Week 11

The nurse is teaching a patient with type 2 diabetes mellitus how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful? - "Smokeless tobacco products decrease the risk of kidney damage." - "I can help control my blood pressure by avoiding foods high in salt." - "I should have yearly dilated eye examinations by an ophthalmologist." - "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL."

- "I can help control my blood pressure by avoiding foods high in salt." Diabetic nephropathy is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney. Risk factors for the development of diabetic nephropathy include hypertension, genetic predisposition, smoking, and chronic hyperglycemia. Patients with diabetes are screened for nephropathy annually with a measurement of the albumin-to-creatinine ratio in urine; a serum creatinine is also needed.

Which comment to a patient by a new nurse regarding palliative care needs to be corrected? - "Even though you're continuing treatment, palliative care is something we might want to talk about." - "Palliative care is appropriate for people with any diagnosis." - "Only people who are dying can receive palliative care." - "Children are able to receive palliative care."

- "Only people who are dying can receive palliative care." Palliative care is available to all patients regardless of age, diagnosis, and prognosis.

The nurse notes a physician's order written at 10:00 AM for two units of packed red blood cells to be administered to a patient who is anemic as a result of chronic blood loss. If the transfusion is picked up at 11:30 AM, the nurse should plan to hang the unit no later than what time? - 11:45 AM - 12:00 noon - 12:30 PM - 3:30 PM

- 12:00 noon The nurse must hang the unit of packed red blood cells within 30 minutes of signing them out from the blood bank.

The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of which foods to help reduce the percent of fat in the diet? - Cheese - Broccoli - Chicken - Oranges

- Cheese Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry. Excess fat in the diet is limited to help avoid macrovascular changes.

What is the palliative care team's primary obligation for the patient with severe pain? - Providing postmortem care. - Teaching about grief stages. - Enhancing the patient's quality of life. - Supporting the family after the death.

- Enhancing the patient's quality of life. Palliative care focuses on enhancing the patient's quality of life.

Results of a patient's most recent blood work indicate an elevated neutrophil level. The nurse recognizes that this diagnostic finding most likely suggests which problem? - Infection - Hypoxemia - Acute thrombotic event - Risk of hypocoagulation

- Infection An increase in the neutrophil count most commonly occurs in response to infection or inflammation. Hypoxemia and coagulation do not directly affect neutrophil production.

A patient who has sickle cell disease has developed cellulitis above the left ankle. What is the nurse's priority for this patient? - Start IV fluids. - Maintain oxygenation. - Maintain distal warmth. - Check peripheral pulses.

- Maintain oxygenation. Maintaining oxygenation is a priority as sickling episodes are frequently triggered by low oxygen tension in the blood which is commonly caused by an infection. Antibiotics to treat cellulitis, pain control, and fluids to reduce blood viscosity will also be used, but oxygenation is the priority.

On entering a room the nurse sees the patient crying softly. What is the most therapeutic response? - Using silence - Asking, "Why are you crying today?" - Using therapeutic touch - Stating, "I see that you're crying."

- Stating, "I see that you're crying." Stating an observation encourages patients to share without putting the patient on the defensive.

Which clinical manifestation of decreased renal function in the diabetic clinic should the nurse anticipate as a potential problem? - Elevated specific gravity - Ketone bodies in the urine - Glucose in the urine - Sustained increase in blood pressure from 130/82 mm Hg to 150/110 mm Hg

- Sustained increase in blood pressure from 130/82 mm Hg to 150/110 mm Hg Hypertension is both a cause and a result of renal dysfunction in the diabetic client. Although ketones and glucose in the urine are findings in diabetes mellitus, they are not specific for renal function. Specific gravity is elevated with dehydration.

A grieving patient complains of confusion, inability to concentrate, and insomnia. What do these symptoms indicate? - These are normal symptoms of grief. - There is a need for pharmacological support for insomnia. - The patient is experiencing complicated grief. - These are common complaints of the admitted patient.

- These are normal symptoms of grief. Symptoms of normal grief include a variety of feelings, thought patterns, physical sensations, and behaviors.

A 36-yr-old female patient suspected of having leukemia is scheduled for a bone marrow aspiration. What statement in the patient's health history requires immediate follow-up by the nurse? - "I had a bad reaction to iodine before and almost died." - "I am taking an antibiotic to treat a urinary tract infection." - "I have rheumatoid arthritis and take aspirin for joint pain." - "I have dialysis for chronic renal failure three times a week."

- "I have rheumatoid arthritis and take aspirin for joint pain." Complications of bone marrow aspiration are minimal, but there is a possibility of damaging underlying structures (especially if the sternum site is used). Other complications include hemorrhage (particularly if the patient is thrombocytopenic) and infection (particularly if the patient is leukopenic). The risk of hemorrhage is increased if the patient takes aspirin because it promotes bleeding by inhibiting platelet aggregation. Contrast dye is not used during a bone marrow aspiration. A bone marrow aspiration is not contraindicated in patients who have chronic renal failure (on dialysis) or a urinary tract infection (on an antibiotic).

The nurse instructs a patient with diabetes mellitus about a healthy eating plan. Which statement made by the patient indicates that teaching was successful? - "I plan to lose 25 lb this year by following a high-protein diet." - "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." - "I should include more fiber in my diet than a person who does not have diabetes." - "If I use an insulin pump, I will not need to limit the amount of saturated fat in my diet."

- "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." Eating carbohydrates when drinking alcohol reduces the risk for alcohol-induced hypoglycemia. Intensified insulin therapy, such as the use of an insulin pump, allows considerable flexibility in food selection and can be adjusted for alterations from usual eating and exercise habits. However, saturated fat intake should still be limited to less than 7% of total daily calories. Daily fiber intake of 14 g/1000 kcal is recommended for the general population and for patients with diabetes mellitus. High-protein diets are not recommended for weight loss.

The nurse has taught a patient admitted with diabetes principles of foot care. The nurse evaluates that the patient understands the principles of foot care if the patient makes what statement? - "I should only walk barefoot in nice dry weather." - "I should look at the condition of my feet every day." - "I am lucky my shoes fit so nice and tight because they give me firm support." - "When I am allowed up out of bed, I should check the shower water with my toes."

- "I should look at the condition of my feet every day." Patients with diabetes mellitus need to inspect their feet daily for broken areas that are at risk for infection and delayed wound healing. Properly fitted (not tight) shoes should be worn at all times. Water temperature should be tested with the hands first.

The nurse teaches a patient recently diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient requires an intervention by the nurse? - "I will discard any insulin bottle that is cloudy in appearance." - "The best injection site for insulin administration is in my abdomen." - "I can wash the site with soap and water before insulin administration." - "I may keep my insulin at room temperature (75F) for up to 1 month."

- "I will discard any insulin bottle that is cloudy in appearance." Intermediate-acting insulin and combination-premixed insulin will be cloudy in appearance. Routine hygiene such as washing with soap and rinsing with water is adequate for skin preparation for the patient during self-injections. Insulin vials that the patient is currently using may be left at room temperature for up to 4 weeks unless the room temperature is higher than 86°F (30°C) or below freezing

The nurse is teaching a patient with type 2 diabetes mellitus about exercise to help control blood glucose. The nurse knows the patient understands when the patient elicits which exercise plan? - "I want to go fishing for 30 minutes each day; I will drink fluids and wear sunscreen." - "I will go running each day when my blood sugar is too high to bring it back to normal." - "I will plan to keep my job as a teacher because I get a lot of exercise every school day." - "I will take a brisk 30-minute walk 5 days per week and do resistance training three times a week."

- "I will take a brisk 30-minute walk 5 days per week and do resistance training three times a week." The best exercise plan for the person with type 2 diabetes is for 30 minutes of moderate activity 5 days per week and resistance training three times a week. Brisk walking is moderate activity. Fishing and teaching are light activity, and running is considered vigorous activity.

The nurse is planning health promotion teaching for a group of healthy older adults in a residential community. Which statement accurately describes expected hematologic effects of aging? - "Platelet production increases with age and leads to easy bruising." - "Anemia is common with aging because iron absorption is impaired." - "Older adults with infections may have only a mild white blood cell count elevation." - "Older adults often have poor immune function with a decreased number of lymphocytes"

- "Older adults with infections may have only a mild white blood cell count elevation." During an infection, the older adult may have only a minimal elevation in the total white blood cell count and may not have a fever. Presentation of infection can initially be nonspecific with disorientation, anorexia, and weakness. Platelets are unaffected by the aging process. However, changes in vascular integrity from aging can manifest as easy bruising. Iron absorption is not impaired in the older patient, but adequate nutritional intake of iron may be decreased. The total white blood cell count and differential are generally not affected by aging. However, a decrease in humoral antibody response and decrease in T-cell function may occur.

A diabetic patient has proliferative retinopathy, nephropathy, and peripheral neuropathy. What should the nurse teach this patient about exercise? - "Jogging for 20 minutes 5 to 7 days a week would most efficiently help you to lose weight." - "One hour of vigorous exercise daily is needed to prevent progression of disease." - "Avoid all forms of exercise because of your diabetic complications." - "Swimming or water aerobics 30 minutes each day would be the safest exercise routine for you."

- "Swimming or water aerobics 30 minutes each day would be the safest exercise routine for you." Exercise is not contraindicated for this client, but modifications are necessary to prevent further injury. Swimming or water aerobics provides support for the joints and muscles while increasing the uptake of glucose and promoting cardiovascular health. Jogging, vigorous exercise, or no exercise would increase the pathologies of this patient.

The nurse instructs an African American man who has sickle cell disease about symptom management and prevention of sickle cell crisis. The nurse determines further teaching is necessary if the patient makes which statement? - "When I take a vacation, I should not go to the mountains." - "I should avoid contact with anyone who has a respiratory infection." - "When my vision is blurred, I will close my eyes and rest for an hour." - "I may experience severe pain during a crisis and need narcotic analgesics."

- "When my vision is blurred, I will close my eyes and rest for an hour." Blurred vision should be reported immediately and may indicate a detached retina or retinopathy. Hypoxia (at high altitudes) and infection are common causes of a sickle cell crisis. Severe pain may occur during a sickle cell crisis, and narcotic analgesics are indicated for pain management.

A patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? - "With type 2 diabetes, the body of the pancreas becomes inflamed." - "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." - "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." - "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."

- "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced and/or the cells of the body become resistant to insulin. The pancreas becomes inflamed with pancreatitis. The patient is totally dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas with type 1 diabetes mellitus.

When preparing to administer an ordered blood transfusion, which IV solution does the nurse use when priming the blood tubing? - Lactated Ringer's - 5% dextrose in water - 0.9% sodium chloride - 0.45% sodium chloride

- 0.9% sodium chloride The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It is also used to flush the blood tubing after the infusion is complete to ensure the patient receives blood that is left in the tubing when the bag is empty. Dextrose and lactated Ringer's solutions cannot be used with blood because they will cause RBC hemolysis.

The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action? - 8:40 PM to 9:00 PM - 9:00 PM to 11:30 PM - 10:30 PM to 1:30 AM - 12:30 AM to 8:30 AM

- 10:30 PM to 1:30 AM Regular insulin exerts peak action in 2 to 5 hours, making the patient most at risk for hypoglycemia between 10:30 PM and 1:30 AM. Rapid-acting insulin's onset is between 10 and 30 minutes with peak action and hypoglycemia most likely to occur between 9:00 PM and 11:30 PM. With intermediate acting insulin, hypoglycemia may occur from 12:30 AM to 8:30 AM.

Before starting a transfusion of packed red blood cells for an older anemic patient, the nurse would arrange for a peer to monitor his or her other assigned patients for how many minutes when the nurse begins the transfusion? - 5 - 15 - 30 - 60

- 15 As part of standard procedure, the nurse remains with the patient for the first 15 minutes after starting a blood transfusion. Patients who are likely to have a transfusion reaction will more often exhibit signs within the first 15 minutes that the blood is infusing. Monitoring during the transfusion will be every 30 to 60 minutes.

A nurse has the responsibility of managing a deceased patient's postmortem care. Which of the following is the proper order for postmortem care? 1. Bathe the body of the deceased. 2. Collect any needed specimens. 3. Remove all tubes and indwelling lines. 4. Position the body for family viewing. 5. Speak to the family members about their possible participation. 6. Ensure that the request for organ/tissue donation and/or autopsy was completed. 7. Notify support person (e.g., spiritual care provider, bereavement specialist) for the family. 8. Accurately tag the body, including the identity of the deceased and safety issues regarding infection control. 9. Elevate the head of the bed. - 9, 1, 2, 4, 3, 5, 7, 8, 6 - 6, 9, 2, 5, 7, 3, 1, 4, 8 - 8, 4, 1, 3, 5, 2, 6, 7, 9 - 2, 1, 5, 3, 7, 9, 4, 8, 6

- 6, 9, 2, 5, 7, 3, 1, 4, 8 This is the proper order for postmortem care.

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

- A 23-yr-old African American man who has a diagnosis of sickle cell disease 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.

The nurse is assigned to care for several patients on a medical unit. Which patient should the nurse check on first? - A 60-yr-old patient with a blood pressure of 92/64 mm Hg and hemoglobin of 9.8 g/dL - A 50-yr-old patient with a respiratory rate of 26 breaths/minute and an elevated D-dimer - A 40-yr-old patient with a temperature of 100.8oF (38.2oC) and a neutrophil count of 256/µL - A 30-yr-old patient with a pulse of 112 beats/min and a white blood cell count of 14,000/µL

- A 40-yr-old patient with a temperature of 100.8oF (38.2oC) and a neutrophil count of 256/µL A low-grade fever greater than 100.4°F (38°C) in a patient with a neutrophil count below 500/µL is a medical emergency and may indicate an infection. An infection in a neutropenic patient could lead to septic shock and possible death if not treated immediately.

The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes mellitus? - A 48-yr-old woman with a hemoglobin A1C of 8.4% - A 58-yr-old man with a fasting blood glucose of 111 mg/dL - A 68-yr-old woman with a random plasma glucose of 190 mg/dL - A 78-yr-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL

- A 48-yr-old woman with a hemoglobin A1C of 8.4% Criteria for a diagnosis of diabetes mellitus include a hemoglobin A1C of 6.5% or greater, fasting plasma glucose level of 126 mg/dL or greater, 2-hour plasma glucose level of 200 mg/dL or greater during an oral glucose tolerance test, or classic symptoms of hyperglycemia or hyperglycemic crisis with a random plasma glucose of 200 mg/dL or greater.

Which patient with type 1 diabetes mellitus would be at the highest risk for developing hypoglycemic unawareness? - A 58-yr-old patient with diabetic retinopathy - A 73-yr-old patient who takes propranolol (Inderal) - A 19-yr-old patient who is on the school track team - A 24-yr-old patient with a hemoglobin A1C of 8.9%

- A 73-yr-old patient who takes propranolol (Inderal) Hypoglycemic unawareness is a condition in which a person does not experience the warning signs and symptoms of hypoglycemia until the person becomes incoherent and combative or loses consciousness. Hypoglycemic awareness is related to autonomic neuropathy of diabetes that interferes with the secretion of counterregulatory hormones that produce these symptoms. Older patients and patients who use β-adrenergic blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.

Which priority intervention will the nurse initiate for the patient having Kussmaul's respirations due to diabetic ketoacidosis? - Administration of oxygen by nasal cannula at 15 L/min - Intravenous infusion of 10% glucose - Implementation of seizure precautions - Administration of intravenous insulin

- Administration of intravenous insulin The Kussmaul's respirations pattern is the body's attempt to reduce the acids produced by utilization of fat for fuel. Administration of insulin will reduce this respiration pattern by assisting glucose transport back into cells to be used for fuel instead of fat. Nasal cannula oxygen is given at 1 to 6 L per minute; intravenous glucose administration will not have the desired effect of treatment; and although seizure precautions may be implemented, they will not have any effect on glucose transport into cells.

The nurse is caring for a patient with a diagnosis of immune thrombocytopenic purpura (ITP). What is a priority nursing action in the care of this patient? - Administration of packed red blood cells - Administration of oral or IV corticosteroids - Administration of clotting factors VIII and IX - Maintenance of reverse isolation and application of standard precautions

- Administration of oral or IV corticosteroids 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.

The nurse teaches which action to the diabetic client who self-injects insulin to prevent local irritation at the injection site? - Be sure to aspirate prior to injecting insulin. - Massage the site after injecting insulin. - Use a 1-inch needle for the injection. - Allow the insulin to warm to room temperature before injecting it.

- Allow the insulin to warm to room temperature before injecting it. Cold insulin from the refrigerator is the most common cause of irritation. Aspiration of insulin is not recommended; massaging the site can cause irritation; and a 1-inch needle is the improper size for insulin injections.

Which of the following is the best intervention to help a hospitalized patient maintain some autonomy? - Use therapeutic techniques when communicating with the patient. - Allow the patient to determine timing and scheduling of interventions. - Encourage family to only visit for short periods of time. - Provide the patient with a private room close to the nurse's station.

- Allow the patient to determine timing and scheduling of interventions. Providing the opportunity for patients to have control of decisions concerning care allows them to maintain autonomy and dignity.

The nurse is caring for a 36-yr-old male patient receiving phenytoin (Dilantin) to treat seizures resulting from his traumatic brain injury as a teenager. It is most important for the nurse to observe for which hematologic adverse effect of this medication? - Anemia - Leukemia - Polycythemia - Thrombocytosis

- Anemia Hematologic adverse effects of phenytoin include anemia, thrombocytopenia, leukopenia, granulocytopenia, agranulocytosis, and pancytopenia.

The nurse is caring for a patient who is to receive a transfusion of two units of packed red blood cells. After obtaining the first unit from the blood bank, the nurse would ask which health team member in the nurses' station to assist in checking the unit before administration? - Unit secretary - A physician's assistant - Another registered nurse - An unlicensed assistive personnel

- Another registered nurse Before hanging a transfusion, the registered nurse must check the unit with another RN or with a licensed practical (vocational) nurse, depending on agency policy. The unit secretary, physician's assistant, or unlicensed assistive personnel should not be asked.

A family member of a dying patient talks casually with the nurse and expresses relief that she will not have to visit at the hospital anymore. Which theoretical description of grief best applies to this family member? -Denial - Anticipatory grief - Yearning and searching - Dysfunctional grief

- Anticipatory grief Family members often grieve the impending loss of companionship, control, and sense of freedom and the mental and physical changes to be experienced by their loved one. Ultimately they grieve the impending death.

The thrombocytopenic patient has had a bone marrow biopsy taken from the posterior iliac crest. What nursing care is the priority for this patient after this procedure? - Position the patient prone. - Apply a pressure dressing. - Administer analgesic for pain. - Return metal objects to the patient.

- Apply a pressure dressing. The sterile pressure dressing is applied after a bone marrow biopsy to ensure hemostasis. If bleeding is present, the patient will lie on the site and may need a rolled towel for additional pressure, thus this patient will not be in the prone position. The analgesic should have been administered preprocedure. Metal objects would be removed for an MRI, not a bone marrow biopsy.

The nurse is assigned to the care of a patient diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in management of the diabetes, what should be the nurse's initial intervention? - Assess patient's perception of what it means to have diabetes. - Ask the patient to write down current knowledge about diabetes. - Set goals for the patient to actively participate in managing his diabetes. - Assume responsibility for all of the patient's care to decrease stress level.

- Assess patient's perception of what it means to have diabetes. For teaching to be effective, the first step is to assess the patient. Teaching can be individualized after the nurse is aware of what a diagnosis of diabetes means to the patient. After the initial assessment, current knowledge can be assessed, and goals should be set with the patient. Assuming responsibility for all of the patient's care will not facilitate the patient's health.

The nurse is caring for a patient with polycythemia vera. What is an important action for the nurse to initiate? - Encourage deep breathing and coughing. - Assist with or perform phlebotomy at the bedside. - Teach the patient how to maintain a low-activity lifestyle. - Perform thorough and regularly scheduled neurologic assessments.

- Assist with or perform phlebotomy at the bedside. Primary polycythemia vera often requires phlebotomy in order to reduce blood volume. The increased risk of thrombus formation that accompanies the disease requires regular exercises and ambulation. Deep breathing and coughing exercises do not directly address the etiology or common sequelae of polycythemia, and neurologic manifestations are not typical.

A patient has been diagnosed with acute myelogenous leukemia (AML). What should the nurse educate the patient that care will focus on? - Leukapheresis - Attaining remission - One chemotherapy agent - Waiting with active supportive care

- Attaining remission Attaining remission is the initial goal of care for leukemia. The methods to do this are decided based on age and cytogenetic analysis. The treatments include leukapheresis or hydroxyurea to reduce the white blood cell count and risk of leukemia-cell-induced thrombosis. A combination of chemotherapy agents will be used for aggressive treatment to destroy leukemic cells in tissues, peripheral blood, and bone marrow and minimize drug toxicity. In nonsymptomatic patients with chronic lymphocytic leukemia, waiting may be done to attain remission, but not with AML.

A patient with type 2 diabetes has a urinary tract infection (UTI), is difficult to arouse, and has a blood glucose of 642 mg/dL. When the nurse assesses the urine, there are no ketones present. What nursing action is appropriate at this time? - Routine insulin therapy and exercise - Administer a different antibiotic for the UTI. - Cardiac monitoring to detect potassium changes - Administer IV fluids rapidly to correct dehydration.

- Cardiac monitoring to detect potassium changes This patient has manifestations of hyperosmolar hyperglycemic syndrome (HHS). Cardiac monitoring will be needed because of the changes in the potassium level related to fluid and insulin therapy and the osmotic diuresis from the elevated serum glucose level. Routine insulin would not be enough, and exercise could be dangerous for this patient. Extra insulin will be needed. The type of antibiotic will not affect HHS. There will be a large amount of IV fluid administered, but it will be given slowly because this patient is older and may have cardiac or renal compromise, requiring hemodynamic monitoring to avoid fluid overload during fluid replacement.

A patient with leukemia is admitted for severe hypovolemia after prolonged diarrhea has a platelet count of 43,000/µL. It is most important for the nurse to take which action? - Insert two 18-gauge IV catheters. - Administer prescribed enoxaparin. - Monitor the patient's temperature every 2 hours. - Check stools for presence of frank or occult blood.

- Check stools for presence of frank or occult blood. A platelet count below 150,000/µL indicates thrombocytopenia. Prolonged bleeding from trauma or injury does not usually occur until the platelet counts are below 50,000/µL. Bleeding precautions (e.g., check all secretions for frank and occult blood) are indicated for patients with thrombocytopenia. Injections (including IVs) should be avoided; however, when needed for critical fluids and medications, IV access should be provided through the smallest bore devices that are feasible. Enoxaparin, an anticoagulant administered subcutaneously, is contraindicated in patients with thrombocytopenia. Monitoring temperature would be indicated in a patient with leukopenia.

Before beginning a transfusion of packed red blood cells (PRBCs), which action by the nurse would be of highest priority to avoid an error during this procedure? - Check the identifying information on the unit of blood against the patient's ID bracelet. - Select new primary IV tubing primed with lactated Ringer's solution to use for the transfusion. - Remain with the patient for 60 minutes after beginning the transfusion to watch for signs of a transfusion reaction. - Add the blood transfusion as a secondary line to the existing IV and use the IV controller to maintain correct flow.

- Check the identifying information on the unit of blood against the patient's ID bracelet. The patient's identifying information (name, date of birth, medical record number) on the ID bracelet should exactly match the information on the blood bank tag that has been placed on the unit of blood. If any information does not match, the transfusions should not be hung because of possible error and risk to the patient. The transfusion is hung on blood transfusion tubing, not a secondary line, and cannot be hung with lactated Ringer's solution because it will cause RBC hemolysis. Usually, the patient will need continuous monitoring for 15 minutes after the transfusion is started, as this is the time most transfusion reactions occur. Then the patient should be monitored every 30 to 60 minutes during the administration.

The nurse has been teaching a patient with diabetes mellitus how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does what? - Chooses a puncture site in the center of the finger pad - Washes hands with soap and water to cleanse the site to be used - Warms the finger before puncturing the finger to obtain a drop of blood - Tells the nurse that the result of 110 mg/dL indicates good control of diabetes

- Chooses a puncture site in the center of the finger pad The patient should select a site on the sides of the fingertips, not on the center of the finger pad because this area contains many nerve endings and would be unnecessarily painful. Washing hands, warming the finger, and knowing the results that indicate good control all show understanding of the teaching.

Which are consequences for a staff nurse related to the use of health informatics? - Clinical decision support tools - Confidentiality of health data - Decreased cost of health care - Personal health record

- Clinical decision support tools The availability of clinical decision support tools at the point of care would be a consequence for a staff nurse. Confidentiality of health data affects patients; a nurse might be involved in ensuring the security and privacy of health information and exchange. A decreased cost of health care would affect a patient; a nurse's ability to reduce duplication of services will influence costs. Adopting a personal health record would be a consequence for a patient.

Which of the following concepts would a nurse consider to have the strongest links to technology and informatics? Select all that apply. - Clinical judgment - Ethics - Leadership - Professionalism - Safety

- Clinical judgment - Ethics - Leadership - Safety Professionalism refers to the attributes and behaviors of a nurse as a representative of the nursing profession and as a health care professional. There are many interrelated concepts that bear some relationship to health information technology and health informatics, including data, information, knowledge, wisdom, trust, health, health care, meaningful use, bandwidth, and interoperability. Others found in this book include clinical judgment, leadership, communication, collaboration, safety, evidence, care coordination, health care quality, ethics, health policy, and health care law.

Which factors influence a person's approach to death? Select all that apply. - Culture - Age - Spirituality - Personal beliefs - Previous experiences with death - Gender - Level of education - Degree of social support

- Culture - Spirituality - Personal beliefs - Previous experiences with death - Degree of social support Culture, spirituality, personal beliefs and values, previous experiences with death, and degree of social support influence how a person approaches death.

When planning care for a diabetic patient with microalbuminuria, it is important to include which goal to reduce the progression to renal failure? - Decrease the total percentage of calories from carbohydrates - Decrease the total percentage of calories from fruits - Decrease the total percentage of calories from proteins - Decrease the total percentage of daily caloric intake

- Decrease the total percentage of calories from proteins Restriction of dietary protein to 0.8 g/kg body weight per day is recommended for clients with microalbuminuria to reduce the progression to renal failure. All other choices can increase blood glucose and total body weight but are not specific for progression to renal failure.

The nurse is providing care for older adults on a subacute, geriatric medical unit. What effect does aging have on hematologic function of older adults? - Thrombocytosis - Decreased hemoglobin - Decreased WBC count - Decreased blood volume

- Decreased hemoglobin Older adults frequently experience decreased hemoglobin levels as a result of changes in erythropoiesis. Decreased blood volume, decreased WBCs, and alterations in platelet number are not considered to be normal, age-related hematologic changes.

When discussing the purposes of nursing health care informatics with a nurse during orientation, a nurse educator would be concerned if the nurse orientee stated that which is a primary purpose of informatics? - Develop a data management system. - Improve disease tracking. - Improve a health provider's work flow. - Increase administrative efficiencies.

- Develop a data management system. Data management is an exemplar of health informatics, but it would not be a primary purpose for a bedside nurse. The nurse educator would use this incorrect response to plan additional teaching about the primary purposes of health care informatics for the staff nurse. Purposes of information health technology include improving health provider work flow, improving health care quality, preventing medical errors, reducing health care costs, increasing administrative efficiencies, decreasing paper work, and improving disease tracking.

A patient is newly diagnosed with type 1 diabetes and reports a headache, changes in vision, and being anxious but does not have a portable blood glucose monitor present. Which action should the nurse advise her to take? - Eat a piece of pizza. - Drink some diet pop. - Eat 15 g of simple carbohydrates. - Take an extra dose of rapid-acting insulin.

- Eat 15 g of simple carbohydrates. When the patient with type 1 diabetes is unsure about the meaning of the symptoms she is experiencing, she should treat herself for hypoglycemia to prevent seizures and coma from occurring. She should also be advised to check her blood glucose as soon as possible. The fat in the pizza and the diet pop would not allow the blood glucose to increase to eliminate the symptoms. The extra dose of rapid-acting insulin would further decrease her blood glucose.

The patient with leukemia has acute disseminated intravascular coagulation (DIC) and is bleeding. What diagnostic findings should the nurse expect to find? - Elevated D-dimers - Elevated fibrinogen - Reduced prothrombin time (PT) - Reduced fibrin degradation products (FDPs)

- Elevated D-dimers The D-dimer is a specific marker for the degree of fibrinolysis and is elevated with DIC. FDP is elevated as the breakdown products from fibrinogen and fibrin are formed. Fibrinogen and platelets are reduced. PT, PTT, aPTT, and thrombin time are all prolonged.

A patient has anemia related to inadequate intake of essential nutrients. Which intervention would be appropriate for the nurse to include in the plan of care for this patient? - Plan for 30 minutes of rest before and after every meal. - Encourage foods high in protein, iron, vitamin C, and folate. - Instruct the patient to select soft, bland, and nonacidic foods. - Give the patient a list of medications that inhibit iron absorption.

- Encourage foods high in protein, iron, vitamin C, and folate. Increased intake of protein, iron, folate, and vitamin C provides nutrients needed for maximum iron absorption and hemoglobin production. The other interventions do not address the patient's identified problem of inadequate intake of essential nutrients. Selection of foods that are soft, bland, and nonacidic is appropriate if the patient has oral mucosal irritation. Scheduled rest is an appropriate intervention if the patient has fatigue related to anemia. Providing information about medications that may inhibit iron absorption (e.g., antacids, tetracycline, soft drinks, tea, coffee, calcium, phosphorus, and magnesium salts) is important but does not address the patient's problem of inadequate intake of essential nutrients.

The nurse is reviewing the objective data from the table below of a patient with suspected allergies. Which assessment finding does the nurse know indicates allergies? Dry cough, Pale skin Neutrophils: 60% Eosinophils: 10% Basophils: 1% Lymphocytes: 20% Monocytes: 6% Acetaminophen 1000 mg every 12 hours, Levothyroxine (Synthroid) 125 mcg each day - Dry cough - Eosinophil result - Lymphocyte result - Acetaminophen use

- Eosinophil result Eosinophils are granulocytes that phagocytize antigen-antibody complexes formed during an allergic response. The normal eosinophil count is 2% to 4% of all white blood cells. The dry cough, lymphocyte result, and acetaminophen use do not indicate allergies.

The nurse is evaluating a patient diagnosed with type 2 diabetes mellitus. Which symptom reported by the patient correlates with the diagnosis? - Excessive thirst - Gradual weight gain - Overwhelming fatigue - Recurrent blurred vision

- Excessive thirst The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and polyphagia (increased hunger). Weight gain, fatigue, and blurred vision may all occur with type 2 diabetes, but are not classic manifestations.

When caring for a patient with metastatic cancer, the nurse notes a hemoglobin level of 8.7 g/dL and hematocrit of 26%. What associated clinical manifestations does the nurse anticipate observing? - Thirst - Fatigue - Headache - Abdominal pain

- Fatigue The patient with a low hemoglobin and hematocrit is anemic and would be most likely to experience fatigue. Fatigue develops because of the lowered oxygen-carrying capacity that leads to reduced tissue oxygenation to carry out cellular functions. Thirst, headache, and abdominal pain are not related to anemia.

The nurse caring for a patient hospitalized with diabetes mellitus would look for which laboratory test result to obtain information on the patient's past glucose control? - Prealbumin level - Urine ketone level - Fasting glucose level - Glycosylated hemoglobin level

- Glycosylated hemoglobin level A glycosylated hemoglobin level detects the amount of glucose that is bound to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the blood cell, which is approximately 120 days. Thus, the test can give an indication of glycemic control over approximately 2 to 3 months. The prealbumin level is used to establish nutritional status and is unrelated to past glucose control. The urine ketone level will only show that hyperglycemia or starvation is probably currently occurring. The fasting glucose level only indicates current glucose control.

It is most important for the nurse to include which risk factors in a teaching plan associated with the development of type 2 diabetes mellitus? Select all that apply. - Hypertension - History of pancreatic trauma - Weight gain of 30 pounds during pregnancy - Body mass index greater than 25 kg/m - Triglyceride levels between 150 and 200 mg/dL - Delivery of a 4.99-kg baby

- Hypertension - Body mass index greater than 25 kg/m - Delivery of a 4.99-kg baby Risk factors for type 2 diabetes include habitual inactivity, hypertension, delivery of a baby weighing over 9 pounds, a history of vascular disease, a body mass index greater than 25 kg/m, and triglyceride levels over 200 mg/dL.

When assessing laboratory values on a patient admitted with septicemia, what does the nurse expect to find? - Increased platelets - Decreased red blood cells - Decreased erythrocyte sedimentation rate (ESR) - Increased bands in the white blood cell (WBC) differential

- Increased bands in the white blood cell (WBC) differential When infections are severe, such as in septicemia, more granulocytes are released from the bone marrow as a compensatory mechanism. To meet the increased demand, many young, immature polymorphonuclear neutrophils (bands) are released into circulation. WBCs are usually reported in order of maturity (initially with the less mature forms on the left side of a written report). Hence, the term "shift to the left" is used to denote an increase in the number of bands. Thrombocytosis occurs with inflammation and some malignant disorders. Decreased red blood cells indicate anemia. Decreased ESR is not indicative of septicemia.

The patient has anemia and has had laboratory tests done to diagnose the cause. Which results does the nurse know indicates a lack of nutrients needed to produce new red blood cells (RBCs) (select all that apply.)? - Increased homocysteine - Decreased reticulocyte count - Decreased cobalamin (vitamin B12) - Increased methylmalonic acid (MMA) - Elevated erythrocyte sedimentation rate (ESR)

- Increased homocysteine - Decreased cobalamin (vitamin B12) - Increased methylmalonic acid (MMA) Increased homocysteine and MMA along with decreased cobalamin (vitamin B12) indicate cobalamin deficiency, which is a nutrient needed for RBC production. Decreased reticulocytes indicate low bone marrow activity in producing RBCs, not available nutrients. Elevated ESR is related to an increased inflammatory process, not anemia.

A 30-yr-old patient has undergone a splenectomy as a result of injuries sustained in a motor vehicle accident. Which phenomena are likely to result from the absence of the patient's spleen (select all that apply.)? - Impaired fibrinolysis - Increased platelet levels - Increased eosinophil levels - Fatigue and cold intolerance - Impaired immunologic function

- Increased platelet levels - Impaired immunologic function Splenectomy can result in increased platelet levels and impaired immunologic function as a consequence of the loss of storage and immunologic functions of the spleen. Fibrinolysis, fatigue, and cold intolerance are less likely to result from the loss of the spleen since coagulation and oxygenation are not primary responsibilities of the spleen.

The nurse is reviewing laboratory results for a patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? - Increased triglyceride levels - Increased high-density lipoproteins (HDL) - Decreased low-density lipoproteins (LDL) - Decreased very-low-density lipoproteins (VLDL)

- Increased triglyceride levels Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. Increased HDL, decreased LDL, and decreased VLDL are positive in relation to atherosclerosis development.

The blood bank notifies the nurse that the two units of blood ordered for a patient is ready for pick up. Which action should the nurse take to prevent an adverse effect during this procedure? - Immediately pick up both units of blood from the blood bank. - Infuse the blood slowly for the first 15 minutes of the transfusion. - Regulate the flow rate so that each unit takes at least 4 hours to transfuse. - Set up the Y-tubing of the blood set with dextrose in water as the flush solution.

- Infuse the blood slowly for the first 15 minutes of the transfusion. Because a transfusion reaction is more likely to occur at the beginning of a transfusion, the nurse should initially infuse the blood at a rate no faster than 2 mL/min and remain with the patient for the first 15 minutes after hanging 1 unit of blood. Only 1 unit of blood can be picked up at a time, it must be infused within 4 hours, and it cannot be hung with dextrose.

The nurse receives a physician's order to transfuse fresh frozen plasma to a patient with acute blood loss. Which procedure is most appropriate for infusing this blood product? - Infuse the fresh frozen plasma as rapidly as the patient will tolerate. - Hang the fresh frozen plasma as a piggyback to the primary IV solution. - Infuse the fresh frozen plasma as a piggyback to a primary solution of normal saline. - Hang the fresh frozen plasma as a piggyback to a new bag of primary IV solution without KCl.

- Infuse the fresh frozen plasma as rapidly as the patient will tolerate. The fresh frozen plasma should be administered as rapidly as possible and should be used within 24 hours of thawing to avoid a decrease in factors V and VIII. Fresh frozen plasma is infused using any straight-line infusion set. Any existing IV should be interrupted while the fresh frozen plasma is infused, unless a second IV line has been started for the transfusion.

When assessing a patient's nutritional-metabolic pattern related to hematologic health, what should the nurse do? - Inspect the skin for petechiae. - Ask the patient about joint pain. - Assess for vitamin C deficiency. - Determine if the patient can perform activities of daily living.

- Inspect the skin for petechiae. Any changes in the skin's texture or color should be explored when assessing the patient's nutritional-metabolic pattern related to hematologic health. The presence of petechiae or ecchymotic areas could be indicative of hematologic deficiencies related to poor nutritional intake or related causes. The other options are not specific to the nutritional-metabolic pattern related to hematologic health.

Based on the nurse's assessment of a diabetic patient, which finding indicates the need for avoidance of exercise at this time? - Ketone bodies in the urine - Blood glucose level of 155 mg/dL - Pulse rate of 66 beats per minute - Weight gain of 1 pound over the previous week's weight

- Ketone bodies in the urine Exercise would lead to further elevations in blood glucose levels due to inadequate insulin to promote intracellular glucose transport and uptake. Assessing for ketones in the urine may indicate insulin deficiency.

A patient, admitted with diabetes mellitus, has a glucose level of 380 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find? - Central apnea - Hypoventilation - Kussmaul respirations - Cheyne-Stokes respirations

- Kussmaul respirations In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored. Central apnea occurs because the brain temporarily stops sending signals to the muscles that control breathing, which is unrelated to ketoacidosis. Hypoventilation and Cheyne-Stokes respirations do not occur with ketoacidosis.

The nurse knows that hemolytic anemia can be caused by which extrinsic factors? - Trauma or splenic sequestration crisis - Abnormal hemoglobin or enzyme deficiency - Macroangiopathic or microangiopathic factors - Chronic diseases or medications and chemicals

- Macroangiopathic or microangiopathic factors Macroangiopathic or microangiopathic extrinsic factors lead to acquired hemolytic anemias. Trauma or splenic sequestration crisis can lead to anemia from acute blood loss. Abnormal hemoglobin or enzyme deficiency are intrinsic factors that lead to hereditary hemolytic anemias. Chronic diseases or medications and chemicals can decrease the number of red blood cell (RBC) precursors which reduce RBC production.

The nurse is teaching a patient who has diabetes about vascular complications of diabetes. What information is appropriate for the nurse to include? - Macroangiopathy does not occur in type 1 diabetes but rather in type 2 diabetics who have severe disease. - Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin. - Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control. - Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by a majority of patients with diabetes.

- Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin. Microangiopathy occurs in diabetes mellitus. When it affects the eyes, it is called diabetic retinopathy. When the kidneys are affected, the patient has nephropathy. When the skin is affected, it can lead to diabetic foot ulcers. Macroangiopathy can occur in either type 1 or type 2 diabetes and contributes to cerebrovascular, cardiovascular, and peripheral vascular disease. Sexual impotency and slowed gastric emptying result from microangiopathy and neuropathy.

A patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8:00 AM. The nurse instructs the patient to only drink water after what time? - 6:00 PM on the evening before the test - Midnight before the test - 4:00 AM on the day of the test - 7:00 AM on the day of the test

- Midnight before the test Typically, a patient is ordered to be NPO for 8 hours before a fasting blood glucose level. For this reason, the patient who has a lab draw at 8:00 AM should not have any food or beverages containing any calories after midnight.

The patient is admitted with hypercalcemia; polyuria; and pain in the pelvis, spine, and ribs with movement. Which hematologic problem is likely to display these manifestations in the patient? - Multiple myeloma - Thrombocytopenia - Megaloblastic anemia - Myelodysplastic syndrome

- Multiple myeloma Multiple myeloma typically manifests with skeletal pain and osteoporosis that may cause hypercalcemia, which can result in polyuria, confusion, or cardiac problems. Serum hyperviscosity syndrome can cause renal, cerebral, or pulmonary damage. Thrombocytopenia, megaloblastic anemia, and myelodysplastic syndrome are not characterized by these manifestations.

A year after her husband's death, a widow visits the unit on which he died. She talks about the anniversary and how much she misses him. Which type of grief is she experiencing? - Normal - Complicated - Chronic - Disenfranchised

- Normal It is normal for anniversaries to prompt feelings of sadness and grief.

The specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice is known as which specialty? - Computer science - Health informatics - Health information technology - Nursing informatics

- Nursing informatics The specialty is nursing informatics. Computer science is a branch of engineering that studies computation and computer technology, hardware, software, and the theoretical foundations of information and computation techniques. Health informatics is a discipline in which health data are stored, analyzed, and disseminated through the application of information and communication technology. Health information technology is an application of information processing that deals with the storage, retrieval sharing, and use of health care data, information, and knowledge for communication and decision making.

A patient with diabetes mellitus who has multiple infections every year needs a mitral valve replacement. What is the most important preoperative teaching the nurse should provide to prevent a cardiac infection postoperatively? - Avoid sick people and wash hands. - Obtain comprehensive dental care. - Maintain hemoglobin A1C below 7%. - Coughing and deep breathing with splinting

- Obtain comprehensive dental care. A person with diabetes is at high risk for postoperative infections. The most important preoperative teaching to prevent a postoperative infection in the heart is to have the patient obtain comprehensive dental care because the risk of septicemia and infective endocarditis increases with poor dental health. Avoiding sick people, hand washing, maintaining hemoglobin A1C below 7%, and coughing and deep breathing with splinting would be important for any type of surgery but are not the priority for this patient with mitral valve replacement.

A patient with an acute peptic ulcer and major blood loss requires an immediate transfusion with packed red blood cells. Which task is appropriate for the registered nurse (RN) to delegate to unlicensed assistive personnel (UAP)? - Confirm the IV solution is 0.9% saline. - Obtain the vital signs before the transfusion is initiated. - Monitor the patient for shortness of breath and back pain. - Double check the patient identity and verify the blood product.

- Obtain the vital signs before the transfusion is initiated. The RN may delegate tasks such as taking vital signs to UAP. Assessments (e.g., monitoring for signs of a blood transfusion reaction [shortness of breath and back pain]) are within the scope of practice of the RN and may not be delegated to UAP. The RN must also assume responsibility for ensuring the correct IV fluid is used with blood products. A licensed nurse must complete verification of the patient's identity and the blood product data.

A young mother is dying of breast cancer with bone metastasis and tells the nurse, "My body hurts so much. I can hardly move. Why is God making me suffer when I have done nothing bad in my life? I feel like giving up. How can I care for my children when I can't even care for myself?" What is the most appropriate nursing diagnosis for this patient? - Spiritual Distress related to questioning God - Hopelessness related to terminal diagnosis - Pain related to disease process - Anticipatory Grief related to impending death

- Pain related to disease process Pain control is always the priority.

A patient is receiving palliative care for symptom management related to anxiety and pain. A family member asks if the patient is dying and now in "hospice." What does the nurse tell the family member about palliative care? Select all that apply. - Palliative care and hospice are the same thing. - Palliative care is for any patient, any time, any disease, in any setting. - Palliative care strategies are primarily designed to treat the patient's illness. - Palliative care relieves the symptoms of illness and treatment. - Palliative care selects home health care services.

- Palliative care is for any patient, any time, any disease, in any setting. - Palliative care relieves the symptoms of illness and treatment. Palliative care focuses on the prevention, relief, reduction, or soothing of symptoms of disease or disorders throughout the entire course of an illness. It can also include, but is not solely, care of the dying. The primary goal of palliative care is to help patients and families achieve the best possible quality of life.

The nurse should institute which precaution for the hypoglycemic patient receiving intramuscular glucagon due to an inability to swallow the oral form? - Elevate the head of the bed. - Have a padded tongue blade at the bedside. - Position the client face down or in a side-lying position. - Apply pressure and massage the injection site for 5 minutes.

- Position the client face down or in a side-lying position. Intramuscular injection of glucagon often causes vomiting, increasing the patient's risk for aspiration. Elevating the head of the bed, instituting the use of a padded tongue blade, or applying pressure at or massaging injection site is not a safe nursing practice.

A patient will receive a hematopoietic stem cell transplant (HSCT). What is the nurse's priority after the patient receives combination chemotherapy before the transplant? - Prevent patient infection. - Avoid abnormal bleeding. - Give pneumococcal vaccine. - Provide companionship while isolated.

- Prevent patient infection. After combination chemotherapy for HSCT, the patient's bone marrow is destroyed in preparation to receive the bone marrow graft. Thus the patient is immunosuppressed and is at risk for a life-threatening infection. The priority is preventing infection. Bleeding is not usually a problem. Giving the pneumococcal vaccine at this time should not be done; it should have been done previously. Providing companionship is not the primary role of the nurse, although the patient will need support during the time of isolation.

To best assist a patient in the grieving process, which of the following is most helpful to determine? - Previous experiences with grief and loss - Religious affiliation and denomination - Ethnic background and cultural practices - Current financial status.

- Previous experiences with grief and loss Previous experiences with loss and grief help individuals develop coping skills and set a pattern of response to future episodes of loss and grief.

When providing postmortem care, which action is a priority for the nurse? - Locating the patient's clothing - Providing culturally and religiously sensitive care in body preparation - Transporting the body to the morgue as soon as possible - Providing postmortem care to protect the family of the deceased from having to view the body

- Providing culturally and religiously sensitive care in body preparation Various cultures and religions have specific postmortem care practices. Honoring these practices is important for the family as they prepare to mourn their loved one.

When planning care for the dying patient, which interventions promote the patient's dignity? Select all that apply. - Providing respect - Viewing patients as a whole - Providing symptom management - Showing interest - Being present - Using a preferred name

- Providing respect - Viewing patients as a whole - Showing interest - Being present - Using a preferred name A sense of dignity includes a person's positive self-regard, the ability to find meaning in life, feeling valued by others, and the way one is treated by caregivers.

To address a goal of improving the health of populations, a nurse is most likely to use informatics in which domain? - Certified clinical information systems - Clinical health care informatics - Public health/population informatics - Translocational bioinformatics

- Public health/population informatics Public health/population informatics is the domain that relates information, computer science, and technology to public health science to improve the health of populations; this domain would provide data for a nurse working with communities. Certified clinical information systems (CISs) refers to the tools used for achieving quality outcomes, including electronic health records, clinical data repositories, decision support programs, and handheld devices, not to the data. Clinical health care informatics and the subset nursing informatics provide for the development of direct approaches to patients and their families that can be used by a staff nurse to promote quality patient care. Translational bioinformatics refers to the research science domain where biomedical and genomic data are combined; it is a new term that describes the domain where bioinformatics meets clinical medicine and generally applies to health care research rather than direct patient care.

In assessing the patient, which abnormal finding should the nurse relate to hemostasis abnormalities? - Purpura - Pruritus - Weakness - Pale conjunctiva

- Purpura Purpura may occur when platelets or clotting factors are decreased and bleeding into the skin occurs. Pruritus is not related to hemostasis but to hematologic cancers (e.g., lymphomas, leukemias) or increased bilirubin. Weakness and pale conjunctiva are not related to hemostasis unless a lot of bleeding leads to anemia with low hemoglobin level.

A 62-yr-old male patient with disseminated intravascular coagulation (DIC) after urosepsis has a platelet count of 48,000/μL. The nurse should assess the patient for which abnormality? - Pallor - Purpura - Pruritus - Palpitation

- Purpura The normal range for a platelet count is 150,000 to 400,000/μL. Purpura is caused by decreased platelets or clotting factors, resulting in small hemorrhages into the skin or mucous membranes. Pallor is decreased or absent coloration in the conjunctiva or skin. Pruritus is an intense itching sensation. Palpitation is a sensation of feeling the heart beat, flutter, or pound in the chest.

The newly diagnosed patient with type 2 diabetes has been prescribed metformin. What should the nurse teach the patient to best explain how this medication works? - Increases insulin production from the pancreas - Slows the absorption of carbohydrate in the small intestine - Reduces glucose production by the liver and enhances insulin sensitivity - Increases insulin release from the pancreas, inhibits glucagon secretion, and decreases gastric emptying

- Reduces glucose production by the liver and enhances insulin sensitivity Metformin is a biguanide that reduces glucose production by the liver and enhances the tissue's insulin sensitivity. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-Glucosidase inhibitors slow the absorption of carbohydrate in the intestine. Glucagon-like peptide receptor agonists increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying.

The nurse recommends the pen-injector insulin delivery system for the client with which clinical presentation? - Confusion and reliance on another person for insulin injections - Requirements for intensive therapy with small, frequent insulin doses - Visual impairment affecting the ability to draw up insulin accurately - Frequent episodes of hypoglycemia

- Requirements for intensive therapy with small, frequent insulin doses The pen injector allows greater accuracy with small doses of less than 5 units. It is not recommended for those with cognitive or visual impairments or those who suffer frequent hypoglycemic episodes.

A patient with a diagnosis of hemophilia had a fall down an escalator earlier in the day and is now experiencing bleeding in the left knee joint. What should be the emergency nurse's immediate action? - Immediate transfusion of platelets - Resting the patient's knee to prevent hemarthroses - Assistance with intracapsular injection of corticosteroids - Range-of-motion exercises to prevent thrombus formation

- Resting the patient's knee to prevent hemarthroses In patients with hemophilia, joint bleeding requires resting of the joint to prevent deformities from hemarthrosis. Clotting factors, not platelets or corticosteroids, are administered. Thrombus formation is not a central concern in a patient with hemophilia.

A diabetic patient is receiving intravenous insulin. Which laboratory results should the nurse anticipate as a potential problem? -Serum chloride level of 90 mmol/L - Serum calcium level of 8 mg/dL - Serum sodium level of 132 mmol/L - Serum potassium level of 2.5 mmol/L

- Serum potassium level of 2.5 mmol/L Insulin activates the sodium-potassium adenosine triphosphatase (ATPase) pump, which increases the movement of potassium from the extracellular fluid into the intracellular fluid, resulting in hypokalemia. The chloride, calcium, and sodium levels are in normal parameters.

The nurse collects a nutritional history from a 22-yr-old woman who is planning to conceive a child in the next year. Which foods reported by the woman would indicate that her diet is high in folate and iron? - Crab, fish, and tuna - Milk, cheese, and yogurt - Spinach, beans, and liver - White rice, potatoes, and pasta

- Spinach, beans, and liver Normal intake of iron and folic acid is necessary for the development of red blood cells, and normal levels before conception and in early pregnancy are particularly important for normal fetal development. Foods high in both folic acid and iron include liver, red meat, egg yolks, turkey or chicken giblets, beans, lentils, chick peas, soybeans, spinach, and collard greens. In addition, enriched cereals, pasta, and breads are also high in both folic acid and iron (check the labels).

A patient with cancer is having chemotherapy treatments and has now developed neutropenia. What care should the nurse expect to provide and teach the patient about (select all that apply.)? - Strict hand washing - Daily nasal swabs for culture - Monitor temperature every hour. - Daily skin care and oral hygiene - Encourage eating all foods to increase nutrients. - Private room with a high-efficiency particulate air (HEPA) filter

- Strict hand washing - Daily skin care and oral hygiene - Private room with a high-efficiency particulate air (HEPA) filter Strict hand washing and daily skin and oral hygiene must be done with neutropenia, because the patient is predisposed to infection from the normal body flora; other people; and uncooked meats, seafood, and eggs; unwashed fruits and vegetables; and fresh flowers or plants. The private room with HEPA filtration reduces the aerosolized pathogens in the patient's room. Blood cultures and antibiotic treatment are used when the patient has a temperature of 100.4°F or more, but temperature is not monitored every hour.

The nurse is caring for a patient with microcytic, hypochromic anemia. What teaching should the nurse provide that would be beneficial to the patient? - Take enteric-coated iron with each meal. - Take cobalamin with green leafy vegetables. - Take the iron with orange juice one hour before meals. - Decrease the intake of the antiseizure medications to improve.

- Take the iron with orange juice one hour before meals. With microcytic, hypochromic anemia may be caused by iron, vitamin B6, or copper deficiency; thalassemia; or lead poisoning. The iron prescribed should be taken with orange juice one hour before meals as it is best absorbed in an acid environment. Megaloblastic anemias occur with cobalamin (vitamin B12) and folic acid deficiencies. Vitamin B12 may help red blood cell (RBC) maturation if the patient has the intrinsic factor in the stomach. Green leafy vegetables provide folic acid for RBC maturation. Antiseizure drugs may contribute to aplastic anemia or folic acid deficiency, but the patient should not stop taking the medications. The health care provider will prescribe changes in medications.

Which clinical manifestation indicates to the nurse a patient's hyperosmolar nonketotic syndrome (HNKS) therapy needs to be adjusted? -Ketone bodies in the urine have been absent for 3 hours. - Blood osmolarity has decreased from 350 to 330 mOsm. - Serum potassium level has increased from 2.8 to 3.2 mEq/L. - The Glasgow Coma Scale is unchanged from 3 hours ago.

- The Glasgow Coma Scale is unchanged from 3 hours ago. Slow but steady improvement in central nervous system functioning should be seen with effective therapy for HNKS. An unchanged level of consciousness may indicate inadequate rates of fluid replacement. Ketone bodies, blood osmolarity, and serum potassium levels are consistent with improvement.

A patient is admitted with diabetes mellitus, malnutrition cellulitis, and a potassium level of 5.6 mEq/L. The nurse understands that what could be contributing factors for this laboratory result (select all that apply.)? - The level may be increased as a result of dehydration that accompanies hyperglycemia. - The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia. - The level is consistent with renal insufficiency that can develop with renal nephropathy. - The patient may be excreting extra sodium and retaining potassium because of malnutrition. - This level demonstrates adequate treatment of the cellulitis and effective serum glucose control.

- The level may be increased as a result of dehydration that accompanies hyperglycemia. - The level may be raised as a result of metabolic ketoacidosis caused by hyperglycemia. - The level is consistent with renal insufficiency that can develop with renal nephropathy. The additional stress of cellulitis may lead to an increase in the patient's serum glucose levels. Dehydration may cause hemoconcentration, resulting in elevated serum readings. The kidneys may have difficulty excreting potassium if renal insufficiency exists. Finally, the nurse must consider the potential for metabolic ketoacidosis because potassium will leave the cell when hydrogen enters in an attempt to compensate for a low pH. Malnutrition does not cause sodium excretion accompanied by potassium retention. Thus, it is not a contributing factor to this patient's potassium level. The elevated potassium level does not demonstrate adequate treatment of cellulitis or effective serum glucose control.

A blood type and cross-match has been ordered for a male patient who is experiencing an upper gastrointestinal bleed. The results of the blood work indicate that the patient has type A blood. Which description explains what this means? - The patient can be transfused with type AB blood. - The patient may only receive a type A transfusion. - The patient has A antigens on his red blood cells (RBCs). - Antibodies are present on the surface of the patient's RBCs.

- The patient has A antigens on his red blood cells (RBCs). An individual with type A blood has A antigens, not A antibodies, on his RBCs. An AB transfusion would result in agglutination, but he may be transfused with either type A or type O blood.

The nurse is caring for a patient with a diagnosis of disseminated intravascular coagulation (DIC). What is the first priority of care? - Administer heparin. - Administer whole blood. - Treat the causative problem. - Administer fresh frozen plasma.

- Treat the causative problem. Treating the underlying cause of DIC will interrupt the abnormal response of the clotting cascade and reverse the DIC. Blood product administration occurs based on the specific component deficiencies and is reserved for patients with life-threatening hemorrhage. Heparin will be administered if the manifestations of thrombosis are present and the benefit of reducing clotting outweighs the risk of further bleeding.

A patient is being treated for non-Hodgkin's lymphoma (NHL). What should the nurse first teach the patient about the treatment? - Skin care that will be needed - Method of obtaining the treatment - Gastrointestinal tract effects of treatment - Treatment type and expected side effects

- Treatment type and expected side effects The patient should first be taught about the type of treatment and the expected and potential side effects. Nursing care is related to the area affected by the disease and treatment. Skin care will be affected if radiation is used. Not all patients will have gastrointestinal tract effects of NHL or treatment. The method of obtaining treatment will be included in the teaching about the type of treatment.

A patient has been diagnosed with stage 1A Hodgkin's lymphoma. The nurse knows that which chemotherapy regimen is most likely to be prescribed for this patient? - Brentuximab vedotin (Adcetris) - Two to four cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine - Four to six cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine - BEACOPP: bleomycin, etoposide, doxorubicin (Adriamycin), cyclophosphamide, vincristine (Oncovin), procarbazine, and prednisone

- Two to four cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine The patient with a favorable prognosis early-stage Hodgkin's lymphoma (stage 1A) will receive two to four cycles of ABVD. The unfavorable prognostic featured (stage 1B) Hodgkin's lymphoma would be treated with four to six cycles of chemotherapy. Advanced-stage Hodgkin's lymphoma is treated more aggressively with more cycles or with BEACOPP. Brentuximab vedotin (Adcetris) is a newer agent that will be used to treat patients who have relapsed or refractory disease.Note: Some of acronyms for drug protocols use the brand/trade name of drugs (Adriamycin, Oncovin). These brand/trade names have been discontinued but the drugs are still available as generic drugs.

What are the physical changes that occur as death approaches? Select all that apply. - Unresponsiveness - Erythema - Mottling - Restlessness - Increased urine output - Weakness - Incontinence

- Unresponsiveness - Mottling - Restlessness - Weakness - Incontinence Patients experience physical changes that accompany the body shutting down.