Nursing Elites

1. An adult patient has presented to the health clinic with a complaint of a firm, painless cervical lymph node. The patient denies any recent infectious diseases. What is the nurse's most appropriate response to the patient's complaint?

• A. Call 911.
• B. Promptly refer the patient for medical assessment.
• C. Facilitate a radiograph of the patient's neck and have the results forwarded to the patient's primary care provider.
• D. Encourage the patient to track the size of the lymph node and seek care in 1 week.

Correct answer: B

Rationale: The most appropriate response for a patient presenting with a firm, painless cervical lymph node and denying recent infectious diseases is to promptly refer the patient for medical assessment. This is crucial to rule out serious underlying conditions such as malignancy or other concerning causes. Calling 911 is not necessary in this situation as it is not an emergency. Ordering a radiograph may not be the most immediate or appropriate action, as further evaluation by a healthcare provider is needed first. Encouraging the patient to wait and track the lymph node for a week is not advisable when a potential serious condition needs to be ruled out promptly.

2. The home health nurse is performing a home visit for an oncology patient discharged 3 days ago after completing treatment for non-Hodgkin lymphoma. The nurse's assessment should include examination for the signs and symptoms of what complication?

• A. Tumor lysis syndrome (TLS)
• B. Syndrome of inappropriate antidiuretic hormone (SIADH)
• C. Disseminated intravascular coagulation (DIC)
• D. Hypercalcemia

Correct answer: A

Rationale: The correct answer is A: Tumor lysis syndrome (TLS). Tumor lysis syndrome is a potential complication after treatment for certain cancers, including non-Hodgkin lymphoma. The rapid breakdown of cancer cells in response to treatment can lead to metabolic abnormalities, such as hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia, which can be life-threatening. Choice B, Syndrome of inappropriate antidiuretic hormone (SIADH), is not typically associated with non-Hodgkin lymphoma treatment. Choice C, Disseminated intravascular coagulation (DIC), is more commonly seen in conditions such as sepsis or trauma, not directly related to non-Hodgkin lymphoma treatment. Choice D, Hypercalcemia, is not a common complication following treatment for non-Hodgkin lymphoma.

3. A client in the emergency department reports difficulty breathing. The nurse assesses the client’s appearance as depicted below: What action by the nurse is most important?

• A. Assess blood pressure and pulse.
• B. Attach the client to a pulse oximeter.
• C. Have the client rate his or her pain.
• D. Facilitate urgent radiation therapy.

Correct answer: A

Rationale: The correct action by the nurse is to assess the client's blood pressure and pulse. Difficulty breathing can be a sign of various conditions, including cardiac issues. Assessing blood pressure and pulse helps in determining the client's hemodynamic status and identifying any cardiovascular compromise. Option B is less crucial as attaching the client to a pulse oximeter may provide oxygen saturation levels but does not directly assess cardiac output. Option C is not the priority in this situation as the client's difficulty breathing is a more urgent concern. Option D is incorrect as urgent radiation therapy is not indicated based on the client's presentation.

4. A patient with chronic lymphocytic leukemia (CLL) is at risk for tumor lysis syndrome. What laboratory values should the nurse monitor to detect this complication?

• A. Creatinine and blood urea nitrogen (BUN)
• B. Electrolytes and uric acid levels
• C. Serum glucose and calcium levels
• D. Liver enzymes and bilirubin levels

Correct answer: B

Rationale: Electrolytes and uric acid levels are important to monitor for the development of tumor lysis syndrome.

5. The nurse is reviewing the medication record for a client receiving chemotherapy and notes that the client is receiving epoetin alfa (Epogen). The nurse determines that this medication has been prescribed to:

• A. Increase white blood cell production
• B. Treat anemia
• C. Reduce pain
• D. Prevent infection

Correct answer: B

Rationale: Epoetin alfa (Epogen) is a synthetic form of erythropoietin, a hormone that stimulates the production of red blood cells in the bone marrow. Chemotherapy often leads to anemia due to its effects on rapidly dividing cells, including those in the bone marrow responsible for red blood cell production. By administering epoetin alfa, the healthcare provider aims to increase the red blood cell count and improve hemoglobin levels, thereby alleviating symptoms associated with anemia, such as fatigue and weakness.

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