A college student who is diagnosed as having infectious mononucleosis asks how the disease is spread. The nurse's response is based on the knowledge that the usual mode of transmission is through:
- A. skin.
- B. genital contact.
- C. contaminated water.
- D. intimate oral contact.
Correct Answer: D
Rationale: Infectious mononucleosis, known as the 'kissing disease,' is spread through intimate oral contact, such as kissing or sharing utensils.
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The client is diagnosed with polycythemia vera. The nurse would prepare to perform which intervention?
- A. Type and crossmatch for a transfusion.
- B. Assess for petechiae and purpura.
- C. Perform phlebotomy of 500 mL of blood.
- D. Monitor for low hemoglobin and hematocrit.
Correct Answer: C
Rationale: Polycythemia vera requires phlebotomy (C) to reduce blood viscosity. Transfusions (A) worsen hyperviscosity, petechiae (B) are for thrombocytopenia, and Hb/Hct (D) are elevated.
The client diagnosed with iron-deficiency anemia is prescribed ferrous gluconate orally. Which should the nurse teach the client?
- A. Take Imodium, an antidiarrheal, over-the-counter (OTC) for diarrhea.
- B. Limit exercise for several weeks until a tolerance is achieved.
- C. The stools may be very dark, and this can mask blood.
- D. Eat only red meats and organ meats for protein.
Correct Answer: C
Rationale: Ferrous gluconate darkens stools (C), potentially masking GI bleeding. Imodium (A) is premature, exercise (B) is encouraged, and diet (D) should be varied, not meat-only.
The nurse and the licensed practical nurse (LPN) are caring for clients on an oncology floor. Which client should not be assigned to the LPN?
- A. The client newly diagnosed with chronic lymphocytic leukemia.
- B. The client who is four (4) hours postprocedure bone marrow biopsy.
- C. The client who received two (2) units of (PRBCs) on the previous shift.
- D. The client who is receiving multiple intravenous piggyback medications.
Correct Answer: D
Rationale: IV piggyback medications (D) require complex assessment (e.g., chemotherapy), beyond LPN scope. New diagnosis (A), post-biopsy (B), and post-transfusion (C) are stable for LPN care.
The client undergoing intensive chemotherapy for Hodgkin’s lymphoma (HL) is hospitalized with fever and depressed immune system functioning. The nurse is administering filgrastim subcutaneously daily. Which laboratory value should the nurse monitor to determine the medication’s effectiveness?
- A. Hemoglobin
- B. Platelet count
- C. Absolute neutrophil count (ANC)
- D. Reed-Sternberg cells
Correct Answer: C
Rationale: A. Epoetin alfa, not filgrastim, is used to treat anemia that is associated with cancer, and its effectiveness would be reflected in the Hgb values. B. Oprelvekin (Neumega), not filgrastim, enhances the synthesis of platelets. C. The nurse should monitor the ANC. Filgrastim (Neupogen) is usually discontinued when the client’s absolute neutrophil count (ANC) is above 1000 cells/mm3. Filgrastim, a granulocyte colony-stimulating factor (G-CSF) analog, is used to stimulate the proliferation and differentiation of granulocytes and treat neutropenia. D. Reed-Sternberg cells are found in lymph node biopsy cells and are indicative of Hodgkin’s lymphoma; they are not monitored to determine the effectiveness of filgrastim, which is used to treat neutropenia.
The client diagnosed with atrial fibrillation is admitted with warfarin (Coumadin) toxicity. Which HCP order would the nurse anticipate?
- A. Protamine sulfate, an anticoagulant antidote.
- B. Heparin sodium, an anticoagulant.
- C. Lovenox, a low molecular weight anticoagulant.
- D. Vitamin K, an anticoagulant agonist.
Correct Answer: D
Rationale: Warfarin toxicity causes bleeding; vitamin K (D) reverses it. Protamine (A) reverses heparin, heparin/Lovenox (B, C) worsen bleeding.
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