Nursing Elites

1. 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.

2. When educating a patient with multiple myeloma who is being discharged home, what should the nurse emphasize regarding the management of this condition?

• A. Increasing fluid intake
• B. Avoiding sunlight exposure
• C. Monitoring for signs of infection
• D. Managing pain

Correct answer: C

Rationale: The correct answer is C: Monitoring for signs of infection. Patients with multiple myeloma have a compromised immune system, making them more susceptible to infections. Emphasizing the importance of monitoring for signs of infection helps in early detection and prompt treatment. Increasing fluid intake (choice A) is essential for many health conditions but is not the priority in managing multiple myeloma. Avoiding sunlight exposure (choice B) may be relevant for certain skin conditions or medications but is not a key aspect of multiple myeloma management. Managing pain (choice D) is important, but in the context of multiple myeloma, monitoring for signs of infection takes precedence due to the increased risk of infections in these patients.

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. Nurse Kate is reviewing the complications of conization with a client who has microinvasive cervical cancer. Which complication, if identified by the client, indicates a need for further teaching?

• A. Infection
• B. Hemorrhage
• C. Cervical stenosis
• D. Ovarian perforation

Correct answer: D

Rationale: The correct answer is D, 'Ovarian perforation.' Ovarian perforation is not a complication associated with conization; therefore, if the client identifies this as a potential complication, it indicates a need for further teaching. Choices A, B, and C are incorrect: Infection, hemorrhage, and cervical stenosis are potential complications of conization, so identifying them would not necessarily indicate a need for further teaching.

5. As part of chemotherapy education, the nurse teaches a female client about the risk for bleeding and self-care during the period of greatest bone marrow suppression (the nadir). The nurse understands that further teaching is needed if the client makes which statement?

• A. I should avoid blowing my nose.
• B. I may need a platelet transfusion if my platelet count is too low.
• C. I should take aspirin for my headache as soon as I get home.
• D. I will count the number of pads and tampons I use when menstruating.

Correct answer: C

Rationale: The correct answer is C. Taking aspirin is not recommended during periods of bone marrow suppression as it can increase the risk of bleeding. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can impair platelet function, further exacerbating the risk of bleeding. Choices A, B, and D are all appropriate statements for a client at risk for bleeding and undergoing chemotherapy. Blowing the nose gently, being prepared for a platelet transfusion if needed, and monitoring menstrual bleeding are all important aspects of self-care during this period.

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