exam 5- metabolism/cellular regulation

the nurse is caring for clients on an oncology unit. which neutropenia precautions should the nurse implement? a. hold all venipuncture sites for atleast five minutes b. limit fresh fruits and flowers c. excessive energy and high platelet counts d. cervical lymph node enlargement and positive acid fast bacillus

2 fresh fruits and flowers may carry bacteria or innsects on the skin of the fruit or dirt on the flowers or leaves, so they are restricted around clients with low white blood counts

The nurse is caring for a patient with esophageal varices with a new order for vasopressin (Pitressin). The nurse reviews the patient's history and notes that the patient's comorbidities include coronary artery disease (CAD), type 2 diabetes, gastroesophageal reflux disease (GERD), and fibromyalgia. The nurse should immediately notify the physician about which component of the patient's history? a. CAD b. Diabetes mellitus (DM) type 2 c. GERD d. Fibromyalgia.

A Vasopressin (Pitressin) is a potent medication that causes vasoconstriction and stops bleeding of esophageal varices. With the use of potent vasoconstrictors such as vasopressin (Pitressin), which constricts all vessels, the possibility of it causing a myocardial infarction (MI) is a very real concern and should be used most cautiously with the patient with CAD.

an older male is diagnosed with cirhhosis of the liver. the nurse knows that the most likely cause of this problem is a. being in military b. traveling to foreign country c. drinking excessive alcohol d. eating bad food

ANS: 3 The destruction to the liver from alcohol often progresses from fatty liver to alcoholic hepatitis and culminates in alcoholic cirrhosis. Alcoholic cirrhosis accounts for a great number of individuals diagnosed with this disease. Cirrhosis is not associated with being in the military, traveling to a foreign country, or eating bad food.

the nurse is emptying the bedside commode of a patient with chronic leukemia and notes that the stool is very dark. Which assumption should guide the nurses action? a. the pt may be bleeding b. the pt may be dehydrated c. the pt is most likely on iron supplements d. the patient ate something that turned the stool of a dark color

ANS: A . Black stools are a sign of gastrointestinal bleeding. C. D. Iron supplements and some foods may change stool color, but if the patient has leukemia, the nurse cannot assume that the cause is unimportant. B. Dehydration is associated with constipation, not dark stools.

Which statement accurately describes induction therapy for acute lymphocytic leukemia (ALL)? a. Induction therapy is an intensive protocol of chemotherapy in high doses to achieve remission. b. Induction therapy is a long-term protocol with smaller doses of chemotherapy to achieve a cure. c. Induction therapy is a 2- to 5-year low-dose chemotherapy regimen to reduce painful symptoms. d. Induction therapy is a combination of chemotherapy and radiation to achieve remission

ANS: A A combination of several antileukemic drugs in high doses has been found to induce a remission.

The nurse is conscientious in the care of the feet and legs of a patient with sickle cell anemia because: a. stasis ulcers are a constant threat b. bleeding may occur on the soles of the feet c. edema of the feet increases activity intolerance d. toenails must be kept short to avoid ingrown nails

ANS: A Because of the sluggish flow of blood, stasis ulcers are a constant threat and are very difficult to heal.

A patient with a 10-year history of alcoholism was admitted to the critical care unit with the diagnosis of acute pancreatitis. Based on the diagnosis, the patient a. is at risk for hypovolemic shock from plasma volume depletion b. requires observation for hypoglycemia and hypercalcemia c. should be started on enteral feedings after the ng tube is placed d. is placed on a fluid restriction to avoid the fluid sequestration

ANS: A Because pancreatitis if often associated with massive fluid shifts, intravenous crystalloids and colloids are administered immediately to prevent hypovolemic shock and maintain hemodynamic stability. Electrolytes are monitored closely, and abnormalities such as hypocalcemia, hypokalemia, and hypomagnesemia are corrected. If hyperglycemia develops, exogenous insulin may be required.

esophagogastric varices are the result of a. portal hypertension resulting in diversion of blood from a high pressure area to a low pressure area b. superficial mucosal erosions as a result of increased stress levels c. proulcer forces breaking down the mucosal resistance d. inflammation and ulceration secondary to nonsteroidal and anti-inflammatory drug use

ANS: A Esophagogastric varices are engorged and distended blood vessels of the esophagus and proximal stomach that develop as a result of portal hypertension secondary to hepatic cirrhosis, a chronic disease of the liver that results in damage to the liver sinusoids. Without adequate sinusoid function, resistance to portal blood flow is increased, and pressures within the liver are elevated. This leads to a rise in portal venous pressure (portal hypertension), causing collateral circulation to divert portal blood from areas of high pressure within the liver to adjacent areas of low pressure outside the liver, such as into the veins of the esophagus, spleen, intestines, and stomach.

A patient with possible viral hepatitis reports recent intake of raw shellfish. Which type of hepatitis should the nurse consider the patient is experiencing? a. Hepatitis A virus b. Hepatitis B virus c. Hepatitis C virus d. Hepatitis D virus

ANS: A Hepatitis A is spread by oralfecal contamination of water, shellfish, eating utensils, or equipment. B. C. D. These types of hepatitis are spread through blood and body fluids.

The patient is admitted with pancreatitis and has severe ascites. In caring for this patient, the nurse should: a. monitor the pt blood pressure and evaluate for signs of dehydration b. restrict iv and oral fluid intake bc of fluid shifts c. avoid the use of colloid iv solutions in managing the patients fluid status d. only use crystalloid fluids to prevent IV from clotting

ANS: A In patients with severe acute pancreatitis, some fluid collects in the retroperitoneal space and peritoneal cavity. Patients sequester up to one third of their plasma volume. Initially, most patients develop some degree of dehydration and, in severe cases, hypovolemic shock. Fluid replacement is a high priority in the treatment of acute pancreatitis. The IV solutions ordered for fluid resuscitation are usually colloids or lactated Ringers solution; however, fresh frozen plasma and albumin may also be used. IV fluid administration with crystalloids at 500 mL/hr is at times required to maintain hemodynamic status. Often, vigorous IV fluid replacement at 250 to 300mL/hr continues for the first 48 hours or a volume adequate to maintain a urine output of greater than or equal to 0.5 mL/kg body weight per hour. Fluid replacement helps to maintain perfusion to the pancreas and kidneys, reducing the potential for complications.

The nurse is aware that a definitive diagnosis of cirrhosis is made based on the results of which diagnostic or laboratory test? a. Liver biopsy b. Elevated aspartate aminotransferase (AST) c. Elevated alanine aminotransferase (ALT) d. Elevated lactate dehydrogenase (LDH)

ANS: A Liver biopsy is the definitive test. AST, ALT, and LDH tests will be elevated, but they are not specific for cirrhosis.

the nurse is caring for a pt who presents to the emergency dept with severe nausea and vomiting with stomach pain that radiates to his right scapula. The patient has a temperature of 101.2. the nurse anticipates that this patient will undergo workup for which problem? a. cholecystitis b. hepatitis c. pancreatitis d. gastroenteritis

ANS: A Nausea and vomiting, fever, and leukocytosis occur with cholecystitis. Pain may be referred to the right clavicle, scapula, or shoulder. Hepatitis causes liver dysfunction, including jaundice. Pancreatitis causes abdominal pain that is usually acute, but this can vary among individuals. The pain is steady and is localized to the epigastrium or left upper quadrant. Gastroenteritis causes nausea, vomiting, and diarrhea.

Pain control is a nursing priority in patients with acute pancreatitis because pain: a. pain increases pancreatic secretions b. is caused by decreased distention of the pancreatic capsule c. decreases the patients metabolism d. is caused by dilation of the biliary system

ANS: A Pain control is a nursing priority in patients with acute pancreatitis not only because the disorder produces extreme patient discomfort but also because pain increases the patients metabolism and thus increases pancreatic secretions. The pain of pancreatitis is caused by edema and distention of the pancreatic capsule, obstruction of the biliary system, and peritoneal inflammation from pancreatic enzymes. Pain is often severe and unrelenting and is related to the degree of pancreatic inflammation.

The nurse is caring for a patient diagnosed with acute pancreatitis who complains of significant pain. Which nursing action holds the highest priority for this patient? a. Instruct the patient to sit and lean forward. b. Monitor intake and output. c. Monitor laboratory values and note changes. d. Check blood glucose values frequently.

ANS: A Pancreatitis causes abdominal pain that is usually acute, steady, and localized to the epigastrium or left upper quadrant. As it progresses, it spreads and radiates to the back and flank. Sitting and leaning forward may ease the pain. The severity of the pain may slowly decrease after 24 hours. Eating makes the pain worse. While monitoring intake and output and laboratory values are important actions, none of these actions actively address the patient's pain.

The nurse is caring for a patient with chronic liver failure. Which laboratory value should the nurse expect as a late sign of liver failure? a. Low serum albumin b. Low serum bilirubin c. Low serum ammonia d. Low serum aspartate aminotransferase (AST)

ANS: A Protein synthesis (albumin) is impaired in liver disease. B. C. D. Ammonia, bilirubin, and AST are all elevated in liver disease.

the nurse is caring for a patient with sickle cell anemia. based on the underlying pathophysiology of this disorder, the nurse should carefully perform which detailed assessment. a. examination for skin breakdown b. auscultation of lungs c. abdominal girth measurement d. palpation of radial pulses

ANS: A Sickle cell anemia results in sluggish blood flow which increases the threat of stasis ulcers and makes it harder for existing wounds to heal. Careful assessment for skin breakdown is of priority importance in this patient. Lung auscultation, assessment of abdominal girth, and palpation of radial pulses do not directly correlate to sickle cell anemia.

the patient with acute myelogenous leukemia asks why he is making more WBCs when he already has so many. which statement clarifies the underlying pathophysiology related to the patients wbcs? a. the large number of leukemic white cells that you already have are not as effective as normal white cells b. the large number of leukemic white cells that you already have protect against infection c. the large number of leukemic white cells that you already have attempt to take over the functions of RBCs d. the large number of leukemic white cells that you already have are produced by the lymphatic system

ANS: A The many leukemic white cells cannot function as normal WBCs do. The bone marrow "rushes" production of immature white cells (blasts) to try to create adequate protection. These cells do not protect against infection, nor do they take over the functions of the RBCs. AML originates in the bone marrow.

The nurse is reinforcing teaching provided to a patient with esophageal varices. Which activity should the patient be taught to avoid? a. Lifting heavy objects b. Participating in aerobic activities c. Eating concentrated carbohydrates d. Rising suddenly from a reclining position

ANS: A The straining associated with lifting can cause the thin-walled varices to tear, causing severe bleeding. C. Eating carbohydrates may be recommended if the patient also has encephalopathy. B. D. Aerobic activities and rising from a reclining position will not increase pressure in the varices.

A patient recovering from hepatitis is concerned about liver damage from the infection. What should the nurse instruct the patient to do to prevent long-term liver damage? (Select all that apply.) a. Get adequate rest. b. Ingest nutritious foods. c. Abstain from all alcohol. d. Restrict physical activity.e. Limit the intake of dairy products.

ANS: A, B, C Recovery varies and depends on the type of hepatitis. Full recovery is measured by the return to normal of all liver function tests and may take as long as 1 year. The effects of hepatitis can be considered reversible if the patient complies with a medical regimen of adequate rest, proper nutrition, and abstinence from alcohol or other liver-toxic agents for at least 1 year after liver function laboratory values return to normal. D. E. Physical activity and dairy products do not need to be restricted.

which of the following is a potential cause for acute liver failure a. ischemia b. hepatitis a b c d e, non a, non b, and non c c. acetaminophen toxicity d. wilson disease e. reyes syndrome f. diabetes

ANS: A, B, C, D, E Diabetes is not a primary cause of acute liver failure but is associated with pancreatitis.

Which of the following are clinical manifestations of pancreatitis? (Select all that apply.) a.Epigastric and abdominal pain b. Nausea and vomiting c. Diaphoresis d. Jaundice e. Hyperactive bowel sounds f. Fever

ANS: A, B, D, F Clinical manifestations of acute pancreatitis include pain, vomiting, nausea, fever, abdominal distention, abdominal guarding, abdominal tympany, hypoactive or absent bowel sounds, severe disease, peritoneal signs, ascites, jaundice, palpable abdominal mass, Grey-Turner sign, Cullen sign, and signs of hypovolemic shock. There may be peritonitis involved with pancreatitis and percussion will reveal a tympanic abdomen; bowel sounds will be decreased or absent.

The nurse caring for a patient recently admitted with acute pancreatitis. Which action(s) should the nurse include in the daily assessments? (select all that apply.) a. Auscultate bowel sounds. b. Carefully evaluate amount of food eaten each meal. c. Measure abdominal girth. d. Monitor for effectiveness of pain control. e. Monitor urine output.

ANS: A, C, D, E The nurse should auscultate bowel sounds, measure abdominal girth to monitor for ascites, monitor for pain and evaluate effectiveness of pain control, and monitor urine output. In early acute pancreatitis, the patient should be kept NPO; measuring food is unnecessary.

the nurse caring for a pt recently admitted with acute pancreatitis. which action should the nurse include in the daily assessments a. auscultate bowel sounds b. carefully evaluate amount of food eaten each meal c. measure abdominal girth d. monitor for effectiveness of pain control e. monitor urine output

ANS: A, C, D, E The nurse should auscultate bowel sounds, measure abdominal girth to monitor for ascites, monitor for pain and evaluate effectiveness of pain control, and monitor urine output. In early acute pancreatitis, the patient should be kept NPO; measuring food is unnecessary.

The nurse is collecting information about sickle cell disease for an upcoming seminar. What should the nurse include as common triggers for a sickle cell crisis? (Select all that apply.) a. anesthesia b. chemotherapy c. severe infection d. strenous exercise e. use of nasal oxygen f. blood loss during surgery

ANS: A, C, D, F Factors that contribute to the development of a sickle cell crisis include those related to decreased oxygenation. Some examples include pneumonia with hypoxia, strenuous exercise, exposure to cold, diabetic acidosis, and severe infection. E. Use of oxygen will increase, not decrease, oxygenation. B. Chemotherapy should not affect oxygenation.

The nurse caring for a patient with acute pancreatitis assesses a bluish tinge around the patient's umbilicus. The nurse recognizes that this finding likely results from which underlying problem? a. Increased amylase b. Retroperitoneal hemorrhage. c. Inflammatory response to a pseudocyst d. ascites

ANS: B A bluish tinge around the umbilicus or in the flank area indicates a retroperitoneal hemorrhage. Increased amylase levels, inflammatory response to a pseudocyst, and ascites do not result in a bluish tinge around the belly button.

A patient with a 10-year history of alcoholism was admitted to the critical care unit with the diagnosis of acute pancreatitis. The patient is preparing for discharge. Nursing intervention should include a.diabetes management. b.alcohol cessation program. c.frequency of hemoccult testing. d. frequency of PT and PTT testing.

ANS: B As the patient moves toward discharge, teaching should focus on the interventions necessary for preventing the recurrence of the precipitating disorder. If an alcohol abuser, the patient should be encouraged to stop drinking and be referred to an alcohol cessation program.

The nurse is caring for a patient with acute pancreatitis who is vomiting. What should the nurse frequently assess in this patient?a. Skin color and pain b. Vital signs and urinary output c. Bowel sounds and body weight d. Ability to move lower extremities

ANS: B Complications of pancreatitis include cardiovascular, pulmonary, and renal failure. Monitoring vital signs and urinary output helps identify for the onset of these life-threatening complications. D. Lower extremity movement is not affected. A. Pain is expected and should be monitored, but it is not life threatening. C. Bowel sounds and body weight are also important, but changes are not as immediately life threatening as cardiovascular, pulmonary, and renal failure.

Esophagectomy is usually performed for a. cancer of the proximal esophagus and gastroesophageal junction. b. cancer of the distal esophagus and gastroesophageal junction. c. cancer of the pancreatic head. d. varices of the distal esophagus and gastroesophageal junction.

ANS: B Esophagectomy is usually performed for cancer of the distal esophagus and gastroesophageal junction.

A patient has reported to the clinic with concerns about contracting hepatitis A from her boyfriend. What response by the nurse is most appropriate? a. "If you are having unprotected sexual intercourse with your partner, there is a relatively high risk for hepatitis A." b. "Hepatitis A is not transmitted as a result of close contact with an infected individual." c. "Hepatitis A transmission is associated with contact with infected body fluids." d. "Hepatitis A is relatively uncommon in our country and seen more in underdeveloped countries."

ANS: B Hepatitis A and hepatitis E viruses are transmitted primarily by the fecal-oral route. They are responsible for the epidemic forms of viral hepatitis. Hepatitis A virus can be transmitted by food handlers to customers or by mollusk shellfish from contaminated waters. Hepatitis B is transmitted via infected blood and body fluids. Hepatitis E virus infection is primarily seen in less developed countries.

The nurse is caring for a patient after surgery to drain a pancreatic abscess. Which action should the nurse take to monitor for complications? a. Document output. b. Monitor blood glucose. c. Monitor for hyperproteinemia. d. Review serum potassium levels.

ANS: B Hyperglycemia will occur if the insulin-producing islets of Langerhans are affected by the surgery. A. Intake and output may be recorded, but they do not directly relate to complications from surgery. C. D. Hyperkalemia and hyperproteinemia are not directly related to pancreatic surgery, although electrolyte imbalances may occur with many surgeries. Low protein level is more likely than high.

The nurse is collecting data for a patient with acute pancreatitis. Which laboratory test result should the nurse expect? a. Decreased serum lipase b. Elevated serum amylase c. Elevated serum albumin d. Decreased serum ammonia

ANS: B In acute pancreatitis, serum amylase (normal: 80 to 180 U/dL) rises quickly and then returns to normal in 3- 5 days. A. In acute pancreatitis. serum lipase (normal: 0 to 160 U/L) may be elevated 5 to 40 times normal. C. Albumin will be low. D. Ammonia is monitored in liver disease.

The nurse is collecting data from a patient with liver failure to detect encephalopathy. What instructions should the nurse give to the patient to collect this data? a. Stand with your eyes closed. b. Hold out your arms and hands. c. Kneel on your hands and knees. d. Bear down as though you were having a bowel movement.

ANS: B Neuromuscular function is monitored by asking the patient to hold his or her arms out straight in front and steady. If asterixis, or liver flap, is present, the patients hands will unwillingly dip and return to the horizontal position in a flapping motion. A. C. D. These actions do not check for encephalopath

the patient is diagnosed with hepatitis. In caring for this patient, the nurse should: a. administer antiinflammatory medications b. provide rest, nutrition and antiemetics if needed c. provide antianxiety medications freely to decrease agitation d. instruct pt to take over the counter antiinflammatory medications at home

ANS: B No definitive treatment for acute inflammation of the liver exists. Goals for medical and nursing care include providing rest and assisting the patient in obtaining optimal nutrition. Medications to help the patient rest or to decrease agitation must be closely monitored because most of these drugs require clearance by the liver, which is impaired during the acute phase. Nursing measures such as administration of antiemetics may be helpful. Small, frequent, palatable meals and supplements should be offered. Patients must be instructed not to take any over-the-counter drugs that can cause liver damage. Alcohol should be avoided.

The nurse is reinforcing teaching provided to a patient with chronic liver failure. What should the patient be instructed to help prevent injury?a. Drink plenty of clear fluids. b. Brush your teeth with a soft-bristled brush. c. Be sure to get 20 minutes of exercise daily. d. Take an aspirin a day to prevent heart complications.

ANS: B Patients with chronic liver failure often have deficient clotting factors, and a firm toothbrush can cause bleeding gums. A. C. Fluids and exercise will not prevent injury and may be contraindicated. D. Aspirin has antiplatelet properties and can increase bleeding risk.

The nurse is reinforcing discharge teaching about recurrence of pancreatitis to a patient with chronic pancreatitis. What information should the nurse include? a. Periodic epigastric pain is a normal occurrence. b. Report anorexia, hyperglycemia, or weight loss. c. Recurrence of pancreatitis is unlikely to happen. d. Report jaundice, flatulence, or amber-colored urine.

ANS: B Symptoms of chronic pancreatitis include epigastric or left upper quadrant (LUQ) pain, weight loss, and anorexia. Malabsorption, fat intolerance, and diabetes mellitus occur late in the disease. D. Jaundice is a sign of liver and gallbladder disease. C. Recurrence is likely. A. Pain is not normalit is a warning sign.

the nurse is caring for a patient with sickle cell anemia. which intervention may best help prevent sickle cell crisis a. taking iron supplements daily b. maintaining adequate fluid intake c. engaging in daily exercise d. eating leafy green vegetables

ANS: B The maintenance of an adequate fluid intake keeps the circulating blood volume hydrated, which discourages clumping of the sickle cells.

The nurse stresses to the patient with sickle cell anemia that one of the most elementary home interventions to help prevent sickle cell crisis is to: a. take iron supplements daily b. maintain adequate fluid intake c. engage in daily exercise d. eat leafy green vegetables

ANS: B The maintenance of an adequate fluid intake keeps the circulating blood volume hydrated, which discourages clumping of the sickle cells.

The nurse is reinforcing teaching provided to a patient with a history of acute pancreatitis. Which item should the patient be instructed to avoid? a. High-sodium foods b. Alcoholic beverages c. Carbonated beverages d. Foods with preservatives

ANS: B The major cause of chronic pancreatitis in men is excessive alcohol ingestion, which causes repeated attacks of acute pancreatitis. Advise patients with acute pancreatitis from excessive alcohol ingestion that abstinence could prevent recurrence of the pancreatitis and prevent the possibility of chronic pancreatitis. A. C. D. Carbonated beverages, sodium, and preservatives do not trigger pancreatitis.

The nurse is identifying care to delegate to unlicensed assistive personnel. Which actions could be safely delegated in the care of a patient with fulminant liver failure? a. Evaluating the patients mental status b. Assisting with bathing and positioning c. Assessing the stool and urine for blood d. Monitoring laboratory studies for abnormal values

ANS: B Unlicensed assistive personnel can safely bathe and position a patient in liver failure. A. C. D. Assessment, monitoring, and evaluating are nursing functions and are beyond the scope of practice for unlicensed assistive personnel.

The nurse is planning skin care of the patient with ascites. Which actions should the nurse include? (select all that apply.) a. Bathe the patient in hot water. b. Apply emollients to decrease itching. c. Closely trim the patient's fingernails. d. Change the patient's position every 1 to 2 hours. e. Coach the patient in deep-breathing exercises.

ANS: B, C, D Applying emollients, cutting the fingernails short, and changing the patient's position frequently are appropriate interventions. The nurse should bathe the patient in tepid water. Deep breathing, although a good intervention in certain situations, has nothing to do with skin care.

While collecting data, the nurse becomes concerned that a patient is at risk for developing liver cancer. What information did the nurse use to come to this conclusion? (Select all that apply.) a. Lives in an urban community b. Ingests four six-packs of beer each dayc. Smokes two packs of cigarettes each day d. Has a history of chronic hepatitis B infection e. Employed as a remote computer operator

ANS: B, C, D Patients with a history of chronic hepatitis B infection, and heavy alcohol use or smoking have an increased risk for cancer of the liver. A. E. Home setting and employment do not increase the patients risk for developing liver cancer.

The nurse is instructing the mother of an adolescent with hepatitis on ways to prevent the spread of infection in the home. What should the nurse include in this mothers teaching? (Select all that apply.) a. Use bar soap. b. Wear rubber gloves when handling the patients used laundry. c. Wash contaminated linens separately from other family linens. d. Identify a separate bedroom and bathroom for the patient to use. e. Wash gloves with 10% bleach solution after use for cleaning the bathroom.

ANS: B, C, D, E At home and if possible, the patient with hepatitis should have a separate bedroom and bathroom. The person cleaning the bathroom should wear disposable gloves or rubber gloves and then clean the gloves with a 10% bleach solution. Contaminated linens used by a patient with hepatitis should be washed separately from household laundry and in hot water. One cup of bleach should be added with the detergent to each load. Rubber gloves should be worn to wash the patients laundry. A. The family should be advised to use liquid soap instead of bar soap.

A patient is admitted with the diagnosis of acute pancreatitis. The nurse expects which of the following laboratory test results to be elevated? (Select all that apply.) a. calcium b. serum amylase c. serum glucose d. potassium e. wbc f. serum triglycerides

ANS: B, C, E, F Calcium and potassium decrease with acute pancreatitis.

The nurse is collecting data for a patient with acute liver failure. Which laboratory test findings should the nurse recognize as supporting this diagnosis? (Select all that apply.) a. Elevated platelet count b. Elevated prothrombin time c. Elevated serum bilirubin level d. Elevated serum potassium level e. Elevated alanine aminotransferase level (ALT) f. Elevated aspartate aminotransferase level (AST)

ANS: B, C, E, FAST and ALT are found in high concentrations in liver cells and are released with death of liver cells. Serum bilirubin and urobilinogen may be elevated. In patients with severe hepatitis, prothrombin time may be elevated because the liver can no longer make prothrombin. A. D. Potassium and platelet counts are not directly affected.

Which of the following interventions would you expect in the management of hepatic failure? (Select all that apply.) a. benzodiazepines for agitation b. pulse oximetry and serial arterial blood gas measurements c. insulin drip for hyperglycemia and hyperkalemia d. monitor electrolyte blood levels e. assess for signs of cerebral edema

ANS: B, D, E The patient may experience a variety of other complications, including cerebral edema, cardiac dysrhythmias, acute respiratory failure, sepsis, and acute kidney injury. Cerebral edema and increased intracranial pressure develop as a result of breakdown of the bloodbrain barrier and astrocyte swelling. Circulatory failure that mimics sepsis is common in acute liver failure and may exacerbate low cerebral perfusion pressure. Hypoxemia, acidosis, electrolyte imbalances, and cerebral edema can precipitate the development of cardiac dysrhythmias. Acute respiratory failure, progressing to acute respiratory distress syndrome, intrapulmonary shunting, ventilationperfusion mismatch, sepsis, and aspiration may be attributed to the universal arterial hypoxemia.

A patient with advanced cirrhosis develops esophageal varices. The nurse anticipates that this complication will be addressed by which type of medication(s)? (select all that apply.) a. Vasodilators b. Intravenous (IV) vasopressin (Pitressin) c. IV iron d. Beta blockers e. Vitamin K

ANS: B, D, E Treatment options include administration of parenteral vasopressors such as vasopressin (Pitressin) to lower portal pressure, a beta blocker to lower blood pressure, and vitamin K to help rectify clotting factor deficiencies. Vasoconstrictors (not vasodilators) such as somatostatin (Zecnil) and octreotide (Sandostatin) are used to reduce portal blood flow, and iron may exacerbate liver failure.

A patient is being tested for possible leukemia. With which diagnostic test should the nurse anticipate assisting? a.Liver biopsy b.Thoracentesis c.Bone marrow biopsy d.Arterial blood gas analysis

ANS: C Although a simple complete blood count (CBC) often points toward the diagnosis, only bone marrow aspiration can show the extent of proliferation of the malignant WBCs and confirm the diagnosis of leukemia. B. D. Thoracentesis and arterial blood gases diagnose pulmonary problems A. Liver biopsy is used to detect liver cancer.

a 54 year old pt is admitted to the hospital in the final stage of chronic lymphocytic leukemia (CLL). which manifestations of CLL should the nurse expect to find while collecting admission a. nausea and vomiting b. hypotension and alopecia c. fever and abnormal bleeding c. cervical lymphadenopathy and chest pain

ANS: C During the acute phase of CLL, the patient may exhibit high fevers from infection and ecchymosis or petechiae from thrombocytopenia. A. B. Nausea, vomiting, and alopecia are side effects of chemotherapy. D. Lymphadenopathy and chest pain are not generally associated with leukemia.

A patient with a 10-year history of alcoholism was admitted to the critical care unit with the diagnosis of acute pancreatitis. The physiologic alteration that occurs in acute pancreatitis is a. uncontrolled hypoglycemia caused by an increased release of insulin b. loss of storage capacity for senescent red blood cells c. premature activation of inactive digestive enzymes, resulting in autodigestion d. release of glycogen into the serum , resulting in hyperglycemia

ANS: C In acute pancreatitis, the normally inactive digestive enzymes become prematurely activated within the pancreas itself, creating the central pathophysiologic mechanism of acute pancreatitis, namely autodigestion.

the nurse is reviewing the current pt census on a care area. which individual is most likely to present with signs or symptoms of sickle cell anemia a. a 1 month old boy who is hispanic b. a 5 year old girl of hispanic orgin c. a 1 year old boy who is african american d. a 3 month old girl who is african american

ANS: C In the United States, sickle cell anemia is most often found in those of African or eastern Mediterranean origin. B. Children of Hispanic origin are the least likely to demonstrate symptoms of sickle cell anemia. A. D. Symptoms are not present until after the age of 6 months due to the hemoglobin made during fetal life.

Which of the following medications is/are given to help control ammonia levels in a patient with acute liver failure (ALF)? a. insulin b. vitamin k c. lactulose d. benzodiazepines

ANS: C Lactulose, a synthetic Ketoanalogue of lactose split into lactic acid and acetic acid in the intestine, is given orally through a nasogastric tube or as a retention enema. The result is the creation of an acidic environment that results in ammonia being drawn out of the portal circulation. Lactulose has a laxative effect that promotes expulsion. Vitamin K is used to help control bleeding. Insulin would be given to control hyperglycemia. Use ofbenzodiazepines and other sedatives is discouraged in a patient with ALF because pertinent neurologic changes may be masked, and hepatic encephalopathy may be exacerbated.

The nurse is caring for a patient with cirrhosis. Which assessment finding warrants the nurse's immediate attention? a. Shiny, tight abdomen b. Yellow sclera c. Confusion d. Paired horizontal bands on the fingernails

ANS: C Mental confusion and coma result from hepatic encephalopathy. Encephalopathy occurs from liver failure that leads to circulating toxins. This finding is an indicator of deteriorating patient condition. Ascites and jaundice are expected findings in cirrhosis and do not necessarily indicate an urgent change in condition. Fingernails that feature horizontal bands in pairs that alternate with normal nail color occur due to hypoalbuminemia from cirrhosis; this finding does not indicate an urgent change in condition.

A 45-year-old patient with acute myelogenous leukemia (AML) is considering the possibility of treatment with a hematopoietic stem cell transplant (HSCT). To assist the patient with treatment decisions, the best approach for the nurse to use is to a. emphasize the positive outcomes of a bone marrow transplant b. discuss the need for adequate insurance to cover post HSCT care c. ask the pt whether there are any questions or concerns about HSCT d. explan that a cure is not possible with any other treatment except HSCT

ANS: C Offering the patient an opportunity to ask questions or discuss concerns about HSCT will encourage the patient to voice concerns about this treatment and also will allow the nurse to assess whether the patient needs more information about the procedure. Treatment of AML using chemotherapy is another option for the patient. It is not appropriate for the nurse to ask the patient to consider insurance needs in making this decision.

A patient with hepatic encephalopathy is required to consume 50 grams of protein each day. Which item should be provided to the patient for a mid-afternoon snack? a. Apple b. Crackers c. Peanut butter d. Whole grain bread

ANS: C Only in cases of severe protein intolerance should protein be restricted and then for as short a time as possible with supplemental branched-chain amino acids administered until normal protein intake is resumed. Of the food choices, peanut butter has the most protein. A. B. D. An apple is protein free. Crackers and whole grain bread are carbohydrates.

The physician has prescribed rifaximin (Xifaxan) for a patient with cirrhosis. The patient questions why he must take this medication. Which response by the nurse is most appropriate? a. Rifaximin (Xifaxan) helps prevent infection. b. Rifaximin (Xifaxan) helps reduce straining during a bowel movement. c. Rifaximin (Xifaxan) kills intestinal flora. d. Rifaximin (Xifaxan) aids in reducing ascites.

ANS: C Rifaximin (Xifaxan) decrease the bowel flora, colonic bacteria that breakdown protein. This treatment lowers the formation of ammonia. This medication may cause headaches or flatulence and is taken twice daily with food.

The patient is admitted with severe abdominal pain due to pancreatitis. The patient asks the nurse, What causes this? Why does it hurt so much? The nurse should answer: a. pancreatitis is extremley rare and no one knows why it causes pain b. pancreatitis is caused by diabetes; you should be checked c. injury to certain cells in the pancreas causes it to digest itself, causing pain d. the pain is localized to the pancreas. fortunately it will not affect anything else

ANS: C The most common theory regarding the development of pancreatitis is that an injury or disruption of pancreatic acinar cells allows leakage of the pancreatic enzymes into pancreatic tissue. The leaked enzymes (trypsin, chymotrypsin, and elastase) become activated in the tissue and start the process of autodigestion. Pancreatitis is one of the most common pancreatic diseases; it is not caused by diabetes. The activated enzymes break down tissue and cell membranes, causing edema, vascular damage, hemorrhage, necrosis, and fibrosis. These now toxic enzymes and inflammatory mediators are released into the bloodstream and cause injury to vessel and organ systems, such as the hepatic and renal systems.

he nurse is caring for a patient with hepatic encephalopathy. Which prescribed medication should the nurse question before providing to this patient? a. Vitamin K b. Neomycin sulfate c. Diazepam (Valium) d. Lactulose (Cephulac)

ANS: C The nurse should question medications such as sedatives, opioids, and tranquilizers because these can precipitate hepatic encephalopathy. Valium is a sedative. A. B. D. These medications are all used in the treatment of liver disorders.

A 22-year-old with acute myelogenous leukemia who is receiving outpatient chemotherapy develops an absolute neutrophil count of 900/l. Which action by the nurse in the outpatient clinic is most appropriate? a. discuss the need for hospital admission to treat the neutropenia b. plan to discontinue the chemotherapy until the neutropenia resolves c. teach the pt how to adminsiter neuopogen injections at home d. obtain a high efficiency particulate air filter for the patient for home use

ANS: C The patient may be taught to self-administer filgrastim injections. Although chemotherapy may be stopped with severe neutropenia (neutrophil count less than 500/l), administration of filgrastim usually allows the chemotherapy to continue. Patients with neutropenia are at higher risk for infection when exposed to other patients in the hospital. HEPA filters are expensive and are used in the hospital, where the number of pathogens is much higher than in the patients home environment.

A patient with liver failure and esophageal varices is prescribed to receive vasopressin. What should the nurse realize is the purpose for this medication? a. To promote portal circulation b. To reduce ammonia buildup and encephalopathy c. To constrict vessels causing bleeding in esophageal varices d. To maintain blood pressure in a patient with hypotension related to bleeding

ANS: C Vasopressin is a vasoconstrictor and will reduce bleeding in varices. A. It reduces, and does not promote, circulation. D. It can maintain blood pressure, but that is not the primary reason it is given to patients with varices. B. It does not affect ammonia levels.

The nurse is caring for a patient diagnosed with chronic hepatitis B. Which medications should the nurse anticipate being prescribed for this patient? (Select all that apply.) a. Interferon alpha-2a b. Ribavirin (Rebetol) c. Adefovir (Hepsera) d. Lamivudine (Epivir) e. Peginterferon alpha-2b

ANS: C, D To manage chronic hepatitis B infection, the antivirals adefovir (Hepsera) or lamivudine (Epivir) may be used. A. B. Interferon therapy (peginterferon alpha-2b [Peg-Intron] or interferon alpha-2a [Pegasys]) along with an antiviral medication (oral ribavirin [Rebetol]) is considered to prevent chronic hepatitis C infection.

A patient with pancreatitis is receiving care to address the nursing diagnosis Imbalanced Nutrition: Less than required related to pain, NPO, and nasogastric suction. After 10 days of treatment, which findings should indicate to the nurse that the treatment plan has been effective? (Select all that apply.)a. The patient reports pain relief. b. The serum sodium is 130 mEq/L. c. The patients albumin level is 3.8 g/L. d. The serum potassium level is 3.7 mEq/L. e. The patient has mild diarrhea and steatorrhea. f. The patient has returned to baseline body weight.

ANS: C, F An albumin level greater than 3.5 mg/dL and return to baseline weight are evidence of improving nutrition. A. D. These are good results but are not directly related to nutrition goals. E. Mild diarrhea and steatorrhea are not desirable outcomes. B. The sodium value is lower than normal and indicates continued electrolyte imbalance.

The nurse is caring for a patient after a liver transplant. Which symptom should the nurse report immediately as a possible indication of rejection of the liver? a. Pulse rate of 80 beats per minute b. Prothrombin time (PT) of 14 seconds c. Decreased alanine aminotransferase (ALT) d. A temperature greater than 101F (38.3C)

ANS: D A fever is associated with immune system activity and possible rejection. C. Decreased ALT is desirable in liver disease. B. Normal PT is 8.8 to 11.6 seconds, so 14 seconds is near normal. A. Pulse of 80 beats/min is normal.

the nurse is caring for a 20 year old female patient with sickle cell trait. which statment accurately reflects this patients condition? a. the condition will evolve into sickle cell anemia as she ages b. all of her children will have sickle cell anemia c. the trait will be transmitted to her male children only d. the trait can be passed down to all children

ANS: D A person who has the trait can pass it on to male or female children, even if there are no symptoms. Fifty percent of the patient's total hemoglobin may be affected. Age does not increase the chance of the trait evolving into the disease.

The nurse is caring for a patient with chronic liver failure. Which medication order should the nurse question? a. Lactulose b. Neomycin c. Multivitamins d. Acetaminophen

ANS: D Acetaminophen (Tylenol) overdose is the most common cause of ALF. Acetaminophen should not exceed 3000 mg in a 24 hour period. A. B. C. Multivitamins, Lactulose, and Neomycin are all used to treat symptoms of liver disease

A patient with acute pancreatitis is experiencing severe pain. What position should the nurse encourage the patient to assume? a. Semi-Fowlers position b. Prone with a pillow under the abdomen c. Supine with legs elevated and head on a small pillow d. Sitting in a chair leaning forward with a pillow for back support

ANS: D An upright position keeps abdominal organs from pressing against the inflamed pancreas. A. B. C. These positions increase the risk of organs pressing against the pancreas

The nurse is caring for a patient with esophageal varices. Which symptom should alert the nurse to possible bleeding? a. Asterixis b. Dark amber urine c. Hard formed stool d. Blood-streaked emesis

ANS: D Blood from varices may streak emesis or may be more frank. B. C. Constipation and dark urine may accompany liver disease but are not signs of bleeding. A. Asterixis is a sign of encephalopathy.

The nurse is caring for a patient with hepatitis. The nurse explains that jaundice occurs in conjunction with hepatitis based on which underlying pathophysiology? a. Liver ischemia in hepatitis causes jaundice. b. Increased bile production by the enlarged Kupffer cells causes jaundice. c. The hepatitis virus destroys red blood cells and causes jaundice. d. Hepatitis causes liver congestion that obstructs bile flow.

ANS: D Congestion from the inflammation obstructs the bile from entering the duodenum and keeps it in the circulating volume.

Which laboratory test will the nurse use to determine whether the prescribed filgrastim (Neupogen) is effective in the treatment of a patient who is receiving chemotherapy for acute lymphocytic leukemia? a. platelet count b. reticulocyte count c. total lymphocyte count d. absolute neutrophil count

ANS: D Filgrastim increases the neutrophil count and function in neutropenic patients. Although total lymphocyte, platelet, and reticulocyte counts also are important to monitor in this patient, the absolute neutrophil count is used to evaluate the effects of filgrastim.

A 20-year-old college student who has not been immunized against hepatitis B virus (HBV) comes to the clinic and reports that he has been exposed to hepatitis B. The nurse anticipates that the health care provider will likely recommend which treatment? a. A prescription for a broad-spectrum antibiotic b. A prescription for an antiviral agent c. The first of the three immunizations for HBV d. An injection of hepatitis B immune globulin (HBIG)

ANS: D HBIG will give immediate passive immunity. Immunization for HBV takes too long for immediate coverage. Oral medications are of little value at this stage.

The nurse is collecting data from a patient with acute pancreatitis. Which symptoms should the nurse anticipate? a. Low abdominal pain, bradycardia, and confusion b. Shortness of breath, hypotension, and restlessness c. Fever, tachycardia, right upper quadrant pain, and jaundice d. Abdominal distention, respiratory distress, and mid-epigastric pain

ANS: D Patients with acute pancreatitis are very ill, with dull abdominal pain, guarding, a rigid abdomen, hypotension or shock, and respiratory distress from accumulation of fluid in the retroperitoneal space. The abdominal pain is generally located in the midline just below the sternum, with radiation to the spine, back, and flank. A. B. C. These manifestations are not associated with pancreatitis.

The patient is complaining of severe joint pain as well as fatigue and shortness of breath. The nurse notices that the patients joints are swollen and his legs are edematous. The nurse realizes that these are symptoms of: a. anemia reflective of low volume b. aplastic anemia c. hemolytic anemia d. sickle cell anemia

ANS: D Patients with sickle cell anemia may have joint swelling or pain, and delayed physical and sexual development. In crisis, the sickle cell patient often has decreased urine output, peripheral edema, and signs of uremia because renal tissue perfusion is impaired as a result of sluggish blood flow.

The nurse evaluates a need for further instruction to the patient with sickle cell anemia when he says: a. i know im not supposed to drink iced drinks b. i surely do miss my three beers in the afternoon c. i walk everyday rather than doing other strenous exervise d. i am looking forward to my annual ski trip to colorado

ANS: D People with sickle cell anemia should avoid cold temperatures and high altitudes, which can bring on a crisis due to thickening of the blood. Avoidance of iced drinks, alcohol, and strenuous exercise is beneficial.

the nurse is providing discharge teaching for a patient who underwent a laparoscopic cholecystectomy. Which statement indicates that the nurses teaching has been successful? a. i should call my doctor if i have any pain b. i should be able to go back to work tomorrow c. i should avoid fatty foods for a few weeks d. i should let these steri strips fall off on their own

ANS: D The nurse should teach the patient to remove the bandages from the puncture site(s) the day after surgery and shower, leaving the Steri-Strips intact. Steri-Strips will fall off in 7 to10 days. The patient should notify the physician in cases of severe abdominal pain that is not relieved by medication or is worsening. Return to work is probable at 1 week postsurgery. The patient should adhere to a low-fat diet for several weeks and slowly introduce fattier foods to determine if they cause unpleasant symptoms.

A 64-year-old with acute myelogenous leukemia (AML) who has induction therapy prescribed asks the nurse whether the planned chemotherapy will be worth undergoing. Which response by the nurse is appropriate? a. if you do not want to have chemotherapy, there are other options for treatment such as stem cell transplantation b. The decision about chemotherapy is one that you and the doctor need to make rather than asking what I would do. c. You dont need to make a decision about treatment right now since leukemias in adults tend to progress quite slowly. d.The side effects of the chemotherapy are difficult, but AML frequently does go into remission with chemotherapy.

ANS: D This response uses therapeutic communication by addressing the patients question and giving accurate information. The other responses either give inaccurate information or fail to address the patients question, which will discourage the patient from asking the nurse for information.

Which of the following should the nurse instruct a client who is receiving treatment for the diagnosis of leukemia? (Select all that apply.) a. see a dentist regularly b. increase fluids c. report any fatigue to the physician d. exepct to have frequent coughs and colds e. use sunblock when outdoors f. report gastrointestinal distress to physician

ANS: a b e f Nursing care for a client diagnosed with leukemia should include regular dental care, increasing fluids, using a sunblock when outdoors, and reporting gastrointestinal distress to the physician. Fatigue is common with this illness and does not need to be reported to the physician. Frequent coughs and colds could be signs of a severe infection and should be reported to the physician.

The nurse is teaching a patient with sickle cell anemia how to prevent crises. Which foods should the nurse teach the patient to avoid? a. citrus fruits b. alcoholic beverages c. chocolates and colas d. whole grain products

ANS: b Alcohol can trigger a sickle cell crisis. A. C. D. Citrus, chocolate, and whole grains are not known to trigger crises.

when the liver is seriously damaged, ammonia levels can rise in the body. one of the treatments for this is a. administering IV neomycin b. giving vitamin k c. giving lactulose d. starting the pt on insulin

ANS: c Lactulose is a laxative that works by pulling water into the stool. It also helps pull ammonia from the blood into the colon for expulsion. IV antibiotics do not reduce serum ammonia levels. Vitamin K controls bleeding, but it does not reduce ammonia levels. Insulin is not used to reduce ammonia levels.

The nurse admits a client who is in sickle cell crisis to the hospital. Which does the nurse prepares the priority in the management of the client? 1 Pain management 2 Fluid administration 3 Oxygen administration 4 Red blood cell transfusion

Answer: 3Rationale: The priority nursing intervention for a client in sickle cell crisisis to administer supplemental oxygen because the client is hypoxemic, and as a result, the red blood cells change to the sickle shape. In addition,oxygen is the priority because airway and breathing are more important than circulatory needs. The nurse also plans for fluid therapy to promote hydration and reverse the agglutination of sickled cells, opioid analgesicsfor relief from severe pain, and, blood transfusions to increase the blood'soxygen-carrying capacity.

A client who usually smokes a pack of cigarettes a day tells the nurse that he cannot stand the smell of smoke. The nurse realizes that this client is in which phase of hepatitis? a. preicteric b. icteric c. posticteric d. recovery

a In the preicteric phase of hepatitis, some smokers will have an aversion to smoking as a first sign of the disease. Smoking is not affected with the icteric or posticteric phases of the disease. Recovery is not a phase of hepatitis.

A client diagnosed with acute myeloid leukemia is recovering from a bone marrow transplant. Which of the following nursing interventions would not be appropriate for this client? a. assess for reactions to anesthesia b. assess vital signs c. maintain isolation precautions d. obtain a low pressure mattress to prevent skin breakdown

a The client having a bone marrow transplant does not receive anesthesia. Maintaining skin integrity, implementing isolation precautions, and monitoring vital signs are appropriate nursing measures for the client recovering from a bone marrow transplant.

A client, diagnosed with acute lymphoblastic leukemia, is receiving the first phase of chemotherapy. The nurse realizes this client is in which phase of treatment for the disorder? a. induction b. consolidation c. maintenance d. central nervous system prophylaxis

a The primary goal of therapy for this type of leukemia is complete remission with restoration of normal hematopoiesis. Induction chemotherapy is administered first. Consolidation occurs afterwards. Maintenance therapy then occurs followed by central nervous system prophylaxis.

the client diagosed with leukemia is being admitted for an induction course of chemotherapy. which laboratory values indicate a diagnosis of leukemia> a. a left shift in the white blood cell count differential b. a large number of wbcs that decreases after the administration of antibiotics c. an abnormally low hemoglobin and hematocrit level d. red blood cells that are larger than normal

a a left shit indicates immature white blood cells are being produced and released into the circulating blood volume, this should be investigated for the malignant process of leukemia

the nurse is assessing a client diagnosed with acute myeloid leukemia, which assessment data supports this diagnosis? a. fever and infections b. nausea and vomiting c. excessive energy and high platelet counts d. cervical lymph node enlargement and positive acid fast bacillus

a fever and infection are hallmark symptoms of leukemia. they occur because the bone marrow is unable to produce white blood cells of the number and maturity needed to fight infection

the nurse is administering a pancreatic enzyme to the client diagnosed with chronic pancreatitis. Which statement best explains the rationale for administering this medication a. it is an exogenous source of protease, amylase, and lipase b. this enzyme increases bowel movements c. this medication breaks down in the stomach to assist with digestion d. pancreatic enzymes help break down fat in the small intestine

a pancreatic enzymes enhance digestion starches in the gi tract by supplying outside sources of protease, amylase, and lipase

the nurse is preparing to administer am medication to clients. which medication should the nurse question before giving? a. pancreatic enzymes to the client who has finished breakfast b. the pain medication, morphine to the client who has RR of 20 c. the loop diuretic to the client with potassium level of 3.9 d. the beta blocker to the client who has an apical pulse of 68

a pancreatic enzymes must be given with meals to enhance digestion of starches and fats in the GI tract

In caring for a patient with hepatitis B, a nurse would employ which precautions? a. Standard Precautions b. Strict isolation c. Contact Precautions d. Surgical asepsis

a standard precautions are needed to care for a pt with hepatitis B. isolation and contact precautions are not indicated for this diagnosis unless experiencing active bleeding

the client is diagnosed with cancer of the head of the pancreas. which signs and symptoms should the nurse expect to assess a. clay colored stools and dark urine b. night sweats and fever c. left lower abdominal cramps and tenesmus d. nausea and coffee ground emesis

a the client will have jaundice, clay colored stools, and tea colored urine resulting from blockage of the bile drainage

the public health nurse is teaching day care workers. which type of hepatitis is transmitted by the fecal oral route via contaminated food, water, or direct contact with an infected person? a. hepatitis a b. hepatitis b c. hepatitis c d. hepatitis d

a the hepatitis a virus is in the stool of infected people and takes up to two weeks before symptoms develop

which signs symptoms should the nurse expects to assess in the client diagnosed with hemophilia A a.. epistaxis b. petechiae c. subcutaneous emphysema d. intermittent claudication

a nose bleeds along with hemarthosis, cutaneous hematoma formation, bleeding gums, hematemsis, occult blood and hematuria are all signs of hemophilia

Which factor(s) may be causative for leukemia? (Select all that apply.) a. Radiation exposure b. Pesticides exposure c. Benzene exposure d. Frequent bacterial infections e. Virulent viral infections

a b c exposure to radiation, pesticides and benzenes has been linked to potential causes of leukemia

The nurse is discussing the impact of cirrhosis on liver function with the family of a dying patient. The nurse explains that, when the damage caused by cirrhosis blocks the blood flow through the liver, it can lead to which complication(s)? (select all that apply.) a. Portal hypertension b. Decrease in metabolic processes of the liver c. Decrease in clotting factors d. Increase in ascites e. Decrease in aldosterone

a b c d Cirrhosis is a progressive, chronic disease of the liver. The destruction of normal hepatic structures and their replacement with necrotic tissue occur. Fibrous bands of connective tissue develop in the organ. The bands eventually constrict and partition the liver tissue into irregular nodules. If this process is halted before too much liver tissue is damaged, the liver tissue will regenerate. Late cirrhosis is considered irreversible. The outcomes of cirrhosis of the liver are failure of its cells to perform their functions and the development of portal hypertension. Aldosterone levels are increased rather than decreased.

A client is diagnosed with portal hypertension. The nurse should assess the client for which of the following disorders associated with this diagnosis? (Select all that apply.) a. esophageal varices b. splenomegaly c. hemerrhoids d. caput medusa e. gastritis f. gall stone formation

a b c d Portal hypertension can lead to the development of esophageal varices, splenomegaly, hemorrhoids, and caput medusae. Portal hypertension does not lead to gastritis or gallstone formation.

A client is recovering from an endoscopic retrograde cholangiopancreatogram (ERCP). Which of the following should the nurse assess as possible complications from this procedure? (Select all that apply a. perforation of the stomach b. perforated duodenum c. pancreatitis d. aspiration of gastric contents e. anaphylactic reaction to the contrast dye f. perforated bladder

a b c d e Potential complications of an ERCP are perforated stomach and duodenum, pancreatitis, anaphylactic reaction to the contrast diet, aspiration of gastric contents, and reaction to anesthesia. A perforated bladder is a possible complication from a paracentesis.

A client is diagnosed with a disorder of the liver. The nurse realizes this client might experience which of the following? (Select all that apply.) a. low vitamin a levels b. increased bleeding c. poor digestion of fats d. insulin resistance e. elevated levels of vitamin e f. nerve damage

a b c d f

A client diagnosed with cirrhosis is experiencing the complication of ascites. Which of the following would be considered treatment for this complication? (Select all that apply.) a. fluid restriction b. low sodium diet c. increased exercise d. diuretic therapy e. pain medication f. bed rest

a b d Ascites is the accumulation of fluid in the peritoneal cavity. Treatment strategies include fluid restriction (1000 to 1500 mL/day), low-sodium diet (200 to 500 mg/day), and diuretic therapy to remove the excessive fluid. Increased exercise, pain medication, and bed rest are not included as treatments for this complication.

The nurse points out to a patient recently diagnosed with hepatitis B virus (HBV) that the virus is found which type(s) of body fluid(s) or secretions? (select all that apply.) a. Semen b. Vaginal secretions c. Sweat d. Breast milk e. Human feces

a b d e HBV, hepatitis C virus (HCV), and hepatitis D virus (HDV) may cause chronic inflammation and necrosis of the tissue. HBV and HCV are transmitted by parenteral routes and sexually as they are present in semen, vaginal secretions, and saliva of carriers, as well as breast milk and human feces. HBV is not transmitted through sweat. Sexual partners of patients who are carriers of HBV and HCV are at high risk for contracting the virus.

The patient with AML has a platelet count of 95,000. What interventions should the nurse include in the patient's care plan? (Select all that apply.) a. Observe for melena and hematuria. b. Instruct the patient to brush and floss at least twice daily. c. Measure abdominal girth daily. d. Apply ice and pressure to puncture sites. e. Instruct the patient to use an electric razor.

a c d e a low platelet makes the pt prone to excessive bleeding. The nurse should monitor for bleeding into the stool and urine. An increase in the abdominal girth will alert the nurse to the possibility of internal bleeding. Ice and pressure on puncture sites aid in stopping bleeding. An electric razor reduces the chance of the patient being cut during shaving. Soft toothbrushes will decrease the likelihood of the gums bleeding, and the patient should not floss too frequently or brush teeth aggressively.

the client diagnosed with leukemia is cheduled for bone marrow transplantation. which interventions should be implemented to prepare the client for this procedure? SATA a. administer high dose chemotherapy b. teach the client about autologous transfusions c. have the family members HLA typed d. monitor the complete blood cell count daily e. provide central line care per protocol

a c d e all of the bone marrow cells must be destroyed prior to implanting the healthy bone marrow. the best bone marrow donor comes from an identical twin, the next best is a sibling. the most complicattions occur from a matched unrelated donor. The CBC must be monitored daily to assess for infections, anemia, and thrombocytopenia. clients will have at least one cnetral venous access

A client diagnosed with sickle-cell anemia is experiencing vaso-occlusive crisis. Which of the following interventions would be appropriate for this client? (Select all that apply.) a. administering oxygen b. decreasing hydration c. managing pain d. promoting activity e. encouraging rest f. restricting calories

a c e The nursing management of sickle-cell anemia is to manage pain and prevent sickling. This type of management is accomplished by adequate hydration, oxygenation, adequate nutrition, rest, medications, management of fever and complications, and use of transfusions. Restricting fluids and calories could be detrimental to the clients recovery. The client should be encouraged to rest and not engage in activity.

the nurse is providing education to an individual with sickle cell anemia. Which activities should the nurse instruct the patient to avoid? (Select all that apply.) a.Scuba diving b.Contact sports c.Sexual activity d.Long-distance driving e.Skiing in the mountains f.Standing for long periods

a e Factors that contribute to the development of a sickle cell crisis include those related to decreased oxygenation. At high altitudes or in scuba diving, there is less oxygen available, making skiing in the mountains or scuba diving unsafe for someone with sickle cell anemia. B. C. D. F. Sexual activity, driving, standing, and contact sports should not alter oxygenation.

the client in end stage liver failure has vitamin k deficiency. which interventions should the nurse implement? SATA a. avoid rectal temperatures b. use a soft bristled tooth brush c. monitor platelet count d. use small guaged needkes e. assess for asterixis

a. vitamin k causes impaired coagulation therefore rectal temps should be avoided, soft tooth brushes prevent bleeding, PTT/INR should be monitored, injections should be avoided

a pt with sickle cell anemia asks the nurse why the sickling crisis does not stop when o2 therapy is started. the nurse explains that a. sickling occurs in response to decreased blood viscosity, which os not affected by o2 therapy b. when rbc sickle, they occlude small vessels, which cause more local hypoxia and more sickling c. destruction of abnormal cells results in fewer rbc to carry o2 d. o2 therapy does not alter shape of abnormal erythrocytes, but allows increased o2 concentration in hemoglobin

answer b: during a crisis sickling cells clog small capillaries and resulting hemostasis promotes self perpetuating cycle of local hypoxia, deoxygenation, or more erythrocytes and more sickling. administration of o2 mau help further sickling, but additional o2 does not reach areas of local hypoxia caused by occluded vessels

A client is admitted to the hospital in sickle cellcrisis. The nurse monitors the client for whichclinical indicator of the disorder? 1 Pain 2 Diarrhea 3 Bradycardia 4 Blurred vision

answer: 1 pain Sickle cell crisis usually causes severe pain in the bones andjoints along with joint swelling. The pain develops as a result of microvascularocclusion from abnormal sickled hemoglobin that occurs withhypoxia. Therapy includes pain management with opioid analgesics,supplemental oxygen, and intravenous fluids. The remaining optionsare not associated with sickle cell crisis.

a clinic nurse instructs the mother of a child with sickle cell disease about the precipitating factors related to pain crisis. which of the following, if identified by the mother as a precipitating factor, indicates the need for further instructions a. infection b.trauma c. fluid overload d. stress

answer: c Pain crisis may be precipitated by infection, dehydration, hypoxia, trauma, or physical or emotional stress. THe mother of a child with sickle cell disease should encourage fluid intake of 1.5-2 times the daily requirement to prevent dehydration!

a child is suspected of having sickle cell disease is seen in a clinic, and lab studies are performed. a nurse checks the laboratory work results, knowing that which of the following would be increased in this disease a. platelet count b. hematocrit level c. reticulocyte count d. hemoglobin level

answer: c Rationale: A diagnosis is established based on a complete blood count, examination for sickled red blood cells in the peripheral smear, and hemoglobin electrophoresis. Laboratory studies will show decreased hemoglobin and hematocrit levels and a decreased platelet count, an INCREASED reticulocyte count and the presence of nucleated red blood cells. Increased reticulocyte counts occur in children with sickle cell disease because the life span of their sickled red blood cells is shortened.

Which of the following should the nurse include in the instructions provided to a client with sickle cell anemia?S elect all that apply 1. Administer pain medications 2. Encourage fluids 3. treat the presence of infection 4. A void informing others of the condition 5. Vigorous exercise is permitted 6. Inform the client that the disorder is nothereditary

answers. 1. 2. 3. Recognition of the signs of a vaso-occlusivecrisis and knowledge of the measures toprevent it are very important in keeping thehealth of a client with sickle cell anemia incontrol. It is essential to administer painmedications, encourage fluids, and treatinfections. Individuals may fear the disease, buteducating friends of the client is a healthyapproach to the disease. Dehydration fromexcessive exercise or heat can precipitate acycle of pain. Sickle cell anemia is a geneticdisorder, and counseling of couples before theyhave offspring is recommended. T he nurse has started a

T he nurse is admitting a client suspected ofhaving sickle cell anemia. The client has a feverof 38.9°C or 102°F, faint yellow-tinged sclera,and is complaining of abdominal pain. Whichof the following clinical manifestations furthersupport this diagnosis? select all that apply. 1. Rapid but regular breathing 2. P ale, dilute urine 3. S kin ulcers on the lower extremities 4. Swollen fingers 5. Pallor 6. Fatigud

answers: 3,4,5, 6 the lient with sickle cell anemia develops skin ulcers on the lower extremities form vaso-occlusive aspects of the disease. the client would have shortness of breath, and be fatigued and pale. they may have swollen fingers, hemolysis of rbc results in billrubinuria. the clients urine is dark colored

The anemia of sickle cell disease is caused by a. intravascular hemolysis of sickled rbc b. accelerated breakdown of abnormal rbc c. autoimmune antibody destruction of rbc d. isoimmune antibody antien reactions with rbc

b

the client diagnosed with sickle cell anemia comes to the emergency dept complaining of joint pain throughout the body. the oral temperature is 102.4 degrees and the pulse oximeter reading is 91%. which action should the emergency nurse implement first? a. request arterial blood gases STAT b. administer oxygen via nasal cannula c. start an IV with an 18 guage catheter d. prepare to administer analgesics as ordered

b a pulse oximeter reading of less than 93% indicates hypoxia, which warrants oxygen

a client is scheduled for a liver biopsy. The nurse realizes that the most important sign to assess for is: a. infection b. bleeding c. pain d. nausea and vomiting

b After a liver biopsy, the client is monitored for bleeding or hemorrhage. Infection and pain are of concern, but they are not the most important signs to be monitored. Nausea and vomiting are not typically associated with a liver biopsy

A school age child is placed on a waiting list for a liver transplant. The nurse knows that the most common reason for children to need this type of transplant is because of: a. cirrhosis due to hepatitis c b. bilary atresia c. diabetes d. crohns disease

b Biliary atresia is the most common reason for children to have a liver transplant. Cirrhosis due to hepatitis C is the reason for most adults to have a transplant. Children do not typically need a liver transplant for diabetes or Crohns disease.

A client is diagnosed with macrovesicular fatty liver. Which of the following should the nurse instruct this client? a. expect to develop jaundice b. avoid all alcohol c. increase exercise d. treatment includes antibiotic therapy

b The client diagnosed with macrovesicular fatty liver should be instructed to avoid all alcohol. Jaundice is a symptom of microvesicular fatty liver. The client should be instructed to rest. Antibiotic therapy is not indicated for macrovesicular fatty liver.

The nurse is caring for a patient with cirrhosis. The nurse is educating the patient about nutritional implications related to his diagnosis. Which statement indicates that the nurse's teaching has been successful? a. "I should eat lots of sweet potatoes and carrots for vitamin A." b. "I should choose proteins like cottage cheese and quinoa instead of chicken." c. "I should eat oysters and shellfish for a good source of copper." d. "I should eat red meat and dark, leafy vegetables to boost my iron stores."

b Traditionally, limitation of dietary protein intake was prescribed; however, this approach is being challenged and the current recommendation is to manage encephalopathy with medications rather than to restrict protein. Vegetable proteins are preferred because they do not contribute to encephalopathy. Substituting meat proteins for protein sources like quinoa and cottage cheese is a good dietary choice. Patients with liver inflammation or cirrhosis should avoid taking large doses of vitamins and minerals. Vitamin A, iron, and copper can worsen the liver damage, so this patient should not try to increase intake of these vitamins and minerals.

which instruction should the nurse discuss with the client who is in the icteric phase of hepatitis C? a. decrease alcohol intake b. encourage rest periods c. eat a large evening meal d. drink diet drinks and juices

b adequate rest is needed for maintaining optimal immune function

a client diagnosed with acute myeloid leukemia receives a bone marrow transplant. which medication to prevent graft versus host disease should a nurse anticipate in receiving an order to administer? a. a cephalosporin antibiotic such as cetazidine (Fortaz) b. an immunosuppresent such as cyclosporine (neoral) c. a chemotherapeutic agent such as cisplatin (platinol a-q) d. peginterferon alfa-2a for prevention and tx of hepatitis

b an immunosuprressant prevents the immune response from occuring during transplant

which client problem has priority for the client diagnosed with acute pancreatitis? a. risk for fluid volume deficit b. alteration in comfort c. imbalanced nutrition less than body requirements d. knowledge deficit

b autodigestion of the pancreas results in severe epigastric pain,accompanied by nausea vomiting abdominal tenderness and muscle gaurding

the client diagnosed with liver problems asks the nurse "why are my stools clay colored" on which scientific rational should the nurse base the response? a. there is an increase in serum ammonia level b. the liver is unable to excrete bilirubin c. the liver is unable to metabolize fatty foods d. a damaged liver cannot detoxify vitamins

b billirubin the biproduct of red blood cell destruction is metabolized in the liver and excreted via the feces, which causes the feces to be brown in color, if the liver is damaged, the bilirubin is excreted via urine and skin

the client with hemophilia a is expierencing hemarthorisis. which intervention should the nurse recommend to the client a. alternate aspirin and acetaminophen to help with pain b. apply cold packs for 24-48 hours to the affected area c. perform active range of motion exercise on the extremity d. put the affected extremity in the dependent position

b hemarthosis is bleeding into the joint, applying ice to the area can help with vasoconstriction

which type of precaution should the nurse implement to protect from being exposed to any of the hepatitis virus a. airborne precautions b. standard precautions c. droplet precautions d. exposure precautions

b standard precautions apply to blood, bodily fluids, secretions and excretions

the nurse is assessing a client with complaints of vague upper abdominal plan worse at night but relieved by sitting up and leaning forward. which assessment does the nurse ask next a. have you noticed a yellow haze when you look at things b. does the pain get worse when you eat a meal or snack c. have you had your amylase and lipase checked recently d. how much weight have you gained since you saw an hcp

b the abdominal pain is often made worse by eating and lying supine in diagnosed with cancer of the pancreas

the female nurse sticks herself with a contaminated needle. which action should the nurse implement first a. notify the infection control nurse b. cleanse the area with soap and water c. request postexposure anaphylaxis d. check the hepatitis status of the client

b the nurse should first clean the needle stick with soap and water to remove any virus into the skin

which nursing interventions should the nurse implement when caring for a client diagnosed with hemophilia A. SATA a. instruct the client to use a razor blade to shave b. avoid administering enemas to the client c. encourage participation in noncontact sports d. teach the client how to apply direct pressure if bleeding occurs e. explain the imporance of not flossing the gums

b c d enemas, rectal thermometers and IM injections can pose a risk of tissue and vascular trauam that can precipitate bleeding, even minor trauma can lead to serious bleeding episodes, direct pressure occludes bleeding vessels

which assessment question is priority for the nurse to ask the client diagnosed with end stage liver failure a. how many years have you been drinking alcohol b. have you completed an advanced directive c. when did you have your last alcoholic drink d. what foods did you eat at your last meal

c

A patient is admitted in sickle cell crisis with symptoms of dyspnea and leg pain. The patients significant other asks, I dont really understand why he is hurting so badly. Which response by the nurse is best? a. the pain is due to a disturbance in cellular metabolism b. the bone marrow is expanding with the sickle cells and that causes pain c. clumping of abnormal red blood cells block the flow of blood through the capillaries d. bleeding in the joints occurs because red blood cells are being rapidly destroyed by the bone marrow

c As sickling occurs, blood becomes sluggish and does not flow easily. It tends to collect in the capillaries and veins of the organs of the chest and abdomen, as well as joints and bones, and can cause infarction (tissue necrosis resulting from lack of blood supply). Tissue necrosis results in pain, fever, and swelling. A. B. Pain from sickle cell anemia is not associated with changes in cellular metabolism or bone marrow pathology. D. Bleeding into joints is more common with hemophilia.

Because health care workers are at a greater risk of hepatitis B infection, it is recommended that all health care workers: a. wash their hands often b. avoid foreign travel c. become vaccinated d. drink bottled water only

c Because of the risk of blood and body fluid exposure, it is recommended that all health care workers be vaccinated against hepatitis B virus. All health care workers should engage in frequent handwashing, but handwashing is not the primary mechanism to prevent the onset of hepatitis B. Avoiding foreign travel and drinking bottled water only will not reduce the risk of hepatitis B.

The nurse, caring for a client recovering from the placement of a shunt to treat portal hypertension, should assess the client for which of the following complications associated with this surgery? a. myocardial infarction b. pulmonary emboli c. pulmonary edema d. decreased peripheral pulses

c Complications after shunt surgery include the development of pulmonary edema. Myocardial infarction, pulmonary emboli, and decreased peripheral pulses are not complications associated with this type of surgery.

during the health history portion of the assessment, the client states, i have sickle cell trait. The nurse realizes that: a. precautions should be taken to prevent the cell from sickling b. the client is a carrier c. the client will show signs of the disease as she grows older d. the client will transmit the disease to any off spring

c Sickle-cell anemia is an autosomal recessive disorder passed from parent to offspring in this pattern. An individual with one HbS has the sickle-cell trait and has a 50% chance of transmitting the gene to each child. There are no precautions to take to prevent the cell from sickling. The client will not demonstrate signs of the disease as she grows older. It will depend upon the other parent having the trait if any offspring will be affected with the disorder.

A female client is surprised to learn that she has been diagnosed with hemochromatosis. Which of the following should the nurse respond to this client? a. it doesnt affect people after they are in their 50s b. i would ask the doctor if hes sure about the diagnosis c. females often do not experience the effects of the disease until menopause d. all women have the disorder but not the symptoms

c Women do not experience the effects of hemochromatosis until menopause when the regular loss of blood stops. This disorder is a genetic disorder and can affect individuals of all ages. The nurse should not doubt the physicians diagnosis. All women do not have this disorder.

a nurse teaches a coworker that the treatment of hemophilia will likely include periodic self administration of a. platelets b. whole blood c. factor concentrates d. fresh frozen plasma

c a person with hemophilia a is deficient in factor VIII

which medication is contraindicated for a client diagnosed with leukemia? a. bactrim, a sulfa antibiotic b. morphine, a narcotic analgesic c. epogen, a biologic response modifier d. gleevec, a genetic blocking agent

c epogen is a biologic response modifier that stimulates the bone marrow to produce red blood cells. tge bone marrow is the area of malignancy in leukemia, stimulating the bone marrow would be generally ineffective for the desired results and would have the potential to stimulate malignant growth

The nurse realizes that the organ which is a major site for metastases, harboring and growing cancerous cells that originated in some other part of the body, is the: a. spleen. b. gallbladder. c. liver. d. stomach.

c in most developed countries, this secondary type of liver cancer is more common than cancer that originates in the liver itself. The spleen, gallbladder, and stomach are not major sites for metastases.

the nurse is planning a program for clients at a health fair regarding the prevention and early detection of cancer of the pancreas. which self care activity should the nurse discuss which is an example of a primary nursing intervention a. monitor for elevated blood glucose levels at random intervals b. inspect the skin and sclera of the eyes for a yellow tint c. limit meat in the diet and eat a low fat diet d. instruct the client with hyperglycemia about insulin injections

c limiting the intake of meat and fats in the diet is an example of primary interventions

the client diagnosed with leukemia has central nervous system involvement. which of the following instruction should the nurse teach? a. sleep with the head of the bed elevated to prevent increased intracranial pressure. b. take an analgesic medication for pain only when the pain becomes severe c. explain radiation therapy to the head may result in permanent hair loss d. discuss end of life decisions prior to cognitive deterioration

c radiation to the head and scalp area is the treatment of choice for central nervous system involvement of any cancer. radiation therapy has longer lasting side effects than chemotherapy.

the client is admitted to the medical department with a diagnosis of r/0 acute pancreatitis. which laboratory values should the nurse monitor to confirm this diagnosis a. creatinine and BUN b. troponin and CK-MB c. serum amylase and lipase d. serum billirubin and calcium

c serum amylase increases within 2-12 hours of the onset of acute pancreatitis to two to three times normal and returns within 4 days; lipase elevates for seven to 14 days

the client diagnosed with acute pancreatitis is in pain. which position should the nurse assist the patient to assume to help decrease pain? a. recommend lying in prone position with legs extended b. maintain a tripod position over the bedside table c. place in side lying position with knees flexed d. encourage supine position with pillow under the knees

c the fetal position decreases pain caused by stretching of the peritoneum as result of edema

the client admitted to rule out pancreatic tumors complains of fealing weak, shaky and sweaty. Which priority intervention should be implemented by the nurse a. start an iv with d5w b. notify the health care provider c. perform glucose check d. explain the client should eat as much as possible

c these are symptoms of hypoglycemia

which is apotential complication that occurs specifically to a male client with diagnosed with sickle cell anemia during a sickle cell crisis? a chest syndrome b. compartment syndrome c. priapism d. hypertensive crisis

c vasoocclusive crisis, the most frequent crisis, is characterized by organ infarction, which will result in blood urine secondary to kidney infarction

A client is diagnosed with liver disease. Which of the following is one impact of this disorder on a clients fluid and electrolyte status? a. hyperkalemia b. hypercalcemia c. hypernatremia d. hyponatremia

d Liver disease effects the fluid and electrolyte status by causing ascites, edema, hypokalemia, hypocalcemia, and hyponatremia. Liver disease does not cause hyperkalemia, hypercalcemia, or hypernatremia.

A pediatric nursing instructor asks a nursing student to describe the cause of the clinical manifestations that occur in sickle cell disease. The student responds correctly by telling the instructor that a. Sickled cells increase the blood flow through the body and cause a great deal of pain. b. sickled cells mix with the unsickled cells and cause the immune system to become depressed. c. bone marrow depression occurs because of the development of sickled cells. d. sickled cells are unable to flow easily through the microvasculature and their clumping obstructs blood flow.

d Rationale: all of the clinical manifestations of sickle cell disease result from the sickled cells being unable to flow easily through the microvasculature, and their clumping obstructs blood flow. With re-oxygenation, most of the sickled red blood cells resume their normal shape. Options 1, 2, and 3 are incorrect statements.

the client diagnosed with end stage liver failure is admitted with hepatic encephalopathy. which dietary restriction should be implemented by the nurse to address this complication a. restrict sodium intake to 2 g a day b. limit oral fluids to 1500 ml a day c. decrease the daily fat intake d. reduce protein intake to 60-80 g day

d ammonia is a by product of protein metabolism and contributes to hepatic encephalopathy. reducing protein intake should decrease ammonia levels

the client is in the preicteric phase of hepatitis. which signs and symptoms should the nurse expect to exhibit during this phase. a. clay colored stools and jaundice b.normal appetite and pruritus c. being afebrile and left upper quadrant pain d. complaints of fatigue and diarrhea

d flu like symptoms are the first complaints of the client in the preicteric phase of hepatitis

the nurse is caring for a client diagnosed with acute myeloid leukemia. which of the assessment data warrant immediate intervention a. temp 99 pulse 102 rr 22 and bp 132/68 b. hyperplasia of the gyms c. weakness and fatigue d. pain in the left upper quadrant

d pain is expected but it is a priority and should be met immediately

the student asks the nurse "what is sickle cell anemia" which statement by the nurse is the best answer. a. there is some written material at the desk that will explain the disease b. it is a congenital disease of the blood in which the blood does not clot c. the client has decreased synovial fluid that causes joint pain d. the blood becomes thick when the client is deprived of oxygen

d sickle cell anemia is a disorder of the red blood cells characterized by abnormal shaped red cells that sickle or clump together

the client is admitted with acute pancreatitis. which health care providers order should the nurse question a. bedrest with bathroom priveliges b, initiate iv therapy of D5W at 125 ml / hr c. weigh client daily d. low fat, low carbohydrate diet

d the client will be NPO which will decrease stimulation of the pancreatic enzymes, resulting in decreased autodigestion of the pancreas, therefore decreasing pain

the male client with sickle cell anemia comes to the emergency room with a temperature of 101.4 and tells the nurse he is having a sickle cell crisis. which diagnostic test should the nurse anticipate the emergency room doctor ordering for the client a. spinal tap b. hemoglobin elecrophoresis c. sickle turbidity test d. blood cultures

d the elevated temperatures is the first sign of bacteremia, leading to a sickle cell crisis

The nurse instructs the 20-year-old female patient with sickle cell trait that: a. the condition will evolve into sickle cell anemia as she ages b. all of her children will have sickle cell anemia c. the trait will be transmitted to male children only d. the trait can be passed on to all children

ANS: D A person who has the trait can pass it on to male or female children, even if there are no symptoms. Fifty percent of the patients total hemoglobin may be affected. Age does not increase the chance of the trait evolving into the disease.

The nurse is identifying approaches to reduce the risk of infection in a patient with leukemia. Why is it important for the nurse to institute infection control measures for this patient? a. infection can precipitate hemorrhage in the patient with leukemia b. the drugs needed to fight infection have life threatening side effects c. infection in the patient with leukemia can lead to permanent neurological damage d. leukemia seriously impairs the leukocytes

. ANS: D Leukemia is a malignant disease of the WBCs. The immature WBCs are abnormal and unable to effectively fight infection. A. C. Infection does not precipitate hemorrhage and does not typically lead to neurological damage. B. Chemotherapy, not antibiotics, has serious side effects.

he employee health nurse is preparing vaccines to administer to patient care staff to permanently protect them from hepatitis. For which types of hepatitis does the nurse have vaccines? a. HAV b. HBV c. HCV d. both HAV and HBV

ANS: D Vaccines against HBV are available and provide permanent, active immunity to HBV. A vaccine for HAV has also been developed. C. A vaccine for hepatitis C does not exist.

the nurse is caring for a patient in sickle cell crisis. what is the rationale for providing warm compresses and blankets for this patient? a. sickle cell crisis causes shivering and discomfort b. heat helps prevent the cells from becoming sickled c. heat speeds production of new healthy RBCs d. heat prevents vasoconstriction and impaired circulation

ANS: D Warm compresses help dilate vessels to reduce clumping of cells. A. Sickle cell crises are not associated with shivering. B. C. Heat will not prevent sickling or speed production of blood cells.

Laboratory studies are performed for a child suspected of having iron deficiency anemia. THe nurse reviews the laboratory results, knowing that which of the following results would indicate this type of anemia? 1. An elevated hemoglobin level 2. a decreased reticulocyte count 3. an elevated rbc count 4. rbc that are microcytic and hypochromic

Answer: 4The results of a cbc in children with iron deficiency anemia will show a decreased hemoglobin level and and microcytic and hypochromic rbc the rbc count is decreased, the reticulocyte count is usually normal or elevated.

The nurse is caring for a patient admitted with suspected acute viral hepatitis. Which laboratory value would best support this diagnosis? a. Decreased aspartate aminotransferase (AST) b. Decreased alanine aminotransferase (ALT) c. Decreased gamma-glutamyl transpeptidase (GGT) d. Increased prothrombin time

D During the acute phase of hepatitis, the patient will likely display prolonged prothrombin times. Levels of aspartate aminotransferase (AST), alanine aminotransferase and GGT will be elevated.

The nurse is caring for a child who is in the hospital experiencing sickle cell crisis. The parents are asking the nurse which treatment will help cure the child. The nurse responds with which of the following? 1. Treatment with an exchange transfusion of blood will cure the child. 2. Treatment with morphine will cure sickle cell disease. 3. There is no treatment for sickle cell crisis. 4. Treatment is aimed at pain control, oxygen therapy, and hydration, but does not provide a cure.

Rationale:Treatment for sickle cell crisis is pain control, oxygenation, and fluid resuscitation. There is no cure for sickle cell disease. The nurse teaches families how to prevent sickle cell crisis.

A client is demonstrating yellow pigmentation of the skin and sclera. Which of the following can be used to describe this clients symptoms? (Select all that apply.) a. jaundice b. dyspepsia c. icterus d. sclerosis e. kernicterus f. cirrhosis

Terms used to describe yellow pigmentation of the skin and sclera include jaundice, icterus, and kernicterus. Dyspepsia, sclerosis, and cirrhosis are not terms used to describe the yellow pigmentation of the skin and sclera.

a child care worker complains of flu like symptoms. On further assessment hepatitis is suspected. The nurse realizes that this individual is at risk for which type of hepatitis? a. hepatitis a b. hepatitis b c. hepatitis c d. hepatitis d

a Hepatitis A virus (HAV) is spread through the fecal-oral route. Child care workers are at greater risk because of potentially poor hygiene practices. Child care workers are not at the same risk for contracting hepatitis B, C, or D.

the client is diagnosed with chronic lymphocytic leukemia after routine laboratory tests during a yearly physical. Which is the scientific rationale for the random nature of discovering the illness? a. CCL is not serious, and clients will die from other causes first b. there are no symptoms with this form of leukemia c. this is a childhood illness and is self limiting d. in early stages, the client may be asymptomatic

d in this form of atoptosis (programmed cell death) , which results in many thousands of mature cells, clogging the body . because the cells are mature the client may be asymptomatic in early stages