A nurse is caring for a client with leukemia who has developed a cough and increased fatigue. What is the primary nursing intervention?

Administer an antitussive.

Place a cooling blanket on the client.

Evaluate the client for potential infection.

Medicate the client to relieve pain.

Answer and Explanation

The Correct Answer is C

A. Administer an antitussive: While an antitussive may help relieve a cough, it does not address the potential underlying cause of the cough, especially in a client with leukemia who may be at increased risk for infections or complications.

B. Place a cooling blanket on the client: Cooling blankets are typically used for fever management, but increased fatigue and a cough may indicate a more serious condition, such as infection, rather than just a need for temperature regulation.

C. Evaluate the client for potential infection: In clients with leukemia, the immune system is compromised, making them more susceptible to infections. A cough and increased fatigue could be signs of an infection, such as pneumonia, which requires prompt evaluation and intervention.

D. Medicate the client to relieve pain: While pain management is important, the primary concern is determining whether the client's symptoms are due to an infection or a serious complication. Pain management would come after evaluating the cause of the symptoms.

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Correct Answer is C

Explanation

A. "Monitor your temperature daily.": While monitoring temperature can be important, it is not the primary focus for a client with sickle cell anemia after an acute crisis. The main concern should be preventing dehydration and maintaining proper hydration.

B. "Apply cold compresses when they have pain.": Cold compresses can constrict blood vessels, potentially worsening pain during a sickle cell crisis. Heat is generally recommended for pain management in sickle cell anemia, as it helps dilate blood vessels and improve blood flow.

C. "Drink fluids multiple times every day.": Proper hydration is essential in sickle cell anemia to prevent dehydration, which can trigger a sickle cell crisis. Drinking fluids regularly helps maintain blood volume and reduces the risk of vaso-occlusion.

D. "Restrict outdoor activity to 1 hour per day.": There are no specific restrictions on outdoor activity unless the client is experiencing symptoms like fatigue or pain. Encouraging moderate activity, while avoiding extreme temperatures and overexertion, is more beneficial than strict time limits.

A. Teaching the client to use NSAIDs effectively B. Helping the client manage the opioid analgesic regimen C. Implementing distraction techniques D. Educating the client about the effective use of hot and cold packs

Correct Answer is B

Explanation

A. Teaching the client to use NSAIDs effectively: While NSAIDs can be used for mild to moderate pain, they are not the first choice for severe bone pain, especially in conditions like multiple myeloma. NSAIDs can also have adverse effects on kidney function, particularly in clients with compromised renal function, common in multiple myeloma.

B. Helping the client manage the opioid analgesic regimen: Severe bone pain in multiple myeloma is often best managed with opioids due to the intensity of the pain. The nurse should prioritize ensuring the client is using the opioid analgesic regimen effectively and safely to control the pain while minimizing side effects and risk of addiction.

C. Implementing distraction techniques: Distraction techniques can help with mild to moderate pain, but they are not sufficient for managing severe pain from conditions like multiple myeloma. Pharmacologic pain management is more appropriate for severe pain.

D. Educating the client about the effective use of hot and cold packs: Hot and cold packs can provide temporary relief for some types of pain, but they are not sufficient for managing the severe bone pain associated with multiple myeloma. Pharmacologic management is the priority intervention.

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A nurse is caring for a client with leukemia who has developed a cough and increased fatigue. What is the primary nursing intervention?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is discharging a client who has sickle cell anemia after an acute crisis episode. Which of the following instructions should the nurse include in the teaching?

Correct Answer is C

Explanation

A home health nurse is caring for a client with multiple myeloma. What intervention should the nurse prioritize when addressing the client's severe bone pain?

Correct Answer is B

Explanation

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