NCM 112 Lecture (Oxygen-Transport)

A new RN is preparing to administer packed red blood cells (PRBCs) to a client whose anemia was caused by blood loss after surgery. Which action by the new RN requires that you, as charge nurse, intervene immediately?

• The new RN waits 20 minutes after obtaining the PRBCs before starting the infusion.
• The new RN starts an intravenous line for the transfusion using a 22-gauge catheter.
• The new RN primes the transfusion set using 5% dextrose in lactated Ringer’s solution.
• The new RN tells the client that the PRBCs may cause a serious transfusion reaction.

A 32-year-old client with a history of sickle cell anemia is admitted to the hospital during a sickle cell crisis. The physician orders all of these interventions. Which order will you implement first?

• Give morphine sulfate 4-8 mg IV every hour as needed.
• Start a large-gauge IV line and infuse normal saline at 200 mL/hour.
• Immunize with Pneumovax and Haemophilus influenzae vaccines.
• Administer oxygen at an F102 of 100% per non-rebreather mask.

You are making a room assignment for a newly arrived client whose laboratory testing indicates pancytopenia. All of these clients are already on the nursing unit. Which one will be the best roommate for the new client?

• The client with digoxin toxicity
• The client with viral pneumonia
• The client with shingles
• The client with cellulitis

A client admitted to the hospital with a sickle cell crisis complains of severe abdominal, hip, and knee pain. You observe an LPN accomplishing these client care tasks. Which one requires that you, as charge nurse, intervene immediately?

• The LPN encourages the client to use the ordered PCA.
• The LPN positions cold packs on the client’s knees.
• The LPN places a “No Visitors” sign on the client’s door.
• The LPN checks the client’s temperature every 2 hours.

After receiving change-of-shift report about all of these clients, which one will you assess first?

• A 26-year-old with thalassemia major who has a short-stay admission for a blood transfusion
• A 44-year-old who was admitted 3 days previously with a sickle cell crisis and has orders for a CT scan
• A 50-year-old with newly diagnosed stage IV non-Hodgskin’s lymphoma who is crying and stating “I’m not ready to die.”
• A 69-year-old with chemotherapy-induced neutropenia who has an elevated oral temperature

The nurse in the outpatient clinic is assessing a 22-year-old with a history of a recent splenectomy after a motor vehicle accident. Which information obtained during the assessment will be of most immediate concern to the nurse?

• The client engages in unprotected sex.
• The client has an oral temperature of 99.7o F
• The client has abdominal pain with light palpation.
• The client admits to occasional marijuana use.

After receiving the change-of-shift report, which client will you assess first?

• A 20-year-old with possible acute myelogenous leukemia who has just arrived on the medical unit
• A 38-year-old with aplastic anemia who needs teaching about decreasing infection risk prior to discharge
• A 40-year-old with lymphedema who requests help to put on compression stockings before getting out of bed
• A 60-year-old with non-Hodgkin’s lymphoma who is refusing the ordered chemotherapy regimen

The nurse is preparing to teach a client with microcytic hypochromic anemia about the diet to follow after discharge. Which of the following foods should be included in the diet?

• Eggs
• Lettuce
• Citrus fruits
• Cheese

The nurse would instruct the client to eat which of the following foods to obtain the best supply of vitamin B12?

• Whole grains
• Green leafy vegetables
• Meats and dairy products
• Broccoli and Brussels sprouts

The nurse has just admitted a 35-year-old female client who has a serum B12 concentration of 800 pg/ml. Which of the following laboratory findings would cue the nurse to focus the client history on specific drug or alcohol abuse?

• Total bilirubin, 0.3 mg/dL
• Serum creatinine, 0.5 mg/dL
• Hemoglobin, 16 g/dL
• Folate, 1.5 ng/mL