Inflammation

The nurse more closely assesses patients with which conditions for signs of pernicious anemia? Select all that apply.  

Which patient characteristic increases the risk for pernicious anemia following a subtotal gastrectomy?  

Four hours after a rectal resection for treatment of rectal cancer, the patient is noted to be pale and diaphoretic. Which assessments are the priority? Select all that apply.  

The nurse most closely monitors the temperature for the patient who underwent which procedure?  

The nurse clarifies the order for a perineal prostatectomy for treatment of prostate cancer in the patient with which condition?   

The 62-year-old male patient presents to the office complaining of difficulty urinating, with a weak stream, waking multiple times in the night to urinate, and the feeling of not completely emptying the bladder that has been occurring for months. Which test must be performed first for this patient? 

The patient with psoriasis has been prescribed a keratolytic for management of cutaneous symptoms. The nurse instructs the patient to stop the medication and contact the provider if which symptoms occur? Select all that apply.   

The patient with severe psoriasis has been prescribed methotrexate. The nurse instructs the patient to schedule which follow-up tests? Select all that apply.   

The patient who has been prescribed methotrexate for the treatment of severe psoriasis has received medication teaching. Which statements indicate the teaching was effective? Select all that apply.

The patient on bowel rest has been prescribed 10% dextrose total parenteral nutrition at 50 mL/h, intravenous lipids 3 grams/kg/day, and 10 mg intravenous famotidine every other day. Which information in the patient’s chart prompts the nurse to contact the provider? 

The nurse is caring for the patient who is at the nadir for bone marrow suppression. Which order does the nurse clarify with the provider?  

The nurse questions which orders for the 12-year-old patient in sickle cell crisis? Select all that apply.

The patient is admitted to the hospital after fainting at home. Blood tests reveal a hypochromic, microcytic anemia with a large amount of fetal hemoglobin. Thrombocytopenia is noted as well. The lymph nodes, spleen, and liver are all within normal limits for size and consistency. A blood transfusion and platelet transfusion are administered, with less than expected results. The nurse anticipates administering antithymocyte globulin in response to which result?   

The patient is hospitalized after being diagnosed with aplastic anemia. Which question is most important to ask the patient?   

The nurse assessing the 4-month-old brought to the emergency room for poor feeding and signs of dehydration notes the infant seems to be looking down and sclera is visible superior to the iris. The nurse reports this assessment to the provider and receives orders for care. Which order does the nurse question? 

The 8-month-old patient has had 4 skin abscesses in the past 3 months that have required draining. Each abscess drains less than 5 mL non-purulent fluid. The infant appears well otherwise and the parents deny respiratory infections. The infant’s complete blood count shows an elevated white blood cell count without bands or segmented cells. Immunoglobulin levels are appropriate for the age of the infant. The patient has a positive nitroblue test. The nurse plans care to include which intervention? 

The 11-month-old, previously healthy infant is brought to the emergency department after becoming increasingly lethargic over the past 24 hours. The infant’s vital signs are notable for a temperature of 40.8°C, heart rate 138 bpm, respiratory rate 31, and blood pressure 84/50 mmHg. Upon assessment, the nurse notes sensitivity to light and sound, bulging anterior fontanelle, and significant resistance to turning the head. Place the interventions in the correct order.  

The 68-year-old patient is admitted after 5 days of extremely foul-smelling watery diarrhea with a temperature of 37.9°C, heart rate 118 bpm, and blood pressure 98/52 mmHg. The patient’s recent medical history is significant for being treated 2 weeks ago for a diverticulitis flare-up. Upon assessment, the patient is pale, diaphoretic, and has a tense, distended abdomen that he does not guard with palpation. Lab studies reveal an elevated creatinine (1.9 mg/dL), high white blood cell count (20,000 cells/mL), and normal hemoglobin and hematocrit. The nurse prepares to perform which diagnostic test for this patient?  

The 68-year-old patient is admitted after 5 days of extremely foul-smelling watery diarrhea with a temperature of 37.9°C, heart rate 118 bpm, and blood pressure 98/52 mmHg. The patient’s recent medical history is significant for being treated 2 weeks ago for a diverticulitis flare-up. Upon assessment, the patient is pale, diaphoretic, and has a tense, distended abdomen that he does not guard with palpation. Lab studies reveal an elevated creatinine (1.9 mg/dL), high white blood cell count (20,000 cells/mL), and normal hemoglobin and hematocrit. Which intervention is most important to prevent the spread of this condition to other patients? 

The patient with acquired immunodeficiency syndrome who has been noncompliant with highly active antiretroviral therapy (HAART) presents to the emergency department with a productive cough, fever, night sweats, and weight loss. The patient’s chest x-ray reveals diffuse infiltrates bilaterally and the CD4 count is 182 cells/µL. Which question by the nurse is most important?  

The 5-day-old 38-week-gestation neonate was born to a 25-year-old primigravida woman after a pregnancy and vacuum-assisted delivery complicated by gestational diabetes, large for gestational age fetus, and shoulder dystocia. The neonate required vigorous stimulation and positive pressure ventilation. Apgar scores were 3 and 8 at 1 and 5 minutes of life. At the pediatrician’s appointment after discharge, the neonate is found to have a large bruise at the back of the head that was sustained during birth and eyes glued shut with yellow, mucopurulent discharge. A gram stain of the drainage reveals gram-negative cocci in pairs. The mother states, “No matter what I do, it keeps coming back. I’ve used warm compresses and washed it away.” Additionally, the mother reports the infant is breastfeeding well with 4 wet diapers and 1 stool per day. The nurse informs the provider of the assessment and requests which order first?  

The 32-year-old patient presents complaining of severe itching on the arms that has gotten worse as her job has gotten more stressful. Upon assessment, the nurse observes erythematous lichen patches on the arms and in the antecubital fossa, where it is fissured and weeping. The nurse anticipates providing education about which medication?  

The nurse is preparing the otherwise healthy 54-year-old patient for a right knee replacement surgery and checks to see if the patient is allergic to which medication? 

The 20-year-old student went on a mission trip to Ghana to help at a local hospital. She presented to the clinic 12 days after her return; she began to experience anorexia, flu-like symptoms, and fatigue. Ten days later, she noticed her eyes and skin looked yellow. Her history, assessment, and vitals are within normal limits except her yellow sclera and jaundiced skin. Initial lab studies reveal a total bilirubin of 16, indirect bilirubin of 8, AST of 1320 and ALT of 1400. The nurse prepares the patient for which test next? 

The 4-week-old neonate in the neonatal intensive care unit was born at 29 weeks gestation. The patient is stable on room air and has been tolerating nasogastric feedings of expressed breast milk. Generally an active and responsive patient, the nurse notes the patient is lethargic and does not react to his diaper change. Additionally, the patient’s heart rate is 194 bpm, respiratory rate is 82 breaths per minute, and the blood pressure is 54/21 mm Hg. The patient’s abdomen is distended and discolored; dark green emesis is noted as well. An abdominal x-ray is ordered and performed. Which x-ray findings are consistent with the patient’s clinical picture? Select all that apply.  

The 23-year-old patient is brought to the emergency department after contacting emergency services to report profound weakness that started in his feet and worsened and spread cranially over the past few days. He reports severe diarrhea after a camping trip a week ago. Upon assessment, strength, sensation, and deep tendon reflexes are significantly reduced, with the lower extremities more severely affected than his upper extremities. Vital signs are normal and the patient seems to be breathing well. The nurse anticipates which finding on the lumbar puncture result?  

The 23-year-old patient is brought to the emergency department after contacting emergency services to report profound weakness that started in his feet and worsened and spread cranially over the past few days. He reports severe diarrhea after a camping trip a week ago. Upon assessment, strength, sensation, and deep tendon reflexes are significantly reduced, with the lower extremities more severely affected than his upper extremities. Vital signs are normal and the patient seems to be breathing well. There is increased protein in the cerebrospinal fluid found after a lumbar puncture. The patient is admitted to the intensive care unit for further management and observation. The ICU nurse includes which interventions in the plan of care? Select all that apply.  

The 23-year-old patient is brought to the emergency department after contacting emergency services to report profound weakness that started in his feet and worsened and spread cranially over the past few days. He reports severe diarrhea after a camping trip a week ago. Upon assessment, strength, sensation, and deep tendon reflexes are significantly reduced, with the lower extremities more severely affected than his upper extremities. There is increased protein in the cerebrospinal fluid found after a lumbar puncture. The patient begins taking more shallow breaths and becomes confused. The patient is intubated and mechanically ventilated. Once the patient is stable, the nurse anticipates administering which medication? 

The patient with human immunodeficiency virus (HIV) presents with a disseminated rash. The nurse notes purple papules over the trunk, arms, and on mucous membranes. Some are scabbed. The patient’s CD4 count is 64. Although highly active antiretroviral therapy (HAART) has been prescribed, the patient reports being noncompliant because of intolerable side effects. The nurse suspects which infection is most responsible for this new rash? 

The patient with well-controlled chronic obstructive pulmonary disorder presents with a 3 day history of increased cough with sputum production, fever, and malaise. Upon assessment, breath sounds are clear after coughing and the patient appears to breathe comfortably with no retractions or nasal flaring. His chest x-ray is clear and his screening complete blood count is largely normal, with exception of a white blood cell count of 16. The nurse anticipates the provider to order which medication(s)? Select all that apply. 

The 20-year-old patient with asthma presents to the emergency department with increased work of breathing and severe wheezing after exposure to household dust and mold. The patient used the albuterol inhaler 6 times in the previous 4 hours with minimal relief. Upon inspection, the nurse notes extensive accessory respiratory muscle use with moderate supraclavicular retractions and nasal flaring. The nurse auscultates expiratory wheezing in all lung fields. The patient is afebrile, normotensive, significantly tachypneic, and mildly tachycardic. The nurse anticipates which findings on a chest x-ray?

The 20-year-old patient with asthma presents to the emergency department with increased work of breathing and severe wheezing after exposure to household dust and mold. The patient used the albuterol inhaler 6 times in the previous 4 hours with minimal relief. Upon inspection, the nurse notes extensive accessory respiratory muscle use with moderate supraclavicular retractions and nasal flaring. The nurse auscultates expiratory wheezing in all lung fields. The patient is afebrile, normotensive, significantly tachypneic, and mildly tachycardic. The chest x-ray is clear. The nurse prepares to administer which medication first? 

The patient who has received a heart transplant is prescribed trimethoprim-sulfamethoxazole (TMP-SMZ) for Pneumocystis jiroveci pneumonia (PJP) prophylaxis. Which statements does the nurse provide to educate the patient about adverse effects of the TMP-SMZ? Select all that apply.

The patient who began taking celecoxib one week ago for severe osteoarthritis reports diarrhea for the past three days. The patient’s vital signs are all within normal limits and the urine output is adequate. Which instruction by the nurse is appropriate?