Nokea
A patient newly diagnosed with thrombocytopenia is admitted to the medical unit. After the admission assessment, the patient asks the nurse to explain the disease. What should the nurse explain to this patient?
- A. There could be an attack on the platelets by antibodies.
- B. There could be decreased production of platelets.
- C. There could be impaired communication between platelets.
- D. There could be an autoimmune process causing platelet malfunction.
Correct Answer: B
Rationale: Thrombocytopenia can result from a decreased platelet production, increased platelet destruction, or increased consumption of platelets. Impaired platelet communication, antibodies, and autoimmune processes are not typical pathologies.
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A nurse is a long-term care facility is admitting a new resident who has a bleeding disorder. When planning this resident's care, the nurse should include which of the following?
- A. Housing the resident in a private room
- B. Implementing a passive ROM program to compensate for activity limitation
- C. Implementing of a plan for fall prevention
- D. Providing the patient with a high-fiber diet
Correct Answer: C
Rationale: To prevent bleeding episodes, the nurse should ensure that an older adult with a bleeding disorder does not suffer a fall. Activity limitation is not necessarily required, however. A private room is not necessary and there is no reason to increase fiber intake.
A patient with Von Willebrand disease (vWD) has experienced recent changes in bowel function that suggest the need for a screening colonoscopy. What intervention should be performed in anticipation of this procedure?
- A. The patient should not undergo the normal bowel cleansing protocol prior to the procedure.
- B. The patient should receive a unit of fresh-frozen plasma 48 hours before the procedure.
- C. The patient should be admitted to the surgical unit on the day before the procedure.
- D. The patient should be given necessary clotting factors before the procedure.
Correct Answer: D
Rationale: A goal of treating vWD is to replace the deficient protein (e.g., vWF or factor VIII) prior to an invasive procedure to prevent subsequent bleeding. Bowel cleansing is not contraindicated and FFP does not reduce the patient's risk of bleeding. There may or may not be a need for preprocedure hospital admission.
A patient comes to the clinic complaining of fatigue and the health interview is suggestive of pica. Laboratory findings reveal a low serum iron level and a low ferritin level. With what would the nurse suspect that the patient will be diagnosed?
- A. Iron deficiency anemia
- B. Pernicious anemia
- C. Sickle cell anemia
- D. Hemolytic anemia
Correct Answer: A
Rationale: A low serum iron level, a low ferritin level, and symptoms of pica are associated with iron deficiency anemia. TIBC may also be elevated. None of the other anemias are associated with pica.
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 caring for a patient who has sickle cell anemia and the nurses assessment reveals the possibility of substance abuse. What is the nurses most appropriate action?
- A. Encourage the patient to rely on complementary and alternative therapies.
- B. Encourage the patient to seek care from a single provider for pain relief.
- C. Teach the patient to accept chronic pain as an inevitable aspect of the disease.
- D. Limit the reporting of emergency department visits to the primary health care provider.
Correct Answer: B
Rationale: The patient should be encouraged to use a single primary health care provider to address health care concerns. Emergency department visits should be reported to the primary health care provider to achieve optimal management of the disease. It would be inappropriate to teach the patient to simply accept his or her pain. Complementary therapies are usually insufficient to fully address pain in sickle cell disease.