Hematology/Pain EAQ

A client is prescribed 4 mg of hydromorphone intravenously (IV) every 4 hours, as needed. Hydromorphone is supplied at 10 mg/mL. How many milliliters of hydromorphone will the nurse administer per dose? Record your answer using one decimal place and leading zero if applicable. ___ mL

0.4

Which finding in a newborn is a behavioral response to pain? Select all that apply. One, some, or all responses may be correct. 1-Crying 2-Tachypnea 3-Diaphoresis 4-Tachycardia 5-Hypertension

1-Crying Crying is a behavioral response. Tachypnea, diaphoresis, tachycardia, and hypertension are physiological responses to pain.

Which task in the care of a client with neutropenia can be delegated to unlicensed assistive personnel (UAP)? 1-Administering antibiotics 2-Assisting with personal hygiene 3-Monitoring for signs and symptoms of infection 4-Teaching the client and caregivers about how to avoid infection

2-Assisting with personal hygiene UAP assist with the client's personal hygiene. The licensed practical nurse administers antibiotics. Monitoring for signs and symptoms is performed by the licensed practical nurse. The registered nurse teaches the client and caregivers how to avoid infection.Test-Taking Tip: Each health care professional has different designations and performs different tasks. Choose the appropriate task for unlicensed assistive personnel.

Which foods will the nurse recommend to a client with iron deficiency anemia? Select all that apply. One, some, or all responses may be correct. 1-Grapes 2-Spinach 3-Oranges 4-Beef liver 5-Cantaloupe

2- Spinach 4- Beef Liver

Which would the nurse include in the client's medication teaching on the administration of aspirin 650 mg every 6 hours as needed for arthritic pain? Select all that apply. One, some, or all responses may be correct. 1-"Report persistent abdominal pain." 2-"Do not chew enteric-coated tablets." 3-"Take the aspirin with meals or a snack." 4-"See a dentist if bleeding gums develop." 5-"Switch to acetaminophen if tinnitus occurs."

1-"Report persistent abdominal pain." 2-"Do not chew enteric-coated tablets." 3-"Take the aspirin with meals or a snack."

Which client statement indicates that teaching about acetaminophen is effective? 1-"I can drink beer with this but not wine." 2-"I need to limit my intake of acetaminophen to 650 mg a day." 3-"I should take an emetic if I accidentally overdose on acetaminophen." 4-"I have to be careful about which over-the-counter cold preparations I take."

4-"I have to be careful about which over-the-counter cold preparations I take." Many over-the-counter cold preparations contain acetaminophen; the amount of acetaminophen in cold preparations must be taken into consideration when the total amount of acetaminophen taken daily is calculated. A typical single dose is 650 mg a day for adults. Acetaminophen should not exceed 3 to 4 g a day. An emetic is contraindicated because it may reduce the client's ability to tolerate oral acetylcysteine, the antidote for acetaminophen toxicity. Alcohol of any type increases the risk of liver injury when taken with acetaminophen.

After surgery, a child experiences intense pain and an analgesic is prescribed. Which would the nurse consider when administering the analgesic? 1-Even though children do not like medicine, analgesics will make them more comfortable. 2-Pain is not felt as strongly by children as by adults; therefore analgesics are not needed as frequently. 3-Children should rarely receive analgesics because they could cause addiction or respiratory depression. 4-Children do not need analgesics because they quickly return to playing or sleeping when they are distracted.

1-Even though children do not like medicine, analgesics will make them more comfortable. Children are as much in need of analgesics for relief of pain as adults are. It is an unsound belief that children are more prone to opioid addiction than adults are. It is a myth that children do not feel pain as strongly as adults; it is difficult for children to communicate pain. Playing or trying to sleep may be the child's way of coping with pain; however, the fact that the child engages in these behaviors is not a reason to withhold an analgesic.

Which pain scale is used to measure the intensity of pain in preschoolers? 1-FACES scale 2-Visual analog scale 3-Numerical rating scale 4-Verbal descriptor scale

1-FACES scale The FACES scale is used to measure the intensity of pain in a preschooler. The scale consists of six cartoon faces ranging from a smiling face ("no hurt") to increasingly less happy faces to a final sad and tearful face ("hurts worst"). The visual analog scale, numerical rating scale, and verbal descriptor scale can be used in young children and adults.

Which actions would the nurse take when admitting a client having a sickle cell crisis to the nursing unit? Select all that apply. One, some, or all responses may be correct. 1-Place on strict isolation. 2-Administer hydroxyurea. 3-Administer aspirin 325 mg daily. 4-Apply oxygen via nasal cannula. 5-Administer intravenous (IV) hydration. 6-Avoid opiate-type analgesics.

2-Administer hydroxyurea. 4-Apply oxygen via nasal cannula. 5-Administer intravenous (IV) hydration. Hydroxyurea can reduce the number of sickling and pain episodes by stimulating fetal hemoglobin production. Providing oxygen via nasal cannula provides additional oxygen, which decreases red blood cell sickling and improves tissue oxygenation. Intravenous hydration will decrease the clumping of sickled cells and decrease obstruction of blood flow. Strict isolation is not needed for clients in sickle cell crisis. Aspirin is not helpful because the obstruction of blood flow is caused by clumping of sickled cells, not by clotting. Tissue ischemia caused by obstruction of blood flow by sickled cells is very painful, and opiate analgesics are frequently needed for pain management.

A client receiving chemotherapy also takes a steroid daily. The client's white blood cell count is 3600 per cubic millimeter and red blood cell count is 4.5 million/mm 3. Which instruction would the nurse teach this client? 1-Omit the daily dose of prednisone. 2-Avoid large crowds and persons with infections. 3-Shave with an electric shaver rather than a safety razor. 4-Increase the intake of high-protein foods and red meats.

2-Avoid large crowds and persons with infections. Moderate leukopenia increases the risk of infection; the client should be taught protective measures. Leukopenia is a side effect of cyclophosphamide, not prednisone. The platelet count has not been provided, so bleeding precautions are not indicated. Increasing the intake of high-protein foods and red meat are measures to correct anemia; protection from infection takes priority.

Which foods will the nurse include when suggesting dietary sources of iron to a client with anemia? Select all that apply. One, some, or all responses may be correct. 1-Raw carrots 2-Boiled spinach 3-Dried prunes 4-Brussel sprouts 5-Asparagus spears

2-Boiled spinach 3-Dried prunes Food sources highest in iron are liver and beef, dried fruits (such as prunes), legumes, dark green leafy vegetables (which would include spinach), whole-grain and enriched bread and cereals, and beans. Carrots are not a high source of iron. Asparagus is not high in iron. Brussels sprouts are not high in iron.

Which physiological alteration would be expected with a higher-than-normal red blood cell (RBC) count? 1-Increased blood pH 2-Decreased hematocrit 3-Increased blood viscosity 4-Decreased immune response

3-Increased blood viscosity Viscosity, a measure of a fluid's internal resistance to flow, is increased as the number of red blood cells suspended in plasma increases. The number of cells does not affect the blood pH. The hematocrit will be higher. RBCs do not affect immunity.Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.

When a client who had abdominal surgery 24 hours ago develops pain, redness, and swelling in the left calf, which action by the nurse is the priority? 1-Elevate the legs. 2-Document the findings. 3-Notify the health care provider. 4-Give the prescribed pain medication.

3-Notify the health care provider.

When a client who is receiving a transfusion of packed red blood cells (PRBCs) after cardiac surgery experiences chest discomfort, chills, and anxiety, which action by the nurse is a priority? 1-Administer nitroglycerin. 2-Monitor the client's vital signs. 3-Stop the transfusion and administer normal saline. 4-Ask the client to describe the pain using a 0 to 10 scale.

3-Stop the transfusion and administer normal saline.

A client receiving morphine is being monitored by the nurse for adverse effects of the medication. Which clinical findings warrant immediate follow up by the nurse? Select all that apply. One, some, or all responses may be correct. 1-Polyuria 2-Unconsciousness 3-Bradycardia 4-Dilated pupils 5-Bradypnea

2-Unconsciousness 3-Bradycardia 5-Bradypnea The central nervous system (CNS) depressant effect of morphine, if severe, can cause unconsciousness. The CNS depressant effect of morphine causes bradycardia and bradypnea. Morphine does not increase urine output. Morphine causes constriction of pupils.

A client with a known history of opioid addiction has a surgical repair of multiple stab wounds to the abdomen. After surgery, the client's pain is not relieved by the prescribed morphine injections. The nurse realizes that the failure to achieve pain relief indicates that the client is probably experiencing which phenomenon? 1-Tolerance 2-Habituation 3-Physical addiction 4-Psychological dependence

1-Tolerance

A client who is receiving methotrexate for acute lymphocytic leukemia (ALL) develops a temperature of 101°F (38.3°C), and the health care provider prescribes aspirin 650 mg every 4 hours as needed. Which action would the nurse take regarding this new prescription? 1-Express concern about the dosage prescribed. 2-Request a prescription for an antacid. 3-Express concern about the type of antipyretic prescribed. 4-Ask if the frequency should be every 6 hours instead.

3-Express concern about the type of antipyretic prescribed. Both ALL and methotrexate may cause thrombocytopenia, with resulting bleeding risk. Aspirin is contraindicated with thrombocytopenia because of its inhibitory effect on platelet aggregation, so the nurse should express concern about the type of antipyretic prescribed. The dosage of aspirin prescribed is within the normal range for a client with a normal platelet count. In clients who need to take nonsteroidal anti-inflammatory drugs like aspirin, an antacid may be appropriate, but aspirin should not be administered to this client. Although the frequency is within acceptable limits, aspirin is contraindicated.

Cyanocobalamin (vitamin B12) 0.2 mg intramuscularly (IM) is prescribed for a client with pernicious anemia. Each vial of the medication contains 100 mcg/mL. How many milliliters will the nurse administer? Record your answer using a whole number. ___mL

2

The nurse is conducting discharge teaching with an adolescent with hemophilia. Which statement by the client indicates a need for further teaching? 1-"I'll use a straight razor when I start shaving." 2-"I plan on trying out for the swim team next year." 3-"If I injure a joint, I'll keep it still, elevate it, and apply ice." 4-"If I get a little scratch, I can apply gentle pressure for 10 to 15 minutes."

1-"I'll use a straight razor when I start shaving."

The nurse is taking care of a client who has chronic back pain. Which nursing considerations would be made when determining the client's plan of care? Select all that apply. One, some, or all responses may be correct. 1-Ask the client about the acceptable level of pain. 2-Eliminate all activities that precipitate the pain. 3-Administer the pain medications regularly around the clock. 4-Use a different pain scale each time to promote patient education. 5-Assess the client's pain every 15 minutes.

1-Ask the client about the acceptable level of pain. 3-Administer the pain medications regularly around the clock

A 78-year-old client comes to the health clinic presenting with fatigue, and laboratory results indicate a hematocrit of 32% (0.32) and hemoglobin of 10.5 g/dL (105 mmol/L). Which action would the nurse take next? 1-Conduct a complete nutritional assessment of the client. 2-Plan to teach the client about taking daily iron supplements. 3-Schedule the client to return to have the test repeated in 3 months. 4-Explain that mild anemia is an expected response to the aging process.

1-Conduct a complete nutritional assessment of the client. A nutritional assessment starts the investigation for a cause of the client's anemia. Although anemia may be caused by iron deficiency, more assessments and testing are needed to establish the etiology of anemia for this client. The client may need to have results repeated in about 3 months, but this will depend on the etiology of the anemia and the treatments that are prescribed. Although mild anemia may occur with aging because of chronic illness, anemia is not considered to be part of the normal aging process and normal hemoglobin and hematocrit values do not change with aging.

A client takes oxycodone every 3 hours for pain after surgery. Which actions would the nurse take before administering each dose of oxycodone? Select all that apply. One, some, or all responses may be correct. 1-Count the client's respiratory rate. 2-Examine the client for petechiae. 3-Observe the client for movement disorders. 4-Ask the client to rate the level of pain. 5-Assess the client's level of consciousness.

1-Count the client's respiratory rate. 4-Ask the client to rate the level of pain. 5-Assess the client's level of consciousness. Oxycodone is an opioid that depresses the central nervous system, resulting in a decreased level of consciousness and depressed respirations. The medication should be administered, delayed, or held, depending on the client's status. It is important to have the client rate the pain level as a basis for comparison when checking to see if the medication relieved the pain. Petechiae (or other signs of bleeding) and movement disorders are not associated with opioid use.

When the nurse obtains vital signs of blood pressure 90/60 mm Hg, pulse 96 beats/minute, and respiratory rate 10 breaths/minute for a postoperative client who is receiving hydromorphone by a patient-controlled analgesia (PCA) pump, which nursing action would be the priority? 1-Give naloxone intravenously per protocol. 2-Assess the client's pain level on a 10-point scale. 3-Document the vital signs in the client record. 4-Notify the hospital rapid response team.

1-Give naloxone intravenously per protocol. A respiratory rate of 10 breaths/minute is abnormal and indicates oversedation with hydromorphone, which should be treated immediately with naloxone administration. Pain level would be assessed, but it is not as high a priority as reversing the opiate-induced respiratory depression. Documentation of findings also needs to be done, but this can be done after naloxone administration. The rapid response team may also be activated, but the nurse would not wait for the rapid response team to give the naloxone

Which topic will the nurse include when teaching a client who has a new diagnosis of polycythemia vera? 1-Need for high fluid intake 2-Purpose for iron supplements 3-Avoidance of any aspirin use 4-Self-administration of erythropoietin

1-Need for high fluid intake Polycythemia vera results in pathologically high concentrations of erythrocytes, leukocytes, and platelets in the blood, leading to increased blood viscosity and high risk for thrombus formation and hypertension. Hydration is important to reduce blood viscosity. Iron supplements are avoided, because the goal is reduced numbers of erythrocytes. Aspirin is frequently used to decrease risk for thrombus formation. Erythropoietin administration would stimulate more erythrocyte production and increase blood viscosity.

The nurse is obtaining a health history from the newly admitted client who has chronic pain in the right knee. Which would the nurse include in the pain assessment? Select all that apply. One, some, or all responses may be correct. 1-Pain history, including location, intensity, and quality of pain 2-Client's purposeful body movement in arranging the papers on the bedside table 3-Pain pattern, including precipitating and alleviating factors 4-Vital signs, such as increased blood pressure and heart rate 5-The client's family statement about increases in pain with ambulation

1-Pain history, including location, intensity, and quality of pain 3-Pain pattern, including precipitating and alleviating factors The initial pain assessment should include information about the location, quality, intensity, onset, duration, and frequency of pain, as well as factors that relieve or exacerbate the pain. Vital signs are a secondary assessment related to the initial pain assessment. Accurate pain assessment includes pain history with the client's identification of pain location, intensity, and quality, and helps the nurse identify what pain means to the client. The pattern of pain includes time of onset, duration, and recurrence of pain, and its assessment helps the nurse anticipate and meet the needs of the client. Purposeless movements such as tossing and turning or involuntary movements such as a reflexive jerking may indicate pain. Assessment of the precipitating factors helps the nurse prevent the pain and determine its cause. Elevated blood pressure and heart rate are physiological responses to pain and not a direct evaluation of pain. Pain is a subjective experience, and the nurse has to ask the client directly instead of accepting the statement of the family members.

When a client develops internal bleeding after abdominal surgery, which clinical manifestations would the nurse expect the client to exhibit? Select all that apply. One, some, or all responses may be correct. 1-Pallor 2-Polyuria 3-Bradypnea 4-Tachycardia 5-Hypertension

1-Pallor 4-Tachycardia Pallor occurs with hemorrhage as the peripheral blood vessels constrict in an effort to shunt blood to the vital organs in the center of the body. Heart rate accelerates (tachycardia) in hemorrhage as the body attempts to increase blood flow and oxygen to body tissues. Urinary output decreases (the opposite of polyuria) with hemorrhage because of a lowered glomerular filtration rate secondary to hypovolemia. Respirations increase (the opposite of bradypnea) and become shallow with hemorrhage as the body attempts to take in more oxygen. Hypotension, not hypertension, occurs in response to hemorrhage as the person experiences hypovolemia.

Which interventions would the nurse implement to prevent infection in a preschool child with acute nonlymphoid leukemia who is admitted with a fever and neutropenia? 1-Placing the child in a private room, restricting ill visitors, and using strict hand-washing techniques 2-Encouraging a well-balanced diet, including iron-rich foods, and helping the child avoid overexertion 3-Avoiding taking rectal temperatures, limiting injections, and applying direct pressure for 5 minutes after venipuncture 4-Offering a moist, bland, soft diet; using toothettes rather than a toothbrush; and providing frequent saline mouthwashes

1-Placing the child in a private room, restricting ill visitors, and using strict hand-washing techniques

Which methods qualify as alternative therapies for pain? Select all that apply. One, some, or all responses may be correct. 1-Prayer 2-Hypnosis 3-Medication 4-Aromatherapy 5-Guided imagery

1-Prayer 2-Hypnosis 4-Aromatherapy 5-Guided imagery Prayer is an alternative therapy that may relax the client and provide strength, solace, or acceptance. The relief of pain through hypnosis is based on suggestion; also, it focuses attention away from the pain. Some clients learn to hypnotize themselves. Aromatherapy can help relax and distract the individual and thus increase tolerance for pain, as well as relieve pain. Guided imagery can help relax and distract the individual and thus increase tolerance for pain, as well as relieve pain. Analgesics, both opioid and nonopioid, long have been part of the standard medical regimen for pain relief, so they are not considered an alternative therapy.

Which action would the nurse take first when a client who is receiving a blood transfusion develops fever, chills, and low back pain? 1-Stop the blood transfusion and infuse saline. 2-Administer the prescribed antipyretic. 3-Obtain a prescription for an antihistamine. 4-Notify the blood bank about the symptoms.

1-Stop the blood transfusion and infuse saline. Fever, chills, and low back pain indicate an acute hemolytic reaction, which is potentially life threatening; discontinuing the transfusion immediately and infusing saline limits kidney damage. Although the client has a fever, administering an antipyretic before stopping the transfusion would allow the transfusion reaction to continue. The client's safety must be addressed first. Obtaining a prescription for an antihistamine may be done after stopping the transfusion and infusing saline. Although the blood bank generally is notified if a reaction occurs, this would be done after stopping the transfusion.

A client is receiving patient-controlled analgesia (PCA) after surgery. Which benefit would this type of therapy provide? Select all that apply. One, some, or all responses may be correct. 1-The client is able to self-administer pain-relieving medications as necessary 2-The amount of medication received is determined entirely by the client 3-Decreases client dependency 4-Relieves the nurse of monitoring the client 5-Increases client's sense of autonomy

1-The client is able to self-administer pain-relieving medications as necessary 3-Decreases client dependency 5-Increases client's sense of autonomy The purpose of patient-controlled analgesia is to give the client the ability to self-administer pain-relieving medications as necessary; usually smaller amounts of analgesics are used with self-administration. The amount and dosage of the medication are programmed to prevent accidents or abuse. Medication levels are kept in a maintenance range, and pain relief is achieved without extreme fluctuations. The client isn't dependent on the nurse availability to administer medication. This increases the client's sense of autonomy. The nurse is not absolved of responsibility when PCA is used; monitoring the client for effectiveness, refilling the apparatus with the prescribed narcotic, and charting the amount administered and the client's response are required.

Which education would the nurse provide to the family of a 10-year-old child diagnosed with hemophilia about the genetic inheritance of the condition? 1-It follows the Mendelian law of inherited disorders. 2-The mother is a carrier of the disorder but usually is not affected by it. 3-It is an autosomal dominant disorder in which the woman carries the trait. 4-A carrier may be male or female, but the disease occurs in the sex opposite that of the carrier.

2- The mother is a carrier of the disorder but usually is not affected by it. A carrier may be male or female, but the disease occurs in the sex opposite that of the carrier. The hemophilia gene is carried on the X chromosome but is recessive. The female is the carrier (an unaffected XO and an affected XH). If the male receives the affected XH (XHYO), he will have the disorder. Hemophilia is carried by the female; the Mendelian laws of inheritance are not sex specific. Hemophilia is a sex-linked recessive disorder. Only females carry the trait; usually males are affected.

After the nurse performs preoperative teaching for a client with Hodgkin disease who is scheduled for a splenectomy, the client appears anxious. Which is the best response by the nurse at this time? 1-"I'll just leave you alone for a while, because you probably need more rest before this surgery." 2-"Sometimes clients having this surgery are anxious. Do you have any concerns or questions?" 3-"Your anxiety may have kept you from understanding all the teaching. I'll repeat the important points." 4-"I'm just going to quiz you about the material we discussed to be sure that you understand everything."

2-"Sometimes clients having this surgery are anxious. Do you have any concerns or questions?" The response "Sometimes clients having this surgery are anxious. Do you have any concerns or questions?" acknowledges that anxiety is normal and provides an opening for sharing of any client concerns. The response "I'll just leave you alone for a while, because you probably need more rest before this surgery" fails to address the nurse's assessment that the client appears anxious and may need to discuss concerns. The response "Your anxiety may have kept you from understanding all the teaching. I'll repeat the important points" makes assumptions that the client is anxious and that learning did not occur and discourages sharing of client concerns. The response "I'm just going to quiz you about the material we discussed to be sure that you understand everything" is likely to increase client anxiety and discourage client sharing of questions or concerns.

A 9-month-old infant with iron-deficiency anemia has been getting supplements but shows no improvement. The nurse recognizes which action by the parents as the reason for the lack of improvement? 1-Administering iron supplements through a straw 2-Administering iron supplements with whole cow's milk 3-Administering iron supplements along with orange juice 4-Administering iron supplements at the back of the mouth

2-Administering iron supplements with whole cow's milk Whole cow's milk binds with free iron and reduces medication absorption. The infant has developed medication insufficiency for maximum therapeutic action. Administering iron supplements through a straw does not reduce medication absorption; it prevents the iron from staining the infant's teeth. Orange juice increases the absorption of iron supplements. Administering iron supplements at the back of the mouth does not reduce medication absorption; it prevents the iron from staining the infant's teeth.

A client has a tentative diagnosis of Hodgkin disease. How would the nurse expect the diagnosis to be confirmed? 1-Bone scan 2-Lymph node biopsy 3-Computed tomography (CT) scan 4-Radioactive iodine (131I) uptake study

2-Lymph node biopsy The diagnosis depends on the identification of characteristic histological features of an excised lymph node. A bone scan is a diagnostic device to assess bony metastasis of cancers. CT scans identify the extent of the disease in the abdominal and thoracic cavities. The 131I uptake study is not indicated for Hodgkin disease; it is used for radiotherapy or diagnosis of thyroid diseases.

Which therapeutic outcomes are expected after administering ibuprofen? Select all that apply. One, some, or all responses may be correct. 1-Diuresis 2-Pain relief 3-Temperature reduction 4-Bronchodilation 5-Anticoagulation 6-Reduced inflammation

2-Pain relief 3-Temperature reduction 6-Reduced inflammation Prostaglandins accumulate at the site of an injury, causing pain; nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen inhibit COX-1 and COX-2 (both are isoforms of the enzyme cyclooxygenase), which inhibit the production of prostaglandins, thereby contributing to analgesia. NSAIDs inhibit COX-2, which is associated with fever, thereby causing the temperature to decline. NSAIDs inhibit COX-2, which is associated with inflammation, thereby reducing inflammation. NSAIDs do not cause diuresis; reversible renal ischemia and renal insufficiency in clients with heart failure, cirrhosis, or hypovolemia can be potential adverse effects of NSAIDs. NSAIDs do not cause bronchodilation. Anticoagulation is an adverse effect, not a desired outcome; NSAIDs can impair platelet function by inhibiting thromboxane, an aggregating agent, resulting in bleeding.

A pain scale of 1 to 10 is used by the nurse to assess a client's degree of pain. The client rates the pain as an 8 before receiving an analgesic and a 7 after being medicated. Which conclusion would the nurse make regarding the client's response to pain medication? 1-The client has a low pain tolerance. 2-The medication is not adequately effective. 3-The medication has sufficiently decreased the pain level. 4-The client needs more education about the use of the pain scale.

2-The medication is not adequately effective. The expected effect should be more than a 1-point decrease in the pain level. Whether a client has a low pain tolerance cannot be determined with the data available. The medication has not achieved an adequate response; pain generally is considered to be tolerable if it is 4 or below on a pain scale of 1 to 10. There is not sufficient data to determine whether the client needs more education about the use of the pain scale.

The parent of a child with hemophilia asks the nurse, "If my son hurts himself, is it all right if I give him two baby aspirins?" Which statement by the nurse is appropriate? 1-"You seem concerned about giving medications to your child." 2-"It's all right to give him baby aspirin when he hurts himself." 3-"Aspirin may cause more bleeding. Give him acetaminophen instead." 4-"He should be given acetaminophen every day. It'll prevent bleeding."

3-"Aspirin may cause more bleeding. Give him acetaminophen instead." "He should be given acetaminophen every day. It'll prevent bleeding." Aspirin, which has an anticoagulant effect, is contraindicated because it may harm a child with bleeding problems; in addition, aspirin is contraindicated for all children because of its relationship to Reye syndrome. Stating that the parent seems concerned about giving medications to the child does not answer the mother's question and may cause the mother to feel defensive. Acetaminophen cannot prevent bleeding episodes; it is an analgesic.

A client is to receive a transfusion of packed red blood cells (PRBCs). Which solution would the nurse use to prime the blood intravenous (IV) tubing? 1-Lactated Ringer solution 2-5% dextrose and water 3-0.9% normal saline 4-0.45% normal saline

3-0.9% normal saline

Which laboratory value would the nurse use to determine whether a client is receiving a therapeutic dose of intravenous heparin? 1-International normalized ratio (INR) is between 2 and 3 2-Prothrombin time (PT) is 2.5 times the control value 3-Activated partial thromboplastin time (APTT) is 70 seconds 4-Activated clotting time (ACT) is in the range of 70 to 120 seconds

3-Activated partial thromboplastin time (APTT) is 70 seconds When a client is receiving intravenous heparin, the APTT should be 1.5 to 2 times the normal APTT of 40 seconds, or 60 to 80 seconds. INR and PT are used to evaluate therapeutic levels of warfarin. The ACT is not commonly used for monitoring of heparin, but ACT increases to a range of 150 to 200 seconds when heparin reaches therapeutic levels.

After a client has a bone marrow aspiration performed, which action would the nurse take first? 1-Position the client on the affected side. 2-Administer prescribed analgesics for pain. 3-Apply firm pressure over the aspiration site. 4-Monitor the client's blood pressure and pulse.

3-Apply firm pressure over the aspiration site. The initial action will be to hold pressure over the site until bleeding stops. The other actions are also needed after the nurse has assured that bleeding has stopped. Clients are positioned on the side of the procedure to apply pressure to the aspiration site, which will decrease bleeding risk. If clients report pain after the procedure, analgesics are given as prescribed. Because clients having a bone marrow aspiration may be thrombocytopenic and bleeding may recur after the procedure, the nurse will monitor blood pressure and pulse and assess the site for bleeding at frequent intervals.

Which clinical manifestation would the nurse expect to find in a client with a new diagnosis of acute lymphocytic leukemia (ALL)? 1-Alopecia 2-Insomnia 3-Ecchymosis 4-Hypertension

3-Ecchymosis Bleeding tendencies as shown in ecchymosis occur because of thrombocytopenia associated with overproduction of rapidly proliferating leukocytes. Alopecia is associated with chemotherapy; there is no change in hair with leukemia. Because fatigue is associated with ALL, the client may be sleeping more than usual, not less as with insomnia. Hypertension is not a clinical manifestation of leukemia.

A child is experiencing pain after abdominal surgery and is given an opioid analgesic. Which statement is correct regarding children in pain and their response to opioid analgesics when they are prescribed? 1-Addiction to opioids is more of a risk for children than adults. 2-Analgesics are not needed as frequently because pain is not as strongly felt by children as it is by adults. 3-Even though children do not like taking medicines, analgesics will make them more comfortable. 4-Children do not need analgesics because they are easily distracted and will quickly return to play or sleep.

3-Even though children do not like taking medicines, analgesics will make them more comfortable. Children are as much in need of analgesics for relief of pain as adults are. It is an unsound belief that children are more prone to opioid addiction than adults are. It is a myth that children do not feel pain as strongly as adults; it is difficult for children to communicate pain. Playing or trying to sleep may be the child's way of coping with pain; however, the fact that the child engages in these behaviors is not a reason to withhold an analgesic.

A client with a history of osteoporosis and vertebral compression has been coming to the clinic more frequently for prescription refills of hydrocodone/acetaminophen. Which inference will the nurse make? 1-The half-life of the medication has decreased. 2-An idiosyncratic reaction has occurred. 3-Higher doses are needed to achieve pain relief. 4-An emotional dependence on the medication has developed.

3-Higher doses are needed to achieve pain relief. As the body adapts to the medication (tolerance), an increased dose is needed to produce the desired effect. The half-life of a medication does not change and is related to the time required for it to be absorbed, distributed, metabolized, and excreted from the body. Idiosyncratic reactions are unpredictable; these sporadic reactions are unrelated to dosage. The data are insufficient for the nurse to conclude that emotional or physiological dependence has developed.

To avoid complications in a client who has developed severe bone marrow depression after receiving chemotherapy for cancer, which actions by the nurse are appropriate? Select all that apply. One, some, or all responses may be correct. 1-Monitor for signs of alopecia. 2-Encourage an increase in fluids. 3-Wash hands before entering the client's room. 4-Advise use of a soft toothbrush for oral hygiene. 5-Report an elevation in temperature immediately. 6-Teach the client to avoid eating raw fruits or vegetables.

3-Wash hands before entering the client's room. 4-Advise use of a soft toothbrush for oral hygiene. 5-Report an elevation in temperature immediately. Bone marrow depression causes neutropenia; it is essential to prevent infection in this client by thorough hand washing before touching the client or client's belongings. Thrombocytopenia occurs with chemotherapy-induced bone marrow depression; using a soft toothbrush helps prevent bleeding gums. Any temperature elevation in a client with neutropenia must be reported to the primary health care provider immediately because it may be a sign of infection. Although alopecia does occur with chemotherapy, it is not related to bone marrow suppression. Increasing fluids will neither reverse bone marrow suppression nor stimulate hematopoiesis. Clients who have neutropenia may eat raw fruits and vegetables after washing off soil that may contain disease-causing microbes.

When a client who has sickle cell anemia has been admitted with acute chest syndrome, which prescribed treatment would the nurse question? 1-Oxygen administration 2-Daily folic acid tablet 3-Daily iron supplement. 4-Morphine sulfate as needed

3Daily iron supplement. The nurse would question the use of iron supplements in sickle cell anemia because sickle cell disease is not caused by iron deficiency. In addition, many clients with sickle cell anemia receive blood transfusions and iron toxicity can develop secondary to frequent transfusions. Oxygen administration would be appropriate for a client with a pulmonary complication such as acute chest syndrome. Folic acid supplements are recommended for clients with sickle cell disease, because folic acid is needed in the production of new red blood cells to replace cells lost to hemolysis. Morphine sulfate is frequently prescribed to treat ischemic pain caused by sickled cells.

After abdominal surgery, a client reports pain. Which action would the nurse take first? 1-Reposition the client. 2-Obtain the client's vital signs. 3-Administer the prescribed analgesic. 4-Determine the characteristics of the pain.

4-Determine the characteristics of the pain.

After abdominal surgery, a client reports pain. Which action would the nurse take first? 1-Reposition the client. 2-Obtain the client's vital signs. 3-Administer the prescribed analgesic. 4-Determine the characteristics of the pain.

4-Determine the characteristics of the pain. The exact nature of the pain must be determined to distinguish whether or not it is a result of the surgery. Repositioning the client, obtaining the client's vital signs, and administering the prescribed analgesic should be done later; the first action is to determine the cause of the pain.

When evaluating the white blood cell count differential, which statement indicates the meaning of "a shift to the left"? 1-Heightened phagocytosis 2-Functioning bone marrow 3-Infection is being contained 4-Increased immature neutrophils

4-Increased immature neutrophils A "shift to the left" in the white blood cell count differential indicates immature neutrophils are being released into the blood. The immature neutrophils are not capable of phagocytizing. The bone marrow is unable to produce mature neutrophils, and the infection is continuing, not being contained.

When the nurse is assessing a 20-year-old client who has come to the clinic reporting recent unintended weight loss and fatigue, which finding would be most important to communicate to the health care provider? 1-Pallor of skin 2-Heart rate 98 beats/minute 3-Cool feet and decreased pedal pulses 4-Nontender enlarged cervical lymph node

4-Nontender enlarged cervical lymph node Nontender and enlarged lymph nodes in a 20-year-old client suggest possible Hodgkin lymphoma, especially with the client's history of unintended weight loss. The client is likely to be scheduled quickly for lymph node biopsy. The other findings would be reported to the health care provider, but do not indicate a need for rapid action. Skin pallor may be associated with anemia, or may be normal for the client. Heart rate is in the upper range of normal for an adult. Cold feet and decreased pedal pulses may be caused by anxiety or because the examination room is cold.

A hospice client who has severe pain asks for another dose of oxycodone. Which consideration is the nurse's primary concern when responding to the client's request? 1-Prevent addiction. 2-Determine why the medication is needed. 3-Provide alternative comfort measures. 4-Reduce the client's pain.

4-Reduce the client's pain. Hospice clients with severe pain need increasing levels of analgesics and should be maintained at a pain-free level, even if addiction occurs. Pain management, not the prevention of addiction, is the priority. The client has severe pain, and the priority is to relieve the pain. Comfort measures should augment, not be substitutes for, pharmacological interventions when clients are experiencing severe pain.