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HESI RN EXIT CASE STUDY - PERNICIOUS ANEMIA
1. pernicious anemia case study: John Baker is a 45-year-old Caucasian male who was admitted to the
medical-surgical unit 6 hours ago from the Emergency Department due to nausea, vomiting, shortness of breath, pallor, weakness, and severe fatigue. John is divorced with no children and has been practicing law for 15 years. He also has had a medical history of chronic gastric ulcers.
2. The nurse receives shift report and proceeds to Mr. Baker's room, bringing the vital sign
measurement equipment. Which vital sign should concern the nurse the most ANS: Blood pressure is 142/80 mmHg. Rationale: This elevated blood pressure indicates an underlying issue that must be addressed.
3. The nurse asks Mr. Baker how he is feeling today. He reports that he does not have time for this
hospitalization. The nurse notes that he seems annoyed. He coughs as he tries to sit up. He turns on the television, focuses on a news station, and ignores the nurse. Which type of assessment should the nurse perform on Mr. Baker ANS: A focused assessment. Rationale: This assessment is for evaluating the status of specific previously identi- fied problems and any symptoms of new problems developing
4. The nurse performs a focused assessment. Which systems should the nurse evaluate?
(Select all that apply.): Cardiovascular system. Rationale: The client has hypertension and an elevated heart rate. Respiratory system. Rationale: The client has a cough.
5. The nurse finds that Mr. Baker has a weak, irregular, and rapid pulse and his tongue is inflamed.
The nurse decides to perform a neurological assessment because of mild tremoring. His unexpected neurological findings included hyperactive deep tendon reflexes and mild burning and prickling sensations on his feet and hands. He also appears to startle easily, and he has lost about 15% of his weight as compared to his last visit, which was four months ago. During the assessment, the nurse suspects that the client may have perni- cious anemia. Which pathophysiological process promotes this condition ANS: -
also the reason that the client must be placed on telemetry until the hypokalemia is resolved.
9. Morning laboratory results have begun appearing in Mr. Baker's electronic health record. Which
electrolyte deficiency would make the nurse suspect that this client may be suffering from chronic alcoholism ANS: Magnesium.. Rationale: A magnesium deficit is consistent with the client's assessment findings, and it is commonly associated with chronic alcoholism
10. The nurse assesses Mr. Baker's lifestyle choices to explore what resources he has for health
promotion. Which lifestyle choice may concern the nurse about a client with possible chronic alcoholism ANS: He enjoys staying out all night at his favorite local bar.
Rationale: While the bar may provide social stimulation, it also provides access to alcohol.
11. Mr. Baker is 45-years-old. Which life style choice is surprising given his psychosocial
developmental stage ANS: He enjoys staying out all night at his favorite local bar. Rationale: Regularly staying out all night is the behavior of someone younger who is seeking intimacy.
12. The nurse notes that Mr. Baker has had many personal losses in his life, and he recently lost his
legal partner in an accident. His electronic health record has no one listed as a person to contact in case of emergencies. Which comment is the best way for the nurse to begin assessing Mr. Baker's support systems and available resources ANS: Who would you like to have listed as your emergency contact person? Rationale: Initiating the conversation using electronic record data omissions is a less threatening way to begin to ask the question, "To whom can you go to for support at home or at work?"
13. The nurse has received new prescriptions by electronic health record in response to the recent
laboratory results. One of the prescriptions is for intravenous potassium chloride 20 mEq/100 ml over one hour. Which drug implications are important for the nurse to consider before giving it? (Select all that apply.): The intravenous site should be monitored closely for infiltration. Rationale: This is a very important nursing action as infiltration can lead to painful and damaging extravasation around the intravenous catheter site. The intravenous infusion is best given through a central line. Rationale: This is the preferred intravenous route; however, a slower flow rate can be used if this is not possible. Giving the infusion too rapidly can cause fatal hyperkalemia. Rationale: This is a true statement. Administering the intravenous medication can burn a peripheral vein. Rationale: This is an important nursing consideration and can be rectified by slowing the rate and/or reducing
14. The nurse notices that the client has no central line and only has one peripheral intravenous
catheter in the left forearm. Which intervention is the best way to give this prescription ANS: Consult with a pharmacist about giving slowly over two hours. Rationale: This option is the easiest way to prevent vein irritation while administering the prescribed medication. Pharmacists are the best colleagues to consult for situations like this one. Most of the time, the pharmacist can adjust the prescription; however, if this is not the case, the pharmacist can also assist with communicating with the healthcare provider.
15. Mr. Baker starts vomiting. The nurse looks in his medication administration record and notices
that he has a prescription for treating nausea and vomiting. He has also not had any of it since he was admitted to the unit. The healthcare provider has prescribed ondansetron (Zofran) 8 mg iv push every 8 hours as needed. How many milliliters (mL) of ondansetron (Zofran) should the nurse should draw into a syringe in preparation for administration? (enter numerical value only. If rounding is necessary, round to the whole number.): 10 mL 8mgx 5mL/4mg =40/4 =
16. Mr. Baker says that he is feeling better and it is now time to give the scheduled medications.
Because of the new medical diagnosis of pernicious anemia, the healthcare provider has prescribed vitamin B12 (cyanocobalamin) 100 mcg/day subcutaneously for seven days with a follow up clinical visit for laboratory work on the seventh day. Before giving the medication, what should the nurse do first ANS: Teach the client about the medication being given. Rationale: Teaching the client about their medication enhances medication safety and con- tributes to discharge teaching.
17. The nurse is preparing to give the cyanocobalamin as prescribed. This label comes from the
medication packaging that the pharmacy delivered for Mr. Baker. What should the nurse do next ANS: Hold the medication and call to inform the pharmacist.
Rationale: Cyanocobalamin is the right medication, but the wrong route has been provided.
ANS: Blood urea nitrogen and serum creatinine levels. Rationale: Magnesium is eliminated by the kidneys; therefore, renal function should be moni-
tored. The BUN and creatinine levels offer a convenient indirect evaluation of kidney function.
22. The nurse is reviewing Mr. Baker's electronic health record and is dis- cussing with the
healthcare provider the possible need for an inter-profession- al conference with the client due to the increasing complexity of his medical problems. The nurse uses a problem-solving approach to client inter-profes- sional consultation and assists the healthcare provider with obtaining con- sultants to better inform the process for promoting the changes needed for this client. To begin this process, the nurse creates a list of known problems. Which problems should the nurse include in this evaluation? (Select all that apply.): Pernicious anemia. This diagnosis is measurable and the signs and symptoms apparent, such as nausea, vomiting, shortness of breath, pallor, weakness, inflamed tongue, tremors, and severe fatigue. Chronic gastritis. This diagnosis is measurable, and the signs and symptoms have been apparent for quite some time. He has nausea, vomiting, and weight loss, and he has developed pernicious anemia due to fewer functioning gastric parietal cells. Electrolyte imbalances. This diagnosis is measurable and the signs and symptoms apparent. He has been diagnosed as having hypomagnesemia and hypokalemia during this hospitalization. Grief and loss. This diagnosis is measurable and the signs and symptoms apparent. He lost his business partner in an accident recently.
23. In collaboration with the nurse, the attending healthcare provider has consulted several
specialists for a conference to plan Mr. Baker's care. The nurse is also preparing to initiate a follow up discussion about treatment options with Mr. Baker after the meeting. Which consultants will be most helpful during this meeting? (Select all that apply.): Internist. He has been diagnosed as having hypomagnesemia and hypokalemia. Psychologist/Psychiatrist. He has grief issues, as well as possible alcoholism and social isolation. Gastroenterologist. He has a history of chronic gastritis and his symptoms are nausea, vomiting, and
person's life. This response reflects that he does not acknowl- edge that he has a drinking problem.
26. Mr. Baker informs the nurse that he can quit drinking any time he chooses and that he is not
interested in psychotherapy or attending any Alcoholics Anonymous meetings. How should the nurse respond to these statements?- : It's great that you are taking better care of yourself. Rationale: This response reflects on what he is doing for himself, respects the client's decision, and keeps the conversation open for further interaction with him. It is also a good transition to discussing his medications with him in preparation for discharge to home. He has agreed to grief support meetings, which is also an open door.
27. Several hours have passed and all medications have been given. The healthcare provider is
thinking about discharging Mr. Baker. Mr. Baker's latest laboratory test results have arrived in his electronic health record, and the nurse has performed another focused assessment. Which finding satisfies the nurse that the potassium electrolyte replacement medication has been effective ANS: A 12-lead electrocardiography strip confirms a normal sinus rhythm. Rationale: This result shows that the intravenous potassium has resolved the hypokalemia and the T-wave has returned from flatted to normal size.
28. The healthcare provider writes discharge prescriptions for Mr. Baker. The nurse provides
discharge instructions that include prescriptions to be filled by his chosen pharmacy, the date and time of his follow up appointment, and other self-care information on a printed document for him to take home. Which intervention is most important for the nurse to perform after giving Mr. Baker his discharge information ANS: Document the teaching in his health record. Rationale: This is an important action for the nurse to take after providing discharge teaching.
