Nokea
The nurse is caring for four clients on the medical-surgical unit of the hospital. What client is mostly likely to be receiving treatment for sickle cell crisis?
- A. A 29-year-old Caucasian male
- B. A 19-year-old male of African descent
- C. A 24-year-old Native American/First Nations female
- D. A 36-year-old Eastern European female
Correct Answer: B
Rationale: Sickle cell disease is a common genetic disorder found primarily in clients of African descent but also in people from Mediterranean and Middle Eastern countries. It is unlikely that a Caucasian male, Native American/First Nations female, or eastern European female will be affected by this disease.
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A client is experiencing chronic hypovolemic anemia as evidenced by laboratory results. What symptoms does the nurse expect to find for this client when collecting objective data?
- A. Postural hypotension
- B. Urinary output of 10 mL/hr
- C. Altered consciousness
- D. Extreme pallor
Correct Answer: A
Rationale: Symptoms of chronic hypovolemic anemia include pallor, fatigue, chills, postural hypotension, and rapid heart rate and respiratory rates. The symptom of decreased urinary output, altered consciousness, and extreme pallor are all signs of acute hypovolemic anemia from severe blood loss. These signs indicate hypovolemic shock.
The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia?
- A. Erythrocytes that are microcytic and hypochromic
- B. Erythrocytes that are macrocytic and hyperchromic
- C. Clustering of platelets with sickled red blood cells
- D. An increased number of erythrocytes
Correct Answer: A
Rationale: A blood smear reveals erythrocytes that are microcytic (smaller than normal) and hypochromic (lighter in color than normal). It does not reveal macrocytic (larger than normal) or hyperchromic erythrocytes. Clustering of platelets with sickled red blood cells would indicate sickle cell anemia. An increase in the number of erythrocytes would indicate polycythemia vera.
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.
A client diagnosed with polycythemia vera has come into the clinic because they have developed a night-time cough, fatigue, and shortness of breath. From these clinical manifestations, what complication would the nurse suspect in this client?
- A. Stroke
- B. Tissue infarction
- C. Congestive heart failure
- D. Pulmonary embolus
Correct Answer: C
Rationale: The symptoms exhibited by this client are indicative of heart failure. Complications of polycythemia vera include hypertension, heart failure, stroke, tissue and organ infarction, and hemorrhage.
The nurse reinforces education for a client who is diagnosed with a coagulopathy. Which client statement indicates a correct understanding of the definition for this disorder?
- A. My diagnosis means that I am missing or lacking components needed to control bleeding.
- B. My diagnosis is a bleeding disorder caused by a deficiency of globulins in my blood.
- C. My diagnosis is a bleeding disorder that involves red blood cells.
- D. My diagnosis means that I am at risk for developing blood clots.
Correct Answer: A
Rationale: The term coagulopathy refers to conditions in which a component that is necessary to control bleeding is missing or inadequate. Two common examples are thrombocytopenia and hemophilia. Coagulopathies do not involve red blood cells, nor are they characterized by a deficiency of globulins in the plasma.