Nokea
A nurse at a long-term care facility is amending the care plan of a resident who has just been diagnosed with essential thrombocythemia (ET). The nurse should anticipate the administration of what medication?
- A. Dalteparin
- B. Allopurinol
- C. Hydroxyurea
- D. Hydrochlorothiazide
Correct Answer: C
Rationale: Hydroxyurea is effective in lowering the platelet count for patients with ET. Dalteparin, allopurinol, and HCTZ do not have this therapeutic effect.
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An emergency department nurse is triaging a 77-year-old man who presents with uncharacteristic fatigue as well as back and rib pain. The patient denies any recent injuries. The nurse should recognize the need for this patient to be assessed for what health problem?
- A. Hodgkin disease
- B. Non-Hodgkin lymphoma
- C. Multiple myeloma
- D. Acute thrombocythemia
Correct Answer: C
Rationale: Back pain, which is often a presenting symptom in multiple myeloma, should be closely investigated in older patients. The lymphomas and bleeding disorders do not typically present with the primary symptom of back pain or rib pain.
The clinical nurse educator is presenting health promotion education to a patient who will be treated for non-Hodgkin lymphoma on an outpatient basis. The nurse should recommend which of the following actions?
- A. Avoiding direct sun exposure in excess of 15 minutes daily
- B. Avoiding grapefruit juice and fresh grapefruit
- C. Avoiding highly crowded public places
- D. Using an electric shaver rather than a razor
Correct Answer: C
Rationale: The risk of infection is significant for these patients, not only from treatment-related myelosuppression but also from the defective immune response that results from the disease itself. Limiting infection exposure is thus necessary. The need to avoid grapefruit is dependent on the patients medication regimen. Sun exposure and the use of razors are not necessarily contraindicated.
A patient who is undergoing consolidation therapy for the treatment of leukemia has been experiencing debilitating fatigue. How can the nurse best meet this patients 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: Sitting in a chair is preferable to bed rest, even if a patient is experiencing severe fatigue. A patient who has debilitating fatigue would not likely be able to perform stair exercises. Teaching about mobility may be necessary, but education must be followed by interventions that actually involve mobility. Deep breathing and coughing reduce the risk of respiratory complications but are not substitutes for physical mobility in preventing deconditioning.
Diagnostic testing has resulted in a diagnosis of acute myeloid leukemia (AML) in an adult patient who is otherwise healthy. The patient and the care team have collaborated and the patient will soon begin induction therapy. The nurse should prepare the patient for which of the following?
- A. Daily treatment with targeted therapy medications
- B. Radiation therapy on a daily basis
- C. Hematopoietic stem cell transplantation
- D. An aggressive course of chemotherapy
Correct Answer: D
Rationale: Attempts are made to achieve remission of AML by the aggressive administration of chemotherapy, called induction therapy, which usually requires hospitalization for several weeks. Induction therapy is not synonymous with radiation, stem cell transplantation, or targeted therapies.
A patient with a diagnosis of acute myeloid leukemia (AML) is being treated with induction therapy on the oncology unit. What nursing action should be prioritized in the patients care plan?
- A. Protective isolation and vigilant use of standard precautions
- B. Provision of a high-calorie, low-texture diet and appropriate oral hygiene
- C. Including the family in planning the patients activities of daily living
- D. Monitoring and treating the patients pain
Correct Answer: A
Rationale: Induction therapy causes neutropenia and a severe risk of infection. This risk must be addressed directly in order to ensure the patients survival. For this reason, infection control would be prioritized over nutritional interventions, family care, and pain, even though each of these are important aspects of nursing care.