Nokea
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.
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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.
Which of the following assessment data obtained by the nurse when caring for a patient with thrombocytopenia should be immediately communicated to the health care provider?
- A. The platelet count is 52 x 10^9/L.
- B. The patient is difficult to arouse.
- C. There are large bruises on the back.
- D. There are purpura on the oral mucosa.
Correct Answer: B
Rationale: Difficulty in arousing the patient may indicate a cerebral hemorrhage, which is life-threatening and requires immediate action. The other information should be documented and reported, but would not be unusual in a patient with thrombocytopenia.
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.
The nurse is caring for a patient with polycythemia vera. Which of the following actions should the nurse implement during treatment?
- A. Place the patient on bed rest.
- B. Administer iron supplements.
- C. Avoid use of aspirin products.
- D. Monitor fluid intake and output.
Correct Answer: D
Rationale: Monitoring hydration status is essential in polycythemia vera to prevent thrombosis due to increased blood viscosity. Aspirin therapy is used to decrease risk for thrombosis. The patient should be encouraged to ambulate to prevent deep vein thrombosis (DVT). Iron is contraindicated in patients with polycythemia vera.
Which of the following nursing interventions should be included in the care plan for a patient with immune thrombocytopenic purpura (ITP)?
- A. Assign the patient to a private room.
- B. Avoid intramuscular (IM) injections.
- C. Use rinses rather than a toothbrush for oral care.
- D. Restrict activity to passive and active range of motion.
Correct Answer: B
Rationale: IM or subcutaneous injections should be avoided because of the risk for bleeding. A soft toothbrush can be used for oral care. There is no need to restrict activity or place the patient in a private room.