Nokea
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.
You may also like to solve these questions
A 12-year-old patient with localized osteosarcoma is being treated with cisplatin, doxorubicin, and high-dose methotrexate. The pain at his primary site rapidly resolves after initiation of chemotherapy. After tumor resection, pathology reveals the tumor was greater than 95% necrotic. You want to continue cisplatin, doxorubicin, and high-dose methotrexate. Which of the following is the best answer regarding the evaluations that should be performed to monitor for toxicity in patients receiving cisplatin, doxorubicin, and high-dose methotrexate?
- A. Complete blood count, creatinine, liver function tests
- B. Complete blood count, serum electrolytes (sodium, potassium, BUN, chloride), and EKG to monitor for prolonged QTc
- C. Complete blood count, creatinine, serum magnesium, audiogram, and echocardiogram
- D. Complete blood count, creatinine, serum magnesium, chest x-ray
Correct Answer: C
Rationale: The correct answer is C because it includes essential evaluations to monitor for toxicity associated with cisplatin, doxorubicin, and high-dose methotrexate.
1. Complete blood count: To monitor for potential bone marrow suppression caused by chemotherapy drugs.
2. Creatinine: To assess renal function, as cisplatin can cause nephrotoxicity.
3. Serum magnesium: Monitoring for hypomagnesemia, a common side effect of cisplatin.
4. Audiogram: To screen for hearing loss, a known side effect of cisplatin.
5. Echocardiogram: To evaluate for cardiotoxicity, especially with doxorubicin known to cause cardiomyopathy.
Other choices are incorrect:
A: Does not include serum magnesium, audiogram, and echocardiogram, which are important for monitoring toxicity.
B: While electrolytes and EKG are relevant, it lacks creatinine, serum magnesium, and other crucial tests.
D:
Which of the following characteristics are similar with respect to Factor VIII and von Willebrand factor (vWF)?
- A. Both are made in endothelial cells and megakaryocytes.
- B. Both are activated by thrombin.
- C. They are present in normal to high relative amounts in newborns.
- D. They are stored in Weibel-Palade bodies in endothelial cells.
Correct Answer: C
Rationale: Step-by-step rationale:
1. Factor VIII and vWF are present in normal to high relative amounts in newborns due to the physiological adaptation to the low levels at birth.
2. Both Factor VIII and vWF play crucial roles in the coagulation cascade, but their levels decrease after birth.
3. The other choices are incorrect because:
- A: Factor VIII is primarily made in endothelial cells and vWF is made in endothelial cells and platelets, not megakaryocytes.
- B: Thrombin activates Factor VIII but not vWF, which is activated by shear stress.
- D: Factor VIII is stored in Weibel-Palade bodies, but vWF is stored in platelets and endothelial cells, not in the Weibel-Palade bodies.
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 patient's 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 patient's activities of daily living
- D. Monitoring and treating the patient's pain
Correct Answer: A
Rationale: The correct answer is A: Protective isolation and vigilant use of standard precautions. This is the priority because patients with AML undergoing induction therapy are immunocompromised and at high risk for infection. Isolating the patient and using standard precautions help prevent exposure to pathogens.
B: Providing a high-calorie, low-texture diet and oral hygiene is important but not the priority as infection control takes precedence.
C: Including the family in planning activities of daily living is beneficial for holistic care but not the priority compared to infection prevention.
D: Monitoring and treating pain is essential, but in this case, infection prevention is the priority due to the patient's immunocompromised state.
A nurse is caring for a client who is taking clopidogrel to prevent stent restenosis. The nurse should monitor the client for which of the following adverse reactions?
- A. Hyperuricemia
- B. Hyponatremia
- C. Lymphocytopenia
- D. Thrombocytopenia
Correct Answer: D
Rationale: The correct answer is D: Thrombocytopenia. Clopidogrel is an antiplatelet medication that works by inhibiting platelet aggregation. Therefore, monitoring for thrombocytopenia, a decrease in platelet count, is crucial to assess the drug's effectiveness and potential side effects. Hyperuricemia (A) is not directly associated with clopidogrel use. Hyponatremia (B) is not a common adverse reaction of clopidogrel. Lymphocytopenia (C) is not typically linked to clopidogrel and is more commonly seen with other medications or conditions.
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 staging, CNS involvement is rare at initial presentation. Therefore, routine CSF analysis is not recommended unless there are specific neurological symptoms suggestive of CNS disease. A lumbar puncture carries risks of complications and should not be performed routinely. Choices A, B, and C are appropriate for staging in Hodgkin lymphoma to evaluate for distant metastases and characterize disease extent.