NCLEX-PN Test #6 3 — Questions and Answers
Question 1: A client receiving chemotherapy has an absolute neutrophil count (ANC) of 400/mm³. Which nursing intervention is the highest priority?
- Restrict visitors with fresh flowers and live plants
- Place the client in strict protective (reverse) isolation
- Administer prescribed prophylactic antibiotics
- Monitor temperature every 4 hours and report any fever ≥38°C (100.4°F) (Correct answer)
Correct answer: Monitor temperature every 4 hours and report any fever ≥38°C (100.4°F)
Neutropenic fever (fever ≥38°C with ANC < 500/mm³) is an oncologic emergency with high mortality risk. Fever is often the only sign of serious infection in neutropenic clients because the immune response is blunted. Immediate notification and antibiotic initiation within 1 hour are critical. Temperature monitoring is the key surveillance action.
Question 2: The PN is caring for a client with HIV who has a CD4 count of 150 cells/mm³. Which opportunistic infection is this client most at risk for at this CD4 level?
- Oral candidiasis
- Pneumocystis jirovecii pneumonia (PCP) (Correct answer)
- Herpes zoster
- Kaposi's sarcoma
Correct answer: Pneumocystis jirovecii pneumonia (PCP)
PCP occurs when CD4 count falls below 200 cells/mm³ and is the most common AIDS-defining opportunistic infection. Prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) is started when CD4 < 200. Oral candidiasis can occur at higher CD4 counts; Kaposi's sarcoma is associated with CD4 < 200 but is less immediately life-threatening than PCP.
Question 3: A client with non-Hodgkin's lymphoma develops tumor lysis syndrome after starting chemotherapy. Which electrolyte imbalances are expected?
- Hypokalemia, hyponatremia, hypocalcemia
- Hyperkalemia, hyperphosphatemia, hypocalcemia (Correct answer)
- Hypernatremia, hypokalemia, hypermagnesemia
- Hypokalemia, hypophosphatemia, hypercalcemia
Correct answer: Hyperkalemia, hyperphosphatemia, hypocalcemia
Tumor lysis syndrome occurs when massive tumor cell destruction releases intracellular contents. The classic metabolic triad is hyperkalemia (from intracellular K+ release), hyperphosphatemia (from nucleic acid breakdown), and hypocalcemia (phosphate binds calcium). Hyperuricemia and acute kidney injury also occur.
Question 4: A client with systemic lupus erythematosus (SLE) asks why the nurse is applying sunscreen before an outdoor activity. What is the best response?
- "Sunscreen prevents the skin rash from worsening for cosmetic reasons."
- "UV radiation triggers SLE flares by activating the immune response in the skin." (Correct answer)
- "Your medications cause photosensitivity as a side effect."
- "All clients with chronic illness should avoid sun exposure."
Correct answer: "UV radiation triggers SLE flares by activating the immune response in the skin."
In SLE, UV radiation stimulates keratinocytes to release autoantigens that activate the abnormal immune response, precipitating systemic flares. UV exposure is a well-documented trigger for SLE exacerbation. Sun avoidance and sunscreen use are key disease management strategies, not just cosmetic measures.
Question 5: The nurse is preparing a client for a bone marrow biopsy. Which site is most commonly used for this procedure in adults?
- Sternum
- Iliac crest (posterior superior iliac spine) (Correct answer)
- Tibia
- Femur
Correct answer: Iliac crest (posterior superior iliac spine)
The posterior iliac crest (posterior superior iliac spine) is the preferred site for bone marrow biopsy in adults because it has a large, accessible marrow space and is away from vital structures. The sternum may be used for aspiration only (not biopsy) due to risk of mediastinal injury.
Question 6: A client with multiple myeloma reports new onset of back pain and bilateral leg weakness. What complication does the nurse suspect?
- Hyperviscosity syndrome
- Spinal cord compression (Correct answer)
- Pathological vertebral fracture without neurological involvement
- Peripheral neuropathy from chemotherapy
Correct answer: Spinal cord compression
Spinal cord compression is an oncologic emergency in multiple myeloma caused by plasmacytoma growth or vertebral collapse. Bilateral leg weakness, sensory changes, or loss of bladder/bowel control with back pain require emergent MRI and intervention. Untreated, it leads to permanent paralysis.
NCLEX-PN Test #6 3
A client receiving chemotherapy has an absolute neutrophil count (ANC) of 400/mm³.
Which nursing intervention is the highest priority?