Nokea
The nurse has finished teaching a patient about taking oral ferrous sulphate. Which of the following patient statements indicates that additional instruction is needed?
- A. I will call the doctor if my stools start to turn black.
- B. I will take a stool softener if I feel constipated occasionally.
- C. I should take the iron with orange juice about an hour before eating.
- D. I should increase my fluid and fibre intake while I am taking the iron tablets.
Correct Answer: A
Rationale: It is normal for the stools to appear black when a patient is taking iron and the patient should not call the doctor about this. The other patient statements are correct.
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The nurse is caring for a patient with neutropenia who is started on a cephalosporin. Which of the following common adverse effects should the nurse observe for in the patient?
- A. Nephrotoxicity
- B. Rash
- C. Ototoxicity
- D. Fever
- E. Pruritus
Correct Answer: B,D,E
Rationale: Adverse effects common to cephalosporins include rashes, fever, and pruritus. Adverse effects common to aminoglycosides include nephrotoxicity and ototoxicity.
The nurse is caring for a patient with a sickle cell crisis. While caring for the patient during the crisis, which of the following actions is priority?
- A. Limit the patient's intake of oral and IV fluids.
- B. Evaluate the effectiveness of opioid analgesics.
- C. Encourage the patient to ambulate as much as tolerated.
- D. Teach the patient about high-protein, high-calorie foods.
Correct Answer: B
Rationale: Pain is the most common clinical manifestation of a crisis and usually requires large doses of continuous opioids for control. Fluid intake should be increased to reduce blood viscosity and improve perfusion. Rest is usually ordered to decrease metabolic requirements. Patients are instructed about the need for dietary folic acid, but high-protein, high-calorie diets are not emphasized.
Which of the following menu choices indicate that the patient understands the nurse's teaching about best dietary choices for iron-deficiency anemia?
- A. Omelet and whole wheat toast
- B. Cantaloupe and cottage cheese
- C. Strawberry and banana fruit plate
- D. Cornmeal muffin and orange juice
Correct Answer: A
Rationale: Eggs and whole grain breads are high in iron. The other choices are appropriate for other nutritional deficiencies, but are not the best choice for a patient with iron-deficiency anemia.
The nurse is caring for a patient with acute myelogenous leukemia (AML) who is considering the possibility of treatment with a hematopoietic stem cell transplant (HSCT). Which of the following actions is best for the nurse to implement to assist the patient with treatment decisions?
- A. Emphasize the positive outcomes of a bone marrow transplant.
- B. Discuss the need for adequate insurance to cover post-HSCT care.
- C. Ask the patient whether there are any questions or concerns about HSCT.
- D. Explain that a cure is not possible with any other treatment except HSCT.
Correct Answer: C
Rationale: Offering the patient an opportunity to ask questions or discuss concerns about HSCT will encourage the patient to voice concerns about this treatment and also will allow the nurse to assess whether the patient needs more information about the procedure. Treatment of AML using chemotherapy is another option for the patient. It is not appropriate for the nurse to ask the patient to consider insurance needs in making this decision.
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.