NCLEX Review: CH 20

A nurse is teaching her patient with multiple myeloma how to prevent hypercalcemia. Which piece of advice is incorrect? 1) increase urine output to at least 1L/day 2) Maintain mobility 3) Maintain hydration 4) Watch renal function

1) Increase urine output to at least 3L/day

Which of the following medications may need to be held in a patient with anemia? 1) Lipitor 2) Metoprolol 3) Aspirin 4) Vitamin C supplement

2) Antihypertensives may need to be held in a patient with anemia due to the tissue perfusion problems already associated with anemia.

A patient is undergoing phlebotomy as therapy for polycythemia vera. Which of the following indicates that treatment is working? 1) Patient's complexion is less ruddy 2) Patient's blood pressure is now within normal limits 3) Patient's hematocrit is below 42% 4) Patient has sufficient iron levels in the blood

3) The goals of therapy are to decrease Hct levels to below 45% in men and 42% in women. The patient will also likely be rendered iron-deficient, but this will keep the patient from making erythrocytes excessively.

A nursing student is learning about anemia in real disease, and realizes that which of the following does NOT contribute to anemia in a patient with CKD? 1) Patients undergoing hemodialysis may lose blood into the dialyzer and become iron deficient. 2) Patients may experience a deficiency in erythropoietin. 3) Patients may experience folic acid deficiency as this vitamin passes into the dialysate. 4) Patients are more subject to spontaneous bleeding, which can cause anemia.

4)

Which of the following disorders is NOT thought to cause or contribute to secondary polycythemia? 1) cigarette smoking 2) COPD 3) cyanotic heart disease 4) living at a low altitude

4) living at a HIGH altitude may cause this.

Which of the following is NOT a general complication that can occur as a result of severe anemia? 1) heart failure 2) paresthesias 3) confusion 4) ESRD

4) ESRD is not listed

While providing teaching to a patient diagnosed with PV, a nurse would include which of the following as complications that can occur? Select all that apply 1) MI 2) ulcers 3) nosebleeds 4) proteinuria 5) CVA

Answers: 1, 2, 3, 5 4: hematuria, not proteinuria, is expected.

A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? a) Hypercalcemia b) Hyperkalemia c) Hypernatremia d) Hypermagnesemia

a)

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

a)

The nurse practitioner suspects that a patient has multiple myeloma based on his major presenting symptom and the analysis of his laboratory results. Select the classic symptom for this disease. a) Bone pain in the back of the ribs b) Gradual muscle paralysis c) Debilitating fatigue d) Severe thrombocytopenia

a)

Which of the following is the most serious side effect in dialysis patients when the hematocrit rapidly increases to a high level? a) Hypertension b) Nausea c) Muscle cramping d) Hypotension

a)

Which of the following terms refers to an abnormal decrease in white blood cells, red blood cells, and platelets? a) Pancytopenia b) Anemia c) Thrombocytopenia d) Leukopenia

a)

A client is prescribed 325 mg/day of oral ferrous sulfate. The nurse includes in client teaching, "Take your iron pill a) 1 hour before breakfast" b) with dairy products" c) along with a decreased amount of dietary fiber" d) and decrease fruits and juices in your diet"

a) Instructions the nurse will provide for the client taking oral ferrous sulfate is to administer the medication on an empty stomach. Instructions also include that there is decreased absorption of iron with food, particularly dairy products. The client is to increase vitamin C intake (fruits, juices, tomatoes, broccoli), which will enhance iron absorption. The client is to also increase foods high in fiber to decrease risk of constipation.

A health care provider orders a unit of packed red blood cells (PRBC) for a postoperative patient. The nurse is responsible for patient assessment and health care information pre- and post-transfusion. Which of the following are the guidelines that the nurse should follow? Select all that apply. a) a. Determine the history of any previous transfusions and possible reactions. b) b. Review the signs and symptoms of a transfusion reaction. c) c. Explain that since 1985 the supply of blood available for transfusions is risk-free. d) d. Explain that urticaria is a harmless, common reaction to a transfusion occurring at least 50% of the time. e) e. Report any increase of 1 degree in temperature, during or after transfusion, which falls into a febrile range.

a, b, e

A nurse assisting at a blood donation drive is screening individuals for eligibility. An individual would be rejected if he or she had: a) A hemoglobin level of 14.5 g/dL. b) A body weight of 60 kg. c) Oral surgery within 72 hours. d) Received a blood transfusion 15 months prior to the current date for donating.

c)

A nurse is assessing a client with multiple myeloma. The nurse should keep in mind that clients with multiple myeloma are at risk for: a) chronic liver failure. b) hypoxemia. c) pathologic bone fractures. d) acute heart failure.

c)

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

c)

An 89-year-old client is preparing to leave the physician's office. The nurse is discussing with the client some strategies for ingesting iron to combat her iron-deficient anemia. Which of the following are among the nurse's strategies? a) Avoid vitamin C - it prevents absorption. b) Taking iron pills with milk aids in absorption. c) Drink liquid iron preparations with a straw. d) Take iron with an antacid to avoid stomach upset.

c)

A client reports feeling tired, cold, and short of breath at times. Your assessment reveals tachycardia and reduced energy. What would you expect the physician to order? a) Chest radiograph b) ECG c) Antibiotic d) CBC

d)

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy? a) "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." b) "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear." c) "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal." d) "I will receive parenteral vitamin B12 therapy for the rest of my life."

d)

A patient with ESRD is taking recombinant erythropoietin for the treatment of anemia. What laboratory study does the nurse understand will have to be assessed at least monthly related to this medication? a) Potassium level b) Creatinine level c) Folate levels d) Hemoglobin level

d)

Which of the following would the nurse expect to see in a patient diagnosed with polycythemia vera? Select all that apply 1) severe and painful itching worsened by water 2) pallor in the face, hands, and feet 3) hypotension 4) burning and redness in the fingers and toes that feels better when an ice pack is placed on the extremities 5) gout

1, 4, 5 2) ruddy complexion moreso expected 3) hypertension moreso expected

Which of the following is a hallmark symptom of polycythemia vera? 1) splenomegaly 2) Hct above 45% 3) hypertension 4) low O2 sats

1) Other symptoms of PV include: splenomegaly, a ruddy complexion, increased blood volume, increased blood viscocity, HTN, gout, renal stone formation, pruritus, severe/painful itching worsened by water, erythromelalgia

A nurse is teaching her patient about his newly-prescribed iron supplement. Which statement, if made by the patient, indicates that further instruction is necessary? 1) "I will eat plenty of fiber to prevent constipation and continue taking my Pepto-bismal with my supplement." 2) "I will begin with one iron tablet, and I will gradually increase my dosage to prevent my stomach becoming upset." 3) "I eat plenty of tomatoes and broccoli, which is good since these foods will help me absorb my iron." 4) "If I forget to take my iron supplement and end up taking it with food, it is best to avoid dairy products."

1) Antacids should not be taken with an iron supplement.

When teaching a client newly-diagnosed with anemia about her diet, which of the following are important teaching points to be made by the nurse? Select all that apply: 1) "Alcoholic beverages should be avoided completely if possible." 2) "You should try to maintain a healthy diet that includes fresh fruits and vegetables." 3) "It is unlikely that you will be taking any vitamins in addition to your daily multi-vitamin." 4) "You will likely be placed on iron and vitamin B12 supplements, and it's important to be compliant with your therapy." 5) "Your iron supplement may cause constipation, so it's important to maintain a good intake of fiber."

Answers: 1, 2, 4, 5 The patient will likely be on a vitamin B12 supplement, making answer 3 incorrect.

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

a) The client requires additional teaching if he states that he'll eat four servings of dark green vegetables every day. Dark, green vegetables contain vitamin K, which reverses the effects of warfarin. The client should limit his intake to one to two servings per day. The client should report bleeding gums and severe or unexplained bruising, which may indicate an excessive dose of warfarin. The client should use an electric razor to prevent cutting himself while shaving.