Nursing 311: Cellular regulation (Evolve NCO)
Which type of hypersensitivity reaction is present in a client with a body temperature of 102 °F, severe joint pain, rashes on the extremities, and enlarged lymph nodes from serum sickness?
Immune complex-mediated reaction: Serum sickness is a type III immune complex-mediated reaction. A delayed reaction is a type IV hypersensitivity reaction that may include poison ivy skin rashes, graft rejection, and sarcoidosis. A cytotoxic reaction is a type II hypersensitivity reaction that includes autoimmune hemolytic anemia, Goodpasture syndrome, and myasthenia gravis. An immediate reaction is a type I hypersensitive reaction that includes allergic asthma, hay fever, and anaphylaxis.
A client with small-cell lung cancer is receiving chemotherapy. A complete blood count is prescribed before each round of chemotherapy. Which component of the complete blood count is of greatest concern to the nurse?
White blood cells (WBCs) : Antineoplastic drugs depress bone marrow, which causes leukopenia; the client must be protected from infection, which can be life threatening. RBCs diminish slowly and can be replaced with a transfusion of packed red blood cells. Platelets decrease as rapidly as WBCs, but complications can be limited with infusions of platelets.
A nurse cares for a client suspected of having atrial fibrillation. After reviewing the client's medical history, the nurse suspects that the medication may have been administered at a fast rate. Which medication might have caused this condition?
Zoledronic acid : Zoledronic acid may cause atrial fibrillation when it is infused too quickly into the body. Citracal may cause hypercalcemia, cardiac dysrhythmias, and urinary stones. Raloxifene may increase the risk of liver disease and liver thromboembolism. Alendronate may cause esophagitis, esophageal ulcers, and gastric ulcers.
A client with psoriasis is prescribed corticosteroids. What should be taught to the client for a positive outcome? Select all that apply.
"Apply the drug directly to the skin." "Apply the drug using warm or moist dressings." Corticosteroids should be applied directly to the skin using warm or moist dressings to enhance the action of the drug. The drug should not be discontinued even if the symptoms subside, as abruptly stopping the drug may cause adverse effects. Anthralin should be applied for shorter periods to each lesion while avoiding coming into contact with uninvolved skin to prevent chemical burns.
A client has a basal cell carcinoma that is scheduled to be removed. The client expresses concerns that the cancer has metastasized. Which is the best response by the nurse?
"Basal cell tumors usually do not spread." : Basal cell tumors usually do not spread, so the statement is accurate. The response "You are a low surgical risk" does not speak to the client's concern. The response "I can understand how you must feel" may provide reassurance but does not permit further exploration of concern. The response "The primary healthcare provider probably caught it just in time" reinforces the client's fears instead of pointing out reality.
A 63-year-old woman with the diagnosis of estrogen receptor-positive cancer of the breast undergoes lumpectomy and radiation therapy, and tamoxifen is prescribed. The client asks the nurse how long she will have to take the medication. How will the nurse respond?
"You'll need to take it for 5 years, after which it will be discontinued." : Tamoxifen is an estrogen antagonist antineoplastic medication that has been found to be effective in 50% to 60% of women with estrogen receptor-positive cancer of the breast. After 5 years of administration there is an increased risk of complications, and the drug is discontinued. Tamoxifen usually is prescribed for 5 years after initiation of therapy, not for the rest of the client's life; this duration will not produce positive effects for the client. Tamoxifen usually is prescribed for 5 years after initiation of therapy, not just for 10 days. Tamoxifen may cause the adverse effect of bone pain, which indicates the drug's effectiveness. Medication is given to manage the pain and the drug is continued.