NCLEX EXAM ga ga
Exam Solution ga
PEARSON NCLEX RN Questions & Rationales 2026 A+ G ga ga ga ga ga ga ga ga
RADE ASSURED COMPLETE SOLUTIONS AND VERIFIED ga ga ga ga ga ga
ANSWERS (9EAA1) ga
QUESTION 1 ga
2. A 30-year-
ga ga
old male from Haiti is brought to the emergency department in sickle cell crisis. What is
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga g
the best position for this client? Side-lying with knees flexed Knee-
a ga ga ga ga ga ga ga ga ga ga
chest High Fowler's with knees flexed Semi-Fowler's with legs extended on the bed
ga ga ga ga ga ga ga ga ga ga ga ga
ANSWER
Semi-Fowler's with legs extended on the bed ga ga ga ga ga ga
QUESTION 2 ga
3. A 25-year-
ga ga
old male is admitted in sickle cell crisis. Which of the following interventions would be o
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
f highest priority for this client? Taking hourly blood pressures with mechanical cuff Enc
ga ga ga ga ga ga ga ga ga ga ga ga ga
ouraging fluid intake of at least 200mL per hour Position in high Fowler's with knee gat
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ch raised Administering Tylenol as ordered
ga ga ga ga ga
ANSWER
Encouraging fluid intake of at least 200mL per hour. It is important to keep the client in sickle cell crisi
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
s hydrated to prevent further sickling of the blood.
ga ga ga ga ga ga ga ga
QUESTION 3 ga
4. Which of the following foods would the nurse encourage the client in sickle cell crisis
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
to eat? Peaches Cottage cheese Popsicle Lima beans
ga ga ga ga ga ga ga
ANSWER
Popsicle. Hydration is important in the client with sickle cell disease to prevent thrombus formation. Po
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
psicles, gelatin, juice, and pudding have high fluid content.
ga ga ga ga ga ga ga ga
,QUESTION 4 ga
6. The nurse is instructing a client with iron-
ga ga ga ga ga ga ga ga
deficiency anemia. Which of the following meal plans would the nurse expect the client t
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
o select? Roast beef, gelatin salad, green beans, and peach pie Chicken salad sandwich, c
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
oleslaw, French fries, ice cream Egg salad on wheat bread, carrot sticks, lettuce salad, rai
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
sin pie Pork chop, creamed potatoes, corn, and coconut cake
ga ga ga ga ga ga ga ga ga
ANSWER
Egg salad on wheat bread, carrot sticks, lettuce salad, raisin pie Egg yolks, wheat bread, carrots, raisins,
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga g
aand green, leafy vegetables are all high in iron, which is an important mineral for this client. Roast beef
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
, cabbage, and pork chops are also high in iron, but the side dishes accompanying these choices are not
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
QUESTION 5 ga
7. Clients with sickle cell anemia are taught to avoid activities that cause hypoxia and hy
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
poxemia. Which of the following activities would the nurse recommend? A family vacatio
ga ga ga ga ga ga ga ga ga ga ga ga
n in the Rocky Mountains Chaperoning the local boys club on a snow-
ga ga ga ga ga ga ga ga ga ga ga ga
skiing trip Traveling by airplane for business trips A bus trip to the Museum of Natural
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
History
ANSWER
A bus trip to the Museum of Natural History A family vacation in the Rocky Mountains at high altitudes,
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
cold temperatures, and airplane travel can cause sickling episodes and should be avoided
ga ga ga ga ga ga ga ga ga ga ga ga ga
QUESTION 6 ga
8. The nurse is conducting an admission assessment of a client with vitamin B12 deficie
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ncy. Which of the following would the nurse include in the physical assessment? Palpate
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
the spleen Take the blood pressure Examine the feet for petechiae Examine the tongue
ga ga ga ga ga ga ga ga ga ga ga ga ga
ANSWER
Examine the tongue The tongue is smooth and beefy red in the client with vitamin B12 deficiency, so e
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
xamining the tongue should be included in the physical assessment.
ga ga ga ga ga ga ga ga ga
QUESTION 7 ga
9. An African American female comes to the outpatient clinic. The physician suspects vit
ga ga ga ga ga ga ga ga ga ga ga ga ga
amin B12 deficiency anemia. Because jaundice is often a clinical manifestation of this ty
ga ga ga ga ga ga ga ga ga ga ga ga ga
pe of anemia, what body part would be the best indicator? Conjunctiva of the eye Soles o
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
f the feet Roof of the mouth Shins
ga ga ga ga ga ga ga
ANSWER
,Roof of the mouth The oral mucosa and hard palate (roof of the mouth) are the best indicators of jaund
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ice in dark- ga ga
skinned persons. The conjunctiva can have normal deposits of fat, which give a yellowish hue; thus, ans
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
wer A is incorrect. The soles of the feet can be yellow if they are calloused, making answer B incorrect;
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
the shins would be an area of darker pigment
ga ga ga ga ga ga ga ga
QUESTION 8 ga
10. The nurse is conducting a physical assessment on a client with anemia. Which of the
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
following clinical manifestations would be most indicative of the anemia? BP 146/88 Re
ga ga ga ga ga ga ga ga ga ga ga ga
spirations 28 shallow Weight gain of 10 pounds in 6 months Pink complexion
ga ga ga ga ga ga ga ga ga ga ga ga
ANSWER
Respirations 28 shallow When there are fewer red blood cells, there is less hemoglobin and less oxygen
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
. Therefore, the client is often short of breath
ga ga ga ga ga ga ga ga
QUESTION 9 ga
11. The nurse is teaching the client with polycythemia vera about prevention of complic
ga ga ga ga ga ga ga ga ga ga ga ga ga
ations of the disease. Which of the following statements by the client indicates a need fo
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
r further teaching? "I will drink 500mL of fluid or less each day." "I will wear support ho
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
se when I am up." "I will use an electric razor for shaving." "I will eat foods low in iron."
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ANSWER
"I will drink 500mL of fluid or less each day." The client with polycythemia vera is at risk for thrombus
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga g
formation. Hydrating the client with at least 3L of fluid per day is important in preventing clot formati
a ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
on
QUESTION 10 ga
12. A 33-year- ga ga
old male is being evaluated for possible acute leukemia. Which of the following would th
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
e nurse inquire about as a part of the assessment? The client collects stamps as a hobby.
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga g
The client recently lost his job as a postal worker. The client had radiation for treatmen
a ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
t of Hodgkin's disease as a teenager. The client's brother had leukemia as a child.
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ANSWER
The client had radiation for treatment of Hodgkin's disease as a teenager. Radiation treatment for other
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
types of cancer can result in leukemia. Some hobbies and occupations involving chemicals are linked t
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
o leukemia, but not the ones in these answers; therefore, answers A and B are incorrect. Answer D is in
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
correct because the incidence of leukemia is higher in twins than in siblings.
ga ga ga ga ga ga ga ga ga ga ga ga
QUESTION 11 ga
, 13. An African American client is admitted with acute leukemia. The nurse is assessing f
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
or signs and symptoms of bleeding. Where is the best site for examining for the presenc
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
e of petechiae? The abdomen The thorax The earlobes The soles of the feet
ga ga ga ga ga ga ga ga ga ga ga ga ga
ANSWER
The soles of the feet Petechiae are not usually visualized on dark skin. The soles of the feet and palms
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
of the hand provide a lighter surface for assessing the client for petichiae.
ga ga ga ga ga ga ga ga ga ga ga ga
QUESTION 12 ga
14. A client with acute leukemia is admitted to the oncology unit. Which of the following
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
would be most important for the nurse to inquire? "Have you noticed a change in sleepi
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ng habits recently?" "Have you had a respiratory infection in the last 6 months?" "Have y
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ou lost weight recently?" "Have you noticed changes in your alertness?"
ga ga ga ga ga ga ga ga ga ga
ANSWER
"Have you had a respiratory infection in the last 6 months?" The client with leukemia is at risk for infec
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
tion and has often had recurrent respiratory infections during the previous 6 months. Insomnolence, w
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
eight loss, and a decrease in alertness also occur in leukemia, but bleeding tendencies and infections ar
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
e the primary clinical manifestations
ga ga ga ga
QUESTION 13 ga
15. Which of the following would be the priority nursing diagnosis for the adult client wi
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
th acute leukemia? Oral mucous membrane, altered related to chemotherapy Risk for inj
ga ga ga ga ga ga ga ga ga ga ga ga
ury related to thrombocytopenia Fatigue related to the disease process Interrupted fami
ga ga ga ga ga ga ga ga ga ga ga
ly processes related to life-threatening illness of a family member
ga ga ga ga ga ga ga ga ga
ANSWER
Risk for injury related to thrombocytopenia The client with acute leukemia has bleeding tendencies due
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
to decreased platelet counts, and any injury would exacerbate the problem. The client would require cl
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ose monitoring for hemorrhage, which is of higher priority
ga ga ga ga ga ga ga ga
QUESTION 14 ga
17. A client has autoimmune thrombocytopenic purpura. To determine the client's respo
ga ga ga ga ga ga ga ga ga ga ga
nse to treatment, the nurse would monitor: Platelet count White blood cell count Potassi
ga ga ga ga ga ga ga ga ga ga ga ga ga
um levels Partial prothrombin time (PTT)
ga ga ga ga ga
ANSWER
Platelet count Clients with autoimmune thrombocytopenic purpura (ATP) have low platelet counts, mak
ga ga ga ga ga ga ga ga ga ga ga ga
ing answer A the correct answer. White cell counts, potassium levels, and PTT are not affected in ATP
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
QUESTION 15 ga
Exam Solution ga
PEARSON NCLEX RN Questions & Rationales 2026 A+ G ga ga ga ga ga ga ga ga
RADE ASSURED COMPLETE SOLUTIONS AND VERIFIED ga ga ga ga ga ga
ANSWERS (9EAA1) ga
QUESTION 1 ga
2. A 30-year-
ga ga
old male from Haiti is brought to the emergency department in sickle cell crisis. What is
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga g
the best position for this client? Side-lying with knees flexed Knee-
a ga ga ga ga ga ga ga ga ga ga
chest High Fowler's with knees flexed Semi-Fowler's with legs extended on the bed
ga ga ga ga ga ga ga ga ga ga ga ga
ANSWER
Semi-Fowler's with legs extended on the bed ga ga ga ga ga ga
QUESTION 2 ga
3. A 25-year-
ga ga
old male is admitted in sickle cell crisis. Which of the following interventions would be o
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
f highest priority for this client? Taking hourly blood pressures with mechanical cuff Enc
ga ga ga ga ga ga ga ga ga ga ga ga ga
ouraging fluid intake of at least 200mL per hour Position in high Fowler's with knee gat
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ch raised Administering Tylenol as ordered
ga ga ga ga ga
ANSWER
Encouraging fluid intake of at least 200mL per hour. It is important to keep the client in sickle cell crisi
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
s hydrated to prevent further sickling of the blood.
ga ga ga ga ga ga ga ga
QUESTION 3 ga
4. Which of the following foods would the nurse encourage the client in sickle cell crisis
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
to eat? Peaches Cottage cheese Popsicle Lima beans
ga ga ga ga ga ga ga
ANSWER
Popsicle. Hydration is important in the client with sickle cell disease to prevent thrombus formation. Po
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
psicles, gelatin, juice, and pudding have high fluid content.
ga ga ga ga ga ga ga ga
,QUESTION 4 ga
6. The nurse is instructing a client with iron-
ga ga ga ga ga ga ga ga
deficiency anemia. Which of the following meal plans would the nurse expect the client t
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
o select? Roast beef, gelatin salad, green beans, and peach pie Chicken salad sandwich, c
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
oleslaw, French fries, ice cream Egg salad on wheat bread, carrot sticks, lettuce salad, rai
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
sin pie Pork chop, creamed potatoes, corn, and coconut cake
ga ga ga ga ga ga ga ga ga
ANSWER
Egg salad on wheat bread, carrot sticks, lettuce salad, raisin pie Egg yolks, wheat bread, carrots, raisins,
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga g
aand green, leafy vegetables are all high in iron, which is an important mineral for this client. Roast beef
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
, cabbage, and pork chops are also high in iron, but the side dishes accompanying these choices are not
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
QUESTION 5 ga
7. Clients with sickle cell anemia are taught to avoid activities that cause hypoxia and hy
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
poxemia. Which of the following activities would the nurse recommend? A family vacatio
ga ga ga ga ga ga ga ga ga ga ga ga
n in the Rocky Mountains Chaperoning the local boys club on a snow-
ga ga ga ga ga ga ga ga ga ga ga ga
skiing trip Traveling by airplane for business trips A bus trip to the Museum of Natural
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
History
ANSWER
A bus trip to the Museum of Natural History A family vacation in the Rocky Mountains at high altitudes,
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
cold temperatures, and airplane travel can cause sickling episodes and should be avoided
ga ga ga ga ga ga ga ga ga ga ga ga ga
QUESTION 6 ga
8. The nurse is conducting an admission assessment of a client with vitamin B12 deficie
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ncy. Which of the following would the nurse include in the physical assessment? Palpate
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
the spleen Take the blood pressure Examine the feet for petechiae Examine the tongue
ga ga ga ga ga ga ga ga ga ga ga ga ga
ANSWER
Examine the tongue The tongue is smooth and beefy red in the client with vitamin B12 deficiency, so e
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
xamining the tongue should be included in the physical assessment.
ga ga ga ga ga ga ga ga ga
QUESTION 7 ga
9. An African American female comes to the outpatient clinic. The physician suspects vit
ga ga ga ga ga ga ga ga ga ga ga ga ga
amin B12 deficiency anemia. Because jaundice is often a clinical manifestation of this ty
ga ga ga ga ga ga ga ga ga ga ga ga ga
pe of anemia, what body part would be the best indicator? Conjunctiva of the eye Soles o
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
f the feet Roof of the mouth Shins
ga ga ga ga ga ga ga
ANSWER
,Roof of the mouth The oral mucosa and hard palate (roof of the mouth) are the best indicators of jaund
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ice in dark- ga ga
skinned persons. The conjunctiva can have normal deposits of fat, which give a yellowish hue; thus, ans
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
wer A is incorrect. The soles of the feet can be yellow if they are calloused, making answer B incorrect;
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
the shins would be an area of darker pigment
ga ga ga ga ga ga ga ga
QUESTION 8 ga
10. The nurse is conducting a physical assessment on a client with anemia. Which of the
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
following clinical manifestations would be most indicative of the anemia? BP 146/88 Re
ga ga ga ga ga ga ga ga ga ga ga ga
spirations 28 shallow Weight gain of 10 pounds in 6 months Pink complexion
ga ga ga ga ga ga ga ga ga ga ga ga
ANSWER
Respirations 28 shallow When there are fewer red blood cells, there is less hemoglobin and less oxygen
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
. Therefore, the client is often short of breath
ga ga ga ga ga ga ga ga
QUESTION 9 ga
11. The nurse is teaching the client with polycythemia vera about prevention of complic
ga ga ga ga ga ga ga ga ga ga ga ga ga
ations of the disease. Which of the following statements by the client indicates a need fo
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
r further teaching? "I will drink 500mL of fluid or less each day." "I will wear support ho
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
se when I am up." "I will use an electric razor for shaving." "I will eat foods low in iron."
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ANSWER
"I will drink 500mL of fluid or less each day." The client with polycythemia vera is at risk for thrombus
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga g
formation. Hydrating the client with at least 3L of fluid per day is important in preventing clot formati
a ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
on
QUESTION 10 ga
12. A 33-year- ga ga
old male is being evaluated for possible acute leukemia. Which of the following would th
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
e nurse inquire about as a part of the assessment? The client collects stamps as a hobby.
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga g
The client recently lost his job as a postal worker. The client had radiation for treatmen
a ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
t of Hodgkin's disease as a teenager. The client's brother had leukemia as a child.
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ANSWER
The client had radiation for treatment of Hodgkin's disease as a teenager. Radiation treatment for other
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
types of cancer can result in leukemia. Some hobbies and occupations involving chemicals are linked t
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
o leukemia, but not the ones in these answers; therefore, answers A and B are incorrect. Answer D is in
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
correct because the incidence of leukemia is higher in twins than in siblings.
ga ga ga ga ga ga ga ga ga ga ga ga
QUESTION 11 ga
, 13. An African American client is admitted with acute leukemia. The nurse is assessing f
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
or signs and symptoms of bleeding. Where is the best site for examining for the presenc
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
e of petechiae? The abdomen The thorax The earlobes The soles of the feet
ga ga ga ga ga ga ga ga ga ga ga ga ga
ANSWER
The soles of the feet Petechiae are not usually visualized on dark skin. The soles of the feet and palms
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
of the hand provide a lighter surface for assessing the client for petichiae.
ga ga ga ga ga ga ga ga ga ga ga ga
QUESTION 12 ga
14. A client with acute leukemia is admitted to the oncology unit. Which of the following
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
would be most important for the nurse to inquire? "Have you noticed a change in sleepi
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ng habits recently?" "Have you had a respiratory infection in the last 6 months?" "Have y
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ou lost weight recently?" "Have you noticed changes in your alertness?"
ga ga ga ga ga ga ga ga ga ga
ANSWER
"Have you had a respiratory infection in the last 6 months?" The client with leukemia is at risk for infec
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
tion and has often had recurrent respiratory infections during the previous 6 months. Insomnolence, w
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
eight loss, and a decrease in alertness also occur in leukemia, but bleeding tendencies and infections ar
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
e the primary clinical manifestations
ga ga ga ga
QUESTION 13 ga
15. Which of the following would be the priority nursing diagnosis for the adult client wi
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
th acute leukemia? Oral mucous membrane, altered related to chemotherapy Risk for inj
ga ga ga ga ga ga ga ga ga ga ga ga
ury related to thrombocytopenia Fatigue related to the disease process Interrupted fami
ga ga ga ga ga ga ga ga ga ga ga
ly processes related to life-threatening illness of a family member
ga ga ga ga ga ga ga ga ga
ANSWER
Risk for injury related to thrombocytopenia The client with acute leukemia has bleeding tendencies due
ga ga ga ga ga ga ga ga ga ga ga ga ga ga
to decreased platelet counts, and any injury would exacerbate the problem. The client would require cl
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
ose monitoring for hemorrhage, which is of higher priority
ga ga ga ga ga ga ga ga
QUESTION 14 ga
17. A client has autoimmune thrombocytopenic purpura. To determine the client's respo
ga ga ga ga ga ga ga ga ga ga ga
nse to treatment, the nurse would monitor: Platelet count White blood cell count Potassi
ga ga ga ga ga ga ga ga ga ga ga ga ga
um levels Partial prothrombin time (PTT)
ga ga ga ga ga
ANSWER
Platelet count Clients with autoimmune thrombocytopenic purpura (ATP) have low platelet counts, mak
ga ga ga ga ga ga ga ga ga ga ga ga
ing answer A the correct answer. White cell counts, potassium levels, and PTT are not affected in ATP
ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga ga
QUESTION 15 ga
