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Nursing care for a client undergoing chemotherapy includes assessment for signs of bone marrow depression. Which finding accounts for some of the symptoms related to bone marrow depression?
- A. erythrocytosis
- B. leukocytosis
- C. polycythemia
- D. thrombocytopenia
Correct Answer: D
Rationale: Thrombocytopenia is an abnormal decrease in the number of platelets, which results in bleeding tendencies. Erythrocytosis is an abnormal increase in the number of circulating red blood cells. Leukocytosis is an increase in the number of white blood cells in the blood. Polycythemia is also an excess of red blood cells and is a synonym for erythrocytosis. With chemotherapy there is a decrease in red and white blood cells, not an increase.
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The adolescent is brought to the ED with wheezing, nystagmus, ataxia, and sensorimotor neuropathy after inhaling paint thinner by “bagging.†Which nursing intervention is priority?
- A. Monitor the client's cardiac rhythm.
- B. Place the client on seizure precautions.
- C. Apply oxygen via nasal cannula at 4 liters.
- D. Notify lab to obtain a toxicology screen.
Correct Answer: C
Rationale: Applying oxygen is the priority to address wheezing and potential oxygen displacement from inhalant use.
The nurse is providing teaching to the client receiving a thiazide diuretic. Which points should the nurse plan to include? Select all that apply.
- A. Take the radial pulse before setting up the medication.
- B. Include fruits such as melons and bananas in the diet.
- C. Report side effects such as muscle cramps, nausea, or a skin rash.
- D. Take the last dose at bedtime when fluids are at the highest level.
- E. Avoid high-fat foods; thiazide diuretics increase cholesterol levels.
Correct Answer: B,C,E
Rationale: A: It is unnecessary for the client to monitor the pulse prior to taking thiazide diuretics. B: Thiazide diuretics can cause hypokalemia, and potassium-rich foods can help maintain potassium levels. C: Muscle cramps are a sign of possible medication side effects of hypokalemia and hypocalcemia. Nausea and rash are also medication side effects. D: A diuretic taken at bedtime can cause nocturia and loss of sleep. The usual timing of the last daily dose of a diuretic is at suppertime. E: Thiazide diuretics can increase serum cholesterol, LDL, and triglyceride levels, so teaching the client to avoid high-fat foods will help maintain cholesterol levels.
The nurse is developing a teaching plan for the client prescribed nortriptyline. Which self-care aspects should be included to minimize medication side effects and prevent injury? Select all that apply.
- A. Avoid eating processed meats, cheeses, and wines.
- B. Suck on candy or ice chips to keep your mouth moist.
- C. Run water in the bathroom to stimulate urination if needed.
- D. Increase fluid and fiber in the diet to prevent constipation.
- E. Avoid driving until vision is completely clear to prevent injury.
- F. Increase exposure to sunlight to facilitate vitamin D absorption.
Correct Answer: B,C,D,E
Rationale: Nortriptyline (Pamelor) causes dry mouth, urinary retention, constipation, and blurred vision. Sucking on candy, running water to stimulate urination, increasing fluid and fiber, and avoiding driving until vision is clear are appropriate.
A client who is newly diagnosed with Parkinson's disease and beginning medication therapy asks the nurse, 'How soon will I see improvement?' The nurse's best response is:
- A. That varies from client to client
- B. You should discuss that with your physician
- C. You should notice a difference in a few days
- D. It might take several weeks before you notice improvement
Correct Answer: D
Rationale: Parkinson's medications often take several weeks to show improvement, as they gradually adjust neurotransmitter levels to manage symptoms.
Melissa Smith came to the Emergency Department in the last week before her estimated date of confinement complaining of headaches, blurred vision, and vomiting. Suspecting PIH, the nurse should best respond to Melissa's complaints with which of the following statements?
- A. The physician will probably want to admit you for observation.'
- B. The physician will probably order bed rest at home.'
- C. These are really dangerous signs.'
- D. The physician will probably prescribe some medicine for you.'
Correct Answer: B
Rationale: Pregnancy-induced hypertension (PIH) symptoms like headaches, blurred vision, and vomiting suggest preeclampsia, which is best managed with bed rest at home unless severe, requiring hospitalization.