ATI RN
Burns Pediatric Primary Care 7th Edition Test Bank Questions
Question 1 of 5
A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron-deficiency anemia?
Correct Answer: C
Rationale: Iron-deficiency anemia is a common type of anemia characterized by a lack of iron in the body, which leads to decreased production of red blood cells containing hemoglobin. The assessment findings characteristic of iron-deficiency anemia include dyspnea (shortness of breath) due to decreased oxygen-carrying capacity of the blood, tachycardia (rapid heart rate) as the body tries to compensate for decreased oxygen delivery, and pallor (pale skin and mucous membranes) due to reduced red blood cell production. These symptoms result from insufficient iron levels affecting the body's ability to produce an adequate number of healthy red blood cells. Night sweats, weight loss, and diarrhea are not typically associated with iron-deficiency anemia. Nausea, vomiting, anorexia, itching, rash, and jaundice are also not primary manifestations of iron-deficiency an
Question 2 of 5
The nursing staff has a team conference on AIDS and discusses the routes of transmission of the human immunodeficiency virus (HSV). The discussion reveals that an individual has no risk of exposure to HIV when that individual;
Correct Answer: C
Rationale: The correct answer is C. An individual has no risk of exposure to HIV when they limit sexual contact to those without HIV antibodies. This is because HIV is primarily transmitted through contact with body fluids such as blood, semen, vaginal fluids, and breast milk of an infected person. If an individual only engages in sexual activities with people who do not have HIV antibodies, the risk of exposure to the virus is significantly reduced. It is important to note that although this reduces the risk, it does not completely eliminate it, as there is still a chance of transmission through other means such as sharing needles or from mother to child during pregnancy, childbirth, or breastfeeding.
Question 3 of 5
You would not find which of the following assessments in a patient with severe anemia?
Correct Answer: C
Rationale: Severe anemia is associated with a reduced number of red blood cells, leading to decreased oxygen delivery to the body's tissues. Therefore, symptoms commonly seen in patients with severe anemia include pallor (pale skin), fatigue (due to decreased energy levels), and dyspnea (shortness of breath) especially on exertion (due to the heart working harder to compensate for the reduced oxygen-carrying capacity of the blood). Cold sensitivity is not a typical symptom of anemia and is not directly related to the reduced oxygen-carrying capacity of the blood.
Question 4 of 5
A 50-year-old African American patient is diagnosed with anemia. Where can the nurse assess for pallor?
Correct Answer: D
Rationale: When assessing for pallor in a patient with anemia, the nurse should specifically look at the conjunctivae (the membranes that cover the white part of the eyes). In individuals with anemia, the lack of red blood cells can result in paleness in the conjunctivae, which can be observed as a pale or whitish color. This area is especially useful for assessing pallor in individuals with darker skin tones, such as African Americans, where pallor may be less noticeable on other areas of the body.
Question 5 of 5
For a client with polycythemia vera, how can the nurse help decrease the risk for thrombus formation?
Correct Answer: B
Rationale: For a client with polycythemia vera, there is an increased risk for thrombus formation due to the increased viscosity of the blood. Wearing thromboembolic stockings or support hose can help promote circulation, prevent stasis, and reduce the risk of thrombus formation. Compression stockings provide external pressure to the legs, which helps prevent blood from pooling and clotting. This intervention is commonly recommended for patients at risk for thrombus formation to improve blood flow in the lower extremities and reduce the risk of deep vein thrombosis (DVT) and pulmonary embolism.