Nokea
Four clients are receiving tyrosine kinase inhibitors (TKIs). Which of these four clients would the nurse assess first?
- A. Dry, itchy, peeling skin.
- B. Serum calcium of 9.2 mg/dL (2.3 mmol/L).
- C. Serum potassium of 2.8 mEq/L (2.8 mmol/L).
- D. Weight gain of 0.5 lb (1.1 kg) in 1 day.
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
You may also like to solve these questions
A patient with acute lymphocytic leukemia (ALL) is undergoing chemotherapy and develops neutropenia. What is the most important nursing intervention for this patient?
- A. Administering antipyretics
- B. Restricting visitors
- C. Maintaining a sterile environment
- D. Administering prophylactic antibiotics
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A client hospitalized for chemotherapy has a hemoglobin of 6.1 mg/dL (61 mmol/L). The client is symptomatic but refuses blood transfusions. What medication does the nurse prepare to administer?
- A. Epoetin alfa.
- B. Filgrastim.
- C. Mesna.
- D. Dexrazoxane.
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube. The nurse should take which most appropriate action?
- A. Measure abdominal girth.
- B. Irrigate the nasogastric tube.
- C. Continue to monitor the drainage.
- D. Notify the health care provider (HCP).
Correct Answer: D
Rationale: In the immediate postoperative period following a gastrectomy, any bloody drainage from the nasogastric (NG) tube is concerning and requires prompt evaluation. This could indicate potential complications such as bleeding from the surgical site, erosion, or other postoperative issues. Notifying the healthcare provider immediately is crucial to ensure that the patient receives timely assessment and intervention. The presence of blood may necessitate further diagnostic procedures, interventions, or changes in management to prevent serious complications.
A nurse is providing care to a patient who has just received a diagnosis of acute myeloid leukemia (AML). What is the priority nursing diagnosis for this patient?
- A. Risk for bleeding
- B. Risk for infection
- C. Impaired gas exchange
- D. Imbalanced nutrition
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The nurse on a bone marrow transplant unit is caring for a patient with cancer who is preparing for HSCT. What is a priority nursing diagnosis for this patient?
- A. Fatigue related to altered metabolic processes
- B. Altered nutrition: less than body requirements related to anorexia
- C. Risk for infection related to altered immunologic response
- D. Body image disturbance related to weight loss and anorexia
Correct Answer: C
Rationale: Patients preparing for hematopoietic stem cell transplantation (HSCT) undergo intensive chemotherapy and/or radiation, which significantly suppresses their immune system. This immunosuppression leads to a heightened risk for infection, making it the most critical nursing diagnosis for these patients. As the body's ability to fight off pathogens is compromised, close monitoring and interventions aimed at preventing infections are essential for their safety and recovery.