A client receiving high-dose chemotherapy who has bone marrow suppression has been receiving daily injections of epoetin alfa (Procrit). Which assessment finding indicates to the nurse that today's dose should be held and the health care provider notified?

Correct Answer: C

Rationale: The correct answer is C. A significant blood pressure change from $130 / 90 \mathrm{~mm} \mathrm{Hg}$ to $148 / 98 \mathrm{~mm} \mathrm{Hg}$ indicates a potential hypertensive crisis which could be a serious adverse effect of epoetin alfa. Holding the dose and notifying the healthcare provider is crucial to prevent further complications. A: A hematocrit of $28 \%$ is low but expected in bone marrow suppression and is not an immediate concern. B: A total white blood cell count of 6200 cells $/ \mathrm{mm} 3$ is within normal range and not a reason to hold the dose. D: A temperature change from $99^{\circ} \mathrm{F}$ to $100 \mathrm{~F}$ is a mild elevation and not directly related to epoetin alfa administration.

Correct Answer: B

Rationale: The correct answer is B: Starting a 24- to 48-hour urine specimen collection. The Schilling test is used to diagnose pernicious anemia by evaluating vitamin B12 absorption. Collecting urine over 24-48 hours helps measure excretion of radioactive B12, indicating absorption. Administering methylcellulose (A) is not part of the Schilling test. Maintaining NPO status (C) is unnecessary for this test. Starting a 72-hour stool specimen collection (D) is not relevant as the test primarily focuses on urine collection.

Correct Answer: B

Rationale: The correct answer is B: MCV (Mean Corpuscular Volume). MCV measures the average volume of red blood cells, with the normal range being 82-98 fl. This parameter helps in determining the size of red blood cells. MCH (Mean Corpuscular Hemoglobin) measures the average amount of hemoglobin in red blood cells, not size. MCHC (Mean Corpuscular Hemoglobin Concentration) measures the concentration of hemoglobin in red blood cells, not size. RDW (Red Cell Distribution Width) measures the variation in red blood cell size, not the average size. Therefore, MCV is the correct choice for determining the relative size of red blood cells.

Correct Answer: D

Rationale: Hypocupremia is a condition characterized by low levels of copper in the blood. Both osteoporosis and nephrotic disease can lead to copper deficiency, as they affect copper absorption and utilization. Similarly, sprue and celiac disease can also cause hypocupremia due to malabsorption issues. Therefore, the correct answer is D, as both A and B choices are conditions associated with hypocupremia. Choices C (cardiovascular disease, colon cancer) are not directly linked to copper deficiency, making them incorrect.

Correct Answer: B

Rationale: The correct answer is B: Clopidogrel. Patients sensitive to aspirin can take clopidogrel as it is an antiplatelet agent that works differently from aspirin, making it suitable for those who cannot tolerate aspirin. Sulfinpyrazone and ticlopidine are not recommended for patients sensitive to aspirin due to potential cross-reactivity. Choice D is incorrect as sulfinpyrazone is not recommended for aspirin-sensitive patients.