A nurse is caring for a client who is receiving cisplatin to treat bladder cancer.
After several treatments, the client reports fatigue.
Which of the following actions should the nurse take?
Examine the client for hepatomegaly.
Assess the client for a hypersensitivity reaction.
Check the results of the client's most recent CBC.
Evaluate the client for hypercalcemia.
The Correct Answer is C
Choice A rationale
Examining the client for hepatomegaly can be part of a broader assessment but does not directly address the fatigue related to chemotherapy, particularly cisplatin, which is known to cause bone marrow suppression.
Choice B rationale
Assessing for a hypersensitivity reaction is important during chemotherapy, but it does not specifically address the issue of fatigue, which is often related to blood cell counts.
Choice C rationale
Checking the results of the client's most recent CBC (complete blood count) is crucial because cisplatin can cause anemia, leukopenia, and thrombocytopenia, all of which can lead to significant fatigue.
Choice D rationale
Evaluating for hypercalcemia is not typically associated with cisplatin treatment; it is more relevant in malignancies associated with bone metastasis or overproduction of parathyroid hormone-related protein.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Applying powder to sensitive skin areas can cause dryness and irritation, exacerbating SLE symptoms. Powders can also block pores, increasing the risk of skin infections.
Choice B rationale
Using a strong protein shampoo is not relevant to managing SLE. It won't address the photosensitivity or skin issues commonly associated with SLE.
Choice C rationale
Sun protection is crucial for SLE patients due to photosensitivity. UV exposure can trigger flare-ups, making a sun-blocking agent with SPF 30 or higher essential for skin protection.
Choice D rationale
Moisturizing lotions help prevent dryness and protect the skin barrier, which is important in SLE management. Avoiding them can lead to skin complications.
Correct Answer is A
Explanation
Choice A rationale
A raised rash across the nose and face, known as a butterfly rash, is a classic and distinctive manifestation of systemic lupus erythematosus (SLE), often exacerbated by sunlight exposure.
Choice B rationale
Hypothermia is not a common manifestation of SLE; patients more frequently experience fevers due to inflammation and immune system dysregulation.
Choice C rationale
Weight gain is not a typical direct manifestation of SLE; patients might experience weight changes due to medications or complications but not as a primary symptom.
Choice D rationale
Muscle hyperreflexia is not associated with SLE; neurological symptoms in SLE might include seizures or cognitive dysfunction, but not hyperreflexia.
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