322 Exam #4

A client has a 10-year history of rheumatoid arthritis and is concerned now that the client's child is experiencing some morning stiffness and pain. What would be the most appropriate response by the nurse?

"There is some evidence that a genetic basis for the disease may exist, so you might want to have your child evaluated."

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?

"I will receive parenteral vitamin B12 therapy for the rest of my life."

A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process?

"It will get better and worse again."

The nurse is preparing to administer 500 mL of whole blood to a client. The blood is to be infused over 4 hours. The infusion tubing delivers 10 gtt/mL. How many drops of blood per minute must the nurse infuse to complete the infusion in 4 hours? Record your answer using a whole number.

21

A client is receiving nonsteroidal anti-inflammatory drugs (NSAIDs) to manage the pain of rheumatoid arthritis. What information should the nurse give to the client about taking these medications?

Take NSAIDs with food.

A client develops a facial rash and urticaria after receiving penicillin. Which laboratory value does the nurse expect to be elevated?

IgE

A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client?

Use the smallest needle possible for injections.

A client with aplastic anemia is instructed to eat foods rich in iron. The nurse should instruct the client to include which food in the diet to increase iron intake?

dark green leafy vegetables

A multidisciplinary oncology team of health care providers, nurses, and the social worker notes that a client who has been undergoing chemotherapy is now experiencing pancytopenia. When reviewing the laboratory data, which values support this diagnosis? Select all that apply.

decreased white blood cells decreased platelets decreased RBCs

A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia?

dyspnea, tachycardia, and pallor

A client takes prednisone, as ordered, for rheumatoid arthritis. During follow-up visits, the nurse should assess the client for common adverse reactions to this drug, such as

fluid retention and weight gain.

A nurse is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 47. Following the American Cancer Society (Canadian Cancer Society) guidelines, the nurse should recommend that the women

have a mammogram annually.

A female client is at risk for developing osteoporosis. Which action will reduce the client's risk?

initiating weight-bearing exercise routines

A client with cancer is receiving radiation therapy and develops thrombocytopenia. What is the priority nursing goal to prevent which effect of thrombocytopenia for this client?

injury related to the decreased platelet count

A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The physician begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption?

intrinsic factor

A nurse is caring for a client who recently underwent a total hip replacement. The nurse should:

limit hip flexion of the client's hip when he sits.

A diet plan is developed for a client with gouty arthritis. The nurse should advise the client to limit his intake of

organ meats.

A nurse is interviewing a client about their past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer?

polyps

A 4-year-old child is having a sickle cell crisis. The initial nursing intervention should be to

provide oral and I.V. fluids.

A client with rheumatoid arthritis tells the nurse that she feels "quite alone" in adjusting to changes in her lifestyle. Which response by the nurse will be most effective?

telling the client about her community's arthritis support group.

The nurse is collaborating with the healthcare provider to develop a care plan to help control chronic pain in a client with cancer who is receiving hospice home care. Which plan would be most appropriate for managing the client's pain?

Administer analgesics on a regular basis, with the administration of additional analgesics for breakthrough pain.

A client is to have a below-the-knee amputation. Prior to the surgery, what should the circulating nurse in the operating room do?

Initiate a time-out.

A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 - S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurological symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period?

Logroll the client from side to side.

The nurse is developing a care plan for a client who has leukemia. What instructions should the nurse include in the plan? Select all that apply.

Monitor temperature and report elevation. Recognize signs and symptoms of infection. Avoid crowds. Maintain integrity of skin and mucous membranes.

During chemotherapy, an oncology client has a nursing diagnosis of Impaired oral mucous membrane related to decreased nutrition and immunosuppression secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is most likely to decrease the pain of stomatitis?

Providing a solution of viscous lidocaine for use as a mouth rinse

A client receiving a blood transfusion experiences an acute hemolytic reaction. Which nursing intervention is the most important?

Stop the transfusion, infuse normal saline solution, and call the physician.

A client received treatment with cytotoxic medications 24 hours ago. Which precautions are necessary when caring for the client?

Wear personal protective equipment when handling blood, body fluids, and feces.

The nurse is making a room assignment for a client whose laboratory test result indicate pancytopenia. Which client should the nurse put into the same room with the client with pancytopenia?

a client with digoxin toxicity

What are important nursing priorities on the first postoperative day for a client who has had an open reduction and internal fixation (ORIF) after a right hip fracture?

assessing the neurovascular status in the right leg, providing pain control, encouraging position changes, and early ambulation

The family of an older adult with terminal cancer asks about having hospice services. What should the nurse tell the family?

focuses on supportive care for the client and family.

A male client comes to the clinic with complaints of pain in his great toe. The client reports that the pain is worse at night. Assessment reveals tophi. The nurse suspects the client has

gouty arthritis.

The teaching plan for the client with rheumatoid arthritis includes rest promotion. What position of the involved joints should the nurse tell the client to avoid when at rest?

maintaining the joints in a flexed position

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide concerning cast care?

"Keep your right leg elevated above heart level."

A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct?

"OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."

A client with osteoarthritis tells the nurse they are concerned that the disease will prevent them from doing their chores. Which suggestion should the nurse offer?

"Pace yourself and rest frequently, especially after activities."

A nurse is caring for a client who complains of lower back pain. Which instruction should the nurse give to the client to prevent back injury?

"Stand close to the object you're lifting."

A client has been diagnosed with osteoporosis after a bone density test and is asking what has caused it. Discussion of risk factors would include:

heavy smoking, sedentary lifestyle, and high intake of carbonated drinks

The client asks the nurse to explain what it means that Hodgkin's disease is diagnosed at stage 1A. What should the nurse explain about the involvement of the disease?

involvement of a single lymph node

A client asks the nurse what PSA is. The nurse should reply that it stands for

prostate-specific antigen, which is used to screen for prostate cancer.

A client diagnosed with idiopathic thrombocytopenia purpura needs a peripherally inserted central catheter (PICC) placed. When explaining the catheter to the client, the nurse explains that one advantage of a catheter is that it can be used

to provide long-term access to central veins.

A client with rheumatoid arthritis tells the nurse, "I know it's important to exercise my joints so that I won't lose mobility, but my joints are so stiff and painful that exercising is difficult." Which response by the nurse would be most appropriate?

"Take a warm tub bath or shower before exercising. This may help with your discomfort."

A client with the beta-thalassemia trait plans to marry a person of Italian ancestry who also has the trait. Which client statement indicates understanding of the teaching provided by the nurse?

"We'll need more genetic counseling in the future."

A nurse is managing the care of a client with osteoarthritis. Appropriate treatment strategies for osteoarthritis include

administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and initiation of an exercise program.