Question 1 of 6
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The nurse anticipates that which diagnostic tests will be prescribed when multiple myeloma is suspected in a patient who reports backache and bone pain?
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- Serum electrolytes and liver function testsSerum electrolytes are helpful in evaluating circulating calcium levels, but Bence-Jones protein is the definitive diagnostic tool for multiple myeloma. A white blood cell differential may indicate the specific leukocyte affected.
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- Bone marrow aspiration and biopsyAlthough the bone marrow aspiration and biopsy are diagnostic tests used to evaluate bone marrow function, they are not used initially. The biopsy is highly invasive and accompanied by a significant risk for bleeding.
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- Serum calcium level and arterial blood gases (ABGs)Although serum calcium levels need evaluation in a patient with multiple myeloma, ABGs are of little benefit unless the patient has signs of dyspnea.
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- Complete blood count with differential and urinary Bence-Jones protein levelsEssential information would be obtained first with the 24-hour urine collection for Bence-Jones protein.
Question 2 of 6
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The nurse suspects which bleeding disorder when a patient with sepsis experiences continuous bleeding around an intravenous insertion site despite the application of pressure?
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- AnemiaAnemia is a state in which there are insufficient numbers of functioning red blood cells (RBCs), or a lack of hemoglobin (Hb), to meet the demands of the tissues for oxygen.
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- Aplastic anemiaAnemia is a state in which there are insufficient numbers of functioning RBCs, or a lack of hemoglobin, to meet the demands of the tissues for oxygen.
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- Polycythemia veraPolycythemia vera is a neoplastic disorder resulting in overproduction of RBCs.
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- Disseminated intravascular coagulation (DIC)DIC is a serious disorder that may be associated with diseases or disorders such as gram-negative sepsis. The first signs of DIC are usually continuous bleeding from an injection or intravenous site, extensive bruising in areas of injury, ecchymoses where there has been no trauma, and petechiae.
Question 3 of 6
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Which statement made by a patient with hemophilia indicates that further education is needed regarding management of the disorder?
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- “I should eat a lot of red meat.”It is beneficial for the patient to eat a lot of red meat; meat is rich in iron and required for hemoglobin production.
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- “If my pain increases, I can take aspirin.”Aspirin must never be taken by patients with hemophilia because aspirin increases the bleeding problems because of its antiplatelet properties.
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- “If I have pain, I can apply cold packs to my joints.”In addition to administering the necessary clotting factors, interventions include applying cold packs.
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- “I should not participate in contact sports.”The patient should not participate in contact sports because of potential injury and the risk for prolonged bleeding.
Question 4 of 6
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The nurse would monitor for which complication in a patient who takes medication to prevent deep vein thrombosis?
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- ThrombocytosisThrombocytosis occurs when there is a higher level of platelets than normal.
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- Idiopathic thrombocytopenic purpuraThe patient is undergoing deep vein thrombosis prophylaxis therapy; therefore the condition is not likely to be idiopathic.
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- Heparin-induced thrombocytopeniaIncreased use of heparin preparations for deep vein thrombosis prophylaxis has led to more instances of heparin-induced thrombocytopenia.
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- Polycythemia veraPolycythemia vera results in a high red blood cell count.
Question 5 of 6
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The nurse identifies that which statement made by a patient with thrombocytopenia indicates the need for further teaching?
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- “I eat green, leafy vegetables with each meal.”Eating green, leafy vegetables may be a concern if a patient is taking an anticoagulant, which is not likely in the patient with thrombocytopenia.
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- “I will not receive routine platelet transfusions.”Platelet transfusions are used only for significant clinical bleeding.
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- “I will avoid processed foods.”Processed foods often contain ingredients that are unhealthy.
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- “I plan to have my ears pierced next week.”Piercings could lead to excessive bleeding when a patient is experiencing thrombocytopenia.
Question 6 of 6
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The nurse would intervene when observing a health care team member performing which intervention when caring for a patient with multiple myeloma?
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- Providing oral care with a mouth spongeOral care with a mouth sponge presents no risks for a patient with multiple myeloma.
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- Checking a blood pressure on the upper armChecking a blood pressure on the upper arm is not contraindicated in a patient with multiple myeloma.
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- Turning the patient without a draw sheetDraw sheets should be used when turning a patient to prevent pathologic fractures.
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- Clipping the patient’s toenailsFoot care is not contraindicated in a patient with multiple myeloma.
