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The nurse is caring for a client with leukemia who has the priority problem of fatigue. What action by the client indicates this need has been met?
- A. Doing activities of daily living (ADLs) using rest periods
- B. Helping plan a daily activity schedule
- C. Requesting a sleeping pill at night
- D. Telling visitors to leave when fatigued
Correct Answer: A
Rationale: Fatigue is a common problem for clients with leukemia. This client is managing his or her own ADLs using rest periods, which indicates an understanding of fatigue and how to control it. Helping to plan an activity schedule is a lesser indicator. Requesting a sleeping pill does not control fatigue during the day. Asking visitors to leave when tired is another lesser indicator. Managing ADLs using rest periods demonstrates the most comprehensive management strategy.
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A client hospitalized with sickle cell crisis frequently asks for opioid pain medications, often shortly after receiving a dose. The nurses on the unit believe the client is drug seeking. When the client requests pain medications, what action by the nurse is best?
- A. Give the client pain medication if it is time for another dose.
- B. Instruct the client not to request pain medication too early.
- C. Give the client a placebo instead of pain medication.
- D. Tell the client it is too early to have more pain medication.
Correct Answer: A
Rationale: Clients with sickle cell crisis often have severe pain that is managed with up to 48 hours of IV opioid analgesics. Even if the client is addicted and drug seeking, he or she is still in extreme pain. If the client can receive another dose of medication, the nurse should provide it. The other options are judgmental and do not address the client's pain. Giving placebos is unethical.
A nurse caring for a client with sickle cell disease (SCD) reviews the clients laboratory work. Which finding should the nurse reports to the provider?
- A. Creatinine: 2.9 mg/dL
- B. Hemlacture: 30.9%
- C. Sodium: 147 mEq/L
- D. White blood cell count: 12,000/mm3
Correct Answer: A
Rationale: An elevated creatinine indicates kidney damage, which occurs in SCD. A hematocrit level of 30.9% is an expected finding, as is a slightly elevated white blood cell count. A sodium level of 147 mEq/L, although slightly high, is not concerning.
A client with chronic anemia has had many blood transfusions. What medications does the nurse anticipate teaching the client about adding to the regimen? (Select all that apply.)
- A. Azacitidine (Vidaza)
- B. Darbepoetin alfa (Aranesp)
- C. Decitabine (Dacogen)
- D. Epoetin alfa (Epogen)
- E. Methylprednisolone (Solu-Medrol)
Correct Answer: B,D
Rationale: Darbepoetin alfa and epoetin alfa are red blood cell colony-stimulating factors that help increase red blood cell production. Azacitidine and decitabine are used for myelodysplastic syndromes, and methylprednisolone is a steroid not used for anemia.
A client has Hodgkin's lymphoma, Ann Arbor stage Ib. For what manifestations should the nurse assess the client? (Select all that apply.)
- A. Headaches
- B. Night sweats
- C. Persistent fever
- D. Urinary frequency
- E. Weight loss
Correct Answer: B,C,E
Rationale: In Ann Arbor stage Ib, Hodgkin's lymphoma may present with systemic symptoms like night sweats, persistent fever, and weight loss, known as B symptoms. Headaches and urinary frequency are not typical manifestations of this stage.
A client has thrombocytopenia. What client statement indicates the client understands self-management of this condition?
- A. I brush and use dental floss every day.
- B. I chew hard candy for my dry mouth.
- C. I usually put ice on bumps or bruises.
- D. Nonslip socks are best when I walk.
Correct Answer: C
Rationale: The client should be taught to apply ice to areas of minor trauma to reduce bleeding risk. Flossing is not recommended due to the risk of gum bleeding. Hard foods should be avoided to prevent injury, and while nonslip socks promote safety, they do not directly address thrombocytopenia management.