Nursing Elites

1. A client, age 28, was recently diagnosed with Hodgkin's disease. After staging, therapy is planned to include combination radiation therapy and systemic chemotherapy with MOPP"?nitrogen mustard, vincristine (Onconvin), prednisone, and procarbazine. In planning care for this client, the nurse should anticipate which of the following side effects to contribute to a sense of altered body image?

• A. Cushingoid appearance
• B. Alopecia
• C. Temporary or permanent sterility
• D. Pathologic fractures

Correct answer: B

Rationale: The correct answer is B: alopecia. Chemotherapy drugs like vincristine and nitrogen mustard commonly cause hair loss (alopecia), which can significantly impact body image. While a Cushingoid appearance can be a side effect of long-term steroid use, it is not typically associated with the chemotherapy regimen mentioned. Temporary or permanent sterility can result from chemotherapy, affecting fertility but not directly contributing to altered body image. Pathologic fractures are not commonly linked to Hodgkin's disease or its treatment, unlike alopecia which is a well-known side effect.

2. Elderly persons with pernicious anemia should be instructed:

• A. to increase their dietary intake of foods high in B12.
• B. that they do not need to return for follow-up for at least a month after initiation of treatment.
• C. that oral B12 is safer and less expensive than parenteral replacement.
• D. that diarrhea can be a transient side effect of B12 injections.

Correct answer: D

Rationale: Elderly persons with pernicious anemia, a condition characterized by vitamin B12 deficiency due to lack of intrinsic factor, should be informed about the potential side effects of B12 injections. Diarrhea is a known transient side effect of B12 injections, along with pain and burning at the injection site, and peripheral vascular thrombosis. Increasing dietary intake of B12-rich foods would not be sufficient due to the malabsorption issue in pernicious anemia. Follow-up is essential in managing pernicious anemia, so instructing patients they do not need to return for follow-up is incorrect. While oral B12 may be a suitable option for some cases, it is not the preferred choice for pernicious anemia where malabsorption is the primary issue.

3. While performing wound care to a donor skin graft site, the nurse notes some scabbing at the edges and a black collection of blood. What is the nurse's next action?

• A. Leave the scabbed area alone and apply extra ointment
• B. Notify the physician
• C. Gently remove the debris and re-dress the wound
• D. Apply skin softening lotion for 3 hours and then re-dress

Correct answer: C

Rationale: When the nurse notes scabbing at the edges and a black collection of blood, it indicates the presence of debris that needs to be addressed. Leaving the scabbed area alone and applying extra ointment may not address the underlying issue and could lead to complications. Notifying the physician is important in some cases, but immediate action is required to prevent infection in this situation. Gently removing the debris and re-dressing the wound is the correct course of action to promote healing and prevent complications.

4. While making rounds at 3 am, the nurse discovers a small fire in a client's room. What should the nurse do first?

• A. Remove the client from the room immediately.
• B. Leave the client's room to obtain a fire extinguisher.
• C. Instruct a nurse tech to pull the fire alarm.
• D. Evacuate all clients from the unit.

Correct answer: A

Rationale: During a fire emergency, the priority is the safety of the individual in the room where the fire is located. Removing the client from the room immediately is the first step in the RACE acronym for fire safety: Rescue/Remove, Alarm, Contain, and Extinguish. This action ensures the client's safety before addressing the fire itself. Choice B is incorrect as leaving the client's room to obtain a fire extinguisher can delay the immediate removal of the client from the danger. Choice C is incorrect as pulling the fire alarm should be done after ensuring the client's safety. Choice D is incorrect as evacuating all clients from the unit should come after ensuring the safety of the individual in immediate danger.

5. The client is being discharged after a concussion. Which of the following symptoms should be reported?

• A. Difficulty waking up
• B. Headache (3/10 on the pain scale)
• C. Bruising on knees and elbows
• D. Achy feeling all over

Correct answer: A

Rationale: The correct answer is 'Difficulty waking up' because it indicates a change in consciousness, which is a concerning symptom following a concussion. Reporting this symptom is crucial as it may signify a more severe head injury. 'Headache (3/10 on the pain scale)' may be common after a concussion but is not as urgent as a change in consciousness. 'Bruising on knees and elbows' is likely unrelated to the concussion and not a priority for reporting. 'Achy feeling all over' is a vague symptom and not specific to a concerning change in the client's condition post-concussion.

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