Page 1333 - Saunders Comprehensive Review For NCLEX-RN

level. An increased white blood cell count may or may not be present and is not
related specifically to multiple myeloma.
Test-Taking Strategy: Focus on the subject, laboratory findings in multiple
myeloma. Noting the name of the disorder and recalling the pathophysiology of the
disease and that proliferation of plasma cells in the bone occurs will direct you to the
correct option.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Adult Health: Oncology
Health Problem: Adult Health: Cancer: Multiple Myeloma
Priority Concepts: Cellular Regulation; Clinical Judgment
Reference: Ignatavicius, Workman, Rebar (2018), pp. 829-830.

444. Answer: 1

Rationale: Hypercalcemia caused by bone destruction is a priority concern in the
client with multiple myeloma. The nurse should administer fluids in adequate
amounts to maintain a urine output of 1.5 to 2 L/day; this requires about 3 L of fluid
intake per day. The fluid is needed not only to dilute the calcium overload but also
to prevent protein from precipitating in the renal tubules. Options 2, 3, and 4 may be
components of the plan of care but are not the priority in this client.
Test-Taking Strategy: Note the strategic word, priority. Recalling the
pathophysiology of this disorder and that hypercalcemia can occur will direct you to
the correct option.
Level of Cognitive Ability: Creating
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Planning
Content Area: Adult Health: Oncology
Health Problem: Adult Health: Cancer: Multiple Myeloma
Priority Concepts: Cellular Regulation; Clinical Judgment
Reference: Lewis et al. (2017), p. 646.

445. Answer: 2, 3, 4

Rationale: The time that the nurse spends in the room of a client with an internal
radiation implant is 30 minutes per shift. The client must be placed in a private room
with a private bath. Lead shielding can be used to reduce the transmission of
radiation. The dosimeter film badge must be worn when in the client’s room.
Children younger than 16 years of age and pregnant women are not allowed in the
client’s room.
Test-Taking Strategy: Focus on the subject, radiation precautions. Recalling the
time frame related to exposure to the client will assist in eliminating option 1. From
the remaining options, select the correct options because of the possible risks
associated with exposure to radiation.
Level of Cognitive Ability: Analyzing
Client Needs: Safe and Effective Care Environment

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