Nokea
A nurse knows that the patient with stage 3 based on Ann-arber staging has:
- A. 2 or more lymph node involvement and outside the lymph nodes
- B. 2 or more lymph node involvement on one side of the body
- C. 2 or more lymph nodes on the breasts
- D. 2 or more lymph node involvement on both sides of the body
Correct Answer: D
Rationale: In the Ann Arbor staging system for lymphomas, Stage 3 indicates that the disease has spread beyond the initial lymph node region to involve lymph nodes on both sides of the diaphragm (i.e., the areas above and below the diaphragm). This includes lymphatic involvement in both the thoracic and abdominal regions, signifying a more advanced disease state.
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An older adult patient is undergoing diagnostic testing for chronic lymphocytic leukemia (CLL). What assessment finding is certain to be present if the patient has CLL?
- A. Increased numbers of blast cells
- B. Increased lymphocyte levels
- C. Intractable bone pain
- D. Thrombocytopenia with no evidence of bleeding
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A client with breast cancer is receiving doxorubicin (Adriamycin). The nurse monitors the client closely for:
- A. Pulmonary fibrosis
- B. Cardiotoxicity
- C. Hepatotoxicity
- D. Nephrotoxicity
Correct Answer: B
Rationale: Doxorubicin (Adriamycin) is an anthracycline chemotherapy agent commonly used to treat various cancers, including breast cancer. One of the significant side effects associated with doxorubicin is cardiotoxicity, which can lead to serious complications such as heart failure and arrhythmias. The risk of cardiotoxicity is dose-dependent, meaning that higher cumulative doses increase the likelihood of cardiac damage. Therefore, it is essential for nurses to monitor cardiac function closely through assessments such as echocardiograms or monitoring for signs and symptoms of heart failure, such as shortness of breath, fatigue, and edema.
The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm?
- A. Placing cool compresses on the affected arm
- B. Elevating the affected arm on a pillow above heart level
- C. Avoiding arm exercises in the immediate postoperative period
- D. Maintaining an intravenous site below the antecubital area on the affected side
Correct Answer: B
Rationale: After a mastectomy, particularly when lymph nodes are removed, there is an increased risk of lymphedema in the affected arm due to impaired lymphatic drainage. Elevating the affected arm above heart level helps promote lymphatic drainage and reduces the risk of swelling. This intervention facilitates the return of lymph fluid and helps prevent fluid accumulation in the arm.
A nurse is providing care to a patient who has just received a diagnosis of acute myeloid leukemia (AML). What is the priority nursing diagnosis for this patient?
- A. Risk for bleeding
- B. Risk for infection
- C. Impaired gas exchange
- D. Imbalanced nutrition
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A patient with advanced leukemia is responding poorly to treatment. The nurse finds the patient tearful and trying to express his feelings, but he is clearly having difficulty. What is the nurses most appropriate action?
- A. Tell him that you will give him privacy and leave the room.
- B. Offer to call pastoral care.
- C. Ask if he would like you to sit with him while he collects his thoughts.
- D. Tell him that you can understand how hes feeling.
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.