a client who participates in a health maintenance organization hmo needs a bone marrow transplant for treatment of breast cancer the client tells the

ATI LPN

ATI PN Adult Medical Surgical 2019

1. A client who participates in a health maintenance organization (HMO) needs a bone marrow transplant for the treatment of breast cancer. The client tells the nurse that she is concerned that her HMO may deny her claim. What action by the nurse best addresses the client's need at this time?

A. Have the client's healthcare provider write a letter to the HMO explaining the need for the transplant.
B. Help the client place a call to the HMO to seek information about limitations of coverage.
C. Encourage the client to contact a lawyer to file a lawsuit against the HMO if necessary.
D. Have the social worker contact the state board of insurance to register a complaint against the HMO.

Correct answer: B

Rationale: The best action for the nurse to take in this situation is to help the client directly contact the HMO to seek information about limitations of coverage. This approach addresses the client's immediate concerns and clarifies the situation, enabling the client to understand the coverage and potential outcomes regarding the bone marrow transplant. Choice A is not the best option as having the healthcare provider write a letter may not provide immediate clarification on coverage. Choice C is inappropriate as legal action should be considered as a last resort, and choice D involving the state board of insurance is not necessary at this initial stage of addressing the client's concern.

2. The nurse is caring for a client with a history of deep vein thrombosis (DVT) who is receiving warfarin (Coumadin). Which laboratory value should the nurse monitor closely?

A. Platelet count.
B. Prothrombin time (PT).
C. Hemoglobin level.
D. White blood cell count.

Correct answer: B

Rationale: Prothrombin time (PT) is monitored to ensure therapeutic levels of warfarin and prevent bleeding complications.

3. The mother of a 9-month-old who was diagnosed with respiratory syncytial virus (RSV) yesterday calls the clinic to inquire if it will be all right to take her infant to the first birthday party of a friend's child the following day. What response should the nurse provide this mother?

A. The child can be around other children but should wear a mask at all times.
B. The child will no longer be contagious, no need to take any further precautions.
C. Make sure there are no children under the age of 6 months around the infected child.
D. Do not expose other children. RSV is very contagious even without direct oral contact.

Correct answer: D

Rationale: The correct response is to advise the mother not to expose other children to the infected child. RSV is highly contagious, and transmission can occur even without direct oral contact. It is crucial to prevent the spread of the virus to protect other children from getting infected.

4. A 65-year-old female client arrives in the emergency department with shortness of breath and chest pain. The nurse accidentally administers 10 mg of morphine sulfate instead of the prescribed 4 mg. Later, the client's respiratory rate is 10 breaths/minute, oxygen saturation is 98%, and she states her pain has subsided. What is the legal status of the nurse?

A. The nurse is guilty of negligence and will be sued.
B. The client would not be able to prove malpractice in court.
C. The nurse is protected by the Good Samaritan Act.
D. The healthcare provider should have given the morphine sulfate dose.

Correct answer: B

Rationale: The correct answer is B because, in this scenario, the client would not be able to prove malpractice in court. Despite the nurse administering a higher dose of morphine than prescribed, the client's respiratory rate, oxygen saturation, and pain relief indicate that no harm resulted from the error. Therefore, the client would not have legal grounds to pursue a malpractice case against the nurse.

5. A 46-year-old man with a history of cirrhosis is brought in by his wife because he has been acting strangely. On examination, he is disoriented, ataxic, and has slurred speech. He is also hyperreflexic. His white blood cell count is normal. His hematocrit is 34%. Coagulation times are elevated. His ammonia level is normal. Which of the following statements regarding his management is correct?

A. He should be treated with a low-protein diet and lactulose
B. Lorazepam is not the drug of choice to control his behavior
C. He should not be placed on gentamicin prophylactically to prevent the development of peritonitis
D. If the patient complains of pain, acetaminophen should be avoided and nonsteroidal anti-inflammatory agents should be used

Correct answer: A

Rationale: This patient presents with symptoms consistent with hepatic encephalopathy. Despite having a normal ammonia level, he should be treated with lactulose and a low-protein diet as recommended for stage 2 hepatic encephalopathy. The normal ammonia level does not exclude the diagnosis, as it lacks sensitivity and specificity. Medications like lorazepam, gentamicin, and NSAIDs should be avoided due to their potential adverse effects in patients with liver disease. Acetaminophen should also be avoided in such patients.