Nokea
A client with chronic anemia has had many blood transfusions. What medications does the nurse anticipate teaching the client about adding to the regimen? (Select all that apply.)
- A. Azacitidine (Vidaza)
- B. Darbepoetin alfa (Aranesp)
- C. Decitabine (Dacogen)
- D. Epoetin alfa (Epogen)
- E. Methylprednisolone (Solu-Medrol)
Correct Answer: B,D
Rationale: Darbepoetin alfa and epoetin alfa are red blood cell colony-stimulating factors that help increase red blood cell production. Azacitidine and decitabine are used for myelodysplastic syndromes, and methylprednisolone is a steroid not used for anemia.
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A client has a sickle cell crisis with extreme lower extremity pain. What comfort measure does the nurse delegate to the client?
- A. Apply ice packs to the client's legs.
- B. Elevate the client's legs on pillows.
- C. Keep the lower extremities warm.
- D. Place elastic bandage wraps on the client's legs.
Correct Answer: C
Rationale: During a sickle cell crisis, the tissue distal to the occlusion has decreased blood flow and ischemia, leading to pain. Keeping the legs warm helps improve comfort due to decreased blood flow causing coolness. Elevation or elastic bandages may further reduce perfusion, and ice packs are not indicated.
A client has been admitted after sustaining a humerus fracture that occurred when picking up the family cat. What test result would the nurse correlate to this condition?
- A. Bence-Jones protein in urine
- B. Epstein-Barr virus positive
- C. Hemoglobin: 18 mg/dL
- D. Red blood cell count 8.2/mm3
Correct Answer: A
Rationale: This client has possible multiple myeloma. A positive Bence-Jones protein finding would correlate with this condition. The Epstein-Barr virus is associated with infectious mononucleosis and some cancers, not directly with multiple myeloma. Hemoglobin of meaningful correlation. Similarly, a red blood cell count of 8.2/mm3 is high but requires further information for specific correlation.
A nurse is caring for four clients with leukemia. After hand-off report, which client should the nurse see first?
- A. Client who had two bloody diarrhea stools this morning
- B. Client who has been premedicated for nausea prior to chemotherapy
- C. Client with a respiratory rate change from 18 to 22 breaths/min
- D. Client with an unchanged lesion to the lower right lateral malleolus
Correct Answer: A
Rationale: The client with two bloody diarrhea stools may be hemorrhaging in the gastrointestinal tract, indicating a potentially life-threatening condition requiring immediate assessment. The client with a respiratory rate change may have an infection or worsening anemia and should be seen next. The other two clients are not as urgent.
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 thrombocytopenia. What client statement indicates the client understands self-management of this condition?
- A. I brush and use dental floss every day.
- B. I chew hard candy for my dry mouth.
- C. I usually put ice on bumps or bruises.
- D. Nonslip socks are best when I walk.
Correct Answer: C
Rationale: The client should be taught to apply ice to areas of minor trauma to reduce bleeding risk. Flossing is not recommended due to the risk of gum bleeding. Hard foods should be avoided to prevent injury, and while nonslip socks promote safety, they do not directly address thrombocytopenia management.