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A patient, 25 years of age, comes to the emergency department complaining of excessive bleeding from a cut sustained when cleaning a knife. Blood work shows a prolonged PT but a vitamin K deficiency is ruled out. When assessing the patient, areas of ecchymosis are noted on other areas of the body. Which of the following is the most plausible cause of the patients signs and symptoms?
- A. Lymphoma
- B. Leukemia
- C. Hemophilia
- D. Hepatic dysfunction
Correct Answer: D
Rationale: Prolongation of the PT, unless it is caused by vitamin K deficiency, may indicate severe hepatic dysfunction. The majority of hemophiliacs are diagnosed as children. The scenario does not describe signs or symptoms of lymphoma or leukemia.
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A night nurse is reviewing the next day's medication administration record (MAR) of a patient who has hemophilia. The nurse notes that the MAR specifies both oral and subcutaneous options for the administration of a PRN antiemetic. What is the nurse's best action?
- A. Ensure that the day nurse knows not to give the antiemetic.
- B. Contact the prescriber to have the subcutaneous option discontinued.
- C. Reassess the patient's need for antiemetics.
- D. Remove the subcutaneous route from the patient's MAR.
Correct Answer: B
Rationale: Injections must be avoided in patients with hemophilia. Consequently, the nurse should ensure that the prescriber makes the necessary change. The nurse cannot independently make a change to a patient's MAR in most cases. Facilitating the necessary change is preferable to deferring to the day nurse.
A woman who is in her third trimester of pregnancy has been experiencing an exacerbation of iron deficiency anemia in recent weeks. When providing the patient with nutritional guidelines and meal suggestions, what foods would be most likely to increase the woman's iron stores?
- A. Salmon accompanied by whole milk
- B. Mixed vegetables and brown rice
- C. Beef liver accompanied by orange juice
- D. Yogurt, almonds, and whole grain oats
Correct Answer: C
Rationale: Food sources high in iron include organ meats, other meats, beans (e.g., black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron. All of the listed foods are nutritious, but liver and orange juice are most likely to be of benefit.
A nurse is providing education to a patient with iron deficiency anemia who has been prescribed iron supplements. What should the nurse include in health education?
- A. Take the iron with dairy products to enhance absorption.
- B. Increase the intake of vitamin E to enhance absorption.
- C. Iron will cause the stools to darken in color.
- D. Limit foods high in fiber due to the risk for diarrhea.
Correct Answer: C
Rationale: The nurse will inform the patient that iron will cause the stools to become dark in color. Iron should be taken on an empty stomach, as its absorption is affected by food, especially dairy products. Patients should be instructed to increase their intake of vitamin C to enhance iron absorption. Foods high in fiber should be consumed to minimize problems with constipation, a common side effect associated with iron therapy.
The nurse on the pediatric unit is caring for a patient with a diagnosis of hemophilia. The patient is a childâ??a 10-year-old boy. The nurse knows that a priority nursing diagnosis for this patient would be what?
- A. Hypothermia
- B. Diarrhea
- C. Ineffective coping
- D. Imbalanced nutrition
Correct Answer: C
Rationale: Most patients with hemophilia are diagnosed as children. They often require assistance in coping with the condition because it is chronic, places restrictions on their lives, and is an inherited disorder that can be passed to be passed to future generations. Children with hemophilia are not at risk of hypothermia, diarrhea or imbalanced nutrition.
A group of nurses are learning about the high incidence of anemia prevalence of anemia among different populations. Which of the following patients would be the most likely to suffer from anemia a patient?
- A. A 50-year-old African American woman who is going through menopause
- B. An ?¾?????°?½?° ?? 80??80 elderly woman who has a diagnosis of heart failure
- C. A 48-year-old man who travels widely and has a high pressure job
- D. A 13-year-old girl who has just commenced menstruation
Correct Answer: B
Rationale: The incidence and prevalence of anemia are exceptionally high among older adults, and the risk of anemia is compounded by the presence of heart disease. None of the other listed individuals exhibits high-risk factors for anemia, though exceptionally heavy menstrual flow can result in anemia.