WEEK 11 COMBINE

The client's caregiver asks many questions about sickle cell anemia. She is very concerned about the child and what will happen to her in the future. The nurse is aware there are many serious complications she could experience. Which potentially fatal complication(s) can occur? (Select all that apply. One, some, or all options may be correct.)Select all that apply Vaso-occlusive crisis Cerebral vascular accident Priapism Hypertensive crisis Heart failure

BE

The nurse is caring for a patient with emphysema. The patient is complaining of shortness of breath and dyspnea on minimal exertion. Which assessment finding alerts the nurse that the patient is going into respiratory failure? A. The patient has bibasilar lung crackles. B. The patient is sitting in the tripod position. C. The patient's respirations have decreased from 30 to 10 breaths/minute. D. The patient's pulse oximetry indicates an O2 saturation of 91%.

C. The patient's respirations have decreased from 30 to 10 breaths/minute.

The nurse concludes that the teaching about sickle cell anemia has been understood when an adolescent with the disorder makes which statement? a. "I'll start to have symptoms when I drink less fluid." b. "I'll start to have symptoms when I have fewer platelets." c. "I'll start to have symptoms when I decrease the iron in my diet." d. "I'll start to have symptoms when I have fewer white blood cells.

a. "I'll start to have symptoms when I drink less fluid."

Before starting a transfusion of packed red blood cells, the nurse would arrange for a peer to monitor their other assigned patients for how many minutes when the nurse begins the transfusion? 5 15 30 60

15 As part of standard procedure, the nurse remains with the patient for the first 15 minutes after starting a blood transfusion. Patients who are likely to have a transfusion reaction will more often exhibit signs within the first 15 minutes that the blood is infusing. Monitoring during the transfusion will be every 30 to 60 minutes.

For which medication would the nurse monitor a client closely for hemolytic anemia? 1 Tacrolimus 2 Methyldopa 3 Azathioprine 4 Procainamide

2 Methyldopa Hemolytic anemia is an autoimmune disorder in which destruction of red blood cells occurs before the end of their normal lifespan. This disorder may result after administration of methyldopa. Tacrolimus may cause adverse effects such as nephrotoxicity, lymphoma, and leukopenia. Azathioprine, administered as an immunosuppressant, may cause bone marrow suppression. Procainamide can induce the formation of antinuclear antibodies and cause a lupus-like syndrome.

A client develops hemolytic anemia. Which client medication can cause this adverse effect? 1 Famotidine 2 Methyldopa 3 Levothyroxine 4 Ferrous sulfate

2 Methyldopa Methyldopa is associated with acquired hemolytic anemia and should be discontinued to prevent progression and complications. Famotidine will not cause these symptoms; it decreases gastric acid secretion, which will decrease the risk of gastrointestinal bleeding. Ferrous sulfate is an iron supplement to correct, not cause, anemia. Levothyroxine is not associated with red blood cell destruction.

Self-care at homeThe client is discharged home with a home health referral. The home health nurse visits the day after she is discharged from the hospital. The client's caregiver asks the home-health nurse, "I received some information from the Sickle Cell Foundation, but I have never heard of it. What kind of group is it?" How should the nurse respond? "It is a foundation that deals primarily with research to find the cure for sickle cell anemia." "It provides information on the disease and on support groups in this area." "They didn't discuss this organization with you in the hospital?" "The foundation arranges for families with children who have sickle cell to meet each other."

B

The ED nurse continually assesses the client for signs and symptoms of hypoxia. The client's caregiver presses the call bell to tell the nurse there is blood in the commode after the client went to the bathroom to urinate. Which action should the nurse implement? Notify the HCP immediately. Explain that blood in the urine is expected. Request a stat hemoglobin level. Request a stat sterile urine specimen.

B

Before beginning a transfusion of packed red blood cells (PRBCs), which action by the nurse would be of highest priority to avoid an error during this procedure? Add the blood transfusion as a secondary line to the existing IV. Stay with the patient for 60 minutes after starting the transfusion. Check the identifying information on the unit of blood against the patient's ID bracelet. Prime new primary IV tubing with lactated Ringer's solution to use for the transfusion.

Check the identifying information on the unit of blood against the patient's ID bracelet. The patient's identifying information (name, date of birth, medical record number) on the ID bracelet should exactly match the information on the blood bank tag that has been placed on the unit of blood. If any information does not match, the transfusions should not be hung because of possible error and risk to the patient. The transfusion is hung on blood transfusion tubing, not a secondary line, and cannot be hung with lactated Ringer's solution because it will cause RBC hemolysis. Usually, the patient will need continuous monitoring for 15 minutes after the transfusion is started, as this is the time most transfusion reactions occur. Then the patient should be monitored every 30 to 60 minutes during the administration.

The nurse receives a provider's order to transfuse fresh frozen plasma to a patient with acute blood loss. Which procedure is most appropriate for infusing this blood product? Hang the fresh frozen plasma with lactated Ringer's solution. Fresh frozen plasma must be given within 24 hours after thawing. Infuse the fresh frozen plasma at a rate of 50 mL/hr for the duration. Hang the fresh frozen plasma as a piggyback to a primary IV solution without KCl.

Fresh frozen plasma must be given within 24 hours after thawing. The fresh frozen plasma should be administered as rapidly as possible and should be used within 24 hours of thawing to avoid a decrease in factors V and VIII. Fresh frozen plasma is infused using any straight-line infusion set. Any existing IV should be interrupted while the fresh frozen plasma is infused, unless a second IV line has been started for the transfusion.

When assessing laboratory values on a patient admitted with septicemia, what does the nurse expect to find? Increased platelets Increased red blood cells Decreased erythrocyte sedimentation rate (ESR) Increased bands in the white blood cell (WBC) differential

Increased bands in the white blood cell (WBC) differential When infections are severe, such as in septicemia, more granulocytes are released from the bone marrow as a compensatory mechanism. To meet the increased demand, many young, immature polymorphonuclear neutrophils (bands) are released into circulation. WBCs are usually reported in order of maturity (initially with the less mature forms on the left side of a written report). Hence, the term "shift to the left" is used to denote an increase in the number of bands. Thrombocytosis occurs with inflammation and some malignant disorders. Increased red blood cells or decreased ESR is not indicative of septicemia.

The nurse is caring for a patient with microcytic, hypochromic anemia. What teaching should the nurse provide about medication therapy? Take enteric-coated iron with each meal. Take cobalamin with green leafy vegetables. Take the iron with orange juice 1 hour before meals. Decrease the intake of the antiseizure medications to improve.

Take the iron with orange juice 1 hour before meals. With microcytic, hypochromic anemia may be caused by iron, vitamin B6, or copper deficiency; thalassemia; or lead poisoning. The iron prescribed should be taken with orange juice 1 hour before meals as it is best absorbed in an acid environment. Megaloblastic anemias occur with cobalamin (vitamin B12) and folic acid deficiencies. Vitamin B12 may help red blood cell (RBC) maturation if the patient has the intrinsic factor in the stomach. Green leafy vegetables provide folic acid for RBC maturation. Antiseizure drugs may contribute to aplastic anemia or folic acid deficiency, but the patient should not stop taking the medications. The health care provider will prescribe changes in medications.

A nurse in a home setting is assessing a 79-year-old male patient's risk for malnutrition. The nurse suspects malnutrition when reviewing which laboratory results? (Select all that apply.) A. Body mass index (BMI) of 17 Correct B. Waist-to-hip ratio of 1.0 C. Weight loss of 6% since last month's visit D. Prealbumin level of 16 mg/dL E. Hematocrit level of 50% F. Hemoglobin level of 8.2 g/dL

A, C, F

The nurse asks the client how he is feeling. He reports that he does not have time for this hospitalization. The nurse notes that he seems annoyed. He coughs as he tries to sit up. He turns on the television, focuses on a news station, and ignores the nurse. A focused assessment. A comprehensive assessment. An emergency assessment. A psychosocial assessment.

A

Which recommendation about immunization should the school nurse make to the client's caregiver? The client needs her second scheduled dose of MMR #2. The client is current with her immunizations. The client needs her Hepatitis A immunizations. The client needs her influenza vaccine.

A

Which finding would the nurse expect when assessing the nasal passages of a client with thrombocytopenia? 1 Blood clots 2 Nasal polyps 3 Purulent discharge 4 Pale, swollen turbinates

1 Blood clots Thrombocytopenia increases risk for epistaxis and the nurse may see bleeding or clots. Nasal polyps are not associated with thrombocytopenia. Purulent discharge may occur with foreign bodies in the nose or sinus infection, but would not be expected with thrombocytopenia. Pale and swollen turbinates are caused by allergies and not associated with thrombocytopenia.

When reviewing the results of a toddler's complete blood count, the nurse notes decreased hemoglobin and hematocrit levels. Which other laboratory findings would the nurse expect in iron-deficiency anemia? Select all that apply. One, some, or all responses may be correct. 1. microcytic red blood cells 2. hyperchromic red blood cells 3. low total iron-binding capacity 4. slightly reduced reticulocyte count 5. increased erythrocyte sedimentation rate (ESR)

1. microcytic red blood cells 4. slightly reduced reticulocyte count

The nurse notes a provider's order written at 10:00 AM for two units of packed red blood cells to be administered to a patient who is anemic as a result of chronic blood loss. If the transfusion is picked up at 11:30 AM, the nurse should plan to hang the unit no later than what time? 11:45 AM 12:00 noon 12:30 PM 3:30 PM

12:00 noon The nurse must hang the unit of packed red blood cells within 30 minutes of signing them out from the blood bank.

When a client is admitted to the emergency department with disseminated intravascular coagulation caused by sepsis, which prescribed action will the nurse take first? 1 Apply antiembolism stockings. 2 Draw blood for culture and sensitivity. 3 Administer vancomycin 1 gram intravenously. 4 Transfer the client to the intensive care unit.

2 Draw blood for culture and sensitivity. Treatment of disseminated intravascular coagulation focuses on treatment of the cause of the abnormal coagulation, so rapid initiation of antibiotic therapy is essential. However, blood cultures are drawn before antibiotic administration to ensure that appropriate antibiotics can be prescribed. Antiembolism stockings are needed to help prevent venous thrombosis, but are not the priority action. The client needs to be transferred to the intensive care unit, but the nurse would not wait for the transfer to obtain cultures and administer antibiotics.

An adolescent is admitted with an acute hemophilia episode. For which are rest, ice, compression, and elevation most helpful? 1 Encouraging immobilization 2 Decreasing swelling and inflammation 3 Providing pain relief and reducing anxiety 4 Controlling bleeding and retaining joint function

4 Controlling bleeding and retaining joint function Rest, ice, compression, and elevation (RICE) therapy is implemented to support joints and prevent bleeding into joints during an acute hemophilia episode. Reducing inflammation is not the goal of treatment for the hemophiliac process. Total immobilization is not required. Pain may be relieved to some degree but is not assured.

The nurse notices that the client has no central line and only has one peripheral intravenous catheter in the left forearm. Which intervention is the best way to give the ordered potassium? Consult with a pharmacist about giving it slowly over two hours. Administer the intravenous potassium as it was ordered. Call the healthcare provider and request a new order. Inject lidocaine into the intravenous bag and give as prescribed.

A

Which patient is most likely to develop anemia related to an increased destruction of red blood cells? A 23-yr-old black man who has sickle cell disease A 59-yr-old man whose alcohol use caused folic acid deficiency A 13-yr-old child with impaired growth and development due to thalassemia A 50-yr-old woman with a history of "heavy periods" accompanied by anemia

A 23-yr-old black man who has sickle cell disease A result of a sickling episode in sickle cell anemia involves increased hemolysis of the sickled cells. Thalassemias and folic acid deficiencies cause a decrease in erythropoiesis, whereas the anemia related to menstruation is a direct result of blood loss.

Appropriate approaches used by the long-term care nurse to provide education for a 73-year-old who has just been diagnosed with diabetes include which of the following? (Select all that apply.) A. Schedule a visit by another resident who is diabetic. B. Demonstrate food choices using food photographs. C. Avoid discussion of the patient's favorite foods. D. Remind the patient that a lot of damage has already occurred. E. Encourage the patient's family to participate in teaching sessions. F. Ask the patient about past experiences with lifestyle changes.

A, B, E, F

The nurse is caring for a patient diagnosed with peptic ulcer disease (PUD). The patient was prescribed the proton pump inhibitor Prevacid (lansoprazole). Which of the following supplements may be prescribed to prevent deficiency? A. Vitamin B12 B. Vitamin C C. Vitamin D D. Omega-3 fatty acids

A. Vitamin B12

What is the most significant modifiable risk factor for the development of impaired gas exchange? A. Age B. Tobacco use C. Drug overdose D. Prolonged immobility

B. Tobacco use

The client thanks the nurse for the concern and states that he does not have a desire to attempt suicide. He states that since he has had some rest, good food, and medical treatment, he is feeling much better. He tells her what he knows about his treatment plan: He will start attending grief support meetings and taking better care of himself in general, but he will not be going to psychotherapy or attending any Alcoholics Anonymous meetings. The client has not mentioned what he will do about his chronic alcohol use while describing his treatment plan. Which term would the nurse use to summarize where he is in his alcohol misuse treatment plan? Depression. Bargaining. Denial. Acceptance.

C

Several hours have passed and all medications have been given. The healthcare provider (HCP) is thinking about discharging client. The client's latest laboratory test results have arrived in his electronic medical record (EMR), and the nurse has performed another focused assessment. Which findings satisfy the nurse that the potassium electrolyte replacement medication has been effective? The client's mood and affect have improved significantly. The client's nausea and vomiting have resolved, and appetite has returned. Lack of tremoring when inflating the blood pressure cuff on the left arm. A 12-lead electrocardiography strip confirms a normal sinus rhythm and potassium level is 4.6 mEq/L (4.6 mmol/L).

D

an underlying symptom of ischemia is

Pain Ischemia is associated with pain.

Which assessment finding would the nurse expect when assessing an 11-month-old infant with iron-deficiency anemia whose hemoglobin is 8 g/dL (80 mmol/L)? a. pallor b. tremors c. cyanosis d. spasticity

a. pallor

Which action is most important for the nurse to perform before calling the healthcare provider (HCP) to report the lab values? Initiate telemetry. Complete an SBAR form. Give PO potassium chloride. Notify the unit manager.

A

Which value for hemoglobin would the nurse expect in a client who is experiencing sickle cell crisis? a. 6 to 8 g/100 mL (60-80 mmol/L) b. 10 to 12 g/100 mL (100-120 mmol/L) c. 12 to 14 g/100 mL (120-140 mmol/L) d. 16 to 18 g/100 mL (160-180 mmol/L

a. 6 to 8 g/100 mL (60-80 mmol/L)

A client with sickle cell anemia is experiencing a painful episode (vaso-occlusive crisis) and has a patient-controlled analgesia (PCA) pump. The current pain rating is 5 on a scale of 1 to 10 at the right elbow. The nurse observes that the pump is "locked out" for another 10 minutes. Which action would the nurse implement? a. Turning on the television for diversion b. Placing the prescribed as-needed warm, wet compress on the elbow c. Calling the primary health care provider for another analgesic prescription d. Informing the client gently that she must wait until the pump reactivates to get more medication

b. Placing the prescribed as-needed warm, wet compress on the elbow

How would the nurse explain physiological anemia to a pregnant client? a. Erythropoiesis decreases. b. Plasma volume increases. c. Utilization of iron decreases. d. Detoxification by the liver increases

b. Plasma volume increases.

A client with mild preeclampsia is admitted to the labor and birthing suite. Which signs or symptoms would the client be likely to display if she were developing hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome)? Select all that apply. One, some, or all responses may be correct. 1 Headache 2 Constipation 3 Right upper quadrant abdominal pain 4 Vaginal bleeding 5 Nausea and vomiting

1 Headache 3 Right upper quadrant abdominal pain 5 Nausea and vomiting Headache, right upper quadrant abdominal pain, and nausea and vomiting are all indications of increasing severity of preeclampsia and HELLP syndrome. Constipation and vaginal bleeding are not related to preeclampsia.

The parents of a child who has just been diagnosed with hemophilia A ask the nurse what symptoms of bleeding they should look for in the future. Which symptoms would the nurse list? Select all that apply. One, some, or all responses may be correct. 1 Nosebleeds 2 Blood in the urine 3 Painful and swollen joints 4 Easy bruising 5 Frequent fevers 6 Fast clotting of injuries 7 Dark-colored tarry stools

1 Nosebleeds 2 Blood in the urine 3 Painful and swollen joints 4 Easy bruising 7 Dark-colored tarry stools Epistaxis, also known as nosebleeds, is a common symptom of a lack of clotting factor. Hematuria (blood in the urine) may be grossly apparent. The child may experience joint pain and deformities from bleeding into joints. Excessive bruising will occur from bleeding into tissue with seemingly minor injuries. Dark-colored tarry consistency stools are indicative of gastrointestinal bleeding. Frequent fevers are not associated with hemophilia. Prolonged clotting times occur with this condition.

Which nursing intervention is the priority when the nurse notices that the client receiving a blood transfusion is having an acute hemolytic reaction? 1 Stop the blood transfusion immediately. 2 Report to the primary health care provider. 3 Recheck identifying tags and numbers on the client. 4 Maintain a patent intravenous (IV) line with saline solution.

1 Stop the blood transfusion immediately. An incompatible blood transfusion can result in an acute hemolytic reaction in the client. During acute hemolytic reactions, the nurse would stop a blood transfusion as a priority nursing intervention. After stopping the blood transfusion, the nurse would report it to the primary health care provider. The nurse can then recheck the client's identifying tags and numbers and maintain a patent IV line with saline solution.

A transfusion of packed red blood cells is prescribed for a client with anemia. List the actions in the order in which they will be performed by the nurse. 1. Ensure that the client signed a consent for the transfusion. 2. Determine the client's vital signs. 3. Verify that the number on the blood product, laboratory record, and client arm band match. 4. Don a pair of clean gloves. 5. Initiate the transfusion slowly.

1. Ensure that the client signed a consent for the transfusion. 2. Determine the client's vital signs. 3. Verify that the number on the blood product, laboratory record, and client arm band match. 4. Don a pair of clean gloves. 5. Initiate the transfusion slowly.

In which order will the nurse take these actions when caring for a client who is having a hemolytic reaction to a transfusion of packed red blood cells? 1.Stop the transfusion. 2.Change the intravenous (IV) administration set. 3.Run 0.9% normal saline at a rapid rate. 4.Notify the primary health care provider and blood bank

1.Stop the transfusion. 2.Change the intravenous (IV) administration set. 3.Run 0.9% normal saline at a rapid rate. 4.Notify the primary health care provider and blood bank The priority is to stop the transfusion to prevent further hemolysis. The next action would be to change the IV administration set to prevent infusing any blood product remaining in the tubing. Running normal saline rapidly will help decrease shock and hypotension. Notifying the primary health care provider and blood bank would be the last step because these can be done after taking action to prevent further complications of hemolysis.

The nurse calculates the client's intake and output (I&O) for the shift. She has had 24 ounces of water, 8 ounces of apple juice, and three 4-ounce cartons of milk. She received 50 mL of IV fluids per hour for the last 12 hours and had a urinary output of 1200 mL, plus one episode of wetting the bed. What is the total intake for this shift? (Enter the numerical value only. If rounding is necessary, round to the whole number.)

1920

The mother of a toddler with hemophilia A asks the nurse, "Can I give my child ibuprofen for fever or pain?" How will the nurse respond? 1 "Ibuprofen is a good choice for fever or pain." 2 "Give your child acetaminophen. Ibuprofen may cause bleeding." 3 "No. I'll explain why your child isn't allowed pain medications." 4 "You seem concerned about giving medications to your child."

2 "Give your child acetaminophen. Ibuprofen may cause bleeding." The parent is asking a specific question that should be answered by the nurse. Ibuprofen is contraindicated because it interferes with platelet function and may cause more bleeding; therefore an analgesic such as acetaminophen should be administered because it does not interfere with coagulation. Analgesics are permitted, provided they do not have anticoagulant effects

A client who is underweight has autoimmune hemolytic anemia that has been unresponsive to corticosteroids. A splenectomy is scheduled. For which complication would the nurse assess the client in the immediate postoperative period? 1 Dehiscence 2 Hemorrhage 3 Wound infection 4 Abscess formation

2 Hemorrhage A client is at risk for hemorrhage because of the vascularity of the spleen. Dehiscence is not expected; it usually occurs in obese clients. Wound infection is a complication that will take days to develop. Abscess formation is a complication that will take days to develop.

A child has been diagnosed with hemophilia type A after experiencing excessive bleeding from a minor trauma. The mother states that the toddler is very active and is difficult, constantly saying "no". Which response would the nurse communicate that would be an appropriate response? 1 "Toddlers are curious, trying to make decisions and be independent." 2 "Saying 'no' at this stage is a signal that the child may need some therapy." 3 "You must show the child from a young age that you are the boss and in charge." 4 "Responsible parenting means you must protect the child from all future injuries."

1 "Toddlers are curious, trying to make decisions and be independent." Toddlers are curious, trying to make decisions and being independent, and learning autonomy, which is a normal developmental stage for this age group. Saying "no" is the toddler's means of developing independence rather than a need for therapy. The developmental task according to Erikson is autonomy verses shame, so caregivers need to allow some independence. No person can protect absolutely another individual from all injuries.

The nurse is caring for a patient with polycythemia vera. What is an important action for the nurse to initiate? Encourage deep breathing and coughing. Assist with or perform phlebotomy at the bedside. Teach the patient how to maintain a low-activity lifestyle. Perform thorough and regularly scheduled neurologic assessments.

Assist with or perform phlebotomy at the bedside. Primary polycythemia vera often requires phlebotomy in order to reduce blood volume. The increased risk of thrombus formation that accompanies the disease requires regular exercises and ambulation. Deep breathing and coughing exercises do not directly address the etiology or common sequelae of polycythemia, and neurologic manifestations are not typical.

A patient has been diagnosed with acute myelogenous leukemia (AML). What should the nurse educate the patient that care will focus on? Leukapheresis Attaining remission One chemotherapy agent Waiting with active supportive care

Attaining remission Attaining remission is the initial goal of care for leukemia. The methods to do this are decided based on age and cytogenetic analysis. The treatments include leukapheresis or hydroxyurea to reduce the white blood cell count and risk of leukemia-cell-induced thrombosis. A combination of chemotherapy agents will be used for aggressive treatment to destroy leukemic cells in tissues, peripheral blood, and bone marrow and minimize drug toxicity. In nonsymptomatic patients with chronic lymphocytic leukemia, waiting may be done to attain remission, but not with AML.

The client informs the nurse that he can quit drinking any time he chooses and that he is not interested in psychotherapy or attending any Alcoholics Anonymous (AA) meetings. How should the nurse respond to these statements? Ask the client if he has a better solution than going to psychotherapy. Acknowledge that it's great that the client is taking better care of himself. State that you would be glad if the client would agreed to attend an AA meeting. Have the client state why won't he at least attend an AA meeting.

B

The client is transferred from the ED to the pediatric intensive care department (PICU). In developing the plan of care with the RN team leader, the nurses identify the nursing problem, "Acute pain related to tissue ischemia" as a priority. Which intervention should be included in the care plan? Assess pain by using a numerical pain scale. Explain how to use a patient controlled analgesic pump. Apply cold compresses periodically to painful joints. Administer acetaminophen as needed (PRN) as needed for pain.

B

The client says that he is feeling better and it is now time to give the scheduled medications. Because of the new medical diagnosis of pernicious anemia, the healthcare provider (HCP) has prescribed cyanocobalamin (vitamin B12) 100 mcg/day subcutaneously (SQ) for seven days with a follow up clinical visit for laboratory work on the seventh day. Before giving the medication, what should the nurse do first? Sign off the medication in the electronic medical record (EMR). Teach the client about the medication being given. Locate the ventrogluteal muscle of the left hip. Ask if the client has been NPO for the last 8 hours.

B

The client's HCP has advised her caregiver to get pneumococcal and meningococcal vaccines for her at the follow-up office visit. The caregiver asks the nurse, "Why does she need to have those other vaccines? I hate for her to get more shots. She cries, and I know it hurts." What is the best response by the nurse? "I will get the HCP to explain why the vaccines are needed." "She is susceptible to infections. These vaccinations may help prevent a crisis." "These vaccines are required for all children younger than 10 years of age." "I know you don't like to see her hurt, but she must have these vaccines."

B

The client's caregiver goes downstairs to get something to eat from the hospital cafeteria. The unlicensed assistive personnel (UAP) informs the nurse the client urinated in the bed, is crying, and wants her caregiver. Which intervention should the nurse implement first? Change the bed linens. Help change her clothes. Find the client's caregiver in the cafeteria. Document the incident in the chart.

B

An person of Northern heritage is at an increased risk for which of the following: (Select all that apply.) A. Vitamin c deficiency B. Type 1 diabetes C. Celiac disease D. Type 2 diabetes E. Hypertension F. Metabolic syndrome

B, C

The nurse is assessing a group of patients to determine their risk of vitamin D deficiency. Which of the following patients has the highest risk for vitamin D deficiency? A. Caucasian female who is 39 weeks gestation. B. An African-American female who is breastfeeding. C. An Asian female diagnosed with hypoglycemia. D. A Hispanic female who has a BMI of 24.1.

B. An African-American female who is breastfeeding.

The nurse is caring for a 50-year-old man who has a body mass index (BMI) of 31 kg/m2, a normal C-reactive protein level, and low serum transferrin and albumin levels. The nurse will plan patient teaching to increase the patient's intake of foods that is high in: A. Iron B. Protein C. Calories D. Carbohydrate

B. Protein

The nurse performs a focused assessment. Which systems should the nurse evaluate? (Select all that apply. One, some, or all options may be correct.) Neurological system. Cardiovascular system. Respiratory system. Integumentary system. Gastrointestinal system.

BCE

Once the client is cleaned up and repositioned in bed, she states she is hungry, and would like to have a snack. Which food should the nurse offer to the client who is in a sickle cell crisis? Peaches. Cottage cheese. Popsicles. Lima beans.

C

The ED HCP completes the assessment and diagnoses the client with a vaso-occlusive sickle cell crisis, probably secondary to pneumonia. Which orders should the nurse anticipate? Select all that apply Provide the client with cold packs to place on her joints. Admit the client to a private room and keep her in reverse isolation. Infuse 5% Dextrose in 0.33% sodium chloride (NS) at 75 mL/hr via pump. Insert a 22 French indwelling urinary catheter with an urometer.

C

The client is 45-years-old. Which life style choice is surprising given his psychosocial developmental stage based on Erikson? His sexual preferences. He prefers to live in a city where there is a lot of action. He enjoys staying out all night at his favorite local bar. He works ten to twelve hours every day in the office.

C

A patient with leukemia is admitted for severe hypovolemia after prolonged diarrhea. The platelet count is 43,000/µL. It is most important for the nurse to take which action? Insert two 18-gauge IV catheters. Administer prescribed enoxaparin. Monitor the patient's temperature every 2 hours. Check stools for presence of frank or occult blood.

Check stools for presence of frank or occult blood. A platelet count below 150,000/µL indicates thrombocytopenia. Prolonged bleeding from trauma or injury does not usually occur until the platelet counts are below 50,000/µL. Bleeding precautions (e.g., check all secretions for frank and occult blood) are indicated for patients with thrombocytopenia. Injections (including IVs) should be avoided; however, when needed for critical fluids and medications, IV access should be provided through the smallest bore devices that are feasible. Enoxaparin, an anticoagulant administered subcutaneously, is contraindicated in patients with thrombocytopenia. Monitoring temperature would be indicated in a patient with leukopenia.

After attending school for 2 weeks without any problems, the client reports to the school nurse that she doesn't feel well. The nurse determines she has a temperature of 102° F (38.8o C). The school nurse calls her caregiver and advises the nurse to take the client directly to the emergency department (ED). She reported pain in her knees, in her elbows, and throughout her body. In the ED, the nurse confirms vital signs with temperature 102u00b0 F (38.8° C), pulse 104 beats per minute, respirations 24 breaths per minute, blood pressure 90/68 mmhg, and pulse oximeter reading 91%. The nurse notifies the ED physician of the child's vital signs, which are: vital signs as Temperature 102° F (38.8° C), Pulse 104 beats per minute, Respirations 24 breaths per minute, Blood Pressure 90/68 mmhg, and pulse oximeter reading 91%. The school nurse reviews immunization records from the client's previous school. The nurse notes the client had four scheduled doses of DTaP, three scheduled doses of Hib, and one dose of MMR and received her Hep B series as an infant. The nurse anticipates an order for which diagnostic test by the ED HCP? Peripheral blood smear. Hemoglobin electrophoresis. Sickle-turbidity test (Sickledex). Blood cultures.

D

The following Monday, the client goes with her caregiver to the local elementary school, where she is enrolled in the third grade. The caregiver meets with the school nurse to discuss the client's needs while she attends school. The school nurse has cared for several children with SCD and is very knowledgeable about the needs of children with the disease. The school nurse discusses the client's condition with the classroom teacher. Which intervention should the nurse implement? Explain that the other children should be extra nice to the client. Instruct the teacher to have the client sit at the front of the classroom. Encourage the client to participate in all playground activities. Request the client be allowed to go to the bathroom whenever she asks.

D

The night nurse assesses the client and notes that her vital signs are now temperature 98.3° F (36.8o C), pulse 108 beats per minute, respirations 22 breaths per minute, blood pressure 96/60 mmhg. Which action should the nurse implement? Notify the HCP immediately. Retake and assess the vital signs in 1 hour. Encourage the client to turn, cough, and deep breathe. Document the findings on the graphic sheet.

D

The nurse meets with the client and the caregiver to discuss their health condition. The caregiver asks the nurse, "I have heard of sickle cell disease (SCD) and I know it can be very bad, but I don't know exactly what it is." Which is the best initial response by the nurse to explain SCD to the client's caregiver? "I have some written material that will explain all about the disease." "It is a disease of the blood that requires taking medication every day." "Your daughter will probably have episodes of severe joint pain and will need to be hospitalized." "Red blood cells become 'C' shaped, stiff, and sticky, which blocks the blood vessels."

D

The nurse notes that the client has had many personal losses in his life, and he recently lost his legal partner in an accident. His electronic medical record (EMR) has no one listed as a person to contact in case of emergencies. Which question is the best way for the nurse to begin assessing the client's support systems and available resources? "Can you tell me more about what happened to your professional partner?" "Which neighborhood bar do you regularly go to after work in the evenings?" "I'm sorry for your loss. Was your legal partner also your domestic partner?" "Who would you like to have listed as your emergency contact person?"

D

Which sign or diagnostic result should the nurse expect to observe in a client due to hypokalemia? An arm tremor while taking the client's blood pressure. Hyperactive deep tendon reflexes. Elevated serum glucose level. A dampened or flattened T-wave on an electrocardiogram (ECG).

D

The blood bank notifies the nurse that 2 units of blood ordered for a patient is ready for pick up. Which action should the nurse take to prevent an adverse effect during this procedure? Immediately pick up both units of blood from the blood bank. Infuse the blood slowly for the first 15 minutes of the transfusion. Regulate the flowrate so that each unit takes at least 4 hours to transfuse. Set up the Y-tubing of the blood set with dextrose in water as the flush solution.

Infuse the blood slowly for the first 15 minutes of the transfusion. Because a transfusion reaction is more likely to occur at the beginning of a transfusion, the nurse should initially infuse the blood at a rate no faster than 2 mL/min and remain with the patient for the first 15 minutes after hanging 1 unit of blood. Only 1 unit of blood can be picked up at a time, it must be infused within 4 hours, and it cannot be hung with dextrose.

When evaluating a patient's nutritional-metabolic pattern related to hematologic health, what priority assessment should the nurse perform? Inspect the skin for petechiae. Ask the patient about joint pain. Assess for vitamin C deficiency. Determine if the patient can perform activities of daily living

Inspect the skin for petechiae. Any changes in the skin's texture or color should be explored when assessing the patient's nutritional-metabolic pattern related to hematologic health. The presence of petechiae or ecchymotic areas could be indicative of hematologic deficiencies related to poor nutritional intake or related causes. The other options are not specific to the nutritional-metabolic pattern related to hematologic health.

Questions 1. The nurse is assessing a female patient at the neighborhood clinic. The patient is complaining of "feeling tired all the time." The nurse knows that fatigue may be an underlying symptom of which condition? A. Ischemia B. Pneumonia C. Myocardial infarction D. Peptic ulcer disease

Myocardial infarction Fatigue is an atypical symptom of myocardial infarction in women.

A patient with an acute peptic ulcer and major blood loss requires an immediate transfusion with packed red blood cells. Which task is appropriate for the registered nurse (RN) to delegate to unlicensed assistive personnel (UAP)? Confirm the IV solution is 0.9% saline. Obtain the vital signs before the transfusion is initiated. Monitor the patient for shortness of breath and back pain. Double-check the patient identity and verify the blood product.

Obtain the vital signs before the transfusion is initiated. The RN may delegate tasks such as taking vital signs to UAP. Assessments (e.g., monitoring for signs of a blood transfusion reaction [shortness of breath and back pain]) are within the scope of practice of the RN and may not be delegated to UAP. The RN must also assume responsibility for ensuring the correct IV fluid is used with blood products. A licensed nurse must complete verification of the patient's identity and the blood product data.

an underlying symptom of Peptic ulcer disease is

Peptic ulcer disease is associated with pain and intestinal discomfort.

A pregnant client and her husband tell the nurse they have a 1-year-old daughter with sickle cell anemia, but that they themselves do not have the disease. Which response would correctly answer the clients' question, "Will this baby also have sickle cell anemia?" a. "The chance that another child will have sickle cell anemia is 25%." b. "Only one child in a family is affected, so the others will probably be all right." c. "The most likely conclusion is that your children will have sickle cell anemia." d. "If your partner has the sickle cell gene, 50% of your children will have sickle cell anemia."

a. "The chance that another child will have sickle cell anemia is 25%."

Which is the most appropriate nursing intervention for an adolescent child with sickle cell anemia? a. Teaching the family how to limit sickling episodes b. Preparing the child for occasional blood transfusions c. Educating the family about prophylactic medications d. Explaining to the child how excess oxygen causes sickling

a. Teaching the family how to limit sickling episodes

An adolescent child with sickle cell anemia is admitted to the pediatric unit during a vaso-occlusive crisis. Which pathophysiology is correct? a. Severe depression of the circulating thrombocytes b. Diminished red blood cell (RBC) production by the bone marrow c. Pooling of blood in the spleen with splenomegaly as a consequence d. Blockage of small blood vessels as a result of clumping of RBCs

d. Blockage of small blood vessels as a result of clumping of RBCs

A 36-yr-old patient suspected of having leukemia is scheduled for a bone marrow aspiration. What statement in the patient's health history requires immediate follow-up by the nurse? "I had a bad reaction to iodine before and almost died." "I am taking an antibiotic to treat a urinary tract infection." "I have rheumatoid arthritis and take aspirin for joint pain." "I have dialysis for chronic renal failure three times a week."

"I have rheumatoid arthritis and take aspirin for joint pain." Complications of bone marrow aspiration are minimal, but there is a possibility of damaging underlying structures, especially if the sternum site is used. Other complications include hemorrhage, particularly if the patient is thrombocytopenic, and infection if the white blood cell count is low. The risk of hemorrhage is increased if the patient takes aspirin because it promotes bleeding by inhibiting platelet aggregation. Contrast dye is not used during a bone marrow aspiration. A bone marrow aspiration is not contraindicated in patients who have chronic renal failure on dialysis or a urinary tract infection on an antibiotic.

The nurse is teaching the parents of a toddler with a recent diagnosis of hemophilia about the disease. Which area of the body would the nurse include as the most common site for bleeding? 1 Brain 2 Joints 3 Kidneys 4 Abdomen

2 Joints The joints are the most commonly involved areas because of weight bearing and constant movement. Neither the brain, kidneys, nor abdomen is the most common site; however, bleeding may occur in any of these areas.

The nurse teaches a black man with sickle cell disease about symptom management and prevention of sickle cell crisis. The nurse determines further teaching is necessary if the patient makes which statement? "When I take a vacation, I should not go to the mountains." "I should avoid being with anyone who has a respiratory infection." "I may have severe pain during a crisis and need opioid analgesics." "When my vision is blurred, I will close my eyes and rest for an hour."

"When my vision is blurred, I will close my eyes and rest for an hour." Blurred vision should be reported immediately and may indicate a detached retina or retinopathy. Hypoxia (at high altitudes) and infection are common causes of a sickle cell crisis. Severe pain may occur during a sickle cell crisis, and narcotic analgesics are indicated for pain management.

When preparing to administer an ordered blood transfusion, which IV solution does the nurse use when priming the blood tubing? Lactated Ringer's 5% dextrose in water 0.9% sodium chloride 0.45% sodium chloride

0.9% sodium chloride The blood set should be primed before the transfusion with 0.9% sodium chloride, also known as normal saline. It is also used to flush the blood tubing after the infusion is complete to ensure the patient receives blood that is left in the tubing when the bag is empty. Dextrose and lactated Ringer's solutions cannot be used with blood because they will cause RBC hemolysis.

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." A straight razor should not be used by the adolescent with hemophilia, so further teaching is required. The adolescent with hemophilia should be taught to use an electric razor for shaving. Contact sports should be avoided, but swimming is a recommended activity, so trying out for the swim team indicates that the adolescent understands the teaching. If a superficial injury occurs, gentle, prolonged pressure should be applied until the bleeding has stopped. If a muscle or joint injury occurs, the area should be immobilized, elevated, and iced. Both statements indicate that the adolescent has understood the teaching.

Which iron-rich foods should the nurse recommend for a toddler-age client who is diagnosed with iron deficiency anemia? Select all that apply. 1. Carrots 2. Chicken 3. Broccoli 4. Lean steak 5. Whole milk

2, 3, 4 Parents should be encouraged to provide an iron-rich diet that includes heme and nonheme iron sources such as poultry (chicken), green leafy vegetables (broccoli), and red meats (lean steak). Carrots are not a source of iron in the diet. Whole milk consumption should be limited as it is a source of oxalates, which decrease the absorption of iron.

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.

A 6-year-old child with sickle cell disease is admitted with a vasoocclusive crisis (pain episode). Which are the priority nursing concerns? Select all that apply. One, some, or all responses may be correct. 1. Nutrition 2. Hydration 3. Pain management 4. Prevention of infection 5. Oxygen supplementation

2. Hydration 3. Pain management 5. Oxygen supplementation

3. A patient is experiencing periods of confusion, and the family is concerned. The patient's son asks the nurse for an explanation and recommendation. What is the nurse's best response? A. "Your father may be having mini-strokes; I will notify his physician." B. "Your father is just confused about some things since he is in the hospital." C. "The confusion will pass. Your father just has to get up and move around." D. "Talk with your father about past events, and that will help with the confusion."

A. "Your father may be having mini-strokes; I will notify his physician." Periods of confusion may be related to mini-strokes, or transient ischemic attacks (TIAs). Confusion during hospitalization does not occur with every patient. Talking with the patient or thinking the confusion may pass is not a viable solution. The patient should be assessed and the reason for the confusion identified. Awarded 1.0 points out of 1.0 possible points.

The nurse is administering oral glucocorticoids to a patient with asthma. What assessment finding would the nurse identify as a therapeutic response to this medication? A. No observable respiratory difficulty or shortness of breath over the last 24 hours B. A decrease in the amount of nasal drainage and sneezing C. No sputum production, and a decrease in coughing episodes D. Relief of an acute asthmatic attack

A. No observable respiratory difficulty or shortness of breath over the last 24 hours

The nurse has received new orders by electronic medical record (EMR) in response to the recent laboratory results. One of the orders is for intravenous potassium chloride 20 mEq/100 mL over one hour. Which drug implications are important for the nurse to consider before giving it? (Select all that apply. One, some, or all options may be correct.) A. The intravenous site should be monitored closely for infiltration. B. Giving the infusion too rapidly can cause fatal hyperkalemia. C. It should be injected directly and slowly by intravenous push. D. The intravenous infusion is best given through a central line. E. The intravenous potassium can be given by gravity infusion. F. Administering the intravenous medication can burn a peripheral vein.

ABDF

The nurse is caring for a 36-yr-old patient receiving phenytoin (Dilantin) to treat seizures resulting from a traumatic brain injury as a teenager. It is most important for the nurse to observe for which hematologic adverse effect of this medication? Anemia Leukemia Polycythemia Thrombocytosis

Anemia Hematologic adverse effects of phenytoin include anemia, thrombocytopenia, leukopenia, granulocytopenia, agranulocytosis, and pancytopenia.

The nurse is caring for a patient who is to receive a transfusion of two units of packed red blood cells. After obtaining the first unit from the blood bank, the nurse would ask which health team member in the nurses' station to assist in checking the unit before administration? Unit secretary A physician's assistant Another registered nurse An unlicensed assistive personnel

Another registered nurse Before hanging a transfusion, the registered nurse must check the unit with another RN or with a licensed practical (vocational) nurse, depending on agency policy. The unit secretary, physician's assistant, or unlicensed assistive personnel should not be asked.

Morning laboratory results have begun appearing in the client's electronic medical record (EMR). Which electrolyte deficiency would make the nurse suspect that this client may be suffering from chronic alcohol use? Potassium. Magnesium. Phosphate. Sodium.

B

The caregiver listens attentively to the nurse discussing the client's condition and what must be done to competently care for her. After reviewing the needed care, the nurse asks the caregiver if there are any other questions. The caregiver asks, "How did my child get this awful disease? "How should the nurse respond? "This disease is an inherited autosomal recessive disease and your daughter inherited the gene responsible for causing the disease." "Your daughter has the disease because she inherited the gene from one of her parents, who is a carrier." "She must have had a bad reaction to a transfusion as a child." "She was exposed to a virus while her caregiver was pregnant."

B

4. A patient is questioning the nurse about circulation and perfusion. What is the nurse's best response? A. Perfusion assists the body by preventing clots and increasing stamina. B. Perfusion assists the cell by delivering oxygen and removing waste products. C. Perfusion assists the heart by increasing the cardiac output. D. Perfusion assists the brain by increasing mental alertness.

B. Perfusion assists the cell by delivering oxygen and removing waste products. Perfusion delivers much needed oxygen to the cells of the body and then helps to remove waste products. Perfusion does not prevent clots, does not increase cardiac output, and does not increase mental alertness. Awarded 1.0 points out of 1.0 possible points.

A patient is having the arterial blood gas (ABG) measured. What would the nurse identify as the parameters to be evaluated by this test? A. Ratio of hemoglobin and hematocrit B. Status of acid-base balance in arterial blood C. Adequacy of oxygen transport D. Presence of a pulmonary embolus

B. Status of acid-base balance in arterial blood

In collaboration with the nurse, the attending healthcare provider (HCP) has consulted several specialists for a conference to plan the client's care. The nurse is also preparing to initiate a follow up discussion about treatment options with the client after the meeting. Which consultants will be most helpful during this meeting? (Select all that apply. One, some, or all options may be correct.) Occupational therapy. Hematologist. Psychologist/Psychiatrist. Gastroenterologist. Internist. Speech therapy.

BCDE

The nurse finds that the client has a weak, irregular, and rapid pulse and his tongue is inflamed. The nurse decides to perform a neurological assessment because of mild tremoring. His unexpected neurological findings include hyperactive deep tendon reflexes and mild burning and prickling sensations on his feet and hands. He also appears to startle easily, and he has lost about 15% of his weight compared to his last visit, which was four months ago. During the assessment, the nurse suspects that the client may have pernicious anemia. Which pathophysiological process promotes this condition? Presence of Reed-Sternberg cells. Diminished total iron-binding capacity. Destruction of gastric parietal cells. Inadequate intake of dietary folate.

C

Which of the following tools is the best measure to determine a patient's gas exchange and respiratory function? A. Chest x-ray B. Oxygen saturation C. Arterial blood gas (ABG) analysis D. Central venous pressure monitoring

C. Arterial blood gas (ABG) analysis

The nurse assesses the client's lifestyle choices to explore what resources he has for health promotion. Which lifestyle choice could concern the nurse about a client with possible chronic alcohol use? Sexual preferences. He works ten to twelve hours every day in the office. He prefers to live in a city where there is a lot of action. He enjoys staying out all night at his favorite local bar.

D

2. The nurse is assessing a patient for sleep patterns. The patient reports that he has trouble sleeping when lying flat. The best response from the nurse is A. open a window to let fresh air into the room. B. use nasal strips to assist with breathing. C. sleep in a side-lying position. D. use pillows to prop yourself up while sleeping.

D. use pillows to prop yourself up while sleeping. Correct Using pillows to prop himself up during sleep allows the patient to breathe more easily and comfortably. Nasal strips will help with breathing, but they do not always bring relief when one is lying flat. Sleeping in a side position or opening a window does not help one to breathe more easily when one is lying flat. Awarded 1.0 points out of 1.0 possible points.

The nurse is providing care for older adults on a subacute, geriatric medical unit. What effect does aging have on hematologic function of older adults? Thrombocytosis Decreased hemoglobin Decreased WBC count Decreased blood volume

Decreased hemoglobin Older adults often have decreased hemoglobin levels as a result of changes in erythropoiesis. Decreased blood volume, decreased WBCs, and alterations in platelet number are not considered to be normal, age-related hematologic changes.

The patient with leukemia has acute disseminated intravascular coagulation (DIC) and is bleeding. What diagnostic findings should the nurse expect to find? Elevated D-dimers Elevated fibrinogen Reduced prothrombin time (PT) Reduced fibrin degradation products (FDPs)

Elevated D-dimers The D-dimer is a specific marker for the degree of fibrinolysis and is elevated with DIC. FDP is elevated as the breakdown products from fibrinogen and fibrin are formed. Fibrinogen and platelets are reduced. PT, PTT, aPTT, and thrombin time are all prolonged.

The nurse is reviewing the objective data listed in the table below of a patient with suspected allergies. Which assessment finding indicates allergies? Tab 1 Physical examination Dry cough Pale skin Tab 2 Laboratory results Neutrophils: 60%Eosinophils: 10%Basophils: 1%Lymphocytes: 20%Monocytes: 6% Tab 3 Medications Acetaminophen 1000 mg every 12 hoursLevothyroxine (Synthroid) 125 mcg each day Dry cough Eosinophil result Lymphocyte result Acetaminophen use

Eosinophil result Eosinophils are granulocytes that phagocytize antigen-antibody complexes formed during an allergic response. The normal eosinophil count is 2% to 4% of all white blood cells. The dry cough, lymphocyte result, and acetaminophen use do not indicate allergies.

The patient diagnosed with anemia had laboratory tests done. Which results indicate a lack of nutrients needed to produce new red blood cells (RBCs)? (Select all that apply.) Increased homocysteine Decreased reticulocyte count Decreased cobalamin (vitamin B12) Increased methylmalonic acid (MMA) Elevated erythrocyte sedimentation rate (ESR)

Increased homocysteine Decreased cobalamin (vitamin B12) Increased methylmalonic acid (MMA) Increased homocysteine and MMA along with decreased cobalamin (vitamin B12) indicate cobalamin deficiency, which is a nutrient needed for RBC production. Decreased reticulocytes indicate low bone marrow activity in producing RBCs, not available nutrients. Elevated ESR is related to an increased inflammatory process, not anemia.

A patient had a splenectomy for injuries sustained in a motor vehicle accident. Which phenomena are likely to result from the absence of the patient's spleen? (Select all that apply.) Impaired fibrinolysis Increased platelet levels Increased eosinophil levels Fatigue and cold intolerance Impaired immunologic function

Increased platelet levels Impaired immunologic function Splenectomy can result in increased platelet levels and impaired immunologic function because of the loss of storage and immunologic functions of the spleen. Fibrinolysis, fatigue, and cold intolerance are less likely to result from the loss of the spleen since coagulation and oxygenation are not primary responsibilities of the spleen.

Results of a patient's most recent blood work indicate an elevated neutrophil level. The nurse recognizes that this diagnostic finding suggests which problem? Infection Hypoxemia Acute thrombotic event Risk of hypocoagulation

Infection An increase in the neutrophil count most commonly occurs in response to infection or inflammation. Hypoxemia and coagulation do not directly affect neutrophil production.

The patient is admitted with hypercalcemia, polyuria, and pain in the pelvis, spine, and ribs with movement. Which hematologic problem would most likely cause these manifestations? Multiple myeloma Thrombocytopenia Megaloblastic anemia Myelodysplastic syndrome

Multiple myeloma Multiple myeloma typically manifests with skeletal pain and osteoporosis that may cause hypercalcemia, which can result in polyuria, confusion, or cardiac problems. Serum hyperviscosity syndrome can cause renal, cerebral, or pulmonary damage. Thrombocytopenia, megaloblastic anemia, and myelodysplastic syndrome are not characterized by these manifestations.

an underlying symptom of pneumonia is

Pneumonia is associated with pain and shortness of breath.

A patient will receive a hematopoietic stem cell transplant (HSCT). What is the nurse's priority after the patient receives combination chemotherapy before the transplant? Prevent patient infection. Avoid abnormal bleeding. Give pneumococcal vaccine. Provide companionship while isolated.

Prevent patient infection. After combination chemotherapy for HSCT, the patient's bone marrow is destroyed in preparation to receive the bone marrow graft. Thus, the patient is immunosuppressed and is at risk for a life-threatening infection. The priority is preventing infection. Bleeding is not usually a problem. Giving the pneumococcal vaccine at this time should not be done; it should have been done previously. Providing companionship is not the primary role of the nurse, although the patient will need support during the time of isolation.

Which assessment finding would support the presence of a hemostasis abnormality? Purpura Pruritus Weakness Pale conjunctiva

Purpura Purpura may occur when platelets or clotting factors are decreased and bleeding into the skin occurs. Pruritus is not related to hemostasis but to hematologic cancers (e.g., lymphomas, leukemias) or increased bilirubin. Weakness and pale conjunctiva are not related to hemostasis unless a lot of bleeding leads to anemia with low hemoglobin level.

A 62-yr-old patient with disseminated intravascular coagulation (DIC) after urosepsis has a platelet count of 48,000/μL. The nurse should assess the patient for which abnormality? Pallor Purpura Pruritus Palpitation

Purpura The normal range for a platelet count is 150,000 to 400,000/μL. Purpura is caused by decreased platelets or clotting factors, resulting in small hemorrhages into the skin or mucous membranes. Pallor is decreased or absent coloration in the conjunctiva or skin. Pruritus is an intense itching sensation. Palpitation is a sensation of feeling the heart beat, flutter, or pound in the

A patient with a diagnosis of hemophilia had a fall down an escalator earlier in the day and now has bleeding in the left knee joint. What should be the emergency nurse's immediate action? Immediate transfusion of platelets Resting the patient's knee to prevent hemarthroses Assistance with intracapsular injection of corticosteroids Range-of-motion exercises to prevent thrombus formation

Resting the patient's knee to prevent hemarthroses In patients with hemophilia, joint bleeding requires resting of the joint to prevent deformities from hemarthrosis. Clotting factors, not platelets or corticosteroids, are administered. Thrombus formation is not a central concern in a patient with hemophilia.

A blood type and cross-match has been ordered for a patient who has an upper gastrointestinal bleed. The results of the blood work indicate that the patient has type A blood. Which description explains this result? The patient can be transfused with type AB blood. The patient may only receive a type A transfusion. The patient has A antigens on his red blood cells (RBCs). Antibodies are present on the surface of the patient's RBCs.

The patient has A antigens on his red blood cells (RBCs). A person with type A blood has A antigens, not A antibodies, on his RBCs. An AB transfusion would result in agglutination, but he may be transfused with either type A or type O blood.

The nurse is preparing to perform an assessment for a newly admitted patient with a potential hematologic disorder and petechiae. What does the nurse anticipate finding when assessing this patient? Tiny purple spots on the skin Large ecchymotic areas on the skin Hyperkeratotic papules and plaques Small, raised red areas on the soles of the feet

Tiny purple spots on the skin Petechiae present as tiny purple spots on the skin. Large ecchymotic areas are purpura. Hyperkeratotic papules and plaques characterize actinic keratosis. Small, raised red areas on the soles of the feet signify Osler's nodes.

The nurse is caring for a patient with a diagnosis of disseminated intravascular coagulation (DIC). What is the first priority of care? Administer heparin. Administer whole blood. Treat the causative problem. Administer fresh frozen plasma.

Treat the causative problem. Treating the underlying cause of DIC will interrupt the abnormal response of the clotting cascade and reverse the DIC. Blood product administration occurs based on the specific component deficiencies and is reserved for patients with life-threatening hemorrhage. Heparin will be administered if the manifestations of thrombosis are present and the benefit of reducing clotting outweighs the risk of further bleeding.

A patient is being treated for non-Hodgkin's lymphoma (NHL). What should the nurse first teach the patient about the treatment? Skin care that will be needed Method of obtaining the treatment Treatment type and expected side effects Gastrointestinal tract effects of treatment

Treatment type and expected side effects The patient should first be taught about the type of treatment and the expected and potential side effects. Nursing care is related to the area affected by the disease and treatment. Skin care will be affected if radiation is used. Not all patients will have gastrointestinal tract effects of NHL or treatment. The method of obtaining treatment will be included in the teaching about the type of treatment.

When a client develops iron-deficiency anemia, which of the client's laboratory test results would the nurse expect to be decreased? a. ferritin level b. platelet count c. WBC count d. total iron-binding capacity

a. ferritin level

The nurse is caring for a patient with a diagnosis of immune thrombocytopenic purpura (ITP). What is a priority nursing action in the care of this patient? Administration of packed red blood cells Administration of oral or IV corticosteroids Administration of clotting factors VIII and IX Maintenance of reverse isolation and application of standard precautions

administration of oral or IV corticosteroids Common treatment modalities for ITP include corticosteroid therapy to suppress the phagocytic response of splenic macrophages. Blood transfusions, administration of clotting factors, and reverse isolation are not interventions that are indicated in the care of patients with ITP. Standard precautions are used with all patients.

After the nurse has finished teaching a client about sickle cell anemia, which statement indicates that the client has a correct understanding of the condition? a. "I have abnormal platelets." b. "I have abnormal hemoglobin." c. "I have abnormal hematocrit." d. "I have abnormal white blood cells.

b. "I have abnormal hemoglobin."

A child with sickle cell anemia is experiencing a painful episode (vaso-occlusive crisis). The nurse assesses the child, obtains the child's vital signs, and reviews the child's laboratory test results. Which is the priority nursing action? a. Providing oxygen therapy b. Administering an analgesic c. Initiating a blood transfusion d. Monitoring intravenous fluids

b. Administering an analgesic

The nurse is helping an adolescent with iron-deficiency anemia make breakfast meal choices. Which food would the nurse suggest? a. apple fruit cup b. bowl of raisin bran c. cup of blueberry yogurt d. slice of wheat bread toast with butter

b. bowl of raisin bran

Which cause of anemia would the nurse recognize as the most common cause of anemia in 1-year-olds? a. thalassemia b. lead poisoning c. iron deficiency d. sickle shape of blood cells

c. iron deficiency

The nurse is teaching a pregnant client with sickle cell anemia about the importance of taking supplemental folic acid. Which response by the nurse explains how folic acid would help? a. "It lessens sickling of red blood cells." b. "It prevents vaso-occlusive crises." c. "It helps decrease the cellular oxygen need." d. "It will promote production of hemoglobin."

d. "It will promote production of hemoglobin."

The parents of a 3-month old infant who is breast-fed ask the nurse how to prevent nutritional anemia. Which is the best response by the nurse? a. Supplemental iron will not be needed for the first year. b. Solid foods need not be introduced until 7 or 8 months of age. c. Anemia will not develop as long as the infant is gaining weight. d. Baby cereal or an iron supplement should be given around 4 months of age

d. Baby cereal or an iron supplement should be given around 4 months of age

Which is the nurse's priority when evaluating a child with sickle cell anemia whose spleen autoinfarcted 2 years prior? a. Monitoring for signs of jaundice b. Assessing the abdomen frequently c. Monitoring serial hematocrit readings d. Determining parental knowledge about infection

d. Determining parental knowledge about infection

The nurse is planning health promotion teaching for a group of healthy older adults in a residential community. Which statement accurately describes expected hematologic effects of aging? "Platelet production increases with age and leads to easy bruising." "Anemia is common with aging because iron absorption is impaired." "Older adults with infections may have only a mild white blood cell count elevation." "Older adults often have poor immune function with a decreased number of lymphocytes."

"Older adults with infections may have only a mild white blood cell count elevation." During an infection, the older adult may have only a minimal elevation in the total white blood cell count and may not have a fever. Presentation of infection can initially be nonspecific with disorientation, anorexia, and weakness. Platelets are unaffected by the aging process. However, changes in vascular integrity from aging can manifest as easy bruising. Iron absorption is not impaired in the older patient, but adequate nutritional intake of iron may be decreased. The total white blood cell count and differential are generally not affected by aging. However, a decrease in humoral antibody response and decrease in T-cell function may occur.

Which iron-rich foods would the nurse encourage the client with mild anemia in early pregnancy to eat? Select all that apply. One, some, or all responses may be correct. 1. Dark leafy green vegetables 2. Legumes 3. Dried fruits 4. Yogurt 5. Ground beef patty

1. Dark leafy green vegetables 2. Legumes 3. Dried fruits 5. Ground beef patty

Which dietary choices by a client with iron deficiency anemia indicate that the nurse's dietary teaching has been effective? Select all that apply. One, some, or all responses may be correct. 1. scrambled eggs 2. baked potatoe 3. steamed carrots 4. spinach salad 5. dried apricots 6. sliced oranged

1. scrambled eggs 2. baked potatoe 4. spinach salad 5. dried apricots

Mr. Baker starts vomiting. The nurse looks in his medication administration record and notices that he has a prescription for treating nausea and vomiting. He has also not had any of it since he was admitted to the unit. The healthcare provider has prescribed ondansetron (Zofran) 8 mg iv push every 8 hours as needed.How many milliliters (mL) of ondansetron (Zofran) should the nurse should draw into a syringe in preparation for administration? (enter numerical value only. If rounding is necessary, round to the whole number.)

10

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. 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.

Which parent education would the nurse provide the pregnant mother whose son was recently diagnosed with hemophilia about the chances that her next child will also be affected? 1 There is a 5% chance that the baby will be affected. 2 There is a 25% chance that the baby will be affected. 3 There is a 50% chance that the baby will be affected. 4 There is a 75% chance that the baby will be affected.

2 There is a 25% chance that the baby will be affected. Hemophilia is an X-linked recessive disorder. The mother is usually the carrier, and the father is unaffected. Before the sex of the unborn child is known, the odds are 25%; 50% of pregnancies will result in boys, and a boy has a 50% chance of having hemophilia. The laws of Mendelian genetics do not include a 5% probability of inheritance of hemophilia. A 50% or 75% chance is too high; there is only a 25% chance that the fetus will be affected.

A 2-year-old child with previously diagnosed hemophilia is admitted to the pediatric unit for observation after a motor vehicle collision. The toddler has several bruises but no other apparent injuries. Which is the nurse's specific concern regarding this child? 1 Possibility of falls 2 Undetected injury 3 Low fluid volume 4 Development of infection

2 Undetected injury Although the child has no apparent injuries, internal bleeding may have occurred. The child should be monitored for internal bleeding in case there is an undetected injury. Although all 2-year-olds are at risk for falls, falls are not the greatest danger for this child at this time. Although all toddlers are at risk for fluid imbalances because of their larger percentage of body fluid to body mass, this is not a priority at this time. A child with hemophilia is at no greater risk for infection than any other child; the skin is intact, so this is not a priority.

When performing a focused assessment on a client with a possible diagnosis of iron deficiency anemia, which locations would the nurse examine? SATA 1. Sclera 2. Nail beds 3. conjunctivae 4. palms of hands 5. bony prominences

2. Nail beds 3. conjunctivae 4. palms of hands

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 medication would the nurse expect to administer to control bleeding in a child with hemophilia A? 1 Albumin 2 Fresh frozen plasma 3 Factor VIII concentrate 4 Factors II, VII, IX, X complex

3 Factor VIII concentrate Factor VIII is the missing plasma component necessary to control bleeding in a child with hemophilia A. Factor VIII is not provided by albumin. Although fresh frozen plasma does contain factor VIII, there is an insufficient amount in a plasma transfusion; a higher volume is required. A complex of factors II, VII, IX, and X is not useful in this situation.

Which assessment finding indicates that disseminated intravascular coagulation (DIC) is occurring in a postpartum client who has experienced an abruptio placentae? 1 Boggy uterus 2 Hypovolemic shock 3 Multiple vaginal clots 4 Bleeding at the venipuncture site

4 Bleeding at the venipuncture site Bleeding at the venipuncture site indicates afibrinogenemia; massive clotting in the area of the separation has resulted in a decrease in the circulating fibrinogen level. A boggy uterus indicates uterine atony. Although hypovolemic shock may occur with DIC, there are other causes of hypovolemic shock, not just DIC. Blood clots indicate an adequate fibrinogen level; however, vaginal clots may indicate a failure of the uterus to contract and should be explored further.

Which postpartum client is at the highest risk for disseminated intravascular coagulation (DIC)? 1 Gravida III with twins 2 Gravida V with endometriosis 3 Gravida II who had a 9-lb baby 4 Gravida I who has had an intrauterine fetal death

4 Gravida I who has had an intrauterine fetal death Intrauterine fetal death is one of the risk factors for DIC; other risk factors include abruptio placentae, amniotic fluid embolism, sepsis, and liver disease. Multiple pregnancy, endometriosis, and increased birthweight are not risk factors for DIC.

After fluids have started, the client relates that her pain is an 8 on the Wong-Baker FACES pain scale. Which medication should the nurse expect to be ordered for pain control? Morphine sulfate Ibuprofen. Acetaminophen. Meperidine.

A

The charge nurse is transcribing prescriptions at the nurse's station. Other responsibilities of the charge nurse include answering the phone, assisting with visitor's questions, and answering the child's call lights. Which nursing task is best for the charge nurse to delegate to the UAP? Take the hourly vital signs for a child receiving a unit of blood. Teach the child's caregiver how to apply warm soaks to her joints. Educate the child about a healthy lifestyle. Change the morphine vial on the client-controlled analgesia pump.

A

The healthcare provider (HCP) has also prescribed a single dose of intravenous (IV) magnesium sulfate 2 mg in 100 mL of 5% dextrose in water over one hour to be given now. The nurse is preparing to give the prescribed intravenous (IV) magnesium. Which laboratory values should the nurse monitor cautiously before starting the medication? Blood urea nitrogen (BUN) and serum creatinine levels. White blood cell (WBC) and red blood cell counts (RBC). Activated partial thromboplastin time (aPTT). Hemoglobin (Hb), hematocrit (Hct), and platelet count.

A

The nurse receives shift report and proceeds to the client's room, bringing equipment to measure his vital signs. Which vital sign should concern the nurse the most? Blood pressure is 142/80 mmHg. Respiration rate of 24 breaths/minute. Heart rate of 98 beats/minute. Pulse oxygenation of 94%.

A

Which statement by the client indicates she is meeting Erikson's stage of development for her age? "Look, I finished putting the puzzle together." "I don't want any of my friends to visit me here." "I need my stuffed dog so that I can go to sleep." "When I grow up, I want to be a nurse just like you."

A

The nurse is assigned to care for several patients on a medical unit. Which patient should the nurse assess first? A 60-yr-old patient with a blood pressure of 92/64 mm Hg and hemoglobin of 9.8 g/dL A 50-yr-old patient with a respiratory rate of 26 breaths/minute and an elevated D-dimer A 40-yr-old patient with a temperature of 100.8°F (38.2°C) and a neutrophil count of 256/µL A 30-yr-old patient with a pulse of 112 beats/min and a white blood cell count of 14,000/µL

A 40-yr-old patient with a temperature of 100.8°F (38.2°C) and a neutrophil count of 256/µL A low-grade fever greater than 100.4° F (38° C) in a patient with a neutrophil count below 500/µL is a medical emergency and may indicate an infection. An infection in a neutropenic patient could lead to septic shock and possible death if not treated immediately.

The thrombocytopenic patient has had a bone marrow biopsy taken from the posterior iliac crest. What intervention is the priority for this patient after this procedure? Position the patient prone. Apply a pressure dressing. Administer analgesic for pain. Return metal objects to the patient.

Apply a pressure dressing. The sterile pressure dressing is applied after a bone marrow biopsy to ensure hemostasis. If bleeding is present, the patient will lie on the site and may need a rolled towel for additional pressure, thus this patient will not be in the prone position. The analgesic should have been administered preprocedure. Metal objects would be removed for an MRI, not a bone marrow biopsy.

The following day, after all consultants have either met with the client or the attending healthcare provider (HCP), the nurse prepares for a follow up discussion about treatment options. The psychologist reports that the client has newly diagnosed alcohol misuse, and he has probably had it for quite some time. He has reported that he usually enjoys about three quarts of whiskey each week. The client agrees to the nurse's request to sit with him for a while to discuss his treatment plan. His usual disengaged and surly affect has changed significantly. Today he is pleasant and very glad to see the nurse. What question should the nurse ask the client first? Are you able to tell me about your treatment plan? Do you have any thoughts of harming yourself? Have you been drinking any alcohol at all today? How do you feel about your new diagnosis of alcohol misuse?

B

The healthcare provider (HCP) writes discharge orders for the client. The nurse provides discharge instructions that includes prescriptions to be filled by his chosen pharmacy, the date and time of his follow up appointment, and other self-care information on a printed document for him to take home. Which intervention is most important for the nurse to perform after giving the client his discharge information? Advise him to attend Alcoholics Anonymous (AA). Document the teaching in his medical record. Escort him to his car to ensure his safety. Provide a list of foods high in vitamin B12.

B

The nurse finishes documenting the client interview and notices that new laboratory results have been posted in the electronic medical record (EMR). The nurse notes that the serum magnesium level is 1.22 mg/dL (0.50 mmol/L), and the normal range is 1.58 to 2.55 mg/dL (0.65 to 1.05 mmol/L). Which other result will need intervention? Chloride of 99 mEq/L (99 mmol/L). Potassium of 2.9 mEq/L (2.9 mmol/L). Glucose of 105 mg/dL (5.83 mmol/L). Sodium of 137 mEq/L (137 mmol/L).

B

Which action should the ED nurse implement first? Request arterial blood gasses stat. Administer oxygen via nasal cannula. Send the client for an x-ray of her knees and elbows. Prepare to administer analgesics as prescribed.

B

When evaluating the concept of gas exchange, how would the nurse best describe the movement of oxygen and carbon dioxide? A. Oxygen and carbon dioxide are exchanged across the capillary membrane to provide oxygen to hemoglobin. B. Gas moves from an area of high pressure to an area of low pressure across the alveolar membrane. C. The level of inspired oxygen must be sufficient to displace the carbon dioxide molecules in the alveoli. D. Gases are exchanged between the atmosphere and the blood based on the oxygen-carrying capacity of the hemoglobin.

B. Gas moves from an area of high pressure to an area of low pressure across the alveolar membrane.

Before giving cyanocobalamin, the nurse teaches the client about his medication. The client interrupts the teaching session and asks, "What happens if I just do not take the shots?" What is the best way for the nurse to respond? Are you not going to comply with this prescription? It sounds like you do not want to take these shots. You will gradually get very ill and die in 1 to 3 years. Let me talk to the healthcare provider and get you the tablets.

C

Client is starting to feel better and is requiring less pain medication. Client is sleeping as the nurse makes evening rounds. Her caregiver shares with the nurse, "I have no idea what my daughter should be allowed to do so she can have some fun?" Which statement is the best response by the nurse? "You sound like you are worried about taking your daughter home." "I recommend enrolling her in a sport with running, such as soccer." " School-aged children like being in groups like Girl Scouts or Girls' Clubs." "Your daughter should not be around a lot of children, so her activities will be limit

C

Discharge Instructions Client is scheduled for discharge the next day. The nurse is completing discharge teaching with her caregiver who says they are planning a visit to Colorado to see the caregiver's sister and her family for the Christmas holidays. The client is very excited and can't wait to meet her cousins. What is the best response by the nurse? "I know that she will enjoy meeting her family." "I think you should talk to her HCP before you go." "Your planned trip may put her at risk for a crisis." "Could your family come here for the Christmas holidays instead?"

C

ManagementThe day shift is coming on duty to the pediatric department. The staff available includes two experienced RNs, one new graduate who has just finished the 3-month pediatric internship, and two unlicensed assistive personnel (UAP). Which child should the charge nurse assign to the new graduate nurse? A school-aged child newly diagnosed with Cystic Fibrosis. The adolescent, who is scheduled as a probable discharge for tomorrow. A school-aged child who had an appendectomy 2 days ago. A school-aged child being evaluated for possible physical abuse.

C

The client is in the ICU for 3 days and is transferred to the pediatric floor. Her caregiver has been at the hospital every day and is very concerned about her condition. The caregiver asks the nurse, "What can I do to make sure this never happens again?" Which is the best initial response by the nurse? "When your daughter gets a fever give her 1 baby aspirin." "Keep her away from anyone who has an infection." "There is no way you can make sure this never happens again." "Make sure she does not participate in any strenuous activity."

C

The nurse is caring for a 25-year-old woman who is requesting information to lose weight. What information will the nurse include in a weight-loss plan? A. Weigh yourself at the same time every morning and evening. B. Stick to a 600- to 800-calorie diet for the most rapid weight loss. C. Low carbohydrate diets lead to rapid weight loss but are difficult to maintain. D. Weighing all foods on a scale is necessary to choose appropriate portion sizes.

C. Low carbohydrate diets lead to rapid weight loss but are difficult to maintain.

Which drink would the nurse instruct a client with iron deficiency anemia to choose to drink with the supplement for efficient absorption? A. Water B. Skim milk C. Orange Juice D. a strawberry milkshake

C. Orange juice Vitamin C helps aid in the absorption of iron. Therefore iron supplements should be taken with a glass or orange juice or a vitamin C tablet.

The nurse is reviewing the client's electronic medical record (EMR) and is discussing with the healthcare provider (HCP) the possible need for an interprofessional conference with the client due to the increasing complexity of his medical problems. The nurse uses a problem-solving approach with the client to facilitate interprofessional communication and assists the healthcare provider (HCP) with obtaining appropriate consults to better inform the team of identified issues for promoting the changes needed for this client. To begin this process, the nurse creates a list of known problems. Which problems should the nurse include in this evaluation? (Select all that apply. One, some, or all options may be correct.) Social isolation. Chronic alcohol use. Chronic gastritis. Pernicious anemia. Electrolyte imbalances. Grief and loss.

CDEF

To evaluate the discharge teaching completed at the hospital, the home health nurse discusses acute exacerbations of SCD with the client and her caregiver. Which behavior indicates to the nurse the caregiver understands about acute exacerbations of sickle cell disease? She is able to take the client's radial pulse within 4 beats of the nurse. She does not allow client to go outside unless she is with her. She measures client's fluid intake to remain under 1 liter a day. She demonstrates how to accurately read an oral thermometer.

D

The nurse would anticipate that which of the following patients will need to be treated with insertion of a chest tube? A. A patient with asthma and severe shortness of breath B. A patient undergoing a bronchoscopy for a biopsy C. A patient with a pleural effusion requiring fluid removal D. A patient experiencing a problem with a pneumothorax

D. A patient experiencing a problem with a pneumothorax

The nurse is caring for a patient who suddenly becomes agitated and confused. Which action should the nurse takes first? A. Notify the health care provider. B. Check pupils for reaction to light. C. Attempt to calm and reorient the patient. D. Assess oxygenation using pulse oximetry.

D. Assess oxygenation using pulse oximetry.

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). The patient tells the nurse he is having a "hard time breathing." His respiratory rate is 32 breaths per minute, his pulse is 120 beats per minute, and the oxygen saturation is 90%. What would be the best nursing intervention for this patient? A. Begin oxygen via a face mask at 60% FiO2 (fraction of inspired oxygen) B. Administer a PRN (as necessary) dose of an intranasal glucocorticoid C. Encourage coughing and deep breathing to clear the airway D. Initiate oxygen via a nasal cannula, and begin at a flow rate of 3 L/min

D. Initiate oxygen via a nasal cannula, and begin at a flow rate of 3 L/min

A patient has anemia related to inadequate intake of essential nutrients. Which intervention would be appropriate for the nurse to include in the plan of care for this patient? Plan for 30 minutes of rest before and after every meal. Encourage foods high in protein, iron, vitamin C, and folate. Teach the patient to select only soft, bland, and nonacidic foods. Give the patient a list of medications that inhibit iron absorption.

Encourage foods high in protein, iron, vitamin C, and folate. Increased intake of protein, iron, folate, and vitamin C provides nutrients needed for maximum iron absorption and hemoglobin production. The other interventions do not address the patient's identified problem of inadequate intake of essential nutrients. Selection of foods that are soft, bland, and nonacidic is appropriate if the patient has oral mucosal irritation. Scheduled rest is an appropriate intervention if the patient has fatigue related to anemia. Providing information about medications that may inhibit iron absorption (e.g., antacids, tetracycline, soft drinks, tea, coffee, calcium, phosphorus, and magnesium salts) is important but does not address the patient's problem of inadequate intake of essential nutrients.

When caring for a patient with metastatic cancer, the nurse notes a hemoglobin level of 8.7 g/dL and hematocrit of 26%. What associated clinical manifestations does the nurse anticipate observing? Thirst Fatigue Headache Abdominal pain

Fatigue The patient with a low hemoglobin and hematocrit is anemic and would likely have fatigue. Fatigue develops because of the lowered oxygen-carrying capacity that leads to reduced tissue oxygenation to carry out cellular functions. Thirst, headache, and abdominal pain are not related to anemia.

5. Exercise and activity are included in a cardiac rehabilitation program for which purposes? (Select all that apply.) Increase cardiac output Correct Increase serum lipids Increase blood pressure Increase blood flow to the arteries Correct Increase muscle mass Correct Increase flexibility Correct A cardiac rehabilitation program seeks to increase cardiac output, blood flow to the arteries, muscle mass, and flexibility. The rehabilitation program does not want to increase serum lipids or blood pressure. Awarded 1.0 points out of 1.0 possible points. Continue

Increase cardiac output Increase blood flow to the arteries Increase muscle mass Increase flexibility A cardiac rehabilitation program seeks to increase cardiac output, blood flow to the arteries, muscle mass, and flexibility. The rehabilitation program does not want to increase serum lipids or blood pressure. Awarded 1.0 points out of 1.0 possible points. Continue

The nurse knows that hemolytic anemia can be caused by which extrinsic factors? Trauma or splenic sequestration crisis Abnormal hemoglobin or enzyme deficiency Macroangiopathic or microangiopathic factors Chronic diseases or medications and chemicals

Macroangiopathic or microangiopathic factors Macroangiopathic or microangiopathic extrinsic factors lead to acquired hemolytic anemias. Trauma or splenic sequestration crisis can lead to anemia from acute blood loss. Abnormal hemoglobin or enzyme deficiency are intrinsic factors that lead to hereditary hemolytic anemias. Chronic diseases or medications and chemicals can decrease the number of red blood cell (RBC) precursors which reduce RBC production.

A patient who has sickle cell disease has developed cellulitis above the left ankle. What is the nurse's priority for this patient? Start IV fluids. Maintain oxygenation. Maintain distal warmth. Check peripheral pulses.

Maintain oxygenation. Maintaining oxygenation is a priority as sickling episodes are frequently triggered by low oxygen tension in the blood which is commonly caused by an infection. Antibiotics to treat cellulitis, pain control, and fluids to reduce blood viscosity will also be used, but oxygenation is the priority.

The nurse collects a nutritional history from a 22-yr-old woman who is planning to conceive a child in the next year. Which foods reported by the woman would indicate that her diet is high in folate and iron? Crab, fish, and tuna Milk, cheese, and yogurt Spinach, beans, and liver White rice, potatoes, and pasta

Spinach, beans, and liver Normal intake of iron and folic acid is necessary for the development of red blood cells, and normal levels before conception and in early pregnancy are particularly important for normal fetal development. Foods high in both folic acid and iron include liver, red meat, egg yolks, turkey or chicken giblets, beans, lentils, chickpeas, soybeans, spinach, and collard greens. In addition, enriched cereals, pasta, and breads are also high in both folic acid and iron (check the labels).

A patient with cancer is having chemotherapy treatments and has now developed neutropenia. What care should the nurse expect to provide and teach the patient about? (Select all that apply.) Strict hand washing. Daily nasal swabs for culture. Monitor temperature every hour. Daily skin care and oral hygiene. Encourage the patient to eat all foods to increase nutrients. Private room with a high-efficiency particulate air (HEPA) filter

Strict hand washing. Daily skin care and oral hygiene. Private room with a high-efficiency particulate air (HEPA) filter Strict hand washing and daily skin and oral hygiene must be done with neutropenia, because the patient is predisposed to infection from the normal body flora; other people; and uncooked meats, seafood, and eggs; unwashed fruits and vegetables; and fresh flowers or plants. The private room with HEPA filtration reduces the aerosolized pathogens in the patient's room. Blood cultures and antibiotic treatment are used when the patient has a temperature of 100.4° F or more, but temperature is not monitored every hour.

A patient has been diagnosed with stage 1A Hodgkin's lymphoma. The nurse knows that which chemotherapy regimen is most likely to be prescribed for this patient? Brentuximab vedotin (Adcetris) Two to four cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine Four to six cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine BEACOPP: bleomycin, etoposide, doxorubicin (Adriamycin), cyclophosphamide, vincristine (Oncovin), procarbazine, and prednisone

Two to four cycles of ABVD: doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine The patient with a favorable prognosis early-stage Hodgkin's lymphoma (stage 1A) will receive two to four cycles of ABVD. The unfavorable prognostic featured (stage 1B) Hodgkin's lymphoma would be treated with four to six cycles of chemotherapy. Advanced-stage Hodgkin's lymphoma is treated more aggressively with more cycles or with BEACOPP. Brentuximab vedotin (Adcetris) is a newer agent that will be used to treat patients who have relapsed or refractory disease.Note: Some of acronyms for drug protocols use the brand/trade name of drugs (Adriamycin, Oncovin). These brand/trade names have been discontinued but the drugs are still available as generic drugs.

A client who has renal failure asks the nurse why anemia keeps recurring. Which reason would the nurse explain to the client? a. Increase in blood pressure b. Decrease in erythropoietin c. Increase in serum phosphate levels d. Decrease in sodium concentration

b. Decrease in erythropoietin

Which instruction would the nurse give to the pregnant client with anemia? a. Take an iron and calcium supplement together daily. b. Drink orange juice with an iron supplement. c. Include fresh fruit at every meal. d. Include 4 servings of calcium-rich foods daily

b. Drink orange juice with an iron supplement

A client had part of the ileum surgically removed. The nurse monitors the client closely for anemia based on which rationale? a. folic acid is absorbed in the ileum b. cobalamin is absorbed in the ileum c. Iron absorption is dependent on simultaneous bile salt absorption in the ileum. d. Copper, cobalt, and nickel are dependent on simultaneous bile salt absorption in the ileum

b. cobalamin is absorbed in the ileum

Which parent education would the nurse provide when teaching an infant's parents about the major cause of iron-deficiency anemia? a. blood disorders b. overfeeding of milk c. lack of adequate iron reserves from the mother d. introduction of solid foods too early for adequate absorption

b. overfeeding of milk

A 4-year-old child diagnosed with sickle cell anemia is at a high risk of acquiring pneumococcal diseases. The child has previously received two doses of the pneumococcal conjugate vaccine (PCV). Based on the immunization protocol, which dose of PCV should the nurse administer? a. Administer four more doses of PCV. b. Administer three more doses of PCV. c. Administer two more doses of PCV. d. Administer one more dose of PCV

c. Administer two more doses of PCV.

The parents of a child with sickle cell anemia (SSA) tell the nurse, "We have never had any symptoms of SSA and do not understand why our child has this problem." Which information will the nurse include when teaching the parents? a. SSA is caused by a random genetic mutation with no known cause. b. People who are carriers of SSA may not have symptoms, but all of their children will have SSA. c. If both parents are carriers of SSA, there is a 25% chance that offspring will have SSA. d. When a child is born with SSA, genetic testing of both parents is needed to determine if they have sickle cell trait.

c. If both parents are carriers of SSA, there is a 25% chance that offspring will have SSA.

The nurse assesses a client for the development of pernicious anemia after reviewing the client's history. Which condition did the nurse most likely find in the history? a. Acute gastritis b. Diabetes mellitus c. Partial gastrectomy d. Unhealthy dietary habits

c. Partial gastrectomy

The parent of a child with sickle cell anemia tells the nurse that the family is going camping by a lake in the mountains this summer. The parent inquires what activities are appropriate. Which activity would the nurse suggest? a. Swimming in the lake b. Soccer with the family c. Climbing the mountain trails d. Motorboat rides around the lake

d. Motorboat rides around the lake

Which laboratory result in a client who has just been admitted with anemia of unknown etiology requires the most rapid action by the nurse? a. Hematocrit 30% (0.30) b. Hemoglobin 10 g/dL (100 g/L) c. Platelet count 120,000 mm 3 (120 × 10 9/L) d. White blood cell count 950 mm 3 (950 × 10 9/L)

d. White blood cell count 950 mm 3 (950 × 10 9/L)

A patient with thrombocytopenia secondary to sepsis has small, pinpoint deposits of blood visible through the skin on the anterior and posterior chest. The nurse will document this skin abnormality as: petechiae. erythema. ecchymosis. telangiectasia.

petechia Petechiae are pinpoint, discrete deposits of blood less than 1 to 2 mm in the extravascular tissues and visible through the skin or mucous membranes. Erythema is redness occurring in patches of variable size and shape. Telangiectasia is visibly dilated, superficial, cutaneous small blood vessels. Ecchymosis is a large, bruise-like lesion caused by a collection of extravascular blood in the dermis and subcutaneous tissue.