Nokea
The nurse is assessing a new patient with complaints of overwhelming fatigue and a sore tongue that is visibly smooth and beefy red. This patient is demonstrating signs and symptoms associated with what form of what hematologic disorder?
- A. Sickle cell anemia
- B. Hemophilia
- C. Megaloblastic anemia
- D. Thrombocytopenia
Correct Answer: C
Rationale: A red, smooth, sore tongue is a symptom associated with megaloblastic anemia. Sickle cell disease, hemophilia, and thrombocytopenia do not have symptoms involving the tongue.
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A patient is admitted to the diagnosis of pernicious anemia. The nurse should prepare to administer which of the following medications?
- A. Folic acid
- B. Vitamin B12
- C. Lactulose
- D. Magnesium sulfate
Correct Answer: B
Rationale: Pernicious anemia is characterized by vitamin B12 deficiency. Magnesium sulfate, lactulose, and folic acid do not address the pathology of this type of anemia.
A woman who is in her third trimester of pregnancy has been experiencing an exacerbation of iron deficiency anemia in recent weeks. When providing the patient with nutritional guidelines and meal suggestions, what foods would be most likely to increase the woman's iron stores?
- A. Salmon accompanied by whole milk
- B. Mixed vegetables and brown rice
- C. Beef liver accompanied by orange juice
- D. Yogurt, almonds, and whole grain oats
Correct Answer: C
Rationale: Food sources high in iron include organ meats, other meats, beans (e.g., black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron. All of the listed foods are nutritious, but liver and orange juice are most likely to be of benefit.
A patient is being treated on the medical unit for a sickle cell crisis. The nurse's most recent assessment reveals an oral temperature of 100.5°F and a new onset of fine crackles on lung auscultation. What is the nurse's most appropriate action?
- A. Apply supplementary oxygen by nasal cannula.
- B. Administer bronchodilators by nebulizer.
- C. Liaise with the respiratory therapist and consider high-flow oxygen.
- D. Inform the primary care provider that the patient may have an infection.
Correct Answer: D
Rationale: Patients with sickle cell disease are highly susceptible to infection; thus any early signs of infection should be reported promptly. There is no evidence of respiratory distress, so oxygen therapy and bronchodilators are not indicated.
A patient, 25 years of age, comes to the emergency department complaining of excessive bleeding from a cut sustained when cleaning a knife. Blood work shows a prolonged PT but a vitamin K deficiency is ruled out. When assessing the patient, areas of ecchymosis are noted on other areas of the body. Which of the following is the most plausible cause of the patients signs and symptoms?
- A. Lymphoma
- B. Leukemia
- C. Hemophilia
- D. Hepatic dysfunction
Correct Answer: D
Rationale: Prolongation of the PT, unless it is caused by vitamin K deficiency, may indicate severe hepatic dysfunction. The majority of hemophiliacs are diagnosed as children. The scenario does not describe signs or symptoms of lymphoma or leukemia.
A patient with a pulmonary embolism is being treated with a heparin infusion. What diagnostic finding suggests to the nurse that treatment is effective?
- A. The patient's PT is within reference ranges.
- B. Arterial blood sampling tests positive for the presence of factor XIII.
- C. The patient's platelet level is below 100,000/mm3.
- D. The patient's activated partial thromboplastin time (aPTT) is 1.5 to 2.5 times the control value.
Correct Answer: D
Rationale: The therapeutic effect of heparin is monitored by serial measurements of the aPTT; the dose is adjusted to maintain the range at 1.5 to 2.5 times the laboratory control. Heparin dosing is not determined on the basis of platelet levels, the presence or absence of clotting factors, or PT levels.