Nokea
The nurse is caring for a patient with anemia who is experiencing increased fatigue and occasional palpitations at rest. Which of the following laboratory findings should the nurse expect?
- A. Normal red blood cell (RBC) indices
- B. Hematocrit (Hct) of 38%
- C. Hemoglobin (Hb) of 86 g/L
- D. RBC count of 4.5 x 10^12/L
Correct Answer: C
Rationale: The patient's clinical manifestations indicate moderate anemia, which is consistent with an Hb of 60-100 g/L. The other values are all within the range of normal.
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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.
Which of the following newly admitted patients should the nurse assign as a roommate for a patient who has aplastic anemia?
- A. A patient with severe heart failure
- B. A patient who has viral pneumonia
- C. A patient who has right leg cellulitis
- D. A patient with multiple abdominal drains
Correct Answer: A
Rationale: Patients with aplastic anemia are at risk for infection because of the low white blood cell production associated with this type of anemia, so the nurse should avoid assigning a roommate with any possible infectious process.
Which of the following laboratory tests should the nurse use to determine whether the prescribed filgrastim is effective in the treatment of a patient who is receiving chemotherapy for acute lymphocytic leukemia?
- A. Platelet count
- B. Reticulocyte count
- C. Total lymphocyte count
- D. Absolute neutrophil count
Correct Answer: D
Rationale: Filgrastim increases the neutrophil count and function in neutropenic patients. Although total lymphocyte, platelet, and reticulocyte counts also are important to monitor in this patient, the absolute neutrophil count is used to evaluate the effects of filgrastim.
Which of the following actions should the nurse include in the care plan for a hospitalized patient who is neutropenic?
- A. Avoid any IM or subcutaneous injections.
- B. Check the oral temperature every 4 hours.
- C. Omit all fruits or vegetables from the diet.
- D. Place a 'No Visitors' sign on the patient door.
Correct Answer: B
Rationale: The earliest sign of infection in a neutropenic patient is an elevation in temperature. Although unpeeled fresh fruits and vegetables should be avoided, fruits and vegetables that are peeled or cooked are acceptable. Injections may be required for administration of medications such as filgrastim. The number of visitors may be limited and visitors with communicable diseases should be avoided, but a 'no visitors' policy is not needed.
The nurse is caring for a patient with polycythemia vera. Which of the following actions should the nurse implement during treatment?
- A. Place the patient on bed rest.
- B. Administer iron supplements.
- C. Avoid use of aspirin products.
- D. Monitor fluid intake and output.
Correct Answer: D
Rationale: Monitoring hydration status is essential in polycythemia vera to prevent thrombosis due to increased blood viscosity. Aspirin therapy is used to decrease risk for thrombosis. The patient should be encouraged to ambulate to prevent deep vein thrombosis (DVT). Iron is contraindicated in patients with polycythemia vera.