Nursing Elites

1. A nurse practitioner is assessing a patient who has a fever, malaise, and a white blood cell count that is elevated. Which of the following principles should guide the nurses management of the patients care?

• A. There is a need for the patient to be assessed for lymphoma.
• B. Infection is the most likely cause of the patients change in health status.
• C. The patient is exhibiting signs and symptoms of leukemia.
• D. The patient should undergo diagnostic testing for multiple myeloma.

Correct answer: B

Rationale: An elevated white blood cell (WBC) count, also known as leukocytosis, is most commonly a response to infection. When the body detects an infection, the immune system responds by increasing the production of white blood cells to fight off the invading pathogens. The accompanying symptoms of fever and malaise are typical signs of infection, supporting the likelihood that this patient’s health status is related to an infectious process rather than a more serious hematologic condition like lymphoma or leukemia.

2. What advice should the oncology nurse give to a client planning a beach vacation after completing radiation treatments for cancer?

• A. Avoid getting salt water on the radiation site.
• B. Do not expose the radiation area to direct sunlight.
• C. Have a wonderful time and enjoy your vacation!
• D. Remember you should not drink alcohol for a year.

Correct answer: B

Rationale: The correct answer is B because the skin at the radiation site is sensitive to sunlight, and exposure can cause further damage. It is crucial to protect the area from direct sunlight to prevent skin irritation or burns. Choice A is incorrect as salt water typically does not pose a significant risk to the radiation site. Choice C is a positive and encouraging response but does not provide necessary advice for post-radiation care. Choice D, while important in some cases, is not directly related to the client's beach vacation after completing radiation treatments.

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. Nurse Maria is preparing a care plan for a client receiving external radiation therapy. Which of the following interventions should be included?

• A. Use heating pads on the treated area
• B. Wear loose, soft clothing over the treated area
• C. Expose the treated area to sunlight
• D. Apply ice packs to the treated area

Correct answer: B

Rationale: Radiation therapy can cause skin irritation, dryness, and sensitivity in the treated area. Wearing loose, soft clothing helps minimize friction and pressure on the skin, reducing irritation and promoting comfort. The skin in the treated area is often more sensitive and vulnerable to damage, so this intervention helps protect the skin while maintaining the client’s comfort during the course of treatment.

5. A patient diagnosed with acute myelogenous leukemia has just been admitted to the oncology unit. When writing this patient's care plan, what potential complication should the nurse address?

• A. Pancreatitis
• B. Hemorrhage
• C. Arteritis
• D. Liver dysfunction

Correct answer: B

Rationale: The correct answer is B: Hemorrhage. Patients with acute myelogenous leukemia are at high risk of hemorrhage due to low platelet count and abnormal clotting factors caused by bone marrow suppression. Pancreatitis (choice A) is not a common complication of acute myelogenous leukemia. Arteritis (choice C) refers to inflammation of arteries and is not a typical complication of this type of leukemia. Liver dysfunction (choice D) is not a primary concern in the immediate care plan for a patient with acute myelogenous leukemia.

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