A nurse is caring for a patient with cancer who is undergoing chemotherapy. The patient's white blood cell count is low.
The physician would most likely place him on which of the following medications?
Filgrastim (Neupogen).
Epoetin alfa (Epogen).
Vancomycin (Vancocin).
Vincristine (Oncovin).
The Correct Answer is A
Choice A rationale
Filgrastim (Neupogen) is a granulocyte colony-stimulating factor (G-CSF) that stimulates the production, maturation, and activation of neutrophils within the bone marrow. In patients undergoing chemotherapy with low white blood cell counts, particularly neutropenia, filgrastim is crucial for accelerating neutrophil recovery and reducing the incidence, severity, and duration of febrile neutropenia, thereby minimizing infection risk.
Choice B rationale
Epoetin alfa (Epogen) is an erythropoiesis-stimulating agent (ESA) that promotes red blood cell production. While chemotherapy can cause anemia, epoetin alfa specifically targets erythropoiesis and would not address a low white blood cell count. Its primary indication is for the treatment of chemotherapy-induced anemia, not neutropenia.
Choice C rationale
Vancomycin (Vancocin) is an antibiotic primarily used to treat serious bacterial infections, especially those caused by Gram-positive bacteria like methicillin-resistant Staphylococcus aureus (MRSA). It directly combats existing infections and does not stimulate the production of white blood cells. Administering an antibiotic would be appropriate for an infection, not to increase a low white blood cell count.
Choice D rationale
Vincristine (Oncovin) is a vinca alkaloid chemotherapy agent itself, commonly used in the treatment of various cancers. It works by inhibiting microtubule formation, leading to cell cycle arrest and apoptosis of rapidly dividing cells, including cancer cells. Administering another chemotherapy agent would further suppress bone marrow function, exacerbating a low white blood cell count, rather than improving it.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Encouraging bed rest without a thorough assessment could exacerbate complications, as prolonged immobility can lead to muscle atrophy, deep vein thrombosis, and pressure injuries. While rest may be part of a care plan, it is not the initial priority when a serious neurological complication is suspected.
Choice B rationale
Recommending increased physical activity without a definitive diagnosis or understanding of the cause of the back pain could be detrimental. If the pain is due to spinal cord compression, physical activity could worsen the compression, leading to irreversible neurological damage and further compromising mobility.
Choice C rationale
Prostate cancer frequently metastasizes to bone, particularly the spine. New-onset back pain in this context raises immediate concern for spinal cord compression, a oncologic emergency. Prompt assessment is crucial to identify neurological deficits, which, if untreated, can lead to permanent paralysis due to nerve damage.
Choice D rationale
While pain medication is important for comfort, it addresses the symptom without identifying the underlying cause. Administering analgesics without assessing for spinal cord compression could mask critical neurological signs, delaying necessary intervention and potentially leading to irreversible neurological deficits and worsening patient outcomes.
Correct Answer is D
Explanation
Choice A rationale
Monitoring temperature is crucial for detecting infection, which is a risk for all chemotherapy patients, but it is not the highest priority specifically for thrombocytopenia. Thrombocytopenia's primary risk is bleeding, not infection, although infections can exacerbate bleeding.
Choice B rationale
Monitoring for pathological fractures is primarily associated with bone metastases or certain bone diseases, not directly with thrombocytopenia. While some cancers can affect bone integrity, thrombocytopenia itself does not increase the risk of pathological fractures.
Choice C rationale
Ambulation three times daily is a general mobility intervention. For a client with thrombocytopenia, ambulation could increase the risk of injury and subsequent bleeding, especially if the platelet count is critically low. Therefore, it would not be the highest priority and might even be contraindicated depending on the severity.
Choice D rationale
Thrombocytopenia is a condition characterized by a low platelet count, which impairs the body's ability to form clots and stop bleeding. Therefore, monitoring the platelet count provides direct quantitative information on the severity of the bleeding risk and guides interventions to prevent hemorrhage, making it the highest priority. Normal platelet count is 150,000 to 450,000 platelets per microliter of blood.
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