Nursing Elites

1. A patient on the oncology unit is receiving carmustine, a chemotherapy agent, and the nurse is aware that a significant side effect of this medication is thrombocytopenia. Which symptom should the nurse assess for in patients at risk for thrombocytopenia?

• A. Interrupted sleep pattern
• B. Hot flashes
• C. Epistaxis (nose bleed)
• D. Increased weight

Correct answer: C

Rationale: Thrombocytopenia is a condition characterized by a low platelet count, which increases the risk of bleeding and hemorrhage. Patients receiving chemotherapy agents like carmustine may experience thrombocytopenia as a significant side effect. Epistaxis (nosebleeds) is a common symptom associated with thrombocytopenia, as the blood vessels can become more fragile, and even minor trauma or spontaneous bleeding can occur. Therefore, assessing for signs of bleeding, including epistaxis, is crucial in patients at risk for thrombocytopenia.

2. A nurse is caring for a client admitted for Non-Hodgkin’s lymphoma and chemotherapy. The client reports nausea, flank pain, and muscle cramps. What action by the nurse is most important?

• A. Request an order for serum electrolytes and uric acid.
• B. Increase the client’s IV infusion rate.
• C. Instruct assistive personnel to strain all urine.
• D. Administer an IV antiemetic.

Correct answer: A

Rationale: The client's symptoms of nausea, flank pain, and muscle cramps are suggestive of tumor lysis syndrome (TLS), a potentially life-threatening complication of chemotherapy in which cancer cells break down rapidly, releasing large amounts of intracellular components into the bloodstream. This leads to imbalances in electrolytes (elevated potassium, phosphate, and uric acid levels, with low calcium levels), which can cause severe metabolic disturbances, including kidney damage, arrhythmias, and muscle cramps. Checking serum electrolytes and uric acid levels is crucial for diagnosing and managing TLS early, preventing further complications.

3. The client is assessing a client who has a new ureterostomy. Which statement by the client indicates the need for more education about urinary stoma care?

• A. I change my pouch every week.
• B. I change the appliance in the morning.
• C. I empty the urinary collection bag when it is two-thirds full.
• D. When I'm in the shower, I direct the flow of water away from my stoma.

Correct answer: D

Rationale: The correct answer is D because directing water away from the stoma while showering is incorrect. The stoma can and should be cleaned with water. Choices A, B, and C demonstrate proper stoma care practices, such as changing the pouch regularly, changing the appliance in the morning, and emptying the collection bag when it is two-thirds full, which are all appropriate actions for caring for a urinary stoma.

4. A nurse is caring for a patient who has been diagnosed with leukemia. The nurse's most recent assessment reveals the presence of ecchymoses on the patient's sacral area and petechiae on her forearms. In addition to informing the patient's primary care provider, what action should the nurse take?

• A. Initiate measures to prevent venous thromboembolism (VTE).
• B. Check the patient's most recent platelet level.
• C. Place the patient on protective isolation.
• D. Ambulate the patient to promote circulatory function.

Correct answer: B

Rationale: The patient's signs of ecchymoses and petechiae are suggestive of thrombocytopenia, which is a common complication of leukemia. Thrombocytopenia is a condition characterized by a low platelet count, leading to abnormal bleeding. Checking the patient's most recent platelet level is crucial to assess the severity of thrombocytopenia and guide further interventions. Initiating measures to prevent venous thromboembolism (VTE) (Choice A) is not directly related to the patient's current signs. Placing the patient on protective isolation (Choice C) is not necessary for ecchymoses and petechiae. Ambulating the patient (Choice D) is not appropriate without addressing the underlying cause of abnormal bleeding.

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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