Nursing Elites

1. Nurse Ben is reviewing the laboratory results of a client undergoing chemotherapy. Which of the following values would require immediate intervention?

• A. Platelet count of 150,000/mm3
• B. White blood cell count of 6,000/mm3
• C. Hemoglobin level of 14 g/dL
• D. Absolute neutrophil count of 500/mm3

Correct answer: D

Rationale: An absolute neutrophil count of 500/mm3 indicates severe neutropenia, putting the client at high risk for infection. Neutrophils are crucial in fighting off infections; a low count increases susceptibility to infections. Platelet count, white blood cell count, and hemoglobin levels are within normal ranges and do not require immediate intervention in this scenario.

2. An older adult patient is undergoing diagnostic testing for chronic lymphocytic leukemia (CLL). What assessment finding is certain to be present if the patient has CLL?

• A. Increased numbers of blast cells
• B. Increased lymphocyte levels
• C. Intractable bone pain
• D. Thrombocytopenia with no evidence of bleeding

Correct answer: B

Rationale: An increased lymphocyte count (lymphocytosis) is always present in patients with CLL.

3. The nurse should plan to implement which intervention in the care of a client experiencing neutropenia as a result of chemotherapy?

• A. Restrict all visitors.
• B. Restrict fluid intake.
• C. Teach the client and family about the need for hand hygiene.
• D. Insert an indwelling urinary catheter to prevent skin breakdown.

Correct answer: C

Rationale: In clients experiencing neutropenia, particularly due to chemotherapy, the immune system is significantly compromised, increasing the risk of infections. Hand hygiene is one of the most effective methods for preventing the spread of pathogens that can lead to infections. Teaching both the client and their family about the importance of frequent and proper handwashing helps create a safer environment and reduces the risk of infections, which can be critical in neutropenic patients.

4. A 35-year-old male is admitted to the hospital complaining of severe headaches, vomiting, and testicular pain. His blood work shows reduced numbers of platelets, leukocytes, and erythrocytes, with a high proportion of immature cells. The nurse caring for this patient suspects a diagnosis of what?

• A. AML
• B. CML
• C. MDS
• D. ALL

Correct answer: D

Rationale: Acute Lymphocytic Leukemia (ALL) is a type of cancer where immature lymphocytes (a type of white blood cell) proliferate uncontrollably in the bone marrow. This leads to a reduction in the production of platelets, leukocytes, and erythrocytes, causing symptoms such as fatigue, anemia, bleeding tendencies, and increased susceptibility to infection. In ALL, leukemic cell infiltration into other organs is common, which can manifest as severe headaches (due to central nervous system involvement), vomiting, and testicular pain (due to infiltration of leukemic cells into the testes). These are hallmark signs of ALL, especially in younger patients.

5. A patient with Hodgkin lymphoma is receiving chemotherapy. Which side effect is the nurse most concerned about?

• A. Nausea and vomiting
• B. Alopecia
• C. Fatigue
• D. Peripheral neuropathy

Correct answer: D

Rationale: The correct answer is D, Peripheral neuropathy. This can be a serious and dose-limiting side effect of chemotherapy for Hodgkin lymphoma. Peripheral neuropathy can cause tingling, numbness, and pain in the hands and feet due to nerve damage. While nausea and vomiting, alopecia, and fatigue are common side effects of chemotherapy, they are not typically as concerning or dose-limiting as peripheral neuropathy in the context of Hodgkin lymphoma treatment.

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