All-in-One Nursing Care Planning
Resource
Medical-Surgical, Pediatric,
Maternity, and Psychiatric-Mental
Health
5th Edition
• Author(s)Pamela L. Swearingen;
Jacqueline Wright
TEST BANK
,1) MCQ — Cancer Care: Febrile Neutropenia
Clinical Scenario:
A 62-year-old patient receiving chemotherapy for colorectal
cancer reports chills and feels weak. The nurse obtains vital
signs: T 38.4°C (101.1°F), HR 112/min, BP 98/60 mm Hg, and
the latest absolute neutrophil count (ANC) is 450/mm³.
Question Stem:
What is the nurse’s priority action?
Answer Options:
A. Give acetaminophen and reassess the temperature in 4
hours.
B. Place the patient in a private room and notify the oncology
provider immediately.
C. Encourage the patient to ambulate to improve circulation.
D. Offer a warm blanket and increase oral fluid intake only.
Correct Answer:
B
Detailed Rationale:
Fever with neutropenia is a medical emergency because the
patient has limited ability to mount an immune response. The
nurse should immediately initiate infection precautions and
,notify the provider so rapid evaluation and broad-spectrum
treatment can begin.
Incorrect Option Analysis:
• A: Incorrect because it delays urgent care and may mask
worsening infection.
• C: Incorrect because ambulation is not the priority in
suspected neutropenic fever.
• D: Incorrect because supportive comfort measures do not
address the life-threatening risk.
Nursing Process Linkage: Assessment → Implementation
NCJMM Competencies: Recognize Cues, Prioritize Hypotheses,
Take Action
Difficulty: Moderate
Bloom’s Level: Analyze
NCLEX Client Needs: Physiological Adaptation
Nursing Diagnosis Integration:
• Priority diagnosis: Risk for Infection / Infection
• Risk factors: Chemotherapy-induced neutropenia
• Defining characteristics: Fever, chills, low ANC
Expected Outcome: The patient receives prompt
evaluation and treatment with no delay in antimicrobial
therapy.
, Key Learning Objective: Identify and respond to life-
threatening complications of chemotherapy.
2) SATA — Cancer Care: Chemotherapy Teaching
Clinical Scenario:
A patient starting outpatient chemotherapy asks how to reduce
infection risk and manage treatment side effects at home.
Question Stem:
Which statements show correct understanding? Select all that
apply.
Answer Options:
A. “I will use a soft toothbrush.”
B. “I should wait 24 hours before reporting a fever.”
C. “I will drink plenty of fluids unless I am told to restrict them.”
D. “I should avoid crowds and people who are sick.”
E. “I will use an electric razor instead of a blade.”
Correct Answers:
A, C, D, E
Detailed Rationale:
Soft oral care, hydration, avoiding exposure to infection, and
reducing bleeding risk are standard chemotherapy teaching
points. Fever should be reported immediately, not delayed.
Incorrect Option Analysis:
Resource
Medical-Surgical, Pediatric,
Maternity, and Psychiatric-Mental
Health
5th Edition
• Author(s)Pamela L. Swearingen;
Jacqueline Wright
TEST BANK
,1) MCQ — Cancer Care: Febrile Neutropenia
Clinical Scenario:
A 62-year-old patient receiving chemotherapy for colorectal
cancer reports chills and feels weak. The nurse obtains vital
signs: T 38.4°C (101.1°F), HR 112/min, BP 98/60 mm Hg, and
the latest absolute neutrophil count (ANC) is 450/mm³.
Question Stem:
What is the nurse’s priority action?
Answer Options:
A. Give acetaminophen and reassess the temperature in 4
hours.
B. Place the patient in a private room and notify the oncology
provider immediately.
C. Encourage the patient to ambulate to improve circulation.
D. Offer a warm blanket and increase oral fluid intake only.
Correct Answer:
B
Detailed Rationale:
Fever with neutropenia is a medical emergency because the
patient has limited ability to mount an immune response. The
nurse should immediately initiate infection precautions and
,notify the provider so rapid evaluation and broad-spectrum
treatment can begin.
Incorrect Option Analysis:
• A: Incorrect because it delays urgent care and may mask
worsening infection.
• C: Incorrect because ambulation is not the priority in
suspected neutropenic fever.
• D: Incorrect because supportive comfort measures do not
address the life-threatening risk.
Nursing Process Linkage: Assessment → Implementation
NCJMM Competencies: Recognize Cues, Prioritize Hypotheses,
Take Action
Difficulty: Moderate
Bloom’s Level: Analyze
NCLEX Client Needs: Physiological Adaptation
Nursing Diagnosis Integration:
• Priority diagnosis: Risk for Infection / Infection
• Risk factors: Chemotherapy-induced neutropenia
• Defining characteristics: Fever, chills, low ANC
Expected Outcome: The patient receives prompt
evaluation and treatment with no delay in antimicrobial
therapy.
, Key Learning Objective: Identify and respond to life-
threatening complications of chemotherapy.
2) SATA — Cancer Care: Chemotherapy Teaching
Clinical Scenario:
A patient starting outpatient chemotherapy asks how to reduce
infection risk and manage treatment side effects at home.
Question Stem:
Which statements show correct understanding? Select all that
apply.
Answer Options:
A. “I will use a soft toothbrush.”
B. “I should wait 24 hours before reporting a fever.”
C. “I will drink plenty of fluids unless I am told to restrict them.”
D. “I should avoid crowds and people who are sick.”
E. “I will use an electric razor instead of a blade.”
Correct Answers:
A, C, D, E
Detailed Rationale:
Soft oral care, hydration, avoiding exposure to infection, and
reducing bleeding risk are standard chemotherapy teaching
points. Fever should be reported immediately, not delayed.
Incorrect Option Analysis:
