Nokea
The client is diagnosed with severe iron-deficiency anemia. Which statement is the scientific rationale regarding oral replacement therapy?
- A. Iron supplements are well tolerated without side effects.
- B. There is no benefit from oral preparations; the best route is IV.
- C. Oral iron preparations cause diarrhea if not taken with food.
- D. Very little of the iron supplement will be absorbed by the body.
Correct Answer: D
Rationale: Oral iron has low absorption (D), requiring high doses. Side effects (A) include GI upset, IV (B) is for severe cases, and diarrhea (C) is not primary (constipation is common).
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The client undergoing intensive chemotherapy for Hodgkin’s lymphoma (HL) is hospitalized with fever and depressed immune system functioning. The nurse is administering filgrastim subcutaneously daily. Which laboratory value should the nurse monitor to determine the medication’s effectiveness?
- A. Hemoglobin
- B. Platelet count
- C. Absolute neutrophil count (ANC)
- D. Reed-Sternberg cells
Correct Answer: C
Rationale: A. Epoetin alfa, not filgrastim, is used to treat anemia that is associated with cancer, and its effectiveness would be reflected in the Hgb values. B. Oprelvekin (Neumega), not filgrastim, enhances the synthesis of platelets. C. The nurse should monitor the ANC. Filgrastim (Neupogen) is usually discontinued when the client’s absolute neutrophil count (ANC) is above 1000 cells/mm3. Filgrastim, a granulocyte colony-stimulating factor (G-CSF) analog, is used to stimulate the proliferation and differentiation of granulocytes and treat neutropenia. D. Reed-Sternberg cells are found in lymph node biopsy cells and are indicative of Hodgkin’s lymphoma; they are not monitored to determine the effectiveness of filgrastim, which is used to treat neutropenia.
A college student who is diagnosed as having infectious mononucleosis asks how the disease is spread. The nurse's response is based on the knowledge that the usual mode of transmission is through:
- A. skin.
- B. genital contact.
- C. contaminated water.
- D. intimate oral contact.
Correct Answer: D
Rationale: Infectious mononucleosis, known as the 'kissing disease,' is spread through intimate oral contact, such as kissing or sharing utensils.
The client is admitted with a diagnosis of colon cancer. Which finding in the client’s admission information should prompt the nurse to consider that the cancer may be located in the client’s descending colon?
- A. Pain in the lower abdomen
- B. Change in bowel habits
- C. Bright red blood in the stool
- D. Nausea and vomiting
Correct Answer: C
Rationale: A. Pain may be a symptom of a tumor located on the left side of the colon, but it is not exclusive and could be a symptom of a tumor elsewhere in the colon. B. Change of bowel habits may be a symptom of a tumor located on the left side of the colon, but this is not exclusive and could be a symptom of a tumor elsewhere in the colon. C. Bright red blood in the stool is a sign or symptom of a colorectal tumor located in the descending colon. D. Nausea and vomiting are not symptoms specific to colon cancer.
Which laboratory result would the nurse expect in the client diagnosed with DIC?
- A. A decreased prothrombin time.
- B. A low fibrinogen level.
- C. An increased platelet count.
- D. An increased white blood cell count.
Correct Answer: B
Rationale: DIC consumes clotting factors, lowering fibrinogen (B). PT is prolonged (A), platelets decrease (C), and WBCs (D) are nonspecific.
The client diagnosed with iron-deficiency anemia is prescribed ferrous gluconate orally. Which should the nurse teach the client?
- A. Take Imodium, an antidiarrheal, over-the-counter (OTC) for diarrhea.
- B. Limit exercise for several weeks until a tolerance is achieved.
- C. The stools may be very dark, and this can mask blood.
- D. Eat only red meats and organ meats for protein.
Correct Answer: C
Rationale: Ferrous gluconate darkens stools (C), potentially masking GI bleeding. Imodium (A) is premature, exercise (B) is encouraged, and diet (D) should be varied, not meat-only.