Chapter 31 My Nursing Test Banks

 

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E
Chapter 31

Question 1

Type: MCMA

The client receives epoetin alfa (Epogen) subcutaneously, and says to the nurse, My doctor said I have anemia. Are there little red blood cells in that shot? What are the best responses by the nurse?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Your kidney makes more erythropoietin if it doesnt get enough oxygen.

2. Erythropoietin also helps your body make hemoglobin.

3. This stimulates your kidney to make more red blood cells.

4. It is similar to a kidney hormone, erythropoietin, and helps your body make more red blood cells.

5. Your kidney makes more erythropoietin when you have too much fluid in your body.

Correct Answer: 1,2,4

Rationale 1: Erythropoiesis is regulated by the kidney hormone, erythropoietin. The primary signal for increased secretion is a reduction in oxygen reaching the kidney.

Rationale 2: This hormone reacts with receptors on hematopoietic stem cells to increase erythrocyte production. It also stimulates production of hemoglobin.

Rationale 3: Red blood cells are manufactured in the bone marrow, not in the kidney.

Rationale 4: Epoetin alfa is identical to the natural hormone erythropoietin and stimulates the production of red blood cells in the same manner.

Rationale 5: Reduced oxygen, not over-hydration is the stimulus for the kidney to produce additional erythropoietin.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 31-1

Question 2

Type: MCMA

The nurse is teaching a class on how red blood cell formation is regulated by the body to a group of clients who have AIDS. The nurse evaluates that learning has occurred when the clients make which statements?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Red blood cell formation is regulated through chemicals called colony-stimulating factors that come from white blood cells.

2. Red blood cell formation is regulated through messages from the hormone, secretin, which is located in the kidney.

3. Red blood cell formation is regulated through specific liver enzymes and a process called hemochromatosis.

4. Red blood cell formation is regulated through messages from the hormone erythropoietin.

5. Red blood cell formation is regulated through specific transporter proteins called apolipoprotein A and B.

Correct Answer: 4

Rationale 1: Colony-stimulating factors affect white blood cell production.

Rationale 2: Secretin stimulates the pancreas to release a fluid that neutralizes stomach acid and aids in digestion; it has nothing to do with red blood cell formation.

Rationale 3: Hemochromatosis refers to excess iron accumulation in the body, not to red blood cell formation.

Rationale 4: Regulation of hematopoiesis occurs through messages from hormones such as erythropoietin.

Rationale 5: Apolipoprotein refers to a protein found in cholesterol particles; it has nothing to do with red blood cell formation.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 31.2

Question 3

Type: MCSA

The client receives chemotherapy as therapy for cancer. The physician orders epoetin alfa (Procrit) subcutaneously. The client asks the nurse if this drug is also chemotherapy. What is the best response by the nurse?

1. No, but it works with your chemotherapy to make it more effective.

2. No, this drug helps to counteract the nausea and vomiting caused by your chemotherapy.

3. No, it will stimulate your immune system to help you battle the cancer.

4. No, this drug will help prevent anemia that can be caused by your chemotherapy.

Correct Answer: 4

Rationale 1: Epoetin alfa (Procrit) is prescribed to treat anemia associated with chemotherapy; it does not make the chemotherapy more effective.

Rationale 2: Epoetin alfa (Procrit) is prescribed to treat anemia associated with chemotherapy; it does not counteract nausea and vomiting.

Rationale 3: Epoetin alfa (Procrit) is prescribed to treat anemia associated with chemotherapy; it does not stimulate the immune system.

Rationale 4: Epoetin alfa (Procrit) is given to clients undergoing cancer chemotherapy to counteract the anemia caused by antineoplastic agents.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 31-3

Question 4

Type: MCSA

The client receives filgrastim (Neupogen). He asks the nurse, That is such a funny name; where do you suppose it comes from? What is the best response by the nurse?

1. It comes from the interleukins it stimulates; this one stimulates neuocytes.

2. It comes from the blood cell it stimulates; this one stimulates neutrophils.

3. It comes from the stem cells it stimulates, such as filgrastims.

4. It is a complicated process; the drug companies are secretive about it.

Correct Answer: 2

Rationale 1: There arent any interleukins named neuocytes.

Rationale 2: Colony-stimulating factors (CSFs) are named according to the types of blood cells that they stimulate. Granulocyte colony-stimulating factor (G-CSF) increases the production of neutrophils, the most common type of granulocyte.

Rationale 3: There arent any stem cells named filgrastims.

Rationale 4: Naming of drugs is not a complicated process.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 31.4

Question 5

Type: MCSA

The client is receiving ferrous sulfate (Feosol) for the treatment of anemia. The nurse has taught the client about this drug and about anemia. The nurse evaluates that learning has occurred when the client makes which statement?

1. My anemia was caused by blood loss from my ulcer, but there are other causes too.

2. My anemia was caused by drinking too many carbonated beverages with caffeine.

3. There are many causes for anemia; mine was caused by heart failure and fluid overload.

4. I think my anemia occurred when I started that vegetarian diet.

Correct Answer: 1

Rationale 1: The three categories of blood loss are hemorrhage, increased erythrocyte destruction, and impaired erythrocyte production.

Rationale 2: Anemia is not caused by too much caffeine.

Rationale 3: Anemia is not caused by heart failure or fluid overload.

Rationale 4: A well-balanced vegetarian diet will not result in anemia.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 31-5

Question 6

Type: MCSA

The client had stomach cancer and a surgical removal of his stomach several years ago. The physician prescribed cyanocobalamin (Crystamine). The client stopped this drug several months ago. What will the nurse most likely assess in this client?

1. Memory loss, numbness in the limbs, and depression

2. A gradual decrease in red blood cell counts

3. Jaundice, and tarry stools

4. Low hemoglobin and hematocrit counts

Correct Answer: 1

Rationale 1: The most common cause of vitamin B12 deficiency (pernicious anemia) is absence of intrinsic factor, a protein secreted by stomach cells. This protein is required for vitamin B12 to be absorbed from the intestine. Symptoms of pernicious anemia involve the nervous system, and include memory loss, confusion, tingling or numbness in the limbs, and mood disturbances.

Rationale 2: A decrease in red blood cells does not occur with pernicious anemia.

Rationale 3: Jaundice and tarry stools do not occur with pernicious anemia.

Rationale 4: Low hemoglobin and hematocrit counts do not occur with pernicious anemia. A decrease in red blood cells does not occur with pernicious anemia.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 31-6

Question 7

Type: MCSA

The client has chronic alcoholism. He asks the nurse why his doctor put him on folic acid (Folvite) since he promised the doctor that he would stop drinking. What is the best response by the nurse?

1. You should ask your doctor since you promised him that you would not drink anymore.

2. You have been drinking instead of eating, and alcohol interferes with folate metabolism in your liver.

3. You need folic acid to make up for the vitamin B12 deficiency that was caused by your alcoholism.

4. You need folic acid because you have not been compliant with taking your vitamins and attending Alcoholics Anonymous (AA) meetings.

Correct Answer: 2

Rationale 1: Referring the client back to the physician is inappropriate; the nurse can answer this question.

Rationale 2: Insufficient folic acid can manifest itself as anemia. This is often observed in chronic alcoholism, since alcoholics consume alcohol instead of eating nutritious foods. Alcohol interferes with folate metabolism in the liver.

Rationale 3: Folic acid anemia is not caused by a vitamin B12 deficiency.

Rationale 4: The client needs folic acid because his liver cannot metabolize folate, not because he has missed his vitamins and Alcoholics Anonymous (AA) meetings.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 31-7

Question 8

Type: MCSA

The nurse teaches a class on iron-deficiency anemia to a group of pregnant clients who are all taking ferrous sulfate (Feosol). The nurse evaluates that additional learning is needed when the clients make which statement?

1. Most iron in our bodies is stored on hemoglobin in the red blood cell.

2. Transferrin is a protein that transports iron to places in our bodies where it is needed.

3. We need extra iron because when our red blood cells die, all their iron is excreted from the body.

4. The most common cause of nutritional anemia is iron deficiency.

Correct Answer: 3

Rationale 1: Most iron in our bodies is stored on hemoglobin in the red blood cell.

Rationale 2: Transferrin is a protein that transports iron to places in our bodies where it is needed.

Rationale 3: After erythrocytes die, nearly all of the iron in their hemoglobin is incorporated into transferrin and recycled for later use.

Rationale 4: The most common cause of nutritional anemia is iron deficiency.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 31-8

Question 9

Type: MCSA

The physician has prescribed epoetin alfa (Epogen) for the client. What is the priority assessment by the nurse?

1. The clients blood pressure

2. The clients report of a headache, indicating a stroke

3. The clients ability to use the proper injection techniques for self-administration

4. The clients hemoglobin and hematocrit levels

Correct Answer: 1

Rationale 1: The most serious adverse effect of epoetin alfa (Epogen) is hypertension, which can raise blood pressure to dangerous levels, and which occurs in as many as 30% of clients receiving the drug.

Rationale 2: Clients are at risk for a stroke, but this is a complication of uncontrolled hypertension; blood pressure assessment is a priority.

Rationale 3: Assessment of hypertension takes precedence over injection techniques.

Rationale 4: Hemoglobin and hematocrit levels should be assessed, but they are not as high a priority as blood pressure.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 31-9

Question 10

Type: MCSA

The physician has ordered filgrastim (Neupogen) intravenously for the client. What is a priority plan by the nurse prior to administering this drug?

1. Plan to monitor the clients ECG readings.

2. Plan to insert a Foley catheter and monitor urine output.

3. Plan to administer 10% oxygen during the infusion.

4. Plan to have a white blood cell (WBC) count drawn every 30 minutes.

Correct Answer: 1

Rationale 1: Filgrastim (Neupogen) may cause abnormal ST-segment depression.

Rationale 2: There is no need to monitor urine output during the infusion.

Rationale 3: There is no need to administer oxygen during the infusion.

Rationale 4: There is no need to have a white blood cell (WBC) count drawn every 30 minutes.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 31-9

Question 11

Type: MCSA

The client is pregnant and has been told by her physician that she needs cyanocobalamin (Nascobal). She asks the nurse, Will this hurt my baby? What is the best response by the nurse?

1. No, this medication will not hurt your baby as long as you take it with ascorbic acid.

2. No, this is safe as long as long as you take it in pill form; it is a Pregnancy Category A drug, which means it is safe for your baby.

3. No, this medication will not hurt your baby as long as you take the pills only in the third trimester.

4. No, this is safe in either pill or injectable form; it is a Pregnancy Category A drug which means it is safe for your baby.

Correct Answer: 2

Rationale 1: Ascorbic acid affects the stability of cyanocobalamin (Nascobal), and should not be used concomitantly with cyanocobalamin.

Rationale 2: Cyanocobalamin (Nascobal), oral formulation, is a Pregnancy Category A drug, but it is a Pregnancy Category C when used parenterally.

Rationale 3: There is no evidence to support that oral cyanocobalamin (Nascobal) is teratogenic during the first or second trimesters.

Rationale 4: Cyanocobalamin (Nascobal) is a Pregnancy Category C when used parenterally.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 31-9

Question 12

Type: MCSA

The client complains of constipation while receiving ferrous sulfate (Feosol). What is the best plan by the nurse to assist the client in resolving this common side effect?

1. Plan to teach the client about which laxatives are the safest to use.

2. Plan to teach the client to increase fluids and high-fiber foods in the diet.

3. Plan to teach the client to self-administer Fleets enemas.

4. Plan to teach the client to increase exercise.

Correct Answer: 2

Rationale 1: The use of laxatives will make the bowel lazy and contribute to constipation.

Rationale 2: Constipation is a common side effect of ferrous sulfate; therefore, an increase in dietary fiber may be indicated.

Rationale 3: The use of Fleets enemas will make the bowel lazy and contribute to constipation.

Rationale 4: Increasing exercise will help relieve constipation, but is not as effective as other interventions.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 31-9

Question 13

Type: MCSA

The client is receiving chemotherapy for cancer. The physician has prescribed oprelvekin (Neumega). The nurse has completed medication education and evaluates it as effective when the client makes which statement?

1. This medication will help my chemotherapy work better.

2. This medication will help increase my platelet count.

3. This medication will help me regain the weight I have lost.

4. This medication will help increase my red blood cell count.

Correct Answer: 2

Rationale 1: Oprelvekin (Neumega) does not enhance the effectiveness of chemotherapy.

Rationale 2: Oprelvekin (Neumega) is used to stimulate the production of platelets in clients who are at risk for thrombocytopenia caused by cancer chemotherapy.

Rationale 3: Oprelvekin (Neumega) does not promote weight gain.

Rationale 4: Oprelvekin (Neumega) does not increase red blood cell count.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 31.9

Question 14

Type: MCSA

The client calls the nurse and is very frantic. I think something is wrong! My stools are black and they have never been this color before! The client is receiving ferrous sulfate (Feosol). What is the best response by the nurse?

1. This is an expected side effect of ferrous sulfate (Feosol); it is okay.

2. This sounds serious; you may have started bleeding again.

3. Do you have hemorrhoids? That could be the problem.

4. I will speak with your doctor and call you right back.

Correct Answer: 1

Rationale 1: Ferrous sulfate (Feosol) will turn stools a harmless, dark green or black color; this is an expected side effect of the medication.

Rationale 2: To tell a client that this sounds serious is non-therapeutic, as the nurse should know that black stools are an expected side effect of the drug.

Rationale 3: Hemorrhoids are unlikely the problem, they would cause bright red color in the stool.

Rationale 4: There is no need to call the physician; this is an expected side effect of the drug.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 31-10

Question 15

Type: MCSA

The process for regulating hematopoiesis occurs via

1. white bone marrow.

2. hematopoietic stem cell.

3. hormones.

4. essential vitamins and nutrients.

Correct Answer: 3

Rationale 1: Hematopoiesis occurs primarily in red bone marrow.

Rationale 2: The process of hematopoiesis begins with a stem cell.

Rationale 3: Regulation of hematopoiesis occurs through messages from hormones.

Rationale 4: Hematopoiesis occurs primarily in red bone marrow, and requires B vitamins, vitamin C, copper, iron, and other nutrients.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 31.1

Question 16

Type: MCSA

Colony-stimulating factors (CSFs) are named according to

1. type of blood cell stimulated.

2. type of hormone secreted.

3. type of homeostatic control.

4. type of stem cell stimulated.

Correct Answer: 1

Rationale 1: CSFs are named according to types of blood cells stimulated.

Rationale 2: The type of hormone is responsible for hematopoiesis regulation.

Rationale 3: Homeostatic control is influenced by hormones and growth factors.

Rationale 4: The type of stem cell stimulated is responsible for hematopoiesis.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 31-4

Question 17

Type: MCSA

In monitoring clients receiving hematopoietic agents, it is most important for the nurse to monitor for

1. thromboembolus.

2. TIA (transient ischemic attack).

3. MI (myocardial infarction).

4. stroke.

Correct Answer: 1

Rationale 1: Clients are at greater risk for thrombolitic disease, which can result in MI, stroke, and TIA.

Rationale 2: Transient ischemic attack can occur as a result of thromboembolic disease.

Rationale 3: Myocardial infarction can occur as a result of thromboembolic disease.

Rationale 4: Stroke can occur as a result of thromboembolic disease.

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 31-9

Question 18

Type: MCSA

To decrease gastric irritation, anti-anemia medications, such as ferrous sulfate (Ferosol), should be taken with

1. milk.

2. other medications, such as calcium.

3. orange juice.

4. food.

Correct Answer: 4

Rationale 1: Taking with milk would decrease absorption.

Rationale 2: Several medications can increase or decrease absorption.

Rationale 3: Taking with orange juice can increase gastric irritations.

Rationale 4: Taking iron medications with food will decrease gastric irritation.

Global Rationale:

Cognitive Level: Understanding

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 31-9

Question 19

Type: MCSA

The mechanism of action of colony-stimulating factors, such as filgrastim (Neupogen), is to

1. increase neutrophil production.

2. supplement iron in the body.

3. replace vitamin B12 factor.

4. increase erythrocyte production.

Correct Answer: 1

Rationale 1: The primary mechanism of action is to increase neutrophil production and phagocytosis in chemotherapy clients.

Rationale 2: Anti-anemic iron supplements increase iron in the body.

Rationale 3: Anti-anemic vitamin supplements increase B12 in the body.

Rationale 4: Hematopoietic growth factors increase erythrocytes in the bone marrow.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts:

Learning Outcome: 31-4

Question 20

Type: MCSA

Per classification of anemias, the morphology for pernicious anemia or folate-deficiency anemia results in

1. hematocytichematochromic erythrocytes.

2. microcytichypochromic erythrocytes.

3. macrocyticnormochromic erythrocytes.

4. normocyticnormochromic erythrocytes.

Correct Answer: 3

Rationale 1: Hematocytichematochromic erythrocytes do not classify anemias.

Rationale 2: Microcytichypochromic erythrocytes classify iron-deficiency anemia or thalassemia.

Rationale 3: Macrocyticnormochromic erythrocytes classify pernicious and folate-deficiency anemia.

Rationale 4: Normocyticnormochromic erythrocytes classify aplastic, hemorrhagic, sickle-cell, and hemolytic anemia.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts:

Learning Outcome: 31-5

Question 21

Type: MCMA

A client is to receive darbepoetin alfa (Aranesp) adjunctive medication during chemotherapy. The client says, Not another drug. Why do I need this one? How should the nurse respond?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. I know you are tired of drugs, but this is just one more.

2. This drug will help you grow red blood cells.

3. This drug will help keep you from getting infections.

4. This is an erythropoiesis-stimulating factor.

5. This drug will help you get more oxygen around to your tissues so you feel better.

Correct Answer: 2,5

Rationale 1: This response does not answer the clients question.

Rationale 2: Darbepoetin alfa (Aranesp) is an erythropoiesis-stimulating factor.

Rationale 3: Darbepoetin alfa (Aranesp) does not increase immunity.

Rationale 4: The nurse should explain the medication in terms the client can understand.

Rationale 5: Darbepoetin alfa (Aranesp) stimulates production of red blood cells which carry oxygen. Getting additional oxygen to the tissues helps the client feel better.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 31.8

Question 22

Type: MCMA

A client has been treated with an erythropoiesis-stimulating factor. Which client assessment would the nurse interpret as indicating the goal of this treatment has been reached?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The clients hemoglobin values have risen.

2. The client reports less shortness of breath on exertion.

3. The client has not had an episode of epistaxis in over three weeks.

4. The client reports enjoying a walk with family for the first time in months.

5. The client has not had a fever since treatment began.

Correct Answer: 1,2,4

Rationale 1: The purpose of this therapy is to increase red blood cells which would increase hemoglobin.

Rationale 2: Since the client has more RBCs, more oxygen can be carried to tissues.

Rationale 3: This drug supports RBC production, not platelet production.

Rationale 4: Increase in activity level indicates treatment success.

Rationale 5: This treatment supports red blood cell production, not white blood cell production.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 31.10

Question 23

Type: MCMA

A client is scheduled to have chemotherapy Thursday at 9 a.m. Filgrastim (Neupogen) has also been ordered. The nurse should plan which dosing time for the Neupogen?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. No later than 9 a.m. on Wednesday

2. At the time of the chemotherapy infusion

3. Immediately following the chemotherapy

4. No earlier than 9 a.m. Friday

5. Immediately before the chemotherapy

Correct Answer: 1,4

Rationale 1: Neupogen should be given at least 24 hours before chemotherapy.

Rationale 2: The effectiveness of the Neupogen will be diminished by the chemotherapy.

Rationale 3: The effectiveness of the Neupogen will be diminished by the chemotherapy.

Rationale 4: Neupogen should be given no earlier than 24 hours after chemotherapy.

Rationale 5: The effectiveness of the Neupogen will be diminished by the chemotherapy.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 31.8

Question 24

Type: MCMA

A clients blood work shows an anemia that was not present at the last clinic visit 6 months ago. Which questions should the nurse ask this client?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Have you had a significant dietary change in the last 6 months?

2. Do you handle chemicals in your new job?

3. Have your stools changed in appearance?

4. Have you been eating more carbohydrates than usual?

5. Are your menstrual periods heavier than normal for you?

Correct Answer: 1,2,3,5

Rationale 1: Dietary changes may significantly influence production of red blood cells.

Rationale 2: Chemicals can cause RBC destruction.

Rationale 3: Change to dark tarry stool, red stools, or much looser stools could indicate blood loss.

Rationale 4: There is no connection between carbohydrate ingestion and anemia.

Rationale 5: Heavy menstrual flow is a leading cause of blood loss anemia in women.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 31-5

Question 25

Type: MCMA

A nurse is preparing to administer ferrous sulfate IM to a client with anemia. What should the nurse consider when giving this injection?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Give the injection in the deltoid muscle.

2. Iron is best absorbed if given subcutaneously.

3. Iron is irritating to the tissues.

4. The z-track method should be used.

5. Iron preparations should be administered through a needle gauge 16 or larger.

Correct Answer: 3,4

Rationale 1: The injection should be given deep IM in a larger muscle.

Rationale 2: Iron should be given deep IM.

Rationale 3: Iron is irritating to tissues.

Rationale 4: Z-track injection reduces leakage into the tissues and is the preferred method of IM injection of iron.

Rationale 5: There is no indication of need to use a large diameter needle for injection.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 31.8

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E

Copyright 2014 by Pearson Education, Inc.

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