A client with leukemia is receiving intravenous (IV) chemotherapy. Which assessment finding should the nurse report to the healthcare provider immediately?
Mild redness and tenderness at the IV site
Temperature of 99.8°F (37.7°C)
A small amount of blood in the IV tubing
Crackles and decreased breath sounds on auscultation
The Correct Answer is D
A) This choice is incorrect because mild redness and tenderness at the IV site are common findings and may indicate a local inflammatory response to the IV infusion.
B) This choice is incorrect because a temperature of 99.8°F (37.7°C) is slightly elevated but not a critical finding. The client's healthcare provider should be notified if the temperature is significantly elevated or if other symptoms are present.
C) This choice is incorrect because a small amount of blood in the IV tubing may be due to a minor infiltration or a common occurrence during IV administration. However, the nurse should monitor the IV site and flow rate closely.
D) This choice is correct. Crackles and decreased breath sounds on auscultation may indicate fluid overload or pulmonary edema, which could be a severe complication of IV chemotherapy. The healthcare provider should be notified immediately to assess the client's respiratory status and provide appropriate intervention.
Questions
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A) This choice is incorrect because stimulating the production of red blood cells in the bone marrow is not the primary purpose of immunotherapy.
B) This choice is incorrect because suppressing the immune system is not the primary purpose of immunotherapy in leukemia treatment. In fact, immunotherapy aims to enhance the immune system's ability to recognize and target cancer cells.
C) This choice is correct. Immunotherapy is used to boost the body's natural defense mechanisms, particularly the immune system, to better recognize and attack leukemia cells.
D) This choice is incorrect because inhibiting the growth of cancerous tumors is not the primary purpose of immunotherapy. Other treatment approaches, such as chemotherapy or targeted therapy, may be used for this purpose.
Questions
Correct Answer is B
Explanation
A) This choice is incorrect because stem cells used in transplantation are typically not extracted from the client's cancerous tissues.
B) This choice is correct. In a stem cell transplant, stem cells are collected from the bone marrow of a matched donor (allogeneic transplant) or the client themselves (autologous transplant). These stem cells are then infused into the client's bloodstream to replace the damaged bone marrow and produce healthy blood cells.
C) This choice is incorrect because stem cells used in transplantation are not taken from a tumor.
D) This choice is incorrect because stem cells used in transplantation are not harvested from the client's peripheral blood.
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