NCLEX-PN Test #6 3

Question 1

A client receiving chemotherapy has an absolute neutrophil count (ANC) of 400/mm³. Which nursing intervention is the highest priority?

Accepted Answer

Monitor temperature every 4 hours and report any fever ≥38°C (100.4°F)

Answer

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?

Accepted Answer

Pneumocystis jirovecii pneumonia (PCP)

Answer

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?

Accepted Answer

Hyperkalemia, hyperphosphatemia, hypocalcemia

Answer

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?

Accepted Answer

"UV radiation triggers SLE flares by activating the immune response in the skin."

Answer

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?

Accepted Answer

Iliac crest (posterior superior iliac spine)

Answer

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.

NCLEX Practice Test

NCLEX Practice Test

NCLEX-PN Test #6 3