Chapter 40 Flashcards
A nurse caring for a client with sickle cell disease (SCD) reviews the client’s laboratory work. Which finding should the nurse report to the provider?
Creatinine: 2.9 mg/dL
A client hospitalized with sickle cell crisis frequently asks for opioid pain medications, often shortly after receiving a dose. The nurses on the unit believe the client is drug seeking. When the client requests pain medication, what action by the nurse is best?
Give the client pain medication if it is time for another dose.
A client in sickle cell crisis is dehydrated and in the emergency department. The nurse plans to start an IV. Which fluid choice is best?
0.45% normal saline
A client presents to the emergency department in sickle cell crisis. What intervention by the nurse takes priority?
Administer oxygen.
A client has a serum ferritin level of 8 ng/mL and microcytic red blood cells. What action by the nurse is best?
Perform a Hemoccult test on the client’s stools.
A client has Crohn’s disease. What type of anemia is this client most at risk for developing?
Folic acid deficiency
A nurse in a hematology clinic is working with four clients who have polycythemia vera. Which client should the nurse see first?
Client who reports shortness of breath
A nursing student is caring for a client with leukemia. The student asks why the client is still at risk for infection when the client’s white blood cell count (WBC) is high. What response by the registered nurse is best?
“Those WBCs are abnormal and don’t provide protection.”
The family of a neutropenic client reports the client “is not acting right.” What action by the nurse is the priority?
Assess the client for infection.
A nurse is caring for a client who is about to receive a bone marrow transplant. To best help the client cope with the long recovery period, what action by the nurse is best?
Help the client find things to hope for each day of recovery.
A nursing student is struggling to understand the process of graft-versus-host disease. What explanation by the nurse instructor is best?
“The donor’s cells are actually attacking the client’s cells.”
The nurse is caring for a client with leukemia who has the priority problem of fatigue. What action by the client best indicates that an important goal for this problem has been met?
Doing activities of daily living (ADLs) using rest periods
A nurse is caring for a young male client with lymphoma who is to begin treatment. What teaching topic is a priority?
Sperm banking
A client has been admitted after sustaining a humerus fracture that occurred when picking up the family cat. What test result would the nurse correlate to this condition?
Bence-Jones protein in urine
A client with multiple myeloma demonstrates worsening bone density on diagnostic scans. About what drug does the nurse plan to teach this client?
Zoledronic acid (Zometa)
A client with autoimmune idiopathic thrombocytopenic purpura (ITP) has had a splenectomy and returned to the surgical unit 2 hours ago. The nurse assesses the client and finds the abdominal dressing saturated with blood. What action is most important?
Taking a set of vital signs and notifying the surgeon
A client has a platelet count of 9000/mm3. The nurse finds the client confused and mumbling. What action takes priority?
Calling the Rapid Response Team
A nurse is preparing to administer a blood transfusion. What action is most important?
Ensuring informed consent is obtained if required
A nurse is preparing to hang a blood transfusion. Which action is most important?
Putting on a pair of gloves
A client receiving a blood transfusion develops anxiety and low back pain. After stopping the transfusion, what action by the nurse is most important?
Double-checking the client and blood product identification
A client has thrombocytopenia. What client statement indicates the client understands self-management of this condition?
“I usually put ice on bumps or bruises.”
A client has a sickle cell crisis with extreme lower extremity pain. What comfort measure does the nurse delegate to the unlicensed assistive personnel (UAP)?
Keep the lower extremities warm.
A client admitted for sickle cell crisis is distraught after learning her child also has the disease. What response by the nurse is best?
“I can see you are upset. I can stay here with you a while if you like.”
A client with sickle cell disease (SCD) takes hydroxyurea (Droxia). The client presents to the clinic reporting an increase in fatigue. What laboratory result should the nurse report immediately?
White blood cell count: 38,000/mm3
A nurse is caring for four clients with leukemia. After hand-off report, which client should the nurse see first?
Client who had two bloody diarrhea stools this morning
A client has frequent hospitalizations for leukemia and is worried about functioning as a parent to four small children. What action by the nurse would be most helpful?
Assist the client to make “sick day” plans for household responsibilities.
A client has been treated for a deep vein thrombus and today presents to the clinic with petechiae. Laboratory results show a platelet count of 42,000/mm3. The nurse reviews the client’s medication list to determine if the client is taking which drug?
Unfractionated heparin
The nurse assesses a client’s oral cavity and makes the discovery shown in the photo below:
What action by the nurse is most appropriate?
Teach the client about cobalamin therapy.
A nurse working with clients with sickle cell disease (SCD) teaches about self-management to prevent exacerbations and sickle cell crises. What factors should clients be taught to avoid? (Select all that apply.)
a. Dehydration
b. Exercise
c. Extreme stress
d. High altitudes
e. Pregnancy
A,C,D,E
A student studying leukemias learns the risk factors for developing this disorder. Which risk factors does this include? (Select all that apply.)
a. Chemical exposure
b. Genetically modified foods
c. Ionizing radiation exposure
d. Vaccinations
e. Viral infections
A,C,E
