The client has developed graft versus host disease (GVHD) during treatment for acute lymphoblastic leukemia (ALL). The client has a generalized pruritic rash on the trunk and the extremities. What nursing measures should the nurse use to address this problem?

Apply bacitracin liberally to the affected areas

Request a medical prescription for diphenhydramine or hydroxyzine

Instruct client to shower with cool water and use a mild soap

Clip fingernails and encourage the use of prescribed lotions

Answer and Explanation

Correct Answer : B,C,D

A.   Bacitracin is an antibiotic ointment typically used to prevent or treat bacterial infections in minor cuts and scrapes. It is not appropriate for treating a pruritic rash associated with GVHD. The rash may not be due to an infection but rather an immune response, so using bacitracin would not address the underlying issue.
B.   Diphenhydramine (Benadryl) and hydroxyzine are antihistamines that can help alleviate itching and provide relief from pruritus. Requesting a prescription for one of these medications is an appropriate response to manage the symptoms of GVHD.
C.   Showering with cool water can soothe irritated skin and reduce itching. Using mild soap helps to avoid further irritation or dryness that harsher soaps can cause. This intervention supports skin care and helps manage pruritus effectively.
D.   Clipping fingernails can help prevent skin damage from scratching, which could lead to secondary infections. Encouraging the use of prescribed lotions can help keep the skin moisturized and alleviate dryness, further addressing the pruritus associated with GVHD.

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Correct Answer is C

Explanation

A. While blood vessel spasms can occur after a stroke, t-PA does not directly affect them.
B. Platelet aggregation is the process by which platelets stick together to form a clot. t-PA dissolves clots, but it does not prevent their formation.
C. Tissue plasminogen activator (t-PA) is a medication that can dissolve blood clots. In the case of a thrombotic stroke, a blood clot has blocked blood flow to the brain. By dissolving the clot, t-PA can restore blood flow and limit brain damage.
D. t-PA does not have any direct effect on the risk of infection in the brain.

A. Trisomy 21 (Down syndrome) B. Fragile X syndrome C. BRCA1 gene mutation D. Philadelphia chromosome (BCR-ABL fusion gene)

Correct Answer is D

Explanation

A. Trisomy 21 is a chromosomal disorder resulting in Down syndrome. While individuals with Down syndrome have an increased risk of developing certain leukemias (such as acute lymphoblastic leukemia), it is not directly associated with CML.
B. Fragile X syndrome is a genetic condition caused by a mutation in the FMR1 gene on the X chromosome, leading to intellectual disability and other developmental issues. It is not associated with CML or any form of leukemia. This option is unrelated to the genetic abnormalities seen in CML.
C. The BRCA1 gene mutation is associated with an increased risk of breast and ovarian cancers. While mutations in BRCA1 can affect cancer susceptibility, they are not linked to Chronic Myelogenous Leukemia. Thus, this option does not apply to CML.
D. The Philadelphia chromosome is a specific genetic abnormality found in the majority of patients with CML. It results from a translocation between chromosomes 9 and 22, creating the BCR-ABL fusion gene, which produces a tyrosine kinase that drives the proliferation of leukemic cells.

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Blood Cell	Normal Ranges
Red blood cells (mature, circulating)	Male: 451-6.01 million/mm3 Female: 4.01-5.51 million/mm3
Hemoglobin	Adult (15-64 yr) Male 14-17.3 g/dL Female 11.7-155 g/dL
Hematocrit	42%-52% in males 36% -48% in females
Reticulocytes	0.5% -2.5% of total RBC count
White blood cells (total)	4.5-11.1 10/mm3
Neutrophils	59% Bands 3% Segs-56%
Eosinophils	2.7%
Basophils	0.5%
Lymphocytes	34%
Monocytes	4%


Platelets	150,000-450,000/mm3

The client has developed graft versus host disease (GVHD) during treatment for acute lymphoblastic leukemia (ALL). The client has a generalized pruritic rash on the trunk and the extremities. What nursing measures should the nurse use to address this problem?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a client who had a thrombotic stroke in the Emergency Department. It has been less than 3 hours since the onset of symptoms. The rationale for using tissue plasminogen activator (t-PA) for this client is to:

Correct Answer is C

Explanation

What genetic abnormality would a nurse expect in a client diagnosed with Chronic Myelogenous Leukemia (CML)?

Correct Answer is D

Explanation

Which assessment data would indicate to the nurse that the client would be at risk for a hemorrhagic stroke?

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