Which action will the nurse include in the plan of care for a 72-year-old woman admitted with multiple myeloma?

Monitor fluid intake and output.

Limit weight bearing and ambulation.

Assess lymph nodes for enlargement.

Administer calcium supplements.

Answer and Explanation

The Correct Answer is A

A.   Monitor fluid intake and output. Monitoring fluid intake and output is essential in patients with multiple myeloma to assess for signs of dehydration or fluid overload, which can occur due to renal complications.
B.   Limit weight bearing and ambulation. Limiting weight bearing and ambulation is not a
standard intervention for multiple myeloma unless there are specific complications such as bone fractures.
C.   Assess lymph nodes for enlargement. Multiple myeloma primarily affects the bone marrow and plasma cells, not the lymph nodes.
D.   Administer calcium supplements. While calcium supplementation may be necessary in some cases of multiple myeloma, it is not a priority action upon admission without further assessment.

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Correct Answer is A

Explanation

A. Performing breast self-examination (BSE) on the first day of each month provides a consistent schedule for the client to conduct the examination, making it easier to remember and ensuring regularity.
B. The first day of the menstrual cycle may not be the best time to perform BSE for all women, as breast tissue may be more tender or swollen during menstruation.
C. Seven days after the menstrual cycle begins may not be the best time for BSE, as hormonal fluctuations and breast changes may not yet have stabilized.
D. Performing BSE every month during ovulation is not necessary, as ovulation does not directly affect breast tissue changes that need to be monitored.

A. "You will need to empty your bladder just before the exam." B. "You should douche the evening prior to the examination." C. "You will be required to sign an informed consent prior to the exam." D. "You will be given light sedation before the examination starts."

Correct Answer is A

Explanation

A. "You will need to empty your bladder just before the exam.": Emptying the bladder before a pelvic examination allows for better visualization and manipulation of the pelvic organs.
B. "You should douche the evening prior to the examination.": Douching is not recommended before a Pap test as it can disrupt the natural flora of the vagina and may interfere with test results.
C. "You will be required to sign an informed consent prior to the exam.": Informed consent may be required for certain procedures but is not typically needed for a Pap test.
D. "You will be given light sedation before the examination starts.": Sedation is not typically used for a Pap test, which is a simple procedure that does not usually cause significant discomfort.

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Which action will the nurse include in the plan of care for a 72-year-old woman admitted with multiple myeloma?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is A

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Correct Answer is A

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