Test review 1 1.26.2020

You just received a patient on the oncology unit where you work. You obtain their recent lab results and notice their ANC is 450. You know this patient needs to be put on neutropenic isolation precautions. What do these precautions include? (Select all that apply)

• Limit all visitors until patients ANC returns to a normal value.

• Place the patient in a positive pressure airflow room.

• Remove the steamed broccoli and apple juice the cafeteria just brought up to the room with the patients dinner.

• Place a stop sign on the patient’s door and the steps to take before entering the room.

• Question the order for insertion of a foley catheter.

Patient has a Hgb level of 10g/dL, what interventions are appropriate for this client? Select all that apply.

• Schedule resting period for the patient after a meal

• Call HCP and suggest blood transfusion.

• Minimize risk of injury from falls.

• Assess for tachycardia at rest.

• Hgb levels are within normal range, no intervention is needed.

Which statement by a patient who underwent a hematopoietic stem cell transplant 2 days ago would require immediate intervention by the nurse?

• “I haven’t had a bowel movement in 2 days’

• “I’ve thrown up a few times and feel pretty sick”

• “I feel exhausted”

• “I’ve been coughing up clear stuff”

A nurse counsels a client with anemia on iron-rich foods. Which of the following foods would the nurse encourage the client to eat?

• Sweet Potato

• Bananas

• Baked Beans

• Scrambled Eggs

Interventions for individual patients who are diagnosed with aplastic anemia include the following (Select all that apply).

• Monitor for hypotension and request order for Lactated Ringer Solution

• Monoclonal Antibody drugs (Rituximab/Alemtuzumab)

• Monitor for infection

• Monitor for fever

• Give ibuprofen for mild to moderate pain

Nursing intervention for a patient with Hgb level of 5 includes the following (Select all that apply):

• Taking vitals q 12 hours

• Instructions for high iron diet

• Monitor stool for occult blood

• Call HCP about potential blood transfusion

• Provide multiple items of care at one time

Which intervention does the nurse include when caring for a client undergoing treatment for immune thrombocytopenia purpura (ITP)?

• Administer a stool softener daily.

• Administer 81 mg of aspirin daily.

• Encourage cough and deep breathe.

• Transfuse random donor platelets.

A patient started receiving their first unit blood at 10:00 and it is now 10:10. The patient is reporting itching, chills, and a headache. In addition, the patient’s temperature is now 99.8 from 98.0. Your next nursing action is…?

• Stop the transfusion

• Notify the physician

• Decrease the rate of the transfusion

• Reassure the patient that this is normal and will resolve in 30 minutes

The nurse assesses a patient with pernicious anemia. Which assessment finding would the nurse expect?

• Yellow-tinged sclera

• Shiny, Smooth tongue

• Numbness of the extremities

• Gum bleeding and tenderness

The nurse is caring for a patient with colon cancer who is scheduled for external radiation therapy to the abdomen. Which information obtained by the nurse would indicate a need for patient teaching?

• The patient has a history of dental caries.

• The patient swims several days a week.

• The patient snacks frequently during the day.

• The patient showers each day with mild soap