Which intervention is most important for the nurse to implement to prevent complications from tumor lysis syndrome during chemotherapy?

Applies pressure to all injection sites for 5 minutes

Monitors telemetry every hour during therapy

Ensures the client has a fluid intake of 3000 to 5000 mL/day

Assists the client in all ambulatory activities

Answer and Explanation

The Correct Answer is C

A. Applying pressure to injection sites helps reduce bleeding but does not directly prevent tumor lysis syndrome.
B. Monitoring telemetry is important for patients with potential cardiac issues but is not specifically related to preventing complications from tumor lysis syndrome.
C. Ensuring a high fluid intake of 3000 to 5000 mL/day helps dilute electrolytes and reduce the risk of acute kidney injury and other complications associated with tumor lysis syndrome, making this the most crucial intervention.
D. Assisting the client in ambulatory activities may support their overall well-being but does not address the prevention of tumor lysis syndrome.

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Correct Answer is ["12"]

Explanation

Calculate the dilution factor of the insulin solution:
- Dilution factor = Total volume / Insulin units
- Dilution factor = 150 mL / 75 units
- Dilution factor = 2 mL/unit
Determine the volume of the insulin solution needed to deliver 6 units/h:
- Volume = Desired dosage * Dilution factor
- Volume = 6 units/h * 2 mL/unit
- Volume = 12 mL/h

A. no bowel sounds noted during the assessment. B. an SPO2 which registers 90% while the client is asleep. C. increasing abdominal distention. D. a small amount of green-tinged fluid from the nasogastric tube.

Correct Answer is C

Explanation

A. The absence of bowel sounds shortly after surgery is not uncommon, especially within the first few hours, and does not necessarily indicate a complication at this time.
B. An SPO2 of 90% while the client is asleep may warrant attention, but it is not as critical as signs of a potential surgical complication. The nurse should assess the patient's respiratory status and consider interventions, but immediate notification to the surgeon is not required.
C. Increasing abdominal distention is a concerning sign that may indicate complications such as an anastomotic leak or bowel obstruction, which requires immediate evaluation and possible intervention by the surgeon.
D. A small amount of green-tinged fluid from the nasogastric tube is generally expected postoperatively and does not necessarily indicate a problem, thus does not require immediate notification of the surgeon.

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Which intervention is most important for the nurse to implement to prevent complications from tumor lysis syndrome during chemotherapy?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is to receive a continuous infusion of IV Insulin at 6 units per hour. Pharmacy delivers a concentration of 75 units of regular insulin in 150 mL of NSS. At what rate should the nurse set the IV pump?

Correct Answer is ["12"]

Explanation

The nurse is caring for a client who had a bowel resection 2 hours ago for adenocarcinoma removal. It would be necessary for the nurse to immediately notify the surgeon if the client's assessment revealed:

Correct Answer is C

Explanation

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