Nokea
Which client should be assigned to the experienced medical-surgical nurse who is in the first week of orientation to the oncology floor?
- A. The client diagnosed with non-Hodgkin’s lymphoma who is having daily radiation treatments.
- B. The client diagnosed with Hodgkin’s disease who is receiving combination chemotherapy.
- C. The client diagnosed with leukemia who has petechiae covering both anterior and posterior body surfaces.
- D. The client diagnosed with diffuse histolytic lymphoma who is to receive two (2) units of packed red blood cells.
Correct Answer: C
Rationale: Leukemia with extensive petechiae (C) indicates severe thrombocytopenia, requiring experienced assessment for bleeding. Radiation (A), chemotherapy (B), and transfusions (D) are less complex.
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The client has a blood type of B negative. The client’s family asks if they can donate blood for the client. The nurse informs the family that they would need to be of which blood type to be considered for a directed donation of RBCs for this client?
- A. Type A positive
- B. Type B positive
- C. Type B negative
- D. Type O positive
- E. Type O negative
- F. Type AB positive
Correct Answer: C, E, A
Rationale: Blood type A positive has the D antigen on the RBC, making it incompatible with blood type B negative. B. Blood type B positive has the D antigen on the RBC, making it incompatible with blood type B negative. C. The client with B negative blood type has B antigen on the RBC and does not have an Rh (or D) antigen on the cell. Because the client can receive RBCs of the same blood type, a person with type B negative blood could be considered for a directed donation. D. Blood type O positive has the D antigen, making it incompatible with blood type B negative. E. Type O negative has no antigens on the RBC so a directed donation from a person with type O negative blood could also be considered. F. Blood type AB positive has the D antigen on the RBC, making it incompatible with blood type B negative.
Laboratory tests are prescribed for the client who has a smooth and reddened tongue and ulcers at the corners of the mouth. Which result would the nurse find if the client has iron-deficiency anemia?
- A. Low hemoglobin and hematocrit
- B. Elevated red blood cells (RBCs)
- C. Prolonged prothrombin time (PT)
- D. Elevated white blood cells (WBCs)
Correct Answer: A
Rationale: A. A smooth, red tongue, ulcers at the corners of the mouth (angular cheilosis), and a low Hgb are signs of iron-deficiency anemia. B. Excess RBCs are associated with polycythemia vera. C. Prolonged PT is seen with clients taking antico-agulants or experiencing a coagulation disorder. D. Elevated WBCs are not associated with iron-deficiency anemia but with an infection. Ulcers, if infected, would elevate the WBCs.
The nurse is caring for a client diagnosed with sickle cell disease. Which should the nurse include in the client’s plan of care?
- A. Teach the client to limit fluids.
- B. Discuss interventions to maintain hydration.
- C. Measure the client’s calf for swelling.
- D. Have the client take narcotic pain medication every four (4) hours.
Correct Answer: B
Rationale: Hydration (B) prevents sickling in SCD. Limiting fluids (A) worsens crisis, calf swelling (C) is for DVT, and scheduled narcotics (D) risk dependency.
The client is placed on neutropenia precautions. Which information should the nurse teach the client?
- A. Shave with an electric razor and use a soft toothbrush.
- B. Eat plenty of fresh fruits and vegetables.
- C. Perform perineal care after every bowel movement.
- D. Some blood in the urine is not unusual.
Correct Answer: A
Rationale: Neutropenia precautions include electric razors and soft toothbrushes (A) to prevent bleeding/infection. Fresh produce (B) risks infection, perineal care (C) is routine, and hematuria (D) is abnormal.
Which client would be most at risk for developing disseminated intravascular coagulation (DIC)?
- A. A 35-year-old pregnant client with placenta previa.
- B. A 42-year-old client with a pulmonary embolus.
- C. A 60-year-old client receiving hemodialysis three (3) days a week.
- D. A 78-year-old client diagnosed with septicemia.
Correct Answer: D
Rationale: Septicemia (D) is a major DIC trigger due to systemic inflammation/coagulation. Placenta previa (A), PE (B), and dialysis (C) are lower risk.