Chapter 28 High Acuity Nursing 6th Edition by Kathleen Dorman Wagner

Chapter 28 High Acuity Nursing 6th Edition by Kathleen Dorman Wagner

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

 

Question 1

Type: MCSA

A patient diagnosed with chronic renal insufficiency has a hemoglobin level of 8.6 mg/dL. The nurse plans care for a patient with which level of anemia?

1. Grade 1 or mild
2. Grade 3 or severe
3. Grade 4 or life threatening
4. Grade 2 or moderate

Correct Answer: 4

Rationale 1: Anemia is considered grade 1 or mild if the hemoglobin level is 10.0 g/dL or higher to normal.

Rationale 2: Anemia is considered grade 3 or severe if the hemoglobin level is between 6.5 and 7.0 g/dL.

Rationale 3: Anemia is considered grade 4 or life threatening if the hemoglobin is less than 6.5 g/dL.

Rationale 4: Anemia is considered grade 2 or moderate if the hemoglobin level is 8.0 to 9.9 g/dL.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 28-1

 

Question 2

Type: MCMA

A patient with rheumatoid arthritis has a hemoglobin level of 10.0 g/dL. The nurse would consider this anemia to be related to inflammation if which other findings are present?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The patient has low vitamin B₁₂ levels.
2. Laboratory testing shows low hepcidin level.
3. Increased destruction of erythrocytes is occurring.
4. Serum iron levels are low.
5. The patient’s stools are guaiac positive.

Correct Answer: 2,4

Rationale 1: Low vitamin B₁₂ levels are associated with anemia of decreased red blood cell production.

Rationale 2: Hepcidin is an iron-regulating hormone produced in the liver. Some of the cytokines due to inflammation regulate hepciden, resulting in low levels.

Rationale 3: Anemia caused by increased red blood cell destruction can occur from congenital or acquired problems and is not typically associated with rheumatoid arthritis.

Rationale 4: Anemia of inflammation is associated with low serum iron levels.

Rationale 5: Stools that are positive for blood may indicate blood loss anemia is present.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 28-1

 

Question 3

Type: MCSA

A patient receiving chemotherapy for cancer is diagnosed with anemia secondary to bone marrow depression. The nurse would expect which intervention?

1. Recombinant erythropoietin therapy
2. Iron supplements
3. Fresh frozen plasma
4. Hematopoietic stem-cell transplantation

Correct Answer: 1

Rationale 1: Recombinant erythropoietin therapy, such as Procrit or Epogen, has been used for some time for treatment of blood loss anemia seen in some cancers.

Rationale 2: Iron supplementation is not likely to be effective in reversing this anemia.

Rationale 3: Fresh frozen plasma may help to expand volume, but will not improve oxygen carrying capacity.

Rationale 4: Hematopoietic stem-cell transplantation is the definitive treatment for aplastic anemia, but is not indicated during chemotherapy.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 28-1

 

Question 4

Type: MCSA

A patient with sickle cell disease tells the nurse that she knows when the disease is going to flare because she has pain in her arms and legs. Which explanation would the nurse provide?

1. “The shape of your blood cells blocks the small capillaries in your arms and legs.”
2. “The pain is really due to your history of malaria along with having sickle cell anemia.”
3. “Your spleen is destroying all the malformed red blood cells which makes you anemic and causes arm and leg pain.”
4. “The chronic blood loss associated with sickle cell anemia causes pain in the arms and legs.”

Correct Answer: 1

Rationale 1: In sickle cell disease, the red blood cell membrane is stiffer and cells are misshapen which slows down or obstructs blood flow in the small capillaries. This can lead to microvascular occlusion leading to pain in the arms and legs as well as other body areas.

Rationale 2: Having a history of malaria is related to disease development as a genetic adaptation.

Rationale 3: The spleen does destroy the malformed red blood cells but this does not cause pain in the arms and legs.

Rationale 4: Blood loss is not typically seen in sickle cell disease.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 28-2