Nokea
The client receiving hospice care has cancer pain and requires treatment with a co-analgesic for pain control. Which medication should the nurse request an HCP to prescribe because it gives the best pain-relieving response when given with opioids?
- A. Promethazine
- B. Gabapentin
- C. Diphenhydramine
- D. Droperidol
Correct Answer: B
Rationale: Promethazine (Phenergan) is given with pain medications, but it treats nausea and vomiting, not pain. Gabapentin (Neurontin) is often administered with opioid pain medications because of its efficacy in relieving neuropathic pain and its limited adverse effects. Diphenhydramine (Benadryl) is not a co-analgesic but an antihistamine. Droperidol (Inapsine) is not a co-analgesic but an antiemetic to control nausea and vomiting.
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A toddler is diagnosed with sickle cell anemia. Her mother is four months pregnant with her second child. The mother asks if there is any chance the new baby will have sickle cell anemia. She says that neither she nor her husband has sickle cell anemia. What is the best response for the nurse to make?
- A. No. Sickle cell anemia is not inherited.'
- B. Yes. The new baby will also have sickle cell anemia.'
- C. There is a 25% chance that each child you have will have the disease.'
- D. Because neither of you has the disease, another child will not have it. You should ask your physician.'
Correct Answer: C
Rationale: Sickle cell anemia is autosomal recessive. If both parents are carriers (trait), there is a 25% chance each child will have the disease.
The client diagnosed with leukemia is being admitted for an induction course of chemotherapy. Which laboratory values indicate a diagnosis of leukemia?
- A. A left shift in the white blood cell (WBC) count differential.
- B. A large number of WBCs that decreases after the administration of antibiotics.
- C. An abnormally low hemoglobin (Hb) and hematocrit (Hct) level.
- D. Red blood cells (RBCs) that are larger than normal.
Correct Answer: C
Rationale: Leukemia causes bone marrow suppression, leading to low Hb/Hct (C). Left shift (A) indicates infection, antibiotic response (B) suggests infection, and large RBCs (D) indicate megaloblastic anemia.
The nurse has identified the concept of cellular deviation for a client diagnosed with chronic myelogenous leukemia. Which intervention should the nurse implement? Select all that apply.
- A. Screen visitors for infection before allowing them to enter the room.
- B. Assess the client’s vital signs every four (4) hours.
- C. Do not allow fresh fruits and vegetables on diet trays.
- D. Monitor the client’s white blood cell count.
- E. Place the client on droplet isolation.
- F. Check the client’s bone marrow results daily.
Correct Answer: A,C,D
Rationale: Screening visitors (A), avoiding fresh produce (C), and monitoring WBCs (D) reduce infection risk in CML. Vitals (B) are routine, droplet isolation (E) is excessive, and daily bone marrow (F) is impractical.
The client received two (2) units of packed red blood cells of 250 mL with 63 mL of preservative each during the shift. There was 240 mL of saline remaining in the 500-mL bag when the nurse discarded the blood tubing. How many milliliters of fluid should be documented on the intake and output record?
Correct Answer: 886
Rationale: Each unit = 250 mL RBC + 63 mL preservative = 313 mL. Two units = 313 × 2 = 626 mL. Saline used = 500 – 240 = 260 mL. Total intake = 626 + 260 = 886 mL.
The nurse is caring for the client experiencing superior vena cava syndrome secondary to lung cancer. Which problem should be the nurse’s priority?
- A. Ineffective breathing pattern
- B. Ineffective tissue perfusion
- C. Risk for infection
- D. Impaired skin integrity
Correct Answer: A
Rationale: A. Ineffective breathing pattern occurs with superior vena cava syndrome because the superior vena cava is located next to the main stem bronchus and causes compression of the intrathoracic structures. B. Ineffective tissue perfusion may occur with superior vena cava syndrome, but ineffective breathing pattern is priority. C. Risk for infection occurs with chemotherapy treatment and not from superior vena cava syndrome. D. Impaired skin integrity occurs with malignant skin conditions and usually not from lung cancer.