1. ANSWER C.

Good sources of vitamin B12 include meats and dairy

products. Whole grains are a good source of thiamine. Green leafy
vegetables are good sources of niacin, folate, and carotenoids (precursors of
vitamin A). Broccoli and Brussels sprouts are good sources of ascorbic acid
(vitamin C).

2. ANSWER B. The defining characteristic of pernicious anemia, a
megaloblasticanemia, is lack of the intrinsic factor, which results from
atrophy of the stomach wall. Without the intrinsic factor, vitamin B12
cannot be absorbed in the small intestines, and folic acid needs vitamin B12
for DNA synthesis of RBCs. The gastric analysis was done to determine the
primary cause of the anemia. An elevated excretion of the injected
radioactive vitamin B12, which is protocol for the first and second stage of
the Schilling test, indicates that the client has the intrinsic factor and can
absorb vitamin B12 into the intestinal tract. A sedimentation rate of 16
mm/hour is normal for both men and women and is a nonspecific test to
detect the presence of inflammation. It is not specific to anemias. An RBC
value of 5.0 million is a normal value for both men and women and does not
indicate anemia.

3. ANSWER B. Clients with aplastic anemia are severely
immunocompromised and at risk for infection and possible death related
to bone marrow suppression and pancytopenia. Strict aseptic technique
and reverse isolation are important measures to prevent infection.
Although diet, reduced stress, and rest are valued in supporting health,
the potentially fatal consequence of an acute infection places it as a
priority for teaching the client about health maintenance. Animal meat
and dark green leafy vegetables, good sources of vitamin B12 and folic
acid, should be included in the daily diet. Yoga and meditation are good
complimentary therapies to reduce stress. Eight hours of rest and naps
are good for spacing and pacing activity and rest.

4. D. STAY WITH THE CLIENT DURING THE IST 15MINS OF
INFUSION, To further assess any anaphylactic reaction during blood
transfusion, the ist 15mins you can identify any transfusion reaction.
choice letter A, You should not discontinue the IV catheter. Choice
letter B, the needle used is gauge 18 not gauge 20. Choice letter C, PNSS
is place as sidedrip in KVO rate. Isotonic solution can neutralize the blood
transfusion.
5. ANSWER A. Aplastic anemia decreases the bone marrow production
of RBCs, WBCs, and platelets. The client is at risk for bruising and
bleeding tendencies. A change in the intake and output is important,
but assessment for the potential for bleeding takes priority. Change
in the peripheral nervous system is a priority problem specific to
clients with vitamin B12 deficiency. Change in bowel function is not
associated with aplastic anemia.


7 B. ECCHYMOSES ARE LARGE PURPLE SKIN BRUISES.
Petechiae is a small pinpoint red dots on the skin, Purpura is a large
skin bruises, Abrasion is an open cut on the skin.
8.
9.
10.
11.
12.
13.
14.
15. C. REED STERNBERG CELLS, the Sternberg cell is on the
background of lymphocytes. Reed Sternberg cells are small
lymphocytes with large multi nucleated nuclei derived from malignant
B-cells, interspersed throughout a lymp node. These malignant cells
spread from one lymph node group to another in a sequential pattern.
Choices A,B,D is not indicator of having Hodgkins Disease.
16. A, URINE OUTPUT GREATER THAN 30ml/hr. In hypovolemic
shock, one of the hallmark sign is decreased in urine output, the nurse
should monitor the intake and output specifically the urine output,
decreased in urine output is expected and strictly monitored in
clients with hypovolemic shock.