Nursing Elites

1. A 58-year-old male patient has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest x-ray shows carcinoma. The patient is anxious and asks if he can smoke. Which statement by the nurse would be most therapeutic?

• A. Smoking is the reason you are here.
• B. The doctor left orders for you not to smoke.
• C. You are anxious about the surgery. Do you see smoking as helping?
• D. Smoking is OK right now, but after your surgery it is contraindicated.

Correct answer: C

Rationale: Choice C is the most therapeutic response as it acknowledges the patient's anxiety and encourages reflection on his behavior. This approach can help the patient explore his feelings and thoughts about smoking in relation to his surgery, promoting self-awareness and potentially opening the door for a constructive discussion. Choices A and B are more directive and may not address the underlying anxiety and need for reflection. Choice D is also somewhat permissive about smoking before surgery, which may not be in the patient's best interest.

2. The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm?

• A. Placing cool compresses on the affected arm
• B. Elevating the affected arm on a pillow above heart level
• C. Avoiding arm exercises in the immediate postoperative period
• D. Maintaining an intravenous site below the antecubital area on the affected side

Correct answer: B

Rationale: After a mastectomy, particularly when lymph nodes are removed, there is an increased risk of lymphedema in the affected arm due to impaired lymphatic drainage. Elevating the affected arm above heart level helps promote lymphatic drainage and reduces the risk of swelling. This intervention facilitates the return of lymph fluid and helps prevent fluid accumulation in the arm.

3. The school nurse is teaching a nutrition class in the local high school. One student states that he has heard that certain foods can increase the incidence of cancer. The nurse responds, Research has shown that certain foods indeed appear to increase the risk of cancer. Which of the following menu selections would be the best choice for potentially reducing the risks of cancer?

• A. Smoked salmon and green beans
• B. Pork chops and fried green tomatoes
• C. Baked apricot chicken and steamed broccoli
• D. Liver, onions, and steamed peas

Correct answer: C

Rationale: The correct choice is 'Baked apricot chicken and steamed broccoli' because fruits and vegetables have been shown to reduce the risk of cancer. Option A, smoked salmon and green beans, although a healthy choice, does not incorporate as many cancer-fighting foods as the correct answer. Option B, pork chops and fried green tomatoes, contains fried food which is associated with increased cancer risk. Option D, liver, onions, and steamed peas, includes organ meats which are not considered beneficial for reducing cancer risk.

4. During a health promotion program on testicular cancer, a community health nurse finds that more information is necessary if a community member says which of the following is a sign of testicular cancer?

• A. Alopecia
• B. Back pain
• C. Painless testicular swelling
• D. Heavy sensation in the scrotum

Correct answer: A

Rationale: The correct answer is A, 'Alopecia.' Alopecia is not a sign of testicular cancer; it can occur due to chemotherapy. Back pain (choice B) is not typically associated with testicular cancer. Painless testicular swelling (choice C) and a heavy sensation in the scrotum (choice D) can be actual signs of testicular cancer, so they do not require further information.

5. The nurse on a bone marrow transplant unit is caring for a patient with cancer who is preparing for HSCT. What is a priority nursing diagnosis for this patient?

• A. Fatigue related to altered metabolic processes
• B. Altered nutrition: less than body requirements related to anorexia
• C. Risk for infection related to altered immunologic response
• D. Body image disturbance related to weight loss and anorexia

Correct answer: C

Rationale: Patients preparing for hematopoietic stem cell transplantation (HSCT) undergo intensive chemotherapy and/or radiation, which significantly suppresses their immune system. This immunosuppression leads to a heightened risk for infection, making it the most critical nursing diagnosis for these patients. As the body’s ability to fight off pathogens is compromised, close monitoring and interventions aimed at preventing infections are essential for their safety and recovery.

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