A nurse is caring for a client who is receiving cisplatin for the treatment of ovarian cancer. The client's most recent complete blood count (CBC) is shown in the table below. It is important for the nurse to consider which of the following for the client?

- WBC: 1,400/mm³

- RBC: 4.3 x 10¹²/L

- Hgb: 12.1 g/dL

- Hct: 36.5%

- Platelets: 170,000/mm³

- Albumin: 4.5 g/dL

Given the options:

The client should receive an erythropoiesis-stimulating agent.

The client should receive a diet with increased protein.

The client has an increased risk of infection.

The client has an increased risk for bleeding.

Answer and Explanation

The Correct Answer is C

Choice A reason: The use of erythropoiesis-stimulating agents (ESAs) is indicated for anemia due to chemotherapy¹. However, the client's hemoglobin (Hgb) level is 12.1 g/dL, which is within the normal range (normal: 12-15.5 g/dL for women). Therefore, administering an ESA is not indicated based on the Hgb level provided.

Choice B reason: A diet with increased protein can be beneficial for patients undergoing chemotherapy as it helps in tissue repair and immune system function. However, the client's albumin level is 4.5 g/dL, which falls within the normal range (normal: 3.4-5.4 g/dL), suggesting adequate protein intake. Thus, there is no indication that the client requires an increased protein diet based on the albumin level provided.

Choice C reason: The client's white blood cell (WBC) count is 1,400/mm³, which is below the normal range (normal: 4,500-11,000/mm³). This condition, known as leukopenia, significantly increases the risk of infection³. Therefore, the nurse should prioritize monitoring for signs of infection and implementing infection control measures.

Choice D reason: The client's platelet count is 170,000/mm³, which is within the normal range (normal: 150,000-450,000/mm³). Although cisplatin can cause thrombocytopenia, the current platelet count does not indicate an increased risk for bleeding⁴. Therefore, this choice is not correct based on the platelet count provided.

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Correct Answer is C

Explanation

Choice A reason:
Adjusting the rate of the bladder irrigant may be necessary if there is an issue with the flow or the amount of fluid, but it is not the first action to take. The nurse must first ensure that there is no mechanical obstruction causing the lack of drainage.

Choice B reason:
Irrigating the catheter could be the next step if checking the tubing does not resolve the issue. However, it is not the first action to take because if there is a kink in the tubing, irrigation will not be effective and could potentially cause harm.

Choice C reason:
The first action the nurse should take is to check the tubing for kinks because this is a common and easily correctable cause of obstruction in catheter drainage. If the tubing is kinked, straightening it may allow urine to drain properly.

Choice D reason:
Notifying the provider is important if the other interventions do not resolve the issue. However, it is not the first action to take. The nurse should first perform basic troubleshooting steps to identify and correct any simple mechanical issues with the catheter system.

A. Thyroid hormones B. NSAIDs C. Anticoagulants D. Cardiac glycosides

Correct Answer is A

Explanation

Choice A reason:
Thyroid hormones, particularly when taken in excess, can lead to bone loss and increase the risk of osteoporosis. This is because thyroid hormones can stimulate bone resorption, which is the process where bone tissue is broken down and the minerals are released into the bloodstream.

Choice B reason:
NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are not typically associated with an increased risk of osteoporosis. While long-term use of NSAIDs can have various side effects, they do not directly contribute to bone density loss or osteoporosis.

Choice C reason:
Anticoagulants, such as warfarin, have been associated with an increased risk of osteoporotic fractures. However, the evidence is not as strong as it is for other medications like corticosteroids or thyroid hormones.

Choice D reason:
Cardiac glycosides, used to treat heart conditions, have not been shown to be a direct risk factor for osteoporosis. While they affect heart muscle contractions, they do not have a known impact on bone metabolism.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is 5 hours postoperative following a transurethral resection of the prostate (TURP). The nurse notes that the client's indwelling urinary catheter has not drained in the past hour. Which of the following actions should the nurse take first?

Correct Answer is C

Explanation

A nurse is reviewing risk factors for osteoporosis with a group of nursing students. The nurse should include that which of the following types of medication therapy is a risk factor for osteoporosis?

Correct Answer is A

Explanation

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