AH Chp 33 Prep U

A patient with sickle cell crisis is admitted to the hospital in severe pain. While caring for the patient during the crisis, which of the following is the priority nursing intervention?

Administering and evaluating the effectiveness of opioid analgesics

A nurse caring for a client who has hemophilia is getting ready to take the client's vital signs. What should the nurse do before taking a blood pressure?

Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints.

Which of the following are assessment findings associated with thrombocytopenia? Select all that apply. Bleeding gums Epistaxis Hematemesis Hypertension Dyspnea

Bleeding gums Epistaxis Hematemesis others: hypotension, tachypnea

Which of the following vitamins enhance the absorption of iron? K C D E

C

A patient with sickle cell anemia is to begin treatment for the disease with hydroxyurea (Hydrea). What does the nurse inform the patient will be the benefits of treatment with this medication? (Select all that apply.) -Fewer painful episodes of sickle cell crisis -Lower incidence of acute chest syndrome -Decreased need for blood transfusions -Reverse damage to cells

Fewer painful episodes of sickle cell crisis Lower incidence of acute chest syndrome Decreased need for blood transfusions

A male client has been receiving a continuous infusion of weight-based heparin for more than 4 days. The client's PTT is at a level that requires an increase of heparin by 100 units per hour. The client has the laboratory findings shown above (platelet count steadily decreasing). The most important action of the nurse is to

Consult with the physician about discontinuing heparin. platelet count too low

A patient's family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which of the following statements made by the nurse correctly explains the cause of DIC?

DIC is caused by an abnormal activation of clotting pathway causing excessive amounts of tiny clots to form inside organs.

A patient with severe anemia is complaining of the following symptoms: tachycardia, palpitations, exertional dyspnea, cool extremities, and dizziness with ambulation. Lab results reveal low hemoglobin and hematocrit levels. Based on the assessment data, which of the following nursing diagnoses is most appropriate for this patient?

Ineffective tissue perfusion related to inadequate hemoglobin and hematocrit

James is a 25-year-old African American male, hospitalized with sickle cell anemia on the hematology floor where you practice nursing. You are preparing a teaching plan to review with James and his family. Which of the following interventions will you include? Select all that apply. Never exceed the recommended dosages of analgesics. Dress warmly in cold temperatures. While participating in physical exercise, wear constrictive clothing to support circulation. Decrease fluid intake

Never exceed the recommended dosages of analgesics. Dress warmly in cold temperatures. While participating in physical exercise, wear constrictive clothing to support circulation.

A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn's disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for?

The onset of a bacterial infection

The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include a nutritional assessment for this patient? a. It will determine what type of anemia the patient has. b. It may indicate deficiencies in essential nutrients. c. It is a required assessment

b. It may indicate deficiencies in essential nutrients.

The nurse is caring for an older adult client who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine where the blood loss is coming from, what intervention can the nurse provide? a. observe for facial drooping b. observe stool for blood c. observe sputum for blood d. observe gums for signs of bleeding

b. observe stool for blood

A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia? a. night sweats, weight loss, diarrhea b. nausea, vomiting, anorexia c. itching, rash, jaundice d. dyspnea, tachycardia, pallor

d. Dyspnea, tachycardia, and pallor

A client is hospitalized 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin at home, which is now discontinued. To prevent the formation of blood clots, it is important for the nurse to a. limit amount of dietary vit K b. decrease amount of ambulation c. apply compression stockings to decrease risk of DVT d. administer the prescribed enoxaparin (Lovenox).

d. administer the prescribed enoxaparin (Lovenox).

Which of the following terms refers to an abnormal decrease in white blood cells, red blood cells, and platelets?

Pancytopenia

antidote to heparin?

Protamine sulphate

A client is seen in the emergency department with severe pain related to a sickle cell crisis. What does the nurse understand is occurring with this client? a. decreased pain tolerance b. overhydration c. Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.

Vascular occlusion in small vessels decreasing blood and oxygen to the tissues.

A patient with end-stage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia? a. creatinine level of 6 mg/100 mL b. K level of 3.5 c. Mg level of 2

a. creatinine level of 6 mg/100 mL

A patient with chronic renal failure is examined by the nurse practitioner for anemia. The nurse knows to review the laboratory data for a decreased hemoglobin level, red blood cell count, and which of the following?

a. decreased level of erythropoietin

You are caring for an 87-year-old female who has been admitted to your unit with iron-deficiency anemia. What would you suspect? a Decrease in the total body iron stores with age b. Blood loss from the gastrointestinal or genitourinary tract c. Excessive caffeine consumption

b. Blood loss from the gastrointestinal or genitourinary tract If an older adult is anemic, blood loss from the gastrointestinal or genitourinary tract is suspected.

Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents? a. hyperchromic b. hypochromic c. microcytic d. normocytic

b. hypochromic

A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. She reports that she first felt pain after manually opening her garage door and that she is taking prednisone daily. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain? a. muscle wasting b. osetoporosis c. hypertension d. truncal obesity

b. osetoporosis all are side effects of corticosteroid treatment but osteoporosis is the most likely cause of her pain

A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client? a. encourage the client to use a wheelchair b. use the smallest needle possible for injections c. limit family visits d. limit fluid intake

b. use the smallest needle possible for injections

The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia? a. RBC are macrocytic and hyperchromic b. RBC are microcytic and hyperchromic c. RBC are microcytic and hypochromic d. RBC are macrocytic and hypochromic

c. RBC are microcytic and hypochromic

A client is being admitted to the hospital with abdominal pain, anemia, and bloody stools. He complains of feeling weak and dizzy. He has rectal pressure and needs to urinate and move his bowels. The nurse should help him: a. assist client to the bathroom b. assist client w. bedside comode c. assist client w. bedpan

c. assist client w. bedpan

A client has hereditary hemochromatosis. Laboratory test results indicate an elevated serum iron level, high transferrin saturation, and normal complete blood count (CBC). It is most important for the nurse to a. encourage ambulation b. edu pt on potential side effects c. remove prescribe unit of blood

c. remove prescribe unit of blood

Which of the following is a symptom of Hemochromatosis? a. inflammation of tongue b. inflammation of skin c. pallor d. bronzing of the skin

d. bronzing of the skin

A patient with ESRD is taking recombinant erythropoietin for the treatment of anemia. What laboratory study does the nurse understand will have to be assessed at least monthly related to this medication?

hemoglobin level

The nurse is educating a patient with iron deficiency anemia about food sources high in iron and how to enhance the absorption of iron when eating these foods. What can the nurse inform the client would enhance the absorption?

liver + vit C

Vitamin B and folic acid deficiencies are characterised by production of abnormally large erythrocytes called

megaloblasts.

In adults, bone marrow is usually aspirated from which area? a. post iliac crest b. sternum c. rib d. vertebrae

a. post iliac crest

A client is prescribed 325 mg/day of oral ferrous sulfate. The nurse includes in client teaching, "Take your iron pill a. take 1 hr before breakfast b. decreased fluid intake c. take med w. dairy d. decrease vit C intake

a. take 1 hr before breakfast take on an empty stomach

Which of the following medications is the antidote to Coumadin? a. vit K b. protamine sulfate c. aspirin d. plavix

a. vit K protamine sulfate = antidote for heparin

The nurse's role in the management of polycythemia vera is primarily that of an educator. Choose the best health promotion advice that a nurse could give. a. take aspirin daily b. Participate in regular phlebotomy procedures to decrease blood viscosity. c. daily use of compression stockings

b. Participate in regular phlebotomy procedures to decrease blood viscosity.

When teaching a patient with iron deficiency anemia about appropriate food choices, the nurse will encourage the patient to increase the dietary intake of which of the following foods? a. fruits high in vit C b. beans, dried fruits, leafy greens c. dairy

b. beans, dried fruits, leafy greens

A patient with sickle cell anemia has a a. high hematocrit b. low hematocrit c. normal hematocrit d. normal smear

b. low hematocrit sickle cell anemia has a low hematocrit and sickled cells on the smear

A client with a diagnosis of pernicious anemia comes to the clinic complaining of numbness and tingling in their arms and legs. What do these symptoms indicate? a. loss of senses b. neuro involvement c. insufficient intake of dietary nutrients d. confusion

b. neuro involvement

A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client? a. sore tongue, jaundice, weight gain b. pallor, tachycardia, sore tongue c. double vision, tachycardia, weight loss d. bradycardia, reduced pulse pressure, pallor

b. pallor, tachycardia, sore tongue CM: pallor, tachycardia, sore tongue, anorexia, weight loss, palpitations, angina bradycardia, reduced pulse pressure, weight gain + double vision NOT cm

A patient with sickle cell disease comes to the emergency department complaining of severe pain in the back, right hip, and right arm. What intervention is important for the nurse to provide? a. administer aspirin b. start an IV of dextrose 5% in 0.25 ns c. provide supplemental O2

b. start an IV of dextrose 5% in 0.25 ns adequate hydration is essential and most imp. during sickle cell crisis O2 may also be needed

The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions? a. Avoid vit C as it inferferes w. absorption b. Encourage use of antacid to aid in absorption c. Dilute the preparation with another liquid and drink from a straw

c. Dilute the preparation with another liquid and drink from a straw

An 89-year-old client is preparing to leave the physician's office. The nurse is discussing with the client some strategies for ingesting iron to combat her iron-deficiency anemia. Which of the following are among the nurse's strategies? a. Taking iron pills with milk aids in absorption. b. Decrease vit C intake. c. Drink liquid iron preparations with a straw. d. Take iron supplement with an antacid to aid absorption

c. Drink liquid iron preparations with a straw. -vit C promotes absorption -antacid interferes w. absorption

Parents arrive to the clinic with their 5-year-old child and inform the nurse the child has just been diagnosed with sickle cell disease. The parents ask the nurse how this could have happened and which one of them is the carrier. What is the best response by the nurse? a. The disease is acquired, not inherited b. The father is the most likely carrier of the gene c. The child must inherit 2 defective genes, one from each parent

c. The child must inherit 2 defective genes, one from each parent

During the review of morning lab values on a patient complaining of severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which of the following findings? a. increased MCV b. increased RBC level c. increased hematocrit d. low ferritin level

d. low ferritin level most consistent indicator of iron deficiency anemia is a low ferritin level, which reflects low iron stores

While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters? a. blood glucose levels, WBC count and platelet count b. WBC count, platelet count, and prothrombin time c. Ca levels, K levels and WBC count d. platelet count, prothrombin time, and partial thromboplastin time

d. platelet count, prothrombin time, and partial thromboplastin time diagnosis of DIC: prothrombin time, platelet count, thrombin time, partial thromboplastin time, and fibrinogen level

During preparation for bowel surgery, a client receives an antibiotic to reduce intestinal bacteria. The nurse knows that hypoprothrombinemia may occur as a result of antibiotic therapy interfering with synthesis of which vitamin? a. vit a b. vit d c. vit e d. vit K

d. vit K