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A patient's anemia is described as having erythrocytes that demonstrate anisocytosis. The nurse would recognize the erythrocytes would be:

Correct Answer: Able to assume various shapes
Response Feedback: Anisocytosis means the erythrocytes are able to assume various shapes.

A newborn is diagnosed with congenital intrinsic factor deficiency. Which of the following types of anemia will the nurse see documented on the chart?

Correct Answer: Pernicious anemia
Response Feedback: A lack of the intrinsic factor leads to pernicious anemia

When a nurse is reviewing lab results and notices that the erythrocytes contain an abnormally low concentration of hemoglobin, the nurse calls these erythrocytes:

Correct Answer: Hypochromic
Response Feedback: Hypochromic erythrocytes have low concentrations of hemoglobin.

A 5-year-old male was diagnosed with normocytic-normochromic anemia. Which of the following anemias does the nurse suspect the patient has?

Correct Answer: Hemolytic anemia
Response Feedback: Hemolytic anemia is an example of normocytic-normochromic anemia. Sideroblastic anemia is an example of microcytic hypochromic anemia. Pernicious anemia is an example of a macrocytic anemia. Iron deficiency anemia is an example of microcytic hypochromic anemia.

After initial compensation, what hemodynamic change should the nurse monitor for in a patient who has a reduction in the number of circulating erythrocytes?

Correct Answer: Hyperdynamic circulatory state
Response Feedback: After initial compensation, the blood flows faster and more turbulently than normal blood, causing a hyperdynamic circulatory state.

A 25-year-old female has a heavy menses during which she loses a profuse amount of blood. Which of the following adaptations should the nurse expect?

Correct Answer: Peripheral vasoconstriction
Response Feedback: When the anemia is severe or acute in onset (e.g., hemorrhage), the initial compensatory mechanism is peripheral blood vessel constriction, diverting blood flow to essential vital organs.

A 60-year-old female emphysema patient experiences a rapid and pounding heart, dizziness, and fatigue with exertion. Which of the following respiratory assessment findings indicate the respiratory system is compensating for the increased oxygen demand?

Correct Answer: Increased rate and depth of breathing
Response Feedback: The rate and depth of breathing increase in an effort to increase oxygen availability accompanied by an increase in the release of oxygen from hemoglobin.

A 2-year-old malnourished child has vitamin B12 and folate deficiencies. A blood smear suggests the deficiency is macrocytic and normochromic. The nurse would expect the hemoglobin to be:

Correct Answer: Normal
Response Feedback: The macrocytic (megaloblastic) anemias are characterized by unusually large stem cells (megaloblasts) in the marrow that mature into erythrocytes that are unusually large in size (macrocytic), thickness, and volume. The hemoglobin content is normal, thus allowing them to be classified as normochromic.

A 45-year-old male is diagnosed with macrocytic, normochromic anemia. The nurse suspects the most likely cause of this condition is:

Correct Answer: Defective DNA synthesis
Response Feedback: These anemias are the result of ineffective erythrocyte deoxyribonucleic acid (DNA) synthesis.

When a patient wants to know why vitamin B12 and folate deficiencies cause anemia, how should the nurse respond?

Correct Answer: Red blood cells have a shorter life span.
Response Feedback: These deficiencies lead to defective erythrocytes that die prematurely, which decreases their numbers in the circulation, causing anemia.

A 20-year-old female undergoes lab testing for anemia. Results show high iron, bilirubin, and transferrin and low hemoglobin and hematocrit. Which of the following is the most likely diagnosis to be documented on the chart?

Correct Answer: Sideroblastic anemia
Response Feedback: Individuals with sideroblastic anemia may show signs of iron overload (hemosiderosis), including mild to moderate enlargement of the liver (hepatomegaly) and spleen (splenomegaly).

A 35-year-old female is diagnosed with vitamin B12 deficiency anemia (pernicious anemia). How should the nurse respond when the patient asks what causes pernicious anemia? A decrease in ______ is the most likely cause.

Correct Answer: Intrinsic factor
Response Feedback: The underlying alteration in pernicious anemia (PA) is the absence of intrinsic factor (IF), an enzyme required for gastric absorption of dietary vitamin B12, a vitamin essential for nuclear maturation and DNA synthesis in red blood cells.

Which of the following individuals should the nurse assess first for a vitamin B12 deficiency anemia?

Correct Answer: 47-year-old male who had a gastrectomy procedure (removal of the stomach)
Response Feedback: With removal of the stomach, the intrinsic factor is also removed, leading to an inability to absorb B12; thus, the person with removal of the stomach is at greatest risk

A 65-year-old male experienced loss of appetite, weight loss, lemon-yellow skin, liver enlargement, and a beefy red tongue shortly before his death. Autopsy suggested pernicious anemia, and the cause of death would most likely reveal:

Correct Answer: Heart failure
Response Feedback: When the hemoglobin has decreased to 7 to 8 g/dL, the individual experiences the classic symptoms of anemia: weakness, fatigue, paresthesias of feet and fingers, difficulty walking, loss of appetite, abdominal pain, weight loss, and a sore tongue that is smooth and beefy red. The skin may become "lemon yellow" (sallow), caused by a combination of pallor and jaundice. Hepatomegaly, indicating right-sided heart failure, may be present in the elderly.

A 40-year-old male vegetarian is diagnosed with folate deficiency anemia. He reports that he is an alcoholic. Which of the following factors put him at greatest risk for developing his disease?

Correct Answer: Being alcoholic
Response Feedback: Folate deficiency occurs more often in alcoholics and individuals who are malnourished because of fad diets or diets low in vegetables. A diet high in vegetables would help prevent folate deficiency.

How should the nurse prepare a patient who is to receive a Schilling test for pernicious anemia?

Correct Answer: Administer radioactive cobalamin and measure its excretion in the urine.
Response Feedback: The Schilling test is performed by administering radioactive cobalamin and then measuring its excretion in the urine. Low urinary excretion is significant for pernicious anemia (PA).

A 67-year-old female has chronic gastrointestinal bleeding. A nurse recalls the primary cause of her anemia is:

Correct Answer: Iron deficiency
Response Feedback: A continuous loss of blood is one of the most common causes of iron deficiency anemia (IDA)

A 34-year-old male presents in the emergency room with extreme fatigue and shortness of breath. His skin and sclera appear to have a yellowish discoloration. These assessment findings are consistent with which type of anemia?

Correct Answer: Hemolytic anemia
Response Feedback: A yellow appearance to the skin and sclera are consistent with hemolytic anemia.

A 58-year-old female presents in the clinic presenting with fatigue, weight loss, and tingling in her fingers. Laboratory findings show low hemoglobin and hematocrit, a high mean corpuscular volume, and normal plasma iron. These assessment findings are consistent with which type of anemia?

Correct Answer: Pernicious anemia
Response Feedback: Pernicious anemia is manifested by tingling paresthesias of feet and fingers.

A 21-year-old female was recently diagnosed with iron deficiency anemia. In addition to fatigue and weakness, which of the following clinical signs and symptoms would she most likely exhibit?

Correct Answer: Spoon-shaped nails
Response Feedback: Iron deficiency anemia is manifested by fingernails that become brittle and "spoon shaped" or concave.

A 21-year-old woman was recently diagnosed with iron deficiency anemia. Her hematocrit is 32%. Which of the following treatments would the nurse expect to be prescribed for her?

Correct Answer: Iron replacement
Response Feedback: Iron replacement therapy is required and very effective. Initial doses are 150 mg to 200 mg/day and are continued until the serum ferritin level reaches 50 mg/L.

A 45-year-old male is diagnosed with sideroblastic anemia. When he asks what the most likely cause of this disease is, what is the nurse's best response?

Correct Answer: Ineffective iron uptake and abnormal hemoglobin production
Response Feedback: Sideroblastic anemia is due to ineffective iron uptake and hemoglobin production.

A 50-year-old female was diagnosed with sideroblastic anemia. Which of the following assessment findings would most likely occur?

Correct Answer: Bronze colored skin
Response Feedback: The skin of the patient with sideroblastic anemia is bronze in color. The patient with sideroblastic anemia shows signs of iron overload.

A nurse is preparing to teach the staff about aplastic anemia. Which information should the nurse include? Aplastic anemia is caused by:

Correct Answer: Stem cell deficiency
Response Feedback: In aplastic anemia, erythrocyte stem cells are underdeveloped, defective, or absent.

A nurse recalls posthemorrhagic anemia can result in death when a patient's blood loss is in excess of:

Correct Answer: 40% to 49%
Response Feedback: Death can occur if blood loss exceeds 40% to 49% of plasma volume.

A 57-year-old male presents to his primary care provider for red face, hands, feet, ears, and headache and drowsiness. A blood smear reveals an increased number of erythrocytes, indicating:

Correct Answer: Polycythemia vera (PV)
Response Feedback: PV is manifested by increased numbers of erythrocytes. PV is characterized by excessive proliferation of erythrocyte precursors in the bone marrow.

A 67-year-old female is admitted to the emergency department with a diagnosis of polycythemia vera. Upon taking the history, the patient will most likely report:

Correct Answer: Chest pain
Response Feedback: Coronary blood flow may be affected, precipitating angina. The patient will experience signs of interrupted blood flow due to increased blood viscosity. They will not experience hyperactivity. Blood pressure will be increased, not decreased. The skin will be red over the face hands, feet, and ears.

A 68-year-old female is admitted to the emergency department with a diagnosis of polycythemia vera (PV). A nurse realizes the patient's symptoms are mainly the result of:

Correct Answer: Increased blood viscosity
Response Feedback: The symptoms of PV are due to increased blood viscosity.

A 67-year-old female is admitted to the emergency department with a diagnosis of polycythemia vera (PV). Which treatment should the nurse discuss with the patient?

Correct Answer: Therapeutic phlebotomy
Response Feedback: Treatment of PV is phlebotomy to reduce red cell mass and blood volume.

A 70-year-old male is brought to the emergency department, where he dies shortly thereafter. Autopsy reveals polycythemia vera (PV). His death was most likely the result of:

Correct Answer: Cerebral thrombosis
Response Feedback: 50% of individuals with PV die within 18 months of the onset of initial symptoms because of thrombosis or hemorrhage.

A 67-year-old male was diagnosed with polycythemia vera (PV) but refused treatment. His condition is at risk for converting to:

Correct Answer: Acute myeloid leukemia
Response Feedback: A significant potential outcome of PV is the conversion to acute myeloid leukemia (AML), occurring spontaneously in 10% of individuals and generally being resistant to conventional therapy.

A staff member asks what leukocytosis means. How should the nurse respond? Leukocytosis can be defined as:

Correct Answer: A high leukocyte count
Response Feedback: Leukocytosis is present when the count is higher than normal.

A 20-year-old female has an increase in eosinophils. When the patient wants to know the most likely cause of the eosinophilia. What is the nurse's best response?

Correct Answer: Parasitic invasion and allergic reactions
Response Feedback: Parasitic invasion can lead to eosinophilia.

A 15-year-old female presents with splenomegaly, hepatomegaly, and lymph node enlargement. She is diagnosed with infectious mononucleosis. What should the nurse tell the patient about the recovery time?

Correct Answer: A few weeks
Response Feedback: Infectious mononucleosis (IM) is usually self-limiting, and recovery occurs in a few weeks; severe clinical complications are rare (5%). Fatigue may last for 1 to 2 months after resolution of other symptoms.

A 35-year-old male with hyperthyroidism begins treatment to decrease thyroid activity. A nurse monitors for which of the following conditions that could result secondary to the treatment?

Correct Answer: Basophilia
Response Feedback: Basophilia results from antithyroid therapy.

A 15-year-old male is diagnosed with infectious mononucleosis. When the patient asks how he got this disease, how should the nurse respond? The most likely cause is:

Correct Answer: Epstein-Barr virus (EBV)
Response Feedback: Infectious mononucleosis (IM) is an acute infection of B lymphocytes (B cells) with EBV.

A 15-year-old male with infectious mononucleosis is being given instructions on how to prevent the spread of this infection to others. Which statement represents a correct instruction?

Correct Answer: Do not share drinking glasses or eating utensils.
Response Feedback: Transmission of mononucleosis is usually through saliva from close personal contact. The virus also may be secreted in other mucosal secretions of the genital, rectal, and respiratory tract, as well as blood.

A 10-year-old male is diagnosed with leukemia. The nurse assesses for which other condition that could be associated with his disease?

Correct Answer: Down syndrome
Response Feedback: There is also an increased incidence of leukemia in association with other hereditary abnormalities such as Down syndrome.

A 5-year-old female is diagnosed with acute leukemia. The nurse will most likely treat this patient with:

Correct Answer: Chemotherapy
Response Feedback: Chemotherapy, used in various combinations, is the treatment of choice for leukemia.

A 35-year-old female is diagnosed with lymphadenopathy. Which assessment finding will help confirm this diagnosis?

Correct Answer: Enlarged lymph nodes
Response Feedback: Lymphadenopathy is evidenced by enlarged lymph nodes.

A 35-year-old male has enlarged lymph nodes in the neck and a mediastinal mass. He was diagnosed with Hodgkin lymphoma. Which of the following abnormal cells would the nurse expect to find with this disease?

Correct Answer: Reed-Sternberg cell
Response Feedback: Hodgkin lymphoma is manifested by Reed-Sternberg cells.

The people from which country have the lowest risk for Hodgkin lymphoma?

Correct Answer: Japan
Response Feedback: Japan has the lowest rate of Hodgkin lymphoma.

A 62-year-old female tells her health care provider she has been experiencing regular night sweats that cause her to wake up drenched. She also remarks that she has been unintentionally losing weight. Physical exam reveals enlarged lymph nodes on her neck that do not appear to be painful. She should be screened for which of the following cancers?

Correct Answer: Hodgkin lymphoma
Response Feedback: The patient has symptoms of Hodgkin lymphoma. About a third of individuals will have some degree of systemic symptoms. Intermittent fever, without other symptoms of infection, drenching night sweats, itchy skin (pruritus), and fatigue are relatively common.

A 10-year-old male presents with abdominal swelling, night sweats, fever, and weight loss. He is diagnosed with Burkitt lymphoma. Upon obtaining the history, which of the following is the most likely cause?

Correct Answer: Epstein-Barr virus (EBV)
Response Feedback: EBV is associated with almost all cases of Burkitt lymphoma.

For a patient experiencing hypersplenism, the nurse expects the erythrocytes to be:

Correct Answer: Sequestered
Response Feedback: Hypersplenism results in sequestering of the blood cells.

Thrombocytopenia may be:

Correct Answer: Congenital or acquired
Response Feedback: The condition may also be either congenital or acquired and may be either primary or secondary to other conditions.

A 30-year-old female presents with hematuria, menorrhagia, and bleeding gums. She is diagnosed with immune thrombocytic purpura (ITP). A nurse realizes the most likely cause is:

Correct Answer: Antibody destruction of platelets
Response Feedback: The majority of cases of ITP are due to immune driven destruction of platelets.

A 50-year-old female is diagnosed with primary thrombocythemia. A nurse would expect the blood smear to reveal _____ platelets.

Correct Answer: Overproduced
Response Feedback: Thrombocythemia is characterized by a platelet count more than 400,000 platelets/mm3 of blood and is symptomatic when the count exceeds 1,000,000/ mm3, at which time the risk for intravascular clotting (thrombosis) is high

A 52-year-old male IV drug user was diagnosed with hepatitis C 5 years ago. He is now experiencing impaired blood clotting. The nurse suspects a decrease in which of the following vitamins?

Correct Answer: K
Response Feedback: Lack of vitamin K interferes with clotting.

A nurse checks individuals with liver disease for clotting problems because:

Correct Answer: Clotting factors are produced in the liver.
Response Feedback: Clotting factors are produced by the liver.

A 40-year-old female develops disseminated intravascular coagulation (DIC). Upon obtaining the history, which finding is the most likely cause of this condition?

Correct Answer: Sepsis
Response Feedback: Sepsis is one of the most common conditions associated with DIC.

A nurse is teaching the staff about disseminated intravascular coagulation (DIC). Which information should the nurse include? The sequence of events in DIC is initiated by the release of:

Correct Answer: Clotting factors are depleted.
Response Feedback: Intravascular clotting leads to depletion of clotting factors.

A 22-year-old female just delivered a healthy baby girl. She suffered from eclampsia during her pregnancy, and on the second postpartum day she complained of bleeding gums and bruising on her arms and legs. Hematology lab tests indicate that she had disseminated intravascular coagulation (DIC). Further review of lab tests by the nurse revealed an increase in:

Correct Answer: Fibrin degradation products (FDPs)
Response Feedback: Patients with DIC have high levels of FDPs.

When the nurse sees a diagnosis of hereditary hemochromatosis on the chart, the nurse knows this is a disorder of:

Correct Answer: Iron overload
Response Feedback: Iron overload can be primary, as in hereditary hemochromatosis.

A patient has microcytic hypochromic anemia. Which of the following pathogenic mechanisms may cause anemia in this patient? (Select all that apply.)

Correct Answers: Decreased erythrocyte life span, Failure of mechanisms of compensatory erythropoiesis, Disturbances of the iron cycle
Response Feedback: Causes of microcytic hypochromic anemia are decreased erythrocyte life span, failure of mechanisms of compensatory erythropoiesis, or disturbance of the iron cycle. Increased metabolic rate and swelling of tissues does not lead to anemia.

A 22-year-old female just delivered a healthy baby girl. She suffered from eclampsia during her pregnancy, and on the second postpartum day she complained of bleeding gums and bruising on her arms and legs. Hematology lab tests indicate that she had disseminated intravascular coagulation (DIC). Further review of lab tests by the nurse revealed an increase in:

Correct Answer: Fibrin degradation products (FDPs)
Response Feedback: Patients with DIC have high levels of FDPs.

A 15-year-old male is diagnosed with infectious mononucleosis. Which of the following assessment findings would he most likely demonstrate? (Select all that apply.)

Correct Answers: Lymph node enlargement, Fever and sore throat, Fatigue, Enlargement of liver and spleen
Response Feedback: At the time of diagnosis, the individual commonly presents with the classic group of symptoms: fever, sore throat, cervical lymph node enlargement, and fatigue; generalized lymph node enlargement also may develop, as well as enlargement of the spleen and liver.

A patient wants to know about risk factors for acute leukemia. Which of the following should the nurse include? (Select all that apply.)

Correct Answers: Chemotherapy treatment for other cancers, Excessive ultraviolet radiation exposure, Ovarian cancer
Response Feedback: Hepatitis C or HIV can predispose the patient to leukemia, not CMV. Drugs that cause bone marrow depression, such as chemotherapeutic agents, predispose an individual to leukemia; eating genetically modified food is not a predisposing factor. Excessive ultraviolet radiation exposure can predispose an individual to myelogenous leukemia. Acute leukemia also may develop secondary to certain acquired disorders, including ovarian cancer.

A 35-year-old male was diagnosed with hepatitis B. Further tests revealed neutropenia characterized by a neutrophil count less than _____ per milliliter.

Correct Answer: 2000

A nurse realizes a patient has thrombocytopenia when the platelet count is below _____ platelets per cubic millimeter.

Correct Answer: 100,000

A 1-year-old female is diagnosed with anemia secondary to insufficient erythropoiesis. When the parents asked what caused this, how should the nurse respond? The most likely cause(s) is (are):

Correct Answer: An iron deficiency
Response Feedback: The most common cause of insufficient erythropoiesis is iron deficiency.

A 12-month-old toddler weighing 18 pounds is brought to the clinic because of weakness, slow physical growth, and developmental delays. His mother reports that the only food he will consume is cow's milk. Considering this information, the nurse decides that the child probably has _____ anemia.

Correct Answer: Iron deficiency
Response Feedback: As many as one-third of infants with severe iron deficiency anemia have chronic intestinal blood loss induced by exposure to a heat-labile protein in cow's milk. Such exposure causes an inflammatory gastrointestinal reaction that damages the mucosa and results in diffuse hemorrhage.

A 16-month-old female presents with tachycardia, pallor, anorexia, and systolic murmur. The nurse is checking the lab results, and the hemoglobin determination indicates a level below _____ g/dL.

Correct Answer: 5
Response Feedback: When hemoglobin levels fall below 5 g/dL, pallor, anorexia, tachycardia, and systolic murmurs may occur.

Which mother is at most risk for a maternal-fetal blood incompatibility?

Correct Answer: Mother is Rh-negative, and fetus is Rh-positive.
Response Feedback: Maternal-fetal incompatibility exists if mother and fetus differ in ABO blood type or if the fetus is Rh-positive and the mother is Rh-negative.

A 10-year-old male is diagnosed with sickle cell anemia. When the parents ask who is responsible for this disease, what is the nurse's best response? He most likely inherited it from:

Correct Answer: Both his mother and father
Response Feedback: Sickle cell is a recessive disorder inherited from both parents.

In the United States, which group of people should be assessed first for sickle cell disease?

Correct Answer: African-Americans
Response Feedback: In the United States, sickle cell disease is most common in African-Americans.

A 25-year-old female has a child that is diagnosed with sickle cell anemia. She does not have the disease. Which of the following characterizes the genetic makeup of the parents with regard to this trait?

Correct Answer: Hb S and Hb A
Response Feedback: In this instance the child inherits Hb S from one parent and normal hemoglobin (Hb A), not Hb S, for both.

A 12-year-old male is diagnosed with sickle cell anemia. A blood smear reveals severely sickled cells. A nurse recalls the sickled cells will be removed from circulation mostly by the:

Correct Answer: Spleen
Response Feedback: Sickled cells undergo hemolysis in the spleen or become sequestered there, causing blood pooling and infarction of splenic vessels.

Which major symptom in a patient with sickle cell anemia indicates to the nurse, the patient is experiencing a vaso-occlusive crisis?

Correct Answer: Pain
Response Feedback: Vaso-occlusive crisis is extremely painful and may last for days or even weeks, with an average duration of 4 to 6 days.

For which type of sickle cell crisis should the nurse assess for in young children?

Correct Answer: Sequestration crisis
Response Feedback: Sequestration occurs when large amounts of blood become acutely pooled in the liver and spleen. This type of crisis is seen only in a young child.

A 5-year-old female dies from sickle cell disease. The pediatrician will document the most likely cause of death is:

Correct Answer: Infection
Response Feedback: Infection is the most common cause of death related to sickle cell disease.

A 2-year-old male presented with growth and maturation retardation and splenomegaly. He died shortly after arriving at the ER. Autopsy revealed thalassemia secondary to defective:

Correct Answer: Hemoglobin synthesis
Response Feedback: Thalassemia would be secondary to defective hemoglobin synthesis.

The mother of a 3-year-old child speaks to the pediatrician because the child took several hours to stop bleeding following a minor scrape. Testing reveals that the child has hemophilia A resulting from a deficiency in factor:

Correct Answer: VIII
Response Feedback: Hemophilia A is a deficiency in factor VIII.

A nurse wants to chart the other name for hemophilia B. Which term should the nurse write?

Correct Answer: Christmas disease
Response Feedback: Hemophilia B is also known as Christmas disease.

A 3-year-old child presents with bruising on the legs and trunk and a petechial rash. The mother also reports frequent nosebleeds. Lab tests reveal a decreased platelet count. Which is the most likely diagnosis the nurse will see documented on the chart?

Correct Answer: Idiopathic thrombocytopenic purpura (ITP)
Response Feedback: A decreased platelet count is the cause of ITP.

Which of the following clusters of symptoms would lead the nurse to suspect a child has idiopathic thrombocytopenic purpura (ITP)?

Correct Answer: Spontaneous nosebleeds, bruising, petechiae
Response Feedback: Nosebleeds, bruising, and petechiae are signs of a lack of clotting due to low platelets and ITP.

A 1-year-old is diagnosed with idiopathic thrombocytopenic purpura (ITP). The nurse assesses for the most serious concern, which is development of:

Correct Answer: Intracranial bleeding
Response Feedback: Although the incidence is less than 1%, intracranial hemorrhage is the most serious complication of ITP.

A nurse monitors for the most common childhood cancer, which is:

Correct Answer: Acute lymphoblastic leukemia (ALL)
Response Feedback: Approximately 80% to 85% of leukemias in children are ALL.

A 10-year-old male with Down syndrome undergoes chemotherapy for cancer. Following treatment, monitoring for which condition is priority?

Correct Answer: Acute myelogenous leukemia (AML)
Response Feedback: AML is attributable to prior chemotherapy.

A 10-year-old female is diagnosed with a malignancy in the brain and lung. DNA analysis reveals translocation at chromosome 7 and 14. The most likely medical diagnosis the primary care provider will make is:

Correct Answer: Lymphoblastic non-Hodgkin lymphoma (NHL)
Response Feedback: Lymphoblastic NHL shows chromosomal translocations, particularly chromosomes 7 and 14.

Which condition makes the patient most prone for developing non-Hodgkin lymphoma (NHL)?

Correct Answer: AIDS
Response Feedback: Children with AIDS have an increased risk of developing NHL.

What is a priority assessment for Hodgkin lymphoma in children?

Correct Answer: Painless adenopathy in cervical nodes
Response Feedback: Painless adenopathy in the lower cervical chain, with or without fever, is the most common symptom in children with Hodgkin lymphoma.

Which laboratory test will assist the nurse in identifying infants who are prone to develop hemolytic disease of the newborn (HDN)?

Correct Answer: Coombs
Response Feedback: Routine evaluation of fetuses at risk for HDN includes the Coombs test.

A nurse is planning care for a child with iron deficiency anemia. Characteristics of iron deficiency anemia include which of the following? (Select all that apply.)

Correct Answers: It is most common between the ages of 6 months and 2 years, It may be related to socioeconomic factors, It is difficult to diagnose in early stages.
Response Feedback:
Iron deficiency anemia is the most common blood disorder of infancy and childhood, with the highest incidence occurring between 6 months and 2 years of age. Incidence is not related to gender or race, but socioeconomic factors are important because they affect nutrition. The symptoms of mild anemia—listlessness and fatigue—usually are not present or are undetectable in infants and young children who are unable to describe these symptoms. Therefore, parents generally do not note any change in the child's behavior or appearance until moderate anemia has developed.

A 5-year-old male is diagnosed with leukemia. Which of the following symptoms would the nurse expect? (Select all that apply.)

Correct Answers: Fatigue, Pallor, Petechiae
Response Feedback: Pallor, fatigue, petechiae, purpura, bleeding, and fever generally are present. Jaundice is not.

A 60-year-old male presents to his primary care provider reporting chest pain. He is diagnosed with atherosclerosis. This disease is caused by:

Correct Answer: Abnormal thickening and hardening of vessel walls
Response Feedback: Atherosclerosis is a form of arteriosclerosis characterized by thickening and hardening of the vessel wall.

A patient wants to know what causes atherosclerosis. How should the nurse respond? In general, atherosclerosis is caused by:

Correct Answer: Endothelial injury and inflammation
Response Feedback: Atherosclerosis begins with injury to the endothelial cells that line artery walls.

A staff member asks a nurse what foam cells are. What is the nurse's best response? Foam cells in a fatty streak are:

Correct Answer: Macrophages that engulf low-density lipoprotein (LDL)
Response Feedback: Foam cells are lipid-laden macrophages that engulf LDL.

A nurse takes an adult patient's blood pressure and determines it to be normal. What reading did the nurse obtain?

Correct Answer: Systolic pressure less than 120 mm Hg and diastolic pressure less than 80 mm Hg
Response Feedback: Normal blood pressure has a systolic pressure less than 120 mm Hg and diastolic pressure less than 80 mm Hg. A systolic pressure of 140 mm Hg or more would indicate stage I hypertension. A systolic pressure of less than 100 mm Hg would indicate low blood pressure. A diastolic pressure greater than 90 mm Hg would indicate hypertension.

Most cases of combined systolic and diastolic hypertension have no known cause and are documented on the chart as _____ hypertension.

Correct Answer: Primary
Response Feedback: Most cases of hypertension are diagnosed as primary hypertension.

A 30-year-old Caucasian female was recently diagnosed with primary hypertension. She reports that she eats fairly well, usually having red meat and potatoes daily. She also reports that her father has hypertension as well. A nurse determines which of the following risk factors is most likely associated with this diagnosis?

Correct Answer: Genes
Response Feedback: Genetic factors, such as family history of hypertension, are the number one factor in the development of hypertension.

A 65-year-old male presents for a routine checkup. A blood pressure check reveals a systolic pressure of 160 mm Hg and a diastolic pressure of 70 mm Hg. Which of the following is the most likely cause of this type of pressure elevation?

Correct Answer: Rigidity of the aorta
Response Feedback: Older adults experience stiffening of the arteries, which could lead to hypertension. A vasospasm could lead to chest pain, not hypertension. Increased sodium intake, not decreased, could lead to increased blood volume and hypertension. Lung disease would not lead to hypertension.

A 52-year-old male is diagnosed with primary hypertension. He has no other health problems. Present treatment would cause the nurse to anticipate administering which drug to the patient?

Correct Answer: A diuretic
Response Feedback: Diuretics have been shown to be the safest and most effective medications for lowering blood pressure and preventing the cardiovascular complications of hypertension.

A 55-year-old female has undiagnosed hypertension. She presents to her primary care provider reporting impaired vision and chronic edema. Lab tests reveal that she also has renal insufficiency. While planning care, the nurse realizes the most likely cause for these findings is:

Correct Answer: End-organ damage
Response Feedback: The patient is experiencing end-organ damage, as indicated by renal insufficiency.

When a nurse checks the patient for orthostatic hypotension, what did the nurse have the patient do?

Correct Answer: Stand up
Response Feedback: Orthostatic hypotension refers to a drop in blood pressure when standing up.

A 50-year-old male is diagnosed with orthostatic hypotension. Which of the following symptoms would he most likely experience?

Correct Answer: Syncope and fainting
Response Feedback: Orthostatic hypotension is often accompanied by dizziness, blurring or loss of vision, and syncope or fainting.

A 65-year-old female presents to the emergency department reporting difficulty swallowing and shortness of breath. A CT scan would most likely reveal an aneurysm in the:

Correct Answer: Thoracic aorta
Response Feedback: Thoracic aortic aneurysms can cause dysphagia (difficulty swallowing) and dyspnea (breathlessness).

What term should the nurse document for a detached blood clot?

Correct Answer: Thromboembolus
Response Feedback: A detached thrombus is a thromboembolus.

A 32-year-old female presents with lower leg pain, with swelling and redness. While obtaining the patient's history, which finding could have caused her condition?

Correct Answer: Venous thrombus
Response Feedback: A thrombus formation in the vein leads to inflammation that may cause pain and redness with obstruction. Increased pressure in the vein behind the clot may lead to edema of the extremity.

A 28-year-old female presents with severe chest pain and shortness of breath. She is diagnosed with pulmonary embolism, which most likely originated from the:

Correct Answer: Deep veins of the leg
Response Feedback: The most likely origin of the embolism is from the deep veins of the legs.

Individuals with Raynaud disease need to be counseled to avoid which of the following conditions to prevent severe symptoms?

Correct Answer: Cold exposure
Response Feedback: Raynaud disease consists of vasospastic attacks triggered by brief exposure to cold.

A 75-year-old obese female presents to her primary care provider reporting edema in the lower extremities. Physical exam reveals that she has varicose veins. Upon performing the history, which of the following is a possible cause for the varicose veins?

Correct Answer: Long periods of standing
Response Feedback: The probable cause of the patient's varicose veins is gradual venous distention caused by the action of gravity on blood in the legs due to long periods of standing. Varicose veins are most likely due to long periods of standing leading to the action of gravity promoting venous distention. Exercise would help prevent this. Trauma can occur, but usually this affects the more superficial veins. Ischemia affects arteries not veins.

A 52-year-old male presents with pooling of blood in the veins of the lower extremities and edema. The diagnosis is chronic venous insufficiency, and an expected assessment finding of this disorder is:

Correct Answer: Skin hyperpigmentation
Response Feedback: Symptoms include edema of the lower extremities and hyperpigmentation of the skin of the feet and ankles. Edema in these areas may extend to the knees. Symptoms include edema and hyperpigmentation of the skin, but deep vein thrombi do not form.Gangrene does not occur in veins, but in arteries. Edema does not occur above the knee.

While planning care for a patient with superior vena cava syndrome (SVCS), which principle should the nurse remember? SVCS is a progressive _____ of the superior vena cava (SVC) that leads to venous distention of the upper extremities and head.

Correct Answer: Occlusion
Response Feedback: SVCS is a progressive occlusion of the SVC that leads to venous distention in the upper extremities and head.

A 50-year-old male with a 30-year history of smoking was diagnosed with bronchogenic cancer. He developed edema and venous distention in the upper extremities and face. Which of the following diagnosis will the nurse observe on the chart?

Correct Answer: Superior vena cava syndrome (SVCS)
Response Feedback: SVCS is a progressive occlusion of the superior vena cava that leads to venous distention in the upper extremities and head.

A 52-year-old female is diagnosed with coronary artery disease. The nurse assesses for myocardial:

Correct Answer: Ischemia
Response Feedback: Coronary artery disease leads to myocardial ischemia.

A 56-year-old male is diagnosed with coronary artery disease. Which of the following modifiable risk factors would the nurse suggest the patient change?

Correct Answer: Smoking cigarettes
Response Feedback: Cigarette smoking leads to vasoconstriction and should be the first behavior the patient changes.

A 50-year-old obese male with hypertension and coronary artery disease visits a nutritionist for food counseling. He has an elevated level of low-density lipoprotein (LDL) and a low level of high-density lipoprotein (HDL). Which of the following should the nurse advise him to avoid?

Correct Answer: Trans fats
Response Feedback: Trans fats are primarily found in artificially solidified (hydrogenated) oils (e.g., margarine and vegetable shortening). By becoming more solid, they lose essential fatty acids (EFAs). They can raise LDL and lower HDL levels.

When a patient asks the nurse what is the most common cause of myocardial ischemia, which statement is the correct response? The most common cause of myocardial ischemia is:

Correct Answer: Atherosclerosis
Response Feedback: The most common cause of myocardial ischemia is atherosclerosis.

A 51-year-old male presents with recurrent chest pain on exertion. He is diagnosed with angina pectoris. When he asks what causes the pain, how should the nurse respond? The pain occurs when:

Correct Answer: The myocardial oxygen supply has fallen below demand.
Response Feedback: Angina is chest pain caused by myocardial ischemia, which develops if the flow or oxygen content of coronary blood is insufficient to meet the metabolic demands of myocardial cells.

A 62-year-old male presents to his primary care provider reporting chest pain at rest and with exertion. He does not have a history of coronary artery disease and reports that the pain often occurs at night. He is most likely experiencing which type of angina?

Correct Answer: Prinzmetal
Response Feedback: Chest pain that occurs at rest and at night is descriptive of Prinzmetal angina. Unstable angina is a form of acute coronary syndrome that results from reversible myocardial ischemia. Stable angina is predictable and occurs with activity. Silent angina has few, if any, symptoms.

A 51-year-old male is at the health clinic for an annual physical exam. After walking from the car to the clinic, he developed substernal pain. He also reported discomfort in his left shoulder and his jaw, lasting 2 to 3 minutes and then subsiding with rest. He indicates that this has occurred frequently over the past few months with similar exertion. The nurse suspects he is most likely experiencing:

Correct Answer: Stable angina
Response Feedback: Stable angina is associated with activity and subsides with rest.

A 49-year-old male presents to his primary care provider reporting chest pain. EKG reveals ST elevation. He is diagnosed with myocardial ischemia. Which of the following interventions would be most beneficial?

Correct Answer: Apply oxygen to increase myocardial oxygen supply.
Response Feedback: Increase myocardial oxygen supply is indicated to treat ischemia.

A 68-year-old male presents to the ER reporting chest pain. He has a history of stable angina that now appears to be unstable. He most likely has:

Correct Answer: Impending myocardial infarction (MI)
Response Feedback: Unstable angina is an indication of impending MI.

A 55-year-old male died of a myocardial infarction. Autopsy would most likely reveal:

Correct Answer: Platelet aggregation within the atherosclerotic coronary artery

A 60-year-old female had a myocardial infarction. She was brought to the hospital 30 minutes later. She survived, but now the nurse is providing care for impaired ventricular function because:

Correct Answer: The resulting ischemia leads to hypoxic injury and myocardial cell death.
Response Feedback: The patient has impaired ventricular functioning because a portion of the myocardium has died due to ischemia.

A 75-year-old male has severe chest pain and dials 911. Lab tests at the hospital reveal elevated levels of cardiac troponins I and T. Based upon the lab findings, the nurse suspects which of the following has occurred?

Correct Answer: Myocardial infarction (MI)
Response Feedback: The diagnosis of acute MI is made on the basis of serial cardiac biomarker alterations. The cardiac troponins (troponins I and T) are the most specific indicators of MI.

A 28-year-old female presents to the ER reporting severe chest pain that worsens with respirations or lying down. She has a fever, tachycardia, and a friction rub. Based upon the assessment findings, the nurse determines the patient is experiencing:

Correct Answer: Acute pericarditis
Response Feedback: Severe chest pain that worsens with respirations or lying down in a patient with fever, tachycardia, and a friction rub is characteristic of acute pericarditis.

A 56-year-old male presents to his primary care provider for a checkup. Physical exam reveals edema, hepatomegaly, and muffled heart sounds. Which of the following is of greatest concern to the nurse?

Correct Answer: Tamponade
Response Feedback: Muffled heart sounds is an indication of tamponade, and with tamponade the blood backs up into the venous system, leading to hepatomegaly.

A 42-year-old female is diagnosed with constrictive pericarditis. The nurse assesses the blood pressure for decreased cardiac output because of:

Correct Answer: Fibrosis and calcification of the pericardial layers
Response Feedback: In constrictive pericarditis, fibrous scarring compresses the heart and eventually reduces cardiac output.

Many valvular stenosis and regurgitation disorders in adults have a common etiology. Which of the following conditions should alert the nurse that the patient may have both types of valve dysfunction?

Correct Answer: Rheumatic fever or heart disease
Response Feedback: Valvular dysfunction is often related to rheumatic fever.

While planning care, the nurse remembers which principle? In valvular _____, the valve opening is constricted and narrowed because the valve leaflets, or cusps, fail to open completely.

Correct Answer: Stenosis
Response Feedback: Valvular stenosis occurs when the valve opening is constricted and narrowed.

A 67-year-old female was previously diagnosed with rheumatic heart disease. Tests reveal lipoprotein deposition with chronic inflammation that impairs blood flow from the left ventricle into the aorta. Which of the following is the most likely diagnosis recorded on the chart?

Correct Answer: Aortic stenosis
Response Feedback: Aortic stenosis would impair blood flow from the left ventricle to the aorta.

A 60-year-old female was diagnosed with mitral stenosis. As a result, the nurse realizes the patient has incomplete emptying of the:

Correct Answer: Left atrium
Response Feedback: Mitral stenosis would result in incomplete emptying of the left atrium, as the mitral valve is located between the left atrium and left ventricle.

A 72-year-old female has a history of hypertension and atherosclerosis. An echocardiogram reveals backflow of blood into the left ventricle. Which of the following is the most likely diagnosis documented on the chart?

Correct Answer: Aortic regurgitation
Response Feedback: Aortic regurgitation would allow backward flow of blood into the left ventricle.

Upon assessment of the patient, the nurse finds a widened pulse pressure and throbbing peripheral pulses. Which valve disorder does the nurse suspect?

Correct Answer: Aortic regurgitation
Response Feedback: Aortic regurgitation is manifested by widened pulse pressure resulting from increased stroke volume and diastolic backflow.

A 35-year-old male presents with pulmonary hypertension. Testing reveals he is in right heart failure. Which of the following is the most likely diagnosis the nurse will see listed on the chart?

Correct Answer: Tricuspid regurgitation
Response Feedback: Tricuspid regurgitation leads to volume overload in the right atrium and ventricle, increased systemic venous blood pressure, and right heart failure.

A nurse recalls the most common cardiac valve disease in the United States, which tends to be most prevalent in young women, is:

Correct Answer: Mitral valve prolapse
Response Feedback: Mitral valve prolapse is the most common valve disorder in the United States.

A 10-year-old male presents with fever, lymphadenopathy, arthralgia, and nose bleeds. He is diagnosed with rheumatic heart disease. When a staff member asks what caused the disease, what is the nurse's most correct response? The most likely cause of this disease is:

Correct Answer: Group A β-hemolytic streptococcus infections
Response Feedback: Rheumatic fever is a systemic, inflammatory disease caused by a delayed exaggerated immune response to infection by the group A β-hemolytic streptococcus.

A 10-year-old male presents with fever, lymphadenopathy, arthralgia, and nose bleeds. He is diagnosed with rheumatic heart disease. While planning care, which characteristic changes should the nurse remember?

Correct Answer: Antigens that bind to the valvular lining, triggering an autoimmune response
Response Feedback: The immune response cross-reacts with molecularly similar self-antigens in heart, muscle, joints, and the brain, causing an autoimmune response resulting in diffuse, proliferative, and exudative inflammatory lesions in these tissues.

A 30-year-old female presents to her primary care provider with fever, cardiac murmur, and petechial skin lesions. She is diagnosed with infective endocarditis. When the patient wants to know what caused the disease, what is the nurse's best response? The most likely cause of the disease is:

Correct Answer: Bacteria
Response Feedback: Infective carditis is due to a bacterial infection

A nurse is teaching staff about endocarditis. Which information should the nurse include? Inflammatory cells have difficulty limiting the colonization of microorganisms in infective endocarditis because the:

Correct Answer: Microorganisms are sequestered in a fibrin clot.
Response Feedback: In endocarditis, bacterial colonies are inaccessible to host defenses because they are embedded in the protective fibrin clots.

A 50-year-old male visits the cardiologist for an EKG. Results indicate that he has no PR interval and a variable QRS rate with rhythm irregularity. Which of the following is the most likely diagnosis to be recorded on the chart?

Correct Answer: Atrial fibrillation
Response Feedback: Atrial fibrillation is characterized by no PR interval and a variable QRS response.

Which characteristic changes should the nurse keep in mind while caring for a patient with left heart failure? As left heart failure progresses:

Correct Answer: Left ventricular preload increases.
Response Feedback: Left ventricular preload increases in left heart failure because less blood is ejected from the left ventricle.

A 65-year-old male with a history of untreated hypertension is now experiencing left heart failure. A nurse recalls his untreated hypertension led to:

Correct Answer: Myocardial hypertrophy and ventricular remodeling
Response Feedback: With hypertension comes increased afterload and resistance to ventricular emptying and more workload for the ventricle, which responds with hypertrophy of the myocardium and ventricular remodeling.

A 59-year-old female is diagnosed with left ventricular failure. If a decrease in kidney perfusion occurs, the nurse knows this would ultimately cause:

Correct Answer: Increased systemic vascular resistance
Response Feedback: With a decrease in kidney perfusion, renin is released with the ultimate outcome of increased systemic vascular resistance to raise blood pressure to increase blood flow to the kidney.

A 68-year-old female is experiencing left heart failure. Physical exam reveals elevated blood pressure. The nurse understands this is most likely caused by:

Correct Answer: Sympathetic nervous system compensation for decreased cardiac output
Response Feedback: The sympathetic nervous system increases peripheral vascular resistance (PVR) and leads to hypertension.

When a patient with left heart failure starts to have a cough and dyspnea, which principle should the nurse remember? Pulmonary symptoms, common to left heart failure, are a result of:

Correct Answer: Pulmonary vascular congestion
Response Feedback: The clinical manifestations of left heart failure are the result of pulmonary vascular congestion and inadequate perfusion of the systemic circulation.

A 73-year-old female has increased pulmonary pressure resulting in right heart failure. The nurse should monitor for a possible complication because a potential cause for her heart to fail is:

Correct Answer: Left heart failure
Response Feedback: Right-sided failure often follows left-sided failure when pulmonary congestion forces backward flow of blood into the left ventricle.

65-year-old male is diagnosed with chronic pulmonary disease and elevated pulmonary vascular resistance. Which of the following heart failures should the nurse assess for in this patient?

Correct Answer: Right heart failure
Response Feedback: Right-sided failure occurs when the patient experiences chronic pulmonary disease and elevated pulmonary vascular resistance because the blood has difficulty overcoming the pressure and blood builds up in the right side of the heart.

A 72-year-old female has a history of right heart failure caused by a right ventricular myocardial infarction. Which of the following symptoms are specifically related to her right heart failure?

Correct Answer: Significant edema to both lower legs and feet
Response Feedback: Right-sided failure allows blood to back up into the systemic circulation, leading to peripheral edema.

Which condition should cause the nurse to assess for high-output failure in a patient?

Correct Answer: Anemia
Response Feedback: Common causes of high-output failure include anemia.

When a person is in shock, a nurse remembers impairment in cellular metabolism is caused by:

Correct Answer: Inadequate tissue perfusion
Response Feedback: In shock, impaired cellular metabolism is caused by inadequate tissue perfusion.

A nurse is planning care for a patient in shock. Which principle should the nurse remember? During shock states, glucose uptake is usually:

Correct Answer: Impaired
Response Feedback: Some compensatory mechanisms activated by shock contribute to decreased glucose uptake by the cells.

A 50-year-old male was admitted to the intensive care unit with a diagnosis of acute myocardial infarction (MI). He is being treated for shock. His cardiopulmonary symptoms include low blood pressure, tachycardia, and tachypnea. His skin is pale and cool. The primary cause of his shock is most likely:

Correct Answer: Decreased cardiac contractility
Response Feedback: MI leads to decreased cardiac contractility due to a damaged myocardium and would lead to shock.

An 82-year-old female was admitted to the hospital with confusion and severe hypotension. Her body's compensatory mechanisms are increased heart rate, vasoconstriction, and movement of large volumes of interstitial fluid to the vascular compartment. What kind of shock does the nurse suspect the patient is experiencing?

Correct Answer: Hypovolemic
Response Feedback: In hypovolemic shock, heart rate and SVR increase, boosting both cardiac output and tissue perfusion pressures. Interstitial fluid moves into the vascular compartment.

A 27-year-old male is admitted to a neurologic unit with a complete C-5 spinal cord transection. On initial assessment, he is bradycardic, hypotensive, and hyperventilating. He appears to be going into shock. The most likely mechanism of his shock is:

Correct Answer: Vasodilation caused by a decrease in sympathetic stimulation
Response Feedback: The patient is experiencing neurogenic shock in which blood volume has not changed, but SVR decreases drastically so that the amount of space containing the blood has increased, leading to hypotension.

What factors make a patient prone to neurogenic shock? Neurogenic shock can be caused by any factor that inhibits the:

Correct Answer: Sympathetic nervous system
Response Feedback: Neurogenic shock is caused by any factor that inhibits the sympathetic nervous system.

A 15-year-old male who is allergic to peanuts eats a peanut butter cup. He then goes into anaphylactic shock. Which assessment findings will the nurse assess for?

Correct Answer: Bronchoconstriction, hives or edema, and hypotension
Response Feedback: Anaphylactic shock is characterized by bronchoconstriction, hives, and hypotension.