Nursing Elites

1. A client is diagnosed as having a positive reaction to the Mantoux test. Which of the following is the most appropriate nursing action?

• A. Isolate the client in a private room.
• B. Administer isoniazid (INH) as prescribed.
• C. Schedule the client for a chest x-ray.
• D. Begin a 9-month course of medication therapy.

Correct answer: C

Rationale: The correct answer is to schedule the client for a chest x-ray. A positive Mantoux test indicates exposure to TB, but it does not confirm active disease. A chest x-ray is necessary to assess the presence of active TB disease. Isolating the client in a private room (Choice A) is not necessary based solely on a positive Mantoux test result. Administering isoniazid (INH) (Choice B) or beginning a 9-month course of medication therapy (Choice D) is premature without confirming active TB through a chest x-ray.

2. 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.

3. Following an extensive diagnostic workup, an older adult patient has been diagnosed with a secondary myelodysplastic syndrome (MDS). What assessment question most directly addresses the potential etiology of this patient's health problem?

• A. Were you ever exposed to toxic chemicals in any of the jobs that you held?
• B. When you were younger, did you tend to have recurrent infections of any kind?
• C. Have your parents or siblings had any disease like this?
• D. Would you say that you've had a lot of sun exposure in your lifetime?

Correct answer: A

Rationale: The correct answer is A. Secondary MDS can occur at any age and results from prior toxic exposure to chemicals, including chemotherapeutic medications. Asking about exposure to toxic chemicals in previous jobs directly addresses the potential etiology of this patient's health problem. Choices B, C, and D are not as directly related to the etiology of secondary MDS. Recurrent infections (Choice B) are not a known cause of MDS. Family history (Choice C) is more pertinent to primary MDS, which has a genetic component, while sun exposure (Choice D) is not associated with the etiology of MDS.

4. The patient is anxious about subjection to radiation therapy. Which of the following statements of the student nurse requires additional teaching?

• A. Teletherapy is radiation from an external source.
• B. Brachytherapy can be administered via oral or IV.
• C. Brachytherapy is a radiation from inside the patient's body.
• D. Chemotherapy is effective in killing all cancer cells.

Correct answer: D

Rationale: The correct answer is D because the statement 'Chemotherapy is effective in killing all cancer cells' is incorrect. Chemotherapy does not kill all cancer cells and is not the same as radiation therapy. Chemotherapy targets rapidly dividing cells, including cancer cells, but it may not kill every single cancer cell. It is important for the student nurse to understand and communicate this distinction to the patient. Choices A, B, and C provide accurate information about teletherapy, brachytherapy, and chemotherapy, respectively, and do not require additional teaching.

5. A patient with multiple myeloma has developed hypercalcemia. What symptoms should the nurse monitor for in this patient?

• A. Increased heart rate
• B. Decreased urine output
• C. Muscle weakness
• D. Hypertension

Correct answer: C

Rationale: The correct answer is C: Muscle weakness. In patients with multiple myeloma who have developed hypercalcemia, monitoring for muscle weakness is crucial. Hypercalcemia can lead to muscle weakness due to its effects on neuromuscular function. Choice A, increased heart rate, is more commonly associated with conditions like dehydration or anxiety rather than hypercalcemia. Choice B, decreased urine output, is commonly seen in conditions leading to acute kidney injury rather than hypercalcemia. Choice D, hypertension, is not a typical symptom of hypercalcemia and is more commonly associated with other conditions like uncontrolled high blood pressure.

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