Nokea
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: Step-by-step rationale:
1. CLL is characterized by the proliferation of abnormal lymphocytes.
2. Increased lymphocyte levels are a hallmark of CLL due to the accumulation of these abnormal cells.
3. Lymphocytosis is a key diagnostic feature in CLL.
4. Other choices are incorrect because blast cells are characteristic of acute leukemia, bone pain is more common in multiple myeloma, and thrombocytopenia with no bleeding is not a specific finding in CLL.
Summary: Increased lymphocyte levels are certain to be present in a patient with CLL due to the abnormal proliferation of lymphocytes. Other choices are incorrect as they do not align with the characteristic features of CLL.
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A patient with leukemia has developed stomatitis and is experiencing a nutritional deficit. An oral anesthetic has consequently been prescribed. What health education should the nurse provide to the patient?
- A. Chew with care to avoid inadvertently biting the tongue.
- B. Use the oral anesthetic 1 hour prior to meal time.
- C. Brush teeth before and after eating.
- D. Swallow slowly and deliberately.
Correct Answer: A
Rationale: The correct answer is A: Chew with care to avoid inadvertently biting the tongue. Stomatitis causes mouth sores, making it crucial for the patient to be cautious while chewing to prevent accidental injury to the mouth. This helps in reducing pain and promoting healing.
Choice B is incorrect because using the oral anesthetic 1 hour prior to mealtime may not provide immediate relief during eating. Choice C is incorrect as brushing teeth before and after eating can irritate the mouth sores further. Choice D is incorrect as swallowing slowly and deliberately does not address the issue of preventing accidental biting of the tongue.
Which of the following statements about myeloablative, myeloablative but reduced toxicity, reduced intensity, and non-myeloablative approaches is not correct?
- A. Myeloablative approaches are needed for high-risk malignancies to maximize depth of remission and decrease the likelihood of relapse.
- B. Reduced intensity regimens can be successfully used for most nonmalignant disorders to minimize risk of late effects.
- C. Reduced intensity regimens can markedly decrease the risk of transplant-related mortality in patients who have underlying significant comorbidities but at the cost of more relapse and possibly more graft-versus-host disease.
- D. Non-myeloablative regimens are used for the very highest risk patients to minimize toxicity and for certain diseases such as aplastic anemia.
Correct Answer: B
Rationale: The correct answer is B because reduced intensity regimens are used to minimize toxicity and late effects, not for most nonmalignant disorders. Myeloablative approaches are needed for high-risk malignancies to maximize remission depth (A), reduced intensity regimens can increase transplant-related mortality in high-risk patients (C), and non-myeloablative regimens are used for the highest risk patients and certain diseases like aplastic anemia (D).
A nurse is caring for four clients. After reviewing today's laboratory results, which client should the nurse see first?
- A. Client with an international normalized ratio of 2.8
- B. Client with a platelet count of 128000/mm³
- C. Client with a prothrombin time (PT) of 28 seconds
- D. Client with a red blood cell count of 5.1 million/L
Correct Answer: C
Rationale: The correct answer is C because a prothrombin time (PT) of 28 seconds indicates a prolonged clotting time, putting the client at risk for bleeding. This requires immediate assessment and intervention to prevent complications.
Choice A (INR of 2.8) is within the therapeutic range for clients on anticoagulant therapy, so it does not require immediate attention.
Choice B (platelet count of 128000/mm³) is low but not critically low enough to warrant immediate action unless there are signs of active bleeding.
Choice D (red blood cell count of 5.1 million/L) is within normal limits and does not indicate an urgent issue.
A nurse is caring for a client who is about to begin taking folic acid to treat megaloblastic anemia. The nurse should monitor which of the following laboratory values to determine therapeutic effectiveness?
- A. Amylase level
- B. Reticulocyte count
- C. C-reactive protein
- D. Creatinine clearance
Correct Answer: B
Rationale: The correct answer is B: Reticulocyte count. Reticulocytes are immature red blood cells, and monitoring their count can help determine the effectiveness of folic acid in treating megaloblastic anemia. Increased reticulocyte count indicates improved production of red blood cells. Amylase level, C-reactive protein, and creatinine clearance are not directly related to monitoring the effectiveness of folic acid in treating megaloblastic anemia.
A nurse is caring for a client who is about to begin alteplase therapy to treat pulmonary embolism. Which of the following drugs should the nurse have available in the event of a severe adverse reaction?
- A. Vitamin K
- B. Aminocaproic acid
- C. Protamine
- D. Deferoxamine
Correct Answer: B
Rationale: The correct answer is B: Aminocaproic acid. This drug is a fibrinolytic inhibitor that can be used to manage bleeding complications associated with alteplase therapy. It helps to prevent excessive bleeding by inhibiting the breakdown of blood clots. Having aminocaproic acid available is crucial in case the client experiences severe bleeding as a result of alteplase therapy.
A: Vitamin K is used to reverse the effects of warfarin, a blood thinner, and is not indicated for managing bleeding due to alteplase therapy.
C: Protamine is used to reverse the effects of heparin, not alteplase, and is not indicated for managing bleeding due to alteplase therapy.
D: Deferoxamine is an antidote for iron poisoning and is not indicated for managing bleeding due to alteplase therapy.
In summary, aminocaproic acid is the correct choice as it helps manage bleeding complications associated with alteplase therapy