Nokea
A patient with a documented history of glucose-6-phosphate dehydrogenase deficiency has presented to the emergency department with signs and symptoms including pallor, jaundice, and malaise. Which of the nurse's assessment questions relates most directly to this patient's hematologic disorder?
- A. When did you last have a blood transfusion?
- B. What medications have taken recently?
- C. Have you been under significant stress lately?
- D. Have you suffered any recent injuries?
Correct Answer: B
Rationale: Exacerbations of glucose-6-phosphate dehydrogenase deficiency are nearly always precipitated by medications. Blood transfusions, stress, and injury are less common triggers.
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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 comes into the clinic complaining of fatigue. Blood work shows an increased bilirubin concentration and an increased reticulocyte count. What would the nurse suspect the patient has?
- A. A hypoproliferative anemia
- B. A leukemia
- C. Thrombocytopenia
- D. A hemolytic anemia
Correct Answer: D
Rationale: In hemolytic anemias, premature destruction of erythrocytes results in the liberation of hemoglobin from the erythrocytes into the plasma; the released hemoglobin is converted in large part to bilirubin, and therefore the bilirubin concentration rises. The increased erythrocyte destruction leads to tissue hypoxia, which in turn stimulates erythropoietin production. This increased production is reflected in an increased reticulocyte count as the bone marrow responds to the loss of erythrocytes. Hypoproliferative anemias, leukemia, and thrombocytopenia lack this pathology and presentation.
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 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.