Nokea
The nurse is teaching a client about the signs of infection after chemotherapy. Which of the following should the nurse emphasize?
- A. Frequent urination
- B. Increased thirst
- C. Chills and shaking
- D. Fever over 100.4°F (38°C)
Correct Answer: D
Rationale: In clients undergoing chemotherapy, the immune system is often compromised due to the effects of treatment, making them more susceptible to infections. A fever over 100.4°F (38°C) is considered a critical sign of infection in these patients and requires immediate medical evaluation. Fever may indicate the presence of an infection that could escalate quickly in immunocompromised individuals, so it is vital for patients to recognize this symptom and seek prompt medical attention.
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Nurse Meredith is instructing a premenopausal woman about breast self-examination. The nurse should tell the client to do her self-examination:
- A. at the end of her menstrual cycle.
- B. on the same day each month.
- C. on the 1st day of the menstrual cycle.
- D. immediately after her menstrual period.
Correct Answer: D
Rationale: For premenopausal women, the best time to perform a breast self-examination (BSE) is immediately after their menstrual period ends. This timing is ideal because hormonal fluctuations during the menstrual cycle can cause breast tissue to become swollen and tender, making it more difficult to detect any lumps or changes. After the menstrual period, breast tissue is usually softer and less lumpy, allowing for a more accurate assessment of any abnormalities.
A patient on the oncology unit is receiving carmustine, a chemotherapy agent, and the nurse is aware that a significant side effect of this medication is thrombocytopenia. Which symptom should the nurse assess for in patients at risk for thrombocytopenia?
- A. Interrupted sleep pattern
- B. Hot flashes
- C. Epistaxis (nose bleed)
- D. Increased weight
Correct Answer: C
Rationale: Thrombocytopenia is a condition characterized by a low platelet count, which increases the risk of bleeding and hemorrhage. Patients receiving chemotherapy agents like carmustine may experience thrombocytopenia as a significant side effect. Epistaxis (nosebleeds) is a common symptom associated with thrombocytopenia, as the blood vessels can become more fragile, and even minor trauma or spontaneous bleeding can occur. Therefore, assessing for signs of bleeding, including epistaxis, is crucial in patients at risk for thrombocytopenia.
An older adult patient is undergoing diagnostic testing for chronic lymphocytic leukemia (CLL). What assessment finding is certain to be present if the patient has CLL?
- A. Increased numbers of blast cells
- B. Increased lymphocyte levels
- C. Intractable bone pain
- D. Thrombocytopenia with no evidence of bleeding
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A nurse at a long-term care facility is amending the care plan of a resident who has just been diagnosed with essential thrombocythemia (ET). The nurse should anticipate the administration of what medication?
- A. Dalteparin
- B. Allopurinol
- C. Hydroxyurea
- D. Hydrochlorothiazide
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A patient has a diagnosis of multiple myeloma and the nurse is preparing health education in preparation for discharge from the hospital. What action should the nurse promote?
- A. Daily performance of weight-bearing exercise to prevent muscle atrophy
- B. Close monitoring of urine output and kidney function
- C. Daily administration of warfarin (Coumadin) as ordered
- D. Safe use of supplementary oxygen in the home setting
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.