A nurse is providing care for a client undergoing treatment for leukemia. The client develops neutropenia. What is the nurse's priority intervention?

Administering pain medication for bone pain

Monitoring for signs of bleeding or bruising

Implementing strict isolation precautions

Avoiding invasive procedures and injections

Answer and Explanation

The Correct Answer is C

A) This choice is incorrect because administering pain medication for bone pain is important for the client's comfort, but it is not the priority in this situation. Neutropenia is characterized by a low neutrophil count, which can lead to an increased risk of infection.

B) This choice is incorrect because while monitoring for signs of bleeding or bruising is essential for a client with thrombocytopenia (low platelet count), it is not the priority in this scenario. Neutropenia increases the risk of infection, which is the primary concern.

C) This choice is correct. Implementing strict isolation precautions is the priority for a client with neutropenia. Neutropenia results in a decreased ability to fight off infections, so measures to prevent exposure to potential pathogens are crucial in reducing the risk of infection.

D) This choice is incorrect because avoiding invasive procedures and injections is a precaution for clients with thrombocytopenia, not specifically neutropenia. While both conditions involve low blood cell counts, the risk of infection is the primary concern in neutropenia.

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Correct Answer is D

Explanation

A) This choice is incorrect because a bone marrow biopsy is not performed to remove a tumor mass. The purpose of the procedure is to obtain a sample of bone marrow tissue for diagnostic evaluation.

B) This choice is incorrect because assessing the presence of circulating cancer cells in the bloodstream is typically done through a blood test, not a bone marrow biopsy. The biopsy provides direct information about the condition of the bone marrow.

C) This choice is incorrect because evaluating the overall blood cell count and differential is typically done through a complete blood count (CBC) test, not a bone marrow biopsy. The biopsy provides more detailed information about the bone marrow and its cellular composition.

D) This choice is correct. The primary purpose of a bone marrow biopsy is to obtain a sample of bone marrow tissue for examination under a microscope. This allows healthcare professionals to assess the presence of abnormal cells, determine the type and extent of leukemia, and guide treatment decisions.

A. Mild redness and tenderness at the IV site B. Temperature of 99.8°F (37.7°C) C. A small amount of blood in the IV tubing D. Crackles and decreased breath sounds on auscultation

Correct Answer is D

Explanation

A) This choice is incorrect because mild redness and tenderness at the IV site are common findings and may indicate a local inflammatory response to the IV infusion.

B) This choice is incorrect because a temperature of 99.8°F (37.7°C) is slightly elevated but not a critical finding. The client's healthcare provider should be notified if the temperature is significantly elevated or if other symptoms are present.

C) This choice is incorrect because a small amount of blood in the IV tubing may be due to a minor infiltration or a common occurrence during IV administration. However, the nurse should monitor the IV site and flow rate closely.

D) This choice is correct. Crackles and decreased breath sounds on auscultation may indicate fluid overload or pulmonary edema, which could be a severe complication of IV chemotherapy. The healthcare provider should be notified immediately to assess the client's respiratory status and provide appropriate intervention.

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A nurse is providing care for a client undergoing treatment for leukemia. The client develops neutropenia. What is the nurse's priority intervention?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with leukemia is undergoing a bone marrow biopsy for diagnosis and staging. The nurse should explain that the primary purpose of this procedure is to:

Correct Answer is D

Explanation

A client with leukemia is receiving intravenous (IV) chemotherapy. Which assessment finding should the nurse report to the healthcare provider immediately?

Correct Answer is D

Explanation

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