Nursing Elites

1. An oncology patient has just returned from the post-anesthesia care unit after an open hemicolectomy. This patient’s plan of nursing care should prioritize which of the following?

• A. Assess the patient hourly for signs of compartment syndrome.
• B. Assess the patient’s fine motor skills once per shift.
• C. Assess the patient’s wound for dehiscence every 4 hours.
• D. Maintain the patient’s head of bed at 45 degrees or more at all times.

Correct answer: C

Rationale: After an open hemicolectomy (surgical removal of part of the colon), monitoring the surgical wound for signs of dehiscence (wound reopening) is a critical nursing priority. Dehiscence is a serious postoperative complication that can occur if the surgical site does not heal properly. Regular wound assessments every 4 hours allow the nurse to identify early signs of complications, such as redness, swelling, increased drainage, or separation of the wound edges. Early detection is key to preventing further complications, such as infection or evisceration (protrusion of abdominal organs through the wound).

2. The nurse is caring for a patient who has just been given a 6-month prognosis following a diagnosis of extensive-stage small-cell lung cancer. The patient states that he would like to die at home, but the team believes that the patient's care needs are unable to be met in a home environment. What might you suggest as an alternative?

• A. Discuss a referral for rehabilitation hospital.
• B. Panel the patient for a personal care home.
• C. Discuss a referral for acute care.
• D. Discuss a referral for hospice care.

Correct answer: D

Rationale: In this scenario, the most appropriate alternative to address the patient's desire to die at home while ensuring proper care is hospice care. Hospice care is specifically designed to provide support to patients and families in situations where the patient's needs cannot be met at home. Rehabilitation hospital (Choice A), personal care home (Choice B), and acute care (Choice C) are not the most suitable options in this case as they do not focus on end-of-life care and support like hospice care does.

3. A nurse is planning the care of a patient who has been admitted to the medical unit with a diagnosis of multiple myeloma. In the patients care plan, the nurse has identified a diagnosis of Risk for Injury. What pathophysiologic effect of multiple myeloma most contributes to this risk?

• A. Labyrinthitis
• B. Left ventricular hypertrophy
• C. Decreased bone density
• D. Hypercoagulation

Correct answer: C

Rationale: In multiple myeloma, the malignant proliferation of plasma cells within the bone marrow leads to the secretion of osteoclast-activating factors, which increase the breakdown of bone tissue (osteolysis). This results in decreased bone density, osteoporosis, and osteolytic lesions, making bones fragile and more prone to pathologic fractures. Patients with multiple myeloma are at high risk for fractures even with minimal trauma due to the weakened bone structure, which is why Risk for Injury is a key diagnosis.

4. A nurse is planning care for a patient with leukemia who has been experiencing severe fatigue. What is the most appropriate intervention to include in the care plan?

• A. Encouraging the patient to remain in bed
• B. Scheduling frequent rest periods
• C. Providing a high-calorie diet
• D. Administering blood transfusions

Correct answer: B

Rationale: In patients with leukemia, severe fatigue is a common symptom due to factors such as anemia, the disease process itself, and the effects of treatments like chemotherapy. The most appropriate intervention is to schedule frequent rest periods to help manage fatigue while encouraging a balance between rest and activity. This approach allows the patient to conserve energy for essential tasks and prevent exhaustion, without promoting complete inactivity, which can lead to deconditioning.

5. A nurse is caring for a patient with myelodysplastic syndrome (MDS) who is receiving erythropoietin therapy. What should the nurse monitor to evaluate the effectiveness of this treatment?

• A. Platelet count
• B. Hemoglobin level
• C. White blood cell count
• D. Oxygen saturation

Correct answer: B

Rationale: Erythropoietin therapy is used to stimulate the production of red blood cells in patients with myelodysplastic syndrome (MDS), a disorder characterized by ineffective blood cell production, including red blood cells. The primary goal of erythropoietin therapy is to increase red blood cell count, improving the patient's oxygen-carrying capacity and reducing symptoms of anemia, such as fatigue and weakness. Monitoring hemoglobin levels is the best way to evaluate the effectiveness of this therapy because it directly reflects the patient's red blood cell count and the success of erythropoiesis (red blood cell production).

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