Med Surge Exam #3
Hgb female
12-16 g/dL
Hgb Males
14-18 g/dL
platelet count
150,000-400,000
RBC count females
4.2-5.4 million/uL
RBC count male
4.7-5.1 million
Hct males
42-52%
Iron (female)
60-160 mcg/dL
iron males
80-180 mcg/dL
A female patient has a hemoglobin of 6.4 g/dL and is preparing to have a blood transfusion. Why would it be important for the nurse to obtain information about the patient's history of pregnancy prior to the transfusion? A) a high number of pregnancies can increase the risk of reaction B) if the patient has never been pregnant, it increases the risk of reaction C) obtaining information about gravity and parity is routine information for all female patients D) if the patient has been pregnant, she may have developed allergies
A
A nurse is caring for a client who has DIC. Which of the following medications should the nurse anticipate administering? A) heparin B) vitamin K C) mefoxin D) simvastatin
A
A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn's disease. The patient has developed lymphopenia with a lymphocyte count of less than 1500 mm3. That should the nurse monitor the client for? A) onset of a bacterial infection B) bleeding C) abdominal pain D) diarrhea
A
A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse recognize is the most likely clinical disorder the patient is being treated for? A) essential thrombocythemia B) extreme leukocytosis C) sickle cell disease D) renal transplantation
A
A patient who has long-term PRBC transfusions has developed symptoms of iron toxicity that affect liver function. What immediate treatment should the nurse anticipate preparing the patient for that may help prevent organ damage? A) iron chelation therapy B) oxygen therapy C) therapeutic phlebotomy D) anticoagulation therapy
A
A nurse is caring for a pt who is receiving a blood transfusion. Which of the following actions should the nurse expect if an allergic transfusion reaction is suspected? (select all that apply) A) stop the transfusion B) monitor for HTN C) maintain an IV infusion with 0.9% sodium chloride D) position the pt in an upright position with the feet lower than the heart E) administer diphenhydramine
A C E
A nurse in a clinic receives a phone call from a client seeking information about his new prescription for erythropoietin (Epogen). Which of the following information should be reviewed with the client? A. The client needs an erythrocyte sedimentation rate (ESR) test weekly. B. The client should have his hemoglobin checked twice a week. C. Oxygen saturation levels should be monitored. D. Folic acid production will increase.
B
A nurse is caring for a pt who is receiving warfarin for anticoagulation therapy. Which of the following lab test results indicates to the nurse that the pt needs an increase in the dosage? A) aPTT 38 seconds B) INR 1.1 C) PT 22 seconds D) D-dimer negative
B
A nurse is completing an integumentary assessment of a client who has anemia. Which of the following findings should the nurse expect? A) absent turgor B) spoon-shaped nails C) shiny, hairless legs D) yellow mucous membranes
B
A patient is receiving plasma develops transfusion-related acute lung injury (TRALI) 4 hours after the transfusion. What type of aggressive therapy does the nurse anticipate the patient will receive to prevent death from the injury? (select all that apply) A) performance of serial chest x-rays B) supplemental oxygen C) provision of IV fluid support D) intubation and mechanical ventilation E)intra-aortic ballon pump
B C D
A nurse is assessing a client and suspects the pt is experiencing DIC. Which of the following physical finding should the nurse anticipate? A) bradycardia B) HTN C) epistaxis D) xerostomia
C
A nurse is caring for a client who has ITP. The nurse should notify the provider and report possible small-vessel clotting when which of the following is present? A) petechia on the upper chest B) HTN C) cyanotic nail beds D) severe headache
C
A nurse is teaching a pt who has a new prescription for ferrous sulfate. Which of the following include in the teaching? A) stools will be dark red B) take with a glass of milk if GI distress occurs C) foods high in vitamin C will promote absorption D) take for 14 days
C
A nurse in a clinic is caring for a client who has suspected anemia. Which of the following laboratory test results should the nurse expect? A) iron 90 mcg/dL B) RBC 6.5 million/uL C) WBC 4,800 mm3 D) Hgb 10 g/dL
D
A nurse is teaching a newly licensed nurse about heparin-induced thrombocytopenia. Which of the following risk factors for this disorder should the nurse include in the teaching? A) warfarin therapy for atrial fibrillation B) placental abruption C) systemic lupus erythematosus D) heparin therapy for DVT
D
A nurse preceptor is observing a newly licensed nurse on the unit who is preparing to administer a blood transfusion to an older adult pt. Which of the following actions by the newly licensed nurse indicates an understanding of the procedure? A) inserts an 18G IV catheter in the pt B) verifies blood compatibility and expiration date of the blood with an assistive personnel (AP) C) administers dextrose 5% in 0.9% sodium chloride IV with the transfusion D) obtains vital signs every 15 mins throughout the procedure
D
A patient had gastric bypass surgery 3 years ago and now, experiencing fatigue, visits the clinic to determine the cause. The patient takes pantoprazole for the treatment of frequent heartburn. What type of anemia is this patient at risk for? A) aplastic anemia B) iron deficiency anemia C) sickle cell disease D) pernicious anemia
D
A patient with AML has a neutrophil count that persists at less than 100/mm3. What should the nurse cautiously monitor this patient for? A) abdominal cramps B) hypotension C) seizure activity D) infection
D
A patient with chronic anemia has had many blood transfusions over the last 3 years. What type of transfusion reaction should the nurse monitor for that is commonly found in patients who frequently receive blood transfusion? A) allergic reactions B) acute hemolytic reaction C) circulatory overload D) febrile nonhemolytic reactions
D
A patient with end-stage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia? A) potassium level of 5.2 mEq/L B) magnesium level of 2.5 mg/dL C) calcium level of 9.4 mg/dL D) creatinine level of 6 mg/100 mL
D
A patient with sickle cell disease is brought to the ED by a parent. The patient has a fever of 101.6F, HR of 116, and RR of 32. The nurse ausculates bilateral wheezes in both lung fields. What does the nurse suspect this patient is experiencing? A) pneumocystis pneumonia B) acute chest syndrome C) an exacerbation of asthma D) pulmonary edema
D
The nurse is administering a blood transfusion to a patient over 4 hours. After 2 hours the patient reports chills and has a fever of 101F and increase from a precious temp of 99.2F. What does the nurse recognize is occurring with this patient? A) the patient is having an allergic reaction to the blood B) the patient is experiencing vascular collapse C) the patient is having decrease in tissue perfusion from a shock state D) the patient is having a febrile nonhemolytic reaction
D
Which disorder results from a deficiency of circulating platelets? A) hemophilia B) sickle cell anemia C) von Willebrand's disease D) thrombocytopenia
D
A patient with AML is having aggressive chemo to attempt to achieve remission. The patient is aware that hospitalization will be necessary for several weeks. What type of therapy that the patient will receive will the nurse educate the patient about? A) induction therapy B) supportive therapy C) antimicrobial therapy D) standard therapy
A
A pt with blood type B can receive a transfusion of: A) type A or type O blood B) type B or type O blood C) type AB or type O blood D) type A or type B
B
A patient with ESRD is taking recombinant erythtopoietin for the treatment of anemia. What laboratory study does the nurse determine will have to be assessed at least monthly related to this medication? A) potassium level B) creatinine level C) hemoglobin level D) folate levels
C
Hct females
37-47%
A pt is taking hyrdoxyurea for the treatment of primary myelofibrosis. While the pt is taking this medication, what will the nurse monitor to determine effectiveness? A) leukocyte and platelet count B) BUN and creatinine levels C) asparate aminotransgerase (AST) and alanine transaminase (ALT) levels D) hemoglobin and hematocrit
A
A pt with polycythemia vera reports severe itching. What triggers does the nurse know can cause this distressing symptom? (select all that apply) A) temperature change B) allergic reaction to the RBC increase C) alcohol consumption D) exposure to water of any temperature E) aspirin
A C D
A nurse is providing teaching for a pt who is scheduled for a bone marrow biopsy of the iliac crest. Which of the following statements made by the pt indicates an understanding of the teaching? A) this test will be performed while I am lying flat on my back B) I will need to stay in bed for about an hours after the test C) this test will determine which antibiotic I should take for treatment D) I will receive general anestesia for the test
B
A patient with AML is having hematopoietic stem cell transplantation (HSCT) with radiation therapy. With which complication does the nurse know that the donor's lymphocytes recognize the patient's body as foreign and set up reactions to attack the foreign host? A) acute respiratory distress syndrome B) Graft-versus-host disease C) remission D) bone marrow depression
B
A patient with CKD has chronic anemia. What pharmacologic alternative to blood transfusion may be used for the patient? A) GM-CSF B) erythropoietin C) eltrombopag D) thrombopoietin
B
The nurse is assessing a patient who comes to the clinic reporting feeling constantly tired and very weak. The patient also has a very sore tongue, and upon observing the patient's oral cavity, the nurse notices the tongue is beefy red. What type of anemia does the nurse know these symptoms indicate? A) iron deficiency anemia B) megaloblastic anemia C) sickle cell disease D) aplastic anemia
B
The nurse is assessing a patient who is a strict vegetarian. What type of anemia is the nurse aware that this patient is at risk for? A) iron deficiency anemia B) megaloblastic anemia C) sickle cell disease D) aplastic anemia
B
The blood cells that transport oxygen and carbon dioxide to and from body tissues are: A) RBCs B) WBCs C) platelets D) granulocytes
A
The nurse is caring for a patient with CML who is taking imatinib mesylate. In what phase of the leukemia does the nurse understand that this medication is most useful to induce remission? A) chronic B) transformation C) accelerated D) blast crisis
A
The nurse is caring for a pt with AML with a high uric acid level. What medication does the nurse anticipate administering that will prevent crystallization of uric acid and stone formation? A) allopurinol B) filgrastim C) hyroxyurea D) asparaginase
A
Which patient does the nurse recognize as being most likely to be affected by sickle cell disease? A) 14 year old African American boy B) 26 year old Eastern European Jewish woman C) 18 year old Chinese woman D) 28 year old Israeli man
A
The nurse is administering PRBC transfusions for a pt with MDS. The pt has had several transfusions and is likely to receive several more. What is a priority for the nurse to monitor related to the transfusion? A) creatinine and BUN levels B) iron levels C) magnesium levels D) potassium levels
B
The nurse is education a pt taking imatinib mesylate for treatment of leukemia. What should the nurse be sure to include when educating the patient on the best way to take the medication to optimize absorption? A) take the med with a source of vitamin C to enhance absorption B) take antacids if needed for GI upset 2 hours after taking the medication C) take the medication with food to enhance the absorption D) take the med with acetaminophen to prevent decreased absorption and GI upset
B
The nurse is preparing the patient for a test to determine the cause of vitamin B12 deficiency. The patient will receive a small oral dose of radioactive vitamin B12 followed by a large parenteral dose of nonradioactive dose of B12. What test is the patient being prepared for? A) bone marrow aspiration B) Schilling test C) bone marrow biopsy D) MRI study
B
A nurse is preparing preoperative teaching for a pt who requests autologous donation in preparation for a scheduled orthopedic surgical procedure. Which of the following statements should the nurse include in the teaching? A) you should make an appt to donate blood 8 weeks prior to the surgery B) if you need an autologus transfusion, the blood your brother donates can be used C) you can donate blood each week if you Hgb is stable D) any unused blood that is donated can be used for other pts
C
The nurse is caring for a pt who will begin taking long-term biphosphate therapy. Why is it important for the nurse to encourage the pt to receive through evaluation of dentition, including panoramic dental x-rays? A) the pt is at risk for tooth decay B) the pt will develop gingival hyperplasia C) the pt can develop osteonecrosis of the jaw D) the pt can develop loosening of the teeth
C
The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include a nutritional assessment for this patient? A) it is part of the required assessment information B) it is important for the nurse to determine what type of foods the patient will eat C) it may indicate deficiencies in essential nutrients D) it will determine what type of anemia the patient has
C
A patient develops a hemolytic reaction to a blood transfusion. What actions should the nurse take after this occurs? (select all that apply) A) administer diphenhydramine B) begin iron chelation therapy C) collect a urine sample to detect hemoglobin D) document the reaction according to policy
C D E
A nurse is monitoring a pt who began receiving a unit of PRBCs 10 min ago. Which of the following findings should the nurse identify as an indication of a febrile transfusion reaction? (select all that apply) A) temperature change from 37C (98.6F) pretransfusion to 37.2C (99.0F) B) current BP 178/90 mm Hg C) HR change from 88/min pretransfusion to 120/min D) client report of itching E) client appears flushed
C E
Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)? A) 24 year old female taking oral contraceptives B) 40 year old patient with a history of HTN C) 52 year old patient with acute kidney injury D) 72 year old with a history of cancer
D
A patient describes numbness in the arms and hands with a tingling sensation and frequent stumbling when walking. What vitamin deficiency does the nurse determine may contribute to some of these symptoms? A) thiamine B) folate C) B12 D) iron
C
A patient will need a blood transfusion for the replacement of blood loss from the GI tract. The patient states, "That stuff isn't safe!" What is the best response from the nurse? A) I agree that you should be concerned with the safety of the blood but it's important that you have this transfusion B) the blood is carefully screened so there is no possibility of you contracting any illness or disease from the blood C) I understand your concern. The blood is carefully screened but is not completely risk free D) you will have to decide if refusing the blood transfusion is worth the risk to your health
C
A patient with sickle cell disease comes to the ED reporting sever pain in the back, right hip, and right arm. What intervention is important for the nurse to provide? A) administer aspirin B) administer ibuprofen C) start an IV line with dextrose 5% in 0.24 NS D) begin oxygen at 2 L/M
C
A nurse is preparing to administer PRBCs to a client who has a Hgb of 8 g/dL. Which of the following actions should the nurse plan to take during the first 15 min of the transfusion? A) obtain consent from the pt for the transfusion B) assess for an acute hemolytic reaction C) explain the transfusion procedure to the pt D) obtain blood culture specimens to send to the lab
b
The nurse is educating a patient with iron deficiency anemia about food sources high in iron and how to enhance the absorption of iron when eating these foods. What can the nurse inform the client would enhance the absorption? A) eating calf's liver with a glass of orange juice B) eating leafy green vegetables with a glass of water C) eating apple slices with carrots D) eating a steak with mushrooms
A
A nurse is planning care for a pt who has Hgb 7.5 g/dL and Hct 21.5%. Which of the following actions should the nurse include in the plan of care? (select all that apply) A) provide assistance with ambulation B) monitor oxygen saturation C) weigh the client weekly D) obtain stool specimen for occult blood E) schedule daily rest periods
A B D E
The nurse is administering two units of PRBCs to an older adult patient with a bleeding duodenal ulcer. The patient begins to experience difficulty breathing and the nurse assesses crackles in the lung bases, JVD and an increase in blood pressure. What action by the nurse is necessary if the reaction is severe? (select all that apply) A) continue the infusion but slow the rate down B) place the patient in an upright position with the feet dependent C) administer diuretics as prescribed D) discontinue the transfucion E) administer oxygen
B C D E
The nurse is assessing a pt with polycythemia vera. What skin assessment data would the nurse determine is a normal finding for this pt? A) pale skin and mucous membranes B) bronze skin tone C) ruddy complexion D) jaundice skin and sclera
C
The nurse is performing an assessment on a patient with AML and observes multiple areas of ecchymosis and petechia. What lab study should the nurse be concerned about? A) WBC count of 4200 cells/mcL B) hematocrit of 38% C) platelet count of 9000/mm3 D) creatinine level of 1.0 mg/dL
C
The nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. What position will the nurse place the patient in? A) lateral position with one leg flexed B) lithotomy position C) supine with head of the bed elevated 30 degrees D) jackknife position
A
The nurse observes a coworker eating ice frequently. The nurse encourages the coworker to have an examination and diagnostic workup with the healthcare provider. What type of anemia is the nurse concerned the coworker may have? A) iron deficiency anemia B) megaloblastic anemia C) sickle cell disease D) aplastic anemia
A
A nurse is caring for a pt who has DIC. Which of the following laboratory values indicates the pt's clotting factors are depleted? (select all that apply) A) platelets 100,000/mm3 B) fibrinogen levels 57 mg/dL C) fibrin degradation products 4.3 mcg/mL D) D-dimer 0.03 mcg/mL E) sedimentation rate 38 mm/hr
A B
A nurse is providing discharge teaching to a pt who had a gastrectomy for stomach cancer. Which of the following information should the nurse include in the teaching? (select all that apply) A) you will need a monthly injection of vitamin B12 for the rest of your life B) using the nasal spray form of vitamin B12 on a daily basis can be an option C) an oral supplement of B12 taken on a daily basis can be an option D) you should increase your intake of animal proteins, legumes, and dairy products to increase B12 in your diet E) add soy milk fortified with B12 to your diet to decrease the risk of pernicious anemia
A B
A patient with sickle cell disease is to begin treatment for the disease with hydroxyurea. What does the nurse inform the patient will be the benefits of treatment with this medication? (select all that apply) A) fewer painful episodes of sickle cell crisis B) lower incidence of acute chest syndrome C) decreased need for blood transfusion D) decreased need for other analgesic medication E) ability to reverse the damage done from sickling cells
A B C
The nurse is caring for a pt with Hodgkin lymphoma in the hospital and preparing discharge planning education. Because this pt is at risk for the development of a second malignancy, what education would be beneficial to reduce the risk factors? (select all that apply) A) reduce exposure to excessive sunlight B) smoking cessation C) decrease alcohol intake D) decrease intake of antipyretic medications such as acetaminophen E) decrease fat intake
A B C
Which type of anemia results from deficiency of all the blood's formed elements, caused by failure of the bone marrow to generate enough cells? A) sickle cell anemia B) folic acid deficiency anemia C) aplastic anemia D) iron deficiency anemia
C
