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A client with sickle cell disease (SCD) takes hydroxyurea (Droxia). The client presents to the clinic reporting an increase in fatigue. What laboratory result should the nurse report immediately?
- A. Hematocrit: 25%
- B. Hemoglobin: 2.2 mg/dL
- C. Potassium: 3.2 mEq/L
- D. White blood cell count: 38,000/mm3
Correct Answer: D
Rationale: Although individuals with SCD often have elevated white blood cell counts, an extreme elevation like 38,000/mm3 could indicate leukemia, a serious complication of hydroxyurea, or a severe infection, both critical in SCD patients. Hematocrit and hemoglobin levels are typically low in SCD, and the potassium level, while slightly low, is less urgent.
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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 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.
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.
A client receiving a blood transfusion develops anxiety and low back pain. After stopping the transfusion, what action by the nurse is most important?
- A. Correctly identifying client using two identifiers
- B. Double-checking client and blood type information
- C. Placing the client on strict bedrest until the pain subsides
- D. Reviewing the client's medical record for known allergies
Correct Answer: B
Rationale: This client has a hemolytic transfusion reaction, most commonly caused by blood type or Rh incompatibility. The nurse should double-check all identifying information for both the client and blood type to confirm the error. Documentation occurs after the client is stable. Bedrest may not be needed, and allergies to medications or environmental items are not related.
The nurse assesses a client's oral cavity and makes the discovery shown in the photo below: What action by the nurse is most appropriate?
- A. Encourage the client to have genetic testing
- B. Instruct the client on high-fiber foods
- C. Place the client in neutropenic precautions
- D. Teach the client about cobalamin therapy
Correct Answer: D
Rationale: The condition shown is glossitis, characteristic of B12 deficiency anemia, treated with cobalamin (vitamin B12). Genetic testing, high-fiber foods, or neutropenic precautions are not relevant to this condition.