82 STUDY GUIDE

Warfarin sodium has been prescribed for a client, and the nurse teaches the client and family about the medication. Which statement by the client indicates a need for further teaching?

"I will not take any over-the-counter medications except aspirin."

A nurse is collecting data from a client who has manifestation of aplastic anemia which of the following findings should the nurse expect

(Ecchymyosis) Perechiae

A nurse is assisting in the care of a client who is hypovolemic shock while waiting for the unit of blood the nurse should plan to administer which of the following IV solutions

0.9% sodium chloride

A client with chronic kidney disease is receiving ferrous sulfate. The nurse should monitor the client for which common side effect associated with this medication?

Constipation

The client diagnosed with pernicious anemia asked the nurse why do I have to take a shot of vitamin B 12 I would rather just eat foods high in vitamins or take supplements what is the nurses best response

Do you like Innsbruck factor which is required to perform the vitamin B 12 orally

The nurse is caring for a client with a diagnosis of aplastic anemia. Which are the most likely signs/symptoms associated with aplastic anemia? Select all that apply.

Fatigue Infection Petechiae Shortness of breath Aplastic anemia is a decrease in red blood cells, white blood cells, and platelets. A reduced number of red blood cells will cause the hemoglobin to drop, and clients commonly report fatigue and shortness of breath. A reduced number of white blood cells will make the client susceptible to infection. A reduced number of platelets will cause the blood to not clot properly and can result in bleeding manifested as petechiae. Pain is a symptom of sickle cell disease, chronic myelogenous leukemia, and multiple myeloma. Nausea is not a symptom of aplastic anemia.

client has been diagnosed with disseminated intravascular coagulation (DIC). Which laboratory tests should the nurse anticipate being prescribed? Select all that apply.

Hemoglobin Prothrombin time D-dimer The D-dimer is elevated with DIC. There is decreased hemoglobin due to bleeding. The prothrombin time is increased because clotting factors are being used up. Albumin is checked for disorders of the liver and/or edema, and amylase is checked for disorders of the liver or pancreas, not for DIC. The potassium level should not be greatly affected by DIC either.

A client in renal failure is receiving epoetin alfa. The nurse should monitor the client for which adverse effect of this medication?

Hypertension Epoetin alfa is an erythropoietic growth factor and generally is well tolerated, although hypertension can occur and is the most significant adverse effect. Occasionally, tachycardia also may occur as a side effect and may cause an improved sense of well-being. Fever, depression, and bradycardia are not adverse effects of epoetin alfa.

A nurse is reinforcing teaching with a client who has anemia and a new prescription of a potent alpha which information should the nurse include in the teaching

Hypertension is a common adverse effect of this medication

The nurse is interacting with client who has been in treatment for leukemia for several months which statement by the client would alert the nurse to refer the client to social services

I noticed my spouse is not interested in attending my doctor appointments as much as before

A nurse is contributing to a plant care for a client nurse in the clinic is collecting data from a client who has a history of peripheral artery disease which of the following findings in the clients lower extremity should the nurse expect anemia which of the following intervention should the nurse recommend

Initiate weekly injections of vitamin B 12

The nurse is providing teaching to the client following a new diagnosis aplastic anemia why would the nurse include in the teaching plan all that apply

Monitor for signs of bleeding come intestinal in neural. Invasive procedures walked up will be done with sterile techniques. Avoid crowds and exposure to people who are sick.

A client is admitted to the hospital with vitamin B12 deficiency. When taking the client's history, which symptoms should the nurse expect the client to report? Select all that apply.

Numbness in hands Difficulty in walking Muscle weakness Rationale:Vitamin B12 is necessary for red blood cell production, myelin maintenance, and nerve function. Lack of vitamin B12 can lead to anemia, as well as damage to the spinal cord, peripheral nerves, and brain. Neurological symptoms include muscle weakness, difficulty in walking, and numbness in hands. Craving to eat ice and dry and brittle hair are symptoms of iron deficiency anemia.

A nurse is collecting data from a client who has pernicious anemia which of the following findings should the nurse expect

Paresthesias in the hands and feet

The nurse is caring for a client with thrombocytopenia. Which data should the nurse monitor for related to this condition? Select all that apply.

Platelet count less than 150,000 mm3 Purpura Ecchymoses Purpura, which is small areas of petechiae, is a sign of thrombocytopenia. Ecchymoses, areas of hemorrhage under the skin, are seen with thrombocytopenia. A platelet count under 150,000 mm3 is indicative of thrombocytopenia. A hemoglobin of 14.0 is within normal range for a male or female. Thrombocytes are platelets, and 300,000 mm3 is within normal range. A prothrombin time of 14 seconds is within the normal coagulation time of 12 to 14 seconds.

A nurse is caring for a client who is postoperative following being litigation and stripping for varicose veins which of the following actions should the nurse take

Position the clients of pain with his legs elevated when in bed

A nurse is caring for a client who has hemophilia the client reports pain and swelling in a joint following an injury which of the following actions should the nurse take

Prepare for replacement of missing clotting factor

The nurse is caring for a client with thrombocytopenia what assessment finding would alert the nurse to notify the provider

Restlessness and anxiety The nurse would recognize that the restlessness is the sign of bleeding internally the heart rate and blood pressure are normal finding a weight gain of 2 pounds in four months would be documented but it's not abnormal finding related to thrombocytopenia

Which test should the nurse expect to have done for a client suspected of having pernicious anemia?

Schilling test The Schillling test determines the ability to absorb vitamin B12 and is used to diagnose pernicious anemia. D-dimer is used for diagnosis of pulmonary embolism and disseminated intravascular coagulation. Myoglobin is used to detect damage to the myocardium. Hemoglobin A1c is a test to tell average glucose control over a 3-month period.

A nurse is caring for an anemic client admitted to the healthcare facility what signs and symptoms with the nurse expect to assess in this client

Shortness of breath pulse rate of 110 and activity intolerance ,"hypotension

The nurse is reviewing the postoperative prescriptions for a client who has just returned from surgery and notes that the surgeon has prescribed lepirudin. Which is this medication prescribed to prevent?

Thromboembolic complications

The nurse is reviewing the primary health care provider's (PHCP) prescriptions for a client scheduled for a cardiac catheterization and notes that the PHCP has prescribed tirofiban. The nurse understands that this medication has been prescribed for which purpose?

To inhibit thrombus formation Tirofiban is an antiplatelet and antithrombotic medication. It produces rapid inhibition of platelet aggregation by preventing binding of fibrinogen to receptor sites on platelets. This action inhibits thrombus formation. It is used as an adjunct to aspirin and heparin for hospitalized clients at high risk for myocardial infarction or for clients undergoing a cardiac catheterization procedure. The action of tirofiban is not the prevention of infection or dysrhythmias. Bleeding is a side effect of the medication.

The nurse reinforces instructions to a pregnant client regarding the administration of iron. The nurse determines that the teaching is effective if the client states that she will take the iron with which food items?

Tomato juice Foods containing ascorbic acid (vitamin C), such as tomato juice, may increase absorption of iron. Additionally, absorption of iron is affected by many substances. Calcium and phosphorus in milk and tannin in tea decrease iron absorption. Water will not act to increase the absorption of the iron.

Iron dextran is prescribed to be administered intramuscularly to a client. The nurse prepares the medication and determines that the appropriate method of administration is which?

Using the Z-track technique A disadvantage of administering iron dextran intramuscularly is that it causes pain and discoloration at the injection site. When intramuscular administration is prescribed, the medication should be injected deep into the buttock with the Z-track technique. Z-track injection keeps the iron dextran deep in the muscle, thereby minimizing leakage and surface discoloration. The Z-track technique is used for injection of medications that can stain or irritate the skin. A ⅝-inch needle is used for subcutaneous injections. Applying heat to an injection site before administration is an incorrect action.

A nurse is assisting in developing a plan of care for an older adult client who has received the unit of RBCs which of the following actions should the nurse recommend

Verify the information on the RBC packet with another nurse

He has his caring for a client who reports mood swings weakness tingling and numbness of the fingers and feet and a sore tongue the vitamin deficiency would the nurse further assess for this client

Vitamin B 12

A client has experienced several episodes of sickle cell crisis. Which reinforced instructions should be included in the client's teaching plan to prevent recurrence? Select all that apply.

Wear shoes and socks when walking outside to prevent damage to the feet. To recognize early symptoms of infection and contact primary health care provider (PHCP). Rationale:Wearing socks and shoes will prevent wounds to the legs and feet, which heal slowly and frequently become infected in clients with sickle cell disease. Recognizing the early symptoms of an infection and seeking medical assistance may lessen the severity and avoid a crisis. Vigorous exercise and iced liquids can precipitate a crisis and should be avoided. Opioid tolerance is not a priority or immediate concern for clients experiencing a sickle cell crisis. These clients experience a great deal of pain and require opioids for pain relief. Pain medication should be taken when the client recognizes a crisis.

a client who had excessive hemorrhaging as a result of gastrointestinal bleeding is ordered a blood transfusion what nursing measures should be employed during blood transfusion?

observe for reaction during the first 15 min of transfusion The nurse should monitor the client for a blood transfusion reaction during the first 15 minutes of transfusion procedure they are the most critical time for a nurse to make these observations. The nurse should not take the blood out of the refrigerator more than 30 minutes before the procedure. The nurse should not allow transfusion of a single unit of blood for more than 4 hours. IV medication should not be confused through the same administration said.

A client who was recently prescribed warfarin is being instructed on diet changes necessary with this medication. The client reports enjoying all of these food items. Which items should the nurse instruct the client to limit consuming? Select all that apply.

pinach salad Mustard greens mustard greens contain vitamin K, which can interfere with the function of warfarin. The client needs instruction to eat these foods in limited amounts to prevent interference. The other options do not contain large amounts of vitamin K. Bananas and orange juice contain potassium (K+), but this is not the same as vitamin K.

Intravenous heparin therapy is prescribed for a client. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit?

rotamine sulfate

The nurse is caring for a client with a diagnosis of chronic kidney disease who is receiving dialysis. Epoetin alfa has been prescribed for the client. How should the nurse prepare to administer the medication?

subcutaneous route Rationale:Epoetin alfa is dispensed for subcutaneous or intravenous injections. Vials should not be shaken because epoetin alfa is a protein that can be denatured by agitation. Epoetin alfa is not to be mixed with other medications. The medication should be refrigerated but should not be frozen.

A client with sickle cell disease has been admitted to the hospital complaining of a sudden onset of severe pain in the extremities, abdomen, back, and chest. Which interventions should the nurse expect to be included in the care of the client? Select all that apply.

1.Administer oxygen per nasal cannula. . 3.Administer the prescribed opioid analgesic. 5.Encourage the client to keep extremities extended. 6.Hydrate the client with 0.9% normal saline 125 mL/hr intravenously. A client in a sickle cell crisis will have pain as the body's tissues become hypoxic. A state of adequate hydration is important. The nurse administers oxygen, an opioid analgesic to control the pain, and isotonic intravenous fluids to achieve and maintain hydration. Keeping the extremities extended and not bent decreases sickling risk. The client should be kept warm to counteract the sickling. The room should be 72 degrees or higher and ice bags should not be applied to joint

The nurse is reviewing the laboratory results of a client receiving chemotherapy. The nurse prepares to initiate neutropenic precautions when the nurse notes which laboratory result?

A white blood cell (WBC) count of 2000 mm3 Rationale:When the WBC count drops, neutropenic precautions need to be implemented. The normal WBC count is 5000 to 10,000 mm3. This includes protective isolation measures to protect the client from infection. Bleeding precautions need to be initiated when the platelet count drops. Bleeding precautions include avoiding all trauma such as rectal temperatures or injections. The normal platelet count is 150,000 to 450,000 mm3. The normal bleeding time is 1 to 6 minutes, depending on laboratory method used. The normal ammonia value is 10 to 80 mcg/dL.

The nurse is caring for a hospitalized client with a mechanical heart valve who is receiving maintenance therapy of warfarin sodium. The client's international normalized ratio (INR) is 3. The nurse anticipates which prescription?

Administering the next dose of warfarin sodium A client's INR of 2 to 3 is appropriate for most clients. An INR of 3 to 4.5 is recommended for clients with mechanical heart valves. If the client's INR is below the recommended range, the warfarin sodium dose is increased. If the client's INR is above the recommended range, the warfarin sodium dose is decreased. Because the value identified in this question is within the therapeutic range, the nurse would administer the next dose of warfarin.

The nurse is caring for a client with bleeding disorders what interventions with the nurse include in the clients care plan

Avoid exposure to infection. Avoid constipation. Avoid any aspirin products. And report any excessive bleeding from brushing teeth.

The nurse is caring for a client with a suspected diagnosis of aplastic anemia. Which test should the nurse anticipate to be performed to confirm the diagnosis?

Bone marrow aspiration A bone marrow aspiration will identify aplastic anemia and will identify pancytopenia, a deficiency in erythrocytes, leukocytes, and thrombocytes and confirm that the source of the problem is bone marrow dysfunction. A Schilling test is diagnostic for pernicious anemia. A sickle cell screen is diagnostic for sickle cell anemia. A complete blood cell count will identify anemia but may not identify the specific type and also the leukopenia and thrombocytopenia.

The nurse is assisting in preparing a diet plan for a client who is taking the anticoagulant, warfarin. The nurse instructs the client to limit which food from the diet?

Broccoli Rationale:Anticoagulant medications act to prevent coagulation by antagonizing the action of vitamin K. When a client is taking an anticoagulant, foods high in vitamin K are often omitted from the diet. Vitamin K is found in large amounts in green, leafy vegetables. Pasta, oranges, and potatoes are very low in vitamin K.

A client is receiving supplemental therapy with folic acid. The nurse evaluates the effectiveness of this therapy by monitoring the results of which laboratory study?

Complete blood count Folic acid is necessary for red blood cell production and is classified as a vitamin and an antianemic agent. The effectiveness of therapy can be measured by monitoring the results of periodic complete blood count levels, noting particularly the hematocrit level. Blood glucose, Blood urea nitrogen, and alkaline phosphatase are not associated with the use of this medication.

The nurse is reinforcing instructions to a client with iron deficiency anemia about eating a diet with iron-rich foods. Which food sources should the nurse include in the discharge teaching plan of a client with iron deficiency anemia? Select all that apply.

Eggs Liver Rationale:Liver and muscle meats; eggs; dried fruits; and dark green, leafy vegetables are iron-rich foods. Milk, fish, and cheese are not significant sources of iron.

Which food sources should the nurse include in the discharge teaching plan of a client with vitamin B12 deficiency anemia? Select all that apply.

Eggs Liver Red meats Rationale: Eggs, enriched grain products, and red meats, especially liver, are food sources high in vitamin B12. Ice cream (high in calcium and fat) and citrus fruits (high in vitamin C) are not food sources high in vitamin B12.

A nurse is checking for a laboratory values of an adult client who has sickle cell anemia and is in crisis which of the following complications with the nurse monitor

Elevated Billy Rubin The client who has sickle cell anemia and is in crisis will have an elevated Billy Rubin because he more lysis of the abnormal red blood cells a curse

The nurse is doing discharge teaching with a client who has sickle cell disease. The nurse reinforces instructions to the client to avoid which factors that could precipitate a sickle cell crisis? Select all that apply.

Emotional stress Infection

Enoxaparin sodium is prescribed for the client following hip replacement surgery. The nurse prepares to have which available in the event that an overdose of the medication occurs?

Protamine sulfate Rationale:Enoxaparin sodium is a low molecular weight heparin anticoagulant. Accidental overdose of this medication may lead to bleeding complications. The antidote is protamine sulfate. Naloxone is the antidote for opioids. Phytonadione is the antidote for warfarin sodium. Epinephrine is used to treat hypersensitivity reactions or acute bronchial asthma attacks and bronchospasms.

The nurse is evaluating a clients laboratory results for hours after administering fresh frozen plasma FFP which of the following laboratory values should the nurse review

Prothrombin time

The nurse is reinforcing instructions to a client regarding epoetin alfa that will be administered subcutaneously by the client at home. The nurse tells the client to do which action?

Refrigerate the medication. Rationale:The medication should be refrigerated but not frozen. The client should be instructed not to shake the medicine bottle. Syringes with a ½-inch needle are used to administer subcutaneous injections.

A nurse is monitoring a client who is receiving a unit of packed RBCs following surgery the client reports itching and has hives 30 minutes after the infusion begins which of the following actions should the nurse first take

Stop the infusion of blood

A nurse is assisting in the preparation of a unit packed red blood cells for a client who has anemia which of the following actions should the nurse do first

Witness informed consent

A client with iron deficiency anemia has been prescribed iron suppliments whqt nursing care measures should be employed when administering iron supplements to a client

administer liquid iron with straw inform client iron will change color of stool give citrus juices along with iron