Nursing Elites

1. A month after receiving a blood transfusion, an immunocompromised client develops fever, liver abnormalities, a rash, and diarrhea. The nurse should suspect this client has:

• A. no relation to the blood transfusion.
• B. graft-versus-host disease (GVHD).
• C. myelosuppression.
• D. an allergic reaction to a recent medication.

Correct answer: B

Rationale: In this scenario, the symptoms of fever, liver abnormalities, rash, and diarrhea in an immunocompromised client a month after a blood transfusion are indicative of graft-versus-host disease (GVHD). GVHD occurs when white blood cells in donor blood attack the tissues of an immunocompromised recipient. This process can manifest within a month of the transfusion. While choices 1 and 4 are plausible, it is crucial for the nurse to consider the possibility of GVHD in immunocompromised transfusion recipients due to the significant risk. Myelosuppression, choice C, typically presents with decreased blood cell counts and is not consistent with the symptoms described. An allergic reaction to medication, choice D, would present with different manifestations such as itching, hives, or anaphylaxis, which are not described in the scenario.

2. A 27-year-old woman has delivered twins in the OB unit. The patient develops a condition of 5-centimeter diastasis recti abdominis. Which of the following statements is the most accurate when instructing the patient?

• A. Avoid sit-ups to prevent worsening the condition.
• B. Surgery is not always necessary for this condition.
• C. Guarding the abdominal region is important at this time.
• D. Antibiotics are not needed for diastasis recti abdominis.

Correct answer: C

Rationale: After experiencing diastasis recti abdominis, it is crucial for the patient to protect and guard the abdominal region to facilitate healing. Choice A is correct since avoiding sit-ups is important to prevent worsening the condition by increasing intra-abdominal pressure. Choice B is accurate as not all cases of diastasis recti abdominis require surgery; conservative management is often effective. Choice D is also correct as antibiotics are not indicated for diastasis recti abdominis since it is a separation of the abdominal muscles and not an infectious condition.

3. What is appropriate care for a client with neutropenia?

• A. Avoiding fresh fruits and vegetables.
• B. Having a private room.
• C. Wearing a mask when out of the room.
• D. Practicing routine hand washing.

Correct answer: C

Rationale: When a client has neutropenia, they have low white blood cell levels, which increases the risk of infections due to a weakened immune system. Wearing a mask when out of the room is crucial to reduce the risk of exposure to respiratory infections. Avoiding fresh fruits and vegetables is also necessary as they may contain harmful pathogens. Having a private room helps minimize exposure to pathogens and ensures that visitors are carefully screened for any signs of illness. Routine hand washing is essential to prevent the spread of infections in the healthcare setting, but the most direct measure to protect the client from potential infections is wearing a mask when out of the room.

4. A 46-year-old has returned from a heart catheterization and wants to get up to start walking 3 hours after the procedure. The nurse should:

• A. Tell the patient to remain with the leg straight for at least another hour and check the chart for activity orders.
• B. Allow the patient to begin limited ambulation with assistance.
• C. Recommend a physical therapy consultation for ambulation.
• D. Tell the patient to remain with the leg straight for another 6 hours and check the chart for activity orders.

Correct answer: A

Rationale: The correct answer is to tell the patient to remain with the leg straight for at least another hour after a heart catheterization before starting ambulation. This period allows for proper healing and reduces the risk of complications such as bleeding or hematoma formation at the catheter insertion site. Starting ambulation too soon can disrupt the healing process and lead to adverse events. Choice B is incorrect because limited ambulation should not be initiated shortly after the procedure as it may increase the risk of complications. Choice C is incorrect as physical therapy consultation is not typically necessary for initial ambulation post-heart catheterization; this can be managed by nursing staff. Choice D is incorrect as keeping the leg straight for 6 hours is excessive and unnecessary, potentially leading to complications such as deep vein thrombosis due to prolonged immobility.

5. Chemotherapeutic agents often produce a degree of myelosuppression including leukopenia. Leukopenia does not present immediately but is delayed several days or weeks because:

• A. the client's hemoglobin and hematocrit are normal.
• B. red blood cells are affected first.
• C. folic acid levels are normal.
• D. the current white cell count is not affected by chemotherapy.

Correct answer: D

Rationale: Leukopenia does not present immediately after chemotherapy because time is required to clear circulating cells before the effect on precursor cell maturation in the bone marrow becomes evident. Leukopenia is characterized by an abnormally low white blood cell count. The correct answer is D because the white cell count is not immediately affected by chemotherapy. Choices A, B, and C are incorrect as they pertain to red blood cells (hemoglobin and hematocrit), which are not directly related to the delayed onset of leukopenia.

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