Nursing Elites

1. A patient’s most recent diagnostic imaging has revealed that his lung cancer has metastasized to his bones and liver. What is the most likely mechanism by which the patient’s cancer cells spread?

• A. Hematologic spread
• B. Lymphatic circulation
• C. Invasion
• D. Angiogenesis

Correct answer: B

Rationale: In the case of lung cancer that has metastasized to the bones and liver, lymphatic circulation is a key mechanism by which cancer cells spread from the primary tumor site to distant organs. Cancer cells can invade nearby lymphatic vessels and travel through the lymphatic system, eventually reaching lymph nodes and spreading to other tissues and organs. This route is significant in the metastasis of many types of cancer, including lung cancer.

2. The nurse is caring for a client who is at risk for tumor lysis syndrome. Which laboratory value requires the nurse to intervene?

• A. Decreased blood urea nitrogen (BUN)
• B. Increased serum calcium
• C. Increased creatinine level
• D. Increased blood glucose level

Correct answer: C

Rationale: Tumor lysis syndrome (TLS) is a potentially life-threatening condition that occurs when large numbers of cancer cells die rapidly, releasing their contents into the bloodstream. This can overwhelm the kidneys and lead to acute kidney injury. Creatinine is a waste product filtered out of the blood by the kidneys, and an elevated creatinine level is a sign of kidney dysfunction or damage. In TLS, increased creatinine levels indicate that the kidneys are struggling to filter out the excess waste products from cell breakdown, requiring immediate intervention to prevent further complications, such as acute renal failure.

3. The hospice nurse is caring for a patient with cancer in her home. The nurse has explained to the patient and the family that the patient is at risk for hypercalcemia and has educated them on the signs and symptoms of this health problem. What else should the nurse teach this patient and family to do to reduce the patient’s risk of hypercalcemia?

• A. Stool softeners are contraindicated.
• B. Laxatives should be taken daily.
• C. Consume 2 to 4 L of fluid daily.
• D. Restrict calcium intake.

Correct answer: C

Rationale: The nurse should encourage the patient to consume 2 to 4 liters of fluid daily to reduce the risk of hypercalcemia.

4. The cells of a normal individual can replicate in a specified rate. If the rate of replication becomes uncontrollable, which of the following is lacking from the patient?

• A. Apoptosis
• B. Contact inhibition
• C. Stable cells
• D. Labile cells

Correct answer: B

Rationale: Contact inhibition is a regulatory mechanism that prevents cells from proliferating once they reach a certain density. Normally, when cells grow and touch each other (such as in a monolayer), they stop dividing, maintaining tissue integrity and structure. When contact inhibition is lacking, as in many cancerous cells, cells continue to grow and divide uncontrollably, leading to tumor formation. This loss of regulation is a hallmark of cancerous growth.

5. A nurse is preparing to administer filgrastim to a client undergoing chemotherapy. What is the primary purpose of this medication?

• A. Increase white blood cell production.
• B. Reduce the risk of infection.
• C. Enhance red blood cell production.
• D. Control chemotherapy-induced nausea and vomiting.

Correct answer: A

Rationale: Filgrastim is primarily used to increase white blood cell production in clients undergoing chemotherapy.

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