Prep U's
A patient will need a blood transfusion for the replacement of blood loss from the gastrointestinal tract. The patient states, "That stuff isn't safe!" What is the best response from the nurse?
"I understand your concern. The blood is carefully screened but is not completely risk free."
A nurse cares for a client with megaloblastic anemia who had a total gastrectomy three years ago. What statement will the nurse include in the client's teaching regarding the condition?
"The condition is likely caused by a vitamin B12 deficiency."
A patient is diagnosed with overactivity of the adrenal medulla. What epinephrine value does the nurse recognize is a positive diagnostic indicator for overactivity of the adrenal medulla?
450 pg/mL
The nurse is aware that the best time of day for the total large corticosteroid dose is between:
7:00 AM and 8:00 AM
A female client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that the client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia?
A
A client with Hodgkin disease had a bone marrow biopsy yesterday and reports aching at the biopsy site, rated a 5 (on a 1-10 scale). After assessing the biopsy site, which nursing intervention is most appropriate?
Administer acetaminophen 500 mg po, as ordered
A client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which gland?
Adrenal cortex
A nurse is assigned to care for a patient with ascites, secondary to cirrhosis. The nurse understands that the fluid accumulation in the peritoneal cavity results from a combination of factors including an alteration in oncotic pressure gradients and increased capillary permeability. Therefore, the nurse monitors the serum level of the plasma protein responsible for maintaining oncotic pressure, which is:
Albumin
The nurse is obtaining the health history of a client suspected of having a hematological condition. The nurse notes the client has a history of alcohol abuse. Which clinical presentation is related to alcohol consumption?
Anemia
Which type of leukocyte contains histamine and is an important part of hypersensitivity reactions?
Basophils
A patient has been diagnosed with Cushing's syndrome. The nurse would expect which of the following features to be present upon physical examination? Select all that apply.
Buffalo hump, Thin extremities, Moon face, Truncal obesity, Purple striae.
When high levels of plasma calcium occur, the nurse is aware that the following hormone will be secreted:
Calcitonin
A nurse is assigned to care for a patient with increased parathormone secretion. Which of the following serum levels should the nurse monitor for this patient?
Calcium
Surgical removal of the thyroid gland is the treatment of choice for thyroid cancer. During the immediate postoperative period, the nurse knows to evaluate serum levels of __________ to assess for a serious and primary postoperative complication of thyroidectomy.
Calcium
Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany?
Calcium gluconate
Trousseau's sign is elicited by which of the following?
Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff.
A client with a history of sickle cell anemia has developed iron overload from repeated blood transfusions. What treatment does the nurse anticipate will be prescribed?
Chelation therapy
Which diagnostic test is done to determine a suspected pituitary tumor?
Computed tomography
The nurse is instructing the client with polycythemia vera how to perform isometric exercises such as contracting and relaxing the quadriceps and gluteal muscle during periods of inactivity. What does the nurse understand is the rationale for this type of exercise?
Contraction of skeletal muscle compresses the walls of veins and increases the circulation of venous blood as it returns to the heart.
Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex?
Cushing syndrome
The actions of parathyroid hormone (PTH) are increased in the presence of which vitamin?
D
The nurse is reviewing the laboratory and diagnostic test findings of a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following would the nurse expect to find?
Decreased serum osmolarity
Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance?
Desmopressin (DDAVP)
A client receiving a unit of packed red blood cells (PRBCs) has been prescribed morphine 1 mg intravenously now for pain. What is the best method for the nurse to administer the morphine?
Disconnect the blood tubing, flush with normal saline, and administer morphine.
A client receiving a blood transfusion reports shortness of breath, appears anxious, and has a pulse of 125 beats/minute. What is the best action for the nurse to take after stopping the transfusion and awaiting further instruction from the health care provider?
Ensure there is an oxygen delivery device at the bedside.
A client with severe anemia is admitted to the hospital. Because of religious beliefs, the client is refusing blood transfusions. The nurse anticipates pharmacologic therapy with which drug to stimulate the production of red blood cells?
Epoetin alfa
A client with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this client?
Erythropoietin
Which is a clinical manifestation of diabetes insipidus?
Excessive thirst
A client is being seen in the clinic to receive the results of the lab work to determine thyroid levels. The nurse observes the client's eyes appear to be bulging, and there is swelling around the eyes. What does the nurse know that the correct documentation of this finding is?
Exophthalmos
A client wants to donate blood before his or her abdominal surgery next week. What should be the nurse's first action?
Explain the time frame needed for autologous donation.
Which outcome indicates that treatment of a client with diabetes insipidus has been effective?
Fluid intake is less than 2,500 ml/day.
The nurse is caring for a client with diabetes who developed hypoglycemia. What can the nurse administer to the client to raise the blood sugar level?
Glucagon
A woman with a progressively enlarging neck comes into the clinic. She mentions that she has been in a foreign country for the previous 3 months and that she didn't eat much while she was there because she didn't like the food. She also mentions that she becomes dizzy when lifting her arms to do normal household chores or when dressing. What endocrine condition should the nurse expect the health care provider to diagnose?
Goiter
A nurse is caring for a patient who has had a bone marrow aspiration with biopsy. What complication should the nurse be aware of and monitor the patient for?
Hemorrhage
The nurse is aware that the clinical symptoms of a patient with hypoparathyroidism are the result of the initial physiologic response of:
Hypocalcemia.
Which nursing diagnosis takes highest priority for a client with hyperthyroidism?
Imbalanced nutrition: Less than body requirements related to thyroid hormone excess
A nurse is preparing to palpate the thyroid gland. Where would the nurse expect to find this gland?
In the lower neck, anterior to the trachea
The nurse knows to assess a patient with hyperthyroidism for the primary indicator of:
Intolerance to heat
A nurse cares for a client with myelodysplastic syndrome who requires frequent PRBC transfusions. What blood component does the nurse recognize as being most harmful if accumulated in the tissues due to chronic blood transfusions?
Iron
The client's CBC with differential reveals small-shaped hemoglobin molecules. The nurse expects to administer which medication to this client?
Iron
A patient who has long-term packed RBC (PRBC) transfusions has developed symptoms of iron toxicity that affect liver function. What immediate treatment should the nurse anticipate preparing the patient for that can help prevent organ damage?
Iron chelation therapy
A client reports feeling faint after donating blood. What is the nurse's best action?
Keep client in recumbent position to rest.
The nurse is preparing a patient for a bone marrow aspiration and biopsy from the site of the posterior superior iliac crest. What position will the nurse place the patient in?
Lateral position with one leg flexed
A nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy?
Levothyroxine (Synthroid)
Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following?
Liver
Which term refers to a form of white blood cell involved in immune response?
Lymphocyte
A client is suspected to have a pituitary tumor due to signs of diabetes insipidus. What initial test does the nurse help to prepare the client for?
Magnetic resonance imaging (MRI)
Which intervention is the most critical for a client with myxedema coma?
Maintaining a patent airway
A client is receiving long-term treatment with high-dose corticosteroids. Which of the following would the nurse expect the client to exhibit?
Moon face
Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets?
Myeloid stem cell
A client receiving thyroid replacement therapy develops influenza and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing which life-threatening complication?
Myxedema coma
The body responds to infection by increasing the production of white blood cells (WBCs). The nurse should evaluate the differential count for what type of WBCs, which are the first WBCs to respond to an inflammatory event?
Neutrophils
Which assessment would a nurse perform on a client with Cushing's syndrome who is at high risk of developing a peptic ulcer?
Observe stool color.
Which of the following assessments should the nurse perform to determine the development of peptic ulcers when caring for a patient with Cushing's syndrome?
Observe the color of stool.
Which glands regulate calcium and phosphorous metabolism?
Parathyroid
Which is a symptom of severe thrombocytopenia?
Petechiae
Which statement best describes the function of fibrinogen?
Plays a key role in forming blood clots
The nurse is completing a physical assessment on a client's lymphatic system. The nurse should palpate for enlarged nodes in which areas? Select all that apply.
Popliteal ,Inguinal, Submental, Neck
While assessing a client with hypoparathyroidism, the nurse taps the client's facial nerve and observes twitching of the mouth and tightening of the jaw. The nurse would document this finding as which of the following?
Positive Chvostek's sign
A client with acromegaly is admitted to the hospital with complaints of partial blindness that began suddenly. What does the nurse suspect is occurring with this client?
Pressure on the optic nerve
A nurse is assisting a client into position prior to bone marrow aspiration. Which position will the nurse place the client prior to the procedure?
Prone
The nurse is reviewing the plan of care for a client with a disorder of the thyroid gland. Which diagnostic test would the nurse expect the physician to order to evaluate thyroid hormones?
Radioimmunoassay
The nurse is working at a blood donation clinic. What teaching should the nurse provide to the donor immediately after blood donation?
Remain for observation after eating and drinking.
A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?
Restricting fluids
A nurse cares for several mothers and babies in the postpartum unit. Which mother does the nurse recognize as being most at risk for a febrile nonhemolytic reaction?
Rh-negative mother; Rh-positive child
A nurse reviews a client's laboratory results and notes the client has a decreased lymphocyte count. What nursing diagnosis will the nurse use when planning the client's care?
Risk for infection
Patients with hyperthyroidism are characteristically:
Sensitive to heat
A client has a decreased level of thyroid hormone being excreted. What will the feedback loop do to maintain the level of thyroid hormone required to maintain homeostatic stability?
Stimulate more hormones using the negative feedback system
A nurse is transfusing whole blood to a client with impaired renal function. During the transfusion, the client tells the nurse, "I feel very short of breath all of a sudden." What is the nurse's primary action?
Stop the infusion.
Which type of lymphocyte is responsible for cellular immunity?
T lymphocyte
A nurse, caring for a client with human immunodeficiency virus (HIV), reviews the client's differential WBC count. What type of WBC will the nurse check the level of?
T lymphocytes
The health care provider believes that the client has a deficiency in the leukocyte responsible for cell-mediated immunity. What should the nurse check the WBC count for?
T lymphocytes
A nurse is caring for a female client with hypothyroidism. The client is extremely upset about her altered physical appearance. She doesn't want to take her medication because she doesn't believe it's doing any good. What should the nurse do?
Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency.
A 18-year-old client presents to the emergency department with a severe open fracture of the lower extremity. The health care provider tells the client that the client will need a blood transfusion. The client refuses, despite the advise of the health care provider. What does the nurse understand is the legal implication of the scenario?
The client has a right to refuse the transfusion.
When teaching about the advantages of autologous blood transfusion to a client, the nurse should include which information?
The primary advantage is prevention of viral infections.It is safer for clients with a history of transfusion reactions.If not needed immediately, the blood can be frozen for future use.
Which group of clients should not receive potassium iodide?
Those who are allergic to seafood
Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse assesses the client (who now has nausea) and records a temperature of 105°F (40.5°C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?
Thyroid crisis
Which of the following hormones would the nurse identify as being secreted by the thyroid gland?
Thyroxine
A client is returned to his room after a subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside?
Tracheostomy set
While caring for a client, the nurse notes petechiae on the client's trunk and lower extremities. What precaution will the nurse take when caring for this client?
Use an electric razor when assisting client with shaving.
The client is to receive a unit of packed red blood cells. What is the nurse's first action?
Verify that the client has signed a written consent form.
The physician orders a transfusion with packed red blood cells (RBCs) for a client hospitalized with severe iron deficiency anemia. When blood is administered, what is the most important action the nurse can take to prevent a transfusion reaction?
Verify the client's identity according to hospital policy
Trousseau sign is elicited
by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff.
A client presents with a huge lower jaw, bulging forehead, large hands and feet, and frequent headaches. What could be causing this client's symptoms?
hyperpituitarism
For the first 72 hours after thyroidectomy surgery, a nurse should assess a client for Chvostek's sign and Trousseau's sign because they indicate:
hypocalcemia.
A client has been experiencing a decrease in serum calcium. After diagnostics, the physician believes the calcium level fluctuation is due to altered parathyroid function. What is the role of parathormone?
increase serum calcium level
A nurse is reviewing a client's morning laboratory results and notes a left shift in the band cells. Based on this result, the nurse can interpret that the client
may be developing an infection.
Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called
megaloblasts.
A young client has a significant height deficit and is to be evaluated for diagnostic purposes. What could be the cause of this client's disorder?
pituitary disorder
A client visits the physician's office complaining of agitation, restlessness, and weight loss. The physical examination reveals exophthalmos, a classic sign of Graves' disease. Based on history and physical findings, the nurse suspects hyperthyroidism. Exophthalmos is characterized by:
protruding eyes and a fixed stare.
A nurse should expect a client with hypothyroidism to report:
puffiness of the face and hands.
A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering:
vasopressin.
