HESI RN EXIT CASE STUDY - PERNICIOUS ANEMIA
1. pernicious anemia case study: John Baker is a 45-year-old Caucasian
male who was admitted to the medical-surgical unit 6 hours ago from the
Emergency Department due to nausea, vomiting, shortness of breath, pallor,
weakness, and severe fatigue. John is divorced with no children and has been
practicing law for 15years. He also has had a medical history of chronic
gastric ulcers.
2. The nurse receives shift report and proceeds to Mr. Baker's room,
bringingthe vital sign measurement equipment. Which vital sign should
concern the nurse the most
ANS: Blood pressure is 142/80 mmHg.
Rationale: This elevated blood pressure indicates an underlying issue that
must beaddressed.
3. The nurse asks Mr. Baker how he is feeling today. He reports that he
does not have time for this hospitalization.The nurse notes that he seems
annoyed.He coughs as he tries to sit up. He turns on the television,
focuses on a newsstation, and ignores the nurse.
Which type of assessment should the nurse perform on Mr. Baker
1/8
,ANS: A focusedassessment.
Rationale: This assessment is for evaluating the status of specific previously
identi-fied problems and any symptoms of new problems developing
4. The nurse performs a focused assessment. Which systems should
thenurse evaluate? (Select all that apply.): Cardiovascular system.
Rationale: The client has hypertension and an elevated heart rate.
Respiratory system.
Rationale: The client has a cough.
5. The nurse finds that Mr. Baker has a weak, irregular, and rapid pulse
and histongue is inflamed. The nurse decides to perform a neurological
assessmentbecause of mild tremoring. His unexpected neurological
findings included hyperactive deep tendon reflexes and mild burning and
prickling sensationson his feet and hands. He also appears to startle
easily, and he has lost about15% of his weight as compared to his last
visit, which was four months ago.
During the assessment, the nurse suspects that the client may have
perni- cious anemia. Which pathophysiological process promotes this
condition
ANS: -
2/8
, Destruction of gastric parietal cells.
Rationale:
Pernicious anemia is often associated with chronic gastritis. This is because
destruc-tion of gastric parietal cells due to inflammation and cellular hypoxia
causes gradualgastric atrophy and a reduction of available intrinsic factor,
which is a transporter molecule that is required to promote the
bioavailability of vitamin B12.
6. The nurse finished documenting the client interview and notices that
new laboratory results have been posted in the electronic health record.
The nursenotes that the serum magnesium level is 1.0 mEq/L (0.50
mmol/L), and the normal range is 1.3 to 2.1 mEq/L (0.65 to 1.05 mmol/L).
Which other result willneed intervention
ANS: Potassium of 2.9 mEq/L (mmol/L).
Rationale:
This is a low serum potassium level; normal range is 3.5 to 5 mEq/L (mmol/L
7. Which action is most important for the nurse to perform before calling
thehealthcare provider to report the lab values
ANS: Initiate telemetry.
3/8
1. pernicious anemia case study: John Baker is a 45-year-old Caucasian
male who was admitted to the medical-surgical unit 6 hours ago from the
Emergency Department due to nausea, vomiting, shortness of breath, pallor,
weakness, and severe fatigue. John is divorced with no children and has been
practicing law for 15years. He also has had a medical history of chronic
gastric ulcers.
2. The nurse receives shift report and proceeds to Mr. Baker's room,
bringingthe vital sign measurement equipment. Which vital sign should
concern the nurse the most
ANS: Blood pressure is 142/80 mmHg.
Rationale: This elevated blood pressure indicates an underlying issue that
must beaddressed.
3. The nurse asks Mr. Baker how he is feeling today. He reports that he
does not have time for this hospitalization.The nurse notes that he seems
annoyed.He coughs as he tries to sit up. He turns on the television,
focuses on a newsstation, and ignores the nurse.
Which type of assessment should the nurse perform on Mr. Baker
1/8
,ANS: A focusedassessment.
Rationale: This assessment is for evaluating the status of specific previously
identi-fied problems and any symptoms of new problems developing
4. The nurse performs a focused assessment. Which systems should
thenurse evaluate? (Select all that apply.): Cardiovascular system.
Rationale: The client has hypertension and an elevated heart rate.
Respiratory system.
Rationale: The client has a cough.
5. The nurse finds that Mr. Baker has a weak, irregular, and rapid pulse
and histongue is inflamed. The nurse decides to perform a neurological
assessmentbecause of mild tremoring. His unexpected neurological
findings included hyperactive deep tendon reflexes and mild burning and
prickling sensationson his feet and hands. He also appears to startle
easily, and he has lost about15% of his weight as compared to his last
visit, which was four months ago.
During the assessment, the nurse suspects that the client may have
perni- cious anemia. Which pathophysiological process promotes this
condition
ANS: -
2/8
, Destruction of gastric parietal cells.
Rationale:
Pernicious anemia is often associated with chronic gastritis. This is because
destruc-tion of gastric parietal cells due to inflammation and cellular hypoxia
causes gradualgastric atrophy and a reduction of available intrinsic factor,
which is a transporter molecule that is required to promote the
bioavailability of vitamin B12.
6. The nurse finished documenting the client interview and notices that
new laboratory results have been posted in the electronic health record.
The nursenotes that the serum magnesium level is 1.0 mEq/L (0.50
mmol/L), and the normal range is 1.3 to 2.1 mEq/L (0.65 to 1.05 mmol/L).
Which other result willneed intervention
ANS: Potassium of 2.9 mEq/L (mmol/L).
Rationale:
This is a low serum potassium level; normal range is 3.5 to 5 mEq/L (mmol/L
7. Which action is most important for the nurse to perform before calling
thehealthcare provider to report the lab values
ANS: Initiate telemetry.
3/8
