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A client hospitalized with sickle cell crisis frequently asks for opioid pain medications, often shortly after receiving a dose. The nurses on the unit believe the client is drug seeking. When the client requests pain medications, what action by the nurse is best?
- A. Give the client pain medication if it is time for another dose.
- B. Instruct the client not to request pain medication too early.
- C. Give the client a placebo instead of pain medication.
- D. Tell the client it is too early to have more pain medication.
Correct Answer: A
Rationale: Clients with sickle cell crisis often have severe pain that is managed with up to 48 hours of IV opioid analgesics. Even if the client is addicted and drug seeking, he or she is still in extreme pain. If the client can receive another dose of medication, the nurse should provide it. The other options are judgmental and do not address the client's pain. Giving placebos is unethical.
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A student studying leukemia learns the risk factors for developing this disorder. Which risk factors does this include? (Select all that apply.)
- A. Chemical exposure
- B. Genetically modified foods
- C. Ionizing radiation exposure
- D. Vaccinations
- E. Viral infections
Correct Answer: A,C,E
Rationale: Chemical exposure, ionizing radiation, and viral infections are known risk factors for leukemia. Genetically modified foods and vaccinations have not been established as risk factors.
The nurse is caring for a client with leukemia who has the priority problem of fatigue. What action by the client indicates this need has been met?
- A. Doing activities of daily living (ADLs) using rest periods
- B. Helping plan a daily activity schedule
- C. Requesting a sleeping pill at night
- D. Telling visitors to leave when fatigued
Correct Answer: A
Rationale: Fatigue is a common problem for clients with leukemia. This client is managing his or her own ADLs using rest periods, which indicates an understanding of fatigue and how to control it. Helping to plan an activity schedule is a lesser indicator. Requesting a sleeping pill does not control fatigue during the day. Asking visitors to leave when tired is another lesser indicator. Managing ADLs using rest periods demonstrates the most comprehensive management strategy.
A nurse is preparing to administer a blood transfusion to an older adult. Understanding age-related changes, what alterations to the usual protocol are necessary for the nurse to implement? (Select all that apply.)
- A. Monitor vital signs every 15 minutes
- B. Hold other IV fluids running
- C. Premedicate to prevent reactions
- D. Transfuse each unit over 8 hours
Correct Answer: A,B
Rationale: Older adults require frequent vital sign monitoring (every 15 minutes) due to subtle signs of transfusion reactions and holding other IV fluids to prevent fluid overload. Premedication and prolonged transfusion times are not standard alterations.
The nurse instructor is best?
- A. Because of immunosuppression, the donor cells take over.
- B. In like a transfusion reaction because no perfect matches exist.
- C. The client's cells are fighting donor cells for dominance.
- D. The donor's cells are actually attacking the client's cells.
Correct Answer: D
Rationale: Graft versus host disease is an autoimmune-type process in which the donor cells recognize the client's cells as foreign and begin attacking them. The other answers are not accurate.
A client has heparin-induced thrombocytopenia (HIT). The student nurse asks how this is treated. About what drugs does the nurse instructor teach? (Select all that apply.)
- A. Argatroban (Argatroban)
- B. Bivalirudin (Angiomax)
- C. Clopidogrel (Plavix)
- D. Lepirudin (Refludan)
- E. Methylprednisolone (Solu-Medrol)
Correct Answer: A,B,D
Rationale: Argatroban, bivalirudin, and lepirudin are direct thrombin inhibitors used to treat HIT. Clopidogrel is an antiplatelet agent, and methylprednisolone is a steroid, neither used for HIT.