Nokea
What is the major effect of filgrastim (Neupogen) in a patient with chronic renal failure?
- A. Decreases neutropenia related to chemotherapy
- B. Decreases white blood cells related to infection
- C. Decreases growth of blood vessels due to ischemia
- D. Decreases platelet count related to bleeding
Correct Answer: A
Rationale: The major effect of filgrastim (Neupogen) is to stimulate the production of neutrophils, thereby decreasing neutropenia in patients undergoing chemotherapy. This medication helps the bone marrow produce more white blood cells, specifically neutrophils, to reduce the risk of infections associated with low neutrophil counts. Choices B, C, and D are incorrect because filgrastim does not decrease white blood cells related to infection, growth of blood vessels, or platelet count related to bleeding.
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How should the nurse prepare a patient who is to receive a Schilling test for pernicious anemia?
- A. Administer radioactive cobalamin and measure its excretion time
- B. Measure antigen-antibody immune complexes
- C. Measure serum ferritin and total iron-binding capacity
- D. Administer folate and evaluate folate content in a blood serum sample
Correct Answer: A
Rationale: The correct answer is A. To prepare a patient for a Schilling test for pernicious anemia, the nurse should administer radioactive cobalamin and measure its excretion time. This test is specifically designed to assess the absorption of vitamin B12. Choices B, C, and D are incorrect because they do not align with the preparation and procedure of a Schilling test. Measuring antigen-antibody immune complexes, serum ferritin, or total iron-binding capacity, as well as administering folate and evaluating folate content, are not part of the Schilling test protocol.
A patient with breast cancer is prescribed tamoxifen (Nolvadex). What key point should the nurse include in the patient education?
- A. Tamoxifen may increase the risk of venous thromboembolism.
- B. Tamoxifen may cause hot flashes and other menopausal symptoms.
- C. Tamoxifen may cause weight gain and fluid retention.
- D. Tamoxifen may decrease the risk of osteoporosis.
Correct Answer: A
Rationale: The correct answer is A: "Tamoxifen may increase the risk of venous thromboembolism." It is crucial for patients to be aware of the signs and symptoms of blood clots while taking tamoxifen. Choice B is incorrect because hot flashes and menopausal symptoms are common side effects of tamoxifen, but they are not the key point to emphasize. Choice C is incorrect as weight gain and fluid retention are potential side effects of tamoxifen but not the key point for patient education. Choice D is incorrect as tamoxifen does not decrease the risk of osteoporosis; in fact, it may increase the risk of bone loss.
What is the best method to identify which type of stroke the client has?
- A. Obtain a 12-lead electrocardiogram STAT
- B. Obtain a blood specimen for electrolytes and blood cultures
- C. Ask the client about current allergies
- D. Obtain a cranial computerized tomogram (CT) STAT
Correct Answer: D
Rationale: The correct answer is to obtain a cranial computerized tomogram (CT) STAT. A cranial CT scan is the best method to quickly identify the type of stroke a client is experiencing. Options A, B, and C are not appropriate for identifying the type of stroke as they are not specific to assessing stroke types.
A female client with bone metastases secondary to lung cancer is admitted for palliative radiation treatment and pain control. The client is currently experiencing pain that she rates at 9 out of 10. Which of the following nonpharmacologic treatments is most likely to be a useful and appropriate supplement to pharmacologic analgesia at this point?
- A. Teaching the client guided imagery and meditation
- B. Initiating neurostimulation
- C. Heat therapy
- D. Relaxation and distraction
Correct Answer: D
Rationale: In the scenario described, the client is experiencing high pain levels, rated at 9 out of 10. Relaxation and distraction techniques are effective nonpharmacologic interventions for managing pain. Teaching the client guided imagery and meditation (Choice A) can also be beneficial; however, in this acute situation of severe pain, relaxation and distraction techniques are more likely to provide immediate relief. Initiating neurostimulation (Choice B) and heat therapy (Choice C) may not be suitable for immediate pain relief in this scenario and are not as commonly used for managing high pain levels in palliative care settings.
What serious adverse effect should the nurse monitor for during testosterone therapy?
- A. Testosterone therapy increases the risk of cardiovascular events, so regular monitoring is essential.
- B. Testosterone therapy can cause liver dysfunction, so liver function tests should be monitored regularly.
- C. Testosterone therapy can lead to prostate cancer, so regular screenings are recommended.
- D. Testosterone therapy can lead to bone fractures, so bone density should be monitored.
Correct Answer: A
Rationale: The correct answer is A. Testosterone therapy is associated with an increased risk of cardiovascular events. Therefore, the nurse should monitor the patient for cardiovascular complications. While monitoring liver function tests (choice B) and bone density (choice D) may be important in some cases, the primary concern during testosterone therapy is the risk of cardiovascular events. Prostate cancer screenings (choice C) are not directly related to testosterone therapy's adverse effects.