<P>

<Q>The
<TYPE>single</TYPE>
nurse would assess a client who has undergone a small bowel resection of
the ileum forof
<MC1>Sickle
<MC2>Vitamin
<MC3>Anemia
<MC4>Aplastic
<F>Rationale:
<CORRECT>2</CORRECT>
cell
B₁₂
development
anemia</MC4>
Resection
chronic
anemia</MC1>
disease</MC3>
ofofthe
deficiency
which
distal
typeileum
anemia</MC2>
of anemia?</Q>
results in the impaired absorption o
f vitamin B₁₂ (option 2). Sickle cell anemia (option 1) and G6PD anem
ia (option 3) are both genetic. Aplastic anemia results from inadequate producti
on of RBC
Cognitive
Client
Integrated
Content
Strategy:
Need:
Area:
from
Level:
Define
Process:
Physiological
Adult
theeach
Application
bone
Nursing
Health:
ofmarrow
theIntegrity:
Process:
Hematological
anemias
(optionin
Assessment
Physiological
4).
the distracters.
Adaptation
Compare these definitio
ns to the situation
Reference: LeMone, P., in &theBurke,
question.
K. (2008). <i>Medical-surgical nursing: Critical
thinking in client care</i> (4th ed.). Upper Saddle River, NJ: Pearson Educatio
n, p.client
<Q>A
<TYPE>single</TYPE>
<P>
</P> 1105.</F>
receiving a continuous infusion of heparin would likely have which o
f the followingHeparin
<MC1>Platelet
<MC2>Hemoglobin
<MC3>Activated
<MC4>Prothrombin
<F>Rationale:
<CORRECT>3</CORRECT>
count
partial
laboratory
oftime
8.5
below
ofthromboplastin
isgrams/dL</MC2>
14100,000/mm³</MC1>
an values?</Q>
seconds</MC4>
anticoagulant.
time Therapeutic
(aPTT) of 60dose
seconds</MC3>
is achieved when the
aPTT is 1.5 to 2 times normal (option 3). Sodium warfarin (Coumadin) would affe
ct the prothrombin time (option 4). Hemoglobin level and platelet count (options
Cognitive
Client
Integrated
Content
Strategy:
2 and Need:
1)Area:
are
Level:
Recall
Process:
Physiological
notthe
Adult
Application
affected
Nursing
Health:
mechanism
byHematological
Integrity:
Process:
the
of action
heparin.
Assessment
Pharmacologic
for heparinand
andParenteral
how to monitor
Therapies
for a th
erapeutic dose.
Reference: Adams,ThisM.,will
Holland,
allowL.,you&toBostwick,
choose the
P. (2008).
aPTT as <i>Pharmacology
the correct option.for nu
rses: A pathophysiologic approach</i> (2nd ed.). Upper Saddle River, NJ: Pearson
<Q>The
<TYPE>single</TYPE>
<P>
</P>
Education,
nursep.is383.</F>
assessing a group of clients and identifies which of the followi
ng clients as being at high risk for the development of folic acid deficiency an
<MC1>Obese
emia?</Q>
<MC2>A
<MC3>An
<MC4>An
<F>Rationale:
<CORRECT>2</CORRECT>
client
adolescent</MC3>
athlete</MC4>
individual</MC1>
with alcoholism</MC2>
Individuals who are chronically undernourished including the elder
ly, alcoholism, substance abuse, and those with high metabolic requirements and
on total parenteral nutrition are at risk for folic acid deficiency anemia (opti
on 2). Obesity is a risk factor for cardiovascular diseases (option 1). Athletes
are more inclined toward musculoskeletal injuries (option 4). Adolescents are m
ore inclined
Cognitive
Client
Integrated
Content
Strategy:
Need:
Area:
Level:
Note
Process:
toAdult
Health
that
trauma-related
Application
Promotion
Nursing
Health:
each of the
Process:
Hematological
and
injuries
distracters
Maintenance
Analysis
(option
is a3).
risk factor for specific diseas
es. Select the distracter that is directly related to the deficiencies of malnut
Reference: LeMone, P., & Burke, K. (2008). <i>Medical-surgical nursing: Critical
rition.
thinking in client care</i> (4th ed.). Upper Saddle River, NJ: Pearson Educatio
n, pp. 1105-1106.</F>
<Q>Which
<TYPE>single</TYPE>
<P>
</P> of the following questions during the data-gathering phase is important
<MC1>"Do
<MC2>"What
<MC3>"Do
<MC4>"Have
<F>Rationale:
<CORRECT>3</CORRECT>
for the you
nurse
color
youhave
experience
Vitamin
toare
noticed
askyour
any aanany
pain?"</MC1>
B₁₂
client
stools?"</MC2>
increase
tingling
suspected
indeficiency
orbruising?"</MC4>
numbness?"</MC3>
of having
anemia
a nutritional
causes neurologic
anemia?</Q>
symptom
s such as numbness and paresthesia (option 3). Pain occurs during a sickle cell
crisis because the RBC sickling clogs vessels and causes ischemia (option 1). Bl
ood loss as a cause of anemia can cause black or tar-colored stools (option 2).
Petechiae are an indication of the lack of production of platelets and indicate
a bone Need:
Cognitive
Client
Integrated
Content
Strategy:
marrow
Area:
Level:
Recall
Process:
Physiological
problem
Adult
Analysis
that
Nursing
Health:
a(option
nutritional
Integrity:
Process:
Hematological
4). anemia
Assessment
Physiological
is relatedAdaptation
to the type of food ingest
ed and/or absorbed. Eliminate distracters that are inconsistent with this type o
f anemia. LeMone, P., & Burke, K. (2008). <i>Medical-surgical nursing: Critical
Reference:
thinking in client care</i> (4th ed.). Upper Saddle River, NJ: Pearson Educatio
n, pp.couple
<Q>A
<TYPE>single</TYPE>
<P>
</P> 1105-1106.</F>
seeks genetic counseling for sickle cell anemia. Both individuals ha
ve sickle cell traits. The nurse concludes that the couple has what chance with
each pregnancySickle
<F>Rationale:
<CORRECT>2</CORRECT>
<MC4>100%</MC4>
<MC3>50%</MC3>
<MC2>25%</MC2>
<MC1>0%</MC1> of having
celladisease
child whois an
develops
autosomal
sickle
recessive
cell disease?</Q>
genetic disorder whe
re the individual is homozygous for the abnormal hemoglobin. If both parents hav
e sickle cell traits, there is a 25% chance that each pregnancy will produce a c
hild with
Cognitive
Client
Integrated
Content
Strategy:
Need:
Area:
the
Level:
This
Process:
Health
disease
Adult
question
Analysis
Promotion
Nursing
Health:
(option
is related
Process:
Hematological
2). Maintenance
and The
toAnalysis
othertransmission
the options therefore
of a recessive
cannot begene
true.
when
both parents are trait carriers. Recall that there are 4 scenarios: mother passe
s gene but father doesn't (trait); father passes gene and mother doesn't (trait)
; neither passes the gene; and both pass the gene (disease). Since there are 4 c
ombinations,LeMone,
Reference: reasonP.,that& Burke,
the riskK.is(2008).
therefore
<i>Medical-surgical
25%. nursing: Critical
thinking in client care</i> (4th ed.). Upper Saddle River, NJ: Pearson Educatio
n, p. 1107.</F>
<Q>The
<TYPE>single</TYPE>
<P>
</P> nurse is preparing a teaching plan for a client with sickle cell disease
about ways to prevent crisis episodes. Which of the following should be emphasiz
ed to prevent
<MC1>Eat
<MC2>Seek
<MC3>Take
<MC4>Avoid
<F>Rationale:
<CORRECT>2</CORRECT>
nutritious
treatment
adequate
anyClients
sickle
typeamounts
foods
for
ofcell
with
physical
infections
crisis?</Q>
that
of supplemental
sickle
are
activity.</MC4>
cell
highsoon
as disease
in vitamins
iron.</MC1>
as possible.</MC2>
have scarred
and minerals.</MC3>
spleen resulting in
decreased ability to fight off infection. The individual with sickle cell diseas
e must seek early treatment of infections (option 2). Options 1 and 3 are approp
riate treatments for an anemia related to nutritional deficiency. Normal physica
l activity does not have to be restricted in any type of anemia and should be de
terminedNeed:
Cognitive
Client
Integrated
Content
Strategy: Area:
byEliminate
Level:
Process:
symptoms
Health
Adult
Application
Promotion
Nursing
Health:
distracters
(optionHematological
Process:
4).
andthat
Maintenance
Planning
are unrelated to sickle cell anemia. Select
the distracter that is related to the destruction of the tissue as a result of
Reference: LeMone, P., & Burke, K. (2008). <i>Medical-surgical nursing: Critical
sickling.
thinking in client care</i> (4th ed.). Upper Saddle River, NJ: Pearson Educatio
n, pp. 1107-1108.</F>
<Q>Which
<TYPE>single</TYPE>
<P>
</P> of the following nursing diagnoses should receive the highest priority
in a client with
<MC2>Self-care
<MC1>Pain</MC1>
<MC3>Activity
<MC4>Ineffective
<F>Rationale:
<CORRECT>1</CORRECT>
intolerance</MC3>
The
deficit</MC2>
sickle
health
clientmaintenance</MC4>
cell
in sickle
crisis?</Q>
cell crisis will have pain related to ischemi
c tissue injury resulting from obstruction of blood flow (option 1). The other d
iagnoses although important are of lesser priority than the nursing diagnosis of
pain, especially since the others focus on activities of daily living and none
of themNeed:
Cognitive
Client
Integrated
Content
Strategy:significantly
Area:
Level:
The
Process:
Physiological
Adult
correct
Analysis
Nursing
Health:
address
response
Integrity:
Process:
Hematological
threats
is directly
Analysis
to therelated
Physiological
airway,toAdaptation
breathing,
the lack oforblood
circulation.
flow to
the tissue LeMone,
Reference: beyond the P.,area
& Burke,
of sickling
K. (2008).
and <i>Medical-surgical
occlusion. nursing: Critical
thinking in client care</i> (4th ed.). Upper Saddle River, NJ: Pearson Educatio
n, pp. 938-939.</F>
<Q>Which
<TYPE>single</TYPE>
<P>
</P> of the following statements made by a client with iron-deficiency anemi
a indicates
<MC1>"I
<MC2>"I should
thedilute
stop
needtaking
for
thefurther
liquid
the medicine
teaching?</Q>
iron preparation
if my stools
andturn
use ablack."</MC1>
straw when taking it
<MC3>"I can prevent the constipation by increasing the intake of fluids and fibe
."</MC2>
<MC4>"I should return to the clinic if my stomach upset worsens with this medica
r."</MC3>
<F>Rationale: The client taking an oral iron preparation should be taught to exp
<CORRECT>1</CORRECT>
tion."</MC4>
ect stools to be black because of the excessive iron that is eliminated (option
1). If the oral form is used, it should be placed on the back of the tongue with
a dropper or be well diluted and taken with a straw to avoid staining the teeth
(option 2). Iron can cause constipation, and fluids and fiber may prevent its d
evelopment (option 3). If GI symptoms develop, an enteric-coated tablet can be p
rescribed
Cognitive
Client
Integrated
Content
Strategy:
Need:
Area:
(option
Level:
Recall
Process:
Physiological
Pharmacology
Analysis
the
4).Nursing
mechanism
Integrity:
Process:
of action
Evaluation
Pharmacological
of iron and recommended
and Parenteral
procedures
Therapies
for
administration.
Reference: LeMone,Specific
P., & Burke,
nursingK.knowledge
(2008). <i>Medical-surgical
is needed to answer nursing:
this question.
Critical
thinking in client care</i> (4th ed.). Upper Saddle River, NJ: Pearson Educatio
n, pp. 1106-1108.</F>
<Q>Which
<TYPE>single</TYPE>
<P>
</P> of the following statements made by a client with sickle cell trait ind
icates the
<MC1>"I don't
needhave
fortofurther
worry about
teaching?</Q>
developing sickle cell crisis since I only hav
e the trait."</MC1>
<MC2>"I will need to seek genetic counseling before I get married and plan child
<MC3>"I will need to plan my activities, avoiding those that decrease my oxygen
ren."</MC2>
<MC4>"I need toClients
levels."</MC3>
<F>Rationale:
<CORRECT>1</CORRECT>
avoid with
the use
sickle
of recreational
cell trait maydrugs
alsoanddevelop
alcohol."</MC4>
sickle cell crisis
, although their symptoms are often milder since only about 30% of their hemoglo
bin is abnormal (option 1). Since sickle cell is transmitted genetically, geneti
c counseling is advised (option 2). Vigorous exercise can create tissue hypoxia
and cause a crisis (option 3). Recreational drugs and alcohol can induce a crisi
s (option
Cognitive
Client
Integrated
Content
Strategy:
Need:
Area:
4).
Level:
This
Process:
Health
Adult
itemApplication
Promotion
Nursing
Health:
is askingHematological
Process:
and selection
for Maintenance
Evaluation
of the distracter that does <i>not</
i> indicate an understanding of sickle cell disease. Select the distracter that
is inconsistent
Reference: LeMone,withP.,the& Burke,
disease.K. (2008). <i>Medical-surgical nursing: Critical
thinking in client care</i> (4th ed.). Upper Saddle River, NJ: Pearson Educatio
n, pp. 1106-1107.</F>
<Q>Which
<TYPE>single</TYPE>
<P>
</P> of the following nursing observations indicate that a positive outcome
for a clienthas
<MC1>Client
<MC2>Urinary
<MC3>Client
<MC4>Client
<F>Rationale:
<CORRECT>1</CORRECT>
complains
with
output
Anaanobservation
sickle
temperature
intake
isof20persistent
cell
of for
ml 3,000
per
crisis
of hour.</MC2>
100<deg>
the
mLjoint
has
client
perbeen
day.</MC1>
pain.</MC3>
F.</MC4>
inmet?</Q>
sickle cell crisis that indicates
a positive outcome includes an oral intake of 3,000 mL/day, which can help prev
ent a crisis by promoting blood flow (option 1). The normal urinary output is 30
mL/hour (option 2). Joint pain is indicative of a crisis (option 3). A temperat
ure elevation
Cognitive
Client
Integrated
Content
Strategy:
Need:
Area:
Level:
Eliminate
Process:
Safe
putsAnalysis
Adult Effective
the
Nursing
Health:
the client
distracters
Care
Process:
Hematological
at Environment:
riskthat
Evaluation
forare
a crisis
abnormal
Management
(option
findings.
of4).
CareSelect the distr
acter that LeMone,
Reference: indicatesP.,that & Burke,
the established
K. (2008).goal
<i>Medical-surgical
is accomplished.nursing: Critical
thinking in client care</i> (4th ed.). Upper Saddle River, NJ: Pearson Educatio
n, pp. 1106-1107.</F>
</P>