A 22-year-old with stage I Hodgkin's disease is admitted to the oncology unit for radiation therapy. During the initial assessment, the client tells you, 'Sometimes I am afraid of dying.' Which response is most appropriate at this time?

Correct Answer: C

Rationale: The most appropriate response in this scenario is option C: "Tell me a little bit more about your fear of dying." This response demonstrates active listening and empathy, allowing the patient to express their emotions and concerns freely. It opens up a channel for the patient to share their feelings, which can help in addressing their fears and providing appropriate support. Option A is incorrect because it does not directly address the patient's specific fear of dying, which may require further exploration. Option B is inappropriate as it immediately jumps to suggesting medication without fully understanding the source of the patient's fear. Option D, while providing some reassurance, does not acknowledge or validate the patient's feelings of fear. In an educational context, it is crucial for healthcare providers to develop strong communication skills to effectively address the emotional needs of patients, especially in oncology settings where patients may experience significant distress. By actively listening and encouraging patients to express their emotions, healthcare providers can build trust, provide holistic care, and support patients through their treatment journey.

Correct Answer: A

Rationale: In this scenario, the correct answer is option A) A 36-year-old client with chronic renal failure who will need a subcutaneous injection of epoetin (Procrit). The LPN/LVN is most likely to be assigned to provide care and administer medications to this client because administering subcutaneous injections falls within the scope of practice for LPNs/LVNs. Administering epoetin requires knowledge of safe injection techniques, monitoring for adverse reactions, and understanding the medication's purpose in treating anemia associated with chronic renal failure. Option B) is incorrect because administering a blood transfusion requires a higher level of training and assessment skills that are typically within the RN's scope of practice. Option C) is incorrect because phlebotomy for a client with polycythemia vera involves specialized knowledge and monitoring of blood parameters, which is more aligned with the RN's role. Option D) is incorrect because a bone marrow aspiration is a more complex procedure requiring specialized training and assessment skills, typically performed by a physician or under direct supervision of a healthcare provider with advanced training. In an educational context, it is crucial for nursing students to understand the scope of practice for different levels of nursing personnel to ensure safe and effective patient care assignments. Understanding these roles and responsibilities helps in providing quality care while promoting interprofessional collaboration within the healthcare team.

Correct Answer: B

Rationale: In this scenario, the most immediate concern for the nurse is option B) The client has an oral temperature of 99.7°F. Explanation: 1. Correct Answer: A post-splenectomy patient is at risk for infection due to the spleen's role in filtering bacteria from the blood. A temperature of 99.7°F could indicate the presence of an infection, which is a serious concern considering the client's recent splenectomy. 2. Incorrect Options: A) Engaging in unprotected sex may raise concerns about sexually transmitted infections, but in this context, infection risk post-splenectomy is more critical. C) Abdominal pain with light palpation could be due to various reasons, but infection needs immediate attention. D) Occasional marijuana use, while important for overall health, is not the most immediate concern in this case. Educational Context: Understanding the increased risk of infection post-splenectomy is crucial for nurses in hematology/oncology. Assessing vital signs and promptly identifying signs of infection are essential to prevent serious complications in these patients. This question highlights the importance of prioritizing assessment findings based on the patient's unique health status.

Correct Answer: C

Rationale: In this scenario, assigning the LPN with 2 years of experience on the oncology unit to care for the client with a low ANC is the most appropriate choice. The LPN's familiarity with oncology unit protocols, procedures, and patient population makes them well-suited for this assignment. Their experience indicates they have likely received specific training in managing oncology patients, including those in protective isolation. Option A, the LPN from the same-day-surgery unit, lacks the specialized experience required for oncology care. Option B, the RN from the float pool with a background in surgical care, may not have the expertise needed for oncology patients. Option D, the RN from the ED, may also lack the specialized knowledge and skills necessary for caring for oncology patients in protective isolation. In an educational context, this question highlights the importance of matching staff expertise with the specific needs of patients in different care settings. It underscores the significance of experience and training in specialized areas like oncology, where patients often require complex care and interventions. By understanding the rationale behind staffing assignments, healthcare professionals can ensure the best possible outcomes for their patients.

Correct Answer: A

Rationale: In the context of a client with acute myelogenous leukemia undergoing induction chemotherapy, the most concerning assessment information is a serum potassium level of 7.8 mEq/L (Option A). Chemotherapy, especially in the induction phase, can lead to tumor lysis syndrome, causing a rapid release of intracellular contents into the bloodstream, including potassium. Hyperkalemia can lead to serious cardiac arrhythmias and must be addressed promptly. Option B, urine output less than intake by 400 mL, may indicate renal dysfunction, but hyperkalemia poses a more immediate threat to the client's life. Option C, inflammation and redness of oral mucosa, and Option D, ecchymoses present on the anterior trunk, are common manifestations of leukemia and its treatment but do not pose immediate life-threatening risks compared to severe hyperkalemia. Educationally, this question highlights the importance of prioritizing assessments in clients undergoing chemotherapy, specifically focusing on identifying potentially life-threatening complications. Understanding the significance of laboratory values and their implications for client care is crucial in providing safe and effective nursing interventions in oncology settings.