Nokea
A school-age child with terminal leukemia is admitted to the pediatric unit. The nurse must discuss advance directives with the child's parents. The nurse should include which information?
- A. Positive appraisal of the child's prognosis
- B. Chemotherapy options
- C. Comfort care options
- D. Bone marrow transplantation information
Correct Answer: C
Rationale: The nurse shouldn't give a positive appraisal of the child's prognosis because doing so gives the parents false hope. The nurse must be honest about the child's prognosis and provide them accurate information about treatment options, which include palliative care, comfort care, and pain management. The physician - not the nurse - should discuss such treatment options as chemotherapy or bone marrow transplantation, if indicated.
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A patient with Alzheimer's disease is admitted with suspected dehydration after his daughter reports that he's refused to drink anything for the past 3 days.
Which lab result is most expected with dehydration?
- A. Urine specific gravity of 1.005.
- B. Serum sodium level of 150 mEq/L.
- C. Hematocrit of 38%
- D. Elevated WBC
Correct Answer: B
Rationale: Hypernatremia (elevated sodium) is expected in dehydration due to water loss.
A client with seizure disorder is to receive Dilantin (Phenytoin) and Phenobarbital. The nurse knows that when she administers Phenobarbital and Dilantin (Phenytoin):
- A. A larger dose of Phenobarbital might be required.
- B. A smaller dose of Phenobarbital might be required.
- C. There will be no need to alter the amount of Phenobarbital.
- D. The two drugs cannot be given together.
Correct Answer: A
Rationale: Phenytoin induces liver enzymes, potentially reducing phenobarbital levels, so a larger dose of phenobarbital may be needed.
Marie is a 5-year-old girl is admitted with a diagnosis of Acute Lymphoblastic Leukemia.
Which of the following nursing interventions would be contraindicated to the patient with Leukemia?
- A. Take rectal temperature.
- B. Use soft toothbrush.
- C. Use normal saline for mouthwash TID.
- D. Avoid using dental floss.
Correct Answer: A
Rationale: Rectal temperatures risk rectal injury and infection in neutropenic patients.
The importance of monitoring blood sugar, activity level, and insulin doses is to
adjust the activity level based on the blood sugar level.
- A. adjust the diet and insulin doses as the activity level increases or decreases.
- B. adjust the diet and activity level based on the blood sugar level.
- C. adjust the insulin doses based on the sugar level in the urine.
Correct Answer: B
Rationale: If a patient injects too much insulin, exercises too much in relation to carbohydrate consumed, or does not eat enough or at the appropriate times, the blood glucose level can fall low enough to cause hypoglycemia. Adjusting diet and insulin doses based on activity level helps maintain balance.
The nurse is assessing a client with suspected rheumatoid arthritis. Which of the following findings would support this diagnosis?
- A. Morning stiffness lasting over 30 minutes.
- B. Heberden’s nodes on the fingers.
- C. Pain in a single joint after exercise.
- D. Fever and weight loss without joint pain.
Correct Answer: A
Rationale: Morning stiffness lasting over 30 minutes is a hallmark of rheumatoid arthritis due to synovial inflammation. Heberden’s nodes (B) indicate osteoarthritis, single-joint pain (C) suggests injury, and fever/weight loss (D) are nonspecific without joint involvement.