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A 17-year-old female presents with cervical adenopathy and a history of daily fevers and drenching night sweats. A biopsy is performed and reveals classic Hodgkin lymphoma. Which of the following is least appropriate as part of the staging workup?
- A. Chest x-ray
- B. CT scan of chest, abdomen, and pelvis
- C. Functional imaging (PET scan)
- D. Lumbar puncture and cerebrospinal fluid (CSF) analysis
Correct Answer: D
Rationale: The correct answer is D, Lumbar puncture and cerebrospinal fluid (CSF) analysis. In Hodgkin lymphoma, central nervous system involvement is rare at presentation, making routine CSF analysis unnecessary. Staging workup typically includes imaging studies (A, B, C) to assess disease extent and involvement of distant organs. CSF analysis is reserved for cases with neurological symptoms or signs suggestive of CNS involvement. Therefore, in this case, the least appropriate option for staging workup is D.
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A nurse is caring for a client who is taking filgrastim to treat neutropenia. The nurse should assess the client for which of the following adverse effects?
- A. Dusky nail beds
- B. Petechiae
- C. Enlarged spleen
- D. Swollen calf
Correct Answer: C
Rationale: The correct answer is C: Enlarged spleen. Filgrastim stimulates the production of neutrophils, which can lead to splenomegaly as the spleen stores a large number of these cells. This can cause symptoms such as abdominal discomfort or fullness. Dusky nail beds (A), petechiae (B), and swollen calf (D) are not typically associated with filgrastim therapy and are more likely related to other conditions or medications.
Oral iron supplements are given for iron deficiency anemia. Which of the statement is true regarding the absorption of oral iron supplements?
- A. Absorption occurs in the large intestine
- B. Intrinsic factor is necessary for the iron absorption
- C. Ascorbic acids reduces iron absorption
- D. Absorption is increased in hereditary hemochromatosis
Correct Answer: A
Rationale: Rationale:
A: Correct - Iron absorption primarily occurs in the duodenum and upper small intestine, not the large intestine.
B: Incorrect - Intrinsic factor is necessary for Vitamin B12 absorption, not iron.
C: Incorrect - Ascorbic acid (Vitamin C) actually enhances iron absorption.
D: Incorrect - Absorption is decreased in hereditary hemochromatosis, a condition of iron overload.
You are treating a patient with localized osteosarcoma of the distal femur with methotrexate, doxorubicin, and cisplatin (MAP) chemotherapy. At week 10 of treatment, the patient undergoes complete resection of the tumor. Pathology demonstrates 40% necrosis. Which of the following represents the most appropriate further therapy?
- A. Ifosfamide and etoposide (IE)
- B. MAP plus ifosfamide and etoposide (MAPIE)
- C. Gemcitabine docetaxel
- D. MAP
Correct Answer: D
Rationale: Rationale: The correct answer is D, continuing with MAP chemotherapy. The 40% necrosis rate indicates a good response to the current regimen. Continuing MAP ensures completion of the planned therapy and maximizes the benefit of the initial treatment's response. Choice A (Ifosfamide and etoposide) and B (MAPIE) are not indicated as the response to MAP was favorable. Choice C (Gemcitabine docetaxel) is not the standard of care for osteosarcoma. Continuing with MAP is the most appropriate option for this patient.
A patient who is undergoing consolidation therapy for the treatment of leukemia has been experiencing debilitating fatigue. How can the nurse best meet this patient's needs for physical activity?
- A. Teach the patient about the risks of immobility and the benefits of exercise.
- B. Assist the patient to a chair during awake times, as tolerated.
- C. Collaborate with the physical therapist to arrange for stair exercises.
- D. Teach the patient to perform deep breathing and coughing exercises.
Correct Answer: B
Rationale: The correct answer is B because assisting the patient to a chair during awake times allows for gradual physical activity, promoting mobility without overwhelming the patient. This option supports the patient's need for movement while considering their current level of fatigue.
A is incorrect because educating the patient about the benefits of exercise may not be feasible or appropriate given the patient's current fatigue levels.
C is incorrect as stair exercises may be too strenuous for a patient experiencing debilitating fatigue, potentially leading to further exhaustion and risk of injury.
D is incorrect because deep breathing and coughing exercises primarily focus on respiratory health and may not directly address the patient's need for physical activity to combat fatigue.
A nurse is assessing a dark-skinned client for pallor. What action is best?
- A. Assess the conjunctiva of the eye.
- B. Have the client open the hand widely.
- C. Look at the roof of the client's mouth.
- D. Palpate for areas of mild swelling.
Correct Answer: A
Rationale: The correct answer is A: Assess the conjunctiva of the eye. This is because pallor, which is paleness of the skin, can be difficult to detect on dark skin. The conjunctiva of the eye is a mucous membrane that is not pigmented and can provide a more accurate indication of pallor. Options B, C, and D are not ideal for assessing pallor in a dark-skinned client as they may not show paleness accurately. B is more related to checking for pallor in fair-skinned individuals. C and D are not reliable indicators of pallor in any skin type.