2
NUR 211 Final Exam with precise detailed answers || || || || || || ||
A nurse caring for a client with sickle cell disease (SCD) reviews the client's laboratory
|| || || || || || || || || || || || || || ||
work. Which finding should the nurse report to the provider?
|| || || || || || || || ||
A. Creatinine: 2.9
|| ||
B. Hematocrit: 30%
|| ||
C. Sodium: 147
|| ||
D. WBC: 12,000 - ✔✔A. Creatinine: 2.9
|| || || || || ||
An elevated creatinine indicates kidney damage, which occurs in SCD. A hematocrit level of
|| || || || || || || || || || || || ||
30% is an expected finding, as is a slightly elevated white blood cell count. A sodium of 147,
|| || || || || || || || || || || || || || || || || || ||
although slightly high, is not concerning || || || || ||
A client hospitalized with sickle cell crisis frequently asks for opioid pain medications, often
|| || || || || || || || || || || || ||
shortly after receiving a dose. The nurses on the unit believe the client is drug seeking.
|| || || || || || || || || || || || || || || || ||
When the client requests pain medication, what action by the nurse is best?
|| || || || || || || || || || || ||
A. Give the client pain medication if it is time for another dose.
|| || || || || || || || || || || ||
B. Instruct the client not to request pain medication too early.
|| || || || || || || || || ||
C. Request the provider to leave a prescription for a placebo
|| || || || || || || || || ||
D. Tell the client it is too early to have more pain medication - ✔✔A. Give the client pain
|| || || || || || || || || || || || || || || || || || ||
medication it it is time for another dose. || || || || || || ||
Clients with sickle cell crisis often have severe pain that is managed with up 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 doe of medication, the nurse should provide
|| || || || || || || || || || || || || || ||
it, The other options are judgmental and do not address the client's pain. Giving placebos is
|| || || || || || || || || || || || || || || ||
unethical.
,2
A client in sickle cell crisis is dehydrated and in the emergency department. The nurse
|| || || || || || || || || || || || || || ||
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 Ringers solution - ✔✔A. 0.45% normal saline
|| || || || || || || ||
Because clients in sickle cell crisis are often dehydrated, the fluid of choice is a hypotonic
|| || || || || || || || || || || || || || || ||
solution such as 0.45% normal saline. ).9% normal saline and lactated ringers solution are
|| || || || || || || || || || || || || ||
isotonic. D50 is hypertonic and not used for hydration.
|| || || || || || || ||
A client presents to the emergency department in sickle cell crisis. What intervention by the
|| || || || || || || || || || || || || ||
nurse takes priority?
|| || ||
A. Administer oxygen
|| ||
B. Apply an oximetry probe
|| || || ||
C. Give pain medication
|| || ||
D. Start an IV line - ✔✔A. Administer oxygen
|| || || || || || || ||
All actions are appropriate, but remembering the ABCs, oxygen would come first. The main
|| || || || || || || || || || || || || ||
problem in a sickle cell crisis is tissue and organ hypoxia, so providing oxygen helps halt the
|| || || || || || || || || || || || || || || ||
process.
||
A client has a sickle cell crisis with extreme lower extremity pain. What comfort measure
|| || || || || || || || || || || || || || ||
does the nurse delegate to the UAP?
|| || || || || ||
A. Apply ice packs to the client's legs
|| || || || || || ||
B. Elevate the clients legs on pillows
|| || || || || ||
C. Keep the lower extremities warms.
|| || || || ||
D. Place elastic bandage wraps on the client's legs. - ✔✔C. Keep the lower extremities warm
|| || || || || || || || || || || || || || ||
,2
During a sickle cell crisis, the tissue distal to the occlusion has decreased blood flow and
|| || || || || || || || || || || || || || || ||
ischemia, leading to pain. Due to decreased blood flow, the clients legs will be cool or cold.
|| || || || || || || || || || || || || || || || ||
The UAP can attempt to keep the clients legs warm. Ice and elevation will further decrease
|| || || || || || || || || || || || || || || ||
perfusion. Elastic bandage wraps are not indicated and may constrict perfusion in the legs
|| || || || || || || || || || || || ||
A client admitted for sickle cell crisis is distraught after learning her child also has the
|| || || || || || || || || || || || || || || ||
disease. What response by the nurse is best? || || || || || || ||
A. Both you and the father are equally responsible for passing it on.
|| || || || || || || || || || || ||
B. I can see you are upset. I can stay here with you awhile if you like
|| || || || || || || || || || || || || || || ||
C. It's not your fault; there is no way to know who will have this disease
|| || || || || || || || || || || || || || ||
D. There are many good treatments for sickle cell disease these days. - ✔✔B. I can see you
|| || || || || || || || || || || || || || || || || ||
are upset. I can stay here with you awhile if you like.
|| || || || || || || || || || || ||
The best response is for the nurse to offer self, a therapeutic communication technique that
|| || || || || || || || || || || || || || ||
uses presence. Attempting to assign blame to both parents will not help the client feel
|| || || || || || || || || || || || || || ||
better. There is genetic testing available, so it is inaccurate to state there is no way to know
|| || || || || || || || || || || || || || || || || ||
who will have the disease. Stating that good treatments exist belittles the client's feelings.
|| || || || || || || || || || || || ||
A client with sickle cell disease (SCD) takes hydroxyurea (Droxia). The client presents to
|| || || || || || || || || || || || || ||
the clinic reporting an increase in fatigue. What laboratory result should the nurse report
|| || || || || || || || || || || || || ||
immediately?
A. Hematocrit: 25%
|| ||
B. Hemoglobin: 9.2
|| ||
C. Potassium: 3.2
|| ||
D. WBC: 38,000 - ✔✔D. WBC: 38,000
|| || || || || ||
Although individuals with SCD often have elevated WBC counts, this extreme elevation
|| || || || || || || || || || || ||
could indicate leukemia, a complication of taking hydoxyurea. The nurse should report this
|| || || || || || || || || || || || ||
, 2
finding immediately. Alternatively, it could indicate infection, a serious problem for clients
|| || || || || || || || || || || ||
with SCD. Hematocrit and hemoglobin levels are normally low in people with SCD. The
|| || || || || || || || || || || || || ||
potassium level, while slightly low, is not worrisome as the WBCs. || || || || || || || || || ||
A nurse working with clients with sickle cell disease teaches about self-management to
|| || || || || || || || || || || || ||
prevent exacerbations and sickle cell crisis. What factors should clients be taught to avoid?
|| || || || || || || || || || || || || ||
(Select all that apply) || || ||
A. Dehydration
||
B. Exercise
||
C. Extreme stress
|| ||
D. High altitudes
|| ||
E. Pregnancy - ✔✔A,C,D,E
|| || ||
Several factors cause RBCs to sickle in SCD, including dehydration, extreme stress, high
|| || || || || || || || || || || || ||
altitudes, and pregnancy. Strenuous exercise can also cause sickling, but not unless it is very
|| || || || || || || || || || || || || ||
vigorous.
||
The nurse is teaching a client who has sickle cell disease and was admitted for
|| || || || || || || || || || || || || || ||
splenomegaly and abdominal pain. Which instruction does the nurse include in the clients || || || || || || || || || || || || ||
discharge teaching? ||
A. Avoid drinking large amounts of fluids
|| || || || || ||
B. Eat six small meals daily instead of large meals
|| || || || || || || || ||
C. Engage in aerobic 3 days a week
|| || || || || || ||
D. Receive a yearly influenza vaccination - ✔✔D. Receive a yearly influenza vaccination
|| || || || || || || || || || || ||
Abdominal pain and a palpable spleen could indicate blood trapped in the spleen. Over
|| || || || || || || || || || || || || ||
time, the spleen may become nonfunctional, which the client at risk for infection. An
|| || || || || || || || || || || || || ||
annual influenza vaccination helps prevent infection. A client with sickle cell disease
|| || || || || || || || || || || ||
NUR 211 Final Exam with precise detailed answers || || || || || || ||
A nurse caring for a client with sickle cell disease (SCD) reviews the client's laboratory
|| || || || || || || || || || || || || || ||
work. Which finding should the nurse report to the provider?
|| || || || || || || || ||
A. Creatinine: 2.9
|| ||
B. Hematocrit: 30%
|| ||
C. Sodium: 147
|| ||
D. WBC: 12,000 - ✔✔A. Creatinine: 2.9
|| || || || || ||
An elevated creatinine indicates kidney damage, which occurs in SCD. A hematocrit level of
|| || || || || || || || || || || || ||
30% is an expected finding, as is a slightly elevated white blood cell count. A sodium of 147,
|| || || || || || || || || || || || || || || || || || ||
although slightly high, is not concerning || || || || ||
A client hospitalized with sickle cell crisis frequently asks for opioid pain medications, often
|| || || || || || || || || || || || ||
shortly after receiving a dose. The nurses on the unit believe the client is drug seeking.
|| || || || || || || || || || || || || || || || ||
When the client requests pain medication, what action by the nurse is best?
|| || || || || || || || || || || ||
A. Give the client pain medication if it is time for another dose.
|| || || || || || || || || || || ||
B. Instruct the client not to request pain medication too early.
|| || || || || || || || || ||
C. Request the provider to leave a prescription for a placebo
|| || || || || || || || || ||
D. Tell the client it is too early to have more pain medication - ✔✔A. Give the client pain
|| || || || || || || || || || || || || || || || || || ||
medication it it is time for another dose. || || || || || || ||
Clients with sickle cell crisis often have severe pain that is managed with up 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 doe of medication, the nurse should provide
|| || || || || || || || || || || || || || ||
it, The other options are judgmental and do not address the client's pain. Giving placebos is
|| || || || || || || || || || || || || || || ||
unethical.
,2
A client in sickle cell crisis is dehydrated and in the emergency department. The nurse
|| || || || || || || || || || || || || || ||
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 Ringers solution - ✔✔A. 0.45% normal saline
|| || || || || || || ||
Because clients in sickle cell crisis are often dehydrated, the fluid of choice is a hypotonic
|| || || || || || || || || || || || || || || ||
solution such as 0.45% normal saline. ).9% normal saline and lactated ringers solution are
|| || || || || || || || || || || || || ||
isotonic. D50 is hypertonic and not used for hydration.
|| || || || || || || ||
A client presents to the emergency department in sickle cell crisis. What intervention by the
|| || || || || || || || || || || || || ||
nurse takes priority?
|| || ||
A. Administer oxygen
|| ||
B. Apply an oximetry probe
|| || || ||
C. Give pain medication
|| || ||
D. Start an IV line - ✔✔A. Administer oxygen
|| || || || || || || ||
All actions are appropriate, but remembering the ABCs, oxygen would come first. The main
|| || || || || || || || || || || || || ||
problem in a sickle cell crisis is tissue and organ hypoxia, so providing oxygen helps halt the
|| || || || || || || || || || || || || || || ||
process.
||
A client has a sickle cell crisis with extreme lower extremity pain. What comfort measure
|| || || || || || || || || || || || || || ||
does the nurse delegate to the UAP?
|| || || || || ||
A. Apply ice packs to the client's legs
|| || || || || || ||
B. Elevate the clients legs on pillows
|| || || || || ||
C. Keep the lower extremities warms.
|| || || || ||
D. Place elastic bandage wraps on the client's legs. - ✔✔C. Keep the lower extremities warm
|| || || || || || || || || || || || || || ||
,2
During a sickle cell crisis, the tissue distal to the occlusion has decreased blood flow and
|| || || || || || || || || || || || || || || ||
ischemia, leading to pain. Due to decreased blood flow, the clients legs will be cool or cold.
|| || || || || || || || || || || || || || || || ||
The UAP can attempt to keep the clients legs warm. Ice and elevation will further decrease
|| || || || || || || || || || || || || || || ||
perfusion. Elastic bandage wraps are not indicated and may constrict perfusion in the legs
|| || || || || || || || || || || || ||
A client admitted for sickle cell crisis is distraught after learning her child also has the
|| || || || || || || || || || || || || || || ||
disease. What response by the nurse is best? || || || || || || ||
A. Both you and the father are equally responsible for passing it on.
|| || || || || || || || || || || ||
B. I can see you are upset. I can stay here with you awhile if you like
|| || || || || || || || || || || || || || || ||
C. It's not your fault; there is no way to know who will have this disease
|| || || || || || || || || || || || || || ||
D. There are many good treatments for sickle cell disease these days. - ✔✔B. I can see you
|| || || || || || || || || || || || || || || || || ||
are upset. I can stay here with you awhile if you like.
|| || || || || || || || || || || ||
The best response is for the nurse to offer self, a therapeutic communication technique that
|| || || || || || || || || || || || || || ||
uses presence. Attempting to assign blame to both parents will not help the client feel
|| || || || || || || || || || || || || || ||
better. There is genetic testing available, so it is inaccurate to state there is no way to know
|| || || || || || || || || || || || || || || || || ||
who will have the disease. Stating that good treatments exist belittles the client's feelings.
|| || || || || || || || || || || || ||
A client with sickle cell disease (SCD) takes hydroxyurea (Droxia). The client presents to
|| || || || || || || || || || || || || ||
the clinic reporting an increase in fatigue. What laboratory result should the nurse report
|| || || || || || || || || || || || || ||
immediately?
A. Hematocrit: 25%
|| ||
B. Hemoglobin: 9.2
|| ||
C. Potassium: 3.2
|| ||
D. WBC: 38,000 - ✔✔D. WBC: 38,000
|| || || || || ||
Although individuals with SCD often have elevated WBC counts, this extreme elevation
|| || || || || || || || || || || ||
could indicate leukemia, a complication of taking hydoxyurea. The nurse should report this
|| || || || || || || || || || || || ||
, 2
finding immediately. Alternatively, it could indicate infection, a serious problem for clients
|| || || || || || || || || || || ||
with SCD. Hematocrit and hemoglobin levels are normally low in people with SCD. The
|| || || || || || || || || || || || || ||
potassium level, while slightly low, is not worrisome as the WBCs. || || || || || || || || || ||
A nurse working with clients with sickle cell disease teaches about self-management to
|| || || || || || || || || || || || ||
prevent exacerbations and sickle cell crisis. What factors should clients be taught to avoid?
|| || || || || || || || || || || || || ||
(Select all that apply) || || ||
A. Dehydration
||
B. Exercise
||
C. Extreme stress
|| ||
D. High altitudes
|| ||
E. Pregnancy - ✔✔A,C,D,E
|| || ||
Several factors cause RBCs to sickle in SCD, including dehydration, extreme stress, high
|| || || || || || || || || || || || ||
altitudes, and pregnancy. Strenuous exercise can also cause sickling, but not unless it is very
|| || || || || || || || || || || || || ||
vigorous.
||
The nurse is teaching a client who has sickle cell disease and was admitted for
|| || || || || || || || || || || || || || ||
splenomegaly and abdominal pain. Which instruction does the nurse include in the clients || || || || || || || || || || || || ||
discharge teaching? ||
A. Avoid drinking large amounts of fluids
|| || || || || ||
B. Eat six small meals daily instead of large meals
|| || || || || || || || ||
C. Engage in aerobic 3 days a week
|| || || || || || ||
D. Receive a yearly influenza vaccination - ✔✔D. Receive a yearly influenza vaccination
|| || || || || || || || || || || ||
Abdominal pain and a palpable spleen could indicate blood trapped in the spleen. Over
|| || || || || || || || || || || || || ||
time, the spleen may become nonfunctional, which the client at risk for infection. An
|| || || || || || || || || || || || || ||
annual influenza vaccination helps prevent infection. A client with sickle cell disease
|| || || || || || || || || || || ||
