A nurse is caring for a client who has chronic renal disease and is receiving therapy with epoetin alfa.
Which of the following laboratory results should the nurse review for an indication of a therapeutic effect of the medication?
The hematocrit (Hct).
The erythrocyte sedimentation rate (ESR).
The platelet count.
The leukocyte count.
The Correct Answer is A
Choice A rationale
The hematocrit (Hct). This statement is correct. Epoetin alfa is used to treat anemia by stimulating the production of red blood cells. An increase in hematocrit levels indicates a therapeutic effect of the medication, as it reflects an increase in the proportion of red blood cells in the blood.
Choice B rationale
The erythrocyte sedimentation rate (ESR). This statement is incorrect. The ESR is a non- specific marker of inflammation and is not used to monitor the therapeutic effect of epoetin alfa. It does not provide information about red blood cell production or anemia.
Choice C rationale
The platelet count. This statement is incorrect. The platelet count measures the number of platelets in the blood, which are involved in clotting. It is not affected by epoetin alfa therapy and does not indicate the therapeutic effect of the medication.
Choice D rationale
The leukocyte count. This statement is incorrect. The leukocyte count measures the number of white blood cells in the blood, which are involved in the immune response. It is not affected by epoetin alfa therapy and does not indicate the therapeutic effect of the medication.
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Correct Answer is ["A","B","C","D","E","G"]
Explanation
Choice A rationale
The skin assessment reveals bruising and petechiae, which are signs of thrombocytopenia, a condition where the blood has a lower than normal number of platelets. This is significant in a child with leukemia as it may indicate a relapse or bone marrow suppression. The presence of petechiae and unexplained bruising should be reported to the provider as they can be indicative of bleeding disorders or a decrease in platelet count.
Choice B rationale
Oxygen saturation of 92% on room air is below the normal range (95-100%) for a child. This indicates hypoxemia, which can be a sign of respiratory distress or other underlying conditions. Given the child’s history of an upper respiratory infection and leukemia, this finding is critical and should be reported to the provider to ensure appropriate interventions are taken to improve oxygenation.
Choice C rationale
The WBC count is crucial in a child with leukemia. An abnormal WBC count can indicate an infection, relapse, or bone marrow suppression. Monitoring the WBC count helps in assessing the child’s immune status and the effectiveness of the leukemia treatment. Any significant changes in the WBC count should be reported to the provider for further evaluation and management.
Choice D rationale
Subcostal retractions are a sign of increased work of breathing and respiratory distress. This finding, along with the child’s statement of feeling like they can’t breathe, indicates that the child is struggling to maintain adequate ventilation. Reporting this to the provider is essential for timely intervention to prevent further respiratory compromise.
Choice E rationale
An ongoing upper respiratory infection for the last 2 months that has not resolved is concerning, especially in a child with a history of leukemia. This could indicate an underlying immunodeficiency or a more serious infection that requires further investigation and treatment. Reporting this to the provider is necessary to address the persistent infection and prevent complications.
Choice F Rationale:
Clear breath sounds are typically a reassuring finding; however, in the context of this child’s symptoms and history, the presence of subcostal retractions and a subjective feeling of difficulty breathing are concerning. While the breath sounds are clear, the child's respiratory status is compromised, as evidenced by retractions, a low oxygen saturation level, and the child’s report of dyspnea. Clear breath sounds in the setting of other signs of respiratory distress might suggest that the issue is not in the airways but could be related to other factors like decreased oxygenation or inadequate ventilation. Reporting the breath sounds to the provider, especially in the context of the other respiratory findings, ensures that the full clinical picture is communicated and that the provider considers all aspects of the child's respiratory status when planning further interventions.
Choice G rationale
The respiratory rate is an important vital sign that can indicate respiratory distress or other underlying conditions. An abnormal respiratory rate, whether too high or too low, can be a sign of respiratory or metabolic issues. Monitoring and reporting the respiratory rate to the provider helps in assessing the child’s respiratory status and determining the need for further intervention.
Correct Answer is B
Explanation
Choice A rationale
Chest pain and dyspnea are concerning symptoms but are not the most immediate manifestations to report in a client undergoing radiation therapy for brain cancer. These symptoms could be related to other conditions and require further evaluation.
Choice B rationale
Seizures are the most immediate manifestation to report because they indicate increased intracranial pressure or other neurological complications related to brain cancer and radiation therapy. Seizures require prompt medical intervention to prevent further complications.
Choice C rationale
Hematuria is a concerning symptom but is not the most immediate manifestation to report in this context. It could be related to other conditions and requires further evaluation.
Choice D rationale
Swelling of the extremities is a concerning symptom but is not the most immediate manifestation to report in this context. It could be related to other conditions and requires further evaluation.