Nokea
A client with leukemia who has been receiving Trimetrexate (methotrexate) has an order for Wellcovorin (leucovorin). The rationale for administering Wellcovorin is to:
- A. Treat anemia caused by the methotrexate
- B. Create a synergistic effect that shortens treatment time
- C. Increase the number of circulating neutrophils
- D. Reverse drug toxicity and prevent tissue damage
Correct Answer: D
Rationale: Leucovorin (Wellcovorin) is a rescue therapy given after methotrexate to reverse its toxicity and protect healthy cells from damage particularly in bone marrow and mucosal tissues. It does not treat anemia enhance synergy or increase neutrophils.
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A client's congestive heart failure has been treated, and he will soon be discharged. Discharge teaching should include instruction to call the physician if he notices a 2-lb weight gain in a 24-hour period. Increased weight gain may indicate:
- A. A diet too high in calories and saturated fat
- B. Decreasing cardiac output
- C. Decreasing renal function
- D. Development of diabetes insipidus
Correct Answer: B
Rationale: A 2-lb weight gain in 24 hours suggests fluid retention due to decreasing cardiac output, activating the renin-angiotensin-aldosterone system.
The nurse is caring for a client with acquired immunodeficiency syndrome. Which finding should be reported to the doctor immediately?
- A. Temperature of 100.2°F
- B. White patches on the tongue
- C. Weight loss of 10 pounds
- D. Respiratory rate of 26 breaths per minute
Correct Answer: D
Rationale: A respiratory rate of 26 breaths per minute suggests respiratory distress, a critical issue in AIDS due to possible opportunistic infections like Pneumocystis pneumonia, requiring immediate reporting.
The nurse is teaching a client with a history of kidney stones about dietary modifications. The nurse should tell the client to:
- A. Increase fluid intake
- B. Avoid all calcium
- C. Consume high-oxalate foods
- D. Reduce protein intake
Correct Answer: A
Rationale: Increasing fluid intake dilutes urine, reducing the risk of kidney stone formation.
A female client is anticipating a visit with her parents over the Thanksgiving holidays. She has recently begun experiencing periods of extreme shortness of breath, which her physician has labeled as panic attacks. Which of the following statements by the nurse would enhance therapeutic communication?
- A. Why do you feel this way?'
- B. Tell me about your dislike for your parents.'
- C. Don't worry, everything will be all right on your visit with your parents.'
- D. Perhaps you and I can discover what produces your anxiety.'
Correct Answer: D
Rationale: Asking the client to provide an explanation for her feelings is often intimidating. This response is probing and may make the client feel used and valued only for the information she can provide. This underrates the client's feelings and belittles her concerns. It may cause the client to stop sharing feelings for fear that they will be ridiculed. The emphasis is on working with the client. It shows that there is hope for change through collaboration.
The nurse is caring for a client with a history of a fractured femur who is in a cast. The client complains of swelling. The nurse should:
- A. Apply ice to the cast
- B. Elevate the leg
- C. Massage the leg
- D. Notify the physician immediately
Correct Answer: B
Rationale: Elevating the leg reduces swelling in a casted femur by improving venous return. Ice is helpful, massage is contraindicated, and notification is needed if swelling persists.