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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.
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The client in balanced suspension traction is transported to surgery for closed reduction and internal fixation of his fractured femur. Which of the following should the nurse do when transporting the client to the operating room?
- A. Transfer the client to a cart with manually suspended traction.
- B. Call the surgeon to request an order to temporarily remove the traction.
- C. Send the client on his bed with extra help to stabilize the traction.
- D. Remove the traction and send the client on a cart.
Correct Answer: C
Rationale: Transporting on the bed with extra help maintains traction stability, preventing fracture displacement.
The nurse is assessing a client's nutritional status preoperatively. Which of the following observations would indicate poor nutrition in a 5-foot 7-inch female client who is 21 years of age?
- A. Poor posture.
- B. Little mass.
- C. Dull expression.
- D. Weight of 128 lb (58.1 kg).
Correct Answer: B
Rationale: Little mass in a 5'7' female suggests low body weight or muscle wasting, indicative of poor nutrition. A weight of 128 lb is within a healthy range, and poor posture or dull expression are less specific to nutritional status.
The nurse is preparing the discharge of a client with a metal joint. The nurse should instruct the client about which of the following? Select all that apply.
- A. Notify health care providers about the joint prior to invasive procedures.
- B. Avoid use of Magnetic Resonance Imaging (MRI) scans.
- C. Notify airport security that the joint may set off alarms on metal detectors.
- D. Refrain from carrying items weighing more than 5 lb.
- E. Limit fluid intake to 1,000 mL/day.
Correct Answer: A,C
Rationale: Notifying providers and airport security about the metal joint prevents complications and delays. MRI scans are generally safe with modern prostheses.
An adult client with type 2 diabetes is taking metformin (Glucophage) 1,000 mg two times every day. After the nurse provides instructions regarding the interaction of alcohol and metformin, the nurse evaluates that the client understands the instructions when the client says:
- A. If I know I'll be having alcohol, I must not take metformin; I could develop lactic acidosis.'
- B. If my physician approves, I may drink alcohol with my metformin.'
- C. Adverse effects I should watch for are feeling excessively energetic, unusual muscle stiffness, low back pain, and a rapid heartbeat.'
- D. If I feel bloated, I should call my physician.'
Correct Answer: A
Rationale: Alcohol combined with metformin increases the risk of lactic acidosis, a serious complication. The client should avoid alcohol while taking metformin.
A nurse receives the taped change-of-shift report for assigned clients and prioritizes client rounds. In what order should the nurse assess these clients?
- A. A client with an endotracheal tube transferred out of the intensive care unit that day.
- B. A client with type 2 diabetes who had a cerebrovascular accident 4 days ago.
- C. A client with cellulitis of the left lower extremity with a fever of 100.8°F (38.2°C).
- D. A client receiving D5W I.V. at 125 mL/hour with 75 mL remaining.
Correct Answer: A,C,B,D
Rationale: The client with a new endotracheal tube (A) is highest priority due to airway risk. The febrile client with cellulitis (C) is next for infection monitoring. The stroke client (B) is stable 4 days post-event. The I.V. fluid client (D) is lowest priority.