Nokea
Which of the following statements by a patient with sickle cell anemia indicates good understanding of the nurse's teaching about prevention of sickle cell crisis?
- A. Home oxygen therapy is frequently used to decrease sickling.
- B. There are no effective medications that can help prevent sickling.
- C. Routine continuous dosage narcotics are prescribed to prevent a crisis.
- D. Risk for a crisis can be lowered by having an annual influenza vaccination.
Correct Answer: D
Rationale: Since infection is the most common cause of a sickle cell crisis, influenza, Haemophilus influenzae, pneumococcal pneumonia, and hepatitis immunizations should be administered. Although continuous dose opioids and oxygen may be administered during a crisis, patients do not receive these therapies to prevent crisis. Hydroxyurea is used for many patients to decrease the number of sickle cell crises.
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The nurse is caring for a patient receiving a transfusion of packed red blood cells who develops chills, fever, headache, and anxiety 30 minutes after the transfusion is started. After stopping the transfusion, which of the following actions is priority?
- A. Draw blood for a new crossmatch.
- B. Send a urine specimen to the laboratory.
- C. Give the PRN diphenhydramine.
- D. Administer the PRN acetaminophen.
Correct Answer: D
Rationale: The patient's clinical manifestations are consistent with a febrile, nonhemolytic transfusion reaction. The transfusion should be stopped and antipyretics administered for the fever as ordered. A urine specimen is needed if an acute hemolytic reaction is suspected. Diphenhydramine is used for allergic reactions. This type of reaction does not indicate incorrect crossmatching.
The nurse is admitting a patient with type A hemophilia who has severe pain and swelling in the right knee. Which of the following actions should the nurse implement initially?
- A. Immobilize the knee
- B. Apply heat to the joint
- C. Assist the patient with light weight bearing
- D. Perform passive range of motion to the knee
Correct Answer: A
Rationale: The initial action should be total rest of the knee to minimize bleeding. Ice packs are used to decrease bleeding. Range of motion (ROM) and weight-bearing exercise are contraindicated initially, but after the bleeding stops, ROM and physical therapy are started.
The nurse is caring for a patient with idiopathic aplastic anemia. Which of the following collaborative problems should the nurse include when developing the care plan?
- A. Potential complication: seizures
- B. Potential complication: infection
- C. Potential complication: neurogenic shock
- D. Potential complication: pulmonary edema
Correct Answer: B
Rationale: Because the patient with aplastic anemia has pancytopenia, the patient is at risk for infection and bleeding. There is no increased risk for seizures, neurogenic shock, or pulmonary edema.
A routine complete blood count indicates that a patient may have myelodysplastic syndrome. At this time, which of the following information should the nurse include in the teaching plan?
- A. Packed red blood cells (PRBCs) transfusion
- B. Bone marrow biopsy
- C. Filgrastim administration
- D. Erythropoietin administration
Correct Answer: B
Rationale: Bone marrow biopsy is needed to make the diagnosis and determine the specific type of myelodysplastic syndrome. The other treatments may be necessary if there is progression of the myelodysplastic syndrome, but the initial action for this asymptomatic patient will be a bone marrow biopsy.
The nurse is planning discharge teaching for a patient who was admitted with neutropenia. Which of the following instructions should the nurse include?
- A. Limit fluids to 2-3 litres a day.
- B. Include eggs and fish in the diet.
- C. Avoid exposure to crowds as much as possible.
- D. Drink only one or two caffeinated beverages daily.
Correct Answer: C
Rationale: Exposure to crowds increases the risk of infection in neutropenic patients. Limiting fluids or caffeinated beverages is not necessary, and eggs and fish are acceptable in the diet unless otherwise contraindicated.