ATI Cellular Regulation Level 3

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Sample questions from ATI Cellular Regulation Level 3

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.At change of shift on an oncology unit, a 68-year-old client receiving chemotherapy has a temperature of 38.3 C, chills, and an absolute neutrophil count (ANC) of 420/mm3. Which action should the nurse take first?

   • A.Schedule the client for a complete blood count the next morning
   • B.Give acetaminophen and reassess the temperature in 1 hour
   • C.Place the client on a low-bacteria diet
   • D.Obtain prescribed blood cultures and promptly administer the prescribed broad-spectrum antibiotic

   Rationale: Fever with an ANC of 420/mm3 indicates febrile neutropenia, a time-critical emergency requiring cultures followed promptly by broad-spectrum antibiotics. Acetaminophen can mask fever and does not treat the infection. A low-bacteria diet and a later blood count do not address the immediate risk of sepsis.

2. 2.In the pediatric oncology clinic, a 9-year-old receiving chemotherapy has an ANC of 380/mm3 and asks to attend a crowded indoor birthday party. Which instructions should the nurse give the family? Select all that apply.

   • A.Avoid crowded indoor gatherings while the ANC is severely decreased
   • B.Take the child's temperature and report a fever according to the oncology team's instructions
   • C.Give a rectal temperature if the child feels warm
   • D.Perform frequent hand hygiene and ask visitors to do the same
   • E.Allow visitors with mild cold symptoms if they wear a mask

   Rationale: Severe neutropenia increases the risk of infection, so avoiding crowded gatherings, monitoring for fever, and meticulous hand hygiene are appropriate. A mask does not make a symptomatic visitor a safe contact for a profoundly immunocompromised child. Rectal temperatures can injure mucosa and introduce infection, so an appropriate nonrectal method should be used.

3. 3.The provider prescribes a vesicant chemotherapy infusion for a 54-year-old client through a peripheral IV in the forearm. The client reports burning at the site, and the nurse sees swelling and loss of blood return. Which action is the priority?

   • A.Slow the infusion and reassess the site in 15 minutes
   • B.Remove the catheter and apply firm pressure
   • C.Stop the infusion and leave the catheter in place while following the extravasation protocol
   • D.Flush the catheter briskly with normal saline

   Rationale: Burning, swelling, and absent blood return suggest vesicant extravasation; the infusion must stop immediately. The catheter is initially retained so the medication can potentially be aspirated or an antidote administered per protocol. Flushing can spread the vesicant, while simply slowing the infusion or removing the catheter can delay treatment.

4. 4.During a home visit, a 72-year-old client with metastatic bone cancer reports sudden severe back pain and new leg weakness. Which action should the nurse take?

   • A.Teach the client to use a heating pad and call the oncology clinic tomorrow
   • B.Arrange emergency evaluation for possible spinal cord compression
   • C.Document the symptoms as an expected effect of bone metastases
   • D.Encourage walking to prevent deconditioning

   Answer and rationale are in the full material.

5. 5.In the oncology unit, a 47-year-old client with acute leukemia has platelets of 18,000/mm3 and scattered petechiae. Which interventions should the nurse include in the plan of care? Select all that apply.

   • A.Use an electric razor for shaving
   • B.Apply prolonged pressure after venipuncture
   • C.Encourage flossing after every meal
   • D.Use a soft toothbrush for oral care
   • E.Avoid intramuscular injections when possible

   Answer and rationale are in the full material.