Nokea
The nurse is caring for a patient who is undergoing bone marrow transplantation. Which of the following information should the nurse include in the patient's teaching plan?
- A. Transplant of the donated cells is painful because of the nerves in the tissue lining the bone.
- B. Donor bone marrow cells are transplanted through an incision into the sternum or hip bone.
- C. The transplant procedure takes place in a sterile operating room to minimize the risk for infection.
- D. Hospitalization will be required 2-4 weeks after transplantation.
Correct Answer: D
Rationale: The patient requires strict protective isolation to prevent infection for 2-4 weeks after marrow transplantation while waiting for the transplanted marrow to start producing cells. The transplanted cells are infused through an IV line, so the transplant is not painful, nor is an operating room or incision required.
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The nurse is caring for a patient with ovarian cancer who is distressed because her husband rarely visits and tells the nurse, 'He just doesn't care.' The husband indicates to the nurse that 'I never know what to say to help her.' Which of the following nursing diagnoses is most appropriate?
- A. Disabled family coping related to persistently unexpressed feelings by support person
- B. Impaired home maintenance related to insufficient support system
- C. Risk for caregiver role strain as evidenced by increase in care needs
- D. Dysfunctional family processes related to insufficient problem-solving skills
Correct Answer: D
Rationale: The data indicate that this diagnosis is most appropriate because poor communication among the family members is affecting family processes. No data suggest preoccupation with an outside concern as an etiology. The data do not support impairment in home maintenance or a burden caused by caregiving responsibilities.
Which of the following information noted by the nurse reviewing the laboratory results of a patient who is receiving chemotherapy is most important to report to the health care provider?
- A. Hematocrit of 30%
- B. Platelets of 150 ?? 10^9/L
- C. Hemoglobin of 161 g/L
- D. WBC count of 4 ?? 10^9/L
Correct Answer: D
Rationale: The low WBC count places the patient at risk for severe infection and is an indication that the chemotherapeutic drug dose may need to be lower or that white blood cell (WBC) growth factors such as filgrastim are needed. The other laboratory data do not indicate any immediate life-threatening adverse effects of the chemotherapy.
The nurse is caring for a patient who is a single mother of four school-age children and is hospitalized with metastatic ovarian cancer. The nurse finds the patient crying, and she tells the nurse that she does not know what will happen to her children when she dies. Which of the following is the most appropriate response?
- A. Why don't we talk about the options you have for the care of your children?
- B. Perhaps the children's father will take care of them when you aren't able to.
- C. For now you need to concentrate on getting well, not worry about your children.
- D. Many patients with cancer live for a long time, so it's time to plan for your children.
Correct Answer: A
Rationale: This response expresses the nurse's willingness to listen and recognizes the patient's concern. The responses beginning 'Many patients with cancer live for a long time' and 'For now you need to concentrate on getting well' close off discussion of the topic and indicate that the nurse is uncomfortable with the topic. In addition, the patient with metastatic ovarian cancer may not have a long time to plan. Although it is possible that the patient's ex-husband will take the children, more assessment information is needed before making plans.
Which statement by a patient who is scheduled for a needle biopsy of the prostate indicates that the nurse's teaching about the purpose of the biopsy has been effective?
- A. The biopsy will remove the cancer in my prostate gland.
- B. The biopsy will determine how much longer I have to live.
- C. The biopsy will help decide the treatment for my enlarged prostate.
- D. The biopsy will indicate whether the cancer has spread to other organs.
Correct Answer: C
Rationale: A biopsy is used to determine whether the prostate enlargement is benign or malignant and determines the type of treatment that will be needed. Biopsy does not give information about metastasis, life expectancy, or the impact of cancer on the patient's life; the three remaining statements indicate a need for patient teaching.
A patient with a large stomach tumour that is attached to the liver is scheduled to have a debulking procedure. When teaching the patient, which of the following is the expected outcome of this surgery?
- A. Relief of pain by cutting sensory nerves in the stomach
- B. Control of the tumour growth by removal of malignant tissue
- C. Decrease in tumour size to improve the effects of other therapy
- D. Promotion of better nutrition by relieving the pressure in the stomach
Correct Answer: C
Rationale: A debulking surgery reduces the size of the tumour and makes radiation and chemotherapy more effective. Debulking surgeries do not control tumour growth. The tumour is debulked because it is attached to the liver, a vital organ (not to relieve pressure on the stomach). Debulking does not sever the sensory nerves, although pain may be lessened by the reduction in pressure on the abdominal organs.