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The nurse is developing a plan of care for marrow suppression, the major dose-limiting adverse reaction to floxuridine (FUDR). How long after drug administration does bone marrow suppression become noticeable?
- A. 24 hours
- B. 7 to 14 days
- C. 2 to 4 days
- D. 21 to 28 days
Correct Answer: C
Rationale: Marrow suppression is the major dose-limiting adverse reaction to floxuridine (FUDR). It typically becomes noticeable 2 to 4 days after drug administration. Floxuridine acts by interfering with DNA replication and is most toxic to rapidly dividing cells, such as those in the bone marrow. As a result, bone marrow suppression leading to decreased production of blood cells can occur relatively quickly after the administration of floxuridine. Monitoring for bone marrow suppression is essential in patients receiving this medication to ensure timely intervention and prevention of complications such as anemia, thrombocytopenia, and leukopenia.
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Which client statement would indicate to the nurse that the client with polycythemia vera is in need further of instruction?
- A. I'll be flying overseas to see my son and grandchildren for the holidays
- B. I plan to do my leg exercises at least three times a week
- C. I'm going to be walking in the mall everyday to build up my strength
- D. At night when I sleep, I like to use two pillows to raise my head up CARING FOR CLIENTS FOR DISORDERS OF THE LYMPHATIC SYSTEM
Correct Answer: A
Rationale: Clients with polycythemia vera are at an increased risk for developing blood clots due to the increased thickness of their blood. Flying long distances, especially overseas, can further increase this risk. Therefore, traveling long distances by plane can be dangerous for clients with polycythemia vera. The nurse should provide instructions to the client regarding the importance of discussing travel plans with their healthcare provider to ensure appropriate measures are in place to minimize the risk of blood clots.
A 12-year-old male adolescent, recently diagnosed with Hodgkin lymphoma, shows left cervical and supraclavicular lymph node involvement and drenching night sweats. Based on Ann Arbor Classification, the patient is classified as
- A. stage IA
- B. stage IB
- C. stage IIA
- D. stage IIB
Correct Answer: D
Rationale: Involvement of two lymph node regions above the diaphragm with systemic symptoms corresponds to stage IIB.
The nurse is caring for a client who is HIV positive. To prevent the spread of the HIV virus, what do the Centers for Disease Control and Prevention recommend?
- A. Universal blood and body fluid precautions
- B. Body systems isolation
- C. Laminar flow room during active infection
- D. Needle and syringe precautions
Correct Answer: A
Rationale: The Centers for Disease Control and Prevention (CDC) recommend universal blood and body fluid precautions for preventing the spread of the HIV virus. These precautions are designed to protect healthcare workers and patients from exposure to bloodborne pathogens. Universal precautions involve treating all blood and body fluids from all individuals as potentially infectious. This includes using personal protective equipment (such as gloves, gowns, and masks), proper handling and disposal of needles and other sharps, and following appropriate infection control practices. By implementing universal precautions, healthcare providers can minimize the risk of transmission of HIV and other bloodborne pathogens.
The nurse is aware that a common physiologic adaptation of children with tetralogy of Fallot is:
- A. Clubbing of fingers
- B. Slow, irregular respirations
- C. Subcutaneous hemorrhages
- D. Decreased red blood cell count
Correct Answer: A
Rationale: Clubbing of fingers is a common physiologic adaptation seen in children with tetralogy of Fallot. Clubbing is the result of chronic hypoxia and decreased oxygen levels in the blood. In children with tetralogy of Fallot, there is a structural defect in the heart that leads to mixing of oxygenated and deoxygenated blood in the heart and decreased oxygenation of the blood circulating to the body. This chronic hypoxia can cause clubbing of the fingers, where the tips of the fingers appear enlarged and the nails are rounded. Therefore, clubbing of fingers is a key sign to monitor in children with tetralogy of Fallot.
Which of the following statements about fluid replacement is accurate for a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS)?
- A. Administer 2 to 3L of IV fluid rapidly
- B. Administer 6L of IV fluid over the first 24 hours
- C. Administer a dextrose solution containing normal saline solution
- D. Administer IV fluid slowly to prevent circulatory overload and collapse
Correct Answer: B
Rationale: For a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS), the correct statement is to administer 6L of IV fluid over the first 24 hours (option B). The management of HHNS focuses on correcting dehydration and hyperglycemia. The initial fluid resuscitation in HHNS aims to address the profound dehydration that occurs due to osmotic diuresis from hyperglycemia. The recommended rate is to administer 1 to 1.5 L/hour of IV fluid until the patient is hemodynamically stable and urine output is adequate. Administering fluid rapidly helps to address the hypovolemia and prevent complications associated with shock. Administering fluid too slowly may delay the correction of dehydration and lead to further complications.