Nokea
The hemophilia clinic nurse receives a call from a patient with hemophilia to discuss all of these problems. Which of the following problems is most important to communicate to the health care provider?
- A. Joint swelling
- B. Painful hematuria
- C. Multiple bruises
- D. Dark tarry stools
Correct Answer: D
Rationale: Melena is a sign of gastrointestinal bleeding and requires collaborative actions such as checking hemoglobin and hematocrit and administration of coagulation factors. The other problems indicate a need for patient teaching about how to avoid injury, but are not indicators of possible serious blood loss.
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The nurse is teaching a patient with a new diagnosis of pernicious anemia about the disorder. Which of the following patient statements indicates that the teaching has been effective?
- A. I need to start eating more red meat or liver.
- B. I will stop having a glass of wine with dinner.
- C. I will need to take a proton pump inhibitor like omeprazole.
- D. I would rather use the nasal spray than have to get injections of vitamin B12.
Correct Answer: D
Rationale: Since pernicious anemia prevents the absorption of vitamin B12, this patient requires injections or intranasal administration of cobalamin. Alcohol use does not cause cobalamin deficiency. Proton pump inhibitors decrease the absorption of vitamin B12. Eating more foods rich in vitamin B12 is not helpful because the lack of intrinsic factor prevents absorption of the vitamin.
Which of the following nursing actions should the nurse include in the plan of care for a patient admitted with multiple myeloma?
- A. Monitor fluid intake and output.
- B. Administer calcium supplements.
- C. Assess lymph nodes for enlargement.
- D. Limit weight bearing and ambulation.
Correct Answer: A
Rationale: A high fluid intake and urine output helps prevent the complications of kidney stones caused by hypercalcemia and renal failure caused by deposition of Bence Jones protein in the renal tubules. Weight bearing and ambulation are encouraged to help bone retain calcium. Lymph nodes are not enlarged with multiple myeloma. Calcium supplements will further increase the patient's calcium level and are not used.
The nurse is caring for a patient who has been receiving a heparin infusion and warfarin for a deep vein thrombosis (DVT) with a diagnosis of heparin-induced thrombocytopenia (HIT). Which of the following actions should the nurse include in the plan of care?
- A. Use low-molecular-weight heparin (LMWH) only.
- B. Flush all intermittent IV lines using normal saline.
- C. Administer platelet transfusions.
- D. Teach the patient that heparin cannot be used in the future.
Correct Answer: D
Rationale: All heparin is discontinued when HIT is diagnosed. The patient should be instructed to never receive heparin or LMWH. Warfarin is usually not given until the platelet count has returned to 150 x 10^9/L. The platelet count does not drop low enough in HIT for a platelet transfusion, and platelet transfusions increase the risk for thrombosis.
The nurse is caring for a patient with acute myelogenous leukemia who is receiving outpatient chemotherapy and develops an absolute neutrophil count of 0.9 x 10^9/L. Which of the following actions by the nurse in the outpatient clinic is best?
- A. Discuss the need for hospital admission to treat the neutropenia.
- B. Plan to discontinue the chemotherapy until the neutropenia resolves.
- C. Teach the patient how to administer filgrastim injections at home.
- D. Obtain a high-efficiency particulate air (HEPA) filter for the patient for home use.
Correct Answer: C
Rationale: The patient may be taught to self-administer filgrastim injections. Although chemotherapy may be stopped with severe neutropenia (neutrophil count less than 0.5 x 10^9/L), administration of filgrastim usually allows the chemotherapy to continue. Patients with neutropenia are at higher risk for infection when exposed to other patients in the hospital. HEPA filters are expensive and are used in the hospital, where the number of pathogens is much higher than in the patient's home environment.
The nurse is caring for a patient with von Willebrand disease who is admitted to the hospital for minor knee surgery. Which of the following laboratory information should the nurse assess?
- A. Platelet count
- B. Bleeding time
- C. Thrombin time
- D. Prothrombin time
Correct Answer: B
Rationale: The bleeding time is affected by von Willebrand disease. Platelet count, prothrombin time, and thrombin time are normal in von Willebrand disease.