Nursing Elites

1. A patient with stage I nonsmall cell lung cancer expresses a preference for chemotherapy over surgery. Which response by the nurse is most appropriate?

• A. Are you concerned about the potential pain from surgery?
• B. Have you had negative experiences with previous surgeries?
• C. Surgery is the recommended treatment for stage I lung cancer.
• D. Tell me about your understanding of the different available treatments.

Correct answer: D

Rationale: The most appropriate response by the nurse in this situation is to gather more information about the patient's concerns and preferences. By asking the patient to share their understanding of the available treatments, the nurse encourages open communication and gains insight into the patient's knowledge and preferences. Option A focuses solely on pain, which may not be the patient's primary concern. Option B assumes negative experiences without exploring the patient's current thoughts. Option C, stating that surgery is the recommended treatment, dismisses the patient's preference and does not address their concerns. Chemotherapy is not the primary treatment for nonsmall cell lung cancer; it may be used for nonresectable tumors or as adjuvant therapy to surgery, making it crucial for the nurse to explore the patient's treatment preferences and understanding.

2. A client is scheduled for an Intravenous Pyelogram (IVP). In order to prepare the client for this test, the nurse would:

• A. Instruct the client to maintain a regular diet the day prior to the examination.
• B. Restrict the client's fluid intake 4 hours prior to the examination.
• C. Administer a laxative to the client the evening before the examination.
• D. Inform the client that only 1 x-ray of his abdomen is necessary.

Correct answer: C

Rationale: The correct preparation for an Intravenous Pyelogram (IVP) involves administering a laxative to the client the evening before the examination. This is crucial to ensure adequate bowel preparation, which in turn allows for better visualization of the bladder and ureters during the procedure. An IVP is an x-ray exam that utilizes contrast material to evaluate the kidneys, ureters, and bladder, aiding in the diagnosis of conditions like blood in the urine or pain in the side or lower back. Administering a laxative helps in achieving optimal imaging quality, which is essential for accurate diagnosis and subsequent treatment planning. Choice A is incorrect because maintaining a regular diet is not the standard preparation for an IVP. Choice B is incorrect as fluid intake is not typically restricted for this procedure. Choice D is incorrect as an IVP involves multiple x-rays to assess the urinary system, not just one of the abdomen.

3. A nurse is caring for a client who was recently diagnosed with breast cancer. The oncologist uses the TNM staging system to classify this case as T2, N2, M0. The nurse understands that TNM stands for:

• A. Tumor, Necrosis, Metastasis
• B. Tumor, Node Involvement, Mastectomy
• C. Tumor, Node Involvement, Metastasis
• D. Therapy, Necrosis, Metastasis

Correct answer: B

Rationale: The TNM staging system is a classification system for determining the size and extent of cancerous tissue. The TNM system helps providers to identify the most accurate forms of treatment. The T stands for tumor, the N stands for node involvement, and the M stands for metastasis. Choice A, 'Tumor, Necrosis, Metastasis,' is incorrect because it does not include the node involvement component. Choice B, 'Tumor, Node Involvement, Mastectomy,' is incorrect as it erroneously includes the treatment approach 'Mastectomy' instead of 'Metastasis.' Choice D, 'Therapy, Necrosis, Metastasis,' is incorrect because it includes 'Therapy' instead of the correct component 'Node Involvement.'

4. When teaching the client with tuberculosis about follow-up home care, the nurse should emphasize that a laboratory appointment for which of the following lab tests is critical?

• A. Liver function
• B. Kidney function
• C. Blood sugar
• D. Cardiac enzymes

Correct answer: A

Rationale: The nurse should emphasize the importance of monitoring liver function tests in clients taking INH due to the risk of hepatocellular injury and hepatitis associated with this medication. Regular assessment of liver enzymes can help detect liver damage early. Monitoring kidney function, blood sugar levels, or cardiac enzymes is not specifically required for clients taking INH and tuberculosis treatment.

5. The nurse is taking the health history of a patient being treated for Emphysema and Chronic Bronchitis. After being told the patient has been smoking cigarettes for 30 years, the nurse expects to note which assessment finding?

• A. Increase in Forced Vital Capacity (FVC)
• B. A widened chest cavity
• C. Clubbed fingers
• D. An increased risk of cardiac failure

Correct answer: C

Rationale: 1. Increase in Forced Vital Capacity (FVC): Forced Vital Capacity is the volume of air exhaled from full inhalation to full exhalation. A patient with COPD would have a decrease in FVC. Therefore, this choice is incorrect. 2. A widened chest cavity: A patient with COPD often presents with a 'barrel chest,' which is seen as a widened chest cavity. Hence, a narrowed chest cavity is not an expected finding. 3. Clubbed fingers - CORRECT: Clubbed fingers are a sign of a long-term, or chronic, decrease in oxygen levels, which is commonly seen in patients with chronic respiratory conditions like Emphysema and Chronic Bronchitis. 4. An increased risk of cardiac failure: Although a patient with these conditions would indeed be at an increased risk for cardiac failure, this is a potential complication and not an assessment finding, making it an incorrect choice.

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