A 36-year-old female presents at the clinic with symptoms of fatigue, palpitations, tinnitus, and excessive tiredness with activity.

These symptoms have gradually increased in severity over the last 2 months. The nurse suspects anemia.

For each statement, select whether it is consistent with Iron deficiency anemia, Vitamin B12 deficiency anemia, or Folic acid deficiency anemia.

Each statement can have more than one correct answer.

Iron deficiency anemia

Vitamin B12 deficiency

Folic acid deficiency anemia

Answer and Explanation

The Correct Answer is {"A":{"answers":"A,B"},"B":{"answers":"C,B"},"C":{"answers":"B"}}

Choice A rationale

Chronic alcoholism is often associated with both Vitamin B12 and Folic acid deficiency anemia. Alcohol interferes with the absorption of these vitamins in the gut, leading to their deficiency.

Choice B rationale

Malabsorption syndrome can lead to Iron deficiency anemia, Vitamin B12 deficiency anemia, and Folic acid deficiency anemia. In malabsorption syndrome, the small intestine can’t absorb enough of certain nutrients and fluids.

Choice C rationale

Dietary deficiency can result in Iron deficiency anemia, Vitamin B12 deficiency anemia, and Folic acid deficiency anemia. These types of anemia can occur when the body doesn’t have enough of the vitamins needed to produce enough healthy red blood cells.

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Correct Answer is D

Explanation

Choice A rationale
Using a cushion when sitting can provide comfort but does not directly address the client’s electrolyte imbalance, elevated blood pressure, or weight gain.
Choice B rationale

Offering a high protein diet can be beneficial for clients with hepatic failure to support liver regeneration and prevent malnutrition. However, it does not directly address the client’s immediate issues.
Choice C rationale
Providing only distilled water does not address the client’s electrolyte imbalance, elevated blood pressure, or weight gain. In fact, it could potentially exacerbate electrolyte imbalances.
Choice D rationale
Documenting abdominal girth can help monitor for fluid accumulation (ascites), a common complication of hepatic failure that can contribute to weight gain and elevated blood pressure.

A. Cease the use of the nasal cannula. B. Reduce the flow rate to 1 L/minute. C. Apply lubricant to the cannula tubing. D. Attach padding around the cannula tubing.

Correct Answer is D

Explanation

Choice A rationale
Ceasing the use of the nasal cannula would interrupt the client’s oxygen therapy, which could potentially worsen their condition. Therefore, this is not the best course of action.
Choice B rationale
Reducing the flow rate to 1 L/minute may not be appropriate as the client’s oxygen needs may not be met at a lower flow rate. The redness under the chin is likely due to the friction from the cannula tubing, not the flow rate of the oxygen.
Choice C rationale
Applying lubricant to the cannula tubing may not be effective in preventing skin breakdown and could potentially cause additional discomfort or complications for the client.
Choice D rationale
Attaching padding around the cannula tubing can help reduce the friction between the tubing and the skin, which can help prevent skin breakdown. This is the most appropriate action to take in this situation.

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Naxlex Comprehensive Predictor Exams

A client with hepatic failure has an electrolyte imbalance, elevated blood pressure, and a weight gain of 4.4 lbs (2 kg) in 24 hours. What intervention should the nurse include in the plan of care?

Correct Answer is D

Explanation

The nurse notices redness under the chin of a client who is receiving oxygen at 2 L/minute via a nasal cannula. What action should the nurse take?

Correct Answer is D

Explanation

What is the most crucial nursing intervention to include in the care plan for a patient who is 12 hours post- thyroidectomy?

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