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A patient with acute lymphocytic leukemia (ALL) is undergoing chemotherapy and develops neutropenia. What is the most important nursing intervention for this patient?
- A. Administering antipyretics
- B. Restricting visitors
- C. Maintaining a sterile environment
- D. Administering prophylactic antibiotics
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube. The nurse should take which most appropriate action?
- A. Measure abdominal girth.
- B. Irrigate the nasogastric tube.
- C. Continue to monitor the drainage.
- D. Notify the health care provider (HCP).
Correct Answer: D
Rationale: In the immediate postoperative period following a gastrectomy, any bloody drainage from the nasogastric (NG) tube is concerning and requires prompt evaluation. This could indicate potential complications such as bleeding from the surgical site, erosion, or other postoperative issues. Notifying the healthcare provider immediately is crucial to ensure that the patient receives timely assessment and intervention. The presence of blood may necessitate further diagnostic procedures, interventions, or changes in management to prevent serious complications.
The nurse is reviewing the medication record for a client receiving chemotherapy and notes that the client is receiving epoetin alfa (Epogen). The nurse determines that this medication has been prescribed to:
- A. Increase white blood cell production
- B. Treat anemia
- C. Reduce pain
- D. Prevent infection
Correct Answer: B
Rationale: Epoetin alfa (Epogen) is a synthetic form of erythropoietin, a hormone that stimulates the production of red blood cells in the bone marrow. Chemotherapy often leads to anemia due to its effects on rapidly dividing cells, including those in the bone marrow responsible for red blood cell production. By administering epoetin alfa, the healthcare provider aims to increase the red blood cell count and improve hemoglobin levels, thereby alleviating symptoms associated with anemia, such as fatigue and weakness.
A 16-year-old female patient experiences alopecia resulting from chemotherapy, prompting the nursing diagnoses of disturbed body image and situational low self-esteem. What action by the patient would best indicate that she is meeting the goal of improved body image and self-esteem?
- A. The patient requests that her family bring her makeup and wig.
- B. The patient begins to discuss the future with her family.
- C. The patient reports less disruption from pain and discomfort.
- D. The patient cries openly when discussing her disease.
Correct Answer: A
Rationale: When a patient experiences alopecia due to chemotherapy, it can significantly impact their self-esteem and body image, particularly in adolescents who are especially sensitive to physical changes. A request for makeup and a wig indicates that the patient is actively taking steps to enhance her appearance and cope with the changes brought on by her treatment. This action reflects a positive engagement with her body image and suggests a desire to feel more comfortable and confident in her appearance, signaling an improvement in her self-esteem.
A client undergoing chemotherapy is at risk for developing mucositis. What nursing intervention is most appropriate to help manage this condition?
- A. Encourage the client to drink plenty of fluids.
- B. Administer antifungal mouthwash.
- C. Teach the client to avoid spicy or acidic foods.
- D. Apply a topical anesthetic to the oral mucosa before meals.
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The hospice nurse is caring for a patient with cancer in her home. The nurse has explained to the patient and the family that the patient is at risk for hypercalcemia and has educated them on the signs and symptoms of this health problem. What else should the nurse teach this patient and family to do to reduce the patient¢â‚¬â„¢s risk of hypercalcemia?
- A. Stool softeners are contraindicated.
- B. Laxatives should be taken daily.
- C. Consume 2 to 4 L of fluid daily.
- D. Restrict calcium intake.
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.