Nokea
Several patients call the outpatient clinic and ask to make an appointment as soon as possible. Which patient should the nurse schedule to be seen first?
- A. A 44-year-old with sickle cell anemia who reports his eyes always look somewhat yellow
- B. A 23-year-old with no previous health problems who has a nontender lump in the axilla
- C. A 50-year-old with early-stage chronic lymphocytic leukemia who reports chronic fatigue
- D. A 19-year-old with hemophilia who wants to learn to self-administer factor VII replacement
Correct Answer: B
Rationale: The patient's young age and the presence of a nontender lump in the axilla raise concerns for possible lymphoma, which requires prompt evaluation and treatment. This patient should be seen first to rule out any serious underlying condition. Choice A is less urgent as yellowish eyes in sickle cell anemia may be due to jaundice but not necessarily an acute issue. Choice C, a 50-year-old with chronic fatigue related to early-stage chronic lymphocytic leukemia, is a known condition that can be managed on a routine basis. Choice D, a 19-year-old with hemophilia wanting to self-administer factor VII replacement, is important but less urgent compared to the potential lymphoma presentation in choice B.
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The nurse is caring for a patient who is being discharged after an emergency splenectomy following a motor vehicle crash. Which instructions should the nurse include in the discharge teaching?
- A. Check frequently for swollen lymph nodes.
- B. Watch for excessive bleeding or bruising.
- C. Take iron supplements to prevent anemia.
- D. Wash hands regularly and avoid individuals who are ill.
Correct Answer: D
Rationale: The correct answer is D: 'Wash hands regularly and avoid individuals who are ill.' After a splenectomy, the patient is at an increased risk of infection, particularly from gram-positive bacteria. Proper hand hygiene and avoiding contact with sick individuals are crucial to prevent infections. Choices A, B, and C are incorrect because checking for swollen lymph nodes, watching for excessive bleeding or bruising, and taking iron supplements are not specifically related to the increased infection risk post-splenectomy.
A patient who has acute myelogenous leukemia develops an absolute neutrophil count of 850/µL while receiving outpatient chemotherapy. Which action by the outpatient clinic nurse is most appropriate?
- A. Discuss the need for hospital admission to treat the neutropenia
- B. Teach the patient to administer filgrastim (Neupogen) injections
- C. Plan to discontinue the chemotherapy until the neutropenia resolves
- D. Order a high-efficiency particulate air (HEPA) filter for the patient's home
Correct Answer: B
Rationale: The correct answer is B because filgrastim (Neupogen) is a medication used to stimulate the production of neutrophils. Teaching the patient to self-administer these injections can help increase the neutrophil count and reduce the risk of infection. Option A is incorrect as hospital admission may not be necessary if the patient can manage the condition at home. Option C is not ideal as discontinuing chemotherapy can impact the leukemia treatment. Option D is unrelated to managing neutropenia in this scenario.
A patient who is receiving methotrexate for severe rheumatoid arthritis develops a megaloblastic anemia. The nurse will anticipate teaching the patient about increasing oral intake of
- A. iron.
- B. folic acid.
- C. cobalamin (vitamin B12).
- D. ascorbic acid (vitamin C).
Correct Answer: C
Rationale: The correct answer is C: cobalamin (vitamin B12). Methotrexate can lead to a deficiency in cobalamin, resulting in megaloblastic anemia. Therefore, increasing the oral intake of cobalamin is essential to address this deficiency. Choice A, iron, is incorrect because megaloblastic anemia caused by methotrexate is not typically due to iron deficiency. Choice B, folic acid, is also incorrect as methotrexate does not directly cause folic acid deficiency. Choice D, ascorbic acid (vitamin C), is incorrect as it is not directly related to megaloblastic anemia caused by methotrexate; instead, cobalamin is the key vitamin that needs attention.
An appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia is to
- A. provide a diet high in vitamin K
- B. alternate periods of rest and activity
- C. teach the patient how to avoid injury
- D. place the patient on protective isolation
Correct Answer: B
Rationale: In severe hemolytic anemia, the priority nursing intervention is to alternate periods of rest and activity. This approach helps to balance activity levels to prevent excessive fatigue while promoting mobility and preventing complications such as muscle weakness or deconditioning. Providing a diet high in vitamin K (choice A) is not directly related to managing hemolytic anemia. Teaching the patient how to avoid injury (choice C) is important but may not be the immediate priority. Placing the patient on protective isolation (choice D) is not indicated for hemolytic anemia, as it is not a contagious condition.
The health care provider orders a liver and spleen scan for a patient who has been in a motor vehicle crash. Which action should the nurse take before this procedure?
- A. Check for any iodine allergy.
- B. Insert a large-bore IV catheter.
- C. Administer prescribed sedatives.
- D. Assist the patient to a flat position.
Correct Answer: D
Rationale: Before a liver and spleen scan, it is essential to assist the patient to a flat position. This position helps obtain clear images of the liver and spleen. Checking for iodine allergy (Choice A) is more relevant for procedures involving contrast dye, not a liver and spleen scan. Inserting a large-bore IV catheter (Choice B) may not be necessary for this specific procedure. Administering sedatives (Choice C) is not typically required for a liver and spleen scan, as the patient needs to remain still during the procedure.