NRSG 3420 Exam 1 Questions with CORRECT Answers
(Grade A+)
Question 1:
medical management of sickle cell anemia
Answer:
hematopoietic stem cell transplant (HSCT) - may cure SCD but is not readily available due to lack of
compatible donors or due to severe organ damage that may be already present in patient pharmacologic
therapy: - hydroxyurea (increases levels of fetal hemoglobin decreasing formation of sickled cells) -
folic acid supplements (maintain the amount needed for increased erythropoiesis to counteract the
effects of hemolysis) - infections are common and can lead to crisis: immunization - transfusion
therapy (caution with repeat blood transfusions - pt can develop antibodies to donor blood, hemolytic
transfusion reactions may mimic the s/sx of sickle cell crisis - supportive therapy (pain management,
aspirin, NSAIDS, PCA, hydration, oxygen therapy)
Question 2:
cancer & thrombocytopenia
Answer:
many chemotherapy agents cause some degree of myelosuppression (depression of bone marrow
function), resulting in: - leukopenia - neutropenia - anemia - thrombocytopenia - increased r/o infection
and bleeding is predictable: - pts usually reach point at which blood counts are lowest 7 to 14 days after
chemo - during 2 weeks, nurses anticipate associated toxicities, especially a fever associated with
neutrophil count less than 1500 cells/mm3 - frequent monitoring of CBC is essential - pts are educated
on strategies to protect against infection, injury, and blood loss - erythropoetin (EPO) stimulated RBC
production, decreasing the symptoms of treatment-induced chronic anemia and reducing the need for
blood transfusions - interleukin 11 (IL-11) (oprelvekin) stimulates the production of megakaryocytes
(precursors to platelets) and can be used to prevent and treat severe thrombocytopenia but has had
limited use because of toxicities
Question 3:
thrombocytopenia
Answer:
abnormally low platelet levels <20,000 - petechiae, gingival bleeding, excessive menstrual bleeding,
excessive bleeding after surgery/dental extractions <5,000 - fatal CNS, or GI hemorrhage
,Question 4:
management of thrombocytopenia
Answer:
treat underlying condition monitor for factors increasing risk of bleeding (elevated INR/PT/aPTT,
decreased fibrinogen, use of medications) assess for and instruct patient/family on s/sx of bleeding
(petechiae, bleeding, decrease HgB/HcT, frank or occult blood in body fluids, altered mental status,
tachycardia) minimize risk of bleeding: - use soft toothbrush, electric razor for shaving, keep lips
moisturized, maintain fluid intake of at least 3 L q24 hrs - avoid rectal temp, avoid IM injections (use
smallest needle possible) - apply direst pressure to venipuncture site for at least 5 min - avoid aspirin -
caution against forceful nose blowing
Question 5:
preventing hemorrhage post-op
Answer:
hemorrhage is an uncommon yet serious complication of surgery that can result in hypovolemic shock
and death. patient presents with hypotension; rapid, thready pulse; disorientation; restlessness, oliguria;
and cold, pale skin; concentrated urine; air hunger (looking to catch breath) assessment and
identification of at-risk individuals, monitoring
Question 6:
nursing management of transfusion reactions
Answer:
- stop the transfusion, maintain the IV line with NS through new IV tubing (given at slow rate) - assess
pt carefully; comparing the VS with baseline, respiratory status, changes in mental status, jugular vein
distention, back pain or urticaria - notify primary provider of assessment findings - notify blood bank
and send blood container/tubing to blood bank for repeat typing and culture hemolytic
transfusion/bacterial infection: - obtain appropriate blood specimens from pt - collect urine sample to
determine hemoglobin - document reaction
Question 7:
mild reaction to blood transfusion nursing managment
Answer:
urticaria, localized erythemia, facial flushing, dyspnea, wheezing, itching pause transfusion, keep vein
open, notify provider, monitor vital signs, administer antihistamine (or benadryl 30 mins before),
resume transfusion if symptoms abate with antihistamine
, Question 8:
severe reaction (anaphylaxis) to blood transfusion nursing management
Answer:
anxiety, hypotension, shock, wheezing, urticaria discontinue transfusion, keep vein open with just NS,
administer CPR, anticipate order for steroids, maintain BP, prevention using well washed RBCs where
plasma has been extracted
Question 9:
febrile reaction to blood transfusion nursing management
Answer:
discontinue transfusion, keep vein open with NS, notify provider, monitor VS, administer antipyretic
Question 10:
anticoagulation medications: patient education
Answer:
- take med as prescribed - do not stop taking unless directed - warfarin: take same time each day - carry
identification indicating anticoag. med is taken - keep all scheduled appts for blood tests - be aware of
med-med interactions (vitamins, cold medicines, antihistamines, antibiotics, aspirin, laxatives,
anti-inflamms) - avoid alcohol - avoid changes in eating habits (especially foods high in vit. K like
green leafy veggies - can reduce effectiveness) - contact provider before dental work/surgery - describe
potential side effects of coagulation such as bruising/bleeding (use electric shaver, soft toothbrush,
avoid contact sports/activities) stop taking warfarin if: - bleeding that does not stop - bruises enlarge -
reddish/brownish urine - red/black bowel movements
Question 11:
multiple myeloma: nursing interventions
Answer:
- pain (NSAIDS); monitor renal function; long-acting opioids - pt education to minimize r/o infection -
assess s/sx of hypercalcemia (polyuria, nausea, constipation, anorexia) - education pt on activity
restrictions (lift no more than 10 lb, proper body mechanics) - bisphosphonate therapy - oral hygiene
and good dental care - monitor renal function closely (maintain high urine output 3L/day) - maintain
mobility and hydration - education about appropriate infection prevention techniques; contact provider
immediately if fever or other signs of infection develop - receive immunizations (pneumococcal and
flu) - high risk of VTE (take low-dose aspirin & anticoag therapy) - assess for symptoms related to
peripheral neuropathy (education on symptoms to report)
(Grade A+)
Question 1:
medical management of sickle cell anemia
Answer:
hematopoietic stem cell transplant (HSCT) - may cure SCD but is not readily available due to lack of
compatible donors or due to severe organ damage that may be already present in patient pharmacologic
therapy: - hydroxyurea (increases levels of fetal hemoglobin decreasing formation of sickled cells) -
folic acid supplements (maintain the amount needed for increased erythropoiesis to counteract the
effects of hemolysis) - infections are common and can lead to crisis: immunization - transfusion
therapy (caution with repeat blood transfusions - pt can develop antibodies to donor blood, hemolytic
transfusion reactions may mimic the s/sx of sickle cell crisis - supportive therapy (pain management,
aspirin, NSAIDS, PCA, hydration, oxygen therapy)
Question 2:
cancer & thrombocytopenia
Answer:
many chemotherapy agents cause some degree of myelosuppression (depression of bone marrow
function), resulting in: - leukopenia - neutropenia - anemia - thrombocytopenia - increased r/o infection
and bleeding is predictable: - pts usually reach point at which blood counts are lowest 7 to 14 days after
chemo - during 2 weeks, nurses anticipate associated toxicities, especially a fever associated with
neutrophil count less than 1500 cells/mm3 - frequent monitoring of CBC is essential - pts are educated
on strategies to protect against infection, injury, and blood loss - erythropoetin (EPO) stimulated RBC
production, decreasing the symptoms of treatment-induced chronic anemia and reducing the need for
blood transfusions - interleukin 11 (IL-11) (oprelvekin) stimulates the production of megakaryocytes
(precursors to platelets) and can be used to prevent and treat severe thrombocytopenia but has had
limited use because of toxicities
Question 3:
thrombocytopenia
Answer:
abnormally low platelet levels <20,000 - petechiae, gingival bleeding, excessive menstrual bleeding,
excessive bleeding after surgery/dental extractions <5,000 - fatal CNS, or GI hemorrhage
,Question 4:
management of thrombocytopenia
Answer:
treat underlying condition monitor for factors increasing risk of bleeding (elevated INR/PT/aPTT,
decreased fibrinogen, use of medications) assess for and instruct patient/family on s/sx of bleeding
(petechiae, bleeding, decrease HgB/HcT, frank or occult blood in body fluids, altered mental status,
tachycardia) minimize risk of bleeding: - use soft toothbrush, electric razor for shaving, keep lips
moisturized, maintain fluid intake of at least 3 L q24 hrs - avoid rectal temp, avoid IM injections (use
smallest needle possible) - apply direst pressure to venipuncture site for at least 5 min - avoid aspirin -
caution against forceful nose blowing
Question 5:
preventing hemorrhage post-op
Answer:
hemorrhage is an uncommon yet serious complication of surgery that can result in hypovolemic shock
and death. patient presents with hypotension; rapid, thready pulse; disorientation; restlessness, oliguria;
and cold, pale skin; concentrated urine; air hunger (looking to catch breath) assessment and
identification of at-risk individuals, monitoring
Question 6:
nursing management of transfusion reactions
Answer:
- stop the transfusion, maintain the IV line with NS through new IV tubing (given at slow rate) - assess
pt carefully; comparing the VS with baseline, respiratory status, changes in mental status, jugular vein
distention, back pain or urticaria - notify primary provider of assessment findings - notify blood bank
and send blood container/tubing to blood bank for repeat typing and culture hemolytic
transfusion/bacterial infection: - obtain appropriate blood specimens from pt - collect urine sample to
determine hemoglobin - document reaction
Question 7:
mild reaction to blood transfusion nursing managment
Answer:
urticaria, localized erythemia, facial flushing, dyspnea, wheezing, itching pause transfusion, keep vein
open, notify provider, monitor vital signs, administer antihistamine (or benadryl 30 mins before),
resume transfusion if symptoms abate with antihistamine
, Question 8:
severe reaction (anaphylaxis) to blood transfusion nursing management
Answer:
anxiety, hypotension, shock, wheezing, urticaria discontinue transfusion, keep vein open with just NS,
administer CPR, anticipate order for steroids, maintain BP, prevention using well washed RBCs where
plasma has been extracted
Question 9:
febrile reaction to blood transfusion nursing management
Answer:
discontinue transfusion, keep vein open with NS, notify provider, monitor VS, administer antipyretic
Question 10:
anticoagulation medications: patient education
Answer:
- take med as prescribed - do not stop taking unless directed - warfarin: take same time each day - carry
identification indicating anticoag. med is taken - keep all scheduled appts for blood tests - be aware of
med-med interactions (vitamins, cold medicines, antihistamines, antibiotics, aspirin, laxatives,
anti-inflamms) - avoid alcohol - avoid changes in eating habits (especially foods high in vit. K like
green leafy veggies - can reduce effectiveness) - contact provider before dental work/surgery - describe
potential side effects of coagulation such as bruising/bleeding (use electric shaver, soft toothbrush,
avoid contact sports/activities) stop taking warfarin if: - bleeding that does not stop - bruises enlarge -
reddish/brownish urine - red/black bowel movements
Question 11:
multiple myeloma: nursing interventions
Answer:
- pain (NSAIDS); monitor renal function; long-acting opioids - pt education to minimize r/o infection -
assess s/sx of hypercalcemia (polyuria, nausea, constipation, anorexia) - education pt on activity
restrictions (lift no more than 10 lb, proper body mechanics) - bisphosphonate therapy - oral hygiene
and good dental care - monitor renal function closely (maintain high urine output 3L/day) - maintain
mobility and hydration - education about appropriate infection prevention techniques; contact provider
immediately if fever or other signs of infection develop - receive immunizations (pneumococcal and
flu) - high risk of VTE (take low-dose aspirin & anticoag therapy) - assess for symptoms related to
peripheral neuropathy (education on symptoms to report)
