A client hospitalized for chemotherapy has a hemoglobin of 6.1 mg/dL (61 mmol/L). The client is symptomatic but refuses blood transfusions. What medication does the nurse prepare to administer?

Correct Answer: A

Rationale: In this scenario, the correct medication for the client with a hemoglobin of 6.1 mg/dL who refuses blood transfusions is option A) Epoetin alfa. Epoetin alfa is a medication that stimulates red blood cell production in the bone marrow, thereby increasing hemoglobin levels. This is crucial for a symptomatic client with a low hemoglobin level as it can improve oxygen-carrying capacity and alleviate symptoms like fatigue and weakness. Option B) Filgrastim is a medication that stimulates the production of white blood cells and is used to prevent infection in patients undergoing chemotherapy. It is not indicated for increasing hemoglobin levels. Option C) Mesna is a uroprotective agent used to prevent hemorrhagic cystitis in patients receiving ifosfamide or cyclophosphamide chemotherapy. It is not indicated for treating low hemoglobin levels. Option D) Dexrazoxane is a cardioprotective agent used to prevent anthracycline-induced cardiotoxicity in patients receiving doxorubicin or daunorubicin. It is not indicated for increasing hemoglobin levels. Educationally, understanding the rationale behind using Epoetin alfa in this context highlights the importance of managing hematologic side effects of chemotherapy. It also emphasizes the role of supportive care medications in improving quality of life for oncology patients. This case underscores the need for nurses to be knowledgeable about hematologic parameters and appropriate pharmacological interventions in oncology care.

Correct Answer: B

Rationale: In the context of a client with long-standing heart failure being treated for cancer and given ondansetron for nausea, the most important action for the nurse to take is to request a prescription for cardiac monitoring (Option B). This is crucial because ondansetron can prolong the QT interval on an electrocardiogram, which can be particularly risky for patients with heart failure due to the potential for arrhythmias and other cardiac complications. Assessing the client for a headache or dizziness (Option A) is important in general when administering medications like ondansetron, but it is not the most critical action in this specific case where cardiac monitoring takes precedence due to the client's underlying heart failure. Instructing the client to change positions slowly (Option C) is important for patients on certain medications to prevent orthostatic hypotension, but it is not the most crucial action given the potential cardiac effects of ondansetron in a patient with heart failure. Weighing the client daily before eating (Option D) is not directly related to the administration of ondansetron or the client's heart failure and cancer treatment. In an educational context, this question highlights the importance of understanding the potential side effects and interactions of medications, especially in patients with comorbidities such as heart failure. It emphasizes the need for nurses to prioritize actions based on the specific risks posed by medications in individual patient scenarios to ensure safe and effective care.

Correct Answer: A

Rationale: In this scenario, the correct answer is option A) Allowing a very tired client to skip oral hygiene and sleep. This action requires intervention from the nurse because maintaining proper oral hygiene is crucial for oncology patients to prevent complications such as oral mucositis, infections, and discomfort. Skipping oral hygiene can lead to oral health issues that could exacerbate the patient's condition and quality of life. Option B) Assisting clients with washing the perianal area every 12 hours is an appropriate task for the assistive personnel on an oncology unit to maintain skin integrity and prevent infections, so it does not require intervention. Option C) Helping the client use a soft-bristled toothbrush for oral care is also a suitable action as it is gentle on the sensitive oral tissues of oncology patients, promoting oral hygiene without causing harm. Option D) Reminding the client to rinse the mouth with water or saline is another important aspect of oral care for oncology patients to prevent dryness, infections, and mucositis. This action does not require intervention as it contributes to the overall oral hygiene regimen. In an educational context, this question highlights the importance of proper oral hygiene in oncology care and the role of healthcare professionals in ensuring that all aspects of patient care are addressed, even when tasks are delegated to assistive personnel. It underscores the critical thinking and decision-making skills required in nursing practice to prioritize patient needs and intervene when necessary to maintain patient well-being.

Correct Answer: C

Rationale: In the context of a client undergoing chemotherapy at risk for developing mucositis, the most appropriate nursing intervention to help manage this condition is option C: Teach the client to avoid spicy or acidic foods. This intervention is correct because spicy or acidic foods can further irritate and inflame the oral mucosa, exacerbating mucositis symptoms. By advising the client to avoid these types of foods, we aim to reduce irritation and promote healing of the oral mucosa during chemotherapy. Option A (Encourage the client to drink plenty of fluids) is a good general recommendation for overall health but may not directly address the specific issue of mucositis. Option B (Administer antifungal mouthwash) is not the best choice for managing mucositis unless there is a specific fungal infection present. Option D (Apply a topical anesthetic to the oral mucosa before meals) may provide symptomatic relief but does not address the underlying cause of mucositis. In an educational context, it's crucial for nurses to understand the pathophysiology of mucositis and how chemotherapy can lead to this condition. Teaching clients about proper oral care, including avoiding irritating foods, is essential in managing mucositis and improving their quality of life during cancer treatment.

Correct Answer: A

Rationale: In the context of oncology, the primary purpose of administering filgrastim to a client undergoing chemotherapy is to increase white blood cell production. Chemotherapy often leads to a decrease in white blood cell count, which can leave the patient vulnerable to infections due to compromised immune function. Filgrastim, a granulocyte colony-stimulating factor, works by stimulating the bone marrow to produce more white blood cells, specifically neutrophils, to help prevent infections and maintain immune function during chemotherapy. Option A, increasing white blood cell production, is the correct answer because it directly addresses the main goal of using filgrastim in this scenario. Options B, C, and D are incorrect because: B) Reducing the risk of infection is a secondary outcome of increasing white blood cell production with filgrastim, not the primary purpose. C) Enhancing red blood cell production is not the function of filgrastim; it primarily targets white blood cell production. D) Controlling chemotherapy-induced nausea and vomiting is typically managed with antiemetic medications and is not the primary purpose of administering filgrastim. Understanding the rationale behind using filgrastim in chemotherapy patients is crucial for nurses to provide safe and effective care, ensuring optimal outcomes for their oncology patients. By grasping the mechanism of action and primary purpose of medications, nurses can contribute significantly to the holistic care of patients undergoing chemotherapy.