NURS435 ADVANCED ACUTE
CARE (NURSING PRACTICE II)
EXAM I ALL SOLVED WITH
RATIONALE
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?
a. RBC count of 4,500,000/μL
b. Hematocrit (Hct) value of 38%
c. Normal red blood cell (RBC) indices
d. Hemoglobin (Hgb) of 8.6 g/dL (86 g/L)
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?
a. Omelet and whole wheat toast
,b. Cantaloupe and cottage cheese
c. Strawberry and banana fruit plate
d. Cornmeal muffin and orange juice
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?
a. Iron
b. Folic acid
c. Cobalamin (vitamin B12)
d. Ascorbic acid (vitamin C)
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?
a. "I need to start eating more red meat and liver."
b. "I will stop having a glass of wine with dinner."
c. "I could choose nasal spray rather than injections of vitamin B12."
d. "I will need to take a proton pump inhibitor such as omeprazole (Prilosec)."
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?
a. Provide a diet high in vitamin K.
b. Teach the patient how to avoid injury.
c. Encourage alternating rest and activity.
d. Place the patient on protective isolation.
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?
a. "I could take a stool softener if I feel constipated."
b. "I can take the iron with orange juice before eating."
c. "I should notify my health care provider if my stools turn black."
d. "I will increase my fluid and fiber intake while I am taking iron."
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?
a. Seizures
CARE (NURSING PRACTICE II)
EXAM I ALL SOLVED WITH
RATIONALE
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?
a. RBC count of 4,500,000/μL
b. Hematocrit (Hct) value of 38%
c. Normal red blood cell (RBC) indices
d. Hemoglobin (Hgb) of 8.6 g/dL (86 g/L)
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?
a. Omelet and whole wheat toast
,b. Cantaloupe and cottage cheese
c. Strawberry and banana fruit plate
d. Cornmeal muffin and orange juice
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?
a. Iron
b. Folic acid
c. Cobalamin (vitamin B12)
d. Ascorbic acid (vitamin C)
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?
a. "I need to start eating more red meat and liver."
b. "I will stop having a glass of wine with dinner."
c. "I could choose nasal spray rather than injections of vitamin B12."
d. "I will need to take a proton pump inhibitor such as omeprazole (Prilosec)."
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?
a. Provide a diet high in vitamin K.
b. Teach the patient how to avoid injury.
c. Encourage alternating rest and activity.
d. Place the patient on protective isolation.
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?
a. "I could take a stool softener if I feel constipated."
b. "I can take the iron with orange juice before eating."
c. "I should notify my health care provider if my stools turn black."
d. "I will increase my fluid and fiber intake while I am taking iron."
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?
a. Seizures
