Nokea
The nurse is caring for a patient with tumour lysis syndrome (TLS) who is taking allopurinol. Which of the following laboratory values should the nurse monitor to determine the effectiveness of the medication?
- A. Uric acid level
- B. Serum potassium
- C. Serum phosphate
- D. Blood urea nitrogen
Correct Answer: A
Rationale: Allopurinol is used to decrease uric acid levels. BUN, potassium, and phosphate levels are also increased in TLS but are not affected by allopurinol therapy.
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The nurse in the outpatient clinic is caring for a patient who smokes heavily. To reduce the patient's risk of dying from lung cancer, which of the following actions will be best for the nurse to take?
- A. Educate the patient about the seven warning signs of cancer
- B. Plan to monitor the patient's carcinoembryonic antigen (CEA) level.
- C. Discuss the risks associated with cigarettes during every patient encounter.
- D. Teach the patient about the use of annual chest x-rays for lung cancer screening.
Correct Answer: C
Rationale: Education about the risks associated with cigarette smoking is recommended at every patient encounter, since cigarette smoking is associated with multiple health problems. A tumour must be at least 0.5 cm large before it is detectable by current screening methods and may already have metastasized by that time. Oncofetal antigens such as CEA may be used to monitor therapy or detect tumour recurrence, but are not helpful in screening for cancer. The seven warning signs of cancer are actually associated with fairly advanced disease.
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 undergoing external radiation and has developed a dry desquamation of the skin in the treatment area. Which of the following patient statements indicates that the nurse's teaching about management of the skin reaction has been effective?
- A. I can buy some aloe gel to use on the area.
- B. I will expose the treatment area to a sun lamp daily.
- C. I can use ice packs to relieve itching in the treatment area.
- D. I will scrub the area with warm water to remove the scales.
Correct Answer: A
Rationale: Aloe gel and cream may be used on the radiated skin area. Ice and sunlamps may injure the skin. Treatment areas should be cleaned gently to avoid further injury.
The nurse is caring for a patient who is receiving chemotherapy for leukemia. The patient's laboratory report shows a neutrophil count of 400/?¼L. Which of the following is the priority nursing intervention?
- A. Administer prescribed antibiotics immediately.
- B. Teach the patient to avoid crowded places.
- C. Assess the patient for signs of bleeding.
- D. Monitor the patient's temperature every 4 hours.
Correct Answer: D
Rationale: A neutrophil count of 400/?¼L indicates severe neutropenia, placing the patient at high risk for infection. Monitoring temperature every 4 hours is the priority to detect early signs of infection. Antibiotics may be needed but only after signs of infection are confirmed. Teaching about avoiding crowds is important but not the immediate priority. Assessing for bleeding is relevant for low platelet counts, not neutropenia.