Nokea
A client with pernicious anemia asks why she must take vitamin B12 injections for the rest of her life. Which is the nurse's best response?
- A. The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient acid.'
- B. The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor.'
- C. The reason for your vitamin deficiency is an excessive excretion of the vitamin because of kidney dysfunction.'
- D. The reason for your vitamin deficiency is an increased requirement for the vitamin because of rapid red blood cell production.'
Correct Answer: B
Rationale: Pernicious anemia results from a lack of intrinsic factor, a gastric protein necessary for vitamin B12 absorption. This necessitates lifelong B12 injections, as oral supplements are ineffective. The other responses are incorrect, as stomach acid, kidney dysfunction, or increased B12 demand are not the primary causes.
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The nurse is administering a medication to a client with myeloid leukemia and does not know the use, dose, or side effects. To obtain the most up-to-date information about this drug, the nurse should:
- A. Check the Physician's Drug Reference (PDR) at the nurses' station.
- B. Obtain a pharmacology textbook from the hospital library.
- C. Consult the drug guide provided by the hospital on the nurses' PDA.
- D. Review information at the drug manufacturer's website.
Correct Answer: C
Rationale: The hospital's drug guide on the nurse's PDA provides the most up-to-date and accessible information on medication use, dose, and side effects, tailored to hospital protocols. PDR and textbooks may be outdated, and manufacturer websites are less reliable for clinical use.
When receiving a client from the postanesthesia care unit after a splenectomy, which should the nurse assess after obtaining vital signs?
- A. Nasogastric drainage.
- B. Urinary catheter.
- C. Dressing.
- D. Need for pain medication.
Correct Answer: C
Rationale: After a splenectomy, the nurse should assess the dressing for signs of bleeding, as the spleen is highly vascular, and postoperative hemorrhage is a risk. Nasogastric drainage, urinary output, and pain are assessed later, but the dressing is the priority to detect complications.
The nurse is planning to give preoperative instructions to a client who will be undergoing rhinoplasty. Which of the following instructions should be included:
- A. After surgery, nasal packing will be in place for 7 to 10 days.
- B. Normal saline nose drops will need to be administered preoperatively.
- C. The results of the surgery will be immediately obvious postoperatively.
- D. Aspirin-containing medications should not be taken for 2 weeks before surgery.
Correct Answer: D
Rationale: Aspirin can increase bleeding risk, so it should be avoided for 2 weeks before surgery. Nasal packing is typically removed within 1–3 days. Saline drops are not routinely required preoperatively. Surgical results may take weeks to months to be fully apparent due to swelling.
Angiotensin-converting enzyme (ACE) inhibitors may be prescribed for the client with diabetes mellitus to reduce vascular changes and possibly prevent or delay development of:
- A. Chronic obstructive pulmonary disease.
- B. Pancreatic cancer.
- C. Renal failure.
- D. Cerebrovascular accident.
Correct Answer: C
Rationale: ACE inhibitors protect against renal failure in diabetes by reducing vascular damage and proteinuria.
A client with terminal cancer is transitioning to hospice care. The nurse should prioritize which of the following in the care plan?
- A. Aggressive pain management.
- B. Curative chemotherapy.
- C. Nutritional supplementation.
- D. Physical therapy.
Correct Answer: A
Rationale: Aggressive pain management is the priority in hospice care to ensure comfort and quality of life for a client with terminal cancer.