A nurse is caring for a client who has cancer and is undergoing chemotherapy.

Exhibits

Which of the following assessments indicates an improvement in the client's condition?

(Select all that apply.)

WBC count

Platelet count

Bleeding episodes

Oral health

Weight change

Answer and Explanation

Correct Answer : C,D

A.   In January, WBC count was 5,500/mm3. In February, it decreased to 4,500/mm3. A decrease in WBC count indicates worsening in the client's condition since they are prone to infections.
B.   In January, platelet count was 150,000/mm3. In February, it decreased slightly to 140,000/mm3. The slight decrease in platelet count may not necessarily indicate improvement but is relatively stable.
C.   In January, the client reported bleeding episodes from mouth ulcers. In February, the client reports no bleeding episodes. The absence of bleeding episodes indicates improvement in oral mucosal health and potential effectiveness of interventions.
D.   In January, the oral mucosa was inflamed. In February, there is noted improvement with less inflammation. Improved oral health with reduced inflammation indicates a positive response to interventions and potentially better oral hygiene practices.
E.   The client experienced weight loss of 1.5 kg (3.3 lb) from January to February. Weight loss may indicate ongoing challenges with nutrition despite efforts to increase food intake and manage symptoms.

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Correct Answer is D

Explanation

A. Removing the elastic bandages could lead to rapid systemic absorption of venom, increasing the severity of envenomation.
B. Pain management is important but secondary to administering anti-venom in cases of snakebite.
C. Discharging the client without proper evaluation and treatment for potential envenomation could lead to serious complications.
D. Administering the appropriate anti-venom is critical to neutralize venom effects and prevent worsening of symptoms.

A. Assessment of incision site B. Assessment of lower extremities C. Blood pressure D. Sodium level E. Creatinine level F. Bowel sounds G. Lung sounds

Correct Answer is ["A","B","E","F"]

Explanation

A. Tenderness in the area of the transplant incision can be a sign of inflammation or rejection.
B. Bilateral edema (swelling) in the lower legs can be a sign of fluid retention, which can occur with kidney dysfunction or rejection.
C. While high blood pressure can be a concern, it's not a specific indicator of transplant rejection in this scenario.
D. The sodium level is within normal limits in this case, decreasing the risk of a transplant rejection.
E. An elevated creatinine level can indicate worsening kidney function, which could be a sign of rejection.
F. Hypoactive bowel sounds in all four quadrants can suggest decreased blood flow or intestinal ischemia, which can be a complication of transplant rejection.
G. Normal lung sounds are not necessarily indicative of rejection.

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A nurse is caring for a client who has cancer and is undergoing chemotherapy. Exhibits Which of the following assessments indicates an improvement in the client's condition? (Select all that apply.)

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Naxlex Comprehensive Predictor Exams

A nurse in an emergency department is assessing a client who was bitten on the left leg by a poisonous snake. The client has placed elastic bandages snuggly above and below the bite marks and is in no apparent distress. Which of the following actions should the nurse take?

Correct Answer is D

Explanation

A nurse is caring for a client who is admitted to the emergency department for fatigue. Exhibits Which of the following findings indicate that the client may be experiencing transplant rejection? (Select all that apply).

Correct Answer is ["A","B","E","F"]

Explanation

Following an earthquake, patients are triaged by emergency medical personnel and transported to the emergency department (ED). Which patient will the nurse need to assess first?

A nurse is assisting with triaging clients following an explosion. Which of the following clients should the nurse identify as the highest priority?

The nurse teaches patients about drug therapy after a kidney transplant. Which statement by the patient would indicate a need for further instructions?

A nurse is planning care for a client who has leukemia and a platelet count of 130,000/mm3. Which of the following interventions should the nurse include in the plan of care?

A nurse is planning care for a client who is to undergone a stem cell transplant. Which of the following actions should the nurse plan to take?

The following interventions are part of the emergency department (ED) protocol for a patient who has been admitted with multiple bee stings to the hands. Which action should the nurse take first?

A home health nurse is interviewing a client and asks the client, "Have you or your family been exposed to any chemical liquids, fumes, lead, or unusual smells?" Which type of assessment is the nurse conducting?

A nurse is caring for a client who has cancer and is undergoing chemotherapy.

Exhibits

Which of the following assessments indicates an improvement in the client's condition?

(Select all that apply.)