evolve NCLEX questions Flashcards

The typical patient with polycythemia is a middle-aged male with elevated blood pressure and an erythematous appearance. The elevated blood pressure results from fluid volume excess, resulting from excessive bone marrow production. The erythema results from increased erythrocytes. A thin older white woman with a pale complexion and an older male with pallor and activity intolerance would better fit the profile of someone with anemia.Hypotension and syncope are not classic signs or symptoms of polycythemia. These could be signs/symptoms of numerous disorders, including dehydration, cardiac dysfunction, and other disorders.REF: Page 1508

infection

The most severe risk for a patient with agranulocytosis is that of infection. Agranulocytosis is a potentially fatal condition of the blood characterized by a severe reduction in the number of granulocytes. Both the WBC count and the differential neutrophil counts are extremely low. The patient with this disorder is highly susceptible to a life-threatening infection. Although pain may be a symptom of the disease, it is not the most severe risk for the patient. Although malnutrition may result from the general malaise that accompanies the disease, it is not the most severe risk for the patient. The risk for the patient with agranulocytosis is acquiring—not spreading—an infection.REF: Page 1509

the absence

• Pernicious anemia results from the absence of a glycoprotein intrinsic factor secreted by the gastric mucosa. Intrinsic secretion fails because of gastric mucosal atrophy. This is an autoimmune disease; the gastric atrophy probably results from destruction of parietal cells. The type of anemia resulting from blood loss or hemorrhage is called hypovolemic anemia, or blood loss anemia. The type of anemia resulting from exposure to viral invasion, medications, chemicals, radiation, or chemotherapy in which the hemopoietic tissue is replaced by fatty marrow, causing a defect in RBC production is known as acquired aplastic anemia. This is probably an immune-mediated disease. There is also a congenital form of aplastic anemia caused by chromosomal alterations. In both, depression of erythrocyte production results in lowered hemoglobin and RBCs. Leukopenia and thrombocytopenia may develop. The type of anemia resulting from an abnormal crescent-shaped red blood cell containing a defective hemoglobin molecule is called sickle-cell anemia. It is the most common genetic disorder in the United States, affecting predominantly African Americans.REF: Page 1500

Reed-Sternberg cells are atypical histiocytes consisting of large, abnormal, multinucleated cells in the lymphatic system found in Hodgkin disease. Reticulum cell sarcoma is a common type of lymphoma, but is not the diagnostic feature of Hodgkin disease. Bence Jones protein is found in the urine of a patient with multiple myeloma. Philadelphia chromosome is found in a patient with chronic myelogenous leukemia.REF: Page 1524

• Ineffective tissue perfusion
• Fluid volume deficit
• Anxiety
• Pain
• Ineffective tissue perfusion will probably be on the nursing care plan; this is related to blood loss from the patient’s coagulation deficit. Fluid volume deficit will likely be on the nursing care plan; this is related to blood loss. Anxiety is a likely nursing diagnosis for this patient, because bleeding from coagulation deficits can be life threatening. Pain is also a likely nursing diagnosis for this patient, because patients with hemophilia often have joint pain from bleeding into the joints.REF: Pages 1516-1518

Thrombocytopenia associated with leukemia makes a patient susceptible to hemorrhage. Without sufficient numbers of thrombocytes, the body is unable to clot blood. It is essential that nursing care be delivered in a safe and gentle manner. Anemia in the patient with leukemia would manifest itself as fatigue and pallor. Leukopenia in the patient with leukemia would render the patient vulnerable to infection, which could be life threatening. The usual inflammatory process to control infection is decreased. Frequent observation for signs and symptoms of infection is essential. Infiltration of WBCs into patient organs is not a blood dyscrasia, although it does occur in leukemia. Infiltration of WBCs into patient organs leads to problems such as splenomegaly, hepatomegaly, bone pain, meningeal irritation, and oral lesions. Enlarged lymph nodes and painless splenomegaly may be the first manifestations of the disease in some patients.REF: Page 1513

Disseminated intravascular coagulation, or DIC, is a grave disease process in which the patient experiences both bleeding and intravascular clotting at the same time. It results from the overstimulation of clotting and anticlotting processes in response to disease or injury, including septicemia, obstetrical complications, malignancies, tissue trauma, transfusion reactions, burns, shock, or snake bites. von Willebrand disease is an inherited bleeding disorder characterized by abnormally slow coagulation of blood and spontaneous episodes of gastrointestinal bleeding, epistaxis, and gingival bleeding caused by a mild deficiency of factor VIII. It is common during postpartum periods, as menorrhagia, and after surgery or trauma. It affects both women and men. Multiple myeloma is a malignant neoplastic immunodeficiency disease of the bone marrow. The tumor, composed of plasma cells, destroys osseous tissue, especially in flat bones, causing pain, fractures, and skeletal deformity. Lymphedema is a primary or secondary disorder characterized by the accumulation of lymph in soft tissue and edema. This can be caused by obstruction, increased amount of lymph, or removal of lymph channels and nodes; it may be hereditary.REF: Page 1519

Type AB blood is considered to be the “universal recipient” because it contains neither anti-A nor anti-B antibodies in its plasma. Therefore it does not clump any donor’s RBCs containing A or B antigens. The RBCs of type A contain type A antigen and the plasma contains anti-B antibodies. The RBCs of type B contain type B antigen and the plasma contains anti-A antibodies. Type O blood contains neither A nor B antigens. It can be used in an emergency as donor blood without the danger of anti-A or anti-B antibodies clumping its RBCs. Type O blood is known as the “universal donor.”REF: Pages 1493-1494

Bands, or immature polymorphonuclear leukocytes, are in their final stage of development. In a severe infection, the bone marrow releases these immature cells, because it has used up its reserve. When the band count exceeds 8% of the number of polymorphonuclear leukocytes (“polys”) this is called a “shift to the left.” Eosinophils are WBCs that play a role in allergic reactions and are effective against certain parasitic worms. Normal values of eosinophils are 1% to 4%. Neutrophils are granular circulating leukocytes essential for phagocytosis and release of lysozyme. The normal value of neutrophils is 60% to 70%. Monocytes are WBCs that function similarly to neutrophils. They circulate in the bloodstream and move into tissue, where they engulf foreign antigens and cell debris. Normal values of monocytes are 2% to 6%.REF: Page 1492

A CT scan is now the preferred diagnostic test for evaluating deep lymph nodes. It is less invasive than lymphangiography, requires less patient preparation, and has no major side effects. MRI is not the preferred diagnostic test for evaluating deep lymph nodes, although it can be used to evaluate the lymph nodes, spleen, and liver. Lymphangiography used to be the preferred method of evaluating deep lymph nodes in the past; however, with the advent of CT and MRI, these newer technologies are now preferred. A peripheral smear is not relevant for evaluating deep lymph nodes. A peripheral smear is an examination of the size, shape, and structure of individual red blood cells and platelets. This is useful in differentiating various forms of anemias and blood dyscrasias.REF: Page 1496

Monitoring the heart rate and rhythm by apical pulse and ECG patterns

Nursing care for a patient with a new pacemaker would include closely monitoring heart rate and rhythm by apical pulse and ECG patterns. Also, vital signs and level of consciousness are checked frequently. The insertion site is observed for erythema, edema, and tenderness, which could be signs of infection. Bed rest for 24 hours is not necessary for a patient with a new pacemaker. Nursing care for a patient with a new pacemaker would include bed rest for the first few hours only, unless unexpected complications occurred. Scheduling of an MRI to verify pacemaker placement would be inappropriate. The patient must avoid proximity to high-output generators and to large magnets, such as MRI scanners. Performing range of motion every 4 hours to the arm on the pacemaker side would be inappropriate. The arm on the pacemaker side should be immobilized for the first few hours, and the patient should not raise the arm above his or her head for several days. After this time, normal activities can be resumed.REF: Page 1551

troponin I

SA node→AV node→Bundle of His→Right and left bundle branches→Purkinje fibers

• Angina indicates a lack of oxygen and blood supply to the heart
• Angina may resemble heartburn or indigestion.
• Angina is usually relieved by nitroglycerin.
• Angina may appear as jaw pain.

Even with lower doses of medications, the older adult should be observed for signs and symptoms of toxicity.

Even with lower doses of medications, the older adult should be observed for signs and symptoms of toxicity, because the rate of drug metabolism and excretion decreases with age. The older adult should be encouraged to maintain regular contact with his or her physician and to seek care at the first sign of problems. The cardiac output tends to be decreased in the older adult due to changes in cardiac musculature and reduced efficiency and strength. Progressive coronary artery changes can lead to the development of collateral coronary circulation. The older adult tends to have a more extensive network of collateral circulation than the younger adult. Angina is a typical symptom of a myocardial infarction in the younger adult, whereas dyspnea may be a more common symptom in the older adult, owing to the severity of signs and symptoms being modified by the development of collateral circulation.REF: Page 1542

The patient with an acute myocardial infarction will be on bed rest with commode privileges for 24 to 48 hours.

The patient with an acute myocardial infarction will be on bed rest with commode privileges for 24 to 48 hours. After this period, activities are resumed gradually, depending on the size of the infarct and patient characteristics. A program of cardiac rehabilitation will be designed for the patient and implemented. Thrombolytic agents are used to minimize infarct size and maximize heart function. Aspirin is an antiplatelet medication, not a thrombolytic agent. Thrombolytic agents must be initiated within 3 to 5 hours of the onset of symptoms to be effective, although it is most effective if administered within 30 minutes to 1 hour. Morphine sulfate is useful for the patient with a myocardial infarction, because it helps with vasodilation of coronary arteries, relief of pain, and reduction of apprehension. It also decreases myocardial oxygen demands, reduces contractility, and slows the heart rate.REF: Page 1562

Hyperlipidemia

Ventricular fibrillation

Ventricular fibrillation is a medical emergency that will result in death if left untreated. It is a state whereby the ventricles are quivering with disorganized electrical and mechanical activity. Prompt treatment, including CPR and defibrillation, are essential and must be performed promptly (ideally within 20 seconds) to give the patient the best chance of recovery. Atrial fibrillation, although serious, is not as imminently life threatening as ventricular fibrillation. In atrial fibrillation, electrical activity is disorganized, and the atria quiver at a rate of 350 to 600/min rather than contract in an organized manner. Ventricular response may be 100 to 180 beats per minute, and the patient experiences decreased cardiac output along with symptoms of palpitations, dyspnea, syncope, light-headedness, decreased level of consciousness, and pulmonary edema. Treatment involves slowing the ventricular rate, treating the atrial irritability, and treating the cause of the arrhythmia. Supraventricular tachycardia is the sudden onset of a rapid heartbeat, originating in the atria. It is characterized by a pulse rate of 150 to 250 beats per minute. The patient with supraventricular tachycardia may experience palpitations, light-headedness, dyspnea, and angina. Sinus bradycardia is a slow rhythm that originates in the SA node and is characterized by a rate of less than 60 beats per minute. Causes can be sleep, vomiting, intracranial tumors, myocardial infarction, vagal stimulation, endocrine disorders, and hypothermia. It may be completely normal in athletes. Treatment of sinus bradycardia depends on the cause.REF: Page 1548

Fluoroscopy

Fluoroscopy is the diagnostic test that allows observation of real time movement via radiography. This is invaluable for placement of pacemakers and intracardial catheter placement. Angiography is a series of radiographs taken following administration of contrast dye. This test aids in diagnosis of vessel occlusion, pooling in various heart chambers, and congenital abnormalities. Echocardiography uses high-frequency ultrasound directed at the heart. The reflected sound is recorded, outlining size, shape, and position of cardiac structures. This is useful in detecting pericardial effusion, evaluating ventricular function, cardiac chamber size and contents, ventricular muscle and septal motion and thickness, cardiac output, cardiac tumors, valvular function, and congenital heart disorders. Cardiac monitoring records the cardiac electrical activity of patients. A cardiac monitor displays information transferred via the conductive electrodes, which transfer electrical activity of the heart and relay it to a video display screen. This is useful for patients with known or suspected arrhythmias, or patients who may be likely to develop arrhythmias.REF: Page 1537

• SA node→AV node→Bundle of His→Right and left bundle branches→Purkinje fibers

The impulse pattern of the cardiac conduction system is as follows: SA node→AV node→Bundle of His→Right and left bundle branchesàPurkinje fibersREF: Page 1535