a client is receiving rituximab what assessment by the nurse takes priority
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Nursing Elites

ATI RN

Oncology Test Bank

1. A client is receiving rituximab. What assessment by the nurse takes priority?

Correct answer: A

Rationale: When a client is receiving rituximab, the nurse's priority assessment should be monitoring the blood pressure. Rituximab can lead to infusion-related reactions, such as hypotension. Therefore, assessing the client's blood pressure is crucial to detect and manage any potential adverse reactions promptly. While monitoring temperature, oral mucous membranes, and pain are essential aspects of care, they are not the priority when a client is receiving rituximab.

2. A patient who is undergoing consolidation therapy for the treatment of leukemia has been experiencing debilitating fatigue. How can the nurse best meet this patients needs for physical activity?

Correct answer: B

Rationale: For patients undergoing consolidation therapy for leukemia, severe fatigue is a common side effect of treatment due to factors such as anemia, decreased nutritional intake, and the body’s response to chemotherapy. While exercise is beneficial, the patient's fatigue may limit their ability to engage in strenuous activity. Assisting the patient to sit in a chair during awake times is a practical way to encourage some physical activity while respecting their fatigue levels. This intervention helps prevent complications associated with immobility, such as muscle atrophy and venous stasis, without overwhelming the patient. It allows the patient to engage in light activity that is manageable and promotes recovery.

3. A client is receiving chemotherapy for the treatment of cancer. The nurse monitors the client for which of the following signs indicating a complication of the therapy?

Correct answer: C

Rationale: The correct answer is C: Elevated temperature. A fever may indicate infection, a common and serious complication of chemotherapy, requiring prompt intervention. Choice A, Alopecia, is a common side effect of chemotherapy but not a sign of a complication. Choice B, Weight gain, is not typically a sign of a complication of chemotherapy. Choice D, Decreased hemoglobin level, may occur due to chemotherapy but is not a direct sign of a complication.

4. A nurse is caring for a patient with myelodysplastic syndrome (MDS) who is receiving erythropoietin therapy. What should the nurse monitor to evaluate the effectiveness of this treatment?

Correct answer: B

Rationale: Erythropoietin therapy is used to stimulate the production of red blood cells in patients with myelodysplastic syndrome (MDS), a disorder characterized by ineffective blood cell production, including red blood cells. The primary goal of erythropoietin therapy is to increase red blood cell count, improving the patient's oxygen-carrying capacity and reducing symptoms of anemia, such as fatigue and weakness. Monitoring hemoglobin levels is the best way to evaluate the effectiveness of this therapy because it directly reflects the patient's red blood cell count and the success of erythropoiesis (red blood cell production).

5. 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?

Correct answer: C

Rationale: Hydroxyurea is effective in lowering the platelet count for patients with ET.

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