Nursing Elites

1. The nurse should plan to implement which intervention in the care of a client experiencing neutropenia as a result of chemotherapy?

• A. Restrict all visitors.
• B. Restrict fluid intake.
• C. Teach the client and family about the need for hand hygiene.
• D. Insert an indwelling urinary catheter to prevent skin breakdown.

Correct answer: C

Rationale: In clients experiencing neutropenia, particularly due to chemotherapy, the immune system is significantly compromised, increasing the risk of infections. Hand hygiene is one of the most effective methods for preventing the spread of pathogens that can lead to infections. Teaching both the client and their family about the importance of frequent and proper handwashing helps create a safer environment and reduces the risk of infections, which can be critical in neutropenic patients.

2. A client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing which condition?

• A. Rupture of the bladder
• B. The development of a vesicovaginal fistula
• C. Extreme stress caused by the diagnosis of cancer
• D. Altered perineal sensation as a side effect of radiation therapy

Correct answer: B

Rationale: The correct answer is B. A vesicovaginal fistula is an abnormal connection between the bladder and the vagina, leading to the passage of urine through the vagina. This condition can occur due to various reasons, including radiation therapy. Choice A, rupture of the bladder, is incorrect because a rupture would present with more severe symptoms and is not consistent with the client's description. Choice C, extreme stress, is incorrect as it does not explain the physical symptom of voiding through the vagina. Choice D, altered perineal sensation, is incorrect as it does not involve a direct connection between the bladder and the vagina.

3. A client is having a catheter placed to deliver chemotherapy beads into a liver tumor via the femoral artery. What action by the nurse is most important?

• A. Assessing the client’s abdomen beforehand.
• B. Ensuring that informed consent is on the chart.
• C. Marking the client’s bilateral pedal pulses.
• D. Reviewing client teaching done previously.

Correct answer: B

Rationale: Before any invasive procedure, such as placing a catheter to deliver chemotherapy beads into a liver tumor, it is essential to ensure that informed consent has been obtained from the client. This is a legal and ethical requirement that ensures the client understands the procedure, its risks, benefits, and alternatives. Ensuring that the signed consent is on the chart is the most important action the nurse can take before the procedure, as the procedure cannot legally proceed without it.

4. A client is diagnosed with multiple myeloma and the client asks the nurse about the diagnosis. The nurse bases the response on which description of this disorder?

• A. Altered red blood cell production
• B. Altered production of lymph nodes
• C. Malignant exacerbation in the number of leukocytes
• D. Malignant proliferation of plasma cells within the bone

Correct answer: D

Rationale: Multiple myeloma is a type of cancer that involves the malignant proliferation of plasma cells, which are a type of white blood cell that produces antibodies. In multiple myeloma, these abnormal plasma cells accumulate in the bone marrow, where they interfere with the production of normal blood cells and lead to the formation of tumors in the bones. This can cause bone pain, fractures, anemia, and impaired immune function. The excessive production of abnormal antibodies can also result in kidney damage and other systemic complications.

5. A nurse is caring for a patient whose diagnosis of multiple myeloma is being treated with bortezomib. The nurse should assess for what adverse effect of this treatment?

• A. Stomatitis
• B. Nephropathy
• C. Cognitive changes
• D. Peripheral neuropathy

Correct answer: D

Rationale: The correct answer is D: Peripheral neuropathy. Bortezomib, used in the treatment of multiple myeloma, is known to cause peripheral neuropathy as a significant adverse effect. Stomatitis (Choice A), which is inflammation of the mouth and lips, is not a common adverse effect of bortezomib. Nephropathy (Choice B), referring to kidney disease, is not a typical adverse effect of bortezomib. Cognitive changes (Choice C) are not a commonly reported adverse effect of bortezomib treatment.

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