The nurse on the oncology unit is caring for a patient receiving chemotherapy for treatment of leukemia.
Which patient finding is the nurse's priority for implementing interventions?

Pain 6/10 from mucositis and oral tissue injury.

Weakness and fatigue with activity.

Blood pressure 90/64 mmHg, pulse 102 beats per minute, oral temperature 38.5 degrees C.

Scattered ecchymosis and petechiae noted on arms.

Answer and Explanation

The Correct Answer is C

Choice A rationale

Pain from mucositis and oral tissue injury is a significant concern for patients undergoing chemotherapy. However, it is not typically life-threatening and can be managed with appropriate pain relief measures and oral care.

Choice B rationale

Weakness and fatigue with activity are common side effects of chemotherapy and the disease process itself. While these symptoms impact the patient's quality of life, they do not usually require urgent intervention.

Choice C rationale

Blood pressure of 90/64 mmHg, pulse of 102 beats per minute, and oral temperature of 38.5 degrees Celsius suggest possible sepsis or severe infection. These vital signs indicate an urgent need for intervention to prevent further deterioration and potentially life-threatening complications.

Choice D rationale

Scattered ecchymosis and petechiae are signs of thrombocytopenia (low platelet count), which is a common complication of leukemia and its treatment. While important to monitor and manage, these findings are not typically as urgent as signs of sepsis or severe infection.

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Correct Answer is C

Explanation

Choice A rationale

Dosimeter badges are used for monitoring radiation exposure, not for handling chemotherapy. They are worn by healthcare workers working in areas with ionizing radiation to track their cumulative exposure and ensure it stays within safe limits.

Choice B rationale

Lead aprons are also used to protect against radiation exposure, not chemotherapy. They shield the body from ionizing radiation but do not provide protection from the cytotoxic effects of chemotherapy agents.

Choice C rationale

Personal protective equipment (PPE), including gloves and gowns, is essential for safely handling chemotherapy drugs to prevent skin contact and inhalation of hazardous chemicals. This reduces the risk of exposure to these toxic agents, protecting both the nurse and the patient.

Choice D rationale

Chemotherapy waste should be disposed of in designated chemotherapy waste containers, not in standard sharps containers. These specialized containers ensure that hazardous waste is handled according to safety regulations, reducing the risk of environmental contamination and exposure.

A. Hypoventilation and hypoglycemia. B. Intermittent episodes of angina and arrhythmias. C. Weight gain of five pounds in one week. D. Normal body temperature and pulse rate.

Correct Answer is D

Explanation

Choice A rationale

Hypoventilation and hypoglycemia are symptoms of untreated hypothyroidism rather than an indicator of effective levothyroxine treatment.

Choice B rationale

Angina and arrhythmias can occur if the dosage of levothyroxine is too high, indicating overmedication rather than effective treatment.

Choice C rationale

Weight gain is a sign of undertreated hypothyroidism and would indicate that the medication is not effective in managing the condition.

Choice D rationale

Normal body temperature and pulse rate indicate that levothyroxine is effectively managing the symptoms of hypothyroidism, as it restores metabolic function to normal levels. .

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The nurse on the oncology unit is caring for a patient receiving chemotherapy for treatment of leukemia.Which patient finding is the nurse's priority for implementing interventions?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is D

Explanation

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The nurse on the oncology unit is caring for a patient receiving chemotherapy for treatment of leukemia.
Which patient finding is the nurse's priority for implementing interventions?