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The nurse reviews lab results of a second-day postoperative client and notes a hemoglobin level of 10g/dl. During assessment of the client, the nurse would expect to see which of the following? A. No clinical sign B. Pallor C. Palpitations D. Shortness of breath

A. No clinical sign Mild anemia usually has no clinical sign. Pallor, palpitations, and shortness of breath are associated with severe anemia.

A client was admitted to the hospital with iron deficiency anemia and blood-streaked emesis. Which question is most appropriate for the nurse to ask in determining the extent of the client's activity intolerance? 1. "What daily activities were you able to do 6 months ago compared with the present?" 2. "How long have you had this problem?" 3. "Have you been able to keep up with all your usual activities?" 4. "Are you more tired now than you used to be?"

1. "What daily activities were you able to do 6 months ago compared with the present?" Because iron deficiency anemia can occur gradually and individual endurance varies, the nurse can best assess the client's activity tolerance by asking the client to compare activities 6 months ago and at present

The nurse is aware that in addition to the client's platelet count, the best test to confirm the diagnosis of essential thrombocytopenia would be? 1. Bleeding time 2. White blood cell count 3. Immunoglobulin level 4. Prothrombin time and international normalized ratio.

1. Bleeding time After a platelet count, the best test to determine thrombocytopenia is a bleeding time. The platelet count is decreased and bleeding time may be prolonged. IGC assays are nonspecific but may help determine the diagnosis. WBC shows WBC values, and the PT and INR evaluate the effect of warfarin therapy.

A client is always tired. The client has a temperature of 99.5F (37.5C); the skin is dark bronze, and the urine has a dark color. The hemoglobin level is 9g/dL; the hematocrit is 49, and red blood cells are 2.75 million/microliter. What should the nurse do first? 1. Initiate an intake and output record. 2. Place the client on bedrest. 3. Place the client on contact isolation. 4. Keep the client out of sunlight.

1. Initiate an intake and output record. The nurse should prepare to start an intake and output record because the client is exhibiting clinical manifestations of anemia with jaundice and is demonstrating a fluid imbalance

. A client with iron deficiency anemia is refusing to take the prescribed oral iron medication because the medication is causing nausea. The nurse should do which of the following? Select all that apply. 1. Suggest that the client use ginger when taking the medication. 2. Ask the client what is causing the nausea. 3. Tell the client to use stool softeners to minimize constipation. 4. Offer to administer the medication by an intramuscular injection. 5. Suggest that the client take the iron with orange juice.

1. Suggest that the client use ginger when taking the medication. 2. Ask the client what is causing the nausea. 5. Suggest that the client take the iron with orange juice.

When teaching the client older than age 50 who is receiving long-term prednisone therapy, the nurse should recommend which of the following? 1. Take the prednisone with food. 2. Take over-the-counter drugs as needed. 3. Exercise three to four times a week. 4. Eat foods that are low in potassium.

1. Take the prednisone with food. Nausea, vomiting, and peptic ulcers are gastrointestinal adverse effects of prednisone, so it sis recommended that clients take the prednisone with food

What is the earliest clinical manifestation of a client with acute disseminated intravascular coagulation (DIC)? 1. Severe shortness of breath. 2. Bleeding without history or cause. 3. Orthopnea. 4. Hematuria.

2. Bleeding without history or cause. there is no well-defined sequence for acute DIC other than that the client starts bleeding without a history or cause and does not stop bleeding.

A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse would instruct the client to: 1. lie supine with his neck extended. 2. sit upright, leaning slightly forward. 3. blow his nose and then put lateral pressure on it. 4. hold his nose while bending forward at the waist.

2. sit upright, leaning slightly forward.

A client is to be discharged on prednisone. Which of the following statements indicates that the client understands important concepts about the medication therapy? 1. "I need to take the medicine in divided doses at morning and bedtime." 2. "I am to take 40 mg of prednisone for 2 months then stop." 3. " I need to wear or carry identification that I am taking prednisone. 4. "Prednisone will give me extra protection from colds and flu."

3. " I need to wear or carry identification that I am taking prednisone. The client needs to wear or carry information containing the name of the drug, dosage, physician and contact information and emergency instructions because additional corticosteroid drug therapy would be needed during emergency situations

A nurse is teaching a client about idiopathic thrombocytopenia and explains that the average normal life span of a platelet is: 1. 1 to 3 days. 2. 3 to 5 days. 3. 7 to 10 days. 4. 3 to 4 months.

3. 7 to 10 days The normal life span of a platelet is 7 to 10 days. However, in idiopathic thrombocytopenia, the platelet life span is reduced to 1 to 3 days.

. The nurse is preparing to administer platelets. The nurse should: 1. Check the ABO compatibility. 2. Administer the platelets slowly. 3. Gently rotate the bag. 4. Use a whole blood tubing set.

3. Gently rotate the bag. The bag containing platelets need to be gently rotated to prevent clumping

Which of the following is a late symptom of polycythemia vera? 1. Headache. 2. Dizziness. 3. Pruritis. 4. Shortness of breath

3. Pruritis. Pruritis is a late symptom that results from abnormal histamine metabolism.

The nurse is reviewing client's charts. Select the client who would be most at risk for developing anemia. 1. a 2-year old in day care 2. a 22-year old college student 3. a 55-year old neighbor 4. An elderly nursing home resident

4. An elderly nursing home resident Elderly people are most at risk for developing anemia, often due to financial concerns affecting protein intake or poor dentition that interferes with chewing meat.

The nurse is administering packed red blood cells (PRBCs) to a client. The nurse should first: 1. Discontinue the IV catheter if a blood transfusion reaction occurs. 2. Administer the PRBCs through a percutaneously inserted central catheter line with a 20-guage needle. 3. Flush PRBCs with 5% dextrose and 0.45% normal saline solution. 4. Stay with the client during the first 15 minutes of the infusion.

4. Stay with the client during the first 15 minutes of the infusion. The most likely time for a blood transfusion reaction to occur is during the first 15 minutes or first 50 mL. of the infusion

The nurse is preparing a teaching plan about increased exercise for a female client who is receiving long-term corticosteroid therapy. What type of exercise is most appropriate for this client? 1. Floor exercises. 2. Stretching. 3. Running. 4. Walking.

4. Walking. the best exercise for females who are on long-term corticosteroid therapy is a low-impact, weightbearing exercise such as walking

A nurse is documenting care for a client with iron deficiency anemia. What is the most appropriate nursing diagnosis? 1. Impaired gas exchange 2. Deficient fluid volume 3. Ineffective airway clearance 4. Ineffective breathing pattern

1. Impaired gas exchange Iron is necessary for hemoglobin synthesis. Hemoglobin is responsible for oxygen transport in the body. Iron deficiency anemia causes subnormal hemoglobin levels, which impair tissue oxygenation and warrant a nursing diagnosis of impaired gas exchange.

The nurse should instruct the client to eat which of the following foods to obtain the best supply of vitamin B12? 1. Whole grains. 2. Green leafy vegetables. 3. Meats and dairy products. 4. Broccoli and brussels sprouts.

3. Meats and dairy products. Good sources of vitamin B12 include meats and dairy products. Whole grains are a good source of thiamine. Green, leafy vegetables are good sources of niacin, folate, and carotenoids (precursors of vitamin A). Broccoli and brussels sprouts are good sources of ascorbic acid (vitamin C).

A client asks the nurse about what commonly causes anemia. The best response by the nurse would be? 1. Lack of dietary iron 2. Vitamin C deficiency 3. Virus 4. Hereditary disorders of the red blood cells

1. Lack of dietary iron Anemia can commonly be caused by a lack of vitamin B12, iron, and folic acid as well as inflammation caused by some chronic diseases. Vitamin C deficiency doesn't cause anemia. Viruses and hereditary disorders are less common causes of anemia.

The nurse is developing a care plan for a client with leukemia. The plan should include which of the following? Select all that apply. 1. Monitor the temperature and report elevation. 2. Recognize signs and symptoms of infection. 3. Avoid crowds. 4. Maintain integrity of skin and mucous membranes. 5. Take a baby aspirin each day.

1. Monitor the temperature and report elevation. 2. Recognize signs and symptoms of infection. 3. Avoid crowds. 4. Maintain integrity of skin and mucous membranes.

A client has a platelet count of 31,000/uL. The nurse should instruct the client to: 1. Pad sharp surfaces to avoid minor trauma when walking. 2. Assess for spontaneous petechiae in the extremities. 3. Keep the room darkened. 4. Check for blood in the urine.

1. Pad sharp surfaces to avoid minor trauma when walking the client with a platelet count of 30,00 to 50,000 is susceptible to bruising with minor trauma. Padding areas that the client might bump, scratch, or hit may help prevent minor trauma

The nurse should assess a client with thrombocytopenia who has developed a hemorrhage for which of the following? 1. Tachycardia. 2. Bradycardia. 3. Decreased Paco2. 4. Narrowed pulse pressure.

1. Tachycardia The nurse observes tachycardia in the hemorrhaging client because the heart beats faster to compensate for decreased circulating volume and decreased numbers of oxygen-carrying red blood cells. The degree of cardiopulmonary distress and anemia will be related to the amount of the hemorrhage that occurred and the period of time over which it occurred.

Platelets should not be administered under which of the following conditions? 1. The platelet bag is cold. 2. The platelets are 2 days old. 3. The platelets bag is at room temperature. 4. The platelets are 12 hours old.

1. The platelet bag is cold. Platelets cannot survive cold temperatures. The platelets should be stored at room temperature and last for no more than 5 days

The nurse's best explanation for why the severely neutropenic client is placed in reverse isolation is that reverse isolation helps prevent the spread of organisms: 1. To the client from sources outside the client's environment. 2. From the client to health care personnel, visitors, and other clients. 3. By using special techniques to dispose of contaminated materials. 4. By using special techniques to handle the client's linens and personal items.

1. To the client from sources outside the client's environment.

. The nurse should teach the client with neutropenia and the family to avoid which of the following? 1. Using suppositories or enemas. 2. Using a high-efficiency particulate air filter mask. 3. Performing perianal care after every bowel movement. 4. Performing oral care after every meal.

1. Using suppositories or enemas. neutropenic client is at risk for infection, especially bacterial infection of the respiratory and gastrointestinal tracts. Breaks in the mucous membranes, such as those that could be caused by the insertion of a suppository or enema tube, would be a break in the first line of the body's defence and a direct port of entry for infection.

The nurse is assessing a postoperative client who is recovering from a partial gastrectomy. The nurse is aware that the client is at risk for developing: 1. anemia 2. polycythemia 3. purpura 4. thrombocytopenia

1. anemia Surgery is a risk factor for anemia. Polycythemia can occur from severe hypoxia due to congenital heart and pulmonary disease. Purpura and thrombocytopenia may result from decreased bone marrow production of platelets and do not result from surgery.

The nurse is preparing a care plan for a client with polycythemia vera on ways to maintain nutrition. The nurse should include which of the following in the plan? 1. increase intake of foods high in iron. 2. encourage small, frequent meals. 3. increase the amount of red meats in the diet. 4. encourage the use of hot spices in foods to stimulate appetite.

1. increase intake of foods high in iron Clients with polycythemia vera experience satiety and fullness resulting from hepatomegaly and splenomegaly. Frequent small meals will help maintain adequate nutrition. Foods rich in iron are not appropriate because there are increased erythrocytes.

When a client with thrombocytopenia has a severe headache, the nurse interprets that this may indicate which of the following? 1. Stress of the disease. 2. Cerebral bleeding. 3. Migraine headache. 4. Sinus congestion.

2. Cerebral bleeding. When the platelet count is very low, red blood cells leak out of the blood vessels and into the tissue. If the blood pressure is elevated and the platelet count falls to less that 15,000/uL, internal bleeding in the brain can occur. A severe headache occurs from meningeal irritation when blood leaks out of the cerebral vasculature. When a client has thrombocytopenia, the nurse should always assess for cerebral bleeding by checking vital signs and performing neurological checks.

A client who had received 25 mL. of packed red blood cells has low back pain and pruritis. After stopping the infusion, the nurse should take what action next? 1. Administer prescribed antihistamine and aspirin. 2. Collect blood and urine samples and send to the lab. 3. Administer prescribed diuretics. 4. Administer prescribed vasopressors.

2. Collect blood and urine samples and send to the lab. AB)- and Rh-incompatible blood causes an antigen-antibody reaction that produces hemolysis or agglutination of red blood cells. At the first indication of any sign/symptom of reaction, the blood transfusion is stopped. Blood and urine samples are obtained from the client and sent to the lab along with the remaining untransfused blood

The nurse evaluates that the client correctly understands how to report signs and symptoms of bleeding when the client makes which of the following statements? 1. "Petechiae are large, red skin bruises." 2. Ecchymoses are large, purple skin bruises." 3. "Purpura is an open cut on the skin." 4. "Abrasions are small pinpoint red dots on the skin."

2. Ecchymoses are large, purple skin bruises." Large, purplish skin lesions caused by hemorrhage are called ecchymoses. Small, flat, red pinpoint lesions are petechiae. Numerous petechiae result in a reddish, bruised appearance called purpura. An abrasion is a wound caused by scraping.

A client with disseminated intravascular coagulation develops clinical manifestations of microvascular thrombosis. The nurse should assess the client for: 1. Hemoptysis. 2. Focal ischemia. 3. Petechiae. 4. Hematuria.

2. Focal ischemia manifestations of microvascular thrombosis are those that represent a blockage of blood flow and oxygenation to the tissue that results in eventual death of the organ. Examples of microvascular thrombosis include acute respiratory distress syndrome, focal ischemia, superficial gangrene, oliguria, azotemia (Presence of nitrogenous bodies espec. uria in increased amount, in the blood), cortical necrosis, acute ulceration, delirium, and coma.

Which of the following lab values should the nurse report to the health care provider when the client has anemia? 1. Schilling test result, elevated. 2. Intrinsic factor, absent. 3. Sedimentation rate, 16 mm/h 4. Red blood cells within normal range.

2. Intrinsic factor, absent. The defining characteristic of pernicious anemia, a megaloblastic anemia, is lack of the intrinsic factor, which results from atrophy of the stomach wall.

A client with neutropenia has an absolute neutrophil count (ANC) of 900. What is the client's risk of infection? 1. Normal risk. 2. Moderate risk. 3. High risk. 4. Extremely high risk.

2. Moderate risk. A client is at moderate risk when the absolute neutrophil count (ANC is less than 1,000. The ANC decreases proportionate to the increased risk for infection. The client is at normal risk for infection if the ANC is 1,500 or greater. The client is at high risk for infection is the ANC is less than 500. An ANC of 100 or less if life threatening.

The nurse should instruct the client with a platelet count of less that 150,000/uL to avoid which of the following activities? 1. Ambulation. 2. Valsalva's maneuver. 3. Visiting with children. 4. Semi-Fowler's position.

2. Valsalva's maneuver When the platelet count is less that 150,000/uL., prolonged bleeding can occur from trauma, injury, or straining such as with Valsalva's maneuver. Clients should avoid any activity that causes straining to evacuate the bowel.

The nurse is teaching a client with polycythemia vera about potential complications from this disease. Which manifestations should the nurse include in the client's teaching plan? Select all that apply. 1. Hearing loss 2. Visual disturbance. 3. Headache. 4. Orthopnea. 5. Gout. 6. Weight loss.

2. Visual disturbance. 3. Headache. 4. Orthopnea. 5. Gout. Polycythemia vera, a condition in which too many red blood cells are produced in the blood serum, can lead to an increase in the hematocrit and hypervolemia, hyperviscosity, and hypertension. Subsequently, the client can experience dizziness, tinnitus, visual disturbances, headaches, or a feeling of fullness in the head. The client may also experience cardiovascular symptoms such as heart failure (shortness of breath and orthopnea) and increased clotting time or symptoms of an increased uric acid level such as painful, swollen joints

The nurse is reviewing a 52-year-old client's laboratory values. The platelet count is 75,000/ul. How would the nurse interpret this value? 1. normal platelet count 2. thromobocytopenia 3. thrombocytopathy 4. thrombocytosis

2. thromobocytopenia Thrombocytopenia is a decreased number of platelets. In adults, this would be less than 100,00/ul. Normal platelet count ranges from 140,000/ul to 400,000/ul. Thrombocytopathy is platelet dysfunction and thrombocytosis is an excess number of platelets.

Which of the following is contraindicated for a client diagnosed with disseminated intravascular coagulation (DIC)? 1. Treating the underlying cause. 2. Administering heparin. 3. Administering warfarin sodium (Coumadin). 4. Replacing depleted blood products.

3. Administering warfarin sodium (Coumadin). DIC has not been found to respond to oral anticoagulants such as warfarin sodium (Coumadin). Treatments for DIC are controversial but include treating the underlying cause, administering heparin, and replacing depleted blood products.

The nurse is aware that a client with a diagnosis of thrombocytopenia would be likely to complain of which of the following? 1. Weakness and fatigue 2. Dizziness and vomiting 3. Bruising and petechiae 4. Light-headedness and nausea

3. Bruising and petechiae Platelets are necessary for clot formation so petechiae and bruising are classic signs of a decreased number of platelets. Weakness and fatigue are signs of anemia. Lightheadedness, nausea, dizziness and vomiting are not classic signs of thrombocytopenia.

Which of the following is an assessment finding associated with internal bleeding with disseminated intravascular coagulation? 1. Bradycardia. 2. Hypertension. 3. Increasing abdominal girth. 4. Petechiae.

3. Increasing abdominal girth. As blood collects in the peritoneal cavity, it causes dilation and distention, which is reflected in increased abdominal girth. The client would be tachycardic and hypotensive. Petechiae reflect bleeding in the skin.

A client is having a blood transfusion reaction. The nurse must do the following in what order of priority from first to last? 1. Notify the attending physician and blood bank. 2. Complete the appropriate Transfusion Reaction Form(s). 3. Stop the transfusion. 4. Keep the IV open with normal saline solution.

3. Stop the transfusion. 4. Keep the IV open with normal saline solution. 1. Notify the attending physician and blood bank. 2. Complete the appropriate Transfusion Reaction Form(s).

A client has been admitted with active rectal bleeding, and has been typed and crossmatched for 2 units of packed red blood cells (RBCs). Within 10 minutes of admission, the client faints when getting up to the bedside commode. The nurse notifies the health care provider, who prescribes a unit of blood to be administered immediately. The nurse can safely administer which type of blood for immediate transfusion? 1. A negative. 2. B negative. 3. AB negative. 4. O negative.

4. O negative. A routine serology study to confirm compatibility between a blood donor and recipient takes about 1 hour. In an emergency, O negative RBCs can be safely administered to most clients, which if why a person with O-negative blood is called a universal donor. The other types of RBCs may cause an adverse reaction.

The client with idiopathic thrombocytopenic purpura (ITP) asks the nurse why it is necessary to take steroids. Which is the nurse's best response? 1. Steroids destroy the antibodies and prolong the life of platelets. 2. Steroids neutralize the antigens and prolong the life of platelets. 3. Steroids increase phagocytosis and increase the life of platelets. 4. Steroids alter the spleen's recognition of platelets and increase the life of platelets.

4. Steroids alter the spleen's recognition of platelets and increase the life of platelets. ITP is treated with steroids to suppress the splenic macrophages from phagocytizing the antibody-coated platelets, which are recognized as foreign bodies, so that the platelets live longer. The steroids also suppress the binding of the autoimmune antibody to the platelet surface. Steroids do not destroy the antibodies on the platelets, neutralize antigens, or increase phagocytosis.

A physician prescribes vitamin B12 for a client with pernicious anemia. Which sites are appropriate for the nurse to administer vitamin B12? Select all that apply. 1. Median cutaneous. 2. Greater femur trochanter. 3. Acromion muscle. 4. Ventrogluteal. 5. Upper back. 6. Dorsogluteal.

4. Ventrogluteal 6. Dorsogluteal A client with pernicious anemia has lost ability to absorb vitamin B12 either because of the lack of an acidic gastric environment or the lack of the intrinsic factor. Vitamin B12 must be administered by a deep intramuscular route.

A client diagnosed with leukemia is now experiencing neutropenia. Which of the following is a priority assessment by the nurse? 1. blood pressure 2. bowel sounds 3. heart sounds 4. breath sounds

4. breath sounds Pneumonia, both viral and fungal, is a common cause of death in clients with neutropenia, so frequent assessment of respiratory rate and sounds is required.