Nokea
Which of the following would be the most appropriate snack for a client who has iron deficiency anemia?
- A. Half of a grapefruit
- B. A carrot raisin salad
- C. A cup of yogurt
- D. Apple slices and cheese
Correct Answer: B
Rationale: Carrot raisin salad contains raisins, which are a good source of iron, making it appropriate for iron deficiency anemia.
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The nurse and an unlicensed assistive personnel (UAP) are caring for clients on a medical unit. Which task should the nurse delegate to the UAP?
- A. Check on the bowel movements of a client diagnosed with melena.
- B. Take the vital signs of a client who received blood the day before.
- C. Evaluate the dietary intake of a client who has been noncompliant with eating.
- D. Shave the client diagnosed with severe hemolytic anemia.
Correct Answer: B
Rationale: Taking vital signs post-transfusion (B) is within UAP scope. Checking melena (A), evaluating diet (C), and shaving with anemia (D) require nursing judgment due to bleeding risks.
The client is diagnosed with chronic lymphocytic leukemia (CLL) after routine laboratory tests during a yearly physical. Which is the scientific rationale for the random nature of discovering the illness?
- A. CLL is not serious, and clients die from other causes first.
- B. There are no symptoms with this form of leukemia.
- C. This is a childhood illness and is self-limiting.
- D. In early stages of CLL, the client may be asymptomatic.
Correct Answer: D
Rationale: Early CLL is often asymptomatic (D), detected via routine labs. CLL is serious (A), has symptoms later (B), and is adult-onset (C), not self-limiting.
A young man who has infectious mononucleosis asks what the treatment is for his condition. What is the best response for the nurse to make?
- A. You will receive large doses of antibiotics for the next 10 days.'
- B. Rest and good nutrition are the best things you can do.'
- C. You will be given an antiviral agent that will help to control the symptoms.'
- D. You will probably be given steroid medications for several months.'
Correct Answer: B
Rationale: Rest and good nutrition support recovery from infectious mononucleosis, a viral illness with no specific antiviral or steroid treatment.
The nurse is caring for multiple 25-year-old female clients. The nurse should plan to consult the HCP about a referral for genetic counseling and family planning for which clients?
- A. Client diagnosed with thalassemia major
- B. Client diagnosed with sickle cell anemia
- C. Client diagnosed with hemophilia A
- D. Client diagnosed with autoimmune hemolytic anemia
- E. Client diagnosed with hemophilia B
Correct Answer: A, B, C, E
Rationale: Thalassemia is a hereditary disorder; the client could benefit from a referral for genetic counseling. B. Sickle cell anemia is a hereditary disorder; the client could benefit from a referral for genetic counseling. C. Hemophilia A is a hereditary disorder; the client could benefit from a referral for genetic counseling. D. Autoimmune hemolytic anemia is an acquired hemolytic anemia. E. Hemophilia B is a hereditary disorder; the client could benefit from a referral for genetic counseling.
The male client with sickle cell anemia comes to the emergency department with a temperature of 101.4°F and tells the nurse that he is having a sickle cell crisis. Which diagnostic test should the nurse anticipate the emergency department doctor ordering for the client?
- A. Spinal tap.
- B. Hemoglobin electrophoresis.
- C. Sickle-turbidity test (Sickledex).
- D. Blood cultures.
Correct Answer: D
Rationale: Fever (101.4°F) in SCA crisis suggests infection; blood cultures (D) identify the cause. Spinal tap (A) is for meningitis, electrophoresis (B) confirms SCA, and Sickledex (C) screens for sickle trait.