Question

1. a nurse is preparing to administer epoetin to a client who has anemia due to chemotherapy. which of the following actions should the nurse plan to take?

a. review the clients Hgb level prior to administration.

b. use the z-track method when administering the medication.

c. shake the vial for 30 seconds prior to withdrawing the medication.

d. ensure the client is not taking iron supplements while on this medication.

2. a nurse is caring for a client who is postoperative and reports frequent leakage of small amounts of urine. the nurse notes that the client's bladder is palpable upon examination. the nurse should identify these findings as which of the following forms of incontinence?

a. stress.

b. urge.

c. functional.

d. overflow.

3. a nurse is assessing a client who has Guillain-Barrè syndrome. which of the following findings should the nurse report to the provider immediately?

a. decreasing leg strength.

b. decreasing voice volume.

c. decreased deep tendon reflexes.

d. decreased sensation in the arms.

Answer 1

1. Answer Option A. review the clients Hgb level prior to administration

Option A is correct in case of chemotherapy treatment the level of RBCs and hemoglobin decreases drastically. So if hormone epoietin is to be given to the anemic patient then the concentration and level of hemoglobin in the patient needs to be known prior to the administration. This is very important to decide the dosage and the duration in which the hormone would be required for the anaemic patient. Any excess administration in case of chemotherapy patient would result in difficulty in the immune system of the patient and can lead to multiple complications in a stage where immunity is of concern and we do not want excess of any other hormone in the body. So it is important to review the haemoglobin level of the clients prior to the administration of the hormone

Option B is incorrect as method of administration is not relevant as compared to the amount of medication that is to be administered

Option C is incorrect as shaking the vial before administering is a general practice and is not relevant in this scenario

Option D is incorrect as the and supplement in case of any work patient is often prescribed by the doctor and in the dietary requirement the supply of iron is also encouraged but there hormone is only admin listed in cases of serious anaemia. Small iron supplements is not relevant in this scenario

2. Answer. Option D overflow

Option D is correct as this case the bladder is palpable as checked by the nurse and the nurse should identify this findings as overflow forms of incontinence. In case of overflow the urine is continuously found to be dripping and the witnesses observe and this is due to the palpable bladder and the regular bladder is not being empty post-operative

Option A is incorrect as stress and the bladder voiding is not in alignment with the help of gallbladder observed by the nurse and the patient is also not under any stress

Option B does not apply as the urge using case of any urinary infection or neurological disorder and difficulty in bladder voiding which is not the case in this scenario

Option C is incorrect as functional urine incontinence due to physical and mental impairment of not wearing the bladder in time and hence the urine.

3. Answer Option D decreased sensation in arms

Option D is correct as in case of guillain barre syndrome neurological disorder affects the nervous system and the nerves controlling in different parts of the body. Symptom of decreased sensation in the arms is declared evidence to be reported of the guillain barre syndrome progressed at advanced stage. The nurse should report the loss of sensation in the patient with the syndrome immediately as this my give clear treatment suggestion in time in the disease progression of the patient

Option A is incorrect as leg strength loss is a gradual symptom of the neurological disorder and not the immediate one

Option B is incorrect as the loss of voice strength how the patient with this syndrome is a progressive symptom and not to be reported immediately and hence is does not apply in the situation

Option C is it incorrect as the deep tendon reflexes are usually observed in patients with disorder and not an immediate priority to be reported by the nurse