Nursing Elites

1. A nurse is caring for a patient whose diagnosis of multiple myeloma is being treated with bortezomib. The nurse should assess for what adverse effect of this treatment?

• A. Stomatitis
• B. Nephropathy
• C. Cognitive changes
• D. Peripheral neuropathy

Correct answer: D

Rationale: The correct answer is D: Peripheral neuropathy. Bortezomib, used in the treatment of multiple myeloma, is known to cause peripheral neuropathy as a significant adverse effect. Stomatitis (Choice A), which is inflammation of the mouth and lips, is not a common adverse effect of bortezomib. Nephropathy (Choice B), referring to kidney disease, is not a typical adverse effect of bortezomib. Cognitive changes (Choice C) are not a commonly reported adverse effect of bortezomib treatment.

2. A new nurse has been assigned a client who is in the hospital to receive iodine-131 treatment. Which action by the nurse is best?

• A. Ensure the client is placed in protective isolation.
• B. Have pregnant visitors stay 6 feet from the client.
• C. No special action is necessary to care for this client.
• D. Read the policy on handling radioactive excreta.

Correct answer: D

Rationale: Handling radioactive excreta requires special precautions; the nurse must be familiar with the facility's policies.

3. When planning care for a 77-year-old male admitted with suspected acute myeloid leukemia (AML), what epidemiologic fact should the nurse be aware of?

• A. Early diagnosis is associated with good outcomes.
• B. Five-year survival for older adults is approximately 50%.
• C. Five-year survival for patients over 75 years old is less than 2%.
• D. Survival rates are wholly dependent on the patient's pre-illness level of health.

Correct answer: C

Rationale: In the context of AML, the 5-year survival rate significantly decreases with age. The 5-year survival rate for patients over 75 years old is less than 2% compared to 43% for those 50 years or younger, and 19% for those between 50 and 64 years. Choice A is incorrect as early diagnosis does not necessarily guarantee good outcomes in AML. Choice B is inaccurate as the 5-year survival rate is not approximately 50% for older adults with AML. Choice D is incorrect as survival rates for AML patients are influenced by various factors beyond just the pre-illness level of health.

4. The nurse is assessing the colostomy of a client who has had an abdominal perineal resection for a bowel tumor. Which assessment finding indicates that the colostomy is beginning to function?

• A. The passage of flatus
• B. Absent bowel sounds
• C. The client’s ability to tolerate food
• D. Bloody drainage from the colostomy

Correct answer: A

Rationale: The passage of flatus (gas) from the colostomy is an early sign that the bowel is beginning to function after surgery. This indicates that peristalsis, or the movement of the intestines, has resumed and that the digestive system is actively moving gas and eventually stool through the bowel and out of the colostomy. It’s a positive sign that the bowel is recovering from the surgery and starting to work as intended.

5. 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.

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