Nursing Elites

1. The nurse is caring for a 39-year-old woman with a family history of breast cancer. She requested a breast tumor marking test and the results have come back positive. As a result, the patient is requesting a bilateral mastectomy. This surgery is an example of what type of oncologic surgery?

• A. Salvage surgery
• B. Palliative surgery
• C. Prophylactic surgery
• D. Reconstructive surgery

Correct answer: C

Rationale: Prophylactic surgery refers to the preventive removal of tissues or organs at high risk for developing cancer, even when no cancer is currently present. In this case, the patient has a positive breast tumor marking test and a significant family history of breast cancer, which places her at increased risk for developing the disease. A bilateral mastectomy is performed to significantly reduce this risk by removing both breasts, thereby preventing the potential future occurrence of breast cancer.

2. When preparing for the patient's subsequent care after completing the full course of treatment for acute lymphocytic leukemia without a significant response, what action should the nurse take?

• A. Arrange a meeting between the patient's family and the hospital chaplain.
• B. Assess the factors underlying the patient's failure to adhere to the treatment regimen.
• C. Encourage the patient to vigorously pursue complementary and alternative medicine (CAM).
• D. Identify the patient's specific wishes around end-of-life care.

Correct answer: D

Rationale: In cases where a patient does not respond appreciably to therapy, it is crucial to identify and respect the patient's choices regarding treatment, including preferences for end-of-life care. Option A is incorrect because it focuses on spiritual support rather than the patient's care preferences. Option B is incorrect as it assumes non-adherence to treatment without evidence. Option C is incorrect as it suggests an alternative treatment approach without considering the patient's wishes for end-of-life care.

3. The nurse is assessing a client with leukemia who is receiving chemotherapy. Which of the following findings would be of most concern?

• A. Alopecia
• B. Fatigue
• C. Nausea and vomiting
• D. Mouth sores

Correct answer: D

Rationale: The correct answer is D, 'Mouth sores.' Mouth sores (stomatitis) are a common and potentially serious side effect of chemotherapy. They can lead to difficulty eating, increased risk of infection, and overall decreased quality of life for the client. While alopecia, fatigue, and nausea/vomiting are also common side effects of chemotherapy, they are generally manageable and do not pose the same level of immediate concern as the development of mouth sores in a client undergoing chemotherapy.

4. A patient with acute myeloid leukemia (AML) is receiving induction therapy. What is the priority nursing intervention during this phase of treatment?

• A. Administering pain management
• B. Monitoring for signs of infection
• C. Providing emotional support
• D. Monitoring fluid balance

Correct answer: B

Rationale: Induction therapy for acute myeloid leukemia (AML) involves intensive chemotherapy aimed at achieving remission by eliminating a large number of cancerous cells. However, this aggressive treatment also severely reduces the production of healthy blood cells, including neutrophils, which leads to neutropenia (a dangerously low number of neutrophils). This makes the patient highly susceptible to infections, which can be life-threatening. Monitoring for signs of infection is critical during this phase, as infections may occur quickly and progress rapidly due to the compromised immune system. Early detection and prompt treatment of infections are vital to improving patient outcomes during induction therapy.

5. The clinical nurse educator is presenting health promotion education to a patient who will be treated for non-Hodgkin lymphoma on an outpatient basis. The nurse should recommend which of the following actions?

• A. Avoiding direct sun exposure in excess of 15 minutes daily
• B. Avoiding grapefruit juice and fresh grapefruit
• C. Avoiding highly crowded public places
• D. Using an electric shaver rather than a razor

Correct answer: C

Rationale: Patients with non-Hodgkin lymphoma (NHL) often experience a compromised immune system due to both the disease itself and the effects of treatments like chemotherapy and radiation, which cause myelosuppression (decreased production of blood cells, including white blood cells). This puts them at significant risk for infections. Avoiding crowded places is a crucial preventive measure, as it reduces the patient's exposure to pathogens that could lead to infections, which can be particularly severe due to their weakened immune system.

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