Nokea
The nurse is preparing to administer a unit of packed red blood cells (PRBCs). The nurse should
- A. obtain a bag of 250 mL of 0.9% saline.
- B. obtain a bag of 250 mL of Dextrose 5% in water (D5W).
- C. insert a 22 gauge intravenous (IV) catheter.
- D. initiate continuous telemetry monitoring.
Correct Answer: A
Rationale: 0.9% saline is required to prime the tubing for PRBC transfusions, as it is compatible and prevents hemolysis. D5W causes hemolysis, a 22-gauge catheter is too small for blood products, and telemetry is not routinely required.
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Which of the following statements is most accurate regarding the long-term toxic effects of cancer treatments on the immune system?
- A. Clients with persistent immunologic abnormalities after treatment are at a much greater risk for infection than clients with a history of splenectomy.
- B. The use of radiation and combination chemotherapy can result in more frequent and more severe immune system impairment.
- C. Long-term immunologic effects have been studied only in clients with breast and lung cancer.
- D. The helper T cells recover more rapidly than the suppressor T cells, which results in positive helper cell balance that can last 5 years.
Correct Answer: B
Rationale: Radiation and combination chemotherapy can cause significant and prolonged immune suppression, increasing infection risk, which is a well-documented long-term effect.
A 68-year-old male has been receiving monthly doses of chemotherapy for treatment of stage III colon cancer. He comes to the clinic for his fourth monthly dose. Which laboratory result(s) should be reported to the oncologist before the next dose of chemotherapy is administered? Select all that apply.
- A. Hemoglobin of 14.5 g/dL.
- B. Platelet count of 40,000/mm³.
- C. Blood urea nitrogen (BUN) level of 12 mg/dL.
- D. White blood cell count of 2,300/mm³.
- E. Temperature of 101.2°F (38.4°C).
- F. Urine specific gravity of 1.020.
Correct Answer: B,D,E
Rationale: Low platelet count (B), low white blood cell count (D), and fever (E) indicate thrombocytopenia, neutropenia, and possible infection, respectively, which are contraindications for chemotherapy due to increased risk of bleeding and infection.
The nurse monitors the client with pancreatitis for early signs of shock. Which of the following conditions is primarily responsible for making it difficult to manage shock in pancreatitis?
- A. Severity of intestinal hemorrhage.
- B. Loss of fluids into the retroperitoneal space.
- C. Infection from pancreatic necrosis.
- D. Decreased cardiac output.
Correct Answer: B
Rationale: In pancreatitis, fluid sequestration into the retroperitoneal space (B) causes hypovolemia, complicating shock management. Intestinal hemorrhage (A), infection (C), and decreased cardiac output (D) are less primary contributors.
The client has had a below-the-knee amputation secondary to arterial occlusive disease. The nurse is instructing the client in stump care. Which of the following statements by the client indicates that she understands how to implement her plan of care?
- A. I should inspect the incision carefully when I change the dressing every other day.'
- B. I should wash the incision, dry it, and apply moisturizing lotion daily.'
- C. I should rewrap the stump as often as needed.'
- D. I should elevate the stump on pillows to decrease swelling.'
Correct Answer: C
Rationale: Rewrapping the stump as often as needed ensures proper compression to shape the stump for a prosthesis and reduce edema, indicating correct understanding of stump care. Inspecting every other day may be insufficient, washing and moisturizing the incision risks infection, and elevating on pillows is not standard for arterial disease.
Which assessment is critical for a client with a recent stroke?
- A. Swallowing ability.
- B. Blood glucose.
- C. Cholesterol levels.
- D. Joint mobility.
Correct Answer: A
Rationale: Assessing swallowing ability is critical to prevent aspiration in stroke patients.