A protocol of chlorambucil (Leukeran) and prednisone is prescribed for Mr. Johnson. The most serious delayed toxic symptom of antileukemic chemotherapy is

Correct Answer: A

Rationale: The correct answer is A) bone marrow depression. In the context of antileukemic chemotherapy like chlorambucil and prednisone, the most serious delayed toxic symptom is bone marrow depression. This is because these drugs target rapidly dividing cells, which include not only cancer cells but also normal cells in the bone marrow responsible for producing blood cells. Option B) loss of hair and libido is a common side effect of chemotherapy, but it is not the most serious delayed toxic symptom in this case. Option C) periorbital edema is not typically associated with chlorambucil and prednisone chemotherapy. Option D) orange urine may be a side effect of certain medications but is not the most serious delayed toxic symptom of antileukemic chemotherapy. In an educational context, understanding the potential toxicities and side effects of chemotherapy is crucial for healthcare professionals managing patients with hematologic malignancies. Recognizing the most serious toxicities can help in monitoring patients for potential complications and providing timely interventions to minimize risks and improve outcomes.

Correct Answer: C

Rationale: The correct answer is option C: The new RN primes the transfusion set using 5% dextrose in lactated Ringer's solution. This action is incorrect because blood products like PRBCs should only be infused using normal saline (0.9% sodium chloride) and never with dextrose solutions. Infusing blood products with dextrose can cause the red blood cells to hemolyze, leading to serious complications for the patient. Option A is not the best practice as there is no need to wait 20 minutes after obtaining PRBCs before starting the infusion. Timely administration is crucial for patients requiring blood transfusions. Option B is suboptimal because a larger gauge catheter (usually 18-20 gauge) is recommended for blood transfusions to prevent hemolysis and ensure a smooth flow of blood products. Option D is not ideal because it is important for the nurse to provide accurate and reassuring information to the patient about the transfusion process. Informing the patient about potential risks is part of informed consent and should be done in a supportive and educational manner. Educationally, this question highlights the importance of proper blood transfusion practices, including the choice of IV solution, catheter gauge selection, and patient education. Nurses must adhere to evidence-based guidelines to ensure patient safety and positive outcomes during blood transfusions.

Correct Answer: A

Rationale: The correct answer is A) Use Hemoccult slides to obtain stool specimens because this task involves collecting a sample for testing, which is within the scope of practice for a nursing assistant. Nursing assistants are trained to perform basic tasks like specimen collection under the supervision of licensed healthcare professionals. Option B) Having the client sign a colonoscopy consent form requires explanation of the procedure, potential risks, and benefits, which is beyond the nursing assistant's scope of practice. Option C) Administering PEG-ES bowel preparation involves medication administration, which should be done by a licensed nurse who has the knowledge and training to assess the client's response and manage any potential side effects. Option D) Checking for allergies to contrast dye or shellfish requires knowledge of allergies, potential reactions, and appropriate interventions, which should be done by a licensed healthcare provider who can make clinical judgments. Educationally, understanding the scope of practice for different healthcare team members is crucial for effective delegation and ensuring safe and efficient patient care. Nursing assistants play a vital role in supporting the healthcare team by performing delegated tasks within their scope of practice, contributing to optimal patient outcomes.

Correct Answer: A

Rationale: The correct answer is A) The client with digoxin toxicity. When a client presents with pancytopenia, it indicates a decrease in all three blood cell types (red blood cells, white blood cells, and platelets). Digoxin toxicity can cause bone marrow suppression leading to pancytopenia. By rooming the new client with digoxin toxicity, you are pairing them with a peer who shares a common underlying cause for their condition, potentially facilitating understanding and support between the two individuals. The other options are incorrect because they do not have a direct correlation to pancytopenia. The client with viral pneumonia is experiencing a respiratory infection, the client with shingles has a viral skin rash, and the client with cellulitis has a bacterial skin infection. These conditions do not typically cause pancytopenia and would not provide the same level of shared experience and potential mutual support as the client with digoxin toxicity. In an educational context, this question highlights the importance of understanding the underlying causes of hematologic disorders and their potential implications for patient care and management. It also emphasizes the significance of creating supportive environments for clients with similar health conditions to foster empathy, shared experiences, and potentially better outcomes through peer support.

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.