Anemia NCLEX Practice

At what point after a burn injury should the nurse be most alert for the complication of hypokalemia? A. Immediately following the injury B. During the fluid shift C. During fluid remobilization D. During the late acute phase

C Hypokalemia is most likely to occur during the fluid remobilization period as a result of dilution, potassium movement back into the cells, and increased potassium excreted into the urine with the greatly increased urine output.

The burned client newly arrived from an accident scene is prescribed to receive 4 mg of morphine sulfate by IV push. What is the most important reason to administer the opioid analgesic to this client by the intravenous route? A. The medication will be effective more quickly than if given intramuscularly. B. It is less likely to interfere with the client's breathing and oxygenation. C. The danger of an overdose during fluid remobilization is reduced. D. The client delayed gastric emptying.

C The most important reason is to prevent an overdose from accumulation of drug in the interstitial space during the fluid shift of the emergent phase. When edema is present, cumulative doses are rapidly absorbed when the fluid shift is resolving.

The newly admitted client has burns on both legs. The burned areas appear white and leather-like. No blisters or bleeding are present, and the client states that he or she has little pain. How should this injury be categorized? A. Superficial B. Partial-thickness superficial C. Partial-thickness deep D. Full thickness

D

Which statement made by the client with facial burns who has been prescribed to wear a facial mask pressure garment indicates correct understanding of the purpose of this treatment? A. "After this treatment, my ears will not stick out." B. "The mask will help protect my skin from sun damage." C. "Using this mask will prevent scars from being permanent." D. "My facial scars should be less severe with the use of this mask."

D

A patient receiving a transfusion of packed red blood cells develops chills, fever, headache, and anxiety 30 minutes after the transfusion is started. After stopping the transfusion, what is the first action that the nurse should take? a. Draw blood for a new crossmatch. b. Send a urine specimen to the laboratory. c. Give the PRN diphenhydramine (Benadryl). d. Administer the PRN acetaminophen (Tylenol

D these are clinical manifestations of a febrile nonhemolytic reaction stop infusion and give antipyretics for fever

The paraplegic client is being admitted to a medical unit from home with a stage IV pressure ulcer over the right ischium. which assessment tool should be completed on admission to the hospital. 1. Complete the Braden scale. 2. Monitor the client on a Glasgow Coma Scale. 3. Assess for babinski sign. 4. Initiate a Brudzinski flow sheet.

1. Complete the Braden scale.

The client who is debilitated and has developed multiple pressure ulcers complains to the nurse during a dressing change that he is "tired of it all". Which is the nurses best therapeutic response? 1. These wounds can heal if we get enough protein in you. 2. Are you tired of the treatments and needing to be cared for? 3. why would you say that? we are doing our best. 4. Have you made out an advance directive to let the HCP know your wishes?

2. Are you tired of the treatments and needing to be cared for?

The client has some equipment that is noisy, and the roommate also has equipment that makes noise, and the room is close to a noisy nursing station, where they can be watched a little closer. Which of the following interventions by the nurse would be best for the client as well as reduce the risk of sensory overload? 1. Move the client away from the nurses' station area. 2. Explain the sounds in the environment. 3. Tell the client to ignore the sounds. 4. Play the client's favorite music louder than the sounds.

2. Explain the sounds in the environment.

The charge nurse is making assignments on a medical floor. Which client should be assigned to the most experienced nurse? 1. Client diagnosed with iron-deficiency anemia who is prescribed iron supplements. 2. Client diagnosed with pernicious anemia who is receiving vitamin B12 intramuscularly. 3. Client diagnosed with aplastic anemia who has developed pancytopenia. 4. The client diagnosed with renal disease wo has a deficiency of erythropoietin.

3. Client diagnosed with aplastic anemia who has developed pancytopenia.

A client was admitted with iron deficiency anemia and blood-streaked emesis. Which question is most appropriate for the nurse to ask in determining the extent of the client's activity intolerance? A. "What activities were you able to do 6 months ago compared with the present?" B. "How long have you had this problem?" C. "Have you been able to keep up with all your usual activities?" D. "Are you more tired now than you used to be?"

A. It is difficult to determine activity intolerance without objectively comparing activities from one time frame to another. Because iron deficiency anemia can occur gradually and individual endurance varies, the nurse can best assess the client's activity tolerance by asking the client to compare activities 6 months ago and at the present.

Which type of fluid should the nurse expect to prepare and administer as fluid resuscitation during the emergent phase of burn recovery? A. Colloids B. Crystalloids C. Fresh-frozen plasma D. Packed red blood cells

B. Crystalloids examples are NS and LR

Common signs and symptoms of vitamin B12 deficiency, seen in pernicious anemia are:

Feeling tired and weak, tingling and numbness in hands and feet & a bright red, smooth tongue

What causes hemolytic anemia?

Hemolytic anemia is a disorder in which red blood cells are destroyed faster than they can be made. The destruction of red blood cells is called hemolysis.

Anemia or insufficient hemoglobin content is common in older persons. The client's body compensates for the deficiency by: Decreasing the respiratory and heart rates. Increasing the heart and respiratory rates. Shunting blood away from vital organs and skin. Decreasing blood viscosity in order to supply oxygen to hypoxic tissues.

Increase the Heart & RR all anemias result in loss of Oxygen carrying capacity of the blood and generalized hypoxia. The body compensates for this by raising HR and RR

The nurse would instruct the client to eat which of the following foods to obtain the best supply of vitamin B12? Whole grains Green leafy vegetables Meats and dairy products Broccoli and Brussels sprouts

Meats and dairy products whole grains=thiamine

Polycythemia Vera

Polycythemia vera is a slow-growing blood cancer in which the bone marrow makes too many red blood cells. These excess cells thicken the blood, slowing its flow. This causes complications, such as blood clots which can cause a stroke. Hydrating the client with 3 L of fluid prevents clot formation. Aspirin helps prevent thrombosis. Ambulation is also important to prevent DVT.

What are the symptoms of hemolytic anemia?

Yellowish skin, eyes, and mouth (jaundice). Dark-colored urine, fever, enlarged spleen and liver.

An African American female comes to the outpatient clinic. The physician suspects vitamin B12 deficiency anemia. Because jaundice is often a clinical manifestation of this type of anemia, what body part would be the best indicator? a. Conjunctiva of the eye b. Soles of the feet c. Roof of the mouth d. Shins

c The oral mucosa and hard palate (roof of the mouth) are the best indicators of jaundice in dark-skinned persons. Skin assessment of patients with dark skin should be done in natural light when possible in order to ascertain the condition; it may be necessary to check mucous membranes, sclera, lips, nail beds, palms, and soles of feet for accurate assessment.

Erythropoietin sometimes is administered subcutaneously to treat which of the following? (Select all that apply.) Clients with marrow suppression Clients with chronic liver disease Clients with Hodgkin's disease and non-Hodgkin's lymphoma Clients with anemia and fatigue related to non-myeloid cancers

clients w/ anemia & fatigue r/t non-myeloid cancer

2.) Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia. The nurse instructs the mother to administer the iron with which best food item? 1. Milk 2. Water 3. Apple juice 4. Orange juice

orange juice it has vitamin C to help increase absorption of iron in the body

The most common cause of macrocytic anemia in the older person is B12 or folate deficiency. Failure to absorb vitamin B12 from the G.I. tract is called: Macrocytic anemia. Aplastic anemia. Pernicious anemia. Thalassemia anemia

thalassemia anemia

The nurse is teaching the client with polycythemia vera about prevention of complications of the disease. Which of the following statements by the client indicates a need for further teaching? a. "I will drink 500mL of fluid or less each day." b. "I will wear support hose when I am up." c. "I will use an electric razor for shaving." d. "I will eat foods low in iron.

A The client with polycythemia vera is at risk for thrombus formation. Hydrating the client with at least 3L of fluid per day is important in preventing clot formation. Polycythemia vera is a slow-growing blood cancer in which the bone marrow makes too many red blood cells. These excess cells thicken blood, slowing its flow and causes complications, such as blood clots.

1. The nurse is caring for a client with an electrical burn. Which structures have the greatest risk for soft tissue injury? A. Fat, tendons, and bones B. Skin and hair C. Nerves, muscle, and blood vessels D. Skin, fat, and muscle

A Fat, tendon, and bone have the most resistance. The higher the resistance, the greater the heat generated by the current, thereby increasing the risk for soft tissue injury.

32. Which statements by the mother of a toddler would lead the nurse to suspect that the child has iron-deficiency anemia? Select all that apply. "He drinks over 3 cups of milk per day." "I can't keep enough apple juice in the house; he must drink over 10 ounces per day." "He refuses to eat more than 2 different kinds of vegetables." "He doesn't like meat, but he will eat small amounts of it." "He sleeps 12 hours every night and take a 2-hour nap."

A and B Toddlers should have between 2 and 3 cups of milk per day and 8 ounces of juice per day. If they have more than that, then they are probably not eating enough other foods, including iron-rich foods that have the needed nutrients.

2. The newly admitted client has a large burned area on the right arm. The burned area appears red, has blisters, and is very painful. How should this injury be categorized? A. Superficial B. Partial-thickness superficial C. Partial-thickness deep D. Full thickness

B

The client who experienced an inhalation injury 6 hours ago has been wheezing. When the client is assessed, wheezes are no longer heard. What is the nurse's best action? A. Raise the head of the bed. B. Notify the emergency team. C. Loosen the dressings on the chest. D. Document the findings as the only action.

B

The burned client relates the following history of previous health problems. Which one should alert the nurse to the need for alteration of the fluid resuscitation plan? A. Seasonal asthma B. Hepatitis B 10 years ago C. Myocardial infarction 1 year ago D. Kidney stones within the last 6 month

C

When planning discharge teaching for the patient who was admitted with a sickle cell crisis, which instruction will the nurse include? a. Limit fluids to 2 to 3 quarts a day. b. Take a daily multivitamin with iron. c. Avoid exposure to crowds as much as possible. d. Drink only one or two caffeinated beverages daily

C exposure to crowds increases pts risk of infection

A patient with anemia is experiencing increased fatigue and occasional palpitations at rest. The nurse would expect the patient's laboratory findings to include a. normal red blood cell (RBC) indices. b. a hematocrit (Hct) of 38%. c. a hemoglobin (Hb) of 8.6 g/dL (86 g/L). d. an RBC count of 4,500,000/L.

C. The patient's clinical manifestations indicate moderate anemia, which is consistent with an Hb of 6 to 10 g/dL. The other values are all within the range of normal.

A vegetarian client was referred to a dietician for nutritional counseling for anemia. Which client outcome indicates that the client does not understand nutritional counseling? The client: A. Adds dried fruit to cereal and baked goods B. Cooks tomato-based foods in iron pots C. Drinks coffee or tea with meals D. Adds vitamin C to all meal

C. coffe and tea increase GI mobility and inhibit the absorption of iron

4. Which vitamin deficiency is most likely to be a long-term consequence of a full-thickness burn injury? A. Vitamin A B. Vitamin B C. Vitamin C D. Vitamin D

D

Fifteen minutes after a transfusion of packed red blood cells is started, a patient complains of back pain and dyspnea. The pulse rate is 124. The nurse's first action should be to a. administer oxygen therapy at a high flow rate. b. obtain a urine specimen to send to the laboratory. c. notify the health care provider about the symptoms. d. disconnect the transfusion and infuse normal saline.

D

A 43-year-old African American male is admitted with sickle cell anemia. The nurse plans to assess circulation in the lower extremities every 2 hours. Which of the following outcome criteria would the nurse use? a. Body temperature of 99°F or less b. Toes moved in active range of motion c. Sensation reported when soles of feet are touched d. Capillary refill of < 3 seconds

D It is important to assess the extremities for blood vessel occlusion in the client with sickle cell anemia because a change in capillary refill would indicate a change in circulation.

During treatment of the patient with an acute exacerbation of polycythemia vera, a critical action by the nurse is to a. place the patient on bed rest. b. administer iron supplements. c. avoid use of aspirin products. d. monitor fluid intake and output

D Monitoring hydration status is important during an acute exacerbation because the patient is at risk for fluid overload or underhydration. Aspirin therapy is used to decrease risk for thrombosis. The patient should be encouraged to ambulate to prevent deep vein thrombosis (DVT). Iron is contraindicated in patients with polycythemia vera.

What additional laboratory test should be performed on any African American client who sustains a serious burn injury? A. Total protein B. Tissue type antigens C. Prostate specific antigen D. Hemoglobin S electrophoresi

D sickle cell disease are common among african americans

The newly admitted client has deep partial-thickness burns. The nurse expects to see which clinical manifestations? A) Painful red and white blisters B) Painless, brownish-yellow eschar C) Painful reddened blisters D) Painless black skin with eschar

A: there wouldn't be any eschar becuae he is newly admitted. Eschar forms after a few days

The primary purpose of the Schilling test is to measure the client's ability to: Store vitamin B12 Digest vitamin B12 Absorb vitamin B12 Produce vitamin B12

Absorb vitamin B12 Pernicious anemia is caused by the body's inability to absorb vitamin B12. This results in a lack of intrinsic factor in the gastric juices. Schilling's test helps diagnose pernicious anemia by determining the ability to absorb vitamin B12.

Aplastic Anemia/Bone Marrow Aplasia

Aplastic anemia is a condition that occurs when the body stops producing enough new blood cells. Aplastic anemia causes fatigued and risk of infections and uncontrolled bleeding. Aplastic anemia develops when damage occurs to the bone marrow, slowing or shutting down the production of new blood cells. Treatment include medications, blood transfusions or a stem cell transplant, also called a bone marrow transplant.

The nurse on a burn unit has just received change-of-shift report about these patients. Which patient should be assessed first? A) A 20-year-old patient admitted a week ago with deep partial-thickness burns over 35% of the body who is complaining of pain at a level 7 (0-to-10 scale) B) A 26-year-old firefighter with smoke inhalation and facial burns who has just arrived on the unit and whispers "I can't catch my breath!" C) A 50-year-old electrician who suffered external burn injuries a month ago and is requesting that you call the doctor immediately about discharge plans D) A 60-year-old patient admitted yesterday with partial- and full-thickness burns over 40% of the body who is receiving IV fluids at 250 mL/hr

B Smoke inhalation and facial burns are associated with airway inflamation and obstruction.

31. A mother asks the nurse if her child's iron deficiency anemia is related to the child's frequent infections. The nurse responds based on the understanding of which of the following? A. Little is known about iron-deficiency anemia and its relationship to infection in children. B. Children with iron deficiency anemia are more susceptible to infection than are other children. C. Children with iron-deficiency anemia are less susceptible to infection than are other children. D. Children with iron-deficient anemia are equally as susceptible to infection as are other children.

B. Children with iron-deficiency anemia are more susceptible to infection because of marked decreases in bone marrow functioning with microcytosis.

The nurse devises a teaching plan for the patient with aplastic anemia. Which of the following is the most important concept to teach for health maintenance? A. Eat animal protein and dark leafy vegetables each day B. Avoid exposure to others with acute infection C. Practice yoga and meditation to decrease stress and anxiety D. Get 8 hours of sleep at night and take naps during the day

B. avoid exposure to infection Clients with aplastic anemia are severely immunocompromised and at risk for infection and possible death related to bone marrow suppression and pancytopenia. Strict aseptic technique and reverse isolation are important measures to prevent infection

A 52-year-old patient has a new diagnosis of pernicious anemia. After teaching the patient about pernicious anemia, the nurse determines that the patient understands the disorder when the patient states, a. "I need to start eating more red meat or liver." b. "I will stop having a glass of wine with dinner." c. "I will need to take a proton pump inhibitor like omeprazole (Prilosec)." d. "I would rather use the nasal spray than have to get injections of vitamin B12

D Since pernicious anemia prevents the absorption of vitamin B12, this patient requires injections or intranasal administration of cobalamin. Alcohol use does not cause cobalamin deficiency. Proton pump inhibitors decrease the absorption of vitamin B12. Eating more foods rich in vitamin B12 is not helpful because the lack of intrinsic factor prevents absorption of the vitami

A client is to receive epoetin (Epogen) injections. What laboratory value should the nurse assess before giving the injection? Hematocrit Partial thromboplastin time Hemoglobin concentration Prothrombin time

Hematocrit Epogen is a recombinant DNA form of erythropoietin, which stimulates the production of RBCs and therefore causes the hematocrit to rise. The elevation in hematocrit causes an elevation in blood pressure; therefore, the blood pressure is a vital sign that should be checked. Erythropoietin can be used to correct anemia by stimulating red blood cell production in the bone marrow in these conditions. The medication is known as epoetin alfa (Epogen, Procrit) or as darbepoietin alfa (Arnesp). It can be given as an injection intravenously or subQ.

The nurse has provided nutritional teaching on foods high in folate to a client with folate deficiency related to malabsorption syndromes and poor nutrition. Which of the following foods, if chosen by the client, indicates that the client understands the teaching? Liver and dark green leafy vegetables Whole milk and eggs Potatoes and carrots Bread and fish

Liver & dark green leafy veggies

Pernicious/Megaloblastic Anemia

Pernicious anemia is a type of macrocytic anemia. It's sometimes called megaloblastic anemia because of the abnormally large size of the red blood cells produced. It's caused by an inability to absorb the vitamin B-12 needed for RBC's. Without enough vitamin B-12, the body will produce abnormally large RBC's which is unable to leave the bone marrow and enter the bloodstream. This decreases the amount of oxygen-carrying RBC in the bloodstream and causes fatigue and weakness. The reason this happens is often due to the lack of a stomach protein called "intrinsic factor". The body can't absorb vitamin B-12 without it.

Vitamin B12

Vitamin B12 is mainly found in animal products, especially meat and dairy products. Those on vegans diets, fortified foods can be good sources of this vitamin. You may develop a vitamin B12 deficiency if your body does not produce enough intrinsic factor, or if you don't eat enough vitamin-B12-rich foods. Animal Liver, Kidneys, Organ meats. Fortified cereal, Clams. Diary.

The nurse understands that the client with pernicious anemia will have which distinguishing laboratory findings? Schilling's test, elevated Intrinsic factor, absent. Sedimentation rate, 16 mm/hour RBCs 5.0 million

intrinsic factor absent The defining characteristic of pernicious anemia, a megaloblastic anemia, is lack of the intrinsic factor, which results from atrophy of the stomach wall. Without the intrinsic factor, vitamin B12 cannot be absorbed in the small intestines, and folic acid needs vitamin B12 for DNA synthesis of RBCs.

The nurse is developing a plan of care for a client diagnosed with left-sided paralysis secondary to a right-sided cerebrovascular accident (stroke). Which should be included in the interventions? 1. Use a pillow to keep the heels off the bed when supine. 2. Order a low air-loss therapy bed immediately. 3. Prepare to insert nasogastric feeding tube. 4. Order an occupational therapy consult for strength training.

1. Use a pillow to keep the heels off the bed when supine.

11. Which type of fluid should the nurse expect to prepare and administer as fluid resuscitation during the emergent phase of burn recovery? A. Colloids B. Crystalloids C. Fresh-frozen plasma D. Packed red blood cells

B

13. The client who experienced an inhalation injury 6 hours ago has been wheezing. When the client is assessed, wheezes are no longer heard. What is the nurse's best action? A. Raise the head of the bed. B. Notify the emergency team. C. Loosen the dressings on the chest. D. Document the findings as the only action

B

The nurse prioritizes which in emergent phase? A.Assessing body temp B.Monitoring urine output C.Emotional support D.Fluid resuscitation

fluid resuscitation

Because older persons can have severe anemia for a long period of time without detection, when diagnosed, quick reversal is warranted. Which of the following orders most likely would be prescribed at this time? Platelet transfusion and osmotic diuretic Ferrous sulfate 325 mg orally three times a day Packed red blood cells followed by oral furosemide (Lasix) Erythropoietin (Procrit) injection twice per week

packed RBCs follow by oral furosemide (Lasix)

The nurse is caring for clients on a medical unit. After the shift report, which client should be assessed first? 1. the 34-year old client who is quadriplegic and cannot move his arms. 2. the elderly client diagnosed with a CVA who is weak on the right side. 3. The 78 year old client with pressure ulcers who has a temperature of 102.3 4. The young adult who is unhappy with the care that was provided last shift.

3. The 78 year old client with pressure ulcers who has a temperature of 102.3

The client diagnosed with a iron-deficiency anemia is prescribed ferrous gluconate orally. Which should the nurse teach the client? 1. Take Imodium, an antidiarrheal, OTC for diarrhea. 2. Limit exercise for several weeks until a tolerance is achieved 3. The stools may be very dark, and this can mask blood. 4. Eat only red meats and organ meats for protein.

3. The stools may be very dark, and this can mask blood.

The nurse in a long term care facility is teaching a group of new unlicensed assistive personnel. Which information regarding skin care should the nurse emphasize? 1. Keep the skin moist by leaving the skin damp after the bath. 2. Do not rub any lotion into the skin. 3. Turn the clients who are immobile at least every two hours. 4. Only the licensed nursing staff may care for the clients skin.

3. Turn the clients who are immobile at least every two hours.

16. Twelve hours after the client was initially burned, bowel sounds are absent in all four abdominal quadrants. What is the nurse's best action? A. Reposition the client onto the right side. B. Document the finding as the only action. C. Notify the emergency team. D. Increase the IV flow rate.

B

33. Which of the following foods would the nurse encourage the mother to offer to her child with iron deficiency anemia? A. Rice cereal, whole milk, and yellow vegetables B. Potato, peas, and chicken C. Macaroni, cheese, and ham D. Pudding, green vegetables, and rice

B Potato, peas, chicken, green vegetables, and rice cereal contain significant amounts of iron and therefore would be recommended.

The nurse is conducting a physical assessment on a client with anemia. Which of the following clinical manifestations would be most indicative of the anemia? a. BP 146/88 b. Respirations 28 shallow c. Weight gain of 10 pounds in 6 months d. Pink complexion

B When there are fewer red blood cells, there is less hemoglobin and less oxygen. Therefore, the client is often short of breath. The client with anemia is often pale in color, has weight loss, and may be hypotensive.

During the admission assessment of a patient with hemolytic anemia, the nurse notes jaundice of the sclerae. The nurse will plan to check the laboratory results for a. the Schilling test. b. the bilirubin level. c. the stool occult blood test. d. the gastric analysis testing

B jaundice is caused by the elevation of bilirubin level associated with RBC hemolysis

26. A client with iron deficiency anemia is scheduled for discharge. Which instruction about prescribed ferrous gluconate therapy should the nurse include in the teaching plan? "Take the medication with an antacid." "Take the medication with a glass of milk." "Take the medication with cereal." "Take the medication on an empty stomach."

take on an empty stomach In aplastic anemia, the most likely diagnostic findings are decreased levels of all the cellular elements of the blood (pancytopenia). T-helper cell production doesn't decrease in aplastic anemia. Reed-Sternberg cells and lymph node enlargement occur with Hodgkin's disease.

The burned client on admission is drooling and having difficulty swallowing. What is the nurse's best first action? A. Assess level of consciousness and pupillary reactions. B. Ask the client at what time food or liquid was last consumed. C. Auscultate breath sounds over the trachea and mainstem bronchi. D. Measure abdominal girth and auscultate bowel sounds in all four quadrants.

C

A patient is admitted to the hospital with idiopathic aplastic anemia. Which of these collaborative problems will the nurse include when developing the care plan? a. Potential complication: seizures b. Potential complication: infection c. Potential complication: neurogenic shock d. Potential complication: pulmonary edema

B the pt is at risk for infection and bleeding from aplastic anemia

Aplastic Anemia

Aplastic anemia is a condition that occurs when your body stops producing enough new blood cells. It leaves you feeling fatigued and with a higher risk of infections and uncontrolled bleeding. Treatment for aplastic anemia may include medications, blood transfusions or a stem cell transplant, also known as a bone marrow transplant.

The nurse is instructing a client with iron-deficiency anemia. Which of the following meal plans would the nurse expect the client to select? a. Roast beef, gelatin salad, green beans, and peach pie b. Chicken salad sandwich, coleslaw, French fries, ice cream c. Egg salad on wheat bread, carrot sticks, lettuce salad, raisin pie d. Pork chop, creamed potatoes, corn, and coconut cake

C Egg yolks, wheat bread, carrots, raisins, and green, leafy vegetables are all high in iron, which is an important mineral for this client.

Which of the following foods would the nurse encourage the client in sickle cell crisis to eat? a. Peaches b. Cottage cheese c. Popsicle d. Lima beans

C Hydration is important in the client with sickle cell disease to prevent thrombus formation. Popsicles, gelatin, juice, and pudding have high fluid content.