Test Bank for Concepts for Nursing Practice, 4th Edition
(Giddens, 2024), Chapter 1-57 | All Chapters | 9780323809825
A nurse caring for a client with sickle cell disease (SCD) reviews the client's laboratory test results.
Which finding would the nurse report to the primary health care provider?
A. Creatinine: 2.9 mg/dL
B. Hematocrit: 30%
C. Sodium: 146 mEq/L
D. White blood cell count: 12,000 mm^3 - ANSWER: A. An elevated creatinine indicates kidney
damage, which occurs in SCD. The rest are expected findings in SCD.
The nurse is assessing a client in sickle cell disease crisis. What PRIORITY client problem will the nurse
expect?
A. Infection
B. Pallor
C. Pain
D. Fatigue - ANSWER: C. The priority expected client problem for clients experiencing SCD crisis is
pain, often concentrated in the legs, arms, and joints.
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 Ringer's solution - ANSWER: A. Because clients in sickle cell crisis are often dehydrated,
the fluid of choice is a hypotonic solution such as 0.45% normal saline.
A client presents to the emergency department in sickle cell crisis. What intervention by the nurse
takes PRIORITY?
A. Administer oxygen
B. Initiate pulse oximetry
C. Give pain medication
D. Start an IV line - ANSWER: A. 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 hospitalized with sickle cell disease crisis frequently asks for opioid pain medications, often
shortly after receiving a dose. The nurses on the unit believe that 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 primary health care provider leave a prescription for a placebo.
D. Tell the - ANSWER: A. 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 dose of medication, the nurse would provide it.
The nurse is caring for a client experiencing sickle cell disease crisis. Which PRIORITY action would
help prevent infection.
A. Administering prophylactic antibiotics.
B. Monitoring the client's temperature.
C. Checking the client's white blood cell count
D. Performing frequent handwashing - ANSWER: D. Frequent and thorough handwashing is the most
important intervention that helps prevent infection.
,A nurse in a hematology clinic is working with four different clients who have polycythemia vera.
Which client would the nurse assess first?
A. Client with a blood pressure of 180/98 mm Hg
B. Client who reports shortness of breath
C. Client who reports calf tenderness
D. Client with a swollen and painful left great toe - ANSWER: B. Clients with polycythemia vera often
have clotting abnormalities due to hyperviscous blood with sluggish flow. The client reporting
shortness of breath may have a pulmonary embolism and should be seen first.
The nurse is teaching a client who has pernicious anemia about necessary dietary changes. Which
statement by the client indicates UNDERSTANDING about those changes?
A. "I'll increase animal proteins like fish and meat."
B. "I'll work on increasing my fats and carbohydrates."
C. "I'll avoid eating green leafy vegetables."
D. "I'll limit my intake of citrus fruits." - ANSWER: A. Clients who have pernicious anemia have a
vitamin B12 deficiency and need to consume foods high in vitamin B12, such as animal and plant
proteins, citrus fruits, green leafy vegetables, and dairy products.
An assistive personnel (AP) is caring for a client with leukemia and asks why the client is still at risk for
infection when the white blood cell count (WBC) is high. What response by the nurse is correct?
A. "If the WBCs are high, there already is an infection present."
B. "The client is in a blast crisis and has too many WBCs."
C. "There must be a mistake; the WBCs should be very low."
D. "Those WBCs are abnormal and don't provide protection." - ANSWER: D. In leukemia, the WBCs are
abnormal and do not provide protection to the client against infection.
The family of a neutropenic client reports that the client "is not acting right." What action by the
nurse is the PRIORITY?
A. Ask the client about pain.
B. Assess the client for infection.
C. Take a set of vital signs.
D. Review today's lab results. - ANSWER: B. Neutropenic clients often do not have classic
manifestations of infection, but infection is the most common cause of death in neutropenic clients.
The nurse would definitely assess for infection.
A nurse is caring for a client who is about to receive a bone marrow transplant. To best help the client
cope with the long recovery period, what action by the nurse is best?
A. Arrange a visitation schedule among family and friends.
B. Explain that this process is difficult but must be endured.
C. Help the client find things to hope for each day of recovery
D. Provide plenty of diversionary activities for this time. - ANSWER: C. Providing hope is an essential
nursing function during treatment for any disease process, but especially during the recovery period
after bone marrow transplantation, which can take up to 3 weeks. The nurse can help the client look
ahead to the recovery period and identify things to hope for during this time.
A client asks about the process of graft-versus-host disease. What explanation by the nurse is correct?
A. "Because of immunosuppression, the donor cells take over."
B. "It's like a transfusion reaction because no perfect match exists."
C. "The patient's cells are fighting the donor cells for dominance."
D. "The donor's cells are actually attacking the patient's cells." - ANSWER: D. Graft-versus-host disease
is an autoimmune-type process in which the donor cells recognize the client's cells as foreign and
begin attacking them.
The nurse is caring for a patient with leukemia who has severe fatigue. What action by the client best
indicates that an important outcome to manage this problem has been met?
A. Doing activities of daily living using rest periods.
B. Helping plan a daily activity schedule
, C. Requesting a sleeping pill at night.
D. Telling visitors to leave when fatigued. - ANSWER: A. Fatigue is a common problem for clients with
leukemia. This client is managing her own ADLs using rest periods, which indicates an understanding
of fatigue and how to control it.
A nurse is caring for a young male client with lymphoma who is to begin treatment. What teaching
topic is a PRIORITY?
A. Genetic testing
B. Infection prevention
C. Sperm banking
D. Treatment options. - ANSWER: C. All teaching topics are important to the client with lymphoma,
but for a young male, sperm banking is of particular concern if the client is going to have radiation to
the lower abdomen or pelvis.
A client has a platelet count of 9*10^9/L. The nurse finds the client confused and mumbling. What
nursing action takes PRIORITY at this time?
A. Call the Rapid Response Team
B. Take a set of vital signs
C. Institute bleeding precautions
D. Place the client on bedrest - ANSWER: A. With a platelet count this low, the client is at high risk of
spontaneous bleeding. The most disastrous complication would be intracranial bleeding. The nurse
needs to call the RRT as this client has manifestations of a sudden neurologic change.
A nurse is preparing to administer a blood transfusion. What action is MOST IMPORTANT?
A. Correctly identify client using two identifiers.
B. Ensure that informed consent is obtained.
C. Hang the blood product with lactated ringers
D. Stay with the client for the entire transfusion - ANSWER: B. If the facility requires informed consent
for transfusions, this action is most important because it precedes the other actions taken during the
transfusion. Correctly identifying the patient and blood product is a National Patient Safety Goal and
is the most important action AFTER obtaining informed consent.
A nurse is preparing to administer a blood transfusion. Which action is MOST IMPORTANT?
A. Document the transfusion
B. Place the client on NPO status
C. Place the client in isolation
D. Put on a pair of gloves - ANSWER: D. To prevent bloodborne illness, the nurse should don a pair of
gloves prior to hanging the blood.
A client receiving a blood transfusion develops anxiety and low back pain. After stopping the
transfusion, what action by the nurse is MOST IMPORTANT?
A. Document the events in the client's medical record.
B. Double-check the client and blood product identification.
C. Place the client on strict bedrest until the pain subsides.
D. Review the client's medical record for known allergies. - ANSWER: B. This client most likely had a
hemolytic transfusion reaction, most commonly caused by blood type or Rh incompatibility. The nurse
should double-check all identifying information for both the client and the blood product.
A client has thrombosytopenia. What statement indicates that the client understands self-
management of this condition?
A. "I brush and use dental floss every day."
B. "I chew hard candy for my dry mouth."
C. "I usually put ice on bumps or bruises."
D. "Nonslip socks are best when I walk." - ANSWER: C. The client should be taught to apply ice to
areas of minor trauma.
(Giddens, 2024), Chapter 1-57 | All Chapters | 9780323809825
A nurse caring for a client with sickle cell disease (SCD) reviews the client's laboratory test results.
Which finding would the nurse report to the primary health care provider?
A. Creatinine: 2.9 mg/dL
B. Hematocrit: 30%
C. Sodium: 146 mEq/L
D. White blood cell count: 12,000 mm^3 - ANSWER: A. An elevated creatinine indicates kidney
damage, which occurs in SCD. The rest are expected findings in SCD.
The nurse is assessing a client in sickle cell disease crisis. What PRIORITY client problem will the nurse
expect?
A. Infection
B. Pallor
C. Pain
D. Fatigue - ANSWER: C. The priority expected client problem for clients experiencing SCD crisis is
pain, often concentrated in the legs, arms, and joints.
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 Ringer's solution - ANSWER: A. Because clients in sickle cell crisis are often dehydrated,
the fluid of choice is a hypotonic solution such as 0.45% normal saline.
A client presents to the emergency department in sickle cell crisis. What intervention by the nurse
takes PRIORITY?
A. Administer oxygen
B. Initiate pulse oximetry
C. Give pain medication
D. Start an IV line - ANSWER: A. 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 hospitalized with sickle cell disease crisis frequently asks for opioid pain medications, often
shortly after receiving a dose. The nurses on the unit believe that 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 primary health care provider leave a prescription for a placebo.
D. Tell the - ANSWER: A. 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 dose of medication, the nurse would provide it.
The nurse is caring for a client experiencing sickle cell disease crisis. Which PRIORITY action would
help prevent infection.
A. Administering prophylactic antibiotics.
B. Monitoring the client's temperature.
C. Checking the client's white blood cell count
D. Performing frequent handwashing - ANSWER: D. Frequent and thorough handwashing is the most
important intervention that helps prevent infection.
,A nurse in a hematology clinic is working with four different clients who have polycythemia vera.
Which client would the nurse assess first?
A. Client with a blood pressure of 180/98 mm Hg
B. Client who reports shortness of breath
C. Client who reports calf tenderness
D. Client with a swollen and painful left great toe - ANSWER: B. Clients with polycythemia vera often
have clotting abnormalities due to hyperviscous blood with sluggish flow. The client reporting
shortness of breath may have a pulmonary embolism and should be seen first.
The nurse is teaching a client who has pernicious anemia about necessary dietary changes. Which
statement by the client indicates UNDERSTANDING about those changes?
A. "I'll increase animal proteins like fish and meat."
B. "I'll work on increasing my fats and carbohydrates."
C. "I'll avoid eating green leafy vegetables."
D. "I'll limit my intake of citrus fruits." - ANSWER: A. Clients who have pernicious anemia have a
vitamin B12 deficiency and need to consume foods high in vitamin B12, such as animal and plant
proteins, citrus fruits, green leafy vegetables, and dairy products.
An assistive personnel (AP) is caring for a client with leukemia and asks why the client is still at risk for
infection when the white blood cell count (WBC) is high. What response by the nurse is correct?
A. "If the WBCs are high, there already is an infection present."
B. "The client is in a blast crisis and has too many WBCs."
C. "There must be a mistake; the WBCs should be very low."
D. "Those WBCs are abnormal and don't provide protection." - ANSWER: D. In leukemia, the WBCs are
abnormal and do not provide protection to the client against infection.
The family of a neutropenic client reports that the client "is not acting right." What action by the
nurse is the PRIORITY?
A. Ask the client about pain.
B. Assess the client for infection.
C. Take a set of vital signs.
D. Review today's lab results. - ANSWER: B. Neutropenic clients often do not have classic
manifestations of infection, but infection is the most common cause of death in neutropenic clients.
The nurse would definitely assess for infection.
A nurse is caring for a client who is about to receive a bone marrow transplant. To best help the client
cope with the long recovery period, what action by the nurse is best?
A. Arrange a visitation schedule among family and friends.
B. Explain that this process is difficult but must be endured.
C. Help the client find things to hope for each day of recovery
D. Provide plenty of diversionary activities for this time. - ANSWER: C. Providing hope is an essential
nursing function during treatment for any disease process, but especially during the recovery period
after bone marrow transplantation, which can take up to 3 weeks. The nurse can help the client look
ahead to the recovery period and identify things to hope for during this time.
A client asks about the process of graft-versus-host disease. What explanation by the nurse is correct?
A. "Because of immunosuppression, the donor cells take over."
B. "It's like a transfusion reaction because no perfect match exists."
C. "The patient's cells are fighting the donor cells for dominance."
D. "The donor's cells are actually attacking the patient's cells." - ANSWER: D. Graft-versus-host disease
is an autoimmune-type process in which the donor cells recognize the client's cells as foreign and
begin attacking them.
The nurse is caring for a patient with leukemia who has severe fatigue. What action by the client best
indicates that an important outcome to manage this problem has been met?
A. Doing activities of daily living using rest periods.
B. Helping plan a daily activity schedule
, C. Requesting a sleeping pill at night.
D. Telling visitors to leave when fatigued. - ANSWER: A. Fatigue is a common problem for clients with
leukemia. This client is managing her own ADLs using rest periods, which indicates an understanding
of fatigue and how to control it.
A nurse is caring for a young male client with lymphoma who is to begin treatment. What teaching
topic is a PRIORITY?
A. Genetic testing
B. Infection prevention
C. Sperm banking
D. Treatment options. - ANSWER: C. All teaching topics are important to the client with lymphoma,
but for a young male, sperm banking is of particular concern if the client is going to have radiation to
the lower abdomen or pelvis.
A client has a platelet count of 9*10^9/L. The nurse finds the client confused and mumbling. What
nursing action takes PRIORITY at this time?
A. Call the Rapid Response Team
B. Take a set of vital signs
C. Institute bleeding precautions
D. Place the client on bedrest - ANSWER: A. With a platelet count this low, the client is at high risk of
spontaneous bleeding. The most disastrous complication would be intracranial bleeding. The nurse
needs to call the RRT as this client has manifestations of a sudden neurologic change.
A nurse is preparing to administer a blood transfusion. What action is MOST IMPORTANT?
A. Correctly identify client using two identifiers.
B. Ensure that informed consent is obtained.
C. Hang the blood product with lactated ringers
D. Stay with the client for the entire transfusion - ANSWER: B. If the facility requires informed consent
for transfusions, this action is most important because it precedes the other actions taken during the
transfusion. Correctly identifying the patient and blood product is a National Patient Safety Goal and
is the most important action AFTER obtaining informed consent.
A nurse is preparing to administer a blood transfusion. Which action is MOST IMPORTANT?
A. Document the transfusion
B. Place the client on NPO status
C. Place the client in isolation
D. Put on a pair of gloves - ANSWER: D. To prevent bloodborne illness, the nurse should don a pair of
gloves prior to hanging the blood.
A client receiving a blood transfusion develops anxiety and low back pain. After stopping the
transfusion, what action by the nurse is MOST IMPORTANT?
A. Document the events in the client's medical record.
B. Double-check the client and blood product identification.
C. Place the client on strict bedrest until the pain subsides.
D. Review the client's medical record for known allergies. - ANSWER: B. This client most likely had a
hemolytic transfusion reaction, most commonly caused by blood type or Rh incompatibility. The nurse
should double-check all identifying information for both the client and the blood product.
A client has thrombosytopenia. What statement indicates that the client understands self-
management of this condition?
A. "I brush and use dental floss every day."
B. "I chew hard candy for my dry mouth."
C. "I usually put ice on bumps or bruises."
D. "Nonslip socks are best when I walk." - ANSWER: C. The client should be taught to apply ice to
areas of minor trauma.
