Nursing Elites

1. A nurse at a long-term care facility is amending the care plan of a resident who has just been diagnosed with essential thrombocythemia (ET). The nurse should anticipate the administration of what medication?

• A. Dalteparin
• B. Allopurinol
• C. Hydroxyurea
• D. Hydrochlorothiazide

Correct answer: C

Rationale: Hydroxyurea is effective in lowering the platelet count for patients with ET.

2. A client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing which condition?

• A. Rupture of the bladder
• B. The development of a vesicovaginal fistula
• C. Extreme stress caused by the diagnosis of cancer
• D. Altered perineal sensation as a side effect of radiation therapy

Correct answer: B

Rationale: The correct answer is B. A vesicovaginal fistula is an abnormal connection between the bladder and the vagina, leading to the passage of urine through the vagina. This condition can occur due to various reasons, including radiation therapy. Choice A, rupture of the bladder, is incorrect because a rupture would present with more severe symptoms and is not consistent with the client's description. Choice C, extreme stress, is incorrect as it does not explain the physical symptom of voiding through the vagina. Choice D, altered perineal sensation, is incorrect as it does not involve a direct connection between the bladder and the vagina.

3. A clinic nurse is working with a patient who has a long-standing diagnosis of polycythemia vera. How can the nurse best gauge the course of the patient's disease?

• A. Document the color of the patient's palms and face during each visit.
• B. Follow the patient's erythrocyte sedimentation rate over time.
• C. Document the patient's response to erythropoietin injections.
• D. Follow the trends of the patient's hematocrit.

Correct answer: D

Rationale: The course of polycythemia vera can be best ascertained by monitoring the patient's hematocrit, which should remain below 45%. Hematocrit levels are a key indicator in assessing the progression of the disease. Choices A, B, and C are not the most appropriate methods for gauging the course of polycythemia vera. Monitoring the color of the patient's palms and face, or their response to erythropoietin injections, may not provide an accurate reflection of the disease's progression. Similarly, while erythrocyte sedimentation rate can be affected in polycythemia vera, it is not the primary marker for monitoring the disease's course.

4. A client with breast cancer is receiving doxorubicin (Adriamycin). The nurse monitors the client closely for:

• A. Pulmonary fibrosis
• B. Cardiotoxicity
• C. Hepatotoxicity
• D. Nephrotoxicity

Correct answer: B

Rationale: Doxorubicin (Adriamycin) is an anthracycline chemotherapy agent commonly used to treat various cancers, including breast cancer. One of the significant side effects associated with doxorubicin is cardiotoxicity, which can lead to serious complications such as heart failure and arrhythmias. The risk of cardiotoxicity is dose-dependent, meaning that higher cumulative doses increase the likelihood of cardiac damage. Therefore, it is essential for nurses to monitor cardiac function closely through assessments such as echocardiograms or monitoring for signs and symptoms of heart failure, such as shortness of breath, fatigue, and edema.

5. A client is admitted to the hospital with a suspected diagnosis of Hodgkin’s disease. Which assessment finding would the nurse expect to note specifically in the client?

• A. Fatigue
• B. Weakness
• C. Weight gain
• D. Enlarged lymph nodes

Correct answer: D

Rationale: Hodgkin’s disease (Hodgkin’s lymphoma) is a type of cancer that originates in the lymphatic system, particularly affecting the lymph nodes. A hallmark sign of Hodgkin’s disease is the painless enlargement of lymph nodes, often in the neck, armpit, or groin. These enlarged lymph nodes are typically firm and rubbery to the touch. This is one of the most distinctive and common early signs that healthcare providers look for when diagnosing the disease.

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