Chapter 40

A client presents to the emergency department in sickle cell crisis. What intervention by the nurse takes priority?

Administer oxygen

A client has heparin-induced thrombocytopenia (HIT). The student nurse asks how this is treated. About what drugs does the nurse instructor teach? (Select all that apply)

Argatroban (Argatroban). Bivalirudin (Angiomax). Lepirudin (Refludan).

The family of neutropenic client is not acting right. What action by the nurse is the priority?

Assess the client for infection

A nurse is preparing to administer a blood transfusion to an older adult. Understanding age-related changes, what alterations in the usual protocol are necessary for the nurse to implement? (Select all that apply)

Assess vital signs more often. Hold other IV fluids running.

A client has frequent hospitalizations for leukemia and is worried about functioning as a parent to four small children. What action by the nurse would be most helpful?

Assist the client to make sick day plans for household responsibilities

A student studying leukemias learns the risk factors for developing this disorder. Which risk factors does this include? (Select all that apply)

Chemical exposure. Ionizing radiation exposure. Viral infections.

A student nurse is helping a registered nurse with a blood transfusion. Which actions by the student are most appropriate? (Select all that apply)

Hanging the blood product using normal saline and a filtered tubing set. Taking a full set of vital signs prior to starting the blood transfusion. Using gloves to start the clients IV if needed and to handle the blood product.

A client has a platelet count of 25,000/mm3. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply)

Help the client choose soft foods from the menu. Shave the male client with an electric razor. Use a life sheet when needed to re-position the client.

A nurse is caring for a client who is about to receive a bone marrow transplant. To best help the client cope with the long recovery period, what action by the nurse is best?

Help the client find things to hope for each day of recovery

A client admitted for sickle cell crisis is distraught after learning her child has the disease. What response by the nurse is best?

I can see you are upset. I can stay here with you a while if you like

A client has thrombocytopenia. What client statement indicates the client understands self-management of this condition?

I usually put ice on bumps or bruises

A client has Hodgkins lymphoma, Ann Arbor stage Ib. For what manifestations should the nurse assess the client? (Select all that apply)

Night sweats. Persisten fever. Weight loss.

A client has a serum ferritin level of 8 ng/mL and microcytic red blood cells. What action by the nurse is best?

Perform a Hemoccult test on the clients stools

A client has received a bone marrow transplant and is waiting for engraftment. What actions by the nurse are most appropriate? (Select all that apply)

Placing the client in protective precautions. Teaching visitors appropriate hand hygiene. Telling visitors not to bring live flowers or plants.

A nurse is preparing to hang a blood transfusion. Which action is most important?

Putting on a pair of gloves

A nurse is caring for a young male client with lymphoma who is to begin treatment. What teaching topic is a priority?

Sperm banking

A nursing student is caring for a client with leukemia. The student asks why the client is still at risk for infection when the clients white blood cell count (WBC) is high. What response by the registered nurse is best?

Those WBCs are abnormal and don't provide protection

A client with chronic anemia has had many blood transfusions. What medications does the nurse anticipate teaching the client about adding to the regimen? (Select all that apply)

Darbepoetin alfa (Aranesp). Epoetin alfa (Epogen).

A nurse working with clients with sickle cell disease (SCD) teaches about self-management to prevent exacerbations and sickle cell crisis. What factors should clients be taught to avoid? (Select all that apply)

Dehydration. Extreme stress. High altitudes. Pregnancy.

The nurse is caring for a client with leukemia who has the priority problem of fatigue. What action by the client best indicates that an important goal for this problem has been met?

Doing activities of daily living (ADLs) using rest periods

A student nurse is learning about blood transfusion compatibilities. What information does this include? (Select all that apply)

Donor blood type A can donate to recipient blood type AB. Donor blood type O can donate to anyone.

A client is receiving a blood transfusion develops anxiety and low back pain. After stopping the transfusion, what action by the nurse is most important?

Double-checking the client and blood product identification

A nurse is preparing to administer a blood transfusion. What action is most important?

Ensuring informed consent is obtained if required

A client has Crohns disease. What type of anemia is this client most at risk for developing?

Folic acid deficiency

A client is hospitalized with sickle cell crisis frequently asks for opioid pain medications, often shortly after receiving a dose. The nurses on the unit believe the client is drug seeking. When the client requests pain medication, what action by the nurse is best?

Give the client pain medication if it is time for another dose

A client in sickle cell crisis is dehydrated and in the emergency department. The nurse plans to start an IV. Which fluid choice is best?

0.45% normal saline

A client has been admitted after sustaining a humerus fracture that occurred when picking up the family cat. What test result would the nurse correlate to this condition

Bence-Jones protein in urine

A client has a platelet count of 9000/mm3. The nurse finds the client confused and mumbling. What action takes priority?

Calling the Rapid Response Team

A nurse is caring for four clients with leukemia. After hand-off report, which client should the nurse see first?

Client who had two bloody diarrhea stools this morning

A nurse in a hematology clinic is working with four clients who have polycythemia vera. Which client should the nurse see first?

Client who reports shortness of breath

A nurse caring for a client with sickle cell disease (SCD) reviews the clients laboratory work. Which finding should the nurse report to the provider?

Creatinine: 2.9 mg/dL

A client has a sickle cell crisis with extreme lower extremity pain. What comfort measure does the nurse delegate to the unlicensed assistive personnel (UAP)?

Keep the lower extremities warm

A client with autoimmune idiopathic thrombocytopenic purpura (ITP) has had a spenectomy and returned to the surgical unit 2 hours ago. The nurse assesses the client and finds the abdominal dressing saturated with blood. What action is most important?

Taking a set of vital signs and notifying the surgeon

A nursing student is struggling to understand the process of graft-versus-host disease. What explanation by the nurse instructor is best?

The donors cells are actually attacking the clients cells

A client has been treated for a deep vein thrombus and today presents to the clinic with petechiae. Laboratory results show a platelet count of 42,000/mm3. The nurse reviews the clients medication list to determine if the client is taking which drug?

Unfractionated heparin

A client with sickle cell disease (SCD) takes hydroxyurea (Droxia). The client presents to the clinic reporting an increase in fatigue. What laboratory result should the nurse report immediately?

White blood cell count: 38,000/mm3

A client with multiple myeloma demonstrates worsening bone density on diagnostic scans. About what drug does the nurse plan to teach this client?

Zoledronic acid (Zometa)