Immune and Hematologic Disorders
A client with autoimmune thrombocytopenia and a platelet count of 8,000/μl develops epistaxis and melena. Treatment with corticosteroids and immunoglobulins has been unsuccessful, and the physician recommends a splenectomy. The client states, "I don't need surgery — this will go away on its own." In considering her response to the client, the nurse must depend on the ethical principle of: autonomy. advocacy. justice. beneficence.
automony
A client diagnosed with systemic lupus erythematous (SLE) is experiencing an exacerbation. Which statement made by the client indicates further education should be reinforced? "I need to work on managing stress in my life." "I need to stay away from sunlight." "I don't have to worry if I get strep throat." "I don't have to worry about changing my diet."
"I don't have to worry if I get strep throat."
A person visiting with a client asks the nurse what's wrong with the client. The nurse's best response is "You'll need to discuss this concern directly with the client." "I'm not allowed to disclose that information." "Are you a relative or family member?" "Let me see if you're on the list of people I may speak with."
"Let me see if you're on the list of people I may speak with."
After being admitted to the hospital with sickle cell crisis, a client asks a nurse how he can prevent another crisis. Which response by the nurse is best? "Make sure that you drink plenty of fluids." "Make sure that you get plenty of strenuous exercise." "Apply cold compresses to painful areas as soon as you experience pain." "Wear tight clothing to provide you with additional support."
"Make sure that you drink plenty of fluids."
A client with rheumatoid arthritis reports flatulence and heartburn after taking piroxicam. Which instruction should the nurse reinforce to address the client's concern? "These side effects will subside as you continue to take the medication." "Take an antacid at the same time that you take the medication." "This medication is used for short-term treatment of your arthritis." "Try taking a lower dose of the medication to relieve your symptoms."
"Take an antacid at the same time that you take the medication."
A client reports nausea and vomiting as a side effect of radiation and chemotherapy. When is the best time for the nurse to administer antiemetics? when therapy is completed 30 minutes before initiation of therapy with the administration of therapy immediately after nausea begins
30 minutes before initiation of therapy
A client is receiving a blood transfusion. If this client experiences an acute hemolytic reaction, which nursing intervention is the most important? Stop the transfusion, notify the blood bank, and administer antihistamines. Immediately stop the transfusion, infuse dextrose 5% in water (D5W), and call the physician. Immediately stop the transfusion, infuse normal saline solution, notify the blood bank, and call the physician. Slow the transfusion and monitor the client closely.
Immediately stop the transfusion, infuse normal saline solution, notify the blood bank, and call the physician.
Two days after a client undergoes splenectomy, a nurse changes his abdominal dressings according to the physician's order. How should the nurse proceed with the dressing change? Put on a gown, sterile gloves, and a mask. Place clean dressings over the incision. Dispose of the soiled dressings in the trash can. Remove the soiled dressings using clean gloves.
Remove the soiled dressings using clean gloves.
When a nurse removes an I.V. from an client with acquired immunodeficiency syndrome (AIDS), blood splashes into the nurse's eyes. What should the nurse do next? Rinse their eyes with water, report the incident, and go to Employee Health. Rinse their eyes, contact Employee Health and document their findings. Wash their hands, complete an incident report, and see a physician as soon as possible. Rinse their eyes with water, record the incident on the client's chart, and see Employee Health.
Rinse their eyes with water, report the incident, and go to Employee Health.
Which client assigned to the nurse has the highest risk of developing anemia? a client with dumping syndrome a client with gastroesophageal reflux disease (GERD) a client who has had a gastrectomy a client with a colostomy following colon resection
a client who has had a gastrectomy
A nurse is caring for several client's with human immunodeficiency virus (HIV) infection. Which client does the nurse suspect has acquired immunodeficiency syndrome (AIDS) wasting syndrome? a client with impaired memory, hallucinations, loss of balance, and personality changes a client who has lost 12% of her body weight, with weakness, fever, and chronic diarrhea for the past 35 days a client with recurrent vaginitis causing intense itching and white, thick vaginal discharge a client with oral pain, dysphagia, and yellow-white plaques in his mouth and throat
a client who has lost 12% of her body weight, with weakness, fever, and chronic diarrhea for the past 35 days
A client is receiving chemotherapy and is not required to be in reverse isolation. What activity will the nurse recommend to the client? out of bed for brief periods activity as tolerated bed rest walks to bathroom only
activity as tolerated
Which type of leukemia with fast growing immature lymphocytes accounts for most cases of childhood leukemia? acute myeloid leukemia (AML) acute lymphocytic leukemia (ALL) chronic lymphocytic leukemia (CLL) chronic myeloid leukemia (CML)
acute lymphocytic leukemia (ALL)
A client is admitted with hemophilia. Which sports should the nurse recommend for this client? Select all that apply. basketball swimming golf soccer baseball
swimming golf
A nurse is caring for several clients on an oncology unit. Which client should the nurse see first? client receiving brachytherapy for prostate cancer client with a white blood cell count of 2000 µL client who is on complete bed rest client who is 2 days postoperative following a hemicolectomy
client with a white blood cell count of 2000 µL
Which would the nurse incorporate when reinforcing education for the parents of a neonate diagnosed with sickle cell anemia? stress the importance of monthly vitamin B 12 injections explain that immunizations are contraindicated stress the importance of iron supplementation demonstrate how to take an accurate temperature
demonstrate how to take an accurate temperature
Which aspect is most important for successful management of the child with Reye syndrome? staging of the illness initiation of antibiotics isolation of the child early diagnosis
early diagnosis
A child is admitted to the hospital for an asthma exacerbation. The nursing history reveals this client was exposed to chickenpox 1 week ago. When would this client require isolation if he or she were to remain hospitalized? isolation isn't required 10 days after exposure 12 days after exposure immediate isolation is required
immediate isolation is required
The nurse is working in the emergency department when a child is admitted in sickle cell crisis. Which intervention should the nurse expect to perform? increase fluid intake and give analgesics give blood transfusions give antibiotics prepare the child for a splenectomy
increase fluid intake and give analgesics
A client is receiving the drug epoetin alfa. Which findings would indicate the effectiveness of the drug? increase in white blood cells increase in red blood cells decrease in blood coagulation decrease in blood glucose
increase in red blood cells
During the admission process, the nurse evaluates a client with rheumatoid arthritis. To assess for the most obvious disease manifestations first, the nurse checks for: joint abnormalities. muscle weakness. painful subcutaneous nodules. gait disturbances.
joint abnormalities
A client has been taking a decongestant for allergic rhinitis. During a follow-up visit, which data collected by the nurse suggest that the decongestant has been effective? headache less sneezing increased tearing clear nasal drainage
less sneezing
The nurse is caring for a client diagnosed with leukemia who is going to have a chemotherapy treatment. Which test would the nurse expect to be done to evaluate the client's ability to metabolize chemotherapeutic agents? complete blood count (CBC) lumbar puncture peripheral blood smear liver function studies
liver function studies
The nurse is meeting with a client who has recently been diagnosed with human immunodeficiency virus (HIV). The client is concerned about the impact of sharing the recent diagnosis with friends and family. What information can the nurse provide to the client? sharing the diagnosis often causes friends and family to turn away there are few benefits of sharing the information with friends and family as long as one's health is stable disclosing the diagnosis to social contacts may result in feelings of isolation sharing the diagnosis with friends and family members will provide a needed source of support
sharing the diagnosis with friends and family members will provide a needed source of support
A nurse obtains data from a client receiving a blood transfusion and determines that the client is wheezing, has chills, and back pain. What is the priority action of the nurse? notify the blood bank stop the transfusion. raise the head of the bed notify the primary RN
stop the transfusion
Which symptom is the most common manifestation of severe combined immunodeficiency disease (SCID)? susceptibility to infection increased bruising prolonged bleeding failure to thrive
susceptibility to infection
A nurse is reinforcing nutritional counseling to the parent of a child with celiac disease. Which statement by the parent indicates understanding of the diet? "I need to read food labels carefully to avoid gluten additives in foods." "My child needs a diet rich in all grains." "My child can safely eat frozen and packaged foods." "I should avoid feeding my child potatoes, rice, flour, and cornstarch."
"I need to read food labels carefully to avoid gluten additives in foods."
A nurse has instructed a client about taking ferrous sulfate liquid preparation. Which statement by the client indicates the need for additional education? "I should add the iron to juice and drink it with a straw." "I should rinse my mouth with water after taking the iron." "I expect my stools to be dark green or black." "I should take the iron with an antacid to prevent gastric distress."
"I should take the iron with an antacid to prevent gastric distress."
A staff member on the transplant unit is having problems logging into the computer to chart client information. The staff member asks a nurse for their personal identification number (PIN) to log in. What is the nurse's best response? "I'll log you in. Be sure to log out when you are finished charting." "You know that isn't appropriate." "Sure. Just be sure to destroy the information after you are finished charting." "I'll be happy to contact Information Services to assist you with the problem."
"I'll be happy to contact Information Services to assist you with the problem."
A client with acquired immunodeficiency syndrome (AIDS) is prescribed zidovudine (azidothymidine, AZT), 200 mg by mouth every 4 hours. When teaching the client about this drug, the nurse should provide which instruction? "Take zidovudine exactly as prescribed." "Take over-the-counter (OTC) drugs to treat minor adverse reactions." "Take zidovudine with meals." "Take zidovudine on an empty stomach."
"Take zidovudine exactly as prescribed."
What should be included in the plan of care for clients receiving intravenous immunoglobulin (IVIG)? Select all that apply. Pre-medicate with acetaminophen and diphenhydramine 30 minutes before infusion. Stop the infusion at the first sign of a reaction. Assess vital signs before, during, and after treatment. Administer the infusion at a slow rate of 3 mL/hr. Monitor for common side effects like flushing and reports of a tickle or lump in the throat.
Assess vital signs before, during, and after treatment. Pre-medicate with acetaminophen and diphenhydramine 30 minutes before infusion. Stop the infusion at the first sign of a reaction.
How can a nurse best protect herself after she experiences a minor allergic reaction to latex? Avoid using latex gloves. Use latex products on a limited basis. Carry an allergic reaction kit. Avoid use of all latex products.
Avoid use of all latex products
The nurse is teaching a client who will be discharged soon how to change a sterile dressing on the right leg. During the teaching session, the nurse notices redness, swelling, and induration at the wound site. What do these signs suggest? Evisceration Infection Dehiscence Hemorrhage
Infection
A client with allergic rhinitis is prescribed loratadine. On a follow-up visit, the client tells the nurse, "I take one 10-mg tablet of Claritin with a glass of water two times daily." The nurse concludes that the client requires additional teaching about this medication because: loratadine isn't available in 10-mg tablets. loratadine should be taken on an empty stomach. loratadine isn't available in tablet form. loratadine should be taken once daily for allergic rhinitis.
loratadine should be taken once daily for allergic rhinitis.
A client is injected with radiographic contrast medium and immediately shows signs of dyspnea, flushing, and pruritus. Which intervention should take priority? make sure the airway is patent call the health care provider check vital signs apply a cold pack to the IV site
make sure the airway is patent
When caring for a child with sickle cell anemia in vaso-occlusive crisis, what does the nurse identify as the priority nursing intervention? immobilize the affected part manage pain provide a cool environment restrict fluids
manage pain
