is characterized by bleeding into the joint spaces, as is seen in hemophilia. Bleeding in the joints causes local inflammation. The image shows inflammation of the knee joint and is therefore acute hemarthrosis. Severe ecchymosis causes accumulation of waste blood due to hematomas. Therefore the image for severe ecchymosis will show red coloration on the body. Heparin-induced thrombocytopenia (HIT) will show skin necrosis. Acute idiopathic thrombocytopenic purpura will show purplish petechiae.

The nurse suspects heparin-induced thrombocytopenia (HIT) in a patient who is receiving heparin therapy. Which nursing interventions would be beneficial for this patient? Select all that apply. A. Administering argatroban B. performing plasmapheresis C. Applying vascular catheters D. Discontinuing heparin therapy E. Administering platelet transfusions

ANS A. Administering argatroban B. Performing plasmapheresis D. Discontinuing heparin therapy Rationale: Argatroban should be administered to a patient who has developed heparin-induced thrombocytopenia (HIT) to maintain anticoagulation. Plasmapheresis should be performed to clear the platelet-aggregating immunoglobulin G from the blood. Heparin should be immediately discontinued when HIT is first recognized to prevent further complications. Vascular catheters should also be removed. Platelet transfusions will not be beneficial in the patient, because they may enhance thromboembolic events.

The nurse teaches home care measures to a patient diagnosed with hemophilia and should include which instructions? Select all that apply A. Avoid contact sports B. Perform oral hygiene daily C. Use alcohol-based mouthwashes D. Wear gloves while doing household chores E. Blow your nose with force if there is a nosebleed.

ANS A. Avoid contact sports. B. Perform oral hygiene daily D. Wear gloves while doing household chores. Rationale: A patient diagnosed with bleeding disorders such as hemophilia should perform oral hygiene daily without causing trauma. The patient should be advised to play only noncontact sports such as golf to avoid injuries. Gloves should be used while doing household chores to prevent abrasions and cuts from knives and other tools. Alcohol-based mouthwashes should be avoided, because they dry the gums and increase bleeding. If there is a nosebleed, the patient should be advised to gently pat the nose with a tissue, because force blowing may further increase bleeding.

A patient receives a prescription for rituximab. Prior to administering the medication, the nurse should check the patient's history for which condition? A. Hepatitis B. Migraine attack C. Vitamin D deficiency D. Vitamin A deficiency

ANS A. Hepatitis Rationale: Rituximab is used to treat non-Hodgkin's lymphoma. The nurse should check for hepatitis before administering the medication before administering the medication because this drug may reactivate hepatitis.

The assessment findings of a patient with hemophilia A include ecchymosis and subcutaneous hematomas. The patient is prescribed desmopressin acetate. The nurse recognizes that the medication is expected to produce what therapeutic outcome? a. Increase in factor VIII b. Increase platelet count c. Increase in hemoglobin d. Increase in neutrophil count

ANS A. Increase in factor VIII Rationale: Ecchymosis and subcutaneous hematomas are the clinical manifestations of bleeding in a patient with hemophilia A. Desmopressin acetate is used to stimulate an increase in factor VIII in patients with hemophilia. An increase in platelet count is a therapeutic outcome related to corticosteroids and immunosuppressants, which are used in the treatment of thrombocytopenia. An increase in hemoglobin is seen in the patients who are receiving erythropoietin therapy for anemia. Granulocyte colony-stimulating factors such as filgrastim and pegfilgramstim are used in the treatment of neutropenia. These drugs stimulate the production of neutrophils, thereby increasing the neutrophil count.

A patient with mild hemophilia receives a prescription for desmopressin acetate, an analog of vasopressin. The nurse recognizes that it is appropriate to administer the medication based on what effect it has on the clotting mechanisms? A. It stimulates an increase in factor VIII B. it suppresses the von Willebrand factor (vWF) C. it inhibits plasminogen activation in the fibrin clot D. it stabilizes clots in areas of increased fibrinolysis

ANS A. It stimulates an increase in factor VIII Rationale: Desmopressin acetate is a synthetic analog of vasopressin. This drug acts on platelets and endothelial cells and stimulates the release of vWF. vWF binds with factor VIII and increases its concentration to promote clotting. The drug does not suppress vWF but instead stimulates its release. Antifibrinolytic therapy inhibits plasminogen activation in the fibrin clot and stabilizes clots in areas of increased fibrinolysis. Desmopressin acetate is not an antifibrinolytic agent.

When teaching a patient about treatment for iron deficiency, the nurse provides a list of foods that provide nutritional support for hemoglobin synthesis. Which foods should the nurse include on the list? Select all that apply. A. Legumes B. Dried fruits C. Strawberries D. Milk products E. Dark green leafy vegetables

ANS A. Legumes B. Dried fruits E. Dark green leafy vegetables Rationale: Legumes, dried fruits, and dark green leafy vegetables contain iron, which supports hemoglobin synthesis. Strawberries provide vitamin C, which converts folic to its active forms and aids iron absorption but not hemoglobin synthesis. Milk products contain riboflavin and amino acids but do not support hemoglobin synthesis.

The nurse is caring for a patient with severe anemia. The nurse expects with compensatory respiratory changes? Select all that apply. a. Orthopnea b. Tachypnea c. Dyspnea at rest d. Dyspnea on exertion e. Impaired thought process

ANS A. Orthopnea B. Tachypnea C. Dyspnea Rationale: The compensatory respiratory changes that occur in severe anemia are tachypnea, orthopnea, and dyspnea at rest. Impaired thought process is a neurologic symptom associated with severe anemia. Dyspnea on exertion is seen in mild anemia.

A nurse mentor provides teaching to a group of nursing students about the cardiac manifestations of severe anemia. Which compensatory cardiac changes should the nurse include? Select all that apply. A. Tachycardia B. Heart failure C. Diastolic murmurs D. Intermittent claudication E. Decreased pulse pressure

ANS A. Tachycardia B. Heart failure D. Intermittent claudication Rationale: The compensatory cardiac symptoms of severe anemia are tachycardia, heart failure, and intermittent claudication. The cardiac murmurs that occur in severe anemia are systolic, not diastolic, in nature. In severe anemia, there is an increase in pulse pressure.

A competent patient is hospitalized with suspected internal bleeding. The patient states, "I am a Jehovah's Witness and do not want to receive any blood products if they are needed." Shortly after admission, the patient becomes unconscious. It is determined that the patient needs packed red blood cells (pRBCs). What is the nurse's most appropriate action? A. Withhold the blood products B. Contact the agency's ethics committee. C. Contact the family for permission to administer the blood products to the patient. D. Administer blood products with the intent of informing the patient after the procedure.

ANS A. Withhold the blood products Rationale: Competent adults have the right to make all health care decisions, including the right to refuse treatment based on their religious beliefs. The nurse should withhold the blood products in accordance with the patient's wishes. Contacting the ethics committee is not necessary since the patient's wishes are clear. Administering the blood products with intent of informing the patient later or after contacting the family is unethical, as either action is in violation of the patient's stated refusal.

The nurse recognizes that desmopressin acetate needs to be given to a patient in repeated doses for what reason? A. It is relatively short-lived B. it is effective within 30 minutes C. it stimulates an increase in factor VIII D. It acts on platelets and endothelial cells.

ANS A. it is relatively short-lived Rationale: Desmopressin acetate is relatively short-lived and therefore should be given in repeated doses to prolong its beneficial effects. Effectiveness of desmopressin acetate within 30 minutes does not indicate the need for repeated dosing. Increased stimulation of factor VIII and its action on platelets and endothelial cells do not indicate the need for repeated dosing.

A nurse is providing care for a patient with hemophilia who has developed bleeding in a knee joint. Which self-care strategies are appropriate to be included in the rehabilitative plan of care? Select all that apply A. Packing the joint with ice B. resting during an acute episode C. taking high-dose aspirin to reduce pain D. avoiding weight bearing until swelling subsides E. avoiding mobilization until the muscle regains strength

ANS A. packing the joint with ice B. Resting during an acute episode D. avoiding weight bearing until swelling subsides Rationale: Hemophilia increases the risk of bleeding in joints. Packing the joint with ice provides comfort and reduces inflammation. Providing rest to the affected joint is important to promote healing and prevent further bleeding. Weight bearing should be avoided until the swelling subsides and muscle strength improves. Aspirin-based medications should be avoided, because they increase the risk of bleeding. Mobilization of the joint should be started as soon as the bleeding stops in order to facilitate healing; immobilization may cause stiffness of the joint.

The nurse provides education to a patient about the proper intake of iron capsules. Which should the nurse include in the teaching? Select all that apply. A. Take laxatives if needed B. take the medication with orange juice. C. Take the medication about one hour after meals D. The medication may cause the stools to become black. E. Stop therapy when hemoglobin level returns to noraml

ANS A. take laxatives if needed B. take the medication with orange juice D. the medication may cause the stools to become black. Rationale: The nurse should teach the patient to take iron capsules with orange juice or vitamin C to enhance iron absorption. The patient should be informed that use of iron preparations will make the stool appear black because the gastrointestinal (GI) tract excretes excess iron. Constipation is a common side effect, and the patient should be started on stool softeners or laxatives. Iron should be taken at least one hour before meals, when the duodenal mucosa is most acidic to enhance absorption; however, gastric side effects may necessitate ingesting iron with meals. In order to replenish the body's stores, the patient needs to take iron therapy for two to three months after the hemoglobin level returns to normal.

The nurse assesses a patient who has severe anemia and expects to find which manifestations? Select all that apply. a. Vertigo b. Dyspnea at rest c. Sensitivity to heat d. Jaundice and pruritus e. Glossitis and smooth tongue

ANS A. vertigo B. Dyspnea at rest D. jaundice and pruritus E. Glossitis and smooth tongue Rationale: In severe anemia (HGB less than 6 g/dL [60 g/L]), the patient has many clinical manifestations involving multiple body systems, including jaundice, pruritis, glossitis, smooth tongue, vertigo, dyspnea at rest, and sensitivity to cold. The patient will not have sensitivity to heat.

Which finding supports the nurse's conclusion that a patient has pernicious anemia? A. Bleeding of the gums B. Smooth, beefy-red tongue C. Spoon-shaped concave nails D. Fissures in corners of the mouth

ANS B Smooth, Beefy-red tongue Rationale: Pernicious anemia is characterized by the presence of a smooth, beefy-red tongue, and abdominal pain. Platelet function is reduced in the patient with leukemia; therefore, bleeding from the gums is associated with leukemia. The presence of spoon-shaped, concave nails and fissures in the corners of the mouth is associated with iron deficiency anemia.

The nurse provides education to a patient with hemophilia about safety measures. Which statements made by the patient indicates an understanding of the teaching? Select all that apply. A. "I should participate in contact sports." B. "I should wear a Medic Alert tag wherever I go." C. "I should wear gloves while doing household chores." D. "I should carry an epinephrine injection wherever I go." E. "I should immediately consult my health care provider after severe injury."

ANS B. "I should wear a Medic Alert tag wherever I go." C. "I should wear gloves while doing household chores." E. "I should immediately consult my health care provider after severe injury." Rationale: Patients with hemophilia should not participate in contact sports to prevent cuts and abrasions. Patients with hemophilia should wear a Medic Alert tag to ensure that health care providers know about the hemophilia in case of an accident. Patients with hemophilia should wear gloves while doing household chores to prevent any cuts or abrasions. Patients with hemophilia should immediately consult a physician after severe injury because bleeding may cause complications. Patients with hemophilia are at risk for bleeding, not allergic reactions.

Which patient is most likely to experience anemia related to an increased destruction of red blood cells? A. A 59-year-old man whose alcoholism has precipitated folic acid deficiency B. A 23-year-old African American man who has a diagnosis of sickle cell disease C. A 30-year-old woman with a history of "heavy periods" accompanied by anemia D. A 3-year-old child whose impaired growth and development is attributable to thalassemia

ANS B. A 23-year-old African American man who has a diagnosis of sickle cell disease. Rationale: A result of a sickling episode in sickle cell anemia involves increased hemolysis of the sickled cells. Thalassemias and folic acid deficiencies cause a decrease in erythropoiesis, whereas the anemia related to menstruation is a direct result of blood loss.

A patient with a platelet count of 52,000/mm 3 is diagnosed with thrombocytopenia. The nurse expects what clinical manifestations? A. Weakness and fatigue B. Bruising and petechiae C. Dizziness and vomiting D. Lightheadedness and nausea

ANS B. Bruising and petechiae Rationale: A low platelet count, known as thrombocytopenia, may be accompanied by signs of hemorrhage, such as bruising and petechiae. A normal platelet count is 150,000 to 400,000/mm 3. The symptoms listed in the other answer options are not directly associated with thrombocytopenia.

When monitoring a patient who is receiving a transfusion of packed red blood cells (PRBCs), the nurse should perform which interventions? Select all that apply. A. Start the infusion at a rate of 5 mL/minute. B. Check the patient's vital signs after the first 15 minutes C. Infuse the blood over two hours, but no longer than four hours D. Remain with the patient during the first 15 minutes of blood infusion E. Stop the infusion if the patient develops chills, fever, or low back pain

ANS B. Check the patient's vital signs after the first 15 minutes C. Infuse the blood over two hours, but no longer than four hours D. Remain with the patient during the first 15 minutes of blood infusion E. Stop the infusion if the patient develops chills, fever, or low back pain Rationale: During the first 15 minutes or 50 mL of blood infusion, remain with the patient. If there are any untoward reactions, they are most likely to occur at this time. The rate of infusion during this period should be no more than two mL/minute. Most patients not in danger of fluid overload can tolerate the infusion of one unit of PRBCs over two hours. The transfusion should not take more than four hours to administer because of the increased risk of bacterial growth in the product once it is out of refrigeration. Chills, fever, low back pain, flushing, tachycardia, dyspnea, tachypnea, and hypotension are some manifestations of an acute hemolytic reaction. The nurse needs to stop the transfusion immediately if signs of a reaction are noted.

The nurse recalls that which type of deficiency causes hemophilia B in a patient? A. iron deficiency B. Christmas factor deficiency C. Anti-hemophilic factor deficiency D. Von Willebrand coagulation protein deficiency

ANS B. Christmas factor deficiency Rationale: Christmas factor, or factor IX, is a clotting protein and its deficiency causes hemophilia B; this leads to prolonged or spontaneous bleeding. Iron deficiency causes anemia. Anti-hemophilic factor, or factor VIII deficiency, causes hemophilia A. Von Willebrand coagulation protein deficiency causes von Willebrand disease.

A patient receives a prescription for ferrous gluconate. The nurse should provide education related to what potential side effect? A. Hypotension B. Constipation C. Clay-colored stool D. Abdominal swelling

ANS B. Constipation Rationale: Iron supplements such as ferrous gluconate reduce peristalsis and result in constipation. Ferrous gluconate does not reduce blood pressure and does not result in hypotension. Ferrous gluconate can cause gastrointestinal bleeding and black, tarry stools. Ferrous gluconate does not cause fluid accumulation in the peritoneal cavity or abdominal swelling.

The nurse provides care for a patient with immune thrombocytopenic purpura (ITP) that has a platelet count of 90,000/mcL of blood. What could be the reason for this condition in the patient? A. Destruction of platelets B. Decreased production of platelets C. Enhanced aggregation of platelets D. increased consumption of platelets

ANS B. Decreased production of platelets Rationale: The normal platelet count is in the range of 150,000 to 450,000 platelets/mcL of blood. A decreased blood platelet count indicates thrombocytopenia in the patient. A patient with ITP will have thrombocytopenia because of decreased platelet production. Ingestion of herbs results in thrombocytopenia by destroying the platelets. Enhanced aggregation of platelets is associated with thrombotic thrombocytopenic purpura (TTP). Increased consumption of platelets will cause heparin-induced thrombocytopenia (HIT).

A patient with thalassemia major that is receiving a blood transfusion shows signs of hemochromatosis. The nurse anticipates a prescription for what medication? A. methotrexate B. Deferoxamine C. Ferrous gluconate D. Iron dextran complex

ANS B. Deferoxamine Rationale: A patient with thalassemia major requires frequent blood transfusions and is at risk of iron toxicity. Deferoxamine chelates with the iron and reduces iron overload or hemochromatosis. Methotrexate is an anticancer drug, and it does not reduce iron overload. Iron supplements such as ferrous gluconate and iron dextran complex should not be administered to the patient because they further increase the risk of iron overload.

The nurse provides teaching to a patient who receives a prescription for an iron supplement. What should the nurse include in the education? A. Take the iron supplement with food. B. Dilute the liquid iron and ingest it through a straw C. Refrain form drinking orange juice when taking iron D. Refrain form the use of laxative when on iron

ANS B. Dilute the liquid iron and ingest it through a straw Rationale: Undiluted liquid iron may stain the patient's teeth; therefore liquid iron should be diluted and ingested through a straw. Iron is best absorbed as ferrous sulfate (Fe 2+) in an acidic environment. Therefore iron supplements should be taken about an hour before meals when the duodenal mucosa is acidic. Orange juice contains vitamin C (ascorbic acid), which enhances iron absorption. Therefore it is advisable to take vitamin C supplements along with iron. Constipation may occur commonly in patients who are prescribed iron therapy. Therefore it is advisable to take laxatives and stool softeners when receiving iron therapy.

A patient experiences a decreased neutrophil count (neutropenia). To prevent complications, which interventions should the nurse include in the patient's discharge teaching? Select all that apply. a. Encourage the patient to eat raw eggs b. Encourage the patient to wash hands frequently c. Encourage the patient to frequent crowded areas d. Advise the patient to notify the HCP if a fever develops e. Advise the patient to brush the teeth four times a day with a soft toothbrush.

ANS B. Encourage the patient to wash hands frequently D. Advise the patient to notify the HCP if a fever develops E. Advise the patient to brush the teeth four times a day with a soft toothbrush Rationale: Neutropenia, or decreased neutrophil count, increases the risk of developing infection. Therefore measures should be taken to prevent infections. The selfcare instructions provided by the nurse should include frequent hand washing to prevent transmission of germs. Brushing the teeth four times a day with a soft toothbrush prevents the risk of oral infections. Fever is an emergency situation in cases of neutropenia and should be immediately reported to the HCP. Eating raw eggs and staying in crowed areas increase the risk of acquiring infections, and should be avoided.

A patient with cancer who is receiving methotrexate therapy has developed anemia. The nurse recognizes that which therapies may benefit this patient? Select all that apply. A. Oral iron B. Epoetin alfa C. Oral folic acid D. Blood transfusion E. Parenteral vitamin B12

ANS B. Epoetin alfa C. Oral folic acid Rationale: Epoetin alfa is used to treat anemia related to cancer and its therapies. Methotrexate leads to folic acid deficiency resulting in megaloblastic anemia. Therefore folic acid therapy is given to treat the patient. Oral iron is administered to patients with iron deficiency anemia, which is seen mostly in premenopausal and pregnant women. Blood transfusions are required to keep the approximate hemoglobin level to at least 10 g/dL in the case of thalassemia and severe anemia. Parenteral vitamin B 12 is administered to treat cobalamin deficiency caused by pernicious anemia.

A patient's laboratory findings show an elevated hemoglobin and RBC count with microcytosis, as well as an elevated WBC count with basophilia. The nurse should provide what interventions? Select all that apply. A. Monitoring liver function tests B. Evaluating fluid intake and output C. Assessing the patient's nutritional status D. initiating active and passive leg exercises E. instructing the patient to avoid high altitudes

ANS B. Evaluating fluid intake and output C. Assessing the patient's nutritional status D. Initiating active and passive leg exercises Rationale: In polycythemia vera, laboratory findings show an elevated hemoglobin and RBC count with microcytosis, as well as an elevated WBC count with basophilia. Fluid intake and output should be evaluated to avoid fluid overload, because this may further complicate circulatory congestion. Nutritional status should be assessed regularly, because inadequate food intake may result in gastrointestinal symptoms such as fullness, pain, and dyspepsia. Active and passive leg exercises should be initiated to prevent thrombus formation. Liver function tests should be monitored regularly in patients who require lifelong supplementation of iron. Patients with sickle cell disease should be advised to avoid high altitudes, because this may lead to hypoxia.

A patient that is receiving treatment for thalassemia show evidence of hemolysis. The nurse anticipates a prescription for which supplementation? a. Zinc b. Folic acid c. Vitamin B12 d. Ascorbic acid

ANS B. Folic acid Rationale: Folic acid is given if there is any evidence of hemolysis in patients with thalassemia. Zinc supplementation is required in patients with thalassemia after chelation therapy, because zinc levels may decline. Vitamin B12 supplementation is required for patients with megaloblastic anemias. Ascorbic acid supplementation may be needed during chelation therapy in patients receiving treatment for thalassemia, because it increases urinary excretion of iron.

A patient is scheduled to receive cobalamin (vitamin B 12) 1,000 mcg by mouth (PO). The pharmacy issues 250-mcg tablets. How many tablets should the nurse give to the patient? A. Two tablets B. Four tablets C. Six tablets D. Eight tablets

ANS B. Four tablets Rationale: Using ratio and proportion, multiply 250 by x and multiply 1000 x 1 to yield 250x=1000. Divide 1000 by 250 to yield four tablets.

The nurse reviews a patient's medical record and notes assessment findings with include fatigue, arthralgia, abdominal pain, weight loss, an enlarged liver, and a total body iron level of 70 g. The nurse suspects which condition? a. Polycythemia b. Hemochromatosis c. Sickle cell disease d. Iron deficiency anemia

ANS B. Hemochromatosis Rationale: i. The normal range of total body iron is 2 to 6 g and its concentration exceeds 50 g in case of hemochromatosis. Fatigue, arthralgia, abdominal pain, weight loss, and enlarged liver and spleen are the clinical manifestations of hemochromatosis. Polycythemia is characterized by laboratory manifestations such as elevated hemoglobin and RBC count, low to normal erythropoietin, elevated WBC, platelet, uric acid, and cobalamin levels. The clinical manifestations include headaches, vertigo, dizziness, tinnitus, and visual disturbances. In patients with sickle cell disease, the peripheral blood smear will show sickled cells and abnormal reticulocytes. The patient may have elevated serum bilirubin levels, and bone and joint deformities. In patients with iron deficiency anemia, the laboratory findings indicate a low total body iron and hemoglobin levels along with clinical manifestations such as glossitis, cheilitis, and pallor.

1. The nurse cares for a patient with iron-deficiency anemia. Which nursing diagnostic statement associated with the condition is the highest priority? a. Deficient fluid volume b. Impaired gas exchange c. Impaired breathing pattern d. Decreased cardiac output

ANS B. Impaired gas exchange Rationale: Iron is necessary for hemoglobin synthesis. Hemoglobin is responsible for oxygen transport in the body. With iron-deficiency anemia a subnormal hemoglobin level cannot carry enough oxygen to the tissues. This results in impaired gas exchange. Deficient fluid volume and decreased cardiac output are not directly associated with iron-deficiency anemia. An impaired breathing pattern may develop as a result of impaired gas exchange.

A patient with factor VIII deficiency experiences joint bleeding. Which nursing interventions to include in the patient's plan of care? Select all that apply. A. Administer aspirin B. Pack the joint in ice C. Provide analgesics such as acetaminophen D. Encourage the patient to perform weight-bearing activity to increase muscle strength E. Encourage the patient to perform range-of-motion exercises when bleeding is stopped

ANS B. Pack the joint in ice. C. provide analgesics such as acetaminophen E. Encourage the patient to perform range-of-motion exercises when bleeding is stopped Rationale: Factor VIII deficiency leads to hemophilia, which is a severe bleeding disorder. When joint bleeding occurs, the joint should be packed in ice to reduce bleeding. Analgesics such as acetaminophen should be provided to reduce pain. When bleeding is stopped, the patient should be encouraged to perform range-of-motion exercises to increase mobilization. Aspirin should be avoided because it may increase bleeding. Weight bearing activity should be performed when the swelling has decreased and muscle strength has returned.

The nurse provides education regarding daily activities to a patient with thrombocytopenia. Which patient activity indicates understanding of the teaching? A. flossing using thick tape floss B. Shaving using an electric razor C. Wearing flip flops to go walking D. Brushing using a stiff-bristle toothbrush

ANS B. Shaving using an electric razor Rationale: A patient with thrombocytopenia has a decreased number of platelets, and therefore prolonged bleeding will be observed even for minor injuries. Shaving using an electric razor blade decreases the risk of cuts and wounds resulting in decreased bleeding. Therefore this activity of the patient indicates understanding of the nurse's teaching. Walking with flip flops can cause the patient to trip, causing the risk for cuts or wounds and increased bleeding. Flossing using a thick tape floss is not safe and can cause an increased risk for bleeding. Brushing using a stiff-bristle toothbrush causes injury to the gums and is not safe; therefore the nurse needs to perform more patient teaching.

The nurse provides care for a patient experiencing thrombocytopenia. It is likely that platelets administration will be prescribed when what occurs? Select all that apply. A. When refractory cases are observed B. When the platelet count in the patient is 8,000/µL C. When the patient does not respond to drug therapy D. When there is anticipated bleeding before a procedure E. When the patient has thrombotic thrombocytopenic purpura (TTP)

ANS B. When the platelet count in the patient is 8,000/µL D. When there is anticipated bleeding before a procedure Rationale: Platelet administration is indicated in a patient with a blood platelet count of 8,000/µL to maintain normal platelet count. Administering platelets is beneficial if a patient has anticipated bleeding before a procedure to prevent the risk of hemorrhage. Immunosuppressive therapy is indicated when refractory cases are observed. Splenectomy is indicated when the patient does not respond to drug therapy. Administration of platelets is contraindicated in a patient with thrombotic thrombocytopenic purpura (TTP) because it may lead to new von Willebrand factor-platelet complexes and increased clotting.

A patient with thalassemia major is anemic and has a history of many blood transfusions. The nurse expects which interventions to be included in the patient's treatment plan? Select all that apply. A. Iron supplementation B. Zinc supplementation C. Oral deferasirox (Exjade) D. Continued blood transfusion E. Ascorbic acid supplementation

ANS B. Zinc supplementation C. Oral deferasirox (Exjade) D. Continued blood transfusion E. Ascorbic acid supplementation Rationale: The patient has thalassemia, is anemic, and has a history of blood transfusions. Oral deferasirox (Exjade) is a chelating agent that binds with iron to prevent iron overload. Such chelation therapy reduces zinc in the body, so zinc supplements should be administered. Blood transfusions are performed to keep the hemoglobin level at approximately 10 g/dL. Adequate hemoglobin promotes erythropoiesis and prevents spleen enlargement. Ascorbic acid supplements increase the excretion of iron in the urine, so they are administered during the chelation therapy. Blood transfusions and hemolysis lead to iron overload, so iron supplements should not be administered.

What should the nurse consider to be the highest priority when caring for a patient with thrombocytopenia? A. maintaining a quiet environment B. Protecting the patient from injury C. administering pain medication as needed D. Encouraging the patient to ambulate as much as can be tolerated

ANS B. protecting the patient from injury Rationale: A patient with thrombocytopenia has a very low platelet count and an impaired clotting mechanism. Any injury, even a minor one, could cause spontaneous hemorrhage, internally or externally. Quiet, pain medication, and ambulation are not priority aspects of nursing care in regard to thrombocytopenia.

A patient with neutropenia asks how the prescribed protective (reverse) isolation helps prevent the spread of organisms. What primary explanation should the nurse give? A. "it is designed to use special techniques to decrease discharge from your body." B. "It is designed to use special techniques to handle your linens and personal items." C. "it is designed to minimize the spread of germs to you from sources outside your environment." D. "It is designed to minimize the spread of germs from you to health care personnel, visitors, and other patients."

ANS C. "It is designed to minimize the spread of germs to you from sources outside your environment." Rationale: The primary purpose of protective, or reverse, isolation is to reduce transmission of organisms to the patient from sources outside the patient's environment. The use of special techniques to destroy discharge or handle the patient's linen and personal items and preventing the spread from the patient to others are not the purpose of protective isolation.

1. A patient with anemia receives a new prescription for oral iron supplements. What should the nurse include in the medication education related to improving the absorption of the supplement? a. "Take it with meals." b. "Take it one hour after eating." c. "Take it one hour before breakfast, with orange juice." d. "Take it on an empty stomach with a full glass of water."

ANS C. "take it one hour before breakfast, with orange juice." Rationale: Iron is absorbed best as ferrous sulfate in an acidic environment. For this reason and to avoid binding the iron with food, iron should be taken about an hour before meals, when the duodenal mucosa is most acidic. Taking iron with vitamin C (ascorbic acid) or orange juice, which contains ascorbic acid, enhances iron absorption. Gastric side effects, however, may necessitate ingesting iron with meals.

What nursing intervention should be the priority in the care of a patient that is diagnosed with immune thrombocytopenic purpura (ITP)? A. Administration of packed red blood cells B. Administration of clotting factors VIII and IX C. Administration of oral or intravenous (IV) corticosteroids D. Maintenance of reverse isolation and application of standard precautions.

ANS C. Administration of oral or intravenous (IV) corticosteroids Rationale: Common treatment modalities for ITP include corticosteroid therapy to suppress the phagocytic response of splenic macrophages. Blood transfusions, administration of clotting factors, and reverse isolation are not interventions that are indicated in the care of patients with ITP. Standard precautions are used with all patients.

Which nursing intervention would be helpful to a patient with hemophilia who experiences severe joint bleeding? A. Giving aspirin to the patient B. Providing physical therapy at the joint C. Applying direct pressure with ice at the joint. D. Elevating the affected extremity of the patient

ANS C. Applying direct pressure with ice at the joint. Rationale: A patient with hemophilia who experiences joint bleeding should have the involved joint totally immobilized. Pressure should also be applied with ice to prevent crippling deformities from hemarthrosis. Aspirin should not be given, because it will further increase the bleeding. Physical therapy should be provided after the bleeding stops. Elevating the affected extremity does not stop bleeding in the joint.

The nurse provides dietary teaching to a patient with anemia and should include which food sources to promote red blood cell (RBC) maturation? Select all that apply. A. Shellfish B. Bananas C. Avocados D. Red meat E. Cornmeal

ANS C. Avocados D. Red meat Rationale: Avocado contains niacin, which is required for the maturation of RBC. Red meat is rich in cobalamin (Vitamin B 12). Cobalamin is an essential nutrient that plays an important role in erythropoiesis by enhancing the RBC maturation. Therefore, the nurse would expect these two food sources to promote red blood cell (RBC) maturation. Shellfish contains copper, which is an essential nutrient useful for mobilization of iron from tissues to plasma. Bananas and cornmeal are rich in pyridoxine (Vitamin B 6), which is essential for hemoglobin synthesis.

A patient experiences a minor bleeding episode during a dental procedure. The nurse recognizes that which therapy will be beneficial? A. tranexamic acetate B. Fresh frozen plasma C. Desmopressin acetate D. Epsilon-aminocaproic acid

ANS C. Desmopressin acetate Rationale: Desmopressin acetate is used to treat minor bleeding episodes and dental procedures. Tranexamic acetate is the antifibrinolytic used to stabilize the clot in patients with epistaxis and menorrhagia. Fresh frozen plasma is used as replacement therapy in treating hemophilia. Epsilon-aminocaproic acid is the antifibrinolytic used for clot stability in patients with difficult episodes of epistaxis and menorrhagia.

1. A patient with hemophilia is scheduled for an invasive dental procedure. The nurse recognizes that is appropriate to prescribe what blood products to a patient with this disorder? Select all that apply a. Thrombin b. Factor VI c. Factor VIII d. Factor IX e. Desmopressin acetate (DDAVP)

ANS C. Factor VIII D. Factor IX E. Desmopressin acetate (DDAVP) Rationale: Replacement of deficient clotting factors is the primary means of supporting a patient with hemophilia. In addition to treating acute crises, replacement therapy may be given before surgery and dental care as a prophylactic measure. For hemophilia, the clotting factors include Factor VIII and Factor IX, as well as the administration of DDAVP, a synthetic analog of vasopressin, which may be used to stimulate in increase in factor VIII. Thrombin and Factor VI are not used to replace clotting factors in hemophiliacs.

A patient experiences thrombocytopenia. The nurse should monitor the patient for which major complication? A. Fatigue B. Weakness C. Hemorrhage D. Abdominal pain

ANS C. Hemorrhage Rationale: The major complication of thrombocytopenia is hemorrhage. This occurs due to a decreased number of platelets in blood, which results in excessive bleeding. Fatigue, weakness, and abdominal pain are minor complications of thrombocytopenia.

The nurse is caring for a patient admitted for treatment of sickle cell disease (SCD). The nurse recalls that with repeated episodes of sickling, there is gradual involvement of all body systems and organs, especially which one? A. Liver B. Heart C. Lungs D. Stomach

ANS C. Lungs Rationale: With repeated episodes of sickling, there is gradual involvement of all body systems and organs, especially the spleen, lungs, kidneys, and brain. Organs that have a need for large amounts of O 2, like the lungs, are most often affected and form the basis for many of the complications of SCD. Although the liver, heart, and stomach may be affected, they are less so when compared to the lungs.

The nurse reviews a patient's medical record and suspects heparin-induced thrombocytopenia (HIT). Which finding supports the nurse's conclusion? A. patient has a viral infection B. Patient has hemolytic anemia C. Patient has a platelet count of 100,000/µL D. Patient has systemic lupus erythematosus

ANS C. Patient has a platelet count of 100,000/µL Rationale: Long-term heparin therapy can causes heparin-induced thrombocytopenia (HIT) that results in decrease in the platelet count. A platelet count of 100,000/µL indicates HIT. Immune thrombocytopenic purpura (ITP) will be suspected if the patient has a viral infection. Thrombotic thrombocytopenic purpura (TTP) will be suspected if the patient has hemolytic anemia and an autoimmune disorder like systemic lupus erythematosus.

1. A patient is receiving heparin therapy. The nurse anticipates a prescription for warfarin therapy based on what assessment finding? a. Signs of thrombolytic agents b. Signs of severe blood clotting c. Platelet count of 150,000/mcl d. Platelet count of 180,000/mcl

ANS C. Platelet count of 150,000/mcL Rationale: The platelet count of 150,000/mcL in a patient who is on heparin therapy indicates heparin-induced thrombocytopenia (HIT) and requires warfarin therapy. The platelet count of 180,000/mcL does not indicate the need for warfarin therapy in the patient. Warfarin reverses HIT and prevents microvascular thrombosis in the patient. Plasmapheresis should be performed during severe clotting. Thrombolytic agents should be used to treat a thromboembolic event.

A patient with von Willebrand disease receives a prescription for laboratory studies. The nurse anticipates that which result will be normal? A. Factor assays B. Bleeding time C. Prothrombin D. Partial thromboplastin time

ANS C. Prothrombin time Rationale: Prothrombin time is normal; there is no involvement of extrinsic system. Partial thromboplastin time is prolonged because of deficiency in intrinsic clotting system factor. Bleeding time is prolonged because of structurally defective platelets. There will be a reduction of vWF.

A patient has received instructions about the use of liquid iron supplements. During a follow-up visit, the nurse determines that the patient still has iron-deficiency anemia even after receiving complete treatment. Which action could be responsible for this condition? a. Taking iron supplements with a straw b. Taking iron supplements during bedtime c. Taking iron supplements along with meals d. Taking iron supplements along with orange juice

ANS C. Taking iron supplements along with meals Rationale: i. Iron is mostly absorbed in the form of ferrous sulfate. Ferrous sulfate chelates with food, impairing iron absorption. Iron supplements should be taken one hour before meals to ensure effective absorption. Iron supplements may stain teeth, so they may be taken with a straw. The patient can take iron supplements at bedtime if he or she experiences abdominal discomfort. Orange juice is rich in vitamin C, which enhances iron absorption.

The nurse provides education to a patient with thrombocytopenia about precautions to be taken at home. The nurse identifies that further teaching is needed when the patient performs which action? A. Drinks 14 glasses of water daily B. Shaves once a day using an electric razor C. Uses an alcohol based mouthwash twice a day D. Brushes teeth with a soft-bristle toothbrush twice a day.

ANS C. Uses an alcohol based mouthwash twice a day Rationale: A patient with thrombocytopenia should not use alcohol-based mouthwashes, because alcohol-based mouthwashes will dry the mouth and increase bleeding. Patients with thrombocytopenia should drink plenty of fluids to prevent constipation. Patients with thrombocytopenia should shave using an electric razor, not blades, to prevent the risk for injury. Patients with thrombocytopenia should use a soft-bristle toothbrush to prevent gum injury.

The nurse cares for a patient with polycythemia vera and expects what assessment finding? A. orthopnea B. Peripheral edema C. Increased hemoglobin D. Increased C-reactive protein

ANS C. increased hemoglobin Rationale: In polycythemia vera, hemoglobin and hematocrit are increased because of a hyperproliferation of red blood cells. Orthopnea, peripheral edema, and increased C-reactive protein are not associated with polycythemia vera.

A neutropenic patient is hospitalized with a febrile episode. The nurse identifies that which action is appropriate for inclusion on the plan of care and should be performed first? A. administer an oral antibiotic B. obtain cultures of the throat C. obtain blood cultures from two sites D. Administer a broad spectrum intravenous (IV) antibiotic

ANS D Administer a broad spectrum intravenous (IV) antibiotic Rationale: The first nursing intervention for a febrile neutropenic patient is to administer a broad spectrum antibiotic by IV route within one hour. Because of the rapid lethal effects of infection, this should be done even before obtaining cultures to determine a specific causative organism. Administration of a broad spectrum antibiotic by the IV route is preferred to oral antibiotic for initial management because it is the faster administration method.

A patient who is receiving heparin therapy manifests signs of heparin overdose. The nurse should make preparations to administer which medication? A. Lepirudin B. Rituximab C. Prednisone D. Protamine sulfate

ANS D Protamine sulfate Rationale: Protamine sulfate reverses the anticoagulant effects of circulating heparin during severe clotting. Lepirudin is given to maintain anticoagulation. Rituximab is given to reduce the immune recognition of platelets. Prednisone is used to suppress the phagocytic response of splenic macrophages.

A patient experiences anemia secondary to acute blood loss following trauma. The patient asks the nurse about treatment that will be needed following discharge. How should the nurse respond? A. "You will need to take an iron supplement for the rest of your life to make sure the anemia does not return." B. "You will need to make dietary changes to help support the production of red blood cells for the nest one to two years." C. "It would be best to take several supplements to prevent the anemia from recurring, including folic acid, niacin, and riboflavin." D. "Once the blood loss is controlled and blood volume is replaced, the anemia generally corrects itself, so no long-term treatment is needed."

ANS D. "Once the blood loss is controlled and blood volume is replaced, the anemia generally corrects itself, so no long-term treatment is needed." Rationale: Anemia caused by acute blood loss generally resolves itself once the source of the bleeding is identified and controlled and blood/fluid volume is replaced. It is incorrect to tell the patient he or she will need supplements for the rest of his or her life, that several supplements are necessary to prevent recurrence, or that dietary changes will be necessary for the next year or two.

Which instruction in beneficial for the nurse to provide to a patient diagnosed with pernicious anemia? a. "Avoid consuming red meat and fish." b. "Limit consuming milk and dairy products." c. "Undergo frequent hepatitis C screenings." d. "Undergo frequent gastrointestinal cancer screenings."

ANS D. "Undergo frequent gastrointestinal cancer screenings." Rationale: Pernicious anemia is characterized by decreased secretion of hydrochloric acid in the stomach due to autoimmune-mediated destruction of parietal cells and thereby causes an increased risk for gastric cancer. The patient with cobalamin deficiency can develop pernicious anemia, so the patient should consume foods such as red meat, fish, milk and dairy products. Patients with thalassemia may contract hepatitis C from blood transfusions.

The nurse cares for a patient with mild hemophilia A. Which treatment does the nurse anticipate to be prescribed for this patient? A. Splenectomy B. IV immunoglobulin C. Rominplostim therapy D. Desmopressin acetate (DDAVP)

ANS D. Desmopressin acetate (DDAVP) Rationale: Desmopressin acetate (DDAVP) is beneficial for a patient with mild hemophilia A and certain subtypes of von Willebrand disease. It is a synthetic analog of vasopressin and may be used to stimulate an increase in factor VIII and vWF. Splenectomy is indicated only if the patient does not respond to drug therapy. Intravenous immunoglobulin is used in a patient who is unresponsive to corticosteroids or splenectomy. Romiplostim therapy is used in a patient with chronic immune thrombocytopenic purpura (ITP) who had an insufficient response to the other treatments or who has a contraindication to splenectomy.

The nurse creates patient teaching information related to heparin therapy. The nurse recalls that heparin should never be given to a patient with a history of what? A. Splenomegaly B. Thromboembolism C. Hepatic encephalopathy D. Heparin-induced thrombocytopenia (HIT)

ANS D. Heparin-induced thrombocytopenia (HIT) Rationale: With HIT, heparin causes decreased platelet counts and increases the risk for hemorrhage. Patients who have had HIT should never be given heparin or low-molecular heparin (LMWH). This should be clearly marked in the patient's medical record. Splenomegaly is an enlarged spleen; this often occurs with anemia and autoimmune disorders. Hepatic encephalopathy occurs in alcoholic clients when brain tissue is destroyed due to decreased thiamine. Thromboembolism is another term for blood clot; heparin is used to treat clots and would not cause them.

The nurse assesses a patient with pernicious anemia and expects to find what classic sign of this condition? a. Diarrhea b. Indigestion c. Flushed skin d. Red, beefy tongue

ANS D. Red, beefy tongue Rationale: The decreased absorption of vitamin B12 resulting from a lack of intrinsic factor causes a decrease in hemoglobin, hematocrit, and red blood cells. A smooth, red, enlarged or "beefy" appearance of the tongue may also be seen. Intrinsic factor is produced by the parietal cells of the stomach lining and is required to absorb vitamin B12 from the intestines. Causes of decreased intrinsic factor production include surgical alterations such as gastrectomy and autoimmune disease. Diarrhea, indigestion, and flushed skin appearance are not signs specifically associated with pernicious anemia.

The nurse recognizes that patients with von Willebrand disease are at risk for prolonged bleeding times for what reason? A. Adequate platelet production B. Deficiency in intrinsic clotting system factor C. Impairment of thrombin fibrinogen reaction D. Variable factor VIII deficiencies and platelet dysfunction.

ANS D. Variable factor VIII deficiencies and platelet dysfunction Rationale: Von Willebrand disease is characterized by a deficiency of the von Willebrand coagulation protein and variable factor VIII deficiencies and platelet dysfunction. Therefore the bleeding time is prolonged in the patient with von Willebrand disease. Adequate platelet production does not alter the normal bleeding time in a patient. Deficiency in intrinsic clotting system factor will alter the PTT. Impairment of thrombin fibrinogen reaction alters the thrombin time.

A patient with primary polycythemia is admitted to the health care facility every two months for phlebotomy. Which intervention should the nurse perform when caring for the patient? A. provide plenty of fluids B. ensure iron supplementation C. ensure that hematocrit is at 60% D. initiate active or passive leg exercises.

ANS D. initiate active or passive leg exercises Rationale: The nurse should initiate active or passive leg exercises and ambulation with medication if required to decrease thrombus formation. The nurse should evaluate fluid intake and output during hydration therapy to avoid fluid overload, which further complicates the circulatory congestion and underhydration, which can make the blood even more viscous. Although repeated phlebotomies may eventually cause the patient to be deficient in iron, supplementation is avoided. The aim of phlebotomy is to reduce the hematocrit and keep it less than 45% to 48%.