Nokea
The client diagnosed with von Willebrand’s disease calls a clinic after experiencing hemarthrosis. The client states that factor concentrate is infusing. Which intervention should the nurse recommend now?
- A. “Take two 325-mg aspirin tablets every 4 hours for pain.”
- B. “Apply a cold pack to the area for 30 minutes every 1 to 2 hours.”
- C. “Come to the clinic; you need an infusion of fresh frozen plasma.”
- D. “If wearing a splint, remove it to avoid compartment syndrome.”
Correct Answer: B
Rationale: A. Aspirin (Ecotrin) and NSAIDs are contraindicated because they interfere with platelet aggregation. B. Hemarthrosis is bleeding into the joint. The pressure of the ice pack and cold will reduce the bleeding and swelling. The ice pack should be covered with a cloth. C. The client and family are usually taught how to administer factor concentrates at home at the first sign of bleeding. D. The splint should be left on initially to control bleeding. The client should be instructed on how to assess for adequate tissue perfusion.
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Which statement is the scientific rationale for infusing a unit of blood in less than four (4) hours?
- A. The blood will coagulate if left out of the refrigerator for greater than four (4) hours.
- B. The blood has the potential for bacterial growth if allowed to infuse longer.
- C. The blood components begin to break down after four (4) hours.
- D. The blood will not be affected; this is a laboratory procedure.
Correct Answer: B
Rationale: Blood must infuse within 4 hours (B) to minimize bacterial growth risk. Coagulation (A) is not primary, components (C) degrade minimally, and lab procedure (D) is incorrect.
Which medication is contraindicated for a client diagnosed with leukemia?
- A. Bactrim, a sulfa antibiotic.
- B. Morphine, a narcotic analgesic.
- C. Epogen, a biologic response modifier.
- D. Gleevec, a genetic blocking agent.
Correct Answer: C
Rationale: Epogen (C) stimulates RBC production, risky in leukemia due to blast proliferation. Bactrim (A) treats infections, morphine (B) manages pain, and Gleevec (D) targets CML.
The client with COPD has developed polycythemia vera, and the nurse completes teaching on measures to prevent complications. During a home visit, the nurse evaluates that the client is correctly following the teaching when which actions are noted?
- A. Tells the nurse about discontinuing iron supplements.
- B. States increasing alcohol intake to decrease blood viscosity.
- C. Presents a record that shows a daily fluid intake of 3000 mL.
- D. Discusses yesterday’s phlebotomy treatment to remove blood.
- E. Shows the nurse 3 menu plan for eating three large meals daily.
- F. Wears antiembolic stockings and sits in a recliner with legs uncrossed
Correct Answer: A, C, D, F
Rationale: Iron supplements, including those in multi-vitamins, should be avoided because the iron stimulates RBC production. B. Alcohol increases the risk of bleeding. C. Increasing fluid intake to 3000 mL daily will help decrease blood viscosity. D. Phlebotomy is performed on a routine or intermittent basis to diminish blood viscosity, deplete iron stores, and decrease the client’s ability to manufacture excess erythrocytes. E. Frequent, small meals are better tolerated, especially if the liver is involved. F. Elevating the legs, avoiding constriction or crossing the legs, and wearing antiembolic stockings help prevent DVT.
Which test is considered diagnostic for Hodgkin's lymphoma?
- A. A magnetic resonance image (MRI) of the chest.
- B. A computed tomography (CT) scan of the cervical area.
- C. An erythrocyte sedimentation rate (ESR).
- D. A biopsy of the cervical lymph nodes.
Correct Answer: D
Rationale: Lymph node biopsy (D) diagnoses Hodgkin’s via Reed-Sternberg cells. MRI/CT (A, B) stage disease, ESR (C) is nonspecific.
The client diagnosed with anemia has an Hb of 6.1 g/dL. Which complication should the nurse assess for?
- A. Decreased pulmonary functioning.
- B. Impaired muscle functioning.
- C. Congestive heart failure.
- D. Altered gastric secretions.
Correct Answer: C
Rationale: Severe anemia (Hb 6.1) reduces oxygen delivery, straining the heart and risking CHF (C). Pulmonary (A), muscle (B), and gastric (D) issues are less direct.