Nursing Elites

1. The nurse is caring for a client who is at risk for tumor lysis syndrome. Which laboratory value requires the nurse to intervene?

• A. Decreased blood urea nitrogen (BUN)
• B. Increased serum calcium
• C. Increased creatinine level
• D. Increased blood glucose level

Correct answer: C

Rationale: Tumor lysis syndrome (TLS) is a potentially life-threatening condition that occurs when large numbers of cancer cells die rapidly, releasing their contents into the bloodstream. This can overwhelm the kidneys and lead to acute kidney injury. Creatinine is a waste product filtered out of the blood by the kidneys, and an elevated creatinine level is a sign of kidney dysfunction or damage. In TLS, increased creatinine levels indicate that the kidneys are struggling to filter out the excess waste products from cell breakdown, requiring immediate intervention to prevent further complications, such as acute renal failure.

2. A nurse provides care on a bone marrow transplant unit and is preparing a female patient for a hematopoietic stem cell transplantation (HSCT) the following day. What information should the nurse emphasize to the patient’s family and friends?

• A. Your family should gather at the bedside in case there is a negative outcome.
• B. Ensure she abstains from eating any food 24 hours before the procedure.
• C. Wear a hospital gown when entering the patient's room.
• D. Avoid visiting if you've had a recent infection.

Correct answer: D

Rationale: The correct answer is D: 'Avoid visiting if you've had a recent infection.' Before a hematopoietic stem cell transplantation, it is essential for visitors to refrain from visiting if they have had a recent illness or vaccination to minimize the risk of infection to the patient. Choice A is incorrect because emphasizing a negative outcome is not beneficial to the patient or their family. Choice B is incorrect as it is not necessary to abstain from food for a hematopoietic stem cell transplantation. Choice C is irrelevant to the situation as wearing a hospital gown is not the key information for family and friends to be aware of.

3. A nurse is caring for a patient with myelodysplastic syndrome (MDS) who is at risk for anemia. What is the most appropriate intervention to address this risk?

• A. Administering iron supplements
• B. Administering blood transfusions
• C. Providing a high-iron diet
• D. Administering erythropoietin

Correct answer: D

Rationale: In myelodysplastic syndrome (MDS), the bone marrow does not produce enough healthy blood cells, leading to conditions such as anemia. Administering erythropoietin is an effective intervention to manage anemia in MDS patients because it stimulates the production of red blood cells. This can help improve the patient’s hemoglobin levels, reducing symptoms such as fatigue and weakness associated with anemia. Erythropoietin is commonly used in MDS to enhance red blood cell production and reduce the need for frequent blood transfusions.

4. The nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which is an early sign of this oncological emergency?

• A. Cyanosis
• B. Arm edema
• C. Periorbital edema
• D. Mental status changes

Correct answer: C

Rationale: Superior vena cava syndrome (SVCS) occurs when the superior vena cava, the large vein that carries blood from the upper body to the heart, becomes compressed or obstructed, often by a tumor or enlarged lymph nodes, typically in cancers like lung cancer or lymphoma. The obstruction leads to increased venous pressure and reduced blood flow, resulting in swelling and edema in areas drained by the superior vena cava. Periorbital edema (swelling around the eyes) is one of the earliest signs of SVCS. This occurs because the impaired venous return causes fluid to accumulate in the soft tissues of the face, especially around the eyes. As the condition progresses, facial swelling can worsen, and other symptoms develop.

5. The nurse has educated a client on precautions to take with thrombocytopenia. What statement by the client indicates a need to review the information?

• A. I will be careful if I need enemas for constipation.
• B. I will use an electric shaver instead of a razor.
• C. I should only eat soft food that is either cool or warm.
• D. I won’t be able to play sports with my grandkids.

Correct answer: A

Rationale: The correct answer is A because enemas can cause injury to a thrombocytopenic client due to the risk of bleeding. Choices B, C, and D are correct precautions for a client with thrombocytopenia. Using an electric shaver reduces the risk of cuts that could lead to bleeding. Eating soft, cool, or warm food helps prevent injuries to the oral mucosa. Avoiding activities like sports that carry a risk of injury is also advisable.

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