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 C

Explanation

Choice A reason: Positioning the client supine and flat is not specifically aimed at preventing phantom pain. Phantom pain is a common issue after amputations, and its management typically involves medications, therapies, and psychological support rather than positioning. Keeping the client supine and flat may not address the immediate concerns of bleeding and swelling, which are critical in the initial postoperative period.
Choice B reason: Turning the client prone every 2 hours to prevent hip flexion contractures is an important intervention to prevent contractures after a below-the-knee amputation. However, this is not the immediate priority immediately following surgery. The primary concern in the immediate postoperative period is to manage bleeding, swelling, and ensuring proper healing of the residual limb.
Choice C reason: Elevating the residual limb on pillows to prevent bleeding and swelling is the most crucial intervention immediately after a below-the-knee amputation. Elevation helps reduce edema, promote venous return, and minimize the risk of postoperative bleeding. Proper elevation also supports the healing process of the surgical site. This intervention addresses the immediate needs of the client and helps prevent complications in the critical early stages after surgery.
Choice D reason: Positioning the residual limb below the heart to promote healing for prosthetic fitting is not recommended in the immediate postoperative period. Keeping the limb elevated is more beneficial to reduce swelling and manage bleeding. The focus in the immediate phase is to ensure proper healing and prevent complications, with considerations for prosthetic fitting coming later in the rehabilitation process.

A. Initiate contact isolation precautions. B. Explain the need to keep the affected areas dry. C. Prepare the client for allergen testing. D. Review stress reduction strategies with the client.

Correct Answer is D

Explanation

Choice A reason: Initiating contact isolation precautions is not necessary for psoriasis. Psoriasis is not an infectious or contagious condition, so isolation is not required. The focus should be on managing symptoms and providing appropriate care to alleviate the client's discomfort.
Choice B reason: Explaining the need to keep the affected areas dry is not an appropriate action for psoriasis management. Psoriasis is characterized by dry, scaly patches of skin, and keeping the areas dry may worsen the condition. It is important to keep the skin moisturized and hydrated to reduce flaking and discomfort.
Choice C reason: Preparing the client for allergen testing is not relevant in this context. Psoriasis is an autoimmune condition, not an allergic reaction. Allergen testing is not typically used in the diagnosis or management of psoriasis. The focus should be on addressing factors that can exacerbate symptoms, such as stress, infections, and certain medications.
Choice D reason: Reviewing stress reduction strategies with the client is the most appropriate action. Stress is known to be a significant trigger for psoriasis flare-ups. By helping the client identify and implement stress reduction techniques, the PN can assist in managing the client's symptoms and improving their overall well-being. Techniques such as mindfulness, relaxation exercises, and counseling can be beneficial in reducing stress and minimizing psoriasis symptoms.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The practical nurse (PN) is caring for a client with type 1 diabetes mellitus. Which intervention should the PN implement immediately after a below-the-knee (BKA) amputation due to gangrene?

Correct Answer is C

Explanation

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

Correct Answer is D

Explanation

A client is receiving a unit of packed red blood cells (PRBCs). Which is the first action the practical nurse (PN) should take if the client begins to shake and reports feelings of nausea and vomiting?

The practical nurse (PN) is monitoring a client who was admitted following a motor vehicle collision (MVC). The PN is unable to auscultate breath sounds on the left side, and the healthcare provider is notified. While awaiting the arrival of the healthcare provider, which action should the PN take?

A client with Crohn's disease has a serum sodium level of 130 mEq/L (130 mmol/L). Which foods should the practical nurse (PN) encourage the client to eat? Reference Range: Sodium: 136 to 145 mEq/L (136 to 145 mmol/L)

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.

A client is diagnosed with a seizure disorder and is completing testing before discharge from the healthcare facility. What information should the practical nurse (PN) reinforce to avoid the incidence of seizure episodes? Select all that apply.

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?

The practical nurse (PN) is performing a focused assessment on a client with hyperthyroidism. To confirm the presence of exophthalmos, which action should the PN include in the assessment?