The nurse is caring for an older adult client who has been admitted to the unit with anemia. What would the nurse expect the client to possibly exhibit?

Elimination of iron by the body

Excessive consumption of coffee or tea

Blood loss from the gastrointestinal or genitourinary tract

Decrease in the total body iron stores with age

Answer and Explanation

The Correct Answer is C

Reasoning:

Choice A reason: Elimination of iron by the body is not a typical cause of anemia in older adults. Iron is tightly regulated, and excessive loss occurs through bleeding, not spontaneous elimination. Anemia in the elderly is more commonly due to chronic blood loss or impaired absorption, not iron excretion.

Choice B reason: Excessive coffee or tea consumption can inhibit iron absorption due to tannins binding dietary iron, but it is not a primary cause of anemia in older adults. Blood loss or chronic disease are more common culprits, making dietary inhibition a less likely contributor in this population.

Choice C reason: Blood loss from the gastrointestinal or genitourinary tract is a common cause of anemia in older adults. Chronic bleeding from ulcers, colon cancer, or urinary tract issues depletes iron stores, leading to iron deficiency anemia, a frequent finding in the elderly due to higher prevalence of these conditions.

Choice D reason: A decrease in total body iron stores with age is not a primary cause of anemia. While absorption may decline slightly, blood loss from gastrointestinal or genitourinary sources is a more significant contributor in older adults, as it directly reduces iron available for hemoglobin synthesis.

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Correct Answer is B

Explanation

Reasoning:

Choice A reason: Constant supervision is impractical and not the most effective way to reduce fall risk in Cushing syndrome. While supervision can help, it does not address environmental hazards or promote independence. Muscle weakness from corticosteroid-induced myopathy increases fall risk, making targeted prevention strategies more practical and effective.

Choice B reason: Fall-prevention measures, such as removing obstacles, ensuring adequate lighting, and using non-slip mats, directly address the risk of injury from muscle weakness in Cushing syndrome. These measures reduce environmental hazards and promote safety, effectively mitigating the risk of falls due to corticosteroid-induced myopathy and osteoporosis.

Choice C reason: Encouraging bed rest increases the risk of complications like muscle atrophy and thromboembolism in Cushing syndrome. Prolonged immobility exacerbates muscle weakness and bone loss, both already worsened by corticosteroids, making bed rest counterproductive to maintaining strength and reducing injury risk from falls.

Choice D reason: Assistive devices like canes or walkers can help, but they are not the primary strategy. Fall-prevention measures address environmental risks broadly, benefiting all patients with weakness. Devices are useful for severe mobility issues but are less comprehensive than environmental modifications for preventing falls in Cushing syndrome.

A. Seizures B. Septicemia C. Bleeding D. Acute pain

Correct Answer is C

Explanation

Reasoning:

Choice A reason: Seizures can occur post-stroke due to cortical irritation, but they are not the primary complication of t-PA. Thrombolytics increase bleeding risk, particularly intracranial hemorrhage, which is more immediate and life-threatening, making seizure monitoring secondary to vigilant observation for bleeding signs.

Choice B reason: Septicemia is not a direct complication of t-PA or ischemic stroke. While infections may occur later due to immobility or hospitalization, t-PA’s primary risk is bleeding due to its fibrinolytic action, making septicemia a less urgent concern in the immediate post-treatment period.

Choice C reason: Bleeding, particularly intracranial hemorrhage, is the most critical complication to monitor post-t-PA in ischemic stroke. t-PA dissolves clots, increasing the risk of bleeding in the brain or other sites, which can lead to neurological deterioration or death, requiring close monitoring in the ICU.

Choice D reason: Acute pain is not a primary complication of t-PA or ischemic stroke. Pain may occur in stroke from spasticity or other causes, but bleeding is the most immediate and severe risk of thrombolytic therapy, requiring prioritized monitoring over pain assessment.

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The nurse is caring for an older adult client who has been admitted to the unit with anemia. What would the nurse expect the client to possibly exhibit?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse providing care for a client with Cushing syndrome has identified the nursing diagnosis of risk for injury related to weakness. How should the nurse best reduce this risk?

Correct Answer is B

Explanation

A client with a new diagnosis of ischemic stroke was treated in the ED with tissue plasminogen activator (t-PA) and then admitted to the ICU. In addition to closely monitoring the client’s cardiac and neurologic status, the nurse monitors the client for signs of what complication?

Correct Answer is C

Explanation

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The nurse is caring for an older adult client who has been admitted to the unit with anemia. What would the nurse expect the client to possibly exhibit?

The most common cause of iron deficiency anemia in male clients and postmenopausal female clients is:

A nurse is caring for a client with Cushing’s syndrome. Which interventions would the nurse include in the client’s plan of care? (Select all that apply)

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