Nokea
The nurse caring for an older adult with a diagnosis of leukemia would encourage the client to use an electric razor. What is the rationale for this statement by the nurse?
- A. Trauma and microabrasions from a non-electric razor may contribute to anemia.
- B. Strong tissues and intact clotting mechanisms may prevent hemorrhage.
- C. The client is at risk for spontaneous and uncontrolled bleeding.
- D. The client is not at risk for infection from microorganisms.
Correct Answer: A
Rationale: In a client with leukemia who is at risk for hemorrhage, the nurse handles the client gently when assisting and encourages the client to use electric razors. Trauma and microabrasions from razors may contribute to anemia from bleeding. Fragile tissues and altered clotting mechanisms may result in hemorrhage even after minor trauma. Therefore, the nurse inspects the skin for signs of bruising and petechiae and reports melena, hematuria, or epistaxis (nosebleeds). The risks for spontaneous and uncontrolled bleeding or infection from microorganisms are not addressed by the use of electric razors.
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The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions?
- A. Do not take medication with orange juice because it will delay absorption of the iron.
- B. Iron may cause indigestion and should be taken with an antacid such as Mylanta.
- C. Dilute the liquid preparation with another liquid such as juice and drink with a straw.
- D. Discontinue the use of iron if your stool turns black.
Correct Answer: C
Rationale: Dilute liquid preparations of iron with another liquid such as juice and drink with a straw to avoid staining the teeth. Avoid taking iron simultaneously with an antacid, which interferes with iron absorption. Drink orange juice or take other forms of vitamin C with iron to promote its absorption. Expect iron to color stool dark green or black.
The nurse is instructing the client with sickle cell disease about the use of an inhaled vasodilator that may reduce sickling. What medication is the nurse instructing the client about?
- A. Nitszyst oxide
- B. Nitric oxide
- C. Betamethasone
- D. Terbutaline
Correct Answer: B
Rationale: Inhaled nitric oxide-not nitrous oxide (laughing gas), a vasodilating agent- is believed to reduce sickling by promoting the binding of oxygen to hemoglobin. It is being used in the form of handheld inhalers to abort or relieve pain experienced during sickle cell crises. Betamethasone is a corticosteroid, and terbutaline is not used as an inhaler.
A client with a diagnosis of pernicious anemia comes to the clinic complaining of numbness and tingling in his arms and legs. What do these symptoms indicate?
- A. Loss of vibratory and position senses
- B. Neurologic involvement
- C. Severity of the disease
- D. Insufficient intake of dietary nutrients
Correct Answer: B
Rationale: In clients with pernicious anemia, numbness and tingling in the arms and legs and ataxia are the most common signs of neurologic involvement. Some affected clients lose vibratory and position senses. Jaundice, irritability, confusion, and depression are present when the disease is severe. Insufficient intake of dietary nutrients is not indicated by these symptoms.
A client comes to the walk-in clinic complaining of weakness and fatigue. While assessing this client, the nurse finds evidence of petechiae and ecchymoses. The nurse notes that the spleen appears enlarged. What would the nurse suspect is wrong with this client?
- A. Aplastic anemia
- B. Pernicious anemia
- C. Iron-deficiency anemia
- D. Agranulocytosis
Correct Answer: A
Rationale: Clients with aplastic anemia experience all the typical characteristics of anemia (weakness and fatigue). In addition, they have frequent opportunistic infections plus coagulation abnormalities that are manifested by unusual bleeding, small skin hemorrhages called petechiae, and ecchymoses (bruises). The spleen becomes enlarged with an accumulation of the client's blood cells destroyed by lymphocytes that failed to recognize them as normal cells, or with an accumulation of dead transfused blood cells. The blood cell count shows insufficient numbers of blood cells. A bone marrow aspiration confirms that the production of stem cells is suppressed. This scenario does not describe a client with pernicious anemia, iron-deficiency anemia, or agranulocytosis.
The nurse is admitting a client with Cooley's anemia to the hospital with a hemoglobin of 6.2 g/dL and hematocrit of 26%. What does the nurse document about the client's skin?
- A. Bronzing of the skin
- B. Jaundice of the skin and mucous membranes
- C. Ruddy complexion
- D. Pale skin and mucous membranes
Correct Answer: A
Rationale: Clients with Cooley's anemia, a severe form of beta-thalassemia, exhibit symptoms of severe anemia and a bronzing of the skin caused by hemolysis of erythrocytes. The client is not jaundiced, ruddy, or pale with this disorder.