gastrointestinal bleed

A client with a gastrointestinal bleed secondary to alcohol abuse and a hemoglobin level of 5.8 g/dL has been ordered a transfusion of packed red blood cells. The client possesses type B antibodies but lacks type D antigens on his red cells. Transfusion of which of the following blood types would be least likely to produce a transfusion reaction?

Answers:

A. A–

B. A

C. B–

D. B

Question 18

Which of the following clients’ signs and symptoms would allow a clinician to be most justified in ruling out stroke as a cause? An adult

Answers:

A. has vomited and complained of a severe headache.

B. states that his left arm and leg are numb, and gait is consequently unsteady.

C. has experienced a sudden loss of balance and slurred speech.

D. has had a gradual onset of weakness, headache, and visual disturbances over the last 2 days.

Question 19

Amniocentesis has suggested that a couple’s first child will be born with sickle cell disease. The parents are unfamiliar with the health problem, and their caregiver is explaining the complexities. Which of the following statements by the parents would suggest a need for further teaching or clarification?

Answers:

A. “Our baby’s red cells are prone to early destruction because of his or her weak membranes.”

B. “Our son or daughter likely won’t show the effects of sickling until he or she is school-aged because of the different hemoglobin in babies.”

C. “Not all of his or her red cells will be sickled, but low oxygen levels can cause them to become so.”

D. “Sickled cells can block his or her blood vessels, especially in the abdomen, chest, and bones.”

Question 20

During science class, a student asks, “What’s the difference between plasma and serum in the blood?” The nurse responds that the primary difference between plasma and serum is that plasma contains

Answers:

A. hydrogen ions.

B. heparin.

C. white blood cells.

D. fibrinogen.

Question 21

During a flu shot clinic, one of the questions the student nurse asks relates to whether the patient has had Guillain-Barré syndrome in his medical history. The patient asks, “What is that?” How should the nursing student reply?

Answers:

A. “A type of paralysis that affects movement on both sides of the body that may even involve the respiratory muscles”

B. “Influenza-like illness where you had fever and chills for 2 to 3 days after your last flu shot”

C. “A degenerative disease where you have trouble walking without the help of a cane or walker”

D. “Swelling of your arm where you got your flu shot, and maybe your eyes and lips had some swelling as well”

Question 22

A 22-year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem?

Answers:

A. Excess acetylcholinesterase production; treatment with thymectomy

B. A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins

C. Cerebellar lesions; surgical and immunosuppressive treatment

D. Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids

Question 23

A baseball player was hit in the head with a bat during practice. In the emergency department, the physician tells the family that he has a “coup”injury. How will the nurse explain this to the family so they can understand?

Answers:

A. “It’s like squeezing an orange so tight that the juice runs out of the top.”

B. “When the bat hit his head, his neck jerked backward causing injury to the spine.”

C. “Your son has a contusion of the brain at the site where the bat hit his head.”

D. “Your son has a huge laceration inside his brain where the bat hit his skull.”

Question 24

Which of the following glycoproteins is responsible for treating such diseases as bone marrow failure following chemotherapy and hematopoietic neoplasms such as leukemia? Answers:

A. Growth factors and cytokines

B. T lymphocytes and natural killer cells

C. Neutrophils and eosinophils

D. Natural killer cells and granulocytes

Question 25

While being on subcutaneous heparin injections for deep vein thrombosis during her latter pregnancy, a patient begins to experience major side effects. Her OB-GYN physician has called in a specialist who thinks that the patient is experiencing heparin-induced thrombocytopenia. The nurse should anticipate which of the following orders?

Answers:

A. Immediately discontinue the heparin therapy

B. Switch to Coumadin 2.5 mg once/day

C. Decrease the dose of heparin from 5000 units b.i.d to 3000 units b.i.d

D. Infuse FFP stat

Question 26

Which of the following individuals would most likely experience global ischemia to his or her brain?

Answers:

A. A woman who is being brought to hospital by ambulance following suspected carbon monoxide poisoning related to a faulty portable heater

B. A male client who has just had an ischemic stroke confirmed by CT of his head

C. A woman who has been admitted to the emergency department with a suspected intracranial bleed

D. A man who has entered cardiogenic shock following a severe myocardial infarction

Question 27

A new mother and father are upset that their 2-day-old infant is requiring phototherapy for hyperbilirubinemia. The pediatrician who has followed the infant since birth is explaining the multiplicity of factors that can contribute to high serum bilirubin levels in neonates. Which of the following factors would the physician be most likely to rule out as a contributor?

Answers:

A. Transitioning of hemoglobin F (HbF) to hemoglobin A (HbA)

B. Hepatic immaturity of the infant

C. Hypoxia

D. The fact that the infant is being breast-fed

Question 28

A 14-year-old boy has been diagnosed with infectious mononucleosis. Which of the following pathophysiological phenomena is most responsible for his symptoms?

Answers:

A. Viruses are killing some of his B cells and becoming incorporated into the genome of others.

B. The Epstein-Barr virus (EBV) is lysing many of the boy’s neutrophils.

C. The virus responsible for mononucleosis inhibits the maturation of myeloblasts into promyelocytes.

D. The EBV inhibits the maturation of white cells within his peripheral lymph nodes.

Question 29

A 16-year-old female has been brought to her primary care physician by her mother due to the girl’s persistent sore throat and malaise. Which of the following facts revealed in the girl’s history and examination would lead the physician to rule out infectious mononucleosis?

Answers:

A. Chest auscultation reveals crackles in her lower lung fields bilaterally.

B. Her liver and spleen are both enlarged.

C. Blood work reveals an increased white blood cell count.

D. The girl has a temperature of 38.1°C (100.6°F) and has enlarged lymph nodes.

Question 30

A 30-year-old woman who has given birth 12 hours prior is displaying signs and symptoms of disseminated intravascular coagulation (DIC). The client’s husband is confused as to why a disease of coagulation can result in bleeding. Which of the nurse’s following statements best characterizes DIC?

Answers:

A. “The same hormones and bacteria that cause clotting also cause bleeding.”

B. “Massive clotting causes irritation, friction, and bleeding in the small blood vessels.”

C. “So much clotting takes place that there are no available clotting components left, and bleeding ensues.”

D. “Excessive activation of clotting causes an overload of vital organs, resulting in bleeding.”

Question 31

A 20-year-old has been diagnosed with an astrocytic brain tumor located in the brain stem. Which of the following statements by the oncologist treating the client is most accurate?

Answers:

A. “Our treatment plan will depend on whether your tumor is malignant or benign.”

B. “This is likely a result of a combination of heredity and lifestyle.”

C. “The major risk that you face is metastases to your lungs, liver, or bones.”

D. “Your prognosis will depend on whether we can surgically resect your tumor.”