patient is experiencing bone marrow depression as a result of chemotherapy. Which assessment should the nurse expect because of this health problem?
platelet count of 50.000
nausea and vomiting
temperature of 38.9 C (102F)
alopecia
The Correct Answer is C
A. Platelet count of 50,000 is low (normal is usually 150,000-450,000), and this can be associated with bone marrow depression caused by chemotherapy. However, bone marrow depression itself doesn't cause a fever directly. The low platelet count increases the risk of bleeding, but it wouldn't necessarily lead to a temperature elevation by itself.
B. Nausea and vomiting are common side effects of chemotherapy but are not directly related to bone marrow depression. Bone marrow depression typically affects the production of blood cells (red blood cells, white blood cells, and platelets), but nausea and vomiting are more directly associated with the chemotherapy agents themselves rather than the resulting bone marrow suppression.
C. A fever of 38.9°C (102°F) could indicate an infection, which is a serious risk for patients with bone marrow depression due to chemotherapy. The suppression of white blood cell (WBC) production from chemotherapy leads to neutropenia, leaving the patient more vulnerable to infections. A fever in this context is a medical emergency and requires immediate attention, as it may signify a bacterial or fungal infection, which could be life-threatening in an immunocompromised patient.
D. Alopecia (hair loss) is a well-known side effect of chemotherapy, but it is not a direct consequence of bone marrow depression. It is more related to the chemotherapy drugs affecting rapidly dividing cells, like those in hair follicles. While it is a common and distressing symptom, it is not an indicator of bone marrow function or depression.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. The first action should be to call the blood bank to report the mismatch in blood type. The patient is A positive, and the blood unit is AB negative, which is not compatible and could lead to a serious transfusion reaction. The blood bank can provide the correct unit of blood.
B. Initiating the transfusion with the wrong blood type is dangerous and could cause a life-threatening reaction.
C. Taking and recording vital signs is important but should only occur after confirming the correct blood product. Starting a transfusion with the wrong blood is a safety hazard.
D. While notifying the physician is important, the immediate action is to contact the blood bank to resolve the blood type mismatch.
Correct Answer is B
Explanation
A. Decreased surface antigens are more relevant to hepatitis B infection than to monitoring HIV treatment effectiveness.
B. Increased CD4 cells indicate an effective response to antiretroviral therapy, as CD4 cells are a key component of the immune system that HIV targets and destroys. Effective therapy allows CD4 counts to recover.
C. Decreased killer T cells (CD8 cells) would not be a desired effect; these cells help control viral infections, including HIV.
D. Increased viral burden (or viral load) suggests worsening of the infection, not improvement. Effective therapy should decrease the viral load.
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