Chapter 29 Med Surg

A nurse is planning the care of a client with a diagnosis of sickle cell disease who has been admitted for the treatment of an acute vaso-occlusive crisis. Which nursing diagnosis should the nurse prioritize in the client's plan of care? Functional urinary incontinence related to urethral occlusion Ineffective tissue perfusion related to thrombosis Ineffective thermoregulation related to hypothalamic dysfunction Risk for disuse syndrome related to ineffective peripheral circulation

Ineffective tissue perfusion related to thrombosis

A client is receiving chemotherapy for cancer. The nurse reviews the client's laboratory report and notes that the client has thrombocytopenia. To which nursing diagnosis should the nurse give the highest priority? Activity intolerance Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI Impaired tissue integrity Impaired oral mucous membranes

Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI

A client is being treated on the medical unit for a sickle cell crisis. The nurse's most recent assessment reveals a fever and a new onset of fine crackles on lung auscultation. Which action by the nurse would be the most appropriate? Liaise with the respiratory therapist and consider high-flow oxygen. Apply supplementary oxygen by nasal cannula. Inform the health care provider that the client may have an infection. Administer bronchodilators by nebulizer.

Inform the health care provider that the client may have an infection.

Which iron-rich foods should a nurse encourage an anemic client requiring iron therapy to eat? Lobster and squash Lamb and peaches Cheese and bananas Shrimp and tomatoes

Lamb and peaches

The nurse is collecting data for a client who has been diagnosed with iron-deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia? "I feel hot all of the time." "I have a difficult time falling asleep at night." "I have an increase in my appetite." "I have difficulty breathing when walking 30 feet."

"I have difficulty breathing when walking 30 feet."

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." "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear." "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal."

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

A home care nurse visits a client diagnosed with atrial fibrillation who is ordered warfarin. The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching? "I'll eat four servings of fresh, dark green vegetables every day." "I'll use an electric razor to shave." "I'll watch my gums for bleeding when I brush my teeth." "I'll report unexplained or severe bruising to my health care provider right away."

"I'll eat four servings of fresh, dark green vegetables every day."

A client with a recent diagnosis of ITP has asked the nurse why the care team has not chosen to administer platelets, stating, "I have low platelets, so why not give me a transfusion of exactly what I'm missing?" How should the nurse best respond? "Finding a matching donor for a platelet transfusion is exceedingly difficult." "Transfused platelets usually aren't beneficial because they're rapidly destroyed in the body." "A very small percentage of the platelets in a transfusion are actually functional." "A platelet transfusion often further blunts your body's own production of platelets."

"Transfused platelets usually aren't beneficial because they're rapidly destroyed in the body."

A client with a documented history of glucose-6-phosphate dehydrogenase deficiency has presented to the emergency department with signs and symptoms including pallor, jaundice, and malaise. Which of the nurse's assessment questions relates most directly to this client's hematologic disorder? "Have you been under significant stress lately?" "When did you last have a blood transfusion?" "What medications have you taken recently?" "Have you suffered any recent injuries?"

"What medications have you taken recently?"

A client with idiopathic thrombocytopenic purpura (ITP) is admitted to an acute care facility. The nurse monitors the client's platelet count and observes closely for signs and symptoms of bleeding. The client is at greatest risk for cerebral hemorrhage when the platelet count falls below what number? 20,000/?l. 10,000/?l. 75,000/?l. 135,000/?l.

10,000/?l.

A client with acute kidney injury has decreased erythropoietin production. Upon analysis of the client's complete blood count, the nurse will expect which of the following results? An increased mean corpuscular volume (MCV) and red cell distribution width (RDW) An increased hemoglobin and decreased hematocrit A decreased mean corpuscular volume (MCV) and red cell distribution width (RDW) A decreased hemoglobin and hematocrit

A decreased hemoglobin and hematocrit

A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the health care provider immediately because the client probably is experiencing which problem? A hemolytic reaction caused by bacterial contamination of donor blood A hemolytic reaction to Rh-incompatible blood A hemolytic allergic reaction caused by an antigen reaction A hemolytic reaction to mismatched blood

A hemolytic allergic reaction caused by an antigen reaction

A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving: B-positive blood to an AB-positive client. O-negative blood to an O-positive client. O-positive blood to an A-positive client. A-positive blood to an A-negative client

A-positive blood to an A-negative client.

A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify? Low levels of urine constituents normally excreted in the urine Potential hepatic dysfunction indicated by decreased blood urea nitrogen (BUN) and creatinine levels Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels Electrolyte imbalance that could affect the blood's ability to coagulate properly

Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels

A client with sickle cell crisis is admitted to the hospital in severe pain. While caring for the client during the crisis, which is the priority nursing intervention? Administering and evaluating the effectiveness of opioid analgesics Limit foods that contain folic acid Limiting the client's intake of oral and IV fluids Encouraging the client to ambulate immediately

Administering and evaluating the effectiveness of opioid analgesics

A client being treated for iron deficiency anemia with ferrous sulfate continues to be anemic despite treatment. The nurse should assess the client for use of which medication? Amoxicillin Aluminum hydroxide Prednisone Tegretol

Aluminum hydroxide

A group of nurses are learning about the high incidence and prevalence of anemia among different populations. Which individual is most likely to have anemia? An 81-year-old female who has chronic heart failure A 48-year-old male who travels extensively and has a high-stress job A 13-year-old female who has just experienced menarche A 50-year-old female who is going through menopause

An 81-year-old female who has chronic heart failure

A client with several chronic health problems has been newly diagnosed with a qualitative platelet defect. What component of the client's previous medication regimen may have contributed to the development of this disorder? Vitamin D Vitamin B12 Aspirin Calcium carbonate

Aspirin

A nurse is providing discharge education to a client who has recently been diagnosed with a bleeding disorder. Which topic should the nurse prioritize when teaching this client? Avoiding buses, subways, and other crowded, public sites Avoiding activities that carry a risk for injury Avoiding foods high in vitamin K Keeping immunizations current

Avoiding activities that carry a risk for injury

When teaching a client with sickle cell disease about strategies to prevent crises, what measures should the nurse recommend? Limiting psychosocial stress and eating a high-protein diet Avoiding cold temperatures and ensuring sufficient hydration Using prophylactic antibiotics and performing meticulous hygiene Maximizing physical activity and taking OTC iron supplements

Avoiding cold temperatures and ensuring sufficient hydration

A client who is in the third trimester of pregnancy has been experiencing an exacerbation of iron-deficiency anemia in recent weeks. When providing the client with nutritional guidelines and meal suggestions, what foods would be most likely to increase the client's iron stores? Salmon accompanied by whole milk Yogurt, almonds, and whole grain oats Mixed vegetables and brown rice Beef liver accompanied by orange juice

Beef liver accompanied by orange juice

The nurse is educating a client about iron supplements. The nurse teaches that what vitamin enhances the absorption of iron? A C D E

C

A client has been receiving a continuous infusion of weight-based heparin for more than 4 days. The client's PTT is at a level that requires an increase of heparin by 100 units per hour. The client has the laboratory findings shown above. What is the most important action for the nurse to take? Consult with the health care provider about discontinuing heparin. Increase the heparin infusion by 100 units per hour. Continue with the present infusion rate of heparin. Begin treatment with the prescribed warfarin (Coumadin).

Consult with the health care provider about discontinuing heparin.

The nurse should advise a client with iron deficiency anemia to take which action in order to prevent staining of the teeth? Take iron with or immediately after meals Avoid taking iron simultaneously with an antacid Dilute liquid preparations of iron with juice and drink with a straw Do not combine iron with other prescribed or over-the-counter medications

Dilute liquid preparations of iron with juice and drink with a straw

The nurse is caring for a client with external bleeding. What is the nurse's priority intervention? Application of a tourniquet Direct pressure Elevation of the extremity Pressure point control

Direct pressure

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 Itching, rash, and jaundice Nights sweats, weight loss, and diarrhea Nausea, vomiting, and anorexia

Dyspnea, tachycardia, and pallor

A client with sickle cell disease is taking opioid analgesics for pain control. Which intervention by the nurse would decrease the risk for erroneous use of prescription drugs? Encourage the client to rely on complementary and alternative therapies. Teach the client to accept chronic pain as an inevitable aspect of the disease. Limit the reporting of emergency department visits to the primary health care provider. Encourage the client to seek care from a single provider for pain relief.

Encourage the client to seek care from a single provider for pain relief.

A client who is diagnosed multiple myeloma experiences decreased production of red bloodcells (RBCs). Which prescribed medication should the nurse prepare to administer to increase the production of erythrocytes? ****** Erythropoietin Dexamethasone Filgrastim Pegfilgrastim

Erythropoietin

A client's electronic health record notes that the client has previously undergone treatment for secondary polycythemia. The nurse should assess for which factor? A history of venous thromboembolism Recent blood donation Impaired renal function Evidence of lung disease

Evidence of lung disease

An adult client has been diagnosed with iron deficiency anemia. Which is most likely based on this client's health status? Fatigue related to decreased oxygen-carrying capacity Acute pain related to uncontrolled hemolysis Infection related to tissue hypoxia Deficient fluid volume related to impaired erythropoiesis

Fatigue related to decreased oxygen-carrying capacity

The results of a client's most recent blood work and physical assessment are suggestive of immune thrombocytopenic purpura (ITP). This client should undergo testing for which of the following potential causes? Select all that apply. HIV Hepatitis Malignant melanoma Cholecystitis Acute kidney injury

HIV Hepatitis

A 25-year-old client comes to the emergency department with excessive bleeding from a cut sustained when cleaning a knife. Blood work shows a prolonged prothrombin time (PT), but a vitamin K deficiency is ruled out. When assessing the client, areas of ecchymosis are noted on other areas of the body. Which of the following is the most plausible cause of the client's signs and symptoms? Leukemia Hemophilia Lymphoma Hepatic dysfunction

Hepatic dysfunction

Which of the following describes a red blood cell (RBC) that has pale or lighter cellular contents? Normocytic Hypochromic Microcytic Hyperchromic

Hypochromic

A nurse is caring for a client with a history of GI bleeding, sickle cell anemia, and a platelet count of 22,000/μl. The client, who is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hour, reports severe bone pain and is scheduled to receive a dose of morphine sulfate. For which administration route should the nurse question an order? I.M. Oral Subcutaneous (subQ) I.V.

I.M.

A nurse in a long-term care facility is admitting a new resident who has a bleeding disorder. When planning this resident's care, the nurse should include which action? Implementing a passive ROM program Implementing of a plan for fall prevention Providing the client with a high-fiber diet Housing the resident in a private room

Implementing of a plan for fall prevention

The nurse is assessing a new client with reports of acute fatigue and a sore tongue that is visibly smooth and beefy red. This client is demonstrating signs and symptoms associated with what form of hematologic disorder? Hemophilia Thrombocytopenia Sickle cell disease Megaloblastic anemia

Megaloblastic anemia

A nursing instructor is evaluating a student caring for a neutropenic client. The instructor concludes that the nursing student demonstrates accurate knowledge of neutropenia based on which intervention? Monitoring the client's blood pressure and reviewing the client's hematocrit Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential Monitoring the client's breathing and reviewing the client's arterial blood gases Monitoring the client's heart rate and reviewing the client's hemoglobin

Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential

A nurse is admitting a client with immune thrombocytopenic purpura to the unit. In completing the admission assessment, the nurse must be alert for what medications that potentially alter platelet function? Select all that apply. Penicillins NSAIDs Aspirin-based drugs Sulfa-containing medications Antihypertensives

NSAIDs Aspirin-based drugs Sulfa-containing medications

A nurse is planning the care of a client who has a diagnosis of hemophilia A. When addressing the nursing diagnosis of Acute Pain Related to Joint Hemorrhage, what principle should guide the nurse's choice of interventions? NSAIDs are contraindicated due to the risk for bleeding. Opioids may cause vasodilation and exacerbate bleeding. Gabapentin (Neurontin) is effective because of the neuropathic nature of the client's pain. Opioids partially inhibit the client's synthesis of clotting factors.

NSAIDs are contraindicated due to the risk for bleeding.

A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. The client is taking prednisone daily and reported feeling pain after manually opening the garage door. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain? Osteoporosis Truncal obesity Muscle wasting Hypertension

Osteoporosis

A client with a history of cirrhosis is admitted to the ICU with a diagnosis of bleeding esophageal varices; an attempt to stop the bleeding has been only partially successful. What would the critical care nurse expect the care team to prescribe for this client? Packed red blood cells (PRBCs) Vitamin K Oral anticoagulants Heparin infusion

Packed red blood cells (PRBCs)

While assessing a client, the nurse will recognize what as the most obvious sign of anemia? Flow murmurs Jaundice Pallor Tachycardia

Pallor

A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client? Pallor, bradycardia, and reduced pulse pressure Sore tongue, dyspnea, and weight gain Angina pectoris, double vision, and anorexia Pallor, tachycardia, and a sore tongue

Pallor, tachycardia, and a sore tongue

A nurse is caring for a client with severe anemia. The client is tachycardic and reports dizziness and exertional dyspnea. What signs and symptoms might develop if this client goes into heart failure? Nausea and vomiting Migraine Fever Peripheral edema

Peripheral edema

A nurse is developing a care plan for a client with disseminated intravascular coagulation (DIC). Which nursing intervention should the nurse include? Administer aspirin daily as ordered. Administer meperidine (Demerol) I.M. as needed for pain. Provide mouth care every 4 hours with lemon-glycerin swabs. Place a pressure-reducing mattress on the client's bed.

Place a pressure-reducing mattress on the client's bed.

While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters? Fibrinogen level, WBC, and platelet count Thrombin time, calcium levels, and potassium levels Platelet count, blood glucose levels, and white blood cell (WBC) count Platelet count, prothrombin time, and partial thromboplastin time

Platelet count, prothrombin time, and partial thromboplastin time

A nurse should expect to administer which vaccine to the client after a splenectomy? Pneumovax 23 Recombivax HB Tetanus toxoid Attenuvax

Pneumovax 23

A young client with a diagnosis of hemophilia A has been brought to emergency department after suffering a workplace accident resulting in bleeding. Rapid assessment has revealed the source of the client's bleeding and established that their vital signs are stable. What should be the nurse's next action? Administer a normal saline bolus to increase circulatory volume. Establish IV access for the administration of vitamin K. Position the client in a prone position to minimize bleeding. Prepare for the administration of factor VIII.

Prepare for the administration of factor VIII.

A young birth parent with a 2 year old and a 6 month old is experiencing fatigue related to anemia. The client states that they are having difficulty performing the activities needed for their job, family, and home. With what task is it most appropriate for the nurse to assist the client? Finding a babysitter to take care of their children. Obtaining assistance from someone to help with cleaning in the home. Prioritizing and balancing activities and rest. Requesting a leave of absence from their job.

Prioritizing and balancing activities and rest.

A client has been living with a diagnosis of anemia for several years and has experienced recent declines in hemoglobin levels despite active treatment. Which assessment finding would signal complications of anemia? Epistaxis and gastroesophageal reflux Fever and signs of hyperkalemia Venous ulcers and visual disturbances Shortness of breath and peripheral edema

Shortness of breath and peripheral edema

Which type of hemolytic anemia is categorized as inherited disorder? Sickle cell anemia Cold agglutinin disease Autoimmune hemolytic anemia Hypersplenism

Sickle cell anemia

A critical care nurse is caring for a client with immune hemolytic anemia. The client is not responding to conservative treatments, and the client's condition is now becoming life-threatening. The nurse is aware that a treatment option in this case may include which intervention? Hepatectomy Platelet transfusion Splenectomy Vitamin K administration

Splenectomy

A client newly diagnosed with thrombocytopenia is admitted to the medical unit. After the admission assessment, the client asks the nurse to explain the condition. What should the nurse explain to this client? There could be impaired communication between platelets. There could be decreased production of platelets. There could be an autoimmune process causing platelet malfunction. There could be an attack on the platelets by antibodies.

There could be decreased production of platelets.

After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/mm3. What term should the nurse use to describe this low platelet count? Anemia Leukopenia Neutropenia Thrombocytopenia

Thrombocytopenia

The nurse should advise a client with iron deficiency anemia to take which action in order to prevent staining of the teeth? ***** Do not combine iron with other prescribed or over-the-counter medications. Avoid taking iron simultaneously with an antacid. Take iron with or immediately after meals. Use a straw or place a spoon at the back of the mouth to take the liquid supplement.

Use a straw or place a spoon at the back of the mouth to take the liquid supplement.

A nurse is caring for a client with thrombocytopenia. What is the best way to protect this client? Limit visits by family members. Encourage the client to use a wheelchair. Use the smallest needle possible for injections. Maintain accurate fluid intake and output records.

Use the smallest needle possible for injections.

A client is admitted to the hospital with a diagnosis of pernicious anemia. The nurse should prepare to administer which of the following medications? Folic acid Magnesium sulfate Lactulose Vitamin B12

Vitamin B12

During preparation for bowel surgery, a client receives an antibiotic to reduce intestinal bacteria. The nurse knows that hypoprothrombinemia may occur as a result of antibiotic therapy interfering with synthesis of which vitamin? Vitamin E Vitamin K Vitamin D Vitamin A

Vitamin K

Which medication is the antidote to warfarin? Clopidogrel Vitamin K Protamine sulfate Aspirin

Vitamin K

The couple with the lowest risk of having a child with sickle cell anemia disease is the one in which the: one parent is HbS and the other is HbAS. one parent is HbA and the other is HbS. both parents are HbS. both parents are HbAS.

one parent is HbA and the other is HbS.

A client admitted to the hospital with abdominal pain, anemia, and bloody stools reports feeling weak and dizzy. The client has rectal pressure and needs to urinate and move their bowels. The nurse should help them: to a standing position so they can urinate. onto the bedpan. to the bathroom. to the bedside commode.

onto the bedpan.

An older adult client is to receive 2 units of packed red blood cells. During the transfusion of the first unit at 125 mL/hour, the client reports shortness of breath 30 minutes into the process. The client exhibits the vital signs shown in the accompanying table. What is the nurse's best intervention? contact the health care provider and obtain an order for diphenhydramine (Benadryl) administer oxygen through nasal cannula at 2 L/minute obtain blood and urine specimens for a transfusion reaction slow the rate of the transfusion and obtain an order for furosemide

slow the rate of the transfusion and obtain an order for furosemide