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Which of the following nursing interventions should be included in the care plan for a patient with immune thrombocytopenic purpura (ITP)?
- A. Assign the patient to a private room.
- B. Avoid intramuscular (IM) injections.
- C. Use rinses rather than a toothbrush for oral care.
- D. Restrict activity to passive and active range of motion.
Correct Answer: B
Rationale: IM or subcutaneous injections should be avoided because of the risk for bleeding. A soft toothbrush can be used for oral care. There is no need to restrict activity or place the patient in a private room.
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When a febrile episode occurs in a patient with neutropenia, at what time should antibiotic therapy be initiated?
- A. Within 1 hour
- B. After the causative agent is identified from the culture
- C. Once the fever drops below 38°C (100.4°F)
- D. For long-term therapy over 3 months.
Correct Answer: A
Rationale: When a febrile episode occurs in a patient with neutropenia, antibiotic therapy must be initiated immediately (within 1 hour), even before the determination by culture of a specific causative organism. Treatment does not wait until the fever drops. Long-term therapy over 3 months is not required at this time.
Which of the following actions should the nurse include in the care plan for a hospitalized patient who is neutropenic?
- A. Avoid any IM or subcutaneous injections.
- B. Check the oral temperature every 4 hours.
- C. Omit all fruits or vegetables from the diet.
- D. Place a 'No Visitors' sign on the patient door.
Correct Answer: B
Rationale: The earliest sign of infection in a neutropenic patient is an elevation in temperature. Although unpeeled fresh fruits and vegetables should be avoided, fruits and vegetables that are peeled or cooked are acceptable. Injections may be required for administration of medications such as filgrastim. The number of visitors may be limited and visitors with communicable diseases should be avoided, but a 'no visitors' policy is not needed.
The nurse is caring for a patient with acute myelogenous leukemia who is receiving outpatient chemotherapy and develops an absolute neutrophil count of 0.9 x 10^9/L. Which of the following actions by the nurse in the outpatient clinic is best?
- A. Discuss the need for hospital admission to treat the neutropenia.
- B. Plan to discontinue the chemotherapy until the neutropenia resolves.
- C. Teach the patient how to administer filgrastim injections at home.
- D. Obtain a high-efficiency particulate air (HEPA) filter for the patient for home use.
Correct Answer: C
Rationale: The patient may be taught to self-administer filgrastim injections. Although chemotherapy may be stopped with severe neutropenia (neutrophil count less than 0.5 x 10^9/L), administration of filgrastim usually allows the chemotherapy to continue. Patients with neutropenia are at higher risk for infection when exposed to other patients in the hospital. HEPA filters are expensive and are used in the hospital, where the number of pathogens is much higher than in the patient's home environment.
The nurse is caring for a patient who is receiving methotrexate and develops a megaloblastic anemia. Which of the following nutrients should the nurse include in the teaching plan?
- A. Iron
- B. Folic acid
- C. Cobalamin (vitamin B12)
- D. Ascorbic acid (vitamin C)
Correct Answer: B
Rationale: Methotrexate use can lead to folic acid deficiency. Supplementation with oral folic acid supplements is the usual treatment. The other nutrients would not correct folic acid deficiency, although they would be used to treat other types of anemia.
The nurse is caring for a patient who has a history of a transfusion-related acute lung injury (TRALI) and is to receive a transfusion of packed red blood cells (PRBCs). Which of the following actions should the nurse take to decrease the risk for TRALI for this patient?
- A. Infuse the PRBCs slowly over 4 hours.
- B. Transfuse only leukocyte-reduced PRBCs.
- C. Administer the scheduled oral diuretic before the transfusion.
- D. Give the PRN dose of antihistamine before starting the transfusion.
Correct Answer: B
Rationale: TRALI is caused by a reaction between the donor and the patient leukocytes that causes pulmonary inflammation and capillary leaking. The other actions may help prevent respiratory condition caused by circulatory overload or by allergic reactions, but they will not prevent TRALI.