After receiving change-of-shift report about all of these clients, which one will you assess first?

Correct Answer: D

Rationale: In this scenario, the correct answer is D) A 69-year-old with chemotherapy-induced neutropenia who has an elevated oral temperature. This client should be assessed first because neutropenia (low white blood cell count) puts them at high risk for infections, and an elevated temperature could indicate the presence of an infection, which is a medical emergency in this case. Option A, the 26-year-old with thalassemia major, is stable and scheduled for a blood transfusion, which is not an immediate concern. Option B, the 44-year-old with sickle cell crisis awaiting a CT scan, is also stable for the moment and can wait for assessment. Option C, the 50-year-old with non-Hodgkin's lymphoma expressing emotional distress, while important, does not present an immediate physiological threat that requires urgent assessment compared to the risk of infection in the neutropenic patient. Educationally, this question highlights the importance of prioritizing patient care based on the urgency of the situation and the potential risks involved. It reinforces the significance of recognizing signs of infection in immunocompromised patients and the need for prompt assessment and intervention in such cases to prevent further complications.

Correct Answer: D

Rationale: In the context of a client admitted with multiple myeloma, the most immediate implication for the client's care is option D) The client is unable to plantarflex the feet. This finding indicates a potential complication of multiple myeloma known as spinal cord compression, which is a medical emergency requiring urgent intervention to prevent permanent neurological damage. Option A) The client complaining of chronic bone pain is a common symptom of multiple myeloma, but it does not indicate an immediate need for intervention. Option B) Elevated blood uric acid levels can occur in multiple myeloma due to increased cell turnover but do not pose an immediate threat. Option C) Bence-Jones protein in the urine is a hallmark of multiple myeloma, but its presence does not require immediate action compared to spinal cord compression. In an educational context, understanding the acute complications of multiple myeloma is crucial for nurses and healthcare providers to prioritize care and intervene promptly to prevent serious consequences for the patient. Recognizing signs of spinal cord compression, such as the inability to plantarflex the feet, can lead to timely assessment, imaging, and treatment to ensure the best outcomes for the client.

Correct Answer: C

Rationale: In this scenario, the best option to delegate to a newly graduated RN with a 6-week orientation to the unit is option C) Infusion of D5.45% normal saline at 125 mL/hour to the client. This task involves a routine and stable procedure that aligns with the RN's level of experience and training. Infusion of fluids is a common nursing responsibility that requires attention to detail but does not involve complex decision-making or critical thinking beyond the scope of a new RN's training. Options A, B, and D involve higher levels of complexity and critical thinking. Option A requires the administration of specific medications with potential side effects and interactions that need careful monitoring and assessment, which is beyond the scope of a newly graduated RN. Option B involves assessing a client for signs of infection, which requires a deeper understanding of GVHD and its complications. Option D requires educating the client about infection prevention, which involves communication skills and a comprehensive understanding of patient education strategies. In an educational context, it is crucial to teach new RNs how to prioritize tasks based on their level of experience and competence. Delegation is a vital skill in nursing that involves assigning appropriate tasks to team members based on their knowledge and skill level. By understanding the rationale behind task delegation, nurses can provide safe and efficient care while promoting professional growth and development.

Correct Answer: D

Rationale: The most important information to communicate to the LTC charge nurse prior to transferring a client with newly diagnosed chronic myeloid leukemia is option D) The client's chemotherapy has resulted in neutropenia. Neutropenia is a critical concern in leukemia patients as it indicates a decreased number of neutrophils, which are important in fighting infections. Leukemia and its treatment compromise the immune system, making patients more susceptible to infections. This information is crucial for the LTC charge nurse to be vigilant about signs of infection and to implement appropriate infection control measures. Option A) The presence of the Philadelphia chromosome in the blood smear is important for diagnosing chronic myeloid leukemia but does not impact immediate care or management at the LTC facility. Option B) Elevated glucose levels due to prednisone therapy may be relevant for managing diabetes but are not as urgent as addressing neutropenia in a leukemia patient. Option C) Weight loss is a common symptom in leukemia, but it does not pose an immediate threat as neutropenia does. Educationally, understanding the priority of communicating critical health information when transferring patients is vital for healthcare professionals to ensure continuity of care and patient safety. This scenario highlights the importance of recognizing and addressing complications of leukemia and its treatment to prevent life-threatening infections in vulnerable patients.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Numbness and tingling of the feet. This symptom is of most concern because it can indicate peripheral neuropathy, a serious side effect of cyclosporine. Peripheral neuropathy is a condition that affects the nerves outside of the brain and spinal cord, and it can lead to significant complications if not addressed promptly. Option A) Bleeding of the gums while brushing the teeth could be a sign of gum disease or poor oral hygiene, which are common but less urgent issues compared to peripheral neuropathy. Option B) Non-tender swelling in the right groin could be related to various factors such as lymphadenopathy or a hernia, but these are not directly linked to cyclosporine use. Option C) Occasional nausea after taking the medication is a common side effect of many drugs, including cyclosporine, and may not be as concerning as peripheral neuropathy. From an educational standpoint, understanding the potential side effects of medications used in post-transplant care is crucial for healthcare professionals to provide safe and effective patient care. Recognizing and prioritizing symptoms like peripheral neuropathy can help prevent serious complications and improve patient outcomes. It is essential to monitor patients closely for such side effects and intervene promptly to ensure their well-being.