D454 - Adult Health III

Question 41: A patient with sickle cell disease is planning a vacation and asks the nurse for advice about destinations and activities to avoid. Which recommendation by the nurse is most appropriate based on known sickling triggers?

Avoid traveling to high-altitude destinations because the lower oxygen levels at elevation can trigger sickling of red blood cells

Choose destinations with extremely cold climates because cold weather helps keep sickled cells from clumping together

Any destination is equally safe as long as the patient takes hydroxyurea on the morning of travel

High altitudes are actually beneficial because the thinner air forces red blood cells to carry more oxygen efficiently

Question 42: During a sickle cell vaso-occlusive crisis, the nurse implements the three cornerstones of crisis treatment. A new nurse on the unit questions why aggressive intravenous hydration is considered equally important as pain management in this situation. Which explanation best justifies the role of hydration in crisis management?

Hydration is given primarily to prepare the patient for an anticipated blood transfusion that is always required during every crisis

Intravenous fluids contain dissolved oxygen that directly oxygenates the sickled cells and reverses their abnormal shape

Hydration helps dilute the concentration of sickled cells in the bloodstream and improves blood flow through occluded vessels, reducing the duration and severity of the crisis

Fluids are administered to flush the sickled cells out of the body through the kidneys so they can be replaced by normal cells

Question 43: A nurse is caring for a patient with aplastic anemia and reviews the most recent laboratory results showing dangerously low levels of all three blood cell lines. Which combination of nursing interventions directly addresses the two most critical risks this patient faces?

Encouraging increased oral fluid intake for dehydration prevention and starting a high-calorie diet for energy restoration

Administering supplemental oxygen for the low red blood cells and starting physical therapy to prevent muscle wasting

Initiating fall precautions for dizziness and scheduling daily blood draws to monitor for spontaneous improvement

Implementing bleeding precautions for the low platelets and strict infection prevention measures for the low white blood cells

Question 44: A parent of a child with sickle cell disease asks the nurse to explain why their child's red blood cells change shape under certain conditions. Which explanation by the nurse best describes the underlying cause in terms the parent can understand?

The disease is caused by a temporary viral infection that damages the bone marrow and produces abnormally shaped cells until the infection clears

Your child inherited a change in the hemoglobin gene that causes the hemoglobin protein to become rigid and distort the red blood cells into a sickle shape when oxygen levels drop

Your child's spleen is attacking normal red blood cells and reshaping them, which is why removing the spleen would cure the condition

The sickle shape is caused by severe iron deficiency that makes the red blood cells too weak to maintain their normal round shape

Question 45: A patient with suspected aplastic anemia needs a bone marrow biopsy for definitive diagnosis, but the patient is confused and disoriented. The nurse knows that informed consent is required for this invasive procedure. Which action by the nurse is most appropriate in this situation?

Proceeding with the biopsy without consent because the diagnostic need outweighs the consent requirement in confused patients

Asking the patient to sign the consent form anyway since confused patients can still understand medical procedures if spoken to slowly

Canceling the procedure entirely because bone marrow biopsies cannot be performed on patients who have ever experienced confusion

Contacting the patient's designated family member or legal representative to obtain informed consent on the patient's behalf

Question 46: A patient with polycythemia vera asks the nurse whether taking an iron supplement would help with occasional fatigue. The nurse explains why iron supplementation is specifically contraindicated in this condition. Which explanation is most accurate?

Iron supplements are avoided because providing additional iron would fuel even greater red blood cell overproduction, worsening the dangerous blood thickening

Iron supplements would convert the polycythemia into aplastic anemia by overwhelming the bone marrow with excessive raw materials

Iron supplements would cause an allergic reaction in patients with polycythemia vera due to their already elevated red blood cell mass

Iron has no effect on red blood cell production and is only contraindicated because it interferes with the therapeutic phlebotomy schedule

Question 47: A nurse is caring for a patient with polycythemia vera who is receiving therapeutic phlebotomy. Which assessment is most important for the nurse to perform consistently to evaluate the patient's fluid status and response to treatment?

Assessing skin turgor every shift to determine if the patient is developing dehydration from excessive sweating

Checking the patient's temperature every hour to detect febrile reactions to the phlebotomy procedure

Monitoring strict intake and output to track fluid balance as blood volume is being actively reduced through phlebotomy

Weighing the patient weekly to determine if the excess red blood cells are causing measurable weight changes

Question 48: A nurse is developing a discharge education plan for a patient who underwent splenectomy following a traumatic injury. The nurse must ensure the patient understands the lifelong implications of living without a spleen. Which element of the teaching plan addresses the most critical long-term risk?

Emphasizing the importance of vaccination against encapsulated organisms such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, and seeking immediate medical attention for any fever

Advising the patient to avoid all public spaces for the first year after surgery to prevent exposure to any type of infectious organism

Instructing the patient to take daily iron supplements because the spleen was responsible for iron storage and its removal creates a permanent deficiency

Explaining that the patient should limit physical activity permanently because the surgical site will always be vulnerable to reopening

Question 49: A post-splenectomy patient presents to the urgent care clinic with a fever and reports feeling generally unwell since the previous evening. The triage nurse recognizes that this presentation requires a different level of urgency compared to a febrile patient with an intact spleen. Which nursing action is most appropriate?

Advising the patient to take over-the-counter fever reducers and only return if the temperature exceeds a specific high threshold

Treating this as a medical emergency requiring immediate evaluation and blood cultures because post-splenectomy patients can deteriorate from infection to septic shock within hours

Sending the patient home with instructions to rest and return if the fever has not resolved within three to five days

Scheduling the patient for a routine follow-up appointment next week to have blood cultures drawn at that time

Question 50: A nurse is caring for two patients simultaneously. Patient one has polycythemia vera with dangerously elevated hemoglobin and is experiencing headaches and blurred vision. Patient two has aplastic anemia with pancytopenia and has developed a fever. Which priority nursing actions correctly match each patient's most urgent need?

Patient one needs therapeutic phlebotomy to reduce blood viscosity and thrombosis risk, while Patient two needs immediate infection workup and protective measures because fever with neutropenia is a medical emergency

Both patients should be placed on complete bed rest and monitored without intervention because their conditions will self-correct over time

Both patients need identical treatment with therapeutic phlebotomy because removing blood would benefit the elevated counts in one and stimulate production in the other

Patient one needs iron supplementation to normalize the red blood cells, while Patient two needs vigorous exercise to stimulate the bone marrow into producing more cells