Nokea
All of these patients call the outpatient clinic and ask to make an appointment as soon as possible. Which of the following patients should the nurse schedule to be seen first?
- A. 19-year-old with no previous health problems who has a nontender lump in the axilla
- B. 46-year-old with sickle cell anemia who says 'that my eyes always look sort of yellow'
- C. 21-year-old with hemophilia who wants to learn how to self-administer factor VII replacement
- D. 50-year-old with early-stage persistent lymphocytic leukemia who has complaints of persistent fatigue
Correct Answer: A
Rationale: The patient's age and presence of a nontender axillary lump suggest possible lymphoma, which needs rapid diagnosis and treatment. The other patients have questions about treatment or symptoms that are consistent with their diagnosis but do not need to be seen urgently.
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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 who is receiving methotrexate and develops a megaloblastic anemia. Which of the following nutrients should the nurse include in the teaching plan?
- A. Iron
- B. Folic acid
- C. Cobalamin (vitamin B12)
- D. Ascorbic acid (vitamin C)
Correct Answer: B
Rationale: Methotrexate use can lead to folic acid deficiency. Supplementation with oral folic acid supplements is the usual treatment. The other nutrients would not correct folic acid deficiency, although they would be used to treat other types of anemia.
Which of the following nursing actions should the nurse include in the plan of care for a patient admitted with multiple myeloma?
- A. Monitor fluid intake and output.
- B. Administer calcium supplements.
- C. Assess lymph nodes for enlargement.
- D. Limit weight bearing and ambulation.
Correct Answer: A
Rationale: A high fluid intake and urine output helps prevent the complications of kidney stones caused by hypercalcemia and renal failure caused by deposition of Bence Jones protein in the renal tubules. Weight bearing and ambulation are encouraged to help bone retain calcium. Lymph nodes are not enlarged with multiple myeloma. Calcium supplements will further increase the patient's calcium level and are not used.
The nurse is caring for a patient with myelodysplastic syndrome who has 20% blasts in marrow and the health care provider has prescribed high-intensity treatment. Which of the following treatments should the nurse prepare the patient to receive?
- A. Antibiotics
- B. Antifungals
- C. Chemotherapy
- D. A blood transfusion
Correct Answer: C
Rationale: Low-risk patients (<5% blasts in marrow) can often be treated with transfusions, antibiotics, antifungals, EPO, and hematopoietic growth factors. High-risk patients (<5% blasts in marrow) may be treated with single-agent chemotherapy (e.g., hydroxyurea) or intensive chemotherapy as in AML.
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.