Nursing Elites

1. Nurse Joy is caring for a client with cancer who has been receiving cisplatin (Platinol-AQ). Which laboratory result requires an intervention by the nurse?

• A. White blood cell count of 6000 cells/microL
• B. Serum potassium level of 3.5 mEq/L
• C. Blood urea nitrogen (BUN) of 18 mg/dL
• D. Platelet count of 150,000 cells/microL

Correct answer: C

Rationale: The correct answer is C. A BUN level of 18 mg/dL is within the normal range; however, since cisplatin is nephrotoxic, it requires close monitoring. Elevated BUN levels can indicate impaired kidney function. Choices A, B, and D are within normal ranges and do not directly relate to cisplatin therapy or require immediate intervention.

2. A public health nurse has formed an interdisciplinary team that is developing an educational program entitled Cancer: The Risks and What You Can Do About Them. Participants will receive information, but the major focus will be screening for relevant cancers. This program is an example of what type of health promotion activity?

• A. Disease prophylaxis
• B. Risk reduction
• C. Secondary prevention
• D. Tertiary prevention

Correct answer: C

Rationale: Secondary prevention involves screening and early detection activities that seek to identify early-stage cancer in individuals who lack symptoms.

3. A 58-year-old male patient has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest x-ray shows carcinoma. The patient is anxious and asks if he can smoke. Which statement by the nurse would be most therapeutic?

• A. Smoking is the reason you are here.
• B. The doctor left orders for you not to smoke.
• C. You are anxious about the surgery. Do you see smoking as helping?
• D. Smoking is OK right now, but after your surgery it is contraindicated.

Correct answer: C

Rationale: Choice C is the most therapeutic response as it acknowledges the patient's anxiety and encourages reflection on his behavior. This approach can help the patient explore his feelings and thoughts about smoking in relation to his surgery, promoting self-awareness and potentially opening the door for a constructive discussion. Choices A and B are more directive and may not address the underlying anxiety and need for reflection. Choice D is also somewhat permissive about smoking before surgery, which may not be in the patient's best interest.

4. A patient with a myelodysplastic syndrome is being treated on the medical unit. What assessment finding should prompt the nurse to contact the patients primary care provider?

• A. The patient is experiencing a frontal lobe headache.
• B. The patient has an episode of urinary incontinence.
• C. The patient has an oral temperature of 37.5C (99.5F).
• D. The patients SpO2 is 91% on room air.

Correct answer: C

Rationale: Patients with myelodysplastic syndrome (MDS) have a dysfunctional bone marrow that leads to ineffective blood cell production, including white blood cells, which are crucial for fighting infections. As a result, they are at high risk for infections. Even a slight elevation in temperature, such as 37.5°C (99.5°F), could be an early sign of infection in an immunocompromised patient. Early detection and treatment of infections are critical in MDS patients, as infections can quickly become severe or life-threatening due to their compromised immune system.

5. A client with a history of prostate cancer is in the clinic and reports new onset of severe low back pain. What action by the nurse is most important?

• A. Assess the client’s gait and balance.
• B. Ask the client about any changes in urinary symptoms.
• C. Document the report thoroughly.
• D. Inquire about the client’s recent activities.

Correct answer: A

Rationale: The correct action by the nurse is to assess the client’s gait and balance. Severe low back pain in a client with a history of prostate cancer may indicate spinal cord compression, a serious complication. Assessing gait and balance can help determine if there is any spinal cord involvement, which requires immediate medical attention. Asking about changes in urinary symptoms (choice B) is important to assess for possible urinary obstruction, but assessing gait and balance takes precedence due to the risk of spinal cord compression. Documenting the report thoroughly (choice C) is essential but not the most immediate action needed. Inquiring about recent activities (choice D) is not as critical as assessing for spinal cord involvement.

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