Nokea
A Schilling test has been ordered for a client suspected of having pernicious anemia. What is the nurse's primary responsibility in relation to this test?
- A. Collect the blood samples
- B. Collect a 24-hour urine sample
- C. Assist the client to x-ray
- D. Administer an enema
Correct Answer: B
Rationale: The Schilling test involves administering radioactive vitamin B12 orally and collecting a 24-hour urine sample to assess absorption, indicating the nurse's primary responsibility.
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The nurse writes a nursing problem of 'altered nutrition' for a client diagnosed with leukemia who has received a treatment regimen of chemotherapy and radiation. Which nursing intervention should be implemented?
- A. Administer an antidiarrheal medication prior to meals.
- B. Monitor the client's serum albumin levels.
- C. Assess for signs and symptoms of infection.
- D. Provide skin care to irradiated areas.
Correct Answer: B
Rationale: Altered nutrition requires monitoring serum albumin (B) to assess protein status. Antidiarrheals (A) are symptom-specific, infection (C) is unrelated, and skin care (D) addresses radiation effects.
The client diagnosed with thalassemia, a hereditary anemia, is to receive a transfusion of packed RBCs. The crossmatch reveals the presence of antibodies that cannot be crossmatched. Which precaution should the nurse implement when initiating the transfusion?
- A. Start the transfusion at 10 to 15 mL/hr for 15 to 30 minutes.
- B. Re-crossmatch the blood until the antibodies are identified.
- C. Have the client sign a permit to receive uncrossmatched blood.
- D. Have the unlicensed assistive personnel stay with the client.
Correct Answer: A
Rationale: Uncrossmatched blood requires slow infusion (10–15 mL/hr) initially (A) to monitor reactions. Re-crossmatching (B) is impractical, consent (C) is for emergencies, and UAP (D) cannot monitor.
The nurse is preparing to administer epoetin alfa to the client who has chemotherapy-associated anemia. The nurse recognizes the need to consult with the HCP before administration when the client makes which statements?
- A. “I spend most of my days lying on the couch.”
- B. “I usually eat a lot of salads for my main meals.”
- C. “I seem to have an aversion to eating eggs right now.”
- D. “I developed a blood clot in my leg on my last admission.”
- E. “I hope this helps so I don’t have to have a blood transfusion.”
Correct Answer: A, D
Rationale: Erythropoiesis-stimulating agents, such as epoetin alfa (Epogen), can cause thromboembolic events. It would be concerning if the client had limited activity because this could further increase the client’s risk of a thromboembolic event. B. Dark green, leafy vegetables are high in iron and help with Hgb synthesis and therefore would be beneficial. C. Eggs are high in iron, but there are other food sources high in iron that the client can consume if an aversion exists. D. A history of a thromboembolic event and use of epoetin alfa increase the client’s risk for another thromboembolic event. E. The use of epoetin alfa is recommended as a treatment option for clients with chemotherapy-associated anemia and an Hgb concentration that is approaching, or has fallen below, 10 g/dL, to increase the Hgb level and decrease the need for a transfusion.
The client who has renal cancer that has metastasized rates pain at a 9 on a 0 to 10 pain scale. Which medication should the nurse plan to administer now and then schedule to be administered at the prescribed dosing interval?
- A. Meperidine
- B. Propoxyphene
- C. Pentazocine
- D. Oxycodone
Correct Answer: D
Rationale: A. Meperidine (Demerol) is not recommended because it causes CNS toxicity from metabolites. It should not be used for the treatment of chronic pain. B. Propoxyphene
When planning care for a client who is HIV positive, the nurse should do what?
- A. Teach persons coming in contact with the client to wear a gown and mask at all times
- B. Teach persons to wear gloves when handling any of the client's body fluids
- C. Restrict visitors to immediate family
- D. Encourage the client to stay away from other persons as much as possible
Correct Answer: B
Rationale: Wearing gloves when handling body fluids follows standard precautions to prevent HIV transmission. Gowns and masks are not always necessary, and restricting visitors or isolating the client is not required.