NUR528: Exam 4 Questions

A nurse is caring for a patient who has sickle cell anemia and was admitted for a vaso-occlusive crisis. Which of the following findings should the nurse report to the provider immediately? (a) Slurred speech (b) Hemoglobin level of 9g/dL (c) Hematuria (d) Pain level of 7

(a) Slurred speech

A nurse is creating a plan of care for a client who has sickle cell anemia and is experiencing a vaso-occlusive crisis. Which of the following interventions is the priority for the nurse to include? (a) Monitor the client's oxygen saturation level (b) Administer prescribed antibiotics to the child (c) Increase the client's fluid intake (d) Apply warm compresses to the client's affected joints

(a) Monitor the client's oxygen saturation level Use ABC approach (airway, breathing, circulation).

A nurse is transfusing a unit of O-negative fresh frozen plasma (FFP) to a client whose blood type is B positive. Which of the following actions should the nurse take? (a) Continue to monitor for manifestations of a transfusion reaction (b) Remove the unit of plasma immediately and start an IV infusion of normal saline solution (c) Continue the transfusion and repeat the type and crossmatch (d) Prepare to administer a dose of diphenhydramine IV

(b) Remove the unit of plasma immediately and start an IV infusion of normal saline solution ABO compatibility is required for the transfusion of FFP. A client whose blood type is B can only receive type B or AB plasma. Transfusion of ABO-incompatible plasma containing anti-A or anti-B, usually from a group O donor, can cause haemolysis of the recipient's recd cells.

A nurse is caring for a client who is receiving a blood transfusion. The client reports flank pain, and the nurse notes reddish-brown urine in the client's urinary catheter bag. The nurse recognizes these manifestations as which of the following types of transfusion reactions? (a) Hemolytic (b) Febrile (c) Circulatory overload (d) Sepsis

(a) Hemolytic A hemolytic reaction occurs when the client's blood is incompatible with the donor's blood. Chills, low back pain, hypotension, and tachycardia are indications of a hemolytic transfusion reaction. A febrile reaction occurs when the client's blood is sensitive to WBCs and platelets in the donor's blood. Fever, chills, headaches, and flushing are indications of a febrile reaction. Circulatory overload occurs when blood is administered too quickly for the client's circulatory system to handle. Dyspnea, coughing, headaches, and hypertension are indications of circulatory overload. Sepsis occurs when blood is contaminated with bacteria. High fevers, vomiting, and diarrhea are indications of sepsis.

A school nurse is assessing an adolescent who returned to school following a case of mononucleosis. The child has a note from his provider excusing him from gym class. Which of the following findings should the nurse identify as the reason for this excusal? (a) Potential for sustaining abdominal trauma (b) Deficient dietary intake (c) Exposing peers to the illness (d) Straining sore joints

(a) Potential for sustaining abdominal trauma An adolescent who has mononucleosis will have lymphadenopathy and often splenomegaly, which can persist for many months.

A nurse is caring for a patient who has sickle cell anemia. Which of the following actions should the nurse plan to take to help decrease the risk of a vaso-occlusive crisis? (a) Provide adequate fluid intake throughout the day (b) Provide oxygen at 2L/min via nasal cannula (c) Administer a blood transfusion (d) Give ibuprofen to manage pain

(a) Provide adequate fluid intake throughout the day Adequate hydration is an effective strategy to help prevent sickle cell crises. Maintaining adequate hydration can reduce the risk of sickle cell formation. Oxygen, blood transfusion, and ibuprofen might be necessary to manage a sickle cell crisis, but these are not routinely used to prevent a crisis.

A nurse is caring for a client who has breast cancer and is receiving a combination of chemotherapy medications. The client expresses confusion about the therapy. Which of the following explanations should the nurse provide? (a) "The risk of renal toxicity is lessened when a combination of chemotherapy medications is used." (b) "The chemotherapy medications act at different stages of cell division so more tumor cells are destroyed." (c) "The use of more chemotherapy medications will shorten the time you have to be in treatment." (d) "The combination of chemotherapy medications will eliminate the potential for bone marrow suppression."

(b) "The chemotherapy medications act at different stages of cell division so more tumor cells are destroyed."

A nurse is planning care for a client who has pernicious anemia. Which of the following interventions should the nurse include in the plan? (a) Administer ferrous sulfate supplementation (b) Increase dietary intake of folic acid (c) Initiate weekly injections of Vitamin B12 (d) Initiate a blood transfusion

(c) Initiate weekly injections of vitamin B12 Pernicious anemia is caused by a lack of intrinsic factor needed to absorb vitamin B12 from the GI tract.

A nurse is assessing a client who has pernicious anemia. Which of the following findings should the nurse expect? (a) Thick, white coating on the client's tongue (b) Decreased pulse rate (c) Paresthesias in the hands and feet (d) joint pain in the extremities

(c) Paresthesias in the hands and feet The nurse should identify that paresthesias (tingling sensations) in the hands and feet is an expected finding of pernicious anemia. Other manifestations include weight loss and fatigue. Thick, white coating on the tongue is a manifestation of oral candidiasis. Tachycardia, not bradycardia, is an expected finding of pernicious anemia. Joint pain is a manifestation of sickle cell disease rather than pernicious anemia.

A nurse is reviewing the laboratory results for a client who has a prescription for filgrastim. An increase in which of the following values indicates a therapeutic effect of this medication? (a) Erythrocyte count (b) Neutrophil count (c) Lymphocyte count (d) Thrombocyte count

(b) Neutrophil count

A nurse is caring for a client who has a new diagnosis of pernicious anemia. The nurse should expect the client's provider to prescribe which of the following medications for this client? (a) Ferrous sulfate (b) Epoetin alfa (c) Vitamin B12 (d) Folic acid

(c) Vitamin B12

A nurse is planning care for a client who is pregnant and is Rh-negative. In which of the following situations should the nurse administer Rh(D) immune globulin? (a) While the client is in labor (b) Following an episode of influenza during pregnancy (c) Prior to a blood transfusion (d) At 28 weeks gestation

(d) At 28 weeks gestation

A nurse documents the presence of clubbing of the fingernails for a client who has emphysema. Which of the following is the underlying cause of this finding? (a) Trauma (b) Severe infection (c) Iron-deficiency anemia (d) Chronic hypoxemia

(d) Chronic hypoxemia

A nurse is assessing a client for manifestations of aplastic anemia. Which of the following findings should the nurse expect? (a) Plethoric appearance of facial skin (b) Glossitis and weight loss (c) Jaundice with an enlarged liver (d) Petechiae and ecchymosis

(d) Petechiae and ecchymosis In aplastic anemia, all 3 major blood components (RBCs, WBCs, and platelets) are reduced or absent, which is known as pancytopenia. Manifestations of petechiae and ecchymosis usually develop gradually.

A nurse is teaching a client who has iron-deficiency anemia. The nurse should encourage the client to increase consumption of which of the following foods? (a) Beef liver (b) Oranges (c) Turnips (d) Whole milk

(a) Beef liver

A nurse is reviewing recent lab values during a prenatal visit for a client who is pregnant. The nurse notes a hemoglobin level of 10g/dL. Which of the following actions should the nurse take? (a) Review the medical record for a history of gastric bypass surgery (b) Advise the client to start iron and vitamin C supplementation (c) Review the medication list to determine if the client is taking an anticonvulsant (d) Request an order for sickle cell anemia screening

(b) Advise the client to start iron and vitamin C supplementation Clients who have a history of gastric bypass surgery and those receiving anticonvulsant therapy are at risk for anemia caused by folate-deficiency, not iron deficiency. Hemoglobin levels in clients who have sickle cell anemia are significantly lower than 10.4g/dL, at approximately 6-8g/dL.

A nurse is planning care for a client who has cancer and has developed thrombocytopenia following chemotherapy. Which of the following precautions should the nurse offer to minimize the adverse effects of thrombocytopenia? (a) Monitor visitors for manifestations of infection (b) Remind the client to use an electric razor (c) Encourage frequent rest periods (d) Instruct the client to rinse mouth daily with normal saline

(b) Remind the client to use an electric razor

A nurse is teaching a client who has polycythemia vera about self-care measures. Which of the following interventions should the nurse include? (a) "Drink at least 1 liter of fluid each day." (b) "Continuously wear support hose." (c) "Elevate your legs when sitting." (d) "Use dental floss daily."

(c) "Elevate your legs when sitting." Clients who have polycythemia vera should elevate their legs when seated to avoid venous pooling with subsequent clot formation. They should drink at lest 3L of fluid per day to help lower blood viscosity. These clients should wear support hose when awake. They also tend to take anticoagulants. They should not floss between their teeth due to the risk of bleeding.

A nurse is providing teaching to a client who is receiving chemotherapy and has developed neutropenia. Which of the following statements indicates that the client needs further instructions? (a) "I'll keep an antibacterial hand gel in my purse." (b) "My partner will have to take care of the cat's litter boxes for a while." (c) "I'm planning a large gathering of friends and family for the holidays." (d) "I will eat canned fruits and vegetables."

(c) "I'm planning a large gathering of friends and family for the holidays."

A nurse is caring for a newborn who has a prescription for phototherapy. The mother asks why the newborn needs to lay under a special light. Which of the following responses should the nurse make? (a) "The light helps your baby maintain his body temperature." (b) "The light helps your baby establish a regular sleeping pattern." (c) "The light will help lower your baby's bilirubin level." (d) "The light will help regulate your baby's blood sugar."

(c) "The light will help lower your baby's bilirubin level." Jaundice is caused by the breakdown of red blood cells, which release bilirubin. A newborn's immature liver is unable to filter and excrete the bilirubin efficiently, leading to accumulation of bilirubin in the tissues. The UV light in phototherapy assists in breaking down the bilirubin so that it can be excreted in the urine and feces.

A nurse in a clinic is assessing a client who was diagnosed with mononucleosis 2 weeks ago. Which of the following findings should the nurse report to the provider immediately? (a) Headache and fatigue (b) Swollen lymph nodes in the neck (c) Abdominal pain in the left upper quadrant (d) Fever and sore throat

(c) Abdominal pain in the left upper quadrant The nurse should determine that the priority finding is left upper-quadrant pain, which can indicate an enlarged spleen. An enlarged spleen can rupture, leading to internal hemorrhaging. The nurse should encourage the client to refrain from engaging in strenuous activities until the splenomegaly is resolved.

A nurse is assessing the hematologic system of an older adult client. The nurse should report which of the following findings to the provider as a possible indication of a hematologic disorder? (a) Pallor (b) Jaundice (c) Absence of hair on the legs (d) Poor nailbed capillary refill

(c) Absence of hair on the legs Thinning or absence of hair on the extremities indicates poor arterial circulation to that area. Pallor, jaundice, and poor nailbed capillary refill are unreliable indicators of anemia in older adults.

A nurse is providing teaching to a client who has anemia and a new prescription for epoetin alfa. Which of the following pieces of information should the nurse include in the teaching? (a) Hospitalization is required when administering each treatment. (b) The maximum effect of the medication will occur in 6 months. (c) Hypertension is a common adverse effect of this medicaton. (d) Blood transfusions are needed with each treatment.

(c) Hypertension is a common adverse effect of this medication. A common adverse effect of epoetin alfa is hypertension because of the rise in the production of erythrocytes and other blood cell types.

A nurse is providing preoperative teaching to a client who is scheduled for arthroplasty in the next month and may require a blood transfusion. The client expresses concern about the risk of acquiring an infection from the blood transfusion. Which of the following statements should the nurse share with the client? (a) "Ask you provider to prescribe epoetin before the surgery." (b) "You should ask your provider about taking iron supplements prior to the surgery." (c) "Ask a family member to donate blood for you." (d) "Donate autologous blood before the surgery."

(d) "Donate autologous blood before the surgery." Autologous blood transfusion is the collection and reinfusion of the client's blood. Autologous blood is the safest form of blood transfusion. While taking epoetin prior to surgery can boost the client's hematocrit levels, it is inappropriate if the client already has an adequate hematocrit level. While taking an iron supplement prior to surgery can boost the client's hemoglobin levels, it is inappropriate if the client already has an adequate hemoglobin level and intake of iron.

A nurse is providing discharge teaching to a client who has aplastic anemia. Which of the following statements indicates that the client understands the instructions? (a) "I need to stay active to prevent blood clots in my legs." (b) "If I have a bad headache, I can take aspirin to get rid of it." (c) "I should eliminate uncooked foods from my diet now." (d) "I should eat more iron-fortified cereal to strengthen my blood."

(d) "I should eliminate uncooked foods from my diet for now."

A nurse is admitting a client who has multiple myeloma and a WBC of 2200/mm^3. Which of the following foods should the nurse prohibit the family members from brining to the client? (a) Fried chicken from a fast food restaurant (b) A case of canned nutritional supplements (c) A factory-sealed box of chocolates (d) A fresh fruit basket

(d) A fresh fruit basket Raw fruits and vegetables are contraindicated for a client who has neutropenia, as the skin of these food items might harbor bacteria that can cause an infection.

A nurse observes tachycardia, dyspnea, a cough, and distended neck veins in a client who is receiving a transfusion of packed red blood cells (PRBCs). Which of the following interventions should the nurse use to prevent these manifestations with the client's next transfusion? (a) Warm the unit of blood to room temperature before administering it (b) Administer acetaminophen prior to the blood transfusion (c) Give an antihistamine prior to the transfusion (d) Use a transfusion pump to regulate and maintain the transfusion at a slower rate

(d) Use a transfusion pump to regulate and maintain the transfusion at a slower rate These are manifestation of a hypervolemic reaction due to circulatory overload, which likely occurs when the blood transfusion is too rapid for the client's size or status.

A nurse is providing discharge teaching for a client who had a bone marrow transplant and has thrombocytopenia. Which of the following statements indicates that the client understands the precautions he must take at home? (a) "I'll stick with soft foods for now." (b) "My family will be brining me fresh flowers today." (c) "I'll use a new disposable razor each day." (d) "I'll blow my nose more often to avoid nosebleeds."

(a) "I'll stick with soft foods for now."

A nurse is teaching a client who has iron-deficiency anemia. The nurse should encourage the client to increase her consumption of which of the following foods? (a) Lentils (b) Avocados (c) Cabbage (d) Broccoli

(a) Lentils

A home health nurse is visiting an older adult client who has anemia. Which of the following foods should the nurse recommend to increase the client's iron intake? (a) Greek yogurt (b) Bran muffin (c) PB sandwich (d) Dried fruit

(d) Dried fruit

A nurse is reviewing lab values for an adult client who has sickle cell anemia and a history of receiving blood transfusions. For which of the following complications should the nurse monitor? (a) Hypokalemia (b) Lead poisoning (c) Hypercalcemia (d) Iron toxicity

(d) Iron toxicity A client who has received several blood transfusions is at risk of hemosiderosis, which is the excess storage of iron in the body.

A nurse is caring for an adolescent who has sickle cell anemia. Which of the following manifestations is/are the result of chronic vaso-occlusive phenomena? (SATA) (a) Enlarged heart (b) Enuresis (c) Leg ulcers (d) Extrahepatic cholestasis (e) Retinal detachment

a, b, c, e. Chronic vaso-occlusive phenomena result from the obstruction of organs by the red blood cells, leading to stasis and enlargement of the organs, infarction due to ischemia, and scarring. An enlarged heart, enuresis, leg ulcers, and retinal detachment are manifestations of chronic vaso-occlusive phenomena.

A nurse in a provider's office is reviewing the medical records of a group of clients. Which of the following clients is at risk for iron deficiency? (SATA) (a) A client who is postmenopausal (b) A client who is vegetarian (c) A middle adult male client (d) A client who is pregnant (e) A toddler who is overweight

b, d, e Clients who are vegetarian might require additional iron because the availability of iron in vegetable food sources is limited. During pregnancy, maternal blood volume increases, and the fetus requires additional iron. Toddlers who are overweight may get most of their calories from milk and foods that are not considered healthy, which increases their risk for iron-deficiency anemia.

A nurse is preparing to transfuse a unit of packed red blood cells (RBCs) for a client who has anemia. Which of the following actions should the nurse take first? (a) Hang an IV infusion of 0.9% sodium chloride with the blood (b) Compare the client's identification number with the number on the blood (c) Witness the informed consent document (d) Obtain pre-transfusion vital signs

(c) Witness the informed consent document

A nurse is assessing a child who is postoperative and received a unit of packed RBCs during a surgical procedure. Which of the following findings indicates the child is experiencing a hemolytic transfusion reaction? (a) Chills and flank pain (b) Pruritus and flushing (c) Rales and cyanosis (d) Bradycardia and diarrhea

(a) Chills and flank pain Pruritus and flushing indicate a response to allergens present in the transfused blood product (allergic reaction). Rales and cyanosis indicate the blood product might have been administered too quickly (fluid overload). Bradycardia and diarrhea indicate a complication due to the transfusion of large amounts of blood or a problem with the kidneys (electrolyte imbalance).

A nurse is providing teaching to a client who has chronic kidney failure with an AV fistula for hemodialysis and a new prescription of epoetin alfa. Which of the following therapeutic effects of epoetin alfa should the nurse include in the teaching? (a) Reduces blood pressure (b) Inhibits clotting of fistula (c) Promotes RBC production (d) Stimulates growth of neutrophils

(c) Promotes RBC production

A nurse is assessing a client who is receiving a transfusion of packed red blood cells (RBCs). Which of the following findings should the nurse identify as an indication of an acute intravascular hemolytic reaction? (a) Severe hypertension (b) Low body temperature (c) Sudden oliguria (d) Decreased respirations

(c) Sudden oliguria Hypotension due to circulatory shock, fever and tachypnea are indications of an intravascular hemolytic reaction.

A nurse is teaching a client who has pernicious anemia. The nurse should encourage the client to increase consumption of which of the following foods? (a) Eggs (b) Squash (c) Kale (d) Tofu

(a) Eggs The nurse should encourage the client to increase consumption of foods rich in Vitamin B12, such as dairy products, animal protein, poultry, shellfish, and eggs.

A nurse is reviewing the lab results of a client who has end-stage renal disease and reports fatigue. The client's hemoglobin level is 8g/dL. The nurse should expect a prescription for which of the following medications? (a) Erythropoietin (b) Erythromycin (c) Filgrastim (d) Calcitriol

(a) Erythropoietin

A nurse is reviewing the lab results of a client who is taking medications and notes that the client's blood tests show an elevated level of the enzymes aspartate aminotransferase (AST) and alanine aminotransferase (ALT). The nurse should recognize that these findings are potential indications of which of the following conditions? (a) Renal dysfunction (b) Myelotoxicity (c) Hepatic toxicity (d) Cardiac dysrhythmia

(c) Hepatic toxicity

A nurse is caring for a client who has an upper GI bleed and a hematocrit of 24%. Prior to initiating a transfusion of packed red blood cells (RBCs), which of the following actions should the nurse take? (SATA) (a) Assess and document the client's vital signs (b) Restart the IV with a 22-gauge needle (c) Verify with another nurse the blood type and Rh of the packed RBCs (d) Hang a bag of lactated ringer's IV solution (e) Change IV tubing to a set that has a filter

a, c, e The nurse should administer packed RBCs through IV tubing that has a filter to prevent the administration of aggregates and possible contaminants.

A nurse is caring for a client who recently had chemotherapy and now has myelosuppression. Which of the following interventions should the nurse initiate? (SATA) (a) Prohibit visitors from bringing fresh flowers and plants into the client's room. (b) Encourage frequent visits from family and friends. (c) Ensure thorough cleaning of the client's room and bathroom daily. (d) Replace wound dressings every other day. (e) Use dedicated equipment such as stethoscopes.

a, c, e Fresh flowers and potted plants can introduce microorganisms into the client's immediate environment, and the client is at high risk for infection.

A nurse in an oncology clinic is assessing a client who has early stage Hodgkin's lymphoma. Which of the following findings should the nurse expect? (a) Bone and join pain (b) Enlarged lymph nodes (c) Intermittent hematuria (d) Productive cough

(b) Enlarged lymph nodes

A nurse is teaching a client who has chemotherapy-induced anemia and a prescription for epoetin alpha. The nurse should instruct the client to report which of the following findings as an adverse effect of epoetin alpha? (a) Hypertension (b) Leukocytosis (c) Bone pain (d) neutropenia

(a) Hypertension. The nurse should instruct the client to report hypertension, which is an adverse effect of epoetin alfa (growth factor that is used to stimulate production of red blood cells in the bone marrow). Other adverse effects can include headaches, seizures, heart failure, and thromboembolic events related to increased hemoglobin levels.

A nurse is reviewing a client's laboratory results and notes a WBC count of 3600/mm^3. The nurse should identify this result as which of the following conditions? (a) Leukoplakia (b) Leukemia (c) Leukocytosis (d) Leukopenia

(a) Leukopenia A normal WBC count is 4000-11000/mm^3.