Nokea
The nurse is caring for a patient who is receiving methotrexate and develops a megaloblastic anemia. Which of the following nutrients should the nurse include in the teaching plan?
- A. Iron
- B. Folic acid
- C. Cobalamin (vitamin B12)
- D. Ascorbic acid (vitamin C)
Correct Answer: B
Rationale: Methotrexate use can lead to folic acid deficiency. Supplementation with oral folic acid supplements is the usual treatment. The other nutrients would not correct folic acid deficiency, although they would be used to treat other types of anemia.
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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.
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 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.
The nurse is caring for a patient with septicemia who develops prolonged bleeding from venipuncture sites and blood in the stools. Which of the following actions is most important for the nurse to take?
- A. Notify the patient's health care provider.
- B. Give the ordered dose of warfarin.
- C. Avoid unnecessary venipunctures.
- D. Give prescribed proton-pump inhibitors.
Correct Answer: A
Rationale: The patient's new onset of bleeding and diagnosis of sepsis suggest that disseminated intravascular coagulation (DIC) may have developed, which will require collaborative actions such as diagnostic testing, blood product administration, and heparin administration. The other actions also are appropriate, but the most important action should be to notify the physician so that DIC treatment can be initiated rapidly.
The nurse is caring for a patient who is hospitalized for treatment of severe hemolytic anemia. Which of the following actions should the nurse implement?
- A. Provide a diet high in vitamin K.
- B. Place the patient on protective isolation.
- C. Alternate periods of rest and activity.
- D. Teach the patient how to avoid injury.
Correct Answer: C
Rationale: Nursing care for patients with anemia should alternate periods of rest and activity to encourage activity without causing undue fatigue. There is no indication that the patient has a bleeding disorder, so a high vitamin K diet or teaching about how to avoid injury is not needed. Protective isolation might be used for a patient with aplastic anemia, but it is not indicated for hemolytic anemia.