Nursing Elites

1. Which laboratory test will the nurse use to determine whether filgrastim (Neupogen) is effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy?

• A. Platelet count
• B. Reticulocyte count
• C. Total lymphocyte count
• D. Absolute neutrophil count

Correct answer: D

Rationale: The correct answer is D, Absolute neutrophil count. Filgrastim (Neupogen) works by stimulating the production and function of neutrophils. Therefore, monitoring the Absolute neutrophil count is crucial to assess the effectiveness of filgrastim in increasing neutrophil levels. Choices A, B, and C are incorrect because platelet count, reticulocyte count, and total lymphocyte count do not directly reflect the effectiveness of filgrastim in increasing neutrophils, which are essential in fighting infections during chemotherapy.

2. The nurse notes scleral jaundice in a patient being admitted with hemolytic anemia. The nurse will plan to check the laboratory results for the

• A. Schilling test
• B. bilirubin level
• C. gastric analysis
• D. stool occult blood

Correct answer: B

Rationale: The correct answer is B: bilirubin level. Jaundice, characterized by scleral jaundice, is caused by the elevation of bilirubin levels associated with red blood cell hemolysis. Checking the bilirubin level in the laboratory results will help assess the severity of jaundice in the patient. Choices A, C, and D are incorrect because the Schilling test is used to assess vitamin B12 absorption, gastric analysis is used to evaluate gastric function, and stool occult blood is used to detect hidden blood in the stool, which are not directly related to evaluating jaundice in a patient with hemolytic anemia.

3. A healthcare provider reviews the laboratory data for an older patient. The healthcare provider would be most concerned about which finding?

• A. Hematocrit of 35%
• B. Hemoglobin of 11.8 g/dL
• C. Platelet count of 400,000/μL
• D. White blood cell (WBC) count of 2800/μL

Correct answer: D

Rationale: A low white blood cell (WBC) count in an older patient is concerning as it indicates a potential compromise in the patient's immune function. White blood cells are crucial for fighting infections and a low count could lead to an increased risk of infections. Hematocrit, hemoglobin, and platelet count are important parameters to assess, but a low WBC count takes priority in this case due to its direct impact on immune health.

4. Which task for a patient with neutropenia is appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/LVN)?

• A. Assessing the patient for signs and symptoms of infection
• B. Teaching the patient the purpose of neutropenic precautions
• C. Administering subcutaneous filgrastim (Neupogen) injection
• D. Developing a discharge teaching plan for the patient and family

Correct answer: C

Rationale: The correct answer is C because administering subcutaneous medications falls within the education and scope of practice of an LPN/LVN. Assessing the patient for signs and symptoms of infection, teaching the patient, and developing a discharge plan are tasks that require an RN level of education and scope of practice. LPN/LVNs can assist in patient care, but tasks that involve assessment, teaching, and care planning are typically the responsibility of an RN.

5. Which patient statement to the nurse indicates a need for additional instruction about taking oral ferrous sulfate?

• A. I will call my health care provider if my stools turn black.
• B. I will take a stool softener if I feel constipated occasionally.
• C. I should take the iron with orange juice about an hour before eating.
• D. I should increase my fluid and fiber intake while I am taking iron tablets.

Correct answer: A

Rationale: It is normal for the stools to appear black when a patient is taking iron, and the patient should not call the health care provider about this.

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