Which statement, made by a client being discharged to home after a radical cystectomy, indicates a need for further clarification by the nurse? "I will:

notify the provider if the urine output is absent."

resume voiding normally within one week."

take a stool softener daily to decrease the chance of straining."

monitor the skin around the surgical site for redness."

Answer and Explanation

The Correct Answer is B

A.   After a radical cystectomy, the client may have a urinary diversion (such as a stoma) and should be vigilant about monitoring urine output. Absence of urine output can indicate a serious issue, and notifying the provider is crucial.
B.   This statement indicates a need for further clarification. After a radical cystectomy, clients typically do not resume normal voiding because the bladder is removed. Instead, they may have a urinary diversion or need to learn how to manage their new urinary output. Normal voiding as before surgery is not possible, so this statement reflects a misunderstanding of the procedure's implications.
C.   After surgery, particularly abdominal surgery like a radical cystectomy, patients are often advised to take stool softeners to prevent constipation. Straining can increase the risk of complications and affect the surgical site, so this is a valid precaution.
D.   Monitoring the surgical site for signs of infection, such as redness, swelling, or discharge, is an essential part of post-operative care. Clients should be educated on how to check their surgical site for any concerning changes.

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Correct Answer is C

Explanation

A. This value is within the normal range for adult males (14-17.3 g/dL) and borderline for females (11.7- 15.5 g/dL). While the specific context of the patient (e.g., gender) matters, generally, a hemoglobin level of 14 g/dL would not typically cause concern.

B. A platelet count of 150,000/mm³ is at the lower limit of normal (150,000-450,000/mm³). While this may be concerning in certain clinical contexts, it is still within the acceptable range and would not typically raise alarm for a post-op nephrectomy patient unless there are other indications of bleeding or clotting issues.
C. This white blood cell count is elevated (normal range is 4.5-11.1 x 10³/mm³). An elevated WBC count can indicate an infection, inflammation, or a response to surgery, which is particularly concerning post- operatively. This result would warrant further investigation to rule out infection, which is critical for recovery.
D. The neutrophil percentage of 59% is within the normal range (typically around 40-70% for total WBCs). While it is slightly elevated, it is not concerning on its own without additional context, especially since it may be elevated in response to surgery or stress.

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 4.51-6.01 million/mm3 Female: 4.01-5.51 million/mm3
Hemoglobin	Adult (15-64 yr) Male 14-17.3 g/dL Female 11.7-15.5 g/dL
Hematocrit	42% -52% in males 36% -48% in females
Reticulocytes	0.5% -2.5% of total RBC count
White blood cells (total)	4.5-11.1 103/mm3
Neutrophils	59% Bands 3% Segs-56%
Eosinophils	2.7%
Basophils	0.5%
Lymphocytes	34%
Monocytes	4%
Platelets	150,000-450,000/mm3

Which statement, made by a client being discharged to home after a radical cystectomy, indicates a need for further clarification by the nurse? "I will:

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Naxlex Comprehensive Predictor Exams

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

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