Nokea
Fifteen minutes after a transfusion of packed red blood cells is started, a patient has symptoms of back pain and dyspnea and a pulse rate of 124 beats/minute. Which of the following actions should the nurse implement initially?
- A. Administer oxygen therapy at a high flow rate.
- B. Obtain a urine specimen to send to the laboratory.
- C. Notify the health care provider about the symptoms.
- D. Disconnect the transfusion and infuse normal saline.
Correct Answer: D
Rationale: The patient's symptoms indicate a possible acute hemolytic reaction caused by the transfusion. The first action should be to disconnect the transfusion and infuse normal saline. The other actions also are needed but are not the highest priority.
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Which of the following menu choices indicate that the patient understands the nurse's teaching about best dietary choices for iron-deficiency anemia?
- A. Omelet and whole wheat toast
- B. Cantaloupe and cottage cheese
- C. Strawberry and banana fruit plate
- D. Cornmeal muffin and orange juice
Correct Answer: A
Rationale: Eggs and whole grain breads are high in iron. The other choices are appropriate for other nutritional deficiencies, but are not the best choice for a patient with iron-deficiency anemia.
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.
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.
The nurse is caring for a patient with a sickle cell crisis. While caring for the patient during the crisis, which of the following actions is priority?
- A. Limit the patient's intake of oral and IV fluids.
- B. Evaluate the effectiveness of opioid analgesics.
- C. Encourage the patient to ambulate as much as tolerated.
- D. Teach the patient about high-protein, high-calorie foods.
Correct Answer: B
Rationale: Pain is the most common clinical manifestation of a crisis and usually requires large doses of continuous opioids for control. Fluid intake should be increased to reduce blood viscosity and improve perfusion. Rest is usually ordered to decrease metabolic requirements. Patients are instructed about the need for dietary folic acid, but high-protein, high-calorie diets are not emphasized.
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.