ATI RN COMPREHENSIVE PREDICTOR RETAKE EXAM 2019 WITH VERIFIED SOLUTIONS GRADED A+

ATI RN COMPREHENSIVE PREDICTOR RETAKE EXAM 2019 WITH VERIFIED SOLUTIONS GRADED A+ Chapter 37: Concepts of Care for Patients With Hematologic Problems 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. DIF: Analyzing TOP:: IntaegbratierdbPs: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 pamin 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 4. Thenurseiscaring foraclient experiencing sicklecell diseasecrisis. Which priority action would help prevent infection? 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. 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: IntaegbratierdbPs: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