Unit 6 exam set
A child is getting induction therapy for Burkitt lymphoma. The nurse finds the child lethargic and complaining of side and back pain. The childs morning laboratory results indicate a serum calcium level of 7.2 mg/dL. What actions by the nurse are the most appropriate at this time? (Select all that apply.) a. Administer a dose of pain medication. b. Assess Chvostek and Trousseau signs. c. Call the rapid response team. d. Encourage an increased oral intake. e. Prepare to administer allopurinol (Aloprim).
a. Administer a dose of pain medication. b. Assess Chvostek and Trousseau signs. e. Prepare to administer allopurinol (Aloprim).
The nurse has obtained the health history, physical assessment data, and laboratory results shown in the accompanying figure for a patient admitted with aplastic anemia. Which information is most important to communicate to the health care provider? a. Neutropenia b. Increasing fatigue c. Thrombocytopenia d. Frequent constipation
a. Neutropenia
Which information obtained by the nurse assessing a patient admitted with multiple myeloma is most important to report to the health care provider? a. Serum calcium level is 15 mg/dL. b. Patient reports no stool for 5 days. c. Urine sample has Bence-Jones protein. d. Patient is complaining of severe back pain.
a. Serum calcium level is 15 mg/dL.
A boy with leukemia screams whenever he needs to be turned or moved. The most probable cause of this pain is: A Edema. c.Petechial hemorrhages. b.Bone involvement. d. Changes within the muscles.
b. Bone involvement
Which action will the admitting nurse include in the care plan for a 30-year old woman who is neutropenic? a. Avoid any injections. b. Check temperature every 4 hours. c. Omit fruits or vegetables from the diet. d. Place a "No Visitors" sign on the door.
b. Check temperature every 4 hours.
A neonate born with ambiguous genitalia is diagnosed with congenital adrenogenital hyperplasia. Therapeutic management includes administration of: a. Vitamin D. b. Cortisone. c. Stool softeners. d. Calcium carbonate.
b. Cortisone.
A 45-year-old male patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question should the nurse ask? a. Have you had a recent head injury? b. Do you have to wear larger shoes now? c. Is there a family history of acromegaly? d. Are you experiencing tremors or anxiety?
b. Do you have to wear larger shoes now?
Which collaborative problem will the nurse include in a care plan for a patient admitted to the hospital with idiopathic aplastic anemia? a. Potential complication: seizures b. Potential complication: infection c. Potential complication: neurogenic shock d. Potential complication: pulmonary edema
b. Potential complication: infection
A 30-year-old man with acute myelogenous leukemia develops an absolute neutrophil count of 850/µL while receiving outpatient chemotherapy. Which action by the outpatient clinic nurse is most appropriate? a. Discuss the need for hospital admission to treat neutropenia. b. Teach the patient to administer filgrastim (Neupogen) injections. c. Plan to discontinue the chemotherapy until the neutropenia resolves. d. Order a high-efficiency particulate air (HEPA) filter for the patient's home.
b. Teach the patient to administer filgrastim (Neupogen) injections.
Which patient requires the most rapid assessment and care by the emergency department nurse? a. The patient with hemochromatosis who reports abdominal pain b. The patient with neutropenia who has a temperature of 101.8° F c. The patient with sickle cell anemia who has had nausea and diarrhea for 24 hours d. The patient with thrombocytopenia who has oozing after having a tooth extracted
b. The patient with neutropenia who has a temperature of 101.8°
The nurse notes scleral jaundice in a patient being admitted with hemolytic anemia. The nurse will plan to check the laboratory results for the a. Schilling test. b. bilirubin level. c. stool occult blood test. d. gastric analysis testing.
b. bilirubin level.
A routine complete blood count indicates that an active 80-year-old man may have myelodysplastic syndrome. The nurse will plan to teach the patient about a. blood transfusion b. bone marrow biopsy. c. filgrastim (Neupogen) administration. d. erythropoietin (Epogen) administration.
b. bone marrow biopsy. MDS-a condition where the bone marrow does not produce enough healthy blood cells. It is a form of blood cancer caused by genetic damage in the primitive cells (stem cells) in the bone marrow. Patients with MDS often have anemia (low red blood cells). Additionally, they can also have neutropenia (low white blood cells) and/or thrombocytopenia (low platelets).
The nurse is assessing a 41-year-old African American male patient diagnosed with a pituitary tumor causing pan hypopituitarism. Assessment findings consistent with pan hypopituitarism include a. high blood pressure. b. decreased facial hair. c. elevated blood glucose. d. tachycardia and cardiac palpitations.
b. decreased facial hair.
A 56-year-old patient who is disoriented and reports a headache and muscle cramps is hospitalized with possible syndrome of inappropriate antidiuretic hormone (SIADH). The nurse would expect the initial laboratory results to include a(n) a. elevated hematocrit. b. decreased serum sodium. c. low urine specific gravity. d. increased serum chloride
b. decreased serum sodium.
It is important for the nurse providing care for a patient with sickle cell crisis to a. limit the patients intake of oral and IV fluids. b. evaluate the effectiveness of opioid analgesics. c. encourage the patient to ambulate as much as tolerated. d. teach the patient about high-protein, high-calorie foods.
b. evaluate the effectiveness of opioid analgesics.
The nurse determines that demeclocycline (Declomycin) is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) based on finding that the patients a. weight has increased. b. urinary output is increased. c. peripheral edema is decreased. d. urine specific gravity is increased.
b. urinary output is increased.
A patient with possible disseminated intravascular coagulation arrives in the emergency department with a blood pressure of 82/40, temperature 102° F (38.9° C), and severe back pain. Which physician order will the nurse implement first? a. Administer morphine sulfate 4 mg IV. b. Give acetaminophen (Tylenol) 650 mg. c. Infuse normal saline 500 mL over 30 minutes. d. Schedule complete blood count and coagulation studies.
c. Infuse normal saline 500 mL over 30 minutes.
When a patient with splenomegaly is scheduled for splenectomy, which action will the nurse include in the preoperative plan of care? a. Discourage deep breathing to reduce risk for splenic rupture. b. Teach the patient to use ibuprofen (Advil) for left upper quadrant pain. c. Schedule immunization with the pneumococcal vaccine (Pneumovax). d. Avoid the use of acetaminophen (Tylenol) for 2 weeks prior to surgery.
c. Schedule immunization with the pneumococcal vaccine (Pneumovax).
A 54-year-old woman with acute myelogenous leukemia (AML) is considering treatment with a hematopoietic stem cell transplant (HSCT). The best approach for the nurse to assist the patient with a treatment decision is to a. emphasize the positive outcomes of a bone marrow transplant. b. discuss the need for adequate insurance to cover post-HSCT care. c. ask the patient whether there are any questions or concerns about HSCT. d. explain that a cure is not possible with any other treatment except HSCT.
c. ask the patient whether there are any questions or concerns about HSCT.
A 42-year-old female patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma. During preoperative teaching, the nurse instructs the patient about the need to a. cough and deep breathe every 2 hours postoperatively. b. remain on bed rest for the first 48 hours after the surgery. c. avoid brushing teeth for at least 10 days after the surgery. d. be positioned flat with sandbags at the head postoperatively.
c. avoid brushing teeth for at least 10 days after the surgery.
A 52-year-old patient has a new diagnosis of pernicious anemia. The nurse determines that the patient understands the teaching about the disorder when the patient states, "I a. need to start eating more red meat and liver." b. will stop having a glass of wine with dinner." c. could choose nasal spray rather than injections of vitamin B12." d. will need to take a proton pump inhibitor like omeprazole (Prilosec)."
c. could choose nasal spray rather than injections of vitamin B12.
An expected nursing diagnosis for a 30-year-old patient admitted to the hospital with symptoms of diabetes insipidus is a .excess fluid volume related to intake greater than output. b. impaired gas exchange related to fluid retention in lungs. c. sleep pattern disturbance related to frequent waking to void. d. risk for impaired skin integrity related to generalized edema Nocturia occurs as a result of the polyuria caused by diabetes insipidus
c. sleep pattern disturbance related to frequent waking to void.
Which statement by a patient indicates a good understanding of the nurse's teaching about prevention of sickle cell crisis? a. "Home oxygen therapy is frequently used to decrease sickling." b. "There are no effective medications that can help prevent sickling." c. "Routine continuous dosage narcotics are prescribed to prevent a crisis." d. "Risk for a crisis is decreased by having an annual influenza vaccination."
d. "Risk for a crisis is decreased by having an annual influenza vaccination."
Which laboratory test will the nurse use to determine whether filgrastim (Neupogen) is effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy? a. Platelet count b. Reticulocyte count c. Total lymphocyte count d. Absolute neutrophil count
d. Absolute neutrophil count
Which laboratory result will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)? a. Prothrombin time b. Erythrocyte count c. Fibrinogen degradation products d. Activated partial thromboplastin time
d. Activated partial thromboplastin time
An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough. These manifestations are most suggestive of: a. Air embolism. C. Hemolytic reaction. B. Allergic reaction. d. Circulatory overload.
d. Circulatory overload.
A patient who has been receiving a heparin infusion and warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when her platelet level drops to 110,000/µL. Which action will the nurse include in the plan of care? a. Use low-molecular-weight heparin (LMWH) only. b. Administer the warfarin (Coumadin) at the scheduled time. c. Teach the patient about the purpose of platelet transfusions. d. Discontinue heparin and flush intermittent IV lines using normal saline.
d. Discontinue heparin and flush intermittent IV lines using normal saline.
A child will start treatment for precocious puberty. This involves injections of synthetic: a.vThyrotropin. b. Gonadotropins. c. Somatotropic hormone. d. Luteinizing hormone releasing hormone.
d. Luteinizing hormone releasing hormone.
Which finding by the nurse when assessing a patient with a large pituitary adenoma is most important to report to the health care provider? a. Changes in visual field b. Milk leaking from breasts c. Blood glucose 150 mg/dL d. Nausea and projectile vomiting
d. Nausea and projectile vomiting
The nurse is caring for a child with suspected diabetes insipidus. Which clinical manifestation would she or he expect to observe? a. Oliguria c. Nausea and vomiting b. Glycosuria d. Polyuria and polydipsia
d. Polyuria and polydipsia
Which statement by a patient indicates a good understanding of the nurses teaching about prevention of sickle cell crisis? a. Home oxygen therapy is frequently used to decrease sickling. b. There are no effective medications that can help prevent sickling. c. Routine continuous dosage narcotics are prescribed to prevent a crisis. d. Risk for a crisis is decreased by having an annual influenza vaccination.
d. Risk for a crisis is decreased by having an annual influenza vaccination.
Which patient information is most important for the nurse to monitor when evaluating the effectiveness of deferoxamine (Desferal) for a patient with hemochromatosis? a. Skin color b. Hematocrit c. Liver function d. Serum iron level
d. Serum iron level
An 18-year-old male patient with a small stature is scheduled for a growth hormone stimulation test. In preparation for the test, the nurse will obtain a. ice in a basin. b. glargine insulin. c. a cardiac monitor. d.50% dextrose solution.
d.50% dextrose solution. This is given to treat hypoglycemia induced during the test.
The most common type of leukemia in older adults is A. acute myelocytic leukemia. B. acute lymphocytic leukemia. C. chronic myelocytic leukemia. D. chronic lymphocytic leukemia.
B. acute lymphocytic leukemia.
Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vaso-occlusive crisis? A. Circulatory collapse B Cardiomegaly, systolic murmurs C. Hepatomegaly, intrahepatic cholestasis D. Painful swelling of hands and feet, painful joints
D. Painful swelling of hands and feet, painful joints
Because myelodysplastic syndrome (MDS) arises from the pluripotent hematopoietic stem cells in the bone marrow, expected laboratory results include A. an excess of T cells. B. an excess of platelets. C. an increase in lymphocytes. D. a deficiency of all cellular blood components.
D. a deficiency of all cellular blood components.
Pediatric fluid Bolus & 1 1/12 Maintenance Fluids Calculation Maintenance IVF formula: Determine weight in Kg 100cc for 1st 10 Kg 50cc for next 10 Kg 20cc for remaining Kg Then divide by 24 for ml/hr If asking for 1 ½ maintenance add extra ½ before dividing by 24
Determine weight in Kg 100cc for 1st 10 Kg 50cc for next 10 Kg 20cc for remaining Kg Then divide by 24 for ml/hr If asking for 1 ½ maintenance add extra ½ before dividing by 24
Disseminated intravascular coagulation (DIC) is initiated by intravascular release of which substance? A. Platelets B. Fibrin C. Thrombin D. Histamine
Thrombin
A child with growth hormone (GH) deficiency is receiving GH therapy. The best time for the GH to be administered is: a. At bedtime. b. After meals. c. Before meals. d. On arising in the morning.
a. At bedtime.
Which action will the nurse include in the plan of care for a 72-year-old woman admitted with multiple myeloma? a. Monitor fluid intake and output. b. Administer calcium supplements. c. Assess lymph nodes for enlargement. d. Limit weight bearing and ambulation.
a. Monitor fluid intake and output
The nurse is caring for a patient admitted with diabetes insipidus (DI). Which information is most important to report to the health care provider?
a. The patient is confused and lethargic
An appropriate nursing intervention for a patient with non-Hodgkin's lymphoma whose platelet count drops to 18,000/µL during chemotherapy is to a. check all stools for occult blood. b. encourage fluids to 3000 mL/day. c. provide oral hygiene every 2 hours. d. check the temperature every 4 hours.
a. check all stools for occult blood.
After receiving change-of-shift report for several patients with neutropenia, which patient should the nurse assess first? a. 56-year-old with frequent explosive diarrhea b. 33-year-old with a fever of 100.8° F (38.2° C) c. 66-year-old who has white pharyngeal lesions d. 23-year old who is complaining of severe fatigue
b. 33-year-old with a fever of 100.8° F (38.2° C)
The nurse is planning postoperative care for a patient who is being admitted to the surgical unit form the recovery room after transsphenoidal resection of a pituitary tumor. Which nursing action should be included? a. Palpate extremities for edema. b. Measure urine volume every hour. c. Check hematocrit every 2 hours for 8 hours. d. Monitor continuous pulse oximetry for 24 hours.
b. Measure urine volume every hour.
A patient with septicemia develops prolonged bleeding from venipuncture sites and blood in the stools. Which action is most important for the nurse to take? a. Avoid venipunctures. b. Notify the patient's physician. c. Apply sterile dressings to the sites. d. Give prescribed proton-pump inhibitors.
b. Notify the patient's physician. *The patient's new onset of bleeding and diagnosis of sepsis suggest that disseminated intravascular coagulation (DIC) may have developed, which will require collaborative actions such as diagnostic testing, blood product administration, and heparin administration
An appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia is to a. provide a diet high in vitamin K. b. alternate periods of rest and activity. c. teach the patient how to avoid injury. d. place the patient on protective isolation.
b. alternate periods of rest and activity.
Which action will the nurse include in the plan of care for a patient who has thalassemia major? a. Teach the patient to use iron supplements. b. Avoid the use of intramuscular injections. c. Administer iron chelation therapy as needed. d. Notify health care provider of hemoglobin 11g/dL.
c. Administer iron chelation therapy as needed.
Which action for a patient with neutropenia is appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Assessing the patient for signs and symptoms of infection b. Teaching the patient the purpose of neutropenic precautions c. Administering subcutaneous filgrastim (Neupogen) injection d. Developing a discharge teaching plan for the patient and family
c. Administering subcutaneous filgrastim (Neupogen) injection
Which instruction will the nurse plan to include in discharge teaching for the patient admitted with a sickle cell crisis? a. Take a daily multivitamin with iron. b. Limit fluids to 2 to 3 quarts per day. c. Avoid exposure to crowds when possible. d. Drink only two caffeinated beverages daily.
c. Avoid exposure to crowds when possible.
Which additional information will the nurse need to consider when reviewing the laboratory results for a patient's total calcium level? a. The blood glucose is elevated. b. The phosphate level is normal. c. The serum albumin level is low. d. The magnesium level is normal.
c. The serum albumin level is low.
A 68-year-old woman with acute myelogenous leukemia (AML) asks the nurse whether the planned chemotherapy will be worth undergoing. Which response by the nurse is appropriate? a. "If you do not want to have chemotherapy, other treatment options include stem cell transplantation." b. "The side effects of chemotherapy are difficult, but AML frequently goes into remission with chemotherapy." c. "The decision about treatment is one that you and the doctor need to make rather than asking what I would do." d. "You don't need to make a decision about treatment right now because leukemias in adults tend to progress quite slowly."
"The side effects of chemotherapy are difficult, but AML frequently goes into remission with chemotherapy."
Which intervention will the nurse include in the plan of care for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)? a. Encourage fluids to 2 to 3 L/day. b. Monitor for increasing peripheral edema. c. Offer the patient hard candies to suck on. d. Keep head of bed elevated to 30 degrees.
. Offer the patient hard candies to suck on.
A patient is to receive an infusion of 250 mL of platelets over 2 hours through tubing that is labeled: 1 mL equals 10 drops. How many drops per minute will the nurse infuse?
21 drops/minute.
By definition, neutropenia occurs when the white blood cell (WBC) count drops below? A. 4000/μL B. 3000/μL C. 2000/μL D. 1000/μL
A. 4000/μL
What is the priority nursing intervention for a child hospitalized with hemarthrosis resulting from hemophilia? A. Immobilization and elevation of the affected joint B. Administration of acetaminophen for pain relief C. Assessment of the childs response to hospitalization D. Assessment of the impact of hospitalization on the family system
A. Immobilization and elevation of the affected joint
A 19-year-old woman with immune thrombocytopenic purpura (ITP) has an order for a platelet transfusion. Which information indicates that the nurse should consult with the health care provider before obtaining and administering platelets? A. The platelet count is 42,000/mL. b. Petechiae are present on the chest. c. Blood pressure (BP) is 94/56 mm Hg. d. Blood is oozing from the venipuncture site.
A. The platelet count is 42,000/mL. Not recommended until below 10,000 to 20,000 mm3
Priority nursing actions when caring for a hospitalized patient with new-onset temperature of 102.2° F and severe neutropenia include (select all that apply) A. administering the prescribed antibiotic STAT. B. drawing peripheral and central line blood cultures. C. ongoing monitoring of the patient's vital signs for septic shock. D. taking a full set of vital signs and notifying the physician immediately.
A. administering the prescribed antibiotic STAT. B. drawing peripheral and central line blood cultures. C. ongoing monitoring of the patient's vital signs for septic shock. D. taking a full set of vital signs and notifying the physician immediately.
In all types of leukemia proliferating cells depress bone marrow production. Most frequent S&S result from infiltration of bone marrow: fever, pallor, fatigue, anorexia, hemorrhage (usually petechiae), and bone & joint pain. Frequently, vague abdominal pain is caused by inflammation from normal flora within the GI.
ABDOMEN PAIN & BONE PAIN HEADACHE NAUSEA & VOMITING EXTRA NODAL SITES: BREASTS & TESTES weakness, fatigue, pruritic skin lesions, anemia, thrombocytopenia and enlarged spleen
Acute Lymphatic leukemia (ALL)
Acute = Rapid onset, 80% b Cells, 20% T cells Children 2-4years old 80% 5 year survival rate Stem cells become cancerous. They divide, stop producing blood cells; white and red, and can matastisis.
A patient is admitted with diabetes insipidus. Which action will be appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)?
Administer prescribed subcutaneous DDAVP.
The nurse has initiated a blood transfusion on a preschool child. The child begins to exhibit signs of a transfusion reaction. Place in order the interventions the nurse should implement, sequencing from the highest priority to the lowest. a. Take the vital signs. 2 B. Stop the transfusion. 1 C. Notify the practitioner. 4 D. Maintain a patent intravenous (IV) line with normal saline 3
B stop the infusion A. Take the vital signs D, Maintain a patent IV C. Notify the practitioner
The nurse is planning care for a school-age child admitted to the hospital with hemophilia. Which interventions should the nurse plan to implement for this child (Select all that apply)? A Fingerstick for blood work instead of venipunctures B. Avoidance of intramuscular (IM) injections C. Acetaminophen (Tylenol) for mild pain control D Soft toothbrush for dental hygiene E. Administration of packed red blood cells
B. Avoidance of intramuscular (IM) injections C. Acetaminophen (Tylenol) for mild pain control D Soft toothbrush for dental hygiene
An adolescent is being seen in the clinic for evaluation of acromegaly. The nurse understands that which occurs with acromegaly? A. There is a lack of growth hormone (GH) being produced. B. There is excess GH after closure of the epiphyseal plates. C. There is an excess of GH before the closure of the epiphyseal plates. D There is a lack of thyroid hormone being produced.
B. There is excess GH after closure of the epiphyseal plates.
Your primary goal in the care of the patient with DIC is to A. provide emotional support. B. recognize early signs of occult or overt bleeding. C. monitor nutritional intake. D. report abnormal laboratory results
B. recognize early signs of occult or overt bleeding.
If the patient with DIC is actively bleeding, platelets are given to correct thrombocytopenia if the count is less than A. 150,000/μL. B. 100,000/μL. C. 50,000/μL. D. 30,000/μL.
C. 50,000/μL.
Nursing care of a child diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) should include (Select all that apply) a. Weigh daily. b. Encourage fluids. c. Turn frequently. d. Maintain nothing by mouth. e. Restrict fluids.
Daily weights Restrict fluids
AML: Gingival hyperplasia, hyperplasia of the bone marrow. Sternal tenderness. Hepatosplenomegaly.
One of the main things that differentiates AML from the other main forms of leukemia is that it has eight different subtypes, which are based on the cell that the leukemia developed from. The types of acute myelogenous leukemia include: Myeloblastic (M0) - on special analysis Myeloblastic (M1) - without maturation Myeloblastic (M2) - with maturation Promyeloctic (M3) Myelomonocytic (M4) Monocytic (M5) Erythroleukemia (M6) Megakaryocytic (M7) Acute myeloid leukemia treatment options
During the teaching session for a patient who has a new diagnosis of acute leukemia the patient is restless and is looking away, never making eye contact. After teaching about the complications associated with chemotherapy, the patient asks the nurse to repeat all of the information. Based on this assessment, which nursing diagnosis is most appropriate for the patient? a. Risk for ineffective adherence to treatment related to denial of need for chemotherapy b. Acute confusion related to infiltration of leukemia cells into the central nervous system c. Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis d. Deficient knowledge: chemotherapy related to a lack of interest in learning about treatment
Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis