A hospitalized patient is receiving packed red blood cells (PRBCs) for treatment of severe anemia. Which of the following is the most accurate statement?
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Solution
Transfusion reaction is most likely during the first 15 minutes of infusion, and a nurse should be present during this period.
Option B: PRBCs should be infused through a 19g or larger IV catheter to avoid slow flow, which can cause clotting.
Option C: PRBCs must be flushed with 0.45% normal saline solution. Other intravenous solutions will hemolyze the cells.
A clinic patient has a hemoglobin concentration of 10.8 g/dL and reports sticking to a strict vegetarian diet. Which of the follow nutritional advice is appropriate?
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Solution
Normal hemoglobin values range from 11.5-15.0. This vegetarian patient is mildly anemic. When food is prepared in iron cookware its iron content is increased.
Option A: In addition, dark green leafy vegetables, such as spinach and kale, and legumes are high in iron.
Option B: Mild anemia does not require that animal sources of iron be added to the diet. Many non-animal sources are available.
Option D: Coffee and tea increase gastrointestinal activity and inhibit absorption of iron.
A patient received surgery and chemotherapy for colon cancer, completing therapy three (3) months previously, and she is now in remission. At a follow-up appointment, she complains of fatigue following activity and difficulty with concentration at her weekly bridge games. Which of the following explanations could account for her symptoms?
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Solution
Three months after surgery and chemotherapy the patient is likely to be feeling the after-effects, which often includes anemia because of bone-marrow suppression.
Option B: There is no evidence that the patient is immunosuppressed, and fatigue is not a typical symptom of immunosuppression.
Options C and D: The information given does not indicate that depression or dehydration is a cause of her symptoms.
A clinic patient has recently been prescribed nitroglycerin for treatment of angina. He calls the nurse complaining of frequent headaches. Which of the following responses to the patient is correct?
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Solution
Nitroglycerin is a potent vasodilator and often produces unwanted effects such as headache, dizziness, and hypotension. Patients should be counseled, and the dose titrated, to minimize these effects. In spite of the side effects, nitroglycerin is effective at reducing myocardial oxygen consumption and increasing blood flow.
Option A: The patient should not stop the medication.
Option B: Nitroglycerine does not cause bleeding in the brain.
A patient with a history of congestive heart failure arrives at the clinic complaining of dyspnea. Which of the following actions is the first the nurse should perform?
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Solution
A patient with congestive heart failure and dyspnea may have pulmonary edema, which can cause severe hypertension. Therefore, taking the patient’s blood pressure should be the first action.
Option A: Lying flat on the exam table would likely worsen the dyspnea, and the patient may not tolerate it.
Option B: Blood draws for chemistry and ABG will be required, but not prior to the blood pressure assessment.
A patient arrives in the emergency department with symptoms of myocardial infarction, progressing to cardiogenic shock. Which of the following symptoms should the nurse expect the patient to exhibit with cardiogenic shock?
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Solution
Cardiogenic shock severely impairs the pumping function of the heart muscle, causing diminished blood flow to the organs of the body. This results in diminished brain function and confusion, as well as hypotension, tachycardia, and weak pulse. Cardiogenic shock is a serious complication of myocardial infarction with a high mortality rate.
Following myocardial infarction, a hospitalized patient is encouraged to practice frequent leg exercises and ambulate in the hallway as directed by his physician. Which of the following choices reflects the purpose of exercise for this patient?
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Solution
Exercise is important for all hospitalized patients to prevent deep vein thrombosis. Muscular contraction promotes venous return and prevents hemostasis in the lower extremities.
Options A, B, and D: This exercise is not sufficiently vigorous to increase physical fitness, nor is it intended to prevent bedsores or constipation.
Tissue plasminogen activator (t-PA) is considered for treatment of a patient who arrives in the emergency department following onset of symptoms of myocardial infarction. Which of the following is a contraindication for treatment with t-PA?
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Solution
A history of cerebral hemorrhage is a contraindication to tPA because it may increase the risk of bleeding. TPA acts by dissolving the clot blocking the coronary artery and works best when administered within 6 hours of onset of symptoms.
Option C: Prior MI is not a contraindication to tPA.
Option D: Patients receiving tPA should be observed for changes in blood pressure, as tPA may cause hypotension.
There are a number of risk factors associated with coronary artery disease. Which of the following is a modifiable risk factor?
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Solution
Obesity is an important risk factor for coronary artery disease that can be modified by improved diet and weight loss.
Options B, C, and D: Family history of coronary artery disease, male gender, and advancing age increase risk but cannot be modified.
A nurse is administering IV furosemide to a patient admitted with congestive heart failure. After the infusion, which of the following symptoms is NOT expected?
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Solution
Furosemide, a loop diuretic, does not alter pain.
Option A: Furosemide acts on the kidneys to increase urinary output.
Option B: Fluid may move from the periphery, decreasing edema.
Option D: Fluid load is reduced, lowering blood pressure.