NURS 435 EXAM 1 QUESTIONS AND ANSWERS
ELABORATIONS!!
An adult male with chronic anemia is experiencing increased fatigue and
occasional palpitations at rest. Which laboratory data would the nurse identify as
consistent with these symptoms?
Answers :Answer: Hemoglobin (Hgb) of 8.6 g/dL (86 g/L)
Rationale: The patient's symptoms 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.
Which menu choice indicates that the patient understands the nurse's
recommendations about dietary choices for iron-deficiency anemia?
Answers :Answer: Omelet and whole wheat toast
Rationale: 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.
A patient who is receiving methotrexate for severe rheumatoid arthritis develops a
megaloblastic anemia. Which nutrient supplement should the nurse plan to explain
to the patient?
Answers :Answer: Folic acid
Rationale; Methotrexate use can lead to folic acid deficiency. Supplementation
with oral folic acid supplements is the usual treatment. The other nutrients would
not correct folic acid deficiency, although they would be used to treat other types
of anemia.
,Which patient statement to the nurse indicates that the patient understands self-care
for pernicious anemia?
Answers :Answer: "I could choose nasal spray rather than injections of vitamin
B12."
Rationale: 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.
Which is an appropriate nursing intervention for a hospitalized patient with severe
hemolytic anemia?
Answers :Answer: Encourage alternating rest and activity.
Rationale: Nursing care for patients with anemia should alternate periods of rest
and activity to avoid 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.
Which patient statement to the nurse indicates a need for additional instruction
about taking oral ferrous sulfate?
Answers :Answer: "I should notify my health care provider if my stools turn
black."
,Rationale: It is normal for the stools to appear black when a patient is taking iron,
and the patient should not call the health care provider about this. The other patient
statements are correct.
Which potential complication should the nurse identify as a high risk for a patient
admitted to the hospital with idiopathic aplastic anemia?
Answers :Answer: Infection
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.
Which nursing intervention is important when providing care for a patient with
sickle cell crisis?
Answers :Answer: Evaluating the effectiveness of opioid analgesics
Rationale: 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.
Which statement by a patient indicates good understanding of the nurse's teaching
about preventing sickle cell crisis?
Answers :Answer: "Risk for a crisis is decreased by having an annual influenza
vaccination."
, Rationale: 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.
Which instruction will the nurse plan to include in discharge teaching for a patient
admitted with a sickle cell crisis?
Answers :Answer: Avoid exposure to crowds when possible.
Rationale: 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.
The nurse observes scleral jaundice in a patient being admitted with hemolytic
anemia. Which laboratory result the nurse should check?
Answers :B. Bilirubin level
Rationale: Jaundice is caused by the elevation of bilirubin level associated with red
blood cell hemolysis. Other tests would not be helpful in monitoring hemolytic
anemia.
What action is expected by the nurse caring for a patient who has an acute
exacerbation of polycythemia vera?
Answers :Answer: Monitor fluid intake and output.
ELABORATIONS!!
An adult male with chronic anemia is experiencing increased fatigue and
occasional palpitations at rest. Which laboratory data would the nurse identify as
consistent with these symptoms?
Answers :Answer: Hemoglobin (Hgb) of 8.6 g/dL (86 g/L)
Rationale: The patient's symptoms 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.
Which menu choice indicates that the patient understands the nurse's
recommendations about dietary choices for iron-deficiency anemia?
Answers :Answer: Omelet and whole wheat toast
Rationale: 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.
A patient who is receiving methotrexate for severe rheumatoid arthritis develops a
megaloblastic anemia. Which nutrient supplement should the nurse plan to explain
to the patient?
Answers :Answer: Folic acid
Rationale; Methotrexate use can lead to folic acid deficiency. Supplementation
with oral folic acid supplements is the usual treatment. The other nutrients would
not correct folic acid deficiency, although they would be used to treat other types
of anemia.
,Which patient statement to the nurse indicates that the patient understands self-care
for pernicious anemia?
Answers :Answer: "I could choose nasal spray rather than injections of vitamin
B12."
Rationale: 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.
Which is an appropriate nursing intervention for a hospitalized patient with severe
hemolytic anemia?
Answers :Answer: Encourage alternating rest and activity.
Rationale: Nursing care for patients with anemia should alternate periods of rest
and activity to avoid 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.
Which patient statement to the nurse indicates a need for additional instruction
about taking oral ferrous sulfate?
Answers :Answer: "I should notify my health care provider if my stools turn
black."
,Rationale: It is normal for the stools to appear black when a patient is taking iron,
and the patient should not call the health care provider about this. The other patient
statements are correct.
Which potential complication should the nurse identify as a high risk for a patient
admitted to the hospital with idiopathic aplastic anemia?
Answers :Answer: Infection
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.
Which nursing intervention is important when providing care for a patient with
sickle cell crisis?
Answers :Answer: Evaluating the effectiveness of opioid analgesics
Rationale: 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.
Which statement by a patient indicates good understanding of the nurse's teaching
about preventing sickle cell crisis?
Answers :Answer: "Risk for a crisis is decreased by having an annual influenza
vaccination."
, Rationale: 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.
Which instruction will the nurse plan to include in discharge teaching for a patient
admitted with a sickle cell crisis?
Answers :Answer: Avoid exposure to crowds when possible.
Rationale: 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.
The nurse observes scleral jaundice in a patient being admitted with hemolytic
anemia. Which laboratory result the nurse should check?
Answers :B. Bilirubin level
Rationale: Jaundice is caused by the elevation of bilirubin level associated with red
blood cell hemolysis. Other tests would not be helpful in monitoring hemolytic
anemia.
What action is expected by the nurse caring for a patient who has an acute
exacerbation of polycythemia vera?
Answers :Answer: Monitor fluid intake and output.
