ATI RN COMPREHENSIVE PREDICTOR RETAKE EXAM 2019 WITH VERIFIED SOLUTIONS GRADED A+
Chapter 37: Concepts of Care for Patients With Hematologic Problems
... [Show More] Ignatavicius: Medical-Surgical
MULTIPLE CHOICE
1. A client insicklecell crisis is dehydrated and intheemergency department. Thenurse
plans to start an IV. Which fluid choice is best?
a. 0.45% normal saline
b. 0.9% normal saline
c. Dextrose 50%
(D50)
d. Lactated Ringer’s solution
ANS: A
Because clients in sickle cell crisis are often dehydrated, the fluid of choice is a hypotonic
solutionsuch as 0.45% normal saline. 0.9% normal saline and lactated Ringer’s solution
are isotonic. D50 is hypertonic and not used for hydration.
abirb.com/test
abirb.com/test
DIF: Analyzing TOP:: IntaegbratierdbPr.oceoss:mNu/rtsiengsPtrocess Analysis
KEY: Hematologicsystem, Anemias, Fluidandelectrolyteimbalance, IVfluids, Hydration
MSC: Client Needs Category: Physiological Integrity: Pharmacologicaland Parenteral
Therapies
2. A client presents totheemergaenbcy
irdbep.a
crtmoemnt i/ntesic
skl
te cell diseasecrisis. What intervention
by the nurse takes priority?
a. Administeroxygen.
b. Initiatepulse
oximetry.
c. Give pain medication.
d. Start an IV line.
ANS: A
All actions are appropriate, but remembering the ABCs, oxygen would come first. The main
problem in asicklecell crisis is tissueand organ hypoxia, soprovidingoxygen helps halt
the
process
.
DIF: Applying TOP: Integrated Process: Nursing Process:
Implementation KEY: Hematologic system, Anemias, Oxygen, Oxygen
therapy
MSC: Client Needs Category: S
a
af
b
e a
i
n
r
d
b
E
.
ff
c
ec
o
tivm
e C
/
a
t
re
e
E
s
nv
t
ironment: Managementof Care
3. A client hospitalized with sickle cell diseasecrisis frequentlyasks for opioid pain
medications,oftenshortly after receiving adose. Thenurses on theunitbelievethat the
client isdrugseeking. Whenthecliaenbt reirqbue.stcsopamin m/ tedeicsatti o n , whatactionbythenurse
is best?
a. Give the client pain medication if it is time for another dose.
b. Instruct theclientnot torequest pain medication too early.
c. Request theprimary health care provider leave aprescription for a placebo.
d. Tell the client that it is too early to have more pain medication.
ANS: A
Clients withsickle cell crisis often have severe pain that is managed withup to 48 hours
of IV opioid analgesics. Even if the client is addicted and drug seeking, he or she is still in
extreme pain. If the client can receive another dose of medication, the nurse would
provide it. The other options are judgmental and do not address the client’s pain. Giving a
placebo is
unethical.
DIF: Applying TOP: Integrated Process: Nursing Process:
Implementation KEY: Hematologic system, Anemias, Pain, Caring
MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation
abirb.com/test
4. Thenurseiscaring foraclient experiencing sicklecell diseasecrisis. Which priority
action would help prevent infection?abirb.com/test a. Administering prophylactic antibiotics b. Monitoring theclient’s temperature
c. Checking theclient’s white bloodcell count
d. Performing frequent handwashing
ANS: D
Frequent and thorough handwashing is the most important intervention that helps prevent
infection. Antibiotics are not usually used to prevent infection. Monitoring the client’s
temperatureor whitebloodcell counthelps todetect thepresenceof infection, but
prevent it.
abirb.com/test DIF: Applying TOP: Integrated Process: Nursing Process:
Implementation KEY: Hematologic system, Sickle cell disease
MSC: Client Needs Category: SafeandEffective CareEnvironment: SafetyandInfection
Control
5. A nursecaring for aclient withsicklecell disease (SCD) reviews theclient’s laboratory
test results. Which finding would the nurse report to the primary health care provider?
a. Creatinine:2.9 mg/dL (256 mcmol/L)
b. Hematocrit: 30%
c. Sodium: 146 mEq/L (146 mmol/L)
d. Whiteblood cell count: 1a
2,0b
00ir/mbm.
3
c
(o
12m 1/
0t
9
e
/Ls
)
ANS: A
An elevatedcreatinine indicates kidneydamage, which occurs in SCD. A hematocrit level of
30%isanexpectedfinding,aa
s ib
s air
sb
lig.
hc
tlyo
emlev/
at
tee
dsw ht
i t e bloodcellcountduetochronic
inflammation. A sodium level of 146 mEq/L (146 mmol/L), although slightly high, is not
concerning.
DIF: Analyzing TOP: IntaegbratierdbPr.oceoss:mCo/mtmeusnitcation and Documentation
KEY: Hematologic system, Laboratory values, Anemias
MSC: Client Needs Category: Physiological Integrity: Reductionof Risk Potential
6. Thenurseisassessingacli en
a
t i
b
ns
i
i
r
c
b
kle
.c
ce
o
ll mdise
/a
t
s
e
e (
sSC
tD)crisis. What priorityclient
problem will the nurse expect?
a. Infection
b. Pallor
c. Pain
d. Fatigue [Show Less]
