A nurse is caring for a client who is receiving cisplatin for treatment of ovarian cancer. The client's most recent complete blood count (CBC) is shown in the table below. It is important for the nurse to consider which of the following for the client? WBC

1,400/mm3

RBC

4.3 x 1012/L

Hgb

Hct

Platelets

Albumin

12.1 g/dL

36.5%

170,000/mm3

5 g/dL

The client has an increased risk of infection.

The client should receive a diet with increased protein.

The client has an increased risk for bleeding.

The client should receive an erythropoiesis stimulating agent.

Answer and Explanation

Correct Answer : A,C

Answer: A. The client has an increased risk of infection.

Rationale: This is because the client's white blood cell (WBC) count is low, which indicates a compromised immune system. The normal range for WBC is 4,000 to 11,000/mm3. A low WBC count can be caused by chemotherapy, which is a common treatment for ovarian cancer. The nurse should monitor the client for signs of infection, such as fever, chills, redness, swelling, or drainage, and implement infection prevention measures, such as hand hygiene, sterile technique, and isolation precautions.

Answer: C. The client has an increased risk for bleeding.

Rationale: This is because the client's platelet count is low, which indicates a reduced ability to form clots and stop bleeding. The normal range for platelets is 150,000 to 400,000/mm3. A low platelet count can be caused by chemotherapy, which can damage the bone marrow where platelets are produced. The nurse should monitor the client for signs of bleeding, such as petechiae, ecchymosis, hematuria, or melena, and implement bleeding prevention measures, such as avoiding invasive procedures, applying pressure to puncture sites, and using soft-bristled toothbrushes.

Nursing Test Bank

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Free Nursing Study Resources

Correct Answer is C

Explanation

This is because central cyanosis reflects a decrease in arterial oxygen saturation and is best seen in areas where blood vessels are close to the surface, such as the oral mucosa, tongue, and lips. Peripheral cyanosis, which may be caused by vasoconstriction or poor circulation, can be seen in the soles of the feet, ear lobes, and nail beds, but it does not necessarily indicate hypoxemia.

A. Connective tissue B. Peripheral vascular system C. Muscle tissue D. Lymphatic system

Correct Answer is A

Explanation

This is because SLE is an autoimmune disorder that causes inflammation and damage to various organs and tissues, such as the skin, joints, kidneys, heart, and blood vessels. Connective tissue is a type of tissue that supports and binds other tissues and organs in the body.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who has asthma. Which of the following areas should the nurse evaluate as the most reliable indicator of central cyanosis?

Correct Answer is C

Explanation

A nurse is caring for a client who has a new diagnosis of systemic lupus erythematosus (SLE) and asks where this disease originates within the body. The nurse should tell the client that SLE originates in which of the following locations in the body?

Correct Answer is A

Explanation

A nurse is caring for a client who has asthma and is taking fluticasone. The nurse should monitor the client for which of the following adverse effects?

A nurse is assessing a client who has viral rhinitis and a history of herpes simplex virus type 1 (HSV-1) lesions. The nurse should assess which of the following areas of the body for the recurrence of HSV-1 lesions?

A nurse is caring for a client who has HIV. Exhibits The client is at risk for developing .

A nurse is assessing a client who has asthma. Which of the following areas should the nurse evaluate as the most reliable indicator of central cyanosis?

A nurse is caring for a client who is receiving mechanical ventilation and has an ideal weight of 60 kg. The nurse should expect the tidal volume to be set at which of the following?

A nurse is developing a plan of care for a client who has COPD. The nurse should include which of the following interventions in the plan?

A nurse on a medical-surgical unit is performing an admission assessment of a client who has COPD with emphysema. The client reports that he has a frequent productive cough and is short of breath. The nurse should anticipate which of the following assessment findings for this client?

A nurse is caring for a client who is receiving positive-pressure mechanical ventilation. Which of the following interventions should the nurse implement to prevent complications? (Select all that apply.)