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A patient has been living with a diagnosis of anemia for several years and has been experiencing recent declines in hemoglobin levels despite ongoing treatment. Which of the following findings would indicate complications from anemia?
- A. Venous ulcers and visual disturbances
- B. Fever and signs of hyperkalemia
- C. Epistaxis and gastroesophageal reflux
- D. Ascites and peripheral edema
Correct Answer: D
Rationale: A significant complication of anemia is heart failure from chronic diminished blood volume and the heart's compensatory effort to increase cardiac output. Patients with anemia should be assessed for signs and symptoms of heart failure, including ascites and peripheral edema. None of the other listed signs and symptoms is characteristic of heart failure.
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A patient with a history of cirrhosis is admitted to the ICU with a diagnosis of bleeding esophageal varices; an attempt to stop the bleeding has been only partially successful. What would the critical care nurse expect the care team to order for this patient?
- A. Packed red blood cells (PRBCs)
- B. Vitamin K
- C. Oral anticoagulants
- D. Heparin infusion
Correct Answer: A
Rationale: Patients with liver dysfunction may have life-threatening hemorrhage from peptic ulcers or esophageal varices. In these cases, replacement with fresh frozen plasma, PRBCs, and platelets is usually required. Vitamin K may be ordered once the bleeding is stopped, but that is not what is needed to stop the bleeding of the varices. Anticoagulants would exacerbate the patient's bleeding.
A nurse is providing discharge education to a patient who has recently been diagnosed with a bleeding disorder. What topic should the nurse prioritize when teaching this patient?
- A. Avoiding buses, subways, and other crowded, public sites
- B. Avoiding activities that carry a risk for injury
- C. Keeping immunizations current
- D. Avoiding foods high in vitamin K
Correct Answer: B
Rationale: Patients with bleeding disorders need to understand the importance of avoiding activities that increase the risk of bleeding, such as contact sports. Immunizations involve injections and may be contraindicated for some patients. Patients with bleeding disorders do not need to normally avoid crowds. Foods high in vitamin K may be beneficial, not detrimental.
A patient is being treated for DIC and the nurse has prioritized the nursing diagnosis of Risk for Deficient Fluid Volume Related to Bleeding. How can the nurse best determine if goals of care relating to this diagnosis are being met?
- A. Assess for edema.
- B. Assess skin integrity frequently.
- C. Assess the patient's level of consciousness frequently.
- D. Closely monitor intake and output.
Correct Answer: D
Rationale: The patient with DIC is at a high risk of deficient fluid volume. The nurse can best gauge the effectiveness of care by closely monitoring the patient's intake and output. Each of the other assessments is a necessary element of care, but none addresses fluid balance as directly as close monitoring of intake and output.
A patient with poorly controlled diabetes has developed end-stage renal failure and consequent anemia. When reviewing this patient's treatment plan, the nurse should anticipate the use of what drug?
- A. Magnesium sulfate
- B. Epoetin alfa
- C. Low-molecular weight heparin
- D. Vitamin K
Correct Answer: B
Rationale: The availability of recombinant erythropoietin (epoetin alfa [Epogen, Procrit], darbepoetin alfa [Aranesp]) has dramatically altered the management of anemia in end-stage renal disease. Heparin, vitamin K, and magnesium are not indicated in the treatment of renal failure or the consequent anemia.
A young man with a diagnosis of hemophilia A has been brought to emergency department after suffering a workplace accident resulting in bleeding. Rapid assessment has revealed the source of the patient's bleeding and established that his vital signs are stable. What should be the nurse's next action?
- A. Position the patient in a prone position to minimize bleeding.
- B. Establish IV access for the administration of vitamin K.
- C. Prepare for the administration of factor VIII.
- D. Administer a normal saline bolus to increase circulatory volume.
Correct Answer: C
Rationale: Injuries in patients with hemophilia necessitate prompt administration of clotting factors. Vitamin K is not a treatment modality and a prone position will not be appropriate for all types and locations of wounds. A normal saline bolus is not indicated.