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The nurse is caring for a patient who is being discharged after an emergency splenectomy following an automobile accident. Which instructions should the nurse include in the discharge teaching?
- A. Watch for excess bruising.
- B. Check for swollen lymph nodes.
- C. Take iron supplements to prevent anemia.
- D. Wash hands and avoid persons who are ill.
Correct Answer: D
Rationale: The correct answer is D because after a splenectomy, the patient is at risk for infections due to a compromised immune system. Washing hands and avoiding sick individuals can help prevent infections.
A: Watching for excess bruising is not directly related to post-splenectomy care.
B: Checking for swollen lymph nodes is not a priority concern for a post-splenectomy patient.
C: Taking iron supplements may not be necessary immediately post-splenectomy and should be discussed with the healthcare provider.
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Outstanding feature of ITP:
- A. fever
- B. gum bleeding
- C. moderate splenomegaly
- D. stema tenderness
Correct Answer: B
Rationale: The correct answer is B: gum bleeding. In immune thrombocytopenic purpura (ITP), the hallmark feature is low platelet count leading to easy bruising and bleeding, including gum bleeding. Fever (choice A) is not a typical feature of ITP. Moderate splenomegaly (choice C) is less common in ITP. Stema tenderness (choice D) is not a recognized feature of ITP. Therefore, gum bleeding is the outstanding feature of ITP due to the primary underlying mechanism of platelet destruction.
The nurse notes that a patient's gaping wound is developing a blood clot. Which body substance is responsible for this clot formation?
- A. Plasma
- B. Platelets
- C. Red blood cells
- D. White blood cells
Correct Answer: B
Rationale: Platelets are responsible for clot formation in the body. When a wound occurs, platelets adhere to the site and release chemicals to initiate clotting. They then aggregate to form a plug, stopping bleeding. Plasma carries platelets but is not directly involved in clot formation. Red blood cells transport oxygen but do not participate in clotting. White blood cells are part of the immune system and do not play a role in clot formation. Therefore, platelets are the correct choice for clot formation in this scenario.
A patient with a diagnosis of acute myeloid leukemia (AML) is being treated with induction therapy on the oncology unit. What nursing action should be prioritized in the patient's care plan?
- A. Protective isolation and vigilant use of standard precautions
- B. Provision of a high-calorie, low-texture diet and appropriate oral hygiene
- C. Including the family in planning the patient's activities of daily living
- D. Monitoring and treating the patient's pain
Correct Answer: A
Rationale: The correct answer is A: Protective isolation and vigilant use of standard precautions. This is the priority because patients with AML are at high risk for infections due to compromised immune systems. Isolation and strict infection control measures help prevent exposure to pathogens. B is incorrect as the main priority is infection prevention, not diet. C is incorrect as involving the family is important but not the priority. D is incorrect as pain monitoring is important but not the priority in this case.
A 12-year-old patient with localized osteosarcoma is being treated with cisplatin, doxorubicin, and high-dose methotrexate. The pain at his primary site rapidly resolves after initiation of chemotherapy. After tumor resection, pathology reveals the tumor was greater than 95% necrotic. You want to continue cisplatin, doxorubicin, and high-dose methotrexate. Which of the following is the best answer regarding the evaluations that should be performed to monitor for toxicity in patients receiving cisplatin, doxorubicin, and high-dose methotrexate?
- A. Complete blood count, creatinine, liver function tests
- B. Complete blood count, serum electrolytes (sodium, potassium, BUN, chloride), and EKG to monitor for prolonged QTc
- C. Complete blood count, creatinine, serum magnesium, audiogram, and echocardiogram
- D. Complete blood count, creatinine, serum magnesium, chest x-ray
Correct Answer: C
Rationale: The correct answer is C because it includes essential evaluations to monitor for toxicity associated with cisplatin, doxorubicin, and high-dose methotrexate.
1. Complete blood count: To monitor for potential bone marrow suppression caused by chemotherapy drugs.
2. Creatinine: To assess renal function, as cisplatin can cause nephrotoxicity.
3. Serum magnesium: Monitoring for hypomagnesemia, a common side effect of cisplatin.
4. Audiogram: To screen for hearing loss, a known side effect of cisplatin.
5. Echocardiogram: To evaluate for cardiotoxicity, especially with doxorubicin known to cause cardiomyopathy.
Other choices are incorrect:
A: Does not include serum magnesium, audiogram, and echocardiogram, which are important for monitoring toxicity.
B: While electrolytes and EKG are relevant, it lacks creatinine, serum magnesium, and other crucial tests.
D:
A 17-year-old female presents with cervical adenopathy and a history of daily fevers and drenching night sweats. A biopsy is performed and reveals classic Hodgkin lymphoma. Which of the following is least appropriate as part of the staging workup?
- A. Chest x-ray
- B. CT scan of chest, abdomen, and pelvis
- C. Functional imaging (PET scan)
- D. Lumbar puncture and cerebrospinal fluid (CSF) analysis
Correct Answer: D
Rationale: The correct answer is D: Lumbar puncture and cerebrospinal fluid (CSF) analysis. In Hodgkin lymphoma staging, CNS involvement is rare at initial presentation. Therefore, routine CSF analysis is not recommended unless there are specific neurological symptoms suggestive of CNS disease. A lumbar puncture carries risks of complications and should not be performed routinely. Choices A, B, and C are appropriate for staging in Hodgkin lymphoma to evaluate for distant metastases and characterize disease extent.