Which of the following nursing diagnoses (nursing problem) would be of highest priority for the patient hospitalized for a bone marrow transplant to treat relapse of acute myelocytic leukemia?
Disturbed body image
Anxiety
Ineffective protection
Imbalanced nutrition: less than body requirements
The Correct Answer is C
Choice A reason: While disturbed body image is a concern, it is not the highest priority for a patient undergoing a bone marrow transplant.
Choice B reason: Anxiety is important to address but does not take precedence over physical health concerns in the immediate post-transplant period.
Choice C reason: Ineffective protection is the highest priority because patients undergoing bone marrow transplants have compromised immune systems and are at high risk for infection.
Choice D reason: Imbalanced nutrition is a concern but is secondary to the risk of infection in the immediate care of a patient post bone marrow transplant.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: While painful and red-tinged urination is a concern, it is not directly related to the intravenous pyelogram procedure.
Choice B reason: The end of the menstrual period is not relevant to the intravenous pyelogram procedure.
Choice C reason: Drinking fluids is generally encouraged but does not need to be reported unless it is restricted before the procedure.
Choice D reason: The client's allergy to shellfish is important to report because the contrast dye used in an intravenous pyelogram may contain iodine, which can cause a reaction in people with shellfish allergies.
Correct Answer is C
Explanation
Choice A reason: Fluid volume status affects preload, not afterload.
Choice B reason: Atrial contraction contributes to filling of the ventricles, not to afterload.
Choice C reason: Afterload is the resistance left ventricular must overcome to circulate blood, which is accurately described as resistance to blood flow.
Choice D reason: Myocardial compliance refers to the elasticity of the heart muscle, which affects how the heart fills, not the resistance it must overcome to eject blood.
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