Nokea
A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse would indicate a need for further teaching?
- A. The patient ambulates around the room.
- B. The patient's visitors bring in fresh peaches.
- C. The patient cleans with a warm washcloth after having a stool.
- D. The patient uses soap and shampoo to shower every other day.
Correct Answer: B
Rationale: Neutropenia post-chemo drops immunity fresh peaches with thin skins harbor bacteria, a no-no on neutropenic diets. Walking , cleaning post-stool , and mild showers are fine safe self-care. Nurses in oncology reteach this raw fruits are infection traps, a critical miss for this fragile patient.
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The nurse is caring for a 6-year-old child with leukemia who is having an oncological emergency. Which of the following signs and symptoms would indicate hyperleukocytosis?
- A. Bradycardia and distinct S1 and S2 sounds
- B. Wheezing and diminished breath sounds
- C. Respiratory distress and poor tissue perfusion
- D. Intermittent fever and frequent vomiting
Correct Answer: C
Rationale: Hyperleukocytosis, a leukemia emergency with white blood cell counts over 100,000/mm³, causes blood hyperviscosity, leading to venous stasis and microvessel occlusion by blast cells. This results in respiratory distress (from lung infarction or hypoxemia) and poor tissue perfusion (from impaired circulation), critical signs requiring urgent intervention like leukapheresis or hydration. Bradycardia and clear heart sounds don't fit tachycardia might occur from hypoxia, not bradycardia. Wheezing and diminished breath sounds suggest asthma or infection, not hyperleukocytosis's systemic impact. Fever and vomiting are non-specific and less acute here. Nurses recognizing these symptoms prioritize airway and circulation support, aligning with oncology's focus on rapid response to life-threatening complications in pediatric leukemia care.
Which atypical pneumonia can be vaccinated against?
- A. coxiella burnetii
- B. mycoplasma pneumoniae
- C. chlamydia pneumoniae
- D. legionella
Correct Answer: A
Rationale: Coxiella Q fever has a vaccine, not mycoplasma, chlamydia duo, or legionella. Nurses jab this chronic farm bug shield.
How do oxygen radicals react with different molecules?
- A. By accepting an electron
- B. By donating an electron
- C. By accepting a proton
- D. By donating a proton
Correct Answer: A
Rationale: Oxygen radicals grab electrons unpaired, they steal, wrecking cells, not giving or juggling protons. A chronic chaos starter nurses know this chemistry bite.
When conventional routes of analgesia have been unsuccessful or are contraindicated for chronic pain syndromes, intrathecal drug delivery systems may be considered. Appropriate indications are likely to include:
- A. Patients with cancer-related pain in whom life expectancy is estimated to be >3 months.
- B. Chronic pancreatitis.
- C. Haematuria loin pain syndrome.
- D. Chronic low back pain.
Correct Answer: A
Rationale: Intrathecal drug delivery systems (IDDS) treat severe, refractory pain. Cancer pain with >3 months life expectancy justifies IDDS, balancing implantation risks with prolonged benefit shorter expectancy favors simpler methods. Chronic pancreatitis may respond, but evidence is weaker; it's not a primary indication. Haematuria loin pain syndrome (loin pain haematuria syndrome) is niche, rarely managed with IDDS due to limited data. Chronic low back pain often fails conservative treatment, but IDDS is reserved for extreme cases (e.g., failed back surgery syndrome), not routine. Chronic refractory angina is cardiac, not typically IDDS-eligible. Cancer pain's prevalence, severity, and responsiveness to intrathecal opioids/ziconotide make it the clearest indication, optimizing quality of life in palliative care.
The nurse is arriving at the beginning of her shift and has taken report on four clients on a medical surgical unit. Which client should the nurse see first?
- A. A Client with pyelonephritis with nausea and vomiting
- B. A client with chronic obstructive pulmonary disease with an oxygen saturation of $90 \%$ on room air
- C. A client post vaginoplasty with bright red blood and clots in her catheter
- D. A client post-total abdominal hysterectomy with 9/10 pain
Correct Answer: C
Rationale: Bright red blood and clots post-vaginoplasty scream hemorrhage ABCs prioritize circulation, needing instant check for shock or transfusion. Pyelonephritis nags, COPD's stable at 90\%, pain's urgent but not bleeding. Nurses hit bleeding first, a life-line call in this post-op rush.