chapter 33 med surge

8/12/2019 Chapter 33 med surge

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Information Field: Page and #eader#ighest $nswer Letter: %

&ultiple 'eywords in Same Paragraph: No

Chapter: Chapter ((: $ssessment and &anagement of Patients )ith #ematologic Disorders

&ultiple Choice

*+ ,ou are caring for a patient with a hematologic disorder+ -he patient as.s you where the !ody

forms !lood cells+ )here would you tell the patient that !lood cells are formed/$0 In the spleenB0 In the .idneys

C0 In the !one marrow

D0 In the liver

$ns: C

Chapter: ((

Client Needs: D1*Cognitive Level: Comprehension

Difficulty: %asy

Integrated Process: Nursing Process!"ective: *

Page and #eader: 2345 $natomic and Physiologic verview

Feed!ac.: Bone marrow is the primary site for hematopoiesis+ -he liver and spleen may !e

involved during em!ryonic development or when marrow is destroyed+ -he .idneys release

erythropoietin5 which stimulates the marrow to increase production of 6BCs+ Blood cells are not

formed in the spleen5 .idneys5 or liver+


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7+ $n elderly man trips over his dog and receives an in"ury to the s.in5 which causes minor!lood loss+ Primary hemostasis is activated in this patient+ )hat occurs in primary hemostasis/

$0 Severed !lood vessels constrict+

B0 -hrom!oplastin is released+C0 Prothrom!in is converted to throm!in+

D0 Fi!rin is lysed+

$ns: $

Chapter: ((

Client Needs: D14

Cognitive Level: ComprehensionDifficulty: &oderate

Integrated Process: Nursing Process

!"ective: 7


Feed!ac.: Primary hemostasis involves the severed vessel constricting and platelets collecting atthe in"ury site+ Secondary hemostasis occurs when throm!oplastin is released5 prothrom!in

converts to throm!in5 and fi!rin is lysed+

(+ $ patient has come to the B9,N clinic with complaints of a heavy menstrual flow+ -henurse .nows that red !lood cell production will !e increased in the patient;s !ody+ Because of

this5 the nurse is aware that the patient may need to increase her daily inta.e of what/

$0


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4+ ,ou are caring for a patient with a diagnosis of hypoproliferative anemia+ ,ou are aware that

this type of anemia is due to what/

$0 Lac. of production of 6BCsB0 Loss of 6BCs

C0 In"ury to the 6BCs in circulation

D0 $!normality of 6BCs

$ns: $

Chapter: ((

Client Needs: D14Cognitive Level: Comprehension

Difficulty: %asy


!"ective: (Page and #eader: 2*35 $nemia

Feed!ac.: #ypoproliferative anemia is usually a result of inade>uate num!ers of 6BCs !eing

produced !y the !one marrow+ Loss of 6BCs is usually a result of !lood loss+ #emolytic anemia

can !e a result of in"ury to the 6BCs in circulation5 possi!ly due to heart valve hemolysis+$!normality of 6BCs can occur in sic.le cell anemia+

=+ $ nurse is caring for a *?1year1old who has sic.le cell anemia+ -he nurse is concerned a!out

su!stance a!use in this patient+ )hat would the nurse encourage the patient to do to preventsu!stance a!use of analgesics in this patient/

$0 See. care from a variety of sources for pain relief+

B0 See. care from a single provider for pain relief+C0 $ccept chronic pain !eing continually present as a fact of the disease+

D0 Limit the reporting of emergency department visits to the primary health care provider+

$ns: BChapter: ((

Client Needs: D1(

Cognitive Level: $pplicationDifficulty: %asy

Integrated Process: -eaching9Learning

!"ective: 4Page and #eader: 2745 #emolytic $nemias

Feed!ac.: -he patient should !e encouraged to use a single primary health care provider to

address health care concerns+ %mergency department visits should !e reported to the primary


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health care provider to achieve optimal management of the disease+

?+ $ *71year1old on the oncology unit at children;s hospital tells the nurse that they havediscovered there are different .inds of leu.emia+ -he child as.s the nurse to e@plain what ma.es

them all Aleu.emia+ )hat would the nurse reply

$0 -he different leu.emias all have unregulated proliferation of white !lood cells+B0 -he different leu.emias all have unregulated proliferation of red !lood cells+

C0 -he different leu.emias all have a decrease in production of white !lood cells+

D0 -he different leu.emias all have a decrease in production of red !lood cells+

$ns: $

Chapter: ((

Client Needs: D14

Cognitive Level: $pplicationDifficulty: &oderate

Integrated Process: -eaching9Learning!"ective: =

Page and #eader: 2(75 Leu.emia

Feed!ac.: Leu.emia commonly involves unregulated proliferation of white !lood cells+

Decreased production of red !lood cells is associated with anemias+ Decreased production of

white !lood cells is associated with leu.openia+

+ ,ou are the nurse caring for a patient with acute leu.emia+ )hat would you do to assess the

ris. for infection/

$0 &onitor creatinine levelsB0 &onitor hepatic function tests

C0 &onitor electrolyte levels

D0 &onitor )BC count

$ns: D

Chapter: ((

Client Needs: D1(Cognitive Level: $pplication

Difficulty: %asy

Integrated Process: Nursing Process!"ective: ?

Page and #eader: 2(5 Chronic Lymphocytic Leu.emia

Feed!ac.: -o monitor the ris. of infection5 the nurse should chec. the )BC count to assess the


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ris. for infection+ -herefore options $5 B5 and C are incorrect+

8+ -he nursing instructor is tal.ing with the students a!out the care of a patient with multiplemyeloma who is e@periencing !one destruction+ )hat would the instructor tell the students the

patient should !e assessed for signs of/

$0 #ypercalcemiaB0 #yperproteinemia

C0 %levated serum viscosity

D0 %levated 6BC count

$ns: $

Chapter: ((

Client Needs: D14


Integrated Process: Nursing Process!"ective:

Page and #eader: 24=5 &ultiple &yeloma

Feed!ac.: #ypercalcemia may occur when !one destruction occurs due to the disease process+

%levated serum viscosity occurs !ecause plasma cells e@crete e@cess immunoglo!ulin+ 6BC

count will !e decreased+ #yperproteinemia would not !e present+

2+ $ patient newly diagnosed with throm!ocytopenia is admitted to your unit+ $fter the

admission assessment5 the patient as.s you to e@plain the disease to her+ )hat would you e@plain

to the patient a!out this condition/$0 -here could !e an attac. on the platelets !y the anti!odies+

B0 -here could !e decreased production of platelets+

C0 -here could !e elevated platelet production+

D0 -here could !e decreased white !lood cell production+

$ns: B

Chapter: ((Client Needs: D14

Cognitive Level: $pplication

Difficulty: &oderateIntegrated Process: -eaching9Learning

!"ective: 8

Page and #eader: 2425 -hrom!ocytopenia


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Feed!ac.: -hrom!ocytopenia can result from a decreased platelet production5 increased platelet

destruction5 or increased consumption of platelets+ Increased production of platelets is associated

with throm!ocythemia5 and decreased white !lood cell production is associated with leu.openia+

*3+ $ critical care nurse is caring for a patient with autoimmune hemolytic anemia+ -he patient

is not responding to conservative treatments5 and his condition is now !ecoming life threatening+-he nurse is aware that a treatment option in this case may include what/

$0 #epatectomy

B0


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!"ective: 2

Page and #eader: 2?25 -ransfusion

Feed!ac.: uelae of multiple myeloma+ #ypo@emia is not usually related to multiple myeloma+

*(+ $ student nurse is caring for a patient who is receiving chemotherapy for cancer+ -he student

nurse reviews the la!oratory data with his preceptor and notes that the patient has

throm!ocytopenia+ )hich nursing diagnosis should the nurse give the highest priority/$0 $ctivity intolerance

B0 Impaired tissue integrity

C0 Impaired oral mucous mem!ranesD0 Ineffective tissue perfusion cere!ral5 cardiopulmonary5 I0

$ns: D

Chapter: ((


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Client Needs: D1(

Cognitive Level: $nalysis

Difficulty: &oderateIntegrated Process: Nursing Process

!"ective: 8

Page and #eader: 2=85 Disseminated Intravascular Coagulation

Feed!ac.: -hese are all appropriate nursing diagnoses for the client with throm!ocytopenia

reduced platelet count0+ #owever5 the ris. of cere!ral and I hemorrhage and hypotension posethe greatest ris. to the client;s physiologic integrity+

*4+ $ patient with advanced leu.emia is responding poorly to treatment+ ,ou find the patient

tearful and trying to e@press his feelings5 !ut he is having difficulty+ )hat would !e your first

nursing action/$0 -ell him that you;ll leave for now !ut you;ll !e !ac.+

B0 ffer to call pastoral care+C0 $s. if he would li.e you to sit with him while he collects his thoughts+

D0 -ell him that you can understand how he;s feeling+

$ns: C

Chapter: ((

Client Needs: C


Integrated Process: Caring

!"ective: ?Page and #eader: 2(25 Chronic Lymphocytic Leu.emia

Feed!ac.: Providing emotional support and discussing the uncertain future are crucial+ ption $is incorrect !ecause leaving the patient doesn;t show acceptance of his feelings+ ption B is

incorrect !ecause offering to call pastoral care may !e helpful for some patients !ut should !e

done after the nurse has spent time with the patient+ ption D is incorrect !ecause telling the

patient that you understand how he;s feeling is inappropriate !ecause it doesn;t help him e@presshis feelings+

*=+ -he nurse is providing education to a patient with iron deficiency anemia who has !eenprescri!ed iron supplements+ )hat will the nurse include in her teaching/

$0 -a.e the iron with dairy products to enhance a!sorption+

B0 Increase the inta.e of vitamin % to enhance a!sorption+

C0 Iron will cause the stools to dar.en in color+


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D0 Limit foods high in fi!er due to the ris. for diarrhea+

$ns: CChapter: ((

Client Needs: D17



!"ective: 4Page and #eader: 2*=5 #ypoproloferative $nemias

Feed!ac.: -he nurse will inform the patient that iron will cause the stools to !ecome dar. in

color+ Iron should !e ta.en on an empty stomach5 as its a!sorption is affected !y food5 especiallydairy products+ Patients should !e instructed to increase their inta.e of vitamin C to enhance iron

a!sorption+ Foods high in fi!er should !e consumed to minimiEe pro!lems with constipation5 a

common side effect associated with iron therapy+

*?+ ,ou are assessing a new patient with complaints of a sore5 red5 and smooth tongue+ Based

upon your assessment findings5 you .now that the patient is demonstrating symptoms associatedwith what/

$0 Sic.le cell anemia

B0 #emolytic anemia

C0 &egalo!lastic anemiaD0 $plastic anemia

$ns: CChapter: ((

Client Needs: D14



!"ective: (

Page and #eader: 2*5 #ypoproloferative $nemias

Feed!ac.: $ red5 smooth5 sore tongue is a symptom associated with meaglo!lastic anemia+ Iron

deficiency anemia may !e characteriEed !y a smooth5 red tongue+ Sic.le cell and hemolyticanemia do not have symptoms involving the tongue+

*+ $ nursing student is caring for a patient with acute myeloid leu.emia who is preparing to

undergo induction therapy+ In preparing a plan of care for this patient5 the student should assign


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the highest priority to which nursing diagnoses/

$0 $ctivity intolerance

B0 6is. for infectionC0 Distur!ed processes

D0 6is. for spiritual distress

$ns: B

Chapter: ((

Client Needs: D14Cognitive Level: $nalysis

Difficulty: &oderate


!"ective: =Page and #eader: 2(45 $cute &yeloid Leu.emia

Feed!ac.: Induction therapy places the patient at ris. for infection5 and this is the priority

nursing diagnosis+ During the time of induction therapy5 the patient is very ill5 with !acterial5fungal5 and occasional viral infections !leeding and severe mucositis5 which causes diarrhea

and mar.ed decline in the a!ility to maintain ade>uate nutrition+ Supportive care consists ofadministering !lood products and promptly treating infections+ ptions $5 C5 and D are valid

nursing diagnosis for this patient !ut they are not the highest priority+

*8+ $ patient with renal failure has decreased erythropoietin production+ Gpon analysis of thepatient;s complete !lood count5 the nurse will e@pect which of the following complete !lood

count results/

$0 $n increased hemoglo!in and hematocritB0 $ decreased hemoglo!in and hematocrit

C0 $ decreased &C< and &C#

D0 $n increased &C< and &C#

$ns: B

Chapter: ((

Client Needs: D14Cognitive Level: $nalysis

Difficulty: Difficult

Integrated Process: Nursing Process!"ective: *

Page and #eader: 2*75 $nemia

Feed!ac.: -he decreased production of erythropoietin will result in a decreased hemoglo!in and

hematocrit+ -he patient will have normal &C< and &C# values+ -his ma.es options $5 C5 and

D incorrect+


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*2+ $ student as.s the physiology instructor a!out the clotting cascade+ -he instructor e@plains

that plasminogen is a component necessary in the clotting cascade+ )here in the !ody is

plasminogen present/$0 &yocardial muscle tissue

B0 $ll !ody fluids

C0 Cere!ral tissueD0 6enal tissue

$ns: B


Cognitive Level: Comprehension

Difficulty: %asy

Integrated Process: Nursing Process!"ective: 7


Feed!ac.: Plasminogen5 which is present in all !ody fluids5 circulates with fi!rinogen+

Plasminogen is found in !ody fluids5 not tissue+

73+ $ patient comes to the clinic complaining of fatigue and pica+ La!oratory findings reveal a

low serum iron level and a low ferritin level+ )hat would the nurse suspect that the patient will

!e diagnosed with/$0 Iron deficiency anemia

B0 Pernicious anemia

C0 Sic.le cell anemiaD0 #emolytic anemia

$ns: $




!"ective: (

Page and #eader: 2*45 #ypoproloferative $nemias

Feed!ac.: $ low serum iron level5 a low ferritin level5 and symptoms of pica are associated with

iron deficiency anemia+ -IBC may also !e elevated+ None of the other anemias are associated

with pica+


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7*+ ,ou are caring for a patient whose !one marrow has !een replaced !y scar tissue in many of

the areas that produce !lood cells for the !ody+ )hat organs can !ecome active in !lood cellproduction !y the process of e@tramedullary hematopoiesis/

$0 Spleen and .idneys

B0 'idneys and pancreasC0 Pancreas and liver

D0 Liver and spleen

$ns: DChapter: ((

Client Needs: $1*



!"ective: *Page and #eader: 2345 $natomic and Physiologic verview

Feed!ac.: In adults with disease that causes marrow destruction5 fi!rosis5 or scarring5 the liverand spleen can also resume production of !lood cells !y a process .nown as e@tramedullary

hematopoiesis+ -he .idneys and pancreas do not produce !lood cells for the !ody+

&ultiple Selection

77+ In the process of hematopoiesis stem cells differentiate into either myeloid or lymphoid stem

cells+ )hat do myeloid stem cells further differentiate into/ &ar. all that apply+0

$0 Leu.ocytesB0 &ast cells

C0 -hrom!ocytes

D0 Platelets%0 %rythrocytes

$ns: $5 D5 %Chapter: ((

Client Needs: $1*




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!"ective: *

Page and #eader: 2345 $natomic and Physiologic verviewFeed!ac.: &yeloid stem cells differentiate into three !road cell types: erythrocytes5 leu.ocytes5

and platelets+

&ultiple Choice

7(+ )hen a human !ody receives an in"ury that causes !lood loss5 there are several processes

involved in maintaining hemostasis+ )hen a !lood clot is no longer needed5 what digests the

fi!rinogen and fi!rin/$0 Plasminogen

B0 -hrom!inC0 Prothrom!in

D0 Plasmin

$ns: D

Chapter: ((

Client Needs: B

Cognitive Level: ComprehensionDifficulty: &oderate


!"ective: 7Page and #eader: 2325 $natomic and Physiologic verview

Feed!ac.: -he su!stance plasminogen is re>uired to lyse !rea. down0 the fi!rin+ Plasminogen5which is present in all !ody fluids5 circulates with fi!rinogen and is therefore incorporated into

the fi!rin clot as it forms+ )hen the clot is no longer needed eg5 after an in"ured !lood vessel has

healed05 the plasminogen is activated to form plasmin+ Plasmin digests the fi!rinogen and fi!rin+

Prothrom!in is converted to throm!in,which in turn catalyEes the conversion of fi!rinogen tofi!rin so a clot can form+

74+ $ *?1year1old female comes into the clinic complaining of fatigue+ Blood wor. shows anincreased !iliru!in concentration and an increased reticulocyte count+ )hat would the nurse

suspect the patient has/

$0 $ hypoproliferative anemia

B0 $ leu.emia


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C0 $ !leeding disorder

D0 $ hemolytic anemia

$ns: D

Chapter: ((

Client Needs: BCognitive Level: $pplication


Integrated Process: -eaching9Learning!"ective: (


Feed!ac.: In hemolytic anemias5 premature destruction of erythrocytes results in the li!erationof hemoglo!in from the erythrocytes into the plasma the released hemoglo!in is converted in

large part to !iliru!in5 and therefore the !iliru!in concentration rises+ -he increased erythrocyte

destruction leads to tissue hypo@ia5 which in turn stimulates erythropoietin production+ -his

increased production is reflected in an increased reticulocyte count as the !one marrow respondsto the loss of erythrocytes+ ptions $5 B5 and C are incorrect+

7=+ -he nurse is caring for a patient with severe anemia+ -he patient is tachycardic and

complains of diEEiness and e@ertional dyspnea+ -he nurse .nows that in an effort to deliver more

!lood to hypo@ic tissue the wor.load on the heart is increased+ )hat signs and symptoms might

develop if this patient goes into heart failure/$0 #epatomegaly

B0 $scites

C0 Fluid overloadD0 Pulmonary edema

$ns: $Chapter: ((

Client Needs: D14


Difficulty: DifficultIntegrated Process: Caring

!"ective: 4


Feed!ac.: Cardiac status should !e carefully assessed+ )hen the hemoglo!in level is low5 the

heart attempts to compensate !y pumping faster and harder in an effort to deliver more !lood tohypo@ic tissue+ -his increased cardiac wor.load can result in such symptoms as tachycardia5

palpitations5 dyspnea5 diEEiness5 orthopnea5 and e@ertional dyspnea+ #eart failure may eventually

develop5 as evidenced !y an enlarged heart cardiomegaly0 and liver hepatomegaly0 and !y

peripheral edema+ -his patient would not e@hi!it ascites5 fluid overload5 or pulmonary edema+


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7?+ $ patient is admitted to the hospital with pernicious anemia+ )hat possi!le complications

would the nurse caring for this patient .now to monitor for/$0 Pulmonary edema

B0 Confusion

C0 Peripheral edemaD0 $scites

$ns: B

Chapter: ((Client Needs: D1(



Integrated Process: Nursing Process!"ective: 4

Page and #eader: 2*(5 $nemia

Feed!ac.: Based on the assessment data5 potential complications that may develop include heart

failure5 angina5 paresthesias5 and confusion+ Potential complications of the anemias generally donot include pulmonary or peripheral edema or ascites+

7+ $ ?1year1old male is admitted to your unit with a suspected diagnosis of acute myeloid

leu.emia $&L0+ -he patient as.s you how much time he has left+ )hat would you tell thispatient/

$0 A-he =1year survival rate for $&L is (=H+

B0 ANo one can predict who lives and who dies+C0 A-he =1year survival rate for those older than ?= years of age is 4H+

D0 A-hat is something I can;t answer for you+

$ns: CChapter: ((

Client Needs: B

Cognitive Level: $nalysisDifficulty: &oderate

Integrated Process: Communication and Documentation

!"ective: =Page and #eader: 2((5 $cute &yeloid Leu.emia

Feed!ac.: -he =1year survival rate for patients with $&L who are ?= years of age or younger is

(=H it drops to 4H for those older than ?= years of age+ ptions B and D are incorrect !ecause


16/23

they avoid answering the patient;s >uestion+ ption $ is incorrect !ecause is not a complete

correct answer to the patient;s >uestion+

78+ $ (=1year1old male is admitted to the hospital complaining of severe headaches5 vomiting5

and testicular pain+ #is !lood wor. shows reduced num!ers of platelets5 leu.ocytes5 and

erythrocytes with a high proportion of immature cells+ -he nurse caring for this patient suspects adiagnosis of what/

$0 $&L

B0 C&L

C0 &DSD0 $LL

$ns: D

Chapter: ((Client Needs: $1*

Cognitive Level: $nalysisDifficulty: &oderate


!"ective: =Page and #eader: 2(?5 Chronic Lymphocytic Leu.emia

Feed!ac.: In acute lymphocytic leu.emia5 manifestations of leu.emic cell infiltration into other

organs are more common than with other forms of leu.emia5 and include pain from an enlargedliver or spleen and !one pain+ -he central nervous system is fre>uently a site for leu.emic cells

thus5 patients may e@hi!it headache and vomiting !ecause of meningeal involvement+ ther

e@tranodal sites include the testes and !reasts+

72+ $ patient with leu.emia has developed stomatitis and is not eating+ $n oral anesthetic has

!een prescri!ed+ )hat would you warn the patient a!out/

$0 Chew with e@treme care to avoid inadvertently !iting the tongue+B0 Gse the oral anesthetic * hour prior to meal time+

C0 Brush the teeth !efore and after eating+

D0 Swallow slowly+

$ns: $

Chapter: ((Client Needs: D1(





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!"ective: ?

Page and #eader: 2(25 Chronic Lymphocytic Leu.emia

Feed!ac.: If oral anesthetics are used5 the patient must !e warned to chew with e@treme care to

avoid inadvertently !iting the tongue or !uccal mucosa+ $n oral anesthetic would !e meta!oliEed

!y the time the patient eats if it is used * hour prior to meals+ ,ou would not warn the patienta!out !rushing the teeth or swallowing slowly !ecause an oral anesthetic has !een used+

(3+ $ patient diagnosed with leu.emia has "ust !een admitted to the oncology unit+ ,ou are

helping to write this patient;s care plan+ ,ou .now that potential complications for patients withleu.emia include what/

$0 Pancreatitis

B0 DIC

C0 Nutritional e@cessD0 Liver dysfunction

$ns: B

Chapter: ((

Client Needs: D1(Cognitive Level: $nalysis



!"ective: ?Page and #eader: 2(85 Chronic Lymphocytic Leu.emia

Feed!ac.: Based on the assessment data5 potential complications that may develop includeinfection5 !leeding9DIC5 renal dysfunction5 tumor lysis syndrome5 nutritional depletion5

mucositis5 depression5 and an@iety+ Pancreatitis and liver dysfunction are generally not

complications of leu.emia+

(*+ ,ou are triaging patients in the wal.1in clinic+ $ 1year1old man comes in complaining of

fatigue and !ac. pain+ )hat should !e closely evaluated in this patient/

$0 #odg.in;s diseaseB0 Non1#odg.in;s lymphoma

C0 &ultiple myeloma

D0 $cute throm!ocythemia

$ns: C

Chapter: ((

Client Needs: D14


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Integrated Process: Nursing Process!"ective:

Page and #eader: 24?5 &ultiple &yeloma

Feed!ac.: Bac. pain5 which is often a presenting symptom in multiple myeloma5 should !e

closely investigated in older patients+ -he lymphomas and !leeding disorders do not present with

the primary symptom of !ac. pain+

(7+ -he home health nurse is caring for a patient with multiple myeloma+ )hat does the nurse

.now is a priority issue to !e managed in a patient with multiple myeloma/

$0 Nutrition

B0 StressC0 Coping

D0 Pain

$ns: D




Integrated Process: Caring!"ective:

Page and #eader: 24?5 &ultiple &yeloma

Feed!ac.: Pain management is very important in patients with multiple myeloma+ Nutrition5

stress5 and coping may !e issues the home health nurse addresses5 !ut the priority management

issue is pain+

((+ ,ou are caring for a patient with #odg.in;s lymphoma at the oncology clinic+ )hile doing

patient teaching you .now you need to stress what/

$0 6is. of infectionB0 Need for nutritious diet

C0 Need for ade>uate sleep

D0 6is. of losing support networ.

$ns: $

Chapter: ((

Client Needs: D1(


19/23



Integrated Process: -eaching9Learning!"ective:

Page and #eader: 24(5 #odg.in Lymphoma

Feed!ac.: Patients need to !e taught to minimiEe the ris.s of infection5 to recogniEe signs of

possi!le infection5 and to contact their health care provider if such signs develop+ $ nutritious

diet and ade>uate sleep may !e included in the teaching !ut will not !e stressed li.e the ris. ofinfection+ ption D is a distracter for this >uestion+

(4+ ,ou are doing patient teaching with a patient newly diagnosed with primary

throm!ocythemia+ )hile teaching the patient a!out the signs and symptoms of throm!osis5 what

neurologic manifestations would you include/$0 %cchymosis

B0


20/23

$0 $ntihypertensives

B0 Penicillins

C0 Sulfa1containing medicationsD0 $spirin1!ased drugs

%0 NS$IDs

$ns: C5 D5 %

Chapter: ((

Client Needs: D17Cognitive Level: $pplication



!"ective: 8Page and #eader: 2=*5 Idiopathic -hrom!ocytopenic Purpura

Feed!ac.: -he nurse must !e alert for sulfa1containing medications and others that alter platelet

function eg5 aspirin1!ased or other NS$IDs0+ -he antihypertensive drugs and the penicillins do

not alter platelet function+

&ultiple Choice

(?+ $ patient5 7= years of age5 comes to the emergency department complaining of e@cessive

!leeding from a cut sustained when cleaning a .nife+ Blood wor. shows a prolonged P- !ut a

vitamin ' deficiency is ruled out+ )hen assessing the patient5 areas of ecchymosis are noted onother areas of the !ody+ -he nurse caring for this patient suspects what/

$0 Lymphoma

B0 Leu.emiaC0 #emophilia

D0 #epatic dysfunction

$ns: DChapter: ((

Client Needs: B



!"ective: 2Page and #eader: 2=45 Liver Disease

Feed!ac.: Prolongation of the P-5 unless it is caused !y vitamin ' deficiency5 may indicate

severe hepatic dysfunction+ ption C is incorrect as the ma"ority of hemophiliacs are diagnosed


21/23

as children+ -he scenario does not descri!e signs or symptoms of lymphoma or leu.emia+

(+ $ patient is admitted to the ICG with a diagnosis of !leeding esophageal varices+ -he patienthas a comor!idity of cirrhosis+ $n attempt to stop the !leeding has !een only partially successful+

)hat would the critical care nurse e@pect to have ordered for this patient/

$0 Fresh froEen plasmaB0


22/23

Page and #eader: 2??5 Procuring Blood and Blood Products

Feed!ac.: -he primary advantage of autologous transfusions is the prevention of viral infectionsfrom another person;s !lood+ ther advantages include safe transfusion for patients with a history

of transfusion reactions5 prevention of alloimmuniEation5 and avoidance of complications in

patients with alloanti!odies+

(2+ -he nurse on the pediatric unit is caring for a *31year1old !oy with a diagnosis of

hemophilia+ -he nurse .nows that a priority nursing diagnosis for a patient with hemophilia is

what/$0 Infection

B0 Self1image

C0 Coping

D0 Nutrition

$ns: CChapter: ((

Client Needs: D14

Cognitive Level: $nalysisDifficulty: Difficult


!"ective: 8

Page and #eader: 2=(5 #emophilia

Feed!ac.: &ost patients with hemophilia are diagnosed as children+ -hey often re>uire

assistance in coping with the condition !ecause it is chronic5 places restrictions on their lives5and is an inherited disorder that can !e passed to future generations+ From childhood5 patients are

helped to cope with the disease and to identify the positive aspects of their lives+ -hey are

encouraged to !e self1sufficient and to maintain independence !y preventing unnecessary traumathat can cause acute !leeding episodes and temporarily interfere with normal activities+ $s they

wor. through their feelings a!out the condition and progress to accepting it5 they can assume

more and more responsi!ility for maintaining optimal health+ $ll of the other options need to !e

addressed with these patients5 !ut they are not all priorities+

43+ $ patient with non1#odg.in;s lymphoma is receiving information from the oncology nurse+

-he patient as.s the nurse why she should stop drin.ing and smo.ing and stay out of the sun+)hat would !e the nurse;s !est response/

$0 A%veryone should do these things+

B0 A,ou don;t want to develop a second cancer5 do you/

C0 Aust to !e on the safe side+


23/23

D0 A,ou need to reduce other factors that increase the ris. of developing second cancers+

$ns: DChapter: ((

Client Needs: D14

Cognitive Level: $pplicationDifficulty: %asy


!"ective: Page and #eader: 2445 Non1#odg.in Lymphomas

Feed!ac.: -he nurse should encourage patients to reduce other factors that increase the ris. of

developing second cancers5 such as use of to!acco and alcohol and e@posure to environmentalcarcinogens and e@cessive sunlight+ ptions $5 B5 and C do not answer the patient;s >uestion5

and also ma.e light of the patient;s >uestion+

chapter 33 med surge

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