Prof. Exam in Medicine Part II

EXAM 2 1. The nurse is completing discharge teaching for the client diagnosed with a sickle cell crisis. The nurse recommends the client getting the flu and pneumonia vaccines. The client asks, "Why should I take those shots? I hate shots." Which statement by the nurse is the best response? ● You are susceptible to infections. These shots may help prevent crisis 2. The nurse is reviewing laboratory studies results for a client with suspected irondeficiency anemia. Which result indicates iron-deficiency anemia? ● Low ferritin 3. The nurse and an unlicensed assistive personnel (UAP) are caring for clients on an oncology floor. Which nursing task would be delegated to the UAP? ● Assist a client who received 10 units of platelets in brushing the teeth. 4. The nurse is assessing a 35-year-old Hispanic female client diagnosed with acute myeloid leukemia. Which assessment data support this diagnosis? ● Fever and infections 5. The nurse is caring for clients on an oncology unit. Which neutropenic precautions should be implemented? ● Limit fresh fruits and flowers 6. An 83 year-old elderly Indian male client is diagnosed with congestive heart failure and anemia. The physician ordered a transfusion of one (1) unit of packed red blood cells. The unit has 350 ml of red blood cells plus 50 ml of additive. At what rate should the nurse set the IV pump to infuse the unit of packed red blood cells ● 100 mL/hr 7. The nurse writes a diagnosis of altered tissue perfusion for a 40-year-old Hispanic female client diagnosed with anemia. Which interventions should be included in the plan of care? Select all that apply. ● Monitor the clients hemoglobin and hematocrit ● Move the client to a room near the nurses desk ● Assess the client for numbness and tingling ● Allow for a rest periods during the day for the client 8. The client diagnosed with sickle cell anemia comes to the emergency department complaining of joint pain throughout the body. The oral temperature is 102.4 F and the pulse oximeter reading is 91%. Which action should the emergency department nurse implement first? ● Administer oxygen via nasal cannula 9. The nurse is assessing a 35-year-old Hispanic female client diagnosed with acute The client’s CBC indicates an RBC 6 (*106)/mm3, Hgb14.2 g/dL, HCT 42% and platelets 69 (*103)/mm3. Which intervention should the nurse implement? Teach the client to use a soft-bristle toothbrush. 10. The nurse is reviewing laboratory results of a client diagnosed with aplastic anemia. Which of these results correlate with the diagnosis? Hypoplastic or aplastic marrow replaced with fat 11. The nurse is admitting a 45-year-old Hispanic male client with a diagnosis of rule-out anemia. The client has a history of gastric bypass surgery for morbid obesity six (6) years ago. Current assessment findings include height 5'4", weight 80 kg; P 120, R 29, and BP 100/60; pale mucous membranes and dyspnea on exertion. Which type of anemia would the nurse suspect the client has developed? ● Vitamin B-12 deficiency 12. Fifteen minutes after the nurse has initiated a transfusion of packed red blood cells, the client becomes restless and complains of itching on the trunk and arms. Which intervention should the nurse implement first? ● Stop the infusion at the hub 13. The client's laboratory values are RBCs 5.5 (×106)/mm3, WBCs 8.9 (*103)/mm3, and platelets 189 (×103)/mm3. Which intervention should the nurse implement? ● Continue to monitor the client 14. The physician orders two (2) units of packed red blood cells to be administered over eight (8) hours for a client diagnosed with heart failure. Which intervention(s) should the nurse implement? ● Retrieve the blood from the laboratory and Infuse each unit for four (4) hours. 15. Which is a potential complication that occurs specifically to a 20-year-old African American male client diagnosed with sickle cell anemia during a sickle cell crisis? ● Priapism 16. Which statement is the scientific rationale for infusing a unit of blood within four (4) hours? ● The blood has the potential for bacterial growth if allowed to infuse longer. 17. The charge nurse is making assignments on a medical floor. Which client should be assigned to the most experienced nurse? ● The client diagnosed with aplastic anemia who has developed pancytopenia. 18. During an acute sickle cell crisis, clients diagnosed with sickle cell anemia can experience acute chest syndrome, pulmonary hypertension, avascular necrosis, stroke, and reproductive problems. ● maintain iv fluids and administer pain medication PRN ● Morphine is the drug of choice for a crisis. ● Do not give patients meperidine 19. A 30-year-old African American client with Acute Myeloid Leukemia completed induction therapy with high doses of Cytarabine (cytosar). After several weeks in the hospital, the client's absolute neutrophil count (ANC) and platelet counts have normalized and all infections have resolved with supportive therapies. What additional therapy can the nurse anticipate as the next step in the patient's treatment to eliminate any residual leukemia cells that are not clinically detectable to reduce the chance for recurrence? ● Consolidation therapy 20. The nurse is analyzing the laboratory results of a male client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the nurse note as a result of tumor lysis syndrome that occurred from the chemotherapy? ● Uric acid 21. The laboratory results for a male client diagnosed with leukemia include RBC count 2.1 x 106/mm3, WBC count 150 × 103/mm3, platelets 22 x103/mm3, K+ 3.8 mEq/L, and Na+ 139 mEq/L. Based on these results, which intervention should the nurse teach the client? ● Instruct the client to use an electric razor when shaving. 22. The client is admitted to the emergency department after a motor-vehicle accident. The nurse notes profuse bleeding from a right-sided abdominal injury. Which intervention should the nurse implement first? ● Initiate an IV with an 18-gauge needle and hang normal saline. 23. Laboratory tests are prescribed for the client who has a smooth and reddened tongue and ulcers at the corners of the mouth. Which result would the nurse find if the client has iron-deficiency anemia? ● Low hemoglobin and hematocrit 24. A 60-year-old African American female client is symptomatic with a Hgb of 7.4 g/dL but refuses blood and blood products transfusions for religious reasons. The nurse should prepare the client that the physician may prescribe which alternatives? ● Epoiten alpha ● Folic acid 25. A 28-year-old Caucasian female client diagnosed with leukemia is scheduled for bone marrow transplantation. Which interventions should be implemented to prepare the client for this procedure? Select all that apply. ● Administer high-dose chemotherapy. ● Have the family members HLA typed. ● Monitor the complete blood cell count daily. ● Provide central line care per protocol. 26. The client diagnosed with anemia is admitted to the emergency department with dyspnea, cool pale skin, and diaphoresis. Which assessment data warrant immediate intervention? ● The vital signs are T 98.6, P 116, R 28, BP 88/62. Client is in shock 27. The client is diagnosed with leukemia and has leukocytosis. Which laboratory value would the nurse expect to assess? ● An elevated WBC count 28. The nurse is instructing a client with iron-deficiency anemia regarding the administration of a liquid oral iron supplement. Which instruction would the nurse tell the client? ● Administer the iron through a straw 29. The client diagnosed with leukemia is being admitted for an induction course of chemotherapy. Which laboratory values indicate a diagnosis of leukemia? ● A left shift in the WBC count differential 30. During a routine annual physical examination, an 85-year-old caucasian male client is diagnosed with chronic lymphocytic leukemia (CLL) after routine laboratory tests revealed elevated lymphocyte count of >100,000/ mm3. Which is the scientific rationale for the random nature of discovering the illness? ● In early stages of CLL, the client may be asymptomatic. 31. The client who received 50 mL from a unit of whole blood has new onset low back pain. What should the nurse do first? ● Stop the infusion 32. The nurse is teaching the client who is a strict vegetarian how to decrease the risk of developing megaloblastic anemia. Which information should the nurse provide? ● Supplement the diet with vitamin B12 33. The nurse is caring for clients that are placed on neutropenic precautions on an oncology floor. Which interventions should the nurse implement? Select all that apply. ● Perform hand hygiene before touching any of the client’s belongings ● Stop visitors from entering the room if observed to be coughing ● Teach client to avoid eating unwashed and uncooked fruits and veggies ● Prevent anyone from bringing fresh flowers in the room 34. Match each item with the correct answer. 1. Four Types of Leukemia AML,CML,ALL,CLL 2. 3. 4. 5. 6. 7. 8. Acute Myeloid Leukemia Fever and infection Complications of Hematopoietic Stem Cell Transplantation Graft vs Host This syndrome causes increased uric acid levels Gout Elevated uric acid levels are treated with this drug. Allopurinol Iron overload is treated with this treatment Chelation therapy Absolute Neutrophil Count ANC- monitor neutrophil count The central nervous system of Acute Lymphocytic Anemia is treated with this drug because of its toxic effect to the lymph Dexamethasone 9. Chronic Lymphocytic Leukemia has the following clinical manifestations. Asymptomatic 10. Polycythemia Vera phlebotomy 35. A 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? ● Blood cultures 36. A 30-year-old Asian female client diagnosed with menorrhagia complains to the nurse of feeling lethargic and tired all the time. Which scientific rationale would explain why these symptoms occur? ● Menorrhagia has caused the client to have decreased levels of hemoglobin. 37. The client is hospitalized with a diagnosis of sickle cell crisis. Which findings should prompt the nurse to consider that the client is ready for discharge? Select all that apply. ● Leukocyte count is 7500/mm3 ● Describes the importance of keeping warm ● Pain controlled at 2 on a 0 to 10 scale on analgesics. ● Has not had chest pain or dyspnea for past 24 hours 38. The nurse assesses that the client with hemolytic anemia has weakness, fatigue, malaise, and skin and mucous membrane pallor. Which finding should the nurse also associate hemolytic anemia? ● Scleral jaundice 39. The client with COPD has developed polycythemia vera, and the nurse completes teaching on measures to prevent complications. During a home visit, the nurse evaluates that the client is correctly following the teaching when which actions are noted? Select all that apply. ● Tells the nurse about discontinuing iron supplements ● Presents a record that shows a daily fluid intake of 3000 mL ● Discusses yesterday’s phlebotomy treatment to remove blood ● Wears anti embolic stockings and sits in a recliner with legs uncrossed 40. The client is diagnosed with chronic myeloid leukemia and leukocytosis. Which signs/symptoms would the nurse expect to find when assessing this client? ● Dyspnea and slight confusion 41. The client diagnosed with end-stage renal disease (ESRD) has developed anemia. Which would the nurse anticipate the Health Care Provider (HCP) prescribing for this client? ● Erythropoietin 42. I truthfully utilized all the resources that were provided to me to prepare for this exam and to successfully care for the patients that were assigned to me in these 49 questions. Select All that Apply to YOU. You are guaranteed the 2 points no matter what the answers are. 43. The client is diagnosed with polycythemia vera. The nurse would prepare to perform which intervention? ● Perform a phlebotomy of 500 mL of blood. 44. The nurse is preparing to administer a transfusion of one (1) unit packed red blood cells (PRBCs) to a 38-year-old Hispanic female client with a hemoglobin of 6.7g/dl. Which interventions should the nurse implement? List in order of performance. ● Confirm transfusion has been prescribed ● Check pt’s blood has been typed and cross matched ● Verify the client signed a written consent. ● Educate and explain procedure to pt ● Take pt’s vital signs for baseline ● Assess the IV site for size and patency. ● Obtain the blood from the laboratory. ● Check the blood with another nurse at the bedside. ● Start the transfusion slowly. 45. The nurse is administering a granulocyte colony stimulating factor (filgrastim [Neupogen]) subcutaneously daily to a neutropenic patient. Which laboratory value should the nurse monitor to determine the medication's effectiveness? ● Absolute Neutrophil Count 46. A male client receiving a unit of PRBCs begins to experience chills and develops hives all over his body. Which action should be the nurse's first response? ● Stop the infusion and change the tubing at the hub 47. The nurse assesses a client with Acute Myeloid Leukemia. Which finding should be the nurse's priority for implementing interventions? ● Pain from mucositis and oral tissue injury 48. The nurse is providing teaching to a client prior to initiating one (1) unit of packed red blood cells. Which of these statements indicate the client needs further teaching? 49. The client diagnosed with acute myeloid leukemia receives a bone marrow transplant. Which medication to prevent graft-versus-host disease (GVHD) should the nurse plan to administer? ● Dexamethasone 50. A 25-year-old African American female client diagnosed with iron-deficiency anemia is prescribed ferrous gluconate orally. Which should the nurse teach the client? ● The stools may be very dark, and this can mask blood