final exam questions Flashcards Preview

med/surg > final exam questions > Flashcards

Flashcards in final exam questions Deck (39)
Loading flashcards...
1

The nurse is caring for a patient who is being discharged after an emergency splenectomy following an automobile accident. Which instructions should the nurse include in the discharge teaching

Watch for excess bruising.
Check for swollen lymph nodes.
Take iron supplements to prevent anemia.
Wash hands and avoid persons who are ill.

Wash hands and avoid persons who are ill.

Splenectomy increases the risk for infection, especially with gram-positive bacteria. The risks for lymphedema, bleeding, and anemia are not increased after a person has a splenectomy.

2

A nurse reviews the laboratory data for an older patient. The nurse would be most concerned about which finding

Hematocrit of 35%
Hemoglobin of 11.8 g/dL
Platelet count of 400,000/µL
White blood cell (WBC) count of 2800/µL

White blood cell (WBC) count of 2800/µL

Because the total WBC count is not usually affected by aging, the low WBC count in this patient would indicate that the patient’s immune function may be compromised and the underlying cause of the problem needs to be investigated. The platelet count is normal. The slight decrease in hemoglobin and hematocrit are not unusual for an older patient.

3

The nurse assesses a patient with pernicious anemia. Which assessment finding would the nurse expect

Yellow-tinged sclerae
Shiny, smooth tongue
Numbness of the extremities
Gum bleeding and tenderness

Numbness of the extremities

Extremity numbness is associated with cobalamin (vitamin B12) deficiency or pernicious anemia. Loss of the papillae of the tongue occurs with chronic iron deficiency. Yellow-tinged sclera is associated with hemolytic anemia and the resulting jaundice. Gum bleeding and tenderness occur with thrombocytopenia or neutropenia.

4

A patient’s complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding

“Have you had a recent weight loss”
“Do you have any history of lung disease”
“Have you noticed any dark or bloody stools”
“What is your dietary intake of meats and protein”

“Do you have any history of lung disease”


The hemoglobin and hematocrit results indicate polycythemia, which can be associated with chronic obstructive pulmonary disease (COPD). The other questions would be appropriate for patients who are anemic.

5

The nurse is reviewing laboratory results and notes an aPTT level of 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication

Aspirin
Heparin
Warfarin
Erythropoietin

Heparin


Activated partial thromboplastin time (aPTT) assesses intrinsic coagulation by measuring factors I, II, V, VIII, IX, X, XI, XII. aPTT is increased (prolonged) in heparin administration. aPTT is used to monitor whether heparin is at a therapeutic level (needs to be greater than the normal range of 25 to 35 sec). Prothrombin time (PT) and international normalized ratio (INR) are most commonly used to test for therapeutic levels of warfarin (Coumadin). Aspirin affects platelet function. Erythropoietin is used to stimulate red blood cell production.

6

When assessing a newly admitted patient, the nurse notes pallor of the skin and nail beds. The nurse should ensure that which laboratory test has been ordered

Platelet count
Neutrophil count
White blood cell count
Hemoglobin (Hgb) level

Hemoglobin (Hgb) level

Pallor of the skin or nail beds is indicative of anemia, which would be indicated by a low Hgb level. Platelet counts indicate a person's clotting ability. A neutrophil is a type of white blood cell that helps to fight infection.

7

A patient who had a total hip replacement had an intraoperative hemorrhage 14 hours ago. Which laboratory result would the nurse expect to find

Hematocrit of 46%
Hemoglobin of 13.8 g/dL
Elevated reticulocyte count
Decreased white blood cell (WBC) count

Elevated reticulocyte count

Hemorrhage causes the release of reticulocytes (immature red blood cells) from the bone marrow into circulation. The hematocrit and hemoglobin levels are normal. The WBC count is not affected by bleeding

8

The complete blood count (CBC) indicates that a patient is thrombocytopenic. Which action should the nurse include in the plan of care

Avoid intramuscular injections.
Encourage increased oral fluids.
Check temperature every 4 hours.
Increase intake of iron-rich foods.

Avoid intramuscular injections.

Thrombocytopenia is a decreased number of platelets, which places the patient at high risk for bleeding. Neutropenic patients are at high risk for infection and sepsis and should be monitored frequently for signs of infection. Encouraging fluid intake and iron-rich food intake is not indicated in a patient with thrombocytopenia.

9

The nurse reviews the complete blood count (CBC) and white blood cell (WBC) differential of a patient admitted with abdominal pain. Which information will be most important for the nurse to communicate to the health care provider

Monocytes 4%
Hemoglobin 13.6 g/dL
Platelet count 168,000/µL
White blood cells (WBCs) 15,500/µL

White blood cells (WBCs) 15,500/µL


The elevation in WBCs indicates that the patient has an inflammatory or infectious process ongoing, which may be the cause of the patient’s pain, and that further diagnostic testing is needed. The monocytes are at a normal level. The hemoglobin and platelet counts are normal.

10

A 62-year old man with chronic anemia is experiencing increased fatigue and occasional palpitations at rest. The nurse would expect the patient’s laboratory findings to include

a hematocrit (Hct) of 38%.
an RBC count of 4,500,000/L.
normal red blood cell (RBC) indices.
a hemoglobin (Hgb) of 8.6 g/dL (86 g/L).

a hemoglobin (Hgb) of 8.6 g/dL (86 g/L).

The patient’s clinical manifestations indicate moderate anemia, which is consistent with a Hgb of 6 to 10 g/dL. The other values are all within the range of normal.

11

Which menu choice indicates that the patient understands the nurse’s teaching about best dietary choices for iron-deficiency anemia

Omelet and whole wheat toast
Cantaloupe and cottage cheese
Strawberry and banana fruit plate
Cornmeal muffin and orange juice

Omelet and whole wheat toast

Eggs and whole grain breads are high in iron. The other choices are appropriate for other nutritional deficiencies but are not the best choice for a patient with iron-deficiency anemia.

12

A 52-year-old patient has a new diagnosis of pernicious anemia. The nurse determines that the patient understands the teaching about the disorder when the patient states, “I

need to start eating more red meat and liver.”

will stop having a glass of wine with dinner.”

could choose nasal spray rather than injections of vitamin B12.”

will need to take a proton pump inhibitor like omeprazole (Prilosec).”

could choose nasal spray rather than injections of vitamin B12.”


Because 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.

13


An appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia is to

provide a diet high in vitamin K.
alternate periods of rest and activity.
teach the patient how to avoid injury.
place the patient on protective isolation.

alternate periods of rest and activity.

Nursing care for patients with anemia should alternate periods of rest and activity to encourage activity without causing undue fatigue. There is no indication that the patient has a bleeding disorder, so a diet high in vitamin K or teaching about how to avoid injury is not needed. Protective isolation might be used for a patient with aplastic anemia, but it is not indicated for hemolytic anemia.

14

Which collaborative problem will the nurse include in a care plan for a patient admitted to the hospital with idiopathic aplastic anemia

Potential complication: seizures
Potential complication: infection
Potential complication: neurogenic shock
Potential complication: pulmonary edema

Potential complication: infection

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.

15

It is important for the nurse providing care for a patient with sickle cell crisis to


limit the patient’s intake of oral and IV fluids.

evaluate the effectiveness of opioid analgesics.

encourage the patient to ambulate as much as tolerated.

teach the patient about high-protein, high-calorie foods.

evaluate the effectiveness of opioid analgesics

Pain is the most common clinical manifestation of a crisis and usually requires large doses of continuous opioids for control. Fluid intake should be increased to reduce blood viscosity and improve perfusion. Rest is usually ordered to decrease metabolic requirements. Patients are instructed about the need for dietary folic acid, but high-protein, high-calorie diets are not emphasized..

16

Which statement by a patient indicates good understanding of the nurse’s teaching about prevention of sickle cell crisis

“Home oxygen therapy is frequently used to decrease sickling.”

“There are no effective medications that can help prevent sickling.”

“Routine continuous dosage narcotics are prescribed to prevent a crisis.”

“Risk for a crisis is decreased by having an annual influenza vaccination.”

“Risk for a crisis is decreased by having an annual influenza vaccination.”


Because 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 (Hydrea) is a medication used to decrease the number of sickle cell crises.

17

Which instruction will the nurse plan to include in discharge teaching for the patient admitted with a sickle cell crisis

Take a daily multivitamin with iron.
Limit fluids to 2 to 3 quarts per day.
Avoid exposure to crowds when possible.
Drink only two caffeinated beverages daily.

Avoid exposure to crowds when possible.

Exposure to crowds increases the patient’s risk for infection, the most common cause of sickle cell crisis. There is no restriction on caffeine use. Iron supplementation is generally not recommended. A high-fluid intake is recommended.

18

The nurse notes scleral jaundice in a patient being admitted with hemolytic anemia. The nurse will plan to check the laboratory results for the

Schilling test.
bilirubin level.
stool occult blood test.
gastric analysis testing.

bilirubin level.

Jaundice is caused by the elevation of bilirubin level associated with red blood cell (RBC) hemolysis. The other tests would not be helpful in monitoring or treating a hemolytic anemia.

19

Which intervention will be included in the nursing care plan for a patient with immune thrombocytopenic purpura (ITP)

Assign the patient to a private room.
Avoid intramuscular (IM) injections.
Use rinses rather than a soft toothbrush for oral care.
Restrict activity to passive and active range of motion.

Avoid intramuscular (IM) injections.

IM or subcutaneous injections should be avoided because of the risk for bleeding. A soft toothbrush can be used for oral care. There is no need to restrict activity or place the patient in a private room.

20

Which laboratory result will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)

Prothrombin time
Erythrocyte count
Fibrinogen degradation products
Activated partial thromboplastin time

Activated partial thromboplastin time

Platelet aggregation in HIT causes neutralization of heparin, so that the activated partial thromboplastin time will be shorter and more heparin will be needed to maintain therapeutic levels. The other data will not be affected by HIT.

21

Which action will the admitting nurse include in the care plan for a 30-year old woman who is neutropenic

Avoid any injections.
Check temperature every 4 hours.
Omit fruits or vegetables from the diet.
Place a “No Visitors” sign on the door.

Check temperature every 4 hours.

The earliest sign of infection in a neutropenic patient is an elevation in temperature. Although unpeeled fresh fruits and vegetables should be avoided, fruits and vegetables that are peeled or cooked are acceptable. Injections may be required for administration of medications such as filgrastim (Neupogen). The number of visitors may be limited and visitors with communicable diseases should be avoided, but a “no visitors” policy is not needed.

22

Which laboratory test will the nurse use to determine whether filgrastim (Neupogen) is effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy

Platelet count
Reticulocyte count
Total lymphocyte count
Absolute neutrophil count

Absolute neutrophil count

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.

23

A patient with a history of a transfusion-related acute lung injury (TRALI) is to receive a transfusion of packed red blood cells (PRBCs). Which action by the nurse will decrease the risk for TRALI for this patient

Infuse the PRBCs slowly over 4 hours.

Transfuse only leukocyte-reduced PRBCs.

Administer the scheduled diuretic before the transfusion.

Give the PRN dose of antihistamine before the transfusion.

Transfuse only leukocyte-reduced PRBCs.

TRALI is caused by a reaction between the donor and the patient leukocytes that causes pulmonary inflammation and capillary leaking. The other actions may help prevent respiratory problems caused by circulatory overload or by allergic reactions, but they will not prevent TRALI.

24

Which action will the nurse include in the plan of care for a 72-year-old woman admitted with multiple myeloma

Monitor fluid intake and output.
Administer calcium supplements.
Assess lymph nodes for enlargement.
Limit weight bearing and ambulation.

Monitor fluid intake and output.

A high fluid intake and urine output helps prevent the complications of kidney stones caused by hypercalcemia and renal failure caused by deposition of Bence-Jones protein in the renal tubules. Weight bearing and ambulation are encouraged to help bone retain calcium. Lymph nodes are not enlarged with multiple myeloma. Calcium supplements will further increase the patient’s calcium level and are not used.

25

An appropriate nursing intervention for a patient with non-Hodgkin’s lymphoma whose platelet count drops to 18,000/µL during chemotherapy is to

check all stools for occult blood.
encourage fluids to 3000 mL/day.
provide oral hygiene every 2 hours.
check the temperature every 4 hours.

check all stools for occult blood.

Because the patient is at risk for spontaneous bleeding, the nurse should check stools for occult blood. A low platelet count does not require an increased fluid intake. Oral hygiene is important, but it is not necessary to provide oral care every 2 hours. The low platelet count does not increase risk for infection, so frequent temperature monitoring is not indicated.

26

A 30-year-old man with acute myelogenous leukemia develops an absolute neutrophil count of 850/µL while receiving outpatient chemotherapy. Which action by the outpatient clinic nurse is most appropriate


Discuss the need for hospital admission to treat the neutropenia.

Teach the patient to administer filgrastim (Neupogen) injections.

Plan to discontinue the chemotherapy until the neutropenia resolves.

Order a high-efficiency particulate air (HEPA) filter for the patient’s home.

each the patient to administer filgrastim (Neupogen) injections.

The patient may be taught to self-administer filgrastim injections. Although chemotherapy may be stopped with severe neutropenia (neutrophil count less than 500/µL), administration of filgrastim usually allows the chemotherapy to continue. Patients with neutropenia are at higher risk for infection when exposed to other patients in the hospital. HEPA filters are expensive and are used in the hospital, where the number of pathogens is much higher than in the patient’s home environment.

27

Which information obtained by the nurse caring for a patient with thrombocytopenia should be immediately communicated to the health care provider

The platelet count is 52,000/µL.
The patient is difficult to arouse.
There are purpura on the oral mucosa.
There are large bruises on the patient’s back.

The patient is difficult to arouse.

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.

28

The nurse is planning to administer a transfusion of packed red blood cells (PRBCs) to a patient with blood loss from gastrointestinal hemorrhage. Which action can the nurse delegate to unlicensed assistive personnel (UAP)

Verify the patient identification (ID) according to hospital policy.

Obtain the temperature, blood pressure, and pulse before the transfusion.

Double-check the product numbers on the PRBCs with the patient ID band.

Monitor the patient for shortness of breath or chest pain during the transfusion.

Obtain the temperature, blood pressure, and pulse before the transfusion.

UAP education includes measurement of vital signs. UAP would report the vital signs to the registered nurse (RN). The other actions require more education and a larger scope of practice and should be done by licensed nursing staff members.

29

A postoperative patient receiving a transfusion of packed red blood cells develops chills, fever, headache, and anxiety 35 minutes after the transfusion is started. After stopping the transfusion, what action should the nurse take

Draw blood for a new crossmatch.
Send a urine specimen to the laboratory.
Administer PRN acetaminophen (Tylenol).
Give the PRN diphenhydramine (Benadryl).

Administer PRN acetaminophen (Tylenol).

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 (Benadryl) is used for allergic reactions. This type of reaction does not indicate incorrect crossmatching.

30

A patient in the emergency department complains of back pain and difficulty breathing 15 minutes after a transfusion of packed red blood cells is started. The nurse’s first action should be to

administer oxygen therapy at a high flow rate.
obtain a urine specimen to send to the laboratory.
notify the health care provider about the symptoms.
disconnect the transfusion and infuse normal saline.

disconnect the transfusion and infuse normal saline