A client with leukemia who is receiving chemotherapy has a hemoglobin of 10 g/dL (6.21 mmol/L), hematocrit of 38% (0.38 volume fraction), a white blood cell (WBC) count of 2,500/mm³ (2.5 x 10⁹/L), and a platelet count of 250,000/mm³ (250 x 10⁹/L). Which is the most significant problem that the practical nurse (PN) should consider when planning care for this client?

Reference Range:

Hemoglobin (Hgb): 14 to 18 g/dL (8.69 to 11.17 mmol/L)

Hematocrit (Hct): 42% to 52% (0.42 to 0.52 volume fraction)

White Blood Cell (WBC): 5,000 to 10,000/mm³ (5 to 10 x 10⁹/L)

Platelets: 150,000 to 400,000/mm³ (150 to 400 x 10⁹/L)

Nausea.

Fatigue.

Infection.

Bleeding.

Answer and Explanation

The Correct Answer is C

Choice A reason: Nausea is a common side effect of chemotherapy and can significantly affect the client's quality of life. Managing nausea is important for ensuring the client can maintain adequate nutrition and hydration. However, it is not the most critical problem when planning care for a client with leukemia, as it does not pose an immediate threat to life compared to the risk of infection.
Choice B reason: Fatigue is another common issue experienced by clients undergoing chemotherapy. It can result from the treatment itself, the underlying disease, or anemia. While addressing fatigue is essential for improving the client's daily functioning and well-being, it is not the most urgent concern in this scenario. The client's significantly low WBC count poses a more immediate risk to their health.
Choice C reason: Infection is the most significant problem to consider when planning care for this client. The client's WBC count of 2,500/mm³ (2.5 x 10⁹/L) is well below the normal range, indicating leukopenia, which increases their susceptibility to infections. Clients with leukemia receiving chemotherapy are at a higher risk for infections due to both the disease and the treatment's impact on the immune system. Monitoring for signs of infection, implementing infection control measures, and providing prompt treatment if an infection is detected are critical to prevent severe complications.
Choice D reason: Bleeding is a potential concern for clients with leukemia, especially if platelet counts are low. However, in this case, the client's platelet count is within the normal range (250,000/mm³ or 250 x 10⁹/L). While it is important to monitor for bleeding, the immediate risk of infection due to the low WBC count is more pressing and requires prioritized attention.

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Correct Answer is B

Explanation

Choice A reason: There is no specific requirement to avoid upper body exercise on the day of a mammogram. While vigorous exercise might cause some temporary muscle discomfort, it does not impact the results of the mammogram. The primary concern is ensuring clear imaging of the breast tissue, not the effects of exercise.
Choice B reason: Clients are instructed not to use underarm deodorant on the day of a mammogram because deodorants, antiperspirants, powders, or lotions can contain metallic particles that may appear on the mammogram images as white spots. These spots can be mistaken for calcifications, leading to potential misinterpretation of the results or the need for additional imaging. Ensuring the client avoids using these products helps achieve the clearest possible images for accurate diagnosis.
Choice C reason: Avoiding aspirin for one week prior to a mammogram is not a standard instruction. Aspirin can affect blood clotting, and such instructions are typically given before surgical procedures rather than imaging tests. There is no direct impact of aspirin on the mammogram process or results.
Choice D reason: There is no requirement to avoid eating or drinking for 6 hours before a mammogram. This instruction is more relevant for procedures that involve anesthesia or sedation, where an empty stomach is necessary to reduce the risk of aspiration. Mammograms do not involve these risks, and clients can eat and drink as usual.

A. Ask if he understands the consequences of continuing to smoke. B. Encourage the client to substitute cigars for the cigarettes. C. Recommend an acupuncturist to assist with smoking cessation efforts. D. Reinforce information about consequences related to smoking and heart disease. E. Record the client's exact words in the electronic medical record.

Correct Answer is ["A","D","E"]

Explanation

Choice A reason: Asking if the client understands the consequences of continuing to smoke is essential for assessing his level of awareness about the risks associated with smoking, especially after a myocardial infarction. This step helps gauge the client's knowledge and can serve as a starting point for providing further education. It opens up a dialogue where the nurse can discuss the detrimental effects of smoking on cardiovascular health and the increased risk of recurrent heart attacks. Understanding the client's perspective and providing education can foster a more informed decision-making process and may encourage the client to consider quitting smoking.
Choice B reason: Encouraging the client to substitute cigars for cigarettes is not a recommended intervention. Cigars, like cigarettes, contain nicotine and other harmful chemicals. Substituting one form of tobacco for another does not reduce the health risks associated with smoking. Cigars can also lead to nicotine addiction and contribute to heart disease and other health issues. The goal should be to support the client in achieving complete smoking cessation rather than replacing one harmful habit with another. This approach does not align with evidence-based practices for promoting health and reducing cardiovascular risks.
Choice C reason: Recommending an acupuncturist to assist with smoking cessation efforts is an alternative therapy that some individuals may find beneficial. However, it should not be the first-line recommendation. Evidence-based strategies such as nicotine replacement therapy, medications, and counseling should be prioritized. Acupuncture can be considered as a complementary therapy in conjunction with these proven methods. It is important to provide the client with a range of options and support them in choosing the most effective and suitable approach for smoking cessation. However, this option alone does not address the immediate need for education and support regarding the risks of continued smoking.
Choice D reason: Reinforcing information about the consequences related to smoking and heart disease is crucial. Education plays a significant role in helping the client understand the impact of smoking on cardiovascular health. Providing detailed information about how smoking contributes to heart disease, the benefits of quitting, and the potential for improved outcomes can motivate the client to consider cessation. Reinforcement of this information helps to ensure that the client is fully aware of the serious health risks and the importance of quitting smoking to prevent further cardiovascular events.
Choice E reason: Recording the client's exact words in the electronic medical record is important for accurate documentation and continuity of care. This documentation provides a clear record of the client's statements, attitudes, and intentions regarding smoking. It ensures that all members of the healthcare team are informed of the client's position and can tailor their interventions accordingly. Accurate documentation also helps in tracking the client's progress and responses to interventions over time, facilitating a coordinated and comprehensive approach to care.

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Naxlex Comprehensive Predictor Exams

The practical nurse (PN) is preparing a client for a mammogram. Which instruction should the PN provide the client?

Correct Answer is B

Explanation

A male client who recently had a myocardial infarction tells the practical nurse (PN) that he refuses to give up his habit of smoking two packs of cigarettes daily. Which intervention(s) should the PN implement? Select all that apply.

Correct Answer is ["A","D","E"]

Explanation

A client with a tentative diagnosis of a gastric ulcer is scheduled for an endoscopy. Which concern should the practical nurse (PN) expect this client to have after the procedure is completed?

A client with psoriasis reports an increase in symptoms. Which action should the practical nurse (PN) implement?

A client with a fractured femur is placed in Buck's traction to immobilize the fracture. When transporting this client to another room, how should the practical nurse (PN) handle the traction?

A client is admitted with the diagnosis of possible pneumonia, and laboratory studies are prescribed to rule out the etiology. Which specimen should the practical nurse (PN) collect prior to the beginning of antibiotic therapy?

A client fell 20 feet (6.1 meters) from the tree stand while deer hunting, sustaining a ruptured spleen. The client is receiving blood and fluid replacement while being prepared for a splenectomy. Which finding should the practical nurse (PN) report to the charge nurse?

A client is recovering from a transurethral prostatectomy. Which activity should the practical nurse (PN) reinforce with the client to limit until after the first postoperative visit?