Nursing Elites

1. The nurse on a bone marrow transplant unit is caring for a patient with cancer who is preparing for HSCT. What is a priority nursing diagnosis for this patient?

• A. Fatigue related to altered metabolic processes
• B. Altered nutrition: less than body requirements related to anorexia
• C. Risk for infection related to altered immunologic response
• D. Body image disturbance related to weight loss and anorexia

Correct answer: C

Rationale: Patients preparing for hematopoietic stem cell transplantation (HSCT) undergo intensive chemotherapy and/or radiation, which significantly suppresses their immune system. This immunosuppression leads to a heightened risk for infection, making it the most critical nursing diagnosis for these patients. As the body’s ability to fight off pathogens is compromised, close monitoring and interventions aimed at preventing infections are essential for their safety and recovery.

2. 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.

3. Nurse Joy is caring for a client with an internal radiation implant. When caring for the client, the nurse should observe which of the following principles?

• A. Limit the time with the client to 1 hour per shift
• B. Do not allow pregnant women into the client’s room
• C. Remove the dosimeter badge when entering the client’s room
• D. Individuals younger than 16 years old may be allowed to go in the room as long as they are 6 feet away from the client

Correct answer: B

Rationale: Clients with internal radiation implants (also known as brachytherapy) emit a small amount of radiation, which can pose a risk to others. Pregnant women are particularly vulnerable to the harmful effects of radiation because it can affect both the mother and the developing fetus. Radiation exposure can lead to birth defects, miscarriage, or other developmental issues, so pregnant women should avoid any exposure by not entering the client's room.

4. Traditionally, nurses have been involved with tertiary cancer prevention. However, an increasing emphasis is being placed on both primary and secondary prevention. What would be an example of primary prevention?

• A. Yearly Pap tests
• B. Testicular self-examination
• C. Teaching patients to wear sunscreen
• D. Screening mammograms

Correct answer: C

Rationale: Primary prevention involves actions taken to reduce the risk of developing cancer by preventing exposure to known risk factors or promoting healthy behaviors. Teaching patients to wear sunscreen is an example of primary prevention because it aims to reduce the risk of skin cancer by minimizing exposure to harmful ultraviolet (UV) radiation from the sun. Encouraging protective measures such as wearing sunscreen, avoiding tanning beds, and wearing protective clothing are all steps to prevent skin cancer before it develops.

5. A patient with Hodgkin lymphoma is receiving radiation therapy. What side effect should the nurse monitor for that is most common with this type of treatment?

• A. Alopecia
• B. Fatigue
• C. Nausea
• D. Mucositis

Correct answer: D

Rationale: Mucositis is a common side effect of radiation therapy that should be closely monitored.

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