Nokea
The client diagnosed with leukemia has received a bone marrow transplant. The nurse monitors the client’s absolute neutrophil count (ANC). What is the client’s neutrophil count if the WBCs are 2.2 (x103/mm3), neutrophils are 25%, and bands are 5%?
Correct Answer: 660
Rationale: ANC = WBC × (neutrophils% + bands%). WBC = 2,200/mm3, neutrophils = 25%, bands = 5%. ANC = 2,200 × (0.25 + 0.05) = 2,200 × 0.3 = 660/mm3.
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A 1-year-old is admitted to the hospital with sickle cell anemia in crisis. Upon admission, which therapy will assume priority?
- A. Fluid administration
- B. Exchange transfusion
- C. Anticoagulant
- D. IM administration of iron and folic acid
Correct Answer: A
Rationale: Fluid administration is the priority in sickle cell crisis to prevent dehydration and reduce blood viscosity, which can worsen sickling.
The female client recently diagnosed with Hodgkin's lymphoma asks the nurse about her prognosis. Which is the nurse’s best response?
- A. Survival for Hodgkin’s disease is relatively good with standard therapy.
- B. Survival depends on becoming involved in an investigational therapy program.
- C. Survival is poor, with more than 50% of clients dying within six (6) months.
- D. Survival is fine for primary Hodgkin’s, but secondary cancers occur within a year.
Correct Answer: A
Rationale: Hodgkin’s has a good prognosis with standard therapy (A) (5-year survival >85%). Investigational therapy (B) isn’t required, survival isn’t poor (C), and secondary cancers (D) are long-term risks.
The client who is receiving doxorubicin for the first time to treat multiple myeloma develops flushing, facial swelling, headache, chills, and back pain. Which statement made by the nurse is best?
- A. “These symptoms usually resolve in 1 day and are limited to the first dose.”
- B. “These are signs of toxicity; you may want to consider refusing treatment.”
- C. “I can give you ondansetron prescribed prn now to alleviate these symptoms.”
- D. “Side effects occur with chemotherapy, but focus on your cancer being cured.”
Correct Answer: A
Rationale: A. This response is best. The nurse informs the client correctly that the symptoms of doxorubicin (Adriamycin) are limited to the first dose. B. The nurse is providing unsolicited advice. C. Ondansetron (Zofran) is an antiemetic and will not alleviate all of the symptoms. D. This response belittles the client’s symptoms. There is no cure for multiple myeloma. Treatment will control the illness and maintain the client’s level of functioning for several years or more.
The client diagnosed with end-stage renal disease (ESRD) has developed anemia. Which would the nurse anticipate the HCP prescribing for this client?
- A. Place the client in reverse isolation.
- B. Discontinue treatments until blood count improves.
- C. Monitor CBC daily to assess for bleeding.
- D. Give client erythropoietin, a biologic response modifier.
Correct Answer: D
Rationale: ESRD causes erythropoietin deficiency; prescribing erythropoietin (D) treats anemia. Isolation (A), stopping treatment (B), and daily CBC (C) are inappropriate.
The nurse is discussing the prevention of bladder cancer with the client. Which factors that increase the client’s risk for bladder cancer should the nurse emphasize?
- A. Consuming caffeine beverages
- B. Smoking tobacco products
- C. Consuming multivitamins daily
- D. Prolonged exposure to paint smells
- E. Prolonged exposure to rubber smells
Correct Answer: B, D, E, A
Rationale: Consumption of caffeine is not associated with an increased risk for bladder cancer. B. Smoking is the number one cause of bladder cancer in the world. C. Studies show a protective effect with an increased intake of vitamins A, B6, and E. D. Exposure to aromatic amines in the textile and paint industries is clearly associated with bladder cancer. E. Exposure to aromatic amines in the rubber industry is clearly associated with bladder cancer.