Nokea
The nurse is caring for a patient with acute myelogenous leukemia (AML) who has induction therapy prescribed and the patient asks the nurse whether the planned chemotherapy will be worth undergoing. Which of the following responses by the nurse is best?
- A. If you do not want to have chemotherapy, there are other options for treatment such as stem cell transplantation.
- B. The decision about chemotherapy is one that you and the doctor need to make rather than asking what I would do.
- C. You don't need to make a decision about treatment right now since leukemias in adults tend to progress quite slowly.
- D. The adverse effects of the chemotherapy are difficult, but AML frequently does go into remission with chemotherapy.
Correct Answer: D
Rationale: This response uses therapeutic communication by addressing the patient's question and giving accurate information. The other responses either give inaccurate information or fail to address the patient's question, which will discourage the patient from asking the nurse for information.
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The nurse is caring for a patient with non-Hodgkin's lymphoma who develops a platelet count of 38 x 10^9/L during chemotherapy. Which of the following actions should the nurse implement based on this finding?
- A. Provide oral hygiene every 2 hours.
- B. Check all stools for occult blood.
- C. Assess temperature every 4 hours.
- D. Encourage fluids to 3000 mL/day.
Correct Answer: B
Rationale: Because the patient is at risk for spontaneous bleeding, the nurse should check stools for occult blood. A low platelet count does not require an increased fluid intake. Oral hygiene is important, but it is not necessary to provide oral care every 2 hours. The low platelet count does not increase risk for infection, so frequent temperature monitoring is not indicated.
The nurse is caring for a patient receiving a transfusion of packed red blood cells who develops chills, fever, headache, and anxiety 30 minutes after the transfusion is started. After stopping the transfusion, which of the following actions is priority?
- A. Draw blood for a new crossmatch.
- B. Send a urine specimen to the laboratory.
- C. Give the PRN diphenhydramine.
- D. Administer the PRN acetaminophen.
Correct Answer: D
Rationale: The patient's clinical manifestations are consistent with a febrile, nonhemolytic transfusion reaction. The transfusion should be stopped and antipyretics administered for the fever as ordered. A urine specimen is needed if an acute hemolytic reaction is suspected. Diphenhydramine is used for allergic reactions. This type of reaction does not indicate incorrect crossmatching.
The nurse is caring for a patient who has a history of a transfusion-related acute lung injury (TRALI) and is to receive a transfusion of packed red blood cells (PRBCs). Which of the following actions should the nurse take to decrease the risk for TRALI for this patient?
- A. Infuse the PRBCs slowly over 4 hours.
- B. Transfuse only leukocyte-reduced PRBCs.
- C. Administer the scheduled oral diuretic before the transfusion.
- D. Give the PRN dose of antihistamine before starting the transfusion.
Correct Answer: B
Rationale: TRALI is caused by a reaction between the donor and the patient leukocytes that causes pulmonary inflammation and capillary leaking. The other actions may help prevent respiratory condition caused by circulatory overload or by allergic reactions, but they will not prevent TRALI.
The nurse is caring for a patient who is receiving methotrexate and develops a megaloblastic anemia. Which of the following nutrients should the nurse include in the teaching plan?
- A. Iron
- B. Folic acid
- C. Cobalamin (vitamin B12)
- D. Ascorbic acid (vitamin C)
Correct Answer: B
Rationale: Methotrexate use can lead to folic acid deficiency. Supplementation with oral folic acid supplements is the usual treatment. The other nutrients would not correct folic acid deficiency, although they would be used to treat other types of anemia.
Which of the following statements by a patient with sickle cell anemia indicates good understanding of the nurse's teaching about prevention of sickle cell crisis?
- A. Home oxygen therapy is frequently used to decrease sickling.
- B. There are no effective medications that can help prevent sickling.
- C. Routine continuous dosage narcotics are prescribed to prevent a crisis.
- D. Risk for a crisis can be lowered by having an annual influenza vaccination.
Correct Answer: D
Rationale: Since infection is the most common cause of a sickle cell crisis, influenza, Haemophilus influenzae, pneumococcal pneumonia, and hepatitis immunizations should be administered. Although continuous dose opioids and oxygen may be administered during a crisis, patients do not receive these therapies to prevent crisis. Hydroxyurea is used for many patients to decrease the number of sickle cell crises.