A 67-year-old client who is receiving chemotherapy for lung cancer is admitted to the hospital with thrombocytopenia. While you are taking the admission history, the client makes these statements. Which statement is of most concern?

Correct Answer: B

Rationale: In this scenario, the most concerning statement made by the client is option B, "I take one aspirin every morning because of my history of angina." This statement is of utmost concern because aspirin, being a blood thinner, can exacerbate thrombocytopenia by further reducing the number of platelets in the blood, leading to an increased risk of bleeding. Option A, soft and dark brown bowel movements, could indicate gastrointestinal bleeding but is not as immediately concerning as the aspirin use in a thrombocytopenic patient. Option C, decreased appetite, is a common side effect of chemotherapy and may not directly impact the risk of bleeding in this context. Option D, increased bruising, is a common symptom of thrombocytopenia and, though relevant, is not as concerning as the client's aspirin use. Educationally, this question highlights the importance of understanding the potential interactions between medications and a patient's condition. It emphasizes the need for healthcare providers to be vigilant in assessing and addressing all aspects of a patient's history to provide safe and effective care, especially in oncology patients with complex treatment regimens.

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: B

Rationale: In the context of a long-term-care client with chronic lymphocytic leukemia experiencing activity intolerance due to weakness and anemia, delegating the task of checking the client's blood pressure and pulse rate after ambulation to a nursing assistant is the most appropriate choice. This task is within the scope of practice for a nursing assistant and directly relates to monitoring the client's physiological response to activity, which is crucial in assessing their tolerance levels and adjusting care plans accordingly. Option A, evaluating the client's response to normal activities of daily living, requires a higher level of clinical judgment and interpretation of findings, making it more suitable for a licensed nurse. Option C, determining self-care activities the client can do independently, involves assessing the client's functional abilities and should be done by a healthcare provider with a comprehensive understanding of the client's condition and limitations. Option D, assisting the client in choosing a diet to improve strength, involves nutritional assessment and individualized planning, which falls under the scope of a registered dietitian or a nurse with specific training in nutrition. Educationally, understanding the principles of delegation based on scope of practice and client needs is essential for effective healthcare team collaboration. By correctly delegating tasks, nurses can optimize efficiency, promote patient safety, and ensure quality care delivery tailored to each client's unique requirements. Nurses must possess a solid grasp of delegation principles to allocate responsibilities appropriately and maximize the effectiveness of the healthcare team.

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.