Nokea
Which of the following newly admitted patients should the nurse assign as a roommate for a patient who has aplastic anemia?
- A. A patient with severe heart failure
- B. A patient who has viral pneumonia
- C. A patient who has right leg cellulitis
- D. A patient with multiple abdominal drains
Correct Answer: A
Rationale: Patients with aplastic anemia are at risk for infection because of the low white blood cell production associated with this type of anemia, so the nurse should avoid assigning a roommate with any possible infectious process.
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All of these patients call the outpatient clinic and ask to make an appointment as soon as possible. Which of the following patients should the nurse schedule to be seen first?
- A. 19-year-old with no previous health problems who has a nontender lump in the axilla
- B. 46-year-old with sickle cell anemia who says 'that my eyes always look sort of yellow'
- C. 21-year-old with hemophilia who wants to learn how to self-administer factor VII replacement
- D. 50-year-old with early-stage persistent lymphocytic leukemia who has complaints of persistent fatigue
Correct Answer: A
Rationale: The patient's age and presence of a nontender axillary lump suggest possible lymphoma, which needs rapid diagnosis and treatment. The other patients have questions about treatment or symptoms that are consistent with their diagnosis but do not need to be seen urgently.
The nurse is caring for a patient with anemia who is experiencing increased fatigue and occasional palpitations at rest. Which of the following laboratory findings should the nurse expect?
- A. Normal red blood cell (RBC) indices
- B. Hematocrit (Hct) of 38%
- C. Hemoglobin (Hb) of 86 g/L
- D. RBC count of 4.5 x 10^12/L
Correct Answer: C
Rationale: The patient's clinical manifestations indicate moderate anemia, which is consistent with an Hb of 60-100 g/L. The other values are all within the range of normal.
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 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 immune thrombocytopenic purpura (ITP) who has a prescription for a platelet transfusion. Which of the following patient information will cause the nurse to question the transfusion order?
- A. The platelet count is 52 x 10^9/L.
- B. Blood pressure is 94/56 mm Hg.
- C. Blood is oozing from the venipuncture site.
- D. Petechiae are present on the chest and arms.
Correct Answer: A
Rationale: Platelet transfusions are not usually indicated unless the patient is actively bleeding, so the nurse should clarify the order with the health care provider before giving the transfusion. The other data all indicate that bleeding caused by ITP is occurring and support the need for the platelet transfusion.