Nokea
The nurse is evaluating the laboratory results of a patient who has received chemotherapy. The loss of which blood cell leads to lack of energy, fatigue, intolerance of activity and hypoxemia?
- A. White blood cells
- B. Red blood cells
- C. Platelets
- D. Albumin
Correct Answer: B
Rationale: Bone marrow suppression from antineoplastics affects RBC values, leading to severe anemia. RBCs carry oxygen-attached to the hemoglobin-from the lungs to the rest of the body. RBCs also help carry carbon dioxide back to the lungs for exhalation. Therefore, if RBC counts are low (e.g., with anemia), the body does not get the oxygen it needs, which leads to lack of energy, fatigue, intolerance of activity, shortness of breath, and hypoxemia.
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The nurse is monitoring a patient who has severe bone marrow suppression following antineoplastic drug therapy. Which is considered a principal early sign of infection?
- A. Fever
- B. Diaphoresis
- C. Tachycardia
- D. Elevated white blood cell count
Correct Answer: A
Rationale: Fever and/or chills may be the first sign of an oncoming infection. Elevated white blood cell count will not occur because of the bone marrow suppression. The other options are incorrect.
A patient is receiving irinotecan, along with other antineoplastic drugs, as treatment for ovarian cancer. The nurse will monitor for which potentially life-threatening adverse effect that is associated with this drug?
- A. Severe stomatitis
- B. Bone marrow suppression
- C. Delayed-onset cholinergic diarrhea
- D. Immediate and severe nausea and vomiting
Correct Answer: C
Rationale: In addition to producing hematologic adverse effects, irinotecan has been associated with severe diarrhea, known as cholinergic diarrhea, which may occur during infusions. Delayed diarrhea may occur 2 to 10 days after infusion. It is recommended that this condition can be treated with atropine unless use of that drug is strongly contraindicated. This diarrhea can be severe and even life-threatening.
A patient is receiving her third course of 5-fluorouracil therapy and knows that stomatitis is a potential adverse effect of antineoplastic therapy. What will the nurse teach her about managing this problem?
- A. You can take aspirin to prevent stomatitis.
- B. Be sure to watch for and report black, tarry stools immediately.
- C. You need to increase your intake of foods containing fiber and citric acid.
- D. Be sure to examine your mouth daily for bleeding, painful areas, and ulcerations.
Correct Answer: D
Rationale: The symptoms of stomatitis consist of pain or burning in the mouth, difficulty swallowing, taste changes, viscous saliva, dryness, cracking, and fissures, with or without bleeding mucosa. Teach patients to avoid consuming foods containing citric acid and foods that are hot or spicy or high in fiber. Assessing stools is important but is not related to stomatitis, and aspirin must not be used during this therapy.
The nurse is developing a plan of care for a patient who is experiencing gastrointestinal adverse effects, including anorexia and nausea, after the first course of antineoplastic therapy. What is an appropriate outcome for this patient when dealing with this problem?
- A. The patient will eat three balanced meals a day within 2 days.
- B. The patient will return to normal eating pattern within 4 weeks.
- C. The patient will maintain normal weight by consuming healthy snacks as tolerated.
- D. The patient will maintain a diet of small, frequent feedings with nutrition supplements during therapy.
Correct Answer: D
Rationale: Consuming small, frequent meals with nutritional supplements and maintaining a bland diet help to improve nutrition during antineoplastic therapy.
The nurse is teaching about infection-prevention measures with a patient who is receiving antineoplastic drug therapy. During a Teach-Back session, which statement by the patient indicates the need for further education?
- A. I will avoid those who have recently had a vaccination.
- B. I will eat only fresh fruits and raw vegetables.
- C. I will report a sore throat, cough, or low-grade temperature.
- D. It is important for both my family and me to practice good handwashing.
Correct Answer: B
Rationale: Patients who are neutropenic and susceptible to infections need to adhere to a low-microbe diet by washing fresh fruits and vegetables and making sure foods are well cooked. The other options are correct infection-prevention measures.