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The client is experiencing pain due to cancer treatment- The client tells the nurse, “Methadone has always worked well for me in the past.” Which effects of methadone should the nurse consider when administering methadone?
- A. Has a long half-life and high level of potency
- B. May cause an increase in BP and confusion
- C. Causes severe allergic reactions and liver failure
- D. Has active metabolites, but it is well tolerated
Correct Answer: A
Rationale: bg
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The nurse and an unlicensed assistive personnel (UAP) are caring for clients on an oncology floor. Which nursing task would be delegated to the UAP?
- A. Assess the urine output on a client who has had a blood transfusion reaction.
- B. Take the first 15 minutes of vital signs on a client receiving a unit of PRBCs.
- C. Auscultate the lung sounds of a client prior to a transfusion.
- D. Assist a client who received 10 units of platelets in brushing the teeth.
Correct Answer: B
Rationale: Taking initial vital signs (B) during transfusion is within UAP scope. Assessing urine (A), lung sounds (C), and brushing teeth post-platelets (D) require nursing judgment.
The nurse is assisting the HCP with a bone marrow biopsy. Which intervention postprocedure has priority?
- A. Apply pressure to site for five (5) to 10 minutes.
- B. Medicate for pain with morphine slow IVP.
- C. Maintain head of bed in high Fowler’s position.
- D. Apply oxygen via nasal cannula at five (5) L/min.
Correct Answer: A
Rationale: Applying pressure for 5–10 minutes (A) prevents bleeding post-biopsy, a priority. Pain meds (B), HOB (C), and oxygen (D) are secondary or unrelated.
The client undergoing intensive chemotherapy for Hodgkin’s lymphoma (HL) is hospitalized with fever and depressed immune system functioning. The nurse is administering filgrastim subcutaneously daily. Which laboratory value should the nurse monitor to determine the medication’s effectiveness?
- A. Hemoglobin
- B. Platelet count
- C. Absolute neutrophil count (ANC)
- D. Reed-Sternberg cells
Correct Answer: C
Rationale: A. Epoetin alfa, not filgrastim, is used to treat anemia that is associated with cancer, and its effectiveness would be reflected in the Hgb values. B. Oprelvekin (Neumega), not filgrastim, enhances the synthesis of platelets. C. The nurse should monitor the ANC. Filgrastim (Neupogen) is usually discontinued when the client’s absolute neutrophil count (ANC) is above 1000 cells/mm3. Filgrastim, a granulocyte colony-stimulating factor (G-CSF) analog, is used to stimulate the proliferation and differentiation of granulocytes and treat neutropenia. D. Reed-Sternberg cells are found in lymph node biopsy cells and are indicative of Hodgkin’s lymphoma; they are not monitored to determine the effectiveness of filgrastim, which is used to treat neutropenia.
The nurse is caring for a client who is thought to have pernicious anemia. What signs and symptoms would the nurse expect in this person?
- A. Easy bruising
- B. Beefy-red tongue
- C. Fine red rash on the extremities
- D. Pruritus
Correct Answer: B
Rationale: A beefy-red tongue is a hallmark symptom of pernicious anemia due to vitamin B12 deficiency.
The client diagnosed with acute myeloid leukemia receives a bone marrow transplant. Which medication to prevent graft-versus-host disease (GVHD) should the nurse plan to administer?
- A. A cephalosporin antibiotic, such as ceftazidime
- B. An immunosuppressant, such as cyclosporine
- C. A chemotherapeutic agent, such as cisplatin
- D. Peginterferon alfa-2a for prevention and treatment of hepatitis
Correct Answer: B
Rationale: A. Antibiotics such as ceftazidime (Fortaz) are administered to prevent infection. B. GVHD occurs when the T lymphocytes proliferate from the transplanted donor marrow and mount an immune response against the recipient’s tissues. An immunosuppressant such as cyclosporine (Neoral) prevents the immune response. C. Cisplatin (Platinol AQ) is administered mainly to treat metastatic testicular, ovarian, and cervical carcinoma; advanced bladder cancer; and head and neck cancer. D. Interferons such as peginterferon alfa-2a (Pegasys) have antiviral activity, which decrease the progression of hepatic damage associated with hepatitis A and B. This would only be administered if the transplanted cells transmitted the disease. The biological agent interferon is used to treat follicular low-grade lymphomas.