A nurse is assessing a client who has sickle cell anemia. Which of the following findings is the priority for the nurse to report?

Slurred speech

Yellowed sclera

Ulcers on the ankles

Swelling in the joints

Answer and Explanation

The Correct Answer is A

Choice A rationale:

Slurred speech could indicate a potential neurological complication in a client with sickle cell anemia, such as a stroke. Neurological symptoms require immediate attention and reporting to the healthcare provider.

Choice B rationale:

Yellowed sclera (jaundice) can be related to sickle cell anemia but is less acutely concerning than slurred speech.

Choice C rationale:

Ulcers on the ankles are often associated with sickle cell anemia, but they are not as urgent as neurological symptoms.

Choice D rationale:

Swelling in the joints is a potential manifestation of sickle cell anemia, but slurred speech indicates a more acute and concerning issue.

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Correct Answer is A

Explanation

Choice A rationale:

During the manic phase of bipolar disorder, sleep disturbances are common. Setting a goal for the client to achieve an appropriate amount of sleep can help stabilize their mood and reduce the intensity of manic symptoms.

Choice B rationale:

A weight loss goal might be more appropriate during the depressive phase, as manic episodes are often associated with increased energy and decreased appetite.

Choice C rationale:

Increased urine specific gravity is not a specific goal for managing the manic phase of bipolar disorder.

Choice D rationale:

Giving personal gifts to other clients might be a manifestation of the client's manic behavior and is not a goal to strive for.

A. Place the newborn under a radiant warmer. B. Supplement breastfeeding with iron-fortified formula. C. Determine the effectiveness of breastfeeding. D. Administer Rho(D) immune globin to the newborn.

Correct Answer is C

Explanation

Choice A rationale:

Placing the newborn under a radiant warmer is not directly related to addressing breastfeeding-related jaundice.

Choice B rationale:

Supplementing breastfeeding with formula is not the first-line approach and may interfere with establishing successful breastfeeding.

Choice C rationale:

Breastfeeding-related jaundice can occur if the newborn is not effectively breastfeeding and not getting enough milk. Assessing the effectiveness of breastfeeding is important to address the underlying cause of jaundice.

Choice D rationale:

Administering Rho(D) immune globulin is unrelated to addressing jaundice in a breastfed newborn.

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A nurse is assessing a client who has sickle cell anemia. Which of the following findings is the priority for the nurse to report?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is planning care for a client who is in the manic phase of bipolar disorder. Which of the following goals should the nurse include?

Correct Answer is A

Explanation

A nurse is creating a plan of care for a newborn who is breastfed and appears jaundiced. Which of the following interventions should the nurse include?

Correct Answer is C

Explanation

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