Test #1 (Yasmin)
You're providing discharge teaching to a patient about pernicious anemia. Which statement by the patient indicates they did NOT understand the discharge teaching? A. "Pernicious anemia is caused by not consuming enough Vitamin B12." B. "Pernicious anemia causes the red blood cells to appear very large and oval." C. "Treatment for pernicious anemia includes a series of intramuscular injections of Vitamin B12." D. "A red, smooth tongue can be a sign of pernicious anemia."
A. "Pernicious anemia is caused by not consuming enough Vitamin B12." Caused by patient lacking intrinsic factor which helps with the absorption of vitamin B12. The patient can consume supplements or foods with vitamin B12, but they will not absorb B12 because they lack intrinsic factor. All the other statements are correct about pernicious anemia.
The nurse is caring for a client dx with cancer who is immunosuppressed. The nurse would consider implementing neutropenic precautions if the patient's WBC count was which value? A. 2000 mm^3 B. 5800 mm^3 C. 8400 mm^3 D. 11,500 mm^3
A. 2000 mm^3 Normal WBC count ranges from 5000-10,000. A person with low WBC count can be indicative of immunosupression & should be put on neutropenic precautions.
The nurse is monitoring a client receiving peritoneal dialysis & notes the outflow is less than inflow. Which actions should the nurse take? SELECT ALL THAT APPLY A. Check the level of the drainage bag B. Reposition the client on his/her side C. Contact the HCP D. Place the client in good body alignment E. Check the peritoneal dialysis system for kinks F. Increase flow rate of peritoneal dialysis solution
A. Check the level of the drainage bag B. Reposition the client on his/her side D. Place the client in good body alignment E. Check the peritoneal dialysis system for kinks Outflow drainage is inadequate, the nurse should attempt to stimulate outflow by changing the client's position. There is no reason to call the HCP.
A patient presents to the ED with severe internal bleeding post vehicle crash. The patient is severely hypotensive & unresponsive. What IV solution will most likely be given? A. D5LR B. 1/3 NS C. 1/2 NS D. 1/4 NS
A. D5LR For this client, the goal of IV therapy is the expand intravascular volume as quick as possible. The rest of the solutions are hypotonic and would further deplete the circulatory system.
The client has chronic renal failure and is contemplating dialysis. Which type of management is anticipated by the nurse? A. Hemodialysis B. Peritoneal dialysis C. Kidney removal D. Medication treatments
A. Hemodialysis
A client experiences a loss of intracellular fluid. Which of the following IV concentrations should be used to replace this loss? A. Hypotonic solution B. Hypertonic solution C. Isotonic solution D. An electrolyte composition
A. Hypotonic solution
The nurse has the following lab values for a client: WBC 7,500, RBC 5 million, Hemoglobin 13 g/dL, Hematocrit 42.2%, and platelets 18,000/mm^3. Based on these lab results, which intervention does the nurse need to add to the client's care plan? A. Institute bleeding precautions B. Measure VS every 4 hours C. Monitor continuous IV fluids D. Monitor packed red blood cells (PRBC) transfusion
A. Institute bleeding precautions A platelet count of <20,000 places a client at high risk for bleeding. -Measuring VS would offer no immediate benefit to the client with low platelet count, there is no indication the client is receiving IV fluids, and these lab results don't indicate active bleeding.
Why would a patient in ARF be diagnosed with anemia? A. Loss of erythropoietin which is produced in the kidneys B. Elevated BUN & creatinine levels C. Renal dialysis used to treat chronic renal failure D. Loss of blood through urine
A. Loss of erythropoietin which is produced in the kidney Erythropoietin is produced by the kidneys & stimulates RBC production by activation of the bone marrow
A client is experiencing a sickle cell crisis during labor & delivery. What is the BEST action? A. Maintain IV fluid infusion & assess hydration status B. Administer a high concentration of oxygen C. Insert a Foley and monitor I&O D. Provide continuous sedation for pain relief.
A. Maintain IV fluid infusion & assess hydration status Adequate hydration is critical during stress periods of client with sickle cell (ex: labor)
What is the treatment for pernicious anemia? A. Monthly B12 injections B. Daily ferrous sulfate (PO) C. Coagulation studies are important to monitor effects of medication D. Reduce intake of leafy greens & decrease Vitamin K
A. Monthly B12 injections
When a client's serum sodium level is 120 mEq/L, the priority nursing assessment is to monitor the status of which body system? A. Neurological B. Pulmonary C. Hepatic D. Gastrointestinal
A. Neurological
Potassium chloride IV is prescribed for a client with hypokalemia. what actions are appropriate during preparation & administration of potassium? SELECT ALL THAT APPLY A. Obtain an IV infusion pump B. Monitor urine output during administration C. Pepare the medication for bolus administration D. Monitor the IV site for signs of infiltration or phlebitis E. Ensure that the medication is diluted in the appropriate volume of fluid F. Ensure the bag is labeled so that it reads the volume of potassium in the solution
A. Obtain an IV infusion pump B. Monitor urine output during administration D. Monitor the IV site for signs of infiltration or phlebitis E. Ensure that the medication is diluted in the appropriate volume of fluid F. Ensure the bag is labeled so that it reads the volume of potassium in the solution
The client had a myocardial infarction that consequently decreased his overall cardiac output. Within 24 hours he developed acute renal failure. This is an example of which type of condition? A. Prerenal B. Intrarenal C. Postrenal D. Irreversible
A. Prerenal
Which client is at risk for developing a sodium level of 130 mEq/L? A. The client taking diuretics B. The client with hyperaldosteronism C. The client with Cushing's syndrome D. The client who is taking corticosteroids
A. The client taking diuretics
What is a clinical manifestation of hypocalcemia a nurse can expect? A. Twitching B. Hypoactive bowl sounds C. Negative Trousseau's sign D. Hypoactive deep tendon reflexes
A. Twitching
Which ECG changes will you see for a patient with a potassium level of 2.5 mEq/L? SELECT ALL THAT APPLY A. U waves B. Absent P waves C. Inverted T waves D. Depressed ST segment E. Widened QRS complex
A. U waves C. Inverted T waves D. Depressed ST segment
Which of the following would be appropriate instructions for a client dx with polycythemia vera? SELECT ALL THAT APPLY A. You can expect to have repeated phlebotomies B. Take an iron supplement daily C. Low-dose aspirin may be prescribed by your HCP D. A warm bath may be used to decrease generalize pruritus E. Avoid crowds due to increased risk of infection due to your low WBC count F. Try to keep well hydrated by drinking at least 2 liters of fluid per day
A. You can expect to have repeated phlebotomies C. Low-dose aspirin may be prescribed by your HCPF. F. Try to keep well hydrated by drinking at least 2 liters of fluid per day Phlebotomy is the main method of tx to reduce hematocrit. Iron supplements should be avoided because they raise hematocrit. Aspirin is often prescribed for clot prevention. Warm baths may precipitate pruritus, not relieve it. WBC will increase not decrease in polycythemia vera.
What is a likely cause of a phosphorus level of 1.8 mg/dL? A. malnutrition B. renal insufficiency C. hypoparathyroidism D. tumor lysis syndrome
A. malnutrition
The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating hemodialysis. Which finding indicates that the fistula is patent? A. palpitation of thrill over the fistula B. presence of a radial pulse in the left wrist C. visualization of enlarged blood vessels at the fistula site D. capillary refill <3 seconds on left hand
A. palpitation of thrill over the fistula The nurse assess latency by palpating for the presence of a thrill & auscultating for a bruit. -Enlarged vessels are normal but not indicative of fistula patency. The other options indicate adequate circulation not fistula patency.
You are providing education to a patient with CKD about calcium acetate. Which statement by the patient demonstrates they understood your teaching about this medication? Select-all-that-apply: A. "This medication will help keep my calcium level normal." B. "I will take this medication with meals or immediately after." C. "It is important I consume high amounts of oatmeal, poultry, fish, and dairy products while taking this medication." D. "This medication will help prevent my phosphate level from increasing."
B. "I will take this medication with meals or immediately after." D. "This medication will help prevent my phosphate level from increasing." Calcium acetate (aka PhosLo) is a phosphate binder, which will help keep the patient's phosphate level from becoming too high. It helps excrete the phosphate taken in the food by excreting it out of the stool. Therefore, it should be taken with meals or immediately after. Option C is wrong because the patient should AVOID these types of foods high in phosphate.
A client went to the emergency room with sudden onset of high fever and diaphoresis. Serum sodium was one of the laboratory test taken. Which of the following values would you expect to see? A. 130 mEq/L. B. 148 mEq/L. C. 143 mEq/L. D. 139 mEq/L.
B. 148 mEq/L. Diaphoresis & fever could lead to increased loss of fluids resulting in increased sodium level
Which client is most likely to have iron deficiency anemia? A. A client with cancer receiving radiation B. A toddler whose primary intake is milk C. A client with a peptic ulcer who had surgery 6 weeks ago D. A 15-year-old client in sickle cell crisis
B. A toddler whose primary intake is milk A diet based primarily on milk products will not maintain adequate iron supplementation. A client in sickle cell crisis may experience anemia from destruction of RBCs, but not from poor iron intake. A client with radiation will have anemia from bone marrow suppression not poor iron intake. A client with gastric surgery may develop anemia as a result of adequate utilization of vitamin B12.
A child with leukemia is discharged after beginning chemo. What instructions will the nurse include in the teaching plan? A. Provide a diet low in protein & high in carbs B. Avoid unwashed fruits & veggies C. Notify doctor if Childs temp >102* D. Increase use of humidifiers throughout house
B. Avoid unwashed fruits & veggies Fruits & veggies harbor potentially harmful microorganisms, they should be peeled or cooked. HCP should be notified if temp. is >100. Humidified air may harbor fungi in the water.
The nurse is preparing discharge instructions for a patient with aplastic anemia. What will be important information to include? SELECT ALL THAT APPLY A. Take your iron with meals every day and decrease the amount of leafy vegetables from your diet B. Establish a balance between rest & activity- avoid excessive fatigue C. Rest and supplemental oxygen may be required during periods of dyspnea D. Notify your HCP if you begin to experience frequent bruising E. Increase your intake of dairy products and protein
B. Establish a balance between rest & activity- avoid excessive fatigue C. Rest and supplemental oxygen may be required during periods of dyspnea D. Notify your HCP if you begin to experience frequent bruising Iron should be taken on empty stomach unless upset GI occurs. There is no indication dairy & protein intake should be increased. Bruising may indicate problems in the hematologic system.
What will the nurse anticipate administering to a person in DIC? A. Packed red blood cells B. Fresh frozen plasma C. Volume expanders, such as D10W D. Whole blood
B. Fresh frozen plasma Fresh frozen plasma contains all coagulation factors. Packed RBCs will be used to increase oxygenation but this is a 2nd line treatment. Whole blood is less frequently used & does not provide clotting factors. Volume expanders will not help increase clotting factors.
A nurse is reviewing the complete blood count (CBC) of a child who has been diagnosed with idiopathic thrombocytopenic purpura. Which of the following laboratory result should the nurse report immediately to the physician? A. Platelet count of 30,000/mm3. B. Hemoglobin level of 7.5 g/dL. C. Reticulocyte count of 6.5%. D. Eosinophil count of 700 cells/mm3
B. Hemoglobin level of 7.5 g/dL The low hemoglobin level indicates that the client has an active bleeding, and immediate actions such as additional diagnostic exam and blood transfusions can be suggested. Options A, C, and D: Decreased platelet count, increased reticulocyte and increased eosinophil count are expected in a child with idiopathic thrombocytopenic purpura.
The nurse tells a diabetic patient receiving dialysis that it's important to maintain the prescribed dwell time because of which complication? A. Peritonitis B. Hyperglycemia C. Hyperphosphatemia D. Disequilibrium syndrome
B. Hyperglycemia A diabetic patient may require extra insulin while receiving dialysis
The nurse is providing instructions to a client who has just had a splenectomy. The teaching is based on the knowledge that splenectomy clients have: A. Decreased leukocytes B. Increased platelets C. Decreased hemoglobin D. Increased eosinophils
B. Increased platelets Removing the spleen can increase peripheral RBC, WBC, and platelet counts. There is a lifelong risk of infection after splenectomy.
A patient has an order for one unit of packed cells. What is the correct nursing action? A. Initiate the IV with 5% dextrose in water to maintain a patent access site B. Initiate the transfusion within 30 minutes of receiving the blood C. Monitor the patient's VS for the first 5 mins D. Monitor the clients VS every 2 hours during transfusion
B. Initiate the transfusion within 30 minutes of receiving the blood Whole blood must be given within the first 30 minutes to prevent hemolysis & growth of bacteria in blood.
Which patient is at risk for a potassium deficit? A. One who sustained tissue damage B. One who requires NG suctioning C. History of Addison's disease D. Uric acid level of 9.5 mg/dL
B. One who requires NG suctioning
The nurse caring for a client with a serum calcium of 6.8 mg/dL. What would the nurse expect the change on the electrocardiogram (ECG)? A. None. this is a normal calcium level. B. Prolonged QT interval. C. Shortened ST segment. D. Widened T wave
B. Prolonged QT interval. The normal serum calcium level is 8.6 to 10 mg/dL. A serum calcium level lower than 8.6 mg/dL indicates hypocalcemia. Electrocardiographic changes that occur in a client with hypocalcemia include a prolonged ST or QT interval
A nurse is preparing teaching for a family with a child diagnosed with sickle cell anemia. What will the nurse include in the teaching regarding the pathophysiology of sickle cell crisis? A. It results from altered metabolism & dehydration B. Tissue hypoxia & vascular occlusion cause the primary problems C. Increased bilirubin levels will lead to HTN D. There are decreased clotting factors with and increase of WBC
B. Tissue hypoxia & vascular occlusion cause the primary problems When there is inadequate hydration, sickled cells begin to clump together leading to occlusion. Tissue hypoxia can occur from decreased O2 carrying capacity of the sickled cells, as well as vascular occlusion. -There is no decrease in clotting factors in sickle cell
A young adult comes to the clinic complaining of dizziness, weakness, palpitations. What will be important for the nurse to evaluate initially when obtaining the health history? A. activity & exercise patterns B. nutritional patterns C. family health status D. coping & stress tolerance
B. nutritional patterns Iron deficiency anemia is characterized by fatigue, dizziness, weakness, increased pulse, palpitations, and increased sensitivity to cold.
Which client would most likely experience a problem with maintaining a normal electrolyte balance? A. A client with peripheral edema and heart failure B. The client with alcohol intake & liver damage C. A child with an acute episode of nephrotic syndrome D. A client with obstructive lung disease
C. A child with an acute episode of nephrotic syndrome Renal patients have a high likelihood to experience electrolyte imbalances, especially potassium.
What observations does the nurse expect to make when caring for a client dx with polycythemia vera? A. Jaundice B. Hematocrit <48% C. Dark, flushed face D. Hypotension
C. Dark, flushed face Blood in tissues is incompletely oxygenated, intense itching due to vasodilation occurs; blood moves slowly due to increased viscosity. HYPERtension occurs due to increased viscosity, hematocrit is consistently >55%, and jaundice is not present.
An older client has edema & fluid overload. What nursing intervention will be most accurate in evaluating the client's fluid balance? A. Measure I&O B. Check for thirst & skin turgor C. Evaluate changes in daily weight D. Evaluate VS q3 hours
C. Evaluate changes in daily weigh
A client in sickle cell crisis is admitted to the ED. What are the priorities of care in order of importance? A. Nutrition, hydration, electrolyte balance B. Hydration, pain management, electrolyte balance C. Hydration, oxygenation, pain management D. Hydration, oxygenation, electrolyte balance
C. Hydration, oxygenation, pain management Above are the priorities during the crisis to reduce sickling and prevent complications. Electrolyte management & nutrition are not priorities
What other manifestations would you expect to see in a patient with heart failure besides crackles and dyspnea? A. weight loss & dry skin B. Flat neck & hand veins C. Increase in BP & respirations D. Weakness & decreased central venous pressure (CVP)
C. Increase in BP & respirations
A doctor suspects pernicious anemia in a patient presenting with a beefy red tongue. The patient reports feeling extremely fatigued and numbness and tingling in the hands. The doctor orders a peripheral blood smear. From your nursing knowledge, how will the red blood cells appear in the peripheral blood smear if pernicious anemia is present? A. Round-shaped and hypochromic B. Oval-shaped and hyperchromic C. Large and oval-shaped D. Small and hyperchromic
C. Large and oval-shaped
Which of the following compensating mechanisms is most likely to occur in the presence of repiratory acidosis? A. Hyperventilation to decrease the CO2 levels B. Hypoventilation to increase the CO2 levels C. Retain HCO3 by the kidneys to increase the pH level D. Excrete HCO3 by the kidneys to decrease the pH level
C. Retain HCO3 by the kidneys to increase the pH level
Which of the following laboratory results indicates hypoparathyroidism? A. Serum potassium of 3.6 mEq/L. B. Serum calcium level of 4.3 mEq/L. C. Serum phosphorus level of 5.7 mg/dL. D. Serum magnesium level of 1.7 mg/dL.
C. Serum phosphorus level of 5.7 mg/dL. The parathyroid is responsible for the absorption of calcium and phosphorus. When a client has hypoparathyroidism, the serum calcium levels are low and the serum phosphorus levels are high
A client with an excessive alcohol intake has a reduced amount of antidiuretic hormone (ADH). The nurse anticipates this client to exhibit: A. An increased blood pressure B. Oliguria C. Signs of dehydration D. A low serum sodium level
C. Signs of dehydration
What ECG changes can we expect to see with a client diagnosed with hyperkalemia? A. ST depression B. Prominent U wave C. Tall peaked T waves D. Prolonged ST segment E. Widened QRS complex
C. Tall peaked T waves E. Widened QRS complex
The nurse is assisting a client to ambulate. Upon standing at the bedside, the client becomes weak and sits back down. The nurse should assess for which problem? A. sodium imbalance B. altered renal function C. fluid deficit D. hyperkalemia
C. fluid deficit Orthostatic hypotension is a symptom of fluid volume deficit.
The nurse is caring for a client receiving high doses of diuretics that is in heart failure. The client has flat neck veins, generalized muscle weakness, and diminished deep tendon reflexes. Hyponatremia is suspected. What are additional signs the nurse should expect? A. muscle twitches B. decreased urinary output C. hyperactive bowel tones D. increases specific gravity of urine
C. hyperactive bowel tones
An adult FEMALE client has a hemoglobin level of 10.8 g/dL. The nurse interprets that this result is most likely caused by which of the condition noted in the patient's history? A. dehydration B. heart failure C. iron deficiency anemia D. COPD
C. iron deficiency anemia A normal hemoglobin level for an adult female client is 12-16. Iron deficiency anemia may result in lower hemoglobin levels. Dehydration may increase hemoglobin level by hemo-concentration. - Heart failure & COPD may INCREASE hemoglobin level as a result of body's need for more O2 carrying capacity.
A client with Congestive heart failure is about to take a dose of furosemide (Lasix). Which of the following potassium level, if noted in the client's record, should be reported before giving the due medication? A. 5.1 mEq/L. B. 4.9 mEq/L. C. 3.9 mEq/L. D. 3.3 mEq/L
D. 3.3 mEq/L This will deplete already low Potassium levels (loop diuretic)
When a deficit of body fluid exists in the intravascular compartment, which one of the following signs can be expected? A. Rales B. A bounding pulse C. Engorged peripheral veins D. An elevated hematocrit level
D. An elevated hematocrit level
When providing care for a female client with Addison disease, the nurse should be alert for which of the following laboratory value? A. Potassium level of 3.2 mEq/L. B. Calcium level of 3.3 mEq/L. C. Sodium level of 150 mg/dL. D. Hematocrit level of 25%.
D. Hematocrit level of 25%. A client with Addison's disease is at risk for anemia. The normal hematocrit level of a female adult is 35% to 45%. A client with anemia has a low hematocrit level.
An adult male client has a hemoglobin count of 12.5 g/dL. Based on the result, the client is most likely having this due to which of the following noted in the client's record? A. Emphysema. B. Client living in a high altitude. C. Dehydration. D. History of enlarged spleen.
D. History of enlarged spleen. The normal hemoglobin level for an adult male is 14-16.5 g/dL. An enlarged spleen may cause anemia (low hemoglobin count) in clients. Options A and B: Emphysema and living at higher altitudes causes the red blood cell production to naturally increases to compensate for the lower oxygen supply. Option C: Dehydration may increase the hemoglobin level by hemoconcentration.
The kidneys are responsible for performing all the following functions EXCEPT? A. Activating Vitamin D B. Secreting Renin C. Secreting Erythropoietin D. Maintaining cortisol production
D. Maintaining cortisol production
A patient with a hx of GI bleeding has a platelet count of 300,000 mm^3. The nurse should take what action after seeing the lab results? A. Report the abnormally low count B. Report the abnormally high count C. Place the patient on bleeding precautions D. Place the normal report in the client's medial record
D. Place the normal report in the client's medial record Normal platelet count is 150,000-400,000
Lab studies are performed for a child suspected of having iron deficiency anemia. Which results indicate this type of anemia? A. Elevated hemoglobin levels B. Decreased reticulocyte count C. Elevated RBC count D. RBC that are microcytic & hypochromic
D. RBC that are microcytic & hypochromic
Which risk factors are associated with development of a sickle cell crisis? A. Recurrence of acute Otis media B. A fall with swelling at the kneecap & joint C. Fractured radius requiring internal fixation D. Recurrence of respiratory tract infections E. Dehydration F. Traveling to a location of higher altitude
D. Recurrence of respiratory tract infections E. Dehydration F. Traveling to a location of higher altitude RTIs generally involve fever/coughing/malaise which can contribute to dehydration, which can precipitate an attack as the blood is more thicker and prone to clotting. Problems with oxygen (high altitudes) are associated with sickling crisis.
Which of the following clients is at risk of developing a potassium level of 5.5 mEq/L? A. The client with colitis B. The client with Cushing's syndrome C. The client who has been over using laxatives D. The client who has sustained a traumatic burn
D. The client who has sustained a traumatic burn