Nokea
After receiving change-of-shift report for the following four patients with neutropenia, which patient should the nurse assess first?
- A. 66-year-old who has white pharyngeal lesions
- B. 35-year-old who has a fever of 38.2°C (100.8°F)
- C. 36-year-old who has frequent explosive diarrhea
- D. 23-year old who is complaining of severe fatigue
Correct Answer: B
Rationale: Any fever in a neutropenic patient indicates infection and can quickly lead to sepsis and septic shock. Rapid assessment and (if prescribed) initiation of antibiotic therapy within 1 hour are needed. The other patients also need to be assessed but do not exhibit symptoms of potentially life-threatening problems.
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Which of the following nursing interventions should be included in the care plan for a patient with immune thrombocytopenic purpura (ITP)?
- A. Assign the patient to a private room.
- B. Avoid intramuscular (IM) injections.
- C. Use rinses rather than a toothbrush for oral care.
- D. Restrict activity to passive and active range of motion.
Correct Answer: B
Rationale: IM or subcutaneous injections should be avoided because of the risk for bleeding. A soft toothbrush can be used for oral care. There is no need to restrict activity or place the patient in a private room.
A routine complete blood count indicates that a patient may have myelodysplastic syndrome. At this time, which of the following information should the nurse include in the teaching plan?
- A. Packed red blood cells (PRBCs) transfusion
- B. Bone marrow biopsy
- C. Filgrastim administration
- D. Erythropoietin administration
Correct Answer: B
Rationale: Bone marrow biopsy is needed to make the diagnosis and determine the specific type of myelodysplastic syndrome. The other treatments may be necessary if there is progression of the myelodysplastic syndrome, but the initial action for this asymptomatic patient will be a bone marrow biopsy.
The nurse is caring for a patient with acute myelogenous leukemia who is receiving outpatient chemotherapy and develops an absolute neutrophil count of 0.9 x 10^9/L. Which of the following actions by the nurse in the outpatient clinic is best?
- A. Discuss the need for hospital admission to treat the neutropenia.
- B. Plan to discontinue the chemotherapy until the neutropenia resolves.
- C. Teach the patient how to administer filgrastim injections at home.
- D. Obtain a high-efficiency particulate air (HEPA) filter for the patient for home use.
Correct Answer: C
Rationale: The patient may be taught to self-administer filgrastim injections. Although chemotherapy may be stopped with severe neutropenia (neutrophil count less than 0.5 x 10^9/L), administration of filgrastim usually allows the chemotherapy to continue. Patients with neutropenia are at higher risk for infection when exposed to other patients in the hospital. HEPA filters are expensive and are used in the hospital, where the number of pathogens is much higher than in the patient's home environment.
Which of the following newly admitted patients should the nurse assign as a roommate for a patient who has aplastic anemia?
- A. A patient with severe heart failure
- B. A patient who has viral pneumonia
- C. A patient who has right leg cellulitis
- D. A patient with multiple abdominal drains
Correct Answer: A
Rationale: Patients with aplastic anemia are at risk for infection because of the low white blood cell production associated with this type of anemia, so the nurse should avoid assigning a roommate with any possible infectious process.
The nurse is caring for a patient with septicemia who develops prolonged bleeding from venipuncture sites and blood in the stools. Which of the following actions is most important for the nurse to take?
- A. Notify the patient's health care provider.
- B. Give the ordered dose of warfarin.
- C. Avoid unnecessary venipunctures.
- D. Give prescribed proton-pump inhibitors.
Correct Answer: A
Rationale: The patient's new onset of bleeding and diagnosis of sepsis suggest that disseminated intravascular coagulation (DIC) may have developed, which will require collaborative actions such as diagnostic testing, blood product administration, and heparin administration. The other actions also are appropriate, but the most important action should be to notify the physician so that DIC treatment can be initiated rapidly.