Nokea
The nurse is caring for a patient with idiopathic aplastic anemia. Which of the following collaborative problems should the nurse include when developing the care plan?
- A. Potential complication: seizures
- B. Potential complication: infection
- C. Potential complication: neurogenic shock
- D. Potential complication: pulmonary edema
Correct Answer: B
Rationale: Because the patient with aplastic anemia has pancytopenia, the patient is at risk for infection and bleeding. There is no increased risk for seizures, neurogenic shock, or pulmonary edema.
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After receiving change-of-shift report for the following four patients with neutropenia, which patient should the nurse assess first?
- A. 66-year-old who has white pharyngeal lesions
- B. 35-year-old who has a fever of 38.2°C (100.8°F)
- C. 36-year-old who has frequent explosive diarrhea
- D. 23-year old who is complaining of severe fatigue
Correct Answer: B
Rationale: Any fever in a neutropenic patient indicates infection and can quickly lead to sepsis and septic shock. Rapid assessment and (if prescribed) initiation of antibiotic therapy within 1 hour are needed. The other patients also need to be assessed but do not exhibit symptoms of potentially life-threatening problems.
All of these patients are waiting to be admitted by the emergency department nurse. Which one of the following requires the most rapid assessment and care by the nurse?
- A. The patient with hemochromatosis who has symptoms of abdominal pain
- B. The patient with thrombocytopenia who has blood oozing after having a tooth extracted
- C. The patient with chemotherapy-induced neutropenia who has a temperature of 38.2°C (100.8°F)
- D. The patient with a history of sickle cell anemia who has had nausea and diarrhea for 24 hours
Correct Answer: C
Rationale: A neutropenic patient with a fever is assumed to have an infection and developing sepsis. Rapid assessment, cultures, and initiation of antibiotic therapy are needed. The other patients also require rapid assessment and care but not as urgently as the neutropenic patient.
The nurse is caring for a patient with neutropenia who is started on a cephalosporin. Which of the following common adverse effects should the nurse observe for in the patient?
- A. Nephrotoxicity
- B. Rash
- C. Ototoxicity
- D. Fever
- E. Pruritus
Correct Answer: B,D,E
Rationale: Adverse effects common to cephalosporins include rashes, fever, and pruritus. Adverse effects common to aminoglycosides include nephrotoxicity and ototoxicity.
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 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.