Week 2 EAQ/HESI

Question 1

Working with this physician, you see many patient with anemia. The basic pathophysiology of anemia involves a reduction in:

blood volume

the total number of platelets

the total number of circulating erythrocytes

the total number of circulating leukocytes

Answer 1

the total number of circulating erythrocytes

Question 2

Knowing that a variety of problems can contribute to the development of anemia, you ask Mrs. Byrd about any history of: Select all that apply

gastric surgery

kidney disease

childhood illnesses

poor nutrition

bleeding episodes

alcohol abuse

Answer 2

gastric surgery

kidney disease

poor nutrition

bleeding episodes

alcohol abuse

Question 3

Most commonly, anemia is due to _____ deficiency or a result of chronic disease.

Answer 3

iron

Question 4

An electrocardiogram (ECG) is taken. The severely anemic patient may have which of the following ECG changes?

Widened QRS complex

Sinus bradycardia

ST-segment depression

Presence of Q waves

Answer 4

ST-segment depression

Question 5

Mrs. Byrd has iron-deficiency anemia. Which of the following questions is pertinent to her diagnosis?

“Do you use artificial sweeteners?”

“Have you ever had diabetes?”

“Are you anxious about anything?”

“Is your tongue sore?”

Answer 5

“Is your tongue sore?”

An inflamed, sore tongue (glossitis) is a symptom of iron-deficiency anemia. Mrs. Byrd admits that her tongue has been sore, and you note that it is red, swollen, and smooth.

Question 6

Given Mrs. Byrd’s glossitis, which of the following recommendations is appropriate?

Eat soft foods

Restrict fluid intake

Avoid sweet desserts

Drink hot liquids

Answer 6

Eat soft foods

Glossitis is painful. Measures to promote comfort are indicated. Soft foods are non-irritating and should allow for adequate food intake despite an inflamed tongue. Fluid intake should be encouraged. Frozen desserts may offer some relief from the discomfort associated with glossitis. Hot foods and liquids can be irritating and painful on an inflamed tongue and should be avoided.

Question 7

To prevent injury from dizziness when getting out of bed in the morning, you teach Mrs. Byrd to:

take some quick, deep breaths before getting out of bed

get out of bed slowly

get out of bed quickly

hold her breath when getting out of bed

Answer 7

get out of bed slowly

Question 8

__________ is a concavity of the nails. It commonly occurs with iron-deficiency anemia.

Answer 8

Spooning

Question 9

Feosol (ferrous sulfate) is an ______ supplement. It should increase Mrs. Byrd’s hemoglobin levels. Generally, tablets or liquid are prescribed to be taken by mouth three times a day.

Answer 9

iron

Question 10

As expected, the physician prescribes Feosol (ferrous sulfate). You teach Mrs. Byrd about side effects. These include:

nausea

bradycardia

hypertension

epistaxis

Answer 10

nausea

Question 11

You teach Mrs. Byrd to take Feosol (ferrous sulfate):

between meals

with an antacid

before going to bed

Answer 11

between meals

Between-meal dosing is preferred for best drug absorption. If GI distress occurs, Feosol (ferrous sulfate) can be taken after meals, although absorption may be decreased if the drug is taken after meals. The liquid form of the drug should be taken well-diluted with water or juice, using a straw, to avoid discoloration of the teeth. Vitamin C (ascorbic acid) found in juice will increase absorption of the Feosol (ferrous sulfate). Absorption of Feosol (ferrous sulfate) is decreased if taken with caffeinated beverages or milk.

Question 12

To help meet the goal of a normal hemoglobin level, which of the following foods do you encourage Mrs. Byrd to include in her diet?

Pancakes

Eggs

Yogurt

Bananas

Answer 12

Eggs

Egg yolks are a good source of iron. Other sources of iron include liver, oysters, lean meats, kidney beans, spinach, kale, whole wheat bread, and carrots.

Question 13

Constipation is a common adverse effect of _____ supplement therapy.

Answer 13

iron

Question 14

It is important to assess Mrs. Byrd for signs and symptoms of iron overdose. These can include:

respiratory depression

abdominal pain

skin rash

intermittent hypertension

Answer 14

abdominal pain

Question 15

The nurse receives shift report and proceeds to the client’s room, bringing equipment to measure his vital signs. Which vital sign should concern the nurse the most? [Pernicious anemia]

Blood pressure is 142/80 mmHg.

Respiration rate of 24 breaths/minute.

Heart rate of 98 beats/minute.

Pulse oxygenation of 94%.

Answer 15

Blood pressure is 142/80 mmHg.
This elevated blood pressure could indicate an underlying issue that should be addressed.

Question 16

The nurse asks the client how he is feeling. 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 news station, and ignores the nurse.

Which type of assessment should the nurse perform on the client?

A focused assessment.

A comprehensive assessment.

An emergency assessment.

A psychosocial assessment.

Answer 16

A focused assessment.

This assessment is for evaluating the status of specific previously identified problems and any symptoms of new problems developing.

Question 17

During the assessment, the nurse suspects that the client may have pernicious anemia. Which pathophysiological process promotes this condition?

Presence of Reed-Sternberg cells.

Diminished total iron-binding capacity.

Destruction of gastric parietal cells.

Inadequate intake of dietary folate.

Answer 17

Destruction of gastric parietal cells.

Pernicious anemia is often associated with chronic gastritis. This is because destruction of gastric parietal cells due to inflammation and cellular hypoxia causes gradual gastric atrophy and a reduction of available intrinsic factor, which is a transporter molecule that is required to promote the bioavailability of vitamin B12.

Question 18

Which sign or diagnostic result should the nurse expect to observe in a client due to hypokalemia?

An arm tremor while taking the client’s blood pressure.

Hyperactive deep tendon reflexes.

Elevated serum glucose level.

A dampened or flattened T-wave on an electrocardiogram (ECG).

Answer 18

A dampened or flattened T-wave on an electrocardiogram (ECG).

Question 19

A magnesium deficit is consistent with the client’s assessment findings, and it is commonly associated with chronic _________ use.

Answer 19

alcohol

Question 20

Which laboratory values should the nurse monitor cautiously before starting (IV) magnesium sulfate 2 mg in 100 mL of 5% dextrose in water?

Blood urea nitrogen (BUN) and serum creatinine levels.

White blood cell (WBC) and red blood cell counts (RBC).

Activated partial thromboplastin time (aPTT).

Hemoglobin (Hb), hematocrit (Hct), and platelet count.

Answer 20

Blood urea nitrogen (BUN) and serum creatinine levels.

Question 21

If doppler studies are negative and a DVT is still suspected, a ___________ may be needed to make accurate diagonis.

Answer 21

venogram

Question 22

The incoming nurse notices which cue as the cause of observable hematuria in the client’s urinary catheter?

The IV pump infusing at a higher rate than prescribed.

The HCP prescribes a lower rate than recommended.

The day shift nurse reported lowering the rate of infusion prior to shift change.

The urinary catheter bag hangs from the side bedrail.

Answer 22

The IV pump infusing at a higher rate than prescribed.

Question 23

After consulting with the HCP, the nurse is to administer a heparin antagonist. The nurse explains to the client that protamine sulfate is being administered to obtain which expected outcome?

Neutralize blood clots.

Reduce hematuria.

Prevent blood clots.

Avoid strokes.

Answer 23

Reduce hematuria.

Question 24

Another less common complication of heparin therapy is Heparin Induced Thrombocytopenia (HIT). What if the client develops fever and chills? Based on these cues, the nurse recognizes that it is essential to obtain which information first?

Platelet count.

. White blood cell count (WBC).

Renal function tests.

Client’s fluid intake and output.

Answer 24

Platelet count.

To detect HIT, observe the client for decreasing platelet count, skin lesions at the injection site, and systemic reactions such as chills and fever.

Question 25

Which action can be delegated by the nurse to the UAP?

Assess skin for bruising.

Teach the client to use a soft toothbrush.

Review the side effect of anticoagulants.

Obtain stool specimen for guaiac.

Answer 25

Obtain stool specimen for guaiac.

Question 26

With a diagnosis of pneumonia, which assessment finding warrants immediate intervention by the nurse?

Oxygen saturation 90%.

Blood pressure (BP) 132/78 mmHg.

Heart rate 120 beats/minute.

Inelastic skin turgor.

Answer 26

Oxygen saturation 90%.

Question 27

____ pH indicates that acidosis is present.

Answer 27

Low

Question 28

Which nursing action should be implemented before the prescribed levofloxacin is administered?

Auscultate lung sounds.

Assess oral intake.

Obtain a sputum culture with sensitivity.

Assist client to the bathroom.

Answer 28

Obtain a sputum culture with sensitivity.

Question 29

While the client is undergoing nebulizer treatments with albuterol, which assessment is it most important for the nurse to perform?

Monitor pulse oximeter readings.

Monitor respiratory rate.

Monitor pulse and blood pressure.

Monitor temperature.

Answer 29

Monitor pulse and blood pressure.

Question 30

The triad of treatment for a client experiencing a ____________ crisis is: hydration, pain management, and oxygenation

Answer 30

sickle cell