Nokea
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.
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Which of the following laboratory tests should the nurse use to determine whether the prescribed filgrastim is effective in the treatment of a patient who is receiving chemotherapy for acute lymphocytic leukemia?
- A. Platelet count
- B. Reticulocyte count
- C. Total lymphocyte count
- D. Absolute neutrophil count
Correct Answer: D
Rationale: Filgrastim increases the neutrophil count and function in neutropenic patients. Although total lymphocyte, platelet, and reticulocyte counts also are important to monitor in this patient, the absolute neutrophil count is used to evaluate the effects of filgrastim.
The nurse is caring for a patient with von Willebrand disease who is admitted to the hospital for minor knee surgery. Which of the following laboratory information should the nurse assess?
- A. Platelet count
- B. Bleeding time
- C. Thrombin time
- D. Prothrombin time
Correct Answer: B
Rationale: The bleeding time is affected by von Willebrand disease. Platelet count, prothrombin time, and thrombin time are normal in von Willebrand disease.
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 with myelodysplastic syndrome who has 20% blasts in marrow and the health care provider has prescribed high-intensity treatment. Which of the following treatments should the nurse prepare the patient to receive?
- A. Antibiotics
- B. Antifungals
- C. Chemotherapy
- D. A blood transfusion
Correct Answer: C
Rationale: Low-risk patients (<5% blasts in marrow) can often be treated with transfusions, antibiotics, antifungals, EPO, and hematopoietic growth factors. High-risk patients (<5% blasts in marrow) may be treated with single-agent chemotherapy (e.g., hydroxyurea) or intensive chemotherapy as in AML.
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.