Nursing Elites

1. A nurse is caring for a patient who has a diagnosis of acute leukemia. What assessment most directly addresses the most common cause of death among patients with leukemia?

• A. Monitoring for infection
• B. Monitoring nutritional status
• C. Monitoring electrolyte levels
• D. Monitoring liver function

Correct answer: A

Rationale: The correct answer is monitoring for infection. In patients with acute leukemia, the most common cause of death is usually infection or bleeding. By closely monitoring for signs of infection, such as fever, altered mental status, or elevated white blood cell count, healthcare providers can intervene promptly. Monitoring nutritional status (choice B) is important but does not directly address the most common cause of death among leukemia patients. Monitoring electrolyte levels (choice C) and liver function (choice D) are also important assessments in cancer patients; however, they are not the most direct assessment to address the leading cause of death in patients with leukemia.

2. A client is diagnosed as having a positive reaction to the Mantoux test. Which of the following is the most appropriate nursing action?

• A. Isolate the client in a private room.
• B. Administer isoniazid (INH) as prescribed.
• C. Schedule the client for a chest x-ray.
• D. Begin a 9-month course of medication therapy.

Correct answer: C

Rationale: The correct answer is to schedule the client for a chest x-ray. A positive Mantoux test indicates exposure to TB, but it does not confirm active disease. A chest x-ray is necessary to assess the presence of active TB disease. Isolating the client in a private room (Choice A) is not necessary based solely on a positive Mantoux test result. Administering isoniazid (INH) (Choice B) or beginning a 9-month course of medication therapy (Choice D) is premature without confirming active TB through a chest x-ray.

3. The nurse is caring for a patient with an advanced stage of breast cancer and the patient has recently learned that her cancer has metastasized. The nurse enters the room and finds the patient struggling to breathe and the nurse’s rapid assessment reveals that the patient’s jugular veins are distended. The nurse should suspect the development of what oncologic emergency?

• A. Increased intracranial pressure
• B. Superior vena cava syndrome (SVCS)
• C. Spinal cord compression
• D. Metastatic tumor of the neck

Correct answer: B

Rationale: Superior vena cava syndrome (SVCS) occurs when the superior vena cava, the large vein responsible for returning blood from the upper body to the heart, becomes obstructed or compressed, often due to a tumor, such as metastasized breast cancer. SVCS results in impaired venous drainage, leading to symptoms like distended jugular veins, facial swelling, difficulty breathing (dyspnea), and upper body edema. It is a medical emergency that requires prompt intervention to restore blood flow and alleviate symptoms.

4. The clinical nurse educator is presenting health promotion education to a patient who will be treated for non-Hodgkin lymphoma on an outpatient basis. The nurse should recommend which of the following actions?

• A. Avoiding direct sun exposure in excess of 15 minutes daily
• B. Avoiding grapefruit juice and fresh grapefruit
• C. Avoiding highly crowded public places
• D. Using an electric shaver rather than a razor

Correct answer: C

Rationale: Patients with non-Hodgkin lymphoma (NHL) often experience a compromised immune system due to both the disease itself and the effects of treatments like chemotherapy and radiation, which cause myelosuppression (decreased production of blood cells, including white blood cells). This puts them at significant risk for infections. Avoiding crowded places is a crucial preventive measure, as it reduces the patient's exposure to pathogens that could lead to infections, which can be particularly severe due to their weakened immune system.

5. A client undergoing chemotherapy is at risk for developing mucositis. What nursing intervention is most appropriate to help manage this condition?

• A. Encourage the client to drink plenty of fluids.
• B. Administer antifungal mouthwash.
• C. Teach the client to avoid spicy or acidic foods.
• D. Apply a topical anesthetic to the oral mucosa before meals.

Correct answer: C

Rationale: Avoiding spicy or acidic foods can help prevent irritation of the mucosa, which is already sensitive during mucositis.

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